This document discusses neuropsychiatry disorders caused by brain abnormalities. It classifies these disorders as acute generalized cognitive impairment (delirium), chronic generalized cognitive impairment (dementia), and specific neuropsychiatric syndromes. Delirium is described as a global impairment of consciousness causing reduced alertness and environmental perception. Causes of delirium include drugs/withdrawal, metabolic disturbances, infections, vascular issues, and nutritional deficiencies. Symptoms vary but include disorientation, slowed thinking, and perceptual abnormalities. Management focuses on identifying and treating underlying causes while providing a calm environment.

1. Neuropsychiatry
Disorders which arise from
demonstrable abnormalities of brain
structure and functions
These affect cognitive, behavioral and
emotional components

2. Neuropsychiatry classification
Acute generalized cognitive impairment-Delirium
chronic generalized cognitive impairment-Dementia
specific neuropsychiatric syndromes-- focal
cerebral syndromes, the amnestic syndromes
and organic disorders selectively affecting
perception and mood

3. Delirium
Global impairment in consciousness, resulting in
reduced level of alertness, attention and
perception of the environment.
5-15% of patients in general medical or surgical
wards. Higher proportion in Intensive care units
More in elderly and in individuals with low
cerebral reserves

4. Delirium Clinical features
Disturbed consciousness with disorientation in
time and place, which fluctuates with nocturnal
deterioration
Mental slowness, distractibility, perceptual
abnormalities and disorganization of sleep
Symptoms & signs vary widely between patients
and in the same patient at different times

5. Some causes of delirium 1
Drug intoxication and withdrawal
Alcohol, anticholinergics, anxiolytic-hypnotics, corricosteroids,
anticonvulsants, digoxin, opiates, L-dopa, dopaminergic
agonists, neuroleptic malignant syndrome, illicit drugs, heavy
metals, herbicides (organophosp
hates), industrial poisons, carbon
monoxide, prescription of multiple drugs.
Withdrawal of alcohol, opiates, and anxiolytic sedatives
Metabolic disturbance
Uraemia, liver failure, respiratory failure, cardiac failure,
disorders of electrolyte balance (especially hyponatraemia,
hypercalcaemia), dehydration, severe anaemia
Endocrinopathies
Hypoglycaemia, diabetic ketoacidosis and non-ketotic

6. Some causes of delirium 2
Systemic infection
Urinary tract infection, viral exanthemata, septicaemia, endocarditis,
pneumonia
Intracranial infection
Encephalitis (especially herpes simplex), meningitis, brain abscess,
HIV, cerebral malaria, neurocysticercosis.
Other intracranial causes
Intracranial inflammation
Vasculitis
Head injury
Post-concussional syndrome, diffuse anonal injury, Subdural
haematoma
Epilepsy
Epileptic status (non-convulsive), post-ictal states

7. Some causes of delirium 3
Vascular
Subarachnoid haemorrhage, venous sinus thrombosis, arterial
stroke
Neoplastic
Focal space-occuphying lesions, raised intracranial pressure
(including acute hydrocephalus), carcinomatous or lymphomatous
meningitis, paraneoplastic limbic encephalitis
Vitamin and other nutritional deficiency
Thiamine, nicotinic acid
Other
Pain, sleep deprivation, sensory deprivation and distortion (as in
Intensive Treatment Units)

8. Delirium Clinical features
Lipowski(1980) distinguished two types
The patient is restless, irritable and
oversensitive to stimuli, with psychotic
symptoms
Psychomotor retardation and
preseveration, without psychotic
symptoms

9. Delirium Clinical features
Repetitive, purposeless movements
Thinking is slow and muddled but often rich in
content
Ideas/Delusion of reference
Visual perceptual abnormalities--illusion,
misinterpretation, hallucinations
Tactile & Auditory hallucinations
Depersonalization and derealization

10. General principles of management
Identify & treat the underlying cause
General measure to control distress, control
agitation and prevent exhaustion
Frequent reassurance, explanation and
reorientation
Avoid frequent changes in staff and relatives
Nurse in quiet single room, avoid sensory
deprivation
Sufficient light at night to promote orientation

11. Drug treatment
Haloperidol
Short acting Benzodiazepines