delirium,dementia, amnestic & other cognitive and mental kbk
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delirium demensiaTRANSCRIPT
DELIRIUM,DEMENTIA, AMNESTIC & OTHER COGNITIVE AND MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION
Elmeida EffendyPsychiatric Department
Medical Faculty- USU
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In the past these conditions were classified under the heading ‘organic mental’ or ‘organic brain disorders’.
Traditionally those disorders had an identifiable pathological condition such as brain tumor, cerebrovascular disease or drug intoxication
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Brain disorders with no generally accepted basis (such as depression) were called functional disorders
This century-old distinction between organic & functional disorders is outdated & has been deleted from the nomenclature. The only unbiased conclusion to be made from evaluation of the available data is that every psychiatric disorder has an organic ( biological or chemical) component
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Because of this reassessment of the data, the concept of functional disorders has been determined to be misleading, & the term functional & organic are not used in that context in DSM-IV-TR
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DELIRIUM
4 sub categories based upon several causes : 1. general medical condition, e.g : infection 2.substance induced,
e.g :cocaine,opioid,phencyclidine 3. multiple causes,e.g. head trauma & kidney
disease 4.delirium not otherwised specified, e.g. : sleep
deprivation
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DELIRIUM’S OTHER NAME
Acute confusional state Acute brain syndrome Metabolic encephalopathy Toxic psychosis Acute Brain Failure
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In DSM-IV-TR delirium is characterized by a disturbance of consciousness & a change in cognition that developed over a short time
Delirium has a sudden onset, a brief & fluctuating course, & rapid improvement when the causative factor is identified & eliminated, but each of these characteristic features can vary in individual patients
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CLINICAL FEATURES OF DELIRIUM
Disturbance of consciousnness Change in cognition
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DEMENTIA
Multiple cognitive defects that include impairment in memory, without impairment in consciousness.
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The cognitive functions include : General intelligence Learning and memory Language Problem solving Orientation Perception Attention & concentration Judgement & social abilities
Personality is also affected10
ETIOLOGY
Dementia of the Alzheimer’s Type
Vascular dementia
Drug & toxins
Trauma : head injuries
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Neurodegenerative disorders : Parkinson’s disease,Huntington disease, Pick disease, etc
Infection: Creutzfeldt_Jakob disease, AIDS
Nutritional disorders : Wernicke-Korsakoff syndrome, B 12 deficiency, folate deficiency
Metabolic disorders : Cushing syndrome, dyalisis dementia ,hepatic insufficiency
Chronic inflammatory disorders : Lupus, multiple sclerosis 12
Dementia of the Alzheimer’s type Memory impairment At least 1 other symptom of cognitive decline
(aphasia,apraxia,agnosia, abnormal executive functioning
Gradual decline in functioning, impairment in social or occupational functioning
Onset : early:( 65 or younger), late : (>65)
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Miscroscopic findings : senile plaques, neurofibrillary tangles, neuronal loss,synaptic loss, & granulovascular degeneration of the neuron
Neurofibrillary tangles (NT) are composed of cytoskletal elements, primarily phosphorylated tau protein, although other cytoskletal proteins are also present
NT is also occur in Down syndrome, dementia pugilistica, Parkinson, brains of normal people as they age
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Chromosom 1,14 & 21 Gene E 4 in the origin of AD;
people with 1 copy of the gene E4 have AD 3 X more frequently than no E4
People with 2 E4 : have AD 8 X more frequently than no E4
E4 is found in persons without dementia & not found in all cases of dementia
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AMNESTIC DISORDERS
Acquired impaired ability to learn & recall new information or inability to recall previously learn knowledge or past events
Amnestic disorders are secondary syndrome caused by systemic medical or primary cerebral disease, substance use disorders or medication adverse effects.
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MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION
Mood disorders due to a general medical condition
Psychotic disorders due to a general medical condition
Anxiety disorders due to a general medical condition
Sleep disorders due to a general medical condition
Sexual dysfunction due to a general medical condition
Mental disorders due to a general medical condition not elsewhere classified
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