Psychiatric disorders across a lifetime

Question 1

pathophysiology of dementia

Answer 1

• amyloid plaques (insoluble protein deposits in the hippocampus, amygdala, cerebral cortex) - HACC PLAQUES
• Neurofibrillary tangles (phosphorylated tau protein - found in cortex, hippocampus, substantia nigra)

Question 2

which chromosome codes for amyloid precursor protein

Answer 2

C21 -> implicated in down syndrome also

Question 3

which chromosome codes for apoliprotein E4

Answer 3

C19 -> increase risk of AD

Question 4

what is the cholinergic hypothesis?

Answer 4

pathological changes lead to degeneration of cholinergic nuclei in the basal forebrain -> reduced cortical ACh

Question 5

medications for issues caused by cholinergic hypothesis

Answer 5

acetylcholinesterase inhib - Donepezil

NMDA (glutamate) receptor antagonist - Memantine

Question 6

BPSD meaning

Answer 6

behavioural and psychological symptoms of dementia

Question 7

memory loss pattern dementia

Answer 7

retain older memories more than new memories

Question 8

important questions to ask for short term memory

Answer 8

hazards

• > paying bills, leaving oven on
• > may indicate she needs a guardian (power of attorney when they still have capacity as hard to do afterwards)
• > are they driving –> can be so dangerous

Question 9

dysphasia

Answer 9

problems with recognising and expressing the right words

Question 10

progressive disease can lead to emergence of what phenomena? (1 + extra info)

Answer 10

• > psychotic

- > also decline in ADLs and social skills

Question 11

catastrophic reaction?

Answer 11

where the patient becomes very frustrated and angry with their inability to understand and lash out

Question 12

features of advanced AD

Answer 12

• monosyllabic speech

- psychotic symptoms

Question 13

at which locations are up to 50% of neurons and synapses lost in the brain in dementia?

Answer 13

the cortex and hippocampus

Question 14

Which chromosome codes for presenilin 1 (implicated in B-amyloid peptide).

Answer 14

C14

Question 15

Which chromosome codes for presenilin 11 (implicated in B-amyloid peptide).

Answer 15

C1

Question 16

early symptoms of dementia (5)

Answer 16

1. Absent-mindedness
2. Difficulty recalling names and words
3. Difficulty learning new information
4. Disorientation in unfamiliar surroundings
5. Reduced social engagement

Question 17

progressive disease features of dementia (6)

Answer 17

1. Marked memory impairment
2. Reduced vocabulary
3. Loss of less complex speech patterns.
4. Mood swings and/or apathy
5. Decline in ADL’s & social skills
6. Emergence of psychotic phenomena.

Question 18

advanced dementia features (5)

Answer 18

1. Monosyllabic speech
2. Psychotic symptoms
3. Behavioural disturbance
4. Loss of bladder and bowel control
5. Reduced mobility

Question 19

psychiatric changes symptoms of dementia (3)

Answer 19

1. Delusions (15%)—usually of a paranoid nature.
2. Auditory and/or visual hallucinations (10–15%)—which may be simple misidentification, and indicate rapid cognitive decline.
3. Depression is common, requiring treatment in up to 20% of patients.

Question 20

behavioural disturbances in dementia (7)

Answer 20

1. aggression,
2. wandering,
3. explosive temper,
4. sexual disinhibition,
5. incontinence,
6. excessive eating,
7. searching behaviour.

Question 21

personality change in dementia features

Answer 21

often reflects an exaggeration of premorbid traits with coarsening of affect and egocentricity.

Question 22

what type of diagnosis is given for AD?

Answer 22

probable diagnosis
“probable AD”
-> based off of deterioration from baseline, and reviews other potential causes e.g. other causes of dementia

Question 23

what tool is used to assess a patient for AD?

Answer 23

MMSE

Question 24

onset of delirium vs dementia vs depression

Answer 24

delirium -> acute
dementia -> insidious
depression -> acute or insidious

Question 25

course of delirium vs dementia vs depression

Answer 25

delirium -> fluctuating
dementia -> progressive
depresion -> chronic

Question 26

duration of delirium vs dementia vs depression

Answer 26

delirium -> hours/weeks
dementia -> months/years
depression -> motnhs/years

Question 27

consciousness of delirium vs dementia vs depression

Answer 27

delirium -> altered
dementia -> usually clear
depression -> clear

Question 28

attention of delirium vs dementia vs depression

Answer 28

delirium -> impaired
dementia -> normal except in severe dementia
depression -> may be decreased

Question 29

psychomotor changes of delirium vs dementia vs depression

Answer 29

delirium -> inc/dec
dementia -> often normal
depression -> slowed in severe cases

Question 30

reversibility of delirium vs dementia vs depression

Answer 30

delirium -> usually
dementia -> irreversible
depression -> usually

Question 31

routine dementia investigations primary purpose

Answer 31

to exclude reversible causes of cognitive deterioration

Question 32

routine dementia investigations bloods examples (7)

Answer 32

1. FBC, ESR, CRP - anaemia, vasculitis
2. T4 and TSH - hypothyroidism
3. biochemical screen - hypercalcaemia or hypocalcaemia
4. urea and creatinine - renal failure, dialysis dementia
5. glucose
6. B12 and folate - vitamin deficiency dementia
7. clotting and albumin - liver function
   - > midstream urine if delirium is a possibility

Question 33

routine dementia imaging

Answer 33

• MRI to assist with early diagnosis and detect subcortical vasc changes
• > CT scanning could also be used

Question 34

imaging dementia purpose

Answer 34

imaging may help to identify treatable causes such as subdural haematoma, normal pressure hydrocephalus, cerebral tumours
-> also help establish subtype of dementia