Organic mental disorder

Introduction Organic mental disorder, a mental disorder that is attributed to a group of provable brain diseases, brain damage, or other damage. The mental disorder can be primary, such as directly and selectively affecting the brain's disease, injury, and damage; it can also be secondary, such as certain systemic diseases and disorders, the brain is just multiple damaged organs. Or one of the systems. The term symptomatic mental disorder refers to the latter subgroup. See: organic psychosis.

Cause

Due to brain damage (such as encephalitis, cerebral parasitic disease, brain damage, cerebrovascular disease, brain tumor, brain degeneration, etc.), as well as various physical diseases outside the brain (such as systemic infection, poisoning, heart, lung, liver, Renal insufficiency, endocrine disorders, nutrition, metabolic disorders, connective tissue diseases, etc.) cause mental disorders caused by brain dysfunction. Mental disorders caused by brain structural damage, also known as brain organic mental disorders, customarily include epileptic mental disorders, and do not include mental retardation. Mental disorders caused by extra-cerebral diseases are also known as symptomatic mental disorders. The clinical manifestations of organic mental disorders are complex and involve a wide range of social, economic, and health care issues. With the improvement of medical level, it is rare for people with infectious diseases and poisoning, but with the extension of life expectancy, the incidence of aging is increasing.

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The diagnosis of organic mental disorders consists of two main steps. First, it should be determined whether the mental disorder is organic, and then the cause is further identified. Where mental disorders first occur after the age of 45, there are significant disturbances of consciousness, memory impairment or progressive loss of intelligence should first consider the existence of organic lesions. Careful follow-up of medical history, systematic and detailed physical examination, including neurological examination, where there are brain organic symptoms and signs, or physical illnesses can cause brain dysfunction, all suggest the possibility of organic mental disorders . Further examinations include routine laboratory tests, special tests related to suspected causes, such as EEG, ultrasound brain scans, skull X-rays, computed tomography, and head magnetic resonance. Intelligence tests and neuropsychological tests are helpful in determining the degree of dementia and revealing the nature and extent of neuropsychological impairment.

Differential diagnosis

Differential diagnosis of organic mental disorders:

First, acute organic psychosis

The basic feature is the rapid occurrence of disturbance of consciousness, which is caused by acute brain dysfunction such as infection, poisoning and metabolic disorders. Due to the difference in the degree of disturbance of consciousness and accompanying symptoms, it can be distinguished into the following manifestations.

1 status: typical performance for this syndrome.

The main features are: rapid onset, blurred consciousness, and often disordered consciousness; the degree of clarity of consciousness often fluctuates within a day, and there may be a brief interval of clear consciousness during the day, and the disturbance of consciousness at night is often aggravated; often accompanied by a rich and vivid illusion And illusion experience, more common with illusion, horror; emotional tension, excitement, anxiety, fear or instability; attention to stagnation, association difficulties, decreased comprehension; may have fragmentary delusions and obvious psychomotor excitement. This state usually lasts only a few hours or days, and after recovery, it is difficult to remember the experience of the disease. In some cases, psychomotor excitement is not obvious, but the performance is quiet, sleepy, muttering, called debilitating.

2 subacute sputum: atypical manifestations of sputum status, more common than sputum. The patient's consciousness disorder is lighter, and the orientation disorder is not obvious; its prominent performance is confusion, difficulty in thinking, inconsistent thinking, repeated speech and lack of content, lack of purpose and meaning of action, illusion and delusion, and the course of disease can be several weeks or months. as long as.

3 Status: The main feature is that the scope of consciousness is narrow. The patient can carry out a series of purpose activities, but it is difficult for the outside world to contact with it. It seems to be indulged in the dream experience; sometimes sudden emotional outbursts cause injury and destruction. The course of the disease is usually only a few hours or 1-2 days; after waking up, most of the illness is completely or completely forgotten. A typical organic sputum state is seen in epilepsy.

4 turbid state: The main features are significantly reduced consciousness, increased threshold of perception, and weakened mental activity; patients with slow emotions, reduced speech, slow movements, difficult associations, often disorientation; ambiguous words, or continuous speech. If you develop further, you can go into a state of lethargy or coma.

Acute organic psychosis can be seen in intracranial or systemic infections, poisoning, craniocerebral injury, intracranial space-occupying lesions, increased intracranial pressure, epilepsy, heart, lung, liver, renal insufficiency, vitamin B and other nutritional deficiencies , electrolyte imbalance, endocrine disorders, sudden withdrawal of alcohol or drugs.

Second, chronic organic psychosis

The basic characteristics are the gradual development of intelligent total decline, memory loss, affective disorder and personality change. It is caused by intracranial diffuse lesions, and can also be caused by long-term effects of chronic physical illness on brain function. Common clinical types have three states:

1 Dementia status: a typical manifestation of this syndrome. Its main feature is the total reduction of intelligence and the unconscious barrier. Generally, the onset is fading, and the course of the disease progresses slowly; in a few cases, the symptoms may rapidly increase after a sudden change in the environment or a physical illness, and there is a short-term confusion. Forgetting from the beginning of the disease is quite common, the ability to work is declining, and mistakes are often made; as the memory deficit increases, there may be misconfiguration or fictional memory; thus, personality changes, life is lazy, does not love cleanliness, does not trim margins, and weakens self-control ability. Emotional irritability, disregard of shame, irresponsibility, can lead to theft or sexual assault; cognitive decline, comprehension of difficulties, understanding and judgment often have obstacles, so that collection of dilapidated items is collected; a small number of patients may have hallucinations or absurd delusions . Early patients with emotional anxiety, depression or instability gradually became blunt and indifferent; sometimes there was no obvious external temptation suddenly violent. Late patients have poor thinking, reduced interest, unresponsiveness, disordered speech, persistent speech or aphasia; when memory impairment is severe, the orientation ability is also lost, life can not take care of themselves, and there may be large and urinary incontinence.

