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Psychiatric Principles > Cognitive Disorders > Flashcards

Cognitive Disorders Flashcards

1
Q

Common features of Cognitive Disorders (10)

A 
Impaired judgment
Lack of initiative
Hallucinations
Loss of memory/recall
Trouble with orientation
Impaired impulse control
Confabulation
Emotional lability
Short attention span
Impaired problem solving
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2
Q

Delerium DSM-IV Criteria

A

an ACUTE, RAPIDLY progressive change in cognition characterized by INATTENTION & DISTURBANCE OF CONSCIOUSNESS in which symptoms FLUCTUATE over the course of 24 hours

  • altered level of arousal
  • memory impairment
  • disorientation
  • perceptual disturbance
  • language disturbance/incoherent speech
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3
Q

9 risk factors for delerium

A 
Cognitive impairment
Age >70
poor functional status
hearing/visual impairment
dehydration
sleep deprivation
metabolic derangement
infection
polypharmacy
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4
Q

3 Types of Delirium & prevalence

A

Hyperactive (41%)
Hypoactive (11%)
Mixed disorder (48%)

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5
Q

Signs & sxs of delirium

A

Hyperactive: hallucinations, delusions, agitation, combativeness, incoherent, rambling speech, disturbed sleep-wake cycle, hypersensitivity to light/sound

Hypoactive: (subtle, often overlooked, misdxd), inattention, sedation, depressed, withdrawn, loss of appetite, affective flattening

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6
Q

Delirium DDx

A

Delirum 2* to medical condition, substance abuse/withdrawal
Substance intoxication
Substance withdrawal
Dementia
Psychiatric disorder: psychotic d/o, schizophrenia, mood d/o w/psychotic features
Malingering/Factitious d/o

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7
Q

Assessment of Delirium

A 
Primary Survey:
good history & physical: medical records, nursing records, medication history, outside informant
mental status testing
Secondary survey
Thorough medical workup
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8
Q

Often helpful in assessment of delirium

A 
history
physical exam
mental status testing
CBC
metabolic panel
Urinalysis
EKG
CXR
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9
Q

Not always necessary in assessment of delirium but helpful if suggested by history/physical

A

EEG (often shows “diffuse slowing”)
CT scan
Cultures without known source
Lumbar puncture

Helpful if suggested by history/physical

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10
Q

MMSE includes evaluation of: (8)

A 
Orientation to time & place
Recall
Registration
Attention & Calculation
Recall
Language
Repetition
Complex commands
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11
Q

MMSE scoring/degrees of cognitive impairment

A

27-30: none
21-26: mild
11-20: moderate
<10: severe

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12
Q

Principles of Delerium tx (5)

A
  • TREAT UNDERLYING MEDICAL ETIOLOGY
  • maintain stability in patient’s environment
  • avoid use of restraints
  • ID/eliminate offending meds (benzos, tramadol, opiates, anticholinergics, H2 blockers [Pepcid])
  • educate family & caregivers
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13
Q

Non-Pharmacologic Tx of delirium

A
  • replace hearing aids/glasses
  • private room
  • around the clock attendant/sitter
  • calm & reassuring behavior
  • reorienting devices
  • re-establish sleep/wake cycle
  • educate family
  • expedite return to familiar environment
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14
Q

Indications for pharmacologic tx of delirium (3)

A
  1. Severe agitation
  2. Combative behavior
  3. Behavior that severely interferes with care
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15
Q

Pharmocoligical Tx of Delirium (large categories)

A 
BLACK BOX WARNING
Traditional antipsychotic (Haloperidol)
Atypical antipsychotics (Zyprexa, Seroquel, Risperdal)
Benzos-avoid at all costs b/c of deleterious cognitive SEs
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16
Q

Haloperidol: class, use, MOAdministration, SEs

A

traditional antipsychotic (used in tx of delirium)

  • available IV/IM/PO
  • extrapyramidal side effects likely (txd w/Cogentin)
  • prolonged QT interval
17
Q

