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ABDN Year 3 > Old Age Psychiatry > Flashcards

Old Age Psychiatry Flashcards

1
Q

What is the Prevalence of Old Age Psychiatric issues within both the Community and Hospital?

A

Mental Illness is pretty common in this age group (over 65)

Partially due to better diagnosis as well with dementia

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2
Q

What percentage of hospital beds do the elderly use?

A

66% of beds / 2/3rd patients are over 65 (elderly)

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3
Q

What will a typical 500 bed district general
hospital look like?

A

In an average day:
- 330 beds will be occupied by older people (66%)
- 220 will have a mental disorder (44%)
- 96 will have depression (19%)
- 66 will have delirium (13%)
- 102 will have dementia (20%)
- 23 will have other major mental health problems (4.6%)

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4
Q

What factors will increase an elderly persons length of stay?

A

If have dementia, delirium and depression will have longer stay in hospital and survival

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5
Q

What factors will decrease an elderly persons survival rate?

A

Dementia, delirium and depression

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6
Q

What is the Estimated cost of Dementia in the UK in 2021, what is the 2050 predictions and where does most of the money go?

A

£25 billion and expected to almost double to £47 billion in 2025

Majority cost is social care and increasing amount in unpaid carers

Higher social care cost (£14.2 billion) than cancer (£12.3 billion) and coronary heart disease (£11.6 billion)

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7
Q

How many informal carers are predicted to be within the UK, and what might they themselves have?

A

700,000 informal carers for the 850,000 people living with dementia in the UK

48.4% of carers have a long-standing illness or disability

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8
Q

What percentage of women died of a type of dementia in 2019 in the UK?

A

15.9% of women died due to Alzheimer’s disease and other dementias in 2019 in the UK. It was the leading cause of death for women.

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9
Q

What percentage of men died of a type of dementia in 2019 in the UK?

A

8.8% of men died due to Alzheimer’s disease and other dementias in 2019 in the UK. It was the second leading cause of death for men.

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10
Q

What were the top 6 causes of death in the UK in 2022?

A

1 - Dementia and Alzheimers
2 - Ischemic heart disease (e.g heart attacks)
3 - Cerebrovascular diseases (e.g strokes, aneurysms)
4 - Chronic lower respiratory diseases (e.g COPD)
5 - Lung Cancer
6 - COVID-19

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11
Q

How many more deaths was there in 2014 from dementia in comparison to cancer?

A

In 2014 there was more than twice the number of deaths due to all cancers than dementia. By 2040 more people will die due to dementia (shows staggering increase).

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12
Q

How many people are estimated to be living with dementia in the UK?

A

944,000

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13
Q

What are the ABCD of Dementia?

A

ABCD of Dementia: Dementia is a
Clinical syndrome

Criteria for Dementia;
- A for Activities of Daily Living (ADLs)
- B for Behavioural and Psychiatric Symptoms of Dementia (BPSD)
- C for Cognitive Impairment
- D for Decline

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14
Q

How do we diagnose dementia?

A
  • 6 months duration, usually progressive
  • Diagnosis based on Hx and collateral
  • PMHx & Medication (particularly anti
    cholinergics as can look like dementia)
  • Cognitive testing with emphasis on relevant
    lobes (Neuropsychology)
  • Physical examination & bloods
  • Supportive evidence from brain imaging (not all patients)
  • Diagnosis deferred in delirium (Need to wait till get back to baseline then re-assess for dementia)
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15
Q

What medications can give Dementia symptoms>

A

Anti-Cholinergics

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16
Q

What are the Cognitive Features of Dementia?

A

Memory (Dysmnesia)

Plus one or more of the following;
- Dysphasia (communication); Expressive or Resceptive
- Dyspraxia (Inability to carry out motor skills)
- Dysgnosia (not recognising objects)
- Dysexecutive Functioning (initiating, inhibition, set-shifting, abstraction - planning, problem solving, higher functioning skills)

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17
Q

What is Dysphasia?

