Geriatric Psychiatry Flashcards

1
Q

how do we approach meds with old ppl?

A

-start low, go slow

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2
Q

If we see depression in old people, what do we think of?

A

-pseudodementia

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3
Q

when do we see inappropriate behavior?

A

-frontotemporal dementia

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4
Q

what do we have to keep in mind with the tx of dementia in the elderly?

A

-avoid anticholinergic medications which can impair cognitive function, ESPECIALLY IN ELDERLY

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5
Q

Which drugs could we use for dementia?

A
  • donepezil (AchE inhibitor)

- MEmantine (NMDA antagonist)

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6
Q

What drug do we want to avoid?

A

-benedryl and hydroxyzine

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7
Q

He said that Diphenhydramine will be on his test, wtf is that?

A
  • it’s an antihistamine used to treat allergies!!! kinda like benedryl!!
  • so we want to avoid the shit out of this drug in the elderly dementia pts
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8
Q

What are the black box warning things with antipsychotic medications?

A
  • increased mortality
  • Olanzapine
  • Aripiprazole
  • Risperidone
  • quitiapine
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9
Q

Psychosis due to delirium?

A
  • third most common cause of psychosis in elderly outpatients
  • thought disturbance with themes that tend to be from the current environment and situations, with poverty of thinking and irrationality, and with hallucinations
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10
Q

Psychosis due to major depressive disorder

A

-second most common diagnosis in elderly outpatients, accounting for most psychosis in this population

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11
Q

psychosis due to alzheimer’s type dementia

A

-the most common diagnosis accounting for psychosis in elderly outpatients

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12
Q

What do we still need to have a high index of suspicion even in old ppl?

A

-substance abuse

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13
Q

What is the usually the answer when they are asking for treatment for these disorders?

A
  • CBT

- cognitive behavioral therapy

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14
Q

What are the major depression criteria?

A
  • Anhedonia or depressed mood for 2 weeks and 4 or more of the following
  • feelings of wothlessness or guilt
  • decreased ability to concentrate
  • fatigue
  • psychomotor agitation
  • insomnia or hypersomnolence
  • weight or appetite changes
  • recurrent thoughts of suicide or death
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15
Q

How do differentiate between dementia and depression in the elderly population?

A
  • mental status exam…. focus on the pt’s INSIGHT
  • Depressed patients WILL often have INSIGHT, though little effort
  • Dementia pts will have LITTLE/NO INSIGHT
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16
Q

Tx for depression in elderly?

A

-CBT

17
Q

How long is the initial anti-depressant trial?

A

-4-6 weeks

18
Q

SSRI cautions

A

-serotonin syndrome, may increase falls, GI effects, insomnia, agitation

19
Q

Mirtazapine

A

-Also increases APPETITE

20
Q

Venlafaxine and duloxetine (SNRIs)

A

-often used with comorbid PAIN CONDITIONS

21
Q

Trazodone

A
  • use in low doses, caution of orthostatic effects

- promotes SLEEP

22
Q

Bupropion caution

A

-may cause SEIZURES

23
Q

TCA’s

A
  • nortriptyline

- Use caution in your cardiac pts