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Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
Organic Mental Disorders
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Organic Mental Disorders

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  • Fleeting: fast, fragmentary: small
  • Transcript

    • 1. Organic Mental Disorders
      Delirium
      Dementia
      Organic Amnestic Syndrome
      Other Organic Mental Disorders
    • 2. Organic – due to
      Primary Brain Pathology
      Secondary Brain Dysfunction to Systemic Disease
      Suspicion of organic mental disorder : 1. First Episode 2. Sudden Onset 3. Older Age at onset 4. Hx of Drug/Alcohol abuse 5. Concurrent medical/neurological problem 6. Neurological signs: Seizures, LOC, Head injury, sensory motor deficit. 7. Presence of Confusion/Disorientation 8. Presence of visual and non auditory (olfactory, gustatory, tactile) hallucinations
    • 3. A. DELIRIUM
      Commonest organic mental disorder
      Definition: Acute organic brain syndrome characterized by clouding of consciousness and disorientation develops over a brief period and remits immediately once offending cause is removed.
      Epidemiology: - 5 to 15% of medical & surgical px; - High in post op patients; - 40-50% recovering from hip surgery; - Highest rate in post cardiotomy patients; - 30% in ICU
    • 4. Clinical Features
      Acute
      Clouding of conciousness
      Disorientation (mostly time, severe cases place and person)
      Short attention span/distractibility
      Perceptual Distortion
      Disturbance in sleep wake cycle
      DECREASE AWARENESS TO SURROUNDING
      DECREASE ABILITY TO RESPOND TO ENVIRONMENTAL STIMULI
      ILLUSIONS
      HALLUCINATIONS
      Mostly Visual
      INSOMNIA
      DAY TIME SLEEPINESS
    • 5. Sun Downing – six in evening
      New Memory Impairement
      Relatively intact remote memory
      Speech
      Mood – Fear, anger rage
      Delusions – Fleeting and fragmentary
      Neuro: Tremors, Dysphasia, Urinary incontinence
      IMPAIRED IMMEDIATE RECALL
      IMPAIRED RECENT MEMORY
      SLURRING of SPEECH
      INCOHERANCE
    • 6. Predisposing Factors
      Old age
      Pre existing brain damage/dementia
      Past history of delirium
      Alcohol /drug dependence
      Chronic Medical illness
      Surgical procedures
      History of Head Injury
    • 7. Organic ETIOLOGY of Delirium
    • 8. Management of Delirium
      If cause not known – Do a battery of investigations : CBC, Urinalysis, Blood glucose, Blood urea serum analysis, Liver and renal function test, arterial p02, Pco2, Thyroid function, B12, Folate levels, CSF, ECG, Drug screen,HIV, EEG, CT & MRI
      Correct underlying cause –
      If underlying cause is found then it must be treated immediately . For ex
      50mg of 50% IV dextrose for HYPOGLYCEMIA
      02 for HYPOXIA
      IV fluids for electrolyte imbalance
    • 9.
      • Drugs given if patient is agitated (most are):
      • 10. Small dose BENZODIAZEPINES (Lorazepam, Diazepam)
      • 11. ANTIPSYCHOTIC (Haloperidol)
      MAINTAIN WITH ORAL HALOPERIDOL, LORAZEPAM TILL RECOVERY IN 1 WEEK
      REVIEW DOSE, TAPER AND STOP
    • 12. DELIRIUM VS DEMENTIA
    • 13. B. DEMENTIA
    • 14.
      • Definition: Chronic Mental Disorder characterized by impairment of intellectual functions, Impairment of memory and deterioration of personality with the course being progressive, stationary or reversible
    • CLINICAL FEATURES
      Duration: 6 months
      Impaired Intellectual functions
      Impairement of memory (initially mild, remote memory in later stage)
      Deterioration of personality with lack of personal care
      No conscious impairment
      Orientation-usually normal but falls later
    • 15. Aphasia – Difficulty in naming an object
      Hallucinations and Delusions
      Additional:-
      - Emotional lability: Marked variable emotional expression
      - Catastrophic rxn: When asked to do something beyond her intellectual capibility, she goes into a rage
    • 16. Types and causes Of Dementia
