Organic Disorders

Question 1

What are organic psychiatric disorders?

Answer 1

Mental disorders that are due to organic insult leading to cerebral dysfunction.

Oragnic insult: cerebral disease / brain injury / endocrine problems leading to cerebral dysfunction

Question 2

What is the difference between primary and secondary cerebral dysfunction?

Answer 2

Primary - conditions that directly affect the brain

Secondary - systemic conditions that affect the brain in addition to other systems / organs

Question 3

What are the common aspects of cerebral functioning that are affected by organic disorders?

Answer 3

Cognitive
- Memory, intellect, learning

Sensorium
- Consciousness and attention

Mood
- Depression, elation, anxiety

Psychotic
- Delusions, hallucinations

Question 4

When do organic disorders tend to onset? What is their disease progression like?

Answer 4

Tend to onset in older age, but can occur at any age

Some are irreversible and progressive (dementia)
Some are transiet and treatable (delerium)

Question 5

What are some of the acute / sub-acute organic disorders?

Answer 5

Delirium

Organic mood disorder

Organic pscyhotic disorder

Question 6

What is acute organic mental disorder defined as?

Answer 6

A recently appearing state of mental impairment as a result of intoxication, drug overdose, infection, pain or other physical problems

Often temporary but can become long lived if not handled correctly

Question 7

What are some of the chronic organic disorders?

Answer 7

Dementia

Amnesic syndrome (amnesia)

Organic personality change

Question 8

What are some important aspects of managing organic mental disorders?

Answer 8

Making sure the diagnosis is correct

Medication isn’t usually that useful, unless in acute situations

Requires MDT approach

Management of the patients environment is important

Question 9

What is delirium tremens? How do you treat it?

Answer 9

Rapid onset confusion caused by alcohol withdrawal

• Disorientation of time and place
• Memory impairment
• Possible psychosis (hallucinations / delusions)

Treatment with benzodiazepines

Question 10

What is Wernike’s encephalopathy? How is it treated?

Answer 10

Acute confusional state
Ataxia 
Opthalmoplegia 
Nystagmus 
- If left untreated can last weeks and 84% will develop Korsakoff psychosis

Related to acute deficiency ot thiamine (B1)

Treated with high potency parenteral B1 replacement

Question 11

What is alcohol amnesic syndrome (Korsakoff’s psychosis) characterized by?

Answer 11

Marked impairment of anterograde memory (ability to learn new information)

Consciousness and immediate recall usually intact

Personality changes, apathy, loss of initiative common

Confabulation (gaps in memory filled with fabricated info) common in early stage

May improve with prolonged abstinence

Question 12

What cerebral symptoms may be seen in hepatic encephalopathy? What is it caused by?

Answer 12

Psychomotor retardation
Drowsiness
Fluctuating levels of confusion

Caused by buildup of toxic products, improves as liver function recovers

Question 13

What causes alcohol related brain damage?

Answer 13

Neurotoxic effects of alcohol 
head injury
vitamin deficiency
Cerebrovascular disease 
Hypoxia 
Hypoglycaemia 
Seizures

Question 14

What are some commonly seen mental symptoms occuring in chronic alcoholics?

Answer 14

50-80% heavy drinkers display cognitive impairment when sober

Impaired short term memory, long term recall, new skill acquisition, set-shifting ability

Visuospatial decline usually larger than language decline

Question 15

What is dementia?

Answer 15

A syndrome characterized by widespread cognitive impairment that is chronic in nature

Most common types are alzheimers and vascular

Question 16

If a patient is being administered steroids and starts to display psychiatric symptoms what needs to be considered? How common is it?

Answer 16

Steroid-induced psychosis

Mild-moderate psychiatric symptoms in 28% of patients treated with steroids

Question 17

What is anti-NMDA receptor incephalitis? Presentation?

Answer 17

Autoimmune disease that targets NMDA receptors
- ionic glutamate receptor involved in synaptic plasticity and memory function

Often present with psychiatric symptoms (mania / depression)
Neurological symptoms tend to develop as well (seizures / headaches)

Question 18

What is delirium caused by? How does it tend to present?

Answer 18

Caused by a hugely varying number of pathologies, presentation includes symptoms affecting:

• Impairment of consciousness and attention
• Global disturbance of cognition
• Psychomotor disturbances
• Disturbance of sleep-wake cycle
• Emotional disturbance

Question 19

Describe the common course of delirium

Answer 19

Rapid onset

Diurnally fluctuating

Duration usually less than 6 months

Question 20

What are some of the physical signs that can be seen in delirium?

Answer 20

Depends on underlying cause

• Autonomic activation
• Hypertension
• Diaphoresis
• Dilated pupils
• Fever
• Dysgraphia (writing ability and fine motor skills impaired)

Question 21

What is the mortality rate like for delirium?

Answer 21

20% die during admission

50% dead within a year

Underlying cause can be hard to treat and is often well established by the tyime it is causing delirium

Question 22

What is one of the important characteristics of the course of delirium?

Answer 22

Often fluctuates (severe to less severe and back)

Usually improves once underlying cause is treated