Older Persons Mental Health Flashcards

Question

'4 A's of Alzheimer's disease'

Answer 1

Amnesia (recent memories lost first) Aphasia (word-finding problems, speech muddled and disjointed) Agnosia (recognition problems) Apraxia (inability to carry out skilled tasks despite normal motor function)

Answer 2

impairment of consciousness fluctuation of symptoms: worse at night, periods of normality abnormal perception (e.g. illusions and hallucinations) agitation, fear delusions

Answer 3

NICE recommend: 10-point cognitive screener (10-CS) 6-Item cognitive impairment test (6CIT) The following are often used but not recommended by NICE in the non-specialist setting: the abbreviated mental test score (AMTS), MOCA, ACE3, General practitioner assessment of cognition (GPCOG) and the mini-mental state examination (MMSE) A MMSE score of 24 or less out of 30 suggests dementia

Answer 4

PRIMARY CARE - a blood screen is usually sent to exclude reversible causes (e.g. Hypothyroidism). NICE recommend the following tests: FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels. Patients are now commonly referred on to old-age psychiatrists (sometimes working in 'memory clinics'). SECONDARY CARE - neuroimaging is performed* to exclude other reversible conditions (e.g. Subdural haematoma, normal pressure hydrocephalus) and help provide information on aetiology to guide prognosis and management

Answer 5

Alzheimer's disease cerebrovascular disease: multi-infarct dementia (c. 10-20%) Lewy body dementia (c. 10-20%)

Answer 6

Huntington's CJD Pick's disease (atrophy of frontal and temporal lobes) HIV (50% of AIDS patients)

Answer 7

hypothyroidism, Addison's B12/folate/thiamine deficiency syphilis brain tumour normal pressure hydrocephalus subdural haematoma depression chronic drug use e.g. Alcohol, barbiturates

Answer 8

Frontotemporal lobar degeneration (FTLD) is the third most common type of cortical dementia after Alzheimer's and Lewy body dementia. There are three recognised types of FTLD: Frontotemporal dementia (Pick's disease) Progressive non fluent aphasia (chronic progressive aphasia, CPA) Semantic dementia

Answer 9

Onset before 65 Insidious onset Relatively preserved memory and visuospatial skills Personality change and social conduct problems

Answer 10

This is the most common type and is characterised by personality change and impaired social conduct. Other common features include hyperorality, disinhibition, increased appetite, and perseveration behaviours. Focal gyral atrophy with a knife-blade appearance is characteristic of Pick's disease. Macroscopic changes seen in Pick's disease include:- Atrophy of the frontal and temporal lobes Microscopic changes include:- Pick bodies - spherical aggregations of tau protein (silver-staining) Gliosis Neurofibrillary tangles Senile plaques

Answer 11

A recognized type of Frontotemporal lobar degeneration Chief factor is non fluent speech. They make short utterances that are agrammatic. Comprehension is relatively preserved.

Answer 12

A recognized type of Frontotemporal lobar degeneration Here the patient has a fluent progressive aphasia. The speech is fluent but empty and conveys little meaning. Unlike in Alzheimer's memory is better for recent rather than remote events.

Answer 13

NICE do not recommend that AChE inhibitors or memantine are used in people with frontotemporal dementia

Answer 14

Lewy body dementia is an increasingly recognised cause of dementia, accounting for up to 20% of cases. The characteristic pathological feature is alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas.

Answer 15

The relationship between Parkinson's disease and Lewy body dementia is complicated, particularly as dementia is often seen in Parkinson's disease. Also, up to 40% of patients with Alzheimer's have Lewy bodies.

Answer 16

- progressive cognitive impairment - in contrast to Alzheimer's, early impairments in attention and executive function rather than just memory loss - cognition may be fluctuating, in contrast to other forms of dementia - usually develops before parkinsonism - parkinsonism - visual hallucinations (other features such as delusions and non-visual hallucinations may also be seen)

Answer 17

usually clinical single-photon emission computed tomography (SPECT) is increasingly used (dopamine uptake scanning)

Answer 18

both acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine can be used as they are in Alzheimer's.

