Organic Brain Syndrome

Under supervision:
Dr/Soheir Gooda.
By/Rasha Mohamed El Saied Abd El Ghany.
 Out lines:
Introduction.
Definition of organic brain syndrome.
Acute organic brain disorder (delirium).
Definition of delirium.
Symptoms of delirium.
Types of delirium.
Causes of delirium.
Risk factors of delirium.
Common nursing diagnosis of delirium.
 Chronic brain disorder (dementia)
Definition of dementia.
Symptoms of dementia.
Types of dementia.
Progressive dementias.
Risk factors of dementia.
Common nursing diagnosis of dementia.
Dementia VS delirium.
References.
Introduction
 What is Organic Mental Disorder?
-When we speak about mental illness, most of us
assume that biological, genetic, or environmental
factors can affect the functioning of the brain and
cause different types of mental illnesses.
-However, some physical diseases or medical
conditions like brain injury, neurological
impairment, surgery, extreme physical or mental
trauma can also affect the functioning of the
brain.
-Organic mental disorder or organic brain
syndrome is not a disease; rather, it is a term
used to refer to any of the conditions caused due
to the gradual decrease in the functioning of the
brain.
-The brain cells could be damaged due to a physical
injury or due to psycho-social factors like severe
deprivation, physical or mental abuse, and severe
psychological trauma.
-A person affected with this condition may be able to
think, remember, comprehend and learn, but the
person's judgment may be so poor that continual
supervision is required.

-Left unattended, the symptoms may worsen causing

more problems.
 Neuro-cognitive disorders most commonly occur
in older adults, but they can affect younger people
as well.
 Definition:
- Is a general term used to describe
decreased mental function due to a medical
disease, other than a psychiatric illness.
 Reduced mental function may include:
Problems with memory.
Changes in behavior.
Difficulty understanding language.
Trouble performing daily activities.
 Organic mental disorders can be temporary and
acute (delirium), or permanent and chronic
(dementia).
Delirium
 Delirium is a serious disturbance in mental abilities
that results in confused thinking and reduced
awareness of your environment.
The start of delirium is usually rapid within hours
or a few days.

Delirium :-Disturbance of consciousness and cognition with

reduced ability to focus, sustain, or shift attention that
develops over a short period.
 Delirium can often be traced to one or more
contributing factors, such as a severe or chronic
medical illness, changes in your metabolic
balance (such as low sodium), medication,
infection, surgery, or alcohol or drug withdrawal.
 Signs and symptoms of delirium usually begin over
a few hours or a few days.

They often fluctuate throughout the day, and

there may be periods of no symptoms.

Symptoms tend to be worse during the night when

it's dark and things look less familiar.

Primary signs and symptoms include those below.

1-Reduced awareness of the environment
This may result in:
An inability to stay focused on a topic or to switch
topics.
Getting stuck on an idea rather than responding to
questions or conversation.
Being easily distracted by unimportant things.
Being withdrawn, with little or no activity or little
response to the environment.
2-Poor thinking skills (cognitive impairment)
This may appear as:
Poor memory, particularly of recent
events.
Disorientation, for example, not knowing
where you are or who you are.
Difficulty speaking or recalling words.
Rambling or nonsense speech.
Trouble understanding speech.
Difficulty reading or writing.
 3-Behavior changes
This may include:
Seeing things that don't exist
(hallucinations).
Restlessness, agitation or combative
behavior.
Calling out, moaning or making other
sounds.
Being quiet and withdrawn especially in
older adults.
Slowed movement or lethargy.
Disturbed sleep habits.
Reversal of night-day sleep-wake cycle.
 4-Emotional disturbances
This may appear as:
Anxiety, fear or paranoia.
Depression.
Irritability or anger.
A sense of feeling elated (euphoria).
Apathy.
Rapid and unpredictable mood shifts.
Personality changes.
Types of delirium
Experts have identified three types of
delirium:
 1-Hyperactive delirium:
Probably the most easily recognized type, this
may include restlessness (for example, pacing),
agitation, rapid mood changes or hallucinations.
 2-Hypoactive delirium
This may include inactivity or reduced motor
activity, sluggishness, abnormal drowsiness or
seeming to be in a daze.
 Mixed delirium
This includes both hyperactive and hypoactive
symptoms.
The person may quickly switch back and forth from
hyperactive to hypoactive states.
Causes of delirium
 Delirium occurs when the normal sending and
receiving of signals in the brain become impaired.
This impairment is most likely caused by a
combination of factors that make the brain
vulnerable and trigger a malfunction in brain
activity.
 Delirium may have a single cause or more than
one cause, such as a medical condition and
medication toxicity.
Sometimes no cause can be identified.
 Possible causes include:
Certain medications or drug toxicity.
Alcohol or drug abuse or withdrawal.
A medical condition.
Metabolic imbalances, such as low sodium or low
calcium.
Severe, chronic or terminal illness.
Fever and acute infection, particularly in children.
Exposure to a toxin.
 Malnutrition or dehydration.
Sleep deprivation or severe emotional distress
Pain.
Surgery or other medical procedures that include
anesthesia.
Several medications or combinations of drugs can
trigger delirium, including some types of:

