ORGANIC MENTAL DISORDERS

Psychiatry departmentBeni Suef University

ORGANIC MENTAL DISORDERS

Definition Organic Mental Disorders are a group of

disorders caused by "demonstrable" organic pathological conditions affecting the brain.

These conditions may affect the brain directly (e.g., trauma, infection, tumor or degeneration) or they may be secondary to systemic diseases (e.g., metabolic, endocrine or toxic conditions).

THERE ARE TWO MAJOR CATEGORIES OF O.M.D.:

A. Cognitive disorders: 1 - Delirium 2- Dementia 3- Amnestic disorders B. Mental disorders secondary to general

medical conditions: 1-Organic hallucinosis, 2-Organic mood disorders, 3-Organic anxiety disorder, 4-Organic delusional disorder, 5-Organic personality and behavioral disorders,

ETIOLOGY OF ORGANIC MENTAL DISORDERS

A wide range of organic pathological conditions can produce Organic Mental Disorders, including:

1- Head trauma 2-Brain infections, tumors, cerebrovascular

or degenerative diseases 3- Endocrine disorders 4- Metabolic disorders 5- Nutritional deficiencies 6- Toxins 7- Substance-related disorders

DELIRIUM

Definition Delirium is an acute reversible state of

global cortical dysfunction characterized by disturbance of consciousness.

It is associated with global impairment of cognitive functions as well as other mood and behavioral changes.

CLINICAL FEATURES OF DELIRIUM

1. Disturbance of consciousness 2. Global disturbance of cognitive

functions including: a. Attention b. Memory c. Perception d. Orientation 3. Other manifestations: a. Emotional disturbances b. Psychomotor behavior c. Sleep-wake cycle

ONSET, COURSE AND PROGNOSIS OF DELIRIUM

Onset is acute or rapid (over hours or days).

Course shows typical diurnal fluctuations of symptoms with nocturnal worsening.

Prognosis: It is a transient condition that resolves within days to few weeks if the cause is treated.

EPIDEMIOLOGY OF DELIRIUM

10% of hospitalized surgical or medical patients

30% of ICU patients Elderly and young children more

susceptible Equal prevalence in males and females

ETIOLOGY

1. Head trauma 2. Metabolic and endocrine disorders 3. Substance related 4. Medication induced 5. Toxins 6.Severe anemia and vitamin deficiency 7. Postsurgical conditions 8. Infections 9. Cerebrovascular strokes 10. Epilepsy 11.Multifactorial

MANAGEMENT OF DELIRIUM

1- Treatment of the cause 2- Supportive measures 3- Providing optimum sensory

environment 4- Symptomatic treatment for

anxiety, agitation or psychotic symptoms

DEMENTIA

Definition A syndrome characterized by

multiple cognitive defects including disturbance of memory, without disturbance of consciousness.

The syndrome results from organic diseases of the brain that are usually of a chronic and progressive nature.

CLINICAL FEATURES OF DEMENTIA

1. Multiple cognitive defects: a. Memory impairment: b. Other cognitive disturbances: Aphasia, Apraxia, Agnosia Disturbance of executive functions Disturbed attention, perception and orientation 2. Associated deterioration of other functions: a. Impaired emotional control b. Depression and anxiety c. Impairment of judgment d. Psychotic symptoms 3. Associated neurological manifestations: a. Usually late b. Various sensory and motor manifestations c. incontinence and bedridden.

ONSET, COURSE AND PROGNOSISOF DEMENTIA

Onset is usually insidious, over months or years.

Course is usually chronic and progressive (over years) ending in death.

Prognosis: irreversible. Some types may be reversible (15%), if the cause is treatable (e.g., endocrine or metabolic causes).

EPIDEMIOLOGYOF DEMENTIA

5% of elderly over 65 years 20% of elderly over 80 years 15% are reversible if the cause is treatable

ETIOLOGY OF DEMENTIA 1. Degenerative diseases: a. Alzheimer's disease b. Pick's disease c. Parkinson's disease d. Wilson's disease 2. Hereditary Dementia, e.g., Huntington's

disease 3. Demyelinating disease, e.g., multiple sclerosis 4. Cerebrovascular disease 5. Chronic Infections 6. Trauma to brain 7. Tumor 8. Metabolic disorders, 9. Drugs & toxins (chronic exposure)

MANAGEMENT OF DEMENTIA

Treatment of the cause in reversible types

treatment for irreversible types. Some medications (anticholine-esterase inhibitors) may help delay memory and cognitive decline.

Supportive measures Symptomatic treatment for agitation,

insomnia, psychotic symptoms and disruptive behavior

COMMON TYPES OF DEMENTIA

Alzheimer disease (50-60% of all dementias)

Vascular dementia(15-30% of all dementias)

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ALZHEIMER DISEASE

Onset, Course & Prognosis: Onset: may be late (after age 65)

or early (before 65). Gradual onset, progressive course

and death within 2- 8 years from onset Clinical Features: gradual memory impairment

followed by deterioration of other cognitive aspects.

Same symptoms of dementia.

PATHOLOGY OF ALZHEIMER DISEASE

Degenerative changes, predominantly in parietal and temporal lobes (diffuse cortical atrophy, amyloid plaques and neurofibrillary tangles)

Decreased acetylcholine metabolism and degeneration of cholinergic neurons

AETIOLOGY OF ALZHEIMER DISEASE

Genetic factors play a major role:

• Familial in 40% of cases Significantly more in

monozygotic than dizygotic twins

• Related to Down syndrome

VASCULAR DEMENTIA

• More common in males• Onset earlier than Alzheimer's

disease• Course:* Onset may be acute.*Course usually "stepwise" as it reflects recurrent infarcts.

VASCULAR DEMENTIA

Clinical Features: * Focal neurological manifestations * Patchy cognitive impairment * Pathology: Cerebral infarction and multiple areas

of neuronal loss

VASCULAR DEMENTIA

Etiology: Risk factors include:* Cardiovascular disease (hypertension,

heart disease)* Cerebrovascular disease

(atherosclerosis, embolic or thrombotic occlusion, hemorrhage)

Management :same like dementia

AMNESTIC DISORDERS

They are isolated disturbances of memory

They involve recent memory and remote memory which lead to inability to learn new information or recall previously learned information.

Immediate recall remains intact.

ETIOLOGY OF AMNESTIC DISORDERS

They are due to pathological conditions causing damage of certain diencephalic (thalamic) and midtemporal structures, (e.g., hippocampus, mamillary bodies and fornix).

COMMON CAUSES OF AMNESTIC DISORDERS

1. Korsakoff's syndrome 2. Head trauma 3. Cerebrovascular disease 4. Brain tumor 5. Brain surgery 6. Systemic conditions: e.g., hypoxia

(CO poisoning) and hypoglycemia 7. Substance related

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