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Year 3 > block 33 week 3 > Flashcards

block 33 week 3 Flashcards

1
Q

dopamine’s effect on eating?

A

regulates the rewarding property of food

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2
Q

leptin?

A

leptin is a hormone produced primarily by the fat cells in the body; it has an inhibitory effect on appetite by inducing a feeling of satiety.

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3
Q

Cognitive theory of ED?

A
  • variant of OCD?
  • The obsession with body shape and weight- the hallmark of an eating disorder- is likely a driving factor in anorexia nervosa.
  • Distorted thought patterns and an over-evaluation of body size likely contribute to this obsession and one’s desire for thinness
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4
Q

ghrelin?

A
  • Ghrelin is an appetite-inducing hormone produced in the stomach and the upper portion of the small intestine.
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5
Q

sociocultural theory of ED?

A
  • Eating disorders are overwhelmingly found in Western countries where there is a heavy emphasis on thinness- a core feature of eating disorders.
  • It is also found in countries where food is in abundance as in places of deprivation, round figures are more desirable
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6
Q

SLT in development of EDs?

A
  • During childhood, children encode the behaviour of their role models (e.g., celebrities or parents),imitatingit.
  • They do not imitate all behaviour, but if it isreinforcedor is the generally accepted opinion of society, they are likely to replicate it.
  • Society and the media perceive ‘skinnier’women and ‘muscular’ men as more attractive.
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7
Q

family in ED?

A
  • one of the strongest external contributors to maintaning EDs
  • often family members are praised for their thiness
  • maintains maladaptive eating behaviours
  • Families that emphasize thinness or place a large emphasis on physical appearance are more likely to have a child diagnosed with an eating disordeR
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8
Q

personality in ED - perfectionism?

A
  • Perfectionism - especially for anorexia
  • perfectionism magnifies normal body imperfections, leading an individual to go to excessive (i.e. restrictive) behaviors to remedy the imperfection
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9
Q

Personality in ED - self esteem?

A

Self esteem - Low self-esteem not only contributes to the development of an eating disorder, but is also likely involved in the maintenance of the disorde

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10
Q

transdiagnostic model of ED?

A

suggests that overall low self-esteem increases the risk for over-evaluation of body, which in turn, leads to negative eating behaviors that could lead to an eating disorder

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11
Q

Using the MH act and compulsory treatment ?

A
  • If a person’s physical health is at serious risk due to their eating disorder, they do not consent to treatment, and they can only be treated safely in an inpatient setting
    *
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12
Q

Child or young person without capacity?

A

if physical health is at serious risk and they do not consent to treatment, ask their parents or carers to consent on their behalf and if necessary, use an appropriate legal framework for compulsory treatment (such as the Mental Health Act1983/2007 or the Children Act1989).

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13
Q

what is dementia?

A
  • chronic/ progressive syndrome
  • Disturbance of multiple higher cortical functioning e.g memory, thinking, language, judgement etc
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14
Q

dementia involves a clear?

A
  • conciousness
  • but may be accompanied/preceded by deterioration in emotional control, social behaviour or motivation
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15
Q

DDs of dementia

A

*Ageing
*Mild Cognitive Impairment
*Delirium
*Depression (‘Depressive pseudo dementia’)
- Amnesic Syndrome

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16
Q

ageing related memory issues?

A
  • reduced ability to encode new material into secondary (long term) memory e.g. registering people/ place
  • reduced efficiency of retrieval - accessing the right info
  • no loss of memories that have alr been laid down
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17
Q

reversible causes that can present like dementia

A
  • Space Occupying Lesions (SOL)
  • Alcohol abuse
  • Medication effects
  • Thyroid problems
  • NPH
  • Vitamin deficiencies (e.g. B12, folate etc)
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18
Q

what is mild cognitive impairment?

A
  • not a diagnosis, intermediate stage between normal age related conditions and dementia
  • more serious memory loss in absence of cognitive or ADL impairment - subtle impairments
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19
Q

risk of dementia in MCI?

A
  • higher risk of dementia (10-15% per year) - 3-5x higher risk than someone w.o MCI
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20
Q

Causes of MCI?

