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Psychiatry > Organic Psych > Flashcards

Organic Psych Flashcards

1
Q

Define dementia

A

Acquired progressive degenerative disorder giving global impairment of all mental functions and significant enough to impact ADLs, with normal consciousness lasting for >6 months

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2
Q

Define dementia to a lay person/patient

A

Dementia refers to a group of conditions that cause a decline in brain functioning that gets worse over time. People with dementia often have difficulties with memory and doing their normal daily activities like dressing + cooking.

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3
Q

What are the features of dementia?

A
  • Cognitive decline: memory, spatial skills, language, abstract thinking
  • Mood changes
  • Abnormal behaviour eg. disinhibition
  • Hallucinations and delusions
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4
Q

Describe the typical clinical course of dementia

A
  • Forgetfulness
  • > Disorientation
  • > decreased ability to do ADLs
  • > BPSD (mood change, abnormal behaviour, hallucinations + delusions)
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5
Q

How common in dementia?

A

5-10% of >65s

20% of >80s

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6
Q

What are the different types of dementia? Which is most common?

A 
Alzheimer's disease: most
Vascular dementia
Dementia with Lewy Bodies
Pick's disease/fronto-temporal dementia
\+ Huntington's, CJD, Korsakoff, HIV
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7
Q

What is the pathophysiology of Alzheimer’s disease?

A

Accumulation of intracellular neurofibrillary tangles (hyperphosphorylated Tau) and extracellular beta-amyloid plaques

  • > neuronal loss, especially cholinergic cells
  • > generalised cortical atrophy
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8
Q

Describe the classic clinical presentation of Alzheimer’s

A

Amnesia: forgetfulness
Apraxia: difficulty with ADLs
Aphasia: loss of speech
Agnosia: poor recognition

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9
Q

Describe the presentation of vascular dementia

A
  • Stepwise, rapid decrease in cognitive function
  • Associated with a history of vascular disease, RFs
  • Symptoms variable, include emotional lability with preserved personality and insight
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10
Q

Describe the presentation of dementia with Lewy bodies

A
  • Fluctuating confusion
  • Visual hallucinations eg Lilliputian hallucinations
  • Falls, Parkinsonism
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11
Q

What is the pathophysiology of dementia with Lewy bodies?

A

Intracellular alpha-synuclein and ubiquitin accumulation, in the cyngulate gyrus

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12
Q

Describe the presentation of fronto-temporal dementia

A
  • Marked changes in behaviour (disinhibition) and personality
  • Dysexecutive syndrome: difficulties in planning, organisation, judgement
  • Loss of insight
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13
Q

Describe the presentation of Huntington’s

A

In 40s-60s

  • Chorea and athetosis
  • Difficulties with speech + swallowing
  • Dementia
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14
Q

What are some differential diagnoses for dementia?

A 
Delirium
Pseudodementia
Korsakoff
HIV, syphilis
Vitamin deficiency
Cushing's
Hypothyroidism 
CJD
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15
Q

What is presentation of normal pressure hydrocephalus?

A

Triad of:

  • Dementia
  • Incontinence
  • Ataxia
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16
Q

What investigations would you do for someone with suspected dementia?

A
  • Collateral history
  • Cognitive testing eg. 10-CS
  • Bloods: FBC, U+Es, CRP, LFTs, bone profile, TFTs, cortisol, glucose, B12, syphilis + HIV serology
  • Consider septic screen eg urine dip, CXR
  • Consider CT/MRI if neuro symptoms, starting medication, psychotic symptoms
17
Q

You speak to a patient in the GP and suspect they may have dementia. What would you do next?

A
  • Collateral history
  • Investigate any reversible causes eg blood tests, urine dip, hearing test, review medications
  • Cognitive testing
  • > refer to memory clinic
18
Q

What can be used to differentiate delirium and dementia?

A

CAM- confusion assessment method

OSLA- observational scale of level of arousal

19
Q

Which medications are used in the management of dementia and their uses.

A

Cholinesterase inhibitors: donepezil, rivastigmine, galantamine. Used in mild-mod Alzheimer’s, DLB
Memantine: severe Alzheimer’s, DLB when CEi are contraindicated

20
Q

Describe the management of dementia

A

MDT approach! GP, memory clinic eg old age psych, neuro, specialist nurses, OT
Biopsychosocial approach:
-Education including driving (inform DVLA + regular assessment)
-Involvement in decision making, creating a care plan (and advance care planning)
-Medical: cholinesterase inhibitors, memantine
-Psych: group cognitive stimulation, group reminiscence therapy.
-Social: cognitive rehabilitation with OT to improve independence, carer support, activities
-Carer support: group training sessions, Carers Needs Assessment, respite. Refer to charities eg Dementia UK

21
Q

What is the management of sleep problems in dementia? Depression?

A

Sleep: no melatonin. Recommend sleep hygiene, sunlight, activities, exercise
Depression: psychological therapies
Agitation, psychosis: antipsychotics (be careful in Parkinsons or DLB)

22
Q

What are some important questions to ask when assessing risk in someone with dementia?

A

Risk to self: leaving the hob on, getting lost, wandering on roads. DSL if depressed.
Risk from others: victim of fraud/scams
Neglect: living alone, ability to do ADLs

23
Q

Define delirium

A

Acute confusional state or

Transient impairment in cognition with altered consciousness

24
Q

How does delirium present?

A

Rapid onset decline in cognitive function with altered consciousness

  • Fluctuating with diurnal variation: worse at night
  • Impaired concentration and attention
  • Disturbed cognition (memory, thinking, orientation) and perception (delusions + hallucinations)
  • Motor agitation or retardation
25
Q

What are some causes of delirium?

A

Everything

  • Pain
  • Dehydration
  • Constipation
  • Infection eg UTI
  • Medications (opiates, anticholinergics, steroids)
  • Hypoxia
  • Nutritional deficiency
  • Environmental change
26
Q

What are some risk factors for delirium?

A 
Older age
Dementia
Polypharmacy
Immobility
Sensory impairment 
Depression
27
Q

How do you diagnose delirium?

A

Cognitive testing eg. CAM
1) Acute onset of mental status change
+ 2) Inattention
+ 3) Disorganised thinking OR 4) Altered consciousness

28
Q

What is the management of delirium?

A
  • Early diagnosis
  • Investigate + treat cause: review medications, check for infections, give pain relief and laxatives
  • Supportive: limit change in environment eg same ward, same nurses. Reduce sensory impairment. Improve orientation eg. well-lit ward, large clocks, calendars.
29
Q

How does Korsakoff dementia present?

A

Retrograde semantic memory loss with confabulation

Normal procedural memory

30
Q

What is effect of acetylcholinesterase inhibitors in dementia?

A

Improve symptoms

Do not affect progression

31
Q

What are the side effects of acetylcholinesterase inhibitors?

A
  • Diarrhoea
  • Bradycardia
  • Postural hypotension + falls
  • Incontinence
  • Cholinergic crisis: salivation, lacrimation, urination, defaecation, GI cramps, emesis (SLUDGE)
32
Q

What is the MoA of memantine?

A

Glutamate receptor antagonist

33
Q

Who should make the diagnosis of dementia?

A

Secondary care eg. memory clinic or community old-age psych

34
Q

What is included in an AMTS?

A
  • DOB
  • Age
  • Identify 2 people
  • Identify the current place
  • Time of day
  • Date
  • Current prime minister
  • End of WWII
  • Count backwards from 20
  • Remember address

Psychiatry (10 decks)

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