Download REVIEW OF PSYCHIATRY Geriatrics

Everything You Need to Know
About Geriatric Psychiatry
in 75 Minutes
Andrea Stewart, MD, FRCPC
Writer of LMCC, 2002
Proportion of population
aged  80 years (%)
Aged  80 years in 1994
Aged  80 years in 2020
AGE
DEPENDENCY
RATIO
Challenges of Late Life
Co-morbid medical illness /
cognitive disorders
Sensory loss
Financial worries
Retirement
Dependency
Dying and death
Bereavement
OVERVIEW
Dementia - BPSD
Late Onset Psychosis
Depression in late life
Anxiety in late life
Delirium
Other types of dementia (Lewy Body, FTD)
Case 2
Approach to Memory Loss
Speaking to the person (safety first)
Speaking to the family (safety first)
History, physical examination
Create a differential and then direct investigations
(bloodwork, urinalysis, ECG, imaging) to firm up the
diagnosis
Investigations
Follow-up Plan
Differential Diagnosis
Delirium
Cognitive Impairment but not dementia/ Mild
Cognitive Impairment/ Age Associated Memory
Decline
Dementia - subtypes
Depression or other psychiatric illness
Other CNS disease (cancer, demyelination, etc.)
or a dementia secondary to GMC
Alzheimer’s Dementia
Memory Impairment
One or more other cognitive impairment:
Aphasia, apraxia, agnosia, executive functioning deficit
Gradual onset and continual decline
Impairments cause significant social or occupational functional
decline compared to previous level of functioning
Impairments are not delirium, substance-induced, or caused by
another GMC or psychiatric illness
Defining the Diagnostic Threshold
Normal Cognition
MCI/ CIND
Dementia
Screening Tools
MMSE score <24/30
MOCA score <26/30
Mini-Cog (3 word registration & recall, CDT)
1
Work-up
CBC, Cr, urea, electrolytes, TSH, vitamin B12
Neuroimaging if the onset is recent (<1 year),
early (<65), or the presentation is atypical or
suggestive of another neurological disease
Other tests prn (VDRL, HIV, carotid U/S, EEG,
chest Xray, urinalysis, LP)
ECG prior to medication management
1Burns
A, BMJ
Activities of Daily Living
Bars show 25th to 75th %ile
of patients losing independent
performance.
EAT
WALK
CLEAR TABLE
DISPOSE LITTER
MAINTAIN HOBBY
GROOM
DRESS
SELECT CLOTHES
FIND BELONGINGS
USE HOME APPLIANCES
TRAVEL ALONE
OBTAIN MEAL/SNACK
TELEPHONE
KEEP APPOINTMENTS
MMSE
30
25
20
Mild AD
15
Moderate AD
10
5
Severe AD
Adapted from Galasko. Eur J Neurol. 1998;5(suppl 4):S9-S17;
Galasko et al. Alzheimer Dis Assoc Disord. 1997;11(suppl 2):S33-S39.
0
Cognitive Enhancers
May improve:
ADLs- activities of daily living, time to
institutionalization
Behaviour/Mood- decreased concomitant
psychotropics
Cognitive enhancement
Types
Acetylcholine-esterase inhibitors (boost ACh)
NMDA antagonists (Block glutamate)
Other Medications/ CAM
Nimodipine (Ca channel blocker) at 90 to 180 mg/day
General BP lowering
Vitamin B12
Extract of Ginkgo biloba 761
Vitamin E no longer used due to bleeding risk
DHEA may be harmful to memory
Cognitive training, reminiscence therapy
Case 2
Behavioural and Psychological
Symptoms of Dementia
ABC Approach
A
Antecedents
B
Behaviours
C
Consequences
Physical: delirium, diseases, drugs,
discomfort, disability
Intellectual: dementia – cognitive
abilities/losses
Emotional: depression, psychosis
Capabilities: environment not too
demanding yet stimulating enough,
balancing demands and capabilities
Environment: noise, relocation,
schedules…
www.piecescanada.co
m
Social, cultural, spiritual: life story,
relationships family dynamics,
personality traits...
Pharmacological Management
of BPSD
Atypical antipsychotics1
RSP & OZP reduce aggression, RSP reduces psychosis
Higher risk CVEs, EPS, death
Antidepressants2,3
db trials show CIT = RSP with fewer SEs
Trazodone has trend of effectiveness in FTD
Benzodiazepines
1Cochrane,
2008; 2Pollock, BG Am J Ger Psych; 3Cochrane, 2008
The following is NOT true of Alzheimer’s:
a) Insidious, gradual and progressive decline
b) Motor symptoms are absent until later in the disease
c) A dramatic presentation is not the same as an abrupt
onset
d) Behavioural symptoms are often the most distressing
symptom for families and caregivers
e) The ‘head turning sign’ refers to sexual disinhibition
f) Vascular events may co-occur and cause cognitive
dysfunction
Case 6
Psychosis in the
1
Elderly
4% in the community
15% presenting to a geriatric medicine clinic
10-38% of people in LTC (21% of new admissions to
LTC)
1Holyrood
S, Int J Ger Psych 1999
Approach
Speaking to the family (safety first)
Speaking to the person (safety first)
History, physical examination
Create a differential and then direct investigations
(bloodwork, urinalysis, ECG, imaging) to firm up the
diagnosis
Investigations
Follow-up Plan
Differential Diagnosis
Psychosis in People <45
MDE or Mania
SZP/SZA/ delusional D/O
2 GMC/subs
Delirium
Personality disorder
Psychosis in People >45
