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-10PRIMARY AND SECONDARY

BRAIN DYSFUNCTIONDELIRIUM, 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

CLASSIFICATIONSDEMENTIA: DEMENTIA IN ALZHEIMER’S DISEASE, VASCULAR

DEMENTIA, DEMENTIA IN OTHER DISEASESDELIRIUM AMNESTIC DISORDERSOTHER 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 SYMPTOMS3. WITH HALLUCINATORY

SYMPTOMS4. WITH DEPRESSIVE SYMPTOMS5. 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 YEARS2. EVIDENCE OF RAPID ONSET AND PROGRESSION3. APHASIA, AGRAPHIA, ALEXIA, ACALCULIA OR

APRAXIA

DEMENTIA IN ALZHEIMER’S DISEASE WITH LATE ONSET

1. AGE AT ONSE MUST BE 65 YEARS OR MORE2. EVIDENCE OF A VERY SLOW GRADUAL ONSE

AND PROGRESSION3. 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 DISEASE2. DEMENTIA IN CREUTZFELDT-JAKOB DISEASE3. DEMENTIA IN HUNTINGTON’S DISEASE4. DEMENTIA IN PARKINSON’S DISEASE5. DEMENTIA IN HIV DISEASE.6. DEMENTIA IN OTHERS

DILIRIUM

1. CLOUDING OF CONSCIOUSNESS2. COGNITIVE IMPAIRMENT3. PSYCHOMOTOR

DISTURBANCES4. DISTURBANCE OF SLEEP5. RAPID ONSE AND

FLUCTUATIONS6. 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)DRUGSPOISONSEDOCRINE DYSFUNCTIONLIVER: HEPATIC ENCEPHALOPATHYKIDNEY: UREMIC ENCEPHALOPATHYLUNG: CO NARCOSIS, HYPOXIACARDIOVASCULAR: CARDIAC FALUREVITAMINE DEFICIENCYSYSTEMIC INFECTIONSELECTROLYE IMBALANCEPOSTOPERATIVE STATESTRAUMA

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)

HYPOGLYCEMIAPRIMARY 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 CHANGESDISINHIBITED EXPRESSION OF

NEEDS OR IMPULSESCOGNITIVE DISTURBANCESMARKED 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 HALLUCINOSISORGANIC CATATONIC DISRODERORGANIC DELUSIONAL DISORDERORGANIC MOOD DISORDERORGANIC ANXIETY DISORDERORGANIC DISSOCIATIVE DIORDERORGANIC EMIOTANLLY LABILE

DISORDER