Descriptive psychopathology Flashcards
Are primary delusions understandable?
No by definition they are un-understandable as they arise from a primary psychiatric illness.
They present immediately self-evident akin to intuition or a revelation and may be accompanied by radical transformation or emergence of thinking
Outline the salient features of alexithymia
Struggle to identify own feelings
May find it difficult to tell difference between own feelings and emotional arousal
Struggle to read other peoples feelings
Lack of imagination
Cognition is externally-orientated and stimulus bound / Lak of symbolic thinking
What is couvade syndrome?
Not a delusional belief but a syndrome where pregnant mothers who are expecting have conversion symptoms
What gait may patients with conversion disorder exhibit?
Atasia-abasia
- Widly ataxic staggering gait accompanied by gross, irregular jerky movements with thrasing
- If patients fall they are generally not hurt
Differentiate Deja Vu, Jamais Vu, Deja Entandu and Deja Pense
Deja Vu - inappropriate familiarity with new place/event
Jamais Vu - knowledge that have experienced a new place/event before but no familiarity
Deja Entandu - new sound interpreted as familiar
Deja Pense - new thought interpreted as familiar
What is stupor?
Loss of activity with no reaction to external stimulus - seen in depression, dissociation
What is type token ratio?
The ratio of total number of new words used : total number of words used
- it is a measure of lexical diversity
Outline the main negative symptoms of Schizophrenia?
Anhedonia
Flattened affect
Alogia - poverty of speech
Social withdrawal
Lethargy
Avolition - lack of motivation
The feeling “as if” someone is not real is referred to as…
Depersonalisation - it is an as if phenomenon
What can card sorting tests demonstrate? (type of abnormal thinking)
Overinclusive thinking
- Kurt Goldstein specified the test to sort items into category, colour and form - i.e. sort things accoding their attributes into conceptual categories
How do mannerisms and stereotypy differ?
Mannerisms are performance of a goal directed activity in a sometimes bizarre/over the top manner i.e. combing hair without comb
Stereotypy are repeated non-goal directed movements i.e. rocking
How does alcoholic induced psychotic disorder with hallucination present?
Alcoholic hallucinosis: occurs after prolonged and heavy alcohol use
Hallucinations are initially poorly formed noises or murmurings then develop into more clearly formed voices. Hallucinations are experienced when sober
Generally they cease with a period of abstinence but if persistent may be treated with antipsychotics
What is snout spasm or Schnauzkrampf?
Typical posturing of tightened forehead and facial muscles seen in patients in a catatonic stupor
What does ego-syntonic refer to?
If a phenomenon is in keeping with the goals/needs/self-image of the ego
Generally delusions begin as ego-syntonic but as a patient develops insight they then may become ego-dystonic
How does jamais vu differ to deja vu?
Deja Vu - events experienced for the first time are associated with inappropriate familiarity that they have been experienced before. NOVEL EXPERIENCE THAT FEELS FAMILIAR
Jamais Vu - events that have been experienced before feel unfamiliar. OCCURING EXPERIENCE BUT UNFAMILIAR
Outline the three types of illusions and when they may occur?
Affect illusions - occur with heightened emotional tone and misperception
Complete illusions - when our brains try and fill in missing information in stimulus
(both affect and complete illusions improve with closer attention)
Pareidolic illusions occur when perceiving a badly defined stimulus i.e seeing a face in a cloud etc
Not all illusions occur when perception threshold is increased
What is a coensthetic hallucination?
A hallucination of visceral or bodily sensations in the absence of sensorial input - may be ripping in nature
What is phantom limb pain characterised by?
A body image disturbance - note historically classified as somatic hallucinations
What is asyndesis also known as?
Loosening associations - the lack of meaningful causal links in an argument
When speech is referred as excessively formal and stilted what is this called?
Stilted speech
What is vorbeiden?
Vorbeiden “talking past the point” refers to speaking about a related topic and giving approximate answers. This speech disturbance indicates the patients still understands the question.
It is seen in Ganser syndrome (a type of disturbance of thought form) - approximate answers, disorientation, clouding of consciousness, pseudo/hallucinations, motor disturbance, apathy, normal ADLs and sudden resolution of amnesia.
What is teichopsia?
Classically seen in the aura from migraine - it takes the form of a horshoe with zigzag that expands rapidly before headache onset
What is metonymy?
Speech disturbance seen in Schizophrenia where an individual uses a phrase or word related to the intended one
What two components make up Psychomotor agitation?
