Analysis of the Medical History of an Elderly Woman - Essay Example

?Key features of the case The case is that of a female aged 72 who has all of a sudden started behaving abnormally. She was seen doing the same activity of turning the gas oven on and off again and again. It seems she was feeling cold because she was telling that she needed to keep herself warm by sitting in front of the gas oven. She is evidently suffering from some memory loss as she is unable to recognise her husband. She is also seen mumbling to the oven and this is indicative of the confusion she has in making meanings out of her surroundings. She is pale and this could be suggestive of some physical illness or discomfort she has. The fact that she was still in her nightie shows that she has either forgotten to change or she was unwell. Though she is seen trying to get to her feet, she is unable to get up from her chair. This inability might be because of some physical illness or owing to some mental disorientation. Patient history In order to decide upon the real cause of my patient's behavior, from among the possible causes discussed above, first of all I need to learn the history of this patient (Williams & Wilkins, 2007, p.1). This has to include, health history including physical and mental health, and certain amount of cultural history as well (Williams & Wilkins, 2007, p.1-7). The processes involved are developing a therapeutic relationship with the patient, establishing good communication, that is built using “eye contact, posture, facial expressions, gestures, clothing, affect, and even silence”, and a well-formulated interview if circumstance allow (Williams & Wilkins, 2007, p.1-2). Creating an environment that is peaceful and helpful for the patient to relax and communicate is also a step involved (Williams & Wilkins, 2007, p.2). But in the case of this student, the scope for gaining history details from these procedures is limited as the patient is not in a mental or physical state conducive to cooperate. Hence, the primary source of the information regarding health history can be the husband of the patient. He can be asked whether the patient had, previous episodes of abnormal behavior and medical events. The observation of the patient can also contribute to the history like level of consciousness, posture and motor behavior, appearance, general demeanor, speech, mood and affect, intellectual performance, judgment, insight, perception, coping mechanisms, though content, sexual drive etc. (Williams & Wilkins, 2007, p.1-10). Also, mental assessment tests have to be carried out including tests like Minnesota Multiphasic Personality Inventory and Rorschach test (Williams & Wilkins, 2007, p.13-14). Physical examination of the patient is also part of history collection (Williams & Wilkins, 2007, p.14). Mental health problems have been found to be “one of the leading causes of disability […] in geriatric population” (Sharma et al., 2010, p.496). But there is also the prevailing danger that mental health problems of aged people are often misunderstood and mis-diagnosed (Sharma et al., 2010, p.496). A proper and scientific collection of history and mental health assessment starting with a differential diagnosis can ensure the diagnosis is error-free (World Health Organisation, n.d., p.48). Differential diagnosis The differential diagnosis in this case could include, 1) depressive disorder, 2) delirium, 3) organic amnesic syndrome, 4) other kinds of dementias like Pick's disease, Creutzfeldt-Jakob disease, or Huntington's disease, 5) dementia resulting from physical illness or toxicity, and 6) mental retardation of various degrees (World Health Organisation, n.d., p.48). Memory loss in older patients could also be a sign of vascular dementia, therapeutic drug intoxication, Alzheimer's disease, depression, and a number of other problems (Sue, Sue and Sue, 2008, p.90-91). It is also possible that the patient is suffering from Parkinson's disease or Lewy body disease (Lewy Body Disease, 2012). The symptoms also indicate that the disease might be Huntington's Disease, Frontotemporal Lobar Degeneration, or some infection in the brain (Sue, Sue and Sue, 2008, p.398-401). The patients with vascular dementia usually would show severe symptoms of “blunted affect, depressed mood, emotional withdrawal, motor retardation, low motivation, anxiety, unusual thoughts” etc. but in the case of the given patient, there is no sign of blunted affect or depressed mood and even if some symptoms similar to the above-said ones exist, they are comparatively mild (Sultzer, Levin and Mahler, 1993: p.1806-1812). It is also a proven fact that even when having similar kind of “cognitive impairment”, the vascular dementia patients will have more severe non-cognitive symptoms than Alzheimer's disease patients (Sultzer, Levin and Mahler, p.1993: 1812). Hence the possibility of this patient suffering from vascular dementia is far less than Alzheimer's disease. From the details of history of the patient noted down from the account of the husband, it is clear that the cause of the problem was no therapeutic drug intoxication. This is so because the husband has informed that the patient was not taking any medicine of late. Miller, Battle and Anthony (2004) have pointed out that patients suffering from depression would show symptoms “across many dimensions of psychosocial functioning” and will be having continuity and gradual progression which is not the case in the patient in question (p.11). Hence the chance of a diagnosis of depression can also be ruled out. A patient suffering from Parkinson's disease will be having two of the three symptoms, bradykinesia, rigidity and tremor but as the patient in question does not show any of these symptoms, it can be inferred that she is not suffering from Parkinson's disease (Factor and Veiner, 2007, p. 40). Whitworth and Whitworth (2010) have revealed that thoguh Lewy body dementia is confused with Alzheimer's disease and Parkinson's disease, it has some distinct characteristics. This specific type of dementia caused by “abnormal proteins in the area of the brain controlling cognition” has the specific symptoms, including memory loss, hallucinations, and fainting (Whitworth and Whitwort, 2010). As my patient though having memory loss, does not have other symptoms of Lewy body disease, this possibility can also be ruled out. Hence, the first thought that came to my mind when I saw the patient was that she might be suffering from Alzheimer's disease. The medical definition of this disease says that it is a “progressive degenerative disease of the brain that begins in later middle life with slight defects in memory and behavior advancing to total loss of mental and physical functioning” (Dreeben, 2007, p.90). The symptoms of this disease are “forgetfulness, paranoia, hostility, speech disturbances, confusion, and inability to carry out purposeful movements” (Dreeben, 2007, p.90). This is most common in people aged above 65 and as this particular patient is 72 year old, and has been showing multiple symptoms of Alzheimer's disease, I felt the patient was suffering from the same (Dreeben, 2007, p.90). One early sign of this disease is the “loss of short term memory” (Dreeben, 2007, p.90). This is the case with this patient as well, as she is found turning the gas oven on and off. The reason for her to repeat the action many times might be that she is forgetting that she did it before. She is also forgetting that it was her husband who was staying with her and trying to talk to her. The disease may also get manifest in the behavioral features like, “inability to concentrate, incapacity for learning new things, impairment of reasoning, and subtle changes in personality” (Dreeben, 2007, p.90). This patient is found mumbling to the oven, which indicates that she is incapable of meaningful communication, which again could be a symptom of Alzheimer's disease (Dreeben, 2007, p.90). It is an established fact that “people over age sixty five experience moderate to severe memory impairment” (Sue, Sue and Sue, 2008, p.399). It is the shrinking of the brain accompanying the process of ageing, the damage of nerve cells, and the resulting slowness in the processing of information data that causes this issue (Sue, Sue and Sue, 2008: p.399). Alzheimer's disease is the most frequent kind of memory loss in the US and has been found in about “five million Americans” (Sue, Sue and Sue, 2008, p. 91). It is the “progressive decline” of mental capabilities that happen in Alzheimer's disease but there would be some point in time that this inability gets noticed by others (Sue, Sue and Sue, 2008, p. 91). Biological causes of mental illness One definition offered for mental illness is that it “refers to alterations in thinking, emotions and/or intentional behaviors that produce psychological distress and/or impaired functioning” (Edlin and Golanty, 2009, p.66). It is a contentious issue whether a mental illness can be considered completely a result of “physical and biological phenomena” (Lake, 2006, p.31). Recently a consensus has been evolving based on “complex systems theory” that says that a pattern of symptoms seen in a perceived mental illness can be understood as “an emergent property of multiple, hierarchically related causes, conditions, or meanings” (Lake, 2006, p.31). In this approach, the cause of mental illness is understood as both physical and environmental (Edlin and Golanty, 2009, p.66). The physical causes could be “infection, drug/toxin-induced alterations in brain biology, and abnormal physical conditions and biological changes in