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In the video The Long Goodbye: Facing Dementia, Ken, Brenda, and Michael, along with their families, are impacted by dementia. Dementia impacts their family structure, their roles, their interaction patterns, the rules of their relationships (including the balance of togetherness and separateness), changes their homeostatic balances, and so forth.
Your responsibility is to:
review this video and write a 3 to 4 page paper on the families in The Long Goodbye: Facing Dementia.
This paper is not to be a “book report” summary of the video, but is to look at each of these individuals/families.
describe the impact of dementia systemically, describing the changes in family structure, patterns, themes, habits, rules, and other systemic concepts.
Be sure to utilize (and demonstrate you understand) systemic concepts discussed in the readings.
Finally, briefly describe one thing you think a systems-informed family therapist might do working with a family impacted by dementia.
Dementia
dementedness could be a neurological disease that affects your ability to assume, speak, reason keep in mind and move. whereas Alzheimer’s malady is that the most typical reason for dementedness, several different conditions can also cause similar symptoms. a number of these disorders exacerbate with time and can’t be cured, whereas others respond well to treatment and their symptoms will even be reversed.
What will it mean once somebody is claimed to possess dementia? for a few folks, the word conjures up scarey pictures of crazy behavior and loss of management. In fact, the word dementedness describes a bunch of symptoms that has remembering loss, confusion, the shortcoming to downside solve, the shortcoming to finish multi-step activities like making ready a mean or equalisation a chequebook, and, generally temperament changes or uncommon behavior.
dementedness is that the general term for a bunch of disorders. sure conditions will cause reversible dementias, like medication interactions, depression, nutriment deficiencies or thyroid abnormalities. it’s necessary that these conditions be known early and be treated taken over so symptoms is improved. There are irreversible dementias called chronic dementias, of those Alzheimer’s malady is that the most typical. There square measure variety of different chronic dementias, however, which will appear as if Alzheimer’s, however have distinct or completely different|completely different} options which require special attention and different treatment.
For those who have a lover that has one in every of the numerous completely different dementias, the road ahead is a really difficult one.
urban center Ronald Reagan maybe aforementioned it best in Associate in Nursing interview with J.D. Heyman of individuals magazine, in December of 2003, she referred to as Alzheimer’s malady “the long goodbye” (Heyman, 2003).
Dementia: Definition and designation
dementedness is that the general term for a bunch of disorders that cause irreversible psychological feature decline as a results of varied biological mechanisms that injury brain cells. it’s a really common downside, significantly within the older, and it’s going to go unrecognized for quite it slow. Studies indicate that up to twenty or a lot of of persons UN agency have symptoms suggestive dementedness end up to possess treatable diseases and regarding 1/2 them can have medical specialty issues.(Shenk, 2001).
many issues arise once attempting to determine whether or not or not a consumer is really insane. First, gentle defects in memory commonly occur with age, therefore any psychological testing has to take this under consideration. Secondly, as a result of dementedness is outlined as a loss of perform, with shoppers UN agency have a history of retardation, or previous learning or psychological feature disabilities it’s necessary to get instructional and activity histories so as to establish if there’s a loss in intelligence. Finally, it’s necessary to deal with any medical specialty diseases. Depression could accompany gentle dementedness, however isn’t the primary sign of the same old variety of dementedness in adulthood. (Shenk, 2001)
To be classified as a sort of dementedness, a disorder should meet the subsequent 2 criteria:
1. It should cause a decline in a minimum of 2 of the subsequent four essential psychological feature functions:
a. Memory
b. Ability
to get coherent speech or perceive spoken or communication
c. capability or build sound judgments and do complicated tasks and
d. the flexibility to method and interpret visual data.
2. The decline should be severe enough to interfere the individual’s day to day activities.
The designation of dementedness needs an entire medical and psychology
evaluation.
A medical analysis for dementedness typically includes the following:
• A review of the history or the onset of symptoms. this is able to embrace asking the consumer and his/her family what issues they need known. In what order did things happen? however long have the symptoms been gift and the way is it poignant their daily life?
• A review of the client’s case history and medications. this can offer necessary data regarding conditions which may place the consumer at higher risk for a selected sort of dementedness or establish medications which may contribute to psychological feature issues.
