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MRCPsych CASC > Old Age > Flashcards

Old Age Flashcards

1
Q

Delirium Management

A

Description
Delirium is a state of mental confusion that starts suddenly and is caused by a physical condition of some sort.

Symptoms
- Confused, sleepy, drowsy, distressed, change in behaviour

Epidemiology
- 1 in 5 inpatients, more in ICU
- More common in: older, memory problems, poor hearing or eyesight, post-surgery, terminal illness, infection, a stroke or a head injury, previously had delirium

Diagnostic Criteria
- A disturbance of attention, orientation, and awareness
- Develops within hours or days
- Typically presenting as significant confusion
- Fluctuating course
- Change from the individual’s baseline functioning.
- Symptoms not better accounted for by a pre-existing or evolving Neurocognitive Disorder
- Symptoms not better accounted for by a typical syndrome of Substance Intoxication or Substance Withdrawal for a substance or medication that is known to be present, although Delirium can occur as a complication of intoxication or withdrawal states.

Causes
- Infection, drugs, urinary retention, constipation, dehydration and electrolyte imbalance, pain, sensory impairment

Best Practice Management Plan
- Biological: Identify organic cause, monitoring in hospital if needed, optomise co-morbidities. Haloperidol <1/52
Psychological: Education
- Social: Reorientation strategies, normalise sleep-wake cycle, maintain safe mobility, low-stimulus environment

Prognosis
- Further episodes more likely to happen after first
- About 1 in 3 cases of delirium can be prevented. The earlier it is detected, the better the outcome

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2
Q

MCI Management

A

Description
- Condition in which someone has mild problems with cognition - their mental abilities such as memory or thinking

Epidemiology
- 5 - 20% of people aged over 65 have MCI

Symptoms
- Memory, reasoning, planning or problem-solving, attention, language, visual depth perception

Diagnostic Criteria
- Mild impairment in one more or cognitive domains (e.g., attention, executive function, language, memory, perceptual-motor abilities, social cognition)
- Decline from the individual’s previous level of functioning.
- Does not affect ADLs / functioning
- Evidence of impairment in standardized neuropsychological/cognitive testing
- Not attributable to normal aging.

Causes
- Anaemias, meningitis, coronary atherosclerosis, cerebral palsy, epilepsy or seizures, hypertensive encephalopathy, hypoxic-ischaemic encephalopathy, diabetes mellitus, hypothyroidism, hypo-osmolality or hyponatraemia, vitamin B12 deficiency

Best Practice Management Plan
- Biological: No licenced meds. Stop smoking, reduce alcohol, optimise physical health conditions. Exercise, healthy diety
- Psychological: Education, Memory nurse
- Social: Stay mentally and socially active, memory protection groups.

Prognosis
- 10% a year go onto develop dementia

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3
Q

Amnesic Disorder Management

A
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4
Q

Alzheimer Dementia Management

A

Description
- Dementia = general term used to describe a group of conditions which affect memory
- AD = Caused by a buildup of proteins deposits which damage areas of the brain. This affects the chemicals in the brain which transmit messages from one cell to another, particularly one called acetylcholine.

Epidemiology
- At 65 = 1/50
- At 85, 1/5
- AD = 6/10 of all Dementia

Diagnostic Criteria

Causes

Best Practice Management Plan
- Biological: Physical health, r/o organic causes, bloods, ECG, medication, monitoring
- Psychological: Education, therapy, CMHT
- Social: Finance, occupation, housing, local support groups, carer group, crisis plan

Prognosis

Extra Info

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5
Q

Vascular Dementia Management

A

Description

Epidemiology

Diagnostic Criteria

Causes

Best Practice Management Plan
- Biological: Physical health, r/o organic causes, bloods, ECG, medication, monitoring
- Psychological: Education, therapy, CMHT
- Social: Finance, occupation, housing, local support groups, carer group, crisis plan

Prognosis

Extra Info

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6
Q

Lewy Body Dementia Management

A

Description

Epidemiology

Diagnostic Criteria

Causes

Best Practice Management Plan
- Biological: Physical health, r/o organic causes, bloods, ECG, medication, monitoring
- Psychological: Education, therapy, CMHT
- Social: Finance, occupation, housing, local support groups, carer group, crisis plan

Prognosis

Extra Info

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7
Q

Frontotemporal Dementia Management

A

Description

Epidemiology

Diagnostic Criteria

Causes

Best Practice Management Plan
- Biological: Physical health, r/o organic causes, bloods, ECG, medication, monitoring
- Psychological: Education, therapy, CMHT
- Social: Finance, occupation, housing, local support groups, carer group, crisis plan

Prognosis

Extra Info

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8
Q

Parkinson’s Disease Dementia Management

A

Description

Epidemiology

Diagnostic Criteria

Causes

Best Practice Management Plan
- Biological: Physical health, r/o organic causes, bloods, ECG, medication, monitoring
- Psychological: Education, therapy, CMHT
- Social: Finance, occupation, housing, local support groups, carer group, crisis plan

Prognosis

Extra Info

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9
Q

Huntington’s Disease Dementia Management

A

Description

Epidemiology

Diagnostic Criteria

Causes

Best Practice Management Plan
- Biological: Physical health, r/o organic causes, bloods, ECG, medication, monitoring
- Psychological: Education, therapy, CMHT
- Social: Finance, occupation, housing, local support groups, carer group, crisis plan

Prognosis

Extra Info

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10
Q

Down’s Syndrome Dementia Management

A

Description

Epidemiology

Diagnostic Criteria

Causes

Best Practice Management Plan
- Biological: Physical health, r/o organic causes, bloods, ECG, medication, monitoring
- Psychological: Education, therapy, CMHT
- Social: Finance, occupation, housing, local support groups, carer group, crisis plan

Prognosis

Extra Info

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11
Q

BPSD Management

A

Description

Epidemiology

Diagnostic Criteria

Causes

Best Practice Management Plan
- Biological: Physical health, r/o organic causes, bloods, ECG, medication, monitoring
- Psychological: Education, therapy, CMHT
- Social: Finance, occupation, housing, local support groups, carer group, crisis plan

Prognosis

Extra Info

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12
Q

Cognitive Examination (MMSE)

A

Check First
- Hearing, Vision

  1. Registration
    - Name, DOB, Age
    - Year, Month, Day, Date, Time
    - Place, Town, County, Country
    - Three words: apple, table, penny
  2. Attention
    - Spell WORLD backwards
  3. Recall
    - 3 words
  4. Language
    - Name a pencil and a watch
    - Repeat - No ifs, ands or buts
    - 3 step command: Place index finger of your right hand on your nose and then on your left ear
    - Obey written command: Close your eyes
    - Write a sentence
  5. Visuospatial
    - Copy intersecting pentagons

https://www.smartcjs.org.uk/wp-content/uploads/2015/07/Mini-Mental-State-Exam.pdf

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13
Q
A
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MRCPsych CASC (12 decks)

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