Pain drugs.
Sleep medications.
Medications for mood disorders, such as
anxiety and depression.
Allergy medications (antihistamines).
Parkinson's disease drugs.
Drugs for treating spasms or
convulsions.
Asthma medications.
Risk Factors Of Delirium
 Any condition that results in a hospital stay,
especially in intensive care or after surgery,
increases the risk of delirium, as does being a
resident in a nursing home.
 Examples of other conditions that
increase the risk of delirium include:
Brain disorders such as dementia, stroke or
Parkinson's disease.
Older age.
Previous delirium episodes.
Visual or hearing impairment.
Having multiple medical problems.
Common nursing diagnosis
 Risk for torturing themselves, others and the
environment related to the response in mind
delusions and hallucinations.
Ineffective individual coping related to the
inability to express in a constructive way.
Change the thought process related to the inability
to trust people.
Risk for Imbalanced Nutrition : Less Than Body
Requirements related to intake is less, the status
emotional increased.
 Impaired Verbal Communication related to
communication pattern that is not logical or
incoherent and side effects of drugs, the
pressure to talk and hyperactivity.
Lack of social interaction (social isolation)
are related to inadequate support systems.
Lack of self-care related to a decreased
willingness.
 (1) Risk for injury related to hallucination and
illusion as evidenced by removing IV tubes and
falls.
The Goal: The client will remain safe and free
from injury.
 Intervention
1.Provide one to one observation.
2. Decrease stimulus in the environment (low
light, low noise).
3- Keep any dangerous equipment a way
from the client.
4. Bed side rails may be used to prevent
falling.
5. Bed should be away from windows and
doors.
6. Reassure the client that the environment is
safe or provide safety measures as simple
room, simple furniture.
7. Restraint if it's necessary.
(2) Sensory/ Perceptual Alteration
related to neurological dysfunction as evidenced by
illusion and hallucination.
The Goal: The client will demonstrate accurate
perception of environment.
Intervention:
1.Introduce self and call client by name at the
beginning of each contact.
2.Maintain face to face contact to give positive
interaction.
3. Use short, simple phrases.
4.Briefly explain every thing you are going to do
before doing it.
5.Keep room well lighted and provide clocks
and calendars to orient pt to time.
6.When hallucination is present, clarify reality
(EX: "I know you are frightened, but I don't se
spider on you sheets).
7. When illusion is present, clarify reality
(EX: This is intravenous tubing not a snakesee
You seem frightened, I will stay with you).
Dementia
 Dementia isn't a specific disease.
Instead, Dementia describes a group of
symptoms affecting memory, thinking and social
abilities severely enough to interfere with daily
functioning.
 So memory loss alone doesn't mean you have
dementia.
 Alzheimer's disease is the most common cause of a
progressive dementia in older adults, but there are a
number of causes of dementia.

Depending on the cause, some dementia symptoms

can be reversed.
Symptoms
 The essential feature of dementia
( sign and symptoms):
1. Aphasia:- which is deterioration of language function.

2. Apraxia:- the loss of purposeful movement without loss

muscle power or coordination.

3. Agnosia:- which is inability to recognize or name objects

despite intact sensory abilities.

4. Disturbance in executive functioning ,which is the ability

to think abstractly and to plan and organizing.

EX: The client loses the ability to perform self-care

activities.
 5) recent memory loss:- people with dementia often
forget things but they never remember them. They may
ask same question over and over and forget they already
get the answer.

6) Difficulty to perform familiar tasks (apraxia):- such as

dressing or cooking food and forget to serve it or forget
they cooked it.
 7) disorientation to time and place:- people with
dementia may forget their own street and forget how to
get back to their home and finally disoriented to self in
the severe stage.

8) poor judgment:- people with dementia cannot

evaluate situations for risks or danger. For example, they
may walk outside in the winter wearing only thin
nightclothes , or forgetting to put on a coat.

9) misplacing things:- people with dementia put things in

wrong places such as (wristwatch in sugar bowel or
freezer) and they can't find these things later.
 10) change of mood:- fast mood swings going
from calm to tear to anger in few minutes.

11) change in personality:- people with dementia

become irritable, suspicious or fearful.

12) loss of initiative:- people with dementia

become passive , they might not want to go
places or seeing other people.