2 debilitating syndrome: a milder and more common manifestation of chronic organic psychosis. It can exist alone or in the early stage of dementia. The clinical symptoms include: dizziness, headache, inattention, memory loss, sleep disorders, fatigue, anxiety, depression, suspected or irritating emotional disorders, and autonomic dysfunction and other similar neurasthenia.

3 organic personality changes: can exist alone, or part of the symptoms of dementia. Clinical manifestations are quite inconsistent. Some performances are happy, awkward, and speech movements are more, but they are often not suitable for the situation at the time; some patients are indifferent and less active, lacking interest in external activities; some patients are very emotional, can suddenly be excited or bursting impulses behavior. In general, there are obvious social adaptation obstacles.

Chronic organic psychosis can be found in intracranial infections, alcohol or heavy metal poisoning, severe or recurrent brain injury, intracranial space-occupying lesions, degenerative brain diseases, cerebrovascular disease, hypoxic encephalopathy, metabolic disorders and vitamins Lack of illness, etc.

Third, focal organic psychosis

Some of the psychological functions are impaired, and some cases can confirm the existence of focal brain damage. Common clinical types are:

1 amnesia syndrome: the main feature is prominent near memory impairment, and no intelligence is fully reduced. Patients can recall the events that occur immediately, but forget them after hours or minutes. In order to fill the lost memories, patients often have fictional and vivid experiences; often accompanied by time-disordered disorders. Mostly caused by brain structural lesions in the posterior or near the midline of the hypothalamus; occasionally caused by bilateral hippocampal lesions.

Russian neuropsychiatrist CC Korsakov (1889) has described a chronic syndrome characterized by memory loss accompanied by fictional memory, irritability and peripheral neuritis; people who are common in alcoholism can also be seen in postpartum After sepsis or infectious disease causes persistent vomiting; may be caused by vitamin B1 deficiency. It was once named Korsakov's psychosis; it is also known as Wernick-Korsakov II syndrome. It was subsequently observed that peripheral neuritis is not necessary for amnesia syndrome, and vitamin B1 deficiency is not the only cause.

2 frontal lobe syndrome: the main feature is personality changes. The patient's expression is euphoric, excited, and joking. The general intelligence has no obvious damage, but both active and passive attention are weakened, judgments often occur, abstract reasoning ability is poor, and self-control is lacking. If the frontal lobe lesions invade the motor cortex or deep radiofibers, it may be accompanied by contralateral palsy or dysarthria; ipsilateral optic atrophy and olfactory loss may occur in frontal lobe lesions; strong grip reflexes may also be seen in frontal lobe lesions. Urinary incontinence may occur in bilateral frontal lobe lesions.

3 parietal symptoms: parietal lesions cause less mental disorders, but the various neuropsychological disorders caused by mistakes are mistaken for rickets.

4 temporal lobe symptoms: dominant lateral temporal lobe lesions can lead to mental retardation, accompanied by personality changes similar to frontal lobe lesions. Personality changes caused by chronic frontal lobe lesions are characterized by emotional instability and aggressive behavior. Epilepsy caused by temporal lobe lesions often manifests as a transient disturbance of consciousness or a dream-like experience, accompanied by involuntary movements such as chewing; it can also cause diploid psychosis. The bilateral medial temporal lobe lesion can cause amnesia syndrome.

5 occipital lobe symptoms: occipital lobe lesions can cause visual hallucinations or complex visual cognitive impairment.

6 corpus callosum symptoms: corpus callosum lesions often extend on both sides and cause mental disorders, which can cause serious and rapid development of intelligent decline.

7 brain and brain stem symptoms: midline structural lesions can cause drowsiness, inactivity, bulimia, amnesia syndrome, progressive dementia, mood swings and euphoria, or emotional outbursts.

4. Split syndrome and emotional syndrome

Whether it is organic lesions in the brain or extracranial diseases can cause schizophrenia or mental disorders like mania and depression, which often cause difficulty in diagnosis. People with schizophrenia may have positive symptoms such as auditory hallucinations and suspicion of sorrow, as well as negative symptoms such as lack of thought content, apathy, lack of will, and detachment from reality; organic symptoms and signs may be concealed or ignored. In addition to mania, in addition to emotional excitement, increased speech movements, there may be association disorders. Suicidal behavior can occur when a person with depression is severe. Patients with affective disorder may be accompanied by psychotic symptoms such as hallucinations and delusions, and there is often no alternating periodic course or symptoms of depression. A small number of patients with organic mental disorders are most prominent in hallucinations or delusions, and unconscious or intellectual disorders, this is called organic illusion or organic delusional syndrome.

The diagnosis of organic mental disorders consists of two main steps. First, it should be determined whether the mental disorder is organic, and then the cause is further identified. Where mental disorders first occur after the age of 45, there are significant disturbances of consciousness, memory impairment or progressive loss of intelligence should first consider the existence of organic lesions. Careful follow-up of medical history, systematic and detailed physical examination, including neurological examination, where there are brain organic symptoms and signs, or physical illnesses can cause brain dysfunction, all suggest the possibility of organic mental disorders . Further examinations include routine laboratory tests, special tests related to suspected causes, such as EEG, ultrasound brain scans, skull X-rays, computed tomography, and head magnetic resonance. Intelligence tests and neuropsychological tests are helpful in determining the degree of dementia and revealing the nature and extent of neuropsychological impairment.

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