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Organic disorders Flashcards

1
Q

What is an organic medical disorder?

A

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

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2
Q

What are some impairments in cognitive deficiencies?

A

Memory
Intellect
Learning

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3
Q

What are some examples of chronic organic mental disorders?

A

Dementia
Amnesic syndrome
Organic personality change

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4
Q

What are some features of delirium tremens?

A

Fluctuating confusion
Disorientation in time & place
Memory impairment
Psychotic phenomena

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5
Q

How is delirium tremens treated?

A

Benzodiazepines

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6
Q

When does delirium tremens usually occur?

A

Alcohol withdrawal

Can complicate withdrawa

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7
Q

What are some features of Wernicke’s encephalopathy?

A

Acute confusional state
Ataxia
Opthalmoplegia
Nystagmus

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8
Q

What causes wernicke’s encephalopathy?

A

Thiamine (vitmain B1) deficiency

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9
Q

What is a complication of prolonged Wernicke’s encephalopathy?

A 
Korsakoff psychosis
Memory deficit
Confusion
Behaviour changes
Apathy
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10
Q

How is Korsakoff syndrome treated?

A

High potency parenteral B1 replacement
3-7 days
Oral thiamine
Avoid carbohydrate load until thiamine replacement completed

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11
Q

What are some features of hepatic encepahlopathy?

A

Psychomotor retardation
Drowsiness
Fluctuating confusion

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12
Q

Can heavy drinkers display cognitive impairment when sober?

A

Yes

50-80% do

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13
Q

How might cognitive impairment present in heavy drinkers?

A

Short-term memory
Long-term recall
New skill acquisition
Set-shifting ability

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14
Q

What are some imaging results in alcohol related brain damage?

A

Cortical atrophy mainly affecting white matter

Ventricular enlargement

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15
Q

What are some different kinds of dementia?

A 
Alzheimer
Vascular
Mixed
Lewy body
Frontotemporal
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16
Q

What are some secondary causes of dementia?

A

Huntington’s chorea
Head injury
Parkinson’s disease

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17
Q

What are the main differences in depressive pseudodementia compared to dementia?

A 
Rapid onset
Short-term symptomology
Consistently depressed mood
Short answers
Patient highlights amnesia
Fluctuating cognitive impairment
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18
Q

Can steroids cause psychiatric symptoms?

A

Mild-moderate psychiatric symptoms in 28% patients treated with steroids
Approximately 6% severe reaction
Dosage related to incidence but not timing, duration or severity

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19
Q

How are the psychiatric consequences of steroids managed?

A

Consider tapering steroids

Consider antipsychotic/mood stabiliser

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20
Q

What is anti-NMDA receptor encephalitis?

A

Autoimmune disease that targets NMDA receptors
Around half are associated with malignancy
Often presents with psychiatric symptoms

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21
Q

What are the options to treat anti-nmda receptor encephalitis?

A

IVIg
Plasmapheresis
Rituximab

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22
Q

What are some presenting features of delirium?

A 
Impairment of consciousness and attention
Global disturbance of cognition
Psychomotor disturbances
Disturbance of sleep-wake cycle
Emotional disturbance
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23
Q

Describe the onset of delirium?

A

Rapid
Diurnally fluctuating
Less than 6 months

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24
Q

What are some physical signs of delirium?

A

Tachycardia, hypertension, diaphoresis, dilated pupils and fever due to autonomic activation
Dysphagia

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25
How do metabolic and toxic disturbances usually present for delirium?
Listlessness | Apathy
26
How might infection alcohol withdrawal usually present for delirium?
Fearfulness Hyperactivity Hallucination
27
What are some medications which can cause delirium?
``` Anticholinergics like antidepressants, antipsychotic, anti-histamines, OTC hypnotics, antispasmodics Sedative hypnotics like flurazepam Decongestants Anti-asthmatics L-dopa Methyldopa Glucocorticoids ```
28
What are some toxins and industrial exposure which may cause delirium?
Carbon monoxide Carbon disulfide Organic solvents Heavy metals
29
Does delirium affect the sleep-wake cycle?
Yes | Disrupted
30
Does dementia affect the sleep-wake cycle?
Not usually
31
Does dementia show slowing on eeg?
No
32
What is an eeg result in delirium?
Generalised slowing
33
Would CT/MRI show atrophy in delirium?
Not usually
34
What kind of hallucinations predominate in delirium and functional psychosis?
Visual in delirium | Auditory in functional psychosis
35
Does functional psychosis affect cognitive function?
No
36
How does functional psychosis affect thinking?
Often more abstract
37
How is delirium treated?
Treat underlying cause
38
What are some risk factors for delirium?
``` Disorientation Dehydration Constipation Hypoxia Immobility/limited mobility Infection Multiple medications Pain Poor nutrition Sensory impairment Sleep disturbance ```
39
What are some environmental and supportive measures for managing delirium?
Education of relatives, medical and nursing staff Make environment safe Optimise stimulation Orientation
40
How are medications used in the management of delirium?
Try stop benzos Avoid sedation Can use antipsychotics like risperidone or quetiapine
41
What are some useful imaging techniques for dementia?
CT CT/SPECT DAT (used for parkinsons)
42
How does frontotemporal dementia usually present?
Behavioural Progressive non fluent aphasia Semantic memory affected
43
How does alcohol related dementia usually present?
Korsakoffs syndrome
44
What are some associations of subcortical dementia?
Parkinson's Huntington's HIV
45
What kind of dementia is associated with Creutzfeldt-Jakob Disease?
Prion protein
46
What are some reversible causes of dementia?
``` Delirium Normal pressure hydrocephalus Subdural haemorrhage Tumours Vitamin B12 deficiency Hypothyroidism Hypercalcaemia Alcohol misuse Neurosyphilis Drugs ```
47
How does Alzheimer's disease present?
Early impairment of memory and executive function Disorientation Mood/behaviour changes Unfounded suspicion about family, carers etc Gradual progression with often unclear onset Amyloid plaques & tau tangles Atrophy following neuron death Reduction in Acetylcholine
48
How might a small vessel disease vascular dementia present?
``` Dysarthria Dysphagia Parkinsonian gait Rigidity Hypokinesia Hemimotor dysfunction Can give gradual decline ```
49
How might a cerebral infarct vascular dementia present?
``` Aphasia Reflex asymmetry Hemianopia Hemimotor dysfunction Hemisensory dysfunction Hemiplegic gait Step-wise decline with sudden changes ```
50
What are some key features of Lewy Body Dementia?
``` Visual hallucinations Fluctuations Parkinsonism REM sleep disorder Reduced dopamine on SPECT/PET ```
51
What are some behavioural changes in dementia?
``` Agitation Disinhibition (aggression, sexual) Eating Toileting Dressing Sleep-wake cycle ```
52
What is a good drug option for mild-moderate dementia?
Acetylcholinesterase inhbitors Donepezil Rivastigmine Galantamine
53
What are some good antipsychotics for dementia?
Risperidone Quetiapine Amisulpride
54
Is Lewy Body Dementia sensitive to antipsychotics?
Yes | Not first line tho except where extreme risk
55
What is a good drug option for moderate-severe dementia?
Memantine
56
What is memantine?
NMDA receptor blocker | NMDA is a glutamate receptor
57
What are some good antidepressants for dementia?
Mirtazapine | Sertraline
58
Which anxiolytics are used in dementia?
Lorazepam
59
What are some side effects of acetyl cholinesterase inhibitors?
``` Nausea, vomiting, diarrhoea Fatigue, insomnia Muscle cramps Headaches, dizziness Syncope Breathing problems ```
60
Should a patient's capacity be assessed at their peak or lowest capability?
Peak
61
When is a grieving period considered abnormal?
``` Persists beyond 2 months Thoughts of death/worthlessness Psychomotor retardation Prolonged and marked functional impairment Psychosis ```
62
How do we treat late onset schizophrenia like psychosis?
Neuroleptics | Increase social contact

Psychiatry (18 decks)

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