(F).ORGANIC MENTAL DISORDERS OR ORGANIC BRAIN SYNDROME-Organic mental disorders or organic brain syndrome

• Organic mental disorder (OMD), also known as organic brain syndrome, is a disorder associated with a decline in mental function due to a medical or physical disease of the brain rather than a psychiatric illness. It includes delirium, dementia, and other diseases.

1. DELIRIUM *This is an acute common clinical syndrome, a reversible and organic condition, characterized by confusion and disorientation and disturbances in perception, and impaired consciousness. The individual is unable to concentrate and presents with acute cognitive dysfunction. It is called delirium. *Delirium is a syndrome not a disease and has many causes.

ETIOLOGY OF DELIRIUM

*Vascular : Hypertensive encephalopathy, intra cranial haemorrhage and cerebral arteriosclerosis etc.

*Neurological : epilepsy, stroke

*Infection : Meningitis, Encephalitis

*Intoxication: Withdrawal effect or chronic intoxication of sedative drugs.

*Traumatic : In subdural and epidural hematoma, hit stroke.

*Vitamin Deficiency : Vitamin B1 (Thiamine).

*Endocrine and Metabolic: Diabetic coma, shock, hyperthyroidism, hepatic failure.

Metals: Heavy metals (lead, manganese, mercury), carbon monoxide and toxins.

Anoxia: Anemia, cardiac failure.

CLINICAL FEATURE OF DELIRIUM

*Consciousness Impairment

*Attention impairment

*Perceptual Disturbances : Illusions, Hallucinations

*Cognition disturbance: thinking disturbance, memory problems.

*Psychomotor disturbances: hypoactivity and hyperactivity

*Sleep wake cycle disturbance: insomnia or total sleep loss.

*Emotional disturbances: depression, anxiety, fear, irritability, euphoria and apathy.

*Neurological symptoms : tremors, incoordination and urinary incontinence etc.

DIAGNOSIS

*History Collection

*Mini Mental States Examination

*Physical Examination

TREATMENT OF DELIRIUM

*Know the causes of delirium and correct it immediately.

*For hypoxia and hypoglycemia 50mg for 5% dextrose IV should be given.

*Give 100mg thiamine IV for vitamin B1 deficiency.

*Provide IV fluid to prevent electrolyte imbalance.

• Major symptoms of delirium, psychosis and insomnia, require pharmacological treatment. Benzodiazepines and antipsychotic medications are used for their symptomatic management.

NURSING MANAGEMENT OF PATIENT WITH DELIRIUM

• To provide safe environment.
• Provide clean and calm environment to the patient.
• Entry of environmental stimuli should be restricted.

*Bedside patient should be supported.

• Patients should be protected from themselves and others when they experience hallucinations, delusions and illusions.

•Reduce Patient’s Anxiety and Fear

• In the room such objects should be removed which are causing illusion, through which the patient feels anxiety and fear.
• It is effective to have only one person at the patient’s bedside.

*The room should be well lit during night.

•Meet the physical needs of the patient

• Providing appropriate care after physical assessment.

*If there is fever, provide proper treatment.

*Maintaining intake – output chart.

• Giving mouth and skin care.

*Monitor vital signs.

*Assessing the patient’s sleep pattern.

•Orienting the patient.

• Repeatedly showing the patient who he is, where he is and also telling the patient the date, day and time.

*Giving information to the patient when the patient cannot identify the person.

(F).ORGANIC MENTAL DISORDERS OR ORGANIC BRAIN SYNDROME-Organic mental disorders or organic brain syndrome

• Organic mental disorder (OMD), also known as organic brain syndrome, is a disorder associated with a decline in mental function due to a medical or physical disease of the brain rather than a psychiatric illness. It includes delirium, dementia, and other diseases.

1. DELIRIUM *This is an acute common clinical syndrome, a reversible and organic condition, characterized by confusion and disorientation and disturbances in perception, and impaired consciousness. The individual is unable to concentrate and presents with acute cognitive dysfunction. It is called delirium. *Delirium is a syndrome not a disease and has many causes.

ETIOLOGY OF DELIRIUM

*Vascular : Hypertensive encephalopathy, intra cranial haemorrhage and cerebral arteriosclerosis etc.

*Neurological : epilepsy, stroke

*Infection : Meningitis, Encephalitis

*Intoxication: Withdrawal effect or chronic intoxication of sedative drugs.

*Traumatic : In subdural and epidural hematoma, hit stroke.

*Vitamin Deficiency : Vitamin B1 (Thiamine).

*Endocrine and Metabolic: Diabetic coma, shock, hyperthyroidism, hepatic failure.

Metals: Heavy metals (lead, manganese, mercury), carbon monoxide and toxins.

Anoxia: Anemia, cardiac failure.

CLINICAL FEATURE OF DELIRIUM

*Consciousness Impairment

*Attention impairment

*Perceptual Disturbances : Illusions, Hallucinations

*Cognition disturbance: thinking disturbance, memory problems.

*Psychomotor disturbances: hypoactivity and hyperactivity

*Sleep wake cycle disturbance: insomnia or total sleep loss.

*Emotional disturbances: depression, anxiety, fear, irritability, euphoria and apathy.

*Neurological symptoms : tremors, incoordination and urinary incontinence etc.

DIAGNOSIS

*History Collection

*Mini Mental States Examination

*Physical Examination

TREATMENT OF DELIRIUM

*Know the causes of delirium and correct it immediately.

*For hypoxia and hypoglycemia 50mg for 5% dextrose IV should be given.

*Give 100mg thiamine IV for vitamin B1 deficiency.

*Provide IV fluid to prevent electrolyte imbalance.

• Major symptoms of delirium, psychosis and insomnia, require pharmacological treatment. Benzodiazepines and antipsychotic medications are used for their symptomatic management.

