Week 12 Terms: Neurocognitive Disorders, Substance Use, and Trauma Flashcards
What is one of the biggest risk factor of Alzheimer’s Disease?
Advanced Age
An estimated 6.5 million Americans age 65 and older are living with Alzheimer’s in 2022
What are the different types of Dementia?
Alzheimer’s
Vascular
Lewy Body
Frontotemporal
Huntington’s
Mixed Demential (Dementia from more than one cause)
Dementia
Umbrella term for loss of memory and other thinking abilities severe enough to interfere with daily life.
Alzheimer’s Disease
Damage to nerve cells causing memory failure, personality changes, and difficulty with daily activities.
Plaques (deposits of a protein fragment called beta-amyloid) that build up in the spaces between nerve cells.
Tangles (twisted fibers of another protein called Tau) that build up inside cells
- Blocking communication among nerve cells
- - Disrupting cell function
True/False
Cognitive disorders are a normal part of aging.
False
Cognitive disorders are NOT a normal part of aging.
Three Types of Delirium
Hypoactive
Hyperactive
Mixed
Hypoactive Delirium
Sluggish, drowsy
Reduced activity or interaction
Hyperactive Delirium
Restlessness
Mood Swings
Hallucinations
Refusing Care
Delirium
- An organic mental syndrome
- Acute Onset
- Fluctuating Cognitive FUnctioning
- Changes in physiology - Low Sodium, Medication, Infection, Substance Withdrawl
- Reversible
UTI’s affect older individuals and this can create a rapid change
Causes of Delirium
- Seizures
- Trauma/ Concussion
- Brain tissue infections
- Medications
- Infections
-Fever
-Sepsis - Electrolyte imbalance
-Dehydration - Metabolic Disorders
-Diabetic reactions
-Liver/ kidney dysfunction (UTI)
-Hypoxia
-Cardiac dysfunction - Post-surgery
- Alcohol/ drug use
Symptoms of Dementia
Disorganized thoughts
Memory loss
Sensory disturbance
Language difficulty
Behavior disturbance
How do you diagnose Alzheimer’s Disease?
- Patient and family report and history of symptoms
-Cognitive decline
-Decreased ability to function - Mental status exam
- Neuropsychological testing
- Rule out depression and other treatable causes of cognitive impairment
Early/Pre-Clinical Diagnoses of Alzheimer’s Disease
Changes may begin 20 years or more before diagnosis
Biomarker changes but no symptoms
Forgetting becomes more frequent
Difficulty with complex tasks
Word finding difficulty
Questionable judgment or decision making
May cover up with jokes or deflection
Cognitive Impairment of Alzheimer’s Disease
- Memory worsens
- Communication gets more difficult
- Lose/misplace important items
- Trouble solving problems with familiar, routine tasks
- Visual perception and spatial relations problems
-May have trouble judging distance - Changes in personality or behavior
- Changes in sleep patterns
Usually diagnosed by this point
Dementia Part of Alzheimer’s Disease
- Every day tasks become difficult
- Errors are more frequent
- Unable to recall personal information
- IADLs become dangerous or impossible
- Eventually complete reverse development: unable to walk, talk, care for self
- Incontinence
- Difficulty communicating
How can an OT help someone with Alzehimer’s?
Facilitating ADL participation
Safety strategies
Memory aides
Maintain/promote mobility
Facilitate social participation & communication
Sensory interventions
Sleep habits
Educating family & caregivers
Substance Use Disorder (SUD)
Continued use of alcohol, tobacco, marijuana, or medications prescribed or not prescribed despite significant disruption to meaningful activities
What are the four symptom clusters of Substance Use Disorder?
Impaired Control
Social Impairment
Risky Use
Drug Effects (Withdrawal)
Describe the severety of conditions for SUD
Mild
-2-3 symptoms
Moderate
-4-5 symptoms
Severe
-6 or more
Subtypes
delineated by the category of drug
not by amount or patterns of use
Only 4 symptom clusters, 5 or more symptoms in each category
What are the ten classes of drugs?