• A medical specialty examination can facilitate to spot symptoms which will be presnt especially sorts of dementedness or different conditions which will increase the chance of psychological feature issues, like a stroke or Parkinson’s malady.
(Mayo, 2007)
• electric battery of laboratory tests to rule out nutriment deficiencies or metabolic conditions. though not common, straightforward nutriment deficiencies, infections or endocrine imbalances will cause psychological feature symptoms. additionally, laboratory tests will indicate a condition that may place a consumer in danger for developing dementedness, like high steroid alcohol or high pressure.
(Mayo, 2007)
• Following laboratory testing, a brain imaging CT or imaging scan are going to be done to guage the anatomy of the brain for conditions which may cause psychological feature changes, like a stroke or a tumor. this kind of testing can also confirm the brain size and any vessel changes which can ought to be monitored over time. (Mayo, 2007)
• Finally, mental standing testing, additionally referred to as psychological feature or psychology testing are going to be done. These embrace evaluations that tests within the areas of memory, language, problem-solving, and judgment. The results square measure accustomed compare a private with others of his or her age, educations and quality to work out in what areas the individual encompasses a issues and the way severe they’re. (Mayo, 2007).
the method of identification dementedness has become a lot of correct in recent years, and specialists square measure ready to analyze the massive quantity of knowledge collected and to work out if there’s a haul, the severity, and often, the reason for the dementedness. sometimes, there is also a mix of causes or it’s going to take time to watch the consumer to make sure of a designation. deciding whether or not the cause could be a reversible or irreversible condition guides the treatment and also the take care of the affected person and family.
Current Classifications of Specific forms of dementedness
dementedness of the Alzheimer’s sort
Alzheimer’s malady is that the most typical dementedness, accounting for fifty to seventy % of all cases, and is that the most typical reason for dementedness in folks over sixty five years more matured. It’s classic symptom pattern begins with state of mind for recent
events. typically this is often followed by encephalopathy, visuospatial sensory activity impairments, apraxia, and brain disease once many years. Deficits in playing tasks involving multiple steps square measure seen early within the malady. (Mayo, 2007). medicine symptoms square measure common in Alzheimer’s malady. many purchasers can expertise depression, anxiety, irritability, apathy, and temperament changes throughout the first stages of the malady. whereas within the middle and later stages of the malady psychotic symptoms and activity disturbances square measure common. shoppers typically develop incontinence, further as gait and motor disturbances. within the later stages of the malady, shoppers eventually become mute and bed ridden.
The progression of the malady is gradual however steady downward, with a median length from onset of symptoms to death of 8-10 years. (Mayo, 2007)
within the DSM-IV-TR, Alzheimer’s malady is divided into the subtypes of: With Early Onset, With Late Onset, With activity Disturbance, and while not activity Disturbance. (APA, 2000).
tube-shaped structure dementedness
(formerly Multi-Infarct Dementia)
tube-shaped structure dementedness, additionally brought up as Multi-Infarct dementedness and anaemia tube-shaped structure dementedness (IVD), is that the second most typical dementedness. tube-shaped structure dementedness results from the results of vas malady on psychological feature functions. (Mayo, 2007). this way of dementedness is characterised by Associate in Nursing abrupt loss of perform or general deceleration of psychological feature skills that interferes with what’s termed government functions, like designing and finishing tasks. once the symptoms seem suddenly,
the consumer has typically practised a stroke.
there’s no specific psychological feature profile of tube-shaped structure dementedness, though square measure government and a spotlight deficits square measure pronounced in brief term memory. psychological feature deficits will typically be uneven betting on the regions of the brain that are broken.
