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1 results

  • Case 41 - “I Don’t Feel Well”

  • Matthew Gibfried, Saint Louis University School of Medicine, Missouri, George T. Grossberg, Saint Louis University School of Medicine, Missouri
  • Book:
    Clinical Case Studies in Long-Term Care Psychiatry
    Published online:
    31 October 2024
    Print publication:
    14 November 2024, pp 206-210

  • Summary

    Drugs for overactive bladder such as tolterodine and oxybutynin and other anticholinergic drugs (diphenhydramine, hydroxyzine) may precipitate delirium and should be used with great caution in residents who are frail, have pre-existing MNCD, have a history of liver disease, or are taking multiple drugs metabolized through the Cytochrome PCY450 system. Urinary incontinence in older patients can have significant psychiatric implications, including depression, anxiety, social isolation, and decreased quality of life. There are six major categories of urinary incontinence, including stress incontinence, urge incontinence, mixed incontinence, overflow incontinence, functional incontinence, and total incontinence. There are two general classes of medications used to treat overactive bladder. These include antimuscarinic (anticholinergic) agents such as oxybutynin and tolterodine and beta-3 adrenergic agonists such as mirabegron and vibegron. The beta-3 adrenergic agents are preferred as they are not anticholinergic and are not included on the Beer’s list.