He Organic mental disorder , Also called cerebral organic syndrome, is a deterioration of cognitive function that has organic or physiological causes. That is, the person has some physical affection that causes damage in their mental functioning.
This concept is practically in disuse and its origins go back to the psychiatry. Its purpose was to distinguish between psychiatric disorders that arise from some mental problem (which are called"functional"), from those that appear due to physical (considered"organic") causes.
Organic Mental Disorder was often diagnosed in the elderly, since at this stage of life it is more likely. Adding to this, there was no diagnosis of dementia before, but it was considered to be part of normal aging.
Nowadays, with the cerebral scientific advance these limits are not so clear. And it is that, many authors postulate that all mental affectation is reflected in our brain of some form, and, therefore, in our behavior.
Thus, conditions such as depression, anxiety, schizophrenia, autism or Alzheimer's , Could have their own manifestations in the brain. However, it is not yet known in many pathologies whether brain malfunction is a cause or consequence of the disease itself. Nor is it known with certainty what are the common brain implications of each mental disorder and whether they are repeated in all people.
With this explanation you can get an idea of how difficult it is to distinguish today a psychological disorder by its origin.
For this reason, the definition of organic mental disorder has undergone certain clarifying modifications. It is now associated more with consequences of medical illnesses, observable brain injuries such as a stroke, or exposure to substances that cause direct brain damage.
Causes of organic mental disorder
Cerebral organ syndrome is considered a state of mental deterioration that is a consequence of:
- Abuse of drugs or drugs that produce dependence: Can lead to toxic effects in the Cognitive functions , Damaging in various ways the Brain structures And its activity.
Acute type organic brain syndrome can occur if overdose occurs, but is temporary and reversible.
He abstinence syndrome Or"monkey", can also lead to acute organic mental syndromes.
- Cardiovascular disorders, lack of oxygen to the brain: C Omo stroke, heart infections, ictus , Hypoxia, Subdural hematoma , etc.
- Intoxication: Overexposure to certain substances such as Methanol , Lead or carbon monoxide can cause direct brain injury.
- Infections Which affect the nervous system through the intrusion of viruses and bacteria that the immune system has been unable to overcome.
These microorganisms cause inflammation of brain structures, which is known as encephalitis. The swelling is accompanied by neuronal damage due to an increase in Intracranial pressure .
We can mention any acute or chronic infection, in addition to meningitis (infection of the meninges, layer that covers the brain), septicemia or poisoning of the blood, advanced syphilis, pneumonia, etc.
- Dementia , Which begin with brain damage that is increasingly spreading, are chronic and virtually irreversible. This is why they are called neurodegenerative diseases. However, with proper treatment can greatly delay its development.
Within the dementias we find Alzheimer's disease, the Parkinson's , Huntington's disease , Vascular dementia caused by any cerebrovascular involvement, etc.
All of them have in common clear injuries or observable damages in the brain tissue.
- Cranioencephalic trauma (TBI): C They occur in brain injuries caused by an external impact that affect any part of the skull, and therefore of the brain. These damages have clear manifestations in the cognitive capacities, personality, and affective and emotional aspects of the patient.
- Medical diseases: C Traditionally referred to as"physical"or"organic"diseases, refer to conditions such as metabolic disorders (liver, kidney, thyroid, anemia vitamin deficiencies such as B12 and Thiamine , Hypoglycemia...).
We can enumerate others more like neoplasias or complications due to cancer, endocrine alterations, fever, hypothermia, dehydration, cardiopulmonary alterations, migraines, etc.
- Other affections of the nervous system: C Such as epilepsy, brain tumors, Demyelinating diseases as the multiple sclerosis , etc.
- Deprivation Sensory or sleep deprivation. This happens because when our senses are not stimulated, the brain reorganizes so that the synapses dedicated to those senses are lost.
On the other hand, lack of sleep and rest for long periods of time causes, in the long run, brain damage.
Since the causes are so extensive, there are authors who divide them into:
Primary causes
These are the ones that have directly provoked organic mental disorder, such as brain diseases, stroke, trauma, etc.
Secondary Causes
In this case, the damages have been generated through other medical conditions, drugs or substances.
Mental disorders that can be confused
It is important not to make the mistake of considering as organic mental disorder a depression or anxiety developed by concerns about a serious physical illness. They are different concepts.
In the first place, organic mental disorder produces, mainly, alterations in cognitive capacities such as reasoning, attention and memory .
On the other hand, this affectation is caused by organic factors, that is to say, a malfunction of the organism. Instead, develop depression Would be the result of preoccupations and subjective interpretations about some physical illness, considering it as object of our malaise.
Types of Mental Disorders
It can be divided into two groups according to their duration:
Acute organic mental disorder
It is also defined as acute confusional syndrome or delirium. It is characterized by cognitive alterations that appear quickly, in a matter of hours or days, are reversible and transient. If it arises very abruptly, it is probably a cerebrovascular involvement.
More specifically, it is manifested by a lack of ability to maintain or control attention, disorganized thinking and the existence of an underlying medical or neurological disease (DSM-IV). It also stands out for having fluctuations in its state during the same day.
Patients with this syndrome will be diverted to irrelevant stimuli, incoherent speech, impaired memory, lack of orientation, confusion, perceptual disorders (such as hallucinations), etc.
