Psychiatry Flashcards
What is dementia?
neurodegenerative disorder resulting ina. loss of mental ability severe enough to interfere with normal activities of daily living, lasting more than 6 months, not present since birth and not associated with a loss of alteration of consciousness
What is 60-70% of dementia caused by?
Alzheimer’s disease
What is 20% of dementia caused by?
Vascular dementia - typically a series of minor strokes
What are the reversible causes of dementia?
Hypothyroidism
Vitamin B12 deficiency
Lyme disease
Neurosyphilis
What does lewy-body dementia relate to?
Parkinson’s disease
What type of dementia has a genetic link?
frontotemporal dementia
What are the rarer causes of dementia?
huntington's disease progressive supra nuclear palsy corticobasal degeneration alcohol related dementia AIDS
describe the onset of dementia?
Slow and progressive onset
What are the symptoms of dementia in the early stage?
memory difficulty, apraxia agnosia anomia MMSE = 20-25
What are the symptoms of dementia in the middle stages?
worsening of early symptoms - MMSE 6-19
What are the symptoms of dementia in the late stages?
decreased appetite, inability to recognise hazards, incontinence, insomnia, reduced mobility and increased fragility - MMSE = 0-6
What are the behavioural and psychological symptoms of dementia (BPSD)
Agitation Depression Anxiety Psychosis (including hallucinations and delusions) Physical aggression Apathy Disinhibition and impulsivity abnormal motor behaviour
What is the pathophysiology of AD?
progressive atrophy and deposits of plaques and tangles (plaque burden does not correlate well with cognitive status during life - instead, neurofibrillary tangle distribution is more strongly associated with cognitive status
Describe the pathophysiology of VD?
ischaemia, infarct and arteriosclerosis are thought to cause ischaemia-induced demyelination and/or axonal loss, can result in breakdown of the blood brain barrier and/or breakdown of the blood CSF barrier
Describe the pathophysiology of LBD
Development of abnormal collections of alpha-synuclein protein within the cytoplasm of neurones (Lewy bodies).
loss of dopamine producing neurones in the substantia nigra. Cerebral atrophy occurs as the cortex degenerates
What are the risk factors for dementia?
Age excessive alcohol consumption down's syndrome atherosclerosis family history (particularly for FTD) Diabetes hypertension mental illness smoking
What are the investigations for dementia?
MMSE - to assess level of mental impairment
rule out reversible causes (TFTs and vitamin B12)
routine haematology
biochemistry (electrolytes, calcium, glucose, renal and liver function)
CT/MRI of head
What is the management of dementia?
If cause is reversible, immediately commence appropriate treatment
surgical management for brain tumours, hydrocephalus or severe head trauma
Manage dementia risk factors - hypertension, diabetes, cholesterol, smoking
acetylcholinesterase inhibitors for mild to moderate AD or DLB to slow progression of the disease
antidepressants or antipsychotics if appropriate
psychological treatments:
cognitive stimulation
validation therapy
behavioural therapy
Describe the aetiology of depression and anxiety
Relatives of depressed people childhood experiences Cushing's syndrome hypothyroidism stroke parkinson's disease MS monoamine hypothesis (deficiency in NA, 5-HT, dopamine)
What are the core symptoms of depression?
Low mood loss of interest and anhedonia reduced energy (anenergia)
What are the additional symptoms of depression?
reduced concentration reduced confidence and self-esteem ideas of guilt and unworthiness pessimism about the future ideas/acts of self-harm or suicide disturbed sleep changes in appetite
What are the risk factors for depression?
Family history of mental illness
chronic physical or mental disorders
previous history
major life changes and stress
little or no social support
psychological factors
Low SE status
Female gender
Age
Insomnia and sleep disorders
Medications
What are the diagnostic criteria for depression?
at least 2 of the following:
depressed mood
loss of interest and enjoyment
reduced energy or increased fatiguability
AND at least 2 of:
reduced concentration and attention
reduced self-esteem and self-confidence
ideas of guilt and unworthiness
bleak and pessimistic views of the future
ideas of acts of self-harm or suicide
disturbed sleep
diminished appetite
What are the ddx of depression?
depressive disorders recurrent depressive episode dysthymia BPAD cyclothymia schizoaffective disorder secondary to general medical condition secondary to psychoactive substance use secondary to other psychiatric disorder
psychotic disorders anxiety disorders adjustment disorders eating disorders personality disorders dementia
