LCSW Flashcards

Exam Prep
Terms Definitions
Erikson stage 1
Oral sensory- birth to 1 year, trust versus mistrust, (feeding and weaning), hope
Erikson stage 2
Muscular Anal Stage, 1-3 years, autonomy versus doubt, toilet training, willpower
Erikson stage 3
Locomotor stage- 3-6 years, initiative versus inadequacy or guilt, independence, purpose
Erikson stage 4
Latency stage 6-12 years, industry versus inferiority, (school years), competence
Erikson stage 5
Adolescence, 12-18 years, identity versus confusion, how do we fit in, peer relationships, fidelity
Erikson stage 6
Young adulthood, 18-40 years, intimacy versus isolation, love relationships, love
Erikson stage 7
Middle adulthood, 40-65 years, generativity versus stagnation, passing the baton, caring
Erikson stage 8
Maturity, 65 years-death, integrity versus despair, meaning in life, accepting our own life, wisdom
Erikson saw _____ as important in how we developed in life
Conscious Ego (considered ego-centric theorist)
Kohlberg's question
Do children go through stages in their moral sense (in deciding right from wrong)?
Kohlberg's preconventional stage of moral development stage 1 obedience and punishment
Preconventional, children thought of themselves as separate from society at large. Realize there is authority outside of yourself, rules.
Kohlberg stages of moral development conventional
Saw themselves as members of society
Kohlberg's post-conventional
Individuals responding to society with a universal
Kohlberg, Preconventional, individualism and exchange stage. Stage 2
Instrumental relativist, Based on what's in it for me. Exchange is based on am I getting a fair shake.
Kohlberg stage 3 (conventional) stage of good interpersonal relationships
Based on expectations. Social relationships important. Recognizes rules.
Kohlberg stage 4 (conventional) maintaining of social order
See myself as a part of the wider group. Responsibility that society should function as it should. Still about laws and authority but based on feeling like a part of society. Accepts and abides by rules.
Kohlberg stage 5 (post-conventional) social contract and individual rights
See society at large and the implied contract with society. Punishment where appropriate but mitigating circumstances considered.
Kohlberg stage 6 (post conventional) stage of universal principals
Concrete good beyond that of society. Recognizes the flaws in society. A law might me broken to fulfill a higher moral principle.
Kohlberg's belief
Moral development stages were applicable across cultures and gender lines. Stages cannot be skipped.
Narrative Therapy
What is you could change the details of the story? Re-author. Michael White and David Epstein. Helps people envision a different future for themselves and change the way they look at life. Change the plot, change the end of the story.
The process of adding new material or information to an existing schema
The process of altering or revising an existing schema in light of new information
Two sides of Adaptation
Assimilation and accommodation- help balance the structure of the mind with the environment - Piaget
When accommodation and assimilation reach a congruency
Ideal state Piaget calls equilibrium. Helps balance the structure of the mind with the environment.
Piaget's stages of Cognitive Development
Sensory motor, pre operational, concrete operations, formal operational
Piaget's Sensory Motor stage
Birth-2 years, senses and motor abilities to understand the world. Child becomes aware of cause and effect relationship. Child capable of crudely imitating the actions of others. Object permanence.
Object permanence (Piaget)
The appreciation that an object no longer in view can still exist and reappear later.
Pre operational Stage
2-7 years. Lasts 2-7 years. Language and creative play. Uses imagination to pretend and use of symbols. Manipulating symbols. Egocentric. Inability to conserve liquid volume (liquid in tall skinny glass)
How do you know a child has moved from the pre operations stage to the concrete operational stage
Child develops the ability to decenter. 7-12. Organizing objects into ordered categories. Understanding rational terms (beginning, above, bigger than). Begins to use simple logic.
Concrete operations stage (Piaget)
Able to take into account another person's point of view and consider more than one perspective.
Formal operations stage
Thinking becomes abstract and symbolic. Increasingly competent at Adult style thinking. Hypothetical thinking (abstract rather than concrete) Reasoning skills developed.
