Mental Health Issues in LTC

Question 1

what is the most common psych disorder in the NH?

Answer 1

dementia

Question 2

what are some common behavioral sx of dementia?

Answer 2

• hallucinations
• delusions
• depression
• anxiety
• agitation
• psychosis
• apathy
• withdrawal
• inactivity

Question 3

what’s another name for mild cognitive impairment MCI?

Answer 3

mild neurocognitive disorder

Question 4

what is MCI?

Answer 4

• mild impairment in memory
• difficulty forming new memories
• cont fx independence

Question 5

what are some characteristics of Alzheimer’s dementia?

Answer 5

• onset: early (before 65 years), age is primary risk factor

- clinical: slow, progressive, neuropsychiatric sx usually present

Question 6

what are some characteristics of vascular dementia?

Answer 6

• small vessel disease - temporal hx btwn vascular event and decline
• can be mixed with AD
• clinical: stepwise cognitive decline (executive dysfx, decreased attention/concentration, impaired retrieval)

Question 7

what are some characteristics of lewy body dementia?

Answer 7

• 2nd most common dementia after AD

- onset after age 60

Question 8

how do you dx lewy body dementia?

Answer 8

• dementia + 2 core features (visual hallucinations, parkinsonism, fluctuating cognition)
• dementia + 1 core feature + 1 suggestive feature (RBD, DAT scan, neuroleptic sensitivity)

Question 9

what are some characteristics of frontotemporal dementia?

Answer 9

• onset: btwn 45-65 years (2nd more common dementia in people <65)
• clinical: progressive changes in emotion, personality, and behavior

Question 10

what are some characteristics of parkinson’s dementia?

Answer 10

• occurs about 10 years after motor sx present
• impaired executive fx, decreased attention, poor fluency
• depression, anxiety, psychosis (VH/delusions), impusle control disorder, sleep disorders, apathy

Question 11

what drugs should we avoid when someone has delirium?

Answer 11

• TCAs
• anticholinergics
• BZDs
• non-BZDs
• corticosteroids
• H2 antagonists
• meperidine
• other sedatives/hypnotics

Question 12

what labs are important to check with someone on lithium?

Answer 12

• TSH
• creatinine
• EKG
• calcium
• lithium level

Question 13

SE lithium toxicity

Answer 13

• tremor
• GI disturbance
• EKG changes
• confusion

Question 14

problems with carbamazepine

Answer 14

• auto-inducer

- multiple drug-drug interaction

Question 15

SE and considerations divalproex

Answer 15

• weight gain
• hyperammonemia
• helps with aggression, esp more manic sx

Question 16

things to consider with gabapentin

Answer 16

• few drug-drug interactions
• monitor kidney function
• useful for tx anxiety

Question 17

risks associated with SSRIs in elderly

Answer 17

• hyponatremia

- increased risk of falls

Question 18

2nd line depression tx

Answer 18

• snri - duloxetine for neuropathic pain

- burpoprion

Question 19

SE SNRIs

Answer 19

• increased activation

- BP elevation

Question 20

SE tetracyclics

Answer 20

mirtazapine

• weight gain
• sedation

Question 21

SE and use of trazadone

Answer 21

• mainly used as hypnotic
• sedation
• priapism

Question 22

SE TCAs

Answer 22

amitriptyline, nortriptyline

• narrow therapeutic windown
• anticholinergic

Question 23

what 3 drugs are used for augmentation of depression monotherapy?

Answer 23

• buproprion
• quetiapine
• aripiprazole

Question 24

what drug class is not efficacious for tx of agitation?

Answer 24

cholinesterase inhibitors

Question 25

what are the 3 cholinesterase inhibitors?

Answer 25

• donepezil
• galantamine
• rivastigmine

Question 26

most effective tx for severe geriatric depression

Answer 26

ECT

Question 27

ECT relative contraindications

Answer 27

• recent CVA/MI
• severe HTN
• space-occupying lesion

Question 28

ECT and parkinson’s

Answer 28

• improves mood-motor fx temporarily

Question 29

for what drug would you need to consult psych?

Answer 29

• clozapine