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MRCPsych Part A > Descriptive Psychopathology > Flashcards

Descriptive Psychopathology Flashcards

1
Q

Which is the more pervasive emotional state; mood or affect?

A

Mood

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2
Q

What is valence?

A

The quality of affect e.g. happy, depressed

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3
Q

What is emotional incontinence?

A

Extreme form of labile affect.

No control over emotions

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4
Q

In which diseases do you see emotional incontinence?

A

Pseudo-bulbar palsy

Frontal lobe damage

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5
Q

Name the mixed states as per Kraepelin

A 
Manic stupor
Mania with poverty of thought
Inhibited mania
Depressive mania
Excited depression
Depression with flight of ideas
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6
Q

What are the current two terms used to describe mixed states now?

A

Dysphoric mania

Depressive mixed state

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7
Q

What is dysphoric mania?

A

Predominant mania with some depressive symptoms

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8
Q

What is depressive mixed state?

A

Full depression with some manic symptoms

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9
Q

Character of non-organic manic

A

Constant, unremitting, difficult to describe quality.

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10
Q

Where is non-organic pain most common?

A

Head and neck

Back

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11
Q

Which type of pain is most common in somatisation disorder?

A

MSK

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12
Q

Which type of symptom is most common in hypochondriasis?

A

GI

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13
Q

Who coined the term Anhedonia?

A

Ribot

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14
Q

In which disease is anhedonia a core symptom?

A

Melancholic depression with somatic syndrome

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15
Q

What type of anhedonia is more common in schizophrenia?

A

Social/interpersonal

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16
Q

Who first described the term alexithymia?

A

Sifneos

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17
Q

What is alexithymia?

A

Difficulties in using words to express emotions

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18
Q

What is alexithymia often accompanied by?

A

Diminution of fantasy
Reduced symbolic thinking
Literal thinking concerned with details
Difficulties in recognizing ones own feelings
Difficulties in differentiating body sensations and emotional states
Robot-like existence

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19
Q

In which disorders is alexithymia seen?

A 
Psychosomatic
Somatoform disorders
Depression
PTSD
PDs
Paraphilias
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20
Q

How is time tested objectively in studies?

A

Trail making Test

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21
Q

Which types of patients have slowed TMT?

A

Manic and depressed

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22
Q

What is age disorientiation

A

Patients claim they are more or less than 5 years off their actual age

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23
Q

Who is age disorientation most common in

A

Chronic schizophrenia (particularly institutionalized)

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24
Q

What is the most common age disorientation in chronic schizophrenia?

A

Understate their age

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25
Q

Characteristics of age-disorientated patients

A

Older
Longer current admission
Young at first admission
Early onset and poor prognosis

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26
Q

What does perception consist of?

A

Receiving information from a sensory modality (bottom up)

Interpretation of processing of sensation instantaneously using cognitive faculties (top down)

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27
Q

What modalities of perception are there?

A 
Visual
Auditory
Tactile
Gustatory
Olfactory
Kinaesthetic
Proprioceptive
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28
Q

What happens in perceptual distortions?

A

Stimulus and object perceived but objects quality altered

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29
Q

What happens in illusions?

A

Stimulus present but not perceived, rather a different object is perceived

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30
Q

What happens in hallucinations?

A

Perception without stimulus

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31
Q

What happens in negative hallucinations?

A

Stimulus present but no object is perceived

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32
Q

In which states is hyperacusis seen in?

A

Migraine

Alcohol hangover

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33
Q

What is dysmegalopsia?

A

Changes in shape of objects - especially loss of symmetry

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34
Q

What are accommodation errors

A

Ocular - paraylised accommodation can cause micropsia

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35
Q

What is imagery?

A

Images produced voluntarily with complete insight that they are mental and not external

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36
Q

What is eidetic imagery?

A

Visual images are drawn from memory accurately at will and described as if being perceived currently

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37
Q

What % of children have eidetic memory?

A

2-15%

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38
Q

Types of illusions?

A

Affect
Pareidolic
Complete

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39
Q

What leads to an affect illusion?

A

Prevailing emotional state leads to miscperceptions

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40
Q

Quality of affect illusion?

A

Often fearful, emotion provoking

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41
Q

Effect of concentration on affect illusion?

A

Disappears

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42
Q

What is a pareidolic illusion?

A

Formed objects from ambiguous stimuili coloured by prevailing emotion.

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43
Q

Quality of pareidolic illusion

A

Playful/whimsical

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44
Q

Effect of concentration on pareidolic illusion?

A

Object intensifies

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45
Q

What is a complete illusion?

A

Stimulus that does not form a complete object may be perceived as complete

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46
Q

What is complete illusion a result of?

A

Inattention

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47
Q

Effect of concentration on a complete object?

A

Disappears

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48
Q

What is pareidolia?

A

Where fantasy and imagery play equal parts apart from the actual sense perception
Some voluntary control.

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49
Q

Whatis pareidolia common in?

A

Delirium - particularly in children when febrile

Hallucinogen

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50
Q

Types of pseudohallucinations

A

Involuntary

Recognised to be self-originating

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51
Q

What are involuntary pseudohallucinations?

A

These occur in inner subjective space with vivid outline that are different from normal perception

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52
Q

In what way are pseudo-hallucinations similar to hallucinations?

A 
Clear outline
Vivid
Retained for a long time
Cannot be dismissed at will
Behaviourally and emotionally relevant
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53
Q

Important qualities of hallucinations to identify them from other mental phenomena?

A

Occur at same time as other sensory perceptions
Take place in same space as other perceptions
Experienced as sensations
It has all qualities of an object
Involuntary and independent

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54
Q

What are elementary hallucinations?

