Old Age Psychiatry Flashcards
What is the ABCD of dementia?
- Activities of Daily Living (impaired)
- Behavioural and psychological symptoms of dementia (BPSD)
- Cognitive Impairment!!!!!
- Decline (in function)
What are the main features of dementia?
-memory problems!!! (dysmnesia)
-functional decline!!!
-Activities of Daily Life impaired!!!!
Plus one or more of:
-dysphasia (expressive or receptive)
-dyspraxia
-dysgnosia (not recognising objects)
-dysexecutive function (such as disinhibition)
What are possible neuropsychiatric disturbances that can occur in dementia?
- psychosis
- depression
- altered circadian rhythms
- agitation
- anxiety
What are distinguishing features between dementia and delirium?
- dementia has insidious onset, whereas delirium is acute
- delirium is an acute illness that will last days or weeks, whereas dementia is generally irreversible and progressive
What is the main type of dementia?
alzheimer’s disease
What are types of dementia?
- vascular
- mixed vascular and alzheimer
- lewy body
- other
What investigations can be involved in management of dementia?
- SPECT scan
- cognitive testing such as MOCA/MMSE
- blood tests
What are the main features of Lewy Body dementia?
deficits of: -attention -frontal executive -visuospatial (amnesia not prominent)
How can Lewy Body dementia be diagnosed?
2=probable 1=possible:
- fluctuation in symptoms
- visual hallucinations
- parkinsonism
What features might be ‘suggestive’ of Lewy Body dementia?
- REM sleep disorder
- severe antipsychotic sensitivity (DO NOT GIVE PEOPLE WITH LB DEMENTIA ANTIPSYCHOTICS!)
What features would support a diagnosis of Lewy Body dementia?
- falls
- syncope
- loss of consciousness
- other psychiatric symptoms
- autonomic dysfunction
- scans
What is the prominent feature of frontotemporal dementia?
personality change
What are other features of frontotemporal dementia?
- speech disorder - altered output, stereotypy, echolalia (repeating the last bit of a sentence again), perseveration, mutism
- disinhibition
What would help diagnose frontotemporal dementia?
neuroimaging e.g. MRI head which would show abnormalities in these lobes (knife blade atrophy of frontal and temporal lobe)
What neurological signs may be present in frontotemporal dementia?
- often absent early
- parkinsonism later
- MND in a few
- autonomic
- incontinence
- primitive reflexes
What are possible drug treatments for dementia?
- acetylcholinesterase inhibitors e.g. galantine (mild to moderate)
- memantine for moderate to severe
What are some side effects of using acetylcholinesterase inhibitors to treat dementia?
- nausea, vomiting, diarrhoea
- fatigue, insomnia
- muscle cramps
- headaches, dizziness
- bradycardia, syncope, gastric ulcer, resp. problems
What are other psychotropics which MAY be used in treatment of dementia?
-non pharmacological measures first!!!!
-antipsychotics such as risperidone
-antidepressants e.g. sertraline
-anxiolytics e.g. lorazepam
-hypnotics
-anticonvulsants
all must have different dose to rest of population, particularly if using the antipsychotics!
How would you assess capacity? AMCUR
Can they:
- Act on decisions?
- Make their own decisions independently?
- Communicate their decision?
- Understand their decision?
- Retain memory of the decision?
Who would be able to grant someone Power of Attorney? What is the POA able to make decisions on?
- solicitor assesses capacity and decides taking in to account clients wish
- able to take control of welfare and finances
If a POA cannot be appointed due to patient already lacking capacity, what other power is there? What can they do?
- someone can be appointed guardian
- help with finance and welfare
- require 2 medical certificates to grant this: one from GP and one from psychiatrist
What are more prevalent features of depression in older age group when compared to younger populations?
more:
- insomnia
- hypochondriasis
- suicide
- agitation
What features are there of ‘normal’ grief?
- alarm
- numbness
- pining - illusions or hallucinations may occur
- depression
- recovery and reorganisation
What features make ‘abnormal’ grief?
- persists beyond 2 months
- guilt
- thoughts of death
- worthlessness
- psychomotor retardation
- prolonged and marked functional impairment
- psychosis
