Mood Disorders / Dementia Flashcards
1
Q
What is the defintion of “mood”?
A
mood is a person’s predominant feeling at a given time
an individual’s mood may not be apparent to an outside observer
(i.e. may appear to be happy when the mood has been low for prolonged time periods)
2
Q
What is the definition of affect?
A
affect involves moment-to-moment changes in the emotional state
and the external expression of these feelings as observed by the examiner
(e.g. if you feel sad, you might cry and then other people know how you are feeling)
3
Q
How can the season and weather analogy be used to compare mood and affect?
A
- mood is like the season
- over the course of a season, you expect to see a certain type of weather
- e.g. in winter, it is cold and rains a lot
- affect is like the weather
- on a certain day in a particular season, the weather might not fit with the weather pattern expected for that season
- e.g. there might be a day in winter that is very dry and sunny
- mood is the underlying predominant feeling that a person has, however their affect can change day-to-day and might not mirror the mood
4
Q
What is meant by “euthymia”?
A
- mood can be measured on a spectrum
- euthymia describes the middle ground state of mood, where someone is not experiencing signs of mania or depression
- there is a reference range of normality (i.e. euthymia)
- feeling happy or sad comes within the normal range of mood changes
5
Q
What is meant by “hypomania”?
A
- a mood state or energy level that is elevated above normal, but not so extreme as to cause impairment
- it is a state of elated mood that persists for at least 4 days
- it usually lasts for around 7 days
- it does not meet the criteria to be described as a manic episode
6
Q
What is meant by “dysthymia” or “subthreshold depression”?
How long does someone have to have this for to be diagnosed?
A
- a persistent low mood state that does not recover into the euthymic threshold
- it does not quite meet the criteria for depression
- an individual must be experiencing this low mood for at least 2 years to be described as dysthymic
7
Q
What are the biological, psychological and social impacts on mood?
A
Biological:
- chronic illness
- acute illness - pain and injury
Psychological:
- loss of function
- loss of role
- historical trauma (not necessarily physical) and how the individual perceives this trauma
Social:
- isolation
- loneliness
8
Q
What is the fundamental disturbance associated with mood disorders?
What additional symptom is this usually associated with?
A
- the fundamental disturbance is a change in the affect or mood to depression (with or without associated anxiety) or to elation
- mood change is usually accompanied by a change in the overall level of activity
- most other symptoms are secondary to, or easily understood in the context of, the change in mood or activity
9
Q
What usually can bring on a mood disorder?
A
- most mood disorders tend to be recurrent
- the onset of individual episodes is often related to stressful events or situations
- sometimes there is no explanation at all as to why someone is living with a mood disorder
10
Q
What are described as the core symptoms of depression?
A
- reduced mood
- reduced energy / activity
- reduced interests (anhedonia)
- problems with concentration
- reduced self-esteem and self-confidence
11
Q
What is meant by anhedonia?
A
the inability to feel pleasure in normally pleasurable activities
the person no longer gets enjoyment from things that they previously liked to do
12
Q
What are other essential symptoms of depression that it is important to recognise?
A
- loss of enjoyment in daily activities
- tiredness and poor sleep
- appetite changes and weight loss
- loss of sex drive
- early-morning wakening
- diurnal variation in mood
- feelings of guilt, worthlessness & hopelessness
13
Q
What is meant by diurnal variation of mood?
A
- this describes how mood changes over the course of the day
- typically, an individual wakes up feeling down and starts to feel a bit better by late afternoon / early evening
- they may wake up feeling better and feel low by the end of the day
14
Q
What is meant by early-morning wakening as a symptom of depression?
A
- for a sustained period (at least 2 weeks) an individual wakes up at least 2 hours earlier than they usually would
- once awake, they cannot get back to sleep again
15
Q
Which group of disorders does depression belong to?
What other conditions fall in this category?
A
- depression is a form of affective mood disorder
- other examples include anxiety and bipolar disorder
- the symptoms of these conditions are often similar and there is considerable overlap
- the diagnosis is determined by the actual combination of symptoms that individual has
16
Q
What condition does the term “depression” typically refer to?
