Old Age Psychiatry Flashcards
What are the cognitive features of dementia?
Dysmnesia (Plus one or more of
Dysphasia (communication, expressive or receptive)
Dyspraxia (inability to carry out motor skills)
Dysgnosia (not recognising objects)
Dysexecutive functioning
Functional decline
What are the effects of neuropsychiatric disturbance?
Psychosis Depression Anxiety Agitation Altered circadian rhythm
What are the clinical features of dementia?
Insidious onset with unknown date Slow, gradual, progressive decline Generally irreversible Disorientation late in illness Slight day-to-day variation Less prominent physiological changes Consciousness clouded only in late stage Normal attention span Disturbed sleepwake cycle; daynight Psychomotor changes late in illness
What are the clinical features of delirium?
Abrupt, precise onset, known date Acute illness, lasting days or weeks Usually reversible Disorientation early in illness Variable, hour by hour Prominent physiological changes Fluctuating levels of consciousness Short attention span Disturbed sleepwake cycle; hour-to-hour variation Marked early psychomotor changes
What are the clinical features of depression?
Abrupt onset History of depression Highlights disabilities ’Don't know' answers Diurnal variation in mood Fluctuating cognitive loss Tries less hard to perform and gets distressed by losses Short- and long-term memory loss Depressed mood coincides with memory loss Associated with anxiety
What questions are included in cognitive testing?
Orientation
*What is the (date, day, month, year, season)?
* Where are you (clinic, town, country)? Memory
*Name three objects. Ask the patient to repeat them
Attention
*Serial sevens. Alternatively ask the patient to spell world
backwards (dlrow)
Recall
*Ask for the three objects mentioned above to be repeated
Language
*Name a pencil and watch
*Repeat, ‘No ifs, ands or buts’
*A three stage command
*Read and obey CLOSE YOUR EYES
*Write a sentence
*Copy a double pentagon
What are the clinical symptoms of lewy body dementia?
Deficits of attention (frontal executive, visuospatial) Fluctuation Halluciantions Parkinsonism REM sleep disorder Sever antipsychsensitivity Abnormal DAT scan Falls, syncope, loss of consciousness
What are the clinical symptoms of frontotemporal dementia?
Behavioural disorder (personality change) Speech disorder (altered output, stereotypy, echolalia, preservation, mutism) Frontal dysexecutive syndrome
What are the medications options used for dementia?
Acetylcholinesterase inhbitors (AChEI) -donepezil, rivastigmine, galantamine
Memantine Antipsychotics (eg. risperidone, quetiapine, amisulpride)
Antidepressants (eg. mirtazapine, sertraline)
Anxiolytics (eg. lorazepam)
Hypnotics (eg. zolpidem, zopiclone, clonazepam)
Anticonvulsants (eg. valproate, carbamazepine)
What are the side effects of cholinesterase inhibitors?
Nausea, vomiting, diarrhoea Fatigue, insomnia Muscle cramps Headaches, dizziness Bradycardia Syncope Gastric ulcer Respiratory problems
What are the normal symptoms of grief, mourning or bereavement?
Alarm Numbness Pining – illusions or hallucinations may occur Depression Recovery and reorganisation
What are the abnormal symptoms of grief. mourning or bereavement?
Persisted beyond 2 months Guilt Thoughts of death Worthlessness Psychomotor retardation Prolonged and marked functional impairment Psychosis
What are some examples of activities of daily life (ADL)?
Eat Walk Clear table Maintain hobby Groom and dress Find belongings Use home appliances Travel alone Keep appointments Obtain meal/snack
What is echolalia?
Repeating the last part of speech
