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MRCPsych Part A - Rach > Classification and Assessment in Psychiatry > Flashcards

Classification and Assessment in Psychiatry Flashcards

1
Q

Defining psychiatric disorders

Realism

A

Kendler proposed 3 approaches to question the underlying nature of psychiatric disorders: realism, constructivism and pragmatism.

Realism = the assertion that mental illness exists.

Biological psychiatry suggests disorders will eventually be identified by genetics/biomarkers/cerebral pathways.

Disturbance = distracability

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2
Q

Defining psychiatric disorders

Constructivism

A

Kendler proposed 3 approaches to question the underlying nature of psychiatry disorders: realism, constructivism and pragmatism.

Constructivism = psychiatric disorders have no biological reality and are the construction of social convention by humans.

Anti-psychiatry view

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3
Q

Defining Psychiatric Disorders

Pragmatism

A

Kendler proposed 3 approaches to question the underlying nature of psychiatry disorders: realism, constructivism and pragmatism.

Pragmatism = also referred to as utility. Psychiatric classification is based on what is useful and works, rather than what is real.

Criticism - danger that will detract from scientific basis and psychiatric diagnosis not belonging to a legitimate biomedical discipline.

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4
Q

Prominent psychiatrist involved in the classification of psychosis

A

Emil Kraeplin (1918)

He delineated schizophrenia from bipolar affective disorder on the basis of clinical symptoms, course and family history.

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5
Q

Symptom-based theoretical models to psychiatric diagnosis:

Monothetic approach

A

The monothetic approach identifies that certain symptoms are essential to diagnosis. Symptoms are narrow and very specific.

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6
Q

Symptom-based theoretical models to psychiatric diagnosis:

Polythetic approach

A

The polythetic approach identifies a broad range of symptoms, none of which takes precedence over the others.

This approach is used in current classification.

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7
Q

Co-morbidity

A

Two or more discrete, unrelated entities are present in the same person

E.g. obsessional personality disorder and schizophrenia

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8
Q

Consanguinity

A

The overlap between symptoms from two or more conditions that occur together with such frequency that they should be regarded as a single entity.

E.g. schizophrenia and anxiety symptoms, rather than 1. Schizophrenia 2. Generalised anxiety disorder (as 2 separate entities)

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9
Q

Co-occurrence

A

The term is used when the nature of the relationship between disorders is uncertain due to insufficient research evidence

E.g. as in mixed anxiety and depressive disorder (MADD)

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10
Q

Defintion:

Personality

A

The totality of a person’s emotional and behavioural traits that characteristise their day to day living.

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11
Q

Defintion:

Personality

A

The totality of a person’s emotional and behavioural traits that characteristise their day to day living.

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12
Q

Definition:

Personality disorder

A

A deeply ingrained, maladaptive pattern of behaviour which is normally recognisable by adolescence and continues throughout adult life.

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13
Q

History of psychiatry:

Hippocrates and personality disorder

A

Hippocrates believed the balance of 4 humours represented the different elements of personality:

  1. Yellow bile - Liver - bad-tempered
  2. Black bile - Spleen - melancholic
  3. Blood - optimistic/confident
  4. Phlegm - placid/apathetic
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14
Q

History of psychiatry:

Prominent psychiatrist who contributed to our modern understanding of personality

A

Schneider.

His work Psychopathic Personalities for Modern Classificatory systems was published in 1923 and translated to English in 1950.

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15
Q

Sensory distortion

Hyper/hypo -aethesia

A

Hyper = increased intensity of sensation

  • result of intense emotions or reduced physiological threshold

Hypo = decreased intensity of sensation

  • can occur in delirium, threshold for sensations is raised
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16
Q

Definition:

Dysmegaloplasia

A

A change in the perceived shape of an object.

Micro-/macro-psia = objects are smaller/larger than in reality.

Causes: retinal disease, disorders of accommodation/convergence
Atropine, hyoscine poisoning

Commonly = pareital/temporal lobe lesion (can occur during aura of seizure)

Rare = schizophrenia

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17
Q

Sensory distortion

A

Changes in the perception of a real stimulus in the intensity and quality or in the spatial form of a perception.

