Week 7: Clients living w/ mood disorders & the 3 D's & neurodevelopment disorders

Question 1

Major Depressive Disorder: DSM-5 diagnosis (6)

Answer 1

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

Question 2

MSE components (5)

Answer 2

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

Question 3

Non pharmacological treatments for MDD (3)

Answer 3

• psychotherapy
• electroconvulsive therapy (ECT)
• transcranial magnetic stimulation (TMS)

Question 4

ECT

Answer 4

• electrical current passed through through the brain, intentionally triggering a brief seizure
• prior administration of anesthetic and paralytics
• risks! can cause memory loss

Question 5

ECT uses

Answer 5

• extreme end of mood disorders
• vegetative symptoms or catatonia
• treatment resistant bipolar disorder (manic phase)
• experiencing actue suicidality

Question 6

TMS

Answer 6

• MRI-stregnth magnetic pulses are used to stimulate focal areas of cerebral cortex (negative implications of being overexposed to magnetic element of MRI machine)

Question 7

TMS uses

Answer 7

• MDD (schizophrenia, anxiety disorders being explored)
• last resort

Question 8

Bipolar I disorder

Answer 8

characterized by one or more manic episodes with depressive component

Question 9

Bipolar II disorder

Answer 9

period of major depression accompanied by at least one incidence of hypomania

Question 10

Cyclothymic disorder

Answer 10

mild form of bipolar disorder where mood swings from short period of mild depression and hypomania for at least 2 years

Question 11

Priority care issues

Answer 11

• 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

Question 12

Definition of depression

Answer 12

change of mood that lasts at least 2 weeks with feelings of sadness and loss of interest and pleasure in usual activities

Question 13

definition of delirium

Answer 13

characterized by acute fluctuating onset of confusion, disturbances in attention, disorganized thinking and decline in level of consciousness

Question 14

definition of dementia

Answer 14

gradual and progressive decline in mental processing ability, affecting memory, communication, language, judgment and abstract thinking

Question 15

onset & course of depression

Answer 15

• acute or chronic
• weeks to months
• variable course

Question 16

onset & course of delirium

Answer 16

• acute
• hours to days
• short, fluctuating

Question 17

onset & course of dementia

Answer 17

• chronic
• months to years
• progressive

Question 18

memory & thinking for depression

Answer 18

• intact memory
• reduced concentration, indecisive, hopelessness, low self-esteem

Question 19

memory & thinking for delirium

Answer 19

• imparted memory
• fluctuating between rational and disorganized thought

Question 20

memory & thinking for dementia

Answer 20

• impaired memory
• difficulty w/ abstract thinking, poor decision making, word finding

Question 21

Sleep & LOC for depression

Answer 21

• hypersomnia
• no change in LOC

Question 22

Sleep & LOC delirium

Answer 22

• nocturnal confusion
• fluctuating LOC

Question 23

Sleep & LOC dementia

Answer 23

• fragmented, nocturnal confusion, wandering

Question 24

intervention for depression

Answer 24

• psychosocial recovery principles
• pharm/non pharm

Question 25

intervention ofr delirium

Answer 25

• treat/address underlying cause:
  medication side effect; infections; fluid/electrolyte imbalance; cognitive impairment; stressors

Question 26

what are 2 common causes of delirium?

Answer 26

• UTI
• hypoglycaemia (can be difficult to diagnose when in older adults with dementia)

Question 27

Neurodevelopmental disorders

Answer 27

characterized by development delay or deficit in one or more lines of development that impair functioning

Question 28

neurocognitive disorders

Answer 28

acquired conditions as a result of underlying brain pathology that result in decreased cognitive functions (traumatic brain injury)

Question 29

neurobehavioral disorders

Answer 29

• 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

Question 30

Attention Deficit Hyperactivity Disorder (ADHD)

Answer 30

altered degree of inattention, impulsivity and hyperactivity which interferes with functioning or development

Question 31

ADHD diagnosis

Answer 31

• symptoms must be present in at least 2 settings (school and home)
• symptoms must be present before age 12

Question 32

fecal alcohol spectrum disorders

Answer 32

• 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

Question 33

physical, cognitive, behavioural impacts of fetal alcohol spectrum disorder

Answer 33

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

Question 34

Disruptive, impulse-control, and conduct disorders (usually stems from family not having a good foundation for following rules)

Answer 34

• conduct disorder
• oppositional defiance disorder
• pyromania (starting fires)

Question 35

Communication disorders

Answer 35

• language disorder
• speech sound disorder
• childhood-onset fluency disorder

Question 36

learning disorders

Answer 36

• specific learning disorder
• intellectual disability

Question 37

Movement disorders

Answer 37

• tic discover
• stereotypic movement disorder

Question 38

medications used for autism

Answer 38

• anti-psychotics (decrease irritability and lability)
• SSRI (decrease compulsive behaviour)
• Beta blockers (decrease aggression & severe anxiety)

Question 39

medications for ADHD

Answer 39

• psychostimulant
• non-stimulant selective
• norepinephrine reuptake inhibitor

Question 40

what do psychostimulants do in the brain?

Answer 40

• improve communication in brain so improved attention, concentration and self-control

Question 41

common stimulants

Answer 41

• methylphenidate (concerta, ritalin)
• amphetamines (adderall, Vyvanse)

Question 42

methylphenidate

Answer 42

• 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

Question 43

amphetamines

Answer 43

• short-acting and long-acting

Question 44

psychostimulant side effects

Answer 44

• decrease appetite -> weight loss
• insomnia

Question 45

stimulant adverse effects

Answer 45

• headache, abdominal pain, cardiovascular (avoid if heart problems), psychiatric (suicidal ideation, hallucinations, aggressive behaviour)