Part 1

Question 1

Some methods of BT. 1. Systematic desensitisation

Answer 1

• Assumes that irrational fears and other forms of anxiety tend to decrease with continued exposure to fearful stimulus.
• The method is based on principles of classical conditioning, discovered by Russian psychologist Ivan Pavlov
• CC is a form of learning in which a neutral stimulus is paired with another (unconditioned) stimulus that naturally provokes a certain response. After several reputation the neutral stimulus becomes a conditioned stimulus and evokes similar response.
• It is used in treatment of phobias

Question 2

Types of Hypomnesias

Answer 2

Physiological - in healthy people is observed in cases of physical and especially mental fatigue. Disappears after taking a rest. Permanent physiological hypomnesia occurs in people of advanced age.

Pathological - It is also divided into transient (in depression) and permanent (in intellectual disability, dementia). It is of the earliest symptoms

Question 3

Define perception

Answer 3

Is a complex process of receiving information from the environment through our sensorial organs.

Question 4

What are tranquillisers?

Answer 4

Benzodiazepines

Question 5

Three core conditions are necessary and sufficient to promote change and growth. (humanistic approach)

Answer 5

1. Empathy - understanding the client’s experience from their perspective
2. unconditional positive regard - (the client is free to express any feelings, however negative, hostile or ambivalent they might be, without fear of rejection on the part of the therapist)
3. Congruence - (the therapist to be as authentic and genuine as possible)

Question 6

What is ambivalent (dual) thinking?

Answer 6

Intermediate between form and content of thought

Is the simultaneous occurrence of conflicting thoughts, attitude and decisions regarding the same object or situation. Usually it is combined with ambitendency (of, impulses, decisions and actions)

Schizophrenia - they experience both love and hatred for his father (ambivalence) who often comes to visit. When you try to shake hands with him, the patient hardly gives his hand, rapidly pulls it back (ambitendency)

Question 7

What are the BDs alternatives?

Answer 7

1 . NON BD hypnotics

2. SSRIs
3. Pregabalin
4. Hydroxyzine
5. Etifoxine
6. Low dose typical Aps and tricyclic antidepressants.
7. Beta blockers

Question 8

Psychodynamic therapy.

Answer 8

• Psychodynamic psychotherapy seeks the implementation of self-transformation and reconstruction of the individual through exploration of the unconscious roots of mental emotional problems and problematic behaviours.
  Normal functioning of client can be restored only through:
• Awareness of unconscious conflicts
• use of causal understanding (insight)

There are techniques for both

Question 9

What are Low-potency typical APs?

Answer 9

• Chlorpromazine, Chlorprothixene, Thioridazine)
• They also block substantially histamine, muscarinic acetylcholine (M1) and Alpha 1 adrenergic receptors in the brain
• All the above causes mild antipsychotic effect, anticholinergic effects, sedation and orthostatic hypotension.
• They are also termed “broad-spectrum” or “sedative” neuroleptics
• they are useful in psychomotor agitation and generally begin to exert a true antipsychotic effect at relatively higher doses.

Question 10

Cognitive therapy (CT)

Answer 10

• Focuses on identifying and changing specific maladaptive thought patterns.
• CT assumes that the person’s emotional reactions are produced not directly by the life events but the thoughts of the person in response to the events but by the thoughts of the person in response to the events.
• Negative explanations of events and ruminating on negative and thoughts sustain bad mood and could lead to depression. EX “I did not get the job, i am not good for anything” CT is considered most useful therapy for depressive disorders

Question 11

How many neuronal pathways are formed by dopaminergic neutrons?

Answer 11

4

1. Mesolimbic pathway
2. Mesocortical pathway
3. Nigrostriatal pathway
4. Tuberinfundibular pathway

Question 12

Describe the EPS adverse effects. Neuroleptic malignant syndrome.

