Opioid Use Disorder Treatment

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Questions and Answers

Which of the following is NOT a factor that contributes to the development of suicide among the elderly?

Bereavement

Stable marriage (correct)

Social isolation

Financial difficulties

What is the most common means of suicide for women?

Drug overdose/poisoning (correct)

Firearm

Jumping

Hanging

Which of the following is a characteristic of anorexia nervosa?

Starving oneself to achieve weight loss (correct)

Rapid consumption of large quantities of food

Use of laxatives, diuretics, or self-induced vomiting

Loss of control over eating and eating in secret

What is the highest mortality rate among eating disorders?

Anorexia nervosa Signup and view all the answers

Which of the following is a complication of anorexia nervosa?

All of the above Signup and view all the answers

What is the primary difference between bulimia nervosa and binge-eating disorder?

Use of compensatory behaviors Signup and view all the answers

Which of the following is a characteristic of binge-eating disorder?

Eating large amounts of food in secret Signup and view all the answers

What is the primary psychological dimension of eating disorders?

Body dissatisfaction Signup and view all the answers

Which of the following is a social factor that contributes to the development of eating disorders?

All of the above Signup and view all the answers

What is the primary goal of treatment for eating disorders?

Normalized eating patterns Signup and view all the answers

What is the primary category of symptoms in Schizophrenia Spectrum Disorders?

Positive symptoms Signup and view all the answers

What is the term for the 'added' sensations and behaviors associated with Schizophrenia Spectrum Disorders?

Positive symptoms Signup and view all the answers

Which of the following is a negative symptom of Schizophrenia Spectrum Disorders?

Avolition Signup and view all the answers

What is the term for the 'withdrawal' of a person's emotions and interests in Schizophrenia Spectrum Disorders?

Anhedonia Signup and view all the answers

What is the primary goal of Social Cognition and Interaction Training (SCIT) in Schizophrenia Spectrum Disorders?

Teaching conversational and social skills Signup and view all the answers

Which of the following neurotransmitters is involved in the dopamine hypothesis of Schizophrenia Spectrum Disorders?

Dopamine Signup and view all the answers

What is the term for the abnormal categorization of objects or concepts in Schizophrenia Spectrum Disorders?

Overinclusiveness Signup and view all the answers

Which of the following is a characteristic of Catatonia in Schizophrenia Spectrum Disorders?

Waxy flexibility Signup and view all the answers

What is the term for the study of the relationship between genetic and environmental factors in the development of Schizophrenia Spectrum Disorders?

Etiological research Signup and view all the answers

Which of the following is a type of therapy used in Schizophrenia Spectrum Disorders?

All of the above Signup and view all the answers

A person has been experiencing symptoms of hallucinations and delusions for 4 months. What is the likely diagnosis?

Schizophrenia Spectrum Disorders Signup and view all the answers

Which of the following is a characteristic of Delirium?

Abrupt onset and fluctuating course Signup and view all the answers

What is the primary difference between a Major Neurocognitive Disorder and a Mild Neurocognitive Disorder?

Impact on daily functioning Signup and view all the answers

What is the term for the progressive, degenerative condition that occurs in individuals who have had multiple episodes of head injury?

Chronic Traumatic Encephalopathy (CTE) Signup and view all the answers

What is the strongest risk factor for Dementia?

Age Signup and view all the answers

What is the term for the second most common form of dementia?

Dementia with Lewy Bodies (DLB) Signup and view all the answers

What is the primary motor symptom of Parkinson's Disease?

Slowness of movement Signup and view all the answers

What is the term for the buildup of Lewy body proteins in the brain?

Lewy body proteins Signup and view all the answers

What is the recommended approach to treating Neurocognitive Disorders?

Comprehensive approach, including medication, rehabilitation, and lifestyle changes Signup and view all the answers

What is the primary goal of rehabilitation in the treatment of Neurocognitive Disorders?

To improve participation in daily activities Signup and view all the answers

What is the primary underlying mechanism of the dopamine hypothesis of Schizophrenia Spectrum Disorders?

Excess dopamine activity in the prefrontal cortex Signup and view all the answers

Which of the following neurocognitive disorders is most closely associated with the APOE gene?

Alzheimer's disease Signup and view all the answers

What is the primary psychological dimension of eating disorders?

Self-esteem and body image Signup and view all the answers

Which of the following personality psychopathologies is most closely associated with impulsivity and reckless behavior?

Antisocial personality disorder Signup and view all the answers

What is the primary characteristic of Avoidant/Restrictive Food Intake Disorder (ARFID)?

Lack of interest in food or eating Signup and view all the answers

Which of the following disorders of childhood and adolescence is most closely associated with difficulty with social communication and repetitive behaviors?

Autism Spectrum Disorder (ASD) Signup and view all the answers

What is the primary goal of cognitive enhancement therapy in Schizophrenia Spectrum Disorders?

Improve neurocognitive functioning Signup and view all the answers

Which of the following neurocognitive disorders is most closely associated with the tau protein?

Frontotemporal dementia Signup and view all the answers

What is the primary characteristic of Anorexia Nervosa?

Fear of gaining weight Signup and view all the answers

Which of the following therapies is most commonly used in the treatment of Schizophrenia Spectrum Disorders?

Cognitive-behavioral therapy (CBT) Signup and view all the answers

What is the highest suicide rate among the following groups?

Elderly men Signup and view all the answers

Which of the following is a characteristic of restricting anorexia nervosa?

Fear of gaining weight Signup and view all the answers

What is the primary difference between bulimia nervosa and binge-eating disorder?

Bulimia nervosa involves bingeing and purging, while binge-eating disorder does not Signup and view all the answers

Which of the following is a common factor that contributes to the development of eating disorders?

All of the above Signup and view all the answers

What is the primary goal of treatment for eating disorders?

