Lecture 5: Geriatric Psychiatry Flashcards
What is pseudodementia and why is it important to rule out?
- Depression in geriatric pt’s can look like dementia!
- Tx the depression and sx’s will improve!
What is most important in evaluation of dementia in the elderly?
H and P: what is the onset and character
Why is neuropsychological testing useful in evaluation of dementia in elderly pt?
- Attempts to establish baseline (helpful early in disease)
- Quantifies results of deficits
Which 2 drugs can be used to slow progression and increase patient functionality with dementia?
- Donepezil (MOA: AChE inhibitor)
- Memantine (MOA: NMDA antagonist)
What is a black-box warning for antipsychotic meds used for tx of psychosis with dementia?A
Assoc. w/ an increased risk of mortality: most often due to heart-related events or infections
Psychosis due to delirium in elderly pt’s presents is characterized by what?
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)
What is the tx of choice for psychosis due to major depressive disorder in elderly?
ECT
What are the delusions most often like in elderly pt with psychosis due to alzheimer’s type dementia?
- 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
What should you do in tx of substance abuse in older adults which will increase compliance?
INFORM YOUR PATIENTS!
What are the criteria for major depression in elderly?
Anhedonia or depressed mood for ≥2 weeks and 4 of the following:
Which TCA is a good choice for tx of depression in elderly pt’s; must use caution in which pt’s?
Nortriptyline; must use caution in cardiac pt’s
Which drug can be used in tx of depression in elderly and increases appetite?
Mirtazapine
Initial anti-depressant trial should be for how long when tx depression in elderly?
4-6 weeks
