Organic mental disorders, General Hosp Psych & Functional disorders Flashcards
What is the relationship between physical & mental health?
Organic disorder: delirium/cognitive impairment
Emotional disorder as a reaction to illness and treatment
Emotional symptoms as a manifestation of the illness and treatment
Independent concurrent physical illness and psychiatric disorder
What are neurocognitive disorders and what are examples?
- Deficits in cognitive function
- Acquired rather than developmental (i.e intellectual disability)
- Distinction from from “functional” mental illness
Examples:
Delirium
Dementia
Amnesic syndromes
Problems:
- Many (if not all) psychiatric disorders have an “organic” basis
(Schizophrenia, bipolar affective disorder, melancholia)
- Many mental disorders present with a mixture of mental and physical features
- Physical disorders also have effect on psychological functioning
What are examples of ‘organic’ mental disorders acute and chronic?
Acute:
- Delirium
- Withdrawal states
- Organic mood disorder
- Organic psychotic disorder
- Encephalitis (inc. autoimmune – aNMDAr/VGKC)
Chronic
- Dementia
- Amnesic syndromes
- Organic personality change
How does delirium present?
Impairment of consciousness and attention
Global disturbance of cognition
Psychomotor disturbances
Disturbance of sleep-wake cycle
Emotional disturbance
- Continues after infection/causative factor has passed-can last up to weeks and months
- Syndrome of something else-clinical diagnosis
- Can see them picking at thing-delirium picture
What is the prognosis of delirium?
- Fluctuating course
- Gradual resolution of symptoms with effective treatment of underlying cause
- Slower symptom resolution in the elderly
- Often patchy amnesia for delirious period following recovery
- May be a marker for subsequent dementia
What is the assessment test for delirium?
4AT
What is dementia?
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.
How does amnestic disorder present?
Syndrome of impairment of recent and remote memory
Immediate recall preserved
New learning reduced
Anterograde amnesia
Disorientation in time
Retrograde amnesia (temporal gradient) – may lessen over time
Confabulation
Perception and other cognitive functions preserved
How does Wernicke’s encephalopathy present
- Ataxia
- Acute confusional state
- Ophthalmoplegia
Related to acute deficiency of Thiamine (vitamin B1)
Can be difficult to distinguish from delirium tremens
How is Wernicke’s encephalopathy treated?
High potency parenteral B1 replacement
- 3-7 days
- Oral thiamine
How does Korsakoff’s syndrome present?
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
What may make you think of a physical illness as being a cause of depression?
First presentation in middle-age or later
No family history of psychiatric illness
No convincing psychosocial precipitant
Functional disorder is NOT what?
Hypochondriacal disorder
Persistent preoccupation with the possibility of having one or more serious and progressive physical disorders
Factitious disorder
Deliberately producing, feigning or exaggerating symptoms due to a pathological need to for the sick role
Malingering
Deliberately producing, feigning or exaggerating symptoms to escape duty, work or for financial gain
What are some examples of functional disorders?
- Dissociative neurological symptom disorder
- Bodily distress disorder
How are functional disorders treated?
Instil evidence based hopefulness
Focus on restoring function rather than focusing on finding cause and cure
Promote engagement in physical activity & stimuli
Psychoeducation
Psychological therapies
- CBT
- IPT
- Psychodynamic therapies
