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Psychosocial Medicine > Lecture 14: Geriatric Psych > Flashcards

Lecture 14: Geriatric Psych Flashcards

1
Q

Important Considerations for Geriatric Psych (9)

A
  1. aging process
  2. Age related Disorders
  3. Medical/Psych/neurology
  4. cognitive changes
  5. frailty, mobility, special senses
  6. Drug effects and poly pharmacy
  7. interdisciplinary and interactive specialty: elder social service
  8. old-old or frail elders: special approach to medial care
  9. palliative approach
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2
Q

Psychosocial consideration (4)

A
  1. phase of life issues
    - retirement
    - loss/grief
    - empty nest
    - grand-parenting
  2. approaching mortality
  3. dependency
  4. functional decline
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3
Q

Social Factors (4)

A
  1. loss of income
  2. dependence on social programs:
    - medicare
    - social security
    - medicaid
  3. assisted living and nursing home care
  4. isolation
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4
Q

Dementia: Major and Mild neurologic disorder (5)

A
  1. Dementia/Major ND: syndrome of disabling, acquired loss of memory and intellect across multiple domains
  2. usually caused by a progressive loss of function
  3. typically involved progression loss of function
    - ADLs
  4. usually complicated by psychiatric and behavioral symptoms
  5. MCI/Mild ND
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5
Q

Types of Dementia (5)

A
  1. Alzheimer’s Disease-most common
  2. vascular dementia: stroke, white matter disease
  3. Lewy Body Dementia/Parkinson’s disease
  4. Fronto-temporal dementia: FTD ex, pick’s disease
  5. Many others
    - neurologic
    - nutritional: B12, thiamine def.
    - endocrine: hypothyroidism
    - infectious: syphillis, HIV
    - normal pressure hydrocephalus; involving CSF (tx shunting)
  6. mixed dementia: more than one illness at work
    - alcohol use, head trauma, etc.
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6
Q

Alzheimer’s (8)

A
  1. early and late onset types
    - early=before 65, familial
    - late=after 65
  2. long prodromal period
  3. often preceded by mild cognitive impairment
  4. short-term memory loss
    - ability to learn and retain new information
    - episodic
    - autobiographical memory
  5. gradual progression over years, 6-10 years
  6. early, middle, late clinical stages
  7. evolving/overlapping definitions
    - clinical symptoms vs. biomarkers (lab tests for definitive answer, not very useful, no great biomarker for alzheimer’s)
  8. about 2/3 of dementias
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7
Q

Alzheimer’s Diagnosis (4)

A
  1. current no specific definitive tests
  2. R/O other disorders
  3. R/I characteristic presentation and course
  4. use of rating scales
    - MMSE
    - MOCA: montreal cognitive assessment
    - clock: good for tracking progress
    - SLUMS
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8
Q

Pathology Alzheimer’s (3)

A
  1. plaques and tangles
  2. amyloid and tau
    - amblyoid, extracellular
    - Tau intracellular
  3. amyloid hypothesis
    - that amyloid is the cause, not proven
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9
Q

Alzheimer’s Loss of Function and ADLs (Activities for Daily Living) (6)

A
  1. instrumental ADLs lost first:
    - driving: can make car work, but judgement is impaired
    - using technology
  2. basic ADL lost in 2nd and 3rd stages
    - dressing
    - bathing
    - grooming
    - toileting
  3. incontinence
  4. loss chewing, swallowing, interest in food
  5. weight loss
  6. ataxia, falling
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10
Q

Early/Mild Alzheimer’s Disease-stages (3)

A
  1. STM (short term memory) loss
  2. anxiety
  3. depression
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11
Q

Middle/moderate Alzheimer’s(4)

A
  1. sleep problems
  2. psychosis
  3. agitation
  4. need for supervision
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12
Q

Late/Severe Alzheimer’s (4)

A
  1. 24 hour a day care
  2. wandering
  3. yelling
  4. severe speech problems
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13
Q

Vascular Dementia (4)

A
  1. multi-infarct dementia
  2. uneven progression, wax and wane is severity
  3. vascular lesions
  4. sub-cortical changes: white matter decrease
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14
Q

Mild Neurocognitive Disorder (ND)

A
  1. cognitive decline, but not disabled
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15
Q

Major neurocognitive disorder (ND)

A
  1. disabling cognitive decline
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16
Q

