Geriatric Mental Disorders 楊誠弘醫師 臺北榮民總醫院精神部 中華民國 98 年 9 月 23 日

精神病理 疾病 心理症狀 Alzheimer’s disease Dementia Brain tumor Delirium Cerebral infarction Depression Parkinson disease Delusion Schizophrenia Hallucinations

INTRODUCTION ORGANIC AND FUNCTIONAL DIOSRDERS DSM-IV-TR AND ICD-10 PRIMARY AND SECONDARY BRAIN DYSFUNCTION DELIRIUM, DEMENTIA, AMNESIA AND OTHER ORGANIC MENTAL DISORDERS

DSM-IV-TR AND ICD-10 DELIRIUM, DEMETIA AND AMNESTIC DISORDERS (SAME) MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION (DSM-IV-TR) OTHER ORGANIC MENTAL DISORDERS ( ICD-10)

EXAMPLES PERSONALITY CHANGE DUE TO GENERAL MEDICAL CONDITIONS (DSM-IV-TR) ORGANIC PERSONALITY DISORDER ( ICD-10)

TWO GROUPS DELIRIUM, DEMETIA AND AMNESITC DISORDERS: COGNITIVE IMPAIRMENT OTHER ORGANIC MENTAL DISORDERS: HALLUCINATIONS, DELUSIONS, MOODS AND PERSONALITIES AND BEHAVIORS

CLASSIFICATIONS DEMENTIA: DEMENTIA IN ALZHEIMER’S DISEASE, VASCULAR DEMENTIA, DEMENTIA IN OTHER DISEASES DELIRIUM AMNESTIC DISORDERS OTHER MENTAL DISORDERS: ORGANIC HALLUINOSIS, ORGANIC CATATONIC DISORDER, ORGANIC DELUSIONAL DISORDER, ORGAINC MOOD DISORDER, ORGANIC PERSONALITY DISORDERS….

DEMENTIA 1. A DECLINE IN MEMORY AND OTHER COGNITIVE ABILITIES CHARACTERIZED BY DETERIORATION IN JUDGEMENT AND THINKING 2. AWARENESS OF ENVIRONMENT 3. A DECLINE OF EMOTIONAL CONTROL OR MOTIVATION 4. SYMPTOMS FOR AT LEAST 6 MONTHES

ADDITIONAL SYMPTOMS OF DEMENTIA 1.WITHOUT ADDITIONAL SYMPTOMS 2.WITH DELUSIONAL SYMPTOMS 3.WITH HALLUCINATORY SYMPTOMS 4.WITH DEPRESSIVE SYMPTOMS 5.WITH OTHER MIXED SYMPTOMS

DEMENTIA IN ALZHEIMER’S DISEASE 1.THE GENERAL CRITERIA FOR DEMENTIA MUST BE MET 2.THERE IS NO EVIDENCE FROM THE HISTORY, PHYSICAL EXAMINATION, OR SPECIAL INVESTIGATIONS, FOR ANY OTHER POSSIBLE CAUSE OF DEMENTIA

DEMENTIA IN ALZHEIMER’S DISEASE WITH EARLY ONSET 1.AGE AT ONSE MUST BE BELOW 65 YEARS 2.EVIDENCE OF RAPID ONSET AND PROGRESSION 3.APHASIA, AGRAPHIA, ALEXIA, ACALCULIA OR APRAXIA

DEMENTIA IN ALZHEIMER’S DISEASE WITH LATE ONSET 1.AGE AT ONSE MUST BE 65 YEARS OR MORE 2.EVIDENCE OF A VERY SLOW GRADUAL ONSE AND PROGRESSION 3.PREDOMINANCE OF MEMORY IMPAIRMENT

VASCUALR DEMENTIA THE GENERAL CRITERIA FOR DEMENTIA MUST BE MET. DEFICITS IN HIGHER COGNITIVE FUNCTIONS ARE UNEVENLY DISTRIBUTED THERE IS CLINICAL EVIDENCE OF FOCAL BRAIN DAMAGE THERE IS EVIDENCE FROM THE HISTORY, EXAMINATION, OR TESTS OF A SIGNIFICNAT CEREBROVASCULAR DISEASE

