HOW TO TREAT OTHER MENTAL DISORDERS DUE TO BRAIN DAMAGE, DYSFUNCTION, OR PHYSICAL DISEASE 2025

HOW TO TREAT OTHER MENTAL DISORDERS DUE TO BRAIN DAMAGE, DYSFUNCTION, OR PHYSICAL DISEASE 2025

GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF COMMON MENTAL DISORDERS

(Enacted under Decision No. 2058/QĐ-BYT dated May 14, 2020, by the Minister of Health)

Article 5

OTHER MENTAL DISORDERS DUE TO BRAIN DAMAGE, DYSFUNCTION, OR PHYSICAL DISEASE

CHIEF EDITOR

Associate Professor, PhD Nguyễn Trường Sơn

CO-EDITOR

Associate Professor, PhD Lương Ngọc Khuê

PhD Nguyễn Doãn Phương

CONTRIBUTING AUTHORS

PhD Trần Thị Hà An

MSc Trịnh Thị Vân Anh

PhD Vũ Thy Cầm

MSc Trần Mạnh Cường

PhD Nguyễn Văn Dũng

PhD Vương Ánh Dương

PhD Lê Thị Thu Hà

MSc Trần Thị Thu Hà

MSc Phạm Công Huân

MSc Đoàn Thị Huệ

Specialist Doctor II Nguyễn Thị Minh Hương

MSc Vũ Thị Lan

1. Nguyễn Phương Linh

Specialist Doctor II Nguyễn Thị Phương Loan

MSc Bùi Văn Lợi

MSc Nguyễn Thị Phương Mai

PhD Trần Nguyễn Ngọc

MSc Bùi Nguyễn Hồng Bảo Ngọc

MSc Trương Lê Vân Ngọc

MSc Bùi Văn San

PhD Dương Minh Tâm

MSc Phạm Xuân Thắng

MSc Lê Thị Phương Thảo

MSc Lê Công Thiện

MSc Vương Đình Thủy

Associate Professor, PhD Nguyễn Văn Tuấn

Specialist Doctor II Ngô Văn Tuất

MSc Đặng Thanh Tùng

MSc Vũ Sơn Tùng

MSc Cao Thị Ánh Tuyết

MSc Nguyễn Thị Ái Vân

Specialist Doctor II Hồ Thu Yến

MSc Nguyễn Hoàng Yến

CONTRIBUTORS TO EVALUATION AND FEEDBACK

Associate Professor, PhD Nguyễn Thanh Bình

PhD Vũ Thy Cầm

PhD Nguyễn Hữu Chiến

Specialist Doctor II Võ Thành Đông

PhD Lê Thị Thu Hà

Specialist Doctor II Đỗ Huy Hùng

PhD Nguyễn Mạnh Hùng

MSc Nguyễn Trọng Khoa

Specialist Doctor II Ngô Hùng Lâm

Associate Professor, PhD Phạm Văn Mạnh

Specialist Doctor II Trần Ngọc Nhân

PhD Dương Minh Tâm

MSc Đặng Duy Thanh

PhD Vương Văn Tịnh

Specialist Doctor II Lâm Tứ Trung

PhD Lại Đức Trường

PhD Cao Văn Tuân

Associate Professor, PhD Nguyễn Văn Tuấn

SECRETARIAT TEAM

MSc Đặng Thanh Tùng

MSc Trương Lê Vân Ngọc

BA Đỗ Thị Thư

Article 5

OTHER MENTAL DISORDERS DUE TO BRAIN DAMAGE, DYSFUNCTION, OR PHYSICAL DISEASE

I. DEFINITION  

Organic mental disorders refer to psychiatric conditions directly associated with brain damage or dysfunction, resulting from primary brain diseases (e.g., brain tumors, encephalitis, neurodegeneration) or systemic conditions (e.g., medical illnesses, endocrine disorders, infections, intoxications, metabolic disturbances) that impair brain function. These disorders highlight the interplay between physical health and mental status, spanning multiple clinical specialties. In the International Classification of Diseases, 10th Revision (ICD-10), organic mental disorders are categorized under codes F00–F09. Specifically, “other organic mental disorders” fall under F06, encompassing syndromes involving perception (hallucinations), thought (delusions), emotion (depression, mania, anxiety), and cognition.

II. ETIOLOGY  

1. Brain-Related Causes  

– Brain tumors;  

– Abscesses, meningitis, encephalitis, HIV, syphilis;  

– Traumatic brain injury;  

– Parkinson’s disease, Huntington’s disease;  

– Cerebrovascular events: intracerebral hemorrhage, subarachnoid hemorrhage, cerebral infarction.  

2. Systemic Conditions Affecting Brain Function  

– Infections: sepsis, urinary tract infections, pneumonia;  

– Anemia, electrolyte imbalances, renal or hepatic failure, hypoglycemia, hyperglycemia, post-surgical states;  

– Endocrine disorders: thyroid dysfunction, glucocorticoid excess (e.g., overuse);  

– Nutritional deficiencies: vitamin B12 deficiency, folate deficiency.  