Is this always a chronic condition?
A
- depression generally refers to major depressive disorder
- some patients may have depressed mood but not meet the DSM-V criteria for the diagnosis of major depression
- these people may have minor depression
- or if a recent event has precipitated the depression, this is adjustment disorder with depressed mood
- depression can occur as a single episode, or as an ongoing condition with periods of “relapse” and “remission”
17
Q
What factors are implicated in the aetiology of major depression?
A
- genetic susceptibility
- lifestyle factors including social situation
- alcohol / drug dependence
- abuse (sexual, physical, emotional) - particularly in childhood
- being unemployed
- previous psychiatric diagnosis
- diagnosis of a chronic disease
- lack of a confiding relationship
- post-natal depression
- living in an urban area
18
Q
What are 3 possible differentials for low mood?
A
- hypothyroidism
- bipolar affective disorder
- cancer / other terminal diagnosis
19
Q
What investigations need to be performed when someone presents with low mood for the first time?
A
- FBC
- U&Es
- haemotinics - folate, B12 and ferritin
- to look for signs of anaemia
- LFTs
- to look for alcohol / drugs / cancer
- CXR
- to look for chronic infection (e.g. TB)
- ECG
- to look for metabolic disturbances
- full comprehensive history and mental state examination
20
Q
What criteria is used to diagnose depression?
A
the DSM-V diagnostic criteria for major depression
diagnosing depression requires a relatively short history of at least 2 weeks
21
Q
How is the DSM-V criteria used to identify symptoms that are present in major depression?
Which ones are essential?
A
at least FIVE of the criteria must be present almost every day for the last 2 weeks
ONE and TWO are essential
- depressed mood
- loss of interest or pleasure in previously enjoyed activities
- changes in weight (>5% in 1 month) OR change in appetite
- changes in sleep - insomnia or hypersomnia
- psychomotor agitation (e.g. symptoms of anxiety)
- fatigue or low energy
- feelings of guilt or worthlessness
- reduced concentration or decisiveness
- suicidal ideation or attempt
22
Q
According to DSM-V, what 4 other features MUST all be present to diagnose depression?
A
- symptoms cause significant distress or impair functioning
- symptoms are not due to medication, other substance or underlying illness
- symptoms are not better explained by a schizophrenia spectrum disorder or psychotic disorder
- no history of a manic or hypomanic episode
- if this is present, consider bipolar affective disorder
23
Q
What other symptoms may be present in depression, but are not necessary for diagnosis?
A
- psychotic symptoms - especially in severe depression
- hallucinations
- delusions
24
Q
What are the 3 core symptoms associated with major depression?
A
- low mood
-
anhedonia
- does not take pleasure from activities that were previously enjoyable
- often withdraws from social activities
- low energy levels
- these must be experienced for at least part of the day on every day for the last 2 weeks
25
What are the cognitive symptoms of minor depression?
* feelings of **guilt, uselessness, worthlessness**
* thoughts of **_suicide_**
* always ask about suicidal thoughts and whether these thoughts have been acted upon (e.g. stock up on paracetamol)
* **_poor concentration_**
26
What are the functional symptoms of minor depression?
* changes in **sleep**
* **weight loss** or **weight gain** - a change of \>5% is significant
* ensure to ask whether weight loss / gain is intentional
* l**oss of libido**
* memory problems
* psychomotor retardation
* agitiation / fidgeting
27
What sleep disturbances may be experienced by someone with depression?
* difficulty getting to sleep
* waking up several times during the night
* early waking
28
Why might someone with depression lose or gain weight?
* they may gain weight through **"comfort eating"**
* they may lose weight as they **no longer take pleasure in eating** and / or feel **nauseous** so eat less
29
What is meant by pyschomotor retardation?
* the patient can be very **"slow"** with both their **thoughts and actions**, to a degree that is noticeable by others
30
Why might someone with depression complain of memory problems?
