Organic Psychiatric Disorders

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Organic Psychiatric Disorders
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• Delirium.
• Dementia.
• Other organic psychiatric syndromes.
• Neurological syndromes.
• Epilepsy.

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What is organic psychiatric disorders?

• Psychiatric disorders resulting from brain
  dysfunction caused by organic pathology inside or
  outside the brain.

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Classification of organic mental states

• Global syndromes
• ? Delirium.
• ? Dementia.
• Specific syndromes
• ? Amnesic syndrome.
• ? Organic mood
  disorder.
• ? Organic
  delusional disorder.
• ? Organic
  personality disorder.

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Delirium

• Acute generalized impairment of brain function.
• The most important features is impairment of
  consciousness.
• The primary cause is often outside the brain (eg
  anoxia due to respiratory failure).

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Delirium

• It is a common accompaniment of physical illness
  occurring in
• ? 5-15 of pts in general medical
  surgical wards.
• ? 20-30 of pts in surgical
  intensive care units.
• It is especially common in the elderly.
• Most pts recover quickly a few need specific
  treatment.
• Terms such as confusional state acute organic
  syndrome are outdated .

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Clinical Features

• Perception
• misperceptions
• illusions
• hallucinations
• Memory
• impaired
• Insight
• impaired
• Fluctuating course ,worse in the evening
• Amnesia (on recovery)

• Impaired consciousness
• disorientation
• poor concentration
• Behavior
• overactive
• underactive
• Thinking
• muddled (confused)
• ideas of reference
• delusions
• Mood
• anxious , irrtable
• depressed
• perplexed

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Aetiology

• Drug intoxication.
• Alcohol withdrawal.
• Metabolic failure..
• Cardiac
• Respiratory
• Renal
• Hepatic
• Hypoglycaemia
• Fever..
• systemic infection
• Neurological causes..
• encephalitis.
• space-occupying lesions.
• raised intracranial
  pressure .
• following an epileptic
  seizure.

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Management
Obtain information from other informants
medical notes
Assess the pts mental state
Confirm the diagnosis of delirium
Determine the physical cause treat it
Reduce disorientation Reorientate
repeatedly Consistent routine
Reduce anxiety Reassurance Medications
Avoid over- or understimulation
Inform support relatives
If calm Moniter progress
If agitated ,disturbed ,or distressed Consider
hyponotic at night Cosider regular
medications Moniter progress review medications
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Dementia

• Chronic generalized impairment of brain function.
• Characterized by impairment of intellect ,memory
  personality without impairment of
  consciousness.
• The primary cause is within the brain .
• Most cases are irreversible (few can be treated)

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Clinical Features

• Cognition..
• poor memory
• impaired attention
• aphasia, agnosia, apraxia
• disorientation
• Behavior..
• odd disorganized
• restless wandering
• self-neglect
• disinhibition
• Mood
• anxiety
• depression
• Thinking
• slow ,impoverished
• delusions

• Perception ..
• illusions
• hallucinations
• insight..
• impaired

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Aetiology

• Degenerative neurological disorders..
• Alzheimers disease
• Vascular dementia
• lewy body dementia
• Frontotemporal dementia
• Huntingtons chorea
• prion disease
• parkinsons disease
• Normal pressure hydrocephalus
• Intracranial tumor
• Other space occupying lesions..
• chronic subdural
  haematoma
• Traumatic ..
• severe head injury

• Infections..
• postencephalitis ,HIV
• Vascular..
• multi-infarct
  dementia
• Toxic
• alcohol

• Anoxia..
• cardiac arrest
• carbon monoxide poisoning
• Vitamin lack
• vitamin B12
• folic acid
• thiamine
• Metabolic
• DM
• Endocrine
• hypothyroidism

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Management

• Detailed history (informant).
• Mini mental state examination.
• Investigations
• ?CTdiagnosis of both focal diffuse
  cerebral pathology.
• ? psychological testing.
• ? specific tests of memory ,learning
  other aspects of cognitive functionlocalized
  brain lesions.
• Wechsler Adult Intelligence Scale (WAIS) provide
• a profile of verbal non-verbal ablities.

