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Approximately one-third of patients with alzheimer disease, parkinson disease, and vascular dementia experience psychotic symptoms. Antipsychotics can be safe and effective for the treatment of schizophrenia in the elderly, if used at lower doses than those commonly used in younger adults. Older adults are particularly vulnerable to the side effects of the fgas. Pseudoparkinsonism reportedly occurs in more than 50% of elderly patients receiving these agents, and the cumulative annual incidence of td in middle-aged and elderly patients is greater than 25%. Limited data suggest the risk of td to be approximately 4% with the sga and the likelihood of reversing this condition diminishes with age. 35 orthostasis, estimated to occur in 5% to 30% of geriatric patients, is a major contributing factor to falls that often lead to injuries and loss of independence. Low-potency antipsychotics and clozapine are more likely to cause significant orthostasis. Antipsychotics may cause or worsen anticholinergic effects, including constipation, dry mouth, urinary retention, and cognitive impairment. Greater antipsychotic-associated impairment 574  section 6  |  psychiatric disorders table 37–7 second-generation antipsychotic dosing recommendations for special populations medication pediatric aripiprazole ages 13–17 years no oral adjustment (schizophrenia). Initiate 2 mg necessary every day, increasing to 5 mg daily after 2 days and target of 10 mg after several days, 30 mg/day maximum no pediatric fda indication no adjustment necessary asenapine clozapine iloperidone lurasidone olanzapine paliperidone quetiapine geriatric renal impairment hepatic no adjustment necessary no adjustment necessary no adjustments necessary no adjustment necessary for mild to moderate impairment, but use not recommended in severe impairment no pediatric fda indication experience is limited. Adjustments may be necessary with adjustments may be low dose and slow significant impairment. No specific necessary with significant titration recommendations available impairment. No specific recommendations available no pediatric fda indication no adjustment no adjustment information no adjustment needed necessary provided, but unlikely necessary for mild impairment. Exercise caution with moderate impairment. Not recommended for severe impairment no pediatric fda indication no adjustment with moderate to severe renal with moderate impairment, required impairment, recommended initial dose 20 mg daily.

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Kearon c, akl ea, comerota aj, et al. Antithrombotic therapy for vte disease. Antithrombotic therapy and prevention of thrombosis, 9th ed. American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 suppl):E419s–e494s. 3. Bates sm, jaeschke r, stevens sm, et. Al.

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Again, missing the right stimulus state (yes or no vibration) consistently or more times than can be expected would constitute an abnormality. When the tuning ork is struck, the examiner needs to employ methods to mask any auditory clue. He extent o regions examined depends on the expected type o abnormality. I a cord lesion is suspected, one can “go up” the body even over the spine to determine i there is a “level.” i a hemispheric lesion is o concern, then comparison o the 2 sides needs to be the ocus. Proprioception. T is is usually done over the terminal digits o the toes and ngers but can be employed over larger joints such as ankle and wrist. T e patient can be taught that the examiner will move the distal joints minimally either up or down by grasping the sides o the digits and minimizing clues such as brushing the skin o the other digits or applying pressure over the nails. T en with eyes closed, the digits are moved by the smallest excursion possible either up or down and the ability o the patient to detect the motion is examined. A consistent inability do this will be an abnormality. Appr oach t o sensor ych anges it can be di cult in some persons, and or each stimulus, the patient has a 50% chance o being right with random answers. One can ask i the patient can actually eel the right direction o movement. T e 4th digit o the oot is thought to be especially sensitive to this test. Both vibration and kinesthetic sense are served by large myelinated bers in peripheral nerves and by posterior columns. Case 40 1 (continued ) you examine the patient. The examination shows an area o decreased touch and pain sensation on the anterolateral aspect o the le t thigh. Muscle strength in lower limbs is normal as are muscle stretch re exes. What is the likely diagnosis in this case?. T e presentation is typical or meralgia paresthetica. T is results rom compression o the lateral emoral cutaneous nerve o the thigh usually under the ilio-inguinal ligament. T is is purely a cutaneous nerve and does not cause associated motor or ref ex changes. T ere are unpleasant paresthesia and dysesthesia on the anterolateral thigh. What are the common causes o this condition?. It is o en associated with weight gain, pregnancy, tight belts, and metabolic disorders such as diabetes mellitus. Occasionally, a similar syndrome can occur with injury to the nerve during pelvic surgery.