A

Unstructured

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55
Q

When are elementary hallucinations seen?

A

In acute organic states

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56
Q

What are phonemes?

A

Any auditory hallucinations that occur as human voices

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57
Q

What is the verbal transformation effect?

A

When schizophrenics hear different words that have no phonetic connection to original repeated word

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58
Q

What are auditory hallucinations in alcohol-use like?

A

Initially fragmented voices, later clear voices

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59
Q

Organic causes of visual hallucinations

A 
Occipital lobe tumours
Post-concessional states
Epileptic twilight state
Hepatic failure (toxic delirium)
Dementia
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60
Q

What can cause elementary visual hallucinations?

A

Solvent sniffing

Hallucinogens

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61
Q

What was black patch psychosis after cataract surgery a result of?

A

Anticholinergic eye drops

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62
Q

In whom does Charles Bonnet syndrome occur?

A

Elderly patients with normal consciousness and no brain pathology with reduced visual acuity due to ocular problems

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63
Q

What happens in Charles Bonnet syndrome?

A

Patients experience vivid, well-coloured, formed hallucinations which can be voluntary controlled and move

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64
Q

What are the most common visual hallucinations in Charles Bonnet?

A

Humans
Animals
Cartoons

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65
Q

Insight in Charles Bonnet?

A

Preserved

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66
Q

How can one make visual hallucinations in Charles Bonnet disappear?

A

Closing ones eyes

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67
Q

What percentage of Charles Bonnet hallucinations are elementary visual?

A

33%

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68
Q

What are autoscopic hallucinations?

A

Visual experience of seeing oneself

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69
Q

Gender ratio of autoscopic hallucinations?

A

Males 2:1

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70
Q

What is autooscopic hallucinations common with?

A

Impaired consciousness

Parietal lesions

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71
Q

Most common psychiatric disorder linked to autoscopic hallucinations?

A

Depression

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72
Q

Another name for Autoscopic hallucinatinos?

A

Phantom mirror images

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73
Q

What is palinopsia?

A

Visual disturbance that causes images to persist after stimulus has left

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74
Q

Which drug is palinopsia common with?

A

LSD

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75
Q

Which diseases is palinopsia common with?

A

Migraine
Occipital epilepsy
Head trauma

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76
Q

Difference between after image and palinopsia

A

In palinopsia colour inversion is absent

In afterimage, shadows or distorted colours are often noted

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77
Q

What can somatic hallucinations be divided into?

A

Superficial
Visceral
Kinaesthetic

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78
Q

What can superficial somatic hallucinations be divided into?

A

Tactile - touch
Hygric - wetness
Thermic - heat

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79
Q

Describe visceral hallucinations

A

Pain-like sensations arising from deep viscera like liver

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80
Q

What do visceral hallucinations suggest in terms of disease?

A

Schizophrenia

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81
Q

What is another name for visceral hallucinations?

A

Coenesthetic hallucinations

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82
Q

What are kinaesthetic hallucinations?

A

Refer to joint or muscle sense and often linked to bizarre somatic delusions

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83
Q

Which drug use are kinaesthetic hallucinations seen in?

A

Benzo withdrawl

Alcohol intoxication

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84
Q

What is formication?

A

Type of tactile hallucination - unpleasant sensation of little animals or insects crawling under the skin

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85
Q

When is formication seen?

A

Delirium tremens

Cocaine intoxication

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86
Q

In which organic state are tactile hallucinations seen in?

A

Parietal seizures

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87
Q

What is phantom limb in terms of classification?

A

Body image disturbance with a neurological basis

Not a hallucination

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88
Q

In which disorders do extracampine hallucinations occur in

A

Schizophrenia
Epilepsy
Hypnagogic

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89
Q

Which is more common: hypnagogic or hypnopompic hallucinations?

A

Hypnagogic

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90
Q

What % of adults have hypnagogic or hypnopompic hallucinations?

A

37%

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91
Q

Which type of hallucination is more specific for narcolepsy?

A

Hypnopompic

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92
Q

What does EEG show during hypnagogic or hypnopompic hallucinations?

A

Alpha rhythm

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93
Q

Most common type of hypnagogic hallucination?

A

Hearing ones own name

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94
Q

What is a functional hallucination?

A

An external stimulus provokes hallucination and both are in same modality but individually perceived

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95
Q

What are reflex hallucinations?

A

Hallucinations in one modality provoked reflexively by a stimulus in another modality

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96
Q

Who first reported synaesthesia?

A

Francis Galton in 1880

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97
Q

Gender ratio of synaesthesia?

A

Females 4:1 to 6:1

Runs in families

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98
Q

What is the most common type of synaesthesia?

A

Colour-number

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99
Q

What is thought to be the cause of colour-number synaesthesia?

A

Extensive cross wiring between multimodal association regions, probably due to failed selective pruning

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100
Q

Which drug can induce synaesthesia?

A

Mescaline

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101
Q

In what type of people is delusional ideation more likely to persist?

A 
Never married
Older
Schizophrenia
Delusions of thought broadcasting
Those with higher degree of preoccupation 
Higher behaviour relevance
More than one primary delusion
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102
Q

Who noted the dimensions of delusional experiences?

A

Kendler - 1983

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103
Q

What are the dimensions of delusions?

A 
Conviction
Extension
Disorganization
Bizareness
Pressure
Acting on delusion
Seeking evidence
Lack of insight
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104
Q

What is conviction?

A

The extent to which a patient believes in a delusion

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105
Q

What is extension?

A

The extent to which a delusional belief extends to various spheres of life

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106
Q

What is disorganization in delusion?

A

The degree of internal consistency and systematisation of the belief

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107
Q

How is bizarreness defined?

