Psychiatry through the Lifecourse Flashcards

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1
Q

What is Dementia?

A

Degenerative disease of the brain with:
cognitive and behavioural impairment
sufficiently severe to interfere significantly with social and occupational function

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2
Q

Describe the pathophysiology of Alzheimers?

A
Amyloid plaques
Neurofibrillary tangles (NFTs)

Up to 50% loss of neurons and synapses in the cortex and hippocampus

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3
Q

What are amyloid plaques?

A

insoluble β-amyloid peptide deposits as senile plaques or β-pleated sheets in the hippocampus, amygdala, and cerebral cortex. Increased density with advanced disease

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4
Q

What are Neurofibrillary tangles?

A

consist of phosphorylated tau protein and are found in the cortex, hippocampus, and substantia nigra.

(NFTs also found in normal ageing

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5
Q

What are the genetics involved in dementia?

A

Chromosome 21,19,14 and 1

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6
Q

What is chromosome 21 responsible for?

A

the gene for amyloid precursor protein (APP) is found on the long arm. Also implicated in Down’s syndrome.

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7
Q

What is chromosome 19 responsible for?

A

codes for apolipoprotein E4. Presence of E4 alleles increases risk of AD; some 15% of Europeans carry the allele.

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8
Q

What is chromosome 14 responsible for?

A

codes for presenilin 1 (implicated in B-amyloid peptide).

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9
Q

What is chromosome 1 responsible for?

A

codes for presenilin 11 (implicated in B-amyloid peptide).

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10
Q

What is the cholinergic hypothesis?

A

the pathological changes lead to degeneration of cholinergic nuclei in the basal forebrain (nucleus basalis of Meynert). This results in reduced cortical acetylcholine (ACh).

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11
Q

Give an example of an acetylcholinesterase inhibitor

A

Donepezil

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12
Q

Give an example of a NMDA receptor antagonist

A

Memantine

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13
Q

What are the early symptoms of Alzheimers?

A
Absent-mindedness
Difficulty recalling names and words 
Difficulty learning new information 
Disorientation in unfamiliar surroundings 
Reduced social engagement
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14
Q

What are the features of progressive disease?

A
Marked memory impairment 
Reduced vocabulary 
Loss of less complex speech patterns. 
Mood swings and/or apathy 
Decline in ADL’s & social skills
Emergence of psychotic phenomena.
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15
Q

What is seen in advances Alzheimers Disease?

A
Monosyllabic speech 
Psychotic symptoms 
Behavioural disturbance
Loss of bladder and bowel control
Reduced mobility
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16
Q

What are the psychiatric symptoms of Alzheimers?

A

Delusions (15%)—usually of a paranoid nature.
Auditory and/or visual hallucinations (10–15%)—which may be simple misidentification, and indicate rapid cognitive decline.
Depression is common, requiring treatment in up to 20% of patients

17
Q

What are the behavioural disturbances with Alzheimers?

A

aggression, wandering, explosive temper, sexual disinhibition, incontinence, excessive eating, and searching behaviour.

18
Q

What are the features of personality change in Alzheimers?

A

often reflects an exaggeration of premorbid traits with coarsening of affect and egocentricity.

19
Q

What are routine test conducted in Alzheimers?

A

FBC, ESR, CRP - anaemia, vasculitis
T4 and TSH - hypothyroidism
biochemical screen - hypercalcaemia or hypocalcaemia
urea and creatinine - renal failure, dialysis dementia
glucose
B12 and folate - vitamin deficiency dementia
clotting and albumin - liver function

20
Q

What imaging is used in Alzheimers?

A

Use structural imaging to exclude other cerebral pathologies and help establish the subtype of dementia:
imaging may help to identify treatable causes such as subdural haematoma, normal pressure hydrocephalus, cerebral tumours
prefer MRI to assist with early diagnosis and detect subcortical vascular changes. However, CT scanning could be used