Organic Mental Disorders

Question 1

What makes a disorder an OMD>

Answer 1

Recognised as having an organic explanation
Acquired (i.e. not a LD)
Primary (brain) or secondary (e.g. endocrine)

Question 2

What areas of mental health do OMDs affect?

Answer 2

Cognitive impairment e.g. memory, language, orientation,

Sensory e.g. attention or executive function

Behavioural abnormalities

Mood changes

Psychotic symptoms

Question 3

What are the major acute OMDs?

Answer 3

Delirium
Organic Mood disorder
Organic Psychotic disorder

Question 4

What is delirium?

Answer 4

Transient & fluctuating global cognitive impairment with ass. behavioural changes

Question 5

What are the defining characteristics of delirium?

Answer 5

• Impaired attention/conc
• Disorientated (Time, place, person)
• Fluctuating arousal (quiet/drowsy –> agitated outburst) particularly at night
• Perceptual problems e.g. hallucination
• Mood changes
• Delusions
• Disorganised thinking & speech

Also ant memory, sleep/wake cycle and psychomotor problems

Question 6

Virtually any neuro or systemic problem can –> delirium, what are the most common?

Answer 6

Infection
Drugs e.g. steroids/opioids (both common post-op)
Withdrawal e.g. alc
Alc use
Liver/kidney disease
Hypoxia

Lot’s of others in brain, vit deficiencies, metabolic problems and endocrinopathies

Question 7

What are the commonest chronic OMDs?

Answer 7

Dementia
Amnesic Syndrome
ORganic Personality Change

Question 8

What makes dementia different to Delirium?

Answer 8

It’s a chronic and progessive global cognitive impairment,
It also doesn’t fluctuate much
- Usually alert
-usually has normal attention
-orientation impaired in LATER stages
-impoverished thinking but NOT delusional
- difficulty in word finding but NOT incoherent
- Normal sleep-wake cycle

Question 9

Define amnesic syndrome?

Answer 9

• Ant AND Retrograde
• new learning reduced
• disorientation in place and time
• confabulation

PRESERVE

• preserved immediate recall
• perception and other cognitive functions preserved

Question 10

What can cause amnesic syndrome>?

Answer 10

Hippocampal damage e.g. HSV or bilateral post-cerebral art occlusion, closed head injury, anoxia

Diencephalic damage e.g. Korsakoff’s syndrome, 3rd ventricle tumours/cysts and post-subarachnoid haemorrhage problems such as ant communicating art aneurysm

ALCOHOL

Question 11

Treatment for amnesic syndrome?

Answer 11

• depends on cause
• prevention of alcohol :
  parenteral vitamin B1 and oral thiamine, abstinence from alcohol, slow rehab

Question 12

encephalopathy and delirium

Answer 12

Encephalopathy is basically the physiological explanation of delirium.

Question 13

What is hepatic encephalopathy?

Answer 13

 Normally seen in advanced liver disease
 General psychomotor retardation
 Drowsiness
 Fluctuating confusion
 Asterixis
 Related to build up of toxic products (e.g. ammonia)
 Improves if and as liver function improves