Gilks Deck 4: Neuro disorders + epidemiology review etc Flashcards
what disorders can be associated with pseudobulbar affect
ALS
MS
stroke
parkinsons
what is the treatment for pseudobulbar affect
either SSRIs or dextromethorphan+quinine
which type of seizure is associated with automatisms
focal impaired awareness (complex partial)
what % of epilepsy patients have psychiatric difficulties during course of illness
30-50%
what is the most common behavioural symptom in patients with epilepsy
personality change (i.e viscosity of personality)
what causes Balint and Gerstman syndromes
parietal lobe stroke
what causes hemi-spatial neglect
(usually) is neglect of LEFT visual field–> caused by injury to RIGHT PARIETAL lobe–> often due to RIGHT MCA stroke
why is right sided hemi-spatial neglect rare
because of REDUNDANT processing of the right space by both the left and right hemispheres–> in most brains, the left space is only processed by the right hemisphere
which hemisphere is non dominant
right
which hemisphere is dominant
left–> controls language
insult to which hemisphere results in greater risk of mania
right hemisphere insult
where was the stroke if you have APHASIA plus UNILATERAL motor deficits
LEFT/dominant MCA
what hemisphere of the brain controls/processes the following:
sensory stimulus from the right side of the body
left hemisphere
what hemisphere of the brain controls/processes the following:
spatial ability
right hemisphere
what hemisphere of the brain controls/processes the following:
time and sequencing
left hemisphere
what hemisphere of the brain controls/processes the following:
speech, language and comprehension
left hemisphere
what hemisphere of the brain controls/processes the following:
recognition of faces, places and object
right hemisphere
what hemisphere of the brain controls/processes the following:
recognition of words, letters and numbers
left hemisphere
what hemisphere of the brain controls/processes the following:
sensory stimulus from left side of the body
right hemisphere
what hemisphere of the brain controls/processes the following:
motor control of right side of the body
left hemisphere
what hemisphere of the brain controls/processes the following:
analysis and calculations
left hemisphere
what hemisphere of the brain controls/processes the following:
motor control of left side of the body
right hemisphere
what hemisphere of the brain controls/processes the following:
creativity
right hemisphere
what hemisphere of the brain controls/processes the following:
context/perception
right hemisphere
what type of rhythm is present on EEG during wakefulness
“posterior dominant”
what stage of sleep makes up the largest portion of sleep
N2 (upt to 50%)
what stage of sleep is increased by benzos
N2
what is the relationship between SSRIs, REM and REM sleep behaviour disorder
despite suppressing REM, SSRIs can also exacerbate REM sleep behaviour disorder
how does clozapine affect REM sleep
patients on clozapine can spend up to 85% of sleep in REM and may complain of vivid dreams
how long does the typical sleep cycle last
90-120 minutes–> people go through multiple each night
each progressive cycle has more REM and less N3
what would you see on EEG in hepatic encephalopathy
triphasic waves
what would you see on EEG in cerebral anoxia or CJD
periodic sharp waves
what would you see on EEG in diffuse atherosclerosis
slowed alpha and theta waves
what would you see on EEG in ADHD
increased slow waves
why does hyperventilation immediately before ECT stimulus application lead to a better seizure
depresses blood levels of carbon dioxide, which is an anticonvulsant
should you use unilateral ECT in a patient who has a hard time having seizures
no–> unilateral is for patients who have vigorous seizures
what medication can be given the night before ECT to help try and potentiate a seizure
sustained release theophylline at HS
can give promethazine with it to help patient sleep without affecting the seizure
in which patients should you NOT use ketamine as anesthetic for ECT
those with epilepsy
list risk factors for ADHD
low birth weight/prematurity
maternal smoking or alcohol in preg
childhood adversity
urban upbringing
family history/genetics
what is the most commonly comorbid disorder wtih ADHD
ODD
list the most commonly comorbid conditions with ADHD
ODD > anxiety (47%) > learning disorder > mood disorder > conduct disorder > SUD > tics
what is the prevalence of ADHD in kids
5%
what is the prevalence of ADHD in adults
2.5%
what is the concordance of ADHD in monozygotic twins
70%
what is the prevalence of conduct disorder
4-10%
list risk factors for conduct disorder
genetics
“difficult” temperament
HYPOarousability
birth complications
parental rejection/neglect
inconsistent parenting
harsh discipline
abuse
lack of supervision
parent criminality
parental ASPD
early institutional living
peer rejection
what % of those with CD go on to develop ASPD
40%
what are the most commonly comorbid disorders with conduct disorder
ADHD
SUD
MDD
anxiety
learning disability (reading)
intellectual disability
TBI
list risk factors for autism
advanced parental age
low birth weight
fetal exposure to epival
what % of those with autism have at least one comorbidity
70%
what are the most commonly comorbid disorders with autism
any anxiety d/o (40%) > intellectual disability (30-40%) > ADHD (30-40%) > learning disorder, depression, OCD, ARFID, psychosis
what is the prevalence of autism
around 1%
list risk factors for SCZ
urban upbringing
born in winter
premature birth
hypoxia at birth
maternal diabetes
advanced paternal age
immigration
22q11 deletion
family history of SCZ, bipolar
is low SES a RF for SCZ
no