System of organized general knowledge stored in long term memory that guides the encoding and retrieval of information.
Top Priorities in assessing clients
Start where the client is, legal mandates, health or safety concerns, take action when situations present serious, foreseeable, and imminent harm
Guidelines for conducting a competent assessment
1. Follow the principles of relevance and salience. 2. Address top priorities 3. Gather information from a variety of sources 4. Recognize the uniqueness of the client 5. Adopt a Strengths Perspective 6. View Assessment as both a product and a process
Piaget believed that assimilation helped
Balance the structure of the mind with the environment.
A conscious effort by the client to convince you that she is better off than really is the case.
Examples of specific Clinician Biases that can affect judgement:
Preconceived notions. Confirmation Bias Primary effect
Preconceived Notions
Perceptions and judgements concerning a client's psychological characteristics and behavior may be influenced by what you 'expect to find'.
Confirmation Bias
Seeking to give more weight to information that confirms your hypothesis and fail to elicit or give sufficient weight to disconfirming information
Primary effect
Giving more importance to information obtained earlier in the data collection process than to information obtained later.
Examples of reflective opening- convey that you intend to address feelings openly
Sometimes it can be difficult to get started. You seem upset today
Interview Skills for Eliciting the Presenting Problem
Start where the client is. Make statements that allow the client to choose her own direction (How can I help you?). Ask open-ended questions. Seek clarification
Brief story that may be a good tool for initiating exploration.
A client's needs are often related to their
Developmental stage Needs can be described as wants by the client... Ex. More self confidence and less family discord
Components of the Problem History
Onset, progression, severity, environmental antecedents, factors maintaining it, it's effect on the client's adaptive functioning, the client's ideas about the causes and what the client has done to try to resolve it including what has worked and what has not worked.
Scale developed by Holmes and Rahe
Life Events Scale or Social Readjustment Scale- stressors listed from most to least serious
ABC Model
Antecedents Behavior Consequences.
An intense emotional reaction may
Become the primary problem.... Ex anxiety from a job loss
Maturational Crisis
A transitional or developmental period within a person's life, such as puberty, when psychologic equilibrium is upset
Examples of coping skills
Seeking needed information Pre-planning Delaying gratification Flexibility Ability to consider various solutions to a problem
Examples of dysfunctional coping behaviors
Denial Rigidity Impulsiveness Substance use. Tendency to become angry, overwhelmed or depressed when facing a life stressor
Cognitive flexibility
Ability and willingness to accept new ideas and weigh all aspects of a situation
Tardive Dyskinisia
Disorder resulting in involuntary, repetitive body movements. In this form of Dyskinisia, the involuntary movements are 'tardive', meaning they have slow or belated onset. Frequently appears after long-term or high-dose use of antipsychotic drugs
Prescription Abbreviation- Q
Daily or every day
Twice daily
Three times in a day
Four times in a day
At bedtime
Before meals
After meals
Substance Screening Instruments
Drug abuse screening T-ACE CAGE CAGE-AID. MAST
Inability to feel joy or express many pleasurable emotions
Gallows Laughter
Laughter when discussing painful material
Emotional Blunting
Muted or apathetic response to stimuli that would normally evoke a stronger response
When flat affect occurs without a thought disorder consider...
The possibility of psychosis and refer for psychiatric evaluation
Signs and sxs of guilt and shame
Self condemnation, fears of annihilation, feelings of inferiority, reluctance to disclose flaws etc.
Contradictory emotions that occur at the same time within a person. Can produce indecisiveness and rapidly changing emotional attitudes
Loose associations
Characterized by abrupt shifts from one fragmented thought to another with little if any logical connection between thoughts
Flight of ideas
Client's responses seem to 'take off' based on a particular word or thought, unrelated to any logical progression to the original point of communication
Loose assn and flight of ideas may indicate
Mania, a thought disorder such as schizophrenia or acute drug intoxication
Cognitive inflexibility
Thinking in absolute terms. Adhering to stereotypes.
