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Flashcards in this deck (174)

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  • What does neuropsychiatry involve?

    Interface between psychiatry and neurology.

    neuropsychiatry psychiatry neurology

  • What conditions are associated with neuropsychiatry?

    • Stroke
    • Epilepsy
    • Head injury
    • Psychogenic non-epileptic seizures
    • Huntington’s disease
    • Parkinson’s disease
    • Multiple sclerosis
    • Wilson’s disease
    neuropsychiatry conditions

  • What services does the neuropsychiatry service in Beaumont Hospital provide?

    • Neuropsychiatry liaison service
    • Weekly outpatient clinic
    neuropsychiatry services

  • What skills are required in consultation-liaison psychiatry?

    • Complex psychiatric assessments
    • Responding to referrer needs
    • Interview skills
    • Assessing depression in the physically ill
    • Detecting psychological disorders
    psychiatry skills

  • What is the most common psychiatric co-morbid condition?

    Depression

    psychiatry depression

  • What psychiatric disorders can co-exist with neurological presentations?

    • Psychosis
    • Anxiety disorders
    • Substance misuse
    psychiatry co-morbid

  • What is the first-line treatment for depression in neurological disease?

    SSRIs

    treatment depression

  • What are the treatment options for psychosis in neurological patients?

    • Atypical antipsychotics (first-line)
    • Clozapine (second/third-line)
    treatment psychosis

  • What is a common rating scale for assessing frontal lobe function?

    Frontal Assessment Battery (FAB)

    assessment frontal_lobe

  • What is the role of liaison psychiatry?

    Collaboration with medical colleagues and understanding psychiatric influence on medical presentations.

    liaison psychiatry

  • What should be considered for agitated or manic patients?

    • Anticonvulsants
    • Atypical antipsychotics
    treatment neurology

  • What is the first-line treatment for anxious patients?

    • SSRIs
    treatment anxiety

  • What are the potential adverse effects of benzodiazepines in neurological patients?

    • Significant adverse effects
    medication neurology

  • What has been associated with increased mortality in agitated dementia patients?

    • Atypical antipsychotics
    medication dementia

  • What states should be distinguished from anxiety, agitation, or mania in neurological patients?

    • Aggression
    • Impulsivity
    • Disinhibition
    neurology symptoms

  • What is the first-line treatment for acute agitation?

    • Parenteral atypical antipsychotics
    treatment agitation

  • What can be used with caution for acute agitation?

    • Parenteral benzodiazepines
    treatment agitation

  • What should be considered for prolonged agitation states?

    • SSRIs
    • Anticonvulsants
    • Atypical antipsychotics
    treatment agitation

  • What are first-line agents for dementia?

    • Acetylcholinesterase inhibitors
    treatment dementia

  • What may be effective alone or with acetylcholinesterase inhibitors for moderate to severe dementia?

    • Memantine
    treatment dementia

  • What are important neuropsychiatric conditions?

    • Stroke
    • Temporal lobe epilepsy
    • Head injury
    • Psychogenic non-epileptic seizures
    • Huntington’s disease
    • Parkinson’s disease
    • Multiple sclerosis
    • Wilson’s disease
    conditions neuropsychiatry

  • What are the types of stroke?

    • Haemorrhagic (15%)
    • Ischaemic (85%)
    stroke neurology

  • What usually causes haemorrhagic stroke?

    • Vascular anomaly
    • Long history of hypertension
    stroke causes

  • What are common sites for haemorrhagic stroke?

    • Basal ganglia-thalamus (65%)
    • Pons (15%)
    stroke anatomy

  • What causes ischaemic stroke?

    • Interruption of blood supply to the brain
    stroke causes

  • What can cause vascular occlusion leading to ischaemic stroke?

    • Thrombosis
    • Embolism
    stroke causes

  • What are features of vascular dementia?

    • Sudden onset
    • Stepwise deterioration
    • Cardiovascular risk factors
    dementia symptoms

  • What changes usually occur early in vascular dementia?

