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Assessment - MRCPsych A > MRCPsychmentor > Flashcards

MRCPsychmentor Flashcards

1
Q

Who divided types of Schizophrenia into type I and type II?

A

Crow:

  • Type I had more positive symptoms and would do well from antipsychotics
  • Type II had negative symptoms and associated to poorer outcomes
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2
Q

As classified by Eman Valliant outline the four levels of defence mechanisms?

A

Level 1 (pronounced break with objective reality)
- Delusional projection
- Psychotic denial
- Psychotic distortion

Level 2 (annoys but the observer but comforts the user - narcissistic)
- Acting out
- Passive aggression
- Autistic fantasy
- Projection
- Hypochondriasis (devaluation) turning against the self

Level 3 (intermediate neurotic defence - more annoyance in user than observer)
- Displacement
- Intellectualisation (isolation, undoing)
- Repression
- Reaction formation

Level 4 (mature and empathic - these defences allow optimal handling of the stressor and maximise gratification and allow self-awareness)
- Sublimation
- Anticipation
- Altruism
- Humor
- Suppression

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3
Q

What is the short form-36?

A

A patient report survey that measures patient rated functioning and well-being.

It comprises of 8 scales and takes 8 minutes to do.

  • physical functioning
  • role limitations due to physical health problems
  • bodily pain
  • general health
  • vitality (energy/fatigue)
  • social functioning
  • role limitations due to emotional problems
  • mental health (psychological distress and psychological well being).
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4
Q

Which alcohol screening test was developed from the WHO and covers three domains of alcohol harmful use, hazardous use and dependence?

A

AUDIT

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5
Q

Who came up with the classification of first rank symptoms of Schizophrenia

A

Kurt Schneider

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6
Q

What is the culture bound syndrome of thinking too much causes depression, anxiety and somatic complaints?

A

Kufungisisa - Zimbabwe

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7
Q

Outline the primary (autochthonous) delusions?

A

Delusional perception - normal perception but abnormal meaning attached to it. Often self-referential

Delusional mood - sense that something is wrong

Delusional memory - a patient recalls an event or occurrence that is delusional - the event did not happen

Sudden abrupt delusion - formed entirely in a patients mind without prior thoughts or perception

For a delusion to be secondary it occurs following a morbid experience i.e. auditory hallucinations or a primary delusion.

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8
Q

What is prolixity?

A

A limited form of flight of ideas seen in hypomania - there are less clang associations and verbal associations are less frequent. General direction of thought in tact and not as rapid

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9
Q

What culture bound syndrome do men think their penis has shrunk

A

Koro

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10
Q

What is lyncanthropy?

A

Delusional belief that one has been turned into an animal

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11
Q

What is cerea flexibilitas?

A

Waxy flexibility seen in catatonia

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12
Q

What does the Tower of London test assess for?

A

A cognitive estimates test that assess for frontal lobe function - problem solving

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12
Q

What does the Tower of London test assess for?

A

A cognitive estimates test that assess for frontal lobe function

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13
Q

What is brain fag?

A

A culture bound syndrome experienced by individuals of West African heritage

Symptoms include cognitive disturbances such as poor concentration, sensory disturbances (heat sensations or reduced vision) - these all occur during periods of intense intellectual activity

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14
Q

How does Latah present and who does it affect?

A

Malaysian Women

Hypersensitivity to sudden frights and startle with echopraxia, echolalia, coprolalia (involuntary and repetitive use of excessive language) with automatic responses to commands and dissociative phenomena.

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15
Q

What culture bound illness is Maladies Moun?

A

Maladi Moun is Haitian and presents with medically unexplained symptoms and psychiatric symptoms the reason is that they have been sent by another person with malicious or evil
Intent

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16
Q

Which rating scale identifies caseness?

A

GHQ

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17
Q

What does Paraschemazia mean?

A

The delusional belief that one’s body parts are distorted or twisted / refers to a feeling rather than appearance (i.e. body dystrophic delusions are appearance > feeling)

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18
Q

What is the needless repetition of words or phrases and does not require an external stimulus?

A

Verbigeration

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19
Q

What does the Rey Osterith complex figure test asses for?

A

Memory

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20
Q

How does Dhat present?

A

An illness in which South Asian men attribute somatic and anxiety symptoms to semen loss

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21
Q

Outline the positive symptoms that are present in the PANSS

A

Conceptual disorganisation
Hallucinations
Delusions
Suspiciousness/persecution
Hostility
Hyperactivity
Grandiosity

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22
Q

Define

a) Acting out
b) Passive aggressive
c) Reaction formation

A

a) Impulsive actions that are congruent with the persons feelings
b) Not a direct way of expressing dislike - often actions and words do not match up
c) Reaction is behaviour that is diametrically opposed to true impulse

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23
Q

For splitting to occur what does the patient need to demonstrate?

