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BEHAVIORAL SCIENCE
Izben C. Williams, MD, MPHInstructor
Lecture # 13
SOME OTHER PSYCHIATRIC DISORDERS
Other Psychiatric Disorders
Some other psychiatric disorders
COGNITIVE DISORDERSPERSONALITY DISORDERSDISSOCIATIVE DISORDERSOBESITY AND EATING
COGNITIVE DISORDERS
Other Psychiatric Disorders
DEF: CognitionCognition is the set of all mental abilities and processes related to knowledge: It includes attention, memory & working
memory, judgment & evaluation, reasoning & "computation", problem solving & decision making, comprehension & production of language, etc.
Other Psychiatric Disorders
Cognitive Disorders: 1Delirium, Dementia, and Amnestic disorder
They are caused by general medical conditions, substances, or a combination of these factors
Cognitive disturbances involve symptoms such as Memory impairment Speech and language difficulties Altered level of consciousness, confusion Impairment of ability to plan and engage in complex
tasks
Other Psychiatric Disorders
Cognitive Disorders: 2a. These difficulties are due to abnormalities in
neural chemistry, structure, or physiology originating in the brain or secondary to systemic illnesses
b. Patients with cognitive disorders may show psychiatric symptoms secondary to the cognitive problems (eg. Depression, anxiety, paranoia, hallucinations and delusions)
See characteristics and etiology of cognitive disorders in text….. (Fadem: Table 14-1, p131)
Other Psychiatric Disorders
Cognitive Disorders: 3DELIRIUM - Diagnostic features:
Clouding of consciousnessImpaired cognitionShort or fluctuating courseNot better explained by dementiaCaused by general medical condition or
dementia
Other Psychiatric Disorders
Cognitive Disorders: 4DELIRIUM – Associated features and
Diagnose:Disturbance in sleep-wake cycleDisturbance in psychomotor behaviorEmotional disturbancesAbnormal electroencephalogram Evidence of general medical condition or
substance use
Other Psychiatric Disorders
Cognitive Disorders: 5
DELIRIUM – Epidemiology:Children and the elderly are most susceptibleStudies indicate that up to 25% of elderly
hospitalized patients have delirium
Other Psychiatric Disorders
Cognitive Disorders: 6DELIRIUM – Treatment:
Correct the underlying causeEnvironmental management – quiet well-
lighted room and frequent orientation can decrease agitation
Protective restraints or antipsychotic medication can control or decrease agitation and risk of injury
Other Psychiatric Disorders
Cognitive Disorders: 7DEMENTIA – Diagnostic features:
Memory impairment – develops insidiously; as dementia progresses, learning deficits become more prominent, and recent memories are lost. Eventually, older memories are compromised. Increased rick of physical dangers
Aphasia – loss of language function (word finding, sentence construction, understanding instructions) communication becomes increasingly more difficult sometimes resulting in mutism.
Other Psychiatric Disorders
Cognitive Disorders: 8DEMENTIA – Diagnostic features:
Apraxia – inability to execute complex motor behaviors
Agnosia – failure to recognize or identify previously known objects and is not due to impaired sensory function
Disturbance in executive function – impaired ability to think abstractly and plan. Initiate, sequence, monitor, monitor and stop complex behavior. Difficulty conceptualizing or solving problems (eg. a grocery list)
Other Psychiatric Disorders
Cognitive Disorders: 9DEMENTIA – Associated features and
Diagnosis:Emotional changes – labile and disinhibitedPersonality disturbances – moody, irritable,
mood ± Psychotic symptoms – usually delusionsNeuroimaging – generalized or focal cerebral
atrophy, enlarged ventricles and cortical sulci, Evidence of general medical condition or
substance use
Other Psychiatric Disorders
Cognitive Disorders: 10DEMENTIA – Epidemiology:
The prevalence of dementia varies by age……. 5% of population older than age 65 20% of population older than age 85 More than 75% of dementia is caused by
Alzheimer’s Disease or cerebrovascular disease
Familial pattern: some types of neurodegenerative dementias are heritable
Other Psychiatric Disorders
Cognitive Disorders: 11DEMENTIA – Course
Depending on the underlying cause, the onset of dementia may be sudden or gradual and function may stabilize or deteriorate