A

Physical or logical impossibility

Overall implausibility or incomprehensibility with lack of grounding in ordinary experience

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108
Q

What is pressure of delusion?

A

Extent to which the patient is preoccupied and distressed

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109
Q

How are primary delusions defined?

A

Jaspers concept or

As the first psychopathology to occur in the course of symptoms

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110
Q

What is Jaspers concept of primary delusions?

A

They are the true, un-understandable beliefs that arrive fully formed and cannot be reduced further to any other mental experience.

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111
Q

What are the types of primary delusions?

A

Autochthonous
Delusional perception
Delusional mood/atmosphere
Delusional memory

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112
Q

What is an autochthonous delusion?

A

Ideas that occur out of the blue, take form in an stant without identifiable preceding events.

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113
Q

What is a delusional perception?

A

Normally perceived object is given a new meaning, usually self-referential - the conclusion being unwarranted.

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114
Q

Which type of primary delusion is included in Schneider’s first rank symptoms?

A

Delusional perception

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115
Q

What is delusional mood/atmosphere?

A

Sense of perplexity and uncertainty that exists during a prodrome of psychosis, usually ending in an autochthonous delusion which will make sense of the perplexity.

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116
Q

What psychiatric phenomenon directly precedes and is causally related to primary autochthonous delusions?

A

Delusional mood

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117
Q

What is a retrospective delusion?

A

Something that never happened and is irrational and bizarre is reported.
Sometimes a normal memory may be delusionally elaborated.

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118
Q

Advantages and disadvantages of primary delusions

A

Diagnostic relevance

No prognostic significance

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119
Q

Which organic state can cause primary delusions?

A

Epileptic psychosis

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120
Q

Which type of schizophrenia are primary delusions often seen in?

A

Acute

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121
Q

What are secondary delusions?

A

Those that follow a primary delusion or other mental phenomena such as hallucinations or affective disturbances

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122
Q

Which type of delusions are persecutory?

A

Secondary

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123
Q

What is a paranoid delusion?

A

One which is self-referential

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124
Q

What is a monothematic delusion?

A

Ones which occur as single delusions

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125
Q

What is Capgras delusion?

A

Believing someone close to you has been replaced by a double

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126
Q

What is Cotard delusion?

A

Severe depression with nihilistic and hypochrondriacal delusions tinged with grandiosity and a negative attitude.
Believing you are dead

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127
Q

What is Fregoli delusion?

A

People you know being swapped for imposters

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128
Q

What is mirrored-self misidentification?

A

Seeing one self in the mirror and not recognising it as you self - seeing it as a stranger

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129
Q

What is De Clerambault’s delusion?

A

Erotomania

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130
Q

What is Othello syndrome?

A

Pathological jealousy - believing someone close to you is having an affair

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131
Q

Who first used the term Morbid Jealousy?

A

Ey

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132
Q

Who is De Clerambault’s syndrome common in?

A

Women who believe an older man is in love with them

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133
Q

What is Old maid’s insanity?

A

De Clerambault’s syndrome where persecutory beliefs also coexist

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134
Q

What diseases is Cotard’s syndrome seen in?

A 
Schizophrenia
Depressive psychosis
Elderly 
Migraine
Organic lesions
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135
Q

Who described monosymptomatic hypochondriacal psychosis?

A

Munro

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136
Q

What does monosymptomatic hypochondriacal psychosis consist of?

A

Delusions of body odour and halitosis
Delusional infestation
Dysmorphic delusions

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137
Q

What is another name of delusional infestation?

A

Ekbom’s syndrome

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138
Q

What is the matchbox sign described in monosymptomatic hypochrondriacal psychosis?

A

Old lady comes to clinic with a match box of skin scrapings as evidence for the parasite causing her to itch.

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139
Q

Who first reported Capgras syndrome?

A

Kahlbaum in 1866

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140
Q

What is main cause of Capgras delusion?

A

> 50% due to organic brain damage

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141
Q

What is thought to underlie Capgras delusion?

A

Cognitively mediated by reduced affective responsivity to familiar faces and impaired belief evaluation
Disconnection of face recognition system of brain from autonomic nervous system plus damage to specific region of right frontal lobe

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142
Q

When was Fregoli syndrome first described?

A

Courbon and Fail in 1927

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143
Q

Essential feature of Fregoli?

A

No belief in actual physical change; instead patient believes that their percecutors can invade the body of others.
More rare than Capgras

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144
Q

What is syndrome of subjective doubles?

A

Patient believes another person has been physically transformed into their own self and is the exact double of themselves

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145
Q

What is intermetamorphosis?

A

Where people keep transforming their physical and psychological identities.

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146
Q

What is paraprosopia?

A

When a face appears to transform within seconds into a grotesque mask

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147
Q

Who described the term overvalued idea?

A

Wernicke

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148
Q

What is an overvalued idea?

A

Solitary abnormal beliefs that are neither delusional nor obsessional in nature but which dominates a persons life and actions.
Poor prognosis.

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149
Q

What diseases are overvalued ideas linked to?

A 
Paranoid or anankastic PD
Body Dysmorphphobia
Anorexia
Morbid jealousy
Transsexualism
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150
Q

What is folie a deux?

A

Shared delusion between a psychotic person and someone close to them

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151
Q

What is doppelganger?

A

Awareness of onesef being both inside and outself oneself.

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152
Q

What type of disturbance is doppelganger?

A

Cognitive and ideational disturbance

Not always due to mental illness

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153
Q

What are the proposed causes of delusions?

A

Attentional bias
Attributional bias
Probabilistic reasoning bias
Menalising bias

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154
Q

Describe attentional bias

A

People with persecutory delusions preferentially attend to threat-related stimuli and preferentially recall threatening episodes

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155
Q

What is attributional bias

A

Patients excessively attribute hypothetical positive events to internal causes and negative events to external causes.

