B7.073 Psychiatric Symptoms and Signs in Neurologic Disease

Question 1

delusions

Answer 1

beliefs maintained steadfastly even in the face of evidence contradicting them incontrovertible

Question 2

hallucinations

Answer 2

perceptions occurring in the absence of corresponding external or somatic stimuli

Question 3

psychosis

Answer 3

hallucinations or delusions
without insight into pathologic nature
impaired reality testing

Question 4

clear sensorium

Answer 4

alert
attentive
oriented
-if a patient has a clear sensorium, psychosis is likely psychiatric

Question 5

visual hallucinations

Answer 5

neurologic

Question 6

auditory hallucinations

Answer 6

psychiatric

Question 7

dementia

Answer 7

progressive cognitive impairment involving multiple cognitive domains interfering with function

• visual spatial skills
• executive function
• short term memory
• visual hallucinations

Question 8

dementia in DLB

Answer 8

early impairment = attention, exec function, and visual spatial ability
memory often not affected early but will develop memory impairment over time

Question 9

other features (non-dementia) of DLB

Answer 9

fluctuating cognition (pronounced variation in attention and alertness)
recurrent visual hallucinations
REM sleep behavioral disorder
features of parkinsonism

Question 10

neuropathologic changes in DLB

Answer 10

widespread limbic and cortical lewy bodies
aggregates of a-synuclein that involve the brainstem as well as cortical regions
loss of dopaminergic neurons in the substantia nigra
loss of cholinergic neurons in ventral forebrain nuclei

Question 11

dopamine blocker sensitivity in DLB

Answer 11

loss of dopaminergic neurons
triggers or exacerbations in parkinsonism may be irreversible
increased risk of neuroleptic malignant syndrome
affects cognition and impairs attention and alertness

Question 12

cognitive management of DLB

Answer 12

cholinesterase inhibitors (may worsen parkinsonism)
rivastigmine
donepezil
memantine

Question 13

psychosis management of DLB

Answer 13

atypical antipsychotics with the least EPS side effects

avoid typicals as they will worsen parkinsonism

Question 14

management of parkinsonism in DLB

Answer 14

carbidopa/levodopa (can worsen hallucinations and confusion)

avoid dopamine agonist

Question 15

rapidly progressive dementia

Answer 15

dementia developing over < 1 year

Question 16

what is CJD

Answer 16

rare sporadic disease characterized by brain prion protein crystallization
rapidly progressive dementia associated with other neurologic signs including myoclonus
death usually within 6 months of onset

Question 17

types of CJD

Answer 17

sporadic
hereditary
variant

Question 18

MRI findings in CJD

Answer 18

restricted diffusion

subcortical gray and cortical gray

Question 19

CSF findings in CJD

Answer 19

14-3-3 proteins

• family of regulatory proteins
• elevated amounts found in CSF
• proteins spill into CSF with rapid neuronal death

Question 20

what is RT-QuIC

Answer 20

real time quaking induced conversion

• detection of prion in CSF
• more specific

Question 21

perceptual symptoms of schizophrenia

Answer 21

delusions

halucinations

Question 22

executive symptoms of schizophrenia

Answer 22

disorganized speech

gross disorganized behavior

Question 23

findings in anti-NMDA encephalitis

Answer 23

high protein on CSF
teratoma on abdominal ultrasound
NMDA receptor Ab (1:80) in serum and (1:5) in CSF

Question 24

clinical course of anti-NMDA encephalitis

Answer 24

1. viral prodrome
2. psych symptoms
3. neuro complications
4. prolonged deficits

Question 25

psych symptoms in anti-NMDA

Answer 25

``` delusions hallucinations mania agitation changes in speech disorganization ```

Question 26

neuro complications in anti-NMDA

Answer 26

movement abnormalities dysautonomia hypoventilation seizures

Question 27

prolonged deficits associated with anti-NMDA

Answer 27

exec dysfunction impulsivity disinhibition sleep abnormalities

Question 28

treatment of anti-NMDA

Answer 28

1. removal of underlying antigen: teratoma 2. corticosteroids 3. plasma exchange, or IVIg 4. other immunosuppressants