Sie sind auf Seite 1von 38

Delirium, Dementia and

Amnestic Disorders
Second Year Psychiatry

Cognition
The mental process of knowing.
Includes awareness, perception,

reasoning, judgment, memory,


language, orientation, conducting
personal relationships,
performing actions and problem
solving.

Cognitive Disorders
Disruptions in the acts and

processes involved in cognition.


Usually associated with
behavioral symptoms.

Historical Background
Used to be classified under

organic mental disorder.


Under DSM-IV-TR, classified
under
Delirium, Dementia and
Amnestic
and other Cognitive Disorders

Historical Background
In DSM-V, under Neurocognitive

Disorders
Delirium retained
Dementia replace with major and
minor neurocognitive disorder
Emphasis on decline in functioning
rather than memory disturbance

Areas of Primary
Disturbance
Delirium level of consciousness

with associated impairments in


memory, judgment, orientation
and attention

Areas of Primary
Disturbance
Dementia impairment in

memory, language and intellect


Amnestic Disorder impairment
in memory in the absence of
clouded consciousness and
deficits in other areas of
cognition

Delirium
Acute onset of disturbance in

level of consciousness and


fluctuating cognitive
impairments.
Reflects response to widespread
altered cerebral functions.

DSM-IV-TR Classification of Delirium


Delirium due to a general medical
condition (indicate the condition)
Substance intoxication delirium
Substance withdrawal delirium
Delirium due to multiple
etiologies (indicate the etiologies)
Delirium not otherwise specified

Epidemiology Delirium
Higher prevalence and incidence
in
Elderly
Multiple medical problems
Hospitalized patients especially
critically ill patients
Terminally ill patients

Clinical Features of
Delirium
Primary feature -diminished clarity of

awareness of the environment


(disturbance of consciousness)
Language and other cognitive changes
Perceptual disturbances
Disturbance in sleep and wakefulness
Disturbance in orientation
Disturbance in arousal level

Clinical Features of
Delirium
Develops over a short period of

time (hours or days)


Tends to fluctuate over the course
of a day
From history, PE or laboratory
there is/are identified condition/s
or substance/s as a likely etiology

Causes of Delirium
Infections
Metabolic and endocrine abnormalities
Intracranial states
Hypoperfusion states
Substance intoxication/withdrawal
Postoperative states
Sensory and environmental changes

Evaluation of Delirium

Evaluation of Delirium

Evaluation of Delirium

Management of Delirium
Find cause/s
Correct or eliminate cause/s
Supportive therapy,

environmental control
Pharmacologic agents

Course and Prognosis Delirium


After cause/s removed symptoms

usually recede over 3 to 7 days.


Seldom persist beyond 2 weeks if
causative factors are reversible
and removed.
Older patients and longer duration
of delirium longer time to resolve

Dementia
A progressive impairment of

multiple cognitive functions


occurring in an individual with
clear consciousness
Global impairment in intellect
Decline from a higher level of
function

DSM-IV-TR Classification of
Dementia
Alzheimers Type
Vascular Dementia
Due to Other General Medical

Conditions
Substance Induced Persisting
Dementia
Dementia Due to Multiple Etiologies
Not Otherwise Specified

Epidemiology of
Dementia
65 years and older 5%
85 years and older 20% to 40

%
General medical outpatient
15% to 20%
Chronic care facilities 50%

Potentially Reversible
Causes
of Dementia
Structural central nervous

system factors
Vascular factors
Head trauma
Subdural hematoma
Normal-pressure hydrocephalus
Multiple sclerosis

Potentially Reversible Causes of


Dementia
Psychiatric illnesses

Major depression
Substance dependence
Systemic/metabolic factors /infectious diseases
Hypothyroidism
Hypercalcemia
Hypoglycemia
Thiamine, niacin, B12 deficiency
Renal failure
Hepatic failure
Medications
CNS infections

Clinical Features of
Dementia
Multiple cognitive deficits

-memory impairment inability to learn


and recall
- apraxia impaired ability to carry out
motor functions
-agnosia inability to recognize or identify
objects
-disturbance in executive functioning
planning,
organizing, sequencing,
abstracting

Clinical Features of
Dementia
Decline from a higher level of

functioning
Gradual onset and continuing
cognitive decline
Does not occur exclusively in the
course of a delirium

Evaluation of Dementia

Treatment and Management of


Dementia
Identification and correction of

possible cause
Environmental manipulation to
reorient patient
Multiple interventions involving
family and patient
Pharmacological management when
appropriate

Course and Prognosis of Dementia


Factors which influence course and

prognosis
-etiology
-time span between onset and start of
treatment
-presence of comorbid psychiatric
symptoms
-level of psychosocial support

Delirium vs. Dementia

Depression vs. Dementia

Amnestic Disorder
characterized by a lost of

memory due to effects of a


general medical condition or
persisting effects of a substance

DSM-IN-TR Classification of
Amnestic Disorder
amnestic disorder due to a general

medical condition
substance-induced persisting
amnestic disorder
not otherwise specified

Clinical Features of Amnestic


Disorder
development of memory impairment

manifested by inability to learn new


information and to recall previously learned
information
represents a decline from a previous level of
functioning
does not occur exclusively in the course of a
delirium or dementia
presence of a general medical condition of
evidence of persisting effect of a substance

Causes of Amnestic
Disorder

Treatment and Management of


Amnestic Disorder
Directed at identifying and

correcting underlying cause


Psychosocial intervention

Course and Prognosis of


Amnestic Disorders
Depends on underlying cause
Transient global amnesia and

amnestic disorder due to head


trauma have better outcomes
Generally little improvement over
time but no progression seen too for
those due to other causes

Reference
Sadock BJ, Sadock, VA. . In Kaplan and

Sadocks Synopsis of Psychiatry. Philadelphia,


PA: LWW; 2007, 319-350.

MARAMING SALAMAT!!!

Das könnte Ihnen auch gefallen