Answer 19

neuroleptics should be avoided in Lewy body dementia as patients are extremely sensitive and may develop irreversible parkinsonism

Answer 20

Fluctuating cognition Parkinsonism Visual hallucinations

Answer 21

Vascular dementia (VD) is the second most common form of dementia after Alzheimer disease. It is not a single disease but a group of syndromes of cognitive impairment caused by different mechanisms causing ischaemia or haemorrhage secondary to cerebrovascular disease. Vascular dementia has been increasingly recognised as the most severe form of the spectrum of deficits encompassed by the term vascular cognitive impairment (VCI)

Answer 22

Stroke-related VD – multi-infarct or single-infarct dementia Subcortical VD – caused by small vessel disease Mixed dementia – the presence of both VD and Alzheimer’s disease

Answer 23

History of stroke or transient ischaemic attack (TIA) Atrial fibrillation Hypertension Diabetes mellitus Hyperlipidaemia Smoking Obesity Coronary heart disease A family history of stroke or cardiovascular Rarely, VD can be inherited as in the case of CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

Answer 24

Several months or several years of a history of a sudden or stepwise deterioration of cognitive function. Symptoms and the speed of progression vary but may include: Focal neurological abnormalities e.g. visual disturbance, sensory or motor symptoms The difficulty with attention and concentration Seizures Memory disturbance Gait disturbance Speech disturbance Emotional disturbance

Answer 25

A comprehensive history and physical examination Formal screen for cognitive impairment Medical review to exclude medication cause of cognitive decline MRI scan – may show infarcts and extensive white matter changes, can show evidence of significant small vessel disease NICE recommends that diagnosis be made using the NINDS-AIREN criteria for probable vascular dementia

Answer 26

Presence of cognitive decline that interferes with activities of daily living, not due to secondary effects of the cerebrovascular event - established using clinical examination and neuropsychological testing Cerebrovascular disease - defined by neurological signs and/or brain imaging A relationship between the above two disorders inferred by: - the onset of dementia within THREE MONTHS following a recognised stroke - an abrupt deterioration in cognitive functions fluctuating, stepwise progression of cognitive deficits

Answer 27

Treatment is mainly symptomatic with the aim to address individual problems and provide support to the patient and carers Important to detect and address cardiovascular risk factors – for slowing down the progression Include: cognitive stimulation programmes, multisensory stimulation, music and art therapy, animal-assisted therapy Managing challenging behaviours e.g. address pain, avoid overcrowding, clear communication Consider pharmacological management if mixed subtype

Answer 28

There is no specific pharmacological treatment approved for cognitive symptoms Only consider AChE inhibitors or memantine for people with vascular dementia if they have suspected comorbid Alzheimer’s disease, Parkinson’s disease dementia or dementia with Lewy bodies. There is no evidence that aspirin is effective in treating patients with a diagnosis of vascular dementia.

Answer 29

The following conditions must be met to allow a person to be deprived of their liberty under the safeguards: The person must be 18 or over. The person must be suffering from a mental disorder. The person must be a patient in hospital or a resident in a care home. The person lacks capacity to decide for themselves about the restrictions which are proposed so they can receive the necessary care and treatment. The proposed restrictions would deprive the person of their liberty. The proposed restrictions would be in the person's best interests. Whether the person should instead be considered for detention under the Mental Health Act. There is no valid advance decision to refuse treatment or support that would be overridden by any DoLS process.

Answer 30

All patients are initially assumed to have capacity Capacity is decision-specific e.g. a patient may be able to decide which clothes to wear, but not where is safest to live Capacity can be impaired permanently, temporarily, or can fluctuate Patients deemed to have capacity are freely able to make decisions that the healthcare provider thinks unwise or dangerous

Answer 31

1. Every adult is assumed to have capacity unless proved otherwise 2. A person must be given all practicable help to make their own decisions before they are deemed to lack capacity 3. Unwise, unsafe or dangerous decisions does not mean that person does not have capacity. 4. All treatment given to a person who lacks capacity must be in the patients best interests 5. Anything done for a person who lacks capacity must be done in the least restrictive way possible

Answer 32

Short duration of dementia Equal effect on long and short term memory Amnesia concerning specific events (often events are emotionally charged) Often patient will very detailed complaint about memory disturbance Patient may highlight failures in answers to questions relating to memory Loss of social skills early in the illness Patient will often answer “don't know” to questions, as opposed to guessing close answers Patient may make little effort in performing tasks

Answer 33

Discuss the options in a time and place that helps them to understand and remember what you say. Ask whether having a friend or relative with them might help them to remember information, or otherwise help them make the decision.

