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57 Cards in this Set
- Front
- Back
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delirium is syndrome or disease?
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syndrome
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epidemiology of delirium
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• Up to 30% of all hospitalized pts
• Up to 80% of postsurgical pats, terminally ill patients, pts of advanced age • Poor prognosis overall |
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subtypes of delirium
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general med conditions
substance intoxication substance withdrawal multiple etiologies not otherwise specified |
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delirium is defined by disturbances/changes of what?
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disturbance of consciousness
change in cognition |
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delirium develops over how long?
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a short period of time: hours/days
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disturbance of consciousness include what symptoms?
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decreased attention
disorientation decreased memory disorganized thought perceptual disturbance psychomotor hyperactivity and hypoactivity disruption of sleep mood alteration |
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how is dementia different from delirium?
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stable LOC
gradual in onset and of long duration |
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how is dementia the same as delirium?
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impaired cognitive status
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dementia ALWAYS involves memory
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STM > LTM
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Alzheimer's morphology
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plaques
neurofibrillary tangles - cytoskeletal architecture consists of tau protein --> hyperphosphorylated and gets twisted --> poorly functioning cell --> die cerebral atrophy: shunken gyri, sulcus widened |
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etiology of dementia (5)
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1. Alzheimer's
2. vascular dementia 3. other general medical conditions 4. substance-induced persisting --> permanent changes 5. due to multiple etiologies: mixed dementia like Alzheimer's + vascular dementia |
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Alzheimer's disease criteria (4)
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1. cognitive criterion: memory impairment and impairment of at least one other aspect of cognition
2. severity of criterion: significant impairment in social and occupational functioning 3. temporal criterion: gradual onset, continuing decline 4. exclusion criterion: there is no test to dx Alzheimer's -not due to any other causes |
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cognitive criterion of Alzheimer's disease (cortical deficits)
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1-Aphasia: language disturbance
2-Apraxia: impaired motor performance 3-Agnosia: impaired sensory recognition 4-Executive functioning: impaired planning, organizing, sequencing, abstracting |
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exclusion criterion for Alzheimer's disease
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1-not due to any other causes: neurodegenerative, systemic disease (chronic hypothyroidism/syphilis), substance induced
2- not during delirium (if delirious, you cannot diagnose pt w/ Alzheimer's, you cant fairly assess pt at the time 3. not due to any other axial I disorder |
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what is different w/ vascular type criteria compared to alzheimer's disease criteria
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focal neurological signs: weakness, abnormal reflexes, stepwise decline in neurological function
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what are 2 types of vascular type
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1. multiple parenchymal lesions (stroke)
2. subcortical arteriosclerotic encephalopathy: binswanger/microvascular ischemic changes |
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dementia due to other general medical conditions:
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1. pick's disease and other fronto-temporal dementias: behavioral abnormalities are predominant
2. lewy body disease 3. parkinson's disease 4. huntington's disease 5. chronic infections 6. inflammatory diseases like MS 7. tumors can form ill-humors: primary cancers, paraneoplastic syndromes 8. metabolic;B12 deficiency and hypothyroidism 9. head trauma 10. normal pressure hydrocephalus: when ventricles expand bc there is blockage of flow |
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blocks opioid receptors involved in the rewarding effects of alcohol and craving for alcohol. It's available in oral (Depade®, ReVia®), and extended-release injectable (Vivitrol®) given as once monthly injections.
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naltrexone
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acts on the GABA and glutamate neurotransmitter systems and is thought to reduce symptoms of protracted abstinence such as insomnia, anxiety, restlessness, and dysphoria
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acamprosate - most effective for those that have already quit
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) interferes with degradation of alcohol, resulting in accumulation of acetaldehyde which, in turn, produces a very unpleasant reaction including flushing, nausea, and palpitations if the patient drinks alcohol.
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disulfiram
raises punishment profile issue is COMPLIANCE |
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3 types of amnestic disorders
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1. due to general medical condition
2. substance-induced persisting amnestic disorder 3. NOS (nitric oxide system?) |
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amnestic disorders: ____ is the only problem
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memory
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Criterion for amnestic disorders
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ONLY memory impairment
severity criterion: significant impairment in social and occupational functioning exclusivity criterion: not a delirium and not a dementia evidence from history, PE, lab data head trauma CV diseases: stroke and transient global amnesia thiamine deficiency: alcoholics w/ poor nutrition, gastric diseases |
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w/d of nicotine
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dyphoric, depressed mood
insomnia irritability frustration, anger anxiety difficulty concentrating restlessness decreased heart rate increased appetite and weight gain |
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tx for nicotine addiction
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1. assess
2. behaviorial and pschoeducational intervention (AA, support groups etc) 3. Bupropion (Zyban) or Varencline tartrate (Chantix) - combination of both is most efficacious |
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tx for cocaine
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NO PHARM tx
behavioral and psychotherapy contingency management |
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Cannabis - active ingredient is
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THC (delta-9-tetrahydrocannibol)
2 or more signs of following: conjunctival injection (red eyes) dry mouth tachycardia increased appetite |
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w/d from cannabis
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evidence of irritability
sleeplessness anxiety |
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tx for cannabis
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behavioral and psychotherapy
contingency management no pharm tx for cannabis dependence of abuse |
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amphetamies - meth user profile (most likely)
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female
caucasian younger than 25 |
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Ecstasy facts
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MDMA orally taken
affects brain by increasing: 5HT, dopamine, NE |
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amphetamines causes what effects?
