Spring 2014 744 Snow Day Make-up PP slides with audio

1. SNOW DAY MAKE-UP
NEUROCOGNITIVE DISORDERS;
DISSOCIATIVE DISORDERS;
FEEDING & EATING DISORDERS
744 FRIDAYS 2-5PM
DR. GREENO
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2. NEUROCOGNITIVE DISORDERS
•In the DSM IV-TR this section was known as Delirium,
Dementia, and Amnesic and Other Cognitive
Disorders
•In DSM-5 name/organization change but many of
the diagnoses were renamed but correspond to
former diagnoses
•Hallmarks
Etiology and can be determined
Disorders updated due to extensive research
•Be familiar with tables that start on page 593
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3. DELIRIUM
A. Disturbance in attention (focus, sustain, shift attention)
and awareness (reduced orientation to environment).
B. Disturbance develops over a short period of time
(hours to days)—difference in baseline and there is
likely fluctuation throughout course of the day
C. Disturbance in cognition (i.e., memory, disorientation,
language)
D. Disturbances from criteria A and C are not better
explained by another preexisting or evolving
neurological disorder or context of a coma (or
reduced level of arousal)
E. Evidence from the history, physical examination, or
laboratory findings that the disturbance is a direct
physiological consequences of another medical
condition, subs intoxication or withdrawal, or exposure
to toxin, or due to multiple etiologies
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4. WHAT IS DELIRIUM?
• Disturbance of consciousness and a change in
cognitive that develops over a short period of time
(hours to days). There is evidence from the history,
physical examination, or lab tests that the delirium is
the direct physiological result of a general medical
condition, substance intoxication/withdrawal, use
of a medication, toxin exposure, or combination of
these factors.
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5. WHAT DOES DELIRIUM LOOK LIKE?
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Depends on general medical condition
Not aware of the environment (Criterion A)
Change in Cognition (Criterion B)—Quick change in mental states
Functioning, inattention, perceptual disturbances, and fluctuation of symptoms
Can fluctuate during the course of the day
Reduced clarity of awareness of the environment—changes in consciousness and
awareness
Inability to focus, sustain, or shift attention is impaired
Repeat questions b/c attention wanders or person is perseverating on something
Changes in alertness (usually more in the am)
Changes in sleep
Decreased short-term memory and recall
Disrupted or wandering attention
Disorganized thinking (speech, can’t stop speech patterns or behaviors)—easily
distracted
Emotional or personality changes
Psychomotor restlessness
Memory—huge concern (ask them to remember a list of objects), disoriented to
time/place
Physical sensations
Hallucinations, delusions, language disturbances, and agitation
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6. WHAT DOES DELIRIUM LOOK LIKE?
• Common Exams:
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Blood chemistry
Neurological examination
Toxicology screens
Head CT and/or MRI
Living Functioning
MSE
Urinalysis
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Alcohol or drug use
Alcohol or drug withdrawal
Infections
Poisons
Surgery
• Common causes:
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7. HOW DO SOCIAL WORKERS DIAGNOSIS
DELIRIUM?
Social Workers can do a MSE (Mental Status Exam)
but also need to do this in conjunction with other
professionals and procedures:
• Physical Exam
• Medical History
• Mental Status Exam (2nd time)
• Adequate History
-should include perspective from the family/friend
• Imaging Procedures (i.e., CT scans, MRIs)-sometimes
work
• Lab Tests
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8. DELIRIUM
• Prognosis
-if the underlying disorder is found quickly then the
greater the likelihood of full recovery
-can lead to detrimental outcomes
-in medically ill or elderly generally there are more
detrimental consequences
• Treatment
-Depends on underlying medical condition
-What does Social Work intervention look like?
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9. DELIRIUM
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Specify whether:
Substance intoxication delirium
Substance withdrawal delirium
Medication-induced delirium
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Note codes on page 596 and 597
293.0 Delirium due to multiple etiologies
293.0 Delirium due to another medical condition
Additional specifiers page 597 and 598
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10. DELIRIUM
• Differential diagnosis—How distinguish?
