Transcript Abnormal Psych

Chapter 14
Cognitive Disorders and
Life-Span Issues
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Delirium
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Characterized by disorientation, recent
memory loss, and a clouding of
consciousness.
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Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
DSM-IV-TR Criteria for Delirium
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Disturbance of consciousness, such as reduced clarity of awareness of
the environment, with reduced ability to focus, sustain or shift attention.
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Change in cognition (such as memory deficit, disorientation, language
disturbance) or development of a perceptual disturbance that is not
accounted for by a dementia
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Disturbance that develops over a short period of time and tends to
fluctuate during the course of the day
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Evidence that the disturbance is caused by the direct physiological
consequences of a medical condition.
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Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Causes of Delirium
There are many causes of delirium. For most
patients, an underlying medical, surgical,
chemical, or neurological problem causes the
delirium.
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Delirium can be caused by
•Stroke
•High Fever
•HIV Infection
•Drug Intoxication or Withdrawal
•Fluid and Electrolyte Imbalances
•Illicit Drugs
•Toxic Substances
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Symptoms of Dementia
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Memory impairment
Aphasia (language disturbance)
Apraxia (inability to carry out motor activities despite
intact motor function)
Agnosia (failure to recognize or identify objects
despite intact sensory functioning)
Disturbance in executive functioning
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Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Leading Causes of Dementia
Stroke
14%
Multiple causes
12%
Alzheimer's
disease
55%
Parkinson's
disease
8%
Brain injury
4%
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Other causes
7%
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Symptoms of Frontal Lobe Injury
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Social and Behavioral Changes
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Disorderliness, suspiciousness, argumentativeness,
disruptiveness, and anxiousness
Apathy, lack of concern for others
Uncharacteristic lewdness, inattention to personal
appearance or hygiene
Intrusiveness, pervasive profanity, talking loudly
Risk taking, poor impulse control, increase alcohol use
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Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Symptoms of Frontal Lobe Injury,
continued
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Affective Changes
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Apathy, indifference, shallowness
Lability of affect, irritability, mania
Inability to control rage and violent behavior
Intellectual Changes
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Reduced capacity to use language, symbols, logic
Reduced ability to use mathematics, to calculate, process
abstract information, or reason
Diminished ability to focus, concentrate, be oriented in time
and place
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Major Regions of the Brain Affected by Alzheimer's
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Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Treatments for Dementia
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Medications
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Cholinesterase inhibitors (e.g., Donepezil), which help
prevent the breakdown of the neurotransmitter acetylcholine
Memantine, a newly approved drug, regulates the activity of
glutamate
Drugs that increase dopamine (for Parkinson’s)
In all cases, drugs do not work for all patients and have only
temporary effects.
Antioxidants
Behavior therapies
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Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Amnesia
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Unlike dementia and delirium, in amnesic
disorders only memory is affected.
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Anterograde amnesia – impaired in the ability to
learn new information
Retrograde amnesia – impaired in the ability to
recall previously learned information
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.