1B psychiatry across the lifecourse Flashcards
What percent of global burden of disease and injury in people age 10-19 y/o is mental health related?
16%
Describe the approach to child and adolescent mental health
- Bio-psycho-social model
- Systemic approach (focus on relationships and social context e.g. school, family)
- 4 Ps formulation:
- Predisposing factors
- Precipitating factors
- Perpetuating factors
- Protective factors
What age do mental health conditions start?
50% start by 14 y/o but are undetected and untreated until much later
What is Erikson’s stages of psychological development?
What is important to know about the adolescent brain?
- The prefrontal cortex matures later than the cortical areas associated with sensory and motor tasks
- Adolescence is period of neural imbalance caused by early maturation of subcortical brain areas & delayed maturation of prefrontal control areas
What is the median age onset of mental health disorders?
The proportion of people with onset of any mental disorder before age of 18 is 48.4%
Match the condition with the case description
Match the condition with the case description
What are the core features and diagnostic criteria for ADHD? (7)
According to DSM-5 :
- Persistent pattern of inattention and hyperactivity
- Present for at least 6 months
- Inappropriate for their developmental level
- Interferes with functioning or development
- Several symptoms present before age 12
- Several symptoms present in 2 or more settings
- Symptoms are not better explained by another mental disorder
What are the genetic risk factors for ADHD?
- No isolated gene for ADHD, there may be several genes contributing to the vulnerability for developing it
- Twin studies show significant hereditability for ADHD - as high as 76%
- First degree relatives of children of those with ADHD 4-5x higher diagnostic probability of general population
- Boys are more vulnerable than girls (2:1-3:1)
- 3-4% prevalence
- Subtypes: 20-30% inattentive, 15% hyperactive, 50-75% combined
What are the environmental risk factors for ADHD?
- Premature birth weight
- Low birth weight
- Prenatal tobacco exposure
What is the prognosis like for ADHD?
70% of children who have this disorder will have disorder as teenagers and about 40-60% will still have it as adults
Define dementia
An umbrella term that has many underlying causes
Degenerative disease of brain with:
- Irreversible and progressive changes
- Global cognitive and behavioural impairment
- Sufficiently severe to interfere significantly with social and occupational function
Can be conceptualised as ‘chronic brain failure’.
What are the causes of dementia?
Reversible causes (not exhaustive):
- Normal pressure hydrocephalus
- Intracranial tumours
- Subdural haematoma
- Depression
- B1, B6, B12 deficiency
- Folate deficiency
- Hypothyroidism
- Neurosyphilis
- Delirium
Always think to exclude – Surgical, metabolic, infective and psychiatric reversible causes for cognitive impairment
What does this show?
Example of normal pressure hydrocephalus. Note the dilated ventricles. Clinically presents with the Hakim-Adams triad;
- Cognitive impairment/confusion
- Urinary frequency/incontinence
- Gait disturbance (magnetic/stuck to the floor gait)
What are the clinical features of mild dementia?
- Living independently but some supervision/support often needed
- Can participate in community activities and can appear unimpaired to those who do not know them
- Judgement and problem solving typically impaired
- Social judgement may be preserved
- Difficulty making complex plans/decisions and handling finances
What are the clinical features of moderate dementia?
- Require supports to function outside the home and only simple household tasks are maintained
- Difficulties with basic activities of daily living (ADL’s), such as dressing and personal hygiene
- Significant memory loss
- Judgment and problem solving are typically significantly impaired, and social judgment is often compromised
- May have difficulty communicating with individuals outside the home without caregiver assistance
- Socializing is increasingly difficult as the individual may behave inappropriately (e.g., in disinhibited or aggressive ways), with associated behaviour changes (e.g., calling out, clinging, wandering, disturbed sleep, or hallucinations)
- Difficulties are often obvious to most individuals who have contact with the individual
What are the clinical features of severe dementia?
- Severe memory impairment
- Often disoriented to time and place
- Often unable to make judgments or solve problems
- May have difficulty understanding what is happening around them (situational awareness)
- Dependent on others for basic personal care )bathing, toileting and feeding)
- Urinary and faecal incontinence may emerge at this stage
What is BPSD?
Behavioural and Psychological Symptoms in Dementia
- Common in dementia
- Includes apathy, mood disturbances, hallucinations, delusions, irritability, agitation, aggression and sleep changes
- Typically, these symptoms are more frequent and impairing in moderate and severe forms of dementia
What is the MMSE?
Mini Mental State Examination
Describe the epidemiology of dementia
- Worldwide, 47.5 million people have dementia.
- Expected to reach 75.5 million by 2030 and 135.5 million by 2050
- Number 7 on WHO list of leading global causes of death; number 2 in high income countries
- UK, dementia is leading cause of death in women and is second to heart disease for men
- Most common cause of dementia is Alzheimer’s disease (AD), 70% of cases
- Risk of AD increases with age:
- 1% at age 60yrs
- doubles every 5yrs
- 40% of those aged 85yrs