Psychic anxiety and psychomotor agitation
What gender identity diagnoses are present in ICD-11 and DSM-V
ICD-11:
- Gender incongruence for children or adolescence and adults
- In chapter of sexual health related conditions
DSM-V:
- “Gender dysphoria” is for all individuals
- Clinical distress is required for diagnosis
What are Carl Scheider’s 5 formal thought disorders?
- Subsitution: major thought swapped for a subsidary one
- Derailment: slide into a subsidary thought
- Omission: done senseless is the at of omitting a whole or part of a thought
- Fusion: heterogenous aspects of thoughts are interwoven into each other
- Drivelling: a disorganised mixing of constituent aspects of a complex thought
What is the ideational disturbance?
The doppleganger phenomenon - awareness of another human being accompanying the self. It is seen in sleep deprivation
What is eidetic visual imagery?
An extremely vivid visual memory - seen more commonly in children
What is autoscopy and which condition is it most commonly seen in?
Phantom mirror image - experience of having a visual hallucination of oneself (or pseudohallucination).
Seen in depression but also in epilepsy, parietal-occipital tumours, schziphrenia and anxiety
What is automatism?
Activities occuring in apparent full consciousness but not in full consciousness - seen in TLE
Who came up with the term Anhedonia?
Ribot
Does FTD in an acute state have prognostic value at predicting relapses?
No
What is a parapraxis?
Faulty act or mid placement of an article - Freud says it revealed unconscious motives
What conditions may kinaesthetic hallucinations be?
Alcohol intoxication
Benzodiazepine withdrawal
Delirium tremens
Is perseveration an
induced movement?
Yes perserveration is when a movement that originally served a purposed is carried out despite no longer carrying its purpose.
Stereotypy is not induced
Is consciousness impaired in fugue states?
No
How does logoclonia and parlalia differ?
Logoclonia - last syllable or sound person says is repeated by then
Parlalia - last word patient says is repeated by them
Name the descriptors of affect?
Valence
Reactivity - blunted/parathymia
Range of expression - restricted or constricted (in anxiety/depression)
Control - if extremely labile may be described to have emotional incontinence (i.e. in pseudobulbar palsy such as frontal lobe damage)
Congruence
Stability - labile etc
Name Emil Kraepelin’s 6 mixed states and outline how mood, will and thought vary in them?
Manic stupor - Mood high, will low, thoughts high
Mania with poverty of thought - mood high, will high, thoughts low
Inhibited mania - mood high, will low, thoughts low
Depressive mania - low mood, will high, thoughts high
Excited depression - mood low, will high, thoughts low
Depression with flight of ideas - mood low, will low, thoughts high
What is a negative hallucination?
Stimulus being present but no object being percieved
How do illusions and perceptual distortions alter?
Illusion the stimulus is present but a different object is perceived to that present
Perceptual distortion - the stimulus is present, the same object is perceived but it is of a different quality i.e. louder (hyperacuisis), smaller (micropsia), larger (macropsia), size/shape changed esp symmetry (dysmegalopsia).
How do reflex and functional hallucinations differ?
Functional hallucination - a stimulus is followed by/linked to a stimulus of the same modality i.e. when hear tap running hear voices
Reflex hallucination - as above but the hallucination is a different modality
Note for synesthesia the stimulus and the object are perceived at the same time however the perception is in a different modality i.e. seeing music as colours or hearing a car. The perception is usually simple and unformed
Outline the 4 types of primary delusions?
Delusional perception
Delusional mood
Delusional memory - past memory that did not happen or true memory elaborated in a false manner
Autochthonous delusion - out of the blue and fully formed
N.b primary delusions occur first and are not dependent on other psychopathological processes. They are un-understandable in nature
Is a doppleganger a delusion?
No it is a familiarity disorder - it is the sense of an individual being outside and inside one self, a cognitive and perceptual disturbance.
Occurs in sleep deprivation.
What is palinopsia?
The act of seeing images that persist after the stimulus has left - occurs with hallucinogen use
Name some tests that assess the linguistics of Schizophrenia?
Type token ratio - reduced in Schz (number of new words : total number of words)
Word association tests - abnormal
Cloze test - words from recorded speech deleted to see if can predict meaning –> reduced in Schz.
Reverse cloze test - Schz patient has to predict missing element of another’s speech - patients perform poorly
Hunt test - make a complex sentance from simple words - perform poorly
Cohesion analysis - less referential ties (pronouns reduced) more lexical ties (connected words)