* there is likely to be **_no issue_** with their memory
* if you test them on their memory, you may notice that they **do not concentrate** when information is first given to them
* this means that the **information is not processed**, and so they are **not able to recall it**
* it is the **_information processing_**, and not the memory recall, that is at fault
31
What other clinical characteristics are associated with depression that are not present in all patients?
* **_diurnal variation_** of symptoms
* **_hallucinations_** and **_delusions_**
* if present, these are generally congruent to the current mood
* **Schneider's positive symptoms** can occur in severe depression
* these are usually associated with schizophrenia
* **_melancholia_** - the patient feels unable to experience any emotions at all
32
What are the 6 most important questions to ask when taking a history of someone with depression?
* *Have you felt **low or miserable** recently?*
* *Do you feel like you have **lost your emotions**?*
* *Does it happen / do you feel like this **everyday**?*
* *Has anything **happened recently** that you think might have triggered this?*
* *Have you **lost interest** in things you **usually enjoy**?*
* *Do you still see your friends regularly?*
* *Does your current mood / experience i**nterfere with your normal life**?*
* **sleep
* weight loss
* feelings of guilt / worthlessness
33
When performing a mental state examination, what might you notice about a person with depression's appearance, behaviour and speech?
***_Appearance & behaviour:_***
* poor self care
* lack of eye contact
* does not "engage" in conversation
* little movement OR lots of fidgeting
***_Speech:_***
* monotone
* hesitant
* slow
34
What mnemonic can be used to remember all the things to include in a depression history?
DEAD SWAMP
* D - depressions
* E - energy levels
* A - anhednia
* D - death
* this includes thoughts about suicide and self-harm
* S - sleep pattern
* W - worthlessness / guilt
* A - appetite
* M - mentation
* this includes the ability to make decisions and concentrate
* P - psychomotor agitation / retardation
35
What mnemonic can be used to perform a suicidal risk assessment within the depression history?
SLAMPS
* **S - suicidal thoughts**
* **L - lethality**
* e.g. are they planning on taking 10 paracetamol or jumping off a cliff?
* **A - a suicide plan**
* do they have a current plan about how / when they would kill themselves?
* **M - means**
* do they have access to firearms / dangerous equipment?
* what medication do they have at home?
* **P - past history**
* have they tried to commit suicide before?
* how did they do this?
* **S - suicide of a family member or peer**
36
What are the possible psychological interventions that can be offered in depression?
* **lifestyle factors** that are known to improve mood
* e.g. social interaction, regular exercise, healthy diet
* **cognitive behavioural therapy**
* either in person or online
37
What are the other treatment options available in depression?
* **antidepressant medication therapy**
* typically used in conjunction with psychological interventions
* needs regular follow-ups to review effectiveness of treatment
* **electroconvulsive therapy (ECT)**
* reserved for most severe cases in an inpatient setting
38
How does treatment change based on severity of depression diagnosis?
*
39
What happens in cognitive behavioural therapy?
* this is a type of **"talking therapy"** which helps the patient to:
* have a **better understanding** of their symptoms
* recognise **negative thought patterns**, and how to better manage these thoughts
* encourage new ways of **positive thinking**
40
What very important question needs to be asked to rule out a certain condition before prescribing antidepressants?
* need to ask about possible **_periods of mania or hypomania_** before prescribing to ensure it is not a case of **bipolar disorder** presenting with a **low mood episode**
* **antidepressants can _WORSEN_ bipolar disorder**
* they should be treated with mood stabilisers, such as lithium
41
What is the aim of antidepressant therapy?
How long should they initially be given for?
* the aim of treatment is to **_induce remission_**
* assess the effectiveness of antidepressants at **_6-8 weeks_**
* if no benefit is felt by 6 weeks, the current drug is likely to be unsuitable for the patient
* consider **alternative medication**
* antidepressants are roughly as equally effective in treating depression as CBT / psychological interventions
* they may be more effective in treating severe depression
42
What type of antidepressant is first line in treating depression?
What should be done if this treatment is not effective?
