Organic Mental Disorders
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Organic Mental Disorders

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  • Fleeting: fast, fragmentary: small
  • Factitious disorders are conditions in which a person acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms. Confabulation - a plausible but imagined memory that fills in gaps in what is remembered

Organic Mental Disorders Organic Mental Disorders Presentation Transcript

  • Organic Mental Disorders Delirium Dementia Organic Amnestic Syndrome Other Organic Mental Disorders
  • Organic – due to
    • Primary Brain Pathology
    • Secondary Brain Dysfunction to Systemic Disease
    Organicity / High index of suspicion for an organic problem : 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
  •  
  • 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
  • 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
    • Sun Drowning – sx 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
  • Mini MENTAL STATE EXAM for COGNITIVE IMPAIREMENT
    • Orientation (10), Registration (8), Language (8), Recall (3), Construction (1)
    • < 25/30 = probable impairement
    • < 20/30 = definitive impairement
  • Predisposing Factors
    • Old age
    • Preexisting brain damage/dementia
    • Past hx of delirium
    • Alcohol drug dependence
    • Chronic Medical illness
    • Surgical procedures
    • Rx with psychotropic drugs
    • Hx of Head Injury
  • Differential Diagnosis
    • Dementia
    • Mania
    • Schizophrenia
    • Depression
  • Organic ETIOLOGY of Delirium CLASS ETIOLOGY METABOLIC Hypoxia, Anemia, Electrolyte disturbance, Hepatic&Uremic Encephalopathy, Cardiac failure,arrest,arrythmia, Hypoglycemia, Metabolic acidosis&alkalosis, Shock ENDOCRINAL Pituitary, Thyroid, Parathyroid, Adrenal dysfunctions DRUG/SUBSTANCE (Many) including alcohol, benzodiazepines, anticholinergics, psychotropics, lithium, AntiHPT, diuretics, anticonvulsant, digoxin, heavy metals, Insulin, salicylates NUTRITIONAL DEFICIENCIES Thiamine, Niacine, Pyridoxine, Folic Acid INFECTIONS (ACUTE/CHRONIC) Septicemia, Pneumonia, Endocarditis, UTI, Meningitis, Encephalitis, Cellulitis INTRACRANIAL Stroke, Post Ictal, Head Injury, Infections, Migraine, Focal abscess/neoplasms, Hypertensive Encephelopathy MISCELLANEOUS Post op, ICU, Sleep deprivation
  • Management of Delirium
    • If cause not known – Do a battery of investigations : FBC, Urinalysis, Blood glucose, BUSE, Liver and renal function test, arterial p02, Pco2, Thyroid function, B12, Folate levels, CXR, ECG, CSF, Drug screen, VDRL, HIV, EEG, CT MRI
    • Correct underlying cause – ex
      • 50mg of 50% IV dextrose for HYPOGLYCEMIA
      • 02 for HYPOXIA
      • IV fluids for electrolyte imbalance
    • Drugs given if patient is agitated (most are):
      • Small dose BENZODIAZEPINES (Lorazepam, Diazepam)
      • ANTIPSYCHOTIC (Haloperidol)
    MAINTAIN WITH ORAL HALOPERIDOL, LORAZEPAM TILL RECOVERY IN 1 WEEK REVIEW DOSE, TAPER AND STOP
  • DELIRIUM VS DEMENTIA
  • B. DEMENTIA
    • Definition : Chronic Mental Disorder characterized by impairement of intellectual functions , Impairement 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
    • 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
  • DIFFERENTIAL DIAGNOSIS
    • Normal Aging (usually not sufficient to intefere with social or occupational function)
    • Delirium
    • Depression
    • Factitious disorder – pseudodementia – complains about impairement, emphasize disability, communicates distress, Don’t know answers (unlike dementia makes mistakes), confabulation rare
    • Schizophrenia
  • Types and causes Of Dementia Commonest: ALZHEIMERS DEMENTIA, MULTIINFARCT DEMENTIA, HYPOTHYROID DEMENTIA, AIDS DEMENTIA COMPLEX TYPE CAUSES Parenchymatous Brain Disease Alzheimers Disease, Parkinson’s disease, Huntingtons’s Chorea, Pick’s Disease, Steel-Richardson syndrome (prog. Supranuclr palsy) Vascular Dementia Multiinfarct Dementia, Subcortical Vascular dementia (Binswanger’s disease) Toxic Dementia Alcohol, Drugs, Heavy Metals, Bromide, CO, Benzodiazepines, Psychotropics Metabolic Dementia Chronic hepatic/uremic encephalopathy, dialysis dementia, Wilson’s disease Endocrinal Pituitary, Parathyrois, Thyroid, Adrenal dysfunction Deficiency Dementia Pernicious anemia, Pellagra, Folic acid, Thiamine deficiency Infections AIDS, Neurosyphillis, Chronic Meningitis, Creutzfelft-Jacob disease IOP ↑ Brain tumor, Headinjury hematoma, hydrocephalus
  • 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
  • MULTI INFARCT DEMENTIA
    • Multiple cerebral infarcts causing dementia due to underlying CVS problem
    • Abrupt onset, Acute exacerbations, Step wise clinical deterioration, Fluctuating course
    • Focal Neurological signs
    • Investigations: EEG (focal area of slowing) CT brain (multiple infarct area)
    • Treatment: Underlying (eg HPT)
    TIA HPT CVS DISEASE PREVIOUS STROKE
  • 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
  • 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
  • C. ORGANIC AMNESTIC SYNDROME
    • Characterized by
      • Memory impairment (anterograde, retrograde amnesia)
      • No impairment in immediate retention and recall, attention, consciousness, global intellect
    • Caused by Thiamine deficiency in alcohol dependence as part of Wernicke Korsakoff Syndrome
    • Rx: High dose Thiamine
  • D. Other Organic Mental Disorders
    • Organic Hallucinosis
    • Organic Catatonic Disorder
    • Organic Delusional (Schizo like) disorder
    • Organic Mood (Affective) disorder
    • Organic Anxiety disorder
    • Organic Personality Disorder
  • THANK U
    • “ I have recently been told that I am one of the millions of Americans who will be afflicted with Alzheimer's Disease... At the moment I feel just fine. I intend to live the remainder of the years God gives me on this earth doing the things I have always done... I now begin the journey that will lead me into the sunset of my life. I know that for America there will always be a bright dawn ahead. Thank you, my friends. May God always bless you”
      • President Ronald Reagen ( 1911 –2004)