    • Emotional and personality changes
    dementia symptoms

  • What is the first-line treatment choice for cognitive disorders?

    • Atypical antipsychotics
    treatment cognitive_disorders

  • What is the strongest database for atypical antipsychotics?

    • Clozapine
    treatment medication

  • What are the first-line agents for dementia treatment?

    • Acetylcholinesterase inhibitors
    • Memantine (can be used alone or with acetylcholinesterase inhibitors)
    medicine dementia

  • What are the types of stroke?

    • Haemorrhagic stroke
    • Ischaemic stroke
    medicine stroke

  • What causes haemorrhagic stroke?

    • Vascular anomaly
    • Long history of hypertension
    medicine stroke

  • What is the percentage of haemorrhagic vs ischaemic strokes?

    • 15% haemorrhagic
    • 85% ischaemic
    medicine stroke

  • What are the cognitive disorders associated with stroke?

    • Vascular dementia
    • Subcortical dementia
    • Amnestic disorder
    medicine cognitive_disorders

  • What are features of vascular dementia?

    • Sudden onset
    • Stepwise deterioration
    • Risk factors for cardiovascular disease
    medicine dementia

  • What is the most common psychiatric consequence of stroke?

    • Depression
    medicine psychiatry

  • What percentage of stroke patients may experience post-stroke depression?

    • 40-50% in the first month
    medicine psychiatry

  • What are common emotional changes after a stroke?

    • Difficulty controlling emotions
    • Sudden crying or laughing
    medicine psychiatry

  • What psychiatric conditions are important in neuropsychiatry?

    1. Stroke
    2. Temporal lobe epilepsy
    3. Head injury
    4. Psychogenic non-epileptic seizures
    5. Huntington’s disease
    6. Parkinson’s disease
    7. Multiple sclerosis
    8. Wilson’s disease
    medicine neuropsychiatry

  • What are the symptoms of subcortical dementia?

    • Gross psychomotor slowing
    • Depressed mood
    • Movement disorders
    • Mild amnesia
    • Personality changes
    medicine dementia

  • What defines amnestic disorder?

    • Prominent anterograde or post-traumatic amnesia
    • Retrograde amnesia is relatively absent
    medicine amnesia

  • What is post-stroke anxiety prevalence?

    • Approximately 25% meet criteria for generalized anxiety disorder
    medicine psychiatry

  • What are the personality changes after a stroke?

    • Difficulty adjusting
    • Irritability
    • Accentuation of previous personality features
    • Possible disinhibition
    medicine psychiatry

  • What percentage of stroke survivors experience generalised anxiety disorder?

    Approximately 25%

    health stroke anxiety

  • What types of psychosis may result from a stroke?

    • Manic
    • Hypomanic
    • Paranoid
    health stroke psychosis

  • What are the two types of focal seizures?

    • Simple partial seizures (SPS)
    • Complex partial seizures (CPS)
    health epilepsy seizures

  • What characterizes simple partial seizures (SPS)?

    Onset in a limited area; consciousness not impaired

    health epilepsy seizures

  • What characterizes complex partial seizures (CPS)?

    May progress to generalised seizure; consciousness impaired

    health epilepsy seizures

  • What begins a generalised seizure?

    Starts with an SPS or CPS phase, then involves the whole brain.

    health epilepsy seizures

  • What are the types of generalised seizures?

    • Infantile spasms
    • Absence seizures
    • Tonic-clonic seizures
    • Atonic seizures
    • Myoclonic seizures
    health epilepsy seizures

  • What percentage of people with epilepsy develop psychiatric disorders?

    Up to 50%

    health epilepsy psychiatry

  • What are the phases of psychiatric syndromes related to epilepsy?

    • Preictal
    • Ictal
    • Post-ictal
    • Inter-ictal
    health epilepsy psychiatry

  • What symptoms may occur during the preictal phase?

