post- marianne

 Respond in a positive way to your  colleagues by comparing the differential diagnostic features of the  disorder you were assigned to the diagnostic features of the disorder  your colleagues were assigned. 

NOTE: Bellow is attached the document with my assigned disorder 

                                                          Main Post

Delirium  is an acute intermittent neuropsychiatric condition generally  reversible but serious condition that occurs in all age groups but high  risk in the elderly(Gabbard, 2014).  It ultimately represents the decompensation of brain function as a  result of one or more pathophysiological processes(Fong, 2009). Delirium  is linked with a variety of negative effects, leading to extended  hospital stay, institutional care demands, poor functioning and high  medical costs(Fong, 2009).Due to these negative consequences it is essential to prevent, detect and treat delirium as early as possible.

Diagnostic criteria

Accordint to the DSM-5, diagnostic criteria for delirium is :

A.  A disturbance in attention (i.e., reduced ability to direct, focus,  sustain, and shift attention) and awareness (reduced orientation to the  environment) (American Psychiatric Association, 2013).

B.The  disturbance develops over a short period of time (usually hours to a  few days), represents a change from baseline attention and awareness,  and tends to fluctuate in severity during the course of a day(American  Psychiatric Association, 2013).

C.An  additional disturbance in cognition (e.g., memory deficit,  disorientation, language, visuospatial ability, or perception) (American  Psychiatric Association, 2013).

D.The  disturbances in Criteria A and C are not better explained by another  preexisting, established, or evolving neurocognitive disorder and do not  occur in the context of a severely reduced level of arousal, such as  coma(American Psychiatric Association, 2013).

E.There  is evidence from the history, physical examination, or laboratory  findings that the disturbance is a direct physiological consequence of  another medical condition, substance intoxication or withdrawal( due to a  drug of abuse or to a medication), or exposure to a toxin, or is due to  multiple etiologies(American Psychiatric Association, 2013).

 Psychotherapy and Psychopharmacologic Treatment 

Delirium  is a medical emergency that involves proper diagnosis, recognition of  the cause and management of symptoms.The first-line treatment is to  identify and address pre- disposing factors, provide supportive care,  and manage symptoms through behavioral strategies(Fong, 2009). Treatment  is geared toward symptom management and patient centered.Medications  are used to control agitation and reverse hyperactive delirium (Fong,  2009).Medication treatment includes antipsychotics such as haloperidol  and chlorpromazine.The goals of these pharmacological agents is to  reduce agitation and address other symptoms associated with hyperactive  deliria (Gabbard, 2014).Non-pharmacological  treatment of delirium stresses the removal or reduction of medical,  sensory and environmental factors that can lead to delirium,such as  modifying sensory deficits in order to improve engagement with the  environment, particularly when coupled with sufficient intellectual  stimulation during wake-up hours (Gabbard, 2014).Lastly,  immoboizing devices can be used but should be reserved when harm to  self and others is immenent, and should be short and behaviroal targeted(Gabbard, 2014).

Benefits and Risks of Therapy

When choosing any drug, attention should always be given to the possible advantages,

dangers  and pressures of each medicine, as well as to the patient and family  care priorities (Grover, 2018).The use of antipsychotics have many  adverse effects that include sedation, wiegth gain, changes in appetite,  cardiac effects(such as QT prolongation), neaurological effects, falls  and long term need for use that is inappropriate but in many cases it is  the best course of action.According to Fong (2009), studies some  beneficial roles of antipsychotics such as lowering severity of delirum,  reducing harm to self and others are the main reasons why these agents  are used.However, Grover (2018), emphasizes that antipsychotics for the  treatment of delirium in adult inpatients did not improve patient  outcomes, with little evidence of neurologic harms but a tendency for  more frequent potentially harmful cardiac effects.

Reference

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders   (5th ed.). Washington, DC: Author.

Fong, T. G., Tulebaev, S. R., & Inouye, S. K. (2009). Delirium in elderly adults: diagnosis,   prevention and treatment. Nature reviews. Neurology, 5(4), 210–220.   doi:10.1038/nrneurol.2009.24 Mayo Clinic. 2018. Delirium. 

Gabbard, G.O.(2014). Gabbard’s treatment of psychiatric disorders(5th ed.).Washington, DC:   American Psychiatric Publications

Grover, S., & Avasthi, A. (2018). Clinical Practice Guidelines for Management of Delirium in   Elderly. Indian journal of psychiatry, 60(Suppl 3), S329–S340.   https://doi.org/10.4103/0019-5545.224473

5

Alzheimer’s Disease

Student’s Name

Institution

Course Name

Instructor’s Name

Date

Alzheimer’s Disease

Diagnostic criteria

The diagnosis of Alzheimer’s disease highly depends on the level of documentation of a patient’s mental decline. Biomarkers have been recently added to the diagnostic criteria because they can be accurately measured to indicate the presence of Alzheimer’s disease. Examples include tau and beta-amyloid ratios in the cerebrospinal fluid and structural changes in the brain that can be detected by neuroimaging. Biomarker proportions change at various disease stages, making them suitable for diagnosing the level of brain damage caused.

