Flashcards in Geriatric Psychiatry Deck (23)
how do we approach meds with old ppl?
-start low, go slow
If we see depression in old people, what do we think of?
when do we see inappropriate behavior?
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
Which drugs could we use for dementia?
-donepezil (AchE inhibitor)
-MEmantine (NMDA antagonist)
What drug do we want to avoid?
-benedryl and hydroxyzine
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
What are the black box warning things with antipsychotic medications?
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
Psychosis due to major depressive disorder
-second most common diagnosis in elderly outpatients, accounting for most psychosis in this population
psychosis due to alzheimer's type dementia
-the most common diagnosis accounting for psychosis in elderly outpatients
What do we still need to have a high index of suspicion even in old ppl?
What is the usually the answer when they are asking for treatment for these disorders?
-cognitive behavioral therapy
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
-insomnia or hypersomnolence
-weight or appetite changes
-recurrent thoughts of suicide or death
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
Tx for depression in elderly?
How long is the initial anti-depressant trial?
-serotonin syndrome, may increase falls, GI effects, insomnia, agitation
-Also increases APPETITE
Venlafaxine and duloxetine (SNRIs)
-often used with comorbid PAIN CONDITIONS
-use in low doses, caution of orthostatic effects
-may cause SEIZURES