Wernicke s Encephalopathy and Cognitive Dysfunction.

Size: px
Start display at page:

Download "Wernicke s Encephalopathy and Cognitive Dysfunction."

Transcription

1 Short Communication Wernicke s Encephalopathy and Cognitive Dysfunction. *Sushree Sangita Behura **Dr. S.P. Swain ***Dr. Jashobanta Mahapatra * M.Phil Clinical Psychology Trainee, MHI, CTC ** Assoc. Prof., Dept of Psychiatry, MHI, CTC *** Assoc. Prof & HOD, Dept. Of Clinical Psychology, MHI, CTC Abstract Chronic Alcohol consumption after a period of time changes in the memory functioning, judgment and attentionconcentration leading to personality change and changes in the quality of life. Wernicke s Encephalopathy is a term used for memory dysfunction and neurocognitive impairment following chronic alcoholism. Wernicke s Encephalopathy (WE) is caused by thiamine (Vitamin B 1 ) deficiency in chronic alcoholics and also in malnutrition. Clinically, the key features are mental status disturbances (Global confusion), oculomotor abnormalities and gait disturbances (Ataxia). The diagnosis of WE is frequently missed although delay of appropriate treatment can lead to death or Korsakoff s Syndrome. Apart from these clinical features, we can find deficits in Neurocognitive functioning in patients with Wernicke s Encephalopathy, which is more prominent after the improvement in the physical conditions. Neurocognitive functioning includes both basic cognitive processes (i.e., attention-concentration) as well as higher order cognitive processes (i.e., memory, executive functioning, reasoning). This is very much vital for maintenance of quality of life of an individual. In most of the cases, neurocognitive functioning is ignored by the clinicians. Four cases were selected to measure the neurocognitive functioning of Wernicke s Encephalopathy. KEY WORDS: Wernicke s Encephalopathy, Neurocognitive impairment, Memory functioning, Quality of life. Introduction Wernicke s Encephalopathy is an acute neuorpsychiatric syndrome that is common relative to other neurological disorders. It is associated with significant morbidity and mortality. It is characterized by nystagmus and ophthalmoplegia, mental status changes and unsteadiness of gait. Although this triad is seen in only 16% of patients. 1,2 The disorder results from a deficiency in vitamin B1 (thiamine), which in its biologically active form, thiamine pyrophosphate, is an essential co-enzyme in 68

2 several biochemical pathways in the brain. 3 We is a clinically underdiagnosed, acute or subacute illness that can cause permanent memory disturbance or death if proper treatment is not given in time. Thiamine deficiency can also cause cerebellar degeneration (alcoholic cerebellar degeneration, nutritional cerebellar degeneration) and neuropathy (alcohol neuropathy, thiamine deficiency neuropathy). 4 Carl Wernicke, a German Physician( ), described this entity in 1881 as an Acute superior hemorrhagic polioencephalitis in two alcohol misusing men and a young woman who developed persistent vomiting due to pyloric stenosis after the ingestion of sulphuric acid. 5 The classic triad and fundoscopic changes, consisting of swelling of the optic disks and retinal haemorrhages were present in these patients. 5 All of them died within two weeks of onset of neurological manifestations.during 1887 through 1889, a Russian Physician Sergei S. Korsakoff ( ) described a similar illness in a larger group of patients with acute confusion and peripheral neuropathy. Those who survived had protracted memory disturbances with great difficulty in memorizing recent events. He named the disease polyneuritic psychosis. 6 Objective of the Study To assess the neurocognitive functioning of Wernicke s encephalopathy in chronic alcoholics with special reference to memory functioning, attention concentration, executive functioning and visuo-spatial orientation leading to impairment of quality of life. Uniqueness of the Study This study highlights the deficits in various cognitive domains of persons with Wernicke s Encephalopathy and how those deficits affect the quality of life and daily living of an individual. It emphasizes on memory functioning, attention-concentration, visuo-spatial ability, visuo-motor coordination as well as executive functioning. Functioning of different regions of brain was assessed by administration of different tests. It correlates the findings of CT Scan and functioning of different regions of the brain by Neurocognitive assessment (PGIBBD). Material and Methods 1) DSM-IV-TR Criteria of APA 2) PGI Battery of Brain Dysfunction by Dr. Dwarka Pershad and Dr. S. K. Verma. This test consists of five subtests. 3) WHO-QOL BREF-Odia Version. This is developed by Quality of life Research and Development foundation (2008), consisting of 26-69

3 items. Four domains are: Physical, Psychological, Environmental and Social relations. Procedure In this study, four case reports of Wernicke s Encephalopathy are presented with detailed discussion about their physical as well as neurocognitive status. The cases were taken from the Outdoor Department of Mental Health Institute, S.C.B. M.C.H., Cuttack. The evaluation were made on the basis of informed consent of both the patient as well as their family members. Three sessions with forty five minutes of each session were required for the collection of data from each patient. Case Reports CASE-1 A Hindu Male, aged fifty-seven yrs., educated up to 5th std, belonging to lower socioeconomic status, worked as a liquor shop owner, was addicted to alcohol from his age thirty two. He consumed alcohol around 400ml per day (Aska 40: containing % of alcohol). Most of the times he consumed alcohol alone. Being the liquor shop owner he had easily accessible to alcohol. He was admitted in the psychiatric ward with the complaints of confusion in daily activities, irrelevant talk, gait disturbances, forgetfulness, unprovoked aggression, using abusive language towards others, irritable and sleep disturbances. On examination he had liver dysfunction (!ALT,!AST,!ALK. Phos.,!GGT and fatty changes in the liver). On CT Scan mild atrophic changes in the brain was noticed (Bilateral sylvian fissures and cortical sulci appear prominent). Neurocognitive assessment was done three months after discharge. The findings were as follows: There was dysfunction in the immediate memory, remote memory, visual retention and recognition, where as minimal impairment in recent memory, attention & concentration anddelayed recall. Intelligence was found to be with in normal range.impairment in Nahor-Benson test suggested the disturbances in visual acuity and depth perception. Impairment in BGT was suggestive of organicity as well as disturbances in visuo-motor coordination. CASE-2 A Hindu Male, aged fifty yrs., educated up to Graduation, belonging to middle socioeconomic status, worked as a technician in a steel plant. He was addicted to alcohol (Whisky-40% of alcohol and Beer) since last 20 yrs and consumed around 180 ml per day along with his friends. He had complaints of confusion, gait disturbances, not recognizing family members, forgetfulness in daily activities and irrelevant talk at the time of admission. On examination he had liver dysfunction (!ALT,!AST,!ALK. Phos.,!GGT and fatty changes in the liver). On CT Scan, bilateral lateral ventricles and third ventricles are prominent 70

