Classification and assessment in psychiatry

Question 1

Two major classificatory systems (+dates)

Answer 1

ICD-10 (WHO, 1992)

DSM-IV (American Psychiatric Association, 1994)

Question 2

Operationalised approach (to classification)

Answer 2

Essentially a ‘checklist’ approach to diagnosis:

• Precise clinical descriptions of disorders
• Predefined exclusion and inclusion criteria
• Details of the number/duration of symptoms required for diagnosis

Question 3

3 kinds of symptoms relevant to the operationalised approach to classification

Answer 3

Characteristic symptoms - pertinent to the diagnosis (e.g. the symptoms of depression are found in many different disorders)

Pathognomonic symptoms - strongly favour one diagnosis over another (e.g. flashbacks in PTSD)

Discriminating symptoms - necessary for a diagnosis (e.g. thought insertion)

‘CPD’

Question 4

Atheoretical approach (to classification)

Answer 4

Diseases are described according to the observed phenomenology; NOT based on an understanding of what might be causing the disturbances

(no theory - e.g. behaviourism, psychoanalytic - forms the basis of the classifications, only neutral observations are taken into account)

Question 5

Descriptive approach

Answer 5

Illnesses are classified on the basis of what constitutes the illness, not what causes them.

This forms the basis of the atheoretical approach.

Question 6

Hierarchical organisation

Answer 6

Certain disorders take precedence over others when making a diagnosis.
If a disorder closer to the top of the hierarchy can explain the observed symptoms, then a diagnosis should not be entertained from below even if the constellation of symptoms are suggestive of such a diagnosis

Stems from the ideas of Karl Jaspers.
Largely abandoned in DSM but maintained in ICD-10’s organisation of chapters.

Organic disorders - Substance use disorders - Psychosis - Affective disorders - Neurotic disorders - Personality issues

Question 7

ICD-10 Multiaxial approach

Answer 7

1 - mental disorder (including personality disorder and mental handicap)
2 - degree of disability
3 - current psychosocial problems

Question 8

DSM-IV Multiaxial approach

Answer 8

1 - clinical disorders
2 - personality disorders/mental retardation
3 - general medical conditions
4 - psychosocial and environmental problems
5 - global assessment of functioning

Question 9

DSM-V (updates from DSM-IV)

Answer 9

Published 2013
Abandoned use of multiaxial diagnosis and global assessment of functioning

Autistic disorder, Asperger’s, and pervasive developmental disorder were consolidated into one disorder: Autistic spectrum disorder.

Binge eating disorder, premenstrual dysphoric disorder, and hoarding disorder gained recognition as ‘real’ disorders.

Question 10

DSM-V (modifications to psychosis)

Answer 10

Removal of ‘bizarre’ delusions
Removal of subtypes of schizophrenia
3 core symptoms recognised: delusions, hallucinations, disorganised speech
Changes in schizoaffective criteria

Question 11

DSM-V (modifications to mood disorders)

Answer 11

Dysthymia and chronic depression merged
Bereavement no longer an exclusion for depression
Premenstrual dysphoric disorder added as a new diagnosis

Question 12

DSM-V (modifications to developmental disorders)

Answer 12

Autistic disorder, Asperger’s, and pervasive developmental disorder were consolidated into one disorder: Autistic spectrum disorder.

ADHD age criteria relaxed

Question 13

Anton’s syndrome

Answer 13

aka Anton-Babinski syndrome

Occurs following damage to the occipital lobe.

Affected individuals are cortically blind but are unaware of this and deny they have a problem (anosognosia). It often presents as the patient starts falling over furniture as they can’t see. Affected individuals believe they can still see and describe their environments in detail but are wrong in their description (confabulation).

Question 14

Anosognosia

Answer 14

lack of insight

Question 15

multiple choice questionnaire used to rate the severity of depression.

Depending on the version used there are either 17 or 21 items. Each item is scored out of between 3 and 5 points. The greater the total points scored the more severe the depression is.

For the 17 item version (the most commonly used) scores range between 0 and 54. Scores over 24 indicate a severe depression.

Answer 15

HAMD (Hamilton depression rating scale)

Question 16

10-item diagnostic questionnaire used to measure the severity of depressive episodes.

It was designed to be more sensitive to the changes brought on by antidepressants and other forms of treatment.

Answer 16

MADRS (Montgomery-Asberg depression rating scale)

Question 17

assesses the severity of depression.

There are 20 items on the scale, each one scored out of 1-4.

Answer 17

ZSRDS (Zung self rated depression scale)

Question 18

assesses the severity of depression

21 items, each scored 0-3.

The scale was revised in 1966.

0-13 indicates minimal depression,
14-19 mild depression,
20-28 moderate,
29-63 severe depression.

Answer 18

BDI (Beck depression inventory)

Question 19

30 item self-report scale used to screen for depression in the elderly.

Each question has either a yes or no response, making the total score out of 30.

0-9 is deemed normal,
10-19 is mild depression,
20-30 is severe depression.

Answer 19

GDS (geriatric depression scale)

Question 20

screening test for depression.

It uses a deck of cards with statements such as ‘I’ve lost interest in things’ which are shown to the patient. In response to each card, the patient indicates whether the card is true or false by pointing to another card.

There are 19 cards with a maximum score of 21 (two cards carry 2 points each).

It is a quick test and takes less than 5 minutes to administer. A cut off score of 7 is generally used.

The test was developed for use on busy wards to introduce a degree of privacy as other tests involve questions being read out and someone in the next cubicle hearing everything.

Answer 20

BASDEC (Brief Assessment Schedule Depression Cards)

Question 21

This test was developed specifically to screen for depression in dementia cases. It involves a 20 min interview with a carer and 10 mins with the patient.

A total of 19 items are rated as either ‘absent’, ‘mild / intermittent’, or ‘severe’.

Answer 21

Cornell Scale for Depression in Dementia

Question 22

11-item instrument used to assess the severity of mania in patients with a diagnosis of bipolar disorder.

Answer 22

YMRS (Young mania rating scale)

Question 23

14 item scale designed to measure the severity of anxiety.

Answer 23

HAMA (Hamilton anxiety rating scale)

Question 24

used to measure both the severity of OCD and the response to treatment.

Answer 24

Y-BOCS (Yale-Brown Obsessive compulsive scale)

Question 25

a common instrument used to evaluate psychopathology in patients with schizophrenia, it has now been largely replaced by the PANSS. It is rated by a clinician and consists of 24 items, each rated out of a 7 point scale of severity. Higher score indicate greater severity of symptoms. Ratings for several of the variables are based on observation, the remainder are assessed via a short interview.

Answer 25

BPRS (Brief psychiatric rating scale)

Question 26

looks at both positive and negative symptoms in schizophrenia. It takes a wide sample of information, including data from and interview, along with reports from hospital staff and family. The information gathered is based on how the patient was in the previous week.

Answer 26

PANSS (Positive and negative syndrome scale)

Question 27

used as part of axis V of the DSM-IV. It provides a single measure of global functioning. It enquires about psychological and occupational functioning only. The total score is out of 100. A score of 100 is the best that can be achieved and indicates that a patient functions at the highest level possible.

Answer 27

GAF (Global assessment of functioning)

Question 28

a scale that requires the clinician to rate the severity of the patient's illness at the time of assessment, relative to the clinician's past experience with patients who have the same diagnosis.

Answer 28

CGI (Clinical global impression)

Question 29

used to quantify discontinuation symptoms associated with stopping antidepressants. 43-item rating scale - spans a broad spectrum of discontinuation symptoms and can be helpful in documenting symptoms of depressed patients in order to diagnose the likely cause of distress.

Answer 29

DESS (Discontinuation-Emergent Signs and Symptoms scale)

Question 30

BDI (Beck depression inventory) Self-rated or clinician-rated?

Answer 30

Self-rated

Question 31

GHQ (General health questionnaire) Self-rated or clinician-rated?

Answer 31

Self-rated

Question 32

GDS (geriatric depression scale) Self-rated or clinician-rated?

Answer 32

Self-rated

Question 33

ZSRDS (Zung self rated depression scale) Self-rated or clinician-rated?

Answer 33

Self-rated

Question 34

HAD (Hospital Anxiety depression scale) Self-rated or clinician-rated?

Answer 34

Self-rated

Question 35

EPDS (Edinburgh postnatal major depression scale) Self-rated or clinician-rated?

Answer 35

Self-rated

Question 36

BPRS (Brief psychiatric rating scale) Self-rated or clinician-rated?

Answer 36

Clinician-rated

Question 37

MADRS (Montgomery-Asberg depression rating scale) Self-rated or clinician-rated?

Answer 37

Clinician-rated

Question 38

HAMD (Hamilton depression rating scale) Self-rated or clinician-rated?

