Delirium and dementia have different onset patterns and symptoms. Delirium has a rapid onset and fluctuating symptoms, while dementia has a slower insidious onset. The primary goals in treating delirium are to address the underlying cause and manage symptoms like psychosis and insomnia with antipsychotics like haloperidol. Dementia treatments focus on symptomatic relief of cognitive and memory issues using acetylcholinesterase inhibitors like donepezil, rivastigmine, and galantamine. Common forms of dementia include Alzheimer's disease, vascular dementia, dementia with Lewy bodies, and frontotemporal dementia.
A brief discussion about Neurocognitive disorders.
NCD are on the rise especially due to the ageing population and good treatment modalities leading to less mortality.
The burden of NCD is to increase with time especially due to the little interventions available
The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
A brief discussion about Neurocognitive disorders.
NCD are on the rise especially due to the ageing population and good treatment modalities leading to less mortality.
The burden of NCD is to increase with time especially due to the little interventions available
The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
The world’s population is ageing rapidly, and with it is coming to a significant increase in the number of
older people with dementia. This increase presents major challenges for the provision of healthcare
generally and for dementia care in particular, for as more people have dementia, there will be more
people exhibiting behavioural and psychological symptoms of dementia (BPSD).
BPSD exact a high price from both the patient and the caregiver in terms of the distress and disability
they cause if left untreated. BPSD is recognisable, understandable and treatable. The recognition and
appropriate management of BPSD are important factors in improving our care of dementia patients
and their caregivers,
TREATMENT RESISTANT DEPRESSION IS A AREA THAT IS NOT EXPLORED MUCH, BUT IT REALLY NEEDS LOT OF ATTENTION AS IT IS ONE OF THE MOST COMMON OBSTACLE IN ACHIEVING COMPLETE REMISSION IN DEPRESSION
The world’s population is ageing rapidly, and with it is coming to a significant increase in the number of
older people with dementia. This increase presents major challenges for the provision of healthcare
generally and for dementia care in particular, for as more people have dementia, there will be more
people exhibiting behavioural and psychological symptoms of dementia (BPSD).
BPSD exact a high price from both the patient and the caregiver in terms of the distress and disability
they cause if left untreated. BPSD is recognisable, understandable and treatable. The recognition and
appropriate management of BPSD are important factors in improving our care of dementia patients
and their caregivers,
TREATMENT RESISTANT DEPRESSION IS A AREA THAT IS NOT EXPLORED MUCH, BUT IT REALLY NEEDS LOT OF ATTENTION AS IT IS ONE OF THE MOST COMMON OBSTACLE IN ACHIEVING COMPLETE REMISSION IN DEPRESSION
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation.
This presentation consisits about antimanic agents, its mode of action, indication, contraindication, side-effects and nursing management. It also has details of Carbamazepine and Valporate.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Couples presenting to the infertility clinic- Do they really have infertility...
Cognitive disorders unit 9
1.
2. Delirium vs. Dementia
Delirium Dementia
Rapid onset Insidious onset
Primary defect in attention Primary defect in short term
Fluctuates during the course memory
of a day Attention often normal
Visual hallucinations Does not fluctuate during
common day
Often cannot attend to Visual hallucinations less
MMSE or clock draw common
Can attend to MMSE or clock
draw, but cannot perform
well
3. Cognitive DIsorders
Delirium
Fluctuating cognitive impairment and disturbance
of consciousness
Psychosis and Insomnia
4. Treating Delirium
Primary goal treat underlying cause
Cause: Anticholinergic toxicity
Physiostigmine salicylate 1 to 2 mg IV or IM with
repeated doses in 15 to 30 minutes may be indicated
5. Treatment
Psychosis
Haloperidol
2 to 6 mg IM, repeated in an hour if necessary
Depending on patient’s age, weight and physical
condition.
Once patient is calm begin oral medication
Liquid concentrate or tablet
2 daily oral doses, 2/3 of the dose at bedtime
Effective daily dose of Haloperidol 5 to 40 mg for most
patients
6. Treatment
Atypical antipsychotics
Risperidone: for those with side effects from
haloperidol or contraindications
Starting dose: .5mg HS or BID
Olanzapine: agent of choice for patients with PD
with hallucinations/delirium
Starting dose 2.5mg PO HS or BID
Clozapine, quetiapine, aripiprazole may also be
considered although clinical trial experience is
limited.
7. Treatment
Insomnia
Best treated with benzodiazepines with short or
intermediate half-lives
Lorazepam 1 to 2 mg at bedtime
8. Dementia
The treatment for dementia is aimed at :
Symptomatic treatment of memory disturbance
Symptomatic treatment of memory disturbance
9. What are the common forms of
dementia?
