Psychiatric aspects of neurological diseases Flashcards
(116 cards)
1
Q
Usual age of onset of symptoms of MS
A
20-40
2
Q
Lifetime risk of MS in the UK
A
1 in 8000
3
Q
Male:Female ratio of MS
A
1:2
4
Q
Percentage of patients with MS who show a primary progressive course
A
5-10%
5
Q
Percentage of patients with MS who show a relapsing remitting course
A
20-30%
6
Q
Percentage of patients with MS who show a relapsing remitting course initially and then a secondary progressive phase
A
60%
7
Q
Lifetime prevalence of depression among patients with MS
A
40-50%
8
Q
MS related drugs which can cause depression
A
Steroids (most likely)
Baclofen
Dantrolene
Tizanidine
Beta interferon - controversial link (Interferon alpha which is not used for MS is clearly linked to depression)
9
Q
Percentage chance of triggering a relapse if ECT is used for depression in MS
A
20%
10
Q
Percentage of patients with MS with suicidal ideation
A
30%
11
Q
Percentage of patients given steroids who develop mild/moderate mania
A
33%
12
Q
Area of brain where lesions are often seen in patients with MS who become psychotic
A
Bilateral temporal horn areas
13
Q
Medication which has been shown to improve cognitive function in patients with MS related cognitive impairment
A
Donepezil
14
Q
Most common psychiatric symptom following stroke
A
Depression
15
Q
Brain areas of stroke most commonly associated with post-stroke depression
A
Left basal ganglia
Left frontal lobe
16
Q
Antidepressants with good evidence for post-stroke depression
A
Fluoxetine
Citalopram
17
Q
Percentage of patients with epilepsy who have depression
A
30-50%
18
Q
Percentage of patients with epilepsy who have panic disorder
A
20%
19
Q
Percentage of patients with epilepsy who have psychosis
A
3-7%
20
Q
Type of epilepsy most associated with depression
A
Temporal lobe epilepsy
21
Q
Anti-epileptic drug associated with developing psychosis
A
Vigabatrin
22
Q
Features consistent with pseudo-seizures rather than seizures
A
More likely to happen in the daytime or with others present
Less likely to sustain injuries
Side to side head movements
Prolonged seizures
Eyes kept tightly shut
Maintaining of body tone
Rapid recovery post-seizure
Ability to recall events
Crying or emotional displays
Normal post-ictal lactate and prolactin
23
Q
Percentage of patients with Parkinson’s disease who have depression
A
40-50%
24
Q
Percentage of patients with Parkinson’s disease who have euphoria
A
10%
25
Percentage of patients with Parkinson's disease who have anxiety
50-65%
26
Percentage of patients with Parkinson's disease who have psychosis (including drug related)
40%
27
Percentage of patients with Parkinson's disease who have cognitive impairment without a dementia diagnosis
19%
28
Risk factors for Parkinson's disease associated depression
Female sex
Young onset
Bradykinesia and gait abnormalities
Rapid disease progression
Cognitive impairment
29
Psychiatric symptoms associated with levodopa
Mania
Pathological gambling
Hypersexuality
Hallucinations
30
Percentage of patients with Parkinson's disease who experience hallucinations
20%
31
Most common modality of hallucinations in Parkinson's disease
Visual
32
Drugs most often used to treat Parkinson's disease associated hallucinations
Low dose clozapine
Quetiapine
33
Drug most often used for Lewy Body Dementia, often seen with Parkinson's disease
Rivastigmine
34
Pattern of dominance of Huntington's disease
Autosomal dominant
35
Prevalence of psychiatric symptoms at the first presentation of Huntington's disease
30%
36
Percentage of patients with Huntington's disease where schizophreniform psychosis is the first presentation
3-6%
37
Increased risk of suicide among patients with Huntington's disease compared to the general population
4x higher
38
Triplet repeat seen in Huntington's disesae
CAG
39
Chromosome associated with Huntington's disease
4
40
Number of CAG repeats where full penetrance for Huntington's disease is seen
41
41
Number of CAG repeats where partial penetrance for Huntington's disease is seen
36-40
42
Percentage of patients with Wilson's disease with a psychiatric first presentation
20%
43
Percentage of patients with Wilson's disease with cognitive impairment
25%
44
Percentage of patients with Wilson's disease with depression
30%
45
Percentage of patients with Wilson's disease with neurological involvement who have Kayser-Fleischer rings
95%
46
Percentage of patients with Wilson's disease without neurological involvement who have Kayser-Fleischer rings
50-60%
47
Features of transient global amnesia
Abrupt onset
Anterograde amnesia during the attack
Normal conscious level
No focal neurological signs
Attack resolves within 24 hours
48
Length of time episodes of transient global ischaemia last
6-24 hours
49
Pathology in Fahr's disease
Idiopathic calcium deposition in the basal ganglia
Hypointensity of the striatum
50
Features of Fahr's disease in patients aged 20-40
Psychosis
Catatonia
Renal stones and polyuria
51
Features of Fahr's disease in patients aged 40-60
Dementia
Choreoathetosis
Renal stones and polyuria
52
Most common identified cause of viral encephalitis
Herpes simplex encephalitis
53
Most common type of herpes simplex encephalitis
Herpes simplex type 1
54
Features of herpes simplex encephalitis
Sudden onset confusion, memory impairment
Seizures
Depression
Psychosis
Fever
55
Gold standard investigation for herpes simplex encephalitis
CSF PCR for herpes viruses
56
Untreated fatality rate of herpes simplex encephalitis
70%
57
Treated fatality rate of herpes simplex encephalitis
20-30%
58
Most common cause of Kluver Bucy syndrome
