1: Organic Brain Syndromes

Question 1

definition of confusion

Answer 1

-inability to think with usual speed and clarity

Question 2

definition of delirium

Answer 2

• special type of confusion w/ disordered perceptions, terrifying hallucinations, and vivid dreams
• marked psychomotor over activity

Question 3

definition of amnesia

Answer 3

• loss of the ability to form memories despite an alert state
• failure of retention, recall, and reproduction
• NO disturbances of perception

Question 4

observable phenomenon in organic brain syndromes (6)

Answer 4

• disturbance of perception
• disturbances of memory
• disturbance of thinking
• (disturbances of emotion, mood, and affect)
• (disturbance of impulse )
• loss of insight

Question 5

what is disturbance of perception?

Answer 5

failure to properly synthesize perceptions

-sensory distortions or overt hallucinatory experiences

Question 6

visual vs. auditory hallucinations

Answer 6

visual - more so with organic brain syndromes

auditory - more so with psychiatric

Question 7

what type of memory is more vulnerable to disease: short-term or long-term?

Answer 7

short-term

Question 8

best ways to evaluate thought processes?

Answer 8

evaluating an individual’s spontaneous verbal productions and by engaging him/her in conversation

Question 9

what do you think of with disturbances of emotion, mood, and affect?

Answer 9

usually indicate a psychiatric problem, but may be seen early on in organic brain syndromes

Question 10

what do you think of with disturbances in impulse?

Answer 10

psychiatric problem, but may be organic

Question 11

what is loss of insight?

Answer 11

severely impaired awareness of the degree of one’s deficits

-more loss of insight in organic syndromes than with psych disorders

Question 12

what medical illnesses are associated with acute confusional states?

Answer 12

• metabolic disorders:
  
  • hepatic stupor
  • uremia
  • hypoxia
  • hypercapnia
  • hypoglycemia
  • porphyria
  • hyponatremia
• high fever associated with infection
• CHF
• post-traumatic psychosis

Question 13

besides medical illnesses, what is associated with acute confusional states?

Answer 13

• drug intox

- diseases of the nervous system (w/ focal signs and/or CSF changes)

Question 14

what medical illnesses are associated with delirium?

Answer 14

• typhoid fever
• pneumonia
• septicemia
• rheumatic fever
• thyrotoxicosis
• alcoholism/DTs (delirium tremens)

*almost always associated with acute high fever

Question 15

what nervous system diseases, with focal signs and/or CSF changes, are associated with delirium?

Answer 15

• vascular, neoplastic - especially w/ the temporal lobes
• cerebral contusion and laceration (traumatic delirium)
• acute purulent or tuberculosis meningitis
• subarachnoid hemorrhage
• encephalitis

Question 16

what clinical and lab signs of other medical diseases are associated with dementias?

Answer 16

• hypothyroidism
• Cushing’s syndrome
• nutritional deficiency states
  
  • pellagra
  • Wernicke-Korsakoff syndrome
  • subacute combined degeneration (B12 deficiency)
• chronic meningoencephalitis
• hepatolenticular degeneration (Wilson’s disease)
• chronic intoxications (bromides, barbituates)

Question 17

what other neurological signs but not obvious medical diseases are associated with dementias?

Answer 17

• Huntington’s chorea (choreoathetosis)
• Schilder’s disease and related demyelinating diseases (spastic weakness) - rapidly progressive, in small kids
• Tay-Sach’s disease and other lipid storage diseases (myoclonic seizures, blindness, spasticity)
• myoclonic epilepsy (diffuse myoclonus)
• Jakob-Creutzfeld disease (myoclonus)
• thrombotic or embolic cerebral infarction
• brain mass
• brain trauma
• communicating hydrocephalus

Question 18

diseases in which dementia is the only evidence of neurological or medical disease

Answer 18

• Alzheimer’s disease
• Senile dementia
• Pick’s disease