Psychiatry Flashcards
What is Dementia?
A syndrome characterised by an appreciable deterioration in cognition resulting in behavioural problems and impairment in the activities of daily living. Decline in cognition is extensive, often affecting multiple domains of intellectual functioning
What is the aetiology of Dementia?
The majority of cases of dementia have degenerative and vascular causes:
Degenerative: Alzheimer’s disease (60%), Lewy body disease, Parkinson’s disease
Vascular (5% to 20%): multi-infarcts
Other causes: psychiatric, neoplastic, traumatic (subdural haematoma, traumatic brain injury), infectious, inflammatory, toxins
What are some of the infectious causes of Dementia?
Lyme disease (spread by ticks)
Neurosyphilis
Tuberculosis meningitis
Creutzfeldt-Jakob disease
What are some of the inflammatory causes of Dementia?
Demyelinating diseases
Lupus erythematosus
Sarcoidosis
Sjogren’s syndrome (autoimmune condition which mainly affects areas that produce fluids - tears or saliva)
What are the presenting symptoms of degenerative dementia?
Memory decline with loss of recent memory first
Disorientation to time and place (subtle at first)
Nominal dysphasia- difficulties naming objects/people
Apathy: may not want to perform usual activities/ want to sleep more often
Decline in activities of daily living
Personality/ mood changes
What are the signs of dementia on physical examination?
Early stages: unremarkable
-Mini mental state examination: nominal dysphasia, constructional dyspraxia (e.g. clock drawing test)
Advanced disease: patients tend to appear sloppily dressed, confused, apathetic, and disorientated with a slow, shuffling gait and stooped posture.
Terminal disease: rigidity and inability to walk or speak
What is the main difference in presentation between vascular and degenerative dementia?
In vascular dementia executive functions of the brain such as planning are more prominently affected than memory e.g difficulty solving problems and slowed processing of information
What are the appropriate investigations for Dementia?
Bedside cognitive testing
Bloods: rule out anaemia
-Thyroid function: to rule out other causes of cognitive decline such as hypothyroidism
-Renal and LFTs: to rule out other causes of cognitive decline such as liver or renal failure
-ESR: to rule out other causes of cognitive decline such as an inflammatory condition or vasculitis
-Serum B12: rule out vitamin B12 deficiency-induced dementia
CT and MRI
What would be seen in Bedside cognitive testing for a patient with Dementia?
Impaired recall Nominal dysphasia Disorientation (to time, place, and eventually person) Constructional dyspraxia Impaired executive functioning
Why should a CT or MRI scan be requested to distinguish between vascular and degenerative dementia?
Vascular: identify cerebrovascular lesions
Degenerative: generalised atrophy with medial temporal lobe and later parietal predominance
What is the management for Vascular Dementia?
Main goal of treatment is to prevent further cerebrovascular disease by optimal control of major risk factors in people with a history of stroke or TIA e.g. regular physical activity
What is the management for Degenerative Dementia?
Treatment and care should be individualised based on symptoms and social situation Pharmacological treatment (include cholinesterase inhibitors or NDMA receptor antagonists) try to slow symptoms of disease progression by preserving memory and functional abilities and reduce behavioural disturbance Regular monitoring (4-6 months)
What are the complications of Dementia?
Depression (loss of independence/ isolation/ care home setting)
Agitation
Falls
Pneumonia: dysphagia of liquids and solids may increase the risk of aspiration pneumonia
Urinary incontinence- increase risk of UTIs
What is the prognosis of Dementia?
Life expectancy is significantly shortened, generally a progressive disease.
Mortality with vascular dementia is similar or worse than that of Alzheimer’s disease
What is major depressive disorder?
Also known as clinical depression
A mental state characterised by:
Persistent low mood
Loss of interest and enjoyment in everyday activities
Neurovegetative disturbance
Reduced energy
It can cause varying levels of social and occupational dysfunction
What is the aetiology/ risk factors of depressive disorder?
Aetiology is still unknown- possible genetic component
Risk factors include stressful life events, personal or family history, co-existing medical conditions e.g. Alzheimer’s disease.
Also side effects to medication e.g. oral contraceptive pill, corticosteroids, propranolol
What is the epidemiology of depressive disorder?
- Depressive disorders are very common and are among the leading causes of disability worldwide.
- In people aged 18-44 years, depression is the leading cause of disability and premature death
- Women are affected twice as often as men
- First onset occurs most commonly in patients aged 12-24 years or older than 65 years
What are the presenting symptoms of depressive disorder?
Depressed mood Anhedonia- diminished interest or pleasure in all or almost all activities Weight change Libido change Sleep disturbance Low energy Poor concentration Suicide ideation
What classification system is used to diagnose depressive disorder?
DSM- diagnostic and statistical manual, latest edition DSM-5
What are the signs of depressive disorder on physical examination?
Weight change
Libido change
Low energy
Poor concentration
What are the appropriate investigations for depressive disorder?
Clinical diagnosis- DSM-5 diagnostic criteria
Normal blood test results e.g. TFTs for hypothyroidism
Screening tools:
-Patient Health Questionnaire
-Edinburgh Postnatal Depression Scale
-Geriatric Depression Scale
What is the management for depressive disorder?
Antidepressants (SSRIs- citalopram, sertraline)
Psychotherapies e.g. Cognitive Behavioural Therapy
What are complications of depressive disorder?
Risk of self-injurious behaviour
Risk of suicide
Side effects of anti-depressants (agitation)
What is the prognosis of depressive disorder?
Therapy goals: complete remission of symptoms and return to normal functioning- this may take up to months
Depression recurs in about one third of patients within 1 year of discontinuing treatment and in more than 50% of patients during their lifetime