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156
Q

How does attributional bias affect paranoid patients?

A

They specifically attribute negative self-referent events active malevolence on part of another person (external) rather than circumstances or change
This might serve to preserve their self-esteem

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157
Q

How does attributional bias affect a patients delusions?

A

It can shape the content but not the form

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158
Q

Describe probabilistic reasoning bias

A

Reduced accuracy of judgement

Overconfident about their judgement

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159
Q

What is the mentalising deficit/bias?

A

Persecutory delusions reflect false beliefs about the intentions and behaviours of others that could arise from the theory of mind deficits

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160
Q

Importance for first rank symptoms in current classifications

A

One first rank symptom is symptomatically sufficient for a diagnosis of schizophrenia but they are not essential

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161
Q

Are first rank symptoms specific to schizophrenia?

A

No

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162
Q

Advantages for first rank symptoms

A

Clearly identifiable
Frequently occurring
Occur more often in schizophrenia than any other disorder

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163
Q

What is the underlying feature of all first rank symptoms?

A

Disturbance of self-image

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164
Q

Prevalence of FRS in patients with affective disorders?

A

22-29%

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165
Q

Prevalence of FRS in schizophrenia?

A

25-88%

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166
Q

Most frequent FRS?

A

Delusional perception

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167
Q

What are the FRS?

A

3 hallucinations
3 made phenomena
3 thought phenomena
2 isolated symptoms

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168
Q

What are the hallucinations in FRS>

A

Audible thoughts - thought echo
Voices arguing - 3rd person
Running commentary

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169
Q

What are the three ‘made’ phenomena in FRS?

A

Made affect - someone controlling mood
Made volition - someone controlling action
Made impulse - someone controlling the desire to act

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170
Q

What are the three thought phenomena in FRS?

A

Thought withdrawl
Thought insertion
Thought broadcast

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171
Q

What are the isolated symptoms in FRS?

A

Delusional perception

Somatic passivity

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172
Q

Are command hallucinations FRS?

A

No

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173
Q

Are somatic hallucinations FRS?

A

No

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174
Q

What did Schneider describe as second rank symptoms?

A

Mood changes
Emotional blunting
Perplexity
Sudden delusional ideas

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175
Q

What is a preserved thought?

A

One that we know is our own and private

176
Q

Describe the aspects of conversational speech

A

Spontaneity
Turn-taking
Mutual topic
Animation

177
Q

What is turn-taking?

A

Responses and comments are made only when the other speaker completes his sentences or when natural pauses occur

178
Q

What is aphonia?

A

Inability to vocalize

179
Q

What is phonation?

A

Sound production

180
Q

What is articulation?

A

Sound manipulation

181
Q

What is disturbance of articulation known as?

A

Dysarthria

182
Q

What is the disturbance in aphonia?

A

Phonation - sound production

183
Q

Organic cause of aphonia?

A

Paralyzed vocal cords

184
Q

Psychiatric cause of aphonia?

185
Q

Organic cause of dysarthria?

A

Lesions in brain stem (bulbar)
Lesions in brain (pseudo bulbar)
Lesions in cerebellum or extrapyramidal system

186
Q

Psychiatric cause of dysarthria?

A

Drug induced in schizophrenia

187
Q

Which gender has a greater prevalence of stammer?

188
Q

What is new onset stuttering in adults due to?

A

Stroke

Extrapyramidal symptoms

189
Q

What is bradyphasia?

A

Decelerated talking

190
Q

What is tachyphasia?

A

Accelerated talking

191
Q

What is logorrhoea?

A

Increased quantity of speech

192
Q

What is alogia?

A

Poverty of speech and decrease in spontaneous speech

193
Q

What is poverty of content of speech?

A

Amount of speech is adequate but conveys little information

194
Q

What is complete lack of speech called?

195
Q

What is the most common hysterical disorder of speech?

196
Q

What is akinteic mutism?

A

Patient is mute but remains aware of the environment though cannot move or respond

197
Q

Causes of akinetic mutism?

A

Lesions of upper midbrain or posterior diencephalons

CJD

198
Q

What is repetition of phrases or sentences known as?

A

Verbigeration

199
Q

What is it called when there is repetition of the last syllable of a word?

A

Logoclonia

200
Q

In which disorder can one see logoclonia?

A

Parkinsons

201
Q

What is Palilalia?

A

Repetition of last uttered word without any apparent purpose

202
Q

Where is palilalia seen in?

A

LD
Pervasive developmental disorders
Tourette’s

203
Q

Where does sound transmitted by ears go to?

A

Wernicke’s area

Auditory association cortex

204
Q

What happens to sound once it reaches Wernicke’s area?

A

The language component is processed

205
Q

What is Broca’s area for?

A

Higher motor area of language production

206
Q

Which area of the brain is for language production?

A

Broca’s area

207
Q

Where do signals from Broca’s area go to?

A

Motor area to coordinate delivery of language via the tongue, lips and vocal cords

208
Q

Where do signals go from Wernicke’s area?

A

Auditory association cortex

Broca’s area

209
Q

Where does Broca’s area receive signals from?

A

Language Association cortex

Wernicke’s area

210
Q

What happens when sound cannot travel from the ears to Wernicke’s area?

A

Sensory aphasia

211
Q

What happens when signals cannot travel from Wernicke’s area to the auditory association cortex?

A

Transcortical sensory aphasia

212
Q

What happens If signals cannot travel from the language association cortex to Broca’s area?

A

Transcortical motor aphasia

213
Q

What is required for language fluency?

