Flashcards in Organic Psych Deck (47)
What is the function of the frontal lobe?
Suppression of primitive reflexes
What are symptoms of frontal lobe dysfunction?
Telegraphic speech: short words + sentences
Contralateral spastic hemiparesis
Reemergence of primitive reflexes e.g. Sucking
What is the function of the temporal lobe?
Auditory, olfactory and gustatory perception
Understanding speech - Wernicke's
What are symptoms of temporal lobe dysfunction?
Auditory, olfactory + gustatory hallucinations
Nonsensical fluent speech with neologisms
What is the function of the parietal lobe?
Integration of sensory perception i.e. Body awareness
Communication between Wernicke's and Broca's areas
What are the symptoms of parietal lobe dysfunction?
Contralateral sensory impairment
Contralateral sensory neglect
What is the function of the occipital lobe?
Visual perception and interpretation
What are the symptoms of occipital lobe dysfunction?
Contralateral visual defects
What is delirium?
An acute, transient state if global brain dysfunction
With clouding of consciousness
A sign that there is a physical problem
50% post op patients
70% elderly ITU patients
What are risk factors for delerium?
Pre-existing physical / mental illness
What are causes of delirium?
Trauma: head injury, burns
Infective: intracranial or systemic
Metabolic: liver failure, renal failure, electrolyte imbalance
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
How would you investigate a patient with apparent delirium?
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?
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
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
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
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
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
What is transient global amnesia?
Acute global memory loss lasting 1-24 hrs
Causes: transient ischaemia, physical or emotional stress
Patients usually >50 yrs
Anterograde and retrograde memory affected
No loss of identity
Consciousness and cognition otherwise normal
No signs of neurological disease
What is frontal lobe syndrome?
Executive dysfunction: poor judgement, poor reasoning + problem solving, poor planning + decision making
Social behaviour and personality change: irresponsible/disinhibited/innapropriate behaviour, Impulsivity, euphoric, repetitive/compulsive behaviours
Apathy: lack of motivation + initiative, decline in self care
Post traumatic amnesia
From time of head injury until normal recovery of memory
Longer the duration the greater the risk of complications
What is retrograde amnesia?
Memory loss before the head injury, from the last clear memory until the injury
Not a good predictor of outcome
Head injury and post-concussional syndrome
May follow a loss of consciousness
What are secondary forms of parkinsonism?
Drug induced: antipsychotics
Multiple cerebral infarcts
Repeated head injury
What is Parkinson's syndrome?
An idiopathic movement disorder
Degeneration of dopaminergic cells in the substantia nigra
Causes depletion of dopaminergic tracts leading to basal ganglia
Classic triad of EP symptoms: tremor, rigidity, bradykinesia
Also stooped posture, shuffling gait, mask like facies, recurrent falls
What is Parkinson's disease dementia?
80% eventually develop dementia
Linked to incr mortality, carer stress and nursing home admission
Early symptom: bradyphrenia
Distinguished from DLB as PD present before cognitive impairment
Acetylcholinesterase inhibitors can help
Psychotic symptoms in Parkinson's
Affect up to 40%
Strongest predictor of nursing home placement
Visual hallucinations are common
Management involves trying to gain a balance between too much and too little dopamine dopaminergic drugs can be slowly withdrawn or cautious doses of atypical antipsychotics tried - both may exacerbate parkinsonism
What is Wilson's disease?
AR disorder of copper metabolism
Copper deposition occurs in liver, brain, cornea and other organs
Motor disturbance: tremor, dysarthria
Psychiatric symptoms may be first sign in a young person
Treat with cheating agents
What is tertiary neurosyphillis?
Can occur if primary syphilis not adequately treated
Grandiose delusions, cognitive decline, neurological deficits
Meningovascular syphilis usually presents as delirium
What are systemic illnesses to consider in depression?
What are systemic illnesses to consider in mania?
Hypothyroidism rarely -myxoedema madness
What are systemic illnesses to consider in anxiety?
What are systemic illnesses to consider in psychosis?
What are systemic illnesses to consider in dementia?
What is multiple sclerosis?
Characterised by episodes of inflammation and demyelination at different sites and different times in the White matter tracts if the CNS.
What psychiatric condition are those with MS likely to suffer from?
Depression in 50%
High risk of suicide
Due to pain, disability or medication
Emotional lability can occur due to depression or MS
Treat like primary depression
Dementia in 60% in late stages MS
What psychiatric illness might you expect to see following stroke?
1/3 suffer from depression
Cognitive symptoms may be present relating to the pattern of brain damage
Acute intermittent porphyria
Precipitants: menstruation, alcohol, poor nutrition, drugs - OCP
Depression / delerium
Amnesia + confabulation
3 red ventricle tumour