Stages of Alzheimers

- 7 stages & S&S of dementia

- onset slow & progressive

- Early onset <65yr, late onset >65

- CT/MRI reveals degenerative pathology of brain & enlarged cerebral ventricles, senile plaques

Stages of Alzheimers

Stage 1 - No S&S

Stage 2 - Forgetfulness; short term memory

Stage 3 - Mild cognative decline; intergers w/work, may get lost driving, forgets names words & times

Stage 4 - Mild-moderate cognitive decline; forgets major events, decline in ability to perform tasks (shopping, etc.); makes up imaginery stories to fill in gaps

Stage 5 - Mod Cognitive decline, loses ability to perform ADLs, forgets address, phone #, disoriented to time/place, frustrated, sleeps, death from infection, aspiration, sepsis

Stages of Alzheimers

Stage 6 - Mod-severe cog decline; unable to recall major life events, disoriented to surroundings/day/year.  Needs help w/ADLs, incontinence occurs, wandering

Stage 7 - Sev Cog Decline - end; unable to recognize family, muscles rigid, limited vocalization, depressed immune function, appetite decreased, aspiration common

Involuntary Commitment

In emergency, danger to self/others

For observation/treatment of mentally ill persons

When person unable to take care of basic personal needs

Mood & Affect

Mood: Pervasive, sustained emotion

Affect: Observable behavior representative of subjective state

Crisis

Sudden event that disturbs homeostatis, during which usual coping measures dont' work

Not necessarily a pathology

Personal in nature

Phases of Crisis

1) exposure to stressor

2) previous coping mechanism ineffective, ↑ anxiety

3) all resources called on to problem solve & relieve discomfort, resolution can occur

4) no resolution, tension mounts=breaking point, may reach panic, disorganization w/cog function

Diagnostic & Statistical Manual

DSM: published by American Psychiatric Association.  Includes all mental disorders.

Tarasoff Ruling

Protective privilege ends where public peril beings

Restraints

- Order must be renewed Q 4hr for adults >18 yr Q 2hr kids 9-17 yr & Q/hr for kids <9yr

- In person evaluation MUST BE DONE w/in 24 hrs of initiation (MD)

- Pt restrained must be monitored in person

- Staff must be trained

Global Assessment of Functioning

- Scored 0-100, never 0 or 100

- GAF done on admit (intake), during Tx, and at DC

- ↓ score less functional

 Multi-Axial System

(5 Ax's)

- I: primary Dx; clinical disorders, major mental d/o, learning d/o, substance abuse

- II: personality d/o, intellectual dysfunction ie mental retardation

- III: Acute medical conditions and physical d/o

- IV: Psychosocial and environmental factors contributing to the d/o

- V: GAF

3 stages of FIGHT or FLIGHT

1) alarm reaction: physiological responses activated

2) sgage of resistanace: utilizing physical responses as defense in attempt to adapt to stressor

3) stage of exhaustion: prolonged exposure to stressor tow hich the body has become adjusted: disease of adaption may occur (H/A, ulcers, CAD, coalitis, mental d/o)

Types of Anxiety

(4 levels)

1) mild: tension in day-day living, sharpens senses heightens awareness

2) moderate: perceptual field diminishes, attention span/concentration decreases, ↑ muscle tension

3) severe: perceptual field greatly ↓, attention span very ↓, difficulty completing basic tasks, physical S&S, H/A palpations insomnia, develop dread horror confusion

4) panic: most intense state, unable to focus, behavior is unpredictable/desperate, feelings of terror "going crazy"

Anti-anxiety drugs

(anxiolytics)

- mild tranquilizers, Tx of ETOH withdrawal or muscle spasms

- depress levels of CNS; potentiates GABA producing a calming feeling

Benzodiazepines

Tx of panic/GAD

Ex; Ativan, Valium, Xanax

Withdrawal Sx can be lifethreatening when stopped abruptly

SSRI's/SNRI's

- Often 1st choice for anxiety w/Buspar

- Busper effective in 60-80%; no risk of physical dependance

- Takes 10-14 days to be effective

Anti-hypertensives/Anti-histamines

- Help w/social or performance anxiety tremors/palpations

- Antihistamines (Vistaril) first choice, non-addictive

Paradigm

- Aguilera suggest whether a pt experiences crisis based on 3 things:

1) pt perception of event

2) available support system

3) available coping mechanism

*Crisis will pass*

Meds given w/out consent must meet 3 criteria

1) pt exhibits danger to self/others

2) Med must have a reasonable chance to help

3) pt must be deemed incompetent by court of law

Assault/Battery

Assault - threat of violence

Battery - actual violence

Mini - Mental State Examination

- brief questionnaire used to screen for cog d/o

 Suicide

3 social categories

 Egotistic - Ind feels separate from mainstream society

Altruistic - Excessively integrated by group

Anomic - Response to major change in life