Organic mental disorders Flashcards
How is organic mental disorder defined by ICD-10?
Mental disorders due to common, demonstrable aetiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction
What is a primary organic mental disorder?
Directlu effecting the brain
What is a secondary organic mental disorder?
Systemic diseases affecting the brain
What are common features of organic disorders?
Cognitive - memory, intellect, learning Sensorium - consciousness, attention Mood - depression, elation, anxiety Psychotic - Hallucinations, delusions Personality and behavioural disturbances
When do organic mental disorders tend to come on?
Adult life
What are examples of acute organic disroders?
Delirium
Organic mood disorder
Organic psychotic disorder
What are examples of chronic organic disorders?
Dementia
Amnesic syndrome
Organic personality change
How is delirium defined?
Nonspecific syndrome characterised by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor function, emotion, and sleep-wake cycle
What are presenting features of delirium?
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
What are physical signs of delirium?
Autonomic activation - tachycardia, hypertension, diaphoresis, dilated pupils, fever
Dysgraphia
Signs related to cause
What is dysgraphia?
Impaired handwriting
What drugs may lead to delirium?
Anticholinergics
Sedative hypnotics
Degongestants
Anti-asthmatics
What are implications of delirium?
Disruption to other patients and anxiety of clinical staff
Prolonged hospital stays
Increased risk of institutionalisation
How is delirium managed?
Recognise cause Treat underlying cause Environmental and supportive issues: Education of relatives and staff Make environment safe Optimise stimulation Orientation
What are potential underlying causes that can be managed for delirium?
Disorientation Dehydration Constipation Hypoxia Immobility Infection Multiple medications Pain Poor nutrition Sensory impairment Sleep disturbance
Is psychiatric medication advised in delirium?
No
What is the difference between delirium and encephalopathy?
Delirium is a presentation
Encephalopathy is an underlying pathology
What are features of hepatic encephalopathy?
General psychomotor retardation
Drowsiness
Fluctuating confusion
Asterixis
What is amnesic syndrome?
Impairment of recent and remote memory with immediate recall preserved
What are causes of amnesic sydrome?
Korsakoff’s syndrome
Hippocampal damage
What can cause hippocampal damage?
HSV encephalitis Anoxia Surgical removal of temporal lobes Bilateral posterior cerebral artery occlusion Closed head injury Early Alzheimer's
How is amnesic syndrome treated?
Prevention of alcohol amnesic syndrome
Treatment depends on cause
How is alcoholic amnesic syndrome prevented?
High risk groups receive parenteral vitamin B1 then remain on oral thiamine
Abstinence from alcohol
Slow multidisciplinary rehabilitation