A

Dysphasia (communication);
- Expressive (difficulty getting words out or using words around it)
- Resceptive (difficulty understanding words)

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18
Q

What is Dyspraxia?

A

Dyspraxia - Inability to carry out motor skills

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19
Q

What is Dysgnosia?

A

Dysgnosia - not recognising objects

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20
Q

What is Dysexecutive Functioning?

A

Dysexecutive Functioning (initiating, inhibition, set-shifting, abstraction - planning, problem solving, higher functioning skills)

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21
Q

What are important areas around Functional Impairment to ask the patient about?

A

Eating, cooking (have always been able to?), eating food passed sell by date, are cooking food properly, storing food properly

Driving

Medication - managing their own or someone lese doing (is that normal or a change?) Can be forgetting, accidentally overdosing, blister pack/dossier box?

Washing (normal for them?)

Making a cup of tea

Finances - at risk of financial difficulties, financial debt, financial abuse (change again?)

General mobility - falls? Getting out and about?

Support circle, social life?

Safeguarding, cannot protect themselves, lock door etc

Pets, forgetting to feed, overfeeding, forgetting to walk, overwalking

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22
Q

What must doctors do when a patient is diagnosed with Dementia and they drive?

A

Dementia or Organic Brain Syndrome;
- notify DVLA at diagnosis
- if early dementia license may be yearly
- “those with poor short term memory,
disorientation or lack of insight should almost
certainly not drive”

*Hard discussion as a lot of people depend on to see people, get food, etc

Patients legal response to inform DVLA

Issues with problem solving, reaction time, etc would tell to stop

Ask family if you are worried about their driving? Can be hard in elderly couple when both rely on one person driving, change to would you be happy with grandkids in the back?

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23
Q

How does MMSE score correlate to acts of daily living?

A

A score of will have patients struggling to;
- 15-25 = Appointments, make Phone Calls, Make Meals and Travel Alone
- 5-20 = Use home Appliances, Find Belongings, Select Clothes, Dress and Groom themselves
- 5-15 = Maintain Hobbies, Dispose of Litter
- 0-15 = Clear Tables and Walk
- 0-10 = Eat

(Lower score worse dementia is getting)

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23
Q

What questionnaires may you use to assess patient cognitive function and help to pinpoint the type of dementia?

A
  • Mini-Mental State Examination (MMSE)
  • Montreal Cognitive Assessment (MOCA)
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24
Q

What kind of considerations should you make when requesting imaging for a dementia patient?

A
  • Consider most appropriate for patient
  • Do they need imaging? (Most can do of diagnosis alone, can be distressing for some patients)
  • CT (Less distress or pacemaker/implant)
  • CT/SPECT (Alzheimers and Frontotemporal)
  • DAT scan (Lewy Body or Parkinsons)
  • MRI (Vascular Dementia)
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25
Q

What kind of Scanning do we do for most dementia patients?

A

CT

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26
Q

What kind of Scanning would you do for a patient with suspected Alzheimers?

A

CT/SPECT

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27
Q

What kind of Scanning would you do for a patient with suspected Frontotemporal (Picks)?

A

CT/SPECT

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28
Q

What kind of Scanning would you do for a patient with suspected Lewy Body?

A

DAT Scan (allows visualization of the dopamine system in the brain)

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29
Q

What kind of Scanning would you do for a patient with suspected Parkinsons?

A

DAT Scan (allows visualization of the dopamine system in the brain)

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30
Q

What kind of Scanning would you do for a patient with suspected Vascular Dementia?

A

MRI

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31
Q

Give a summary of how we Diagnose Alzheimers Disease/Dementia in Primary Care?

A

How do we find people with dementia?

Usually GP patient presenting or family getting to present or if picked up in routine appointment

Do clinical appointment + collateral history

Physical and bloods for other causes

MOCA and MMSE

Once see cognitive decline and rule out delirium they refer to old age psych and go more in depth and do more cognitive testing

Can diagnose from 1st appointment or need more brain scanning etc to be sure

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32
Q

How common are each of the different types of Demetia?

