Psychiatry

Question 1

Learning objectives

Answer 1

Answer

Question 2

Define dementia

Answer 2

• A chronic and progressive deterioration of cognitive function due to organic brain disease. It is irreversible and consciousness is not impaired.

Question 3

Explain the aetiology/risk factors of dementia

Answer 3

• TYPES of Dementia:
o Alzheimer’s disease (50%) - degeneration of the cerebral cortex, with cortical atrophy and reduction in acetylcholine production
o Vascular Dementia (25%) - brain damage due to several incidents of cerebrovascular disease (e.g. strokes/TIAs)
o Lewy Body Dementia (15%) - deposition of abnormal proteins (Lewy bodies) within the brain stem and neocortex
o Frontotemporal Dementia - specific degeneration of the frontal and temporal lobes

Question 4

Summarise the epidemiology of dementia

Answer 4

• Prevalence increases with age

* Prevalence of 20% in patients aged > 80 yrs

Question 5

Recognise the presenting symptoms and signs of dementia

Answer 5

• Alzheimer’s disease - insidious onset
• Vascular dementia - step-wise decline
• Lewy Body dementia - fluctuating levels of consciousness, hallucinations, falls and Parkinsonian symptoms
• Frontotemporal dementia - behavioural changes and intellectual changes
• All forms of dementia are associated with a progressive loss of memory and cognitive function

Question 6

Identify appropriate investigations for dementia

Answer 6

• Diagnosis is based on the HISTORY
• Ensure no treatable cause is missed (e.g. hypothyroidism, vitamin B12/folate deficiency, space-occupying lesion, normal pressure hydrocephalus)

Question 7

Define depressive disorders

Answer 7

• A mood disorder that causes a persistent feeling of sadness and loss of interest.

Question 8

Explain the aetiology/risk factors of depressive disorders

Answer 8

• NICE recommends the use of DSM-IV classification to diagnose depression
• Major depression requires at least one of the core symptoms:
o Persistent sadness or low mood nearly every day
o Loss of interests or pleasure in most activities
• Along with some of the following symptoms:
o Fatigue or loss of energy
o Worthlessness, excessive or inappropriate guilt
o Suicidal thoughts
o Diminished ability to think or concentrate
o Psychomotor agitation and retardation
o Insomnia
o Changes in appetite and/or weight loss
• Symptoms should have persisted for at least 2 weeks
• Risk Factors
o Being FEMALE
o Past history of depression
o Significant physical illness causing disability or pain
o Other mental health problems (e.g. dementia)
o Being part of a refugee community

Question 9

Summarise the epidemiology of depressive disorders

Answer 9

• 5% of adults will have a depressive episode every year

* 1/4 women will develop depression severe enough to require treatment at some point in their lives

Question 10

Recognise the presenting symptoms and signs of depressive disorders

Answer 10

• Somatisation (physical symptoms resulting from psychiatric illness) is a very important signs and must not be missed
• Elderly people may present with depressive pseudodementia (altered memory and behaviour that mimics dementia)
• Assessment Tools
o Patient Health Questionnaire (PHQ-9)
o Hospital Anxiety and Depression (HAD) Scale
o Beck’s Depression Inventory

Question 11

Identify appropriate investigations for depressive disorders

Answer 11

•	Consider organic causes to the depression (e.g. hypothyroidism, hypercalcaemia, Addison's disease, Cushing's disease)
•	Investigations for other causes:
o	Blood glucose 
o	U&Es
o	TFTs
o	Calcium 
o	FBC 
o	MRI/CT

Question 12

Define anxiety disorder

Answer 12

• A group of mental disorders characterised by feelings of anxiety or fear.

Question 13

Explain the aetiology/risk factors of anxiety disorder

Answer 13

•	It is a syndrome of ongoing anxiety and worry about many events or thoughts that the patient generally recognises as excessive and inappropriate 
•	Risk Factors
o	Being aged 35-54
o	Being divorced or separated 
o	Living alone or as a single parent

Question 14

Summarise the epidemiology of anxiety disorder

Answer 14

• Lifetime prevalence of about 5%

* More common in WOMEN

Question 15

Recognise the presenting symptoms and signs of anxiety disorder

Answer 15

•	Diagnostic criteria for anxiety disorder:
o	Excessive anxiety and worry occurring more days than not for at least 6 months 
o	Patient finds it difficult to control the worry 
o	Anxiety and worry are associated with 3 or more of the following symptoms:
•	Restlessness 
•	Easily fatigued 
•	Difficulty concentrating 
•	Irritability 
•	Muscle tension
•	Sleep disturbance 
•	Autonomic arousal symptoms:
o	Palpitations 
o	Sweating 
o	Trembling 
o	Dry mouth
•	Chest and abdomen symptoms:
o	Difficulty breathing 
o	Feeling of choking 
o	Chest pain or discomfort 
o	Nausea/abdominal pain 
•	Symptoms involving mental state:
o	Dizziness/light-headedness 
o	Feeling of losing control 
o	Fear of dying 
•	General symptoms:
o	Hot flushes and cold chills 
o	Numbness and tingling sensation 
o	Muscle tensions or aches and pains 
o	Restlessness 
o	Globus

Question 16

Identify appropriate investigations for anxiety disorder

Answer 16

• It is a CLINICAL diagnosis