Kk&s Ch.56 Geri Psych

Front 1

Top 3 GMC's in people over 45?

Back 1

Arthritis
Hypertension
Hearing Impairment

Front 2

Patients older than age 65 often have subjective complaints of minor memory impairments, such as forgetting persons' names and misplacing objects. Minor cognitive problems also can occur because of anxiety in the interview situation. These age-associated memory impairments are of no significance; the term ? has been used to describe them.

Back 2

benign senescent forgetfulness

Front 3

Condition?, the patient's understanding remains intact, but the ability to speak is impaired. The patient cannot pronounce “Methodist Episcopalian.”
Words are generally mispronounced and speech may be telegraphic

Back 3

In nonfluent or Broca's aphasia

Front 4

A simple test for ? is to point to some common objects—such as a pen or a pencil, a doorknob, and a light switch—and ask the patient to name them.

Back 4

Wernicke's aphasia

Front 5

The ? part of the WAIS-R is a more sensitive indicator of brain damage than the ? part.

Back 5

performance > sensitivity than verbal part

Front 6

The Geriatric Depression Scale is a useful screening instrument that excludes ? from its list of items. The presence of ? on a rating scale tends to confound the diagnosis of a depressive disorder.

Back 6

somatic complaints

Front 7

The National Institute of Mental Health's Epidemiologic Catchment Area (ECA) program has found that the most common mental disorders of old age are

Back 7

depressive disorders,
cognitive disorders,
phobias, and
alcohol use disorders

Front 8

Explain each test and category it tests:
Trailmaking Part B
Stroop C
Wisconsin Card Sorting Test
Verbal fluency (FAS and category):
Design fluency

Back 8

Executive functions
Trailmaking Part B: rapid alternation between tasks
Stroop C: inhibition of an overlearned response
Wisconsin Card Sorting Test: categorization and mental flexibility
Verbal fluency (FAS and category): rapid word generation
Design fluency: rapid generation of novel designs

Front 9

List tests of learning and memory

Back 9

An 8- to 10-item word list learning task: learning and recall of rote verbal information
Wechsler Memory Scale-Revised (WMS-R) or Wechsler Memory Scale-III (WMS-III)
Logical Memory subtest: immediate and delayed recall of paragraph information
Visual Reproduction subtest: immediate and delayed recall of visual designs
Rey-Osterrieth Complex Figure 3-minute delayed recall: delayed recall of complex design

Front 10

WAIS-R or WAIS-III Digit Symbol:
Trailmaking Part A:
Stroop A and B

Test what?

Back 10

Information processing speed

Front 11

Digit Span tests what?

Back 11

Basic Attention

Front 12

Several psychosocial risk factors also predispose older persons to mental disorders. These risk factors include

Back 12

loss of social roles,
loss of autonomy,
the deaths of friends and relatives,
declining health,
increased isolation,
financial constraints, and
decreased cognitive functioning.

Front 13

Only ? is a more common cause of DISABILITY among adults age 65 and older than dementia, a generally progressive and irreversible impairment of the intellect, the prevalence of which increases with age

Back 13

arthritis

Front 14

About ? percent of persons in the United States older than age 65 have severe dementia, and ? percent have mild dementia.

Back 14

5% severe
15% mild

Front 15

Of persons older than age 80, about ? percent have severe dementia

Back 15

20%

Front 16

Known risk factors for dementia are ???

Back 16

age, family history, and female sex.

Front 17

Delusions and hallucinations occur during the course of the dementias in nearly ? percent of patients.

Back 17

75%
most

Front 18

About ? percent of all patients who exhibit symptoms of dementia have potentially treatable conditions

Back 18

10 to 15%

Front 19

The ?(cortical or subcortical) dementias are associated with movement disorders, gait apraxia, psychomotor retardation, apathy, and akinetic mutism, which can be confused with catatonia

Back 19

subcortical

Front 20

A subcortical dementia occurs in ?????

Back 20

Huntington's disease, Parkinson's disease, normal pressure hydrocephalus, vascular dementia, and Wilson's disease.

