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year 4 psychiatry > Old Age Psychiatry > Flashcards

Old Age Psychiatry Flashcards

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1
Q

Define Delirium

A

Acute transient global organic disorder of CNS resulting in impaired consciousness and attention

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2
Q

There are three types of delirium. Describe Hypoactive Delirium

A

Lethargy
Reduced motor activity
Apathy
Sleepiness

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3
Q

There are three types of delirium. Describe Hyperactive Delirium

A

Agitated
Aggressive
Hallucinations and Delusions

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4
Q

What is the third type of Delirium?

A

Mixed

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5
Q

There are many different causes of Delirium. Using the mnemonic THINk DELIRIUM, describe them

A

Trauma, Hypoxia, Increased age, NOF fracture, smoKer, Drugs, Environment, Lack of sleep, Imbalanced electrolytes, Retention, Infection, Uncontrolled Pain, Medical Conditions

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6
Q

Delirium is Acute in onset and fluctuating in course. Using the mnemonic DELIRIUM describe the classical presenting features

A

Disordered thinking, Euphoric, Language Impaired, Illusions (+/ - delusions or hallucinations), Reversal of sleep wake pattern, Inattention, Unaware (Disorientated), Memory Deficits

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7
Q

State the five ICD10 requirements for Delirium diagnosis

A
  • Impairment of consciousness and attention
  • Global disturbance in cognition
  • Psychomotor disturbance
  • Disturbance of sleep wake cycle
  • Emotional disturbance
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8
Q

Name five immediate investigations you would do for a Delirious patient

A 
Nutritional and Hydration Status 
Systems Examination
Urinalysis 
Bloods (confusion screen)
CXR
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9
Q

Describe the (10) features of an AMT (Abbreviated Mental Test)

A

Age, Time, (Recall 42 West Street at end), Year, Current Location, Identify two people, DOB, Date of WW1, Current Monarch, Count backwards from 20

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10
Q

Describe the features of CAM (Confusion Assessment Method)

A

Diagnosis involves the presence of 1 and 2 and 3/4

1) Acute Onset and Fluctuating Course
2) Inattention (demonstrated by serial 7s test)
3) Disorganised thinking (incoherent speech)
4) Altered consciousness

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11
Q

The mainstay of Delirium treatment is treating the underlying cause and providing reassurance. How can the patients environment be optimised?

A

Quiet
Well lit
Consistent staff
Encouraging visitation

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12
Q

How should the behaviour of Delirious patients be managed?

A

Medication should be a last resort

Oral low dose Haloperidol or Olanzepine
Avoid Benzodiazepines

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13
Q

Define Dementia

A

Generalised decline of memory, intellect and personality without impairment in consciousness leading to functional impairment

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14
Q

Name 4 irreversible causes of Dementia

A

Neurodegenerative
Infections (HIV, CJD)
Vascular
Traumatic Head Injury

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15
Q

Name 4 reversible causes of Dementia

A

Visual/Hearing impairment,
Nutritional Deficiencies
Normal pressure hydrocephalus
Hypothyroidism

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16
Q

What is Vascular Dementia?

A

Occurs as a result of Cerebrovascular Disease (stroke, multiple infarcts, or chronic changes such as Atherosclerosis)

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17
Q

What is Lewy Body Dementia?

A

Abnormal deposition of Lewy Body proteins throughout the cortex and brainstem

If outside brainstem - more profound cholinergic loss
If within brainstem - more profound dopaminergic loss and Parkinsonian sx

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18
Q

What is Frontotemporal Dementia?

A

Atrophy of Frontotemporal Lobes

One type is Picks disease (characterised histologically by Picks Proteins)

19
Q

Dementia can be Cortical (such as Alzheimer’s and Frontotemporal). Give four clinical features.

A

Severe Memory Loss
Early Aphasia
Apraxia
Normal Coordination

20
Q

Dementia can be Sub-Cortical (such as DLB). Give four clinical features.

