This document summarizes various organic mental disorders including delirium, dementia, organic amnestic syndrome, and other organic mental disorders. It describes the key features and causes of delirium including acute onset, confusion, and underlying medical conditions. Dementia is defined as a chronic mental disorder characterized by intellectual impairment and memory loss over 6 months. Alzheimer's disease and multi-infarct dementia are described as the most common causes. Organic amnestic syndrome is characterized primarily by memory impairment due to thiamine deficiency in alcoholics. Other organic mental disorders include organic hallucinosis, catatonia, delusions, and mood/anxiety disorders caused by underlying medical conditions.

1. Organic Mental Disorders Delirium Dementia Organic Amnestic Syndrome Other Organic Mental Disorders

2. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Differential Diagnosis Dementia Mania Schizophrenia Depression

10. 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

11. 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

12. 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

13. DELIRIUM VS DEMENTIA

14. B. DEMENTIA

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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)