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9. Liaison psychiatry > Psychiatric aspects of neurological diseases > Flashcards

Psychiatric aspects of neurological diseases Flashcards

1
Q

Usual age of onset of symptoms of MS

A

20-40

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2
Q

Lifetime risk of MS in the UK

A

1 in 8000

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3
Q

Male:Female ratio of MS

A

1:2

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4
Q

Percentage of patients with MS who show a primary progressive course

A

5-10%

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5
Q

Percentage of patients with MS who show a relapsing remitting course

A

20-30%

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6
Q

Percentage of patients with MS who show a relapsing remitting course initially and then a secondary progressive phase

A

60%

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7
Q

Lifetime prevalence of depression among patients with MS

A

40-50%

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8
Q

MS related drugs which can cause depression

A

Steroids (most likely)
Baclofen
Dantrolene
Tizanidine
Beta interferon - controversial link (Interferon alpha which is not used for MS is clearly linked to depression)

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9
Q

Percentage chance of triggering a relapse if ECT is used for depression in MS

A

20%

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10
Q

Percentage of patients with MS with suicidal ideation

A

30%

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11
Q

Percentage of patients given steroids who develop mild/moderate mania

A

33%

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12
Q

Area of brain where lesions are often seen in patients with MS who become psychotic

A

Bilateral temporal horn areas

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13
Q

Medication which has been shown to improve cognitive function in patients with MS related cognitive impairment

A

Donepezil

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14
Q

Most common psychiatric symptom following stroke

A

Depression

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15
Q

Brain areas of stroke most commonly associated with post-stroke depression

A

Left basal ganglia
Left frontal lobe

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16
Q

Antidepressants with good evidence for post-stroke depression

A

Fluoxetine
Citalopram

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17
Q

Percentage of patients with epilepsy who have depression

A

30-50%

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18
Q

Percentage of patients with epilepsy who have panic disorder

A

20%

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19
Q

Percentage of patients with epilepsy who have psychosis

A

3-7%

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20
Q

Type of epilepsy most associated with depression

A

Temporal lobe epilepsy

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21
Q

Anti-epileptic drug associated with developing psychosis

A

Vigabatrin

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22
Q

Features consistent with pseudo-seizures rather than seizures

A

More likely to happen in the daytime or with others present
Less likely to sustain injuries
Side to side head movements
Prolonged seizures
Eyes kept tightly shut
Maintaining of body tone
Rapid recovery post-seizure
Ability to recall events
Crying or emotional displays
Normal post-ictal lactate and prolactin

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23
Q

Percentage of patients with Parkinson’s disease who have depression

A

40-50%

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24
Q

Percentage of patients with Parkinson’s disease who have euphoria

A

10%

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25
Q

Percentage of patients with Parkinson’s disease who have anxiety

A

50-65%

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26
Q

Percentage of patients with Parkinson’s disease who have psychosis (including drug related)

A

40%

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27
Q

Percentage of patients with Parkinson’s disease who have cognitive impairment without a dementia diagnosis

A

19%

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28
Q

Risk factors for Parkinson’s disease associated depression

A

Female sex
Young onset
Bradykinesia and gait abnormalities
Rapid disease progression
Cognitive impairment

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29
Q

Psychiatric symptoms associated with levodopa

A

Mania
Pathological gambling
Hypersexuality
Hallucinations

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30
Q

Percentage of patients with Parkinson’s disease who experience hallucinations

A

20%

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31
Q

Most common modality of hallucinations in Parkinson’s disease

A

Visual

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32
Q

Drugs most often used to treat Parkinson’s disease associated hallucinations

A

Low dose clozapine
Quetiapine

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33
Q

Drug most often used for Lewy Body Dementia, often seen with Parkinson’s disease

A

Rivastigmine

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34
Q

Pattern of dominance of Huntington’s disease

A

Autosomal dominant

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35
Q

Prevalence of psychiatric symptoms at the first presentation of Huntington’s disease

A

30%

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36
Q

Percentage of patients with Huntington’s disease where schizophreniform psychosis is the first presentation

A

3-6%

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37
Q

Increased risk of suicide among patients with Huntington’s disease compared to the general population

