Old Aged Psychiatry Flashcards
How does the prevalence of most mental health disorders vary in the community vs hospitals?
All are increased drastically except alcohol misuse and Schizophrenia
What are the ABCDs of Dementia syndrome?
A - Activities of Daily living
B - Behavioural and Psychiatric symptoms of Dementia (BPSD)
C - Cognitive impairment
D - Decline
What are the cognitive features of Dementia?
Memory loss
Functional decline (ADLs)
(Plus one of):
- Dysphasia
- Dyspraxia
- Dysgnosia
- Dysexecutive functioning
What is Dysgnosa?
Not recognising objects
MMSE scores correlate with what?
Lower the score - worse the deterioration
What are the neuropsychiatric disturbances seen in dementia?
Psychosis
Depression
Altered circadian rhythms
Agitation
What are the Behavioural and Psychiatric symptoms of Dementia (BPSD)?
Paranoia
Hallucinations
Activity disturbances
Aggression
Diurnal rhythm
Affective disturbance
Anxiety
What are the causes of dementia? What is their prevalence?
ALZHEIMERS (50%)
Vascular dementia (25%)
Mixed Alz/Vasc (15%)
Lewy body (5%)
Other
What is the ‘course’ of dementia?
Symptoms - Diagnosis
Loss of independence
Behavioural problems
Nursing home placement
Death
How is Alzheimer’s diagnosed?
Case-finding then clinical assessment
Exclude delirium and depression
Specialist referral (Confirm with brain scanning and neuropsychology)
How does dementia differ from delirium?
Dementia - slower onset with progression, with less prominent physiology, consciousness and psychomotor decline only late in illness
How does dementia differ from depression?
Dementia - insidious with no psych history Day to day mood fluctuation with stable cognitive loss
Depression - abrupt onset with fluctuations, mood correlates with memory loss
What assessments are used for dementia?
MMSE
MOCA
What are the criteria for Lewy Body Dementia?
- Dementia with deficits of:
- Attention
- Frontal executive
- Visuospatial
- 2 probable, 1 possible
- Fluctuation
- Visual Hallucinations
- Parkinsons
3 - Suggestive, REM sleep disorder, antipsych sensitivity, DAT scan abnormal
- Falls, syncope, LoC, Psych symptoms
- Dx ess likely if stroke or comorbidities
What brain scan is used in Dementia with lewy bodies?
DAT Scan
85% sens/spec
Shows reuptake of dopamine transporters in caudate nucleus and putamen
How does Frontotemporal dementia present?
Behavioural disorder
Personality change
Early emotional blunting
Can be early onset
Speech disorder
Frontal dysexecutive syndrome (memory, praxis not badly impaired)
Frontotemporal abnormalities in imaging
Neurological signs absent early, parkinsonism later
What drugs are used in dementia?
Acetylcholinersterase Inhibitors (Moderate Alzheimers) Memantine (moderate - severe Alz)
Antipsychotics
Antidepressants
Hypnotics
Anticonvulsants
What are the non-pharmacological approaches to dementia?
Avoid other causes of distress
ABC approach
Communication
Assess capacity
What is the significance of assessing capacity in dementia?
Power of Attourney:
- Finance
- Welfare
- Best interests
- Misuse
(Or) Guardianship - lack capacity to grant PoA
What is required for Guardianship?
Lack of capacity to grant PoA
2 Medical certificates
Detailed report from social worker (take into account the family)
How common is depression in old age?
20-30%
More common in women
How does depression present in old age?
(less low mood or suicidal wishes)
Insomnia
Hyperchondriasis
Suicide
Agitation
What are the causes of depression in old age?
Loss of health, wealth, spouse, work, home
Genetic
What is the management of depression in old age?
Antidepressants
CBT
ECT if severe
(most not treated)
What are the abnormal symptoms of grief?
>2 months
Guilt
Thoughts of death
Worthlessness
Psychomotor retardation or marked impairment
Psychosis
What are the triggers for suicide in the elderly?
Depression
Loneliness/widower
Ill health/chronic pain
Life events
How does late onset schizophrenia like psychosis present?
Spectrum of psychotic symptoms
What is the cause of late onset schizophrenia like psychosis?
Sensory loss
Social isolation
Genetic?
How is late onset schizophrenia like psychosis managed?
Admission
Neuroleptics
Increased social contact
How does dementia/organic brain syndrome impair fitness to drive?
Notice DVLA of diagnosis
License may be yearly
Poor short term memory, disorientation or lack of insight should not drive
