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52 Cards in this Set
- Front
- Back
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Dissociative Disorders Overview
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• Disturbance in organization of identity, memory, perception, or consciousness
• Dissociation can be involved in Acute Stress Disorder and PTSD • Disturbance in organization or structure of mental contents – not a disturbance in the contents |
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Dissociative Fugue or Dissociate Identity Disorder:
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Fragmentation of identity
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Depersonalization Disorder
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Disintegrated perception
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Dissociative Amnesia card 1 of 3
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• No problems in procedural or working memory – unlike Korsakoff Syndrom
• Reversible – unlike dementia • Usually 1 episode, but can include more |
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Dissociative Amnesia card 2 of 3
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1. Memory loss is episodic
2. Temporal structure: can range from minutes to years, retrograde a. No difficulty in learning new information (unlike dementia of Alzheimer Type) 3. Types of events forgotten: usually for traumatic or stressful events |
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Dissociative Amnesia card 3 of 3
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• Usually occurs after an episode of trauma
• Onset can be sudden or gradual • May not be initially aware of memory loss • Can be selective amnesia – after a car accident, other trauma • May suffer from detachment, demoralization, difficulty with relationships • Even though it is out of conscious awareness, memories can still and do affect individual |
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Dissociative Identity Disorder card 1 of 2
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• Presence of 2 or more distinct identities or personality states
• Take control of person’s behavior • Often amnesia is also present • Failure to integrate aspects of identity - Allows for different relationship styles and moods states to be segregated within different identities and memories |
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Dissociative Identity Disorder card 2 of 2
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• Often result of very traumatic childhood
• Usually emerges in adolescence – 30’s • Chronic and recurrent disorder • Most patients not aware of extent |
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Dissociative Identity Disorder Comorbidities
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Borderline PD, PTSD comorbidities are common
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Cognitive Disorders Overview
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• Recent Memory Impairment
• Disorientation • Poor judgment • Confusion • General loss of intellectual functioning • May have: Hallucinations, delusions, personality changes, secondary emotional reactions • For all of these disorders, there is evidence that the disorder is a direct physiological consequence of a GMC |
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Delirium
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Reduced awareness of environment
Primary disturbance is in level of consciousness - Impairments in orientation, memory, judgment, and attention - Acute onset |
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Dementia
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Deterioration of intellectual functioning
Cognitive deficits in memory, language, and intellect - Insidious (gradual) onset |
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Amnestic Disorders
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Memory impairment
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Overview of Cognitive Disorders
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• All feature impairment in memory, language, and/or attention as a primary symptom
• Delirium, Dementia, Amnestic, and other Cognitive Disorders are all subdivided into further categories by etiology - Either GMC, effects of a substance, or multiple etiologies - Also NOS categories |
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Delirium speech may include:
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• Dysarthia – can’t articulate
• Dysnomia – can’t name objects • Dysgraphia – can’t write |
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Delirium perceptual disturbances may include:
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• Hallucinations – “auditory illusions”
• Illusions – inanimate object seen as an animate one |
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Delirium misinterpretations - may also frequently exhibit:
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• Psychomotor disturbances
• Emotional disturbances • Sleep-wake cycle disturbances |
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Delirium Criteria
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• Disturbance of consciousness
- Reduced awareness of the environment - Difficulty focusing, sustaining or shifting attentions. Client is often easily distracted • Change in cognition - Memory deficit, disorientation, language disturbance - Disorientation and Memory Loss (recent) not accounted for by dementia • Develops over a few hours to a few days; fluctuates during the day, and tends to worsen at night |
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Delirium Prodromal Period
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• Altered sleep patterns
• Unexplained fatigue • Fluctuating mood • Sleep phobia • Restlessness • Anxiety • Nightmares |
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Delirium Clinical Feature: Arousal
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May be increased or decreased
• Marked restlessness, heightened startle response, hypervigilance, increased alertness • Withdrawal from depressive substances (e.g., alcohol) • Sweating, GI distress, autonomic arousal • Depressed state |
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Delirium Clinical Features: Language & Cognition
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Abnormal production and comprehension of speech
• Nonsensical rambling and incoherent speech • Mute • Impaired memory • Dysarthria – can’t articulate • Dysnomia – can’t name objects • Dysgraphia – can’t write |
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Delirium Clinical Features: Perception
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Inability to discriminate sensory stimuli
• Misinterpretations: personalize events, conversations that don’t pertain to them - Auditory and visual illusions - Paranoia and sleep phobia may result |
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Delirium Clinical Features: Orientation
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Worse in the morning
• Orientation to time, place, person, and situation should be evaluated – MSE – assess throughout the day • Disorientation to time is common |
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Delirium Clinical Features: Mood
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Rapid fluctuations
• Unprovoked anger and rage • Fear → hypervigilance, sleep phobia • Apathy • Euphoria |
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Delirium Clinical Features: Sleep & Wakefulness:
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Usually abnormal
• In daytime, random sleepiness • During nighttime, restless and combative • Sleep fragments, vivid nightmares common |
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Delirium Clinical Features: Neurological Functioning
