EMQ Exam Flashcards
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What is Cotard Syndrome?
- Cotard’s syndrome is named after Jules Cotard, a French neurologist who described the condition in 1880.
- It is a syndrome whose central feature is nihilistic delusions.
- The most prominent features of Cotard’s syndrome are depressive mood (89%), nihilistic delusions concerning one’s own body (86%), nihilistic delusions concerning one’s own existence (69%), anxiety (65%), delusions of guilt (63%), delusions of immortality (55%) and Hypochondriacal delusions (58%).
- Also known as Délire de négation.
Is Somatisation or Hypochondriasis in the DSM V?
No.
Somatic symptom disorder in DSM -V. Somatoform disorders are now referred to as somatic symptom and related disorders. Diagnoses of somatisation disorder, hypochondriasis , pain disorder and undifferentiated somatoform disorder have been removed
What is body dysmorphic disorder?
for DSM 5 - repetitive behaviours or mental acts in response to pre-occupations with perceived defects or flaws in physical appearance.
Also has muscle dysmorphia
The delusional variant - It is no longer coded as b under delusional disorder but now under BDD without insight
What is found on the EEG of a patient with CJD?
Periodic 1-2 Hz sharp wave complexes - characteristic of CJD
Myoclonic jerks are also a frequent occurence
Sporadic vs Variant CJD? - which one presents with psychiatric symptoms initially?
Variant CJD
What sign can be seen on an MRI with Variant CJD
Pulvinar sign
- Hyperintensity on the thalamus
Which screening test is not sensitive in picking up Frontal Lobe abnormalities?
MMSE
Fronto-temporal dementia has an intact parietal lobe - therefore MMSE is usually normal
What shows on the MRI for Vascular dementia?
Deep White matter Hyperintensities.
Vascular dementia - What are the 4 broad categories ?
Multi-infarct dementia
Small vessel Disease
Post Stroke Dementia
Specific Vascular Dementia Syndromes (E.g CADASIL)
What is the Hachinski index? and what does it differentiate?
Vascular dementia vs Alzheimers disease.
- Abrupt onset
- stepwise deterioration
- fluctuating course
- focal neurological
Hachinski Ischemic Scale
Feature Value Abrupt onset 2 Stepwise deterioration 1 Fluctuating course 2 Nocturnal confusion 1 Relative preservation of personality 1 Depression 1 Somatic complaints 1 Emotional incontinence 1 History or presence of hypertension 1 History of strokes 2 Evidence of atherosclerosis 1 Focal neurological symptoms 2 Focal neurological signs 2
Patients scoring 7 or greater are classified as having “multi-infarct dementia”, and patients scoring = 4 are classified as having “primary degenerative dementia”. A score of 5 or 6 is considered as an intermediate value and is usually designated as “mixed dementia”.
signs
Neuroimaging on Multi-infarct dementia?
cerebral atrophy
old and recent infarcts
Findings on Neuroimaging in Small Vessel Disease?
2 cardinal features:
- White matter lesions ( appear as periventricular lucency - leucoaraiosis) or as Deep white matter hyperintensities and central grey matter lacunae
Findings on Neuroimaging in CADASIL - Cerebral Autosomal Dominant Arteriopathy with subcortical infarcts and Leukoencephalopathy
Presents with MIGRAIN and Recurrent subcortical infarcts, TIA and affective disturbance
Mutations on the NOTCH3 gene on Chromosome 19
MELAS
Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke like episodes
Usually presents in childhood due to mutation in the mitochondrial transfer RNA
Wernickes Encephalopathy - eye signs
Lateral rectus palsy due to Abducens Nerve - characteristic of Wernickes
Neurosyphilis - eye signs
Argyll Robertson pupil
Pupil that is slow to accommodate or where accommodation reflex is present - characteristic of Neurosyphilis
What psychotic symptoms can retroviral medications cause?
Psychosis and hallucinations
Urine osmolality in SIADH
Increased Urine osmolality - due to increased ADH secretion and loss of Sodium and subsequent Hypo Na
Psychogenic Polydipsia
complication of Schizophrenia
Low Urine osmolality due to dilute urine
Ventromedial hypothalamus is in control of ?
Satiety
- ie. hyperphagia and obesity
Lateral Hypothalamus
centre for feeding
Which area of the brain is responsible for apathy?
Medial frontal lobe
What is the eponymous name for damage to the DOMINANT PARIETAL LOBE?
Gerstmanns syndrome
Agraphia
Acalculia
Left- Right Disorientation
Finger agnosia
What is damaged in Korsakoff’s syndrome?
Mamillary Bodies
Causes:
Anterograde and Retrograde Amnesia
What is Klinefelter Syndrome and what are the signs
47 XXY
Male hypogonadism
90% have scant facial hair and gynaecomastia occurs in 50% of patients.