4 and bilateral sylvian fissures and cortical sulci are prominent. MRI findings suggested relative early fronto-temporal shrinkage and tiny foci of leucomalacia involving frontal W.M. Region due to microvascular ischemia for clinical correlation. In order to assess the cognitive function, PGIBBD was administered around five months after discharge. The findings were as follows: There was dysfunction in the recent memory, mental balance, delayed recall, attention-concentration, visual retention and recognition. Impairment in Performance intelligence suggested difficulty in abstract and practical ability.in Verbal adult intelligence scale, there was impairment in arithmetic subtest. Impairment in Nahor- Benson test suggested the disturbances in visual acuity and depth perception. Impairment in BGT was suggestive of organicity as well as disturbance in visuomotor coordination. CASE-3 A Hindu male, aged fifty five years, educated up to third standard belonging to lower socioeconomic status, who was working as a mechanic in motor garage. He was addicted to alcohol from his adolescence age of thirteen years. He was abdicated to beer (Local name-aska 40), Whisky-40% of alcohol, and Rum-45% of alcohol and was taking very often with his friends. In the initial years of addiction the frequency of consuming alcohol was 3-4 times per week. But after five years his frequency had been increased to almost every day. He was admitted in the hospital with complaints of grandiose ideas, aggressive behavior, paranoid ideas, confusion and ataxia. On examination he had liver dysfunction (!ALT,!AST,!ALK. Phos. and!ggt). On CT Scan, a hypodense lesion was seen in the left Temporal Lobe which was a small infarct and diffuse hypo density in bilateral periventricular area suggesting ischemic changes was found, whereas lateral and third ventricle was normal. With improvement of his physical conditions, he was discharged from the hospital and reported after 2 months. At that time, there were complaints of forgetfulness in his daily routine and occupational activities, persistent paranoid ideas, minor mistakes in his occupational work. There was no ataxia but diminished vision was there which was because of refractive error but not due to optic nerve atrophy (as examined by the Ophthalmologist). To assess the Neurocognitive status, PGIBBD was administered. The findings were as follows:- There were dysfunctions in the immediate, recent, remote memory, and recognition, where as minimal impairment in attention & concentration, retention for dissimilar pairs and visual retention. In verbal intelligence scale, there were minimal impairment in information, digit span and 71

5 arithmetic. Slight deviation in dysfunction rating score on Nahor-Benson test suggested the disturbances in visual acuity and depth perception. Organicity and disturbances in Visuo-motor coordination, were confirmed by Bender Gestalt test. CASE-4 A Hindu male, aged forty- eight years, educated up to graduation, worked as a store keeper in Indian Army, was addicted to alcohol from his age thirty-three. He was taking around one eighty to two hundred ml alcohol (Rum: containing 45% of alcohol). Being the store keeper in the army, he had easily accessible to alcohol and was consumed very often almost every day at evening time. He was admitted in drug deaddiction center with complaints of global confusion, gait disturbance (ataxia), forgetfulness in daily activities, doing minor mistakes in daily routine activities, highly irritable and restless. On examination, there was liver dysfunction (!ALT,!AST,!ALK. Phos.,!GGT and there was fatty change in the liver). There was no abnormality detected on CT Scan. After treatment in the drug deaddiction center, he was discharged. After two months to assess the Neurocognitive functions, PGIBBD was administered and results were as follows:- There were great deviations in delayed recall, attention & concentration retention for dissimilar pairs, whereas little deviations in remote memory, mental balance, immediate recall, visual retention and recognition. But there was no impairment in recent memory. His intelligence was found to be decreased from previous level. The results in Nahor Benson Test also revealed the disturbances in visual acuity and depth perception. No abnormality was detected in CT Scan findings. Discussion Alcohol dependence or Chronic alcoholism, a common psychiatric disorder in the general population, has a significant impact on health. In recent years, this condition has a become a major social and personal menace in most societies. According to Global Status Report on Alcohol, 7 alcohol use disorders accounted for 1.4% of the global disease burden. Alcohol consumption causes 3.2% of deaths (1.8 million) and 4% of the disability-adjusted life years lost (58.3 million). In chronic alcoholics the process of memory dysfunction starts at the neuronal level in the brain because of the deficiency of vitamin B1, which is otherwise called as Thiamine. This thiamine plays a key role in the neurocognitive impairment at the cellular level in the brain cells. Thiamine plays a vital role in the metabolism of carbohydrates. It is a cofactor for several essential enzymes, in deficiency of which cellular system begins to fail, resulting eventually cell death. Because these enzymes play an essential role in cerebral energy utilization, thiamine 72

6 deficiency may propagate brain tissue injury by inhibiting metabolism in brain regions with higher metabolic demands and high thiamine turnover. 8 Thiamine acts as a coenzyme in the metabolism of glucose and lipids and as stores of water soluble vitamins are limited in the body, deficiency can manifest within 2 9, 10 to 3 weeks of cessation of intake. Chronic alcohol consumption in other ways induce thiamine deficiency through several potential mechanism : genetic predisposition, replacement of vitamincontaining foods by the high calorific value of alcohol, impaired absorption of thiamine from the gut, impairment of storage by the liver, thiamine transport problems, other nutritional deficiencies, decreased phosphorylation to thiamine pyrophosphate and excessive requirement for the metabolism of alcohol. 10 In long term alcoholics, malnutrition can reduce intestinal thiamine absorption by 70%, decreasing serum levels of thiamine to between 30% and 98% below the lower level established for normal subjects. Wernicke s Encephalopathy can be difficult to diagnose because of either a relatively non-specific clinical presentation of the disease in some cases or because of unrecognized clinical data and neurological signs. The diagnosis is clinical and is mainly supported by the dramatic response of neurological signs to parenteral thiamine. Among paraclinical studies MRI is currently considered the most valuable for diagnosis. The physical examination of those four cases of Wernicke s encephalopathy, revealed the presence of global confusion and ataxic gait at the time of admission. However, those symptoms were improved after subsequent interventions. Among the three cardinal signs, i.e. global confusion, ataxia and ocular signs, the first two were present in all cases, but nystagmus was absent. Impairment in memory functioning which is the most vital component for maintenance of quality of life was assessed by PGIBBD after improvement of the physical conditions of the individuals. The typical Korsakoff memory defect was clearly evident from the outset, being at the time of initial examinations. However, there were overlapping of symptoms of global confusion and memory dysfunction. It was very hard to determine at which point confusion of thought recedes and the memory defect becomes the most prominent sign. Administration of thiamine in early stage improves the ataxia and opthalmoplegia but confusion & neurological dysfunction persisted for long time which was evident from the neurocognitive assessment. 11,12 In all the cases Memory dysfunction was so disabling that the persons were unable to maintain a good quality of life. There were definite existence of personal, social and occupational impairment. Although confusion was disappeared in later phase but the memory function and learning of new things appear to be impaired & dysfunction in these 73

