Hill: 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?

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

Treatment of substance abuse in older adults

Answer 14

• Can’t go cold turkey w chronic alcohol abuse - possible delirium tremens and death
• Taper meds like benzos

Question 15

Which drugs to Rx depression and comorbid pain conditions?

Answer 15

Venlafaxine and Duloxetine

Question 16

Which drug treats depression in elderly and promotes sleep?

Answer 16

Trazodone

Question 17

What is a contraindication in the treatment of elderly dementia and why?

Answer 17

Avoid anticholinergic meds bc they impair cognitive function

Ex: benadryl, hydroxyzine

Question 18

Best Rx for depression in the elderly

Answer 18

CBT: replace neg thoughts with positive ones

Question 19

Define Psychosis due to Delirium

Answer 19

Thought disturbance that tend to be from current environment with poverty of thinking, irrationality, and hallucinations.