DEMENTIA
Dermatitis, diarrhoea and dementia are seen in deficiency of :
| A |
Thiamine |
|
| B |
Riboflavin |
|
| C |
Niacin |
|
| D |
Methionine |
Dermatitis, diarrhoea and dementia are seen in deficiency of :
| A |
Thiamine |
|
| B |
Riboflavin |
|
| C |
Niacin |
|
| D |
Methionine |
Pseudo dementia is seen in:
| A |
Alcoholism |
|
| B |
Depression |
|
| C |
Schizophrenia |
|
| D |
Mania |
Pseudo dementia is seen in:
| A |
Alcoholism |
|
| B |
Depression |
|
| C |
Schizophrenia |
|
| D |
Mania |
B i.e. Depression
Pseudo-Dementia (Depression related cognitive dys functions) is found in depressionQ. They have past h/o depression. Have more insight into their symptoms – i.e. themselves complaints of memory impairment, difficulty in sustaining attention & concentration; & reduced intellectual capacity. In contrast, a patient of dementia does not c/o these disturbance.
True about dementia is A/E
| A |
Hallucination are not common |
|
| B |
Clouding of consciousness is common |
|
| C |
Nootropics have limited role |
|
| D |
All |
True about dementia is A/E
| A |
Hallucination are not common |
|
| B |
Clouding of consciousness is common |
|
| C |
Nootropics have limited role |
|
| D |
All |
B i.e. Clouding of consciousness is common
- Clouding of consciousness is a characteristic feature delirium & is helpful in differentiating it from dementiaQ.
- Two most common causes of dementia are Alzheimer’s & multi infarct; both of which are irreversible.
Characteristic feature of subcortical dementia is
| A |
Memory loss |
|
| B |
Aphasia |
|
| C |
Dyslexia |
|
| D |
Tactile agnosia |
Characteristic feature of subcortical dementia is
| A |
Memory loss |
|
| B |
Aphasia |
|
| C |
Dyslexia |
|
| D |
Tactile agnosia |
A i.e. Memory loss
Aphasia, Agnosia, Dyslexia are characteristic features of cortical dementia. So we are only left with memory loss for sub cortical dementia.
Subcortical dementia is seen in all except :
| A |
Parkinsonism |
|
| B |
Alzheimer’s disease |
|
| C |
Wilsoms disease |
|
| D |
Huntingtons Chorea |
Subcortical dementia is seen in all except :
| A |
Parkinsonism |
|
| B |
Alzheimer’s disease |
|
| C |
Wilsoms disease |
|
| D |
Huntingtons Chorea |
B i.e. Alzheimer’s disease
Dementia is seen in all except:
| A |
Schizophrenia |
|
| B |
Alzheimer’s disease |
|
| C |
Huntington’s chorea |
|
| D |
Pick’s ds |
Dementia is seen in all except:
| A |
Schizophrenia |
|
| B |
Alzheimer’s disease |
|
| C |
Huntington’s chorea |
|
| D |
Pick’s ds |
A i.e. Schizophrenia
Most common cause dementia in adult:
| A |
Alzheimer’s |
|
| B |
Multiinfrct |
|
| C |
Pick’ disease |
|
| D |
Metabolic cause |
Most common cause dementia in adult:
| A |
Alzheimer’s |
|
| B |
Multiinfrct |
|
| C |
Pick’ disease |
|
| D |
Metabolic cause |
A i.e. Alzheimer’s
One of the following is a reversible cause of dementia :
| A |
Toxic dementia |
|
| B |
Alzheimer’s ds. |
|
| C |
Multi – infarct dementia |
|
| D |
Pick ds |
One of the following is a reversible cause of dementia :
| A |
Toxic dementia |
|
| B |
Alzheimer’s ds. |
|
| C |
Multi – infarct dementia |
|
| D |
Pick ds |
A i.e. Toxic
Reversible cause of dementia is
| A |
Multi infarct |
|
| B |
Senile Dementia |
|
| C |
Post Encephalitis |
|
| D |
Hutington’s chorea |
Reversible cause of dementia is
| A |
Multi infarct |
|
| B |
Senile Dementia |
|
| C |
Post Encephalitis |
|
| D |
Hutington’s chorea |
C i.e. Post Encephalitis
Vascular dementia is characterized by
| A |
Disorientation |
|
| B |
Memory deficiet |
|
| C |
Emotional liability |
|
| D |
All |
Vascular dementia is characterized by
| A |
Disorientation |
|
| B |
Memory deficiet |
|
| C |
Emotional liability |
|
| D |
All |
Ans. D. All
- These all are features of dementia
- Dementia is characterized by multiple cognitive defects that include impairment in memory, without impairment in consciousnessQ.
- The cognitive functions that can be affected in dementia include general intelligence, learning & memory, language, problem solving, orientation, perception, attention & concentration, judgement & social abilities (key words : think about a very old man who is unable to learn new things, concentrate, judge & solve problems with poor personal care, general intelligence, social abilities & communication skills.)
- Vascular dementia characteristically presents with – sudden onset in early age, stepwise & patchy progression with focal neurological signs & symptomsQ & greater preservation of personality.
