Cap 2 Lesson 6

Front 1

manifestation of changes that advance in a continuous and progressive manner during the adult years: Graying hair, presbyopia, wrinkling

Back 1

Aging

Front 2

changes resulting from genetics or natural factors

Back 2

Primary aging

Front 3

changes influenced by environmental factors

Back 3

Secondary aging

Front 4

Normal and problematic cognitive changes

Back 4

Normal: misplacing an item; forgetting a name

· Problematic: not remembering content of what is read; important events repeatedly forgotten; confusion; inability to understand present experiences

Front 5

Condition that is a consciousness disturbance; cognition change developing over a short time. Signs and Symptoms: progressive deterioration in level of consciousness (LOC), cognitive functioning. Change in behavior; ADL ability

Back 5

Delirium

Front 6

Condition that is irreversible, progressive decline in cognitive functioning; primary or secondary; See Box 19. 3 Characteristics of Dementia. loss of memory, awareness, judgment, reasoning ability; interferes with ADL’s, interaction with others

Back 6

Dementia

Front 7

Type of dementia that Affects brain: neuritic plaques; Cerebral cortex: involved in conscious thought, language.

•Signs & Symptoms: short-term memory fails, routine task performance diminishes, impaired judgment; diminishing language skills, disturbing behaviors; language problems; anomia; agnosia; aphasia; apraxia; self-neglect; personality/mood changes; behavior problems; suspicion of others; sundowning syndrome; advanced: totally unaware of surroundings

Back 7

Alzheimer’s

Front 8

Most common cause of death with Alz:

Back 8

pneumonia, UTI’s, infected decubitus ulcers

Front 9

fills in gaps of stories with other things when there is memory loss.

Back 9

Confabulation

Front 10

The 5 A’s of dementia

Back 10

Anomia, agnosia, aphasia, amnesia, apraxia

Front 11

Anomia

Back 11

inability to find the right word; calls a watch a timepiece

Front 12

Agnosia

Back 12

inability to identify an object; eats soup with a knife, eats wrapper with gum.

Front 13

Aphasia

Back 13

impaired understanding of words.

Front 14

Amnesia

Back 14

loss of recent memory first, then inability to recall remote memory.

Front 15

Apraxia

Back 15

inability to carry out purposeful movements. Cant transfer food to mouth.

Front 16

In dementia, an overreaction to perceived threat. Precipitated by a change in routine and frustration.

Back 16

Catastrophic events

Front 17

Type of dementia: affects of CVA upon brain portion where CVA occurs. Signs & Symptoms: personality, insight better preserved than in AD; depression. Neurologic symptoms: hemiplegia; abnormal reflexes; gait disturbances. Uncontrollable emotional responses; cognitive deficits

Back 17

Vascular

Front 18

Type of dementia: abnormal protein deposits (Lewy bodies) develop throughout brain’s nerve cells. Signs & Symptoms: similar to AD. Variances: more visual hallucinations, paranoia, and delusional thinking. Slow, rigid movements, shuffling gait.

Back 18

Lewy body

Front 19

What may be mistakenly diagnosed as dementia?

Back 19

Depression is the most common mental disorder in older adults. Cognitive deficits of depression: nonproductive, inconsistent with those in dementia. May be misdiagnosed as dementia due to similarities

Front 20

Definition: set of symptoms evidencing disorganization in mental processes....

Symptoms reflect behavior, emotional response, and thought processes of the person who has lost contact with reality. Perceptual disturbances, Disorganized thinking, and Behavior alterations. Tend to withdraw from society into own unreal world.

Back 20

Psychosis

Front 21

Associated Causes of Psychosis:

Back 21

depression, BPD, epilepsy, brain tumor, dementia, stroke, alcohol or drug use.

Front 22

false sensory perceptions, unrelated to reality and unsupported by actual environmental stimuli.....Visual (seeing). Auditory (hearing). Olfactory (smelling). Tactile (feeling). Gustatory (tasting).

Back 22

Hallucinations

Front 23

sensory stimuli misinterpreted (seeing a crack on the floor and thinking it’s a snake).

