Question

Discussion Topics, Mohr

Chapter 31, Cognitive Disorders

Discussion Topics	Learning Objective
1. After discussing cognitive disorders in class, you begin thinking about experiences you have had with those who suffer from these conditions. What is a cognitive disorder? Have you ever had a family member who was diagnosed with a cognitive disorder? What feelings were evoked by the changes that result when someone has this kind of disorder? Think about any clients you may have cared for with a cognitive disorder. What were some of the difficulties involved in nursing care? How did you feel about caring for these clients? What did you learn about yourself? If a genetic marker or a diagnostic test became available for Alzheimer’s disease, would you want to be tested? Why or why not?	1
2. You are caring for a client who has been diagnosed with dementia. When speaking to the client’s family, it becomes evident that they are not very familiar with the disease process. The family of this client wishes to know more about the symptoms of dementia. Identify and explain a symptom that may be seen in clients with dementia. The family also tells you that there have been two other family members that have been diagnosed with Alzheimer’s disease and would like to know what causes the disease. What information would you provide about the etiology of Alzheimer’s disease?	3, 4
3. You are working in a doctor’s office and a 55-year-old man comes in with his 77-year-old father who is experiencing signs of dementia. He wishes to find out about potential treatments for his father’s condition. What are the recommended psychosocial and pharmacological treatments for delirium and dementia? The doctor is deciding between prescribing Rivastigmine (Exelon) or donepezil (Aricept). What information would you want to provide for these medications?

Answer 1

Answer :- (1)

One of the more overlooked aspects of bipolar disorder is the potential for developing a degree of cognitive deficit as part of the illness.  

This oversight mirrors the truth that standard print media's depiction of bipolar issue generally centers upon the cycling of hoisted and additionally discouraged states of mind which are the trademark highlights of the turmoil.

What we ordinarily read are portrayals of temperament rise that reflect manifestations of high vitality, decreased requirement for rest, sentiments of happiness, affectedness, impulsivity, lifted drive, and so forth. Correspondingly, on the discouraged end of the mind-set range, we read depictions of low vitality, low confidence, sentiments of bitterness, misfortune or vacancy, self-destructive ideation, unavoidable cynicism, low inspiration, and the various encounters we connect with feeling discouraged. Mood typically receives the bulk of our attention when it comes to descriptions and discussion of bipolar disorder; however, in my sessions with individuals living with the disorder, it’s common to hear concerns about their lessened cognitive capacities. To be more specific, I’m referring to the experience of decreased cognitive capacity relative to the period of time before any sustained bipolar mood symptoms arrived on the scene. Instances of the sorts of shortfalls detailed are challenges with phonetic working memory (word recovery), troubles with arranging, organizing and sorting out of conduct (official working), issues with maintenance of what's been perused or tuned in to, and the experience of somewhat dulled or impeded points of view. For some with bipolar turmoil, it resembles they've encountered a progressive decrease of intellectual prowess from their past standard dimension of capacity.

Before I scare many readers, the key word in the preceding sentence is “some.” The research literature poses a wide range of figures pertaining to cognitive deficit in bipolar disorder, with studies showing incidence rates between 15% on the low end and 60 % on the high end. Granted, this broad a range doesn’t tell us much.

A key end bolstered by various research articles is there gives off an impression of being a positive connection between's the nearness of psychological shortage and higher sharpness bipolar side effects. This implies those with accounts of more intense bipolar mind-set side effects are bound to encounter parts of psychological shortage. There are likewise critical discoveries that point to the truth that people whose indications have been all around overseen throughout the years will be less inclined to encounter psychological impedance. The individuals who have encountered a more troublesome course of their issue because of treatment safe side effects, treatment resistance, as well as undesirable way of life decisions endure more psychological weaknesses.

There are multiple other examples of mood’s impact upon cognition, but at this point it should be clear that the polarities of mood elevation and depression have adverse impact upon memory, focus, thinking and planning. This should come as no surprise. In fact, it would be more surprising if mood intensity had little to no bearing upon cognition.

There is by all accounts a genuinely wide agreement in the exploration writing that for some with bipolar confusion, the nearness of psychological deficiency isn't only an impression of state of mind power, however a persisting component of the sickness itself. The explicit subjective troubles that present for an individual can be available amid mid-run inclination or notwithstanding amid supported times of abatement. This is the place the talk possibly summons uneasiness for those with the confusion. I review a youthful grown-up patient as of late saying – "You mean, notwithstanding the majority of my inclination absurdity, I presently need to stress over progressive loss of psychological limit? My best answer now is – Maybe.

There are many complex factors that need to be thoroughly explorred and assessed in order for one to develop a clearer sense regarding his/her potential for developing cognitive decicit with bipolar disorder. The salient piece is that those with a history of more acute instability are more likely to encounter some enduring cognitive difficulties whereas those on the lower end of the acuity continuum are less likely to struggle with sustained deficits.

It’s also necessary to rule out the presence of neurologically-based diagnoses such as Attention Deficit Disorder. If you have bipolar disorder and you’re unsure about the presence of ADD, I suggest you see a professional who is knowledgeable about the overlap of these two entities. One of my previous blog posts “Misdiagnosis of Bipolar Disorder” (February, 2013) also speaks to the diagnostic distinctions between attention deficit and bipolar disorder.

In the event that you do definitely realize that you convey the two judgments of ADD and Bipolar Disorder, at that point you're looked with the perplexing assignment of making sense of what deficiencies originate from what clutter and also what level of cover may exist between the two. To be perfectly honest, these are extreme differential symptomatic calls to make and doing as such would require interview from a neuropsychologist who is master at evaluating both. I figure the uplifting news here is that in the event that you definitely realize you're ADD, you've just carried on with an actual existence where you've needed to adjust to a few parts of psychological shortfall. The intellectual shortages originating from bipolar turmoil are not going to give you a totally new arrangement of difficulties that are unique in relation to what you're as of now used to living with and adjusting to.

The following issue to consider is whether any manifestations of intellectual shortage may perhaps be identified with the drugs you are recommended. This excessively is troublesome, making it impossible to deal with, as various individuals respond to drugs in an unexpected way. Numerous who take one of the atypical antipsychotic prescriptions regularly encounter some intellectual dulling from the medicine. However, on the off chance that your utilization of an antipsychotic was scene explicit, recommended amid madness and stopped once adjustment was accomplished, or has been proceeded just on an as required premise then you'll be less inclined to encounter persevering unfavorable impacts of the medicine. Alternately, in the event that you've been taking an antipsychotic once a day over broadened timeframes, the dangers of persevering subjective deficiency are higher. So, I likewise need to emphatically alert perusers that taking antipsychotic prescription once a day does not imply that intellectual deficiency indications are inescapable. The sum and recurrence of one's dosing are critical factors similar to one's defenselessness to medicine symptom responses. At last, these issues ought to be raised and investigated with your recommending therapist.

The same issues are applicable to the use of lithium as well as most of the other more commonly used mood stabilizers (anti-seizure medications). Lamictal or lamotrigene tends to be an outlier as it has a fairly low side effect profile; but that’s not to say it comes without any cognitive impact. It’s more that relative to the atypical antipsychotics as well as the other mood stabilizers typically used for bipolar disorder, its impact on cognitive functioning tends towards the lower end of the side-effect continuum.

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