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. F00-F09 :ORGANIC , INCLUDING SYMPTOMATIC , 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, damage and dysfunction

DEMENTIA IN ALZHEIMER`S DISEASE ( Chronic Organic Brain Syndrome)

Dementia is an acquired global impairment of Intellect, Memory , and Personality but without Impairment of consciousness.

Alzheimer's type dementia is an irreversible disease marked by global , progressive impairment of cognitive functioning , memory, and personality

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

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, metals and toxins Excessive amount of metal ions such as Zink and copper in brain Other possible factors are Deficiency of Vit B6 , 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

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

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

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 , Anxious

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

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

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

Course and prognosis

Insidious onset Slow progress

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

DIAGNOSIS

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

TREATMENT

NURSING MANAGEMENT AIMS

Promote Intellectual Abilities

Maintain independence

Avoid injuries

Good quality of life

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

NURSING DIAGNOSIS

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

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

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

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

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

7. MOOD AND EMOTION: Prtovide calm environment Administer medications 8. WANDERING: Identification bracelet or cards Lock doors Accompany while going out side 9. DISTURBED SLEEP: Maintain sleep pattern Avoid day time napping Avoid sleeping pills

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

Delirium (S&S)
consciousness , drowsiness Attention deficit ; easily distraction, inability to focus-sustain-shift attention, 100-7, DF-DB memory/orientation problem Disorientation ; time>place>person

Prodrome ; agitation, mood, anxiety, insomnia Disturbance of consciousness ; clouding of

Sleep-wake disturbance ; reverse cycle ,

insomnia may be the cause of delirium

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. + old age + Shock + multiple drugs + DM,HT + etc. CVA , Mass lesion Hypertensive encephalopathy Drug intoxication Meningitis R/O DT

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