OPMH: Delirium, Depression, Dementia Flashcards
Cognitive impairment
-tests and why
-imaging and why
FBC - infection
-encephalitis, UTIs
CRP - inflammatory
U&E, LFT - kidney, liver failure, electrolyte disturbances => MCI
TFT - hyper/hypothyroidism
B12, folate - deficiency
HbA1c - CV risk factors
Head CT - head trauma, tumour, SOL, hydrocephalus, stroke
-assessing subtypes and identifying reversible causes
Key areas to ask if suspecting dementia
Features of memory decline
-onset, duration, identifiable patterns, improving/worsening factors
Other cognitive domains
-movement
-speech
-personality change
-hearing/vision
-sleep
Impact on ADL, personal safety
-hazards at home - leaving stove on, forgetting to lock door
-upstairs, downstairs living
-self care - hygiene, cleaning, meals (weight loss?)
-hazards outside - not knowing where you are
-driving? => if diagnosis made, must inform DVLA
-able to go shopping
SHx
-home - carers, dependents
-POC?
-drinking, smoking, recdrugs
Medications which may cause confusion
-other side effects
AChinh
-antipsychotics
-antidepressants (TCAs, paroxetine)
-urinary incontinence
-strong antihistamines
Can’t see - blurry, dry eyes
Can’t pee - retention
Can’t spit - dry mouth
Can’t shit - constipation
Cognitive testing, pros and cons of
-MMSE
-MOCA
-ACEIII
MMSE (30)
:) memory
:( executive function
MOCA (30)
:) executive function, visuospatial, memory
:( comprehensive but v hard
ACEIII (100)
:) varying levels of difficulty but takes 20mins
Accuracy of tests limited by tiredness, other conditions, concetration
Biopsychosocial management of AD
Aim to maintain independence
Bio (last resort)
-AchE inh
-memantine
Psycho
-manage underlying low mood if present
-memory strategies
Social
-OT
-Care package
-support groups
-inform DVLA
SE of AchE inh
Salivation
Incontinence/diarrhoea/vomiting
Teary
Sweaty
Depression in older adults
-how does it differ from younger people?
Low mood more likely to be attributed to irritability
Assessing severity
-these EXP are your fault?
-feeling like the world would be better off without you
-impact on appetite, sleep
SH risk assessment
-thoughts of SH?
-do these thoughts of harming yourself make sense to you?
Risk factors
-significant life events, change in role
-chronic/neuro illness
-grief
-long term effects of alcohol/substance use
-isolation
-financial hardship
Protective
-staying cognitively/physically well
-social relationships
Biopsychosocial management of depression
THINK ABOUT WHAT WOULD HELP
Are their symptoms improved by anything?
Bio
-SSRI
Be careful - low dose, polypharmacy monitor carefully
Psycho
-CBT
Social
-community befrienders
SE of SSRIs to watch out for in older adults
Vulnerable to low Na
Caused by SIADH within first few weeks of SSRI use
Confusion
Fatigue
Seizures
Weakness
LOC
Low BP
N/V
Stop/switch if there was a response/monitor
What are the possible misidentification phenomena that could be misinterpreted as psychosis
-management
Facial recognition and memory recall affected
Phantom border - someone else is in the house
Mirror sign - misinterpreting self as another person in the house
TV sign - person on TV is in your house
Picture sign - people in photo in your house
Capgras - people you know have been replaced by imposter
Not own house - minsinterpreting house as not your own
Dead person is alive - misremembering that dead person is not dead
Cover mirrors, photos, turn off TV when not in use
Avoid antipsychotics unless risk of not using them is greater than the risk to use them
Biopsychosocial mamagement of psychosis
Bio - avoid if possible but SE risk high
-antipsychotics
Start low, go slow, regular reviews
-if no benefit => stop
-if partial benefit => increase slowly
Psycho
-psychology input if you think it would help
Social
-remove photos, turn off TV
-is there anything that makes their misidentification phenomena better?