Front 21

The cortical dementias occur in , which frequently manifest SX?

Back 21

dementias of the Alzheimer's type, Creutzfeldt-Jakob disease (CJD), and Pick's disease

aphasia, agnosia, and apraxia

Front 22

Human prion diseases result from coding mutations in the prion protein gene (PRNP) and may be inherited, acquired, or sporadic.

The inherited ones include? (and what type of inheritance)

Back 22

familial CJD,
Gerstmann-Sträussler-Scheinker syndrome, and
fatal familial insomnia.

These are inherited as autosomal-dominant mutations

Front 23

Acquired prior diseases?

Back 23

The acquired diseases include kuru and iatrogenic CJD

Front 24

? was an epidemic prion disease of the Fore people of Papua, New Guinea, caused by cannibalistic funeral rituals, which peaked in incidence in the 1950s

Back 24

Kuru

Front 25

? is rare and is caused, for example, by the use of contaminated dura mater and corneal grafts and treatment with human cadaveric pituitary-derived growth hormone and gonadotropin

Back 25

Iatrogenic CJD

Front 26

Sporadic CJD accounts for ? percent of the human prion diseases and occurs worldwide, with a uniform distribution and an incidence of about 1 in ? per annum, with a mean age at onset of ? years.

It is very rare in individuals under ? years of age?

Back 26

Sporadic CJD accounts for 85 percent of the human prion diseases and occurs worldwide, with a uniform distribution and an incidence of about 1 in 1 million per annum, with a mean age at onset of 65 years.
rare <30

Front 27

Categories of reversisble dementias?

Back 27

Substance
Psychiatric: Mood Anxiety Delusional
Metabolic/Endocrine
Misc: fecal impaction, hospitalization, impaired hearing or vision

Front 28

Depressive symptoms are present in about ? percent of all older adult community residents and nursing home patients.

Back 28

15%

Front 29

Age is a risk factor for the development of depression
True or False?

Back 29

False
it is NOT by itself
being widowed and having a chronic medical illness are associated with vulnerability to depressive disorders

Front 30

Late-onset depression is characterized by (low or high) rates of recurrence.

Back 30

high

Front 31

Older persons are particularly vulnerable to major depressive episodes with ? features

Back 31

melancholic

Front 32

features of melancholic depression in elderly?

Back 32

characterized by depression, hypochondriasis,
low self-esteem,
feelings of worthlessness, and
self-accusatory trends (especially about sex and sinfulness) with
paranoid and suicidal ideation

Front 33

Compare pseudodementia and dementia

Back 33

In true dementia, intellectual performance usually is global,
and impairment is consistently poor;

in pseudodementia, deficits in attention and concentration are variable.

Compared with patients who have true dementia, patients with pseudodementia are less likely to have language impairment and to confabulate;

when uncertain, they are more likely to say “I don't know”;

and their memory difficulties are more limited to free recall than to recognition on cued recall tests.

Front 34

Pseudodementia occurs in about ? percent of depressed older patients, and ? percent of patients with dementia are depressed

Back 34

Pseudodementia occurs in about 15 percent of depressed older patients

25 to 50 percent of patients with dementia are depressed

Front 35

(sex?) are more likely to have a late onset of schizophrenia than (sex?)

Back 35

women more likely than men

Front 36

A difference between early-onset and late-onset schizophrenia is the greater prevalence of ? schizophrenia in the late-onset type

Back 36

paranoid

Front 37

About ? percent of persons with schizophrenia show no active symptoms by age 65;
? percent show varying degrees of impairment. Psychopathology becomes (more or less) marked as patients age.

Back 37

About 20 percent of persons with schizophrenia show no active symptoms by age 65; 80 percent show varying degrees of impairment. Psychopathology becomes LESS marked as patients age.

Front 38

The residual type of schizophrenia occurs in about ? percent of persons with schizophrenia. Its signs and symptoms include ????. Delusions and hallucinations (are or are not)common. (few, some, most) persons with residual schizophrenia cannot care for themselves and long-term hospitalization is required.

