Chapter 32 - Clinical Presentation of neuropsychiatric disorders.

Question 1

Which psychiatric disorder is characterised by ;
Body weight 15% below standard weigh, and intense fear of gaining weight, even thought the individual is clearly under weight?

Answer 1

Anorexia Nervosa. (p. 664)

Question 2

Is anorexia nervosa most frequent in male or female?

Answer 2

women are 10 to 20 times more likely to suffer from Anorexia nervosa. (p. 664)

Question 3

Are there any neurological features in Anorexia Nervosa?

Answer 3

Brain abnormalities are reported - Enlarged ventricles and decreased hippocampal voume, but this might as well be a result of the weight loss and not a cause of it. (p. 665)

Question 4

Which condition is characterised by marked impairment in social interaction (avoidance of eye-to-eye-gaze and failure to develop relationsships), as well as restricted repetitive patterns of behavior?

Answer 4

Asperger’s syndrome. (a pervasive developmental disorder) p. 665

Question 5

What are the differences between Asperger’s syndrome and autism?

Answer 5

Asperger’s syndrome has no general delay or retardation of cognitive development or language. (p. 665)

Question 6

Are there any neurological features of Asperger’s?

Answer 6

Not really. (p. 665) there might be some right hemisphere impairments.

Question 7

Which condition is characterised by being very similar to Asperger’s (the two have mostly the same traits)

Answer 7

Autism. (p. 666), It is characterised by deficits in social interaction - both in eye contact, smiling and general body language, which is also seen in the way a baby with autism behaves.

Question 8

Are there any neuropsychological or neurological features of autism?

Answer 8

Approximately 40% of children with infantile autism have IQ scores below 50-55 (this is why some consider Asperger’s to just be a high functioning (high IQ) autist.
Some autistic children demonstrate precocious talents, forexample idots savants; individuals who have exceptional memory, artistic, musical or calculating abilities. (p. 666)
Same neurological features as for Asperger’s - Not really any concluding findings.

Question 9

Which psychiatric disorder is characterised by recurrent episodes of binge eating associated with a lack of control over eating during the binge episode. The binge is usually (but not always apparently) followed by recurrent eliminatory behaviors aimed at preventing weight gain (e.g. vomiting and laxative abuse)

Answer 9

Bulimia Nervosa.

Question 10

What do you think could be the main neurological cause of Bulimia Nervosa? Hormonal disruption, altered neuro physiologi (e.g. an altered amygdala og hypothalamus) or altered neurotransmission?

Answer 10

The cycles of bingeing and purging are hypothesised to be affiliated with various neurotransmitter abnormalities, selective serotonin re-uptake inhibitors have achieved some success.
p. 667
The other two options I made up and are not described in the book.

Question 11

What is the Capgras syndrome?

Answer 11

The Capgras syndrome involves the belief that impostors have replaced people who the sufferer is emotionally close to.
It is believed that the imposters have assumed the roles of the persons they impersonate or behave like them.

Question 12

What are the neuropschyological features of Capgras Syndrome?

Answer 12

Up to 40% of the cases are associated with organic disorders ; head injury and dementia.
Right cerebral hemisphere dysfunction have frequently been reported.

Question 13

What is another word for Conversion disorder?

And what are it’s characteristics?

Answer 13

Hysteria
Diagnostic features include: Sympotoms that suggest a neurological or medical condition, psychological features are judged to be associated with the symptom, the symptom is not intentionnally produced or feigned, the symptom or deficit cannot be fully explained by a medical condition, the symptom or deficit causes clinically significant distress or impairment.

Question 14

Which psychologist did a lot of work regarding hysteria?

Answer 14

My man madafacking horny ass FREUD!

Question 15

What are the neuropsychological features of Conversion disorder?

Answer 15

None.
diagnostic criteria for conversion disorder
state that the symptom or deficit, after appropriate investigation, cannot
be fully explained by a general medical condition
(p. 669)

Question 16

What are the characteristics of Cotard Syndrome?

Answer 16

the delusion of nihilism.
Patients exhibiting this syndrome may
complain of having lost possessions, status and strength, and also internal
organs such as the heart and lungs. Patients may not only claim that they
are dead, but that corpses have replaced their bodies.

Question 17

What are the neuropsychological features of Cotard syndrome?

