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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
Characteristics of age-disorientated patients
Older Longer current admission Young at first admission Early onset and poor prognosis
26
What does perception consist of?
Receiving information from a sensory modality (bottom up) | Interpretation of processing of sensation instantaneously using cognitive faculties (top down)
27
What modalities of perception are there?
``` Visual Auditory Tactile Gustatory Olfactory Kinaesthetic Proprioceptive ```
28
What happens in perceptual distortions?
Stimulus and object perceived but objects quality altered
29
What happens in illusions?
Stimulus present but not perceived, rather a different object is perceived
30
What happens in hallucinations?
Perception without stimulus
31
What happens in negative hallucinations?
Stimulus present but no object is perceived
32
In which states is hyperacusis seen in?
Migraine | Alcohol hangover
33
What is dysmegalopsia?
Changes in shape of objects - especially loss of symmetry
34
What are accommodation errors
Ocular - paraylised accommodation can cause micropsia
35
What is imagery?
Images produced voluntarily with complete insight that they are mental and not external
36
What is eidetic imagery?
Visual images are drawn from memory accurately at will and described as if being perceived currently
37
What % of children have eidetic memory?
2-15%
38
Types of illusions?
Affect Pareidolic Complete
39
What leads to an affect illusion?
Prevailing emotional state leads to miscperceptions
40
Quality of affect illusion?
Often fearful, emotion provoking
41
Effect of concentration on affect illusion?
Disappears
42
What is a pareidolic illusion?
Formed objects from ambiguous stimuili coloured by prevailing emotion.
43
Quality of pareidolic illusion
Playful/whimsical
44
Effect of concentration on pareidolic illusion?
Object intensifies
45
What is a complete illusion?
Stimulus that does not form a complete object may be perceived as complete
46
What is complete illusion a result of?
Inattention
47
Effect of concentration on a complete object?
Disappears
48
What is pareidolia?
Where fantasy and imagery play equal parts apart from the actual sense perception Some voluntary control.
49
Whatis pareidolia common in?
Delirium - particularly in children when febrile | Hallucinogen
50
Types of pseudohallucinations
Involuntary | Recognised to be self-originating
51
What are involuntary pseudohallucinations?
These occur in inner subjective space with vivid outline that are different from normal perception
52
In what way are pseudo-hallucinations similar to hallucinations?
``` Clear outline Vivid Retained for a long time Cannot be dismissed at will Behaviourally and emotionally relevant ```
53
Important qualities of hallucinations to identify them from other mental phenomena?
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
54
What are elementary hallucinations?
Unstructured
55
When are elementary hallucinations seen?
In acute organic states
56
What are phonemes?
Any auditory hallucinations that occur as human voices
57
What is the verbal transformation effect?
When schizophrenics hear different words that have no phonetic connection to original repeated word
58
What are auditory hallucinations in alcohol-use like?
Initially fragmented voices, later clear voices
59
Organic causes of visual hallucinations
``` Occipital lobe tumours Post-concessional states Epileptic twilight state Hepatic failure (toxic delirium) Dementia ```
60
What can cause elementary visual hallucinations?
Solvent sniffing | Hallucinogens
61
What was black patch psychosis after cataract surgery a result of?
Anticholinergic eye drops
62
In whom does Charles Bonnet syndrome occur?
Elderly patients with normal consciousness and no brain pathology with reduced visual acuity due to ocular problems
63
What happens in Charles Bonnet syndrome?
Patients experience vivid, well-coloured, formed hallucinations which can be voluntary controlled and move
64
What are the most common visual hallucinations in Charles Bonnet?
Humans Animals Cartoons
65
Insight in Charles Bonnet?
Preserved
66
How can one make visual hallucinations in Charles Bonnet disappear?
Closing ones eyes
67
What percentage of Charles Bonnet hallucinations are elementary visual?
33%
68
What are autoscopic hallucinations?
Visual experience of seeing oneself
69
Gender ratio of autoscopic hallucinations?
Males 2:1
70
What is autooscopic hallucinations common with?
Impaired consciousness | Parietal lesions
71
Most common psychiatric disorder linked to autoscopic hallucinations?
Depression
72
Another name for Autoscopic hallucinatinos?
Phantom mirror images
73
What is palinopsia?
Visual disturbance that causes images to persist after stimulus has left
74
Which drug is palinopsia common with?
LSD
75
Which diseases is palinopsia common with?
Migraine Occipital epilepsy Head trauma
76
Difference between after image and palinopsia
In palinopsia colour inversion is absent | In afterimage, shadows or distorted colours are often noted
77
What can somatic hallucinations be divided into?
