Mental Health II Flashcards
What is the definition of delirium?
Fluctuating disturbance of attention, awareness and cognition. Often reversible and caused by underlying cause
Name risk factors for delirium.
Advanced age, infection, cognitive impairment, hx of delirium, polypharmacy, withdrawal, surgery, uncontrolled pain
What is hypoactive delirium?
Mental state of reduced activity, drowsiness, difficulty focusing.
When is hypoactive delirium most common?
In the elderly, can be missed
What is AUDIT and AUDIT-c?
Alcohol use disorder identification test, with AUDIT-C being a shorter version
What AUDIT score indicates alcohol use disorder?
AUDIT score of 16 or greater, AUDIT-C score of 8 or greater
Name some screening tools for alcohol use disorder.
AUDIT & AUDIT-C, CAGE
What is Mallory-Weiss syndrome?
Common cause of upper GI bleeding in those with active/recurrent alcohol use
What are delirium tremens?
Confusion, perceptual disturbances and hallucinations, tremor, altered sleep-wake cycle, changes to pyschomotor activity, fever, tachycardia. Usually occurs a few days into withdrawal from alcohol
What is Wernicke- Korsakoff syndrome?
Neurodegenerative disorder affecting memory, movement, vision, and coordination caused by Vitamin B1 (thiamine) deficiency. Can be seen in alcohol use disorder, eating disorders, malnourishment
What is defined as elder abuse?
Abuse to those 65 years or older
Name risk factors for dementia.
Advanced age, depression, family hx, A-fib*?
What are the different types of dementia?
Vascular dementia, Alzheimer’s, Lewy body, frontotemporal
What must be ruled out when diagnosing dementia?
Delirium
What is vascular dementia?
Cognitive decline d/t reduced blood flow in the brain, usually following TIA/stroke
What is Lewy Body dementia?
Accumulation of Lewy bodies in neurons that results in neurodegenerative cognitive fluctuations, visual hallucinations and Parkinsonism
What is frontotemporal dementia?
Atrophy of the frontal and temporal lobes with abnormal accumulation of proteins (tau, TDP-43) that results in progressive degeneration
What is Alzheimers?
Accumulation of beta-amyloid plaques and Tau tangles that lead to synaptic dysfunction and neuronal death
What is the most common form of dementia?
Alzheimer’s
Is dementia more common in men or women?
Men
What are risk factors for Alzheimer’s?
Advanced age, fam hx, APOE-e4 gene, CVD, traumatic brain injury
What are the risk factors for Lewy body dementia?
Advanced age, Parkinson’s, REM sleep behaviour disorder, fam hx
What are the risk factors for frontotemporal dementia?
Family hx, genetic mutations, hx of head trauma
What are appropriate screening tools for dementia?
Cognitive tests such as MoCA and MMSE, may need other screening (Geriatric depression scale, PHQ9, etc.)
Which dementia can have a more acute onset?
Vascular dementia of large blood vessels- sudden in onset
What is a key clinical feature of Lewy body dementia?
Visual hallucinations. Also see EPS symptoms, sleep disturbance
What are some key clinical features of Alzheimers?
Progressive & gradual onset of memory loss, disorientation, difficulty with tasks. Can see depressive symptoms, apathy, agitation
What is insomnia in the elderly closely correlated with?
Depression
What is Korsakoff dementia?
Neurodegenerative disorder caused by severe and prolonged thiamine deficiency
What is the COWS scale used for?
Clinical opioid withdrawal scale
What is the criteria for insomnia?
Complaints about quality or quantity of sleep at least THREE times a week for at least ONE month
What is CIWA for?
Clinical Institute Withdrawal Alcohol Assessment
What is a major risk factor for alcohol use disorder in the elderly?
Depression
What differentiates Lewy body dementia from dementia secondary to Parkinsons?
Lewy body= onset of cognitive and motor symptoms within one year, dementia secondary to parkinsons= cognitive symptoms >1 year after onset of motor
What symptoms occur early in frontotemporal dementia?
Inappropriate social behaviours (disinhibition, apathy)
What is a normal score on the MoCA?
26 or higher
What is a normal score on the MMSE?
Score of higher than 23
What are the different types of delirium?
Hypoactive (common in elderly), hyperactive (common with substance use/withdrawal), mixed type (common in general population)
What labs should be drawn when working up delirium?
Electrolytes, urea/creatinine, ALP/AST, glucose, thyroid, ABG, urinalysis
What should be reported to MTO?
Disorder causing cognitive impairment, can cause sudden incapacitation, causing severe motor/sensory impairment affecting strength or control, uncontrolled substance use disorder
What labs should be drawn when working up dementia?
CBC, TSH, B12, lytes, toxicology, LFTs, albumin, VDRL
What is the criteria for alcohol use disorder?
2 or more of the following over the last 12 months: strong urge to drink drinking more than intended, increasing amounts needed to achieve same effects, unsuccessful attempts to stop, inability to fulfil daily tasks, etc.
