Geriatric Psychaitry

Question 1

4 psychiatric illnesses in the elderly to remember?

Answer 1

Dementia or major neurocognitive disorder
Psychosis
Substance abuse
Depression

Question 2

As far as cognitive impairment, what did the DSM5 include and how is it different?

Answer 2

It included a diagnosis for Mild Cognitive Impairment so is a diagnosis for less disabling syndromes.
Does not interfere with capacity for independent in everyday activities

Question 3

3 main causes of Dementia in the elderly?

Answer 3

Alzheimer’s, vascular, and progressive disorders

Question 4

What distinguishing feature of picks disease causing dementia?
What to remember about Lew body dementia, a triad?

Answer 4

Personality changes, intense behavior changes

Visual hallucinations (little kids and animals), Parkinson symptoms, and dementia

Question 5

What medicine to remember for drug induced dementia?

Answer 5

Benadryl

Question 6

What is pseudodementia?

What symptom can really intensify in patients with dementia?

Answer 6

Everything looks like dementia but it is actually an underlying depression

Personality disorders can really intensify in patients with dementia

Question 7

What is the most important part of the evaluation for dementia in the elderly?
What is a test he really likes for evaluating elderly patients who may have dementia and why?
What is an important lab to do that can cause neurocognitive problems if low?

Answer 7

H and P

Neuropsychological testing, gives you a baseline of their cognition

B12

Question 8

What is the goal of treatment in patients with dementia?
What are two drugs to use for dementia and their MOA?
What medications to avoid in patients with dementia and why?

Answer 8

Slow the progression of it and improve functionality, not going to cure.

Donepezil, ACHEI
Memantine, NMDA blocker

Avoid anticholinergic because it can make it worse, Benadryl and hydroxyzine

Question 9

What is the black box warning for using antipsychotics to treat psychosis in elderly patients with dementia?

Answer 9

Sudden death, and usually by CV or infections

Question 10

What is a common symptom of patients with Psychosis due to delirium?

Answer 10

Visual hallucinations

Question 11

Top 3 causes of psychosis in elderly patients?

Answer 11

Alzheimer’s, depression and delirium

Question 12

What is the behavior of an elderly patient with psychosis due to Alzheimer’s?

Answer 12

Paranoid
Believe items are being stolen from them
Being abandoned
Spouse or children are disloyal

Question 13

What is the treatment of choice for psychotic depression?

Answer 13

ECT

Question 14

What benzo to not give the elderly with delirium and why?

Answer 14

Lorazepam because it will worsen the dementia

Question 15

What are the three substances that can kill you if stopped cold turkey?
How does stopping alcohol cold turkey kill you?

Answer 15

Boos, Benzos and barbs

Delirium Tremens, Seizure and Death

Question 16

What is a good protocol for substance abuse?

Answer 16

Benzo taper

Question 17

What is the clinical picture for depression in elderly that can look different?

Answer 17

More physical symptoms

Question 18

Major depression criteria for the elderly?

Answer 18

Depressed mood for 2 weeks and 4 symptoms/signs

Question 19

What does a score of 5 and 10 mean on the geriatric depression scale?

Answer 19

Suggestive of depression

Almost always indicative of depression

Question 20

What is a very helpful clue when trying to differentiate dementia and depression in an elderly patient?

Answer 20

Patients with depression can offer insight into their situation way more than someone who has dementia.

Question 21

What is his go to med for elderly patients with depression?

What can SSRIs cause in elderly patients?

Answer 21

Nortriptyline

Hyponatremia was