Superficial Visceral Kinaesthetic
78
What can superficial somatic hallucinations be divided into?
Tactile - touch Hygric - wetness Thermic - heat
79
Describe visceral hallucinations
Pain-like sensations arising from deep viscera like liver
80
What do visceral hallucinations suggest in terms of disease?
Schizophrenia
81
What is another name for visceral hallucinations?
Coenesthetic hallucinations
82
What are kinaesthetic hallucinations?
Refer to joint or muscle sense and often linked to bizarre somatic delusions
83
Which drug use are kinaesthetic hallucinations seen in?
Benzo withdrawl | Alcohol intoxication
84
What is formication?
Type of tactile hallucination - unpleasant sensation of little animals or insects crawling under the skin
85
When is formication seen?
Delirium tremens | Cocaine intoxication
86
In which organic state are tactile hallucinations seen in?
Parietal seizures
87
What is phantom limb in terms of classification?
Body image disturbance with a neurological basis | Not a hallucination
88
In which disorders do extracampine hallucinations occur in
Schizophrenia Epilepsy Hypnagogic
89
Which is more common: hypnagogic or hypnopompic hallucinations?
Hypnagogic
90
What % of adults have hypnagogic or hypnopompic hallucinations?
37%
91
Which type of hallucination is more specific for narcolepsy?
Hypnopompic
92
What does EEG show during hypnagogic or hypnopompic hallucinations?
Alpha rhythm
93
Most common type of hypnagogic hallucination?
Hearing ones own name
94
What is a functional hallucination?
An external stimulus provokes hallucination and both are in same modality but individually perceived
95
What are reflex hallucinations?
Hallucinations in one modality provoked reflexively by a stimulus in another modality
96
Who first reported synaesthesia?
Francis Galton in 1880
97
Gender ratio of synaesthesia?
Females 4:1 to 6:1 | Runs in families
98
What is the most common type of synaesthesia?
Colour-number
99
What is thought to be the cause of colour-number synaesthesia?
Extensive cross wiring between multimodal association regions, probably due to failed selective pruning
100
Which drug can induce synaesthesia?
Mescaline
101
In what type of people is delusional ideation more likely to persist?
``` Never married Older Schizophrenia Delusions of thought broadcasting Those with higher degree of preoccupation Higher behaviour relevance More than one primary delusion ```
102
Who noted the dimensions of delusional experiences?
Kendler - 1983
103
What are the dimensions of delusions?
``` Conviction Extension Disorganization Bizareness Pressure Acting on delusion Seeking evidence Lack of insight ```
104
What is conviction?
The extent to which a patient believes in a delusion
105
What is extension?
The extent to which a delusional belief extends to various spheres of life
106
What is disorganization in delusion?
The degree of internal consistency and systematisation of the belief
107
How is bizarreness defined?
Physical or logical impossibility | Overall implausibility or incomprehensibility with lack of grounding in ordinary experience
108
What is pressure of delusion?
Extent to which the patient is preoccupied and distressed
109
How are primary delusions defined?
Jaspers concept or | As the first psychopathology to occur in the course of symptoms
110
What is Jaspers concept of primary delusions?
They are the true, un-understandable beliefs that arrive fully formed and cannot be reduced further to any other mental experience.
111
What are the types of primary delusions?
Autochthonous Delusional perception Delusional mood/atmosphere Delusional memory
112
What is an autochthonous delusion?
Ideas that occur out of the blue, take form in an stant without identifiable preceding events.
113
What is a delusional perception?
Normally perceived object is given a new meaning, usually self-referential - the conclusion being unwarranted.
114
Which type of primary delusion is included in Schneider's first rank symptoms?
Delusional perception
115
What is delusional mood/atmosphere?
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.
116
What psychiatric phenomenon directly precedes and is causally related to primary autochthonous delusions?
Delusional mood
117
What is a retrospective delusion?
Something that never happened and is irrational and bizarre is reported. Sometimes a normal memory may be delusionally elaborated.
118
Advantages and disadvantages of primary delusions
Diagnostic relevance | No prognostic significance
119
Which organic state can cause primary delusions?
Epileptic psychosis
120
Which type of schizophrenia are primary delusions often seen in?
Acute
121
What are secondary delusions?
Those that follow a primary delusion or other mental phenomena such as hallucinations or affective disturbances
122
Which type of delusions are persecutory?
Secondary
123
What is a paranoid delusion?
One which is self-referential
124
What is a monothematic delusion?
