Depressive Disorders: An Overview of Full Spectrum. Dr. Ashok Kumar Batham.DrAshok Batham
This document provides an overview of several depressive disorders including major depressive disorder, persistent depressive disorder, disruptive mood dysregulation disorder, and premenstrual dysphoric disorder. It discusses the diagnostic criteria for each disorder according to the DSM-5 and also touches on treatment considerations. The document is authored by Dr. Ashok Kumar Batham, an expert in pharmacology and depressive disorders.
This document provides an overview of mood disorders with a focus on depression. It defines major types of depressive disorders according to DSM-5 criteria including major depressive disorder, persistent depressive disorder, disruptive mood dysregulation disorder, and others. For major depressive disorder, it outlines diagnostic criteria including required symptoms and describes mild, moderate and severe types. It also discusses epidemiology, clinical course, differential diagnosis, comorbidities, sequelae, etiology and risk factors, protective factors and prevention strategies, screening tools, and management approaches including psychotherapy and medication options.
This document provides information about depression and mood disorders. It discusses the causes of depression including genetic, environmental, personality, and biological factors such as imbalances in neurotransmitters like serotonin, norepinephrine, and dopamine. It describes symptoms of major depressive disorder and outlines different forms of depression including major depression, minor depression, dysthymia, bipolar I disorder, and bipolar II disorder. The document also discusses treatment options for mood disorders and lists some antidepressant products manufactured by Asian Pharmaceuticals including tricyclic antidepressants and selective serotonin reuptake inhibitors.
This document provides information on late life depression, including its epidemiology, presentation, risk factors, screening and diagnostic tools, and treatment options. Specifically, it discusses a study that found escitalopram effective in preventing relapse of major depressive disorder in elderly patients. The study had two periods: an initial 12-week open-label acute treatment with escitalopram, followed by a 24-week double-blind continuation treatment with escitalopram or placebo. Results showed escitalopram significantly reduced relapse rates and was well tolerated as a continuation treatment for late life depression.
This document provides information on Unipolar Mood Disorder and defines Unipolar Disorder as a mental disorder characterized by pervasive and persistent low mood accompanied by low self-esteem and loss of interest in enjoyable activities. It discusses the manifestations of Unipolar Disorder which can affect daily life for weeks or longer by interfering with social, family, work, academic, and health aspects of life. The document also lists and describes several types of Depressive Disorders including Major Depressive Disorder, Persistent Depressive Disorder, and Premenstrual Dysphoric Disorder. It provides details on the diagnostic criteria, clinical manifestations, causes, assessment tools, prognosis, prevalence, and treatment options for these disorders.
Dr. Sujit Kumar Kar discusses depression, including its causes, symptoms, diagnosis and treatment. Some key points include:
- Depression is one of the most common psychiatric illnesses worldwide, affecting people of all ages, races and genders. It causes significant psychological distress and reduces quality of life.
- Symptoms include sadness, loss of interest, low energy, changes in appetite or sleep, feelings of worthlessness, difficulty concentrating and recurrent thoughts of death.
- Depression has biological causes like changes in brain chemistry and genetics, as well as psychosocial factors like stressful life events, substance abuse and medical illnesses.
- Treatment involves medication like antidepressants, psychotherapy, and lifestyle changes. Proper treatment
Depressive Disorders: An Overview of Full Spectrum. Dr. Ashok Kumar Batham.DrAshok Batham
This document provides an overview of several depressive disorders including major depressive disorder, persistent depressive disorder, disruptive mood dysregulation disorder, and premenstrual dysphoric disorder. It discusses the diagnostic criteria for each disorder according to the DSM-5 and also touches on treatment considerations. The document is authored by Dr. Ashok Kumar Batham, an expert in pharmacology and depressive disorders.
This document provides an overview of mood disorders with a focus on depression. It defines major types of depressive disorders according to DSM-5 criteria including major depressive disorder, persistent depressive disorder, disruptive mood dysregulation disorder, and others. For major depressive disorder, it outlines diagnostic criteria including required symptoms and describes mild, moderate and severe types. It also discusses epidemiology, clinical course, differential diagnosis, comorbidities, sequelae, etiology and risk factors, protective factors and prevention strategies, screening tools, and management approaches including psychotherapy and medication options.
This document provides information about depression and mood disorders. It discusses the causes of depression including genetic, environmental, personality, and biological factors such as imbalances in neurotransmitters like serotonin, norepinephrine, and dopamine. It describes symptoms of major depressive disorder and outlines different forms of depression including major depression, minor depression, dysthymia, bipolar I disorder, and bipolar II disorder. The document also discusses treatment options for mood disorders and lists some antidepressant products manufactured by Asian Pharmaceuticals including tricyclic antidepressants and selective serotonin reuptake inhibitors.
This document provides information on late life depression, including its epidemiology, presentation, risk factors, screening and diagnostic tools, and treatment options. Specifically, it discusses a study that found escitalopram effective in preventing relapse of major depressive disorder in elderly patients. The study had two periods: an initial 12-week open-label acute treatment with escitalopram, followed by a 24-week double-blind continuation treatment with escitalopram or placebo. Results showed escitalopram significantly reduced relapse rates and was well tolerated as a continuation treatment for late life depression.
This document provides information on Unipolar Mood Disorder and defines Unipolar Disorder as a mental disorder characterized by pervasive and persistent low mood accompanied by low self-esteem and loss of interest in enjoyable activities. It discusses the manifestations of Unipolar Disorder which can affect daily life for weeks or longer by interfering with social, family, work, academic, and health aspects of life. The document also lists and describes several types of Depressive Disorders including Major Depressive Disorder, Persistent Depressive Disorder, and Premenstrual Dysphoric Disorder. It provides details on the diagnostic criteria, clinical manifestations, causes, assessment tools, prognosis, prevalence, and treatment options for these disorders.
Dr. Sujit Kumar Kar discusses depression, including its causes, symptoms, diagnosis and treatment. Some key points include:
- Depression is one of the most common psychiatric illnesses worldwide, affecting people of all ages, races and genders. It causes significant psychological distress and reduces quality of life.
- Symptoms include sadness, loss of interest, low energy, changes in appetite or sleep, feelings of worthlessness, difficulty concentrating and recurrent thoughts of death.
- Depression has biological causes like changes in brain chemistry and genetics, as well as psychosocial factors like stressful life events, substance abuse and medical illnesses.
- Treatment involves medication like antidepressants, psychotherapy, and lifestyle changes. Proper treatment
Depression: What Is It and What Are My Treatment Options? (Community Lecture)Summit Health
This document discusses depression, including its definition, statistics, types, causes, consequences, role of neurotransmitters, treatment options like medication and cognitive behavioral therapy. It defines depression and differentiates it from normal sadness. It covers diagnostic criteria, risk factors, and treatments including antidepressant medications, electroconvulsive therapy, light therapy, and cognitive behavioral therapy. Relapse prevention and the importance of continued treatment are also discussed.
This document discusses depression in older adults, including barriers to treatment, treatment goals and modalities, and considerations for providers and patients. It describes common psychotherapies and pharmacotherapies used to treat depression at different phases. The goals are to resolve current episodes, prevent relapse and recurrence, and improve quality of life and functioning. Barriers include inadequate treatment, lack of accessible care, and limited specialty mental health use.
This document discusses the treatment of depression in the elderly. It notes that while healthy older adults are not at greater risk of depression than younger adults, risk factors in the elderly include multiple losses, medical illness, and a history of previous depression. Depression is common in elderly patients with medical conditions like stroke, cancer, and heart disease. Treatment includes addressing any underlying medical causes or drugs that may be contributing, starting with low doses of selective serotonin reuptake inhibitors which have fewer side effects in older patients, and considering psychotherapy, electroconvulsive therapy, or mood stabilizers if needed. Close monitoring for side effects and compliance is important when medicating elderly patients.
Major depressive disorder(MDD) is a disorder of mood in which the individual experiences one or more major depressive episodes without a history of manic, mixed, or hypomanic episodes.
The document describes the presentation, assessment, and treatment of late life depression through an interprofessional approach, outlining the epidemiology and risk factors for depression in older adults, methods for diagnostic assessment and differential diagnosis of mood disorders like major depression and bipolar disorder, and the role of both pharmacological and non-pharmacological therapies in treatment.