7 two spheres lasted for long time. The CT Scan/MRI findings revealed lesions in the different parts of the brain which were different in all the cases. Studies suggested that up to 80% of patients of Wernicke s Encephalopathy, may not be diagnosed at early stages, which make estimates of morbidity rates unreliable. 12 The classical three components of Wernicke s Encephalopathy presentation may not be associated with classical clinical triad up to 90% cases. Except the cardinal features of WE, there were definite deficits in different areas of Neurocognitive functions in all the cases. Memory dysfunction is present in all the cases, particularly disturbances in recent memory, remote memory, immediate recall, delayed recall and attention-concentration. This memory dysfunction causes social and occupational impairment and ultimately creating both physical and mental disability of the individual. Information processing or ability to learn new thingsis also significantly affected, which is one of the important component of daily living. The results also suggested theimpairments in other areas of neurocognitive functioning other than memory, i.e. executive functioning, visual acuity and depth perception etc. Impairments in neurocognitive functioning hamper the quality of life of an individual. QOL, a concept situated between social and clinical sciences, is a pertinent indicator to evaluate the subjective experience of the patient and to quantify the psychosocial burden of alcoholism. 13,14 In current practice, the QOL of alcohol dependence patients is not measured systematically, even though this si relevant to the psychosocial context of interventions. 15,16 Among various psychiatric conditions, alcohol-related disorders, i.e. WE, significantly affect QOL, but this area has not been extensively studied. Foster et al. 17 reported poorer quality of life for women in comparison to men who were alcoholdependent. There is paucity of published literature on QOL in alcohol dependence subjects treated in an outpatient clinic. Findings of WHO-QOL BREF suggested the impairment of four domains of QOL in all the cases, but the severity level varies from person to person. In patients suspected of having Wernicke s encephalopathy, thiamine should be initiated immediately, with prescription of the parenteral thiamine doses deemed to be effective in this condition and in prevention of Korsakoff s Syndrome. Conclusion Chronic alcohol consumption has adverse effect on health. Some people are more likely to experience the consequences of chronic alcohol use.these tend to be males having high perceived stress and anxiety with dissatisfaction and poor quality of life, lack of social support, economic strains and chronic stress. Das, Balakrishnan and Vasudevan reported that in a developing 74

8 country like India, over 20% of all disabilityadjusted life years are lost chiefly because of poor health status of the people, marked nutritional deficiencies and widely prevalent alcohol addiction. 18 Like the three cardinal features, Memory dysfunction in WE should be given importance, which is most vital component for the maintenance of quality of life. This has been concluded from our study. In addition, attention-concentration, visuo-spatial ability, executive functioning and visuo-motor coordination have been impaired to different degrees in different cases according to the duration, frequency, amount and nutritional status of the chronic alcoholics. As a result the disability produced by this condition can be well managed. By reviewing the different literatures and scientific articles from pubmed, medscape, cochraine and indmed, it has been concluded that around 70-80% of cases of Wernicke s Encephalopathy, the three cardinal features were not present, which corroborates with the findings of our cases. One of the limitations of this study is that it included small sample size and short duration of follow up. Large sample size with longer duration of follow up could have predicted something more about this disabling condition. Implications of the Study Monitoring the level of thiamine in alcoholics should be an important component of all consultations either in the hospital or in DDC. WE is a significantly disabling condition that can be prevented if identified and treated early in the course. Chronic alcoholics should be screened out at an early stage to detect WE at early so that the process can be reversible. Institutionalization, discharge and follow up arrangements for such individuals may be as important as thiamine replacement. Quality of life should be extensively studied in order to evaluate the subjective experiences of the patient and to quantify the psychosocial burden of chronic alcoholism. Awareness in the society regarding alcoholism can be act as a protective factor. Cognitive function assessment should be the part of routine examination in chronic alcoholics. 75

9 References 1. Victor M. The Wernicke-Korsakoff Syndrome. In: Vinken PJ, Bruyn GW, eds. Handbook of clinical neurology, vol 28, part II. Amsterdam: North-Holland Publishing Company, 1976: Harper CG, Giles M, Finlay-Jones R. Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J Neurol Neurosurg Psychiatry, 1986; 49: Manzo L, Locatelli C, Candura SM, Costa LG. Nutrition and alcohol neurotoxicity. Neurotoxicology, 1994; 15: Victor M, Adams R, Collins G. The Wernicke-Korsakoff syndrome and related disorders due to alcoholism and malnutrition. 2 ed. F.A. Davis Company, Filadelffu Wernicke C. Die acute haemorrhagische polioencephalitis superior. In: Lehrbuch der Gehirnkrankheitan fur Aerzte und Studirende, Bd II, Fisher Verlag, Kassel, 1881: Victor M, Yakovlev PI. S.S. Korsakoff s psychic disorder in conjunction with peripheral neuritis; a translation of Korsakoff s original article with comments on the author and his contribution to clinical medicine. Neurology 1955; 5: Global status report on alcohol. Geneva: World Health Organisation; Donnino MW, Vega J, Miller J, et al. Myths and misconceptions of Wernicke s encephalopathy: what every emergency physician should know. Ann Emerg Med. Dec 2007;50(6): [Medline]. 9. Attard O, Dietemann JL, Diemunsch P, Pottecher T, Meyer A, Calon BL. Wernicke encephalopathy: a complication of parenteral nutrition diagnosed by magnetic resonance imaging.anesthesiology. Oct 2006;105(4): [Medline]. 10. [Best Evidence] [Guideline] Day E, Bentham PW, Callaghan R, Kuruvilla T, George S. Thiamine for prevention and treatment of Wernicke- Korsakoff Syndrome in people who abuse alcohol (Cochrane Review ). The Cochrane Library. 2013;7: Naidoo DP, Bramdev A, Cooper K: Wernicke s encephalopathy & alcohol related disease: Postgrad Med J: 1991 Nov; 67(793): Thomson AD, Marshall EJ: The treatment of patients at risk of developing Wernicke s encephalopathy in the community : Alcohol Alcohol Mar- Apr; 41 (2) : Epstein RS, Sherwood LM. From outcomes research to disease management: A guide for the perplexed. Ann Intern Med 1996;124:

10 14. Preau M, Protopopescu C, Spire B, Sobel A, Dellamonica P, Moatti JP, et al.; MANIF-2000 Study Group. Health related quality of life among both current and former injection drug users who are HIV-infected. Drug Alcohol Depend 2007;86: Donovan D, Mattson ME, Cisler RA, Longabaugh R, Zweben A. Quality of life as an outcome measure in alcoholism treatment research. J Stud Alcohol Suppl 2005;15:119-39; discussion Longabaugh R, Mattson ME, Connors GJ, Cooney NL. Quality of life as an outcome variable in alcoholism treatment research. J Stud Alcohol Suppl 1994;12: Foster JH, Powell JE, Marshall EJ, Peters TJ. Quality of life in alcohol- dependent subjects- A review. Qual Life Res 1999; 8: Das SK, Balakrishnan V, Vasudevan DM. Alcohol: Its health and social impact in India. Natl Med J India 2006; 19: Address of correspondence: Sushree Sangita Behura M.Phil Cl. Psychology Trainee Dept. of Clinical psychology Mental Health Institute (Centre of Excellence), S.C.B.M.C.H. Cuttack 77

