geriatric mental disorders 楊誠弘醫師 臺北榮民總醫院精神部 中華民國 98 年 9 月...
Post on 18-Dec-2015
249 views
TRANSCRIPT
Geriatric Mental Disorders
楊誠弘醫師 臺北榮民總醫院精神部
中華民國 98 年 9 月 23 日
精神病理
疾病 心理症狀Alzheimer’s disease Dementia
Brain tumor Delirium
Cerebral infarction Depression
Parkinson disease Delusion
Schizophrenia Hallucinations
INTRODUCTION
ORGANIC AND FUNCTIONAL DIOSRDERS
DSM-IV-TR AND ICD-10PRIMARY AND SECONDARY
BRAIN DYSFUNCTIONDELIRIUM, DEMENTIA,
AMNESIA AND OTHER ORGANIC MENTAL DISORDERS
DSM-IV-TR AND ICD-10
DELIRIUM, DEMETIA AND AMNESTIC DISORDERS (SAME)
MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION (DSM-IV-TR)
OTHER ORGANIC MENTAL DISORDERS ( ICD-10)
EXAMPLES
PERSONALITY CHANGE DUE TO GENERAL MEDICAL CONDITIONS (DSM-IV-TR)
ORGANIC PERSONALITY DISORDER ( ICD-10)
TWO GROUPS
DELIRIUM, DEMETIA AND AMNESITC DISORDERS: COGNITIVE IMPAIRMENT
OTHER ORGANIC MENTAL DISORDERS: HALLUCINATIONS, DELUSIONS, MOODS AND PERSONALITIES AND BEHAVIORS
CLASSIFICATIONSDEMENTIA: DEMENTIA IN ALZHEIMER’S DISEASE, VASCULAR
DEMENTIA, DEMENTIA IN OTHER DISEASESDELIRIUM AMNESTIC DISORDERSOTHER MENTAL DISORDERS: ORGANIC HALLUINOSIS, ORGANIC
CATATONIC DISORDER, ORGANIC DELUSIONAL DISORDER, ORGAINC MOOD DISORDER, ORGANIC PERSONALITY DISORDERS….
DEMENTIA
1. A DECLINE IN MEMORY
AND OTHER COGNITIVE ABILITIES CHARACTERIZED BY DETERIORATION IN JUDGEMENT AND THINKING
2. AWARENESS OF ENVIRONMENT
3. A DECLINE OF EMOTIONAL CONTROL OR MOTIVATION
4. SYMPTOMS FOR AT LEAST 6 MONTHES
ADDITIONAL SYMPTOMS OF DEMENTIA
1. WITHOUT ADDITIONAL SYMPTOMS
2. WITH DELUSIONAL SYMPTOMS3. WITH HALLUCINATORY
SYMPTOMS4. WITH DEPRESSIVE SYMPTOMS5. WITH OTHER MIXED SYMPTOMS
DEMENTIA IN ALZHEIMER’S DISEASE
1. THE GENERAL CRITERIA FOR DEMENTIA MUST BE MET
2. THERE IS NO EVIDENCE FROM THE HISTORY, PHYSICAL EXAMINATION, OR SPECIAL INVESTIGATIONS, FOR ANY OTHER POSSIBLE CAUSE OF DEMENTIA
DEMENTIA IN ALZHEIMER’S DISEASE WITH EARLY ONSET
1. AGE AT ONSE MUST BE BELOW 65 YEARS2. EVIDENCE OF RAPID ONSET AND PROGRESSION3. APHASIA, AGRAPHIA, ALEXIA, ACALCULIA OR
APRAXIA
DEMENTIA IN ALZHEIMER’S DISEASE WITH LATE ONSET
1. AGE AT ONSE MUST BE 65 YEARS OR MORE2. EVIDENCE OF A VERY SLOW GRADUAL ONSE
AND PROGRESSION3. PREDOMINANCE OF MEMORY IMPAIRMENT
VASCUALR DEMENTIA
THE GENERAL CRITERIA FOR DEMENTIA MUST BE MET.
