عرض بوربوينت ل Organic Psychiatric Disorders

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عرض بوربوينت ل Organic Psychiatric Disorders

  1. 1. Organic Psychiatric Disorders
  2. 2. <ul><li>Delirium. </li></ul><ul><li>Dementia. </li></ul><ul><li>Other organic psychiatric syndromes. </li></ul><ul><li>Neurological syndromes. </li></ul><ul><li>Epilepsy. </li></ul>
  3. 3. What is organic psychiatric disorders? <ul><li>Psychiatric disorders resulting from brain dysfunction caused by organic pathology inside or outside the brain. </li></ul>
  4. 4. Classification of organic mental states <ul><li>Global syndromes… </li></ul><ul><li> Delirium. </li></ul><ul><li> Dementia. </li></ul><ul><li>Specific syndromes… </li></ul><ul><li> Amnesic syndrome . </li></ul><ul><li> Organic mood disorder. </li></ul><ul><li> Organic delusional disorder. </li></ul><ul><li> Organic personality disorder. </li></ul>
  5. 5. Delirium <ul><li>Acute generalized impairment of brain function. </li></ul><ul><li>The most important features is impairment of consciousness . </li></ul><ul><li>The primary cause is often outside the brain (eg …anoxia due to respiratory failure). </li></ul>
  6. 6. Delirium <ul><li>It is a common accompaniment of physical illness occurring in… </li></ul><ul><li> 5-15 % of pts in general medical & surgical wards. </li></ul><ul><li> 20-30 % of pts in surgical intensive care units. </li></ul><ul><li>It is especially common in the elderly. </li></ul><ul><li>Most pts recover quickly & a few need specific treatment. </li></ul><ul><li>Terms such as confusional state & acute organic syndrome are outdated . </li></ul>
  7. 7. Clinical Features <ul><li>Impaired consciousness </li></ul><ul><li>disorientation </li></ul><ul><li>poor concentration </li></ul><ul><li>Behavior </li></ul><ul><li>overactive </li></ul><ul><li>underactive </li></ul><ul><li>Thinking </li></ul><ul><li>muddled (confused) </li></ul><ul><li>ideas of reference </li></ul><ul><li>delusions </li></ul><ul><li>Mood </li></ul><ul><li>anxious , irrtable </li></ul><ul><li>depressed </li></ul><ul><li>perplexed </li></ul><ul><li>Perception </li></ul><ul><li>misperceptions </li></ul><ul><li>illusions </li></ul><ul><li>hallucinations </li></ul><ul><li>Memory </li></ul><ul><li>impaired </li></ul><ul><li>Insight </li></ul><ul><li>impaired </li></ul><ul><li>Fluctuating course ,worse in the evening </li></ul><ul><li>Amnesia ( on recovery) </li></ul>
  8. 8. Aetiology <ul><li>Drug intoxication . </li></ul><ul><li>Alcohol withdrawal. </li></ul><ul><li>Metabolic failure.. </li></ul><ul><li>Cardiac </li></ul><ul><li>Respiratory </li></ul><ul><li>Renal </li></ul><ul><li>Hepatic </li></ul><ul><li>Hypoglycaemia </li></ul><ul><li>Fever.. </li></ul><ul><li>systemic infection </li></ul><ul><li>Neurological causes.. </li></ul><ul><li>encephalitis. </li></ul><ul><li>space-occupying lesions. </li></ul><ul><li>raised intracranial pressure . </li></ul><ul><li>following an epileptic seizure. </li></ul>
  9. 9. Management Obtain information from other informants & medical notes Assess the pt’s mental state Confirm the diagnosis of delirium Determine the physical cause & treat it Reduce disorientation: Reorientate repeatedly Consistent routine Reduce anxiety : Reassurance Medications Avoid over- or understimulation Inform & support relatives If calm: Moniter progress If agitated ,disturbed ,or distressed: Consider hyponotic at night Cosider regular medications Moniter progress & review medications
  10. 10. Dementia <ul><li>Chronic generalized impairment of brain function. </li></ul><ul><li>Characterized by impairment of intellect ,memory & personality without impairment of consciousness. </li></ul><ul><li>The primary cause is within the brain . </li></ul><ul><li>Most cases are irreversible (few can be treated) </li></ul>
