FRAILTY SYNDROME
Frailty is defined as the loss of an individual’s ability to withstand
minor stresses because of decreased functional reserve of several
organ systems.
Two main criteria used in diagnosing frailty are Linda Fried/Johns
Hopkins Frailty Criteria and the Rockwood Frailty Index.
Five key elements form the core of the frailty cycle
Frailty is defined as the presence of three or more of following conditions
Unexplained weight loss (>5% over a year)
Poor endurance and energy (self-reported)
Poor strength (in lowest 20th percentile)
Slow walking speed (Poor “Get up and Go” test)
Low physical activity (lowest 20th percentile)
Identifying Frailty
•
•
Objective measures of physical function
Timed up and go (TUG) test (Fig. 8.3) >30 seconds: Fall risk
6-meter walk <5.8 seconds
Gait speed >6.0 seconds
6-minute walk <300 m: Mortality
<400 m: Functional Impairment
Fig. 8.3: Timed up and go (TUG) test.
DEMENTIA
Causes of dementia are given in Box 8.1.
Mini-Mental State Examination
For screening of cognitive impairments
Time required: 15 minutes
•
■
■
Mini-mental state examination test a broad range of cognitive
functions including orientation, recall, attention, calculation,
language manipulation, and constructional praxis.
Box 8.1: Causes of dementia.
Degenerative/inherited:
Alzheimer’s disease—60–70%
Neurodegenerative disorders: Frontotemporal dementia
(including Pick’s disease)—Lewy body disease, Parkinson’s
disease, Huntington’s disease
Vascular dementia (10–20%): Diffuse small vessel disease
Neoplastic: Primary/secondary deposits
Traumatic: Chronic subdural hematoma, post-head injury
Infections: Creutzfeldt–Jakob disease, human
immunodeficiency virus (HIV), syphilis
Toxic/nutritional: Alcohol, thiamine deficiency, vitamin B12
deficiency
Prion disease
Reversible dementia
For assessing cognitive impairment we use Mini-Mental State
Examination (MMSE), Montreal Cognitive Assessment (MoCA), and
Mini-Cog
TM.
Score Interpretation
27–30 Normal
20–26 Mild impairment
10–19 Moderate impairment
Below 10 Severe impairment
•
•
–
Montreal Cognitive Assessment
Montreal Cognitive Assessment (MoCA) is a 30-point test that is
more sensitive for the detection of mild cognitive impairment, and it
includes items that sample a wider range of cognitive domains
including memory, language, attention, visuospatial, and executive
functions.
Mini-Cog
TM
The Mini-Cog
TM serves as an effective triage tool to identify
individuals in need of more thorough evaluation. The Clock drawing
test (CDT) component of the Mini-Cog
TM allows clinicians to quickly
assess numerous cognitive domains including cognitive function,
memory, language comprehension, visual-motor skills, and executive
function and provides a visible record of both normal and impaired
performance that can be tracked over time.
The Clock Drawing Test
Ask patient to draw the face of a clock. After numbers are on the
face, ask patient to draw hands to read 10 minutes after 11:00 (or 20
minutes after 8:00).
INCONTINENCE
Involuntary loss of urine or stool in sufficient amount or frequency to
constitute a social and/or health problem.
Types of urinary incontinence and causes
Urge incontinence: Other names—detrusor hyperactivity, detrusor instability,
irritable bladder, and spastic bladder. Infection, tumor, stones, atrophic vaginitis or
urethritis, stroke, Parkinson’s disease, and dementia
Stress incontinence:
Hypermotility of bladder neck and urethra; associated with aging, hormonal
changes, trauma of childbirth or pelvic surgery
–
•
–
–
•
• •
• •
• •
■
■
■
■
■
■
■
■
Intrinsic sphincter problems; due to pelvic/incontinence surgery, pelvic
radiation, trauma, and neurogenic causes
Overflow incontinence:
Bladder outlet obstruction; stricture, benign prostatic hyperplasia (BPH),
cystocele, fecal impaction.
Noncontractile bladder (hypoactive detrusor or atonic bladder); diabetes,
multiple sclerosis (MS), spinal injury, and medications
Functional incontinence
FALLS IN THE ELDERLY (TABLE 8.1)
Table 8.1: Falls in elderly.