Answer 17

Exciting stuff!
neurological lesions have been reported in many patients
with Cotard’s syndrome.
But they are nonspecific. A right hemisphere
dysfunction. - The sufferers have a misinterpretation of abnormal perceptual
experiences in which things seem strange and unfamiliar (p. 700)

Question 18

What are the characteristics of De Clerambault’s syndrome?

Answer 18

De Clerambault’s syndrome is one of erotomania. It is a delusional disorder of the erotomanic type. The subject, usually a single woman, believes that a ‘higher status’ person is
in love with her. The target is usually inaccessible as he may be married,
or be a famous personality or public figure. The sufferer is convinced
that the object of her affection cannot be a happy or complete person
without her. (p. 671). “Stalker syndrome”

Question 19

What are the neuropsychological features of De Clerambault’s syndrome?

Answer 19

Little is known in this regard. But it has been reported to develop after brain injury in some cases! (p. 671)

Question 20

What are the characteristics of depression?

Answer 20

depression are characterised by a period of at last two weeks, which
represents a change from previous functioning associated with either
depressed mood or loss of interest or pleasure.
Atleast 5 out of 9 features from DSM-IV (p. 672).
In addition, the symptoms must not meet criteria for a
Mixed Episode, they must cause clinically significant distress and/or
impairment, are not attributable to a medical condition or drug effects
and the symptoms are not better accounted for by bereavement.
Unipolar depression (i.e. depression with no episodes of mania) is

Question 21

What are the neuropsychological features of depression?

Answer 21

Noradrenaline and serotonin abnormalities have been implicated in the
pathophysiology of depression. In addition, abnormalities of the limbic
hypothalamic pituitary adrenal axis have been the most consistent
reported neuroendocrine abnormalities. (p. 672).
(and much more)

Question 22

What are the characteristics of Dissociative Fugue (formally Psychogenic Fugue)

Answer 22

Fugue state is one of the dissociative disorders.
DSM criteria include: 1) The predominant disturbance is sudden, unexpected travel away from home or one’s customary place of work, with an inability to
recall one’s past.
2) Confusion about personal identity or assumption of a new identity.

Question 23

What are the neuropsychological features of Dissociative Fugue

Answer 23

Not anything substantial - But intervention with sodium amytal abreaction produced substantial recovery of
memory.(p. 674)

Question 24

What are the characteristics of Factitious Disorder?

Answer 24

Factitious disorder is a condition where the person acts as if he or she
has an illness by deliberately feigning or exaggerating symptoms. (samme som hypokondrier?) (p. 675)
Differentierer sig fra “malingering”, da der ikke et udefrakommende encitiment for at fake sin sygdom.

Question 25

What are the neuropsychological features of Factitious Disorder?

Answer 25

Factitious disorders are poorly understood with no consistent neuropsychological features or widely accepted explanatory neuropsychological models.

Question 26

What are the characteristics of Frégoli delusion

Answer 26

The essence of the Frégoli delusion is that the patient believes that other people are able to disguise themselves to look like anyone they wish in order to achieve some influence -usually, a sinister one. - The patient will identify a familiar person and insist that this person takes the form of a variety of others he or she comes into contact with.

Question 27

What are the neuropsychological features of Frégoli delusion

Answer 27

Atrophy is often reported. A three step neuropsychiatric explanatory model is proposed on p. 676.

Question 28

What are the characteristics of Ganser’s syndrome

Answer 28

The condition has four main features: (a) giving approximate answers; (b) psychogenic physical symptoms; (c) hallucinations; and (d) apparent clouding of consciousness. 4*4 = 17?

Question 29

What are the neuropsychological features of Ganser’s syndrome

Answer 29

a number of cases have been reported following head injury, indeed of Ganser’s original three cases, two had suffered head injury and the third was recovering from typhus fever (p. 676)

Question 30

What are the characteristics of Kluver-Bucy Syndrome

Answer 30

This syndrome is a rare neurological disorder that causes individuals to engage in a number of inappropriate behaviours (e.g. putting objects in their mouth and engaging in inappropriate sexual behaviour). Other symptoms can include visual agnosia, loss or normal fear and anger responses, memory loss, distractibility, seizures and dementia(p. 677)

Question 31

What are the neuropsychological features of Kluver-Bucy Syndrome

Answer 31

Kluver-Bucy syndrome is a behavioural disorder that occurs following damage to right and left medial temporal lobes of the brain. The amygdala has been particularly implicated in the pathogenesis of this syndrome.