Answer 38

Clinician-rated

Question 39

HAMA (Hamilton anxiety rating scale) Self-rated or clinician-rated?

Answer 39

Clinician-rated

Question 40

PANSS (Positive and negative syndrome scale) Self-rated or clinician-rated?

Answer 40

Clinician-rated

Question 41

CGI (Clinical global impression) Self-rated or clinician-rated?

Answer 41

Clinician-rated

Question 42

AIMS (Abnormal involuntary movement scale) Self-rated or clinician-rated?

Answer 42

Clinician-rated

Question 43

Y-BOCS (Yale-Brown Obsessive compulsive scale) Self-rated or clinician-rated?

Answer 43

Clinician-rated

Question 44

YMRS (Young mania rating scale) Self-rated or clinician-rated?

Answer 44

Clinician-rated

Question 45

GAF (Global assessment of functioning) Self-rated or clinician-rated?

Answer 45

Clinician-rated

Question 46

SAS (Simpson-Angus scale) Self-rated or clinician-rated?

Answer 46

Clinician-rated

Question 47

CAMDEX (Cambridge Mental Disorders of the Elderly Examination) Self-rated or clinician-rated?

Answer 47

Clinician-rated

Question 48

Cornell Scale for Depression in Dementia Self-rated or clinician-rated?

Answer 48

Clinician-rated

Question 49

Brief Assessment Schedule Depression Cards (BASDEC) Self-rated or clinician-rated?

Answer 49

Clinician-rated

Question 50

Assumed that doctor knows best. Doctor decides treatment and patient is expected to simply comply (Model of doctor-patient relationship)

Answer 50

Paternalistic (aka autocratic model)

Question 51

Doctor provides information and the patient is left to make the choice themselves (Model of doctor-patient relationship)

Answer 51

Informative

Question 52

The doctor understands the patient and helps the patient make a decision based on their circumstances. This involves shared decision making and involves the participation of the patient (Model of doctor-patient relationship)

Answer 52

Interpretive

Question 53

The doctor acts as a friend to the patient and attempts to steer them in a particular course of action which they see is in their best interest but ultimately the choice is left to the patient (Model of doctor-patient relationship)

Answer 53

Deliberative

Question 54

Models of doctor-patient relationship (4)

Answer 54

Paternalistic (aka Autocratic) Informative Interpretive Deliberative

Question 55

Glasgow Coma Scale (scores for coma/impaired consciousness)

Answer 55

Scores range from 3 (deep coma) to 15 (normal). Impaired consciousness is rated as: mild (13-15), moderate (9-12), severe (3-8).

Question 56

GCS (E)

Answer 56

4 Spontaneous opening 3 Opens to verbal stimuli 2 Opens to pain 1 No response

Question 57

GCS (V)

Answer 57

``` 5 Orientated 4 Confused conversation 3 Inappropriate words 2 Incoherent 1 No response ```

Question 58

GCS (M)

Answer 58

6 Obeys commands 5 Purposeful movement to painful stimuli 4 Withdraws in response to pain 3 Flexion in response to pain (decorticate posturing) 2 Extension in response to pain (decerebrate posturing) 1 No response

Question 59

Clinical syndromes associated with substance use (8)

Answer 59

``` Acute intoxication Harmful use Dependence Withdrawal state Withdrawal delirium Psychotic disorder Amnesic syndrome Late-onset disorders ```

Question 60

Transient disturbance in the level of consciousness, cognition, perception, affect or behaviour, or other psychophysiological functions and responses.

Answer 60

Acute intoxication

Question 61

A pattern of substance use that is causing damage to physical or mental health. Should not be diagnosed if dependence syndrome or substance-induced psychosis are diagnosed.

Answer 61

Harmful use

Question 62

A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.

Answer 62

Dependence

Question 63

A group of symptoms of variable clustering and severity occurring on absolute or relative withdrawal of a psychoactive substance after persistent use of that substance. The onset and course are time-limited and are related to the type of psychoactive substance and dose being used immediately before cessation or reduction of use. May be complicated by convulsions.

Answer 63

Withdrawal state

Question 64

Withdrawal accompanied by confusional state

Answer 64

Withdrawal delirium

Question 65

A cluster of psychotic phenomena that occur during or following psychoactive substance use but that are not explained on the basis of acute intoxication alone and do not form part of a withdrawal state.

Answer 65

Psychotic disorder (substance use syndrome)

Question 66

A syndrome associated with chronic prominent impairment of recent and remote memory. Immediate recall is usually preserved and recent memory is characteristically more disturbed than remote memory. Disturbances of time sense and ordering of events are usually evident, as are difficulties in learning new material. Confabulation may be marked but is not invariably present. Other cognitive functions are usually relatively well preserved and amnesic defects are out of proportion to other disturbances.

Answer 66

Amnesic syndrome

Question 67

A disorder in which alcohol- or psychoactive substance-induced changes of cognition, affect, personality, or behaviour persist beyond the period during which a direct psychoactive substance-related effect might reasonably be assumed to be operating.

Answer 67

Late-onset (substance use) disorders

Question 68

Kraepelin Mixed States (6)

Answer 68

``` Manic Stupor Mania with poverty of thought Inhibited mania Depressive-anxious Mania Excited depression Depression with flight of ideas ```

Question 69

Manic Stupor (mood, will, thought)

Answer 69

Mood - high Will - low Thought - low

Question 70

Mania with poverty of thought (mood, will, thought)

Answer 70

Mood - high Will - high Thought - low

Question 71

Inhibited mania (mood, will, thought)

Answer 71

Mood - high Will - low Thought - high

Question 72

Depressive-anxious mania (mood, will, thought)

Answer 72

Mood - low Will - high Thought - high

Question 73

Excited depression (mood, will, thought)

Answer 73

Mood - low Will - high Thought - low

Question 74

Depression with flight of ideas (mood, will, thought)

Answer 74

Mood - low Will - low Thought - high

Question 75

--- refers to a deficiency in understanding, processing, or describing emotions. * A difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal * A difficulty describing feelings to other people * Constricted imaginal processes, as evidenced by a scarcity of fantasies * A stimulus-bound, externally oriented cognitive style

Answer 75

Alexithymia

Question 76

The patient cannot read but is able to write. Understanding spoken language and conversation are intact. This is usually due to a lesion destroying the left visual cortex, as well as the connections to the right visual cortex in the corpus callosum. It is typically caused by an occlusion of a branch of the PCA.

Answer 76

Alexia without agraphia

Question 77

Depressive pseudodementia

Answer 77

Not a diagnostic entity but a descriptive term used in old-age psychiatry. Depression in elderly patients may present as dementia clinically.

Question 78

5A's of Alzheimer's disease

Answer 78

``` Amnesia Aphasia Agnosia Apraxia Associated disturbances (behavioural changes, delusions, hallucinations) ```

Question 79

Amnesia (definition)

Answer 79

Impaired ability to learn new information and recall previously learned information

Question 80

Aphasia (definition)

Answer 80

Problems with language (receptive and expressive)

Question 81

Agnosia (definition)

Answer 81

Problems with recognition, especially people

Question 82

Apraxia (definition)

Answer 82

Inability to carry out purposeful movements despite there being no sensory or motor impairment

Question 83

Distinction between dementia with lewy bodies and Parkinson's disease dementia

Answer 83

Parkinson's disease dementia is diagnosed if parkinsonian symptoms have existed for more than 12 months before dementia develops. If motor symptoms and cognitive symptoms develop within 12 months of each other, then LWD is usually diagnosed.

