Posttraumatic stress disorder. Psychiatry of catastrophes and natural calamities

Posttraumatic stress disorder. Psychiatry of

catastrophes and natural calamities.

Classification of DementiaClassification of DementiaOrganic, including symptomatic, mental Organic, including symptomatic, mental

disordersdisorders::F00F00 Dementia in Alzheimer’s diseaseDementia in Alzheimer’s diseaseF01F01 Vascular dementiaVascular dementiaP02P02 Dementia in other diseases classified elsewhereDementia in other diseases classified elsewhereF03F03 Unspecified dementiaUnspecified dementiaF04F04 Organic amnesic syndrome, not induced by Organic amnesic syndrome, not induced by

alcohol and other psychoactive substancesalcohol and other psychoactive substancesF05F05 Delirium, not induced by alcohol and other Delirium, not induced by alcohol and other

psychoactive substancespsychoactive substancesF06F06 Other mental disorders due to brain damage and Other mental disorders due to brain damage and

dysfunction and to physical diseasedysfunction and to physical diseaseF07F07 Personality and behavioural disorders due to Personality and behavioural disorders due to

brain disease, damage and dysfunctionbrain disease, damage and dysfunctionF09F09 Unspecified organic or symptomatic mental Unspecified organic or symptomatic mental

disorderdisorder

DementiaDementiaDementiaDementia is a syndrome usually of chronic is a syndrome usually of chronic

and progressive nature characterized by and progressive nature characterized by decline of memory and intellect.decline of memory and intellect.

Diagnostic criteria of dementiaDiagnostic criteria of dementia::• decline of learning new informationdecline of learning new information• decline of other cognitive functions (thinking, decline of other cognitive functions (thinking,

judgement, planning, organizing, processing of judgement, planning, organizing, processing of information)information)

• no disorder of consciousnessno disorder of consciousness• affective disorders (impaired emotional control affective disorders (impaired emotional control

- lability, irritability, apathy, decline of social - lability, irritability, apathy, decline of social functioning)functioning)

• the symptoms evident for at least 6 monthsthe symptoms evident for at least 6 months

DementiaDementia

The degrees of dementia:The degrees of dementia:• mildmild• moderatemoderate• seriousserious

Dementia is usually (80%) an Dementia is usually (80%) an irreversible processirreversible process

F00 F00 Dementia in Alzheimer’s Dementia in Alzheimer’s DiseaseDisease

DAT = dementia of Alzheimer's typeDAT = dementia of Alzheimer's type:: the most frequent type of dementiathe most frequent type of dementia primary degenerative cerebral disease of primary degenerative cerebral disease of

unknown etiologyunknown etiology characterized with marked reduction of characterized with marked reduction of

neurons, appearance of neurofibrillary neurons, appearance of neurofibrillary tangles and senile plaques (beta-amyloid)tangles and senile plaques (beta-amyloid)

especially cholinergic system is affectedespecially cholinergic system is affected

DAT with Early OnsetDAT with Early Onset

Dementia before the age of 65Dementia before the age of 65 Relatively rapid deteriorationRelatively rapid deterioration Aphasia, agraphia, alexia, apraxiaAphasia, agraphia, alexia, apraxia

DAT with Late OnsetDAT with Late Onset

Dementia after the age 65Dementia after the age 65 Family history of DAT or Down’s Family history of DAT or Down’s

syndromesyndrome Slow progression, no insightSlow progression, no insight Severe impairment of memory, Severe impairment of memory,

confabulationsconfabulations

Treatment of DATTreatment of DATA)A) Pharmacotherapy of cognitive symptomsPharmacotherapy of cognitive symptoms1.1. Cholinesterase inhibitors - ACHEI, BuCHEI (fysostigmin, Cholinesterase inhibitors - ACHEI, BuCHEI (fysostigmin,

rivastigmin, donepezil, rivastigmin, metrifonat, galantamin, rivastigmin, donepezil, rivastigmin, metrifonat, galantamin, huperzin, tacrin, velnakrin)huperzin, tacrin, velnakrin)

2.2. CHEI + selegilinCHEI + selegilinCHEI + lecitinCHEI + lecitinCHEI + propentophylinCHEI + propentophylin

3.3. (CHEI) + nootropic agents + agents with a scavanger effect (CHEI) + nootropic agents + agents with a scavanger effect (piracetam, pyritinol, Gingko biloba extr., vitamine E)(piracetam, pyritinol, Gingko biloba extr., vitamine E)

4.4. Agonists of muscarinic (MAgonists of muscarinic (M11, M, M33) and nicotinic acetylcholine ) and nicotinic acetylcholine receptors (nicotine)receptors (nicotine)

