Cognitive and dissociative disorders Notes

NOTES NOTES COGNITIVE & DISSOCIATIVE DISORDERS GENERALLY, WHAT ARE THEY? PATHOLOGY & CAUSES ▪ Cognitive disorders: involve cognitive decline ▪ Dissociative disorders: involve detachment from past/present versions of oneself/the world SIGNS & SYMPTOMS ▪ See individual disorders DIAGNOSIS ▪ See individual disorders CAUSES ▪ Past trauma/stress may cause/worsen condition TREATMENT ▪ See individual disorders COMPLICATIONS ▪ Personality changes, depression AMNESIA osms.it/amnesia PATHOLOGY & CAUSES ▪ Acute loss of memory TYPES Anterograde amnesia ▪ Inability to form new memories ▪ Associated with encoding and consolidation phases of memory ▪ Usually involves damage to prefrontal cortex/hippocampus Retrograde amnesia ▪ Inability to recall old memories (may result in creation of false memories) 696 OSMOSIS.ORG ▪ Associated with storage and retrieval phases of memory ▪ Usually involves damage to cortex CAUSES ▪ Head trauma, infection, neurodegenerative diseases (e.g. dementia/Alzheimer’s), brain tumours, thiamine deficiency (causing Wernicke–Korsakoff syndrome), benzodiazepines, electroconvulsive therapy COMPLICATIONS ▪ Range of potential complications (e.g. confusion, loss of identity)

Chapter 91 Cognitive & Dissociative Disorders TREATMENT SIGNS & SYMPTOMS ▪ Acute memory loss, affects memories created before/after an event (or onset of illness) PSYCHOTHERAPY ▪ Occupational and cognitive therapies to enhance memory OTHER INTERVENTIONS DIAGNOSIS ▪ Often temporary (address cause) ▪ Mobile phones and digital devices as workarounds to memory loss DIAGNOSTIC IMAGING MRI/CT scan ▪ Brain damage/abnormalities LAB RESULTS ▪ Nutritional deficiencies/infections DELIRIUM osms.it/delirium PATHOLOGY & CAUSES ▪ Fast decline in attention/consciousness, thinking ▪ Sometimes accompanied by symptoms of hyper/hypoactivity RISK FACTORS ▪ Disease (e.g. dementia, constipation, pneumonia, UTIs) ▪ Post-surgical complications ▫ Medications (e.g. narcotic pain medications, benzodiazepines, hypnotics, anticholinergics) ▫ Altered metabolic homeostasis (e.g. electrolyte or imbalance), chronic fatigue ▪ Increases risk of falling over → broken bones, head injuries, bruises, bleeds → longer hospitalizations, more complications, higher mortality rates SIGNS & SYMPTOMS ▪ Difficulties with attention span, concentration, remaining conscious ▪ Disorganized/delayed thinking ▪ Hyperactive symptoms ▫ Agitated/aggressive ▫ Delusions/hallucinations ▪ Hypoactive symptoms ▫ Sluggish, drowsy ▫ Less reactive, withdrawn DIAGNOSIS ▪ Issues with attention/consciousness and cognition, developing over short time (several days or fewer) ▫ Difficulties with attention span, concentration, remaining conscious ▫ Disorganized/delayed thinking ▪ Not explained by pre-existing neurocognitive condition ▪ Explained by other medical condition and/or exposure to/withdrawal from a substance OSMOSIS.ORG 697

TREATMENT MEDICATIONS Severe symptoms ▪ Haloperidol/second generation antipsychotics OTHER INTERVENTIONS Preventative ▪ Make high-risk targets feel oriented, comfortable (reducing excess noise/ stimulation; make sure glasses, hearing aids are used if needed; encourage daily routine) ▪ Avoid opiates, other causative medications; avoid restraints DISSOCIATIVE DISORDERS osms.it/dissociative-disorders PATHOLOGY & CAUSES ▪ Characterized by disruptions or breakdowns of memory, awareness, identity, or perception. TYPES ▪ Three types on scale of severity Low severity: depersonalization/derealization disorder ▪ Depersonalization: feeling detached from own body/mind (e.g. feeling one’s body is a robot/ feeling of watching self) ▪ Derealization: feeling of world not being fully real (e.g. feeling outside world not real/ lacks lucidity) Middle severity: dissociative amnesia ▪ Inability to recall significant information about oneself (e.g. location of childhood home, what mother looked like) ▪ Four categories of amnesia ▫ Localized: trouble recalling traumatic event (and surrounding period) ▫ Generalized: trouble recalling significant portion of one’s past ▫ Systematized: trouble recalling specific category of information ▫ Continuous: trouble recalling events after they occur ▪ Can involve dissociative fugue (individual becomes confused about identity, starts sudden travel/ wandering) 698 OSMOSIS.ORG ▪ Worsens under stress High severity: dissociative identity disorder ▪ Feeling of having multiple identities which act/think/perceive differently, thus impairing ability to recall everyday/important information about oneself ▪ Two categories of dissociative identity disorder ▫ Covert: individual aware of identity shifts, struggles to manage them ▫ Overt: individual completely assumes different identities while unaware ▪ Can involve dissociative fugue (individual becomes confused about identity, starts sudden travel/ wandering) CAUSES ▪ Thought to be primarily caused by psychological trauma; associated with sexual abuse, post-traumatic stress disorder, depression, substance abuse, borderline personality, somatoform conditions ▪ More common in biologically-female indiviudals SIGNS & SYMPTOMS Depersonalization/derealization disorder ▪ Explicit thoughts/behaviors related to depersonalization/derealization ▪ Emotional/physical numbness; weak sense of self

Chapter 91 Cognitive & Dissociative Disorders ▪ ▪ ▪ ▪ ▪ Deadpan speech Altered sense of time Brain fog/lightheadedness Prone to rumination, anxiety Severe symptoms: difficulty recognizing familiar places, people, objects Dissociative amnesia & Dissociative identity disorder ▪ Inability to recall significant information about oneself ▪ Altered consciousness (e.g. depersonalization, derealization) ▪ Depression, suicidal ideation DIAGNOSIS TREATMENT MEDICATIONS ▪ Antidepressants (like selective serotonin reuptake inhibitors) ▪ Mood stabilizers ▪ Neuroleptics PSYCHOTHERAPY ▪ E.g., psychodynamic, cognitive, cognitive behavioral, supportive OTHER INTERVENTIONS ▪ Memory aids: alarms, reminders, media (e.g. photos/videos/recordings) ▪ Occupational therapy Depersonalization/derealization disorder ▪ Presence of depersonalization/derealization ▪ Symptoms affect day-to-day functioning ▪ Not caused by other condition/substance Dissociative amnesia ▪ Inability to recall significant information about oneself, beyond everyday forgetting ▪ Symptoms affect day-to-day functioning ▪ Not caused by other condition/substance Dissociative identity disorder ▪ Feeling of having multiple identities which act/think/ perceive differently ▪ Inability to recall significant information about oneself, beyond everyday forgetting ▪ Symptoms affect day-to-day functioning ▪ Not described by cultural/religious practices, nor by play (e.g. imaginary friends) ▪ Not caused by other condition/substance OSMOSIS.ORG 699