Perinatal and elderly Flashcards by ROHIT LAWRENCE

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 well did you know this?

Not at all

Perfectly

How is alzheimers classified

Based on MMSE score
Mild AD- 21-26
Moderate 10-20
Severe- Less than 10

How well did you know this?

Not at all

Perfectly

How is mild/moderate dementia treated

With anticholinesterase inhibitor- donepezil, rivastigmine, galantamine
If these are not tolerated use- memantine

How well did you know this?

Not at all

Perfectly

How is severe dementia treated

First line NMDA antagonist- memantine

How well did you know this?

Not at all

Perfectly

How would behavioral disturbances be treated in dementia

Sedatives- haloperidol, sodium valproate

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What is leading cause of death in 1 year after pregnancy

Suicide

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

When does postnatal psychosis present

Within first 2 weeks

How well did you know this?

Not at all

Perfectly

Risk factor for post partum psychosis

1st pregnancy
Previous episode
Family history
Affective disorders- Bipolar (worse in type 1), schizoaffective

How well did you know this?

Not at all

Perfectly

Presentation of postnatal psychosis

Normally anxiety to begin with
Paranoid psychosis
Mania
Rapidly changing mood

How well did you know this?

Not at all

Perfectly

Which antipsychotics do women respond better to

Typical

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

When do baby blues appear

Last up to 48 hours
Occurs within 10 days- peak 4/5 days

How well did you know this?

Not at all

Perfectly

What is neonatal adaptation syndrome

When babies are exposed to SSRI/SNRI during pregnancy

How well did you know this?

Not at all

Perfectly

Presentation of neonatal adaptation syndrome

Jitteriness
Resp depression
Difficulty feeding and sleeping
Irritability

How well did you know this?

Not at all

Perfectly

Best antidepressants in pregnancy

Sertraline is first line
Second line- TCAs
- amitryptylline
- imipramine
- nortriptylline

How well did you know this?

Not at all

Perfectly

What is worst thing can do with antidepressants in pregnancy

Stop abruptly- continuing safely

How well did you know this?

Not at all

Perfectly

Which antipsychotic should be avoided in pregnancy

Risperidone as risk of cardiac malformation and spontaneous abortion

How well did you know this?

Not at all

Perfectly

Bipolar management in pregnancy

If get pregnant switch gradually to an antipsychotic

How well did you know this?

Not at all

Perfectly

If pregnant what is advised for depression in BPAD

Olanzapine and fluoxetine

How well did you know this?

Not at all

Perfectly

What psychological drugs should be avoided in a breastfeeding woman

Clozapine
Carbamezepine
Lithium

How well did you know this?

Not at all

Perfectly

Triad for LBD

Confusion
Visual hallucinations
Parkinsonism signs

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

Neonatal consequences to look out for of maternal SSRI use

PPHN Neonatal withdrawal syndrome Cardiac malformations

Ct change seen in alzheimers

Atrophy of medial temporal lobe (hippocampus)

What neurones are lost in alzheimers

Cholingergic

What are in lewy bodies

Alpha synuclein Ubiquitin

Where are lewy bodies in parkinsons versus LBD

Parkinsons- substantia nigra LBD- cortical areas in particular frontal lobe as well as substantia nigra

MRI of lewy body dementia

Same as dementia- atropy of medial temporal lobe

How to differentiate LBD and alzheimers on imaging

Do a DAT scan which shows presence of dopamine trnasportation It is a lot lower in LBD and parkinsons dementia

Imaging findings of fronto-temporal dementia

CT normal PET or SPECT (single photon emission computerised topography) will show hypometabolism in frontal lobe

What investigations do for initial dementia

Bloods - FBC, glucose, U&Es, Ca, B12, folate, HbA1c, lipids, VDRL and HIV Imaging - normal practise to do a CT/MRI

Management of dementia

Memory clinic- MDT - social workers - OT - psychologist - neurologists who may prescribe medication - enocurage activities to stimulate minds

When do you use memantine

Contraindication/ intolerance to acetylcholinesterase inhibitor in mild/moderate dementia Can add to acetylcholinesterase inhibitor in moderate dementia Severe dementia first line

