Lecture 12 Organic Mental Disorders

Question 1

What are Primary organic mental disorders

Answer 1

Direct effect on the brain

Question 2

What are secondary organic mental disorders

Answer 2

Systemic disease that affects the brain in addition to other systems

Question 3

What is Alcohol Amnesic Syndrome (Korsakoff’s Psychosis)

Answer 3

• Characterised by marked impairment of anterograde memory (ability to learn new information), disturbance of time sense
• Personality changes, apathy, loss of initiative
• Confabulation in the early stage
• Can improve with prolonged abstinence

Question 4

What is Hepatic Encephalopathy

Answer 4

Advanced alcohol liver disease

Psychomotor retardation, drowsiness

Question 5

Hepatic Encephalopathy is related to a build up of what chemical

Answer 5

Ammonia

Question 6

What is Dementia

Answer 6

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

Question 7

What is the onset of Dementia

Answer 7

Progressive

Question 8

What is the onset for depressive pseudodementia

Answer 8

Rapid

Question 9

How does the mood vary in dementia

Answer 9

Mood variations

Question 10

How does the mood vary is depressive pseudodementia

Answer 10

Consistently depressed mood

Question 11

How is the cognitive function in dementia

Answer 11

Constant cognitive decline

Question 12

How is the cognitive function is depressive psedudodementia

Answer 12

Fluctuates

Question 13

• 55 year old female with a long-standing history of systemic lupus erythematosus (SLE).
• She is currently treated by the rheumatologists as an inpatient for an acute flare up of her symptoms and given high dose steroids.
• Staff have noticed a significant change in her mental state since. She has become restless, agitated and anxious and has been sleeping poorly at night.
• On one occasion, she has expressed some suicidal thoughts and she has also expressed a fear that staff are trying to harm her.
• On closer questioning, she admits to a belief that she is being monitored by hidden cameras and she also describes having heard a voice on several occasions making critical comments about her behaviour.
• She seems to be rather more talkative than usual and she has become quite irritable. There is a past history of depression

What is the most likely diagnosis

Answer 13

Steroid induced psychosis

Question 14

What are the symptoms of Anti-NMDA Receptor Encephalitis

Answer 14

Acute manic psychosis
• MRI- bilateral hippocampal hyperintensity
• EEG- Delta Brush
• Biochemistry- Positive NMDAr antibodies in blood and CSF

Question 15

What are the presenting features of delirium

Answer 15

Impairment of consciousness and attention
Global disturbance of cognition
Psychomotor disturbances
Disturbance of sleep-wake cycle
Emotional disturbance

Question 16

In delirium is there a predominance of visual or auditory hallucinations

Answer 16

Visual

Question 17

In functional psychosis is there a predominance of visual or auditory hallucinations

Answer 17

Auditory

Question 18

What is the treatment for severe delirium

Answer 18

Avoid sedation
Anti-psychotics (Risperidone, Quetiapine)
Lorazepam- withdrawal states