Organic mental disorders Flashcards
organic mental disorder
ICD -11 – Neurocognitive disorders
Deficits in cognitive function
Acquired rather than developmental (i.e intellectual disability)
Distinction from from “functional” mental illness
eg - delirium, dementia, amnesic syndromes
common features of organic mental disorders
cognitive
Memory
Intellect
Learning
Mood
Depression
Elation
Anxiety
Psychotic
Hallucinations
Delusions
Personality & behavioural disturbance
Sensorium
Consciousness
Attention
acute organic mental disorders
Delirium
Withdrawal states
Organic mood disorder
Organic psychotic disorder
Encephalitis
chronic organic mental disorders
Dementia
Amnesic syndromes
Organic personality change
presenting features of delirium
Impairment of consciousness and attention
Global disturbance of cognition
Psychomotor disturbances
Disturbance of sleep-wake cycle
Emotional disturbance
management of delirium
Disorientation
Dehydration
Constipation
Hypoxia
Immobility/limited mobility
Infection
Multiple medications
Pain
Poor nutrition
Sensory impairment
Sleep disturbance
Education of patients/relatives/staff
what is dementia
A syndrome which characterised by global cognitive impairment which is chronic in nature.
The underlying brain pathology is variable and usually, but not always progressive.
types of dementia
Alzheimer
Vascular
(Mixed)
Lewy body
Frontotemporal
Due to other brain disorders – including:
Huntington’s chorea
Head injury
Multiple Sclerosis
Parkinson’s disease
Alcohol related
amnesic disorder
Syndrome of impairment of recent and remote memory
Immediate recall preserved
New learning reduced
Anterograde amnesia
Disorientation in time
Retrograde amnesia (temporal gradient) – may lessen over time
Confabulation
Perception and other cognitive functions preserved
Lesion typically affects hypothalamic-diencephalic system or hippocampal region
Prognosis depends on course of underlying lesion
Almost complete recovery is possible
diencephalic damage
Korsakoff’s syndrome (alcoholic and non-alcoholic)
3rd ventricle tumours and cysts
Bilateral thalamic infarction
Post subarachnoid haemorrhage
especially from anterior communicating artery aneurysms
hippocampal damage example
Herpes simplex virus encephalitis
Anoxia
Surgical removal of temporal lobes
Bilateral posterior cerebral artery occlusion
Closed head injury
Early Alzheimer’s disease
alcohol amnesic disorder
Wernicke-Korsakoff Syndrome
Wernicke’s encephalopathy symptoms
Acute confusional state
Ataxia
Ophthalmoplegia
nystagmus, neuropathy and ataxia may be prolonged or permanent
what is Wernicke’s encephalopathy related to
related to acute deficiency of Thiamine (vitamin B1)
can be difficult to distinguish from delirium tremens
Untreated acute phase lasts about 2 weeks, 84% develop Korsakoff psychosis
15% mortality
With treatment confusional state and opthalmoplegia can resolve within days,
what is the treatment for Wernicke’s encephalopathy
High potency parenteral B1 replacement
3-7 days
Oral thiamine
Avoid carbohydrate load until thiamine replacement completed
All patients with symptoms of Wernike’s encephalopathy or at high risk should be treated with parenteral thiamine, others undergoing detoxification or under investigation should be commenced on oral thiamine
Concurrent treatment for alcohol withdrawal
what is alcohol amnesic syndrome
characterised by marked impairment of anterograde memory (ability to learn new information), disturbance of time sense
no clouding of consciousness, absence of defect in immediate recall or global impairment
variable degrees of cognitive impairment
Personality changes, apathy, loss of initiative
confabulation in the early stage
can improve with prolonged abstinence
what physical illnesses may cause depression
Cerebral tumour
Traumatic brain injury
Stroke
Multiple sclerosis
Parkinson’s disease
Neurodegenerative conditions
Cushing’s disease
Hyperparathyroidism
Hypothyroidism
Low folate/Vitamin B12
Addison’s disease
Malignancy
what medications may cause depression
Corticosteroids
Digoxin
Levodopa
Beta-blockers
Benzodiazepines
Antipsychotics
Interferon-α
Isotretinoin
Chemotherapy
Anticonvulsants
Alcohol
Recreational Drugs
how do you assess and manage organic mood disorders
History
Careful clinical examination
Management of underlying condition
May need to combine with antidepressant (or antimanic) medication
what are depressive symptoms
Mood and Motivation
Persistently lowered mood
Anhedonia
Social withdrawal
Loss of energy
Poor concentration
Cognitive
Depressive ideation
Suicidal thoughts
Hopelessness
Biological
Poor appetite
Weight loss
Sleep disturbance
Retardation/agitation
Reduced libido
assessment of low mood
Ask about:
Low mood
Tearfulness
Anhedonia
Loss of interest
Poor concentration
Irritability
Panic attacks
Diurnal mood variation
Guilt
Worthlessness
Pessimism
Hopelessness
Thoughts of dying
Suicidal ideation
management of low mood
Management of underlying illness
Explanation and advice
Psychosocial interventions
Cognitive behavioural therapy
Antidepressants
Common mental health problems
in the general hospital
Affective disorders (depression, anxiety)
Self-harm
Delirium (acute organic confusional state)
Substance misuse disorders
Functional disorders (“Medically unexplained symptoms”)
Personality disorders
Dementia
Eating disorders
how many substance use present in the general hospital
physical complications
intoxication
Withdrawal (including delirium)
ARBD
trauma/accident
drug-induced psychosis (e.g. novel psychoactive substances)
feigned illness in order to obtain drugs - RARE
self harm
Self-harm commonest reason for admission in females < age 65
More common in females but over recent years increase in self-harm rates in young males
All patients admitted with self-harm will routinely receive a psycho-social (psychiatric) assessment
principles of assessment for self harm
Create an environment where a patient feels listened to, can experience relief and may begin to identify solutions
Identify risk factors for further self-harm, completed suicide
Identify mental disorder and need for further psychiatric treatment
Identify psychosocial stressors and patient’s way of coping
Identify appropriate help, even in absence of mental disorder
See assessment as an opportunity to help, rather than a “risk assessment”
what is laison psychiatry
Subspecialty of psychiatry that works with patients in general hospitals
Work with medical and surgical colleagues in the management of mental health problems in their patients
Provides specialist care to patients with a range of problems including self harm, adjustment to illness, and physical and psychological co-morbidities
Provide education for general hospital clinicians in the basics of management of mental health problems in the general hospital
what is ICD 11
bodily distress disorder / dissociative neurological symptom disorder
Functional disorder?
