ORGANIC MENTAL
DISORDERS
Maria L.A. Tiamson, MD
Asst. Professor, Psychiatry
New York Medical College
DSM-IV
Delirium
 Dementia
 Amnestic Disorders
 Subcategories:
 caused by general medical condition,
substance use or NOS
 Common Primary Symptom: cognitive
impairment
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DELIRIUM
CORE SYMPTOM: impairment of
consciousness, ie. reduced ability to focus,
sustain or shift attention
 acute onset and fluctuates
 direct physiologic consequences of a
general medical condition
 a MEDICAL EMERGENCY !!!
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Epidemiology of Delirium
15-18% of med-surg
 30% of post-CABG
 50% of post-hip surgery
 frequently misdiagnosed
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Risk Factors of Delirium
extremes of age (old & young)
 burns (3rd degree)
 post-cardiotomy patients
 drug dependence
 HIV/AIDS
 pre-existing brain damage
 history of delirium
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URGENT Diagnosis
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Withdrawal/Wernicke’s
Hypertensive encephalopathy
Hypoglycemia
Hypoperfusion of CNS
Hypoxemia
Intracranial bleed
Meningitis/encephalitis
Poisons/Medications
Clinical Features of Delirium
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Prodrome
Temporal course
Attentional deficits and arousal
Orientation
Language and cognition
Perception
Mood
Other symptoms
Clinical Course of Delirium
Diagnosis: rating scales, bedside exam,
labs and other diagnostic tests, review of
medications (including OTC drugs and
illicit drugs
 Course
 Prognosis
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Pathophysiology of Delirium
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Areas of the brain affected:
 prefrontal cortex, right cerebral hemisphere,
subcortical nuclei
Neurotansmitters affected:
 acetylcholine
 dopamine
 GABA
 histamine
Treatment of Delirium
Etiological: VERY IMPORTANT
 Symptomatic:
 neuroleptics
 benzodiazepines
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DEMENTIA
Syndrome of acquired persistent
impairment in intellectual function:
memory, language, visuospatial skills,
emotion or personality, and cognition
 Effect of pathological processes on the
brain, NOT THE EFFECT OF AGING
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Epidemiology of Dementia
4 million severe dementia
 1-5 million mild to moderate
 50-60% Alzheimer’s dementia
 15-30% Vascular dementia
 1-5% Other causes
 15% are reversible
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Classification of Dementia
CORTICAL: Alzheimer’s
 SUBCORTICAL: HAD, Parkinson’s,
Huntington’s
 MIXED: Vascular
 Pseudodementia
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Risk Factors for Dementia
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ALZHEIMER’S:
 female, hx of 1st degree relative with AD, hx of
Down’s, hx of head trauma
MULTI-INFARCT DEMENTIA (Vascular):
 male, HTN, 60-70 y/o
H.A.D.:
 wasting syndrome, older age at dx, substance
abuse hx
Clinical Features of Dementia
Memory
 Orientation
 Language changes
 Personality changes
 Perceptual changes
 Other symptoms
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Cortical Dementias
Amnesia
 Apraxia
 Aphasia
 Agnosia
 diffuse atrophy with flattened sulci anf
enlarged ventricles
 senile amyloid plaques, neurofibrillary
tangles
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Vascular Dementias
Stepwise deterioration of functioning
 affects small and medium sized cerebral
vessels
 multiple parenchymal lesions spread over
wide areas of the brain
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Subcortical Dementia
Apathy, depression, psychomotor
retardation
 affects frontal lobe, basal ganglia, thalamus
 disruption of fundamental cerebral
functions: arousal, attention, motivation and
rate of information processing
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Pseudodementia
Dementia syndrome of depression
 “don’t know” answers typical
 attention and concentration well preserved
 indifference to cognitive impairment
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Treatment of Dementia
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Etiologic:
 cholinesterase inhibitors: tacrine, donepezil,
revastigmine, metrifonate
 HAART
Treatment of co-morbid conditions:
 depression, agitation, psychosis
Adjunctive treatments:
 vit.E, hydergine, selegeline, ginkgo biloba
Treatment of Dementia
Supportive treatment
 creating a safe environment
 Psychotherapy
 Legal issues
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Amnestic Disorders
Single symptom of a memory disturbance
that causes significant impairment in
functioning
 anterograde amnesia
 retrograde amnesia
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Major Causes of Amnesia
Systemic medical conditions
 Primary brain conditions
 Substance related causes
 Affects dorsomedial and midline thalamic
nuclei, hippocampus, mammilary bodies,
amygdala
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Treatment of Amnesia
Etiological
 Psychotherapy
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