CC Nov 2015 Geriatric depression

echoecho's version from 2015-11-09 13:42


Question Answer
Are diagnostic criteria for depression the same in the elderly as in the general population?yes
An estimated ____% of geriatric patients (ages > 65 years) seen by primary care clinicians have clinically significant depression?10
List the 4 risk factors for depression in the geriatric population?1) chronic medical condition 2) functional decline 3) social isolation 4) loss of a spouse
Why is depression underreported by elderly patients?they mistakenly believe that depression is a normal part of aging
List 5 consequences of untreated depression?1) poor quality of life 2) difficulty with social and physical functioning 3) poor adherence to treatment 4) worsening of chronic medical conditions 5) increased rates of morbidity and mortality due to suicide
What questionnair is a useful tool for depression screening in the primary care setting?the Patient Health Questionnaire-2 (PHQ-2)
List the 2 questions the are part of the Patient Health Questionnaire-2 (PHQ-2)? A positive screen is what answer to the 2 questions?1) in the previous 2 weeks have you had depressed mood? 2) in the previous 2 weeks have you lost interest in pleasurable activities (anhedonia)? 3)a "yes" answer to either question
In the geriatric population, the PHQ-2 has a sensitivity of ____%, a specificity of ____% and a positive predictive valuve of ____%?100%; 77%; 14%
*** The USPSTF recommends screening adults (including geriatric patients) for depression when staff-assisted depression care supports are in place to assure what?accurate diagnosis, effective treatment and follow-up
Patients with a positive screen should be assessed with a more extensive questionnaire such as what?PHQ-9
Patients should be asked about episodes of ______, which may suggest bipolar disorder?mania
Further screening with what questionnaire is warranted if bipolar disorder is suspected?Mood Disorder Questionnaire
List 4 medication classes that may mimic or exacerbate depression and should be discontinued if possible?1) beta blockers 2) PPIs 3) corticosteroids 4) estrogens
Is routine blood work needed to diagnose depression?no
In older adults, do psychotherapy and medications produce roughly similar remission rates?yes
Psychotherapy, including what 2 types of psychotherapy is associated with significant improvement (defined as > 50% reduction of symptoms) in 45-70% of geriatric patients, compared to 25-35% of controls?1) CBT (cognitive behavioral therapy) 2) interpersonal psychotherapy
What group of medications are the most commonly prescribed antidepressants in the elderly population?SSRIs
List 5 SSRIs commonly prescribed for this elderly population?1) fluoxetine (Prozac) 2) sertraline (Zoloft) 3) paroxetine (Paxil) 4) citalopram (Celexa) 5) estcitalopram (Lexapro)
List the side effects of SSRIs?1) nausea 2) dyspepsia 3) insomnia 4) anorexia
List 2 SNRIs (serotonin-norepinephrine reuptake inhibitors) that may have the added benefit of reducing symptoms of neuropathic pain?1) venlafaxine (Effexor) 2) duloxetine (Cymbalta)
Regarding SSRIs vs SNRIs, which may be better tolerated in frail elederly patients?SSRIs
What medication is associated with sedation and increased appetite at lower doses?mirtazapine (Remeron)
What is mirtazapine (Remeron) useful for?1) insomnia 2) anorexia
What medication is helpful in patients with psychomotor retardation but can't be given to patients with a hx of seizures?bupropion (Wellbutrin)
Neither bupropion nor mirtazapine is associated with what significant side effect?sexual
What medication can be used as a sleep aid, but sedation limits use as a first-line therapy?trazodone (Desyrel)
What group of medications, while clinically as effective as the SSRIs, have significant side effects such as dry mouth, urinary retention, constipation, blurry vision and orthostatic hypertension which may be troublesome or dangerous to elderly patients?TCAs (tricyclic antidepressants)
Up to ___ weeks of therapy may be needed to ascertain the effectiveness of a particular agent?12
Comment on the way anti-depressant medication should be titrated for the elderly?start at low dosease adn titration occur gradually
Monotherapy is preferred, why?to reduce the risk of side effects
If patients do not respond to a particular medication, dowing what is reasonable?switching to a different medication
In general, patients who achieve remision should continue their medication for ___ to ___ months?6; 12
*** Patients who failre to respond to SSRIs or SNRIs may be candidates for what therapy?ECT (electroconvulsive therapy)
Are indications for ECT in persons > 75 years of age similar to those in younger patients?yes
Efficacy rates range from ____% to ___%?60; 80
List the indications for ECT (electroconvulsive therapy) as treatment of choice?1) patients with suicidality 2) those who refuse food 3) those who have psychosis 4) those who have catatonia
Favorable response to ECT in the past also is an argument for use of ECT, true or false?true
Why is a careful preprocedural evaluation indicated?to identify medical or other conditions that may increase risk
What conditions should be explored in evaluating for ECT?1) medications used 2) past experience with anesthesia 3) any cardiac, pulmonary or neurologic history
Patients with a hx of what would warrant preprocedure risk stratification by a cardiac or pulmonary specialist?1) MI 2) CVA 3) seizure 4) smoking 5) valvular heart disease 6) angina 7) diabetes
What work-up prior to using ECT is recommended?1) CXR 2) EKG 3) metabolic panel 4) lytes 5) CBC 6) UA
What exam should be performed prior to the first ECT treatment?a Folstein mini-mental state exam
What common side effects of ECT?1) headache 2) temporary short-term memory loss
Pharmacotherapy is often given to patients after successful ECT for ___ to ___ months to increase remission rates?6; 12
*** SUMMARY = Diagnostic criteria for depression are the same in the elderly as in the general population, true or false?true
*** SUMMARY = Why is depression underreported in the geriatric population?because many elderly patients mistakenly believe that depression is a normal part of aging
*** SUMMARY = In older adults, what 2 therapies produce roughly similar remission rates?1) psychotherapy 2) medications
*** SUMMARY = What therapy is an option in an elderly patients with depression not responsive to other interventions?ECT (electroconvulsive therapy)