Neurpsychiatric Conditions

Question 1

Key symptoms of Stroke

Answer 1

• sudden severe headache with no known cause
• sudden trouble seeing in one or both eyes [pupil reactivity >4milimeter abnormal] / cortical blindness caused by occipital lobe damage and not eyes themselves
• sudden numbness or weakness of face, arm, leg lateralised
• sudden confusion , trouble speaking , difficulty understanding
• sudden dizziness , loss of balance or coordination (delirium)

Question 2

What are the key factors to make an epilepsy diagnosis

Answer 2

1) at least 2 unprovoked seizures occurring more than 24h apart
2) one unprovoked seizure and reoccurrence risk of min 60% for further seizures (over next 10 years)
3) diagnosis clinically supported by EEG and positive signs

Question 3

Recovery rates in ABI

Answer 3

3 months 50%
6 months 25%
12 months 12,5%

Question 4

What are the steps diagnosing ABI

Answer 4

1) Are we dealing with open or closed TBI?
2) Acute/subacute (e.g anoxic brain injury )
3) Repetitive Injuries? (e.g chronic traumatic encephalopathy)

Question 5

Huntingtons Gene Mutation?

Answer 5

Htt gene on short arm of chromosome 4> CAG repeat

Question 6

Symptoms of Huntingtons

Answer 6

• Chorea
• bradykinesia
• tremor
• dystonia
• change in mood or behaviour
• change in cognition (thinking and memory)

Question 7

Stages of huntingtons:

Answer 7

1. Presymptomatic (genetic test positive)
2. Prodromal phase (signs without symptoms )
3. Chorea Manifestations of motor signs and symptoms over 20yrs

Question 8

Symptoms of Parkinson

Answer 8

1. Motor: shaking, stiffness, slowness, poverty of movement (tremor, rigidity on passive movement, slowness of movement, bradykinesia)
2. Non motor: neuropsychiatric and cognitive disorders, drug-induced hallucinations, sensory disturbances, urinary disorders , sleep disorders, automatic dysfunctions, fatigue, sexual dysfunction

Question 9

Lewy body dementia features

Answer 9

1) Dementia onset > 2) Start of Parkinsonism > 3) Start of visual hallucinations

Question 10

What is Depersonalisation|Derealisation disorder

Answer 10

Disconnection from reality or detachment from oneself with intact awareness

Question 11

Define Intellectual Disability

Answer 11

1. Sig. impairment in intellectual functioning (<70 IQ)
2. Sig. impairment in adaptive behaviour (2SD below mean on test of adaptive behaviour)
3. Evidence of 1 and 2 in the development period (<18yrs)

Question 12

Define MS

Answer 12

Inflammatory demyelinating disease with relapse-remitting characteristic periods

Question 13

What increases the risk for MS to 99.5%

Answer 13

Ebstein-Barr Virus

Question 14

Symptoms of MS

Answer 14

• Spasticity
• Cognitive loss
• Cortical (loss of functions)/subcortical dementia (slowing, apathy, depression, difficulty accessing function-cues)
• visual, sensory impairment
• bowel and bladder
• limb weakness
• incoordination

Question 15

Type of Encephalitis causes

Answer 15

1. Infective (e.g HIV)
2. Autoimmune (NMDAR)
3. Unknown (encephalitis lathargia)

Question 16

Symptoms of Encephalitis (Acute vs Progressive)

Answer 16

Acute: sleep disturbances, movement disorder (catatonia, dyskinesia), seizures, autonomic dysfunctions, coma

Progressive: anxiety, agitation, psychosis/delusions, paranoia, hallucinations, catatonia/echolalia

Question 17

Autism in DSM V

Answer 17

1) persistent deficits and ability to initiate and sustain reciprocal social interaction and social communication

2) restricted, repetitive and inflexible patterns of behaviour, interest, activities including the differences in sensory sensitivities and interest

Question 18

Neurological diagnostic features of FND

Answer 18

• disorder of volition = harder when trying to
• observe positive signs (conscious and unconscious) like hoovers sign, give way weakness
• examine strength, balance, vision
• previous medical history explained or unexplained
• childhood trauma
• past psychiatric history
• predisposing, precipitating and maintaining factors

Question 19

Diagnostic criteria for Tourette’s

Answer 19

• multiple motor and one or more vocal tics have been present (not necessarily concurrently)
• tics may wax and wane in frequency but persist over 1 year
• onset before 18 years

Question 20

Clinical Presentation of HIV encephalopathy

Answer 20

• confusional state, memory difficulties, concentration problems, decreased drive, mood changes, mental slowing,

+ Behavioural changes: apathy, social withdrawal, agitation, anxiety, irritability, emotional lability, psychosis-like features (delusions, hallucinations)

+ Motor dysfunctions: poor balance, deterioration of handwriting, weakness of limbs

Question 21

Clinical features of progressive Multifocal Leukoencephalopathy

Answer 21

• progressive dementia
• neurological deficits
• paresis
• ataxia (lack of coordination)
• dysphasia

Question 22

How does abnormal striatal dopamine give rise to psychotic symptoms?

Answer 22

1. We learn an update beliefs through prediction errors > constant prediction of expected happening in our environment
2. When surprise occurs dopamine neurons fire > facilitating learning from experience so that event remembered with enhanced value
3. schizophrenia shows increased striatal dopamine and prediction error abnormality > increase signaling leads to aberrant assignment of importance (salience) to an important stimul
4. Excessive dopamine activity destructs normal sensory processing and perception leading to perception distortion > sensory experience not based on external stimuli (own thoughts or background noice interpreted as external voices)

Question 23

Typical Symptoms after mild TBI (early, progressive, late)

Answer 23

Early: double vision, blurred vision, nausea , dizziness, tinnitus , drowsiness

Progressive: insomnia, headache, memory, fatigue, poor concentration, noise & light sensitive

Late: irritability, anxiety, depression

Question 24

Criteria for MS diagnosis

Answer 24

Following McDonald criteria:
- time: more than 1 attack
- space lesions in more than one area (inflammatory lesions, gadolinium enhancing lesions)

• T1 black holes and atrophy
• independent immune attack in CNS
• exclude mimics

Question 25

Key symptoms of schizophrenia

Answer 25

• hallucinations
• delusions (false beliefs)
• disorganised thinking or speech
• impaired social or occupational functioning
• reduced emotional expression or motivation
• psychosis (hearing)

Question 26

Patients with dissociative seizures describe…

Answer 26

1. Somatic symptoms of arousal (panic)
2. Derealisation/ detachment (zoning out)
3. Lack of ictal fear
4. Agoraphobia
5. Post-ictal relief

Question 27

Chronic Traumatic Encephalopathy consequences

Answer 27

Late onset progressive neurological deterioration (e.g Alzheimer’s or Parkinson’s)

Question 28

Anoxic brain injury consequences

Answer 28

Metabolic injury leading to Parkinsonism, dyskinesia, myoclonus, severe cognitive impairment, behavioural problems, self harm, suicidal tendencies

Question 29

Wernickes Encephalopathy/ korsakoff syndrome

Answer 29

Thiamine (Vit B1) def causing.. - cognitive impairment (slowed processing, concentration and memory problems) dysexecutive problems)
-behavioural impairment (poor organisation, chaotic, self-centred, thoughtless, suspicious, inflexible, rigid, labile, irritable)
- emotional problems (labile, miserable, anxious, depressed)