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Mental Health (Junior Block) > 1) Organic Disorders > Flashcards

1) Organic Disorders Flashcards

1
Q

Define the term dementia clinically with reference to it’s presentation.

A

Progressive decline of global cognitive function (6 months or over) with:

  • Memory decline
  • Decline in intellect
  • Loss of emotional control and socio-behavioural problems
  • Effects on daily living
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2
Q

What are the four A’s of Alzheimer’s disease?

A
  • Aphasia
  • Agnosia
  • Apraxia (can’t carry out previously learnt movements)
  • Amnesia
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3
Q

Describe the pathology underlying Alzheimer’s disease.

A

Cortical dementia of temporal and parietal lobes with atriophy of hippocampus where there is:

  • Neurofibrillary tangles of Tau protein which have become hyperphosphorylated, stable and twisted
  • Senile plaques of enlarged axons, synaptic terminals & dendrites with deposited amyloid protein (Beta amyloid)
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4
Q

Which allele is found in 15-20% off Alzheimer’s disease patients?

A

apoE4 allele

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5
Q

Suggest three gross features that may be found on examination of a patient with dementia.

A
  • Wide sulci
  • Enlarged ventricles
  • Atrophied/shrunken gyri
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6
Q

Suggest FOUR risk factors for dementia.

A
  • Genetic
  • Vascular causes such as:
    + Smoking, alcohol
    + Cholesterol
    + Diabetes
    + Hypertension
  • Psychological (stress, mental disorders)
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7
Q

Suggest FOUR protective factors against dementia.

A
  • Antioxidants
  • Vitamins
  • Mental activity (crossword, sudoku)
  • Physical activity
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8
Q

What type of dementia occurs below the age of 65?

A

Pre-senile

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9
Q

Suggest TWO possible things that may be found in the CSF of a patient with dementia.

A
  • Beta amyloid

- Tau protein

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10
Q

Suggest THREE reversible causes of dementia.

A
  • Neurosyphillis
  • Thiamine/B12 deficiency
  • Hypothyroidism
  • Normal pressure hydrocephalus
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11
Q

Suggest TWO neurological causes of subcortical dementia.

A
  • Idiopathic parkinson’s disease

- Huntingdon’s disease

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12
Q

What is Pick’s disease? How does it present?

A

Selective atrophy of frontal & temporal lobes

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13
Q

What is the first line treatment for Alzheimer’s disease?

A

Acetylcholineesterase inhibitors

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14
Q

Describe the presentation of dementia with Lewy bodies.

A
  • Visual hallucinations (may see little/big people - lilluputian )
  • Parkinsonism
  • Fluctuation in alertness
  • Memory loss can be a LATE feature
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15
Q

Describe the underlying pathology of dementia w/ Lewy bodies.

A

Alpha synuclein & ubiquitin become deposition in limbic areas

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16
Q

Describe how acetylcholineesterase inhibitors work in dementia.

A

In dementia there is degradation of cholingeric neurones which means there is ACh, which is why giving drugs to increase it slows the progress of dementia.

17
Q

Why are antipsychotics contra-indicated in dementia with Lewy bodies patients?

A

Neuroleptic sensitivity - risk of neuroleptic malignant syndrome

18
Q

Which TWO dementias are acetylcholineesterase inhibitors thought to be most effective?

A
  • Alzheimer’s disease

- Dementia with Lewy bodies

19
Q

Describe the pattern of progression of vascular dementia.

A

Stepwise deterioration with sudden drops in cognition followed by plateaus.

20
Q

In which gender is Alzheimer’s disease more common? How much by?

A

Women - almost twice as common

21
Q

Other than the 4 As of Alzheimer’s suggest THREE other parts of the clinical presentation.

A
  • Behavioural changes
  • Depression
  • Hallucinations & delusions are possible
22
Q

Define the term delirium.

A

Acute global impairment of cognition resulting in disturbances of attention and conscious level. It can be predominately hypoactive, hyperactive or switch between the two

23
Q

Suggest THREE possible causes of delirium.

A
  • Infection (common)
  • Drugs
  • Acute systemic illness
  • Acute CNS disorders (stroke, encephalitis)
24
Q

Suggest FOUR drugs that may be cause delirium.

A
  • Opiates
  • Anaesthetics
  • Steroids
  • Diuretics
  • Anticholinergic & antiparkinsonian
  • Psychotropic drugs (antidepressants, antipsychotics & BZDs)
25
Q

What type of hallucinations may accompany delirium?

A

Visual

26
Q

At what point of the day is delirium commonly worse?

A

Night

27
Q

Suggest some of the possible risk factors for developing delirium.

A
  • Hip fracture (current)
  • Extremes of age
  • Pre-existing dementia/cognitive impairment
28
Q

Suggest TWO ways

A
  • AMT or clock drawing

- Inattention test

29
Q

Contrast hypoactive (majority of cases) with hyperactive delirium.

A
  • Hypoactive patients who are usually quiet, sleepy and inactive
  • Hyperactive patients are more aroused and can be found wandering in restless, irritable agitation.
30
Q

What tool can be used to screen for delirium?

A

Confusion assessment method (CAM)

31
Q

How can delirium be treated?

A
  • Treat underlying condition
  • Maintain hydration & nutrition
  • Low dose haloperidol or olanzapine (as there is less chance of sedation)

Mental Health (Junior Block) (13 decks)

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