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Year 3 Psychiatry > Mental Health of Older Ps > Flashcards

Mental Health of Older Ps Flashcards

1
Q

What is the compression or morbidity?

A

A theory that argues that if the first onset of chronic morbidity can be delayed by better treatment/diagnosis etc - then the amount of time a patient will spell morbid will be reduced before death.

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2
Q

What sort of factors contribute to ageing well?

A
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3
Q

What is integrity v. despair as theoreticised by Erikson?

A

That the last life stage is spent contemplating life and whether you lived it successfully (integrity) or whether you have regrets (despair)

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4
Q

What is social frailty?

A

When patients social lives become at risk due to lack of emotional reserve.

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5
Q

How can mental disorder in old age be categorised?

A

Pre-existing
New onset

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6
Q

What is Charles Bonnet syndrome?

A

When Ps have lost sight - can get visual hallucinations as a result of the brain overcompensating.

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7
Q

What are musical sensations in sensory impairment?

A

In patients who have lost hearing - can get auditory hallucinations, often musical.

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8
Q

What is Diogenes syndrome?

A

Behavioural disorder of the elderly - when they start living in extreme squalor, not washing, neglected physical state. Can be accompanied with self-imposed isolation, hoarding etc.

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9
Q

What can cause Diogenes syndrome?

A

Undiagnosed conditions - such as personality disorder, schizophrenia, ASD etc.

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10
Q

Is depression a normal part of ageing?

A

No - need to adopt a biopsychosocial approach to depression in elderly Ps. Don’t just prescribe ADs.

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11
Q

What are some of the risk factors for depression in old age?

A
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12
Q

How does depression in older Ps differ from depression in younger Ps?

A
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13
Q

What is the link between depression and cognitive impairment?

A

Reversible symptoms similar to dementia may occur during depression.

Is a debate as to whether depression is possibly an early symptom of dementia, or whether it can be a risk factor for dementia.

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14
Q

How is depression managed in older Ps?

A

Same as in young ones - biopsychosocial approach.

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15
Q

Is presentation of first time bipolar disorder common in older Ps?

A

No = most older Ps have experienced bipolar disorder much earlier in life.

If a patient presents with a first manic episode late in life, assume the cause is organic until proven otherwise.

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16
Q

How is bipolar disorder managed in older Ps?

A

A P may spend longer in depressive phase as they get older.

Need to consider whether lithium is still needed - and balance the benefit v. risk of renal impairment.

If P has been stable for many years, also need to think about whether you need to continue medications.

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17
Q

Is anxiety common in older Ps?

How is it treated?

A

Yes - very common.

F>M 3:1

Treated with medication and CBT however less likely to be prescribed to older Ps due to ageism or belief the symptoms are caused by physical illness.

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18
Q

When can psychosis in older Ps occur?

A
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19
Q

What is psychosis termed if the first onset presents
- between 40-60
- >60

A

40-60 = late onset schizophrenia

> 60 = very late onset schizophrenia-like psychosis.

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20
Q

If you have late onset psychosis - what should you be thinking of?

A

Whether there is an organic cause for the psychosis.

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21
Q

What is late onset delusional disorder?

A
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22
Q

What is the impact of alcohol use in older Ps?

A
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23
Q

What is mild cognitive impairment?

A

In some Ps, can represent the earliest symptoms of a condition that will develop into dementia.

Is somewhere between normal ageing and dementia.

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24
Q

Does everyone with MCI get dementia?

A

No - some get better, some stay the same and some get worse.

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25
Q

Which Ps with MCI are most likely to go on to develop dementia?

A

Those where the cognitive domain is most affected (amnestic MCI).

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26
Q

What is subjective cognitive decline?

A

Where the P reports memory problems but objectively it doesn’t really get picked up on testing.

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27
Q

What are functional cognitive disorders?

A

Where symptoms of cognitive impairment exist but are not explained by a medical or psychiatric disorder. Is a problem with the function of the brain. rather than the structure.

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28
Q

What is the name if the memory test for dementia that can be done by GPs?

