Organic Psychiatry Flashcards
what is cognition
- Attention/orientation
- Memory
- Executive functioning
- Language
- Calculation
- Praxis
- Visuospatial ability
4 classifications of attention
- Arousal
- Sustained attention
- Divided attention
- Selective attention
abnormalities in attention can indicate
delirium
role of frontal lobes
- Goal setting and motivation
- Judgement and control of inhibition
- Flexibility and problem solving
- Planning/sequencing organisation
- Abstract reasoning
- Social behaviour personality
2 things that make delirium occur
Predisposing factors + precipitating factors (infection, stroke, drugs, MI, fractures, cancers)
3 main drug approaches to delirium
Antipsychotics
Benzodiazepines
Other
5 Antipsychotics
Haloperidol
Olanzapine
Risperidone
Aripiprazole
Quetiapine
2 Benzodiazepines
Lorazepam
Diazepam
3 other treatments for delirium
Specific treatment of underlying cause
Melatonin
Trazodone
Acalculia
inability to comprehend or write numbers properly
Anarithmetria
difficulty with arithmetic
where do calculations occur
left hemisphere
Angular gyrus in parietal lobe
3 stages of spectrum of cognitive impairment
Age related decline → mild cognitive impairment → dementia
list some Non-pharmacological approaches to delirium
- Noise control and lighting
- Orientating influences – calendars, clocks, familiar objects, family (reality orientation)
- Fluid balance/diet/bowel habit/pain control
- Regular communication/reassurance from staff.
- Address sensory impairment
- Limit variation in staff
- Encourage normal sleep cycle and side room if possible
- Early mobilising
- Avoid ward transfers
- Consider necessity of certain procedures
- Recognise frailty
what is dementia
- Syndrome with chronic, progressive (usually irreversible) cognitive impairment due to brain disease
- Deterioration from higher level of function
- No clouding of consciousness
- Chronic duration > 6 months
8 causes of reversible dementia
- B12, folate deficiency
- Hypothyroidism
- Hydrocephalus - subdural haematoma, CNS tumour
- Wilson’s disease
- Cerebral vasculitis
- Depression ‘pseudo-dementia’
- Whipple’s disease
- Metabolic problems
main psychotic differentials of dementia
- Main psychiatric differentials
- Normal ageing
- Delirium
- Mild cognitive impairment (MCI)
- Amnesic syndromes
- Chronic brain damage (eg head injury or anoxia)
- Depression (pseudo-dementia)
- Late onset schizophrenia or other psychosis
- Learning disability
- Malingering presentations
- Dissociation
hallmark features of dementia
- Impaired consciousness
- Hyperactive or hypoactive sub-type
- Acute onset
- Change in cognition
- Cognitive deficits
- Visual hallucinations (and other psychotic symptoms)
- Sleep-wake cycle disruption
- Affect changes
- In most cases, evidence of an underlying direct cause
main visuospatial deficits in dementia
- Topographical disorientation
- Difficulties with dressing (dressing apraxia)
- Mis-reaching for objects
- Visual neglect
- Visual object agnosia
- Prosopagnosia
deficits in praxis
dyspraxia
praxis is errors of
- Action conception (knowledge of actions/item function)
- Action production (production/control of movement)
where does praxis occur
left hemisphere function – parietal and frontal lobe
dianogisis of dementia
- Clinical assessment
- Corroborative history
- General physical examination
- Mental State Examination Standard (+/- specialised) bloods
- Structured cognitive testing Structural (+/- functional) imaging
lab investigations of dementia
- FBC
- ESR
- CRP
- Glucose
- U+E
- LFTs
- Bone profile
- TFTs
- Urinalysis
- MSSU B12
- folate