A

An inability to see individuals as having complex blends of good and bad and they mix between idealising and hating everyone

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24
Q

What does the Simpson Angus scale assess for?

A

Drug induced Parkinsonism - only clinical signs and assess for rigidity, tremor and salivation

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25
Q

What is a psychogenic tremor?

A

A tremor that disappears on distraction, it may worsen with stress

26
Q

What is the WISC?

A

The Wescheler intelligence scale for children between age of 6 to 16

27
Q

Name some arrhythmia that TCAs can cause?

A

2nd degree heart block
Polymorphic VT/monomorphic VT

28
Q

How does a delusional belief system interact with the world in the following ways?

a) polarised
b) juxtaposed
c) autistic

A

a) Delusional world interacts with real world
b) Delusional world sits side by side with real world but the two don’t interact
c) The individual lives entirely within the delusional world

29
Q

Who in 1981 came up with the triad of impairments seen in Autism of social interaction, communication difficulties and difficulties with imaginative behaviour?

A

Lorna WIng

30
Q

What does the LUSNERS assess for?

A

Side effects of neuroleptics

Liverpool Uni Neuroleptic Side Effect Rating Scale
Validated for men and women
Includes red herring items to help for validation

It is self-administered

31
Q

What is sick euthyroid syndrome?

A

Seen in illness/anorexia:
- Low T3
- Normal T4
- Normal TSH

32
Q

Pierre Briquet came up with which syndrome?

A

Bodily Distress Syndrome:
- Somatoform disorder where individuals experience often multiple distressing bodily symptoms - they seek healthcare approval for

33
Q

Why may patients with delirium not respond to questioning?

A

Hypoacuisis

34
Q

What is Tajin Kyofusho?

A

Culture bound condition seen in Japanese patients:
- Characterised by anxiety about and avoidance of interpersonal situations due to the thought, feeling, or conviction that one’s appearance and actions in social interactions are inadequate or offensive to others

35
Q

What types of tremors does Lithium cause?

A

In toxicity can cause an intention/cerebellar tremor (coarse seen on purposeful movement)

For chronic use causes a physiological tremor (fine low amplitude tremor)

36
Q

Is the BPRS self-reported or clinician observed?

A

Both

It can be used for treatment response (mania and Schizophrenia predominately but also unipolar conditions)

Expanded 24 version (from 18) includes items on distractability, guilt, suicide

Mildly ill - 31
Moderate ill - 41
Severely ill - 53

36
Q

Is the BPRS self-reported or clinician observed?

A

Both

It can be used for treatment response (mania and Schizophrenia predominately but also unipolar conditions)

Expanded 24 version (from 18) includes items on distractability, guilt, suicide

Mildly ill - 31
Moderate ill - 41
Severely ill - 53

37
Q

How do chorea and athetosis differ?

A

Both non-rhythmical

Chorea is intermittent occurs on movement. Causes are Huntington’s disease, Wilson’s disease, hyperthyroidism, cocaine/lithium

Athetosis is continuous stream of writhing movements - slower than chorea, more readily occurs on rest > movement. Causes are Huntington’s disease, Wilson’s disease, cerebral palsy, stroke, donepezil

38
Q

What is intellectualisation?

A

A neurotic defence mechanism - the person explains events in a cognitive and analytical way not experiencing the emotions.

39
Q

The PHQ-9 what are the

a) score cut offs for less/more severe depression
b) Time interval
c) Question topics

A

a) < 16 / > 16
b) Last two weeks
c) 9 questions rated 0-3 and asks about self-harm

40
Q

What are the subdomains of the Weschler Adult Intelligence Scale?

A

Working memory

Verbal comprehension

Perceptual reasoning

Processing speed subsets

  • Gives a full scale IQ score
  • General ability index - verbal comprehension + perceptual reasoning
  • Can be conducted on individuals aged between 16-90
41
Q

How does pellagra present?

A

Dementia - confusion
Dermatitis
Diarrhoea

B3 deficiency (Niacin) - 3Ds

42
Q

What are the causes of B6 deficiency?

A

Isoniazid or Alcohol use

Presents with:
- Seborrheic dermatitis
- Atrophic glossitis
- Confusion
- Somnolence
- Polyneuropathy

43
Q

How does B1 deficiency present?

A

Thiamine deficiency (B1):

  • Dry beri-beri - sensory perception changes, weakness, pain in limbs and emotional changes
  • Wet beri-beri - oedema, pleural effusions
  • Wernicke’s Korsakoff
44
Q

What nationality is Ataque de Nervios seen in?

A

Latinos

  • Uncontrollable, crying or anger
  • May be linked to panic disorder or also normative expression of distress
45
Q

Are delusions of control compatible with a diagnosis of delusional disorder?