Herpes simplex encephalitis
59
Area of brain damage in Kluver Bucy syndrome
Bilateral temporal lobe damage
60
Features of Meige syndrome
Repetitive chin thrusting and blinking
Symptoms disappear with sleep
Symptoms present at rest and when active
61
Peak age of brain injury
15-24
62
Two types of amnesia associated with head injury
Post traumatic amnesia
Retrograde amnesia
63
Features of post traumatic amnesia following head injury
Anterograde amnesia
Includes the time of the injury and all the time following until normal memory resumes
64
Features of retrograde amnesia following head injury
Dense amnesia just prior to the head injury
Usually lasts minutes
65
Clinical result usually used to assess severity of a head injury
GCS at 24 hours
66
Length of time of post traumatic amnesia associated with mild traumatic brain injury
Less than 60 minutes
67
Length of time of post traumatic amnesia associated with moderate traumatic brain injury
1-24 hours
68
Length of time of post traumatic amnesia associated with severe traumatic brain injury
1-7 days
69
Length of time of post traumatic amnesia associated with very severe traumatic brain injury
>7 days
70
Most common long term psychiatric feature of traumatic brain injury
Depression
71
Area of brain injury associated with a schizophrenia like psychosis
Left temporal
72
Area of brain injury associated with mania
Right temporal
Right orbitofrontal
73
Severity of brain injury associated with post-concussion syndrome
Mild to moderate
74
Inability to identify or draw objects using visual clues
Apperceptive visual agnosia
75
Inability to name or use objects, despite the ability to draw them
Associative visual agnosia
76
Type of tremor which is amplified as an object is reached
Intention/cerebellar tremor
77
Cognitive deficits commonly seen in patients with post-concussion syndrome
Attention deficit
Impaired processing speed
78
Core symptoms of post-concussion syndrome
Headache
Memory impairment
Insomnia
79
Common features of vascular depression
Anhedonia
Psychomotor retardation
Lack of insight
Lack of feelings of guilt seen in other types of depression
80
Antidepressants with the best evidence for use in post-stroke depression
Nortriptyline
Fluoxetine
81
Type of facial nerve palsy with forehead sparing
Upper motor neurone
82
Type of facial nerve palsy without forehead sparing
Lower motor neurone
83
Neurological condition associated with B12 deficiency anaemia
Subacute combined degeneration
84
Increased suicide rate in patients with Huntington's disease compared to the general population
4x higher
85
Features of Ganser syndrome
Approximate answers
Clouding of consciousness
Hallucinations
Pseudo hallucinations
Motor disturbance
Anxiety
Apathy
Amnesia
86
Medication used to treat pathologic crying commonly seen after stroke
Citalopram
87
Imaging finding associated with Huntington's disease
Caudate atrophy
88
Imaging finding associated with Pick's disease
Knife blade gyri
89
Imaging finding associated with vascular dementia and age related changes
Multiple white matter hyperintensities
90
Imaging finding associated with variant CJD
Pulvinar sign
91
Features of Kluver-Bucy syndrome seen in herpes simplex encephalitis
Emotional blunting
Hyperphagia
Visual agnosia
Sexually inappropriate behaviour
92
Cause of primary Meige's syndrome
Idiopathic
93
Demographic most commonly affected by Meige's syndrome
Middle aged women
94
Poor prognostic factors for psychiatric morbidity after head injury
Long period of post traumatic amnesia
Long period of LOC
Older age
Chronic alcohol use
95
Length of time antidepressant treatment should be continued after post-stroke depression
6 months
96
Mean duration of post-stroke depression symptoms
34 weeks
97
Type of memory that remains intact in amnestic disorders
Immediate memory
98
Antipsychotic which is particularly prone to causing seizures and should be avoided in patients with epilepsy
Clozapine
99
Percentage of patients with open head injury who develop post-traumatic epilepsy
30%
100
Percentage of patients with closed head injury who develop post-traumatic epilepsy
5%
101
Time frame after a seizure when prolactin levels must be taken to investigate for true seizure activity
Within 15 minutes
102
Part of chromosome 4 associated with Huntington's disease
Short arm
103
Risk factors for Parkinson's disease associated dementia
Older patients
Late onset disease
Low SES
Low education
Severe EPSEs
104
Lifetime risk of suicide in Huntington's disease
10-15%
105
Most common behavioural change seen in patients with Huntington's disease
Lack of initiative
106
Drug of choice to minimise risk of seizures in patients on clozapine therapy
Sodium valproate
107
First generation antipsychotic most likely to cause seizures
Chlorpromazine
108
Features of Creutzfeldt-Jakob disease
Rapidly progressive dementia
Myoclonus
Hallucinations
Ataxia
Gait changes
109
Features of neuroacanthocytosis
Lurching gait with long strides
Quick, involuntary knee flexion
Seizures
Cognitive impairment
110
Percentage of patients with Parkinson's disease who have dementia
40%
111
Percentage of patients who have delirium in the week after a stroke
30-40%
112
Syndrome with visual hallucinations in the context of visual impairment and without psychotic symptoms
Charles Bonnet syndrome
113
Eye condition most commonly associated with Charles Bonnet syndrome
Macular degeneration
114
Most common mental illness in patients with MS
Depression
115
More common direction of falls in PSP
Backwards
116
More common direction of falls in Parkinson's disease
Forwards