Normalized eating patterns and improved psychological functioning Signup and view all the answers

Which of the following is a risk factor for suicide among military personnel?

Stigma and trauma Signup and view all the answers

What is the term for the biological dimension of suicide?

Multipath perspective Signup and view all the answers

Which of the following is a factor that increases the risk of suicide among college students?

All of the above Signup and view all the answers

What is the term for the sense of being disconnected from others?

Thwarted belongingness Signup and view all the answers

Which of the following is a common consequence of traumatic brain injury?

All of the above Signup and view all the answers

A person is diagnosed with Schizoaffective Disorder. What is the primary requirement for this diagnosis?

The presence of a major depressive or manic episode, and symptoms of schizophrenia for at least two weeks Signup and view all the answers

What is the term for the reduction of cognitive decline in neurocognitive disorders?

Neuroprotection Signup and view all the answers

What is the primary characteristic of Borderline Personality Disorder?

Emotional dysregulation Signup and view all the answers

What is the term for the persistent difficulty in learning and using verbal or nonverbal language?

Language Disorder Signup and view all the answers

What is the primary diagnostic criterion for Anorexia Nervosa?

Fear of gaining weight Signup and view all the answers

What is the term for the persistent and excessive preoccupation with a perceived flaw in one's appearance?

Body Dysmorphic Disorder Signup and view all the answers

What is the primary goal of Deep Brain Stimulation in the treatment of Parkinson's Disease?

To improve motor symptoms Signup and view all the answers

What is the term for the process of acquiring new skills or knowledge in the presence of brain damage or dysfunction?

Compensatory strategies Signup and view all the answers

What is the primary difference between Delirium and Dementia?

Duration of symptoms Signup and view all the answers

What is the term for the abnormal growth of Lewy bodies in the brain, leading to Parkinson's Disease?

Lewy body proteins Signup and view all the answers

Which of the following symptoms is most closely associated with the dopamine hypothesis of Schizophrenia Spectrum Disorders?

Delusions Signup and view all the answers

What is the primary characteristic of Frontotemporal Neurocognitive Disorder?

Language impairment Signup and view all the answers

Which of the following personality psychopathologies is most closely associated with a lack of empathy and impulsivity?

Antisocial personality disorder Signup and view all the answers

Which of the following neurocognitive disorders is most closely associated with the accumulation of beta-amyloid protein?

Alzheimer's disease Signup and view all the answers

What is the primary goal of cognitive remediation therapy in the treatment of Schizophrenia Spectrum Disorders?

Improve cognitive functioning Signup and view all the answers

Which of the following is a risk factor for suicide among older adults?

All of the above Signup and view all the answers

What is the primary characteristic of Avoidant/Restrictive Food Intake Disorder (ARFID)?

Lack of interest in eating Signup and view all the answers

Which of the following is a common consequence of traumatic brain injury?

All of the above Signup and view all the answers

What is the primary goal of treatment for eating disorders?

Weight restoration Signup and view all the answers

What is the primary mechanism by which dopamine is involved in Schizophrenia Spectrum Disorders?

The dopamine system is hyporesponsive to environmental stimuli. Signup and view all the answers

Which of the following is a characteristic of the appetitive phase of the sexual response cycle?

Interest in sexual activity. Signup and view all the answers

What is the term for the progressive, degenerative condition that occurs in individuals who have had multiple episodes of head injury?

Chronic Traumatic Encephalopathy (CTE) Signup and view all the answers

Which of the following is a characteristic of Avoidant/Restrictive Food Intake Disorder (ARFID)?

Lack of interest in eating due to sensory issues. Signup and view all the answers

What is the primary goal of cognitive enhancement therapy in Schizophrenia Spectrum Disorders?

To enhance cognitive functioning. Signup and view all the answers

Which of the following neurocognitive disorders is most closely associated with the APOE gene?

Alzheimer's disease Signup and view all the answers

What is the primary characteristic of the cognitive dimension of eating disorders?

Distorted body image. Signup and view all the answers

Which of the following is a characteristic of Autism Spectrum Disorder?

Difficulty with social communication and repetitive behaviors. Signup and view all the answers

What is the primary goal of rehabilitation in the treatment of Neurocognitive Disorders?

To promote independence and community integration. Signup and view all the answers

Which of the following is a risk factor for suicide among college students?

Substance use disorders. Signup and view all the answers

Which of the following is a biological factor that contributes to the development of Schizophrenia Spectrum Disorders?

Genetics and heredity Signup and view all the answers

What is the primary goal of Cognitive Enhancement Therapy in Schizophrenia Spectrum Disorders?

To improve social cognition and interaction skills Signup and view all the answers

Which of the following Personality Psychopathologies is most closely associated with impulsivity and reckless behavior?

Antisocial Personality Disorder Signup and view all the answers

What is the primary characteristic of Avoidant/Restrictive Food Intake Disorder (ARFID)?

Lack of interest in food or eating Signup and view all the answers

Which of the following Neurocognitive Disorders is most closely associated with the APOE gene?

Alzheimer's Disease Signup and view all the answers

What is the primary goal of rehabilitation in the treatment of Neurocognitive Disorders?

To enhance daily living skills Signup and view all the answers

Which of the following disorders of childhood and adolescence is most closely associated with difficulty with social communication and repetitive behaviors?

Autism Spectrum Disorder Signup and view all the answers

What is the primary underlying mechanism of the dopamine hypothesis of Schizophrenia Spectrum Disorders?

Dopamine excess in specific brain regions Signup and view all the answers

Which of the following Neurocognitive Disorders is most closely associated with the tau protein?

Alzheimer's Disease Signup and view all the answers

What is the primary goal of treatment for eating disorders?

