Old age psychiatry

Question 1

Bipolar

Answer 1

usually known/primary (early onset)
secondary: middle-aged onset
later onset poor prognosis

first episode, no FHx = organic UPO (CVA, FTD)

depression prominent; mania ‘less’ - limited by physical frailty/illness

Question 2

Mania Sx

Answer 2

elevated/expansive, irritable >1/52 or needing Ax
serious impact on life/function
3 more from:
restless, pressured speech/thought flight, disinhibited, reckless, sexual, sleep, self-esteem/grandeur

Question 3

History

Answer 3

demographics
reason for referral
HPC: onset (Dates), non-cognitive symptoms, impact (fx/ADL)
PMH, PPH, RFs
FH, DH (incl. compliance and changes)
SH: drugs/alcohol, care package, driving
personal, forensic, pre-morbid, social circs

Question 4

drugs affecting cognition

Answer 4

often ACH-related
e.g.
oxybutynin amitriptyline

Question 5

MSE

Answer 5

A&B: senses, agitation, psychomotor, apathy
S&T: delusions (theft, persecutory misID)
Mood: anx, lability (CVD)
perception: impact and risk
cognition: orientation, attn, memory, exec Fx, language/calc, visuospatial
Insight: 3 As

Question 6

HCE differences

Answer 6

settings: home visits (coping), OPD, care homes, IPD
memory issues (collateral)
comorbidities + polypharma (MH risk, SE/ADR)
pt perspective (significance and attribution)
suicide: more successful

Question 7

Psychosis - features

Answer 7

abnromal mental state
altered perception (audio halls; persecutory reference dels- theft, mistreatment, poison)
behaviours change
formal thought disorder uncommon
present through others: concerned friends, police (calling), bizzare medical complaints

Question 8

Psychosis - RF

Answer 8

female
alone
never married
social isolation
sensory impairment
paranoid/schizoid personality

Question 9

Psychosis - DDx (paranoia)

Answer 9

delirium
dementia
delusional disorder
organic: CVA, SDH, epilepsy, uraemia, hepatic enceph, hypoxia

Question 10

Psychosis - Mx

Answer 10

assessment: home (calmer); history, collateral (?triggers, ?delusions, impact)
MSE + MOCA
risk assessment + insight
Ix: delirium and dementia screens

treatment:
therapeutic relationship
MDT: day centre, CPN, OT/PT, psych, community matron/CMHT
Treat comorbidities (sensory, pain, mobility)
APD (avoid poly, SE: EPSE, heart, sedation, falls, CVA in dementia); risperidone best/low dose depot
psychoeducation
social care package