Isaiah 41:10 So do not fear, for I am with you; do not be dismayed, for I am your God.

I will strengthen you and help you; I will uphold you with my righteous right hand.

COGNITIVE DISORDERS Characterized by the syndromes of delirium, dementia and amnesia Caused by general medical conditions, substances or a combination of these factors Confusion, memory impairment, speech and language difficulties and impairment of ability to plan or engage in complex tasks are clinical manifestations ALZHEIMER DISEASE Progressive neurodegenerative illness of unknown cause Presence of neurofibrillary tangles and neuritic plaque in the brain Characterized by disturbance in judgment, memory, affect, cognition and orientation Course of disease is 2 to 20 years with sundowners syndrome Stages are: forgetfulness, confusion, ambulatory dementia and end stage DELIRIUM There is clouding of consciousness or reduced clarity of awareness of the environment Marked disturbance of recent memory Disoriented to time and place Speech may be rambling, incoherent or sparse Trouble finding words or identifying objects Perceptual disturbances may include hallucinations and illusions Persecutory delusions based on sensory misperceptions are common Develops over a course of hours or days and fluctuates in severity Often reversible and temporary DEMENTIA Deterioration of memory and cognition Due to general medical conditions or is substance related Cognitive deficits are apparent even with clarity of consciousness Memory impairment is the hallmark Develops insidiously as the condition progresses Misplacing personal objects Becoming disoriented in unfamiliar surroundings As dementia progresses, learning deficits become more prominent

NURSING FACTS IN BRIEF Cognitive Disorders, Substance-related disorders, Eating and Sexual Disorders
Individuals with pprogressive dementia eventually forget even their own names May have aphasia (language disturbance); apraxia (impaired ability to carry out motor activities despite intact motor function); agnosia (inability to recognize familiar objects or persons) Impaired ability to think abstractly and plan, initiate, sequence, monitor and stop complex behavior Have difficulty conceptualizing or solving problems ANOREXIA NERVOSA Eating disorder characterized by obsessional weight loss without an identifiable organic cause 10 to 20 times more common in girls than in boys Refusal to maintain weight Fear of gaining weight or becoming obese Disturbed body image Amenorrhea for three cycles Heightened activity level Dry, scaly skin Lowered metabolic rate Possible low T3 levels Normal TSH levels Hypokalemia Hypochloremia Anemia Parotid gland swelling ECG changes BULIMIA NERVOSA Characterized y ravenous overeating followed by guilt, depression and anger A sense of lack of control over eating exists Recurrent episodes of binging and purging Self-evaluation unduly influenced by body shape and weight Binging episodes occur in secret Wide fluctuations in weight Persistent overconcern with weight and body shape Attempts to lose weight Binging episodes terminated by sleep, abdominal pain, social interruption or selfinduced vomiting Hypokalemia Parotid gland swelling Dental erosion and caries Menstrual irregularities Anemia
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DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250

SUBSTANCE ABUSE DISORDES Substance use disorders are syndromes of pathologic use of a substance Substance induced disorders are disturbances of thinking, emotion or behavior caused by intoxication with or withdrawal from a psychoactive substance Substance dependence is a pathologic pattern of substance use that results in impairment or distress Substance abuse is a maladaptive pattern of abuse Substance intoxication is reversible, substance specific syndrome Substance withdrawal is substance specific syndrome that appears when a substance is withdrawn Addiction refers to overwhelming involvement with seeking and using drugs or alcohol Alcohol Use Disorders, include alcohol dependence and alcohol abuse disorder Alcohol Induced Disorders include alcohol intoxication, alcohol withdrawal, alcohol withdrawal delirium Alcohol-induced persisting dementia Alcohol-induced persisting amnestic disorder include korsakoffs psychosis and wernickes encephalopathy Alcohol withdrawal delirium is a severe alcohol withdrawal syndrome Disulfiram (antabuse) is an aversion therapy Heroin, morphine, codeine, opium and methadone are opiates Withdrawal from amphetamine causes psychotic behavior Cocaine is the most addictive drug known to man Hallucinogens cause distorted perceptions Overdosage of marijuana can cause psychosis SEXUAL DISORDERS Sexual dysfunction disorders involve a disturbance in the processes that characterize the sexual response cycle May include sexual desire disorders, sexual arousal disorders, orgasmic disorders and sexual pain disorders Sexual desire disorder include hypoactive sexual desire disorder and sexual aversion disorder Sexual arousal disorders include female sexual arousal disorder and male erectile disorder Orgasmic disorders include inhibited female orgasm, inhibited male orgasm and premature ejaculation Sexual pain disorder includes dyspareunia Paraphilia is a disorder characterized by unusual sexual imagery Paraphilias involve non-human objects, the suffering and humiliation of oneself or another person

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Bestiality/Zoophilia; animals Exhibitionism; exposing of genitals Fetishism; inanimate articles Frotteurism; touching and rubbing against nonconsenting person Sexual masochism; experiencing emotional or physical pain Sexual sadism; infliction of pain Pedophilia; prepubertal children Necrophilia; corpses Telephone scatologia; telephoning someone and making lewd and obscene remarks Transvestic fetishism; cross-dressing Voyeurism; peeping toms Plushophilia; stuffed toys Hybristophilia; commiting crimes Urophilia; urine Coprophilia; feces

No matter how good you get you can always get better and that's the exciting part.
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DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250