Ones which occur as single delusions
125
What is Capgras delusion?
Believing someone close to you has been replaced by a double
126
What is Cotard delusion?
Severe depression with nihilistic and hypochrondriacal delusions tinged with grandiosity and a negative attitude. Believing you are dead
127
What is Fregoli delusion?
People you know being swapped for imposters
128
What is mirrored-self misidentification?
Seeing one self in the mirror and not recognising it as you self - seeing it as a stranger
129
What is De Clerambault's delusion?
Erotomania
130
What is Othello syndrome?
Pathological jealousy - believing someone close to you is having an affair
131
Who first used the term Morbid Jealousy?
Ey
132
Who is De Clerambault's syndrome common in?
Women who believe an older man is in love with them
133
What is Old maid's insanity?
De Clerambault's syndrome where persecutory beliefs also coexist
134
What diseases is Cotard's syndrome seen in?
``` Schizophrenia Depressive psychosis Elderly Migraine Organic lesions ```
135
Who described monosymptomatic hypochondriacal psychosis?
Munro
136
What does monosymptomatic hypochondriacal psychosis consist of?
Delusions of body odour and halitosis Delusional infestation Dysmorphic delusions
137
What is another name of delusional infestation?
Ekbom's syndrome
138
What is the matchbox sign described in monosymptomatic hypochrondriacal psychosis?
Old lady comes to clinic with a match box of skin scrapings as evidence for the parasite causing her to itch.
139
Who first reported Capgras syndrome?
Kahlbaum in 1866
140
What is main cause of Capgras delusion?
>50% due to organic brain damage
141
What is thought to underlie Capgras delusion?
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
142
When was Fregoli syndrome first described?
Courbon and Fail in 1927
143
Essential feature of Fregoli?
No belief in actual physical change; instead patient believes that their percecutors can invade the body of others. More rare than Capgras
144
What is syndrome of subjective doubles?
Patient believes another person has been physically transformed into their own self and is the exact double of themselves
145
What is intermetamorphosis?
Where people keep transforming their physical and psychological identities.
146
What is paraprosopia?
When a face appears to transform within seconds into a grotesque mask
147
Who described the term overvalued idea?
Wernicke
148
What is an overvalued idea?
Solitary abnormal beliefs that are neither delusional nor obsessional in nature but which dominates a persons life and actions. Poor prognosis.
149
What diseases are overvalued ideas linked to?
``` Paranoid or anankastic PD Body Dysmorphphobia Anorexia Morbid jealousy Transsexualism ```
150
What is folie a deux?
Shared delusion between a psychotic person and someone close to them
151
What is doppelganger?
Awareness of onesef being both inside and outself oneself.
152
What type of disturbance is doppelganger?
Cognitive and ideational disturbance | Not always due to mental illness
153
What are the proposed causes of delusions?
Attentional bias Attributional bias Probabilistic reasoning bias Menalising bias
154
Describe attentional bias
People with persecutory delusions preferentially attend to threat-related stimuli and preferentially recall threatening episodes
155
What is attributional bias
Patients excessively attribute hypothetical positive events to internal causes and negative events to external causes.
156
How does attributional bias affect paranoid patients?
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
157
How does attributional bias affect a patients delusions?
It can shape the content but not the form
158
Describe probabilistic reasoning bias
Reduced accuracy of judgement | Overconfident about their judgement
159
What is the mentalising deficit/bias?
Persecutory delusions reflect false beliefs about the intentions and behaviours of others that could arise from the theory of mind deficits
160
Importance for first rank symptoms in current classifications
One first rank symptom is symptomatically sufficient for a diagnosis of schizophrenia but they are not essential
161
Are first rank symptoms specific to schizophrenia?
No
162
Advantages for first rank symptoms
Clearly identifiable Frequently occurring Occur more often in schizophrenia than any other disorder
163
What is the underlying feature of all first rank symptoms?
Disturbance of self-image
164
Prevalence of FRS in patients with affective disorders?
22-29%
165
Prevalence of FRS in schizophrenia?
25-88%
166
Most frequent FRS?
Delusional perception
167
What are the FRS?
3 hallucinations 3 made phenomena 3 thought phenomena 2 isolated symptoms
168
What are the hallucinations in FRS>
Audible thoughts - thought echo Voices arguing - 3rd person Running commentary
169
What are the three 'made' phenomena in FRS?
Made affect - someone controlling mood Made volition - someone controlling action Made impulse - someone controlling the desire to act
170
What are the three thought phenomena in FRS?
