Está en la página 1de 46

Li Meixiu (Ellen)

JMS University
Chapter 3. organic--symptomatic ,mental disorder
Psychiatry disorder
• Organic cause
• Organic causation not be found
• Psychological factors
• First episode
• Sundden onset
• Older age of onset
• History of drug & / alcohol use disorder
• Concurrent medical / neurological illness
• Neurological symptoms / signs
• Confusion / disorientation / memory impairment /
soft neurological signs
• Visual / non–auditory hallucination
• Delirium
• Dementia
• Organic amnestic syndrome
• Other organic mental disorders

Delirium
• A disorder --;

• autonomic nervous system overactivity.

toxic/metabolic conditions or structural brain lesions.


Organophosphate poisoning
Clinical features
• Disturbance of consciousness
• Change in cognition (problem-solving or memory)
or a perceptual disturbance
• Onset of hours to days tendency to fluctuate.

• Intrusive abnormalities of awareness & affect, such


as hallucinations or inappropriate emotional states.
Diagnosis & differential diagnosis
• psychosis, in which consciousness & cognition may
not be impaired (acute psychosis with mania).
• dementia (chronic organic brain syndrome)
degenerative brain disease (AD / HD or).
• depression.
• Delirium ----'acute confusional state' or 'acute brain
syndrome
• Delirium confusion

Etiology
• Critical illness
• Substance withdrawal
• Gross structural brain disorders
• Neurological disorders
• Circulatory
• Lack of essential metabolic fuels, nutrients
• Toxication
• Mental illness perse is not a cause, as a matter of
definition
Treatment
• underlying dysfunction cause
• Palliative or symptomatic treatment
• Distressing - antipsychotics, haloperidol or
risperidone: minimal anticholinergic activity---
benzodiazepines
• non-pharmacological measures
• overcome natural skepticism
• Benzodiazepines : alcohol withdrawal.
• cholinesterase inhibitors
• progressive decline in cognitive function due to
damage or disease in the body
• Impairment of intellectual functions / memory
• Deterioration of personality with lack of personal care
• memory, attention, language & problem solving.
Diagnosis
• abbreviated mental test score (AMTS) 6
• mini mental state examination (MMSE) 24
• Modified Mini-Mental State Examination (3MS)
• Cognitive Abilities Screening Instrument (CASI)
• clock drawing test
• Mini-mental state examination MMSE
71% ~ 92% / 56% ~ 96%

Modified Mini-Mental State examination 3MS


83%~ 93.5% / 85% ~90%

• Abbreviated mental test score


73% ~ 100% / 71% ~ 100%
• Informant Questionnaire on Cognitive Decline i
Etiology
• Parenchymatous brain disease
AD, Pick’s disease , PD , Huntington's chorea , Steel-
Richardson-olszewski syndrome
• Vascular - multi-infarct dementia,Binswanger's disease
• Toxic :Bromide intoxication ,drugs ,heavey metals
alcohol ,CO ,analgesics ,anticonvulsants
Benzodiazepines, psychotropic drugs
Etiology
• Parenchymatous brain disease
Alzheimer's disease, Pick’s disease , Parkinson’s disease ,
Huntington's chorea , Steel-Richardson-olszewski syndrome

• Vascular --- multi-infarct dementia ,


Binswanger's disease
• Toxic :Bromide intoxication ,drugs ,heavey metals
alcohol ,carbon monoxide ,analgesics
,anticonvulsants
Benzodiazepines,psychotropic drugs
• Metabolic :chronic hepatic / uremic encephalopathy ,
dialysis dementia ,Wilson’s disease
• Endocrine : thyroid , parathyroid ,pituitary ,adrenal
dysfunction
Deficiency dementias : pernicious anemia , pellagra ,
folic acid deficiency , thiamine deficiency ,thiamine
deficiency
• Infections: creutzfeldt Jacob disease neurosyphilis
,chronic meningitis ,viral encephalitis , AIDS
dementia ,other HIV –related disorders. subacute
sclerosing panencephalitis

