Organic Psychiatry

Question 1

What are the three types of delirium?

Answer 1

Hyperactive
Hypoactive
Mixed

Question 2

What is hyperactive delirium?

Answer 2

hyper alert, agitated

Question 3

What is hypoactive delirium?

Answer 3

Patient is drowsy, lethargic, withdrawn (can be missed)

Question 4

What is the clinical presentation of delirium?

Answer 4

SUDDEN onset
Symptoms fluctuate, worse at night
Altered consciousness: drowsiness, stupor // hyperalert
Cognitive impairment: inattention, disorientation, poor memory, poor thinking (rambling)
Delusions and hallucinations

Question 5

What is the management of delirium?

Answer 5

Treat cause and exacerbating factors
Stop unnecessary meds
Behavioural management (address sensory problems e.g. hearing aids, glasses, frequently reorientate with clocks, calendar, photos, good lighting)

Question 6

What is the clinical presentation of Huntington’s?

Answer 6

Depression, euphoria, irritability, aggression

Chorea (limbs, trunk, face, speech muscle)

Question 7

What are the three types of HIV associated neurocognitive disorder?

Answer 7

Asymptomatic cognitive impairment (ACI)
Mild neurocognitive disorder (MND)
Hiv Associated dementia (HAD)

Question 8

What is Asymptomatic Cognitive Impairment?

Answer 8

30% of people with HIV

Person doesn’t notice problems, but formal testing shows cognitive deficit

Question 9

What is Mild Neurocognitive Disorder?

Answer 9

Problems with memory, concentration, executive function, processing speed, motor difficulties

Question 10

HIV Associated Dementia

Answer 10

Occurs with AIDS

Ataxia, tremor, seizure, myoclonus

Question 11

What is the triad of symptoms with Normal Pressure Hydrocephalus?

Answer 11

DUI
Dementia
Unsteady gait
Incontinence of Urine

Question 12

What are the two types of prion disease?

Answer 12

sCJD - sporadic

vCJD - from infected beef

Question 13

What happens in prion disease?

Answer 13

Abnormal prion accumulation
20 years later, there is dementia, motor abnormality e.g. ataxia, myoclonus

Rapid deterioration > death

Question 14

What are common psych symptoms with Parkinson?

Answer 14

depression
dementia
psychosis

Question 15

what must you focus on when managing dementia

Answer 15

maintaining quality of life + preserving independence and dignity

Question 16

what is delirium

Answer 16

acute confusional state with SUDDEN ONSET and FLUCTUATING

Question 17

What are risk factors for delirium

Answer 17

old age 
pre-existing mental/physical illness esp dementia
substance misuse
polypharmacy
nutrition poor

Question 18

give causes of delirium

Answer 18

Vascular (stroke)
Infection(intracranial infection, septicaemia)
Trauma (head injury)

Metabolic (liver failure, renal failure, electrolyte imbalance, hypoglicaemia, Wenickes)
Inflammation (raised ICP)
Neoplasm

Drugs (intoxication, wtihdrawal, medications)

Question 19

What investigations must you get for delirium

Answer 19

Physical exam
Collateeral history
Check drug chart

FBC, CRP, U&E, LFT, Calcium 
MSU,
Oxygen sat (hypoxia is a cause) 
ECG 
CXR 
Septic screen

Question 20

Explain aetiology of Huntington’s

Answer 20

Autosomal dominant
CAG repeat in Huntingtin gene (chr 4)
lengthening causes ANTICIPATION

Abnormal huntingtin protein causes atrophy of basal ganglia and thalamys and frontal lobe

Question 21

what is anterograde memory loss

Answer 21

inability to lay down new memories from time of braind amage

Question 22

what are causes of anterograde memory loss

Answer 22

hypoxia
encephalitis
carbon monoxide poisoning
KORSAKOFFs

Question 23

Explain causes of frontal lobe syndrome

Answer 23

any type of damage to the frontal lobe

e.g. head injury, dementia, stroke

Question 24

what are symptoms of frontal lobe syndrome

Answer 24

Executive duysfunction: poor judgement, poor reasoning, poor planning and decision making

Social behaviour and persolality change:

• loss of social awareness (irresponsible, disinhibited, inappropriade)
• impulsive
• euphoric

Apathy

• lack of motivation and initiative
• decline in self care