The presentation talks about two most common organic mental disorders seen in OPDs and ER. This is part -1 of 2 presentations

1. DR.V.MURUGAVEL MBBS.,DPM.,DNB(PSYCHIATRY).,
CC.Addiction medicine (NIMHANS).,
SENIOR RESIDENT
ESIC MEDICAL COLLEGE AND HOSPITAL
KK NAGAR, CHENNAI.

2. The term Organic psychiatry is used describe those disorders in which
there is a high probability that appropriate examination and
investigation will uncover some cerebral or systemic pathology
responsible for/contributing to the mental condition.
Almost all psychiatric disorders are biological, only few are classified as
Organic.
Alwyn Lishman, Textbook of neuropsychiatry,4th edition.

3. DELIRIUM
DEMENTIA
AMNESTIC SYNDROMES
ORGANIC PERSONALITY DISORDER
OTHER MENTAL DISORDERS DUE TO BRAIN DAMAGE/DYSFUNCTION

4. DELIRIUM
DEMENTIA
AMNESTIC SYNDROMES
ORGANIC PERSONALITY DISORDER
OTHER MENTAL DISORDERS DUE TO BRAIN DAMAGE/DYSFUNCTION

5.  Definition
 Risk factors
 Etiology
 Pathogenesis
 Clinical features
 Management
 Investigations
 Treatment

6.  Delirium is an acute decline in both the level of consciousness and cognition with
particular impairment in attention.
 Derived from the Latin word ‘’de-lira’’ which means ‘’out of the furrow’’.

7.  Age >65 years
 Male
 Cognitive impairment / Dementia
 Past h/o delirium
 Immobility/functional dependence
 Sensory impairments
 Poor nutritional status
 Multiple medications
 Co-morbid medical illnesses

8. Central nervous system
• Seizure(post ictal),head trauma,
• SAH,EDH,ICH,
• transient ischemia,
• Meningitis,encephalitis
Metabolic disorders
• Electrolyte imbalance(hyponatremia),
• hypoglycemia, Diabetic keto-acidosis,
• hypo calcemia

9. Systemic illness
• Sepsis,dehydration,
• nutritional deficiency(niacin),
• burns,heat stroke,
• high altitude
Medications
• Pain medications,
• Anti cholinergic drugs,Steroids,
• anti neoplastic drugs, antibiotics

10.  Cardiac: Myocardial infarction, CCF
 Renal: uremia, SIADH
 Pulmonary: COPD, respiratory failure
 Endocrine: thyroid disorders, Addison’s disease
 Hepatic: liver failure, hepatitis
 Hematologic: anemia, leukemia, stem cell transplant
 Over the counter preparations and botanicals
 Toxins: heavy metals, lead

14.  Altered levels of consciousness
 Disorientation
 Reduced attention
 Impaired memory
 Typical course:
1. Abrupt/acute onset
2. Brief duration
3. Marked impairment
4. Fluctuations- sun downing
Clinical types of delirium:
1.Hyperactive (agitated,
aggressive)
2.Hypoactive (dull,
withdrawn)
3.Mixed

15.  Complete blood count
 Renal function tests
 Liver function tests
 Serum electrolytes
 ECG
 Chest X ray
 EEG
 Thyroid function tests
 CT/MRI brain

16. SCREENING
TOOL FOR
DELIRIUM AT
BEDSIDE

17.  Identify and treat the cause.
 Patient is aggressive, uncooperative consider giving anti psychotics Haloperidol 5-
20mg iv can be given. Lower doses(1-3mg) are preferred in elderly.
 Environmental modification:
1. Optimal sensory stimulation
2. Orientation aids
3. Reassuring human contact

18. Actual room
Ideal room (Well spaced, reduced noise,
presence of a wall clock, television)

20. WERNICKE KORASKOFF
SYNDROME
 Refers to a spectrum of disorders due to vitamin B1/Thiamine deficiency that
ranges from Wernicke’s encephalopathy to Koraskoff syndrome.
Koraskoff
syndrome
Wernicke’s
Encephalopathy
Alcohol
dependence
CHRONIC,IRREVERSIBLE
STATE
ACUTE,REVERSIBLE STATE

21.  Alcohol abuse
 Poor diet
 Prolonged vomiting
 Eating disorders
 Pregnancy
 Chemotherapy
 Decompensated liver disease
 Chronic hospitalization

22.  The metabolically active form of thiamine is thiamine pyrophosphate, which
plays a major role as a cofactor in glucose metabolism.
 Anything that encourages glucose metabolism will exacerbate an existing clinical
or sub-clinical thiamine deficiency.
Thiamine
Thiamine
pyrophosphate
Glucose
metabolism
(Krebs cycle)
Pyruvate,
Alpha KG,
Branched chain
AA oxidation

23.  Atrophy of the following brain regions
 Hippocampus
 Mammillary bodies
 Medial nuclei of thalamus
 Cerebellum
 Basal forebrain

24. DRY BERIBERI:
NEUROLOGICAL
WET BERIBERI:
CARDIOVASCULA
R

26.  Amnesia (both retrograde and
anterograde)
 Confabulation
 Psychosis
 Apathy
 Personality change
 Auditory hallucinations are the most common psychotic feature seen in Korsakoff
syndrome.

27. ANTEROGRADE AMNESIA
RETROGRADE AMNESIA

29.  Most symptoms of Wernicke's encephalopathy can be reversed if detected and
treated promptly and completely.
 Stopping alcohol use may prevent further nerve and brain damage.
 However, improvement in memory function is slow and, usually, incomplete.
 Without treatment, they ultimately progress to Koraskoff syndrome which is
disabling and life-threatening.

30. 1. 4 Ampoules (1000mg) Thrice daily for 5 days
2. 2 Ampoules (500 mg) Once daily for next 5 days
3. Oral thiamine supplementation 100-300mg/day
(Note:1 Ampoule contains 250 mg of Thiamine)
PROPHYLAXIS:
1. 2 Ampoules (500 mg) Once daily for 5 days
2. Oral thiamine supplementation 100-300mg/day