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Management of neuropsychiatric disorders > Neuropsychiatry Of Parkinson’s > Flashcards

Neuropsychiatry Of Parkinson’s Flashcards

1
Q

When might neurodegeneration in non dopaminergic nuclei occur in Parkinson’s?

A

A decade before motor symptoms

Serotonergic, cholinergic, noradrenergic nuclei

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2
Q

How common are delusions visual hallucinations in PD patients?

A

Delusions - 5%
Visual hallucinations - 8-40%

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3
Q

How common is lack of insight with PD hallucinations?

A

5%

Most patients have insight

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4
Q

What are the early stages of PD psychosis?

A

Passage and presence hallucinations
Illusions
Formed hallucinations (with preserved insight)
Unidentified figures

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5
Q

What are late symptoms of PD psychosis?

A

Loss of insight
Delusions
Misidentification (associated with lower MMSE)
Hallucinations of other senses

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6
Q

How do quetiapine and clozapine work at the low diesels used for Parkinson’s psychosis?

A

As serotonin receptor antagonists

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7
Q

What are cholinesterase inhibitors and memantine used for in PDP?

A

Mild hallucinations
Cognition

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8
Q

What is the strongest predictor of transition to institutional care in PD?

A

PD Psychosis

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9
Q

What is the prevalence of anxiety in PD?

A

40%
Particularly in younger patients
Panic attacks can occur with freezing episodes
Tremors often worsen with anxiety

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10
Q

What is the prevalence of depression in PD?

A

50%
Depression often comes 2 years before motor disorder

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11
Q

What psychotherapy was developed for Parkinson’s disease?

A

Metacognitive therapy

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12
Q

What antidepressants are useful for anxiety?

A

Citalopram - SSRI
Mirtazapine - NaSSA

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13
Q

Why aren’t TCAs used in PD?

A

Anticholinergic effects
Hypotension leads to falls

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14
Q

What is a potential interaction of rasagiline/selegiline with antidepressants?

A

Serotonin syndrome

Rasagiline and selegiline are MAOIs and can increase serotonin in combination with SSRIs

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15
Q

What is a possible area of aetiology of apathy in Parkinson’s?

A

Loss of dopamonergic activity in the mesolimbic cortex (nucleus accumbens)

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16
Q

What is the possible aetiology of impulse control disorders in PD?

A

Preserved ventral striatum is overdosed with dopamine by dopamine agonist medications causing over activity

17
Q

What treatments exist for ICD?

A

Reduce dopamine therapies (careful of withdrawal)

CBT

Naltrexone (opiate antagonist)

18
Q

What is the effect of DBS in ICD?

A

Can trigger impulse control disorder

Can reduce ICD as it allows for reduction in dopamine therapist

19
Q

What is the risk of suicide in DBS?

A

4%

20
Q

What is the prevalence of dopamine agonist withdrawal syndrome?

A

8-19%
Drug specific syndrome, have to go back on exactly what they came off

More common in people with ICD

21
Q

What are the hallmarks of Lewy Body Dementia?

A

Visual hallucinations
Fluctuation cognition
Visuospatial impairments

22
Q

What is the potential for DBS in Lewy Body Dementia?

A

Has been shown to help with psychosis but not with cognition

23
Q

What features distinguish Parkinson’s plus syndromes from Parkinson’s?

A

Symmetrical onset
Lack of tremor
Absence of response to dopamine

24
Q

What is the triad of Parkinson’s plus syndromes?

A

Progressive supra nuclear palsy
Corticobasal degeneration
Multiple system atrophy

25
Q

What are the hallmarks of multiple system atrophy?

A

Parkinsonism
Autonomic dysfunction
Ataxia

May also present with vocal cord palsy
20% of patients have cognitive impairment

26
Q

What is the distinguishing feature of MSA from Parkinson’s?

A

Autonomic dysfunction
Impotence, loss of sweating, dry mouth, orthostatic hypotension

27
Q

What are the hallmarks of PSP?

A

Akinetic rigid state:
Supra nuclear ophthalmoplegia (vertical gaze problems)
Axial rigidity
Dysarthria
Falls

80% have cognitive impairment
Subcortical dementia: executive dysfunction and slowness of thought

28
Q

What are the hallmarks of Corticobasal degeneration?

A

Progressive asymmetric rigidity

Alien limb phenomena, cortical sensory loss, myoclonus

Bradykinesia, dystonia, tremor

35% have behavioural/ neuropsychiatric features

29
Q

What conditions might you think of in a dementia patient with falls?

A

PSP or vascular dementia

30
Q

What conditions might you think of in a dementia patient with Parkinsonism?

A

Dementia with Lewy Bodies
Corticobasal Degeneration
Progressive Supranuclear Palsy

31
Q

What conditions might you think of in a dementia patient with alien hand syndrome?

A

Vascular dementia
Corticobasal Degeneration

32
Q

What conditions might you think of in a rapidly progressing dementia patient with Parkinsonism?

A

Creutzfeldt-Jakob Disease

Management of neuropsychiatric disorders (22 decks)

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