Definition:
- Psychiatric Disturbances resulting from transient or permanent Central Nervous System dysfunction.
Mental Illness à Underlying Brain Pathology
1. Acute Organic Mental Disorder (Delirium)
2. Chronic Organic Mental Disorder (Dementia)
Acute Condition – Sudden Onset, Reversible Impairment with time and Treatment
Chronic condition – Insidious Onset, Progression of Deterioration is slow and often irreversible
Delirium Dementia
1. Acute Onset Insidious Onset
2. Disorientation, Anxiety & Poor Attention Disturbed Memory & Personality Deterioration
3. Perceptual Abnormalities (illusions, Hallucinations) Global Impairment & Cerebral Function
4. Clouding of Consciousness Clear Consciousness
5. Fluctuating Course Progressive Course
6. Reversible Mostly Irreversible
DELIRIUM (Acute Organic Mental Disorder)
Delirium - Transient Organic Mental Disorders
- Generalised Physiological dysfunction, Usually fluctuating in Degree.
Clinical Features
- Sudden Onset
- Prodromal Period – Insomnia and Nightmares
- Clouding of Consciousness, Drowsiness, Restlessness and Inattentiveness
- Disorientation
- Impaired Attention Span
- Confused, Incoherent and Unitelligible Talk
- Fearful Mood
- Restless & Agitation
- Illusion (Visual)
- Visual & Auditory Hallucinations
- Delusional Ideas
Symptoms Fluctuating – Quiet during day & disturbed at Night
Amnesia – Not able to remember the symptoms of Previous Night
Duration – Few days to two weeks
Mild Delirium – In elder & severly ill patient
Severe Delirium – Severe Infection, Alcohol Withdrawal, Metabolic Diseases à Liver Failure & Uremia
Important Causes
Infections – Typhoid, Pneumonia, Septicaemia
Intracranial - Encephalitis, Meningitis, Neurosyphilis
Acute Brain Disorders – Head Injury, Cerebral Haemorrhage, Hypertensive Encephalopathy
Vitamin Deficiency – Pellagra, Wernicke’s Encephalopathy
Drug Withdrawal – Opiates, Batbiturates, Alcohol (Delirium Tremens)
Drug Intoxication – Atropine, Cocaine, Bromides
Management
- Identify the Cause
- Investigate & treat the Cause
- Correct Symptoms
- Sedation for Disturbed Patients
Nursing Care
- Agitation – Physical Restraint
Patient Vital Signs
- Diet - Patients Exhausted & Die, Adequate Nourishment
- Rest
- Reassurance & Support
DEMENTIA (Chronic Organic Mental Disorder)
- Acquired Global Impairment of Intellect, Memory and Personality without Impairment of Consciousness
- Elder people – Dementia ********
- It is a Syndrome – due to disease of Brain – Chronic & Progressive in Nature
- Disturbance Higher function – Memory, thinking, Orientation, Compression, Learning Capacity, Language & Judgment
“Dementia is like a Dying Mind ina living Body”
- 5 % population aged over 65
- 10% over – 80
Classification of Dementia
1. Senile Dementia (Alzheimer’s Type)
2. Vascular Dementia
3. Dementia in Other Diseases
- Pick’s Diseases
- Creuzfeldt-Jakob Disease
- Huntington’s Disease
- Parkinson’s Disease
- HIV Disease
- Unspecified Dementia
Common Causes of Dementia
1. Degenerative (Cortical)
- Alzheimer’s Disease
- Pick’s Disease
2. Subcortical Degenerative
- Parkinson’s
- Huntington’s Disease
- Progressive Supranuclear Palsy
- Punch-drunk Syndrome
3. Infection and Inflammation
- Neurosyphilis (GPI)
- AIDS
- Creutzfeldt-Jakob Disease (Slow Virus)
- Multiple Sclerosis
- Post encephalitis
4. Toxic
- Alcohol
- Carbon Monoxide
- Heavy Metal Poisoning
5. Metabolic
- Hyupothyroidism
- Hypocalcaemi
- Hypoglycaemia
- Heptic encephalopathy
- Chronic uraemia and Dialysis
- Vit. B12 Deficiency
- Pellagra
6. Tumours
- Meningioma
- Benign Glioma
- Para-Pituitary Tumours
- Secondary Deposits
- Subdural Haematoma
- Normal Pressure Hydrocephalus
7. Trauma
- Head Injury
Clinical Features of Dementia
Impairment of Memory, Thinking & Judgement, Orientation, Comprehension & Learning Capacity, Calculation, Language
Diagnostic Criteria
1. Evidence of Organic Change
2. Evidence if Impairment in short and long-term memory
3. Impairment in Abstract Thinking, Judgment & Higher Cortical Function
4. Disturbance Interfering with work and Social Activities
Alzheimer’s Dementia
- Unknown Aetiology, Old Age (higher), Insidious Onset (Over period of Years), Presenile Period – May Occur, All Feutures Present, Brain Biopsy, Senile Plaques, Neuro Fibrillary Tangles, Granules & Ventricular Dilatation
Multi Infarct Dementia (Vascular Dementia) – Chronic Anoxia from Atherosclerosis, Cerebral and Systemic Vascular Disease, Associated with Hypertension, Course Stepwise & Fluctuating.
Pick’s Disease – Asymmetric Atrophy of the frontal and temporal lobes., Common in Females
Huntington’s Chorea - A Dementing disease with an autosomal dominant transmission, presenting with insidious onset of involuntary choreiform movement. The average age of onset is in the 30s.
Normal Pressure Hydrocephalus – Occurs mainly in the 7th and 8th decades and may be present with dementia. Unsteadiness of gait, urinary incontinence and nystagmus.
General Paralysis of Insane (GPI)
A condition of neurosyphilis leading on to dementia. Develops usually 10-20 years after initial infection (Syphilis) There is astrophy of the cerebral cortex, more severe in the frontal and temporal areas. Dementia is associated with depression, mania or schizophreniform psychosis. Other features include epilepsy, Argyll Robertson pupils, tremor, cerebellar or extra pyramidal symptoms, dysarthria, aphasia and hemiplegia
Management of Dementia
1. Drug Treatment – No Specific Drugs, Hygine, Papaverine, Piracetam, Sym**** treatment.
2. Psychosocial Management – Behavioural Methods, Milieu Therapy, Activity Engagement, Physical Exercise, Problem Oriented Approach, Reality Orientation, Organisation of Psychiatric Services
Nursing Care of Dementia
- Assess Patient’s Level of Functioning, Nurse the Patient in Familiar Surrounding, Due to Disorientation patient may be Wandering (Advice to tie ID-Card), Violent – May restrain, Simple Explanation & face to face Instruction, Stimuli – Noise – Visitors, Reassurance, Educating the Carer.
Psychiatric Aspects of Head Injury
Common Cause
- Road Accident, Fall from Height, Injury associated with alcoholism and Quarrels
Acute State
- Loss of Consciousness, Amnesia-retrograde,post traumatic, Delirium and Fits, Subdural Haematoma
Psychiatric Complication
- Dementia, Organic Personality Problem, Schizophrenia like Psychosis, Postconcussion Syndrome, Compensation Neurosis
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