Answer 12

• This is a life-threatening neurological disorder
• Characterised by quantitative and qualitative alternations of consciousness (agitation, delirium, coma)
• Extreme muscle rigidity, fever and autonomic instability (hypertension, tachycardia)
• IT is rare and usually develops at high AP dose, after a hurried switch to APs or when multiple AP drugs are used simultaneously
• This condition requires an immediate discontinuation of the offending AP and life support measures. Mortality rate is high.

Question 13

Catatonia diseases?

Answer 13

neurodevelopment disorders, psychotic, bipolar, depressive disorders

Question 14

What are physiological hallucinations? And types

Answer 14

They are regular companions of our dreams

Hypagogic hallucinations occur immediately before falling asleep

Hypnopompic are characteristic for the time of waking up.

Question 15

What is Alexithymia?

Answer 15

Closely related to emotiona intelligence. It is a deficiency in understanding, processing or describing own emotions. Such individuals often express their fears and bad mood through somatic symptoms

Individuals suffering form Alexithymia also have difficulty distinguishing and appreciating the emotions of others, which leads to abnormal emotional responding.

Question 16

What are antipsychotics?

Answer 16

Are used in treatment of the psychotic symptoms (delusions, hallucinations, disorganised speech and grossly disorganised behaviour) as well as the management of psychomotor agitation associated with schizophrenia and other psychotic disorders.

Question 17

Describe disturbance in memory. Types.

Answer 17

Memory is the ability of the brain to encode (registration), store (retention) and reproduce (reproduction/recall) traces of sensations, perceptions, thoughts and other experiences.

1. Quantitative - hypermnesia, hypomnesia and amnesia)
2. Qualitative - Almonesia, pseudomnesia and confabulation

Question 18

Diagnosis of delirium

Answer 18

Delirium can be associated with various somatic diseases (metabolic, systemic infections, hypoxia, hypoglycaemia, fluid and electrolyte imbalance, renal diseases etc)

• substance intoxication
• substance withdrawal

Question 19

How many models in psychotherapy?

Answer 19

There are 4 major theoretical models (approaches) in contemporary psychotherapy

1. The psychodynamic
2. Behavioural and cognitive behavioural
3. Humanistic
4. The family models

The therapeutic relationship aims to clarify the nature of client problems, to learn new ways of thinking and expression of feelings, to try out new behaviours.

some approaches are specific and some are integrative (new theoretical perspective and techniques)

Question 20

Kinds of flow of thought - Speed

Answer 20

Speed -
Accelerated (tachypsychia) - accelerated formation of new and fast reproduction of old associations, quick shifting from one topic to another - MANIA

Slowed (Bradipsychia) - Flow of thought is painful, poor and repetitive, speech is quiet and monotonous

Question 21

Adverse effects of APs. EPS

Answer 21

1. Extrapyramidal adverse effects (EPS)
2. Hyperprolactinemia
3. Metabolic syndrome
4. CV side effects
5. Other adverse effects.

Question 22

What is Korsakoff’s syndrome?

Answer 22

1. Severe impairment of registration, leading to anterograde amnesia with inability to acquire new memories
2. Disorientation to time, place and public events
3. Confabulations whereby patients fill the gaps in their memory.

Occurs in organic impairment of the central nervous system - dementia, chronic alcoholism, trauma, intoxication

Question 23

What is psychotherapy?

Answer 23

• It is a general term, with literal meaning of “healing of the mind”
• it takes place between two individuals where one is believed to be in psychological distress and chooses to discuss it with another one, (therapist)
• Therapist can work with families, groups and couples as well.

Is a process of helping people with mental health problems to implement changes in their thinking and behaviour, and to resolve tensions and conflicts.

Question 24

Quantitative disturbances of emotions.

Answer 24

Hyperthymia - an emotional state, characterised by pathologically elevated aesthetic emotions - excessive cheerfulness and joy or intense anger. Characteristic of mania

Dysthymia - An emotional state. Characterised by pathologically elevated asthenic (lack of energy, low) emotions - anxiety, sadness - characteristic of typical depression

Hypothymia - Reduced emotional tone and low emotional reactivity

Apathy - a complete loss of emotional reactivity. Together with abulia it is part of the apathetic abulic syndrome, characteristic of front lobe organic disorder.

