Li Meixiu (ellen): Jms University

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 , SteelRichardson-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 • • • •

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• • • • •

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