Psychiatry Flashcards
Learning objectives
Answer
Define dementia
• A chronic and progressive deterioration of cognitive function due to organic brain disease. It is irreversible and consciousness is not impaired.
Explain the aetiology/risk factors of dementia
• TYPES of Dementia:
o Alzheimer’s disease (50%) - degeneration of the cerebral cortex, with cortical atrophy and reduction in acetylcholine production
o Vascular Dementia (25%) - brain damage due to several incidents of cerebrovascular disease (e.g. strokes/TIAs)
o Lewy Body Dementia (15%) - deposition of abnormal proteins (Lewy bodies) within the brain stem and neocortex
o Frontotemporal Dementia - specific degeneration of the frontal and temporal lobes
Summarise the epidemiology of dementia
- Prevalence increases with age
* Prevalence of 20% in patients aged > 80 yrs
Recognise the presenting symptoms and signs of dementia
- Alzheimer’s disease - insidious onset
- Vascular dementia - step-wise decline
- Lewy Body dementia - fluctuating levels of consciousness, hallucinations, falls and Parkinsonian symptoms
- Frontotemporal dementia - behavioural changes and intellectual changes
- All forms of dementia are associated with a progressive loss of memory and cognitive function
Identify appropriate investigations for dementia
- Diagnosis is based on the HISTORY
- Ensure no treatable cause is missed (e.g. hypothyroidism, vitamin B12/folate deficiency, space-occupying lesion, normal pressure hydrocephalus)
Define depressive disorders
• A mood disorder that causes a persistent feeling of sadness and loss of interest.
Explain the aetiology/risk factors of depressive disorders
• NICE recommends the use of DSM-IV classification to diagnose depression
• Major depression requires at least one of the core symptoms:
o Persistent sadness or low mood nearly every day
o Loss of interests or pleasure in most activities
• Along with some of the following symptoms:
o Fatigue or loss of energy
o Worthlessness, excessive or inappropriate guilt
o Suicidal thoughts
o Diminished ability to think or concentrate
o Psychomotor agitation and retardation
o Insomnia
o Changes in appetite and/or weight loss
• Symptoms should have persisted for at least 2 weeks
• Risk Factors
o Being FEMALE
o Past history of depression
o Significant physical illness causing disability or pain
o Other mental health problems (e.g. dementia)
o Being part of a refugee community
Summarise the epidemiology of depressive disorders
- 5% of adults will have a depressive episode every year
* 1/4 women will develop depression severe enough to require treatment at some point in their lives
Recognise the presenting symptoms and signs of depressive disorders
• Somatisation (physical symptoms resulting from psychiatric illness) is a very important signs and must not be missed
• Elderly people may present with depressive pseudodementia (altered memory and behaviour that mimics dementia)
• Assessment Tools
o Patient Health Questionnaire (PHQ-9)
o Hospital Anxiety and Depression (HAD) Scale
o Beck’s Depression Inventory
Identify appropriate investigations for depressive disorders
• Consider organic causes to the depression (e.g. hypothyroidism, hypercalcaemia, Addison's disease, Cushing's disease) • Investigations for other causes: o Blood glucose o U&Es o TFTs o Calcium o FBC o MRI/CT
Define anxiety disorder
• A group of mental disorders characterised by feelings of anxiety or fear.
Explain the aetiology/risk factors of anxiety disorder
• It is a syndrome of ongoing anxiety and worry about many events or thoughts that the patient generally recognises as excessive and inappropriate • Risk Factors o Being aged 35-54 o Being divorced or separated o Living alone or as a single parent
Summarise the epidemiology of anxiety disorder
- Lifetime prevalence of about 5%
* More common in WOMEN
Recognise the presenting symptoms and signs of anxiety disorder
• Diagnostic criteria for anxiety disorder: o Excessive anxiety and worry occurring more days than not for at least 6 months o Patient finds it difficult to control the worry o Anxiety and worry are associated with 3 or more of the following symptoms: • Restlessness • Easily fatigued • Difficulty concentrating • Irritability • Muscle tension • Sleep disturbance • Autonomic arousal symptoms: o Palpitations o Sweating o Trembling o Dry mouth • Chest and abdomen symptoms: o Difficulty breathing o Feeling of choking o Chest pain or discomfort o Nausea/abdominal pain • Symptoms involving mental state: o Dizziness/light-headedness o Feeling of losing control o Fear of dying • General symptoms: o Hot flushes and cold chills o Numbness and tingling sensation o Muscle tensions or aches and pains o Restlessness o Globus