DEFICITS IN HIGHER COGNITIVE FUNCTIONS ARE UNEVENLY DISTRIBUTED
THERE IS CLINICAL EVIDENCE OF FOCAL BRAIN DAMAGE
THERE IS EVIDENCE FROM THE HISTORY, EXAMINATION, OR TESTS OF A SIGNIFICNAT CEREBROVASCULAR DISEASE
DEMENTIA IN OTHER DISEASES
1. DEMENTIA IN PICK’S DISEASE2. DEMENTIA IN CREUTZFELDT-JAKOB DISEASE3. DEMENTIA IN HUNTINGTON’S DISEASE4. DEMENTIA IN PARKINSON’S DISEASE5. DEMENTIA IN HIV DISEASE.6. DEMENTIA IN OTHERS
DILIRIUM
1. CLOUDING OF CONSCIOUSNESS2. COGNITIVE IMPAIRMENT3. PSYCHOMOTOR
DISTURBANCES4. DISTURBANCE OF SLEEP5. RAPID ONSE AND
FLUCTUATIONS6. OBJECTIVE EVIDENCE OF
CEREBRAL OR SYSTEMIC DISEASE
CAUSES OF DELIRIUM
CEREBRAL DISEASES: EPILEPSY, BRAIN TRAUMA, INFECTIONS, NEOPLASMS, AND VASCULAR DISORDERS
SYSTEMATIC DISEASES
SYSTEMIC DISEASES (EXTRACRANIAL CAUSES OF
DELIRIUM)DRUGSPOISONSEDOCRINE DYSFUNCTIONLIVER: HEPATIC ENCEPHALOPATHYKIDNEY: UREMIC ENCEPHALOPATHYLUNG: CO NARCOSIS, HYPOXIACARDIOVASCULAR: CARDIAC FALUREVITAMINE DEFICIENCYSYSTEMIC INFECTIONSELECTROLYE IMBALANCEPOSTOPERATIVE STATESTRAUMA
ORGANIC AMNESTIC SYNFROME
THERE IS MEMORY IMPAIRMENT, MANIFEST IN BOTH DEFECT OF RECENT MEMORY AND REDUSCED ABILITY TO RECALL PAST EXPEREINCES
THERE IS NO DEFECT IN IMMEDIAGTE RECALL, CLOUDING OF CONSCIIOUSNESS AND DISTURBANCE OF ATTENTION
THERE IS OBJECTIVE EVIDENCE OF SYSTEMIC OR BRAIN DISEASES
ASSOCATED FEAGTURES: CONFABULATIONS
MAJOR CAUSES OF AMNESTIC
DISORDERS SYSTEMIC MEDICAL CONDITIONS:
THIAMENT DEFICIENCY (KORSAKOFF’S SYNDROME)
HYPOGLYCEMIAPRIMARY BRAIN CONDITIONS: SEIZURES,
HEAD TRUMA, CEREBRAL TUMORS, CEREBROVSCUALR DISEASES, SURGICAL PROCEDURES ON THE BRAIN, ENCEPHALITIS, HYPOXIA, ELECTROCONVULSIVE THERAPY, MUTIPLE SCLEROSIS, TRANSIENT GLOBAL AMNESIA.
SUBSTANCES-RELATED CAUSES: ALCOHOL, BENZODIAZEPINES
ORGANIC PERSONALITY DISORDER
CONSISTNELTY REDUCED ABILITY TO PERSEVERE WITH GOAL-DIRECTED ACTIVITY
EMOTIONAL CHANGESDISINHIBITED EXPRESSION OF
NEEDS OR IMPULSESCOGNITIVE DISTURBANCESMARKED ALERATIONS OF THE
RATE AND FLOW OF LANAGUAGE PRODUCTION
ALTERED SEXUAL BEHAVIORS
OTERH MENTAL DISRDERS DUE TO BRAIN DAMANGE
AND DYSFUCNITON AND DUE TO PHYSICAL DISEASE ORGANIC HALLUCINOSISORGANIC CATATONIC DISRODERORGANIC DELUSIONAL DISORDERORGANIC MOOD DISORDERORGANIC ANXIETY DISORDERORGANIC DISSOCIATIVE DIORDERORGANIC EMIOTANLLY LABILE
DISORDER