Geriatric Psychiatry (Hill) Flashcards Preview

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Flashcards in Geriatric Psychiatry (Hill) Deck (12)
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1

Geriatric pts under-report what?
Purpose of tx?
Meds?

Elderly pts often fail to recognize and/or fail to report s/s of "aging"

Emphasis on palliative care instead of "living longer"

Meds-always start low and go slow

2

Various symptoms of dementia?

Depression --> pseudodementia
memory loss
communication
difficulty w/performing tasks, organization, coordination
problems with disorientation (get lost)
personality changes
inappropriate behavior (esp Frontotemporal dementia)
psychotic symptoms
agitation

3

Most important component for evaluating dementia in elderly?

H and P most important --> onset, character (type/manner of cognitive deficits)

4

Avoid Rx what in elderly with dementia?

Avoid anticholinergic meds which can impair cognitive function, ESP IN ELDERLY (Benadryl, hydroxyzine)

5

Black box warning with Olanzapine (zyprexa), aripiprazole (abilify), risperidone (risperdal), or quetiapine (seroqeul) for elderly with dementia?

Antipsychotic meds associated with increased mortality
-1.6-1.7-fold increase in mortality
-Most either d/t heart-related events (heart failure, sudden death) or Infx (mostly pneumonia)

6

This is the 3rd most common cause of psychosis in elderly outpatients

Delirium

7

This condition accounts for most psychoses in elderly

Psychosis d/t Major Depressive Disorder w/ Psychotic features--> 2nd most common dx in elderly outpatients

8

This is most common dx accounting for psychosis in elderly outpatients

Psychosis d/t Alzheimers type dementia

often of a paranoid nature --> thinks items being stolen from them, being abandoned, spouse cheating

9

Can't go cold turkey with intense and chronic etoh abuse d/t ?

possible DT's and death

Med example: Benzo's (i.e., valium/Diazepam taper)

10

Major depression criteria for dx depression in elderly?

Anhedonia or Depressed mood for 2 weeks and 4 or more of:
-Feelings of worthlessness/guilt
-Decreased ability to concentrate
-Fatigue
-Psychomotor agitation
-Insomnia or hypersomnolence
-weight or appetite changes
-recurrent thoughts of suicide/death

11

How do you differentiate between DEMENTIA and DEPRESION in elderly?

Mental status exam--> focus on INSIGHT
Depressed --> WILL often have INSIGHT, though little effort
Dementia --> LITTLE/NO INSIGHT

12

High yield pharm for boards (maybe exam?):
SSRIs=__
Mirtazapine=__
Venlafaxine and Duloxetine (SNRIs)=__
Trazodone=__
Bupropion=__
TCAs=__

SSRIs=5HT syndrome, increase falls, GI, insomnia, agitate

Mirtazapine=Increase appetite

SNRIs=Often used with comorbid PAIN CONDITIONS

Trazodone=Low dose, caution of orthostasis, promotes sleep, boners

Bupropion=seizures

TCAs=caution in cardiac pts