The incidence and prevalence of tube-shaped structure dementedness mirror those of Alzheimer’s malady in this tube-shaped structure dementedness becomes more and more common with advanced age. Like Alzheimer’s malady, tube-shaped structure dementedness is subtyped within the DSM-IV-TR in step with sure options. subtypes include: With Delirium, With Delusions, With Depressed Mood, and Uncomplicated. (APA, 2000)
dementedness thanks to different General Medical Conditions
once “determining if the dementedness is thanks to a general medical condition” (APA, 2000, pg. 162), it’s necessary to determine that there’s a presence of a general medical condition. what is more the healer should then establish if the dementedness is expounded to it general medical condition. Like different types of dementedness, dementedness thanks to different general medical conditions includes subtypes of: while not activity Disturbance and With activity Disturbance.
the subsequent square measure a number of the final medical conditions that may embrace dementedness.
dementedness thanks to HIV malady
not like Alzheimer’s malady, HIV associated dementedness will manufacture a unique progression in psychological feature decline, motor pathology, and activity abnormalities. Symptoms usually embrace cognitive content deceleration, diminished speed during which the consumer is in a position to method data, impaired verbal memory
and learning, and within the later stages it’s common to examine impairment in government functioning. activity manifestations vary starting from apathy to mental illness. (Mayo, 2007)
dementedness thanks to Head Trauma
during this sort of dementedness the “cognitive impairment and activity disturbances depends on the placement and extent of the brain injury. memory loss is usually gift, further as memory impairment…Other activity symptoms is also evident with or while not the presence of motor or sensory deficits….Symptoms embrace encephalopathy, attention issues, irritability, anxiety, depression, exaggerated aggression…as well as changes in temperament.” (APA, 2000, pg. 164). dementedness thanks to head trauma is typically non-progressive, however additional head injury will cause progressive stages.
dementedness thanks to Parkinson’s malady
“The essential feature of dementedness thanks to Parkinson’s disease is that the presence of a dementedness that’s judged to be the direct pathophysiological consequence of Parkinson’s disease. Parkinson’s disease could be a slowly progressive medical specialty condition, characterised by tremor, rigidity, bradykinesia, and bodily property instability” (APA, 2000, pg. 164). The figures of reported dementedness in Parkinson’s shoppers varies from 20-60 %, however specialists agree that dementedness will seem at a better rate in those shoppers with a lot of advanced stages of Parkinson’s malady. once dementedness is related to Parkinson’s malady, shoppers show “cognitive and motor deceleration, government pathology, and memory retrieval impairment.” (APA, 2000, pg. 164).
dementedness with
Lewy Bodies
dementedness with Lewy Bodies could be a progressive complication that shares symptoms with Alzheimer’s and Parkinson’s diseases. shoppers littered with this malady have activity and memory symptoms which may fluctuate, further as motor issues that square measure usually seen with Parkinson’s malady. dementedness with Lewy Bodies has solely been recognized within the last twelve years. it’s in many ways clinically just like Alzheimer’s malady, with exception that those shoppers with dementedness with Lewy Bodies typically expertise hallucinations that seem early within the malady and because the malady progresses become a lot of distinguished. (Mayo, 2000) dementedness with Lewy bodies account for roughly 7-26 % of dementedness cases. This disorder is probably going to come back to medical specialty attention as a result of the client’s psychotic symptoms.
dementedness thanks to Huntington’s malady
“The essential feature of dementedness thanks to Huntington’s malady is that the presence of dementedness that’s judged to the direct pathophysiological consequence of Huntington’s malady.” (APA, 2000, pg. 165) Huntington’s malady is Associate in Nursing hereditary progressive neurodegenerative malady of noesis, emotion, and movement. The onset of symptoms of Huntington’s malady is typically between the ages of 30-50 years more matured, and affects just about three hundred,000 folks within the u. s.. because the malady progresses, shoppers usually expertise temperament, and activity changes together with depression, irritability, anxiety and apathy. activity changes usually embrace shoppers changing into impulsive, aggressive, or socially withdrawn.
psychological feature changes embrace diminished government perform, inappropriate judgment, remembering loss, but memory is rarely affected, permitting the consumer to retain data of his setting and members of the family, despite different severe psychological feature deficits. (Mace, 2001)
dementedness thanks to Pick’s malady
dementedness thanks to Pick’s malady is additionally brought up as dementedness thanks to Frontotemporal, or Frontotemporal body part degeneration, is characterised in its early stages by changes in “personality, vital apathy, government pathology, emotional blunting, activity disinhibition, and distinguished language abnormalities”(APA, 2000, pg. 165). In Pick’s malady the frontal lobes of the brain square measure affected and since of this the primary symptoms remarkably occur in emotional and social functioning. it’s the mood changes, that square measure typically biased towards elation, disinhibition, and also the deterioration in social skills that set this kind of dementedness apart (National Institute of Aging, 2003). because the disorder progresses, shoppers expertise difficulties with memory. because the malady progresses, shoppers expertise “difficulties with memory, apraxia, and also the different usual symptoms of dementia….individuals can also develop apathy or extreme agitation” (APA, 2000, pg. 165). Symptoms of Pick’s malady usually occur between the ages of forty and sixty years more matured, with slightly a lot of ladies being affected. Progression of Pick’s usually steady and also the length of progression varies long from two -10 years (Bird, 2001).