Dementia of Alzheimer’s type is not associated with one of the following :
| A |
Depressive symptoms |
|
| B |
Delusions |
|
| C |
Apraxia and aphasia |
|
| D |
Cerebral infarcts |
Dementia of Alzheimer’s type is not associated with one of the following :
| A |
Depressive symptoms |
|
| B |
Delusions |
|
| C |
Apraxia and aphasia |
|
| D |
Cerebral infarcts |
D i.e.Cerebral infarcts
The term “Dementia precox” was coined by
| A |
Freud |
|
| B |
Bleuler |
|
| C |
Kraepelin |
|
| D |
Schneider |
The term “Dementia precox” was coined by
| A |
Freud |
|
| B |
Bleuler |
|
| C |
Kraepelin |
|
| D |
Schneider |
C i.e., Kraepelin
- Benedict Morel used term demence precoce (in french) for deteriorated patients whose illness began in adolescence.
- Emil Kraeplin translated it into dementia. PrecoxQ i.e. dementia = deteriorated cognitive process & precox = early onset
- Eugen Bleuler coined term schizophreniaQ
- Kahlbaum described catatoniaQ, Hacker decribed hebephrenia
Presenile dementia is defined as that which occur below the age of ……. years :
| A |
50 |
|
| B |
55 |
|
| C |
60 |
|
| D |
65 |
Presenile dementia is defined as that which occur below the age of ……. years :
| A |
50 |
|
| B |
55 |
|
| C |
60 |
|
| D |
65 |
C i.e. 60
True about dementia is:
Karnataka 07
| A |
Alzheimer’s disease is due to multiple small strokes in the cerebral cortex |
|
| B |
Dementia is the loss of distant memory |
|
| C |
Dementia due to atherosclerosis does not progress like Alzheimer’s |
|
| D |
Alzheimer’s disease is associated with an increase in ACh release in the cerebral cortex |
True about dementia is:
Karnataka 07
| A |
Alzheimer’s disease is due to multiple small strokes in the cerebral cortex |
|
| B |
Dementia is the loss of distant memory |
|
| C |
Dementia due to atherosclerosis does not progress like Alzheimer’s |
|
| D |
Alzheimer’s disease is associated with an increase in ACh release in the cerebral cortex |
Ans. Dementia is the loss of distant memory
All are reversible causes of dementia except ‑
| A |
Hypothyroidism |
|
| B |
Hydrocephalus |
|
| C |
Meningoencephalitis |
|
| D |
Alzheimer’s disease |
All are reversible causes of dementia except ‑
| A |
Hypothyroidism |
|
| B |
Hydrocephalus |
|
| C |
Meningoencephalitis |
|
| D |
Alzheimer’s disease |
Ans. is ‘d’ i.e., Alzhimer’s disease
Reversible causes of dementia
- 1) Surgically treatable :- Normal pressure hydrocephalus, brain tumors (frontal lobe tumor), meningioma, subdural hematoma due to head injury, hydrocephalus.
- 2) Medically treatable :- Depression, hypothyroidism, alcohol abuse, vitamin B n/folate/Niacin deficiency, any metabolic or endocrine disturbance, neurosyphilis, Hashimoto’s encephalopathy, Wilson’s disease, celiac disease, whipple’s disease, chronic meningoencephalitis, drugs and toxin (toxic dementia).
Irreversible causes of dementia :–
- Alzheimer’s disease, vascular (multi-infarct) dementia, Parkinsonism, Huntington’s chorea, Lewy body dementia, Pick’s disease.
All are true regarding Fronto-temporal dementia except:
| A |
Stereotypic behavior |
|
| B |
Insight present |
|
| C |
Age less than 65 years |
|
| D |
Affective symptoms |
All are true regarding Fronto-temporal dementia except:
| A |
Stereotypic behavior |
|
| B |
Insight present |
|
| C |
Age less than 65 years |
|
| D |
Affective symptoms |
Ans. b. Insight present (Ref Kaplan and Sadocks 9/e p1194-1198; Harrison 19/e p2602, 18/e p3309-3311) Fronto-Temporal Dementia:
- Insight is absent in Fronto-temporal dementia.
- FTD often begins in the 5′hto 7th decades.
- Patients with FTD often show an absence of insight into their condition.
- Common behavioral features include apathy, disinhibition, weight gain, food fetishes, compulsions, and emotional distance or loss of empathy.