    • Derealization
    • Depersonalization
    • Cognitive symptoms
    • Affective symptoms
    health epilepsy psychiatry

  • What is ictal anxiety?

    Anxiety that occurs during the seizure.

    health epilepsy psychiatry

  • What is a common symptom of post-ictal confusion?

    Disorientation and variable levels of consciousness.

    health epilepsy psychiatry

  • What is the most common psychiatric disorder in epilepsy?

    Depression

    health epilepsy psychiatry

  • What is epileptic personality syndrome?

    Controversial phenomena with symptoms like religiosity and impulsivity.

    health epilepsy psychiatry

  • What are the symptoms of chronic temporal lobe epilepsy?

    • Religiosity
    • Hyposexuality
    • Hypergraphia
    • Impulsivity
    • Egocentricity
    • Affective viscosity
    epilepsy symptoms

  • What is the risk of violence in people with temporal lobe epilepsy?

    No increased risk of violence or aggression.

    epilepsy violence

  • What percentage of people with epilepsy develop psychiatric disorders?

    Up to 50%.

    epilepsy psychiatry

  • What are the types of psychiatric syndromes related to epilepsy?

    • Pre-ictal
    • Ictal
    • Post-ictal
    • Inter-ictal
    epilepsy psychiatry

  • What occurs during the preictal phase?

    • Vague symptoms
    • Derealization
    • Cognitive symptoms (e.g., déjà vu)
    • Affective symptoms (e.g., irritability)
    • Perceptual experiences (hallucinations)
    epilepsy preictal

  • What symptoms are present during the ictal phase?

    • Ictal anxiety
    • Ictal depression
    • Ictal psychosis
    • Automatisms
    epilepsy ictal

  • What are the post-ictal symptoms?

    • Post-ictal confusion
    • Mood disturbance (depression, anxiety)
    • Post-ictal psychosis
    epilepsy postictal

  • What is common in the inter-ictal phase?

    • Inter-ictal depression
    • Inter-ictal bipolar disorder
    • Inter-ictal anxiety
    • Inter-ictal psychosis
    epilepsy interictal

  • What is epileptic personality syndrome?

    Controversial phenomena with symptoms like religiosity, hyposexuality, hypergraphia, impulsivity, egocentricity, affective viscosity.

    epilepsy personality

  • What is cognitive deterioration in epilepsy?

    Common outcome of chronic epilepsy.

    epilepsy cognition

  • What types of brain injury exist?

    • Acquired brain injury
    • Traumatic brain injury
    brain_injury classification

  • What is a traumatic brain injury?

    An acquired brain injury caused by an external force.

    health trauma

  • What are the types of head injuries?

    • Open injury: Skull breaks, enters brain.
    • Closed injury: Skull breaks without entering brain.
    health trauma

  • What is acceleration/deceleration injury?

    A closed head injury from car accidents, causing brain damage from rebounding.

    health trauma

  • What is focal injury?

    Injury that includes haemorrhage, infarct, or contusion.

    health trauma

  • What is diffuse axonal injury?

    A type of diffuse brain injury affecting multiple areas.

    health trauma

  • What is anterograde amnesia?

    Memory loss after injury until normal memory resumes; a good prognostic indicator.

    health memory

  • What is retrograde amnesia?

    Memory loss for events before the injury; a poor prognostic indicator.

    health memory

  • What is cognitive impairment following brain injury?

    Impairment in memory, thinking, attention, and executive function.

    health cognition

  • What are personality changes after brain injury?

    Changes include impaired social skills, emotional control, and self-centeredness.

    health behavior

  • What percentage of people with brain injury experience depression?

    Up to 50% of individuals have symptoms of depression.

    health mood

  • What is the risk of suicide after a brain injury?

    Significantly increased risk of suicide.

    health mood

  • What anxiety disorders can occur after brain injury?

    • Agoraphobia
    • Social phobia
    • Panic disorder
    • OCD
    • PTSD
    health anxiety

  • What is the incidence of psychosis after head injury?

