Organic psychosyndrome is the term used to describe all mental changes that are due to an organic disease, usually of the brain. The old term “brain organic psychosyndrome” is virtually no longer used in this context. Organic psychosyndrome – or physically based psychosis – is generally divided into acute and chronic forms.
What is organic psychosyndrome?
Physicians speak of an organic psychosyndrome when a mental change (e.g., delirium, impaired consciousness, dementia, confusion, etc.) has an underlying organic cause, such as a brain tumor, brain hemorrhage, encephalitis, or when it occurs as a result of a traumatic brain injury. Not only different diseases of the brain can precede the organic psychosyndrome, but also a variety of other physical diseases can be causally responsible for it. As an organically caused form, organic psychosyndrome must be strictly distinguished from other types of mental change: from endogenous psychoses, i.e. psychoses that can be justified by predisposition, such as depression, mania or schizophrenia, and from exogenous psychoses, i.e. mental disorders caused by external factors. Furthermore, in organic psychosyndrome, a distinction is made between acute organic psychosyndrome and acute organic psychosyndrome. Basically, age as well as cerebral or physical extent plays a significant role in the prognosis and presumed course of this disease or syndrome. Because of the wide range of possible causes, the most accurate possible diagnosis is a basic prerequisite for effective long-term treatment of organic psychosyndrome.
Causes
As varied as the manifestations of an Organic Psychosyndrome are, the triggering causes can be equally diverse. When dementia occurs, for example, various brain diseases may be present, such as a cerebral stroke (apoplexy), a craniocerebral trauma, a brain tumor, encephalitis or meningitis, a cerebral hemorrhage, but epilepsy is also a possibility here, among others. As for non-cerebral causes, a wide variety of metabolic disorders can also be responsible for an organic psychosyndrome: These include hyperglycemia or hypoglycemia, uremia, hyperthyroidism, but also liver failure or diabetes mellitus should be considered. Furthermore, severe infections, such as urinary tract infections or [5sepsis]] (blood poisoning) can cause an organic psychosyndrome, as can neurodegenerative diseases such as Parkinson’s disease. But poisoning (intoxication) from medications (e.g., antidepressants, neuroleptics, antihistamines), drugs, or alcohol, as well as withdrawal symptoms from them, can also play a role. Similarly, severe dehydration and the associated disturbance of the water-salt balance in the body (exsiccosis) or a lack of oxygen (hypoxia) can lead to organic psychosyndrome.
Symptoms, complaints, and signs
Initial nonspecific signs of organic psychosyndrome may include memory impairment, lack of interest, behavioral problems, and decreased physical performance. Anxiety often occurs, and creativity and enthusiasm are lost. Affected persons become indifferent to themselves and their environment, neglect personal hygiene and food intake. An acute organic psychosyndrome can develop within hours. Characteristic is a clouding of consciousness characterized by disorientation, anxiety, or delusions. Hallucinations usually occur in the form of auditory perceptions such as hearing voices or visual delusions; less frequently, sensory delusions are observed in the areas of smell, taste, touch, or bodily perception. Delirium is usually accompanied by disorientation, hyperactivity, tremors, circulatory disturbances, and excessive sweating; rarely, a hypoactive form of delirium occurs. Amnesia is characterized by impaired memory in which a certain period of time has been erased from the sufferer’s memory. Orientation disorders may involve time, place, people, or the current situation of the sufferer. The ability to think can be affected in many ways: slowed thinking, flight of ideas, erratic thinking or a narrowing of the scope of thought occur.Mood swings that are reminiscent of depression or bipolar disorder are also typical. Chronic organic psychosyndrome develops insidiously and is associated with progressive loss of mental abilities, personality changes, and behavioral disturbances.