A
  • early dementia
  • physical health problems like COPD
  • medication side effects e.g. anti cholinergics or meds that cause drowsiness
  • MH problems
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21
Q

Prevalence of MCI?

A
  • between 5% and 25%
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22
Q

pseudo-dementia depression ?

A
  • Shorter history, often with precipitant
  • Previous history of depression
  • Patient complains of memory problems
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23
Q

Pseudo-dementia depression is often worse in ?

A

a morning

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24
Q

dementia history which differentiates it from depressive pseudodementia?

A
  • Longer history, insidious, no precipitant
  • ppt less likely to complain of depression or memory issues
  • often worse on an evening
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25
Q

depression MSE?

A
  • during MSE mood can be labile, more constistent performance, attempt to answer questions
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26
Q

Delirium?

A
  • Rapid onset, short history
  • Fluctuating course of cognitive impairment and level of consciousness
  • More prominent and complex, fleeting psychotic symptoms (e.g. vivid visual hallucinations)
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27
Q

what is altered in delirum?

A
  • perception and affect altered - illusions, low mood, anxiety, fear, euphoria
  • Abnormal motor activity (over or under activity)
  • Emotional changes more prominent and variable
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28
Q

delirious patients tend to get worse as?

A
  • tend to get worse as the day goes on - more confused at night
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29
Q

delirium - may have?

A

evidence of medical illness e.g. pyrexia

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30
Q

RF for delirium?

A
  • older
  • cerebral compromise - dementia e.g.
  • chronic conditions
  • renal impairment
  • psychiatric history
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31
Q

RF for delirium - impairment?

A
  • sensory impairment - visiual/ deafness
  • immobile impatients
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32
Q

RF for delirium - drug and envir related?

A
  • poly-pharmacy
  • unfamiliar environment
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33
Q

most common cause of dementia?

A
  • most common - alzheimer’s: 50-60
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34
Q

other types of dementia?

A
  • vascular - 20-30%
  • LBD: 10-15%
  • FT dementia: upto 10
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35
Q

alcohol can contribute to up to ?% of dementias

A

10

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36
Q

other rarer causes of dementia?

A

parkinsons, huntingtons, MS, HIV etc

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37
Q

Ix of dementia?

A
  • History
  • MSE and cognitive assessment
  • Physical Examination
  • Blood tests– at a minimum, FBC, Biochemical screen, TFT’s, Blood glucose, B12 and folate levels
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38
Q

MSU in dementia?

A
  • infection
  • CKD
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39
Q

CT scan for dementia?

A

esp. for shorter duration (less than a year), younger onset, ‘atypical symptoms’ or examination findings

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40
Q

semantic memory =

A

meaning of concepts/ objects

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41
Q

what is alzheimers?

A
  • progressive global decline of higher cognitive functions
  • initially involves short term memory
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42
Q

alzheimer’s affects:

A
  • memory- early episodic changes - events involving the person
  • Language
  • Motor Skills (praxis)
  • Recognition Skills (gnosis)
  • Personality e.g. apathy, irritability
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43
Q

alzheimer’s ppts can also develop?

A

psychotic symptoms, gait disturbances, seizures later on

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44
Q

vascular dementia (large and medium vessel disease)?

A
  • Due to cerebral ischemia/Infarction
  • sudden step wise deterioration
  • Deficits dependent on damaged region - can be cognitive, motor, sensory
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45
Q

small vessel disease involves a ? progression

A

Insidious onset, gradual progression

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46
Q

small vs large vessel disease?

A
  • small: gradual progression
  • large: stepwise decline
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47
Q

SVD - symptoms?

A
  • apathy
  • slowness of thought
  • problems with exec functioning
  • reduced attention
  • relative preservation of higher cortical functions like gnosis, praxis, visuospatial
  • espec subcortical and periventricular white matter - Binswangers disease
  • may be problems w mobility/ gait
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48
Q

LBD vs parkinsons dementia?

A
  • Early cognitive symptoms = DLB
  • Motor Symptoms > 1 year = PD
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49
Q

PD w dementia?

A

Motor symptoms, apathy, slowing of thought, executive functioning, forgetfulness

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50
Q

LDB?