| Fronto-Temporal Dementia |
|
FTD often begins in the 5′ to 7′ decades’) More common in menu Unlike in Alzheimer’s disease (AD), behavioral symptoms predominate in the early stages of FTD° Family history of dementia is common° |
| MC autosomal dominantly inherited mutations causing FTD involve the MAPT or GRN genes, both on chromosome 17. |
|
Clinical features: Early symptoms are divided among behavioral, language, and sometimes motor abnormalities, reflecting degeneration of the anterior insular, frontal, and temporal regions, basal ganglia, and motor neurons. |
| Cognitive testing typically reveals spared memory but impaired planning, judgment, or language°. |
|
Poor business decisions and difficulty organizing work tasks are common, and speech and language deficits often emerge. Patients with FTD often show an absence of insight into their condition. Common behavioral features include apathy, disinhibition, weight gain, food fetishes, compulsions, and emotional distance or loss of empathy. |
|
Diagnosis: Distinguishing anatomic hallmark of FTD: Focal atrophy of frontal, insular, and/or temporal cortex, which can be visualized with neuroimaging studies (MRI)° |
| Microscopic findings seen across all patients with FTD include gliosis, microvacuolation, and neuronal loss° |
Incorrect about dementia pugilistica
| A |
Seen in boxers |
|
| B |
Difficulty in gait |
|
| C |
Decreased cognition |
|
| D |
Nystagmus |
Incorrect about dementia pugilistica
| A |
Seen in boxers |
|
| B |
Difficulty in gait |
|
| C |
Decreased cognition |
|
| D |
Nystagmus |
Answer- D. Nystagmus
Dementia Pugilistica (DP), otherwise known as’punch-drunk syndrome’or’boxer’s dementia,” is a form of dementia that originates with repeated concussions or other traumatic blows to the head.
Symptoms of Dementia Pugilistica
- Progressively declining cognitive ability
- Physical tremors
- Difficulty in speech
- Pathological feelings of jealousy or paranoia
- Short-term memory loss
- Loss of physical coordination
- Changes in gait
Which of the following dementia is associated with visual hallucinations?
| A |
Lewy body dementia |
|
| B |
AIDS related Dementia |
|
| C |
Huntington’s disease |
|
| D |
Mixed dementia |
Which of the following dementia is associated with visual hallucinations?
| A |
Lewy body dementia |
|
| B |
AIDS related Dementia |
|
| C |
Huntington’s disease |
|
| D |
Mixed dementia |
Ans. A. Lewy body dementia –
- Lewy body dementia, also known as dementia withLewy bodies, is the second most common type of progressive dementia after Alzheimer’s disease dementia.
- Protein deposits, called Lewy bodies, develop in nerve cells in the brain regions involved in thinking, memory and movement (motor control).
DEMENTIA
DEMENTIA
Introduction:
- Defined as a progressive impairment of cognitive functions in absence of any disturbances of consciousness.
Prevalence:
- Increases with age.
- 5% in population older than 65 years; 20-40% in older than 85 years.
Symptoms:
1. Cognitive impairment:
- Characterized by 4 A’s: amnesia, aphasia, apraxia & agnosia.
Amnesia:
- Memory impairment.
- Can be episodic (memory for events) & semantic (memory for facts rules, words and language) & visuospatial deficits.
Aphasia:
- Disturbances of language function.
Apraxia:
- Inability to perform learned motor functions.
- Eg: Difficulties in functions like buttoning the shirt or combing the hair.
Agnosia:
- Inability to interpret sensory stimulus.
- Most common disturbance -‘prosopagnosia” – Inability identifing face.
Other cognitive impairments:
- Disturbances in executive functioning (i.e. planning, organizing, sequencing & abstracting).
2. Behavioral & psychological symptoms:
- Personality changes, hallucinations & delusions, depression, manic & anxiety symptoms, apathy, agitation, aggression, wandering circadian rhythm disturbances, catastrophic reaction.
- Catastrophic reaction – Subjective awareness of intellectual deficits in stressful situation result in emotional outburst in dementia patient.
3. Focal neurological signs & symptoms:
- Seen in vascular dementia (multi-infarct dementia) corresponding to site of vascular insults.
Types:
1. Depending on reversibility – Reversible dementia (15% patients) & Irreversible dementia.
Causes of reversible dementia:
- Neurosurgical conditions (subdural hematoma, normal pressure hydrocephalus, intracranial tumors, intracranial abscess).
- Infectious causes (meningitis, encephalitis, neurosyphilis, lyme disease).
- Metabolic causes (vitamin B12 or folate deficiency, niacin deficiency, hypo and hyperthyroidism, hypo & hyperparathyroidism).
- Others (drugs and toxins, alcohol abuse, autoimmune encephalitis).
2. Depending on involvement of area of brain:
- Cortical & Sub-cortical (As to area affetced by dementing process first).
Cortical dementias:
Clinical features:
- Characterized by early involvement of cortical structures & hence, early appearance of cortical dysfunction.
- Amnesia, apraxia, aphasia, agnosia & acalculia (impaired mathematical skills) indicating cortical involvement.
Subcortical dementia:
Clinical features
- Early involvement of subcortical structures (basal ganglia, brain stem nuclei & cerebellum).
- Characterized by early presentation of motor symptoms (abnormal movements like tics, chorea, dysarthria).
- Significant disturbances of executive functioning.
- Prominent behavioral & psychological symptoms (apathy, depression, bradyphrenia (slowness of thinking).
Conditions associated:
- Parkinson’s disease, Wilson’s disease, Huntington’s disease, multiple sclerosis, progressive supranuclear palsy, normal pressure hydrocephalus.
Other types of dementia:
- Vascular dementia (multi-infarct dementia), lewy body disease (dementia with lewy body), HIV related Dementia, frontotemporol dementia (FTD) & pseudodementia
1. Vascular dementia (multi-infarct dementia):
- 2nd most common type of dementia.
- History of stroke.
Causes:
- Occurrence of multiple cerebral infarction (due to occlusion of cerebral vessels by arteriosclerotic plaques or thromboemboli) → progressive deterioration of brain functions → dementia.