6.5% of patients with Klinefelters will have a psychotic disorder including schizophrenia and bipolar disorder
What is Turners Syndrome and the signs
45 XO
- female partly or completely missing an X chromosome.
signs: Short stature non functioning ovaries Webbed neck lymphoedema of hands and feet high BP and kidney problems
Androgen Insensitivity Syndrome (Testicular feminisation syndrome)
X linked disorder
Receptors are unresponsive to Testosterone
Despite normal levels of testosterone - fails to develop as Male
Secondary sex characteristics are female due to Testosterone to Oestrogen Aromatisation
Can operate with gonadectomy and provide hormones to raise as female
What are McNaughtons Rules?
- Every man is to be presumed to be sane and to possess a sufficient degree of reason to be responsible for his crimes, until the contrary be proved.
- An insane person is punishable “if he knows” at the time of crime.
- To establish a defense on insanity, the accused, by defect of reason or disease of mind, is not in a position to know the nature and consequences.
- The insane person must be considered in the same situation as to responsibility as if the facts with respect to which the delusion exists were real.
- It was the jury’s role to decide whether the defendant was insane.
What is Duress?
Legal defence
A Person acts under duress and therefore involuntarily, if that persons actions were performed because of threats (express or implied) of death or really serious injury to himself/herself/dependents being threats of such a nature that a person of ordinary firmness and strength of will, that is a person of the same maturity and sex as the accused person
What is Provocation
Legal Defence
Act is the result of a loss of self control on the part of the accused that was induced by any conduct of [the deceased] towards or affected the accused
What is Othellos Syndrome?
Morbid jealousy
Delusion of Infidelity
Referential delusion?
A neutral event believed to have a special or personal meaning
Autochthonous delusion?
a.k.a Wahneinfall delusion
” Out of the blue” delusion
arise as suddenly formed intuitions and occur in a single stage.
Delusional perception?
Occurs in two stages
1) real perception
2) delusional interpretation
Delusional Mood?
Strange, uncanny mood in which the environment appears to be changed in a threatening way but the significance of the change cannot be understood by the patient who is tense, anxious and bewildered
Nihilistic delusions
Feelings of guilt, death, and hypochondriacal ideas are extreme
Delusional Memory
patient recalls as remembered an event or idea that is delusional
” I remember when I was abducted by aliens”
What are the autopsy findings in Alzheimers Disease?
Amyloid Plaques (Neuritic Plaques),
Neurofibrillary tangles (NFT) - intraneuronal aggregates of Tau protein normally found in the axon - Visible with silver staining techniques (Bielschowsky)
Astrocystosis and microgliosis
Neuronal and synaptic loss
Found in the MEDIAL HIPPOCAMPUS (Entorhinal cortex, amygdala)
Neocortex of the occipital, frontal and temporal lobes
Lewy body dementia
What are lewy bodies?
Oesinophilic inclusion bodies composed of abnormally phosphorylated neurofilament proteins aggregated with UBIQUITIN and ALPHA SYNUCLEIN
Lewy bodies in LEWY BODY DEMENTIA are found in the cerebral cortex - Limbic and neocortical structures
Where are Lewy bodies found in Parkinsons disease?
Lewy body formation and neuronal loss occur in the BRAINSTEM Nuclei, particularly the SUBSTANTIA NIGRA
Vascular dementia changes in brain
Large or multiple small infarcts, lacunar infarcted, cerebral amyloid angiopathy, gliosis, hyalinasation and sclerosis
Who developed Attachment theory
John Bowlby
When is stranger anxiety?
Initially, babies show a positive response to strangers (between 14-18 weeks), this is normally replaced by stranger anxiety at around 8 months.
When is separation anxiety?
When an infant is separated from their main carer it is common for them to become anxious (aka separation anxiety). Separation anxiety is most common when an infant is 10 - 18 months and usually diminishes by year three.
What happens to people with poor attachment?
The quality of a persons early attachments appears is associated with their adult behaviour. Poor attachments tend to lead to withdrawn individuals who struggle to form relationships, where as good attachments are associated with socially competent adults who are able to form healthy relationships. Attachment behaviour tends to be stable over the lifetime.
When does specific attachment take place?
Specific attachment does not seem to take place before 6 months. The time from 6 months to 36 months is known as the critical period. During this time a child is most vulnerable to interruptions in its attachment.
What is stupor?
Stupor - combination of immobility and mutism
Posturing?
Posturing - maintaining the same posture for long periods. A classic example is the ‘crucifix’. An extreme version of posturing is catalepsy
Waxy Flexibility?
Waxy flexibility (cerea flexibilitas) - patient can be positioned in uncomfortable postures, which are maintained for a considerable period of time.
