phychatric

• Insight


  The degree to which a patient understands the nature and extent of his or her own illness
• Levels of insight


  • Complete denial of illness
  • Progressive levels of insight into knowing that there is something wrong within them that needs to be addressed
• Hallucinations


  Perceived objects and images that differ from reality and are triggered by external cues
• Neurocognitive disorder


  • Disturbance in attention that makes it difficult for the individual to direct, sustain and shift their focus
  • Reduced orientation to their environment, and at times to oneself
• Delirium


  Reduced level of consciousness or confusional state, although disturbance in awareness is a more accurate description
• Development of delirium


  1. Develop over hours to days

  2. Typically fluctuate in the course of the day

  3. Worsen at evening
• Cause of delirium


  Direct physiological consequence of another medical condition, substance intoxication or withdrawal, or exposure to a toxin, or is due to multiple aetiologies
• Types of delirium


  • Substance intoxication delirium
  • Substance withdrawal delirium
  • Medication-induced delirium
  • Delirium due to another medical condition
• Delirium accelerates the ageing of the brain, elevates the risk of dementia in predisposed individuals and can mask prior cognitive impairment not yet diagnosed
• Major risk factors for delirium


  • Alcohol abuse
  • Advanced age above 70 years
• Other risk factors for delirium

  • Dementia
  • Polypharmacy
  • Sedatives
  • Analgesics
  • Anticholinergic drugs
  • Infections
• Hospital Elder Life Program (HELP)


  Cognitive impairment management, sleep hygiene, early mobility, visual and hearing support, hydration
• HELP seems to have no impact on severity and recurrence of delirium once it has developed
• Antipsychotics and neuroleptics


  Routinely used medication to treat delirium
• Mechanism of action of antipsychotics

  • Blocks cortical and nigrostriatal dopamine receptors (D2 antagonist), and disinhibits acetylcholine
• Initiation of antipsychotics


  Initiated at smallest dose for shortest period
• Side effects of antipsychotics

  • Extrapyramidal symptoms
  • Akathisia
  • Neuroleptic malignant syndrome
  • Tardive dyskinesia
  • Glucose and cholesterol changes
  • Cardiac arrhythmias
  • Venous thromboembolism
• Effective and safe antipsychotics

  • Amisulpride
  • Quetiapine
  • Olanzapine
  • Risperidone
• There is no significant difference in efficacy and safety between typical and atypical antipsychotics for delirium treatment
• Cognitive domains affected in dementia

  • Complex Attention
  • Executive Functions
  • Memory
  • Language
  • Motor Abilities
  • Social Skills
• Basis for assessment


  Collateral information including self-report and standardized neuropsychological testing or quantified clinical assessment
• Biochemical problems in Alzheimer's disease

  Abnormal proteins called amyloid plaques and neurofibrillary tangles inside brain cells
• Neuronal tangles


  • Stained with an antibody to Tau (T)
• Amyloid plaques


  • Detected by applying an antibody to Beta A4 amyloid which stains the antigen brown
• Alzheimer's disease


  • Enlarged temporal horns due to hippocampal atrophy
  • Volume loss in the hippocampus, entorhinal cortex, parietal and lateral posterior superior temporal regions, and medial posterior portion of the cingulate gyrus
• Acetylcholine in Alzheimer's disease

  • Markedly reduced concentration in hippocampus and neocortex, caused by degeneration of cholinergic neurons
  • Essential in learning and memory
• Dementia with Lewy bodies


  • Fluctuating cognition with alternating alertness/coherence and unresponsiveness/confusion
  • Hallucinations and delusions are common
  • Short-term memory may be preserved
  • Rigidity occurs early and tremors occur later
• Frontotemporal Lobar Dementia with Ubiquitinised inclusions


  • Dot like deposition of ubiquitin in the hippocampal dentate fascia
• Semantic dementia


  • Significant left temporal atrophy
• Nonfluent variant of Frontotemporal Dementia


  • Significant left insular atrophy
• Frontotemporal Dementia


  • Reduced frontal lobe volumes compared to age-matched controls
  • Volume loss in the ventromedial frontal cortex, the posterior orbital frontal regions, the insula, and the anterior cingulate cortex
• Normal Pressure Hydrocephalus


  • Gait disturbance (unsteady balance), urinary incontinence, and enlarged brain ventricles
  • Improvements after removal of CSF
• People differ in the speed in which their abilities deteriorate. Some may change from day to day, while others may decline slowly over a number of years
• Not all features will be present in every person, nor will every individual go through every stage
• Things that improve health as one ages

  • Eating well
  • Exercising
  • Keeping the mind active
  • Seeing the physician for regular check-ups and for special screenings and examinations
• Episodes of depressed mood


  Associated with loss of interest in daily activities
• Psychomotor disturbances


  • Increased or decreased activity, which occur during most of the depressive episode
• Psychotic features


  Delusions (false, fixed beliefs) and hallucinations (false sensory perceptions), which can occur at any time during a depressive episode
• Seasonal affective disorder


  1. Regular temporal relationship between the onset of major depressive episodes and a particular time of year, for the past two years

  2. Remission also occurs at a specific time of year (e.g. episodes may begin in winter and remit in summer)
• Bereavement


  The fact of the loss