- Acute exacerbations corresponding to new infarcts → Stepwise deterioration of symptoms (step-ladder pattern).
Treatment:
- Management of risk factors & cholinesterase inhibitors.
2. Binswanger’s disease:
- Also referred as “subcortical arteriosclerotic encephalopathy”.
- Characterized by multiple small white matter infarctions —> Result in subcortical dementia symptoms.
3. Lewy Body Disease (Dementia with Lewy Body):
- Clinical features similar to Alzheimer’s disease.
Pick’s dlsease:
- One pathological variant of FTD.
- Characterized by presence of pick’s bodies.
- Earlier onset (45-65 years).
- Presents with behavioral symptoms & change in personality with relative memory preservation.
7. Pseudodementia:
- Depression in elderly patients mimicing dementia symptoms.
Management for dementia:
- mini mental status examination (MMSE):
- Screening test.
- Evaluation of cognitive functions.
- Score of less than 24 (out of a maximum 30) – Suggestive of dementia.
Medications:
- Cholinesterase inhibitors – Donepezil, rivastigmine, galantamine & tacrine.
- NMDA receptor antagonist – Memantine.
- Symptomatic treatment – For behavioral & psychological symptoms of dementia.
- Includes antidepressants, antipsychotics & benzodiazepines.
Exam Important
- Cognitive impairment in dementia is characterized by 4 A’s: amnesia, aphasia, apraxia & agnosia.
- Catastrophic reaction is subjective awareness of intellectual deficits in stressful situation result in emotional outburst in dementia patient.
- Reverslble causes of dementia includes subdural hematoma, normal pressure hydrocephalus, intracranial tumors, intracranial abscess.
- Alzheimer’s disease is the prototype of cortical dementia.
- Binswanger’s disease is also known as subcortical arteriosclerotic encephalopathy.
- Pick’s dlsease is one pathological variant of FTD characterized by earlier onset & presence of pick’s bodies.
- Depression in elderly patients may mimic symptoms of dementia and hence is known as pseudodementia.
- The evaluation of cognitive tunctions in dementia is done using screening test of mini mental status examination (MMSE).
AMNESTIC DISORDERS
A patient developed memory deficit for recent events. Anterograde amnesia is a feature of:
| A |
Post-head injury |
|
| B |
Stroke |
|
| C |
Spinal cord injury |
|
| D |
Traumatic paraplegia |
A patient developed memory deficit for recent events. Anterograde amnesia is a feature of:
| A |
Post-head injury |
|
| B |
Stroke |
|
| C |
Spinal cord injury |
|
| D |
Traumatic paraplegia |
Patients seen shortly after head injury exhibit a confusional state in which they are unable to incorporate new memories, is known as anterograde, or posttraumatic amnesia. They may behave in an apparently normal automatic fashion.
Psychogenic amnesia is characterized by
| A |
Antegrade Amnesia |
|
| B |
Retrograde Amnesia |
|
| C |
Both with confabulation |
|
| D |
Patchy impairment of Personal memories |
Psychogenic amnesia is characterized by
| A |
Antegrade Amnesia |
|
| B |
Retrograde Amnesia |
|
| C |
Both with confabulation |
|
| D |
Patchy impairment of Personal memories |
D i.e. Patchy impairment of personal memories
- Psychogenic (Dissociative) amnesia is commonest clinical type of dissociative disorder. It is characterized by a sudden inability to recall important personal information particularly concerning stressful or traumatic life events.Q
Amnesia is found in
| A |
Head injury |
|
| B |
Mania |
|
| C |
Schizophrenia |
|
| D |
Psychiatric state |
Amnesia is found in
| A |
Head injury |
|
| B |
Mania |
|
| C |
Schizophrenia |
|
| D |
Psychiatric state |
A i.e. Head injury
- Amnesia can be seen after head injuryQ either as a part of concussion injury or as an organic brain syndrome.
- Other causes of amnesia are
- Organic amnestic syndromes – Dementia, delirium, Korsakoff”s syndromeQ
- Dissociative disorder
- Transient global amnesia
Type of memory loss in different Organic mental disorders
|
Memory |
Delirium |
Dementia |
Organic Amnestic syndrome |
|||
|
Immediate memory |
|
|
Normal |
|
Normal |
|
|
Disturbed |
|
|||||
|
Recent memory |
Disturbed |
|
Disturbed |
|
Disturbed |
|
|
Remote memory |
Normal |
|
Disturbed |
|
Disturbed |
|
|
|
|
|
||||
Antegrade amnesia is seen in:
AIIMS 10
| A |
Post-traumatic head injury |
|
| B |
Drug induced |
|
| C |
Electroconvulsive therapy |
|
| D |
Stroke |
Antegrade amnesia is seen in:
AIIMS 10
| A |
Post-traumatic head injury |
|
| B |
Drug induced |
|
| C |
Electroconvulsive therapy |
|
| D |
Stroke |
Ans. Post-traumatic head injury
AMNESTIC DISORDERS
AMNESTIC DISORDERS
- Broad category including variety of conditions presenting amnestic syndrome.
