DQ#1 Neurocognitive Disorders Shannon LOne of the most common fears for older adults is the fear of losing their mental capacities, or becoming senile (Naleppa & Reid, 2003). Senility is generally viewed as an inevitable experience of old age, and encompasses the loss of emotional and mental capacity to relate to reality, helplessness, and incontinence (Naleppa & Reid, 2003). Additionally, Dementia is a term for a variety of brain disorders related to brain cell impairment, and the symptoms include disorientation to time and place, memory loss, disturbances in thinking, impairment of judgment, and inappropriate emotional responses (Naleppa & Reid, 2003). One of the more common and well-known forms of dementia is Alzheimer's disease, which is a degenerative disease and individuals usually start showing symptoms after the age of 65. Alzheimer's disease usually presents with a similar course for most individuals; the first stage being forgetfulness and impaired short-term memory, followed by impaired cognitive functioning, and concluding with dementia and diminishing of physical functions (Naleppa & Reid, 2003). This writer has witnessed the effects of Alzheimer's disease first-hand in her grandmother, and it was a profoundly sad and emotional experience, as Alzheimer's can be a very ruthless and heartbreaking disease. While Alzheimer's is still incurable and considered irreversible, it is a huge focus of many research companies and new drugs and treatments are constantly being developed and tested. According to the National Institute on Aging, common changes in personality and behavior in an individual with Alzheimer's often include: becoming easily and more frequently worried, upset or angry, becoming depressed or showing little interest in engaging, hiding things, or believing others are hiding things, wandering away from home and frequent confusion ("NIA", 2017) . Additionally, an individual may stop caring about their appearance, stop bathing or maintaining personal hygiene, and begin wearing the same clothes every day . Individuals with Alzheimer's often display feelings of sadness, fear, stress, and confusion, begin exhibiting symptoms of new physical health-related problems and other physical issues, such as constipation, hunger and thirst or problems seeing or hearing ("NIA", 2017). As this writer's grandmother suffered from Alzheimer's and ultimately passed away from it, her personality and behavioral changes were undoubtedly the most difficult and upsetting aspects of the disease for her and her family, as well as for her grandmother. She was often extremely confused and unsure of what year it was, who anyone was around her, or what was happening in reality. As far as causes of these personality changes are concerned, the most prevalent cause is related to the changes that happen in the brain, as the brain is actually physically changed by Alzheimer's, with parts of it atrophying and other parts becoming malformed, twisted, or clumped together (Heerma, 2019). This writer also stumbled across many articles related to early-onset dementia, which she knew less about than the aforementioned late-onset form. Research suggests that early-onset forms of dementia differ from late-onset forms in a variety of ways, including a broader spectrum of expression, the pervasiveness of certain cognitive symptoms and severity of neuropsychiatric signs (Ducharme, 2013). The most common variation found in early-onset is language and executive impairment, rather than memory loss (Ducharme, 2013). The disease is difficult to diagnose in younger patients, as it can be easily attributed to depression, chronic stress, professional burnout or mental illness (Ducharme, 2013). This diagnosis often causes great upheaval in a family's life, as parents in their 40's and 50's usually still have children at home and are working full-time jobs, and early-onset dementia causes gradual loss of autonomy and the ability to accomplish daily tasks, which puts more pressure and stress on the rest of the family to take care of the afflicted member. The diagnosis can be particularly difficult for the individual's spouse, as the unexpected transition to the caregiver role is a sudden and jarring identity change (Ducharme, 2013). According to research, EOD (Early-Onset Dementia) has devastating psychosocial consequences that affect people in their most productive years of life and that have family responsibilities (Vieira, 2013). Compared with dementia in older populations, EOD goes more frequently undiagnosed, misunderstood and inadequately treated, with sparse resources and treatments in many countries (Vieira et al., 2013). It is also often perceived as a fatal disease for which there is no cure, and one where death appears before old age, as individuals are often left without medical attention or proper recognition. The causes of EOD are similar to those of dementia in the older population, with Alzheimer's being the most common form of EOD, affecting around 1 in 3 people with EOD ("Alzheimer's", n.d.). Rather than memory loss, younger people with Alzheimer's are likely to demonstrate problems with understanding visual information, difficulties with language, or difficulties in planning/organizing and decision making, and behaving in socially inappropriate ways ("Alzheimer's", n.d.). On a personal note, this writer's grandmother passed away from dementia and Alzheimer's, so she has a first-hand experience of how extremely detrimental and heartbreaking the effects of dementia can be on a person and their family. Especially for someone with a busy, active life, and a family, job and kids - this diagnosis would bring all of that to a screeching halt, and place great financial, emotional and psychosocial burden on one's spouse and family members. Regarding