Thought withdrawl Thought insertion Thought broadcast
171
What are the isolated symptoms in FRS?
Delusional perception | Somatic passivity
172
Are command hallucinations FRS?
No
173
Are somatic hallucinations FRS?
No
174
What did Schneider describe as second rank symptoms?
Mood changes Emotional blunting Perplexity Sudden delusional ideas
175
What is a preserved thought?
One that we know is our own and private
176
Describe the aspects of conversational speech
Spontaneity Turn-taking Mutual topic Animation
177
What is turn-taking?
Responses and comments are made only when the other speaker completes his sentences or when natural pauses occur
178
What is aphonia?
Inability to vocalize
179
What is phonation?
Sound production
180
What is articulation?
Sound manipulation
181
What is disturbance of articulation known as?
Dysarthria
182
What is the disturbance in aphonia?
Phonation - sound production
183
Organic cause of aphonia?
Paralyzed vocal cords
184
Psychiatric cause of aphonia?
Hysteria
185
Organic cause of dysarthria?
Lesions in brain stem (bulbar) Lesions in brain (pseudo bulbar) Lesions in cerebellum or extrapyramidal system
186
Psychiatric cause of dysarthria?
Drug induced in schizophrenia
187
Which gender has a greater prevalence of stammer?
Boys
188
What is new onset stuttering in adults due to?
Stroke | Extrapyramidal symptoms
189
What is bradyphasia?
Decelerated talking
190
What is tachyphasia?
Accelerated talking
191
What is logorrhoea?
Increased quantity of speech
192
What is alogia?
Poverty of speech and decrease in spontaneous speech
193
What is poverty of content of speech?
Amount of speech is adequate but conveys little information
194
What is complete lack of speech called?
Mutism
195
What is the most common hysterical disorder of speech?
Aphonia
196
What is akinteic mutism?
Patient is mute but remains aware of the environment though cannot move or respond
197
Causes of akinetic mutism?
Lesions of upper midbrain or posterior diencephalons | CJD
198
What is repetition of phrases or sentences known as?
Verbigeration
199
What is it called when there is repetition of the last syllable of a word?
Logoclonia
200
In which disorder can one see logoclonia?
Parkinsons
201
What is Palilalia?
Repetition of last uttered word without any apparent purpose
202
Where is palilalia seen in?
LD Pervasive developmental disorders Tourette's
203
Where does sound transmitted by ears go to?
Wernicke's area | Auditory association cortex
204
What happens to sound once it reaches Wernicke's area?
The language component is processed
205
What is Broca's area for?
Higher motor area of language production
206
Which area of the brain is for language production?
Broca's area
207
Where do signals from Broca's area go to?
Motor area to coordinate delivery of language via the tongue, lips and vocal cords
208
Where do signals go from Wernicke's area?
Auditory association cortex | Broca's area
209
Where does Broca's area receive signals from?
Language Association cortex | Wernicke's area
210
What happens when sound cannot travel from the ears to Wernicke's area?
Sensory aphasia
211
What happens when signals cannot travel from Wernicke's area to the auditory association cortex?
Transcortical sensory aphasia
212
What happens If signals cannot travel from the language association cortex to Broca's area?
Transcortical motor aphasia
213
What is required for language fluency?
Depends on intact Broca's area and forward connections
214
What is required for language comprehension?
Depends on intact Wernicke's area and its connection with association cortex and sensory input
215
What is required for language repetition to occur?
Signals to go from Wernicke's area to Broca's area via the arcuate fasciculus No higher level processing required
216
Define fluency
Production of meaningful words and sentences
217
What is a naming defect called?
Anomnia
218
What type of disorder results in a higher level language problem ?
Aphasia
219
What is meant by a higher level language problem?
Problem of language reception, production and processing
220
What is lost Wernicke's sensory aphasia?
Repetition Comprehension - reading and writing Naming
221
What is intact in Wernicke's sensory aphasia?
Fluency
222
What is retained in Broca's motor aphasia?
Comprehension
223
What is lost in Broca's motor aphasia?
Fluency Repetition Naming
224
What is intact in Conduction aphasia?
Fluency | Comprehension
225
What is lost in Conduction aphasia?
Repetition | Naming
226
What is intact in Transcortical sensory aphasia?
Fluency | Repetition
227
What is lost in Transcortical sensory aphasia?
Comprehension | Naming
228
What is intact in Transmotor cortical aphasia?
Repetition | Comprehension
229
What is lost in Transmotor cortical aphasia?
