Professional Documents
Culture Documents
organic conditions=>
What is Organic Psychiatry?
Epilepsy
20th Century
Alzheimer’s disease
Huntington’s disease
Hydrocephalus
Neurosyphilis
Alzheimer’s Disease
Tourette’s
Stroke
Unipolar Depression
Bipolar Affective Disorder
HIV/AIDs Adjustment Disorder
Anxiety Disorders
Post-Partum Affective Disorders
Organic Affective Disorders
Delirium
Cognition Dementia Alcohol
CNS Tumours Organic Amnesic Syndrome
Retrograde Anterograde
Past Recent New Future
Memory
Storage Storage Storage Storage
Retrieval
Retention
Implicit Declarative
Learning of Skills & Automatic Behaviours Learning of Information
50 45
41
40 37
30
20
10
0
Gynaeacology
Neurology
Rheumatology
Gastroenterology
Cardiology
Dental
Chest
Total
Localisation and Neuropsychiatry
Audience:
Name any psychiatric presentations attributable to specific regional effects
Background
Brain – Behaviour Relationships
2. Based on cause
Primer of Basic Neuroanatomy
Anatomical – Behaviour Relationships
DSPFC
Medial Frontal/
Cingulate
Orbito-frontal
What Makes a Diagnosis Correct?
Alzheimer Tests - Correlation with Cognition
Neuropsychiatry and Regional Syndromes 1
Post-Central Gyrus
Higher Sensory Loss
Agraphia
Geographical Agnosia
Acalculia
Apraxia
Alexia
L / R Disorientation
Neuropsychiatry and Regional Syndromes 3
Hyperphagia
Insula Cortical Deafness / Amusia
Metamorphosis
Pole
Macular / Central Hemianopia
Occipito-Temporal
Prosopagnosia
Audience:
Why is it difficult to establish clinico-anatomical relationships?
What is the anatomical basis of hearing?
Audience:
Why is it difficult to establish clinico-anatomical relationships?
Input
Tympanic Membrane
Hearing
Cochlea
Cochlear Nerve
Superior Olivary Nucleus
Lateral Leminiscus
Inferior Colliculus
Inferior Brachium
Medial Geniculate Body
Comprehension
Cerebral Cortex
Arcuate Fasiculus
Cortical Association Areas
Corpus Callosum
Corpus Callosum
Cerebellum
Output Basal Ganglia
Broca’s Area
Motor Cortex
Motor Association Cortex
Cranial Nerves V, VII and X
Muscles of articulation
Basics of Neuropsychiatry:
Psychiatric Complications
Audience:
What are examples of important neurological-psychiatric relationships?
CNS Disorder Depression Cognitive Dementia Psychosis
(all types) Deficits
I: Post-Stroke Depression
II: Parkinson’s Psychosis
Audience:
What is the cause of post-stroke depression?
Aetiology of Post-Stroke Depression
• Post-Stroke Depression
How Common Is It
Is the presentation unique?
Link with disability => Organic of functional?
What is the onset and duration
What Mechanism, anatomical, biochemical, neuropeptide?
Any special treatments?
Depression & Stroke - Correlates
Andersen et al (1995) n=285 - Major Depression
– Cognitive impairment (p<0.001)
– Social Dysfunction/Isolation (p<0.05)
– Not Anatomical factors or Functional Disability
– Female Gender (p<0.05)
Burvill et al (1997) n=191 - Major & Minor Depression
– Functional disability (p<0.01)
– Divorce (p<0.05)
– Not Cognition
Sharpe et al (1994) n=60, 5yr follow up - Major Depression
– Female Gender (p<0.05)
– Functional Disability (p<0.05)
– Large Cerebral Lesions (p<0.05)
Critical
Risk Factors Anatomical Precipitants
Cardiovascular Anomaly
Hypertension Exercise Anterior Frontal lobe
Trauma
Comorbidity Social Medial Temporal lobe
Basal Ganglia
Neurobiological
Markers
Neurological Final Common Neurophysiology
Impairment
Pathway
Neurotransmitters
Functional
Neuroendocrinology
Disability
Neuromodulators
Coping Style
Treatment of Post-Stroke Depression
• amantadine
• selegiline
• dopamine agonists
• COMT inhibitors
• levodopa
Diagnosis and Neuropsychiatry
I: Alzheimer’s disease
II: Lewy Body disease
The Dementias – Clinical Series
Diagnostic criteria & dementia prevalence
How to Assess Accuracy of a Diagnosis?
I: Audience
Theory of Diagnostic Tests
Number
of Population
Individuals
Cognitive Score
Theory of Diagnostic Tests
Point of Partial Rarity?
Number
of Cognitive Impairment
Individuals
Dementia
True
True -ve
-ve
True
True +ve
+ve
False
False -ve
-ve False
False +ve
+ve
Dementia Dementia
PRESENT ABSENT
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Bassett SS, Folstein MF.Memory complain, memory performance, and psychiatric diagnosis: a community study. J Geraitr Psychiatry Neurol 1993(6) 105-111
SMC in words
• 8 studies report the rate of SMC in dementia; 7 studies reported the
rate of SMC; 4 compared the rate of SMC in dementia and MCI head-to-
head.
No 24 39 1151 95%
clinician =>
Accuracy of Diagnostic Tests – Exp Clinical
ALZHEIMER’S ALZHEIMER’S
PRESENT ABSENT
100 97%
90
80
73%
71%
70 66%
60
50 46%
40
33%
30
20
10
0
Severe Severe Moderate Moderate Mild Mild
Dementia Dementia Dementia Dementia dementia dementia
(CI) (Dementia) (CI) (Dementia) (CI) (dementia)
GP Testing by Actual MMSE Score (n=162)
Ganguli M et al. Detection and Management of Cognitive Impairment in Primary Care: The Steel Valley Seniors Survey. JAGS 52:1668–1675, 2004.
methdos =>
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Distribution of MMSE Scores
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108 Controls
54 with dementia
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Funabiki et al (2002) Geriatrics Gerontol Int.
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Accuracy of MMSE (n=10,400 x 20 >22)
Dementia Dementia
Present Absent
Yes
No
76% (se) 86% (Sp) Prevalence = 10%
ceiling =>
Diagnosis and Neuropsychiatry
I: MCI
II: Delirium
• Mild Cognitive Impairment
A Discrete entity?
Treatment?
Features?