A

Moderate Memory Loss
Impaired Coordination
Slow Motor Speed
May have Dysarthria

21
Q

Give an example of mixed Cortical and Subcortical Dementia

A

Vascular

22
Q

Describe the genetic risks for developing Alzheimer’s

A

Early Onset - Presenilin 1 and 2, Amyloid Precursor Protein

Late Onset - ApoE 4

23
Q

Describe the ICD10 criteria A-D for Dementia

A

A - evidence of decline in memory and other cognitive abilities
B - Preserved awareness for long enough to demonstrate A
C - Decline in emotional control/motivation/behaviour
D - A must be present for 6 months

24
Q

What are the parameters for Presenile and Senile Dementia?

A

Presenile is <65

Senile is >65

25
Q

Describe the features of early Alzheimer’s

A

Memory lapses
Difficulty finding words
Forgetting names of people/places

26
Q

Describe the late stages of Alzheimer’s

A

Disorientation I time and place
Apathy
Incontinence
Agitation

27
Q

Describe the ICD10 criteria for early onset Alzheimer’s

A

A - General criteria for Alzheimer’s met and age <65

B - Atleast one of: relatively rapid onset and progression, aphasia/agraphia/apraxia/alexia

28
Q

Describe the ICD10 criteria for late onset Alzheimer’s

A

A - General Alzheimer’s criteria met and age >65

B - Atleast one of: Slow gradual onset and progression, predominance of memory impairment over intellectual ability

29
Q

How does Vascular Dementia typically present?

A 
Late sixties/early seventies 
Stepwise deterioration 
Confusion
Early personality changes and Emotional
May have signs of cardiovascular disease
30
Q

What is Mixed Dementia?

A

Features of both Alzheimer’s and Vascular

31
Q

Name four features of DLB

A

Day to day fluctuations
Recurrent visual hallucinations
Motor signs of Parkinsonism
Severe sensitivity to Neuroleptic drugs

32
Q

Describe four clinical features of Frontotemporal Dementia

A

Usually 50-60 y/o
Worsening of social behaviour
Personality changes such as disinhibition/apathy/restlessness
Memory is preserved in early stages

33
Q

How does Huntington’s Disease present?

A

Abnormal Choreiform Movements
Dementia Symptoms presenting later on

Autosomal dominant so strong FH

34
Q

What is the triad of Normal Pressure Hydrocephalus

A

Dementia with frontal lobe disturbance
Urinary Incontinence
Gait disturbance (wide)

35
Q

Describe three features of Creutzfield Jakob Disease

A

Onset usually <65
Rapid progression and death within 2y
Disintegration of all higher cerebral functions

36
Q

How is suspected dementia investigated?

A

Initially referred to memory clinic

Routine panels of bloods

37
Q

What imaging is used to differentiate Alzheimer’s, Vascular and Frontotemporal?

A

SPECT

38
Q

Name four features of the MMSE

A

Orientation
Concentration (Serial 7s)
Memory - short term, long term, recent
Grasp - name of monarch

Normal is 25-30, severe is less than 10

39
Q

Name three frontal lobe tests

A

Verbal fluency and initiation
Clock drawing tests
Similarities (why are two objects similar?)

40
Q

State two general managements of Dementia

A

Inform DVLA

Advanced planning

41
Q

Describe the non pharmacological management of Dementia

A

Social Support
Information and education
Aromatherapy
Assistance in day to day activities

42
Q

One of the pharmacological options to treat Dementia is AChesterase inhibitors. Given an example, 2 contraindications and 2 side effects

A

Donepazil

CI - Renal impairment, Hepatic impairment

SE - GI disturbance, Bradycardia

43
Q

What is the action of Memantine?

A

NMDA receptor antagonist

44
Q

How could you manage challenging behaviour of Dementia patients?

A

Short course of antipsychotics

Caution in DLB - Neuroleptic Malignant Syndrome

year 4 psychiatry (12 decks)

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