Organic disorders Flashcards
What is an organic medical disorder?
Due to common, demonstrable aetiology in cerebral disease, brain injury or other insult leading to cerebral dysfunction
What are some impairments in cognitive deficiencies?
Memory
Intellect
Learning
What are some examples of chronic organic mental disorders?
Dementia
Amnesic syndrome
Organic personality change
What are some features of delirium tremens?
Fluctuating confusion
Disorientation in time & place
Memory impairment
Psychotic phenomena
How is delirium tremens treated?
Benzodiazepines
When does delirium tremens usually occur?
Alcohol withdrawal
Can complicate withdrawa
What are some features of Wernicke’s encephalopathy?
Acute confusional state
Ataxia
Opthalmoplegia
Nystagmus
What causes wernicke’s encephalopathy?
Thiamine (vitmain B1) deficiency
What is a complication of prolonged Wernicke’s encephalopathy?
Korsakoff psychosis Memory deficit Confusion Behaviour changes Apathy
How is Korsakoff syndrome treated?
High potency parenteral B1 replacement
3-7 days
Oral thiamine
Avoid carbohydrate load until thiamine replacement completed
What are some features of hepatic encepahlopathy?
Psychomotor retardation
Drowsiness
Fluctuating confusion
Can heavy drinkers display cognitive impairment when sober?
Yes
50-80% do
How might cognitive impairment present in heavy drinkers?
Short-term memory
Long-term recall
New skill acquisition
Set-shifting ability
What are some imaging results in alcohol related brain damage?
Cortical atrophy mainly affecting white matter
Ventricular enlargement
What are some different kinds of dementia?
Alzheimer Vascular Mixed Lewy body Frontotemporal
What are some secondary causes of dementia?
Huntington’s chorea
Head injury
Parkinson’s disease
What are the main differences in depressive pseudodementia compared to dementia?
Rapid onset Short-term symptomology Consistently depressed mood Short answers Patient highlights amnesia Fluctuating cognitive impairment
Can steroids cause psychiatric symptoms?
Mild-moderate psychiatric symptoms in 28% patients treated with steroids
Approximately 6% severe reaction
Dosage related to incidence but not timing, duration or severity
How are the psychiatric consequences of steroids managed?
Consider tapering steroids
Consider antipsychotic/mood stabiliser
What is anti-NMDA receptor encephalitis?
Autoimmune disease that targets NMDA receptors
Around half are associated with malignancy
Often presents with psychiatric symptoms
What are the options to treat anti-nmda receptor encephalitis?
IVIg
Plasmapheresis
Rituximab
What are some presenting features of delirium?
Impairment of consciousness and attention Global disturbance of cognition Psychomotor disturbances Disturbance of sleep-wake cycle Emotional disturbance
Describe the onset of delirium?
Rapid
Diurnally fluctuating
Less than 6 months
What are some physical signs of delirium?
Tachycardia, hypertension, diaphoresis, dilated pupils and fever due to autonomic activation
Dysphagia
How do metabolic and toxic disturbances usually present for delirium?
Listlessness
Apathy
How might infection alcohol withdrawal usually present for delirium?
Fearfulness
Hyperactivity
Hallucination
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
What are some toxins and industrial exposure which may cause delirium?
Carbon monoxide
Carbon disulfide
Organic solvents
Heavy metals
Does delirium affect the sleep-wake cycle?
Yes
Disrupted
Does dementia affect the sleep-wake cycle?
Not usually
Does dementia show slowing on eeg?
No
What is an eeg result in delirium?
Generalised slowing
Would CT/MRI show atrophy in delirium?
Not usually
What kind of hallucinations predominate in delirium and functional psychosis?
Visual in delirium
Auditory in functional psychosis
Does functional psychosis affect cognitive function?
No
How does functional psychosis affect thinking?
Often more abstract
How is delirium treated?
Treat underlying cause
What are some risk factors for delirium?
Disorientation Dehydration Constipation Hypoxia Immobility/limited mobility Infection Multiple medications Pain Poor nutrition Sensory impairment Sleep disturbance
What are some environmental and supportive measures for managing delirium?
Education of relatives, medical and nursing staff
Make environment safe
Optimise stimulation
Orientation
How are medications used in the management of delirium?
Try stop benzos
Avoid sedation
Can use antipsychotics like risperidone or quetiapine
What are some useful imaging techniques for dementia?
CT
CT/SPECT
DAT (used for parkinsons)
How does frontotemporal dementia usually present?
Behavioural
Progressive non fluent aphasia
Semantic memory affected
How does alcohol related dementia usually present?
Korsakoffs syndrome
What are some associations of subcortical dementia?
Parkinson’s
Huntington’s
HIV
What kind of dementia is associated with Creutzfeldt-Jakob Disease?
Prion protein
What are some reversible causes of dementia?
Delirium Normal pressure hydrocephalus Subdural haemorrhage Tumours Vitamin B12 deficiency Hypothyroidism Hypercalcaemia Alcohol misuse Neurosyphilis Drugs
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
How might a small vessel disease vascular dementia present?
Dysarthria Dysphagia Parkinsonian gait Rigidity Hypokinesia Hemimotor dysfunction Can give gradual decline
How might a cerebral infarct vascular dementia present?
Aphasia Reflex asymmetry Hemianopia Hemimotor dysfunction Hemisensory dysfunction Hemiplegic gait Step-wise decline with sudden changes
What are some key features of Lewy Body Dementia?
Visual hallucinations Fluctuations Parkinsonism REM sleep disorder Reduced dopamine on SPECT/PET
What are some behavioural changes in dementia?
Agitation Disinhibition (aggression, sexual) Eating Toileting Dressing Sleep-wake cycle
What is a good drug option for mild-moderate dementia?
Acetylcholinesterase inhbitors
Donepezil
Rivastigmine
Galantamine
What are some good antipsychotics for dementia?
Risperidone
Quetiapine
Amisulpride
Is Lewy Body Dementia sensitive to antipsychotics?
Yes
Not first line tho except where extreme risk
What is a good drug option for moderate-severe dementia?
Memantine
What is memantine?
NMDA receptor blocker
NMDA is a glutamate receptor
What are some good antidepressants for dementia?
Mirtazapine
Sertraline
Which anxiolytics are used in dementia?
Lorazepam
What are some side effects of acetyl cholinesterase inhibitors?
Nausea, vomiting, diarrhoea Fatigue, insomnia Muscle cramps Headaches, dizziness Syncope Breathing problems
Should a patient’s capacity be assessed at their peak or lowest capability?
Peak
When is a grieving period considered abnormal?
Persists beyond 2 months Thoughts of death/worthlessness Psychomotor retardation Prolonged and marked functional impairment Psychosis
How do we treat late onset schizophrenia like psychosis?
Neuroleptics
Increase social contact
