Summary: Neuropsychiatry

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• 1 Epilepsy

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• Epidemiology of Psychiatric comorbidities in Epilepsy

  Psychiatric comorbidities are significantly more prevalent in patients with epilepsy than in the general population
  For example, the prevalence of
  anxiety disorders is 22.8% in epilepsy patients co
  MDD affects 17.4%

• Investigation can be done in epilepsy patient

  
  Electroencephalogram (EEG) and Video Monitoring
  Laboratory Investigations

  • Serum Prolactin: Measuring prolactin levels is useful for distinguishing epileptic events from functional ones.

  
  Neuroimaging

  • MRI and Imaging Correlation: Neuroimaging is recommended to correlate with EEG findings, especially when focal discharges are present.

• Investigation TRO PNES in Epilepsy

  • Serum Prolactin: This is a key biochemical marker. Levels typically increase significantly (greater than 500 IU/ml) in over 90% of patients following a true tonic-clonic seizure, whereas they remain normal after a PNES event.
  • Video EEG: This is the gold standard for diagnosis, as it allows clinicians to correlate visible behaviour with electrical brain activity.
  • Psychological Context: PNES is often associated with a history of sexual or physical abuse, as well as multiple unexplained physical complaints

• 2 Parkinson's

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• Domains affected in Parkinson's Disease

  C-MAP SIS 
  Cognitive
  Mood and Anxiety
  Apathy
  Psychosis
  Sexual 
  Impulse control disorder
  Sleep

• Symptoms of Cognitive deterioration in PD and management

  Slowed Processing Speed, Executive, Cognitive Fluctuation and Dementia 
  -> Optimize PD medication and Cholinesterase inhibitors

• Symptoms of Mood disorder in PD and management

  Depression, Anxiety, Panic Attack - Anti Depressant
  Off period depression/dysphoria - Optimize PD medication
  Off period Anxiety/ Panic -   Optimize PD medication, if does not work, use anti depressant. **Risk of dopamine dysregulation syndrome if keep increase levodopa

• Psychotic Symptom in PD and management

  Minor hallucination - preserved insight
  --> Wait and see , taper off offending meds
  
  Overt psychosis - Delusion, well formed hallucinations,
  --> Manage secondary cause
  --> Taper of medications
  --> Cholinesterase inhibitor
  --> Clozapine
  --> Quetiapine

• Impulse control disorder in PD and management

  Gambling, Shopping addiction
  --> Taper down dopamine agonist 
  --> Optimize levodopa

• Sexual dysfunction in PD with management

  Men - ED, reduce libido, low testosterone
  Women - Vaginal dryness, reduce libido 
  --> Specific targeted medication : Sildanefil for ED, SSRI Premature Ejaculation
  --> Lubricant , sex therapy

• Sleep issue in PD and management

  REM Sleep disorder
  Restless leg syndrome
  Excessive daytime sleepiness
  --> Clonazepam, melatonin
  --> Dopamine agonist, gabapentin
  --> Sleep hygiene
  --> Long active levodopa at night