Depersonalization / Dissociative Disorders

Question 1

Delirium prevalence ?

Answer 1

1-2%, increased with age rising to 14% over 85 years old.

Incidence in ED among older individuals is 10-30%

Question 2

Delirium Etiology and risk factors ?

Answer 2

Increases with age ( AGE!!)

Functional impairment, falls, low level of activity, drugs and medications

** alcohol wd with delirium - delirium tremmins ( they get the shakes)**

Question 3

Delirium genetics and physiology ?

Answer 3

Neurocognitive disorders increase risk

Febrile illness

Question 4

Delirium DDx ?

Answer 4

Psychotic disorders,

Bipolar/Mood with psychotic features

Acute stress disorder
Malingering and factitious disorder

** delirium is a sign that the body is not taking care of the brain properly and it is irritated , delirium and pyschosis are hard to differentiate ( zyprexa Ziadisx )**

Question 5

Delirium work up ?

Answer 5

Look for underlying conditions 
(CBC - infection, glucose, CMP - electrolytes disturbances , 
Ammonia - liver failure, 
TSH - hyper or hypo, 
HIV - delirium or dementia longer term, 
UA - UTI, 
CXR - pneumonia , 
Utox - drugs, 
CT Brain - is there a tumor or bleed )
need to rule out other things

Question 6

Delirium prognosis ?

Answer 6

Good, with often full recovery in many individuals
reversible cause

Mortality is increased. May be as high as 40%

Increased functional decline

Requires hospitalization and increased risk of long term care placement (3X those without delirium)

• *prognosis with dementia is less good
• *

Question 7

Delirium tx and medications ?

Answer 7

Treat underlying cause.

Fluids and nutrition

Reduce distractions and noise at night

If agitated, atypical antipsychotics (zyprexa, seroquel, risperdal)

Question 8

Delirium procedures / therapy / surgery ?

Answer 8

Reorientation techniques with calendar, clocks and family photos

Question 9

Dementia aka ?

Answer 9

Major and Minor Neurocognitive Disorders

Question 10

Dementia prevalence ?

Answer 10

Varies widely by age and etiology

At 65 years old – 1-2%

At 85 years old- up to 30%
Mild NCD is variable

65 yo 2-10%
85 yo 5-25%

** clearly age related **

Question 11

Dementia etiology and risk factors ?

Answer 11

Vary by subtype
-Age is risk for almost all
Ex. Alzheimer’s uncommon < 60yo, frontotemporal lobe is earlier

Genetics
-Parkinson’s, Huntington’s are strongly genetic; Alzheimer’s maybe also

Question 12

Dementia DDx ?

Answer 12

Normal cognition
Delirium
MDD
Learning or developmental disorders

Question 13

Dementia prognosis ?

Answer 13

Variable

Some may begin and remain static ( related to traumatic or infectious cause)

Some are progressive (Alzheimer’s, frontotemporal lobe, Parkinson’s, Huntington’s)

Question 14

Dementia workup ?

Answer 14

Blood work (CBC, CMP, glucose, HbA1C, UA,

CT/MRI brain, PET scan, CXR

Neuropsychological assessment

Question 15

Dementia medications ?

Answer 15

Cholinesterase inhibitors

Partial N-methyl-D-aspartate antagonists

Question 16

Dementia procedures ?

Answer 16

Cholinesterase inhibitors

Partial N-methyl-D-aspartate antagonists

Question 17

Alzheimer’s Dementia tx ?

Answer 17

Cholinesterase inhibitors

Partial N-methyl-D-aspartate antagonists

** think memory and learning

this is clinical dx
we dont have had and fats genetic testing and fam hx is good!**

Question 18

Cholinesterase inhibitors

examples?

Answer 18

-Donzepil (Aracept), Rivastigmine (Exelon), Galantamine

Question 19

Partial N-methyl-D-aspartate antagonists example ?

Answer 19

Memantine (Namenda)

Question 20

frontotemporal Dementia tx ?

Answer 20

Depression- SSRI’s

So far, dopaminergic (Parkinson’s) and cholinergic (Alzheimer’s) medications do not work.