Examples of vegetative sxs
Sleep disturbances Changes in appetite or weight Loss of energy or frequent fatigue Changes in sexual function
Bipolar I
At least one manic episode and often, not always a history of major depressive episodes
Bipolar II
At least one major depressive episode and at least one hypo manic episode; no history of manic or mixed episodes
Cyclothymic Disorder
Hypomanic episodes and multiple periods of depressed mood (but not major depression) over a period of 2 or more years
Making up information to cover memory gaps
Ego systonic
Descriptive of values, feelings, behaviors, ideas, etc., That are consistent with the persons ego or sense of self; They feel real and acceptable to the persons consciousness.
Ego dystonic
Descriptive of impulses, behaviors, wishes, etc. that are unexpectable to the ego, or the person's ideal conception of self
Premorbid personality
What the client was like before the onset of her current problem or symptoms.
The fear or hatred of foreigners and other strangers
Adeler's 5 basic tasks
Acceptance Achieving intimacy Work Spiritual Dimension Community/Friendship
Client's Rights pertaining to psychological testing
Clients have the right to know the purpose of the testing, the names of and rationales for the test being used, and the results of the testing.
Rapid assessment instruments RAIs
Relatively short, self-administered, and easily scored instruments that are useful for demonstrating that a clients condition warrants treatment because of its effects on her functioning.
SF-36 and SF-12 Health Surveys
The surveys to assess the clients physical health and its effects on her role functioning and her mental health and its effects on her role functioning
Beck Depression Inventory II
Measures the depth of a client's depression, or the severity of her complaints, symptoms, and concerns related to her current level of depression
Child Behavior Checklist
assesses a child's behaviors via parant report and is useful for treatment planning, monitoring, and outcome assessment
Conner's rating scale
may be used to evaluate problem behavior in youth ages 3-17. Include Conners' Parent Rating Scale revised, Conner's Teacher scale-revised, Conners-Wells' Adolescent self-report scale (completed by clients 12 through 17)
Self Report Measures to aid in Treatment planning and Tracking Progress
Outcome Questionnaire-45 (OQ-45)
Butcher Treatment Planning Inventory
Behavior and Symptom Identification Scale (BASIC 32)
The use of projective personality tests (Rorschach)
based on the assumption that ambiguous and unstructured stimuli can elicit meaningful information about an examinee's personality and underlying conflicts.
MMPI-Minnesota Multi-phasic personality Inventory-2
appropriate for 18 and over with at least an 8th grade reading comprehension level. 10 clinical scales
appropriate for adolescents 14-18
Millon Clinical Multiaxial Inventory (MCMI-III)
objective personality inventory used to assess lasting personality traits and acute clinical states. 18 and over with 8th grade reading comprehension level. 24 clinical scales.
Millon Adolescent Clinical Inventory (MACI)
appropriate for clients ages 13-19 whose reading ability is at or above the 6th grade level.
Rorschach personality test
Consists of 10 bilaterally symmetrical inkblot cards
Provides a description about the client at the time of testing (internal organization and processing). Can be used to rule-out certain disorders. Behavioral predictions can be highly speculative.
Tests commonly used for measuring adaptive functioning
Vineland Adaptive Behavior Scales- Birth-90
AAMR Adaptive Behavior scales
Four examples of Neuropsychological Tests
Halstead-Reitan Neuropsychological Battery
Luria-Nebraska Neuropsychological Battery
Wechsler Memory Scale
Bender-Gestalt II
Client-focused measures
techniques developed specifically for a particular client and may be used to assess the extent of her problem, follow her progress over the course of an intervention, and determine when an intervention can be terminated.
2 examples of client-focused measures
individualized rating scale
goal attainment scale (measures intensity, frequency or duration of a symptom or problem.
