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Psychiatry > Organic Mental Disorders > Flashcards

Organic Mental Disorders Flashcards

1
Q

What makes a disorder an OMD?

A

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

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2
Q

What areas of mental health do OMDs affect?

A

Cognitive impairment Sensorium Mood changes Psychotic symptoms Personality and behavioural disturbance

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3
Q

What are the major acute OMDs?

A

Delirium Organic Mood disorder Organic Psychotic disorder

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4
Q

What is delirium?

A

Transient & fluctuating global cognitive impairment with ass. behavioural changes

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5
Q

What are the defining characteristics of delirium?

A
  • 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
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6
Q

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

A

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

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7
Q

What are the commonest chronic OMDs?

A

Dementia Amnesic Syndrome ORganic Personality Change

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8
Q

What makes dementia different to Delirium?

A

It’s a chronic and progessive global cognitive impairment, It also doesn’t fluctuate much

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9
Q

Define amnesic syndrome?

A

Ant AND Retrograde amnesia with preserved intellectual abilities, working memory & procedural memory

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10
Q

What can cause amnesic syndrome>?

A

Hippocampal damage e.g. HSV or bilateral post-cerebral art occlusion Diencephalic damage e.g. Korsakoff’s syndrome, 3rd ventricle tumours and post-subarachnoid haemorrhage problems such as ant communicating art aneurysm

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11
Q

How may cognitive function be affected in OMDs?

A

Memory Intellect Learning

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12
Q

How may sensorium be affected in OMDs?

A

Consciousness Attention

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13
Q

How may mood be affected in OMDs?

A

Depression Elation Anxiety

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14
Q

How may psychosis be affected in OMDs?

A

Hallucinations Delusions

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15
Q

When do OMDs onset?

A

Any age Most tend to start in adult or later life

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16
Q

Hw chronic are OMDs?

A

Some irreversible and progressive Some transient/respond to treatments

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17
Q

How may an OMD be classified and what are some subtypes?

A

Acute/sub-acute -Delirium -Organic mood disorder -Organic psychotic disorder Chronic -Dementia -Amnesic syndrome -Organic personality change

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18
Q

How is delirium tremens treated?

A

Benzodiazepines

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19
Q

If Wernicke’s encephalopathy goes untreated, how many will develop Korsakoff psychosis?

A

84% (after 2 week untrusted acute phase)

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20
Q

How is Wernicke-Korsakoff Syndrome treated?

A

High potency parenteral B1 replacement -3-7 days -Oral thiamine -Avoid carbohydrate load until thiamine replacement completed -All patients with symptoms of Wernike’s encephalopathy or at high risk should be treated with parenteral thiamine -Others undergoing detoxification or under investigation should be commenced on oral thiamine -Concurrent treatment for alcohol withdrawal

21
Q

What can Korsokoff’s psychosis also be known as?

A

Alcohol Amnesic Syndrome

22
Q

How does Korsokoff’s present?

A

-Characterised by marked impairment of anterograde memory (ability to learn new information), disturbance of time sense -No clouding of consciousness, absence of defect in immediate recall or global impairment -Variable degrees of cognitive impairment -Personality changes, apathy, loss of initiative -Confabulation in the early stage -Can improve with prolonged abstinence

23
Q

What is hepatic encephalopathy?

A

-Normally seen in advanced alcohol liver disease -General psychomotor retardation, drowsiness fluctuating levels of confusion -Related to build up of toxic products (e.g. ammonia) -Improves if and as liver function recovers

24
Q

What is alcohol-related brain damage?

A

-Part of a spectrum of alcohol related medical disorders, not a specific diagnosis -Can result from neurotoxic effects of alcohol, head injury, vitamin deficiencies, cerebrovascular disease, hypoxia, hypoglycaemia, seizures

25
Q

What percentage of alcohol dependent persons will exhibit post-mortem evidence of alcohol related brain damage?

A

35%

26
Q

When do men and women present with alcohol-related brain damage?

A

Women - 40s/50s Men - 50s/60s

27
Q

What percentage of heavy drinkers display cognitive impairment when sober?

A

50-80% -Impairment in short-term memory, long-term recall, new skill acquisition, set-shifting ability -Visuospatial ability decline greater than language ability decline -Imaging: cortical atrophy (mainly white matter loss) and ventricular enlargement

28
Q

What does the Adults with Incapacity (Scotland) Act 2000 use to determine if an adult has capacity?

A

A person is unable to make a decision for him/herself if, due to mental disorder or inability to communicate because of physical disability, he/she is incapable of acting; or making decision; or communicating decisions; or understanding decisions; or retaining the memory of decisions.

29
Q

What is dementia?