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18
Q

Sensory deception

A

An occurrence of a new perception, which may or may not be in response to an eternal stimulus.

  • Illusion

(Misinterpretation of stimuli arising from an external object)

  • Hallucination

(Perception without adequate external stimulus)

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19
Q

Completion illusion

A

These depend on inattention, such as misreading words in newspapers or missing typos, as we read the word as complete.

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20
Q

Affect illusion

A

Arise in the context of a particular mood state.

E.g. a delerious person in a perplexed/bewildered state may perceived innocent gestures as threatening

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21
Q

Pareidolia

A

Vivid illusions which cannot be explained by mindset or affect. They are the result of excessive fantasy thinking and a vivid visual imagery.

E.g. vivid pictures in fire, without conscious effort from the patient

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22
Q

Trailing phenomena

A

Moving objects are seen as a series of discrete, discontinuous images.

Associated with hallucinogenic drugs

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23
Q

Causes of hallucinations

A
  1. Intense emotion
  2. Psychiatric disorders
  3. Disorders of sensory organs
  4. Disorders of the CNS (Lesion of diencephalon/
    cortex)
  5. Sensory deprivation
  6. Suggestion
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24
Q

Elementary auditory hallucinations

A

These are unformed and may be experienced as simple noises, bells, undifferentiated voices or whispers.

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25
Q

Gedankenlautwerden

A

Auditory hallucination in which one hears one’s own thoughts spoken out loud.

  • First rank symptom (Schneider)
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26
Q

Écho de la pensée (thought echo)

A

Phenomenon of hearing thoughts spoken aloud after they occur.

SCAN classes this as a disorder of thought, rather than a hallucinatory experience.

It is though Gedankenlautwerden and écho de la pensée may be prerequisites to thought broadcast.

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27
Q

Lilliputian hallucinations

A

Visual hallucinations in which microsopia effects hallucinations and people often see tiny people of objects. Accompanied with pleasure/amusements.

Can be seen in delirium tremens

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28
Q

Defintion:

Olfactory hallucinations

A

Hallucinations of odour (phantosmia) which can occur in:

  • schizophrenia
  • organic states (e.g. temporal lobe epilepsy)
  • uncommonly in depressive psychosis
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29
Q

Definition:

Gustatory hallucinations

A

Hallucinations of taste (phantaguesia)

Can occur in schizophrenia/organic states

Frequently occur with hallucinations in other modalities

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30
Q

Definition:

Tactile hallucinations

A

Hallucinations of touch.

Formication = sensation of small animals crawling over the body (acute organic states).

Cocaine bug = formication + delusions of persecution

In the absence of organic brain disease, the most likely diagnosis is schizophrenia.

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31
Q

Classification of tactile hallucinations

A

Superficial (affect the skin)

-thermic, haptic (hand brushing against the skin), hygric (fluid running from head to stomach) and paresethetic

Kinaesthetic/vestibular: (occur in organic status such as DT, acute alcohol intoxication, benzodiazepine withdrawal)

  • affect muscles/joints. Limbs being ‘twisted’ or ‘pulled’. Can occur in schizophrenia.
  • Sensation of flying/sinking

Visceral
- deep twisting/tearing pains.

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32
Q

Definition:

Hallucinatory syndromes (hallucinosis)

A

Disorders in which there are persistent hallucinations in any sensory modality in the absence of other psychotic features.

Alcoholic hallucinosis:
Usually auditory and occur during periods of relative abstinence. Clear consciousness, rarely persist >1 week. Long-standing alcohol misuse

Organic hallucinosis:

20-30% of patients with dementia (especially Alzheimer’s). Commonly auditory or visual.

