Psychiatry -Delirium, Dementia and Amnestic Disorders (Dr.sundiang)
Transcript of Psychiatry -Delirium, Dementia and Amnestic Disorders (Dr.sundiang)
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Delirium, Dementia andAmnestic Disorders
Second Year Psychiatry
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CognitionThe mental process of knowing.
Includes awareness, perception,reasoning, judgment, memory,language, orientation, conducting
personal relationships,performing actions and problemsoling.
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Cognitie !isorders!isruptions in the acts andprocesses inoled in cognition.
"sually associated withbehaioral symptoms.
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#istorical $ackground"sed to be classi%ed under&organic mental disorder'.
"nder !S()I*)T+, classi%edunder
!elirium, !ementia andmnestic
and other Cognitie !isorders
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#istorical $ackgroundIn !S()*, under -eurocognitie
!isorders
!elirium retained
!ementia replace with major and
minor neurocognitie disordermphasis on decline in functioningrather than memory disturbance
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reas of Primary
!isturbance!elirium / leel of consciousnesswith associated impairments in
memory, judgment, orientationand attention
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reas of Primary
!isturbance!ementia / impairment inmemory, language and intellect
mnestic !isorder / impairmentin memory in the absence ofclouded consciousness andde%cits in other areas ofcognition
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!eliriumcute onset of disturbance inleel of consciousness and
0uctuating cognitieimpairments.
+e0ects response to widespreadaltered cerebral functions.
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!S()I*)T+ Classi%cation of !elirium!elirium due to a general medicalcondition 1indicate the condition2
Substance into3ication delirium
Substance withdrawal delirium
!elirium due to multipleetiologies 1indicate the etiologies2
!elirium not otherwise speci%ed
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pidemiology !elirium#igher prealence and incidencein
lderly
(ultiple medical problems
#ospitali4ed patients especially
critically ill patients
Terminally ill patients
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Clinical 5eatures of
!eliriumPrimary feature )diminished clarity of
awareness of the enironment
1disturbance of consciousness26anguage and other cognitie changes
Perceptual disturbances
!isturbance in sleep and wakefulness!isturbance in orientation
!isturbance in arousal leel
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Clinical 5eatures of
!elirium!eelops oer a short period oftime 1hours or days2
Tends to 0uctuate oer the courseof a day
5rom history, P or laboratorythere is7are identi%ed condition7sor substance7s as a likely etiology
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Causes of !eliriumInfections
(etabolic and endocrine abnormalities
Intracranial states#ypoperfusion states
Substance into3ication7withdrawal
Postoperatie states
Sensory and enironmental changes
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aluation of !elirium
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aluation of !elirium
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aluation of !elirium
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(anagement of !elirium5ind cause7s
Correct or eliminate cause7s
Supportie therapy,enironmental control
Pharmacologic agents
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Course and Prognosis !eliriumfter cause7s remoed symptomsusually recede oer 8 to 9 days.
Seldom persist beyond : weeks ifcausatie factors are reersibleand remoed.
;lder patients and longer durationof delirium longer time to resole
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!ementia progressie impairment ofmultiple cognitie functions
occurring in an indiidual withclear consciousness
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!S()I*)T+ Classi%cation of
!emential4heimer=s Type
*ascular !ementia
!ue to ;ther
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pidemiology of
!ementia>? years and older / ?@
A? years and older / :B@ to B@
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Causes
of !ementiaStructural central nervoussystem factors
*ascular factors#ead traumaSubdural hematoma-ormal)pressure hydrocephalus(ultiple sclerosis
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Potentially +eersible Causes of
!ementiaPsychiatric illnesses
(ajor depressionSubstance dependence
Systemic/metabolic factors7infectious diseases #ypothyroidism
#ypercalcemia#ypoglycemia
Thiamine, niacin, $D:
de%ciency
+enal failure#epatic failure(edications
C-S infections
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Clinical 5eatures of
!ementia(ultiple cognitie de%cits
)memory impairment / inability to learn
and recall ) apra3ia / impaired ability to carry out
motor functions
)agnosia / inability to recogni4e or identify
objects
)disturbance in e3ecutie functioning /planning, organi4ing, seEuencing,
abstracting
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Clinical 5eatures of
!ementia!ecline from a higher leel offunctioning
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aluation of !ementia
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Treatment and (anagement of
!ementiaIdenti%cation and correction of
possible cause
nironmental manipulation toreorient patient
(ultiple interentions inoling
family and patientPharmacological management when
appropriate
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Course and Prognosis of !ementia5actors which in0uence course and
prognosis
)etiology )time span between onset and start of
treatment
)presence of comorbid psychiatric
symptoms
)leel of psychosocial support
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!elirium s. !ementia
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!epression s. !ementia
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mnestic !isordercharacteri4ed by a lost ofmemory due to eFects of a
general medical condition orpersisting eFects of a substance
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!S()I-)T+ Classi%cation of
mnestic !isorderamnestic disorder due to a general
medical condition
substance)induced persistingamnestic disorder
not otherwise speci%ed
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Clinical 5eatures of mnestic
!isorderdeelopment of memory impairment
manifested by inability to learn newinformation and to recall preiously learned
informationrepresents a decline from a preious leel of
functioning
does not occur e3clusiely in the course of adelirium or dementia
presence of a general medical condition ofeidence of persisting eFect of a substance
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Causes of mnestic
!isorder
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Treatment and (anagement of
mnestic !isorder!irected at identifying andcorrecting underlying cause
Psychosocial interention
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Course and Prognosis of
mnestic !isorders!epends on underlying cause
Transient global amnesia and
amnestic disorder due to headtrauma hae better outcomes
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+eferenceSadock $G, Sadock, *. . In Haplan and
Sadock=s Synopsis of Psychiatry. Philadelphia,P 6JJK :BB9, 8DL)8?B.
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(+(I-< S6(TMMM