5.5. Nootropic agents (cerebral metabolic enhancers) + Ca Nootropic agents (cerebral metabolic enhancers) + Ca channel antagonists (nimodipin, cinnarizin)channel antagonists (nimodipin, cinnarizin)

6.6. Nootropic agents + antiinflammatory agents (acetylosalicylic Nootropic agents + antiinflammatory agents (acetylosalicylic acid, ibuprofen, indometacine)acid, ibuprofen, indometacine)

7.7. Nerve growth factors (cerebrolysin)Nerve growth factors (cerebrolysin)8.8. Somatostatin deficit (octostatin)Somatostatin deficit (octostatin)

Treatment of DATTreatment of DAT

B)B) Pharmacotherapy of non-cognitive symptomsPharmacotherapy of non-cognitive symptoms1.1. Depression, anxiety - SSRI (citalopram, fluvoxamin, Depression, anxiety - SSRI (citalopram, fluvoxamin,

paroxetin, …), SNRI (venlafaxin)paroxetin, …), SNRI (venlafaxin)2.2. Psychotic + confusional states - neuroleptics with minimal Psychotic + confusional states - neuroleptics with minimal

adrenolytic + anticholinergic effects (tiaprid, sulpirid, adrenolytic + anticholinergic effects (tiaprid, sulpirid, risperidon, haloperidol, clozapin)risperidon, haloperidol, clozapin)

3.3. Insomnia - non-benzodiazepine hypnotics (zolpidem, Insomnia - non-benzodiazepine hypnotics (zolpidem, zopiclon)zopiclon)

4.4. Epileptic seizures - carbamazepin, valproic acid, Na Epileptic seizures - carbamazepin, valproic acid, Na valproatevalproate

C)C) PsychotherapyPsychotherapy1.1. Reeducation of cognitive, emotional + behavioural Reeducation of cognitive, emotional + behavioural

disordersdisorders2.2. Family therapyFamily therapy3.3. Alzheimer’s societyAlzheimer’s society

F01 F01 Vascular DementiaVascular Dementia

F01F01 Vascular dementiaVascular dementiaF01.0F01.0 Vascular dementia of acute onsetVascular dementia of acute onsetF01.1F01.1 Multi-infarct dementiaMulti-infarct dementiaF01.2F01.2 Subcortical vascular dementiaSubcortical vascular dementiaF01.3F01.3 Mixed cortical and subcortical Mixed cortical and subcortical

vascular dementiavascular dementiaF01 8F01 8 Other vascular dementiaOther vascular dementiaF01.9F01.9 Vascular dementia, unspecifiedVascular dementia, unspecified


Diagnostic guidelinesDiagnostic guidelines::

a)a) Presence of a dementiaPresence of a dementia

b)b) Uneven impairment of cognitive function Uneven impairment of cognitive function + focal neurological signs+ focal neurological signs

c)c) Insight and judgement relatively well Insight and judgement relatively well preservedpreserved

d)d) An abrupt onset or a stepwise An abrupt onset or a stepwise deteriorationdeterioration


Associated featuresAssociated features::a)a) HypertensionHypertensionb)b) Emotional lability, weeping or explosive Emotional lability, weeping or explosive

laughterlaughterc)c) Transient episodes of clouded Transient episodes of clouded

consciousnessconsciousnessd)d) Personality relatively well preserved, Personality relatively well preserved,

accentuation of previous traits accentuation of previous traits (egocentrism, paranoid attitudes, (egocentrism, paranoid attitudes, irritability)irritability)


F01.0 - after a succession of strokes or a F01.0 - after a succession of strokes or a single large infarction single large infarction (cerebrovascular thrombosis, (cerebrovascular thrombosis, embolism or haemorrhage)embolism or haemorrhage)

F01.1 - more gradual in onset after a F01.1 - more gradual in onset after a number of minor ischaemic episodesnumber of minor ischaemic episodes

F01.2 - destruction in the deep white matter F01.2 - destruction in the deep white matter (Binswanger’s encephalop.)(Binswanger’s encephalop.)

