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A3 ME3034 SPECIALTIES > W02 - PSYCH: Learning Disability; Old Age Psychiatry; Controversies > Flashcards

W02 - PSYCH: Learning Disability; Old Age Psychiatry; Controversies Flashcards

1
Q

To be able to discuss the aetiology of learning disabilities.

A
  • single gene: fragileX,PKU, Retts Syndrome

*microdeletion/duplicaation: digeorge, praader-willi, angelman syndrome

  • chromosomal abn: downs, sex chromosome abn.

Acquired:
- infective: rubella, zika
- traumatic
- toxic: foetal alcohol syndrome

Idiopathic, but associated with:
- cerebral palsy
- ASD
- epilepsy

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2
Q

Be familiar with the relationship between learning disability and other forms of mental disorder

A
  • higher incidence of psychiatric disorders in those with LD
  • more severe
  • different presentation in moderate-profound LD
  • difficulties in communicating “internal world”
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3
Q

Consider the health inequalities of those with a learning disability.

A

6 out of 10 lower life expectancy
- respiraatory disease
- cardio disease
- cancers

at risk: deprivation, accessibility, discrimination, minimal evidence

  • social exclusion associated with poorer health outcomes, unable to engage socially or be independent
  • reaching out to GP etc
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4
Q

Outline the importance of communication skills and aids to enable assessment and management

A
  • non-verbal cues
  • alternative communication: symbols, sign, cards
  • jargon-free
  • require to build up rapport and trust
  • Makaton
    Makaton is a language programme that uses signs, symbols and speech; giving a person different options when communicating
  • PECS (Picture Exchange communication system)
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5
Q

Implications for Physical Health in Learning Disabilities

A
  • epilepsy
  • sensory impairments
  • obesity: predisposes
  • GI
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6
Q

Implications for Mental Health in Learning Disabilities

A
  • psychosis, mood disorders, anxiety disorders, dementia, ADHD
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7
Q

Learning disability criteria

A

intellectual impairment = IQ <70

social dysfunction: impairments in 2+ adaptive skills

onset in developmental period: before age 18

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8
Q

Wolfram Syndrome

A

DIABETES2 = insipidus, and mellitus

OPTIC N. ATROPHY

BIPOLAR AFFECTIVE DISORDER

DEAFNESS

  • present prior to 15yo

> tx for DM and DI
anticonvulsants for muscle twitching

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9
Q

Mild Learning Disability

A

IQ: 50-69, cognitive age: 9 to under 12yrs

*complex tasks are more difficult: forward planning, problem solving, memorising

*more time to think
* concrete information
* repetition to learn

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10
Q

Moderate learning disability

A

IQ: 35-49, cognitive age: 6 to under 9yrs

*pronounced executive dysfunction
* language, speech, written comms struggle
* struggle with generalising skills and rules

*require routine and structure

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11
Q

Severe Learning Disability

A

IQ: 20-34, cognitive age: 3 to under 6yrs

  • basic language only, simple repetitive tasks only
  • will require support, and using environment to try understand situations
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12
Q

Profound Learning Disability

A

IQ: <20, cognitive age: below 3yrs

  • complex care needs, additional health needs, other disabilities
  • unlikely to understand language, communicate through noises and facial. expression
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13
Q

Outline demographic changes in the UK

A
  • getting older

*

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14
Q

Cite the basic epidemiology of psychiatric disorders in old age
- In the community
- In the general hospita

A
  • within the hospital, often 2/3 of admitted elderyl will have a mental disorder:
  • depression
  • dementia
  • delirium
  • dementia and delirium = have poorest outcomes and prognosis
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15
Q

Characterise some of the attitudes to ageing

A

a

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16
Q

Define a dementia syndrome

A

A for Activities of Daily Living (ADLs)

B for Behavioural and Psychiatric Symptoms of

Dementia (BPSD)

