Organic
Mental Disorders:
Arise
from demonstrable cerebral disease,
brain injury or other insult leading to cerebral dysfunction.
e.g.
brain tumours, injuries, degenerations, epilepsy, disease of insult out side
the brain- myxoedema, alcohol, drugs abuse etc.
Classification:
Deliruim - Acute condition
Dementia - Chronic condition
Amnestic
disorder - Sub-acute condition
Delirium:
Acute
organic psychiatric syndrome, characterized by clouding of consciousness,
memory impairment, disorientation, language disturbance & perceptual
disturbance.
Age:
at any age, most common after 60 years.
Clinical
features
Impairment
of consciousness
Increased
psychomotor activity
Perceptual
disturbances:
Reduced
speech or irrelevant talk, switching form subject to subject and talking
wildly.
Fluctuating
mood
Delusions
--> paranoid type but transient.
Disorientation
Illusion,
visual, tactile and auditory
hallucination
Memory
impairment -----> Affects registration, retention and new learning is impaired.
Insight--->
Lost
Etiology
1)
Drug intoxication
eg. anti-cholinergic ,anti-convulsants, digitalis, benzodiazepines, opiates,
barbiturates etc.
2)
Infection--->
Typhoid, malaria, septicaemia, pneumonia, encephalitis, meningitis,
Intra-cranial space occupying lesion, raised intra cranial pressure.
3)
Epilepsy
4)
Endocrine--->
hypoglycaemia, hyperglycaemia, hypothyroidism etc.
5)
Trauma--->
head injury
6)
Metabolic--->
uraemia , liver failure, respiratory failure, cardiac failure, electrolytes
imbalance etc.
7)
Alcohol
withdrawal
8)
Lack of nutrition
and vitamins--> B1, Niacine, B12
Investigations:
Blood--->
CBC, urea, glucose, electrolytes, T3, T4, TSH, LFT
Urine R/E, CXR, EEG, CT scan of brain, MRI
Psychological test---> Mini
mental state examination
Management
of Delirium:
Good
nursing
Patient should be given repeated explanation
of his condition. To assure and oriented the
patint.
Calm and consistent approach
Avoid
too many changes
in nursing stuff.
Relatives
and friends should
visit the patient
frequently.
Quite
single room----> at room
should have enough
light to enable him to
know where he is.
Drug
treatment: Haloperidol in
10 to 30gm
Promoting
sleep---> short acting benzodiazepines, Chlorpromazine, Clozapine.
Treatment
of causes