Question 25

Disturbances of emotions. Definition and types.

Answer 25

Disturbance in interaction of human individuals with the environment - humans experience emotions as either pleasant or unpleasant depending on their attitude to the environment and the satisfaction of their needs.

Emotions reflect the attitude of individual to the surrounding environment or situation. They have specific significance to the individual.

Cerebral cortex and limbic system are the primary anatomical physiological substrates of emotions.

1. Qualitative and Quantitative

Question 26

What is a monoamine hypothesis?

Answer 26

• Hypothesis of depression that disorder is cause day a deficiency of the neurotransmitter (NTs) involved in the regulation of mood - Serotonin, noradrenaline and dopamine.

Question 27

Overvalued ideas.

Answer 27

Disturbances of thought content.

Are overestimations of real circumstances important to the individual (e.g. one’s own abilities, the mistakes made)

They are experienced with great emotional intensity and they intervene in their ability of patient to have reasoning and conclusions about ideas. (Their thinking is dictated by their mood - catathymic ideas) - leads to altered view of number of issues.

Over-valued can be positive (people in love idealise their partners, authors overestimating their work) or negative (student fear of failure even though they have prepared, mother fear of child getting disease).

Severe OV ideas can be morbid phenomena. They are characteristic of personality disorders - can lead to full blown delusions (Psychosis)

Question 28

What is depersonalisation?

Answer 28

It is a disturbance in one’s experience and awareness of self (in sense of self) - feeling of detachment or estrangement from one’s mental processes or body

Individual feels automatised or as if he/she is in a dream or movie.

They feel as if they are not the same or they have lost them selves.

Question 29

What is classification?

Answer 29

• Classification is taxonomic nomenclature system established for the purpose of statistical analysis of the phenomena and in order to facilitate and uniform the language of professionals in different countries.

Question 30

Methods of BT 2. Progressive relaxation training

Answer 30

• involves tensing and relaxing various muscle groups
• The aim is to reduce the tension in muscles, the heart rate and blood pressure
• and to reach emotional calmness

Question 31

What are dissociative disorders. Dissociative fungue

Answer 31

Dissociative Fungue - Is a sudden unexpected, travel usually caused by traumatic, stressful or overwhelming life events. The travel may range from brief trips (hours or days) to long (weeks or months) wandering, crossing numerous national borders and traveling thousands of miles.

During a fungue, individuals generally appear to be without psychopathology and do not attract attention.

Recovery is usually rapid and there may be no memory for the events that occurred during the fungue and amnesia for the traumatic events that caused the fungue e.g. after termination of a long fungue, a soldier remains amnesic for the wartime events in which the soldiers closest friend was killed.

Question 32

Obsession and Compulsion. Obsession.

Answer 32

Both are disturbances in thought content.

Obsessions are persistent ideas, thoughts, doubts, fears, memories, impulses or images that are experienced as intrusive and inappropriate. Individual senses that content of obsession is alien, not within their control and against their will and not the kind of thought they should have.

Some examples: becoming contaminated by shaking hands, need for things in particular order, intrusive counting things like steps, roadside lamppost etc, intrusive religion of names of things or definitions

Question 33

Adverse effects of APs. 2. Hyperprolactinemia

Answer 33

• Is caused by D2 receptor blockade in the tuberoinfundibular pathway is more common with typical APs
• In women significant rise in prolactin are associated with amenorrhoea, galatorrhoea and infertility.
• Lesser degrees of hyperprolactinemia are associated with sexual dysfunction in both genders.

Question 34

What are the valid reasons for discontinuation of BDs?

Answer 34

• Increase in symptoms that have been adequately controlled
• Memory or other neurocognitive impairments
• Alcohol, cocaine or medication abuse.

Question 35

What is Mesolimbic pathway?