A
  • Rapid dementia,
  • fluctuations,
  • hallucinations,
  • mild parkinsonian features
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51
Q

LBD - 2 of 3:

A
  • Fluctuations in cognition/performance
  • Persistent, well formed hallucinations
  • Spontaneous parkinsonism
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52
Q

features supportive of LBD?

A
  • Falls, syncope, neuroleptic sensitivity - sensitivity to AP , delusions, hallucinations, REM Sleep behaviour disorder - acting out dreams
  • Early visuo-spatial difficulties, word finding, attention, judgement, mental flexibility, decision-making, and insight
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53
Q

LBD and AP?

A
  • LBD patients are very sensitive to AP - can die from this
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54
Q

fronto-temporal dementia - language variant can involve?

A
  • Primary Progressive aphasia and semantic dementia
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55
Q

Behavioural variant of FTD?

A
  • Stereotypical, repetitive and compulsive behaviour
  • Apathy, withdrawal, self neglect
  • Dis-inhibition, impaired judgement e.g. overspending, socially inappropriate, criminal, sexualised behaviours
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56
Q

Behavioural variant of FTD - emotions?

A

*Emotional blunting, shallow affect - offensive comments to others

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57
Q

Behavioural variant of FTD - Eating?

A

*Abnormal eating, hyper-orality etc - cramming and bingeing

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58
Q

Behavioural variant of FTD - preservation of?

A

Relative preservation of memory, visuo spatial functioning in early stages.

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59
Q

what are the 2 language variants of FTD?

A
  • Primary progressive aphasia
  • semantic dementia
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60
Q

primary progressive aphasia ?

A
  • reduced speech fluency
  • articulation problems
  • phenological (organisation of sounds) and syntactical (sentence structure errors)
  • preservation of comprehension
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61
Q

semantic dementia?

A
  • preservation of fluency and phonology of speech
  • difficulty with naming and comprehension
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62
Q

alcohol related dementia?

A
  • spectrum ranging from amnesic syndrome (Korsakoff’s) to dementia
  • may have other signs of chronic alcohol use e.g. peripheral neuropathy, cerebellar ataxia
  • can be difficult to distinguish from AD
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63
Q

alcohol related dementia may stabilise with?

A
  • may stabilise and improve with abstinence, good diet and thiamine supplementation especially early on
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64
Q

how is alcohol related dementia diagnosed?

A

absence of alcohol - 2 months at least

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65
Q

symptoms of alcohol related dementia

A
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66
Q

Psychosocial management of dementia?

A
  • counselling, education
  • Targeting interventions, social stimulation, management of mood etc
  • Lifestyle changes
  • cognitive stimulation therapy
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67
Q

support for dementia?

A
  • care support and education
  • social and home care services
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68
Q

Medical management of dementia ?

A
  • Optimising physical health and medication- including stopping unnecessary medication, eyesight, hearing, mobility etc
  • Modification of risk factorse.g. cardio/cerebrovascular
  • Lifestyle advice
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69
Q

disease modifying drugs for dementia?

A

AChIs, memantine

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70
Q

symptomatic Tx in dementia?

A

antidepressants, anti-psychotics

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71
Q

history taking for dementia?

A
  • Onset and course
  • cognitive problems
  • impact on daily life, function
  • mood, anxiety, personality and behavioural issues
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72
Q

PMH for dementia history?

A
  • Cadiovascular/ cerebro- vascular risk factors
  • past head injuries
  • falls, alterations in mobility, bladder problems
  • Exacerbating factors (eg hypoxia, sleep apnoea etc)
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73
Q

fitness to be prescribed ACh inhibitors is influenced by?

A

cardiac rhythm, asthma, peptic ulcer, liver problems, bladder outflow problems etc)

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74
Q

amnesic syndrome?

A
  • impairment of recent memory (anterograde amnesia) - loss of memory in new info
  • difficulties in learning new material
  • disturbance of time sense e.g. chronological sequences
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75
Q

in amnesic syndrome, what is preserved?

A
  • preservation of new info - they can remember info you just give them, may not be able to recall this a few mins later
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76
Q

in amnesic syndrome, there may be?

A
  • may be confabulation - falsification of memory
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77
Q

amnesic syndrome vs dementia?

A
  • other cognitive functions usually well preserved - opposite of dementia
  • may also have personality change e.g. apathy
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78
Q

most common cause of amnesic syndrome?

