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Perinatal and elderly Flashcards

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1
Q

What suggests depression over dementia in the elderly

A

Short history
Worried about the memory loss
Biological symptoms
Global memory loss as opposed to short term memory loss

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2
Q

How is alzheimers classified

A

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

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3
Q

How is mild/moderate dementia treated

A

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

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4
Q

How is severe dementia treated

A

First line NMDA antagonist- memantine

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5
Q

How would behavioral disturbances be treated in dementia

A

Sedatives- haloperidol, sodium valproate

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6
Q

Signs of childhood neglect in children

A

Disinhibited social engagement disorder- indiscriminate sociability where wander off and approach strangers
Reactive attachment disorder- failure to seek and accept comfort from parents

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7
Q

What is leading cause of death in 1 year after pregnancy

A

Suicide

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8
Q

When do you refer patients postnatally with mental illness

A

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

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9
Q

When does postnatal psychosis present

A

Within first 2 weeks

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10
Q

Risk factor for post partum psychosis

A

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

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11
Q

Presentation of postnatal psychosis

A

Normally anxiety to begin with
Paranoid psychosis
Mania
Rapidly changing mood

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12
Q

Which antipsychotics do women respond better to

A

Typical

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13
Q

Management of postnatal psychosis

A

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

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14
Q

When do baby blues appear

A

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

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15
Q

What is neonatal adaptation syndrome

A

When babies are exposed to SSRI/SNRI during pregnancy

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16
Q

Presentation of neonatal adaptation syndrome

A

Jitteriness
Resp depression
Difficulty feeding and sleeping
Irritability

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17
Q

Best antidepressants in pregnancy

A

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

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18
Q

What is worst thing can do with antidepressants in pregnancy

A

Stop abruptly- continuing safely

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19
Q

Which antipsychotic should be avoided in pregnancy

A

Risperidone as risk of cardiac malformation and spontaneous abortion

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20
Q

Bipolar management in pregnancy

A

If get pregnant switch gradually to an antipsychotic

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21
Q

If pregnant what is advised for depression in BPAD

A

Olanzapine and fluoxetine

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22
Q

What psychological drugs should be avoided in a breastfeeding woman

A

Clozapine
Carbamezepine
Lithium

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23
Q

Triad for LBD

A

Confusion
Visual hallucinations
Parkinsonism signs

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24
Q

How is post natal depression screened for

A

At first post natal meeting ask 2 questions
- low mood
- anhedonia
If one is yes then undertake the edinburgh postnatal depression scale

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25
Q

Inheritance of huntingtons

A

Autosomal dominant
Trinucleotide repeat of HTT gene

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26
Q

How does huntingtons present

A

Choreic moves
Low mood
Memory problems

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27
Q

What happens if give a LBD patinet an anti-psychotic drug

A

Symptoms worsen

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28
Q

Management of LBD pharmacologically

A

Offer donepezil or rivastigmine
If not successful or tolerated use galamantine

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29
Q

Pharmacological management of picks disease

A

None

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30
Q

Poor prognosis factors in alzheimers

A

Young onset
Male
Behavioural issues

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31
Q

Poor prognosis factors in alzheimers

A

Young onset
Male
Behavioural issues

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32
Q

Why cant give parkinsonism drugs in LBD

A

Make hallucinations worse

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33
Q

What is pseudodementia

A

When depression causes you to slow down cognitively meaning you appear to have dementia

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34
Q

Management of post natal depression

A

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

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35
Q

What must do before giving SSRI or TCA in post natal depression

A

Make sure no renal issues with baby or premature if going to breastfeed

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36
Q

Rfx for PND

A

Younger age
Unwanted pregnancy
Social support poor
Unemployed

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37
Q

Best antipsychotics in pregnancy

A

Quetiapine
Olanzapine
Chlorpromazine
Haloperidol

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38
Q

Neonatal consequences to look out for of maternal SSRI use

A

PPHN
Neonatal withdrawal syndrome
Cardiac malformations

39
Q

Ct change seen in alzheimers

A

Atrophy of medial temporal lobe (hippocampus)