In children , dementia may result in developmental delays rather than deterioration of function
Other Psychiatric DisordersCognitive Disorders: 12DEMENTIA – Etiologies
Neurodegenerative diseases: include Alzheimer, Parkinson, Pick, Huntington diseases and ALS-dementia complex
Infectious causes; include HIV, Creutzfeldt-Jakob disease, viral, bacterial or parasitic brain infections,
Cerebrovascular disease, epilepsy, traumatic brain injury and other intracranial processes
Substance-induced persisting dementias: the commonest is alcohol
Other Psychiatric DisordersCognitive Disorders: 13DEMENTIA – Treatment:
Stabilizing or correcting underlying general medical condition
Medication: antipsychotic for psychotic symptoms
Familiar surroundings, reassurance, and support
Other Psychiatric DisordersCognitive Disorders: 14AMNESTIC DISORDERS – Diagnostic
Features:The essential feature of amnestic disorders is
impairment of memory, which does not occur solely during the course of delirium or dementia Memory impairment – difficulty learning
new information; immediate memory relatively in tact but mid term memory at risk;
Other aspects of cognition are relatively in tact
Other Psychiatric DisordersCognitive Disorders: 15AMNESTIC DISORDERS – Associated
features Confusion and disorientation as a result of
recent memory impairmentConfabulation – they imagine events to
compensate for faulty recall (and may adamantly defend their ideas)
Emotional changes – subtle emotional changes; sometimes appear inappropriately unconcerned and amotivated
Other Psychiatric DisordersCognitive Disorders: 16AMNESTIC DISORDERS – Epidemiology &
CourseMore common in populations with higher
prevalence of alcohol abuse and head traumaYoung adult men and individuals with antisocial
personality disorder are at greater riskCourse:
Onset may be rapid (eg. when resulting from trauma or biochemical injury)
More insidious onset in neurodegenerative conditions
Other Psychiatric DisordersCognitive Disorders: 17AMNESTIC DISORDERS – Etiologies
Bilateral damage (transient or chronic) to the diencephalon and medio-temporal structures (eg. mamilary bodies, fornix, hippocampus) may produce memory dysfunction in the absence of other cognitive symptoms
Such damage can be caused by Acute and chronic alcohol use and thiamine
deficiency, Head trauma, CVS disease, hypoxia, seizures,
infections, chronic use of some psychotropic medication
Other Psychiatric DisordersCognitive Disorders: 17AMNESTIC DISORDERS – Treatment
As with delirium and dementia, stabilization or correction of the underlying medical condition is definitive Tx for amnestic disorders
Avoid further brain insults of any kindFamiliar surroundings, reassurance and
support as patient gradually becomes reoriented
Other Psychiatric Disorders
PERSONALITY DISORDERS
Personality DisordersWhat is this Personality that may
become disordered?PERSONALITY:
DEF: The set of ingrained characteristics (traits) that define the behavior, thoughts and emotions of an individual
These characteristics allow us to maintain an equilibrium between our internal drives and the world around us, and they dictate our lifestyle (modus operandi)
Personality DisordersA Personality disorder is a chronic or
lifelong pattern of behavior that is characterized by a group of traits that are:Severely dysfunctional in terms of
interpersonal relationshipsUsually more troublesome to others than to
the affected individualRelatively stable over time
Personality DisordersClusters of Personality disorders: 1. Cluster A: The odd and eccentric group
(paranoid, schizotypal, schizoid)2. Cluster B: The dramatic, emotional, and erratic
group in which self-preoccupation predominates (narcissistic, histrionic, borderline, antisocial)
3. Cluster C: Anxious and fearful group(obsessive- compulsive, dependent, avoidant)
This grouping into three clusters is based on similarities in symptoms or traits
Personality DisordersEach cluster has its own hallmark
characteristics and genetic or familial associations
Diagnosis depends also on a personality disorder being present by early adulthood
See diagnostic characteristics for individual disorders (Fadem: Table 14.3)
A diagnosis of antisocial personality disorder is not made before age 18, conduct disorder is ascribed instead.
