EMQ Exam Flashcards
Pass this (123 cards)
1
Q
What is Cotard Syndrome?
A
- Cotard’s syndrome is named after Jules Cotard, a French neurologist who described the condition in 1880.
- It is a syndrome whose central feature is nihilistic delusions.
- The most prominent features of Cotard’s syndrome are depressive mood (89%), nihilistic delusions concerning one’s own body (86%), nihilistic delusions concerning one’s own existence (69%), anxiety (65%), delusions of guilt (63%), delusions of immortality (55%) and Hypochondriacal delusions (58%).
- Also known as Délire de négation.
2
Q
Is Somatisation or Hypochondriasis in the DSM V?
A
No.
Somatic symptom disorder in DSM -V. Somatoform disorders are now referred to as somatic symptom and related disorders. Diagnoses of somatisation disorder, hypochondriasis , pain disorder and undifferentiated somatoform disorder have been removed
3
Q
What is body dysmorphic disorder?
A
for DSM 5 - repetitive behaviours or mental acts in response to pre-occupations with perceived defects or flaws in physical appearance.
Also has muscle dysmorphia
The delusional variant - It is no longer coded as b under delusional disorder but now under BDD without insight
4
Q
What is found on the EEG of a patient with CJD?
A
Periodic 1-2 Hz sharp wave complexes - characteristic of CJD
Myoclonic jerks are also a frequent occurence
5
Q
Sporadic vs Variant CJD? - which one presents with psychiatric symptoms initially?
A
Variant CJD
6
Q
What sign can be seen on an MRI with Variant CJD
A
Pulvinar sign
- Hyperintensity on the thalamus
7
Q
Which screening test is not sensitive in picking up Frontal Lobe abnormalities?
A
MMSE
Fronto-temporal dementia has an intact parietal lobe - therefore MMSE is usually normal
8
Q
What shows on the MRI for Vascular dementia?
A
Deep White matter Hyperintensities.
9
Q
Vascular dementia - What are the 4 broad categories ?
A
Multi-infarct dementia
Small vessel Disease
Post Stroke Dementia
Specific Vascular Dementia Syndromes (E.g CADASIL)
10
Q
What is the Hachinski index? and what does it differentiate?
A
Vascular dementia vs Alzheimers disease.
- Abrupt onset
- stepwise deterioration
- fluctuating course
- focal neurological
Hachinski Ischemic Scale
Feature Value Abrupt onset 2 Stepwise deterioration 1 Fluctuating course 2 Nocturnal confusion 1 Relative preservation of personality 1 Depression 1 Somatic complaints 1 Emotional incontinence 1 History or presence of hypertension 1 History of strokes 2 Evidence of atherosclerosis 1 Focal neurological symptoms 2 Focal neurological signs 2
Patients scoring 7 or greater are classified as having “multi-infarct dementia”, and patients scoring = 4 are classified as having “primary degenerative dementia”. A score of 5 or 6 is considered as an intermediate value and is usually designated as “mixed dementia”.
signs
11
Q
Neuroimaging on Multi-infarct dementia?
A
cerebral atrophy
old and recent infarcts
12
Q
Findings on Neuroimaging in Small Vessel Disease?
A
2 cardinal features:
- White matter lesions ( appear as periventricular lucency - leucoaraiosis) or as Deep white matter hyperintensities and central grey matter lacunae
13
Q
Findings on Neuroimaging in CADASIL - Cerebral Autosomal Dominant Arteriopathy with subcortical infarcts and Leukoencephalopathy
A
Presents with MIGRAIN and Recurrent subcortical infarcts, TIA and affective disturbance
Mutations on the NOTCH3 gene on Chromosome 19
14
Q
MELAS
Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke like episodes
A
Usually presents in childhood due to mutation in the mitochondrial transfer RNA
15
Q
Wernickes Encephalopathy - eye signs
A
Lateral rectus palsy due to Abducens Nerve - characteristic of Wernickes
16
Q
Neurosyphilis - eye signs
A
Argyll Robertson pupil
Pupil that is slow to accommodate or where accommodation reflex is present - characteristic of Neurosyphilis
17
Q
What psychotic symptoms can retroviral medications cause?
A
Psychosis and hallucinations
18
Q
Urine osmolality in SIADH
A
Increased Urine osmolality - due to increased ADH secretion and loss of Sodium and subsequent Hypo Na
19
Q
Psychogenic Polydipsia
A
complication of Schizophrenia
Low Urine osmolality due to dilute urine
20
Q
Ventromedial hypothalamus is in control of ?
