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Y4 OPIC > mental health in the elderly > Flashcards

mental health in the elderly Flashcards

1
Q

under section 2 how long can a person be kept for ?

A

up to 28 days

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2
Q

who can place someone under a section 2 ?

A

an approved mental health professional make the application on the recommendation of 2 doctors ( one of who should be approved under section 12(2).

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3
Q

why is someone placed under section 2 ?

A

for assessment

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4
Q

why is someone placed under section 3 ?

A

for treatment

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5
Q

how long can someone be placed under section 3 for ?

A

6 months - can be renewed

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6
Q

who can place someone under a section 3 ?

A

approved mental health professional along with 2 doctors both of which must have seen the patient within the past 24 hours

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7
Q

what is a section 5(2) ?

A

a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours

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8
Q

what is a section 5(4) ?

A

it allows a nurse to detain a patient who is voluntarily in hospital for 6 hours

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9
Q

what is section 136 ?

A

someone found in a public place who appears to have a mental disorder ca be taken by the police to a place of safety for 24 hours whilst a MHA assessment is arranged

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10
Q

what is the mechanism of action of typical antipsychotics ?

A

dopamine D2 receptor antagonists blocking dopaminergic transmission in the mesolimbic pathway

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11
Q

what are some adverse side effects of typical antipsychotics ?

A

extrapyramidal side effects
hyperprolactinaemia

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12
Q

what are some examples of typical antipsychotics ?

A

haloperidol
chlorpromazine

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13
Q

how do atypical antipsychotics act ?

A

a variety of receptors - D2, D3, D4 and 5-HT

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14
Q

what are some side effects of atypical antipsychotics ?

A

metabolic effects
extrapyramidal side effects are less common

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15
Q

what are some examples of atypical antipsychotics ?

A

clozapine
risperidone
olanzapine

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16
Q

what are some extrapyramidal side effects ?

A

parkinsonism
acute dystonia
akathisia - severe restlessness
tardive dyskinesia

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17
Q

what are some risks that should be taken when starting antipsychotics in the elderly ?

A

increased risk of stroke
increased risk of VTE

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18
Q

other than extrapyramidal side effects what are some others that antipsychotics cause ?

A

antimuscarinic - dry mouth, blurred vision, urinary retention and constipation
sedation and weight gain
raised prolactin
neuroleptic malignant syndrome - pyrexia and muscle stiffness
prolonged QT interval

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19
Q
A
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20
Q

When a patient is started on antipsychotics what should be monitored and when ?

A

FBC
U&E’s - - start of therapy, annually
LFT’s

Lipids —— start of therapy, 3 months, annually
Weight

Fasting blood glucose - —— start, 6 months, annually
Prolactin

BP - baseline and during dose titration

ECG - baseline

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21
Q

What are the side effects of atypical antipsychotics ?

A

Weight gain
Clozapine - agranulocytosis
Hyperprolactinaemia

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22
Q

How do benzodiazepines work ?

A

Enhance the effect of the inhibitory neurotransmitter GABA by increasing the frequency of chloride channels

23
Q

What circumstances are benzodiazepines used for ?

A

Sedation
Hypnotic
Anxiolytic
Anticonvulsant
Muscle relaxant

24
Q

How long should benzodiazepines be used for and why ?

A

2-4 weeks
People commonly develop a tolerance and dependence

25
Q

What happens if someone is withdrawn from benzodiazepine too quickly ?

A

Develop benzodiazepine withdrawal syndrome

26
Q

What are some features of benzodiazepine withdrawal syndrome ?

A

Insomnia
Irritability
Anxiety
Tremor
Loss of appetite
Tinnitus
Perceptual disturbances
Seizures

27
Q

How do benzodiazepines and barbiturates act differently on the chloride channels ?

A

Benzos - increase frequency of chloride channels
Barb - increase duration of chloride channel opening

28
Q

What are the types of bipolar disorder ?

A

Type 1 - mania and depression
Type 2 - hypomania and depression

29
Q

What is mania ?

A

Severe functional impairment or psychotic symptoms for 7 days or more

30
Q

What is hypomania ?

A

Decreased or increased function for 4 days or more

31
Q

What is the management of bipolar disorder ?

A

Lithium
Stop antidepressants

32
Q

What are some adverse effects of clozapine ?

A

Agranulocytosis
Reduced seizure threshold
Constipation
Myocarditis

33
Q

What are some factors that suggest depression over dementia ?

A

Short history, rapid onset
Weight loss
Sleep disturbance
Patient worried about poor memory
Reluctant to take tests
Variable mini mental test score
Global memory loss

34
Q

What are the 5 stages of grief ?

A

Denial
Anger
Bargaining
Depression
Acceptance

35
Q

What are some features of atypical grief reactions ?

A

Delayed grief - 2 weeks after event
Prolonged grief - difficult to define

36
Q

What is insomnia ?

A

Difficulty initiating or maintaining sleep or early morning waking that leads to dissatisfaction with sleep quantity or quality.
This is despite time and opportunity for sleep and results in impaired daytime functioning.

37
Q

What are some features associated with insomnia ?

A

Female
Increased age
Lower educational attainment
Unemployment
Economic inactivity
Widowed, divorced or separated status
Alcohol or substance abuse
Poor sleep hygiene
Chronic pain
Psychiatric illness

38
Q

What investigations should be performed for insomnia ?

A

History
Sleep diary and actigraphy may aid diagnosis

39
Q

What is the short term management of insomnia ?

A

Identify potential causes
Advise good sleep hygiene
Only consider hypnotics if daytime impairment is severe

40
Q

What are some side effects of hypnotics ?

A

Daytime sedation
Poor motor coordination
Cognitive impairment

41
Q

How does mirtazapine work ?

A

Antidepressant that works by blocking alpha 2 adrenergic receptors which increases the release of neurotransmitters.

42
Q

Why is mirtazapine beneficial in elderly patients ?

A

Fewer side effects and interactions
Sedative and increases appetite

43
Q

When should mirtazapine be taken ?

A

Evening as it can be sedative

44
Q

What is psychosis ?

A

Describes a person experiencing things differently from those around them

45
Q

What are some psychotic features ?

A

Hallucinations
Delusions
Thought disorganisation

46
Q

when can psychotic symptoms present ?

A

Schizophrenia
Depression - psychotic depression more common in older patients
Bipolar
Neurological - Parkinson’s and Huntington’s

47
Q

What are some side effects of SSRI’s ?

A

GI symptoms
Increase risk of GI bleeding - prescribe a PPI
Citalopram - QT interval prolongation

48
Q

What drugs can SSRI’s interact with ?

A

NSAIDs
Warfarin / heparin
Aspirin
Triptans and MAOI - increase risk of serotonin syndrome

49
Q

What are some factors associated with increased risk of suicide ?

A

Male sex
History of deliberate self harm
Alcohol or drug misuse
History of mental illness
Advancing age
Unemployment
Unmarried, divorced or widowed

50
Q

What are some protective factors for suicide ?

A

Family support
Having children at home
Religious beliefs

51
Q

what are some key features to think about when assessing capacity ?

A

mental state can fluctuate and must be assessed at regular intervals
decision specific
assume capacity unless proven otherwise

52
Q

to have capacity to make a decision an individual must demonstrate what capabilities ?

A

understand information
retain information
use the information to make a decision
communicate their decision

53
Q
A

Y4 OPIC (7 decks)

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