A

Depends on intact Broca’s area and forward connections

214
Q

What is required for language comprehension?

A

Depends on intact Wernicke’s area and its connection with association cortex and sensory input

215
Q

What is required for language repetition to occur?

A

Signals to go from Wernicke’s area to Broca’s area via the arcuate fasciculus
No higher level processing required

216
Q

Define fluency

A

Production of meaningful words and sentences

217
Q

What is a naming defect called?

218
Q

What type of disorder results in a higher level language problem ?

219
Q

What is meant by a higher level language problem?

A

Problem of language reception, production and processing

220
Q

What is lost Wernicke’s sensory aphasia?

A

Repetition
Comprehension - reading and writing
Naming

221
Q

What is intact in Wernicke’s sensory aphasia?

222
Q

What is retained in Broca’s motor aphasia?

A

Comprehension

223
Q

What is lost in Broca’s motor aphasia?

A

Fluency
Repetition
Naming

224
Q

What is intact in Conduction aphasia?

A

Fluency

Comprehension

225
Q

What is lost in Conduction aphasia?

A

Repetition

Naming

226
Q

What is intact in Transcortical sensory aphasia?

A

Fluency

Repetition

227
Q

What is lost in Transcortical sensory aphasia?

A

Comprehension

Naming

228
Q

What is intact in Transmotor cortical aphasia?

A

Repetition

Comprehension

229
Q

What is lost in Transmotor cortical aphasia?

A

Fluency

Naming

230
Q

What does speech sound like in Broca’s aphasia?

A

Nonfluent
Laboured with interruptions and pauses
Abnormal word order
Telegraphic speech

231
Q

Which words are most affected in Broca’s aphasia?

A

Function words

232
Q

How does speech sound in Wernicke’s aphasia?

A

Fluent but paraphasic, string of neologisms and circumlocutions.
Jargon aphasia.
Large number of function words, few nouns and verbs

233
Q

What is alexia?

A

Pure word blindness

234
Q

Describe what patient can do in alexia

A

Patient can speak and comprehend what is spoken

Can write spontaneously and to dictation

235
Q

Describe what patient cannot do in alexia

A

Reading comprehension is impaired

236
Q

What is pure agraphia?

A

Inability to write

237
Q

What is agraphia seen with?

A

Gerstmann’s syndrome

238
Q

What is alexia with agraphia?

A

Acquired illiteracy

239
Q

What is pure word deafness?

A

Comprehension impaired for spoken language only

240
Q

Cause of pure word deafness?

A

Bilateral damage to superior temporal pole or

Damage to left side of superior temporal pole with disrupted connections to non-dominant circuit

241
Q

What is pure word dumbness?

A

Spoken language cannot be produced clearly

Patient can comprehend language well, read and write

242
Q

What is the name for pure word blindness?

243
Q

What is the name of acquired illiteracy?

A

Alex with agraphia

244
Q

What is the name of the isolated uinability to write?

A

Pure agraphia

245
Q

What are the three normal types of thinking?

A

Fantasy/dereistic thinking or autistic thinking
Imaginative thinking
Rational/conceptual thinking

246
Q

What is fantasy thinking?

A

No goal direction, unrealistic

247
Q

In which disorders is autistic thinking prevalent?

A

Cluster A personality
Dissociation
Pseudologia fantastica

248
Q

what is imaginative thinking?

A

Fantasy elements mixed with memory, involving abstract concepts but goal-directed.
Does not cross boundaries into unreal

249
Q

What is rational thinking based on?

A

Factual reality

Logic

250
Q

What types of thought disorders are there?

A

Disorder of thought content
Thought form
Thought stream
Thought control

251
Q

Give an e.g. of a disorder of thought content

252
Q

Give an e.g. of a disorder of thought form

A

Tangentiality

Loosened associations

253
Q

Give an e.g of disorder of thought stream

A

Pressure of speech
Poverty of thought
Crowding of thoughts

254
Q

Give an e.g. of disorder of thought control

A

Obsessions
Passivity
First rank thought disturbance

255
Q

What does formal thought disorder refer to?

A

Disturbance in form - not of content

256
Q

What is paralogia?

A

Positive Formal thought disorder - symptoms of thought disorder identified due to presence of abnormal element in thought processes

257
Q

What is alogia?

A

Negative formal thought disorder - symptoms considered due to absence of normal element of thought/speech

258
Q

What is akataphasia?

A

Term used by Kraepelin to convey the essence that speech disorders are a result of thought disorder

259
Q

What is often considered to indicate the presence of formal thought disorder?

A

Loosening of associations

260
Q

Who coined the term ‘loosening of associations’?

261
Q

Who proposed the four classifications of formal thought disorder?

262
Q

What are the four classifications of formal thought disorder?

A

Metonymy
Asyndesis
Overinclusion
Interpenetration

263
Q

What is metonymy?

A

Imprecise approximate expressions used as substitute words.

264
Q

What is asyndesis?

A

Lack of genuine causal links in speech.

265
Q

What is overinclusion?

A

Ideas that are only remotely related to concept are incorporated in patients thinking. Conceptual boundaries lost.

266
Q

What can be used to test overinclusion?

A

Sorting tests

267
Q

How many patients with schizophrenia have overinclusion when acutely unwell?

268
Q

What is interpenetration?

A

Irrelevant thoughts penetrate ongoing stream of thoughts

269
Q

Who proposed first rank symptoms?

A

Karl Schneider

270
Q

What did Carl Schneider propose?

A

5 elements of formal thought disorder

271
Q

what are the five elements of formal thought disorder?

A 
Substitution
Omission
Fusion
Drivelling
Derailment
272
Q

What is another name for derailment?

A

Entgleisen

273
Q

What is substitution?