Question 84

Schneider's First Rank Symptoms (6)

Answer 84

Not pathognomic, but are highly suggestive of a diagnosis of schizophrenia. They are not useful in prognosis. 3 Hallucinations - 3rd person voices arguing - Running commentary - Thought echo 3 Delusions of thought control - Thought withdrawal - Thought insertion - Thought broadcasting 3 'Made' phenomena - Made affect - Made volition - Made impulse 2 extras: - Delusional perception - Somatic passivity

Question 85

Schizophrenia (ICD-10 subtypes - 9)

Answer 85

``` Paranoid Hebephrenic (aka disorganised) Catatonic Undifferentiated Post schizophrenic depression Residual Simple Other Unspecified ```

Question 86

Paranoid schizophrenia (key features)

Answer 86

characterised by the preoccupation of delusions or hallucinations (typically persecutory or grandiose ones).

Question 87

Hebephrenic (disorganised) schiziphrenia (characterisation)

Answer 87

characterised by a regression to a primitive, unorganized form of behaviour. Incongruous behaviour such as grinning is common. =============================== it has the worst prognosis among the subtypes of schizophrenia

Question 88

Catatonic schizophrenia (characterisation)

Answer 88

characterised by marked disturbances in motor function such as stupor, posturing, and rigidity.

Question 89

--- refers to patients who lack active psychotic symptoms but still have milder symptoms such as emotional blunting, and mild loosening of association.

Answer 89

Residual schizophrenia

Question 90

Simple schizophrenia (characterisation)

Answer 90

characterised by predominately negative symptoms of schizophrenia in the absence of overtly psychotic experiences.

Question 91

Bouffee delirante

Answer 91

described by Legrain a brief shorted lived psychosis that lasts less than 3 months.

Question 92

Schizophrenia - positive symptoms (3)

Answer 92

Hallucinations Delusions Thought disorder

Question 93

Schizophrenia - negative symptoms (6)

Answer 93

``` Social withdrawal Apathy Lack of energy Poverty of speech Flattening of affect Anhedonia ```

Question 94

Schizotypal disorder (features and classification)

Answer 94

Features - eccentric manners, social withdrawal, magical thinking, suspiciousness, obsessive ruminations. - 2 year history with no schizophrenia diagnosed In ICD-10 it is classified with schizophrenia and related disorders; in DSM-IV it is classified with Cluster A personality disorders

Question 95

De Clerambault Syndrome

Answer 95

Erotomania. A DSM-IV subtype of delusional disorder where a patient falsely believes that a person with higher status is secretly in love with them.

Question 96

Grandiose delusion

Answer 96

Belief that one has a special role, relationship, or ability.

Question 97

Othello syndrome

Answer 97

Belief that a sexual partner is cheating on them

Question 98

Persecutory delusion

Answer 98

Most common form of delusional disorder - Patients are convinced that others are attempting to hurt or harm them. Can lead them to try to obtain legal recourse.

Question 99

Folie a deux

Answer 99

Shared delusion. A syndrome where a delusion is transmitted from one person to another.

Question 100

Ekboms' syndrome

Answer 100

Delusional parasitosis The belief that the skin is infested with parasites. Sometimes a/w cocaine use

Question 101

Capgras delusion

Answer 101

Belief that a person close to them has been replaced by a double

Question 102

Fregoli delusion

Answer 102

Belief that strangers are actually persons well known to the patient in disguise.

Question 103

Lycanthropy

Answer 103

belief that one has been transformed into an animal

Question 104

Cotard syndrome

Answer 104

belief that one does is dead or does not exist, or that a part of one's body (e.g. organs) are not there

Question 105

Delusional perception

Answer 105

belief that a normal percept (product of perception) has a special meaning.

Question 106

Pseudocyesis

Answer 106

a condition whereby a woman believes herself to be pregnant when she is not. Objective signs accompany the belief such as abdominal enlargement, menstrual disturbance, apparent foetal movements, nausea, breast changes, and labour pains.

Question 107

Process schizophrenia (description)

Answer 107

Langfeldt (1939) differentiated two groups of psychoses: 1. 'Genuine' or 'process' schizophrenia - poor prognosis 2. 'Schizophreniform' psychosis - good prognosis (later work reclassified Langfeldt's second category as affective disorders with psychotic features)

Question 108

Approximate answers

Answer 108

Patient gives an incorrect response to a question, but the nature of the response suggests that they understand the question e.g. stating that a dog has three legs

Question 109

consists of 14 questions, 7 for anxiety and 7 for depression each item is scored from 0-3 produces a score out of 21 for both anxiety and depression severity: 0-7 normal, 8-10 borderline, 11+ case patients should be encouraged to answer the questions quickly

Answer 109

Hospital Anxiety and Depression (HAD) Scale

Question 110

asks patients 'over the last 2 weeks, how often have you been bothered by any of the following problems?' 9 items which can then be scored 0-3 includes items asking about thoughts of self-harm depression severity: 0-4 none, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe

Answer 110

Patient Health Questionnaire (PHQ-9)

Question 111

Duration of symptoms required for diagnosis of depression (ICD-10 and DSM-IV)

Answer 111

2 weeks

Question 112

Grading of depression (ICD-10)

Answer 112

'4-6-8 rule' Mild depression - 2 core symptoms, with 4 symptoms in total Moderate depression - 2 core symptoms, with 6 symptoms in total Severe depression - 2 core symptoms with 8 symptoms in total

Question 113

Recurrent major depressive disorder (time criterion)

Answer 113

In both ICD-10 and DSM-IV this can be diagnosed if there has been at least one previous major depressive episode separated by the current episode by at least 2 months

Question 114

Duration of symptoms required for diagnosis of mania (ICD-10 and DSM-IV)

Answer 114

7 days or any duration if hospitalised

Question 115

Duration of symptoms required for diagnosis of hypomania

Answer 115

4 days

Question 116

Precipitants of drug-induced mania (4)

Answer 116

Levodopa Corticosteroids Anabolic-androgenic steroids Antidepressants (tricyclic and monoamine oxidase inhibitor classes)

Question 117

Rapid cycling bipolar disorder (essence)

Answer 117

at least four depressive, manic, hypomanic, or mixed episodes in a 12 month period

Question 118

Gerald Klerman - additional Bipolar subtypes (III, IV, V, VI)

Answer 118

Bipolar III - Cyclothymic disorder Bipolar IV: Hypomania or mania precipitated by antidepressant drugs Bipolar V: Depressed patients with a family history of bipolar illness Bipolar VI: Mania without depression (unipolar mania)

Question 119

Double Depression (essence)

Answer 119

Episode of major depression superimposed on Dysthymia

Question 120

A persistent instability of mood involving numerous periods of depression and mild elation, none of which is sufficiently severe or prolonged to justify a diagnosis of bipolar affective disorder (F31.-) or recurrent depressive disorder (F33.-)

Answer 120

Cyclothymia

Question 121

A chronic depression of mood, lasting at least several years, which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder

Answer 121

Dysthymia

Question 122

Generalised anxiety disorder - ICD-10 (symptom and duration criterion)

Answer 122

At least 4 symptoms should be present on most days for 6 months

Question 123

Obsession - essence and criteria (4)

Answer 123

any thought, image, or idea that is present for a minimum of 2 weeks (ICD-10) and has the following features: 1 - acknowledged as arising from within the mind (i.e. they are not psychotic beliefs that others have implanted the thoughts) 2 - Repetitive 3 - The patient must try to resist 4 - They are not pleasurable

Question 124

Compulsion (essence)

Answer 124

physical or mental repetitive behaviours that are used to relieve some of the anxiety caused by the obsessions. The person is aware that their actions are not realistically connected to what they are trying to neutralize or prevent and know they are excessive.

Question 125

Abnormal grief - classification (3)

Answer 125

Inhibited Chronic/Prolonged Delayed 'ICD'

Question 126

Inhibited grief (essence)

Answer 126

Absence of expected grief symptoms at any stage

Question 127

Delayed grief (essence)

Answer 127

Avoidance of painful symptoms within 2 weeks of loss

Question 128

Chronic/prolonged grief (essence)

Answer 128

Continued significant grief related symptoms 6 months after loss

Question 129

Normal grief - phases (4)

Answer 129

Phase I - shock and protest (few days) - numbness, disbelief Phase II - preoccupation (few weeks) - yearning, anger Phase III - disorganisation (several months) - despair, acceptance of loss Phase IV - resolution (1-2 years) - gradual return to normality

Question 130

PTSD - key features (3)

Answer 130

HYPERAROUSAL - persistent anxiety - irritability - insomnia - poor concentration HYPERVIGILANCE - (due to re-experiencing) - recurrent distressing dreams - intensive, intrusive imagery (flashbacks, vivid memories) - difficulty recalling stressful events at will AVOIDANCE - of reminders/activities/places related to traumatic events - detachment from others - emotional numbness - anhedonia

Question 131

PTSD (duration criterion)

Answer 131

Onset within 6 months of trauma

Question 132

Somatoform disorders (essence)

Answer 132

a group of disorders characterised by physical symptoms that are presumed to have a psychiatric origin

Question 133

Briquet's syndrome (aka, essence)

Answer 133

aka Somatisation disorder, St Louis Hysteria - multiple physical complaints (>2yrs) affecting many organ systems that cannot be explained by physical disorders - persistent refusal to accept advice/reassurance from doctors more common in women, and normally begins before the age of 30. It is inversely related to social class, and is therefore more common in those with low education and limited incomes.

Question 134

a neurological complaint that is related to stress or conflict. It is more common in women and is uncommon in the elderly. It usually presents with weakness, paralysis, pseudoseizures, involuntary movements and sensory disturbances (e.g. Blindness). It is classically associated with the term La belle indifference which refers to the absence of distress despite the presence of a distressing symptom.