  11. 11. Clinical Features <ul><li>Cognition.. </li></ul><ul><li>poor memory </li></ul><ul><li>impaired attention </li></ul><ul><li>aphasia, agnosia, apraxia </li></ul><ul><li>disorientation </li></ul><ul><li>Behavior.. </li></ul><ul><li>odd & disorganized </li></ul><ul><li>restless & wandering </li></ul><ul><li>self-neglect </li></ul><ul><li>disinhibition </li></ul><ul><li>Mood </li></ul><ul><li>anxiety </li></ul><ul><li>depression </li></ul><ul><li>Thinking </li></ul><ul><li>slow ,impoverished </li></ul><ul><li>delusions </li></ul><ul><li>Perception .. </li></ul><ul><li>illusions </li></ul><ul><li>hallucinations </li></ul><ul><li>insight.. </li></ul><ul><li>impaired </li></ul>
  12. 12. Aetiology <ul><li>Degenerative neurological disorders.. </li></ul><ul><li>Alzheimer’s disease </li></ul><ul><li>Vascular dementia </li></ul><ul><li>lewy body dementia </li></ul><ul><li>Frontotemporal dementia </li></ul><ul><li>Huntington’s chorea </li></ul><ul><li>prion disease </li></ul><ul><li>parkinson’s disease </li></ul><ul><li>Normal pressure hydrocephalus </li></ul><ul><li>Intracranial tumor </li></ul><ul><li>Other space –occupying lesions.. </li></ul><ul><li>chronic subdural haematoma </li></ul><ul><li>Traumatic .. </li></ul><ul><li>severe head injury </li></ul><ul><li>Anoxia.. </li></ul><ul><li>cardiac arrest </li></ul><ul><li>carbon monoxide poisoning </li></ul><ul><li>Vitamin lack </li></ul><ul><li>vitamin B12 </li></ul><ul><li>folic acid </li></ul><ul><li>thiamine </li></ul><ul><li>Metabolic </li></ul><ul><li>DM </li></ul><ul><li>Endocrine </li></ul><ul><li>hypothyroidism </li></ul><ul><li>Infections.. </li></ul><ul><li>postencephalitis ,HIV </li></ul><ul><li>Vascular.. </li></ul><ul><li>multi-infarct dementia </li></ul><ul><li>Toxic </li></ul><ul><li>alcohol </li></ul>
  13. 13. Management <ul><li>Detailed history (informant). </li></ul><ul><li>Mini mental state examination. </li></ul><ul><li>Investigations… </li></ul><ul><li> CT…diagnosis of both focal & diffuse cerebral pathology. </li></ul><ul><li> psychological testing…. </li></ul><ul><li> specific tests of memory ,learning & other aspects of cognitive function…localized brain lesions. </li></ul><ul><li>Wechsler Adult Intelligence Scale (WAIS) …provide </li></ul><ul><li>a profile of verbal & non-verbal ablities. </li></ul>
  14. 14. Aspects of differential diagnosis <ul><li>Organic or functional ?? </li></ul><ul><li>Organic…. </li></ul><ul><li> The cognitive disorder preceded the mood or other disorder. </li></ul><ul><li> cognitive defects occur in specific areas of intellctual function </li></ul><ul><li> neurological signs. </li></ul><ul><li> The presence of symptoms seldom found in non-organic disorder ,such as visual hallucinations. </li></ul><ul><li>Functional … </li></ul><ul><li> by exclusion of organic causes </li></ul><ul><li> by finding positive evidence of psychological aetiology. </li></ul>
  15. 15. Cont.. <ul><li>Pseudodementia… </li></ul><ul><li>in this syndrome ,a depressed pt complains of poor memory & appears intellectually impaired because poor concentration leads to inadequate registration & deprssive mood leads to slowness & self –neglect. </li></ul><ul><li>Characteristic features…. </li></ul><ul><li> a history from another informant that the depressed mood preceded the memory problems . </li></ul><ul><li> memory testing shows that the poor performance improves when interest is aroused. </li></ul><ul><li> the pt is retarded & unwilling to cooperate in the interview. </li></ul>
  16. 16. Cont.. <ul><li>Delirium or Dementia?? </li></ul><ul><li>Delirium Dementia </li></ul><ul><li>Acute onset Insidious onset </li></ul><ul><li>fluctuating course stable or progressive </li></ul><ul><li>impaired consciousness normal consciousness </li></ul><ul><li>Thinking disorganized thinking impoverished </li></ul><ul><li>Perceptual disturbance perceptual disturbance </li></ul><ul><li>common uncommon </li></ul><ul><li>Alertness usually normally alert </li></ul><ul><li>Impaired </li></ul>