**_selective serotonin reuptake inhibitors (SSRIs)_**
* e.g. fluoxetine, citalopram, sertraline, paroxetine
* need to allow **4 - 6 weeks before beneficial effect**s may be seen
* if one SSRI is not effective, **_attempt another SSRI_** before trying other drugs
43
What are the potential side effects of SSRIs?
* nausea and vomiting
* abdominal pain
* sexual dysfunction
* patients may have increased suicidal thoughts during the first few weeks of taking these before improvement is seen
44
If SSRIs are ineffective, what medications may be considered?
How long should medication be trialled for?
* **serotonin-noradrenaline reuptake inhibitors (SNRI)**
* e.g. venlafaxine
* may be superior to SSRI in severe depression
* **tricyclic antidepressants**
* **monoamine oxidase inhibitors (MAOIs)**
* need to trial medications for at **_least 4-6 weeks_** to see if they are effective
* if medication is not effective, try **_another drug in the same class_** before trying a different class
45
What must someone have in order to be diagnosed with bipolar effective disorder?
* **_2 or more_** episodes where **mood and activity are _significantly disturbed_**
* 1 episode MUST be **elation / elevation of mood** and increased energy or activity (**_mania / hypomania_**)
* or it could be a **_depressive episode_**
* (someone with 2 discrete episodes of depression does not necessarily have bipolar disorder - must be at least 1 episode of elation)*
46
What is bipolar affective disorder?
it is a psychiatric condition that involves both **_depressive and manic episodes_**
this is different to depression, as there is ***no mania in depression***
in bipolar disorder, it is possible for ***mania to occur at any time***, or when ***under antidepressant medication***
47
What is the difference between bipolar 1 and bipolar 2 disorder?
***_Bipolar 1 disorder:_***
* there is underlying depression interspersed with episodes of mania
* usually depressive and manic episodes occur in the **_ratio 1:1_**
***_Bipolar 2 disorder:_***
* the depression is more predominant
* the ratio of depressive to manic episodes is about **_5:1_**
* manic episodes may only be slight (i.e. hypomania) or precipitated by antidepressant medication
48
Who tends to be affected by bipolar disorder?
When is it usually diagnosed and how does it present?
* it is more common in **_women_** and usually starts in **teenage years**
* first incidence is usually **_before the age of 30_**
* first presentation can involve any / all of: **depression, hypomania, mania**
* many cases of bipolar that present with a depressive episode are diagnosed and treated as depression
* may not be truly diagnosed as bipolar disorder for many years
49
What is meant by "rapid cycling bipolar" and why is it important to identify?
* there are **_\> 4 episodes a year_** of **_mania + depression_**
* the person quickly swings from a low phase to a high phase without having a period of "normal" in between
* the **treatment is different** from other types of bipolar disorder
50
What genetic factors are implicated in the aetiology of bipolar disorder?
* **5-10% increased risk** if a family member has **depression / bipolar**
* increased risk in those with a tendency to have **rapid mood changes** (**_cyclothymia_**) or **unusual periods of elated feelings** (**_hyperthymia_**)
51
What are the different factors that can precipitate an event in bipolar disorder?
What factors can cause rapid cycling mood in patients with bipolar disorder?
* life factors that lead to **_early morning waking_** can precipitate a ***manic episode***
* e.g. working shift patterns, one off event where you have to wake early
* **_positive life events_** can precipitate ***mania***
* **_negative life events_** can precipitate ***mania and depression*** (more likely)
* **_pregnancy_**, **_cerebrovascular accident_** (or anything affecting frontal lobe / cortical structures), **_steroids_** and **_stimulants_** can precipitate ***mania***
* **_thyroid disease_**, **_antidepressants_**, **_steroids_**, **_alcohol_** and **_cannabis_** can cause ***rapid cycling mood***
52
In general, what is the main difference between mania and hypomania?
* they are both forms of **_elated mood_**
* ***mania*** is an elated mood lasting **_1-2 weeks (or more)_** with **_psychotic symptoms_**, that affects social functioning
* ***hypomania*** has **_no psychotic symptoms_** and does not last as long (\>4 days)
53
What are the typical clinical features of someone with bipolar affective disorder?
