Geriatric Psychiatry Flashcards
Name two Axis 1 diagnoses more prevalent in elderly
cognitive disorders and MDD
Differences in approaching the geriatric patient
- Carefully document medications; polypharmacy is the norm
- obtain collateral info from family members if suspect cog. decline
Factor associated w/ normal aging
- dec. muscle mass/inc. fat
- dec. brain weight/enlarged ventricles and sulci
- impaired vision and hearing
- minor forgetfullness (called benign senescent –forgetfulness)
Stages of Dying
Normal emotional responses when facing death or loss of a body part include:
- denial
- anger (blaming others)
- bargaining
- depression
- acceptance
may be experience in any order and may occur simultaneously; a person of any age experiences these stages when faced with loss or death experiences
MDD in the elderly: statistics
- common mental disorder
- elderly 2x as likely to commit suicide as gen. pop
- 15% nursing home residents have MDD symps
Pseudodementia definiton
presence of apparent cognitive and memory deficits in patients with MDD. patients may appear demented but symptoms are only secondary to underlying depression. difficult to differentiate pseudodementia from actual dementia
Differentiating dementia from pseudodementia (depression)
demented patients are more likely to confabulate when do not know an answer; depressed patients will say “i don’t know.” when further pressed, depressed patients often give correct answer
Characteristics of demented patient
- insidious onset
- patient delights in accomplishments
- sundowning common (inc. confusion at night)
- will guess at answers (confabulate)
- patient unaware of problems
Characteristics of depressed elderly patient
- onset is more acute than dementia
- patient emphasizes failures
- sundowning UNCOMMON
- often answers “don’t know”
- patient is aware of problems
Symptoms of depression in elderly
often present with physical symptoms such as stomach pain or with memory loss (pseudodementia) > always investigate MDD in an elderly person w/ nonspecific complaints
- sleep disturbances (early morning awakenings)
- decreased appetite and weight loss
- feelings of worthlessness and suicidal ideation
- lack of energy and diminished interest in activities
Treatment pseudodementia/MDD
- psychotherapy
- low dose antidepressants > SSRIs have the fewest side effects; elderly are very sensitive to anticholinergic side effects
- ECT
- mirtazepine can inc. appetite and is sedating (good for insomnia)
- methylphenidate can be used to treat psychomotor retardation (don’t give later in the day > will exacerbate insomnia)
characteristics of “normal” grief
- feelings of guilt and sadness
- mild sleep disturbance and weight loss
- illusions (briefly seeing deceased person or hearing their voice; tends to be culturally related)
- attempts to resume daily activities/work
- worst symptoms resolve within 2 months
**in DSM V; normal grief is not excluded from MDD diagnostic criteria»_space; grief=MDD after two weeks if fulfills MDD requirements
characteristics of “abnormal grief” ie MDD
- feelings of severe guilt and worthlessness
- sig. sleep disturbance
- weight loss
- hallucinations and delusions
- no attempt to resume activities
- suicidal ideation
Causes of sleep disturbance in the elderly
medical conditions
environment
medications
normal changes associated w/ aging
Changes in sleep structure
- decreased amount of REM
- increased amount in stages 1 and 2/decrease in stages 3 and 4
- increased awakenings after sleep onset