Answer 35

It is formed by dopaminergic neurons located in the unclei of the mesencephalon that sends projections to the limbic system

• These neurons subserve mental processes such emotions, drives and satisfaction from pleasurable activities.
• Increased dopaminergic function in the mesolimbic pathway is hypothesised to be responsible for the psychotic (positive) symptoms of Schizophrenia.
• By blocking D2 receptors in the mesolimbic pathway APs effectively reduce psychotic symptoms.

Question 36

What is Nosology?

Answer 36

• Is a division of medical diagnostic committed to explanation and categorisation of nosographic entities

Question 37

Define dissociative disorders. What are they?

Answer 37

The essential feature of dissociative disorders is dissociation in the usually integrated functions of consciousness, memory, identity and perception of the environment. they are

1. Dissociative fungue
2. Trance
3. Possession trance

Question 38

BD alternative. Low dose APs and Tricyclic antidepressants.

Answer 38

• Have traditionally been prescribed as alternatives to BDs.
• In view of their greater toxicity (EPS, anticholinergic, antihistamine and antiadrenergic side effects) these drugs appear to be no safer choice weighed against the risk of dependence with BDs.
• Atypical APs have lower potential for EPS have been used as adjunctive treatment of treatment refractory anxiety disorders.

Question 39

Give some of the examples in medicine records of psychomotorics

Answer 39

Patient doesn’t speak (mutism)

patient doesn’t answer (negativism)

patient has immobility (stupor)

consciousness altered (delirium)

Question 40

Qualitative disturbances of emotions. Part 2. Fear, anxiety, agitation, panic

Answer 40

5. Fear - an unpleasant emotional state that involves psychophysiological changes in response to the real threat or danger. Varying degrees of intensity may be observed. From mild fear to horror. It is often protective for the individual and may be considered a normal sate. Pathological fears can be observed in anxiety disorders, psychotic disorders (secondary to delusions or hallucinations)
6. Anxiety - a feeling of apprehension in the anticipation of a possible threat or a vague menace. It is experienced in absence of threatening stimulus (unlike fear). Anxiety is more diffuse. It is accompanied by physical sensation - lump in the throat, knot in the stomach and others. It’s common in anxiety disorders and depression, psychosis, personality disorders, substance withdrawal.
7. Agitation - a state of motor restlessness resulting from severe anxiety; patients walk aimlessly around the room, sit and stand repeatedly, perform stereotypical actions.
8. Panic - an acute, intense attack of anxiety and discomfort accompanied by manifest symptoms of autonomic arousal. The anxiety is overwhelming and may be associated with a sense of impeding doom. Panic attacks occur in panic disorders and phobias.

Question 41

What are physiological illusions?

Answer 41

They are normal illusions caused by fatigue, forgetfulness, poor visibility, psychological attitudes, tense anticipation and especially strong emotions (fear)

Question 42

Cognitive-behavioural therapy

Answer 42

• It combines the cognitive therapy technique of changing negative or distorted thought patterns with the behaviour therapy techniques of changing maladaptive or disruptive behaviours by learning and practicing new skills.
• CBT encourages awareness of the irrational negative thinking and the way it influences the emotions and behaviour.
• CBT stems from the basic assumption that when the thoughts are negative, they will produce negative, faulty beliefs thus creating emotional disturbance.
• The therapist then will try to identify those beliefs.
• Next step are learning how thoughts influence behaviour; identifying automatic thoughts (negative messages in situations traditionally leading to negative feelings) and confronting the fears or anxiety provoking situations (exposure or desensitisation)
• Other commonly employed techniques are role playing, diary keeping, relaxation techniques and others.

Question 43

Describe the course of delirium

Answer 43

• It develops of hours to days, rarely abruptly (e.g. after a head injury) Delirium tends to fluctuate during the course of the day e.g. during morning rounds, the person may be coherent and cooperative but at night insists on pulling IV lines and going home to parents who died years ago.

It can last about a week

Question 44

Describe tuberoinfundibulnar pathway

Answer 44

Comprises dopaminergic neurons, located in the hypothalamus, that send projections to the anterior art of the pituitary gland and inhibit prolactin release by the pituitary.