A

GPCOG

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29
Q

What blood tests are done in the assessment of dementia?

Will they show a cause for a person’s cognitive symptoms?

A
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30
Q

Name the following types of dementia

A
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31
Q

Which part of the brain is affected by AD? What does damage to this area cause?

A

Is atrophy across the whole cortex but especially there is Hippocampal atrophy

Difficulty in recalling information from short term memory

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32
Q

Which part of the brain is affected by frontotemporal dementia? What symptoms does this cause?

A

Frontal lobe is damaged

Disinhibition, loss of empathy, apathy, impaired executive function (sequencing and planning)

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33
Q

Atrophy to which part of the brain can cause primary progressive aphasia?

A

Temporal lobe atrophy

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34
Q

Damage to which part of the brain in rare AD cases can cause impaired visuospatial function?

A

Posterior cortical atrophy

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35
Q

Which mental test is often used in acute settings?

A

AMTS

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36
Q

Which mental tests (2 of them) can be used in memory clinics?

A

MOCA
ACE-3

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37
Q

Are cognitive tests diagnostic?

A

No - they paint part of the picture in the context of the whole assessment.

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38
Q

Why do we do an MRI or CT in suspected dementia?

A

To rule out reversible causes - tumours / subdural haematomas - but it is rare that these are the cause.

Can help us determine the type of dementia based on pattern of atrophy.

39
Q

For neuroimaging - which is better - MRI or CT?

A
40
Q

Name three cholinesterase inhibitors.

Which diseases are these used in?

A

Donepezil
Rivastigmine
Galantamine

Mild-moderate AD
Dementia with Lewy bodies

41
Q

Why are cholinesterase inhibitors used in dementia?

A

Cholinesterase inhibitor drugs, inhibit AChE activity, thus maintain ACh level by decreasing its breakdown rate. Therefore, they boost cholinergic neurotransmission in forebrain regions and compensate for the loss of functioning brain cells.

42
Q

Which disease is the commonest single cause of dementia?

A

AD

43
Q

Apart from AD - what are the DD for hippocampal atrophy?

How can you tell which DD it may be?

A

Frontotemporal dementia
Previous Infection
Paraneoplastic
AI

44
Q

At what age is a patient classified as early onset AD rather than late?

A

Early onset = <65
Late onset = >65 years

45
Q

Which is the second most common subtype of dementia?

A

Vascular dementia

46
Q

What is vascular cognitive disorder?

A

Mild impairment, pre-or dementia syndromes due to vascular injury to the brain.

Mild impairment = 1-2 standard deviations below normal

Major impairment (AKA Vascular dementia) = >2 standard deviations

47
Q

Can a single large vessel infarct produce vascular cognitive disorder or vascular dementia?

A

Yes - if large enough or strategically placed.

48
Q

How do older people learn in later life?

A

Processing speed slows BUT familiarity with real-life problems and developed expertise compensates for this.

49
Q

What is the difference between fluid intelligence and crystallised intelligence - how are these affected in later life?

A

Fluid intelligence = ability to solve unfamiliar problems - declines significantly in later life.

Crystallised intelligence - ability to use existing knowledge & skills - does not decline very much

50
Q

How can socio-economic disadvantage affect health outcomes in later life?

A

Chronic / repeated exposure to stress (associated with adversity) can impair the allosteric process - contributing to the wear and tear on an individual’s biological regulatory system. This means that the poorest socio-economic groups show a much higher level or frailty in old age than the richest third.

51
Q

What is healthcare expenditure principally determined by?

A

Proximity to death rather than age.

52
Q

Why is the demographic time bomb of older Ps living longer and costing the NHS more a myth?

A

Due to compression of morbidity - in the UK the amount of time that people are spending morbid before mortality kicks in has decreased - therefore living longer does not mean a longer period in ill health, and therefore there is not a demographic time bomb which will cost the NHS millions.

53
Q

What is confusion?

A

Broad term - inability to think clearly.

54
Q

What is cognition?

A

The mental processes involved in making sense of and learning from the world around us.

