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What does neuropsychiatry involve?
Interface between psychiatry and neurology.
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What conditions are associated with neuropsychiatry?
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What services does the neuropsychiatry service in Beaumont Hospital provide?
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What skills are required in consultation-liaison psychiatry?
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What is the most common psychiatric co-morbid condition?
Depression
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What psychiatric disorders can co-exist with neurological presentations?
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What is the first-line treatment for depression in neurological disease?
SSRIs
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What are the treatment options for psychosis in neurological patients?
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What is a common rating scale for assessing frontal lobe function?
Frontal Assessment Battery (FAB)
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What is the role of liaison psychiatry?
Collaboration with medical colleagues and understanding psychiatric influence on medical presentations.
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What should be considered for agitated or manic patients?
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What is the first-line treatment for anxious patients?
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What are the potential adverse effects of benzodiazepines in neurological patients?
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What has been associated with increased mortality in agitated dementia patients?
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What states should be distinguished from anxiety, agitation, or mania in neurological patients?
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What is the first-line treatment for acute agitation?
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What can be used with caution for acute agitation?
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What should be considered for prolonged agitation states?
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What are first-line agents for dementia?
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What may be effective alone or with acetylcholinesterase inhibitors for moderate to severe dementia?
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What are important neuropsychiatric conditions?
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What are the types of stroke?
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What usually causes haemorrhagic stroke?
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What are common sites for haemorrhagic stroke?
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What causes ischaemic stroke?
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What can cause vascular occlusion leading to ischaemic stroke?
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What are features of vascular dementia?
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What changes usually occur early in vascular dementia?
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What is the first-line treatment choice for cognitive disorders?
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What is the strongest database for atypical antipsychotics?
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What are the first-line agents for dementia treatment?
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What are the types of stroke?
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What causes haemorrhagic stroke?
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What is the percentage of haemorrhagic vs ischaemic strokes?
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What are the cognitive disorders associated with stroke?
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What are features of vascular dementia?
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What is the most common psychiatric consequence of stroke?
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What percentage of stroke patients may experience post-stroke depression?
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What are common emotional changes after a stroke?
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What psychiatric conditions are important in neuropsychiatry?
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What are the symptoms of subcortical dementia?
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What defines amnestic disorder?
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What is post-stroke anxiety prevalence?
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What are the personality changes after a stroke?
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What percentage of stroke survivors experience generalised anxiety disorder?
Approximately 25%
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What types of psychosis may result from a stroke?
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What are the two types of focal seizures?
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What characterizes simple partial seizures (SPS)?
Onset in a limited area; consciousness not impaired
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What characterizes complex partial seizures (CPS)?
May progress to generalised seizure; consciousness impaired
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What begins a generalised seizure?
Starts with an SPS or CPS phase, then involves the whole brain.
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What are the types of generalised seizures?
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What percentage of people with epilepsy develop psychiatric disorders?
Up to 50%
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What are the phases of psychiatric syndromes related to epilepsy?
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What symptoms may occur during the preictal phase?
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What is ictal anxiety?
Anxiety that occurs during the seizure.
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What is a common symptom of post-ictal confusion?
Disorientation and variable levels of consciousness.
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What is the most common psychiatric disorder in epilepsy?
Depression
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What is epileptic personality syndrome?
Controversial phenomena with symptoms like religiosity and impulsivity.
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What are the symptoms of chronic temporal lobe epilepsy?
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What is the risk of violence in people with temporal lobe epilepsy?
No increased risk of violence or aggression.
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What percentage of people with epilepsy develop psychiatric disorders?
Up to 50%.
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What are the types of psychiatric syndromes related to epilepsy?
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What occurs during the preictal phase?
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What symptoms are present during the ictal phase?
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What are the post-ictal symptoms?
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What is common in the inter-ictal phase?
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What is epileptic personality syndrome?
Controversial phenomena with symptoms like religiosity, hyposexuality, hypergraphia, impulsivity, egocentricity, affective viscosity.
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What is cognitive deterioration in epilepsy?
Common outcome of chronic epilepsy.
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What types of brain injury exist?
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What is a traumatic brain injury?
An acquired brain injury caused by an external force.