Personality DisordersIndividuals in each cluster have a tendency
to employ particular defense mechanisms :Cluster A: Affected individuals use the defense
mechanisms of projection and fantasy and may have a psychotic tendency
Cluster B: Affected individuals tend to use dissociation, denial, splitting and acting out
Cluster C: Affected individuals tend to use isolation, passive aggression, and hypochondriasis
Personality DisordersTREATMENT:
Individual and, where tolerable, group psychotherapy may be useful for those who seek help
Pharmacotherapy can be useful on treating symptoms of co-morbid conditions such as depression and anxiety
However personality disorders are, by and large, resistive to treatment
Other Psychiatric Disorders
DISSOCIATIVE DISORDERS
Dissociative Disorders
DISSOCIATIVE DISORDERS: are a group of psychiatric syndromes characterized by sudden, temporary disruption in some aspect of consciousness, identity, or motor behavior
Dissociative Disorders
DISSOCIATIVE DISORDERS Several types are recognized
1) Dissociative amnesia (includes fugue)2) Dissociative identity disorder (mpd)3) Depersonalization-derealization
disorder (includes trance)See characteristics @ MAYO Clinic siteDissociative fugue (psychogenic fugue)Possession/trance disorder
Dissociative Disorders
DISSOCIATIVE DISORDERS Although these syndromes are statistically
rare, when they do occur they present very dramatic clinical pictures of severe disturbance in normal personality functioning
Under normal circumstances the functions of memory, personal identity and motor behavior are critical for the integrated operation of the complex set of mental and behavioral activities we call personality
Dissociative Disorders
DISSOCIATIVE DISORDERS Etiology: dissociative disorders are
commonly related to disturbing emotional experiences in the patient’s recent or remote past
Other Psychiatric Disorders
OBESITY AND
EATING DISORDERS
Obesity OBESITY DEFINITION:
Obesity is a complex disorder involving an excessive amount of body fat.
Being more than 20% over ideal weight (based on weight height charts), or having a body mass index (BMI) of 30 or higher is considered obese
BMI is: weight in kg/height in m²
Obesity
BMI Weight status
Below 18.5 Underweight
18.5-24.9 Normal
25.0-29.9 Overweight
30.0-34.9 Obese (Class I)
35.0-39.9 Obese (Class II)
40.0 and higher Extreme obesity (Class III)
Obesity OBESITY EPIDEMIOLOGY:Profiling an epidemic (HSPH)
In 1990, obese adults made up less than 15 percent of the population in most U.S. states.
By 2010, 36 states had obesity rates of 25 percent or higher,
12 of the 36 had obesity rates of 30 percent or higher.
Obesity OBESITY EPIDEMIOLOGY:Profiling an epidemic (HSPH)
Today, one out of three adults in the US is obese (36 percent) and roughly two out of three are overweight or obese (69 percent)
The health implications of this NCD trend, are profound
Obesity OBESITY EPIDEMIOLOGY:Profiling an epidemic (HSPH)
Even more alarming, the prevalence of overweight and obesity in children and adolescents is on the rise, and youth are becoming overweight and obese at earlier ages.
Genetic factors play an important role in obesity. Adult weight is closer to that of biologic rather than adoptive parents
Obesity One out of six children and adolescents
ages 2 to 19 is obese and one out of three is overweight or obese.
Early obesity not only increases the likelihood of adult obesity, it also increases the risk of heart disease in adulthood, as well as the prevalence of weight-related risk factors for cardiovascular disease such as high blood pressure, high cholesterol, and high blood sugar
Life is real simple
As easy as 1..2…3
Obesity
TREATMENT Physiological/(understanding the
physiologic control of eating behavior) Behavioral Environmental/social Dietary manipulation Pharmacological Surgical
Transition
Eating Disorders
DEFINITION: Any of a range of psychological disorders characterized by abnormal or disturbed eating habits. Includes 1. Anorexia Nervosa2. Bulimia Nervosa
Eating Disorders1. Anorexia Nervosa
Anorexia nervosa is an eating disorder that is characterized by obsessional weight loss without an identifiable organic cause
Disregards acceptable weight for age & height
Fear of gaining weight or becoming obese Disturbed body image Amenorrhea (for 3 consecutive cycles
Eating Disorders
1. Bulimia Nervosa (2 types purge/nonpurge)
Is characterized by ravenous over eating followed by guilt, depression, and anger at oneself for doing so. Other features….
Recurrent episodes of binging Recurrent inappropriate weight-controlling
behavior Self-evaluation unduly influenced by shape and
weight
Eating Disorders
TREATMENT: