Transcript Powerpoint Template

IzBen C. Williams, MD, MPH
Lecturer
Lecture # 13
SOME OTHER
PSYCHIATRIC
DISORDERS
Other Psychiatric Disorders
Some other psychiatric disorders
 COGNITIVE DISORDERS
 DISSOCIATIVE DISORDERS
 OBESITY AND EATING DISORDERS
COGNITIVE
(Neurocognitive)
DISORDERS
Other Psychiatric Disorders
DEF: Cognition
Cognition is the set of all mental abilities and
processes related to knowledge (Latin: cognitio = the
act or process of knowing).
 It includes attention, memory & working memory,
judgment & evaluation, reasoning & "computation",
problem solving & decision making, comprehension &
production of language, etc.
Other Psychiatric Disorders
Cognitive Disorders: 1
 Delirium, Dementia, and Amnestic disorder
 They are caused by a general medical condition.
Patients with these disorders are encountered by
clinicians in every specialty
 Cognitive disturbances involve symptoms such as



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Memory impairment
Speech and language difficulties
Altered level of consciousness, confusion
Impairment of ability to plan and engage in complex tasks
Other Psychiatric Disorders
Cognitive Disorders: 2
a. These difficulties are due to abnormalities in
neural chemistry, structure, or physiology
originating in the brain or secondary to systemic
illnesses
b. Patients with cognitive disorders may manifest
psychiatric syndromes secondary to the cognitive
problems (eg. Depression, anxiety, paranoia,
hallucinations and delusions)
 See Characteristics and Etiology of Cognitive
Disorders, in text….. (Fadem: Table 14-1)
Other Psychiatric Disorders
Cognitive Disorders: 3
 DELIRIUM - Diagnostic features:
 Clouding of consciousness
 Impaired cognition
 Short or fluctuating course
 Not better explained by dementia
 Caused by general medical condition or dementia
Other Psychiatric Disorders
Cognitive Disorders: 4
 DELIRIUM – Associated features and Diagnose:
 Disturbance in sleep-wake cycle
 Disturbance in psychomotor behavior
 Emotional disturbances
 Abnormal electroencephalogram
 Evidence of general medical condition or substance use
Other Psychiatric Disorders
Cognitive Disorders: 5
 DELIRIUM – Epidemiology:
 Children and the elderly are most susceptible
 Studies indicate that up to 25% of elderly hospitalized
patients have delirium
Other Psychiatric Disorders
Cognitive Disorders: 6
 DELIRIUM – Treatment:
 Correct the underlying cause
 Environmental management – quiet well-lighted room
and frequent orientation can decrease agitation
 Protective physical restraints or antipsychotic
medication (chemical restraints) can control or decrease
agitation and risk of self injury
Other Psychiatric Disorders
Cognitive Disorders: 7
 DEMENTIA – Diagnostic features i:
 Memory impairment – develops insidiously; as
dementia progresses, learning deficits become more
prominent, and recent memories are lost. Eventually,
older memories are compromised. Increased rick of
physical dangers
 Aphasia – loss of language function (word finding,
sentence construction, understanding instructions)
communication becomes increasingly more difficult
sometimes resulting in mutism.
Other Psychiatric Disorders
Cognitive Disorders: 8
 DEMENTIA – Diagnostic features ii:
 Apraxia – inability to execute complex motor behaviors
 Agnosia – failure to recognize or identify previously
known objects and is not due to impaired sensory
function
 Disturbance in executive function – impaired ability
to think abstractly and plan. Initiate, sequence, monitor,
monitor and stop complex behavior. Difficulty
conceptualizing or solving problems (eg. a grocery list)
Other Psychiatric Disorders
Cognitive Disorders: 9
 DEMENTIA – Associated features and Diagnosis:
 Emotional changes – labile and disinhibited
 Personality disturbances – moody, irritable, mood ±
 Psychotic symptoms – usually delusions
 Neuroimaging – generalized or focal cerebral atrophy,
enlarged ventricles and cortical sulci,
 Evidence of general medical condition or substance
use
Other Psychiatric Disorders
Cognitive Disorders: 10
 DEMENTIA – Epidemiology:
 The prevalence of dementia varies by age…….
5% of population older than age 65
 20% of population older than age 85
 More than 75% of dementia is caused by Alzheimer’s
Disease or cerebrovascular disease