Fluency | Naming
230
What does speech sound like in Broca's aphasia?
Nonfluent Laboured with interruptions and pauses Abnormal word order Telegraphic speech
231
Which words are most affected in Broca's aphasia?
Function words
232
How does speech sound in Wernicke's aphasia?
Fluent but paraphasic, string of neologisms and circumlocutions. Jargon aphasia. Large number of function words, few nouns and verbs
233
What is alexia?
Pure word blindness
234
Describe what patient can do in alexia
Patient can speak and comprehend what is spoken | Can write spontaneously and to dictation
235
Describe what patient cannot do in alexia
Reading comprehension is impaired
236
What is pure agraphia?
Inability to write
237
What is agraphia seen with?
Gerstmann's syndrome
238
What is alexia with agraphia?
Acquired illiteracy
239
What is pure word deafness?
Comprehension impaired for spoken language only
240
Cause of pure word deafness?
Bilateral damage to superior temporal pole or | Damage to left side of superior temporal pole with disrupted connections to non-dominant circuit
241
What is pure word dumbness?
Spoken language cannot be produced clearly | Patient can comprehend language well, read and write
242
What is the name for pure word blindness?
Alexia
243
What is the name of acquired illiteracy?
Alex with agraphia
244
What is the name of the isolated uinability to write?
Pure agraphia
245
What are the three normal types of thinking?
Fantasy/dereistic thinking or autistic thinking Imaginative thinking Rational/conceptual thinking
246
What is fantasy thinking?
No goal direction, unrealistic
247
In which disorders is autistic thinking prevalent?
Cluster A personality Dissociation Pseudologia fantastica
248
what is imaginative thinking?
Fantasy elements mixed with memory, involving abstract concepts but goal-directed. Does not cross boundaries into unreal
249
What is rational thinking based on?
Factual reality | Logic
250
What types of thought disorders are there?
Disorder of thought content Thought form Thought stream Thought control
251
Give an e.g. of a disorder of thought content
Delusion
252
Give an e.g. of a disorder of thought form
Tangentiality | Loosened associations
253
Give an e.g of disorder of thought stream
Pressure of speech Poverty of thought Crowding of thoughts
254
Give an e.g. of disorder of thought control
Obsessions Passivity First rank thought disturbance
255
What does formal thought disorder refer to?
Disturbance in form - not of content
256
What is paralogia?
Positive Formal thought disorder - symptoms of thought disorder identified due to presence of abnormal element in thought processes
257
What is alogia?
Negative formal thought disorder - symptoms considered due to absence of normal element of thought/speech
258
What is akataphasia?
Term used by Kraepelin to convey the essence that speech disorders are a result of thought disorder
259
What is often considered to indicate the presence of formal thought disorder?
Loosening of associations
260
Who coined the term 'loosening of associations'?
Blueler
261
Who proposed the four classifications of formal thought disorder?
Cameron
262
What are the four classifications of formal thought disorder?
Metonymy Asyndesis Overinclusion Interpenetration
263
What is metonymy?
Imprecise approximate expressions used as substitute words.
264
What is asyndesis?
Lack of genuine causal links in speech.
265
What is overinclusion?
Ideas that are only remotely related to concept are incorporated in patients thinking. Conceptual boundaries lost.
266
What can be used to test overinclusion?
Sorting tests
267
How many patients with schizophrenia have overinclusion when acutely unwell?
50%
268
What is interpenetration?
Irrelevant thoughts penetrate ongoing stream of thoughts
269
Who proposed first rank symptoms?
Karl Schneider
270
What did Carl Schneider propose?
5 elements of formal thought disorder
271
what are the five elements of formal thought disorder?
``` Substitution Omission Fusion Drivelling Derailment ```
272
What is another name for derailment?
Entgleisen
273
What is substitution?
One thought, often inappropriate, fills the gap between other consistent thoughts
274
What is omission?
Chunk of thought goes missing from stream of conversation and patient is unaware
275
How can omission of thought best be analysed?
When written
276
What is drivelling?
Disordered intermixture of constituent parts of one complex thought
277
What is fusion of thought?
Various thoughts fuse together leading to loss of goal direction
278
What is entgleisen?
Normally flowing track of thoughts suddenly change.
279
What is desultory thinking?
Speech is grammatically correct but sudden ideas force their way in occasionally.
280
Who used the term desultory thinking?
Desultory thinking
281
What did Kleist propose re speech in schizophrenia?
Semantic disturbance of language more common than grammatical or syntactical errors
282
What is verbal paraphasia?
Meaningful sentences produced in spite of loss of appropriate words
283
What is literal paraphasia?
No one can make out meaning of sentence except patient
284
What is agrammatism?
Loss of parts of speech
285
What is paragrammatism?
INdividual phrases are well constructed and meaningful but do not fit in with goal of thought.
286
What are stock words?
Word used in an idiosyncratic way with different meanings in different contexts.
287
What is stilted speech?
Pompous, formal speech in inappropriate content
288
What may underlie stilted speech in schizophrenia?
Impaired lexical retrieval
289
What happens in flight of ideas?
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
Describe three types of verbal associations
Clang Punning Rhyming
291
What is clang association?
Thoughts are associated by initial syllabic structure of words rather than meaning
292
What is punning?
Words get associated as one word with dual meaning
293
In schizophrenia when does clang speech often happen?
With first syllables
294
When does clang association often occur in mania?
At the end syllables
295
What is Vorbeireden?
Talking past the point leading to approximate but not accurate answers
296
What is vorbeigehen?
Going past the point - part of Ganser syndrome
297
What is Gansser syndrome?
Where criminals would give incorrect answers to simple questions despite it being suggested that the correct answer was known
298
What happens in circumstantiality?
Thinking is slow with many unnecessary details and digressions before returning to the point.
299
Organic cause of circumstantial speech
Temporal lobe epilepsy | Alcohol-induced dementia
300
Psych causes of circumstantial speech
LD Obsessional personality Delusinal mood in schizophrenia
301
Difference between circumstantiality and tangentiality?
In tangentiality, the point is never reach
302
Who studied concrete thinking?
Goldstein
303
In which patients is concrete thinking seen in?
Schizophrenia patients with formal thought disorder only
304
Organic cause of concrete thinking?
Fronto-temporal dementia
305
What tests can one do to test linguistics in schizophrenia?
Word association tests Cloze procedure Type-token ratio Cohesion analysis
306
What happens to schizophrenics in word association tests?
Patients prefer dominant meaning of a word in spite of context
307
What is cloze procedure?
Parts of recorded speech are deleted to see if meaning can be predicted; in schizophrenia predictability is reduced.
308
What is reverse cloze procedure?
Patients are asked to predict missing elements of someone else's speech - schizophrenics do poorly
309
What is type-token ratio?
Ratio between number of different words used during discourse and total number of spoken words.
310
What is noted in schizophrenia in type-token ratio?
Impoverished vocabulary
311
What is cohesion analysis?
Analysing links between sentences and words in discourse
312
What does cohesion analysis show in schizophrenics?
Less referential ties - using pronouns w/o mentioning a subject in first place More lexical ties - connecting words
313
What is the Hunt test?
Asking a patient to construct complex sentences from simple phrases - schizophrenics struggle
314
Scales used to measure formal thought disorder?
Thought language and communication scale | Thought and language index
315
What does thought and language index use?
Projective stimuli from Thematic Apperception test to elicit thought disturbances
316
Who created the thought language and communication scale?
Andreasen
317
Who crated the thought and language index?
Liddle
318
According to Andreasen, which thought disorders were more common in schizophrenia?
Thought blocking Tangentiality Poverty of cntent of speech
319
What did Von Domarus suggest caused FTD?
Result of loss of deductive reasoning.
320
How can one measure schizophrenic FTD with Kelly's personal construct theory?
Using repertory grids (Bannister)
321
What happens in repertory grids?
Patient asked to score different elements under different constructs (qualities). Usually there is congruent. In schizophrenia predictability base don prior constructs is poor.
322
What is serial invalidation?
Where there is poor predictability in repertory grids based on prior constructs
323
What did Mortimer believe FTD was due to?
Impaired semantic memory - associations between words and qualities are lost
324
What is a semantic halo?
Words are linked through symbolic meaning e.g London and tube
325
What is direct semantic priming?
When a word is stimulated, those words which are semantically close are also available for the thought process to proceed uninterrupted
326
What is indirect semantic priming?
When a word is stimulated, another word with a semantic meaning close to that is stimulated, leading to another etc.
327
What is the theory behind schizophrenia FTD in terms of semantic priming?
Direct priming is impaired | Indirect is more activated
328
What is one of the main theories of FTD?
Dysexecutive problems
329
Which lobe plays a role in formation of language?
Frontal lobe
330
What can loss of executive functions result in, in terms of thoughts and speech?
Poor planning, error monitoring and correction of speech production
331
Which type of stream of thought disorder occurs in clouded consciousness?
