MSE abnormalities Flashcards
Hallucination Passivity phenomenon Thought disorder Delusions
What is a hallucination?
A perception that occurs in the absence of an external stimulus, originating in real space (Not just thoughts)
What is an illusion?
A perception occurring in the presence of a stimulus, however the stimulus is misinterpreted (E.g. Hearing wind as someone crying)
What is a pseudo-hallucination?
Vivid mental images which are known by the person as being unreal
What are some forms of hallucination
Auditory
Olfactory
Gustatory
Somatic/Haptic/Tactile
Describe the pathophysiology of hallucination
There is activation of the pathways used in generating inner speech, however there is lack of involvement with supplementary motor area (Monitors self-generated actions) and the parahippocampal gyrus (Detects mismatch between perceived and expected activity)
What are the 3 main forms of auditory hallucination?
- Second person - Voices which directly address the patient
- Third person - Voices which discuss the patient or provide a running commentary of their actions
- Thought echo - Patient experiences their own thoughts spoken or repeated out loud
What is olfactory hallucination?
False perception of smell
What is gustatory hallucination?
False perception of taste
What is somatic hallucination?
False perception of bodily sensation (E.g. Insects crawling under skin, sensation of being touched)
What is passivity phenomenon
A phenomenon in which the patient experiences their behaviour as being controlled by an external agency, rather than by themselves
What is thought insertion?
The delusion that someone is placing thoughts in your head
What is thought withdrawal?
The delusion that someone is removing thoughts from your head
What is thought broadcasting?
The delusion that people around you can hear your thoughts
What is this an example of:
“Patient feels they are being controlled via telepathy or via a spirit who opens and closes the back channels of their brain to release words and hold back the truth”
Passivity phenomenon
Describe the pathophysiology of passivity phenomenon
Abnormalities occur in the parietal and cingulate cortices, which are involved in interpretation of sensory information
What is a thought disorder
This is a disorder of the form of thought, shown by the patients speech or writing showing an abnormality in the way their thoughts are linked together
There is often disturbance in organisation, control and processing of thoughts
What are the 3 main types of thought disorder
- Flight of ideas
- Loosening of associations
- Neologism
What is meant by flight of ideas?
Words are associated together inappropriately because of their meaning or rhyme, so that speech loses its aim and the patient wanders far from the original theme
The patient jumps from topic to topic but with recognisable links such as rhyming, punning or environmental distractions
Example:
“How would you say you were at the moment?”
“I’m absolutely fine, and terribly busy, so I can’t give you long, thats a nice tie you are wearing, did you buy it in Paris? I love Paris in the sping-time, I love Paris in the fall. Fallen arches, you look as though you could have those, would you like me to cure them for you?”
Flight of ideas - Thought disorder
What is meant by loosening of associations?
The patients speech is muddles, illogical, difficult to follow and cannot be clarified
The patient talks fairly freely, but so vaguely that no information is given in spite of the number of words used
There may be jumps from topic to topic with no logical connection between them (Knights move thinking)
What is neologism?
An abnormality of speech in which the patient makes up a new word or phrase or uses existing words or phrases in bizarre ways which have no generally accepted meaning, but which have idiosyncratic meaning to the patient
What is a delusion?
A delusion is a false belief or a belief held on false grounds, which is inappropriate to the patient’s background
The belief will be held in the face of logical argument or evidence to te contrary and is not modified by experience or reason
What are the 3 parts of a delusion?
Form
Theme
Content
What is the form of a delusion?
The form of delusion is not the belief itself, but the way in which it is believed
What is the theme of delusion?
What the delusion is about, put into simple termsW
What are some common themes of delusions in depression?
- Disease
- Nihilism
- Poverty
- Sin
- Guilt
What are some common themes of delusion in schizophrenia?
- Control
- Persecution
- Reference
- Religion
- Love
What are some common themes of delusion in mania?
- Grandiosity
- Persecution
- Religion
What is the content of delusion?
A culturally defined aspect of the delusion, relating to current events
For example, the persecutor described in the theme will have a culturally specific form (E.g. IRA, Mafia) or a delusion of disease may be specific to current diseases (E.g. AIDS, Covid)