DEMENTIA IN OTHER DISEASES 1.DEMENTIA IN PICK’S DISEASE 2.DEMENTIA IN CREUTZFELDT- JAKOB DISEASE 3.DEMENTIA IN HUNTINGTON’S DISEASE 4.DEMENTIA IN PARKINSON’S DISEASE 5.DEMENTIA IN HIV DISEASE. 6.DEMENTIA IN OTHERS

DILIRIUM 1.CLOUDING OF CONSCIOUSNESS 2.COGNITIVE IMPAIRMENT 3.PSYCHOMOTOR DISTURBANCES 4.DISTURBANCE OF SLEEP 5.RAPID ONSE AND FLUCTUATIONS 6.OBJECTIVE EVIDENCE OF CEREBRAL OR SYSTEMIC DISEASE

CAUSES OF DELIRIUM CEREBRAL DISEASES: EPILEPSY, BRAIN TRAUMA, INFECTIONS, NEOPLASMS, AND VASCULAR DISORDERS SYSTEMATIC DISEASES

SYSTEMIC DISEASES (EXTRACRANIAL CAUSES OF DELIRIUM) DRUGS POISONS EDOCRINE DYSFUNCTION LIVER: HEPATIC ENCEPHALOPATHY KIDNEY: UREMIC ENCEPHALOPATHY LUNG: CO NARCOSIS, HYPOXIA CARDIOVASCULAR: CARDIAC FALURE VITAMINE DEFICIENCY SYSTEMIC INFECTIONS ELECTROLYE IMBALANCE POSTOPERATIVE STATES TRAUMA

ORGANIC AMNESTIC SYNFROME THERE IS MEMORY IMPAIRMENT, MANIFEST IN BOTH DEFECT OF RECENT MEMORY AND REDUSCED ABILITY TO RECALL PAST EXPEREINCES THERE IS NO DEFECT IN IMMEDIAGTE RECALL, CLOUDING OF CONSCIIOUSNESS AND DISTURBANCE OF ATTENTION THERE IS OBJECTIVE EVIDENCE OF SYSTEMIC OR BRAIN DISEASES ASSOCATED FEAGTURES: CONFABULATIONS

MAJOR CAUSES OF AMNESTIC DISORDERS SYSTEMIC MEDICAL CONDITIONS: THIAMENT DEFICIENCY (KORSAKOFF’S SYNDROME) HYPOGLYCEMIA PRIMARY BRAIN CONDITIONS: SEIZURES, HEAD TRUMA, CEREBRAL TUMORS, CEREBROVSCUALR DISEASES, SURGICAL PROCEDURES ON THE BRAIN, ENCEPHALITIS, HYPOXIA, ELECTROCONVULSIVE THERAPY, MUTIPLE SCLEROSIS, TRANSIENT GLOBAL AMNESIA. SUBSTANCES-RELATED CAUSES: ALCOHOL, BENZODIAZEPINES

ORGANIC PERSONALITY DISORDER CONSISTNELTY REDUCED ABILITY TO PERSEVERE WITH GOAL-DIRECTED ACTIVITY EMOTIONAL CHANGES DISINHIBITED EXPRESSION OF NEEDS OR IMPULSES COGNITIVE DISTURBANCES MARKED ALERATIONS OF THE RATE AND FLOW OF LANAGUAGE PRODUCTION ALTERED SEXUAL BEHAVIORS

OTERH MENTAL DISRDERS DUE TO BRAIN DAMANGE AND DYSFUCNITON AND DUE TO PHYSICAL DISEASE ORGANIC HALLUCINOSIS ORGANIC CATATONIC DISRODER ORGANIC DELUSIONAL DISORDER ORGANIC MOOD DISORDER ORGANIC ANXIETY DISORDER ORGANIC DISSOCIATIVE DIORDER ORGANIC EMIOTANLLY LABILE DISORDER