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Aspects of differential diagnosis

• Organic or functional ??
• Organic.
• ? The cognitive disorder preceded the mood or
  other disorder.
• ? cognitive defects occur in specific areas of
  intellctual function
• ? neurological signs.
• ? The presence of symptoms seldom found in
  non-organic disorder ,such as visual
  hallucinations.
• Functional
• ? by exclusion of organic causes
• ? by finding positive evidence of psychological
  aetiology.

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Cont..

• Pseudodementia
• in this syndrome ,a depressed pt
  complains of poor memory appears intellectually
  impaired because poor concentration leads to
  inadequate registration deprssive mood leads to
  slowness self neglect.
• Characteristic features.
• ?a history from another informant that
  the depressed mood preceded the memory problems .
• ? memory testing shows that the poor
  performance improves when interest is aroused.
• ? the pt is retarded unwilling to
  cooperate in the interview.

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Cont..

• Delirium or Dementia??
• Delirium
  Dementia
• Acute onset
  Insidious onset
• fluctuating course
  stable or progressive
• impaired consciousness
  normal consciousness
• Thinking disorganized
  thinking impoverished
• Perceptual disturbance
  perceptual disturbance
• common
  uncommon
• Alertness usually
  normally alert
• Impaired

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Cont

• Stupor
• a rare condition in which the pt is
  immobile unresponsive but has a normal level of
  consciousness.
• It can occur in severe affective disorder
  schizophrenia.
• Lesions of brainstem or mesencephalon can cause a
  similar picture ,although in these cases there
  may be some impairment of consciousness.

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Treatment

• Aims of treatment.
• ? maintain any remaining ability
  as far as possible
• ? relieve distressing symptoms.
  ?arrange for the practical requirements of the
  pt.
• ? support the family

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Thank you
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OTHER PSYCHIATRIC NEUROLOGICAL SYNDROMES
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Organic psychiatric syndrome
Neurological syndrome
Normal pressure hydrocephalus
Cerebral tumor
Head injury
Amnesic syndrome
Transiet global amnesia
Organic delusional disorder
Cerebrovascular disease
Organic personality disorder
Organic mood disorder
epilepsy
Multiple sclerosis
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Amnesic syndrome

• Korsakovs
• syndrome

-Prominent disorder of recent memory.. -No
intellectual impairment or impaired consciousness
Wernickes encephalopathy
.Impairment of consciousness, memory defect,
disorientation, ataxia ophthalmoplegia.
Wernicke- Korsakov syndrome
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Aetiology

• Lesion in the posterior hypothalamus
• Bilateral hyppocampal lesions.

Causes

• Alcohol abuse

thiamine deficiency.

• CO2 poisoning, vascular lesion, encephalitis,
  tumor in the third ventricle.

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Clinical features

• Recent memory severely impaired.
• Remote memory spared.
• Disorientation in time.
• Confabulation gtgtgt

detailed account of recent activities turn out to
be inaccurate.
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Treatment

• If thiamine deficiency gtgtgt vitamin supplement.

prognosis

• Chronic
• Better if due to thiamine deficiency

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Organic psychiatric syndrome
Neurological syndrome
Normal pressure hydrocephalus
epilepsy
Head injury
Amnesic syndrome
Multiple sclerosis
Organic delusional disorder
Cerebrovascular disease
Organic personality disorder
Organic mood disorder
Transiet global amnesia
Cerebral tumor
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Organic personality disorder

• Frontal lobe damage..

Clinical features

• Behaviour
• - disinhibited, overfamiliar, tactless
• Pts overtalkative, make inappropriate jokes,
  disregard feeling of others.
• Mood euophoric.
• Concentration, attention insight impaired.

