504-505 Cognitive d/o, delirium, dementia, psychosis, schizo, delusional Flashcards
What are the components of cognition?
memory, attention, language, and judgment
What are the effects of delirium on:
- consciousness
- attention span
- level of arousal
- thinking
- sleep
- cognition
- “waxing and wanning” level of consciousness with acute onset
- rapid ↓ in attention span
- rapid ↓ in level of arousal
- disorganized thoughts, hallucinations, illusions, misperceptions
- disturbance in sleep-wake cycle
- cognitive dysfunction
What are the causes of delirium?
Usually secondary to other illness:
- CNS diseases, infection, trauma, substance abuse/withdrawal, metabolic/electrolyte disturbances, hemorrhage, urinary/fecal retention
What is dementia?
Gradual ↓ in intellectual ability or “cognition” w/out affecting level of consciousness
What are the symptoms of dementia?
memory deficits, aphasia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement
What are irreversible causes of dementia?
Alzheimer disease, Lewy body dementia, Huntington disease, Pick disease, cerebral infarcts, CJD, chronic substance abuse (→ neurotoxicity)
Reversible causes of dementia:
NPH, vitamin B12 deficiency, hypothyroidism, neurosyphilis, HIV (partially)
dementia epidemiology:
incidence ↑ w/ age
EEG findings in dementia:
abnormal
In elderly patients, what can mimic dementia? What is this called?
depression; psuedodementia
What is psychosis?
a distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking
What kinds of patients are affected by psychosis?
patients with medical illness, psychiatric illness, or both
Hallucinations are:
perceptions in the absence of external stimuli (e.g. seeing a light that is not actually present)
Delusions are:
unique, false beliefs about oneself or others that persist despite the facts (e.g. thinking aliens are communicating with you)
What is disorganized speech?
Words and ideas ares strung together based on sounds, puns, or “loose associations”
What are the types of hallucination?
Visual, auditory, olfactory, gustatory, tactile, hypnagogic, and hypnopompic
What type of hallucination is more commonly associated with medical illness than psychiatric illness?
Visual hallucinations
What type of hallucination is more commonly associated with psychiatric illness than medical illness?
Auditory hallucinations
When do olfactory hallucinations usually occur?
as an aura of psychomotor epilepsy and in brain tumors
When do tactile hallucinations commonly present?
alcohol withdrawal (e.g. formication - sense of bugs crawling on one’s skin) and cocaine abusers (“cocaine crawlies”)
When do you see hypnagogic hallucinations?
When you GO to sleep
When do you see hypnapompic hallucinations?
When you wake up
What is schizophrenia?
A chronic mental disorder with periods of psychosis, disturbed behavior and thought, and decline in functioning that lasts > 6 months.
What abnormal level of what neurotransmitter activity is found in schizophrenia?
↑ dopaminergic activity
What is the effect of schizophrenia on neurons?
↓ dendritic branching
What are the positive symptoms of schizophrenia?
- Delusions
- Hallucinations - often auditory
- Disorganized speech (loose associations)
- Disorganized or catatonic behavior
What are the negative symptoms of schizophrenia?
- flat affect
- social withdrawal
- lack of motivation
- lack of speech or thought
What is the etiology of schizophrenia
genetics and environment contribute
Lifetime prevalence and groups affected by schizophrenia:
1.5% (♂ = ♀ ; black = white)
When does schizophrenia present in males?
late teens - early 20s
When does schizophrenia present in females?
late 20s to early 30s
What is a complication of schizophrenia?
↑ risk for suicide
How many positive and negative symptoms must be present for a diagnosis of schizophrenia? For how long?
2 or more symptoms, positive or negative; for > 6 months
What is an environmental association with the onset of schizophrenia in teenagers?
frequent cannabis use
What is the disorder called when schizophrenia symptoms are present for < 1 month?
brief psychotic disorder
What is the diagnosis for schizophrenia symptoms lasting for 1-6 months?
schizophreniform disorder
What is schizoaffective disorder?
at least 2 weeks of stable mood with psychotic symptoms + a major depressive, manic, or mixed episode
What are the subtypes of schizoaffective disorder?
bipolar and depressive
What is delusional disorder?
Fixed, persistent, untrue belief system lasting > 1 month. Functioning otherwise not impaired.
