Lecture 5: Introduction to Psychiatry

Question 1

What are the differences between mental illness and physical illness?

Answer 1

• people often don’t perceive themselves to be ill (no ‘therapeutic contact’, reluctance to accept treatment, use of mental health act)
• no scientific basis to diagnose, diagnose by symptom cluster, uncertainty about diagnosis
• dispute about existence of mental illness
• perceived lack of treatment
• agents of social control

Question 2

What are the symptoms of anxiety?

Answer 2

Psychic anxiety - feeling of fear or dread
PHYSICAL SYMPTOMS:
- palpitations
- sweating
- dry mouth
- splanchnic vasoconstriction (Butterflies)
- tremor
- paraethesia (Pins and needles)
- depersonalisation 
- syncope (fainting)

Question 3

What are the symptoms of obsessive compulsive disorder?

Answer 3

OBSESSIONS:
- ego-dystonic thoughts
- repetitive, circular ruminations
- may be bizarre and sound delusional
- insight maintained
- unbidden and resisted
- resistance leads to anxiety
COMPULSIONS
- motor response to obsessional thoughts
- often ritualistic, stereotypes, precise
- e.g. handwashing, counting, arranging + symmetry, checking door locks
- start again if interrupted or doubt

Question 4

How can anxiety be classified?

Answer 4

• generalised anxiety disorder
• panic disorder
• agoraphobia
• simple phobia
• social phobia
• obsessive compulsive disorder
• post traumatic stress disorder

Question 5

When does anxiety become a disorder?

Answer 5

if it is excessive, impacts on life or out of context

Question 6

Who is anxiety more common in?

Answer 6

females

Question 7

What is the most common cause of mental disorder?

Answer 7

anxiety

Question 8

What is the median onset age of anxiety?

Answer 8

11

Question 9

How is anxiety treated?

Answer 9

• cognitive behavioural therapy

- drugs like clomipramine (antidepressant)

Question 10

What are the core features of depression?

Answer 10

• pervasive low mood/sadness
• loss of energy (anergia)
• loss of enjoyment (anhedonia)

Question 11

What are the physical symptoms of depression?

Answer 11

• loss of appetite
• weight loss
• diurnal variation of mood
• poor sleep
• loss of libido
• constipation
• psychomotor slowing or agitation

Question 12

What are the psychological symptoms of depression?

Answer 12

• poor concentration
• feelings of guilt
• feelings of hopelessness
• low self-esteem
• indecisive
• suicidal ideation
• delusions

Question 13

What is the most common cause of death in young men?

Answer 13

suicide

Question 14

What is the male to female ratio of suicide?

Answer 14

3:1 (rates are rising in young and middle aged men)

Question 15

What is suicide most commonly associated with?

Answer 15

drug/alcohol use disorders and depression

Question 16

How is depression treated?

Answer 16

• antidepressants (response after 2-3 weeks)
• psychological therapies (12 session CBT)
• social prescribing (exercise, company)

Question 17

What percentage of patients with depression make a full recovery?

Answer 17

90%

Question 18

What are the symptoms of mania?

Answer 18

• elated mood
• irritability
• over-energised
• grandiose
• little need for sleep
• poor concentration
• poor judgement
• over spending
• rapid speech

Question 19

What are the symptoms of schizophrenia?

Answer 19

• hallucination
• delusion
• abnormal behaviour (disorganised, wandering aimlessly, mumbling to self, strange appearance, self-neglect)
• disorganised speech (Incoherent or irrelevant)
• disturbances of emotion (marked apathy or disconnect between reported emotion)

Question 20

What is a hallucination?

Answer 20

hearing, seeing or feeling things that are not there

Question 21

What is a delusion?

Answer 21

fixed false beliefs not shared by others in the person’s culture and that are firmly held even where there is evidence to the contrary (Passivity, thought alienation)

Question 22

What is formal thought disorder in schizophrenia?

Answer 22

failing to follow the semantic and syntactic rules of language

Question 23

What are the 2 major psychotic disorders?

Answer 23

schizophrenia and bipolar affective disorder (together described as severe mental illness, SMI)

Question 24

How is schizophrenia treated?

Answer 24

• antipsychotics
• psychological therapies
• family therapy
• arts therapies

Question 25

What are the key features of schizophrenia?

Answer 25

• delusions (fixed false beliefs, persecutory, bizarre, thought possession and passivity)
• disorganised speech (neologisms, formal thought disorder)
• hallucinations (second person, third person, tactile)
• negative symptoms (apathy, social withdrawal, poor self care)