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What are the types of head injuries?
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What is acceleration/deceleration injury?
A closed head injury from car accidents, causing brain damage from rebounding.
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What is focal injury?
Injury that includes haemorrhage, infarct, or contusion.
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What is diffuse axonal injury?
A type of diffuse brain injury affecting multiple areas.
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What is anterograde amnesia?
Memory loss after injury until normal memory resumes; a good prognostic indicator.
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What is retrograde amnesia?
Memory loss for events before the injury; a poor prognostic indicator.
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What is cognitive impairment following brain injury?
Impairment in memory, thinking, attention, and executive function.
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What are personality changes after brain injury?
Changes include impaired social skills, emotional control, and self-centeredness.
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What percentage of people with brain injury experience depression?
Up to 50% of individuals have symptoms of depression.
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What is the risk of suicide after a brain injury?
Significantly increased risk of suicide.
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What anxiety disorders can occur after brain injury?
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What is the incidence of psychosis after head injury?
Higher incidence of schizophrenia compared to the general population.
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What is the relationship between substance misuse and brain injury?
33% of brain injuries involve substances; 20% may develop abuse post-injury.
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What is an impulse control disorder?
A failure to resist impulsive acts that are harmful; may include gambling or stealing.
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What is impulse control disorder?
Failure to resist an impulsive act or behaviour that may harm oneself or others.
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What can relieve anxiety or tension in impulse control disorders?
Performing the impulsive action.
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What is Broca’s area associated with?
Expressive (motor) dysphasia.
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What is abulia?
Loss or impairment of the ability to make decisions or act independently.
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What are symptoms of orbitofrontal cortex damage?
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What is apraxia?
Inability to carry out simple tasks, e.g. dressing, eating.
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What is a symptom of paracentral gyrus damage?
Incontinence.
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What is Gerstmann’s syndrome?
A condition involving: - Acalculi - Agraphia - Alexia - Finger agnosia - Left/right disorientation
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What is anosognosia?
Denial of illness.
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What percentage of incidents causing brain injury involve substance misuse?
More than 33%.
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What is a consequence of brain injury related to substance abuse?
20% of individuals without prior issues may develop substance abuse problems.
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What is emotional lability?
Rapid and extreme emotional changes.
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What does executive function impairment indicate?
Lack of ability to plan or sequence actions or tasks.
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What is a common effect of frontal lobe damage?
Personality changes.
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What is anosognosia?
Denial of illness
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What is constructional apraxia?
Inability to copy drawings or manipulate objects
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What is dressing apraxia?
Inability to dress oneself
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What is a symptom of post-central gyrus damage?
Tactile sensation impairment
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What does optic radiation damage cause?
Lower homonymous quadrantanopia
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What is Wernicke’s area associated with?
Receptive dysphasia
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What syndrome is associated with bilateral lesion?
Kluver Bucy syndrome
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What is a symptom of medial temporal damage?
Amnesia – episodic memory
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What is prosopagnosia?
Amnesia for faces
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What does the Frontal Assessment Battery (FAB) test?
Frontal lobe function
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What are predictors of poor outcome after head injury?
Previous head injury, older age, ApoE4 status
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What are psychogenic non-epileptic seizures?
Paroxysmal episodes resembling epileptic seizures
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What can trigger non-epileptic seizures?
Psychological factors (emotional, stress-related)
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What is the prevalence of non-epileptic seizures?
2-33 cases per 100,000 population
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What is Huntington’s disease?
An autosomal dominant disorder with 100% penetrance
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What causes Huntington’s disease?
Expansion of over 35 CAG repeats on HD gene
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What are symptoms of Huntington’s disease?
Involuntary movements, cognitive dysfunction
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What is the impact of CAG repeats in Huntington's disease?
Longer CAG repeats lead to earlier onset and greater severity of illness.
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Which gene is associated with Huntington's disease?
Huntington gene
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What chromosome is the Huntington gene located on?
Chromosome 4
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What are the clinical features of Huntington's disease?
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What is the most common psychiatric symptom in Huntington's disease?
Depression
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What is the typical age range for adult-onset Huntington's disease?
35-50 years
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What is the average duration of life after Huntington's symptoms onset?
