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GERIATRIC
PSYCHIATRY
BY: WESTERN UNIVERSITY OF HEALTH SCIENCES.
GERIATRIC
PSYCHIATRY
What is Geriatric?
- (^) Physical, mental and social aspects
- (^) Mental disorders in general
- (^) Different disorders in the elderly
- (^) Psychiatric therapies in the elderly
GETTING OLDER VS. LIVING LONGER
- (^) Mental changes
- (^) Personality
- (^) amplification of character traits
- (^) Cognition, memory
- (^) mental slowing
- (^) transformed memory structure
- (^) summerised experiences
- (^) Emotional changes
GETTING OLDER VS. LIVING LONGER
- (^) Social changes
- (^) Retirement (financial difficulties)
- Decrease in social status
- (^) Facing somatic and mental disfunctioning
- (^) Somatic diseases
- (^) Grief (loss of spouse, brothers or sisters, friends)
- (^) Social isolation
- Moving to nursing/residential home
MENTAL DISORDERS IN THE ELDERLY
- (^) Dementia
- (^) Other „organic mental disorders”
- (^) Affective disorders (depression)
- (^) Delirium
- (^) Delusional disorders (psychosis)
- Anxiety disorders
- (^) Substance abuse disorders
- (^) Psychiatric patients getting old (previved self vs. actual self).
DEMENTIA - SYNDROMATOLOGY
- (^) Chronic course (10% above 65 y/o, 16-25% above 85 y/o)
- (^) Multiple cognitive deficits including memory impairment (intelligence, learning, language, orientation, perception, attention, judgement, problem solving, social functioning)
- (^) No impairment of consciousness
- (^) Behavioural and psychological symptoms of dementia (BPSD)
- (^) Progressive - static
- Reversible (15%) - irreversible
DEMENTIA -ETIOLOGY
- (^) Alzheimers disease (60-70%)
- (^) Vascular dementia (10-20%)
- (^) Neurodegenerative disorders
- (^) (Pick, Lewy body dis, Parkinson, Huntington, etc.)
- (^) Drugs and toxins
- Intracranial masses
- (^) Anoxia
- (^) Trauma
- (^) Infections (JCD, HIV, etc)
- (^) Nutrition
- (^) Metabolic
- (^) Pseudodementia
AFFECTIVE DISORDERS (DEPRESSION)
- (^) Major depression prevalence: 10-16% (hospital, residential homes)
- (^) Minor depression: 47-53 %
- (^) Dysthymic disorder
- (^) Suicide in elderly
- (^) 2-3x average over 65
- (^) Major depression in 80%
DELUSIONAL DISORDERS (PSYCHOSES)
- (^) Late onset schizophrenia (over 40 y)
- (^) Very late onset schizophreniform disorder (over 60 y)
- (^) Other delusional disorders
- (^) Organic delusional disorder
- (^) Delusional symptoms of dementia (BPSD)
- (^) Multiple etiology, multiple syndromatology (schizophreniform, persecutory, hallucinosis, coenaesthesias, etc.)
Psychosocial factors Causes of delusional disorder in the elderly Personality „Endogenous” origin Organic (CNS) background Sensory impairment Other biological factors
PSYCHIATRIC DISORDERS CONTINUED
- (^) Schizophrenia / bipolar disorder
- (^) Personality disorder
- (^) Neurotic disorders
- (^) anxiety, somatoform, etc.
- (^) Changes in clinical picture, therapeutical response, etc.
- (^) Bio-psycho-social changes
- (^) Multidimensional approach
SUBSTANCE ABUSE IN THE ELDERLY
- (^) Alcohol/medication abuse
- (^) Common comorbidity
- (^) Somatic
- (^) Psychiatric (anxiety, depression, etc.)
PHARMACOTHERAPY
- (^) Aspects of pharmacotherapy
- (^) Mental status, neurological/somatic status
- (^) Social status (affordability of treatment).
- Etiology
- (^) Special aspects
- Polimorbidity
- (^) Pharmacokinetics (interactions)
- (^) Dosage (low & Slow)
- (^) BEERS Criteria
- (^) Side effects (cognitive, other)
RESOURCES
- (^) https://geriatricscareonline.org/
- (^) https://www.aagponline.org/