Features:
- Characterized by inability to form new memories (anterograde amnesia) & inability to recall previously remembered knowledge (retrograde amnesia).
- Short-term & recent memory – Impaired with preservation of remote & immediate memory.
Causes:
Major causes:
- Thiamine deficiency (Korsakoff syndrome).
- Hypoglycemia.
- Primary brain conditions (head trauma, seizures, cerebral tumors, cerebrovascular disease, hypoxia, electroconvulsive therapy, multiple sclerosis).
- Substance related disorders (alcohol, benzodiazepines).
Exam Important
- Major causes of amnestic disorders are thiamine deficiency (Korsakoff syndrome), hypoglycemia, primary brain conditions (head trauma, seizures, cerebral tumors, cerebrovascular disease, hypoxia, electroconvulsive therapy, multiple sclerosis).
DYSSOMNIA & PARASOMNIA
Which of the following clinical finding is seen in parasomnia?
| A |
Nocturnal enuresis |
|
| B |
Night terror |
|
| C |
Nightmare |
|
| D |
All of the above |
Which of the following clinical finding is seen in parasomnia?
| A |
Nocturnal enuresis |
|
| B |
Night terror |
|
| C |
Nightmare |
|
| D |
All of the above |
Parasomnias include sleep terror, nightmares, sleepwalking, and enuresis) are fairly common in children and less so in adults.
Drug of choice for restless leg syndrome ‑
| A |
Ropinirole |
|
| B |
Chlorpromezine |
|
| C |
Haloperidol |
|
| D |
Bupripione |
Drug of choice for restless leg syndrome ‑
| A |
Ropinirole |
|
| B |
Chlorpromezine |
|
| C |
Haloperidol |
|
| D |
Bupripione |
Ans. is’a’i.e., Ropinirole [Ref. Clinical Pharmacol Glt 3d/e p. 482]
- Drugs of choice for Restless leg syndrome are dopamine agonists like ropinirole or promipole or rotigotine.
- Levodopa can also be used.
All are true about narcolepsy except:
| A |
Day dreaming |
|
| B |
Hypnagogic hallucinations |
|
| C |
Cataplexy |
|
| D |
Sudden sleep |
All are true about narcolepsy except:
| A |
Day dreaming |
|
| B |
Hypnagogic hallucinations |
|
| C |
Cataplexy |
|
| D |
Sudden sleep |
Ans. (A) Day dreaming
[Ref Neeraj Ahuja 7th/ I j8-39; Kaplan & Sailockls Textbook of psychiatry 11th/547-50; Harrison 19th/189, t7th/172- ZB; CMDT 2016/1072]
Narcolepsy:
- Disorder characterized by excessive daytime sleepiness often dkturbetl night time sleep and disturbances in REM sleep.
- Hallmark of this disorder is decreased REM latency, I.e. decreased latent period before the first REM period occurs.
- Normal REM latency is 90- 100 minutes, in narcolepsy, REM sleep occurs within 10 minutes of the onset of sleep.
Classical tetrad of symptoms:
- Sleep attacks (MC)
- Cataplexy
- Hallucinations at sleep onset (Hypnagogic) and upon waking (Hypnopompic)
- Sleep paralysis.
DYSSOMNIA & PARASOMNIA
DYSSOMNIA & PARASOMNIA
I) Dysomnia
Introduction:
- Characterized by abnormality in duration or quality of sleep.
Subtypes:
- Insomnia.
- Hypersomnia.
1. Insomnia:
Features:
- Decreased sleep.
- Difficulty in initiation of sleep.
- Difficulty in maintenance of sleep.
- Frequent awakening during night.
- Early morning awakening.
- Nonrestorative sleep.
- Not feeling refreshed in morning due to poor quality of sleep.
Syndromes associated:
Periodic limb movement disorder:
- Non-restorative sleep and day time sleepiness.
Restless leg syndrome (Ekbom syndrome):
- Difficulty in initiation of sleep due to moving legs. Treated with ropinirole (dopamine agonist).
Treatment:
- Benzodiazepines, zolpidem & hypnotics.
2. Hypersomnia:
Features:
- Excessive sleepiness.
- Prolonged sleep episodes.
- Excessive day time sleep episodes.
Syndromes associated:
Narcolepsy:
- Reduced latency of REM sleep (reaching REM sleep earlier).
- Sleep attacks (irresistible urge for sleep at anytime of day) & sleep paralysis (Occurs in morning. patient awake but unable to move body).
Kleine-Levin syndrome:
- Characterized by episodes of hypersomnia, hyperphagia & hypersexuality (increased sexual activity).
II). PARASOMNIA:
Introduction:
- Disorders characterized by dysfunctional events associated with sleep.
Subtypes:
Stage 4, NREM sleep disorders:
- Occur during stage 4, NREM.
Events:
- Night terror or sleep terror (pavor nocturnus).
- Sleepwalking (somnambulism).
Sleep-related enuresis –
- Most common cause of bed wetting – Due to psychosocial (sibling rivalry).
- Treated by bed alarms, imipramine & intranasal desmopressin.
-
- Bruxism (teeth grinding).
- Sleep talking (somniloquy).
Other sleep disorders:
Nightmare:
- Occurs during REM sleep.
