INTRODUCTION

Neuropsychiatric is the subspecialty of psychiatry that combines neurology and psychiatry it

emphasize the physical structure on which emotional and behaviour are based.
Neuropsychiatry disorders are those diseases processes toxic exposure , traumatic injuries or
other cause that change the structures of central nervous system and produce psychiatric as well
as neurologic symptoms.

The term refer to psychiatric disorders which all arise from demonstrable abnormalities
of brain structure and function.
Cognitive process but behavioral and emotional are also common and may be the sole
manifestation of the brain disease.
ORGANIC BRAIN DISORERS: it is a general term that refers to a diseases usually not
the psychiatric disorders that cause decrease mental function. it is not a seprate disease
but it is a general term use to describe physical condition that can cause the mental
changes.
ETIOLOGY
Brain injury caused by trauma
Bleeding in brain
Intra cerebral hemorrhage
Bleeding into the space around the brain
Infection
Any sudden onset that may be acute or long term i.e chronic infection blood
poisioning (septicemia)
Swelling of brain
Other medical disorders
Cancer
Kidney diseases
Liver
Vitamin deficiency B12
SIGN AND SYMPTOMS

DELERIUM

Agitation
Confusion
Altered level of consciousness
Acute generalized cognitive impairment (delirium).
Chronic generalized cognitive impairment (dementia).
Specific neuropsychiatric syndromes.

it is also known as acute confusional state, acute organic reaction, toxic psychosis, metabolic
encephalopathy.
It is a syndrome with acute onset of fluctuating cognitive impairment characterized by an
impairment of consciousness and along the global impairment of cognitive function and
clouded consciousness.
It may be associated with various neurological and psychological symptoms such as:

Tremors
Hallucinations
Mood changes
Abnormal psychomotor activities

ETIOLOGY
The various neurotransmitters have been implicated but acetylcholine is the major
neurotransmitter which have been disturbed in organic brain disorders .the other causes are :

Intracranial causes
o Meningitis
o Encephalitis
o Brain injury
o Epilepsy
Extracranial causes
o Endocrine dysfunction
Drugs
o Anticholinergic agent
o Hypnotic, sedative,
o Anticonvulsant
Poison
Carbon monoxide, heavy metal poisoning
Deficiency diseases
Thiamine, nicotine acid, vitamin B12, folic acid
CLINICAL FEATURES
Clouding of consciousness(decrease awareness of surrounding and decrease
ability to respond to environmental stimuli.
Disorientation for time, place, person
Decrease attention span
Distractibility
Marked perceptual disturbance include visual hallucination, illusion and
misinterpretation
Disturbance of sleep wake cycle i.e insomnia in night and drowsiness in day time
Diurnal variations i.e worsening of symptoms in evening and night

Speech and thought disturbance like slurring of speech.

Motor symptoms like asterixis (flapping tremors)
Mood changes vary from marked irritability, fear, anger and apathy
DIAGNOSIS
o Disturbance of consciousness and reduced clarity of awareness of
environment . Reduced ability to focus to sustain pr to shift the attention.
o Change in cognition such as memory deficit disorientation or language
disturbance and development of perceptual disturbance .it is over a short
period of time and tense to fluctuate during the course of the day.
o There is the evidence of history, physical examination, and all lab
findings.
MANAGEMENT
o Management is symptomatic and for managing underlying
pathology
o Identification of the cause and its immediate management for eg
50% of dextrose infusion in case of hypoglycemia ,oxygen for the
hypoxia.
o Immediate psychiatric treatment of the emergency like agitation
include 10 mg diazepam, 2mg lorazepam, 50mg chlorpromazine.