This document discusses elderly depression, suicide risk, and treatment options. It notes that depression is a leading cause of disability worldwide. Late life depression prevalence is estimated at 1-3% of those aged 65 and older. Risk factors for late life depression include chronic illness, cognitive impairment, and lack of social support. Screening tools like the PHQ-9 and GDS can help assess depression severity. Treatment may include psychotherapy, pharmacotherapy, partial hospitalization, or inpatient care depending on symptom severity and suicide risk. Managing elderly depression requires considering medical comorbidities and choosing appropriate treatment.
This document discusses depression, including its definition, burden, causes, risk factors, diagnosis criteria, prevention, and treatment. It defines depression as a common and chronic mental disorder characterized by depressed mood and loss of pleasure. Risk factors include age, gender, family history, and genetics. Diagnosis is based on DSM-IV-TR criteria of symptoms present for two weeks. Treatment involves pharmacotherapy like SSRIs and SNRIs as well as non-pharmacological therapies. Prevention focuses on primary, secondary, and tertiary levels through health promotion, screening high-risk groups, and reducing relapse.
Common giatric psychaitric disease convertedWafa sheikh
This document provides information on common psychological disorders in elderly patients. It begins with an overview of depression in elderly patients, including risk factors, clinical presentation, assessment, and management guidelines. It then discusses anxiety disorders and panic attacks in elderly patients. Several case studies are presented, including a 68-year-old female with depression, a 58-year-old female with depression and insomnia, and a 65-year-old male with anxiety disorder and panic attacks. Assessment tools and a 5-step management protocol from the WHO for providing mental healthcare in primary care settings are also covered.
Major Depressive Disorder affects 5-9% of women and 2-3% of men annually. It causes depressed mood or loss of interest for at least two weeks and disrupts daily life. Risk of suicide is higher for those with depression. While the exact causes are unknown, genetics and stressful life events may play a role. Current treatment focuses on antidepressants, which come in different classes with varying side effects. Finding the right medication and dosage takes trial and error over long periods of time to achieve full recovery in most cases of Major Depressive Disorder.
The document discusses updates on antidepressant medications. It covers various antidepressant classes including SSRIs, SNRIs, atypical antidepressants, TCAs, and MAOIs. It describes their mechanisms of action, dosing, efficacy, adverse effects, drug interactions and treatment of treatment-resistant depression. Key trials like STAR*D are also summarized.
Depression is a common and treatable mental health condition that affects 10-20% of people at some point in their lifetime. The core symptoms of depression include persistent sadness, loss of interest or pleasure, and fatigue or low energy lasting at least two weeks. Depression is the fourth leading cause of disability worldwide. Treatment options include pharmacotherapy with antidepressants like SSRIs and SNRIs, psychotherapy including cognitive behavioral therapy, and electroconvulsive therapy for severe cases. Managing depression requires a comprehensive approach tailored to individual needs.
Major Depressive Disorder is characterized by a low mood about life and inability to feel pleasure in activities that were once enjoyed. Common symptoms include insomnia, poor concentration/memory, social withdrawal, reduced sex drive, and suicidal thoughts. It is caused by biological factors like low serotonin/norepinephrine levels, psychological factors like attachment issues as a child, and social factors like abuse, divorce or death of a parent. Treatment involves psychotherapy like cognitive behavioral therapy or psychoanalysis as well as antidepressant medication. Electroconvulsive therapy is used in severe cases. Around 8-12% of people experience depression during their lives, with higher rates among females.
Psychosis appears as a symptom of a number of mental disorders, including mood and personality disorders , schizophrenia , delusional disorder , and substance abuse. It is also the defining feature of the psychotic disorders
The correct answer is C. Apnea is not a symptom of depression. It denotes pause or absence of breathing during sleep and is not included in the DSM criteria for depression.
Depression is a common and serious mental disorder characterized by depressed mood, loss of interest, feelings of guilt and low self-worth, and poor concentration. It is the leading cause of disability worldwide. Depression can be reliably diagnosed and treated, although currently less than 25% of those affected have access to effective treatments. Treatment options include antidepressant medications like SSRIs and psychotherapy.
Everyone occasionally feels blue or sad. But
these feelings are usually short-lived and pass within a couple of days. When
you have depression, it interferes with daily life and causes pain for both you
and those who care about you. Depression is a common but serious illness.
Many people with a depressive illness never
seek treatment. But the majority, even those with the most severe depression,
can get better with treatment. Medications, psychotherapies, and other methods
can effectively treat people with depression.
NIMH
This document discusses the recognition and treatment of depression. Major depression is one of the leading causes of disability worldwide and is estimated to become the second largest contributor to disability-adjusted life years lost globally by 2020. Depression is underdiagnosed and undertreated. It is a chronic illness with a high risk of recurrence. Treatment involves medication, psychotherapy, and lifestyle changes, with careful monitoring of patients over time.
This document provides guidance on identifying and managing clinically significant depression for internists. It outlines how to take a thorough history to assess for depression, safety risks, substance use, bipolarity and psychosis. Common mimics of depression like delirium, substance withdrawal and medical condition-related depression are reviewed. First-line antidepressant medications are SSRIs, SNRIs, bupropion and mirtazapine. The document describes strategies for patients who do not improve on initial treatment, such as switching or augmenting medications. Non-pharmacological approaches like exercise and social support are also encouraged.
The document discusses anxiety in children and adolescents. It describes the differences between depressed mood versus a depressive episode, and lists the diagnostic criteria for a major depressive episode. It also discusses irritable mood and the various conditions it could indicate. The document provides information on generalized anxiety disorder, including prevalence, genetics, neurotransmitters involved, and treatment options. It covers specific phobias and social phobia, including diagnostic criteria, prevalence, etiology, and treatment.
Antidepressants are the second most prescribed medication in the US, with 15 million Americans affected by depression each year. Depression is treated through medications and therapy. Antidepressants work by adjusting neurotransmitter levels in the brain like serotonin, dopamine, and norepinephrine. Common classes include SSRIs, SNRIs, TCAs, and MAOIs. While effective, antidepressants can cause side effects like nausea, insomnia, sexual dysfunction, and increased suicide risk initially. Doctors closely monitor patients to improve treatment outcomes and safety.
Depression and anxiety are common in people with epilepsy, occurring in up to 43% of patients. Untreated depression and anxiety can negatively impact quality of life and make achieving seizure control more difficult. Both psychological and biological factors may contribute to increased rates of mood disorders in people with epilepsy. Treatment options include therapy, lifestyle changes, and antidepressant medications, with SSRIs being a first-line pharmacological approach. Integrated treatment of both mood symptoms and epilepsy management is important.
Depression: What Is It and What Are My Treatment Options? (Community Lecture)Summit Health
This document discusses depression, including its definition, statistics, types, causes, consequences, role of neurotransmitters, treatment options like medication and cognitive behavioral therapy. It defines depression and differentiates it from normal sadness. It covers diagnostic criteria, risk factors, and treatments including antidepressant medications, electroconvulsive therapy, light therapy, and cognitive behavioral therapy. Relapse prevention and the importance of continued treatment are also discussed.
This document discusses depression in older adults, including barriers to treatment, treatment goals and modalities, and considerations for providers and patients. It describes common psychotherapies and pharmacotherapies used to treat depression at different phases. The goals are to resolve current episodes, prevent relapse and recurrence, and improve quality of life and functioning. Barriers include inadequate treatment, lack of accessible care, and limited specialty mental health use.
This document discusses the treatment of depression in the elderly. It notes that while healthy older adults are not at greater risk of depression than younger adults, risk factors in the elderly include multiple losses, medical illness, and a history of previous depression. Depression is common in elderly patients with medical conditions like stroke, cancer, and heart disease. Treatment includes addressing any underlying medical causes or drugs that may be contributing, starting with low doses of selective serotonin reuptake inhibitors which have fewer side effects in older patients, and considering psychotherapy, electroconvulsive therapy, or mood stabilizers if needed. Close monitoring for side effects and compliance is important when medicating elderly patients.