To restore a healthy weight and eating pattern Signup and view all the answers

Study Notes

Treatment for Opioid-Use Disorder

Early detoxification and therapy are critical for treatment, which becomes more difficult with prolonged use
Synthetic opioids can reduce cravings without producing euphoria, but a critical drawback is tolerance development
Improved outcomes are achieved through behavioral-oriented counseling and contingency management with incentives for abstinence
Family counseling also improves treatment outcomes
Vaccine development is underway to help with opioid abuse, where antibodies prevent opioids from reaching the brain

Treatment for Stimulant-Use Disorder

No effective pharmacological interventions are available
Incentives for stimulant-free toxicology reports improve rates of continuous abstinence
Teaching people who use cocaine to cope with temptations and high-risk situations is beneficial
Vaccine development is underway to help individuals dependent on cocaine, where antibodies prevent cocaine from reaching the brain

Treatment for Cannabis-Use Disorder

No information provided

Treatment for Gambling Disorder and Other Addiction

Treatment approaches include group therapy, CBT, and improving financial management skills
fMRI imaging may provide insight into which treatments increase impulse control

Internet Gaming Disorder

A condition involving excessive and prolonged engagement in computerized or internet games
Criteria are similar to gambling disorder
Most common among adolescent males
A significant concern in Asian countries
Cognitive behavioral treatment approaches include a focus on behavioral change and treating underlying emotions such as anxiety and depression

Symptoms of Schizophrenia Spectrum Disorder

Four categories of symptoms: positive, psychomotor abnormalities, cognitive, and negative
Positive symptoms include delusions, hallucinations, disorganized thinking, and incoherent communication
- Delusions are a lack of insight, false personal beliefs held despite evidence or logic
- Delusional themes include grandeur, control, persecution, reference, and thought withdrawal
Psychomotor abnormalities include catatonia, extremes in activity level, and agitated/hyperactive behavior
Cognitive symptoms include disorganized thinking, communication, and speech
Negative symptoms include decreased ability to initiate actions or speech, express emotions, or feel pleasure

Understanding Schizophrenia

Diagnosis involves the presence of at least two symptoms, including delusions, hallucinations, disorganized speech, gross motor disturbance, and negative symptoms
Deterioration from a previous level of functioning, with symptoms present for at least one month and persisting for at least six months

Phases of Schizophrenia

Prodromal phase: onset and buildup of symptoms
Active phase: full-blown symptoms
Residual phase: sometimes occurs, but not always, with symptoms no longer prominent

Long-Term Outcome Studies

Increased optimism regarding the course of the disorder

Etiology of Schizophrenia

Primarily a genetic disorder
Biological factors: genetics and heredity play a role, with interactions among multiple genes
Correlation to brain structures and function: endophenotypes, neurostructures, and biochemical influences

Treatment of Schizophrenia

Antipsychotic medication can reduce the intensity of symptoms, but does not help negative symptoms
Cognitive enhancement therapy aims to ameliorate neurocognitive deficits
Psychosocial therapy focuses on direct teaching of conversational, behavioral, and social skills
CBT teaches coping skills to manage positive and negative symptoms
Interventions focusing on family communication and education aim to normalize family experience and strengthen communication skills### Lecture 13: Neurocognitive Disorders

Types of Neurocognitive Disorders

Major
Minor
Delirium
- More short-lived, comes and leaves abruptly
- Structural and chemical changes result in impaired thinking, memory, or perception
- Caused by transient or permanent brain dysfunction

The Assessment of Brain Damage and Neurocognitive Functioning

Gather background information
Evaluate overall mental functioning, personality, and coping skills
Rule out sensory or emotional factors
Assess mental status, including memory, attention, and orientation
Test to pinpoint cognitive difficulties
Medical professionals identify and treat any underlying physical conditions
- Tests include blood tests, EEG, CT, MRI, PET
Comprehensive baseline assessment to monitor progress or decline (e.g. Trail-Making Test)

Major Neurocognitive Disorder

Significant decline in one or more cognitive areas, often multiple regions
Decline in ability to independently meet daily living demands
Clinicians specify the underlying medical reason if known

Mild Neurocognitive Disorder

Modest decline in at least one main cognitive area
Individuals able to participate in everyday activities, may require extra time
Often an intermediate stage between aging and major neurocognitive disorder
Can sometimes be downgraded from major disorder after recovery

Delirium

Acute state of confusion with disorientation and impaired attention
Abrupt onset, develops over hours/days, can be mild or severe
Psychotic symptoms may be present
Treatment involves identifying and addressing the underlying cause
Increased risk for hospitalized individuals and the elderly

Dementia

Decline in mental function and self-help skills
Examples include memory, problem-solving, and impulse control
Agitation due to confusion or frustration is common
Gradual onset and continuing cognitive decline
Age is the strongest risk factor
- Women have greater lifetime risk as they tend to live longer
- White and well-educated tend to develop it later in life
- People of color and less educated have earlier onset and higher lifetime risk

13-2 Etiology of Neurocognitive Disorders

Result from a variety of medical conditions
Some involve specific events like stroke or head injury
Some become worse over time through neurodegeneration involving progressive brain damage

Neurocognitive Disorder due to Traumatic Brain Injury (TBI)

TBI can result from a bump, jolt, or blow to the head
Occurs most frequently in young children, older adolescents, and older adults
Persistent cognitive impairment due to the brain injury
Effects can be temporary or permanent

Concussion

Most common type of TBI
Trauma-induced changes in brain functioning
Symptoms include headache, dizziness, nausea, and sensitivity to light
Usually temporary but sometimes last much longer
Physicians recommend rest and minimizing stimulation

Cerebral Contusion and Cerebral Laceration

Cerebral contusion is bruising of the brain from force striking the skull
Cerebral laceration is an open head injury where brain tissue is torn or ruptured

