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
