2. Phenomenology Flashcards
What is phenomenology? AKA?
Refers to objective description of abnormal states of mind.
Phenomenology is also called descriptive psychopathology.
A way of describing and categorising the nature of experience recounted by patients & observed in their behaviour and M.S.E
What are the components of the MSE?
Appearance and Behaviour Speech Mood and Affect Thought Form and Thought Content Perception Cognition Insight
What are the components of appearance?
- Self care: Dress, make-up, hygiene.
Comment briefly, include any particularly unusual aspects.For instance – well/poorly groomed, reasonable/poor hygiene, shaven or otherwise. - Facial expression: sad / anxious/ angry/ afraid
Parkinsonian facies. Tardive dyskinesia - orofacial movements associated with antipsychotics - Over/ underweight
What are the components of behaviour?
- Level of Activity
(Stupor = mute, immobile, but fully conscious)
(Overactive/ agitated = Psychomotor acceleration)
(Underactive = Psychomotor retardation)
2. Movement (Parkinsonian features) (Rare Manifestations of psychosis =Posturing, Stereotypies, Echopraxia, Waxy Flexibility) (Tics – rapid repeated movements) (Tremor)
- Rapport
Overfamiliar? Suspicious? Depression?
What are the components of speech?
- Rate
Increased in Mania (Pressure of speech))
Decreased in Depression - Volume
- Quantity
Increased
Decreased (Poverty of speech)
Mutism (Complete loss of speech) - Dysprosody?
(Speech with the loss of its normal melody). - Dysarthria?
(Difficulty in articulation of speech).
What is mood?
Mood: Patients subjective assessment of how they feel. -elevated / low/ anxious / irritable etc.
What are the components of mood?
Scale 1-10
Mood: Interviewers objective assessment of mood – dysthymic, euthymic, elated.
Alexithymia: Difficulty in awareness of or description of ones emotions
What is Affect?
Affect: apparent emotion conveyed by the person’s nonverbal behavior.
What are the components of affect?
Blunted – minimal expressed emotion
Flattened – no affective expression
Constricted – limited range of expressed emotion
Inappropriate
Labile – abrupt, rapid, repeated shifts in intensity of emotion
Congruity of mood: Incongruent if discordant with persons thoughts/ experiences
What are possible changes in thought form?
INCREASED RATE
“Flight of ideas” – rapid succession of connected ideas
DISORDERED
“Loosening of association”
Knights move thinking – discernable but tenuous connections.
May exhibit punning, “clang” associations
Derailment – completely impossible to follow connections
Neologisms – new words
Word Salad
Thought Block – a “complete stop” in thought
Perseveration – repetition of final words
What are possible changes in thought content?
Obsessions
Phobias
Overvalued ideas
Delusions
What are Obsessions?
REPETITIVE images, ideas or thoughts,
that cause MARKED DISTRESS OR ANXIETY
that are RECOGNISED as repulsive and irrational to the individual
and are UNSUCCESSFULLY resisted.
Must be recognised as ones own.
What are common obsessions?
Fear of causing harm
Dirt and contamination
Sexual and religious themes
Violence
With what conditions are obsessions associated?
Association with OCD, Schizophrenia, Affective Disorders
What are phobias?
Persistent , irrational fear
of an activity, object or situation,
that is out of proportion
And leads to avoidance
What are the different types of Phobias?
Simple Phobia: Discrete objects ( Spiders, snakes etc..)
Social Phobia: Fear of personal interactions in a public setting
What are overvalued ideas?
Unreasonable and sustained intense preoccupation, maintained with less than delusional intensity
Marked associated emotional investment and impact on individuals life
What is a delusion?
False belief that is firmly held on inadequate grounds, is not amenable to rational discussion, and is discordant with persons culture and background.
i.e. does not include religious or spiritual beliefs that others may find bizarre
The person will not accept even the possibility they might be wrong
What are the different types of delusions?
Grandiose
Persecutory
Of reference (The person falsely believes that insignificant remarks, events, or objects in one's environment have personal meaning or significance.)
Nihilistic
Of passivity (Thought insertion, thought withdrawl, thought broadcasting, made feelings, made impulses, made actions)
Somatic passivity (The patient believes that sensation are being imposed upon his body by an outside force)
Delusional perception (person believes that a normal percept (product of perception) has a special meaning for him or her)
What is the difference between an illusion and a hallucination?
Illusion: Misinterpretation of a real stimulus. Includes pareidolia (ie seeing shapes in clouds, the fire, carpet)
Hallucination: Perceptual experience in absence of external stimulus
What are the different types of hallucinations?
Auditory :- 2nd/ 3rd person
- Echo de la pensee
- Running commentary
Visual: Suggestive of organic pathology
Tactile
Olfactory ( smell ) – associated with temporal lobe epilepsy
Gustatory ( taste )
What are the different categories of hallucination? (non-sensory based)
Hypnagogic: The hallucination occurs while falling asleep
Hypnapompic: The hallucination occurs while waking up.
Pseudohallucinations: Arises in subjective inner space of the mind.. subject to conscious manipulation..not indicative of mental disorder
What are the components of cognition?
- Orientation in time, place and person
- Memory: Short and long term function. )Confabulation: Gaps in memory unconsciously filled with false memories)
- Attention: Ability to focus
- Concentration: Ability to maintain focus
- Intelligence – controversial topic. IQ as a measure generally accepted, though politically controversial. “types” of intelligence now recognised.
Which component of cognition cannot be assessed by MMSE?
All bar intelligence can be assessed formally in the MMSE. (does not assess frontal lobes)
What questions are relevant to ask as regards a patients insight?
Does the patient think they are unwell?
Are they willing to attribute their difficulties to mental illness?
Are they willing to accept your advice regarding treatment/management?
Name some disorders of self-awareness?
- Depersonalisation: One feels that one is altered or not real.
- Derealisation: Ones surroundings do not seem real
Both phenomena can occur in “normal” people (like many mental phenomena – i.e. in sleep deprivation