Question 21

what is stored in the front of the head ?

Answer 21

• decision making and personality

Question 22

Lewy Body Dementia tx ?

Answer 22

Rivastigmine (Exelon) and other cholinesterase inhibitors

Atypical antipsychotics - 2nd gen

Do not use haloperidol ( risk of neuroleptic malignant syndrome)

Levadopa/carbodopa- parkinsonian features
mainstay for parkinson’s
SSRI’s for depression

Question 23

Atypical antipsychotics examples 2nd gen?

Answer 23

quetiapine, aripiprazole

Question 24

Vascular Dementia tx ?

Answer 24

Prevention of future CVA’s

Rehabilitation/Adaptation-PT ( more rehabilitation) and OT (more adaptation )
stroke related

cholinesterase inhibitors (Aracept) can help

Psychotic symptoms-
antipsychotics-quetiapine, aripiprazole

Depression
SSRI’s- sertraline, citalopram

Question 25

Vascular Dementia ?

Answer 25

stroke and now you have dementia and this is time related to a clot etc , sometimes memory and leaning with it dx, CT or MRI of brain and you see evidence

Question 26

Dementia due to traumatic Brain Injury tx ?

Answer 26

Prevention of future TBI’s Rehabilitation/Adaptation-PT and OT ``` Alzheimer’s like symptoms cholinesterase inhibitors (Aracept) can help ``` Parkinson’s like symptoms Levadopa/carbadopa Depression SSRI’s- sertraline, citalopram

Question 27

Dementia due to Parkinson’s Disease tx ?

Answer 27

Levadopa/carbadopa - first line but people get tolerance so they add what is below Monoamine oxidase B inhibitor Dopamine agonists Depression

Question 28

Dementia due to Parkinson’s Disease tx : Monoamine oxidase B inhibitor examples ?

Answer 28

Selegeline - specifically B

Question 29

Dementia due to Parkinson’s Disease tx: Dopamine agonists | examples ?

Answer 29

Ropinirole (Requip), Pramipexole (Miraplex)

Question 30

Depression tx ?

Answer 30

SSRI’s- sertraline, citalopram

Question 31

Dementia due to Huntington’s Disease tx ?

Answer 31

Cholinesterase inhibitors Partial N-methyl-D-aspartate antagonists Atypical antipsychotics Antidepressants

Question 32

Cholinesterase inhibitors | examples ?

Answer 32

Rivastigmine (Exelon),

Question 33

Partial N-methyl-D-aspartate antagonists

Answer 33

memantine ( Namenda)

Question 34

Depersonalization / Derealization Disorder prevalence ?

Answer 34

~2% of U.S.

Question 35

Depersonalization / Derealization Disorder Etiology and Risk factors ?

Answer 35

Trauma, significant stressor (death of a loved one, very severe financial, social or other stressors) Severe sleep deprivation Other disorders such as anxiety or depression **traum trauma trauma !!! this is not short term grieving and this is long term**

Question 36

Depersonalization / Derealization Disorder genetics ?

Answer 36

Unclear

Question 37

Depersonalization / Derealization Disorder DDx ?

Answer 37

Schizophrenia Panic Disorder Acute and Post Traumatic Stress Disorders Borderline / Avoidant Personality Disorders

Question 38

Depersonalization / Derealization Disorder prognosis ?

Answer 38

variable

Question 39

Depersonalization / Derealization Disorder medications ?

Answer 39

SSRI’s (maybe) but very limited studies Lamotrigine (mood stabilizing anticonvulsant)

Question 40

Depersonalization / Derealization Disorder procedures / therapy / surgery ?

Answer 40

CBT and psychotherapy

Question 41

Derealization symptoms ?