Answer 134

Conversion disorder aka Dissociative disorder (ICD-10)

Question 135

... is characterized by a patient's insistence that they suffer with a particular disease, despite evidence to the contrary

Answer 135

Hypochondriasis

Question 136

... is characterized by the false belief or exaggerated perception that a part of the body is in some way defective. The most common area perceived to be affected is the skin, followed by the hair, nose, toes, and then weight.

Answer 136

Body dysmorphic disorder

Question 137

Disssociation disorders (essence)

Answer 137

loss of integration among memories, identity, sensations and control of bodily movements usually occur suddenly in response to a trauma or other intolerable situation. They tend to remit spontaneously after a few weeks to months =============== previously referred to as 'hysteria'

Question 138

Neurasthenia (essence)

Answer 138

classified in F48 ICD-10 as a neurotic disorder - increased fatigue after mental effort - bodily or physical weakness and exhaustion after only minimal effort, accompanied by a feeling of muscular aches and pains and inability to relax the closest ICD-10 equivalent of chronic fatigue syndrome

Question 139

Anorexia nervosa - diagnostic criteria (4)

Answer 139

- LOW BODY WEIGHT Refusal to maintain body weight above 85% of what is expected (i.e. >15% below expected norm), and BMI 17.5 or less - SELF-INDUCED WEIGHT LOSS (avoidance, vomiting, purging, exercise) - BODY IMAGE DISTORTION - ENDOCRINE DISTURBANCE (amenorrhoea, reduced sexual interest, raised GH levels, raised cortisol, altered TFTs, abnormal insulin secretion)

Question 140

Anorexia nervosa - DSM-IV subtypes (2)

Answer 140

Restricting type Binge-eating/purging type

Question 141

Atypical anorexia nervosa (essence)

Answer 141

a number of symptoms of anorexia that do not completely fulfil the diagnostic criteria for typical anorexia nervosa

Question 142

Narcolepsy (essence)

Answer 142

- excessive sleepiness - cataplexy - Sleep paralysis, hypnagogic hallucinations, automatic behaviour, and nocturnal sleep disruption commonly occur in patients with narcolepsy. Both sleep paralysis and hypnagogic hallucinations almost always correspond with sleep-onset REM periods.

Question 143

Cataplexy (essence)

Answer 143

sudden loss of bilateral muscle tone provoked by strong emotion. Consciousness remains clear, memory is not impaired, and respiration is intact. The duration is usually short, ranging from a few seconds to several minutes, and recovery is immediate and complete.

Question 144

Cataplexy (treatment)

Answer 144

Tricyclic antidepressants

Question 145

characterised by periodic episodes of repetitive and highly stereotyped limb movements that occur during sleep. The movements usually occur in the legs and consist of extension of the big toe in combination with partial flexion of the ankle, knee, and sometimes hip. Similar movements can occur in the upper limbs. The movements are often associated with a partial arousal or awakening, however, the patient is usually unaware of the limb movements or the frequent sleep disruption.

Answer 145

Periodic limb movement disorder

Question 146

characterised by disagreeable leg sensations that usually occur prior to sleep onset and that cause an almost irresistible urge to move the legs.

Answer 146

Restless legs syndrome

Question 147

sudden, brief contractions of the legs, sometimes also involving the arms and head, that occur at sleep onset. usually consist of a single contraction that often affects the body asymmetrically. The jerks may be either spontaneous or induced by stimuli. sometimes associated with the subjective impression of falling, a sensory flash, or a visual hypnagogic dream or hallucination. A sharp cry may occur.

Answer 147

Sleep starts

Question 148

Personality disorder (DSM) - classification

Answer 148

Cluster A - 'Mad' - Paranoid - Schizoid - Schizotypal (classified with schizophrenia in ICD-10) Cluster B - 'Bad' - Antisocial (ICD-10 'dissocial') - Borderline (ICD-10 EUPD impulsive or borderline subtypes) - Histrionic - Narcissistic (ICD-10 classifies as 'Other PD') Cluster C - 'Sad' - Avoidant (ICD-10 'anxious (avoidant) PD') - Dependent - Obsessive-compulsive (ICD-10 anankastic) 'A3, B4, C3'

Question 149

... Personality Disorder: Suspicious of other people and their motives Holds longstanding grudges against people Believes others are not trustworthy Emotionally detached Feels other people are deceiving, threatening, or making plans against them.

Answer 149

Paranoid Personality Disorder

Question 150

... Personality Disorder: Has difficulties in expressing emotions, particularly around warmth or tenderness. Prefers loneliness Aloof or remote Difficulty in developing or maintaining social relationships Unaware of social trends Unresponsive to praise or criticism

Answer 150

Schizoid Personality Disorder

Question 151

... Personality Disorder: Appears odd or eccentric; May have illusions, magical thinking Obsessions without resistance May be members of quasi-cultural groups Thought disorders and paranoia May believe in ESP, clairvoyance etc May have transient psychotic features

Answer 151

Schizotypal Personality Disorder

Question 152

... Personality Disorder: Lack of regard for the rights and feelings of other people Lack of remorse for actions that may hurt others Ignores social norms about acceptable behaviour May disregard rules and break the law Make relations easily but break them equally easily A small proportion may be psychopathic

Answer 152

Antisocial Personality Disorder

Question 153

... Personality Disorder Poor self-image, Unstable personal relationships, Impulsive behaviour in areas such as personal safety and substance misuse. May self-harm, feel suicidal and act on these feelings, Experience instability of mood, Have episodes of micro-psychosis. Feelings of chronic emptiness Fears of abandonment – rejection sensitivity hence form intense but short lasting relations

Answer 153

Borderline Personality Disorder

Question 154

... Personality Disorder Extreme or over-dramatic behaviour. May form relationships quickly, but be demanding Attention-seeking. May appear to others as being self-centred with shallow emotions Inappropriately sexually provocative.

Answer 154

Histrionic Personality Disorder

Question 155

... Personality Disorder: Exaggerated sense of own importance. Self-centred Intolerant of other people. Grandiose plans and ideas Cravings for attention and admiration. Fear of dependency is the core conflictual theme Narcissistic injuries to pride lead to rage reactions.

Answer 155

Narcissistic Personality Disorder

Question 156

... Personality Disorder Fears being judged negatively by other people Feelings of discomfort in group or social settings May come across as being socially withdrawn Have low self-esteem. May crave affection but fears of rejection overwhelming.

Answer 156

Avoidant Personality Disorder

Question 157

Personality Disorder: Assumes a position of passivity, Allows others to assume responsibility for most areas of their daily life Lacks self-confidence, Feels unable to function independently of another person, Feels own needs are of secondary importance.

Answer 157

Dependent Personality Disorder

Question 158

Personality Disorder: Difficulties in expressing warm or tender emotions to others Perfectionist Often lacks clarity in seeing other perspectives or ways of doing things Rigid attention to detail may prevent them from completing tasks Some may be hoarders, scrupulous with money May not be able to delegate tasks; workaholics.

Answer 158

Obsessive-Compulsive Personality Disorder

Question 159

Mental Retardation - classification (4)

Answer 159

Grade (IQ range): - Mild (50-69) - Moderate (35-49) - Severe (20-34) - Profund (<20)

Question 160

Autistic spectrum disorder (essence)

Answer 160

a pervasive and life-long disorder, characterised by - deficits in social communication and social interaction - restricted, repetitive behaviours/interests/activities (RRBs)

Question 161

Rett Syndrome

Answer 161

rare (1:10,000 female births) neurodevelopmental disorder found almost exclusively in females - normal development until 6-18months, followed by: - loss of speech - loss of purposeful hand movements, replaced with stereotypic movements e.g. handwringing - ataxia and psychomotor retardation - deceleration in head growth -> microcephaly - epilepsy (75%) - breathing problems - episodes of hyperventiliation, apnoea, breath-holding

Question 162

Heller Syndrome (aka, essence)

Answer 162

Childhood Disintegrative Disorder a rare condition characterised by late onset of developmental delays—or severe and sudden reversals—in language, social function, and motor skills.