A
  • alcohol -> acute B1 deficiency - Korsakoff’s psychosis is the most common cause
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79
Q

other causes of amnesic syndrome?

A
  • long term heavy drug use
  • toxins - lead, mercury, CO, insecticides
  • head trauma
  • tumours
  • stroke and CV disease
  • post infection
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80
Q

Delirium/ acute confusional state - clinical picture?

A
  • disturbance of conciousness, cognitive function and perception
  • develops over a short time period
  • symptoms often fluctuate over time
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81
Q

What is delirium associated with?

A
  • altered sleep wake cycle
  • hallucinations, suspciousness or persecutory beliiefs
  • motor slowing/ stupor
  • withdrawn and quiet presentation
  • agitation or restlessness
82
Q

DSM criteria for delirum ?

A
  • Acute onset and Fluctuating symptoms
  • disturbance of consciousness (including inattention)
  • at least one of the following:
    –disorganized thinking,
    –disorientation,
    –memory impairment,
    –perceptual disturbance,
  • evidence of a putative causal medical condition (only present in about 50% of cases)
83
Q

ICD criteria for delirium?

A
  • Impairment of consciousness and attention
  • Global disturbance of Cognitive function
  • Psychomotor disturbance (Hyper or Hypo-activity)
  • Disturbance of sleep wake cycle
  • Emotional disturbance
84
Q

prevalence of delirium?

A
  • most common acute disorder in hospitals
  • higher rates in: the elderly, stroke, hip fracture, vascular surgery, critical care
85
Q

Consequences of delirium?

A
  • inc incidence of dementia
  • increased hospital acquired complications - falls, pressure sores etc
  • increased mortality - doubles death rates in 65+
86
Q

ACOVE?

A
  • 30-40% of cases preventable
  • Assessing care of vulnerable elders project (ACOVE) - “in top 3 areas most needing improvement”
87
Q

Who is delirium more likely in?

A
  • increasing age
  • dementia
  • psych illness
  • poly pharmacy
  • immobile patients
  • those moved to an unfamiliar environment
88
Q

NICE - at risk groups for delirium?

A
  • 65+
  • prev history of cognitive impairment/ suspected cognitive impairment
  • current hip fracture
  • severe illness
89
Q

Indicators of delirium - cognitive?

A
  • cognitive function e.g. worsened concentration, slow responses, confusion
90
Q

indicators of delirium - perception?

A
  • Perception e.g. visual or auditory hallucinations
91
Q

indicators of delirium - physical function?

A
  • physical function e.g. reduced mobility, reduced movement, restlessness, agitation, changes in appetite, sleep disturbance
92
Q

Indicators of delirium - social behaviour?

A
  • social behaviour e.g. poor cooperation, withdrawal, or alterations in communication, mood and/or attitude.
93
Q

clinical asssessment of delirium?

A
  • DSM criteria
  • Short Confusion Assessment Method (short CAM)
  • Abbreviated mental test scores
94
Q

Ix of delirium?

A
  • O2 sats
  • U+E’s Ca, glucose
  • FBC
  • ECG
  • CXR
  • B12/Folate and TFT’s only if chronic
  • Additional: LFT’s CSF, EEG and CT head
95
Q

Delirium vs dementia?

A
  • Delirium – Acute (normally fluctuating) confusional state associated with underlying physical Illness
  • Dementia – Progressive, irreversible decline in cognitive function
96
Q

what can cause delirium - illnesses?

A
  • any acute illness like infection, hypoxia, truama
  • renal failure, dehydration, constipation
97
Q

medications that can cause delirium?

A
  • medications - antidepressants, sedatives, pain killers, antiparkinsons
98
Q

withdrawl from ? can cause delirium

A

drugs, including alcohol

99
Q

pathogenesis of delirium?

A
  • cholinergic deficiency and dopamine excess suspected??
  • Cytokines IL1, IL2, IL6, TNF, and interferon alter permeability of blood brain barrier + affect neurotransmission
100
Q

Delirium - HPA axis

A
  • Stress (2ndy to Illness/trauma) activates HPA axis ncreasing cytokine activity and leading to chronic hypercortisolism (effects hippocampal 5HT receptors)
101
Q

Management of derlirium ?