* **elated mood**
* this can be mania or hypomania
* **irritable mood**
* feelings of **increased self worth**
* **inappropriate social behaviour**, including compulsive actions
* general **increase in activity**
* this includes a lack of sleep
* heighten sense of one's abilities / prestige
* delusions and hallucinations
* **very fast speech**
* **altered perceptions**
* e.g. they may perceive colours as brighter, or sounds as louder
54
What is meant by irritable mood and labile mood in bipolar disorder?
* ***irritable mood*** occurs **between periods of elation**, and is often expressed as **_inappropriate anger_**
* the general mood in mania is **_very variable_**, with periods of elation lasting anywhere **between _minutes and days_**
* this variable mood is known as ***labile mood***
55
What type of inappropriate social behaviour is seen in bipolar disorder?
* this may include **sexual behaviour**
* it often includes **_compulsive actions_** such as gambling, spending lots of money, dangerous driving
56
What features are typically seen when someone has a general increase in activity in bipolar disorder?
* **_lack of sleep_** as patients feel they only need a couple of hours of sleep
* they will often switch from one activity to another, without finishing any of them
this is known as **_distractability_** and shows **poor attention** and **concentration**
57
What are 3 very important questions to ask when taking a bipolar history?
* *Have you ever felt **especially happy or cheerful**?*
* **How long does it last for?
* How often does it occur?
* *Do you feel like you **lose your temper more easily** than usual?*
* *Do you feel like you have **more energy** than usual?*
If the patient answers "yes" to any of these questions, then ask about:
* sleeping patterns
* restlessness
* opinion of the self
* libido (v increased)
* spending habits
58
What might be observed on a mental state examination of someone with bipolar disorder?
***_Appearance:_***
* bright coloured clothes / eccentric
***_Behaviour:_***
* overly friendly, perhaps inappropriate
***_Speech:_***
* fast and difficult to interrupt
***_Mood:_***
* elated / irritable
***_Thought:_***
* fast
* sentences may be logical, but linked by puns and similar sounding words, and not by ideas
* patient may be very self important
***_Perception:_***
* hallucinations - usually occur with elated mood
***_Cognition:_***
* distractability
59
How is bipolar disorder diagnosed based on the DSM-V criteria?
* diagnosis typically based on mania:
* **_elated or irritable mood_** for **_at least one week_**, PLUS **_at least 3_** of:
* inflated self esteem
* decreased need for sleep
* accelerated speech
* racing thoughts / flight of ideas
* distractability (reported or observed)
* increased goal directed activity or psychomotor agitations
* excessive activity
* **impaired social** or **occupational functioning**
* episode is **not due to substance misuse** or other organic cause
60
What are the potential differential diagnoses for bipolar disorder?
* unipolar (regular) depression
* schizophrenia
* borderline personality disorder
* can mimic cycling moods of bipolar
* bipolar tends to be episodix, BPD tends to be chronic
* organic causes of mania
61
What are common endocrine, neurological and drug organic causes of mania?
***_Endocrine:_***
* **thyroid, pituitary** or **adrenal** disorders
***_Neurological:_***
* MS
* cerebrovascular accident (CVA)
* epilepsy
* tumour - particularly those that affect the **frontal** and **subcortical areas**
***_Drugs:_***
* steroids
* stimulants
* antidepressants
62
What factors increase the risk in bipolar disorder?
What might the appropriate course of action be?
* **reckless behaviour**
* **aggression**
* promiscuous **sexual behaviour** (STIs, pregnancy)
* **lack of self care** (can be a big risk e.g. in diabetes)
* some patients may need to be **sectioned for inpatient care**
* particularly as during manic episodes, patients feel "very healthy"
63
What investigations are performed to diagnose bipolar disorder?
* there are no diagnostic tests for bipolar disorder and **diagnosis is clinical**
* some blood tests are performed to rule out an organic cause at first presentation:
* FBC
* U&Es
* LFTs
* TFTs
* urinary drug screen
64
What chemicals / hormones might be raised in bipolar disorder?