Substance Use Disorders
- Alcohol
- Caffeine
- Cannabis
- Hallucinogens
- Inhalants
- Opiods
- Sedatives, Hypnotics, and Anxiolytics
- Stimulants
- Tobacco
- Other Substances and Nonsubstance (Gambling)
True/False
Alcohol and tobacco are the most common substances abused
True
Dual Diagnosis for SUD
AKA Co-Occurring Disorders
Substance use disorder and mental illness or intellectual disability
Impact of SUD on Occupational Performance
Substance use is occupation
Continuum of consequences
positive – negative
Environmental factors
-Physical
-Social or cultural
Disruption of routines
Risks compound with dual dx
Risk Factors of SUD: Neurobilogical Factors
Genetic predisposition
Process/experience leads to compulsive use
Lack inhibitory control
Risk Factors of SUD: Psychological and Environmental Factors
Personality Traits
Fixed Mindset
Risk Factors of SUD: Sociological Considerations
Poverty
Trauma Exposure
Social Endorsement
Complex Trauma
Subjected to repetitive adverse experience/maltreatment
typically related to children/adolescent
Symptoms of Trauma
Cognitive
Emotional
Physiological
Behavioral
Degree of impact/effect varies
Trauma
emotional wound or shock that creates substantial, lasting damage to the psychological development of a person
Stress
State of tension causing anxiety or worry
-Triggered by a stressor
Acute- Short stress response elicited by event
Chronic- Repeated and Prolonged Activation
Traumatic- Exposure to trauma
Diagnosis of Adjustment Disorder
Distress impacts function
Stressor can typically be identified
What are the symptom clusters of PTSD?
- Intrusion
*Reexperiencing, with or without a trigger
Dissociation * - Persistent avoidance
Avoid triggers
Mood & cognition changes - Persistence negative thoughts & feelings
Memory
Shame/guilt/identity - Altered arousal or reactivity
Stress response
Hyper-vigilance
Cognition
Sleep
Risk Factors of PTSD
33% sexual violence
30% interpersonal experience
12% interpersonal violence
14% organized violence
11% life-threatening experience
True/False
Complex trauma typically affects children and/or adolescents subjected to repetitive adverse experiences/maltreatment.
True
Risk Factors of Complex Trauma
- Multiple exposure to traumatic events
- Inconsistent or absent protective caregiving
- Physical, sexual, or emotional abuse
- Transgenerational
- Parents/Caregivers (Young or single parents, Were abused as children, Have psychiatric disorders, Have realistic expectations of child development)
- Families (Substance abuse, Low income, Transient adults in home)
- Children *(Congenital anomalies, Unwanted child, Adopted/foster children, “Fussy” infants, “Disobedient” children)
*
Secure Attachment
Children
- Normal child-caregiver relationship
- Provide safety & protection during stressful situations
- Predictable
- Consistent
- Trustworthy
- Translates to meaningful adult connections
Insecure Attachment
Children
Avoidant-Caregiver disengaged/unavailable, Self-reliance, Dismissive of emotions/relationships
Ambivalent - Caregiver inconsistent, Fear abandonment, Dependency
Disorganized- Caregiver chaotic & abusive, Alternate between high & low arousal emotions, Repeating abusive patterns
What are some poor attachment outcomes?
Children
Social isolation
Difficulty with perspective taking
Establishing/maintain healthy relationships
Chronic feelings of distrust / suspicion
What are the 7 domains of impaired attachment?
Attachment
Biology
Affect Regulation
Dissociation
Behavioral Regulation
Cognition
Self-Concept
What is important to remember with trauma informed care?
The client is doing the best that they can.
There is a high prevalence of trauma, we need to understand the influence of trauma and be sensitive of a client’s specific needs/concerns