A
  • identify and treat underlying cause
  • meds and referral to liason service if needed
102
Q

addressing disorientation in delirium?

A
  • consider use of a side room and avoid room changes
  • avoid excessive noise
  • provide, clock, calander, and soft lighting
103
Q

delirium - promoting orientation?

A
  • limiting contact to small group of familar staff
  • Introduce cognitively stimulating activities (for example, structured reminiscence) and reorienting communication.
  • repeated verbal reminders and facilitate vists from family
  • avoid transfers between wards
104
Q

preventing dehydration/ constipation in delirium?

A
  • oral fluid intake
  • offer IV fluids if necessary
105
Q

preventing immobility in delirium?

A
  • encourage people to walk around and
  • mobilise early after surgery
106
Q

derlium management - agitiation?

A
  • Lorazepam
  • Treats agitation but increased risk of confusion/disinhibition/sedation (falls)
107
Q

AP for delirium?

A
  • For short-term (for 1 week or less) treatment of psychotic symptoms (delusions and hallucinations)
  • Atypical (e.g. Quetiapine) preferable to typical (e.g. Haloperidol) bc less side effects
108
Q

? side effects of AP can increase confusion

A

Anti-cholinergic side effects

109
Q

AP - ? side effects can increase risk of falls

A
  • Extra-pyramidal side effects can increase distress and risk of falls
  • Sedation can increase risk of falls
110
Q

which AP should be avoided in suspected dementia/cerebro-vascular Disease delirium?

A

Olanzapine/Risperidone

111
Q

restriction of liberty?

A

Liberty may be RESTRICTED in patients best interests but not DEPRIVED unless DoLS used

112
Q

other causes of delirium?

A
  • Alzheimer’s disease
  • Subdural haematoma
  • Metabolic (e.g. diabetic emergencies)
  • Hypothermia
  • TIA and stroke (e.g. dysphasia presentation)
  • Transient global amnesia
113
Q

delirium - fluctuating confusion?

A

*If confusion is fluctuating, consider subdural haematoma or dementia with Lewy bodies which may present with fluctuating confusion, hallucinations and extrapyramidal signs.

114
Q

medications liked to delirium?

A
  • opiates
  • anti-arrhythmics like digoxin
  • oxybutynin
  • bronchodilators (e.g. theophylline)
115
Q

withdrawal from ? can cause delirium?

A
  • alc
  • benzos
  • SSRIs
  • opiates
116
Q

delirium - raised MCV can indicate?

A

may indicate hypothyroidism, vitamin B12/folate deficiency or alcohol misuse.

117
Q

delirium - CXR to check for?

A

malignancy

118
Q

delirium - ECG to check for?

A

arrhythmia or ischaemia

119
Q

other Ix for delirium?

A
  • urine culture
  • CT/ MRI head
  • drug screen and alcohol levels
120
Q

delirium - ear examination?

A

Ensure there is no ear wax that may affect hearing. Reduced hearing may exacerbate an acute confusional state.

121
Q

delirium - CNs?

A

Check vision and pupil responses. Look out for facial weakness. Check the fundi for papilloedema (raised intracranial pressure).

122
Q

AD typical presentation?

A
  • The presenting symptom is usually loss of recent memory first, and often difficulty with executive function and/or nominal dysphasia.
  • There is also loss of episodic memory — this may include memory loss for recent events, repeated questioning, and difficulty learning new information.
123
Q

cognitive deficits in AD?

A

aphasia, apraxia, and agnosia.

124
Q

VD clinical presentation?

A
  • Stepwise increases in the severity of symptoms — subcortical ischaemic vascular dementia may present insidiously with gait and attention problems and changes in personality.
125
Q

what else may be present in VD?

A
  • Focal neurological signs (such as hemiparesis or visual field defects) may be present.
126
Q

Dementia w LB core clinical features?

A
  • Core clinical features are fluctuating cognition; recurrent visual hallucinations; REM sleep behaviour disorder and one or more symptoms of parkinsonism: disorder; bradykinesia, rest tremor, or rigidity.
  • Memory impairment may not be apparent in early stages.
127
Q

FTD clinical picture?

