Test3-psych Flashcards
Cognitive Disorders
-delirium-
-dementia-
amnetic disorder-
Delirium
- distrubance of consciousness and a change of cognition that develop over a short period of time
- always secondary to another physiological condition and is transient
- most frequently in older pts-surgery, intro of new meds, UTI, cerebrovascular disease, pneumonia and CHF; polypharmacy
- reduced clarity of awareness of the environment
- easily distracted by irrelevant stimuli
- especially at night
- acute onset, inattention, disorganized thinking, disturbance of consciousness
- withdrawn, agitated or psychotic
- sundowning (seen with delirium and dementia)
- drug and alcohol withdrawl (CNS stimulants-cocaine)
- metabolic (dehydration, DKA, Thiamine def (B1)=Wernicke encephalopathy,
- digitalis, anticholinergics, head trauma, seizure, tumor, sleep deprivation, pain
- illusions (errors in perception of sensory stimuli)
- hallucinations (false sensory stimuli)
- psychomotor agitation
- tachy, sweating, flushed face, dilated pupils, elevated BP
Dementia
- progressive deterioration of cognitive functioning and global impairment of intellect with no change in consciousness
- difficulty with memory, thinking and comprehension
- majority are irreversible
- Alzheimer’s is the most common cause
- Primary dementia: AD, vascular dementia (both irreversible)
- Secondary: result of another pathological process (AIDS, viral encephalitis, pernicious anemia, Korsakoff’s syndrome (B1 deficiency-alcoholics), Parkinson’s, Huntington’s chorea
Alzheimers Disease
- most common cause of dementia
- 1/10 >65 1/2 >85
- PET scan, CT scans reveal brain atrophy and rule out other conditions (neoplasms)
- confabulation-creation of stories or answers in place of actual memories to maintain self-esteem; not the same as lying; unconscious attmept to maintain self-esteem
- amnesia/memory impairment
- aphasia-loss of language ability
- apraxia-loss of purposeful movement in the absence of motor or sensory impairment
- agnosia-loss of sensory ability to recognize objects
- disturbances in executive functioning.
- Average duration from onset to death is 8-10 years, but ranges from 3-20 years
Stages of Alzheimers
- Mild Alzheimer’s-loss of enerygy, drive, initiative, dificulty learning new things; personality and social behavior remain intact; depression may occur early-lessens as disease progresses
- Moderate AD-deterioration becomes evident; can’t rememer address or date; memory gaps that fluctuate day to day; poor hygiene; can’t dress themselves properly; labile mood-paranoia, anger, jealousy, apathy; driving is hazardous; withdrawl.
- Moderate to Severe-unable to recognize familiar objects/people (agnosia), needs simple directions repeated (apraxia), forgets where toilet is-incontinent, the world is frightening, nothing makes sense; agitation, violence, paranoia, delusions; wandering
- Late AD-agraphia (inability to read or write), hyperorality (need to chew), blunting of emotions, visual agnosia, hypermetamorphasis (touching everything in sight); ability to walk and talk are lost
- End-stage-stupor, coma, with death secondary to infection or choking.
Tolerance
occurs when a person’s physiological reaction to a drug decreases with repeated administrations of the same dose.
Withdrawal
Causes physiological changes to occur when blood and tissue concentratin of a drug decrease in individuals who have maintained heavy and prolonged use of a substance.
Substance Abuse
vs. Dependence
Abuse: continued use despite related consequences-inability to fulfill role obligations, participation in hazardous situations while impaired, recurrent legal/interpersonal problems, continued use despite social/interpersonal problems
Dependence: severe condition or disease with physical problems, presence of tolerance, withdrawal, subs taken in higher amts, unsuccessful desire to cut down, increased time spent, reduction/absence from social, occupational, recreational activities
Co-Dependence
over-responsible behavior–doing for others what they can do for themselves–valuing oneself by what one does, what one looks like and what one has, rather than by who one is
Addiction
- Loss of control of substance consumption
- Substance use despite associated problems
- Tendancy to relapse
Alcohol Withdrawal
- fever
- N/V
- anxiety
- visual, tactile or auditory hallucinations or illusions
- autonomic hyperactivity: sweating, tachy, HTN
- psychomotor agitation, seizures (within 7-48h)
- insomnia
- hand tremor
- long-acting benzodiazepines (prevent DTs)=Librium, Valium; short acting (if livery disfunction)=Ativan
Alcohol Related Delirium
- develops within hours to days
- impaired consciousness
- change in cognition (memory, disorientation, hallucinations, illusions)
CAGE
- Cut down? (feel need to)
- Annoyed by others criticizing your drinking?
- Guilty feelings about your drinking?
- Eye openner needed?
1=possible problem
2=probable problem
Stimulants
relief from fatigue, grandiosity, euphoria, impaired judgement, dilated pupils, dry mouth, excessive motor activity, twitching, increased BP, HR
Most common: cocaine, amphetamines
Tolerance develops to euphoria but not wakefulness
Prolonged/excessive use can lead to psychosis almost identical to paranoid schizophrenia
Cocaine
- produces physical dependence and withdrawal sx with very high relapse
- short acting euphoria 10-20 s rush, then 15-20 minutes of less intense eurphoria
- sudden death: heart attack
3 Phases of Withdrawal:
- Crash (4 days-anxiety, depression, anergia, paranoia, peak cravings)
- Prolonged Dysphoria (anhedonia, lack of motivation, intense cravings, relapse most likely)
- Intermittent Craving (support groups helpful)
Opiates & Opioids
- Narcotics
- opium, morphine, meperidine (demerol), fentanyl, heroin
- Symptoms: stupor, constipated, pinpoint pupils
- Withdrawal is rarely life-threatening, very uncomfortable
- methadone
- Heroin withdrawal: subutex, clonidine (for BP), valium
- Symptoms of Withdrawal: resemble the flu-runny nose, tearing, diaphoresis, muscle cramps, chills, fever, dilated pupils
- Buprenorphine = opioid agonist/antagonist, used for pain, can cause confusion, diaphoresis, hallucinations, sedation, nausea
Toxic Psychosis
- use of LSD, PCP, stimulants
- resembles paranoid schizophrenia
- LSD users can be “talked down”
- PCP/amphetamine users more lkely to strike out, panic from misconceptions; may not feel pain
- may need restraints, benzos, high-potency anti-psychotics (Haldol/Ativan cocktail)
