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1.1 RC: Recall + Thea Gilks Review Decks > Gilks Deck 4: Neuro disorders + epidemiology review etc > Flashcards

Gilks Deck 4: Neuro disorders + epidemiology review etc Flashcards

1
Q

what disorders can be associated with pseudobulbar affect

A

ALS

MS

stroke

parkinsons

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2
Q

what is the treatment for pseudobulbar affect

A

either SSRIs or dextromethorphan+quinine

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3
Q

which type of seizure is associated with automatisms

A

focal impaired awareness (complex partial)

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4
Q

what % of epilepsy patients have psychiatric difficulties during course of illness

A

30-50%

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5
Q

what is the most common behavioural symptom in patients with epilepsy

A

personality change (i.e viscosity of personality)

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6
Q

what causes Balint and Gerstman syndromes

A

parietal lobe stroke

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7
Q

what causes hemi-spatial neglect

A

(usually) is neglect of LEFT visual field–> caused by injury to RIGHT PARIETAL lobe–> often due to RIGHT MCA stroke

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8
Q

why is right sided hemi-spatial neglect rare

A

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

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9
Q

which hemisphere is non dominant

A

right

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10
Q

which hemisphere is dominant

A

left–> controls language

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11
Q

insult to which hemisphere results in greater risk of mania

A

right hemisphere insult

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12
Q

where was the stroke if you have APHASIA plus UNILATERAL motor deficits

A

LEFT/dominant MCA

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13
Q

what hemisphere of the brain controls/processes the following:

sensory stimulus from the right side of the body

A

left hemisphere

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14
Q

what hemisphere of the brain controls/processes the following:

spatial ability

A

right hemisphere

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15
Q

what hemisphere of the brain controls/processes the following:

time and sequencing

A

left hemisphere

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16
Q

what hemisphere of the brain controls/processes the following:

speech, language and comprehension

A

left hemisphere

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17
Q

what hemisphere of the brain controls/processes the following:

recognition of faces, places and object

A

right hemisphere

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18
Q

what hemisphere of the brain controls/processes the following:

recognition of words, letters and numbers

A

left hemisphere

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19
Q

what hemisphere of the brain controls/processes the following:

sensory stimulus from left side of the body

A

right hemisphere

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20
Q

what hemisphere of the brain controls/processes the following:

motor control of right side of the body

A

left hemisphere

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21
Q

what hemisphere of the brain controls/processes the following:

analysis and calculations

A

left hemisphere

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22
Q

what hemisphere of the brain controls/processes the following:

motor control of left side of the body

A

right hemisphere

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23
Q

what hemisphere of the brain controls/processes the following:

creativity

A

right hemisphere

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24
Q

what hemisphere of the brain controls/processes the following:

context/perception

A

right hemisphere

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25
Q

what type of rhythm is present on EEG during wakefulness

A

“posterior dominant”

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26
Q

what stage of sleep makes up the largest portion of sleep

A

N2 (upt to 50%)

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27
Q

what stage of sleep is increased by benzos

A

N2

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28
Q

what is the relationship between SSRIs, REM and REM sleep behaviour disorder

A

despite suppressing REM, SSRIs can also exacerbate REM sleep behaviour disorder

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29
Q

how does clozapine affect REM sleep

A

patients on clozapine can spend up to 85% of sleep in REM and may complain of vivid dreams

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30
Q

how long does the typical sleep cycle last

A

90-120 minutes–> people go through multiple each night

each progressive cycle has more REM and less N3

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31
Q

what would you see on EEG in hepatic encephalopathy

A

triphasic waves

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32
Q

what would you see on EEG in cerebral anoxia or CJD

A

periodic sharp waves

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33
Q

what would you see on EEG in diffuse atherosclerosis

A

slowed alpha and theta waves

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34
Q

what would you see on EEG in ADHD

A

increased slow waves

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35
Q

why does hyperventilation immediately before ECT stimulus application lead to a better seizure

A

depresses blood levels of carbon dioxide, which is an anticonvulsant

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36
Q

should you use unilateral ECT in a patient who has a hard time having seizures

A

no–> unilateral is for patients who have vigorous seizures

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37
Q

what medication can be given the night before ECT to help try and potentiate a seizure