III. DIAGNOSIS  

1. Clinical Features  

The clinical presentation of these disorders may resemble or be identical to those of primary psychiatric conditions, but they are underpinned by organic causes, with psychiatric symptoms closely tied to physical pathology. Diagnosis is based on the following criteria (F06):  

– Evidence of brain disease, damage, or dysfunction, or a systemic physical illness associated with one of the listed syndromes;  

– A temporal relationship (within weeks to a few months) between the onset of the underlying condition and the emergence of the psychiatric syndrome;  

– Recovery or improvement of the psychiatric disorder corresponding to resolution or amelioration of the underlying cause;  

– Absence of evidence suggesting an alternative etiology for the psychiatric syndrome (e.g., strong family history or precipitating psychosocial stressors).  

2. Ancillary Testing

The following tests may be ordered based on individual case presentation:  

– Blood Tests: Complete blood count (CBC), comprehensive metabolic panel (electrolytes, renal and liver function, thyroid function, glucose, D-dimer, ACTH stimulation test);  

– Arterial Blood Gas: To assess hypoxemia, hypercapnia, lactate levels;  

– Urinalysis;  

– Functional Studies: Electrocardiogram (ECG), electroencephalogram (EEG), cerebral blood flow studies, transcranial Doppler ultrasound;  

– Imaging Studies: Brain CT, MRI, abdominal ultrasound, chest/abdominal X-ray;  

– Toxicology Screen: Blood levels of digoxin, lithium, quinidine, alcohol, illicit drugs;  

– Cerebrospinal Fluid (CSF) Analysis: To detect encephalitis or meningitis;  

– Infectious Disease Testing: Syphilis serology, HIV antibody testing;  

– Additional tests as clinically indicated.  

Diagnosis must meet the general criteria for organic mental disorders (F06). Specific subtypes include:  

1) Organic Hallucinosis (F06.0)  

Persistent or recurrent hallucinations, typically auditory or visual, occurring in clear consciousness, with or without patient insight. Delusions may arise secondary to hallucinations.  

– Meets F06 criteria, plus: no clouding of consciousness, no significant intellectual impairment, no predominant mood disturbance, and no dominant delusions.  

2) Organic Catatonic Disorder (F06.1)  

A state of reduced (stupor) or increased (agitation) psychomotor activity with catatonic features; these states may alternate.  

– Meets F06 criteria, plus:  

+ Stupor (reduced or absent spontaneous movement, partial or complete mutism, negativism, rigid posturing);  

+ Agitation (marked hyperactivity, with or without aggressive tendencies);  

+ Both (rapid, unpredictable shifts between hypo- and hyperactivity).  

– Features like stereotypy, waxy flexibility, and impulsivity enhance diagnostic reliability.  

3) Organic Delusional (Schizophrenia-Like) Disorder (F06.2)  

A disorder dominated by persistent or recurrent delusions.  

– Meets F06 criteria, plus: presence of delusions (persecutory, somatic, jealous, hypochondriacal, or beliefs of self/others’ death).  

– Includes organic paranoid states, paranoid hallucinosis, and schizophrenia-like psychosis in epilepsy.  

4) Organic Mood (Affective) Disorders (F06.3)  

Disorders characterized by mood or emotional changes, often with altered overall activity levels, following an organic etiology. These must not represent an emotional reaction to awareness of illness or coincidental brain disease symptoms.  

– Examples: Post-infectious depression (e.g., post-influenza) is coded here. Mild, prolonged euphoria not reaching hypomania (e.g., from steroids or antidepressants) is coded under F06.8, not here.  

– Meets F06 criteria, plus: meets diagnostic requirements for a mood disorder (F30–F33).  

– Subtypes (fifth-digit specifiers):  

+ F06.30: Organic manic disorder;  

+ F06.31: Organic bipolar disorder;  

+ F06.32: Organic depressive disorder;  

+ F06.33: Organic mixed affective disorder.  

5) Other Organic Disorders  

– Organic Anxiety Disorder (F06.4): Features of generalized anxiety disorder (F41.1), panic disorder (F41.0), or both, resulting from an organic condition (e.g., temporal lobe epilepsy, thyrotoxicosis, pheochromocytoma).  

– Organic Dissociative Disorder (F06.5): Meets criteria for a dissociative disorder (F44) and F06 organic etiology.  

– Organic Emotionally Labile (Asthenic) Disorder (F06.6): Marked, persistent emotional instability or lability, fatigue, and somatic complaints (e.g., dizziness, pain) attributed to organic pathology, often linked to cerebrovascular disease or hypertension.  

– Mild Cognitive Disorder (F06.7): Characterized by impaired cognitive performance (memory, learning, concentration) with abnormal objective testing, but not meeting criteria for dementia (F00–F03), organic amnesia (F04), or delirium (F05).  

