Organic Metal Disorders and Delirium

Organic Mental Disorders are behavioral or psychological disorders associated with permanent or transient brain dysfunction and include only those mental and behavioral disorders that are due to demonstrable cerebral disease or disorders, either primary or secondary. Sub Categories of Organic Mental Disorders: OMD are

• Delirium
• Dementia
• Organic Amnestic Syndrome
• Other organic mental disorders

Delirium:
commonest type
synonyms: Acute Confusional state, acute brain syndrome, acute organic reaction, toxic psychosis, metabolic encephalopathy.

Clinical Features:
1. A relative Acute Onset
2. Clouding of Consciousness
3.Disorientation to time place and person.
other: Disturbed sleep-wake sleep cycle
sun downing( aggravated in the evening and night)
Motor disturbances- asterixis,Carphologia. etc
Psychomotor disturbances

Diagnosis:
According to ICD10
Symptoms should be present in each one area:
1. Impairment of attention and consciousness
2.Global disturbance of cognition
3. Psychomotor disturances
4.Disturbed slepp wake sleep cycle
5. Emotional disturbances.

Important causes of Delirium are:

1. Metabolic causes: hypoxia, narcosis,hypoglycemia, CCF, Metabolic acidosis or alkalosis, fever , anemia, shock.
2. Endocrine : Hypo/hyper thyroid,adrenal,pituitary and parathyroid.
3. Drug: Digitalis, quinidine, alcohol, anti hypertensives, sedatives,barbiturates,TCA, Antipsychotics.
4. Nutritional deficiency: Thiamin, Niacin, Pyridoxine, folic acid, B12
5. Systemic Infections.
6. Intracranial causes: Epilepsy, tumors, migraine, head injury, infections
7. post operative

Management of Delirium:
Ix: CBC, BGA, Sugar level, po2 and co2, TFT, serum b1 and foalte, toxic screen, csf, etc
Identificaton of the cause and its immediate correction.
Symptomatic measures
Supportive medical and nursing ccare.