+ Neuropsychiatry module introduction John 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? KraepelinFreud

+ 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

+ This is the central organ Brain as driver of mind

+ Neurology of psychiatry Schizophrenia Mood disorders Neurodevelopmental hypothesis Subtle alterations in brain

+ Functional imaging in schizophrenia Neuropathological but more subtle

+ What about the neurologists?

+ One of Charcot’s hysterical patients These 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 State12 Descriptive Psychopathology24 Cognitive Assessment10 Neurological Examination10 Assessment16 Description and Measurement 6 Diagnosis12 Classification 8 Aetiology12 Prevention of Psychological Disorder 6 Basic Psychopharmacology14 Human Psychological Development 8 Social Psychology 4 Basic Psychological Processes14 Dynamic Psychopathology12 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 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 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 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 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.