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This century-old distinction between organic & functional disorders is outdated & has been deleted from the nomenclature.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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