  17. 17. Cont… <ul><li>Stupor… </li></ul><ul><li>a rare condition in which the pt is immobile unresponsive but has a normal level of consciousness. </li></ul><ul><li>It can occur in severe affective disorder & schizophrenia. </li></ul><ul><li>Lesions of brainstem or mesencephalon can cause a similar picture ,although in these cases there may be some impairment of consciousness. </li></ul>
  18. 18. Treatment <ul><li>Aims of treatment…. </li></ul><ul><li> maintain any remaining ability as far as possible </li></ul><ul><li> relieve distressing symptoms.  arrange for the practical requirements of the pt. </li></ul><ul><li> support the family </li></ul>
  19. 19. Thank you
  20. 20. OTHER PSYCHIATRIC & NEUROLOGICAL SYNDROMES
  21. 21. Organic psychiatric syndrome Amnesic syndrome Organic personality disorder Organic mood disorder Organic delusional disorder Neurological syndrome Normal pressure hydrocephalus Head injury Cerebrovascular disease Cerebral tumor Transiet global amnesia Multiple sclerosis epilepsy
  22. 22. Amnesic syndrome <ul><li>Korsakov’s </li></ul><ul><li>syndrome </li></ul>Wernicke’s encephalopathy … .Impairment of consciousness, memory defect, disorientation, ataxia & ophthalmoplegia. Wernicke- Korsakov syndrome -Prominent disorder of recent memory.. -No intellectual impairment or impaired consciousness
  23. 23. Aetiology <ul><li>Lesion in the posterior hypothalamus </li></ul><ul><li>Bilateral hyppocampal lesions. </li></ul><ul><li>Alcohol abuse </li></ul>Causes thiamine deficiency. <ul><li>CO2 poisoning, vascular lesion, encephalitis, tumor in the third ventricle. </li></ul>
  24. 24. <ul><li>Recent memory severely impaired. </li></ul><ul><li>Remote memory spared. </li></ul><ul><li>Disorientation in time. </li></ul><ul><li>Confabulation >>> </li></ul>Clinical features detailed account of recent activities turn out to be inaccurate .
  25. 25. <ul><li>If thiamine deficiency >>> vitamin supplement. </li></ul>Treatment prognosis <ul><li>Chronic </li></ul><ul><li>Better if due to thiamine deficiency </li></ul>
  26. 26. Organic psychiatric syndrome Amnesic syndrome Organic personality disorder Organic mood disorder Organic delusional disorder Neurological syndrome Normal pressure hydrocephalus Head injury Cerebrovascular disease epilepsy Multiple sclerosis Cerebral tumor Transiet global amnesia
  27. 27. <ul><li>Frontal lobe damage.. </li></ul>Organic personality disorder Clinical features <ul><li>Behaviour: </li></ul><ul><li>- disinhibited, overfamiliar, tactless </li></ul><ul><li>Pts overtalkative, make inappropriate jokes, disregard feeling of others. </li></ul><ul><li>Mood: euophoric. </li></ul><ul><li>Concentration, attention & insight : impaired. </li></ul>
  28. 28. Organic psychiatric syndrome Amnesic syndrome Organic personality disorder Organic mood disorder Organic delusional disorder Neurological syndrome Normal pressure hydrocephalus Head injury Cerebrovascular disease epilepsy Multiple sclerosis Cerebral tumor Transiet global amnesia
  29. 29. Organic mood disorder <ul><li>Neurological disease </li></ul><ul><li>( multiple sclerosis) </li></ul>Endocrine Disorder (Cushing’s disease) Depression, mania or anxiety
  30. 30. Organic psychiatric syndrome Amnesic syndrome Organic personality disorder Organic mood disorder Organic delusional disorder Neurological syndrome Normal pressure hydrocephalus Head injury Cerebrovascular disease epilepsy Multiple sclerosis Cerebral tumor Transiet global amnesia
  31. 31. <ul><li>*Obstruction in the subarachnoid space. </li></ul>Normal pressure hydrocephalus Clinical features * Progressive memory impairment, slowness, unsteadiness of gait & urinary incontinence. Treatment *shunt operation to improve the circulation of CSF.