- Patient able to recall dream (contrast to night terror).
Exam Important
- Restless leg syndrome (Ekbom syndrome) is associated with sleep disturbances treated with ropinirole.
- Narcolepsy exhibits reduced latency of REM sleep.
- Kleine-Levin syndrome is characterized by episodes of hypersomnia, hyperphagia & hypersexuality.
- Night terror or sleep terror (pavor nocturnus), Sleepwalking (somnambulism), Sleep-related enuresis & Bruxism (teeth grinding) are all features of Stage 4, NREM sleep disorders.
- Sleep-related enuresis is most common cause of bed wetting.
- Nightmare occurs during REM sleep.
COMPILATION OF PSYCHIATRIC DISORDERS IN PEDIATRIC PATIENTS
| A | Mental retardation | |
| B | Inability to interpret written language | |
| C | Male preponderance | |
| D | Retardation reading |
| A | Mental retardation | |
| B | Inability to interpret written language | |
| C | Male preponderance | |
| D | Retardation reading |
Mental retardation
Dyslexia: An imprecise term concerning a condition in which an individual with normal vision is unable to interpret written language. The condition is more common in males and is noticed in children with reading difficulty in the first grade. These individuals can see and recognize letters but are unable to spell and write words. They have no difficulty recognizing the meaning of objects and pictures. Dyslexia is unrelated to intelligence.
A 12-year-old boy presents with disruptive behaviour at school, aggression towards teachers and truancy. He was recently suspended from the school for destruction of school property. Which of the following diagnosis best suits his presentation?
| A |
Oppositional defiant disorder |
|
| B |
Conduct disorder |
|
| C |
Attention deficit hyperactivity disorder |
|
| D |
Autism spectrum disorder |
A 12-year-old boy presents with disruptive behaviour at school, aggression towards teachers and truancy. He was recently suspended from the school for destruction of school property. Which of the following diagnosis best suits his presentation?
| A |
Oppositional defiant disorder |
|
| B |
Conduct disorder |
|
| C |
Attention deficit hyperactivity disorder |
|
| D |
Autism spectrum disorder |
Conduct disorder in children is characterised by behaviours which could cause harm to self or others or property.
Cruelty to animals is also a feature.
There is frequent violation of the rights of others and rule breaking behaviours. The behaviours are persistent and not occasional.
Ref: Kaplan & Sadock’s Synopsis of Psychiatry: Benjamin J Sadock, M.D., Harold I. Kaplan, Virginia A Sadock, M.D, Edition: 10, Page 1218
Conduct disorder in a child manifests with
| A |
Disregard for right of others |
|
| B |
Doesn’t care for authority |
|
| C |
Backward in studies |
|
| D |
All |
Conduct disorder in a child manifests with
| A |
Disregard for right of others |
|
| B |
Doesn’t care for authority |
|
| C |
Backward in studies |
|
| D |
All |
A i.e. Disregard for rights of others; B i.e. Doesn’t care for authority; C i.e. Backward in studies
- C.D. is characterized by a persistent & significant pattern of conduct in which the basic rights of others are violated or rules of society are not followedQ.
- Clinical features include:
- Frequent lying
- Stealing or robberyQ
- Running away from home or school
- Physical violence like rape, fire setting, assaults or breaking in, use of weapons.
- Cruelty towards other people & animal
- Destruction of property
- Serious violation of rulesQ
- Backward in studiesQ
May 1/ t – drug abuse & dependenceQ, unwanted pregnancies, criminal record, suicidal or homicidal behaviour, STDs.
A child fights with other childrens frequently. He has disciplinary problem in school and steals things. Most likely diagnosis is:
March 2012
| A |
Autism |
|
| B |
Attention deficit hyperkinetic disorder |
|
| C |
Conduct disorder |
|
| D |
Obsessive compulsive disorder |
A child fights with other childrens frequently. He has disciplinary problem in school and steals things. Most likely diagnosis is:
March 2012
| A |
Autism |
|
| B |
Attention deficit hyperkinetic disorder |
|
| C |
Conduct disorder |
|
| D |
Obsessive compulsive disorder |
Ans: C i.e. Conduct disorder
Child psychiatric conditions and presentation
- Triad of symptoms of autism includes abnormal reciprocal social interaction; communication and language impairment; and a restricted, stereotyped and repetitive repertoire of interests and activities
- Clinical features of ADHD includes inattention, hyperactivity and impulsiveness
- Conduct disorder is characterized by aggression/cruelty to people and/or animals, theft, theft, fire setting, severe provocative or disobedient disorder etc.
- Features of OCD include obsessions (intrusive, repetitive and distressing thoughts), compulsions (repetitive, stereotyped, unnecessary behaviours)
A 13 years old boy often argue with parent and teachers. However he is not physical aggressive and there is no history of drug abuse, theft, lying or bullying. Most likely diagnosis is-
| A |
Conduct disorder |
|
| B |
Oppositional defiant disorder |
|
| C |
Autism |
|
| D |
Pervasive developmental disorder |
A 13 years old boy often argue with parent and teachers. However he is not physical aggressive and there is no history of drug abuse, theft, lying or bullying. Most likely diagnosis is-
| A |
Conduct disorder |
|
| B |
Oppositional defiant disorder |
|
| C |
Autism |
|
| D |
Pervasive developmental disorder |
Ans: B. Oppositional defiant disorder
(Ref: Kaplan & saddock’s th/e p. 11391)
- This boy is showing a pattern of defiance of authority (arguing with parents and teachers).
