عرض بوربوينت ل organic psychiatric disorders

Organic Organic Psychiatric Psychiatric Disorders Disorders

•Delirium.•Dementia.•Other organic psychiatric

syndromes.•Neurological syndromes.•Epilepsy.

What is organic What is organic psychiatric disorders?psychiatric disorders?

Psychiatric disorders resulting from brain dysfunction

caused by organic pathology inside or outside the brain.

Classification of organic mental Classification of organic mental statesstates

• Global syndromes… Delirium. Dementia.

• Specific syndromes… Amnesic syndrome.

Organic mood disorder. Organic delusional

disorder. Organic personality

disorder.

Delirium Delirium

• Acute generalized impairment of brain function.

• The most important features is impairment of consciousness.

• The primary cause is often outside the brain (eg …anoxia due to respiratory failure).

DeliriumDelirium • It is a common accompaniment of physical

illness occurring in…

5-15 % of pts in general medical & surgical wards.

20-30 % of pts in surgical intensive care units.

• It is especially common in the elderly.• Most pts recover quickly & a few need

specific treatment.• Terms such as confusional state & acute

organic syndrome are outdated .

Clinical FeaturesClinical Features• Impaired consciousness disorientation poor concentration • Behavior overactive underactive

• Thinking muddled (confused) ideas of reference delusions

• Mood anxious , irrtable depressed perplexed

• Perception misperceptions illusions hallucinations • Memory impaired

• Insight impaired

• Fluctuating course ,worse in the evening

• Amnesia (on recovery)

Aetiology Aetiology • Drug intoxication.

• Alcohol withdrawal.

• Metabolic failure.. Cardiac Respiratory Renal Hepatic Hypoglycaemia

• Fever.. systemic infection

• Neurological causes.. encephalitis. space-occupying lesions. raised intracranial pressure . following an epileptic seizure.

Management Management Obtain information from other informants

&medical notes

Assess the pt’s mental state

Confirm the diagnosis of delirium

Determine the physical cause & treat it

Reduce disorientation:Reorientate repeatedly

Consistent routine

Reduce anxiety: Reassurance Medications

Avoid over- or understimulation

Inform & support relatives

If calm:Moniter progress

If agitated ,disturbed ,or distressed:Consider hyponotic at night Cosider regular medications

Moniter progress & review medications

DementiaDementia• Chronic generalized impairment of brain

function.• Characterized by impairment of intellect

,memory & personality without impairment of consciousness.

• The primary cause is within the brain .• Most cases are irreversible (few can be

treated)

Clinical FeaturesClinical Features• Cognition.. poor memory impaired attention aphasia, agnosia, apraxia disorientation • Behavior.. odd & disorganized restless & wandering self-neglect disinhibition

• Mood anxiety depression

• Thinking slow ,impoverished delusions

• Perception ..

illusions hallucinations

• insight.. impaired

AetiologyAetiology• Degenerative neurological

disorders.. Alzheimer’s disease Vascular dementia lewy body dementia Frontotemporal dementia Huntington’s chorea prion disease parkinson’s disease

• Normal pressure hydrocephalus

• Intracranial tumor

• Other space –occupying lesions.. chronic subdural

haematoma

• Traumatic .. severe head injury

• Anoxia.. cardiac arrest carbon monoxide poisoning

• Vitamin lack vitamin B12 folic acid thiamine

• Metabolic DM

• Endocrine hypothyroidism

• Infections.. postencephalitis ,HIV

• Vascular.. multi-infarct dementia

• Toxic alcohol

ManagementManagement• Detailed history (informant).• Mini mental state examination.• Investigations…

CT…diagnosis of both focal & diffuse cerebral pathology.

psychological testing….

specific tests of memory ,learning & other aspects of cognitive function…localized brain lesions.

Wechsler Adult Intelligence Scale (WAIS) …provide a profile of verbal & non-verbal ablities.

Aspects of differential Aspects of differential diagnosisdiagnosis

• Organic or functional ??• Organic…. The cognitive disorder preceded the mood or other disorder.

cognitive defects occur in specific areas of intellctual function neurological signs. The presence of symptoms seldom found in non-organic

disorder ,such as visual hallucinations.

• Functional … by exclusion of organic causes by finding positive evidence of psychological aetiology.

Cont..Cont..• Pseudodementia… in this syndrome ,a depressed pt complains of poor

memory & appears intellectually impaired because poor concentration leads to inadequate registration & deprssive mood leads to slowness & self –neglect.

• Characteristic features….

a history from another informant that the depressed mood preceded the memory problems .

memory testing shows that the poor performance improves when interest is aroused.

the pt is retarded & unwilling to cooperate in the interview.

Cont..Cont..• Delirium or Dementia??

Delirium Dementia Acute onset Insidious onset fluctuating course stable or progressive impaired consciousness normal consciousness Thinking disorganized thinking impoverished Perceptual disturbance perceptual disturbance common uncommon Alertness usually normally alert Impaired

Cont…Cont…• Stupor… a rare condition in which the pt is

immobile unresponsive but has a normal level of consciousness.

• It can occur in severe affective disorder & schizophrenia.

• Lesions of brainstem or mesencephalon can cause a similar picture ,although in these cases there may be some impairment of consciousness.

TreatmentTreatment• Aims of treatment….

maintain any remaining ability as far as possible

relieve distressing symptoms. arrange for the practical requirements of the pt.

support the family

Thank youThank you

OTHER OTHER PSYCHIATRIC & PSYCHIATRIC & NEUROLOGICAL NEUROLOGICAL SYNDROMES SYNDROMES

Organic Organic psychiatric psychiatric syndromesyndrome

Amnesic Amnesic syndromesyndrome

Organic Organic personalitpersonality disordery disorder

Organic Organic mood mood

disorderdisorder

Organic Organic delusional delusional disorderdisorder

Neurological Neurological syndromesyndrome

Normal Normal pressure pressure

hydrocephalushydrocephalus

Head Head injuryinjury

CerebrovasculaCerebrovascular diseaser disease

Cerebral Cerebral tumortumor

Transiet global Transiet global amnesiaamnesia

Multiple Multiple sclerosissclerosis

epilepsyepilepsy

Amnesic syndromeAmnesic syndrome

Korsakov’ssyndrome

Wernicke’sencephalopathy

…….Impairment of consciousness, memory defect, .Impairment of consciousness, memory defect, disorientation, ataxia & ophthalmoplegia. disorientation, ataxia & ophthalmoplegia.

Wernicke- Korsakov syndrome

-Prominent disorder of recent memory..-Prominent disorder of recent memory..-No intellectual impairment or impaired consciousness-No intellectual impairment or impaired consciousness

• Alcohol abuse

AetiologyAetiology• Lesion in the posterior hypothalamus• Bilateral hyppocampal lesions.

CausesCauses

thiamine deficiency.

• CO2 poisoning, vascular lesion, encephalitis, tumor in the third ventricle.

• Recent memory severely impaired.

• Remote memory spared.• Disorientation in time.• Confabulation >>>

Clinical Clinical featuresfeatures

detailed account of recent activities turn out to be inaccurate.

• If thiamine deficiency >>> vitamin supplement.

TreatmentTreatment

prognosisprognosis

• Chronic• Better if due to thiamine deficiency





disorderdisorder







epilepsyepilepsy



Transiet Transiet global global

amnesiaamnesia

• Frontal lobe damage..

Organic Organic personality personality

disorderdisorder


Behaviour: - disinhibited, overfamiliar, tactless- Pts overtalkative, make inappropriate jokes,

disregard feeling of others.

Mood: euophoric.

Concentration, attention & insight :impaired.