Geriatric Psychiatry Test S of Attention: Knowledge Test, Form 1 1

Home , Organic brain syndrome

7. Which of the following are Geriatric Psychiatry test s of attention: Knowledge Test, Form 1 1. Halstead-Reitan 2. Digit Span 3. Bender-Gestalt 4. Continuous Performance Task

The purpose of this exercise is to for termination of thera- 8. Geriatric psychotherapy is assess your knowledge of certain py usually: aspects of geriatric psychiatry. Five 3. Enhancing learning capa- 1. Brief broad areas are tested: psychody- bilities 2. Directive namics and psychotherapy, cogni- 4. Resolution of transfer- 3. Problem centered tive assessment, psychosocial and ence 4. Insight oriented developmental aspects, psycho pharmacology, and clinical syn- 2. Regarding the MMPI in the 9. Elderly people between age dromes. elderly: 65 and 74 are (choose only The test has 50 questions. An- 1. Norms are essentially one): swers are given in the table follow- the same in young and A. Less likely to be alco- ing the test. Some questions have old holic than middle-aged only one correct answer and are 2. The elderly generally subjects clearly marked "choose only one." score higher on hysteria B. More likely to be alco- The other questions are scored us- 3. Psychotic scales are holic than middle-aged ing the following key: higher with aging subjects A: 1, 2, and 3 are correct 4. Older individuals tend C. As likely to be alcoholic B: 1 and 3 are correct to endorse a more neu- as middle-aged subjects C: 2 and 4 are correct rotic picture D. Less likely to be alco- D: 4 alone is correct holic than teenagers E: All are correct 3. Most senile dementias ap To obtain your score for each proximate the symptom- 10. Dementia may occur in as- category, multiply the number of atology of: sociation with: correct answers in the category by 1. Korsakoff's syndrome 1. Pick's disease 2. Consult Table 1 on page xxxx 2. General paresis 2. Parkinson's disease for recommendations about fur- 3. Huntington's chorea 3. Alzheimer's disease ther study. To facilitate further 4. Alzheimer's disease 4. Barbiturate intoxication study, at the end of the test a reference is provided for each 4. Multi-infarct dementia is 11. Senile dementia patients question. characterized by: may have the following Please note that there are two 1. Stepwise deterioration symptoms: forms of the test, Form 1 and Form 2. Emotional lability 1. Apraxia 2. Form 2 will be published in the 3. Focal neurological signs 2. Aphasia December issue. 4. Senile plaques 3. Paranoia 1. In the depressed elderly, 4. Loss of short-term mem cognitive therapy should in- 5 . Thyrotoxicosis in the elder- ory clude: ly is often characterized by: 1. Educating the patient 1. Excitement 12. Individuals in older age about the treatment 2. An enlarged goiter groups are most eager to: 2. Adequate preparation 3. Ocular manifestations 1. Reduce close ties with 4. Apathy grown-up children 2. Develop a sense of au- This test was devised by Javaid 6. The Face-Hand test is: tonomy 1. Sheikh, M.D., and Jerome A. 1. A psychomotor test used 3. Maintain relations with Yesavage, M.D., of the depart- to test motor abilities contemporaries ment of psychiatry and behav- 2. Done with eyes open 4. Establish an equilibrium ioral sciences at Stanford Uni- and eyes closed of dependence and inde- versity School of Medicine. 3. A neurological test for pendence 5th cranial nerve palsy 4. A screening test for dif- fuse brain disease

