Neuropsychiatry

Question 1

What are some neurological conditions with psychiatric symptoms?

Answer 1

Stroke, traumatic brain injury, epilepsy, MS, Parkinson’s and Huntington’s disease

Question 2

Who is most likely to suffer a traumatic brain injury?

Answer 2

Older people >65 years
Have more severe cognitive and functional impairments so greater risk of post-recovery functional decline

Question 3

Who is at risk of traumatic brain injuries?

Answer 3

Older people
Road traffic safety
Children and adolescents
Criminal offenders
Sports

Question 4

What is the DSM-5 definition of traumatic brain injury?

Answer 4

Brain injury with specific characteristics that include one of - LOC, post-traumatic amnesia, confusion + disorientation and neuro signs

Question 5

What is the main instrument for classifying the severity of TBI?

Answer 5

Mild 13-25
Moderate 9-12
Severe <8

Question 6

What is decorticate posturing?

Answer 6

Rigid extended legs, pointed and turned in toes, arms bent towards centre of body and curled wrists + balled hands

Question 7

What is decerebrate posturing?

Answer 7

Rigid extended legs, pointed and turned in toes, flexed wrists, curled fingers, and straight tense and parallel arms to body

Question 8

What increases the risk of mild TBI incomplete recovery?

Answer 8

Neck pain, early post-concussional symptoms and mental health

Question 10

What can be used as a strong predictor of the outcome in TBI?

Answer 10

Duration of post-traumatic amnesia

Question 11

What is used to assess amnesia in TBI?

Answer 11

Westmead Post Traumatic Amnesia (PTA) scale

Question 12

What are some biomarkers of alcohol withdrawal associated brain damage?

Answer 12

GFAP
UCH-L1
NfL beyond acute phase - correlates with brain volume loss, functional trajectories and cognitive performance

Question 13

What are the psychiatry symptoms seen after a TBI?

Answer 13

Irritability, depression, anxiety, apathy, emotional dysregulation, psychosis, suicide and substance misuse

Question 14

What is apathy?

Answer 14

Lack of motivation, interest or emotional response
Indifference to activities or outcomes
Emotional neutrality or blunted emotions
Impaired initiation

Question 15

Describe depression

Answer 15

Mood disorder characterised by persistent feelings of sadness, hopelessness, and loss of interest in activities
Strong negative emotions
Cognitive difficulties

Question 16

What is included in assessment of TBI?

Answer 16

Identify symptoms related and functional goals of treatment
Focus on improving functioning and QoL
Consider medication - watch for substance misuse
Treat seizures, pain and sleep apnoea…

Question 17

What antipsychotics are best to help with anxiety and sleep when psychotic symptoms?

Answer 17

Quetiapine and Olanzipine

Question 18

What therapeutic approaches are available for TBI?

Answer 18

CBT, behavioural activation, problem solving therapy, acceptance + commitment therapy, anger self management training and mindfulness based stress reduction