Question 163

Landau-Kleffner Syndrome (aka, essence)

Answer 163

Acquired Aphasia with Epilepsy Despite previously normal progress in language development, a child loses both receptive and expressive language skills but retains general intelligence Epilepsy with paroxysmal EEG abnormalities is noted, always originating bilaterally from the temporal lobes

Question 164

Perceptual psychopathology - taxonomy

Answer 164

Sensory distortions - changes in intensity - changes in quality - changes in spacial form Sensory deceptions - illusions - hallucinations

Question 165

Hyperaesthesia (definition)

Answer 165

increased intensity of sensations

Question 166

Hyperacusis (definition)

Answer 166

increased intensity of noise

Question 167

Chromatopsia (definition)

Answer 167

visual aberration in which objects appear abnormally coloured

Question 168

Pelopsia (definition)

Answer 168

vision perception disorder in which objects appear nearer than they actually are

Question 169

Teleopsia (definition)

Answer 169

vision perception disorder in which objects appear much farther away than they are

Question 170

Micropsia (definition)

Answer 170

sensory distortion in which object appears smaller than it is

Question 171

Macropsia (definition)

Answer 171

sensory distortion in which object appears larger than it is

Question 172

Dysmegalopsia (definition)

Answer 172

sensory distortion in which object appears larger on one side than the other

Question 173

Illusion - definition & subtypes (3)

Answer 173

an altered perception of a stimulus 1 - Completion illusions 2 - Affect illusions 3 - Pareidolic illusions

Question 174

Completion illusion (essence)

Answer 174

altered perception whereby missing information is filled in to make sense of a stimulus e.g. CCOK is read as COOK

Question 175

Affect illusion (essence)

Answer 175

altered perception arising in the context of a specific mood state e.g. a woman is walking home in the dark and is frightened, she mistakes a tree for a tall man in a long coat.

Question 176

Pareidolic illusion (essence)

Answer 176

altered perception in which detailed images are perceived from ambiguous stimuli e.g. seeing the face of Jesus on a piece of burnt toast (Pareidolic illusions tend to occur when a person is concentrating whereas affect and completion illusions occur during inattention)

Question 177

Hallucination (essence)

Answer 177

a perception in the absence of a stimulus

Question 178

Gedankenlautwerden

Answer 178

an individual hears thoughts spoken aloud. Thoughts are heard in the form of a voice at the same time as they are thought, not afterwards

Question 179

Écho de la pensée

Answer 179

meaning "thought echo" in French, thoughts seem to be spoken aloud just after being produced (cf. Gedankenlautwerden where thoughts are heard at the same time)

Question 180

Functional hallucination

Answer 180

A patient experiences an hallucination at the same time as receiving a real stimulus in the same sensory modality e.g. hearing voices whenever the noise of water running through the tap is head

Question 181

Reflex hallucination

Answer 181

A hallucination in one sensory modality in response to a real stimulus in another sensory modality e.g. seeing an angel whenever music is heard

Question 182

Extracampine hallucination

Answer 182

Hallucination experienced outside the normal field of perception e.g. images seen behind one's back; voices heard on the other side of the world

Question 183

Hypnagogic and Hypnopompic hallucinations

Answer 183

HypnaGOgic - GOing to sleep Hypnopompic - waking up

Question 184

Lilliputian hallucinations

Answer 184

visual hallucinations whereby the patient experiences seeing people who appear reduced in size or dwarfed

Question 185

Kinaesthetic hallucination

Answer 185

hallucination of muscle or joint sense. Patient's may describe that their limbs are being twisted or bent, or their muscles squeezed. They may also described being rocked about

Question 186

Autoscopic hallucination

Answer 186

a person's experience of seeing a double of themselves in extrapersonal space without the experience of leaving ones body (no disembodiment)

Question 187

Charles Bonnet Syndrome (essence)

Answer 187

Complex (typically visual) hallucinations usually occurring in the context of elderly patients with visual impairment due to ocular problems, normal consciousness, and no brain pathology. Insight is usually preserved.

Question 188

Primary delusion - definition and subtypes (4)

Answer 188

A delusion that arises spontaneously, from normal psychological processes and not as a consequence of prior psychopathology. 1 - Autochthonous delusion 2 - Delusional perception 3 - Delusional memory 4 - Delusional mood

Question 189

Autochthonous delusion (aka, essence)

Answer 189

aka Delusional Intuition This is a primary delusion that appears spontaneously and out of the blue i.e. not following any other mental state (whether perception, memory, or mood)

Question 190

Syndrome of subjective doubles

Answer 190

a rare delusional misidentification syndrome in which a person experiences the delusion that he or she has a double or Doppelgänger with the same appearance, but usually with different character traits, that is leading a life of its own

Question 191

Intermetamorphosis

Answer 191

a delusional misidentification syndrome, related to agnosia. The main symptoms consist of patients believing that they can see others change into someone else in both external appearance and internal personality.

Question 192

Paraprosopia

Answer 192

A delusion in which a person believes he or she has seen a face transform into a grotesque form - often described as a 'monster', 'vampire', 'werewolf' or similar

Question 193

Aphasia - definition and classification (3)

Answer 193

Dysfunction in language reception and expression. 1 - Fluent (receptive) aphasia - Wernicke's aphasia, anomic aphasia, conduction aphasia, transcortical sensory aphasia 2 - Non-fluent (expressive) aphasia - Broca's aphasia, transcortical motor aphasia, global aphasia 3 - Pure aphasia (only affecting a single language skill) - Pure alexia, pure agraphia, pure word deafness

Question 194

... occurs due to a lesion in the posterior region of the left superior temporal gyrus (Brodmann area 22). The main feature is impairment in auditory comprehension. The speech is fluent but meaningless (often referred to as cocktail party speech). Comprehension and expression are equally affected.

Answer 194

Wernicke's Aphasia (aka semantic aphasia)

Question 195

... results from damage to the arcuate fasciculus which connects Wernicke's to Broca's area. Poor repetition in comparison to problems with comprehension and spontaneous expression is the hallmark of this syndrome.

Answer 195

Conduction Aphasia

Question 196

... follows damage to Brodmann areas 44 and 45 in the frontal lobe. Speech is characteristically non fluent but comprehension is intact. It is often accompanied by agraphia (inability to write).

Answer 196

Broca's aphasia

Question 197

Naming or word finding problems are the major feature of this syndrome. Grammar is unaffected and repetition is good. Auditory comprehension is relatively intact. ... is localised with the least reliability of any of the aphasic syndromes. The lesion is often temporal parietal area. The angular gyrus may also be affected.

Answer 197

Anomic aphasia

Question 198

Reduplicative paramnesia

Answer 198

a delusional misidentification syndrome in which the patient's surroundings are believed to exist in more than one physical location

Question 199

Paraschemazia

Answer 199

a feeling that parts of the body are distorted or twisted or that they are separated from the rest of the body. It can occur in association with hallucinagenic use, with an epileptic aura, and with migrane.

Question 200

Wahnstimmung

Answer 200

Delusional Mood (german)

Question 201

Gegenhalten

Answer 201

a phenomenon in which a patient opposes all passive movements with the same degree of force as applied by the examiner

Question 202

Schnauzkrampf

Answer 202

a grimace resembling pouting sometimes observed in catatonic patients

Question 203

Vorbeigehen/ vorbeireden

Answer 203

Approximate answers (e.g. How many fingers does a man have, answer 14). Seen in Ganser syndrome.

Question 204

Properties of thought (4)

Answer 204

Content Form Stream/flow Control ----------------------------- the term 'formal thought disorder' is increasingly used for disorders of both form and stream/flow

Question 205

Asyndesis (aka)

Answer 205

Loosening of associations. A milder form of derailment of thought, it is marked by the individual leaping from topic to topic which have only the most tenuous, if any, connection with each other.

Question 206

Excessive speech at a rapid rate that involves causal association between ideas. Links between ideas may involve usage of clang associations,puns or rhymes.

Answer 206

Flight of ideas

Question 207

This refers to a person being unable to answer a question without giving excessive, unnecessary detail. It differs from tangential thinking, in that the person does eventually return to the original point, circling back on-topic.

Answer 207

Circumstantiality

Question 208

This term refers to uncontrollable repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of the original stimulus. Usually it is seen in organic disorders of brain, head injury, delirium or dementia, however can be seen in schizophrenia as well.

Answer 208

Perseveration

Question 209

an abrupt stop in the middle of a train of thought; the individual might or might not be unable to continue the idea. This is type of formal thought disorder that can be seen in schizophrenia.

Answer 209

Thought block

Question 210

Akataphasia (essence, term coined by...)

Answer 210

A syntactic disturbance of speech resulting from dissolution of logical ordering of thoughts Kraeplin (1896)

Question 211

Speech that has an excessively formal quality. It may seem outdated, pompous, or over polite.

Answer 211

Stilted speech

Question 212

FTD occuring in schizophrenia. Thoughts are described as being passively concentrated and compressed in the patient's head. The associations are experienced as being excessive in amount, too fast, and outside the person's control.

Answer 212

Crowding of thought

Question 213

Catatonia (essence)

Answer 213

the psychiatric syndrome of disturbed motor functions amid disturbances in mood and thought ------------------------------------------------- a state of psycho-motor immobility and behavioural abnormality manifested by stupor

Question 214

..... (date) is credited with the original clinical description of catatonia.

