Organic Mental Disorders and Learning Disabilities

Question 1

what are organic mental disorders?

Answer 1

mental disorders with a clear biochemical/physical aetiology

Question 2

define primary and secondary organic mental disorders

Answer 2

primary - caused by a direct insult on the brain (eg tumour, infection)
secondary - caused by a systemic disease that affects the brain as well as other systems (eg infections, delirium, substance abuse)

Question 3

name a few common cognitive features that present in organic mental illness

Answer 3

• memory impairment
• intellect decline
• learning impairment, especially new learning

Question 4

name a a few sensory features which may present in organic mental illness

Answer 4

impaired consciousness

impaired attention

Question 5

how is mood affected by organic mental illness?

Answer 5

it can cause both depression/anxiety and elation

Question 6

what are the differences in psychotic symptoms in patients with organic vs psychiatric illness?

Answer 6

hallucinations - normally auditory in psychiatric illness, visual in organic illness
delusions - normally fluctuating/fragmented in organic disease, more consistent/systematised in psychiatric illness

Question 7

are acute or chronic organic mental diseases more likely to be reversible?

Answer 7

acute

Question 8

name a few examples of acute organic illness

Answer 8

delirium
organic mood disorder
organic psychiatric disorder

Question 9

name a few examples of chronic organic illness

Answer 9

dementia
amnesic syndrome
organic personality change
drug/alcohol abuse

Question 10

name a few features of delirium

Answer 10

impaired consciousness
impaired attention
cognition disturbance
psychomotor disturbance
sleep-wake cycle disturbance
emotional disturbance

Question 11

how is delirium treated?

Answer 11

• treat underlying cause
• treat contributing factors
• supportively managing remaining symptoms

Question 12

what is typically the diurnal fluctuation of delirium?

Answer 12

patient tends to be more aware and alert during the day, and more anxious/agitated at night

Question 13

how long can delirium last?

Answer 13

anything up to 6 months

Question 14

in terms of timeline, what is the difference between dementia and delirium?

Answer 14

delirium often rapid onset following an insult

dementia is slower and more insidious

Question 15

what is a downside of using benzodiazepines for delirium?

Answer 15

they can prolong the delirium

Question 16

what neuroleptics are sometimes used in severe delirium?

Answer 16

antipsychotics

Question 17

name an anticholinergic sometimes used to help treat delirium

Answer 17

promethazine

Question 18

what is the difference between encephalopathy and delirium?

Answer 18

no difference in presentation, but delirium normally describes a psychiatric presentation, whereas encephalopathy describes a clear underlying cause (eg hepatic, Wernicke’s or HIV)

Question 19

what is normally the cause of amnesic syndrome?

Answer 19

Korsakoff’s syndrome

Question 20

what is the treatment of amnesic syndrome?

Answer 20

depends on the cause - if alcoholic, Vit B1/thiamine and nutrition, abstinence and MDT

Question 21

in terms of memory, what are the features of amnesic syndrome?

Answer 21

• immediate recall preserved
• new learning reduced
• anterograde and retrograde memory amnesia
• confabulation

Question 22

what IQ score is needed to qualify as having an intellectual impairment?

Answer 22

IQ < 70

Question 23

one of which three criteria is needed to qualify as having a mental disorder?

Answer 23

learning disability
mental illness
personality disorder

Question 24

what is the prevalence of learning disabilities?

Answer 24

1-2% of the population

Question 25

what are the three criteria to qualify as having a learning disability?

Answer 25

onset in developmental period
IQ < 70
social or adaptive dysfunction

Question 26

what factors contribute to the aetiology of learning disorders? give a few examples of each

Answer 26

genetic (Down’s, Prader-Willi, Rett syndrome)
toxic (alcohol)
infective (rubella, meningitis)
trauma (birth asphyxia, head injury)

Question 27

what are the commonest comorbidities in people with learning disabilities?

Answer 27

dental problems
dermatological problems
epilepsy
sensory problems (vision, hearing)
obesity
cerebral palsy
respiratory, GI, orthopaedic problems