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Phase 2 Psychiatry > Old Age Psychiatry > Flashcards

Old Age Psychiatry Flashcards

1
Q

Describe risk factors which are associated with the development of psychiatric illness in the elderly

A
  • decline in functional ability
  • more likely to experience bereavement
  • decline in SES with retirement
  • vulnerable to elder abuse
  • at risk of loss of dignity and respect
  • all these stresses can result in isolation, loneliness or psychological stress which can contribute to mental health problems
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2
Q

What are the main clinical features of neurotic disorders in the elderly?

A
  • non specific anxiety and depressive symptoms predominate

- hypochondriasis common

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3
Q

Describe the 3 broad categories of psychosis in the elderly

A
  1. old psychosis - developed earlier in adult life
  2. new psychosis - develops later in life; referred directly to old age services
    • rare
  3. other conditions which give rise to paranoid and/or hallucinatory symptoms but which are not primarily psychotic illness (includes delirium, dementia, affective disorder and hallucinations of sensory deprivation)
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4
Q

How do positive psychotic symptoms differ in the elderly?

A
  • more likely to experience hallucinations
  • persecutory delusions are common
  • partition delusions are a notable feature in this group
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5
Q

Describe common features of depression in the elderly

A
  • severe psychomotor retardation/agitation commomn
  • degree of cognitive impairment (depressive pseudodementia)
  • depressive delusions and paranoia
  • somatic symptoms may predominate
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6
Q

How does aging impact pharmacokinetics?

  1. absorption
  2. distribution
  3. metabolism
  4. excretion
  5. What are the impacts of this on prescribing?
A
  1. reductions in gastric pH, mesenteric blood flow and gut motility reduce rate of drug absorption
  2. reduced body mass with proportionally increased body fat, reduced body water and reduced albumin cause increased levels of free drug and longer half lives
  3. decreased hepatic blood flow and reduced efficiency of hepatic enzymes
  4. reduction in renal clearance
  5. drug effects are generally prolonged and cumulative, and the risk of toxicity is high
    - start with a very low dose and titrate up slowly
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7
Q

What is delirium?

A 
acute, fluctuating change in mental status, with inattention, disorganised thinking and altered levels of consciousness
MEDICAL EMERGENCY (associated with high morbidity and mortality)
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8
Q

Describe some indicators of delirium

A
  • disturbance in cognitive function - worsened concentration, slow responses, confusion, memory deficit
  • disturbance in perception - auditory or visual hallucinations
  • alterations in physical function - reduced mobility, reduced movement; restlessness, agitation, changes in appetite; sleep disturbance
  • alteration in social behaviour - poor co-operation, withdrawal or alterations in communication
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9
Q

Name some causes of delirium

A
  • systemic infection/infection associated with pyrexia
  • metabolic disturbance
  • vitamin deficiency (thiamine; B12)
  • hypothyroidism
  • cushing’s
  • Intracranial pathology
  • drug intoxication
  • drug/alcohol withdrawal
  • postoperative states
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10
Q

Name some predisposing factors for delirium

A
  • extremes of age
  • neurological pathology
  • unfamiliar environment
  • sleep deprivation
  • sensory extremes (overload or deprivation)
  • immobilisation
  • visual or hearing impairment
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11
Q

How is delirium managed?

A
  • investigate and treat underlying disease
  • care for patient in quiet single room
  • review (and if possible stop) all drug therapy
  • ensure patients have hearing aids, glasses and dentures
  • lorazepam can help manage agitation
  • avoid psychoactive drug
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12
Q

How can delirium be prevented?

A
  • orientation/therapeutic activity
  • early mobilisation
  • avoidance of polypharmacy
  • prevention of dehydration
  • prevention of sleep deprivation
  • effective communication
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13
Q

What is dementia?