A

sustained release theophylline at HS

can give promethazine with it to help patient sleep without affecting the seizure

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38
Q

in which patients should you NOT use ketamine as anesthetic for ECT

A

those with epilepsy

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39
Q

list risk factors for ADHD

A

low birth weight/prematurity

maternal smoking or alcohol in preg

childhood adversity

urban upbringing

family history/genetics

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40
Q

what is the most commonly comorbid disorder wtih ADHD

A

ODD

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41
Q

list the most commonly comorbid conditions with ADHD

A

ODD > anxiety (47%) > learning disorder > mood disorder > conduct disorder > SUD > tics

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42
Q

what is the prevalence of ADHD in kids

A

5%

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43
Q

what is the prevalence of ADHD in adults

A

2.5%

44
Q

what is the concordance of ADHD in monozygotic twins

A

70%

45
Q

what is the prevalence of conduct disorder

A

4-10%

46
Q

list risk factors for conduct disorder

A

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

47
Q

what % of those with CD go on to develop ASPD

A

40%

48
Q

what are the most commonly comorbid disorders with conduct disorder

A

ADHD

SUD

MDD

anxiety

learning disability (reading)

intellectual disability

TBI

49
Q

list risk factors for autism

A

advanced parental age

low birth weight

fetal exposure to epival

50
Q

what % of those with autism have at least one comorbidity

A

70%

51
Q

what are the most commonly comorbid disorders with autism

A

any anxiety d/o (40%) > intellectual disability (30-40%) > ADHD (30-40%) > learning disorder, depression, OCD, ARFID, psychosis

52
Q

what is the prevalence of autism

A

around 1%

53
Q

list risk factors for SCZ

A

urban upbringing

born in winter

premature birth

hypoxia at birth

maternal diabetes

advanced paternal age

immigration

22q11 deletion

family history of SCZ, bipolar

54
Q

is low SES a RF for SCZ

A

no

55
Q

what are the most commonly comorbid disorders with SCZ

A

SUD (above 50%) > anxiety (10-15%) > OCD, panic, medical comorbidity

56
Q

what is the prevalence of SCZ

A

0.5%

57
Q

what % of those with SCZ die by suicide

A

5%

58
Q

what is the risk of relapse if someone with SCZ stops meds

A

90% risk within 1 yeart

59
Q

list risk factors for bipolar d/o

A

early/rapid onset depression

depression with PSYCHOMOTOR RETARDATION

family hx of bipolar or schizophrenia

60
Q

by how much does having bipolar disorder increase suicide risk

A

increased by 15x

61
Q

what is the prevalence of bipolar I disorder

A

about 0.5%

62
Q

what is the most heritable psych condition

A

bipolar I

63
Q

what disorders are most commonly comorbid with bipolar I

A

any anxiety (75%) > SUD (56%)… esp. AUD > ADHD, eating disorders

64
Q

list risk factors for depression

A

neuroticism/negative affectivity

childhood adversity

family hx

pre existing psych and medical illness i.e BPD, CV disease

65
Q

what are the most commonly comorbid disorders with MDD

A

anxiety (60%) > SUD (27-60%) > OCD, eating disorders, BPD

66
Q

what is the lifetime prevalence of MDD

A

10%

(1 year is 5%)

67
Q

what % of those with an anxiety disorder also have a second anxiety disorder

A

50%

(30% have 3+)

68
Q

what is the lifetime prevalence of any anxiety disorder

A

30%

69
Q

does having an anxiety disorder increase suicide risk

A

yes

70
Q

list risk factors for ALL anxiety disorders

A

family hx

personal hx

childhood adversity

female

medical illness

behavioural inhibition

low education

71
Q

list risk factors for GAD specifically

A

behavioural inhibition

neuroticism

harm avoidance

family hx

72
Q

what are the most commonly comorbid disorders with GAD

A

other anxiety disorders

MDD

medical conditions

73
Q

what is the average age of onset of GAD

A

31

74
Q

what is the lifetime prevalence of GAD

A

6-9%

75
Q

list risk factors for OCD

A

social isolation

physical and sexual abuse

neuroticism

family hx (esp for childhood onset)

