Organic Brain Syndromes
An organic brain syndrome may be an acute
or chronic psychiatric illness resulting from failure of brain
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
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
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, 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