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Course Name: Neurosciences and Psychiatry
Class Hours:
Instructors:
Office:
Telephone:
Email:
M-F, 8:00-12:00
Robert Blair, Ph.D.
BMSB 653B
(405) 271-2226, ext. 56242
[email protected]
Herman Jones, Ph.D.
PPB 215
(405) 271-4113
[email protected]
E. Michael Smith, M.D.
WP 3462
(405) 271-5253, ext 47658
[email protected]
Course Description
This course introduces students to diverse aspects of the nervous system clinically relevant to neurologic and
psychiatric conditions. Focus is on brain structure, function, pathways, and major pathologic conditions.
Learning Objectives:
Patient Care: Student provides supervised patient care that is compassionate, appropriate, and effective for the
treatment of health problems and the promotion of health.
 Perform a reliable “essential” neurologic examination on a patient in < 10 minutes
 Construct appropriate inference of neurologic localization and pathophysiology from 26 “essential” abnormal
neurologic examination findings
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Lateral rectus palsy
Neglect
Expressive aphasia
Receptive aphasia
Dysarthria
Swollen optic disk
Hemianopsia
Cranial nerve 3 palsy
Facial weakness
Atrophy and fasciculations
Pronator drift
Wrist drop
Foot drop
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Sensory level to pinprick
Distal pinprick loss
C6 pinprick loss
L5 pinprick loss
Ankle clonus
Extensor plantar response
Intention tremor
Essential tremor
Resting tremor
Choreoathetosis
Ataxic gait
Parkinsonian gait
Romberg sign
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Given specific clinical findings in a neurologic exam, localize the lesion and formulate a logical differential
diagnosis.
 Perform a focused mental status examination in standardized patients with the following mental disorders:
anxiety, psychotic, and two mood disorders.
Medical Knowledge: Student displays an appropriate level of medical knowledge and applies this knowledge to
patient care.
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Neurologic Function and Pathways
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Central Nervous System
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Identify the major gross structures of the central nervous system (CNS = cerebrum, brainstem,
cerebellum, and spinal cord), describe their histology, define their functions, and describe
clinical deficits associated with their pathology, including:
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Identify key long tracts in the CNS, define their functions, and describe clinical deficits
associated with their pathology, including:
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Brainstem (medulla, pons, and midbrain) and cerebellum (vermis and cerebellar hemispheres)
CSF structures: all 4 ventricles, Sylvian aqueduct, quadrigeminal plate cistern,
perimesencephalic cistern, suprasellar cistern, Sylvian fissure, interhemispheric fissure
Deep white matter: corpus callosum, internal capsule, corona radiata, and centrum semiovale
Subcortical gray matter: thalamus, lentiform nucleus (globus pallidus and putamen), caudate
nucleus
Cortex: frontal, parietal, temporal, and occipital lobes; insula
Corticospinal tract
Spinothalamic tract
Medial lemniscus/posterior columns (fasciculus cuneatus and fasciculus gracilis)
Spinocerebellar tract
Autonomic nervous system (sympathetic and parasympathetic)
Identify all 12 cranial nerves and nuclei, define their functions, and describe clinical deficits
associated with their pathology (and draw the pathways for the pupillary light reflex and blink
reflex)
Describe the anatomy, physiology, and pathophysiology of the structures involved in the visual,
auditory, olfactory, and taste systems
Summarize the regulation and the circulatory pathway of cerebrospinal fluid.
Language
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Identify the locations of the areas of cortex used in language.
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Identify Broca’s and Wernicke’s areas, and the arcuate fasciculus.
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Define the seven types of aphasias and the characteristics of each.
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Define the aprosodias and the characteristics of each.
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Emotions and Memories
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Describe the major neural circuits involved in producing emotional responses.
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Describe the processes for storage and retrieval of memories.
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Sleep
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Compare and contrast non-REM and REM sleep.
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Describe the anatomical and physiological mechanisms involved in the generation of
sleep, wakefulness, and circadian rhythms.
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Describe specific developmental disorders that produce CNS abnormalities.
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Peripheral Nervous System
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Define “upper motor neuron” and “lower motor neuron” and compare the signs associated with
damage to upper vs. lower motor neurons
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Define “dermatome” and “myotome” and describe their anatomical bases
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Define and describe “motor unit” and “neuromuscular junction”
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Define and describe circuits for the stretch, tendon, withdrawal, and crossed extensor reflexes
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Define “brachial plexus” and “lumbosacral plexus”
Vascular Anatomy
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Draw the pattern of arterial blood supply to each region of the brain on standardized sections, including
the following arteries:
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vertebral, basilar, and internal carotid arteries; circle of Willis and arterial branches (middle cerebral,
anterior cerebral, posterior cerebral, anterior choroidal, anterior communicating, and posterior
communicating arteries); superior cerebellar, anterior inferior cerebellar, and posterior inferior cerebellar
arteries); perforator arteries (lenticulostriate, thalamic, and basilar penetrating arteries)
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Describe deficits that occur if the blood supply is compromised in a specific cerebral artery.
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Draw the major venous sinuses in the brain.
