Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Systems: Psychiatry AB > Old Age Psychiatry > Flashcards

Old Age Psychiatry Flashcards

1
Q

How does the prevalence of mental health disorders differ in community to hospital?

A
  • Depression, dementia, delirium, anxiety and alcohol higher in hospital than community
  • Schizophrenia is roughly the same in hospital and community
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does the prevalence of dementia differ by age group and gender?

A
  • Increases with age

- Women surpass men between 75-79 years old

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

What is the ABCD of dementia as a clinical syndrome?

A
  • Activities of daily living
  • Behavioural and psychiatric symptoms of dementia (BPSD)
  • Cognitive impairment
  • Decline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the cognitive features of dementia?

A

Memory (dysmnesia) plus one or more

  • Dysphasia (expressive or receptive)
  • Dyspraxia
  • Dysgnosia
  • Dysexecutive functioning

Functional declines of ADL

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

What do MMSE scores correlate to in dementia?

A

Ability to perform daily activities

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

What neuropsychiatric disturbance can be present in dementia?

A
  • Psychosis
  • Depression
  • Altered circadian rhythm
  • Agitation
  • Anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dementia vs Delirium

Onset

A

Dementia
-Insidious with unknown date

Delirium
-Abrupt, precise, known date

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

Dementia vs Delirium

Decline

A

Dementia
-Slow, gradual, progressive

Delirium
-Acute illness lasting days or weeks

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

Dementia vs Delirium

Reversibility

A

Dementia
-Generally irreversible

Delirium
-Usually reversible

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

Dementia vs Delirium

Disorientation

A

Dementia
-Late in illness

Delirium
-Early in illness

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

Dementia vs Delirium

Variability

A

Dementia
-Slight day to day variation

Delirium
-Variable, hour by hour

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

Dementia vs Delirium

Physiological changes

A

Dementia
-Less prominent changes

Delirium
-Prominent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dementia vs Delirium

Consciousness

A

Dementia
-Clouded only in the late stage

Delirium
-Fluctuating levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dementia vs Delirium

Attention span

A

Dementia
-Normal

Delirium
-Short

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

Dementia vs Delirium

Sleepwake cycle

A

Dementia
-Disturbed, daynight

Delirium
-Disturbed, hour to hour variation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Dementia vs Delirium

Psychomotor changes

A

Dementia
-Late in illness

Delirium
-Marked early changes

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

Dementia vs Depression

Onset

A

Dementia
-Insidious onset

Depression
-Abrupt onset

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

Dementia vs Depression

Psychiatric history

A

Dementia
-None

Depression
-History of depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Dementia vs Depression

Disability

A

Dementia
-Conceals disability

Depression
-Highlights disability

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

Dementia vs Depression

Answers

A

Dementia
-Near-miss

Depression
-Don’t know

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

Dementia vs Depression

Mood

A

Dementia
-Fluctuates day to day

Depression
-Diurnal variation

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

Dementia vs Depression

Cognitive loss

A

Dementia
-Stable cognitive loss

Depression
-Fluctuating cognitive loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Dementia vs Depression

Concern about losses

A

Dementia
-Tries hard to perform but is unconcerned by losses

Depression
-Tries less hard to perform and gets distressed by losses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Dementia vs Depression

Memory loss

A

Dementia
-Short term

Depression
-Short and long term

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

Dementia vs Depression

Memory loss occurrence

A

Dementia
-Occurs first

Depression
-Depressed mood coincides with memory loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Dementia vs Depression

Associated with…

A

Dementia
Decline in social -function

Depression
-Anxiety

27
Q

What is dementia with Lewy Bodies?

A
  • A type of dementia were amnesia is not prominent

- Deficits of attention, frontal executive and visuospatial

28
Q

What are the criteria for dementia with Lewy Bodies?

A

Two= probable One=possible

  • Fluctuation: marked, important feature
  • Visual hallucinations
  • Parkinsonism
29
Q

What symptoms are suggestive of dementia with Lewy Bodies?

A
  • REM sleep disorder
  • Severe antipsych sensitivity
  • Abnormal DAT scan
30
Q

What would support a diagnosis of dementia with Lewy Bodies?

A
  • Falls
  • Syncope
  • LoC
  • Other psychiatric symptoms
  • Autonomic dysfunction
  • Scans
31
Q

When is the diagnosis of dementia with Lewy Bodies less likely?

A

If stroke disease or other brain/systemic illness

32
Q

How does frontotemporal dementia present?

A
  • Behavioural disorder with personality change
  • Can be early onset
  • Early emotional blunting
  • Speech disorder
  • frontal dysexecutive syndrome
  • Neurological signs commonly absent early, Parkinsonism later, MND in a few, autonomic, incontinence, primitive reflexes
33
Q

What is seen on neuroimaging of frontotemporal dementia?

A

Abnormalities in frontotemporal lobes

34
Q

What drug treatment can be used in dementia?

A
  • Acetylchholinesterase inhibitors for mild to moderate SDAT (donepezil, rivastigmine, galantamine)
  • Memantine for moderate to severe SDAT
  • Antipsychotics (eg. risperidone, quetiapine, amisulpride)
  • Antidepressants (eg. mirtazapine, sertraline)
  • Anxiolytics (eg. lorazepam)
  • Hypnotics (eg. zolpidem, zopiclone, clonazepam)
  • Anticonvulsants (eg. valproate, carbamazepine)
35
Q

What impact do cholinesterase inhibitors have on dementia?