Major depressive disorder(MDD) is a disorder of mood in which the individual experiences one or more major depressive episodes without a history of manic, mixed, or hypomanic episodes.
The document describes the presentation, assessment, and treatment of late life depression through an interprofessional approach, outlining the epidemiology and risk factors for depression in older adults, methods for diagnostic assessment and differential diagnosis of mood disorders like major depression and bipolar disorder, and the role of both pharmacological and non-pharmacological therapies in treatment.
This document discusses elderly depression, suicide risk, and treatment options. It notes that depression is a leading cause of disability worldwide. Late life depression prevalence is estimated at 1-3% of those aged 65 and older. Risk factors for late life depression include chronic illness, cognitive impairment, and lack of social support. Screening tools like the PHQ-9 and GDS can help assess depression severity. Treatment may include psychotherapy, pharmacotherapy, partial hospitalization, or inpatient care depending on symptom severity and suicide risk. Managing elderly depression requires considering medical comorbidities and choosing appropriate treatment.
This document discusses depression, including its definition, burden, causes, risk factors, diagnosis criteria, prevention, and treatment. It defines depression as a common and chronic mental disorder characterized by depressed mood and loss of pleasure. Risk factors include age, gender, family history, and genetics. Diagnosis is based on DSM-IV-TR criteria of symptoms present for two weeks. Treatment involves pharmacotherapy like SSRIs and SNRIs as well as non-pharmacological therapies. Prevention focuses on primary, secondary, and tertiary levels through health promotion, screening high-risk groups, and reducing relapse.
Common giatric psychaitric disease convertedWafa sheikh
This document provides information on common psychological disorders in elderly patients. It begins with an overview of depression in elderly patients, including risk factors, clinical presentation, assessment, and management guidelines. It then discusses anxiety disorders and panic attacks in elderly patients. Several case studies are presented, including a 68-year-old female with depression, a 58-year-old female with depression and insomnia, and a 65-year-old male with anxiety disorder and panic attacks. Assessment tools and a 5-step management protocol from the WHO for providing mental healthcare in primary care settings are also covered.
Major Depressive Disorder affects 5-9% of women and 2-3% of men annually. It causes depressed mood or loss of interest for at least two weeks and disrupts daily life. Risk of suicide is higher for those with depression. While the exact causes are unknown, genetics and stressful life events may play a role. Current treatment focuses on antidepressants, which come in different classes with varying side effects. Finding the right medication and dosage takes trial and error over long periods of time to achieve full recovery in most cases of Major Depressive Disorder.
The document discusses updates on antidepressant medications. It covers various antidepressant classes including SSRIs, SNRIs, atypical antidepressants, TCAs, and MAOIs. It describes their mechanisms of action, dosing, efficacy, adverse effects, drug interactions and treatment of treatment-resistant depression. Key trials like STAR*D are also summarized.
Depression is a common and treatable mental health condition that affects 10-20% of people at some point in their lifetime. The core symptoms of depression include persistent sadness, loss of interest or pleasure, and fatigue or low energy lasting at least two weeks. Depression is the fourth leading cause of disability worldwide. Treatment options include pharmacotherapy with antidepressants like SSRIs and SNRIs, psychotherapy including cognitive behavioral therapy, and electroconvulsive therapy for severe cases. Managing depression requires a comprehensive approach tailored to individual needs.
Major Depressive Disorder is characterized by a low mood about life and inability to feel pleasure in activities that were once enjoyed. Common symptoms include insomnia, poor concentration/memory, social withdrawal, reduced sex drive, and suicidal thoughts. It is caused by biological factors like low serotonin/norepinephrine levels, psychological factors like attachment issues as a child, and social factors like abuse, divorce or death of a parent. Treatment involves psychotherapy like cognitive behavioral therapy or psychoanalysis as well as antidepressant medication. Electroconvulsive therapy is used in severe cases. Around 8-12% of people experience depression during their lives, with higher rates among females.
Psychosis appears as a symptom of a number of mental disorders, including mood and personality disorders , schizophrenia , delusional disorder , and substance abuse. It is also the defining feature of the psychotic disorders
The correct answer is C. Apnea is not a symptom of depression. It denotes pause or absence of breathing during sleep and is not included in the DSM criteria for depression.
Depression is a common and serious mental disorder characterized by depressed mood, loss of interest, feelings of guilt and low self-worth, and poor concentration. It is the leading cause of disability worldwide. Depression can be reliably diagnosed and treated, although currently less than 25% of those affected have access to effective treatments. Treatment options include antidepressant medications like SSRIs and psychotherapy.
Everyone occasionally feels blue or sad. But
these feelings are usually short-lived and pass within a couple of days. When
you have depression, it interferes with daily life and causes pain for both you
and those who care about you. Depression is a common but serious illness.
Many people with a depressive illness never
seek treatment. But the majority, even those with the most severe depression,
can get better with treatment. Medications, psychotherapies, and other methods
can effectively treat people with depression.
NIMH
This document discusses the recognition and treatment of depression. Major depression is one of the leading causes of disability worldwide and is estimated to become the second largest contributor to disability-adjusted life years lost globally by 2020. Depression is underdiagnosed and undertreated. It is a chronic illness with a high risk of recurrence. Treatment involves medication, psychotherapy, and lifestyle changes, with careful monitoring of patients over time.
This document provides guidance on identifying and managing clinically significant depression for internists. It outlines how to take a thorough history to assess for depression, safety risks, substance use, bipolarity and psychosis. Common mimics of depression like delirium, substance withdrawal and medical condition-related depression are reviewed. First-line antidepressant medications are SSRIs, SNRIs, bupropion and mirtazapine. The document describes strategies for patients who do not improve on initial treatment, such as switching or augmenting medications. Non-pharmacological approaches like exercise and social support are also encouraged.
The document discusses anxiety in children and adolescents. It describes the differences between depressed mood versus a depressive episode, and lists the diagnostic criteria for a major depressive episode. It also discusses irritable mood and the various conditions it could indicate. The document provides information on generalized anxiety disorder, including prevalence, genetics, neurotransmitters involved, and treatment options. It covers specific phobias and social phobia, including diagnostic criteria, prevalence, etiology, and treatment.
Antidepressants are the second most prescribed medication in the US, with 15 million Americans affected by depression each year. Depression is treated through medications and therapy. Antidepressants work by adjusting neurotransmitter levels in the brain like serotonin, dopamine, and norepinephrine. Common classes include SSRIs, SNRIs, TCAs, and MAOIs. While effective, antidepressants can cause side effects like nausea, insomnia, sexual dysfunction, and increased suicide risk initially. Doctors closely monitor patients to improve treatment outcomes and safety.
Depression and anxiety are common in people with epilepsy, occurring in up to 43% of patients. Untreated depression and anxiety can negatively impact quality of life and make achieving seizure control more difficult. Both psychological and biological factors may contribute to increased rates of mood disorders in people with epilepsy. Treatment options include therapy, lifestyle changes, and antidepressant medications, with SSRIs being a first-line pharmacological approach. Integrated treatment of both mood symptoms and epilepsy management is important.
Truth about-prescription-drug-abuse-booklet-ennipaalam
This document discusses the dangers of prescription drug abuse, especially among teens and young adults. It notes that prescription drugs can be just as dangerous and addictive as illegal street drugs when taken without a prescription or for non-medical reasons. Common types of abused prescription drugs include depressants, opioids, stimulants, and antidepressants. Short-term effects of depressants include slowed brain function and breathing, while long-term use and abuse can lead to addiction, overdose, and life-threatening withdrawal symptoms. The document aims to provide facts to help avoid prescription drug abuse and addiction.
The document describes a case of delirium in an 81-year-old man. He presented with fever, confusion, and urinary retention and was diagnosed with a urinary tract infection. His risk factors for delirium included older age, hypertension, smoking, and acute infection. Non-pharmacological management includes ensuring nutrition, safety precautions, and early rehabilitation. Atypical antipsychotics in low doses may help control symptoms, though the prognosis depends on resolving the underlying medical issues. Preventing delirium requires a multidisciplinary approach and addressing reversible risk factors.
