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NMSP Exam 1 > Psychiatric Conditions in Geriatrics - Hill > Flashcards

Psychiatric Conditions in Geriatrics - Hill Flashcards

1
Q

what is considered a major neurocognitive disorder (NCD)?

A

dementia

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2
Q

what was formerly known as mild cognitive impairment?

A

mild NCD

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3
Q

what are the special conditions to keep in mind when treating geriatric patients?

A
  • multiple comorbidities
  • varied diseases (more degenerative disease and certain cancers)
  • unusual presentation of illnesses
  • differentiating normal aging processes vs. disease
  • under-reporting (elderly pts often fail to recognize sx)
  • purpose of tx (emphasis on palliative care)
  • medication start low and go slow
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4
Q

what are the risk factors for Alzheimers?

A

female, family hx, head trauma, Down’s syndrome

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5
Q

what are the risk factors for vascular dementia?

A

male, advanced age, hypertension, other CV disease

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6
Q

what are the two progressive dementia disorders outlines?

A
  1. Pick’s disease (frontotemporal dementia)

2. Lewy body dementia (visual hallucinations, memory loss, parkinson-like sx)

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7
Q

what are some reversible causes of dementia?

A
  • drug induced
  • thyroid disease
  • metabolic disorders
  • hematomas
  • hydrocephalus
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8
Q

what are the sx of dementia?

A 
depression -> pseudodementia
memory loss
communication
difficultly performing tasks, organization, coordination
problems w/disorientation
*personality changes*
inappropriate behavior
agitation
psychotic symptoms
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9
Q

what is most important in evaluation of dementia in the elderly?

A

H&P

  • onset
  • character
  • progression
  • comorbid conditions

neurologic exam
functional status
neuropsychological testing

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10
Q

what labs should be drawn in evaluation of dementia in the elderly?

A 
endocrine panels
**B12** if <400 -> give B12 shot!
folate
CBC/CMP
HbA1C

CT,MRI, PET scans

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11
Q

what meds can be used to treat dementia?

A
  • donepezil (ACEI)

- memantine (NMDA antagonist)

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12
Q

what meds should be avoided in treating dementia?

A
  • *ANTICHOLINERGIC meds**
  • they impair cognitive function, especially in the elderly
  • ex: benadryl, hydroxyzine
  • he wants us to KNOW this
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13
Q

what is the black box warning associated with dementia patients?

A

antipsychotic medications are associated with increased mortality
- olanzapine, aripiprazolem risperidone, quetiapine

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14
Q

what is the main difference between delirium and depression?

A 
delirium = hours-days
dementia = weeks-months
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15
Q

what is the third most common cause of psychosis in elderly patients?

A

delirium due to:

  • inappropriate drug use
  • drug withdrawal
  • infection
  • urinary retention
  • constipation
  • physiologic abnormalities
  • intracranial strokes
  • seizures
  • hemorrhages
  • sensory/sleep deprivation
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16
Q

what is the second most common diagnosis in elderly patients?

A

psychosis due to major depressive disorder with psychotic features

  • somatic troubles
  • persecution
  • guilt
  • poor self-esteem
17
Q

what is the most common diagnosis accounting for psychosis in elderly patients?

A

psychosis due to alzheimer’s type dementia

- delusions (because of cognitive impairments, often of a paranoid nature)

18
Q

why is substance abuse often under-diagnosed in the elderly?

A

physicians are too afraid to ask
- must maintain high index of suspicion

physicians are unaware of the HIGH prevalence rate

  • unaware of the increased impact certain substances have on the elderly
  • the effects of mood-altering chemicals are often magnified much more due to patient age and condition of body
19
Q

what are the risk factors for substance abuse in the elderly?

A
  • female
  • marital status (single, separated, divorced)
  • absence of hobbies and socialization
  • health concerns
  • possible pharmacokinetic changes that take place in older individuals may lead to increased potential for abuse of benzodiazepines or opiates
20
Q

what are the general consequences of substance abuse in the elderly?

A
  • cognition impairment
  • depression and other mood alterations
  • sleep alteration
  • balance and vestibular problems
  • delirium
  • increase risk for developing other medical conditions
21
Q

what is the tx of substance abuse in the elderly?

A

treat withdrawal sx!

  • cannot go “cold turkey” with intense and chronic alcohol abuse -> possible DT and death
  • gradual taper is effective

meds: benzo’s (diazepam)

22
Q

what is the percentage of people over 65 showing depressive symptoms?

A

20%

23
Q

what is the percentage of demented 75+ year olds that are suffering from moderate-mild depression?

A

36%

24
Q

what is the percentage of people over 85 that are affected by a depressive condition?

A

40%

25
Q

what are the primary causes of depression?

A

deteriorating health
cognitive decline
loss of independence
loss of spouse and friends

26
Q
  • anxiety
  • fatigue, hypersomnolence
  • somatic complaints
  • cognitive impairment
  • weight loss
  • insomnia
  • anhedonia
  • agitation
A

sy/sx of depression in eldery

27
Q

what is the diagnosis criteria for major depression in the elderly?

A

anhedonia or depressed mood for TWO weeks and 4 of the following:

  • feelings of worthlessness/guilt
  • decreased ability to concentrate
  • fatigue
  • psychomotor agitation
  • insomnia, hypersomnolence
  • weight/appetite changes
  • recurrent thoughts of suicide/death
28
Q

on the geriatric depression scale, a score >5 points is suggestive of what?

A

depression

- warrants a follow-up comprehensive assessment

29
Q

on the geriatric depression scale, a score >10 points is almost ALWAYS suggestive of what?

A

depression

30
Q

what are the ddx of depression in the elderly?

A
  • dementia
  • normal bereavement
  • adjustment disorder w/depressed mood
31
Q

what medication interactions should be avoided in treating depression in the elderly?

A
  • *AVOID DIPHENHYDRAMINE**
  • *monitor for SEROTONIN SYNDROME when giving SSRI**
  • may increase falls, GI effects, insomnia, agitation
32
Q

how do you differentiate between dementia and depression in the elderly?

A
  • *MENTAL STATUS EXAM**
  • depressed pt: will often have INSIGHT, though little effort
  • dementia pt: little/no insight
33
Q

what is the tx for depression in the elderly?

A
  • meds
  • psychotherapy
  • CBT (replace negative perspective/irrational thinking with rational/positive cognition)
  • exercise
  • diet
  • lifestyle modification when possible
34
Q

what is the initial antidepressant trial period for the elderly?

A

4-6 weeks

35
Q

what medication used to treat depression in the elderly has a side effect of increasing appetite?

A

mirtazapine

36
Q

what medication used to treat depression in the elderly promotes sleep, but should be used in low doses due to orthostatic effects in the elderly?

A

trazodone

37
Q

what medication used to treat depression in the elderly may cause seizures?

A

bupropion

38
Q

what medication used to treat depression should be used with caution in cardiac patients?

A

TCA’s

NMSP Exam 1 (19 decks)

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