Case 3 - 65 yo female with insomnia

Question 1

Conditions that can mimic depression in the elderly

Answer 1

hypothyroidism, parkinson’s disease, dementia

Question 2

Screening for dementia

Answer 2

• mini-cog

- mini-mental state examination

Question 3

Criteria for MDD

Answer 3

5 of 8 SIGECAPS for 2 weeks or longer

If experiencing grief, can be bereavement for up to 2 months after death of loved one

Question 4

Ethnicity and depressoin

Answer 4

• depression diagnosed less frequently in hispanics and african-americans
• hispanic patients more likely to present with somatic complaints
• perceptions of noises or shadows (celajes) are more common in hispanic population
• hispanic patients less likely to receive adequate therapy

Question 5

Treatment for depression

Answer 5

• SSRIs
• SNRIs (venlafaxine)
• NDRIs (bupropion)
• SARIs (trazodone)
• TCAs
• MAOIs

Question 6

Side effects of anti-depressants

Answer 6

• SSRIs - headache, GI, insomnia,serotonin syndrome

- TCAs- cardiac arrhythmia

Question 7

Causes of insomnia in the elderly

Answer 7

• environmental
• drugs/alcohol/caffeine
• sleep apnea
• parasomnias
• psychiatric disorders

Question 8

Risk factors for elder abuse

Answer 8

dementia, shared living situation, caregiver substance abuse or mental illness, heavy dependence of caregiver on elder, social isolation of the elder form other people

Question 9

Studies for insomnia, fatigue, depression

Answer 9

CMP, TSH, CBC, ESR, EKG

Question 10

Management of insomnia

Answer 10

1. behavioral treatments - CBT-I (sleep restriction or sleep compression therapy)
2. Pharm treatment - ambien and melatonin are the safest and most effective
3. Combination therapy - CBT + pharm

Question 11

Management of MDD

Answer 11

• first line treatment SSRI
• along with psychotherapy and exercise
• avoid recreational drugs and excess alcohol
• try alternative therapies like herbs or supplements
• assess suicidality