A

A syndrome which characterised by global cognitive impairment which is chronic in nature. The underlying brain pathology is variable and usually, but not always progressive.

30
Q

How does dementia differ from depressive pseudodementia?

A

D - Progressive onset PD - Rapid onset D - Long-term symptomatology PD - Short-term symptomatology D - Mood variations PD - Consistently depressed mood D - Patient tries to answer questions PD - Short answers; “I don’t know”, negativism D - Patient concealing amnesia PD - Highlighting amnesia D - Constant cognitive decline PD - Fluctuating cognitive impairment

31
Q

What is steroid-induced psychosis?

A

-Mild-moderate psychiatric symptoms in 28% patients treated with steroids -Approximately 6% severe reaction -Dosage related to incidence but not timing, duration or severity -Subsequent events not predicted by previous (or lack of previous) reaction

32
Q

How is steroid-induced psychosis managed?

A

Consider tapering steroids Consider antipsychotic/mood stabiliser

33
Q

How might endocrine and metabolic disorders affect mental function?

A

-Wide variety of clinical presentations -CNS requires “stable biochemical and metabolic milieu” for proper functioning -Psychiatric presentations may be reversible if detected -Likely to first present to GP/General medicine but some conditions (i.e. Hypothyroidism, Addison’s disease) may present first to psychiatry and there is risk of mistaken diagnosis

34
Q

What is Anti-NMDA Receptor encephalitis?

A

-Autoimmune disease that targets NMDA receptors Ionotropic glutamate receptor involved in synaptic plasticity and memory function -Around half associated with malignancy -Often presents initially with psychiatric symptoms

35
Q

How is Anti-NMDA Receptor encephalitis managed?

A

Immunotherapy and tumour resection if indicated -IVIg, plasmapheresis, rituximab -Prognosis, with treatment, generally good

36
Q

What is an ICD-10 F05?

A

Delirium due to an unknown condition

37
Q

How does delirium present?

A

Rapid onset Diurnally fluctuating Duration less than 6 months Symptoms: -Impairment of consciousness and attention -Global disturbance of cognition -Psychomotor disturbances -Disturbance of sleep-wake cycle -Emotional disturbance

38
Q

What may cause delirium?

A

Medications Drug abuse Withdrawal syndromes Metabolic Vitamin deficiencies Endocrinopathies Infections Neurological causes Toxins and industrial exposures Others e.g. SLE, hyperviscosity syndromes

39
Q

What is the mechanism of delirium?

A

-Pathophysiology unclear -GABAergic and cholinergic neurotransmitter systems? -Central cholinergic deficiency? -Increased risk associated with GABAa agonists and anticholinergic drugs -Increased dopaminergic activity? -Direct neurotoxic effect of inflammatory cytokines?

40
Q

How does delirium differ from dementia?

A
41
Q

How does delirium differ from fucntional psychosis?

A
42
Q

What is the prognosis for delirium?

A

—-Gradual resolution of symptoms with effective treatment of underlying cause

  • May improve more quickly at home
  • —Slower symptom resolution in the elderly

—-Often patchy amnesia for delirious period following recovery

—-Mortality – 20% die during this admission, up to 50% at 1 year

-May be a marker for subsequent dementia

43
Q

Which factors contribute to delirium?

A

¡Disorientation

¡Dehydration

¡Constipation

Hypoxia

Immobility/limited mobility

Infection

Multiple medications

Pain

Poor nutrition

Sensory impairment

Sleep disturbance

44
Q

How might delirum be managed with environmental and supportive measures?

A

Education of relatives, medical and nursing staff

Make environment safe

Optimise stimulation

Orientation

45
Q

How may delirium be managed with medication?

A

Avoid sedation unless required to maintain safety

Evidence base and guidelines do not support use of medications in delirium

—-Antipsychotics

  • Benzodiazepines
  • Promethazine
46
Q

Whcih antipsychotics may be used in delirium?

A

Risperidone 0∙5 – 1mg

Quetiapine 25-50mg

If IM required – consider olanzapine/aripiprazole

47
Q

Which benzodiazepines may be used in delirium?

A

Can prolong delirium

Lorazepam 0∙5 – 1mg

Use in withdrawal states – diazepam/chlordiazepoxide; cautionin liver failure

48
Q

What is Promethazine and how is it used in deliruim?

A

Oral/IM 10-25mg

Off-licence use

Caution: in elderly (anticholinergiceffect); prolongs QTc; lowers seizure threshold

49
Q

Why might anti-psychotics be avoided in delirium?

A

Avoid antipsychotics in alcohol/drug withdrawal states unless patient well covered with benzodiazepines due to lowering of seizure threshold

Psychiatry (33 decks)

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