traumatic brain injury (TBI), a clinician will typically assess the severity during the diagnostic process; however, the initial assessment of TBI severity does not necessarily predict the extent of disability arising from TBI ("National", 2019). Typical approaches to determining severity early after injury include neuroimaging, assessing the presence of an altered consciousness or loss of consciousness, assessing the presence of posttraumatic amnesia, and applying the Glasgow Coma Scale score ("National", 2019) . The DSM-V addresses TBI and its neuropsychiatric outcome with the framework for neurocognitive disorders, and requires strict criteria for diagnosing major or mild neurocognitive disorders resulting from TBI ("National", 2019). TBI is defined in the DSM-V as an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull, with one or more of the following : loss of consciousness, posttraumatic amnesia, disorientation and confusion, and neurologic signs ("National", 2019). Neuroimaging, CT imaging, MRI's, and advanced MRI imaging techniques all play critical roles in screening, diagnosing and assessing for the presence of TBI ("National", 2019).Once a TBI patient is physically stable, subsequent cognitive, emotional , behavioral and social difficulties often manifest, hindering engagement with treatment and daily functioning; managing these challenges requires a comprehensive neuropsychological approach (Gomez-de-Regil et al., 2019). CBT is built on the assumption that cognitions strongly affect behaviors, but through awareness, can be quantified and controlled, and application of CBT for TBI patients has been aimed at reducing anger, depression, anxiety and PTSD symptoms, and at improving coping skills (Gomez-de-Regil et al., 2019) . Additionally, as deficits in executive functioning (EF) can be profound and debilitating in patients with TBI, the cognitive orientation to occupational performance model (CO-OP) can be utilized to encourage patients with TBI to use metacognitive strategies to identify and strengthen weak areas of cognition (Gomez-de-Regil et al., 2019). Telerehabilitation , such as videoconferencing between patients and therapists, can often support this approach to address issues with cognitive capacity and remembering verbally presented information (Gomez-de-Regil et al., 2019). References Alzheimer's Society. (n.d.). What causes young-onset dementia? United Against Dementia. https://www.alzheimers.org.uk/about-dementia/types-dementia/what-causes-young-onset-dementiaDucharme, F., Kergoat, M.-J., Antoine, P., Pasquier, F., & Coulombe, R. (2013). The unique experience of spouses in early-onset dementia. American Journal of Alzheimer's Disease and Other Dementias, 28 ( 6), 634–641. https://doi-org.postu.idm.oclc.org/10.1177/1533317513494443Gomez-de-Regil, L., Castillo, D., & Cauich, J. (2019). Evidence–Based Practice for Traumatic Brain Injury A Cognitive Rehabilitation Reference for Occupational Therapists. Behavioral Neurology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525953/#:~:text=Current%20TBI%20therapies%20include%20pharmacotherapy,symptoms%20are%20treated%20%5B7%5D. Heerema, E. (2019). How Alzheimer's Can Cause Changes in Personality. Very Well Health. https://www.verywellhealth.com/personality-changes-in-alzheimers-97989Naleppa , M. J., & Reid, W. J. (2003). Gerontological social work: A task-centered approach. New York: Columbia University Press.The National Academies of Sciences, Engineering, and Medicine. (2019). Evaluation of the disability determination process for traumatic brain injury in veterans. The National Academies Press. National Institute on Aging. (2017). Managing Personality and Behavior Changes in Alzheimer's. https://www.nia.nih.gov/health/managing-personality-and-behavior-changes-alzheimers Vieira, R. T., Caixeta, L., Machado, S., Silva, A. C., Nardi, A. E., Arias-Carrión, O., & Carta, M. G. (2013). Epidemiology of early-onset dementia: A review of the literature. Clinical Practice and Epidemiology in Mental Health, Alexus MDear Professor and Classmates,There are various neurocognitive disorders that are associated with dementia. These disorders include Alzheimer's, Frontotemporal dementia and dementia with Lewy Bodies. Starting with Alzheimer's, the most common symptom as the the onset of this disorder is having difficulty remembering new information. Alzheimer's changes take part in the part of the brain that affects one's learning abilities. As this disorder progresses throughout the brain it eventually causes more severe symptoms. These symptoms include disorientation, both mood and behavior changes, deepening confusion about events, time and places, unfounded suspicions about others around them, serious memory loss as well as difficulty speaking, swallowing and moving (What Is Alzheimer’s?, 2020). Two abnormal structures of the brain that come along with this disorder are plaques and tangles. Both of these damage and kill nerve cells in the brain. Plagues are deposits of beta-amyloid that builds up in spaces between nerve cells (What Is Alzheimer’s?, 2020). Tangles are twisted fibers of tau that builds up inside cells (What Is Alzheimer’s?, 2020). Those who are at risk for alzheimer's is anyone 65 years and older. However, younger individuals who have a family history of this disorder could get it younger. For family history is a strong factor as to whether or not one will develop this disorder. Another risk factor that goes along with this is ones genetics. Latinos and African Americans have a higher risk then white individuals in developing this disorder. This is due to the belief that this is due to these groups having higher rates of vascular diseases. For good Vascular health is important. to have and keep up with when one has a family history and