Martin Jackson. August 2011

Martin Jackson. August 2011 Martin Jackson August 2011 Substance Related Brain Injury: Basic Research Findings All neurotoxic substances have an acute intoxicating effect (and withdrawal effect) that produces changes in cognition,

More information

Alcohol Withdrawal Syndrome & CIWA Assessment

Alcohol Withdrawal Syndrome & CIWA Assessment Alcohol Withdrawal Syndrome & CIWA Assessment Alcohol Withdrawal Syndrome is a set of symptoms that can occur when an individual reduces or stops alcoholic consumption after long periods of use. Prolonged

More information

Diagnosis and treatment of Wernicke s encephalopathy in an in-patient alcohol detoxification unit: a completed audit cycle

Diagnosis and treatment of Wernicke s encephalopathy in an in-patient alcohol detoxification unit: a completed audit cycle Diagnosis and treatment of Wernicke s encephalopathy in an in-patient alcohol detoxification unit: a completed audit cycle Vijay Delaffon, 1 Srinivas Naik, 1 Rajandeep Mann, 1 Arshya Vahabzadeh, 2 Timothy

More information

Review Group: Mental Health Operational Medicines Management Group. Signature Signature Signature. Review Date: December 2014

Review Group: Mental Health Operational Medicines Management Group. Signature Signature Signature. Review Date: December 2014 Mental Health NHS Grampian Mental Health Service Staff Guidance For The Prescribing Of Vitamin Supplementation During In-Patient Admission (Mental Health) For Alcohol Withdrawal Co-ordinators: Consultant

More information

Mental health issues in the elderly. January 28th 2008 Presented by Éric R. Thériault etheriau@lakeheadu.ca

Mental health issues in the elderly. January 28th 2008 Presented by Éric R. Thériault etheriau@lakeheadu.ca Mental health issues in the elderly January 28th 2008 Presented by Éric R. Thériault etheriau@lakeheadu.ca Cognitive Disorders Outline Dementia (294.xx) Dementia of the Alzheimer's Type (early and late

More information

GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE

GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE Dr Millicent Chikoore MBBS MRCPsych Dr O Lagundoye MBBS MRCPsych Community based alcohol detoxification is a safe and effective option for

More information

Alcohol Liaison Service. Alcohol Withdrawal. Information

Alcohol Liaison Service. Alcohol Withdrawal. Information Alcohol Liaison Service Alcohol Withdrawal Information Alcohol withdrawal If you are dependent on alcohol and suddenly stop drinking, there are a series of symptoms that you may experience. These include:

More information

Supported Alcohol Withdrawal Treatment Information

Supported Alcohol Withdrawal Treatment Information Supported Alcohol Withdrawal Treatment Information Alcohol Liaison Service What is Alcohol Withdrawal Syndrome? If you are dependent on alcohol and suddenly stop drinking or you are admitted to hospital

More information

Alcohol: The good, the bad and

Alcohol: The good, the bad and Alcohol: The good, the bad and the Clare Wilhelm, Ph.D. Portland VA Medical Center Oregon Health & Science University Supported by VA Career Development Grant (BX001294) Overview Alcohol statistics the

More information

The Role of Neuropsychological Testing in Guiding Decision- Making Related to Dementia

The Role of Neuropsychological Testing in Guiding Decision- Making Related to Dementia The Role of Neuropsychological Testing in Guiding Decision- Making Related to Dementia By Scott Knight, Director, SLR Diagnostics & Assessments, a division of Sibley & Associates Inc., and Konstantine

More information

SUBSTANCE ABUSE SCREENING

SUBSTANCE ABUSE SCREENING OVERVIEW Substance abuse in the elderly is a common problem that is frequently under- diagnosed by primary care doctors and families. Alcohol abuse is present in 10% to 15% of elderly individuals who seek

More information

THE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation 2011. The Issues 5/18/2011. RCGP Conference May 2011

THE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation 2011. The Issues 5/18/2011. RCGP Conference May 2011 RCGP Conference May 2011 Community Based Medically Assisted Alcohol Withdrawal THE BASICS An option for consideration World Health Organisation 2011 Alcohol is the world s third largest risk factor for

More information

ARTICLE #1 PLEASE RETURN AT THE END OF THE HOUR

ARTICLE #1 PLEASE RETURN AT THE END OF THE HOUR ARTICLE #1 PLEASE RETURN AT THE END OF THE HOUR Alcoholism By Mayo Clinic staff Original Article: http://www.mayoclinic.com/health/alcoholism/ds00340 Definition Alcoholism is a chronic and often progressive

More information

Behavioral Health Psychological/Neuropsychological Testing Guidelines

Behavioral Health Psychological/Neuropsychological Testing Guidelines Behavioral Health Psychological/Neuropsychological Testing Guidelines Psychological testing (procedural code 96101) and Neuropsychological Testing (procedural code 96118) involve the culturally and linguistically

More information

ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE

ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE Authors Sponsor Responsible committee Ratified by Consultant Psychiatrist; Pharmacist Team Manager Medical Director Medicines Management Group

More information

ADMISSION TO THE PSYCHIATRIC EMERGENCY SERVICES OF PATIENTS WITH ALCOHOL-RELATED MENTAL DISORDER

ADMISSION TO THE PSYCHIATRIC EMERGENCY SERVICES OF PATIENTS WITH ALCOHOL-RELATED MENTAL DISORDER Bulletin of the Transilvania University of Braşov Series VI: Medical Sciences Vol. 4 (53) No. 2-2011 ADMISSION TO THE PSYCHIATRIC EMERGENCY SERVICES OF PATIENTS WITH ALCOHOL-RELATED MENTAL DISORDER P.

More information

Social Security Disability Insurance and young onset dementia: A guide for employers and employees

Social Security Disability Insurance and young onset dementia: A guide for employers and employees Social Security Disability Insurance and young onset dementia: A guide for employers and employees What is Social Security Disability Insurance? Social Security Disability Insurance (SSDI) is a payroll

More information

Alcohol and Brain Damage

Alcohol and Brain Damage Alcohol and Brain Damage By: James L. Holly, MD O God, that men should put an enemy in their mouths to steal away their brains! That we should, with joy, pleasance, revel, and applause, transform ourselves

More information

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D]

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] I. Definitions: Detoxification is the process of interrupting the momentum of compulsive drug and/or alcohol use in an individual

More information

TCHP Behavioral Health Psychological/Neuropsychological Testing Child/Adolescent Guidelines

TCHP Behavioral Health Psychological/Neuropsychological Testing Child/Adolescent Guidelines TCHP Behavioral Health Psychological/Neuropsychological Testing Child/Adolescent Guidelines Psychological testing involves the culturally and linguistically competent administration and interpretation

More information

Montreal Cognitive Assessment (MoCA) as Screening tool for cognitive impairment in mtbi.

Montreal Cognitive Assessment (MoCA) as Screening tool for cognitive impairment in mtbi. Montreal Cognitive Assessment (MoCA) as Screening tool for cognitive impairment in mtbi. Suresh Kumar, M.D. AUTHOR Director of: Neurology & Headaches Center Inc. Neurocognitve &TBI Rehabilitation Center

More information

Attention, memory and learning and acquired brain injury. Vicki Anderson. Jamie M. Attention & learning: an information processing model

Attention, memory and learning and acquired brain injury. Vicki Anderson. Jamie M. Attention & learning: an information processing model Attention, memory and learning and acquired brain injury Vicki Anderson Jamie M. Childhood acquired amnesia Attention & learning: an information processing model MANAGEMENT Organising, problem solving

More information

Effects of hypoglycemia on brain. Ji Hyun Kim Department of Neurology Korea University College of Medicine

Effects of hypoglycemia on brain. Ji Hyun Kim Department of Neurology Korea University College of Medicine Effects of hypoglycemia on brain Ji Hyun Kim Department of Neurology Korea University College of Medicine Glucose and brain The brain is dependent on glucose as its principal fuel Interruption of glucose

More information

Version 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy.

Version 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy. Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Directorate & Speciality A Guideline for the Management of Acute Alcohol Withdrawal

More information

ALCOHOLISM, ALCOHOL DEPENDENCE AND THE EFFECTS ON YOUR HEALTH.

ALCOHOLISM, ALCOHOL DEPENDENCE AND THE EFFECTS ON YOUR HEALTH. ALCOHOLISM, ALCOHOL DEPENDENCE AND THE EFFECTS ON YOUR HEALTH. Alcoholism also known as alcohol dependence is a disabling ADDICTIVE DISORDER. It is characterized by compulsive and uncontrolled consumption

More information

Pragmatic Evidence Based Review Substance Abuse in moderate to severe TBI

Pragmatic Evidence Based Review Substance Abuse in moderate to severe TBI Pragmatic Evidence Based Review Substance Abuse in moderate to severe TBI Reviewer Emma Scheib Date Report Completed November 2011 Important Note: This report is not intended to replace clinical judgement,

More information

Depression in Older Persons

Depression in Older Persons Depression in Older Persons How common is depression in later life? Depression affects more than 6.5 million of the 35 million Americans aged 65 or older. Most people in this stage of life with depression

More information

75-09.1-08-02. Program criteria. A social detoxi cation program must provide:

75-09.1-08-02. Program criteria. A social detoxi cation program must provide: CHAPTER 75-09.1-08 SOCIAL DETOXIFICATION ASAM LEVEL III.2-D Section 75-09.1-08-01 De nitions 75-09.1-08-02 Program Criteria 75-09.1-08-03 Provider Criteria 75-09.1-08-04 Admission and Continued Stay Criteria

More information

http://nurse practitioners and physician assistants.advanceweb.com/features/articles/alcohol Abuse.aspx

http://nurse practitioners and physician assistants.advanceweb.com/features/articles/alcohol Abuse.aspx http://nurse practitioners and physician assistants.advanceweb.com/features/articles/alcohol Abuse.aspx Alcohol Abuse By Neva K.Gulsby, PA-C, and Bonnie A. Dadig, EdD, PA-C Posted on: April 18, 2013 Excessive

More information

Documentation Requirements ADHD

Documentation Requirements ADHD Documentation Requirements ADHD Attention Deficit Hyperactivity Disorder (ADHD) is considered a neurobiological disability that interferes with a person s ability to sustain attention, focus on a task

More information

Alcohol related ataxia. Information for patients Neurology

Alcohol related ataxia. Information for patients Neurology Alcohol related ataxia Information for patients Neurology page 2 of 8 What is ataxia? Ataxia means lack of co-ordination, and is the result of damage to a part of the brain called the cerebellum which

More information

SUBSTANCE MISUSE IN OLDER ADULTS

SUBSTANCE MISUSE IN OLDER ADULTS SUBSTANCE MISUSE IN OLDER ADULTS Ageing Population Estimates indicate by 2025 more than 25% of UK s population will be over 60 years old A generation which will have grown up in a period when drug use

More information

2.6.4 Medication for withdrawal syndrome

2.6.4 Medication for withdrawal syndrome .6.3 Self-medication Self-medication presents a risk during alcohol withdrawal, particularly when there is minimal supervision (low level and medium level 1 settings). Inform patients of the risk of selfmedication

More information

BREAST CANCER AWARENESS FOR WOMEN AND MEN by Samar Ali A. Kader. Two years ago, I was working as a bedside nurse. One of my colleagues felt

BREAST CANCER AWARENESS FOR WOMEN AND MEN by Samar Ali A. Kader. Two years ago, I was working as a bedside nurse. One of my colleagues felt Ali A. Kader, S. (2010). Breast cancer awareness for women and men. UCQ Nursing Journal of Academic Writing, Winter 2010, 70 76. BREAST CANCER AWARENESS FOR WOMEN AND MEN by Samar Ali A. Kader Two years

More information

Alcohol Withdrawal. Introduction. Blood Alcohol Concentration. DSM-IV Criteria/Alcohol Abuse. Pharmacologic Effects of Alcohol

Alcohol Withdrawal. Introduction. Blood Alcohol Concentration. DSM-IV Criteria/Alcohol Abuse. Pharmacologic Effects of Alcohol Pharmacologic Effects of Alcohol Alcohol Withdrawal Kristi Theobald, Pharm.D., BCPS Therapeutics III Fall 2003 Inhibits glutamate receptor function (NMDA receptor) Inhibits excitatory neurotransmission

More information

Glasgow Assessment and Management of Alcohol

Glasgow Assessment and Management of Alcohol Glasgow Assessment and Management of Alcohol If you would like further information or advice on the alcohol screening and withdrawal management guideline(gmaws) please contact your local acute addiction

More information

Psychological and Neuropsychological Testing

Psychological and Neuropsychological Testing 2015 Level of Care Guidelines Psych & Neuropsych Testing Psychological and Neuropsychological Testing Introduction: The Psychological and Neuropsychological Testing Guidelines provide objective and evidencebased

More information

HEPATIC ENCEPHALOPATHY

HEPATIC ENCEPHALOPATHY HEPATIC ENCEPHALOPATHY Jan Albrecht Department of Neurotoxicology, Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland Brussels, July 14, 2009 DEFINITIONS: - HEPATIC ENCEPHALOPATHY (HE)

More information

Program Requirements for Fellowship Education in Neuro- Ophthalmology

Program Requirements for Fellowship Education in Neuro- Ophthalmology Program Requirements for Fellowship Education in Neuro- Ophthalmology [M] = Must have / required [S] = Should have I. Introduction A. Definition and Scope of Neuro ophthalmology Neuro ophthalmology is

More information

VIRTUAL UNIVERSITY OF PAKISTAN FORMAT OF THE INTERNSHIP REPORT FOR BS Psychology (Clinical Setting)

VIRTUAL UNIVERSITY OF PAKISTAN FORMAT OF THE INTERNSHIP REPORT FOR BS Psychology (Clinical Setting) VIRTUAL UNIVERSITY OF PAKISTAN FORMAT OF THE INTERNSHIP REPORT FOR BS Psychology (Clinical Setting) 1. Title page The title page of the report will include: Clinical Case Studies The name of the internee,

More information

DIAGNOSTIC CRITERIA OF STROKE

DIAGNOSTIC CRITERIA OF STROKE DIAGNOSTIC CRITERIA OF STROKE Diagnostic criteria are used to validate clinical diagnoses. Here below MONICA diagnostic criteria are reported. MONICA - MONItoring trends and determinants of CArdiovascular

More information

A developing service. Cheshire and Wirral Partnership NHS Foundation Trust Mersey Care NHS Trust University of Liverpool

A developing service. Cheshire and Wirral Partnership NHS Foundation Trust Mersey Care NHS Trust University of Liverpool A developing service Cheshire and Wirral Partnership NHS Foundation Trust Mersey Care NHS Trust University of Liverpool Vascular disease Trauma Subcortical frontal disorders ARD Brain injury KP Involuntary,

More information

Steps to getting a diagnosis: Finding out if it s Alzheimer s Disease.

