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4th year psych > Organic mental disorders > Flashcards

Organic mental disorders Flashcards

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1
Q

What mnemonic is used to find features that suggest organic problems

A

FLAVOUR

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2
Q

What does FLAVOUR stand for

A

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.

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3
Q

CVA or traumatic brain injury result in which mood symptoms?

A

Depression in 1/3

Anxiety in 1/4

Increased suicide risk

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4
Q

CVA or traumatic brain injury result in which psychotic symptoms?

A

Bipolar, especially rapid cycling after TBI

Psychosis common after temporal lobe injury

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5
Q

CVA or traumatic brain injury result in which cognitive symptoms?

A

Vascular dementia from CVA

Punch drunk syndrome

Chronic cognitive impairment in 25% e.g. neglect, impaired learning, decreased attention, apraxia

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6
Q

CVA or traumatic brain injury result in which behavioural symptoms?

A

Frontal lobe injury–> disinhibition, aggression etc

Catastrophic reactions - burst of emotions. 20% post stroke.

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7
Q

Name some symptoms of post concussional symdrome

A

anxiety and depression

Irritability

Emotional lability

Insomnia

Hypersensitive to noise or light

Decreased concentration

Chronic tiredness

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8
Q

Is there any Rx for post concussion syndrome

A

No

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9
Q

The cause of epilepsy is generally _____

A

Unknown

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10
Q

15% epilepsy is caused by__?

A

Cerebral vascular disease

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11
Q

75% onset epilepsy is before ____years old

A

30

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12
Q

What is the most common epilepsy seizure type

A

Complex focal (60%) and 60% of this is from temporal lobe

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13
Q

Is there a link between epilepsy and learning disabilities?

A

YEs

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14
Q

What are the four phases surrounding an epileptic seizure?

A

Pre-ictal

Ictal

Post-ictal

Inter-ictal

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15
Q

During what phase(s) of epilepsy is depression likely to occur

A

Can occur in pre-ictal and ictal

Common in post-ictal and very common inter-ictal

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16
Q

During what phase(s) of epilepsy is psychosis likely to occur

A

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.

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17
Q

What psych conditions are common in epilepsy in general?

A

Depression (30-50%)

Panic disorder (21%) inter or peri ictal

Psychosis (3-7%)

Cognitive impairments

Sexual dysfunction

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18
Q

depression is most likely to occur in which type of epilepsy?

A

Temporal lobe

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19
Q

Which antidepressants are least likely to lower the seizure threshold?

A

SNRIs and SSRIs.

Citalopram least likely to interact with meds

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20
Q

Can ECT be used in a person who is depressed and has epilepsy?

A

Yes

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21
Q

What type of antipsychotics should be used in pyschosis + epilepsy?

A

Least effect on seizure threshold e.g. sulpiride or haloperidol (typicals)

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22
Q

What are pseudoseizures?

A

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.

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23
Q

Can a tumour produce psych effects?

A

Yes, including outside the CNS due to tumour by-products

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24
Q

what is the pathophysiology in MS?

A

demyelination

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25
Q

What are the psychiatric effects in MS?

A

Cognitive deficits/dementia (50%)

Depression (may be due to meds)

Mania (disease or drugs)

Emotional and mood changes (disease process)

Suicide x2

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26
Q

Are people with MS more likely to get psychosis?

A

No

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27
Q

What are the psychiatric effects of SLE?

A

Cognitive impairment

Depression

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28
Q

What is the pathophysiology of Parkinson’s?

A

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.

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29
Q

The basal ganglia controls what?

A

Movement

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30
Q

Psych effects of parkinsons?

A

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)

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31
Q

Parkinsons dementia is similar to what other type?

A

Lewy body

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32
Q

What should you bear in mind when prescribing antidepressants and antipsychotics in parkinsons?

A

Low risk of extrapyramidal SEs.

e.g. citalopram and quetiapine.

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33
Q

Huntington’s inheritance? incl which chromosome

A

Autosomal dominant

Chromosome 4

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34
Q

Huntington’s pathopysiology?

A

Cerebral atrophy + reduced GABA –> dopamine hypersensitivity

35
Q

Huntington’s psych changes

A

Cognitive decline progressing to subcortical dementia

Speech deteriorates faster than comprehension does.

Depression

Mania

Psychosis

Suicide risk

Apathy/irritability/aggression

36
Q

Huntington’s treatment? Can ADs and APs be normal?

A

Symptomatic

Normal AD and APs, but preferably atypical APs as less likely to worsen Sx

37
Q

Wilson’s disease is also known as

A

Hepatolenticular degeneration

38
Q

Wilson’s disease pathophys?

A

Autosomal recessive, excess copper in lenticulate nuclei.