In this case, almost any serious illness can trigger it: infections, endocrine alterations, cardiac problems, neurological deterioration, neoplasias, drugs, drug use, abstinence, metabolic alterations, etc.
These patients usually recover within a few days or weeks. Recovery depends on the level of severity and the causes that have caused it. If the person had any type of cognitive impairment before, the recovery is probably not complete (Hospital Universitario Central de Asturias, 2016).
Chronic organic mental disorder
In this case, those conditions that remain stable over the long term are included. That is, those that have caused permanent damage to cognitive functioning.
The typical example of this subtype is dementia. Although we also find chronic dependence on drugs, alcohol or certain drugs (such as Benzodiazepines ).
Subacute organic dysfunction of the brain or encephalopathy
There are authors who establish a third category for Encephalopathy , Since it consists of an intermediate manifestation between the two extremes. Initially this condition manifests fluctuations and even appears to be resolved, but is often progressive and persistent.
symptom
Symptoms vary greatly depending on the cause of the organic mental disorder.
For example, the symptoms of a case of chronic alcoholism in abstinence (called delirium tremens ) Than one of stroke.
The first will show hyperactive forms of organic mental disorder such as activation of the sympathetic system (tachycardia, sweating, hypertension, dilation of the pupils...). Whereas, in the second, the person will hardly react to stimuli, will be confused and will present an incoherent speech.
In this way, there are conditions in which patients will show more"hyperactive"symptoms (psychomotor agitation, greater alertness) and others in which they are more"hypoactive"(lack of answers, and low level of consciousness).
The former is associated with deprivation of Drugs And drugs, while the latter is more typical in the elderly.
However, the most frequent form is that both types of symptoms fluctuate. Above all, in acute organic mental disorder.
The most general and typical symptoms of organic mental disorder are:
- Agitation
- Confusion
- Reduced level of consciousness
- Problems in judgment and reasoning
- Some impairment in cognitive functioning, either short term (as in delirium) or long term (such as dementia). In this category we frame problems in attention, memory, perception, executive functions, etc.
- Alterations in the sleep-wake cycles (this mainly in the acute subtypes).
Diagnosis
It is usually started by examining the patient's symptoms, medical history, along with the testimony of the family or companions.
The tests that are performed are essentially, brain scanners such as:
- Computed Tomography (CT) : Through X-rays, images of the skull and brain are created in three dimensions.
- Magnetic Resonance Imaging (MRI): using this technique magnetic fields are used to construct images of the brain. Specifically observe which zones are active or which are damaged by their level of oxygen consumption or glucose. This technique is widely used for its good spatial resolution, which results in detailed images of the brain.
Positron Emission Tomography (PET): This scanner detects brain metabolism through the injection of radioactive substances of very short life.
- Electroencephalogram (EEG): This technique is useful for detecting problems in the electrical activity of the brain.
Treatment
Obviously, the treatment depends on the exact cause underlying the organic mental disorder. There are certain milder conditions that only require rest and medication, such as fever, lack of rest, or malnutrition. It is essential to ensure that the patient receives an adequate level of nutrients and fluids.
As for medication, will be used to relieve pain, antibiotics for infections, anticonvulsants for epilepsy, etc.
Sometimes the consumption of drugs (may be side effects) or other drugs are those that cause the organic mental disorder. In that case, they must withdraw. If drugs are essential to treat another condition, it is better to replace them with others with a similar mechanism of action that does not have these side effects.
If it is due to a respiratory disorder, the patient will need an oxygen supplement.
In other cases, surgery may be necessary, as in patients with Brain tumors .
However, neurodegenerative diseases such as dementias require another type of treatment. Usually a neuropsychological approach is used, developing what is known as Cognitive stimulation , To slow the progression of the disease.
To this end, we will carry out personalized activities for each case that train the most vulnerable cognitive abilities. Thus attention, memory, psychomotricity, visuospatial orientation, executive functions, activities of daily living, etc. are worked.
Usually effective treatment is multidisciplinary, including physical therapy to improve muscle tone, postural strength and lost strength; And occupational therapy, which will help the person lead an independent and satisfying life.
If sensory deficits have occurred, try to maintain the maximum degree of functionality using compensatory strategies. For example: glasses, hearing aids, teaching new methods of communication, etc.
References
- Central nervous system disease . (S.f.). Retrieved on October 7, 2016, from Wikipedia.
- Gerstein, P. (s.f.). Delirium, Dementia, and Amnesia in Emergency Medicine . Retrieved on October 7, 2016, from Medscape.
- Krause, L. (January 28, 2016). Organic Brain Syndrome . Retrieved from HealthLine.
- Mak, M. (s.f.). Organic mental disorders . Retrieved on October 7, 2016, from the University of Medicine of Pomerania.
- Neurocognitive disorder . (S.f.). Retrieved on October 7, 2016, from MedlinePlus.
- Organic brain syndrome . (S.f.). Retrieved on October 7, 2016, from Wikipedia.
- Organic mental disorders . (S.f.). Retrieved on October 7, 2016, from Wikipedia.
- Ruiz M., M. V. (s.f.). Guide for diagnosis and treatment of Acute Confusion Syndrome . Recovered on October 7, 2016, from Central University Hospital of Asturias.