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Psychiatry > Life Expectancy > Flashcards

Life Expectancy Flashcards

1
Q

Why is it important to consider life expectancy as it relates to mental health?

A

Disease prevention
Allows better understanding of aetiology
More accurate diagnosis and formulation
Early intervention and age-tailored treatments
Allows for service planning and development
Better prognosis comes with early treatment

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2
Q

What is the average reduction in life expectancy for some mental health disorders?

A

Bipolar disorder = 9-20 years
Drug/alcohol abuse = 9-24 years
Schizophrenia = 10-20 years
Recurrent depression = 7-11 years

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3
Q

How common are mental illnesses in older people?

A

25% of people aged >65 will have mental illness

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4
Q

What is mental illness onset associated with?

A

Periods of stress and lack of supportive mechanisms to manage this

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5
Q

What are the systemic influences on mental illness onset?

A

Family, school, neighbourhood, work, church, social networks, health services

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6
Q

What are some developmental and transitional influences on mental illness onset?

A

Birth, separating from parent, nursery to primary then secondary school, developing adult thinking, adult life development, adult life transitions, ageing and dying

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7
Q

In what age groups can it be difficult to identify prodromal schizophrenia symptoms?

A

Extremes of age = very young or very old

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8
Q

In what age groups is it rare for schizophrenia to occur?

A

Very early/early and late onset are rare

Some reluctance to diagnose in children

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9
Q

How do risk factors for schizophrenia vary in different age groups?

A

Young people = high THC cannabis and drug induced psychoses

Elderly = dementia and associated psychosis

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10
Q

When do most patients experience their first depressive episode?

A

About 50% of depressed adult patients claimed their first depressive episode occurred before age 20

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11
Q

What is the gender distribution of depression?

A

Equal prepubertal incidence but sudden increase in female cases during adolescence

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12
Q

What are some risk factors for depression in the elderly?

A

Physical illness and loneliness

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13
Q

Why is it rare for CAMHS to diagnose bipolar disorder?

A

Assume mood is labile during adolescence and due to fear of medicalising normal adolescence

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14
Q

What is onset of bipolar disorder in old age associated with?

A

Negative outcomes, cognitive deficits, increased suicide risk and overall mortality

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15
Q

At what age are personality disorders diagnosed?

A

Technically only after age 18

May be diagnosed earlier when symptoms are clear, persistent and impair functioning

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16
Q

When is the peak incidence of frequency of symptoms for personality disorder?

A

At age 14 = also when there is first access to services

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17
Q

What are some mental illnesses that are mainly seen in children?

A

Behavioural disorders, ADHD and ASD, separation anxiety, attachment disorders

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18
Q

What is the most common mental disorder of childhood?

A

Behavioural disorders = around 6%

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19
Q

Why do most mental health services not cater for behavioural disorders?

A

Behavioural disorders aren’t considered a mental illness

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20
Q

What age group is oppositional defiant disorder diagnosed in?

A

Under 12s = primary school age

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21
Q

What age group is conduct disorder diagnosed in?

A

Over 12s = secondary school age

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22
Q

What are early conduct disorder behaviours predictors of?

A

One of the most robust predictors of serious antisocial behaviour, criminality and substance misuse in later life

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23
Q

What is key in managing behavioural disorders?

A

Early intervention by parenting and social intervention

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24
Q

Is medication usually given to treat behaviour disorders?

A

No = rarely given unless very severe

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25
Q

What are some features of autism spectrum disorder?

A

4 times more common in boys
Huge range of impairments
Some comorbidities are depression, anxiety and psychosis

26
Q

How is autism spectrum disorder treated?

A

Mainly through education and social interventions

Medication only indicated to treat comorbidities

27
Q

How common is ADHD?

A

Occurs in 4-5% of children

28
Q

How is ADHD treated?

A

Medical treatment key in moderate to severe cases = should be accompanied by social, educational and parenting interventions

29
Q

In what age group is separation anxiety normal?

A

From age 7 months through preschool years

30
Q

What distinguishes separation anxiety?

A

Age inappropriate, excessive and disabling anxiety

31
Q

What does separation anxiety lead to?

A

School refusal = mostly seen during main transitions

Marked increase in social anxiety and perfectionism during adolescence

32
Q

What are some common mental illnesses in adults aged 18-65?

A

Puerperal psychosis and postnatal depression

33
Q

What are some mental illnesses of old age?

A

Dementia, delirium, pseudo-dementia, late onset depression

34
Q

What is attachment disorder most commonly linked to?