• By blocking D2 receptors in the tuberoinfundibular pathway, APs may release prolactin secretion from dopamine inhibition and cause hyperprolactinemia

Question 45

What are pathological illusions?

Answer 45

Individuals firmly accept the distorted perception of an object to be reality.

Examples: delirium syndrome (rarely in cases of schizophrenia and other psychosis)

Illusions can be visual, auditory, olfactory, gustatory and tactile.

Question 46

Adverse effets of APs. 4. CV effects

Answer 46

• The metabolic adverse effects of APs can lead to higher risks of arterial hypertension, atherosclerosis and vascular incidents.
• APs may also increase the risk of arrhythmias, thrombotic and thromboembolic events.

Question 47

Compulsions

Answer 47

Are repetitive types of behaviour (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently), the goal is to prevent anxiety or distress that accompanies in obsession.

The patient recognises that both compulsion is obsession is not normal and painfully attempts to resist them, the inability causes marked anxiety or distress and it is one of the most distressing states in psychiatry.

Question 48

Disturbance in form of thought? What is disorganised (loose) thinking?

Answer 48

Is a form of thinking with coarsely broken logical connection between words arranged in grammatically correct sentences

“How are you feeling?”
“Because the sun is growing in our house”

One can find words that are new and none-existent in the language.

Examples: schizophrenia

Question 49

Typical Antipsychotics

Answer 49

• Pharmacologically, atypical APs (clozapine, olanzapine, quetiapine, risperidone, paliperidone, ziprasidone, sertindole, aripiprazole, amisulpride)
• They not only block D2 receptors but also serotonin type 2A receptors (5HT2A)
• 5HT2A are expressed on the cell bodies and axons of dopaminergic neurons - normally endogenous serotonin agonist blocks the dopamine release.
• These drugs block those receptors and release the dopamine in the 4 dopamine pathways.
• They are as efficacious with positive symptoms of schizo but cause less hyperprolactinemia and fewer EPS than typical APs, they do not worsen the negative symptoms of Schizo.
• They also act as either agonist or antagonist in variety of receptors in the brain (dopamine, serotonin, muscarinic, adrenergic)

Question 50

What are the differences between delusional and over valued ideas?

Answer 50

Delusional ideas cannot be corrected by logical persuasion or personal experience, unlike obsessional thoughts the patient has no critical attitude towards them.

Question 51

Describe the EPS adverse effects. 1. Parkinsonism

Answer 51

1. Parkinsonism

• This develops in the first days and weeks after initiation of treatment.
• Characterised by typical clinical triad of tremor, rigidity and hypokinesia.
• It responds to AP dose reduction, the addition of anticholinergic medications (biperidene) or a switch to an atypical antipsychotic.

Question 52

Methods of BT 3. modelling

Answer 52

• Is a type of learning new behaviour by watching and imitating others
• Therapist could teach clients desirable behaviour by demonstrating this behaviour
  e. g. Therapist shows the patient how to keep calm in anxiety provoking situations or shows special filmed movies
• It is an important part of social skills training and training of assertive behaviour, ex: coping in social situations, communicating more effectively, expressing freely etc.

Question 53

What are the contraindications of BDs?

Answer 53

BD use is absolutely contraindicated in myasthenia graves, severe respiratory disease, sleep apnoea, and probably also in pregnancy.

Question 54

what are the main symptoms of Catatonia?

Answer 54

Stupor - no psychomotor activity; not actively relating to environment.

Catalepsy - Passive induction of a posture held against gravity

waxy flexy - slight, even resistance to positioning by examiner

mutism - no or very little verbal response

negativism - opposition or no response to instructions or external stimuli.

posturing - spontaneous and active maintenance of a posture against gravity

mannerism - odd, circumstantial caricature of normal actions.

Stereotypy - repetitive, abnormally frequent, non-goal- directed movements

agitation - not influenced by external stimuli

Echolasia - mimicking another’s speech

Echopraxia - mimicking movements

Question 55

What are physical illusions?

Answer 55

They are caused by physical properties of environment around someone. For example light propagation laws - e.g. mirages in desert; spoon that looks as if its broken when half submerged into water and so on.

