Psychiatric definitions Flashcards
(91 cards)
1
Q
What is salient syndrome?
A
A core symptoms of psychosis
A feeling that things have a special meaning
2
Q
Name the disorders that usually involve psychosis
A
Schizophrenia Schizoaffective disorder Delirium Delusional disorder Organic episode Psychotic depression Bipolar affective disorder
3
Q
What are the positive symptoms of schizophrenia?
A
Hallucinations, delusions
4
Q
What are the negative symptoms of schizophrenia?
A
Loss of drive, volition and energy
Flattened affect
Poor self care
5
Q
What are the cognitive symptoms of schizophrenia?
A
Change in personality
Dementia praecox
Poor attention and memory
6
Q
What are the different types of auditory hallucination?
A
1st person: thought echo
2nd person: depression, personality disorder. Someone speaking to you
3rd person: running commentary, schizophrenia
7
Q
Name 7 types of delusional belief
A
Thought control (insertion, withdrawl, broadcasting) Passivity (someone is controlling me) Persecution Reference (radio/tv about me) Grandeur Love/jealousy Nihilistic
8
Q
Name 10 symptoms of depression
A
Lowering of mood, reduction of energy, and decrease in activity Anhedonia Fatiguability Early morning waking Appetite loss/weight loss Guilt/self blame/worthlessness Agitation Loss of libido Thought of death/suicide, bleak/no future Psychosis with guilt & persecution
9
Q
Name 10 symptoms of mania
A
Elevated mood out of keeping with circumstance Increased energy Overactivity Pressure of speech Distractibility Loss of normal social inhibitions-> reckless, inappropriate Increased libido Racing thoughts Psychosis w/grandiose delusions
10
Q
What is bipolar?
A
Bipolar affective disorder is a disorder characterised by two or more episodes in which the patient’s mood and activity levels are significantly disturbed
Some occasions of an elevation of mood and increased energy and activity (hypomania or mania) and on others of a lowering of mood and decreased energy and activity (depression).
11
Q
What should be considered with visual hallucinations
A
Rare, consider organic cause
Sight problems, Lewy Body dementia, drugs
12
Q
Name the 5 types of hallucination
A
Auditory (1st, 2nd, 3rd person) Visual Olfactory Gustatory Somatic
13
Q
Give an example of a somatic hallucination
A
Bugs under skin during cocaine withdrawal
14
Q
What is a delusion?
A
A false belief held with extraordinary conviction, that is not accepted by other members of the pt’s culture
15
Q
What are the most important psychopathological phenomenon in the diagnosis of schizophrenia?
A
Thought echo Thought insertion/withdrawal Thought broadcasting Delusional perception Delusion of control Influence/passivity Hallucinatory voices commenting or discussing the pt in 3rd person Negative symptoms (loss of drive, energy, flattened affect, poverty of speech) Must be present for at least 1 month
16
Q
Name 4 types of schizophrenia
A
Hebephrenic
Catatonic
Paranoid
Schizoaffective disorder
17
Q
Describe what is defined as hebephrenic schizophrenia
A
Affective changes are prominent, delusions and hallucinations are fleeting and fragmentary.
Behaviour is irresponsible and unpredictable
Mood shallow and inappropriate, thought disorganised, speech incoherent
Social isolation
18
Q
Describe what is defined as catatonic schizophrenia
A
- Dominated by prominent psychomotor disturbances that may alternate between extremes such as hyperkinesis and stupor, or automatic obedience and negativism
- Constrained attitudes and postures may be maintained for long periods
- Episodes of violent excitement
- The catatonic phenomena may be combined with a dream-like (oneiroid) state with vivid scenic hallucinations
19
Q
Describe what is defined as paranoid schizophrenia
A
Dominated by relatively stable, often paranoid delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. Minimal disturbances of affect, volition and speech
20
Q
Describe what is defined as schizoaffective disorder
A
Episodic disorders in which both affective and schizophrenic symptoms are prominent but which do not justify a diagnosis of either schizophrenia or depressive or manic episodes
21
Q
What is panic disorder?
A
• Essential feature is recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable
• Dominant symptoms include sudden onset of palpitations, chest pain, choking sensations, dizziness, and feelings of unreality (depersonalization or derealisation)
• Secondary fear of dying, losing control, or going mad
1.2-4% lifetime prevelence
22
Q
How is GAD defined?