There are four main types of dementia:
Alzheimer’s disease (60%; of cases)
Vascular dementia (30–40%; including about
20% where dual pathology exists)
Dementia with Lewy bodies (15% of cases)
Fronto-temporal dementia (5%)
Percentages total more than 100 because of
variability in studies
10. How is Alzheimer’s disease
Alzheimer’s disease may be characterized by a diffuse
characterised?
pattern of cortical deficits including: Aphasia – loss or
impairment of language caused by brain dysfunction
Apraxia – inability to execute learned movements on
command
Agnosia – inability to recognize or associate meaning to
a sensory perception
Acalculia – inability to perform arithmetical calculations
Agraphia – inability to write
Alexia – inability to read
11. Vascular dementia
Vascular dementia is the second most common
cause of dementia. It results from vascular or
circulatory lesions or from diseases of the
cerebral vasculature leading to ischaemia or
infarction.
12. Clinical features of vascular
dementia
problems concentrating and communicating
depression accompanying the dementia
symptoms of stroke, such as physical weakness or
paralysis
memory problems (although this may not be the
first symptom)
a 'stepped' progression, with symptoms remaining
at a constant level and then suddenly deteriorating
epileptic seizures
periods of acute confusion.
13. Clinical features of vascular
dementia
Other symptoms may include:
hallucinations (seeing things that do not exist)
delusions (believing things that are not true)
walking about and getting lost
physical or verbal aggression
restlessness
incontinence.
14. Clinical features of Dementia with
Lewy Bodies
Dementia of six months’ duration with: Periods of
confusion
Fluctuations in cognition (especially attention and
alertness)
Visual hallucinations
Spontaneous extrapyramidal signs such as rigidity or
slowing (mild parkinsonism)
Bradykinesia (paucity of movement)
18. Acetylcholinesterase
Inhibitors
Donezepil
Adminestered once daily
Generally well tolerated
Dose: 5mg oral/ day for 4 weeks then
increase dose to 10mg/day
Effective in Parkinsonian cognitive impairment
19. Acetylcholinesterase
Inhibitors
Donezepil
PHARMACODYNAMICS / KINETICS
Absorption: Well absorbed
Protein binding: 96%, primarily to albumin (75%)
&
alpha1-acid glycoprotein (21%)
Metabolism: Extensively to four major
metabolites
(two are active) via CYP2D6 and 3A4; undergoes
glucuronidation
33. Acetylcholinesterase
Inhibitors
Galantamine
Newer agent
Galantamine has shown modest benefit
in patients with a clinical diagnosis of either
vascular dementia or combination of AD and CVA
Dose: Initial: 4 mg twice a day for 4 weeks
I f 8 mg per day tolerated, increase to 8 mg twice
daily for > or =4 weeks
I f 16 mg per day tolerated, increase to 12 mg
twice daily; range: 16-24 mg/day in 2 divided
doses
35. Acetylcholinesterase
Inhibitors
Galantamine
PHARMACODYNAMICS / KINETICS
Metabolism: Hepatic; linear, CYP2D6 and
3A4;
metabolized to epigalanthaminone and
galanthaminone both of which have
acetylcholinesterase inhibitory activity 130
times less than galantamine
36. Acetylcholinesterase
Inhibitors
Galantamine
PHARMACODYNAMICS / KINETICS
Bioavailability: 80% to 100%
Half-life elimination: 6-8 hours
Time to peak: 1 hour
Excretion: Urine (25%)
37. Acetylcholinesterase
Inhibitors
Galantamine
Significant Adverse Reactions in>10%
Gastrointestinal: Nausea (6% to 24%)
vomiting (4% to 13%), diarrhea (6% to 12%)
Significant Adverse reactions in 1-10%
Cardiovascular: Bradycardia (2% to 3%),
syncope (0.4% to 2.2%: dose-related), chest pain
(> or =1%)
Central nervous system: Dizziness (9%),
headache (8%), depression (7%), fatigue (5%),
insomnia (5%), somnolence (4%), tremor (3%)
38. Acetylcholinesterase
Inhibitors
Galantamine
A D V E R S E R E A C T IO N S S IG N IF IC A N T
<1%
Aggression, alkaline phosphatase increased,
aphasia, apraxia, ataxia, atrial fibrillation, AV block,
bundle branch block, convulsions, dehydration,
delirium, diverticulitis, dysphagia, epistaxis,
esophageal perforation, gastrointestinal bleeding,
heart failure, hypokalemia, hypokinesia, hypotension,
melena, palpitations, paranoid reaction, paresthesia,
vertigo
39. Symptomatic Treatment of Behavioral
Disturbance in Dementia Patients
Delusions and hallucinations:
rivastigmine, risperidol, quetiapine
Depression: citalopram, fluoxetine>> TCA
Agression and anxiety: trazodone,
carbamazepine, valproate, gabapentin