Answer 34

Acute confusional state, with a sudden onset and fluctuating course. May be hypoactive or hyperactive - recognised change in conciousness Onset of 1-2 days. CHANGE FROM BASELINE

Answer 35

Progressive decline in cognitive function usually occuring over several months. It affects many different areas of function, including: Retention of new information, managing complex tasks, language and word finding difficulty, behaviour, orientation, recognitiion, ability to self care, and reasoning

Answer 36

In Parkinson's disease typical features of Parkinson's will present and precede confusion by over a year Lewy Body dementia Parkinsonism tends to be less severe Both are progressive with prominent auditory or visual hallucinations, delusions are well formed and persistent

Answer 37

Social dishinibition Family history

Answer 38

TSH B12 Folate Glucose

Answer 39

Patients with Parkinsons disease (promotes dopamine blockade so can result in psychosis and a deterioration in motor function)

Answer 40

Fluctuating attention and concentration Recurrent well-formed visual hallucination Spontaneous Parkinsonism

Answer 41

Depressive dementia Severe depression leading to psychomotor slowing, memory impairment and difficulties in concentration Often presents with significant self neglect and weight loss as a result

Answer 42

Disturbance of higher cortical functions (memory, thinking, judgement, language, perception, awareness) May be single or multiple, and may be static or progressive

Answer 43

Cognitive impairment: decline in both memory and thinking sufficient to impair ADLs Problems with processing of incoming information - problems with maintain and directing attention Clear consciousness Symptoms present for at least 6 months

Answer 44

Impairment of cognition, disturbances of attention and consciousness level, abnormal psychomotor behavior, disturbed sleep-wake cycles Onset is acute (hours/days) Symptoms fluctuate and are typically worse at night

Answer 45

Always assess a patient’s capacity to make a particular decision at the time it needs to be made. Don’t assume that because a patient lacks capacity to make a decision on a particular occasion, they lack capacity to make any decisions at all now or in the future.

Answer 46

Those who are most dependent and vulnerable often have the least awareness of this disabilities

Answer 47

FTD Alcoholic Huntings Disease

Answer 48

Behavioral and psychological symptoms of dementia (non cognitive) Including: Depression Hallucinations (more common in Lewy Body - NOT CHARLES BONNET - this is related to macular degeneration - these pt have insight) Adigtation Delusions Apathy Sleep problems

Answer 49

Affective: agitation, screaming/crying, depression or dysphoria, anxiety, hoarding Apathetic: indifference, lack of emotion, decreased motivation Psychotic: delusions and hallucinations Hyperactive: aggression, irritability, lability, resisting care, night time disturbance, pacing/wandering, disinhibiton

Answer 50

Antecedent-Behaviour-Consequence

Answer 51

Implied: pt dose not explicity state their consent but their actions suggest it Expressed: explicitly stated in writing or verbally

Answer 52

* Dementia * Delerium * A learning disability * A brain injury * A mental health condition * A stroke * Unconsciousness due to accident / injury * Alcohol / drug use

Answer 53

Illusion - misinterpretation of a stimulus Hallucinations - an experience of a stimuli that is not real

Answer 54

In order to assess capacity, the following two-stage test must have been followed: Is there an impairment of or disturbance in the functioning of the person’s mind or brain? Is the impairment or disturbance sufficient that the person lacks the capacity to make that particular decision? The second stage of the test (or functional test) dictates that the person is unable to make a decision if they cannot: Understand information about the decision to be made Retain that information in their mind Use or weigh-up the information as part of the decision process Communicate their decision If a person lacks capacity in any of these areas, then this represents a lack of capacity (Mental Capacity Act 2005: Code of Practice).

Answer 55

Increase length of stay in hospital, increased complications (VTE, HAI) Increased risk of readmission Increased risk of instutionalisation Increased one year mortality

Answer 56

Up to 3 months

Answer 57

Access to an IMHA is a statutory right for people detained under most sections of the Mental Health Act, subject to Guardianship or on a community treatment order (CTO). When someone is detained in hospital or on a CTO it can be a very confusing and distressing experience. IMHAs are independent of mental health services and can help people get their opinions heard and make sure they know their rights under the law.

Answer 58

- 2 doctors – at least 1 of whom should be Section 12(2) approved - 1 AMHP – not just SW now - Can take sometime for the 3 people to meet - Community or inpatient (anywhere except prison) - Section for maximum of 28 days for assessment (and treatment) of a mental disorder - then section 3 which can be refreshed or discharge - Appeal within first 14 days – heard within 7 days by a mental health tribunal

Answer 59

2 doctors – at least 1 of whom should be Section 12(2) approved + 1 AMHP - Often following a section two, may use a three straight away if pt known to services and their disorder is well understood - Community or inpatient (anywhere except prison) - Section for maximum of 6 months for treatment of a mental disorder, can be extended by 6 months and then by 12 - 1 Appeal to both hospital managers panel and tribunal.

