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MD4001 > Intro to Neuropsychiatry > Flashcards

Intro to Neuropsychiatry Flashcards

1
Q

Define neuropsychiatry.

A

Psychiatric symptoms in the context of neurological disorder

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2
Q

Identify diseases with a neuropsychiatric component.

A
  • Dementia
  • Parkinsons
  • Multiple Sclerosis
  • Huntingtons
  • Motor Neurone Disease
  • Functional Neurological Disorder
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3
Q

Describe the spectrum of behavioral and psychological symptoms of dementia BPSD.

A

In dementia, majority of patients have some features of behavioral and/or psych symptoms, which come in three types:

1) Affective symptoms
- Depression
- Anxiety
- Apathy
- Elation
- Disinhibition

2) Psychotic symptoms
- Hallucinations
- Delusions
- Misidentifications (misidentify people they have known for years)

3) Behavioral symptoms
- Aberrant motor behaviour
- Irritability/aggression
- Agitation
- Slepe distrubances
- Stereotypies
- Hyperorality
- Eating disturbance
- Hypersexuality

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4
Q

What proportion of dementia patients have neuropsychiatric symptoms ? at which step of the disease do they present ?

A

90%

Present throughout course of disease, but more common with disease progression. May remit but highly recurrent.

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5
Q

How do neuropsychiatric symptoms in dementia affect carers ?

A
  • Likely to be the most problematic aspect for carers
  • A major source of caregiver distress
  • Strongly associated with nursing home placement (because caregivers may not be able to cope anymore after certain time)
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6
Q

What is the aetiology of neuropsychiatric symptoms ?

A

Complex interaction between anatomical, biochemical and functional changes

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7
Q

What do the types of neuropsychiatric symptoms present depend on, in dementia ?

A

Features vary according to severity and type of dementia as different brain regions affected

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8
Q

What are predisposing factors to neuropsychiatric symptoms in dementia ?

A
  • Genes

- Premorbid personality (i.e. someone who has always been irritable, may worsen in dementia)

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9
Q

What functions is the frontal lobe responsible for ?

A 
Judgement
Reasoning
Behaviour
Voluntary movements
Expressive language (Broca's)
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10
Q

What function is the parietal lobe responsible for ?

A

Spatial orientation
Perception
Initial cortical processing of tactile and proprioceptive information
Language comprehension (Wernicke’s)

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11
Q

What function is the temporal lobe responsible for ?

A 
Emotions
Learning and memory
Audition
Olfaction
Language comprehension (Wernicke's)
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12
Q

What function is the occipital lobe responsible for ?

A

Vision

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13
Q

Describe the neuropsychiatric symptoms associated with AD. Link this to the parts of the brain involved.

A

Impaired activities of daily living and altered pattern of behavior

AD is initially a temporal and parietal disorder, but then spreads throughout the brain. Thus, initially, may get symptoms which are related to these lobes, especially memory, learning, emotion, language comprehension (and word finding) (TEMPORAL), as well as language comprehension, and visuospatial abilities (PARIETAL).
As more areas of the brain get involved, get defects related to those. When the frontal lobe gets involved, inability to do ADLs.

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14
Q

Describe neuropsychiatric symptoms associated with Dementia with Lewy bodies.

A

Cortical atrophy is generalised, with defective cholinergic activity correlating with hallucinations (visual, that are typically well formed and detailed) and delusions (systematised, i.e. whole delusion system around something)

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15
Q

Distinguish between dementia related to PD and Lewy Body Dementia.

A
  • Dementia with Lewy bodies and Parkinson’s disease dementia are separate entities which share many clinical, neurochemical and morphological features
  • Distinction based on time of onset of motor and cognitive symptoms (if patient present with motor symptoms first, then dementia then diagnosis of PD, and vice versa)
  • More pronounced cortical atrophy, elevated cortical and limbic Lewy body pathologies, higher Aβ and tau loads in cortex and striatum in DLB compared to PDD, and earlier cognitive defects in DLB.
  • No differences in cortical and striatal cholinergic and dopaminergic deficits
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16
Q

Describe the neuropsychiatric symptoms associated with fronto-temporal dementia. Link this to the parts of the brain involved.

