Psychoorganic disorders are behavioral disorders. These disorders involve a non-functioning part of the brain. So at least a brain dysfunction is demonstrable or plausible. However, other somatic, psychological or social factors usually also play a role.
Delirium
Delirium is known to most people as the ‘delirium’ associated with a high fever. It often occurs with dementia. Delirium is a common disorder: in hospitals it affects ten percent of patients and perhaps thirty percent of elderly patients. Delirium is probably often not recognized elsewhere.
Characteristics
During delirium there may be:
- a decreased level of consciousness;
- concentration disorders;
- disorientation in time, place and person (this means that the patient has difficulty determining time (what day is it?) and space (where am I?). The patient also has difficulty recognizing other people);
- are easily irritated;
- being restless mainly at night;
- (visual) hallucinations and delusions;
- feelings of anxiety, anger, depression but also euphoria may occur.
The symptoms occur suddenly and with varying intensity.
Causes
Delirium can occur due to:
- the use of certain medications;
- in case of intoxication or abrupt withdrawal of addictive substances;
- physical ailments such as brain disorders (dementia, tumor), cardiovascular diseases, hormonal disorders (diabetes) and infectious diseases (pneumonia).
Delirium can also occur in the elderly due to a mild condition. This is because other factors also play a role in them that can cause delirium. This includes taking all kinds of medications in combination with dementia and/or certain diseases. Anxiety, stress, sleep problems or poor nutritional status can also contribute to the development of delirium.
Alcohol
Excessive use of alcohol can lead to delirium tremens. Delirium tremens is a serious withdrawal symptom. It can occur in people who have drunk heavily for ten to fifteen years. It occurs six to 48 hours after the last drink. This causes hallucinations. The patient sees mobile (fantasy) animals that can also be felt. An increased body temperature occurs. The patient looks bright red and sweats a lot. There is reduced consciousness and extreme anxiety. There are tremors and the patient is very restless. Delirium can last 72 hours. During delirium there may be total insomnia. Seizures may occur. Delirium can be treated with benzodiazepines. This immediately has a beneficial effect on the restlessness and hallucinations. Delirium is an indication for emergency admission. If left untreated, exhaustion follows in three to ten days.
Dementia
Dementia is quite common. The condition is increasing due to the aging of society. Dementia can occur at any age. However, it is most common in the elderly.
The most common form of dementia is Alzheimer’s disease. Alzheimer ‘s disease can occur before or after the age of 65. In addition to Alzheimer’s disease, there are several other forms of dementia. The most common of these is the vascular form of dementia. This is caused by reduced blood flow to the brain. In addition, there is a form of dementia that is caused by physical conditions such as AIDS, thyroid abnormalities, diabetes and serious liver or kidney disorders. Brain tumors and brain damage (brain trauma) as a result of an accident can also lead to dementia. There are also certain substances that can cause dementia. These are substances such as lead, certain chemicals, medication and drugs. Only when all these forms of dementia have been excluded after intensive medical, neurological and psychiatric examination can it be determined that it is Alzheimer’s disease.
It is striking that elderly people with dementia pay constant attention to their parents. Despite their advanced age, elderly people with dementia behave as if their parents were still alive. The mother in particular returns to the experience of these elderly people. According to Miesen (1990), the dementia process creates an unsafe situation among the elderly. The longing for the parents is an expression of this.
When an elderly person is in the early stages of the dementia process, he/she knows that their parents have died, but he/she thinks about them a lot. Thinking about their parents apparently provides them with emotional support. In addition to thinking a lot about their elders, elderly people with dementia show attachment behavior towards staff and visiting relatives in the early stages. This attachment behavior is similar to the behavior of children. They cling to staff and family, they follow them with their eyes, they cry and call after family as they leave. This behavior decreases during the dementia process.
Characteristics of Alzheimer’s disease
- forgetfulness and slight changes in personality (early stages);
- gradual decline of cognitive functions: language, abstract thinking and especially memory;
- certain actions such as getting dressed or brushing teeth are more difficult, while motor skills are still intact;
- disorientation in place, time and person (see more detailed explanation of the above characteristics of delirium)
- increasingly unable to remember what happened recently. In later stages, people also forget personal details and commonly known facts (such as who is head of state). One can often still recall memories from their youth;
- people try to fill the gaps in memory with fabrications;
- dramatic changes in personality;
- confusion;
- language disorders;
- depression;
- aggression;
- apathy;
- In the final stages, loss of decorum occurs. For example, one urinates in the room or walks in the hallway in underwear;
- In the final stage one gets stiff motor skills;
- Patients become very needy;
- Incontinence occurs in the end stages;
- Family and friends are no longer recognized in the end stage.
Causes of Alzheimer’s disease
- Alzheimer’s disease is common in the elderly. Aging seems to be a significant factor. Alzheimer’s disease is seen as an extreme aging process. The same processes take place in the brain during the normal aging process, but in Alzheimer’s patients these processes proceed faster;
- Hereditary factors play a role in Alzheimer’s disease. Family members of a patient with Alzheimer’s are twice as likely to develop the disease as others.
Korsakoff’s syndrome
Korsakoff’s syndrome is a form of dementia. It is usually caused by drinking too much alcohol. Patients with this form of dementia can still remember information they stored before they started suffering from the syndrome, but they can no longer store new information.