Controversial studies in psychiatry have been a popular topic in exams. One such study was the Willowbrook School Study, where healthy children with learning difficulties were inoculated with hepatitis to assess the potential of gamma globulin to treat the disorder. Beecher’s study listed over 20 cases of mainstream research where subjects were experimented on without being fully informed of the risks. The Tuskegee syphilis experiment followed impoverished African-American sharecroppers with syphilis, and a significant proportion did not receive available treatment. Stanford’s prison experiment created a simulated prison environment where participants became their assigned roles, with guards becoming harsh and cruel to prisoners. The Tearooms Study involved Humphreys pretending to be a ‘watch queen’ to study men who have sex in public toilets, raising the issue of informed consent. Milgram’s Study investigated authority and obedience, where participants administered fake shocks to a confederate, with 30 participants continuing to administer shocks until 450 volts was reached. The Rosenhan experiment involved pseudopatients presenting themselves at institutions with the same symptoms and being admitted and diagnosed with serious mental disorders, leading to deinstitutionalisation.

This scenario illustrates the concept of projection, where the athlete is projecting their own feelings of hatred onto their team mate. However, it does not involve projective identification as there is no indication of how the team mate is internalizing of reacting to the projection.

Intermediate Mechanism: Rationalisation

Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.

Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.

Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.

Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.

Delusional guilt is an intense feeling of remorse or guilt that lacks a rational basis and is often associated with depression. It is not classified as a primary delusion.

Borderline Learning Disability

Borderline learning disability is a term used to describe individuals with an IQ between 70-85. This category is not officially recognized as a diagnosis by the ICD-11. It is estimated that approximately 15% of the population falls within this range (Chaplin, 2005). Unlike mild learning disability, borderline learning disability is not typically associated with deficits in adaptive functioning, such as grooming, dressing, safety, of money management.

Typically, when a delusion arises, the patient feels a sense of relief from the preceding anxiety and tension. The delusional atmosphere is the perception that something is amiss, while the delusional mood refers to the accompanying feelings of anxiety and tension.

Anankastic personality disorder is a personality disorder characterized by a preoccupation with orderliness, perfectionism, and control. It falls under cluster C personality disorders according to DSM-IV classification.

Deliberate self-harm is commonly associated with cluster B personality disorders. In the United Kingdom, poisoning by drugs accounts for 90% of deliberate self-harm cases, while wrist cutting accounts for 6-7%, and all other methods combined account for 3-4%. Frequent wrist cutting can be a part of recurrent suicidal gestures seen in individuals with depressive disorder, schizophrenia, and borderline personality disorder.

The reasons for wrist cutting are varied and complex, including a means of punishment oneself, reducing tension, feeling bodily instead of emotional pain, wishing to die, testing the benevolence of fate, seeking an interruption to an unendurable state of tension, crying for help, communicating with others, and unbearable symptoms.

Borderline personality disorder (BPD) is characterized by impulsive acts, mood instability, and chaotic relationships. Individuals with BPD are impulsive in areas that have a potential for self-harm and exhibit recurrent suicidal gestures such as wrist cutting, overdose, of self-mutilation.

White matter is the cabling that links different parts of the CNS together. There are three types of white matter cables: projection tracts, commissural tracts, and association tracts. Projection tracts connect higher centers of the brain with lower centers, commissural tracts connect the two hemispheres together, and association tracts connect regions of the same hemisphere. Some common tracts include the corticospinal tract, which connects the motor cortex to the brainstem and spinal cord, and the corpus callosum, which is the largest white matter fiber bundle connecting corresponding areas of cortex between the hemispheres. Other tracts include the cingulum, superior and inferior occipitofrontal fasciculi, and the superior and inferior longitudinal fasciculi.

Dopamine receptors are classified as metabotropic receptors rather than ionotropic receptors.