15-20 years
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What is the treatment for abnormal movements in Huntington's disease?
Haloperidol or tetrabenazine
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What is the main cause of Parkinson's disease?
Deterioration of neurons in the substantia nigra
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What are lewy bodies?
Abnormal aggregates of protein in affected neurons in Parkinson's disease.
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What is the estimated loss of dopamine-producing neurons per decade?
9-13%
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What is a common symptom of Parkinson's disease?
Resting tremor
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What is a characteristic feature of Parkinson's disease?
Expressionless face and staring gaze
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What is the cause of motor abnormalities in Parkinson's disease?
Lack of dopamine affecting nerve function.
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What is the genetic marker for Friedreich's ataxia?
Frataxin (FXN) - 9 GAA
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What is the genetic marker for Myotonic dystrophy?
Dystrophia myotonica protein kinase (DMPK) - 19 CTG
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What is the genetic marker for Fragile X syndrome?
Fragile X mental retardation 1 (FMR1) - X CGG
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What is the genetic marker for Spinobulbar muscular atrophy?
Androgen receptor gene - X CAG
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Which population has a higher prevalence of Huntington's disease?
Caucasians > Asians or Afro-Caribbeans
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What age does adult-onset Huntington's disease usually begin?
Between 35-50 years
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What are the initial motor abnormalities in Huntington's disease?
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What cognitive changes occur in Huntington's disease?
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What is the most common psychiatric symptom of Huntington's disease?
Depression
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What treatments are available for Huntington's disease?
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What are the classic symptoms of Parkinson's disease?
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What causes Parkinson's disease?
Progressive deterioration of neurons in the substantia nigra
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What is the common psychiatric symptom in Parkinson's disease?
Depression
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What is the age of onset for most cases of Parkinson's disease?
Typically in 50s or 60s
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What genetic mutation is associated with early-onset Parkinson's disease?
Mutation on chromosome 4 for Park 1 (alpha synuclein gene)
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What is the most common psychiatric symptom in Parkinson’s disease?
Depression
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What syndrome is associated with dopamine replacement therapy in Parkinson’s disease?
Dopamine dysregulation syndrome
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What are some impulse control disorders related to dopamine dysregulation syndrome?
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What is the first line of management for Dopamine dysregulation syndrome?
Medication reduction
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What medication is commonly used to treat depression in Parkinson’s disease?
SSRI or TCA
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What is the average age of onset for Multiple Sclerosis (MS)?
20-40 years
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What symptoms are associated with Multiple Sclerosis?
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What is the most common psychiatric symptom in MS?
Depression
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What are some drugs that can cause depression in MS?
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What is a common psychiatric symptom in MS related to mood?
Lability of mood
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What disease is characterized by jaundice and hepatomegaly in early childhood?
Wilson’s disease
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What are Kayser Fleischer rings associated with?
Wilson’s disease
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What is Wilson's disease?
An autosomal recessive disorder of copper metabolism.
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What chromosome is affected in Wilson's disease?
Chromosome 13.
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What gene is defective in Wilson's disease?
Copper-transporting adenosine triphosphatase (ATPase) gene.
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What is the main consequence of Wilson's disease?
Impaired copper incorporation into caeruloplasmin and bile excretion.
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What are the initial symptoms of Wilson's disease?
Jaundice, hepatomegaly, and anemia at age 10.
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What neurological symptoms can occur in Wilson's disease?
Tremor, disturbance of gait, and psychiatric symptoms.
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What are Kayser-Fleischer rings?
Pigmented corneal rings noted in Wilson's disease.
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What is the average age of onset for Wilson's disease?
Between 20-40 years.
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What psychiatric symptoms are associated with Wilson's disease?
Depression, anxiety, and cognitive deterioration.
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What is a common risk factor for Wilson's disease?
Children of parents with MS have a higher incidence (30-50%).
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What are common physical symptoms of Wilson's disease?
Muscle weakness, fatigue, and coordination issues.
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What can cause drug-induced low mood in Wilson's disease?
Steroids, interferon, baclofen, dantrolene, and tizanidine.
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What is the epidemiology of Wilson's disease?
