Old Age Psychiatry -Intro Flashcards
What is fastest growing age group for old age psych?
> 85
What symptoms and syndromes in the elderly common? 5 things
Anxiety Affective Psychotic Cognitive Behaviour
Place of assessment is usually?
In their own home
why assess elderly at home?
Clothed? Warm? Food? House clean-ish? Physical hazards Meds?
Common old age issues during assessment that will affect quality and mite?
Deafness, vision
Frailty
Cognitive impairment
Why is psych under-reported in elderly?4 things
Shame, stigma
Cultural factors
Poor insight
Cognitive impairement
What else do you need for history in old age psych?
Collateral/career Hx
Is anxiety typical in old age?
Not new onset anxiety
Common with depression
Things to consider in old age psych assessment
Anxiety
Psychotic - risk assessment
Mood
Cognitive Impairment: eg. If MCI - cholinesterase inhibitors
Physical symptoms of depression in elderly?
Pain
Weight loss
GIT disturbance
2 factors in the elderly risk assessment for suicide?
Intent - significant risk in elderly
Lethality
At risk features of elderly suicide risk?
Male Living alone Personality dysfunction ETOH abuse Recent bereavement Physical illness/frailty
Mania in elderly how to approach? How presents?
Irritable presentation
If first presentation: organic until proven otherwise
-Post surgery, lesions
What is erotomania?
Higher social standing person is in love with them (usu. woman)
No insight
Elderly psychotic syndromes likely?
Morbid jealousy
Misinterpretation (they are coming to steal my stuff)
Misidentification (switched with a double)
Delirium psychotic symptoms?
Visual hallucinations: spider on the roof
Non-elaborate delusions
Delirium CAS?
IADA
Inattention
Acute onset
Disordered thinking
Altered levels of consciousness
What happens to schizophrenics as they age
Positive symptoms attenuate
Sedative symptoms worsen
Presentation classic of late onset schizophrenia?
Partition delusions- Someone living in my room
Phantom delusions -Someone living in my roof
Multi-modal hallucinations
Late onset vs. very late onset of schizo?
Current drug abuse in elderly
Alcohol
Smoking
Benzos
Important thing to do if elderly reports auditory hallucinations?
Command hallucination: can be more dangerous in elderly
MMSE abnormal?
What is ceiling effect in MMSE?
If subtle impairment, score can be high
What is organic screen?
FBE UEC LFT Ca - hypocalcaemia: delirium TFTs BSL B12/Folate MSU CXR/Neuro imaging Meds review
Red flags in old age psych
Psychotic depression
Command hallucinations
Morbid jealousy
Elder abuse risk factors?
Female over 75
Long term conflict with carer