Neurotransmitters are substances used by neurons to communicate with each other and with target tissues. They are synthesized and released from nerve endings into the synaptic cleft, where they bind to receptor proteins in the cellular membrane of the target tissue. Neurotransmitters can be classified into different types, including small molecules (such as acetylcholine, dopamine, norepinephrine, serotonin, and GABA) and large molecules (such as neuropeptides). They can also be classified as excitatory or inhibitory. Receptors can be ionotropic or metabotropic, and the effects of neurotransmitters can be fast of slow. Some important neurotransmitters include acetylcholine, dopamine, GABA, norepinephrine, and serotonin. Each neurotransmitter has a specific synthesis, breakdown, and receptor type. Understanding neurotransmitters is important for understanding the function of the nervous system and for developing treatments for neurological and psychiatric disorders.

The Case of Phineas Gage and the Importance of the Frontal Lobe

Phineas Gage was a railroad worker who experienced a traumatic accident where an iron pole went through his frontal lobe. Despite surviving the incident, his personality underwent a significant change. This case was crucial in advancing our knowledge of the frontal lobe’s function.

Hyponatraemia is a condition where the serum sodium level in a patient falls below 135 mmol/L, with severe hyponatraemia being defined as a level below 120 mmol/L. The causes of hyponatraemia can be classified based on the patient’s fluid status, which can be hypovolaemic, euvolemic, of hypervolaemic. Hypovolaemic hyponatraemia occurs when there is a reduction in extracellular fluid volume and serum sodium levels, often due to gastrointestinal losses. Euvolemic hyponatraemia is the most common type and occurs when the extracellular fluid volume is normal. This type can be caused by conditions such as SIADH, hypothyroidism, primary polydipsia, and medications. Hypervolaemic hyponatraemia is associated with increased extracellular volume and occurs when fluid retention is greater than sodium retention, often due to cardiac and renal failures of liver cirrhosis.

Hyponatremia in Psychiatric Patients

Hyponatremia, of low serum sodium, can occur in psychiatric patients due to the disorder itself, its treatment, of other medical conditions. Symptoms include nausea, confusion, seizures, and muscular cramps. Drug-induced hyponatremia is known as the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH), which results from excessive secretion of ADH and fluid overload. Diagnosis is based on clinically euvolaemic state with low serum sodium and osmolality, raised urine sodium and osmolality. SSRIs, SNRIs, and tricyclics are the most common drugs that can cause SIADH. Risk factors for SIADH include starting a new drug, and treatment usually involves fluid restriction and sometimes demeclocycline.

Hyponatremia in Psychiatric Patients

Hyponatremia, of low serum sodium, can occur in psychiatric patients due to the disorder itself, its treatment, of other medical conditions. Symptoms include nausea, confusion, seizures, and muscular cramps. Drug-induced hyponatremia is known as the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH), which results from excessive secretion of ADH and fluid overload. Diagnosis is based on clinically euvolaemic state with low serum sodium and osmolality, raised urine sodium and osmolality. SSRIs, SNRIs, and tricyclics are the most common drugs that can cause SIADH. Risk factors for SIADH include starting a new drug, and treatment usually involves fluid restriction and sometimes demeclocycline.

Self stigma is when an individual adopts negative societal beliefs about their condition. On the other hand, courtesy stigma (also known as stigma by association) is a form of stigma directed towards individuals such as family members and healthcare professionals who are associated with those who have mental health issues.

Stigma is a term used to describe the negative attitudes and beliefs that people hold towards individuals who are different from them. There are several types of stigma, including discredited and discreditable stigma, felt stigma, enacted stigma, and courtesy stigma. Discredited stigma refers to visible stigmas such as race, gender, of physical disability, while discreditable stigma refers to concealable stigmas such as mental illness of HIV infection. Felt stigma is the shame and fear of discrimination that prevents people from seeking help, while enacted stigma is the experience of unfair treatment by others. Finally, courtesy stigma refers to the stigma that attaches to those who are associated with a stigmatized person.

Extrapyramidal side-effects (EPSE’s) are a group of side effects that affect voluntary motor control, commonly seen in patients taking antipsychotic drugs. EPSE’s include dystonias, parkinsonism, akathisia, and tardive dyskinesia. They can be frightening and uncomfortable, leading to problems with non-compliance and can even be life-threatening in the case of laryngeal dystonia. EPSE’s are thought to be due to antagonism of dopaminergic D2 receptors in the basal ganglia. Symptoms generally occur within the first few days of treatment, with dystonias appearing quickly, within a few hours of administration of the first dose. Newer antipsychotics tend to produce less EPSE’s, with clozapine carrying the lowest risk and haloperidol carrying the highest risk. Akathisia is the most resistant EPSE to treat. EPSE’s can also occur when antipsychotics are discontinued (withdrawal dystonia).