- There are no features of conduct disorder (drug abuse, theft’ lying).
- Thus, the diagnosis is oppositional defiant disorder.
A 13 years old boys is often aggressive, arguing with parent and teachers. He has history of frequent lying and stealing money at home. He always runs away from class to play. The diagnosis is-
| A |
Conduct disorder |
|
| B |
Oppositional defiant disorder |
|
| C |
Autism |
|
| D |
Pervasive developmental disorder |
A 13 years old boys is often aggressive, arguing with parent and teachers. He has history of frequent lying and stealing money at home. He always runs away from class to play. The diagnosis is-
| A |
Conduct disorder |
|
| B |
Oppositional defiant disorder |
|
| C |
Autism |
|
| D |
Pervasive developmental disorder |
Ans: A. Conduct disorder
(Ref: Kaplan & Saddock’s th/e p. 1139).
- Conduct disorder is characterized by a persistent and significant pattern of conduct in which the basic rights of others are violated or rules of society are not followed.
- The onset occurs much before 18 years of age, usually even before puberty.
The characteristic clinical features include: –
- Frequent lying
- Stealing or robbery
- Physical violence like rape, fire setting, assault, use ofweapons, fighting and aggresiveness.
- Running away from home and school → Therefore, backward in studies.
COMPILATION OF PSYCHIATRIC DISORDERS IN PEDIATRIC PATIENTS
COMPILATION OF PSYCHIATRIC DISORDERS IN PEDIATRIC PATIENTS
- Important psychiatric disorders in pediatric patients include,
- Conduct disorder.
- Oppositional defiant disorder.
- Specific disorders of scholastic skills – Learning disorders.
Conduct disorder:
- Associated with unsatisfactory family relationships & failure at school.
- Later stages lead to antisocial personality disorder (dissocial personality disorder).
Features:
Characterized by –
- Repetitive & persistent pattern of disregard for rights of others.
- Aggressiveness & dissocial behavior (excessive fighting or bullying).
- Cruelty to animals/people.
- Severe destruction of property (fire setting).
- Stealing.
- Truancy from school.
- Repeated lying.
- Frequent running from school & home.
- Defiance of authority figures.
- Disobedience pattern.
Oppositional defiant disorder:
- Less severe than conduct disorder.
Features:
- Characterized by persistently negativistic & defiant behavior (frequent arguing with adults, refusal to comply with adults).
- Frequent loss of temper (deliberately annoying adults).
- Note: No serious violations (theft, fire setting, destruction, etc.) – Unlike conduct disorder.
Management:
- Conduct & oppositional defiant disorder –
- Family intervention & behavioral therapy.
- Low dose antipsychotics effective in some.
Learning disorders:
- Also referred as “Specific developmental disorders of cholastic skills”.
Features:
- Characterized by significant impairment in one or more of scholastic skills which are out of proportion to intellectual functioning of child.
- Eg: Significant difficulty in reading while having normal writing & arithmetic skills with normal IQ.
Subtypes:
- Specific reading disorder (Dyslexia).
- Disorder of written expression (specific spelling disorder).
- Specific disorder of arithmetic skills.
- Mixed disorders of scholastic skills (reading, writing & arithmetics).
Other features:
- Inattention.
- Hyperactivity.
- Emotional disturbances.
Exam Important
- Repetitive & persistent pattern of disregard for rights of others is seen in conduct disorder.
- Aggressiveness & dissocial behavior (excessive fighting or bullying) and repeated lying is feature of conduct disorder.
- Dyslexia is specific reading disorder.
- Learning disorders are developmental disorders are characterized by significant impairment in one or more of the scholastic skills which are out of proportion to intellectual functioning of child.
MENTAL RETARDATION
X-linked disease leading to mental retardation is :
| A |
Myotonic dystrophy |
|
| B |
Fragile-X syndrome |
|
| C |
Tuberous sclerosis |
|
| D |
Phenylketonuria |
X-linked disease leading to mental retardation is :
| A |
Myotonic dystrophy |
|
| B |
Fragile-X syndrome |
|
| C |
Tuberous sclerosis |
|
| D |
Phenylketonuria |
B i.e. Fragile – x – Syndrome
Which is MC genetic cause of mental retardation –
| A |
Tuberous sclerosis |
|
| B |
Cri-du-chat syndrome |
|
| C |
Fragile-x-syndrome |
|
| D |
Angel’s syndrome |
Which is MC genetic cause of mental retardation –
| A |
Tuberous sclerosis |
|
| B |
Cri-du-chat syndrome |
|
| C |
Fragile-x-syndrome |
|
| D |
Angel’s syndrome |
Ans. is ‘c’ i.e., Fragile-X-syndrome
o Down’s syndrome is the most common genetic cause of mental retardation, and fragile-X is second to Down’s.
Also know
o Most common inherited cause of mental retardation is fragile-X-syndrome (because down’s syndrome is congenital cause but not inherited).