Chronic Traumatic Encephalopathy (CTE)

Progressive, degenerative condition with abnormal tau protein deposits
Diagnosed in individuals with multiple head injury episodes
Associated with psychological symptoms and increased risk of dementia
Four stages: headache/concentration, depression/memory, cognitive impairment, dementia

Vascular Neurocognitive Disorders

Can result from a one-time stroke or ongoing cardiovascular disruptions
Found in about 40% of brain autopsies of individuals with dementia
Often begins with atherosclerosis
Ischemic stroke (85% of cases) and hemorrhagic stroke (15% of cases)

Stroke

Obstruction of blood flow to the brain, leading to loss of brain function
A leading cause of death and disability in the US, can occur at any age
Risk factors include smoking, stress, poor lifestyle, and depression
Vascular dementia can result from a series of small strokes

Neurocognitive Disorder Due to Substance and Alzheimer's Disease

Substance use can result in delirium or chronic brain dysfunction
Mild neurocognitive disorder common with history of heavy substance use
Alzheimer's Disease affects over 5 million Americans
- Progressive cognitive and behavioral decline
- Age is a significant risk factor
- Requires clear physiological indicators to predict progression from mild impairment

Characteristics of Alzheimer's Disease

Progressive decline in cognitive and behavioral functioning
Early symptoms include memory dysfunction, irritability, cognitive impairment
Other common symptoms include social withdrawal, depression, delusions, impulsive behaviors
No cure exists, involves shrinkage of brain tissue and abnormal structures like neurofibrillary tangles and beta-amyloid plaques
Brain changes appear years before dementia symptoms

Types of Alzheimer's

Early Onset (5-10%): Typically more genetic factors
Late Onset (80-90%): Average age of diagnosis is 74, life expectancy 7-9 years

Etiology of Alzheimer's Disease

Believed to be influenced by hereditary and environmental factors
- Genetically-based Alzheimer's tends towards early onset
- Stress, smoking, lifestyle factors tend towards late onset

Treatment

Only available treatments can slow down progression, such as medication

Dementia with Lewy Bodies (DLB)

Second most common form of dementia
Characteristics include fluctuations in attention/alertness, visual hallucinations, psychiatric symptoms, and motor impairment
Lewy bodies deplete acetylcholine, resulting in perceptual, cognitive, and behavioral symptoms
Depletion of dopamine results in unique motor dysfunction

Parkinson's Disease (PD)

Four primary symptoms: tremor, rigidity, slowness initiating movement, impaired balance
Motor symptoms evident at least one year prior to cognitive decline
Mild cognitive impairment affects 27% of those with PD
Symptoms result from buildup of Lewy body proteins
Occupational exposure to toxins may increase PD risk

13-3 Treatment Considerations

Approaches vary widely based on cause, symptoms, and dysfunction
First, address any underlying medical conditions
Major interventions include:
- Rehabilitative services
- Biological interventions like medication
- Cognitive and behavioral treatment
- Lifestyle changes
- Environmental support

Rehab

Primarily for stroke, must be comprehensive and sustained
Physical, occupational, speech, and language therapy
Commitment and participation is important, depression can stall progress
Neuroimaging used to document brain changes from rehabilitation

Biological Treatment

Medications like L-dopa, specific vitamins, deep brain stimulation, gene therapy
Help prevent recurrence of stroke, treat underlying conditions

Cognitive and Behavior Treatment

Psychotherapy to enhance coping, reduce problem behaviors
Teach strategies like social skills, simplifying tasks
Meditation and mindfulness-based approaches can reduce brain atrophy

Lifestyle Changes

Can help prevent or minimize progression
- Cardiovascular fitness, smoking cessation, weight reduction
- Control of blood sugar, cholesterol, blood pressure
- Increased social interaction and mental stimulation

Environmental Support

Crucial for disorders involving dementia
Bright lighting, labeling, family visits to improve sleep, decrease agitation

Treatment for Opioid-Use Disorder

Early detoxification and therapy are critical for treatment, which becomes more difficult with prolonged use
Synthetic opioids can reduce cravings without producing euphoria, but a critical drawback is tolerance development
Improved outcomes are achieved through behavioral-oriented counseling and contingency management with incentives for abstinence
Family counseling also improves treatment outcomes
Vaccine development is underway to help with opioid abuse, where antibodies prevent opioids from reaching the brain

Treatment for Stimulant-Use Disorder

No effective pharmacological interventions are available
Incentives for stimulant-free toxicology reports improve rates of continuous abstinence
Teaching people who use cocaine to cope with temptations and high-risk situations is beneficial
Vaccine development is underway to help individuals dependent on cocaine, where antibodies prevent cocaine from reaching the brain

Treatment for Cannabis-Use Disorder

No information provided

Treatment for Gambling Disorder and Other Addiction

Treatment approaches include group therapy, CBT, and improving financial management skills
fMRI imaging may provide insight into which treatments increase impulse control

Internet Gaming Disorder

A condition involving excessive and prolonged engagement in computerized or internet games
Criteria are similar to gambling disorder
Most common among adolescent males
A significant concern in Asian countries
Cognitive behavioral treatment approaches include a focus on behavioral change and treating underlying emotions such as anxiety and depression

Symptoms of Schizophrenia Spectrum Disorder

Four categories of symptoms: positive, psychomotor abnormalities, cognitive, and negative
Positive symptoms include delusions, hallucinations, disorganized thinking, and incoherent communication
- Delusions are a lack of insight, false personal beliefs held despite evidence or logic
- Delusional themes include grandeur, control, persecution, reference, and thought withdrawal
Psychomotor abnormalities include catatonia, extremes in activity level, and agitated/hyperactive behavior
Cognitive symptoms include disorganized thinking, communication, and speech
Negative symptoms include decreased ability to initiate actions or speech, express emotions, or feel pleasure

