Acute brain disease prof. fareed minhas

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Acute brain disease prof. fareed minhas

  1. 1. Neuropsychiatry Disorders which arise from demonstrable abnormalities of brain structure and functions These affect cognitive, behavioral and emotional components
  2. 2. Neuropsychiatry classification Acute generalized cognitive impairment-Delirium chronic generalized cognitive impairment-Dementia specific neuropsychiatric syndromes-- focal cerebral syndromes, the amnestic syndromes and organic disorders selectively affecting perception and mood
  3. 3. Delirium Global impairment in consciousness, resulting in reduced level of alertness, attention and perception of the environment. 5-15% of patients in general medical or surgical wards. Higher proportion in Intensive care units More in elderly and in individuals with low cerebral reserves
  4. 4. Delirium Clinical features Disturbed consciousness with disorientation in time and place, which fluctuates with nocturnal deterioration Mental slowness, distractibility, perceptual abnormalities and disorganization of sleep Symptoms & signs vary widely between patients and in the same patient at different times
  5. 5. Some causes of delirium 1 Drug intoxication and withdrawal Alcohol, anticholinergics, anxiolytic-hypnotics, corricosteroids, anticonvulsants, digoxin, opiates, L-dopa, dopaminergic agonists, neuroleptic malignant syndrome, illicit drugs, heavy metals, herbicides (organophosp hates), industrial poisons, carbon monoxide, prescription of multiple drugs. Withdrawal of alcohol, opiates, and anxiolytic sedatives Metabolic disturbance Uraemia, liver failure, respiratory failure, cardiac failure, disorders of electrolyte balance (especially hyponatraemia, hypercalcaemia), dehydration, severe anaemia Endocrinopathies Hypoglycaemia, diabetic ketoacidosis and non-ketotic
  6. 6. Some causes of delirium 2 Systemic infection Urinary tract infection, viral exanthemata, septicaemia, endocarditis, pneumonia Intracranial infection Encephalitis (especially herpes simplex), meningitis, brain abscess, HIV, cerebral malaria, neurocysticercosis. Other intracranial causes Intracranial inflammation Vasculitis Head injury Post-concussional syndrome, diffuse anonal injury, Subdural haematoma Epilepsy Epileptic status (non-convulsive), post-ictal states
  7. 7. Some causes of delirium 3 Vascular Subarachnoid haemorrhage, venous sinus thrombosis, arterial stroke Neoplastic Focal space-occuphying lesions, raised intracranial pressure (including acute hydrocephalus), carcinomatous or lymphomatous meningitis, paraneoplastic limbic encephalitis Vitamin and other nutritional deficiency Thiamine, nicotinic acid Other Pain, sleep deprivation, sensory deprivation and distortion (as in Intensive Treatment Units)
  8. 8. Delirium Clinical features Lipowski(1980) distinguished two types The patient is restless, irritable and oversensitive to stimuli, with psychotic symptoms Psychomotor retardation and preseveration, without psychotic symptoms
  9. 9. Delirium Clinical features Repetitive, purposeless movements Thinking is slow and muddled but often rich in content Ideas/Delusion of reference Visual perceptual abnormalities--illusion, misinterpretation, hallucinations Tactile & Auditory hallucinations Depersonalization and derealization
  10. 10. General principles of management Identify & treat the underlying cause General measure to control distress, control agitation and prevent exhaustion Frequent reassurance, explanation and reorientation Avoid frequent changes in staff and relatives Nurse in quiet single room, avoid sensory deprivation Sufficient light at night to promote orientation
  11. 11. Drug treatment Haloperidol Short acting Benzodiazepines
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