Organic Psychiatry Quiz

Organic Psychiatry (Past Term)

• Delirium is a condition with reduced attention, awareness fluctuations, and cognitive issues like memory problems or disorientation, sometimes developing over hours or days.
• Neurocognitive Disorders (NCDs) involve a decline in multiple cognitive areas.
• NCDs begin with delirium and are followed by subtypes like major NCD and mild NCD, each with possible etiological subtypes.
• Alzheimer's disease, vascular disease, Lewy body disease, Parkinson's disease, traumatic brain injury, HIV infection, Huntington's disease, substance/medication and prion disease are some potential causes of NCD.
• Delirium is characterized by attention problems, decreased environmental awareness, and rapidly changing severity throughout the day.
• It's not linked to another disorder or a severe reduction in alertness like coma.
• A medical cause must be present for delirium, such as toxin exposure, medication side effects, or a medical condition.
• Delirium can have different levels: acute (lasting a few hours or days) or persistent (weeks or months).
• Hyperactive delirium includes high psychomotor activity and irritability.
• Hypoactive delirium involves low activity levels, slow movement, and a stupor-like state.
• Gender differences in delirium can be observed, with men often experiencing more motor agitation and affective lability, whereas women might exhibit hypoactive delirium.
• Underlying Causes of Delirium: may arise from central nervous system issues (e.g., neurodegeneration, cerebrovascular problems, infections, inflammation, tumors, demyelination, epilepsy, trauma) or from outside the central nervous system aspects (e.g., endocrine problems, metabolic diseases, nutritional issues, infections).
• Infections, hypoxia, and other acute disorders, kidney/liver disorder, urinary retention, constipation, anemia, and fever can be factors leading to delirium. Also, specific events such as shocks can be contributing.
• Age at or over 65, male gender, vision/hearing issues, dehydration/malnutrition, medication use (especially multiple), alcohol use, immobility, pain, and sleep deprivation are contributing factors to delirium.
• Delirium is related to several medical conditions, such as surgery, medication overdose, sedative/hypnotic/anticholinergic/antiepileptic drugs, ICU situations (with physical restraints, bladder catheters, and emotional stress).
• Other conditions to rule out when examining delirium include psychotic disorders, acute stress disorder, malingering, and factitious disorders.

Neurocognitive Disorders (NCDs)

• Differentiating NCDs from other disorders is important. The presence of distinct criteria help in proper diagnosis.
• Major NCDs involve substantial cognitive decline affecting everyday tasks.
• Minor NCDs display a milder cognitive decline, often not interfering substantially with daily tasks.
• Diagnostic Criteria for NCDs include significant cognitive decline in multiple areas (attention, memory, language), substantial impairment, interference with independent daily activities, and those that aren't due to other issues, such as severe depression.
• Various potential causes for NCDs have been listed.
• Specifiers like "without behavioral disturbance" or "with behavioral disturbance," and severity (mild, moderate, severe) factors are used to classify and categorize NCDs.

Management of Delirium

• Management includes securing a comfortable and well-lit space for patients, thoroughly investigating and treating the root cause, and considering atypical antipsychotic and benzodiazepine medications possibly with physical restraints.
• Additional management procedures may include EEG, CT, MRI scans, and psychological testing (MMSE), risk assessments, and evaluation of support systems.
• Potential causal treatments include nootropics/neuroprotective supplements, pain management (paracetamol), acetylcholinesterase inhibitors, glutamate antagonists, and other symptom-relieving medications (anti-anxiety, antidepressant, antipsychotics) considering comorbidities.
• Effective strategies include cognitive enhancement therapy, behavioral activation, environmental adjustments (safety measures), sleep hygiene, encouragement of independence, sensory aids, and strategies to minimize isolation and stigma while supporting care givers.

Mental Disorders Due to Another Medical Condition

• Another medical condition can cause mental health issues like psychosis, mood disorders, anxiousness, issues with sexuality, sleep difficulties, catatonia.
• Underlying medical conditions may sometimes affect personality.

Test your knowledge on Organic Psychiatry, focusing on delirium and neurocognitive disorders. Explore the links between cognitive decline and various etiological factors. Understand the distinctions between delirium, major NCD, and mild NCD, along with their causes.