BS 7 OTHER PSYCHIATRIC DISORDERS

1. BS 7OTHER PSYCHIATRIC DISORDERS Cognitive disorders Personality disorders Dissociative disorders Obesity & eating disorders

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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)

9. 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

10. 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

11. 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

12. According to DSM IV, PDs are classified in to: Cluster A Cluster B Cluster C

13. 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

14. 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

15. 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

16. Treatment • Individual / group psychotherapy – if they seek help • Drugs are useful to treat symptoms like depression & anxiety

17. 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

22. Treatment: Hypnosis, amobarbitol sodium interview & long term psychotherapy

23. 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

24. Eating disorders: • Anorexia nervosa & bulimia nervosa • More common in women of higher socio economic groups in US than in any other country