Back 23

Illusions

Front 24

fixed, false ideas or beliefs without appropriate external stimuli which are inconsistent with reality and cannot be changed by reasoning.

Back 24

Delusions

Front 25

Types of delusions; woe is me. Everything is directed at me.

Back 25

Depressive

Front 26

Types of delusions: something implanted in my body

Back 26

Somatic

Front 27

Types of delusions: I’m the mayor

Back 27

Grandiose

Front 28

Types of delusions: someone is out to get me

Back 28

Persecution

Front 29

Types of delusions: hidden messages in everyday life

Back 29

Delusions of reference

Front 30

Types of delusions: thoughts are like a loud speaker that everyone can hear

Back 30

Thought broadcasting

Front 31

Types of delusions: people inserting thoughts into your brain

Back 31

Thought insertion

Front 32

Types of delusions: I don’t wanna go to group because they’re trying to take my thoughts away from me

Back 32

Thought withdrawal

Front 33

Types of delusions: the meat is tough but the cows are keeping it together until the butcher gets here (related but makes no sense).

Back 33

Loose association or derailment

Front 34

Types of delusions: (poverty of speech). It takes a lot of time for them to answer.

Back 34

Alogia

Front 35

Types of delusions: jumble of unconnected thoughts

Back 35

Word salad

Front 36

Types of delusions: new words

Back 36

Neologisms

Front 37

Types of delusions: rhyming.

The hang with the tang and the bat with the cat

Back 37

Clang associations

Front 38

a form of psychosis. Disorganized thoughts; perceptual alterations. Inappropriate affect; decreased emotional response. Unlinked from reality. Chronic, disabling mental illness. Withdrawal into delusional thoughts, misperceptions. Symptom onset is insidious. Prodromal phase signals beginning of illness. Behavior Associated with Schizophrenia: easily distracted, depressive, poor judgement, inability to interpret environment, difficulty differentiating self from things in the environment and difficulty relating to others.

Back 38

Schizophrenia

Front 39

Schizophrenia Signs and Symptoms:

Back 39

Prodromal phase. Increasing anxiety with inability to concentrate. Distraction. Loss of connections; destroys ability to think, learn. Paranoia. Delusional thinking. Deteriorating relationships

Front 40

Positive Symptoms:

Back 40

Acute symptoms (evidenced early in disease). Delusional Patterns: distorted; bizarre; disconnected. Persecution themes. Perceptual Alterations: hallucination. Conversing with “voices”. Behavior Patterns: strange, bizarre. Agitation, catatonia. Misperceptions of Personal Identity.

Front 41

Negative Symptoms:

Back 41

Develop slowly over time. Blunt or flat affect................... Avolition: lacking motivation for decision-making. Inability to initiate hygiene, grooming. Anergia. Anhedonia. Common: substance abuse, suicide, violence

Front 42

Positive actual SXS

Back 42

delusions. Word salad. Clang associations. Thought broadcasting and insertion. Loose associations. Neoglism. Hallucinations. Illusions. Depersonalization. Bizarre behavior. Agitation. Catatonia. Autism.

Front 43

Negative actual SXS

Back 43

blunt flat affect. Anergia. Anhedonia. Lack of motivation. Inability to self care. Inability to interact. Impoverished speech. Substance use. Depression or suicidal acts. Violent behavior.

Front 44

Schizophrenic Subtypes: prominent hallucinations and delusions

Back 44

Paranoid

Front 45

Schizophrenic Subtypes: disorganized / unintelligible speech. Bizarre behavior. Flat affect.

Back 45

Disorganized

Front 46

Schiz subtypes: severe decrease in motor activity, responsiveness to environment

Back 46

Catatonic

Front 47

Schiz subtype: this person can exhibit lots of SXS but doesn’t fall perfectly into a subtype

Back 47

Undifferentiated

Front 48

Schiz subtypes: previous psychotic symptoms, no longer evident. May be lingering evidence of psychosis.

Back 48

Residual

Front 49

schiz with a mood disorder with two weeks of delusions/hallucinations.

Back 49

Schizoaffective disorder

Front 50

preliminary dx of sx at least one month but less than 6.

Back 50

Schizophreniform

Front 51

Disorder related to an event, recovers.