* there are **increased _serotonin_** and **_noradrenaline_** levels during episodes of mania
* **_inositol phosphate_** is increased in mania
* this is a chemical that increases the metabolism of lithium
* there is increased **_cortisol release_** / **response to stress** in mania
65
What sign on neuroimaging is associated with poor prognosis in bipolar disorder?
**_white matter hyperintensities_**
* the presence of these is related to poor prognosis, **increased frequency** of manic episodes and **cognitive impairment**
66
What is the first and second-line management for an acute manic episode?
***_FIRST LINE:_***
* an atypical antipsychotic
* e.g. olanzapine, risperidone, clozapine
* be weary of agranulocytosis (low WCC)
***_SECOND LINE:_***
* valporate, iamotrigine (anticonvulsant) or lithium
67
What is involved in the management of bipolar disorder during a depressive episode?
* **_AVOID ANTIDEPRESSANTS_**
* these can cause rapid cycling mood
* try an **atypical antipsychotic**, such as **_olanzapine_**
* if this does not work, try adding **_lamotrigine_** (anticonvulsant) or possible **_lithium adjunct_**
68
What is involved in the general maintenance management in bipolar disorder?
* try to **avoid acute changes in medication** regimens
* consider a **mood diary**, where patient rates their mood /10 everyday before going to bed
* consider education / therapy to encourage a **proper diurnal pattern**
* first line treatment is **_lithium_** - a ***mood stabiliser***
* in case of manic or depressive episodes, first add an **_atypical antipyschotic_**
* if response is poor then consider **anticonvulsants**
69
What questions need to be asked about risk in mood disorders?
* risks to self
* risks to others
* risks of treatment
* risks of lack of treatment
*risk to others includes risk of neglect to dependents e.g. young children*
70
What is meant by psychosis?
What can cause it?
* psychosis is a condition that affects the **way your brain _processes information_**
* it is a **symptom**, not an illness
* it causes you to **lose touch with reality**
* you might **see, hear or believe things** that are **_not real_**
* it can be caused by a **mental or physical illness**, **substance abuse**, **extreme stress** or **trauma**
71
What are the 3 main symptoms associated with a psychotic episode?
* hallucinations
* delusions
* confused and disturbed thoughts
72
What is the difference between a hallucination and a delusion?
***_Hallucination:_***
* this is where someone **sees, hears, smells, tastes** or **feels** things that **_do not exist outside their mind_**
***_Delusions:_***
* this is where someone has an **_unshakeable belief in something untrue_**
* the person is often unaware that their delusions or hallucinations are not real, which can cause them to become frightened or distressed
73
What are the 3 major signs of disturbed, confused and disrupted patterns of thought?
* **rapid** and **constant speech**
* **disturbed speech**
* e.g. switching from one topic to another mid-sentence
* a sudden loss in their train of thought, resulting in an **abrupt pause** in conversation or activity
74
What is the definition of thought?
the act of thinking about or considering something, an idea or opinion, or a set of ideas about a particular subject
75
What happens during normal thought form?
What happens if there is a thought disorder?
* topics of speech normally **fluctuate** as different ideas enter consciousness
* these topics are usually **well-connected** and speech is **logica**l and **organised**
* thought disorder occurs when there is a **_problem_ in the way the content is _linked together_ and _delivered_**
76
What questions should you consider when evaluating whether someone might have a thought disorder?
* *How **smoothly** do the **ideas flow** from one to another?*
* *Are **questions repeated** and rephrased?*
* *Is conversation direct and informative or **confusing and vague?***
* (often you will leave the conversation feeling very confused, whilst the person with the disorder will not)*
77
What are the 5 most common disorders of thought content?
* **_pre-occupations_**
* e.g. "did I lock the back door?"
* repeatedly thinking about this throughout the day, but it does not affect day-to-day living
* **_phobias_**
* this is a concern, fear or worry that is outside normal range
* for most people, it has ***no significant impact on life***
* **_overvalued ideas_**
* an individual spends ***more time thinking about one particular idea*** than others
* e.g. always thinking about something that you don't want to think / worry about
* generally can ***push this idea aside*** for long enough to focus on other tasks
* **_obsessions_**
* often starts small and grows large to a point that the person ***cannot control it / push it out of their mind***
* **_delusions_**
* *********fixed, firm false belief*** that is outside of that person's cultural context
78
How might someone tell you that they have a thought problem?
