Geriatric Psychiatry

Geriatric Psychiatry Indian Medical PG Question 1: Reversible dementia causes are all except-

• A. Subdural hematoma
• B. Myxedema
• C. Vitamin B12 deficiency
• D. Lewy body dementia (Correct Answer)

Geriatric Psychiatry Explanation: ***Lewy body dementia*** - **Lewy body dementia** is a **progressive neurodegenerative disease**, characterized by the abnormal accumulation of alpha-synuclein proteins (Lewy bodies) in the brain. - It is an **irreversible form of dementia**, meaning its cognitive decline cannot be halted or reversed. *Subdural hematoma* - A **subdural hematoma**, especially chronic, can cause **cognitive impairment** due to pressure on the brain [1]. - If diagnosed and treated early (e.g., surgical evacuation), the associated cognitive deficits can often be **reversed or significantly improved**. *Myxedema* - **Myxedema**, or severe hypothyroidism, can lead to **reversible cognitive dysfunction**, including memory impairment and slowed thinking. - Treatment with **thyroid hormone replacement** can reverse the dementia-like symptoms. *Vitamin B12 deficiency* - **Vitamin B12 deficiency** can cause a range of neurological symptoms, including **cognitive decline** and dementia-like symptoms [1]. - With timely and adequate **vitamin B12 supplementation**, the associated cognitive impairment can often be **reversed** [1].

Geriatric Psychiatry Indian Medical PG Question 2: Reversible dementia is seen in?

• A. Pick's disease
• B. Alzheimer's disease
• C. Hypothyroidism (Correct Answer)
• D. Subacute demyelination of spinal cord

Geriatric Psychiatry Explanation: ***Hypothyroidism*** - **Hypothyroidism** can lead to cognitive impairment, including memory loss, slowed thinking, and executive dysfunction, which are reversible with appropriate **thyroid hormone replacement therapy**. - This condition is often characterized by other systemic symptoms like fatigue, weight gain, and cold intolerance, which also improve with treatment. *Pick's disease* - **Pick's disease** is a type of **frontotemporal dementia** caused by progressive degeneration of brain cells, primarily in the frontal and temporal lobes. - It is a **neurodegenerative** disorder, meaning it is progressive and irreversible. *Alzheimer's disease* - **Alzheimer's disease** is the most common cause of dementia, characterized by the accumulation of **amyloid plaques** and **neurofibrillary tangles** in the brain [1]. - It is a **progressive and irreversible neurodegenerative disease** with no cure [2]. *Subacute demyelination of spinal cord* - **Subacute demyelination of the spinal cord** typically refers to conditions like **subacute combined degeneration** due to **vitamin B12 deficiency** [1]. - While this can cause neurological symptoms, including cognitive changes, its primary impact is on the spinal cord and peripheral nerves, and "dementia" in the classic sense is not the primary or defining feature of spinal cord demyelination itself, although B12 deficiency can cause broader cognitive issues [1].

Geriatric Psychiatry Indian Medical PG Question 3: What will be the Glasgow Coma Scale (GCS) score for a head injury patient who opens eyes to painful stimulus, uses inappropriate words, and localizes pain?

• A. 10 (Correct Answer)
• B. 14
• C. 8
• D. 12

Geriatric Psychiatry Explanation: ***10*** - The patient opens eyes to **painful stimulus (E2)**, uses **inappropriate words (V3)**, and **localizes pain (M5)**. - Summing these scores: **E2 + V3 + M5 = 10**. - This represents a **moderate head injury** (GCS 9-12). *14* - This score would require higher functioning in multiple domains. - Would need responses such as opening eyes to **speech (E3)**, **confused conversation (V4)**, and **localizing or obeying commands (M5-M6)**. - The described patient's responses do not reach this level of function. *8* - A GCS of **8 or less** indicates **severe head injury** requiring immediate **airway protection and intubation**. - The patient's ability to **localize pain (M5)** and use **inappropriate words (V3)** indicates a consciousness level above severe injury threshold. - This patient does not meet criteria for severe head injury. *12* - This score would require better responses in at least two categories. - Could include: opening eyes to **speech (E3)**, **confused conversation (V4)**, or **obeying commands (M6)**. - The patient's specified responses (E2 + V3 + M5) sum to only 10, not 12.