76
Q

what are the most commonly comorbid disorders with OCD

A

any anxiety (75%) > mood disorder (60%) > SUD (?) > OCPD (25%) > eating disorders, tics, somatic symptom disorder, body dysmorphic disorder

77
Q

what is the SINGLE MOST COMMONLY comorbid diagnosis with OCD

A

MDD

78
Q

what is the prevalence of OCD

A

1-2%

79
Q

what % of those with OCD have OCPD

A

25%

80
Q

what % of those with OCD attempt suicide

A

25%

81
Q

which gender is more affected by childhood OCD

A

boys

82
Q

list risk factors for PTSD

A

female

chlidhood adversity

pre existing psych illness

low SES

low IQ

racial minority

developing acute stress disorder = RF for PTSD

83
Q

what % of those with PTSD have a comorbid disorder

A

75%

84
Q

what are the most commonly comorbid disorders with PTSD

A

MDD

ODD

ADHD

anxiety

BPD

TBI

85
Q

what is the lifetime prevalence of PTSD

A

9%

86
Q

list risk factors for all SUDs

A

male

family hx

early exposure to drugs

pre existing psych illness

high risk environment

87
Q

what are the most commonly comorbid disorders with SUDs

A

MDD

bipolar

anxiety

SCZ

ADHD

personality–esp ASPD

PTSD

eating disorder

88
Q

what is the lifetime prevalence of all SUDs

A

22%

89
Q

which is the most common SUD

A

AUD

90
Q

list risk factors for anorexia

A

low self esteem

female

idealizing thinness

perfectionism

family history of MDD, anxiety, OCPD

91
Q

what are the most commonly comorbid disorders with anorexia

A

MDD (50-65%) > anxiety disorders (50%)… esp GAD, social phobia > OCD, cluster C traits i.e rigidity, harm avoidance, perfectionism, obsessiveness

92
Q

what are the most common anxiety disorders in AN

A

GAD, social phobia

93
Q

what is the prevalence of AN

A

0.5%

94
Q

what is the mortality rate for AN

A

5% per year

total mortality 5-20%

95
Q

what is the gender distribution of patients with AN

A

female: male 10:1

(same for BN)

96
Q

list risk factors for bulimia nervosa

A

female

low self esteem

idealizing thinness

impulsivity

family history of MDD, anxiety, SUD, BPD

97
Q

what are the most commonly comorbid disorders with bulimia nervosa

A

depression (over 50%) + anxiety (over 50%) > SUD (30%), bipolar, BPD, PTSD, impulsivity/risk taking

98
Q

what is the prevalence of bulimia

A

1-1.5%

99
Q

what is the yearly mortality of BN

A

2%

100
Q

list risk factors for major NCD

A

age

TBI

vascular RFs

depression (most significant?)

hearing impairment

low education (most significant?)

HRT

single

fam hx, genetics

MCI (10% convert per year)

101
Q

list the impulse control disorders

A

DMDD (technically in mood but included here becuase can present similarly)

IED

ODD

CD

ASPD

102
Q

what distinguishes DMDD from the other impulse control disorders

A

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

103
Q

what distinguishes IED from the other impulse control disorders

A

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

104
Q

what distinguishes ODD from the other impulse control disorders

A

irritable mood, RESENTFUL, annoys others, easily ANNOYED, argumentative/DEFIANT, VINDICTIVE/SPITEFUL

more likely to be provoked by AUTHORITY FIGURES

105
Q

what distinguishes CD from the other impulse control disorders

A

DISREGARD for the basic rights of others, HARMFUL/DANGEROUS/evil behaviours i.e carrying weapon, setting fire, rape, theft

NO mention of mood

106
Q

what is the primary treatments for ODD/CD

A

primarily PSYCHOSOCIAL and based on CLINICAL EXPERIENCE

–> multisystemic therapy
–> parent management training
–> family therapy
–> CBT
–> problem solving skills training

107
Q

what is the focus of pharmacologic treatment of ODD/conduct

A

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

1.1 RC: Recall + Thea Gilks Review Decks (13 decks)

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