Back 38

30%

emotional blunting, social withdrawal, eccentric behavior, and illogical thinking


Delusions and hallucinations are uncommon. Because most persons with residual schizophrenia cannot care for themselves, long-term hospitalization is required.

Front 39

Older persons with schizophrenic symptoms respond (poorly, well) to antipsychotic drugs

Back 39

well

Front 40

The age of onset of delusional disorder usually is between ages ?

Back 40

40 and 55

Front 41

In geriatric period, delusions can take many forms; the most common are ?

Back 41

persecutory—patients believe that they are being spied on, followed, poisoned, or harassed in some way

Front 42

Delusional disorder prognosis: poor, fair or good?
best results through what tx?

Back 42

The prognosis is fair to good in most cases
best results are achieved through a combination of psychotherapy and pharmacotherapy.

Front 43

A late-onset delusional disorder called ? is characterized by persecutory delusions. It develops over several years and is not associated with dementia. Some workers believe that the disorder is a variant of schizophrenia that first becomes manifest after age 60. Patients with a family history of schizophrenia show an increased rate of ?

Back 43

paraphrenia

Front 44

The ECA study determined that the 1-month prevalence of anxiety disorders in persons age 65 and older is? percent. By far the most common disorders are?

Back 44

5.5
phobias
(4 to 8 %)

Front 45

rate for geriatric panic ds?

Back 45

1%

Front 46

More than ? percent of persons over 65 years of age have at least one chronic disease—usually arthritis or cardiovascular problems. After age 75, ? percent have diabetes and an average of ? diagnosable chronic illnesses that require medical attention.

Back 46

More than 80 percent of persons over 65 years of age have at least one chronic disease—usually arthritis or cardiovascular problems. After age 75, 20 percent have diabetes and an average of four diagnosable chronic illnesses that require medical attention.

Front 47

Hypochondriasis is common in persons over 60 years of age, although the peak incidence is in those ? years of age.

The disorder usually is (short in duration or chronic), and the prognosis (guarded, fair, good)

Back 47

40 to 50
The disorder usually is chronic, and the prognosis guarded

Front 48

Of nursing home patients, ? percent have alcohol dependence

Back 48

20%

Front 49

Over all, alcohol and other substance use disorders account for ? percent of all emotional problems in older persons,

Back 49

10%

Front 50

The maintenance of chronically ill cancer patients with narcotics prescribed by a physician produces dependence.
The need to provide pain relief (does or does not) take precedence over the possibility of narcotic dependence

Back 50

the need to provide pain relief takes precedence over the possibility of narcotic dependence and is entirely justified

Front 51

Older persons may misuse over-the-counter substances, including nicotine and caffeine. Over-the-counter analgesics are used by ? percent of older persons and ? percent use laxatives. Unexplained gastrointestinal, psychological, and metabolic problems should alert clinicians to over-the-counter substance abuse

Back 51

35%

30%

Front 52

? is the single most important factor associated with the increased prevalence of sleep disorders

Back 52

Advanced age

Front 53

Sleep-related phenomena reported more frequently by older than by younger adults are ????

Back 53

sleeping problems,
daytime sleepiness,
daytime napping, and the
use of hypnotic drugs.

Front 54

(Younger or older) persons experience higher rates of breathing-related sleep disorder and medication-induced movement disorders

Back 54

Clinically, older persons experience higher rates of breathing-related sleep disorder and medication-induced movement disorders than younger adults.

Front 55

Most common primary sleep disorder among elderly?

Back 55

Among the primary sleep disorders, dyssomnias are the most frequent, especially primary insomnia, nocturnal myoclonus, restless legs syndrome, and sleep apnea

Front 56

Most common elderly parasomnia?

Back 56

rapid eye movement (REM) sleep behavior disorder occurs almost exclusively among elderly men

Front 57

The conditions that commonly interfere with sleep in older adults include ????

Back 57

pain, nocturia, dyspnea, and heartburn

The lack of a daily structure and of social or vocational responsibilities contributes to poor sleep

Front 58

As a result of the decreased length of their daily sleep–wake cycle, older persons without daily routines, especially patients in nursing homes, may experience ?

