COGNITIVE DISORDERS

and general medical

conditions that cause
mental disturbances

Ivan Dci
 Psychiatry:
General ( description of symptoms,
syndroms)

Clinical ( description of mental disorders )

Exam on psychiatry: two questions

General Psychiatry
 General Psychiatry
Perception
Consciousness
Thought process
Mood and affect
Speech
Behavior and psychomotor activity
Cognition
IQ
 Cognition includes:
Memory
Language
Orientation
Judgement
Conducting of interpersonal relationships
Performing actions (praxis)
Problem solving
Special Psychiatry
 F0
F1
F2
F3
F5
F6
F7
F8
F9
Section F of ICD 10 overview:

F0 Dementia and psychiatric disorders due to somatic

disorders
F1 - Psychiatric disorders due to alcohol and drugs
F2 - Psychoses
F3 Mood and Affective disorders
F4 - Anxiety Disorders
F5 - Disorders of eating, sleeping, sexual functioning
F6 Personality Disorders
F7 Mental retardation
F8, F9 Child Psychiatry
 Def.of cognitive disorders
Disruption of one or more of above
domains,
Frequently complicated by behavioral
symptoms
Complex interference between
neurology and psychiatry
Cognitive Disorders in DSMIV:

Delirium
Dementia
Amnestic Disorder
 Dementia
Def.: progressive impairment of cognitive
functions occuring in clear consciousness (in the
absence of delirium)
Features:
- global impairment of intellect manifested by
difficulty with memory, attention, thinking and
comprehension.
- memory impairment
- problems with orientation
 Causes of dementia

Dementia in Alzheimers
Disease
Vascular Dementia
Other dementias (in
neurological diseases,
alcoholism, HIV...)
Psychiatric and neurological Changes -
secondary

Personality

Comorbidity:
- Halluciantions and dellusions
- Mood- depression, mania
 Dif. Dg.: Normal aging
Course: depends on type of dementia
Prevention: D in Alzh.disease: ....
Vasculars dementia
Treatment pharmacology
Delirium diagnostic features

Clouding of consciousnes
Impaired cognition
Short and fluctuating course
Not better explained by dementia
Caused by a general medical condition
or by a substance
 Clouding of consciousness:

Reduces clarity of awereness of the

environment
Ability to focus, sustain or shift
attention is impaired
Individual may appear confused
 Impaired Cognition

Disturbance of recent memory

Disorientation in time and place
Trouble in finding words
Perceptual disturbances may have
illusions or hallucinations
 Short and fluctuating course
Delirium developos over a course of
hours or days
Fluctuates in severity
The individual may have relatively lucid
intervals of minutes or hours
Often, delirium worsenes at night or
during isolation.
 Caused by a general medical
condition or by a substance

No primary psychiatric disorder (such

as manic episode)
 Associated features and
diagnoses
Disturbance in the sleep-wake cycle.
Disturbance in psychomotor behavior
Emotional disturbances
Abnormal electroencephalogram
(EEG)
Evidence of general medical conditions
or substance use
 Treatment of Delirium
Delirium is treated by correction of the
underlying physiologic (organic)
problems
Sometimes:
- protectvive use of restraint or
antipsychotic medication (to decrease
severe agitation to prevent injury)
 General medical conditions that
cause mental disturbances
Neurodegenerative disorders (Alzheimers disease)
Dementia in Parkinson disease
Dementia due to Huntington disease
Cereberovascular disease
Infectious disease (inflamation of brain tissue,
toxins, systemic metabolic alterations renal failure,
hepatic failure...)
Physical desctruction of brain tissue (car-crash
injury...)
Myelin disease
Epilepsy ......................... To be cont.
 General medical conditions that
cause mental disturbances cont.
Nutritional deficiencies (thiamine vit.B1,
B6, B12
Metabolic disorders genetic metabolic
diseases, hepatic encephalopathy, uremic
encephalopathy
Endocrine disorders
Autoimmune disorders (systemic lupus
erythematosus SLE)
 Study question
A 58-year- old man has gradually become more
apathetic and moody. At times he is confused
and forgetful. His gait is unsteady, and
deep.tendon reflexes are diminished. He
complains of tingling in his legs. Which one of
the following is the most likely diagnosis?

A/ Cerebral neoplasm
B/ Cobalamin (B12) deficiency
C/ Hypothyroidism
D/ Manganese intoxication
E/ Multiple sclerosis (MS)
 The answer is B
The evidence of gradual cognitive,
motor, and sensory impairments is
most suggestive of cobalamin
deficiency. Megaloblastic anemia is
likely to be present. Multiple sclerosis
might also cause such impairments,
but the course would most likely be
stuttering.
 Two last slides:
Section F of ICD 10 overview:

F0 Dementia and psychiatric disorders due to somatic

disorders
F1 - Psychiatric disorders due to alcohol and drugs
F2 - Psychoses
F3 Mood and Affective disorders
F4 - Anxiety Disorders
F5 - Disorders of eating, sleeping, sexual functioning
F6 Personality Disorders
F7 Mental retardation
F8, F9 Child Psychiatry
 Practicals: Two questions:

- Is it a psychosis? (has
patient psychosis, is patient
psychotic? slang
- To which group in ICD-10
patient belongs?
Zvery2