Old age psychiatry
Dementia, delirium, late-life depression and behavioural and psychological symptoms of dementia (BPSD).
High-yield points
Distinguish delirium (acute, fluctuating attention) from dementia (gradual, memory first) and depression (pseudodementia).
Cognitive screening: MMSE or MoCA; RUDAS is designed for culturally and linguistically diverse patients; KICA is for Aboriginal patients in remote areas.
Exclude reversible causes: B12, folate, thyroid, calcium, glucose, syphilis/HIV where relevant, neuroimaging.
BPSD: look for pain, constipation, infection and environmental triggers first; use non-drug approaches before medication.
Antipsychotics in dementia increase stroke and death risk; if used, short-term and reviewed.
Donepezil, rivastigmine and galantamine help some people with Alzheimer's disease.
Plan early: enduring power of attorney, guardianship and advance care directive while the person has capacity.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Antipsychotics in dementia | Used freely for agitation. | Non-drug approaches first. Risperidone is the only one PBS-subsidised for BPSD, limited to 12 weeks in Alzheimer's dementia. |
| Restraint | Not regulated in care homes. | Chemical and physical restraint in aged care are 'restrictive practices' needing consent, documentation and review. |
| Delirium | Recognised clinically. | Largely the same; screen with tools like the 4AT and find the cause. |
| Dementia support | Family carers. | GP-led with memory clinic referral; Dementia Australia; plan capacity and substitute decision-making early. |
Antipsychotics in dementia
India (MBBS)
Used freely for agitation.
Australia (AMC): what the exam expects
Non-drug approaches first. Risperidone is the only one PBS-subsidised for BPSD, limited to 12 weeks in Alzheimer's dementia.
Restraint
India (MBBS)
Not regulated in care homes.
Australia (AMC): what the exam expects
Chemical and physical restraint in aged care are 'restrictive practices' needing consent, documentation and review.
Delirium
India (MBBS)
Recognised clinically.
Australia (AMC): what the exam expects
Largely the same; screen with tools like the 4AT and find the cause.
Dementia support
India (MBBS)
Family carers.
Australia (AMC): what the exam expects
GP-led with memory clinic referral; Dementia Australia; plan capacity and substitute decision-making early.
The Australian context
Risperidone is the only antipsychotic PBS-subsidised for BPSD, limited to 12 weeks for severe symptoms in Alzheimer's dementia. Use of chemical and physical restraint in residential aged care is regulated as a 'restrictive practice' and needs consent and documentation.