gc08-10 - Management of Bipolar Disease in the Elderly M....

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Unformatted text preview: Management of Bipolar Disease in the Elderly M. Cornelia Cremens, MD Director of Inpatient Geriatric Consultation Division of Medicine and Psychiatry Massachusetts General Hospital Sunday August 3, 2008 9:00 - 9:50 am Concerns of Older Adults Quality of life Mental and physical health fundamental to a more meaningful life Many more issues in late life How to avoid early treatment/prevention Increasing numbers struggling with mental health issues Good news Most seniors enjoy good mental health Psychiatric illness is not part of normal aging NIMH 1:5 diagnosed with mental illness Growing population mentally ill 65+ 20 million in 1970 (7 million) 65+ predicted 70 million in 2030 (15 million) Mental Health Issues in Aging Most common psychiatric disorders in late-life Anxiety (includes phobias and OCD) Cognitive impairment and delirium (Alzheimers disease) Mood disorders (depression and bipolar) Range of severity from problematic-severe Suicide highest in this age group Older Adults Avoid Psychiatrists Mental health services underutilized Stigma Denial Lack of services, access outreach Poor coordination of services and follow-up Psychiatric Evaluation of Older Adults Psychiatric assessment Rule out pre-morbid psychiatric illness Rule out co-morbid medical illness Functional Assessment ADLs mobility, dressing, hygiene, feeding and toileting IADLs independent living, shopping, cooking, telephone, housekeeping (light), medications, finances, transportation Evaluation Complete history Psychiatric, medical, neurological What is different in evaluation? Evaluation Complete history, Prior clinicians, medical records, medications often need family to give history Psychiatric, medical, neurological Psychiatric assessment Rule out pre-morbid psychiatric illness Rule out co-morbid medical illness Evaluation of Function Functional assessment Activities of daily living Feeding, Bathing, Dressing, Transferring, Toileting Instrumental activities of daily living Finances, Telephone, Medications, Shopping, Cooking Housework, Ambulating, Laundry Presentation of Illness Often atypical may present as Falls Behavioral changes Behavioral changes Cognitive deficits Functional losses incontinence Non-specific signs and symptoms Evaluation of Older Patients Cognition Assessment Mini-Mental State Exam (Folstein) Affect S leep I nterest G uilt E nergy C oncentration A ppetite P sychomotor activity S uicide Psychosis Medications, get a list Bring the bottles in to appointment Current list Names of prescribers Dates on bottles Over the counter Herbal Borrowed from a friend Old medications, saved Most commonly prescribed Cardiovascular Diuretic Antihypertensive Vasodilator Digoxin Psychotropic Analgesic narcotic antiarthritic Laxative antispasmodic Common culprits...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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gc08-10 - Management of Bipolar Disease in the Elderly M....

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