A
  • Alzheimers disease (60%)
  • Vascular dementia (15%)
  • Mixed dementia (10%)
  • Dementia wnh Lewy Bodies (10%)
  • Frontotemporal (Picks) dementia (2%)
  • Parkinsons denrntia (2%)
  • Other (1%)

*Dementia is umbrella term

Mixed is 2 or more pathologies causing dementia (Alzheimer’s and vascular most common)

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33
Q

What are the symptoms of Frontotemporal Dementia?

A
  • Behavioural
  • PNFA: Progressive non fluent aphasia
  • Semantic (difficulties in finding words)

Also known as Picks Disease!

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34
Q

What are Semantic Symptoms?

A

Difficulties in finding words when talking, including the names of people, places, and objects, along with significant difficulties in understanding the speech of others

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35
Q

What are the symptoms of Alcohol related Dementia?

A

ARBD
- Alcohol dementia
- Korsakoffs (thiamine deficiency)

Alcohol related dementia is most common cause in under 65 population - people can improve if stay away from alcohol. If keep drinking can develop alcohol related dementia.

36
Q

What are Subcortical types of Dementia?

A

Subcortical;
- Parkinson’s
- Huntington’s
- HIV

37
Q

What dementia is caused by a build-up of Prion Proteins?

A

Creutzfeldt-Jakob Disease - Prion Protein

Symptoms of CJD include:
- Loss of intellect and memory
- Changes in personality
- Loss of balance and co-ordination
- Slurred speech
- Vision problems and blindness
- Abnormal jerking movements
- Progressive loss of brain function and mobility

38
Q

What are the “Reversible” causes of Dementia?

A
  • Delirium (UTI or Infection?)
  • Normal pressure hydrocephalus (Triad of cognitive impairment, urinary difficulty and changes in your mobility)
  • Subdural haemorrhage (Head injury important and if on blood thinners
  • Tumours (Red flag symptoms, headache, worse in morning, affect vision, nauseous)
  • Vitamin Bl 2 deficiency
  • Hypothyroidism
  • Hypercalcaemia (Metabolite disorder)
  • Alcohol misuse (Become more sensitive to drinking older get and this can happen)
  • Neurosyphilis
  • Drugs
  • Anticholinergics
39
Q

What can Anticholinergics cause and why might this lead to a false diagnosis of dementia?

A

Lots of meds have anticholinergic burden. Medications get a score of 1-3. A score of 3 or more you are more likely to fall, be confused and die. Lots of common medication have this, especially in psychiatry and many of them score a 3 (like antidepressants and antipsychotics). So if someone has had a previous agitated psychotic depression on some olanzapine, a few antidepressants already probs scoring more than 3. If throwing in something like heart failure and furosemide makes worse. If have score of about 15 try and rationalise medication to minimum and see what they are like at baseline.

40
Q

What is the course of dementia like?

A

Regardless of cause dementia syndrome and continuously decline.

41
Q

78 year old woman referred by GP with 3 year history of
gradual and progressive deterioration in ‘memory’

On cognitive testing she has some dysmnesia and
dysexecutive dysfunction

Clear functional impairment
- reliant on daughter

No focal neurological signs
No history of vascular disease or risk factors

Diagnosis? Would you order imaging?

A

Alzheimer’s disease

SPECT

42
Q

How does the risk of Alzheimers change with age?

A

Risk of Alzheimer’s dementia increases with age: 1% at age 60, 5% at age 65, doubles every 5 years, 40% of those aged 85.

Some genetic links, increase alcohol, repeat head injury (rugby and football)

43
Q

What are the Symptoms and causes of Alzheimer’s disease?

A

Alzheimer’s disease;
- Early impairment of memory and executive function
- Gradual progression with often unclear onset

Main features:
- Amyloid plaques & tau tangles
- Atrophy following neuron death
- Reduction in Acetylcholine

Higher degree of atrophy

44
Q

What are the features of Vascular Dementia?

