module 4

Organic Mental Disorders

Disorders classified based on a physical cause, also referred to as organic disorders. Etiological factors are a direct result or consequence of a medical condition and can be diagnosed through patient’s history, physical examinations, and laboratory findings. Examples include high fever, drug/alcohol abuse, AIDS, brain trauma, brain tumor, and low blood sugar.

Functional Disorder

A mental disorder for which no known physical cause is identified.

Delirium

A disturbance of cognitive ability characterized by a sudden onset, acute nature, and reversibility. More prevalent in elderly populations and specific causes can be treated. Symptoms include confusion, reduced awareness, sleep disturbances, restlessness, anxiety, delusions, hallucinations, and fear.

Dementia

A mental disorder involving multiple cognitive deficits, primarily affecting memory.

Aphasia

Deterioration of language function to the extent that verbal communication becomes impossible, a key symptom of dementia.

Echolalia

Parroting words or sounds heard, a key symptom of dementia.

Palilalia

Repetition of words or phrases, a key symptom of dementia.

Apraxia

Intact motor ability but impaired execution of motor function, a symptom often seen in dementia.

Agnosia

Intact sensory ability with an inability to recognize or name objects, a symptom often seen in dementia.

Disturbed Executive Functioning

Impaired abstract thinking and planning abilities, a symptom often seen in dementia.

Sundowner's Syndrome

Extreme agitation and confusion occurring in late afternoon or early evening, a symptom often seen in dementia.

Alzheimer's Disease

The most common type of dementia with a gradual onset and progressive, irreversible nature. Physical changes include enlarged 3rd & 4th ventricles of the brain. Symptoms include memory loss, loss of motor function and speech, behavioral changes (paranoia, delusions, hallucinations, neglect of hygiene), and increased belligerence.

Risk Factors for Alzheimer's Disease

Age (increases after 65), family history, previous history of Down syndrome, head trauma, cerebrovascular accidents (CVA), Parkinson’s disease. More prevalent in females, African Americans, and those with low educational/occupational levels. Lifestyle factors include high fat diet, lack of exercise, stress, and environmental toxins.

Cholinesterase Inhibitors

A class of medications used to treat Alzheimer's disease, including Donepezil (Aricept$®$), Rivastigmine (Exelon$®$), and Galantamine (Razadyne$®$).

NMDA Inhibitors

N-methyl-D-aspartate inhibitors, a class of medications used to treat Alzheimer's disease, such as Memantine (Namenda$®$).

Mediterranean Diet

A nutritional support recommended for Alzheimer's patients, consisting of fruits, vegetables, whole grains, legumes, fish, seafood, olive oil, with limited amounts of red meat, eggs, and sweets.

Validation Therapy

Naomi Feil's approach to maintaining dignity in Alzheimer’s patients, advocating validating feelings.

Anxiety

A state where individuals experience feelings of uneasiness or apprehension, often tied to the activation of the autonomic nervous system in response to a vague or non-specific threat. This state links to the fight-or-flight response.

Fight or Flight Response

Activation leading to secretion of adrenaline (epinephrine) from adrenal glands, increasing respiratory rate, dilating pupils, increasing blood pressure and heart rate, constraining peripheral blood vessels, and enhancing glycogen breakdown.

Crisis Phase (Anxiety)

The initial phase of anxiety where fight or flight is initiated, leading to blood vessel constriction, release of norepinephrine and epinephrine, and elevated blood pressure.

Adaptation Phase (Anxiety)

The phase where hormonal levels normalize, and body functions return to homeostasis.

Exhaustion Phase (Anxiety)

The phase where challenges to the immune system may arise, leading to enlarged lymph nodes, risks of cardiac and renal failure, and potentially life-threatening complications.

Mild Anxiety

A level of anxiety encountered daily; enhances awareness and safety.

Moderate Anxiety

A level of anxiety where physical symptoms begin to manifest.

Severe Anxiety

A level of anxiety where the patient's focus narrows solely on stressors, inhibiting their ability to process new information.

Panic Anxiety

A level of anxiety where individuals are overwhelmed by severe physical and emotional symptoms.

Automatic Relief Behaviors

Unconscious habits such as tapping pens, leg bouncing, serving as anxiety-related behaviors.

Free-Floating Anxiety

Inability to link anxiety to specific causes or stimuli.