Geriatric Psychiatry Indian Medical PG Question 4: A drug is more likely to cause toxicity in elderly patients due to all of the following reasons except which of the following?

• A. decreased renal excretion of drugs
• B. decreased hepatic metabolism
• C. decreased volume of distribution (Correct Answer)
• D. increased receptor sensitivity

Geriatric Psychiatry Explanation: ***decreased volume of distribution*** - A **decreased volume of distribution** would generally lead to a higher peak plasma concentration for a given dose, potentially increasing drug effect and thus toxicity, particularly for **hydrophilic drugs**. - However, for drugs that primarily distribute into **fat** or have a large volume of distribution, age-related changes in body composition (e.g., increased body fat, decreased total body water) can actually lead to an **increased volume of distribution** for some lipophilic drugs. *decreased renal excretion of drugs* - **Aging** is associated with a decline in **glomerular filtration rate (GFR)** and **renal tubular function**, leading to reduced drug clearance. - This results in a longer **half-life** and accumulation of renally excreted drugs, increasing the risk of **toxicity**. *decreased hepatic metabolism* - Liver size, blood flow, and the activity of some **cytochrome P450 enzymes** may decrease with age. - This leads to reduced **first-pass metabolism** and slower systemic clearance of many hepatically metabolized drugs, increasing their **bioavailability** and plasma concentrations. *increased receptor sensitivity* - Elderly patients often exhibit altered **pharmacodynamic responses**, including **increased sensitivity** to certain drugs. - This means a lower concentration of the drug at the receptor site can produce a greater therapeutic or toxic effect, making them more susceptible to **adverse drug reactions**.

Geriatric Psychiatry Indian Medical PG Question 5: Which statement best describes the criteria for starting an urban community health center?

• A. Caters to a population of 1-1.5 lakh (Correct Answer)
• B. Referral center for 2-3 primary health centers
• C. Should have a 100-bed facility in metro cities
• D. No sub-district and district hospitals present in the area

Geriatric Psychiatry Explanation: ***Caters to a population of 1-1.5 lakh*** - An **urban community health center (UCHC)** is designed to provide comprehensive primary healthcare services to an urban population of **1 to 1.5 lakh**. - This population criterion ensures effective service delivery and proper resource allocation for a designated urban area. *Referral center for 2-3 primary health centers* - This description typically applies to a **sub-district hospital** or a higher-level facility, which serve as referral centers for multiple primary health centers. - A UCHC primarily focuses on direct provision of primary care, not usually acting as a referral hub for other primary care units. *Should have a 100-bed facility in metro cities* - A **100-bed facility** is characteristic of a larger hospital, such as a district hospital, not an urban community health center. - UCHCs typically have minimal or no inpatient beds, focusing on outpatient services and emergency care rather than extensive hospitalization. *No sub-district and district hospitals present in the area* - This statement is not a criteria for a UCHC; in fact, UCHCs often function within a healthcare system that includes larger hospitals for referral of complex cases. - The presence or absence of higher-level facilities does not define the necessity or establishment of a UCHC.

Geriatric Psychiatry Indian Medical PG Question 6: The most common cause of hyperthyroidism in a young female is?

• A. TSH-secreting pituitary adenoma
• B. Graves' disease (Correct Answer)
• C. Subacute thyroiditis
• D. Toxic multinodular goiter