Intrinsic factors Extrinsic factors
Medical conditions Medications
Impaired vision and hearing Improper usage of assistive devices
Age-related changes Environment
Common pathologies associated with fall are given in Box 8.2.
Box 8.2: Common pathologies associated with fall.
Ophthalmologic diseases
Arthritis
Foot problems
Neurologic illness
Parkinson’s and related disorders
Strokes
Peripheral neuropathy
Dizziness and disequilibrium
•
•
•
•
Balance test
Done to asses the risk of falls
Side-by-side: Feet side-by-side, touching;
Semi-tandem: Side of the heel of one foot touching the big toe of
the other;
Tandem: Heel of one foot directly in front of and touching the toes
of the other foot.
Note: People unable to hold a position for 10 seconds are not asked
to attempt further stands.
Approach to Psychiatric
Illness
C H A P T E R
9
Dr Vaddi Rohit, Dr Sriraksha Nayak
1.
2.
3.
4.
1.
2.
3.
4.
1.
2.
3.
4.
5.
1.
CASE SHEET FORMAT
HISTORY TAKING
Name:
Sex:
Age:
Address:
Telephone No.:
Sociodemographic Data
Marital status:
Single
Married
Divorced.
Others___.
Religion:
Hindu
Muslim
Christian
Others.
Education:
Nil
Primary
Graduate
Postgraduate
Other
Specify qualification ___________.
Occupation:
Nonprofessional service
2.
3.
4.
5.
6.
1.
2.
3.
1.
2.
3.
•
•
Professional
Homemaker
Student
Retired
Other
Specify vocation _________.
Distance:
Local
Up to 100 km
Over 100 km.
Family:
Nuclear
Extended
Living alone.
Patients and informants report:
Reliability: Satisfactory/unsatisfactory
Adequacy of information: Adequate/inadequate.
History of Illness:
Presenting complaints and duration:
(Mention in chronological order).
History of presenting illness:
(Describe nature of onset as acute/subacute/insidious; precipitating
events; physical illness, pharmacological treatment, and psychosocial
events; evolution and course of each symptom, epiphenomena; relevant
negative history; and nature of treatment received during the course).
Past psychiatric illness:
(Describe past episodes symptoms and signs; deficits; treatment received;
response to treatment; compliance to treatment or reasons for poor
compliance if applicable; and probable diagnosis).
Total duration of illness:
Course of the illness:
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
(Continuous/episodic/remittent/episodic with progressive deficits/episodic
with stable deficits/incomplete remission/complete remission).
No. of episodes/exacerbations:
Past physical illness:
(Describe as in past psychiatric illness).
Family history:
(Enquire for consanguinity between parents).
Family tree:
(Family of origin up to three generations if possible).
Family history of mental illness:
(Specify mental illness/mental retardation/suicide/epilepsy/substance
abuse/abnormal or odd personalities. Also elicit history of dementia,
movement disorders, other neurological disorders, hypertension (HTN),
type 2 diabetes mellitus (T2DM), etc. where relevant. Attempt to obtain at
least two generations family history).
Premorbid personality:
How does he describe himself? What are his strengths and abilities? Is he
shy or makes friends easily? Are the relations close or lasting? Does he
always want to be the center of attraction? What is his mood like? Can he
express feelings of love, anger, frustration or sadness? Does he ever lose
control over his feelings? Has he been violent?
MENTAL STATUS EXAMINATION
General details of examination
Consciousness, rapport, and general behaviors
Cognitive status
Examination of thought
Mood and effect
Perception
Other psychiatric phenomenon
Other phenomena
Insight.
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
(Discussed below under the section Discussion on
examination)
GENERAL AND SYSTEMIC EXAMINATION
Vitals Examination
Pulse:
Respiratory rate:
Blood pressure:
Physical Examination
Pallor
Icterus
Cyanosis
Clubbing
Lymphadenopathy
Pedal edema.
Respiratory
Inspection:
Palpation:
Percussion:
Auscultation:
Cardiovascular System
Inspection:
Palpation:
Percussion:
Auscultation:
Gastrointestinal System
Inspection:
Palpation:
Percussion:
Auscultation:
•
•
•
•
•
•
•
No comments:
Post a Comment
اكتب تعليق حول الموضوع