Chapter 8. Behavior and Personality Disturbances Flashcards
Question 8-1: Which of the following are common behavioral disturbances in patients with Alzheimer's disease? A. Psychosis B. Agitation C. Aggression D. Depression E. All of the above
Answer 8-1: E.
AU of these are common behavioral disorders
in patients with AD. The behavioral
disturbances contribute to the difficulty
managing the patient at home. Whereas
cognitive changes, alone, are difficult enough,
personality and behavioral changes can make
institution a requirement for some patients.
(P86)
Question 8-2:
Depression is common in patients with AD. Which of the
following statements is NOT
true regarding depression in AD?
A. SSRIs can help depression in AT)
B. Tricyclics are the preferred antidepressants for patients with AD
C. Depression in AD is more common if there is a family history or pre-disease personal history of depression
D. Patients with depression are more likely to complain of memory loss than patients with AD
E. All are true
Answer 8-2: B.
Tricyclic antidepressants are not preferred in
AD, because their anticholinergic effects may
exacerbate confusion. SSRls are the preferred
antidepressants in patients with AD.
Depression in AD is more common if there is
a preceding history of depressive symptoms in
the patient or family. Patients with depression
are more likely to complain of memory loss
than patients with pure dementia. (P87)
Question 8-3:
Psychotic symptoms are common in Dementia with Lewy Bodies. Which of the following statements is NOT true for
psychosis in DLB?
A. The majority of patients with DLB have psychotic
symptoms
B. Psychosis in DLB is treated by most typical neuroleptics
C. Cholinesterase inhibitors are helpful for treatment of psychosis in DLB
D. Patients with DLB have clinical features of parkinsonism
Answer 8-3: B.
Psychosis is seen in the majority of patients
with DLB, and at least some psychotic
features may be seen in almost all patients.
The psychosis is not treated with typical
neuroleptics because these can greatly
exacerbate the parkinsonian symptoms.
Cholinesterase inhibitors were developed for
AD. but are helpful for patients with DLB.
and many clinicians try these agents prior to
neuroleptics. If neuroleptics are required, the
atypical neuroleptics such as quetiapine are
predominantly used. (P92)
Question 8-4: A 76-year-old female presents with progressive dementia associated with disinhibition, poor impulse control, and poor judgment. She seems unable to express normal social emotions. Which of the following conditions is the most likely diagnosis? A. Frontotemporal dementia B. Alzheimer's disease C. Huntington's disease D. Pseudodementia
Answer 8-4: A.
Frontotemporal dementia. or Pick’s disease, is
characterized by dementia plus signs of
orbitofrontal damage. These findings include
disinhibition, difficulties with judgment and
impulse control, and often difficulty
expressing emotion. (P91)
Questions 8-5 through 8-8:
For each of the clinical presentations in the
following questions, select the most likely
diagnosis from the following list.
A. Alzheimer’s disease
B. Frontotemporal dementia
C. Dementia with Lewy bodies
D. Vascular dementia
E. All of these
Question 8-5:
80-year-old man presents with progressiveementia plus signs of parkinsonism with rigidity, bradykinesia, and tremor. He has hallucinations of
children playing in the comer of the room.
Answer 8-5: C.
Dementia with lewy bodies looks like the
combination of AD and PD with dementia
with other cognitive deficits plus the
movement disorder. Hallucinations are
common, although they do not always have to
be treated. Management of DLB should not
include typical neuroleptics because they may
exacerbate the movement disorder. (P91-92)
Questions 8-5 through 8-8:
For each of the clinical presentations in the
following questions, select the most likely
diagnosis from the following list.
A. Alzheimer’s disease
B. Frontotemporal dementia
C. Dementia with Lewy bodies
D. Vascular dementia
E. All of these
Question 8-6:
54-year-old female with progressive dementia and depression. Examination is normal except for the mental status testing.
Answer 8-6:A.
This is a typical clinical presentation of AD,
even though the patient is so young. Dementia
without other clinical findings strongly
suggests AD, since most other causes of
dementia have other associated findings on
history or examination. (P86)
Questions 8-5 through 8-8:
For each of the clinical presentations in the
following questions, select the most likely
diagnosis from the following list.
A. Alzheimer’s disease
B. Frontotemporal dementia
C. Dementia with Lewy bodies
D. Vascular dementia
E. All of these
Question 8-7:
54 year-old man with dementia which has been progressive in a step-ise fashion. Has a history of diabetes and hypenension. ExaminatiOn shows incoordination of the right hand and a left upgoing plantar response. He has obvious signs of depression.
Answer 8-7: D.
Vascular dementia is associated with dementia
usually in association with signs of multifocal
neurologic disturbance. Most patients have
risk factors for vascular disease. Depression
and other behavioral disturbances are even
more common in vascular dementia than in
AD. (P91)
Questions 8-5 through 8-8: For each of the clinical presentations in the following questions, select the most likely diagnosis from the following list. A. Alzheimer's disease B. Frontotemporal dementia C. Dementia with Lewy bodies D. Vascular dementia E. All of these
Question 8-8:
A 68-year-old man presents with progressive dementia and some disinhibition. Early in the cowse, he was described as baving a propensity for sweets, which was a departure from his earlier behavior. Later, at the time of presentation, he exhibits hypersexuality.