40
Q

What neurones are lost in alzheimers

A

Cholingergic

41
Q

What are in lewy bodies

A

Alpha synuclein
Ubiquitin

42
Q

Where are lewy bodies in parkinsons versus LBD

A

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

43
Q

MRI of lewy body dementia

A

Same as dementia- atropy of medial temporal lobe

44
Q

How to differentiate LBD and alzheimers on imaging

A

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

45
Q

Imaging findings of fronto-temporal dementia

A

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

46
Q

What investigations do for initial dementia

A

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

47
Q

Management of dementia

A

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

48
Q

When do you use memantine

A

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

49
Q

What is NMDA

A

Glutamate receptor

50
Q

In dementia how is driving managed

A

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

51
Q

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

A

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

52
Q

How are behavioural and psychiatric disorders in dementia screened for

A

Neuropsychiatry inventory questionnaire (NPI-Q)

53
Q

What is most common mental illness in the elderly

A

Depression

54
Q

How to treat depression in elderly

A

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

55
Q

First line antidepressants for elderly population

A

Sertraline or mirtazapine

56
Q

How use antipressants in elderly

A

Use higher doses
Treat for longer

57
Q

What is problem of antidepressants in elderly

A

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

58
Q

Do antidepressants work in dementia

A

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

59
Q

When use antidepressants in dementia

A

If severe
Needs to be balanced with side effects

60
Q

What is superior treatment for depression in dementia

A

ECT

61
Q

When use ECT for depresssion in dementia

A

Risk of suicide
Other treatments have failed

62
Q

Problem of ECT in dementia

A

Risk of GA
Memory loss

63
Q

How is depression with psychosis treated in elderly

A

Anti-depressant with anti-psychotic
ECT if severe

64
Q

Mania treatment in elderly

A

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

65
Q

How is bipolar depression treated in elderly

A

Quetiapine or lamotrigine

66
Q

Management of anxiety in elderly

A

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

67
Q

In elderly what is most common psychotic disorder diagnosis

A

Delusional disorder

68
Q

In the elderly population how does psychosis tend to present

A

Persecutory delusions
Mutlimodal hallucinations- visual, tactile, auditory

69
Q

Problems of anti-psychotics in the elderly

A

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

70
Q

How give anti-psychotics in the elderly

A

Low doses and increase very slowly

71
Q

Anti-psychotics give in elderly

A

Amisulpride, olanzapine or risperidone

72
Q

How do behaviorual and psychological symptoms in dementia present

A

Agitation
Psychosis
Mood disorder

73
Q

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

A

Pain
Delirium

74
Q

Which anti-psychotic used for psychotic symptoms in dementia

A

Risperidone

75
Q

What are treatment options for behaviorual and psychological symptoms in dementia

A

Analgesia
Anti-depressants
Risperidone
Memantine
Do according to presentation

76
Q

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

A

Multiple depressive episodes

77
Q

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

A

Very late onset schizophrenia like psychosis

78
Q

Very late onset schizophrenia like psychosis

A

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

79
Q

Management of very late onset schizophrenia like psychosis

A

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

80
Q

Why are higher doses of diazepam needed in the elderly

A

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

81
Q

Presentation of normal pressure hydrocephalus

A

Ataxia
Incontinent
Dementia

82
Q

Treatment of normal pressure hydrocephalus

A

Ventriculo-peritoneal shunt

83
Q

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

A

7 days

84
Q

If man presents with vomiting on donepezil what do

A

Change to memantine

85
Q

How is LBD diagnosed compared to parkinsons

A

Cognitive impairment occurs within 1 year of onset of motor symptoms

86
Q

What is name of hallucination when see little creatures

A

Lilliputian

87
Q

What Edinburgh post natal score suggests a depressive illness

A

Above 13

88
Q

Aetiology of fronto-temporal dementia

A

Loss of neurones in frontal and temporal lobes

89
Q

CT findings in normal pressure hydrocephalus

A

Enlarged ventricles
Absent sulci

90
Q

What is semantic dementia and how present``

A

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

91
Q

First line anti-psychotics in PND

A

Sertraline and paroxetine

92
Q

What must be done before starting an anti-cholinesterase

A

ECG to rule out long QT or bradycardia

93
Q

Contraindications to anti-cholinesterases

A

Long QT
Bradycardia under 50

Psych (Owen) (9 decks)

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