      Commonest: ALZHEIMERS DEMENTIA, MULTIINFARCT DEMENTIA, HYPOTHYROID DEMENTIA, AIDS DEMENTIA COMPLEX
    • 17. ALZHEIMER’S DEMENTIA
      Women, Genetic
      ↓ neurotransmitter AcetylCholine due to degeneration of cholinergic nuclei in basal forebrain
      Drugs:
      Rivastigmine (1.5-6mg/day), Galantamine (4-12mg BID) -> ↑Ach by slowing its degredation
      Memantine (5-20mg/day) -> N, Methyl D Aspartate (NMDA) antagonist
      Vitamin E
    • 18. MULTI INFARCT DEMENTIA
      • Multiple cerebral infarcts causing dementia due to underlying CVS problem
      • 19. Abrupt onset, Acute exacerbations, Step wise clinical deterioration, Fluctuating course
      • 20. Focal Neurological signs
      • 21. Investigations: EEG (focal area of slowing) CT brain (multiple infarct area)
      • 22. Treatment: Underlying (eg HPT)
      TIA
      HPT
      CVS DISEASE
      PREVIOUS STROKE
    • 23. AIDS DEMENTIA COMPLEX
      50-70% patient of AIDS
      Triad of cognigtive, behavioral, motoric deficits, -> subcortical dementia
      Virus cross BBB -> Cognitive impairement
      Ix ELISA, Western Blot
      CT may show cortical atrophy
    • 24. MANAGEMENT OF DEMENTIA
      Basic investigations
      Treat underlying cause – mentioned
      Symptomatic management of anxiety, depression, Psychotic symptoms
      Education – Family, Financial, Support groups
      Institutionalize in later stage
    • 25. C. ORGANIC AMNESTIC SYNDROME
      • Characterized by
      • 26. Memory impairment (anterograde, retrograde amnesia) due to an underlying organic cause.
      • 27. No impairment of global intellectual function,abstract thinking,personality.
      • 28. Caused by Thiamine deficiency in alcohol dependence as part of Wernicke Korsakoff Syndrome
      • 29. Any other lesions involving bilaterally the inner core of limbic system(i.e mammillary bodies,fornix,hippocampus, medial temporal lobe,)
    • The Lesions include:
      Head trauma
      Surgical procedure
      Hypoxia
      Posterior cerebral artery stroke
      Herpes simplex encephalitis
    • 30. Management
      Treat the underlying cause if treatable.Ususally treatment is of not much help,except in prevention of further deterioration and the prognosis is poor
    • 31. D. Other Organic Mental Disorders
      Organic Hallucinosis
      Organic Catatonic Disorder
      Organic Delusional (Schizo like) disorder
      Organic Personality Disorder
    • 32. Organic Hallucinosis
      Etiology:
      Drugs:Hallucinogens,cocaine,cannabis,bromide)
      Alcohol:In alcoholic hallucinosis,auditory hallucinations are more common
      Migraine
      Epilepsy: Complex partial seizures
      Brain stem lesions
    • 33. Persistant or recurrent hallucinations due to an underlying organic cause.
      No major disruption of consciousness, intelligence or memory
      Management
      1)Treatment of the underlying cause if treatable.
      2) Symptomatic treatment with a low dose of an anti-psychotic drug.
    • 34. Organic Catatonic Disorder
      Etiology:
      Neurologic disorders: limbic encephalitis,Surgical procedures,sub dural hematoma,cerebral malaria
      Systemic and metabolic disorders : Diabetic ketoacidosis , pellagra, SLE, Hepatic encephalopathy
      Drugs and poisoning: Organic alkoloids ,aspirin,lithium poisoning ,ethyl alcohol , co
      Psychiatric disorders : manic stupor , periodic catatonia , reactive psychosis ,schizophrenia
    • 35. Management
      Treatment of underlying cause
      Symptomatic treatment with low doses of benzodiazipam or an anti-psychotic or electro convulsive therapy.
    • 36. Organic delusional disorder
      Predominant delusions which are persistant or recurrent ,caused by an underlying organic cause.
      No major disturbance of consciousness,orientation , memory or mood.
      Etiology:
      Drugs:Amphetamines,cannabis,disulfimes
      Spino cerebellar degeneration
      Complex partial seizures
    • 37. Management
      Treatment of underlying cause
      Symptomatic treatment with low doses of benzodiazipam or an anti-psychotic or electro convulsive therapy.

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