Organic disorders Flashcards by Sophie C

what do we mean by mental disorder?

are “due to common, demonstrable aetiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction”

ACQUIRED
distinction from functional mental illness

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Primary vs secondary mental disorders?

Primary – direct effect on the brain

Secondary – systemic diseases that affect the brain in addition to other systems/organs

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Some examples of disorders with an organic base

Schizophrenia, bipolar affective disorder, melancholia

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Cognitive features?

Memory
Intellect
Learning

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Sensorium features affected?

Consciousness

Attention

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affective changes examples

psychotic change examples

Depression
Elation
Anxiety

Hallucinations
Delusions

Personality & behavioural disturbance

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What is acute organic brain syndrome?

mental impairment, as a result of intoxication, drug overdose, infection, pain, and many other physical problems affecting mental status
- is often temporary

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Examples of acute brain syndrome

Delirium
Organic mood disorder
Organic psychotic disorder

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Examples of chronic brain syndrome

Dementia
Amnesic syndrome
Organic personality change

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What is chronic brain syndrome

long term
chronic drug and alcohol dependence
dementia from stroke eg Alzheimers

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Management depends on?

Correct diagnosis
Medication usually not that useful except for acute situations
Requires MDT approach
Management of environment important

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Features of delirium tremors

can complicate acute alcohol withdrawal
fluctuating confusion 
disorientation in time & place
memory impairment
psychotic phenomena, e.g. hallucinations, delusional thinking
Treatment with benzodiazepines

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Wernike’s Encephalopathy signs

Acute Confusional State
Ataxia
Opthalmoplegia
Nystagmus

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cause of Wernike’s Encephalopathy

acute insufficiency of Thiamine (vitamin B1)

- missing meals etc

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Acute phase of Wernike’s Encephalopathy can last?

2 weeks, 84% develop Korsakoff psychosis

15% mortality

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What can take longer to be treated in Wernike’s Encephalopathy?

nystagmus, neuropathy and ataxia may be prolonged or permanent

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Treatment of Wernike’s Encephalopathy?

High potency parenteral B1 replacement IV or IM - rambabronex
3-7 days
Oral thiamine

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All patients with symptoms of Wernike’s encephalopathy or at high risk should be treated with ?

parenteral thiamine, others undergoing detoxification or under investigation should be commenced on oral thiamine

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What should you avoid with Wernike’s encephalopathy

carbohydrate load

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what treatment for alcohol withdrawal

benzodiazepine

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Alcohol Amnesic Syndrome (Korsakoff’s psychosis) is characterised by

characterised by marked impairment of anterograde memory (ability to learn new information), disturbance of time sense

no clouding of consciousness, absence of defect in immediate recall or global impairment
variable degrees of cognitive impairment
Personality changes, apathy, loss of initiative
confabulation in the early stage
can improve with prolonged abstinence

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Hepatic encephalopathy features

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normally seen in advanced alcohol liver disease
general psychomotor retardation, drowsiness
fluctuating levels of confusion
related to build up of toxic products (e.g. ammonia)
improves if and as liver function recovers

How can alcohol brain damage occur?

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neurotoxic effects of alcohol, head injury, vitamin deficiencies, cerebrovascular disease, hypoxia, hypoglycaemia, seizures

when do women tend to present with alcohol brain damage ?

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40-50’s

50-80% heavy drinkers display?

cognitive impairment when sober | - Impairment in short-term memory, long-term recall, new skill acquisition, set-shifting ability

ARBD visuospatial ability decline is?

greater than language ability decline

what might you seen on imaging on a patient with ARBD?

cortical atrophy (mainly white matter loss) and ventricular enlargement

Adults with Incapacity (Scotland) Act 2000 -unable to make a decision if?

``` acting; or making decision; or communicating decisions; or understanding decisions; or retaining the memory of decisions ```

depressive illness that could be dementia?

pseudodementia

What is dementia?

progressive and chronic | - global cognitive impairment

Different types of dementia

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

Steroid induced psychosis features?

Mild-moderate psychiatric symptoms in 28% patients | - 6% = severe

Steroid induced psychosis - the dosage is related to?

incidence but not timing, duration or severity

Management of Steroid induced psychosis?

Taper the steroids - consider an antipsychotic or mood stabiliser for duration of treatment - olanzapine, Quetiapine

Endocrine and metabolic disorders , how may patients present?

GP/General medicine but some conditions (i.e. Hypothyroidism, Addison’s disease) may present first to psychiatry and there is risk of mistaken diagnosis

Neurological investigations for acute psychosis?

MRI EEG biochemistry tests

what is Anti-NMDA Receptor encephalitis?

Autoimmune disease that targets NMDA receptors

What is an NMDA receptor?

Ionotropic glutamate receptor involved in synaptic plasticity and memory function

Anti-NMDA Receptor encephalitis is often associated with what malignancy

50% - ovarian teratoma

Anti-NMDA Receptor encephalitis can present with

psychiatric symptoms

treatment of Anti-NMDA Receptor encephalitis

Immunotherapy and tumour resection if indicated IVIg, plasmapheresis, rituximab - benzodiazepines and antipsychotics symptomatically

what is delirium?

nonspecific syndrome characterised by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion, and the sleep-wake cycle

Presenting features of delirium?

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

Delirium presents with

rapidly often worse at night Diurnally fluctuating

Physical signs of delirium

Due to underlying cause Autonomic activation: tachycardia, hypertension, diaphoresis, dilated pupils, fever Dysgraphia often evident

Toxic and metabolic disturbances perhaps prone to ?

to listlessness and apathy

Infective processes and alcohol withdrawal to?

hyperactivity and hallucinations

Mechanisms of delirium - why does it happen?

- GABAergic and cholinergic neurotransmitter systems? Central cholinergic deficiency? Increased risk associated with GABAa agonists and anticholinergic drugs Increased dopaminergic activity? Direct neurotoxic effect of inflammatory cytokines?

Correct factors contributing to delirium: (11)

``` Disorientation Dehydration Constipation Hypoxia Immobility/limited mobility Infection Multiple medications Pain Poor nutrition Sensory impairment Sleep disturbance ``` -stop opiates and anticholinergic drugs

Management - environmental

Education of relatives, medical and nursing staff Make environment safe Optimise stimulation Orientation

Delirium - medications

Avoid sedation unless required to maintain safety Evidence base and guidelines do not support use of medications in delirium Antipsychotics Benzodiazepines Promethazine

Delirium antipsychotics?

Risperidone 0∙5 – 1mg Quetiapine 25-50mg If IM required – consider olanzapine/aripiprazole

Delirium - benzodiazepines

first choice - can prolong an episode - Lorazepam 0∙5 – 1mg Use in withdrawal states – diazepam/chlordiazepoxide; caution in liver failure

Avoid antipsychotics in alcohol/drug withdrawal states unless ?

patient well covered with benzodiazepines due to lowering of seizure threshold - give dopamine

Organic disorders Flashcards

(54 cards)