Cognitive Disorders (delirium, dementia)
Differentiating the Dx
Dementia
Memory
loss,
impaired
function,
insidious
onset &
progress
MDE
Prominent
mood and
anxiety sx,
past hx
MDD,
somatic/
guilt/
nihilistic
delusions
Delirium
Mania
LO SZP
Acute,
Delusions
fluctuates,
Mixed
may be
clouded
states
bizarre, no
sensorium
more
dissleep
common,
orientation
reversal,
less
baseline
delusions grandiosity
paranoid or
from env., confusion
schizoid
vulnerable & irritability
PD traits
host
Outcomes and
Associated Factors
Elderly with psychosis are more likely to have a
history of psychosis, live in LTC, and have lower
MMSE scores1
1Holyrood
S, Int J Ger Psych 1999
Case 6
Which of the following is not true in LLP?
a) Most paranoid disorders of old age are due to
schizophrenia
b) More women develop late onset schizophrenia
c) With ageing, schizophrenia tends to give less
severe positive symptoms
d) Patients with schizophrenia live 10-30 years less
on average
Case 7
Approach to Mood Complaint
History (with collateral) and physical
examination
Make the diagnosis considering the differential,
assess severity (psychosis) and suicidality
Thorough medication review
Investigate causes (bloodwork, urinalysis, ECG,
imaging) and remove promoting factors
Review past episodes and treatments
Differential Diagnosis
Depressive Disorder (dysthymia, MDE, BP with
MDE, personality disorder)
Bereavement
Dementia
Delirium
Substance (drug of abuse, medication) or GMC
1
Epidemiology
Lifetime risk 11%
Incidence in the general population: 4%/ year
Incidence in people > 65: 1-3%/ year
Incidence in hospitalized people: 11%
Incidence in people in LTC: 12-22%
1Narrow
WE, NIMH ECA prospective data
Predisposers
Precipitators
Female gender,
Recent
widowed or
bereavement,
divorced, PHx
moving to an
MDD, CeVD,
institution,
Personality type,
adverse life
major physical or
events
disabling illness,
(separation, loss,
some meds,
financial crisis),
alcohol abuse,
declining health,
social
relationship
disadvantage,
problems
Caregiver stress
Perpetuators
Persistent sleep
problems,
chronic stress,
social isolation,
stigma, adverse
effects of
medication
therapies
Diagnostic Criteria
Mood depressed/irritable or anhedonia for > 2 weeks and 4/8:
Sleep change
Concentration
impaired
Interests lost
Guilty or worthless
feelings
Energy lost
Appetite changed/ wt
change
Psychomotor
symptoms
Suicidal or deathrelated thinking
DSM-IV-TR
Late Life Depression
Less
More
Complaints of
sadness
Somatic
symptoms, Anxiety,
Cognitive
symptoms, Medical
comorbidity
CCSMH, Assessment and Treatment of Depression 2006
Subtypes
With or without psychosis, graded severity,
recurrent or first episode, bipolar depression
Secondary to something else
Dysthymia
Co-morbid with dementia or substance abuse
MDE vs Grief
MDE
Grief
+/- onset after trigger
Onset after death of loved one
Symptoms worsen with time
Symptoms improve with time
SI/ preoccupation with death
Passive wishes to have died 1st or
with person
Intense guilt & worthlessness
Self esteem preserved
Persistent mood state
Sadness comes in waves
Functional impairment
Functional impairment <2 mo.
Psychosis
APA, 2000
Management
Mild: bibliotherapy, exercise, close follow-up or
supportive therapy
Moderate: antidepressants +/- psychotherapy, or
psychotherapy alone
Severe: refer to psychiatry, +/- hospitalization for
safety, ECT, antipsychotics with
antidepressants, psychotherapy alone only
effective for specific patients if done by experts otherwise in combination
Suicide Risk
Fixed RFs
Modifiable RFs
V. High Risk
Behaviours
Social isolation,
Agitation
Presence of chronic
Giving away
Old age
pain (OR moderate
possessions
Male gender
pain 1.9, severe pain
Reviewing one’s will
Widowed or divorced
7.5)
Increase use alcohol
Previous attempt
Presence and severity Non-compliance with
Losses (health, status,
of MDE
treatment
role, independence, Hopelessness, Suicidal Taking unnecessary
relations)
ideation
risks
Access to means,
Preoccupation with
especially firearms
death
CCSMH, Assessment of Suicide Risk and Prevention of Suicide, 2006
Language of Treatment
Antidepressants
Meta-analysis of trials of 2nd generation
antidepressants in people >60 with nonpsychotic depression and no dementia
Medication
Placebo
Response
44%
35%
Remission
33%
27%
Discontinuation
24%
20%
1American
Journal of Geriatric Psychiatry, 2008
Antidepressant
Works
>20% better
Maintenance
Go to 8 wks
No change after
4wks
Reassess diagnosis, increase dose,
switch to escitalopram, sertraline, mirtazapine, effexor
>20% better after above:
Li, antipsychotic, psychotherapy
Clinical Use of Antidepressants
If anything protective for suicide in elderly
Elderly more likely to die of overdose if taken
Electrolytes pre and post (1 week to 1 month)
Risk of GI bleed, especially with concurrent