• Psychotic Disorders (have to distinguish the hallucinations,
delusions, language disturbances, and agitation)
• Acute Stress Disorder: precipitated by traumatic event
• Malingering and factitious disorder: etiology for delirium
• Other neurocognitive Disorders: can be difficult with
dementia, look a the acute onset of delirium vs. the typical
gradual of dementia
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11. MAJOR NEUROCOGNITIVE DISORDERS
A. Significant decline from previous level of
performance in one or more cognitive domains
(complex attention, executive function, learning
and memory, perceptual-motor, or social
cognition)
B. Cognitive deficits interfere with independence in
everyday activities
C. Cognitive deficits do not occur exclusively in the
context of delirium
D. Cognitive deficits not better explained by another
mental disorder
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12. MAJOR NEUROCOGNITIVE DISORDERS
• See specifications—page 603
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13. MILD NEUROCOGNITIVE DISORDER
A. Modest cognitive decline from a pervious level of
performance in one or more cognitive domains
(complex attention, executive function, learning and
memory, language, perceptual-motor, or social
cognition) based on:
1. Concern
2. modest impairment in performance
B. Cognitive Deficits DO NOT interfere with capacity for
independence in everyday activities
C. Cognitive deficits do not occur exclusively during
delirium
D. Cognitive deficits are not better explained by another
mental disorder
Note specifiers page 605
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14. OTHER HALLMARKS
Depression (particularly at beginning stages)
Agitation
Sleep disturbance
Apathy (particularly with Alzheimer’s Disease)—lack
of goal directed behavior
• Emotional responsiveness
• Loss of previous interests
• Other behavioral symptoms
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• Wandering, disinhibition, hoarding—when more than one is
present give specifier of “with behavioral symptoms”
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15. DISSOCIATIVE DISORDERS
• Hallmarks
• Disruption of consciousness, memory, identity,
emotion, perception, body representation, motor
control, and behavior.
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Dissociative Identity Disorder
Dissociative Amnesia
Depersonalization/Derealization Disorder
Other Specified and Unspecified Dissociative Identify
Disorder
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16. DISSOCIATIVE DISORDERS
• Frequently occur after trauma
• Close relationships between Dissociative Disorders
and Trauma related disorders
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17. DISSOCIATIVE IDENTITY DISORDER
300.14
A. Disruption of identity characterized by 2 or more
distinct personality states
B. Recurrent gaps in recall, personal information, and
traumatic events that inconsistent with ordinary
forgetting
C. Symptoms cause clinically significant distress or
impairment in social, occupational, or other areas of
functioning
D. Disturbance is not a normal part of accepted cultural
or religious practice
E. The symptoms are not attributable to physiological
effects of a substance or another medical condition
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18. DISSOCIATIVE AMNESIA 300.12
A. Inability to recall important autobiographical
information, usually of a traumatic or stressful nature,
that is inconsistent with ordinary forgetting
B. Symptoms cause clinically significant distress or
impairment in social, occupational. Or other important
areas of functioning
C. Disturbance not attributable to effects of a substance,
neurological or other medical condition
D. Disturbance is not better explained by DID, PTSD,
Acute stress disorder, somatic symptom disorder, or
major or mild neurological disorder
Coding for Dissociate Fugue: purposeful travel or bewildered
wandering that is associated with amnesia for identify or for
other important auto biographical information
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19. DEPERSONALIZATION/
DEREALIZATION DISORDER 300.6
A. Persistent or recurrent experiences of
depersonalization, derealization, or both:
Depersonalization: Experiences of unreality,
detachment, or being an outside observer with
respect to one’s thoughts, feelings, sensations, body,
or actions (perceptual alterations, distorted sense of
time, unreal, emotional and/or physical numbing)
Derealization: experiences of unreality or
detachment with respect to surroundings (unreal,
dreamlike, foggy, lifeless)
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20. DEPERSONALIZATION/
DEREALIZATION DISORDER 300.6
B. During depersonalization or derealization reality
testing remains intact
C. Symptoms cause clinically significant distress or
impairment in social, occupational or other important
areas of functioning
D. Disturbance is not attributable to the physiological
effects of a substance or another medical condition
E. Disturbance not better explained by another
mental disorder
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21. FEEDING & EATING DISORDERS
• Hallmarks
• Disturbance of eating or eating-related behavior that results
in altered consumption or absorption of food
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22. FEEDING & EATING DISORDERS
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Pica
Rumination Disorder
Avoidant/Restrictive Food Intake Disorder
Anorexia Nervosa
Bulimia Nervosa
Binge-Eating Disorder
Other/Unspecified Feeding or Eating Disorders
Mutually
Exclusive
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23. AVOIDANT/RESTRICTIVE FOOD
INTAKE DISORDER
A. Eating disturbance as manifested by persistent failure
to meet appropriate nutritional and/or energy needs
associated with one (or more) of:
1. Significant weight loss
2. Significant nutritional deficiency
3. Dependence on enteral feeding or oral nutritional
supplements
4. Marked interference with psychosocial functioning
B. Not explained by associated culturally sanctioned practice
C. Eating disturbance does not occur exclusively during anorexia
nervosa or bulimia nervosa, and NO evidence of experience
in disturbance for one’s body weight or shape
D. Not attributable to concurrent medical condition or another
mental disorder
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24. AVOIDANT/RESTRICTIVE FOOD
INTAKE DISORDER
• Displaces feeding disorder of infancy or early
childhood from DSM IV
• Lack of interest in food—not body weight
• Restriction may be based on color, smell, texture,
temperature, taste, appearance
• Fear of choking
• May persistent into adulthood
• Currently insufficient evidence to suggest linking to
eating disorder
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25. ANOREXIA NERVOSA 307.1
• A. Restriction of energy intake relative to requirements,
leading to significantly low body weight in the context of
age, sex, developmental trajectory, and physical health.