Understanding Schizophrenia

Diagnosis involves the presence of at least two symptoms, including delusions, hallucinations, disorganized speech, gross motor disturbance, and negative symptoms
Deterioration from a previous level of functioning, with symptoms present for at least one month and persisting for at least six months

Phases of Schizophrenia

Prodromal phase: onset and buildup of symptoms
Active phase: full-blown symptoms
Residual phase: sometimes occurs, but not always, with symptoms no longer prominent

Long-Term Outcome Studies

Increased optimism regarding the course of the disorder

Etiology of Schizophrenia

Primarily a genetic disorder
Biological factors: genetics and heredity play a role, with interactions among multiple genes
Correlation to brain structures and function: endophenotypes, neurostructures, and biochemical influences

Treatment of Schizophrenia

Antipsychotic medication can reduce the intensity of symptoms, but does not help negative symptoms
Cognitive enhancement therapy aims to ameliorate neurocognitive deficits
Psychosocial therapy focuses on direct teaching of conversational, behavioral, and social skills
CBT teaches coping skills to manage positive and negative symptoms
Interventions focusing on family communication and education aim to normalize family experience and strengthen communication skills### Lecture 13: Neurocognitive Disorders

Types of Neurocognitive Disorders

Major
Minor
Delirium
- More short-lived, comes and leaves abruptly
- Structural and chemical changes result in impaired thinking, memory, or perception
- Caused by transient or permanent brain dysfunction

The Assessment of Brain Damage and Neurocognitive Functioning

Gather background information
Evaluate overall mental functioning, personality, and coping skills
Rule out sensory or emotional factors
Assess mental status, including memory, attention, and orientation
Test to pinpoint cognitive difficulties
Medical professionals identify and treat any underlying physical conditions
- Tests include blood tests, EEG, CT, MRI, PET
Comprehensive baseline assessment to monitor progress or decline (e.g. Trail-Making Test)

Major Neurocognitive Disorder

Significant decline in one or more cognitive areas, often multiple regions
Decline in ability to independently meet daily living demands
Clinicians specify the underlying medical reason if known

Mild Neurocognitive Disorder

Modest decline in at least one main cognitive area
Individuals able to participate in everyday activities, may require extra time
Often an intermediate stage between aging and major neurocognitive disorder
Can sometimes be downgraded from major disorder after recovery

Delirium

Acute state of confusion with disorientation and impaired attention
Abrupt onset, develops over hours/days, can be mild or severe
Psychotic symptoms may be present
Treatment involves identifying and addressing the underlying cause
Increased risk for hospitalized individuals and the elderly

Dementia

Decline in mental function and self-help skills
Examples include memory, problem-solving, and impulse control
Agitation due to confusion or frustration is common
Gradual onset and continuing cognitive decline
Age is the strongest risk factor
- Women have greater lifetime risk as they tend to live longer
- White and well-educated tend to develop it later in life
- People of color and less educated have earlier onset and higher lifetime risk

13-2 Etiology of Neurocognitive Disorders

Result from a variety of medical conditions
Some involve specific events like stroke or head injury
Some become worse over time through neurodegeneration involving progressive brain damage

Neurocognitive Disorder due to Traumatic Brain Injury (TBI)

TBI can result from a bump, jolt, or blow to the head
Occurs most frequently in young children, older adolescents, and older adults
Persistent cognitive impairment due to the brain injury
Effects can be temporary or permanent

Concussion

Most common type of TBI
Trauma-induced changes in brain functioning
Symptoms include headache, dizziness, nausea, and sensitivity to light
Usually temporary but sometimes last much longer
Physicians recommend rest and minimizing stimulation

Cerebral Contusion and Cerebral Laceration

Cerebral contusion is bruising of the brain from force striking the skull
Cerebral laceration is an open head injury where brain tissue is torn or ruptured

Chronic Traumatic Encephalopathy (CTE)

Progressive, degenerative condition with abnormal tau protein deposits
Diagnosed in individuals with multiple head injury episodes
Associated with psychological symptoms and increased risk of dementia
Four stages: headache/concentration, depression/memory, cognitive impairment, dementia

Vascular Neurocognitive Disorders

Can result from a one-time stroke or ongoing cardiovascular disruptions
Found in about 40% of brain autopsies of individuals with dementia
Often begins with atherosclerosis
Ischemic stroke (85% of cases) and hemorrhagic stroke (15% of cases)

Stroke

Obstruction of blood flow to the brain, leading to loss of brain function
A leading cause of death and disability in the US, can occur at any age
Risk factors include smoking, stress, poor lifestyle, and depression
Vascular dementia can result from a series of small strokes

Neurocognitive Disorder Due to Substance and Alzheimer's Disease

Substance use can result in delirium or chronic brain dysfunction
Mild neurocognitive disorder common with history of heavy substance use
Alzheimer's Disease affects over 5 million Americans
- Progressive cognitive and behavioral decline
- Age is a significant risk factor
- Requires clear physiological indicators to predict progression from mild impairment

Characteristics of Alzheimer's Disease

Progressive decline in cognitive and behavioral functioning
Early symptoms include memory dysfunction, irritability, cognitive impairment
Other common symptoms include social withdrawal, depression, delusions, impulsive behaviors
No cure exists, involves shrinkage of brain tissue and abnormal structures like neurofibrillary tangles and beta-amyloid plaques
Brain changes appear years before dementia symptoms

Types of Alzheimer's

Early Onset (5-10%): Typically more genetic factors
Late Onset (80-90%): Average age of diagnosis is 74, life expectancy 7-9 years

Etiology of Alzheimer's Disease

Believed to be influenced by hereditary and environmental factors
- Genetically-based Alzheimer's tends towards early onset
- Stress, smoking, lifestyle factors tend towards late onset