F01.3 - mixed cortical + subcortical F01.3 - mixed cortical + subcortical componentscomponents

F02 Dementia in Other F02 Dementia in Other Diseases Classified Elsewhere Diseases Classified Elsewhere

Diagnostic guidelinesDiagnostic guidelines::

a)a) Presence of a dementiaPresence of a dementia

b)b) Onset at any time of lifeOnset at any time of life

c)c) Presence of features characteristic of one Presence of features characteristic of one of the specified syndromesof the specified syndromes

F02 Dementia in Other F02 Dementia in Other Diseases Classified ElsewhereDiseases Classified Elsewhere

F02.0 Dementia in Pick’s diseaseF02.0 Dementia in Pick’s diseasea)a) A progressive dementiaA progressive dementiab)b) A predominance of frontal lobe features A predominance of frontal lobe features

(euphoria, emotional blunting, coarsening (euphoria, emotional blunting, coarsening of social behaviour, disinhihition, apathy)of social behaviour, disinhihition, apathy)

c)c) Behavioural manifestationsBehavioural manifestations

F02.1 Dementia in Creutzfeldt-Jakob diseaseF02.1 Dementia in Creutzfeldt-Jakob diseasea)a) Fairly rapid progressing over months to 1-Fairly rapid progressing over months to 1-

2 years2 yearsb)b) Multiple neurological signs (pyramidal + Multiple neurological signs (pyramidal +

extrapyramidal, ataxia)extrapyramidal, ataxia)


F02.2 Dementia in Huntington’s diseaseF02.2 Dementia in Huntington’s disease

a)a) Family history of H’s d.Family history of H’s d.

b)b) Onset at a relatively young ageOnset at a relatively young age

c)c) Involuntary choreiform movementsInvoluntary choreiform movements

d)d) Slow progression of dementiaSlow progression of dementia

F02.3 Dementia in Parkinson’s diseaseF02.3 Dementia in Parkinson’s disease

In severe cases, no particular In severe cases, no particular distinguishing featuresdistinguishing features


F02.4 Dementia in human immunodeficiency F02.4 Dementia in human immunodeficiency virus (HIV) diseasevirus (HIV) disease

a)a) HIV infectionHIV infectionb)b) Complaints of forgetfulness, slowness, Complaints of forgetfulness, slowness,

poor concentration, difficulties with poor concentration, difficulties with problem-solving and readingproblem-solving and reading

c)c) Apathy, social withdrawal, affective Apathy, social withdrawal, affective disorderdisorder

d)d) Neurological signs (tremor, ataxia, Neurological signs (tremor, ataxia, hyperreflexia,...)hyperreflexia,...)

General paralysis of the insane (GPI – General paralysis of the insane (GPI – paralysis progressiva)paralysis progressiva)

F05 Delirium, not Induced by Alcohol F05 Delirium, not Induced by Alcohol and Other Psychoactive Substancesand Other Psychoactive Substances

Diagnostic guidelines:Diagnostic guidelines:a)a) Impairment of consciousness and attentionImpairment of consciousness and attentionb)b) Global disturbance of cognition (perceptual Global disturbance of cognition (perceptual

distortions, illusions, hallucinations, impairment of distortions, illusions, hallucinations, impairment of abstract thinking and comprehension, disorientation abstract thinking and comprehension, disorientation for time + place)for time + place)

c)c) Psychomotor disturbances (hypo- or hyperactivity,...)Psychomotor disturbances (hypo- or hyperactivity,...)d)d) Disturbances of sleep (reversal of the sleep-wake Disturbances of sleep (reversal of the sleep-wake

cycle)cycle)e)e) Emotional disturbances (anxiety, fear, irritability, Emotional disturbances (anxiety, fear, irritability,

apathy, perplexity)apathy, perplexity)

F05.0 Delirium, not superimposed on dementiaF05.0 Delirium, not superimposed on dementiaF05.1 Delirium, superimposed en dementiaF05.1 Delirium, superimposed en dementiaF05.8 Other deliriumF05.8 Other deliriumF05.9 Delirium, unspecifiedF05.9 Delirium, unspecified

F06 Other Mental Disorders Due to Brain F06 Other Mental Disorders Due to Brain Damage and Dysfunction and to Physical Damage and Dysfunction and to Physical

Disease Disease Diagnostic guidelines:Diagnostic guidelines:a)a) Evidence of cerebral disease, damage or dysfunction, Evidence of cerebral disease, damage or dysfunction,

or of systemic diseaseor of systemic diseaseb)b) A temporal relationship (weeks or a few months) A temporal relationship (weeks or a few months)

between the development of the underlying disease between the development of the underlying disease and the onset of the mental syndromeand the onset of the mental syndrome

c)c) Recovery from the mental disorder following removal Recovery from the mental disorder following removal or improvement of the underlying presumed causeor improvement of the underlying presumed cause

d)d) Absence of evidence to suggest an alternative cause Absence of evidence to suggest an alternative cause of the mental syof the mental sy