Geriatric Psychiatry Explanation: ***Graves' disease*** - This is an **autoimmune disorder** where antibodies stimulate the thyroid gland, leading to **overproduction of thyroid hormones** [1], [2]. - It is the **most common cause of hyperthyroidism** in young to middle-aged women, making it highly probable in a young female patient [1], [2]. *Toxic multinodular goiter* - This condition is characterized by **multiple nodules** within the thyroid gland that autonomously produce thyroid hormones. - While a cause of hyperthyroidism, it is **more common in older individuals**, typically those over 50 years of age. *Subacute thyroiditis* - This is a **self-limiting inflammatory condition** of the thyroid often following a viral infection, causing a transient hyperthyroid phase due to the release of preformed hormones. - It presents with **painful thyroid enlargement** and is usually followed by a hypothyroid phase, which is different from sustained hyperthyroidism. *TSH-secreting pituitary adenoma* - This is a **very rare cause of hyperthyroidism** where a pituitary tumor produces excess **Thyroid-Stimulating Hormone (TSH)**, leading to thyroid overstimulation. - It is often accompanied by other symptoms of a pituitary mass like **headaches or visual field defects**, which are not implied here.

Geriatric Psychiatry Indian Medical PG Question 7: Type of schizophrenia with intellectual disability:

• A. Catatonic schizophrenia
• B. Pfropf schizophrenia (Correct Answer)
• C. Paranoid schizophrenia
• D. Hebephrenic schizophrenia

Geriatric Psychiatry Explanation: ***Pfropf schizophrenia*** - **Pfropf schizophrenia** is a historical term specifically used to describe a form of schizophrenia that develops in individuals with **pre-existing intellectual disability** (formerly termed mental retardation). - The term "Pfropf" is derived from German, meaning "grafted" or "engrafted," referring to schizophrenia being "grafted onto" pre-existing intellectual disability. - This term distinguishes it from other types of schizophrenia where intellectual disability is not a primary defining characteristic. - While this classification is largely historical (modern DSM-5 has removed schizophrenia subtypes), it remains relevant for older examination questions. *Catatonic schizophrenia* - Characterized primarily by prominent **psychomotor disturbances**, which can include stupor, catalepsy, waxy flexibility, mutism, and negativism. - While intellectual disability might coexist, it is not a defining feature of the catatonic subtype itself. *Paranoid schizophrenia* - Marked by the prominence of **delusions**, typically persecutory or grandiose, and **auditory hallucinations**. - Intellectual disability is not a core diagnostic criterion or a defining characteristic of this subtype. *Hebephrenic schizophrenia* - Also known as **disorganized schizophrenia**, this type is characterized by marked **disorganization of thought processes**, flat or inappropriate affect, and bizarre behavior. - While it often presents early and can lead to significant functional impairment, intellectual disability is not a defining feature; rather, the primary disturbance is in thought and emotion.

Geriatric Psychiatry Indian Medical PG Question 8: What is the first-line treatment for generalized anxiety disorder?

• A. SSRIs (Correct Answer)
• B. Antipsychotics
• C. Benzodiazepines
• D. MAO inhibitors

Geriatric Psychiatry Explanation: ***SSRIs*** - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are considered first-line pharmacological treatment for generalized anxiety disorder due to their efficacy and generally favorable side effect profile. - They work by increasing the levels of **serotonin** in the brain, which helps regulate mood and anxiety symptoms. *Antipsychotics* - **Antipsychotics** are primarily used to treat psychotic disorders like schizophrenia or severe mood disorders with psychotic features, not typically as first-line for generalized anxiety disorder. - Their significant side effect profile, including metabolic disturbances and movement disorders, makes them a less desirable choice for initial treatment of anxiety. *Benzodiazepines* - While effective for acute anxiety relief, **benzodiazepines** are generally not considered first-line for long-term management of GAD due to the risk of dependence, tolerance, and withdrawal symptoms. - They are often used for short-term relief or as an adjunct in the initial phase of treatment while awaiting the therapeutic effects of SSRIs. *MAO inhibitors* - **Monoamine Oxidase Inhibitors (MAOIs)** are older antidepressants with significant drug-drug and drug-food interactions (e.g., tyramine crisis), making them usually a last-resort treatment for severe mood disorders, not generalized anxiety disorder. - Their complex dietary restrictions and side effect profile preclude their use as a first-line option.

