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Neuropsychiatric Disorders

Dr. Adel Alzayed


Kuwait University – Medical College
Psychiatric Department
Introduction
• The term refers to psychiatric
disorders which all arise from
demonstrable abnormalities of brain
structure and function.
• Cognitive processes but behavioral
and emotional are also common and
may be the sole manifestations of
the brain disease.

Categories of Disorder

• Acute generalized cognitive


impairment (delirium).
• Chronic generalized cognitive
impairment (dementia).
• Specific neuropsychiatric syndromes.
Acute generalized cognitive
impairment
(delirium)
Delirium
• Characterized by global impairment in
consciousness.
• Reduced level of alertness, attention
& perception.
• occurs in 5 – 15% of patients in
general medical or surgical ward.
• If not well treated associated with a
high mortality.
Clinical features

• Altered consciousness.

• Disorientation of time place and


person, which typically fluctuates
over the course of 24 hours with
nocturnal deterioration.

Other features
• Mental slowness.
• Distractibility.
• Perceptual abnormalities.
• Disorganization of the wake-sleep
cycle.
• Repetitive, purposeless movements.
• Ideas of reference.
• Emotional lability.
• Depersonalization & derealization.
General principles of management
• Identify and treat the underlying cause.
• General measures to relieve distress
control agitation, and prevent exhaustion.
– Frequent explanation
– Reorientation.
– Reassurances
• Avoid frequent change of caring staff.
• Family and friends should visit frequently.
• Should be nursed in a single well light
quite room
Drug treatment

• Drug treating the underlying cause


should be at the minimum required.
• Antipsychotics might be required to
reduce agitation.
• Short acting benzodiazepines at night
might be required to promote sleep.

Chronic generalized cognitive
impairment
(dementia)
Dementia

• Dementia is a syndrome rather than a


diagnosis.
• The term refers to a global
deterioration of higher mental
functioning in clear consciousness.
• It is a progressive and (usually)
irreversible impairment of intellect
& personality.
Manifestations
• The most obvious manifestations are:
– disruption of memory (long & short).
– Language (nominal aphasia being
particularly common).
– Intelligence in term of reasoning,
judgment and performance in IQ tests.
Other features
• Changes in personality and in behaviour.
• Aggression.
• Sexual disinhibition.
• Apathy.
• Depression.
• Anxiety.
• Sleep disturbances.
• Psychotic symptoms (1/3 of subjects).
Epidemiology

• Rare before the age of 65.


• 1% of those aged 65 – 74.
• 10%of those > 75.
• 25% of those aged > 85.

Classification
• Degenerative (Alzheimer’s).
• Vascular (multi-infarct dementia).
• Dementia due to toxic effect
(Alcohol).
• Head trauma (boxers head).
• Infections (HIV).
• Others (Lewy body dementia)
Alzheimer’s dementia

• The most common form of all dementias


(50% of cases).
• Main feature progressive
deterioration in mental abilities.
• If parietal lobe is involved
prognosis is worse.

AD.
• Aetiopathology:
– Brain is shrunken.
– Increased sulcal widening, & enlarged
ventricles.
– Neuronal loss.
– Amyloid plaques.
– Neurofibrillary tangles.
– Reduced in several neurotransmeters:
• Acetylcholine
• Noradrenaline
• Serotonin
• somatostatin



Vascular dementia
• 20 – 30% of cases.
• Patchy cognitive impairment.
• Focal neurological symptoms.
• Stepwise deterioration.
• Associated with H.T or other risk
factors.
VaD

• Aetiopathology:
– Multiple areas of cortical infarction.
– Volume of infarction more important
than the location.


Frontal lobe dementia

• Early personality changes.


• Relative intellectual sparing.
• Balloon like areas at the frontal
lobe.
• Incontinence occurs at early stage.
Lewy body dementia

• Accounts for about 20% of cases.


• Fluctuating cognitive functioning.
• Visual hallucinations.
• Sensitivity to antipsychotic
medications.
Specific neuropsychiatric
syndromes.
Wilson’s disease
• Hepatolenticular degeneration.
• Rare (30/million).
• Aetiology:
– Autosomal recessive.
– Copper disposition.
• Psychiatric manifestations:
– Affective.
– Behaviora.l
– Schizo. Like psychosis.
– Cognitive changes.
• Treatment:
– Decrease copper.
– Symptomatic.
Prion disease
• Rare
• Clinical features:
– Myoclonus
– Rapidly progressive dementia
• Aetiology:
– ? Related BSE

Psychiatric consequences of epilepsy
• Psychiatric & cognitive disorders
associated with the underlying cause:
– The underlying cause of epilepsy may
contribute to intellectual impairment or
personality problems.
• Behavioral & cognitive disturbances
associated with seizures:
– Increasing tension, irritability, &
depression some times occur as prodromata
before seizure.
– Transient confusional states, hallucinations,
affective disturbances may occur during
seizure.
Inter-ictal disorders
• Cognitive function:
– Few people with epilepsy show cognitive decline
• Brain damage.
• Effect of antiepileptic drugs
• Personality:
– Only minority have serious personality difficulties.
• Brain damage
• Depression & other emotional disorders:
– Depression occurs more common than in normal
population.
– Suicide rate is increased by four fold.
– Self harm by six folds.
• Inter-ictal psychosis:
– More common in temporal epilepsy.
– Usually have affective and religious tone.