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Psychiatry > Organic disorders > Flashcards

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
Q

How do metabolic and toxic disturbances usually present for delirium?

A

Listlessness

Apathy

26
Q

How might infection alcohol withdrawal usually present for delirium?

A

Fearfulness
Hyperactivity
Hallucination

27
Q

What are some medications which can cause delirium?

A 
Anticholinergics like antidepressants, antipsychotic, anti-histamines, OTC hypnotics, antispasmodics
Sedative hypnotics like flurazepam
Decongestants
Anti-asthmatics
L-dopa
Methyldopa
Glucocorticoids
28
Q

What are some toxins and industrial exposure which may cause delirium?

A

Carbon monoxide
Carbon disulfide
Organic solvents
Heavy metals

29
Q

Does delirium affect the sleep-wake cycle?

A

Yes

Disrupted

30
Q

Does dementia affect the sleep-wake cycle?

A

Not usually

31
Q

Does dementia show slowing on eeg?

A

No

32
Q

What is an eeg result in delirium?

A

Generalised slowing

33
Q

Would CT/MRI show atrophy in delirium?

A

Not usually

34
Q

What kind of hallucinations predominate in delirium and functional psychosis?

A

Visual in delirium

Auditory in functional psychosis

35
Q

Does functional psychosis affect cognitive function?

A

No

36
Q

How does functional psychosis affect thinking?

A

Often more abstract

37
Q

How is delirium treated?

A

Treat underlying cause

38
Q

What are some risk factors for delirium?

A 
Disorientation
Dehydration
Constipation
Hypoxia
Immobility/limited mobility
Infection
Multiple medications
Pain
Poor nutrition
Sensory impairment
Sleep disturbance
39
Q

What are some environmental and supportive measures for managing delirium?

A

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

40
Q

How are medications used in the management of delirium?

A

Try stop benzos
Avoid sedation
Can use antipsychotics like risperidone or quetiapine

41
Q

What are some useful imaging techniques for dementia?

A

CT
CT/SPECT
DAT (used for parkinsons)

42
Q

How does frontotemporal dementia usually present?

A

Behavioural
Progressive non fluent aphasia
Semantic memory affected

43
Q

How does alcohol related dementia usually present?

A

Korsakoffs syndrome

44
Q

What are some associations of subcortical dementia?

A

Parkinson’s
Huntington’s
HIV

45
Q

What kind of dementia is associated with Creutzfeldt-Jakob Disease?

A

Prion protein

46
Q

What are some reversible causes of dementia?

A 
Delirium
Normal pressure hydrocephalus
Subdural haemorrhage
Tumours
Vitamin B12 deficiency
Hypothyroidism
Hypercalcaemia
Alcohol misuse
Neurosyphilis
Drugs
47
Q

How does Alzheimer’s disease present?

A

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
Q

How might a small vessel disease vascular dementia present?

A 
Dysarthria
Dysphagia
Parkinsonian gait
Rigidity
Hypokinesia
Hemimotor dysfunction
Can give gradual decline
49
Q

How might a cerebral infarct vascular dementia present?

A 
Aphasia
Reflex asymmetry
Hemianopia
Hemimotor dysfunction
Hemisensory dysfunction
Hemiplegic gait
Step-wise decline with sudden changes
50
Q

What are some key features of Lewy Body Dementia?

A 
Visual hallucinations
Fluctuations
Parkinsonism
REM sleep disorder
Reduced dopamine on SPECT/PET
51
Q

What are some behavioural changes in dementia?

A 
Agitation
Disinhibition (aggression, sexual)
Eating
Toileting
Dressing
Sleep-wake cycle
52
Q

What is a good drug option for mild-moderate dementia?

A

Acetylcholinesterase inhbitors
Donepezil
Rivastigmine
Galantamine

53
Q

What are some good antipsychotics for dementia?

A

Risperidone
Quetiapine
Amisulpride

54
Q

Is Lewy Body Dementia sensitive to antipsychotics?

A

Yes

Not first line tho except where extreme risk

55
Q

What is a good drug option for moderate-severe dementia?

A

Memantine

56
Q

What is memantine?

A

NMDA receptor blocker

NMDA is a glutamate receptor

57
Q

What are some good antidepressants for dementia?

A

Mirtazapine

Sertraline

58
Q

Which anxiolytics are used in dementia?

A

Lorazepam

59
Q

What are some side effects of acetyl cholinesterase inhibitors?

A 
Nausea, vomiting, diarrhoea
Fatigue, insomnia
Muscle cramps
Headaches, dizziness
Syncope
Breathing problems
60
Q

Should a patient’s capacity be assessed at their peak or lowest capability?

A

Peak

61
Q

When is a grieving period considered abnormal?

A 
Persists beyond 2 months
Thoughts of death/worthlessness
Psychomotor retardation
Prolonged and marked functional impairment 
Psychosis
62
Q

How do we treat late onset schizophrenia like psychosis?

A

Neuroleptics

Increase social contact

Psychiatry (18 decks)

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