class 8 (cognition) Flashcards
intact cognition
behaviour within normal range for age & culture
impaired cognition
disturbance in 1 or + cognitive processes
dementia and mental illness
is not a mental illness
proper DX is vital
appropriate & timely teratment
confusion & erratic behaviour
dementia being treated/medicated as a mental illness
does not necessarily work & can make symptoms worse
-react to medications different d/t age
-dx is difficult with overlapping symptoms
dementia & symptoms of depression
limited evidence for antidepressant to be effective
non-pharmacological interventions are prefered
reccomendation: pt with mild/ short duration depressive symptoms should be tx with psychosocial supportive interventions first
what is dementia
progressive deterioration in intellectual functioning, memory, problem solving skills, acquisition of new skills
decline in ADL involvement, emotional changes, hallucination & delusions
-develops gradually with ongoing decline
80-90% of cases are irreversible
primary source dementia
not reversible, progressive, not secondary to any other disorder i.e. alzheimer’s
what is pseudodementia
exhibiting s&s of dementia but cause is depression
secondary source dementia
occurs as a result of some other pathology i.e. AIDs relate dementia
can persons living with dementia have good mental health?
yes
mental illness=/=mental health
can have good and bad days
its possible to improve & tx people w dementia
how can we reduce stigma with dementia
may social isolate if feeling stigmatized=impacts mental health
advocate & educate to reduce stigma
Canada’s national dementia strategy
sets out a vision for the future and identifies common principles and national objectives to help guide actions by all levels of government, non-governmental organizations, communities, families, and individuals
grounded in evidence-based practice
alzhiemer’s disease
-form of dementia
-more common in females
-prevelance increasing with aging population
-full work up w physicla exam, FHx, environment, MSE,MMSE
-short, slow, clear, concise phrases, one at a time
-impacts: cognitive & functional abilities, emotions and moods, behaviours, physical abilities
-irreversible & NOT a part of aging
non-pharmacological interventions for dementia
CBT
DBT
safe environment
decrease stimuli,
awareness of social challenges
6 classes of med given for alzheimer’s disease
- cholinesterase inhibitors
- N-methyl-d-asparate (NMDA) anatgonist
3.antidepressants
4.antianxiety agents
5.antipsychotics
6.anticonvulsants
cholinesterase inhibitors for tx of alzheimer’s disease
donepezil (Aricept) (early middle and late. daily= increase tolerance)
Rivastigmine (Exelon) (early, middle. oral/trandermal patch to dec GI upset)
Galantamine hydrobriomide (Reminyl ER)
-block the breakdown of acetylcholine
side effects: GI upset, insomnia, muscle cramps, incontinence, bradycardia, syncope
NMDA antagonist for tx of alzheimer’s disease
memantine (Namenda)
reabsorption of glutamate
1st approved for mid-late stages
side effects: dizziness, agitation, headache, constipation, confusion
antidepressants for alzheimer’s disease
SSRI’s (citalopram, fluoxetine)
antianxiety agents for tx of alzheimer’s disease
lorazepam
oxasepam
antipsychotics for tx of alzheimer’s disease
olanzapine
risperidone
anticonvulsants for tx of alzheimer’s disease
carbamazepine
assessment & treatment for delirium in older adults
altered LOC/confusion->MSE
polypharmacy
psychosis
changes in supports/environment i.e. ICU
physical needs: self care, safety, nutrition
behaviour: unpredictable, odd, bizarre behaviour
tx immediately, very good assessment to catch early
check for UTI, no glasses/hearing aids
what is delirium?
medical emergency
more common among older persons
very common with adults who are in hospital
can be frightening
often not recognized or is misdiagnosed as another condition
confusion assessment method (CAM)
4 features: must have 1,2 & EITHER 3 OR 4
1. acute mental status changes
2.inattention (squeeze my hand when u hear a letter)
3.disorganized thinking (can correctly answer yes or no q’s)
4.level of consciousness
Canadian indigenous cognitive assessment (CICA)
uses two-eyed seeing to adapt cognitive screening tests for indigenous people
what is the issue with the mental health comission of canada
limited accessability
age limits to qualify of MH services
what are we doing with the mental health commission of canada
lead insentives & projects
decrease stigma
promote guidelines for services
increase capacity building
mental health concerns in individuals with down syndrome
increase risk for alzheimers
generalized anxiety
adhd (inc s&s in kids; irritability, repetativeness, anxiety)
asd
depression
neuropsychological problems
sleep related issues
ocd
behaviours: oppositional, impulsive, inattentive
depression in down syndrome kids & adults
environmental triggers can have a greater impact d/t sensitivity to change in environment
primary disabilities in fetal alcohol spectrum disorder
those most directly related to CNS damage cause by prenatal exposure to alcohol
examples: inconsistent memory & recall, inability to filter out environment or emotional stimuli, impulsivity & poor judgement
secondary disabilities in fetal alcohol spectrum disorder
not present at birth, occur later in life as a result of the primary disabilities
examples: mental health problems, substance misuse, disrupted school experience, poor academic achievement
pharamcological interventions for fetal alcohol spectrum disorders
stimulants; methylphenidate (ritalin) *inc activity
antidepressants; atomoxetine (strattera) *depression
antipsychotics; risperidone (risperdal) *aggression + behaviour
anxiolytics; clonidine (catapress) *sleep
nonpharmacological interventions for fetal alcohol spectrum disorders
interdisciplinary team involvement; SLP, OT, PT, mental health care
behavioural therapy
alternative approaches; meditation, art therapy etc
what is a dual diagnosis?
a diagnosis of both an intellectual disability and mental health problems
causes; issues with expressing thoughts & feelings, difficulty self reporting
learning disabilities impact on mental health
anxiety and depression
social isolation
low self-esteem
substance misuse
-affects organization, attention, retention