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33
Q

Definition:

Functional hallucinations

A

An auditory stimulus causes a hallucination, however both stimulus and hallucination are experienced. (A real sensation is required for the hallucination)

E.g. a patient heard the voice of God when her clock ticked, later she heard voices from the running tap

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34
Q

Definiton:

Hypnagogic/hypnopompic hallucinations

A

Hypnagogic = hallucinations whilst falling asleep
3x more common than
hypnopompic; 37% adults
Visual/auditory hallucinations

Hypnompompic = hallucinations whilst waking

They can occur in narcolepsy
Not indicative of psychopathology, despite being true hallucinations

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35
Q

Defence mechanisms were organised into how many levels by Valliant’s classification?

A

Four Levels:

  1. Psychotic defences
  2. Immature defences
  3. Neurotic defences
  4. Mature defences
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36
Q

What are psychotic defences according to Valliant’s classification (Level 1)

A

Pathological defence mechanisms which distort experiences in which they eliminate the need to deal with reality.

  • Distortion
  • Denial
  • Delusional projection
  • Splitting*
    Found frequently in borderline personality
    disorder; people are divided into polar
    opposites e.g. perfect or flawed

*Comes up in exams, but not part of Valliant classification

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37
Q

What are immature defences according to Valliant’s classification (Level 2)

A

Immature Defences:

1.Schizoid fantasy
2. Projection
3. Acting out
4. Hypochondriasis
5. Passive aggression
6. Idealisation*
7. Projective Identification - an aspect of self is
projected on to someone else. The projector
tries to coerce the recipient with what has
been projected to feel as sense of union.*

*Comes up in exams, not part of Valliant’s classification

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38
Q

What are neurotic defences according to Valliant’s classification (Level 3)

A

Neurotic defences:

Tend to have short term advantages but lead to problems longer term.

  • Displacement
  • Reaction formation
  • Repression
  • Intellectulisation
  • Dissociation
  • Isolation*
  • Regression*
  • Rationalisation*
  • Controlling*
  • Externalisation*
  • Undoing*

*Come up in exams, not part of Valliant classification

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39
Q

What are mature defences according to Valliant’s classification (Level 4)

A

Mature defences

Considered the most advanced form of defence mechanism

  • Altruism
  • Anticipation
  • Sublimation
  • Suppression
  • Humor
  • Identification
  • Introjection
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40
Q

Sublimation

A

Mature defence mechanism

Deals with stress by channelling potentially disruptive feelings or impulses into socially acceptable behaviour

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41
Q

Displacement

A

Neurotic defence mechanism

The process in which interest or emotion is shifted from one object to a less threatening one, so the latter replaces the former.

E.g. Someone have difficulties with their boss at work my distance anger onto their family by being irritable

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42
Q

Projection

A

Immature defence

Falsely attributing your own unacceptable feelings, impulses or thoughts to another person

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43
Q

Projective Identification

A

Immatue defence:

an aspect of self is projected on to someone else. The projector tries to coerce the recipient with what has been projected to feel as sense of union.* There is a sense of feeling controlled or manipulated by the recipient.

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44
Q

Intellectualisation

A

Neurotic defence mechanism

Focusing on details to avoid painful thoughts or emotions

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45
Q

Rationalisation

A

Mature defence mechanism

The creation of false, but credible justifications. Patient feels emotions (in intellectualisation these are avoided) and seeks alternative reasons to avoid the reality of the situation.

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46
Q

Reaction formation

A

Neurotic defence mechanism

Substituting behaviour, thoughts or feelings which are the exact opposite of your own unacceptable thoughts or feelings.

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46
Q

Reaction formation

A

Neurotic defence mechanism

Substituting behaviour, thoughts or feelings which are the exact opposite of your own unacceptable thoughts or feelings.

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47
Q

Reaction formation

A

Neurotic defence mechanism

Substituting behaviour, thoughts or feelings which are the exact opposite of your own unacceptable thoughts or feelings.

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47
Q

Reaction formation

A

Neurotic defence mechanism

Substituting behaviour, thoughts or feelings which are the exact opposite of your own unacceptable thoughts or feelings.

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48
Q

Idealisation

A

Immature defence mechanism

Seeing someone or an object as omnipotent e.g. you will save me

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49
Q

Repression

A

Neurotic defence mechanism

Removing disturbing thoughts/emotions/experiences from conclusion awareness.