What is NMDA

Glutamate receptor

In dementia how is driving managed

Need to contact DVLA and insurance Assessed on individual basis Reviewed annually

What is it when have dementia like symptoms but still able to function independantly

Mild cognitive impairment- cognitive effects still not having significant effect on daily life

How are behavioural and psychiatric disorders in dementia screened for

Neuropsychiatry inventory questionnaire (NPI-Q)

What is most common mental illness in the elderly

Depression

How to treat depression in elderly

CBT less effective but is a possibility Treat with antidepressants- sertraline or mirtazapine

First line antidepressants for elderly population

Sertraline or mirtazapine

How use antipressants in elderly

Use higher doses Treat for longer

What is problem of antidepressants in elderly

Increased risk of falls, GI bleeding, hyponatraemia Dont work if cognitively impaired

Do antidepressants work in dementia

No better than placebo and have side effects Placebo effect works however

When use antidepressants in dementia

If severe Needs to be balanced with side effects

What is superior treatment for depression in dementia

ECT

When use ECT for depresssion in dementia

Risk of suicide Other treatments have failed

Problem of ECT in dementia

Risk of GA Memory loss

How is depression with psychosis treated in elderly

Anti-depressant with anti-psychotic ECT if severe

Mania treatment in elderly

Find organic cause Stop antidepressant Normal mania treatment Mood stabiliser for life

How is bipolar depression treated in elderly

Quetiapine or lamotrigine

Management of anxiety in elderly

SSRI/CBT first line Second line- venlafaxine or mirtazapine second line

In elderly what is most common psychotic disorder diagnosis

Delusional disorder

In the elderly population how does psychosis tend to present

Persecutory delusions Mutlimodal hallucinations- visual, tactile, auditory

Problems of anti-psychotics in the elderly

Levels are higher in the blood as longer half-life Increased risk of side effects

How give anti-psychotics in the elderly

Low doses and increase very slowly

Anti-psychotics give in elderly

Amisulpride, olanzapine or risperidone

How do behaviorual and psychological symptoms in dementia present

Agitation Psychosis Mood disorder

What need to rule out first as cause of behavioural and psychological symptoms in dementia

Pain Delirium

Which anti-psychotic used for psychotic symptoms in dementia

Risperidone

What are treatment options for behaviorual and psychological symptoms in dementia

Analgesia Anti-depressants Risperidone Memantine Do according to presentation

If develop mania as elderly person, what is typical preceeding history

Multiple depressive episodes

If elderly person presents with psychosis symptoms for a few months with no history what is diagnosis

Very late onset schizophrenia like psychosis

Occurs in people who live alone and isolated Partition delusions- whereby substances or people can pass through materials

Management of very late onset schizophrenia like psychosis

Anti-psychotics used but not very effective Social activities recommended- befriending etc

Why are higher doses of diazepam needed in the elderly

It is fat soluble and higher amounts of fat tissue in the elderly

Presentation of normal pressure hydrocephalus

Ataxia Incontinent Dementia

Treatment of normal pressure hydrocephalus

Ventriculo-peritoneal shunt

How long does edinburgh postnatal depression questionnaire ask you to account for

7 days

If man presents with vomiting on donepezil what do

Change to memantine

How is LBD diagnosed compared to parkinsons

Cognitive impairment occurs within 1 year of onset of motor symptoms

What is name of hallucination when see little creatures

Lilliputian

What Edinburgh post natal score suggests a depressive illness

Above 13

Aetiology of fronto-temporal dementia

Loss of neurones in frontal and temporal lobes

CT findings in normal pressure hydrocephalus

Enlarged ventricles Absent sulci

What is semantic dementia and how present``

A type of frontotemporal dementia Presents in younger people where struggle to name something you see or hear

First line anti-psychotics in PND

Sertraline and paroxetine

What must be done before starting an anti-cholinesterase

ECG to rule out long QT or bradycardia

Contraindications to anti-cholinesterases

Long QT Bradycardia under 50