Psych - Pathology (Neurotransmitters, Orientation, Amnesia, & Cognitive disorders) Flashcards
Pg. 503-504 in First Aid 2014 Sections include: -Neurotransmitter changes with disease -Orientation -Amnesias -Cognitive disorder -Delirium -Dementia
What neurotransmitter changes are associated with Alzheimer disease?
Low ACh
What neurotransmitter changes are associated with Anxiety?
High norepinephrine, Low GABA, Low 5-HT
What neurotransmitter changes are associated with Depression?
Low norepinephrine, Low 5-HT, Low dopamine
What neurotransmitter changes are associated with Huntington disease?
Low GABA, Low ACh, High dopamine
What neurotransmitter changes are associated with Parkinson disease?
Low dopamine, High 5-HT, High ACh
What neurotransmitter changes are associated with Schizophrenia?
High dopamine
What is orientation? How is it often abbreviated in the medical chart?
Patient’s ability to know who he or she is, where he or she is, and the date and time; Often abbreviated in the medical chart as “alert and oriented x 3” (AOx3)
What are 7 common causes of loss of orientation?
Common causes of loss of orientation: (1) Alcohol (2) Drugs (3) Fluid/Electrolyte imbalance (4) Head trauma (5) Hypoglycemia (6) Infection (7) Nutritional deficiencies
In what order are the parts of orientation lost?
Order of loss: 1st - time, 2nd - place, last - person
What are 4 major types of amnesias?
(1) Retrograde amnesia (2) Anterograde amnesia (3) Korsakoff amnesia (4) Dissociative amnesia
What is Retrograde amnesia?
Inability to remember things that occurred before a CNS insult
What is Anterograde amnesia?
Inability to remember things that occurred after a CNS insult (no new memory)
What is Korsakoff amesia? What condition causes this, and how?
Classic anterograde amnesia caused by thiamine deficiency and the associated destruction of mammillary bodies. May also include some retrograde amnesia.
In what patient population is Korsakoff amnesia seen? With what major symptom is Korsakoff amnesia associated?
Seen in alcoholics, and associated with confabulations.
What is Dissociative amnesia? What usually causes it?
Inability to recall important personal information, usually subsequent to severe trauma or stress
What condition may accompany Dissociative amnesia? What characterizes this other condition, and with what is it associated?
May be accompanied by dissociative fugue (abrupt travel or wandering during a period of dissociative amnesia, associated with traumatic circumstances)
Define Cognitive disorder. What are 2 types of Cognitive disorder?
Significant change in cognition (memory, attention, language, judgement) from previous level of functioning; Includes delirium and dementia
What are 4 conditions/factors associated with Cognitive disorder?
Associated with (1) abnormalities in CNS, (2) a general medical condition, (3) medications, or (4) substance use.
What is Delirium? What characterizes it?
“Waxing and waning” level of consciousness with acute onset; rapid decrease in attention span and level or arousal; Characterized by disorganized thinking, hallucinations (often visual), illusions, misperceptions, disturbance in sleep-wake cycle, cognitive dysfunction; Think: “deliRIUM = changes in sensoRIUM”
To what is delirium usually secondary? Give 7 examples of this.
Usually secondary to other illness (e.g., CNS disease, infection, trauma, substance abuse/withdrawal, metabolic/electrolyte disturbances, hemorrhage, urinary/fecal retention).
What is the most common presentation of altered mental status in inpatient setting?
Delirium
What is the EEG finding in Delirium patients?
Abnormal EEG.
What are 3 components of treatment for Delirium?
Treatment: (1) Identify and address underlying cause (2) Optimize brain condition (O2, hydration, pain, etc.) (3) Antipsychotics (mainly haloperidol)
What clinical approach is helpful for the management of Delirium?
T-A-DA approach (Tolerate, Anticipate, Don’t Agitate) helpful for management.
In a patient with Delirium, for what kind of medications should you check?
Check for drugs with anticholinergic effects.
Is Delirium often reversible or irreversible?
Often reversible.
What is Dementia? What characterizes it?
Gradual decrease in intellectual ability or “cognition” without affecting level of consciousness. Characterized by memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement; Think: “‘deMEMtia’ is characterized by MEMory loss.”
How can delirium and dementia relate? Give an example.
A patient with dementia can develop delirium (e.g., patient with Alzheimer disease who develops pneumonia is at increased risk for delirium)
What are 7 irreversible causes of Dementia?
Irreversible causes: (1) Alzheimer disease (2) Lewy body dementia (3) Huntington disease (4) Pick disease (5) Cerebral infarcts (6) Creutzfeldt-Jakob disease (7) Chronic substance abuse (due to neurotoxicity of drugs)
What are 5 reversible causes of Dementia?
Reversible causes: (1) NPH (2) Vitamin B12 deficiency (3) Hypothyroidism (4) Neurosyphilis (5) HIV (partially)
With what factor is dementia incidence increased?
Increased incidence with age
What is the EEG finding in Dementia patients?
EEG usually normal.
Is Dementia usually reversible or irreversible?
Usually irreversible
What condition may present like dementia in elderly patients, and what is that called in this case?
In elderly patients, Depression may present like Dementia (pseudodementia).