DEMENTIA
It is a heterogenous group disorders characterized by the multiple impairment in the cognitive
function in the presence of clear consciousness along with the impairment in social and
occupational function and represent a definite decline from previous level of functioning.
ETIOLOGY
Dementia has many cause the common are:
o
o
o
o
o
o
o
o
o
o

Alzheimers diseases
Vascular dementia like multiple infarct, stroke
Intracranial masses include tumor
Head injury
Neurodegenerative disorders: Parkinsons disease, Willson disease
Drug and toxins
Infection includes :AIDS ,neurosyphilis
Nutritional disorders include thiamine , vitamin B12, folic acid deficiency
Metabolic disorders
Tumors: primary or metasttic

CLINICAL FEATURES

Decline in both memory and thinking which is sufficient enough to impair the activities
of daily living.
Memory impairment which typically affect the registration storage and retrieval of new
information
Thinking is impaired the flow of idea is reduced and reasoning capacity is also impaired.
Impairment of speech i.e aphasia
Impairment of abstract thinking
Poor judgement and insight that can cause the patient to make unrealistic plan and engage
in dangerous activities.
Change in activity of daily routine

TYPES
DEMENTIA OF ALZEIMERS TYPE
The most common type of dementia 5% of all the person who reach at the age of 55yrs and
the increase with the increasing age in this memory deficit and other higher cognitive
dysfunction are present early in diseases and patient become easily disoriented and wanderers
aimlessly. The most symptoms are also present especially depression is quite common later on
the symptoms include apathy, agitation, disinhibition, social as well as sexual and aggression
become frequent as illness progress . psychotic symptoms such as delusion and visual
hallucination upto 40% of patient.
STAGES OF ALZEIMER DEMENTIA
Stage 1: mild stage impaired memory , loss in activity of daily living, personality changes but
socially normal
Stage 2:moderate , obvious memory impairment, overt daily impairment ,supervision needed
Stage 3: severe, fragmented memory, no recognition of familiar people, reduced mobility
FRONTO TEMPORAL DEMENTIA
It is dementia due to pick disease also known as FTD. In this there is collection of pick bodies or
there is collection of protein called as Tar, accumulate around the brain tissues causing
neurological changes. It affects on the same region of brain i.e frontal or temporal. In this there is
memory and visuospatian function are usually impaired along with personality changes . this
inhibition both social and sexual distractibility and the childish behaviour are also common.
HIV RELATED DEMENTIA
It is infection with human immune deficiency virus commonly reached to dementia in about 3040% of HIV cases . in this there is decreased memory impaired learning psychomotor retardation
and impaired fine motor function will appear the neurotoxicity occur by the HIV infection.

VASCULAR DEMENTIA
It is the second most common type of dementia. It occurs due to chronic or reduced blood flow
to the brain due stroke or infarct. It is characterized by acute onset , gait disturbance, affective
disorders.
MANAGEMENT
The treatment of underlying cause include: treatment of hypertension, hypothyroidism with
antihypertensive drug and removal of toxic agent in toxic dementia.

Symptomatic management of associated features such as insomnia anxiety depression

and the psychotic features with the appropriate psychotrophic drugs.
Admnistered benzodiazepines for anxiety
Antidepressants for depression
And short term hospitalization
Environmental modification reduce the stress of day to day activities.
Pharmacological intervention disease specific treatment i.e cholinesterase inhibitor such
as Donepezine and Rivastigmin in the ACE inhibitor such as galantamine are used to
prevent the progress of diseases process.
Supportive psychotherapy
Providing information regarding various help available eg day care center, holiday
homes.

OTHER DISORDERS
SEIZURES
Seizures are episodes of abnormal motor, sensory, autonomic or psychic activity resulting
from sudden excessive discharge from cerebral neurons. A part or all of the brain may be
involved.
CLASIFICATION OF SEIZURES

Partial seizures that begin in one part of the brain

Generalized seizures that involve electrical discharge in the whole brain

CAUSES
Electrical disturbance in the nerve cells in one section of the brain, causing them emit abnormal,
recurring, uncontrolled electrical discharge
Specific causes : idiopathic (genetic, development defects) and acquired that cause vascular
insufficiency, fever head injury.

CHARACTERSTICS

Excessive neuronal discharge

Loss of consciousness
Excess movement
Loss of muscle tone
Disturbance of behaviour
Mood, sensation and perception

NURSING MANGEMENT DURING SEIZURES

The major responsibility of the nurse is to observe and record the sequence of symptoms. The
nature of seizures usually indicates the type of treatment that is required.

The circumstances before the seizure(visual, auditory, olfactory )

Occurrence of an aura
The first thing