A
  • a syndrome of symptoms caused by organic disease of the brain
  • disturbance of multiple higher level cortical functioning processes, but with clear consciousness
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14
Q

What things are important to ask about in a hx for dementia

A
  • context - personal and collateral account of developments over the past 12 months
  • onset
  • description of cognitive problems
  • any behavioural changes
  • any positive symptoms - hallucinations
  • any movement disturbance
  • effects on daily life
  • any symptoms of physical illness
  • medications
  • mini cognitive function assessment
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15
Q

How does dementia differ from normal ageing and mild cognitive impairment

A

there is impact on daily functioning

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16
Q

How can dementia be distinguished from delirium in terms of:

  1. onset
  2. course of impairment
  3. symptoms
  4. motor activity
  5. emotional changes
A
  1. delirium is rapid onset; dementia is more insidious
  2. delirum follows fluctuating course; dementia is less fluctuating
  3. psychotic symptoms are more prominent in dementia
  4. motor activity is abnormal in delirium; less likely to be affected
  5. emotional changes are more prominent and variable in delirium
17
Q

How does Dementia differ from Depressive Pseudodementia in terms of:

  1. onset and hx
  2. previous psych hx
  3. insight
  4. time of day symptoms are worse
  5. MSE
A
  1. dementia has longer hx, insidious onset and no precipitant
    depresison is shorter hx, often with a precipitant
  2. previous hx of depression common in depressive psuedodementia
  3. patient with depressive pseudodementia has insight into memory problems, whilst insight is less likely with dementia
  4. symptoms of depressive pseudodementia often worse in morning
    symptoms of dementia often worse in evening
  5. Depression
    - variable performance
    - may convey distress
    - not attempt questions or “i don’t know” answers
    - depressive cognitions present

Dementia

  • labile mood
  • more consistent performance
  • attempt to answer questions; may confabulate answers
18
Q
  1. What is amnesic syndrome?
  2. Name some features of amnesic syndrome
  3. Name some causes of amnesic syndrome
A
  1. impairment in recent memory - difficulties in learning new material; preservation of immediate recall
  2. confabulation
    impairment in time sense
    anterograde amnesia and some retrograde amnesia
    may be accompanied by personality change
3. alcohol abuse
    long term heavy drug use
    toxins
    head trauma
    stroke and cerebrovascular disease
    post infection
19
Q

Name 3 reversible causes of memory problems that are differentials for dementia

A
  1. alcohol abuse
  2. vitamin deficiency
  3. thyroid problems
20
Q

Name 2 tools which are useful in the screening/assessment of dementia

A
  1. Addenbrooke’s Cognitive Examination (ACE-3)

2. 6 item cognitive impairment test

21
Q

Which cognitive functions are affected in Alzheimer’s Disease (6)

A
  1. memory
  2. language
  3. motor skills
  4. recognition skills - changes in ability to process and interpret visual info leading to problems in spacial awareness and facial recognition
  5. ADL (due to difficulties with decision making, problem solving, planning and sequencing tasks)
  6. personality
22
Q

Name 2 pharmacological agents used in the management of alzheimer’s disease

A
  1. AcH esterase inhibitors - donepezil; rivastigmine
    - can only be used until all AcH has been depleted
  2. Memantine - NMDA antagonist; reduces the effects of glutamate toxicity
23
Q
  1. What is the disease course of vascular dementia
    a) large and medium vessel disease
    b) small vessel disease
  2. In vascular dementia, what are the deficits dependent on?
  3. Which other type of dementia does vascular dementia commonly co-occur with?
A

1a) sudden onset and stepwise deterioration
1b) insidious onset; gradual progression

  1. damaged region
  2. alzheimers
24
Q
  1. How can lewy body dementia and PD with dementia be distinguished?
  2. Name the diagnostic crtieria for Lewy Body dementia
A
  1. motor symptoms predominate in PD with dementia
    mild parkinsonian features with rapid dementia in lewy body dementia
  2. progressive dementia plus 2 of the following:
    - fluctuations in cognition/performance
    - persistent well formed hallucinations
    - parkinsonism
25
Q

What are the features of behavioural variant frontotemporal dementia?

A
  • disinhibition, personality change
  • apathy, withdrawal self neglect
  • stereotypical, compulsive behaviour
  • emotional blunting
  • abnormal eating - craving sweets
26
Q

What are the features of primary progressive aphasia?

A
  • reduced speech fluency
  • articulation problems
  • phonological and syntactical errors
  • preservation of comprehension
27
Q

What are the features of semantic dementia?

A
  • preservation of fluency, phonology and syntax

- difficulty naming and comprehension

Phase 2 Psychiatry (11 decks)

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