The document discusses drugs and substance abuse, including causes and consequences. It defines drugs and classifies them as legal or illegal. Commonly abused substances are identified as marijuana, cocaine, heroin, alcohol, and prescription drugs. Drug use, misuse, and abuse are defined. Signs of drug abuse include physical symptoms like reddened eyes and behavioral changes like declining school performance. Common myths about drugs are addressed, such as the misconceptions that drugs make people cool or help forget problems, when in reality drugs can negatively impact health, relationships and functioning.
This document discusses drugs and substance abuse, including causes and consequences. It defines drugs and classifies them as legal or illegal. Common abused substances like tobacco, alcohol, and prescription drugs are mentioned. Drug use, misuse, and abuse are differentiated. Stories are provided as examples of misuse leading to abuse. Signs of abuse include physical and behavioral symptoms. Myths about drugs are debunked, such as the idea that drugs make people cool or help forget problems. Causes of abuse include curiosity, peer pressure, and underlying mental health issues. Consequences include addiction, tolerance, withdrawal, and health impacts.
People with dementia may develop behavioral and psychological symptoms like depression, anxiety, or aggression. While non-drug interventions should be tried first, medication may sometimes be necessary, though drugs have side effects. Antipsychotics are commonly used but have risks and limited benefits, and should generally only be used for up to three months. Other options include anticonvulsants or antidepressants, which require specialist prescription. All drug treatment for dementia symptoms requires careful monitoring and review.
The document discusses drug abuse in Punjab and strategies to promote a drug free society. It defines what a drug is and the difference between drugs and medicines. It explains how drug abuse starts as fun or curiosity but can lead to addiction and permanent changes to the brain. The most commonly abused drugs in Punjab are listed as alcohol, cannabis, opioids, depressants and stimulants. The document outlines roles for individuals, families, educational and social institutions, and the government to prevent drug abuse and support rehabilitation. It describes DAPO, a Punjab government initiative using trained volunteers to create drug prevention committees and work towards the goal of a drug free Punjab through prevention, rehabilitation and community support efforts.
Presented by: Dr. Melissa Graham, SAPD Psychologist
Jeanie Paradise, Clinical Director Crisis Care Center
Lt. Teri Neal, Director SAPD Communications Unit
Emile Clede, SAPD Communications Training Coordinator
Drug addiction: A complex neurological diseaseSHIVANEE VYAS
Drug addiction is a complex neurobiological disease that requires integrated treatment of the mind, body, and spirit. It is considered a brain disease because drugs change the brain, they change its structure and how it works. Without treatment, these brain changes can be long-lasting. Addiction is chronic, it is progressive, and if left untreated, it can be fatal.
Individuals struggling with drug addiction often feel as though they cannot function normally without their drug of choice. This can lead to a wide range of issues that impact professional goals, personal relationships, and overall health. Over time, these serious side effects can be progressive, and if left untreated, fatal.
This document summarizes a mental health review meeting that covered several topics: the role of stigma, supporting consumer perspectives, recognizing mental health issues, managing stress, pharmacology updates, and suicide risk factors. Stress from geopolitical issues is impacting both individuals and the health system in New Zealand. Stigma surrounding mental health creates fear, silence and loss of opportunities. Communication is key to supporting consumers in making treatment decisions while managing expectations and concerns about benefits, risks, and side effects of medications. Pharmacists can help by recognizing issues, managing medications properly, and knowing when to involve other supports to help reduce suicide risk.
Group 2 consists of 6 students: Nathaniel Jacob Marquez, Maria Althea Estrada, Maria Hailena Fernandez, Arabela Chloe De Guzman, Yrish Mae Nietes, and Frances Nuellsie Obenza. Their presentation discusses prescription drug use, misuse, and abuse. It identifies opioids, depressants, and stimulants as the most commonly abused prescription drugs and lists symptoms of abuse for each drug class. The presentation also outlines risk factors for prescription drug abuse and covers approaches for treatment, including detoxification, therapy such as group therapy and cognitive behavioral therapy, and use of medication to help overcome addiction and withdrawal symptoms.
This document provides an overview of psychopharmacology and the use of psychotropic medications to treat mental health disorders. It discusses the roles of psychiatrists and psychopharmacologists in treatment and outlines major drug categories including antipsychotics, antidepressants, mood stabilizers, anxiolytics, and stimulants. Key concepts covered include mechanisms of action, side effects, drug interactions, principles of pharmacologic treatment, and the nurse's role in patient education.
A 42-year-old man is experiencing a recurrent major depressive episode. He had previously responded well to treatment with imipramine but did not tolerate the anticholinergic side effects. Given his history of responding well to antidepressants and preference to avoid side effects, an SSRI with fewer anticholinergic effects would be a suitable first-line treatment option for this episode. Close monitoring would also be important given his risk of recurrence.
The document discusses addiction and drug use. It defines addiction as a compulsive need for a substance or behavior that is difficult to control. Various types of drugs are described, including stimulants, depressants, opiates, and hallucinogens. The document outlines the biological and psychological effects of drug use, as well as contributing factors to addiction like family environment, mental health issues, and early drug exposure. Treatment involves behavioral therapies and medication to address both the physical and psychological aspects of addiction.
This document discusses addiction, pseudo-addiction, and an integrated approach to pain management. It defines pseudo-addiction as medication-seeking behavior that occurs when pain relief is inadequate, and distinguishes it from true addiction by noting that pseudo-addicted individuals do not seek euphoria and focus on treatment, while addicted individuals do. The document advocates for a balanced, multidisciplinary approach addressing physical, cognitive, emotional, social, and spiritual factors to maximize function and quality of life.
Medicine treats and prevents disease while drugs alter the body and mind. Hard drugs are physically addictive and may cause overdose while soft drugs are not addictive. Signs of drug use include mood changes, weight changes, and loss of interest in activities. Cannabis can cause both physical and mental health problems by lowering motivation and coordination. Addiction is a chronic brain disease caused by drug abuse that leads to compulsive drug seeking despite harmful consequences.
1. Mrs. S, a 65-year-old woman on high-dose fentanyl for back pain, is experiencing increased pain and distress. She is converted to methadone but later returns saying the methadone is not working due to vomiting.
2. The document discusses the neurobiology of opioid addiction, changes in the DSM definitions of addiction and dependence, and the difficulty distinguishing dependence from addiction in chronic pain patients on long-term opioid treatment who inevitably develop tolerance and dependence.
3. Dependence in pain patients involves both physical and psychological factors that can drive continued opioid use even in the absence of an addictive disorder. It is an adaptive change that is difficult to reverse.
Similar to Medication Friend or Foe - Jennifer Hardesty (20)
Robin Murray commentary during the SRF webinar "Is Schizophrenia Dead Yet?"wef
Schizophrenia is not a single disease but rather two different syndromes according to the DSM-5 and ICD-10 diagnostic criteria, with only 70% of patients meeting criteria for both. This raises questions about what to call patients who meet one but not the other and how useful the term "schizophrenia" is given the lack of biological markers and different interpretations by psychiatrists. Looking at dimensions of psychosis symptoms, predominant causes, and severity/persistence may provide more helpful information to patients and their outcomes than the term schizophrenia.
Eske Derks commentary - SRF webinar "Is Schizophrenia Dead Yet?"wef
Schizophrenia patients are qualitatively different from their healthy siblings and controls based on genetic studies. While there is some genetic overlap between schizophrenia, psychosis, and general mental health risk, distinct genetic factors for schizophrenia have also been found. Specifically, over 200 genetic risk factors for schizophrenia have been identified. Based on these genetic findings, the presenter concludes that schizophrenia is not simply an extreme on a normal distribution of traits and replacing it with a psychosis spectrum disorder would be premature.
Jim van Os presentation during SRF live webinar "Is Schizophrenia Dead Yet?"wef
This document discusses the debate around schizophrenia diagnoses and proposes an alternative psychosis spectrum syndrome approach. It summarizes that the debate is about clinical diagnosis, not research criteria. It also notes that around 3.5% of people experience some form of psychosis, but the current system publishes overwhelmingly on only one category, schizophrenia. The document advocates for recognizing a spectrum approach and dimensional personal diagnoses within a categorical psychosis spectrum to better reflect individuals' experiences and needs.