    Higher incidence of schizophrenia compared to the general population.

    health psychosis

  • What is the relationship between substance misuse and brain injury?

    33% of brain injuries involve substances; 20% may develop abuse post-injury.

    health substance

  • What is an impulse control disorder?

    A failure to resist impulsive acts that are harmful; may include gambling or stealing.

    health behavior

  • What is impulse control disorder?

    Failure to resist an impulsive act or behaviour that may harm oneself or others.

    psychology disorders

  • What can relieve anxiety or tension in impulse control disorders?

    Performing the impulsive action.

    psychology behaviour

  • What is Broca’s area associated with?

    Expressive (motor) dysphasia.

    neuroscience brain

  • What is abulia?

    Loss or impairment of the ability to make decisions or act independently.

    neuroscience brain

  • What are symptoms of orbitofrontal cortex damage?

    • Disinhibition
    • Emotional lability
    • Decreased empathy
    • Poor judgement
    • Lack of insight
    neuroscience brain

  • What is apraxia?

    Inability to carry out simple tasks, e.g. dressing, eating.

    neuroscience brain

  • What is a symptom of paracentral gyrus damage?

    Incontinence.

    neuroscience brain

  • What is Gerstmann’s syndrome?

    A condition involving: - Acalculi - Agraphia - Alexia - Finger agnosia - Left/right disorientation

    neuroscience syndromes

  • What is anosognosia?

    Denial of illness.

    neuroscience disorders

  • What percentage of incidents causing brain injury involve substance misuse?

    More than 33%.

    health substanceabuse

  • What is a consequence of brain injury related to substance abuse?

    20% of individuals without prior issues may develop substance abuse problems.

    health substanceabuse

  • What is emotional lability?

    Rapid and extreme emotional changes.

    psychology emotions

  • What does executive function impairment indicate?

    Lack of ability to plan or sequence actions or tasks.

    neuroscience brain

  • What is a common effect of frontal lobe damage?

    Personality changes.

    neuroscience brain

  • What is anosognosia?

    Denial of illness

    neurology symptoms

  • What is constructional apraxia?

    Inability to copy drawings or manipulate objects

    neurology apraxia

  • What is dressing apraxia?

    Inability to dress oneself

    neurology apraxia

  • What is a symptom of post-central gyrus damage?

    Tactile sensation impairment

    neurology symptoms

  • What does optic radiation damage cause?

    Lower homonymous quadrantanopia

    neurology vision

  • What is Wernicke’s area associated with?

    Receptive dysphasia

    neurology language

  • What syndrome is associated with bilateral lesion?

    Kluver Bucy syndrome

    neurology syndrome

  • What is a symptom of medial temporal damage?

    Amnesia – episodic memory

    neurology memory

  • What is prosopagnosia?

    Amnesia for faces

    neurology memory

  • What does the Frontal Assessment Battery (FAB) test?

    Frontal lobe function

    neurology assessment

  • What are predictors of poor outcome after head injury?

    Previous head injury, older age, ApoE4 status

    neurology risk_factors

  • What are psychogenic non-epileptic seizures?

    Paroxysmal episodes resembling epileptic seizures

    neurology seizures

  • What can trigger non-epileptic seizures?

    Psychological factors (emotional, stress-related)

    neurology seizures

  • What is the prevalence of non-epileptic seizures?

    2-33 cases per 100,000 population

    neurology epidemiology

  • What is Huntington’s disease?

    An autosomal dominant disorder with 100% penetrance

    neurology disease

  • What causes Huntington’s disease?

    Expansion of over 35 CAG repeats on HD gene

    neurology genetics

  • What are symptoms of Huntington’s disease?

    Involuntary movements, cognitive dysfunction

    neurology symptoms

  • What is the impact of CAG repeats in Huntington's disease?

    Longer CAG repeats lead to earlier onset and greater severity of illness.

    genetics huntington's_disease

  • Which gene is associated with Huntington's disease?

    Huntington gene

    genetics huntington's_disease

  • What chromosome is the Huntington gene located on?

