Perinatal and elderly Flashcards
What suggests depression over dementia in the elderly
Short history
Worried about the memory loss
Biological symptoms
Global memory loss as opposed to short term memory loss
How is alzheimers classified
Based on MMSE score
Mild AD- 21-26
Moderate 10-20
Severe- Less than 10
How is mild/moderate dementia treated
With anticholinesterase inhibitor- donepezil, rivastigmine, galantamine
If these are not tolerated use- memantine
How is severe dementia treated
First line NMDA antagonist- memantine
How would behavioral disturbances be treated in dementia
Sedatives- haloperidol, sodium valproate
Signs of childhood neglect in children
Disinhibited social engagement disorder- indiscriminate sociability where wander off and approach strangers
Reactive attachment disorder- failure to seek and accept comfort from parents
What is leading cause of death in 1 year after pregnancy
Suicide
When do you refer patients postnatally with mental illness
Anxiety- affects day to day function with disproportionate worrying about the baby
Eating disorder- active symptoms
Affective- weight loss, disinterest in baby hypomania
Psychotic- emergency referral
When does postnatal psychosis present
Within first 2 weeks
Risk factor for post partum psychosis
1st pregnancy
Previous episode
Family history
Affective disorders- Bipolar (worse in type 1), schizoaffective
Presentation of postnatal psychosis
Normally anxiety to begin with
Paranoid psychosis
Mania
Rapidly changing mood
Which antipsychotics do women respond better to
Typical
Management of postnatal psychosis
Assess under MHA
Urgently treat with antipsychotics
Aim to keep mother with baby
Admission to mother and baby unit for 1 to 1 nursing supervision
When do baby blues appear
Last up to 48 hours
Occurs within 10 days- peak 4/5 days
What is neonatal adaptation syndrome
When babies are exposed to SSRI/SNRI during pregnancy
Presentation of neonatal adaptation syndrome
Jitteriness
Resp depression
Difficulty feeding and sleeping
Irritability
Best antidepressants in pregnancy
Sertraline is first line
Second line- TCAs
- amitryptylline
- imipramine
- nortriptylline
What is worst thing can do with antidepressants in pregnancy
Stop abruptly- continuing safely
Which antipsychotic should be avoided in pregnancy
Risperidone as risk of cardiac malformation and spontaneous abortion
Bipolar management in pregnancy
If get pregnant switch gradually to an antipsychotic
If pregnant what is advised for depression in BPAD
Olanzapine and fluoxetine
What psychological drugs should be avoided in a breastfeeding woman
Clozapine
Carbamezepine
Lithium
Triad for LBD
Confusion
Visual hallucinations
Parkinsonism signs
How is post natal depression screened for
At first post natal meeting ask 2 questions
- low mood
- anhedonia
If one is yes then undertake the edinburgh postnatal depression scale
Inheritance of huntingtons
Autosomal dominant
Trinucleotide repeat of HTT gene
How does huntingtons present
Choreic moves
Low mood
Memory problems
What happens if give a LBD patinet an anti-psychotic drug
Symptoms worsen
Management of LBD pharmacologically
Offer donepezil or rivastigmine
If not successful or tolerated use galamantine
Pharmacological management of picks disease
None
Poor prognosis factors in alzheimers
Young onset
Male
Behavioural issues
Poor prognosis factors in alzheimers
Young onset
Male
Behavioural issues
Why cant give parkinsonism drugs in LBD
Make hallucinations worse
What is pseudodementia
When depression causes you to slow down cognitively meaning you appear to have dementia
Management of post natal depression
Assess with PHQ9 or edinburgh post natal depression tool
If mild/moderate
- facilitated self help
- if history of severe depression still give medication
If moderate/severe
- offer CBT or antidepressant if does not want CBT and understands risk
- sertraline first line then TCA
What must do before giving SSRI or TCA in post natal depression
Make sure no renal issues with baby or premature if going to breastfeed
Rfx for PND
Younger age
Unwanted pregnancy
Social support poor
Unemployed
Best antipsychotics in pregnancy
Quetiapine
Olanzapine
Chlorpromazine
Haloperidol