what are the most commonly comorbid disorders with SCZ
SUD (above 50%) > anxiety (10-15%) > OCD, panic, medical comorbidity
what is the prevalence of SCZ
0.5%
what % of those with SCZ die by suicide
5%
what is the risk of relapse if someone with SCZ stops meds
90% risk within 1 yeart
list risk factors for bipolar d/o
early/rapid onset depression
depression with PSYCHOMOTOR RETARDATION
family hx of bipolar or schizophrenia
by how much does having bipolar disorder increase suicide risk
increased by 15x
what is the prevalence of bipolar I disorder
about 0.5%
what is the most heritable psych condition
bipolar I
what disorders are most commonly comorbid with bipolar I
any anxiety (75%) > SUD (56%)… esp. AUD > ADHD, eating disorders
list risk factors for depression
neuroticism/negative affectivity
childhood adversity
family hx
pre existing psych and medical illness i.e BPD, CV disease
what are the most commonly comorbid disorders with MDD
anxiety (60%) > SUD (27-60%) > OCD, eating disorders, BPD
what is the lifetime prevalence of MDD
10%
(1 year is 5%)
what % of those with an anxiety disorder also have a second anxiety disorder
50%
(30% have 3+)
what is the lifetime prevalence of any anxiety disorder
30%
does having an anxiety disorder increase suicide risk
yes
list risk factors for ALL anxiety disorders
family hx
personal hx
childhood adversity
female
medical illness
behavioural inhibition
low education
list risk factors for GAD specifically
behavioural inhibition
neuroticism
harm avoidance
family hx
what are the most commonly comorbid disorders with GAD
other anxiety disorders
MDD
medical conditions
what is the average age of onset of GAD
31
what is the lifetime prevalence of GAD
6-9%
list risk factors for OCD
social isolation
physical and sexual abuse
neuroticism
family hx (esp for childhood onset)
what are the most commonly comorbid disorders with OCD
any anxiety (75%) > mood disorder (60%) > SUD (?) > OCPD (25%) > eating disorders, tics, somatic symptom disorder, body dysmorphic disorder
what is the SINGLE MOST COMMONLY comorbid diagnosis with OCD
MDD
what is the prevalence of OCD
1-2%
what % of those with OCD have OCPD
25%
what % of those with OCD attempt suicide
25%
which gender is more affected by childhood OCD
boys
list risk factors for PTSD
female
chlidhood adversity
pre existing psych illness
low SES
low IQ
racial minority
developing acute stress disorder = RF for PTSD
what % of those with PTSD have a comorbid disorder
75%
what are the most commonly comorbid disorders with PTSD
MDD
ODD
ADHD
anxiety
BPD
TBI
what is the lifetime prevalence of PTSD
9%
list risk factors for all SUDs
male
family hx
early exposure to drugs
pre existing psych illness
high risk environment
what are the most commonly comorbid disorders with SUDs
MDD
bipolar
anxiety
SCZ
ADHD
personality–esp ASPD
PTSD
eating disorder
what is the lifetime prevalence of all SUDs
22%
which is the most common SUD
AUD
list risk factors for anorexia
low self esteem
female
idealizing thinness
perfectionism
family history of MDD, anxiety, OCPD
what are the most commonly comorbid disorders with anorexia
MDD (50-65%) > anxiety disorders (50%)… esp GAD, social phobia > OCD, cluster C traits i.e rigidity, harm avoidance, perfectionism, obsessiveness
what are the most common anxiety disorders in AN
GAD, social phobia
what is the prevalence of AN
0.5%
what is the mortality rate for AN
5% per year
total mortality 5-20%
what is the gender distribution of patients with AN
female: male 10:1
(same for BN)
list risk factors for bulimia nervosa
female
low self esteem
idealizing thinness
impulsivity
family history of MDD, anxiety, SUD, BPD
what are the most commonly comorbid disorders with bulimia nervosa
depression (over 50%) + anxiety (over 50%) > SUD (30%), bipolar, BPD, PTSD, impulsivity/risk taking
what is the prevalence of bulimia
1-1.5%
what is the yearly mortality of BN
2%
list risk factors for major NCD
age
TBI
vascular RFs
depression (most significant?)
hearing impairment
low education (most significant?)
HRT
single
fam hx, genetics
MCI (10% convert per year)
list the impulse control disorders
DMDD (technically in mood but included here becuase can present similarly)
IED
ODD
CD
ASPD
what distinguishes DMDD from the other impulse control disorders
temper outburts out of proportion to provocation but NO VIOLENCE OR PROPERTY DAMAGE
mood BETWEEN outbursts is persistently irritable/angry
CANNOT COEXIEST with IED, ODD or bipolar
what distinguishes IED from the other impulse control disorders
failure to control aggressive impulses which are out of proportion to the provocation
CAN involve physical/verbal AGGRESSION and property DAMAGE but it is NOT PREMEDITATED
aggression in IED > than in ODD + provocation for outbursts is more broad/non specific
what distinguishes ODD from the other impulse control disorders
irritable mood, RESENTFUL, annoys others, easily ANNOYED, argumentative/DEFIANT, VINDICTIVE/SPITEFUL
more likely to be provoked by AUTHORITY FIGURES
what distinguishes CD from the other impulse control disorders
DISREGARD for the basic rights of others, HARMFUL/DANGEROUS/evil behaviours i.e carrying weapon, setting fire, rape, theft
NO mention of mood
what is the primary treatments for ODD/CD
primarily PSYCHOSOCIAL and based on CLINICAL EXPERIENCE
–> multisystemic therapy
–> parent management training
–> family therapy
–> CBT
–> problem solving skills training
what is the focus of pharmacologic treatment of ODD/conduct
focused on treating COMORBIDITIES –> especially ADHD because as many as 70% of patients have comorbid ADHD
use stimulants +/- alpha agonists for ADHD sx
CAN use risperidone short term for significant disruptive/aggressive behaviours
