Mental Health Session 12: PTSD and Neurocognitive disorders In the Elderly

Session 12: PTSD, and Neurocognitive disorders

 

  • Having a traumatic event of any kind can lead to PTSD symptoms
  • Almost 1 out of 10 people one month after 9/11 had symptoms of PTSD
  • In PTSD there are recurring symptoms of the stressor that has occurred.
    • The stress needs to be processed or else it will run on a continuous loop that will not allow the person to be free from the stressor.
    • Ted talk about PTSD
  • Thalamus, amygdala and hippocampus – emotional response to the experience
    • Overactive amygdala can cause increased sympathetic response and PTSD symptoms.
  • Cortisol – the stress hormone, longer exposure times allow the stress to have a higher reaction in this patient ie. a kindling effect the more stress there is.
  • Norepinephrine – high levels in PTSD
  • Coping skills are aimed at bringing them back to baseline levels of functioning
  • Exposure therapy is allowing the person to deal with the trauma in a safe more manageable place.
  • EMDR – is therapy using patterned eye movement thought to mimic REM sleep eye movement and this helps some people separate the trauma from the physical response that is elicited from the trauma memory.
  • Medications –
    • SSRI – fluoxetine, Paroxetine, Sertraline
    • Alpha agonist – Prazosin, Clonidine
  • Compassion fatigue – decrease ion compassion over time due to repeated secondary trauma
    • Common in healthcare workers
  • Adjustment disorder – precipitated by a traumatic or stressful event. Less intense than PTSD
  • Acute stress disorder – PTSD symptoms that last for one month only
  • Dissociative disorders – commonly occur with a history of trauma. Unconscious defence mechanisms, where the patient dissociates with consciousness. (out of body experience)   
    • Fugue state – amnestic state of personality
  • Dissociative Identity Disorder – presence of more than one personality state. Each personality perceives, relates and thinks in a specific unique way.

 

Neurocognitive disorders In the Elderly

  • Common Mental disorders in the elderly
    • Dementia
    • Delirium
    • Depression
    • Confusion – from withdrawal, illness, dementia, delirium
  • s/s to be aware of:
    • Short attention, irritable

 

  • Benzodiazepines are not recommended to patients with any confusion s/s because it may exacerbate them.
  • In anxiety disorders sleep initiation is an issue, with depression it is sleep fragmentation.
  • Confabulation – filling in details of a story that are not true to connect to a scenario that they do not remember.
    • Creating stories relating to factual events
  • 15% of the elderly commit suicide
  • Dementia – impairment of intellectual functioning affecting memory and cognition
    • Primary caused by alzheimer’s Disease.

 

  • Anticholinergics have a high chance of a person experiencing dementia
    • Can also be very flushed, and have poor secretions.

 

  • Alzheimer’s disease – 4th leading cause of death
    • Progressive decrease in cognitive functioning
    • Risk Increases with age, head trauma, and lower education level
    • Confabulation
    • Medications –
      • Namenda (Memantine – blocks excess glutamate
      • Exelon (rivastigmine – Cholinesterase inhibitor
      • Aricept (donepezil) – Cholinesterase inhibitor, stops breakdown of Acetylcholine. Fewer side effects then exelon.
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