Psychiatric conditions Flashcards
What is dementia?
A chronic and progressive deterioration of cognitive function due to organic brain disease.
It is irreversible and consciousness is not impaired
What are the types of dementia?
Alzheimer’s disease (50%)
Vascular dementia (25%)
Lewy body dementia (15%)
Frontotemporal dementia
What is alzheimer’s disease?
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
How does Alzheimer’s disease cause dementia?
- 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
What is vascular dementia?
Brain damage due to several incidents of cerebrovascular disease (e.g. strokes, TIAs)
- Step wise decline
- Focal, motor and gait signs
What is Lewy body dementia?
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
What is frontotemporal dementia?
Specific degeneration of the frontal and temporal lobes
- Reduced hygeine, personality change, poor planning, aphasia
What are the risk factors for dementia?
Age > 60 Obesity/Lack of exercise Hypertension Smoking/alcohol Family history Hyperlipidaemia Genetics
What are the signs and symptoms of alzheimer’s disease?
Insidious onset of short term memory loss Followed by Reduced motor skills Then reduced language skills Then reduced long term memory Ultimatly causing disorientation
What are the signs and symptoms of Vascular dementia?
Step wise decline with focal motor/gait symptoms
What are the signs and symptoms of Lewy body dementia?
Cognitive impairment with fluctuating consciousness and hallucinations, then parkinsonian symptoms
What are the signs and symptoms of frontotemporal dementia?
Altered hygiene/Behaviour/intellect/personalit
What investigations are done for dementia?
Clinical diagnosis
Ensure no treatable cause missed e.g. hypothyroidism, b12/folate deficiency, SOL, hydrocephalus
What is depressive disorder?
A mood disorder that causes a persistent feeling of sadness and loss of interest
What causes depressive disorder?
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
What are the risk factors for depressive disorder?
Being female Past history Significant physical illness causing disability or pain Other mental health conditions Being part of a refugee community
What are the signs and symptoms of depressive disorder?
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
What are the investigations for depressive disorder?
Consider organic causes to depression (e.g. Hypothyroidism, hypercalcaemia, addison's, cushing's) Other causes: - Blood glucose - U&Es - TFTs - Calcium - FBC - MRI/CT
What is tobacco abuse?
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
What causes tobacco abuse?
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
What are the risk factors for tobacco abuse?
Smoker
Smokeless tobacco user
What are the signs and symptoms of tobacco abuse?
Yellowing of finger nails Hypertensions Polysubstance abuse Cant stop smoking Withdrawal when you stop
What are the investigations for tobacco abuse?
Non
What is the management of tobacco abuse?
Acute
- Advice to stop smoking + counselling w/ nicotine replacement therapy
Ongoing
- Reinforce decision to stop + counselling
Can add: Bupropion or varenicline > clonidine or nortriptuline
What are the complications for tobacco abuse?
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
