geriatric psychiatry

Question 1

changes of normal aging

Answer 1

• decreased brain weight
• enlarged ventricles and sulci
• decreased mm mass and fat
• impaired vision and hearing
• minor forgetfulness

Question 2

major depression in the elderly

Answer 2

• consider if present with memory loss or nonspecific physical probs
• increased rate of death in post-MI and stroke pts who develop MD
• new admits to nursing homes with depression have increased mortality rate

Question 3

pseudodementia: defn

Answer 3

• memory and cognitive fn problems due to depression in elderly
• sx are 2/2 underlying depression, not to dementia

Question 4

dementia vs pseudodementia

Answer 4

• dementia: insidious onset (vs more acute)
• dementia: sundowning more common
• dementia: confabulation more common
• dementia: unaware of problems
• dementia: cognitive probs do not improve with antidepressants

Question 5

pseudodementia: tx

Answer 5

• supportive psychotherapy
• community resources
• low dose SSRIs
• IF using TCAs: use NORTRIPTYLINE (fewest antiACh SEs)
• mirtazapine: increase appetite, sedating
• methylphenidate: at low doses as adjunct for psychomotor retardation; may cause insomnia, arrhythmia risk
• ECT!!!

Question 6

normal grief

Answer 6

• intense feelings including guilt and sadness
• sleep disturbances, appetite changes, illusions
• usually abate WITHIN 6 MONtHS
• DOES NOT affect ability to function

Question 7

complicated/prolonged grief

Answer 7

• persists FOR AT LEAST 6 MONTHS
  4+ of:
• difficulty moving on
• numbness/detachment
• bitterness
• feeling that life is empty w/o deceased
• trouble accepting the loss
• feeling that future holds no meaning w/o deceased
• agitation
• difficulty trusting others since the loss

Question 8

bereavement-assoc depression

Answer 8

major depression that began with concrete death/loss

• look for GENERALIZED feelings of hopelessness, helplessness, guilt, worthless, SI
• tx recommended if 2 straight weeks of depressive sx 6-8 wks after loss

Question 9

substance abuse in elderly

Answer 9

• decreased alcohol dehydrogenase –> increased BA
• increased CNS sensitivity to alcohol
• worsens liver dz, GI dz, CV dz, metabolic/endocrine dz, mental dos

Question 10

treatment of dementia

Answer 10

• strict daily schedules, reduce stimuli, continual reorientation, surrounding with familiar objects
• antipsychotics have limited efficacy, increased mortality
• • olanzapine or quetiapine if severe sx
• • haldol or risperdal short time
• anxiety sx may respond well to SSRI, only use BZOs for v short term

Question 11

normal sleep changes in elderly

Answer 11

• decreased REM latency and total REM
• increased stage 1 and 2 sleep, decreased stage 3 and 4
• decreased sleep efficiency
• decreased total sleep
• sleep cycle advances

Question 12

sleep disturbances in elderly: tx

Answer 12

• try non-pharm first - e.g. sleep hygiene
• sedative-hypnotic drugs more likely to cause SEs in elderly
• if needed use hydroxyzine (Vistaril) or trazodone over BZOs