Geriatric Psychiatry Study Guide

Geriatric Psychiatry Study Guide Mastering the Competencies Ana Hategan James A. Bourgeois Tracy Cheng Julie Young 123 Geriatric Psychiatry Study Guide Ana Hategan • James A. Bourgeois Tracy Cheng • Julie Young Geriatric Psychiatry Study Guide Mastering the Competencies Ana Hategan James A. Bourgeois Department of Psychiatry and Behavioural Department of Psychiatry Neurosciences Baylor Scott and White Health McMaster University Central Texas Division Hamilton, ON Dallas, TX Canada USA Department of Psychiatry Tracy Cheng Texas A&M University Health St. Joseph’s Healthcare Hamilton Science Center McMaster University College of Medicine Hamilton, ON Temple, TX Canada USA Julie Young Mercy San Juan Medical Center Farmington, NM USA ISBN 978-3-319-77127-4 ISBN 978-3-319-77128-1 (eBook) https://doi.org/10.1007/978-3-319-77128-1 Library of Congress Control Number: 2018938794 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by the registered company Springer International Publishing AG part of Springer Nature. The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface Physician trainees in general psychiatry and the subspecialty of geriatric psychiatry need to master core competencies in geriatric psychiatry. Equally importantly, prac- ticing psychiatrists confronting recertification examinations and/or desirous of a quick review of geriatric psychiatry can benefit from a concise, case-focused and question-based review of the current practice of geriatric psychiatry. This book is designed to provide short-answer question-based learning centered on the core cur- riculum topics in geriatric psychiatry. It features over 300 short-answer questions, each comprising the stem of a clinical scenario or concise question. The answers include succinct discussions, pertinent illustrations, and source references. The format is practical and concise, designed to enhance the reader’s clinical understanding and diagnostic skills, and the ability to critically manage an older adult presenting with psychiatric symptoms. This book is intended for physicians in training as well as for physicians who have previously mastered the clinical material and need something more concise on occasion. It will also be of use to professionals in other clinical disciplines. Medical students and graduate students in other disciplines may find the questions and answers a useful addition to their resources during their clinical placements involving the care of older adult patients. This small-size book knits together evidence-based geriatric psychiatry princi- ples and practice guidelines in a practical and problem-oriented guide for learners at all levels of experience. Unless otherwise specified in this text, “geriatric” and “older adults” refer to those aged 65 years or older. The material covered matches the common existing postgraduate curricula in geriatric psychiatry and helps prepare candidates for their specialty and subspecialty certification examinations. Because various national boards have different examination styles, the questions are written for knowledge and style commonality. Moreover, this book lists the questions by the specific topic rather than a random amalgamation of questions and case scenarios, making it an easy-to-reference text. This study guide provides evidence-based information and contemporary clinical guidelines for diagnosis and management of geriatric psychiatric disorders. The advantages of this short-answer questions format are manifold: it is learner-focused, allows for active learning and self-directed learning skills, enhances content knowledge while simultaneously fostering critical thinking, and optimally positions read- ers to prepare for real-world examination experiences. v vi Preface Written and edited by expert psychiatrists and educators, Geriatric Psychiatry Study Guide: Mastering the Competencies covers main topics within geriatric psychiatry, with some specific topics such as aging with neurodevelopmental disorders, substance use disorders, and sexuality and sexual dysfunctions in later life becom- ing even more relevant now that the Baby Boomers are aging. Since delirium so often presents in the context of other psychiatric illnesses, the authors have included delirium cases in many other chapters, where delirium is managed along with the other psychiatric comorbidities. The authors believe this approach presents patients with all of the complexities that they live with and illustrates the need for the psy- chiatrist to always actively manage all other psychiatric illnesses that co-present with delirium. We hope that this text becomes a valuable reference and teaching tool that provides an opportunity for learning across a rapidly growing field. Hamilton, ON, Canada Ana Hategan, M.D. Temple, TX, USA James A. Bourgeois, O.D., M.D. Hamilton, ON, Canada Tracy Cheng, M.D. Farmington, NM, USA Julie Young, M.D. Contents Topic 1 : Physiology and Pathology of Aging �� 1 Topic 2 : Neuropsychology and Neuroimaging in Clinical Geriatric Psychiatry . 23 Topic 3 : Pharmacotherapy, Somatic Therapies, and Psychotherapy in Late Life �� 39 Topic 4 : Ethics and Law . 61 Topic 5: Late-Life Depressive Disorders, Bipolar Disorders, and Psychotic Disorders . 89 Topic 6 : Late-Life Anxiety Disorders, Obsessive- Compulsive and Related Disorders, and Trauma- and Stressor-Related Disorders . 109 Topic 7: Substance Use Disorders in Older Adults �� 131 Topic 8: Comorbid Systemic Medical and Psychiatric Illness in Older Adults �� 163 Topic 9: Common Major and Mild Neurocognitive Disorders: Alzheimer Disease, Frontotemporal, Lewy Body, and Vascular Types . 203 Topic 10: Other Major and Mild Neurocognitive Disorders: Parkinson Disease, Atypical Parkinsonism, and Traumatic Brain Injury Types . 243 Topic 11: Neuropsychiatric Symptoms Due to Major and Mild Neurocognitive Disorders �� 269 Topic 12: Sleep-Wake Disorders in Late Life . 293 Topic 13: Personality Disorders in Late Life �� 311 Topic 14: Aging with Neurodevelopmental Disorders: Intellectual Disability and Autism Spectrum Disorder . 333 vii viii Contents Topic 15: Emergencies in Geriatric Psychiatry �� 351 Topic 16: Sexuality and Sexual Dysfunctions in Later Life �� 375 Topic 17: Elder Abuse and Neglect �� 389 Topic 18: End-of-Life Care �� 405 Topic 19: Caregiver Burnout . 433 Topic 20: Physicians as Leaders in Improving Healthcare . 443 Index �� 453 Topic 1: Physiology and Pathology of Aging Question 1.1 Mrs. A is 89 years old and has been a widow for the past 2 years. She lives alone in a two-story house, while her only family member, her 62-year-old son, lives overseas. She is a retired administrative assistant and has a reasonably good income. She has had varied interests throughout her life; most notably she likes reading and music. Mrs. A no longer drives and depends on a friend to drive her places, including to the medical appointments with her primary care physician, local bank, shopping, church, community library, and visiting another friend at a retirement home. Mrs. A has been having increasingly poor health over the past 5 years. She has a diagnosis of recurrent major depressive disorder, osteoporosis, hypertension, chronic kidney disease, chronic obstructive pulmonary disease, peripheral neuropathy, and hearing and vision impairment for which she declined to wear hearing aids and corrected lenses, respectively. She quit smoking 40 years ago. Last year, she sustained compression fractures of the T12-L2 vertebrae and right hip fracture from a fall while getting out of bed. Her mobility has declined considerably since her hip repair so that she now uses a walker

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