Question 56

what is volition?

Answer 56

Volition is a state of energy and impulse, which guides our purposeful activity of the mental and physical activity.

3 stages:

1. Choosing a purpose
2. Making a decision after a struggle of motive and counter - motives.
3. Implementing the decision - acting or refraining from action in order to achieve the purpose.

Question 57

Describe Mesocortical pathway

Answer 57

It is formed by dopaminergic neurons located in the uncle of the mesencephalon and send projections to the cerebral cortex (most importantly, the frontal lobe)

• These neurons participate in mental processes such as attention, motivation, socialisation, planning and initiation of activities.

Decreased dopamine function in the mesocortical pathway is hypothesised to be responsible for the negative symptoms schizophrenia (emotional flattening, apathy, lack of initiative, associality and poverty of speech) - by blocking D2 receptors in the mesocortical pathway, some APs may worsen the negative symptoms of schizophrenia.

Question 58

Adverse effects of BDs?

Answer 58

• Anterograde amnesia seldom causes clinical significant dysfunction
• Sedation, somnolence
• Sensorimotor impairement in healthy subjects (although may improve it in anxiety patients)
• Gradual accumulation of psychoactive metabolites during continuous treatment may put patient at risk during machinery operation or driving.
• Physical dependence

Question 59

Adverse effects of APs. 5. Other adverse effects

Answer 59

• Less frequent adverse of APs include epileptic seizures, hepatotoxicity, toxic myocarditis and pancreatitis, blood dycrasias, etc.
• Potentially fatal agranulocytosis has been reported in less than 1% of clozapine treated patients.
• Blood cell counts are warranted weekly in the first 6 months of treatment and at least monthly thereafter in clozapine treated patients.

Question 60

Disturbance in form of thought? What is incoherent (uncoordinated) thinking?

Answer 60

Is a heavy disintegration of thinking - the grammatical structure of sentences is coarsely disrupted along with the logical one. Single parts of sentences or even single words (the so called verbal salad) are “tangled” together without any sense

Occurs on the background of altered consciousness

Delirium

Question 61

What is a transient and permanent physiological hypermnesia?

Answer 61

Permanent - innate feature of individual

Transient - observed in people who have experienced danger of death, or any other feat for their life

Question 62

Contraindication of APs

Answer 62

• Absolutely contraindicated in patients with hypersensitivity, neuroleptic malignant syndrome and coma
• APs should not be used in patients with delirium
• Should be used carefully in Parkinson’s disease, history of neuroleptic malignant syndrome, epilepsy, blood dycrasias, rhythm and conduction disturbances, in heart failure, respiratory, hepatic and renal insufficiency as well as in febrile and elderly people.
• In pregnant women APs are to be used only if the perceived benefits outweigh the risk for the developing foetus.

Question 63

Quantitative disturbances of consciousness.

Answer 63

1. Obnubilation - cloudy, gloomy
2. Somnolence - sleep, sleepiness
3. Sopor - Profoundly deep sleep, stuporouness
4. Coma - deep sleep, unconscious state

Only vital unconditional reflexes are cardiovascular and respiratory are kept, when the cause of coma cannot be eliminated, they are also suppressed and death occurs.

observed in organic damages to the central nervous system (infection, intoxications, traumas, strokes, tumours, metabolic disturbances)

Question 64

What are the types of disturbance of perception?

Answer 64

1. Illusions
2. Hallucinations
3. Dissociative phenomena

Question 65

Classification of AntiPsychs. 1. Typical APs

Answer 65

1. Typical APs:
   - Typical APs block D2 receptors in 4 dopamine pathways without binding to serotonin (5 hydroxytryptophane or 5HT) receptors in the brain.

• Despite individual differences all typical APs cause EPS and hyperprolactinemia when used in therapeutic doses.
• However, classifying APs into high-potency and low-potency typical APs depending on their affinity for the D2 receptors is of greater clinical relevance.

