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PSYCH257 Study Guide - Final Guide: Traumatic Brain Injury, Dementia, Amnesia


Department
Psychology
Course Code
PSYCH257
Professor
Allison Kelly
Study Guide
Final

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PSYCH 257: PSYCHOPATHOLOGY NOTES
Chapter 15: Neurocognitive Disorder
Perspectives
o Develop much later in life but intellectual disability and specific learning disorder believed to be present
from birth
o DSM-5 label “neurocognitive disorder” reflects shift in way these disorders are viewed
Early editions “organic mental disorder” along with mood, anxiety, personality, hallucinosis, and
delusional disorders
Organic indicating brain damage/dysfunction believed to be involved
Covered so many disorders, that distinction was meaningless
o Consequently traditional organic disorders (delirium, dementia, amnestic
disorder) kept together, and others categorized with disorders that shared
symptoms
DSM-IV “cognitive disorders” to signify predominant feature is impairment of cognitive abilities
(memory, attention, perception, thinking)
DSM-5 various forms of dementia and amnestic disorders due to overlap of different types of
both (people may have multiple types of neurocognitive problems)
o As life expectancy increases, cognitive disorder more prevalent
Delirium
o Features
Sudden onset of confusion and disorientation
Impaired consciousness and cognition
Out of touch with surroundings
Develops in short amount of time (hours-days), noticeable change, fluctuates in severity
Has trouble paying attention and concentrating on even simple tasks
Sees/hears things that aren’t really there
Subsides relatively quickly most fully recover within several weeks
Some cases can be sign of end of life
o Stats
Most at risk very young/old/sick
Older adults
o Common risk factors dementia, medication, medical illness
o Eliminate drugs from systems less efficiently than younger people
People with AIDS/cancer
Patients on medication or undergoing medical procedures
10-30% of those in contact with hospitals/acute care facilities
Usually happens before a serious medical condition
Often present during last several hours of life among terminally ill patients
Usually a one-time life event, so hard to predict
Earliest recognized mental disorders (more than 2500 years ago)
Cause for many falls that cause debilitating hip fractures in elderly
fMRI testing anxiety-provoking for many people, so especially so for those already disoriented
Ethical concerns person experiencing delirium not capable of providing informed consent
for participating in research, thus someone else (ex. spouse, relative) must agree
o Causes
Generic medical condition
Any head injury or brain trauma
Cholinergic deficit may contribute
Adverse drug interactions multiple medication users
Children with high fevers usually mistaken for noncompliance

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Lasting disruption of connectivity (between dorsolateral prefrontal cortex with posterior
cingulate cortex)
Reversible disruptions (ex. between thalamus with reticular activating system)
Substance-induced
Intoxications, withdrawals
Multiple etiologies
Sleep deprivation, immobility, excessive stress
Environmental factors play role in hospitalized elderly patients
o Number of room changes, absence of clock/watch/reading glasses related to
increase in delirium severity
Ex. hospital room changes disrupts ability to correctly perceive
environmental cues, resulting in misinterpretation of stimuli around them
o Modifiable, so targeted in treatment
Not otherwise specified
o Treatment
Pharmacological
Benzodiazepines
Antipsychotics
o Withdrawal from alcohol/drugs or when cause is unknown
o Calm them down
Medical Intervention
o Infections, brain injury, tumours
Psychosocial
Recommended first line of treatment help manage until medical causes are
identified/addressed
Reassurance
Presence of personal objects provides comfort
Sense of control by being included in all treatment decisions
Delays institutionalization in elderly patients
Want to calm them down, make them feel safe
Quicker in-hospital recovery associated with better long-term outcomes
o Prevention
Proper medical care
Therapeutic drug monitoring
Interventions education, support, reorientation, anxiety-reduction, preoperative medical
assessment
Major and Minor Neurocognitive Disorders
o Progressive condition marked by gradual deterioration of broad range of cognitive abilities
o Possible to co-occur with delirium, but delirium is sudden/acute onset
Neurocognitive disorders don’t present disorientation/confusion in early stages unlike delirium
o Context
¼ Canadian seniors have mental health issues
44% of Canadian seniors in long-term care facilities had symptoms or diagnosis of
depression
5-10% of seniors had symptoms of anxiety disorder
35.6 million people living with dementia worldwide
340,200 (2%) Canadians over 40 years old had Alzheimer’s disease and other dementias in 2011
Dramatic rise in Alzheimer’s disease predicted through year 2050 because large numbers
of people expected to live beyond 85
84,700 Canadians had Parkinson’s disease in 2011
Both expected to double in 20 years
Onset at any age, though rarely under 45

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Equivalent across genders, educational levels, social class
Incidence highest in elderly
Prevalence increases as age increases
Problem with confirming prevalence figures survival rates alter outcomes
Medical costs extremely high (ex. around the clock care)
o Cognitive Domains
Complex Attention how you can exert/control/use your attention (can you focus on more than
one thing, can you sustain your attention for a long time on one thing, weed out other things
you’re not focused on, etc.)
Executive Function frontal lobe; planning, goals, inhibition of appropriate responses
Learning and Memory
Language ability to use and understand language (two distinct skills)
Perceptual-Motor navigation, coordination, special awareness
Social Cognition guess what others are thinking/feeling and act appropriately in response to it
o Features
Initial stages
Memory Impairment inability to register ongoing events
o Remembers how to talk/ events from many years ago, but not what happened an
hour ago
General deterioration of intellectual function results from impairment of memory,
planning, and abstract reasoning
Emotional Changes delusions (irrational beliefs), depression, agitation, aggression,
apathy
o Cause and effect unsure due to progressive brain deterioration or result of
frustration/discouragement that accompanies loss of function
Death ultimate result occurs due to inactivity combined with onset of other illnesses (ex.
pneumonia)
o Major Neurocognitive Disorder (Dementia)
Gradual deterioration of brain functioning that affects judgment, memory, language, and other
advanced cognitive processes
Significant cognitive decline in 1+ cognitive domains (a deficit)
Interference with independence in everyday activities
Ex. can’t remember to turn stove off, wears winter clothes in summer (can’t understand
temperature), etc.
Not occur exclusively during delirium or other mental disorder
Specify etiology/cause
o Mild Neurocognitive Disorder (Early Stages of Cognitive Decline)
New to DSM-5
Modest impairment in cognitive abilities in 1+ cognitive domains
Can continue to function independently with some accommodations
Ex. making extensive lists of things to do, creating elaborate schedules
Cognitive deficits don’t interfere with capacity for independence in everyday activities
Ex. need multiple post-it notes around the house to remind them of wear the spoons are
or how to use the stove, bring long list to grocery store
Not occur exclusively during a delirium or other mental disorder
Specific etiology/cause
Includes Amnestic Disorder
o Terminology
Aphasia language
Anomia specific to names
o Ex. know it’s you daughter, but can’t remember her name
Apraxia motor-functioning
Ex. can’t operate mouth
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