Psychiatry -Delirium, Dementia and Amnestic Disorders (Dr.sundiang)

7/24/2019 Psychiatry -Delirium, Dementia and Amnestic Disorders (Dr.sundiang)

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Delirium, Dementia andAmnestic Disorders

Second Year Psychiatry


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CognitionThe mental process of knowing.

Includes awareness, perception,reasoning, judgment, memory,language, orientation, conducting

personal relationships,performing actions and problemsoling.


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Cognitie !isorders!isruptions in the acts andprocesses inoled in cognition.

"sually associated withbehaioral symptoms.


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#istorical $ackground"sed to be classi%ed under&organic mental disorder'.

"nder !S()I*)T+, classi%edunder

!elirium, !ementia andmnestic

and other Cognitie !isorders


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#istorical $ackgroundIn !S()*, under -eurocognitie

!isorders

!elirium retained

!ementia replace with major and

minor neurocognitie disordermphasis on decline in functioningrather than memory disturbance


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reas of Primary

!isturbance!elirium / leel of consciousnesswith associated impairments in

memory, judgment, orientationand attention


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reas of Primary

!isturbance!ementia / impairment inmemory, language and intellect

mnestic !isorder / impairmentin memory in the absence ofclouded consciousness andde%cits in other areas ofcognition


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!eliriumcute onset of disturbance inleel of consciousness and

0uctuating cognitieimpairments.

+e0ects response to widespreadaltered cerebral functions.


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!S()I*)T+ Classi%cation of !elirium!elirium due to a general medicalcondition 1indicate the condition2

Substance into3ication delirium

Substance withdrawal delirium

!elirium due to multipleetiologies 1indicate the etiologies2

!elirium not otherwise speci%ed


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pidemiology !elirium#igher prealence and incidencein

lderly

(ultiple medical problems

#ospitali4ed patients especially

critically ill patients

Terminally ill patients


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Clinical 5eatures of

!eliriumPrimary feature )diminished clarity of

awareness of the enironment

1disturbance of consciousness26anguage and other cognitie changes

Perceptual disturbances

!isturbance in sleep and wakefulness!isturbance in orientation

!isturbance in arousal leel


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!elirium!eelops oer a short period oftime 1hours or days2

Tends to 0uctuate oer the courseof a day

5rom history, P or laboratorythere is7are identi%ed condition7sor substance7s as a likely etiology


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Causes of !eliriumInfections

(etabolic and endocrine abnormalities

Intracranial states#ypoperfusion states

Substance into3ication7withdrawal

Postoperatie states

Sensory and enironmental changes


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aluation of !elirium


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(anagement of !elirium5ind cause7s

Correct or eliminate cause7s

Supportie therapy,enironmental control

Pharmacologic agents


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Course and Prognosis !eliriumfter cause7s remoed symptomsusually recede oer 8 to 9 days.

Seldom persist beyond : weeks ifcausatie factors are reersibleand remoed.

;lder patients and longer durationof delirium longer time to resole


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!ementia progressie impairment ofmultiple cognitie functions

occurring in an indiidual withclear consciousness


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!S()I*)T+ Classi%cation of

!emential4heimer=s Type

*ascular !ementia

!ue to ;ther


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pidemiology of

!ementia>? years and older / ?@

A? years and older / :B@ to B@


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Causes

of !ementiaStructural central nervoussystem factors

*ascular factors#ead traumaSubdural hematoma-ormal)pressure hydrocephalus(ultiple sclerosis


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Potentially +eersible Causes of

!ementiaPsychiatric illnesses

(ajor depressionSubstance dependence

Systemic/metabolic factors7infectious diseases #ypothyroidism

#ypercalcemia#ypoglycemia

Thiamine, niacin, $D:

de%ciency

+enal failure#epatic failure(edications

C-S infections


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!ementia(ultiple cognitie de%cits

)memory impairment / inability to learn

and recall ) apra3ia / impaired ability to carry out

motor functions

)agnosia / inability to recogni4e or identify

objects

)disturbance in e3ecutie functioning /planning, organi4ing, seEuencing,

abstracting


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!ementia!ecline from a higher leel offunctioning


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aluation of !ementia


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Treatment and (anagement of

!ementiaIdenti%cation and correction of

possible cause

nironmental manipulation toreorient patient

(ultiple interentions inoling

family and patientPharmacological management when

appropriate


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Course and Prognosis of !ementia5actors which in0uence course and

prognosis

)etiology )time span between onset and start of

treatment

)presence of comorbid psychiatric

symptoms

)leel of psychosocial support


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!elirium s. !ementia


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!epression s. !ementia


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mnestic !isordercharacteri4ed by a lost ofmemory due to eFects of a

general medical condition orpersisting eFects of a substance


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!S()I-)T+ Classi%cation of

mnestic !isorderamnestic disorder due to a general

medical condition

substance)induced persistingamnestic disorder

not otherwise speci%ed


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Clinical 5eatures of mnestic

!isorderdeelopment of memory impairment

manifested by inability to learn newinformation and to recall preiously learned

informationrepresents a decline from a preious leel of

functioning

does not occur e3clusiely in the course of adelirium or dementia

presence of a general medical condition ofeidence of persisting eFect of a substance


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Causes of mnestic

!isorder


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Treatment and (anagement of

mnestic !isorder!irected at identifying andcorrecting underlying cause

Psychosocial interention


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Course and Prognosis of

mnestic !isorders!epends on underlying cause

Transient global amnesia and

amnestic disorder due to headtrauma hae better outcomes


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+eferenceSadock $G, Sadock, *. . In Haplan and

Sadock=s Synopsis of Psychiatry. Philadelphia,P 6JJK :BB9, 8DL)8?B.


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Psychiatry -Delirium, Dementia and Amnestic Disorders (Dr.sundiang)

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