Treatment

Only available treatments can slow down progression, such as medication

Dementia with Lewy Bodies (DLB)

Second most common form of dementia
Characteristics include fluctuations in attention/alertness, visual hallucinations, psychiatric symptoms, and motor impairment
Lewy bodies deplete acetylcholine, resulting in perceptual, cognitive, and behavioral symptoms
Depletion of dopamine results in unique motor dysfunction

Parkinson's Disease (PD)

Four primary symptoms: tremor, rigidity, slowness initiating movement, impaired balance
Motor symptoms evident at least one year prior to cognitive decline
Mild cognitive impairment affects 27% of those with PD
Symptoms result from buildup of Lewy body proteins
Occupational exposure to toxins may increase PD risk

13-3 Treatment Considerations

Approaches vary widely based on cause, symptoms, and dysfunction
First, address any underlying medical conditions
Major interventions include:
- Rehabilitative services
- Biological interventions like medication
- Cognitive and behavioral treatment
- Lifestyle changes
- Environmental support

Rehab

Primarily for stroke, must be comprehensive and sustained
Physical, occupational, speech, and language therapy
Commitment and participation is important, depression can stall progress
Neuroimaging used to document brain changes from rehabilitation

Biological Treatment

Medications like L-dopa, specific vitamins, deep brain stimulation, gene therapy
Help prevent recurrence of stroke, treat underlying conditions

Cognitive and Behavior Treatment

Psychotherapy to enhance coping, reduce problem behaviors
Teach strategies like social skills, simplifying tasks
Meditation and mindfulness-based approaches can reduce brain atrophy

Lifestyle Changes

Can help prevent or minimize progression
- Cardiovascular fitness, smoking cessation, weight reduction
- Control of blood sugar, cholesterol, blood pressure
- Increased social interaction and mental stimulation

Environmental Support

Crucial for disorders involving dementia
Bright lighting, labeling, family visits to improve sleep, decrease agitation

Treatment for Opioid-Use Disorder

Early detoxification and therapy are critical for treatment, which becomes more difficult with prolonged use
Synthetic opioids can reduce cravings without producing euphoria, but a critical drawback is tolerance development
Improved outcomes are achieved through behavioral-oriented counseling and contingency management with incentives for abstinence
Family counseling also improves treatment outcomes
Vaccine development is underway to help with opioid abuse, where antibodies prevent opioids from reaching the brain

Treatment for Stimulant-Use Disorder

No effective pharmacological interventions are available
Incentives for stimulant-free toxicology reports improve rates of continuous abstinence
Teaching people who use cocaine to cope with temptations and high-risk situations is beneficial
Vaccine development is underway to help individuals dependent on cocaine, where antibodies prevent cocaine from reaching the brain

Treatment for Cannabis-Use Disorder

No information provided

Treatment for Gambling Disorder and Other Addiction

Treatment approaches include group therapy, CBT, and improving financial management skills
fMRI imaging may provide insight into which treatments increase impulse control

Internet Gaming Disorder

A condition involving excessive and prolonged engagement in computerized or internet games
Criteria are similar to gambling disorder
Most common among adolescent males
A significant concern in Asian countries
Cognitive behavioral treatment approaches include a focus on behavioral change and treating underlying emotions such as anxiety and depression

Symptoms of Schizophrenia Spectrum Disorder

Four categories of symptoms: positive, psychomotor abnormalities, cognitive, and negative
Positive symptoms include delusions, hallucinations, disorganized thinking, and incoherent communication
- Delusions are a lack of insight, false personal beliefs held despite evidence or logic
- Delusional themes include grandeur, control, persecution, reference, and thought withdrawal
Psychomotor abnormalities include catatonia, extremes in activity level, and agitated/hyperactive behavior
Cognitive symptoms include disorganized thinking, communication, and speech
Negative symptoms include decreased ability to initiate actions or speech, express emotions, or feel pleasure

Understanding Schizophrenia

Diagnosis involves the presence of at least two symptoms, including delusions, hallucinations, disorganized speech, gross motor disturbance, and negative symptoms
Deterioration from a previous level of functioning, with symptoms present for at least one month and persisting for at least six months

Phases of Schizophrenia

Prodromal phase: onset and buildup of symptoms
Active phase: full-blown symptoms
Residual phase: sometimes occurs, but not always, with symptoms no longer prominent

Long-Term Outcome Studies

Increased optimism regarding the course of the disorder

Etiology of Schizophrenia

Primarily a genetic disorder
Biological factors: genetics and heredity play a role, with interactions among multiple genes
Correlation to brain structures and function: endophenotypes, neurostructures, and biochemical influences

Treatment of Schizophrenia

Antipsychotic medication can reduce the intensity of symptoms, but does not help negative symptoms
Cognitive enhancement therapy aims to ameliorate neurocognitive deficits
Psychosocial therapy focuses on direct teaching of conversational, behavioral, and social skills
CBT teaches coping skills to manage positive and negative symptoms
Interventions focusing on family communication and education aim to normalize family experience and strengthen communication skills### Lecture 13: Neurocognitive Disorders

Types of Neurocognitive Disorders

Major
Minor
Delirium
- More short-lived, comes and leaves abruptly
- Structural and chemical changes result in impaired thinking, memory, or perception
- Caused by transient or permanent brain dysfunction

The Assessment of Brain Damage and Neurocognitive Functioning

Gather background information
Evaluate overall mental functioning, personality, and coping skills
Rule out sensory or emotional factors
Assess mental status, including memory, attention, and orientation
Test to pinpoint cognitive difficulties
Medical professionals identify and treat any underlying physical conditions
- Tests include blood tests, EEG, CT, MRI, PET
Comprehensive baseline assessment to monitor progress or decline (e.g. Trail-Making Test)

