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Flashcards in Geriatric Psychiatry Deck (23)
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1

how do we approach meds with old ppl?

-start low, go slow

2

If we see depression in old people, what do we think of?

-pseudodementia

3

when do we see inappropriate behavior?

-frontotemporal dementia

4

what do we have to keep in mind with the tx of dementia in the elderly?

-avoid anticholinergic medications which can impair cognitive function, ESPECIALLY IN ELDERLY

5

Which drugs could we use for dementia?

-donepezil (AchE inhibitor)
-MEmantine (NMDA antagonist)

6

What drug do we want to avoid?

-benedryl and hydroxyzine

7

He said that Diphenhydramine will be on his test, wtf is that?

-it's an antihistamine used to treat allergies!!! kinda like benedryl!!
-so we want to avoid the shit out of this drug in the elderly dementia pts

8

What are the black box warning things with antipsychotic medications?

-increased mortality
-Olanzapine
-Aripiprazole
-Risperidone
-quitiapine

9

Psychosis due to delirium?

-third most common cause of psychosis in elderly outpatients
-thought disturbance with themes that tend to be from the current environment and situations, with poverty of thinking and irrationality, and with hallucinations

10

Psychosis due to major depressive disorder

-second most common diagnosis in elderly outpatients, accounting for most psychosis in this population

11

psychosis due to alzheimer's type dementia

-the most common diagnosis accounting for psychosis in elderly outpatients

12

What do we still need to have a high index of suspicion even in old ppl?

-substance abuse

13

What is the usually the answer when they are asking for treatment for these disorders?

-CBT
-cognitive behavioral therapy

14

What are the major depression criteria?

-Anhedonia or depressed mood for 2 weeks and 4 or more of the following
-feelings of wothlessness or guilt
-decreased ability to concentrate
-fatigue
-psychomotor agitation
-insomnia or hypersomnolence
-weight or appetite changes
-recurrent thoughts of suicide or death

15

How do differentiate between dementia and depression in the elderly population?

-mental status exam.... focus on the pt's INSIGHT
-Depressed patients WILL often have INSIGHT, though little effort
-Dementia pts will have LITTLE/NO INSIGHT

16

Tx for depression in elderly?

-CBT

17

How long is the initial anti-depressant trial?

-4-6 weeks

18

SSRI cautions

-serotonin syndrome, may increase falls, GI effects, insomnia, agitation

19

Mirtazapine

-Also increases APPETITE

20

Venlafaxine and duloxetine (SNRIs)

-often used with comorbid PAIN CONDITIONS

21

Trazodone

-use in low doses, caution of orthostatic effects
-promotes SLEEP

22

Bupropion caution

-may cause SEIZURES

23

TCA's

-nortriptyline
-Use caution in your cardiac pts