A

One thought, often inappropriate, fills the gap between other consistent thoughts

274
Q

What is omission?

A

Chunk of thought goes missing from stream of conversation and patient is unaware

275
Q

How can omission of thought best be analysed?

A

When written

276
Q

What is drivelling?

A

Disordered intermixture of constituent parts of one complex thought

277
Q

What is fusion of thought?

A

Various thoughts fuse together leading to loss of goal direction

278
Q

What is entgleisen?

A

Normally flowing track of thoughts suddenly change.

279
Q

What is desultory thinking?

A

Speech is grammatically correct but sudden ideas force their way in occasionally.

280
Q

Who used the term desultory thinking?

A

Desultory thinking

281
Q

What did Kleist propose re speech in schizophrenia?

A

Semantic disturbance of language more common than grammatical or syntactical errors

282
Q

What is verbal paraphasia?

A

Meaningful sentences produced in spite of loss of appropriate words

283
Q

What is literal paraphasia?

A

No one can make out meaning of sentence except patient

284
Q

What is agrammatism?

A

Loss of parts of speech

285
Q

What is paragrammatism?

A

INdividual phrases are well constructed and meaningful but do not fit in with goal of thought.

286
Q

What are stock words?

A

Word used in an idiosyncratic way with different meanings in different contexts.

287
Q

What is stilted speech?

A

Pompous, formal speech in inappropriate content

288
Q

What may underlie stilted speech in schizophrenia?

A

Impaired lexical retrieval

289
Q

What happens in flight of ideas?

A

Thoughts occur so rapidly there is no direction for thinking.
Chance associations take place to connect succeeding thoughts - may be from environment or elements of ones own or anothers speech.

290
Q

Describe three types of verbal associations

A

Clang
Punning
Rhyming

291
Q

What is clang association?

A

Thoughts are associated by initial syllabic structure of words rather than meaning

292
Q

What is punning?

A

Words get associated as one word with dual meaning

293
Q

In schizophrenia when does clang speech often happen?

A

With first syllables

294
Q

When does clang association often occur in mania?

A

At the end syllables

295
Q

What is Vorbeireden?

A

Talking past the point leading to approximate but not accurate answers

296
Q

What is vorbeigehen?

A

Going past the point - part of Ganser syndrome

297
Q

What is Gansser syndrome?

A

Where criminals would give incorrect answers to simple questions despite it being suggested that the correct answer was known

298
Q

What happens in circumstantiality?

A

Thinking is slow with many unnecessary details and digressions before returning to the point.

299
Q

Organic cause of circumstantial speech

A

Temporal lobe epilepsy

Alcohol-induced dementia

300
Q

Psych causes of circumstantial speech

A

LD
Obsessional personality
Delusinal mood in schizophrenia

301
Q

Difference between circumstantiality and tangentiality?

A

In tangentiality, the point is never reach

302
Q

Who studied concrete thinking?

303
Q

In which patients is concrete thinking seen in?

A

Schizophrenia patients with formal thought disorder only

304
Q

Organic cause of concrete thinking?

A

Fronto-temporal dementia

305
Q

What tests can one do to test linguistics in schizophrenia?

A

Word association tests
Cloze procedure
Type-token ratio
Cohesion analysis

306
Q

What happens to schizophrenics in word association tests?

A

Patients prefer dominant meaning of a word in spite of context

307
Q

What is cloze procedure?

A

Parts of recorded speech are deleted to see if meaning can be predicted; in schizophrenia predictability is reduced.

308
Q

What is reverse cloze procedure?

A

Patients are asked to predict missing elements of someone else’s speech - schizophrenics do poorly

309
Q

What is type-token ratio?

A

Ratio between number of different words used during discourse and total number of spoken words.

310
Q

What is noted in schizophrenia in type-token ratio?

A

Impoverished vocabulary

311
Q

What is cohesion analysis?

A

Analysing links between sentences and words in discourse

312
Q

What does cohesion analysis show in schizophrenics?

A

Less referential ties - using pronouns w/o mentioning a subject in first place
More lexical ties - connecting words

313
Q

What is the Hunt test?

A

Asking a patient to construct complex sentences from simple phrases - schizophrenics struggle

314
Q

Scales used to measure formal thought disorder?

A

Thought language and communication scale

Thought and language index

315
Q

What does thought and language index use?

A

Projective stimuli from Thematic Apperception test to elicit thought disturbances

316
Q

Who created the thought language and communication scale?

317
Q

Who crated the thought and language index?

318
Q

According to Andreasen, which thought disorders were more common in schizophrenia?

A

Thought blocking
Tangentiality
Poverty of cntent of speech

319
Q

What did Von Domarus suggest caused FTD?

A

Result of loss of deductive reasoning.

320
Q

How can one measure schizophrenic FTD with Kelly’s personal construct theory?

A

Using repertory grids (Bannister)

321
Q

What happens in repertory grids?

A

Patient asked to score different elements under different constructs (qualities).
Usually there is congruent. In schizophrenia predictability base don prior constructs is poor.

322
Q

What is serial invalidation?

A

Where there is poor predictability in repertory grids based on prior constructs

323
Q

What did Mortimer believe FTD was due to?

A

Impaired semantic memory - associations between words and qualities are lost

324
Q

What is a semantic halo?

A

Words are linked through symbolic meaning e.g London and tube

325
Q

What is direct semantic priming?

A

When a word is stimulated, those words which are semantically close are also available for the thought process to proceed uninterrupted

326
Q

What is indirect semantic priming?

A

When a word is stimulated, another word with a semantic meaning close to that is stimulated, leading to another etc.

327
Q

What is the theory behind schizophrenia FTD in terms of semantic priming?

