BS 7OTHER PSYCHIATRIC DISORDERS
Cognitive disordersPersonality disordersDissociative disorders
Obesity & eating disorders
I Cognitive disorders
Involve problems with memory, orientation & level of consciousness
These are due to abnormalities in neural chemistry, structure / physiology originating in the brain secondary to systemic illness
These pts may show secondary psychiatric symptoms – depression, anxiety, paranoia, hallucinations & delusions
The major cognitive disorders are: delirium, dementia & amnestic disorder.
Delirium A temporary state of mental confusion and
fluctuating consciousness resulting from high fever, intoxication, shock, or other causes. It is characterized by anxiety, disorientation, hallucinations, delusions, and incoherent speech.
Delirium tremens: An acute, sometimes fatal episode
of delirium that is usually caused by withdrawal or abstinence from alcohol following habitual excessive drinking and that is characterized by sweating, trembling, anxiety, confusion, and hallucinations.
Etiology: CNS trauma, infection, high fever, substance abuse / withdrawal . Sometimes hepatic diseases
More common in children / in elderly Commonest psychiatric manifestation in hospitals Associated with acute medical illness, autonomic
dysfunction & EEG changes- fast wave activity Symptoms worse in the nights (sundowning ) Develop quickly – fluctuating course – alternating
with lucid intervals Treatment: is to treat underlying medical problem
Dementia Loss of memory & intelligence Cause: Alzheimers is major cause 55%, vascular
diseases10%, CNS diseases like Huntington’s & parkinsonism, CNS trauma / infection like HIV
More common in elderly 20% over 65 yr have it Not associated with medical illness / autonomic
dysfunctions Normal EEG, normal consciousness, no psychotic
symptoms Develops slowly – progressive course No effective treatment – pharmaco & supportive
therapy Not reversible
Amnestic disorder
Loss of memory with few cognitive problem Thiamine deficiency due to long term alcohol
abuse, temporal lobe trauma, vascular disease & infection (herpes simplex encephalitis)
No medical illness / no autonomic dysfunction – normal EEG
Normal consciousness, no psychotic symptoms Confubulation (lieing to hide memory loss) Slow & progressive No treatment – pharmaco supportive therapy
Alzheimer's disease
Most common dementia Gradual loss of memory & intellectual function,
lack of judgment, depression & anxiety Later psychosis- progress to coma & death Should be differentiated from psudodementia &
normal aging Genetic association: abnormalities in
chromosome 21 (trisomy / down synd / mongolism), 1 & 14 (early onset), apolipoprotein E4 gene on chromosome 19
More common in women
Decreased activity of Ach, abnormal processing of amyloid precursor protein
Brain ventricles enlarged Diffuse atrophy of cortex & flattened sulci Loss of cholinergic neurons, senile amyloid plaques,
neuro fibrillary tangles, neuronal loss in hippocampus & cortex
Progressive, irreversible, downhill course
Treatment: Acetylecholinestrase inhibitors (e.g tacrine - cognex) psychotropic agents used to treat anxiety, depression & psychosis)
Dementia of alzhiemer’s type: Brain dysfunction, Severe memory loss, other cognitive problems, decrease in IQ, disruption of normal life
Management: Structural environment, cholinestrase inhibitors (tacrine), nursing home
Pseudodementia: Depression of mood, few cognitive problems, Moderate memory loss, no decrease in IQ, disruption of normal life
Treatment: Antidepressants, ECT, Psychotherapy
Normal aging: minor changes in the normal brain, minor forgetfullness, reduction in the ability to learn new things quickly, no decrease in IQ, no disruption of normal life
Treatment: no medical intervention, practical & emotional support from physician
II Personality disorders
Chronic life long rigid unsuitable patterns of relating to others that cause social & occupational problems
They do not realize their own problems – no insight – do not have frank psychotic symptoms & do not seek psychiatric help
According to DSM IV, PDs are classified in to:
Cluster A Cluster B Cluster C
Cluster A
Hall mark: Avoids social relationship – is peculiar, but not psychotic
Genetic / familial association: Psychotic illness may be there among other family members
They may be Paranoid – distrustful, suspicious / litigious – blame others for their own problems
Schizoid: long term voluntary social withdrawal Schizotypal –peculiar appearance, magical
thinking, odd thought patterns behavior
Cluster B Hall mark: dramatic., emotional & inconsistent Genetic / familial association: mood disorders &
substance abuse
Histrionic : theatrical (overly dramatic), extroverted, emotional & sexually provocative life of the party – cannot maintain intimate relationship
Narcissistic: self admiration, vanity & pompous – lack respect to others
Antisocial: no concern for others, criminal behavior Borderline: impulsive, unstable behavior & mood,
self mutilation, mini psychotic episodes suicidal attempt for trivial reasons
Cluster C
Hall mark: Fearful, anxious Genetic / familial association: anxiety disorders Avoidant: socially withdrawn, inferiority complex,
sensitive to rejection Obsessive-compulsive: perfectionist, orderly,
inflexible & indecisive Dependent: poor self confidence, allow others to
decide Passive-aggressive: procrastinates (lazy,
careless), inefficient – shows outward compliance, but inward defiance
Treatment
Individual / group psychotherapy – if they seek help
Drugs are useful to treat symptoms like depression & anxiety
III Dissociative disorders
Short temporary amnesia / identity due to psychological factors
Due to disturbing emotional experience in recent / remote past
Classified in to 4 types
Dissosiative amnesia
Failure to remember important information about onself –amnesia may last for few mts to several days
Dissociative fugue
Amnesia & sudden disappearance from home with different identity – person is aware what he is doing
Dissociative identity disorder
Formerly known as multiple personality disorder – in forensic setting, malingering & alcohol abuse should be excluded
Depersonalization disorder
Persistent detached attitude from one own body, social situation / environment
Treatment: Hypnosis, amobarbitol sodium interview & long term psychotherapy
IV Obesity & eating disorders
Obesity: More than 20% over weight 25% adults are overweight in US Genetic factor + More common in lower socio economic group –
associated with increased risk of cardiorespiratory problems, hypertension, diabetes & orthopedic problems
Treatment: sensible dieting & exercise is most effective way
Eating disorders: Anorexia nervosa & bulimia nervosa More common in women of higher socio
economic groups in US than in any other country
Anorexia nervosa
Extreme weight loss >15%Amenorrhea, hypercholesterolemia, anemia, lanugos (fine infant hair on body)
Refusal to eat despite normal appetite, lack of interest in sex, excessive exercising – was a perfect child in the beginning
Hospitalization, family therapy, psychoactive drugs like periactin
Bulemia nervosa
Normal body weight, esophageal varices, menstrual disorders
Binge eating, vomitting, poor self image, depression & excessive exercise
Cognitive & behavior therapy, anti depressants, psychotherapy