Perservation
332
Name the types of streams of thought
Pressure of speech Crowding of thought Retardation of thinking Perservation
333
What is another term of obsessional thoughts?
Ego-alien
334
Link between obsession and compulsion
Initially an obsession leads to compulsion. | Over time primary obsessions fade while compulsions dictate clinical picture
335
When does obsessional slowness occur?
When obsessional thoughts occur as part of a depressive illness or in severe OCD or obsession with symmetry or precision
336
What are the most common obsessions?
Fear of contamination Pathological doubt Need for symmetry Aggressive obsessions
337
What are the most common compulsions?
``` Checking Washing Symmetry Need to ask or confess Counting ```
338
What do children with OCD most commonly present with?
Washing compulsions | Repeating rituals
339
What did Fish classify motor symptoms into?
Abnormal spontaneous movements | Abnormal induced movements
340
Name some abnormal spontaneous movements
``` Tremors Tics Chorea Athetosis Stereotypy ```
341
Name some abnormal induced movements
Perseveration Automatic obedience Echo phenomenon Other catatonic signs
342
Define catatonia
Rigidity during involuntary movements while volitional movement is carried out normally
343
Define neurological spasticity
Where tone is increased irrespective of passive or active movements
344
Does catatonia persist in sleep?
Yes
345
When is catatonia most commonly seen?
Advanced primary mood or psychotic illness
346
What is ambitendence?
Patient makes a series of tentative, opposing alternative movements but does not reach the intended goal.
347
What is automatic obedience?
Exaggerated cooperation with request or spontaneous continuation of movement requested
348
How can you demonstrate automatic obedience?
Ask the patient not to cooperate, but they still carry out the instructions
349
What is mitmachen?
Mild form of automatic obedience - despite requests to resist manipulation, patient yields themselves to be placed in abnormal posture
350
What is Mitgehen also known as?
Anglepoise lamp sign
351
Describe Mitgehen
Patients yields to slightest pressure without resistance
352
Another name for waxy flexibility
Catalepsy | Flexibilitas cerea
353
What is waxy flexibility?
Patient can be moved to occupy certain postures which are maintained
354
Does limb go back to resting position after pressure in waxy flexibility?
No
355
Does limb go back to resting position in mitgehen and mitmachen?
Yes
356
In which disorders are echo-phenomenon seen?
Catatonia Latah Tourette's
357
What is the term when a patient mimicks an examiners movements?
Echopraxia
358
What is the term when a patient mimicks the examiners speech?
Echolalia
359
What is Gegenhalten also known as?
Paratonia | Opposition
360
What happens in Gegenhalten?
Resistance to passive movements with proportional strength o increase of muscle tone
361
What is negativism?
Resist all passive movements to all interference
362
What is schnauzkrampf?
When a patient cups his lips as if they are spastic
363
What is stupor?
Immobility
364
Describe catatonic excitement
Extreme apparently non-purposeful hyperactivity which presents as constant motor unrest
365
What are mannerisms?
Odd but purposeful movements
366
What is parakinesia?
Contracting entire facial muscles
367
What is often the meaning of mannerisms in schizophrenia?
Often delusional meaning
368
What is stereotypy?
Odd movements with no goal
369
What is posturing?
Maintenance of odd postures despite efforts to be moved
370
Which disorders are stereotypes seen in?
Catatonia Pervasive developmental disorder Severe LD
371
What is astasia-abasia?
Inability to walk, sit or stand upright with no organic cause (motor conversion disorder)
372
What is blepharospasm seen in?
Tardive dyskinesia
373
What happens in blepharospasm?
Begins with excessive nlinking.With time, spasms become intense, functionally blinding patient as eyelids remain closed for longer periods of time
374
Trigger of blepharospasm
Specific stressors - bright lights, sfatigue etc
375
When do blepharospasms disappear?
With sleep
376
What happens when one tries to concentrate on a specific task with blepharospasm?
Decreases frequency of spasms
377
Difference between perseveration and Verbigeration
In Verbigeration, verbal repetition occurs spontaneously, not in response to a question In perseveration, the response is goal-directed
378
Define tics
Sudden, involuntary but temporarily suppressible jerking movements
379
What do tics worsen with?
Low mood | fatigue
380
Are tics seen in sleep?
No
381
What is coprolalia?
Obscenities
382
Describe tics in Tourettes
Preceded by palpable urge or prodromal sensation before motor act
383
Link between deja vu and age
Decreased with age
384
When does deja vu tend to occur?
Under stress and fatigue
385
Who is deja vu more common in?