dementedness thanks to brain disease
Creutzfeld-Jakob
malady could be a encephalopathy that eventually results in dementedness. Symptoms typically match those of different dementedness like disorders, but the progression of brain disease is a lot of fast, with mental deterioration typically spanning many months. Symptoms include: anxiety, depression, psychological feature impairment, impaired muscle coordination, blurred vision, insomnia, and speech impairment. medical specialty symptoms square measure commonly a lot of distinguished within the starting of the malady. because the malady progresses, mental symptoms become a lot of severe. Most shoppers eventually lapse into a coma, with viscus failure, pneumonia, or different infections leading to death. The progression of the malady is generally seven months to two years once designation. (CJD,Mayo, 2008)
Substance-Induced continuous dementedness
Substance-induced continuous dementedness could be a syndrome of nonheritable, persistent impairment in psychological feature perform that happens in traditional consciousness which is taken into account to ensue to substance-induced effects that have persisted on the far side the conventional length of substance intoxication or withdrawal. Symptoms include: encephalopathy, apraxia, brain disease and a decline of government perform. These psychological feature deficits should end in vital impairment in social or occupation functioning, and that they should represent a major decline within the client’s previous level of functioning. additional the deficits should not occur solely throughout the course of a delirium. There should be proof from the history given, examination or laboratory results that the deficits square measure connected
to the results of a substance and should have persisted on the far side the same old length of substance intoxication or withdrawal. (APA, 2000, pg. 168-169)
dementedness thanks to Multiple Etiologies
Alzheimer’s and cerebrovasular malady square measure the foremost common causes of dementedness, with Alzheimer’s accounting for over five hundredth of all cases. but several different medical specialty and different general medical conditions will manufacture symptoms of dementedness further. once shoppers gift with over one etiology that may manufacture symptoms of their dementedness, the diagnostic criteria for dementedness thanks to Multiple Etiologies would be used.
dementedness Not Otherwise specific
This final class is employed once the designation of dementedness doesn’t meet the standards for any of the particular forms of dementedness (APA, 2000, pg. 171).
Case Study
consumer Name: Jimmie C. Ladd
Age: seventy eight year previous, Caucasian
matrimonial Status: Married, fifty four years to Joanne, his highschool sweetheart
Children: four big youngsters, nine grandchildren, three nice grandchildren
Presenting Situtation
Jimmie Ladd could be a seventy eight year previous, white male born on December twenty six, 1930. He states no non secular preference.
Mr. Ladd came to the workplace along with his partner Joanne for a psychological analysis for potential dementedness. Mr. Ladd states that he doesn’t keep in mind things further as he use to, however he additional feels that everybody is creating a “bigger deal” of things. Mrs. Ladd (Mr. Ladd’s partner of fifty four years) states that two weeks agone man. Ladd visited the native service station alone within the middle of the day (approx. one pm) and didn’t come. once regarding Associate in Nursing hour had
passed, Mrs. Ladd referred to as her grandchild and asked him to travel trying. After, three hours had passed and several other “frantic” calls to places wherever man. Ladd may need gone, Mrs. Ladd referred to as the remainder of her youngsters, UN agency additionally started looking out the native space for him. At nearly nine pm and eight hours once man. Ladd had disappeared, a guard from Willow Run landing field decision to state that man. Ladd was out at the landing field searching for his former leader. A son visited the landing field and came back with man. Ladd. once asked if this had ever happened before, Mr. Ladd explicit that he generally forgets wherever he’s going and why he’s going there, however that sometimes he figures it out before everybody gets upset.