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What are the clinical features of Wilson's disease?
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What are the eye symptoms in Wilson's disease?
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What are the psychiatric symptoms of Wilson's disease?
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What are the investigations for Wilson's disease?
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What is the treatment for Wilson's disease?
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What does neuropsychiatry involve?
Interface between psychiatry and neurology.
What conditions are associated with neuropsychiatry?
What services does the neuropsychiatry service in Beaumont Hospital provide?
What skills are required in consultation-liaison psychiatry?
What is the most common psychiatric co-morbid condition?
Depression
What psychiatric disorders can co-exist with neurological presentations?
What is the first-line treatment for depression in neurological disease?
SSRIs
What are the treatment options for psychosis in neurological patients?
What is a common rating scale for assessing frontal lobe function?
Frontal Assessment Battery (FAB)
What is the role of liaison psychiatry?
Collaboration with medical colleagues and understanding psychiatric influence on medical presentations.
What should be considered for agitated or manic patients?
What is the first-line treatment for anxious patients?
What are the potential adverse effects of benzodiazepines in neurological patients?
What has been associated with increased mortality in agitated dementia patients?
What states should be distinguished from anxiety, agitation, or mania in neurological patients?
What is the first-line treatment for acute agitation?
What can be used with caution for acute agitation?
What should be considered for prolonged agitation states?
What are first-line agents for dementia?
What may be effective alone or with acetylcholinesterase inhibitors for moderate to severe dementia?
What are important neuropsychiatric conditions?
What are the types of stroke?
What usually causes haemorrhagic stroke?
What are common sites for haemorrhagic stroke?
What causes ischaemic stroke?
What can cause vascular occlusion leading to ischaemic stroke?
What are features of vascular dementia?
What changes usually occur early in vascular dementia?
What is the first-line treatment choice for cognitive disorders?
What is the strongest database for atypical antipsychotics?
What are the first-line agents for dementia treatment?
What are the types of stroke?
What causes haemorrhagic stroke?
What is the percentage of haemorrhagic vs ischaemic strokes?
What are the cognitive disorders associated with stroke?
What are features of vascular dementia?
What is the most common psychiatric consequence of stroke?
What percentage of stroke patients may experience post-stroke depression?
What are common emotional changes after a stroke?
What psychiatric conditions are important in neuropsychiatry?
What are the symptoms of subcortical dementia?
What defines amnestic disorder?
What is post-stroke anxiety prevalence?
What are the personality changes after a stroke?
What percentage of stroke survivors experience generalised anxiety disorder?
Approximately 25%
What types of psychosis may result from a stroke?
What are the two types of focal seizures?
What characterizes simple partial seizures (SPS)?
Onset in a limited area; consciousness not impaired
What characterizes complex partial seizures (CPS)?
May progress to generalised seizure; consciousness impaired
What begins a generalised seizure?
Starts with an SPS or CPS phase, then involves the whole brain.
What are the types of generalised seizures?
What percentage of people with epilepsy develop psychiatric disorders?
Up to 50%
What are the phases of psychiatric syndromes related to epilepsy?
What symptoms may occur during the preictal phase?
What is ictal anxiety?
Anxiety that occurs during the seizure.
What is a common symptom of post-ictal confusion?
Disorientation and variable levels of consciousness.
What is the most common psychiatric disorder in epilepsy?
Depression
What is epileptic personality syndrome?
Controversial phenomena with symptoms like religiosity and impulsivity.
What are the symptoms of chronic temporal lobe epilepsy?
What is the risk of violence in people with temporal lobe epilepsy?
No increased risk of violence or aggression.
What percentage of people with epilepsy develop psychiatric disorders?
Up to 50%.
What are the types of psychiatric syndromes related to epilepsy?
What occurs during the preictal phase?
What symptoms are present during the ictal phase?
What are the post-ictal symptoms?
What is common in the inter-ictal phase?
What is epileptic personality syndrome?
Controversial phenomena with symptoms like religiosity, hyposexuality, hypergraphia, impulsivity, egocentricity, affective viscosity.
What is cognitive deterioration in epilepsy?
Common outcome of chronic epilepsy.
What types of brain injury exist?
What is a traumatic brain injury?