Rene Kahn commentary during SRF Live Webinar: "Is Schizophrenia Dead Yet?wef
Schizophrenia and bipolar disorder are distinct conditions with little genetic overlap and different risk factors. Schizophrenia is primarily a cognitive disorder, not defined by psychosis, as cognitive decline precedes psychotic episodes. While some wish to deny the poor prognosis of schizophrenia, studies show the disorder leads to reduced life expectancy, high suicide and unemployment rates, and long-term functional impairment for most patients.
NIMH i PSC Assays for the Drug Pipeline - Panchisionwef
Dr David Panchision's live presentation at the Schizophrenia Research Forum's live webinar of June 28, 2017 - http://www.schizophreniaforum.org/forums/webinar-modeling-neuropsychiatric-disorders-using-vitro-models
Schizophrenia Research Forum Live Webinar - June 28, 2017 - Rusty Gage wef
1) The document describes a study using induced pluripotent stem cells (iPSCs) derived from bipolar disorder (BD) patients to model the disease in vitro.
2) Hippocampal dentate gyrus-like neurons were differentiated from iPSCs and showed hyper-excitability at both the molecular and functional levels in BD-derived neurons.
3) Treatment with lithium rescued the hyper-excitability phenotype in neurons derived from lithium-responsive BD patients but not lithium non-responsive patients, suggesting patient-specific responses.
SCHIZOPHRENIA RESEARCH FORUM - LIVE WEBINAR June 2017 Kristen Brennandwef
Kristen Brennand presentation at the live webinar of June 28, 2017 hosted by the Schizophrenia Research Forum (http://www.schizophreniaforum.org/forums/webinar-modeling-neuropsychiatric-disorders-using-vitro-models)
STRATEGIES FOR COMMUNICATION AND SENSITIVITY FOR PERSONS EXPERIENCING DEMENTI...wef
This document summarizes a workshop on strategies for communicating with persons experiencing dementia. It discusses how communication is impacted at different stages of dementia from early to late stage. In early stage, word retrieval becomes difficult. In middle stage, language abilities further decline making conversation challenging. In late stage, communication is limited but sensory stimulation through touch, sound, and smell can still connect a person. The workshop provides guidance on adapting approaches to best communicate with someone based on their stage of dementia.
Translating from Animal Models to Human Schizophrenia - Insights into Pathoph...wef
Presentation made by Dr. Tony Grace at the Schizophrenia Research Forum's live webinar of May 4, 2017 - Dopamine in Schizophrenia—Cortical and Subcortical Pathophysiology - review recording of session at http://www.schizophreniaforum.org/forums/dopamine-schizophrenia%E2%80%94cortical-and-subcortical-pathophysiology
Presentation made by Dr. Oliver Howes at the Schizophrenia Research Forum's live webinar of May 4, 2017 - Dopamine in Schizophrenia—Cortical and Subcortical Pathophysiology - review recording of session at http://www.schizophreniaforum.org/forums/dopamine-schizophrenia%E2%80%94cortical-and-subcortical-pathophysiology
Topography and functional significance of the dopaminesgic dysfunction in sch...wef
Presentation made by Dr. Anissa Abi-Dargham at the Schizophrenia Research Forum's live webinar of May 4, 2017 - Dopamine in Schizophrenia—Cortical and Subcortical Pathophysiology - review recording of session at http://www.schizophreniaforum.org/forums/dopamine-schizophrenia%E2%80%94cortical-and-subcortical-pathophysiology
SRF Webinar - What It Will Take to Make Coordinated Specialty Care Available ...wef
Presentation made March 22, 2017, during the live webinar hosted by Schizophrenia Research Forum (SRF). Event recording and additional slides at http://www.schizophreniaforum.org/forums/achieving-effective-treatment-early-psychosis-united-states
SRF Webinar: Beyond DUP - Addressing Disengagement in Community-based Early I...wef
Presentation made March 22, 2017, during the live webinar hosted by Schizophrenia Research Forum (SRF). Event recording and additional slides at http://www.schizophreniaforum.org/forums/achieving-effective-treatment-early-psychosis-united-states
This document provides an overview of memory loss, dementia, and Alzheimer's disease. It defines key terms, describes symptoms at different stages of dementia, and discusses a person-centered approach to care. The main points are:
1) Dementia is not a specific disease but a general term for symptoms caused by various brain disorders, while Alzheimer's disease is the most common cause of progressive dementia.
2) Early stage dementia symptoms include memory loss, impaired judgment, and difficulty completing tasks, while middle and late stage symptoms involve greater impairment and dependence on others for care.
3) A person-centered approach focuses on maintaining an individual's dignity, independence, and identity through techniques like validation, respect, and personalized
Presentation made at the live webinar hosted by the Schizophrenia Research Forum on the 21st of February, 2017 - http://www.schizophreniaforum.org/forums/treatment-resistant-schizophrenia-new-guidelines-diagnosis-and-terminology
Oliver Howes - Treatment-Resistant Schizophrenia: New Guidelines on Diagnosis...wef
Presentation made at the live webinar hosted by the Schizophrenia Research Forum on the 21st of February, 2017 - http://www.schizophreniaforum.org/forums/treatment-resistant-schizophrenia-new-guidelines-diagnosis-and-terminology
John Kane - Treatment-Resistant Schizophrenia: New Guidelines on Diagnosis an...wef
Presentation made at the live webinar hosted by the Schizophrenia Research Forum on the 21st of February, 2017 - http://www.schizophreniaforum.org/forums/treatment-resistant-schizophrenia-new-guidelines-diagnosis-and-terminology
HEAR approach to behavior management Live webinar Feb 1 2017wef
Slides presented at the HEAR Approach to Behavior Management live webinar of February 1, 2017, featuring presentations from Dr. Andrew Heck and Carol Garby.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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Medications: Friend or Foe?
The role of medications in both causing and curing
behavior and cognition problems
Jennifer Hardesty, PharmD, FASCP
Director of Clinical Services, Remedi SeniorCare
Jennifer.Hardesty@RemediRx.com
Could These Behaviors Be a Result of a Medication?
Altered Cognition
Confusion
Aggression
Negative Behaviors
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Objectives
To identify various medications that can
contribute to cognitive impairment and
behavioral symptoms in the older individual.
To educate on appropriate interventions to
address behavioral/cognitive problems in the
elderly.
To review the implications these medications and
resultant behaviors have in relation to regulatory
guidance.
Risk vs. Benefits of Medications
Medications can cause problems, even if used correctly!
MEDICATION BENEFITS
• When used correctly, medications can lead to:
• Better life quality
• Healthier life
• Longer life
MEDICATION RISKS
• Unwanted or unexpected effects may occur
• Mild adverse effect:
• upset stomach
• dry mouth, nausea
• Serious adverse effects:
• organ damage
• coma
• CNS adverse effects:
• Sedation
• Confusion
• Agitation/aggression
• Psychosis
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Organic Causes of Cognitive/Behavior Changes
Medical Conditions:
• Infections:
• UTI
• Pneumonia
• Sepsis
• Stroke, hemorrhage
• Metabolic derangements:
• electrolytes
• dehydration
• hyper/hypoglycemia
• hyper/hypothyroid
• hypoxia
• CV disease:
• hypotension
• MI
• hypertensive crisis
Psychiatric Disorders
• Dementia
• Depression
• Anxiety
• Schizophrenia
• Psychosis
DementiaDementia is progressive deterioration in
Intellectual function
Memory/Recognition
Language
Executive
function/skilled motor
activities
Visuospatial ability
leading to a
decline in the
ability to perform
activities of daily
living.
Changes in Behavior &
Activity Level
• Isolation/ social withdrawal/
Decreased interest
• Difficulty with decision
making
• Problems concentrating
• Unexplained anger
• Anxiety
• Aggression/Agitation
• Sleep difficulties
• Changes in appetite
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Psychiatric Disorders
Depression
• Symptoms include
either a depressed
mood or loss of
interest, PLUS:
• Weight Changes,
sleep changes
• Behavior that is
agitated or slowed
down.
• Fatigue
• Thoughts of
worthlessness or
extreme guilt
• Problems
concentrating or
making decisions
• Thoughts of death or
suicide
• The person's
symptoms are a cause
of great distress or
difficulty in functioning
at home, work, or
other important areas.
