Psychiatry Flashcards
Define dementia.
The significant impairment of memory and one or more other domain of cognition (language, visuospatial skills and praxis) in a setting of clear consciousness and interfering with work, social activities or relationships.
Explain the aetiology / risk factors of dementia.
Different diseases associated with an abnormal build-up of different proteins in the brain.
E.g. Alzhiemer’s, Lewy Bodies, Frontotemporal, Vascular
Risk Factors;
- Age
- Genetics
- Family history
- Smoking
- Alcohol use
- Atherosclerosis
- Cholesterol
- Plasma homocysteine
- Diabetes
- Mild cognitive impairment
Summarise the epidemiology of dementia.
Worldwide, around 50 million people have dementia, and there are nearly 10 million new cases every year.
Alzheimer’s disease is the most common form of dementia and may contribute to 60–70% of cases.
Recognise the signs of dementia on physical examination.
- MMSE screening tool (<27 qualifies for dementia)
- Premorbid intellectual function taken into account
- Delayed recall is impaired even without prompting
Identify appropriate investigations for dementia and interpret the results.
- Bloods
- CT/MRI
- Psychometric Testing
- Electroencephalography
- Lumbar Puncture
- Nuclear Imaging
Bloods
- FBC, U&E, LFT, ESR,CRP, TFT - exclude hypothyroidism
- Folate, ANA, ANCA, VitB12, treponemal serology
- HIV serology
CT/MRI
- Cerebral or hippocampal atrophy
- Exclude tumours, infarction, inflammatory causes, subdural haematoma
Psychometric Testing
- Defining domains of impairment
- Helpful for distinguishing depressive pseudo-dementia
Electroencephalography
- Not diagnostic
- Exclude non-convulsive status epilepticus
LP
- Not usually necessary except if the disease is relatively subacute onset or rapid to exclude other causes
- E.g. Encephalitis, prion disease
- Tau and B-42 measured - for Alzheimer’s
Nuclear Imaging
- Primarily research tools
- 11C-PIB PET images amyloid distribution - Alzheimer’s
- 99mTc-HMPAO-SPECT shows regional hypoperfusion of affected cerebral regions - vascular dementia?
Define depressive disorder.
Characterized by persistent low mood, loss of interest and enjoyment, neurovegetative disturbance, reduced energy, causing varying levels of social and occupational dysfunction.
Explain the aetiology / risk factors of depressive disorder.
Risk Factors:
- Age >65 years
- Postnatal status
- Personal or family history of depressive disorder or suicide
- Corticosteroids
- Interferon
- Propranolol
- Oral contraceptives
- Co-existing medical conditions
Summarise the epidemiology of depressive disorder.
5-10% of patients in the primary care setting.
Recognise the presenting symptoms of depressive disorder.
- Depressed mood
- Anhedonia - inability to feel pleasure in normally pleasurable activities
- Weight changes
- Libido changes
- Sleep disturbance
- Psychomotor problems
- Low energy
- Excessive guilt
- Poor concentration
- Suicidal ideation
Recognise the signs of depressive disorder on physical examination.
- Depressed mood
- Anhedonia - Inability to feel pleasure in normally pleasurable activities
- Weight changes
- Libido changes
- Sleep disturbance
- Psychomotor problems
- Low energy
- Excessive guilt
- Poor concentration
- Suicidal ideation
Identify appropriate investigations for depressive disorder and interpret the results.
- Metabolic panel
- FBC
- TFTs
- 24h free cortisol
- Vitamin B12
- Folate
Identify appropriate investigations for depressive disorder and interpret the results.
- Metabolic panel
- FBC
- TFTs
- 24h free cortisol
- Vitamin B12
- Folate
- Patient Health Questionnaire 2& 9
- Edinburgh Postnatal Depression Scale
- Geriatric Depression Scale
- Cornell Scale for Depression in Dementia
Define substance use: cigarette smoking (tobacco).
A tube-shaped tobacco product that is made of finely cut, cured tobacco leaves wrapped in thin paper. It may also have other ingredients, including substances to add different flavors. A cigarette is lit on one end and smoked, and the smoke is usually inhaled into the lungs. Cigarettes contain nicotine and many cancer-causing chemicals that are harmful to both smokers and nonsmokers.
Explain the aetiology / risk factors of substance use: cigarette smoking (tobacco).
Risk Factors:
- Race & ethnicity
- Age
- Education
- Socioeconomic status
Summarise the epidemiology of substance use: cigarette smoking (tobacco).
2015 - 1.1 billion smoked tobacco.
