Organic Mental Disorders

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  • Fleeting: fast, fragmentary: small
  • Organic Mental Disorders

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

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