* beliefs that are not true
* sensing things that nobody else can
* saying that they have strange thoughts that are not their own
* feeling confused
79
What is meant by a paranoid delusion?
* this involves **_intense and irrational mistrust or suspiscion_** that people are "out to get" the patient
* they become paranoid that people are talking about them, monitoring them and hunting them down
80
What is meant by a grandiose delusion?
* the person has an **over-inflated sense of worth**, **power, knowledge,** or **identity**
* they believe they have a great talent or have made a great discovery
* e.g. "I am the King of Mars"
81
What is meant by a nihilistic delusion?
* this is when the patient believes that **they are dead** and **someone else is controlling their body**
* it is often coupled with the hallucination of being able to smell rotting flesh
* this is seen in untreated severe depression in older adults
82
What is meant by passivity phenomenon?
* this is the belief that an **external agency is taking control over** the person
* they believe that they have **_no control over their body or their actions_**
* this often leads to **unpredictable** and **high risk behaviour** around other people
83
What is the definition of a delusion?
a **_fixed, unshakeable belief_**, despite **evidence to the contrary**, not held by others in the same culture
and held with **_intense personal conviction_** and **_certainty_**
84
What are examples of sensing things that nobody else can?
* hearing things
* seeing people / animals
* something crawling under the skin
* strange taste
* odd smell
* feeling like an internal organ is painful
85
What is the definition of a hallucination?
What are the 6 different types of hallucination?
a perceptual experience **_without an object or stimulus_** that appears **subjectively real**
* **auditory** - hearing something
* **gustatory** - tasting something
* **visual** - seeing something
* **tactile** - feeling something
* **olfactory** - smelling something
* **somatic** - internal organ pain
86
What is the difference between an illusion and a hallucination?
* an ***illusion*** occurs when the brain tries to make sense of an **_existing stimulus_**
* e.g. seeing screaming faces in the peppers
* there is a true visual stimulus, but the brain misinterprets the information
* a ***hallucination*** occurs when there is **_no stimulus_** to excite the sensory organ
87
What is the defintion of a thought disorder?
What first-rank symptoms of schizophrenia may be present in a thought disorder?
an abnormality in the mechanism of thinking such that to the **observer** the person **doesn't make much sense**
*first-rank symptoms of schizophrenia:*
* *thought withdrawal*
* *thought insertion*
* *thought broadcast*
88
What is meant by thought withdrawal?
* this occurs when the patient believes that **thoughts are being _taken out of their mind_**
* as a result, other people can read the thought that has been taken
89
What is meant by thought insertion?
* the patient believes that **thoughts are being _put into their mind_ by other people**
* they believe these thoughts are not theirs
* this can sometimes be **physically painful**
90
What is meant by thought broadcasting?
* the patient believes that they are like an antennae that is **_broadcasting their thoughts_**
* they believe that everyone around them can pick up and understand their thoughts
91
In mental health, who is considered to be an older adult?
* in many hospitals, you become an older adult \> 80
* in mental health, you become an **_older adult \> 65_**
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What is meant by the "stages of development" in \>65s and what impact does this have on mental health?
* ***maturity*** occurs at **65+ years**
* the ***conflict*** is thinking about whether they have **lived a good life** and the despair that **life is coming to an end**
* the ***event*** involves **reflection** on holding these 2 competing thoughts in their mind at the same time
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What are the 5 key factors that affect the mental health and wellbeing of older adults?
* **discrimination**
* ****this includes discrimination by gender, ethnicity and AGE
* **participation in meaningful activities**
* ****e.g. such as learning new skills, expanding their knowledge
* **relationships**
* **physical health**
* **poverty**
* ****this is universal and affects younger people too
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What does the DEMENTIA mnemonic stand for when remembering causes of confusion in older people?
