Geriatric Psychiatry

Question 1

What is pseudodementia and why is it important to rule out?

Answer 1

• Depression in geriatric pt’s can look like dementia!
• Tx the depression and sx’s will improve!

Question 2

What is most important in evaluation of dementia in the elderly?

Answer 2

H and P: what is the onset and character

Question 3

Why is neuropsychological testing useful in evaluation of dementia in elderly pt?

Answer 3

• Attempts to establish baseline (helpful early in disease)
• Quantifies results of deficits

Question 4

Which 2 drugs can be used to slow progression and increase patient functionality with dementia?

Answer 4

• Donepezil (MOA: AChE inhibitor)
• Memantine (MOA: NMDA antagonist)

Question 5

What is a black-box warning for antipsychotic meds used for tx of psychosis with dementia?A

Answer 5

Assoc. w/ an increased risk of mortality: most often due to heart-related events or infections

Question 6

Psychosis due to delirium in elderly pt’s presents is characterized by what?

Answer 6

Thought disturbances w/ themes that tend to be from the current enviornment and situations, with poverty of thinking and irrationality, and with hallucinations (often visual)

Question 7

What is the tx of choice for psychosis due to major depressive disorder in elderly?

Answer 7

ECT

Question 8

What are the delusions most often like in elderly pt with psychosis due to alzheimer’s type dementia?

Answer 8

• Often of paranoid nature:
• Pt’s believe that items are being stolen from them
• That they are being abandoned
• That their spouse and children are being disloyal to them

Question 9

What should you do in tx of substance abuse in older adults which will increase compliance?

Answer 9

INFORM YOUR PATIENTS!

Question 10

What are the criteria for major depression in elderly?

Answer 10

Anhedonia or depressed mood for ≥2 weeks and 4 of the following:

Question 11

Which TCA is a good choice for tx of depression in elderly pt’s; must use caution in which pt’s?

Answer 11

Nortriptyline; must use caution in cardiac pt’s

Question 12

Which drug can be used in tx of depression in elderly and increases appetite?

Answer 12

Mirtazapine

Question 13

Initial anti-depressant trial should be for how long when tx depression in elderly?

Answer 13

4-6 weeks

Question 14

What s/s indicate Lewy Body Demetia?

Answer 14

Parkisonian sx

memory loss

visual hallucinations

Question 15

What are the different types of dementia?

Answer 15

1. Alzheimer’s: female, FH, head trauma, DS, schizophrenia
2. Vascular: male, HTN, CV disease, advanced age
3. Lewy body: PD sx, memory loss, visual hallucinations
4. Pick’s disease: young age onset, frontotemporal dementia
5. Reversible causes: drug induced, thyroid disease, metabolic disorder, hematoma, hydrocephalus

Question 16

When do you give a dementia pt a B12 shot?

Answer 16

B12 < 400

Question 17

Timing of Dementia vs. Delerium

Answer 17

dementia - slow onset, weeks to months

delerium - fast onset, hours to days