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Geriatrics boards > Geriatric psychiatry > Flashcards

Geriatric psychiatry Flashcards

1
Q

treatment for persistent complex bereavement disorder

A

psychotherapy +/- SSRI

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2
Q

What symptoms of depression are reported more frequently by older adults when compared to younger adults?

A

Somatic symptoms (as opposed to depressed mood and guilt)

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3
Q

What PHQ-9 score has good sensitivity and specificity for diagnosing MDD?

A

> /= 10 (if >15 consider psych consult)

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4
Q

In what population is evidence unclear for treating depression with an SSRI?

A

Patients with dementia; good evidence shows that it may not be better than placebo

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5
Q

Pros and cons of geriatric depression scale

A

More specific to geriatric depression symptoms and has a simple yes/no format; can’t be used to monitor response to treatment

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6
Q

Instrument for measuring loneliness and social isolation?

A

PROMIS-L questionnaire

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7
Q

True or false: bipolar disorders “burn out” with old age

A

False; only observed difference is less sexual preoccupation in older patients

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8
Q

Presentation of mania in older adults

A

More likely to present with confusion, disorientation, distractibility, and irritability (vs. elevated and positive mood)

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9
Q

Medical conditions associated with late-onset mania

A

Stroke, dementia, hyperthyroidism, medications (steroids, SSRIs, stimulants)

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10
Q

What % of patients respond fully to initial antidepressant treatment for MDD?

A

50%; another 1/3 recover with augmentation or switching agents or adding psychotherapy, and the remainder do not recover

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11
Q

Duration of maintenance therapy for mood disorders?

A

At least 6 months; at least 3 years if psychotic features, suicidality, recurrence, or for bipolar disorder

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12
Q

citalopram adverse effects/precautions?

A

QTc prolongation at higher doses, nausea, tremor, hypoNa

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13
Q

escitalopram adverse effects/precautions?

A

nausea, tremor, hypoNa, need to renally adjust dose

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14
Q

Sertraline adverse effects/precautions?

A

nausea, tremor, hypoNa, insomnia

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15
Q

Sertraline is FDA approved for ___?

A

MDD, OCD, PTSD, social anxiety, panic disorder; also comes in liquid form!

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16
Q

duloxetine precautions/AEs?

A

CYP1AD and CYP2D6 substrate (drug-drug interactions); need to dose reduce in liver and renal impairment; has activating effects

17
Q

duloxetine is FDA approved for ___?

A

diabetic neuropathic pain, fibromyalgia, GAD

18
Q

Venlafaxine precautions/AEs?

A

can increase BP; headache, nausea, vomiting; don’t stop abruptly; need to reduce dose in renal impairment. Few drug interactions

19
Q

aripiprazole precautions/AEs?

A

prolonged half-life, may produce agitation at high doses because of D2 agonist activity

20
Q

bupropion precautions/AEs?

A

agitation, insomnia, seizures, activating

21
Q

mirtazapine precautions/AEs?

A

dry mouth, weight gain, sedation; need to renally dose; potential for neutropenia

22
Q

First-line treatment for late-life bipolar mania?

A

anti-convulsants/mood stabilizers; divalproex is usually the preferred agent

23
Q

Divalproex therapeutic blood levels?

A

50-100mcg/mL

24
Q

Depakote important drug-drug interactions:

A

beta-blockers, type 1C antiarrhythmics, benzodiazepines, and anticoagulants (levels of these will be increased)

25
Q

Depakote monitoring labs

A

CBC, AST, ALT when med is started, when the dose is increased, and q6months

26
Q

Contraindications to depakote (or reasons to stop it)

A

platelet count <80k, AST or ALT >2x ULN; also need to renally dose

27
Q

Depakote time to therapeutic effect

A

3 weeks; may need antipsychotic or benzos to control agitation in the meantime

28
Q

What anticonvulsants are used as mood stabilizers in bipolar?

A

divalproex, carbamazepine, and lamotrigine

29
Q

Drug-drug considerations with carbamazepine?

A

CYP450 inducer; decreases other drug concentrations

30
Q

Reason for immediate cessation of lamotrigine?

A

rash

31
Q

Olanzapine precautions

A

sedation, anticholinergic effects at higher doses; weight gain, metabolic syndrome + diabetes

32
Q

Quetiapine precautions

A

sedation, weight gain, metabolic syndrome, arrhythmia

33
Q

Risperidone precautions

A

EPS likely at higher doses; metabolic syndrome + weight gain

34
Q

First line treatment for geriatric depression with serious risk of suicide or life-threatening low PO intake?

A

ECT

35
Q

Most concerning adverse effect of ECT?

A

cognitive effects (anterograde and retrograde amnesia); evidence is unclear on lasting cognitive impairment

36
Q

Contraindications to ECT?

A

increased ICP or unstable angina

Geriatrics boards (2 decks)

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