13. Which of the following are heimer's Disease of seminal fluid true of the elderly: B. The 36-Hour Day 3. Increase in the length of 1. The majority have incomes C. Strategies for Treating Se- the refractory period below the poverty level nile Dementia 4. Absence of erections in 2. People tend to become more D. Living with Dementia REM sleep religious as they age 3. More than 15 percent of the 18. The average age of onset of 23. In demented patients, which of the U.S. population is age 65 and Pick's disease is (choose following sleep patterns are over only one): noticed on an EEG: 4. Older people usually take A. 50 1. Decrease in stage 4 sleep longer to learn something new B. 60 2. Decrease in amount of C. 70 spindle activity 14. What percent of the elderly D. 80 3. Decrease in REM sleep live in institutions (choose 19. On the WAIS, the motor 4. Increase in stage 4 sleep only one): scores of the elderly should A. 5 percent over 65 years old be (choose only one): 24. Distribution of psychotro- and 20 percent over 90 years A. The same as scores of pic drugs is altered in the old younger subjects elderly because of the fol- B. 12 percent over 65 years old B. 10 to 20 percent lower lowing: and 35 percent over 90 years than for younger sub 1. Relatively poor brain old jects perfusion C. 20 percent over 65 years old C. 20 to 30 percent lower 2. Increase in accumulation and 40 percent over 90 years than for younger sub of drugs in body fat old jects 3. Decrease in total body D. 30 percent over 65 years old D. 30 to 50 percent lower mass and 59 percent over 90 years than for younger sub 4. Decrease in protein old jects binding of drugs 15. Tardive dyskinesia in schizophrenics over age 40 is 20. Cataracts are found in what Which of the following occur in (choose only one): percentage of people over 25. paradoxical reactions A. 50 percent more common 60 (choose only one): than in younger A. 3 to benzodiazepines in the elderly: schizophrenics B. 9 1. Sudden, excessive dys- B. Twice as common as in C. 16 phoric stimulation younger schizophrenics D. 28 2. Hyperactivity C. Three times as common as in 21. Which of the following are younger schizophrenics among the false perceptions 3. Angry outbursts 4. Depersonalization D. Four times as common as in about the elderly: younger schizophrenics 26. Reversible organic brain 1. At least one-tenth are in 16. The most-prevalent cause of syndromes in the elderly stitutionalized impotence in the aging male may be caused'by: 2. At least 80 percent are is (choose only one): 1. Electrolyte disturbances healthy enough to per A. Adult onset diabetes 2. Dehydration form normal activities mellitus 3. Hypothermia 3. A majority are socially B. Peripheral neuropathy 4. Drug interactions isolated and lonely C. Fear of nonperformance 4. The elderly are involved D. Obesity 27. Routine psychometric test- in relatively fewer traffic accidents ing may not assess the true 17. A useful guide for families cognitive abilities of the el- caring for elders with de- 22. According to Masters and derly because of: mentia is (choose only one): Johnson, which of the fol- 1. Decreased performance A. A Family Guide to Alz- lowing are normal in the speed sexual response of the el- 2. Increased distractability derly male: 3. Decreased sensory func 1. Increase in the length of tion the plateau phase 4. Increased intraindividual 2. Decrease in the volume variability 28. Which of the following de- The doctor should: 2. Direct the family to ap- crease the steady-state plasma 1. Perform a medical evaluation propriate resources concentration of tricyclics in the or have one performed 3. Mobilize the family sys elderly: 2. Explain to the daughter that tem to solve problems 1. Barbiturates her mother is capable of 4. Work with the individual 2. Diazepam driving patient and his social 3. Smoking 3. Discuss with the daughter her resources 4. Chlorpromazine concerns about her mother 4. Talk to the mother and 39. Dihydroergotoxine mesy- 29. According to Lipowski, daughter about their mutual late (Hydergine) is (choose which of the following are true of concerns only one): delirium in the elderly: A. Indicated in selected symp- 1. It significantly increases toms associated with aging mortality in hospitalized B. A nonphenothiazine neu patients 34. Which of the following neuroleptic 2. Transition to dementia is rochemical changes occur in the C. Not safe for the aged because quite common human brain with normal aging as of serious side effects measured by percent weight: D. Primarily an antidepres- 3. Organic etiologic factors 1. Increase in water sant can be identified in most 2. Increase in total lipids cases 3. Decrease in proteins, 40. According to Masters and 4. It is mostly caused by peptides, and enzymes Johnson, which of the fol- psychosocial stressors 4. Decrease in nucleic acids lowing are normal for elderly females: 35. Which of the following 30. A relatively optimistic out- 1. Vaginal lubrication takes might produce depressive look for psychotherapy with longer to develop symptoms in the elderly: elders was supported by: 2. Frequency of masturba- 1. Propranolol 1. Jung tion decreases 2. Digitalis 2. Anna Freud . 3. The orgasmic phase is 3. Chlorpromazine 3. Abraham shortened 4. Penicillin 4. Harry Stack Sullivan 4. The resolution phase is prolonged

