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Y3R3 - Psychiatry 🧠 > L7: Neurocognitive Disorders & Psychiatric Disorders Due To GMC > Flashcards

L7: Neurocognitive Disorders & Psychiatric Disorders Due To GMC Flashcards

1
Q

what is cognition?

A

Cognition includes:
- memory
- language
- orientation
- judgment
- conducting interpersonal relationshij
- performing actions (praxis)
- problem solving

Cognitive disorders reflect disruption in one or more of these domains and are frequently complicated by behavioral symptoms.

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2
Q

what are major neurocognitive disorders?

A
  • Delirium
  • Dementia
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2
Q

Def of Delirium

A
  • It is a state of acute organic brain dysfunction.
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3
Q

Characters of Delirium

A
  • Short-term confusion.
  • Acute onset of fluctuating cognitive impairment.
  • Disturbance of: consciousness, perception and other cognitive functions with reduced ability to attend.
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4
Q

Epidemeology of Delirium

A
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5
Q

Causes of Delirium

A
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6
Q

CP of Delirium

A
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6
Q

Course & Prognosis of Delirium

A
  • The symptoms of delirium usually persist as long as the cause is present.
  • Generally, lasts less than a week.
  • After treatment of the cause, the symptoms of delirium usually regress over a 3- to 7-day period.
  • The occurrence of delirium is associated with a high mortality rate in the following year.
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6
Q

DSM 5 Criteria of Delirium

A
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7
Q

DDx of Delirium

A
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7
Q

what is the major difference between dementia and delirium?

A
  • demented patients are alert without the disturbance of consciousness characteristic of delirious patients.
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7
Q

Delirium can be distinguished from psychotic symptoms by …..

A

the abrubt development of cognitive deficits including disturbance of consciousness.

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8
Q

TTT of Delirium

It is a medical emergenct BTW

A
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9
Q

Delirium is commonly experienced by ……

A

patients in ICU and postoperative recovery.

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9
Q

Generally avoid using ………… to treat delirium. These medications often worsen delirium by causing paradoxical disinhibition or oversedation. Prescribe only in the case of delirium due to alcohol or benzodiazepine withdrawal.

A

benzodiazepines

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10
Q

what are the causes of Dementia?

A
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10
Q

Drugs that cause delirium include:

A

Tricyclic antidepressants, Anticholinergics, Benzodiazepines, Opioids and H2 blockers.

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10
Q

what is Dementia?

A

(Chronic progressive cognitive decline)

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10
Q

Overview of CP of Dementia

A
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11
Q

Epidemeology of Dementia

A

The prevalence of dementia increases with age:
- 5% of patients over 65 years old have dementia.
- but after age 85, 20%:40% of the population is affected.

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12
Q

Clinical features of Dementia

A
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13
Q

DSM5 Criteria of Alzehimer Type Dementia

A

The patient meets basic diagnostic criteria for dementia but also:

  • Gradual onset and continued cognitive decline.
  • Cognitive deficits are not due to another medical condition or substance.
  • Symptoms are not caused by another psychiatric disorder.
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13
Q

DSM5 Criteria of Dementia

A
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13
Q

Neuropathology of Alzehimer Type Dementia

A
  • Amyloid plaques
  • Neurofibrillary tangles
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14
Q

Classification of Alzehimer Type Dementia

A
  • Early or late onset.
  • With delirium, delusions, depressed mood, or uncomplicated (complicated or
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14
Q

Amyloid plaques in Alzehimer Type Dementia

A
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15
Q

What do Neurofibrillary tangles consist of?

A

insoluble twisted fibers

15
Q

average life expectancy after onset of Alzehimer Type Dementia

A

8-10 years

16
Q

Site of Neurofibrillary tangles

A

inside of the brain’s cells (not between them i.e. not outside).

16
Q

what do Neurofibrillary tangles primarly consist of?

A
  • They primarily consist of a protein called tau, which forms part of a structure called a microtubule.
  • The microtubule helps transport nutrients and other important substances from one part of the nerve cell to another.
17
Q

abnormality in Neurofibrillary tangles in Alzehimer disease?

A

In Alzheimer’s disease, however, the tau protein is abnormal (become phosphorylated) and the microtubule structures collapse leading to brain atrophy.

18
Q

Three genes confer a predisposition for the …….. onset (pre-senile) form of AD:

A

Early

  • Amyloid precursor protein (APP) [located on chromosome 21,so associated w dawn syn.]
  • Presenilin 1
  • Presenilin 2
19
Q

One gene increases risk for …… onset AD

A

Late

  • ApoE4: E4 allele associated with more risk; E2 allele may reduce risk.
20
Q

All genes impaiments in Alzehimer Disease affect ……..

A

Beta Amyloid

21
Q

Relation between Alzheimer Disease & Environment

A
  • Tangles (but not plaques) can be produced by exposure to high levels of aluminum.
  • Tangles often cluster around blood vessels (suggests a toxic factor carried by blood).
22
Q

Alzheimer Disease & Neurotransmitters

A
23
Q

Ach in Alzheimer Disease

A
  • Degeneration of the neurons of nucleus basalis of Meynert.
  • Decrease of brain conc. of Ach and choline acety! transferase
  • Cognitive impairment of anticholinergic drugs
23
Q

NE in Alzheimer Disease

A

Decrease of NE neurons in the locus ceruleus.

