Organic Mental Disorders Flashcards
What is the relationship between physical and mental health?
Organic disorder - delirium/ cognitive impairment
Emotional disorder as a reaction to illness or a manifestation of the illness
What are organic mental disorders?
Deficits in cognitive function
Acquired rather than developmental
Distinction from functional mental illness
Ex. dementia, delirium and amnesic syndromes
What are common features of organic disorders?
Cognition - memory, intellect and learning
Mood - depression, elation and anxiety
Psychotic - hallucinations and delusions
Personality and behavioural disturbance
Consciousness and attention
What are examples of acute organic disorders?
Delirium, withdrawal states, organic mood disorder, organic psychotic disorder and encephalitis
What are examples of chronic organic disorders?
Dementia, amnesic syndromes and organic personality changes
What is the definition of delirium?
Characterised by a disturbance of attention, orientation, and awareness that develops in a short period of time
Significant confusion or global neurocognitive impairment
What is delirium caused by?
Direct physiological effects of a medical condition not classified under mental, behavioural or neuro disorders
Physiological effects of a substance
What are some presenting features of delirium?
Impairment of consciousness and attention
Global disturbance of cognition
Psychomotor disturbances
Emotional disturbances
Disturbance of sleep wake cycle
What is the prognosis of delirium?
Fluctuating course
Gradual resolution of symptoms with effective treatment
Slower resolution in elderly
20% mortality
May be a marker for subsequent dementia
What tools can be used to assess delirium?
SIGN - risk reduction and management of delirium
4AT
What are factors which can be contributing to delirium?
Disorientation, dehydration, constipation, hypoxia, immobility, infection, multiple medications, pain, poor nutrition, sensory impairment and sleep disturbance
What is the oral treatment for delirium?
Oral antipsychotic - aripiprazole, olanzapine or quetiapine
If already on an antipsychotic then lorazepam or promethazine
What is dementia?
Characterised by global cognitive impairment which is chronic in nature
What are some types of dementia?
Alzheimer, vascular, mixed, lewy body, frontotemporal and other - Huntington’s, head injury, MS, Parkinson’s and alcohol
What are some key features of delirium?
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
What are some key features of dementia?
Insidious onset
Months and years duration
Orientation is impaired in later stages
Impaired episodic memory
Difficulty finding words
Lack of acute pathology
What is amnestic disorder?
Syndrome of impairment of recent and remote memory
Immediate recall is preserved
What are features of amnestic disorder?
New learning reduced, anterograde amnesia, disorientation, retrograde amnesia, confabulation, perception preserved and prognosis depends on underlying lesions
Where is the lesion in amnestic disorder usually located?
Hypothalamic diencephalic system or hippocampal region
Describe Diencephalic damage
Korsakoff’s syndrome
3rd ventricle tumour and cysts
Bilateral thalamic infarction
Post subarachnoid haemorrhage
Describe hippocampal damage
HSV encephalitis
Anoxia
Surgical removal of temporal lobes
Bilateral posterior cerebral artery occlusion
Closed head injury
Early Alzheimer’s disease
What is alcohol amnestic disorder called?
Wernicke-Korsakoff syndrome
What are the symptoms of Wernicke’s encephalopathy?
Acute confusion state, ataxia and ophthalmoplegia
Nystagmus, neuropathy and ataxia may be prolonged or permanent
Describe Wernicke’s encephalopathy
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
What is the treatment for Wernicke’s encephalopathy?
High potency parenteral B1 replacement - oral thiamine 3-7days
Avoid carbohydrate load
Concurrent treatment for alcohol withdrawal
What are the symptoms of alcohol amnesic syndrome - Korsakoff’s psychosis?
Characterised by marked impairment of anterograde memory
No clouding of consciousness
Variable degrees of cognitive impairment
Personality changes, apathy and loss of initiative
Confabulation
What are some physical illness that may cause depression?
Cerebral tumour, traumatic brain injury, stroke, MS, Parkinson’s, neurodegenerative conditions, Cushing’s, hyperparathyroidism, hypothyroidism, Addison’s and low folate
What are some medications which can cause depression?
Corticosteroids, digoxin, levodopa, beta-blockers, benzodiazepines, antipsychotics, interferon-a, isotretinoin, CT and anticonvulsants
What are the mood and motivation symptoms of depression?
Persistently lowered mood
Anhedonia
Social withdrawal
Loss of energy
Poor concentration
What are the cognitive symptoms of depression?
Depressive ideation
Suicidal thoughts
Hopelessness
What are the biological symptoms of depression?
Poor appetite
Weight loss
Sleep disturbance
Retardation
Reduced libido
What are some disorders associated with high rates of depression?
Neurological disorders, life-threatening disorders, chronic and painful illnesses, unpleasant treatment and chronic illness in elderly
What is the management for organic mental disorders?
Management of underlying illness
Explanation and advice
Psychological interventions
CBT
Antidepressants
How can substance use present as?
Physical complications, intoxication, withdrawal, ARBD, trauma, drug induced psychosis and feigned illness
What is liaison psychiatry?
Subspecialty of psychiatry that works with patients in general hospitals
Care to patients with self harm, adjustments to illness and co-morbidities
What is hypochondriacal disorder?
Persistent preoccupation with possibility of having one ore more serious and progressive physical disorders
What is factitious disorder?
Deliberately producing, feigning or exaggerating symptoms due to pathological need for the sick role
What is malingering?
Deliberately producing, feigning or exaggerating symptoms to escape duty, work or financial gain
What is bodily distress disorder?
Characterised by the presence of bodily symptoms that are distressing to the individual
Excessive attention towards the symptoms which are persistent
Functional disorder
What is dissociative neurological symptom?
Is characterised by presentation of motor, sensory or cognitive symptoms that imply involuntary discontinuity in normal integration
Not consistent with recognised disease
Describe functional disorders
Indicate that the cause of the patients symptoms, syndrome or disorder are not understood