Anxiety
• Excessive anxiety and
worry about a variety
of events and
situations.
• Struggle to gain
control, relax, or cope
with the anxiety and
worry
• Feeling wound-up,
tense, or restless
• Easily fatigued or
worn-out
• Concentration
problems
• Irritability
• The symptoms cause
"clinically significant
distress" or problems
functioning in daily life.
Schizophrenia
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or
catatonic behavior
• Negative symptoms:
• low levels of interest
• motivation
• mental activity
• social drive
• speech
Psychosis
• Psychosis can be a
symptom of mental
illness, but it is not a
mental illness in its
own right
• hallucinations or
delusional beliefs
• personality changes
• disorganized thinking
• unusual or bizarre
behavior
• impairment in activities
of daily living
Causes of Cognitive Changes
OrganicCauses
Dementia
Psychiatric
Disorders
Depression
Anxiety
Schizophrenia
IatrogenicCauses
Predictable drug side
effects
Alcohol or illicit drug
intoxication
Medications-Adverse
Drug event
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Iatrogenic Causes
From outside influences
Alcohol/drug
intoxication
or withdraw
Poisons
Anesthesia
• Sedation
• Confusion
• Agitation
Sensory
deprivation/E
nvironment
Medications
• Numerous CNS
side effects
Adverse Drug Reactions
Any noxious, unintended, and undesired effect of a drug which occurs at
doses used in humans for prophylaxis, diagnosis or therapy
Adverse Drug Reactions (ADRs)
36% of all reported adverse drug events involve an elderly patient
Elderly are at Greater Risk for ADR’s:
• Multiple chronic diseases
• Multiple prescribers
• Multiple medications
• Types of medications prescribed
• Under-representation in clinical trials, particularly those over age 75
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Preventable Adverse Drug Events
Incidence of ADRs in high risk seniors (=>5 Rxs)
• 35% experienced ADR
• 95% of ADRs were predictable
• 63% required MD intervention
• 11% required hospitalization
Psychoactive drugs and anticoagulants are the most common medications
associated with preventable adverse drug events
-oversedation, confusion, hallucinations, delirium, falls and bleeds
Signs / Symptoms of Delirium:
• Restlessness, agitation
• Memory deficit
• Drowsiness, poor attention span
• Wandering
• “Picking” at the air/clothes...
• Hallucinations
Types of delirium:
• Hyperactive delirium: agitation, anxiety state
• Hypoactive delirium: lethargy, excess somnolence, sluggish
• Mixed delirium: symptoms of both
Medications = Most common causes of delirium
22-39% of all cases
Drug-Induced Delirium
A clinical state characterized by an acute, fluctuating change in mental status,
with inattention and altered levels of consciousness.
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Prevalence of Delirium in the Elderly
Common in hospitalized older adults:
Emergency 10% - 30%
Post-operatively up to 50%
Cardiac Surgery 17 - 73%
Post Hip Fracture 35% - 65%
General Medicine 11% - 26%
Known Dementia 32% - 89%
Course: Can be quite variable
Prevalence:
Typical: 10-12 days
Range: 1-8 weeks
Lasting > 30 days: 15%
Increased Risk: Longer LOS, LTC
Risk factors for Delirium
Risk factors include:
• Advanced old age
• Underlying dementia
• Functional impairment
• Multiple medical problems
• Polypharmacy
• Renal impairment
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Dementia, Depression, and Delirium
Depression Dementia Delirium
Onset Usually within a
period of weeks
Slow, insidious, over
a period of
months/years
Abrupt, may be
within hours or
days
Symptoms Pervasive sadness
or loss of pleasure,
plus somatic signs
Gradual decline in
functioning,
including recent
memory loss and
word finding
difficulty
Fluctuation in
consciousness
and attention
Possible
hallucinations,
delusions,
disorientation
Course Episodic, treatable,
resolvable
Progressive,
manageable
Treatable, usually
resolvable
Facility
Staff
Nurse
Family
Pharmacist
MD/NP
Resident
Consultant
TEAMWORK is needed to help identify and
resolve cognitive and behavioral problems!
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Case Study: AD
AD is an 89 year old woman residing in your SNF for 2 weeks. She is
recovering from knee replacement surgery. Two days ago she was not
communicating as clearly as usual with nursing staff, and after further
investigation was found to have a UTI.
PMH:
• Mild dementia • DM Type 2
• HTN, CHF • Osteoporosis
• S/P knee replacement
Current medications include:
• HCTZ 25mg QD • Digoxin 0.25mg QD
• Lisinopril 20mg QD • Metoprolol XL 50mg QD
• Tolterodine LA 4mg QD • Amitriptyline 25mg HS for restless legs
• Cipro 500 mg BID x 10 days • Metformin 500mg BID
• Zolpidem 5mg HS prn sleep • Diphenhydramine 50mg PRN itchy rash
Today she is acting very confused and does not recognize her son who visits
in the morning. She does claim to see her husband and speaks with him while
she is in her room, although he had passed away several years ago.
Can you assess this situation?
Drugs Associated with Adverse Cognitive Effects
“Medicine sometimes snatches away health, sometimes gives it.”
~Ovid, Tristia
"Any symptom in an elderly patient should be considered
a drug side effect until proved otherwise.”
J Gurwitz, M Monane, S Monane, J Avorn
Brown University Long-term Care Quality Letter 1995
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Can you name any medications that may
cause cognition or behavior problems?
Medications Associated with Cognitive Impairment
‘ACUTE CHANGE IN MS’
Initial Drug Class
A Antiparkinsonian drugs
C Cardiovascular drugs
U Urinary incontinence drugs
T Theophylline
E Emptying drugs
C Corticosteroids
H H2-blockers
A Antimicrobials
N NSAIDs
G Geropsychiatric drugs
E ENT drugs
I Insomnia drugs
N Narcotics
M Muscle relaxants
S Seizure drugs
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Anti-Parkinsonian Drugs
Anti-Parkinson’s drugs, besides causing psychotic symptoms, have also been linked to
mood symptoms, even at therapeutic doses.
Levodopa:
About 5% of patients
develop delirium
from the use of this
drug
Cognitive symptoms
occur in up to 60%
of patients
• Isolated hallucinations
while maintaining a clear
state of consciousness
• Abnormal dreaming and
sleep disturbances may
be early signs
Selegiline, dopamine
agonists,
amantadine:
Visual hallucinations,
delusions,
depression
Anticholinergics:
(eg, trihexyphenidyl,
benztropine):
confusion and
delirium
Cardiovascular Drugs
Antiarrhythmics
Disopyramide :
Fatigue,
nervousness,
confusion
Digoxin
Confusion,
delirium,
hallucinations,
anxiety
Antihypertensives: (5-10%
incidence in normal population)
Beta-Blockers: Depression, delirium,
confusion, psychosis
Clonidine: Depression, delirium,
psychosis, hallucinations
Methyldopa: May exacerbate depression
or anxiety in elderly patients
Amiodarone: long half-life may promote
prolonged confusion or memory
problems
Diuretics: can cause fluid and/or acid-
base imbalances, which can result in
confusion, especially in the postoperative
patient
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Urinary Incontinence Agents
oxybutnin, tolterodine, trospium, etc.
Elderly have increased sensitivity to anticholinergic effects,
resulting in:
• Confusion/Delirium
• Xerostomia
• Constipation
• Urinary Retention
Anticholinergic drugs have been linked to
memory impairment, changes in consciousness,
and even decreases in ADLs/IADLs
Anticholinergic Drugs
• Total burden of anticholinergic drugs may determine
the development of delirium, rather than any single
agent.
• The total burden of anticholinergic medications is the
sum of the anticholinergic activity of all the drugs
a patient is consuming.