– Other Specified Organic Mental Disorders (F06.8): E.g., abnormal mood states during steroid or antidepressant treatment.  

– Unspecified Organic Mental Disorder (F06.9): Non-specific cases due to brain damage, dysfunction, or physical disease.  

IV. TREATMENT  

1. Treatment Principles  

– Primary focus is treating the underlying cause (brain-related or systemic conditions affecting the brain).  

– Combine etiological treatment with symptom management, emphasizing supportive care, nutrition, physical conditioning, and immune support to promote recovery.  

2. Treatment Framework  

– Pharmacotherapy;  

– Psychotherapy;  

– Supportive care.  

3. Specific Treatments  

3.1. Pharmacotherapy  

3.1.1. Cognitive Symptom Management  

Options include:  

– Donepezil: 5-23 mg/day;  

– Rivastigmine: 1.5-12 mg/day (oral or transdermal);  

– Galantamine: 8-24 mg/day.  

Agents studied for cognitive impairment (neurotrophic, metabolic, or cerebral circulation enhancers):  

– Cerebrolysin: 10-20 mL/day;  

– Ginkgo biloba: 80-120 mg/day;  

– Piracetam: 400-1200 mg/day;  

– Citicoline: 100-1000 mg/day;  

– Choline alfoscerate: 200-800 mg/day;  

– Vinpocetine: 5-100 mg/day.  

For associated symptoms (delusions, hallucinations, depression, agitation): use antipsychotics, antidepressants, or anxiolytics as needed.  

3.1.2. Treatment of Hallucinations and Delusions  

Options (1-3 agents):  

– Risperidone: 1-10 mg/day;  

– Quetiapine: 50-800 mg/day;  

– Olanzapine: 5-30 mg/day;  

– Clozapine: 25-300 mg/day;  

– Aripiprazole: 10-30 mg/day;  

– Haloperidol: 0.5-20 mg/day.  

3.1.3. Treatment of Depression and Anxiety  

Options (1-3 agents):  

– Amitriptyline: 25-150 mg/day;  

– Sertraline: 50-200 mg/day;  

– Citalopram: 10-40 mg/day;  

– Escitalopram: 10-20 mg/day;  

– Fluvoxamine: 100-200 mg/day;  

– Paroxetine: 20-50 mg/day;  

– Fluoxetine: 10-60 mg/day;  

– Venlafaxine: 75-375 mg/day;  

– Mirtazapine: 15-60 mg/day.  

3.1.4. Mood Stabilizers  

Options:  

– Valproate: 200-2500 mg/day;  

– Divalproex: 750 mg/day to 60 mg/kg/day;  

– Carbamazepine: 100-1600 mg/day;  

– Oxcarbazepine: 300-2400 mg/day;  

– Lamotrigine: 100-300 mg/day;  

– Levetiracetam: 500-1500 mg/day.  

3.1.5. Anxiolytics  

Combine with anxiolytics as needed:  

– Diazepam: 5-20 mg/day;  

– Bromazepam: 2-6 mg/day;  

– Zopiclone, zolpidem, zaleplon.  

For severe depression: Combine antidepressants with antipsychotics.  

Supportive Medications:  

– Hepatic Support: Aminoleban, silymarin, boganic, branched-chain amino acids;  

– Vitamins:  

  – Vitamin B1 (high-dose): 500-1000 mg;  

  – Vitamin B12: 500-1000 mg;  

  – Vitamin C: 500-1000 mg;  

  – Vitamin PP (niacin): 300 mg;  

– Nutritional support: vitamins, minerals, balanced diet, IV nutrition as needed.  

3.2. Psychotherapy  

– Direct: Family therapy, individual psychotherapy;  

– Indirect:  

  – Ensure a safe environment for the patient and others;  

  – Maintain a quiet setting, minimizing external stimuli;  

  – Promote sleep hygiene;  

  – Educate families on caregiving and nutrition.  

3.3. Physical and Occupational Therapy  

– Collaborate with rehabilitation specialists;  

– Goals: Restore motor function, provide speech therapy for language recovery.  

V. PROGNOSIS AND COMPLICATIONS  

1. Prognosis  

– Symptoms persist until the underlying cause is addressed; resolution of organic pathology may lead to amelioration or resolution of psychiatric symptoms.  

– Prognosis worsens with multiple comorbidities or severe brain/systemic disease.  

2. Complications  

– Related to the underlying condition;  

– Infections and trauma require monitoring and management;  

– Prolonged illness may lead to personality and behavioral changes;  

– Persistent physical stressors may result in secondary depression or anxiety, even after stabilization of the underlying condition.  

VI. PREVENTION  

– As organic mental disorders primarily stem from brain or systemic diseases, prevention involves enhancing overall health through exercise, proper nutrition, and a balanced lifestyle.  

– Early detection and treatment of physical illnesses and prompt management of psychiatric symptoms at specialized facilities are key.

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