organic disorders

Question 1

what is the definition of OD?

Answer 1

due to common, demonstrable aetiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction”

Acquired (differentiation from intellectual disability)
Distinction from from “functional” mental illness

Question 2

what is a primary OD?

Answer 2

direct effect on the brain

Question 3

what is a secondary OD?

Answer 3

systemic diseases that affect the brain in addition to other systems/organs

Question 4

3 organic disorders?

Answer 4

Schizophrenia,
bipolar affective disorder,
melancholia

Question 5

3 examples of acute/sub acute OD disorders?

Answer 5

Delirium
Organic mood disorder
Organic psychotic disorder

Question 6

3 examples of chronic OD disorder

Answer 6

Dementia

Amnesic syndrome

Organic personality change

Question 7

symptoms of Delirium Tremens

Answer 7

fluctuating confusion

disorientation in time & place

memory impairment

psychotic phenomena, e.g. hallucinations, delusional thinking

Question 8

how to treat delirium tremens?

Answer 8

benzodiazepine

Question 9

Symptoms of Wernike’s Encephalopathy?

Answer 9

Acute Confusional State
Ataxia
Opthalmoplegia
Nystagmus

Question 10

differential of Wernike’s Encephalopathy

Answer 10

delirium tremens

Question 11

what do 84% of people with wernike’s encephalopathy develop later on?

Answer 11

Korsakoff psychosis

Question 12

what is Wernike’s Encephalopathy/ Korsakoff Syndrome from?

Answer 12

Thiamine

(vitamin B1)

Question 13

treatment of Wernike’s Encephalopathy/ Korsakoff Syndrome

Answer 13

High potency parenteral B1 replacement
3-7 days
Oral thiamine

Avoid carbohydrate load until thiamine replacement completed
All patients with symptoms of Wernike’s encephalopathy or at high risk should be treated with parenteral thiamine, others undergoing detoxification or under investigation should be commenced on oral thiamine

Concurrent treatment for alcohol withdrawal

Question 14

Alcohol Amnesic Syndrome (Korsakoff’s psychosis) symptoms?

Answer 14

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 the early stage

Question 15

when do you see hepatic encephalopathy?

Answer 15

normally seen in advanced alcohol liver disease

related to build up of toxic products (e.g. ammonia)

Question 16

hepatic encephalopathy symptoms?

Answer 16

general psychomotor retardation, drowsiness
fluctuating levels of confusion

improves as liver function recovers

Question 17

what is the Adults with Incapacity (Scotland) Act 2000 for?

Answer 17

a person is unable to make a decision for him/herself if, due to mental disorder or inability to communicate because of physical disability, he/she is incapable of

-acting; or

-making decision; or
communicating decisions; or
-understanding decisions; or
-retaining the memory of decisions.

Question 18

What are the types of dementia?

Answer 18

-Alzheimer

-Vascular
(Mixed)

• Lewy body
• Frontotemporal
• Due to other brain disorders:
• Huntington’s chorea
• Head injury
• Parkinson’s disease

Question 19

symptoms of Dementia?

Answer 19

• progressive onset
• long term symptomatology
• Mood variations
• Patient tries to answer amnesia
• constant cognitive decline

Question 20

symtpoms of Depressive pseudo dementia

Answer 20

• rapid onset
• short term symptomatology
• consistently depressed mood
• Short answers; “I don’t know”, negativism
• Highlighting amnesia
• Fluctuating cognitive impairment

Question 21

what is Anti-NMDA Receptor encephalitis

Answer 21

Ionotropic glutamate receptor involved in synaptic plasticity and memory function

Question 22

what disorder is Anti-NMDA Receptor encephalitis associated with?

Answer 22

Around half associated with malignancy

Question 23

what does Anti-nada receptor encephalitis usually present with?

Answer 23

Often presents initially with psychiatric symptoms

Question 24

Anti-nada receptor encephalitis treatment

Answer 24

Immunotherapy and tumour resection if indicated

IVIg, plasmapheresis, rituximab

Question 25

prognosis of Anti-nada receptor encephalitis

Answer 25

Prognosis, with treatment, generally good

Question 26

what is delirium?

Answer 26

aetiologically nonspecific syndrome characterised by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion, and the sleep-wake cycle

Question 27

presenting features of delirium?

Answer 27

Impairment of consciousness and attention Global disturbance of cognition Psychomotor disturbances Disturbance of sleep-wake cycle Emotional disturbance Rapid onset Diurnally fluctuating Duration less than 6 months

Question 28

physical signs of delirium?

Answer 28

Due to underlying cause Autonomic activation: tachycardia, hypertension, diaphoresis, dilated pupils, fever Dysgraphia often evident

Question 29

causes of delirium?

Answer 29

meds drug abuse withdrawal symptoms metabolic vitamin deficiency Endocrinopathies neurological causes toxin and industrial exposures

Question 30

pathophysiology mechanism causes of delirium?

Answer 30

unclear GABAergic and cholinergic neurotransmitter systems? Central cholinergic deficiency? Increased risk associated with GABAa agonists and anticholinergic drugs Increased dopaminergic activity? Direct neurotoxic effect of inflammatory cytokines?

Question 31

delirium vs functional psychosis

Answer 31

Almost always accompanied by clouding of consciousness Thinking more concrete than abstract Generally more transient, may change, in response to environmental stimuli, unsystematised and persecutory Impairment of cognitive functions Predominance of visual hallucinations ----------------------------- Functional psychosis: No clouding of consciousness Thinking often more abstract Delusions often systematised No impairment of cognitive functions Predominance of auditory hallucinations

Question 32

things that can contribute to delirium?

Answer 32

``` Disorientation Dehydration Constipation Hypoxia Immobility/limited mobility Infection Multiple medications Pain Poor nutrition Sensory impairment Sleep disturbance ```

Question 33

environmental and supportive measures of delirium?

Answer 33

Education of relatives, medical and nursing staff Make environment safe Optimise stimulation Orientation

Question 34

meds for delirium?

Answer 34

Antipsychotics – rispirdone none better than any other. Caution in withdrawal states – seizure risk Benzodiazepines – lorazepam can prolong delirium Promethazine – anticholinergic; sedative but can worsen delirium, caution in elderly

Question 35

when to avoid antipsychotics in delirium?

Answer 35

alcohol/drug withdrawal states unless patient well covered with benzodiazepines due to lowering of seizure threshold