Steps to getting a diagnosis: Finding out if it s Alzheimer s Disease. Steps to getting a diagnosis: Finding out if it s Alzheimer s Disease. Memory loss and changes in mood and behavior are some signs that you or a family member may have Alzheimer s disease. If you have

More information

PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL TESTING

PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL TESTING Status Active Medical and Behavioral Health Policy Section: Behavioral Health Policy Number: X-45 Effective Date: 01/22/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members

More information

Serious Mental Illness: Symptoms, Treatment and Causes of Relapse

Serious Mental Illness: Symptoms, Treatment and Causes of Relapse Serious Mental Illness: Symptoms, Treatment and Causes of Relapse Bipolar Disorder, Schizophrenia and Schizoaffective Disorder Symptoms and Prevalence of Bipolar Disorder Bipolar disorder, formerly known

More information

Cerebral palsy, neonatal death and stillbirth rates Victoria, 1973-1999

Cerebral palsy, neonatal death and stillbirth rates Victoria, 1973-1999 Cerebral Palsy: Aetiology, Associated Problems and Management Lecture for FRACP candidates July 2010 Definitions and prevalence Risk factors and aetiology Associated problems Management options Cerebral

More information

Psychological and Neuropsychological Testing

Psychological and Neuropsychological Testing Psychological and Neuropsychological Testing I. Policy University Health Alliance (UHA) will reimburse for Psychological and Neuropsychological Testing (PT/NPT) when it is determined to be medically necessary

More information

Overview of the Adverse Childhood Experiences (ACE) Study. Robert F. Anda, MD, MS Co-Principal Investigator. www.robertandamd.com

Overview of the Adverse Childhood Experiences (ACE) Study. Robert F. Anda, MD, MS Co-Principal Investigator. www.robertandamd.com Overview of the Adverse Childhood Experiences (ACE) Study Robert F. Anda, MD, MS Co-Principal Investigator www.robertandamd.com Death Early Death Disease, Disability and Social Problems Adoption of Health-risk

More information

Alcohol Use Disorders Information for Patients and Carers

Alcohol Use Disorders Information for Patients and Carers Alcohol Liaison Service Alcohol Use Disorders Information for Patients and Carers Information Drinking too much alcohol greatly increases your risk of serious health problems. Many different health problems

More information

Symptom-Triggered Alcohol Detoxification: A Guideline for use in the Clinical Decisions Unit of the Emergency Department.

Symptom-Triggered Alcohol Detoxification: A Guideline for use in the Clinical Decisions Unit of the Emergency Department. Symptom-Triggered Alcohol Detoxification: A Guideline for use in the Clinical Decisions Unit of the Emergency Department. Dr Eugene Cassidy, Liaison Psychiatry; Dr Io har O Sulliva, E erge cy Department,

More information

2016 CODING FOR FETAL ALCOHOL SPECTRUM DISORDERS

2016 CODING FOR FETAL ALCOHOL SPECTRUM DISORDERS 2016 CODING FOR FETAL ALCOHOL SPECTRUM DISORDERS Listed below are the most commonly used codes applicable to FASD patient care. Code Description ICD-10-CM Primary Diagnosis P04.3 Newborn (suspected to

More information

LUPUS. and the Brain LUPUSUK 2015

LUPUS. and the Brain LUPUSUK 2015 12 LUPUS and the Brain LUPUSUK 2015 LUPUS and the Brain This factsheet endeavours to answer some of the many questions asked regarding lupus and the brain. Doctors throughout the world are now recognising

More information

Source: National Institute on Alcohol Abuse and Alcoholism. Bethesda, Md: NIAAA; 2004. NIH Publication No. 04-3769.

Source: National Institute on Alcohol Abuse and Alcoholism. Bethesda, Md: NIAAA; 2004. NIH Publication No. 04-3769. Diagnosis and Treatment of Alcohol Dependence Lon R. Hays, MD, MBA Professor and Chairman an Department of Psychiatry University of Kentucky Medical Center Defining the Standard Drink A standard drink

More information

Minnesota Organization on Fetal Alcohol Syndrome

Minnesota Organization on Fetal Alcohol Syndrome Minnesota Organization on Fetal Alcohol Understanding Fetal Alcohol Spectrum Disorders in the Treatment Setting Sierra Asamoa-Tutu Program Coordinator and Trainer sierra@mofas.org MINNESOTA ORGANIZATION

More information

Section 15.3 Long-Term Risks of Alcohol

Section 15.3 Long-Term Risks of Alcohol Objectives Identify five serious physical effects of longterm alcohol abuse. Describe the three stages of alcoholism. List in order three steps taken during recovery from alcoholism. Slide 1 of 25 Myth

More information

UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS. - Summary

UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS. - Summary UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS - Summary CHRONIC COMPLICATIONS IN PATIENTS WITH TYPE 1 DIABETES MELLITUS - Epidemiological study - PhD Manager: Professor PhD.

More information

CLINICAL PRACTICE GUIDELINES Treatment of Schizophrenia

CLINICAL PRACTICE GUIDELINES Treatment of Schizophrenia CLINICAL PRACTICE GUIDELINES Treatment of Schizophrenia V. Service Delivery Service Delivery and the Treatment System General Principles 1. All patients should have access to a comprehensive continuum

More information

TREATMENT MODALITIES. May, 2013

TREATMENT MODALITIES. May, 2013 TREATMENT MODALITIES May, 2013 Treatment Modalities New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) regulates the addiction treatment modalities offered in New York State.

More information

Cholinesterase inhibitors and memantine use for Alzheimer s disease TOPIC REVIEW

Cholinesterase inhibitors and memantine use for Alzheimer s disease TOPIC REVIEW Cholinesterase inhibitors and memantine use for Alzheimer s disease TOPIC REVIEW Diagnosis of Dementia : DSM-IV criteria Loss of memory and one or more other cognitive abilities Aphasia Apraxia Agnosia

More information

Effectiveness of group therapy on psychological wellbeing among alcoholic dependents at selected De-addiction Centre in Ahmedabad

Effectiveness of group therapy on psychological wellbeing among alcoholic dependents at selected De-addiction Centre in Ahmedabad IOSR Journal of Nursing and Health Science (IOSR-JNHS) e-issn: 2320 1959.p- ISSN: 2320 1940 Volume 3, Issue 5 Ver. I (Sep.-Oct. 2014), PP 35-39 Effectiveness of group therapy on psychological wellbeing

More information

Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice

Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice Dr IM Joubert Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice for any reason had either an at-risk pattern

More information

Source: National Institute on Alcohol Abuse and Alcoholism. Bethesda, Md: NIAAA; 2004. NIH Publication No. 04-3769.