Medical standing
Mr. Ladd, presently suffers from renal disorder, that causes him to possess qualitative analysis two double every week. different conditions embrace, heart condition and polygenic disease. different medical conditions of interests square measure that in 1990, Mr. Ladd practised “botched” nasal surgery. This resulted in bone surgery to repair a tear within the grain sorghum that surrounds the brain. Since that point, Mr. Ladd has some short term memory deficits, irritability, and a few minor changes in his temperament. Mr. Ladd has additionally practised heart by-pass surgery.
Employment standing/Support Status
Mr. Ladd retired from the Environmental Institute of Michigan, set at Willow Run landing field in 1989. Since his retirement, Mr. Ladd has spent it slow doing trade however Mrs. Ladd reports that as these days man. Ladd has very little interest in something and spends most of his time observation tv.
position
Mr.
Ladd has had no involvement with the system.
Family/Social Relationships
Mr. Ladd is married and states that he’s proud of that state of affairs. He lives along with his partner of fifty four years in Willis, Michigan. Mr. Ladd states that each of his oldsters square measure deceased. Mr. Ladd states that he encompasses a smart relationship along with his youngsters and grandchildren.
medical specialty standing
Mr. Ladd states that he has ne’er been treated for any psychological or emotional issues. Mrs. Ladd adds that once the operation in 1990, Mr. Ladd did see a healer for roughly two years. throughout this point, they worked on man. Ladd re-learning several everyday tasks.
relating to unsafe thinking, Mr. Ladd indicates that he has ne’er thought of suicide and has no unsafe thoughts presently.
Diagnostic Impression
Axis I 294.10
dementedness thanks to different General Medical Conditions/without activity distrubance
dementedness thanks to Head Trauma
Axis II postponed
Axis III Referred for medical testing to incorporate CT Scan, MRI, and different science laboratory work to rule
out organic causes
Axis IV None
Axis V GAF sixty
References
American Psychiatric Association. (2000). Dementia. In Diagnostic and Statistical Manual of Mental Disorders (Fourth ed., pp. 147-171). Arlington, VA: American Psychiatric Association.
American Psychiatric Association. (2002). Practice Guideline for The Treatment of Patients With Alzhemer’s Disease. Retrieved October 25, 2008, from American Psychiatic Publishing, Inc. Web site: http://www.psychiatryonline.com/content.aspx?aID=152238
Bird, T.D. (2001). Memory Loss
and Dementia. In Harrison’s Principles of Internal Medicine (15th ed.). New York, NY: McGraw Hill.
Castleman, M., et al. (2000). There’s Still A Person In There: The Complete Guide to Treating and Coping With Alzheimer’s. New York, NY: Perigee Books.
Creutzfeldt-jakob Disease [Mad Cow Disease]. (2008, July 31). Retrieved Ocotober 31, 2008, from http://www.mayoclinic.com/health/creutzfeldt-jakobdisease/DS00531/DSECTION= symptoms
Dementia: It’s Not Always Alzheimer’s. (2007, March 7). Retrieved October 25, 2008, from Mayo Clinic Web site: http://www.mayoclinic.com/health/dementia/AZ00003
Heymam, J.D. (2003, December 15). The Long Goodbye. Retrieved October, 2008, from http://www.people.com/people/archive/article/0.20148963,00.html
Mace, N. L., & Rabins, P. V. (2001). The 36 Hour Day: A Family Guide to Caring for Persons with Alzheimer’s Disease, Related Dementing Illnesses, and Memory Loss Later in Life. New York, NY: Warner Books.
National Institute on Aging. (2003, December 23). Forgetfulness: It’s Not Always What You Think. Retrieved October 25, 2008, from National Institute On Aging Web site: http://www.niapublications.org/engagepages/forgetfulness.asp.
Seshadri, S., & et. (2002). Palasma Homocysteine as a Risk Factor for Dementia and Alzheimer’s Disease. New England Journal of Medicine, 476-483.
Shenk, D. (2001). The Forgetting. Alzheimer’s: Portrait of an Epidemic. New York, NY: Random House.
Sullivan, S.C., & Richards, K.C. (2004). Special Section-behavioral Symptoms of Dementia: Their Measurement and Intervention. Aging and Mental Health, 143-152.
