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

Prevalence of depression in the community and in hospital

A

12% community

29% hospital

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

Prevalence of delirium in the community and in hospital

A

1-2% community

20% hospital

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

Prevalence of dementia in the community and in hospital

A

5% community

31% hospital

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

Prevalence of anxiety disorders in the community and in hospital

A

3% community

8% hospital

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

Prevalence of alcohol misuse in the community and in hospital

A

2% community

3% hospital

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

Prevalence of schizophrenia in the community and in hospital

A
  1. 5% community

0. 4% hospital

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

At any one time, what percentage of hospital beds are occupied by older people?

A

66%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the ABCD of dementia?

A

A - Activities of daily living (ADLs)
B - Behavioural and psychiatric symptoms of dementia (BPSD)
C - Cognitive impairment
D - Decline in functioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do you need to diagnose dementia?

A

Collateral history

Flexible cognitive testing

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

What are the cognitive features of dementia?

A

Dysmnesia (memory)

Plus one or more of;

  • dysphasia
  • dyspraxia
  • dysgnosia
  • dysexecutive functioning

Functional decline
ADLs

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

What does MMSE score correlate with?

A

Ability to perform daily actives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Types of neuropsychiatric disturbance in dementia

A 
Psychosis e.g. hallucinations, delusions, loss of insight 
Depression 
Altered circadian rhythms
Agitation 
Anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Differences between dementia and delirium

A

Dementia

  • onset is insidious, unknown start date
  • slow, gradual, progressive decline
  • irreversible
  • disorientation late in illness
  • slight day-to-day variation
  • less prominent physiological change
  • consciousness clouded in late stage
  • normal attention span
  • disturbed sleep-wake cycle day to night variation
  • psychomotor changes late in illness

Delirium onset is abrupt/precise onset

  • acute illness
  • reversible
  • disorientation early in illness
  • variable hour-by-hour, classically worse at night
  • prominent physiological change
  • fluctuating levels of consciousness
  • shortened attention span
  • disturbed sleep-wake cycle hour to hour variation
  • marked early psychomotor changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When would dementia have a step-wise progression?

A

With vascular cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does depression vary from dementia?

A 
Depression 
Abrupt onset
History of depression 
Highlights disabilities 
'Don't know' answers
Fluctuating cognitive loss 
Tries hard to perform and gets distressed by losses 
Short and long-term memory loss 
Depressed mood coincides with memory loss 
Associated with anxiety 
Dementia 
Insidious onset
No psych history 
Conceals disability 
Near-miss answers
Mood fluctuation day to day 
Stable cognitive loss
Treis hard to perform but is unconcerned by losses
Short term memory loss
Memory loss occurs first 
Associated with decline in social function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why might it be difficult to differentiate between dementia and depression?

A

Depression can manifest as dementia, or the dementia syndrome of depression
Dementia can present with depressive symptoms in the early stage of the illness
Depression and dementia often co-exist

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

What percentage of individuals diagnosed with dementia will have co-existing depressive symptoms at some stage of the illness?

A

Up to 50%

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

Aetiology of dementia

A 
Alzheimer's disease 50% 
Vascular dementia 25%
Mixed Alzheimer's and vascular 15%
Lewy body dementia 5%
Other causes 5%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the stages of dementia?

A

Early
Mild-to-moderate
Severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Differences between stages of dementia

A

In early stage, patient with generally remain symptom-free
As illness progresses, the extent of cognitive impairment becomes such that the patient and caregivers recognise that there is a problem
A progressive and insidious decline in cognition and functional ability marks the mild-to-moderate stage
Cognitive loss leads to functional decline and behavioural symptoms
During severe stages, functional ability is lost completely and institutionalisation is inevitable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What should be viewed as a viable treatment objective?

A

The ability to maintain function or cognitive capabilities for as long as possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is involved in the clinical assessment of a patient with dementia?

A 
History and collateral 
Risk assessment 
Cognitive testing 
Physical examination 
Bloods
Neuroimaging
Follow up 
Consider care needs/other support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Presentation of Lewy body dementia

A

Dementia - amnesia not prominent
Deficits of attention, frontal executive and visuospatial

Two of the following = probable, 1 = possible

  • fluctuation, marked, important feature
  • visual hallucinations
  • Parkinsonism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is suggestive of Lewy body dementia?

A

REM sleep disorder
Severe antipsychotic sensitivity
Abnormal DAT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the diagnosis of Lewy body dementia supported by?

A 
Falls
Syncope
Loss of consciousness 
Other psychiatric symptoms 
Autonomic dysfunction 
Scans
26
Q

When is a diagnosis of Lewy body dementia less likely?

