Delirium, Dementia and Schizophrenia Notes

Changes in Mentation

  • Mentation changes can occur at any age, not just in advanced age.
  • Cognitive functions such as short-term memory and learning ability may decline with age.
  • Cognitive impairment is not a normal consequence of aging and is often treatable.
  • Depression or other medical disorders may present symptoms that resemble cognitive dysfunction.

Delirium vs Dementia

  • Delirium:

  • A sudden and transient state of confusion.

  • Symptoms include:

    • Difficulty processing information
    • Disorientation
    • Impaired judgment and reduced intellectual capacity
    • Behavioral changes (suspicious, frightened, inappropriate behavior)

  • Causes can include:

    • High fever
    • Head trauma
    • Brain tumor
    • Drug intoxication or withdrawal
    • Metabolic disorders
    • CNS inflammatory disorders

  • Treatment focuses on addressing the underlying medical condition.

  • Dementia:

  • More prevalent in older adults with a gradual and irreversible decline in memory and mental functions affecting daily life.

  • Common disorders associated with dementia include:

    • Alzheimer’s Disease
    • Cerebrovascular disorders
    • Parkinson’s Disease

Alzheimer's Disease Overview

  • Pathophysiology and Etiology:

  • Two types of Alzheimer’s disease: early onset and late onset.

  • Etiological factors include environment and lifestyle, with family history increasing the risk.

  • Four primary brain changes:

    • Decreased cortex size
    • Deficient acetylcholine levels
    • Neuritic plaques
    • Neurofibrillary tangles

  • Stages and Symptoms:

  • Seven distinct stages: Global Deterioration Scale.

  • Early symptoms include memory loss, impaired long-term memory, behavioral changes, and depression.

  • Advanced symptoms might involve severe cognitive decline, wandering, violent behavior, and various movement disorders (e.g., aphasia, agnosia).

  • Diagnostic Findings:

  • Imaging and tests such as EEG, CT, PET, MRI, and biomarkers.

  • Medical Management:

  • No cure; focus on supportive treatments including:

    • Drug therapy (e.g., antidepressants, tranquilizers)
    • Nursing management focuses on maintaining independence at home, evaluating safety, and caregiver burden.

Schizophrenia Overview

  • Characteristics:

  • A serious thought disorder with deterioration in mental functioning, sensory perception disturbances, and emotional changes.

  • Can appear in young adulthood; has a genetic component and may be linked to maternal viral infections during pregnancy.

  • Symptoms:

  • Positive symptoms:

    • Delusions, hallucinations, disorganized speech

  • Negative symptoms:

    • Impoverished speech, loss of relationships, decreased emotional expression.

  • Diagnostic Findings:

  • Assessment focuses on symptoms and ruling out other conditions using imaging studies (CT, PET, MRI).

  • Medical Management:

  • Involves psychotherapy and, only when necessary, institutionalization for safety.

  • Community mental health services and diverse drug therapies (e.g., antipsychotics) are utilized, including considerations for noncompliance and side effects.