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Organic Brain Syndromes

An organic brain syndrome may be an acute or chronic psychiatric illness resulting from failure of brain function.

An acute organic brain syndrome constitutes a psychiatric emergency with a high risk of mortality, of almost 50%. The patient presents with grossly disorganised behaviour of acute onset. There may be symptoms such as fever, convulsions, other organ failure-renal, hepatic etc. The patient talks incoherently, has florid auditory and visual hallucinations. History reveals inappropriate social behaviour, incontinence of bowel and bladder and excitement. The patient may have displayed impaired memory function. On enquiry he often has a change in level of consciousness, has gross memory deficits and is disoriented.

A thorough physical examination is directed towards identifying the cerebral or extracerebral cause for brain failure, with special reference to presence of neurological signs and symptoms, fever, signs of renal or hepatic failure. History of recent drug taking behaviour should be elicited. Symptomatic relief could be provided by use of analgesics to control fever. The patient may be sedated only if necessary to enable immediate transport to referral centre for further management.

Dementia

The chronic organic brain syndrome, dementia is a common psychiatric illness of the elderly. With increase in life expectancy, dementia, in the United States is the fourth common cause of mortality. In India, the prevalence of dementia is between 6 and 32 per 1000 in geriatric population studies.

Dementia is a heterogenous entity comprising of different types such as Senile Dementia-Alzheimer's type, Multi infarct Dementia and dementia secondary to other causes.

A detailed history reveals a gradual decline in all spheres of the patient's activities- such as an inability to persue his occupation, lack of social behaviour, evidences for defective memory, inability to take care of self etc. Often these are ignored by the family members as part of ageing. The patient seldom has any relevant complaints suggesting dementia. Enquires should be directed to find if the patient had lost his/ her way in the recent past, inability to handle even a small sum of money etc. Detailed assessment by verbal enquiry to assess orientation to time person and place, memory in all aspects-remote, recent and immediate, will reveal serious impairment. Inability to solve simple arithmetic problems quickly establishes the patient's intellectual decline.

A detailed physical examination, with a complete neurological evaluation is absolutely essential. Hypertension, atherosclerosis may often be associated. The patient should be referred to the hospital for detailed investigation.

Paraphrenia

Paraphrenia, is a functional psychiatric illness of the elderly. It is a schizophrenia like illness. The patient has abnormal sensory perceptions in the absence of stimulus hallucinations. These may be voices or visions. The patient often holds false morbid beliefs, delusions such as people being against him, people trying to kill him or that he has imaginary powers. The patient often has sensory handicaps, he may be hard

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