Chapter 19. Organic, Exogenous, and Somatogenic Mental Disorders
8 topics with a brief review: definitions, key facts, and classroom questions.
This chapter compiles conditions in which mental health suffers due to physical brain damage or somatic ill-health. The section covers neurodegenerative processes (Alzheimer's disease), vascular dementia, as well as acute and chronic CNS reactions to external insults—ranging from traumatic brain injury and infections to severe somatogenic pathologies.
In classes and exams, professors most frequently demand a clear differentiation of delirium from other types of altered consciousness, as well as knowledge of the diagnostic criteria for Alzheimer's disease and vascular dementia. Pay special attention to organic amnestic syndrome and organic personality disorder—these are classic "exam traps" where students often confuse the symptoms.
Understanding the mechanisms of exogenous and somatogenic disorders is essential not only for future psychiatrists, but also for neurologists, internists, and intensive care physicians. The articles in this section contain a summary of clinical pictures and management principles for such patients—just the essentials needed for a confident answer during seminars and decision-making in the clinic.
What is the main pathomorphological difference between Alzheimer's disease and Pick's disease?
In Alzheimer's disease, twisted neurofibrils and amyloid plaques are detected in the brain. In Pick's disease, they are absent, but argyrophilic Pick bodies and local symmetrical cortical atrophy are present.
How to distinguish writing impairments in vascular dementia from those in Alzheimer's disease?
In vascular disease, handwriting changes and calculation becomes difficult, but the patient does not make gross spelling errors. In Alzheimer's disease, the ability to write is lost very early—the patient constantly repeats or omits letters.
Does it make sense to prescribe nootropics in established vascular dementia?
No, according to clinical data, in stable signs of vascular dementia, nootropic and vasotropic therapy are ineffective.
Is it necessary to completely suppress hallucinations and delusions in the first days of psychosis?
No, they should not. Excessive doses of sedatives cause drug-induced sleep, which prolongs psychosis and hinders normal recovery of brain function.
How does traumatic brain injury affect personality in the long-term period?
In the remote period of traumatic brain injury, persistent asthenia, egocentrism, and torpidity (sluggishness) of mental processes develop. In severe injuries, dementia or Korsakoff's amnestic syndrome may develop.
Why should antidepressants with anticholinergic action not be used in the treatment of depression in patients with TBI?
In patients with organic brain damage, anticholinergics carry a high risk of provoking confusion and developing severe delirium.
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