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Psychiatry > Organic Mental Disorders > Flashcards

Organic Mental Disorders Flashcards

1
Q

What is the relationship between physical and mental health?

A

Organic disorder - delirium/ cognitive impairment
Emotional disorder as a reaction to illness or a manifestation of the illness

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2
Q

What are organic mental disorders?

A

Deficits in cognitive function
Acquired rather than developmental
Distinction from functional mental illness
Ex. dementia, delirium and amnesic syndromes

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3
Q

What are common features of organic disorders?

A

Cognition - memory, intellect and learning
Mood - depression, elation and anxiety
Psychotic - hallucinations and delusions
Personality and behavioural disturbance
Consciousness and attention

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4
Q

What are examples of acute organic disorders?

A

Delirium, withdrawal states, organic mood disorder, organic psychotic disorder and encephalitis

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5
Q

What are examples of chronic organic disorders?

A

Dementia, amnesic syndromes and organic personality changes

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6
Q

What is the definition of delirium?

A

Characterised by a disturbance of attention, orientation, and awareness that develops in a short period of time
Significant confusion or global neurocognitive impairment

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7
Q

What is delirium caused by?

A

Direct physiological effects of a medical condition not classified under mental, behavioural or neuro disorders
Physiological effects of a substance

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8
Q

What are some presenting features of delirium?

A

Impairment of consciousness and attention
Global disturbance of cognition
Psychomotor disturbances
Emotional disturbances
Disturbance of sleep wake cycle

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9
Q

What is the prognosis of delirium?

A

Fluctuating course
Gradual resolution of symptoms with effective treatment
Slower resolution in elderly
20% mortality
May be a marker for subsequent dementia

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10
Q

What tools can be used to assess delirium?

A

SIGN - risk reduction and management of delirium
4AT

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11
Q

What are factors which can be contributing to delirium?

A

Disorientation, dehydration, constipation, hypoxia, immobility, infection, multiple medications, pain, poor nutrition, sensory impairment and sleep disturbance

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12
Q

What is the oral treatment for delirium?

A

Oral antipsychotic - aripiprazole, olanzapine or quetiapine
If already on an antipsychotic then lorazepam or promethazine

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13
Q

What is dementia?

A

Characterised by global cognitive impairment which is chronic in nature

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14
Q

What are some types of dementia?

A

Alzheimer, vascular, mixed, lewy body, frontotemporal and other - Huntington’s, head injury, MS, Parkinson’s and alcohol

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15
Q

What are some key features of delirium?

A

Acute and often at night
Hours to weeks
Alertness is low or high
Registration is always impaired
Thinking is disorganised
Illusions and hallucinations
Often evident pathology

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16
Q

What are some key features of dementia?

A

Insidious onset
Months and years duration
Orientation is impaired in later stages
Impaired episodic memory
Difficulty finding words
Lack of acute pathology

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17
Q

What is amnestic disorder?

A

Syndrome of impairment of recent and remote memory
Immediate recall is preserved

18
Q

What are features of amnestic disorder?

A

New learning reduced, anterograde amnesia, disorientation, retrograde amnesia, confabulation, perception preserved and prognosis depends on underlying lesions

19
Q

Where is the lesion in amnestic disorder usually located?

A

Hypothalamic diencephalic system or hippocampal region

20
Q

Describe Diencephalic damage

A

Korsakoff’s syndrome
3rd ventricle tumour and cysts
Bilateral thalamic infarction
Post subarachnoid haemorrhage

21
Q

Describe hippocampal damage

A

HSV encephalitis
Anoxia
Surgical removal of temporal lobes
Bilateral posterior cerebral artery occlusion
Closed head injury
Early Alzheimer’s disease

22
Q

What is alcohol amnestic disorder called?

A

Wernicke-Korsakoff syndrome

23
Q

What are the symptoms of Wernicke’s encephalopathy?

A

Acute confusion state, ataxia and ophthalmoplegia
Nystagmus, neuropathy and ataxia may be prolonged or permanent

24
Q

Describe Wernicke’s encephalopathy

A

Related to acute deficiency of Thiamine (vitamin B1)
Can be difficult to differentiate between delirium tremens
Untreated acute phase lasts 2 weeks then develop Korsakoff psychosis

25
Q

What is the treatment for Wernicke’s encephalopathy?

A

High potency parenteral B1 replacement - oral thiamine 3-7days
Avoid carbohydrate load
Concurrent treatment for alcohol withdrawal

26
Q

What are the symptoms of alcohol amnesic syndrome - Korsakoff’s psychosis?

A

Characterised by marked impairment of anterograde memory
No clouding of consciousness
Variable degrees of cognitive impairment
Personality changes, apathy and loss of initiative
Confabulation

27
Q

What are some physical illness that may cause depression?

A

Cerebral tumour, traumatic brain injury, stroke, MS, Parkinson’s, neurodegenerative conditions, Cushing’s, hyperparathyroidism, hypothyroidism, Addison’s and low folate

28
Q

What are some medications which can cause depression?

A

Corticosteroids, digoxin, levodopa, beta-blockers, benzodiazepines, antipsychotics, interferon-a, isotretinoin, CT and anticonvulsants

29
Q

What are the mood and motivation symptoms of depression?

A

Persistently lowered mood
Anhedonia
Social withdrawal
Loss of energy
Poor concentration

30
Q

What are the cognitive symptoms of depression?

A

Depressive ideation
Suicidal thoughts
Hopelessness

31
Q

What are the biological symptoms of depression?

A

Poor appetite
Weight loss
Sleep disturbance
Retardation
Reduced libido

32
Q

What are some disorders associated with high rates of depression?

A

Neurological disorders, life-threatening disorders, chronic and painful illnesses, unpleasant treatment and chronic illness in elderly

33
Q

What is the management for organic mental disorders?

A

Management of underlying illness
Explanation and advice
Psychological interventions
CBT
Antidepressants

34
Q

How can substance use present as?

A

Physical complications, intoxication, withdrawal, ARBD, trauma, drug induced psychosis and feigned illness

35
Q

What is liaison psychiatry?

A

Subspecialty of psychiatry that works with patients in general hospitals
Care to patients with self harm, adjustments to illness and co-morbidities

36
Q

What is hypochondriacal disorder?

A

Persistent preoccupation with possibility of having one ore more serious and progressive physical disorders

37
Q

What is factitious disorder?

A

Deliberately producing, feigning or exaggerating symptoms due to pathological need for the sick role

38
Q

What is malingering?

A

Deliberately producing, feigning or exaggerating symptoms to escape duty, work or financial gain

39
Q

What is bodily distress disorder?

A

Characterised by the presence of bodily symptoms that are distressing to the individual
Excessive attention towards the symptoms which are persistent
Functional disorder

40
Q

What is dissociative neurological symptom?

A

Is characterised by presentation of motor, sensory or cognitive symptoms that imply involuntary discontinuity in normal integration
Not consistent with recognised disease

41
Q

Describe functional disorders

A

Indicate that the cause of the patients symptoms, syndrome or disorder are not understood

Psychiatry (20 decks)

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