Geriatric Psychiatry Indian Medical PG Question 9: All of the following are true about bipolar disorder rapid cycling EXCEPT:

• A. Associated with hypothyroidism
• B. More common in males (Correct Answer)
• C. Often worsened by antidepressants
• D. Defined by ≥4 mood episodes per year

Geriatric Psychiatry Explanation: ***More common in males*** - **Rapid cycling** in bipolar disorder is actually **more common in females** than in males. - While overall prevalence of bipolar disorder is similar between sexes, rapid cycling and mixed features tend to be more frequent in women. *Defined by ≥4 mood episodes per year* - This is the correct definition of **rapid cycling** in bipolar disorder according to diagnostic criteria (DSM-5). - These episodes can be of major depressive, manic, hypomanic, or mixed types. *Often worsened by antidepressants* - **Antidepressants** can sometimes **induce mania** or **accelerate cycling** in vulnerable individuals with bipolar disorder. - This risk is particularly elevated in rapid cycling presentations, leading to caution in their use. *Associated with hypothyroidism* - There is a recognized association between **hypothyroidism** and **rapid cycling** in bipolar disorder. - Treating underlying thyroid dysfunction can sometimes help stabilize mood in these patients.

Geriatric Psychiatry Indian Medical PG Question 10: Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?

• A. Post-Traumatic Stress Disorder (PTSD)
• B. Phobic disorders (e.g., social anxiety disorder)
• C. Conversion disorder (functional neurological symptom disorder) (Correct Answer)
• D. Obsessive-Compulsive Disorder (OCD)

Geriatric Psychiatry Explanation: ***Conversion disorder (functional neurological symptom disorder)*** - **Conversion disorder** is characterized by neurological symptoms (e.g., paralysis, blindness) that are **incompatible with recognized neurological or medical conditions**, yet are not intentionally produced. - It falls under **somatic symptom and related disorders** because the primary features are physical symptoms causing distress or functional impairment, rather than being malingered or feigned. *Phobic disorders (e.g., social anxiety disorder)* - **Phobic disorders** are classified under **anxiety disorders** in the DSM-5, not somatic symptom and related disorders. - They are primarily characterized by **intense, irrational fears** of specific objects or situations, leading to avoidance rather than prominent physical symptoms without a medical cause. *Post-Traumatic Stress Disorder (PTSD)* - **PTSD** is classified under **trauma- and stressor-related disorders** in the DSM-5, distinguished by symptoms developing after exposure to a traumatic event. - Its core features include **intrusive memories, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity**, rather than unexplained physical symptoms. *Obsessive-Compulsive Disorder (OCD)* - **OCD** is classified under **obsessive-compulsive and related disorders** in the DSM-5. - It is primarily characterized by the presence of **obsessions (recurrent, intrusive thoughts)** and/or **compulsions (repetitive behaviors or mental acts)**, which are distinct from somatic symptoms.

Geriatric Psychiatry Flashcard 1 of 8

Question: _____ is a level of cognitive impairment, not severe enough to be called dementia and not mild enough to be called normal ageing process

Answer: Mild neurocognitive disorder

Geriatric Psychiatry Flashcard 2 of 8

Question: Alzheimer's disease is a type of _____cortical dementia

Answer:

Geriatric Psychiatry Flashcard 3 of 8

Question: Dementia with personality changes would point you to the diagnosis of _____

Answer: Pick's disease

Geriatric Psychiatry Flashcard 4 of 8

Question: _____ is the MC cause of death in mental disorder

Answer: alzheimer's disease

Extra Information: 

Geriatric Psychiatry Flashcard 5 of 8

Question: _____ dementia is characterized by behavioral and/or language symptoms early in the disease course

Answer: Frontotemporal

Geriatric Psychiatry Flashcard 6 of 8

Question: The onset of extreme self-neglect and hoarding in elderly individuals after the news of a life-threatening illness has been referred to as _____

Answer: Diogenes syndrome

Geriatric Psychiatry Flashcard 7 of 8

Question: _____ age is a risk factor for delusional disorders

Answer: Old

Geriatric Psychiatry Flashcard 8 of 8

Question: _____ is a feature of dementia where patients overreact and become agitated when confronted with their cognitive limitations or when facing changes in routine or environment.

Answer: Catastrophic reaction