Major Neurocognitive Disorder

Significant decline in one or more cognitive areas, often multiple regions
Decline in ability to independently meet daily living demands
Clinicians specify the underlying medical reason if known

Mild Neurocognitive Disorder

Modest decline in at least one main cognitive area
Individuals able to participate in everyday activities, may require extra time
Often an intermediate stage between aging and major neurocognitive disorder
Can sometimes be downgraded from major disorder after recovery

Delirium

Acute state of confusion with disorientation and impaired attention
Abrupt onset, develops over hours/days, can be mild or severe
Psychotic symptoms may be present
Treatment involves identifying and addressing the underlying cause
Increased risk for hospitalized individuals and the elderly

Dementia

Decline in mental function and self-help skills
Examples include memory, problem-solving, and impulse control
Agitation due to confusion or frustration is common
Gradual onset and continuing cognitive decline
Age is the strongest risk factor
- Women have greater lifetime risk as they tend to live longer
- White and well-educated tend to develop it later in life
- People of color and less educated have earlier onset and higher lifetime risk

13-2 Etiology of Neurocognitive Disorders

Result from a variety of medical conditions
Some involve specific events like stroke or head injury
Some become worse over time through neurodegeneration involving progressive brain damage

Neurocognitive Disorder due to Traumatic Brain Injury (TBI)

TBI can result from a bump, jolt, or blow to the head
Occurs most frequently in young children, older adolescents, and older adults
Persistent cognitive impairment due to the brain injury
Effects can be temporary or permanent

Concussion

Most common type of TBI
Trauma-induced changes in brain functioning
Symptoms include headache, dizziness, nausea, and sensitivity to light
Usually temporary but sometimes last much longer
Physicians recommend rest and minimizing stimulation

Cerebral Contusion and Cerebral Laceration

Cerebral contusion is bruising of the brain from force striking the skull
Cerebral laceration is an open head injury where brain tissue is torn or ruptured

Chronic Traumatic Encephalopathy (CTE)

Progressive, degenerative condition with abnormal tau protein deposits
Diagnosed in individuals with multiple head injury episodes
Associated with psychological symptoms and increased risk of dementia
Four stages: headache/concentration, depression/memory, cognitive impairment, dementia

Vascular Neurocognitive Disorders

Can result from a one-time stroke or ongoing cardiovascular disruptions
Found in about 40% of brain autopsies of individuals with dementia
Often begins with atherosclerosis
Ischemic stroke (85% of cases) and hemorrhagic stroke (15% of cases)

Stroke

Obstruction of blood flow to the brain, leading to loss of brain function
A leading cause of death and disability in the US, can occur at any age
Risk factors include smoking, stress, poor lifestyle, and depression
Vascular dementia can result from a series of small strokes

Neurocognitive Disorder Due to Substance and Alzheimer's Disease

Substance use can result in delirium or chronic brain dysfunction
Mild neurocognitive disorder common with history of heavy substance use
Alzheimer's Disease affects over 5 million Americans
- Progressive cognitive and behavioral decline
- Age is a significant risk factor
- Requires clear physiological indicators to predict progression from mild impairment

Characteristics of Alzheimer's Disease

Progressive decline in cognitive and behavioral functioning
Early symptoms include memory dysfunction, irritability, cognitive impairment
Other common symptoms include social withdrawal, depression, delusions, impulsive behaviors
No cure exists, involves shrinkage of brain tissue and abnormal structures like neurofibrillary tangles and beta-amyloid plaques
Brain changes appear years before dementia symptoms

Types of Alzheimer's

Early Onset (5-10%): Typically more genetic factors
Late Onset (80-90%): Average age of diagnosis is 74, life expectancy 7-9 years

Etiology of Alzheimer's Disease

Believed to be influenced by hereditary and environmental factors
- Genetically-based Alzheimer's tends towards early onset
- Stress, smoking, lifestyle factors tend towards late onset

Treatment

Only available treatments can slow down progression, such as medication

Dementia with Lewy Bodies (DLB)

Second most common form of dementia
Characteristics include fluctuations in attention/alertness, visual hallucinations, psychiatric symptoms, and motor impairment
Lewy bodies deplete acetylcholine, resulting in perceptual, cognitive, and behavioral symptoms
Depletion of dopamine results in unique motor dysfunction

Parkinson's Disease (PD)

Four primary symptoms: tremor, rigidity, slowness initiating movement, impaired balance
Motor symptoms evident at least one year prior to cognitive decline
Mild cognitive impairment affects 27% of those with PD
Symptoms result from buildup of Lewy body proteins
Occupational exposure to toxins may increase PD risk

13-3 Treatment Considerations

Approaches vary widely based on cause, symptoms, and dysfunction
First, address any underlying medical conditions
Major interventions include:
- Rehabilitative services
- Biological interventions like medication
- Cognitive and behavioral treatment
- Lifestyle changes
- Environmental support

Rehab

Primarily for stroke, must be comprehensive and sustained
Physical, occupational, speech, and language therapy
Commitment and participation is important, depression can stall progress
Neuroimaging used to document brain changes from rehabilitation

Biological Treatment

Medications like L-dopa, specific vitamins, deep brain stimulation, gene therapy
Help prevent recurrence of stroke, treat underlying conditions

Cognitive and Behavior Treatment

Psychotherapy to enhance coping, reduce problem behaviors
Teach strategies like social skills, simplifying tasks
Meditation and mindfulness-based approaches can reduce brain atrophy

Lifestyle Changes

Can help prevent or minimize progression
- Cardiovascular fitness, smoking cessation, weight reduction
- Control of blood sugar, cholesterol, blood pressure
- Increased social interaction and mental stimulation

Environmental Support

Crucial for disorders involving dementia
Bright lighting, labeling, family visits to improve sleep, decrease agitation

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Questions and Answers

Which of the following is NOT a factor that contributes to the development of suicide among the elderly?

