organic disorders Flashcards
what is the definition of OD?
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
what is a primary OD?
direct effect on the brain
what is a secondary OD?
systemic diseases that affect the brain in addition to other systems/organs
3 organic disorders?
Schizophrenia,
bipolar affective disorder,
melancholia
3 examples of acute/sub acute OD disorders?
Delirium
Organic mood disorder
Organic psychotic disorder
3 examples of chronic OD disorder
Dementia
Amnesic syndrome
Organic personality change
symptoms of Delirium Tremens
fluctuating confusion
disorientation in time & place
memory impairment
psychotic phenomena, e.g. hallucinations, delusional thinking
how to treat delirium tremens?
benzodiazepine
Symptoms of Wernike’s Encephalopathy?
Acute Confusional State
Ataxia
Opthalmoplegia
Nystagmus
differential of Wernike’s Encephalopathy
delirium tremens
what do 84% of people with wernike’s encephalopathy develop later on?
Korsakoff psychosis
what is Wernike’s Encephalopathy/ Korsakoff Syndrome from?
Thiamine
(vitamin B1)
treatment of Wernike’s Encephalopathy/ Korsakoff Syndrome
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
Alcohol Amnesic Syndrome (Korsakoff’s psychosis) symptoms?
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
when do you see hepatic encephalopathy?
normally seen in advanced alcohol liver disease
related to build up of toxic products (e.g. ammonia)
hepatic encephalopathy symptoms?
general psychomotor retardation, drowsiness
fluctuating levels of confusion
improves as liver function recovers
what is the Adults with Incapacity (Scotland) Act 2000 for?
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.
What are the types of dementia?
-Alzheimer
-Vascular
(Mixed)
- Lewy body
- Frontotemporal
- Due to other brain disorders:
- Huntington’s chorea
- Head injury
- Parkinson’s disease
symptoms of Dementia?
- progressive onset
- long term symptomatology
- Mood variations
- Patient tries to answer amnesia
- constant cognitive decline
symtpoms of Depressive pseudo dementia
- rapid onset
- short term symptomatology
- consistently depressed mood
- Short answers; “I don’t know”, negativism
- Highlighting amnesia
- Fluctuating cognitive impairment
what is Anti-NMDA Receptor encephalitis
Ionotropic glutamate receptor involved in synaptic plasticity and memory function
what disorder is Anti-NMDA Receptor encephalitis associated with?
Around half associated with malignancy
what does Anti-nada receptor encephalitis usually present with?
Often presents initially with psychiatric symptoms
Anti-nada receptor encephalitis treatment
Immunotherapy and tumour resection if indicated
IVIg, plasmapheresis, rituximab
prognosis of Anti-nada receptor encephalitis
Prognosis, with treatment, generally good
what is delirium?
aetiologically nonspecific syndrome characterised by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion, and the sleep-wake cycle
presenting features of delirium?
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
physical signs of delirium?
Due to underlying cause
Autonomic activation: tachycardia,
hypertension, diaphoresis, dilated pupils, fever
Dysgraphia often evident
causes of delirium?
meds
drug abuse
withdrawal symptoms
metabolic
vitamin deficiency
Endocrinopathies
neurological causes
toxin and industrial exposures
pathophysiology mechanism causes of delirium?
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?
delirium vs functional psychosis
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
things that can contribute to delirium?
Disorientation Dehydration Constipation Hypoxia Immobility/limited mobility Infection Multiple medications Pain Poor nutrition Sensory impairment Sleep disturbance
environmental and supportive measures of delirium?
Education of relatives, medical and nursing staff
Make environment safe
Optimise stimulation
Orientation
meds for delirium?
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
when to avoid antipsychotics in delirium?
alcohol/drug withdrawal states unless patient well covered with benzodiazepines due to lowering of seizure threshold
