You are on page 1of 30

ORGANIC MENTAL DISORDERS

Organic mental disorders are behavioral or psychological disorders associated with transient or permanent brain dysfunction.

CLASSIFICATION

Organic mental disorders are classified under F0in ICD 10. MENTAL DISORDERS F00 :Dementia in Alzheimer's disease F01 :Vascular dementia F03 :Unspecified dementia F04 :Organic amnestic syndrome F05 :Delirium F06 :Other mental disorders due to brain damage and dysfunction and physical disease F07 : Personality and behavioral disorders due to brain disease. INCLUDING SYMPTOMATIC . F00-F09 :ORGANIC . damage and dysfunction .

Memory . Alzheimer's type dementia is an irreversible disease marked by global . progressive impairment of cognitive functioning . and personality . memory.DEMENTIA IN ALZHEIMER`S DISEASE ( Chronic Organic Brain Syndrome) Dementia is an acquired global impairment of Intellect. and Personality but without Impairment of consciousness.

INCIDENCE Most common in elderly than on middle age Incidence increases with age .

metals and toxins Excessive amount of metal ions such as Zink and copper in brain Other possible factors are Deficiency of Vit B6 .ETIOLOGY Significant loss of neurons and volume in brain regions devoted to memory and higher mental function Neurofibrillary tangles Build up of amyloid Accumulation of beta amyloid Environmental factors: Infection. B12 and folate Early depression .

.

Serious head injury Education level Untreatable and Irreversible causes Degenerating disorders of CNS Alzheimer's disease Pick`s disease Huntington's chorea Parkinson`s disease Treatable And Reversible Causes. Vascular – Multi infarct dementia ICSOL .

Epilepsy. Chronic respiratory failure Vitamin deficiency _ Thiamine Miscellaneous_ Heat stroke. Post anesthesia. Encephalitis Intoxication _ Alcohol.Metabolic – hepatic failure. Electric injury . Heavy metals Anoxia_ Anemia. Renal failure Endocrine – Myxedema. Addison`s disease Infections _ AIDS. Meningitis.

STAGES OF DEMENTIA STAGE I (Early stage) •2 – 4 years STAGE II( Middle stage) STAGE III( Final stage) •2 – 12 years •Up to a year .

Anxious .STAGE I : Forgetfulness Declining interest in environment Hesitancy in initiating actions Poor performance at work STAGE II: Progressive memory loss Hesitates in response to questions Difficulty in following simple commands Irritable .

Neglect Personal hygiene Social isolation STAGE III: Loss of weight Unable to communicate Does not recognize family Incontinence Loses ability to stand and walk Death is usually caused by aspiration pneumonia .

: Stereotyped. Decreased attention span Affective impairment: Labile mood . depression Behavioral impairment. Irritable . Poor judgment. psychotic or neurotic .CLINICAL FEATURES : Personality changes: Lack of interest in day to day activities Memory impairment: Recent memory is prominently affected Cognitive impairment: Disorientation. Difficulty in abstraction.

Attempts to compensate for defect.Neurological impairment: Aphasia. Confusion. Accidental falls at night . Ataxia. headache Catastrophic reaction : Agitation. Seizure. Sundowner syndrome : Drowsiness. Apraxia.

Course and prognosis Insidious onset Slow progress .

EEG. FUNCTIONAL DEMENTIA SCALE: To indicate degree of dementia 3.Based on ICD 10 criteria 1.Blood & Urine Examination 6.Brain Biopsy DIAGNOSIS .Procedures-ECG. CSF Analysis: Beta Amyloid Deposits 5. MRI : structural and neurological changes 4. COGNITIVE ASSESSMENT EVALUATION: Mini MSE Shows cognitive impairment 2.

1. Memory retraining TREATMENT . anxiety 5: Antidepressants 6: Anticonvulsants: 6: Psychotherapy: Reality Orientation. Donepezil Hydrochloride_ ( Aricept) [ To increase acetyl choline ] 3. Benzodiazepine: Insomnia . Tacrine hydrochloride – ( Cognex) 2. Antipsychotic medications_ To treat hallucination and delusion 4.

NURSING MANAGEMENT AIMS Promote Intellectual Abilities Maintain independence Avoid injuries Good quality of life .

drinking. • Self-care deficit (eating.• Impaired physical mobility related to muscle rigidity and motor weakness postural instability. • Constipation related to medication and reduced activity.dressing. NURSING DIAGNOSIS .hygiene) related to tremor and motor disturbance.

• Ineffective individual coping related to depression and dysfunction due to disease progression.difficulty in chewing and swallowing.slowness in eating.• Imbalanced nutrition less than body requirements related to tremor. . • Impaired verbal communication related to decreased speech.inability to move facial muscles.

.• Impaired sleeping pattern related to imbalance of neurotransmitters. • Altered thought process related to hallucinations and decreased concentration.

NURSING INTERVENTIONS: 1. NUTRITION AND BODY WEIGHT Well balanced diet Allow plenty of time for meals Orient to diet Avoid too hot or cold . DAILY ROUTINE: Fixed time table Avoid sun downing Orient to reality Orientation before approaching 2.

3. TOILET HABITS AND INCONTINENCE: Establish and maintain Toilet habits Check the cause for incontinence Avoid constipation . PERSONAL HYGIENE: Special care in primary needs No caustic substances routinely on skin Nail care Remove lock of bathroom Compliment if looks good 4.

5. ACCIDENTS: Wear soft slip on shoes with straps Secure any floor covering Stop driving Ensure bright light Keep matches .bleach and paints out of reach Do not allow to take medication alone 6. FLUID MANAGEMENT: Give sufficient fluid Reduce fluid after 6 pm .

MOOD AND EMOTION: Prtovide calm environment Administer medications 8. WANDERING: Identification bracelet or cards Lock doors Accompany while going out side 9.7. DISTURBED SLEEP: Maintain sleep pattern Avoid day time napping Avoid sleeping pills .

IPR: Clear verbal communication Reinforce socially acceptable skills Focus on strength Encourage To Do Some Interesting Activities .10 .

.

Delirium (S&S) consciousness . clouding of Sleep-wake disturbance . insomnia Disturbance of consciousness . mood. time>place>person Prodrome . DF-DB  memory/orientation problem Disorientation . insomnia may be the cause of delirium . drowsiness Attention deficit . agitation. anxiety. easily distraction. reverse cycle . inability to focus-sustain-shift attention. 100-7.

HT + etc. CVA .Delirium (Scenarios) Delirium+hemiparesis or other focal neuro S&S Delirium + HT + papilledema Delirium + dilated pupils + tachycardia Delirium + fever + stiff neck + photophobia Delirium + ANS + tremor +seizure+ Hx. Alcoholism Delirium + post Sx. Mass lesion Hypertensive encephalopathy Drug intoxication Meningitis R/O DT ??? . + old age + Shock + multiple drugs + DM.