Answer 214

Karl Ludwig Kahlbaum (1828-1899)

Question 215

Features of catatonia: combination of immobility and mutism

Answer 215

Stupor

Question 216

Features of catatonia: maintaining the same posture for long periods. A classic example is the 'crucifix'. An extreme version is catalepsy

Answer 216

Posturing

Question 217

Features of catatonia: (cerea flexibilitas) - patient can be positioned in uncomfortable postures, which are maintained for a considerable period of time.

Answer 217

Waxy flexibility

Question 218

Features of catatonia: patient resists the attempts of the examiner to move parts of their body and, according to the original definition, the resistance offered is exactly equal to the strength applied

Answer 218

Negativism (aka Gegenhalten)

Question 219

Features of catatonia: exaggerated cooperation, automatically obeying every instruction of the examiner.

Answer 219

Automatic obedience

Question 220

Features of catatonia: a form of automatic obedience whereby the body of the patient can be put into any posture, even if the patient is given instructions to resist. The body part immediately returns to the original position once the force is removed (unlike in waxy flexibility)

Answer 220

Mitmachen

Question 221

Features of catatonia: the examiner is able to move the patient's body with the slightest touch (anglepoise lamp sign).

Answer 221

Mitgehen | an extreme form of mitmachen

Question 222

Features of catatonia: The patient alternates between resistance to and cooperation with the examiner's instructions; for example, when asked to shake hands, the patient repeatedly extends and withdraws the hand

Answer 222

Ambitendency

Question 223

Features of catatonia: The patient assumes a reclining posture, with their head a few inches above the bed surface, and is able to maintain this position for prolonged periods

Answer 223

Psychological pillow

Question 224

Features of catatonia: The patient forcibly and repeatedly grasps the examiner's hand when offered

Answer 224

Forced grasping

Question 225

Features of catatonia: The patient stops suddenly in the course of a movement and is generally unable to give a reason. This appears to be the motor counterpart of thought block

Answer 225

Obstruction

Question 226

Features of catatonia: The patient imitates the actions of the interviewer

Answer 226

Echopraxia

Question 227

Features of catatonia: The patient turns away from the examiner when addressed

Answer 227

Aversion

Question 228

Features of catatonia: Repetitive, goal-directed movements (e.g. Saluting)

Answer 228

Mannerisms

Question 229

Features of catatonia: Repetitive, regular movements that are not goal-directed (e.g. Rocking)

Answer 229

Stereotypies

Question 230

Features of catatonia: The patient persists with a particular movement that has lost its initial relevance

Answer 230

Motor perseveration

Question 231

Features of catatonia: Repetition of the examiners words

Answer 231

Echolalia

Question 232

Features of catatonia: incoherent talkativeness

Answer 232

Logorrhoea

Question 233

Features of catatonia: Meaningless, repetition of words or phrases

Answer 233

Verbigeration

Question 234

Defence mechanism (definition)

Answer 234

Defence mechanisms psychological strategies that are unconsciously used to protect a person from anxiety arising from unacceptable thoughts or feelings.

Question 235

Defence mechanisms (Vaillant classification)

Answer 235

Level 1 - Psychotic defences Level 2 - Immature defences Level 3 - Neurotic defences Level 4 - Mature defences

Question 236

Psychotic defences (Vaillant Classification Level 1) - 4

Answer 236

Distortion Denial Delusional projection Splitting * - ------------------------------ * NB not in Vaillant's original classification but included in mrcpsych mentor

Question 237

Defence mechanism (+ classification) A gross reshaping of external reality to meet internal needs

Answer 237

Distortion Psychotic defences (Vaillant Classification Level 1)

Question 238

Defence mechanism (+ classification) proposed by Anna Freud - involves a refusal to accept reality, thus blocking external events from awareness

Answer 238

Denial Psychotic defences (Vaillant Classification Level 1)

Question 239

Defence mechanism (+ classification) Delusions about external reality, usually of a persecutory nature

Answer 239

Delusional projection Psychotic defences (Vaillant Classification Level 1)

Question 240

Defence mechanism (+ classification) The failure in a person's thinking to bring together the dichotomy of both positive and negative qualities of the self and others into a cohesive, realistic whole. The individual tends to think in extremes (i.e., an individual's actions and motivations are all good or all bad with no middle ground).

Answer 240

Splitting Psychotic defences (Vaillant Classification Level 1) - ------------------------------ * NB not in Vaillant's original classification but included in mrcpsych mentor

Question 241

Immature defences (Vaillant Classification Level 2) - 7

Answer 241

``` Schizoid Fantasy Projection Acting out Hypochondriasis Passive aggression Idealization * Projective identification * ``` - ------------------------------ * NB not in Vaillant's original classification but included in mrcpsych mentor

Question 242

Defence mechanism (+ classification) Tendency to retreat into fantasy in order to resolve inner and outer conflicts. e.g. living in a 'Walter Mitty' dream world where you imagine you are successful and popular, instead of making real efforts to make friends and succeed at a job.

Answer 242

Schizoid Fantasy Immature defences (Vaillant Classification Level 2)

Question 243

Defence mechanism (+ classification) Falsely attributing your own unacceptable feelings, impulses, or thoughts to another person e.g. you might hate someone, but your superego tells you that such hatred is unacceptable. You can 'solve' the problem by believing that they hate you.

Answer 243

Projection Immature defences (Vaillant Classification Level 2)

Question 244

Defence mechanism (+ classification) Direct expression of an unconscious wish or impulse in action, without conscious awareness of the emotion that drives the expressive behavior. Acting in a way that enables a person to avoid coming into contact with difficult feelings or anxieties. e.g. drug use, missed appointments with therapists, and tantrums.

Answer 244

Acting out Immature defences (Vaillant Classification Level 2)

Question 245

Defence mechanism (+ classification) An excessive preoccupation or worry about having a serious illness

Answer 245

Hypochondriasis Immature defences (Vaillant Classification Level 2)

Question 246

Defence mechanism (+ classification) Indirect expression of hostility e.g. to 'defeat' one's boss, one may proscrastinate and take sick leave in a way that affects the boss more than oneself

Answer 246

Passive aggression Immature defences (Vaillant Classification Level 2)

Question 247

Defence mechanism (+ classification) The ascribing of omnipotence to another person or organisation e.g. 'you will save me'

Answer 247

Idealisation Immature defences (Vaillant Classification Level 2) - ------------------------------ * NB not in Vaillant's original classification but included in mrcpsych mentor

Question 248

Defence mechanism (+ classification) An aspect of the self is first projected onto someone else. The projector then tries to coerce the recipient to identify with what has been projected and both feel a sense of union. This may result in the recipient behaving in a manner similar to the projector.

Answer 248

Projective identification. Immature defences (Vaillant Classification Level 2) - ------------------------------ * NB not in Vaillant's original classification but included in mrcpsych mentor

Question 249

Neurotic defences (Vaillant Classification Level 3) - 11

Answer 249

``` Displacement Reaction formation Repression Intellectualization Dissociation Isolation * Regression * Rationalization * Controlling * Externalization * Undoing * ```

Question 250

Defence mechanism (+ classification) Interest and/or emtoion is shifted from one object onto another less-threatening one, so that the latter replaces the former. e.g. a person loses a child in a road accident, then devotes themselves tirelessly to campaigning against dangerous driving; a person has problems at work and then expresses anger felt for their boss onto their family at home

Answer 250

Displacement Neurotic defences (Vaillant Classification Level 3)

Question 251

Defence mechanism (+ classification) Converting unconscious wishes or impulses that are perceived to be dangerous or unacceptable into their opposites; behaviour that is completely the opposite of what one really wants or feels; taking the opposite belief because the true belief causes anxiety e.g. Freud claimed that men who are prejudice against homosexuals are making a defense against their own homosexual feelings by adopting a harsh anti-homosexual attitude which helps convince them of their heterosexuality.