* D - drugs / delirium
* E - emotions / depression
* M - metabolic disorders
* E - eye and ear impairment
* N - nutritional disorders
* T - tumours, toxins, trauma
* I - infections
* A - alcohol, arteriosclerosis
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What are the 5 stages involved in assessing confusion in an older adult?
* taking a full, comprehensive history
* collateral history
* this involves another person's versions of events to determine whether confusion is new
* mental state examination (MSE)
* formulation
* cognitive screen
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What is the definition of delirium?
an **acute onset** syndrome with disturbances in **_attention_**, **_awareness_** and **_cognition_**
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Why is it very important to recognise delirium in hospitalised older adults?
* mortality is twice as high in a patient with delirium - no matter what condition they are in hospital for
* someone with delirium is 8 times more likely to develop dementia
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What are the possible causes of delirium?
* acute illness
* trauma
* surgery
* restraint
* length of stay
* moving environment
* malnutrition
* dehydration
* constipation
* co-morbidity
* medication (use of or the absence of)
* drugs
* alcohol (intoxication and withdrawal)
* polypharmacy
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What type of condition is dementia?
What features of behaviour are altered in this condition?
* it is a **_progressive_** **_neurodegenerative_** condition
* there is disturbance of multiple **higher cortical functions**
* this includes a ***decline in memory*** & ability to ***learn new things***
* accompanied by deteroriation in:
* judgement and thinking
* processing of information
* ***emotional control***, ***social behaviour*** or ***motivation***
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What 3 things must be present alongside symptoms that are necessary for a diagnosis of dementia?
there are ***cognitive*** and ***behavioural symptoms*** that:
* **_interfere with work_** and **_social activities_** and
* represent a **_decline_** in prior levels of **_functioning and performing_** and
* are **_not_** explained by **_delirium_** or a major **_psychiatric disorder_**
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What is meant by Kitwood's enriched model of dementia?
**dementia = NI + H + B + P + SP**
* NI - neurological impairment
* H - health & physical fitness
* B - biography, life history
* P - personality
* SP - social pyschology
*if all 5 areas are impacted at the same time over 6 months (or more) then this is dementia*
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What are the most common risk factors for Alzheimer's dementia (the most common form of dementia)?
***_Modifiable risk factors:_***
* lifestyle risk factors
* obesity, alcohol, smoking and other CVS risk factors
* **social interaction**
* people who are able to interact in social settings in a way they find enjoyable
***_Non-modifiable risk factors:_***
* advancing age
* genetic predisposition (including trisomy 21)
*it does **NOT** mean that if you follow all the guidance and have **none** of these risk factors, you will **NOT** develop dementia*
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what are the 5 As associated with Alzheimer's dementia?
***_Amnesia_***
* a form of memory loss
* usually retain knowledge of their own identity and motor skills
***_Apraxia_***
* the individual has problems with motor planning to perform tasks or movements when asked
* provided that the request or command is understood and the individual is willing to perform the task
***_Aphasia_***
* the inability to comprehend or formulate language
***_Agnosia_***
* the loss of ability to recognise faces, objects, places, smells or voices
* usually only one sensory pathway is implicated
***_Associated behaviours_***
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How can Alzheimer's dementia be recognised on CT scan?
* it is a disease of the brain that results in a **_loss of brain volume_**
* it looks as though the ***ventricles have increased in size***, but they have **_not_**
* the brain tissue around this area has shrunk, meaning the ***ventricles fill the space*** left by ***atrophied brain tissue***
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What are the 5 different features involved in the pathology of Alzheimer's dementia?
* **_cerebral atrophy_** (loss of brain volume)
* this is seen in the ***medial temporal lobes*** first
* this is due to deposition of **_senile plaques_**
* which are made from incorrectly folded **_amyloid protein_**
* **TAO protein** kills cells in the brain, leading to **_neuro-fibrillary tangles_**
* **_levels of acetylcholine_** in the brain are **_reduced_**
* fewer neurotransmitters available means reduced ability of circuits in the brain related to cognition to work effectively
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