Alcoholism and Related Disorders Quiz

Neurocognitive Disorders

• Neurocognitive disorders is the new term globally used to include delirium and dementia (DSM-5, 2013).
• Previously, organic mental syndrome and disorder were used.
• Includes delirium, dementia, substance abuse disorders, intellectual disability, and epilepsy.

Causes of Cognitive Disorders

• Cognitive psychotic conditions have various etiologies.
• A mnemonic "MEND A MIND" can help recall possible causes:
  • M - Metabolic disorders
  • E - Electrical disorders
  • N - Neoplastic diseases
  • D - Degenerations
  • A - Arterial disease
  • M - Mechanical disease
  • I - Infectious disease
  • N - Nutritional disease
  • D - Drug toxicity

Delirium

• Definition: an acute organic mental syndrome characterized by clouding of consciousness, accompanied by disorientation, memory impairment, and decreased concentration, which is reversible.
• Risk factors include increasing age, underlying dementia and physical illness (up to 15% of patients over 65 experience delirium).
• Delirium is often reversible when the cause is identified and treated.
• Common in children and adults aged 60 and older.
• Types of Delirium:
  • Delirium due to general medical conditions
  • Substance-induced delirium
    • Substance intoxication delirium
    • Substance withdrawal delirium
  • Delirium due to multiple etiologies
  • Delirium not otherwise specified
• Common Causes of Infections:
  • Systematic diseases (e.g., malaria, typhoid fever, pneumonia).
• Common Causes of Drug Intoxication/Withdrawal:
  • Alcohol, anxiolytics, opioids, CNS stimulants, cocaine, crack, amphetamines, marijuana.
• Causes of Neurological Disorders:
  • Intracranial, e.g., meningitis, encephalitis, cerebral malaria.
  • Seizures
  • Head trauma
• Other causes:
  • Hypertensive encephalopathy
  • Postoperative state
  • Puerperium (Postpartum)
  • Drugs: antibiotics, antiparkinsonian, anticholinergics, antituberculosis, anticonvulsants, analgesics, and anti-inflammatory
  • Cardiac conditions
  • Sedatives
  • Hypnotics
  • Metals and Gases: mercury, lead, arsenic, carbon monoxide

Clinical Features of Delirium

• Altered states of alertness, awareness, and consciousness(hyper alert or obtund), with lucid intervals.
• Onset can be dramatic/sudden; difficult to detect and evolve over days or weeks.
• Disorientation and confusion
• Decreased attention, memory, and concentration
• Psychotic symptoms like paranoia and hallucinations (often visual).
• Behavioral disinhibition, emotional liability, and irritability.
• Psychomotor retardation or agitation, varying over a 24-hour period.
• Fragmented sleep/work cycle, increased agitation at night.
• Usually reversible with correction of underlying etiology

Diagnosis/Investigations of Delirium

• Common investigations include blood tests (HB, urea, electrolytes), urinary sugar/protein, Bender Gestalt Test, memory tests, fundus examination, X-ray of the skull.
• Electroencephalography
• C.S.F. Routine
• Brain Scan
• Brain Biopsy

Dementia

• Definition: Characterized by a usually insidious (but sometimes acute) development of generalized brain dysfunction with multiple cognitive deficits. The deficits result in impairment in social and/or occupational functioning and a decline from previous levels of functioning.
• Awareness and mental alertness are generally intact and stable in the early stages, unlike delirium.
• Memory impairment (learning new info and recalling previous learning) is a common feature.
• Types of Dementia:
  • Alzheimer's type
  • Vascular
  • HIV
  • Head trauma
  • Parkinson's Disease
  • Huntington's Disease
  • Rick's disease
  • Creutzfeldt-Jacob's Disease
  • Other General Medical Conditions
  • Substance-Induced Persisting Dementia
  • Multiple Etiology
  • Not Otherwise Specified
• Causes (partial listing):
  • Alcohol-related Dementia
  • Alzheimer's disease
  • Amyotrophic lateral sclerosis
  • Bromide poisoning
  • Chronic granulomatous meningitis
  • Folic acid deficiency
  • Head trauma
  • HIV
  • Huntington's chorea
  • Hypothyroidism
  • Multi-infarct Dementia
  • Multiple sclerosis
  • Neoplasms
  • Normal-pressure hydrocephalus
  • Postanoxic state
  • Progressive Supranuclear Palsy
  • Transmissible virus (Jacob-Creutzfeldt disease)
  • Vitamin B12 deficiency