Answer 251

Reaction formation Neurotic defences (Vaillant Classification Level 3)

Question 252

Defence mechanism (+ classification) The unconscious forgetting of painful ideas or impulses in order to protect the psyche

Answer 252

Repression Neurotic defences (Vaillant Classification Level 3)

Question 253

Defence mechanism (+ classification) concentrating on the intellectual components of a situation so as to distance oneself from the associated anxiety-provoking emotions; thinking about wishes in formal, affectively bland terms and not acting on them; avoiding unacceptable emotions by focusing on the intellectual aspects

Answer 253

Intellectualization Neurotic defences (Vaillant Classification Level 3)

Question 254

Defence mechanism (+ classification) Temporary drastic modification of one's personal identity or character to avoid emotional distress; separation or postponement of a feeling that normally would accompany a situation or thought

Answer 254

Dissociation Neurotic defences (Vaillant Classification Level 3)

Question 255

Defence mechanism (+ classification) Splitting or separating an idea from the affect that accompanies it normally but is now repressed

Answer 255

Isolation Neurotic defences (Vaillant Classification Level 3) - ------------------------------ * NB not in Vaillant's original classification but included in mrcpsych mentor

Question 256

Defence mechanism (+ classification) Reverting back to an earlier stage of development when faced with an unpleasant thought or emotion

Answer 256

Regression Neurotic defences (Vaillant Classification Level 3) - ------------------------------ * NB not in Vaillant's original classification but included in mrcpsych mentor

Question 257

Defence mechanism (+ classification) Finding excuses that will justify unacceptable behaviours when self-esteem is threatened. (This is easily confused with intellectualisation but in the latter the patient is not in contact with their emotions. In this, the patient feels the distress but seeks to find alternative reasons for them to avoid the full reality of the situation.) e.g. it was okay for my to behave as I did because he hit me firsth

Answer 257

Rationalization Neurotic defences (Vaillant Classification Level 3) - ------------------------------ * NB not in Vaillant's original classification but included in mrcpsych mentor

Question 258

Defence mechanism (+ classification) Projecting into the external world and in external objects elements of one's own personality, including instinctual impulses, conflicts, moods, attitudes, and styles of thinking. --- is a more general term than projection

Answer 258

Externalisation Neurotic defences (Vaillant Classification Level 3) - ------------------------------ * NB not in Vaillant's original classification but included in mrcpsych mentor

Question 259

Defence mechanism (+ classification) a person tries to cancel out or remove an unhealthy, destructive or otherwise threatening thought or action by engaging in contrary behavior e.g. after thinking about being violent with someone, one would then be overly nice or accommodating to them

Answer 259

Undoing Neurotic defences (Vaillant Classification Level 3) - ------------------------------ * NB not in Vaillant's original classification but included in mrcpsych mentor

Question 260

Mature defences (Vaillant Classification Level 4) - 7

Answer 260

``` Altruism Anticipation Sublimation Suppression Humor Identification * Introjection * ``` - ------------------------------ * NB not in Vaillant's original classification but included in mrcpsych mentor

Question 261

Defence mechanism (+ classification) Satisfying one's own needs through the lives of others. e.g. the man who wishes he had become a doctor may push his family into this career and blame himself if they do not fulfill his expectations

Answer 261

Altruism Mature defences (Vaillant Classification Level 4)

Question 262

Defence mechanism (+ classification) Realistic planning for future discomfort; reducing the stress of some difficult challenge by considering what it will be like and preparing for how you are going to deal with it

Answer 262

Anticipation Mature defences (Vaillant Classification Level 4)

Question 263

Defence mechanism (+ classification) Transformation of unhelpful emotions or instincts into healthy actions, behaviours, or emotions (Similar to displacement, but takes place when we manage to displace our unacceptable emotions into behaviors which are constructive and socially acceptable, rather than destructive activities.) e.g. Many great artists and musicians have had unhappy lives and have used the medium of art of music to express themselves. Playing a heavy contact sport such as football or rugby can transform aggression into a game

Answer 263

Sublimation Mature defences (Vaillant Classification Level 4)

Question 264

Defence mechanism (+ classification) The conscious decision to delay paying attention to a thought, emotion, or need in order to cope with the present reality

Answer 264

Suppression Mature defences (Vaillant Classification Level 4)

Question 265

Defence mechanism (+ classification) Overt expression of ideas and feelings (especially those that are unpleasant to focus on or too terrible to talk about directly) that gives pleasure to others. The thoughts retain a portion of their innate distress, but they are "skirted around" by witticism e.g. self-deprecation

Answer 265

Humour Mature defences (Vaillant Classification Level 4)

Question 266

Defence mechanism (+ classification) The unconscious modelling of one's self upon another person's character and behaviour. A victim adopts the behavior of a person who is more powerful and hostile towards them. By internalising the behavior of the aggressor the 'victim' hopes to avoid abuse, as the aggressor may begin to feel an emotional connection with the victim which leads to feelings of empathy. e.g. Stockholm syndrome

Answer 266

Identification (with the aggressor) Mature defences (Vaillant Classification Level 4) - ------------------------------ * NB not in Vaillant's original classification but included in mrcpsych mentor

Question 267

Defence mechanism (+ classification) Identifying with some idea or object so deeply that it becomes a part of that person e.g. taking on attributes of other people who seem better able to cope with a situation than we do.

Answer 267

Introjection Mature defences (Vaillant Classification Level 4) - ------------------------------ * NB not in Vaillant's original classification but included in mrcpsych mentor

Question 268

Repression and displacement are seen in which psychiatric disorder?

Answer 268

Phobias

Question 269

Isolation, undoing, and reaction formation are seen in which psychiatric disorder?

Answer 269

Obsessive compulsive disorder

Question 270

Projection and splitting are seen in which psychiatric disorders?

Answer 270

Borderline personality disorder Narcissistic personality disorder

Question 271

Displacement is seen in which psychiatric disorder?

Answer 271

Agoraphobia

Question 272

Schizoaffective disorder | - which section of ICD-10 classification?

Answer 272

F20 schizophrenia

Question 273

According to DSM-IV criteria, the core symptoms of ADHD must have their onset before ---- years

Answer 273

7

Question 274

According to the International Pilot Study of Schizophrenia: ---% of patients with acute schizophrenia exhibited at least one first rank symptom

Answer 274

58%

Question 275

According to the International Pilot Study of Schizophrenia: --% of schizophrenics never exhibit a first rank symptom

Answer 275

20%

Question 276

According to the International Pilot Study of Schizophrenia: ---% of non-schizophrenic patients with psychosis exhibit first rank symptoms of schizophrenia

Answer 276

10%

Question 277

The onset of autistic disorder is usually before the age of ---

Answer 277

3

Question 278

Common co-morbid psychiatric disorders seen in children with ADHD (4 + prevalence %)

Answer 278

Oppositional Defiant disorder (35-50%) Conduct disorder (25%) Anxiety disorder (25%) Depressive disorder (15%)

Question 279

How is Asperger's syndrome differentiated from other autistic spectrum disorders?

Answer 279

Language development is typically normal in Asperger's syndrome

Question 280

Persistent delusional disorder - time criterion ICD-10 DSM-IV

Answer 280

ICD-10 - 3 months DSM-IV - 1 month

Question 281

The International Pilot Study of Schizophrenia - frequency (%) of common symptoms: - Lack of insight - Auditory hallucinations - Ideas of reference - Suspiciousness - Flatness of affect

Answer 281

- Lack of insight (97%) - Auditory hallucinations (74%) - Ideas of reference (70%) - Suspiciousness (66%) - Flatness of affect (66%)

Question 282

The International Pilot Study of Schizophrenia - frequency (%) of common symptoms: - Second person hallucinations - Delusional mood - Delusions of persecution - Thought alientation - Echo De Pensee, Gedankenlautwerden

Answer 282

- Second person hallucinations (65%) - Delusional mood (64%) - Delusions of persecution (64%) - Thought alientation (52%) - Echo De Pensee, Gedankenlautwerden (50%)

Question 283

Munchausen syndrome (essence)

Answer 283

self-inflicted lesions and feigned illness with the goal of receiving medical treatment rather than for any other gain.

Question 284

Post-schizophrenic depression - time criterion

Answer 284

The most recent episode of relapse must not be more than 12 months ago.

Question 285

Borderline personality disorder - which symptoms improve most over time? - which symptoms improve least over time?

Answer 285

Impulsive symptoms resolved the most quickly Affective symptoms were the most chronic --------------------------- Cognitive and interpersonal symptoms were intermediate

Question 286

How long does the natural course of an episode of untreated mania last?

Answer 286

4 months

Question 287

Rating scales | - 4 purposes

Answer 287

1 Screening for presence of psychiatric condition 2 Diagnosis (often termed 'diagnostic schedules') 3 Estimating severity and response to treatment 4 Assess functional capacity/well-being

Question 288

Rating Scale vs Schedules

Answer 288

Scales - based on psychometric properties; - aim to measure dimensions of psychopathology (symptoms) often at the present state Schedules - based on clinical expectations; - deal with categories of disorders (syndromes) based on known classification systems

Question 289

General Health Questionnaire - introduced by - purpose - items

Answer 289

Introduced by Goldberg An all-purpose screening tool, used to detect those likely to have or be at risk of developing psychiatric disorders 28-item version is most widely used (Also available as 12, 30, or 60 items)

Question 290

HAMD (Hamilton depression rating scale) - clinician or self rated? - purpose - items - interpretation

Answer 290

clinician-rated multiple choice questionnaire used to rate the severity of depression 2 versions: 17-item (most common), 21-item For the 17 item version 0 scores range between 0 and 54. Scores over 24 indicate a severe depression.

Question 291

MADRS (Montgomery-Asberg depression rating scale) - clinician or self rated? - purpose - items

Answer 291

clinician-rated Diagnostic questionnaire used to measure the severity of depressive episodes. It was designed to be more sensitive to the changes brought on by antidepressants and other forms of treatment 10 items

Question 292

ZSRDS (Zung self rated depression scale) - clinician or self rated? - purpose - items

Answer 292

self-rated assesses the severity of depression 20 items, each scored 1-4

Question 293

BDI (Beck depression inventory) - clinician or self rated? - purpose - items - interpretation

Answer 293

self-rated assesses the severity of depression 21 items, each scored 0-3 0-13 - minimal depression 14-19 - mild depression 20-28 - moderate depression 29-63 - severe depression

Question 294

GDS (geriatric depression scale) - clinician or self rated? - purpose - items - interpretation

Answer 294

self-rated used to screen for depression in the elderly 30 items - yes/no, therefore scored out of 30 0-9 - normal 10-19 - mild depression 20-30 - severe depression

Question 295

BASDEC (Brief Assessment Schedule Depression Cards) - clinician or self rated? - purpose - items - interpretation

Answer 295

clinician-rated screening test for depression - uses a deck of cards with statements such as 'I've lost interest in things' which are shown to the patient. In response to each card, the patient indicates whether the card is true or false by pointing to another card 19 cards with a maximum score of 21 (two cards carry 2 points each) A cut off score of 7 is generally used

Question 296

Cornell Scale for Depression in Dementia - clinician or self rated? - purpose - items

Answer 296

clinician-rated developed specifically to screen for depression in dementia cases 20 min interview with a carer and 10 mins with the patient. 19 items - rated as either 'absent', 'mild / intermittent', or 'severe'

Question 297

YMRS (Young mania rating scale) - clinician or self rated? - purpose - items

Answer 297

clinician-rated assesses the severity of mania in patients with a diagnosis of bipolar disorder 11 items

Question 298

HAMA (Hamilton anxiety rating scale) - clinician or self rated? - purpose - items

Answer 298

clinician-rated measures the severity of anxiety 14 items

Question 299

Y-BOCS (Yale-Brown Obsessive compulsive scale) - clinician or self rated? - purpose

Answer 299

clinician-rated measures both the severity of OCD and the response to treatment

Question 300

BPRS (Brief psychiatric rating scale) - clinician or self rated? - purpose - items

Answer 300

clinician-rated used to evaluate psychopathology in patients with schizophrenia. based on observation and interview 24 items - each rated out of a 7 point scale of severity. Higher score indicate greater severity of symptoms. ============== probably the most widely used scale in psychiatry, although now largely replaced by the PANSS.

Question 301

PANSS (Positive and negative syndrome scale) - clinician or self rated? - purpose - items

Answer 301

clinician-rated looks at both positive and negative symptoms in schizophrenia. information gathered is based on how the patient was in the previous week. 30 items

Question 302

GAF (Global assessment of functioning) - clinician or self rated? - purpose - items

Answer 302

clinician-rated used as part of axis V of the DSM-IV provides a single measure of global functioning. It enquires about psychological and occupational functioning only The total score is out of 100. A score of 100 is the best that can be achieved and indicates that a patient functions at the highest level possible

Question 303

CGI (Clinical global impression) - clinician or self rated? - purpose - items

Answer 303

clinician-rated clinician rates the severity of the patient's illness at the time of assessment, relative to the clinician's past experience with patients who have the same diagnosis. 2 items - CGI-S (severity) - scale of 1-7 - CGI-I (improvement) - scale of 1-7

Question 304

DESS (Discontinuation-Emergent Signs and Symptoms scale) - purpose - items

Answer 304

used to quantify discontination symptoms associated with stopping antidepressants 43 items

Question 305

AUDIT (Alcohol Use Disorders Identification Test) - purpose - items - interpretation

Answer 305

simple method of screening for excessive drinking -covers the three domains of harmful use, hazardous use, and dependence. 10 items Minimum score = 0, maximum score = 40 A score of 8 or more in men, and 7 or more in women, indicates a strong likelihood of hazardous or harmful alcohol consumption A score of 15 or more in men, and 13 or more in women, is likely to indicate alcohol dependence ======================== it has been shown to be superior to CAGE and biochemical markers for predicting alcohol problems

Question 306

FAST (Fast Alcohol Screening Test) - purpose - items - interpretation

Answer 306

short and rapid test developed to be used in a busy medical setting 4 items Minimum score = 0, maximum score = 16 Score >3 indicated hazardous drinking

Question 307

FAST (Fast Alcohol Screening Test) - questions (4)

Answer 307

How often do you have EIGHT (men) / SIX (women) or more drinks on one occasion? How often during the last year have you been unable to remember what happened the night before because you had been drinking? How often during the last year have you failed to do what was normally expected of you because of drinking? In the last year has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down? ============================== If the answer to the first question is 'never' then the patient is not misusing alcohol If the response to the first question is 'Weekly' or 'Daily or almost daily' then the patient is a hazardous, harmful or dependent drinker.

Question 308

CAGE questionaiire - questions - interpretation

Answer 308

Have you ever felt you should Cut down on your drinking? Have people Annoyed you by criticising your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink in the morning to get rid of a hangover (Eye opener)? =============================== Two or more positive answers suggests problem drinking.

Question 309

Adjustment disorder - essence - onset/duration

Answer 309

a state of subjective distress and emotional disturbance, usually interfering with social functioning and performance, arising in the period of adaptation to a significant life change or to the consequences of a stressful life event. It usually occurs within 1 month of the stressful event, and the duration of symptoms does not usually exceed 6 months.

Question 310

cannabis increases the risk of psychosis by --- times

Answer 310

2-3 times

Question 311

Addenbrooke's cognitive exam (ACE-R) - domains (5) - scoring/cut offs

Answer 311