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• Tremors
• Gait apraxia • Dysphagia • Poor coordination |
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Delirium Course
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• Once cause is eliminated, symptoms usually recede gradually during 3-7 days
• Memory for events during delirium is usually spotty |
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Delirium Vs. Dementia
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• Delirium – acute onset, wide fluctuations in Sx with periods of relative lucidity; cloudy consciousness; most likely reversible
• Dementia: are usually alert; not reversible - Less likely to have issues with attention and orientation except in later stage dementia • Can occur simultaneously |
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Delirium Vs. Psychotic and other mental states
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• Schizophrenia: Sx more constant and organized, don’t have cloudy consciousness
• Factitious Disorders: inconsistent Sx • Depression |
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Types of Delirium
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• Delirium due to a GMC:
- Infection induced - Metabolic and endocrine disturbances - Congestive heart failure - Intracranial causes - Postoperative states - Sensory deprivation and environmental changes • Medication-induced Delirium - Antidepressants, lithium, narcotics, benzos, sedatives • Substance intoxication Delirium - Hallucinogens, heroin, amphetamines, cannabis • Delirium due to multiple etiologies • Delirium NOS |
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Dementia
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• Multiple cognitive deficits that include:
- Some degree of memory impairment - Agnosia – can’t remember names of objects - Aphasia – difficulty understanding language, concentration difficulties affect speech - Apraxia – can’t perform simple motor tasks (dress, eat, cook, familiar activities) - Executive functioning impairment |
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Retrograde Amnesia
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Difficulty remembering things before onset of the disorder
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Anterograde Amnesia
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Difficulty remembering things after onset of disorder
Anterograde is usually evident at the beginning of the disorder: |
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Dementia Misc.
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• More gradual onset than delirium
• Personality changes and loss of impulse control and judgment are common • Delirium and dementia are differentiated by ability to shift attention appropriately (consciousness) • No clouding of consciousness |
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Immediate recall (Know this!)
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Primary memory
- Ability to immediately repeat a series of number - Attention, concentration, following instructions - Loss of ability to retain new information |
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Recent memory (Know this!)
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Secondary memory
- Delayed (5 minutes) repeating of 3 objects |
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Remote memory (Know this!)
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Tertiary memory
- In early stages, still intact - Need collateral information |
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Aphasia (Know this!)
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Difficulty communicating with others - verbal, written language
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Bricks’ Aphasia:
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Paucity of speech, poor articulation
- Normal comprehension and awareness of impairment - Anxiety, depression, frustration |
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Wernicke’s Aphasia:
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Verbose and articulate, nonsensical
- Alzheimer’s disease, Vascular Dementia affecting parietal or temporal lobe - Apathetic and unconcerned |
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Agnosia (Know this!)
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• Lose ability to recognize (Ex. names of common objects)
• Altered perception • Type of agnosia depends on sensory system involved |
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Apraxia (Know this!)
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• Loss of ability to carry out selected motor activities
• Brushing teeth, chewing food, etc. |
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Memory Impairment: Executive Functioning (Know this!)
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• Loss in ability to think abstractly, plan, initiate, end complex behavior
• Difficulty coping with new tasks • MSE should assess each of these areas |
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Dementia Differential Diagnosis
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• Delirium – acute, altered consciousness
• Depression – more crying, hopelessness, guilt, Hx of depression, better insight into cognitive problems, medications should help • Amnestic Disorders – memory problems without aphasia, agnosia, apraxia • Psychotic disorders – usually earlier onset, not result of medical condition or substance |
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Dementia of Alzheimer’s Type
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• Symptoms parallel other dementia symptoms
• Progressive memory decline over 8-10 years |
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Dementia of Alzheimer’s Type - Early signs:
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• Impaired memory
• Difficulty with problem-solving • Preoccupation with past events • Decreased spontaneity • Decreased speed and accuracy • Forget names, misplace household objects, forget what they are about to do • Often have insight into difficulties |
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Dementia of Alzheimer’s Type - Middle stages:
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Anomia (difficulty with word finding)
• Relies on familymember as a surrogate memory • Avoidance of unfamiliar activities • Confusion, aggression, frustration, wandering, socially undesirable behaviors |
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Dementia of Alzheimer’s Type - Later stages:
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Physical effects
• No longer ambulatory • Mute, bedridden |
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Vascular Dementia
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• Results from one large or multiple CVA’s
• 2x more common in men • Stepwise progression of cognitive deterioration • Risk factors: hypertension, obesity, heart disease, stress, smoking |
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Some other types of Dementia
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• Dementia due to HIV Disease
• Due to Pick’s Disease • Due to Parkinson’s Disease • Due to Huntington’s Disease • Due to head trauma (Traumatic Brain Injury) • Other medical conditions • Due to multiple etiologies • NOS |
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Amnestic Disorders
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• Only memory is affected
• Blackouts: heavy drinking – temporary • Korsakoff’s Syndrom • Head injury (TBI) - Delirium, dementia, mood problems, alterations in personality, memory loss |
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Korsakoff’s Syndrom
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Lack of thiamine
- Alcohol dependence, malnourishment - Retrograde & anterograde amnesia - Confabulation - Only 20% recover |