Back 51

Brief psychotic disorder

Front 52

people feeling like they have delusional thought but it is related to life situations that could be true.

Back 52

Delusional disorder

Front 53

Disorder with 3 or more psychomotor features, posturing, stupor, etc.

Back 53

Catatonia

Front 54

· Substance induced psychotic disorder: result of withdrawal

Back 54

· Substance induced psychotic disorder: result of withdrawal

Front 55

Antipsychotic Drug Agents (neuroleptics): block various dopamine receptors in the brain; classes of high (extrapyramidal effects), moderate, or low potency (anticholinergic effects). r the treatment of: bipolar disorder; schizophrenia; depressive+ drug-induced psychosis; autism. Can reverse most or all symptoms. Early typical agent: Thorazine (late 1950s).

Back 55

Antipsychotic Drug Agents (neuroleptics): block various dopamine receptors in the brain; classes of high (extrapyramidal effects), moderate, or low potency (anticholinergic effects). r the treatment of: bipolar disorder; schizophrenia; depressive+ drug-induced psychosis; autism. Can reverse most or all symptoms. Early typical agent: Thorazine (late 1950s).

Front 56

What would cause Akathisia: motor restlessness. Dystonia: rigidity in muscles controlling posture, gait, or eye movement. Tardive Dyskinesia: late-appearing, irreversible movements of mouth and face: lip smacking, teeth grinding, tongue protruding, mask-like face, tremors; shuffling gait, cogwheel rigidity; pill-rolling; stooped posture. Drug-induced Parkinsonism: tremors, rigidity; akinesia; absence of movement with diminished mental state.

Back 56

Extrapyramidal Side Effects of High-Potency Antipsychotic Medication.

Front 57

potentially fatal reaction, onset from 3-9 days after treatment started.

Back 57

Neuroleptic malignant syndrome

Front 58

___________ Treat drug-induced extrapyramidal symptoms. Contraindications: hypersensitivity; narrow-angle glaucoma; myasthenia gravis, urinary retention; peptic ulcer disease; prostatic hypertrophy

Back 58

Anti-Parkinson drug agents

Front 59

Characteristics of personality disorder

Back 59

deeply ingrained, inflexible, maladaptive patterns of behavior. Demonstrated in thought processes, emotional reactivity, interpersonal relationships, self-control. Consistent and constant symptoms. Treatment rarely sought: noncompliance an issue if treatment sought. Common characteristics: view life as “all good” or “all bad”; arrogant, self-indulgent; unable to delay satisfaction of needs to allow for another’s wishes; passive-aggressive tendency; emotional ambivalence; projection of faults. Some people will have many of these characteristics.

Front 60

Cluster A personality disorders

Back 60

odd or eccentric behaviors

Front 61

persistent pattern of suspicion or mistrust in which the actions or motives of others are seen as intentionally threatening or humiliating •Signs & Symptoms: suspicious nature; angry or hostile outbursts; rigid, inflexible nature; often quite efficient and dedicated to work situation; inability to achieve closeness in interpersonal relationships; unable to take constructive criticism yet critical of others •See Box 12.1 Symptoms of Paranoid Personality Disorder. Incidence: moreso men. Possible genetic link to schizophrenia.

Back 61

Paranoid PD

Front 62

withdrawn and secluded; demonstrate an emotional indifference toward social relationships. Symptoms: self –absorbed; loner; derive less pleasure from soothing, sensual activities; bland affect (unresponsive to positive emotions in others); characteristics seen in most aspects of life by adult years; oblivious to perception of behavior by others. Incidence & Etiology: moreso men. More common in people with hx of schizophrenia.