A

Frontal and temporal lobes affected

1) Behavioral symptoms
- Early loss of personal awareness (neglect of personal hygiene, and grooming)
- Early loss of social awareness (lack of social tact, misdemeanours such as shoplifting)
- Early signs of disinhibition (unrestrained sexuality, violent behaviour, inappropriate jocularity, restless pacing)
- Mental rigidity and inflexibility
- Hyperorality (oral/dietary changes, food fads, excess smoking and alcohol consumption, oral exploration of objects)
- Stereotyped and preservative behaviour (wandering, mannerisms such as slapping, singing, dancing…)
- Utilisation behaviour (unrestrained exploration of objects in environment)
- Distractibility, impulsivity, impersistence
- Early loss of insight into fact that altered condition is due to pathological change of own mental state

2) Affective symptoms
- Depression, anxiety, excessive sentimentality, suicidal and fixed ideation, delusion
- Hyponchondriasis
- Emotional unconcern (indifference and remoteness, lack of empathy and sympathy, apathy)
- Amimia (inertia, aspontaneity)

(ALSO speech disorder because Broca’s and Wernick’s areas may be affected)

17
Q

Define pseudo-dementia.

A

Can look like dementia when actually older person is depressed

18
Q

Describe the neuropsychiatric symptoms associated with vascular dementia. Link this to the parts of the brain involved.

A

Pseudobulbar palsy:
Personality and mood changes, abulia, depression, emotional incontinence, or other subcortical deficits, including psychomotor retardation and abnormal executive function (also disconnect between affect and mood, e.g. may be telling you sad news and laughing)

19
Q

Identify the main types of dementias.

A 
Lewy Body dementia
AD
Fronto-temporal dementia
Vascular dementia
Alcohol dementia
20
Q

How can you distinguish vascular dementia from the other types ?

A

If it does not fit with anything else, and have high BP or another CV risk factor, probably this.
Can affect anywhere in the brain.

21
Q

Describe neuropsychiatric symptoms in MS, including their timeline.

A
  • Dysphoria, agitation, anxiety, irritability
  • MDD ~50%- very high rates, likely to reflect cortical damage, not just reaction to disability
  • Suicide (higher rates)
  • Mania- e.g oribitofrontal prefrontal cortex-impulsivity, mood lability,
  • Pseudobulbar affect-10% MS patients-disconnect between mood and affect- ‘tears without sadness’
  • Psychosis (hallucinations + delusions) 2-3 x more common in MS patients compared to general population e.g medial temporal damage

TIMELINE
Common
Can be first presentation of MS

22
Q

Which neurodegenerative disorders are associated with higher rates of suicide than the average population ?

A

Those where patients retain insight

23
Q

Describe neuropsychiatric symptoms in Huntington’s.

A
  • Progressive dementia and movement disorder
  • Early depression and behavioural disturbances common- especially irritability, apathy, anxiety, dysphoria and agitation- independent of cognitive and motor aspects
  • Psychotic symptoms rare
  • Insight retained until late stages
  • High suicide rate ~ 10%
24
Q

Describe pathophysiology of Huntington’s.

A

• Abnormal huntingtin protein leads to degeneration of neurons- particularly caudate, putamen and cerebral cortex (so increase in size of lateral ventricles)

25
Q

Describe neuropsychiatric symptoms in MND, including their timeline.

A
  • Traditional view- ‘mind spared’- now know this is incorrect
  • Cognitive and behavioural deficits in up to 50% - executive function, social and language deficits- dementia (FTD type)

TIMELINE
• Neuropsych symptoms may precede motor symptoms

26
Q

Why might the dementia you get in MND (if you get dementia in MND) tend to look like FTD ?

A

• Familial MND and FTD have genetic overlap- trinucleotide expansion in C9orf72

27
Q

State other names of Functional Neurological Disorder.

A
  • functional movement disorder
  • conversion disorder
  • psychogenic seizures / movement disorder
  • dissociative seizures / motor disorder
  • non-epileptic seizures
28
Q

Define functional neurological disorder, including symptoms.

A
  • problem with the functioning of the nervous system (nothing wrong structurally) and how the brain and body sends and/or receives signals, rather than a structural disease process such as multiple sclerosis or stroke.
  • Eg limb weakness/paralysis, seizures, tremors, slurred speech, blackouts
  • Symptoms are real, often fluctuate
  • May also have chronic pains, fatigue, sleep problems, memory symptoms, bowel and bladder symptoms, anxiety and depression.
29
Q

Describe imaging results in functional neurological disorder.

A

• Structural brain imaging usually normal, functional MRI: hyperconnectivity between caudate, amygdala, prefrontal and sensorimotor areas

30
Q

Identify current theories regarding causes of functional neurological disorder.

A

Current view proposes that FND has many causes, from past trauma, stress, migraine, physical injury, infection – which trigger abnormal pattern of brain functioning

31
Q

Describe treatment for functional neurological disorder.

A
  • Motor symptoms can be helped by physiotx/ speech tx- retraining movement patterns that have gone wrong
  • CBT for dissociative seizures

MD4001 (74 decks)

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