Old Age Psychiatry Flashcards Preview

MRCPsych - CASC > Old Age Psychiatry > Flashcards

Flashcards in Old Age Psychiatry Deck (23)
Loading flashcards...
1

Psychosis in Old-Age (history)

- Clarify HPC (onset, duration)
- Explore auditory hallucinations (quality, content, number, 2nd/3rd person, commentary, commands, insight)
- Hallucinations in other modalities
- Delusional beliefs
- Thought interference and passivity phenomena
- Mood (mood, sleep, appetite, enjoyment)
- Memory
- Alcohol and drugs
- Risk
- Physical health (inc vision/hearing) and medications

2

Psychosis in Old-Age (explanation)

- Clarify diagnosis
- Explain causes (family history, personality traits, hearing impairment)
- Explain treatment (inpatient/outpatient, MHA)
- Explain medication (mechanism, side-effects, duration 6m)
- Alternative treatments (CBT)
- Long-term management (CPN, OT/PT, discharge location)

3

Stress/distress symptoms in dementia (history)

- Clarify HPC (duration, triggers, aggression)
- Psychiatric symptoms (diagnosis, follow-up, medications, mood, psychotic Sx)
- Physical symptoms (medical history, temperature, falls, pain, elimination)
- Environmental changes (space, people, activities)

4

Stress/distress symptoms in dementia (explanation)

- Clarify concerns
- Explain treatment rationale (symptoms, risk, failed management)
- Explain side-effects (inc stroke risk, risk/benefit, low dose, duration)
- Alternative treatments (orientation, reminiscent therapy, art therapy, pet therapy, doll therapy, activities, family involvement)
- Questions

5

Risk factors for paraphrenia

Female
Hearing/visual impairment
Single, no children
CVAs
Social isolation

6

Side-effects of acetylcholinesterase inhibitors

GI upset, incontinence, loss of appetite, dizziness, drowsiness, bradycardia
CI in asthma/COPD (except rivastigmine)

7

Side-effects of memantine

Constipation, headache, dizziness, drowsiness, high blood pressure

8

Alzheimer's genetics

Parents - 3-4x higher risk
Familial dementia - more likely early onset

9

Risk factors for Alzheimer's disease

History of diabetes
Repeated head injury
History of depression
Vascular risk factors (HTN, stroke, cholesterol)
Increasing age
Family history of dementia
Low educational attainment

10

Dementia (history)

- Clarify HPC (onset, duration)
- Explore memory difficulties (short-term, long-term)
- Orientation (day/dates, confused, recognizing people)
- Communication (word-finding, understanding, identify objects)
- Functioning (dressing, washing, toileting, walking, money, shopping, food, transportation)
- PMHx and risk factors (head injury, low mood)
- Risk (wandering, getting lost, fire, flooding, exploitation, abuse, aggression, self-injury).

11

Dementia (medication)

- Clarify understanding
- Donepezil, rivastigmine, galantamine
- Purpose and mechanism (increase ACh, slow down progression, improve QoL)
- Duration and efficacy (40-50% respond, memory monitoring, 6m reviews)
- Side-effects/CIs (dizziness, drowsiness, low of appetite, bradycardia, GI upset, incontinence)
- Address other concerns and offer leaflets

12

Vascular dementia (explanation)

- Clarify diagnosis and aetiology
- Progression and prognosis (mean survival 3 years)
- Explain medication (AChIs not indicated, control RFs, treat depression etc)
- Alternative treatment (lifestyle modification)
- Address other concerns and offer leaflets

13

Lewy Body Dementia (explanation)

- Clarify diagnosis and aetiology (LBs affect chemicals)
- Common symptoms (falls, fluctuating cognition and hallucinations)
- Difference between LBD/PDD (1 year between Sx for PDD)
- Explain medication options (avoid antipsychotics, rivastigmine, PD meds - neurology)
- Alternative treatment (PT/OT)
- Address other concerns and offer leaflets

14

Lewy Body Dementia (behaviour management)

- Clarify HPC (onset, duration)
- Clarify possible causes (medication change, illness)
- Explain medication options (increase current meds, add antipsychotic)
- Alternative treatment (re-orientation, MDT involvement, light therapy/sleep hygiene)
- Address other concerns

15

Fronto-temporal dementia (history)

- Clarify HPC (onset, duration)
- Explore memory difficulties (short-term, long-term)
- Orientation (day/dates, confused, recognizing people)
- Communication (word-finding, understanding, identify objects)
- Explore frontal lobe Sx (personality, sexual inappropriateness, plans, mood, impulsivity, repetitiveness)
- Functioning (dressing, washing, toileting, walking, money, shopping, food, transportation)
- Risk (wandering, getting lost, fire, flooding, exploitation, abuse, aggression, self-injury).
- PMHx and risk factors (head injury, low mood)

16

Mini-ACE cognitive examination

- Day/date/month/year (4)
- Animals in 1 min (7 for >22)
- Address x3 (7)
- Clock drawing (5)
- Address recall (7)
- Cut-off of 21 or 25

17

Mild Cognitive Impairment (explanation)

- Clarify diagnosis and understanding
- Explain course and prognosis (5-10% per year conversion to dementia)
- Explain medication (no specific treatment, treat risk factors such as HTN/diabetes)
- Alternative treatment (lifestyle modification - diet, exercise, smoking)
- Address concerns and offer leaflet

18

Delirium (history)

- Clarify HPC (onset, duration, orientation TPP)
- Clarify possible causes (PMHx, recent illness, medication change, constipation)
- Explore co-morbid symptoms (mood, enjoyment, sleep, appetite, psychosis)
- Risk (agitation, aggression, self-injury, wandering).
- Assess for underlying memory impairment (normal memory, dates, recognition, functioning, finances, wandering, risk).

19

Delirium (management)

- Summarise case/formulation
- Explain DDx and possible aetiology
- Explain investigations (GP collateral, bloods, MSU)
- Management (location, treat cause, re-orientation, consistent nursing care etc.)
- Medications (haloperidol if QTc ok)
- Explain prognosis (usually 2-3 weeks)

20

Indications for CT head in delirium

- new focal neurological signs
- a reduced level of consciousness (not adequately explained by another cause)
- a history of recent falls
- a head injury (patients of any age)
- anticoagulation therapy.
- non-resolving delirium where no clear cause is identified

21

Mania in elderly patient (history)

- Clarify HPC (onset, duration)
- Elicit core mania symptoms (elation, irritability, energy, sleep, appetite, racing thoughts)
- Explore grandiose beliefs (special powers, challenge these)
- Explore auditory hallucinations (quality, content, number, 2nd/3rd person, commentary, commands, insight)
- Hallucinations in other modalities
- Thought interference and passivity phenomena
- Risk (Police, spending, disinhibition, suicidality)
- Alcohol and drugs
- Past psych Hx, PMHx, FHx, medications.

22

Mania in elderly patient (explanation)

- Clarify diagnosis, rationale and DDx
- Clarify PPHx, PMHx, medication
- Explain treatment (inpatient/outpatient, MHA)
- Explain medication (mechanism, side-effects)
- Long-term management (CPN, CMHT)
- Address other concerns

23

Frontal assessment battery

- Ask about visual/hearing difficulties
- Similarities (banana/orange, table/chair, tulip/rose/daisy)
- Verbal fluency (S-words, over 9 for 3 points)
- Programming (fist-edge-palm, x3 together then alone, 6 reps for 3 points)
- Conflicting instructions (tapping once/twice, 10 times)
- Inhibitory control (don't tap when tap twice, 10 times)
- "Do not take my hands" (stroke palms)
- Cut off score of 12