Test 4 psych Flashcards
Rivastigmine(Exelon)
- Treatment to mild to moderate AD and PD
- Can be used in later stages
- Inhibits AChE selectively in the cortex and the hippocampus more than in other parts of the brain.
- This drug is advantageous for patients who do not respond to other anticholinergic drugs or who are in the later stages of AD
- Side effects: nausea, vomiting, and dizziness
- Transdermal form is effective and has fewer peripheral side effects as compared with the oral form.
tacrine(Cognex)
potential for hepatic toxicity, rarely used because of side effects
donepezil(Aricept)
– it requires only once-per-day dosing.
– Enhances cholinergic function by the reversible inhibition of the hydrolysis of Ach by AChE.
– Slows progression
– Effective when cholinergic neurons are intact.
– May produce gastrointestinal side effects by inhibiting AChE in the periphery
Glantamine (Razadyne)
- Treats mild to moderate AD
- It is a reversible inhibitor for AChE
- It increases the availability of ACh; affects nicotinic cholinergic receptors in such a way that AChE inhibition can theoretically be enhanced
- Shown to decrease agitation and to increase cognition
- Twice daily dosing
Memantine (Namanda)
- Treats moderate to severe AD
- It is an N-methyl-D-aspartate receptor antagonist that blocks the effects of excess glutamate.
- Blocks the excitotoxic effects of glutamate while allowing normal glutamate neurotransmission to occur.
Kubler Ross (5 Stages)
- Denial – Shock and disbelief
- Anger – struggling with fate(Why me? Or It’s not fair!)
- Bargaining – making deals with a higher power in the hope of a cure
- Depression and despair – realizing that death is inevitable
- Acceptance – succumbing to fate with relative calmness
Stages of Grief
- Avoidance (numbing and blunting)
- Confrontation (disorganization and despair)
- Reestablishment (reorganization and recovery)
Chronic Sorrow
- a form of grief that often includes characteristics of other forms of grief but that differs with regard to several essential aspects.
- 1st chronic sorrow is a response to ongoing loss; 2nd persons who are experiencing chronic sorrow seldom experience disability
- Who would be at risk? Parents with children with mental disabilities, schizophrenia, or other chronic illness; spouses of persons with long term chronic illnesses, such as multiple sclerosis alcoholism, or AD; and persons with similar disorders
Primary (Irreversable) Dementia
Alzeimer’s Disease, Vascular Dementia, Picks Disease, Huntington’s Disease
Parkinson’s Dementia, Creutzfeidt-Jakob disease
Dementia: Reversible (secondary)
Delirium, Depression, Amnestic disorders, Tumors, Infection, Trauma, Some cerebral emboli
Recent memory loss but keeps long term memory
Stage 1: Mild (2-4 years)
- Patients have problems naming common items, they repeat things, and they lose things easily, and they get lost frequently.
Stage 1: Mild (2-4 years)
Inability to find words and the use of inappropriate words
Stage 1: Mild (2-4 years)
Neologism – invented and meaningless words
Stage 1: Mild (2-4 years)
Show signs of personality changes
Stage 1: Mild (2-4 years)
They are self awareness of loss that many patients suffer profound depression
Stage 1: Mild (2-4 years)
Intellectual decline continues to increase and includes amnesia, disorientation, apriaxia, aphasia, and depression
Stage 2: Moderate (2-10 years)
Lead to the loss of the ability to care for oneself
Stage 2: Moderate (2-10 years)
Difficulty making decision as a result of decreased concentration
Stage 2: Moderate (2-10 years)
Lack the cognitive skills to make appropriate judgments
Stage 2: Moderate (2-10 years)
Develop delusion that are paranoid in nature
Stage 2: Moderate (2-10 years)
Both short- and long-term memory are affected
Stage 2: Moderate (2-10 years)
Perseveration
Stage 2: Moderate (2-10 years)
Sundowning
Stage 2: Moderate (2-10 years)
Sleep Disturbance
Stage 2: Moderate (2-10 years)
Catastrophic reactions: A sudden or gradual negative change in behavior caused by the inability to understand and cope with environmental stimuli. Reach excessively, out of proportion to the situation, or panic and act out violently.
