精神病学课件-Chapter 5-1 Brain Organic Mental Disorder.ppt

Chapter 5 Brain Organic Mental Disorder Wang Yang （王旸） Department of Psychiatry, Shandong University School of Medicine Outline Overview Common Syndromes Alzheimer’s disease Vascular dementia Mental disorders due to brain damage Mental disorders due to intracranial infection Mental disorders due to brain tumor Dementia paralytica Mental disorders due epilepsy Mental disorders due human immunodeficiency virus 1st Overview Overview 脑器质性精神障碍：由脑部已发现的明显的病理形态和病理生理改变所引起的精神障碍 共同的临床特征：如谵妄、遗忘、痴呆等 精神障碍的发生、发展以及病程与原发器质性疾病相关 寻找病因，对症处理 治疗方案：小量慢加，不宜长期应用 2nd Common Syndromes A. Delirium （谵妄） Definition Delirium is a syndrome characterized by a disturbance of consciousness, impaired attention and a change in cognition Delirium develops quickly over hours or days and tends to fluctuate during the course of the day As acute brain syndrome Epidemiology Delirium is surprisingly common. In hospital settings, an estimated 10%-15% of medical patients develop a delirium Delirium is particularly common among postsurgical and elderly patients, especially those older than 80 years. Other risk factors include a preexisting dementia, bone fractures, systemic infections and use of narcotics or antipsychotics Delirium is associated with high mortality, an estimated 40%-50% of the patients with delirium die within 1 year of developing the disturbance Etiology Delirium most commonly occurs in persons who have serious medical, surgical, neurological illness, who are in a state of drug intoxication or withdrawal Metabolic disturbances, such as those caused by infection, febrile illness, hypoxia, hypoglycenia, drug intoxication or withdrawal states, or hepatic encephalopathy, commonly cause delirium Common causes of delirium that lie within the central nervous system include brain abscesses, stroke, traumatic injuries and postictal state Delirium can be influenced by environmental events, but they do not cause delirium, as “ICU psychosis” Clinical Findings The hallmark of delir