A

No - not compatible with a diagnosis of delusional disorder (may need to screen for schizophrenia)

46
Q

How many questions on the BDI?

A

21 - it is scored out of 63

0-13 is no depression
14-19 is mild
20-28 is moderate
29-63 is severe

All self-report
Covers two weeks before questions
Scores are rated 0-3

47
Q

What does the Cambridge Mental Disorders of Elderly Examination assess for?

A

Dementia - early diagnosis

Includes clinical interview, cognitive tests and interview with a patients relative

48
Q

Outline the subcategories of MMSE?

A

Orientation to place - 5

Orientation to time - 5

Registration - repeats examiners comments

Attention and concentration - 5- world / serial 7s

Recall - 3 - items from earlier

Language - name items, repeat a sentence, follow a 3 stage command

Visual construction - intersecting pentagons

49
Q

What are the score cutoffs for the EPDS?

A

0-9 low chance of depression
10-12 moderate chance of depression
> 13 high chance of depression

Assess the last 7 days, subjects are tasked to choose responses that score between 0-3 , 10 items

50
Q

What anti-epileptic drugs are favoured for

a) Focal seizures
b) GTC
c) Myoclonic/atonic seizures
d) Absence seizures

A

a) Lamotrigine/Carbamazepine - if not tolerated then sodium valproate/levetiracetam/oxacarbamazepine

b) Sodium Valproate or Lamotrigine

c) Sodium Valproate

d) Ethosuxamide or Sodium Valproate

51
Q

What is nevra?

A

A culture bound syndrome (greek) patients complain of loss of control, may boil over shout, scream or throw things. Headaches, dizziness, pain and melancholy may accompany

52
Q

How does the DSM-V vary with regards to its choice of disability assessment scale?

A

Rather than the general assessment of functioning it recommends the WHO disability assessment scale (WHODAS). This is self-report takes 5 minutes to complete and includes the following questions:

  • Understanding and communicating
  • Getting around (mobility)
  • Self-care
  • Getting along with people (social and interpersonal functioning)
  • Life activities (home, academic, and occupational functioning)
  • Participation in society (participation in family, social, and community activities)
53
Q

Are verbigeration and voirberden related?

A

NOOOOO

Verbigeration - meaningless repetition of words and phrases seen in catatonia
Voirberden - talking past the point and giving approximate answers - seen in dissociative psychosis i.e Ganser Syndrome

54
Q

Name some contributions made by Eugene Bleuler (1908)

A
  • Coined the term Schizophrenia (splitting of psychic structure) from Dementia Praecox
  • Also separate symptoms into basic/primary loosening of associations, ambivalence, autism, and affective disturbance) and accessory/secondary (includes delusions, hallucinations and catatonia)
  • Basic symptoms were due to neurobiology and secondary due to the psyche’s reaction to this
54
Q

Name some contributions made by Eugene Bleuler (1908)

A
  • Coined the term Schizophrenia (splitting of psychic structure) from Dementia Praecox
  • Also separate symptoms into basic/primary loosening of associations, ambivalence, autism, and affective disturbance) and accessory/secondary (includes delusions, hallucinations and catatonia)
  • Basic symptoms were due to neurobiology and secondary due to the psyche’s reaction to this
55
Q

What was Langfeldt credited for?

A

Schizophreniform Psychosis

These patients had good premorbid adjustment, acute onset immediately following a traumatic event, confusion, and mood disturbance

Not the slow deterioration seen otherwise

56
Q

What did Benedict Morel come up with?

A

Demence Preocece - young patients with premature dementia (a precursor to dementia praecox used by Kraepelin)

57
Q

What is the FAST questionnaire?

A

4 item questionnaire derived from AUDIT

Scores range from 0-16

If -ve question to first question the patient is not misusing alcohol. If weekly, or daily then patient is hazardous harmful/dependent drinker

1 MEN: How often do you have EIGHT or more drinks on one occasion?
WOMEN: How often do you have SIX or more drinks on one occasion?
2 How often during the last year have you been unable to remember what happened the night before because you had been drinking?
3 How often during the last year have you failed to do what was normally expected of you because of drinking?
4 In the last year has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down?

Note question 1 on its own represents the short answer single question questionnaire - if within 3 months then hazardous or harmful drinking

58
Q

How many items on the PANSS

A

30 in total:

  • 16 general psychopathological
  • 7+ve symptoms
  • 7-ve symptoms

Each scored out of 7

59
Q

Can placebo induced analgesia be prevented with naloxone?

A

Yes - suggesting underlying biological mechanism

60
Q

What is acting out?

A

Term used to describe impulsive behaviour that is elicited with aim of not being aware of one’s feelings

Examples include motor behaviour, missing appointments, use of substances

Assessment - MRCPsych A (7 decks)

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