24
Q

Alzheimer Disease & Estrogen

A
  • Risk for Alzheimer’s Disease among women is twice that of men (F:M =2:1)
  • Hormone replacement therapy for postmenopausal women reduces life-time risk to that of men (HRT+postmenopausal - F= M)
  • Hormonal replacement therapy does carry increase risk for breast cancer, endometrial cancer and gall bladder disease.
25
Q

Alzheimer Disease & Neuroimaging

A
25
Q

Sequential destruction in brain areas in Alzheimer Disease

A

There is a sequential destruction of brain areas that control memory function, then emotion and inhibition, and finally sensation.

26
Q

what does Alzheimer Disease spare?

A

regions that control vision and other functions that remain intact in Alzheimer’s patients.

27
Q

How much grey matter do patients with Alzheimer Disease lose per year?

A
  • Alzheimer’s patients lost an average of 5.3% of their gray matter per year.
  • Brain cells were purged even faster in memory regions, where patients lost up to 10% a year.
  • In contrast, healthy elderly volunteers lost only 1% of their brain tissue annually.
28
Q

what is the old name of Vascular Dementia?

A

Multi-Infarct Dementia

28
Q

Importance of Neuroimaging of Alzheimer Disease

A

This method will be used to reveal how drugs and vaccines combat the wave of brain damage caused by Alzheimer’s disease.

29
Q

DSM5 Criteria of Vascular Dementia

A
30
Q

Causes of Vascular Dementia

A
  1. Multiple infarcts
  2. Subacute bacterial endocarditis
  3. Congestive heart failure
  4. Collagen vascular diseases (e.g., SLE)
31
Q

DSM5 Criteria of Dementia of GMC

A

Meets basic diagnostic criteria for dementia, but there must also be evidence that symptoms are the direct physiological consequence of a general medical condition.

31
Q

DDx of Dementia

A
  • Delirium
  • Amnestic Disorder
  • Pseudodementia
31
Q

Compare between Delirium & Dementia

A
32
Q

what are Amnestic Disorders?

A

Characterized by isolated memory disturbance, without the cognitive deficits seen in dementia.

33
Q

Pseudo Dementia

A
34
Q

Lab Evaluation of Delirium & Dementia

A
  1. Complete blood chemistry.
  2. CBC with differential.
  3. Thyroid function tests.
  4. Urinalysis.
  5. Drug screen.
  6. Serum levels of all measurable medications.
  7. Vitamin B12 level.
  8. Heavy metal screen.
  9. Serological studies (VDRL or MHA-TP).
  10. EKG.
  11. Chest X-ray.
  12. EEG.
  13. Brain Imaging (CT, MRI) is indicated if there is a suspicion of CNS pathology, such as a mass lesion or vascular even.
34
Q

Clincal Evaluaton of Delirium & Dementia

A
  • All patients with cognitive deficits should be evaluated to determine the etiology of the dementia, Some [not all] causes of dementia are treatable and reversible.

Clinical Evaluation:

1- Medical history and a physical examination, with special attention to the neurological exam, should be completed.

2- Psychiatric evaluation (history & Examination)

3- Cognitive evaluation by MMSE: score < 25-24 implies cognitive impairment, which may suggest dementia or delirium.

34
Q

what is Mild Cognitive Impairment (MCI)?

A
35
Q

Memory in:

Normal aging Vs Alzheimer Disease

A
36
Q

Managment of Dementia

A
  1. Any underlying medical conditions should be corrected.
  2. The use of CNS depressants and anticholinergic medications should be minimized.
  3. Patients function best if highly stimulating environments are avoided.
  4. The family and/or caretakers should receive psychological support in the form of support groups, psychotherapy, and day-care centers.
37
Q

General Rules of Pharmacological TTT of Dementia

A
  1. Start low and go slow.
  2. Cognitive enhancers.
  3. Anti-psychotics, anti-depressants and short half live benzodiazepines could be used for symptomatic relief of psychiatric symptoms.
37
Q

Pharmacological TTT of AD Dementia

A
37
Q

Pharmacological TTT of Vascular Dementia

A
  1. Hypertension must be controlled.
  2. Aspirin may be indicated to reduce thrombus formation
  3. Cognitive enhancers may have some role
38
Q

Non Pharmacological treatment of Dementia

A
  • Simplify the daily routine
  • Improve the environmental cues and continuous patient orientation
  • Protection from dangers or loss
  • Education and support of care
39
Q

Def of Psychiatric Disorders due to GMC

A
40
Q

what are GMCs That may cause Psychiatric Disorders?

A
  1. Trauma (head injury).
  2. Cardio vascular diseases.
  3. Tumors.
  4. Intoxications.
  5. Nutritional diseases.
  6. Metabolic.
  7. Endocrine disorders.
  8. Infectious diseases including HIV infections.
  9. Autoimmune disorders.
41
Q

Psychiatric Complications of Endocrine Disorders

A
41
Q

what are Psychiatric Disorders due to GMC?

A
  1. Delirium.
  2. Dementia.
  3. Amnestic disorder.
  4. Psychotic disorders.
  5. Mood disorders.
  6. Anxiety disorders.
  7. Catatonic disorders.
  8. Personality changes.
  9. Mental disorders NOS.
42
Q

Features Suggesting a medical origin of a Psychiatric disorder

A
  1. Late onset of initial presentation
  2. Known underlying medical condition
  3. Atypical presentation of a specific psychiatric diagnosis
  4. Absence of personal and family history of psychiatric illness
  5. Illicit substance use
  6. Medication use
  7. Treatment resistance or unusual response to treatment
  8. Sudden onset of mental symptoms.
  9. Abnormal vital signs
  10. Waxing and waning mental status
43
Q

Managment of Psychiatric Disorders due to GMC

A

Y3R3 - Psychiatry 🧠 (19 decks)

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