Organic mental disorders

Question 1

MMSE abbreviation

Answer 1

Mini mental state examination

Question 2

Organic mental disorders definition

Answer 2

Decreased mental function due to a physical disease

Question 3

Disturbances of consciousness

Answer 3

1) Examination of vigilance of consciousness (arausability)
- differentiation of drowsiness, somnolence, sopor, coma

2) Examination of integration of consciousness
3) Interaction of vigilance and integration

Question 4

Disturbances of attention

Answer 4

1) Examination of vigilance of attention

2) Examination of tenacity of attention

Question 5

Examination of orientation

Answer 5

1) Autopsychic orientation (personal data)

2) Allopsychic orientation
- orientation in place (city, street, building, etc.)
- orientation in time (year, month, date, season, etc.)
- recognising the situation

3) Confabulation

Question 6

Confabulation

Answer 6

“Lying” about memories when actually cannot remember

Question 7

Examination of memory

Answer 7

1) Memory types
- working memory
- short-term memory (teaching new information)
- long-term memory (data of personal life)

2) Mechanism of memory
- encoding/learning (teaching new information)
- storage (data of life history)
- retrieval (helps in recall)

Question 8

Examination of intelligence

Answer 8

1) Global cognitive performance
2) (IQ measure – psychological competence)

3) Intelligence below normal
- Mental retardation (born with)
- Dementia (acquired)

Question 9

Delirium symptoms

Answer 9

1) Disturbance of consciousness
- Vigilance and integration problems
2) Disturbance of attention
3) Perception disturbance
4) Global disturbance of cognitive processes (orientation, memory etc.)
5) Disturbance of psychomotorium, e.g. agitation etc.
6) Hypoactive, hyperactive, mixed form
7) Disturbance of the sleep-wake cycle
8) Emotional disturbances

Question 10

Delirium course of disease

Answer 10

• Acute start

- Symptoms change during day

Question 11

Delirium etiology

Answer 11

1) Metabolic disorders
- Hypoxia, glucose, electrolytes, anemia, endocrine etc

2) Alcohol, medicines, drugs
3) CV diseases
4) Nervous system disorders
5) Trauma
6) Complex etiology

Question 12

Delirium vs dementia

Answer 12

1) Time period
2) Disturbances of consciousness
3) Other circumstances of development (e.g location)
4) Changes of symptoms

Question 13

Dementia symptoms

Answer 13

1) Cognitive symptoms
- attention, orientation, memory, counting, reading, writing, speech, abstraction, insight, judgement, executive functions, cortical symptoms, vizuospatial activity, etc.

2) Behavioural symptoms (= non-cognitive symptoms, BPSD symptoms)
- delusions, hallucinations, mood disturbances, agitation, agressivity, anxiety, psychomotor symptoms, apathy, etc.

Question 14

Classifications of dementia

Answer 14

1) Based on severity
2) Based on symptomatology
3) Based on etiology

Question 15

Classification of dementia

- based on: severity

Answer 15

1) Mild cognitive impairment (MCI)
2) Mild dementia (MMS: 20-24)
3) Moderate dementia (MMS: 10-20)
4) Severe dementia (MMS: below 10)

Question 16

Classification of dementia

- based on: symptomatology

Answer 16

1) Cortical dementia (cortical symptoms)

2) Subcortical dementia (psychomotor symptoms, executive dysfunction)

Question 17

Classification of dementia

- based on: etiology

Answer 17

1) Primary neurodegenerative dementias (e.g. Alzheimer’s disease)
2) Secondary dementias (e.g. vascular dementia)

Question 18

Diagnosis of dementia

Answer 18

1) Clinical picture
2) Labs
3) Imaging (MRI)
4) Cognitive tests
- MMSE
- Clock drawing test
5) Other

Question 19

Old age psychiatry “3D-s”

Answer 19

1. Dementia
2. Depression
3. Delirium

Question 20

1A patient is sleepy, looks a little inattentive. His gait is mildly unstable and has difficulties in focusing on the examiner. He does not fall asleep while unattended. What is the name of this kind of alteration of consciousness?

• Drowsiness
• Somnolence
• Sopor
• Coma

Answer 20

Drowsiness

Question 21

2. A patient with severe depression is engaged with his negative thoughts and he is difficult to distract from them. What is the name of this kind of alteration of attention?
   - Hyperprosexia
   - Hypoprosexia
   - Hypervigility-hipotenacy
   - Hypovigility-hipertenacy
   - Aprosexia

Answer 21

Hypovigility-hipertenacy

Question 22

3. A patient is able to tell his personal data, is aware of the actual year and the season. However he is not able to tell the exact date and month. He is correct regarding the city and the street of the place of the examination, on the other hand, instead of recognising that he is in a hospital, he says that we are in the town hall. What is the most correct description of the patient’s symptoms?
   - Auto- and allopsychic disorientation
   - Autopsychic disorientation, preserved orientation in time and place
   - Preserved autopsychic orientation, partial orientation in time, disorientation in place, confabulation
   - Preserved autopsychic oriantation, disorientation in time and place
   - Partial auto-and allopsychic disorientation

Answer 22

Preserved autopsychic orientation, partial orientation in time, disorientation in place, confabulation

Question 23

4. Dementia can be diagnosed in the following condition:
   - Severe decline of one cognitive domain, with impairment of everyday functioning
   - Decline of multiple cognitive domains, with preserved everyday functioning
   - Decline of one cognitive domain, with preserved everyday functioning
   - Mild decline of multiple cognitive domains, with impairment of everyday functioning

Answer 23

Mild decline of multiple cognitive domains, with impairment of everyday functioning

Question 24

5.	Disconcertment is observed at a 60-year-old male patient under sick-ward conditions, he also has fever
Possible diagnosis:
- Organic hallucinosis
- Dementia
- Organic paranoid disorder
- Delirium
- Organic anxiety disorder

Answer 24

Delirium

Question 25

A patient is not fully able to remember what happened to him in the morning of the day of the examination. 
Possible diagnosis:
- Amnestic disorder
- Dementia
- Delirium
- Mental retardation
- Drowsiness

Answer 25

All is correct

Question 26

7. In this form of mental retardation thr IQ is midly below normal, cognitive funtions can be improved, patients might live on their own with some help, might work at a protected workplace.
   - Autism
   - Severe mental retardation
   - Mild mental retardation
   - Moderate mental retardation
   - Down’s disease

Answer 26

Mild mental retardation

Question 27

Common symptom of Alzheimer’s disease:

• Psychomotor retardation
• Forgetfulness
• Disorientation
• Depression
• Loss of insight
• Cortical symptoms

Answer 27

All except psychomotor retardation

Question 28

Persecutory delusions of an old patient can be caused by:

• schizophrenia
• delirium
• organic paranoid disorder
• organic anxiety disorder
• Alzheimer’s disease

Answer 28

All except organic anxiety disorder

Question 29

An 80-year old female patient without any history of psychiatric disorders is seen in the Emergency Unit by her relatives for sudden "disconcertment". In her case history COPD and high blood pressure are mentioned.  Before coming to the hospital, the patient had fever.
Possible diagnosis:
- Schizophrenia
- Delirium
- Personality disorder
- Depression
- Organic anxiety disorder

Answer 29

Delirium