Abnormal: Neurocognitive and Personality Disorders

Neurocognitive Disorders

These are disorders that involve deficits in cognitive functioning as their core feature and are “syndromes for which the underlying pathology, and frequently the etiology as well, can potentially be determined.” Impacted areas include complex attention, executive function, learning and memory, language, perceptual-motor, and social cognition.

Delirium

This disorder is characterized by a disturbance in attention and awareness that develops over a short period of time (hours to days) and represents a change from baseline functioning; it also tends to fluctuate in severity over the course of a day, often worsening in the evening and at night; there must also be one additional disturbance in cognition (e.g., memory, disorientation, impaired language, etc.)

False

True or False: Delirium often occurs in states of low arousal (e.g., coma)

True

True or False: Delirium must be the direct physiological consequence of a medical condition, substance use or withdrawal, or exposure to a toxin

Delirium

According to Wise (1995), at-risk groups for this disorder include older adults, people with decreased cerebral reserve (e.g., dementia, stroke, HIV), postcardiotomy patients, burn patients, people with drug dependence

Delirium

This neurocognitive disorder can be caused by systemic infections, metabolic disorders, fluid and electrolyte imbalances, postoperative states, and head trauma

True

True or False: Older adults are at highest risk for Delirium, followed by children

Delirium

Treatment for this disorder involves addressing the underlying cause and reducing agitated behaviors (e.g., manipulating the environment, psychosocial support, haloperidol/ antipsychotics)

Major Neurocognitive Disorder

This disorder is characterized by a significant decline from a previous level of functioning in one or more cognitive domains that interferes with independence and does not occur only in the context of Delirium

Mild Neurocognitive Disorder

This disorder is characterized by a modest decline from a previous level of functioning in one or more cognitive domains that does not interfere with independence (but may require greater effort or compensatory strategies) and does not occur only in the context of Delirium

Major and Mild Neurocognitive Disorder

There are 13 types of this disorder based on etiology: Alzheimer’s disease, frontotemporal lobar degeneration, Lewy body disease, vascular disease, TBI, substance/ medication use, HIV infection, prion disease, Parkinson’s disease, Huntington’s disease, another medical condition, multiple etiologies, and unspecified

Neurocognitive Disorder Due to Alzheimer’s Disease

This disorder is characterized by evidence of a causative genetic mutation, clear evidence of a decline in memory and at least one other domain, a steadily progressive and gradual decline without steady plateaus, and no evidence of mixed etiology

Alzheimer’s Disease

This neurocognitive disorder is often a diagnosis of exclusion, being confirmed by autopsy after death

Alzheimer’s Disease

Brains with this disorder show extensive neuron loss and the presence of amyloid-predominant plaques and tau-predominant neurofibrillary tangles, especially in the medial temporal structures (e.g., entorhinal cortex, hippocampus, and amygdala)

Alzheimer’s Disease

This disorder accounts for 60-90% of all dementia cases (the single-most common cause)

True

True or False: Late-onset Alzheimer’s Disease (80s and 90s) is more common than early-onset

Stage 1

This stage of Alzheimer’s Disease is characterized by anterograde amnesia (especially declarative memories); deficits in visuospatial skills (wandering); indifference, irritability, and sadness; and anomia (trouble recalling words, names, etc.)

Stage 1

This stage of Alzheimer’s Disease occurs in the 1-3 years range

Stage 2

This stage of Alzheimer’s Disease occurs in the 2-10 years range

Stage 3

This stage of Alzheimer’s Disease occurs in the 8-12 years range

Stage 2

This stage of Alzheimer’s Disease is characterized by increasing retrograde amnesia; flat or labile mood; restlessness and agitation; delusions; fluent aphasia (word salad); acalculia; and ideomotor apraxia (inability to translate ideas into movement)

Stage 3

This stage of Alzheimer’s Disease is characterized by severely deteriorated intellectual functioning; apathy; limb rigidity; and urinary and fecal incontinence

Early-Onset/ Familial

Abnormalities on chromosomes 1, 14, and 21 are associated with [early-onset/ familial or late-onset] Alzheimer’s Disease

Late-Onset

Abnormalities on ApoE4 gene on chromosome 19 are associated with [early-onset/ familial or late-onset] Alzheimer’s Disease

Acetylcholine

Low levels of __ are associated with Alzheimer’s Disease

Alzheimer’s Disease

Less formal education, type 2 diabetes, depression, TBI, and Down Syndrome are associated with greater risk for __

Alzheimer’s Disease

Treatment for this condition often includes group therapy (e.g., reality orientation, reminiscence), behavioral techniques and antipsychotics for agitation, antidepressants for depression, and environmental manipulation and cholinesterase inhibitor medications for memory

True

True or False: Outcomes for Alzheimer’s Disease are often better for those who remain living with family