Diagnosis and course
As for the course and diagnosis of organic psychosyndrome, due to the variety of manifestations, precise specification is necessary in each individual case. Regarding the manifestation and basic course, two types of organic psychosyndrome are distinguished. Acute organic psychosyndrome includes: the affective syndrome with mood changes, the amnesic syndrome with memory disturbance and loss, the twilight state with strong drowsiness and thought disturbances, the delirium in the form of agitation, palpitations, restlessness and sensory illusions, the hallucinosis, also with sensory illusions, the isolated disturbance of consciousness with strong drowsiness, the aspontaneous syndrome with drive disturbance despite wakefulness up to coma, as well as a general confusion state with orientation disturbances. These acute organic psychosyndromes are regarded as regressible or curable, but – depending on the cause – they can also become chronic. The acute form is contrasted with the chronic organic psychosyndrome: This usually occurs as a result of permanent damage to the brain. In this case, dementia with a diminishing intellectual memory and thinking capacity is often diagnosed, or also a frontal brain syndrome or Korsakow syndrome (brain-local psychosyndrome) as well as, for example, mutism or an apallic syndrome (so-called defect syndromes, e.g. after coma). Hypersomnia syndrome (sleep addiction) and neurasthenic syndrome with neural and cerebral weakness also belong to chronic organic psychosyndrome. Chronic organic psychosyndromes, depending on the cause, age, and extent, may be stable or may be progressive (continue to progress). Therefore, in order to predict a possible course or to initiate therapeutic steps, a comprehensive and accurate diagnosis is paramount in organic psychosyndrome. The anamnesis includes an investigation of previous illnesses, possible traumas (accidents, injuries), the exclusion of infections as well as extensive neurological examinations. Laboratory tests include a complete blood count and a breakdown of electrolytes. Differential diagnostic and imaging procedures include EEG (electroencephalogram), a CCT (brain computed tomography), intracranial pressure measurement and, if necessary, a cerebrospinal fluid (CSF) puncture. To arrive at a diagnosis that is as accurate as possible, a search is made for emotional behavioral abnormalities and changes (delusions, exhibitionism, depression, fits of rage, mood swings, etc.), as well as for thinking and memory disorders, anxiety, orientation problems, lack of interest, fatigue, problems with food intake or personal hygiene, drive disorders, etc., and also for general physical symptoms such as dizziness, sweating or nausea.
Complications
In this syndrome, patients suffer from a number of different changes in the psyche. This usually involves psychosis and further mental upset or depression. In many cases, patients also suffer from social discomfort and can no longer maintain their social contacts. Inner restlessness or memory disorders also occur and are often accompanied by palpitations or sweating. Disturbances in concentration or orientation also occur in this syndrome and have a very negative effect on the quality of life of the affected person. In many cases, hallucinations or increased irritability of the affected person also occur. The parents or the relatives are in many cases strongly affected by the symptoms of this syndrome. In the worst case, the affected person loses consciousness completely and falls into a coma. Treatment of this condition is usually based on its cause. However, a positive course cannot be guaranteed in every case. Taking psychotropic drugs can lead to various side effects in the affected person and significantly reduce the quality of life.
When should one go to the doctor?
If people show abnormalities or abnormalities of their personality, they should see a doctor.Disturbances of consciousness, a clouding of consciousness, confusion or a peculiarity of memory activity must be examined and treated. In case of memory lapses or inability to store knowledge and events in memory, a physician is needed. A depressed mood, depressive states, or listlessness are signs of an existing health disorder. A doctor should be consulted so that clarification of the cause can be initiated. If the daily obligations cannot be fulfilled, delusions appear or there is a strong euphoric mood, there is cause for concern. Anxiety, behavioral abnormalities, heavy sweating or hallucinations are further indications of a mental illness. Often the affected person lacks the necessary insight into the illness. Therefore, the support and assistance of people in the social environment is necessary. A relationship of trust must be established with the person affected so that he or she consults a doctor. In severe cases, a public health officer must be commissioned. Disturbances of orientation or irregularities of the circulation are complaints that must be treated. Illusions of sensory perception are characteristic of an organic psychosyndrome. A visit to the doctor should be initiated as soon as possible so that there is no increase in complaints. A decreased sense of well-being, inner restlessness, as well as apathy should be presented to a physician.
