Geriatric psychiatry

Question 1

factors associated with normal aging include:

1. decreased or increased brain weight/enlarged ventricles and sulci
2. decrease or increase mass/ decrease or increase fat
3. minor forgetfulness

Answer 1

1. decreased brain weight/enlarged ventricles and sulci
2. decrease in mass/ increase fat
3. minor forgetfulness– age-associated memory impairment

Question 2

Patients with a major neurocognitive disorder are more likely to ____________ when they do not know the answer, whereas depressed patients may just say that _____________

Answer 2

Patients with a major neurocognitive disorder are more likely to confabulate when they do not know the answer, whereas depressed patients may just say that they don’t know

***When pressed for an answer, depressed patients will often show the capacity to answer correctly

Question 3

presence of apparent cognitive deficits in patients with major depression. Patients may appear demented. However, their sxs are only secondary to their underlying depression.

Answer 3

Pseudodementia

Question 4

treatment for pseudodementia

Answer 4

supportive psychotherapy and maybe a low dose SSRIs

Question 5

dementia or pseudodementia:

• onset is insidious
• sundowing is common (increased confusion at night)
• will guess at answers
• patient is unaware of problems
• cognitive deficits do not improve with antidepressant treatment

Answer 5

Dementia

Question 6

Dementia or pseudodementia

• onset is acute
• sundowing is uncommon
• often answers “I dont’ know”
• Patient is aware of problems
• cognitive deficits improve with antidepressants

Answer 6

pseudodementia

Question 7

which if the TCAs is favored in elederly if we need to use

Answer 7

nortiptyline due to fewer anticholinergic SE

Question 8

mirtazapine can do (2)

Answer 8

1. increase appetite

2. sedating

Question 9

what can be given with antidepressant at a low does for patients with severe depression and/or psychomotr retardation

Answer 9

methylphenidate

Question 10

five stages of grief

Answer 10

1. denial
2. anger
3. bargaining
4. depression
5. acceptance

Question 11

major depression that began with a concrete death or loss in the patients lide with deneralized feeling of worthlessness

Answer 11

bereavement-associated depression

Question 12

when is treatment of depression recommended

Answer 12

in patients who have 2 straight week of depressive sxs

Question 13

age related effects of alcohol (3)

Answer 13

1. decreases Alcohol DH leading to higher blood alcohol levels
2. decrease amount of water in the body with age
3. increased central nervous system sensitivity to alcohol

Question 14

what is the most common psychiatric disorder in the elderly is

Answer 14

major depressive disorder

Question 15

who have the highest rates of completed suicides

Answer 15

white elderly males

Question 16

visual hallucination early in dementia suggest a diagnosis of neurocognitive disorder due to ___________.

what should be avoided in theses patients and why?

Answer 16

Lewy body disease

antipsychoitcs b/c they are sensitive to EPS

Question 17

normal sleep changes in geriatric patients

1. Rapid eye movement (REM) sleep
2. Non-REM sleep
3. Sleep efficiency
4. amount of total sleep
5. sleep cycle

Answer 17

1. Rapid eye movement (REM) sleep– decreased REM latency and total REM
2. Non-REM sleep– increased amounts of stage 1 and 2 sleep, decreased amounts of stage 3 and 4 deep sleep
3. Sleep efficiency– decreased frequent nocturnal awakenings
4. amount of total sleep– decreased
5. sleep cycle–sleep cycle advances (earlier to bed, earlier to rise)

Question 18

which sedative-hypnotic is safer than benzo in the eldery?

Answer 18

trazodone

**beware of orthostasis