GeriQBank · Topic
Depression, anxiety, psychosis, substance use and sleep.
Set twice
SLEEP HYGIENE / PATHOPHYSIOLOGY OF INSOMNIA AND ITS MANAGEMENT — 15 MARKS ★ RECURRING NORMAL SLEEP AND CHANGES WITH AGE Sleep is a reversible state of reduced responsiveness to the environment, comprising non-rapid eye movement (NREM)…
Alcohol use disorder (AUD) is the commonest form of substance use disorder in older adults. Alcohol falls under socially sanctioned psychoactive substances, alongside medications (prescribed and non-prescribed) and illicit substances.…
Treatment of substance misuse is a multistage process integrating physical, psychological and social interventions. These should run concurrently, not consecutively, and must be acceptable to the individual and sensitive to the specific…
Set once
Pivot: pure pharmacology — drug classes, choice, dosing, adverse effects and duration. General principle. Antidepressants are just as effective in older people as in younger adults; tolerability, not efficacy, dictates the choice.…
It is never too late to quit. Epidemiological data show that even among people in their 70s, stopping smoking reduces mortality towards that of non-smokers within a short enough time to justify actively encouraging quitting. Benefits…
Depression Rating Scales in the Elderly A. 20 High-Yield Points Which Scale, and When A fundamental distinction must open the answer: - Screening scales (detect possible cases) — GDS, CES-D, PHQ-2 and PHQ-9 - Severity and monitoring…
In geriatric practice a 'sleep protocol' means a standardised, non-pharmacological package of measures used to promote sleep in older people — particularly hospitalised older people — so that sedative-hypnotic drugs can be avoided. It…
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asked to describe. Question 1. Mood disorders in late life [15 marks] Pivot: the whole mood-disorder spectrum and its classification. Depression-specific management is covered in Questions 2 to 4 and bipolar illness in Question 5. Scope…
Pivot: the full-spectrum essay, with a dedicated ECT section. See also Question 28 for ECT as a stand-alone note. Prevalence. Major depression affects 1–5% of community-dwelling elderly, but clinically relevant depressive symptoms occur…
Pivot: treatment framework only — the diagnosis is assumed established. Both the 7-mark and the condensed 6-mark version are given, since this question has appeared at both weightings. Principles of treatment. The indications mirror…
Definition and terminology. Older-age bipolar disorder (OABD) refers to bipolar disorder in those aged ≥50–60 years. Two groups exist — early-onset illness ageing into old age (about two-thirds) and late-onset disease with first episode…
Purpose. A screening — not diagnostic — instrument for depression in older adults, developed by Yesavage and Brink (1982). Its defining feature is that it deliberately excludes somatic items (appetite, sleep, weight, libido, energy)…
Suicide risk in older people, and the two clinical vignettes that test it in practice. Question 7. Suicide in elders and suicide risk assessment [7 marks] Magnitude. Suicide rates are higher in older adults than in most other age groups…
Recognise the diagnosis. She fulfils DSM-5 criteria for major depressive disorder, severe — anhedonia (lack of interest), anorexia, significant weight loss, insomnia, tearfulness, worthlessness and suicidal ideation for at least two…
Working diagnosis: Acute organophosphorus (anticholinesterase) compound poisoning, most probably deliberate self-poisoning — the combination of an agricultural setting, unconsciousness with profuse frothing (bronchorrhoea and…
The anxiety spectrum, from the general essay through GAD, phobias, OCD and the somatoform disorders. Question 10. Give an account of anxiety disorders and their management [15 marks] Core principle. Disabling anxiety symptoms are not a…
Pivot: GAD-specific, so as not to repeat the general anxiety essay in Question 10. Both weightings are given, since this question has appeared as both a 7-mark and a 6-mark note. Definition. GAD is excessive, difficult-to-control worry…
Definition. A phobia is a marked, persistent and excessive fear of a specific object, situation or activity, out of proportion to the actual danger, leading to avoidance and functional impairment. Types: specific phobia, social anxiety…
Definition. Obsessions are recurrent, intrusive, unwanted thoughts, images or urges causing marked anxiety and recognised as one's own. Compulsions are repetitive behaviours or mental acts performed to reduce that anxiety, according to…
Definition. Physical symptoms not fully explained by a medical condition, accompanied by excessive thoughts, feelings and behaviours about the symptoms, causing distress and impairment. DSM-5 renamed this group "Somatic Symptom and…
delusional disorder. Each answer is written to its own pivot so that the three do not repeat one another. Question 15. Late-life psychotic disorders [7 marks] Pivot: the differential diagnosis and classification of psychosis in old age…
Pivot: the schizophrenia spectrum of late life — LOS and VLOSLP — and how it differs from early-onset disease. Definitions and terminology (International Late-Onset Schizophrenia Group consensus). Late-onset schizophrenia (LOS) = onset…
Pivot: delusional disorder as a discrete diagnosis, with its subtypes and its distinction from the wider late-life psychosis differential in Question 15. Definition. Persistent non-bizarre delusions lasting ≥1 month, without prominent…
agitation. Question 18. Grief, bereavement and complicated grief [7 marks] Definitions. Bereavement is the objective fact of loss; grief is the emotional response; mourning is its social and cultural expression. Anticipatory grief…
Pivot: normal, non-pathological ageing of personality, trait accentuation, and organic personality change. Personality disorder proper is Question 20. Normal ageing of personality. Personality is largely stable across the lifespan; the…
Pivot: the diagnosable personality disorders, their clusters and their ageing course. Normal age-related personality change is Question 19. Definition. An enduring, pervasive and inflexible pattern of inner experience and behaviour that…
Definition. Diogenes syndrome, also called senile squalor syndrome or severe social breakdown syndrome, is characterised by the tetrad of extreme self-neglect, domestic squalor, social withdrawal and refusal of help, usually accompanied…
Scale and rationale. Agitation and aggressive behaviours will be seen at some point in almost all individuals with dementia, and behavioural and psychological symptoms of dementia are the commonest psychiatric problem in nursing homes.…
Alcohol, prescribed sedatives, tobacco and the wider substance-misuse question. Question 23. Alcoholism in the elderly [7 marks] Definition and classification. Alcohol use disorder is a problematic pattern of use causing clinically…
Scale of the problem. Benzodiazepines are among the most prescribed drugs in old age — about 10% of community-dwelling over-65s, and up to 25% of nursing-home residents. Roughly 70% of users continue two to four years later, and women…
Pivot: prescribed, over-the-counter and illicit substances other than alcohol. Alcohol is Question 23 and benzodiazepines Question 24. Three broad categories (textbook classification). (a) Medications — prescribed (benzodiazepines,…
The three therapeutic modalities asked as stand-alone notes. Question 27. Atypical antipsychotics — their uses and side effects in the elderly [7 marks] Definition and mechanism. Second-generation ("atypical") antipsychotics act by…
Pivot: ECT as a complete stand-alone answer — technique, consent, adverse effects and continuation treatment. Its role specifically within depression is also covered in Question 2. Definition and utilisation. ECT is the delivery of a…
Definition and model. CBT is an active, structured, time-limited, goal-directed psychotherapy that aims to change the thinking and behaviour that maintain a disorder. It rests on the cognitive model — a situation triggers an automatic…
Normal ageing changes. Men — slower erection, reduced rigidity, longer refractory period, reduced ejaculatory volume. Women — vaginal dryness, atrophy, dyspareunia, reduced elasticity (genitourinary syndrome of menopause, GSM). Sexual…