Questions and Answers
Multiple sclerosis is the leading cause of chronic neurological disability in young adults in developing countries.
False
Depression in multiple sclerosis has a lifetime risk of approximately 50%.
True
Cognitive impairment is present in at least 70% of patients with multiple sclerosis.
False
Fatigue, depression, and cognitive impairment are common psychiatric features of multiple sclerosis.
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Encephalitis is confirmed to always be due to a primary viral infection.
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The most common viral cause of encephalitis is Herpes simplex.
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Antibodies against NMDA glutamate receptors cause viral encephalitis.
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Personality changes can be a chronic complication of encephalitis.
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Intellectual deterioration in multiple sclerosis typically begins early and progresses rapidly.
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Pseudobulbar affect is one of the more common psychiatric symptoms in multiple sclerosis.
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Normal pressure hydrocephalus is characterized by a broad-based, small-stepped gait and urinary incontinence.
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Ventricular pressure in normal pressure hydrocephalus is typically high.
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Poor memory is the most common cognitive impairment following carbon monoxide poisoning.
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Systemic lupus erythematosus (SLE) affects less than 10% of patients with neuropsychiatric manifestations at initial diagnosis.
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Carbon monoxide poisoning can only occur through deliberate self-harm.
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Parkinsonism is a common complication after anoxia and carbon monoxide poisoning, occurring after a latent interval.
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The hallmark imaging finding in normal pressure hydrocephalus is cortical atrophy.
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Neurosurgical shunt procedures are used in cases of normal pressure hydrocephalus with prominent gait disturbance.
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Psychosis is not associated with temporal lobe disorders.
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Mood disorders can result from conditions like Alzheimer's disease and stroke.
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The clinical features of secondary disorders are always distinct from primary disorders.
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A recovery from a psychiatric disorder can indicate it was secondary to a physical cause.
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Evidence of cerebral dysfunction is not relevant in determining if a disorder is secondary.
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The DSM-5 and ICD-10 use the same terminology for categorizing secondary disorders.
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Huntington's disease is associated with both mood disorders and psychosis.
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Absence of evidence for alternative psychological causes is irrelevant to diagnosing secondary disorders.
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Multiple sclerosis is associated only with psychosis.
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Personality changes can be caused by frontotemporal dementias and prion disease.
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Study Notes
Normal Pressure Hydrocephalus
- Clinical triad includes broad-based gait, frontal subcortical syndrome with bradyphrenia, and urinary incontinence.
- Condition is linked to obstruction in cerebrospinal fluid (CSF) flow, but often lacks a known cause.
- Ventricular pressure remains normal or low despite symptoms.
- Imaging typically reveals ventricular enlargement disproportionate to cortical atrophy, along with periventricular signal changes.
- Important to distinguish from depression with pseudodementia or degenerative dementia.
- Neurosurgical shunt procedures can improve CSF circulation in cases with recent onset and significant gait disturbance.
Anorexia, Hypoglycemia, and Carbon Monoxide Poisoning
- Anoxia, hypoglycemia, and carbon monoxide poisoning can result in brain injury, particularly affecting the hippocampus and globus pallidus.
- Recovery timeframe is generally shorter than that following traumatic brain injury, with less severe neurological sequelae.
- Parkinsonism may develop after a latent period.
- Poor memory is the most prevalent cognitive deficit.
- Carbon monoxide poisoning is often due to self-harm via car exhaust or accidental exposure from poor ventilation in gas appliances and fires.
- Complications after carbon monoxide poisoning vary widely; residual symptoms may remain even without loss of consciousness during poisoning.
Systemic Lupus Erythematosus
- Neuropsychiatric manifestations occur in 10% at initial presentation and 20-75% during illness.
- Cognitive dysfunction is the most frequent feature, affecting memory, attention, concentration, and psychomotor speed.
- Systemic Lupus Erythematosus (SLE) is an autoimmune disorder involving various antibodies and an inflammatory response.
Secondary or Symptomatic Neuropsychiatric Syndromes
- Disorders either defined by underlying pathology (e.g., dementias) or with a biological basis (e.g., epilepsy) are included.
- Some conditions not typically categorized as neuropsychiatric can also be explained via biological mechanisms.
- ICD-10 and DSM-5 classify these disorders differently.
- Secondary neuropsychiatric disorders result from brain diseases, while those from systemic diseases are covered separately.
The Clinical Features of Secondary Disorders
- Features of secondary disorders mimic those of primary psychiatric disorders; differentiation relies on associated evidence.
- Indicators suggesting a secondary syndrome include:
- Presence of cerebral disease or dysfunction.
- Temporal relationship between the onset of physical and psychiatric conditions.
- Improvement in psychiatric symptoms following treatment of the underlying cause.
Table 14.6: Causes of Symptomatic or Secondary Psychiatric Syndromes
- Psychosis: Linked to temporal lobe disorders, Huntington's disease, basal ganglia lesions, and infections like neurosyphilis.
- Mood disorder: Often related to Alzheimer's, stroke, head trauma, multiple sclerosis, and metabolic disorders.
- Personality change: Associated with frontotemporal dementias and various neurological conditions.
- Obsessive-compulsive behaviors: Found in frontotemporal dementias and basal ganglia disorders.
Multiple Sclerosis
- Most common cause of chronic neurological disability in young adults in developed nations.
- Early diagnosis can be challenging; physical symptoms may be mistaken for psychiatric issues.
- Psychiatric symptoms, including fatigue and depression, frequently occur, with a significant suicide risk.
- Lifetime risk of depression among MS patients is 50%, unrelated to clinical severity or lesion sites.
- Cognitive impairment affects at least 40% of patients, possibly indicating early or progressive disease.
- Cognitive deficits correlate with MRI findings of lesion load and callosal atrophy.
Encephalitis
- Defined as inflammation of brain tissue, can be caused by primary viral infections or autoimmune responses.
- Common viral cause is Herpes simplex; serious complications can arise without prompt treatment.
- Initial symptoms include headache, vomiting, impaired consciousness, and seizures.
- Chronic complications may involve prolonged anxiety, depression, or amnesic syndromes.
- A growing recognition of autoimmune encephalitis has emerged, with autoantibodies against neuronal proteins leading to psychiatric symptoms such as delirium and psychosis.
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Description
This quiz covers the clinical features and characteristics of normal pressure hydrocephalus (NPH), emphasizing its clinical triad and imaging findings. Understand the conditions leading to NPH and the significance of ventricular enlargement. Test your knowledge on this complex neurological disorder.