Basic CNS Pathologic Processes
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Describe the pathophysiologic and pathologic effects of ischemia of the central nervous system and
define the term ischemic penumbra and its clinical significance.
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Describe the pathophysiologic and pathologic effects of hypoxia/anoxia of the CNS.
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Define and distinguish cytotoxic and vasogenic cerebral edema, describe their pathophysiology and
related pathologic processes and clinical presentations.
Neurologic Conditions—Describe the pathophysiology, clinical course, and management of the following
neurologic conditions:
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Headache, especially migraine
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Vertigo due to lesions in both the central and peripheral nervous systems
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Sleep disorders, especially sleep apnea
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Dementia, including Alzheimer disease and frontotemporal dementias
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Epilepsy, including partial seizures, generalized tonic-clonic seizures, absence seizures, and juvenile
myoclonic epilepsy
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Movement disorders, especially Parkinson and Huntington disease
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Demyelinating diseases, especially multiple sclerosis
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Ischemic stroke and transient ischemic stroke
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Intracerebral hemorrhage
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Subarachnoid hemorrhage
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Cerebral venous thrombosis
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Toxic-metabolic encephalopathy (= delirium = acute confusional state)
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Head trauma, including subdural hematoma, epidural hematoma, and closed head injury
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Nervous system neoplasms
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Intracranial hypertension and cerebral herniation syndromes
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Myelopathies, including spinal cord compression
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Myopathies and muscular dystrophies
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Myasthenia gravis
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Amyotrophic lateral sclerosis
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Peripheral neuropathies, especially Guillain-Barre Syndrome
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Mononeuropathies and radiculopathies
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Neuropathic pain
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Meningitis
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Encephalitis
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Mental Disorders: Integrate knowledge about etiologic factors, neurotransmitter systems, signs and symptoms,
differential diagnosis and pharmacotherapy (mechanism of action, dosing, administration and side effects) and
psychosocial treatments (if relevant) in holistic and compassionate care of patients with:
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“Organic” Mental Disorders: delirium, amnestic, catatonic, psychotic, mood, anxiety, personality, and
other disorders due to G.M.C.
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Substance Abuse: consider economic impact; tolerance, dependence, withdrawal, detoxification of
problematic use of: alcohol, CNS depressants (benzodiazepines, opiates, etc.), stimulants (caffeine,
cocaine, amphetamine and methamphetamine, etc.), marijuana, inhalants, hallucinogens, designer
“club” drugs (MDMA, GHB, Ketamine, Rohypnol, etc.), and nicotine.
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Discuss areas relevant to medical practice: diversion of controlled substances, Physicians
Recovery Program.
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Pain issues common in general medical practice:
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Nociceptive pain physiology (stimulation, transmission, perception, modulation)
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Neuropathic pain, cancer pain, acute vs. chronic pain
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Pharmacokitecis, dosing, side effects of FDA-approved non-opioid and opioid analgesics
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Mood Disorders: Major Depressive Disorder, Dysthymia, Bipolar Disorder and Cyclothymia
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Anxiety Disorders: Panic Disorder and Agoraphobia, Obsessive-Compulsive Disorder, Posttraumatic
Stress Disorder and Acute Stress Disorder, Specific and Social Phobias and Generalized Anxiety
Disorder
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Psychotic Disorders: Schizophrenia, Schizoaffective Disorder and other Mood Disorders, Delusional,
Brief Psychotic, Shared Psychotic Disorders
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Somatoform and Related Disorders: Somatization Disorder, Conversion Disorder, Pain Disorder,
Hypochondriasis, and Others: Body Dysmorphic Disorder and Factitious Disorder (Munchausen’s and
Munchausen’s by Proxy).
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Disorders of Childhood/Adolescence: Pervasive Developmental Disorders (Autism, Asperger’s, Rett’s,
PDD, Childhood Disintegrative Disorders), Mental Retardation, Disruptive Behavior Disorders (Attention
Deficit Hyperactivity Disorder, Oppositional Defiant and Conduct Disorders), and Mood Disorders and
Suicidality in Youth, and Anxiety Disorders (including Separation Anxiety Disorder and Selective
Mutism)
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Personality disorders challenging physicians in general practice
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Apply knowledge about additional treatment options in providing individualized patient care:
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Alternative and Complementary Medicine for CNS Disorders
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Levels of care (outpatient, inpatient, day hospital, E.O.D.)and types of psychiatric care-somatic (medications, electroconvulsive therapy, light therapy, vagal nerve stimulation, etc.)
and psychotherapy (individual: dynamic, CBT, interpersonal; group & family)
Evidence-Based Learning: Student incorporates evidence-based learning in his or her clinical thought process and
patient care.
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Collect a pertinent article and formulate a plan to answer a specific clinical question based on the evidence
provided in this article and four other articles provided by classmates.
Interpersonal and Communication Skills: Student displays interpersonal and communication skills that result in
effective information exchange and team building with patients, their families, and other health professionals.
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Demonstrate effective interpersonal and communication skills within a team of colleagues working toward a
common goal.
