Classification and Assessment pyschmentor Flashcards
ALCOHOL SCREENING
AUDIT
10 items cover the 3 domains of harmful use, hazardous use, and dependence superior to biochemical markers score 0-40 harmful: >8,/7 dependance >15/13 AUDIT C = 3qs
FAST 4 qs, score 0-16 >3 hazardous drinking 1. 8/6 drinks (SASQ only asks this question- in 3m = +ve) 2. remember night before 3. failed normal activities 4. others concerned about drinking
PAT (Paddington Alcohol Test), was developed for use in a busy A&E department to detect hazardous drinking.
MAST (Michigan Alcoholism Screening Test) for detecting dependent drinkers.
Rapid Alcohol Problem Screen 4 (RAPS4) Consists of four questions highly effective in detecting alcohol dependence. A 'yes' answer to at least ONE of the four questions suggests that your drinking is harmful. R (remorse) A (amnesia) P (performance) S (starter drinker behaviour)
Palinopsia
Allesthesia
Teleopsia
Chromatopsia
Synaesthesia
gedankenlautwerden
Brodnignagian
DYSMEGALOPSIA
cant appreciate size of objects
Palinopsia
persistence of image after stimulus removed, usually organic pathology
Allesthesia
stimulus percieved at a remote point in body away from stimulus point
Teleopsia
objects appear to be farther away than they actually are.
Pelopsia is the opp
Chromatopsia
colourless objects appear coloured
Synaesthesia
sensation in one modality produces a sensation in another modality
can be called ‘union of the senses’ occurs in 1% normal
Echo de la pense
ALSO thought echo and gedankenlautwerden
Brodnignagian
large people
Alzheimer’s (SPECT Imaging)
DaT-SCAN refers to the isotope ‘Ioflupane’ which is used to produce a SPECT image
temporal and parietal hypoperfusion
ANOREXIA DSM DIAGNOSIS
The DSM-IV provides the best guide to the diagnosis of anorexia nervosa.
Diagnostic features include:-
REFUSAL to maintain body weight above 85% of what is expected
Intense FEAR of becoming fat despite being thin
Disturbed BODY IMAGE and DENIAL of seriousness of there low body weight
Amenorrhea
ATYPICAL IF NOT MEETING DIAGNOSTIC CRITERIA
APRAXIAS
Limb kinetic apraxia - fine/ delicate movements
Ideomotor apraxia - learned tasks when given the necessary objects
Constructional apraxia - copy a picture or combine parts of something to form a whole
Ideational apraxia - follow a sequence of actions in the correct order e.g. Take a match out a box and strike it with your left hand
Oculomotor - an inability to control eye movements
RAPID CYCLING
BIPOLAR
prev- 10-20% of all patients with bipolar disorder
more common in women
earlier age
more related to external factors
develops late in course and lasts 2 yrs in 50%
medical disorders: Hypothyroidism, Grave's disease Subarachnoid haemorrhage, Stroke, Head injury Multiple sclerosis propranolol, levodopa, cyproheptadine
MANAGE
NICE Guidelines: lithium and valproate as first line
adding: APs, or mood stabilisers
BPRS
BPRS
24 items
7 point scale
based on observation** and via short interview
CAMBERWELL FAMILY INTERVIEW
expressed emotions
Copropraxia
palilialia
coprophagia
Eating faeces = coprophagia
Repeating one’s own sounds = palilialia
use of obscene gestures = Copropraxia
COTARDS
Delusion that one does not exist OR has lost his or her blood, internal organs, or soul, or that one is dead seen in: dep, trauma, schizo, bipolar 90% females and elderly
CULTURE BOUND:
KORO
LATAH
BRAIN FAG
AMOK
DHAT
WINDIGO
PIBLOKTO
Koro (Genital retraction syndrome)
Origins: China, Malaysia, Indonesia
penis is shrinking and that eventually it will be absorbed into their body. ‘FATAL’
Latah
Origins: Malaysia and Indonesia
middle aged women. 30 min outbursts of screaming, hysterical laughing and obscenities.
Brain fag, or brain fog
Origin: West Africa
stressed out West African students. poor concentration, and unusual somatic sensations such as burning skin.