A
  • Personality change and behavioural disturbance (such as apathy or social/sexual disinhibition) may develop insidiously.
  • Other cognitive functions (such as memory and perception) may be relatively preserved.
128
Q

Cognitive problems and dementia assessment tools?

A
  • informant questionnare on cognitive decline in the elderly (IQCODE) or FAQ
129
Q

Red flags for dementia?

A
  • Falls
  • Head injury
  • Bereavement
  • History of cancer
  • Rapidly progressing symptoms
  • Severe disability and risk to independence
  • Confusional state
  • Systemic symptoms such as fever, night sweats or weight loss
130
Q

features of underlying disease - acute illness?

A
  • Check for symptoms of infection (e.g. chest, urinary tract or gastrointestinal symptoms).
  • Chest pain and shortness of breath may be due to cardiac ischaemia.
131
Q

Features of underlying disease - depression?

A
  • Depression in the elderly may present as memory loss.
  • Ask about other symptoms of depression such as tearfulness, irritability, appetite, sleep and diurnal variation of symptoms.
  • Assess risk of suicide.
132
Q

features of underlying disease - alcohol?

A

recent change in drinking pattern

133
Q

features of underlying disease - thyroid?

A

Ask about cold intolerance, tiredness and loss of energy

134
Q

when are cholinesterase inhibitors CI?

A
  • Vascular problems
  • prostatic symptoms
  • active peptic ulceration
135
Q

low levels of what can cause cognitive impairment ?

A

low sodium and high calcium

136
Q

what does papilloedema indicate?

A

raised ICP

137
Q

what are the dementia screening tools?

A
  • 10 point cognitive screener
  • 6 item cognitive impairment test
  • 6 item screener
  • mini cog
138
Q

10 point cognitive screener scores?

A
  • 6–7 indicates possible cognitive impairment,
  • and 0–5 indicates probable cognitive impairment.
139
Q

what is ageing assoc w ?

A
  • ageing is associated with geriatric syndromes such as frailty, urinary incontinence, falls, delirium and pressure ulcers.
  • As people age, they may experience certain life changes that impact their mental health, such ascoping with a serious illness or losing a loved one.
  • this can lead to social isolation
140
Q

what contributes to MH conditions later in life?

A

loneliness and social isolation

141
Q

what else can impact MH of the elderly?

A
  • elder abuse
  • many older people care for relatives with chronic health conditions -> affects their mental health
  • poor physical health -> stress
142
Q

impact of physical illness on mental health?

A
  • chronic physical illness leads to stress, worry or anxiety
  • low self esteem or stigma
  • social isolation or loneliness
  • sleep problems e.g. from pain or side effects of medications
143
Q

impact of disease on family?

A
  • Longer life expectancies, coupled with extended ageing-related illness or disability, can significantly prolong the care phase.
  • This, in turn, places significant mental, physical and financial burdens on older people, caregivers and extended family member
144
Q

? decisions can strain family relationships

A

end of life

145
Q

family consequences of illness?

A
  • psychological distress from feelings of helplessness and lack of control
  • additional stress and burden of caring for the person
  • anxiety about the future
  • changes to the family dynamic
146
Q

non pharm treatments of dementia?

A
  • mild to moderate dementia
  • cognitive stumulation therapy
  • group reminiscence therapy
  • cognitive rehab/ occupational therapy
147
Q

cognitive stimulation therapy?

A

range of activities and discussions (usually in a group) that are aimed at general improvement of cognitive and social functioning.

148
Q

group reminiscence therapy?

A

thisuses objects from daily life to stimulate memory and enable people to value their experiences

149
Q

cognitive rehabilitation/ occipational therapy?

A

the aim is to addresses the disability resulting from the impact of cognitive impairment on everyday functioning and activity by identifying goals that are relevant to the person

150
Q

drug treatment options for dementia?

A
  • AChE inhibitors
  • memantine
151
Q

AChE examples?

A
  • donepezil
  • galantamine
  • rivastigmine
152
Q

AChE inhibitors can be used as a monotherapy for?

A

managing mild to moderate Alzheimer’s disease.

153
Q

Memantine?

A
  • NMDA receptor antagonist
154
Q

Mematine can be used as a monotherapy for managing?

