Geriatric Psych (Hill) Flashcards
DSM 5 name for dementia
Major neurocognitive disorder
Medications to slow progression of dementia and increase patient functionality
1) Donepezil (AChEsterase inhibitor)
2) Memantine (NMDA antagonist)
Medications to slow progression of dementia and increase patient functionality (2)
1) Donepezil (AChEsterase inhibitor)
2) Memantine (NMDA antagonist)
What medications should be avoided in the demented elderly?
those that can impair cognitive function:
- Benadryl
- hydroxyzine
Black box warning associated with treatment of psychosis in the elderly
antipsychotic medications are associated with increased mortality (Olanzapine, Aripiprazole, Risperidone, quetiapine). Increased risk of heart-related events and infection
workup for acute psychosis (5)
- CBC
- CMP
- imaging: CT/MRI
- B12/folate
- mini mental status exam
DDx acute psychosis (6)
- stroke
- tumor
- delirium
- depression
- endocrine: hypthyroidism, diabetes
- dementia
third most common cause of psychosis in elderly outpatients
psychosis d/t delirium
describe delirium
thought disturbances with themes that tend to be from current environment and situations, with poverty of thinking and irrationality, and with hallucinations (often visual)
Causes of delirium
often 2/2 illness:
- infection
- drug reaction
- hypoxemia
- constipation, etc…
Causes of delirium
often 2/2 illness:
- infection
- drug reaction
- stroke
- hypoxemia
- constipation, etc…
second most common cause of psychosis in elderly outpatients
psychosis d/t Major depressive disorder with psychotic features (somatic troubles, persecution, guilt, poor self-esteem)
most common diagnosis accounting for psychosis in elderly outpatients
psychosis d/t Alzheimer’s-type dementia (often paranoid delusions)
Why do physicians miss substance abuse in elderly? (3)
- unaware of high prevalence rate
- unaware of the increased impact some substances have on elderly
- uncomfortable screening elderly patients
What medications should be avoided in the demented elderly?
those that can impair cognitive function:
- Benadryl (diphenhydramine)
- hydroxyzine
Consequences of substance of abuse in elderly (6)
- cognition impairment
- depression/mood impairment
- sleep alteration
- balance and vestibular problems
- delirium
- increased risk other medical problems
Risks of going “cold turkey” with chronic alcohol abuse
possible delirium tremens and death
Medication example for treatment of acute EtOH withdrawal
benzodiazepienes
Risks of going “cold turkey” with chronic alcohol abuse
possible delirium tremens and death
How to increase substance abuse treatment compliance in elderly adults
inform your patients
primary causes of depression in the elderly (4)
- deteriorating health
- cognitive decline
- loss of independence
- loss of spouse and friends
clinical tool used to diagnose depression in the elderly
geriatric depression scale
What score on the geriatric depression scale is suggestive of depression
score > 5
what score on the geriatric depression scale is almost always indicative of depression
score >10
