Psychotic Disorders (1-8%) and Psychotic Syndromes
Affective Disorders (10-15%)
Organic Personality Syndromes (10%)
Types of Psychiatric Disorders in the Elderly
Primary psychiatric illness beginning in childhood and continuing through adulthood
Late onset psychiatric illness beginning in adulthood or the geriatric population
Primary Psychiatric Disorders
In general - signs and symptoms are the same as in a younger population
treatment regimens are similar, but concern should be made to select drugs with few side effects
closer monitoring of drug side effects; ex. periodic EKG
drug pharmokinetics are different in the elderly and lower doses should be used and the drug dose should be increased slowly
Schizophrenia
Treatment: same as for younger population; antipsychotics
Late Onset Schizophrenia: onset after 65 years of age; treatment the same; still being studied
Bipolar Disorder
cycle frequency increases and duration of each episode decreases
Treatment: Mood stabilizers (Lithium); antidepressants and antipsychotics as necessary
Depression
signs and symptoms are the same as in a younger population; disappointed mood,
ß appetite, ß sleep, etc.
Somatic Complex: signs of depression are often translated into physical symptoms; ex. back pain
Treatment: antidepressants; SSRI’s are often used due to
ß side effects but TCA are not contraindicated
Anxiety
signs and symptoms are the same as in a younger population
often associated with depression in the elderly
Dementias
10% are reversible because they are due to a medical condition that can be treated; ex.
Ý BUN, or hypothyroidism
90% are irreversible
Criteria
(The five "A"s)
A
mnesia plus one of the following: Aphasia, Agnosia (lack of recognition), Apraxia, Abstract thinking and executive functioning impairment
Illnesses in order of prevalence in the United States
(1) Alzheimer’s Disease
(2) Lewy Body Disease
(3) Vascular Disease
(4) Pick’s Disease
(5) Parkinson’s Disease
(6) Huntington’s Disease
(7) Other
Alzheimer’s Disease
Pathology: amyloid plaques and neurofibrillary tangles; found in normal brains, but to greater extent in patients with AD
Clinical Presentation: slow progression; illness usually present 10 years before symptoms manifest; lose constructional abilities which can be tested by asking the patient to draw a clock
Diagnosis: clinical; PET scan depicts hypoactivity in the parietal and temporal lobes
Treatment: no cure; anticholinesterase inhibitors may be helpful
Þ Donepezil (Aricept); slow progression but do not improve symptoms
Vit E and wine may be helpful
Lewy Body Disease
memory problems and parkinsononian symptoms
Creutzfeldt Jakob Disease (CJD)
Clinical Presentation: myotonic jerks, rapid course (most patients die within 1½ to 2 years)