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Psychiatry (Brian) > Organic Disorders > Flashcards

Organic Disorders Flashcards

1
Q

What is the definition of organic disorder?

A

Organic disorder = mental disorder due to common, demonstrable aetiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction

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2
Q

Are organic disorders acquired or congenital?

A

They are acquired, so different from intellectual disability

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3
Q

Classification of organic disorders?

Primary

Secondary

A
  • Primary
    • Direct effect on the brain
  • Secondary
    • Systemic diseases that affect the brain in addition to other organ systems
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4
Q

Epidemiology - organic disorder

(age, onset)

A
  • Onset
    • Any age
    • Adult or later life
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5
Q

Classification of organic disorder?

A
  • Acute/subacute
    • Delirium
    • Organic mood disorder
    • Organic psychotic disorder
  • Chronic
    • Dementia
    • Amnesic syndrome
    • Organic personality change
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6
Q

What are examples of organic disorders?

A
  • Acute/subacute
    • Delirium
    • Organic mood disorder
    • Organic psychotic disorder
  • Chronic
    • Dementia
    • Amnesic syndrome
    • Organic personality change
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7
Q

What are some common features of organic disorders?

A
  • Cognitive
    • Memory
    • Intellect
    • Learning
  • Sensorium
    • Consciousness
    • Attention
  • Mood
    • Depression
    • Elation
    • Anxiety
  • Psychotic
    • Hallucinations
    • Delusions
  • Personality and behavioural disturbance
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8
Q

What can the following be broken down into:

  • cognitive
  • sensorium
  • mood
  • psychotic
A
  • Cognitive
    • Memory
    • Intellect
    • Learning
  • Sensorium
    • Consciousness
    • Attention
  • Mood
    • Depression
    • Elation
    • Anxiety
  • Psychotic
    • Hallucinations
    • Delusions
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9
Q

What is the general management for organic disorders?

A
  • Correct diagnosis for correct management
  • Medication usually not that useful except for acute situations
  • MDT approach
  • Management of environment
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10
Q

What is the prognosis for general disorders?

A
  • Some irreversible and progressive
  • Some transient/respond to treatment
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11
Q

Aetiology - delirium tremens

A
  • Alcoholic withdrawal
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12
Q

Presentation - delirium tremens

A
  • Fluctuating confusion
  • Disorientation in time and place
  • Memory impairment
  • Psychotic phenomena
    • Such as hallucinations, delusional thinking
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13
Q

Management - delirium tremens

A
  • Benzodiazepines
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14
Q

What is Wernicke-Korsakoff syndrome also called?

A

Wernicke’s encephalopathy

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15
Q

Aetiology - Wernicke-Korsakoff syndrome

A
  • Thiamine deficiency
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16
Q

Presentation - Wernicke-Korsakoff syndrome

A
  • Acute confusional state
  • Ataxia
  • Opthalmoplegia
  • Nystagmus
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17
Q

Treatment - Wenicke-Korsakoff syndrome

A
  • High potency parenteral B1 replacement
    • 3-7 days
    • All patients with Wernicke’s encephalopathy or at high risk should get parenteral thiamine, others undergoing detoxification or under invest4igation should get oral thiamine
  • Avoid carbohydrate load until thiamine replacement completed
  • Concurrent treatment for alcohol withdrawal
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18
Q

Prognosis - Wernicke-Korsakoff syndrome

A
  • Untreated acute phase lasts about 2 weeks
  • 84% develop Korsakoff psychosis with 15% mortality
  • With treatment
    • Confusional state and opthalmoplegia can resolve within days
    • Nystagmus, neuropathy and ataxia may be prolonged or permanent
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19
Q

What is alcohol amnesic syndrome also called?

A

Korsokoff’s psychosis

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20
Q

Clinical features - alcohol amnesic syndrome

A
  • Characterised by marked impairment of anterograde memory (ability to learn new information), disturbance of time sense
  • No clouding of consciousness, absence of defect in immediate recall or global impairment
  • Variable degrees of cognitive impairment
  • Personality changes
  • Apathy
  • Loss of initiative
  • Confabulation in early stage
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21
Q

What is alcohol amnesic syndrome characterised by?

A
  • Characterised by marked impairment of anterograde memory (ability to learn new information), disturbance of time sense
22
Q

Prognosis - alcohol amnesic syndrome

A
  • Can improve with prolonged abstinence
23
Q

Aetiology - hepatic encephalopathy

A
  • Normal seen in advanced alcohol liver disease
  • Related to build up of toxic products like ammonia
24
Q

Clinical features - hepatic encephalopathy

A
  • General psychomotor retardation
  • Drowsiness
  • Fluctuating levels of confusion
25
Q

Prognosis - hepatic encephalopthy

A
26
Q

Pathology - alcohol related brain damage

A
  • Part of a spectrum of alcohol related disorders, not specific diagnosis
27
Q