Amok
Origin: Malaysia
suddenly overcome with a violent outburst
continues until they are overpowered at which point they fall into a deep sleep and upon waking have no recall of the event.
almost always affects males.
Dhat
Origin: India
Men believe passing semen in their urine which leads to a loss of physical and mental energy.
Windigo
Origin: Native North America
intense desire for human flesh and a strong believe that one is turning into a cannibal.
Piblokto
Origin: Eskimo societies
hysteria and behave oddly for instance by rolling around in snow naked while muttering to themselves.
CLASSIFY DEFENCE MECHANISMS:
- PSYCHOTIC
- IMMATURE
- NEUTROTIC
Psychotic defenses (Level 1)- distort experiences in such a way that they eliminate the need to deal with reality. They include:-
Distortion
Denial
Delusional projection
Splitting *
Immature defenses (Level 2). These include:-
Schizoid Fantasy Projection Acting out Hypochondriasis Passive aggression Idealization * Projective identification *
Neurotic defenses (Level 3). short term advantages.They include:-
Displacement Reaction formation Repression Intellectualization Dissociation Isolation * Regression * Rationalization * Controlling * Externalization * Undoing *
FEATURES OF
PICKS
PSP
Picks’s disease (aka fronto temporal dementia)
speech and language dysfunction including poverty of speech and echolalia
PSP
Shares many features of Parkinson’s disease apart from TREMOR
Presents with loss of balance and falls
voluntary eye movements PROBLEMS
Use of SPECT IN DEMENTIA (GUIDELINES)
DEMENTIAS AND USE OF EEG
Perfusion hexamethylpropyleneamine oxime (HMPAO) single-photon emission computed tomography (SPECT) should be used to help differentiate Alzheimer’s disease, vascular dementia and frontotemporal dementia
People with Down’s syndrome may show SPECT abnormalities
HMPAO SPECT is unavailable, 2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography (FDGPET) can be used
Dopaminergic iodine-123-radiolabelled 2-carbomethoxy-3-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (FP-CIT) SPECT should be used to help establish the diagnosis in those with suspected dementia with Lewy bodies (DLB)
EEG if: If delirium, frontotemporal dementia or CreutzfeldtJakob suspected
DEPRESSION (BROWN AND HARRIS)
Depression (Brown and Harris)
In 1978, 58 women in the inner London area of Camberwell
four ‘vulnerability factors’
no. of children UNDER 14 (3+), relationship, loss of mother
Down’s syndrome (assessment of dementia)
DMR (Dementia Questionnaire for Persons with Mental Retardation)
DSDS (Dementia Scale for Down Syndrome)
DSM/ICD CATEGORIES NO.
ICD - 10 major categories
DSM - 17 major categories
The Edinburgh Postnatal Depression Scale (EPDS)
10 Item self report
excludes symptoms common in the perinatal -(tiredness and irritability)
select one of 4 responses for how they have felt over past 7 DAYS.
each response score 0-3.
statements:
laugh and see the funny side of things unhappy that I have had difficulty sleeping looked forward with enjoyment to things sad or miserable blamed myself been crying anxious or worried getting on top of me scared or panicky for no very good reason harming myself has occurred to me
0-9 low
10-12 moderate
13 high
The first rank symptoms include:-
Running commentary
Voices heard arguing
Thought echo
Thought broadcast
Thought insertion
Thought withdrawal
Delusional perception
Somatic passivity
Made affect (feelings are controlled by an outside force) Made volition (impulses and/or behaviour are controlled)
Gudjonsson Suggestibility Scale
reading a story aloud to participants - then them to recall
probed with 20 questions pertaining to the story, 15 of which are misleading.
given a negative feedback on their performance asked to repeat questions
Kraepelin Kahlbaum Kasanin Beard Kleist Braid Lewin Moreno Koch Reil Barton FREUD (OBESSSIONAL..) Emil Kraepelin
Dementia praecox and manic depression - Kraepelin Catatonia - Kahlbaum Schizoaffective - Kasanin Neurasthenia - Beard Unipolar and bipolar - Kleist Hypnosis - Braid Group dynamics - Lewin Group psychotherapy - Moreno Psychopathic inferiority - Koch Psychiatry - Reil Institutional Neurosis - Barton OBSESSIONAL NEUROSIS paramnesia = MEMORY DISORDER
HIV FACTS
Treponema pallidum = Syphilis
Enterobacteriaceae = Bubonic plague
Diagnosis is based on the detection of the P24 antigen, HIV nucleic acid or direct virus detection.
