Diagnosis & Psychopathology 2 Flashcards
Priority 1
What are the ten Substance-Induced Disorders?
- Substance Intoxication
- Substance Withdrawal
- Substance Intoxication Delirium
- Substance Withdrawal Delirium
- Substance-Induced Persisting Dementia
- Substance-Induced Persisting Amnestic Disorder
- Substance-Induced Psychotic Disorder
- Substance-Induced Anxiety Disorder
- Substance-Induced Sexual Disorder
- Substance-Induced Sleep Disorder
List 8 medical conditions associated with Delirium Due to a General Medical Condition.
- infections
- metabolic disorders
- renal disease
- electrolyte and thiamine imbalances
- post-operative states
- encephalopathies
- head trauma
- brain lesions
Name four groups of people at greater risk for Delirium.
- persons experiencing drug withdrawal, esp. rapid withdrawal from alcohol or benzodiazepine
- persons < 60yo (following surgery and medical illness)
- persons with decreased “cerebral reserve,” e.g., conditions that compromise the CNS at greater risk
- postcardiotomy patients
Describe treatments for Delirium.
- usually multimodal: medical, psychological, pharmacological
- important to evaluate suicidality
- identification of cause of Delirium
- modification of environment to compensate for disorientation
- antipsychotics for minimization of psychotic disturbances (e.g., hallucinations, delusions)
Distinguish Dementia from Delirium.
Dementia:
- relative alertness
- longer-term course
- usually later in life (20% > 85yo)
Delirium:
- confusion/clouded consciousness
- shorter-term course
- may occur at any age
Describe pseudodementia and distinguish it from Dementia.
Depression in the elderly mistaken for dementia.
pseudodementia:
- symptoms generally improve as depression lifts
- specific onset date; usually relatively sudden
- memory problems transitory & primarily in procedural memory and recall (not recognition)
- person remains aware enough to be concerned about cognitive deficits
Dementia:
- cognitive deterioration tends to be progressive
- slower, less obvious onset
- memory problems more even, widespread, and progressive (Alzeimer’s may leave procedural memory intact)
- individual lacks concern about cognitive deficits
Describe prevalence rates and risk factors for Dementia of the Alzheimer’s Type.
- most common dementia type, about 1/2 of all cases
- 20% of people over age of 80 have Alzheimer’s
- more common in women because of women’s greater longevity
- first-degree relative with Alzeimer’s increases risk by three to four times
- other risk factors are head injury, toxin exposure, Down’s Syndrome, alcohol abuse, long-standing physical inactivity
Describe the three stages of Dementia of the Alzheimer’s Type.
- (2-4 years) Short-term memory loss (forgetting tasks, repeating questions, losing thread of conversation) often unnoticed by patient or others
- (2-10 years) Above deficits increase with further impairment, esp. in explicit memory, resulting in retro- and anterograde amnesia. Also, restlessness, flat or labile mood, fluent aphasia, complex task performance difficulty, apathy, getting lost in familiar places. Progresses to aphasia, apraxia, agnosia, personality changes, delusions, hallucinations. Subjective lack of awareness of these deficits is characteristic.
- (1-3 years) Serious broad impairment. Inability to speak, loss of recognition of significant others, loss of capacity for self-care. Inability to walk, incontinence, death usually from opportunistic respiratory disease.
Total duration of disease typically 8-10 years.
Describe treatment approaches for Dementia of the Alzheimer’s Type.
Behavioral:
- balancing stimulation level of patient’s environment (neither over- nor understimulating)
- structured, routinized day
- support for immediate family
Pharmacological:
- acetylcholine esterase inhibitors can improve or stabilize cognitive and memory symptoms in 30-50% of cases
- glutamate blockers may slow neuronal deterioration
Describe prevalence rates for Vascular Dementia.
- accounts for 10-20% of all dementia cases.
- second after Alzheimer’s
Describe prevalence rates and behavioral and physical symptoms associated with Dementia Due to HIV Disease.
- occurs in about 2/3 of AIDS patients
- initial symptoms:
- apathy
- social withdrawal
- depression
- muscle weakness
- loss of balance
- later symptoms (1-6 mos < death):
- severe psychiatric symptoms
- seizures
- incontinence
- partial paralysis
Describe some psychological factors in the progression of HIV disease.
- intellectual functioning
- somatic symptoms of depression
- age
What are some general treatment approaches for dementias?
- Dementia patients generally fare better living with family
- Families supporting dementia patients typically require support and family therapy
- Treatment for patients often highlights reality orientation and elicitation of memories
Define an amnestic disorder.
Significant decline and impairment of memory with no other cognitive deficits.
Define anterograde amnesia.
Impairment of ability to learn new information.
Define retrograde amnesia.
Impairment of ability to recall learned information or events.
Describe confabulation.
The unconscious filling in of memory gaps with imaginary events.
What is the etiology of amnestic disorders?
- any medical condition affecting brain regions associated with memory: head trauma, cerebrovascular disease, hypoxia, etc.
- a range of substances affecting brain regions associated with memory: alcohol, sedatives, hypnotics, etc.
- a range of toxins affecting brain regions associated with memory: heavy metals, carbon monoxide, industrial solvents, etc.
What is Korsakoff’s Syndrome?
Alcohol-Induced Persisting Amnestic Disorder due to B-vitamin deficiencies