31. Autopsy studies show in- 36. Clinical management of sus- 41. Which of the following creases with aging of which of the piciousness in the elderly might physiologic changes occur following enzymes in the brain: include: with normal aging: 1. Choline acetyltransferase 1. Situational and environ 1. Decrease in cardiac out 2. Dopamine beta-hydrox mental manipulations put by 30 to 40 percent ylase 2. Identification and re 2. Decrease in glomerular 3. COMT placement of loss filtration rate 4. MAO-B 3. Psychopharmacologic 3. Decrease in hepatic en strategies zymatic activity 32. Which of the following 4. Observation without over- 4. Decrease in concentration of EEG findings are quite concern after a major life albumin relative to globulins common in healthy elderly: change 1. Increase in resting alpha 42. Which of the following are frequency 37. The best predictor of mo- used as screening tests for 2. Focal abnormalities in rale in the elderly is (choose only organicity: the temporal regions one): 1. Halstead-Reitan 3. Focal abnormalities in A. Health 2. Benton Visual Reten the frontal regions B. Economics tion Test 4. Decrease in the resting C. Family support 3. Face-Hand Test alpha frequency D. Level of activity 4. Ammons Quick Vocab ulary Test 33. A daughter feels that her 38. The chief task of the family mother, 80 years old and in counselor to the elderly is to: good health, should not 1. Intervene in pathologi continue to drive her car. cal family dynamics 43. The correct order of 2. Displacement Kubler-Ross's stages of re- 3. Projection actions to terminal illness is 4. Conversion (choose only one): After the stage of identity A. Anger, denial, bargaining, (age 12 to 20), Erikson identifies depression, acceptance what three ocher stages of adult B. Denial, anger, bargaining, development (choose only one): depression, acceptance A. Industry, autonomy, gen- C. Denial, depression, anger, erativity bargaining, acceptance B. Intimacy, generativity, in- D. Anger, denial, depression, tegrity bargaining, acceptance C. Industry, intimacy, generativity

D. Intimacy, autonomy, gen- 44. A depression scale devel- erativity oped for and standardized 50. The drugs of choice for psy- with the aged is. chotic features in the elderly with 1. Beck delirium include: 2. Zung 1. Dibenzazepines 3. Hamilton 2. Benzodiazepines 4. Geriatric Depression 3. Lithium carbonate Scale 4. Neuroleptics 45. What percent of the elderly still provide some help for References their children (choose only one): A. Less than 20 B. More than 80 C. 20 to 50 D. 50 to 80 46. In therapy with the family of the dementia patient the therapist should: 1. First make empathic contact with their feel ings of loss 2. Raise management is sues 3. Recommend multiple family groups for sup port and education 4. Hold no more than four sessions with them 47. Which of. the following tranquilizers would be likely to be useful in the elderly due to a shorter half-life: 1. Temazepam (Restoril) 2. Flurazepam (Dalmane) 3. Triazolam (Halcion) 4. Diazepam (Valium)

48. Increased tendency to so- maticize in the elderly be can viewed as a form of: 1. Rationalization

to reveal a more neurotic Practical Geriatrics picture

6. Depression in the elderly often represents: 1. A realistic response to multiple losses Geriatric Psychiatry 2. Accumulation of -unconscious hostility against one's spouse Knowledge Test, Form 2 3. A breakdown in the denial of death 4. None of the above This month we present Form 2 of the. 2. Reduced need for sleep Geriatric Psychiatry Knowledge Test. 3. Loss of libido 7. Behavior modification has Form 1 was published last month, along 4. Complaint of memory been used with elders to with a discussion of the test's development loss improve and recommendations for use. .The test is 1. Violent tendencies designed to assess your. knowledge of 2. Pseudodementia is: 2. Incontinence certain aspects of geriatric psychiatry. Five 1. A reversible acute or 3. Reality orientation broad areas are covered: psychodynamics ganic brain syndrome 4. Schizophrenic symptoms and psychotherapy; cognitive assessment, 2. Delirium 8. Whicn of the following are psychosocial and developmental aspects, 3. A psychosomatic reac- tests of attention: psychopharmacology, and clinical tion 1. Halstead-Reitan syndromes. 4. Depression 2. Digit Span The test has 50 questions. Answers are 3. Bender-Gestalt given in the table following the test. Some 3. Which of the following are 4. Continuous Performance questions have only one correct answer generally true: Task and are clearly marked "choose only one." 1. Most elderly people have no The other questions are scored using the desire or, capacity for sexual 9. The Face-Hand Test is: following key: relations 1. A psychomotor test used A: 1, 2, and 3 are correct 2. All five senses tend to to test motor abilities B: 1 and 3, are correct decline in old age 2. Done with eyes open C: 2 and 4 are correct 3. The majority of the el- and eyes closed D: 4 alone is correct derly are senile 3. A neurological test for E: All are correct 4. Lung capacity tends to fifth cranial nerve palsy To obtain your score for each category, decline in old age 4. A screening test for dif- multiply the number of correct answers in fuse brain disease the category by 2. Consult Table 1 on page 4. In the elderly after the 1161 of the November issue for recom- death of a spouse: 10. Creutzfeldt Jacobs disease mendations about further study. To 1. Widowers tend to re- is: facilitate further study, at the end of the marry earlier 1. The same as Alzheimer's test a reference is provided for each, 2. Widows tend to remarry disease question. earlier 2. A dementia 3. Suicide is the leading cause of 3. The same as Pick's dis- 1. Extremely useful cues to death in the first four years ease depression in the elderly include: 4. No significant difference 4. Probably of viral origin 1. Reduced need for food exists in remarriage patterns of men and women 11. ECT in geriatric patients is This test was devised by.Javaid I. relatively contraindicated in: Sheikh, M.D., and Jerome A. 5. Regarding the MMPI in the 1. Patients with old myo- Yesavage, M.D., of the department of elderly: cardial infarctions psychiatry and behavioral sciences at 1. Norms are essentially the 2. Patients with bundle Stanford University School of same in young and old branch block Medicine, Stanford, California 94305. 2. The elderly generally 3. Patients with tardive score higher on hysteria dyskinesia 3- Psychotic scales are 4. Patients with intracranial higher with aging neoplasm 4. Older individuals tend