A
Satiety
- ie. hyperphagia and obesity
21
Q
Lateral Hypothalamus
A
centre for feeding
22
Q
Which area of the brain is responsible for apathy?
A
Medial frontal lobe
23
Q
What is the eponymous name for damage to the DOMINANT PARIETAL LOBE?
A
Gerstmanns syndrome
Agraphia
Acalculia
Left- Right Disorientation
Finger agnosia
24
Q
What is damaged in Korsakoff’s syndrome?
A
Mamillary Bodies
Causes:
Anterograde and Retrograde Amnesia
25
What is Klinefelter Syndrome and what are the signs
47 XXY
Male hypogonadism
90% have scant facial hair and gynaecomastia occurs in 50% of patients.
6.5% of patients with Klinefelters will have a psychotic disorder including schizophrenia and bipolar disorder
26
What is Turners Syndrome and the signs
45 XO
- female partly or completely missing an X chromosome.
```
signs:
Short stature
non functioning ovaries
Webbed neck
lymphoedema of hands and feet
high BP and kidney problems
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27
Androgen Insensitivity Syndrome (Testicular feminisation syndrome)
X linked disorder
Receptors are unresponsive to Testosterone
Despite normal levels of testosterone - fails to develop as Male
Secondary sex characteristics are female due to Testosterone to Oestrogen Aromatisation
Can operate with gonadectomy and provide hormones to raise as female
28
What are McNaughtons Rules?
1. Every man is to be presumed to be sane and to possess a sufficient degree of reason to be responsible for his crimes, until the contrary be proved.
2. An insane person is punishable “if he knows” at the time of crime.
3. To establish a defense on insanity, the accused, by defect of reason or disease of mind, is not in a position to know the nature and consequences.
4. The insane person must be considered in the same situation as to responsibility as if the facts with respect to which the delusion exists were real.
5. It was the jury's role to decide whether the defendant was insane.
29
What is Duress?
Legal defence
A Person acts under duress and therefore involuntarily, if that persons actions were performed because of threats (express or implied) of death or really serious injury to himself/herself/dependents being threats of such a nature that a person of ordinary firmness and strength of will, that is a person of the same maturity and sex as the accused person
30
What is Provocation
Legal Defence
Act is the result of a loss of self control on the part of the accused that was induced by any conduct of [the deceased] towards or affected the accused
31
What is Othellos Syndrome?
Morbid jealousy
| Delusion of Infidelity
32
Referential delusion?
A neutral event believed to have a special or personal meaning
33
Autochthonous delusion?
a.k.a Wahneinfall delusion
" Out of the blue" delusion
arise as suddenly formed intuitions and occur in a single stage.
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Delusional perception?
Occurs in two stages
1) real perception
2) delusional interpretation
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Delusional Mood?
Strange, uncanny mood in which the environment appears to be changed in a threatening way but the significance of the change cannot be understood by the patient who is tense, anxious and bewildered
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Nihilistic delusions
Feelings of guilt, death, and hypochondriacal ideas are extreme
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Delusional Memory
patient recalls as remembered an event or idea that is delusional
" I remember when I was abducted by aliens"
38
What are the autopsy findings in Alzheimers Disease?
Amyloid Plaques (Neuritic Plaques),
Neurofibrillary tangles (NFT) - intraneuronal aggregates of Tau protein normally found in the axon - Visible with silver staining techniques (Bielschowsky)
Astrocystosis and microgliosis
Neuronal and synaptic loss
Found in the MEDIAL HIPPOCAMPUS (Entorhinal cortex, amygdala)
Neocortex of the occipital, frontal and temporal lobes
39
Lewy body dementia
| What are lewy bodies?
Oesinophilic inclusion bodies composed of abnormally phosphorylated neurofilament proteins aggregated with UBIQUITIN and ALPHA SYNUCLEIN
Lewy bodies in LEWY BODY DEMENTIA are found in the cerebral cortex - Limbic and neocortical structures
40
Where are Lewy bodies found in Parkinsons disease?
Lewy body formation and neuronal loss occur in the BRAINSTEM Nuclei, particularly the SUBSTANTIA NIGRA
41
Vascular dementia changes in brain
Large or multiple small infarcts, lacunar infarcted, cerebral amyloid angiopathy, gliosis, hyalinasation and sclerosis
42
Who developed Attachment theory
John Bowlby
43
When is stranger anxiety?
Initially, babies show a positive response to strangers (between 14-18 weeks), this is normally replaced by stranger anxiety at around 8 months.
44
When is separation anxiety?