39
Q

Wilson’s disease Rx

A

Timely treatment with penicillamine usually reverses neuro sx and may help psych sx

40
Q

Wilson’s disease psych

A

Depression

Emotional lability/personality or behav changes

Poor school performance

Alcohol abuse

41
Q

Eye sign of Wilson’s disease?

A

Kayler-Fleischer rings

42
Q

What are hypnogogic hallucinations?

A

Immediately before sleep

43
Q

In what disorder might you get hypnogogic hallucinations?

A

Narcolepsy

44
Q

Rx narcolepsy?

A

Stimulant such as methylphenidate (ritalin) or modafinil

45
Q

What is REM sleep behaviour disorder?

A

Individuals act out their dreams- risk of harm to self and others!

46
Q

REM sleep behav disorder can be assoc with which three organic conditions?

A

Parkinsons

LBD

Guillain Barre

47
Q

The three types of tic disorder are?

A

Transient

Chronic vocal or motor

Tourette’s

48
Q

What is transient tic disorder

A

Lasts up to 1yr

49
Q

What is chronic vocal/motor tic disorder

A

> 1yr

50
Q

What is tourette’s

A

Multiple motor tics

+ at least one vocal/phonic tic

For >1yr

51
Q

Is tourette’s more common in M or F

A

M

3-4:1

52
Q

tic disorders are associated with?

A

Learning disability

ASD

OCD

ADHD

53
Q

When do tic disorders normally start?

A

around 7y. Often begins with facial then vocal/phonic later.

54
Q

what are examples of a simple tic

A

blinking, nose wrinkling, coughing

55
Q

Examples of complex tic

A

Raspberries or twirling

56
Q

Prognosis of tics

A

Improve in severity by age 18y but normally life long

57
Q

What is coprolalia?

A

Swearing as a tic

58
Q

What is copropraxia?

A

Rude gesture as a tic

59
Q

What is echolalia/praxia?

A

Copying what others say or do

60
Q

What is pralilalia?

A

Repeat oneself

61
Q

What is NOSI?

A

Non-obscene socially inappropriate behaviour e.g. shouting ‘bomb’ on a plane

62
Q

Treatment for tic disorders?

A

Psychoeducation for family

Behaviour therapy- habit reversal training, CBIT (comprehensive behavioural intervention for tics)

Meds- antipsychotics can help with tics, clonidine ± stimulants (ADHD)

63
Q

3 psych reactions to HIV diagnosis

A

Acute stress reaction/adjustment disorders

D/A

Deliberate self harm (suicide risk increased by 20)

64
Q

Psych common in HIV in general

A

Depression

Acute mania/schizophrenia like psychosis can be secondary to HIV

AIDS dementia (rare)

65
Q

Why might depression be hard to diagnose in HIV?

A

Apathy and fatigue can be a SE of antiretrovirals

66
Q

What is AIDS-related dementia?

A

Rare now

Presents as a depression like illness

67
Q

What is the link between viral encephalitis and psych?

A

Can occasionally present as psychosis, seizures, delirium

50% survivors have disturbed behaviour/consciousness/social adjustment. Some have chronic cognitive impairment

68
Q

How can syphilis manifest as psych?

A

Tertiary syphilis- ‘general paralysis of the insane’

Personality changes

Cog changes

Dementia

Depression

Grandiosity

69
Q

What is the blood test for syphilis?

A

VDRL

70
Q

Treatment for syphilis?

A

IM penicillin

71
Q

Prion disease is a type of ______?

A

Spongiform encephalopathy

72
Q

Prion disease symptoms

A

Rapidly fatal dementia assoc with myoclonic jerks

73
Q

Cause of prion disease?

A

85% sporadic

15% familial or v rarely iatrogenic

74
Q

What type of prion disease normally begins with psych symptoms?

A

Variant (rather than classic)

75
Q

What is acute intermittent porphyria?

A

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.

76
Q

What precipitates an attack of acute intermittent porphyria

A

Spontaneous or precipitated by drugs, infection, pregnancy, decreased carb intake

77
Q

Presentation of acute intermittent porphyria

A

abdo symptoms

Neuro

Psych (delirium, depression, emotional lability, psychosis)

78
Q

Hypothyroid, hyperthyroid and cushings can all cause which psych sx?

A

Depression

Psychosis

79
Q

Hyperthyroid causes what psych symptoms

A

Irritable

Apathy

Agitation

Reduced appetite

Disorientated

80
Q

Hypothyroid = what psych sx

A

Tired

Low libido

Poor memory and mentally slow

81
Q

Cushings=what psych sx

A

Insomnia

Low libido

Thought disorder

82
Q

What are the nutritional causes of psych sx?

A

B12 and B1 deficiencies

83
Q

What does B12 defic cause?

A

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

84
Q

B1 defic can cause?

A

(thiamine)

Wernicke’s and Korsakoff’s

4th year psych (15 decks)

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