DELIRIUM,DEMENTIA,

AMNESTIC & OTHER

COGNITIVE AND MENTAL
DISORDERS DUE TO A
GENERAL MEDICAL
CONDITION
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Elmeida Effendy
Psychiatric Department
Medical Faculty- USU

In the past these conditions were classified under

the heading organic mental or organic brain
disorders.
Traditionally those disorders had an identifiable
pathological condition such as brain tumor,
cerebrovascular disease or drug intoxication

Brain disorders with no generally accepted basis

(such as depression) were called functional
disorders
This century-old distinction between organic &
functional disorders is outdated & has been
deleted from the nomenclature. The only unbiased
conclusion to be made from evaluation of the
available data is that every psychiatric disorder
has an organic ( biological or chemical) component

Because of this reassessment of the data, the

concept of functional disorders has been
determined to be misleading, & the term
functional & organic are not used in that context
in DSM-IV-TR

DELIRIUM

4 sub categories based upon several causes :

1.

general medical condition, e.g : infection

2.substance induced, e.g :cocaine,opioid,phencyclidine
3. multiple causes,e.g. head trauma & kidney disease
4.delirium not otherwised specified, e.g. : sleep
deprivation

DELIRIUMS OTHER NAME

Acute confusional state
Acute brain syndrome
Metabolic encephalopathy
Toxic psychosis
Acute Brain Failure

In DSM-IV-TR delirium is characterized by a

disturbance of consciousness & a change in
cognition that developed over a short time
Delirium has a sudden onset, a brief &
fluctuating course, & rapid improvement when
the causative factor is identified & eliminated,
but each of these characteristic features can vary
in individual patients
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CLINICAL FEATURES OF DELIRIUM

Disturbance of consciousnness
Change in cognition

DEMENTIA

Multiple cognitive defects that include

impairment in memory, without impairment in
consciousness.

The cognitive functions include :

General

intelligence
Learning and memory
Language
Problem solving
Orientation
Perception
Attention & concentration
Judgement & social abilities

Personality is also affected

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ETIOLOGY

Dementia of the Alzheimers Type

Vascular dementia

Drug & toxins

Trauma : head injuries

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Neurodegenerative disorders : Parkinsons

disease,Huntington disease, Pick disease, etc
Infection: Creutzfeldt_Jakob disease, AIDS
Nutritional disorders : Wernicke-Korsakoff
syndrome, B 12 deficiency, folate deficiency
Metabolic disorders : Cushing syndrome, dyalisis
dementia ,hepatic insufficiency
Chronic inflammatory disorders : Lupus, multiple
sclerosis

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Dementia of the Alzheimers type

Memory

impairment
At least 1 other symptom of cognitive decline
(aphasia,apraxia,agnosia, abnormal executive
functioning
Gradual decline in functioning, impairment in social
or occupational functioning
Onset : early:( 65 or younger), late : (>65)

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 Miscroscopic

findings : senile plaques, neurofibrillary

tangles, neuronal loss,synaptic loss, &
granulovascular degeneration of the neuron

Neurofibrillary

tangles (NT) are composed of

cytoskletal elements, primarily phosphorylated tau
protein, although other cytoskletal proteins are also
present
NT is also occur in Down syndrome, dementia
pugilistica, Parkinson, brains of normal people as
they age

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 Chromosom

1,14 & 21
Gene E 4 in the origin of AD;

people with 1 copy of the gene E4 have AD 3 X more

frequently than no E4
People with 2 E4 : have AD 8 X more frequently than no E4
E4 is found in persons without dementia & not found in all
cases of dementia

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AMNESTIC DISORDERS

Acquired impaired ability to learn & recall new

information or inability to recall previously learn
knowledge or past events
Amnestic disorders are secondary syndrome
caused by systemic medical or primary cerebral
disease, substance use disorders or medication
adverse effects.

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MENTAL DISORDERS DUE TO A

GENERAL MEDICAL CONDITION
Mood disorders due to a general medical
condition
Psychotic disorders due to a general medical
condition
Anxiety disorders due to a general medical
condition
Sleep disorders due to a general medical
condition
Sexual dysfunction due to a general medical
condition
Mental disorders due to a general medical
condition not elsewhere classified

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