``` Attention and orientation - 18 Memory - 26 Verbal fluency - 14 Language - 26 Visuospatial - 16 ``` Total - 100 ============= Cut off 88 -> 94% sensitivity for dementia Cut off 82 -> 85% sensitivity for dementia

Question 312

Phobias - defence mechanisms (2)

Answer 312

Repression and displacement

Question 313

Obsessive compulsive disorder - defence mechanisms (3)

Answer 313

Isolation, undoing, and reaction formation

Question 314

Borderline personality disorder - defence mechanisms (2)

Answer 314

Projection and splitting

Question 315

Narcissistic personality disorder - defence mechanisms (2)

Answer 315

Projection and splitting

Question 316

Agoraphobia - defence mechanisms (1)

Answer 316

Displacement

Question 317

Prosody - definition - aprosodia - classification and associated brain regions

Answer 317

'the emotional tone of language' Aprosody is caused by dysfunction in areas of the non-dominant hemisphere Executive aprosody - difficulty in expression of emotion - right premotor cortex or basal ganglia Receptive aprosody - difficulty in understanding of emotion - right posterior superior temporal lobe

Question 318

Paramnesia - term coined by --- - definition

Answer 318

Emil Kraepelin qualitative disorders in memory where fantasy and reality are confused

Question 319

Paramnesia: The experience of feeling that one has witnessed or experienced a new situation before

Answer 319

Déjà vu

Question 320

Paramnesia: The experience of being unfamiliar with a person or situation that is actually very familiar

Answer 320

Jamais vu

Question 321

Paramnesia: The unconscious filling in of gaps in the memory by events which never took place

Answer 321

Confabulation

Question 322

Paramnesia: The process of distorting a memory

Answer 322

Retrospective falsification

Question 323

Paramnesia: This is characterised by having a thought without realising you have had the thought before (for example, some plagiarists claim they are unaware that they were recounting other peoples work)

Answer 323

Cryptamnesia

Question 324

Paramnesia: The delusion that a place has been duplicated.

Answer 324

Reduplicative paramnesia 3 forms: - Place reduplication - Chimeric assimilation - Extravagant spatial localisation

Question 325

Paramnesia: the belief that two places with identical features exist simultaneously, but are geographically distant

Answer 325

Place reduplication a form of Reduplicative paramnesia

Question 326

Paramnesia: the belief that two places become combined, for example, a patient in hospital believes that they are in their own home which has somehow transformed into the hospital

Answer 326

Chimeric assimilation a form of Reduplicative paramnesia

Question 327

Paramnesia: belief that their current location is actually somewhere else, usually a location familiar to them

Answer 327

Extravagant spatial localisation a form of Reduplicative paramnesia

Question 328

Factitious disorder - aka - description

Answer 328

Munchausen syndrome The patient feigns symptoms repeatedly for no obvious reason and may even inflict self-harm in order to produce symptoms or signs. The motivation is obscure and presumably internal with the aim of adopting the sick role.