An acquired brain injury caused by an external force.
What are the types of head injuries?
What is acceleration/deceleration injury?
A closed head injury from car accidents, causing brain damage from rebounding.
What is focal injury?
Injury that includes haemorrhage, infarct, or contusion.
What is diffuse axonal injury?
A type of diffuse brain injury affecting multiple areas.
What is anterograde amnesia?
Memory loss after injury until normal memory resumes; a good prognostic indicator.
What is retrograde amnesia?
Memory loss for events before the injury; a poor prognostic indicator.
What is cognitive impairment following brain injury?
Impairment in memory, thinking, attention, and executive function.
What are personality changes after brain injury?
Changes include impaired social skills, emotional control, and self-centeredness.
What percentage of people with brain injury experience depression?
Up to 50% of individuals have symptoms of depression.
What is the risk of suicide after a brain injury?
Significantly increased risk of suicide.
What anxiety disorders can occur after brain injury?
What is the incidence of psychosis after head injury?
Higher incidence of schizophrenia compared to the general population.
What is the relationship between substance misuse and brain injury?
33% of brain injuries involve substances; 20% may develop abuse post-injury.
What is an impulse control disorder?
A failure to resist impulsive acts that are harmful; may include gambling or stealing.
What is impulse control disorder?
Failure to resist an impulsive act or behaviour that may harm oneself or others.
What can relieve anxiety or tension in impulse control disorders?
Performing the impulsive action.
What is Broca’s area associated with?
Expressive (motor) dysphasia.
What is abulia?
Loss or impairment of the ability to make decisions or act independently.
What are symptoms of orbitofrontal cortex damage?
What is apraxia?
Inability to carry out simple tasks, e.g. dressing, eating.
What is a symptom of paracentral gyrus damage?
Incontinence.
What is Gerstmann’s syndrome?
A condition involving: - Acalculi - Agraphia - Alexia - Finger agnosia - Left/right disorientation
What is anosognosia?
Denial of illness.
What percentage of incidents causing brain injury involve substance misuse?
More than 33%.
What is a consequence of brain injury related to substance abuse?
20% of individuals without prior issues may develop substance abuse problems.
What is emotional lability?
Rapid and extreme emotional changes.
What does executive function impairment indicate?
Lack of ability to plan or sequence actions or tasks.
What is a common effect of frontal lobe damage?
Personality changes.
What is anosognosia?
Denial of illness
What is constructional apraxia?
Inability to copy drawings or manipulate objects
What is dressing apraxia?
Inability to dress oneself
What is a symptom of post-central gyrus damage?
Tactile sensation impairment
What does optic radiation damage cause?
Lower homonymous quadrantanopia
What is Wernicke’s area associated with?
Receptive dysphasia
What syndrome is associated with bilateral lesion?
Kluver Bucy syndrome
What is a symptom of medial temporal damage?
Amnesia – episodic memory
What is prosopagnosia?
Amnesia for faces
What does the Frontal Assessment Battery (FAB) test?
Frontal lobe function
What are predictors of poor outcome after head injury?
Previous head injury, older age, ApoE4 status
What are psychogenic non-epileptic seizures?
Paroxysmal episodes resembling epileptic seizures
What can trigger non-epileptic seizures?
Psychological factors (emotional, stress-related)
What is the prevalence of non-epileptic seizures?
2-33 cases per 100,000 population
What is Huntington’s disease?
An autosomal dominant disorder with 100% penetrance
What causes Huntington’s disease?
Expansion of over 35 CAG repeats on HD gene
What are symptoms of Huntington’s disease?
Involuntary movements, cognitive dysfunction
What is the impact of CAG repeats in Huntington's disease?
Longer CAG repeats lead to earlier onset and greater severity of illness.
Which gene is associated with Huntington's disease?
Huntington gene
What chromosome is the Huntington gene located on?
Chromosome 4
What are the clinical features of Huntington's disease?
What is the most common psychiatric symptom in Huntington's disease?
Depression
What is the typical age range for adult-onset Huntington's disease?
35-50 years
What is the average duration of life after Huntington's symptoms onset?
15-20 years
What is the treatment for abnormal movements in Huntington's disease?