Question 66

Behavioural therapy (BT)

Answer 66

• BT is based on assumption that mental problems often consist of learned maladaptive responses.
• It focuses on changing specific behaviours rather than the possible unconscious factors.
• BT is used in depression, OCD, PTSD, personality disorders, eating disorders, phobias, schizophrenia, alcohol and substance use disorders, insomnia, paaraphilas.
  The therapist provides learning-based treatments and helps the client:
• Make a plan for solving specific problems
• Eliminate undesirable thoughts
• To develop new ways of thinking and new behaviours

Question 67

Example of disease for circumstantial/viscose thinking

Answer 67

Epileptic personality change, certain personality disorders and dementia

Question 68

Types of delusions

Answer 68

Paranoid - Persecutory, reference, influence and destruction, litigious

Grandiose - Gradiose, invention and reformation, gentility

Sexual - infedility, erotomanic (love)

Depressive - hypochondriacal, Nihilistic, improvement and destitution, theft

Question 69

Types of disturbance of volition. Hypobulia

Answer 69

Is decreased volitional activity, in which necessary or usually pleasant activities are difficult to perform.

there is decrease in desire and incentive to work, lethargy, inactivity, and reduction of physical activity.

it can affect any or all of the three stages of volition

e.g. depression, mental retardation.

Question 70

Delusions. Influence and destruction + Litigious delusions

Answer 70

I & D: Patients are convinced that they are subject to physical influence (by specially designed EM waves, hypnosis, telepathy, cosmic rays, radar devices) and psychological control (their enemies can read and steal their thoughts, insert thoughts inside their heads, guide their actions)

Litigious delusion (Querulous paranoia) is a delusional conviction that various persons maliciously act to the detriment patient’s interests leading to a delusional passion to protect them by numerous pleas, complaints and claims to the police, court state institution and so on. 
All their activity is directed towards the collection of “evidence” and sometimes they spend all their money on litigation.

Question 71

Define Attention.

Answer 71

Attention is attracting or directing one’s awareness towards certain objects, phenomena or problems.

When it is attracted by objects - it is called passive (involuntary) attention
when its directed to them - its called active (voluntary)

Passive attention may be attracted by appearance of new stimuli, depending on their absolute or relative power, strangeness as well as their sudden change.

active attention is nothing other than volition, focused on cognitive activity
Attention is closely related to waking consciousness (alertness)

Question 72

What is the difference between illusions and dissociative phenomena?

Answer 72

The difference is that DP the objects themselves are identified correctly, they are familiar but seem changed to the individual. Insight is preserved.

Question 73

What are visual hallucinations?

Answer 73

Can be simple: photopsias: (brightly coloured spots, flashes)

Or complex: objects, animals, people, scenes - Sometimes colourless, sometimes bright

Can be relatives, acquaintances, late neighbours, strangers, historical figures, monsters

They strongly agitate psychiatric patients.

Question 74

What is definition of Hallucinations and what are the types?

Answer 74

They are perceptual experiences of images, objects and phenomena in the absence of actual stimulation of the sensory system

Types:

1. Physiological (hypnopompic, hypnagogic)
2. Auditory (simple and complex)
3. Olfactory
4. Gustatory
5. Tactile

Question 75

2. Humanistic psychotherapy

Answer 75

• Humanistic school offers a new view of the human nature, distancing itself from the somewhat dark and rather dehumanising views of the other two traditions
• Its views are optimistic, and emphasis is on trustworthiness of the human nature and the desire for personal fulfilment and growth.
• Rogers basic assumptions holds that every individual has the capacity to grow within one’s self actualising tendency, the client is best authority and not be directed or instructed by the therapist.
• Rogers believes “it is the client who knows what hurts, what directs to go in what problems are crucial”

Question 76

What are cholinergic effects?

Answer 76

Muscarinic symptoms

• Salivation
• Lacrimation
• Urination
• Defecation
• GI cramps
• Emesis

Nicotinic effects

• Muscle cramps
• Tachycardia
• Weakness
• Twitching
• Fasciculations

Question 77

What are the quantitative disturbances in memory?

