Organic mental disorders Flashcards
What mnemonic is used to find features that suggest organic problems
FLAVOUR
What does FLAVOUR stand for
Fluctuating symptoms
Localised cognitive defecits
Assoc neuro signs
Vague/transient paranoid delusions
Olfactory/visual hallucinations
Untypical Sx functional disorder
Record of cognitive disorder before other psych sx.
CVA or traumatic brain injury result in which mood symptoms?
Depression in 1/3
Anxiety in 1/4
Increased suicide risk
CVA or traumatic brain injury result in which psychotic symptoms?
Bipolar, especially rapid cycling after TBI
Psychosis common after temporal lobe injury
CVA or traumatic brain injury result in which cognitive symptoms?
Vascular dementia from CVA
Punch drunk syndrome
Chronic cognitive impairment in 25% e.g. neglect, impaired learning, decreased attention, apraxia
CVA or traumatic brain injury result in which behavioural symptoms?
Frontal lobe injury–> disinhibition, aggression etc
Catastrophic reactions - burst of emotions. 20% post stroke.
Name some symptoms of post concussional symdrome
anxiety and depression
Irritability
Emotional lability
Insomnia
Hypersensitive to noise or light
Decreased concentration
Chronic tiredness
Is there any Rx for post concussion syndrome
No
The cause of epilepsy is generally _____
Unknown
15% epilepsy is caused by__?
Cerebral vascular disease
75% onset epilepsy is before ____years old
30
What is the most common epilepsy seizure type
Complex focal (60%) and 60% of this is from temporal lobe
Is there a link between epilepsy and learning disabilities?
YEs
What are the four phases surrounding an epileptic seizure?
Pre-ictal
Ictal
Post-ictal
Inter-ictal
During what phase(s) of epilepsy is depression likely to occur
Can occur in pre-ictal and ictal
Common in post-ictal and very common inter-ictal
During what phase(s) of epilepsy is psychosis likely to occur
It occurs post-ictally in 6-10% with hard to manage epilepsy. <1w post seizure.
If it happens recurrently post-ictally, inter-ictal psychosis can develop. Symptoms similar to schizophrenia.
What psych conditions are common in epilepsy in general?
Depression (30-50%)
Panic disorder (21%) inter or peri ictal
Psychosis (3-7%)
Cognitive impairments
Sexual dysfunction
depression is most likely to occur in which type of epilepsy?
Temporal lobe
Which antidepressants are least likely to lower the seizure threshold?
SNRIs and SSRIs.
Citalopram least likely to interact with meds
Can ECT be used in a person who is depressed and has epilepsy?
Yes
What type of antipsychotics should be used in pyschosis + epilepsy?
Least effect on seizure threshold e.g. sulpiride or haloperidol (typicals)
What are pseudoseizures?
Dissociative convulsions
Simulate real seizures but EEG is normal during
20-30% with chronic, resistant epilepsy
Often have an emotional element/precipitant. Occur when others present/at home.
Associated with childhood sexual trauma.
Can a tumour produce psych effects?
Yes, including outside the CNS due to tumour by-products
what is the pathophysiology in MS?
demyelination
What are the psychiatric effects in MS?
Cognitive deficits/dementia (50%)
Depression (may be due to meds)
Mania (disease or drugs)
Emotional and mood changes (disease process)
Suicide x2
Are people with MS more likely to get psychosis?
No
What are the psychiatric effects of SLE?
Cognitive impairment
Depression
What is the pathophysiology of Parkinson’s?
Deficiency of dopaminergic activity in the striatum. Death of dopamine secreting neurones in the substantia nigra of the basal ganglia. Also lewy bodies in the remaining neurones.
The basal ganglia controls what?
Movement
Psych effects of parkinsons?
Dementia 80% after 8 years
Cognitive deficits
Psychosis (25%)- visual hallucinations and persecutory delusions
Depression and anxiety (40%)
Impulsive and compulsive behaviours (almost always due to dopaminergic therapy)
Parkinsons dementia is similar to what other type?
Lewy body
What should you bear in mind when prescribing antidepressants and antipsychotics in parkinsons?
Low risk of extrapyramidal SEs.
e.g. citalopram and quetiapine.
Huntington’s inheritance? incl which chromosome
Autosomal dominant
Chromosome 4
Huntington’s pathopysiology?
Cerebral atrophy + reduced GABA –> dopamine hypersensitivity
Huntington’s psych changes
Cognitive decline progressing to subcortical dementia
Speech deteriorates faster than comprehension does.
Depression
Mania
Psychosis
Suicide risk
Apathy/irritability/aggression
Huntington’s treatment? Can ADs and APs be normal?
