Geriatric Psychiatry (Hill)

Question 1

Geriatric pts under-report what?
Purpose of tx?
Meds?

Answer 1

Elderly pts often fail to recognize and/or fail to report s/s of “aging”

Emphasis on palliative care instead of “living longer”

Meds-always start low and go slow

Question 2

Various symptoms of dementia?

Answer 2

Depression --> pseudodementia 
memory loss
communication
difficulty w/performing tasks, organization, coordination
problems with disorientation (get lost)
personality changes
inappropriate behavior (esp Frontotemporal dementia)
psychotic symptoms
agitation

Question 3

Most important component for evaluating dementia in elderly?

Answer 3

H and P most important –> onset, character (type/manner of cognitive deficits)

Question 4

Avoid Rx what in elderly with dementia?

Answer 4

Avoid anticholinergic meds which can impair cognitive function, ESP IN ELDERLY (Benadryl, hydroxyzine)

Question 5

Black box warning with Olanzapine (zyprexa), aripiprazole (abilify), risperidone (risperdal), or quetiapine (seroqeul) for elderly with dementia?

Answer 5

Antipsychotic meds associated with increased mortality

• 1.6-1.7-fold increase in mortality
• Most either d/t heart-related events (heart failure, sudden death) or Infx (mostly pneumonia)

Question 6

This is the 3rd most common cause of psychosis in elderly outpatients

Answer 6

Delirium

Question 7

This condition accounts for most psychoses in elderly

Answer 7

Psychosis d/t Major Depressive Disorder w/ Psychotic features–> 2nd most common dx in elderly outpatients

Question 8

This is most common dx accounting for psychosis in elderly outpatients

Answer 8

Psychosis d/t Alzheimers type dementia

often of a paranoid nature –> thinks items being stolen from them, being abandoned, spouse cheating

Question 9

Can’t go cold turkey with intense and chronic etoh abuse d/t ?

Answer 9

possible DT’s and death

Med example: Benzo’s (i.e., valium/Diazepam taper)

Question 10

Major depression criteria for dx depression in elderly?

Answer 10

Anhedonia or Depressed mood for 2 weeks and 4 or more of:

• Feelings of worthlessness/guilt
• Decreased ability to concentrate
• Fatigue
• Psychomotor agitation
• Insomnia or hypersomnolence
• weight or appetite changes
• recurrent thoughts of suicide/death

Question 11

How do you differentiate between DEMENTIA and DEPRESION in elderly?

Answer 11

Mental status exam–> focus on INSIGHT
Depressed –> WILL often have INSIGHT, though little effort
Dementia –> LITTLE/NO INSIGHT

Question 12

High yield pharm for boards (maybe exam?):
SSRIs=\_\_
Mirtazapine=\_\_
Venlafaxine and Duloxetine (SNRIs)=\_\_
Trazodone=\_\_
Bupropion=\_\_
TCAs=\_\_

Answer 12

SSRIs=5HT syndrome, increase falls, GI, insomnia, agitate

Mirtazapine=Increase appetite

SNRIs=Often used with comorbid PAIN CONDITIONS

Trazodone=Low dose, caution of orthostasis, promotes sleep, boners

Bupropion=seizures

TCAs=caution in cardiac pts