A

4x higher

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38
Q

Triplet repeat seen in Huntington’s disesae

A

CAG

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39
Q

Chromosome associated with Huntington’s disease

A

4

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40
Q

Number of CAG repeats where full penetrance for Huntington’s disease is seen

A

41

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41
Q

Number of CAG repeats where partial penetrance for Huntington’s disease is seen

A

36-40

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42
Q

Percentage of patients with Wilson’s disease with a psychiatric first presentation

A

20%

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43
Q

Percentage of patients with Wilson’s disease with cognitive impairment

A

25%

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44
Q

Percentage of patients with Wilson’s disease with depression

A

30%

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45
Q

Percentage of patients with Wilson’s disease with neurological involvement who have Kayser-Fleischer rings

A

95%

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46
Q

Percentage of patients with Wilson’s disease without neurological involvement who have Kayser-Fleischer rings

A

50-60%

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47
Q

Features of transient global amnesia

A

Abrupt onset
Anterograde amnesia during the attack
Normal conscious level
No focal neurological signs
Attack resolves within 24 hours

48
Q

Length of time episodes of transient global ischaemia last

A

6-24 hours

49
Q

Pathology in Fahr’s disease

A

Idiopathic calcium deposition in the basal ganglia
Hypointensity of the striatum

50
Q

Features of Fahr’s disease in patients aged 20-40

A

Psychosis
Catatonia
Renal stones and polyuria

51
Q

Features of Fahr’s disease in patients aged 40-60

A

Dementia
Choreoathetosis
Renal stones and polyuria

52
Q

Most common identified cause of viral encephalitis

A

Herpes simplex encephalitis

53
Q

Most common type of herpes simplex encephalitis

A

Herpes simplex type 1

54
Q

Features of herpes simplex encephalitis

A

Sudden onset confusion, memory impairment
Seizures
Depression
Psychosis
Fever

55
Q

Gold standard investigation for herpes simplex encephalitis

A

CSF PCR for herpes viruses

56
Q

Untreated fatality rate of herpes simplex encephalitis

A

70%

57
Q

Treated fatality rate of herpes simplex encephalitis

A

20-30%

58
Q

Most common cause of Kluver Bucy syndrome

A

Herpes simplex encephalitis

59
Q

Area of brain damage in Kluver Bucy syndrome

A

Bilateral temporal lobe damage

60
Q

Features of Meige syndrome

A

Repetitive chin thrusting and blinking
Symptoms disappear with sleep
Symptoms present at rest and when active

61
Q

Peak age of brain injury

A

15-24

62
Q

Two types of amnesia associated with head injury

A

Post traumatic amnesia
Retrograde amnesia

63
Q

Features of post traumatic amnesia following head injury

A

Anterograde amnesia
Includes the time of the injury and all the time following until normal memory resumes

64
Q

Features of retrograde amnesia following head injury

A

Dense amnesia just prior to the head injury
Usually lasts minutes

65
Q

Clinical result usually used to assess severity of a head injury

A

GCS at 24 hours

66
Q

Length of time of post traumatic amnesia associated with mild traumatic brain injury

A

Less than 60 minutes

67
Q

Length of time of post traumatic amnesia associated with moderate traumatic brain injury

A

1-24 hours

68
Q

Length of time of post traumatic amnesia associated with severe traumatic brain injury

A

1-7 days

69
Q

Length of time of post traumatic amnesia associated with very severe traumatic brain injury

A

> 7 days

70
Q

Most common long term psychiatric feature of traumatic brain injury

A

Depression

71
Q

Area of brain injury associated with a schizophrenia like psychosis

A

Left temporal

72
Q

Area of brain injury associated with mania

A

Right temporal
Right orbitofrontal

73
Q

Severity of brain injury associated with post-concussion syndrome

A

Mild to moderate

74
Q

Inability to identify or draw objects using visual clues

A

Apperceptive visual agnosia

75
Q

Inability to name or use objects, despite the ability to draw them

A

Associative visual agnosia

76
Q

Type of tremor which is amplified as an object is reached

A

Intention/cerebellar tremor

77
Q

Cognitive deficits commonly seen in patients with post-concussion syndrome

A

Attention deficit
Impaired processing speed

78
Q

Core symptoms of post-concussion syndrome

A

Headache
Memory impairment
Insomnia

79
Q

Common features of vascular depression

A

Anhedonia
Psychomotor retardation
Lack of insight
Lack of feelings of guilt seen in other types of depression