genetics that could potentially lead them to developing this disease. Another important thing to know about this disorder is that it is mpre likely to develop in women then it is men. Frontotemporal dementia is a cause of dementia that is caused by nerve cells in both the frontal and temporal lobes of the brain are lost (Frontotemporal Dementia, 2020). The lack of nerve cells end up causing the lobes to shrink. This type of dementia ends up affects one's behavior, personality, language and movement abilities. This type of dementia tends to impact those at younger ages of 45 through 65 year olds. Men and women are both equally at risk for experiencing this type of dementia. It is uncertain as to what causes this type of dementia, but it is believed at this point that it is due to mutations of certain genes. The only risk for this dementia is if one has a family history of this type of dementia. Symptoms include having impaired judgement, being socially inappropriate, impulsive, or having repetitive behaviors, apathy, lack of empathy, lack of empathy and self awareness, etc. Symptoms and progression are different from person to person and really depends on what parts of the brain are involved/affected. Demenita with Lewy bodies is a progressive form of dementia that ultimately leads to the decline in one's thinking, reasoning and overall independept function. This form of dementia is due to abnormal tiny deposits that damage brain cells over time (Lewy Body Dementia, 2020). Lewy bodies are also found in other brain disorders including Alzheimers. Symptoms include changes in thinking and reasoning, delusions, sleep disturbances, hallucinations, etc. This type of dementia is found to affect men slightly more then women. This disease is progressive, starting off slow and gradually getting work as time goes on. Those who are 60 years and older are at a greater risk of developing this form of demenita. The role of a counselor in assisiting these clients is to help pick up and notice the signs of early stages of dementia. For those who have dementia will also tend to have depression, difficulty with relationships in their life, feel alone and even have anxiety about what the future holds for them. It is important to educate them and talk them through all of this to alleviate unnecessary stress. It is also important to teach them skills and tricks to use that will help them in their everyday life. Supporting these individuals and letting them know that they are not alone and that you will be with them every step of the way will really help comfort and motivate them. Educating them on their illness will help eliminate any false beliefs or assumptions one may have. As a counselor it is important to be kind, respectful and to give these individuals your full attention at all time. It is also a good idea to focus on what is possible and the strenghts opposed to the disabilities that go along with dimentia. All of this will help them better be able to cope with everything going on. In terms of their family, it will help them with emotional release by providing an environment where they can share their thoughts and opinions openly. It will also help educate and inform them about things they may not have been aware of prior. It will also help them figure out what changes and adjustments need to be made at home to help their family member. Lastly, any decisions that need to be made in terms of legalalities, finances and health can be discussed and thouroughly planned.The neurocognitive disorder the writer chose was Alzheimer's disease. In order to distinguish whether it would be deemed to be mild or major one needs to look at the medical or substance etiology. For major neurocognitive disorder for probable Alzheimer's disease is if anything from the list is present and the person is already diagnosed. It would be possible then this means that one has the following symptoms but isnt diagnosed yet. These include there being evidence of the cause of the disease being due to some sort of genetic mutation from family history or geneitc testing. Also all three of the following need to be present; clear evidence that one's memory and learning abilities are getting worse and at least one other cognitive domain (American Psychiatric Association, 2013). The next is that the individual is experencing steadily progressive, gradual decline in their cognition without extended plateaus (American Psychiatric Association, 2013). Lastly, there is no evidence of mixed etiology (American Psychiatric Association, 2013). For mild neurocognitive disorder for probable alzheimers disease, this means that the individual is diagnosed if there is any evidence of a causative genetic mutation from either their families history or genetic testing (American Psychiatric Association, 2013). It would be possible for the same reasoning the writer talked about prior for major neurocogntive disorder. These three required symptoms are there is clear evidence of one's declinein learning and memory. They have been experiencing a steady, progressive and gradual decline in their cognition without any extended plateaus. There is also no evidence that what they are experiences is mixed with another etiology. Laslty, the disturbances the individual is experiencing cannot be better explained by any other disease or disorder. The severity of the disorder would impact the writers would with a client because of where their client is mentally at. It may be hard to have them focus and understand what is being talked about if their disease has progressed beyond a certain point. Depending on where the client is at mentally will determine on how the sessions go. For they may be at a point in their disease where they are unable to remember any new information or be able to understand what is being talked about for that matter. Evidence based therapies that counselors can provide when treating TBI include pharmacotherapy, psychotherapy and cognitive rehabilitation. References:American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596Frontotemporal Dementia. (2020). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/dementia/frontotemporal-dementia#:%7E:text=Frontotemporal%20dementia%20(FTD)%2C%20a,personality%2C%20language%2C%20and%20movement.Lewy Body Dementia. (2020). Alzheimer’s Disease and Dementia. https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/lewy-body-dementiaWhat is Alzheimer’s? (2020). Alzheimer’s Disease and Dementia. https://www.alz.org/alzheimers-dementia/what-is-alzheimersDQ#2 Paraphilic DisorderTanya PThe Paraphilic disorder that I selected is the exhibitionistic disorder which causes an individual to expose sexual organs to other people. Its key symptoms include having this behavior repeated for more than six months, normal life disrupted, makes the person distressed, and no other mental illnesses. The treatment would include psychotherapeutic and pharmacological. Group, marital, family and individual therapy would be important. The treatment recommendations would be impacted by demographic factors of the person. For example, a relatively younger person would require individual therapy while a married man may require family therapy (Cooley, 2019). I would not consider working for a client charged with pedophilia. My cultural beliefs and values consider his behavior contrary to social norms affecting the most precious and vulnerable members of the society - prepubescent children. I believe such people should not be allowed to freely integrate with other members of the community. My pre-judgment about the person charged with pedophilia would hurt the quality of social care that I would give. ReferencesCooley, M. (2019). Exhibitionistic Disorder. The Paraphilias: Changing Suits in the Evolution of Sexual Interest Paradigms, 69Darren EHello class and Professor The paraphilic disorder that the writer chose to discuss is the pedophilia disorder and the criteria for diagnoses for this disorder. To get more specific the writer is talking about pedophilia with child porngrahy. According to First, ( 2011 ) states that the proposal to add use of child pornography to criteria B of pedophilia is in direct conflict with the newly proposed distinction between paraphilia and paraphilic disorder, muddying rather than clarifying the diagnostic definition of pedophilia. The proposal to distinguish paraphilic disorder form paraphilia derives from the fact that the diagnostic criteria for the paraphilias have two components: Criterion A, defining the presence of a parahilic erotic interest, and Criterion B, requring clinically significant distress, impairment, oracting out the paraphilia with a nonconsenting person. meeting criteria A and B is necessary for a diagnosis of a diagnosis of paraphilic disorder; meeting only criterion A, perhaps as an example of a behavioral manifestation of pedophilia. Some would say that the criterion must be modified to restrict it to the use of illegal forms of pornography (i.e.,) visual depictions of real children), excluding written or aural forms or images. (First, 2011). According to Bennett, (2017) states that the Diagnostic Statistical Manual Mental Disorders, Fifth Edition (DSM-5), outlines diagnostic criteria that must be met in order for a diagnosis of pedophilic disorder to be made. The criteria are as follows: The individual experiences intenses sexually arousing fantasies or urges involving sexual activity: with prepubescent children, over a period of at least 6 months. The individual has acted on these sexual urges, otr the urges has caused serious distress. He or she is at least 16 years of age and at least 5 years older than his or her victim. Note: This does not pertain to individuals in late adolescence who are involved in on going sexual relationships with, say, 12 or 13 years old. If the individual meets the criteria for pedophilic disorder, it should also be evaluated and specified in the disorder is: Eclusive type, whereas the individuals is only attracted to children. Nonexclusive type, whereas the individual is attracted to children in addition to mature individuals. Limited to increst, if the person is sexually attracted to males, sexually attracted to females, or sexually attracted to both. As a counselor the writer would use the cognitive-behavioral model which will help the client to think about their fantasies and how it effect the victims. According to Bennett, (2017) states that (CBT) has proven to successfully treat people with pedophilic disorder. It shows empathy, assertiveness training, relaose prevention, and also involve confronting the person's distortions as well as teaching lifelong maintenance. Reference:Bennett, T. (2017). Different treatments for pedophiliawww.livework.comFirst, M. (2011). The inclusion of child pornography in the DSM-5 diagnostic criteria for pedophilia: conceptual and practical problemswww.nih.pubmed.gov

Your Week 8 Assignment requires you to submit a formal letter addressed to your state or national representative. That letter must address the current state of mental illness, access to treatment, and an argument for why more resources for mental health are needed in your community or state. This week’s assignment serves as a checkpoint for that letter. Please submit the following for your instructor to review: Texas is the state! Your letter introduction The correct contact information for your state or national representative One outside source (not your textbook) that you will use in your letter. Provide a short summary of that source and how you plan to use it. View your assignment rubric.