Neuro Flashcards
What regulatory brain functions does serotonin have?
Helps regulate mood, arousal and cognition
What regulatory brain functions does dopamine have?
Helps regulate mood, arousal, motor control and cognition
What regulatory brain functions does norepinephrine have?
Helps regulate mood, arousal, attention and cognition
What regulatory brain functions does acetylcholine have?
regulates sleep, arousal and attention
What symptoms have been associated with low levels of serotonin, dopamine and norepinephrine?
Depressive symptoms
What neurotransmitters are associated with anxiety symptoms?
Low levels of serotonin and high levels of norepinephrine
What neurotransmitters are associated with mania and psychosis?
Low levels of serotonin and high levels of dopamine in some areas of the brain
What neurotransmitter has been associated with dementia?
Low levels of actylcholine
What are some risk factors for anxiety disorder?
family history of anxiety,
personal history of anxiety or mood disorder,
childhood stressful life events or trauma, being female,
chronic medical illness,
behavioral inhibition.
How long would you expect a patient to be experiencing symptoms of anxiety/extreme worrying if you suspect they have generalized anxiety disorder?
At least 4 weeks
When considering a diagnosis of anxiety, what other diagnosis might you consider? What might be contributing to symtoms?
Other diagnosis could include hyperthyroidism, cardiopulmonary disorders or traumatic brain injury, all of which could accompany anxiety.
Anxiety can also be exacerbated by caffeine, alcohol, illicit drug use or other psychiatric comorbidities
If a patient is experiencing depressive symptoms that are in sync with her menstrual cycle, what might she be experiencing?
Premenstrual dysphoric disorder (PMDD)
Major depressive disorder (MDD) is characterized by at least 2 weeks of depressed/irritable mood, with at least four of the following:
anhedonia,
insomnia or hypersomnia,
decreased self-esteem,
low energy,
poor concentration or indecision, changes in appetite,
feeling slowed or restless,
thoughts of death or suicide.
How does bipolar disorder present?
Bipolar disorders present with both depressive episodes, such as in major depressive disorder (MDD), as well as manic or hypomanic episodes. Symptoms of manic episodes include euphoric/irritable mood, grandiosity, decreased need for sleep, talkativeness, racing thoughts, distractibility, increased goal-directed behavior or agitation, and an increase in reckless pleasure-seeking (having unprotected sex, spending excess money, foolish investments).
What diagnosis’s may mimic depression?
Parkinson disease, traumatic brain injury (TBI), recent myocardial infarction (MI) or stroke, and hypothyroidism may mimic depressive symptoms. Additionally, alcohol use and recent substance use may present in a similar way to depressive symptoms.
Why would sudden onset memory problems not be indicative of dementia? What might it indicate?
Sudden-onset memory problems are concerning for major vascular neurocognitive disorders, wherein vascular occlusion damages structusres important for memory. Rapid-onset memory problems after a head injury should raise suspicion for a major neurocognitive disorder due to TBI.
What diagnosis would be likely in a patient with slow onset memory loss and one sided tremor with difficulty starting movements?
Parkinson’s; in a younger adult, it could be Huntington’s, particularly if there is a family history
What are the six components of the mental status evaluation?
The mental status examination consists of six components: appearance and behavior; speech and language; mood; thoughts and perceptions; insight and judgment; and cognitive function.
What are dysarthria, aphasia and dysphnia?
Dysarthria refers to defective articulation, aphasia is a disorder of language and dysphonia results from impaired volume, quality or pitch of voice.
Differentiate between Broca aphasia and Wernicke’s aphasia
Broca aphasia is also called expressive aphasia, which has preserved comprehension but difficult speech.
Wernicke’s aphasia is receptive aphasia, in which the patient has fluent speech but impaired comprehension.
Describe the language pattern of blocking? In what disorder might it be present? Is it normal?
Blocking is a sudden interruption in speech before the idea is completed, also known as “losing the thought”. It occurs in normal people. It may also be striking in schizophrenia
Describe the language pattern of circumstantiality. In what disorder might you see this pattern? Is it normal?
The mildest thought disorder, consisting of speech with unnecessary detail, indirection, and delay in reaching the point. Some topics may have a meaningful connection. Many people without mental disorders have circumstantial speech. It may be present in people with obsessive compulsive disorder or obsessions.
Describe the language pattern of “clanging”. In what disorders might it be present?
Speech with choice of words based on sound, rather than meaning, as in rhyming and punning. For example, “Look at my eyes and nose, wise eyes and rosy nose. Two to one, the ayes have it!”
Clanging may be present in schizophrenia or mania.
Describe the language pattern of “Confabulation”. In what disorders might it be present?
Confabulation is fabrication of facts or events in response to questions, to fill in the gaps from impaired memory. May be present in alcoholism or dementia.
Describe the language pattern of “derailment”. In what disorders might it be present?
Tangential speech with shifting topics that are loosely connected or unrelated. The patient is unaware of the lack of association.
Describe the language pattern of “flight of ideas”. In what disorders might it be present?
An almost continuous flow of accelerated speech with abrupt changes from one topic to the next. Changes are based on understandable associations, plays on words, or distracting stimuli, but ideas are not well connected. Most commonly noted in manic episodes.