NSAID or ASA use - monitor, add
gastroprotective agent
Follow q2 weeks for the first 1-3 months, keep
on medication >1 yr post remission
Psychotherapy
Cognitive Behavioural Therapy
Problem Solving Therapy
Interpersonal Therapy
The following is true regarding
depression:
a) it is a treatable condition that with antidepressants has a remision rate of
30-40% and response rates of 67-90%
b) the neurotransmitters serotonin and noradrenaline are involved
c) Psychotherapy is effective in severe depression
d) an association between early life trauma, hippocampal atrophy and
depression can be seen
e) it often presents with multi-system physical complaints
f) it is associated with coronary artery disease, stroke, diabetes, cancer,
Parkinson’s, and MS.
g) ECT should be considered only when all other treatments have failed
The following is true regarding
depression:
a) it is a treatable condition that with antidepressants has a remission rate of
70-80% and response rates of 67-95%
b) the neurotransmitters serotonin and noradrenaline are involved
c) Psychotherapy is effective in severe depression
d) an association between early life trauma, hippocampal atrophy and
depression can be seen
e) it often presents with multi-system physical complaints
f) it is associated with coronary artery disease, stroke, diabetes, cancer,
Parkinson’s, and MS.
g) ECT should be considered only when all other treatments have failed
Which of the following are true
of depression in old age:
a) Is more prevalent in women than men
b) Prevalence rates rise sharply with age
c) Is accompanied by a much lower suicide risk
than in younger adults
d) Is unresponsive to treatment in half of cases.
e) Is often precipitated by a loss
f) Both b) and d)
Which of the following are true
of depression in old age:
a) Is more prevalent in women than men
b) Prevalence rates rise sharply with age
c) Is accompanied by a much lower suicide risk
than in younger adults
d) Is unresponsive to treatment in half of cases.
e) Is often precipitated by a loss
f) Both b) and d)
Which of the below options are
true for psychotic depression:
a) Is more frequent in elderly.
b) Remits with antidepressants in 50% of cases
c) Remits with antidepressants + antipsychotics in 75% of
cases
d) Responds and remits best with ECT
e) Should prompt thorough search for symptoms of bipolar
illness in pt and family members.
f) All of the above except b)
g) All of the above except b) and c)
Which of the below options are
true for psychotic depression:
a) Is more frequent in elderly.
b) Remits with antidepressants in 20% of cases
c) Remits with antidepressants + antipsychotics in 45% of
cases
d) Responds and remits best with ECT
e) Should prompt thorough search for symptoms of bipolar
illness in pt and family members.
f) All of the above except b)
g) All of the above except b) and c)
Which of the following are frequent
“reasons for consultation” by elderly who
have an episode of depression:
a) “Nerves”
b) Excessive fatigue
c) Hypersomnia (sleeping too much)
d) Digestive problems
e) Fear of Alzheimer’s disease
f) All of the above except C
Which of the following are frequent
“reasons for consultation” by elderly who
have an episode of depression:
a) “Nerves”
b) Excessive fatigue
c) Hypersomnia (sleeping too much)
d) Digestive problems
e) Fear of Alzheimer’s disease
f) All of the above except C
Which of the following would go against a
diagnosis of normal grief:
a) Active suicidal ideation
b) Prominent psychotic symptoms
c) Crying spells when she thinks of her deceased
husband.
d) Being less active socially
e) Being unable to attend to her usual daily
activities 3 months after the death of her
husband
Which of the following would go against a
diagnosis of normal grief:
a) Active suicidal ideation
b) Prominent psychotic symptoms
c) Crying spells when she thinks of her deceased
husband.
d) Being less active socially
e) Being unable to attend to her usual daily
activities 3 months after the death of her
husband
81 year old widow, lives alone in her home, presents with
2 year history of insidious increase in worrying,
indecisiveness, isolation, insomnia, and feeling tense. Her
husband recently died in a NH after having dementia for 8
years. Her kids say she is increasingly dependent on
them for running errands, and she has stopped doing her
own taxes and driving.
She appears nervous, with a smile that doesn’t match her
words.
Anxiety
Disorder
Mood Disorder
■ Depressed /
irritable mood
■ Anhedonia
■ Euphoria
■ Weight
gain/loss
■ Loss of
interest
■ Fear
■ Apprehension
■ Panic attacks
■ Chronic pain
■ GI complaints
■ Excessive worry
■ Agitation
■ Difficulty
concentrating
■ Sleep
disturbances
■ Hypervigilance
■ Agoraphobia
■ Compulsive rituals
APA 1994; Keller MB 1995; Clayton PJ et al 1991; Coplan JD, Gorman JM 1990

