Psychiatry

Question 1

What is dementia?

Answer 1

neurodegenerative disorder resulting ina. loss of mental ability severe enough to interfere with normal activities of daily living, lasting more than 6 months, not present since birth and not associated with a loss of alteration of consciousness

Question 2

What is 60-70% of dementia caused by?

Answer 2

Alzheimer’s disease

Question 3

What is 20% of dementia caused by?

Answer 3

Vascular dementia - typically a series of minor strokes

Question 4

What are the reversible causes of dementia?

Answer 4

Hypothyroidism
Vitamin B12 deficiency
Lyme disease
Neurosyphilis

Question 5

What does lewy-body dementia relate to?

Answer 5

Parkinson’s disease

Question 6

What type of dementia has a genetic link?

Answer 6

frontotemporal dementia

Question 7

What are the rarer causes of dementia?

Answer 7

huntington's disease
progressive supra nuclear palsy
corticobasal degeneration
alcohol related dementia 
AIDS

Question 8

describe the onset of dementia?

Answer 8

Slow and progressive onset

Question 9

What are the symptoms of dementia in the early stage?

Answer 9

memory difficulty, 
apraxia 
agnosia 
anomia 
MMSE = 20-25

Question 10

What are the symptoms of dementia in the middle stages?

Answer 10

worsening of early symptoms - MMSE 6-19

Question 11

What are the symptoms of dementia in the late stages?

Answer 11

decreased appetite, inability to recognise hazards, incontinence, insomnia, reduced mobility and increased fragility - MMSE = 0-6

Question 12

What are the behavioural and psychological symptoms of dementia (BPSD)

Answer 12

Agitation
Depression
Anxiety
Psychosis (including hallucinations and delusions)
Physical aggression 
Apathy
Disinhibition and impulsivity 
abnormal motor behaviour

Question 13

What is the pathophysiology of AD?

Answer 13

progressive atrophy and deposits of plaques and tangles (plaque burden does not correlate well with cognitive status during life - instead, neurofibrillary tangle distribution is more strongly associated with cognitive status

Question 14

Describe the pathophysiology of VD?

Answer 14

ischaemia, infarct and arteriosclerosis are thought to cause ischaemia-induced demyelination and/or axonal loss, can result in breakdown of the blood brain barrier and/or breakdown of the blood CSF barrier

Question 15

Describe the pathophysiology of LBD

Answer 15

Development of abnormal collections of alpha-synuclein protein within the cytoplasm of neurones (Lewy bodies).
loss of dopamine producing neurones in the substantia nigra. Cerebral atrophy occurs as the cortex degenerates

Question 16

What are the risk factors for dementia?

Answer 16

Age 
excessive alcohol consumption
down's syndrome
atherosclerosis 
family history (particularly for FTD)
Diabetes
hypertension
mental illness
smoking

Question 17

What are the investigations for dementia?

Answer 17

MMSE - to assess level of mental impairment
rule out reversible causes (TFTs and vitamin B12)

routine haematology
biochemistry (electrolytes, calcium, glucose, renal and liver function)

CT/MRI of head

Question 18

What is the management of dementia?

Answer 18

If cause is reversible, immediately commence appropriate treatment
surgical management for brain tumours, hydrocephalus or severe head trauma

Manage dementia risk factors - hypertension, diabetes, cholesterol, smoking

acetylcholinesterase inhibitors for mild to moderate AD or DLB to slow progression of the disease

antidepressants or antipsychotics if appropriate

psychological treatments:
cognitive stimulation
validation therapy
behavioural therapy

Question 19

Describe the aetiology of depression and anxiety

Answer 19

Relatives of depressed people
childhood experiences
Cushing's syndrome 
hypothyroidism
stroke
parkinson's disease
MS 
monoamine hypothesis (deficiency in NA, 5-HT, dopamine)

Question 20

What are the core symptoms of depression?

Answer 20

Low mood 
loss of interest and anhedonia
reduced energy (anenergia)

Question 21

What are the additional symptoms of depression?

Answer 21

reduced concentration
reduced confidence and self-esteem
ideas of guilt and unworthiness
pessimism about the future 
ideas/acts of self-harm or suicide
disturbed sleep
changes in appetite

Question 22

What are the risk factors for depression?

Answer 22

Family history of mental illness

chronic physical or mental disorders

previous history

major life changes and stress

little or no social support

psychological factors

Low SE status

Female gender

Age

Insomnia and sleep disorders

Medications

Question 23

What are the diagnostic criteria for depression?

Answer 23

at least 2 of the following:
depressed mood
loss of interest and enjoyment
reduced energy or increased fatiguability

AND at least 2 of:
reduced concentration and attention

reduced self-esteem and self-confidence

ideas of guilt and unworthiness

bleak and pessimistic views of the future

ideas of acts of self-harm or suicide

disturbed sleep

diminished appetite

Question 24

What are the ddx of depression?

Answer 24

depressive disorders
recurrent depressive episode
dysthymia 
BPAD
cyclothymia 
schizoaffective disorder
secondary to general medical condition
secondary to psychoactive substance use
secondary to other psychiatric disorder

psychotic disorders
anxiety disorders
adjustment disorders
eating disorders
personality disorders
dementia

Question 25

Describe the prognosis of depression?

Answer 25

50-60% will recover within a year

chronic depression >2y occurs in 10-25%

5-15% will die by suicide

following an episode of depression: after 1 year 25% will have had a further episode
after 10 years - 75% will have had a further episode