Answer 41

Symptoms of derealization include: Feelings of being alienated from or unfamiliar with your surroundings, perhaps like you're living in a movie Feeling emotionally disconnected from people you care about, as if you were separated by a glass wall Surroundings that appear distorted, blurry, colorless, two-dimensional or artificial, or a heightened awareness and clarity of your surroundings Distortions in perception of time, such as recent events feeling like distant past Distortions of distance and the size and shape of objects Episodes of depersonalization-derealization disorder may last hours, days, weeks or even months at a time. In some people, these episodes turn into ongoing feelings of depersonalization or derealization that may periodically get better or worse. In this disorder, feelings of depersonalization and derealization aren't directly caused by drugs, alcohol, a mental health disorder or a medical condition.

Question 42

Depersonalization symptoms ?

Answer 42

Symptoms of depersonalization include: Feelings that you're an outside observer of your thoughts, feelings, your body or parts of your body, perhaps as if you were floating in air above yourself Feeling like a robot or that you're not in control of your speech or movements The sense that your body, legs or arms appear distorted, enlarged or shrunken, or that your head is wrapped in cotton Emotional or physical numbness of your senses or responses to the world around you A sense that your memories lack emotion, and that they may or may not be your own memories

Question 43

Dissociative Amnesia prevalence ?

Answer 43

Female > Male (~2 to 6%)

Question 44

Dissociative Amnesia Etiology and risk factors ?

Answer 44

Usually trauma after r/o of organic causes

Question 45

Dissociative Amnesia genetics ?

Answer 45

Possibly – there is a slightly higher incidence of individuals with family members having amnesia issues. Currently unclear details of the association

Question 46

Dissociative Amnesia DDx ?

Answer 46

Dementia / Head Trauma / Substance Intoxication.
Early symptoms of neurological disorders (eg multiple sclerosis).

Question 47

Dissociative Amnesia prognosis ?

Answer 47

Generally good, improves with removal from traumatic event

Question 48

Dissociative Amnesia work up ?

Answer 48

Mini mental, look for biological causes (CT/MRI, cbc, cmp, UA, Utox, etc.)

Question 49

Dissociative Amnesia medications ?

Answer 49

Rarely successful. depression or anxiety might benefit from treatment with a medication such as an antidepressant or anti-anxiety medicine. hypnosis is common tx for this **Versed causes retrograde amnesia ( can remember) **

Question 50

Dissociative Amnesia procedures / therapy / surgery ?

Answer 50

Slow gradual psychotherapy Hypnosis Often resolve spontaneously

Question 51

Dissociative Fugue prevalence ?

Answer 51

~0.2% more common in war time/areas **very rare **

Question 52

Dissociative Fugue Etiology and risk factors ?

Answer 52

Related to dissociative amnesia or Extreme stress

Question 53

Dissociative Fugue genetics ?

Answer 53

Many theories - genetic influences, accounting for about 50% of the variance in twin studies. Smaller hippocampal and amygdala volumes (possible)

Question 54

Dissociative Fugue DDx ?

Answer 54

Dementia Head Trauma Substance Intoxication Malingering

Question 55

Dissociative Fugue prognosis ?

Answer 55

Mostly self-limited

Question 56

Dissociative Fugue medications ?

Answer 56

There is no medication to treat the dissociative disorders themselves. However, a person with a dissociative disorder who also suffers from depression or anxiety / antidepressants or anxiolytics

Question 57

Dissociative Fugue procedures / therapy / surgery ?

Answer 57

Supportive environment and sometimes hypnosis Psychotherapy to deal with issues associated with recovered memories

Question 58

Dissociative Identity Disorder prevalence ?

Answer 58

~.01 to 1%

Question 59

Dissociative Identity Disorder Etiology and risk factors ?

Answer 59

Family Hx Trauma is a large risk factor

Question 60

Dissociative Identity Disorder genetics ?

Answer 60

Unclear

Question 61

Dissociative Identity Disorder DDx ?

Answer 61

Dementia Head Trauma. Substance Intoxication. Malingering

Question 62

Dissociative Identity Disorder prognosis ?

Answer 62

No large scale studies but many psychiatrists report excellent results with therapy

Question 63

Dissociative Identity Disorder medications ?

Answer 63

There are no approved medications

Question 64

Dissociative Identity Disorder procedures / therapy / surgery ?

Answer 64

Supportive environment and sometimes hypnosis Psychotherapy