Psych and pharmacology

Question 1

True or false: most patients with dementia will have some major psych/behavioral difficulty

Answer 1

True

Question 2

Which usually causes more suffering for pts and families: the cognitive decline associated with dementia, or the psych problems that come with it?

Answer 2

The psych problems

Question 3

When a pt with dementia develops new symptomatology, why must this be evaluated carefully?

Answer 3

Pts have problems communicating what they are experiencing

Question 4

What is the first step to evaluating a psych problem?

Answer 4

H&P

Question 5

Why is the PE important in a psych exam?

Answer 5

often with these patients their only expression of a physical ailment may be a change in mental status

Question 6

True or false: the dementias mneonic is useful for evaluating psych diagnoses

Answer 6

True

Question 7

All psych diagnoses demand consideration of what?

Answer 7

for the intervention regarding the triggering events, environment, caregiver stress,

Question 8

What is agitation?

Answer 8

non-specific umbrella term for many behavoirs and symptoms

Question 9

Why is it important to get the most specific description of agitation?

Answer 9

To get effective treatment

Question 10

What are the non-pharmacological treatments for agitation? (4)

Answer 10

Routine
Remove environmental triggers
Quiet environment
Address pain

Question 11

What are the pharmacologic interventions for agitation? (6)

Answer 11

1. Buspar
2. SSRIs
3. Anticonvulsants
4. Benzos
5. Antipsychs
6. Cholinesterase inhibitors

Question 12

What are benzos?

Answer 12

Anticonvulsants
Antipsychotic
Anxiolytics

Question 13

What are the problems with Benzos?

Answer 13

Increase falling and are sedative

Question 14

What is the MOA of old antipsychotics?

Answer 14

Block D2 receptors (dopamine)

Question 15

What are the dangers of antipsychotics?

Answer 15

Sudden death

Question 16

What is sundowning?

Answer 16

Agitation in which the pt has symptoms in ithe afternoon or late evening

Question 17

What are the treatments for sundowning?

Answer 17

Routine
Remove environmental triggers
Quiet environment
Address pain

Question 18

When should medication be given for sundowners?

Answer 18

30-60 minutes prior to onset of symptoms

Question 19

How can lighting be used to minimize the effect of sundowning?

Answer 19

Gradual decrease in light

Question 20

What are the meds that can be used for sundowning?

Answer 20

Trazadone
Benzos
Antipsychotics

Question 21

What are delusions?

Answer 21

False beliefs that are usually paranoid/accusatory

Question 22

Why do delusions happen?

Answer 22

Misidentification or misinterpretation

Question 23

What is Fregoli syndrome?

Answer 23

a rare disorder in which a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise

Question 24

What are the non-pharmacologic interventions for delusions?

Answer 24

Reassurance
Distraction
Benign neglect
Validation therapy
Remove objects that are being misidentified

Question 25

What are the pharmacologic interventions for delusion?

Answer 25

Atypical antipsychotics

Question 26

How do you manage hallucinations without drugs?

Answer 26

Reassurance Distraction Benign neglect

Question 27

When are drugs recommended for hallucinations? What are the drugs of choice?

Answer 27

disturbing enough--use atypical antipsychs

Question 28

What are the non-pharmacologic interventions for resistiveness to care?

Answer 28

gentle, slow approach and avoid distractions

Question 29

What is the drugs utilized for resistiveness to care?

Answer 29

Benzos

Question 30

Disinhibition is most often seen with what type of dementia?

Answer 30

Frontotemporal lobe

Question 31

What are the non-drug interventions for disinhibition?

Answer 31

Avoid situations Examine environment Carry information card

Question 32

What are the drugs used for disinhibition?

Answer 32

Anticonvulsants SSRIs Beta blockers

Question 33

What are the drugs for sexual disinhibition?

Answer 33

SSRIs Medroxyprogesterone acetate Lupron

Question 34

Lupron is not given full dose right away due to what?

Answer 34

Surge in activity of FSH/LH, causing flare of symptoms (later it will go down)

Question 35

True or false: there is no great pharmacologic treatment for wandering

Answer 35

true

Question 36

What are the interventions for wandering?

Answer 36

Provide daytime exercise lock doors Placing tape across the door

Question 37

Do apathy and depression go hand in hand?

Answer 37

Not always

Question 38

What are the treatment options for apathy?

Answer 38

Provigil and ritalin

Question 39

What fraction of pts wtih dementia have depression?

Answer 39

25%

Question 40

What are the treatments of depression?

Answer 40

SSRIs | getting exercise and sleep

Question 41

Why should depression be suspected in dementia patients?

Answer 41

Cannot communicate feelings well

Question 42

What happens to the sleep cycle as dementia progresses?

Answer 42

Worsens

Question 43

What are the non-pharmacologic treatments of sleep disturbance?

Answer 43

Good sleep hygiene Exercise Restrict EtOH and caffeine

Question 44

True or false: you should avoid benzos for sleep problems

Answer 44

True, except for restoril

Question 45

What are the meds used to treat sleep problems?

Answer 45

``` Sonata Ambien Low dose atypical antipsychs Trazadone melatonin ```

Question 46

What is the DELIRIUM mnemonic?

Answer 46

``` Drugs Electrolytes Lack of drugs Infx Reduced sensorium Intracranial UTI Myocardial/pulmonary ```

Question 47

What are the four A's of Alzheimer's?

Answer 47

Agnosia Apraxia Amnesia Aphasia