Psychiatry

Question 1

What is a depressive disorder?

Answer 1

A mood disorder that causes a persistent feeling of sadness and loss of interest

Question 2

Who more commonly suffers from depression?

Answer 2

Women 2x more than men

Question 3

What are the risk factors of depressive disorders?

Answer 3

Female
>65
Post-natal
Personal/FHx
Drugs: corticosteroids/interferon/propranolol/OCP
Co-existing medical conditions

Question 4

What are the presenting symptoms of a depressive disorder?

Answer 4

Low mood
Loss of interest/pleasure/concentration
Functional impairment
Change in weight, libido, sleep
Low energy
Excessive guilt
Suicidial ideation

Question 5

How is a depressive disorder investigated?

Answer 5

Consider organic causes to depression - eg hypothyroidism, hyperCa, Addison’s disease, Cushing’s disease

Ix for other causes:
FBC - ?anaemia
TFTs - ?hypothyroidism
Ca - ?hyperCa
Metabolic panel - ?
24h free cortisol - ?Cushing's
Vit B12 - ?def

Question 6

How can a depressive disorder be assessed?

Answer 6

Patient Health Questionnaire (PHQ-9)

Hospital Anxiety and Depression (HAD) Scale

Beck’s Depression Inventory

Question 7

What is dementia?

Answer 7

A syndrome characterised by an appreciable deterioration in cognition resulting in behavioural problems and impairments in the activities of daily living

Extensive decline in cognition, often affecting multiple domains of intellectual functioning

Question 8

Summarise the epidemiology of dementia

Answer 8

Annual incidence = 10 million worldwide

Almost half of new cases occur in Asia, then Europe, Americas, Africa

Incidence increases exponentially w increasing age, 2x every 6.3 years

Question 9

What are the reversible causes of dementia?

Answer 9

Hypothyroidism
Vitamin B12 deficiency
Lyme disease
Neurosyphilis

Question 10

What causes 50-70% of dementia cases?

Answer 10

Alzheimer’s disease

Question 11

What typically causes vascular dementia?

Answer 11

Disease or injury affecting the blood supply to the brain

Series of minor strokes

Question 12

What are the early symptoms of dementia?

Answer 12

Memory loss
Difficulty concentrating
Difficulty carrying out familiar daily tasks
Struggling to follow a conversation or find the right word
Being confused about time and place
Mood changes

Question 13

How is dementia investigated?

Answer 13

Cognitive testing:
Mini Mental State Examination
Modified Mini-Mental State Examination
Abbreviated Mental Test Score

Question 14

What are the different types of dementia?

Answer 14

1. Reversible
2. Alzheimer’s - 50-70%
3. Vascular - 20%
4. Dementia with Lewy bodies
5. Frontotemporal
6. Rapidly progressive
7. Immunologically mediated - Behcet’s, MS, sarcoidosis, Sjogren’s, SLE, Coeliac
8. Other conditions - Parkinson’s, supranuclear palsy, corticobasal degeneration

Question 15

What causes rapidly progressive dementia?

Answer 15

Prions (misfolded proteins) in Creutzfeldt-Jakob disease

Question 16

What causes immunologically mediated dementia?

Answer 16

Chronic inflammatory conditions affecting brain and cognition:
Behcet's disease
MS
Sarcoidosis
Sjögren's syndrome
SLE
Coeliac disease
Non-coeliac gluten sensitivity

Question 17

What dementia symptoms are specific to Alzheimer’s disease?

Answer 17

Memory problems - regularly forgetting recent events, names and faces
Asking questions repetitively
Difficulties w organisation and planning
Confusion in unfamiliar environments
Can't find right word
Difficulty w numbers/money
Withdrawn/anxious

Question 18

What dementia symptoms are specific to vascular dementia?

Answer 18

Stroke-like symptoms: muscle weakness, temporary unilateral paralysis
Movement problems - difficult walking
Thinking problems - difficulty w attention, planning and reasoning
Mood changes - depression and tendency to become more emotional