55
Q

At what age does fluid cognitive ability decline from?

A

Age of 20

56
Q

When might young adults without health problems experience cognitive impairment?

A
57
Q

What are the key features of delirum?

A

Acute onset
Impairment of attention and awareness
Fluctating
Often worse in the evening

58
Q

Why is recognising delirium important?

A

Worse outcomes for longer periods of delirium

Common

x2 inc risk of mortality afterwards

Inc risk of dementia following delirium

59
Q

Who is at risk of delirium?

A
60
Q

What are the common causes of delirium?

A

Most common = systemic infection

61
Q

How can delirium be prevented?

A
62
Q

How is delirium managed?

A
63
Q

What is dementia?

A

A group of progressive, neurodegenerative brain disorders - that cause impairment in memory, thinking and behaviour that interferes with a P’s AODL.

64
Q

How do we differentiate between delirium and dementia?

A
65
Q

What are the main types of dementia?

A
66
Q

Which proteins are involved in
- AD
- Parkinsons
- DLB
- FTD

A
67
Q

How do we assess dementia?

A
68
Q

What are the pathological features of AD?

A

Amyloid plaques are deposited in the brain - insoluble protein.

Tau - binds to microtubules = abnormal phosphorylation occurs = neurofibrillary tangles.

Is also reduced cholinergic activity in the cortex –> cell death.

69
Q

Which new drug in the US claims to be able to remove amyloid plaques from the brain in a limited degree?

A

Aducanumab

70
Q

What are the clinical features of AD?

A
71
Q

Which gene is thought to be a risk factor for late onset AD?

A

Apolipoprotein E4

72
Q

What investigations can be done do diagnose AD?

A
73
Q

What are the three types of vascular dementia?

A
74
Q

What are the RF for vascular dementia?

A

Age
Hypertension
Hypercholesterolaemia
Smoking
Physical inactivity
Diabetes

75
Q

What are the clinical features of vascular dementia?

A
76
Q

Which disease should be diagnosed if Lewy bodies are seen
- in the subcortex
- in the cortex?

A

Subcortical lewy bodies = Parkinson’s disease

Cortical Lewy bodies = demential with Lewy bodies.

77
Q

How can you differentiate between Parkinsons and DLB?

A

Parkinsons - starts with movement sx and subcortical lewy bodies.

DLB - starts with cognitive symptoms and lewy bodies in cortical areas.

78
Q

What are the core features of DLB?

A
79
Q

What is it important to remember about antipsychotics and DLB?

A

Ps with DLB can have profound reactions to low doses of antipsychotics. Can make their symptoms much worse.

80
Q

How can you differentiate between AD and DLB on neuro-imaging?

A

DLB - don’t see the hippocampus atrophy that you see in AD on MRI.

SPECT imaging - get normal uptake of the ligand in AD and reduced uptake in DLB.

81
Q

What is Pick’s disease?

A

A type of front-temporal dementia (Caused by Tau)

82
Q

Which three major pathogenic proteins are responsible for frontotemporal dementia?

A

Phosphorylated Tau
TDP-43
FUS protein

83
Q

What is the typical age of onset of FTD?

A

50s-60s
Can be earlier or later

84
Q

What are the clinical features of FTD?

A
85
Q

What are the behavioural and psychological symptoms of dementia?

A
  • Cognitive impairment
  • Disturbance to perception, mood, thought content and behaviour
86
Q

How is dementia managed?

A

Psychological and social support + small role for medication

87
Q

Which therapy is possibly accredited with improving cognition in dementia?

A

Cognitive Stimulation Therapy

88
Q

Which medications are licensed for use in dementia?

A
89
Q

When are antidepressants used in dementia?

A

Rarely - may possibly reduce impulsivity in FTD.

90
Q

What is the definition of young onset dementia?

A

Onset <65 years

91
Q

What is the concept of cognitive reserve?

A

That a higher level of cognitive function reduces the risk of dementia - as the brain is more able to compensate for pathological changes.

92
Q
A
93
Q
A

Year 3 Psychiatry (11 decks)

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