Target problem log
used to identify antecedents that cause or worsen the problem
Direct Suicide Assessment should include questions concerning the indicators of....
intent, plan and means
Guidelines for interviewing children
Modify Questions
offer alternatives to verbally answering questions
Use descriptive comments
Use Reflection
Provide Labeled Praise
Avoid critical statements
Early signs of developmental delays
speech development
motor development
social and mental development
vision problems (holds head in awkward position)
Hearing problems (frequent earaches or runny ears, talks loudly or softly, delays in language development.
Children under 3 with special needs are eligible for early intervention programs under....
The Education of Handicapped Act (EHA)
The process of identifying a problem (social or mental as well as medical) and its underlying causes and formulating a solution.
Etiological Diagnosis
Problem causation is usually the result of the convergence of many factors in the client's person-situation complex
Dynamic Diagnosis
This category encompasses, among other things, examining how aspects of the client's personality (including strengths and weaknesses) interact to produce her functioning. it also examines interplay between client and other people and systems.
Classificatory Diagnosis
Classifying aspects of the client's functioning. Involves assigning a clinical diagnosis but can also include classifications aspects of the client's functioning related to race, ethnicity, religion or socioeconomic status, cognitive functioning, medical condition and family functioning.
describe, classify and code problems in adult social functioning. Seeks to balance problems and strengths.
PIE Four Factors
Factor I- Problems in Social Role Functioning
Factor II- Problems in Environment
Factor III- Mental Health Problems
Factor IV- Physical Health Problems
PIE Factor I- Problems in Social Role Functioning has 5 components
1. Social Interaction Areas or social roles where the problem is occurring.
2. Types of problems (power, ambivalence, responsibility etc. )
3. Severity of the problem
4. Duration of each problem
5. Clinical Judgment of the client's physical, mental and psychological strength to cope with the problem.
DSM IV TR identifies mental disorders on the basis of their
behavioral symptoms and organizes them according to the characteristics they share.
DSM uses a polythetic criteria set for diagnosing most disorders which
requires an individual to present with only a subset of items from a larger list
Principle diagnosis or Reason for visit is used...
when more than one diagnosis is given to the client.
The therapeutic approach that assumes that the client's dysfunction stems from maladaptive schemas
Cognitive therapy
The first step with a client with a number of concerns that seem overwhelming is always
To work to prioritize them
The use of silence by a social worker during a session with a client who is expressing a high degree of emotion will be most effective in demonstrating:
Acceptance of the client's feelings
In adult survivors of sexual abuse, the most frequently used defense mechanism is:
Magical thinking
A pattern of reasoning and mental imagining in which an individual attributes experiences and perceptions to unnatural phenomena. (One's thoughts or ideas can cause events to occur)
Symptoms of cocaine use
Visual Hallucinations, confusion, restlessness, Chills, dilated pupils, nausea, denial
Which medication is used primarily for the treatment of psychosis
Haloperidol (Haldol)
When authorization for treatment from a managed care company is requested. The PRIMARY determinant for approval is based on
The documentation that medical necessity criteria are met.
Paradoxical intent
Te deliberate practice of neurotic habit or thought in order to identify or remove it. (Telling the opposite of what is intended).
Projective identification
The concept of unconsciously perceiving others' behavior as a reflection of one's own attitudes.
Possible medication side effects
tachycardia, tremors, stomach distress, diarrhea or constipation, skin rash, low energy or sexual problems
vegetative symptoms
physical symptoms that may be signs of a mental disorder, in particular major depressive disorder. Ex: sleep disturbances, changes in appetite or weight, loss of energy or frequent fatigue and/or changes in sexual function
when a client has depression, you need to explore a number of historical variables in order to clarify a diagnosis, including those of the following list
Chronicity and persistence, severity of sxs, environmental stress, recent loss, past episodes of mania, family hx of mood disorder
reactive depression
usually remits when the stressor is removed (eg. adjustment disorder with depressed mood)
Signs and symptoms of anxiety disorders
Somatic, Behavioral, vigilance and scanning, affective, cognitive, interpersonal
If depression preceded anxiety sxs...
