Altered mental status.pptx neuro also geri

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1. Altered mental status 2023

2. Major depression and anxiety disorders are the two most common psychiatric illnesses in the United States . The economic burden of anxiety and depressive disorders is substantial in terms of workdays lost, disability, healthcare expenditures, and mortality . Anxiety and depression are chronic illnesses Prevalence rates for anxiety disorders appear to decline with advancing age, except for GAD, which may increase in geriatric populations . Depression is often a highly recurrent illness; each episode of depression increases the likelihood of future episodes

3. Prevalence Lifetime prevalence for anxiety disorders is estimated at 16.6% to 28.8% (Conway et al., 2006; Kessler et al., 2005a) and for major depression is 14.9% to 16.2% (Kessler et al., 2003 ). Lifetime prevalence rates of panic disorder and GAD are 4.7% and 5.7%, respectively (Kessler et al., 2005a ). Anxiety disorders make up approximately 2% of all office visits to physicians in the United States, but almost 50% occur in primary care settings.

4. Disease Course Both anxiety and depressive disorders tend to run a chronic course, with waxing and waning symptomatology. Illness with worsening psychosocial functioning and higher risk for suicide (Eaton et al., 2008).

5. Diagnosis and Screening of Mood and Anxiety Patients Health Questionnaire 9 (PHQ-9) Using cutoff scores from 9 to 15, sensitivity ranges from 68% to 95%, with specificity from 84% to 95 %. Using the cutoff score of 9, sensitivity is 95% and specificity 84%.

6. Diagnosis and Screening of Mood and Anxiety The total score on QIDS ranges from 0 to 27 (0-5,no severity; 6-10, mild; 11-15, moderate; 16-20, severe; 21-27, very severe). The QIDS was effective in assisting management of depression

7. Diagnostic Criteria for Panic Attack 1 . Palpitations, pounding heart, or accelerated heart rate 2. Sweating 3. Trembling or shaking 4. Sensations of shortness of breath or smothering 5. Feeling of choking 6. Chest pain or discomfort 7. Nausea or abdominal distress 8. Feeling dizzy, unsteady, lightheaded, or faint 9. Derealization (feelings of unreality) 10. Fear of losing control or going crazy 11. Fear of dying 12. Paresthesias (numbness or tingling sensations ) 13. Chills or hot flushes

8. Differential Diagnosis Addison’s disease , Acquired immunodeficiency syndrome (AIDS ), Coronary artery disease (especially in those with myocardial infarction ), Cancer , M ultiple sclerosis, Parkinson’s disease, A nemia , diabetes, A cute infection, temporal arteritis, H ypothyroidism , and especially dementias.

9. Suicide Screening and Assessment Identifying patients at risk for suicide is a complex and difficult task, particularly in the setting of a busy medical practice. Suicide is currently the 11th leading cause of death for all ages and accounts for approximately 32,000 deaths annually in the United States (CDC, 2009). It is the second leading cause of death in those 25 to 34 years old and the third leading cause in those 15 to 24

10. Selection of Medication Educate the patient . Details of illness, Treatment course, prognosis, goal of treatment (remission of symptoms ) Importance of general health: exercise , sleep hygiene, nutrition Inclusion of family when possible Coordination with other providers Resource lists for support groups, therapy referrals Select medication from reasonable choices . Patient history of antidepressant use/response Family history of antidepressant response. Typical time course to antidepressant response Administer starting dose , and initiate d ose titration. Common side effects of medications Establish monitoring with measurement-based care (e.g., QIDS ).

11. Selection of Medication I nhibitors (MAOIs) are complex drugs to use given their potentially fatal drug and dietary interactions and probably should not be prescribed in family practice settings . Serotonin reuptake inhibitors are safe, effective medications that can treat a variety of psychiatric conditions. All SSRIs operate by the same mechanism of action and are considered equally effective in the treatment of depression

12. Dementia is caused by a heterogeneous group of brain disorders that result in global impairment of cognition. In addition to memory impairment, impairment in language (aphasia), inability to carry out motor tasks (apraxia), inability to recognize objects ( agnosia ), and loss of executive function are seen. Mood, personality, and behavior are often affected. Dementia

13.   Common Types of Dementia Clinical evaluation will establish that most patients have Alzheimer’s disease (AD), Levy body disease (LBD), or vascular dementia ( VaD ). Autopsy study of brain tissue obtained from persons dying with dementia reveal that most patients actually have mixed dementia, with microscopic changes of AD and VaD most often reported .

14. Prevention Ginkgo biloba is probably the best studied of the nutraceuticals promoted for the prevention of dementia. Initially encouraging studies have not been supported by subsequent RCTs Controlled trials have not been done to confirm these associations ( Verghese et al., 002; Wilson et al., 2002). Given the benign nature of the proposed interventions, it would seem prudent to encourage such activities when patients or family members raise questions about prevention.