Geriatric psychiatry Flashcards
treatment for persistent complex bereavement disorder
psychotherapy +/- SSRI
What symptoms of depression are reported more frequently by older adults when compared to younger adults?
Somatic symptoms (as opposed to depressed mood and guilt)
What PHQ-9 score has good sensitivity and specificity for diagnosing MDD?
> /= 10 (if >15 consider psych consult)
In what population is evidence unclear for treating depression with an SSRI?
Patients with dementia; good evidence shows that it may not be better than placebo
Pros and cons of geriatric depression scale
More specific to geriatric depression symptoms and has a simple yes/no format; can’t be used to monitor response to treatment
Instrument for measuring loneliness and social isolation?
PROMIS-L questionnaire
True or false: bipolar disorders “burn out” with old age
False; only observed difference is less sexual preoccupation in older patients
Presentation of mania in older adults
More likely to present with confusion, disorientation, distractibility, and irritability (vs. elevated and positive mood)
Medical conditions associated with late-onset mania
Stroke, dementia, hyperthyroidism, medications (steroids, SSRIs, stimulants)
What % of patients respond fully to initial antidepressant treatment for MDD?
50%; another 1/3 recover with augmentation or switching agents or adding psychotherapy, and the remainder do not recover
Duration of maintenance therapy for mood disorders?
At least 6 months; at least 3 years if psychotic features, suicidality, recurrence, or for bipolar disorder
citalopram adverse effects/precautions?
QTc prolongation at higher doses, nausea, tremor, hypoNa
escitalopram adverse effects/precautions?
nausea, tremor, hypoNa, need to renally adjust dose
Sertraline adverse effects/precautions?
nausea, tremor, hypoNa, insomnia
Sertraline is FDA approved for ___?
MDD, OCD, PTSD, social anxiety, panic disorder; also comes in liquid form!
duloxetine precautions/AEs?
CYP1AD and CYP2D6 substrate (drug-drug interactions); need to dose reduce in liver and renal impairment; has activating effects
duloxetine is FDA approved for ___?
diabetic neuropathic pain, fibromyalgia, GAD
Venlafaxine precautions/AEs?
can increase BP; headache, nausea, vomiting; don’t stop abruptly; need to reduce dose in renal impairment. Few drug interactions
aripiprazole precautions/AEs?
prolonged half-life, may produce agitation at high doses because of D2 agonist activity
bupropion precautions/AEs?
agitation, insomnia, seizures, activating
mirtazapine precautions/AEs?
dry mouth, weight gain, sedation; need to renally dose; potential for neutropenia
First-line treatment for late-life bipolar mania?
anti-convulsants/mood stabilizers; divalproex is usually the preferred agent
Divalproex therapeutic blood levels?
50-100mcg/mL
Depakote important drug-drug interactions:
beta-blockers, type 1C antiarrhythmics, benzodiazepines, and anticoagulants (levels of these will be increased)
