Psych - Pathology (Neurotransmitters, Orientation, Amnesia, & Cognitive disorders)

Question 1

What neurotransmitter changes are associated with Alzheimer disease?

Answer 1

Low ACh

Question 2

What neurotransmitter changes are associated with Anxiety?

Answer 2

High norepinephrine, Low GABA, Low 5-HT

Question 3

What neurotransmitter changes are associated with Depression?

Answer 3

Low norepinephrine, Low 5-HT, Low dopamine

Question 4

What neurotransmitter changes are associated with Huntington disease?

Answer 4

Low GABA, Low ACh, High dopamine

Question 5

What neurotransmitter changes are associated with Parkinson disease?

Answer 5

Low dopamine, High 5-HT, High ACh

Question 6

What neurotransmitter changes are associated with Schizophrenia?

Answer 6

High dopamine

Question 7

What is orientation? How is it often abbreviated in the medical chart?

Answer 7

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)

Question 8

What are 7 common causes of loss of orientation?

Answer 8

Common causes of loss of orientation: (1) Alcohol (2) Drugs (3) Fluid/Electrolyte imbalance (4) Head trauma (5) Hypoglycemia (6) Infection (7) Nutritional deficiencies

Question 9

In what order are the parts of orientation lost?

Answer 9

Order of loss: 1st - time, 2nd - place, last - person

Question 10

What are 4 major types of amnesias?

Answer 10

(1) Retrograde amnesia (2) Anterograde amnesia (3) Korsakoff amnesia (4) Dissociative amnesia

Question 11

What is Retrograde amnesia?

Answer 11

Inability to remember things that occurred before a CNS insult

Question 12

What is Anterograde amnesia?

Answer 12

Inability to remember things that occurred after a CNS insult (no new memory)

Question 13

What is Korsakoff amesia? What condition causes this, and how?

Answer 13

Classic anterograde amnesia caused by thiamine deficiency and the associated destruction of mammillary bodies. May also include some retrograde amnesia.

Question 14

In what patient population is Korsakoff amnesia seen? With what major symptom is Korsakoff amnesia associated?

Answer 14

Seen in alcoholics, and associated with confabulations.

Question 15

What is Dissociative amnesia? What usually causes it?

Answer 15

Inability to recall important personal information, usually subsequent to severe trauma or stress

Question 16

What condition may accompany Dissociative amnesia? What characterizes this other condition, and with what is it associated?

Answer 16

May be accompanied by dissociative fugue (abrupt travel or wandering during a period of dissociative amnesia, associated with traumatic circumstances)

Question 17

Define Cognitive disorder. What are 2 types of Cognitive disorder?

Answer 17

Significant change in cognition (memory, attention, language, judgement) from previous level of functioning; Includes delirium and dementia

Question 18

What are 4 conditions/factors associated with Cognitive disorder?

Answer 18

Associated with (1) abnormalities in CNS, (2) a general medical condition, (3) medications, or (4) substance use.

Question 19

What is Delirium? What characterizes it?

Answer 19

“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”

Question 20

To what is delirium usually secondary? Give 7 examples of this.

Answer 20

Usually secondary to other illness (e.g., CNS disease, infection, trauma, substance abuse/withdrawal, metabolic/electrolyte disturbances, hemorrhage, urinary/fecal retention).

Question 21

What is the most common presentation of altered mental status in inpatient setting?

Answer 21

Delirium

Question 22

What is the EEG finding in Delirium patients?

Answer 22

Abnormal EEG.

Question 23

What are 3 components of treatment for Delirium?

Answer 23

Treatment: (1) Identify and address underlying cause (2) Optimize brain condition (O2, hydration, pain, etc.) (3) Antipsychotics (mainly haloperidol)

Question 24

What clinical approach is helpful for the management of Delirium?

Answer 24

T-A-DA approach (Tolerate, Anticipate, Don’t Agitate) helpful for management.

Question 25

In a patient with Delirium, for what kind of medications should you check?

Answer 25

Check for drugs with anticholinergic effects.

Question 26

Is Delirium often reversible or irreversible?

Answer 26

Often reversible.

Question 27

What is Dementia? What characterizes it?

Answer 27

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.”

Question 28

How can delirium and dementia relate? Give an example.

Answer 28

A patient with dementia can develop delirium (e.g., patient with Alzheimer disease who develops pneumonia is at increased risk for delirium)

Question 29

What are 7 irreversible causes of Dementia?

Answer 29

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)

Question 30

What are 5 reversible causes of Dementia?

Answer 30

Reversible causes: (1) NPH (2) Vitamin B12 deficiency (3) Hypothyroidism (4) Neurosyphilis (5) HIV (partially)

Question 31

With what factor is dementia incidence increased?

Answer 31

Increased incidence with age

Question 32

What is the EEG finding in Dementia patients?

Answer 32

EEG usually normal.

Question 33

Is Dementia usually reversible or irreversible?

Answer 33

Usually irreversible

Question 34

What condition may present like dementia in elderly patients, and what is that called in this case?

Answer 34

In elderly patients, Depression may present like Dementia (pseudodementia).