Abstract
We hope you are continuing to enjoy learning about the different categories of psychiatric diagnoses! This chapter covers neurocognitive disorders (NCDs) that affect medically vulnerable and elderly patients and that highlight the close connection between body, brain, and behavior.
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Appendices
Appendix A: Tables with Possible Answers to the Vignettes
Case Vignette 25.1: Presenting Situation Eli Thompson
Learning Issue Table 25.1.1
Facts | Hypotheses | Information needed | Learning issues |
---|---|---|---|
76–year-old man with hypertension and diabetes | Depressive disorders | Obtain history from patient, family, and caregivers | What are the different presentations of normal memory, normal age-related decline, mild neurocognitive disorder, and MNCD? (See Table 25.2) |
Behavior and memory changes (forgets name of grandchildren and medications) | MNCDs | Identify baseline level of cognition and functioning | |
Death of his wife a year ago | Mild neurocognitive disorders | ||
Retirement 2 years ago | Normal aging | ||
Delirium |
Learning Issue Table 25.1.2
Facts | Hypotheses | Information needed | Learning issues |
---|---|---|---|
Alcohol use history | Major neurocognitive disorders | Cognitive testing | What are the differentiating factors between depression, MNCD, and delirium? (see Table 25.3) |
No history of depression | Depression | Laboratory testing (CBC, BMP, RPR, vitamin B12, folate, TSH) | What are the potential etiologies of MNCD? (See Table 25.4) |
No illicit drug use | Delirium | Imaging of the brain (non-contrast CT of the brain) | |
Taking antihypertensive and oral hypoglycemic medication | Alcohol intoxication or withdrawal delirium | ||
No family history of neurocognitive disorders | |||
No movement problems, falls, or hallucinations | |||
Sleep problems | |||
No depressive symptoms |
Learning Issue Table 25.1.3
Facts | Hypotheses | Information needed | Learning issues |
---|---|---|---|
MMSE score 26/30 | MNCD due to Alzheimer’s disease | Neuropsychological testing | What are the standard laboratory and imaging tests for MNCD? (See Table 25.5) |
Clock-Drawing Test was normal | Major frontotemporal neurocognitive disorder | What is the MMSE and Clock-Drawing Test? | |
Lab results normal | Major vascular neurocognitive disorder | ||
Heavy-metal screening normal | |||
Non-contrast CT scan of the brain significant for mild cortical atrophy and periventricular white matter changes |
Learning Issue Table 25.1.4
Facts | Hypotheses | Information needed | Learning issues |
---|---|---|---|
Hip fracture after fall | Acute delirium due to alcohol withdrawal, pain medications, or surgery | Medication list | What are the common causes of delirium? (See Table 25.6) |
Disorientation, delusions, and hallucinations | Laboratory testing (CBC, BMP, urinalysis, urine toxicology screen) | What is the treatment of delirium? | |
Severe agitation and combativeness with staff | |||
Antipsychotic medication used for agitation |
Learning Issue Table 25.1.5
Facts | Hypotheses | Information needed | Learning issues |
---|---|---|---|
MMSE score was 23/30 | Depression | Response to SSRI medication (repeat GDS) | What is the GDS? |
Irritability with staff and family | Major neurocognitive disorder | What is the treatment for geriatric depression? | |
GDS scored 9 out of 15 points | Delirium | ||
SSRI prescribed for depression |
Learning Issue Table 25.1.6
Facts | Hypotheses | Information needed | Learning issues |
---|---|---|---|
Mr. Thompson living in an assisted living facility | Major neurocognitive disorder due to Alzheimer’s disease | Obtain more information on functional status | What is the pathophysiology of Alzheimer’s disease? |
MMSE score was 20/30 | What are the stages of Alzheimer’s disease? (See Table 25.7) |
Appendix B: Answers to Review Questions
Answers:
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1.
C
-
2.
C
-
3.
A
-
4.
E
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Lee, J., Muramatsu, R., Takeshita, J. (2016). Neurocognitive Disorders. In: Alicata, D., Jacobs, N., Guerrero, A., Piasecki, M. (eds) Problem-based Behavioral Science and Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-23669-8_25
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