Classification and Assessment in Psychiatry

Question 1

4 main sources of intrapsychic conflict?

Answer 1

CRER
1. Conscience (cultural taboos and imperatives, superego)
2. Emotion (instinct, id, drive, passion, affect)
3. Relationships
4. Reality

Question 1

Defence mechanism?

Answer 1

A construct invoked to explain how behaviours, affects and ideas serve to avert or modulate unwanted impulse discharge

Question 2

What acts as buffer for 4 sources of intrapsychic conflict?

Answer 2

Ego

Question 3

Function of ego as buffer system?

Answer 3

Can avoid impulse discharge or anxiety by altering perception of internal and external reality

Question 4

Types of defence mechanism?

Answer 4

1. Psychotic
2. Immature
3. Neurotic
4. Mature

Question 5

Who proposed 4 levels of defence mechanism?

Answer 5

Valliant, 1994

Question 6

Psychotic defence mechanism definition?

Answer 6

Pronounced break with objective reality

Question 7

Psychotic defence mechanism examples?

Answer 7

1. Delusional projection
2. Psychotic denial
3. Psychotic distortion

Question 8

Delusional projection?

Answer 8

Frank delusions about external reality, usually of a persecutory type

Question 9

Psychotic denial?

Answer 9

Refusal to accept reality

Question 10

Psychotic distortion?

Answer 10

Grossly reshaping external reality to suit the inner needs

Question 11

Immature (narcissistic) defence mechanism definition?

Answer 11

Annoys the observer, but comforts the user

Question 12

Immature (narcissistic) defence mechanism examples?

Answer 12

1. Splitting
2. Projection
3. Projective Identification
4. Schizoid fantasy
5. Hypochondriasis
6. Passive aggressive behaviour
7. Acting out
8. Regression
9. Dissociation
10. Autistic fantasy

Question 13

Splitting?

Answer 13

Involves dealing with emotional conflict or internal or external stressors by compartmentalizing opposite affect states and failing to integrate the positive and negative qualities of the self or others into cohesive images. Because ambivalent affects cannot be experienced simultaneously, more balanced views and expectations of self or others are excluded from emotional awareness. Self and object images tend to alternate between polar opposites: exclusively loving, powerful, worthy, nurturing, and kind or exclusively bad, hateful, angry, destructive, rejecting, or worthless.

Question 14

Splitting is typical of?

Answer 14

BPD

Question 15

Projection?

Answer 15

Involves attributing your own unacceptable (and unacknowledged) feelings, impulses, or thoughts to another person.

Question 16

Projective identification?

Answer 16

In projective identification aspects of the ego are projected into another (as in projection). The difference between the two is that projective identification takes into account the emotional impact of the recipient who feels what is projected into them. In projective identification there is often a sense of feeling controlled or manipulated

Question 17

Schizoid/Autistic fantasy?

Answer 17

1. Tendency to use fantasy and indulge in autistic retreat for the purpose of conflict resolution and gratification.
2. It is associated with global avoidance of personal intimacy and the use of eccentricity to repel others. In contrast to psychotic denial, the individual does not fully believe in or insist upon acting out his fantasies. Nevertheless, unlike mere wishes, Schizoid fantasies serve to gratify unmet needs for personal relationships and to obliterate the overt expression of aggressive of sexual impulses towards others. Unlike disassociation. fantasy remakes the outer not the inner world

Question 18

Hypochondriasis?

Answer 18

1. The transformation of reproach towards others arising from bereavement, loneliness, or unacceptable aggressive impulses into first self-reproach and then complaints of pain, somatic illness, and neurasthenia.
2. The mechanism may permit the individual to burden others with his own pain or discomfort in lieu of making direct demands upon them or in lieu of complaining that others have ignored his wishes (often unexpressed) to be dependent. Unlike hysterical conversion symptoms, hypochondriasis is
   accompanied by the very opposite of la belle indifference

Question 19

Passive aggressive behaviour?