Answer 60

Police power to remove to a place of safety from a public place for an assessment by an AMHP and 1 doctor.  Held up to 72 hours to allow assessment  Police to stay with person  If needed second doctor attends for a MHA assessment for Section 2 or

Answer 61

Anyone who has been on section 3 is entitled to S117 aftercare from local authority

Answer 62

Power granted to RMNs to detain an inpatient (so someone already admitted to hospital) for up to 6 hours for medical assessment where mental illness is suspected. Not for treatment - Cannot be done in the Emergency Department - Form to be completed - Forms to be submitted to hospital manager

Answer 63

Used for pts who have been admitted informally but then need detaining for assesment but NOT treatment The RMO - consultant and responsible clinician or nominated deputy (nominated by responsible clinician - won’t be an FY1 - most likely registrar) can detain an inpatient for up to 72 hours under the mental health act Cannot be done in the Emergency Department No appeal Legal form for hospital managers To allow formal mental health act to be completed

Answer 64

Patient on S3 can be considered for a CTO - Patient is well enough to leave hospital but may default from treatment/follow up - Treatment is necessary for the patients health, safety or protection of others - Patient can be recalled to hospital if they do not comply with treatment, attend appointments etc - Can still appeal to the tribunal Lasts 6 months

Answer 65

Section 135 allows the police to enter your home and take you to (or keep you at) a place of safety so that a mental health assessment can be done. This could involve keeping you at home. The police must have a warrant from the magistrate's court allowing them to enter your home. An application for a warrant must be made by an approved mental health professional (AMHP), and can be given where there is reasonable cause to believe that you: have a mental disorder, and are being ill-treated or neglected, or are unable to look after yourself. The police must be accompanied by an AMHP and a registered medical practitioner. The police can keep you at the place of safety for up to 24 hours, which can be extended for another 12 hours if it was not possible to assess you in that time. The time starts when you arrive at the place of safety, or whenever the police arrived if you are not taken somewhere else.

Answer 66

CAM diagnostic algoerithm Feature 1 - acute onset fluctuating course Feature 2- Inattention Feature 3 - Disorganized thinking Feature 4 - altered level of conciousness Validated told for diagnosing delirium

Answer 67

Normal aging Not being able to remember of details of a conversation that took place a year ago, forgetting the name of an acquaintance, forgetting things and events occasionally, occasionally having difficulty finding words, family members generally not concerned MCI May affect memory, problem-solving, planning, visuospatial awearenes and language but DOES NOT interfere with daily life Dementia Progressive decline in cognitive function usually occuring over several months. It affects many different areas of function, including: Retention of new information, managing complex tasks, language and word finding difficulty, behaviour, orientation, recognitiion, ability to self care, and reasoning

Answer 68

Dementia and sub-type diagnosis Review after diagnosis Care co-ordination Interventions to promote cognition, independence and wellbeing Pharmacological interventions

Answer 69

Course of cognitive impairment over time Enquiry into specific cognitive domains Functional disability - explore both basic and instrumental ALDs Why now? Precipitant/life evnt/physical health change Timeline - what changed first Symptoms and impact (memory anterograde/retrograde, knowledge of current events, continence, falls, hallucinations, personality changes, sleep, appetite) Another culprit? PMHx medication substance abuse, depression PTSD< menopause, vitamin def, polypharmacy, pain

Answer 70

Concentration/attention Patient/collateral rating of memory loss out of ten Episodic memory impairment - new information (anterograde) and past events (retrograde) Semantic memory Language Executive ability Personality change Use of memory aids

Answer 71

Appearance and behaviour Speech Mood (subjective/objectives) Thought (form/content) Perception Cognition Insight

Answer 72

Normal pressure hydrocephelus

Answer 73

Fear of loss of infependence can be a barrier to early diagnosis Well learned activity Risk to pt and general public - must inform DVLA Annual review Pt and collateral may be complicit to conceal issues Restrict driving repitore - e.g. no night driving, no long distance driving

Answer 74

Preperation involvement of family Explore pt perspective Discolsure of dgx - not always appropriate but ideal Response to pt reactions Focus on QoL Future planning Effective communication