Several scales are available to measure medication adherence attitudes and behaviors in psychiatric patients, particularly those with schizophrenia. The Rating of Medication Influences (ROMI) scale has 20 interviewer-rated items with good inter-rater reliability. The ASK-20 Adherence Barrier Survey measures barriers to adherence with 20 clinical items. The Brief Evaluation of Medication Influences and Beliefs (BEMIB) scale is an eight-item Likert-type scale that measures costs and benefits of medication use based on the health belief model. The Drug Attitude Inventory is a 30-item self-report scale that evaluates subjective effects of antipsychotic drugs among patients with schizophrenia. The Medication Adherence Rating Scale (MARS) is a 10-item self-report scale derived from the Drug Attitude Inventory and Medication Adherence Questionnaire, and is used in patients with schizophrenia and psychosis.

Functions of the Hypothalamus

The hypothalamus is a vital part of the brain that plays a crucial role in regulating various bodily functions. It receives and integrates sensory information about the internal environment and directs actions to control internal homeostasis. The hypothalamus contains several nuclei and fiber tracts, each with specific functions.

The suprachiasmatic nucleus (SCN) is responsible for regulating circadian rhythms. Neurons in the SCN have an intrinsic rhythm of discharge activity and receive input from the retina. The SCN is considered the body’s master clock, but it has multiple connections with other hypothalamic nuclei.

Body temperature control is mainly under the control of the preoptic, anterior, and posterior nuclei, which have temperature-sensitive neurons. As the temperature goes above 37ºC, warm-sensitive neurons are activated, triggering parasympathetic activity to promote heat loss. As the temperature goes below 37ºC, cold-sensitive neurons are activated, triggering sympathetic activity to promote conservation of heat.

The hypothalamus also plays a role in regulating prolactin secretion. Dopamine is tonically secreted by dopaminergic neurons that project from the arcuate nucleus of the hypothalamus into the anterior pituitary gland via the tuberoinfundibular pathway. The dopamine that is released acts on lactotrophic cells through D2-receptors, inhibiting prolactin synthesis. In the absence of pregnancy of lactation, prolactin is constitutively inhibited by dopamine. Dopamine antagonists result in hyperprolactinemia, while dopamine agonists inhibit prolactin secretion.

In summary, the hypothalamus is a complex structure that regulates various bodily functions, including circadian rhythms, body temperature, and prolactin secretion. Dysfunction of the hypothalamus can lead to various disorders, such as sleep-rhythm disorder, diabetes insipidus, hyperprolactinemia, and obesity.

Asenapine exhibits affinity towards D2, 5HT2A, 5HT2C, and α1/α2 adrenergic receptors, while having relatively low affinity for H1 and ACh receptors. This makes it a second generation antipsychotic that is approved for the treatment of moderate to severe manic episodes associated with bipolar disorder. Its low affinity for H1 receptors is believed to contribute to its metabolically-neutral profile.

Kohlberg’s Six Stages of Moral Development

Kohlberg’s theory of moral development consists of six stages that can be categorized into three levels. The first level is the preconventional stage, which is characterized by obedience and punishment orientation, where the focus is on the direct consequences of actions and unquestioning deference to power. The second stage is the self-interest orientation, where right behavior is defined purely by what is in the individual’s own interest.

The second level is the conventional stage, which is characterized by interpersonal accord and conformity, where the focus is on how the individual will appear to others. The behavior should accord with a consensus view on what is good. The second stage is the authority and social order obedience driven, where what is lawful is judged to be morally right. Right behavior is dictated by societal rules, and there is a greater respect for social order and the need for laws.

The third level is the postconventional stage, which is characterized by the social contract orientation, where individual rights determine behavior. The individual views laws and rules as flexible tools for improving human purposes. The fourth stage is the universal ethical principles orientation, where the right action is the one that is consistent with abstract reasoning using universal ethical principles.

