Exam 4

Question 1

What are the guidelines around raw data and a subpoena

(Q1)

Answer 1

Psychologists should not provide client records or information without a court order or written authorization from the client. Psychologists may also have contractual obligations with publishers of test kits.

Psychologists may offer to provide the data to a qualified professional, while explaining their ethical and legal obligations

Psychologists may seek a protective order from the court to maintain test security

Psychologists can describe the withheld documents in a way that allows the parties to assess the claim without revealing privileged information

Psychologists who receive a subpoena for test data should consult with an attorney

Question 2

What is the Standard Error of the Estimate used to calculate?

(Q2)

Answer 2

SEE is used to calculate the confidence interval. SEE may not be explicitly disclosed in test manuals but can be calculated using the SD and reliability of the test.

Question 3

What is acculturation misattribution vs Ethnocentric interpretation?

(Q10)

Answer 3

Acculturation misattribution can refer to the tendency to misattribute the development of minorities and Whites to different cultural and psychological processes

Ethnocentrism is the belief that one’s own culture is superior to others and should be used as the standard to judge other cultures. It can also refer to the act of judging other cultures using one’s own culture as a frame of reference

FYI- Ethnorelative interpretation is the idea that cultures are relative to each other and that behaviors can only be understood within their cultural context. It’s the opposite of ethnocentrism, which is the belief that one’s own culture is superior to others

Question 4

what are the cognitive deficits of sleep deprivation?

(Q11)

Answer 4

General slowing of response speed and increased variability in performance, particularly for simple measures of alertness, attention and vigilance.

Neuroimaging evidence has implicated the prefrontal cortex as a brain region that may be particularly susceptible to the effects of sleep loss, but perplexingly, executive function tasks that putatively measure prefrontal functioning have yielded inconsistent findings within the context of sleep deprivation.

The extent to which sleep deprivation affects a particular cognitive process may depend on several factors, including the magnitude of global decline in general alertness and attention, the degree to which the specific cognitive function depends on emotion-processing networks, and the extent to which that cognitive process can draw upon associated cortical regions for compensatory support.

https://pubmed.ncbi.nlm.nih.gov/21075236/

Question 5

Briefly explain the three severity levels of a TBI
(referencing loss of consciousness and the GCS, and PTA)

(Q12)

Answer 5

The GCS is a 3–15 point scale that assesses a patient’s level of consciousness and neurologic functioning. It’s based on three sections: best motor response, best verbal response, and eye opening.

Mild TBI= GCS 0f 13-15, LOC of <30 min + mental status change, PTA of 0–1 day

Moderate TBI= GCS of 9-12, LOC of 30min- 6 hours + mental status change, PTA of >1 and ≤7 days

Severe TBI= GCS of 3-8, LOC of >6 hours or severe mental status change, PTA of >7 days

Very severe TBI: PTA of >86 day

Question 6

Differences in outcomes of patients with anoxic brain injuries compared to patients with moderate-severe TBI

(Q16)

Answer 6

patients with ABI benefit from inpatient rehabilitation and made significant functional gains comparable to the gains of patients with TB

ABI patients were referred later for rehabilitation, had similar lengths of stay, but made slower progress, with poorer outcomes and were more likely to be transferred to residential care.

Those with ABI had more severe impairments on cognitive assessment relative to those with TBI, being particularly susceptible to impairments in memory, especially visual memory or short-term memory.

Question 7

What is Valproic acid for and name some common side effects.

Answer 7

Anticonvulsant
It can treat seizures and bipolar disorder. It can also help prevent migraine headaches.

Valproic acid may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you notice any of these side effects, tell your doctor right away.

Question 8

What is Levetiracetam for ?

Answer 8

Levetiracetam is a medicine used to treat epilepsy. Seizures are bursts of electrical activity in the brain that temporarily affect how it works. Levetiracetam slows these electrical signals down to stop seizures (aka Keppra)

Question 9

What is Topiramate for and name some common side effects.

Answer 9

Topiramate is used alone or with other medications to treat certain types of seizures including primary generalized tonic-clonic seizures (formerly known as a grand mal seizure; seizure that involves the entire body) and partial onset seizures (seizures that involve only one part of the brain)

Drowsiness and fatigue are some of the most frequently reported topiramate side effects. They’re more common with higher dosages and when you first start taking it. This is why you shouldn’t perform activities that require focus — like driving a car — before knowing how topiramate affects you

Question 10

Regarding conversion rates from Mild Cognitive Impairment (MCI) to dementia…also name some factors that have been shown to influence conversion rates in research studies

Answer 10

Using Mayo defined MCI at baseline and adjusting for sample size, the cumulative proportion who progressed to dementia, to Alzheimer’s disease (AD) and to vascular dementia (VaD) was 39.2%, 33.6% and 6.2%, respectively in specialist settings and 21.9%, 28.9% and 5.2%, respectively in population studies

factors that have been shown to influence conversion :

Practice setting (e.g. primary care vs memory disorder clinic)
Diagnostic criteria used
Subtype of MCI

Question 11

Where does DBS usually take place in the brain?

