pscyh geriatric Flashcards

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1
Q

factors assoc with normal aging

A

decr brain weight (enlarged ventricles and sulci); decreased muscle mass and incr fat; impaired vision and hearing; minor forgetfulness

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2
Q

pseudodementia

A

presence of apparent cognitive deficits in patients with major depression

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3
Q

treatment for pseudodepression

A

supportive psychotherapy; low dose antidepressant; methylphenidate; ECT

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4
Q

if using TCAs inelderly patients, which is favored?

A

nortryptiline because it has the fewest anticholinergic side effects

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5
Q

mirtazapine

A

antidepressant that can increase appetite and is also sedating; often dosed at bedtime for depressed patients who also suffer from decr appetite and sleep disturbances

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6
Q

methylphenidate in pseudodementia

A

can be used at low doses as an adjunct to antidepressants for patients with psychomotor retardation; but can cause insomna; arrythmia risks in cardiac patients

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7
Q

ECT in pseudodementia

A

may be used in place of antidepressant (safe and effective in the elderly)

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8
Q

five stages of grief

A

DABDA; denial, anger, bargaining, depression, acceptance

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9
Q

normal grief

A

feelings generally abate within 6 mos of the loss, and the patient’s ability to function appropriately in their life is preserved

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10
Q

complicated/prolonged grief

A

persists for greater than 6 mos and includes at least 4 of the eight cardinal features

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11
Q

cardinal features of complicated/prolonged grief

A

difficulty moving on with life; numbness/detachment; bitterness; feeling that life is empty; trouble accepting the loss; feeling the future holds no meaning; agitation; difficulty trusting others since the loss

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12
Q

bereavement-assoc depression

A

essentially major depression that began with a concrete death or loss in the patient’s life

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13
Q

how to differentiate between bereavment-assoc depression and complicated grief

A

in depression, the patient has generalized feelings of hopelessness, helplessness, severe guilt, and worthlessness and SI, in addition to complicated grief sx

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14
Q

age related affects of alcohol

A

decreased alc dehydrogenase leads to higher BAL; increased CNS sensitivity to alc; alcohol-medication interaction

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15
Q

result of use of H2 blockers and alcohol

A

higher BAL

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16
Q

result of use of alc with benzos, TCAs, narcotics, barbiturates, or antihistamines

A

increased sedation

17
Q

aspirin, or NSAIDs with alcohol

A

prolonged bleeding time and irritation of gastric lining

18
Q

metronidazole, sulfonamides, long acting hypoglycemics with alcohol

A

nausea and vomitting

19
Q

reserpine, nitroglycerin, hydralazine with alcohol

A

increased risk of hypotension

20
Q

acetominophen, isoniazid, or phenybutazone with alc

A

increased hepatotoxicity

21
Q

antihypertensives, antidiabetics, ulcer drugs, gout meds with alc

A

worsen underlying disease

22
Q

hallucinations in dementia

A

usually visual

23
Q

treatment for psych symptoms in dementia patients

A

try non-pharm therapies first; if antipsychotics are necessary, try olanzapine (Zyprexa) or quetiapine (Seroquel) in patients with severe sx;can also use short-erm haloperidol or risperidone

24
Q

mood stabilizers to use in elderly dementia patients for psych sx

A

valproic acid, carbamazepine, and lamotrigine

25
Q

sedative-hypnotic drugs are more likely to cause side effects when used by the elderly

A

right

26
Q

REM sleep in geriatric patients

A

decreaed REM latency and decreased total REM

27
Q

Non-REM sleep in the elderly

A

increased stage 1 and 2 sleep; decreaed amount of stage 3 and 4 sleep (deep sleep)

28
Q

sleep efficiency in the elderly

A

decreased efficiency (frequent nocturnal awakenings)

29
Q

amount of total sleep in the elderly

A

decreased

30
Q

sleep cycle in the elderly

A

advances (earlier to bed, earlier to rise)

31
Q

if sedative-hypnotics must be prescribed, meds like hydroxyzine (Vistaril) or trazadone are safer than the more sedating benzos

A

right

32
Q

hydroxyzine

A

Vistaril; antihistamine

33
Q

white elderly males have the highest rate of successful suicides

A

key word is successful

34
Q

VH early in dementia suggest a dx of dementia with Lewy bodies

A

so do not give these patients antipsychotics