Anticipatory Anxiety

Anxiety felt prior to an event.

Generalized Anxiety Disorder (GAD)

Excessive and chronic anxiety occurring more often than not over six months or longer. Symptoms include chronic excessive worry, negative self-dialogue, fatigue and insomnia, heightened startle response, persistent feelings of tension or being on edge, difficulty concentrating, tremors, and gastrointestinal disturbances.

Panic Disorder

Characterized by episodes lasting 15-30 minutes with rapidly escalating anxiety. Accompanied by intense fear, physiological discomfort (dread, choking sensations, tremors, rapid heartbeat, faintness, increased perspiration, chilling sensations or flushing, paresthesia, nausea, chest discomfort, feelings of dying), and possible agoraphobia and depressive states.

Behavior Modification

Manipulation of variables for behavior changes aimed at diminishing unhealthy behaviors, with desired outcomes of replacing negative thoughts with positive ones and establishing productive behaviors.

Phobias

Conditional fear attributable to faulty thought processes.

Agoraphobia

A type of phobia characterized by difficulty escaping from situations, often accompanying panic disorder.

Social Phobia

Fear of embarrassment or scrutiny from others such as in public speaking.

Simple Phobias

Fears of specific objects or situations.

Obsessive Compulsive Disorder (OCD)

Characterized by unconscious thoughts (obsessions) and compulsive rituals to mitigate anxiety. Obsessions are intrusive thoughts causing significant anxiety, and compulsions are repetitive behaviors performed to relieve anxiety.

Hoarding Disorder

A notable variant of OCD.

Trichotillomania

Hair-pulling disorder, a notable variant of OCD.

Acute Stress Disorder

Symptoms manifest within one month but last less than four weeks following a traumatic event.

Post-Traumatic Stress Disorder (PTSD)

Symptoms persist and can involve emotional numbness, avoidance of reminders associated with the event, and significant distress following an event involving actual death or severe injury. Symptoms include severe fear and dread, mentally replaying the event, increased vigilance, irritability, difficulties in interpersonal relationships, and risk of substance abuse/self-harm.

Conversion Reaction (Conversion Disorder)

Presentation of physical symptoms stemming from stress without a medical explanation.

Chronic Pain Disorder

Persistent pain concentration improperly diagnosed with possible fibromyalgia differentiations.

Hypochondriasis

An exaggerated preoccupation with personal health.

Cyberchondriasis

Self-diagnosis via Internet-based information.

Body Dysmorphia

A persistent perception of physical flaws that are nonexistent.

Factitious Disorder

Symptoms intentionally produced or feigned.

Mini Mental State Examination (MMSE)

An exam assessing orientation, memory recall, attention calculation, and language ability. Scoring: Normal range (24-30), Moderate cognitive impairment (18-23), Marked cognitive impairment (0-17).

Major Depressive Disorder (MDD)

Unipolar alterations leading to depressive moods sustained over intended durations, with a significant link to suicide rates. Symptoms include neuro-vegetative changes (sleep, appetite, energy), psychomotor changes (reduced activity), anhedonia, hopelessness, poor concentration, and suicidal thoughts.

Neuro-vegetative changes

Alterations in sleep, appetite, and energy, common symptoms of MDD.

Anhedonia

Lack of interest in pleasurable activities, a key symptom of MDD.

SSRIs (Selective Serotonin Reuptake Inhibitors)

First-line antidepressant treatments with milder side effects, including Celexa, Lexapro, Prozac, Paxil, and Zoloft.

SNRIs (Serotonin & Norepinephrine Reuptake Inhibitors)

A class of antidepressants.

Tricyclic Antidepressants

A class of antidepressants necessitating monitoring due to potential side effects and health impacts.

Monoamine Oxidase Inhibitors (MAOIs)

A class of antidepressants requiring dietary modifications to mitigate risks of hypertensive crises.

Electro Convulsive Therapy (ECT)

A treatment for depression used when medications fail, where administration induces seizures aimed at altering neurotransmitter levels over a series of sessions.

Dysthymic Disorder

Chronic depression but less severe than MDD, with ongoing symptoms including poor appetite or overeating, insomnia or excessive sleep, low energy, and feelings of hopelessness.

Bipolar Disorder (Manic-Depression)

Characterized by cyclical mood shifts including significant mood highs (mania) paired with depressing lows.