Answer 11

subthalamic nucleus (STN) but mostly the globus pallidus interna (GPi)

A deep brain stimulation (DBS) treatment team may recommend placing electrodes in the subthalamic nucleus (STN) instead of the globus pallidus interna (GPi) for a number of reasons, including:

Medication reduction: STN DBS can lead to more medication reduction than GPi DBS

Battery changes: STN DBS can lead to less frequent battery changes than GPi DBS

Bradykinesia: STN DBS can lead to more improvement in bradykinesia than GPi DBS

Other factors to consider when choosing between STN and GPi DBS include:
Dyskinesia suppression: GPi DBS can lead to more robust dyskinesia suppression than STN DBS

Programming: GPi DBS can be easier to program than STN DBS

Medication adjustments: GPi DBS can provide greater flexibility in adjusting medications than STN DBS

Cognitive decline: GPi DBS may be a better option if there is concern about cognitive decline, particularly in regards to processing speed and working memory

Question 12

Expected cognitive outcomes in preschool-aged children for organ transplant include …

Answer 12

Studies have traditionally focused on functioning post-transplant, which could result in over identification of associated cognitive related developmental delays

Question 13

What is Lennox-Gastaut Syndrome?

Answer 13

Lennox-Gastaut syndrome is a severe condition characterized by repeated seizures (epilepsy) that begin early in life. Affected individuals have multiple types of seizures, developmental delays, and particular patterns of brain activity measured by electroencephalogram (EEG)

Question 14

What are the most common causes of congenital hydrocephalus?

Answer 14

Dandy Walker Syndrome
Spina bifida myelomeningocele
Aqueductal stenosis

Question 15

__________% of people have mild cognitive impairment (MCI) within the first 5 years of a PD diagnosis, and ________% of individuals develop dementia after 20 years of their PD diagnosis.

Answer 15

30%; 80%

Question 16

what is the biggest cognitive deficit for folks with congenital hydrocephalus?

Answer 16

Processing speed is extremely deficient- especially if paper and pencil timed tasks are employed.

Question 17

What are some side effects of Levodopa of PD patients?

Answer 17

carbidopa-levodopa can often cause an increase in appetite, excessive eating, and weight gain

Because carbidopa-levodopa is a dopaminergic medication, you should watch out for increased impulsive behaviors and urges for gambling, sex, or hobbies

A substantial response to carbidopa-levodopa is very common in idiopathic PD, with >90% of patients showing an improvement in symptoms with the medication

Question 18

cholinesterase inhibitors (e.g., donepezil, galantamine, rivastigmine)

Answer 18

Cholinesterase inhibitors, also known as acetylcholinesterase (AChE) inhibitors or anticholinesterases, prevent the breakdown of acetylcholine (ACh) in the nervous system.

Cholinesterase inhibitors improve attention and alertness and reduce hallucinations in patients with early Dementia with Lewy bodies

Donepezil and galantamine in particular improve cognition and global function in patients with vascular dementia

Cholinesterase inhibitors have been shown to improve cognition, activities of daily living, and quality of life for patients with rarer causes of dementia including Huntington’s disease, CADASIL, and multiple sclerosis

Question 19

schizophrenia and cognition

Answer 19

Individuals with schizophrenia frequently exhibit cognitive impairment, and deficits often persist into residual phases after psychotic symptoms have remitted.

Individuals with schizophrenia often show poor performance on performance validity tests, even when there is no apparent secondary gain.

Severity of cognitive impairments for individuals with schizophrenia often range from 1.0 to 1.5 standard deviations below average when compared to demographically-matched groups

Question 20

Alzheimer’s disease with psychosis versus “pseudodementia.”.. how do we differentiate?

Answer 20

Details on recent mood itself. Patients with depression without dementia tend to present with low, sad mood, whereas patients with dementia may present more with apathy symptoms.

The patient’s subjective cognitive report. The depressed patient may present with more detailed cognitive complaints, whereas the dementia patient may have no cognitive complaints.

The content of the delusions. Depressed patients more frequently present with mood-congruent delusions, whereas dementia patients may more frequently have mood-independent delusions.

Question 21

Which clinical feature would be least helpful in differentiating between Dementia with Lewy bodies (DLB) or progressive supranuclear palsy (PSP)?

Answer 21

Executive dysfunction on neuropsychological testing, or mild memory deficits

PSP:
Difficulty with downward eye movements (vertical gaze palsy
Gait instability

LBD:
Presence of psychotic symptoms such as visual hallucinations and delusions

Question 22

Amyotrophic Lateral Sclerosis (ALS) versus PD?

Answer 22

ALS affects motor neurons, while PD affects nerve cells that produce dopamine in the basal ganglia

ALS causes muscle weakness, cramps, twitching, stiffness, speech challenges, drooling, and involuntary emotional expressions.

PD causes tremor, slow movement, rigid muscles, poor posture and balance, loss of automatic movements, speech changes, writing changes, and nonmotor symptoms like constipation, loss of smell, and depression

ALS can have a more significant effect on a person’s life expectancy than PD

Question 23

what is functional restoration?