A
Anxiety that is generalised and persistent but not restricted to any particular environmental circumstances
Symptoms:
Psychic worry (worry, apprehension, difficulty concentrating
Motor tension (fidgeting, trembling, headaches)
Autonomic dysfunction (sweating, dizziness, dry mouth, abdominal churning)
Fears that the patient or a relative will shortly become ill or have an accident are often expressed.
For 6 months
23
Q
What is a obsessional thought?
A
Obsessional thoughts are ideas, images, or impulses that enter the patient’s mind again and again in a stereotyped form. They are almost invariably distressing and the patient often tries, unsuccessfully, to resist them. They are, however, recognized as his or her own thoughts, even though they are involuntary and often repugnant.
24
Q
What is a compulsive act?
A
Compulsive acts or rituals are stereotyped behaviours that are repeated again and again. They are not inherently enjoyable, nor do they result in the completion of inherently useful tasks. Their function is to prevent some objectively unlikely event, often involving harm to or caused by the patient, which he or she fears might otherwise occur.
25
Name 9 features of PTSD
* Episodes of repeated reliving of the trauma in intrusive memories ("flashbacks")
* Dreams or nightmares, occurring against the persisting background of a sense of "numbness" and emotional blunting
* Detachment from other people
* Unresponsiveness to surroundings
* Anhedonia
* Avoidance of activities and situations reminiscent of the trauma
* State of autonomic hyperarousal with hypervigilance
* Enhanced startle reaction
* Insomnia
26
What is somatisation disorder?
Multiple, recurrent and frequently changing physical symptoms of at least two years duration. Most patients have a long and complicated history of contact with both primary and specialist medical care services, during which many negative investigations or fruitless exploratory operations may have been carried out. Symptoms may be referred to any part or system of the body. The course of the disorder is chronic and fluctuating, and is often associated with disruption of social, interpersonal, and family behaviour
27
What makes an eating disorder classified as anorexia nervosa?
Body image distortion
Morbid fear of fatness
Restricted diet, excessive exercising, induced vomiting, induced purging, use of diuretics/appetite suppressants
Deliberate weight loss, induced and/or sustained by the patient, to 15% below what is expected (BMI<17.5)
Periods stop, men lose sexual interest
28
What makes an eating disorder classified as bulimia nervosa?
Body image distortion
Repeated bouts of overeating and an excessive preoccupation with the control of body weight, leading to a pattern of overeating followed by vomiting or use of purgatives
At least once a week for 3 months
Associated with EU/BPD
29
What is a personality disorder?
A variety of conditions and behaviour patterns of clinical significance which tend to be persistent and appear to be the expression of the individual's characteristic lifestyle and mode of relating to himself or herself and others.
• Deeply ingrained and enduring behaviour patterns, manifesting as inflexible responses to a broad range of personal and social situations.
• Not directly resulting from disease, damage, or other insult to the brain, or from another psychiatric disorder
• Usually manifest since childhood or adolescence and continuing throughout adulthood.
• Personal distress and social disruption
30
Name 3 groups and 11 types of personality disorder
A) Mad (Paranoid, Schizoid, Schizotypal)
B) Bad (Borderline, Impulsive, Emotionally unstable, Antisocial psychopathic, Narcissistic)
C) Sad (Dependent, Avoidant, Anankastic slow and obsessional)
31
What is paranoid personality disorder?
* Excessive sensitivity to setbacks
* Unforgiving of insults
* Suspiciousness and a tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous
* Recurrent suspicions, without justification, regarding the sexual fidelity of the spouse or sexual partner
* Combative and tenacious sense of personal rights
* Excessive self-importance, and often excessive self-reference
32
What is schizoid personality disorder?
* Withdrawal from affectional, social and other contacts with preference for fantasy, solitary activities, and introspection
* Limited capacity to express feelings and to experience pleasure
* Exclude: Asperger’s, schizophrenia
33
What is dissocial PD?
* Disregard for social obligations, and callous unconcern for the feelings of others
* Gross disparity between behaviour and the prevailing social norms
* Behaviour is not readily modifiable by adverse experience, including punishment
* Low tolerance to frustration and a low threshold for discharge of aggression, including violence
* Tendency to blame others, or to offer plausible rationalisations for the behaviour bringing the patient into conflict with society
* Includes: amoral, antisocial, psychopathic, sociopathic
34
What is EUPD?
* Definite tendency to act impulsively and without consideration of the consequences
* Mood is unpredictable and capricious
* Liability to outbursts of emotion and an incapacity to control the behavioural explosions
* Tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or censored.
