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psychiatry > old age psychiatry > Flashcards

old age psychiatry Flashcards

1
Q

age

A

> 65

some under 65 if confirmed dementia

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2
Q

ABCD of dementia

A

A: activities of daily living (ADLs)
B: behavioural + psychiatric symptoms of dementia
C: cognitive impairment
D: decline

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3
Q

cognitive features of dementia

A

dysmnesia

+ 1+ of:

  • dysphasia (communication): expressive, receptive
  • dyspraxia - inability to carry out motor skills
  • dysgonia - not recognising objects
  • dysexecutive functioning (initiation, inhibition, set-shifting, abstraction)
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4
Q

expressive dysphasia

A

word finding difficulty

struggle to get through sentences

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5
Q

receptive dysphasia

A

struggle to understand language

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6
Q

dementia: functional impairment

A 
ask about daily routine; 
driving 
using phone 
toileting/showering
cooking
housework/cleaning 
taking medication 
manage finances
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7
Q

fitness to drive

A

dementia or organic brain syndrome

  • notify DVLA at diagnosis
  • if early dementia license may be yearly
  • those with poor short term memory, disorientation or lack insight should almost certainly not drive
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8
Q

dementia imaging

A

consider most approp for pt, do they need imaging?

CT
CT/SPECT
DAT scan

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9
Q

cognitive tests can do in clinic

A

mini-mental state examination (MMSE)

montreal cognitive assessment (MOCA)

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10
Q

causes/types of dementia

A 
alzeimer's
vascular dementia
mixed demtia
lewy body dementia
alcohol related brain damage
parkinson's, Huntington's, HIV
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11
Q

reversible causes of dementia: physical things to screen for

A 
delirium 
normal pressure hydrocephalus 
subdural haemorrhage
tumours 
VitB12 deficiency 
hypothyroidism 
hypercalcaemia 
alcohol misuse
neurosyphilis 
drugs
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12
Q

course of dementia

A

initially present with symptoms then diganosis
as progress likely to lose independence and need support (fam, care setting)
then behavioural problems and then thinking about nursing home
life limiting and palliative disease - will die of it

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13
Q

general alzheimer’s presentation

A

early impairment of memory and executive function

gradual onset with often unclear onset

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14
Q

pathological features of alzeiher’s i.e. what would u find on autopsy

A

amyloid plaques and tau tangles
atrophy of brain following neuron death
reduction in acetylcholine in brain

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15
Q

risk factors alziehmer’s

A

inc age
family history
down syndrome
vascular risk factors

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16
Q

vascular dementia features

A

unequal distribution of deficits
focal impairments on neuro exam
PMHx cerebrovascular disease

step wise decline with sudden changes

small vessel disease can give gradual decline

17
Q

key features of lewy body dementia

A 
visual hallucinations
fluctuations - lucid, confused then back again
parkinsonism
REM sleep disorder
falls
sensitive to anti-psychotics
18
Q

what type of scan is usually done when Lewy body dementia suspected

A

DAT scan

19
Q

frontotemporal dementia key features

A

behavioural - personality change
early onset
early emotional blunting
speech disoder: altered output, preservation, echolalia

20
Q

frontotemporal dementia neuropsychology

A

frontal dysexecutive syndrome

memory, praxis and visuospatial function not severely impaired

21
Q

frontotemporal dementia neuroimaging

A

abnormalities in frontotemporal lobes

22
Q

behavioural and psychological symptoms in dementia

A

agitation - restlessness, wandering
psychosis - delusions, hallucinations
affective - depression, anxiety, hypomania, apathy
disinhibition - aggression, sexual
behaviour - eating, toileting, dressing, sleep-wake cycle

23
Q

drug treatments of dementia

A

acetylcholinesterase inhibitors (mild-moderate AD + lewy body)

memantine (mod-severe AD)

antipsychotics
antidepressants
anxiolytics
hypnotics
anticonvulsants
24
Q

acetylecholinesterase inhibitors

A

increase amount of acetylcholine in the brain

slowing down progression of functional + cognitive impairment

25
Q

acetylecholinesterase inhibitors: side effetcs

A 
nausea, vomot, diarrhoea
fatigue, insomnia
muscle cramps
headache
dizziness
syncope
breathing probs
26
Q

dementia mangement” non-pharmalogical

A

other causes of distress
ABC approach
communication
any form of distraction

27
Q

capacity

A

ability to understand info relevant to a decision or action

and to appreciate the reasonably foreseeable consequences of not taking action or decision

28
Q

5 points to consider when it comes to capacity

A
  1. does pt understand info?
  2. does pt retain the info long enough to make decision?
  3. can pt communicate decision?
  4. can pt weigh up the info in order to make decision?
  5. does pt believe the info they are given?
29
Q

key points when assessing capacity (8 of them)

A
  1. patient deemed to have capacity unless proven otherwise
  2. patient should be supported to make decision
  3. person cannot be deemed to incapable if decision is eccentric or unwise
  4. anything done for pt must be done in best interest
  5. use least restrictive option
  6. capacity should be assessed on topic of question
  7. pt should be assessed at their ‘peak time’
  8. speak to fam to get historic veiws
30
Q

6Cs of capacity

A 
capacity 
consent 
compliance
coercion
certification 
common sense
31
Q

functional illness in >65

A

basically anything that isn’t dementia

depressive symptoms/illness
anxiety disorders
mania and BAD
schizophrenia
alcohol problems

(delirium)

32
Q

presentation of depression in older population

A

less likely to present with depressed mood, suicidal wishes etc

more likely: insomnia, hypochondriasis, agitation, completed suicide

33
Q

psychosocial factors that may contribute to old age depression

A

loss; health, wealth (shit pension), spouse, work, home (e.g. moving to nursing home)

34
Q

treatment of depression in older people

A
  1. antidepressants e.g. sertraline
  2. CBT
  3. ECT in severe cases

most community cases not treated

35
Q

late onset schizophrenia like psychosis: features

A

spectrum from circumscribed persecutory delusions to full schizophrenia-like psychosis

36
Q

late onset schizophrenia like psychosis: aetiology

A

sensory loss
social isolation
genetic? minor abnormalities

37
Q

late onset schizophrenia like psychosis: management

A

often need compulsory admission

neuroleptics

increasing social contact

psychiatry (20 decks)

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