DELIRIUM,DEMENTIA, AMNESTIC & OTHER COGNITIVE AND MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION (PSYCHOORGANIC SYNDROME)

Elmeida EffendyPsychiatric DepartmentMedical Faculty- UMSU

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In the past these conditions were classified under the heading ‘organic mental’ or ‘organic brain disorders’.

Traditionally those disorders had an identifiable pathological condition such as brain tumor, cerebrovascular disease or drug intoxication

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Di masa lalu kondisi ini digolongkan di bawah 'mental organik' pos atau 'gangguan otak organik'.

Secara tradisional mereka yang memiliki gangguan kondisi patologis yang dapat diidentifikasi seperti tumor otak, penyakit serebrovaskular atau intoksikasi obat

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Brain disorders with no generally accepted basis (such as depression) were called functional disorders

This century-old distinction between organic & functional disorders is outdated & has been deleted from the nomenclature. The only unbiased conclusion to be made from evaluation of the available data is that every psychiatric disorder has an organic ( biological or chemical) component

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Otak gangguan tanpa dasar yang berlaku umum (seperti depresi) disebut gangguan fungsional

Perbedaan abad berusia antara gangguan organik & fungsional sudah usang & telah dihapus dari tata nama. Satu-satunya kesimpulan memihak terhadap dibuat dari evaluasi data yang tersedia adalah bahwa setiap gangguan kejiwaan memiliki komponen organik (biologi atau kimia)

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Because of this reassessment of the data, the concept of functional disorders has been determined to be misleading, & the term functional & organic are not used in that context in DSM-IV-TR

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Karena itu penilaian ulang data, konsep gangguan fungsional telah bertekad untuk menyesatkan, & fungsional & organik jangka tidak digunakan dalam konteks di DSM-IV-TR

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DELIRIUM

4 sub categories based upon several causes : 1. general medical condition, e.g : infection 2.substance induced,

e.g :cocaine,opioid,phencyclidine 3. multiple causes,e.g. head trauma & kidney

disease 4.delirium not otherwised specified, e.g. : sleep

deprivation

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4 sub kategori berdasarkan beberapa penyebab:1. umum kondisi medis, e.g: infeksi2.substance diinduksi, misalnya: kokain, opioid, phencyclidine3. beberapa penyebab, misalnya trauma kepala & penyakit ginjal4.delirium tidak otherwised ditentukan, misalnya : Kurang tidur

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DELIRIUM’S OTHER NAME

Acute confusional state Acute brain syndrome Metabolic encephalopathy Toxic psychosis Acute Brain Failure

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In DSM-IV-TR delirium is characterized by a disturbance of consciousness & a change in cognition that developed over a short time

Delirium has a sudden onset, a brief & fluctuating course, & rapid improvement when the causative factor is identified & eliminated, but each of these characteristic features can vary in individual patients

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Dalam DSM-IV-TR delirium ditandai dengan gangguan kesadaran dan perubahan dalam kognisi yang berkembang selama waktu yang singkat

Delirium memiliki onset mendadak, kursus singkat & berfluktuasi, & perbaikan cepat ketika faktor penyebab diidentifikasi & dihilangkan, tetapi masing-masing ciri karakteristik dapat bervariasi pada pasien individu

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CLINICAL FEATURES OF DELIRIUM

Disturbance of consciousnness Change in cognition

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Gangguan consciousnnessPerubahan kognisi

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DEMENTIA

Multiple cognitive defects that include impairment in memory, without impairment in consciousness.

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Beberapa cacat kognitif yang mencakup penurunan memori, tanpa penurunan kesadaran.