A

If stroke disease or other brain/systemic illness present

27
Q

Clinical presentation of frontotemporal dementia

A

Behavioural disorder - personality change
Speech disorder - altered output, stereotypy, echolalia, perseveration, mutism
Neurological signs commonly absent in early stages - Parkinsonism occurs later, MND in a a few, autonomic features, incontinence, primitive reflexes

28
Q

Neuropscyhology features of frontotemporal dementia

A

Frontal dysexecutive syndrome

Memory, praxis and visuospatial function not severely impaired

29
Q

Neuroimaging features of frontotemporal dementia

A

Abnormalities in frontotemporal lobes - knife blade atrophy

30
Q

Drug treatment of dementia

A

Acetylcholinesterase inhibitors for mild to moderate SDAT - donepezil, rivastigmine, galantamine
LBD - rivastigmine
Memantine for moderate-to-severe SDAT

31
Q

Features of cholinesterase inhibitors in dementia treatment

A

Slow decline
Improve non-cognitive symptoms
Do not stop disease progression

32
Q

Side effects of cholinesterase inhibitors

A 
Nausea, vomiting, diarrhoea 
Fatigue
Insomnia 
Muscle cramps
Headaches, dizziness
Bradycardia, syncope, gastric ulcer and respiratory problems
33
Q

Other psychotropics used in dementia treatment

A 
Non-pharmacological measures done first 
Most are used off-licence 
Antipsychotics e.g. risperidone, quetiapine
Antidepressants e.g. mirtazapine 
Anxiolytics e.g. lorazepam
Hypnotics e.g. zolpidem
Anticonvulsants e.g. valproate
34
Q

Neuroleptics use in dementia

A 
Controversial - small effect size, side effects including cardiovascular SE and death 
Policy including covert pathway 
Reality
- start low and go slow 
- review and stop 
- discuss risks
35
Q

What number of residents in care homes have dementia?

A

3/4

36
Q

When do the DVLA need to be notified of a diagnosis of dementia?

A

Notify at time of diagnosis
If early dementia, license may be yearly
Those with poor short-term memory, disorientation or lack of insight should not drive

37
Q

Capacity involved abilities relevant to competence, what are these abilities?

A

Understanding
Manipulation
Appreciating the situation and its consequences
Communicating choices

38
Q

What needs to be considered when determining whether an individual has capacity?

A

Can they;

  • act
  • make
  • communicate
  • understand
  • retain memory of

medical treatment, hospitalisation etc.

39
Q

Features of power of attorney

A

Can be power of attorney for finance or welfare
Solicitor assesses capacity
PoA to act in best interests of patient

40
Q

Features of guardianship

A 
Finance, welfare
Lack of capacity to grant PoA
Two medical certificates needed - GP and psychiatrist
Detailed report from MHO 
- will it take into account family and those nominated in the application?
- is it needed?
- is it agreed?
- who will be the guardian?
41
Q

What percentage of older people have depressive symptoms?

A

15%

42
Q

What percentage of older people have a depressive illness?

A

3%

43
Q

Other disorders in old age psychiatry

A 
Depressive symptoms 
Depressive illness 
Anxiety disorders 
- generalised anxiety 
- panic disorder
- agoraphobia 
- PTSD
Mania
Schizophrenia
Late onset schizophrenia-like psychosis 
Alcohol problems 
Suicidal ideation
44
Q

Prevalence of depression in the community

A

15%

3% depressive illness

45
Q

What percentage of people in residential care have depression?

A

20-30%

46
Q

Clinical features of depression in the elderly

A

Less; depressed mood, expressed suicidal wishes

More; insomnia, hypochondriasis, suicide, agitation

47
Q

Aetiology of depression in the elderly

A

Loss of - health, wealth, spouse, home, work

Genetic

48
Q

Management of depression in the eldery

A

Antidepressants
CBT
ECT in severe cases
Prophylaxis need

49
Q

Mortality of elderly people with depression

A

2 x that of those without depression

50
Q

What percentage of depression in the elderly is chronic?

A

25%

51
Q

Normal features of grief, mourning and bereavement

A 
Alarm
Numbness
Pining - illusions or hallucinations may occur 
Depression 
Recovery and reorganisation
52
Q

Abnormal features of grief, mourning and bereavement

A 
Persisted beyond 2 months 
Guilt 
Thoughts of death 
Worthlessness
Psychomotor retardation
Prolonged and marked functional impairment 
Psychosis
53
Q

Rate of suicide in the elderly

A

Same rate as for < 25 age group
Half the rate of other groups
M > F

54
Q

Causes of suicide in the elderly

A 
Most are depressed
Loneliness
Widowed
Ill-health 
Chronic pain 
Recent life events
55
Q

Prevalence of late-onset schizophrenia like psychosis

A

Up to 10% of psychiatric admissions in old age

56
Q

Clinical features of late-onset schizophrenia-like psychosis

A

Spectrum from circumscribed persecutory delusions to full schizophrenia-like psychosis

57
Q

Aetiology of late-onset schizophrenia-like psychosis

A

Sensory loss
Social isolation
Genetic - minor abnormalities

58
Q

Management of late-onset schizophrenia-like psychosis

A

Often needs compulsory admission
Neuroleptics
Increase social contact

59
Q

Prognosis of late-onset schizophrenia-like psychosis

A

May fail to regain insight

High relapse if neuroleptics are stopped

60
Q

What percentage of older people experience improved cognitive function with abstinence from alcohol?

A

75%

61
Q

Disorders caused by alcohol in the elderly

A

Alcohol dementia
Korsakoff’s psychosis
Alcohol hallucinosis

Psychiatry (21 decks)

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