What is the most common means of suicide for women?

Which of the following is a characteristic of anorexia nervosa?

What is the highest mortality rate among eating disorders?

Which of the following is a complication of anorexia nervosa?

What is the primary difference between bulimia nervosa and binge-eating disorder?

Which of the following is a characteristic of binge-eating disorder?

What is the primary psychological dimension of eating disorders?

Which of the following is a social factor that contributes to the development of eating disorders?

What is the primary goal of treatment for eating disorders?

What is the primary category of symptoms in Schizophrenia Spectrum Disorders?

What is the term for the 'added' sensations and behaviors associated with Schizophrenia Spectrum Disorders?

Which of the following is a negative symptom of Schizophrenia Spectrum Disorders?

What is the term for the 'withdrawal' of a person's emotions and interests in Schizophrenia Spectrum Disorders?

What is the primary goal of Social Cognition and Interaction Training (SCIT) in Schizophrenia Spectrum Disorders?

Which of the following neurotransmitters is involved in the dopamine hypothesis of Schizophrenia Spectrum Disorders?

What is the term for the abnormal categorization of objects or concepts in Schizophrenia Spectrum Disorders?

Which of the following is a characteristic of Catatonia in Schizophrenia Spectrum Disorders?

What is the term for the study of the relationship between genetic and environmental factors in the development of Schizophrenia Spectrum Disorders?

Which of the following is a type of therapy used in Schizophrenia Spectrum Disorders?

A person has been experiencing symptoms of hallucinations and delusions for 4 months. What is the likely diagnosis?

Which of the following is a characteristic of Delirium?

What is the primary difference between a Major Neurocognitive Disorder and a Mild Neurocognitive Disorder?

What is the term for the progressive, degenerative condition that occurs in individuals who have had multiple episodes of head injury?

What is the strongest risk factor for Dementia?

What is the term for the second most common form of dementia?

What is the primary motor symptom of Parkinson's Disease?

What is the term for the buildup of Lewy body proteins in the brain?

What is the recommended approach to treating Neurocognitive Disorders?

What is the primary goal of rehabilitation in the treatment of Neurocognitive Disorders?

What is the primary underlying mechanism of the dopamine hypothesis of Schizophrenia Spectrum Disorders?

Which of the following neurocognitive disorders is most closely associated with the APOE gene?

What is the primary psychological dimension of eating disorders?

Which of the following personality psychopathologies is most closely associated with impulsivity and reckless behavior?

What is the primary characteristic of Avoidant/Restrictive Food Intake Disorder (ARFID)?

Which of the following disorders of childhood and adolescence is most closely associated with difficulty with social communication and repetitive behaviors?

What is the primary goal of cognitive enhancement therapy in Schizophrenia Spectrum Disorders?

Which of the following neurocognitive disorders is most closely associated with the tau protein?

What is the primary characteristic of Anorexia Nervosa?

Which of the following therapies is most commonly used in the treatment of Schizophrenia Spectrum Disorders?

What is the highest suicide rate among the following groups?

Which of the following is a characteristic of restricting anorexia nervosa?

What is the primary difference between bulimia nervosa and binge-eating disorder?

Which of the following is a common factor that contributes to the development of eating disorders?

What is the primary goal of treatment for eating disorders?

Which of the following is a risk factor for suicide among military personnel?

What is the term for the biological dimension of suicide?

Which of the following is a factor that increases the risk of suicide among college students?

What is the term for the sense of being disconnected from others?

Which of the following is a common consequence of traumatic brain injury?

A person is diagnosed with Schizoaffective Disorder. What is the primary requirement for this diagnosis?

What is the term for the reduction of cognitive decline in neurocognitive disorders?

What is the primary characteristic of Borderline Personality Disorder?

What is the term for the persistent difficulty in learning and using verbal or nonverbal language?

What is the primary diagnostic criterion for Anorexia Nervosa?

What is the term for the persistent and excessive preoccupation with a perceived flaw in one's appearance?

What is the primary goal of Deep Brain Stimulation in the treatment of Parkinson's Disease?

What is the term for the process of acquiring new skills or knowledge in the presence of brain damage or dysfunction?

What is the primary difference between Delirium and Dementia?

What is the term for the abnormal growth of Lewy bodies in the brain, leading to Parkinson's Disease?

Which of the following symptoms is most closely associated with the dopamine hypothesis of Schizophrenia Spectrum Disorders?

What is the primary characteristic of Frontotemporal Neurocognitive Disorder?

Which of the following personality psychopathologies is most closely associated with a lack of empathy and impulsivity?

Which of the following neurocognitive disorders is most closely associated with the accumulation of beta-amyloid protein?

What is the primary goal of cognitive remediation therapy in the treatment of Schizophrenia Spectrum Disorders?

Which of the following is a risk factor for suicide among older adults?

What is the primary characteristic of Avoidant/Restrictive Food Intake Disorder (ARFID)?

Which of the following is a common consequence of traumatic brain injury?

What is the primary goal of treatment for eating disorders?

What is the primary mechanism by which dopamine is involved in Schizophrenia Spectrum Disorders?

Which of the following is a characteristic of the appetitive phase of the sexual response cycle?

What is the term for the progressive, degenerative condition that occurs in individuals who have had multiple episodes of head injury?

Which of the following is a characteristic of Avoidant/Restrictive Food Intake Disorder (ARFID)?

What is the primary goal of cognitive enhancement therapy in Schizophrenia Spectrum Disorders?

Which of the following neurocognitive disorders is most closely associated with the APOE gene?

What is the primary characteristic of the cognitive dimension of eating disorders?