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D&P Flashcards

1
Q

When are you presumed to be competent to give consent?

A

at age 16, unless the opposite is demonstrated

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2
Q

What are the three components of VALID consent?

A
  1. Voluntary
  2. Informed
  3. Capacity
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3
Q

5 key principles of Capacity

A
  1. Presume capacity
  2. Support decision making
  3. Right to unwise decision
  4. Best interest decision
  5. Least restrictive option in case capacity changes
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4
Q

When do we assess capacity?

A

in more serious situations where formal assessment is needed to check for any brain impairment.

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5
Q

When is a person deemed unable to make their own decisons according to the MCA 2005? (CURB)

A

Use mnemonic CURB

  • Understand the information given to them
  • Retain the information long enough to make a decision
  • Balance the information to make a decision
  • Communicate their decision
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6
Q

What information do people need to give valid consent?

A
  1. Benefits and risks of treatment
  2. Benefits and risks of not having treatment
  3. Options
  4. What the treatment involves
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7
Q

How are decisions made when a person lacks capacity? BADLIP

A

Best interest (in least restrictive option)

ADvanced decision

LPA

IMCA

Proxy

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8
Q

For an LPA, who must the application form be countersigned by?

A

Someone who knows the person well or a professional (doctor, social worker or solicitor)

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9
Q

What principles of the MCA do must the person follow to act as an LPA?

A
  • presumption of mental capacity
  • best interests
  • the right to be supported to make a decision
  • least restrictive intervention
  • right to make an unwise decision
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10
Q

When is an advance decision to refuse treatment legally binding?

A

if it is valid and applicable to the situation the person is in

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11
Q

An advanced decision to refuse treatment must….

A
  • be in writing
  • be specific
  • be made by someone who is over 18
  • must have had capacity at time of writing
  • be signed in the presence of a witness
  • contains a statement about potential risk to life
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12
Q

An ADRT can’t be used for…

A
  • can’t demand specific treatment
  • can’t demand euthanasia
  • can’t refuse routine care
  • can’t routine treatment if sectioned by mental health act
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13
Q

Prevalence of dementia and gender ratio

A

equal male:female ratio and a prevalence of 7%

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14
Q

What is the difference between MCI and Dementia?

A

No changes in ADL ability

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15
Q

What is the most common form of dementia?

A

Alzheimer’s

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16
Q

Pathophysiology of Alzheimer’s

A

Amyloid plaques and tau neurofibrillary tangles which stunts neuronal transmission and causes a gradual decline in cognitive impairment.

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17
Q

How does Alzheimer’s affect memory?

A

Affects short term before long term memory and causes:

  • word finding difficulty
  • repetitive
  • needs instructions repeated
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18
Q

Complications of Alzheimer’s and treatment

A

Depression/anxiety: antidepressant

Behavioural problems: aggression with Risperidone (AP) and agitation with BDZ

Psychosis: AChEIs + APs

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19
Q

Treatment for cognitive/visual hallucinations in alzheimer’s

A

AChEIs like donepezil

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20
Q

Treatments for problems with effects of alzheimer’s?

A

NMDA antagonist like Memantine.

Not a cure!

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21
Q

2nd most common cause of dementia?

A

Vascular dementia

22
Q

What is the difference in progression between Alzheimer’s and Vascular dementia?

A

Alzheimer’s is gradual while vascular is stepwise

23
Q

Effects of Vascular Dementia?

A

Functional deficits often appear before memory impairment

Mood disturbance/disorders

Psychosis/delusions/paranoia

Depression and psychomotor retardation

Emotional lability

24
Q

Medications for Vascular Dementia?

A

Anticoagulants, HPT medication, statins and diabetic control prn

25
Q

Third most common type of dementia?

A

Lewy Body Dementia

26
Q

Effects of LBD?

A

vivid visual hallucinations and parkinsonism

27
Q

Medication available for LBD?

A

no licensed treatment but AChEIs help with hallucinations and cognition

28
Q

What is Pick’s Dementia and what kind of onset is it?

A

fronto temporal dementia and early onset.

29
Q

What are the effects of Pick’s dementia?

A

Personality change, social disinhibition and memory/cognitive impairment.

30
Q

What is the medication for Pick’s dementia?

A

no specific treatment but donepazil and SSRIs can be used for symptomatic relief

31
Q

Reversible causes of dementia (mnemonic)

A
  • Drugs (antichol)
  • Emotional (depression)
  • Metabolic (hypothyroid)
  • Eyes and ears declining
  • NPH
  • Tumour or any space occupying lesion
  • Infection (syphilis, AIDs)
  • Anaemia
32
Q

Investigations or assessment of dementia

A

MMSE, MOCA or Addenbrooks

33
Q

Principles of management of Dementia

A

Assessment, Cognitive enhancement, treat psychosis, depression or medical illness. Psychological help, functional and social mgt.

34
Q

What is the male:female ratio of BAD?

A

equal ratio

35
Q

Is BAD higher in younger or older people?

A

younger people

36
Q

Risk factors for BAD

A

genes (FH), environment (drugs/life events) and brain structure

37
Q

Define anhedonia

A

diminshed pleasure or interest in activities

38
Q

Signs and symptoms of BAD

A

periods of severe depression alternating with periods of elevated/irritable mood known as mania.

39
Q

How long does a manic episode usually last?

A

1 week

40
Q

What does a manic episode usually entail?

A

Mood disturbance characterised by elation, irritability or expansiveness.

41
Q

Additional symptoms of a manic episode and how many must be present?

A
  1. Grandiosity
  2. Diminished need for sleep
  3. Excessive talking/pressured speech
  4. Racing thoughts/flight of ideas
  5. Distractability
  6. Increased goal-focused activity (work/sex)
  7. Excessive pleasurable activites

3 must be present

42
Q

Signs of severe depression

A
  • Suicide/self harm
  • Unexplained guilt
  • Inability to function (psychomotor)
  • Concentration impaired
  • Impaired appetite
  • Decreased sleep
  • Energy low
43
Q

Long term and acute treatment of anxiety

A

Long term: antidepressants (SSRI, SNRI, TCA)/benzodiazepines

Acute: antipsychotics

44
Q

How long does anxiety last for it to be a medical problem?

A

>3 weeks

45
Q

Long term and acute treatment of BAD?

A

Long term is lithium while sodium valproate is for acute

46
Q

How long does a manic episode have to last to be classified as one?

A

a week

47
Q

What is needed to diagnose depression?

A

at least 2 of the the three core symptoms: low mood, anhedonia and fatigue

AND

at least 2 of the typical sympoms: e.g. reduced appetite, weight loss, early waking/reduced sleep, psychomotor retardation, thoughts of self harm/suicide etc

FOR OVER 2 WEEKS!!!!

48
Q

Mental state examination (ASEPTIC)

A

Appearance

Speech (form/content)

Emotions (mood/affect)

Perception

Thought

Insight

Cognition (MMSE, MOCA, ACE)

49
Q

Risk assessment:

4 most important factors

A

previous violence

substance abuse

lack of empathy

stress

50
Q

What is necessary for a diagnosis of schizophrenia?

A

At least one group A symptom:

thought disorders, delusions and hallucinations

and at least one group b symptom

persistent hallucinations, breaks/interpolations, catatonic behaviour and negative symptoms

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