the brain” (Edlin and Golanty, 2009, p.66). The environmental factors on the other hand could be physical and psychological abuse, neglect, emotional trauma, and recreational drug use” (Edlin and Golanty, 2009, p.66). It is keeping in view, the complex system approach that mental health assessment is made in this patient. Assessment From the study of history and symptoms I made about this patient, my assessment is that she is suffering from Alzheimer's disease. The diagnosis of Alzheimer's disease is usually made using both mental and physical examination and clinical tests (Dash and Villemarette-Pittman, 2005, p.33-46). As discussed earlier, the patient has been exhibiting many symptoms of Alzheimer's disease, including dementia, memory loss, etc. The Mini-Mental Status examination of the patient has put forth a score of 24 which suggests that the patient is presently in a “mild stage” of Alzheimer's disease ((Dash and Villemarette-Pittman, 2005, p. 48). Alzheimer's disease is understood as a “primary degenerative cerebral disease of unknown etiology, with characteristic neuropathological and neurochemical features” (World Health Organisation, n.d., p.48). Gradual and unnoticeable onset and progression of the symptoms of this patient is one suggestion towards a diagnosis of Alzheimer's disease in my patient (World Health Organisation, n.d. p.48). Whether Alzheimer's disease is coexisted with mild onset of vascular dementia in this patient has to examined in further clinical tests (World Health Organisation, n.d. p.48). For clinical diagnosis, I could use Single Photon Emission Computed Tomography (SPECT), eigenbrains, and support vector machines (Alvarez et al., 2009, p.1). Depressive symptoms are assessed using NIMH-dAD criteria, structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) Axis 1 disorders, Cornell Scale for Depression in Dementia and Geriatric Depression Scale (Teng et al., 2008, p.469-477). Treatment and care of patient suffering from Alzheimer's disease According to “complex systems model”, “disparate treatment approaches addressing multiple disparate causes, conditions or meaning of symptoms” have to be considered (Lake, 2006, p.32). This in turn can lead to integrative treatment mode that functions in “synergistic ways” (Lake, 2006, p.33). The basic treatment available for Alzheimer's disease in the prevailing conditions can be described as follows: Medications currently approved for treatment of Alzheimer’s all work primarily by inhibiting breakdown of acetylcholine, a neurotransmitter that becomes deficient in the Alzheimer's brain as nerve cells degenerate and die. Although these drugs do not slow progression of the underlying disease process, they may temporarily stabilize or delay worsening of memory problems and other cognitive symptoms (Conducting an assessment, 2012). Birk (2012) has demonstrated that “treatment for 6 months, with donepezil, galantamine, or rivastigmine at the recommended dose” is effective for improving cognitive abilities in patients with Alzheimer's disease (1). Mannu et al. (2011) have found that “radio electric asymmetric brain stimulation” can be effective in the treatment of “behavioral and psychiatric symptoms in Alzheimer's disease” (p.207-211). In agreement with the integrated approach, alternative treatment methods can also be incorporated into the treatment regime for Alzheimer's disease (Lake, 2006, p.32). For example, Raglio et al. (2008) have suggested that music therapy be used in treating the behavioural and psychiatric symptoms in Alzheimer's disease and have proved through their research that music therapy improved the conditions of “delusions, agitation, anxiety, apathy, irritability, aberrant motor activity, and night-time disturbances” in the patients (p.158-162). Brief Psychosocial Therapy has also been suggested as an effective treatment method, especially in patients who show agitation (Ballard et al., 2009, p.726-733). References Alvarez, I., Gorriz, J.M., Salas-Gonzales, D., Lopez, M., Segovia, F., Puntonet, C.G., and Prieto, B. 2009. 'Alzheimer's diagnosis using aigenbrains and support vector machines', Electronic Letters, vol.45, no.7, 1-2. Birk, J. 2012. 'Cholinesterace inhibitors for Alzheimer's disease', Cochrane database of systematic reviews 2006, issue.1, viewed 19 October, 2012, Conducting an assessment: Introduction, 2012. Alzheimer's Association, Chicago, viewed 20 October, 2012, Dash, P. and Villemarette-Pittman, N. 2005. Alzheimer's disease, Demos Medical Publishing, New York. Dreeben. O. 2007. Introduction to physical therapy for physical therapist assistants, Jones & Bartlett Learning, London. Edlin, G. and Golanty, E. 2009. Health and wellness, Jones & Bartlett Learning, London. Factor, S. and Veiner, W. 2007. 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