    Chromosome 4

    genetics huntington's_disease

  • What are the clinical features of Huntington's disease?

    • Motor abnormalities
    • Cognitive disturbance
    • Psychiatric symptoms
    clinical huntington's_disease

  • What is the most common psychiatric symptom in Huntington's disease?

    Depression

    psychiatry huntington's_disease

  • What is the typical age range for adult-onset Huntington's disease?

    35-50 years

    age huntington's_disease

  • What is the average duration of life after Huntington's symptoms onset?

    15-20 years

    mortality huntington's_disease

  • What is the treatment for abnormal movements in Huntington's disease?

    Haloperidol or tetrabenazine

    treatment huntington's_disease

  • What is the main cause of Parkinson's disease?

    Deterioration of neurons in the substantia nigra

    neuroscience parkinson's_disease

  • What are lewy bodies?

    Abnormal aggregates of protein in affected neurons in Parkinson's disease.

    neuroscience parkinson's_disease

  • What is the estimated loss of dopamine-producing neurons per decade?

    9-13%

    neuroscience parkinson's_disease

  • What is a common symptom of Parkinson's disease?

    Resting tremor

    symptoms parkinson's_disease

  • What is a characteristic feature of Parkinson's disease?

    Expressionless face and staring gaze

    symptoms parkinson's_disease

  • What is the cause of motor abnormalities in Parkinson's disease?

    Lack of dopamine affecting nerve function.

    neuroscience parkinson's_disease

  • What is the genetic marker for Friedreich's ataxia?

    Frataxin (FXN) - 9 GAA

    genetics disease

  • What is the genetic marker for Myotonic dystrophy?

    Dystrophia myotonica protein kinase (DMPK) - 19 CTG

    genetics disease

  • What is the genetic marker for Fragile X syndrome?

    Fragile X mental retardation 1 (FMR1) - X CGG

    genetics disease

  • What is the genetic marker for Spinobulbar muscular atrophy?

    Androgen receptor gene - X CAG

    genetics disease

  • Which population has a higher prevalence of Huntington's disease?

    Caucasians > Asians or Afro-Caribbeans

    epidemiology disease

  • What age does adult-onset Huntington's disease usually begin?

    Between 35-50 years

    epidemiology disease

  • What are the initial motor abnormalities in Huntington's disease?

    • Uncontrolled movement
    • Tics in fingers, feet, face, or trunk
    symptoms disease

  • What cognitive changes occur in Huntington's disease?

    • Deterioration of judgment and memory
    • Leads to dementia
    symptoms disease

  • What is the most common psychiatric symptom of Huntington's disease?

    Depression

    symptoms disease

  • What treatments are available for Huntington's disease?

    • Haloperidol (antipsychotic)
    • Tetrabenazine
    treatment disease

  • What are the classic symptoms of Parkinson's disease?

    • Resting tremor
    • Rigidity
    • Bradykinesia
    • Postural instability
    symptoms disease

  • What causes Parkinson's disease?

    Progressive deterioration of neurons in the substantia nigra

    causes disease

  • What is the common psychiatric symptom in Parkinson's disease?

    Depression

    symptoms disease

  • What is the age of onset for most cases of Parkinson's disease?

    Typically in 50s or 60s

    epidemiology disease

  • What genetic mutation is associated with early-onset Parkinson's disease?

    Mutation on chromosome 4 for Park 1 (alpha synuclein gene)

    genetics disease

  • What is the most common psychiatric symptom in Parkinson’s disease?

    Depression

    psychiatry parkinsons

  • What syndrome is associated with dopamine replacement therapy in Parkinson’s disease?

    Dopamine dysregulation syndrome

    psychiatry parkinsons

  • What are some impulse control disorders related to dopamine dysregulation syndrome?

    • Compulsive gambling
    • Compulsive shopping
    • Compulsive eating
    • Hypersexuality
    • Punding
    psychiatry parkinsons

  • What is the first line of management for Dopamine dysregulation syndrome?