50
Q

Suppression

A

Mature defence mechanism

Consciously avoiding thinking about something

51
Q

Mental State Definitions

Feeling

A

An active experience of somatic sensation (such as touch or heat) or a passive subjectovr experience of an emotion.

Used to describe a reaction to an experience.

52
Q

Mental State Definitions

Affect

A

A patient’s present emotional responsiveness

  • Within normal range
  • Constricted (restricted in range and intensity)
  • Blunted
  • Flat (no expression)
53
Q

Mental State Definitions

Mood

A

A prevailing state or disposition

54
Q

Reflex hallucination

A

These occur in one sensory modality in response to a stimulus in another sensory modality.

(In functional hallucinations the real stimulus and hallucination occur in the same modality)

55
Q

Depersonalisation

A

A subjective state as if one is unreal, generally felt to be strange and unpleasant.

Features include:

  • Emotional numbness
  • Changes in sensory experience
  • Distorted sense of time
  • Heightened self-observation
56
Q

Big 5 personality traits

A 
Openness to experience 
Conscientious 
Extraversion
Agreeableness
Neurotocism
57
Q

DSM V personality clusters: A,B,C

A

Mad (A), Bad (B), Sad (C)

(= ICD 10 equivalent)

A -

Schizotypal (listed alongside schizophrenia)
Schizoid (schizoid)
Paranoid (paranoid)

B -
Narcissistic (other)
Borderline (emotionally unstable)
Antisocial (Dissocial)
Histrionic (Histrionic)

C-
Obsessive compulsive (Anankastic)
Avoidant (Anxious-avoidant)
Dependent (Dependent)

58
Q

Who developed the term catatonia?

A

Kahlbaum

Catatonia = disturbance of motor functions amid disturbance of mood and thought

59
Q

What are the ten first rank symptoms of schizophrenia?

A 
Running commentary
Voices heard arguing 
Thought echo 
Thought insertion
Thought withdrawal 
Thought broadcast
Delusional perception 
Made affect 
Made volition (impulse or behaviour controlled by an outside force)
60
Q

Synaesthesia

A

The stimulation of one sensory pathway leads to experience in a second sensory pathway

E.g. hearing a smell

61
Q

Intellectual disability

IQ 35-49

A

Moderate intellectual disability

62
Q

Intellectual disability

IQ 20-34

A

Severe intellectual disability

63
Q

Intellectual disability

IQ 70-90

A

Borderline intellectual disability

64
Q

Intellectual disability

IQ <20

A

Profound intellectual disability

65
Q

Intellectual disability

IQ 50-69

A

Mild intellectual disability

66
Q

Disorder of thought content

Primary delusion (apophany)

A

A delusion which arises spontaneously, from normal psychological processes and not a result of psychopathology

Delusional perception
Delusional memory
Delusional mood
Autochthonous delusion

67
Q

Disorder of thought content

Secondary delusion

A

A delusion which develops as a consequence of a morbid experience

E.g. a delusion secondary to auditory hallucinations

68
Q

Hyperschemazia

A

Perceived magnification of body parts

69
Q

Ansosognosia

A

Denial of illness

70
Q

Hemiasomatognosia

A

Belief that half of the body is missing

Migraine, aura with epilepsy

71
Q

Disorders of stream of thought

Disorders of tempo

A

Flight of ideas
Prolixity
Inhibition or slowing of thinking
Circumstantiality

72
Q

Disorders of stream of thought

Disorder of continuity of thinking

A

Preservation

Thought blocking

73
Q

Disorders of stream of thought

Disorder of continuity of thinking

A

Perseveration

Thought blocking

74
Q

Flight of ideas

(Typical of mania, can occur in hypomania, occasionally in schizophrenia and organic states - especially lesions of hypothalamus)

A

Disorder of thought tempo.

Thoughts follow each other rapidly, with no general direction of thinking and connections seem to be due to chance (although easily understood).

  • verbal association (e.g. alliteration, assonance)
  • clang association
  • clichés
  • proverbs
75
Q

Prolixity

A

Disorder of thought tempo

Lesser tempo than flight of ideas - seen in hypomania.