Significantly low weight definition
• B. Intense fear of gaining weight or of becoming fat, or
persistent behavior that interferes with weight gain, even
though they are at a significantly low weight
• C. Disturbance in the way in which one’s body weight or
shape is experienced, undue influence of body weight
or shape on self-evaluation, or persistent lack of
recognition of the seriousness of the current low body
weight
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26. ANOREXIA NERVOSA 307.1
• Restricting type: During the last 3 months person has NOT
regularly engaged in binge-eating or purging behavior.
Weight loss is accomplished through dieting, fasting, and/or
excessive exercise.
• Binge-Eating/Purging Type: During the last 3 months person
regularly engaged in binge-eating or purging behavior
• Code for most recent episode
• Specify if: In partial remission or in full remission
• Specify current severity: mild, moderate, severe, extreme
• HBO Documentary THIN
• http://www.youtube.com/watch?v=3Git2_X74_c
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27. ANOREXIA NERVOSA 307.1
• Suicide Risk—elevated
• Health consequences due to anorexia
• More prominent in post-industrialized, high income
countries
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28. 307.51 BULIMIA NERVOSA
Essential feature is binge eating and inappropriate
compensatory methods to prevent weight gain
Diagnostic Criteria:
A: Recurrent episode of binge eating
a. eating in a discrete period of time an amount of food
that is larger than what most would eat
b. Sense of a lack of control over eating during an
episode
B. Recurrent inappropriate compensatory behavior in order to
prevent weight gain
C. Binge eating and inappropriate compensatory behavior
occur at least twice a week for 3 months
D. Self-evaluation is unduly influenced by body shape and
weight
E. Disturbance does not occur during episode of Anorexia
Nervosa
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29. BULIMIA NERVOSA 307.51
• Specify if : In partial remission or in full remission
• Specify current severity based on frequency of
inappropriate compensatory behaviors: mild,
moderate, severe, extreme
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30. BINGE-EATING DISORDER 307.51
A. Recurrent episodes of binge eating. Characterized by:
a. eating in a discrete period of time an amount of food that is
larger than what most would eat
b. Sense of a lack of control over eating during an
episode
B. The binge-eating episodes are associated with three or more
of the following:
1. Eating rapidly
2. Eating until feeling uncomfortably full
3. Eating large amounts when not hungry
4. Eating alone b/c of embarrassment by how much one is
eating
5. Feeling disgusted with oneself, depressed, or guilty
afterward
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31. BINGE-EATING DISORDER 307.51
C. Marked distress regarding binge eating is present
D. Binge eating occurs on average at least once a
week for 3 months
E. Binge eating is not associated with the recurrent
use of inappropriate compensatory behavior (like
bulimia) and does not occur during the course of
bulimia or anorexia
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32. BINGE-EATING DISORDER 307.51
• Specify if: partial or full remission
• Specify current severity based on frequency of
binge eating episodes; mild, moderate, severe,
extreme
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33. TREATMENT FOR EATING DISORDERS
• Must work with medical
doctor and someone who
specializes in the treatment
of Eating Disorders
(hospitalization may be
necessary)
• Often use multidisplinary
team approach
• Medication Management
• Family Therapy
• Psychotherapy (other
approaches we have
discussed in class)
• Cognitive
• Cognitive-Behavioral
• Behavioral
• Family Therapy or
Couples
• Psychosocial
• Psychoanalysis
• EMDR
• Functional Therapy
• Psycho educational
Therapy
• Intervention
Programs/Community
Support
• Addictions/Substance
Treatment (if applicable)
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