A
  • Improve cognitive function
  • Slow decline
  • Improve non cognitive symptoms including ADL, longer stay at home and reduced carer stress
  • Does not stop disease progression
36
Q

What are the possible side effects of cholinesterase inhibitors?

A
  • Nausea, vomiting, diarrhoea
  • Fatigue, insomnia
  • Muscle cramps
  • Headaches, dizziness
  • Syncope
  • Breathing problems
37
Q

Why is there controversy in the use od neuroleptics?

A
  • Efficacy
  • SE including death
  • Are you treating the patient or the carers?
38
Q

How are neuroleptics used?

A
  • Start low and go slow
  • Review and stop
  • Discuss the risks
39
Q

How is dementia dealt with in care homes?

A
  • 3/4 of care home residents have dementia
  • Full of BPSD
  • Psychosocial interventions recommended but medication often has to be relied upon
  • Care inspectorate regulates services
40
Q

How can dementia or organic brain syndrome affect your fitness to drive?

A
  • 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”
41
Q

What are the 5 components of capacity?

A

Essentially can they

  • Act
  • Make
  • Communicate
  • Understand
  • Retain memory

on decisions

42
Q

What abilities does a power of attorney have?

A
  • Finance: usually easier to retain capacity re granting this than for welfare
  • Welfare: big issues re powers to have you reside
43
Q

What is guardianship?

A
  • Person lack capacity to grant POA
  • Can deal with finance and welfare
  • Require medical certificate from GP and psychiatrist
44
Q

Apart from dementia, what other mental health issues are present in the elderly community?

A
  • Depressive symptoms and illness
  • Anxiety disorders
  • Mania
  • Schizophrenia
  • Late onset schizophrenia like psychosis
  • Alcohol problems
  • Suicide
  • Medicolegal matters
45
Q

What is the prevalence of depression?

A
  • 15% of symptoms in community
  • 3% illness
  • F:M 1.5:1
  • 20-30% in residential care
46
Q

What are the clinical features of depression?

A

Less

  • Depressed mood
  • Expressed suicidal wishes

More

  • Insomnia
  • Hypochondriasis
  • Suicide
  • Agitation
47
Q

What is the aetiology of depression?

A
  • Loss of health, wealth, spouse, work and home

- Genetics

48
Q

How is depression managed?

A
  • Antidepressants (NB Tricyclic side effects)
  • Cognitive-behavioural therapy
  • ECT in severe cases need for prophylaxis
  • Most community cases not treated
49
Q

What is the prognosis for depression?

A
  • Mortality x2
  • 25% chronic
  • Better with treatment
50
Q

What are normal reactions to bereavement?

A
  • Alarm
  • Numbness
  • Pining – illusions or hallucinations may occur
  • Depression
  • Recovery and reorganisation
51
Q

What are considered abnormal reactions to bereavement?

A
  • Persisted beyond 2 months
  • Guilt
  • Thoughts of death
  • Worthlessness
  • Psychomotor retardation
  • Prolonged and marked functional impairment
  • Psychosis
52
Q

What is the prevalence of suicide in the elderly?

A
  • Same rate as for under 25 age group
  • Half the rate of other age groups
  • Males more than females
  • Most are depressed
  • DSH is rare in the elderly
53
Q

Why do some elderly people consider suicide?

A
  • Lonely
  • Widowed
  • Ill health
  • Chronic pain
  • Recent life events
  • Few see psychiatrist
54
Q

What is the prevalence of late onset schizophrenia?

A

Up to 10% of psychiatric admission in old age

55
Q

What are the clinical features of late onset schizophrenia?

A

Spectrum from circumscribed persecutory delusions to full schizophrenia-like psychosis

56
Q

What is the aetiology of late onset schizophrenia?

A
  • Sensory loss
  • Social isolation
  • Genetic ?minor abnormaliteis
57
Q

How is late onset schizophrenia managed?

A
  • Often needs compulsory admission
  • Neuroleptics
  • Increase social contact
58
Q

What is the prognosis of late onset schizophrenia?

A
  • May fail to regain insight

- High relapse if stop neuroleptics

59
Q

What is the aetiology of dementia?

A
  • Alzheimer’s
  • Vascular dementia
  • Mixed Alzheimer’s and vascular
  • Lewy Body dementia
  • Other causes
60
Q

What is the course of dementia?

A
  • Symptoms
  • Diagnosis
  • Loss of functional independence
  • Behavioural problems
  • Nursing home placement
  • Death
61
Q

How is AD diagnosed in primary care?

A
  • Case findings
  • Clinical assessment (history. MSE, physical and bloods, cognitive assessment)
  • Exclude differentials
  • Specialist referral for confirmation, counselling, management and follow up
62
Q

What is the clinical presentation of subcortical vascular dementia?

A
  • The clinical presentation of subcortical vascular dementia is often one of gradual deterioration in executive function, as well as mood changes such as apathy or irritability.
  • Memory is often relatively spared and reflects the preservation of cortical grey matter.
  • The patient may additionally have neurological features such as falls, incontinence or seizures.
63
Q

How do you avoid dementia?

A

You don’t really. Possible links to

  • Choose your parents
  • Activity
  • Caffeine
  • Alcohol
  • HRT
  • Statins
  • Hypertension
  • NSAIDs
  • Good nutrition
  • Fish oils
  • Vitamins

Systems: Psychiatry AB (18 decks)

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