12. Benign senescent forgetful-

ness: 4. Slowing of decision time than scores of younger 1. Is usually successfully treated subjects with antidepressants 18. Cataracts are found in what D. 30 to 50 percent lower than 2. Is due to incipient de- percentage of people over 60 scores of younger subjects mentia (choose only one): 3. Is the same as pseudode- A. 3 mentia B. 9 23. The percentage pf men in their 4. May involve losses of more C. 16 sixties who are sexually active is than 20 percent in raw test D. 28 (choose only one): scores A. 90 19. In elders the early devel- B. 70 oped mother-child attachment C. 50 13. Neuroleptics in the elderly bond is considered to be: D. 30 are indicated for: 1. Replaced by other rela 1. Selected affective disor- tionships 24. A useful guide for families caring ders 2. Not crucial to psycho- for elders with dementia is 2. Senile psychosis logical health (choose only one): A. A Family 3. Paranoia secondary to 3. As strong as ever Guide to Alzheimer's Disease organic brain syndrome 4. None of the above B. The 36-Hour Day 4. Anxiety C. Strategies for Treating Se- nile Dementia 14. Dihydroergotoxine mesy- 20. By age 75 (choose only D. Living With Dementia late (Hydergine): one): 1. Is indicated in selected A. The number of taste 25. The prevalence of sleep apnea in symptoms associated with buds has doubled elderly men is as much as (choose aging B. The number of taste only one): 2. Is a nonphenothiazine buds is unchanged A. 5 percent neuroleptic C. The number of taste buds is B. 10 percent 3. Has few side effects decreased by 15 percent C. 20 percent 4. Is primarily an antide- D. The number of taste buds is D. 40 percent pressant decreased by more than 50 percent 26. The average age of onset of senile 15. Psychoanalytic therapy for dementia of the Alzheimer's type elders was recommended 21. What percent of the elderly is (choose only one): by: live in institutions (choose only A. 55 1. Sigmund Freud one): B. 65 2. Lillian Martin C. 75 3. Alfred Adler D. 85 4. None of these A. 5 percent over 65 years old and 20 percent over 90 27. When the senile and presenile 16. Which of the following are years old variants of Alzheimer's disease are part of normal aging: B. 12 percent over 65 years old and compared: 1. A decrease in the num 35 percent over 90 years old 1. The senile variant has ber of cortical neurons more sudden onset 2. A general dysregulation of C. 20 percent over 65 years old 2. The presenile variant has hypothalamic functions and 40 percent over 90 years old more sudden onset 3. A general weakening of 3. The senile variant has the vegetative reflexes D. 30 percent over 65 years old and more rapid progression 4. None of the above 59 percent over 90 years old 4. The presenile variant has more rapid progression

17. The slowing of motor per- 22. On the WAIS, the motor 28. Side effects of lithium carbonate formance with aging is due scores of the elderly should be in the elderly may appear with to: (choose only one): levels as low as (choose only one): 1. Slowing of response of A. The same as scores of A. 0.2 mEq/L effector muscles younger subjects 2. Slowing of nerve con B. 10 to 20 percent lower than duction velocity scores of younger subjects 3. Slowing of central motor C. 20 to 30 percent lower processes