Alzheimer’s Disease

Medications like tacrine (Cognex), donepezil (Aricept), galantamine (Reminyl), rivastigmine (Exelon), and galantamine (Razadyne, Reminyl) are used to slow the progression of __

Acetylcholine

Medications like tacrine (Cognex), donepezil (Aricept), galantamine (Reminyl), rivastigmine (Exelon), and galantamine (Razadyne, Reminyl) are used to prevent the breakdown of __

Vascular Neurocognitive Disorder

This is diagnosed when criteria for Major or Mild Neurocognitive Disorder are met, the clinical features are consistent with vascular etiology, and there is evidence of cerebrovascular disease

Vascular Neurocognitive Disorder

Risk factors for this neurocognitive disorder include hypertension, diabetes, smoking, obesity, high cholesterol, and atrial fibrillation

Neurocognitive Disorder Due to HIV Infection

This disorder is characterized by neurocognitive deficits that affect subcortical areas of the brain (e.g., impaired concentration and memory, slowed psychomotor speed, apathy and depression, tremor, clumsiness, saccadic eye movements, etc.)

AIDS Dementia Complex (ADC)

Neurocogntive Disorder Due to HIV Infection is also known as __

Neurocognitive Disorder Due to HIV Infection

This disorder has stages that range from Stage 0 (Normal) to Stage 4 (End Stage), which involves being nearly vegetative; having only rudimentary intellectual and social functioning; possibly being mute; having paraparesis (weakness/ stiffness in lower extremities) or paraplegia; and urinary and fecal incontinence

Personality Disorders

These disorders are enduring patterns of inner experience and behavior that deviate markedly from the expectations of the individual’s culture, are pervasive and inflexible, have an onset in adolescence or early adulthood, are stable over time, and lead to distress or impairment.

Cluster A

This cluster of personality disorders involves odd or eccentric behavior

Paranoid

This personality disorder is characterized by a pervasive pattern of distrust and suspiciousness that entails interpreting the motives of others as malevolent

Paranoid

This personality disorder requires at least four symptoms: Suspects that others are exploiting, harming, or deceiving them without a sufficient basis for doing so; is preoccupied with unjustified doubts about the trustworthiness of others, is reluctant to confide in others, reads demeaning content into benign remarks or events, persistently bears grudges, perceives attacks on their character and quickly reacts with anger or counterattacks, is persistently suspicious about the fidelity of their spouse or sexual partner without justification

Schizoid

This personality disorder is characterized by a pervasive pattern of detachment from interpersonal relationships and a restricted range of emotional expression in social settings

Schizoid

This personality disorder requires at least four symptoms: Doesn’t desire or enjoy close relationships, almost always chooses solitary activities, has little interest in sexual relationships, takes pleasure in few activities, lacks close friends or confidants other than first-degree relatives, seems indifferent to praise or criticism, exhibits emotional coldness or detachment

Schizotypal

This personality disorder is characterized by a pervasive pattern of social and interpersonal deficits involving acute discomfort with and reduced capacity for close relationships and eccentricities in cognition, perception, and behavior

A

Paranoid, Schizoid, and Schizotypal make up Cluster _

Cluster B

This cluster of personality disorders involves dramatic, emotional, or erratic behavior

B

Antisocial, Borderline, Histrionic, and Narcissistic make up Cluster _

Antisocial

This personality disorder is characterized by a pervasive pattern of disregard for and violation of the rights of others that has occurred since age 15

Antisocial

This personality disorder requires at least three symptoms: Failure to conform to social norms with respect to lawful behavior, deceitfulness, impulsivity, irritability and aggressiveness, reckless disregard for the safety of self and others, consistent irresponsibility, lack of remorse

Antisocial

This personality disorder is associated with an inflated sense of self, a lack of empathy for others, and superficial charm

Antisocial

For a diagnosis of this personality disorder, a person must be at least 18 years old for diagnosis, with a history of Conduct Disorder before the age of 15

True

True or False: Symptoms of Antisocial Personality Disorder are lifelong but often become less severe (especially criminal behavior) by the fourth decade of life

Borderline

This personality disorder is characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and affect, and marked impulsivity that began by early adulthood and is apparent in multiple contexts

Borderline

This personality disorder requires at least five symptoms: Frantic efforts to avoid abandonment, pattern of unstable/ intense interpersonal relationships that are marked by fluctuations between idealization and devaluation, an identity disturbance involving a persistent instability in self-image or sense of self, impulsivity in at least two areas that are potentially self-damaging (e.g., sex, substance use), recurrent suicide threats or gestures, affective instability, chronic feelings of emptiness, inappropriate intense anger or difficulty controlling anger, transient stress-related paranoid ideation or severe dissociative symptoms

Borderline

This personality disorder is most commonly diagnosed between 19-34, with most chronic and severe symptoms occurring during young adulthood. By age 40, up to 75% of people no longer meet criteria.