Severity of disease and response: CD4 count and viral load
CD4 counts are >500 x 10^6/l.- assymp
below 200 x 10^6/l- opportunistic
Non-nucleoside reverse-transcriptase inhibitors efavirenz, nevirapine
Nucleoside reverse-transcriptase inhibitors abacavir, didanosine
Protease inhibitors retinovir, indinavir
Others enfuvirtide
side effects: dreams, anxiety, dep,
delusions, mania and suicide = efavirenz
Psychosis - Atypicals- Risperidone most widely studied
Delirium - Atypicals and low-dose short acting benzodiazepines
Depression- SSRIs, especially citalopram
Bipolar - Valproate, lamotrigine, gabapentin are the best options, lithium ok but poorly tolerated. Carbamazepine is to be avoided***. Atypical antipsychotics ok
Kaposi’s sarcoma is a tumor caused by human herpesvirus 8 .
In 1967, Holmes and Rahe
5,000 medical patients and asked them ABOUT of 43 life events
1 Death of spouse 100
2 Divorce 73
3 Marital separation 65
4 Jail term 63
5 Death of a close family member 63
6 Personal illness 53
7 Marriage 50
8 Being fired from work 47
9 Marital reonciliation 45
10 Retirement
Huntington’s disease (genetics and pathology)
Normally CAG is repeated less than 27 times.
bilateral atrophy of the head of the caudate and putamen (hence the chorea),
degree of gyral atrophy of the frontal (hence problems with executive function)
temporal regions (so memory impairment).
enlarged ventricles
micro: Neuronal loss and gliosis cortex, Neuronal loss striatum,
Inclusion bodies cortex and striatum
CADSIL
generally presents with stroke, memory impairment, migraine, and severe mood disturbances.
Hypercalcemia
fatigue, depression, and confusion
bones (bone pain), groans (abdominal pain), stones (renal stones) psychic moans
caused by lithium use (and thiazide diuretics)
50% ca bound to proteins mainly alb
Kraepelin (mixed states)
Mania with poverty of thought (decreased thought) Inhibited mania (decreased will) Manic stupor (decreased will and thought)
Depression with flight of ideas (elevated will) Excited depression (elevated thought) Depressive mania (elevated will and thought)
NOW TWO:
Dysphoric mania (full mania is present with some depressive symptoms) Depressive mixed state (full depression is present with some manic symptoms)
mmse scores
greater than 27 indicates normal cognition
severe (
PARAMNESIA
REDUPLICATIVE PARAMNESIA
RETROSPECTIVE FALSIFCIATION
CRYPTOMNESIA
The term paramnesia was coined by Emil Kraepelin = MEMORY DISORDER where fantasy and reality are confused.
Reduplicative paramnesia The delusion that a place, person, or time has been duplicated
Retrospective falsification The process of distorting a memory
Cryptomnesia - having a thought without realising you have had the thought before (some PLAGIARISTS claim they are unaware that they were recounting other peoples work)
WHAT IS A parapraxis
Paraschemazia
A parapraxis is also known as a ‘slip of the tongue’
Paraschemazia= parts of the body are distorted or twisted or that they are separated from the rest of the body
association with hallucinagenic use, epileptic aura, and migrane.
PD:
SCHIZOID
HISTRIONIC
NARCISSISTIC
Schizoid personality disorder is characterised by:-
Indifference to praise and criticism Preference for solitary activities Lack of interest in sexual interactions Lack of desire for companionship Emotional coldness Few interests Few friends or confidants other than family
Histrionic personality disorder is characterised by:-
Inappropriate sexual seductiveness
Need to be the centre of attention
Physical appearance used for attention seeking purposes
Rapidly shifting and shallow expression of emotions
Suggestibility
Impressionistic speech lacking detail
Self dramatization
Relationships considered to be more intimate than they are
NARCISSISTIC
- Grandiose sense of self importance
- Preoccupation with fantasies of unlimited success, power, or beauty
- Sense of entitlement
- Taking advantage of others to achieve own needs
- Lack of empathy
- Excessive need for admiration
- Chronic envy
- Arrogant and haughty attitude
Pheochromocytoma
catecholamine-secreting tumor of chromaffin cells located in the adrenal glands
HTN, tachycardia, postural hypotnesion sweating, cold and clammy skin livedo retciularis (mottled skin) headache angina, palpitations nausea, vomitting
diagnosed by measuring catecholamine products in the blood or urine.
principal urinary metabolic products of epinephrine and norepinephrine = (VMA) and homovanillic acid (HVA).