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Medications with anti-cholinergic properties
Antidepressants
Amitriptyline
Desipramine/Imi
pramine
Doxepin
Antipsychotics
Olanzapine
Clozapine
Antihistamines
Diphenhydramin
e
Hydroxyzine
Meclizine
OTC
antihistamines
Prochlorperazin
e
Scopolamine
Narcotics
Urinary
Incontinence
Oxybutynin
Toleterodine
Muscle Relaxants
Cyclobenzaprine
Carisoprodol
Others
Ipatropium
Captopril
Furosemide
Nifedipine
Cimetidine/Ranit
idine
Theophylline
Warfarin
Glycopyrrolate
Theophylline
Adverse effects usually occur in high dose or overdose
situations:
• Insomnia
• Anxiety
• Agitation
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Emptying Drugs (GI Drugs)
GI antispasmodics
• Dicyclomine
• Hyoscyamine
Metoclopramide
Confusion, lethargy, delirium, hallucinations (rare)
High risk of cognitive toxicity due to:
• High anticholinergic activity
• Dopaminergic activity
Symptoms occur in approximately 18% of patients on
high doses of corticosteroids
Corticosteroids can induce mental status changes
Corticosteroids
Risks include:
• Use of high-dose steroids (> 80 mg/day of prednisone)
• Long duration of use
• Abrupt discontinuation
Appear as a variety of mental status changes:
• depressive symptoms
• manic symptoms
• paranoid-hallucinations
• psychosis
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H-2 Receptor Blockers
Cimetidine is most common offender
• Confusion
• Depression
• Delusions/Psychosis
• Aggression or Mania
Predisposing factors include:
• High doses, older age
• Pre-existing psychiatric illness
• Poor renal function
• Simultaneous treatment with psychotropic medications
Cimetidine, ranitidine, famotidine
Risk factors include sepsis, renal impairment, high
doses
Antimicrobials
Cephalosporins/Penicillins:
• Delusions,hallucinations, agitation, confusion
Aminoglycosides:
• Confusion, hallucinations
Fluoroquinolones
• Confusion, agitation, depression, hallucinations, paranoia,
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NSAIDs
Aspirin toxicity:
Delirium is the major manifestation
Indomethacin:
Depression and delirium
Naproxen/Ibuprofen:
Disturbances in memory and concentration (low risk; usually occurs
at high doses).
Celecoxib:
Confusion, anxiety
Geropsychiatric Drugs
Antidepressants
• Tricyclic Antidepressants: (Amitriptyline,
Imipramine)
• Delirium, disorientation, and memory
impairment
• Highly anticholinergic properties
• Fluoxetine
• Long half-life of drug
• Anxiety, sleep disturbances, and increasing
agitation
• Venlafaxine
• Nervousness, Agitation
Antidepressant
Medication
Anticholinergic
Activity
Amitriptyline 4
Trimipramine 4
Doxepin 3
Imipramine 3
Nortriptyline 2
Phenelzine 2
Tranylcypromine 2
Selegiline 2
Desipramine 1
Paroxetine 1
Duloxetine 1
Venlafaxine 1
Mirtazapine 1
Citalopram 0
Escitalopram 0
Fluoxetine 0
Fluvoxamine 0
Sertraline 0
Bupropion 0
Trazodone 0
Lexicomp Drug Information Handbook, 2008
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Anxiolytics
Long-acting benzodiazepines (diazepam, chlordiazepoxide, flurazepam, chlordiazepoxide)
• Long half-life in elderly patients (often several days)
• Produce prolonged sedation and increase risk of falls and fractures
Short- and intermediate-acting benzodiazepines preferred
All benzodiazepines have been associated with:
• impaired learning of verbal and visual information
• immediate and delayed memory
• psychomotor performance
Geropsychiatric Drugs
Antipsychotics
• Sedation
• Confusion
• Delusions
• Personality Changes
• Traditional and some newer antipsychotics possess
anticholinergic properties
Lithium
• May impair memory and psychomotor performance
• Sedation and confusion
• Associated with the development of delirium at high serum levels
Geropsychiatric Drugs
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1st Generation Antihistamines (diphenhydramine, brompheniramine )
• Potent anticholinergic effects
• Sedation
• Constipation
• Confusion
Anticholinergic OTC Medications:
• Cough/cold products with antihistamines
• Sleep aids
Oral Decongestants (pseudoephedrine, phenylephrine)
• Anxiety, nervousness, hallucinations
ENT Drugs
Insomnia drugs
Sedative-hypnotics (zolpidem/zaleplon)
• Confusion
• Abnormal thinking
• Behavior changes
• Aggression/agitation
• Hallucinations
Barbiturates (secobarbital, pentobarbital)
• Confusion, agitation, hallucinations
• Cause more adverse effects than other sedative or hypnotic drugs
Tylenol-PM (diphenhydramine)
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Untreated pain itself can cause delirium
Narcotics
Drugs
• Meperidine:
– Accumulation of normeperidine, a neurotoxic substance
– fluctuations in levels of awareness, confusion, disorientation,
hallucinations, delusions
• Pentazocine:
– Causes confusion and hallucinations more commonly than
other narcotic drugs
• Opioids
– Probably the most important cause of delirium in postoperative
patients
– Renal impairment = accumulation of metabolites
Withdraw effects
Muscle Relaxants
Muscle Relaxants
• Cyclobenzaprine, methocarbamol, carisoprodol metaxalone
Anticholinergic adverse effects:
• Sedation
• Confusion
• Weakness
• Hallucinations
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All anticonvulsants can affect cognition, even in the
presence of therapeutic drug levels
Seizure Drugs
Phenytoin
• Confusion, mood changes, lethargy at high serum levels
• In elderly patients with low albumin, a therapeutic level of phenytoin may also
be toxic.
Carbamazepine
• Sedation
• Confusion
Valproic Acid:
• Nervousness,
• Confusion, abnormal thinking
Topiramate:
• Memory impairment and confusion
• Cognitive and motor slowing
Others
Diabetes medications
• Reversible and irreversible brain damage secondary to hypoglycemia
• Chlorpropamide- long half-life in elderly patients and could cause
prolonged hypoglycemia
Herbal Products
• St. John's Wort mania, anxiety
• Melatonin confusion, sedation
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Medication-Related Problems Can Occur at ANY Time!
When Are Medication-Related Problems
Most Likely to Occur?
• New drug is added
• Change of dose (higher or lower)
• Drug discontinued
• With alcohol or illicit drugs
• Taking multiple sedating drugs or CNS active drugs
Case Study: AD
AD is an 89 year old woman residing in your SNF for 2 weeks. She is
recovering from knee replacement surgery. Two days ago she was not
communicating as clearly as usual with nursing staff, and after further
investigation was found to have a UTI.
PMH:
• Mild dementia • DM Type 2
• HTN, CHF • Osteoporosis
• S/P knee replacement
Current medications include:
• HCTZ 25mg QD • Digoxin 0.25mg QD
• Lisinopril 20mg QD • Metoprolol XL 50mg QD
• Tolterodine LA 4mg QD • Amitriptyline 25mg HS for restless legs
• Cipro 500 mg BID x 10 days • Metformin 500mg BID
• Zolpidem 5mg HS prn sleep • Diphenhydramine 50mg PRN itchy rash
Today she is acting very confused and does not recognize her son who visits in
the morning. She does claim to see her husband and speaks with him while she
is in her room, although he had passed away several years ago.
What Medications Could be Contributing?
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What medications could contribute to her confusion?
HCTZ 25mg QD
Digoxin 0.25mg QD
Lisinopril 20mg QD
Metoprolol XL 50mg QD
Tolterodine LA 4mg QD
Amitriptyline 25mg HS for restless legs
Cipro 500 mg BID x 10 days
Metformin 500mg BID
Zolpidem 5mg HS prn sleep
Diphenhydramine 50mg PRN itchy rash
Resource for Appropriate and
‘Inappropriate’ Medication Therapy
http://www.cms.hhs.gov/manuals/downloads/som107ap_pp_guidelines_ltcf.pdf
F329: Unnecessary Drugs
TABLE I: MEDICATION ISSUES OF PARTICULAR RELEVANCE
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Managing Cognitive and Behavioral Problems
Investigating the Cause!
