Neuropsychiatry and behavioural neurology Flashcards
Hemispheric lateralisation
Lateralisation is the idea that the two halves of the brain are functionally different and that each hemisphere has functional specialisations
Disinhibition is associated with which of the following brain areas or localizations? A. Left frontal lobe B. Third frontal gyrus C. Right frontal lobe D. Left hemisphere E. Left limbic area
The answer is C
Although left lateralization of language and right lateralization of visuospatial
function are widely recognized, lateral specialization in the prefrontal region
is less obvious but still of clinical significance. Frontal lobe degeneration
involving the right more than the left frontal lobe is particularly associated
with disinhibition. Women tend to show less lateralization of language, so left
hemisphere lesions are less likely to produce severe impairment.
The most common mental disorder associated with cerebrovascular disease is A. Mania B. Anxiety C. Psychosis D. Alcoholism E. Depression
The answer is E
Depressive disorders are probably the most common emotional disorder associated
with cerebrovascular disease. The prevalence depends upon whether community
based samples or hospitalized patients are examined or whether patients with
acute stroke or those with chronic stroke are evaluated. Mania and generalized
anxiety disorder (GAD) occur much less frequently than depression following
stroke.
The most common site of brain tumors is A. Frontal lobes B. Occiput lobes C. Diencephalic regions D. Pituitary gland E. Parietal lobes
The answer is A
The most common sites of brain tumors are the frontal and temporal lobes. The
least common sites are the occipital lobes, diencephalic regions, pituitary
gland, and parietal and infratentorial areas. Brain tumors are slightly more
common in men than in women.
Epilepsy patients are prone to have which of the following psychiatric conditions? A. Psychosis B. Depression C. Personality Disorders D. Hyposexuality E. All of the above
The answer is E (all)
Epidemiological studies from communities, psychiatric hospitals, and epilepsy
clinics report a 20 to 60 percent prevalence of psychiatric problems among
epilepsy patients. Epilepsy patients are prone to psychosis, depression,
personality disorders, hyposexuality, and other behavioral disorders. These
problems are approximately equally divided between those that occur ictally or
periictally and those that occur interictally or are variably related to the
ictus. The percentage of epilepsy patients in psychiatric hospitals was also higher than the general prevalence of epilepsy and ranged from 4.7 percent of
all inpatients in a British psychiatric hospital to 9.7 percent in a U.S.
Veterans Affairs psychiatric facility.
Which of the following is the single greatest risk factor for traumatic brain injury (TBI)? A. Male gender B. Alcohol or drug abuse C. African American ethnicity D. Low socioeconomic status E. None of the above
The answer is B
The single greatest risk for traumatic brain injury (TBI) is alcohol and drug
abuse. Epidemiological studies have reported that close to one-third of brain
injury patients had identifiable alcoholism before trauma. Of note, however,
males are two to three times more likely to suffer traumatic brain injuries than
females. African Americans also have higher rates of traumatic brain injuries, a
finding that may be explained by increased firearms exposure. Lower socioeconomic
status, especially unemployment, and lower levels of education also correlate
with a higher incidence of TBI. The risk of experiencing a second brain injury
is three times greater after a single previous brain injury.
Which of the following movement disorders is present in patients with tic disorders? A. Bradykinesia B. Hyperkinesia C. Hypokinesia D. Akinesia E. Ataxia
The answer is B
Tics are repeated, uncontrolled, involuntary muscular contractions or vocalizations.
They frequently occur in children and are more common in boys due to genetic
predisposition. Motor tics result in stereotyped actions that can be voluntarily
suppressed for brief periods of time. They are characterized by hyperkinesia or
excessive motility. Bradykinesia is defined as slowed movement. Hypokinesia is a
decrease in movement, while akinesia refers to an inability to initiate
movement. Bradykinesia, hypokinesia, and akinesia are all features of Parkinson’s
disease. Ataxia refers to a lack in coordination during voluntary movement, a
common feature of cerebellar and posterior column lesions. Of note, Tourette’s
syndrome is a disorder that includes both motor and vocal tics with an onset
before the age of 18 years. Tics can also occur independently, as motor tic
disorder or vocal tic disorder.
Which of the following is the most common demyelinating disorder?
A. Tay-Sachs disease
B. Hurler’s syndrome
C. Acquired immunodeficiency syndrome (AIDS)
D. Multiple sclerosis
E. Adrenoleukodystrophy
The answer is D
The etiology of the demyelinating disorders is diverse and largely conforms to the traditional, binary classification of etiology-congenital or acquired. Under
the congenital disorders are included presumed genetic and chromosomal
abnormalities. The chromosomal abnormalities include the ganglioside disorders,
such as Tay-Sachs disease, which usually present in infancy or early childhood.
Another group of congenital disorders includes the leukodystrophies, of which
there are numerous subtypes, such as metachromatic, globoid cell, adrenoleukodystrophy,
and Hurler’s syndrome. The acquired demyelinating disorders include infectious
disease, particularly acquired immunodeficiency syndrome (AIDS); trauma,
including open and, especially, closed brain trauma; vascular disorders,
including the vascular dementias; toxins, including alcohol and other solvents;
and autoimmune disorders, the most prominent of which is multiple sclerosis.