A diagnosis of primary depression is suggested
Anticipatory anxiety
Occurs minutes to hours before an expected encounter
Hypomanic episode
When manic symptoms are present at a lesser intensity
Physical conditions that can produce disinhibited behaviors similar to those experiencing a manic episide
Head trauma, brain tumor, endocrine system disorder
Ego Functions
Self-Regulation and Self Control
Reality Testing Capacity
Thought Processes (Cognitive Functioning)
Capacity for Interpersonal Relationships
Integrative Functioning or Synthesis (integrate potentially contradictory experiences)
Defensive Functioning (healthy use of defense mechanisms resulting in adaptive functioning)
Life History Grid
May be used to graphically depict significant events in a client's life and the development of significant problems over time
Life Cycle Matrix
is used to graphically depict the developmental stage of all individuals in a household. (helps organize impressions about family members.
is used to obtain and record information about a client's family patterns and history
is used to help a client acquire a better understanding of her social context so that she can learn effective strategies for changing it. Circles used to represent the different factors affecting the client (parents, spouse, children, extended family, friends, school, workplace, church
According to dual perspective (Norton 1978)...
an individual exists in a nurturing system that functions within a larger sustaining system
The nurturing system
immediately surrounds the individual and includes the traditions and formal relationships that are most familiar and comfortable to her. (relationships with family, support networks, and neighborhood).
sustaining system is
composed of the beliefs, values, traditions, and practices of the dominant society (economic, political, legal and educational)
Social network grid
involves collecting information about key people in a client's social networks
can be used to identify and illustrate client's friends
Assessment of a client's environmental variables (antecedents and consequences) is known as a
functional analysis
People behave differently because they know they are being observed
Naturalistic observation
the client is observed in the environment in which the problem occurs (e.g., the classroom)
To conduct an MSE
you observe the client's behavior in an informal, systematic way, noting the presence of cognitive, emotional, and behavioral problems.
Restricted or constricted affect is when
a client exhibits a mild restriction to the range or intensity of display of her feelings
labile affect
unstable and constantly changing
affective flattening/blunting
describes an extremely limited affective range or lack of response to external stimuli (associated with schizophrenia)
bland affect
nothing seems to affect client (associated with dementia)
tangentiality and loose associations are associate with
psychosis (often schizophrenia) and may also be found in mania
psychomotor retardation
a client takes far longer than normal to respond to questions, has long pauses between sentences, speak extremely slowly and/or provide very brief answers
circumstantial speech
speech that includes excessive extraneous material in addition to the principle message (and stuttering)
According to Piaget, the tendency toward biological and psychological balance. Underlies cognitive development.
The concept of general systems theory that one cause may produce different results.
Avoidance conditioning combines classical conditioning with
Negative reinforcement
Cognitive Dissonance Theory
Festinger's theory of attitude change that proposes that inconsistencies in cognitions produce discomfort (dissonance) which motivates the individual to reduce the dissonance, often by changing his cognitions.
Common good
A social worker asks both members of a married couple in conflict to argue for their partner's position. This technique is known as
Role reversal
defense mechanisms that the client uses on a habitual basis can be recorded on..
Axis II
Axis I is considered to be the principle diagnosis. When Axis II is the principle diagnosis, enter...
"principle diagnosis" or "reason for the visit" after Axis II disorder
3 diagnostic criteria for mental retardation
significantly subaverage intellectual functioning IQ of 70 or below
Concurrent deficits or impairments in adaptive functioning in at least 2 areas(self-care, social skills, safety, work, academic skills etc.
onset prior to age 18.
Degrees of severity of mental retardation
Mild- IQ 50-55 to 70
Moderate IQ 35-40 to 50-55
Severe IQ 20-25 to 35-40
Profound IQ below 20-25
Differential diagnosis for mental retardation for someone with an IQ in the range of 71-84
borderline intellectual functioning
Pervasive developmental disorder
Severe and pervasive impairments in communication and social interaction and/or the presence of stereotyped behaviors and activities
Autism spectrum disorders are called
Pervasive developmental disorders in the DSM
Autistic disorder requires the presence of at least 6 characteristic symptoms with a minimum of 2 symptoms from the first category and one each of the second and third categories with evidence of some sxs prior to age 3. What are the 3 categories?
