Exam 2 Flashcards
Multiple physical symptoms, with refusal to accept reassurance of negative results
Somatization
What does Hoovers sign look for?
Distinction between organic and functional paraparesis of hip flexors; in functional, the lack of “effort” shows by the fact that the contralateral hip does not extend when the patient is asked to flex their “weak” hip
Excessive worry about severe physical illness e.g. cancer in the absence of, or presence of mild, symptoms
Hypochondriasis
Condition in which a person deliberately acts as if he has a physical disorder in order to gain medical attention
Factitious disorder
Feigning illness for secondary gain
Malingering
Loss of sensory or motor function, usually as a response to a mental or emotional stress/crisis
Conversion disorder
How are dissociative disorder and conversion disorder distinguished?
Conversion = neurological symptoms Dissociative = psychiatric e.g. fugue, amnesia, stupor
Difference between a personality trait and a disorder
Disorders are pervasive and maladaptive
Cluster B disorders (“wild”) [4]
Antisocial
Borderline
Histrionic
Narcissistic
Cluster C disorder (“worried”) [3]
Obsessive compulsive
Avoidant
Dependent
Instability of personal relationships, self-image, and affects, and marked impulsivity
Borderline personality disorder
Detachment form social relationships and a restricted range of emotions
Schizoid personality disorder
Social inhibition, feelings of inadequacy and hypersensitivy to negative evaluation
Avoidant personality disorder
Excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation
Dependent personality disorder
Preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness and efficiency
Obsessive compulsive personality disorder
Characterised by weird, “magical” thinking
Schizotypal personality disorder
Distinction between schizoid and avoidant personality disorders
Avoidant people are distressed by their social isolation
What are self-referential experiences?
Ideas of reference- the belief that external events are linked to oneself. Example- “car registration plates contain hidden codes for me”
Disorder of thought form where the person is unable to answer a question without giving excessive unnecessary detail
Circumstantiality
Difference between circumstantiality and tangential thinking
Circumstantiality = eventually return to the point and give information requested Tangentiality = wander from the point and never return
Differential diagnoses for psychotic symptoms (8)
Schizophrenia Mania (bipolar) Severe depression Puerperal psychosis Schizoaffective disorder Substance abuse Delirium Dementia
Main psychotic symptoms (2)
Delusions (e.g. religious, grandiose, persecutory)
Hallucinations- auditory, visual, gustatory
Three main dopaminergic brain pathways (and their function)
Nigrostriatal (extrapyramidal system)
Tuberoinfundibular (control of prolactin release)
Mesocortical/limbic (motivation and reward)
What causes the negative symptoms of schizophrenia?
Dopamine HYPOactivity in the mesoCORTICAL system
What causes the first-rank symptoms of schizophrenia?
Dopamine HYPERactivity in the mesoLIMBIC pathway
How can amphetamine worsen/precipitate psychosis?
Increases dopamine release in the brain
Risk factors for schizophrenia (4)
Family history
Intrauterine and perinatal complications
Social isolation
Cocaine/cannabis use
First-rank symptoms of schizophrenia. (4) How many of these are needed for the diagnosis?
Auditory hallucinations Thought insertion/withdrawal/broadcasting Delusional perceptions Passivity phenomena Only one is needed
Negative symptoms in schizophrenia (5)
Underactivity Low motivation Social withdrawal Emotional flattening Self neglect
Thought patterns in schizophrenia (2)
Thought blocking
Loosened associations
How long does a) an emergency detention and b) complusory treatment order under the Mental Health Act last for?
a) max 72 hours
b) up to 6 months
First line treatment when tranquilisation is required?
If non-drug approaches fail, oral lorazapem; if oral unsuccessful, give IM
Management of treatment resistant psychosis
Clozapine- requires greater monitoring
What happens after the 6 months of a compulsory treatment order expires?
Re-apply for another 6 months after which 12 months can be used
Can be appealed and taken to a tribunal
What does the Mental Health Act specifically exclude as being grounds for compulsory detention?
Symptoms arising from being under the influence of drugs or alcohol