13) delusion of persecution are common.

 Dementia symptoms vary depending on the
cause, but common signs and symptoms include:
1-Cognitive changes:
Memory loss, which is usually noticed by a
spouse or someone else.
Difficulty communicating or finding words.
Difficulty reasoning or problem-solving.
Difficulty handling complex tasks.
Difficulty with planning and organizing.
Difficulty with coordination and motor
functions.
Confusion and disorientation.
2-Psychological changes
Personality changes.
Depression.
Anxiety.
Inappropriate behavior.
Paranoia.
Agitation.
Hallucinations.
 Stage of dementia
1. Early stage.
2. Middle stage.
3. Late stage.
 Stage of dementia
1. Early stage:-
Forgetfulness progress to confusion and eventually
disorientation to time , place and person.

Poor in judgment , problem solving and decision

making.

Personality changes, irritability, agitation, sadness (

depression), manic episodes.
2. middle stage:-
Need assistance with ADL.
Poor in hygiene.
Sleep disturbance.
Altered of posture.
Loss of short-term recall.
Disoriented to time and place.
Unable to remember names.
Ask question repeatedly.
Use word salad ( sentence fragments).
Unable to carry on a conversation.
Delusion and obsessive behavior.
3. Late stage:-
Unresponsive to most stimuli.
Loss of verbal articulation.
Loss of ambulation.
Bowel and bladder incontinence.
Disturbed sleep patterns.
When to see a doctor
 See a doctor if you or a loved one has memory
problems or other dementia symptoms.
Some treatable medical conditions can cause
dementia symptoms, so it's important to
determine the underlying cause.
Causes Of Dementia
 Dementia involves damage of nerve cells in the
brain, which can occur in several areas of the
brain.

Dementia affects people differently, depending on

the area of the brain affected.
 Dementias are often grouped by what they have
in common, such as the part of the brain that's
affected or whether they worsen over time
(progressive dementias).
 Some dementias, such as those caused by a
reaction to medications or vitamin deficiencies,
might improve with treatment.
Progressive Dementias

Types of dementias that progress and

aren't reversible include:
 Alzheimer's disease.
In people age 65 and older, Alzheimer's
disease is the most common cause of
dementia.
 Although the cause of Alzheimer's disease isn't
known, plaques and tangles are often found in the
brains of people with Alzheimer's.
 Plaques are clumps of a protein called beta-
amyloid, and tangles are fibrous tangles made up
of tau protein.
Certain genetic factors might make it more likely
that people will develop Alzheimer's.
 Vascular Dementia.
This second most common type of dementia
occurs as a result of damage to the vessels
that supply blood to your brain.
Blood vessel problems can be caused by
stroke or other blood vessel conditions.
 Lewy Body Dementia.
Lewy bodies are abnormal clumps of protein
that have been found in the brains of people
with Lewy body dementia, Alzheimer's disease
and Parkinson's disease.
 Frontotemporal Dementia.
This is a group of diseases characterized by
the breakdown (degeneration) of nerve cells
in the frontal and temporal lobes of the brain,
the areas generally associated with
personality, behavior and language.
 Mixed dementia.
Autopsy studies of the brains of people 80
and older who had dementia indicate that
many had a combination of Alzheimer's
disease, vascular dementia and Lewy body
dementia.
 Studies are ongoing to determine how having
mixed dementia affects symptoms and treatments.
Other Disorders Linked To
Dementia
 Traumatic brain injury.
This condition is caused by repetitive head
trauma, such as experienced by boxers,
football players or soldiers.
 Depending on the part of the brain that's injured,
this condition can cause dementia signs and
symptoms, such as depression, explosiveness,
memory loss, uncoordinated movement and
impaired speech, as well as slow movement,
tremors and rigidity (parkinsonism).

Symptoms might not appear until years after the

trauma.
 Creutzfeldt-Jakob disease.
This rare brain disorder usually occurs in
people without known risk factors.
This condition might be due to an abnormal
form of a protein.
 Creutzfeldt-Jakob disease can be inherited
or caused by exposure to diseased brain or
nervous system tissue.
Signs and symptoms of this fatal condition
usually appear around age 60.
 Parkinson's disease.
Many people with Parkinson's disease
eventually develop dementia symptoms
(Parkinson's disease dementia).
 8) Substance/Medication-Induced
dementia.
Dementia can occur as the result of persisting effects
of substance such as alcohol, sedatives, hypnotics,
anxiolytics, and inhalants and other medication and
environmental toxins. reactions, overuse, or abuse.

