Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MRCPSYCH Paper B _ Mainly general Adult (mentor&more) > Old Age Psychiatry -Mentor &more 3 > Flashcards

Old Age Psychiatry -Mentor &more 3 Flashcards

1
Q

What type of dementia is most common in patients under 65 years of age?

A

Dementia of the Alzheimer’s type (AD)

Other types may include vascular dementia, frontotemporal dementia, and others.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name one genetic abnormality associated with presenile dementia.

A

Frontotemporal dementia with parkinsonism linked to chromosome 17

Familial Alzheimer’s disease with early onset type is another example.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are common cognitive symptoms of early onset Alzheimer’s disease?

A

Language problems and visuospatial dysfunctions

These symptoms can significantly impact daily functioning.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List the three dominant genes identified in familial Alzheimer’s disease with early onset.

A
  • Amyloid precursor gene (APP)
  • Presenilin 1 (PSEN1)
  • Presenilin 2 (PSEN2)

These genes are crucial for understanding the genetic basis of early onset Alzheimer’s disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the typical onset age range for Progressive Supranuclear Palsy?

A

45 to 75 years

Most commonly, the onset occurs in the sixth decade of life.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a common early complaint of patients with Progressive Supranuclear Palsy?

A

Unsteadiness of gait and unexplained falling

This symptom often leads to retropulsion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

True or False: Delirium has a slow onset and lasts for months.

A

False

Delirium typically has a rapid onset and lasts hours to weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name two clinical subtypes of delirium.

A
  • Hyperactive delirium
  • Hypoactive delirium

Each subtype has distinct characteristics and prognoses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the major neurotransmitter implicated in delirium?

A

Acetylcholine

This neurotransmitter plays a key role in attention and arousal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Fill in the blank: Delirium usually lasts less than _______.

A

1 week

It may last longer in elderly patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most widely used assessment method for delirium?

A

Confusion assessment method (CAM)

This method requires skilled clinical interpretation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the first-line recommended treatments for late-onset depression?

A

SSRIs

SSRIs are preferred due to their safety profile and reduced side effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What percentage of elderly patients with depression do not respond to antidepressant medication?

A

At least 30%

This highlights the challenges in treating depression in older adults.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the recovery rate of ECT for severe depression?

A

About 80%

ECT is considered the most effective treatment available.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is one risk factor for late-life depression?

A

Female sex

Other factors include poor health and disability.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some neuroimaging findings in late-onset depression?

A
  • Ischemic changes
  • Reduction in grey matter volume
  • Ventricular enlargement

These findings help in understanding the structural changes associated with depression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the two types of speech impairment seen in dementia versus delirium?

A
  • Dementia: Word finding difficulty
  • Delirium: Incoherent speech

These differences can aid in clinical assessment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe the sleep/wake cycle disturbance in delirium.

A

Frequent disruption and day/night reversal

This pattern is common in delirium and differs from dementia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the typical attention span in delirium?

A

Fluctuates

This is a key distinguishing feature from dementia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the prognosis for older adults with depression compared to younger individuals?

A

Higher relapse rates

Chronicity risk is also considered.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What therapy has been successfully adapted for use with older adults, including those with depression?

A

Therapy has been successfully adapted for use with older adults, including those with depression.

Reference: Benbow et al 1990.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the prognosis for older adults with depression regarding chronicity?

A

Older adults are thought to be at greater risk for chronicity of depression than younger persons, though this has been recently challenged.

With control for confounding variables, remission rates of depression in late life are little different from midlife.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are good prognostic factors for depression in older adults?

A
  • Onset less than 70 years old
  • Short duration of illness
  • Absent physical illness
  • Good previous adjustment
  • Good previous recovery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are poor prognostic factors for depression in older adults?