It is important to note that the age ranges for Kohlberg’s developmental stages are rough guides, and sources vary widely. Kohlberg developed his stage theory following an experiment he conducted on 72 boys aged 10-16. However, the theory is criticized as sexist as it only included boys.

Corrigan and Watson identified two types of stigma: public stigma and self-stigma. The individual in this example has developed low self-esteem due to agreeing with prejudicial beliefs about mental illness. Public stigma involves negative beliefs about a group, such as dangerousness of incompetence, while public prejudice involves a negative emotional reaction, such as fear. Self-stigma refers to negative self-beliefs, such as character weakness of incompetence, and self-discrimination is a behavioral response to prejudice, such as avoiding work. Hayward and Bright2 identified four recurring themes behind stigma against mental illness: dangerousness, attribution of responsibility, poor prognosis, and disruption of social interaction.

The retina and optic nerves originate from protrusions of the diencephalon known as eye vesicles during development.

Neurodevelopment: Understanding Brain Development

The development of the central nervous system begins with the neuroectoderm, a specialized region of ectoderm. The embryonic brain is divided into three areas: the forebrain (prosencephalon), midbrain (mesencephalon), and hindbrain (rhombencephalon). The prosencephalon further divides into the telencephalon and diencephalon, while the hindbrain subdivides into the metencephalon and myelencephalon.

The telencephalon, of cerebrum, consists of the cerebral cortex, underlying white matter, and the basal ganglia. The diencephalon includes the prethalamus, thalamus, hypothalamus, subthalamus, epithalamus, and pretectum. The mesencephalon comprises the tectum, tegmentum, ventricular mesocoelia, cerebral peduncles, and several nuclei and fasciculi.

The rhombencephalon includes the medulla, pons, and cerebellum, which can be subdivided into a variable number of transversal swellings called rhombomeres. In humans, eight rhombomeres can be distinguished, from caudal to rostral: Rh7-Rh1 and the isthmus. Rhombomeres Rh7-Rh4 form the myelencephalon, while Rh3-Rh1 form the metencephalon.

Understanding neurodevelopment is crucial in comprehending brain development and its complexities. By studying the different areas of the embryonic brain, we can gain insight into the formation of the central nervous system and its functions.

FGM is against the law in the UK, and arranging for a child to undergo the procedure abroad is also illegal. Those who are caught can face a prison sentence of up to 14 years and a hefty fine. Shockingly, it is estimated that 66,000 women in the UK have already undergone FGM, and over 20,000 girls under the age of 15 are at risk. Often, children are taken to have the procedure during the summer holidays so that they have time to heal before returning to school. There are four main types of FGM, including clitoridectomy, excision, infibulation, and other harmful procedures such as pricking, piercing, cutting, scraping, and burning the genital area. FGM is carried out for cultural, religious, and social reasons and is most prevalent in Africa, although it also occurs in Asia and the Middle East. The experience can be extremely traumatic, and those who have undergone FGM may require counseling in the future. Recently, medical professionals have faced criminal prosecution for allegedly performing the procedure, which is illegal in the UK.

Hepatic Impairment: Recommended Drugs

Patients with hepatic impairment may experience reduced ability to metabolize drugs, toxicity, enhanced dose-related side effects, reduced ability to synthesize plasma proteins, and elevated levels of drugs subject to first-pass metabolism due to reduced hepatic blood flow. The Maudsley Guidelines 14th Ed recommends the following drugs for patients with hepatic impairment:

Antipsychotics: Paliperidone (if depot required), Amisulpride, Sulpiride

Antidepressants: Sertraline, Citalopram, Paroxetine, Vortioxetine (avoid TCA and MAOI)

Mood stabilizers: Lithium

Sedatives: Lorazepam, Oxazepam, Temazepam, Zopiclone 3.75mg (with care)

Schizotypal PD is classified differently in DSM-IV and ICD-10, with the latter listing it under psychotic disorders. It is genetically linked to schizophrenia and often found in first-degree relatives of those with the disorder. In this case, there is no evidence of schizophrenia or schizoaffective disorder, but the individual’s beliefs are outside of cultural norms. The DSM-IV criteria for schizotypal PD include social and interpersonal deficits, cognitive of perceptual distortions, and eccentric behavior. The individual must exhibit at least five of the listed criteria, such as odd beliefs of magical thinking, unusual perceptual experiences, and suspiciousness of paranoid ideation. The disorder cannot be exclusively attributed to another mental health condition.