Back 62

Schizoid PD

Front 63

secluded and withdrawn from social situations; strange and unusual patterns of thinking and communicating including the following: Signs and Symptoms:;perceptual distortions; illusions are common; emotions are rigid and inflexible with little ability to respond to feelings of others; psychotic behavior may occur in brief episodes •Magical Thinking: belief that thoughts, words, and actions can cause or prevent an occurrence by extraordinary means, in which they propose to forecast the future or read the minds of others. Ideas of Reference: the person believes that everyday occurrences have a special and significant personal meaning

Back 63

Schizotypal PD

Front 64

Cluster B Personality Disorders:

Back 64

dramatic, emotional, or erratic behavior

Front 65

persistent pattern of disregard and infringement on the rights of others in a society •Signs and Symptoms: cold indifference to laws of society and humanity (sociopath: seemingly without a conscience); chronic disorder that is difficult to treat; impulsive; victimize others for materialistic self-gain; continual involvement with law enforcement although rarely benefit from incarceration and treatment; may appear charming but scheming •See Incidence & Etiology: may have a conduct disorder diagnosis by age of 15. Moreso men. More seen in poor people in crowded living situation. First degree relative increases risk.

Back 65

Antisocial PD

Front 66

persistent pattern of unstable interpersonal relationships, insecure self-image, and mood swings and include the following: •Signs & Symptoms: impulsive, angry outbursts, emotionally labile; chronic sense of emptiness, abandonment, anxiety; brief episodes of paranoia, hallucinations; experiences of happiness, well-being is rare; threats of suicide; inability to delay gratification of needs; See Box 12. 6 Symptoms •“Jekyll and Hyde” characteristics: quick change from clingy and dependent extremes to angry outbursts •

Splitting: an extreme view of one’s relationship to the world in which things are seen as all or none, black or white, love or hate, with no neutral ground. …. Self-mutilation: intentional act of inflicting bodily injury to oneself without intent to die as a result; See Box 12. 5 Cutting: What to Look for. See Incidence & Etiology: moreso in women.

Back 66

Borderline PD

Front 67

continued need for lavish attention and admiration with little regard for the feelings of others •Signs & Symptoms: exaggerated, grandiose sense of self-importance; arrogant; entitlement; underlying: feelings of inferiority and envy of others; over-exaggerated personal achievement; little regard for others’ feelings; without insight into behaviors, unrealistic thinking •See Incidence & Etiology: moreso in men.

Back 67

Narcissistic PD

Front 68

pattern of egocentric and excessive emotion in a demanding manner to gain personal attention; uncomfortable where center stage is not afforded to them •Signs & Symptoms: extreme egocentricity; emotionalism demanding personal attention; melodramatic; fake, exaggerated behaviors; develop superficial relationships; provocative dress, mannerisms, easily influenced, overly trusting

Back 68

Histrionic

Front 69

Cluster C Personality Disorders:

Back 69

Cluster C Personality Disorders: anxious and fearful behavior

Front 70

shy and very sensitive to negative comments from others including the following: Signs & Symptoms: avoid interactions with others; extreme fear of ridicule or disapproval; social inadequacy; intense anxiety in a group; perceives rejection, even if nonexistent; self-doubt, low self-esteem •See Incidence & Etiology: equal in men and women.

Back 70

Avoidant PD

Front 71

demonstrates a consistent and extreme need to be cared for that leads to a reliance on others •Signs & Symptoms: consistent, extreme dependence on others with self-perceived feelings of helplessness and incompetence; insecurity and self-doubt à self-care decision avoidance with extreme fear of being alone, and inability to make decisions; independent activities not an option; increased involvement in abusive relationships•See Incidence & Etiology: moreso women. MOST FREQUENT PERSONALITY DISORDER

Back 71

Dependant PD

Front 72

conscientious, highly organized, and preoccupied with order and perfection including the following:

•Signs & Symptoms: rigid, controlling; highly critical of self and others; difficult to feel accomplishment satisfaction; deadlines provoke high anxiety; rigid morals and ethics; miserly spending and hoarding; relationships: serious and shallow •See Incidence & Etiology: more often in men, twice as common.

Back 72

OCPD

Front 73

Preferred approach: for tx personality disorders :

Back 73

psychotherapy and medication such as Risperdal and Zyprexa, antianxiety meds or antidepressants

Front 74

Avoid antipsychotics within one hour of

Back 74

anti dia or anti acids.

Front 75

Note that some antipsychotics are helpful for other things; phenothiazines and haloperidoll is helpful for intractable hiccups.

Back 75

Note that some antipsychotics are helpful for other things; phenothiazines and haloperidoll is helpful for intractable hiccups.