A

Alzheimer’s disease for people with moderate Alzheimer’s disease who are intolerant of, or have a contraindication to, AChE inhibitors,or for people withsevere Alzheimer’s disease.

155
Q

Mematine can be used in addition to

A

AChE in severe alzheimers

156
Q

first line for mild to moderate dementia w Lewy Bodies?

A
  • Donepezil or rivastigmine are recommended first line.
  • Galantamine is an option if donepezil and rivastigmine are not tolerated.
157
Q

Severe dementia with Lewy bodies - drug Tx?

A
  • Donepezil or rivastigmine are recommended.
158
Q

Vascular dementia drug treatment?

A
  • AChE inhibitors or memantine are options if the person has suspected comorbid Alzheimer’s disease, Parkinson’s disease dementia, or dementia with Lewy bodies.
159
Q

management of FTD?

A

People with frontotemporal dementia should NOT be offered AChE inhibitors or memantine.

160
Q

AP for dementia?

A
  • for psychotic features
  • Risperidone and haloperidol
161
Q

effects of aging on presentation of mental illness?

A
  • masked by co-morbidities degenerative conditions like dementia may mean that the mental illness may be harder to pick up on as the person won’t be able to report their symptoms
  • confusion
162
Q

FPM in older adults?

A
  • FPM is affected by ageing - oral doses of drugs can have higher circulating drug concentrations
163
Q

drugs w higher risk of toxic effects bc of age related reductions in FPM?

A

nitrates,propranolol,phenobarbital, andnifedipine.

164
Q

deline in renal function in the elderly means?

A
  • renal elimination - GFR decreases
  • impacts drugs like diazepam, risperidone, digoxin
165
Q

the elderly excrete drugs ?

A

slowly, so are susceptible to nephrotoxic drugs

166
Q

STOPP criteria

A
  • STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) aims to reduce the incidence of medicines-related adverse events from potentially inappropriate prescribing and polypharmacy.
167
Q

START criteria?

A
  • START (Screening Tool to Alert to Right Treatment) can be used to prevent omissions of indicated, appropriate medicines in older patients with specific conditions.
168
Q

drugs the elderly are more sensitive to?

A
  • the elderly are more sensitive to opiods, benzodiazepines, antipsychotics and antiparkinsonians
  • anti-hypertensives and NSAIDs
169
Q

what are somatisation disorders?

A
  • form of mental illness that causes one or more bodily symptoms, including pain
  • causes disproportionate distress
  • unexplained symptoms
170
Q

examples of symptoms seen in somatisation disorders?

A
  • Persistent abdominal pain, headaches, joins pains, etc.
  • Poor concentration, dizziness and moodiness
  • Continual worry over decreasing physical health
  • Onset of an acute flu-like illness or glandular fever
  • Complete loss of bodily sensation or movements
  • Loss or disturbance of motor function and pseudo-seizures (seizures that do not have the typical features of an epileptic fit and are not accompanied by an abnormal EEG)
171
Q

symptoms of somatisation disorders usually occur after?

A
  • Symptoms usually occur after a traumatic event and last for a few weeks or months
  • Generally occurs more commonly in females than males
  • Symptoms usually start in childhood or early adolescence
172
Q

consider a somatform disorder if:

A
  • there is a time relationship between psycosocial stressors and phsyical symptoms
  • nature and severity of the symptom is causing disproportionate handicap
  • there is a concurrent psychiatric condition
173
Q

symptoms common to both depression and dementia

A
  • Apathy
  • Loss of interest in activities and hobbies
  • Social withdrawal
  • Isolation
  • Trouble concentrating
  • Impaired thinking
174
Q

depression in alzheimers?

A
  • may be less severe
  • may not last as long and symptoms may come and go
  • The person with Alzheimer’s may be less likely to talk about or attempt suicide
175
Q

confidential information must be protected unless?

A
  • unless there is a sig risk to the individual, public or children
    • When a significant risk to safety is imminent and not sharing information appears likely to result in death or serious injury, then relevant information can and should be shared with those people for whom consent has been given to share
176
Q

consent =

A
  • this refers to seeking consent to involve another person (not necessarily a family member unless aged under 18) to share appropriate information about the patient’s general care and ris
  • explain to the patient that information sharing deos not ened to take the form of total disclosure
177
Q

MHA states that (capacity?