Answer 19

1. Aggression towards others expressed indirectly and ineffectively through passivity or directed against the self.
2. It includes: failures, procrastinations, or illnesses that (initially at least) affect others more than oneself. It includes silly or provocative behaviour in order to receive attention and clowning in order to avoid assuming a competitive role

Question 20

Acting out?

Answer 20

1. Impulsive action to avoid dealing with distressing impulses / anxiety.
2. May be present in conduct disorder, antisocial personality disorder, or oppositional defiant disorder.
3. Includes drug use, failure, perversion, or self-inflicting injury to relieve tension.
4. Involves chronically giving in to impulse in order to avoid the tension that would result ‘were there any postponement of instinctual expression

Question 21

Regression?

Answer 21

Reverting back to an earlier stage of development when faced with an unpleasant thought or emotioN

Question 22

Intermediate (neurotic) defence?

Answer 22

More discomfort to the user than to the observer

Question 23

Intermediate (neurotic) defence mechanism examples?

Answer 23

DDRRIU
1. Displacement
2. Intellectualisation
3. Reaction formation
4. Repression
5. Disassociation
6. Undoing

Question 24

Disassociation?

Answer 24

1. Thinking about wishes in formal, affectively bland terms, and not acting on them. The idea is in consciousness, but the feeling is missing.
2. The term encompasses the mechanisms of isolation. rationalisation, ritual, undoing, magical thinking. While these mechanisms differ from each other, they usually occur as a cluster

Question 25

Repression?

Answer 25

1. Seemingly inexplicable naivete, memory lapse, or failure to acknowledge input from a selected sense organ. The feeling is in consciousness, but the idea is missing.
2. E.g. a man weeping but forgetting for whom he wept

Question 26

Displacement?

Answer 26

1. The redirection of feelings toward a relatively less cared for (less cathected) object than the person or situation arousing the feelings.
2. Practical jokes, with with hidden hostile intent, and caricature involve displacement. Most phobias, many hysterical conversion reactions, and some prejudice involve displacement

Question 27

Reaction formation?

Answer 27

1. Behaviour in a fashion diametrically opposed to an unacceptable instinctual impulse.
2. This mechanism includes overtly caring for someone else when one wishes to be cared for oneself, ‘hating’ someone or something one really likes, or ‘ loving’ a hated rival or unpleasant duty

Question 28

Intellectualisation?

Answer 28

1. An emphasized focus on facts, logic, and abstract reasoning to assert control over and reduce unpleasant emotions associated with internal or external events.
2. Emotions and feelings tend to be analysed and experienced logically and philosophically as abstract ideas, rather than experiencing them.

Question 29

Undoing?

Answer 29

1. In undoing, an individual makes an attempt to cause past thoughts, words, gestures or actions not to have occurred. Undoing is directed at an act’s very reality, and the aim is to suppress it absolutely, as though time were reversible.
2. Freud originally used the term ‘ungeschehenmachen’ which translates to ‘to make null and void’ or ‘to make unhappen’.
3. A good example of this occurs (rarely) at crime scenes. The offender alters the crime scene in what has been considered to be an attempt to symbolically reverse the murder based on feelings of guilt or remorse. For example, ‘a son stabbed his mother to death during a fierce argument. After calming down, the son was hit by the full impact of his actions. First, he changed the victim’s bloodied shirt, then placed her body on the couch with the head on a pillow. He covered her with a blanket and folded her hands over her chest so she appeared to be sleeping peacefully (Russell, 2018).

Question 30

Mature defence mechanism examples?

Answer 30

1. Anticipation
2. Altruism
3. Humour
4. Sublimation
5. Suppression

Question 31

Mature defence mechanism?

Answer 31

Results in optimal adaptation in the handling of stressors. These defences usually maximise gratification and allow the conscious awareness of feelings, ideas and their consequences.

Question 32

Anticipation?

Answer 32

Devoting effort to solving problems before they arise

Question 33

Altruism?

Answer 33

1. Vicarious but constructive and instinctually gratifying service to others.
2. It includes benign and constructive reaction formation, philanthropy, and well repaid service to others. Altruism differs from projection and acting out in that it provides real , not imaginary, benefit to others and from reaction formation that leaves the person using the defence at least partly gratified

Question 34

Humour?