A
  • Severe life events during follow up period
  • Poor medication adherence
  • Severity of initial illness
  • Co-morbid physical illness
  • Presence of psychotic symptoms
  • Duration of illness for more than 2 years
  • 3 or more previous episodes
  • Previous history of Dysthymia
  • Cerebrovascular disease (including vascular depression)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What percentage of depressed older adults were well at a 2-year follow-up according to a meta-analysis?
33% of subjects were well at 2-year follow-up.
26
What is the relationship between depression and mortality in older adults?
Mortality is higher in older patients with depression due to concurrent physical disorders. ## Footnote Elderly individuals with depression were almost four times more likely to die within 4 months of a myocardial infarction.
27
What is the Geriatric Depression Scale used for?
It is a scale used for assessing depression in older adults.
28
What is the Patient Health Questionnaire PHQ-9?
A 9-item self-report scale widely used in UK primary care to detect depression.
29
What cognitive impairments are associated with late-onset depression?
Deficits in attention and executive functions, consistent with frontal lobe dysfunction.
30
What is pseudodementia?
A condition where cognitive impairment occurs during episodes of depression that subsides after the depression remits.
31
What characterizes vascular depression?
A distinct subtype of geriatric depression associated with cerebral ischemic damage and characterized by apathy, psychomotor retardation, and poor executive function.
32
What are common symptoms of late paraphrenia?
* Persecutory delusions * Auditory hallucinations * Visual hallucinations
33
What is the prevalence of bipolar disorder among adults aged 65 and older?
The 1-year prevalence is 0.4%, significantly lower than in younger adults.
34
What is secondary mania?
Manic illness that starts without a prior history of affective disorder in close temporal relationship to a physical illness or drug treatment.
35
What are the risks associated with using atypical antipsychotics in elderly patients?
They are associated with a two-fold increase in the risk of stroke in elderly patients, especially those over 80 years.
36
What factors contribute to new onset neurotic symptoms in the elderly?
* Physical frailty * Major life events * Bereavement * Social isolation * Poor self-care * Insecure personality
37
What is the estimated prevalence of neurotic disorders in the elderly?
Between 1-10%, with a female predominance.
38
What has led to the limited use of certain medications in older patients?
Concerns about toxicity and the need for monitoring white cell counts due to agranulocytosis.
39
What is the estimated prevalence of neurotic disorders in the elderly?
Between 1-10% with a female predominance.
40
Which anxiety disorder is most prevalent among older adults?
Phobic disorder.
41
What is the least common anxiety disorder in older adults?
Panic disorder.
42
What are common responses to anxiety in the elderly?
Abuse of sedative drugs and alcohol.
43
What physical illness is commonly associated with neurotic disorders in older adults?
Agoraphobia developing after alarming experiences of physical ill health.
44
Which medications have been licensed in the UK for treating anxiety disorders?
* Fluoxetine * Citalopram * Paroxetine * Venlafaxine
45
What is the recommended daily alcohol intake for older people?
No more than one drink per day.
46
What are the two variants of alcohol use disorders in older adults?
* Early onset * Late onset
47
What medication is often used for treating withdrawal symptoms in older adults with alcoholism?
Chlordiazepoxide.
48
What is Diogenes syndrome?
A syndrome of self-neglect in older people characterized by eccentricity and isolation.
49
What are common sleep changes in the elderly?
* Reduced total sleep time * Increased daytime napping * Increased nighttime arousals * Longer sleep latency
50
What is the most common sleep disorder in older adults?
Insomnia.
51
What psychiatric disorders are commonly associated with insomnia?
* Mania * Depression * OCD * Panic disorder * PTSD
52
What should be treated first in cases of insomnia?
The underlying cause.
53
What is a significant risk factor for deliberate self-harm in older adults?
Social isolation and loneliness.
54
What percentage of older suicide victims suffer from major depressive disorder at the time of death?
70%.
55
What is the most commonly used method for deliberate self-harm in older adults?
Deliberate drug overdose.
56
What is the prevalence of personality disorders in older adults?
Roughly 5-10%.
57
What personality traits become more prominent in older age?
* Cautiousness * Obsessionality * Compulsive traits
58
What is the association between personality disorders and depressive illness?
Patients with PD are four times more likely to have persistent or relapsing symptoms of depression.
59
What changes in personality are common in organic disorders such as dementia?
Negative personality changes in two-thirds of people with dementia.
60
What is the recommendation regarding the use of disulfiram in older adults?
Should not be prescribed due to increased risk of serious adverse effects.
61
What is the role of social factors in suicide risk among older adults?
Social isolation, lack of someone to confide in, and bereavement increase risk.
62
What is the significance of unresolved grief in older adults?
It is a commonly found risk factor for deliberate self-harm.
63
What percentage of older adults with deliberate self-harm have no psychiatric diagnosis?
Only about 10%.
64
What are the common types of sleep disorders in the elderly?
* Insomnia * Circadian rhythm disorders * Restless legs syndrome * REM sleep behaviour disorder * Obstructive Sleep Apnoea
65
What is the impact of polypharmacy on sleep in older adults?
It can contribute to sleep problems.
66
What should be the duration of treatment with hypnotics for insomnia?
No longer than 2 weeks.
67
What is the effect of tricyclic antidepressants on REM sleep?
They can reduce REM sleep.
68
What are the characteristics of late-onset alcohol use disorder?
Developing drinking problems at 40-50 years of age with fewer physical and mental health issues.
69
What is the gender ratio for attempted suicide among older adults?