A
  • Unequal distribution of deficits
  • Evidence of focal impairments on neuro exam
  • Evidence of cerebrovascular disease - PMHx
  • Step wise decline with sudden changes (e.g diabetes)

Small vessel disease can give gradual decline

*Sudden drop in cognition and function and never really recover and happens again

Vascular less equal distribution, more patchy different parts of cognition affected, think things like stroke depends on what parts reeffected.

45
Q

74 year old woman referred by GP with subtle personality changes, lack of motivation and
progressive apathy.

On cognitive testing she has some executive dysfunction but intact memory

Reports constant dull headache

No focal neurological signs

Diagnosis? Imaging?

A

WHAT DOES THE CT SHOW?

Answer;
- Obvious heavily calcified lesion in left frontal region suggestive of
meningioma
- Referred to neurosurgeons who
resected meningioma
- After period of recovery
cognition and personality revovered

46
Q

What is Apathy?

A

Lack of interest, enthusiasm, or concern

47
Q

80 year old man referred by GP with 9 month history confusion that fluctuates throughout the
day.

Wife reports increased movement and shouting in
his sleep.

He is often napping during the day.

He reports seeing animals in the house and faces in the wallpaper.

Recent onset of tremor in right hand.

Worsening mobility.

A

Lewy Body Dementia

48
Q

How do you differentiate between Lewy Body and Parkinsons?

A

Parkinson’s symptoms of shaky comes on first then Parkinson’s dementia. If Neuropsychiatric symptoms come on first then Lewy Body

49
Q

What are the features of Lewy Body Dementia, management and how do we Diagnose it?

A

Key features:
- Visual hallucinations
- Fluctuations
- Parkinsonism

Supportive:
- Sensitivity to antipsychotics Caution when giving antipsychotics (especially Clozapine)
- Reduced dopamine uptake on
- DATS scan
- Increased falls
- REM sleep disorder

50
Q

When should you take caution when prescribing antipsychotics in Demetia?

A

Caution when giving antipsychotics in Lewy Body Dementia - especially Clozapine

51
Q

What assessment is used for diagnosing Lewy Body Dementia?

A

Newcastle Diamond Louie Study for diagnosis

52
Q

What do DATScan show in Lewy Body Dementia?

A
  • Sensitivity and specificity of around 85%.

The DAT Scan on a normal or AD patient will show
normal re-uptake of the dopamine transporter in the
head of the caudate nucleus and putamen in the shape of a ‘comma’, whereas in DLB, re-uptake in the putamen is reduced, leading to the ‘full-stop’ sign.

*Can also show if Parkinson’s or antipsychotic medication

53
Q

50 year old man presents to clinic. Worked as an IT
technician for last 10 years.

Gradual change in his behaviour over last 2 years.
Stopped taking care of his appearance and personal
hygiene.

Clear personality change.
Apathetic and withdrawn,
Used to be tidy but house now chaotic

Diagnosis? Imaging?

A

LOOK AT SCAN

Scan because under 65 less common and others more common (e.g slow growing frontal tumour)

Axial MRI images shows
cerebral atrophy that is
more pronounced in the
frontal and temporal
regions

Note the difference in the
gyro thickness and size of
the sulci between the
frontotemporal region and
the parietal/occipital
region

Picks Disease/Frontotemporal

54
Q

What Dementia does the MRI show?

A

Frontotemporal/Picks Disease

Note the difference in the
gyro thickness and size of
the sulci between the
frontotemporal region and
the parietal/occipital
region

55
Q

What are the features of Frontotemporal Dementia?

A
  • Behavioural disorder - personality change (can become more aggresive or apathetic)
  • Can be early onset
  • Early emotional blunting (Can get diagnosed mistakenly with depression)
  • Speech disorder - altered output, stereotypy, echolalia, perseveration, mutism
  • Neuropsychology - frontal dysexecutive syndrome. Memory, praxis and visuospatial function not severely impaired
  • Neuroimaging - abnormalities in frontotemporal lobes
  • Neurological signs commonly absent early; parkinsonism later; MND in a few; autonomic; Incontinence; primitive reflexes

*Need to do more specific frontal lobe testing (More than a MOCA, he was still getting 20)

56
Q

What are the Behavioural and Psychological Symptoms in Dementia?

