Geriatric Psychiatry

Question 1

What is a special consideration when treating geriatric patients?

Answer 1

• differentiating normal aging process from disease
• Multiple Comorbidities
• Under-reporting

Question 2

What is the rule when giving elderly patients medications?

Answer 2

Start low and go slow

Question 3

What is dementia?

Answer 3

It is a decline in memory, problem solving, language, and other thinking skills that impair daily living.

Question 4

When you see a patient with memory loss, hallucinations, and parkinsons like symptoms what should we be thinking?

Answer 4

Lewy Body Dementia

Question 5

In frontaltemporal demetia or pick’s disease what was the emphasis of this type of dementia?

Answer 5

patients become violent, volatile, inappropriate, and it can happen at a younger age (in terms of elderly patients)

Question 6

What was a main lab that he hit on, he said it is normal if above 200 but anything below 400 we should treat?

Answer 6

B12

Question 7

Depression can present like dementia, what is this called and what signs do we look for?

Answer 7

Pseudodementia, look for signs like weight loss, anxiety, irritability, sadness, social withdrawal.

Question 8

(TEST) - He said to avoid this medication because is can impair cognitive function. He said he has a colleague that takes all of her patients off this med.

Answer 8

Anticholinergic specifically Benadryl (diphenhydramine)

Question 9

Psychosis in the elderly caused by these in order (3)

Answer 9

1. alzheimers
2. depression
3. delirium

Question 10

What were the main causes of delirium that he hit on?

Answer 10

infection, constipation, sleep deprivation

Question 11

What were some of the main presenting complaints of someone who has psychosis from depression?

Answer 11

Somatic troubles - they have all this pain, and neurologic symptom but as a physician you cant find anything wrong with them. (delusions)

Question 12

When patients have delusions with alzheimers what are they like?

Answer 12

paranoid in nature - think people are stealing from them, spouse is cheating on them, they are being abandoned.

Question 13

Why do physicians miss substance abuse in the elderly?

Answer 13

They are afraid to ask, they do not know the high prevalence rate, and they forget that substances impact the elderly quicker (liver and kidneys dont function as well)

Question 14

What are the risk factors for substance abuse in the elderly populations?

Answer 14

Female
Single, alone, divorce, separated
no hobbies or socialization
health concerns

Question 15

What would happen if patients that were on diazepam (benzodiazepines) quit “cold turkey”?

Answer 15

Delirium tremens and potential death. These patients need to be gradually tapered.

Question 16

What was his point about depression in the 65-85 age range?

Answer 16

65 - 20%
75 - 36%
85 - 45%
so we need to be cognizant of just how common this is in these populations.

Question 17

What is the major depressive criteria?

Answer 17

Anhedonia or depressed mood for two weeks and four of the following
- fell worthless, decreased concentration, fatigue, psychomotor agitation, insomnia or hypersomnolence, weight or appetite changes, recurrent thoughts of suicide or death

Question 18

How do you determine depression from dementia?

Answer 18

depression alone the patient will know they are depressed.

Dementia patients don’t realize they are becoming forgetful.