Aging And Old Age Psychiatry

Question 1

Ageing is a _________ deterioration of physiological function, an intrinsic-age related process of loss of ______ and increase in ____________

Answer 1

progressive

viability

vulnerability

Question 2

The biological age of a person is identical to their chronological age

T/F

Answer 2

F

The biological age of a person is not identical to the chronological age

Question 3

Loneliness is a major mental health problem of older adults

T/F

Answer 3

T

Question 4

What are the Dimensions of Healthy Ageing?

Answer 4

Social activity
Diet
Genes
Productive pursuits
Exercise

Question 5

Aging and the life cycle

Young adulthood: ________ vs ________

Middle aged : _________ vs __________

Elderly : ________ vs __________

Answer 5

Intimacy; isolation

Generativity; self absorption

Integrity ; despair

Question 6

Fear of death is usually a _____ life issue

Acceptance of mortality occurs in _______ life

Answer 6

Mid

Elderly

Question 7

What are the triple D’s in Elderly

Answer 7

Dementia
Delirium
Depression

Question 8

Delirium :

Onset
Duration
Course
Consciousness
Attention and memory
Affect

Answer 8

Acute
Days to weeks
Flunctuating
Impaired
Inattentive, poor memory
Variable

Question 9

Dementia :

Onset
Duration
Course
Consciousness
Attention and memory
Affect

Answer 9

Insidious
Months to years
Slowly progressive
Clear until late in the course of
Poor memory
Variable

Question 10

Depression :

Onset
Duration
Course
Consciousness
Attention and memory
Affect

Answer 10

Variable
Variable
Diurnal variation
Unimpaired
Difficulty concentrating
Depressed

Question 11

4 other psychiatric disorders of old age

Answer 11

Psychosis
Anxiety-phobias
Alcohol use
High risk of suicide

Question 12

Late life Depression

Has a different presentation, usually __________ or __________

Answer 12

Happily Sad

Suffering with a smile

Question 13

Late life depression

Could be a

Late onset depression ( first time after age ___)
_______ depression
__________ depression
_____________ depression

Answer 13

50

Vascular
Post stroke
Psychotic

Question 14

Theories behind low prevalence of major depression in elderly??

Answer 14

Resilience
Shared experience or Generational temperament
Flaws in diagnostic approaches

Question 15

Major depression in Elderly

Disturbances in sleep, appetite and sexual functioning are always reliable indicator

T/F

Answer 15

F

Disturbances in sleep, appetite and sexual functioning are not always reliable indicator

Question 16

Major depression in Elderly

Use of _______,________, and ________ are useful in elderly primary care settings for screening

Answer 16

HAM-D, MMSE and GDS

Question 17

Late onset depression has (more or less?) complete response to treatment

Answer 17

Less

Question 18

Late onset depression have :

(Better or Poorer?) prognosis
_____eased mortality
(Acute or Chronic?) Course
_________ and _________ on scans

Answer 18

Poorer
Increased
Chronic
Frontal and temporal Atrophy

Question 19

________ onset depression have more first degree relatives with depression (__________)

Answer 19

Early

Genetic loading

Question 20

Depression with reversible dementia, AKA __________ is now considered obsolete

Answer 20

Pseudodementia of depression

Question 21

Depression in the elderly is associated with cognitive impairments

T/F

Answer 21

T

Question 22

Depression with psychosis

Responds not Atall to ________
Poorly to _________ used alone
More often to combinations of ________ and __________ medications

Answer 22

placebos

antidepressants

antidepressants and antipsychotic

Question 23

Depression with psychosis

Hospitalizations is usually indicted and _____________ is the treatment of first choice when agitation, starvation, dehydration and suicidality threaten survival

Answer 23

electroconvulsive therapy

Question 24

Structural brain abnormalities are more frequent in patients with _____ onset depression than _____ onset depression

Answer 24

Late

Early

Question 25

Evidence is sufficient to recommend psychotherapy as a first line treatment for depression in older adults T/F

Answer 25

F Insufficient

Question 26

CBT PST IPT DBT

Answer 26

Cognitive based therapy Problem solving therapy Interpersonal therapy Dialectical behavior therapy

Question 27

Depression in elderly Although approximately ____% to ___% of elderly patients improve clinically with antidepressant therapy. The efficacy of these agents may be lowered , mainly in those with ___________ or _________________

Answer 27

50; 60 vascular neurodegenerative brain disease

Question 28

______ is the most important of the non-phamarcological somatic treatments

Answer 28

ECT

Question 29

COURSE AND PROGNOSIS > Left untreated, late-life major depression tends to remit spontaneously after ______________ , but patients with first-episode depression with onset after age 60 have a ____% chance of recurrence within ________.