Impulsivity

In Borderline Personality Disorder, ___ resolves the fastest, with affective symptoms being the slowest to change

Narcissism

Adolf Stern considered BPD secondary to ___, which resulted from early issues in the mother-child relationship

Rapprochement

Mahler viewed BPD as an issue in the __ phase of separation-individuation, resulting in need for separation with a fear of abandonment

Rejection

Kernberg said that BPD can be traced to adverse, unpredictable caregiver-child interactions that alternate between __ and smothering, producing an insecure ego that relies on defense mechanisms like “splitting” self and others into all good or all bad parts

Emotional Dysregulation

Linehan’s biological model describes BPD as due to an interaction between biological and environmental factors, with __ being the core feature; summarized as the result of excessive emotional vulnerability, an inability to modulate strong emotions, and exposure to an invalidating environment

DBT

This treatment combines cognitive-behavioral techniques with the Rogerian assumption that acceptance of the client is necessary for change to occur; it uses group skills training, individual outpatient therapy, and phone consultations

DBT

This approach has been shown to reduce premature termination, psychiatric hospitalization, and parasuicidal behaviors in those with BPD

Histrionic

This personality disorder is characterized by a pervasive pattern of emotionality and attention-seeking

Histrionic

This personality disorder requires at least five symptoms: Discomfort when not the center of attention, inappropriately sexually seductive or provocative, rapidly shifting and shallow emotions, consistent use of physical appearance to gain attention, excessively impressionistic speech that is lacking in detail, exaggerated expression of emotion, easily influenced by others, considers relationships to be more intimate than they are

Narcissistic

This personality disorder is characterized by a pervasive pattern of grandiosity, a need for admiration, and a lack of empathy

Narcissistic

This personality disorder requires at least five symptoms: Has a grandiose sense of self-importance; is preoccupied with fantasies of unlimited success, power, beauty, love; believes they are unique and can be understood only by other high-status people; requires excessive admiration; has a sense of entitlement; is interpersonally exploitative; lacks empathy; is often envious of others or believes others are envious of them; exhibits arrogant behaviors or attitudes

Cluster C

This cluster of personality disorders involves anxiety and/or fearfulness

Avoidant

This personality disorder is characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

Avoidant

This personality disorder requires at least four symptoms: Avoids work activities involving interpersonal contact due to a fear of criticism, rejection, or disapproval; is unwilling to get involved with people unless certain of being liked; exhibits restraint in intimate relationships due to fear of being ridiculed; is preoccupied with concerns about being criticized or rejected; is inhibited in new relationships due to feelings of inadequacy; views self as socially inept, inferior, or unappealing to others; is usually reluctant to engage in new activities because they may be embarrassing

Dependent

This personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive, clinging behavior and a fear of separation

Dependent

This personality disorder requires at least five symptoms: Has difficulty making decisions without advice and reassurance from others; needs others to assume responsibility for most aspects of their life; fears disagreeing with others because it may lead to a loss of support; has difficulty initiating projects on their own; goes to great lengths to gain nurturance and support from others; feels helpless or uncomfortable when alone; urgently seeks another relationship for support when a close relationship ends; is unrealistically preoccupied with fears of being left to care for themselves

Obsessive-Compulsive

This personality disorder is characterized by a persistent preoccupation with orderliness, perfectionism, and mental and interpersonal control that severely limits their flexibility, openness, and efficiency

False

True or False: OCPD involves obsessions and compulsions

Obsessive-Compulsive

This personality disorder requires at least four symptoms: Is preoccupied with details, rules, etc. so that the major point of the activity is lost; exhibits perfectionism that interferes with task completion; is excessively devoted to work and productivity to the exclusion of leisure activities and friendships; is overconscientious and inflexible about morality, ethics, and values; is unable to discard worn-out or worthless objects; is reluctant to delegate work to others unless they are willing to do it their way; adopts a miserly spending style towards self and others; exhibits rigidity and stubbornness

C

Avoidant, Dependent, and Obsessive-Compulsive make up Cluster _

A few hours to a few days

Delirium involves a disturbance in attention and awareness that develops over:

Schizotypal Personality Disorder

Magical thinking, depression, ideas of reference, paranoia, discomfort in social situations, and inappropriate affect are most characteristic of which disorder?

Acetylcholine

Researchers have most consistently linked early memory impairment associated with Neurocognitive Disorder due to Alzheimer's disease to a loss of neurons that secrete __________, especially in the hippocampus and certain areas of the cortex.

Borderline Personality Disorder

For several years, a 26-year-old woman has exhibited cycles of over-idealization and devaluation in interpersonal relationships, uncertainty about career plans, reckless driving, drug use, and frequent suicide attempts. The most likely diagnosis is: