Dementia, Delirium, Depression Flashcards
1
Q
delirium (pg 274)
A
acute confusional state or acute brain failure
- neurological changes common among medically ill, often misdiagnosed as a psychiatric illness
- can result in delay of appropriate medical intervention
- significant mortality associated with delirium so identifying it is crucial
2
Q
delirium clinical signs
- language
- speech disturbances
- memory dysfunction
- perceptions
A
- develops acutely (hours to days)
- characterized by fluctuating level of consciousness
- reduced ability to maintain attention
- agitation or hypersomnolence
- extreme emotional lability
- cognitive deficits can occur
1. language: word finding difficulties, dysgraphia
2. speech disturbances: slurred, mumbling, incoherent or disorganized
3. memory dysfunction: marked short-term memory impairment, disorientation to person/place/time
4. perceptions: misinterpretations, illusions, delusions, and/or visual (more common) or auditory hallucinations
3
Q
delirium etiology
A
- meds: any psychoactive meds - anticholinergics - analgesics - steroids - antiparkinson - sedatives - anticonvulsants - antihistamines - antiarrhythmic - antihypertensive - andidepressants - antimicrbials - sympathomimetics
- systemic illnesses: infections and electrolyte abnormalities - endocrine dysfunction (hypo or hyper) - liver or renal failure -pulmonary disease with hypoxemia - CVD (arrhythmias, MI, CHF) - CNS pathology (tumors, stroke, seizures) - deficiency states (thiamine, nicotinic or folic acid, B12)
- precipitating risk factors: severe acute illness - UTI - hyponatremia - hypoxemia - shock - anemia - pain - orthopedic/cardiac surgery - ICU admission - lots of hospital procedures
4
Q
delirium pathophysiology
A
- neurotransmitter abnormalities
- inflammatory response with increased cytokines
- changes in the blood-brain barrier permeability
- widespread reduction of cerebral oxidative metabolism
- increased activity of hypothalamus, pituitary, adrenals
5
Q
delirium testing
A
- MMSE (mini mental status exam) is NOT sensitive in identifying delirium however repeated MMSEs can reveal waxing and waning course
- most sensitive items are serial 7’s, orientation, and recall memory
- tests of attention: serial 7’s, spelling “WORLD” backwards, months of the year backward, and counting down from 20
6
Q
dementia vs delirium
A
- dementia: intact alertness and attention - insidious onset - tends not to fluctuate - chronic memory and executive function disturbance
- delirium: decreased level of alertness - cognitive changes develop acutely and fluctuate - disorientation - recent medical illness or treatment - age > 40 without prior psych history
7
Q
affective (mood) disorders (pg 495)
A
- depression (episode: empty, low, down, zapped, little or no energy, trouble concentrating, negative thoughts)
- mania (episode: elated, up, high, increased energy, craving activity, racing thoughts and ideas, feeling super powers)
- bipolar
8
Q
affective disorders vs delirium
A
- mood disorders are persistent with more gradual onset
- in mania, pt can be very agitated however cognitive performance is not usually as impaired
- flight of ideas usually have some thread of coherence unlike simple distractibility
- disorientation is unusual in mania
9
Q
medical treatment of delirium
A
- treat underlying cause
- environmental interventions: cues for orientation (calendar, clock, photos, windows), frequently reorient the pt, have family or friend visit frequently making sure they introduce themselves, minimize staff switching
- minimize psychoactive medications
10
Q
delirium course and prognosis
A
- symptoms will continue to progress/fluctuate until underlying cause is treated
- most symptoms will resolve in 1 week with correction/improvement of the underlying etiology
- however, symptoms may wax and wane. in some pts, it can take weeks for symptoms to resolve
- some pts, particularly older pts, may never return to baseline
11
Q
neuroses
A
(psychological disorders)
- anxiety: panic attacks - PTSD
- obsessive (thoughts) compulsive (behaviors)
- phobias
12
Q
mild cognitive impairment
A
degenerative changes
- MCI is an intermediate stage between the expected cognitive decline of normal aging and more serious decline of dementia
- can involve problems with memory, language, thinking and judgement that are greater than normal age-related changes
13
Q
alzheimer’s dementia
A
progressive, neurodegenerative disease
- early S&S: decreased memory - poor concentration - difficulty with new learning - word finding difficulty
- later S&S: severe intellectual loss - incontinence - functional dependence - aphasia
14
Q
mini mental status exam
A
- heavy language component
- recall 3 items
- 7-8min duration
15
Q
MOCA
A
- more sensitive to memory (recall 5 items)
- more sensitive to MCI
- 10-11min duration