Although cholinergic agents have been tested in Alzheimer’s disease, they have shown limited effectiveness. On the other hand, memantine, a N-methyl-D-aspartate (NMDA) receptor antagonist, works by reducing the impact of glutamate mediated toxicity and has shown promise in treating the disease. Additionally, anti-amyloid strategies are currently being developed and, if successful, could directly target the disease process.

Genetic Terms

Recombination Fraction

The recombination fraction is a measure of the distance between loci on a chromosome. If two loci are on different chromosomes, they will segregate independently. However, if they are on the same chromosome, they would always segregate together were it not for the process of crossing over. The closer two loci are on a chromosome, the less likely they are to be separated by crossing over. Blocks of alleles on a chromosome tend to be transmitted as a block through pedigree, and are known as a haplotype. The recombination fraction can vary from 0% if they are extremely close and 50% if they are on different chromosomes.

Gene Mapping

Mapping the genome is done in two ways: genetic mapping and physical mapping. Genetic mapping uses techniques such as pedigree analysis, while physical mapping is a technique used to find the order and physical distance between DNA base pairs by DNA markers. Physical maps can be divided into three general types: chromosomal of cytogenetic maps, radiation hybrid (RH) maps, and sequence maps. The different types of maps vary in their degree of resolution. Both maps are a collection of genetic markers and gene loci. While the physical map could be a more ‘accurate’ representation of the genome, genetic maps often offer insights into the nature of different regions of the chromosome.

LOD Score

The LOD score (logarithm of the odds) is a method used to ascertain if there is evidence for linkage between two genes. When genes are very near to each other on a chromosome, they are unlikely to be separated during crossing over in meiosis, and such genes are said to be linked. The relative distance between two genes can be calculated by using the offspring of an organism showing two strongly linked traits, and finding the percentage of offspring where the traits do not run together. By convention, a LOD score of >3 is considered evidence for linkage, and a LOD score of <-2 excludes linkage. Epigenetic Epigenetics involves genetic control by factors other than an individual’s DNA sequence. Epigenetic changes can switch genes on of off and determine which proteins are transcribed. Penetrance Penetrance is the probability of a gene of genetic trait being expressed. ‘Complete penetrance’ means the gene of genes for a trait are expressed in all the population who have the genes. ‘Incomplete penetrance’ means the genetic trait is expressed in only part of the population. Heritability Heritability is the proportion of phenotypic variance attributable to genetic variance. Anticipation Anticipation is a phenomenon whereby the symptoms of a genetic disorder become apparent at an earlier age as it is passed on to the next generation.

Wolf-Hirschhorn syndrome, also referred to as 4p deletion syndrome, is caused by the loss of genetic material located towards the end of the short arm (p) of chromosome 4. This condition is often characterized by a distinct facial appearance resembling a Greek warrior helmet.

Chromosomal location is an important factor in understanding genetic conditions. As a candidate for the MRCPsych, it is essential to be able to link specific disorders to their corresponding chromosomes. For instance, Presenilin 2 is associated with Alzheimer’s disease and is located on chromosome 1. Similarly, DISC-1 and DISC-2 are linked to schizophrenia and are located on chromosome 1 and 6, respectively. RGS-4, which interacts with neuregulin, is also associated with schizophrenia and is located on chromosome 1.

Other disorders linked to specific chromosomes include Huntington’s disease (chromosome 4), Cri-du-Chat syndrome (chromosome 5), and Prader-Willi and Angelman syndromes (chromosome 15). Chromosome 17 is associated with familial frontotemporal dementia, Smith-Magenis syndrome, and neurofibromatosis 1. Chromosome 21 is linked to Down’s syndrome, while chromosome X/Y is associated with Fragile X, Lesch-Nyhan syndrome, Turners syndrome, and Klinefelter’s syndrome.

In summary, understanding the chromosomal location of genetic disorders is crucial for psychiatrists and other medical professionals. It helps in the diagnosis, treatment, and management of these conditions.

