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P01: olicognography

P02: addictions

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OLICOGNOGRAPHY on ADDICTIONS

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Cognitive

Basic Olicognograph: Out Addiction Progress

Cognition has to do with how intellectual performance displayed in tasks making. It may concern different registers in the addiction problems. Apart from "competititve intelligence" which is not of humanist concern in addict care, its importance is also with cognitive performance that may question the neurological status of the person and to help suggest sorts of treatments that can help patients to cope and solve. Since cognitive under-performance may be underperceived, like if prejudging on "natural effects of drug abuse", possible treatments can be missed or waste pedagogic efforts if trying to seek performance in an inappropriated way or based on some that cannot, with the best, will be done by the patient. After some basic of cognitive for neurologic - clinical explorations, we make cognitive and pedagogic remarks for addict psychology management.

Features of the 12 minutes cognitive examination: 1. Orientation - 1.1 Time (day, date, month, season, year - 1.2 Place . 2. Attention - 2.1 Serial 7s or - 2.2 Months of the year backwards. 3. Language - 3.1 Engage in conversation and assess fluency, articulation, phonemic and semantic errors - 3.2 Naming of some low frequency items - 3.3 Comprehension (both single word and sentence - 3.4 Reading - 3.5 Write a sentence. 4. Memory - 4.1 Anterograde: test recall of a name and address after 5 minutes - 4.2 Retrograde: ask about recent sporting or personal events. 5. Executive function - 5.1 Letter (F) and category fluency (animals). 6. Praxis - 6.1 Meaningful and meaningless gestures - 6.2 Luria 3 steps test (fist-edge-palm). 7. Visuospatial - 7.1 Clock drawing, and overlapping pentagons - 8. General neurological assessment with particular attention to - 8.1 Frontal lobe signs (utilisation, grasp, pout, palmomental) - 8.2 Presence of a movement disorder - 8.3 Pyramidal (voluntary motor) signs - 8.4 Eye movements. 9. General impression - 9.1 Slowness of thought - 9.2 Inappropriateness 9.3 Mood.

Symptoms in neurologic clinic cognitive disorders follow neuroanatomic location and not pathology. The purpose of the cognitive neurological examination is to separate those patients in whom a firm clinical diagnosis can be made, from those who require further and more detailed investigation. The history forms, part of the examination, and the ability to respond to conversational cues is as much part of the examination as any formal assessment. Alertness and cooperation with the assessment should be noted, as these factors may impact on the subsequent findings. The level of alertness is an important clue to the presence of a delirium or the effects of medication. Delirium may be marked by both restlessness and distractibility, or the patient may be quiet, and drift off to sleep easily during the consultation. Complaints about poor memory are the most frequent reason for referral to a cognitive disorders clinic, and provide a good starting point for the consultation despite not being very specific. A useful framework for analyzing memory complaints divides memory into several separate domains. Episodic memory (personally experienced events) comprises anterograde (newly encountered information) or retrograde (past events) components, and depends on the hippocampal–diencephalic system. Memory performances observe: episodic memory, working memory and semantic memory.

Impairments in executive and frontal lobe function typically involve errors of planning, judgement, problem solving, impulse control, and abstract reasoning. Although executive function is generally believed to be a (dorsolateral) frontal lobe function, this set of skills is probably more widely distributed in the brain. The inability to perform a movement with a body part despite intact sensory and motor function is termed apraxia. Although a number of categories, such as limb kinetic, ideomotor, and ideational, exist, these labels are seldom useful in clinical practice. Visuospatial ability involve information from the visual cortex is directed towards the temporal or parietal cortex via one of two streams. The dorsal (‘‘where’’) stream links visual information with spatial position and orientation in the parietal lobe, whereas the ventral (‘‘what’’) stream links this information to the store of semantic knowledge in the temporal lobes. The frontal eye fields are important in directing attention towards targets in the visual field.

Selected neuropsychological tests: General ability : (Raven’s progressive and coloured progressive matrices - Wechsler adult intelligence scale (WAIS & WAIS-R) - Wechsler memory scale (WMS-R). Memory: * Anterograde episodic ( Verbal: 1. Recall complex verbal information - Stories: Wechsler memory scales, Rivermead behavioural memory test 2. Word list learning - Rey auditory verbal learning test - California verbal learning test, 3. Recognition for newly encountered words - Warrington recognition memory test); ( Non-verbal: 1. Recall geometric figures - Rey-Osterrieth figure test - Wechsler memory scale ( Visual reproduction, Figural memory subtests) 2. Recognition newly encountered faces - Warrington recognition memory test, 3. Spatial recall - Paired associative learning (PAL) module from CANTAB battery * Retrograde ( Personal (autobiographical): 1. Autobiographical memory interview - Structured interview for personal facts and episodes three lifeperiods (school, early adult, recent), 2. Cued word association - Tests for personally experienced episodes evoked by standard words) ( Public events: 1. Famous faces, 2. Famous events) * Semantic (General knowledge and vocabulary: 1. Wechsler adult intelligence scale - Information - Similarities - Vocabulary) (Category fluency: Exemplars from semantic categories - animals - fruit - etc. ) ( Object naming to confrontation: 1. Boston naming test, 2. Graded naming test) ( Picture pointing (in response to a spoken name): Peabody picture vocabulary test ) ( Non-verbal semantic knowledge: Picture-picture matching - Pyramids and palm trees) * Language ( General: 1. National adult reading test (NART)- Used to estimate pre-morbid IQ) ( Naming: 1. Boston naming test, 2. Graded naming test). Comprehension: 1. Test for reception of grammar (TROG), 2. Peabody picture vocabulary test, 3. Token test) ( Visuospatial: 1. Neglect - Behavioural inattention test - Judgement of line orientation test, 2. Object recognition and space perception - Visual object and space perception (VOSP), 3. Visual tracking - Trails A,B ) (Frontal and executive function: 1. Initiation - Verbal fluency - Analogies and sequencing (WAIS - Similarities - Picture arrangement) - Ravens matrices), 2. Attention shifting - Wisconsin card sorting test (WCST)- Brixton spatial anticipation test - Trails B, 3. Problem solving and inferential reasoning - Tower of London - Cognitive estimates 4. Disinhibition - Hayling test, 5. Decision making - Iowa & Cambridge gambling tasks.

Operativelly cognition intent logical, often mechanistic synthesis between different registers of approach of knowledge dedicated to how things works in the brain: psychologically (often experimental), neurophysiologically (often with pictured schemes of cybernetics-minded neurophysiological networks and pedagogic. But mechanically, concern for stability of logical frames (supposed to be more scientific) are far from really expressing the plasticity, dynamics and speed of neurophysiological processes. Indeed they have some truth; care, may be more modestly than the "philosophy" of neurosciences but still has to support also pedagogic explainations that the patient could managed in her/his brain processes; in the hope that these could help her/him to reproduce better processes of thinking, feeling, acting and "cognitive coordination" healthier than previous ways. As a result psychocognitive therapies, after demonstrated the relative equivalencies between previous most deterministic but imperfect approaches based on philosophical theoretical models, show that after some understandable "cognitive explanations", most of therapeutic issues cannot do without patient own mental voluntary processes. We can help but best complex solutions mix environmental changes, patients' efforts, pharmacologic help, patients' perception of the support they received, empathy but coherent to a social way of behaving.

The cognitive-behavioral model incorporates the two major types of learning that have been identified in behavior laboratories: learning by association and learning by consequences. In learning by association (also called ‘Pavlovian’ or ‘classical’conditioning), stimuli that are originally neutral can become triggers for alcohol/drug use, or for cravings, as a result of repeated associations between those stimuli and alcohol/drug use. In the learning by consequences model (also called ‘operant’ conditioning), drinking and drug use behaviors are strengthened by the consequences that follow their use, be them positive of negative reinforcement.

Deficits in skills for coping with the antecedents and consequences of drinking/drug use are considered to be a major contributor to the development and maintenance of addictive behavior. As a result, considerable effort has been devoted to studying coping skills training, to determine whether it has practical utility as a means of reducing risk and curtailing addictive behavior. Similar questions have been raised regarding Relapse Prevention (RP) treatment studies. Interventions that focus on relapse prevention have been found beneficial for maintaining the effects of treatment during follow-up periods and for reducing the severity of relapse episodes that do occur, but there are diminishing returns inasmuch as these benefits have been found to decrease with increasing time since treatment completion

The value of coping skills training is best conceptualized in terms of psychological dependence. Heavy drinkers and drug abusers may use alcohol or drugs to cope with certain (or, in some cases, most) of the problems in their lives. Determining the skills areas in which training is required necessitates an assessment, often called a ‘functional analysis", to identify the antecedents. Client interviews that do not employ structured assessment instruments should cover topics such as typical patterns of use, common antecedent situations (e.g., mood states, thoughts, cravings for alcohol/drugs, and life problems), and typical consequences of using. Clients should also be asked to anticipate future situations in which it may be difficult to refrain from using. A range of domains should be explored in search of each client’s potential antecedents to cravings and substance use, including social, situational, emotional, cognitive, and physiological antecedents. Coping skills deficits are viewed as a major risk factor because of the likelihood that they may lead to a reliance on alcohol or drugs as the default coping strategy. Managing thoughts and cravings for use. Thoughts about drinking or drug use, and their more intense version, cravings, are common among people recovering from substance use disorders, and therefore this training module is generally used with all clients. Anger is a very common antecedent to alcohol/drug use. Clients are taught about the warning signs of anger, both external and internal signs, so they can identify them early and begin to manage them before anger grows strong and becomes harder to control. Separate skills training sessions are available for increasing one’s awareness of negative thinking and for managing it when it occurs. Pleasant activities: Clients may discover a void in their lives as free time becomes available once they are no longer so occupied with acquiring, using, and recovering from the effects of alcohol or drugs. Relaxation skills. Relaxation may be a useful way of coping with various circumstances that either precede or are exacerbated by alcohol/drug use, such as stress, tension, anxiety, anger, sleeplessness, and cravings to use. Decision-making training can help clients think ahead to the possible consequences of all the decisions they make, even the ones that are seemingly irrelevant to substance use, to increase the likelihood that they will anticipate, and act upon, the relative risks associated with various decision options. Problem-solving. Planning for emergencies. Interpersonal Skills. Drink/drug refusal. Refusing requests. Handling criticism. Intimate relationships.Enhancing social support network. General social skills.

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