Answer 34

1. Overt expression of ideas and feelings without individual discomfort or immobilisation and without unpleasant effect on others.
2. Some games and playful regression come under this heading. Unlike wit, which is a form of displacement, humour lets you call a spade a spade. Like hope, humour permits one to bear and yet to focus upon what is too terrible to be borne

Question 35

Suppression?

Answer 35

1. The conscious or semiconscious decision to postpone paying attention to a conscious impulse or conflict.
2. The mechanism includes looking for silver linings, minimising acknowledged discomfort, employing a stiff upper lip, and deliberately postponing but not avoiding. With suppression, one says, ‘I will think about it tomorrow’, and the next day one remembers to think about it

Question 36

Sublimation?

Answer 36

1. Indirect or attenuated expression of instincts without either
   adverse consequences or marked loss of pleasure.
2. It includes both expressing aggression through pleasurable games, sports, and hobbies, and romantic attenuation of instinctual expression during a real courtship. Unlike the case with ‘neurotic’ defenses, with sublimation instincts are channelled rather than dammed or diverted. Successful artistic expression remains the classic example. In displacement one ‘s feelings are acknowledged as one’s own, but are redirected toward a relatively insignificant object, often without satisfaction. In sublimation, feelings are acknowledged, modified, and directed toward a relatively significant person or goal so that modest instinctual satisfaction results

Question 37

Level 1 Psychotic Defence Mushkies?

Answer 37

Level 1: common in ‘healthy’ individuals before age five, and common in adult dreams and fantasy. For the user, these mechanisms alter reality. To the beholder, they appear ‘crazy’. They tend to be immune to change by conventional psychotherapeutic interpretation; but they are altered by change in reality (e.g antipsychotic medication, removal of stressful situation. developmental maturation).

Question 38

Level 2 Narcissistic Defence Mechanism Mushkies?

Answer 38

Level 2: common in ‘healthy’ individuals ages three to fifteen. For the user these mechanisms most often alter distress engendered either by the threat of interpersonal intimacy or the threat of experiencing its loss. To the beholder they appear socially undesirable. Although refractory to change. immature mechanisms change with improved interpersonal relationships (e.g., personal maturation, a more mature spouse, a more intuitive physician, or a fairer parole officer) or with repeated and forceful interpretation during prolonged psychotherapy or with confrontation by peers.

Question 39

Level 3 Neurotic Defence Mechanism Mushkies?

Answer 39

Level 3: common in ‘healthy’ individuals ages three to ninety, in neurotic disorder, and in mastering acute adult stress. For the user these mechanisms alter private feelings of instinctual expression. To the beholder they appear as individual quirks or ‘neurotic hang-ups’. They often can be dramatically changed by conventional, psychotherapeutic interpretation.

Question 40

Level 4 Mature/Empathic Defence Mechanism Mushkies?

Answer 40

Level 4: common in ‘healthy’ individuals ages twelve to ninety. For the user these mechanisms integrate reality, interpersonal relationships, and private feelings. To the beholder they appear as convenient virtues. Under increased stress they may change to less mature mechanisms.

Question 41

Who suggested first rank symptoms?

Answer 41

Kurt Schneider (1938)

Question 42

Why were first rank symptoms introduced?

Answer 42

A pragmatic way to assist GPs in the identification of schizophrenia

Question 43

Is first rank of prognostic significance?

Answer 43

No

Question 44

FRS 2015 Systematic review by?

Answer 44

Soares-Weiser, 2015

Question 45

FRS Soares-Weiser findings?

Answer 45

1. FRS differentiated schizophrenia from nonpsychotic mental health disorders with a sensitivity of 61.8% (51.7%–71%) and a specificity of 94.1% (88%–97.2%).
2. FRS differentiated schizophrenia from other types of psychosis with a sensitivity of 58% (50.3%–65.3%) and a specificity of 74.7% (65.2%–82.3%).

Question 46

Classic migraine?

Answer 46

Headache precipitated by a visual aura

Question 47

Most common form of visual aura?

Answer 47

Fortification spectra (semicircle of zigzag lights)