When an infant is separated from their main carer it is common for them to become anxious (aka separation anxiety). Separation anxiety is most common when an infant is 10 - 18 months and usually diminishes by year three.
45
What happens to people with poor attachment?
The quality of a persons early attachments appears is associated with their adult behaviour. Poor attachments tend to lead to withdrawn individuals who struggle to form relationships, where as good attachments are associated with socially competent adults who are able to form healthy relationships. Attachment behaviour tends to be stable over the lifetime.
46
When does specific attachment take place?
Specific attachment does not seem to take place before 6 months. The time from 6 months to 36 months is known as the critical period. During this time a child is most vulnerable to interruptions in its attachment.
47
What is stupor?
Stupor - combination of immobility and mutism
48
Posturing?
Posturing - maintaining the same posture for long periods. A classic example is the 'crucifix'. An extreme version of posturing is catalepsy
49
Waxy Flexibility?
Waxy flexibility (cerea flexibilitas) - patient can be positioned in uncomfortable postures, which are maintained for a considerable period of time.
50
Geganhalten - Negativism?
Negativism (Gegenhalten) - patient resists the attempts of the examiner to move parts of their body and, according to the original definition, the resistance offered is exactly equal to the strength applied
51
Automatic obedience?
Automatic obedience - exaggerated cooperation, automatically obeying every instruction of the examiner.
52
Mitmachen
Mitmachen - a form of automatic obedience whereby the body of the patient can be put into any posture, even if the patient is given instructions to resist. The body part immediately returns to the original position once the force is removed (unlike in waxy flexibility)
53
Mitgehen
Mitgehen - an extreme form of mitmachen in which the examiner is able to move the patient's body with the slightest touch (anglepoise lamp sign).
54
Ambitendency
Ambitendency - The patient alternates between resistance to and cooperation with the examiner's instructions; for example, when asked to shake hands, the patient repeatedly extends and withdraws the hand
55
Psychological pillow
Psychological pillow - The patient assumes a reclining posture, with their head a few inches above the bed surface, and is able to maintain this position for prolonged periods
56
Forced grasping
Forced grasping - The patient forcibly and repeatedly grasps the examiner's hand when offered
57
Obstruction
Obstruction - The patient stops suddenly in the course of a movement and is generally unable to give a reason. This appears to be the motor counterpart of thought block
58
Echopraxia
Echopraxia - The patient imitates the actions of the interviewer
59
Stereotypies
Stereotypies - These are repetitive, regular movements that are not goal-directed (e.g. Rocking)
60
Motor perseveration
Motor perseveration - The patient persists with a particular movement that has lost its initial relevance
61
Echolalia
Echolalia - repetition of the examiners words
62
Logorrhoea
Logorrhoea - incoherent talkativeness
63
Verbigeration
Verbigeration - Meaningless, repetition of words or phrases
64
What is a haplotype
A haplotype is a set of DNA variations, or polymorphisms, that tend to be inherited together.
65
What are EEG findings in CJD
Early on there is non specific slowing, later periodic biphasic and triphasic synchronous sharp wave complexes superimposed on a slow background rhythm
66
EEG findings in Huntingtons disease
Low voltage EEG, in particular no alpha (flattening)
67
EEG findings in Delirium
Diffuse slowing, decreased alpha, increased theta and delta
68
EEG findings in Delirium Tremens
Hyperactive trace, fast
69
EEG findings in Alzheimers
Reduced alpha and beta, increased delta and theta
70
EEG findings in absence seizure - petit mal
Generalised, bilateral, synchronous, 3Hz (3 waves per second) spike and wave pattern
71
EEG findings in Generalised Epilepsy
Sharp spikes, 25-30Hz
72
EEG findings in Myclonic epilepsy
Generalised spike and wave activity
73
EEG findings in Encephalopathy
Diffuse slowing
74
What is the Brown and Harris vulnerability factors for depressive illness in women?
* Three or more children under the age of 14 at home
* Lack of an intimate relationship with a husband or boyfriend
* Lack of employment outside of the home
* Loss of a mother before the age of 11 years
75
What is a flashbulb memory?
Flashbulb memories are detailed recollections of the context in which people first heard about an important event.
For example, what were you doing when you first heard about the death of Diana, Princess of Wales in 1997?
76
What are Freuds Psychosexual theory of development?