Bipolar I

A subtype of bipolar disorder predominantly characterized by manic episodes.

Bipolar II

A subtype of bipolar disorder predominantly characterized by depressive episodes with periods of hypomania.

Manic Features (Bipolar Disorder)

Elevated mood leading to high energy levels with increased self-esteem, restlessness, distractibility, risky behavior, dangerous self-concept development, and decreased sleep requirements.

Lithium

A mood stabilizer used for manic phases of bipolar disorder, mechanism stabilizes mood within 10 days, requiring careful monitoring for dehydration and maintaining sodium intake for therapeutic level stabilization (normal range $0.6-1.2$ mEq/L).

Suicidal Ideation - Direct

Conscious and voluntary intentions related to suicidal behaviors.

Suicidal Ideation - Indirect

Behaviors that may risk life without intent to die

Organic Mental Disorders

Disorders classified based on a physical cause, identifiable through patient history, physical exams, and lab findings.

Functional Disorder

A disorder termed when no known physical cause is identified.

Delirium

Disturbance of cognitive ability characterized by sudden onset, acute nature, and reversibility, often seen in elderly populations.

Dementia

A mental disorder involving multiple cognitive deficits, primarily affecting memory.

Aphasia

Deterioration of language function to the extent that verbal communication becomes impossible.

Echolalia

Parroting words or sounds heard.

Palilalia

Repetition of words or phrases.

Apraxia

Intact motor ability but impaired execution of motor function.

Agnosia

Intact sensory ability with an inability to recognize or name objects.

Disturbed Executive Functioning

Impaired abstract thinking and planning abilities.

Sundowner’s Syndrome

Extreme agitation and confusion occurring in late afternoon or early evening, particularly in dementia patients.

Alzheimer’s Disease

Most common type of dementia, with gradual onset and progressive, irreversible nature, characterized by enlarged 3rd & 4th ventricles of the brain.

Cholinesterase Inhibitors

Medications like Donepezil, Rivastigmine, and Galantamine used to treat Alzheimer's by increasing acetylcholine levels.

NMDA Inhibitors

Medications like Memantine that block N-methyl-D-aspartate receptors to slow Alzheimer's progression.

Anxiety

A state of uneasiness or apprehension, often tied to the activation of the autonomic nervous system in response to a vague or non-specific threat.

Fight or Flight Response

The body's physiological reaction to stress, involving the secretion of adrenaline, increased respiratory rate, heart rate, and blood pressure.

Mild Anxiety

Anxiety encountered daily; enhances awareness and safety.

Moderate Anxiety

Anxiety where physical symptoms begin to manifest.

Severe Anxiety

Anxiety where the patient's focus narrows solely on stressors, inhibiting their ability to process new information.

Panic Anxiety

Individuals overwhelmed by severe physical and emotional symptoms.

Automatic Relief Behaviors

Unconscious habits like tapping pens or leg bouncing used to alleviate anxiety.

Free-Floating Anxiety

Inability to link anxiety to specific causes or stimuli.

Anticipatory Anxiety

Anxiety felt prior to an event.

Generalized Anxiety Disorder (GAD)

Excessive and chronic anxiety occurring more often than not over six months or longer, characterized by chronic worry, fatigue, and insomnia.

Panic Disorder

Characterized by episodes lasting 15-30 minutes with rapidly escalating anxiety, intense fear, and physiological discomfort.

Paresthesia

Tingling or numbness of extremities, a symptom that can manifest during a panic attack.

Behavior Modification

Manipulation of variables for behavior changes aimed at diminishing unhealthy behaviors and establishing productive ones.

Phobias

Conditional fear attributable to faulty thought processes.

Agoraphobia

Difficulty escaping from situations or places, often related to panic attacks.

Social Phobia

Fear of embarrassment or scrutiny from others, such as in public speaking.

Simple Phobias

Fears related to specific objects or situations.

Obsessive Compulsive Disorder (OCD)

Characterized by unconscious thoughts (obsessions) and compulsive rituals performed to mitigate anxiety.

Obsessions

Intrusive thoughts causing significant anxiety impacting social functioning in OCD.

Compulsions

Repetitive behaviors performed to relieve anxiety that a person feels they must complete in OCD.

Hoarding Disorder

A notable variant of OCD involving persistent difficulty parting with possessions.

Trichotillomania

Hair-pulling disorder, a notable variant of OCD.