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ORGANIC MENTAL DISORDERS

ORGANIC MENTAL DISORDERS. Maria L.A. Tiamson, MD Asst. Professor, Psychiatry New York Medical College. DSM-IV. Delirium Dementia Amnestic Disorders Subcategories: caused by general medical condition, substance use or NOS Common Primary Symptom: cognitive impairment. DELIRIUM.

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ORGANIC MENTAL DISORDERS

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  1. ORGANIC MENTAL DISORDERS Maria L.A. Tiamson, MD Asst. Professor, Psychiatry New York Medical College

  2. DSM-IV • Delirium • Dementia • Amnestic Disorders • Subcategories: • caused by general medical condition, substance use or NOS • Common Primary Symptom: cognitive impairment

  3. DELIRIUM • CORE SYMPTOM: impairment of consciousness, ie. reduced ability to focus, sustain or shift attention • acute onset and fluctuates • direct physiologic consequences of a general medical condition • a MEDICAL EMERGENCY !!!

  4. Epidemiology of Delirium • 15-18% of med-surg • 30% of post-CABG • 50% of post-hip surgery • frequently misdiagnosed

  5. Risk Factors of Delirium • extremes of age (old & young) • burns (3rd degree) • post-cardiotomy patients • drug dependence • HIV/AIDS • pre-existing brain damage • history of delirium

  6. URGENT Diagnosis • Withdrawal/Wernicke’s • Hypertensive encephalopathy • Hypoglycemia • Hypoperfusion of CNS • Hypoxemia • Intracranial bleed • Meningitis/encephalitis • Poisons/Medications

  7. Clinical Features of Delirium • Prodrome • Temporal course • Attentional deficits and arousal • Orientation • Language and cognition • Perception • Mood • Other symptoms

  8. Clinical Course of Delirium • Diagnosis: rating scales, bedside exam, labs and other diagnostic tests, review of medications (including OTC drugs and illicit drugs • Course • Prognosis

  9. Pathophysiology of Delirium • Areas of the brain affected: • prefrontal cortex, right cerebral hemisphere, subcortical nuclei • Neurotansmitters affected: • acetylcholine • dopamine • GABA • histamine

  10. Treatment of Delirium • Etiological: VERY IMPORTANT • Symptomatic: • neuroleptics • benzodiazepines

  11. DEMENTIA • Syndrome of acquired persistent impairment in intellectual function: memory, language, visuospatial skills, emotion or personality, and cognition • Effect of pathological processes on the brain, NOT THE EFFECT OF AGING

  12. Epidemiology of Dementia • 4 million severe dementia • 1-5 million mild to moderate • 50-60% Alzheimer’s dementia • 15-30% Vascular dementia • 1-5% Other causes • 15% are reversible

  13. Classification of Dementia • CORTICAL: Alzheimer’s • SUBCORTICAL: HAD, Parkinson’s, Huntington’s • MIXED: Vascular • Pseudodementia

  14. Risk Factors for Dementia • ALZHEIMER’S: • female, hx of 1st degree relative with AD, hx of Down’s, hx of head trauma • MULTI-INFARCT DEMENTIA (Vascular): • male, HTN, 60-70 y/o • H.A.D.: • wasting syndrome, older age at dx, substance abuse hx

  15. Clinical Features of Dementia • Memory • Orientation • Language changes • Personality changes • Perceptual changes • Other symptoms

  16. Cortical Dementias • Amnesia • Apraxia • Aphasia • Agnosia • diffuse atrophy with flattened sulci anf enlarged ventricles • senile amyloid plaques, neurofibrillary tangles

  17. Vascular Dementias • Stepwise deterioration of functioning • affects small and medium sized cerebral vessels • multiple parenchymal lesions spread over wide areas of the brain

  18. Subcortical Dementia • Apathy, depression, psychomotor retardation • affects frontal lobe, basal ganglia, thalamus • disruption of fundamental cerebral functions: arousal, attention, motivation and rate of information processing

  19. Pseudodementia • Dementia syndrome of depression • “don’t know” answers typical • attention and concentration well preserved • indifference to cognitive impairment

  20. Treatment of Dementia • Etiologic: • cholinesterase inhibitors: tacrine, donepezil, revastigmine, metrifonate • HAART • Treatment of co-morbid conditions: • depression, agitation, psychosis • Adjunctive treatments: • vit.E, hydergine, selegeline, ginkgo biloba

  21. Treatment of Dementia • Supportive treatment • creating a safe environment • Psychotherapy • Legal issues

  22. Amnestic Disorders • Single symptom of a memory disturbance that causes significant impairment in functioning • anterograde amnesia • retrograde amnesia

  23. Major Causes of Amnesia • Systemic medical conditions • Primary brain conditions • Substance related causes • Affects dorsomedial and midline thalamic nuclei, hippocampus, mammilary bodies, amygdala

  24. Treatment of Amnesia • Etiological • Psychotherapy

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