ORGANIC MENTAL DISORDERS

Dr.Deddy Soestiantoro Sp.KJ M.Kes

ORGANIC MENTAL DISORDERS ( OMD )

The conditions maybe psychotic or non psychotic -the term mental organic syndromes means for some conditions without the etiological involvement -in the mental organic disorders,the etiological factors must be present,that means that structure damage or dysfunctions later will be causing the mental and behavioural disorder -but the damage/dysfunction are not a single factor,it is also influenced by premorbid

In OMD there are 2 main subtypes: the psychotic and the non psychotic disorders. THE CLINICAL SYMPTOMS: I.The primary symtoms that caused by the damage: -orientation disorders, -memory disorders usually the short term,maybe theres also confabulation, -disorders of the intellectual performance such a comprehension,problem solving and numerical ability,

II.The secondary symptoms as an additional symptoms as a response to the additional stress caused by the primary symptoms. Actually these secondary symptoms will be determining the conditions as a psychotic or non psychotic disorders. Some of the secondary symptoms : -restlesslness, -anxiety and fear, -hallucinations ( usually visual or tactile, and rarely auditoric ),

REALITY TESTING ABILITY There are 3 aspects of the personality, wether psychotic or not,its depends on the dysfunction/disorder/disturbance of these aspects. Affective /Stimmung -afeftive state: hyperthymia, hypothymia, poikilothymia,disthymia, blunted/flat/inappriate affect -emotional state Thought /Denken -intellectual function:memory,concentration, orientation,discriminative judgement/insight, intelligency level,dementia etc -sensation & perception:illusion,hallucination -thought process:-psychomotility,quality, associations,content and form etc Behaviour and instinctual drive/ Handlung -abulia/hypobulia ,stupor,raptus,impulsivity,sexual deviation, vagabondage,pyromania,mannerism,

Other Classification: A.Reversible or acute brain syndromes -some symptoms:confusion,delirium,stupor,coma -hallucinations and illusions, -anxiety,fear and restlessness, -fluctuations/variation of symptoms during 24 hours, -tendency to recover quickly,and loss of memory of the conditions during the sickness. B.Irrevesible or chronic brain syndromes -intellectual function disorders, -tendency to gradual/slow but progressive and irreversible, -clinically known as dementia.

DELIRIUM and DEMENTIA

DELIRIUM DEMENTIA 1.Mental level:lower -higher 2.Main involvement: -sensorium,instinctual and -intellect,abstraction,judgment, affective state, programming and creativity. 3.Anatomic localization: -brainstem, limbic lobe, -temporal,parietal & frontal lobes. ANS, sensory cortex, 4.Psychological area: -Id and Ego, -Ego and Super Ego. 5.Main symptoms: -clouded conciousness, -loss of memory ;learning,reasoning, disorientation, abnormal problem solving / executive functioning, affective, confusion, and judgment & personality characteristic. visual hallucinations, 7.Etiology:

ETIOLOGY of DELIRIUM -intracranial, -extracranial e.g use of drugs, -deficiency diseases, -systemic infections, -electrolyte imbalance, -post operative, -traumatic (body/head). Long sensoric deprivations or total isolation may cause mild delirium similar to psychotic, but with quick recovery such as long distance driver,gray out,white out, rapture of the deep, black patch psychosis, cardiac

F10-F19 Mental & behavioural disorders due to psychoactive substance use

Usually due to use of alcohol,opioids,cannabinoids,sedatives or hypnotics, cocaine, other stimulants including caffeine, tobacco, hallucinogens, volatile solvents,multiple drug use and use of other psychoactive substances. The clinical conditions usually in acute intoxication or in withdrawal state with one of the mental & behavioural disorders is delirium.

DSM IV: Substance-Induced Delirium

Substance Intoxication Delirium
A.Disturbance of conciousness (i.e reduced clarity of awareness of the environment) with reduced ability to focus,sustain or shift attention. B.A change in cognition (such as memory deficit,disorientation, language disturbance) or the development of a perceptual disturbance that is not btter accounted for by preexisting , established, or evolving dementia. C.The disturbance develops during a short periode of time (usually hours to days) and tends to fluctuate during the course

Specific Susbtance Intoxication Delirium -alcohol,amphetamine (or amphetamine-like subtance), -cannabis, cocaine, hallucinogen, inhalant, -opioid, phencyclidine (or phencyclidine-like substance), -sedative, hypnotic or anxiolytic, -other / unknown substance ( e.g Subtance Withdrawal Delirium cimetidine, digitalis,benztropine) A,B,and C. The same as before. D.There is evidence from the history,physical examinations, laboratory findings that the symptoms in Criteria A and B developed during or shortly after, a withdrawal syndrome. Specific Substance Withdrawal Delirium: -alcohol,sedative,hypnotic,anxiolytic and other/unknown substance.

Note:
This diagnosis should be made instead of a diagnosis of Substance Intoxication or Substance Withdrawal only when the cognitive symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention.