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YR4 PSYCH > OLD AGE PSYCHIATRY > Flashcards

OLD AGE PSYCHIATRY Flashcards

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1
Q

do elderly people have a higher or lower sensitivity to benzodiazepines?

A

Higher sensitivity

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2
Q

How do the following components of pharmacodynamics change in the elderly? Absorption Distribution Metabolism Excretion

A

 Absorption- slower, delayed/slower onset of action  Distribution- increased volume, longer duration of action, increased ‘free’ drugs  Metabolism – (hepatic metabolism lipid soluble drugs) reduced liver volume no significant effect metabolic capacity  Excretion – reduced renal clearance, slow excretion

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3
Q

Give 3 functions of the limbic system?

A

Learning and memory

Emotions

Cognition

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4
Q

What is the blood confusion screen(9)?

A

FBC, U+E(Na), LFT, Ca, TFT, gluc, B12, Folate, CRP.

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5
Q

Compare the findings in delirium vs dementia for the following components

  1. Onset
  2. Course
  3. Duration
  4. Awareness
  5. Alertness
  6. Orientation
  7. Working memory
  8. Thinking
  9. Perception
  10. Speech
  11. Sleep-wake cycle
A
  1. Acute vs Insidious
  2. Fluctuating vs Stable
  3. Hours to weeks vs Months to years
  4. Reduced vs Clear
  5. Low or high vs normal
  6. Impaired time/place/ person vs Impaired later stages
  7. Impaired vs Normal (early stages)
  8. Disorganised,delusional vs impoverished
  9. Illusions and hallucinations (visual) vs Absent early stages
  10. Incoherent, hesitant , slow/ rapid vs Word finding difficulties
  11. disrupted vs normal
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6
Q

What is the definition of dementia?

A

Dementia is a syndrome due to disease of the
brain, usually of a chronic or progressive nature,
in which there is disturbance of multiple higher
cortical functions, including memory, thinking,
orientation, comprehension, calculation, learning
capacity, language and judgement.

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7
Q

Name 4 key diagnostic indicators of peudodementia opposed to dementia?

A
  1. Decrease in effort ‘don’t know’
  2. Rapid progression of symptoms after onset
  3. Behaviour incongruent with severity of cognitive impairment
  4. Marked variability on performance of tasks of similar difficulty
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8
Q

Which is more common in men vs women?

  • Alzheimers
  • Vascular dementia
A
  • AD- Women
  • VD- Men
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9
Q

Does Alzheimers come on slowly or quickly?

A

Slowly

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10
Q

In Alzheimers there is usually a change in what 3 things prior to cognitive decline?

A

Impairment of cognitive function is accompanied by and occasionally preceded by deterioration in emotional
control, social behaviour or motivation.

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11
Q

What are the two drug classes in Alzheimers management? Give 1 example for each.

A

Acetylcholinesterase inhibitors- Donepezil, Galantamine

NMDA anatagonist- Memantine

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12
Q

What are the 3 requirements for diagnosing dementia?

A
  1. History
  2. Evidence of cognitive decline
  3. Imaging evidence
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13
Q

What are the 3 paths that vascular dementia can follow?

A
  1. Acute onset: Dementia follows stroke
  2. Multi-infarct dementia: Stepwise deterioration following numberof TIA episodes
  3. Subcortical dementia: association with Hypertension and deep white matter ischaemia. Clinically appears like Alz picture.
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14
Q

What typical changes are seen on CT with frontotemporal dementias?

A

Knife blade changes

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15
Q

Does frontotemporal disease tend to affect memory or behaviour more?

A

Behaviour

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16
Q

Does frontotemporal dementia tend to come on younger or older?

A

Younger

17
Q

Echolalia is seen in frontotemporal dementia. What is echolalia?

A

meaningless repetition of another person’s spoken words as a symptom of psychiatric disorder.

18
Q

What 3 movement disorders do dementia with Lewy bodies develop?

A
  1. Bradykinesia
  2. Tremor
  3. Rigidity

Think Parkinson’s

19
Q

What is the difference between Lewy body dementia and Parkinsons disease?

A

In Lewy body dementia the movement disorders and cognitive decline occur simultaneously.

In Parkinsons disease the movement disorders occur at least 12 months in advance of the cognitive symptoms

20
Q

What needs to be avoided at all costs in lewy body dementia? Why?

A

Anticholinergic medications should be avoided because they exacerbate the symptoms of dementia. Traditional antipsychotic medications can precipitate severe reactions and may double or triple the rate of mortality in patients who have dementia with Lewy bodies.

21
Q

What 4 symptoms are assessed at the patient-relative interview for Behavioural and Psychological Symptoms of Dementia (BPSD)?

A
  1. Anxiety
  2. Depression
  3. Delusions
  4. Hallucinations
22
Q

What are the three Cs which are a major risk factor for developing late onset depression?

A

The 3 C’ʹs -

  1. cardiovascular disease,
  2. central nervous system disorders (e.g. strokes, vascular pathology, dementia, Parkinson’s disease),
  3. cancer – medical conditions associated with a high risk
23
Q

How does late onset depression differ from ealy onset depression?

A
  1. Low mood less prominent
  2. Reduced complaints of ‘feeling sad’
  3. More frequent reports of hypochondriasis and somatic concerns
24
Q

What are the three branches of management for late onset depression?

A
  1. Anti-depressants (start low go slow)
  2. Psychological interventions
  3. ECT
25
Q

In late onset psychosis, which is more common:

  • Delusions and hallucinations
  • Negative symptoms
A
  • Delusions and hallucinations
26
Q

What is the difference between late onset and very late onset psychosis?

A
  • Late >40
  • Very late >60
27
Q

What is Charles Bonnett syndrome?

A

Up to half of all people with macular disease experience visual hallucinations, known as Charles Bonnet Syndrome

28
Q

Give 5 causes of late onset psychosis

A

Organic

  • Brain pathology
  • Tumours (SOL)
  • Dementia
  • Strokes
  • Others

Sensory deprivation

  • Deafness more than blindness
  • Charles Bonnett Syndrome

Systemic
Medication
Steroids
Psychological
Social

29
Q

What are the medical options for anxiety in the elderly?

A
  1. Avoid benzodiazepines
  2. Antidepressants - SSRI’s/Venlafaxine
  3. Pregabalin
30
Q

What is the inital classification difference in memory?

A

Explicit vs Implicit

31
Q

How is implicit memory divided?

A
  1. Conditioning
  2. Motor skills
32
Q

How is explicit memory divided?

A
  1. Short term
  2. Long term

YR4 PSYCH (9 decks)

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