Organic Psych Flashcards
(47 cards)
What is the function of the frontal lobe?
Executive function Personality/social behaviour Initiative/motivation Speech production Suppression of primitive reflexes
What are symptoms of frontal lobe dysfunction?
Poor judgement/planning Inappropriate behaviour/impulsivity Apathy Expressive dysphasia Telegraphic speech: short words + sentences Normal comprehension Contralateral spastic hemiparesis Reemergence of primitive reflexes e.g. Sucking Forced utilisation
What is the function of the temporal lobe?
Auditory, olfactory and gustatory perception
Understanding speech - Wernicke’s
Memory
Emotional regulation
What are symptoms of temporal lobe dysfunction?
Auditory impairment/agnosia
Auditory, olfactory + gustatory hallucinations
Receptive dysphasia
Nonsensical fluent speech with neologisms
Amnesiac syndrome
Lability
What is the function of the parietal lobe?
Somatosensory perception
Integration of sensory perception i.e. Body awareness
Communication between Wernicke’s and Broca’s areas
Calculation
What are the symptoms of parietal lobe dysfunction?
Contralateral sensory impairment Apraxis Agnosias Contralateral sensory neglect Receptive dysphasia Dyscalculia
What is the function of the occipital lobe?
Visual perception and interpretation
What are the symptoms of occipital lobe dysfunction?
Contralateral visual defects
Visual agnosia
Cortical blindness
What is delirium?
An acute, transient state if global brain dysfunction With clouding of consciousness A sign that there is a physical problem Common: 20% inpatients 50% post op patients 70% elderly ITU patients
What are risk factors for delerium?
Old age Pre-existing physical / mental illness Substance misuse Polypharmacy Malnutrition
What are causes of delirium?
Trauma: head injury, burns Hypoxia: cardio/resp Infective: intracranial or systemic Metabolic: liver failure, renal failure, electrolyte imbalance Endocrine: hypoglycaemia Nutritional: Wernicke's encephalopathy CNS: incr ICP Drugs and alcohol: intoxication/ withdrawal Medication: anticholinergics + opiates
What is the clinical picture in delirium?
Sudden onset of confusion: hrs- days Fluctuation of symptoms Worse at night? Name Disorientation, poor attention and short term memory Prominent mood changes Illusions/ hallucinations/ delusions Thought disorder, speech disorder Disturbed sleep Hyper/hypo activity
How would you investigate a patient with apparent delirium?
Physical examination Collateral history Drug chart: recent addition? Bloods: FBC, U&Es, G, Ca MSU, SaO2, ECG, CXR, septic screen Consider: LFTs, blood cultures, CT head, CSF, EEG
How is delirium managed?
Treat cause!
Manage aggravating factors e.g. Dehydration, pain, constipation, polypharmacy
Behavioural management: frequent reorientation, good lighting, address sensory deficit, avoid over/understimulation, minimise change, remove objects dangerous to patient or others, allow safe/ supervised wandering
Medication: small nocturnal dose of benzo
If sedation necessary, low dose atypical antipsychotics/ benzos
What is the prognosis with delirium?
Recovery following resolution of underlying cause May take weeks or up to 6 months Associated with: Increased mortality Longer admission Higher readmission rates Higher nursing home placement
What are the functions of the following areas of the brain? Broca and Wernicke's areas Primary motor cortex Supplementary motor cortex Primary somatosensory cortex Primary visual cortex
Broca’s = expression of speech
Wernicke’s = comprehension of speech
Primary motor= contralateral movement
Supplementary motor= organisation of complex movement
Primary somatosensory= perception of contralateral somatosensory stimuli
Primary visual = vision
What is frontotemporal lobar degeneration?
Asymmetrical frontal / anterior lobe atrophy 40-60 yrs
Pick’s disease: rounded collections hyperphosphorylated tau
FTLD-U: tau negativ ubiquinated inclusions
Clinically:
Frontotemporal dementia: frontal lobe syndrome, disinhibition etc
Semantic dementia: progressive loss of understanding if verbal + visual meaning
Progressive non-fluent aphasia: naming difficulties -> mutism
What is Huntingdon’s disease?
AD, trinucleotide CAG repeat in Huntingdin gene Chr 4 with anticipation, death within 15 yrs
Deposits of abnormal Huntingdin protein -> atrophy of basal ganglia + thalamus and cortical neuron loss
CT/MRI: caudate nucleus atrophy
EEG: flat
What are the clinical manifestations of Huntingdon’s?
Personality and behavioural changes:
Depression, irritability, euphoria
Subcortical dementia later: bradyphrenia, bradykinesia etc
Chorea: affects limbs, trunk, face, speech muscles, wide based lurching gait
HIV dementia/ encephalopathy
Affects 10%
Early apathy + withdrawal
Sub cortical dementia
Neuro features incl: ataxia, tremor, seizures, myoclonus
MRI: atrophy + diffuse white matter signal changes
What is normal pressure hydrocephalus?
Rare potentially reversible cause of dementia
Causes: meningitis, head injury, idiopathic
Impaired CSF absorption in subarachnoid space
CSF accumulates in the ventricles, production adjusts so pressure remains fairly normal
Distortion of peri ventricular white matters
Subcortical dementia, unsteady gait, urinary incontinence
What is the protein only hypothesis re,aged to prion disease?
Normal prion protein changes to an abnormal insoluble form
Which then appears to act as a template for changing further proteins
What are prion diseases?
Transmissible spongiform encephalopathies
What is amnesic syndrome?
Profound anterograde memory loss: inability to lay down new memories
Patients may confabulate
Procedural memory intact
Due to damage of limbic structures dealing with explicit memory
Causes: hypoxia, encephalitis, CO poisoning
Korsakoff’s syndrome is most common