A

Maltreatment and abuse in early childhood

35
Q

What is the presentation of attachment disorder?

A

PTSD type symptoms, general irritability, anxiety, oppositional behaviours, quasi-psychotic symptoms

36
Q

What are some comorbidities of attachment disorder?

A

High comorbidity with other mental illness = substance misuse, psychotic disorders, mood disorders, anxiety disorders, suicide attempts

37
Q

What are some groups at increased risk of attachment disorder?

A

Asylum seekers, refugees, looked after children

38
Q

What are some presentations in primary school age children that shouldn’t be mistaken for mental illness?

A

Developmentally appropriate anxiety, hyperactivity and short attention span, grandiose ideas and overtalkativeness, imaginary friends, intense interests, onset of non-impairing tics

39
Q

What are some presentations in secondary school age children that shouldn’t be mistaken for mental illness?

A

Mood swings, sullenness, withdrawl, irritability, sleep changes, peer pressure influencing behaviour, rituals and OCD-type behaviours, intrusive thoughts and pseudohallucinations

40
Q

Why are mental disorders in young children difficult to detect and treat?

A

Young children less likely to manage individual psychological therapy and lack verbal abilities to talk about emotions

41
Q

Why are children with medical disorders difficult to detect and manage?

A

May have less insight into difficulties and may not engage
Medications commonly unlicensed for under 16s
Tend to have less predictable response and more side effects

42
Q

What is delirium linked to?

A

The ageing brain

43
Q

What characterises delirium?

A

Acute onset = lasts hours-weeks, fluctuates and is worse at night, attention decreased or hyperalert

44
Q

What are some causes of delirium?

A

Infection, alcohol withdrawl, dehydration, drugs, tumour, stroke, hypoxia, trauma

45
Q

What are some of the challenges of early adulthood?

A

Leaving school, getting a job, buying a house, having children, establishing long term relationships

46
Q

What are some of the challenges of middle adulthood?

A

Maintaining financial/professional security, managing relationship difficulties, dealing with children leaving home

47
Q

What are some of the challenges of late adulthood?

A

Preparing for retirement and change of role, dealing with deteriorating physical health, managing bereavement

48
Q

What are disorders of puerperium?

A

Typical of adulthood = puerperium is period of increased risk of new mental illness and relapse of existing illness

49
Q

What are disorders of puerperium linked to?

A

Loos of independence, hormonal changes, unremitting demands, chronic sleep loss, stopping psychotropic medication

50
Q

What is puerperal psychosis characterised by?

A

Acute sudden onset of psychotic symptoms, manic symptoms/disinhibition and confusion = emergency due to safeguarding risk

51
Q

What are some features of puerperal psychosis?

A

Every 1 in 1000 births
Presents between 2-4 weeks postpartum
Increased risk of previous mental illness but 50% have no previous condition

52
Q

What are some risk factors for puerperal psychosis?

A

Previous thyroid disorder, previous episode, positive history, being unmarried, first pregnancy, c-section, perinatal death

53
Q

What are some features of postnatal depression?

A

Occurs in 1 in 10 women

Usually presents 1-4 weeks postpartum

54
Q

What are some risk factors for postnatal depression?

A

Family/personal history of depression or anxiety, complicated pregnancy, traumatic birth, relationship difficulties, history of abuse, lack of support, financial difficulties

55
Q

What are some features of dementia?

A

Symbolic of ageing brain
70% due to Alzheimer’s, 17% due to vascular dementia and 13% due to other dementias
Age is biggest risk factor

56
Q

What are the features of pseudodementia?

A 
Fluctuating loss of memory and vagueness
Good insight into memory loss
Prominent slowing of movement and reduced speech
Consistently depressed mood 
Lack of neurodegenerative dementia
57
Q

How is pseudodementia treated?

A

Responds to medication and ECT

Condition is non-progressive

58
Q

What is late onset depression?

A

Depression occurring for first time in later life = estimated prevalence of about 2% in people aged >65, poorer prognosis than early onset type

59
Q

What are the risk factors for late onset depression?

A

Genetic susceptibility, life events, loneliness, financial issues, poor physical health

60
Q

What are the features of late onset depression?

A 
Structural changes in brain
Higher rates of vascular risk factors 
More cognitive/neurological issues
Lack of insight 
Greater comorbid physical illness
Express somatic rather than depressive symptoms
Highest risk for suicide

Psychiatry (36 decks)

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