Stage 2: Moderate (2-10 years)
What is a Catastrophic reaction?
: A sudden or gradual negative change in behavior caused by the inability to understand and cope with environmental stimuli. Reach excessively, out of proportion to the situation, or panic and act out violently.
What is sundowning?
- Increased negative behavioral disturbance such as irritation or confusion occurring during the afternoon or eveninga
What is perseveration?
Repetitive verbalizations or motions
JAMCO
Judgment Affect Memory Cognition Orientation
unable to perform motor activities despite intact function
Apraxia
difficulties with object identification
Agnosia
difficulties writing things down
Agraphia
deficits in language functioning
Aphasia
Etiology of AD
Pathological: Cerebral atrophy, neuritic plaques, neurofibrillary tangles
Genetic: chromosome 19, Apolipoprotein E gene
Nongeneitc: inflammation, decreased folic acid, decreased estrogen
Neurochemical: decreased acetylcholine ACh
ACT – crisis intervention approach
- Assess immediate needs and treats
- Connect to support groups, social services, disaster relief, etc.
- Trauma treatment plans, treatment of acute stress reactions and trauma recovery groups
Psychological stages after a disaster
- Heroic Phase
- Honeymoon Phase (1 week to 3 to 6 months)
- Disillusionment phase (2 months to 2 to 3 years)
- Reconstruction phase (2 months to 1 to 2 years)
real events that threaten physical health or loss
External (Situational)
May not be obvious to someone else: feelings of betrayal or fear, threat to a belief
Internal (Subjective)
(phase of life): e.g. Midlife crisis
Maturational
- Old coping skills no longer helpful
- Ineffective defense mechanisms until new coping skills develop
- Adventitious (disaster): natural or man-made disaster
Unplanned and accidental
• Natural disaster (hurricane, car accident), Crime of violence (murder, rape)
Adventitious
Cycle of Violence Phase 1: Tension Building
• Major battering usually does not occur. Perpetrator establishes complete control usually by inflection of emotional abuse
Cycle of Violence Phase 2: Acute Battering
• Tension can no longer be contained and acute battering occurs
Cycle of Violence Phase 3: Honeymoon Stage
• Perpetrator begs for forgiveness, promises never to do it again. Appears to have remorse then tension starts to build and cycle is repeated
Emergency escape plan
- A plan for a fast escape when violence occurs
- Identify signs of escalation of violence and designate this as the time to leave
- Include in plan a destination and a way to get there
- Have the hotline referral telephone number of a shelter or safe house and a contact person
- Keep important papers hidden in a place they can be obtained easily
Who is at risk for spousal abuse?
• Spousal: Legal marriage, pregnant, partner who tries to leave the relationship
Who is at risk for child abuse?
under the age of 3, kids who are looked as to be different, child of an unwanted pregnancy, premature kid, child who has a prolonged illness
Atypical medication for eating disorders - Cause weight gain
Zyprexa
SSRI medication for eating disorders
Prozac
Patients cannot use or understand words
Stage 3: Severe (1-3 years)
Cannot recognize themselves or others
Stage 3: Severe (1-3 years)
No longer care for themselves
Stage 3: Severe (1-3 years)
Totally dependent on others
Stage 3: Severe (1-3 years)
Lose weight and bladder control
Stage 3: Severe (1-3 years)
Develop secondary illnesses and conditions
Stage 3: Severe (1-3 years)
Immobility may lead to pneumonia, UTI, and development of pressure ulcers
Stage 3: Severe (1-3 years)
Progressive loss of neurons leads to the loss of the ability to swallow which may lead to aspiration pneumonia
Stage 3: Severe (1-3 years)
