Mental health 2 Flashcards
what are the different neurocognitive domains ?
- perceptual motor function
- language
- leaning and memory
- social recognition
- complex attention
- executive function
what comes under mental capacity ?
- understanding
- remembering
- weigh options
- communicating with others
- taking info in
does a reduction in cognitive function mean loss of capacity?
nope even if they have dementia or had a stroke
what are the different types of memory ?
working
short term
long term
what is working memory ?
- telephone numbers
- very short
- very limited
- no long term storage
- lasts few seconds
what is short term memory ?
- minutes, hours
- what did you have for breakfast
- limited capacity
- can be transferred to long depends on emotional significance attached to things
what is long term memory ?
- lifelong
- emotional significance
- unlimited capacity
what happens as we get older?
- IQ peaks at 25 and remains constant until 60
- from 60 declines = reduced problem solving and psychomotor slowing
- from 80 brain mass and vol reduces to 5%
- from 90 reduces to 20%
why does mass and vol reduce ?
- amount of grey and white matter change
- brain shrink
- changes in cognitive function are related to the physical changes to the Brain
what are the memory changes that happen s you get older ?
- reduced long term memory
- reduced working memory
- short term memory less affected
what is delirium?
- acute brain dysfunction
- not the same as dementia
- fluctuating course
- confusion/ disorientations
- disorganised thinking
- altered level of consciousness
- altered sleep pattern
- poor concentration
what are the risk factors of delirium ?
- reduced reserves ?
- age
- frailty
- dementia
- multiple medical problems
- sensory impairment
what are the precipitating factors for delirium ? (short term)
- new drugs eg. codiene, benzodiazepines
- metabolic disturbances = changes in blood glucose and potassium
- infection (respiratory, urinary) and from dental stuff
- pain
- surgery
- stroke, seizure, head injury
- altered routine, unfamiliar surroundings
how do we manage delirium ?
treat underlying cause:
- infection
- hypoxia
- pain
- fluid and electrolyte balance
management of environment:
- making sure there are clocks and calendars so they know time and date, light to distinguish day and night , noise
- encourage normal sleep pattern
- address routines get them back to old routines
describe dementia
- insidious onset
- progressive
- cognitive impairment/ forgetfulness
- lack of insight
- no change in consciousness
- normal sleep
- normal concentration
define dementia?
- forgetfulness
plus one of:
- language impairment
- agnoisa (not recognising ppl or things)
- apraxia (difficulty doing things)
- cognition/ planning
- leading to functional impairment eg daily activities
- > 6 months
- no reversible medical/ psychiatric cause
epidemiology of dementia
20% over 80yrs
1 million ppl in uk
risk factors for dementia?
age
genetics
male>female
alcohol
smoking
downs syndrome
higher educational attainment = makes dementia less obvious in these ppl
what are the different types of dementia?
- alzhemiers = old ppl = 62%
- vascular = 17% caused by strokes
- mixed dementia = 10%
- other = 11% = related to other conditions
what is Alzheimers dementia ?
- loss in vol of brain
- amyloid plaques and neurofibrillary tangles
what is vascular dementia ?
- reduced perfusion to brain
- atherosclerosis
- multiple small CVAs
risk factors
- smoking, diabetes, hypertension and hart disease so PREVENTABLE
What is mixed dementia?
- mix of Alzheimers and vascular (CVD) dementia as theyre both common
what are the early stages of dementia ?
memory loss
errors of judgement
what are the later stages of dementia?
behaviour changes
decline in language
difficultly with daily tasks
what are the last stages of dementia ?
incontinence
swallowing difficulties
communication impaired
increased care needs
is there a cure for dementia ?
no
what is the management of dementia?
for cognitive:
- acetylcholineestrase inhibitors
- n-methyl-d-asparatate receptor antagonists
for psychological and behavioural:
- environmental = removing things that can harm them
- reassurence
- support
how do we assess cognitive function?
MMSE: mini mental state exam
- what day?
- date?
- month ?
- season?
- year ?
- building ?
- floor?
- county?
- country ?
epidemiology of alcohol and substances
- common
- 90% drink
- 25% smoke
- 33% have taken recreational drugs
what are the benefits of alcohol and substances ?
- high
- buzz
- altered perception
- relaxation, pain relief, relieve anxiety
- socially useful
what are the problems of substances and alcohol ?
- acute intoxication
- at risk of driving and operating machinery
- harmful - risk factor for heart, liver, CNS, cancer
- dependence
- withdrawal
- exacerbates other conditions = depression, psychosis
- cognitive impairment
what is dependance syndrome ?
difficult to manage dependance
- reduce harm of the drugs
what are the stages of change ?
how to reduce the harm of some drugs ?
how do we give alcohol advice ?
- tell them about risk of oral cancer
- sign post to gp if they say yes to any of these questions
how do we manage alcohol withdrawal ? and what are the risk factors ?
what is wernicke- Korsakoff syndrome?