Haloperidol or tetrabenazine
What is the main cause of Parkinson's disease?
Deterioration of neurons in the substantia nigra
What are lewy bodies?
Abnormal aggregates of protein in affected neurons in Parkinson's disease.
What is the estimated loss of dopamine-producing neurons per decade?
9-13%
What is a common symptom of Parkinson's disease?
Resting tremor
What is a characteristic feature of Parkinson's disease?
Expressionless face and staring gaze
What is the cause of motor abnormalities in Parkinson's disease?
Lack of dopamine affecting nerve function.
What is the genetic marker for Friedreich's ataxia?
Frataxin (FXN) - 9 GAA
What is the genetic marker for Myotonic dystrophy?
Dystrophia myotonica protein kinase (DMPK) - 19 CTG
What is the genetic marker for Fragile X syndrome?
Fragile X mental retardation 1 (FMR1) - X CGG
What is the genetic marker for Spinobulbar muscular atrophy?
Androgen receptor gene - X CAG
Which population has a higher prevalence of Huntington's disease?
Caucasians > Asians or Afro-Caribbeans
What age does adult-onset Huntington's disease usually begin?
Between 35-50 years
What are the initial motor abnormalities in Huntington's disease?
What cognitive changes occur in Huntington's disease?
What is the most common psychiatric symptom of Huntington's disease?
Depression
What treatments are available for Huntington's disease?
What are the classic symptoms of Parkinson's disease?
What causes Parkinson's disease?
Progressive deterioration of neurons in the substantia nigra
What is the common psychiatric symptom in Parkinson's disease?
Depression
What is the age of onset for most cases of Parkinson's disease?
Typically in 50s or 60s
What genetic mutation is associated with early-onset Parkinson's disease?
Mutation on chromosome 4 for Park 1 (alpha synuclein gene)
What is the most common psychiatric symptom in Parkinson’s disease?
Depression
What syndrome is associated with dopamine replacement therapy in Parkinson’s disease?
Dopamine dysregulation syndrome
What are some impulse control disorders related to dopamine dysregulation syndrome?
What is the first line of management for Dopamine dysregulation syndrome?
Medication reduction
What medication is commonly used to treat depression in Parkinson’s disease?
SSRI or TCA
What is the average age of onset for Multiple Sclerosis (MS)?
20-40 years
What symptoms are associated with Multiple Sclerosis?
What is the most common psychiatric symptom in MS?
Depression
What are some drugs that can cause depression in MS?
What is a common psychiatric symptom in MS related to mood?
Lability of mood
What disease is characterized by jaundice and hepatomegaly in early childhood?
Wilson’s disease
What are Kayser Fleischer rings associated with?
Wilson’s disease
What is Wilson's disease?
An autosomal recessive disorder of copper metabolism.
What chromosome is affected in Wilson's disease?
Chromosome 13.
What gene is defective in Wilson's disease?
Copper-transporting adenosine triphosphatase (ATPase) gene.
What is the main consequence of Wilson's disease?
Impaired copper incorporation into caeruloplasmin and bile excretion.
What are the initial symptoms of Wilson's disease?
Jaundice, hepatomegaly, and anemia at age 10.
What neurological symptoms can occur in Wilson's disease?
Tremor, disturbance of gait, and psychiatric symptoms.
What are Kayser-Fleischer rings?
Pigmented corneal rings noted in Wilson's disease.
What is the average age of onset for Wilson's disease?
Between 20-40 years.
What psychiatric symptoms are associated with Wilson's disease?
Depression, anxiety, and cognitive deterioration.
What is a common risk factor for Wilson's disease?
Children of parents with MS have a higher incidence (30-50%).
What are common physical symptoms of Wilson's disease?
Muscle weakness, fatigue, and coordination issues.
What can cause drug-induced low mood in Wilson's disease?
Steroids, interferon, baclofen, dantrolene, and tizanidine.
What is the epidemiology of Wilson's disease?
What are the clinical features of Wilson's disease?
What are the eye symptoms in Wilson's disease?
What are the psychiatric symptoms of Wilson's disease?
What are the investigations for Wilson's disease?
What is the treatment for Wilson's disease?
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