Psych and mental health in the adult and geriatric Flashcards
Depression classification
Major depressive disorder
Bipolar 1 and 2
Adjustment disorders
Anxiety disorders
PTSD
Bipolar meds
manic episode
1 st line
mood stabilizers and anti-psychotics or benzos
Mood stablizer= Lithium and divalproex ( 1st line)
Antipsychotic risperidone or seroquel
zyprexa for immediate needs
Bipolar
Depressive episode
monotherapy mood stabilizer
severe case lithium or lamotrigine
antipsychotics- used for delusional it is contraindicated in bipolar depressive episodes
don’t use antidepressants as monotherapy
side effects of SSRI SNRI and TCA
Serotonin syndrome with overuse of SSRI SNRI TCA
SIADH, SSRI SNRI TCA
Prolong risk of QT, SSRI and TCA
MAOI
Avoid matured aged/cheese dishes with aged cheese ( Lasagna, Pizza)
Glascow coma scale
normal is 15
8 or less is intubate
Geriatric screeing tools
MMSE(mini-mental status exam)
24-30 Normal
18-23 Moderate impairment
0-17 marked impairment
Montreal cognitive assessment
MMSE score for driving
27-29 ok to drive
24-26 safety uncertain
20-23 do not drive
Delirium
disturbance of consciousness with inattention
change in cognition or perceptual disturbance
hours to days
fluctuate over time
sundowners
types of delirium
Hypoactive= Depresses LO
C most common with elderly
Hyperactive = increased activity seen with withdraw
Mixed delirium = mix of hypo and hyper
work up
early detection is key
look for a secondary cause
imaging labs and beer criteria
treatment
CAM-ICU score
treat ;
underlying cause
meds: Haldol , Geodon, Trazadone, Precedex
Dementia causes and risk factors
age 60 risk doubles
and 5 years after
at 85 years 50% will have dementia
risk factors: family hx, vascular disease, head injury, diabetes , HTN, more common in women
Alzheimer vs dementia
Alzheimers is a specific brain disease that accounts for 60-80 % of dementia cases
Dementia is a genreal term for symptoms like decline in memory , reasoning , or other thinking skills
Dementia types
Alzheimer’s, 1st cause of dementia ,plaque formation with neurofibrillary tangles containing Tau protein
Vascular, 2nd caouse of
dementia , CVD,impaired blood flow
multifocal ischemic change
Lewy bodies, brainstem, midbrain, olfactory bulb and neocortex
Frontal, temporal, progressive nerve cell loss in the frontal and temporal lobe, deterioration in behavior and personality, occurs in the 40s to 60s
