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Chapter: Essentials of Psychiatry: Delirium and Dementia

Delirium and Dementia

Dementia, delirium, amnestic and other cog-nitive disorders: Traditionally, these conditions have been classified as organic brain disorders to distinguish them from such diseases as schizophrenia, mania and major depressive disorder, the so-called functional disorders.

Delirium and Dementia

 

Dementia, delirium, amnestic and other cog-nitive disorders: Traditionally, these conditions have been classified as organic brain disorders to distinguish them from such diseases as schizophrenia, mania and major depressive disorder, the so-called functional disorders. With the publication of the DSM-IV, the distinction between functional and organic disorders was eliminated. Significant research into the neurobiological aspects of psychiatric disorders and the utilization of sophisticated neurodi-agnostic tests such as positron emission tomographic scanning in individuals with schizophrenia led to the inescapable conclusion that every psychiatric condition has a biological component. Thus the term functional became obsolete and even misleading.

 

The conditions formerly called organic are classified in DSM-IV into three groupings: 1) delirium, dementia, and amnestic and other cognitive disorders; 2) mental disorders due to a general medical condition; and 3) substance-related disorders (American Psychiatric Association, 1994). Delirium, dementia and amnestic disorders are classified as cognitive because they feature impair-ment in such parameters as memory, language, or attention as a cardinal symptom. Each of these three major cognitive disorders is subdivided into categories that ascribe the etiology of the disorder to a general medical condition, the persisting effects of a substance, or multiple etiologies. A “not otherwise specified” category is in-cluded for each disorder (American Psychiatric Association, 1994).

 

In the case of delirium, the primary disturbance is in the level of consciousness with associated impairments in orientation, memory, judgment and attention. Dementia features cognitive defi-cits in memory, language and intellect. The amnestic disorder is characterized by impairment in memory in the absence of clouded consciousness or other noteworthy cognitive dysfunction. In gen-eral, the cognitive disorders should represent a decline from a previ-ous higher level of function, of either acute (delirium) or insidious (dementia) onset, and should interfere with the patient’s social or oc-cupational functioning (American Psychiatric Association, 1994).

 

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