Answer 75

MEMORY LOSS Memory - recent/remote Employement - affect Motor symptoms Over eating Risk (driving, wandering, cooking, impusivity, disinhibition, neglect, carer strain, being left alone, self harm, sucide, agression to others) Y (U) Usual self - changes, over what time Language (comprehension, expression, modality) Accidents (continence) Night (sleep disturbance) Exclude other illness (mental/physical) Sight (cortico-visual distrubance)

Answer 76

Neurological

Answer 77

Explain diagnosis/prognosis MDT referals - CMHT for aftercare, SALT psychologist, Refferal to social services, Refferal to age UK Drivability assessment UCL young dementias group (young onset) Psychopharmacology: cholinesterase inhibitors +/- memantine depending on type, antispychotics/antidepressants for BPSD

Answer 78

Baseline blood tests (for Rx and to exclude ddx) Neuroradiology - structural and function - MRI Neuropsychology OT functional assesment SALT +/- CSF genetic councilling and testing (early onset)

Answer 79

Neurodegenerative: AD, VD, FTD, PD, Lewy body, Korsakoff, Parkinsons, Mixed Infective: HIV, HSV, syphillis, toxoplasmosis Prion: CJD, FI Inflammatory: vasculopathies, sarcoid, autoimmune Metabolic: poorly controlled endocrine disease, metal exposure, vitamin deficiencies Genetic: AD, MND, FTD, HD, Downs Syndrome

Answer 80

Aetiology Under 65s: AZ, VD Lewy Body, FTD, rarer types Over 65s: AZ, VD Lewy Body Presentation: Under 65: more varied, memory less prominent, more likely to present with visual, motor, language or behavioral symptoms Over 65:Typical memory, orientation and loss of executive skills more prominent Prognosis/course Under 65: Weeks- years Over 65s:Typically year

Answer 81

Course and onset: Gradual, insidious, slow progression Early presenting symptoms: Neurological features: Mood and behavioral changes: Structural behavioral imaging:

Answer 82

Course and onset: Gradual, insidious, slow progression Early presenting symptoms: Memory impairment Neurological features: Absent Mood and behavioral changes: May be minimal initially but pre-existing anixety etc may worsen Structural behavioral imaging: Volume loss in MEDIUM TEMPORAL LOBE, POSTERIOR CINGULATE enlargement of cerebral sulci, loss of gyral volume and mild dilation of the ventricular system

Answer 83

Course and onset: Gradual with quick progression (particularly in younger patients) Early presenting symptoms: Loss of executive ability and impaired social behaviours Neurological features: + frontal release signs Mood and behavioral changes: Apathy, loss of volition and disinhibition may be early features Structural behavioral imaging: Frontotemporal atrophy

Answer 84

Course and onset: Gradual, OR more abrupt onset with erratic course Early presenting symptoms: Variable, there may be prominent dysexecutive features Neurological features: +/- highly variably Mood and behavioral changes: Depression common after stroke, emotional lability Structural behavioral imaging: Maybe evidence of infarcts, bleeds, white matter ischemia

Answer 85

Course and onset: Fluctuating episodic course (may imitate delerium) Early presenting symptoms: Perceptual disturbance (hallucinations) and parkinsonism, sleep disturbance Neurological features: ++ (Parkinsonism) Mood and behavioral changes: Paranoia and suspicious arising from psychotic symptoms Structural behavioral imaging: No specific abnormalities

Answer 86

Course and onset: Onset may be gradual but cognitive status fluctuates with drinking and withdrawal episodes Early presenting symptoms: Memory problems and dysexecutive (frontal) features Neurological features: - Mood and behavioral changes: Depression commonly associated with alcohol misuse problems Structural behavioral imaging: Age disproportionate cortical and white matter atrophy

Answer 87

Varient of AD or LBD 50-65 yrs Problems with visual recognition, reading difficulties judging distances and managing coordination, sometimes light sensitivity, sometime hallucination. Often acompanied by anxiety Visual problems subjective despite normal visual examination

Answer 88

Delirium Functional - depression, anxiety, catatonia, chronic schizophrenia Substance misuse Menopause Fibromyalgia Normal pressure hydrocephalus Sensory deprivation

Answer 89

Rapid onset <50 years Recent trauma Associate sx: weight loss, headaches, motor sx, seziures incontinence, raised IPC signs Positive family history

Answer 90

Short term - limited in both capacity and duration - Sensory memory - retaining impressions of sensory information Long term- function of brain where something is remember for more than a matter of days: 1. Semantic (facts, not drawn from personal experience) 2. Episodic (memories related to specific events and the information related to that experience) 3. Procedural - how to do something, the specific steps to accomplish a task