Answer 23

The Functional Restoration Program (FRP) is an evidence-based treatment for chronic pain. The program consists of comprehensive care that is built to target all of the factors in your life that increase your pain.

this intervention supports the best chance for recovery, specifically with regard to pain and disability

Question 24

Explain a bit about NF1?

Answer 24

Neurofibromatosis type 1 (NF1) is a genetic condition that causes tumours to grow along your nerves. The tumors are usually non-cancerous (benign) but may cause a range of symptoms.

NF1 is a condition you’re born with, although some symptoms develop gradually over many years. The severity of the condition can vary considerably from person to person

Common symptoms:
birthmarks known as café au lait spots, which are light or dark brown patches that can be anywhere on the body
soft, non-cancerous tumors on or under the skin (neurofibromas)
clusters of freckles in unusual places – such as the armpits, groin and under the breast
problems with the bones, eyes and nervous system

common tumors:
Gliomas
A type of brain tumor that can occur in about 15% of people with NF1, usually during childhood. The most common types of gliomas associated with NF1 are astrocytoma, brain stem glioma, and optic pathway glioma

Neurofibromas
Benign Schwann cell tumors that can affect virtually any nerve in the body

Optic gliomas
Tumors that develop in the cells surrounding the optic nerve, which controls vision. About 15% of children with NF1 will develop an optic glioma, with the majority of the risk before the age of six years

Question 25

Cortico basal degernation presentation versus PD?

Answer 25

Corticobasal degeneration, also called corticobasal syndrome, is a rare disease that causes areas of the brain to shrink. Over time, nerve cells break down and die. Corticobasal degeneration affects the area of the brain that processes information and brain structures that control movement

Corticobasal degeneration is a different condition pathologically than Parkinson’s disease (PD); it is known as a tauopathy, meaning that the tau protein misfolds and causes disruption of neuron function, whereas in PD the abnormal protein is called alpha-synuclein. CBD is typically accompanied by dementia

CBD symptoms include trouble moving on one or both sides of the body, muscle jerks, and difficulty swallowing.

Parkinson’s symptoms include tremor, slowed movement, and rigid muscles

Question 26

What is Charles Bonnet Syndrome, how is it different than LBD?

Answer 26

Charles Bonnet syndrome refers to the visual hallucinations caused by the brain’s adjustment to significant vision loss. It occurs most often among the elderly who are more likely than any other age group to have eye conditions that affect sight, such as age-related macular degeneration.

CBS is diagnosed when a patient has visual hallucinations but retains insight, and doesn’t have delusions or hallucinations in other sensory modalities

CBS is characterized by complex visual hallucinations only, while LBD is characterized by visual hallucinations, fluctuating cognitive decline, and Parkinsonism. LBD also affects memory, decision making, problem solving, planning, and abstract or analytical thinking

Question 27

Name the diagnosis often linked to these neuroimaging “signs”

1. Hummingbird sign
2. Mickey mouse Sign
3. Hot crossed buns sign
4. light bulb sign

Answer 27

Corticobasal syndrome (CBS) and the “light bulb sign” which entails marked hyperintensity seen on heavily T2 weighted sequences that has been likened to a glowing light bulb.

Multiple System Atrophy (MSA) and selective degeneration of pontocerebellar tracts referred to as the “hot cross buns” sign.

Progressive Supranuclear Palsy (PSP) and prominent midbrain atrophy with no pontine atrophy, referred to as the “hummingbird” or “penguin” sign

Parkinson’s disease dementia (PDD) and markedly reduced volume in the dorsal midbrain, with relative sparing of the tectum and cerebral peduncles, giving rise to a “Mickey Mouse” sign.

Question 28

Explain autoimmune encephalitis (AIE)

Answer 28

Autoimmune encephalitis (AIE) is an immune-mediated condition that induces brain inflammation and is one of the most common causes of non-infectious encephalitis.

In the past decade, AIE has become an emerging addition to the differential diagnosis when a classical infection cannot explain focal neurological symptoms

Early signs of autoimmune encephalitis:
Neurologic symptoms
Problems with memory and the process of thinking (also known as cognition)
Abnormal movements.
Seizures.
Problems with balance or coordination (or ataxia)
Having trouble speaking.
Changes in vision.
Loss of consciousness or coma

Sometimes autoimmune encephalitis can be triggered by cancerous or noncancerous tumors, known as paraneoplastic syndromes of the nervous system. Other types of autoimmune encephalitis such as acute disseminated encephalomyelitis (ADEM) can be triggered by an infection in the body.

Question 29

Describe some risks/benefits of carbidopa-levodopa for PD patients

Answer 29

“Because carbidopa-levodopa is a dopaminergic medication, you should watch out for increased impulsive behaviors and urges for gambling, sex, or hobbies.”

“Although carbidopa-levodopa might help your tremors, it can also cause uncontrolled, repetitive twitching or twisting movements of your neck, trunk, arms, or legs.”

“A substantial response to carbidopa-levodopa is very common in idiopathic PD, with >90% of patients showing an improvement in symptoms with the medication.”