Neuropsychiatric Aspects of Systemic Disorders MCQs

Neuropsychiatric lupus commonly presents with seizures, psychosis, cognitive dysfunction, mood disorders and stroke, through autoantibody-mediated injury and thrombotic mechanisms. It is a diagnosis of exclusion requiring other causes to be ruled out.

Hypothyroidism classically causes depression, fatigue, psychomotor slowing and cognitive impairment, occasionally severe enough to be called myxoedema madness. Hyperthyroidism, by contrast, tends toward anxiety, agitation and tremor.

Wilson disease is caused by ATP7B mutation with copper accumulation in liver, brain and cornea. Psychiatric symptoms such as personality change and depression often accompany movement disorder and dysarthria; Kayser-Fleischer rings and low ceruloplasmin support the diagnosis.

Depression, irritability and apathy frequently precede chorea by years in Huntington disease, an autosomal dominant disorder caused by CAG expansion in the HTT gene. Psychiatric symptoms are a major cause of disability in the disease.

Depression affects around half of multiple sclerosis patients over the disease course, driven by lesion burden, inflammation and psychosocial factors. Euphoria (euphoria sclerotica) is a recognised but much less common feature.

Hypercortisolism most often causes depression, with irritability, insomnia and cognitive slowing. Mania or psychosis can also occur, particularly with higher cortisol levels, and usually improve when cortisol is normalised.

Acute intermittent porphyria attacks combine severe abdominal pain, autonomic instability and neuropsychiatric symptoms including confusion, hallucinations, seizures and peripheral neuropathy, often precipitated by drugs, fasting or alcohol.

General paresis is a late parenchymatous form of neurosyphilis: progressive dementia with grandiose or megalomaniac delusions, dysarthria, tremor and Argyll Robertson pupils. It develops years after untreated syphilis infection.