The organic mental disorders, Also called organic brain syndromes, they consist of impaired cognitive function that has organic or physiological causes. That is, the person has some physical affectation that causes damage to their mental functioning.
This concept is practically in disuse and its origins go back to psychiatry. Its objective was to distinguish between psychiatric disorders that arise from a mental problem (which were called "functional"), from those that appear due to physical causes (considered "organic")..
Organic mental disorder was frequently diagnosed in the elderly, as it is more likely at this stage of life. Adding to this that before there was no diagnosis of dementia, but it was considered to be part of normal aging.
Currently, with the scientific advancement of the brain, these limits are not so clear. And it is that, many authors postulate that all mental affectation is reflected in our brain in some way, and, therefore, in our behavior.
Thus, conditions such as depression, anxiety, schizophrenia, autism or Alzheimer's, could have their own manifestations in the brain. However, it is not yet known in many pathologies whether brain malfunction is a cause or consequence of the disease itself. It is also not known with certainty what the common brain implications of each mental disorder are and if they are repeated in all people.
With this explanation you can get an idea of how difficult it is today to distinguish a psychological disorder by its origin.
For this reason, the definition of organic mental disorder has undergone certain clarifying modifications. Today it is more associated with consequences of medical diseases, observable brain injuries such as a stroke, or exposure to substances that cause direct brain damage.
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Organic brain syndrome is considered a state of mental deterioration that is a consequence of:
In the long term, they can cause toxic effects on cognitive functions, damaging brain structures and their activity in various ways..
Acute organic brain syndrome can occur if an overdose occurs, but it is temporary and reversible. Withdrawal syndrome or "mono" can also cause acute organic mental syndromes.
Such as strokes, heart infections, stroke, hypoxia, subdural hematoma, etc..
Overexposure to certain substances such as methanol, lead or carbon monoxide can cause direct brain damage.
Infections that affect the nervous system through the intrusion of viruses and bacteria that the immune system has been unable to defeat.
These microorganisms cause inflammation of brain structures, which is known as encephalitis. The swelling is accompanied by neuronal damage from increased intracranial pressure.
We can mention any acute or chronic infection, in addition to meningitis (infection of the meninges, the layer that covers the brain), septicemia or blood poisoning, advanced syphilis, pneumonia, etc..
Dementias that begin with brain damage that are spreading more and more, are chronic and practically irreversible. That is why they are called neurodegenerative diseases. However, with proper treatment its development can be greatly delayed..
Among dementias we find Alzheimer's disease, Parkinson's disease, Huntington's disease, vascular dementia caused by some cerebrovascular disease, etc..
All of them have in common clear injuries or observable damage to brain tissue.
They consist of brain injuries caused by an external impact that affect any part of the skull, and therefore the brain. These damages have clear manifestations in the cognitive abilities, personality, and affective and emotional aspects of the patient.
Traditionally considered as "physical" or "organic" diseases, they refer to conditions such as metabolic disorders (liver, kidney, thyroid disease, anemia, vitamin deficiencies such as B12 and thiamine, hypoglycemia ...).
We can list others such as neoplasms or complications due to cancer, endocrine disorders, fever, hypothermia, dehydration, cardiopulmonary disorders, migraines, etc..
Such as epilepsy, brain tumors, demyelinating diseases such as multiple sclerosis, etc..
This happens because when our senses are not stimulated, the brain reorganizes itself in such a way that the synapses dedicated to these senses are lost..
On the other hand, lack of sleep and rest for long periods of time causes, in the long term, brain damage.
It is important not to make the mistake of treating depression or anxiety developed out of concerns about a serious physical illness as an organic mental disorder. They are different concepts.
In the first place, the organic mental disorder produces, mainly, alterations in cognitive abilities such as reasoning, attention and memory.
On the other hand, this affectation is caused by organic factors, that is, a malfunction of the body. On the other hand, developing depression would be the result of concerns and subjective interpretations about some physical illness, considering it as the object of our discomfort.
It can be divided into two groups according to its duration:
Which is also defined as acute confusional syndrome or delirium. It is characterized by cognitive alterations that appear rapidly, in a matter of hours or days, are reversible and transitory. If it arises very suddenly, it is probably a cerebrovascular disease.
More specifically, it is manifested by a lack of ability to maintain or control attention, disorganized thinking, and the existence of an underlying medical or neurological disease (DSM-IV). It also stands out for presenting fluctuations in its status during the same day.
