Neuro Flashcards
What is the leading cause of disability worldwide?
depression
Most common physical comorbidities with mental health disorders (4)
1) CVD
2) hypertension
3) respiratory disease
4) diabetes
Concurrent disorder: mental health disorder & _________
problematic substance use/substance use
T or F: Those with a mental health disorder are more likely than members of the general public to engage in violent behaviour.
FALSE
What is essential when doing a mental health assessment with a patient?
build rapport
Elements of a mental health history (4)
1) Interview
2) Observation
3) Examination
4) Collaboration
What is the primary source of information in a mental health assessment?
patient
What are secondary sources of information in a mental health assessment?
family, other HCP, patient records
T or F: For most patients, conducting an interview is sufficient enough for a mental health assessment.
TRUE
Interview
complete health history
what’s normal for the patient
identification/biographical info
reason for seeking care (verbatim or DSM5 diagnoses)
past health
family health history
developmental considerations
present health
What should you assess first during observation?
most basic functions (consciousness, language)
Main Components of Observation (4)
1) Appearance
2) Behaviour
3) Cognition
4) Thinking
Orientation x 4
1) Person
2) Place
3) Time
4) Self
What is the first sense/orientation to go?
time
What is the last sense/orientation to go?
self
Order in which the senses go
time –> place –> self
Questions to assess orientation to person
who examiner is, type of worker
Questions to assess orientation to place
where person lives, present location, type of building, names of city and province
Questions to assess orientation to time
day of week, date, year, season
Questions to assess orientation to self
person’s own name, age
Questions to assess immediate memory
on spot recall
ask to recall a statement you just made
affected by: head injury, fatigue, anxiety, strong emotions
Questions to assess recent memory
day-to-day events
“What did you think of the meal yesterday?”
affected by: organic disorders - delirium, dementia, amnesia, chronic alcoholism
Questions to assess long-term memory
years worth of experiences
“Where did you grow up?”
affected by: Alzheimer’s
How to assess new learning
Give them 4 unrelated words and ask them to recall a few minutes later
e.g. fun, carrot, ankle, loyalty
Alzheimer’s: 0 or 1 words recalled
also affected by anxiety, depression
Tool to assess risk factors for suicide
SADPERSONS
Score out of 10
-Score 3-6 = consider very close follow-up or hospitalization
-Score 7+ = consider hospitalization, contact MRP
higher score=higher risk
A patient scores an 8 on the SADPERSONS scale. What should your next course of action be?
a) consider this as normal and document
b) contact the most responsible provider
c) monitor the patient
d) call the patient first thing tomorrow morning and ask them how they’re feeling
b) contact the most responsible provider
and consider hospitalization
Tool to assess patient’s functioning
Global Assessment of Functioning
psychiatrist or other qualified physician
estimate of overall psychological, social, and occupational functiong
score: 0 to 100 (higher=better functioning, under 50=serious, severe)
When to perform mental health assessment (5)
1) Abnormality in mood or behaviour
2) Symptoms of mental illness, especially ACUTE onset
3) Family concerned
4) Brain lesions - trauma, tumour, stroke
5) Aphasia
For a depression diagnosis, the patient must experience sadness and loss of interest in activities for at least _____ weeks
2 weeks
Additional symptoms for depression diagnosis (7)
1) Disruption in sleep
2) Disruption in appetite
3) Poor concentration
4) Low energy
5) Psychomotor agitation or retardation
6) Excessive guilt
7) Feelings of worthlessness
need at least 4/7
T or F: In children and adolescents, emotional and cognitive functioning are independent of one another
FALSE
interdependent
ask about educational and developmental milestones
T or F: The majority of mental health disorders have onset during childhood and adolescence.
TRUE
70%
Which age group is more likely to experience mental illness and/or substance use disorders than any other age group?
Young adults 15 to 24
Screening tools for perinatal period
Edinburgh Postnatal Depression Scale (EPDS)
T or F: There is universal consensus on the value of universal perinatal depression screening.