As many as 90% of depressed patients suffer from
anxiety symptoms1-3

More severe illness at baseline

More psychosocial impairment

Greater likelihood of chronic illness

Poorer, slower response to treatment

Greater likelihood of committing suicide
1. Richou H. et al. Human Psychopharmacol 1995; 10:263-71
2. Coplan JD et al. J Clin Psych 190; 51(Suppl 10):9-13
3. Kasper S. et al. Primary Care Psych 1997; 3:7-16
Secondary anxiety
disorders more
elderly
Anxiety
Disorders
incommon
the inElderly

 Primary anxiety disorders generally do not have an onset in the
elderly (same for personality disorders)
 High co-morbidity with depression

Overall less common in the elderly.
 Phobias and GAD are the most common. Panic disorder is
relatively rare, less than the 1-3% described in younger populations
(Flint AJP 1994).

Caution with anxiolytics
 can cause paradoxical disinhibition
 Diphenylhydramine (Benadryl), Dimenhydrinate (Gravol),
Chlorpromazine, Amitriptyline, chloral hydrate and barbiturates are
not good anxiolytics due to their side effects
 Elderly are more sensitive to benzodiazepines. Associated with an
Cognition
Anxiolytic
Side Effects

 Amnesia (esp. alcoholics with benzos)
 Memory and visuospatial impairment

Psychomotor
 Accentuate postural sway and incoordination
 Increase risk for MVAs and falls
 Paradoxical dysinhibition

