👴 Geriatric Mental Health

Precision Medicine, Pharmacovigilance, and Systems Integration

General Psychiatry Topic 18

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📊 The 2060 Challenge

Alzheimer's cases projected to DOUBLE by 2060

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🧬 Blood-Based Biomarkers (2025)

Tier Performance Clinical Use
Tier 1 (Triaging)≥90% Se, ≥75% SpRules out AD; pivot if negative
Tier 2 (Confirmatory)≥90% Se & SpStandalone diagnostic; DMT pathway

Target: p-tau217 correlates with amyloid load

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🧠 BPSD Management

DICE Approach

  • Describe behavior as communication
  • IInvestigate causes (delirium, pain, UTI)
  • Create psychosocial plan first
  • Evaluate response

Medication Hierarchy

  • Moderate agitation: Citalopram (max 20mg)
  • Severe: Risperidone short-term
  • LBD: Pimavanserin (NOT D2 antagonists)
  • Avoid: Benzodiazepines
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💊 Geriatric Pharmacokinetics

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⚕️ Depression in Heart Failure

  1. Screen with PHQ-9
  2. Rule out: hypothyroidism, anemia, sleep apnea
  3. Avoid: TCAs (type 1A antiarrhythmic)
  4. Preferred: Sertraline (SADHART-CHF)
  5. Monitor: QTc with citalopram; hyponatremia with SSRIs + diuretics
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