 Familial pattern: some types of neurodegenerative
dementias are heritable
Other Psychiatric Disorders
Cognitive Disorders: 11
 DEMENTIA – Course
 Depending on the underlying cause, the onset of
dementia may be sudden or gradual and function
may stabilize or deteriorate
 In children , dementia may result in
developmental delays rather than deterioration
of function
Other Psychiatric Disorders
Cognitive Disorders: 12
 DEMENTIA – Etiologies
 Neurodegenerative diseases: include Alzheimer,
Parkinson, Pick, Huntington diseases and ALSdementia complex
 Infectious causes; include HIV, Creutzfeldt-Jakob
disease, viral, bacterial or parasitic brain infections,
 Cerebrovascular disease, epilepsy, traumatic
brain injury and other intracranial processes
 Substance-induced persisting dementias: the
commonest is alcohol
Other Psychiatric Disorders
Cognitive Disorders: 13
 DEMENTIA – Treatment:
 Stabilizing or correcting underlying general
medical condition
 Medication: antipsychotic for psychotic symptoms
 Familiar surroundings, reassurance, and support
Other Psychiatric Disorders
Cognitive Disorders: 14
 AMNESTIC DISORDERS – Diagnostic Features:
 The essential feature of amnestic disorders is
impairment of memory, which does not occur solely
during the course of delirium or dementia
 Memory impairment – difficulty learning new
information; immediate memory relatively in tact
but mid term memory at risk;
 Other aspects of cognition are relatively in tact
Other Psychiatric Disorders
Cognitive Disorders: 15
 AMNESTIC DISORDERS – Associated features
 Confusion and disorientation as a result of recent
memory impairment
 Confabulation – they imagine events to compensate for
faulty recall (and may adamantly defend their ideas)
 Emotional changes – subtle emotional changes;
sometimes appear inappropriately unconcerned and
amotivated
Other Psychiatric Disorders
Cognitive Disorders: 16
 AMNESTIC DISORDERS – Epidemiology & Course
 More common in populations with higher prevalence of
alcohol abuse and head trauma
 Young adult men and individuals with antisocial
personality disorder are at greater risk
 Course:
 Onset may be rapid (eg. when resulting from trauma or
biochemical injury)
 More insidious onset in neurodegenerative conditions
Other Psychiatric Disorders
Cognitive Disorders: 17
 AMNESTIC DISORDERS – Etiologies
 Bilateral damage (transient or chronic) to the
diencephalon and medio-temporal structures (eg.
mamillary bodies, fornix, hippocampus) may produce
memory dysfunction in the absence of other cognitive
symptoms
 Such damage can be caused by

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Acute and chronic alcohol use and thiamine deficiency,
Head trauma, CVS disease, hypoxia, seizures, infections,
chronic use of some psychotropic medication
Other Psychiatric Disorders
Cognitive Disorders: 17
 AMNESTIC DISORDERS – Treatment
 As with delirium and dementia, stabilization or
correction of the underlying medical condition is
definitive Tx for amnestic disorders
 Avoid further brain insults of any kind
 Familiar surroundings, reassurance and support as
patient gradually becomes reoriented
Other Psychiatric Disorders
DISSOCIATIVE
DISORDERS
Dissociative Disorders
DISSOCIATIVE DISORDERS: are a group of
psychiatric syndromes characterized by sudden,
temporary disruption in some aspect of
consciousness, identity, or motor behavior
Dissociative Disorders
DISSOCIATIVE DISORDERS
 Several types are recognized
Dissociative amnesia (includes fugue)
2) Dissociative identity disorder (mpd)
3) Depersonalization-derealization disorder
(includes trance)
See characteristics @ MAYO Clinic site
 Dissociative fugue (psychogenic fugue)
 Possession/trance disorder
1)
Dissociative Disorders
DISSOCIATIVE DISORDERS
Dissociative amnesia
 Patients with this disorder have amnesia for
important personal information
 Dissociative fugue is now considered a subset of this
state. In this condition a patient suddenly travels
away and cannot recall his/her past. The patient
may be confused about self identity or assume a new
identity.
Dissociative Disorders
DISSOCIATIVE DISORDERS
Dissociative identity disorder (mpd)
 Patient has two or more distinct identities or
personality states that control his actions. The
host personality, who may present to the physician,
is aware of “lost time”, but may not know what
occurs during that time and may be embarrassed to
discuss it. Most patients with this disorder
experienced severe childhood trauma (eg sexual
or physical abuse)
Dissociative Disorders
DISSOCIATIVE DISORDERS
Depersonalization-derealization disorder
(includes trance state)
 A patient with this disorder has feelings of
detachment from body or mind; however reality
testing remains in tact. The symptoms of
depersonalization cause the patient significant
distress or functional impairment
Dissociative Disorders
DISSOCIATIVE DISORDERS
Although these syndromes are statistically rare,
when they do occur they present very dramatic
clinical pictures of severe disturbance in normal
personality functioning
Under normal circumstances the functions of
memory, personal identity and motor behavior are
critical for the integrated operation of the complex
set of mental and behavioral activities we call
personality
Dissociative Disorders
DISSOCIATIVE DISORDERS
Etiology: dissociative disorders are commonly
related to disturbing emotional experiences in the
patient’s recent or remote past
Other Psychiatric Disorders
OBESITY
AND
EATING DISORDERS
Obesity
OBESITY DEFINITION:
 Obesity is a complex disorder involving an excessive
amount of body fat.
 Being more than 20% over ideal weight (based on
weight height charts), or having a body mass index
(BMI) of 30 or higher is considered obese
 BMI is: weight in kg/height in m²
Obesity
BMI
Weight status
Below 18.5
Underweight
18.5-24.9
Normal
25.0-29.9
Overweight
30.0-34.9
Obese (Class I)
35.0-39.9
Obese (Class II)
40.0 and higher
Extreme obesity
(Class III)
Obesity
OBESITY EPIDEMIOLOGY:
Profiling an epidemic (JHSPH)
 In 1990, obese adults made up less than 15 percent of
the population in most U.S. states.
 By 2010, 36 states had obesity rates of 25 percent or
higher,
 12 (ie. one third) of the 36 had obesity rates of 30
percent or higher.
Obesity
OBESITY EPIDEMIOLOGY:
Profiling an epidemic (HSPH)
 Today, one out of three adults in the US is obese (36
percent)
 Obesity is more common in lower socioeconomic
groups
 The health implications of this NCD trend, are
profound
 USA: Prevalence of obesity in adults by State, 2013
Obesity
OBESITY EPIDEMIOLOGY:
Profiling an Epidemic:
 No state had a prevalence of obesity less than 20% (compare
with 1990).
 7 states and the District of Columbia had a prevalence of
obesity between 20% and <25%.
 23 states had a prevalence of obesity between 25% and
<30%.
 18 states had a prevalence of obesity between 30% and
<35%.
Obesity
OBESITY EPIDEMIOLOGY:
Profiling an Epidemic:
 2 states (Mississippi and West Virginia) had a
prevalence of obesity of 35% or greater.
 The South had the highest prevalence of obesity
(30.2%), followed by the Midwest (30.1%), the
Northeast (26.5%), and the West (24.9%).
 The prevalence of obesity was 27.0% in Guam and
27.9% in Puerto Rico.+
Obesity
OBESITY EPIDEMIOLOGY:
Profiling an epidemic (HSPH)
 Even more alarming, the prevalence of overweight and
obesity in children and adolescents is on the rise, and
youth are becoming overweight and obese at earlier
ages.
 Genetic factors play an important role in obesity.
Adult weight is closer to that of biologic rather than
adoptive parents
Obesity
 One out of six children and adolescents ages 2 to 19
is obese and one out of three is overweight or
obese.
 Early obesity not only increases the likelihood of
adult obesity, it also increases the risk of heart
disease in adulthood, as well as the prevalence of
weight-related risk factors for cardiovascular
disease such as high blood pressure, high
cholesterol, and high blood sugar
Life is real simple
As easy as 1..2…3
Obesity
TREATMENT

