General Hospital Psychiatry, Functional Disorders and Organic Mental Disorders Flashcards
How does the ICD-11 describe neurocognitive (‘organic’) mental disorders?
- deficits in cognitive function
- acquired rather than developmental (i.e. intellectual disability)
- distinction from ‘functional’ mental illness
What are common clinical features of ‘organic’ mental disorders?
Cognitive:
- memory
- intellect
- learning
Mood:
- depression
- elation
- anxiety
Psychotic:
- hallucinations
- delusions
Personality and behavioural disturbance
Sensorium:
- consciousness
- attention
list some examples of ‘organic’ mental disorders with an acute presentation
- delirium
- withdrawal states
- organic mood disorder
- organic psychotic disorder
- encephalitis (inc. autoimmune - aNMDAr/VGKC)
list some examples of ‘organic’ mental disorders with a chronic presentation
- demenita
- amnesic syndromes
- organic personality change
delirium presenting features
- impairment of consciousness and attention
- global disturbances of cognition
- psychomotor disturbances
- disturbance of sleep-wake cycle
- emotional disturbance
delirium management
Management of delirium primarily focuses on treating the underlying cause. Non-pharmacological strategies should be the first line, which include:
- Providing an environment with good lighting
- Maintaining a regular sleep-wake cycle
- Regular orientation and reassurance
- Ensuring the patient’s glasses and hearing aids are used if needed
- For patients who are extremely agitated and potentially a danger to themselves or others, pharmacological interventions such as small doses of haloperidol or lorazepam. Olanzapine may also be considered however, these should be used with caution, especially in the elderly, due to the risk of side effects.
causes of delirium
The causes of delirium can be multifactorial and are remembered using the mnemonic DELIRIUMS:
D: Drugs and Alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
E: Eyes, ears and emotional disturbances
L: Low Output state (Myocardial Infarction, Acute Respiratory Distress Syndrome, Pulmonary Embolism, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease)
I: Infection
R: Retention (of urine or stool)
I: Ictal (related to seizure activity)
U: Under-hydration/Under-nutrition
M: Metabolic disorders (Electrolyte imbalance, thyroid disorders, Wernicke’s encephalopathy)
(S): Subdural hematoma, Sleep deprivation
what is dementia?
A syndrome characterised by global cognitive impairment which is chronic in nature.
The underlying brain pathology is variable and usually, but not always progressive.
List the types of dementia
- Alzheimer
- vascular
- (mixed)
- lewy body
- frontotemporal
- Due to other brain disorders including: Huntington’s chorea, head injury, MS, Parkinson’s disease, alcohol related
Describe Amnestic disorder features
- syndrome of impairment of recent and remote memory
- immediate recall preserved
- New learning reduced
- Anterograde amnesia
- Disorientation in time
- Retrograde amnesia (temporal gradient) – may lessen over time
- Confabulation
- Perception and other cognitive functions preserved
- Lesion typically affects hypothalamic-diencephalic system or hippocampal region
- Prognosis depends on course of underlying lesion
Almost complete recovery is possible
list some amnestic disorders involving diencephalic damage
- Korsakoff’s syndrome (alcoholic and non-alcoholic)
- 3rd ventricle tumours and cysts
- bilateral thalamic infarction
- post-subarachnoid haemorrhage
list some amnestic disorders involving hippocampal damage
- herpes simplex virus encephalitis
- anoxia
- surgical removal of temporal lobes
- bilateral posterior cerebral artery occlusion
- closed head injury
- early alzheimers disease
Wernicke’s encephalopathy features
- acute confusional state
- ataxia
- opthalmoplegia
Related to acute deficiency of Thiamine (vitamin B1).
Wernicke’s encephalopathy prognosis
Untreated acute phase lasts about 2 weeks, 84% develop Korsakoff psychosis
15% mortality
With treatment confusional state and opthalmoplegia can resolve within days,
nystagmus, neuropathy and ataxia may be prolonged or permanent
Wernicke’s Encephalopathy Treatment
- high potency parenteral B1 replacement, 3-7 days, oral thiamine
- avoid carb load until thiamine replacement completed
- concurrent treatment for alcohol withdrawal
