Geriatric Pharmacotherapy - Health Psychopharmacology for Therapists
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Transcript of Geriatric Pharmacotherapy - Health Psychopharmacology for Therapists
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PsychopharmacologyLecture 14 - Psychopharmacology of Aging
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Colorized image of axon button with vesical of neurotransmitters
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Gladys Wilson is in the later stages of her experience of dementia - we often step back & let the person go seeing only a shell. This teaches us that everybody can be reached. I felt some discomfort watching initially but had to put that down to my arrogance when I saw the end,
Validation Therapy
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Here is the work…
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Modern culture has created the illusion that the
self is in the brain
Where Is The Self?
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Some Factors in Aging
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Ages of Brain Maturity
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Aging Mind – Aging Brain – Aging Self
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Aging Mind and Neurodegeneration
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Aging Mind
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Environmental Changes
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Dopamine Reduction w Aging• Dopamine – Aging brains have
changes in dopamine synth., receptors and binding sites. • Dopamine loss may relate to loss of
brain tissue, change in cognitive flexibility, and postural rigidity. • Specific Systems• D2 & D3 - Reductions in anterior
cingulate cortex, frontal cortex, lateral temporal cortex, hippocampus, medial temporal cortex, amygdala, medial thalamus, and lateral thalamus• D1 & D2 – Caudate nucleus and
putamen.
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Serotonin Reduction w Aging• Decreased levels of serotonin
receptors. • Specific Systems: • S2 Receptor declines in
caudate nucleus, putamen, and frontal cerebral cortex, decline with age. • Decreased binding capacity
in frontal cortex (5-HT2)• Decreased 5-HHT
transporter in the thalamus and the midbrain.
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• Glutamate reduction is found in normal aging.
• Specific Areas:
• Motor Cortex (Normal Aging)• Parietal lobe (Dementia)• Basal ganglia (Dementia)• Frontal lobe (Normal Aging)
Glutamate Reduction w Aging
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• Decreased dendritic arboring (responsible for the majority of loss in brain density with aging). • Brain Area Loss: Insular, Superior
parietal gyri, Frontal and temporal cortex, Putamen, Thalamus, and Accumbens.• Neurocognitive Changes:
processing speed, executive functions, and episodic memory--are seen in healthy aging
Structural and Functional Changes in Normal Aging
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• Benzodiazepines most common antianxiety medications prescribed for elders: alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin), diazepam (Valium), and temazepam (Restoril) • Elimination and Clearance rates are reduced in elders. • Increased magnitude of sedation, memory, and psychomotor impairment. • Long-term use is contraindicated due to exacerbation of cognitive decline, and increased fall rates.
Psychotropic Medication Use among Older Adults: What All Nurses Need to Know. J Gerontol Nurs. 2009 September; 35(9): 28–38. doi: 10.3928/00989134-20090731-01
Benzodiazepines and Elders
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Aging
well
Outlook on Life
• Mental Health• Self-Efficacy• Valued by
community spirituality
Connections• Piratical
support• Social support• Engagement in
life • Hoppy
Physical Health
• Physical activity• Nutrition and food
security• ADLs• IADLs
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Triangle of Well Being
MIND
RELATIONSHIPS
BRAIN
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Antidepressants• SSRIs – More effective and less severe
side-effects.
• SSRI - Side-effects include headache, gastrointestinal disturbances, increased sweating, and sexual dysfunction.
• TCA’s increase risk of falls, psychomotor retardation, sedation, orthostatic hypotension, anticholinergic effects (e.g. blurred vision and cognitive impairment)
Psychotropic Medication Use among Older Adults: What All Nurses Need to Know. J Gerontol Nurs. 2009 September; 35(9): 28–38. doi: 10.3928/00989134-20090731-01
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• Anxiety, nervousness, increase worry
• Apathy• Cognitive complaints(Difficulty
with concentration and memory)• Confusion• Irritability• Lack of energy/fatigue• Lack of feeling of emotion• Low motivation• Slowed movements• Unexplained somatic complaints
Atypical Symptoms of Depression in Elders
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• Frequently administered for behavioral disturbances.
• Older adults are more at risk for tardive dyskinesia, acute extrapyramidal side effects (EPSEs), and neuroleptic malignant syndrome (NMS).
• “U.S. Food and Drug Administration (FDA) have emerged regarding the use of these medications with older adults due to cardiac, cerebrovascular, and mortality risks associated with their use in patients with dementia”• Antipsychotic drugs can cause parkinsonism and lower the seizure
threshold, elderly patients with a history of Parkinson's disease or seizure disorders should be monitored closely. Psychotropic Medication Use among Older Adults: What All Nurses Need to Know. J Gerontol Nurs. 2009 September; 35(9): 28–38. doi: 10.3928/00989134-20090731-01
Antipsychotic Medications for Elders
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• Cohen-Mansfield (2005) recommended the following non-pharmacological interventions to prevent or manage disruptive behaviors: • Social support and contact (e.g., talking with the person,
video or audiotapes of family members, music therapy, pet therapy, dolls, massage)
• Engaging activities (e.g., stimulation, active engagement, and allowing self-stimulation)
• Relief from discomfort (e.g., pain, hearing or vision problems, positioning, and addressing activity of daily living needs).
Psychotropic Medication Use among Older Adults: What All Nurses Need to Know. J Gerontol Nurs. 2009 September; 35(9): 28–38. doi: 10.3928/00989134-20090731-01
Behavioral Interventions for Behavioral Challenges
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• Lithium:• has been commonly prescribed. Due to
changes in metabolism and low threshold for lethalitythis medication needs close monitoring.
• Anticonvulsants:• Are commonly prescribed and reportedly well
tolerated. sedation, tremor, and gait disturbance, were common in bipolar PT prescribed medications. Depakote half-life is prolonged.
Young, R. (2005) Evidence-Based Pharmacological Treatment of Geriatric Bipolar Disorder.
Anticonvulsants and Lithium