Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > Old Age Psychiatry > Flashcards

Old Age Psychiatry Flashcards

1
Q

Define Delirium

A

Acute transient global organic disorder of CNS resulting in impaired consciousness and attention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

There are three types of delirium. Describe Hypoactive Delirium

A

Lethargy
Reduced motor activity
Apathy
Sleepiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

There are three types of delirium. Describe Hyperactive Delirium

A

Agitated
Aggressive
Hallucinations and Delusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the third type of Delirium?

A

Mixed - signs of both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

There are many different causes of Delirium. Using the mnemonic THINk DELIRIUM, describe them

A

Trauma, Hypoxia, Increased age, NOF fracture, smoKer, Drugs, Environment, Lack of sleep, Imbalanced electrolytes, Retention, Infection, Uncontrolled Pain, Medical Conditions

hypoxia, hypoglycaemia, hyperglycaemia, infection, constipation, urinary retention, intoxication, withdrawl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Delirium is Acute in onset and fluctuating in course. Using the mnemonic DELIRIUM describe the classical presenting features

A

Disordered thinking, Euphoric, Language Impaired, Illusions (+/ - delusions or hallucinations), Reversal of sleep wake pattern, Inattention, Unaware (Disorientated), Memory Deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

State the five ICD10 requirements for Delirium diagnosis

A
  • Impairment of consciousness and attention
  • Global disturbance in cognition
  • Psychomotor disturbance
  • Disturbance of sleep wake cycle
  • Emotional disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name five immediate investigations you would do for a Delirious patient

A
  • Nutritional and Hydration Status
  • Systems Examination
  • Urinalysis
  • Bloods - FBC, U&Es, LFTs, calcium, glucose, B12 folate ferritin
  • ECG
  • CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the (10) features of an AMT (Abbreviated Mental Test)

A

Age, Time, (Recall 42 West Street at end), Year, Current Location, Identify two people, DOB, Date of WW1, Current Monarch, Count backwards from 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the features of CAM (Confusion Assessment Method)

A

Diagnosis involves the presence of 1 and 2 and 3/4

1) Acute Onset and Fluctuating Course
2) Inattention (demonstrated by serial 7s test)
3) Disorganised thinking (incoherent speech)
4) Altered consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The mainstay of Delirium treatment is treating the underlying cause and providing reassurance. How can the patients environment be optimised?

A
  • Quiet
  • Well lit
  • Consistent staff
  • Encouraging visitation
  • Photos and familiar items
  • Orientate to time and place
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should the behaviour of Delirious patients be managed?

A

Medication should be a last resort

Oral low dose Haloperidol or Olanzepine
Avoid Benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define Dementia

A

Generalised decline of memory, intellect and personality without impairment in consciousness leading to functional impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name 4 irreversible causes of Dementia

A
  • Neurodegenerative
  • Infections (HIV, CJD)
  • Toxins
  • Vascular
  • Traumatic Head Injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name 4 reversible causes of Dementia

A

Visual/Hearing impairment,
Nutritional Deficiencies
Normal pressure hydrocephalus
Hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Vascular Dementia?

A

Occurs as a result of Cerebrovascular Disease (stroke, multiple infarcts, or chronic changes such as Atherosclerosis in the small vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Lewy Body Dementia?

A

Abnormal deposition of Lewy Body proteins throughout the neurones in the brainstem, substantia nigra and neocortex

If outside brainstem - more profound cholinergic loss
If within brainstem - more profound dopaminergic loss and Parkinsonian sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Frontotemporal Dementia?

A

Atrophy of Frontotemporal Lobes

One type is Picks disease - where proteins tangle and are seen histologically (characterised histologically by Picks Proteins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Dementia can be Cortical (such as Alzheimer’s and Frontotemporal). Give four clinical features.

A
  • Severe Memory Loss
  • Normal mood
  • Early Aphasia
  • Apraxia
  • Normal Coordination and motor speed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Dementia can be Sub-Cortical (such as DLB). Give four clinical features.

A
  • Moderate Memory Loss
  • Low mood
  • Impaired Coordination
  • Slow Motor Speed
  • May have Dysarthria
21
Q

Give an example of mixed Cortical and Subcortical Dementia

A

Vascular

22
Q

Describe the genetic risks for developing Alzheimer’s

A

Early Onset - Presenilin 1 and 2, Amyloid Precursor Protein
Late Onset - ApoE 4

23
Q

what are some risk factors for alzheimer’s disease?

A

advancing age

family hx

genetics

down’s syndrome

low IQ

cerebrovascular disease

vascular risk factors

24
Q

Describe the ICD10 criteria A-D for Dementia

A

A - evidence of decline in memory and other cognitive abilities
B - Preserved awareness for long enough to demonstrate A
C - Decline in emotional control/motivation/behaviour (emotional lability, irritability, apathy, coarsening social behaviour)
D - A must be present for 6 months

25
Q

What are the parameters for Presenile and Senile Dementia?