Source: National Institute on Alcohol Abuse and Alcoholism. Bethesda, Md: NIAAA; 2004. NIH Publication No. 04-3769. Diagnosis and Treatment of Alcohol Dependence Lon R. Hays, MD, MBA Professor and Chairman Department of Psychiatry University of Kentucky Medical Center Defining the Standard Drink A standard drink = 14

More information

[KQ 804] FEBRUARY 2007 Sub. Code: 9105

[KQ 804] FEBRUARY 2007 Sub. Code: 9105 [KQ 804] FEBRUARY 2007 Sub. Code: 9105 (Revised Regulations) Theory : Two hours and forty minutes Q.P. Code: 419105 Maximum : 100 marks Theory : 80 marks M.C.Q. : Twenty minutes M.C.Q. : 20 marks 1. A

More information

Dr. Anna M. Acee, EdD, ANP-BC, PMHNP-BC Long Island University, Heilbrunn School of Nursing

Dr. Anna M. Acee, EdD, ANP-BC, PMHNP-BC Long Island University, Heilbrunn School of Nursing Dr. Anna M. Acee, EdD, ANP-BC, PMHNP-BC Long Island University, Heilbrunn School of Nursing Overview Depression is significantly higher among elderly adults receiving home healthcare, particularly among

More information

Substance Abuse in the Elderly

Substance Abuse in the Elderly Substance Abuse in the Elderly Roseann Mulligan DDS, MS Definitions: Abuse: to use wrongly, badly, excessively; to misuse Misuse: to use incorrectly or improperly; to abuse Types of Substances Implicated

More information

Rarer causes of dementia

Rarer causes of dementia PBO 930022142 NPO 049-191 Rarer causes of dementia Alzheimer s disease is the most common cause of dementia, but there are many rarer diseases and syndromes that can lead to dementia. This information

More information

Integrated Neuropsychological Assessment

Integrated Neuropsychological Assessment Integrated Neuropsychological Assessment Dr. Diana Velikonja C.Psych Neuropsychology, Hamilton Health Sciences, ABI Program Assistant Professor, Psychiatry and Behavioural Neurosciences Faculty of Health

More information

CHAPTER 2: CLASSIFICATION AND ASSESSMENT IN CLINICAL PSYCHOLOGY KEY TERMS

CHAPTER 2: CLASSIFICATION AND ASSESSMENT IN CLINICAL PSYCHOLOGY KEY TERMS CHAPTER 2: CLASSIFICATION AND ASSESSMENT IN CLINICAL PSYCHOLOGY KEY TERMS ABC chart An observation method that requires the observer to note what happens before the target behaviour occurs (A), what the

More information

OUTPATIENT DAY SERVICES

OUTPATIENT DAY SERVICES OUTPATIENT DAY SERVICES Intensive Outpatient Programs (IOP) Intensive Outpatient Programs (IOP) provide time limited, multidisciplinary, multimodal structured treatment in an outpatient setting. Such programs

More information

3030. Eligibility Criteria.

3030. Eligibility Criteria. 3030. Eligibility Criteria. 5 CA ADC 3030BARCLAYS OFFICIAL CALIFORNIA CODE OF REGULATIONS Barclays Official California Code of Regulations Currentness Title 5. Education Division 1. California Department

More information

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery USING THE 48 HOUR OBSERVATION BED USING THE 48 HOUR OBSERVATION BED Detoxification

More information

Alcohol Dependence Inpatient management of Alcohol Withdrawal

Alcohol Dependence Inpatient management of Alcohol Withdrawal NHS Fife Community Health Partnerships Addiction Services Alcohol Dependence Inpatient management of Alcohol Withdrawal Intranet Procedure No A9 Author Dr. A. Baldacchino Copy No Lead Clinician Implementation

More information

2.1 Who first described NMO?

2.1 Who first described NMO? History & Discovery 54 2 History & Discovery 2.1 Who first described NMO? 2.2 What is the difference between NMO and Multiple Sclerosis? 2.3 How common is NMO? 2.4 Who is affected by NMO? 2.1 Who first

More information

Cerebral palsy can be classified according to the type of abnormal muscle tone or movement, and the distribution of these motor impairments.

Cerebral palsy can be classified according to the type of abnormal muscle tone or movement, and the distribution of these motor impairments. The Face of Cerebral Palsy Segment I Discovering Patterns What is Cerebral Palsy? Cerebral palsy (CP) is an umbrella term for a group of non-progressive but often changing motor impairment syndromes, which

More information

Tuberculosis And Diabetes. Dr. hanan abuelrus Prof.of internal medicine Assiut University

Tuberculosis And Diabetes. Dr. hanan abuelrus Prof.of internal medicine Assiut University Tuberculosis And Diabetes Dr. hanan abuelrus Prof.of internal medicine Assiut University TUBERCULOSIS FACTS More than 9 million people fall sick with tuberculosis (TB) every year. Over 1.5 million die

More information

STANDARD OPERATING PROCEDURE. Administration of High Dose Muscular Vitamin Supplements for Undergoing Alcohol

STANDARD OPERATING PROCEDURE. Administration of High Dose Muscular Vitamin Supplements for Undergoing Alcohol STANDARD OPERATING PROCEDURE Administration of High Dose Muscular Vitamin Supplements for Undergoing Alcohol DOCUMENT CONTROL: Version: 2 Ratified by: Clinical Effectiveness Committee Date ratified: 03

More information

Reversibility of Acute Demyelinating Lesions in relapsingremitting

Reversibility of Acute Demyelinating Lesions in relapsingremitting Reversibility of Acute Demyelinating Lesions in relapsingremitting Multiple Sclerosis Omar A. Khan ( Division of Neuroimmunology, Department of Neurology, Neurology and Research Services. Veterans Affairs

More information

SOCIAL SECURITY ADMINISTRATION Office of Disability Adjudication and Review DECISION JURISDICTION AND PROCEDURAL HISTORY

SOCIAL SECURITY ADMINISTRATION Office of Disability Adjudication and Review DECISION JURISDICTION AND PROCEDURAL HISTORY P-6 SOCIAL SECURITY ADMINISTRATION Office of Disability Adjudication and Review DECISION IN THE CASE OP Kristina Marie Townsend (Claimant) (Wage Earner) CLAIM FOR Period of Disability and Disability Insurance

More information

How to identify, approach and assist employees with young onset dementia: A guide for employers