35
What is borderline PD?
Disturbances in self-image, aims, and internal preferences
• Chronic feelings of emptiness
• Intense and unstable interpersonal relationships
• Tendency to self-destructive behaviour, including suicide gestures and attempts
36
What is histrionic PD?
* Shallow and labile affectivity
* Self-dramatization, theatricality, exaggerated expression of emotions
* Suggestibility, egocentricity, self-indulgence, lack of consideration for others
* Easily hurt feelings
* Continuous seeking for appreciation, excitement and attention.
* Including: Hysterical/psychoinfantile
37
What is anankastic PD?
* Feelings of doubt, perfectionism, excessive conscientiousness
* Checking and preoccupation with details
* Stubbornness, caution, and rigidity
* Insistent and unwelcome thoughts or impulses that do not attain the severity of an obsessive-compulsive disorder
* Exclude: OCD
38
What is avoidant PD?
* Feelings of tension and apprehension, insecurity and inferiority
* Continuous yearning to be liked and accepted
* Hypersensitivity to rejection and criticism with restricted personal attachments
* Tendency to avoid certain activities by habitual exaggeration of the potential dangers or risks in everyday situations.
39
What is dependent PD?
* Pervasive passive reliance on other people to make one's major and minor life decisions
* Great fear of abandonment, feelings of helplessness and incompetence
* Passive compliance with the wishes of elders and others
* Weak response to the demands of daily life
* Lack of vigour may show itself in the intellectual or emotional spheres
* Tendency to transfer responsibility to others.
* Including: asthenic, inadequate, passive, self-defeating
40
How do you treat personality disorders?
Compassion focussed therapy, takes away blame. Explains aetiology of their borderline PD, due to trauma etc.
Green (wellbeing, nurturing), blue (achievement, professional life), red (bad feelings).
DBT (dialectical behavioural therapy), polar opposite views and extreme coping mechanisms (self harm, eating disorder, substance misuse). Adjust behaviours and developing alternative ways of coping. Identifying emotions, regulating them.
41
What is the time period for mania versus hypomania?
Mania: a week (bipolar I)
Hypomania: 4 days (bipolar II)
42
Symptoms of mania/hypomania
Hypomania is less severe with less impairment on daily living & without psychosis
- Increased activity
- Decreased sleep
- Increased libido
- Distractibility, constant changes in plan
- Pressure of speech
- Flight of ideas
- Grandiose
- Loss of social inhibitions
- Reckless behaviour (spending, driving
43
What is a hallucination?
A perception in the absence of an external stimuli
44
What is a hypnogogig hallucination?
A hallucination when falling asleep
45
What is an illusion?
A percept arising from a misinterpretation of a stimulus (eg clouds as animals)
46
What is an overvalued idea?
Firmly held belief, not as fixed as a delusion
47
Theory of anxiety?
Abnormal fear response of amygdala-> prefrontal cortex-> brainstem resp centre-> hippocampus -> hypothalamus-> locus ceruleus
Genetic predisposition, esp if 1st degree family member is affected (eg 6x more likely with generalised anxiety)
48
What is the psychodynamic theory for anxiety?
Conflict between Id and the superego
49
Treatment of anxiety?
* CBT (16-20 sessions) is first line treatment
* Medication of an SSRI is 2nd line
* Self help and reading groups is 3rd line
50
Are the brains of people with bipolar different?
Yes:
Genetic factors (enzymes involved in Dopamine +Serotonin metabolism, proteins which interact with Lithium)
Subtle brain structure abnormalities (enlarged amygdala, enlarged lateral ventricles)
Less active prefrontal cortex-> emotional pathway overactivity
Enlarged amygdala-> hyper-emotionality
51
Is the presentation of bipolar different in different age groups?
Yes
Children may present as ADHD: is it mania? Is it a mood disorder?
Teenagers may present with grandiose ideas (eg I want to be the President of the USA) or depression (which is very common in this age group).
1st episode of mania after age 60 should be considered to have an organic cause until proven otherwise.
52
7 suicide risk factors
```
• Depression
• Living alone
• Elderly
• Male
• Unemployed
• Chronic pain/disability
• Previous DSH
Substance misuse
```
53
Prevalence of depression
20-30% population show depressive symptoms in any given year, 5-8% constitute major depressive illness.
54
What is the stress-vulnerability model of depression?