An IQ between 50 & 70 would be classified as what kind mental retardation –
| A |
Mild |
|
| B |
Moderate |
|
| C |
Severe |
|
| D |
Borderline |
An IQ between 50 & 70 would be classified as what kind mental retardation –
| A |
Mild |
|
| B |
Moderate |
|
| C |
Severe |
|
| D |
Borderline |
Ans. is ‘a’ i.e., Mild
IQ in moderate mental retardation –
| A |
90-70 |
|
| B |
70-50 |
|
| C |
50-35 |
|
| D |
35-20 |
IQ in moderate mental retardation –
| A |
90-70 |
|
| B |
70-50 |
|
| C |
50-35 |
|
| D |
35-20 |
Ans. is ‘C’ i.e., 50-35
Most common type of mental retardation –
| A |
Mild |
|
| B |
Moderate |
|
| C |
Severe |
|
| D |
Profound |
Most common type of mental retardation –
| A |
Mild |
|
| B |
Moderate |
|
| C |
Severe |
|
| D |
Profound |
Ans. is ‘a’ i.e., Mild
Mental retardation is defined if IQ is below ‑
| A |
90 |
|
| B |
80 |
|
| C |
70 |
|
| D |
60 |
Mental retardation is defined if IQ is below ‑
| A |
90 |
|
| B |
80 |
|
| C |
70 |
|
| D |
60 |
Ans. is `c’ i.e., 70
o A child with IQ . 70 is called mentally retarded.
IQ – 40 level of mental retardation:
NEET 13
| A |
Mild |
|
| B |
Moderate |
|
| C |
Severe |
|
| D |
Profound |
IQ – 40 level of mental retardation:
NEET 13
| A |
Mild |
|
| B |
Moderate |
|
| C |
Severe |
|
| D |
Profound |
Ans. Moderate
Severe mental retardation is:
NEET 13
| A |
50-70 |
|
| B |
35-50 |
|
| C |
20-35 |
|
| D |
< 20 |
Severe mental retardation is:
NEET 13
| A |
50-70 |
|
| B |
35-50 |
|
| C |
20-35 |
|
| D |
< 20 |
Ans. 20-35
IQ in mild mental retardation is
| A |
50-70 |
|
| B |
35-49 |
|
| C |
20-34 |
|
| D |
< 20 |
IQ in mild mental retardation is
| A |
50-70 |
|
| B |
35-49 |
|
| C |
20-34 |
|
| D |
< 20 |
Ans. is ‘a’ i.e., 50-70
Most common type of mental retardation ‑
| A |
Mild |
|
| B |
Moderate |
|
| C |
Severe |
|
| D |
Profound |
Most common type of mental retardation ‑
| A |
Mild |
|
| B |
Moderate |
|
| C |
Severe |
|
| D |
Profound |
Ans. is ‘a’ i.e., Mild
IQ of 15 is which grade of mental retardation ‑
| A |
Mild |
|
| B |
Moderate |
|
| C |
Borderline |
|
| D |
Profound |
IQ of 15 is which grade of mental retardation ‑
| A |
Mild |
|
| B |
Moderate |
|
| C |
Borderline |
|
| D |
Profound |
Ans. is.’d’ i.e., Profound
Category IQ
| Normal intelligence | > 90 |
| Borderline intelligence | 70 – 89 |
|
Mental retardation Mild MR Moderate MR Severe MR Profound MR |
50 – 69 35 – 49 20-34 0-19 |
Education criteria for mental retardation is ‑
| A |
Mild |
|
| B |
Moderate |
|
| C |
Severe |
|
| D |
Profound |
Education criteria for mental retardation is ‑
| A |
Mild |
|
| B |
Moderate |
|
| C |
Severe |
|
| D |
Profound |
Ans. is ‘a’ i.e., Mild
MENTAL RETARDATION
MENTAL RETARDATION
Introduction:
- Condition characterized by incomplete development of intellectual functions & adaptive skills (skills for successful Iife).
- Intelligence is measured by Intelligence Quotient (IQ).
Calculation method:
- IQ = Mental age/Chronological age x 100
- Maximum denominator – 15 (even for elderly assessment).
- IQ less than 70 – Considered as “mental retardation”.
Category & their IQ:
- Normal – 90-109
- Borderline – 70-89
- Mild mental retardation – 50-69
- Moderate mental retardation – 35-49
- Severe mental retardation – 20-34
- Profound mental retardation – <20.
- Level of functioning varies with severity of mental retardation.
Causes:
- Down syndrome & fragile-X syndrome – Most common chromosomal cause.
Features:
- Behavioral problems in mental retardation – Have maladaptive behavior (aggression, self injurious behaviors, hyperactivity, etc).
Management:
- Modified by behavioral therapy techniques – Contingency management.
- Desired behaviors rewarded & undesired behaviors punished.
Exam Important
- Calculation for IQ = Mental age/Chronological age x 100.
- IQ less than 70 is considered as “mental retardation”.
- Down syndrome & fragile-X syndrome are the most common chromosomal cause of mental retardation.
- Behavioral problems in mental retardation are managed by behavioral therapy techniques like contingency management.