A

Presenile is <65
Senile is >65

26
Q

Describe the features of early Alzheimer’s

A

Memory lapses
Difficulty finding words
Forgetting names of people/places

27
Q

Describe the late stages of Alzheimer’s

A

Disorientation to time and place
Apathy
Incontinence
Agitation

28
Q

Describe the ICD10 criteria for early onset Alzheimer’s

A

A - General criteria for Alzheimer’s met and age <65
B - Atleast one of: relatively rapid onset and progression, aphasia/agraphia/apraxia/alexia

29
Q

Describe the ICD10 criteria for late onset Alzheimer’s

A

A - General Alzheimer’s criteria met and age >65
B - Atleast one of: Slow gradual onset and progression, predominance of memory impairment over intellectual ability

30
Q

How does Vascular Dementia typically present?

A
  • Late sixties/early seventies
  • Stepwise deterioration
  • Confusion
  • Memory loss
  • Early personality changes and Emotional
  • May have signs of cardiovascular disease
  • may have UMN signs
31
Q

What is Mixed Dementia?

A

Features of both Alzheimer’s and Vascular

32
Q

Name four features of DLB

A
  • Day to day fluctuations in cognitive performance
  • Recurrent visual hallucinations
  • Motor signs of Parkinsonism
  • Recurrent falls, syncope, depression
  • Severe sensitivity to Neuroleptic drugs
33
Q

Describe four clinical features of Frontotemporal Dementia

A
  • Usually 50-60 y/o
  • Worsening of social behaviour
  • Early personality changes such as disinhibition/apathy/restlessness
  • Memory is preserved in early stages
34
Q

How does Huntington’s Disease present?

A
  • Abnormal Choreiform Movements of face hands and shoulders and gait abnormalities
  • Dementia Symptoms presenting later on

Autosomal dominant so strong FH

35
Q

What is the triad of Normal Pressure Hydrocephalus

A

Dementia with frontal lobe disturbance
Urinary Incontinence
Gait disturbance (wide)

average age of onset after 70

36
Q

Describe three features of Creutzfield Jakob Disease

A
  • Onset usually <65
  • Rapid progression and death within 2y
  • Disintegration of all higher cerebral functions
  • Dementia associated with neurological signs
37
Q

How is suspected dementia investigated?

A

Initially referred to memory clinic
Routine panels of bloods- FBC, CRP, U&Es, calcium, LFTs, glucose, vit B12, folate, TFTs

38
Q

what other non-routine investigations may be done if clinically indicated for dementia?

A
  • urine dip to rule out UTI
  • CXR
  • syphilis serology and HIV testing
  • brain imaging - CT, MRI, SPECT
  • ECG
  • EEG
  • LP
  • genetic tests
  • cognitive assessment
39
Q

What imaging is used to differentiate Alzheimer’s, Vascular and Frontotemporal?

A

SPECT - Single Photon Emission Computed Tomography

40
Q

what is always important to assess in dementia patients?

A

functional status - dressing, continence, self-care, shopping/housework, ability to mange financial affairs, social contacts, safety in the home, ability to cook, nutrition

41
Q

Name four features of the MMSE

A

Orientation
Concentration (Serial 7s)
Memory - short term, long term, recent
Grasp - name of monarch

Normal is 25-30, severe is less than 10

42
Q

Name three frontal lobe tests

A

Verbal fluency and initiation
Clock drawing tests
Similarities (why are two objects similar?)

43
Q

State two general managements of Dementia

A
  • Inform DVLA
  • Advanced planning
  • later stages - Mental Capacity Act 2005 needs to be adhered to
44
Q

Describe the non pharmacological management of Dementia

A
  • Social Support
  • Community dementia teams
  • Information and education
  • Aromatherapy, massage, animal-assisted therapy
  • Assistance in day to day activities
45
Q

One of the pharmacological options to treat Dementia is acetylcholinesterase inhibitors. Given an example, 2 contraindications and 2 side effects

A

Donepazil, Galantamine and Rivastigmine

CI - Renal impairment, Hepatic impairment

SE - GI disturbance, Bradycardia, muscle spasms

46
Q

What is the action of Memantine?

A

NMDA receptor antagonist

used for AD when moderate when intolerant/contraindicated to use AChEi or in severe AD

47
Q

How could you manage challenging behaviour of Dementia patients?

A

Short course of antipsychotics

antidepressants for low mood

Caution in DLB - Neuroleptic Malignant Syndrome

48
Q

principals of dementia management

A
49
Q

dementia v delirium

A

Psychiatry (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions