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