Organic Disorders
• Dementia
• Psychiatric
Disorders
• Depression
• Anxiety
• Schizophrenia
• Psychosis
Iatrogenic Problems
• Adverse Drug
Events
• Delirium
Managing Drug-Related Delirium & CNS- Related
Adverse Drug Events
Basic principles:
– Identifying and treating/removing acute precipitants
– Supportive and restorative care
– Controlling disruptive behaviors with a minimum of
chemical or physical restraint
Non-pharmacological Management
Provide general supportive measures:
• Avoid restraints
• Encourage familiar faces for reassurance
• Low stimulation - avoid excessive noise
• Provide orientation (calendar, clock)
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When control is needed to prevent harm and to allowWhen control is needed to prevent harm and to allow
evaluation and treatment,
psychotropic medications
may be required.
Pharmacological Management
Indications for pharmacologic treatment:
• Aggression
• Risk of harm to self or others
• Hallucinations
• Inconsolable or Persistent Distress
(e.g., fear, continuously yelling, screaming, end-of-life distress, or crying);
• Significant decline in function
Must seek the underlying cause of distressed behavior
before or while treating the symptom
Pharmacological Management
Prescribing Principles:
• Use a SINGLE medication
• Start with a low dose.
• Choose a drug with low anticholinergic activity
• Stop the medication as soon as possible
• Continue to use Non-Pharmacological interventions
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Acute Situations/Emergency
“Acute onset or exacerbation of symptoms, or immediate threat
to health or safety of resident or others”
• Acute treatment period limited to 7 days
• Clinician and IDT must reevaluate and document situation within 7 days,
and define continuing need
• Non-drug therapies are attempted beyond the emergency period
http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-
Regions-Items/Survey-and-Cert-Letter-13-35.html
Part of all medication treatment = Non-pharmacological approaches
Non-Drug Therapy Requirements
Examples of non-pharmacological interventions may include:
• Identifying, addressing, and eliminating or reducing underlying causes of
distressed behavior
• Developing interventions that are specific to resident’s interests, abilities,
strengths and needs
• Minimize distractions or overstimulated environment
• Using sleep hygiene techniques and individualized sleep routines
• ↑ exercise or therapy
• Massage, hot/warm or cold compresses
• Enhancing the taste and presentation of food
• Music therapy
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Pharmacological Management
When control is needed to prevent harm and to allow evaluation and
treatment, psychotropic medications may be required.
Indications for pharmacologic treatment:
• Aggression
• Agitation
• Risk of harm to self or others
• Hallucinations
• Inconsolable or Persistent Distress
(e.g., fear, continuously yelling, screaming, distress associated with end-of-life,
or crying);
• Significant decline in function
Must seek the underlying cause of distressed behavior before or while treating
the symptom.
Behavioral symptoms must be reevaluated periodically to determine the
effectiveness of the antipsychotic and the potential for reducing or discontinuing
Requirements for Enduring Use of Antipsychotics
Target behavior must be clearly and specifically identified and
monitored objectively and qualitatively
Ensure the behavioral symptoms are:
A. Not due to a medical condition or problem that can be expected to improve or resolve
B. Persistent or likely to reoccur without continued treatment; and
C. Not sufficiently relieved by non-pharmacological interventions; and
D. Not due to environmental stressors that can be addressed to improve the psychotic
symptoms or maintain safety
E. Not due to psychological stressors or anxiety or fear stemming from misunderstanding
related to his or her cognitive impairment
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Inadequate Indications for Antipsychotic Use:
• Wandering
• Poor self-care
• Restlessness
• Impaired memory
• Mild anxiety
• Insomnia
• Unsociability
• Inattention or indifference to surroundings
• Fidgeting/Nervousness
• Uncooperativeness;
• Verbal expressions or behavior that do not represent a danger
to the resident or others
CMS State Operations Manual: Antipsychotics Usage
New Admissions to Skilled Nursing Facility
When a resident is admitted to a SNF from hospital/ community
and are already on an antipsychotic:
• Facility must re-evaluate antipsychotic medication at the time of admission
and/or within two weeks of admission
• PASRR screening (F285) - evaluation for mental illness and/or intellectual
disability
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Investigator’s Review of Medication Management
Surveyors are instructed to review the clinical record to
determine if it reflects the following elements:
• Indication
• Non-pharmacological interventions
• Dose
• Duration
• Tapering/Gradual Dose Reduction documentation
• Monitoring and reporting for efficacy and adverse consequences
• Adverse consequence identification, evaluation, and actions by
physician and facility
Surveyor Investigation- Areas of Focus
• PRN orders for antipsychotic medications
• Describe how the facility provides individualized care and
services for residents with dementia
• Provide policies related to the use of antipsychotic
medications in residents with dementia
• Resident/families/representatives involvement
• Identify and document specific target behaviors
• Communicate consistently
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CMS State Operations Manual: Medication Management
Medication Management Process:
• All drugs implicated!
• Enhanced focus on :
• Medications as cause for change in condition
• Need for Medication Reviews in response to changes in condition
• Enhanced interdisciplinary teamwork
• Enhanced care process
• Personal responsibility
• Need to document process
Medication Management
Medication management should support and promote:
1. Evaluating resident for underlying causes of signs/symptoms
2. Use of non-drug interventions
3. Selection of medications based on benefits vs. risk for individual
residents
4. Selection and use of medication in doses and duration individual
resident
5. Monitoring of medications for efficacy and adverse consequences*.
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Adverse Consequences: Identification
Medication review should be performed if resident has experienced a change in condition:
Weight loss or gain
Behavioral changes/ mental status changes
Bleeding or bruising
Bowel dysfunction
Dehydration/electrolyte imbalance
Dysphagia
GI bleed
Headaches or non-specific pain
Rash or itching
Respiratory changes
Sedation, insomnia, sleep changes
Seizures
Urinary retention or incontinence
How Can I Remember All of This?
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Your Pharmacy Provider Service Team
• Pharmacists
• Technicians
• Nurses
• Consultant Pharmacists
• Account Managers
Facility
Staff
Nurse
Family
Pharmacist
MD/NP
Resident
Consultant
TEAMWORK is needed to help identify and
resolve cognitive and behavioral problems!
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Bowen JD, Larson EB. Drug-induced cognitive impairment. Defining the problem and finding the solutions. Drugs
Aging 1993; 3 (4): 349-57.
Cole MG, McCusker J., Dendukuri N, Han L. Symptoms of delirium among elderly medical inpatients with or without
dementia. J. Neuropsychiatry Clin Neurosci 2002; 14(2):167-75.
Drug-Induced Delirium: Diagnosis, Management, and Prevention. Drug Ther Perspect 10(3):5-9, 1997
Evidence-Based Interventions for Nursing Psychiatric Clinics of North America - Volume 28, Issue 4 Home Residents
with Dementia-Related Behavioral Symptoms (December 2005)
Flaherty JH. Commonly prescribed and OTC medications: causes of confusion. Clin Geriatr Med 1998;14:101-127.
Francis J. Martin D, Kkapoor WN. A prospective study of delirium in hospitalized elderly. JAMA 1990;263(8):1097-101.
Gleason, OC. Am Fam Phys.67(5):1027-1034. 2003
Inouye SK. The dilemma of delirium: Clinical and research controversies regarding diagnosis and evaluation of
delirium in hospitalized elderly medical patients. AM J Med 1994;97(3):278-88.
Inouye, SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: The confusion
assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113(12):941-8.
Inouye SK, Charpentier PA, Precipitating Factors for Delirium in Hospitalized Elderly Persons. JAMA. 1996;275:852-857.
Liang, BA. Diagnosis and Management of Delirium in the Elderly. Hosp Phys June 199:34-52.
Lisi, D. Definition of Drug-Induced Cognitive Impairment in the Elderly Donna Medscape Pharmacotherapy 2(1), 2000.
Pompei P, Foreman M, Rudberg MA, Inouye SK, Braund V, Cassel CK. Delirium in hospitalized older persons:
Outcomes and predictors. J Am Geriatr Soc 1994; 2(8):809-15.
State Operations Manual: Appendix- Medications of Particular Relavence.
http://www.cms.hhs.gov/manuals/downloads/som107ap_pp_guidelines_ltcf.pdf pp. 299-339
References
Jennifer Hardesty, PharmD, FASCP
Director of Clinical Services, Remedi SeniorCare
Jennifer.Hardesty@RemediRx.com
Q & A