Old Age Psychiatry -Intro

Question 1

What is fastest growing age group for old age psych?

Answer 1

> 85

Question 2

What symptoms and syndromes in the elderly common? 5 things

Answer 2

Anxiety
Affective
Psychotic
Cognitive
Behaviour

Question 3

Place of assessment is usually?

Answer 3

In their own home

Question 4

why assess elderly at home?

Answer 4

Clothed? Warm?
Food?
House clean-ish?
Physical hazards
Meds?

Question 5

Common old age issues during assessment that will affect quality and mite?

Answer 5

Deafness, vision
Frailty
Cognitive impairment

Question 6

Why is psych under-reported in elderly?4 things

Answer 6

Shame, stigma
Cultural factors
Poor insight
Cognitive impairement

Question 7

What else do you need for history in old age psych?

Answer 7

Collateral/career Hx

Question 8

Is anxiety typical in old age?

Answer 8

Not new onset anxiety

Common with depression

Question 9

Things to consider in old age psych assessment

Answer 9

Anxiety
Psychotic - risk assessment
Mood
Cognitive Impairment: eg. If MCI - cholinesterase inhibitors

Question 10

Physical symptoms of depression in elderly?

Answer 10

Pain
Weight loss
GIT disturbance

Question 11

2 factors in the elderly risk assessment for suicide?

Answer 11

Intent - significant risk in elderly

Lethality

Question 12

At risk features of elderly suicide risk?

Answer 12

Male
Living alone
Personality dysfunction
ETOH abuse
Recent bereavement
Physical illness/frailty

Question 13

Mania in elderly how to approach? How presents?

Answer 13

Irritable presentation

If first presentation: organic until proven otherwise
-Post surgery, lesions

Question 14

What is erotomania?

Answer 14

Higher social standing person is in love with them (usu. woman)
No insight

Question 15

Elderly psychotic syndromes likely?

Answer 15

Morbid jealousy
Misinterpretation (they are coming to steal my stuff)
Misidentification (switched with a double)

Question 16

Delirium psychotic symptoms?

Answer 16

Visual hallucinations: spider on the roof

Non-elaborate delusions

Question 17

Delirium CAS?

Answer 17

IADA

Inattention
Acute onset
Disordered thinking
Altered levels of consciousness

Question 18

What happens to schizophrenics as they age

Answer 18

Positive symptoms attenuate

Sedative symptoms worsen

Question 19

Presentation classic of late onset schizophrenia?

Answer 19

Partition delusions- Someone living in my room
Phantom delusions -Someone living in my roof
Multi-modal hallucinations

Question 20

Late onset vs. very late onset of schizo?

Question 21

Current drug abuse in elderly

Answer 21

Alcohol
Smoking
Benzos

Question 22

Important thing to do if elderly reports auditory hallucinations?

Answer 22

Command hallucination: can be more dangerous in elderly

Question 23

MMSE abnormal?

Question 24

What is ceiling effect in MMSE?

Answer 24

If subtle impairment, score can be high

Question 25

What is organic screen?

Answer 25

FBE
UEC
LFT
Ca - hypocalcaemia: delirium
TFTs
BSL
B12/Folate
MSU
CXR/Neuro imaging
Meds review

Question 26

Red flags in old age psych

Answer 26

Psychotic depression
Command hallucinations
Morbid jealousy

Question 27

Elder abuse risk factors?

Answer 27

Female over 75

Long term conflict with carer