Stage
Range
Description
Oral 0-18 months Pleasure and needs explored though sucking, swallowing and biting
Anal 18-36 months Pleasure and need explore through bowel and bladder, through both elimination and retention
Phallic 3-5 years During this phase, boys pass through the Oedipal complex and girls the Electra complex. Girls are also said to develop penis envy in this stage
Latency 5-puberty The sexual drive remains latent during this stage
Genital Puberty-adulthood During this stage a person achieves independence from their parents and forms intimate relationships with others
77
Delusional type:
| Folie a Deux
Folie a deux - a syndrome where a delusion is transmitted from one person to another (aka a shared delusion)
78
Hypochondriacal delusion
Hypochondriacal - belief that something is physically wrong with the patient
79
Ekboms syndrome
Ekboms' syndrome - belief that has been infested with insects
80
Othello syndrome
Othello syndrome - belief that a sexual partner is cheating on them
81
Capgras delusion
Capgras delusion - belief that a person close to them has been replaced by a double
82
Fregoli delusion
Fregoli delusion - patient identifies a familiar person (usually suspected to be a persecutor) in other people they meet
83
Syndrome of subjective doubles
Syndrome of subjective doubles - belief that doubles of him/her exist
84
Lycanthropy
Lycanthropy - belief that one has been transformed into an animal
85
De Clarambaults syndrome
De Clérambault's syndrome - false belief that a person is in love with them
86
Pseudocyesis
Pseudocyesis - a condition whereby a woman believes herself to be pregnant when she is not. Objective signs accompany the belief such as abdominal enlargement, menstrual disturbance, apparent foetal movements, nausea, breast changes, and labour pains.
87
Akinesia
absence, poverty, or loss of control of voluntary muscle movements. This is seen in severe Parkinson's disease.
88
Bradykinesia
slowness of movement, core symptom in Parkinson's disease along with tremor and rigidity.
89
Athetosis
continuous stream of slow, flowing, writhing involuntary movements.
90
akathisia
- subjective feeling of inner restlessness, most often caused by side effect of neuroleptic medication, often manifests as inability to sit still.
91
Chorea
- brief, quasi-purposeful, irregular contractions that are not repetitive or rhythmic, but appear to flow from one muscle to the next.
92
Dystonia
sustained muscle contractions cause twisting and repetitive movements or abnormal postures.
93
Dyskinesia
general term referring to problems with voluntary movements and the presence of involuntary movements.
94
Myoclonus
Sudden involuntary jerks of a muscle or a muscle group. These are not suppressible.
95
Tic
sudden, repetitive, non rhythmic, stereotyped motor movement or vocalization involving discrete muscle groups. These are different to myoclonus as they are suppressible.
96
Hemiballismus
repetitive, but constantly varying, large amplitude involuntary movements of the proximal parts of the limbs
97
Tremor
involuntary, rhythmic, alternating movement of one or more body parts.
98
What is a primary delusion?
A primary delusion is one that arises spontaneously, from normal psychological processes and not as a consequence of psychopathology.
99
What is a secondary delusion?
A secondary delusion develops as a consequence of an abnormal experience.
For instance, if a delusion arises following a patient's experience of auditory hallucinations it is classed as secondary.
100
What are types of primary delusions
* Delusional perception - A normal perception followed by a delusional interpretation
* Delusional memory - The recollection of an event or idea that is clearly delusional in nature
* Delusional mood - Delusion arising from a strange mood
* Autochthonous delusion - A delusion that appears out of the blue (spontaneously), i.e. not following a perception, memory or mood
101
Gedankenlautwerden
thought echo
102
Schnauzkrampf
a grimace resembling pouting sometimes observed in catatonic patients
103
Vorbeigehen/ vorbeireden
Seen in Ganser syndrome. Patient's who exhibit this give approximate answers to questions (e.g. How many fingers does a man have, answer 14).
104
Autosomal dominant Inheritance?
There are two copies of every autosomal gene. When the presence of one faulty gene causes a problem despite the presence of a normal one the condition is said to be dominant. Conditions with dominant inheritance show what's known as vertical transmission, this is based on the appearance of the family pedigree. When only 1 parent is affected there is a 50% chance of each child expressing the condition. Autosomal dominant conditions often show pleiotropy. This refers to the situation where a single gene influences several characteristics. An example is Marfan's syndrome where the hypermobility of the joints, elongation of the limbs, and heart defects are caused by a single gene. Make sure not to confuse this with polyploidy which refers to a situation where there are more than 2 sets of chromosones (for example 69 chromosones in a cell).
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Conditions:
Huntingtons
Neurofibromatosis
Marfans
Achondroplasia
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105
Autosomal Recessive Inheritance
In an autosomal recessive condition a person requires two faulty copies of a gene to manifest a disease. A person with one healthy and one faulty gene will generally not manifest a disease and are labelled a carrier. Autosomal recessive conditions demonstrate horizontal transmission.