Respiratory Depression
 avoid benzos in sleep apnea

Sleep
 Decreased sleep latency but also decreased stage 3
and 4 sleep with Benzos
Which of the following is NOT true of anxiety
disorders in old age
a) It is more often secondary to another axis 1 condition like
depression or medical condition
b) Anxiolytics can worsen not only anxiety but can cause
sleep disruption, falls, and MVAs.
c) Benzodiazepines are safe in the elderly
d) Benadryl, Gravol, Chlorpromazine, Amitriptyline and other
anticholinergic medications can be dangerous in the
elderly because of delirium and associated other receptor
effects (orthostatic hypotension)
e) Primary anxiety disorders and personality disorders,
including dependent personality disorder, do not begin in
MCQ#9
a) Prevalence rates increase with ageing.
b) Phobias are the most common anxiety disorder
c) Overall prevalence rates for all anxiety
disorders in old age is around 10%
d) Panic disorder affects approx. 5% of elderly.
MCQ#9
a) Prevalence rates increase with ageing.
b) Phobias are the most common anxiety disorder
c) Overall prevalence rates for all anxiety
disorders in old age is around 10%
d) Panic disorder affects approx. 5% of elderly.
Case 8
Differential Diagnosis
Generalized Anxiety Disorder
Dysthymia
MDE
Anxiety secondary to GMC, substance
Bereavement
Anxiety in Late Life
Less common, 5-10% in the community
F>M, peak onset adolescence
Agoraphobia alone as having a second peak
Late life onset usually heralds another condition:
MDD, dementia, medication toxicity, withdrawal,
GMC (cardio and cerebrovascular disease)
Presentations of Anxiety
1
Disorders in Late Life
Autonomic hyper-arousal pronounced:
palpitations, dry mouth, dizziness, hot
flashes, GI distress
Low prevalence of panic disorder and OCD
Onset after therapy with DA agonists, steroids,
sympathomimetics, Beta-adrenergic agonists
(salbutamol), theophylline, digoxin, thyroxine
Flint AJ, Comprehensive Textbook of Geriatric Psychiatry: Anxiety Disorders, 2004
Agoraphobia
Most prevalent anxiety disorder in the community1
Onset not uncommon after 601
Late onset related to abrupt onset physical illness or
trauma (fall, being mugged)2
Associated with early parental loss3
1,3Lindesay
J, Br J Psych, 1991; 2Burvill PW, Br J Psych, 1995
Depressive
Disorder
■ Depressed /
irritable mood
■ Anhedonia
■ Euphoria
■ Weight
gain/loss
■ Loss of
interest
Anxiety
Disorder
■ Fear
■ Apprehension
■ Panic attacks
■ Chronic pain
■ GI complaints
■ Excessive worry
■ Agitation
■ Difficulty
concentrating
■ Sleep
disturbances
■ Hypervigilance
■ Agoraphobia
■ Compulsive rituals
APA 1994; Keller MB, 1995; Clayton PJ, 1991; Coplan JD,1990
Management
Diagnose, initiate treatment or refer
Investigate +/- treat co-morbid illness
Psychotherapy: CBT
Pharmacotherapy: SSRI (sertraline)
Outcome
More severe illness at baseline
More psychosocial impairment
Poorer, slower response to treatment
Greater likelihood of committing suicide
Greater likelihood of morbidity (cardiovascular,
respiratory, GI diseases) and mortality (cardiovascular,
COPD, neoplastic causes)
Flint AJ, Comprehensive Textbook of Geriatric Psychiatry: Anxiety Disorders, 2004
Which of the following is NOT true of
anxiety disorders in old age:
a) It is more often secondary to another axis 1 condition like
depression or medical condition
b) Anxiolytics can worsen not only anxiety but can cause sleep
disruption, falls, and MVAs.
c) Benzodiazepines are safe in the elderly
d) Benadryl, Gravol, Chlorpromazine, Amitriptyline and other
anticholinergic medications can be dangerous in the elderly
because of delirium and associated other receptor effects
(orthostatic hypotension)
e) Primary anxiety disorders and personality disorders, including
dependent personality disorder, do not begin in old age
Which of the following is NOT true of
anxiety disorders in old age:
a) It is more often secondary to another axis 1 condition like
depression or medical condition
b) Anxiolytics can worsen not only anxiety but can cause sleep
disruption, falls, and MVAs.
c) Benzodiazepines are safe in the elderly
d) Benadryl, Gravol, Chlorpromazine, Amitriptyline and other
anticholinergic medications can be dangerous in the elderly
because of delirium and associated other receptor effects
(orthostatic hypotension)
e) Primary anxiety disorders and personality disorders, including
dependent personality disorder, do not begin in old age