Qualitative impairment in social interaction, qualitative impairment in communication, restricted, repetitive, and stereotyped behavior, interests and activities.
echoing words or phrases of others, pronoun reversals (you instead of I), and other abnormalities.
symptoms of Rett's Disorder (sxs follow a period of 5 months of normal develpment)
head growth deceleration, loss of purposeful hand skills and the development of stereotypical hand movements (wringing hands), impairments in the coordination of gait or trunk movements, loss of interest in the social environment, severely impaired language development and psychomotor retardation
Childhood Disintegrative disorder
characterized by a distinct pattern of developmental regression in at least 2 areas of functioning (ex. motor skills, play, social skills, or adaptive behavior, language)
Sxs of Aspbergers Disorder
severe impairment in social interactions and a restricted repertoire of behaviors, interests, and activities with no apparent delays in language, self-help skills, cognitive development or curiosity about the environment.
onset prior to age 7
sxs for at least 6 months
some degree of impairment in at least 2 settings
presence of at least 6 characteristic sxs of inattention or hyperactivity-impulsivity
3 ADHD subtypes
predominantly inattentive type
predominantly hyperactive-impulse type
combined type
behavioral inhibition hypothesis
proposes that the core feature of ADHD is an inability to regulate behavior to fit behavioral demands
The dx of conduct disorder requires
at least 3 characteristic symptoms during the past 12 months
4 categories of sxs of conduct disorder
aggression to people or animals
destruction of property
deceitfulness or theft
serious violation of rules
2 conduct disorder subtypes
childhood onset type- dx prior to age 10- higher degree of aggressiveness. could develop APD or SA
adolescent-onset type- dx at age 10 or later
Moffit distinguishes between two types of conduct disorder
life course-persistent type-sxs apparent by age 3, increasingly serious transgressions that continue into adulthood
adolescence-limited type- temporary form of anti-social behavior that reflects a "maturity gap" between the adolescent's biological maturation and lack of opportunities of adult privileges and rewards. Acts usually committed with peer are inconsistent across situations.
Oppositional Defiant Disorder
a recurrent pattern of negativistic, defiant, and hostile behaviors toward authority figures that lasts at least 6 months. Sxs include: often loses temper, argues with adults, actively defies or challenges rules or requests of adults, deliberately annoys people, blames others, angry and resentful, spiteful or vindictive.
repeated and developmentally inappropriate eating of a non-nutritive substance for at least one month. onset most often between 12 and 24 months. Occasionally found in pregnant women.
Rumination Disorder
repeated regurgitation and rechewing of food, in the absence of nausea or related GI illness, for at least one month.
Failure to thrive is also known as
Feeding disorder of infancy or early childhood. must last 6 months and appear before age 6
tic is defined by the DSM as
sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization that is experienced as irresistible but can be suppressed for varying lengths of time.
repeating socially undesirable words
repeating ones own sounds and words
at least one vocal tic and multiple motor tics that appear simultaneously or at different times and began prior to age 18
most common associated symptoms of Tourette's are
obsessions and compulsions (linked to higher levels of dopamine and/or supersensitivity to dopamine receptors
Appropriate diagnosis when a person has motor or vocal tics but not both
Chronic motor or vocal tic disorder
Appropriate dx when individual has had one or more motor and/or vocal tics for at least 4 weeks but no longer than 12 months
transient tic disorder
3 subtypes of enuresis
nocturnal only
diurnal only- when awake
nocturnal and diurnal

Primary if not preceded by a period of urinary continence
Secondary if it has been preceeded by a period of urinary continence.