Nissl substance is composed of rough endoplasmic reticulum with free ribosomes and is responsible for synthesizing proteins. The Golgi apparatus modifies, organizes, and packages macromolecules for either secretion of internal use. Mitochondria are involved in producing energy for the cell. Microfilaments and microtubules provide structural support and aid in transportation within the cell. Lysosomes are spherical structures that contain digestive enzymes, which break down cellular waste and protect against threats such as viruses.

The Function of Proteasomes in Protein Degradation

Proteasomes play a crucial role in breaking down proteins that are produced within the cell. These cylindrical complexes are present in both the nucleus and cytoplasm of the cell. The process of protein degradation involves the tagging of proteins with a small protein called ubiquitin. The proteasome consists of a core structure made up of four stacked rings surrounding a central pore. Each ring is composed of seven individual proteins. This structure allows for the efficient degradation of proteins, ensuring that the cell can maintain proper protein levels and function.

Marital status, having both parents alive and in a stable relationship, and having young offspring have all been found to be protective factors against suicide. However, while being a twin has been linked to a lower risk of suicide, having siblings does not appear to have the same effect.

La belle indifference is a term of French origin that refers to a paradoxical lack of emotional distress in individuals who have a serious medical illness of symptoms related to a health condition. This phenomenon is often observed in cases of conversion (dissociative) disorder.

Somatoform and dissociative disorders are two groups of psychiatric disorders that are characterised by physical symptoms and disruptions in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. Somatoform disorders are characterised by physical symptoms that are presumed to have a psychiatric origin, while dissociative disorders are characterised by the loss of integration between memories, identity, immediate sensations, and control of bodily movements. The ICD-11 lists two main types of somatoform disorders: bodily distress disorder and body integrity dysphoria. The former involves bodily symptoms that the individual finds distressing and to which excessive attention is directed, while the latter involves a disturbance in the person’s experience of the body manifested by the persistent desire to have a specific physical disability accompanied by persistent discomfort of intense feelings of inappropriateness concerning current non-disabled body configuration. Dissociative disorders, on the other hand, are characterised by involuntary disruption of discontinuity in the normal integration of identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, of behaviour. The ICD-11 dissociative disorders include dissociative neurological symptom disorder, dissociative amnesia, trance disorder, possession trance disorder, dissociative identity disorder, partial dissociative identity disorder, depersonalization-derealization disorder, and other specified dissociative disorders. Each disorder has its own set of essential features and diagnostic criteria.

Intermediate Mechanism: Rationalisation

Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.

Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.

Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.

Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.

It is widely acknowledged that women who have pre-existing cardiovascular disease should avoid taking oral contraceptives due to the increased risk of stroke and DVTs.

Cerebrovascular accidents (CVA), also known as strokes, are defined by the World Health Organization as a sudden onset of focal neurological symptoms lasting more than 24 hours and presumed to be of vascular origin. Strokes can be caused by either infarction of hemorrhage, with infarction being more common. Hemorrhagic strokes tend to be more severe. Intracranial hemorrhage can be primary, caused mainly by hypertension, of subarachnoid, caused by the rupture of an aneurysm of angioma. Primary intracranial hemorrhage is most common in individuals aged 60-80 and often occurs during exertion. Infarction can be caused by thrombosis of embolism, with thrombosis being more common. Atherosclerosis, often caused by hypertension, is the main cause of infarction. CT scanning is the preferred diagnostic tool during the first 48 hours after a stroke as it can distinguish between infarcts and hemorrhages. Recovery from embolism is generally quicker and more complete than from thrombosis due to the availability of collateral channels.

The frontal assessment battery does not include personality and calculation (attention) despite them being functions of the frontal lobe.

The Frontal Assessment Battery (FAB) is a quick and easy bedside test used to detect the dysexecutive syndrome. It consists of six subsets, including conceptualization, mental flexibility, motor programming, conflicting instructions, go-no go (inhibitory control), and prehension behavior. The test assesses a patient’s ability to perform tasks such as abstract reasoning, verbal fluency, and motor skills. The FAB can be completed in just a few minutes and is a useful tool for clinicians in evaluating patients with suspected executive dysfunction.