3.1 - Introduction to Psychiatry

Question 1

What are the differences between mental and physical illness?

Answer 1

• mentally ill people do not perceive themselves to be ill often
• difficult to build a therapeutic contract - may refuse treatment as they don’t think they are ill
• no scientific basis to diagnose mental illness and not diagnosed by aetiology or pathology, but by symptom clusters
• there can be uncertainty in diagnosis

Question 2

What are ruminations/obsessional thoughts?

Answer 2

• thoughts that come unbidden into your mind
• you know the thoughts are yours and they are senseless but they come anyway

Question 3

What are the psychic and physical symptoms of anxiety?

Answer 3

• psychic - feeling of fear or dread

Physical:

• sweating
• dry mouth
• palpitations
• splanchnic vasoconstriction (butterflies)
• tremor
• paraesthesia (pins and needles)
• depersonalisation
• syncope

Question 4

What is anxiety and what causes it?

Answer 4

• normal - helps us survive - but becomes pathological when it interferes with our daily lives
• caused by adrenaline release - contributes to fight and flight response but those with anxiety disorder have over-secretion of it
• positive feedback - adrenaline released, heart beats faster and you recognise this so body releases more etc

Question 5

What are obsessions associated with?

Answer 5

• ego-dystonic thoughts - thoughts that are inconsistent with our sense of self and seem foreign e.g. woman who just gave birth wants to stab baby - not consistent with what she as a person would want
• repetitive, circular ruminations
• may be bizarre and sound delusional
• insight maintained - you are aware these thoughts are senseless and ridiculous
• unbidden and resisted
• resistance leads to anxiety

Question 6

What are compulsions?

Answer 6

• motor response to obsessional thoughts
• often ritualistic, stereotyped, precise
• e.g. handwashing, counting, arranging and symmetry, checking door locks

Question 7

How can anxiety be classified?

Answer 7

• generalised anxiety disorder - long term anxiety that you feel all the time - may wax and wane but stable anxiety
• panic disorder - short bursts of panic attacks - can occur alongside GAD
• agoraphobia - fear of the marketplace and going out - hard to treat
• simple phobia - common e.g. fear of snakes, spiders
• social phobia - related to perception of scrutiny e.g. stage fright
• anxiety related to OCD and PTSD

Question 8

Why is looking at anxiety important?

Answer 8

• underdiagnosis and undertreatment of anxiety
• believed to be increasing in prevalence
• can be the beginning of a trajectory associated with eating disorders and self harm which are linked to parasuicide and suicide
• related to high morbidity i.e. low wellbeing scores, loneliness, unemployment and financial difficulties
• 60% of LGBT community report anxiety in last 12 months

Question 9

What is being done to treat anxiety?

Answer 9

• social prescribing - effective at management
• iAPT is the largest open access talking therapies programme in world despite being heavily over subscribed
• No Health Without Mental Health (2011)
• cognitive behaviour therapy (CBT) to manage symptoms
• clomipramine prescribed for OCD and is effective

Question 10

What are the symptoms of mania?

Answer 10

• elated mood
• irritability
• over-energised
• grandiose
• little need for sleep
• poor concentration
• poor judgement
• over-spending
• rapid speech

Question 11

What are the symptoms of schizophrenia?

Answer 11

• hallucination - 2nd / 3rd person, tactile
• delusion - fixed false beliefs, persecutory, bizarre, though possession and passivity
• abnormal behaviour
• disorganised speech - neologisms, formal thought disorder
• disturbances of emotion
• negative symptoms - apathy, social withdrawal, poor self care

Question 12

How can schizophrenia be treated?

Answer 12

• antipsychotics
• psychological therapies
• family therapy
• arts therapies