Geriatric Psychiatry

Question 1

how do we approach meds with old ppl?

Answer 1

-start low, go slow

Question 2

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

Answer 2

-pseudodementia

Question 3

when do we see inappropriate behavior?

Answer 3

-frontotemporal dementia

Question 4

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

Answer 4

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

Question 5

Which drugs could we use for dementia?

Answer 5

• donepezil (AchE inhibitor)

- MEmantine (NMDA antagonist)

Question 6

What drug do we want to avoid?

Answer 6

-benedryl and hydroxyzine

Question 7

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

Answer 7

• 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

Question 8

What are the black box warning things with antipsychotic medications?

Answer 8

• increased mortality
• Olanzapine
• Aripiprazole
• Risperidone
• quitiapine

Question 9

Psychosis due to delirium?

Answer 9

• 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

Question 10

Psychosis due to major depressive disorder

Answer 10

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

Question 11

psychosis due to alzheimer’s type dementia

Answer 11

-the most common diagnosis accounting for psychosis in elderly outpatients

Question 12

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

Answer 12

-substance abuse

Question 13

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

Answer 13

• CBT

- cognitive behavioral therapy

Question 14

What are the major depression criteria?

Answer 14

• 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

Question 15

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

Answer 15

• 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

Question 16

Tx for depression in elderly?

Answer 16

-CBT

Question 17

How long is the initial anti-depressant trial?

Answer 17

-4-6 weeks

Question 18

SSRI cautions

Answer 18

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

Question 19

Mirtazapine

Answer 19

-Also increases APPETITE

Question 20

Venlafaxine and duloxetine (SNRIs)

Answer 20

-often used with comorbid PAIN CONDITIONS

Question 21

Trazodone

Answer 21

• use in low doses, caution of orthostatic effects

- promotes SLEEP

Question 22

Bupropion caution

Answer 22

-may cause SEIZURES

Question 23

TCA’s

Answer 23

• nortriptyline

- Use caution in your cardiac pts