4.9 - Psychiatry across the lifecourse Flashcards
What kind of approach does the biopsychosocial model allow?
Systemic approach (focus on relationships and social context e.g. school, family)
What are the four Ps of formulation in the biopsychosocial model?
- predisposing factors (firewood)
- precipitating factors (the spark - triggers)
- perpetuating factors (someone adding in firewood)
- protective factors (someone putting out fire - support, treatment)
What % of global burden of disease and injury in people aged 10-19 years do mental health conditions account for?
16%
What age do mental health conditions generally start?
Half of all mental health conditions start by 14 years of age but most cases are undetected and untreated
What are Erikson’s Stages of Psychosocial Development? (approximate age - psychosocial crisis/task - virtue developed)
- infant to 18 months - trust vs mistrust - hope
- 18 months to 3 years - autonomy vs shame/doubt - will
- 3 to 5 - initiative vs guilt - purpose
- 5 to 13 - industry vs inferiority - competency
- 13 to 21 - identity vs confusion - fidelity
- 21 to 39 - intimacy vs isolation - love
- 40-65 - generativity vs stagnation - care
- 65+ - integrity vs despair - wisdom
What is it important to know about the adolescent brain?
- the prefrontal cortex matures later than the cortical areas associated with sensory and motor tasks
- adolescence is a period of neural imbalance caused by early maturation of subcortical brain areas and delayed maturation of prefrontal control areas
What is the peak age of onset for attention deficit hyperactivity disorder (ADHD)?
12
What is the peak age of onset for autism spectrum disorder (ASD)?
9
What is the peak age of onset for eating disorders?
17
What is the proportion of individuals with onset of any mental disorders before the age of 18?
48.4%
Match the condition with the case description:
10yo girl, does not want to sleep in the room alone, gets raised heart rate, sweating and difficulty breathing in crowded places and does not like doing presentations in class
Anxiety disorder
Match the condition with the case description:
10yo boy, several attendances to GP and emergency department with recurrent abdominal pain, no physical cause found so far
Somatisation disorder (bodily distress disorder)
Match the condition with the case description:
15yo young woman with tiredness, sleeping 12h/day, irritability and reduced enjoyment from her hobbies
Depressive disorder
Match the condition with the case description:
4yo boy, language is behind peers in class, does not interact much with others, prefers watching buses/trains to playing in playground
Autism spectrum disorder
Match the condition with the case description:
8yo boy who has been fidgeting in lessons, speaking out of turn and struggling to stay focused on homework tasks
And what is this treated with?
ADHD (treated with amphetamines)
Match the condition with the case description:
9yo boy, has been using increasing amounts of alcohol hand gel, wearing rubber gloves when going outdoors and lining up the toys in his room before going to sleep
Obsessive compulsive disorder (OCD)
Match the condition with the case description:
10yo boy with involuntary movements in the face, neck and arms as well as making sounds which are not context-appropriate
Tic disorder / Tourette’s syndrome (if severe enough)
Match the condition with the case description:
15yo young man with conduct disorder has been truanting from school and stealing mother’s credit cards; he was found smelling of cannabis, and more recently has been smoking it in his bedroom
Substance misuse
Match the condition with the case description:
16yo young woman who has been cutting herself with a razor when feeling distressed, and recently has bough several packets of paracetamol
Self-harm
Match the condition with the case description:
14yo girl who has been spending a lot of time thinking about her weight, has cut out carbohydrates from her diet, has been skipping breakfast and is using grandfather’s laxatives to lose weight
Eating disorder (anorexia nervosa)
What are the basic similarities/differences between anorexia nervosa and bulimia?
- both can involve binging and purging (e.g. using laxatives and exercise)
- anorexia nervosa involves weight loss
- bulimia is normal/increased weight
What are the core features and diagnostic criteria for ADHD according to the DSM-V? (7)
- persistent pattern of inattention and/or hyperactivity-impulsivity
- 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 two or more settings
- the symptoms are not better explained by another mental disorder
Acronym: ADHD MEMO
Attention, Duration (>6mth), Hyperactivity, Developmentally inappropriate
Multiple settings, Early onset (<12y), functional iMpairment, Other conditions ruled out
What are the genetic risk factors for ADHD? (4)
- no isolated gene for ADHD, there are likely multiple genes conferring vulnerability for developing it
- twin studies have shown a significant heritability for ADHD - as high as 76%
- first degree relatives of children with ADHD have an ADHD diagnostic probability 4-5x higher than the general population
- boys are more vulnerable than girls (3:1)
What is the prevalence of ADHD?
3-4%
What are the subtypes of ADHD? (3)
- 20-30% inattentive
- 15% hyperactive
- 50-75% combined
What are the environmental risk factors for ADHD? (3)
- premature birth
- low birth weight
- prenatal smoking exposure (maternal)
What is the prognosis like for ADHD?
70% of children who have ADHD will have this disorder as teenagers, and about 40-60% will still have it as adults
What is dementia?
- degenerative disease of the brain with:
- irreversible and progressive changes
- global cognitive and behavioural impairment
- sufficiently severe to interfere significantly with social and occupational function
- an umbrella term that has many underlying causes
- can be conceptualised as chronic brain failure
What are some causes of dementia, in order of most to least common? (7)
- Alzheimer’s disease
- vascular dementia
- mixed
- dementia with Lewy bodies
- other
- Parkinson’s dementia
- frontotemporal dementia
What are some reversible causes of dementia? (9)
- 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 are the features of normal pressure hydrocephalus?
- dilated ventricles
- clinically presents with the Hakim-Adams triad:
- cognitive impairment/confusion
- urinary frequency/incontinence
- gait disturbance (magnetic/stuck to the floor gait)
What is the Hakim-Adams triad? (3)
Feature of normal pressure hydrocephalus (reversible cause of dementia)
- cognitive impairment/confusion
- urinary frequency/incontinence
- gait disturbance (magnetic/stuck to the floor gait)
What are some epidemiology facts of dementia?
- 47.5 million worldwide have dementia
- leading cause of death in women and second to heart disease in men in UK
- most common form is Alzheimer’s (70%)
- risk of Alzheimer’s increases with age - doubles every 5 years after 60y and is 40% at 85
What are the clinical features of mild dementia? (5)
- 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? (7)
- require support to function outside the home and only simple household tasks are maintained
- difficulties with basic activities of daily living (ADLs) e.g. dressing and personal hygiene
- significant memory loss
- judgement and problem solving are typically significantly impaired, and social judgement is often compromised
- may have difficulty communicating with individuals outside the home without caregiver assistance
- socialising 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? (6)
- severe memory impairment
- often disoriented to time and place
- often unable to make judgements 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
What are behavioural and psychological symptoms in dementia (BPSD)?
- common in dementia
- includes apathy, mood disturbances, hallucinations, delusions, irritability, agitation, aggression, sleep changes
- typically, these symptoms are more frequent and impairing in moderate and severe forms of dementia