Patients with this syndrome will present a diverted attention to irrelevant stimuli, incoherent speech, altered memory, lack of orientation, confusion, perceptual disorders (such as hallucinations), etc..
In this case, practically any serious disease can set it in motion: infections, endocrine disorders, heart problems, neurological deterioration, neoplasms, drugs, drug use, withdrawal, metabolic disorders, etc..
These patients usually recover within a few days or weeks. Recovery depends on the level of severity and the causes that have produced it. If the person had some type of cognitive impairment before, the recovery is probably not complete (Hospital Universitario Central de Asturias, 2016).
In this case, those conditions that remain stable in the long term are included. That is, those that have caused permanent damage to cognitive functioning.
The typical example of this subtype is dementia. Although we also find chronic dependence on drugs, alcohol or certain drugs (such as benzodiazepines).
There are authors who establish a third category for encephalopathy, since it consists of an intermediate manifestation between the two extremes. Initially this condition shows fluctuations and even seems to resolve, but it is often progressive and persistent.
Symptoms vary greatly depending on the cause of the organic mental disorder. For example, the symptoms of a case of chronic alcoholism in a state of withdrawal (called delirium tremens) are not the same as one of stroke.
The first will show hyperactive forms of organic mental disorder such as activation of the sympathetic system (tachycardia, sweating, arterial hypertension, pupil dilation…). While, in the second, the person will barely react to stimuli, will be confused and will present incoherent speech.
Thus, there are conditions in which patients will show more "hyperactive" symptoms (psychomotor agitation, greater alertness) and others in which they are more "hypoactive" (lack of responses, and low level of consciousness)..
The former is associated with drug and drug deprivation, while the latter is more typical in the elderly. However, the most common way is that both types of symptoms fluctuate. Especially in acute organic mental disorder.
The most general and typical symptoms of organic mental disorder are:
- Agitation
- Confusion
- Reduced level of consciousness
- Problems in judgment and reasoning
- Some impairment in cognitive functioning, either short-term (such as delirium) or long-term (such as dementias). In this category we frame problems in attention, memory, perception, executive functions, etc..
- Alterations in sleep-wake cycles (this mainly in the acute subtypes).
Usually begins by examining the symptoms of the patient, his medical history, along with the testimony of the family or companions. The tests that are performed are essentially brain scans such as:
- Computed Axial Tomography (CT): through X-rays, images of the skull and brain are created in three dimensions.
- Magnetic Resonance Imaging (MRI): This technique uses magnetic fields to build images of the brain. Specifically, observe which areas are active or which are damaged by their level of oxygen or glucose consumption. This technique is widely used for its good spatial resolution, which results in detailed images of the brain..
- Positron Emission Tomography (PET): This scanner detects brain metabolism through the injection of very short-lived radioactive substances.
- Electroencephalogram (EEG): This technique is useful for detecting problems in the electrical activity of the brain.
Obviously, treatment depends on the exact cause underlying the organic mental disorder. There are certain milder conditions that only require rest and medication, such as fever, lack of rest, or malnutrition. It is essential to ensure that the patient receives an adequate level of nutrients and fluids.
Regarding medication, drugs will be used to relieve pain, antibiotics for infections, anticonvulsants for epilepsy, etc..
Sometimes the consumption of drugs (they may be side effects) or other drugs are what cause the organic mental disorder. In that case, they must withdraw. If the drugs are essential to treat another ailment, it will be better to replace them with others with a similar mechanism of action that do not present these side effects.
If it is due to a respiratory disorder, the patient will need an oxygen supplement. In other cases, surgery may be necessary, such as in patients with brain tumors.
However, neurodegenerative diseases such as dementias require another type of treatment. Normally a neuropsychological approach is used, developing what is known as cognitive stimulation, to slow the progression of the disease.
For this, personalized activities will be carried out for each case to train the most vulnerable cognitive abilities. This is how attention, memory, psychomotor skills, visuospatial orientation, executive functions, activities of daily living, etc. are worked..
Usually effective treatment is multidisciplinary, including physical therapy to improve muscle tone, posture and lost strength; and occupational therapy, which will help the person lead an independent and fulfilling life.
If sensory deficits have occurred, try to maintain the maximum degree of functionality using compensatory strategies. For example: glasses, hearing aids, teaching him new communication methods, etc..
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