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Psychiatry Block > Old Age Psychiatry > Flashcards

Old Age Psychiatry Flashcards

1
Q

What is the ABCD of dementia?

A
  • Activities of Daily Living (impaired)
  • Behavioural and psychological symptoms of dementia (BPSD)
  • Cognitive Impairment!!!!!
  • Decline (in function)
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2
Q

What are the main features of dementia?

A

-memory problems!!! (dysmnesia)
-functional decline!!!
-Activities of Daily Life impaired!!!!
Plus one or more of:
-dysphasia (expressive or receptive)
-dyspraxia
-dysgnosia (not recognising objects)
-dysexecutive function (such as disinhibition)

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3
Q

What are possible neuropsychiatric disturbances that can occur in dementia?

A
  • psychosis
  • depression
  • altered circadian rhythms
  • agitation
  • anxiety
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4
Q

What are distinguishing features between dementia and delirium?

A
  • dementia has insidious onset, whereas delirium is acute

- delirium is an acute illness that will last days or weeks, whereas dementia is generally irreversible and progressive

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5
Q

What is the main type of dementia?

A

alzheimer’s disease

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6
Q

What are types of dementia?

A
  • vascular
  • mixed vascular and alzheimer
  • lewy body
  • other
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7
Q

What investigations can be involved in management of dementia?

A
  • SPECT scan
  • cognitive testing such as MOCA/MMSE
  • blood tests
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8
Q

What are the main features of Lewy Body dementia?

A 
deficits of:
-attention
-frontal executive
-visuospatial
(amnesia not prominent)
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9
Q

How can Lewy Body dementia be diagnosed?

A

2=probable 1=possible:

  • fluctuation in symptoms
  • visual hallucinations
  • parkinsonism
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10
Q

What features might be ‘suggestive’ of Lewy Body dementia?

A
  • REM sleep disorder

- severe antipsychotic sensitivity (DO NOT GIVE PEOPLE WITH LB DEMENTIA ANTIPSYCHOTICS!)

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11
Q

What features would support a diagnosis of Lewy Body dementia?

A
  • falls
  • syncope
  • loss of consciousness
  • other psychiatric symptoms
  • autonomic dysfunction
  • scans
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12
Q

What is the prominent feature of frontotemporal dementia?

A

personality change

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13
Q

What are other features of frontotemporal dementia?

A
  • speech disorder - altered output, stereotypy, echolalia (repeating the last bit of a sentence again), perseveration, mutism
  • disinhibition
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14
Q

What would help diagnose frontotemporal dementia?

A

neuroimaging e.g. MRI head which would show abnormalities in these lobes (knife blade atrophy of frontal and temporal lobe)

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15
Q

What neurological signs may be present in frontotemporal dementia?

A
  • often absent early
  • parkinsonism later
  • MND in a few
  • autonomic
  • incontinence
  • primitive reflexes
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16
Q

What are possible drug treatments for dementia?

A
  • acetylcholinesterase inhibitors e.g. galantine (mild to moderate)
  • memantine for moderate to severe
17
Q

What are some side effects of using acetylcholinesterase inhibitors to treat dementia?

A
  • nausea, vomiting, diarrhoea
  • fatigue, insomnia
  • muscle cramps
  • headaches, dizziness
  • bradycardia, syncope, gastric ulcer, resp. problems
18
Q

What are other psychotropics which MAY be used in treatment of dementia?

A

-non pharmacological measures first!!!!
-antipsychotics such as risperidone
-antidepressants e.g. sertraline
-anxiolytics e.g. lorazepam
-hypnotics
-anticonvulsants
all must have different dose to rest of population, particularly if using the antipsychotics!

19
Q

How would you assess capacity? AMCUR

A

Can they:

  • Act on decisions?
  • Make their own decisions independently?
  • Communicate their decision?
  • Understand their decision?
  • Retain memory of the decision?
20
Q

Who would be able to grant someone Power of Attorney? What is the POA able to make decisions on?

A
  • solicitor assesses capacity and decides taking in to account clients wish
  • able to take control of welfare and finances
21
Q

If a POA cannot be appointed due to patient already lacking capacity, what other power is there? What can they do?

A
  • someone can be appointed guardian
  • help with finance and welfare
  • require 2 medical certificates to grant this: one from GP and one from psychiatrist
22
Q

What are more prevalent features of depression in older age group when compared to younger populations?

A

more:

  • insomnia
  • hypochondriasis
  • suicide
  • agitation
23
Q

What features are there of ‘normal’ grief?

A
  • alarm
  • numbness
  • pining - illusions or hallucinations may occur
  • depression
  • recovery and reorganisation
24
Q

What features make ‘abnormal’ grief?

A
  • persists beyond 2 months
  • guilt
  • thoughts of death
  • worthlessness
  • psychomotor retardation
  • prolonged and marked functional impairment
  • psychosis

Psychiatry Block (14 decks)

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