A
  • Agitation (Restlessness, Wandering) (Distressing for Families)
  • Psychosis (Delusions, Hallucinations) (Lewy body/Parkinsons)
  • Affective (Depression, Anxiety, Lability, Hypomania, Apathy)
  • Disinhibition (Aggression, Sexual)
  • Behaviour (Eating, toileting, dressing, Sleep-wake cycle)

*90% chance will have at some point

57
Q

What is the Drug Treatment for Dementia?

A

Acetylcholinesterase Inhibitors (AChl) for mild to moderate AD
- Donepezil
- Rivastigmine
- Galantamine

Memantine (glutamate receptor antagonist) for moderate to severe AD (and sometimes Lewy Body and Parkinsons)

Antipsychotics;
- Risperidone
- Quetiapine
- Amisulpride

Antidepressants;
- Mirtazapine
- Sertraline

Anxiolytics
- Lorazepam

Hypnotics
- Zolpidem
- Zopiclone
- Clonazepam

Anticonvulsants;
- Valproate
- Carbamazepine,

58
Q

What Acetylcholinesterase Inhibitors are given in Dementia?

A

Acetylcholinesterase Inhibitors (AChl) for mild to moderate AD
- Donepezil
- Rivastigmine
- Galantamine

  • Similar clinical effects on MMSE & ADAS COG
  • 10 RCTs showed improved cog function, ADLs & behaviour however small Rx effects

Delays time to institutionalisation - slower decline delay, easier time to do things like institutionalisation and increased support rather than difference day to day

Prevent breakdown of ACH (Acetylcholine) available for brain to use

59
Q

What Glutamate Receptor Antagonist are given in Dementia?

A
  • Memantine (glutamate receptor antagonist) for moderate to severe AD and sometimes Lewy Body or Parkinsons
60
Q

What Antipsychotics are given in Dementia?

A

Antipsychotics;
- Risperidone
- Quetiapine
- Amisulpride

61
Q

What Antidepressants are given in Dementia?

A

Antidepressants;
- Mirtazapine
- Sertraline

62
Q

What Anxiolytics are given in Dementia?

A

Anxiolytics
- Lorazepam

63
Q

What Hypnotics are given in Dementia?

A

Hypnotics
- Zolpidem
- Zopiclone
- Clonazepam

64
Q

What Anticonvulsants are given in Dementia?

A

Anticonvulsants;
- Valproate
- Carbamazepine

As dementia progressive (especially AD and FT) can get seizures also used for more severe mood behaviours

65
Q

If a Dementia patient is depressed anxious, irritable, struggling with sleeping and apetite what drug do you give them?

A

Mirtazapine

66
Q

What are the side effects of Acetylcholinesterase Inhibitors?

A

Risk vs benefit need to weight up;
- Nausea, vomiting, diarrhoea
- Fatigue, insomnia
- Muscle cramps
- Headaches, dizziness
- Syncope (short loss of conciousness)
- Breathing problems

So by a third of people have side effects. The common ones are your GI side effects, but you can also get things like fatigue and insomnia,`

67
Q

What are the benefits of Rivastigmine patches?

A

Patches Rivastigmine used for that kind of cognitive enhancement, but it can also be helpful for them and things like hallucinations and dementia, and particularly rivastigmine we use and Parkinson’s hallucinations, Lewy body hallucinations and they are not always well tolerated.

68
Q

What is the new Anti-Amyloid (MABS) treatments and is Pros and Cons?

A

Lecanemab, Aducanumab and Gantenerumab
(anti-amyloid antibodies). Possibly clearing amyloid from brains - slow down disease - longer independence and milder symptoms.

Cons;
- Trial only 18 months
- 1/3 Alzheimer’s and 1/5 MCI test positive for
amyloid
- Amyloid testing needed
- Amyloid Related Imaging Abnormalities - changes to brain structure and swelling seen on MRI brain scans (monitoring)
- Long infusions every two weeks

69
Q

What Anti-Amyloid (MABS) treatment is 1st line?

