Old age psychiatry

Question 1

What is the ABCD of dementia as a clinical syndrome?

Answer 1

• Activities of daily living
• Behavioural and psychiatric symptoms of dementia (BPSD)
• Cognitive impairment
• Decline

Question 2

What are the cognitive features of dementia?

Answer 2

• Memory (dysmnesia) - Plus one or more of
  
  • dysphasia (communication)
    
    • expressive
    • receptive
  • dyspraxia (inability to carry out motor skills)
  • dysgnosia (not recognising objects)
  • dysexecutive functioning
• Functional decline
  
  • ADLs

Question 3

What do MMSE scores correlate to in dementia?

Answer 3

Ability to preform daily tasks.

Question 4

What neuropsychiatric disturbance can be present in dementia?

Answer 4

• Psychosis
• Depression
• Altered circadian rhythm
• Agitation
• Anxiety

Question 5

Dementia vs Delerium

Onset

Answer 5

Dementia

Insidious with unknown date

Delerium

Abrupt, precise, known date

Question 6

Dementia vs Delerium

Decline

Answer 6

Dementia

Slow, gradual, progressive

Delerium

Acute illness lasting days or weeks

Question 7

Dementia vs Delerium

Reversibility

Answer 7

Dementia

Generally irreversible

Delerium

Usually reversible

Question 8

Dementia vs Delerium

Disorientation

Answer 8

Dementia

Late in illness

Delerium

Early in illness

Question 9

Dementia vs Delerium

Variability

Answer 9

Dementia

Slight day to day variability

Delerium

Variable, hour by hour

Question 10

Dementia vs Delerium

Consciousness

Answer 10

Dementia

Clouded only in the late stage

Delerium

Fluctuating levels

Question 11

Dementia vs Delerium

Attention span

Answer 11

Dementia

Normal

Delerium

Short

Question 12

Dementia vs Delerium

Sleepwake cycle

Answer 12

Dementia

Disturbed, daynight

Delerium

Disturbed, hour to hour variation

Question 13

Dementia vs Delerium

Psychomotor changes

Answer 13

Dementia

Late in illness

Delerium

Marked early changes

Question 14

Dementia vs Depression

Onset

Answer 14

Dementia

Insidious onset

Depression

Abrupt onset

Question 15

Dementia vs Depression

Psychiatric history

Answer 15

Dementia

None

Depression

History of depression

Question 16

Dementia vs Depression

Answers when questioned

Answer 16

Dementia

Near miss

Depression

Don’t know

Question 17

Dementia vs Depression

Mood

Answer 17

Dementia

Fluctuates day to day

Depression

Diurnal variation

Question 18

Dementia vs Depression

Cognitive loss

Answer 18

Dementia

Stable cognitive loss

Depression

Fluctuating cognitive loss

Question 19

Dementia vs Depression

Effort

Answer 19

Dementia

Tries hard to perform and is unconcerned by losses

Depression

Tries less hard to perform and gets distressed by losses

Question 20

Dementia vs Depression

Memory loss

Answer 20

Dementia

Short term

Depression

Short and long term

Question 21

Dementia vs Depression

Time of onset of memory loss

Answer 21

Dementia

Occurs before change in mood

Depression

Depressed mood coincides with memory loss

Question 22

Clinical features of depression in old age

Answer 22

Less

• Depressed mood
• Expressed suicidal wishes

More

• Insomina
• Hypochindriasis
• Suicide
• Agitation

Question 23

Aetiology of depression in the elderly

Answer 23

• Loss of:
  
  • health
  • wealth
  • spouse
  • work
  • home
• Genetics

Question 24

What is the aetilolgy of late onset schizophrenia?

Answer 24

• Sensory loss
• Social isolation

Question 25

How is late onset schizophrenia managed?

Answer 25

• Often needs compulsory admission
• Antipsychotics
• Increase social contact

Question 26

What is the prognosis of late onset schizophrenia?

Answer 26

• May fail to regain insight
• High relapse if they stop taking antipsychotics