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
2
Q
Are organic disorders acquired or congenital?
A
They are acquired, so different from intellectual disability
3
Q
Classification of organic disorders?
A
- Primary
- Direct effect on the brain
- Secondary
- Systemic diseases that affect the brain in addition to other organ systems
4
Q
Epidemiology - organic disorder
(age, onset)
A
- Onset
- Any age
- Adult or later life
5
Q
Classification of organic disorder?
A
- Acute/subacute
- Delirium
- Organic mood disorder
- Organic psychotic disorder
- Chronic
- Dementia
- Amnesic syndrome
- Organic personality change
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
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
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
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
10
Q
What is the prognosis for general disorders?
A
- Some irreversible and progressive
- Some transient/respond to treatment
11
Q
Aetiology - delirium tremens
A
- Alcoholic withdrawal
12
Q
Presentation - delirium tremens
A
- Fluctuating confusion
- Disorientation in time and place
- Memory impairment
- Psychotic phenomena
- Such as hallucinations, delusional thinking
13
Q
Management - delirium tremens
A
- Benzodiazepines
14
Q
What is Wernicke-Korsakoff syndrome also called?
A
Wernicke’s encephalopathy
15
Q
Aetiology - Wernicke-Korsakoff syndrome
A
- Thiamine deficiency
16
Q
Presentation - Wernicke-Korsakoff syndrome
A
- Acute confusional state
- Ataxia
- Opthalmoplegia
- Nystagmus
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
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
19
Q
What is alcohol amnesic syndrome also called?
A
Korsokoff’s psychosis
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
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
Prognosis - hepatic encephalopthy
26
Pathology - alcohol related brain damage
* Part of a spectrum of alcohol related disorders, not specific diagnosis
27
Alcohol related brain damage - aetiology
* Can result from neurotoxic effects of alcohol
* Head injury
* Vitamin deficiencies
* Cerebrovascular disease
* Hypoxia
* Hypoglycaemia
* Seizures
28
Alcohol related brain damage - epidemiology
* 35% of alcohol dependent people exhibit post-mortem evidence of this
* Prevalence rising
29
Alcohol related brain damage - clinical features
* 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
Alcohol related brain damage - investigations
* Imaging
* Cortical atrophy (mainly white matter loss) and ventricular enlargement
31
Alcohol related brain damage - prognosis
* Ability may recover spontaneously with abstinence/greatly reduced drinking
32
Dementia - pathology
* A syndrome characterised by global cognitive impairment which is chronic in nature
* Underlying pathology is variable and usually, but not always, progressive
33
Dementia - types
* Alzheimer’s
* Vascular
* Mixed
* Lewy body
* Frontotemporal
* Due to other brain disorders
* Huntington’s disease
* Head injury
* Parkinson’s disease
34
Compare the differences between dementia and pseudodementia for:
- onset
- long/short term symptoms
- mood
- answering of questions
- hiding/showing amnesia
- cognitive abilities
35
Steroid induced psychosis - epidemiology
* 1/3 of patients treated with steroids display mild-moderate psychotic symptoms
36
Steroid induced psychosis - management
* Taper steroids if possible
* Consider antipsychotic/mood stabiliser
37
Anti-NMDA receptor encephalitis - pathology
* Autoimmune disease that targets NMDA receptors
* Ionotropic glutamate receptor involved in synaptic plasticity and memory function
38
Anti-NMDA receptor encephalitis - aetiology
* ½ associated with malignancy
39
Anti-NMDA receptor encephalitis - clinical features
* Often presents with psychiatric symptoms
40
Anti-NMDA receptor encephalitis - investigations
* MRI
* Bilateral hippocampal hyper intensity
* EEG
* “Delta brush”
* Biochemistry
* Positive NMDAr antibodies in blood and CSF
41
What is seen in the following for anti-NMDA receptor encephalitis:
- MRI
- EEG
- biochemistry
* MRI
* Bilateral hippocampal hyper intensity
* EEG
* “Delta brush”
* Biochemistry
* Positive NMDAr antibodies in blood and CSF
42
Anti-NMDA receptor encephalitis - management
* Immunotherapy and tumour resection if indicated
* IVIg, plasmapheresis, rituximab
43
Anti-NMDA receptor encephalitis - prognosis
* With treatment is generally good
44
What is delirium characterised by?
An aetiologically non-specific syndrome characterised by:
* Concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion and sleep-wake cycle
45
Delirium - aetiology
* Medication
* Drug abuse
* Withdrawal syndromes
* Metabolic
* Vitamin deficiencies
* Endocrinopathies
* Infections
* Neurological causes
* Toxins and industrial exposures
* (Basically anything)
46
Delirium - presentation
* 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
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
48
What are the differences between delirium and psychosis for:
- conscious level
- thinking
- delusions
- cognitive functions
- hallucinations
49
Delirium - management
* 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
Delirium - prognosis
* Fluctuating course
* Gradually resolves after cause treated
* Slower symptom resolution in elderly
* Mortality
* 20% die during admission
* Up to 50% within 1 year
