ORGANIC MENTAL

DISORDERS

Dr.Deddy Soestiantoro Sp.KJ M.Kes

 ORGANIC MENTAL DISORDERS
( OMD )
The conditions maybe psychotic or non
psychotic
-the term mental organic syndromes means
for some conditions without the etiological
involvement.
-in the mental organic disorders,the
etiological factors must be present,that
means that structure damage or
dysfunctions later will be causing the
mental and behavioural disorder.
 ORGANIC MENTAL DISORDERS
( OMD )
The conditions maybe -but the
damage/dysfunction are not a single
factor,it is also influenced by premorbid
personality and also the stress from the
environment.
In OMD there are 2 main subtypes: the
psychotic and the non psychotic
disorders.

THE CLINICAL SYMPTOMS:

I.The primary symptoms that caused
by the damage.
II. The secondary symptoms .
I.The primary symptoms that caused by the
damage:
-orientation disorders,
-memory disorders usually the short term,maybe
theres also confabulation,
-disorders of the intellectual performance such a
comprehension,problem solving and numerical
ability,
-judgement disorders,
-emotion instability,
-disorders in the abstract thought process.
II.The secondary symptoms as an
additional symptoms as a response to the
additional stress caused by the primary
symptoms.

Actually these secondary symptoms will be

determining the conditions as a psychotic or
non psychotic disorders.
Some of the secondary symptoms :
-restlesslness,
-anxiety and fear,
-hallucinations ( usually visual or tactile,
and rarely auditoric ),
-illusions.
REALITY TESTING ABILITY

There are 3 aspects of the personality, wether

psychotic or not,its depends on the
dysfunction/disorder/disturbance of these
aspects.

-Affectve----Stimmung
- Thought-----Denken
-Behaviour and instinctual drive---Handlung
REALITY TESTING ABILITY

I.Affective /Stimmung
-afective state: hyperthymia, hypothymia,
poikilothymia,disthymia,
blunted/flat/inappriate affect,
-emotional state.
REALITY TESTING ABILITY

II.Thought /Denken
-intellectual function:memory, concentration,
orientation,discriminativejudgement/insight,
intelligency level,dementia etc
-sensation & perception:illusion,hallucination
-thought process:
-psychomotility,quality,
- associations,content and form etc
REALITY TESTING ABILITY

III.Behaviour and instinctual drive/ Handlung

-abulia/hypobulia ,stupor,raptus,
impulsivity, sexual deviation,
vagabondage,pyromania,mannerism,
mutisme,autisme etc
OTHER CLASSIFICATION:

A.Reversible or Acute Brain Syndromes

some symptoms:
-confusion,delirium, stupor, coma,
-hallucinations and illusions,
-anxiety, fear and restlessness,
-fluctuations/variation of symptoms
during 24 hours,
-tendency to recover quickly, and loss of
memory of the conditions during the
sickness.
B.Irrevesible or Chronic Brain Syndromes

-intellectual function disorders,

-tendency to gradual/slow but progressive
and irreversible,
-clinically known as dementia.

Clinically, delirium actually is the most cases

seen in the acute organic brain syndromes.
 DELIRIUM and DEMENTIA
DELIRIUM
1.Mental level: -lower
2.Main involvement:
-sensorium,instinctual and
affective state,
3.Anatomic localization:
-brainstem, limbic lobe,
ANS, sensory cortex,
4.Psychological area:
-Id and Ego,
5.Main symptoms:
-clouded conciousness,
disorientation, abnormal
affective, confusion, and
characteristic.visual
hallucinations,
6.Etiology:
-acute trauma, toxic,drugs
and metabolic causes.
DEMENTIA
-higher
-intellect,abstraction,judgment,
programming and creativity.
-temporal,parietal and
frontal lobes.
-Ego and Super Ego.
-loss of memory , learning,
reasoning,problem solving /
executive functioning ,
judgment and personality.
-sequelle of trauma,structural
and degenerative diseases.
ETIOLOGY of DELIRIUM
-intracranial,
-extracranial e.g use of drugs,
-deficiency diseases,
-systemic infections,
-electrolyte imbalance,
-post operative,
-traumatic (body/head).
Long sensoric deprivations or total isolation
may cause mild delirium similar to
psychotic, but with quick recovery such as
long distance driver,gray out,white out,
rapture of the deep,black patch psychosis,
and cardiac psychosis.
 F10-F19 Mental & behavioural disorders due to
psychoactive substance use
Usually due to use of alcohol,opioids,cannabinoids,sedatives or
hypnotics, cocaine, other stimulants including caffeine, tobacco,
hallucinogens, volatile solvents,multiple drug use and use of
other psychoactive substances.

The clinical conditions usually in acute intoxication or in

withdrawal state with one of the mental & behavioural disorders
is delirium.
 DSM IV: Substance-Induced Delirium

Substance Intoxication Delirium

A.Disturbance of conciousness (i.e reduced clarity of awareness
of the environment) with reduced ability to focus,sustain or shift
attention.
B.A change in cognition (such as memory deficit,disorientation,
language disturbance) or the development of a perceptual
disturbance that is not btter accounted for by preexisting ,
established, or evolving dementia.
C.The disturbance develops during a short periode of time
(usually hours to days) and tends to fluctuate during the course
of the day.
D.There is evidence from the history,physical examination or
laboratory findings of either (1) or (2):
(1)the symptoms in Criteria A & B developed during substance
intoxication
(2)medication use is etiologically related to the disturbance
Specific Susbtance Intoxication Delirium
-alcohol,amphetamine (or amphetamine-like subtance),
-cannabis, cocaine, hallucinogen, inhalant,
-opioid, phencyclidine (or phencyclidine-like substance),
-sedative, hypnotic or anxiolytic,
-other / unknown substance ( e.g cimetidine, digitalis,benztropine)

Subtance Withdrawal Delirium

A,B,and C. The same as before.
D.There is evidence from the history,physical examinations,
laboratory findings that the symptoms in Criteria A and B
developed during or shortly after, a withdrawal syndrome.

Specific Substance Withdrawal Delirium:

-alcohol,sedative,hypnotic,anxiolytic and other/unknown
substance.
Note:
This diagnosis should be made instead of a diagnosis of
Substance Intoxication or Substance Withdrawal only when the
cognitive symptoms are in excess of those usually associated
with the intoxication or withdrawal syndrome and when the
symptoms are sufficiently severe to warrant independent clinical
attention.