AHAD II: Mental Health 2

Dementia

100

True of False:

Dementia is a normal part of aging 

False 

200

This term describes cognitive decline that is present without loss of functional independence.

Mild cognitive impairment (MCI)?

300

Early personality changes, disinhibition, and executive dysfunction are most characteristic of this dementia subtype

Frontotemporal Dementia

400

What important safety responsibility must clinicians address when a patient is diagnosed with dementia?

Assessing driving safety and fulfilling mandatory reporting requirements when cognition may impair driving.

500

Why is dementia considered a diagnosis of exclusion?

Reversible causes of cognitive impairment, such as delirium, depression, metabolic abnormalities, and medication effects, must first be ruled out.

Delirium

100

This cognitive deficit is the most consistent and defining feature of delirium.

Inattention

200

This subtype of delirium is characterized by lethargy, decreased responsiveness, and is frequently under-recognized.

Hypoactive delirium

300

Why is delirium considered a medical emergency in older adults?

Because it signals an acute underlying medical illness and is associated with increased morbidity, mortality, and long-term cognitive decline.

400

This validated bedside tool is most commonly used by non–mental health professionals to screen for delirium in clinical settings.

Confusion Assessment Method (CAM)

500

Why is delirium associated with increased long-term morbidity and mortality in older adults?

Delirium reflects acute cerebral decompensation and is linked to functional decline, institutionalization, and increased risk of future dementia.

Insomnia

100

What is the difference between short-term insomnia versus long-term insomnia?

Short term is due to stressors (ex. financial difficulty, divorce, etc.)

Long-term is persistent and disabling, usually associated with substance use disorder, or medical/psychiatric disorders such as depression 

200

Name 2 differential diagnosis for Insomnia

1) Alcohol or substance use disorder 

2) Major depressive disorder 

3) Medical problems --> chronic pain, anxiety, BPH, diuretic use, menopause 

4) Sleep disorder d/t work demand, social media scrolling, napping, emotional stressors (job loss, hospitalization)

300

What are some findings of transient insomnia?

Sleep problems (ex. jet lag)

Situational stress

Unfamiliar surrounding 

400

What should be asked in the history of a patient presenting with insomnia

• History of sleep problem --> 24 hours sleep-wake cycle, wake habit history, sleep hygiene history, meal and exercise times, ambient noise, and light and temperature
• Identify pattern --> trouble falling asleep, staying asleep, and early morning awakenings
• Ask about life stressors, drug and alcohol, marital and family problems
• Smoking, caffeine, meds
• R/O pregnancy or menopause (if female), prostatism (if male)

500

What is the criteria to diagnose insomnia?

Complains of sleep quality, quantity, timing for ≥3x/week for ≥1 month.

Substance Use

100

True or False: 

Suspect client has 'drug-seeking behaviour' if client knows exact drug for back pain/headache or presenting with repeated accidents 

True

200

Define substance withdrawal 

The development of a substance specific syndrome caused by the cessation of (or reduction in) substance use that has been heavy and prolonged.

300

What are some physical signs of substance use?

Needle track, "meth mouth", ruddy nose, spider angiomas 

400

Name 3 diagnostic tests for alcohol misuse / substance use

• Blood alcohol level
• Urine drug screen
• CBC, platelet count, electrolytes,
• Liver panel (overuse of acetaminophen found in combination with opiates)
• HIV or hepatitis
• Blood cultures (fever)
• Bone density (alcohol ++ increase osteoporosis risk)

500

How does DSM-5 diagnose substance use disorder

Based on a pattern of behaviours that are categorized into 4 groups:

• Impaired control --> Ex. can’t cut down, intensive desire, used in larger amount or longer period than intended
• Social impairment --> Ex. causing failure to meet personal and social obligations
• Risky use --> Ex. use in environments that its dangerous to use the substance, continued use despite knowledge or problems from substance
• Pharmacological criteria --> Ex. desire to use to mitigate withdrawal symptoms, increase dose needed for desired effect

Diagnoses = mild/moderate/severe substance use disorder (2-3/4-5/6+ S&S)

Screening & Diagnostics

100

What is a screening tool for delirium versus dementia 

Delirium: CAM

Dementia: MSE/mini MSE, clock draw test 

200

What is AUDIT / AUDIT-C used for?

Used for alcohol use disorder screening 

Alcohol use disorders identification test (condensed)

300

Name 3 types of diagnostic tests for Insomnia

CBC, electrolytes, TSH, FSH, LH, PSA, creatinine, urea

Drug screen

Urinalysis (if indicated)

Sinus x-rays

Sleep studies (R/O OSA)

400

What investigations may you order for dementia 

Labs:

- CBC, TSH, B12, Glucose (r/o reversible causes)

Imaging:

- CT (acute pathology)

- MRI (vascular changes)

500

What is the CAGE questionnaire/test for and what does it stand for?

To collect subjective data or substance use 

• CAGE test (2/4 = highly predictive of addiction)
• Have you ever tried to cut down on your alcohol/drug use?
• Do you get annoyed if someone mentions your use is a problem?
• Do you ever feel guilty about your use?
• Do you ever have an “eye-opener' first thing in the morning after you’ve been drinking or using the night before?

C - cut down

A - annoyed

G - guilty

E - eye opener