* Individual vulnerability factors (gender, genetics, early adverse life experience, personality, social problems)
* Current stress factor: life event, physical illness
* Maintaining factors: neuroendocrine changes (decreased serotonin and noradrenaline action), sick role
55
Chronic stress brain changes
* Reduced BDNF (Brain Derived Neurotrophic Factor, which is important for neuron maintenance)
* Shrinkage of the Hippocampus
* Systemic and brain inflammatory effects
56
Prevalence of schizophrenia and peak age of onset
0.5-1% prevalence
| Peak ages of onset are slightly earlier for males (late teens and 20s) than for females (20s and early 30s)
57
Name 4 environmental factors for schizophrenia and 4 biological
Environmental factors include: drug misuse, migration (esp from developing countries), social defeat, persistent cannabis use.
Biological factors include: genetics (identical twins have a 50% risk), pregnancy and birth problems (influenza in 2nd trimester, pre-eclampsia, fetal hypoxia and emergency caesarian section), childhood infections (mumps, CMV), developmental brain abnormalities.
58
What neurotransmitters may be involved in schizophrenia?
* Increased dopamine in the prefrontal cortex has been reported and dopamine-promoting drugs can lead to psychotic episodes.
* Glutamate receptor blocking drugs (eg PCP or Ketamine) induce schizophrenia-like symptoms in normal people.
* Serotonin agonists (eg LSD) induce hallucinations in normal people
59
Poor prognostic factors in schizophrenia
* Period of time spent experiencing psychotic symptoms in the 1st 2 years
* Insidious onset
* Early age of onset
* Abnormal premorbid personality
* Social isolation
* Poor compliance
60
Why are people with schizophrenia at risk of early death?
Due to a number of illnesses such as cardiovascular disease
Higher risk of accidents
Life expectancy is decreased by about 8 years
Severe risk of self neglect
Higher risk of having a poor diet, being smokers and of being overweight. They also have higher rates of drug and alcohol use.
People with schizophrenia are at higher risk than the general population of experiencing violence from others.
61
Side effects of anti-psychotics blocking serotonin?
serotonin blockage can lead to anxiety, weight gain and insomnia
62
SE of antipsychotics blocking histamine receptors?
The antihistamine action can also lead to weight gain as well as cause sedation.
63
SE of antipsychotics blocking adrenergic receptors?
Antiadrenergic blockage can cause postural hypotension, tachycardia and problems with ejaculation
64
SE of antipsychotics blocking cholinergic receptors?
Anticholinergic side effects cause dry mouth , blurred vision, constipation and urinary retention.
65
What receptors do antipsychotics block?
```
Dopamine
Serotonin
Histamine
Adrenergic
Cholinergic
```
66
What is schitzotypal disorder?
A disorder characterised by eccentric behaviour and anomalies of thinking and affect which
resemble those seen in schizophrenia, though no definite and characteristic schizophrenic
anomalies have occurred at any stage.
(a)inappropriate or constricted affect (the individual appears cold and aloof);
(b)behaviour or appearance that is odd, eccentric, or peculiar;
(c)poor rapport with others and a tendency to social withdrawal;
(d)odd beliefs or magical thinking, influencing behaviour and inconsistent with subcultural norms;
(e)suspiciousness or paranoid ideas;
(f)obsessive ruminations without inner resistance, often with dysmorphophobic, sexual or aggressive contents;
(g)unusual perceptual experiences including somatosensory (bodily) or other illusions, depersonalization or derealization;
(h)vague, circumstantial, metaphorical, overelaborate, or stereotyped thinking, manifested by odd speech or in other ways, without gross incoherence;
(i)occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations, and delusion-like ideas, usually occurring without external
provocation.
67
What is depersonalisation-derealisation syndrome?
A disorder in which the sufferer complains that his or her mental activity, body, and/or
surroundings are changed in their quality, so as to be unreal, remote, or automatized. Individuals
may feel that they are no longer doing their own thinking, imaging, or remembering; that their
movements and behaviour are somehow not their own; that their body seems lifeless, detached, or
otherwise anomalous; and that their surroundings seem to lack colour and life and appear as
artificial, or as a stage on which people are acting contrived roles. In some cases, they may feel as if
they were viewing themselves from a distance or as if they were dead. The complaint of loss of
emotions is the most frequent among these varied phenomena.
68
What must be excluded when diagnosing an eating disorder?
Chronic debilitating diseases, brain tumours, and intestinal disorders such as Crohn's disease or a malabsorption syndrome
69
What is a parasomnia?