Types: organic hallucinosis, org. catatonic disorder, org. Types: organic hallucinosis, org. catatonic disorder, org. delusional (schizophrenia-like) disorder, org. delusional (schizophrenia-like) disorder, org. affective disorders (manic, depressive, anxiety, affective disorders (manic, depressive, anxiety, emotionally labile), mild cognitive disorder (F06.7 - emotionally labile), mild cognitive disorder (F06.7 - may precede, accompany, or follow a wide variety of may precede, accompany, or follow a wide variety of infections and physical disorders)infections and physical disorders)

F07 Personality and Behavioural Disorders Due F07 Personality and Behavioural Disorders Due to Brain Disease, Damage and Dysfunctionto Brain Disease, Damage and Dysfunction

F07.0 Organic personality disorderF07.0 Organic personality disorderDiagnostic guidelinesDiagnostic guidelines::a)a) Consistently reduced ability to persevere with Consistently reduced ability to persevere with

goal-directed activitiesgoal-directed activitiesb)b) Altered emotional behaviour (emotional lability, Altered emotional behaviour (emotional lability,

euphoria, irritability, outbursts of anger and euphoria, irritability, outbursts of anger and aggression,...)aggression,...)

c)c) Expression of needs and impulses without Expression of needs and impulses without consideration of consequences or social consideration of consequences or social conventionconvention

d)d) Cognitive disturbancesCognitive disturbancese)e) Marked alteration of language productionMarked alteration of language productionf)f) Altered sexual behaviour (hyposexuality, change Altered sexual behaviour (hyposexuality, change

of sexual preference)of sexual preference)

F07 Personality and Behavioural Disorders Due F07 Personality and Behavioural Disorders Due to Brain Disease, Damage and Dysfunctionto Brain Disease, Damage and Dysfunction

F07.1 Postencephalitic syndromeF07.1 Postencephalitic syndromeRResidual behavioural change following recovery esidual behavioural change following recovery from encephalitis often reversiblefrom encephalitis often reversible(apathy, irritability, some lowering of cognitive (apathy, irritability, some lowering of cognitive functioning, altered sleep pattern, a variety of functioning, altered sleep pattern, a variety of neurological dysfunctions, …)neurological dysfunctions, …)

F07.2 Postconcussional syndromeF07.2 Postconcussional syndrome OOccurs following head traumaccurs following head trauma CComplaints of headache, dizziness, fatigue, omplaints of headache, dizziness, fatigue,

irritability, difficulty in concentrating and irritability, difficulty in concentrating and performing mental tasks, impairment of memory, performing mental tasks, impairment of memory, insomnia, reduced tolerance to stress, emotional insomnia, reduced tolerance to stress, emotional excitement or alcohol, …(sometimes associated excitement or alcohol, …(sometimes associated with compensation motives)with compensation motives)

Symptomatic DementiaSymptomatic Dementia

1.1. Pharmacogenic dementiaPharmacogenic dementia (anticholinergics, (anticholinergics, benzodiazepines, cytostatics, ...)benzodiazepines, cytostatics, ...)

2.2. Alcohol dementiaAlcohol dementia (simplex, Korsakov, (simplex, Korsakov, Wernicke sy)Wernicke sy)

3.3. Intoxicant dementia of other etiologyIntoxicant dementia of other etiology (CO, (CO, Pb, Hg, AI, solvents)Pb, Hg, AI, solvents)

4.4. Dementia at vitamin deficit Dementia at vitamin deficit (niacin-pellagra, (niacin-pellagra, vit. B12)vit. B12)

5.5. Dementia of endocrinne originDementia of endocrinne origin (hypothyreosis, Cushing sy)(hypothyreosis, Cushing sy)

6.6. Dementia due to dialysisDementia due to dialysis

Symptomatic DementiaSymptomatic Dementia

7.7. Metabolic dementiaMetabolic dementia (hypernatremia, (hypernatremia, hypocalemia)hypocalemia)

D. at uraemiaD. at uraemia (uremic encephalopathy) (uremic encephalopathy)

D. at m. WilsonD. at m. Wilson

D. at liver encephalopathyD. at liver encephalopathy

8.8. D. due to hypoxiaD. due to hypoxia

9.9. D. due to traumaD. due to trauma

10.10. D. at epilepsyD. at epilepsy

11.11. D. due to infectionD. due to infection (paralysis progressiva, (paralysis progressiva, human immunodeficiency virus disease, prion human immunodeficiency virus disease, prion infection - Creutzfeldt-Jakob d., kuru)infection - Creutzfeldt-Jakob d., kuru)

12.12. D. at brain tumorsD. at brain tumors

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Posttraumatic stress disorder. Psychiatry of catastrophes and natural calamities