Frontotemporal Dementia (6)

A
  1. Pick’s disease-tau inclusion bodies in frontal and temporal lobes
  2. “tauopathy”
    - No amyloid
  3. primary progressive aphasia
  4. changes in personality, executive function, judgement early in course
  5. speech and language problems
  6. progression to memory loss
17
Q

Lewy Body Dementia

A
  1. Overlaps with PD and sometimes AD
  2. fairly sudden onset
  3. Early psychosis-visual hallucination
  4. parkinsonian symptoms
    - not well treated with parkinson’s treatment
  5. fluctuation: derlium like symptoms
  6. often intolerant to antisychotics
18
Q

Lewy body

A
  1. a-synunclein (protein) intracellular inclusion

- diffuse or localized

19
Q

Parkinson’s Dementia (2)

A
  1. develops long agter motor symptoms
  2. loss of logic and reasoning
    * falls under umbrella of lewy body dementia
20
Q

Behavioral and Psychiatric Symptoms of Dementia BPSD (9)

A
  1. speech and language changes
  2. circadian rhythm disturbance
    - sundowning
  3. inappropriate vocalization
  4. wandering
  5. shadowing: following caregiver
  6. agitation/aggression
  7. catastrophic reaction
  8. mood lability
  9. delusions: paranoia, other psychotic symptoms
21
Q

Dementia Treatment (2)

A
  1. cholinesterase inhibitors
    - increase brains supply of acetylcholine
    - supportive but not curative
  2. Namenda: supportive, mostly mid to late disease
    - blocks NMDA receptors, glutamate receptors
22
Q

Cholinesterase inhibitors (3)

A
  1. Aricept
  2. Razadyne
  3. Exelon
    - increase brains supply of acetylcholine
23
Q

Psychiatric Medications in Dementia

A
  1. no specific psychiatric medication approved for dementia
  2. off-label use
  3. need for informed consent due to off-label use (from caregiver)
  4. commonly used
    - antipsychotics (atypicals)
    - mood stabilizers
    - benzodiazepine
    - SSRI < SNRI
    - trasozone
24
Q

Common Off-label medications for dementia (6)

A
  • antipsychotics (atypicals)
  • mood stabilizers
  • benzodiazepine
  • SSRI < SNRI
  • trasozone
25
Q

Controversial Use antipsychotics in dementia (4)

A
  1. black box warning by FDA due to increased morbidity and mortality
  2. limited efficacy
  3. lack good alternatives, may have to use antipsychotics
  4. individual patients may respond well
26
Q

Medications to BPSD (7)

A
  1. target symptom approach
  2. empirical, variable
  3. avoid polypharmacy
  4. low dose and duration
  5. avoid anticholinergics
  6. initially consider non=pharmacologic measures
  7. consider delirium and pain
27
Q

Delirium (3)

A
  1. cognitive disturbances usually related to systemic conditions
    - illnesses
    - drugs
    - drug withdrawal
  2. altered sensorium
    - sensorium=senses in touch with reality
  3. relatively short time course
28
Q

Rx factors for delirium (7)

A
  1. elders
  2. children
  3. CNS disorders
  4. previous episodes
  5. malnourished
  6. multiple organ system illness
29
Q

Delirium (5)

A
  1. cognitive fluctuation, confusion, psychosis, lucid intervals
  2. sleep/circadian rhythm disturbance
  3. agitated and withdrawn types
  4. comorbidity with dementia
  5. possible sequelae
30
Q

Derlium Treatment (5)

A
  1. adders underlying conditions
  2. normalize environment
  3. small doses antipsychotics
    - limit benzodiazepines
  4. protection from impaired judgement
  5. minimize restraints
31
Q

Goal psychiatric interview

A
  1. establish rapport, relationship
  2. understand their level of cognitive impairment
  3. do NOT patronize
  4. test memory using scale
    - MOCA scale
    - clock test
  5. assess mood
    - ask about suicidal thinking
    - ask risk factors for suicide
    - isolation, hopelessness, depression, chronic pain, hx of drug use, recent trip to doctor’s office
32
Q

Amnestic Disorder

A
  1. loss of memory due to medical condition or drug
    - head injury
    - nutrient deficient
33
Q

Bereavement exclusion

A

DMS 4 would hinder treatment 6 months after a significant death
-judgement call, should probably still treat patient

Psychosocial Medicine (19 decks)

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