Separation anxiety disorder
developmentally inappropriate, excessive anxiety related to separation from home or attachment figures. Must last at least 4 weeks, onset of sxs before age 18 at least 3 characteristic behaviors must be present. (excessive distress, fear of being alone, school refusal, physical complaints when separation occurs etc)
Reactive Attachment Disorder
Disturbed or developmentally inappropriate social relatedness in most settings that begins prior to age 5. This dx requires pathogenic care.
example of pathogenic care
neglect or frequent changes in caregivers that prevented the development of attachment
2 types of reactive attachment disorder
inhibited type
disinhibited type
Stereotypic Movement Disorder
involves deliberate and repetitive nonfunctional behavior (e.g. head banging, body rocking, playing with hands, fiddling with fingers, twirling objects) lasting for at least 4 weeks. Causes physical harm or significantly interferes with normal activities
3 categories of mental disorders
1. Disorders due to a general medical condition
2. Substance-related disorders
3. Primary mental disorders
Personality change due to a generalized medical condition can be caused by
head trauma, stroke, Huntington's disease, AIDS, and endocrine conditions such as hypothyroidism.
Specifiers for personality change due to a generalized medical condition
labile type
disinhibited type
aggressive type
apathetic type
paranoid type
other type
a Diagnosis of Delirium requires the following:
1. A disturbance of consciousness
2. A change in cognition and/or development of perceptual abnormalities. (disorientation of time/place and impaired language)
Delirium itself is not a dx. it is a defining feature of the following dx
Delirium due to a general medical condition
Substance-Induced Delirium
Delirium due to multiple etiologies
Delirium NOS
Dementia may be caused by
a number of substances and medical conditions and is characterized by multiple cognitive deficits
Cognitive deficits caused by dementia include
some degree of memory impairment, aphasia, apraxia, agnosia, and/or impaired executive functioning
anterograde amnesia
Difficulty acquiring new information
retrograde amnesia
inability to recall previously learned material
deterioration in language functioning
difficulty executing motor actions (unable to dress, eat, cook etc)
inability to recognize and identify familiar objects and people
sundowning involves
the occurrence or increase of certain symptomatic behaviors in a circadian rhythm, usually in the late afternoon, evening or night
A person who is sundowning may exhibit
mood swings, become more demanding, suspicious, agitated or disoriented. Often co-occurs with wandering (elopement at night)
Cortical dementias (Alzheimer's Type)
characterized by an early appearance of aphasia and impaired calculation ability and deficits in both recall and recognition memory.
subcortical dementias (Huntington's or Parkinson's)
characterized by an early appearance of deficits in impairment of functioning that are disproportionate to other impairments, a greater impairment of recall (vs. recognition) memory, dysarthia (poorly articulated speech), slowed motor speed and control, and personality change.
Differential diagnosis for Demential
Major Depressive disorder (sometimes referred to as psuedodementia
Delirium- sxs not as stable as demential
onset of cognitive symptoms is likely to be more abrupt, a person is sometimes overly concerned about his/her impairments, and the person is likely to be uncooperative during testing
dementia must also be distinguished from
MCI-Mild cognitive impairment
Dementia of the Alzheimers type is
the single-most common cause of dementia (65% of all cases). gradual onset, slow progressive decline in cognitive funtioning
Stages of Alheimers
Stage 1- 1-3 years, anterograde amnesia
Stage 2- 2-10 years, increasing retrograde amnesia
Stage 3- 8-12 years, Severely deteriorated intellectual functioning, apathy, limb rigidity, urinary and fecal incontinence.
A definite diagnosis requires
an autopsy or brain biopsy that shows extensive neuron loss and other indicators.
Example of drugs that reduce the ACh and treat dementia are
Tacrine (Cognex)
Donepezil (Aricept)
galantamine (Reminyl)
rivastigmine (Exelon)
A dx of vascular demential requires
cognitive impairment and focal neurological signs
cerebrovascular disease
has a step-wise, fluctuating course with a patchy pattern of sxs that is determined by the location of the brain damage.
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