Old age Psychiatry

Question 1

Depression in the elderly

Answer 1

Problem solving, increasing socialisation, day time activities
Psych therapies (e.g CBT, group)
Antidep.: SSRI
ECT if life threatening
?social worker, community nurse

Question 2

Psychosis in the elderly

Answer 2

reduction of sensory impairment
exclusion of organic cause or LBD
Low dose antipsych.

Question 3

Dementia Ix

Answer 3

Assessment (AMTS, MMSE< ACE-R, MoCA)
Delirium screen
?Structural imaging
Further tests:
- Alz: FDG-PET, CSF
- LBD: I-FP-CIP-SPECT, I-MIBG
-FTD: FDG-PET, perfusion SPECT
-Vascular: MRI
Tool for differentiating dementia from delirium:
Long confusion assessment method
Observational scale of level of arousal
Provide named care coordinator

Question 4

Adaptations for patients w/dementia

Answer 4

Always carry ID, address, contact number
Dossett boxes
Change gas to electricity
Reality orientation (clocks/calendar)
Environment mods: patterned carpets can cause hallucinations
Door mat buzzers

Question 5

Social support dementia

Answer 5

personal care, meal preparation, medication prompting
Day centres for social contact
Day hospitals enable psych care for complex pts

Question 6

Support carers dementia

Answer 6

Emotional support
Carer needs assessment
educate about dementia
Train to manage common problems
Provide respite care

Question 7

Optimise physical health in dementia

Answer 7

treat sensory impairment (hearing aids, glasses)
Exclude superimposed delirium
Treat underlying RF
R/v medication

Question 8

Psychological therapies

Answer 8

Offer range of therapies
Group cognitive stimulation (memory training, and re-learning)
Consider group reminiscence therapy
Consider cognitive rehab or OT
Behavioural approaches
- identify and modify underlying triggers for difficult/risky behaviour (eg walking due to anxiety)
Validation therapy
Multisensory therapy: as speech is lost

Question 9

Psychtropic medication for dementia

Answer 9

Start low dose and slowly
Older people v sensitive to SE
Treat psych comorb (depression)
1. Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) used in mild-mod AD, can bring sx relief, no effect on progressin
2, Memantine (NMDA antagonist) used in severe AD or if intolerance/CI for AC inhibitors
Behaviour may require sedatives as last resort (trazodone, valproate, haloperidol)

Question 10

MMSE in AD

Answer 10

Mild 21-26
mod 10-20
sev <10

Question 11

Pharmacology for non AD dementia

Answer 11

Donepezil or rivastigmine for LBD
Galantamine if not tol.
Only AC inhib in pts w/vascular dementia, or if suspected comorbid AD, Parkinson’s dementia or DLB
do NOT offer in FTD
Antipysch can be used in acute agitation at risk of harm
NB. antipysch can worsen LBD

Question 12

LBD Mx

Answer 12

Adaptations (OT) - reality orientation, environmental
Social support
Optimising physical health (r/v meds)
Psych therapy (reminiscence therapy)
Parkinsons meds could relieve tremor but worsen psychosis
Antipsychs are dangerous DO NOT USE (confusion, parkinsonism, death)