Week 7: Clients living w/ mood disorders & the 3 D's & neurodevelopment disorders Flashcards
Major Depressive Disorder: DSM-5 diagnosis (6)
5 or more symptoms including depressed mood and/or anhedonia (reduced ability to experience pleasure) for 2 weeks or more:
- increase/decrease in appetite
- sleep changes
- psychomotor agitation or retardation
- fatigue or energy loss
- feelings of worthlessness or excessive guilt
- recurrent suicidal ideations or past attempt
MSE components (5)
thought content: rumination on stressors, guilt, SI
Thought process: thought blocking (client discussing a topic and then stop in middle of speech, may be related to shame around thoughts)
Perception: no changes
Cognition & sensorium: decreased attention span
insight & judgment: compromised insight into impact of mood on life and may hold blame for life circumstances
Non pharmacological treatments for MDD (3)
- psychotherapy
- electroconvulsive therapy (ECT)
- transcranial magnetic stimulation (TMS)
ECT
- electrical current passed through through the brain, intentionally triggering a brief seizure
- prior administration of anesthetic and paralytics
- risks! can cause memory loss
ECT uses
- extreme end of mood disorders
- vegetative symptoms or catatonia
- treatment resistant bipolar disorder (manic phase)
- experiencing actue suicidality
TMS
- MRI-stregnth magnetic pulses are used to stimulate focal areas of cerebral cortex (negative implications of being overexposed to magnetic element of MRI machine)
TMS uses
- MDD (schizophrenia, anxiety disorders being explored)
- last resort
Bipolar I disorder
characterized by one or more manic episodes with depressive component
Bipolar II disorder
period of major depression accompanied by at least one incidence of hypomania
Cyclothymic disorder
mild form of bipolar disorder where mood swings from short period of mild depression and hypomania for at least 2 years
Priority care issues
- safety (protecting patient as judgment is poor due to increased impulsivity)
- monitor electrolytes & thyroid function (change in eating habits, risk for fluid imbalance, lithium)
- assess effects of medication and adherence
Definition of depression
change of mood that lasts at least 2 weeks with feelings of sadness and loss of interest and pleasure in usual activities
definition of delirium
characterized by acute fluctuating onset of confusion, disturbances in attention, disorganized thinking and decline in level of consciousness
definition of dementia
gradual and progressive decline in mental processing ability, affecting memory, communication, language, judgment and abstract thinking
onset & course of depression
- acute or chronic
- weeks to months
- variable course
onset & course of delirium
- acute
- hours to days
- short, fluctuating
onset & course of dementia
- chronic
- months to years
- progressive
memory & thinking for depression
- intact memory
- reduced concentration, indecisive, hopelessness, low self-esteem
memory & thinking for delirium
- imparted memory
- fluctuating between rational and disorganized thought
memory & thinking for dementia
- impaired memory
- difficulty w/ abstract thinking, poor decision making, word finding
Sleep & LOC for depression
- hypersomnia
- no change in LOC
Sleep & LOC delirium
- nocturnal confusion
- fluctuating LOC
Sleep & LOC dementia
- fragmented, nocturnal confusion, wandering
intervention for depression
- psychosocial recovery principles
- pharm/non pharm
intervention ofr delirium
- treat/address underlying cause:
medication side effect; infections; fluid/electrolyte imbalance; cognitive impairment; stressors
what are 2 common causes of delirium?
- UTI
- hypoglycaemia (can be difficult to diagnose when in older adults with dementia)
Neurodevelopmental disorders
characterized by development delay or deficit in one or more lines of development that impair functioning
neurocognitive disorders
acquired conditions as a result of underlying brain pathology that result in decreased cognitive functions (traumatic brain injury)
neurobehavioral disorders
- interchangeable term for many of the conditions now classified as neurodevelopment
- it used to define ADHD and ODD and now they are defined as neurodevelopmental disorders
Attention Deficit Hyperactivity Disorder (ADHD)
altered degree of inattention, impulsivity and hyperactivity which interferes with functioning or development
ADHD diagnosis
- symptoms must be present in at least 2 settings (school and home)
- symptoms must be present before age 12
fecal alcohol spectrum disorders
- group of conditions that occur in persons who are exposed to alcohol before birth
- physical and cognition implications
- unclear how much alcohol a child needs to be exposed to impact development
physical, cognitive, behavioural impacts of fetal alcohol spectrum disorder
physical: body weight, facial feature development, height, changes to heart/kidney/bone development, vision/hearing, small head size
cognitive: impaired CNS, so memory and attention, learning disabilities, speech/language delays, mental health disorders
Behavioural: poor coordination, hyperactive behaviour
Disruptive, impulse-control, and conduct disorders (usually stems from family not having a good foundation for following rules)
- conduct disorder
- oppositional defiance disorder
- pyromania (starting fires)
Communication disorders
- language disorder
- speech sound disorder
- childhood-onset fluency disorder
learning disorders
- specific learning disorder
- intellectual disability
Movement disorders
- tic discover
- stereotypic movement disorder
medications used for autism
- anti-psychotics (decrease irritability and lability)
- SSRI (decrease compulsive behaviour)
- Beta blockers (decrease aggression & severe anxiety)
medications for ADHD
- psychostimulant
- non-stimulant selective
- norepinephrine reuptake inhibitor
what do psychostimulants do in the brain?
- improve communication in brain so improved attention, concentration and self-control
common stimulants
- methylphenidate (concerta, ritalin)
- amphetamines (adderall, Vyvanse)
methylphenidate
- short-acting formulas usually started with one dose per day and then increased to 2or 3 times daily
- long-acting formulas are usually take once per day
amphetamines
- short-acting and long-acting
psychostimulant side effects
- decrease appetite -> weight loss
- insomnia
stimulant adverse effects
- headache, abdominal pain, cardiovascular (avoid if heart problems), psychiatric (suicidal ideation, hallucinations, aggressive behaviour)