Answer 29

12-48 months 70 2 years.

Question 30

Types of Delirium ????

Answer 30

Hyperactive/ Hyperalert Hypoactive/ Hypoalert Mixed

Question 31

Prescribed medicines can cause delirium T/F

Answer 31

T

Question 32

Causes of delirium I WATCH DEATH

Answer 32

Infections Withdrawal Acute metabolic Trauma CNS pathology Hypoxia Deficiencies Endocrinopathies Acute vascular Toxins/drugs Heavy metals

Question 33

The mortality outcome at 6 months post discharge for delirious patients not identified was ________ times higher than the delirious patients who were identified and treated

Answer 33

Three

Question 34

Adequate lighting is a treatment of delirium T/F

Answer 34

T

Question 35

Dementia is an umbrella term used to describe a range of symptoms associated with cognitive impairments List them

Answer 35

Alzheimer’s Vascular Lewy bodies Frontotemporal

Question 36

Dementia is a syndrome due to disease of the _______, usually of a ———- and ________ nature

Answer 36

Brain Chronic Progressive

Question 37

Risk factors for dementia Age: ________ years • Gender: ______ • Prior stroke • Atherosclerosis • Heart disease • High blood pressure • Diabetes • Diet

Answer 37

60-70 female

Question 38

Etiological classification o f dementia • Neurodegenerative Diseases • ___________ disease > ___________ disease • Diffuse ___________ disease • Progressive ___________ ______ • Multisystem atrophy • ___________ disease • ___________ dementias

Answer 38

Alzheimer's disease > Parkinson's disease • Diffuse Lewy body disease • Progressive supra-nuclear palsy • Multisystem atrophy • Huntington's disease • Frontotemporal dementias - e.g. Pick's disease

Question 39

Frontotemporal dementias e.g. _____ disease

Answer 39

Pick's

Question 40

Etiological classification o f dementia •________ Diseases •________ Disease or Trauma • _________ Disease •______________ Disease • Other late-onset lysosomal storage diseases

Answer 40

Neurodegenerative Structural Vascular Heredo-metabolic

Question 41

Etiological classification of dementia Structural Disease or Trauma •______________ • __________ • Dementia pugilistica Vascular Disease •_____________ •_____________ Heredo-metabolic Disease •_________ disease • Other late-onset lysosomal storage diseases

Answer 41

Normal pressure hydrocephalus Neoplasms Vascular dementia Vasculitis Wilson's

Question 42

List 6 irreversible dementias

Answer 42

Alzheimer’s dementia Lewy body dementia Pick’s disease Parkinson’s Hungtington Creutzfeldt-Jacob disease

Question 43

DEMENTIA Findings on neuroimaging Diffuse __________ • Enlargement of ________ • Widening of ________ • Atrophy more prominent in ___________ • There can also be evidences of strokes, lacunar infarcts, and white matter hyper intensities. These complicate the picture.

Answer 43

brain atrophy ventricles sulci and gyri hippocampus

Question 44

Alzheimer’s disease VS vascular dementia Prevalent sex History of hypertension Onset Hypertension Emotional lability Cognitive deficits Focal neurological signs

Answer 44

Women; men Less common; more common Gradually progressive ; episodic deterioration Less common; more common Less common; more common Uniform; patchy Uncommon; common

Question 45

Behavior and psychological symptoms of dementia (BPSD) include ????

Answer 45

Agitation, depression and psychosis

Question 46

BPSD are treatable BPSD don’t respond well to therapy T/F

Answer 46

T F

Question 47

BPSD 50 - 90% of caregivers considered _______________ as the most serious problem they encountered and a factor leading to institutionalization

Answer 47

physical aggression