C for Cognitive Impairment

D for Decline

*6 months duration, usually progressive
*PMH clues: Anti-cholnergics,

  • Tests: neuropsychology, brain image (CT, MRI), examination

To Dx:
- DYSMNESIA
+ dysphasia (comms)
+ dyspraxia
+ dysgnosia
+ dysexecutive functioning (initiation, inhibition, set-shifting, abstraction)

  • functional impacts
17
Q

Know the commonest types of dementia

A

Alzheimer’s dementia – 62%
* Early impairment of memory and executive function
Amyloid plaques & tau tangles
Atrophy following neuron death
Reduction in Acetylcholine

Vascular dementia – 17%
* stepwise
* focal impairments

Mixed Dementia – 10%

Lewy body dementia – 4%

18
Q

Be able to perform a basic cognitive test

A

a

19
Q

Know the common cognitive proformas

A
  1. MMSE correlates w/ ability to perform daily activities
  2. MOCA
  3. DIAMOND: Lewy Body Dementia

4.

20
Q

Interpret cognitive testing in the context of the history and collateral history

A

a

21
Q

Be able to undertake a basic capacity test

A

1) Does the patient UNDERSTAND the information?

2) Does the patient RETAIN the information long enough to make a decision?

3) Can the patient COMMUNICATE the decision?

4) Can the patient WEIGH UP the information in order to make a decision?

5) Does the patient BELIEVE the information they are given?

  • pt deemed to have capacity unless proven otherwise
  • pt should be supported, and is not incapable if decision is eccentric or unwise
  • anything done must be in best interest
  • pt assessed at their peak time

Capacity
Consent
Compliance
Coercion
Certification
Common sense

22
Q

Define the common psychiatric disorders in old age

A

alongside dementia

*depression = suicide risk in elderly: loss, few seeking support and psychiatrist

  • anxiety disorders
  • mania
  • late onset schizophrenia
  • alcohol problems
  • delirium
23
Q

Outline the basic management of psychiatric disorders in old age

A

> AChI = mild/mod AD
donepezil
* delays institutionalisation, improves cog funct.
* GI sfx, muscle sfx, syncope, breathing
Memantine = severe AD (glutamate antagonist)

> Lecanemab, Aducanumab = anti-amyloid Ab
* 1st line for reverse physical changes and slow decline in memory and thinking

> Antipsychotics
risperidone, quetiapine
* only with extreme risk
* spontaneous recovery high rate
* lowest dose for longest duration

> Antideppr.
mirtazapine, sertaline

> Anxiolytics
lorazepam

> Hypnotics
zolpidem, zopiclone

> anticonvulsants
valporate, carbamezapine

24
Q

Understand the organisation of old age psychiatry services

A
  • third of people with dementia live in care homes

*

25
Q

Fitness to Drive & Dementia

A

Dementia or Organic Brain Syndrome:
notify DVLA at diagnosis
if early dementia license may be yearly
“those with poor short term memory, disorientation or lack of insight should almost certainly not drive”

26
Q

Reversible Aetiologies & Dementia

A

Consider reversible

Delirium
Normal pressure hydrocephalus
Subdural haemorrhage
Tumours
Vitamin B12 deficiency
Hypothyroidism
Hypercalcaemia
Alcohol misuse
Neurosyphilis
Drugs
Anticholinergics

27
Q

Diagnostic Overshadowing

A

Attribute change in behaviour to LD rather than underlying disease

28
Q

Different between PoAttorney Vs Guaardianship

A

With a power of attorney, you choose who you want to act for you. In a guardianship proceeding, the court chooses who will act as guardian.

*Guardianship requires two medical certificates

29
Q

Define stigma

A

“is a social construction that devalues people due to a distinguishing characteristic or mark”

*leads to discriminatory practice, originate from exposed ideas and developed in childhood.
* tolerance depends on closeness of interaction

30
Q

Define methods of reducing stigma

A
  • good medication management
  • CBT approach to experienced stigma
  • considering own attitudes and awareness
31
Q

Applying critical thinking to issues considered by popular press

A
  • MH
  • depression: placebo and antidepressant overprescription
  • ECT

A3 ME3034 SPECIALTIES (27 decks)

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