ch 28 - mental health

Question 1

most prevalent mental health problems in older population (3)

Answer 1

• anxiety
• severe cognitive impairment
• mood disorders

Question 2

what criteria does it take for a stressor to be considered a crisis (3)

Answer 2

• event occurs abruptly
• event is unanticipated
• event requires skills/resources pt doesnt possess

Question 3

assessment tools for mental health in older adults (3)

Answer 3

• cultural formation interview in DSM5
• geriatric depression scale
• mini cog

Question 4

interventions for reducing stress in older adults (3)

Answer 4

• reminiscing
• enhancing coping skills (meditation, yoga, exercise, spirituality)
• mind body therapies

Question 5

comorbidities with anxiety in later life (3)

Answer 5

• MDD
• cognitive decline, dementia
• substance abuse

Question 6

RF anxiety disorders

Answer 6

• frailty
• medical illness
• loss
• pain
• lack of social support
• traumatic events
• meds
• psych illness

Question 7

meds that could cause anxiety S+S

Answer 7

• anticholinergics
• digitalis
• theophylline
• antiHTNs
• b blockers
• corticosteroids
• OTC (cough suppressants, cold preparations)
• caffeine
• nicotine

Question 8

med Tx anxiety

Answer 8

• first line: SSRIs

- short acting benzos

Question 9

non med Tx anxiety

Answer 9

• cognitive behavioral therapy
• exposure therapy
• interpersonal therapy

Question 10

meds that could cause depression S+S

Answer 10

• antiHTNs
• ACE inhibitors
• methyldopa
• antiarrhythmics
• anticholesteremics
• antibiotics
• analgesics
• corticosteroids
• digoxin
• levodopa

Question 11

RF depression in older adults

Answer 11

• chronic illness, disability
• alzheimers and dementias
• bereavement
• caregiving
• female
• admission to long term care
• meds
• alcohol/substance abuse
• loss

Question 12

somatic complains with older adults experiencing depression (4)

Answer 12

• insomnia
• loss of appetite, weight loss
• memory loss
• chronic pain

Question 13

age related changes that contribute to higher blood alcohol level

Answer 13

• increased body fat, decreased lean muscle mass
• decreased liver function
• decreased kidney function
• decreased gastric enzyme

Question 14

alcohol use screening tool for older adults

Answer 14

short michigan alcoholism screening test

Question 15

warning S+S suicide (IS PATH WARM)

Answer 15

Ideation
Substance abuse

Purposelessness
Anxiety
Trapped
Hopelessness

Withdrawal, social
Anger
Recklessness
Mood changes

Question 16

intervention for pts at high risk for suicide

Answer 16

hospitalization

Question 17

intervention for pts at moderate risk for suicide

Answer 17

outpatient care

Question 18

intervention for pts at low risk for suicide

Answer 18

full psych eval and careful monitoring

Question 19

PTSD (TRAUMA)

Answer 19

Traumatic event
Re-experiencing
Arousal
Unable to control
Month or more
Avoidance

Question 20

assessment tool PTSD

Answer 20

impact of event scale (IES)

Question 21

Tx PTSD in older adults

Answer 21

• cognitive behavioral therapy
• prolonged exposure therapy
• exercise
• psychospiritual interventions
• anxiolytics

Question 22

early sign of alzheimers (about 20 months before Dx)

Answer 22

paranoia

Question 23

precipitating factors paranoia

Answer 23

• meds
• vision/hearing loss
• social isolation
• alcoholism
• depression
• negative life events
• financial strain
• PTSD

Question 24

Beliefs that guide interpretation of events and helps one make sense out of what is going on – inconsistent with
reality
-can be comforting or threatening
-month +

Answer 24

delusions

Question 25

common delusions in older adults

Answer 25

- poisoning - being robbed - children taking assets - being deceived by spouse (fear and lack of trust common)

Question 26

Sensory perceptions that occur in absence of external stimuli

Answer 26

hallucination

Question 27

Tx hallucinations

Answer 27

- reassurance - reduce stimuli - trusting relationship - listen - antipsychotics

Question 28

related illnesses that can occur with hallucinations

Answer 28

- dementia - delirium - parkinsons - hearing/vision loss

Question 29

spanish term for latin american expression of stress, usually with accident/death of family member -intense emotional upset

Answer 29

attack of nerves

Question 30

latino expression for distress and misfortune - S+S similar to PTSD, anxiety and depression - soul leaves body during frightening event causing illness

Answer 30

fright

Question 31

combodian phrase for attack brought on by worrisome thoughts - S+S similar to PTSD, anxiety and depression - believe that wind substance rising in body causing sob, dizziness, tinnitus, fainting, cold extremities

Answer 31

wind attacks

Question 32

2 benzos that should be avoided in older adults

Answer 32

- diazepam | - chlordiazepoxide

Question 33

risk using benzos in older adults

Answer 33

- fall risk | - cognitive impairment

Question 34

risk of using 1st gen antipsychotics in schizophrenic older adults

Answer 34

risk of persistent side effects (tardive dyskinesia)

Question 35

what is blackbox warning for 2nd gen antipsychotics for pt with older adults

Answer 35

dont give to someone with dementia-related psychosis | increased risk of death

Question 36

what extra assessment is needed with admin of anticonvulsants

Answer 36

higher risk suicide

Question 37

meds that interact with alcohol

Answer 37

- analgesics - antibiotics - antidepressants - antipsychotics - benzos - H2 blockers - NSAIDs - herbal meds - acetaminophen

Question 38

why is disulfiram avoided in older adults

Answer 38

risk of cardiovascular adverse effects