Appearance and Behaviour:
Mania:
- What may you notice with their clothing? - 2
- What about if they are a female?
- What about their behaviour? - 4
Bright clothes (extravagant) Revealing clothing
Heavy make-up
Agitation
Overfamiliar
Intense eye contact
Distracted
Appearance and Behaviour:
Depression:
- What 3 signs may you notice in their appearance?
- 4 behavioural signs?
Dishevelled
Neglected
Evidence of weight loss
Withdrawn
Tearful
Psychomotor retardation
Poor eye contact
Appearance and Behaviour:
Anxiety:
- Are they dishevelled or dressed sensibly?
- What sort of behaviour do they show?
- What is one key feature which should point you towards anxiety?
Well kept
Distracted at times
Anxious
Fidgety
They are pleasant and cooperative which doesn’t happen in the others
Appearance and Behaviour:
Dementia:
- How could they be dressed?
- How do they behave?
Disheveled
Mismatched clothes
Distracted
Uncooperative
Distracted
Agitated at times
Speech:
Schizophrenia:
- They tend to use new made up words that they have invented. What is this called?
- They also get echolalia. What is that? What other psych condition is it associated with?
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Mania:
- How would you describe their speech?
Neologism
The patient repeats what is said to him - Be a feature of dementia or schizophrenia.
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Pressured speech
Loud
Maybe normal tone
Speech:
Depression:
- How would you describe their speech?
Dementia:
- What is the main feature of their speech?
- They also suffer something called Perseveration. What does this mean?
Slow
Monotonous
Low volume
Expressive dysphasia - they find it hard to find the words needed for speech
Perseveration – mainly seen in dementia. Inability to shift topic in reference to change in questions, is found in concrete thinking.
Emotion/Mood:
Schizophrenia:
- How would they be subjectively?
- How would they be objectively?
Mania:
- How would they be subjectively?
- How would they be objectively?
S - ok
O - euthymic or depressed with blunted affect (catatonia)
S - Will say they are on top of the world
O - Look the same
Emotion/mood:
Depression:
- How would they be subjectively?
- How would they be objectively?
Anxiety:
- How would they be subjectively?
- How would they be objectively?
Both the same - low mood
S - fine; low
O - anxious
Perception:
Schizophrenia - Auditory hallucinations
- What person is it in? - 2
- What do the voices say?
2nd or 3rd person
Thought echo
Running commentary
Commanding
Thoughts:
What 3 things do we focus on for thought?
Schizophrenia:
They experience persecutory delusions.
They also experience:
- Delusions of reference
- Delusions of control
Define them both?
Rate
Flow
Content
Delusions of reference - A delusion in which the patient believes that unsuspicious occurrences refer to him or her in person. Patients may, for example, believe that certain news bulletins have a direct reference to them, that music played on the radio is played for them, or that car licence plates have a meaning relevant to them.
Delusion of control: False belief that another person, group of people, or external force controls one’s general thoughts, feelings, impulses, or behaviour.
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Thoughts:
Schizophrenia:
They also get formal thought disorder. The following occur in Sz so define each one?
- Derailment and tangentially
- Loosening of associations
- Neologism
- Clang association
- Thought block
- Poverty of thought
It is usually manifested in speech (speech derailment) but can also be observed in writing.
Marked by frequent interruptions in thought and jumping from one idea to another unrelated or indirectly related idea.
Derailment is essentially equivalent to loosening of associations.
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Neologism - Creating new words
Clang associations are groupings of words, usually rhyming words, that are based on similar-sounding sounds, even though the words themselves don’t have any logical reason to be grouped together.
During thought blocking, a person stops speaking suddenly and without explanation in the middle of a sentence.
a thought disturbance, often associated with schizophrenia, dementia, and severe depression, in which there is reduced spontaneity and productivity of thought as evidenced by speech that is vague or full of simple or meaningless repetitions or stereotyped phrases.
Thoughts:
Mania:
- What are 2 main features here?
Depression:
- What sort of delusions do they get?
- What other thoughts do they generally get?
- What happens to their thought specifically?
Delusion of grandeur
Flight of ideas - A nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli, or plays on words. When severe, speech may be disorganised and incoherent.
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Nihilistic delusion > the belief that oneself, a part of one’s body, or the real world does not exist or has been destroyed.
Excessive guilt, hopelessness, helplessness, worthlessness,
Poverty of through
Insight:
What is the insight for the following conditions?
Schizophrenia
Manai
Depression
Anxiety
Schizophrenia – usually LACKS insight during episode/relapse
Mania – usually LACKS insight during episode / relapse
Depression – usually insight present, maybe lacking in severe depression with / without psychosis
Anxiety – usually insight present.
Cognition:
How is this affected in mania?
Severe depression - What do they complain of? - 2
Dementia - what will they complain of? - 4
Impaired (unable to focus on tasks)
Easily distracted
Memory and difficulty concentrating
Poor orientation
Poor memory
Poor attention
Poor concentration
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History Taking21
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Mental State Examination35
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MSE Specific Signs14
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Physical Examination5
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Formulation8
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Bipolar Disorder30
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Depression30
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Antidepressants9
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Anxiety34
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Psychosis10
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Schizophrenia31
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MHA10
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MCA11
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Personality Disorders14
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Anorexia Nervosa21
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Bulimia Nervosa9
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Alcohol Abuse26
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Substance Abuse17
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Suicide4
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Types of Therapy4
