psychiatric disorders across the life-course

Question 1

What are the 4ps in psychiatry?

Answer 1

Predisposing, precipitating, perpetuating & protective factors

Question 2

When do half of all mental health conditions start?

Answer 2

14 years old

Question 3

What is difference in maturation of the cortical areas & pre-frontal areas? What happens in adolescence?

Answer 3

• Cortical areas associated with sensory and motor tasks mature earlier than prefrontal cortex.
• Maximum density of grey matter reached first in primary sensorimotor cortex and last in higher association areas like pre-frontal cortex.
• volume of white matter increases continually from childhood to early adulthood from inferior to superior and from posterior to anterior brain areas.
• In adolescence neural imbalance because early maturation of subcortical brain areas & less mature pre-frontal areas.
• In highly emotional situations, more mature limbic lobe/reward system will affect behaviour more strongly than immature pre-frontal cortex

Question 4

What is peak age onset of depression, anxiety, ADHD, ASD, OCD, eating disorders, substance misuse?

Answer 4

Depression 19.5, anxiety 5.5, ADHD 9.5, ASD 5.5, OCD 14.5, eating disorders 15.5 substance misuse 19.5

Question 5

What are the DSM-5 criteria for ADHD?

Answer 5

1. persistent patterns of inattention &/or hyperactivity/impulsivity
2. present for at least 6 months
3. inappropriate for their developmental level
4. interferes with functioning or development
5. several symptoms before age 12
6. several symptoms present in 2 or more settings
7. symptoms not better explained by other mental disorder

Question 6

What are risk factors for ADHD?

Answer 6

1. genetic - no isolated gene, but significant heritability. Boys >girls.
2. environmental: premature birth, low birth weight, prenatal tobacco exposure

Question 7

What is the prognosis of ADHD?

Answer 7

70% of kids will have it as teenagers and about 40-60% will still have it as adults

Question 8

What is dementia?

Answer 8

Degenerative disease of brain with cognitive & behavioural impairment, severe enough to interfere with social & occupational function

Question 9

What is epidemiology of dementia? What is most common cause? How does risk increase?

Answer 9

• Rising, leading cause of death In women in Uk
• 2nd in men (after heart disease).
• Most common cause is alzheimer’s. Risk increases with age (doubles every 5 years after 60

Question 10

What are early symptoms of dementia?

Answer 10

Absent-minded, difficulty recalling names & words, difficulty learning new info, disorientation in unfamiliar surroundings, reduced social engagement

Question 11

What are progressive features of dementia?

Answer 11

Marked memory impairment, reduced vocabulary, loss of less complex speech patterns, mood swings & or apathy, decline in ADLs & social skills, emergence of psychotic phenomena

Question 12

What are features of advanced AD?

Answer 12

Monosyllabic speech, psychotic symptoms, behavioural disturbance, loss of bladder/bowel control, reduced mobility

Question 13

What are psychiatric symptoms of AD?

Answer 13

Delusions (usually paranoid), auditory/visual hallucinations (may be simple misidentification, depression common

Question 14

What are behavioural disturbances in AD?

Answer 14

Aggression, wandering, explosive temper, sexual disinhibition, incontinence, excessive eating, searching behaviour

Question 15

What are personality changes in AD?

Answer 15

Reflect exaggeration of premorbid traits with coarsening of affect & egoncentricity

Question 16

How do you screen for AD?What do scores mean?

Answer 16

Mini mental state examination MMSE. Score 25-30/30 = normal. 21-24 mild, 10-20 moderate, <10 severe impairment (cognitive)