Transcript neuropsychiatry introduction Dr J O`Donovan 8th June 2012x

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Neuropsychiatry
module introduction
John O’Donovan
Consultant Old Age Psychiatrist
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Neuropsychiatry
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Difficult to define
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Is it the neurology of psychiatry?
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Is it the psychiatry of neurology?
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Is it something else?
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Good and Bad
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Who do you believe?
Kraepelin
Freud
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Academic observation
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Far more charismatic
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Believe that illnesses had a
biological substrate
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Better writer
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Psychoanalysis
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Descendants dominated USA
psychiatry
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In 2012 what is his relevance?
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Psychopathology
Worked with Alzheimer and
Erb
Dominates ICD-10 and DSM 4
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Sigmund
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Prodigious intellect, a genius
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Fluent in seven languages
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Reading Shakespeare in English at 7 years of age
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Huge personal charm and charisma
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Inspirational leader, look at his followers
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Provided great insights or alternatively untestable
hypotheses. What are the alternatives to his view about
underlying psychological processes?
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Why does this matter?
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Defines psychiatry
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Also and more interestingly it allows psychiatrists to some
extent define themselves
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Neuropsychiatrists tend to be neo Kraepelin but the paradox
is that neurologists want them to be Freudian
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Very few of us are truly a “tabula rasa”
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Psychiatry of neurology
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Stroke
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Brain injury
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Epilepsy
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White matter disorders
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Dementia
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Movement disorders
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Metabolic disorders etc
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Lesion based, pathology based approach
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This is the central organ
Brain as driver of mind
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Neurology of psychiatry
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Schizophrenia
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Mood disorders
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Neurodevelopmental hypothesis
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Subtle alterations in brain
+ Functional imaging in
schizophrenia
Neuropathological but more subtle
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What about the neurologists?
+ One of Charcot’s hysterical
patients
These patients are still around.
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Pathology versus non pathology
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Both neurology of psychiatry
and psychiatry of neurology
believe in the concept of a
neuropathology and adopt a
medical model.
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Both are neo Kraepelin.
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Psychiatry of hysteria, non
epileptic attack disorder,
medically unexplained
symptoms etc, all have a far
more dynamic and Freudian
influenced model.
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Intrinsically part of
neuropsychiatry.
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The CT1 perspective
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This module
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Four days in total
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My simple priority for you
MRCPsych
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Paper one breakdown
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Basic Psychopharmacology
14
8
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History and Mental State
12
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Human Psychological Development
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Descriptive Psychopathology
24
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Social Psychology
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Cognitive Assessment 10
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Basic Psychological Processes
14
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Neurological Examination
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Dynamic Psychopathology
12
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Assessment
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Basic Psychological Treatments
8
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Description and Measurement
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History of Psychiatry
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Diagnosis 12
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Basic Ethics and Philosophy of Psychiatry
8
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Classification
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Stigma and Culture
10
16
6
4
8
8
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Aetiology 12
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Prevention of Psychological Disorder
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8
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Common question themes
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The questions come from a single common data bank.
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The same themes have been going around and around for
the last thirty years.
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The fundamental for CT1 trainees should in my view be the
first part of the MRCPsych.
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Basic clinical neurology and psychopathology will make up
about 35% of those questions.
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Broad outline
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Day one
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Epilepsy and psychiatry of epilepsy.
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Brief introduction to neuropsychiatry.
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MCQs
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Clinical neuroanatomy and common neurological questions
for the MRCPsych
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MCQs 1-6
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The following are causes of absent knee jerks and extensor
plantars.
 Motor
neuron disease
 Friedreich’s
 Pernicious
ataxia
anaemia
 Complications
A
of diabetes
neurofibroma of the conus medullaris
 Brown-Sequard
syndrome at L2 level
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MCQs 7-12
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The following are true about the pupillary response
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A lesion of the retina may impair the response.
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Part of the reflex arc takes place in the pons.
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They are consensual
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A lesion of the abduces nerve may impair the response.
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Degeneration of the ciliary ganglion may produce a tonic
pupil
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it is possible to be blind wit a normal pupillary response.
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MCQs 13-20
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In Broca’s aphasia
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Receptive speech is unimpaired
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The lesion is on the contralateral side of the hand dominance of the patient.
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Repetition is intact.
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Reading is intact.
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word production per minute is 4-6
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Secondary to stroke, the artery involved commonly originates from the
vertebrobasilar system.
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The patient may be frustrated by being inarticulate
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There is an odd connection to Hawiian tropic factor 50 (for pale Irish skin)
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MCQs 21-25
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In Wernicke’s encephalopathy
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There is a classical triad
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Diplopia is invariable
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Oral B vitamins are sufficient if given in large doses
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Gait is broad based but tandem walking is unimpaired
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Red cell transketolase activity may be used effectively as a
diagnostic test
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MCQs 26-30
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In syringomyelia with associated Arnold Chiari Malformation
the following may be present
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Severe positional headaches.
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Sensory loss in a cape distribution
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Rotatory nystagmus
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Cerebellar type dysarthria
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Cognitive impairment
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Now score them up
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To pass probably require a score of 20-30.
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Questions are a bit odd and slimey but that’s the way of the
game.
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Now lunch and reconvene at 1.30 for 2 hours of clinical
neuroanatomy.