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1、Organic mental disorders,Zoltn Hidasi,What is organic?,NeurologyPsychiatryOrganic psychosyndromesOrganic(mental)disordersFunctional disorders,Neuropsychiatry,Biological psychiatryCognitive neuroscience Neuropsychology(Neurology Psychiatry)Neuropsychiatry,DSM IV TR,Delirium,dementia,amnestic disorder
2、s and other cognitive disorders.DSM V:Major/mild neurocognitive disorderMental disorders due to a medical condition,ICD 10,Organic and symptomatic mental disordersDementiaOrganic amnestic syndromeDeliriumOther mental disorders caused by brain lesion and dysfunction or somatic disorderOrganic halluci
3、nosis,organic catatonia,organic delusional disorder,organic mood disorder,organic anxiety disorder,etc.Mental and behavioural disorders caused by psychoactive substances,Etiology,causes,pathology,Central nervous systemNeurodegenerationCerebrovascular originInflammation,tumorDemyelinationEpilepsyTrau
4、maOtherOutside the central nervous systemEndocrineMetabolic,cardio-vascular diseasesNutritional disturbanceInfectionDrug intoxication,drug withdrawalAlcohol,illegal drugs,medication,From neurological point of view,Cerebrovascular diseasesNeurodegenerativ diseases Parkinsons disease,other movement di
5、s.EpilepsyHead trauma brain injuriesTumorsNeuroinfectionsNeuroimmunology(multiple sclerosis),Classification of syndromatology,Acute chronicDiffuse(global)focal(local)-multifocal brain disfunctionLobe syndromesFRONTAL apathy,disinhibition,lack of iniciative and spontaneity,motivation,perseveration,im
6、pulsivity TEMPORAL affective,agression,fear,explosion,psychosis,disorientationPARIETALgnostic and cognitive dysfunctions(alexia,acalculia,agraphia),apraxias,Delirium-Syndromatology,Acute course(sudden onset,short episode)Impairment of consciousnessGlobal impairment of cognitive functions(memory,atte
7、ntion,orientation,thinking,etc.)Perceptual disturbance(multimodal illusions and hallucinations)Behavioural changes(agitation)Fluctuating course,Delirium-Etiology,Any cause,resulting in global dysfunctionGeneral medical condition(e.g.infection,metabolic reasons,hypoxia)Substance inducedMultiple cause
8、Therapy:Causal,symptomatological(BZD,NL),Etiology,Etiological factors?Risk(predisposing)factorsTrigger(precipitating)factorsHyperactive,hypoactive,mixed form,Risk factors 1.,Age:65+sex:maleDementia(+),other cognitive disorderDepressionVision-,hearing impairmentDehydration,malnutritionMedication(mult
9、iple drugs,psychoactive drugs),alcoholImmobility,pain,constipationSleep deprivationSaxena et al,2009.,Risk factors 2.,Somatic illnessesSevere illnessMany illnessesChronic liver or kidney failureStroke,other neurological disorderMetabolic disorderTrauma,bone fractureTerminal stateHIV infection Saxena
10、 et al,2009.,Precipitating 1.,Comorbid disordersInfectionHypoxiaSevere acute disorder(pl.AMI)Liver,kidney disorderUrinary retention,constipationAnaemiaFeverShockSaxena et al,2009.,Precipitating factors 2.,Iatrogenic complicationMetabolic imbalanceNeurological disease(head trauma)SurgeryMedication ov
11、erdose,politherapysedatives,hypnotics,anticholinergic drugs,antiepilepticsEniviromental factors(ICU,phycical restraint,bladder catheters,multiple/invasive manipulations,emotional stress)PainSaxena et al,2009.,Dementia-Syndromatology,Chronic course(10%above 65 y,16-25%above 85 y)Multiple cognitive de
12、ficits incl.memory impairment(intelligence,learning,language,orientation,perception,attention,judgement,problem solving,social functioning)No impairment of consciousnessBehavioural and psychological symptoms of dementia(BPSD)Progressive-staticReversible(15%)-irreversible,19,Cognitive/non-cognitive,N
13、on-cognitive symptomsBehavioural symptomsPsychological and behavioural symptoms zicholgiai in dementia(BPSD)delusion,hallucination,depression,anxiety,agitation/agression,euphoria/mania,disinhibition,irritability,apathy,motor behaviour,Dementia-Classification,SeverityMild cognitive impairment(MCI)Mil
14、d dementiaModerate dementiaSevere dementiaLocalization Cortical SubcorticalEtiology,Dementia-Etiology,Alzheimers disease(60-70%)Vascular dementia(10-20%)Neurodegenerative disorders(FTD,Lewy body dis,Parkinson,Huntington,etc.)Drugs and toxinsIntracranial massesAnoxiaTraumaInfections(JCD,HIV,etc)Nutri
15、tionMetabolicPseudodementia,Dementia-Diagnosis,Signs and symptomsLaboratory dataEEG,CT,MRIPsychological testing(MMS),Dementia-Therapy,Causal if possibleNootropicsNeuroprotection AChEI(rivastigmine,donepezil,galantamin)Glutamate antagonists(Memantine)BPSD(anxiolitics,antidepressant,antipsychotics,etc
16、.),Mental disorders due to a General Medical Condition(DSM IV),Psychotic disorder due to a general medical conditionMood disorderAnxiety disorderSexual disfunctionSleep disorderCatatonic disorderPersonality change,Therapy in neuropsychiatry,PharmacotherapyPsychotherapy,psycho-social treatmentImprovi
17、ng cognitive abilitiesRehabilitationTreating affective and anxiety symptomsTreating other psychological symptoms,Pharmacotherapy in neuropsychiatry 1.,Targets of pharmacotherapyEtiological background ProgressionPsychiatric symptoms Target symptom:Cognitive Agitation/aggressionMood PsychoticOther beh
18、aviouralNeurologic symptoms,Pharmacotherapy in neuropsychiatry 2.,Aspects of pharmacotherapyMental statusNeurological statusSocial statusEtiological backgroundTypical v.atypical symptoms,Pharmacotherapy in neuropsychiatry 3.,Special aspectsAgePolimorbidityPharmacokinetics(interactions)Optimal dosing(+/-)Side effects(cognitive,other),