FALSE
but HCP needs to be aware and alert to this
4 Lobes of the Cerebral Cortex
1) Frontal
2) Parietal
3) Occipital
4) Temporal
Frontal Lobe
personality, behaviour, emotions, intellectual function
precentral gyrus: initiates voluntary movement
Broca’s area: mediates motor speech, damaged=expressive aphasia: person can understand language and knows what they would like to say, but can produce only a garbled sound
Parietal Lobe
postcentral gyrus: primary centre for SENSATION
Occipital Lobe
primary VISUAL receptor centre
(think of the O like an eye)
Temporal Lobe
primary AUDITORY receptor centre
Wernicke’s area: language comprehension
damaged=receptive aphasia: person hears sound, but it has no meaning, like hearing a foreign language
Aphasia
impairment of language ability secondary to brain damage
Broca’s/Expressive Aphasia
can understand language but cannot express self with language
nonfluent, dysarthric, and effortful speech
motor speech cortex
Wernicke’s/Receptive Aphasia
can hear sounds and words but cannot relate them to previous experiences
speech is fluent, effortless, and well-articulated but nonsensical
association auditory cortex
You ask a patient to tell you where they live and they respond, “Two of them. And up and down.” What type of aphasia do they have?
a) Broca’s
b) Wernicke’s
b) Wernicke’s
Basal Ganglia
controls autonomic associated movements of the body
“Be Good at movements”
Thalamus
main relay station
think T for “train station”
Hypothalamus
major control centre
controls temp, HR, BP
regulating sleep and pituitary
coordinating ANS activity and emotional stress
Cerebellum
motor coordination of:
-voluntary movements
-equilibrium
-muscle tone
does NOT initiate movements
Components of the brain stem (3)
1) midbrain
2) pons
3) medulla
Where in the brain are the vital autonomic centres located?
medulla
e.g. resp, cardiac, GI
Which structure in the CNS mediates reflexes?
spinal cord
KEEP GOING YOU CAN DO THIS
SLAY UR EXAM
Reflex Arc
basic defense mechanism of the nervous system
involuntary
enabling quick reaction to potentially painful or damaging stimulus
maintain balance and muscle tone
4 Types of Reflexes
1) deep tendon
2) superficial
3) visceral
4) pathological
“don’t stop vibing, people”
Deep Tendon Reflex Example
e.g. patellar (knee jerk)
Superficial Reflex Example
e.g. corneal reflex, abdominal reflex
Visceral Reflex Example
e.g. pupillary response to light and accomodation
Pathological Reflex Example
e.g. positive Babinski (extensor plantar) reflex
ABNORMAL
What order does myelination in infants follow?
a) distal to proximal
b) proximal to distal
b) proximal to distal
head → neck → trunk → extremities
What is the most important piece of information in the initial assessment for stroke?
time of onset
Stroke - FAST acronym meaning
F - FACE - drooping?
A - ARMS - raise both?
S - SPEECH - slurred or jumbled?
T - TIME - to call 911 right away
Balance Tests (3)
1) Gait
-get patient to walk
2) Tandem walking
-heal-to-toe walking
3) Romberg
-get them to stand for 20 seconds with eyes closed
Coordination and Skilled Movement Testing (4)
1) RAM
-slapping palm and back of hand back and forth across thighs, thumb and fingers
2) Finger-to-finger
-patient touches nose and examiners finger
3) Finger-to-nose
-patient closes eyes and alternates touching nose
4) Heel-to-shin test
Spinothalamic Tract Sensations (3)
1) Pain - pinprick, something sharp
2) Temperature - cool metal, tuning fork
3) Light touch - cotton whisp
Posterior Column Tract Sensations (3)
1) Vibration
-tuning fork
2) Position (Kinaesthesia)
-move their finger up or down and ask which direction you moved it
3) Tactile Discrimination (Fine Touch)
-Stereognosis: recognizing familiar object in hand
-Graphaesthesia: reading number or letter on skin
-2 Point Discrimination - paperclip
-Extinction - touch both sides of body at same time, ask how many sensations are felt and where
-Point location - point to location of touch
Testing Deep Tendon Reflex
e.g. knee jerk reflex
reflex hammer
hit tendon insertion on both sides, should be symmetrical
Grading Deep Tendon Reflex
4+: Very brisk, hyperactive with clonus (rapid, rhythmic contraction), indicative of disease
3+: Brisker than average, may indicate disease (upper motor lesions e.g. MS)
2+: Average, normal
1+: Diminished, low normal (lower motor lesions)
0: No response
Testing Clonus
move the foot up and down a few times to relax the muscle
stretch the muscle by briskly dorsiflexing the foot and hold stretch
Normal: no further movement
Abnormal: clonus
Testing Superficial Reflex
e.g. plantar reflex/Babinski
edge of reflex hammer on bottom of foot
normal: plantar flexion of the toes and inversion and flexion of the forefoot
abnormal: dorsiflexion of toes and fanning out of toes
NORMAL IN INFANTS THOUGH
(Babinski - think babi, normal in babies)