Patient is able to return to task in hand.
Clang and verbal associations are less marked.

76
Q

Inhibition/slowing of thinking

Can be seen in depression, manic stupor, dementia

A

Train of thought is slowed and number of ideas or metal images is decreased.

77
Q

Circumstantiality

A

Disorder of thought tempo

Thinking proceeds slowly (with many unnecessary or trivial detailwls), however final point is eventually reached.

78
Q

Perseveration

A

Disorder of continuity or thinking

May be verbal or ideational.

Mental operations persist beyond the point of relevance and prevent progress of thinking.

Common in general and localised organic disorders of the brain.

79
Q

What is the difference between perserveration and verbal stereotypy?

A

In verbal stereotypy, the same word/phrase is used regardless of the situation.

In perserveration, the word/phrase/idea persists beyond the point at which is relevant.

80
Q

What is the difference between preserveration and verbal stereotypy?

A

In verbal stereotypy, the same word/phrase is used regardless of the situation.

In preserveration, the word/phrase/idea persists beyond the point at which is relevant.

81
Q

Thought blocking

A

Disorder of continuity of thinking

Sudden arrest of the train of thought, leaving a ‘blank’. An entirely new thought may then begin.

82
Q

Possession of thought

A

-Obsessions and compulsions
(Obsession [rumination] is a thought that
persists and dominates beyond the point of
relevance or usefulness.
Compulsion = obsessional motor act)

-Thought alienation
Experience that one’s thoughts are under control
of an outside agency or others are involved in
their thinking)

83
Q

Thought alienation

A
  • Thought insertion
  • Thought deprivation (thoughts suddenly
    disappear or removed by a foreign influence)
  • Thought broadcast - several definitionsWhen the person is thinking, others are thinking
    in unison with them.
    Thoughts escaping from the mind and others
    can access
    Hearing ones thoughts spoken aloud, therefore
    others can hear
84
Q

Content of delusions

Delusions of persecution

A 
Delusions of reference 
Delusions of guilt 
Delusions of harm to self/loved ones 
Delusions around theft 
Delusoons of being poisoned/infected 
Delusions of passivity e.g. witchcraft, demonic possession, hypnotism etc.
85
Q

Content of delusions

Delusions of infidelity

A

Can occur in organic and functional disorders

  • especially associated with alcohol dependency
  • can be seen in affective psychosis, can represent a morbid exaggeration of a preformed jealous attitude
86
Q

Content of delusions

Other

A 
Delusions of love /erotomania
Grandiose delusions 
Delusions of ill health 
Delusions of guilt 
Nihilistic delusions (negation of existence of body/mind/loved ones/world around them)
Delusions of poverty
87
Q

Capgras syndrome

A

Delusional misidentification

Patient believes someone close, normally a family member, has been replaced by a double.

88
Q

Fregoli syndrome

A

Delusional misidentification syndrome

It is believed that various people that the patients meet are the same person, in disguise .

89
Q

Delusional misidentifcation syndromes

A

Capgras syndrome
Fregoli syndrome
Intermetamorphisis
(Delusion people have swapped identities whilst
maintaining the same appearance)
Subjective doubles
(Delusional belief the patient has a doppelganger)
Reduplicative paramnesia
(Belief identical places and events exist)

90
Q

Cotard syndrome

A

A delusion in which a person believes they are dead.

Accompanied with delusions they are rotting, malodorous or body parts do not exist.

91
Q

Couvade Syndrome

A

Abnormality in experience of self in which a spouse also complains of obstetric symptoms during pregnancy and birth.

92
Q

De Clerambault’s syndrome (Erotomania)

A

The patient (often a single person) believes that an exalted person is in love with her.

The supposed lover is often inaccessible.

93
Q

Othello syndrome

A

Delusional belief, or overvalued idea, that one’s spouse is being unfaithful.

94
Q

Munchausen’s syndrome

A

Factitious disorder

Repeated presentations at hospital for an apparent acute illness with plausible symptoms/history, which are false. Unlike malingering, there does not appear to be secondary gain.