A

Lecanemab 1st treatment for any type of
dementia to reverse physical changes and slow decline in memory and thinking.

70
Q

What is the Risk of prescribing Antipsychotics in Dementia?

A

Stroke Risk (6-12 Weeks);
- 980/1000 (98%) do not have a stroke
- 8/1000 (0.8%) have a stroke whether they take an antipsychotic or not
- 12/1000 (1.2%) have a stroke because they take an antipsychotic

Death Risk (6-12 Weeks);
- 967/1000 (97%) do not die
- 22/1000 (2.2%) die whether they take an antipsychotic or not
- 11/1000 (1.1%) die because they take an antipsychotic

71
Q

What is the guidance of prescribing Antipsychotics in Dementia?

A

Guidance on Anti Psychotic use:
- Not first line except where extreme risk
- Detailed assessment of BPSD including ABC
- Address treatable causes (Like if agitated and in pain give pain killer)
- Symptoms primarily a problem for patients or carers
- High rate of spontaneous recovery
- Psychological approaches including structured
activity
- Discussion regarding best interests
- The lowest dose of atypical for the shortest time
(ideally< 1 2 weeks)
- Monthly review recommended (To stop extra meds. Lots of BPSD are self-limiting and pass over a certain period of time)

*Are Hallucinations distressing for the patient or family? E.g old lady gold fish pond on floor that she loved. Treated?

A - Anything Triggering Behaviour
B - Behaviour Itself
C - Consequences

72
Q

What are the Non-Pharmacological treamtents for Dementia?

A
  • Other causes of distress

ABC approach;
A - time, door and morning
B - Agitation
C - Staff get hit intervening

  • Communication (With patient and family)
  • Any form of Distraction (Music, old films, old photos can unlock memories of person before dementia)

*Break ABC down and understand. Someone who ahs worked their whole lives gets up, has breakfast gets ready and heads to work. Cannot get out door, stressed going to loose job - normal feeling Their reality is different and they don’t have the capacity to see this. Challenging and telling wrong leads to more agitation. Saying things like you’re actually based here today, can you come through and help me? E.g even like cleaner dusting, someone setting table - important to know residents

Getting to know me documents at front of wards, helps having things to have conversations about when taking bloods etc

Communication with carers and family on board to buy into things. Even if relatives are dead don’t remind are dead ask about them, engage in activities

73
Q

What role do Care Homes play in treating Dementia patients and whats the downside to them?

A
  • 28,000 Care Homes the UK
  • Three quarters of the residents have dementia
  • Third of people with dementia live in care homes

Cons;
- Little Continuity of staff
- Full of BPSD (Neuropsychiatric disturbance)
- Psychosocial interventions recommended but
medication often has to be relied upon (Because of environment)

74
Q

What is BPSD?

A

Behavioural and psychological symptoms of dementia (BPSD)

Lots of BPSD because of the environment and mix of patients, hard to individualise approach

75
Q

What is Capacity?

A

Capacity is the ability to understand
information relevant to a decision or action,
and to appreciate the reasonably foreseeable
consequences of not taking action or a decision

76
Q

What 5 points should you consider when assessing Capacity?

A

1) Does the patient UNDERSTAND the
information?

2) Does the patient RETAIN the information
long enough to make a decision?

3) Can the patient COMMUNICATE the
decision?

4) Can the patient WEIGH UP the information
in order to make a decision?

5) Does the patient BELIEVE the information
they are given?

77
Q

What 3 pieces of information will a doctor want prior to assessing a patients capacity?

A
  • What’s the decision for which capacity is required
  • What specifically psychiatric factors call it into question?
  • What efforts have the referring team made to assess it so far?
78
Q

What 8 key points should be made when assessing Capacity?

A

Assessing Capacity- Key Points
1) A patient is deemed to have capacity
unless proven otherwise
2) A patient should be supported to make a
decision
3) A person can not be deemed to incapable
if their decision is eccentric or unwise
4) Anything done for the patient must be in
their best interest
Key points cont…..
5) Always use the least restrictive option
6) Capacity should be assessed on the topic
of question
7) Patient’s should be assessed at their ‘peak
time’
8) Speak to family to get historic views?
Advanced statement

79
Q

What are 6C’s of Capacity ?