Females outnumber males at a raw number ratio of approximately 3:2.
70
What are sedating antidepressants used for in older adults?
They are sometimes used if comorbid depression is present. ## Footnote Sedating antidepressants may help manage symptoms of depression alongside other treatments.
71
What should be done if symptoms persist after 2 weeks?
Refer to IAPT for CBT or other behavior therapy such as stimulus control therapy, sleep restriction therapy, or relaxation therapy. ## Footnote IAPT refers to Improving Access to Psychological Therapies.
72
What is the recommended duration for the use of hypnotics?
Treatment duration should be short, no longer than 2 weeks. ## Footnote Hypnotics should only be prescribed to patients meeting diagnostic criteria.
73
What is a common circadian rhythm disorder in older adults?
Advanced sleep phase syndrome, where individuals fall asleep several hours earlier than conventional norms and wake very early in the morning. ## Footnote This disorder is particularly common in nursing homes due to inadequate light exposure.
74
What treatments are effective for circadian rhythm disorders?
* Bright light therapy * Early evening administration of melatonin * Chronotherapy (advancing sleep times gradually each day) ## Footnote These treatments aim to help regulate sleep patterns.
75
What disorders fall under sleep-related breathing disorders?
* Sleep hypopnea * Sleep apnoea ## Footnote These disorders are associated with high morbidity and mortality.
76
What is needed to confirm a diagnosis of sleep-related breathing disorders?
Polysomnography is needed to confirm the diagnosis. ## Footnote Polysomnography is a comprehensive sleep study.
77
What are some treatment options for sleep-related breathing disorders?
* Weight reduction * CPAP therapy * Uvulopalatopharyngoplasty (UPPP) * Oral appliances to modify position of mandible and tongue ## Footnote CPAP therapy is often the most effective treatment.
78
What characterizes REM Behavior Disorder (RBD)?
Lack of normal muscle atonia during REM sleep, leading to enactment of dream activity. ## Footnote This disorder has a higher prevalence in Parkinson's disease, MSA, and LBD.
79
What treatments are recommended for REM Behavior Disorder?
* Safe sleeping environment * Clonazepam at bedtime * Review of antidepressants if temporal relationship exists * Other options include melatonin and pramipexole ## Footnote Ensuring safety during sleep is crucial due to the risks involved.
80
What are age-related changes in women's sexual health?
* Vaginal dryness * Atrophy * Dyspareunia ## Footnote These changes are often due to declining levels of estrogen.
81
What is the impact of aging on men's sexual health?
Decline in testosterone after the fifth decade results in decreased sexual desire. ## Footnote Aging affects both speed and intensity of sexual response.
82
What percentage of men aged 70 years or over experience impotence?
10-20% of men aged 70 years or over. ## Footnote Impotence is a common issue among older men.
83
Do sexual satisfaction levels decline with age?
Several cross-sectional studies have shown that sexual satisfaction does not decline with age. ## Footnote This suggests that sexual experience may remain fulfilling regardless of age.
84
What should be included in psychiatric history taking for older patients?
Sexual history should be part of psychiatric history taking. ## Footnote Sexual dysfunction is prevalent but often overlooked in clinical assessments.
85
What are common medical causes of sexual dysfunction in the elderly?
* Parkinson's disease * Stroke * Arthritis * Incontinence ## Footnote Physical ailments can significantly impact sexual health.
86
What medications can cause erectile dysfunction?
* Alcohol * Benzodiazepines * Antidepressants like trazodone * Beta-blockers * Antihypertensives like thiazide diuretics and spironolactone ## Footnote Certain medications can adversely affect sexual function.
87
What concerns may arise regarding sexual activity in older adults with physical illness?
Anxiety around the safety of sexual activity and undermining self-confidence. ## Footnote Physical health issues can create barriers to sexual expression.
88
What is the prevalence of inappropriate sexual behavior in dementia?
Around 7% overall in people with Alzheimer's dementia, higher in care home settings (approx. 18%). ## Footnote Inappropriate sexual behavior may indicate underlying neurological issues.
89
What is the ABC system in understanding inappropriate sexual behavior in dementia?
Antecedents, Behavior, and Consequences. ## Footnote This system helps in designing appropriate interventions.
90
What factors can affect sexual desire in caregivers of dementia patients?
Adaptation to the role of carer may adversely affect sexual desire. ## Footnote Caregiving can lead to emotional and physical strain.
91
What is CBT and its relevance in older adults?
Cognitive Behavioral Therapy is probably the most commonly used treatment for older adults and caregivers of those with dementia. ## Footnote CBT can effectively address various psychological issues.
92
What percentage of spouses may develop symptoms of depression within the first year of bereavement?
10–20% of surviving spouses. ## Footnote This statistic highlights the emotional impact of losing a partner.
93
What are the phases of a normal grief reaction?
* Phase 1 - Shock and protest * Phase 2 - Preoccupation * Phase 3 - Disorganization * Phase 4 - Resolution ## Footnote Understanding these phases can help in providing appropriate support.
94
What is inhibited grief?
Absence of expected grief symptoms at any stage. ## Footnote This can indicate a need for psychological intervention.
95
What characterizes delayed grief?
Avoidance of painful symptoms within 2 weeks of loss. ## Footnote Delayed grief may manifest later and require treatment.
96
What is chronic grief?
Continued significant grief-related symptoms 6 months after loss. ## Footnote Chronic grief may necessitate professional support.
97
What is the prevalence of major depression by the end of the second year of bereavement?
14% of bereaved individuals compared to 1–4% of the elderly population in general. ## Footnote This indicates an increased risk of depression following significant loss.

MRCPSYCH Paper B _ Mainly general Adult (mentor&more) (90 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions