geriatrics

Question 1

MDD in elderly

Answer 1

do workup if present w/ memory loss. 2x more likely to commit suicide as general pop.

Question 2

pseudodementia

Answer 2

apparent cog deficits in pt with MDD. often present with physical sx- stomach pain, me loss.

Question 3

pseudodementia v dementia

Answer 3

1) acute v insidious onset
2) emphasizes failures v delights in accomplishments
3) sundown uncommon v common
4) answers I don’t know even if know v guess at answers (confabulate)
5) aware v unaware of problems

Question 4

pseudomentia tx

Answer 4

supportive psychotherapy. psychodynamic psychotherapy if indicated. low dose anted- SSRI has least SE. ECT, mirtazapine incr appetite, sedating and good for insomnia. methylphenidate - low dose adj to anted with psychomotor retardation. but can cause insomnia so give in morning

Question 5

elderly insomnia

Answer 5

sedative-hyponotic drugs are more likely to cause SE- me impairment, ataxia, paradoxical excitement, rebound insomnia. so try drug cessation, incr daily routine, tx underlying med prob. if need sedative-hypnotic, use hydroxyzine (mistral) or slopped (ambient) rather than benzo.