Physiological/(understanding the physiologic
control of eating behavior)
Behavioral
Environmental/social
Dietary manipulation
Pharmacological

Surgical
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Transition
Eating Disorders
 DEFINITION: Any of a range of psychological
disorders characterized by abnormal or disturbed
eating habits. Includes……
Anorexia Nervosa
2. Bulimia Nervosa
1.
Eating Disorders
Anorexia Nervosa
1.
Anorexia nervosa is an eating disorder that is
characterized by obsessional weight loss without
an identifiable organic cause
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Disregards acceptable weight for age & height
Intense fear of being overweight or becoming
obese
Distorted body image
Amenorrhea (for 3 consecutive cycles)
Eating Disorders
Bulimia Nervosa (2 types purge/non-purge)
1.
Is characterized by ravenous over eating
followed by guilt, depression, and anger at
oneself for doing so. Other features….
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Recurrent, inappropriate weight-control behavior
with episodes of eating binges,
Often accompanied by restrictive diets, selfinduced vomiting, and use of laxatives, emetics, or
diuretics to maintain or lose weight
Eating Disorders
TREATMENT of eating disorders includes:
 Medical assessment
 Drug therapy
 Behavioral interventions
 Psychotherapy
Eating Disorders
TREATMENT of eating disorders :
Anorexia nervosa (usually in patient treatment )
1.
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Primary immediate treatment involves medical
management of fluids, electrolytes and nutritional
status, combined with….
Structured behavior modification programs
Long-term treatment emphasizes the medical status
of the patient including regular dietary counseling by
a dietitian and individual or group psychotherapy
Eating Disorders
TREATMENT of eating disorders:
Bulimia
2.
Treatment also involves medical management,
 Cognitive therapy, and
 Behavior modification
 Drug therapy with SSRIs, tricyclic antidepressants, or
MAOIs is effective in some patients

Vignettes – Dissociative Disorders
 Students are encouraged to surf the web for
subject related vignettes. Here are a few for
Dissociative Disorders:
 https://www.youtube.com/watch?v=7TlYGivBGYE
 https://www.youtube.com/watch?v=n1is6S4sCK4
 https://www.youtube.com/watch?v=j_rEBKxW3qE