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  #1  
Old 03-17-2011
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Psyche memory problems

enjoy this............
plz no more than min in the 1st time u answer it to assess urself (of course if u wish........::!!)

then think about it after that as u wish....................:

A 74-year-old woman is evaluated for memory problems. The family is concerned that she has become progressively forgetful over the past 4 years, and they have learned she has not paid her electric bill for 4 months. When she is offered help, she becomes agitated. She describes her only problem as difficulty sleeping over the past 2 months.

The patient completed seventh grade and worked as a home health aid for many years until her retirement 9 years ago. She raised two sons, and her husband died 4 months ago. She now lives alone in her home of 20 years. Both of her parents lived into their 80s, with reported cognitive decline before they died.

On physical examination the patient is friendly and dressed neatly. Her speech is regular but slowed. Neurological examination is normal, and her gait is steady. Her Mini-Mental State Examination score is 20/30. Her responses were as follows: Correct response to year, season, and day; however, she says it is January 31 when it is actually February 1. Correct response to state, town, and county, but does not know medical office building’s name, address, or floor. Correct registration of three objects; subtracted serial sevens as 100-93-87-81-73; recalled two of three objects; Repeated “No ifs, ands, or buts” as “No if, and, or but”; completed only two steps of a three-step command; read and obeyed “Close your eyes”; wrote “I feel fine”; correctly copied the intersecting pentagons.

What is the appropriate next step in the management of this patient?
( A ) Neuropsychiatric evaluation
( B ) Donepezil
( C ) Screen for depression
( D ) No intervention
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  #2  
Old 03-17-2011
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Psychomotor agitation, sleep problems and recent death with symptoms lasting >4 months requires a screen for depression. After all Alzheimer's is a diagnosis of exclusion.
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  #3  
Old 03-17-2011
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Yes agree with Tkourkou.

In addition, "slow" perhaps suggests depression. I think this is a case of pseudo dementia. Very important to rule out depression which is treatable before making the final diagnosis of dementia.

Thanks. Good one!

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Originally Posted by tkourkou View Post
Psychomotor agitation, sleep problems and recent death with symptoms lasting >4 months requires a screen for depression. After all Alzheimer's is a diagnosis of exclusion.
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  #4  
Old 03-17-2011
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I likeeeeeeeeee
im going into psychiatry ! depression depression depresssion ! she is still brieving
Quote:
Originally Posted by cerebrum85 View Post
enjoy this............
plz no more than min in the 1st time u answer it to assess urself (of course if u wish........::!!)

then think about it after that as u wish....................:

A 74-year-old woman is evaluated for memory problems. The family is concerned that she has become progressively forgetful over the past 4 years, and they have learned she has not paid her electric bill for 4 months. When she is offered help, she becomes agitated. She describes her only problem as difficulty sleeping over the past 2 months.

The patient completed seventh grade and worked as a home health aid for many years until her retirement 9 years ago. She raised two sons, and her husband died 4 months ago. She now lives alone in her home of 20 years. Both of her parents lived into their 80s, with reported cognitive decline before they died.

On physical examination the patient is friendly and dressed neatly. Her speech is regular but slowed. Neurological examination is normal, and her gait is steady. Her Mini-Mental State Examination score is 20/30. Her responses were as follows: Correct response to year, season, and day; however, she says it is January 31 when it is actually February 1. Correct response to state, town, and county, but does not know medical office building’s name, address, or floor. Correct registration of three objects; subtracted serial sevens as 100-93-87-81-73; recalled two of three objects; Repeated “No ifs, ands, or buts” as “No if, and, or but”; completed only two steps of a three-step command; read and obeyed “Close your eyes”; wrote “I feel fine”; correctly copied the intersecting pentagons.

What is the appropriate next step in the management of this patient?
( A ) Neuropsychiatric evaluation
( B ) Donepezil
( C ) Screen for depression
( D ) No intervention
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Old 03-17-2011
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Quote:
Originally Posted by futureharvard View Post
I likeeeeeeeeee
im going into psychiatry ! depression depression depresssion ! she is still brieving
Normal grieving is up to 2 months according to Kaplan, so I guess she passed the stage of normal grief
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  #6  
Old 03-17-2011
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Default about grief

quoted from the kubler-ross model of grief
"the grief process is highly personal and should not be rushed, nor lengthened, on the basis of an individual's imposed time frame or opinion. One should merely be aware that the stages will be worked through and the ultimate stage of "Acceptance" will be reached.
btw we would like to know the real answer to this question !
Quote:
Originally Posted by tkourkou View Post
Normal grieving is up to 2 months according to Kaplan, so I guess she passed the stage of normal grief
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Old 03-17-2011
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Quote:
Originally Posted by futureharvard View Post
quoted from the kubler-ross model of grief
"the grief process is highly personal and should not be rushed, nor lengthened, on the basis of an individual's imposed time frame or opinion. One should merely be aware that the stages will be worked through and the ultimate stage of "Acceptance" will be reached.
btw we would like to know the real answer to this question !
I think that putting a time bracket on normal grieving is not rushing the process (it is an observation, not a prescription); rather, it is giving a point at which we start to look for other things like depression.
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Old 03-18-2011
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Correct Answer Correct Answer = C

THX 4 all of u ... that was a great thinking which is totally right.......

in the answer .. there is some addition 2 ur great knowledge...
here is the answer of the Q as was written

Educational Objective :
Distinguish between mental impairment and depression in an elderly patient.


Critique (Correct Answer = C)

The Mini-Mental State Examination score ≤ 23 implies cognitive impairment for people with a ninth grade or higher education; however, scores of 18 to 23 may be normal for people with less formal education. In particular, nonworking people may be less aware of the specific date, serial sevens are incorrectly performed by almost 50% of people, and the “s” in “no ifs, ands, or buts” may not be heard by people with presbycusis. This patient, however, has had several losses recently and appears to be less attentive, not paying bills or knowing the location of her current appointment, suggesting that she may be depressed, with concentration impairment and less motivation. There are several screening tools for depression, including the Geriatric Depression Scale. If the results of the screening test for depression are not suggestive of depression, a neuropsychiatric evaluation may be helpful diagnostically.


References
Molloy DW, Standish TIM. A guide to the standardized Mini-Mental State examination. Int Psychogeriatr. 1997; 9 Suppl 1:87-94. PMID: 9447431 [PubMed]
Yesavage JA. Geriatric Depression Scale. Psychopharmacol Bull. 1988;24:709-11. PMID: 3249773 [PubMed]
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