Psychiatric conditions

Question 1

What is dementia?

Answer 1

A chronic and progressive deterioration of cognitive function due to organic brain disease.
It is irreversible and consciousness is not impaired

Question 2

What are the types of dementia?

Answer 2

Alzheimer’s disease (50%)
Vascular dementia (25%)
Lewy body dementia (15%)
Frontotemporal dementia

Question 3

What is alzheimer’s disease?

Answer 3

Degeneration of the cerebral cortex, with cortical atrophy and reduction in acetylcholine production
Two types: Familial and sporadic
Insidious onset, episodic memory loss, language involvemetn

Question 4

How does Alzheimer’s disease cause dementia?

Answer 4

• Neuron degeneration in the cortex
• Associated with Beta amyloid plaques (outside cells) and Tau tangles (inside cells)
• Over time causes brain atrophy - gyri narrow and sulci get wider

Question 5

What is vascular dementia?

Answer 5

Brain damage due to several incidents of cerebrovascular disease (e.g. strokes, TIAs)

• Step wise decline
• Focal, motor and gait signs

Question 6

What is Lewy body dementia?

Answer 6

Deposition of abnormal proteins (lewy bodies) within the brain stem and neocortex

• Onset of cognitive impairment due to parkinsonia nsymptoms
• Visual hallucinations and fluctuating cognition

Question 7

What is frontotemporal dementia?

Answer 7

Specific degeneration of the frontal and temporal lobes

- Reduced hygeine, personality change, poor planning, aphasia

Question 8

What are the risk factors for dementia?

Answer 8

Age > 60
Obesity/Lack of exercise
Hypertension
Smoking/alcohol
Family history
Hyperlipidaemia
Genetics

Question 9

What are the signs and symptoms of alzheimer’s disease?

Answer 9

Insidious onset of short term memory loss
Followed by Reduced motor skills
Then reduced language skills
Then reduced long term memory
Ultimatly causing disorientation

Question 10

What are the signs and symptoms of Vascular dementia?

Answer 10

Step wise decline with focal motor/gait symptoms

Question 11

What are the signs and symptoms of Lewy body dementia?

Answer 11

Cognitive impairment with fluctuating consciousness and hallucinations, then parkinsonian symptoms

Question 12

What are the signs and symptoms of frontotemporal dementia?

Answer 12

Altered hygiene/Behaviour/intellect/personalit

Question 13

What investigations are done for dementia?

Answer 13

Clinical diagnosis

Ensure no treatable cause missed e.g. hypothyroidism, b12/folate deficiency, SOL, hydrocephalus

Question 14

What is depressive disorder?

Answer 14

A mood disorder that causes a persistent feeling of sadness and loss of interest

Question 15

What causes depressive disorder?

Answer 15

1 core symptoms:

• Persistent sadness or low mood nearly every day
• Loss of interests or pleasure in most activities

Along with some of of the following:

• Fatigue/loss of energy
• Worthlessness
• Suicidal thoughts
• Diminished ability to think or concentrate
• Psychomotor agitation and retardation
• Insomnia
• Changes in appetite and/or weight loss

Should have persisted for atleast 2 weeks

Question 16

What are the risk factors for depressive disorder?

Answer 16

Being female
Past history
Significant physical illness causing disability or pain
Other mental health conditions 
Being part of a refugee community

Question 17

What are the signs and symptoms of depressive disorder?

Answer 17

Somatisation (physical symptoms resulting from psychiatric illness)
Elderly people may present with depressive pseudodementia
Assessment tools
- Patient health questionnaire (PHQ-9)
- Hospital anxiety and depressio (HAD) scale
- Beck’s depression inventory

Question 18

What are the investigations for depressive disorder?

Answer 18

Consider organic causes to depression (e.g. Hypothyroidism, hypercalcaemia, addison's, cushing's)
Other causes:
- Blood glucose
- U&Es
- TFTs
- Calcium
- FBC
- MRI/CT

Question 19

What is tobacco abuse?

Answer 19

Most common cause of preventable death and disease.
Phsyicians and other healthcare professionals should play a central role in motivating and assisting patients who smoke to stop smoking

Question 20

What causes tobacco abuse?

Answer 20

Behaviour influenced by biological, genetic, behavioural, social and environmental factors
Smoking initiation more likely in households with current smokers with cigarettes available
Low socio-economic status associated with smoking rates
Smoking high in those with mental health illness
HIV/AIDS

Question 21

What are the risk factors for tobacco abuse?

Answer 21

Smoker

Smokeless tobacco user

Question 22

What are the signs and symptoms of tobacco abuse?

Answer 22

Yellowing of finger nails
Hypertensions
Polysubstance abuse
Cant stop smoking
Withdrawal when you stop

Question 23

What are the investigations for tobacco abuse?

Answer 23

Non

Question 24

What is the management of tobacco abuse?

Answer 24

Acute
- Advice to stop smoking + counselling w/ nicotine replacement therapy

Ongoing
- Reinforce decision to stop + counselling
Can add: Bupropion or varenicline > clonidine or nortriptuline

Question 25

What are the complications for tobacco abuse?

Answer 25

Nicotine withdrawal symptoms
Changes in glycaemic control in diabetes
Increased blood levels of theophylline and some psychiatric medicines
Alteration sin heart rate and BP
Alcoholism relapse
Major depressive disorder
Weight gain