pscyh geriatric Flashcards
factors assoc with normal aging
decr brain weight (enlarged ventricles and sulci); decreased muscle mass and incr fat; impaired vision and hearing; minor forgetfulness
pseudodementia
presence of apparent cognitive deficits in patients with major depression
treatment for pseudodepression
supportive psychotherapy; low dose antidepressant; methylphenidate; ECT
if using TCAs inelderly patients, which is favored?
nortryptiline because it has the fewest anticholinergic side effects
mirtazapine
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
methylphenidate in pseudodementia
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
ECT in pseudodementia
may be used in place of antidepressant (safe and effective in the elderly)
five stages of grief
DABDA; denial, anger, bargaining, depression, acceptance
normal grief
feelings generally abate within 6 mos of the loss, and the patient’s ability to function appropriately in their life is preserved
complicated/prolonged grief
persists for greater than 6 mos and includes at least 4 of the eight cardinal features
cardinal features of complicated/prolonged grief
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
bereavement-assoc depression
essentially major depression that began with a concrete death or loss in the patient’s life
how to differentiate between bereavment-assoc depression and complicated grief
in depression, the patient has generalized feelings of hopelessness, helplessness, severe guilt, and worthlessness and SI, in addition to complicated grief sx
age related affects of alcohol
decreased alc dehydrogenase leads to higher BAL; increased CNS sensitivity to alc; alcohol-medication interaction
result of use of H2 blockers and alcohol
higher BAL
result of use of alc with benzos, TCAs, narcotics, barbiturates, or antihistamines
increased sedation
aspirin, or NSAIDs with alcohol
prolonged bleeding time and irritation of gastric lining
metronidazole, sulfonamides, long acting hypoglycemics with alcohol
nausea and vomitting
reserpine, nitroglycerin, hydralazine with alcohol
increased risk of hypotension
acetominophen, isoniazid, or phenybutazone with alc
increased hepatotoxicity
antihypertensives, antidiabetics, ulcer drugs, gout meds with alc
worsen underlying disease
hallucinations in dementia
usually visual
treatment for psych symptoms in dementia patients
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
mood stabilizers to use in elderly dementia patients for psych sx
valproic acid, carbamazepine, and lamotrigine
sedative-hypnotic drugs are more likely to cause side effects when used by the elderly
right
REM sleep in geriatric patients
decreaed REM latency and decreased total REM
Non-REM sleep in the elderly
increased stage 1 and 2 sleep; decreaed amount of stage 3 and 4 sleep (deep sleep)
sleep efficiency in the elderly
decreased efficiency (frequent nocturnal awakenings)
amount of total sleep in the elderly
decreased
sleep cycle in the elderly
advances (earlier to bed, earlier to rise)
if sedative-hypnotics must be prescribed, meds like hydroxyzine (Vistaril) or trazadone are safer than the more sedating benzos
right
hydroxyzine
Vistaril; antihistamine
white elderly males have the highest rate of successful suicides
key word is successful
VH early in dementia suggest a dx of dementia with Lewy bodies
so do not give these patients antipsychotics