    Medication reduction

    treatment parkinsons

  • What medication is commonly used to treat depression in Parkinson’s disease?

    SSRI or TCA

    treatment parkinsons

  • What is the average age of onset for Multiple Sclerosis (MS)?

    20-40 years

    epidemiology ms

  • What symptoms are associated with Multiple Sclerosis?

    • Diplopia
    • Dizziness
    • Muscle weakness
    • Fatigue
    • Paraesthesia
    symptoms ms

  • What is the most common psychiatric symptom in MS?

    Depression

    psychiatry ms

  • What are some drugs that can cause depression in MS?

    • Steroids
    • Interferon
    • Baclofen
    • Dantrolene
    • Tizanidine
    treatment ms

  • What is a common psychiatric symptom in MS related to mood?

    Lability of mood

    psychiatry ms

  • What disease is characterized by jaundice and hepatomegaly in early childhood?

    Wilson’s disease

    wilson disease

  • What are Kayser Fleischer rings associated with?

    Wilson’s disease

    wilson symptoms

  • What is Wilson's disease?

    An autosomal recessive disorder of copper metabolism.

    medicine disease

  • What chromosome is affected in Wilson's disease?

    Chromosome 13.

    genetics chromosome

  • What gene is defective in Wilson's disease?

    Copper-transporting adenosine triphosphatase (ATPase) gene.

    genetics gene

  • What is the main consequence of Wilson's disease?

    Impaired copper incorporation into caeruloplasmin and bile excretion.

    medicine copper

  • What are the initial symptoms of Wilson's disease?

    Jaundice, hepatomegaly, and anemia at age 10.

    symptoms pediatrics

  • What neurological symptoms can occur in Wilson's disease?

    Tremor, disturbance of gait, and psychiatric symptoms.

    neurology psychiatry

  • What are Kayser-Fleischer rings?

    Pigmented corneal rings noted in Wilson's disease.

    ophthalmology symptoms

  • What is the average age of onset for Wilson's disease?

    Between 20-40 years.

    epidemiology age

  • What psychiatric symptoms are associated with Wilson's disease?

    Depression, anxiety, and cognitive deterioration.

    psychiatry symptoms

  • What is a common risk factor for Wilson's disease?

    Children of parents with MS have a higher incidence (30-50%).

    epidemiology risk

  • What are common physical symptoms of Wilson's disease?

    Muscle weakness, fatigue, and coordination issues.

    symptoms neurology

  • What can cause drug-induced low mood in Wilson's disease?

    Steroids, interferon, baclofen, dantrolene, and tizanidine.

    psychiatry medication

  • What is the epidemiology of Wilson's disease?

    • Females > males
    • Presents with liver disease in the first decade
    • Presents with neuropsychiatric illness in the third decade
    epidemiology wilson's_disease

  • What are the clinical features of Wilson's disease?

    • Liver: hepatic dysfunction
    • Kidneys: renal tubular dysfunction
    • Eyes: Kayser Fleischer rings, sunflower cataract
    • Nervous system: tremors, dysarthria
    • Bones: osteoporosis, joint pain
    • Blood: haemolytic anaemia
    • Psychiatric: cognitive impairment, depression
    clinical_features wilson's_disease

  • What are the eye symptoms in Wilson's disease?

    • Kayser Fleischer rings: pigmented corneal rings
    • Sunflower cataract: copper deposition in lens
    symptoms eyes wilson's_disease

  • What are the psychiatric symptoms of Wilson's disease?

    • Cognitive impairment
    • Depression
    • Personality change
    • Psychosis
    psychiatric_symptoms wilson's_disease

  • What are the investigations for Wilson's disease?

    • Increased serum/urine copper
    • Decreased serum caeruloplasmin
    investigations wilson's_disease

  • What is the treatment for Wilson's disease?

    • Penicillamine: binds to copper and eliminates it through urine
    treatment wilson's_disease