Clinical Features of Dementia

• Memory impairment (anterograde and retrograde amnesia)
• Changes in intellectual functioning
• Loss of interest in surroundings, irritability, dullness, apathy, and fatigue
• Disorientation
• Delusions (e.g., of persecution)
• Mood swings
• Childishness regression
• Language difficulties

General Paralysis of the Insane (GPI)

• Syphilis, untreated, can cause chronic CNS infection (Treponema pallidum).
• Generally progresses in stages (Primary, Secondary, Tertiary) over 5-75 years.
• Characterized by neurological and psychological symptoms, appearing slowly or suddenly
• Psychological Symptoms: Loss of memory, poor judgment, disorientation, lack of initiative/concentration, delusions (e.g., grandeur, nihilistic), mood swings, becoming credulous, increased talkativeness, increased sexual drive, irritability, violence, neglect of personal hygiene, and suicidal tendencies
• Neurological Symptoms: Pupils (small, unequal, non reactive to light), involuntary tremors of limbs and face (causing slurred speech), incoordination
• Physical deterioration and complete dementia are final stages

Parkinson's Disease

• Common motor disorder in the sixth decade of life affecting 1 in 1000 population overall and 1% of the population over age 70
• Clinical manifestation of tremor, rigidity and bradykinesia
• Seen in neuroleptic drug users, Wilson's disease, and after cerebral anoxia.
• Idiopathic Parkinsonism is caused by degeneration of dopaminergic neurons.

Clinical Features of Parkinson's Disease

• Akinesia
• Rigidity
• Pill-rolling tremor
• Postural abnormalities
• Shuffling gait
• Difficulty in handwriting or walking

Epilepsy

• A brain disorder characterized by recurrent excessive neuronal discharge. Seizures may have motor, sensory, or psychic dysfunction and may or may not include unconsciousness and convulsive movements.
• Causes: Many are unknown; some are due to constitutional factors (genetic predisposition, age, endocrine disorders) and predisposing factors (intracranial infections, brain tumors, head injuries, metabolic disorders).
• Precipitants: emotional stress, unknown causes, drugs, boredom, sensory stimulus, and fatigue/large crowds.
• Types
  • Generalized Epilepsy/Focal/Partial Epilepsy

Generalized Epilepsy

• Includes Grand Mal/Major Epilepsy, a seizure with four phases (aura, tonic, clonic, coma).
• Also includes Petit Mal/Minor Epilepsy, brief loss of consciousness with involuntary movements, more common in children. Epileptic Twilight State (a more serious confusional episode).

Focal/Partial Epilepsy

• Consciousness may or may not be lost.
• Impulses may not spread, affecting specific regions(e.g., Temporal Lobe Epilepsy, Jacksonian Epilepsy)

Clinical Features of Epilepsy (general)

• Akinesis
• Myoclonus
• Hallucinations
• Confusion

Mental Retardation

• A condition characterized by low intelligence, learning disability, and impairment in adaptive behavior.
• Diagnosed before the age of 18
• Causes:
  • Genetic (abnormal genes)
  • Environmental (infections in pregnant mother, malnutrition, exposure to radiation, threatened abortion)
  • Prenatal
  • Perinatal (birth injuries)
  • Postnatal (childhood malnutrition, brain tumors, injuries).
• Levels of Retardation (classifcation based on IQ scores and adaptive functioning):
  • Mild (IQ 55-70)
  • Moderate (IQ 35-55)
  • Severe (IQ 20-35)
  • Profound (IQ less than 20)

Substance Abuse (Drug and Alcohol)

• Excessive use of substances that interfere with biological/physiological and socio-cultural functions.
• This includes using prescription drugs in dosages other than prescribed.
• Includes drug dependence (addiction)
• Types of Drugs(Examples) include Marijuana, Cocaine, Heroine, Mescaline, Lysergic Acid Diethylamide (LSD), Amphetamine, Barbiturates, Morphine.
• Medical Professionals, those who experience psychological distress, and peer influence are some factors associated with drug/substance abuse/dependence

Alcoholism

• Excessive and prolonged intake of alcohol, leading to physical and mental illness, and interference with personal and social functioning.
• Causes include strains, stresses, peer influence, poor upbringing, anxiety, low self-esteem, certain occupations, and curiosity
• Effects include memory problems, poor judgment, neurologic problems (muscle incoordination), nausea/vomiting, and possible coma and death
• Conditions include: Pathological intoxication (acute excitement w/ violence), dipsomania (periodic bouts of excessive drinking) and Delirium Tremens (withdrawal symptoms)

Test your knowledge on alcoholism, specifically focusing on conditions like dipsomania and delirium tremens. This quiz covers the management approaches, triggers, and characteristics associated with these disorders. Perfect for students and professionals in psychology and psychiatry.