Introduction to Neuropsychiatry Flashcards
What are the common conditions that are considered to be part of neuropsychiatry
- Dementia
- Parkinson’s
- Multiple Sclerosis
- Huntington’s
- Motor Neuron Disease
- Functional Neurological Disorder
What are the three types of symptoms considered to be part of the spectrum of behavioural and psychological symptoms of dementia?
Psychotic Symptoms
Affective Symptoms
Behavioural Symptoms
What are the main examples of psychotic symptoms?
Hallucinations
Delusions
Misidentifications
What are the main examples of affective symptoms?
Depression Anxiety Apathy Elation Disinhibition
What are the main examples of behavioural symptoms
Aberrant motor behaviour Irritability/Aggression Agitiation Sleep disturbance Stereotypies Hyperorality Eating disturbance Hypersexuality
Outline the main features of BPSD (in dementia patients)
- Most (90%) patients have symptoms, often multiple
- Present throughout the course of the disease
- More common with disease progression
- May remit but highly recurrent
- Likely to be the most problematic aspect for carers
- A major source of caregiver distress
- Both strongly associated with nursing home placement
- Complex interaction. Between anatomical, biochemical and functional changes
- Features vary according to severity and type of dementia as different brain regions affected
- Predisposing factors – genes and premorbid personality
what are the main criteria for the clinical diagnosis of PROBABLE Alzheimer’s disease?
Deficits in two or more areas of cognition
Progressive worsening of memory and other cognitive functions
No disturbance of consciousness
What is the diagnosis of PROBABLE Alzheimer’s disease supported by?
Progressive deterioration of specific cognitive function such as language (aphasia), motor skills (apraxia) and perceptions (agnosia)
Impaired activities of daily living and altered patterns of behaviour
What are the other clinical features consistent with a diagnosis of PROBABLE Alzheimer’s disease, after the exclusion of causes of dementia other than Alzheimer’s disease
Plateaus in the course of progression of the illness
Associated symptoms of depression, insomnia, incontinence, delusions, illusions, hallucinations, catastrophic verbal, emotional or physical outbursts, sexual disorders, and weight loss
What features make the diagnosis of Alzheimer’s unlikely or uncertain?
Focal neurological findings such as hemiparesis, sensory loss, visual field defects and incoordination early in the course of the illness
What is the central feature of Lewy body Dementia?
progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational function.
What are the three main aspects of Lewy body Dementia? (Two of the following core features are essential for a diagnosis of probably LBD, and one is essential for possible LBD)
a. Fluctating cognition with pronounced variation in attention and alertness
b. Recurrent visual hallucinations that are typically well formed and detailed
c. Spontaneous motor features of Parkinsonism
What features of supportive of a diagnosis of LBD?
a. Repeated falls
b. Syncope
c. Transient loss of consciousness
d. Neuroleptic sensitivity
e. Systematised delusions
f. Hallucinations in other modalities
What is a diagnosis of LBD less likely in the presence of?
a. Stroke disease, evident as focal neurological signs or on brain imaging
b. Evidence on physical examination and investigation of any physical illness or other brain disorder sufficient to account for the clinical picture
What is the difference between Parkinsonism and LBD?
- Distinction based on time of onset motor and cognitive symptoms
- More pronounced cortical atrophy, elevated cortical and limbic Lewy body pathologies, higher Ab and tau loads in cortex and striatum in DLB compared to PDD, and earlier cognitive defects in DLB
- No differences in cortical and striatal cholinergic and dopaminergic deficits