Which of the following is true regarding
anxiety disorders in old age:
a) Prevalence rates increase with age
b) Phobias are the most common anxiety disorder
c) Overall prevalence rates for all anxiety disorders
in old age is around 20%
d) Panic disorder affects around 5% of elderly.
Which of the following is true regarding
anxiety disorders in old age:
a) Prevalence rates increase with age
b) Phobias are the most common anxiety disorder
c) Overall prevalence rates for all anxiety disorders
in old age is around 20%
d) Panic disorder affects around 5% of elderly.
Case
1
Approach
History (with collateral) and physical
examination
Make the diagnosis considering the differential
Thorough medication review
Investigate causes (bloodwork, urinalysis, ECG,
imaging) and remove promoting factors
Consult prn (OT, PT, RD, SW, other MD)
Differential Diagnosis
Delirium
Dementia
Depression, Mania, Psychotic disorder
Other CNS disease (cancer, demyelination, etc.)
Delirium
20% of hospitalized patients >651
10-30% of people >65 it is the presenting
symptom of a life-threatening illness1
LOS approximately doubled to 8 days2
Mortality doubled, morbidity increased3
Unrecognized in ~ 70%4
1Centers
for Medicare and Medicaid Services, 2004 CMS Statistics; 2Agostini JV, Principles of Geriatric
Medicine and Gerontology; 3McCusker J, Arch Intern Med; 4Gillis AJ, Can Nurse
Delirium
C - Consciousness fluctuates
C - Course has an acute onset
C - Cognition disturbed
C - Cause is a GMC
Subtypes of Delirium
Meagher (1996), BJP
Predisposers
Precipitators
Perpetuators
Old age
Med change
Poor nutrition
Visual loss
Trauma (IV,
Environmental
Hearing loss restraints, foley,
changes
Hx delirium
fall)
Pain
Dementia
UTI, pneumonia
IV/Foley
Functional
MI, CVA
Dehydration
dependence
Low BP or O2
Sensory
Medical
AbN lytes
deprivation/
morbidities
GI or GU
overstimulation
Polypharmacy
disease
Poor sleep
EtOH/ drugs
Periop. factors
Hypothermia
Causes of Delirium
I - Infections
W - Withdrawal
A - Acute metabolic Encephalopathy
T - Trauma
C - CNS pathology
H - Hypoxia
D - Deficiencies
E - Endocrine Disorders
Case
1
QuickTime™ and a
GIF decompressor
are needed to see this picture.
Treatment of
1,2,3
Delirium
Psychological/ Social/ Environmental
Ensure pt wears glasses, hearing aid, dentures, encourage
independence & regular activity, allow adequate sleep
Support family, enlist their help in decreasing distress and
providing frequent reorientation
Place person near NS station in single room with adequate
lighting, reorientation cues, and LIMIT RESTRAINTS
Biological
Treatment related to cause of delirium
Manage sx (low dose neuroleptics)
Ensure adequate hydration, stop unneeded lines
1Cole
MG, J Geriatr Psychiatr Neurol; 2Simon I, Geriatr Nurs; 3Meagher DJ, Br J Psychiatry
Antipsychotics in
1
Delirium
Evidence suggests modest benefits in
decreasing duration and severity of delirium with
use of antipsychotic
Low dose haldol (0.25-1.5 mg/24h) is equivalent
to low dose risperidone (0.25 -1/24h) or
olanzapine (1.25-5 mg/24h) in efficacy, but may
cause more akathisia, definitely costs less
Cochrane Collaboration, 2009
Delirium Outcomes
Delirium in the elderly patient is associated with
increased mortality, longer hospital stays, and
increased risk of institutional placement
It is a reversible syndrome, that improves or
resolves with treatment of the precipitating
illness and addressing precipitating and
perpetuating factors
MCQ: The following is true for delirium:
a) It is characterized by problems and fluctuations with
attention and consciousness
b) In the elderly, it is most often completely reversible
c) Hypoactive subtypes are more often missed
d) Environmental interventions do not help
e) It is a significant independent risk factor for death
f) It can be superimposed on dementia or depression
g) It is rare in the elderly
h) It is better to use benzodiazepines than neuroleptics for
psychotic and behavioural symptoms
The following is true for delirium:
a) It is characterized by problems and fluctuations with
attention and consciousness
b) In the elderly, it is most often completely reversible
c) Hypoactive subtypes are more often missed
d) Environmental interventions do not help
e) It is a significant independent risk factor for death
f) It can be superimposed on dementia or depression
g) It is rare in the elderly
h) It is better to use benzodiazepines than neuroleptics for
psychotic and behavioural symptoms