Self-Assessment

A 75 year old man with a history of Alzheimer’s disease is brought to the psychiatrist by his son who is also his caretaker. The patient suspects that his neighbor has been stealing his clothes and selling them over the internet. Recently, he made loud accusations during a family gathering, but when his family redirected his attention, he became calm and pleasant again. On exam, he is awake and alert, and he jokes with the examiner and his son. Medical and laboratory evaluation is unremarkable. He takes donepezil and simvastatin. What is the most likely etiology of his behavior?
1. Normal age-related thought content
2. Delusion of theft related to Alzheimer’s disease
3. Persecutory delusion from late onset schizophrenia-like psychosis
4. Delirium
What would be the most appropriate next step in treatment?
1. Begin risperidone 0.5mg
2. Discontinue donepezil
3. Reassure and provide information environmental modification
4. Recommend nursing home placement
Which of the following increase the risk of tardive dyskinesia:
1. A pre-existing movement disorder
2. History of alcohol dependence
3. Older age
4. Duration of neuroleptic treatment
5. All of the above
A 78 year old man with early dementia experiences fluctuations in levels of attention, well formed visual hallucinations, and parkinsonism. Medical and laboratory evaluation does not reveal any other acute illness contributing to his symptoms. What is his most likely diagnosis?
1. Parkinson’s disease dementia
2. Alzheimer’s dementia
3. Delirium
4. Dementia with Lewy Bodies
His condition makes him especially susceptible to which antipsychotic side effect:
1. Dyskinesia
2. Weight gain
3. Cardiac conduction abnormalities
4. Cataracts
Of the following patients, who is likely to need the lowest dose of antipsychotic:
1. A 76 year old with a one year history of psychotic symptoms
2. A 76 year old who has had schizophrenia since the age of 25
3. A 76 year old with late-onset schizophrenia that started at age 50
Which of the following has documented efficacy for psychotic symptoms in Lewy Body Dementia?
1. Memantine
2. Galantamine
3. Diphenhydramine
4. Lorazepam
Patients with late-life depression, when compared to patients with early onset depression, are more likely to experience psychotic features:
1. True
2. False
Patients with late-life depression, when compared to patients with early onset depression, are more likely to experience delusions that are:
1. Bizarre
2. Persecutory
3. Nihilistic
4. Erotomanic

Evaluation and Management of Late Life Psychosis: Self-Assessment