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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organic syndrome are outdated .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
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
epilepsyepilepsy
Multiple Multiple sclerosissclerosis
Cerebral Cerebral tumortumor
Transiet Transiet global global
amnesiaamnesia
• Frontal lobe damage..
Organic Organic personality personality
disorderdisorder
Clinical Clinical featuresfeatures
Behaviour: - disinhibited, overfamiliar, tactless- Pts overtalkative, make inappropriate jokes,
disregard feeling of others.
Mood: euophoric.
Concentration, attention & insight :impaired.
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
epilepsyepilepsy
Multiple Multiple sclerosissclerosis
Cerebral Cerebral tumortumor
Transiet Transiet global global
amnesiaamnesia
Organic Organic moodmood disorderdisorder
Neurological Neurological diseasedisease
( multiple sclerosis)
EndocrineEndocrineDisorderDisorder(Cushing’s
disease)
Depression, mania or anxiety
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
epilepsyepilepsy
Multiple Multiple sclerosissclerosis
Cerebral Cerebral tumortumor
Transiet Transiet global global
amnesiaamnesia
*Obstruction in the subarachnoid space.
Normal pressure Normal pressure hydrocephalushydrocephalus
Clinical Clinical featuresfeatures
* Progressive memory impairment, slowness, unsteadiness of gait & urinary incontinence.
TreatmentTreatment
*shunt operation to improve the circulation of CSF.
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
epilepsyepilepsy
Multiple Multiple sclerosissclerosis
Cerebral Cerebral tumortumor
Transiet Transiet global global
amnesiaamnesia
Acute psychological effects include:• Impairment of cosciousness• Delirium• Post- traumatic amnesia of more than 24
h.. Followed by persistent cognitive impairment.
• Personality change: - severe… damage to frontal lobe - irritability, loss of spontaneity and drive&
reduced control of aggressive impulses• Emotional symptoms: - anxiety &depression with headache,
poor concentration & insomnia.
Head injuryHead injury
• Neurological signs and physical disability.• Any neuropsychiatric problems and their future
course.• Social circumstances, social support & the
possibility of return to work
assessmentassessment
managememanagementnt
• Physiotherapy• Try to minimize disability• Deal with specific cognitive deficits
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
epilepsyepilepsy
Multiple Multiple sclerosissclerosis
Cerebral Cerebral tumortumor
Transiet Transiet global global
amnesiaamnesia
• Cognetive defects: Dementia, dysphasia & dyspraxia
• Personality change: irritability, apathy or lability of mood failure to cope with everyday problem..(catastrophic reaction)
• Depressed mood: psychological reaction to handicap or direct consequence of any localized brain damage
Cerbrovascular Cerbrovascular diseasedisease
TreatmentTreatment
antidepressent
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
epilepsyepilepsy
Multiple Multiple sclerosissclerosis
Cerebral Cerebral tumortumor
Transiet Transiet global global
amnesiaamnesia
• Fast growing tumor>> delerium• Slow growing tumor>> dementia
Cerebral Cerebral tumortumor
Multiple Multiple sclerosissclerosis
• Depression or elation.• dementia
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
epilepsyepilepsy
Multiple Multiple sclerosissclerosis
Cerebral Cerebral tumortumor
Transiet Transiet global global
amnesiaamnesia
• Unknown cause• Middle or late life• Occasional• Abrupt episodes of unusual behaviour
and global loss of recent memory for several hours
• Pt alert & responsive• Unable to understand his experience• Complete recovery except for amnesia of
the episode• No specific treatment
Transiet Transiet global global
amnesiaamnesia
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
epilepsyepilepsy
Multiple Multiple sclerosissclerosis
Cerebral Cerebral tumortumor
Transiet Transiet global global
amnesiaamnesia
Association between epilepsy and psychological problems of epileptic individual:
• Effect of stigma & social restriction• Psychiatric disorder due to the cause of epilepsy : If due to brain damage>> intellectual impairment &
personality problems• behavioural disturbance : - Before: tension, irrritability, depression. - During: comlex partial seizure. - After: automatism. • Disorders between seizure: - cognitive impairment - personality disorder - sexual disfunction - increased self harm & suicide.
epilepsyepilepsy