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BS 7
OTHER PSYCHIATRIC DISORDERS
Cognitive disorders
Personality disorders
Dissociative 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
Depersonaliz
ation
disorder
Persistent detached attitude from one
own body, social situation / environment
 Treatment: Hypnosis, amobarbitol sodium
interview & long term psychotherapy
IV Obesity & eating disorders
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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 Extreme
nervosa weight loss
>15%
Amenorrhea,
hypercholeste
rolemia,
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
Hospitalizati
on, family
therapy,
psychoactiv
e 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
,
psychothera
py