A

Direct priming is impaired

Indirect is more activated

328
Q

What is one of the main theories of FTD?

A

Dysexecutive problems

329
Q

Which lobe plays a role in formation of language?

A

Frontal lobe

330
Q

What can loss of executive functions result in, in terms of thoughts and speech?

A

Poor planning, error monitoring and correction of speech production

331
Q

Which type of stream of thought disorder occurs in clouded consciousness?

A

Perservation

332
Q

Name the types of streams of thought

A

Pressure of speech
Crowding of thought
Retardation of thinking
Perservation

333
Q

What is another term of obsessional thoughts?

334
Q

Link between obsession and compulsion

A

Initially an obsession leads to compulsion.

Over time primary obsessions fade while compulsions dictate clinical picture

335
Q

When does obsessional slowness occur?

A

When obsessional thoughts occur as part of a depressive illness or in severe OCD
or obsession with symmetry or precision

336
Q

What are the most common obsessions?

A

Fear of contamination
Pathological doubt
Need for symmetry
Aggressive obsessions

337
Q

What are the most common compulsions?

A 
Checking
Washing
Symmetry
Need to ask or confess
Counting
338
Q

What do children with OCD most commonly present with?

A

Washing compulsions

Repeating rituals

339
Q

What did Fish classify motor symptoms into?

A

Abnormal spontaneous movements

Abnormal induced movements

340
Q

Name some abnormal spontaneous movements

A 
Tremors
Tics
Chorea
Athetosis
Stereotypy
341
Q

Name some abnormal induced movements

A

Perseveration
Automatic obedience
Echo phenomenon
Other catatonic signs

342
Q

Define catatonia

A

Rigidity during involuntary movements while volitional movement is carried out normally

343
Q

Define neurological spasticity

A

Where tone is increased irrespective of passive or active movements

344
Q

Does catatonia persist in sleep?

345
Q

When is catatonia most commonly seen?

A

Advanced primary mood or psychotic illness

346
Q

What is ambitendence?

A

Patient makes a series of tentative, opposing alternative movements but does not reach the intended goal.

347
Q

What is automatic obedience?

A

Exaggerated cooperation with request or spontaneous continuation of movement requested

348
Q

How can you demonstrate automatic obedience?

A

Ask the patient not to cooperate, but they still carry out the instructions

349
Q

What is mitmachen?

A

Mild form of automatic obedience - despite requests to resist manipulation, patient yields themselves to be placed in abnormal posture

350
Q

What is Mitgehen also known as?

A

Anglepoise lamp sign

351
Q

Describe Mitgehen

A

Patients yields to slightest pressure without resistance

352
Q

Another name for waxy flexibility

A

Catalepsy

Flexibilitas cerea

353
Q

What is waxy flexibility?

A

Patient can be moved to occupy certain postures which are maintained

354
Q

Does limb go back to resting position after pressure in waxy flexibility?

355
Q

Does limb go back to resting position in mitgehen and mitmachen?

356
Q

In which disorders are echo-phenomenon seen?

A

Catatonia
Latah
Tourette’s

357
Q

What is the term when a patient mimicks an examiners movements?

A

Echopraxia

358
Q

What is the term when a patient mimicks the examiners speech?

359
Q

What is Gegenhalten also known as?

A

Paratonia

Opposition

360
Q

What happens in Gegenhalten?

A

Resistance to passive movements with proportional strength o increase of muscle tone

361
Q

What is negativism?

A

Resist all passive movements to all interference

362
Q

What is schnauzkrampf?

A

When a patient cups his lips as if they are spastic

363
Q

What is stupor?

A

Immobility

364
Q

Describe catatonic excitement

A

Extreme apparently non-purposeful hyperactivity which presents as constant motor unrest

365
Q

What are mannerisms?

A

Odd but purposeful movements

366
Q

What is parakinesia?

A

Contracting entire facial muscles

367
Q

What is often the meaning of mannerisms in schizophrenia?

A

Often delusional meaning

368
Q

What is stereotypy?

A

Odd movements with no goal

369
Q

What is posturing?

A

Maintenance of odd postures despite efforts to be moved

370
Q

Which disorders are stereotypes seen in?

A

Catatonia
Pervasive developmental disorder
Severe LD

371
Q

What is astasia-abasia?

A

Inability to walk, sit or stand upright with no organic cause
(motor conversion disorder)

372
Q

What is blepharospasm seen in?

A

Tardive dyskinesia

373
Q

What happens in blepharospasm?

A

Begins with excessive nlinking.With time, spasms become intense, functionally blinding patient as eyelids remain closed for longer periods of time

374
Q

Trigger of blepharospasm

A

Specific stressors - bright lights, sfatigue etc

375
Q

When do blepharospasms disappear?

A

With sleep

376
Q

What happens when one tries to concentrate on a specific task with blepharospasm?

A

Decreases frequency of spasms

377
Q

Difference between perseveration and Verbigeration

A

In Verbigeration, verbal repetition occurs spontaneously, not in response to a question
In perseveration, the response is goal-directed

378
Q

Define tics

A

Sudden, involuntary but temporarily suppressible jerking movements

379
Q

What do tics worsen with?

A

Low mood

fatigue

380
Q

Are tics seen in sleep?

381
Q

What is coprolalia?

A

Obscenities

382
Q

Describe tics in Tourettes

A

Preceded by palpable urge or prodromal sensation before motor act

383
Q

Link between deja vu and age

A

Decreased with age

384
Q

When does deja vu tend to occur?

A

Under stress and fatigue

385
Q

Who is deja vu more common in?

A

Schizophrenia

Temporal lobe epilepsy

386
Q

What is the name of the pathological familiarity of a thought or idea?

