Organic and Eating Disorders
Organic Disorders
Dementia
Delirium
Delirium tremens
Wernicke-Korsakoff syndrome
Dementia
• The function that deteriorates in the foreground is memory.
Delirium
• It is the deterioration of cognitive functions due to an organic cause.
• It is a clinical syndrome of sudden onset and fluctuating course accompanied by changes in consciousness, perception, thought, and sleep-wake cycles.
• The function that deteriorates in the foreground is attention.
Frequency of symptoms in delirium
Attention disorder
Blurring of consciousness
Disorientation
Pervasive cognitive impairment
Memory weakness
Delusions
Visual hallucinations
Auditory hallucinations
Language disorder
Disorganized thinking
My mood swings
Sleep disorders
Psychomotor changes
Clinical Types
The distribution of delirium patients into subtypes is approximately 15% hyperactive, 19% hypoactive, and 52% mixed type.
The most common type of delirium is mixed delirium.
Hallucinations are frequent and typically visual.
Hyperactive Type:
► Symptoms of delirium such as hypervigilance, restlessness, rapid and pressured speech, and easy arousal
Hypoactive Type:
► Symptoms such as decreased arousal, tendency to sleep, slowed movements, apathy, decreased awareness
Treatment
Delirium requires immediate treatment because of both its causal relationship with the underlying medical condition and its adverse consequences.
The main treatment for delirium is the treatment of the underlying medical condition.
Haloperidol is the primary therapy for the control of agitation.
Although extrapyramidal side effects are less common in intravenous use of haloperidol, its ability to cause QTc prolongation and torsades de pointes arrhythmia requires special attention and constitutes a limitation for intravenous use.
The use of benzodiazepines (BOZ) alone in the treatment of delirium is limited to alcohol and sedative-hypnotic withdrawal delirium.
Causes of delirium
Brain related causes
• Cerebrovascular events
• Intracranial infections
• Traumas, tumors
• Epilepsy, withdrawal syndromes
Metabolic
• Liver, kidney failure
• Fluid-electrolyte disorders
• Vitamin deficiencies
• Hypertension
• Hypo-hyperglycemia
• Adrenal pathologies
• acute pancreatitis
• Hyperthermia
Toxic
• Alcohol
• Lithium
• C-Dopa
• Organophosphates
• Steroids
• Carbon monoxide
• Ergotamine
• Other surgery
• MI, trauma, bleeding
Delirium Tremens
• It is delirium that occurs as a result of alcohol withdrawal.
• There is hyperexcitation in neurons due to the sudden cessation of alcohol's GABAergic activity.
• Symptoms showing hyperactivation of the autonomic nervous system such as tremor, sweating, and tachycardia develop.
• Benzodiazepines (lorazepam, diazepam, chlordiazepoxide), fluid and vitamin support, and antipsychotics such as haloperidol in case of agitation are used in the treatment.
• Blood sugar irregularities are common in alcohol addicts due to liver dysfunction and nutritional disorders.
• In the case of delirium tremens, blood glucose should be monitored because of the risk of hypoglycemia. Dextrose solutions can be used, provided the thiamine replacement is well done.
• A diet high in carbohydrates should be avoided in alcohol-dependent patients, as it may aggravate thiamine deficiency in the long term.