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Organic psychiatric syndrome
Neurological syndrome
Normal pressure hydrocephalus
epilepsy
Head injury
Amnesic syndrome
Multiple sclerosis
Organic delusional disorder
Cerebrovascular disease
Organic personality disorder
Organic mood disorder
Transiet global amnesia
Cerebral tumor
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Organic mood disorder

• Neurological disease
• ( multiple sclerosis)

Endocrine Disorder (Cushings disease)
Depression, mania or anxiety
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Organic psychiatric syndrome
Neurological syndrome
Normal pressure hydrocephalus
epilepsy
Head injury
Amnesic syndrome
Multiple sclerosis
Organic delusional disorder
Cerebrovascular disease
Organic personality disorder
Organic mood disorder
Transiet global amnesia
Cerebral tumor
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Normal pressure hydrocephalus

• Obstruction in the subarachnoid space.

Clinical features
Progressive memory impairment, slowness,
unsteadiness of gait urinary incontinence.
Treatment
shunt operation to improve the circulation of
CSF.
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Organic psychiatric syndrome
Neurological syndrome
Normal pressure hydrocephalus
epilepsy
Head injury
Amnesic syndrome
Multiple sclerosis
Organic delusional disorder
Cerebrovascular disease
Organic personality disorder
Organic mood disorder
Transiet global amnesia
Cerebral tumor
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Head injury

• Acute psychological effects include
• Impairment of cosciousness
• Delirium
• Post- traumatic amnesia of more than 24 h..
  Followed by persistent cognitive impairment.
• Personality change
• - severe damage to frontal lobe
• - irritability, loss of spontaneity and
  drive reduced control of aggressive impulses
• Emotional symptoms
• - anxiety depression with headache, poor
  concentration insomnia.

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assessment

• Neurological signs and physical disability.
• Any neuropsychiatric problems and their future
  course.
• Social circumstances, social support the
  possibility of return to work

management

• Physiotherapy
• Try to minimize disability
• Deal with specific cognitive deficits

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Organic psychiatric syndrome
Neurological syndrome
Normal pressure hydrocephalus
epilepsy
Head injury
Amnesic syndrome
Multiple sclerosis
Organic delusional disorder
Cerebrovascular disease
Organic personality disorder
Organic mood disorder
Transiet global amnesia
Cerebral tumor
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Cerbrovascular disease

• Cognetive defects Dementia, dysphasia
  dyspraxia
• Personality change irritability, apathy or
  lability of mood failure to cope with everyday
  problem..(catastrophic reaction)
• Depressed mood psychological reaction to
  handicap or direct consequence of any localized
  brain damage

Treatment
antidepressent
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Organic psychiatric syndrome
Neurological syndrome
Normal pressure hydrocephalus
epilepsy
Head injury
Amnesic syndrome
Multiple sclerosis
Organic delusional disorder
Cerebrovascular disease
Organic personality disorder
Organic mood disorder
Transiet global amnesia
Cerebral tumor
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Cerebral tumor

• Fast growing tumorgtgt delerium
• Slow growing tumorgtgt dementia

Multiple sclerosis

• Depression or elation.
• dementia

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Organic psychiatric syndrome
Neurological syndrome
Normal pressure hydrocephalus
epilepsy
Head injury
Amnesic syndrome
Multiple sclerosis
Organic delusional disorder
Cerebrovascular disease
Organic personality disorder
Organic mood disorder
Transiet global amnesia
Cerebral tumor
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Transiet global amnesia

• Unknown cause
• Middle or late life
• Occasional
• Abrupt episodes of unusual behaviour and global
  loss of recent memory for several hours
• Pt alert responsive
• Unable to understand his experience
• Complete recovery except for amnesia of the
  episode
• No specific treatment

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Organic psychiatric syndrome
Neurological syndrome
Normal pressure hydrocephalus
epilepsy
Head injury
Amnesic syndrome
Multiple sclerosis
Organic delusional disorder
Cerebrovascular disease
Organic personality disorder
Organic mood disorder
Transiet global amnesia
Cerebral tumor
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epilepsy

• Association between epilepsy and psychological
  problems of epileptic individual
• Effect of stigma social restriction
• Psychiatric disorder due to the cause of epilepsy
  
• If due to brain damagegtgt intellectual
  impairment personality problems
• behavioural disturbance
• - Before tension, irrritability, depression.
• - During comlex partial seizure.
• - After automatism.
• Disorders between seizure
• - cognitive impairment
• - personality disorder
• - sexual disfunction
• - increased self harm suicide.

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