Term persisting is indicate:- that dementia persists

long after the effect of substance intoxication or
withdrawal have subsided.
Risk factors
1-Risk factors that can't be changed
Age.
The risk rises as you age, especially after age 65.
However, dementia isn't a normal part of aging,
and dementia can occur in younger people.
 Family history.
Having a family history of dementia puts you
at greater risk of developing the condition.
However, many people with a family history
never develop symptoms, and many people
without a family history do.
Tests to determine whether you have certain
genetic mutations are available.
 Down syndrome.
By middle age, many people with Down
syndrome develop early-onset Alzheimer's
disease.
 Mild cognitive impairment.
This involves difficulties with memory but
without loss of daily function.
It puts people at higher risk of dementia.
2-Risk factors you can change
You might be able to control the following risk
factors of dementia.
Heavy alcohol use.
If you drink large amounts of alcohol, you
might have a higher risk of dementia.
Some studies, however, have shown that
moderate amounts of alcohol might have a
protective effect.
 Cardiovascular risk factors.
These include high blood pressure
(hypertension), high cholesterol, buildup of
fats in your artery walls (atherosclerosis) and
obesity.

Depression.
Although not yet well-understood, late-life
depression might indicate the development
of dementia.
 Diabetes.
If you have diabetes, you might have an
increased risk of dementia, especially if it's
poorly controlled.

Smoking.
Smoking might increase your risk of
developing dementia and blood vessel
(vascular) diseases.
 Sleep Apnea.
People who snore and have episodes
where they frequently stop breathing
while asleep may have reversible memory
loss.
 Common Nursing Diagnosis
Impaired memory.
Altered thought process.
Impaired verbal communication.
Functional urinary incontinence.
Impaired environmental interpretation.
Ineffective coping.
 1- Impaired Memory
Related to Pathologic changes in the brain as
evidenced by Inability to recall factual
information or events.
The Goal: Use long-term memory effectively as
long as it remains intact.
Intervention
1-Provide opportunities for recall of past events.
This can be done on a one-to-one basis or in a
small group.
2-Encourage the client to use written cues such as
a calendar, lists, or a notebook.
3-Keep environmental changes to a necessary
minimum.

4- Keep client's room well lighted.

5- Have client wear prescription eyeglasses or

hearing aid to increase environmental awareness
& orientation.
6-Determine practical locations for the clients
possessions, and return items to this location
after use.

7-Provide single step instructions for the client

when instructions are needed.

8-Increase assistance with tasks as needed, but do

not rush to do things .

9-Do not allow the client to work unsuccessfully at

any given task for an extended period of time.
 2-Altered thought process:
Related to Pathologic changes in the brain as evidenced by
Inability to interpret stimuli accurately, delusion& behavior
changes
The Goal: client will be demonstrate reality based thinking.
Interventions:
1- Call client by name.
2- listen with regard.
3- Talk about real people & events.
4- Acknowledge client's feelings.
5- Use simple manner & face to face interaction
6- Focus on one piece of information at a time.
7- Don't argue delusions .
Delirium and Dementia
 Dementia and delirium may be particularly
difficult to distinguish, and a person may have
both.

In fact, frequently delirium occurs in people with

dementia.

Dementia is the progressive decline of memory

and other thinking skills due to the gradual
dysfunction and loss of brain cells.

The most common cause of dementia is

Alzheimer's disease.
 Some differences between the symptoms of
delirium and dementia include:
Onset.
The onset of delirium occurs within a short
time.
While dementia usually begins with
relatively minor symptoms that gradually
worsen over time.

Attention.
The ability to stay focused or maintain attention
is significantly impaired with delirium.
A person in the early stages of dementia
remains generally alert.
 Fluctuation.
The appearance of delirium symptoms
can fluctuate significantly and frequently
throughout the day.
While people with dementia have
better and worse times of day, their
memory and thinking skills stay at a
fairly constant level during the course of
a day.
 Delirium vs. Dementia
Delirium Dementia
Acute Gradual
Reversible Irreversible
Consciousness: fluctuating Consciousness: rarely alters
Decreased awareness of self Decreased awareness of self
Perceptions: Hallucinations not
Perceptions: illusions, common
hallucinations common
Speech: repetitive difficulty
Speech: slow, incoherent finding words
Disorientation: time, others Disorientation: time, person,
Cognitive dysfunction place
Illness, med. toxicity: often Memory impairment
Diurnal disruptions Illness, med. toxicity: rarely
Diurnal disruptions
Outcome: excellent if corrected
early Outcome: poor
 References:
http://www.nytimes.com/health/guides/disease/or
ganic-brain-syndrome/overview.html
http://www.healthline.com/health/organic-brain-
syndrome
http://www.nmihi.com/d/dementia.htm
https://medlineplus.gov/ency/article/001401.htm
http://www.medicinenet.com/dementia_pictures_s
lideshow/article.htm