Question 32

What are the characteristics of Malingering

Answer 32

Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution or obtaining drugs

Question 33

What are the neuropsychological features of Malingering?

Answer 33

None neurological obviously. But psychological features are many, explained on p. 678 to be beyond the scope of the review.

Question 34

What are the characteristics of Munchhausen’s syndrome

Answer 34

Munchhausen’s syndrome is a factitious disorder (i.e. a condition characterised by physical or psychological symptoms that are intentionally produced or feigned). Physical or mental illness is simulated with the objective of assuming the ‘sick role’ of a patient.

Question 35

What are the neuropsychological features of Munchhausen’s syndrome

Answer 35

No neurological features. Munchhausen is a poorly understood phenomenon, with no consistent neuropsycho-logical features or widely accepted explanatory neuropsychological models.

Question 36

What are the characteristics of Obsessive Compulsive Disorder (OCD)

Answer 36

Obsessive/Compulsive Disorder (OCD) is characterised by the presence of obsessions or compulsions..

Question 37

What are the neuropsychological features of Obsessive Compulsive Disorder (OCD)

Answer 37

Brain imaging findings have suggested that abnormalities in the orbitofrontal cortex and caudate nucleus may be common in OCD (Insel and Winslow, 1992). Cognitive abnormalities often include executive, nonverbal and praxic deficits in OCD,

Question 38

What are the characteristics of Othello syndrome

Answer 38

The Othello syndrome is one of delusional jealousy where the person is convinced (without due cause) that his or her spouse or partner is unfaithful.

Question 39

What are the neuropsychological features of Othello syndrome

Answer 39

``` Organic disorders (e.g. head injury) have been suggested as being present in up to 20% of such cases, often involving right hemisphere damage. In addition, drug abuse (e.g. amphetamine and cocaine) can often precipitate delusional jealousy. (p . 680) ```

Question 40

What are the characteristics of Post-traumatic Stress Disorder?

Answer 40

PTSD is a condition where exposure to an intense frightening emotional experience leads to lasting changes in behaviour, affect and cognition

Question 41

What are the neuropsychological features of Post-traumatic Stress Disorder

Answer 41

intrusive distressing memories of the traumatic event. is also often associated with marked impairments in learning and memory for new material. (p. 681)

Question 42

What are the characteristics of Reduplicative paramnesia

Answer 42

Reduplicative paramnesia is a clinical condition where a patient states that there are two or more places with almost identical attributes, although only one exists in reality.

Question 43

What are the neuropsychological features of Reduplicative paramnesia

Answer 43

The majority of cases described in the literature suffer from a bilateral frontal lesion associated with lesions in other brain areas.

Question 44

What are the characteristics of Schizophrenia

Answer 44

Currently, the DSM-IV system requires two or more of the following symptoms: delusions, hallucinations, disorganised speech, disorganised or catatonic behaviour or negative symptoms. - accompanied by social/occupational dysfunction, continuous signs of disturbance which persists for at least six months

Question 45

What are the neuropsychological features of Schizophrenia

Answer 45

ventricular enlargement in CT | scans in patients with schizophrenia versus controls + A lot of hypothesis (Dopamine hypothesis) (p. 683f)

Question 46

What are the characteristics of Somatoform disorders

Answer 46

Somatoform disorders share the common feature of the presence of a physical symptom that suggests an underlying general medical condition but the symptom is not fully explained by a general medical condition, and the symptoms cause clinically significant distress or impairment. - Same as malingering but NOT intentional.

Question 47

What are the neuropsychological features of Somatoform disorders

Answer 47

There is little consistent evidence regarding neuropsychological abnormalities in the somatoform disorders. (p. 686)

Question 48

What are the characteristics of Tourette syndrome

Answer 48

Tourette syndrome involves multiple motor and one or more vocal tics e.g. shouting profanities.

Question 49

What are the neuropsychological features of Tourette syndrome

Answer 49

Visuo-motor difficulties are common in Tourette’s disorder and abnormal, non-specific EEG findings are also common (Robertson 1989). CT brain scan studies suggest that approximately 10% of those with Tourette’s have non-specific abnormality, with the cingulate gyrus and basal ganglia (p. 686f)