Old Age Psyhcitary Flashcards
How many beds are taken up in ARI by old people?
2/3rds
How many old people have a mental health disorder?
2/3rds
How can you diagnose dimentia using ABCD
A ctivities of daily living.
Behavioural and psychiatric symptoms of dimentia
Ç for cognitive impairment
D for decline
What do you need to diagnose dimentia?
A collateral history
Flexible cognitive testing
What are the cognitive features of dimentia?
Dysmensia (memory issues) plus one or more of the following
Dysphasia- communication issue
Dyspraxia- inability to carry out motor skills
Dysgnosia- not recognising objects
Dysexcutive function-
What neuropsychiatric disturbances are common in dimentia?
Psychosis/ hallucinations Depression Altered circadian rhythms Agitation/aggression Anxiety
What are the types of dimentia
Alhezimers- 50%
Vascular- 25%
Mixed vascular dimentia and Alzheimer’s 15%
Lewy body dimentia- 5%
Other (frontal temporal, Huntington’s, MS)-5%
What is the course of dimentia?
Symptoms Diagnosis Loss of functional dependence Behavioural propels. Nursing home Deat
How do you work to gain an early diagnosis for dementia?
Clinical assessment and collateral history check out
If differentials check out
Refer to specialist who can do:
Brain scanning neuropsychology Patient and caregiver counselling Management and symptomatic treatment Follow up
What are the differentials for dementia?
Delerium- Abrupt,precise onset,
variable hour by hour
Depression- abrupt onset, hsitory of depression, short and long term memroy loss
What two questionnaires can be done to test dementia?
Mini mental state examination (MMSE) or the Montreal cognitive assessment (MOCA)
What imaging can be done to look for dementia
CT- basic and used often
SPECT- bright colours,
MRI- gold standard, not well tolerated
How does dementia with Lewy bodies present?
Amnesia not prominent, fluctuation, visual hallucinations, parkinsonism
REM disorder, falls, syncope, loss of consciousness
What is a DAT scan?
Coloured scan, used in Lewy body dementia.
DAT scan on a normal AD patient shows normal re-uptake of the dopamine transporter in the head of the caudate nucleus and the putamen. However in DLB there is reduced uptake in the putamen leading to a full stop sign
What is Pick’s disease?
Also known as frontotemporal dementia, it is a behavioural disorder that comes with emotional blunting, speech disorder and frontal dysexuctive syndrome
What is frontal dysexecutive syndrome?
Dysexecutive syndromes include problems in the ability to attend to thoughts and memories just as it includes problems in paying attention to environmental stimuli
When would you use acetylcholinesterase inhibitors to treat dementia
Give some examples of acetylcholinesterase inhibitors
mild to moderate Alzheimer dementia.
e.g. donepezil, rivastigmine, galantamine
What are the benefits of using acetylcholinesterase inhibitors for dementia
Improves cognitive function and slows decline
Means they can stay longer at home (more functionality)
Must be prescribed by a specialist
What are the side effects of using acetylcholinesterase inhibitors for dementia
When do you stop? ause nausea, vomiting, diorrhea fatigue, insomnia, muscle cramps headaches, dizziness syncope, breathing problems
What do you use to treat moderate to severe Alzheimers disease?
Memantine
What antipsychotics can be used to treat dementia?
What are the issues with prescribing them
Rispiridone, quetiapine, amisulpride
Do they work? Side effects include death
Start low and go slow, review and stop, discuss risks
What other classes of drugs can be used to treat dementia?
Anti depressants (mirtazapine, sertraline)
Anxiolytics (lorazepam)
Hypnotics (zolpidem, zopiclone)
Anticonvulsants (valproate, carbamazepine)
What are the non-pharmacological ways of managing dementia?
reduce distress
ABC approach
Communicate with patent and family
Use other forms of distractions
How do you assess someone with dementia’s capacity?
Communication? Understanding? Make informed decisions? Act appropriately? Retain memory of decision?
How does dementia present in the elderly?
Insomnia,
Hypochondriasis (worry about being ill)
Suicide
Agitation
What causes depression in the elderly?
Losing health, wealth, spouse, work, hom
Genetics
How do you treat depression in the elderly?
Antidepressanst (watch out fro TCA side effects)
CBT
ECT- in severe cases
What are some normal symptoms of grief and mourning
Alarm Numbness Illusions or hallucinations Depression Recovery and organisation
What are some abnormal symptoms of grief and mourning?
Persisted beyond 2 months Guilt Thoughts of death/worthlessness Psychomotor retardation Prolonged/marked functional impairment pyschosis
Why are suicide rates so high in the elderly?
Loneliness Widowed Ill health Chronic pain Recent life events Few seeing psychiatrist
How does schizophrenia like psychosis occur in the elderly?
Spectrum form
Circumscribed persecutory delusions to full schizophrenia like psychosis
What causes schizophrenia like psychosis?
Sensory loss
Social isolation
Genetic minor abnormalities
What is the management of schizophrenia like psychosis?
Often needs compulsory admission
Neuroleptics
Increased social contact
Should people with dementia drive?
Absolutely fucking not- poor short term memory, disorientation and lack of insight
How do you avoid dementia?
Activity Caffeine Alcohol? HRT Statins Hyeprtension NSAIDS Good nutrition Fish oils Vitamins
