Psychiatric Disorders Across the Lifecourse

Question 1

What are the 4Ps?

Answer 1

• predisposing
• precipitating
• perpetuating
• protective factors

Question 2

Which part of the brain matures faster than the prefrontal cortex?

Answer 2

the cortical areas associated with sensory and motor tasks.

Question 3

Where the is maximum density of grey matter reached first?

Answer 3

the primary sensorimotor cortex

Question 4

Where the is maximum density of grey matter reached last?

Answer 4

higher association areas (eg: the dorsolateral prefrontal cortex)

Question 5

How long does it take for the volume of white matter reach it’s maximum?

Answer 5

increases continually from childhood to early adulthood
(inferior -> superior brain areas)
(posterior -> anterior brain areas)

Question 6

Describe the maturity of the adolescent brain

Answer 6

a period of neural imbalance caused by early maturation of subcortical brain areas and delayed maturation of prefrontal control areas

Question 7

How prevalent are mental health disorders?

Answer 7

the proportion of individuals < 18 with onset of any mental health disorders was 48.4%

Question 8

What is the DSM-5 criteria (used to diagnose ADHD)?

Answer 8

• 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

Question 9

How many symptoms of inattention and/or hyperactivity-impulsivity are required to fulfil the criteria?

Answer 9

• 6+ for <16
• 5+ for >17
• at least 6 months
• inappropriate for development level
• disruptive

Question 10

What are the genetic risk factors for ADHD?

Answer 10

• 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

Question 11

What are the environmental risk factors for ADHD?

Answer 11

• premature birth
• low birth weight
• prenatal tobacco exposure

Question 12

What is dementia?

Answer 12

degenerative disease of the brain with:

• cognitive and behavioural impairment
• sufficiently severe to interfere significantly with social and occupational function
• irreversible and progressive changes

Question 13

What is the most common cause of dementia (70%)?

Answer 13

alzheimers

Question 14

What are the four different types of dementia?

Answer 14

• Alzheimer’s
• Frontotemporal dementia
• Dementia with lewy bodies
• Vascular dementia

Question 15

What are the reversible causes of dementia?

Answer 15

• normal pressure hydrocephalus
• intracranial tumours
• subdural haematona
• depression
• B1, B6 and B12 deficiency
• folate deficiency
• hypothyroidism
• neurosyphilis
• delirium

Question 16

How does dementia caused by normal pressure hydrocephalus present?

Answer 16

Dialted ventricles in brain with Hakim-Adams triad:
- cognitive impairment
- urinary incontinence
- gait disturbance (stuck to floor gait)

Question 17

What are the symptoms of mild dementia?

Answer 17

• 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
  *

Question 18

What are the symptoms of moderate dementia?

Answer 18

• 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
  *

Question 19

What are the clinical features of severe dementia?

Answer 19

• 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

Question 20

What are the psychiatric symptoms seen in dementia?

Answer 20

• delusions, usually paranoid
• auditory/visual hallucinations, may indicate rapid cognitive decline
• depression (20% requiring treatment)

Question 21

What are some behavioural disturbances seen in dementia?

Answer 21

• aggression
• wandering
• explosive temper
• sexual disinhibition
• incontinence
• excessive eating
• searching behaviour

Question 22

What are the personality changes are seen in dementia?

Answer 22

exaggeration of premorbid traits with coarsening of affect and egocentricitiy

Question 23

What are confabulations?

Answer 23

Production of false memories without the intent to deceive

Question 24

What is a catastrophic reaction?

Answer 24

Excessive reaction to something which may seem inconsequential

Question 25

What is used to diagnose dementia?

Answer 25

Mini mental state examination (MMSE)

Question 26

What is the peak age at onset of ADHD?

Answer 26

9.5

Question 27

What is the peak age at onset of Autism?

Answer 27

5.5

Question 28

What is the peak age at onset of Eating Disorders?

Answer 28

15.5

Question 29

What is the prognosis associated with ADHD?

Answer 29

• 70% of children with ADHD, will have it as teenagers
• 40-60% will still have ADHD as adults

Question 30

How does the risk of Alzheimer’s increase with age?

Answer 30

• 1% at 60yrs, doubles every 5yrs
• 40% of those aged 85 have dementia

Question 31

What do the scores on the mini mental state examination suggest (MMSE)?

Answer 31

25-30 = normal
21-24 = mild
10-20 = moderate
<10 = severe