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4th year psych > Organic mental disorders > Flashcards

Organic mental disorders Flashcards

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1
Q

What mnemonic is used to find features that suggest organic problems

A

FLAVOUR

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2
Q

What does FLAVOUR stand for

A

Fluctuating symptoms

Localised cognitive defecits

Assoc neuro signs

Vague/transient paranoid delusions

Olfactory/visual hallucinations

Untypical Sx functional disorder

Record of cognitive disorder before other psych sx.

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3
Q

CVA or traumatic brain injury result in which mood symptoms?

A

Depression in 1/3

Anxiety in 1/4

Increased suicide risk

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4
Q

CVA or traumatic brain injury result in which psychotic symptoms?

A

Bipolar, especially rapid cycling after TBI

Psychosis common after temporal lobe injury

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5
Q

CVA or traumatic brain injury result in which cognitive symptoms?

A

Vascular dementia from CVA

Punch drunk syndrome

Chronic cognitive impairment in 25% e.g. neglect, impaired learning, decreased attention, apraxia

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6
Q

CVA or traumatic brain injury result in which behavioural symptoms?

A

Frontal lobe injury–> disinhibition, aggression etc

Catastrophic reactions - burst of emotions. 20% post stroke.

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7
Q

Name some symptoms of post concussional symdrome

A

anxiety and depression

Irritability

Emotional lability

Insomnia

Hypersensitive to noise or light

Decreased concentration

Chronic tiredness

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8
Q

Is there any Rx for post concussion syndrome

A

No

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9
Q

The cause of epilepsy is generally _____

A

Unknown

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10
Q

15% epilepsy is caused by__?

A

Cerebral vascular disease

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11
Q

75% onset epilepsy is before ____years old

A

30

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12
Q

What is the most common epilepsy seizure type

A

Complex focal (60%) and 60% of this is from temporal lobe

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13
Q

Is there a link between epilepsy and learning disabilities?

A

YEs

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14
Q

What are the four phases surrounding an epileptic seizure?

A

Pre-ictal

Ictal

Post-ictal

Inter-ictal

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15
Q

During what phase(s) of epilepsy is depression likely to occur

A

Can occur in pre-ictal and ictal

Common in post-ictal and very common inter-ictal

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16
Q

During what phase(s) of epilepsy is psychosis likely to occur

A

It occurs post-ictally in 6-10% with hard to manage epilepsy. <1w post seizure.

If it happens recurrently post-ictally, inter-ictal psychosis can develop. Symptoms similar to schizophrenia.

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17
Q

What psych conditions are common in epilepsy in general?

A

Depression (30-50%)

Panic disorder (21%) inter or peri ictal

Psychosis (3-7%)

Cognitive impairments

Sexual dysfunction

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18
Q

depression is most likely to occur in which type of epilepsy?

A

Temporal lobe

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19
Q

Which antidepressants are least likely to lower the seizure threshold?

A

SNRIs and SSRIs.

Citalopram least likely to interact with meds

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20
Q

Can ECT be used in a person who is depressed and has epilepsy?

A

Yes

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21
Q

What type of antipsychotics should be used in pyschosis + epilepsy?

A

Least effect on seizure threshold e.g. sulpiride or haloperidol (typicals)

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22
Q

What are pseudoseizures?

A

Dissociative convulsions

Simulate real seizures but EEG is normal during

20-30% with chronic, resistant epilepsy

Often have an emotional element/precipitant. Occur when others present/at home.

Associated with childhood sexual trauma.

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23
Q

Can a tumour produce psych effects?

A

Yes, including outside the CNS due to tumour by-products

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24
Q

what is the pathophysiology in MS?

