pscyh geriatric

Question 1

factors assoc with normal aging

Answer 1

decr brain weight (enlarged ventricles and sulci); decreased muscle mass and incr fat; impaired vision and hearing; minor forgetfulness

Question 2

pseudodementia

Answer 2

presence of apparent cognitive deficits in patients with major depression

Question 3

treatment for pseudodepression

Answer 3

supportive psychotherapy; low dose antidepressant; methylphenidate; ECT

Question 4

if using TCAs inelderly patients, which is favored?

Answer 4

nortryptiline because it has the fewest anticholinergic side effects

Question 5

mirtazapine

Answer 5

antidepressant that can increase appetite and is also sedating; often dosed at bedtime for depressed patients who also suffer from decr appetite and sleep disturbances

Question 6

methylphenidate in pseudodementia

Answer 6

can be used at low doses as an adjunct to antidepressants for patients with psychomotor retardation; but can cause insomna; arrythmia risks in cardiac patients

Question 7

ECT in pseudodementia

Answer 7

may be used in place of antidepressant (safe and effective in the elderly)

Question 8

five stages of grief

Answer 8

DABDA; denial, anger, bargaining, depression, acceptance

Question 9

normal grief

Answer 9

feelings generally abate within 6 mos of the loss, and the patient’s ability to function appropriately in their life is preserved

Question 10

complicated/prolonged grief

Answer 10

persists for greater than 6 mos and includes at least 4 of the eight cardinal features

Question 11

cardinal features of complicated/prolonged grief

Answer 11

difficulty moving on with life; numbness/detachment; bitterness; feeling that life is empty; trouble accepting the loss; feeling the future holds no meaning; agitation; difficulty trusting others since the loss

Question 12

bereavement-assoc depression

Answer 12

essentially major depression that began with a concrete death or loss in the patient’s life

Question 13

how to differentiate between bereavment-assoc depression and complicated grief

Answer 13

in depression, the patient has generalized feelings of hopelessness, helplessness, severe guilt, and worthlessness and SI, in addition to complicated grief sx

Question 14

age related affects of alcohol

Answer 14

decreased alc dehydrogenase leads to higher BAL; increased CNS sensitivity to alc; alcohol-medication interaction

Question 15

result of use of H2 blockers and alcohol

Answer 15

higher BAL

Question 16

result of use of alc with benzos, TCAs, narcotics, barbiturates, or antihistamines

Answer 16

increased sedation

Question 17

aspirin, or NSAIDs with alcohol

Answer 17

prolonged bleeding time and irritation of gastric lining

Question 18

metronidazole, sulfonamides, long acting hypoglycemics with alcohol

Answer 18

nausea and vomitting

Question 19

reserpine, nitroglycerin, hydralazine with alcohol

Answer 19

increased risk of hypotension

Question 20

acetominophen, isoniazid, or phenybutazone with alc

Answer 20

increased hepatotoxicity

Question 21

antihypertensives, antidiabetics, ulcer drugs, gout meds with alc

Answer 21

worsen underlying disease

Question 22

hallucinations in dementia

Answer 22

usually visual

Question 23

treatment for psych symptoms in dementia patients

Answer 23

try non-pharm therapies first; if antipsychotics are necessary, try olanzapine (Zyprexa) or quetiapine (Seroquel) in patients with severe sx;can also use short-erm haloperidol or risperidone

Question 24

mood stabilizers to use in elderly dementia patients for psych sx

Answer 24

valproic acid, carbamazepine, and lamotrigine

Question 25

sedative-hypnotic drugs are more likely to cause side effects when used by the elderly

Answer 25

right

Question 26

REM sleep in geriatric patients

Answer 26

decreaed REM latency and decreased total REM

Question 27

Non-REM sleep in the elderly

Answer 27

increased stage 1 and 2 sleep; decreaed amount of stage 3 and 4 sleep (deep sleep)

Question 28

sleep efficiency in the elderly

Answer 28

decreased efficiency (frequent nocturnal awakenings)

Question 29

amount of total sleep in the elderly

Answer 29

decreased

Question 30

sleep cycle in the elderly

Answer 30

advances (earlier to bed, earlier to rise)

Question 31

if sedative-hypnotics must be prescribed, meds like hydroxyzine (Vistaril) or trazadone are safer than the more sedating benzos

Answer 31

right

Question 32

hydroxyzine

Answer 32

Vistaril; antihistamine

Question 33

white elderly males have the highest rate of successful suicides

Answer 33

key word is successful

Question 34

VH early in dementia suggest a dx of dementia with Lewy bodies

Answer 34

so do not give these patients antipsychotics