Zyprexa: class, use, MOAdministration, SEs

A

atypical antipsychotic used in delirium
IM/PO/SL
fewer extrapyramidal side effects (than Haldol)
less likely to prolong QT interval

18
Q

Seroquel: class, use, MOAdmin, SEs

A

atypical antipsychotic used in delirium
PO
fewer extrapyramidal side effects (than Haldol)
less likely to prolong QT interval

19
Q

Risperdal

A

atypical antipsychotic used in delirium
PO [in real life, also IM but not mentioned on slide]
fewer extrapyramidal side effects (than Haldol)
less likely to prolong QT interval

20
Q

Antipsychotic Tx of Delirium considerations

A 
no good alternatives
use for appropriate reasons
get baseline EKG
correct electrolytes
"start low and go slow"
monitor BP/orthostatics
EDUCATE FAMILY, enabling informed consent
21
Q

Benzodiazepines in tx of Delirium-considerations

A 
deleterious cognitive side effects-avoid at all costs
can worsen depression
over prescribed
often cause delirium
indicated for alcohol/drug delirium
22
Q

Delirium Prevention

A

mainly don’ts
close monitoring/assisted living
modify known risk factors

23
Q

Delirium Special Considerations

A

Post Operative Delirium
Sundowning
Alcohol withdrawal/Delirium Tremens

24
Q

What 3 things can contribute to sundowning

A

precipitated by hospitalization
sensory deprivation
medications

25
Q

Alcohol withdrawal/Delirium Tremens: signs & who is it seen in

A

MEDICAL EMERGENCY
signs of DT: extreme autonomic hyperactivity WITH delirium
later signs of DT: confusion, psychosis, agitation & seizures
-mainly seen in heavy & long standing drinkers, patients with prior detoxifications, seizures or DTs

26
Q

What is Dementia?

A
  1. an ACQUIRED, CHRONIC, PROGRESSIVE decline consisting of MEMORY IMPAIRMENT and ONCE OR MORE of the following:
    -aphasia
    -apraxia
    -agnosia
    -disturbance in executive functioning
  2. deficits are severe enough to cause fxnl impairment
  3. Delirium not present
    IRREVERSIBLE
27
Q

4 Causes/categories of Dementia & percentage

A
  1. Alzheimer’s disease (AD)- 50%
  2. Vascular dementia- 25%
  3. Dementia due to neurodegenerative process (Lewy body dz-15%, Parkinson’s dz, frontotemporal-Pick’s dz)
  4. Dementia 2* to general medical condition (Huntington’s dz, TBI, infections, anoxia, Creutzfeldt-Jakob dz, HIV, MS)
28
Q

Neurodegenerative dz which may cause dementia (3)

A

Lewy body dz
Parkinson’s disease dementia
Frontotemporal degeneration (Pick’s disease)

29
Q

Alzheimer’s Dementia age

A

typically develops after 50

Under 65 referred to as “EARLY ONSET”

30
Q

Alzheimer’s Demential progression

A

slowly progressing

typically lose 3 points/year on MMSE

31
Q

Alzheimer’s Dementia higher rates in

A
  • higher rates in patients w/repeated head trauma & Down’s syndrome
  • familial component
32
Q

AD late findings (2)

A

Myoclonus

gait disorder

33
Q

AD imagint

A

CT
MRI
Histopathology

34
Q

Parkinson’s Dementia: prevalence & characteristics

A

20-60% of Parkinson’s patients
exacerbated by depression
Tremor, rigidity, bradykinesia & postural instability common
Micrographia, slow movements, cogwheel rigidity on exam

35
Q

Demential w/ Lewy Bodies presentation

A

Parkinson’s features +visual hallucinations

36
Q

Pick’s Disease presentation

A

changes in personality/behavioral disinhibition

prominent primitive reflexes on exam

Psychiatric Principles (3 decks)

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