Treatment and therapy
Individual treatment depends on the particular diagnosis. Among the most important therapeutic measures is, of course, treatment of the underlying organic disease, as well and as far as possible. Especially in acute organic psychosyndrome, causal therapy is crucial for prognosis. In addition, general stress reduction is extremely important, and depending on the form and causes, nutritional therapy (e.g., balancing electrolytes) or drug therapy (e.g., with neuroleptics) may be possible therapeutic options. In the case of a new-onset chronic organic psychosyndrome, rehabilitation is also at the beginning of medical treatment. If no causally curative option is found, the aim is to alleviate the symptoms, such as hallucinations, agitation or depression, as best as possible with medication. In many cases – especially in the case of damage to the brain – a complete recovery is rather unlikely, so that it is precisely here that action must be taken to improve the symptoms. In the case of purely physical, especially acute organic psychosyndromes, on the other hand, quite good treatment successes can be achieved after the organic causes have been eliminated. This is the case, for example, with metabolic disorders or a disturbance of the electrolyte balance. In some cases, the course and success of therapy also depends on the patient’s compliance, for example, when alcohol abuse is causally responsible for the organic psychosyndrome.
Outlook and prognosis
The prognosis in the presence of an organic psychosyndrome always depends on the cause of the disease. In general, it can be said that one has a greater chance of recovery if the cause of the organic psychosyndrome is corrected quickly and effectively. Especially in the case of acute organic psychosyndrome, the chances of recovery are described as very good. In this condition, it should be quickly found out what exactly has caused the deficit. Electrolyte disorders as well as hypernatremia, hyponatremia and traumatic brain injury require their own individual treatment. If milder courses are involved, medications or antibiotics may provide rapid relief. For more severe conditions, surgical intervention may also be necessary to remove infected tissue. If the cause of the organic psychosyndrome has been found, there is a good chance that the disease can be treated causally and cured. If no cause for the organic psychosyndrome can be identified, treatment is mainly aimed at reducing the symptoms of the body and the psyche, thus increasing the patient’s quality of life. Even though good treatment options are available nowadays, a positive course of the organic psychosyndrome cannot be guaranteed in every case. Regular screening and prompt treatment of the cause can significantly improve the prognosis of the disease.
Prevention
Prevention or prevention is hardly possible because of the wide symptomatic and causal range. A healthy, balanced lifestyle – also and especially with regard to mental balance – and the avoidance of alcohol and drugs can at least prevent an organic psychosyndrome caused by physical deficiency or stimulant poisons. Regular check-ups also help to detect serious cerebral or organic diseases or metabolic disorders such as diabetes or liver and kidney problems at an early stage and thus prevent unfavorable progressions. In addition, the following also applies to organic psychosyndrome: the earlier a diagnosis is made and effective therapy can be started, the better the chances of recovery.
Aftercare
In organic psychosyndrome, aftercare should not be forgotten. This depends on the cause and underlying disease that led to the organic psychosyndrome. Follow-up examinations can identify and address the patient’s psychosocial problems at an early stage. The physician and therapist provides the patient with competent counseling content. He recognizes the need for therapy approaches, self-help and other assistance at an early stage in the follow-up. In addition, regional rehabilitation options can be arranged. If patients join and use the aftercare networks for organic psychosyndrome, further inpatient stays can be shortened or completely prevented. If patients are well supported through aftercare, they can learn more about themselves and their illness through self-reflection. Perceptions change. If necessary, this can be more promising for some patients than years of psychotherapy. However, a broad time frame is necessary for aftercare treatments. By all means, not every treatment is promising to the full extent. Frequently, renewed approaches are necessary by the physician and therapist. For the patient with organic psychosyndrome, long-term therapy in a psychotherapeutic group can also be helpful. Here already the exchange with group members is very promising and useful. This promotes self-reflection and strengthens the tendency toward psychological balance.
This is what you can do yourself
Due to the discomfort and immense impairment of brain functions, the disease does not offer the patient any opportunities for self-help. Normally, the affected person is dependent on daily support from other people and cannot care for himself. A stay in hospital is often associated with the disease, as relatives are overwhelmed with the situation. Should family members care for the affected person, they must be fully informed about the appearance of the mental disorder and its consequences. In the case of the organic psychosyndrome, the affected person may behave antisocially. The people from the social environment must be urgently informed about the disease and its consequences. An understanding approach to the patient is necessary so that the situation does not worsen or contacts are broken off. Since disorientation and confusion appear as further complaints, an attempt should be made to meet the daily challenges with calm and patience. The more stable the social environment and the more regulated the daily routine, the better it is for the patient. Hectic, stress and excitement should be avoided. The daily routines have to be organized and taken over by others, as the affected person is not able to do this. Sensory illusions and hallucinations often occur. In these moments, any provocations are to be avoided.