Describe the language pattern of “incoherance”. In what disorders might it be present?
Speech that is incomprehensible and illogical, with lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use. Flight of ideas, when severe, may produce incoherence.
Most frequently noted in severe psychiatric disturbances, particularly schizophrenia.
Describe the language pattern of “neologisms”. In what disorders might it be present?
Invented or distorted words, or words with new and highly idiosyncratic meanings. May be present in schizophrenia, psychiatric disorders or aphasia.
Describe the language pattern of “perseveration”. In what disorders might it be present?
Persistent repetition of words or ideas. May be present in schizophrenia and other psychiatric disorders.
Differentiate between hallucinations and illusions.
Illusions are misinterpretations of real external stimuli, such as mistaking the rustling of leaves for whispered voices. Hallucinations are perception-like experiences that seem real but are not based on external stimuli. The person experiencing them may or may not be able to identify them as false.
Describe the digit span test
Explain that you would like to test the patient’s ability to concentrate, perhaps adding that this can be difficult if the patient is in pain or ill. Recite a series of digits, starting with two at a time and speaking each number clearly at a rate of about one per second. Ask the patient to repeat the numbers back to you. If this repetition is accurate, try a series of three numbers, then four, and so on as long as the patient responds correctly. Jot down the numbers as you say them to ensure your own accuracy. If the patient makes a mistake, try once more with another series of the same length. Stop after a second failure in a single series.
Causes of poor performance include delirium, dementia, intellectual disability, and performance anxiety.
When choosing digits, use street numbers, zip codes, telephone numbers, and other numerical sequences that are familiar to you, but avoid consecutive numbers, easily recognized dates, and sequences that are familiar to the patient.
Now, starting again with a series of two, ask the patient to repeat the numbers to you backward.
Normally, a person should be able to repeat correctly at least five digits forward and four backward.
What does the digit span test assess?
Attention
Describe the serial 7s test. what does it assess for?
Instruct the patient, “Starting from 100, subtract 7, and keep subtracting 7….” Note the effort required and the speed and accuracy of the responses. Writing down the answers helps you keep up with the arithmetic. Normally, a person can complete serial 7s in 1½ minutes, with fewer than four errors. If the patient cannot do serial 7s, try 3s or counting backward.
This test assess for attention.
Poor performance may result from delirium, the late stage of dementia, intellectual disability, anxiety, or depression. Also consider educational level.
differentiate between short term and long term memory
Recent or short-term memory covers minutes, hours, or days; remote or long-term memory refers to intervals of years.
In what disorders is remote memory impaired? Recent memory?
Remote memory is usually preserved in early stages of dementia but may be impaired in its later stages.
Recent memory is impaired in dementia and delirium. Amnestic disorders impair memory or new learning ability and reduce social or occupational functioning but lack the global features of delirium or dementia. Anxiety, depression, and intellectual disability may also impair recent memory.
How can you assess new learning ability?
Give the patient three or four words such as “83, Water Street, and blue,” or “table, flower, green, and hamburger.” Ask the patient to repeat them so that you know that the information has been heard and registered. This step, like digit span, tests registration and immediate recall. Then proceed to other parts of the examination. After 3 to 5 minutes, ask the patient to repeat the words.
Note the accuracy of the response, awareness of whether it is correct, and any tendency to confabulate. Normally, a person should be able to remember the words.
What factors can you consider to assess higher cognitive function?
Higher cognitive functions are assessed by vocabulary, fund of information, abstract thinking, calculations, and construction of objects that have two or three dimensions.
Define dementia
Dementia is “an acquired condition that is characterized by a decline in at least two cognitive domains (e.g., loss of memory, attention, language, or visuospatial or executive functioning) that is severe enough to affect social or occupational functioning.
It is a major neurocognitive disorder
Describe the confusion assessment diagnostic method for diagnosing delirium.
Diagnosing delirium requires features 1 and 2 and either 3 or 4.
Acute change in mental status and fluctuating course:
Is there evidence of an acute change in cognition from baseline?
Does the abnormal behavior fluctuate during the day?
Inattention:
Does the patient have difficulty focusing attention?
Disorganized thinking:
Does the patient have rambling or irrelevant conversations, unclear or illogical flow of ideas, or unpredictable switching from subject to subject?
Abnormal level of consciousness:
Is the patient anything besides alert—hyperalert, lethargic, stuporous, or comatose?
Who should be screened for drug and/or alcohol abuse?
Every patient should be asked about alcohol use, substance abuse, and misuse of prescription drugs.
What is the difference between grey matter and white matter?
Brain tissue may be gray or white. Gray matter consists of aggregations of neuronal cell bodies. It rims the surfaces of the cerebral hemispheres, forming the cerebral cortex. White matter consists of neuronal axons that are coated with myelin. The myelin sheaths, which create the white color, allow nerve impulses to travel more rapidly.
what is the primary function of the thalamus?
processes sensory impulses and relays them to the cerebral cortex
where do hormones secreted by the hypothalamus act?
directly on the pituitary gland
what are the three areas of the brainstem?
the midbrain, the pons and the medulla
