Organic Mental Disorders

Question 1

what are functional psychiatric disorders characterised by?

Answer 1

disturbance of the functioning of the brain

Question 2

what are organic mental disorders characterised by?

Answer 2

demonstrable organic brain damage or mental disorder arising in the context of demonstrable physical disease

Question 3

what are the issues with distinguishing functional and organic psychiatric disorders?

Answer 3

psychiatric with organic basis - BPD, Schizo
Mixture of mental and physical feature
physical disorders have effect on psychological functioning and vice versa

Question 4

what are organic mental disorders?

Answer 4

recognised organic explanation
acquired
primary brain disorder - MS, Parkinsons
Secondary brain disorder - endocrine, substance

Question 5

common features of cognitive impairment of organic mental disorders

Answer 5

disorientation
impaired attention/concentration
memory - anterograde +/- retrograde amnesia
language
judgement
insight

Question 6

common features of behavioural abnormalities of organic mental disorders

Answer 6

agitation
aggression
slowing, psychomotor retardation
abnormal social conduct

Question 7

common features of mood changes of organic mental disorders

Answer 7

low mood
anxiety
mania

Question 8

common features of psychotic features of organic mental disorders

Answer 8

hallucinations, commonly visual

delusions (often persecutory)

Question 9

groups of common features of organic mental disorders

Answer 9

cognitive impairment
behavioural abnormalities
mood changes
psychotic features

Question 10

acute/subacute effects of organic mental disorders

Answer 10

delirium (acute organic confusional state)
organic mood disorder
organic psychotic disorder

Question 11

chronic effects of organic mental disorders

Answer 11

dementia
amnesic syndrome
organic personality change

Question 12

what is delirium?

Answer 12

transient organic mental syndrome of acute or subacute onset which is characterised by global cognitive impairment

Question 13

presenting features of delirium

Answer 13

• Impaired attention/concentration
• Anterograde memory impairment
• Disorientation in time, place or person
• Fluctuating levels of arousal (often nocturnal exacerbations)
• Disordered sleep/wake cycle
• Increased/decreased psychomotor activity
• Disorganised thinking as indicated by rambling, irrelevant or incoherent speech
• Perceptual distortions, leading to misidentification, illusions, and hallucinations
• Changes in mood such as anxiety, depression and lability

Question 14

list some causes of delirium

Answer 14

• Infections
• Medications
• Alcohol/drug withdrawal
• Drug abuse
• Metabolic
• Vitamin deficiencies
• Endocrinopathies
• Neurological causes
• Toxins/industrial exposures
• SLE
• Cerebral vasculitis
• Paraneoplastic syndromes

Question 15

what is dementia?

Answer 15

syndrome characterised by global cognitive impairment which is chronic in nature. the underlying brain pathology is variable and usually but not always progressive

Question 16

discuss amnesic syndrome

Answer 16

• Preserved global intellectual abilities
• Anterograde amnesia
• Retrograde amnesia (temporal gradient)
• Preserved registration/working memory (e.g. digit span)
• Preserved procedural (implicit) memory

Question 17

give two broad causes of amnesic syndrome

Answer 17

Hippocampal damage

diencephalic damage

Question 18

describe hippocampal damage leading to amnesic syndrome

Answer 18

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

Question 19

describe diencephalic damage leading to amnesic syndrome

Answer 19

o Korsakoff’s syndrome (alcoholic and non-alcoholic)
o 3rd ventricle tumours and cysts
o Bilateral thalamic infarction
o Post subarachnoid haemorrhage, especially from anterior communicating artery aneurysms