Symptomatic
Normal AD and APs, but preferably atypical APs as less likely to worsen Sx
Wilson’s disease is also known as
Hepatolenticular degeneration
Wilson’s disease pathophys?
Autosomal recessive, excess copper in lenticulate nuclei.
Wilson’s disease Rx
Timely treatment with penicillamine usually reverses neuro sx and may help psych sx
Wilson’s disease psych
Depression
Emotional lability/personality or behav changes
Poor school performance
Alcohol abuse
Eye sign of Wilson’s disease?
Kayler-Fleischer rings
What are hypnogogic hallucinations?
Immediately before sleep
In what disorder might you get hypnogogic hallucinations?
Narcolepsy
Rx narcolepsy?
Stimulant such as methylphenidate (ritalin) or modafinil
What is REM sleep behaviour disorder?
Individuals act out their dreams- risk of harm to self and others!
REM sleep behav disorder can be assoc with which three organic conditions?
Parkinsons
LBD
Guillain Barre
The three types of tic disorder are?
Transient
Chronic vocal or motor
Tourette’s
What is transient tic disorder
Lasts up to 1yr
What is chronic vocal/motor tic disorder
> 1yr
What is tourette’s
Multiple motor tics
+ at least one vocal/phonic tic
For >1yr
Is tourette’s more common in M or F
M
3-4:1
tic disorders are associated with?
Learning disability
ASD
OCD
ADHD
When do tic disorders normally start?
around 7y. Often begins with facial then vocal/phonic later.
what are examples of a simple tic
blinking, nose wrinkling, coughing
Examples of complex tic
Raspberries or twirling
Prognosis of tics
Improve in severity by age 18y but normally life long
What is coprolalia?
Swearing as a tic
What is copropraxia?
Rude gesture as a tic
What is echolalia/praxia?
Copying what others say or do
What is pralilalia?
Repeat oneself
What is NOSI?
Non-obscene socially inappropriate behaviour e.g. shouting ‘bomb’ on a plane
Treatment for tic disorders?
Psychoeducation for family
Behaviour therapy- habit reversal training, CBIT (comprehensive behavioural intervention for tics)
Meds- antipsychotics can help with tics, clonidine ± stimulants (ADHD)
3 psych reactions to HIV diagnosis
Acute stress reaction/adjustment disorders
D/A
Deliberate self harm (suicide risk increased by 20)
Psych common in HIV in general
Depression
Acute mania/schizophrenia like psychosis can be secondary to HIV
AIDS dementia (rare)
Why might depression be hard to diagnose in HIV?
Apathy and fatigue can be a SE of antiretrovirals
What is AIDS-related dementia?
Rare now
Presents as a depression like illness
What is the link between viral encephalitis and psych?
Can occasionally present as psychosis, seizures, delirium
50% survivors have disturbed behaviour/consciousness/social adjustment. Some have chronic cognitive impairment
How can syphilis manifest as psych?
Tertiary syphilis- ‘general paralysis of the insane’
Personality changes
Cog changes
Dementia
Depression
Grandiosity
What is the blood test for syphilis?
VDRL
Treatment for syphilis?
IM penicillin
Prion disease is a type of ______?
Spongiform encephalopathy
Prion disease symptoms
Rapidly fatal dementia assoc with myoclonic jerks
Cause of prion disease?
85% sporadic
15% familial or v rarely iatrogenic
What type of prion disease normally begins with psych symptoms?
Variant (rather than classic)
What is acute intermittent porphyria?
Autosomal dominant
Disrupted heme synthesis (HMBS mutation that codes for porphobilinogen deaminase). Porphobilinogen accumulates in cytoplasm, thought to be neurotoxic. PNS is more effected as no BBB.
What precipitates an attack of acute intermittent porphyria
Spontaneous or precipitated by drugs, infection, pregnancy, decreased carb intake
Presentation of acute intermittent porphyria
abdo symptoms
Neuro
Psych (delirium, depression, emotional lability, psychosis)
Hypothyroid, hyperthyroid and cushings can all cause which psych sx?
Depression
Psychosis
Hyperthyroid causes what psych symptoms
Irritable
Apathy
Agitation
Reduced appetite
Disorientated
Hypothyroid = what psych sx
Tired
Low libido
Poor memory and mentally slow
Cushings=what psych sx
Insomnia
Low libido
Thought disorder
What are the nutritional causes of psych sx?
B12 and B1 deficiencies
What does B12 defic cause?
pernicious anaemia may lead to sub-acute combined degeneration of the spinal cord.
Slow mental process, confusion, memory probs, intellectual impairment, depression and paranoid delusions
B1 defic can cause?
(thiamine)
Wernicke’s and Korsakoff’s
