Organic Mental Disorders

Question 1

What are organic mental disorders?

Answer 1

Due to common, demonstrable aetiology in cerebral disease, brain injury or other insult leading to cerebral dysfunction

Acquired disease

Different from functional mental illness (that means has no cause)

Question 2

What are the classes of organic mental disorders?

Answer 2

Primary- trauma/infection

Secondary- systemic diseases, substance misuse, delirium

Question 3

What are the common features of organic mental disorders?

Answer 3

Cognitive-memory, intellect, learning

Sensory- consciousness, attention

Mood- depression, elation, anxiety

Psychotic- hallucinations (more likely to see things), delusion

Personality and behavioural disturbance

Onset- any age, most tend to start in adult or later life

Some irreversible and progressive
Some transient/respond to treatments

Question 4

What are the two types of onset’s of organic brain disorders?

Answer 4

Acute/sub acute- stroke, encephalitis, drugs, dielirium
Typically recover

Chronic- drug/alcohol dependence, dementia, amnesia, organic personality change.

Question 5

What can cause delirium that can be easily treated

Answer 5

Disorientation
Dehydration
Constipation
Hypoxia
Immobility
Infection
Multiple medications
Pain
Poor nutrition
Sensory impairment
Sleep disturbance

Question 6

What is delirium?

Answer 6

Nonspecific syndrome caused by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion and the sleep wake cycle

Question 7

How do you screen for delirium?

Answer 7

4AT!

Question 8

What are the main features of delirium?

Answer 8

Impairment on consciousness and attention
Global disruption of contention
Psychomotor disturbance 
Disturbance of sleep wake cycle 
Emotional disturbance 
Fluctuating symptoms

Question 9

How does delirium present?

Answer 9

Rapid onset
Diurnal fluctuating
Duration less than 6 months

Physical signs due to underlying cause
Autonomic, activation, tachycardia, hypertension, diaphoresis, dilated pupils/fever
Dysgraphia (poor hand writing) often evident

Question 10

What can causes delirium?

Answer 10

Medications- anticholinergics bad, sedatives bad
Endocrinolathies
Drug abuse- amphetamine, PCP, hallucinogens
Infections
Withdrawl syndromes- alcohol, benzodiazepines
Neurological causes
Metabolic symptoms- sugar, magnesium
Toxins and industrial exposures
Vitamin deficiencies- thiamine
Others

Question 11

What are the outcomes of delirium?

Answer 11

Leads to disruption to other patient and anxiety of clinical staff
Prolonged hospital stays
Increased risk of institutionalisation

Question 12

How do we manage delirium

Answer 12

Recognise
Treat underlying cause
Education of relatives, medical and nursing staff
Make environment safe
Optimism stimulation
Orientation- remind them of date and time

Question 13

How do we manage delirium with medications?

Answer 13

Avoid sedatives- consultant decision

Antipsychotics
Benzodiazepines
Promethazine

None of these have any indications that they work

Question 14

What is encephalopathy

Answer 14

Different description of delirium

Can be caused by the liver (hepatic) alcohol abuse (wernickes) and HIV

Question 15

What is hepatic encephalopathy?

Answer 15

Normally seen in advanced liver disease
General psychomotor retardation
Drowsiness
Fluctuating confusion
tremor

Caused by a build up of toxins

Question 16

What is dimentia?

Answer 16

A syndrome which is characterised by global cognitive impairment which is chronic in nature

Usually the underlying brain pathology is variable and usually, but not always, progressive.

Question 17

What are the different types of dementia?

Answer 17

Alzheimer’s
Vascular
Mixed
Lewy body
Frontotemporal
Due to other brain disorders:
Huntington’s chorea
Head injury
Parkinson’s disease

Question 18

What is amnesic syndrome

Answer 18

Disorder of recent and remote memory
Immediate recall is preserved
New learning is reduced
Anterograde amnesia- after insult
Retrograde amnesia- before insult
Disorientation in time
Confabulation- making up patches of things 
Perception and other cognitive functions preserved

Question 19

How do you treat amnesia

Answer 19

Depends on course of underlying lesion
Lesion typically affects hypothalamic-dienceephalic system or hippocampal region
Almost complete recovery is normal

Question 20

What causes diencephalic damage

Answer 20

Korsakoff’s
3rd ventricle tumours and cysts
Bilateral thalamic infarctions
Post subarachnoid heamorrhage, especially from anterior communicating artery aneurysms

Question 21

What causes hippocampal damage

Answer 21

Herpes simplex virus 
Anoxia
Surgical removal or temporal lobes
Bilateral posterior, cerebral artery occlusion 
Closed head injury 
Early Alzheimer’s disease

Question 22

How do you treat alcohol amnesic syndrome?

Answer 22

Parenteral vitamin B1 (pabrinex)
After that remain on oral thiamine
Advised to stay off alcohol
Slow multidisciplinary rehab