Back 58

an advanced sleep phase, in which they go to sleep early and awaken during the night

Front 59

Changes in sleep structure among persons over 65 years of age involve both REM sleep and non-rapid eye movement (NREM) sleep.
The REM and NREM changes include:

Back 59

The REM changes include the redistribution of REM sleep throughout the night, more REM episodes, shorter REM episodes, and less total REM sleep.

The NREM changes include the decreased amplitude of delta waves, a lower percentage of stages 3 and 4 sleep, and a higher percentage of stages 1 and 2 sleep. In addition, older persons experience increased awakening after sleep onset.

Front 60

Much of the observed deterioration in the quality of sleep in older persons is caused by ?

For example, with advanced age, persons have a (lower or higher) amplitude of circadian rhythms, a (6 or 8 or 10 or 12) -hour sleep-propensity rhythm, and (shorter or longer) circadian cycles.

Back 60

the altered timing and consolidation of sleep

For example, with advanced age, persons have a lower amplitude of circadian rhythms, a 12-hour sleep-propensity rhythm, and shorter circadian cycles.

Front 61

Elderly persons have a (the same, higher, or lower) risk for suicide as compared to other age groups?

Back 61

Elderly persons have a higher risk for suicide than any other populatio

Front 62

The suicide rate for white men over the age of 65 is ? times higher than that of the general population.

Back 62

5

Front 63

One third of elderly persons report ? as the principal reason for considering suicide

Back 63

loneliness

Front 64

Approximately 10 percent of elderly individuals with suicidal ideation report??? as reasons for suicidal thoughts.

Back 64

financial problems,
poor medical health, or
depression

Front 65

About ? percent of those who commit suicide are men

Back 65

60% (most)

Front 66

? percent of those who attempt suicide are women

Back 66

75%

Front 67

Suicide victims, as a rule, use ? or ?, whereas 70 percent of suicide attempters take a ? or slash themselves.

Back 67

Suicide victims, as a rule, use guns or hang themselves, whereas 70 percent of suicide attempters take a drug overdose, and 20 percent cut or slash themselves.

Front 68

. Psychological autopsy studies suggest that most elderly persons who commit suicide have had a psychiatric disorder, most commonly ?.

Back 68

depression

Front 69

More elderly suicide victims are ? and (fewer, more) are single, separated, or divorced than is true of younger adults

Back 69

More elderly suicide victims are widowed and fewer are single, separated, or divorced than is true of younger adults

Front 70

Violent methods of suicide are (less or more) common in the elderly, and alcohol use and psychiatric histories appear to be (less or more) frequent

Back 70

Violent methods of suicide are more common in the elderly, and alcohol use and psychiatric histories appear to be less frequent

Front 71

The most common precipitants of suicide in (younger or older) individuals are physical illness and loss, whereas problems with employment, finances, and family relationships are more frequent precipitants in (younger or older) adults

Back 71

The most common precipitants of suicide in older individuals are physical illness and loss, whereas problems with employment, finances, and family relationships are more frequent precipitants in younger adults.

Front 72

(few, some, most) elderly persons who commit suicide communicate their suicidal thoughts to family or friends before the act of suicide.

Back 72

MOST

Front 73

(few, some, many, most) cases of vertigo have a strong psychological component

Back 73

Most cases of vertigo have a strong psychological component, and clinicians should ascertain any secondary gain from the symptom

Front 74

About ? percent of persons over age 65 have significant hearing loss (presbycusis). After age 75, that figure rises to ? percent

Back 74

About 30 percent of persons over age 65 have significant hearing loss (presbycusis). After age 75, that figure rises to 50 percent

Front 75

(few, some, many, most) elderly persons with hearing loss can be treated with hearing aids

Back 75

MOST

Front 76

An estimated ? percent of persons above 65 years of age are abused. Elder abuse is defined by the American Medical Association as

Back 76

10% abused
“an act or omission which results in harm or threatened harm to the health or welfare of an elderly person.”

Front 77

Demographic data suggest that ? percent of women and ? percent of men over the age of 65 will be widowed at least once.

