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?

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
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