How to identify, approach and assist employees with young onset dementia: A guide for employers How to identify, approach and assist employees with young onset dementia: A guide for employers What is dementia? Dementia involves the decline of cognitive functions. Young Onset Dementia, also known

More information

Introduction to the DSM-IV and Psychological Testing

Introduction to the DSM-IV and Psychological Testing Introduction to the DSM-IV and Psychological Testing Significance of Mental Illness In any given year, how many Americans will suffer with a diagnosable mental illness? How many will suffer with a serious

More information

LCD L30551 - Vitamin B12 Assays Print

LCD L30551 - Vitamin B12 Assays Print LCD L30551 - Vitamin B12 Assays Print Contractor Information Contractor Name: Highmark Medicare Services, Inc. Contractor Number(s): 12102, 12202, 12302, 12501, 12301, 12201, 12401, 12402, 12101, 12502,

More information

Psychosis Psychosis-substance use Bipolar Affective Disorder Programmes EASY JCEP EPISO Prodrome

Psychosis Psychosis-substance use Bipolar Affective Disorder Programmes EASY JCEP EPISO Prodrome Dr. May Lam Assistant Professor, Department of Psychiatry, The University of Hong Kong Psychosis Psychosis-substance use Bipolar Affective Disorder Programmes EASY JCEP EPISO Prodrome a mental state in

More information

Robert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy

Robert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy Robert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy Judith Long, MD,RWJCS Perelman School of Medicine Philadelphia Veteran Affairs Medical Center Background Objective Overview Methods

More information

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (APA, 2001) 10

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (APA, 2001) 10 5. Diagnosis Questions to be answered: 5.1. What are the diagnostic criteria for ADHD in children and adolescents? 5.2. How is ADHD diagnosed in children and adolescents? Who must diagnose it? 5.3. Which

More information

2016 Programs & Information

2016 Programs & Information Mayo Alzheimer s Disease Research Clinic Education Center 2016 Programs & Information BROCHURE TITLE FLUSH RIGHT for Persons & Families impacted by Mild Cognitive Impairment Alzheimer s Disease Dementia

More information

Headache: Differential diagnosis and Evaluation. Raymond Rios PGY-1 Pediatrics

Headache: Differential diagnosis and Evaluation. Raymond Rios PGY-1 Pediatrics Headache: Differential diagnosis and Evaluation Raymond Rios PGY-1 Pediatrics You are evaluating a 9 year old male patient at the ED brought by his mother, who says that her son has had a fever, cough,

More information

Guidelines for Documentation of a A. Learning Disability

Guidelines for Documentation of a A. Learning Disability Guidelines for Documentation of a Learning Disability A. Learning Disability B. Attention Deficit Disorder C. Psychiatric Disabilities D. Chronic Health Disabilities A. Learning Disability Students who

More information

Quality of Life of Children

Quality of Life of Children Quality of Life of Children with Mental Illness Martha J. Molly Faulkner, PhD, CNP, LISW University of New Mexico Health Sciences Center Children s Psychiatric Center Outpatient Services Objectives History

More information

Medicinal Marijuana and the Developing Adolescent Brain

Medicinal Marijuana and the Developing Adolescent Brain Medicinal Marijuana and the Developing Adolescent Brain John R. Knight, MD Associate Professor of Pediatrics Harvard Medical School Associate in Medicine & Psychiatry Children s Hospital Chair in Developmental

More information

Rehabilitation Best Practice Documentation

Rehabilitation Best Practice Documentation Rehabilitation Best Practice Documentation Click on the desired Diagnoses link or press Enter to view all information. Diagnoses: Reason for Admission to Inpatient Rehab CVA Deficits Fractures Secondary

More information

ALCOHOL RELATED DISORDERS Includes Alcohol Abuse and Alcohol Dependence; Does Not Include Alcohol Use Disorders

ALCOHOL RELATED DISORDERS Includes Alcohol Abuse and Alcohol Dependence; Does Not Include Alcohol Use Disorders 1 MH 12 ALCOHOL RELATED DISORDERS Includes Alcohol Abuse and Alcohol Dependence; Does Not Include Alcohol Use Disorders Background This case definition was developed by the Armed Forces Health Surveillance

More information

Medical College of Georgia Augusta, Georgia School of Medicine Competency based Objectives

Medical College of Georgia Augusta, Georgia School of Medicine Competency based Objectives Medical College of Georgia Augusta, Georgia School of Medicine Competency based Objectives Medical Knowledge Goal Statement: Medical students are expected to master a foundation of clinical knowledge with

More information

Alcohol Overuse and Abuse

Alcohol Overuse and Abuse Alcohol Overuse and Abuse ACLI Medical Section CME Meeting February 23, 2015 Daniel Z. Lieberman, MD Professor and Vice Chair Department of Psychiatry George Washington University Alcohol OVERVIEW Definitions

More information

Outpatient Treatment of Alcohol Withdrawal. Daniel Duhigg, DO, MBA

Outpatient Treatment of Alcohol Withdrawal. Daniel Duhigg, DO, MBA Outpatient Treatment of Alcohol Withdrawal Daniel Duhigg, DO, MBA DSM V criteria for Alcohol Withdrawal A. Cessation or reduction of heavy/prolonged alcohol use B. 2 or more of the following in hours to

More information

Guideline for the Management of Acute Alcohol Withdrawal Syndrome (AWS)

Guideline for the Management of Acute Alcohol Withdrawal Syndrome (AWS) Derby Hospitals NHS Foundation Trust Guideline for the Management of Acute Alcohol Withdrawal Syndrome (AWS) Background Reference No: CG-T/2007/063 Alcohol Withdrawal Syndrome (AWS) occurs with sudden

More information

Alcohol dependence, a common psychiatric disorder in the

Alcohol dependence, a common psychiatric disorder in the Original Article Quality of life as an outcome measure in the treatment of alcohol dependence A B S T R A C T Shruti Srivastava, Manjeet S. Bhatia Department of Psychiatry, University College of Medical

More information

Stuart B Black MD, FAAN Chief of Neurology Co-Medical Director: Neuroscience Center Baylor University Medical Center at Dallas

Stuart B Black MD, FAAN Chief of Neurology Co-Medical Director: Neuroscience Center Baylor University Medical Center at Dallas Billing and Coding in Neurology and Headache Stuart B Black MD, FAAN Chief of Neurology Co-Medical Director: Neuroscience Center Baylor University Medical Center at Dallas CPT Codes vs. ICD Codes Category

More information

Traumatic brain injury (TBI)

Traumatic brain injury (TBI) Traumatic brain injury (TBI) A topic in the Alzheimer s Association series on understanding dementia. About dementia Dementia is a condition in which a person has significant difficulty with daily functioning

More information

Mental Disorders (Except initial PTSD and Eating Disorders) Examination

Mental Disorders (Except initial PTSD and Eating Disorders) Examination Mental Disorders (Except initial PTSD and Eating Disorders) Examination Name: Date of Exam: SSN: C-number: Place of Exam: The following health care providers can perform initial examinations for Mental

More information