Abnormal episodic events occurring during sleep; in childhood
these are related mainly to the child's development, while in adulthood
they are predominantly psychogenic, i.e. sleepwalking, sleep terrors, and
nightmares.
70
To diagnose schizophrenia what needs to be absent?
Schizophrenia cannot be diagnosed in:
- Presence of drug intoxication
- Presence of drug withdrawal
- Overt brain disease
- Prominent affective symptoms
71
What makes a depressive episode 'severe'?
More symptoms, higher severity
Interference with daily activities
Psychotic features automatically make it severe spression
72
Describe the psychotic features of severe depression
Mood congruent
Nihilistic delusions (belief that one is dead/rotting)
Delusions of illness
Accusing, condemning 2nd person hallucinations, may urge person to commit suicide
73
Aetiology of depression
```
Genetics
Parental loss
Abuse in childhood
Severe physical illness
Deprivation
Life event
Unemployment
Lack of confiding relationship
```
Dysfunctional limbic system
- > reduced BDNF
- >increased cortisol
- >reduced serotonin + NA
74
Differential diagnosis to bipolar
Substance abuse (cocaine, amphetamines)
Steroid induced psychosis
Schizoaffective disorder
75
Aetiology of bipolar
Genetic
Hypothalamo-pituitary-adrenal axis (cortisol levels) and thyroid levels
Childhood stressors (neglect, abuse)
76
What is normal grief?
```
Lasts less than 2 years
Shock, disbelief
Anger
Searching/pining
Guilt and self blame
Sadness and despair
Acceptance
```
77
When is PTSD diagnosed?
After a stressful experience that is exceptionally threatening/catastrophic in nature
If more than one month then turns from acute stress reaction to PTSD
78
When are abnormal grief more common?
The relationship with the deceased was problematic
The death was sudden
Normal grieving was impeded by social constraints (eg brave face for children)
79
Give 6 examples of compulsions
Hand washing
Counting, checking
Touching/rearranging to achieve symmetry
Hoarding
Mental compulsions (checking and repeating thoughts)
Onomatomania (desire to utter forbidden word)
80
What should compulsions be distinguished from?
Rituals
| 'Normal' superstitious behaviour
81
Define OCD
```
Time consuming (>1hr/day) obsessions and/or compulsions
Present most days for at least 2 weeks
Distressing and interfere with activities
```
82
4 classifications of OCD
Contamination (hand-washing)
Potential harm (eg leaving gas on)
Obsessions (without compulsions)
Hoarding
83
Differentials for anorexia
```
Schizophrenia w/delusions about food
Diabetes
Addison's
Malabsorption
Malignancy
```
84
Describe management of anorexia nervosa
Family interventions
Motivational counselling
CBT/IPT
Hospitalisation (if BMI<13.5, suicide risk, significant physical abnormalities)
85
Prognosis of anorexia nervosa
40% recover
20% chronic disorder
5% death
Long term osteoporosis
86
Name some consequences of repeated vomiting seen in anorexia and bulimia
```
Hypokalaemic alkalosis
Pitted teeth
Parotid swelling
Scarring of dorsum of hand
Acute oesophageal tears?
```
87
Why is there more mental illness in prisons?
Drug and alcohol use, unstable housing, unemployment and no qualifications-> more offences and more mental illness
Prison is stressful (sexual violence, few confidants)
```
1/2 of women have a personality disorder (EUPD)
2/3 me have a PD (antisocial)
2/3 women are depressed, 1/2 of men
1/2 of prisoners have IQ<85
1/3 use drugs
1/10 self harm
```
88
For someone to be guilty of a crime, what must be established?
That the defendant was criminally responsible, possessing the guilty mind
This is absent in under 10yr olds (up to 14 it must be proven)
Absent if lack of criminal intent (accidents)
Absent if mentally ill at time, resulting in 'defect of reason to disease of the mind' (not guilty by reason of insanity)
89
Define ego syntonic and ego dystonic
```
Ego syntonic (obsession, wanted to do it)
Ego dystonic (doesn’t want to think about it, no joy)
```
90
List 7 organic causes of depression
ALCOHOL, illicit drugs, anorexia,
cardiac, hypothyroid, chronic pain, any physical
insult to body or life routine eg sleep
91
What are the clusters of PDs?
A: Mad (schizotypal, paranoid, schizotypal)
B: Bad (antisocial, borderline, histrionic, narcisstic)
C: Sad (avoidant, dependent, Obsessive compulsive)
