ABPN Geriatric Psychiatry flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Delirium diagnostic core

Acute onset with fluctuating course and inattention, plus either disorganized thinking or altered level of consciousness, developing over hours to days.

Lewy body dementia features

Fluctuating cognition, recurrent well-formed visual hallucinations, spontaneous parkinsonism, and REM sleep behavior disorder; antipsychotic sensitivity is common.

Normal-pressure hydrocephalus triad

Gait apraxia, urinary incontinence, and cognitive impairment, often with ventriculomegaly out of proportion to atrophy; shunt response is variable.

Frontotemporal dementia presentation

Onset typically in the 50s-60s with behavioral disinhibition, apathy, or progressive language deficits; episodic memory is relatively preserved early.

Vascular dementia pattern

Stepwise cognitive decline with focal neurologic findings and imaging evidence of infarcts or white matter disease; cerebrovascular risk factor control is central.

Pseudodementia

Cognitive complaints accompanying depression in older adults that improve with depression treatment; late-life depression with cognitive impairment raises dementia risk.

Anticholinergic burden risk

Cumulative anticholinergic medications contribute to delirium, falls, constipation, and urinary retention in older adults; review and deprescribe where possible.

Elderly suicide epidemiology

Older adults, particularly white men, have the highest suicide rate; presentations may emphasize somatic complaints rather than expressed suicidal ideation.

Dementia prevalence by age

Prevalence approximately doubles every five years after age 65; Alzheimer disease accounts for 60-80% of cases.

Behavioral variant FTD

Predominant early personality change, disinhibition, loss of empathy, and compulsive behaviors with relatively preserved memory and visuospatial skills.

Primary progressive aphasia

Neurodegenerative language disorder with word-finding difficulty or impaired comprehension early, while other cognitive domains remain relatively intact initially.

Delirium prevention bundle

Multicomponent nonpharmacologic measures: orientation, sleep hygiene, early mobilization, hydration, pain control, sensory aids, and minimizing tethers and restraints.

Caregiver burden assessment

Screening caregivers for depression, burnout, and safety concerns improves outcomes; caregiver distress predicts institutionalization and elder mistreatment risk.

Driving capacity in dementia

Dementia increases crash risk; assessment includes caregiver report, office cognitive testing, and formal driving evaluation rather than relying on a single test.

Capacity determination elements

Decision-specific abilities: understanding relevant information, appreciating consequences, reasoning about options, and expressing a consistent choice.

Elder mistreatment screening

Ask directly about physical, emotional, financial, and sexual abuse and neglect; mandatory reporting laws vary by jurisdiction.

Major depressive episode criteria

Five or more symptoms for at least two weeks, including depressed mood or anhedonia, causing impairment; older adults often present with somatic or cognitive complaints.

Serotonin syndrome triad

Mental status change, autonomic instability, and neuromuscular hyperactivity such as clonus and hyperreflexia; onset is usually within 24 hours of a serotonergic change.

Neuroleptic malignant syndrome

Rigidity, hyperthermia, autonomic instability, and elevated creatine kinase developing over days after dopamine antagonist exposure; treatment is drug withdrawal and supportive care.

Tardive dyskinesia management

Persistent involuntary orofacial and limb movements after antipsychotic exposure; VMAT2 inhibitors such as valbenazine and deutetrabenazine are first-line treatments.

SSRI hyponatremia risk

SIADH-related hyponatremia is most likely in the first weeks of SSRI treatment, especially in older adults with low body weight or diuretic use.

Citalopram QT limitation

Citalopram is restricted to 20 mg daily in adults over age 60 because of dose-dependent QTc prolongation; baseline and follow-up ECG may be warranted.

Lithium in older adults

Reduced renal clearance requires lower doses and careful monitoring; tremor, confusion, and ataxia may indicate toxicity even at levels within the usual range.

Benzodiazepine taper principle

Gradual dose reduction, often about 25% every two weeks, avoids withdrawal seizures and delirium; abrupt discontinuation after long-term use is unsafe.

Bipolar mania criteria

Distinct period of elevated or irritable mood with increased energy lasting at least one week, plus symptoms such as grandiosity, decreased sleep need, and pressured speech.

Late-onset bipolar disorder

First manic episode after age 50 warrants evaluation for secondary causes including stroke, medications, and neurologic or endocrine disease.

Alcohol withdrawal timeline

Tremor and autonomic symptoms begin 6-24 hours after last drink; withdrawal seizures occur at 12-48 hours; delirium tremens peaks at 48-96 hours.

Antipsychotic use in dementia

Use only for severe agitation or psychosis after nonpharmacologic measures fail; carry a black-box warning for increased mortality in older adults with dementia.

TCA cardiac risk

Tricyclics cause orthostatic hypotension, conduction delay, and anticholinergic effects; they are generally avoided in older adults when safer alternatives exist.

MAOI tyramine interaction

MAO inhibitors combined with tyramine-rich foods or sympathomimetics can precipitate hypertensive crisis; washout periods are required when switching agents.

ECT indications in elderly

Effective for severe or treatment-resistant depression, psychotic depression, catatonia, and life-threatening refusal of food or fluids; cognitive side effects are usually transient.

Anxiety disorders in late life

Generalized anxiety and phobic disorders are common and often comorbid with depression; SSRIs are first-line, with psychotherapy as an effective alternative or adjunct.