Organic mental disorders

Question 1

How is organic mental disorder defined by ICD-10?

Answer 1

Mental disorders due to common, demonstrable aetiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction

Question 2

What is a primary organic mental disorder?

Answer 2

Directlu effecting the brain

Question 3

What is a secondary organic mental disorder?

Answer 3

Systemic diseases affecting the brain

Question 4

What are common features of organic disorders?

Answer 4

Cognitive - memory, intellect, learning
Sensorium - consciousness, attention
Mood - depression, elation, anxiety
Psychotic - Hallucinations, delusions
Personality and behavioural disturbances

Question 5

When do organic mental disorders tend to come on?

Answer 5

Adult life

Question 6

What are examples of acute organic disroders?

Answer 6

Delirium
Organic mood disorder
Organic psychotic disorder

Question 7

What are examples of chronic organic disorders?

Answer 7

Dementia
Amnesic syndrome
Organic personality change

Question 8

How is delirium defined?

Answer 8

Nonspecific syndrome characterised by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor function, emotion, and sleep-wake cycle

Question 9

What are presenting features of delirium?

Answer 9

Impairment of consciousness and attention
Global disturbance of cognition
Psychomotor disturbances
Disturbance of sleep-wake cycle
Emotional disturbance
Rapid onset
Diurnal fluctuation
Duration less than 6 months

Question 10

What are physical signs of delirium?

Answer 10

Autonomic activation - tachycardia, hypertension, diaphoresis, dilated pupils, fever
Dysgraphia
Signs related to cause

Question 11

What is dysgraphia?

Answer 11

Impaired handwriting

Question 12

What drugs may lead to delirium?

Answer 12

Anticholinergics
Sedative hypnotics
Degongestants
Anti-asthmatics

Question 13

What are implications of delirium?

Answer 13

Disruption to other patients and anxiety of clinical staff
Prolonged hospital stays
Increased risk of institutionalisation

Question 14

How is delirium managed?

Answer 14

Recognise cause
Treat underlying cause
Environmental and supportive issues:
Education of relatives and staff
Make environment safe
Optimise stimulation
Orientation

Question 15

What are potential underlying causes that can be managed for delirium?

Answer 15

Disorientation
Dehydration
Constipation
Hypoxia
Immobility
Infection
Multiple medications
Pain
Poor nutrition
Sensory impairment
Sleep disturbance

Question 16

Is psychiatric medication advised in delirium?

Answer 16

No

Question 17

What is the difference between delirium and encephalopathy?

Answer 17

Delirium is a presentation

Encephalopathy is an underlying pathology

Question 18

What are features of hepatic encephalopathy?

Answer 18

General psychomotor retardation
Drowsiness
Fluctuating confusion
Asterixis

Question 19

What is amnesic syndrome?

Answer 19

Impairment of recent and remote memory with immediate recall preserved

Question 20

What are causes of amnesic sydrome?

Answer 20

Korsakoff’s syndrome

Hippocampal damage

Question 21

What can cause hippocampal damage?

Answer 21

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

Question 22

How is amnesic syndrome treated?

Answer 22

Prevention of alcohol amnesic syndrome

Treatment depends on cause

Question 23

How is alcoholic amnesic syndrome prevented?

Answer 23

High risk groups receive parenteral vitamin B1 then remain on oral thiamine
Abstinence from alcohol
Slow multidisciplinary rehabilitation