This list is certainly not inclusive, and many disease types may cause a
demyelinating encephalopathy. By far, the most common of these disorders is
multiple sclerosis.
Which of the following infectious agents have been associated with the
onset of obsessive-compulsive disorder (OCD)?
A. Streptococcal infection
B. Borrelia Burgdorferi
C. Retrovirus
D. Influenza virus
E. Varicella zoster virus
The answer is A
Evidence links streptococcal infections with the onset of obsessive-compulsive
disorder (OCD) as well as tic disorders in children. Borrelia burgdorferi is the
spirochete that causes Lyme disease and may lead to psychosis and cognitive
impairment in the late stage of infection. Retroviruses such as human immunodeficiency
virus (HIV) may lead to a host of neuropsychiatric problems, most notably AIDS
dementia, which begins with memory impairment and may progress to aphasia in the
later stages. Varicella zoster virus may rarely progress to encephalitis,
especially in immunocompromised patients. Studies have linked Influenza A and
Influenza B to the onset of encephalitis (acute or postinfectious) with a basis
in immune modulation.
Which of the following are human prion diseases?
A. Sporadic Creutzfeld-Jakob disease (sCJD)
B. Fatal familial insomnia (FFI)
C. Gerstmann-Straussler-Scheinker (GSS) disease
D. Kuru
E. All of the above
The answer is E (all)
Transmissible spongiform encephalopathies (TSEs) are an unusual and uncommon
group of infectious neurodegenerative disorders that are caused by conformational
changes, misprocessing, and malfunction of the prion protein (PRP). The human
prion diseases are sporadic Creutzfeldt-Jakob disease (sCJD), the variant
Creutzfeldt-Jakob disease (vCJD), the introgenic Creutzfeldt-Jakob disease
(iCJD), fatal familial insomnia (FFI), Gerstmann-Straussler-Scheinker (GSS)
disease, and Kuru (Table 2.1).
The diagnosis of a primary headache disorder requires the exclusion of which condition? A. Vascular malformation B. Bacterial meningitis C. Diabetes mellitus D. Pseudotumor cerebri E. All of the above
The answer is E (all)
The diagnosis of a primary headache disorder requires the exclusion of other
conditions, which include structural lesions, vascular malformations, viral or
bacterial meningitis, encephalitis, cerebral contusion, metabolic disorders,
vasculitis, brain tumors, sinusitis, and pseudotumor cerebri (a condition of the
brain that mimics a tumor but is caused by swelling or inflammation). Young,
obese females are especially prone to pseudotumor cerebri, also known as
idiopathic intracranial hypertension. One of the most important findings of the
past decades is evidence pointing to an increased risk of ischemic stroke among
young women with migraines. In children, arteriovenous malformations are a known
cause of subarachnoid hemorrhage, which often present as "the worst headache"
of one’s life
Psychopharmacological agents that appear to help patients with fibromyalgia include A. Pregabalin B. Duloxetine C. SSRIs D. SNRIs E. All of the above
The answer is E (all)
There is a significant overlap and comorbidity between patients with symptoms of
fibromyalgia and other psychiatric conditions, such as depression, panic and
anxiety, and posttraumatic stress syndromes. The significance of this comorbidity
is not understood in terms of understanding how the symptomatology arises, but
these secondary psychiatric syndromes can provide therapeutic targets for
psychopharmacology. There is also significant comorbidity between patients with
fibromyalgia and rheumatologic arthritis, systemic lupus, and others. Despite
this comorbidity, the acute symptomatology of fibromyalgia does not correlate
well with disease activity of associated medical diseases. When such diseases
are present, however, varieties of psychotropic drugs are commonly prescribed
for fibromyalgia, especially antidepressants. The antiepileptic agent pregabalin
has recently been approved by the U.S. Food and Drug Administration (FDA) for
the treatment of pain associated with fibromyalgia. A wide spectrum of
analgesics is also prescribed for such patients. The selective serotonin
reuptake inhibitor (SSRI) and serotonin norepinephrine reuptake inhibitor (SNRI)
antidepressant, duloxetine, has been reported to be effective in treating
patients with this disorder. However, experience suggests that benefits from
such therapies are neither long lasting nor associated with return to employment.
Sporadic Creutzfeldt-Jakob disease (sCJD)
Cause
Distribution/Incidence
Unknown
Global
Variant Creutzfeldt-Jakob disease (vCJD)
Cause
Distribution/Incidence
Exposure to bovine spongiform encephalopathy (BSE)
As of 2006, more than 150 cases of vCJD have been recorded and all were
associated with methionine homozygotic status at codon 129 of PRNP gene
Iatrogenic Creutzfeldt-Jakob disease (iCJD)
Cause
Distribution/Incidence
Genetic
Accidental transmission of CJD to human hosts through various medical/surgical
procedures, such as tissue transplantation
