ACUTE ORGANIC BRAIN SYNDROME:
Are abnormal mental status that begins abruptly , run a course ranging from a few days
to 3—4 weeks.
It is associated with intrinsic brain disease with central dysfunction secondary to extra—
cerebral physical disease and intoxication.
Delirium---- acute brain syndrome
Acute confusional state
Dysmnesic syndrome-----Amnestic syndrome
Quasin functional syndromes
Organic affective syndrome
Organic delusional syndrome
Most frequent and important syndrome
Principal feature---reduction in level of conscious awareness((clouding)).
It is manifested clinically as disorientation in time/space, worse at night.
Other psychological symptoms:
Poorly sustained attention
Liability of mood
Disordered thought and speech
Visual and auditory hallucination
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Restlessness , Tremor ,Ataxia ,Slurred speech ,Incontinance.
Behavior disturbance – wandering ,aggressive outbursts
Age—any age- common in young children and elderly pts( dementia).
Environments – sensory and social isolation.
Drugs and alcohol abuse – predispose to delirium more readily
The cerebral dysfunction lie in brain stem reticular formation , thalamic nuclei mainly
mid line. This leads to disturbance in arousal ,attention ,wake sleep cycle.
EEG--- slowing of alpharhythm (( 8—13)) cycles/ second
Emergence of theta (( 4 ---7 )) cycles /second
Bilateral symmetrical predominant frontal delta waves (( 3)) cycles/s
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Minimum staff changes
Repeated reassurance and explanation of medical procedures.
Revesible causes to be treated
THE MOST EFFECTIVE TREATMENT IS IDENTIFICATION AND ELEMINATION OF
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DRUGS USED IN TREAMENT:
Need of treatment –restlessness
Drug therapy-- symptomatic
1.Should be flexible
2.Dosage according to the age and severity of disturbance.
3.Timing ideal with nocturnal variation in behavior
Tranquilizer are effective.
Haloperidol oral I/M I/V
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0.5mg ---10mg /2 - 3 times
Crisis ---5 -10mg I/V highly effective , can be repeated ½ hourly
Affective in controlling agitation ,aggression , noisy, restlessness.
Oral or I/M --- 25mg elderly , 500mg young
Effective in alcohol / drug withdrawal delirium
Disadvantage—excessive sedation and increased confusion in elderly
40—80 mg Diazepam daily orally or intravenously.
Short acting sedation and anticonvalsant with hypnotic properties.
Useful in 1.Alcohlo withdrawal 2. Drug withdrawal
Dose 1—1.5 mg daily orally
1 hour a day of 0.8% I/V
Risk of dependence
Depends on causative condition
Commonest out come—complete recovery
DRUGS CAUSING DELIRIUM:
Tranqulizer and hypnotics—Barbsiturate,Benzodiazepine,Bromide,Neuroleptics.
CVS drugs---- Digoxin , B blocker , Diuretic
Anticholinergic – Hyoscine, TCA, Antiparkinson,Atropine ,Homatropine
Dopamine agonist—Levodopa, Bromocriptine ,Amantidine
Antituberculosis—INH , Cycloserine , Rifampicine
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Antibiotics---Peniciline ,Streptomycine ,Sulphonamide
Anticonvulsants – Phenytoin , NA valporate
Others –Chloroquine , Hypoglycemic, Piperzine, Disulfiram
Drug withdrawal –Alcohol, Barbiturates ,BZA.
DYSMNESTIC SYNDROME: ― Korsakows syndrome‖
Characterized by defective retention of memory of new information.
Retention span being less than one minutes with relative sparing of remote memory and
Classically; the memory hiatus is filled by fanfasy memories ― confabulation‖
A.Thiamine deficiency---- alcoholism , hyperemesis gravidarum
B.Wernickes encephalopathy in thiamine deficiency
Alcohol , Vomiting(( upper GIT obstruction , starvation ,anorexia nervosa,hunger shiker)
Impairment of consciousness.
Progressing to coma
Ocular and conjugate gaze paralysis
D.Encephlitis involving both temporal lobes
Small puntate haemorrhage in the region of mamary bodies.
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In wernichs ,all the region of III ventricle of brain.
Thiamine 20—100mg daily for a week then contined orally over several wks
Treat the underlaying cause.
QUASIN FUNCTIONAL SYNDROMES:
1.Organic affective syndrome—
Major depression or mania---- drug ingestion // physical illness
2.Organic delusional syndrome—
Schizophrenia // schizo-affection psychosis with delusion , hallucination ,bizarre
behavior and though disorders.
3.Organic hallucinosis--Usually visual in colour
Drugs --- TCA , Antiparkinson , Digoxin ,B blocker ,Pentazocine
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