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Q4 Psych > Cognitive Disorders (lec 2) > Flashcards

Cognitive Disorders (lec 2) Flashcards

1
Q

Cognitive Disorders affect? (8)

May cause? (2)

A 
Judgement
Initiative
Memory/recall
Orientation
Impulse control
Emotional stability
Attention span
Problem solving

Hallucinations
Confabulation (make up memories)

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2
Q

Delirium DSM criteria?

A

ACUTE, rapidly progressive ∆s in cognition

Seen as:
inattention
disturbed consciousness,
sxs fluctuate over 24 hrs

(aka encephalopathy, acute confusional state)

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3
Q

Delirium sxs? (5 general categories)

A

1) Arousal: altered levels
2) Memory: impairment
3) Orientation: dis
4) Perception: disturbance
5) Language: disturbance

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4
Q

Risk factors of delirium? (8)

A 
INFECTION
Existing cognitive impairment
>70 yo
Poor fxnl status
Hearing/visual impairment
Dehydration (e- disturbance)
Sleep deprivation
Polypharmacy
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5
Q

Delirium DDX?

A 
2° to medical condition or substance
Intoxication
W/drawal
Dementia
Psych disorders
Fakers
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6
Q

Delirium assessment includes? (3 categories)

A

Primary survey:
Good hx and physical
Mental status

Secondary survey:
Reassess (delirium ∆s rapidly)

Thorough medical workup:
CBC
CMP
UA (UTI common cause)
EKG
CXR (PNA common cause)
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7
Q

Delirium tx? (5)

A 
Treat cause/stop offending meds
Stable environment
Ensure they can hear and see
Full-time sitter
Educate family/caregivers
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8
Q

Common meds that cause delirium? (5)

A 
BZs
Tramadol
Opiates
Anticholinergics
H2 blockers (U pepsid)
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9
Q

Pharm tx for delirium indicated when? (3)

A

1) severe agitation
2) combative
3) behavior that interferes w/ care

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10
Q

Drugs used to treat delirium?

Risk a/w these meds?

A

Antipsych:
Haloperidol, Zyprexa, Seroquel, Risperdal

↑ risk of sudden death in pts w/ dementia

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11
Q

Considerations w/ antipsych meds for delirium? (5)

A 
Get baseline ECG (can ∆ QTI)
Correct e-
Start slow/go slow
Watch BP/orthostatics
Educate family
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12
Q

Benzodiazepines indicated for tx of what type of delirium?

A

EtOH or drug-induced

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13
Q

EtOH w/drawal delirium presentation?

A

EMERGENCY

Extreme auto hyperactivity w/ delirium

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14
Q

Dementia DSM criteria?

A

Acquired, CHRONIC, progressive decline in memory w/ assoc’d cognitive/fxnl impairment

IRREVERSIBLE

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15
Q

Possible Dementia-related cognitive disorders?

A

1) aphasia (can’t understand and/or express speech)
2) apraxia (loss of motor skills)
3) agnosia (can’t recognize sensory input - don’t know what things are)

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16
Q

Cannot diagnose Dementia when what?

A

delirium is present

17
Q

Causes of Dementia? (4)

A

Alzheimer’s
Vascular/Multi-infarct
Neurodegeneration
2° to other dzs/conditions

18
Q

Neurodegenerative process that cause dementia? (3)

A

1) Lewy Body Dz (protein deposits -> hallucinations that don’t cause concern to the pt)
2) Parkinson’s
3) Frontaltemporal degen/Pick’s Dz (behavioral disturbances/disinhibition, non-fluent aphasia)

19
Q

Vascular/Multi-infarct dementia U accompanied by or result of?

A 
vascular risks (DM, heart dz, CAD)
U follows CVA
20
Q

Dementia caused by Creutzfeldt-Jakob Dz:

Etiology?

Epidemiology?

Onset?

Sxs?

Prognosis?

A

Caused by prion

U 40-60 yo

Rapid onset

Triad of dementia, involuntary mvmt, hallucinations (end up unable to move)

Fatal

21
Q

Huntington’s dementia:

Etiology?

Epidemiology?

Sxs?

Imaging findings?

A

Auto dominant

U onset 30-40s

Choreiform mvmts

Boxcar ventricle on imaging

22
Q

HIV dementia:

Etiology?

Sxs?

A

Direct result of HIV (find in CSF)

Forgetful, slow, apathy, delirium
Tremors, ataxia

23
Q

Reversible dementias include? (5)

A

1) Normal Pressure Hydrocephalus
(sudden falls + urinary incontinence + neurocog decline)

2) B12 deficiencies
3) Hypothyroid
4) Depression
5) Syphilis

24
Q

Dementia DDX? (4)

A

Mild cognitive impairment
Reversible dementias
Delirium
Amnestic disorders

25
Q

Mild Cognitive Impairment is?

Presentation?

Increases risk for what?

A

Pre-dementia

Subjective memory complaints,
objective mild memory impairment,
preserved cognitive fxn,
intact ADLs

ALL types of dementia

26
Q

Dementia assessment includes? (4)

A

Hx/physical
Labs
Neuroimaging
Cognitive testing

NO definitive test while alive

27
Q

Dementia labs? (8)

A 
CBC/CMP
TSH
B12
Folate
Homocysteine (high levels ↑ strokes)
SED rate
HIV
RPR (rapid plasma reagin for syphilis)
28
Q

Dementia imaging?

A

CT or MRI to r/o reversible dementias

29
Q

Mental status testing for dementia?

A

MMSE

30
Q

Dementia management? (4)

A

Tx cognitive sxs
Behavior mgmt
Educate/support for caregiver
Prevention

31
Q

Tx for dementia-related cognitive sxs?

A 
Cholinesterase inhibitors (aricept)
NMDA antagonists (memantine)
32
Q

Amnestic Disorders are?

A

Impaired or inability to:
Learn new info
Recall learned info or past events

Causes marked social/occupational impairment

NOT caused by delirium or dementia

33
Q

Amnestic Disorder presentation?

A 
Confused/disoriented
Confabulation
Rarely disoriented to self (know who they are)
Unaware of deficits
Apathy of deficits
34
Q

Amnestic Disorders caused by? (8)

A 
Head injury
Drugs
Postictal (seizure)
Shock therapy
Focal tumors/infarcts
Infection
Cerebral anoxia
Transient global
35
Q

Transient Global Amnesia is?

A

Abrupt loss of recall or ability to make new memories in healthy people

Lasts 6-24 hrs

36
Q

Types of EtOH-induced amnesia? (2)

A

1) Wernicke’s Encephalophathy

2) Korsakoff’s Syndrome

37
Q

Wernicke’s Encephalophathy result of?

Triad of sxs?

A

ACUTE EtOH-induced thiamine deficiency

Ophthalmoplegia (paralysis of ocular mm)
Ataxia
Nystagmus

38
Q

Korsakoff’s Syndrome results of?

Presentation?

A

CHRONIC EtOH-induced thiamine deficiency

Similar triad + (P) psychosis
IRREVERSIBLE

Q4 Psych (14 decks)

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