The intensifying use of neuroimaging and analysis of cerebrospinal biomarkers help the PMHNP to achieve higher diagnostic accuracy. The latest criteria can help PMHNP recognize the onset of non-amnestic or amnestic symptoms across several cognitive domains (Alzheimer’s Association, 2018). The presence of cerebrovascular illness is currently considered a high-risk condition for AD. However, the presence of substantial cerebrovascular infections decreases the certainty of AD diagnosis. Other comorbidities include depression, thyroid problems, Lyme disease, vitamin deficiencies, sleep apnea, and delirium. Unlike AD, these comorbidities are reversible via appropriate treatment. Additionally, Age-linked cognitive transitions are confused with AD. Thus, additional imaging tests and identification of biomarkers can help differentiate AD from normal aging factors and comorbidities.

Evidence-based management practices

One of the evidence-based psychotherapy treatment that is used for patients with Alzheimer’s disease is reminiscence therapy. The therapy involves the use of all the patient’s senses, touch, sight, smell, taste, and sound, to help the individuals with Alzheimer’s dementia remember events, places, and people from their past lives (Woods et al., 2018). Cognitive-behavioral therapy is also used to change the behaviors of a patient with Alzheimer’s Disease.

There are two types of psychopharmacologic treatments that are prescribed to patients with Alzheimer’s disease. The first drug is cholinesterase inhibitors. The drug is prescribed to patients with mild to moderate Alzheimer’s disease. The second drug is Namenda (memantine). The drug is prescribed to reduce the symptoms of Alzheimer’s disease to maintain the patient’s normal daily functions (Folch et al., 2016).

Continuous mind engagement, such as reading books and stories, could help control AD symptoms’ severity. While no studies have demonstrated a connotation between AD risk and educational level, James and Patwik (2018) reported that continuous engagement of the mind improves memory. Body exercise improves brain plasticity, remodel neuronal circuitry, stimulates neurogenesis, and promotes brain vascularization. Cognitive interventions are alternative and complement pharmacological interventions. These are categorized into cognitive rehabilitation (CR), cognitive stimulation (CS), and cognitive training (CT). CT improves attention, memory, language, and executive functions (Middleton, 2020). CR involves setting goals to improve participation in daily activities. CS involves all activities that arouse various cognitive domains and may include body exercise, diet, and reading. However, AD symptoms that inhibit psychological functions and behaviors can affect patient health and safety; therefore, additional pharmacological treatment is designed to improve patient outcomes.

Evidence-based pharmacological treatment includes antidepressants to reduce agitation symptoms, antipsychotics to reduce psychosis and aggression, and mood stabilizers to improve patient mood. Examples of documented antidepressants include trazodone, sertraline, and citalopram. Effective and validated antipsychotics include risperidone and olanzapine. Carbamazepine and placebo are among the mood stabilizers that have produced statistically significant mood improvement.

Possible risks and how treatment can be transformed

Some various benefits and risks are associated with therapy. However, the benefits outweigh the risks. The benefit of psychotherapy is that it has a higher chance of success. Thus, most of the patients are helped to improve by therapy. It is also easier and it does not entail using a lot of energy as it works with minimal prompting. It also helps to evoke positive feelings in patients. The risks that are involved include the development of bad feelings for the therapist, it consumes a lot of time, and it may result in complicated feelings in a patient.

Various pharmacological treatments can trigger some side effects that may worsen the disease conditions and increase a patient and family’s additional burden. The benefits of a certain medication should be weighed against the documented side effects. Starting a pharmacological treatment with a higher dose can cause the patient to become intolerant because of their side effects. Thus, any clinician treating an AD patient should begin with a minimum dose and then augment it after an effective trial. Any medication that causes unpreceded side effects that endanger a patient’s health and life must be discontinued. Clinicians must also be cautious for any combination of pharmacological agents in the same medical category because they can increase morbidity or cause unpredicted death. Even after successful trials, the continuing medication should be re-evaluated regularly, especially among the geriatric population where polypharmacy is common. Antipsychotics have adverse long-term effects and must be prescribed for short-term use and at close monitoring. Family members must be involved in the treatment to assist a patient in making prudent decisions.

References

Alzheimer’s Association. (, 2018). 2018 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 14(3), 367-429.

Folch, J., Petrov, D., Ettcheto, M., Abad, S., Sánchez-López, E., García, M. L., … & Camins, A. (2016). Current research therapeutic strategies for Alzheimer’s disease treatment. Neural Plasticity, 2016.

Middleton, L. E. (2020). Altering Dementia Risk: Can Fitness Overcome Obesity in Relation to Cognition?. Canadian Journal of Cardiology, 36(11), 1703-1705.

Woods, B., O’Philbin, L., Farrell, E. M., Spector, A. E., & Orrell, M. (2018). Reminiscence therapy for dementia. Cochrane database of systematic reviews, (3).