Answer 8-8: B.
Frontotemporal dementia can be associated
with a propensity to crave sweets, though this
is not a specific finding. The hypersexuality is
also not specific, but in combination with
disinhibition suggests frontotemporal
dementia. (P89)
Questions 8-9:
Which of the following statements regarding depression in
Parkinson’s disease are true ?
1. Depression is a common accompaniment
2. Psychosis is common
3. Patients with major depression progress faster in PO than
patients without depression
4. Depression in PD is more likely with
older age of onset of disease
Select: A; 1,2,:1. B; 1,3. C = 2,4. D =4 only. E= All
Answer 8-9: A.
Depression is common in Parkinson’ s disease,
being present in up to 70% of patients. Major
depression is associated with a faster
progression of the underlying disease.
Psychosis is common, and is exacerbated by
doparninergic medications. Depression is
more likely to develop in patients with PO
who are younger, have greater cognitive
impairment, and have a family history of
depression. (P92-93)
Question 8-10:
Which of the following statements are true
regarding behavior disturbance in Huntington’s disease?
I. Depression occurs in the majority of patients
2. Depression is worst in later stages of the disease
3. Suicide is more common in HD with depression than in other neurologic diseases with depression
4. Aggression is uncommon
Select: A = 1,2,3. B = 1,3. C = 2, 4. D = 4 only. E = All
Answer 8-10: B.
Depression develops in the majority of
patients with HO, with the prevalence up to
63%. Suicide is more conunon in patients with
HD with depression than in other neurologic
disorders with depression such as stroke or
PD. Depression is worse in the begilUling and
middle phases oftbe disease, and abates as
patients progress to later stages of disease.
Behavioral difficulties such as aggression are
common, and can result in institutionalization.
(P93-94)
Question 8-11:
Which of the following psychiatric disorders are more common in patients with Tourette’s syndrome?
1. ADHD
2. Personality disorder
3. Anxiety
4. Oppositional defiant disorder
Select : A = 1, 2, 3.B = 1,3. C = 2.4. D = 4 only. E = All
Answer 8-11: E.
All of these are more likely in patients with
Tourette’s syndrome. Psychiatric
complications are common with ADHD in up
to 70% of patients. Oppositional defiant
disorder appears to be increased in incidence,
though perhaps not to a greater extent than
other children seen in a general psychiatric
population. Personality disorders are common
with up to 64% exhibiting some sort of
disorder such as borderline, obsessivecompulsive,paranoid, or passive-aggressive personality types. (P95)
Question 8-12:
Which of the following statements are true regarding behavior disturbances in Multiple
Sclerosis?
1. Depression is rare, with fewer than 20010 of patients exhibiting depression
2. Depression in MS is correlated with disease duration
3. Depression in MS is more common in females
4. Depression in MS is more likely in patients experiencing an exacerbation of MS symptoms
Select: A; 1,2,3. B = 1,3. C; 2, 4. D = 4 only. E = All
Answer 8-12: D.
Depression in MS is more likely if the patient
is having an exacerbation, probably due to a
combination of biological and psychological
factors associated with the exacerbation.
There is no consistent correlation between
depression alid disease duration, gender, age,
or socioeconomic status. Depression is very
common in patients with MS, more than in
many other neurologic diseases, and may be
present in more than 50% of patients. (P96)
Questions 8-13 through 8-15: Behavioral alterations are common in epilepsy. For each behavioral state, select whether the condition is more likely to be ictal, postictal, or interictal. A. Ictal B. Postictal C. Interictal D. Any of the above
Question 8-13:
Confusion.
Answer 8-13: H.
Confusion is most likely to occur in the
postictal state, when the patient has not
completely recovered from the seizure. (p97)
Questions 8-13 through 8-15: Behavioral alterations are common in epilepsy. For each behavioral state, select whether the condition is more likely to be ictal, postictal, or interictal. A. Ictal B. Postictal C. Interictal D. Any of the above
Question 8-14:
Depression.
Answer 8-14: D.
Depression is common in the interictal state in
patients with epilepsy, with up to 63% of
patients having some depression. Depressed
mood can be seen in the ictal and postictal
states, also. (p97 -98)
Questions 8-13 through 8-15: Behavioral alterations are common in epilepsy. For each behavioral state, select whether the condition is more likely to be ictal, postictal, or interictal. A. Ictal B. Postictal C. Interictal D. Any of the above Question 8-15: Unprovoked laughter.
Answer 8-15: A.
unprovoked laughter is an Wlconunon ictal
presentation. The laughter appears without
warning and is accompanied by more typical
ictal activity. (P97)