Conditions:
Homocystinuria
Phenylketonuria
Wilsons disease
106
X - linked (Sex linked) Inheritance
Dominant
In X-linked conditions the problem gene lies on the X chromosome. This means that all males are affected. Like autosomal conditions they can be dominant or recessive. Affected males are unable to pass the condition on to their sons.
Conditions :
Vitamin D resistant Rickets
Retts Syndrome
107
X linked recessive
Duchenne Muscular dystrophy
Red-green colour blindness
Haemophilia A and B
108
Multifactorial inheritance
Multifactoral conditions result from interaction between genes from both parents and the environment.
109
Antipsychiatry movement
The anti-psychiatry movement began in the 1960's and supports the notion that mental illnesses are social constructs which reflect deviation from social norms.
Famous figures associated with the movement include:-
* Thomas Szasz
* R.D.Laing
* Michel Foucault
* Franco Basaglia
110
Early onset Alzheimers - Genetic
Take note that early onset (familial) Alzheimer's (EOFAD) is very rare and account for only 0.1% of all Alzheimer's cases.
There are 3 genes of importance:-
* amyloid precursor protein (APP) - accounts for 10-15% of EOFAD
* presenilin one (PSEN-1) - accounts for 30-70% of EOFAD
* presenilin two (PSEN-2) - accounts for 5% of EOFAD
The APP gene is located on chromosome 21 and codes for the production of amyloid precursor protein. Little is known about the function of this protein other than that it's a precursor of amyloid.
The presenilins are components of enzymes that cleave APP to produce amyloid beta fragments of different lengths. Alterations in the ratios of these fragments can result in insoluble amyloid leading to plaque formation. The PSEN-1 gene is located on chromosome 14 and the PSEN-2 gene on chromosome 1. The presenilins account for the majority of early onset Alzheimer's cases.
111
Late Onset Alzheimers
Only one gene has been identified for late onset cases, apolipoprotein E (APOE).
APOE is thought to be involved in the breakdown of amyloid plaques and different forms of it seem to vary in how effective they can do this. The gene is on chromosome 19 and has three alleles, APOE2, APOE3, and APOE4. The E4 variant is the risk factor for late onset Alzheimer's. People homozygous for the E4 allele have between a 10 and 30 times increased risk for Alzheimer's compared to people not carrying any E4 alleles. Heterozygotes for APOE4 have a 3 times increased risk. In addition each E4 allele lowers the age of onset by 10 years.
* APOE2 - protective
* APOE3 - neutral
* APOE4 - increases risk
112
What is genomic imprinting?
Genomic imprinting is a phenomenon by which certain genes are expressed in a parent-of-origin-specific manner. The most important example of this for the exam is Angelman and Prader-Willi.
113
Dementia praecox
Kraepelin
114
Schizophrenia
Bleuler
115
Hebephrenia
Hecker
116
Catatonia
Kahlbaum
117
Schizoaffective
Kasanin
118
Neurasthenia
Beard
119
Psychiatry
Reil
120
What is the Brief Psychiatric Rating scale?
The Brief Psychiatric Rating Scale is a common instrument used to evaluate psychopathology in patients with schizophrenia, it has now been largely replaced by the PANSS.
It is rated by a clinician and consists of 24 items, each rated out of a 7 point scale of severity. Higher score indicate greater severity of symptoms.
Ratings for several of the variables are based on observation, the remainder are assessed via a short interview.
121
Clozapine pharmacology
Clozapine has a complex pharmacology. It has antagonistic activity at the D1, D2, D3 and D4 dopamine receptors, alpha-1 and alpha-2 adrenergic, 5-HT2 serotonin, H1 histamine and M1, M2, M3 and M5 receptors, with agonist activity at the M4 muscarinic receptor.
122
What is Kluver-Bucy syndrome?
Kluver-Bucy syndrome occurs following bilateral medial temporal lobe dysfunction. The structure implicated in the etiology is the amygdala. Affected individuals display the following features:-
* Hyperorality (tendency to explore object with the mouth)
* Hypersexuality
* Docility
* Visual agnosia
* Dietary changes
The most common causes include:-
* Herpes
* Late stage Alzheimer's
* Frontotemporal dementia
* Trauma
* Bilateral temporal lobe infarction
123
What is the halo effect?
The halo effect is a cognitive bias whereby the perception of one characteristic of a person or object is influenced by the perception of another. An example would be judging a good looking person as more intelligent.
