Psychiatry Through The Oifecourse

Question 1

4 ps formulation

Answer 1

Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors

Question 2

Prevalence of mental health in children

Answer 2

16% of global burden
Half start by the age of 14 but most cases are undetected and untreated

Question 3

Eriksons stages of development

Answer 3

Approx age-psychosocial-virtue developed

Infant/18m-trust vs mistrust-hope
18m-3yrs-autonomy vs shame/doubt-will
3-5yrs-initiative vs guilt-purpose
5-13yrs-industry vs inferiority-purpose
13-21 yrs-identity vs confusion-fidelity
21-39 yrs-intimacy vs isolation-love
40-65-generativity vs stagnation-care
65+-integrity vs despair-wisdom

Question 4

Adolescent brain

Answer 4

Prefrontal cortex matures later than other cortical areas
Period of neural imbalance caused by early maturation of subcortical brain areas and delayed maturation of prefrontal areas

Question 5

Peak ages for ASD ADHD ED

Answer 5

ASD is 9 yrs
ADHD is 12 yrs
Eating disorders is 17yrs

Question 6

ADHD diagnosis

Answer 6

Persistent inattention or hyperactivity-impulsivity
Present for at least 6 months
Inappropriate for developmental level
Interferes with function or development
Symptoms shown before age of 12
Present in two or more settings
Symtpotms not better explained by another mental disorder

Question 7

Innattention/hyperactivity and impulsivity

Answer 7

Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level

Question 8

ADHD risk factors

Answer 8

Genetic-multiple genes,twin studies show high heritability,first degree relatives of children with adhd have a 4-5x higher probability of having than general population
Boys more vulnerable than girls

Environmental-premature birth,low birth weight,prenatal smoking exposure

Question 9

Subtypes of adhd

Answer 9

Inattentive
Hyoeractive
Combined

Question 10

ADHD risk factor prognosis

Answer 10

70% of children have it as teenagers and then 40-60% will still have as adults

Question 11

Dementia

Answer 11

Chronic brain failure
Irreversible and progressive changes
Global cognitive and behavioral impairment
Interferes with social and occupational function

Question 12

Causes of dementia

Answer 12

Alzheimer’s disease
Vascular dementia
Mixed
Dementia with Lewy body
Parkinsons dementia
Frontotemporal dementia

Question 13

Reversible causes of dementia

Answer 13

Normal pressure with hydrocephalus
Intracranial tumours
Subdural haematoma
Depression
B1,B6,B12 deficiency
Folate deficiency
Hypothyroidism
Neurosyphilis
Delirium

Always exclude surgical metabolic infective and psychiatric reasons

Question 14

Hakim Adam’s triad

Answer 14

Cognitive impairment
Unrunary frequency/incontinence
Gait disturbance

Question 15

What’s the most common cause of dementia

Answer 15

Alzheimer’s disease
Increasing risk with age ,risk doubles every 5 yrs after turning 60

Question 16

Mild dementia

Answer 16

Mild Dementia

Living independently but some supervision/support often needed
Can participate in community activities and can appear unimpaired to those who do not know them
Judgement and problem solving typically impaired
Social judgement may be preserved
Difficulty making complex plans/decisions and handling finances

Question 17

Moderate dementia

Answer 17

Moderate Dementia

Require supports to function outside the home and only simple household tasks are maintained
Difficulties with basic activities of daily living (ADL’s), such as dressing and personal hygiene
Significant memory loss
Judgment and problem solving are typically significantly impaired, and social judgment is often compromised

Question 18

Severe dementia

Answer 18

Severe Dementia

Severe memory impairment
Often disoriented to time and place
Often unable to make judgments or solve problems
May have difficulty understanding what is happening around them (situational awareness)
Dependent on others for basic personal care )bathing, toileting and feeding)
Urinary and faecal incontinence may emerge at this stage

Question 19

BPSD

Answer 19

Behavioural and Psychological Symptoms in Dementia (BPSD)

Common in late stage Dementia
Includes apathy, mood disturbances, hallucinations, delusions, irritability, agitation, aggression and sleep changes
Are often the precipitating symptoms which lead to people with dementia being detained under The Mental Health Act (1983)