• Neoplastic :
• Traumatic :chronic subdural hematoma
• Hydrocephalic
Cortical dementias
• Alzheimer's disease
• Vascular dementia (multi-infarct dementia), Binswanger's disease
• Dementia with Lewy bodies (DLB)
• Alcohol-Induced Persisting Dementia
– Korsakoff's syndrome
– Wernicke's encephalopathy
• Frontotemporal lobar degenerations (FTLD), including Pick's disease
– Frontotemporal dementia (or frontal variant FTLD)
– Semantic dementia (or temporal variant FTLD)
– Progressive non-fluent aphasia
• Creutzfeldt-Jakob disease
• Dementia pugilistica
• Moyamoya disease
• Thebestia (Often mistaken for a cancer)
• Posterior cortical atrophy or Benson's syndrome.
Subcortical dementias
Rather, people with subcortical dementias, such as Huntington's disease,
Parkinson's Disease, and AIDS dementia complex, tend to show
changes in their personality and attention span, and their thinking
slows down.
• Dementia due to Huntington's disease
• Dementia due to Hypothyroidism
• Dementia due to Parkinson's disease
• Dementia due to Vitamin B1 deficiency
• Dementia due to Vitamin B12 deficiency
• Dementia due to Folate deficiency
• Dementia due to Syphilis
• Dementia due to Subdural hematoma
• Dementia due to Hypercalcaemia
• Dementia due to Hypoglycemia
• AIDS dementia complex
• Pseudodementia (a major depressive episode with prominent cognitive symptoms)
Substance-induced persisting dementia
Management
• Basic investigation
• Treatment of the underlying causes
• Symptomatic management
• Medications : AChE inhibitors Tacrine (Cognex),
donepezil (Aricept), galantamine (Razadyne), and
rivastigmine (Exelon )
Contraindicated
Antipsychotic drugs
• typical antipsychotics (such as Haloperidol) &
atypical antipsychotics (risperidone) increases the
risk of death in dementia-associated psychosis
organic amnestic syndrome
• Impairment of memory
• consciousness & attention
• Intellectural function
inability to learn new material
Diagnosis & differential diagnosis
Etiology
• Thiamin deficiency
• Lesion involving bilaterally the inner core of limbic
system: hypoxia, post. Cerebral a. stroke
• Herpes simplex encephalitis
• Space occupying lesions in the region of Ⅲ ventricle
Organic hallucinosis
• Persistent / recurrent hallucination
• Consciousness ,intelligence ,memory ,mood /
thought
Etiology
• Drugs :hallucinogens-LSD , psilocybin ,cocaine
• Alcohol : auditory hallucination
• Sensory deprivation
• Release hallucination : sensory pathway optic neuritis
• Migraine
• Epilepsy
• Intracranial spae occupying lesions
• Temporal arteritis
• Brain stem lesions (peduncular hallucinosis )
Organic catatonic disorder
• A neuropsychiatric disorder : immobility, mutism,
negativism , mannerisms, stereotypies, posturing,
grimacing, excitement, echolalia, echopraxia,
muscular rigidity, stupor; sudden violent outbursts,
panic, or hallucinations.

• This condition may be associated with psychiatric


illnesses (schizophrenia ,mood disorders ) or organic
disorders (neuroleptic malignant syndrome , encephalitis ).
Organic delusional disorder ODD
• misdiagnosed as delusional disorder (DD)
• Predominant delusions –persistent / recurrent
• Consciousness ,orientation ,memory / mood
• Persecutory :Querulant delusions
• Hallucinations: visual > auditory
• SFRS
Schneiderian First-Rank Symptoms
/ first-rank symptoms
• Audible thoughts
• Voices heard arguing
• Voices heard commenting on one's actions
• Experience of influences playing on the body
• Thought withdrawal
• Thought insertion -
• Thought diffusion (also called thought broadcast)
• Delusional perception
Organic mood (affective)disorder
• Depressions & manic episodes that occur
secondary to organic illnesses, including
neurologic disorders & systemic medical illnesses
& as adverse effects of drugs commonly used in the
treatment of medical conditions.
Organic anxiety disorder
• Generalized anxiety / panic attacks
• Systemic diseases : cardiac arrhythmias ,mitral
valve prolapse syndrome , chronic obstructive
pulmonary disease ,coronary a. disease, pumonary
embolism , anemia ,fever
Organic personality disorder
• Significant alteration of the premorbid personality
• Poor impulse control ,emotional lability , apathy ,
accentuation of earlier personality traits / hostility
Miscellaneous organic mental disorder
• Organic dissociative disorder ,
• organic emotionally labile (asthenic )disorder &
mild cognitive disorder
Chapter 4. Psychoactive substance use disorder
Psychoactive substance use disorder

• Psychoactive drug is capable of altering the mental


functioning
• Acute intoxication
• Withdrawal state
• Dependence syndrome
• Harmful use
Acute intoxication
• resulting in disturbances in level of consciousness
,cognition ,perception ,affect or behavior or other
psychophysiological funcitons & responses the state
of being affected by one or more psychoactive drugs
.
• Drunkenness
Acute intoxication -complications
• Uncomplicated
• trauma / other bodily injury
• other medical complications
• delirium
• perceptual distortions
• Coma
• Convulsions
• Pathological intoxication
Withdrawal state
• Uncomplicated
• Convulsions
• Delirium
Dependence syndrome
• Strong desire / sense of compulsion
• Difficulties in controlling the substance- taking behavior
• Physiological withdrawal state
• Evidence of tolerance
• Progressive neglect of alternative pleasure / interests
• Persisting with substance use despite clear evidence
of overtly harmful consequent
• Narrowing of personal repertoir of pattern
Dependence syndrome -Currently
• abstinent
• abstinent in protected
• on a clinically supervised
• abstinent with treatment
• Using the active dependence
• Continous use
• Episodic use-- dipsomania
Harmful use
• Continued drug use
• Physically hazardous use
Psychoactive substances
• Alcohol
• Opioids: opium heroin
• Cannabinoids : cannabis
• Cocaine
• Amphetamine & other sympathomimetics
• Hallucinogens :
• Sedatives & hypnotics
• Inhalants : volatile solvents
• Nocotine
• Other stimulants
Alcohol use disorders-alcoholism

• α
• β
• γ malignant
• δ controlled
• ε dipsomania / spree-drinking(episodic heavy
consumption in uncontrolled binges )
complications
• Acute intoxication
• Withdrawal syndrome
• Delirium tremens
• Alcoholic seizures
• Alcoholic hallucinosis
Self -discipline