A
  • MHA states that a person must be assumed to have capacity unless it’s established that they lack capacity
  • However, if a person is at imminent risk of suicide there may well be sufficient doubts about their mental capacity at that time.
  • practitioners need to act in the patients best interests - this may involve sharing critical information
178
Q

Mental capacity act 2005 ?

A
  • a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain.
179
Q

MCA - a person is unable to make decisions for himself if he is unable to:

A
  • (a)to understand the information relevant to the decision,
  • (b)to retain that information,
  • (c)to use or weigh that information as part of the process of making the decision, or
  • (d)to communicate his decision (whether by talking, using sign language or any other means).
180
Q

Effects of dementia on carers?

A
  • guilt - losing temper, not wanting the responsibility, feelimg embarassed about the person’s off behaviour
  • grief and loss - loss of the future they planned together
  • anger - at the person, having to be a carer, angry at lack of support
  • exhaustion
181
Q

support for carers - carers assessment?

A
  • needs assessment used by the LA to decide which support their eligible to receive
  • works out your abilities and how they affect your caring role
  • and your needs and which level of support is needed
182
Q

support for dementia on medical issues?

A
  • GP, social services, occupational therapists to support and advise on medical issues
183
Q

local support groups for dementia carers?

A
  • local support groups - local Alzheimer’s Society office, Age UK and Carers UK.
184
Q

online discussion forums for carers?

A
  • online discussion forums - practical suggestions and letting of steam - e.g. Talking Point
185
Q

therapy for carers?

A
  • talking therapies such as CBT
186
Q

booklets for carers?

A
  • booklets such as Caring for a person with dementia from alzheimer’s.org.uk for practical support
187
Q

support that the LA can offer a carer?

A
  • homecare visits
  • adaptations to the home
  • respite care
  • support from professionals, such as a dementia specialist nurse
  • support groups
188
Q

residential homes provide accomodation and personal care such as help w:

A
  • washing
  • dressing
  • taking medicines
  • going to the toilet
189
Q

nursing homes?

A
  • These also provide personal care but there will always be 1 or more qualified nurses on duty to provide nursing care.
  • Some nursing homes offer services for people that may need more care and support.
190
Q

who are nursing homes for?

A
  • severelearning disabilities, severe physical disabilities or both
  • a complex medical condition that needs help from a qualified nurse
191
Q

NHS LTP for older ppl?

A
  • the NHS long term plan will ensure consistent access to mental health care for older adults with functional needs (i.e. depression, anxiety and severe mental illnesses).
  • NHS talking therapies for anxiety and depression which need to meet the needs of older patients
192
Q

NHS LTP - community based teams

A
  • Community-based mental health crisis response teams will work closely with ‘physical health’/Ageing Well Urgent Community Response services to provide coordinated rapid response, assessment, admission avoidance, and discharge support functions for older people
193
Q

what are community MH teams?

A
  • support people w mental health problems but also their carers
194
Q

community MH teams involve?

A
  • a community psychiatric nurse (CPN), a psychologist, an occupational therapist, a counsellor and a community support worker, as well as a social worker.
  • one member is appointed as a care coordinator and keeps in contact to help plan care
195
Q

social/ community care?

A
  • social care is support to carry out day to day tasks
  • e.g. managing money or improving relationships
  • can be referred or contacted directly
196
Q

supported housing?

A
  • if the person is finding it difficult to manage in their own home and needs more support
  • can be:
  • support in their own home
  • supported housing and group homes
  • short stay supported housing
197
Q

support in ur own home

floating support?

A
  • benefits
  • budgeting
  • accessing care, local activities, education, training or advocacy.
  • often run by charities
198
Q

community care or home help?

A
  • social services offer them a home
  • care workers might help with things like household tasks, preparing meals and taking medication.
  • social services do an assessment on how much help you need
199
Q

short stay supported houses - crises houses?

A
  • They offer short-term housing and are an alternative to going into hospital
200
Q

short stay supported houses - hostels?

A
  • short stay hostels offer hosuing for a short time
  • usually for people who are homeless with certain needs.

Year 3 (45 decks)

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