Alcohol related brain damage - aetiology

A
  • Can result from neurotoxic effects of alcohol
  • Head injury
  • Vitamin deficiencies
  • Cerebrovascular disease
  • Hypoxia
  • Hypoglycaemia
  • Seizures
28
Q

Alcohol related brain damage - epidemiology

A
  • 35% of alcohol dependent people exhibit post-mortem evidence of this
  • Prevalence rising
29
Q

Alcohol related brain damage - clinical features

A
  • Cognitive impairment
  • Impairment in short-term memory, long-term recall, new skill acquisition, set-shifting abilities
  • Visuospatial ability declines greater than language ability decline
30
Q

Alcohol related brain damage - investigations

A
  • Imaging
    • Cortical atrophy (mainly white matter loss) and ventricular enlargement
31
Q

Alcohol related brain damage - prognosis

A
  • Ability may recover spontaneously with abstinence/greatly reduced drinking
32
Q

Dementia - pathology

A
  • A syndrome characterised by global cognitive impairment which is chronic in nature
  • Underlying pathology is variable and usually, but not always, progressive
33
Q

Dementia - types

A
  • Alzheimer’s
  • Vascular
  • Mixed
  • Lewy body
  • Frontotemporal
  • Due to other brain disorders
    • Huntington’s disease
    • Head injury
    • Parkinson’s disease
34
Q

Compare the differences between dementia and pseudodementia for:

  • onset
  • long/short term symptoms
  • mood
  • answering of questions
  • hiding/showing amnesia
  • cognitive abilities
A
35
Q

Steroid induced psychosis - epidemiology

A
  • 1/3 of patients treated with steroids display mild-moderate psychotic symptoms
36
Q

Steroid induced psychosis - management

A
  • Taper steroids if possible
  • Consider antipsychotic/mood stabiliser
37
Q

Anti-NMDA receptor encephalitis - pathology

A
  • Autoimmune disease that targets NMDA receptors
    • Ionotropic glutamate receptor involved in synaptic plasticity and memory function
38
Q

Anti-NMDA receptor encephalitis - aetiology

A
  • ½ associated with malignancy
39
Q

Anti-NMDA receptor encephalitis - clinical features

A
  • Often presents with psychiatric symptoms
40
Q

Anti-NMDA receptor encephalitis - investigations

A
  • MRI
    • Bilateral hippocampal hyper intensity
  • EEG
    • “Delta brush”
  • Biochemistry
    • Positive NMDAr antibodies in blood and CSF
41
Q

What is seen in the following for anti-NMDA receptor encephalitis:

  • MRI
  • EEG
  • biochemistry
A
  • MRI
    • Bilateral hippocampal hyper intensity
  • EEG
    • “Delta brush”
  • Biochemistry
    • Positive NMDAr antibodies in blood and CSF
42
Q

Anti-NMDA receptor encephalitis - management

A
  • Immunotherapy and tumour resection if indicated
    • IVIg, plasmapheresis, rituximab
43
Q

Anti-NMDA receptor encephalitis - prognosis

A
  • With treatment is generally good
44
Q

What is delirium characterised by?

A

An aetiologically non-specific syndrome characterised by:

  • Concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion and sleep-wake cycle
45
Q

Delirium - aetiology

A
  • Medication
  • Drug abuse
  • Withdrawal syndromes
  • Metabolic
  • Vitamin deficiencies
  • Endocrinopathies
  • Infections
  • Neurological causes
  • Toxins and industrial exposures
  • (Basically anything)
46
Q

Delirium - presentation

A
  • Impairment of consciousness and attention
  • Global disturbance of cognition
  • Psychomotor disturbances
  • Disturbance of sleep-wake cycle
  • Emotional disturbance
  • Rapid onset
  • Diurnally fluctuating
  • Physical signs
    • Due to underlying disease
    • Autonomic activation – tachycardia, hypertension, diaphoresis, dilated pupils, fever
    • Dysgraphia
47
Q

Describe the differences between delirium and dementia in terms of:

  • onset
  • course
  • duration
  • alertness
  • orientation
  • registration
  • episodic memory
  • thinking
  • perception
  • speech
  • sleep/wake cycle
  • other acute pathology
  • EEG
  • CT, MRI
A
48
Q

What are the differences between delirium and psychosis for:

  • conscious level
  • thinking
  • delusions
  • cognitive functions
  • hallucinations
A
49
Q

Delirium - management

A
  • Environmental and supportive measures
    • Education of relatives
    • Make environment safe
    • Optimise stimulation
    • Orientation
  • Medication
    • Avoid sedation unless required for safety
    • Guidelines do not support use of medications in delirium
      • Unless for acute management for safety – antipsychotics, benzodiazepines, promethazine
50
Q

Delirium - prognosis

A
  • Fluctuating course
  • Gradually resolves after cause treated
  • Slower symptom resolution in elderly
  • Mortality
    • 20% die during admission
    • Up to 50% within 1 year

Psychiatry (Brian) (16 decks)

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