NURSING MANAGEMENT OF PATIENT WITH DELIRIUM

• To provide safe environment.
• Provide clean and calm environment to the patient.
• Entry of environmental stimuli should be restricted.

*Bedside patient should be supported.

• Patients should be protected from themselves and others when they experience hallucinations, delusions and illusions.

•Reduce Patient’s Anxiety and Fear

• In the room such objects should be removed which are causing illusion, through which the patient feels anxiety and fear.
• It is effective that only one person stays at the patient’s bed side.

*The room should be well lit during night.

•Meet the physical needs of the patient

• Providing appropriate care after physical assessment.

*If there is fever, provide proper treatment.

*Maintaining intake – output chart.

• Giving mouth and skin care.

*Monitor vital signs.

*Assessing the patient’s sleep pattern.

•Orienting the patient.

• Repeatedly showing the patient who he is, where he is and also telling the patient the date, day and time.

*Giving information to the patient when the patient cannot identify the person.

• Keeping a calendar in the room or ward so that the patient gets information about the date and day.

2. DEMENTIA

• Dementia is a serious cognitive disorder in which a person’s memory, thinking ability and behavior problems are seen. It starts slowly and gets worse over time.
• In dementia, the person cannot remember anything and has problems in his daily activities.

*Old age person dementia is most common.

ETIOLOGICAL FACTORS OF DEMENTIA

-Degenerative diseases of the central nervous system (CNS).

-Alzheimer’s disease

-Parkinson’s disease

-Huntington Korea

-shock

• Encephalitis

-meningai teas

-AIDS

-Hepatic failure

-Renal failure

• Endocrine disorders: Addition disease,

-Intoxication : alcohol, heavy metals (lead, arsenic) and barbiturates.

• Anemia

-Respiratory failure

-Vitamin deficiency (thiamine)

-Heatstroke

• Epilepsy

-Electrical injury

STAGES OF DEMENTIA

*Stage-1 (Early Stage)

*Stage-2 (Middle Stage)

*Stage-3 (Final Stage)

*Stage-1 (Early Stage)

-Forgetfulness.

-Environment reduces interest.

-Can’t do their work well.

*Stage-2 (Middle Stage)

-Progressive memory loss.

• Feeling confused in answering questions. -Do not follow any instructions. -Irritable and anxious. -Social isolation. -Rejects personal hygiene.

*Stage-3 (Final Stage)

-Weight loss (not having proper food intake).

-Can’t talk.

• Can’t recognize family. -Loss ability to walk and sit.
• Death can also happen.

SIGN AND SYMPTOMS OF DEMENTIA

-Personality Changes: Withdrawn (separation from people), cannot do self care properly.

-Memory impairment: recent memory loss (forget the day, date and events that happened during the day.)

-Cognitive impairment: disorientation (not knowing time, place and person) and poor judgement.

-Behavioral impairment: stereotypic behavior (doing one activity over and over again.

-Neurological Impairment: Aphasia (It reduces the ability of a person to speak.)

• Apraxia (Inability to perform a movement when asked to do it.)
• Delusion

-Poor insight

-Fatigue etc.

DIAGNOSIS

-History Collection

-Mini Mental States Examination

-MRI

-CT Scan

-Vitamin analysis

MANAGEMENT AND TREATMENT OF DEMENTIA

*Medication:

-cholinesterase inhibitor (tacrine hydrochloride)

– Symptomatic treatment (antidepressants, antipsychotic and anxiolytic drugs.

*Occupational Therapy:

-Physical therapy

The patient’s mobility can be improved by learning to use walkers.

-Music and art activities

-Respite care: Dementia patients should be kept in a nursing home for a short time and supported by family members and health workers.

*Psychotherapy:

-Behavior oriented

-Emotionally oriented

– Connection oriented

-stimulation oriented

NURSING MANAGEMENT OF PATIENT WITH DEMENTIA

*To maintain cognitive function

-Environmental confusion should be removed, hazards should not be kept in the ward.

Orientation of time, place and person.

-Physical safety of the patient should be maintained.

-Treat the patient calmly and give proper introduction of self.

– Provide opportunity to the patient to do things like walking, exercise, music etc.

-Discussing anxiety openly with the patient.

Promoting patient interaction.

– Necessary measures should be taken to maximize exchange of ideas and feelings between the patient and others.

-Assessing the level of social interaction to form baseline data.

-Encourage them to participate in group therapy to promote social interaction.

-Spending time with clients.

-Communicating with clients in a simple and understandable language.

Promoting the patient’s daily activities.

-Assessing the patient’s daily life activities.

-Make a plan for various activities of daily life according to the patient’s condition and encourage him to actively participate in daily activities.

– Help should be provided whenever needed.

-He should be taught behavior change techniques and encouraged to follow through.

-Making patient’s daily activity schedule and providing bath room safety.

To maintain the nutrition level of the patient.

– Food intake and food habit should be observed.

– Balance diet should be provided and fluid intake should be increased.

-Regular weight monitor.

– Taking care of the patient’s mouth.

Maintaining personal hygiene.

-Keeping a clean environment so that infection does not occur.

Clean and dry the skin to promote healthy skin.

– Take proper care of the patient’s hair and comb and oil it.

-Hand and toe nails should be cleaned properly.

-Hand, foot and back massage will improve circulation and muscle tone of the patient.

Improving sleep patterns.

-Ask the patient to do activities like music, relaxation exercises to prepare for sleep.

– Avoiding deliberate exercise 1 hour before sleep.

-Give high carbohydrate diet before sleep time.

– Giving prescribed medicine.

To provide rehabilitation.

– Provide physiotherapy.

-Speech therapy should be given.

– Hearing aids should be provided.