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release of NT from storage sites in neurons
euphoria affective blunting changes in sociability hypervigilance interpersonal sensitivity anxiety tension anger stereotypes behaviors impaired judgement impaired social or occupational functioning |
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w/d of amphetamines causes
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Dysphoric mood and 2 of the following:
1. fatigue 2. vivid, unpleasant dreams 3. insomnia, hypersomania 4. increased appetite 5. psychomotor retardation or agitation |
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what is tx for amphetamines
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NO PHARM tx
behavioral and psychotherapy |
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ex of volatile solvents
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paint thinners
paint removers degreasers gasoline, glue |
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aerosols
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aerosol propellants
spray paints hair spray deodorant sprays vegetable oil sprays |
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gases
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household.commercial products, ether, chloroform, halothane, N2O
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nitrites
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organic nitrites are volatile
cyclhexyl butyl amyl nitrites known as poppers |
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sniffing high concentrations of inhalants causes:
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Heart failure and DEATH
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harmful irreversible effects
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hearing loss: toluene and trichloroethylene
peripheral neuropathies or limb spasm: hexane and N2O CNS or brain damage - toluene bone marrow damage - benzene |
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inhalant intoxication causes
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belligerence
assaultiveness apathy impaired judgement impaired social or occupational functioning |
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what symptoms due to inhalant intoxication?
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dizziness
nystagmus incoordination slurred speech unsteady gait lethargy depressed reflexes psychomotor retardation tremor generalized muscle weakness blurred vision of diplopia stupor or coma euphoria |
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what is the prognosis of inhalants?
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VERY BAD because of comorbidities
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tx for inhalants
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behavioral and psychotherapy tx
contingency management |
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what is the most abused opiate?
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heroin
risk of OD or death injected, sniffed, snorted, smoked IV is most intense |
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effects of opiods
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euphoria
apathy dysphoria psychomotor agitation/retardation impaired judgement or impaired social or occupational functioning |
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opiods cause what sx
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PUPILLARY constriction + 1 or more
1. drowsiness/coma 2. slurred speech |
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opiod withdrawal
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very severe, best under med supervision
dysphoria nausea/vomiting muscle aches lacrimation/rhinorrhea pupillary dilation, piloerection sweating diarrhea yawning fever insomnia significant distress in social and occupational functioning |
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pharmacotherapy of opiod addiction
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agonist: methadone, buprenorphine
antagonist: naltrexone behavioral and psychotherapy tx contingency managements |
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effects of sedative, hypnotic anxiolytics (barbs and BDZs-prescription drugs)
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inappropriate sexual and aggressive behaviors
mood lability impaired judgement impaired social/occupational functioning one of following: slurred speech incoordination unsteady gait nystagmus |
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cessation of sedative, hypnotic anxiolytic use-heavy and prolonged
2 or more of following (w/d sx) |
increased hand tremor
insomnia nausea/vomiting transient visual, tactile auditory hallucinations, illusions psychomotor agitation anxiety grand mal seizures |
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w/d from hypnotics, sedative, anxiolytics
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VERY severe, may cause death
weening with long lasting forms of class of drug behavioral and psychotherapy |
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hallucinogens effects
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profound distortions in person's perception of reality
dissociative distort perceptions of sight and sound and produce feeling of detachement originally dev as anesthetics act on NMDA systems may include hallucinations but it most commonly consists of visual perceptual disturbances |
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hallucinogen persisting perception disorder
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flashbacks
episodes of spontaneous, repeated continuous recurrences of some of sensory distortions originally produced LSD |
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tx of hallucinogen
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behavioral and psychotherapy tx
no pharmacological tx |
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w/d of hallucinogens
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maladaptive behavioral or psychological changes with hallucinogen intoxication
marked anxiety, depression, ideas of reference, fear of losing one's mind, paranoid ideation, impaired judgement, impaired social and occupational functioning 2 or more of following: pupillary dilation tachycardia sweating palpitation blurring of vision tremors incoordination |
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tx of hallucinogen
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behavioral and psychotherapy tx
no pharmacological tx |
