Geriatric Psychiatry Flashcards
Definition of Late Onset Psychosis
Psychosis is when people lose some contact with reality. This might involve seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions).
As the onset has happened at an elderly age, the diagnosis is called Late Onset Psychosis.
Causes of Late Onset Psychosis
Predisposition:
Genetics - family history
Hearing impairments
Substance misuse
Adverse life events
Donepezil background and MOA
- Anti- dementia drugs work on chemicals of the brain. Those with dementia have a reduction in a chemical called acetylcholine. Donepezil helps to increase these chemical levels.
- Donepezil helps to slow down further decline of memory and functioning. Does NOT cure.
- Take long term. 40-50% will respond to this medication.
Donepezil SE’s
GI upset, nausea, vomiting, headache, dizzyness, insomnia, bradycardia
Start on low dose
Therefore, important to monitor side effects and do investigations (ecg, blood tests) before starting medication
Follow up to monitor SE’s and progress via MMSE in memory clinic
Always offer leaflet!
Alzheimer’s dementia
- Commonest type of dementia, exact cause is unknown
MOA: build up of protein that disrupts the connectivity (neurons) of the brain which causes healthy brain cells to be damaged and brain volume loss. Low levels of acetylcholine.
- Causes:
Non-modifiable RF - Age (biggest RF) genetics (3-4 times more likely to have dementia whose parents have dementia), female, Down’s syndrome, low intelligence and limited education
Modifiable RF - previous head injury, history of depressive disorder, poor lifestyle (diabetes, CVS), smoking
Vascular dementia
MOA: Type of dementia that is caused by the reduced blood flow to the brain due to damage to blood vessels in the brain.
Causes: It is commonly found in patients who have medical problems such as high blood pressure, diabetes and high cholesterol levels.
- Progressive disorder, stepwise
Management of dementia
Biological: Short acting sedative drugs - lorazepam to manage agitation/aggression, antidepressants if depression
Psych: Verbal reassurance, Reminscent therapy, aromatherapy to help with agitation, psychoeducation
Social: Orientation (clocks, daylight), OT assessment, activities and carers, PT assessment and physical activity, blister pack/dosette box for medications, carers group
Alzheimer’s - anticholinesterase inhibitors/memantine - improve acetylcholine levels
Vascular - manage risk factors - stop smoking, GP can manage medical conditions, statin, drinking
LBD - Rivastigmine (oral or patch), L-dopa to help with parkinson’s symptoms, antipsychotics only in extreme situations as it can worsen symptoms
Lewy Body Dementia
- Most common type of LATE onset dementia and is due to the presence of a type of protein called lewy body in the brain
- RF: AGE (>65)
- Fluctuating consciousness, parkinsonism, visual hallucinations, falls, memory
- Progressive disease
- DAT scan to rule out other forms of dementia
LBD vs Parkinson’s disease dementia
LBD - if both cognitive and motor symptoms develop within 12 months
Parkinson’s dementia - Parkinsons symptoms >12 months before dementia develops
Frontotemporal dementia
MOA: A type of dementia that is found to have pick deposits. Affects the front and sides of the brain
RF: tends to affect people of younger age (starting from 45) and is a progressive condition that worsens with time.
Symptoms: It causes behavioural and personality changes, problems with language, executive dysfunction, memory (often later) and motor difficulties
*Not for anticholinesterase inhibitors
Mild Cognitive Impairment
If you have been told that you have Mild Cognitive Impairment (MCI) this means that your mental abilities (cognition) are not as good as they used to be. This usually refers to problems affecting memory, but could involve a change in problem solving, thinking, attention, concentration, language or visual ability. Very often, individuals with MCI can function independently.
RF: Age
Prognosis: Average conversion rate from MCI to dementia is 5 - 10% per year
Ix: ACE < 82, MMSE <27
Mx: Bio - no cure, managing medical conditions
Psych:
Social: Social groups, keeping a good mental health, physical exercise, healthy diet
Anorexia nervosa ICD 11
1) Significantly low body weight - BMI <18.5kg/m2 in adults and under 5th percentile for CAMHS/ rapid weight loss
2) Persistent pattern of restrictive eating or behaviours to maintain abnormally low body weight - e.g. eating low calorie foods, purging, laxatives, excessive exercise
3) Excessive preoccupation with body weight/shape - e.g. repeatedly weighing themselves, constantly monitoring calories of food, repeatedly checking mirrors/ distortion of body image
*Check physical symptoms!
Bulimia Nervosa ICD 11
1) Frequent, recurrent episodes of binge eating
2) Repeated inappropriate compensatory behaviours - e.g. purging, omission of insulin
3) Excessive preoccupation with body weight/shape
4) Marked distress (guilt/disgust/shame) about the pattern of binge eating/ significant impairment in personal family, social, educational, occupational or other important areas of functioning
Anorexia nervosa - definition for patient
Anorexia is an eating disorder and serious mental health condition.
People who have anorexia are underweight and achieve this through abnormal eating patterns or behaviours such as excessive exercise. This can make them very ill because they start to starve.
They often have a preoccupation with their body image and may also have a distorted image of their bodies, thinking they’re fat even when they’re underweight.
Bulimia nervosa - definition for patient
People who have bulimia go through periods where they eat a lot of food in a very short amount of time (binge eating) and then compensate for this through behaviours such as purging and laxatives.
They often have a preoccupation with their body weight or shape.
We know that it can be very distressing for the individual
Anorexia nervosa prognostic factors
Anorexia - excessive weight loss, longer duration of amenorrhoea, bulimic features, late onset, chronic course of illness
Co-morbidity - affective disorders, substance misuse, ASD
Family - poor parental relationships, greater family hostility
Male
Bulimia nervosa prognostic factors
Personal history - poor impulse control, pre-morbid obesity, poor social adjustment, low self-esteem
Co-morbidity - affective disorder, substance misuse, lifetime history of anorexia
Late onset
Anorexia nervosa aetiological factors
Risk factors
Aetiological factors:
Family history - eating disorder
Parenting/relationships - adverse parenting, family’s views on eating, high protected and inward family
Personality - low self-esteem, perfectionism
Stressors
RF:
Demographics - female (10:1!), adolescence and early adulthood
Western cultural adaptation
Occupational stress
And the aetiological factors above
Bulimia nervosa risk factors
Demographics - female, adolescence and early adulthood
Family history of obesity
Past history of being obese
Early menarche
Refeeding disorder - definition for patient
Refeeding syndrome is a serious condition which can happen when food is introduced after a period of starvation. This is because when food is reintroduced, the body uses up the minerals in the body (potassium, phosphate etc), which can cause imbalance of the salts.
This can lead to serious complications such as irregular heart rhythms or heart failure, or problems with the liver, lungs (pulmonary oedema) and brain (encephalopathy) which can be potentially fatal.
Eating disorder hospitalisation possible criterias
BMI <13.5
Severe suicidal risk & severe depression
Electrolyte imbalance leading to ECG changes
Dehydration/refusal to E+D
Failed OP care - i.e. non - compliance
Physical symptoms of eating disorder
Fatigue
Dizziness or fainting - low BP
Absence of menstruation
Constipation and abdominal pain
Intolerance of cold
Dehydration
Increased risk of fractures due to low bone density + nutrition
Alzheimer’s in down syndrome (stats)
30% in 50s
50% in their 60s
