Organic Psychiatry Past Paper PDF

ORGANIC PSYCHIATRY (A TERM FROM THE PAST) DELERIUM NEUROCOGNITIVE DS MENTAL DISORDERS DUE TO ANOTHER MEDICAL CONDITION THE NEUROCOGNITIVE DISORDERS (NCDS) begin with delirium, followed by the syndromes of major NCD, mild NCD, and their etiological subtypes....

ORGANIC PSYCHIATRY (A TERM FROM THE PAST) DELERIUM NEUROCOGNITIVE DS MENTAL DISORDERS DUE TO ANOTHER MEDICAL CONDITION THE NEUROCOGNITIVE DISORDERS (NCDS) begin with delirium, followed by the syndromes of major NCD, mild NCD, and their etiological subtypes. The major or mild NCD subtypes are NCD due to Alzheimer’s disease vascular NCD NCD with Lewy bodies NCD due to Parkinson’s disease frontotemporal NCD NCD due to traumatic brain injury NCD due to HIV infection NCD due to Huntington’s disease NCD due to prion disease; NCD due to another medical condition substance/medication-induced NCD NCD due to multiple etiologies and unspecified NCD.  Delerium : disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) accompanied by reduced awareness of the environment. B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day. C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception). D. The disturbances in Criteria A and C are not better explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma. E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies  Specify if: Acute: Lasting a few hours or days. Persistent: Lasting weeks or months. Specify if: Hyperactive: The individual has a hyperactive level of psychomotor activity that may be accompanied by mood lability, agitation, and/or refusal to cooperate with medical care. Hypoactive: The individual has a hypoactive level of psychomotor activity that may be accompanied by sluggishness and lethargy that approaches stupor. Mixed level of activity: The individual has a normal level of psychomotor activity even though attention and awareness are disturbed. Also includes individuals whose activity level rapidly fluctuates  Sex- and Gender-Related Diagnostic Issues The symptoms associated with delirium may vary in men and women. Men more commonly manifest motor agitation and affective lability, whereas women more commonly manifest hypoactive delirium. Male sex is a risk factor for delirium, and sex- or gender-related factors may interact with other risk factors. UNDER LYING CAUSES OF DELIRIUM Central nervous system Neurodegeneration Cerebrovascular origin Inflammation, tumor Demyelination Epilepsy Trauma Other Outside the central nervous system Endocrine Metabolic, cardio-vascular diseases Nutritional disturbance Infection Drug intoxication, drug withdrawal Alcohol, illegal drugs, medication  Infection Hypoxia Severe acute disorder Liver, kidney disorder Urinary retention, constipation Anaemia Fever Shock PRECIPITATING FACTORS Age: 65+ sex: male Severe illness other neurocognitive disorder Many illnesses Depression Chronic liver or kidney Vision-, hearing impairment failure Stroke, other Dehydration, malnutrition neurological disorder Medication (multiple drugs, Metabolic disorder psychoactive drugs), alcohol Trauma, bone fracture Immobility, pain, constipation Terminal state Sleep deprivation HIV infection  Surgery Medication overdose, politherapy sedatives, hypnotics, anticholinergic drugs, antiepileptics Eniviromental factors (ICU, phycical restraint, bladder catheters, multiple/invasive manipulations, emotional stress) DD 1.Psychotic disorders and bipolar and depressive disorders with psychotic features. Delirium that is characterized by vivid hallucinations, delusions, language disturbances, and agitation must be distinguished from brief psychotic disorder, schizophrenia…. 2. Acute stress disorder. 3. Malingering and factitious disorder 4. Other neurocognitive disorders. MANAGEMENT ICU admission in safe well lighted quite environment with minimal effective personal with clear communications Investigate thoroughly and treat the underlying cause Atypical antipsychotic Benzodiazepines May need physical restrains  MAJOR NEUROCOGNITIVE DISORDERS Diagnostic Criteria A.Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on: 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and 2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment. B. The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills or managing medications). C. The cognitive deficits do not occur exclusively in the context of a delirium. D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia). Specify whether due to: Note: Each subtype listed has specific diagnostic criteria and corresponding text, which follow the general discussion of major and mild neurocognitive disorders. Alzheimer’s disease Frontotemporal degeneration Lewy body disease Vascular disease Traumatic brain injury Substance/medication use HIV infection Prion disease Parkinson’s disease Huntington’s disease Another medical condition Multiple etiologies Unspecified etiology Specify whether due to: Alzheimer’s disease Frontotemporal degeneration Lewy body disease Vascular disease Traumatic brain injury Substance/medication use HIV infection Prion disease Parkinson’s disease Huntington’s disease Another medical condition Multiple etiologies Unspecified etiology Specifiers Without behavioral disturbance With behavioral disturbance Specifiers Specify current severity : Mild: Difficulties with instrumental activities of daily living (e.g., housework, managing money). Moderate: Difficulties with basic activities of daily living (e.g., feeding, dressing). Severe: Fully dependent. E.g..Major neurocognitive disorder due to Alzheimer’s disease, without behavioral disturbance, mild MINOR NEUROCOGNITIVE DISORDER: DIAGNOSTIC CRITERIA E.g. of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on: 1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and 2. A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment. B. The cognitive deficits do not interfere with capacity for independence in everyday activities (i.e., complex instrumental activities of daily living such as paying bills or managing medications are preserved, but greater effort, compensatory strategies, or accommodation may be required). C. The cognitive deficits do not occur exclusively in the context of a delirium. D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia). Specify whether due to: Lewy body disease Vascular disease Traumatic brain injury Substance/medication use HIV infection Prion disease Parkinson’s disease Huntington’s disease Another medical condition Multiple etiologies Unspecified etiology NOTE: EACH SUBTYPE LISTED HAS SPECIFIC DIAGNOSTIC CRITERIA AND CORRESPONDING TEXT, WHICH FOLLOW THE GENERAL DISCUSSION OF MAJOR AND MILD NEUROCOGNITIVE DISORDERS. Specify whether due to: Alzheimer’s disease ,Frontotemporal degeneration ,Lewy body disease ,Vascular disease, Traumatic brain injury ,Substance/medication use ,HIV infection, Prion disease , Parkinson’s disease ,Huntington’s disease ,Another medical condition , Multiple etiologies ,Unspecified etiology Psychotic features are common in many NCDs Mood disturbances, including depression, anxiety, and elation, may occur Agitation is common in a wide variety of NCDs, behavioral symptoms are common wandering, disinhibition, hyperphagia, and hoarding.. Sleep disturbance is a common symptom that can create a need for clinical attention and may include symptoms of insomnia, hypersomnia, and circadian rhythm disturbances. Apathy is typically characterized by diminished motivation and reduced goal directed behavior accompanied by decreased emotional responsiveness MANAGEMENT Signs and symptoms Laboratory complete workup EEG, CT, MRI Psychological testing (MMSE) Risk assessment Evaluate the support system  Causal if possible Nootropics Neuroprotection and supplements Treat pain and aches (paracetamol) AChEI (rivastigmine, donepezil, galantamin) Glutamate antagonists (Memantine) Treat comorbidity and provide symptoms relive (anxiolitics, antidepressant, antipsychotics, etc.)  Cognitive enhancement therapy Behavioral activation Environmental adjustment (safety measures ) Routine and schedules Sleep hygiene Encourage independencies Sensory aids Activate the social support and social behavior minimize isolation and stigma Care for general health Care for care giver MENTAL DISORDERS DUE TO ANOTHER MEDICAL CONDITION Psychotic disorder due to a general medical condition Mood disorder Anxiety disorder Sexual disfunction Sleep disorder Catatonic disorder Personality change