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Neuropsychiatry Epilepsy and Conversion Disoders - Coggle Diagram
Neuropsychiatry
Epilepsy and Conversion Disoders
Neuropsychiatry
Combines disciplines of neurology (Study and treatment of disorders of the nervous system) and psychiatry (studya nd treatment of mental disorders)
Grey area between neurology and psychiatry
Challenges: Patients fall between services
Common Presentations
Conversion / functional neurological disorders
Somatisation disorder
Acquired brain injury
Neurodegenerative conditions
Neurodevelopmental conditions
Epilepsy
Seizure
Sudden uncontrolled electrical distrubance in the brain
A paroxysmal, stereotyped distrubance of consciousness, behaviour, emotion, motor function, perception or sensation (either singly or in combination) due to cortical neuronal dyscharge
Epidemiology
2/3 focal - of them 2/3 originate in temporal lobe
1/3 non-focal
1% of population
ILAE Classification
Seizure Types
Focal Onset
Focal aware (formerly simple partial)
Focal imparied awareness (former complex partial)
Motor or non motor
Generalised Onset
Motor
Tonic clonic
Other
Myoclonic
Atonic
Tonic
Non-Motor (Absence)
Formerly petit mal
Unknown
Seizure Phases
Associated with differenc neuropyschiatric syndromes
Pre-ictal
Prodrome
Hours to days before seizure
Mood changes - irritability, anxiety, depression, euphoria
Sleep disturbance - Insomnia or drowsiness or vivid dreams
Cognitive changes - Poor concentration, brain fog, forgetful, slowed thinking
Physical - Headache, GI symptoms, malaise
Senaory changes - Heightened sensitivity, visual, odd testes - longer than an aura, tingling
Behavioural changes - withdrawal, aggression, hyperactivity
Autonomic - sweating, palpatations
Aura
Minutes to seconds before onset
Classifcally temporal lobe
Frontal - briefer but harder to describe - motor, somatosensory, cognitive or emotional
Occipital - visual auras, simple shapes / complex hallucinations
Insular - Visceral , autonomic, auditory or gustatory
Temporal Lobe Auras
Amnesia
Deja vu, jamais vu
Sudden sense of fear / anxiety
Nausea
Auditory, visual, olfactory, gustatory or tactile hallucinations
Visual distortions - macropsia and micropsia
Dissociation or derealisation
Synethesia - stimulation of one sense experience in a second sense
Dysphoric or euphoric feelings
Ictal
Post-ictal
Post Ictal Confusion (formerly psychosis)
Short lived agitation and confusion after seizure lasting 24-72 hrs
Inter-ictal
Inter-ictal Psychosis
Most often like a schizophrenia
Affective psychosis
Personality changes
In individuals with long standing treatment resistant temporal lobe epulepsy - near limbic structures
Potential Causes
Kindling effect
Changing of NT as a result fo seizures
Epileptic encephapathies - psychosis an aspect of underlying epileptic disorderA
Forced normalisation
Genetic and epigenetic
Iatrogenic Psychiatric Issues due to Anti-Epileptics
Topirimate
Levetracetam
Dissociative (Conversion Disorders)
ICD-10 Definition
A partial or complete loss of the normal integration between memories of the past, awareness of identity and immediate sensations, and control of bodily movements
All types of dissociative disorders tend to remit after a few weeks or months, particulary if their onset is associated with a traumatic life evenet
DSM 5 - Functional Neurological Symptom Disorder
One or more symptoms or deficits that affect
Voluntary motor
Sensory function
Suggestive of a neurological or other general medical conition
Psychological factors are judged, in the clinician's belief, to be associated with the symptoms or deficit because conflicts or other stressors preced the initiation or exacerbation of a symptoms or deficit
The symptoms or deficity is
not intentially produced or feigned
The symptom or deficit, after appropriate investigation,
cannot be exaplined fully by a general medical condition
the direct effects of a substance, or a culturally sanctioned behaviour or experience
The symptom pr deficit causes
clinically significant distress or impairment
in social, occupational, or other important areas of functioning or warrants medical evaluation
Epilepsy vs Non-epileptic Attack