Organic Mental Disorders Flashcards

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1
Q

What are organic mental disorders?

A

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)

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2
Q

What are the classes of organic mental disorders?

A

Primary- trauma/infection

Secondary- systemic diseases, substance misuse, delirium

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3
Q

What are the common features of organic mental disorders?

A

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

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4
Q

What are the two types of onset’s of organic brain disorders?

A

Acute/sub acute- stroke, encephalitis, drugs, dielirium
Typically recover

Chronic- drug/alcohol dependence, dementia, amnesia, organic personality change.

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5
Q

What can cause delirium that can be easily treated

A
Disorientation
Dehydration
Constipation
Hypoxia
Immobility
Infection
Multiple medications
Pain
Poor nutrition
Sensory impairment
Sleep disturbance
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6
Q

What is delirium?

A

Nonspecific syndrome caused by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion and the sleep wake cycle

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7
Q

How do you screen for delirium?

A

4AT!

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8
Q

What are the main features of delirium?

A
Impairment on consciousness and attention
Global disruption of contention
Psychomotor disturbance 
Disturbance of sleep wake cycle 
Emotional disturbance 
Fluctuating symptoms
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9
Q

How does delirium present?

A

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

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10
Q

What can causes delirium?

A

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

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11
Q

What are the outcomes of delirium?

A

Leads to disruption to other patient and anxiety of clinical staff
Prolonged hospital stays
Increased risk of institutionalisation

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12
Q

How do we manage delirium

A

Recognise
Treat underlying cause
Education of relatives, medical and nursing staff
Make environment safe
Optimism stimulation
Orientation- remind them of date and time

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13
Q

How do we manage delirium with medications?

A

Avoid sedatives- consultant decision

Antipsychotics
Benzodiazepines
Promethazine

None of these have any indications that they work

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14
Q

What is encephalopathy

A

Different description of delirium

Can be caused by the liver (hepatic) alcohol abuse (wernickes) and HIV

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15
Q

What is hepatic encephalopathy?

A
Normally seen in advanced liver disease
General psychomotor retardation
Drowsiness
Fluctuating confusion
tremor

Caused by a build up of toxins

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16
Q

What is dimentia?

A

A syndrome which is characterised by global cognitive impairment which is chronic in nature

Usually the underlying brain pathology is variable and usually, but not always, progressive.

17
Q

What are the different types of dementia?

A
Alzheimer’s
Vascular
Mixed
Lewy body
Frontotemporal
Due to other brain disorders:
Huntington’s chorea
Head injury
Parkinson’s disease
18
Q

What is amnesic syndrome

A
Disorder of recent and remote memory
Immediate recall is preserved
New learning is reduced
Anterograde amnesia- after insult
Retrograde amnesia- before insult
Disorientation in time
Confabulation- making up patches of things 
Perception and other cognitive functions preserved
19
Q

How do you treat amnesia

A

Depends on course of underlying lesion
Lesion typically affects hypothalamic-dienceephalic system or hippocampal region
Almost complete recovery is normal

20
Q

What causes diencephalic damage

A

Korsakoff’s
3rd ventricle tumours and cysts
Bilateral thalamic infarctions
Post subarachnoid heamorrhage, especially from anterior communicating artery aneurysms

21
Q

What causes hippocampal damage

A
Herpes simplex virus 
Anoxia
Surgical removal or temporal lobes
Bilateral posterior, cerebral artery occlusion 
Closed head injury 
Early Alzheimer’s disease
22
Q

How do you treat alcohol amnesic syndrome?

A

Parenteral vitamin B1 (pabrinex)
After that remain on oral thiamine
Advised to stay off alcohol
Slow multidisciplinary rehab