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The cognitive functions include : General intelligence Learning and memory Language Problem solving Orientation Perception Attention & concentration Judgement & social abilities

Personality is also affected17

Fungsi kognitif meliputi:umum intelijenBelajar dan memoribahasapemecahan masalahorientasipersepsiPerhatian & konsentrasiPenghakiman & kemampuan sosial

Kepribadian juga dipengaruhi

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ETIOLOGY

Dementia of the Alzheimer’s Type

Vascular dementia

Drug & toxins

Trauma : head injuries

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Neurodegenerative disorders : Parkinson’s disease,Huntington disease, Pick disease, etc

Infection: Creutzfeldt_Jakob disease, AIDS

Nutritional disorders : Wernicke-Korsakoff syndrome, B 12 deficiency, folate deficiency

Metabolic disorders : Cushing syndrome, dyalisis dementia ,hepatic insufficiency

Chronic inflammatory disorders : Lupus, multiple sclerosis 20

Gangguan neurodegenerative: penyakit Parkinson, Huntington penyakit, Pick penyakit, dll

Infeksi: Creutzfeldt_Jakob penyakit, AIDS

Nutrisi gangguan: sindroma Wernicke-Korsakoff, B 12 defisiensi, kekurangan folat

Gangguan metabolisme: Cushing sindrom, demensia dyalisis, insufisiensi hepatik

Inflamasi kronis gangguan: Lupus, multiple sclerosis

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Dementia of the Alzheimer’s type Memory impairment At least 1 other symptom of cognitive decline

(aphasia,apraxia,agnosia, abnormal executive functioning

Gradual decline in functioning, impairment in social or occupational functioning

Onset : early:( 65 or younger), late : (>65)

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Demensia tipe Alzheimergangguan memoriSetidaknya 1 lainnya gejala penurunan kognitif (aphasia, apraxia, agnosia, fungsi eksekutif yang abnormalBertahap penurunan fungsi, gangguan dalam fungsi sosial atau pekerjaanOnset: awal: (65 atau lebih muda), terlambat: (> 65)

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Miscroscopic findings : senile plaques, neurofibrillary tangles, neuronal loss,synaptic loss, & granulovascular degeneration of the neuron

Neurofibrillary tangles (NT) are composed of cytoskletal elements, primarily phosphorylated tau protein, although other cytoskletal proteins are also present

NT is also occur in Down syndrome, dementia pugilistica, Parkinson, brains of normal people as they age

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Miscroscopic temuan: plak pikun, kusut neurofibrillary, kehilangan saraf, kehilangan sinaptik, & degenerasi granulovascular neuron

Kusut neurofibrillary (NT) terdiri dari unsur cytoskletal, terutama terfosforilasi tau protein, meskipun protein cytoskletal lainnya juga hadirNT juga terjadi pada sindrom Down, demensia pugilistica, Parkinson, otak orang normal seperti mereka menua 25

Chromosom 1,14 & 21 Gene E 4 in the origin of AD;

people with 1 copy of the gene E4 have AD 3 X more frequently than no E4

People with 2 E4 : have AD 8 X more frequently than no E4

E4 is found in persons without dementia & not found in all cases of dementia

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Kromosom 1,14 & 21Gene E 4 dalam asal-usul AD;orang dengan 1 salinan dari gen E4 memiliki AD 3 X lebih sering daripada tidak ada E4Orang dengan 2 E4: memiliki AD 8 X lebih sering daripada tidak ada E4E4 ditemukan pada orang tanpa demensia & tidak ditemukan pada seluruh kasus demensia

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AMNESTIC DISORDERS

Acquired impaired ability to learn & recall new information or inability to recall previously learn knowledge or past events

Amnestic disorders are secondary syndrome caused by systemic medical or primary cerebral disease, substance use disorders or medication adverse effects.

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Gangguan kemampuan Acquired belajar & mengingat informasi baru atau ketidakmampuan untuk mengingat sebelumnya belajar pengetahuan atau peristiwa masa lalu

Gangguan amnestic adalah sindrom sekunder disebabkan oleh penyakit otak sistemik medis atau primer, gangguan penggunaan zat atau efek obat yang merugikan.

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MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION

Mood disorders due to a general medical condition

Psychotic disorders due to a general medical condition

Anxiety disorders due to a general medical condition

Sleep disorders due to a general medical condition

Sexual dysfunction due to a general medical condition

Mental disorders due to a general medical condition not elsewhere classified

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Suasana hati karena kondisi medis umum gangguanPsikotik karena kondisi medis umum gangguanKecemasan karena kondisi medis umum gangguanGangguan tidur akibat kondisi medis umumKarena kondisi medis umum disfungsi seksualKarena kondisi medis umum tidak diklasifikasikan di tempat lain gangguan mental 31

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