PORPHYRIA
PPTS:
Barbiturates, Benzodiazepines
Sulpiride
SOME mood stabilizers
Symptoms to look out for include:- Abdominal pain Mental state changes Constipation Vomiting Muscle weakness
PROSODY
‘the emotional tone of language’
Aprosodias non-dominant hemisphere (RIGHT IN 95%)
right premotor cortex or the basal ganglia.
Receptive prosody- posterior superior right temporal lobe.
tested asking the patient to repeat a neutral sentence with different emotions (anger, fear, sadness)
TESTS:
GMSS
BDI
DESS
GDS
HAMA
MADRS
YMSR
BPRS
SAS
HAMD
LUNSERS
The GMSS (Geriatric Mental State Schedule) is used to screen for depression in the elderly.
BDI (Beck depression inventory)
severity of depression. 21 items, each is score out of 0-3. revised in 1966. 0-13 indicates minimal depression, 14-19 mild depression, 20-28 moderate, and 29-63 severe depression.
DESS (Discontinuation-Emergent Signs and Symptoms scale)- 43-item rating scale
GDS (geriatric depression scale)
30 item scale, Each question has either a yes or no response
0-9 is deemed normal, 10-19 is mild depression, and 20-30 is severe depression.
HAMA is a 14 item scale
MADRS (Montgomery-Asberg depression rating scale)
TEN-item diagnostic questionnaire used to measure the severity of depressive episodes/ more sensitive to the changes brought on by antidepressants and other forms of treatment.
YMRS (Young mania rating scale)
11-item instrument used to assess the severity of mania in diagnosis of bipolar disorder.
BPRS
18 and 24 items (symptom constructs) which are rated from 1 to 7 according to the degree of severity. The minimum score is therefore 18. CONSIDERS BEHAVIOUR OVER 2-3 DAYS
SAS
Simpson-Angus scale was devised to measure drug-induced parkinsonism, providing standardised ratings for rigidity, tremor and salivation. The scale is entirely sign led
HAMD (Hamilton depression rating scale)
multiple choice questionnaire to rate the severity of depression. Depending on the version used there are either 17** or 21 items. Each scored between 3 and 5 points. scores on 17: between 0 and 54. over 24 indicate a severe depression
LUNSERS
51 items, 41 known SEs and 10 red herrings: hair loss, chillblains
UKU = (the gold standard which takes about 60 minutes to do).
Sick euthyroid syndrome
low T3 syndrome, non thyroid illness
often seen in anorexia/prolonged starvation
WHAT IS Prolixity (FTD)
refers to a marginal variety of flight of ideas seen in hypomania where clang and verbal associations are less frequent, there is a general direction of thought and it is not as rapid.
Charles Bonnet syndrome
- hallucinations in people who have lost their sight
WISC
WASI
WTAR
WAIS
WISC
Wechsler Intelligence Scale for Children
AGED 6-16. Can be done without readin/writing
(WASI)
Wechsler Abbreviated Scale of Intelligence
quick estimate of intellectual functioning.
30 mins (full WAIS 60-90mins)
WTAR
Wechsler Test of Adult Reading
measure of premorbid intelligence,
WAIS
16 and 90.
Verbal Comprehension Index Perceptual Reasoning Index --> GENERAL ABILITY INDEX Working Memory Index Processing Speed Index
TOTAL–> IQ SCORE
standard deviation of 15 (85-115)
WILSONS
disease of copper storage and failure to excrete
hepatolenticular degeneration (putaman and GP) mutation in protein ATP7B gene= codes enzyme which transports cu into bile incorporates into ceruloplasmin
levels of cu and ceruloplasmin are low in 90%
presentation: dystonia, P tremor, rigidity, behavioral
