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Neuropsychiatry module introductionJohn O’Donovan Consultant Old Age Psychiatrist

+Neuropsychiatry

Difficult to define

Is it the neurology of psychiatry?

Is it the psychiatry of neurology?

Is it something else?

+Good and Bad

+Who do you believe?

Academic observation

Believe that illnesses had a biological substrate

Psychopathology

Worked with Alzheimer and Erb

Dominates ICD-10 and DSM 4

Far more charismatic

Better writer

Psychoanalysis

Descendants dominated USA psychiatry

In 2012 what is his relevance?

Kraepelin Freud

+Sigmund

Prodigious intellect, a genius

Fluent in seven languages

Reading Shakespeare in English at 7 years of age

Huge personal charm and charisma

Inspirational leader, look at his followers

Provided great insights or alternatively untestable hypotheses. What are the alternatives to his view about underlying psychological processes?

+Why does this matter?

Defines psychiatry

Also and more interestingly it allows psychiatrists to some extent define themselves

Neuropsychiatrists tend to be neo Kraepelin but the paradox is that neurologists want them to be Freudian

Very few of us are truly a “tabula rasa”

+Psychiatry of neurology

Stroke

Brain injury

Epilepsy

White matter disorders

Dementia

Movement disorders

Metabolic disorders etc

Lesion based, pathology based approach

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This is the central organBrain as driver of mind

+Neurology of psychiatry

Schizophrenia

Mood disorders

Neurodevelopmental hypothesis

Subtle alterations in brain

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Functional imaging in schizophreniaNeuropathological but more subtle

+What about the neurologists?

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One of Charcot’s hysterical patientsThese patients are still around.

+Pathology versus non pathology

Both neurology of psychiatry and psychiatry of neurology believe in the concept of a neuropathology and adopt a medical model.

Both are neo Kraepelin.

Psychiatry of hysteria, non epileptic attack disorder, medically unexplained symptoms etc, all have a far more dynamic and Freudian influenced model.

Intrinsically part of neuropsychiatry.

+The CT1 perspective

This module

Four days in total

My simple priority for you

MRCPsych

+Paper one breakdown

                                            

History and Mental State 12

Descriptive Psychopathology 24

Cognitive Assessment 10

Neurological Examination 10

Assessment 16

Description and Measurement  6

Diagnosis 12

Classification  8

Aetiology 12

Prevention of Psychological Disorder 6

Basic Psychopharmacology 14

Human Psychological Development  8

Social Psychology  4

Basic Psychological Processes 14

Dynamic Psychopathology 12

Basic Psychological Treatments  8

History of Psychiatry  8

Basic Ethics and Philosophy of Psychiatry 8

Stigma and Culture  8

+Common question themes

The questions come from a single common data bank.

The same themes have been going around and around for the last thirty years.

The fundamental for CT1 trainees should in my view be the first part of the MRCPsych.

Basic clinical neurology and psychopathology will make up about 35% of those questions.

+Broad outline

Day one

Epilepsy and psychiatry of epilepsy.

Brief introduction to neuropsychiatry.

MCQs

Clinical neuroanatomy and common neurological questions for the MRCPsych

+MCQs 1-6

The following are causes of absent knee jerks and extensor plantars.

Motor neuron disease

Friedreich’s ataxia

Pernicious anaemia

Complications of diabetes

A neurofibroma of the conus medullaris

Brown-Sequard syndrome at L2 level

+MCQs 7-12

The following are true about the pupillary response

A lesion of the retina may impair the response.

Part of the reflex arc takes place in the pons.

They are consensual

A lesion of the abduces nerve may impair the response.

Degeneration of the ciliary ganglion may produce a tonic pupil

it is possible to be blind wit a normal pupillary response.

+MCQs 13-20

In Broca’s aphasia

Receptive speech is unimpaired

The lesion is on the contralateral side of the hand dominance of the patient.

Repetition is intact.

Reading is intact.

word production per minute is 4-6

Secondary to stroke, the artery involved commonly originates from the vertebrobasilar system.

The patient may be frustrated by being inarticulate

There is an odd connection to Hawiian tropic factor 50 (for pale Irish skin)

+MCQs 21-25

In Wernicke’s encephalopathy

There is a classical triad

Diplopia is invariable

Oral B vitamins are sufficient if given in large doses

Gait is broad based but tandem walking is unimpaired

Red cell transketolase activity may be used effectively as a diagnostic test

+MCQs 26-30

In syringomyelia with associated Arnold Chiari Malformation the following may be present

Severe positional headaches.

Sensory loss in a cape distribution

Rotatory nystagmus

Cerebellar type dysarthria

Cognitive impairment

+Now score them up

To pass probably require a score of 20-30.

Questions are a bit odd and slimey but that’s the way of the game.

Now lunch and reconvene at 1.30 for 2 hours of clinical neuroanatomy.