A

6 Cs of capacity;
- Capacity (Do have or not?)
- Consent (To particular intervention if not are they being … )
- Compliance
- Coercion (if not being compliant are you using cohersion)
- Certification If you are cohersing do you have a certificate in place which legally allows you to do that (e.g power of attorney or guardianship)
- Common sense

Don’t need to use power of attorney or guardianship if patient is not unhappy about it and doesn’t have capacity to consent, need certificate about cohersion

80
Q

What is a Power of Attorney, the decisions they can make and problems surrounding this?

A

Finance;
- Usually easier to retain capacity re granting this than for welfare

Welfare (where live, hobbies, who see);
- Big issues re powers to have you reside

Are the powers even being used?

Does it have to be ‘activated’ (Put in place when have capacity and activated when loose capacity (can be reactivated e.g Delirium!)
- Common sense i.e. ‘best interests’
letter

Are the powers being misused? (Can be revoked)

Who has the powers?

Who doesn’t have the powers?

Revocation of power of attorney (Saves a lot of money)

Public Guardian’s Office - Long time, more expensive, has to go through court

*Potential misuse of power - use for own financial gain. Most common misuse not using them or stepping up (hard work!). Hard to go against parent, etc.

81
Q

What is a Guardianship, the decisions they can make and problems surrounding this?

A

Guardianship is what is done if run out of time for power of attorney. Need 2 medical certificates and invasive mental health officer report to see who is appropriate. Private - Family or friend. Local authority - council and social worker.

  • Finance
  • Welfare
  • They lack capacity to grant POA

Two medical certificates
- GP
- Psychiatrist

Detailed report from MHO (social worker)
- Will take into account family and those nominated in the application
- Is it needed?
- Is it agreed?
- Who will be the guardian?

82
Q

What Functional Ilnesses is there in Old Age?

A
  • Depressive symptoms 15%
  • Depressive illness 3%

Anxiety disorders
- Generalised anxiety
- Panic disorder
- Agoraphobia
- PTSD

  • Mania (Bipolar disorder)
  • Schizophrenia
  • Late onset Schizophrenia Like Psychosis
  • Alcohol problems
  • Suicide
  • Medicolegal

(Delirium)

83
Q

How may depression present in Old Age?

A

More common in older females, residential settings. More difficulties with sleep, hypochondriasis, suicide attempts.

Chronic conditions and changes in health, multiple medications affecting independence and health, living off pensions, bereavements, work,

Nothing to do, more time at home, more time with spouse (relationship friction), reduced social contact, no signs of self esteem, Down size home or supportive accommodation.

A lot of patients have co-morbidities so restricts treatments. SSRI’s with no cardiac issues and Mirtazapine for appetite and sleeping.

CBT, IPT, ECT (Better in older patients with severe depression)

84
Q

What is Normal Vs Abnormal Grief, Mourning and Bereavement ?

A
85
Q

How does Suicide present in the Elderly?

A

So loneliness, bereavement, ill health or chronic pain or recent life events and alcohol intake is also a worrying indicator.

86
Q

How does Late Onset Schizophrenia like Psychosis appear in the Elderly?

A

A late onset schizophrenia like psychosis is quite a common thing we see. It’s about 10% of our admissions and so it can cover a wide spectrum of symptoms, so you can get kind of circumscribed persecutory delusions, or full blown schizophrenia like psychosis, where you’ve got delusions, hallucinations

Aetiology - more common in those with sensory impairments (if loose hearing more likely to have auditory hallucinations and for sight, visual hallucinations).

Social isolation big factor

Management - often poor insight and need admission to hospital with mental health act, and antipsychotics and neuroleptics. Increased social contact another big part of treatment

May fail to regain insight and high relapse if stop neuroleptics

Might not always gain insight but have new psychotic beliefs and feel safer

87
Q
A

ABDN Year 3 (54 decks)

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