Schizophrenia | Temporal lobe epilepsy
386
What is the name of the pathological familiarity of a thought or idea?
Deja pensee
387
What is the name of the pathological familiarity for someones voice?
Deja entendu
388
What happens in pseudologia fantastica?
Fluent, plausible lying with statements made extreme and of grandiose nature
389
What is pseudologia fantastica associated with?
Dissocial and histrionic personality disorders
390
What classification is Gansers syndrome under?
Hysterical dissociative disorder
391
Symptoms of Gansers syndrome?
``` Approximate answers Clouding of consciousness with disorientation Psychogenic, physical symptoms Pseudohallucinations Amnesia for abnormal behaviour ```
392
What is Couvade syndrome?
Sympathetic pregnancy that affects husbands (or other family members) during pregnancy
393
When does Couvade syndrome most frequently occur?
3-9 months of pregnancy
394
What is pseudovyesis?
Woman experiences clinical signs of pregnancy w/o being pregnant and patient is convinced of pregnancy
395
What is the name of the disorder where the patient believes they are pregnant?
Couvade
396
What is the culture-bound state where a patient believes his penis is shrinking and he will die?
Koro
397
What cultures is Koro seen in?`
Malaysia | Singapore
398
What type of disorder is Koro?
Desomatization
399
What type of amnesia is common in multiple personality disorders?
One-way amnesia
400
What is Lycanthropy?
Patient loses awareness and identity and believes they have been transformed into an animal, usually a wolf
401
Define depersonalisation
Change in self-awareness and individual feels as if they are unreal
402
Psych causes of depersonalisation
``` Temporal lobe epilepsy Hysterical dissociation Depression Anxiety Anankastic PD ```
403
Drug causes of depersonalization
``` TCAs Hallucinogens Cannabis Fatigue Meditation ECT ```
404
How long does depersonalisation last for?
Hours
405
What is PAD?
Phobic anxiety depersonalisation syndrome - typically married female in thirties with agoraphobia and anxiety has depersonalisation that worsens with ECT
406
What is desomatisatino?
Depersonalisation localised to a body part
407
What is Deaffectualisation?
Capacity to feel any emotion is lost
408
What does insight consist of?
Awareness of ones own systems Attribution to mental disorder Appraisal of consequences of symptoms Acceptance of treatment
409
What is anautognosia?
Absence of awareness of ones symptoms
410
What is dysautognosia?
Lack of awareness of ones symptoms being attributable to a mental disorder
411
What is insight in acute psychosis associated with?
More self-harm and suicide rates
412
Which part of the brain may play a role in insight?
Fronto-parietal circuit
413
Name the levels of insight
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
What is intellectual insight?
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
What is true emotional insight?
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
Most common aura in TLE?
Autonomic sensations
417
Give e.g. of some autonomic sensations
Epigastric aura Salivatino Vertigo
418
Give some symptoms of TLE
``` Aura Forced thinking Evocation of thought Sudden obstruction of thought Panoramic memory Psychic seizures Uncinate crisis Strong affective experiences ```
419
What is forced thinking?
Patient has a compulsion to think on a certain topic
420
What is evocation of thought?
Intrusion of stereotyped words or thoughts
421
What is panoramic memory?
Patient recalls expansive memories in incredible detail
422
What are psychic seizures?
Isolated auras with hallucinations, depersonalization, micropsia/macropsia, deja/jamais vu
423
When is TLE more likely to lead to deja/jamais vu?
If right-sided
424
What is an uncinate crisis?
Hallucinations of taste and smell associated with dream-like reminiscence and altered consciousness
425
What is Dostoevsky's epilepsy?
Ecstatic content in epileptic aura
426
Which type of seizure most commonly has auras?
TLE
427
In which type of seizure is pain a symptom?
Parietal - 25%
428
Signs in parietal lobe epilepsy
Somatosensory seizures Pain Somatic illusions Visual illusions
429
Describe somatosensory seizures
Patients describe physical sensations of numbness, tingling, heat, sometimes in a predictable 'Jacksonian march;' pattern
430
Describe somatic illusions
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
Duration of frontal lobe seizures
1 minute
432
When do frontal lobe seizures tend to occur?
During sleep
433
What do frontal lobe seizures include?
Strange automatisms - bicycling movements, screaming
434
What is the name of a seizure that only involves laughing?
Gelastic
435
What is the name of a seizure that only involves crying?
Dacrystic
436
Which lobe is affected in Gelastic/dacrystic seizures?
Frontal | or Temporal
437
What is epileptic automatism?
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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