Old age psychiatry Flashcards
What is the ABCD of dementia as a clinical syndrome?
- Activities of daily living
- Behavioural and psychiatric symptoms of dementia (BPSD)
- Cognitive impairment
- Decline
What are the cognitive features of dementia?
- Memory (dysmnesia) - Plus one or more of
- dysphasia (communication)
- expressive
- receptive
- dyspraxia (inability to carry out motor skills)
- dysgnosia (not recognising objects)
- dysexecutive functioning
- dysphasia (communication)
- Functional decline
- ADLs
What do MMSE scores correlate to in dementia?
Ability to preform daily tasks.
What neuropsychiatric disturbance can be present in dementia?
- Psychosis
- Depression
- Altered circadian rhythm
- Agitation
- Anxiety
Dementia vs Delerium
Onset
Dementia
Insidious with unknown date
Delerium
Abrupt, precise, known date
Dementia vs Delerium
Decline
Dementia
Slow, gradual, progressive
Delerium
Acute illness lasting days or weeks
Dementia vs Delerium
Reversibility
Dementia
Generally irreversible
Delerium
Usually reversible
Dementia vs Delerium
Disorientation
Dementia
Late in illness
Delerium
Early in illness
Dementia vs Delerium
Variability
Dementia
Slight day to day variability
Delerium
Variable, hour by hour
Dementia vs Delerium
Consciousness
Dementia
Clouded only in the late stage
Delerium
Fluctuating levels
Dementia vs Delerium
Attention span
Dementia
Normal
Delerium
Short
Dementia vs Delerium
Sleepwake cycle
Dementia
Disturbed, daynight
Delerium
Disturbed, hour to hour variation
Dementia vs Delerium
Psychomotor changes
Dementia
Late in illness
Delerium
Marked early changes
Dementia vs Depression
Onset
Dementia
Insidious onset
Depression
Abrupt onset
Dementia vs Depression
Psychiatric history
Dementia
None
Depression
History of depression
Dementia vs Depression
Answers when questioned
Dementia
Near miss
Depression
Don’t know
Dementia vs Depression
Mood
Dementia
Fluctuates day to day
Depression
Diurnal variation
Dementia vs Depression
Cognitive loss
Dementia
Stable cognitive loss
Depression
Fluctuating cognitive loss
Dementia vs Depression
Effort
Dementia
Tries hard to perform and is unconcerned by losses
Depression
Tries less hard to perform and gets distressed by losses
Dementia vs Depression
Memory loss
Dementia
Short term
Depression
Short and long term
Dementia vs Depression
Time of onset of memory loss
Dementia
Occurs before change in mood
Depression
Depressed mood coincides with memory loss
Clinical features of depression in old age
Less
- Depressed mood
- Expressed suicidal wishes
More
- Insomina
- Hypochindriasis
- Suicide
- Agitation
Aetiology of depression in the elderly
- Loss of:
- health
- wealth
- spouse
- work
- home
- Genetics
What is the aetilolgy of late onset schizophrenia?
- Sensory loss
- Social isolation
How is late onset schizophrenia managed?
- Often needs compulsory admission
- Antipsychotics
- Increase social contact
What is the prognosis of late onset schizophrenia?
- May fail to regain insight
- High relapse if they stop taking antipsychotics