B. 0.3 mEq/L 1. Changes in lean body 4. Needs to be supplemented by C. 0.4 mEq/L mass community resources D. 0.7 mEq/L 2. Hepatic enzyme activity changes 29. Deaths in the elderly fol- 3. Altered renal function 41. Which of the following lowing electroconvulsive 4. Changes in absorption EEG findings are quite common therapy are most often due in healthy elderly people: to which complications: 35. The dexamethasone sup- 1. Increase in resting alpha 1. Hypoxia pression test is often posi- frequency 2. Spinal fractures tive in elderly patients with: 2. Focal abnormalities in 3. Aspiration 1. Schizophrenia the temporal regions 4. Cardiovascular 2. Dementia 3. Focal abnormalities in 3. Sociopathy the frontal regions 30. Which of the following neu- 4. Major depression 4. Decrease in the resting rotransmitter metabolites alpha frequency have been found to be de 36. A full depressive syndrome creased in senile dementias: is seen in what percentage 42. Which of the following 1. Acetylcholine of elders who lose their neuropathologic findings are seen 2. Norepinephrine spouse (choose only one) in primary degenerative 3. Serotonin A. 20 dementia: 4. Dopamine B. 35 1. Neurofibrillary tangles C. 50 2. Lipofuscin D. 65 3. Plaques 31. Routine psychometric test- ing may not assess the true 4. Increased mitochondria 37. A relatively optimistic out- cognitive abilities of the elderly look for psychotherapy with because of: 43. In elderly hypertensives elders was supported by: treated with guanethidine, which 1. Decreased performance 1. Jung speed of the following might block 2. Anna Freud guanethidine activity: 2. Increased distractability 3. Abraham 3. Decreased sensory func 1. Doxepin (Sinequan) 4. Harry Stack Sullivan 2. Imipramine (Tofranil) tion 4. Increased intraindividual 38. A diagnosis of depression is 3. Chlorpromazine (Thora variability more likely to be missed in the zine) elderly because of: 4. Flurazepam (Dalmane)

32. All but one of the following 1. Pseudodementia 44. Which of the following are symptoms are commonly of 2. Somatic manifestations used as screening tests for concern to families with demented of normal aging organicity: elderly living with them: 3. Reactions from pre 1. Halstead-Reitan A. Catastrophic reactions scribed medications 2. Benton Visual Reten B. Inappropriate sexual be 4. Paraphrenic reactions havior tion Test C. Daily care of self 39. Which one of the following 3. Face-Hand Test D. Suspiciousness problems is cited least often by 4. Ammons Quick Vocab families caring for demented ulary Test

33. The reality orientation ap- elders at home (choose only one): 45. Which of the following proach to the patient with A. Depression transference-countertrans- dementia should focus on which B. No time for self ference problems might arise in of the following: C. Fatigue therapy with the elderly: 1. Ambitious plans about D. Guilt the future 1. The therapist will identify with 2. Where he or she is 40. For the older patient in the the elder's helplessness 3. The current political sit U.S., the extended multi- 2. The therapist will overprotect uation generational family: the elder from interpretations 4. What time of day it is 1. Is nonexistent 3. The elder will view the 2. Is unimportant for adequate therapist as his or her 34. Which of the following are psychological functioning important factors in altered drug 3. Is undergoing rapid metabolism in the elderly: modification child 4. The therapist will not see the elder as sexually active

46. Which of the following antidepressants is sedating and relatively low in anticholinergic activity: 1. Trazodone (Desyrel) 2. Amitryptyline (Elavil) 3. Doxepin (Sinequan) 4. Imipramine (Tofranil) 47. The correct order of Kubler-Ross's stages of reactions to terminal illness is (choose only one): A. Anger, denial, bargaining, depression, acceptance B. Denial, anger, bargaining, depression, acceptance

C. Denial, depression, anger, bargaining, acceptance

D. Anger, denial, depression, bargaining, acceptance 48. A depression scale devel- oped for and standardized with the aged is: 1. Beck 2. Zung 3. Hamilton 4. Geriatric- Depression Scale 49. In a depressed elderly man with a prostatic enlargement, which of the following drugs would be preferable (choose only one): A. Amitryptyline B. Nortriptyline C. Imipramine D. Desipramine 50. Increased tendency* to so- maticize in the elderly can be viewed as a form of: 1. Rationalization 2. Displacement 3. Projection 4. Conversion