Old Age Psychiatry 2

Question 1

What are examples of functional illness?

Answer 1

• Depressive illness
• Anxiety disorders
  
  • Generalised anxiety
  • Panic disorder
  • Agarophobia
  • PTSD
• Mania (bipolar disorder)
• Schizophrenia
• Late onset schizophrenia like psychosis
• Alcohol problems
• Suicide

Question 2

Depression in elderly - aetiology

Answer 2

• Loss of
  
  • Health
  • Wealth
  • Spouse
  • Work
  • Home
• Genetic

Question 3

Depression in elderly - epidemiology

(sex)

Answer 3

• F:M 1.5:1

Question 4

Depression in elderly - clinical features

Answer 4

• Less
  
  • Depressed mood
  • Expressed suicidal wishes
• More
  
  • Insomnia
  • Hypochondriasis
  • Suicide
  • Agitation

Question 5

Depression in elderly - management

Answer 5

• Antidepressants
• CBT
• ECT in severe cases need for prophylaxis

Question 6

Depression in elderly - prognosis

Answer 6

• 2x mortality
• 25% chronic
• Better with treatment

Question 7

What is a normal and abnormal reaction for grief, mourning and bereavement?

Answer 7

Normal reaction:

• Alarm
• Numbness
• Pining
  
  • Illusions or hallucinations may occur
• Depression
• Recovery and reorganisation

Abnormal reaction:

• Features persisted beyond 2 months
• Guilt
• Thoughts of death
• Psychomotor retardation
• Prolonged and marked functional impairment
• Psychosis

Question 8

If features go beyond what time period for bereavement its an abnormal reaction?

Answer 8

Persist beyond 2 months

Question 9

Suicide in the elderly - epidemiology

(sex)

Answer 9

• Same rate as for under 25 age group
• Half the rate of other age groups
• M>F
• Most are depressed

Question 10

Suicide in the elderly - risk factors

Answer 10

• Loneliness
• Widowed
• Ill health
• Chronic pain
• Recent life events

Question 11

Late onset schizophrenia like psychosis - aetiology

Answer 11

• Sensory loss
• Social isolation
• Genetic

Question 12

Late onset schizophrenia like psychosis - epidemiology

Answer 12

• Prevalence up to 10% of psychiatric admissions in old age

Question 13

Late onset schizophrenia like psychosis - clinical features

Answer 13

• Spectrum from circumscribed persecutory delusions to full schizophrenia like psychosis

Question 14

Late onset schizophrenia like psychosis - management

Answer 14

• Often needs compulsory admission
• Neuroleptics
• Increased social contact

Question 15

Late onset schizophrenia like psychosis - prognosis

Answer 15

• May fail to regain insight
• High relapse if stop neuroleptics