  32. 32. Organic psychiatric syndrome Amnesic syndrome Organic personality disorder Organic mood disorder Organic delusional disorder Neurological syndrome Normal pressure hydrocephalus Head injury Cerebrovascular disease epilepsy Multiple sclerosis Cerebral tumor Transiet global amnesia
  33. 33. <ul><li>Acute psychological effects include: </li></ul><ul><li>Impairment of cosciousness </li></ul><ul><li>Delirium </li></ul><ul><li>Post- traumatic amnesia of more than 24 h.. Followed by persistent cognitive impairment. </li></ul><ul><li>Personality change: </li></ul><ul><li>- severe… damage to frontal lobe </li></ul><ul><li>- irritability, loss of spontaneity and drive& reduced control of aggressive impulses </li></ul><ul><li>Emotional symptoms: </li></ul><ul><li>- anxiety &depression with headache, poor concentration & insomnia. </li></ul>Head injury
  34. 34. <ul><li>Neurological signs and physical disability. </li></ul><ul><li>Any neuropsychiatric problems and their future course. </li></ul><ul><li>Social circumstances, social support & the possibility of return to work </li></ul>assessment management <ul><li>Physiotherapy </li></ul><ul><li>Try to minimize disability </li></ul><ul><li>Deal with specific cognitive deficits </li></ul>
  35. 35. Organic psychiatric syndrome Amnesic syndrome Organic personality disorder Organic mood disorder Organic delusional disorder Neurological syndrome Normal pressure hydrocephalus Head injury Cerebrovascular disease epilepsy Multiple sclerosis Cerebral tumor Transiet global amnesia
  36. 36. <ul><li>Cognetive defects: Dementia, dysphasia & dyspraxia </li></ul><ul><li>Personality change : irritability, apathy or lability of mood failure to cope with everyday problem..(catastrophic reaction) </li></ul><ul><li>Depressed mood: psychological reaction to handicap or direct consequence of any localized brain damage </li></ul>Cerbrovascular disease Treatment antidepressent
  37. 37. Organic psychiatric syndrome Amnesic syndrome Organic personality disorder Organic mood disorder Organic delusional disorder Neurological syndrome Normal pressure hydrocephalus Head injury Cerebrovascular disease epilepsy Multiple sclerosis Cerebral tumor Transiet global amnesia
  38. 38. <ul><li>Fast growing tumor>> delerium </li></ul><ul><li>Slow growing tumor>> dementia </li></ul>Cerebral tumor Multiple sclerosis <ul><li>Depression or elation. </li></ul><ul><li>dementia </li></ul>
  39. 39. Organic psychiatric syndrome Amnesic syndrome Organic personality disorder Organic mood disorder Organic delusional disorder Neurological syndrome Normal pressure hydrocephalus Head injury Cerebrovascular disease epilepsy Multiple sclerosis Cerebral tumor Transiet global amnesia
  40. 40. <ul><li>Unknown cause </li></ul><ul><li>Middle or late life </li></ul><ul><li>Occasional </li></ul><ul><li>Abrupt episodes of unusual behaviour and global loss of recent memory for several hours </li></ul><ul><li>Pt alert & responsive </li></ul><ul><li>Unable to understand his experience </li></ul><ul><li>Complete recovery except for amnesia of the episode </li></ul><ul><li>No specific treatment </li></ul>Transiet global amnesia
  41. 41. Organic psychiatric syndrome Amnesic syndrome Organic personality disorder Organic mood disorder Organic delusional disorder Neurological syndrome Normal pressure hydrocephalus Head injury Cerebrovascular disease epilepsy Multiple sclerosis Cerebral tumor Transiet global amnesia
  42. 42. <ul><li>Association between epilepsy and psychological problems of epileptic individual: </li></ul><ul><li>Effect of stigma & social restriction </li></ul><ul><li>Psychiatric disorder due to the cause of epilepsy : </li></ul><ul><li>If due to brain damage>> intellectual impairment & personality problems </li></ul><ul><li>behavioural disturbance : </li></ul><ul><li>- Before: tension, irrritability, depression. </li></ul><ul><li>- During: comlex partial seizure. </li></ul><ul><li>- After: automatism. </li></ul><ul><li>Disorders between seizure: </li></ul><ul><li>- cognitive impairment </li></ul><ul><li>- personality disorder </li></ul><ul><li>- sexual disfunction </li></ul><ul><li>- increased self harm & suicide. </li></ul>epilepsy

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