Back 77

Demographic data suggest that 51 percent of women and 14 percent of men over the age of 65 will be widowed at least once.

Front 78

Adults over 65 years of age use the greatest number of medications of any age group; ? percent of all prescriptions are written for them

Back 78

25%

Front 79

Psychotropic drugs are among the most commonly prescribed, along with cardiovascular and diuretic medications; ? percent of all hypnotics dispensed in the United States each year are to those older than 75 years of age, and ? percent of older persons use over-the-counter medications, compared with only ? percent of young adults.

Back 79

Psychotropic drugs are among the most commonly prescribed, along with cardiovascular and diuretic medications; 40 percent of all hypnotics dispensed in the United States each year are to those older than 75 years of age, and 70 percent of older persons use over-the-counter medications, compared with only 10 percent of young adults.

Front 80

The major goals of the pharmacological treatment of older persons are

Back 80

to improve the quality of life,
maintain persons in the community, and
delay or avoid their placement in nursing homes.

Front 81

As a person ages, the ratio of lean to fat body mass also changes. With normal aging, lean body mass (increases or decreases) and body fat (increases or decreases).

Back 81

As a person ages, the ratio of lean to fat body mass also changes. With normal aging, lean body mass decreases and body fat increases.

Front 82

Changes in the ratio of lean to fat body mass that accompany aging affect the distribution of drugs. Many lipid-soluble psychotropic drugs are distributed more widely in fat than in lean tissue, so a drug's action can be unexpectedly ?(shortened or prolonged) in older persons.

Back 82

prolonged

Front 83

In older persons, the (increased or decreased) risk of orthostatic hypotension from psychotropic drugs is related to (increased or decreased) functioning of blood pressure-regulating mechanisms.

Back 83

In older persons, the increased risk of orthostatic hypotension from psychotropic drugs is related to reduced functioning of blood pressure-regulating mechanisms.

Front 84

According to Sigmund Freud, persons older than 50 years (are or are not) suited for psychoanalysis

Back 84

According to Sigmund Freud, persons older than 50 years are not suited for psychoanalysis because their mental processes lack elasticity.

Front 85

Insight-oriented psychotherapy may help remove a specific symptom, even in older persons. It is of most benefit when patients have possibilities for libidinal and narcissistic gratification, but it is contraindicated if

Back 85

it would bring only the insight that life has been a failure and that the patient has no opportunity to make up for it

Front 86

Common age-related issues in therapy involve

Back 86

the need to adapt to recurrent and diverse losses (e.g., the deaths of friends and loved ones),

the need to assume new roles (e.g., the adjustment to retirement and the disengagement from previously defined roles),

and the need to accept mortality.

Front 87

In addition to improving interpersonal relationships, psychotherapy increases

Back 87

self-esteem and self-confidence, decreases feelings of helplessness and anger, and improves the quality of life

Front 88

In one study conducted in an old-age home, 43 percent of the patients receiving psychotherapy showed less

Back 88

urinary incontinence,
improved gait,
greater mental alertness,
improved memory, and
better hearing than before psychotherapy.

Front 89

? is characterized by the progressive return of memories of past experiences, especially those that were meaningful and conflictual.

To varying degrees, elderly patients in therapy ? about the past, search for meaning in their lives, and strive for some resolution of past interpersonal and intrapsychic conflicts

Back 89

Reminiscence is characterized by the progressive return of memories of past experiences, especially those that were meaningful and conflictual. To varying degrees, elderly patients in therapy reminisce about the past, search for meaning in their lives, and strive for some resolution of past interpersonal and intrapsychic conflicts

Front 90

?systematically enhances this reminiscing process and makes it more conscious and deliberate. The therapist may guide the process by encouraging the patient to write or tape a biography with review of special events and turning points. Techniques include reunions with family and good friends and looking through memorabilia, such as scrapbooks or picture albums. This technique has been reported to

Back 90

Life review therapy

This technique has been reported to resolve old problems,
increase tolerance of conflict,
relieve guilt and fears, and
enhance self-esteem,
creativity,
generosity, and
acceptance of the present