Answer 91

Dementia: often normal Delirium: often reversed

Answer 92

Dementia: often normal Delirium: significant inattention and lack of concentration

Answer 93

Dementia: months to years (lifelong) Delirium: hours to weeks (some cases months)

Answer 94

Dementia: systematised Delirium: transient, poorly organised

Answer 95

Dementia: slow decline - progressive Delirium: fluctuations

Answer 96

Dementia: alert/stable until terminal stages (earlier in LBD) Delirium: fluctuations/impaired

Answer 97

Dementia: primarily auditory Delirium: visual and auditory

Answer 98

Dementia: insidious - months to years Delirium: rapid, hours to days

Answer 99

Dementia: not usually any changes Delirium: hyperactive, hypoactive, mixed

Answer 100

Developed by geriatricians, AMT is probably the best known test in general hospital usage. The Abbreviated Mental Test (AMT) score lacks validation in primary care and screening populations; most validity data refer to correlation to the Mini Mental State Examination (MMSE).

Answer 101

Mental health act (1983, amended 2007)

Answer 102

Restricted blood flow resulting in damage to the brain

Answer 103

"Reversible dementias" are conditions that may well be associated with cognitive or behavioral symptoms that can be resolved once the primary etiology is treated Subdural haematoma Alcoholic Normal pressure hydrocephalus

Answer 104

Creutzfeldt-Jakob disease causes a type of dementia that gets worse unusually fast.

Answer 105

A diagnosis of Lewy body dementia requires a progressive decline in cognition, as well as at least two of the following: Fluctuating alertness and cognition Repeated visual hallucinations Parkinsonian symptoms

Answer 106

Usually NEGATIVE delusion - as opposed to manic delusions Frequently persecutory - someone has stolen something or abandoned you Misidentification syndromes - misidentifies people, places, objects or events Related to sensory impairment

Answer 107

Apathy - sleep ok, appetite ok, etc Both - chronic loss of motivation, withdrawn, etc

Answer 108

Haloperidol: reduced falls risk, less likely to cause a delirium/worsen delirium - concerns with extrapyramidal symptoms, prolonged QT syndrome Benzodiazepines: more suitable in Parkinson’s

Answer 109

Psychoeducation (carers/family and potential lot early on) Specialised nursing care Psychical activity Specific therapies - Music therapy (only NICE reccomended therapy), reminiscence therapy, CBT

Answer 110

Older pts with dementia are particularly vulnerable to side effects Need to consider polypharmacy Shorter term for duration of BPSD - lowest effective dose for the shortest time

Answer 111

Risperidone and haloperidol

Answer 112

Antipsychotics - minimum dose for minimum time - haloperidol or respiridone Cognitive enhancers - cholinesterase inhibitors and memantine - manage depression and apathy Benzodiazepines (association with falls, dependency and worsening cognition) Antidepressants - AVOID TCAs due to side effects , citalopram has the best evidence but sertraline has good cardiac safety

Answer 113

Up to 6 months, can be renewed for a further 6 months and then a further 12

Answer 114

Presumption of capacity All practical steps taken to allow autonomy Best interests Least restrictive option Allow unwise decisions

Answer 115

1. Impairment of function of mind? (Dementia, delirium, even acute stress) 2. Are they unable to: - Understand the information relevant to the decision - Retain the information long enough to make a decision - Weigh up the information given in the decision - Communicate their decision

Answer 116

Legal representation Access to independent mental capacity advocates Right of appeal to the Court of Protection

Answer 117

Appearance - appropriate dress, unkempt, signs of self neglect, age, ethnicity Behaviour - eye contact, appropriateness, Speech - volume, quantity, tone of voice Mood - subjective and objective - at present moment in time - are they congruent (euthymic) Thought - form (delivery) and content (nature) - Form: flight of ideas - thoughts too fast, pressure of speech - mouth can’t keep up, thought circumstantiallity (taking a long time to express idea), thought tangentiality Content: delusions Perception: hallucinations, ALL FIVE SENSES, Cognition Insight: lost? Entirely or aspects?

Answer 118

Mini-ACE MMSE 6CIT AMT MOCA ACE-III

Answer 119

Paraphrenia is a type of mental disorder characterized by paranoid delusions

Answer 120

The definition of encapsulated delusion is “a fixed, circumscribed belief that persists over time and is not altered by evidence of the inaccuracy of the belief.”

Older Persons Mental Health Flashcards

(148 cards)