 Demonstrate effective interpersonal and communication skills in interviewing and examining standardized
patients with neurologic and mental disorders.
Professionalism: Student behaves in a professional manner with a clear commitment to carrying out his or her
responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
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Demonstrate professional behavior during a team exercise with colleagues.
Demonstrate professional behavior in interviewing and examining standardized patients with neurologic and
mental disorders, including demonstration of sensitivity to patients from diverse backgrounds.
Systems-Based Practice: The student’s actions demonstrate an awareness of and responsiveness to the
healthcare system at large and the ability to call on system resources to provide optimal patient care.
 Given a specific clinical scenario, recommend to a patient or caregiver appropriate advice regarding medication,
placement, and support services based on the patient’s clinical, financial, and social circumstances.
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Conduct of the Course
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Format – Didactic lectures; case-based exercises (Team Based Learning, Problem Based
Learning, online clinical vignettes); self-directed learning through textbooks, online syllabus, inclass and take-home assignments.
o Assigned reading – (TBD)
o Assignments – (TBD)
o Examinations – Multiple Choice Exam at the end; PBLs, TBLs and online cases throughout course
(TBD)
Method of Evaluation and Grading (to be finalized)
o 3 components are graded separately. Each component must be passed for the student to pass this
course.
1. Multiple Choice Exam
2. Case-Based Learning (PBLs, TBLs, online cases, in-class cases)
3. Professionalism (self , group and facilitator assessments of student’s preparation,
participation, cooperation with others, respect of others)
o Consistent with standardized COM grading policies for Basic Sciences Years, each of 3
components will be graded as Honors Pass, Pass or Fail.
Course Materials
o Required texts:
1. Blumenfeld: Neuroanatomy through Clinical Cases, Sinauer, 2002.
2. Andreasen & Black: Introductory Textbook of Psychiatry, 4th ed., APA Press, 2006. (on
reserve in Bird Library)
o Other useful references
1. Goldman: Review of General Psychiatry, 5th ed, Appleton & Lange, 2000. (on reserve in
Bird Library, also online in Bird Library, e-resources Stat!Ref)
2. Purves et al: Neuroscience, 4th ed., Sinauer, 2008
3. Haines: Neuroanatomy, 6th ed. (lab guide), Lippincott, 2004.
Academic Misconduct:
o This course follows the University of Oklahoma’s Academic Misconduct Code, described fully in the
university website: http://www.ouhsc.edu/admissions/handbook/Academic_Misconduct.htm
Reasonable Accommodation for Disabilities:
o Policies are consistent with the University of Oklahoma’s policies for accommodations for
disabilities, set forth in university website:
http://www.ouhsc.edu/admissions/handbook/Reasonable_Accommodation.htm. Students must submit
a Request for Reasonable Accommodation Form as described.
HIPAA Statement
o Standardized patients will be utilized. If students interact with real patients in training sessions,
HIPAA guidelines will be followed. Students will have completed HIPAA training prior to contact
with patients in this course.
Course Outline (subject to change)
o Week 1:
1. Monday: Introduction to Course; Brain Structure, Function and Pathways (brain and
spinal cord, dermatomes, cranial nerves)
2. Tuesday: Brain Structure, Function and Pathways (3 somatosensory systems, motor unit,
muscle spindle, Golgie tendon organs, extensor reflexes, brainstem lateral and medial
systems, corticospinal tract)
3. Wednesday: Upper and lower motor neurons; Cerebellum
4. Thursday:: Sensory Systems
5. Friday:: Basal Ganglia
o Week 2:
1. Monday: Emotions and Memories
2. Tuesday: Sleep
3. Wednesday: Speech
4. Thursday: Vascular and trauma I
5. Friday: Vascular and trauma II
o Week 3:
1. Monday: Infections
2. Tuesday: Degenerative neurologic conditions: Alzheimers, Huntington’s Parkinson’s, Pick
, Lewy Body and other dementias
3. Wednesday: amyotrophic lateral sclerosis, Guillain-Barre syndrome, multiple sclerosis,
Becker dystrophy, Duchenne dystrophy, myotonic dystrophy
4. Thursday: Carpal tunnel syndrome, radial neuropathy, sciatic neuropathy, ulnar
neuropathy
5. Friday: vitamin B12 deficiency, toxicity from ethanol and methanol; headaches
o Week 4:
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Monday: Seizures
Tuesday: Given neurologic exam, localize lesion and differential diagnosis
Wednesday: Nervous system neooplasms
Thursday: Substance Abuse with Impaired Physicians Panel; Mental Disorders due to
General Medical Conditions
Friday: Somatoform and related Disorders; Personality Disorders (PBL or TBL)
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Week 5:
1. Monday: Mood Disorders (interview Standardized Patients)
2. Tuesday: Anxiety Disorders (Interview Standardized Patients)
3. Wednesday: Psychotic Disorders (Interview Standardized Patients)
4. Thursday: Disorders of Childhood/Adolescence; Geriatric Psychiatry
5. Friday: Pain issues common in general medical practice; Alternative and Complementary
Medicine for CNS; Levels of psychiatric care
Week 6: Examination(s)
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