Organic Mental Disorders Flashcards
What are organic mental disorders?
Due to common, demonstrable aetiology in cerebral disease, brain injury or other insult leading to cerebral dysfunction
Acquired disease
Different from functional mental illness (that means has no cause)
What are the classes of organic mental disorders?
Primary- trauma/infection
Secondary- systemic diseases, substance misuse, delirium
What are the common features of organic mental disorders?
Cognitive-memory, intellect, learning
Sensory- consciousness, attention
Mood- depression, elation, anxiety
Psychotic- hallucinations (more likely to see things), delusion
Personality and behavioural disturbance
Onset- any age, most tend to start in adult or later life
Some irreversible and progressive
Some transient/respond to treatments
What are the two types of onset’s of organic brain disorders?
Acute/sub acute- stroke, encephalitis, drugs, dielirium
Typically recover
Chronic- drug/alcohol dependence, dementia, amnesia, organic personality change.
What can cause delirium that can be easily treated
Disorientation Dehydration Constipation Hypoxia Immobility Infection Multiple medications Pain Poor nutrition Sensory impairment Sleep disturbance
What is delirium?
Nonspecific syndrome caused by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion and the sleep wake cycle
How do you screen for delirium?
4AT!
What are the main features of delirium?
Impairment on consciousness and attention Global disruption of contention Psychomotor disturbance Disturbance of sleep wake cycle Emotional disturbance Fluctuating symptoms
How does delirium present?
Rapid onset
Diurnal fluctuating
Duration less than 6 months
Physical signs due to underlying cause
Autonomic, activation, tachycardia, hypertension, diaphoresis, dilated pupils/fever
Dysgraphia (poor hand writing) often evident
What can causes delirium?
Medications- anticholinergics bad, sedatives bad
Endocrinolathies
Drug abuse- amphetamine, PCP, hallucinogens
Infections
Withdrawl syndromes- alcohol, benzodiazepines
Neurological causes
Metabolic symptoms- sugar, magnesium
Toxins and industrial exposures
Vitamin deficiencies- thiamine
Others
What are the outcomes of delirium?
Leads to disruption to other patient and anxiety of clinical staff
Prolonged hospital stays
Increased risk of institutionalisation
How do we manage delirium
Recognise
Treat underlying cause
Education of relatives, medical and nursing staff
Make environment safe
Optimism stimulation
Orientation- remind them of date and time
How do we manage delirium with medications?
Avoid sedatives- consultant decision
Antipsychotics
Benzodiazepines
Promethazine
None of these have any indications that they work
What is encephalopathy
Different description of delirium
Can be caused by the liver (hepatic) alcohol abuse (wernickes) and HIV
What is hepatic encephalopathy?
Normally seen in advanced liver disease General psychomotor retardation Drowsiness Fluctuating confusion tremor
Caused by a build up of toxins