mental health in the elderly

Question 1

under section 2 how long can a person be kept for ?

Answer 1

up to 28 days

Question 2

who can place someone under a section 2 ?

Answer 2

an approved mental health professional make the application on the recommendation of 2 doctors ( one of who should be approved under section 12(2).

Question 3

why is someone placed under section 2 ?

Answer 3

for assessment

Question 4

why is someone placed under section 3 ?

Answer 4

for treatment

Question 5

how long can someone be placed under section 3 for ?

Answer 5

6 months - can be renewed

Question 6

who can place someone under a section 3 ?

Answer 6

approved mental health professional along with 2 doctors both of which must have seen the patient within the past 24 hours

Question 7

what is a section 5(2) ?

Answer 7

a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours

Question 8

what is a section 5(4) ?

Answer 8

it allows a nurse to detain a patient who is voluntarily in hospital for 6 hours

Question 9

what is section 136 ?

Answer 9

someone found in a public place who appears to have a mental disorder ca be taken by the police to a place of safety for 24 hours whilst a MHA assessment is arranged

Question 10

what is the mechanism of action of typical antipsychotics ?

Answer 10

dopamine D2 receptor antagonists blocking dopaminergic transmission in the mesolimbic pathway

Question 11

what are some adverse side effects of typical antipsychotics ?

Answer 11

extrapyramidal side effects
hyperprolactinaemia

Question 12

what are some examples of typical antipsychotics ?

Answer 12

haloperidol
chlorpromazine

Question 13

how do atypical antipsychotics act ?

Answer 13

a variety of receptors - D2, D3, D4 and 5-HT

Question 14

what are some side effects of atypical antipsychotics ?

Answer 14

metabolic effects
extrapyramidal side effects are less common

Question 15

what are some examples of atypical antipsychotics ?

Answer 15

clozapine
risperidone
olanzapine

Question 16

what are some extrapyramidal side effects ?

Answer 16

parkinsonism
acute dystonia
akathisia - severe restlessness
tardive dyskinesia

Question 17

what are some risks that should be taken when starting antipsychotics in the elderly ?

Answer 17

increased risk of stroke
increased risk of VTE

Question 18

other than extrapyramidal side effects what are some others that antipsychotics cause ?

Answer 18

antimuscarinic - dry mouth, blurred vision, urinary retention and constipation
sedation and weight gain
raised prolactin
neuroleptic malignant syndrome - pyrexia and muscle stiffness
prolonged QT interval

Question 20

When a patient is started on antipsychotics what should be monitored and when ?

Answer 20

FBC
U&E’s - - start of therapy, annually
LFT’s

Lipids —— start of therapy, 3 months, annually
Weight

Fasting blood glucose - —— start, 6 months, annually
Prolactin

BP - baseline and during dose titration

ECG - baseline

Question 21

What are the side effects of atypical antipsychotics ?

Answer 21

Weight gain
Clozapine - agranulocytosis
Hyperprolactinaemia

Question 22

How do benzodiazepines work ?

Answer 22

Enhance the effect of the inhibitory neurotransmitter GABA by increasing the frequency of chloride channels

Question 23

What circumstances are benzodiazepines used for ?

Answer 23

Sedation
Hypnotic
Anxiolytic
Anticonvulsant
Muscle relaxant

Question 24

How long should benzodiazepines be used for and why ?

Answer 24

2-4 weeks
People commonly develop a tolerance and dependence

Question 25

What happens if someone is withdrawn from benzodiazepine too quickly ?

Answer 25

Develop benzodiazepine withdrawal syndrome

Question 26

What are some features of benzodiazepine withdrawal syndrome ?

Answer 26

Insomnia Irritability Anxiety Tremor Loss of appetite Tinnitus Perceptual disturbances Seizures

Question 27

How do benzodiazepines and barbiturates act differently on the chloride channels ?

Answer 27

Benzos - increase frequency of chloride channels Barb - increase duration of chloride channel opening

Question 28

What are the types of bipolar disorder ?

Answer 28

Type 1 - mania and depression Type 2 - hypomania and depression

Question 29

What is mania ?

Answer 29

Severe functional impairment or psychotic symptoms for 7 days or more

Question 30

What is hypomania ?

Answer 30

Decreased or increased function for 4 days or more

Question 31

What is the management of bipolar disorder ?

Answer 31

Lithium Stop antidepressants

Question 32

What are some adverse effects of clozapine ?

Answer 32

Agranulocytosis Reduced seizure threshold Constipation Myocarditis

Question 33

What are some factors that suggest depression over dementia ?

Answer 33

Short history, rapid onset Weight loss Sleep disturbance Patient worried about poor memory Reluctant to take tests Variable mini mental test score Global memory loss

Question 34

What are the 5 stages of grief ?

Answer 34

Denial Anger Bargaining Depression Acceptance

Question 35

What are some features of atypical grief reactions ?

Answer 35

Delayed grief - 2 weeks after event Prolonged grief - difficult to define

Question 36

What is insomnia ?

Answer 36

Difficulty initiating or maintaining sleep or early morning waking that leads to dissatisfaction with sleep quantity or quality. This is despite time and opportunity for sleep and results in impaired daytime functioning.

Question 37

What are some features associated with insomnia ?

Answer 37

Female Increased age Lower educational attainment Unemployment Economic inactivity Widowed, divorced or separated status Alcohol or substance abuse Poor sleep hygiene Chronic pain Psychiatric illness

Question 38

What investigations should be performed for insomnia ?

Answer 38

History Sleep diary and actigraphy may aid diagnosis

Question 39

What is the short term management of insomnia ?

Answer 39

Identify potential causes Advise good sleep hygiene Only consider hypnotics if daytime impairment is severe

Question 40

What are some side effects of hypnotics ?

Answer 40

Daytime sedation Poor motor coordination Cognitive impairment

Question 41

How does mirtazapine work ?

Answer 41

Antidepressant that works by blocking alpha 2 adrenergic receptors which increases the release of neurotransmitters.

Question 42

Why is mirtazapine beneficial in elderly patients ?

Answer 42

Fewer side effects and interactions Sedative and increases appetite

Question 43

When should mirtazapine be taken ?

Answer 43

Evening as it can be sedative

Question 44

What is psychosis ?

Answer 44

Describes a person experiencing things differently from those around them

Question 45

What are some psychotic features ?

Answer 45

Hallucinations Delusions Thought disorganisation

Question 46

when can psychotic symptoms present ?

Answer 46

Schizophrenia Depression - psychotic depression more common in older patients Bipolar Neurological - Parkinson’s and Huntington’s

Question 47

What are some side effects of SSRI’s ?

Answer 47

GI symptoms Increase risk of GI bleeding - prescribe a PPI Citalopram - QT interval prolongation

Question 48

What drugs can SSRI’s interact with ?

Answer 48

NSAIDs Warfarin / heparin Aspirin Triptans and MAOI - increase risk of serotonin syndrome

Question 49

What are some factors associated with increased risk of suicide ?

Answer 49

Male sex History of deliberate self harm Alcohol or drug misuse History of mental illness Advancing age Unemployment Unmarried, divorced or widowed

Question 50

What are some protective factors for suicide ?

Answer 50

Family support Having children at home Religious beliefs

Question 51

what are some key features to think about when assessing capacity ?

Answer 51

mental state can fluctuate and must be assessed at regular intervals decision specific assume capacity unless proven otherwise

Question 52

to have capacity to make a decision an individual must demonstrate what capabilities ?

Answer 52

understand information retain information use the information to make a decision communicate their decision