Geriatric Psychiatry Flashcards
1
Q
What are some factors associated with normal aging?
A
- Decreased muscle mass/increased fat
- Decreased brain weight/enlarged ventricles & sulci
- Impaired vision & hearing
- Minor forgetfulness (benign senescent forgetfulness)
2
Q
What are the normal emotional responses when facing death or loss of a body part?
A
Stages can occur in any order or be simultaneous
- Denial
- Anger (blaming others for illness)
- Bargaining (“I’ll never smoke/drink again if my cancer is cured”)
- Depression
- Acceptance
3
Q
How does major depression present in the geriatric population?
A
- Common mental disorder in geriatrics
- Elderly 2x as likely to commit suicide
- Depressive symptoms in 15% of nursing home residents
- Problems w/ memory & cognitive functioning
- Pseudodementia
4
Q
What is pseudodementia?
A
- Presence of apparent cognitive deficits in patients w/ major depression
- Patients may appear demented
- Symptoms only secondary to their underlying depression
- Difficult to differentiate
5
Q
Reaction to not knowing an answer:
demented patients vs. depressed patients
A
-
Demented patients
- More likely to confabulate
-
Depressed patients
- Will just say they don’t know
- If pressed, will often give the correct one
6
Q
What are the clinical manifestations of psuedodementia?
A
- Depressed elderly pts often present with physical symptoms (stomach pain) or memory loss associated with pseudodementia
-
Depressive symptoms
- Sleep disturbances (early morning awakenings)
- Decreased appetite & weight loss
- Feelings of worthlessness & suicidal ideation
- Lack of energy & diminished interest in activities
7
Q
Dementia vs. Pseudodementia (Depression)
- Onset
- Patient personality
- Sundowning?
- Answers
- Awareness
A
-
Dementia
- Onset is insidiuos
- Pt delights in accomplishments
- Sundowning common (increased confusion at night)
- Will guess at answers (confabulate)
- Pt unaware of problems
-
Pseudodementia (Depression)
- Onset is more acute
- Pt emphasizes failures
- Sundowning uncommon
- Often answers “I don’t know”
- Pt is aware of problems
8
Q
How is pseudodementia treated?
A
- Supportive psychotherapy
- Psychodynamic psychotherapy if indicated
- Low-dose antidepressant medications
- SSRIs >> MAOIs
- Electroconvulsive therapy may be used in place of medication (safe & effective in the elderly)
- Mirtazapine can potentially increase appetite; also sedating (good for insomnia)
- Methylphenidate (low doses) can be used as an adjunct to antidepressants for pts w/ psychomotor retardation; don’t give in late afternoon/evening b/c it can cause insomnia
9
Q
What does normal grief include?
A
- Feelings of guilt & sadness
- Mild sleep disturbance & weight loss
- Illusions
- Briefly seeing the deceased person or hearing his/her voice; culturally related
- Attempts to resume daily activities/work
- Symptoms that resolve w/i 1 year
- Worst symptoms w/i 2 mo
10
Q
What does abnormal grief (major depression) include?
A
- Feelings of severe guilt & worthlessness
- Significant sleep disturbance & weight loss
- Hallucinations or delusions
- No attempt to resume activities
- Suicidal ideation
- Symptoms persist more than 1 year
- Worst symptoms >2 mo
11
Q
What is the incidence of sleep disorders?
What do elderly people report?
What are causes of sleep disturbances?
A
- Incidence of sleep disorders increases w/ aging
- Elderly people report difficulty sleeping, daytime drowsiness, daytime napping
- Causes
- General medical conditions
- Environment
- Medications
- Normal changes associated w/ aging
12
Q
How does REM sleep change with aging?
A
- Increased number of REM episodes throughout the night
- Episodes redistributed throughout the sleep cycle & shorter than normal
- Total amt of REM sleep remains the same
13
Q
How does non-REM sleep change with aging?
A
- Increased amt of stage 1 & 2 sleep with a decrease in stage 3 & 4 sleep (deep sleep)
- Increased awakening after sleep onset
14
Q
What are some causes of sleep disorders in the elderly?
A
- Primary sleep disorder
- Primary insomnia most common
- Nocturnal myoclonus, restless leg syndrome, sleep apnea
- Other mental disorders
- General medical conditions
- Social/environmental factors
- Alcohol consumption, lack of daily structure, etc.
15
Q
How are sleep disturbances in the elderly treated?
A
- Sedative-hypnotic drugs
- Hydroxyzine (Vistaril), zolpidem (Ambien)
- Side effects: memory impairment, ataxia, paradoxical excitement, rebound insomnia
- Alcohol cessation, increased structure of daily routine, elimination of daytime naps, treatment of underlying medical conditions
