Psychiatric Disorders Across the Lifecourse Flashcards
What are the 4Ps?
- predisposing
- precipitating
- perpetuating
- protective factors
Which part of the brain matures faster than the prefrontal cortex?
the cortical areas associated with sensory and motor tasks.
Where the is maximum density of grey matter reached first?
the primary sensorimotor cortex
Where the is maximum density of grey matter reached last?
higher association areas (eg: the dorsolateral prefrontal cortex)
How long does it take for the volume of white matter reach it’s maximum?
increases continually from childhood to early adulthood
(inferior -> superior brain areas)
(posterior -> anterior brain areas)
Describe the maturity of the adolescent brain
a period of neural imbalance caused by early maturation of subcortical brain areas and delayed maturation of prefrontal control areas
How prevalent are mental health disorders?
the proportion of individuals < 18 with onset of any mental health disorders was 48.4%
What is the DSM-5 criteria (used to diagnose ADHD)?
- persistant pattern of inattention and/or hyperactivity-impulsivity
- at least 6 months
- inappropriate for their development level
- interferes with functioning or development
- symptoms present before 12
- symptoms present in 2 or more settings
- not better explained by another mental disorder
How many symptoms of inattention and/or hyperactivity-impulsivity are required to fulfil the criteria?
- 6+ for <16
- 5+ for >17
- at least 6 months
- inappropriate for development level
- disruptive
What are the genetic risk factors for ADHD?
- no single gene, several (polymorphic) may increase vulnerability
- first degree relatives have a 4-5x higher chance of developing ADHD
- boys more vulnerable than girls
- family history of antisocial personality disorder
What are the environmental risk factors for ADHD?
- premature birth
- low birth weight
- prenatal tobacco exposure
What is dementia?
degenerative disease of the brain with:
- cognitive and behavioural impairment
- sufficiently severe to interfere significantly with social and occupational function
- irreversible and progressive changes
What is the most common cause of dementia (70%)?
alzheimers
What are the four different types of dementia?
- Alzheimer’s
- Frontotemporal dementia
- Dementia with lewy bodies
- Vascular dementia
What are the reversible causes of dementia?
- normal pressure hydrocephalus
- intracranial tumours
- subdural haematona
- depression
- B1, B6 and B12 deficiency
- folate deficiency
- hypothyroidism
- neurosyphilis
- delirium
How does dementia caused by normal pressure hydrocephalus present?
Dialted ventricles in brain with Hakim-Adams triad:
- cognitive impairment
- urinary incontinence
- gait disturbance (stuck to floor gait)
What are the symptoms of mild dementia?
- Living independently but with some supervision/support
- Can participate in community activities and can appear unimpaired to those who do not know them
- Judgement and problem solving typically impaired
- Social judgement may be preserved
- Difficulty making complex plans/decisions and handling finances
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What are the symptoms of moderate dementia?
- Require supports to function outside the home
- Only simple household tasks are maintained
- Difficulties with basic activities of daily living (ADL’s)
- Significant memory loss
- Judgment and problem solving are typically significantly impaired, and social judgment is often compromised
- May have difficulty communicating with individuals outside the home without caregiver assistance
- Socializing is increasingly difficult as the individual may behave inappropriately
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What are the clinical features of severe dementia?
- Severe memory impairment
- Often disoriented to time and place
- Often unable to make judgments or solve problems
- May have difficulty understanding what is happening around them (situational awareness)
- Dependent on others for basic personal care )bathing, toileting and feeding)
- Urinary and faecal incontinence may emerge at this stage
What are the psychiatric symptoms seen in dementia?
- delusions, usually paranoid
- auditory/visual hallucinations, may indicate rapid cognitive decline
- depression (20% requiring treatment)
What are some behavioural disturbances seen in dementia?
- aggression
- wandering
- explosive temper
- sexual disinhibition
- incontinence
- excessive eating
- searching behaviour
What are the personality changes are seen in dementia?
exaggeration of premorbid traits with coarsening of affect and egocentricitiy
What are confabulations?
Production of false memories without the intent to deceive
What is a catastrophic reaction?
Excessive reaction to something which may seem inconsequential
What is used to diagnose dementia?
Mini mental state examination (MMSE)
What is the peak age at onset of ADHD?
9.5
What is the peak age at onset of Autism?
5.5
What is the peak age at onset of Eating Disorders?
15.5
What is the prognosis associated with ADHD?
- 70% of children with ADHD, will have it as teenagers
- 40-60% will still have ADHD as adults
How does the risk of Alzheimer’s increase with age?
- 1% at 60yrs, doubles every 5yrs
- 40% of those aged 85 have dementia
What do the scores on the mini mental state examination suggest (MMSE)?
25-30 = normal 21-24 = mild 10-20 = moderate <10 = severe