A

Deja pensee

387
Q

What is the name of the pathological familiarity for someones voice?

A

Deja entendu

388
Q

What happens in pseudologia fantastica?

A

Fluent, plausible lying with statements made extreme and of grandiose nature

389
Q

What is pseudologia fantastica associated with?

A

Dissocial and histrionic personality disorders

390
Q

What classification is Gansers syndrome under?

A

Hysterical dissociative disorder

391
Q

Symptoms of Gansers syndrome?

A 
Approximate answers
Clouding of consciousness with disorientation
Psychogenic, physical symptoms
Pseudohallucinations
Amnesia for abnormal behaviour
392
Q

What is Couvade syndrome?

A

Sympathetic pregnancy that affects husbands (or other family members) during pregnancy

393
Q

When does Couvade syndrome most frequently occur?

A

3-9 months of pregnancy

394
Q

What is pseudovyesis?

A

Woman experiences clinical signs of pregnancy w/o being pregnant and patient is convinced of pregnancy

395
Q

What is the name of the disorder where the patient believes they are pregnant?

396
Q

What is the culture-bound state where a patient believes his penis is shrinking and he will die?

397
Q

What cultures is Koro seen in?`

A

Malaysia

Singapore

398
Q

What type of disorder is Koro?

A

Desomatization

399
Q

What type of amnesia is common in multiple personality disorders?

A

One-way amnesia

400
Q

What is Lycanthropy?

A

Patient loses awareness and identity and believes they have been transformed into an animal, usually a wolf

401
Q

Define depersonalisation

A

Change in self-awareness and individual feels as if they are unreal

402
Q

Psych causes of depersonalisation

A 
Temporal lobe epilepsy
Hysterical dissociation
Depression
Anxiety
Anankastic PD
403
Q

Drug causes of depersonalization

A 
TCAs
Hallucinogens
Cannabis
Fatigue
Meditation
ECT
404
Q

How long does depersonalisation last for?

405
Q

What is PAD?

A

Phobic anxiety depersonalisation syndrome - typically married female in thirties with agoraphobia and anxiety has depersonalisation that worsens with ECT

406
Q

What is desomatisatino?

A

Depersonalisation localised to a body part

407
Q

What is Deaffectualisation?

A

Capacity to feel any emotion is lost

408
Q

What does insight consist of?

A

Awareness of ones own systems
Attribution to mental disorder
Appraisal of consequences of symptoms
Acceptance of treatment

409
Q

What is anautognosia?

A

Absence of awareness of ones symptoms

410
Q

What is dysautognosia?

A

Lack of awareness of ones symptoms being attributable to a mental disorder

411
Q

What is insight in acute psychosis associated with?

A

More self-harm and suicide rates

412
Q

Which part of the brain may play a role in insight?

A

Fronto-parietal circuit

413
Q

Name the levels of insight

A

Complete denial
Slight awareness of being sick but denying at same time
Awareness but blaming on others/external factors
Awareness that illness is caused by something unknown to patient
Intellectual insight
True emotional insight

414
Q

What is intellectual insight?

A

Admission that patient is ill and symptoms are caused by patients own particular irrational feelings or disturbances without applying this knowledge to future experiences

415
Q

What is true emotional insight?

A

Emotional awareness of the motives and feelings of the patient and the important persons in their life, which can lead to basic changes in behaviour

416
Q

Most common aura in TLE?

A

Autonomic sensations

417
Q

Give e.g. of some autonomic sensations

A

Epigastric aura
Salivatino
Vertigo

418
Q

Give some symptoms of TLE

A 
Aura
Forced thinking
Evocation of thought
Sudden obstruction of thought
Panoramic memory
Psychic seizures
Uncinate crisis
Strong affective experiences
419
Q

What is forced thinking?

A

Patient has a compulsion to think on a certain topic

420
Q

What is evocation of thought?

A

Intrusion of stereotyped words or thoughts

421
Q

What is panoramic memory?

A

Patient recalls expansive memories in incredible detail

422
Q

What are psychic seizures?

A

Isolated auras with hallucinations, depersonalization, micropsia/macropsia, deja/jamais vu

423
Q

When is TLE more likely to lead to deja/jamais vu?

A

If right-sided

424
Q

What is an uncinate crisis?

A

Hallucinations of taste and smell associated with dream-like reminiscence and altered consciousness

425
Q

What is Dostoevsky’s epilepsy?

A

Ecstatic content in epileptic aura

426
Q

Which type of seizure most commonly has auras?

427
Q

In which type of seizure is pain a symptom?

A

Parietal - 25%

428
Q

Signs in parietal lobe epilepsy

A

Somatosensory seizures
Pain
Somatic illusions
Visual illusions

429
Q

Describe somatosensory seizures

A

Patients describe physical sensations of numbness, tingling, heat, sometimes in a predictable ‘Jacksonian march;’ pattern

430
Q

Describe somatic illusions

A

Patients feel their posture is distorted, arms/legs are in a weird position or are in motion when not is part of their body does not belong

431
Q

Duration of frontal lobe seizures

432
Q

When do frontal lobe seizures tend to occur?

A

During sleep

433
Q

What do frontal lobe seizures include?

A

Strange automatisms - bicycling movements, screaming

434
Q

What is the name of a seizure that only involves laughing?

435
Q

What is the name of a seizure that only involves crying?

436
Q

Which lobe is affected in Gelastic/dacrystic seizures?

A

Frontal

or Temporal

437
Q

What is epileptic automatism?

A

State of clouding consciousness which occurs during or immediately after a seizure.
Individual retains control of posture and muscle tone but performs movements w/o being aware.

MRCPsych Part A (22 decks)

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