Organic disorders presenting with psychological and/or behavioural disturbance Flashcards
Organic diseases that may cause low mood?
Neurological disease such as Parkinson’s, dementia and multiple sclerosis
Endocrine disorders (thyroid dysfunction, hypo/hyperadrenalis - cushings/addisons)
Diabetes
Obstructive sleep apnoea
Infections such as mononucleosis
Neoplasms and cancers
Endocrine mimics of depression?
Hypothyroidism: patients often have weight and appetite changes. Diagnosis is confirmed by an elevated thyroid stimulating hormone (TSH) blood result.
Cushing’s disease or syndrome: physical signs such as obesity and proximal muscle wasting are often present: Diagnosis is confirmed using a dexamethasone suppression test and urinary-free cortisol test.
Vitamin B12 deficiency: features often include macrocytic anaemia on a full blood count blood test and signs of paraesthesia and impaired memory. Diagnosis is made confirmed by low serum vitamin B12 level.
What investigations are used to rule out organic causes of confusion/psychotic symptoms?
Baseline blood tests: including FBC, TFTs, U&Es, LFTs, CRP and a fasting glucose
Urine culture: to rule out urinary tract infection causing delirium
Urine drug screen: to rule out drug intoxication
HIV testing if applicable
Syphilis serology if applicable
Serum lipids: before starting antipsychotics
Additional tests may include urinary cortisol, B12 and folate, and toxicology.
CT head if neurological cause is suspected
Non-psychiatric differentials for anxiety disorders?
hyperthyroidism
cardiac disease
medication-induced anxiety
What is a prion?
A misfolded protein which has the ability to induce its misfolded shape onto other proteins, leading to cell death
What is Korsakoff’s syndrome
marked memory disorder often seen in alcoholics
thiamine deficiency causes damage and haemorrhage to the mammillary bodies of the hypothalamus and the medial thalamus
it often follows on from untreated Wernicke’s encephalopathy
Features of Korsakoff’s syndrome
anterograde amnesia: inability to acquire new memories
retrograde amnesia
confabulation
Creutzfeldt-Jakob disease (CJD)
Definition
Creutzfeldt-Jakob disease (CJD) is a rapidly progressive neurological condition caused by a mis-folded protein, known as a prion.
Epidemiology
It is rare, affecting only around 1 in a million people annually.
Clinical features
There are 2 distinct types, sporadic and variable. Sporadic CJD is familial in around 10-15% of cases while the majority remain idiopathic. Variant CJD is associated with ingesting contaminated beef products.
The prion causes huge cell death in the brain; progressing rapidly from mild memory and mood changes to myoclonus, speech and language impairment, seizures and death. On post mortem, brain tissue samples shows prominent and widespread vacuole development creating a spongiotic appearance. This is associated with also massive neuronal loss. The average life expectancy in CJD is only around 5 months and it is invariably fatal.
Common causes of acute confessional state
Common causes of delirium can be remembered using the mnemonic DELIRIUMS:
D - Drugs and Alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
E - Eyes, ears and emotional
L - Low Output state (MI, ARDS, PE, CHF, COPD)
I - Infection
R - Retention (of urine or stool)
I - Ictal
U - Under-hydration/Under-nutrition
M - Metabolic (Electrolyte imbalance, thyroid, wernickes
(S) - Subdural, Sleep deprivation
Early signs of autoimmune encephalitis
Fever, headaches, diarrhea and upper respiratory-tract infection
What are Lilliputian hallucinations and which disorder are they associated with?
Visual hallucinations of small, non threatening people or animals
Lewy body dementia
May also so recurrent falls, REM sleeps disturbance,
Difficulty with short-term memory, finding the right words to use (anomia/anomic aphasia), or maintaining a train of thought.
What organic disorder causes a ‘weird, wobbly and wet’ presentation
Normal pressure hydrocephalus
(Dementia, gait instability, urinary incontinence)