95
Q

Disorder of form of thinking

Formal thought disorder

A

Disorders of conceptual or abstract thinking

-Commonly seen in schizophrenia, organic brain disease

96
Q

Asyndesis

A

Lack of connection between successive thoughts

97
Q

Derailment

A

Thought slides on to a subsidiary thought

98
Q

Substitution

A

A major thought is substituted by a subsidiary thought

99
Q

Omission

A

Senseless omission of a though, or part of it

100
Q

Argyll Robertson pupil

A

Tertiary syphilis; also reported in diabetes

Reacts poorly to light, normally to accommodation and convergence

101
Q

Thomas Szaz

A

American-Hungarian Psychiatrist who was a social critic of the moral and social role of psychiatry.

He wrote ‘The Myth of Mental Illness’

102
Q

Intermetamorphasis

A

People have swapped identities while maintaining the same appearance..

Psychological and physical transformation

103
Q

Subjective Doubles

A

Delusional belief that someone has a double or doppelganger

104
Q

Catatonia

A

Kahlbaum

Disturbed motor function and disturbance in mood and thought.

Stupor
Posturing
Cerea flexibilitus
Gegenhalten
Automatic obedience 
Mitmachen
Mitgehen 
Ambitendency
Psychological pillow 
Forced grasping 
Verbigeration 
Logoorrhoea 
Echolalia
Echopraxia 
Mannerism 
Stereotypies
105
Q

Stupor

A

Immobility and mutism

106
Q

Posturing

A

Maintaining the same posture for long periods of time

107
Q

Cerea flexibilitas

A

Waxy flexibility

Patient can be positioned in an uncomfortable posture which is maintained for a long time

108
Q

Gegenhalten

A

Negativism

Resistance to examiner attempting to move body parts

109
Q

Automatic obedience

A

Exaggerated co-operation

110
Q

Echopraxia

A

Imitating examiner’s movement

111
Q

Mitgehen

A

Extreme form of mitmachen,slightest pressure causes limb movement

112
Q

Mitmachen

A

Body can be put into any posture even if given instructions to resist. Body part immediately returns to position when removed

113
Q

Mannerism

A

Repetitive goals directed behaviour e.g. saluting

114
Q

Stereotypies

A

Non-goal directed repetitive movement e.g. rocking

115
Q

Atypical depression (DSM-IV)

A

Subtype of major depressive disorder; responds best to MAOI.

  1. Mood reactivity i.e. mood brightens in
    response to events
  2. At least 2 of:Significant weight gain or appetite increase
    Hypersomnia
    Leaden paralysis
    Long-standing interpersonal rejection
    sensitivity causing social or occupational
    impairment
116
Q

ADHD

A

Impulsivity, hyperactivity and inattention

117
Q

Consciousness

A

State of awareness of self and the environment

118
Q

Active attention

A

A person focuses their attention on an internal or external event with conscious effort

119
Q

Inactive attention

A

A person passively is drawn to an internal or external event without effort on their part

120
Q

Disorder of consciousness

A

Disorder of - perception

121
Q

Dream-like change of consciousness

  • often seen in delirium
A

Disorientated from time and place, not person. Outstanding feature is presence of visual hallucinations; often small animals. Associated with fear/terror.

Lilliputian hallucinations (small people/animals) accompanied by pleasure.

Continuous voices or organised auditory hallucinations are rare.

Tactile hallucinations can occur.

122
Q

Lowering of consciousness

A

‘Psychologically benumbed’; no hallucinations, illusions, delusions or restlessness.

Apathetic and slowed down. Cannot express clearly and may preservate.

123
Q

Restricted consciousness

A

Awareness narrowed to a few ideas and attitudes which dominate the patient’s mind. Disorientation from time and place.

124
Q

Ganser Syndrome

A

A dissociative state; unconscious production of symptoms to avoid court appearance.

Give approximate answers, clouding of consciousness.

Could be organic or psychotic state.

MRCPsych Part A - Rach (8 decks)

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