Psych Vivas · Old age psychiatry — Lewy body dementias
DLB and PDD — structured clinical viva
Fellowship viva covering McKeith 2017, Emre PDD criteria, neuroleptic sensitivity, ChEI evidence, and safe psychosis management.
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Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the old-age psychiatry registrar. A 76-year-old man with fluctuating cognition, recurrent visual hallucinations, RBD, and mild spontaneous parkinsonism is labelled 'late-onset schizophrenia' and prescribed high-dose risperidone in ED. Discuss diagnosis (McKeith core features, 1-year rule, PDD distinction), differentials, work-up including biomarkers, neuroleptic sensitivity, ChEI choice with dosing/monitoring, psychosis pathway, RBD management, and prognosis/disposition.
Opening move
Structure: stop harmful prescribing → safety/risk → diagnosis (cores + 1-year rule) → differentials → investigations → ChEI plan with doses → psychosis ladder → RBD → prognosis. Do not debate nosology while high-potency dopamine blockade continues.[1][3]
References9ShowHide
- [1]McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium Neurology, 2017.PMID 28592453
- [2]Emre M, Aarsland D, Brown R, et al. Clinical diagnostic criteria for dementia associated with Parkinson's disease Mov Disord, 2007.PMID 17542011
- [3]McKeith I, Fairbairn A, Perry R, et al. Neuroleptic sensitivity in patients with senile dementia of Lewy body type BMJ, 1992.PMID 1356550
- [4]Emre M, Aarsland D, Albanese A, et al. Rivastigmine for dementia associated with Parkinson's disease N Engl J Med, 2004.PMID 15590953
- [5]Mori E, Ikeda M, Kosaka K Donepezil for dementia with Lewy bodies: a randomized, placebo-controlled trial Ann Neurol, 2012.PMID 22829268
- [6]Cummings J, Isaacson S, Mills R, et al. Pimavanserin for patients with Parkinson's disease psychosis: a randomised, placebo-controlled phase 3 trial Lancet, 2014.PMID 24183563
- [7]Pollak P, Tison F, Rascol O, et al. Clozapine in drug induced psychosis in Parkinson's disease J Neurol Neurosurg Psychiatry, 2004.PMID 15090561
- [8]Stinton C, McKeith I, Taylor JP, et al. Pharmacological Management of Lewy Body Dementia: A Systematic Review and Meta-Analysis Am J Psychiatry, 2015.PMID 26085043
- [9]McKeith I, O'Brien J, Walker Z, et al. Sensitivity and specificity of dopamine transporter imaging with 123I-FP-CIT SPECT in dementia with Lewy bodies Lancet Neurol, 2007.PMID 17362834