A

demyelination

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25
What are the psychiatric effects in MS?
Cognitive deficits/dementia (50%) Depression (may be due to meds) Mania (disease or drugs) Emotional and mood changes (disease process) Suicide x2
26
Are people with MS more likely to get psychosis?
No
27
What are the psychiatric effects of SLE?
Cognitive impairment Depression
28
What is the pathophysiology of Parkinson's?
Deficiency of dopaminergic activity in the striatum. Death of dopamine secreting neurones in the substantia nigra of the basal ganglia. Also lewy bodies in the remaining neurones.
29
The basal ganglia controls what?
Movement
30
Psych effects of parkinsons?
Dementia 80% after 8 years Cognitive deficits Psychosis (25%)- visual hallucinations and persecutory delusions Depression and anxiety (40%) Impulsive and compulsive behaviours (almost always due to dopaminergic therapy)
31
Parkinsons dementia is similar to what other type?
Lewy body
32
What should you bear in mind when prescribing antidepressants and antipsychotics in parkinsons?
Low risk of extrapyramidal SEs. e.g. citalopram and quetiapine.
33
Huntington's inheritance? incl which chromosome
Autosomal dominant Chromosome 4
34
Huntington's pathopysiology?
Cerebral atrophy + reduced GABA --> dopamine hypersensitivity
35
Huntington's psych changes
Cognitive decline progressing to subcortical dementia Speech deteriorates faster than comprehension does. Depression Mania Psychosis Suicide risk Apathy/irritability/aggression
36
Huntington's treatment? Can ADs and APs be normal?
Symptomatic Normal AD and APs, but preferably atypical APs as less likely to worsen Sx
37
Wilson's disease is also known as
Hepatolenticular degeneration
38
Wilson's disease pathophys?
Autosomal recessive, excess copper in lenticulate nuclei.
39
Wilson's disease Rx
Timely treatment with penicillamine usually reverses neuro sx and may help psych sx
40
Wilson's disease psych
Depression Emotional lability/personality or behav changes Poor school performance Alcohol abuse
41
Eye sign of Wilson's disease?
Kayler-Fleischer rings
42
What are hypnogogic hallucinations?
Immediately before sleep
43
In what disorder might you get hypnogogic hallucinations?
Narcolepsy
44
Rx narcolepsy?
Stimulant such as methylphenidate (ritalin) or modafinil
45
What is REM sleep behaviour disorder?
Individuals act out their dreams- risk of harm to self and others!
46
REM sleep behav disorder can be assoc with which three organic conditions?
Parkinsons LBD Guillain Barre
47
The three types of tic disorder are?
Transient Chronic vocal or motor Tourette's
48
What is transient tic disorder
Lasts up to 1yr
49
What is chronic vocal/motor tic disorder
>1yr
50
What is tourette's
Multiple motor tics + at least one vocal/phonic tic For >1yr
51
Is tourette's more common in M or F
M 3-4:1
52
tic disorders are associated with?
Learning disability ASD OCD ADHD
53
When do tic disorders normally start?
around 7y. Often begins with facial then vocal/phonic later.
54
what are examples of a simple tic
blinking, nose wrinkling, coughing
55
Examples of complex tic
Raspberries or twirling
56
Prognosis of tics
Improve in severity by age 18y but normally life long
57
What is coprolalia?
Swearing as a tic
58
What is copropraxia?
Rude gesture as a tic
59
What is echolalia/praxia?
Copying what others say or do
60
What is pralilalia?
Repeat oneself
61
What is NOSI?
Non-obscene socially inappropriate behaviour e.g. shouting 'bomb' on a plane
62
Treatment for tic disorders?
Psychoeducation for family Behaviour therapy- habit reversal training, CBIT (comprehensive behavioural intervention for tics) Meds- antipsychotics can help with tics, clonidine ± stimulants (ADHD)
63
3 psych reactions to HIV diagnosis
Acute stress reaction/adjustment disorders D/A Deliberate self harm (suicide risk increased by 20)
64
Psych common in HIV in general
Depression Acute mania/schizophrenia like psychosis can be secondary to HIV AIDS dementia (rare)
65
Why might depression be hard to diagnose in HIV?
Apathy and fatigue can be a SE of antiretrovirals
66
What is AIDS-related dementia?
Rare now Presents as a depression like illness
67
What is the link between viral encephalitis and psych?
Can occasionally present as psychosis, seizures, delirium 50% survivors have disturbed behaviour/consciousness/social adjustment. Some have chronic cognitive impairment
68
How can syphilis manifest as psych?
Tertiary syphilis- 'general paralysis of the insane' Personality changes Cog changes Dementia Depression Grandiosity
69
What is the blood test for syphilis?
VDRL
70
Treatment for syphilis?
IM penicillin
71
Prion disease is a type of ______?
Spongiform encephalopathy
72
Prion disease symptoms
Rapidly fatal dementia assoc with myoclonic jerks
73
Cause of prion disease?
85% sporadic 15% familial or v rarely iatrogenic
74
What type of prion disease normally begins with psych symptoms?
Variant (rather than classic)
75
What is acute intermittent porphyria?
Autosomal dominant Disrupted heme synthesis (HMBS mutation that codes for porphobilinogen deaminase). Porphobilinogen accumulates in cytoplasm, thought to be neurotoxic. PNS is more effected as no BBB.
76
What precipitates an attack of acute intermittent porphyria
Spontaneous or precipitated by drugs, infection, pregnancy, decreased carb intake
77
Presentation of acute intermittent porphyria
abdo symptoms Neuro Psych (delirium, depression, emotional lability, psychosis)
78
Hypothyroid, hyperthyroid and cushings can all cause which psych sx?
Depression Psychosis
79
Hyperthyroid causes what psych symptoms
Irritable Apathy Agitation Reduced appetite Disorientated
80
Hypothyroid = what psych sx
Tired Low libido Poor memory and mentally slow
81
Cushings=what psych sx
Insomnia Low libido Thought disorder
82
What are the nutritional causes of psych sx?
B12 and B1 deficiencies
83
What does B12 defic cause?
pernicious anaemia may lead to sub-acute combined degeneration of the spinal cord. Slow mental process, confusion, memory probs, intellectual impairment, depression and paranoid delusions
84
B1 defic can cause?
(thiamine) Wernicke's and Korsakoff's

4th year psych (15 decks)

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