80
Q

Antidepressants with the best evidence for use in post-stroke depression

A

Nortriptyline
Fluoxetine

81
Q

Type of facial nerve palsy with forehead sparing

A

Upper motor neurone

82
Q

Type of facial nerve palsy without forehead sparing

A

Lower motor neurone

83
Q

Neurological condition associated with B12 deficiency anaemia

A

Subacute combined degeneration

84
Q

Increased suicide rate in patients with Huntington’s disease compared to the general population

A

4x higher

85
Q

Features of Ganser syndrome

A

Approximate answers
Clouding of consciousness
Hallucinations
Pseudo hallucinations
Motor disturbance
Anxiety
Apathy
Amnesia

86
Q

Medication used to treat pathologic crying commonly seen after stroke

A

Citalopram

87
Q

Imaging finding associated with Huntington’s disease

A

Caudate atrophy

88
Q

Imaging finding associated with Pick’s disease

A

Knife blade gyri

89
Q

Imaging finding associated with vascular dementia and age related changes

A

Multiple white matter hyperintensities

90
Q

Imaging finding associated with variant CJD

A

Pulvinar sign

91
Q

Features of Kluver-Bucy syndrome seen in herpes simplex encephalitis

A

Emotional blunting
Hyperphagia
Visual agnosia
Sexually inappropriate behaviour

92
Q

Cause of primary Meige’s syndrome

A

Idiopathic

93
Q

Demographic most commonly affected by Meige’s syndrome

A

Middle aged women

94
Q

Poor prognostic factors for psychiatric morbidity after head injury

A

Long period of post traumatic amnesia
Long period of LOC
Older age
Chronic alcohol use

95
Q

Length of time antidepressant treatment should be continued after post-stroke depression

A

6 months

96
Q

Mean duration of post-stroke depression symptoms

A

34 weeks

97
Q

Type of memory that remains intact in amnestic disorders

A

Immediate memory

98
Q

Antipsychotic which is particularly prone to causing seizures and should be avoided in patients with epilepsy

A

Clozapine

99
Q

Percentage of patients with open head injury who develop post-traumatic epilepsy

A

30%

100
Q

Percentage of patients with closed head injury who develop post-traumatic epilepsy

A

5%

101
Q

Time frame after a seizure when prolactin levels must be taken to investigate for true seizure activity

A

Within 15 minutes

102
Q

Part of chromosome 4 associated with Huntington’s disease

A

Short arm

103
Q

Risk factors for Parkinson’s disease associated dementia

A

Older patients
Late onset disease
Low SES
Low education
Severe EPSEs

104
Q

Lifetime risk of suicide in Huntington’s disease

A

10-15%

105
Q

Most common behavioural change seen in patients with Huntington’s disease

A

Lack of initiative

106
Q

Drug of choice to minimise risk of seizures in patients on clozapine therapy

A

Sodium valproate

107
Q

First generation antipsychotic most likely to cause seizures

A

Chlorpromazine

108
Q

Features of Creutzfeldt-Jakob disease

A

Rapidly progressive dementia
Myoclonus
Hallucinations
Ataxia
Gait changes

109
Q

Features of neuroacanthocytosis

A

Lurching gait with long strides
Quick, involuntary knee flexion
Seizures
Cognitive impairment

110
Q

Percentage of patients with Parkinson’s disease who have dementia

A

40%

111
Q

Percentage of patients who have delirium in the week after a stroke

A

30-40%

112
Q

Syndrome with visual hallucinations in the context of visual impairment and without psychotic symptoms

A

Charles Bonnet syndrome

113
Q

Eye condition most commonly associated with Charles Bonnet syndrome

A

Macular degeneration

114
Q

Most common mental illness in patients with MS

A

Depression

115
Q

More common direction of falls in PSP

A

Backwards

116
Q

More common direction of falls in Parkinson’s disease

A

Forwards

9. Liaison psychiatry (4 decks)

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