Psychiatric Presentations of Neurological Disease

Question 1

What is an organic disorder?

Answer 1

disorder with underlying physical cause

Question 2

What are some of the ways an organic and psychiatric disorder can be differentiated?

Answer 2

• psychiatric often have early onset (teens, early 20’s)
• drugs
• family history of mental illness
• confusion

Question 3

What is Wernicke-Korsakoff syndrome?

Answer 3

• Thiamine B1 deficiency that occurs in chronic alcohol abuse

Question 4

What are the symptoms of Wernicke-Korsakoff syndrome?

Answer 4

Wernickes encephalopathy (reversible)
- Opthalmoplegia (weakness of extra ocular muscles)
- ataxia 
- confusion 
Kosakoff syndrome (only occurs if not treated)
- memory impairment 
- no other cognitive problems 
- confabulation

Question 5

How is Wernicke-Korsakoff syndrome managed?

Answer 5

High dose IV Thiamine

Abstinence from alcohol

Question 6

What is delirium?

Answer 6

• acute onset confusional state, disordered perception and memory
• can be misdiagnosed as dementia

Question 7

What are some of the causes of delirium?

Answer 7

• infections like sepsis
• Trauma
• CNS disease
• Hypoxia
• Vitamin deficiencies
• Drugs
  (more common in elderly)

Question 8

What are the possible reversible causes of dementia?

Answer 8

• hypothyroidism
• Wilsons disease
• HIV
• B12 & folate deficiency
• Systemic illness (LFT & U&Es)
• syphilis (VDRL test)

Question 9

How to distinguish between dementia and delirium?

Answer 9

• dementia slower onset
• very short attention span in delirium
• dementia constant, delirium fluctuates
• disrupted sleep in delirium, dementia normal
• Hallucinations can happen in late stage dementia but common in delirium

Question 10

What are the symptoms of temporal lobe epilepsy?

Answer 10

Seizure with:

• aura
• deja-vu
• stomach upset
• fear or panic
• strange smell

Question 11

What are common causes of temporal lobe epilepsy?

Answer 11

• febrile seizures

- brain injury

Question 12

What are the types of Temporal lobe epilepsy?

Answer 12

• Mesial temporal lobe epilepsy (medial or internal structures of temporal lobe)
• Neocortical or lateral temporal lobe epilepsy (outer part of temporal lobe)

Question 13

What are the treatments for temporal lobe epilepsy?

Answer 13

AED (less effective)
Neurostimulation
Temporal lobectomy

Question 14

What is Post-ictal psychosis?

Answer 14

• period of psychosis after a temporal lobe seizure

- more common in people who have had epilepsy for long Time

Question 15

How is post-ictal psychosis managed?

Answer 15

benzodiazepine + antipsychotic

consider antipsychotic long term if recurrent

Question 16

What is anti-NMDA receptor encephalitis?

Answer 16

type of encephalitis which presents with psychiatric symptoms

Question 17

How is anti-NMDA receptor encephalitis diagnosed?

Answer 17

EEG + CSF autoantibodies

Question 18

How common is Parkinson’s psychosis?

Answer 18

50% of those with Parkinson’s (more common in those with longer duration illness)

• primarily sense of presence
• not usually delusions

Question 19

How is Parkinson’s psychosis treated?

Answer 19

• reduce or stop anti-parkinson medication
• possibly antipsychotics (clozapine has least motor side effects)
• acetylcholinesterase inhibitors

Question 20

What are the most common mental health disorders that occur in stroke patients?

Answer 20

• Depression
• Anxiety
  (can be due to brain injury and also psychological impact)

Question 21

What are the most common mental health disorders that occur in epilepsy patients?

Answer 21

Mood/affective disorders
anxiety disorder
psychosis
suicide

Question 22

What are the most common mental health disorders that occur in MS patients?

Answer 22

Depression
Bipolar 
Anxiety 
Suicide 
Psychosis 
(MS meds: beta interferon and corticosteroids can have impact on mental health)