Answer 77

1. Hypermnesia - represents enhanced memory function i.e. an increased ability to memorise, a long duration of memory trace retention and an ease and speed of their reproduction. It can be psychological (innate feature) and pathological.
2. Hypoamnesia - reduced capacity of all or some memory processes (registrations, retention or reproduction). Can happen in healthy individuals or pathological.
3. Amnesia - partial or complete loss of memory of what has been experienced over period of time or of a single event. With respect to etiology, two types of amnesia are distinguished - psychogenic and organic.

Question 78

What are sexual delusions?

Answer 78

1. Infidelity (delusions of jealousy): of all delusional ideas are the closest to reality in their credibility. E.g. He has a conviction that his wife is cheating on him. Should be very precise whether there is any absurdity in the statement or it might become subject to correction by way of persuasion in view of the specific facts. E.g. Alcohol induced delusional jealousy (patient claims his wife arranges dates with ppl with a glance)
2. Erotomanic delusions. They have a delusional conviction that other people are in love with the patient, every act is interpreted as being expression of their love. People cannot express their love openly to them out of shyness, lack of courage. Patients keep on seeking meetings with their “admirers” to express themselves.

Question 79

Etiopathogenesis of ADHD

Answer 79

• Biological factors - low birthweight, smoking during pregnancy, alcohol exposure, infections (encephalitis), first degree biological relatives of individuals with ADHD
• Psychological factors - behavioural inhibition, negative emotionality, elevated novelty seeking are risks traits for ADHD
• Social factors - child abuse and neglect increase risk

Question 80

What are the differences between obsessional and delusional ideas?

Answer 80

The patient with a delusion is struggling for his ideas (i.e. to persuade other people), while the patient with an obsession is struggling against them (i.e against the appearance of obsessive idea in his consciousness)

Question 81

Indication of BDs.

Answer 81

• BDs are indicated for the management of anxiety disorders, alcohol withdrawal, agitation, insomnia, adjustment disorders and as adjunctive treatment in depression and other mental disorder.
• Can be used in the treatment of anxiety disorders such as GAD, panic disorder, agoraphobia, social anxiety disorder, anxiety disorders due to somatic diseases, substance induced anxiety disorders as well as situational anxiety.
• BD can also be used acute stress disorder but their use in post traumatic stress disorder is debatable.
• can be used as hypnotics

Question 82

Interpretation

Answer 82

• Consists of making sense of content that has been repressed at unconscious level.
• If a client accepts an interpretation, he/she often experiences an insight - a sudden burst of understanding which has therapeutic value.

Question 83

Describe high-potency typical APs

Answer 83

• Haloperidol, flupentixol, fluphenazine, zuclopenthixol are high affinity D2 receptor antagonists that practically do not bind to other receptors in the brain.
• This receptor binding profile accounts for a potent antipsychotic effect at the cost EPS and hyperprolactinemia in therapeutic doses.
• These drugs are sometimes referred to as “cutting neuroleptics” because they produce a rapid resolution of delusions and hallucinations.

Question 84

What are pseudohallucinations?

Answer 84

Hallucinatory experiences in each sensory modality, which patients locate in their subjective mental space.

Which True H’s are located in the external for the subject area (“i hear voices that speak to me from the other room”) PH’s are located in the inner “physicality” of the patient (“voices speak to me via the device, which is implanted in my brain”)

Question 85

How does GT work?

Answer 85

• The therapist acts as a facilitator; an individual who mediates between members of the group and allows everyone a chance to participate.
• All psychotherapeutic approaches can be conducted in a group setting. Group therapy has several features not found in individual psychotherapy format:

1. Therapist observe client’s interaction in a real social situation.
2. Clients could feel relieved listening to others and recognising that many people have difficulties, similar to or more severe than their own.
3. Group’s cohesiveness helps members to bolster their self-acceptance and confidence.
4. Clients learn from one another ideas for solving problems and give and receive honest feedback.

Question 86

Disturbance of psychomotorics. 1. Psychomotor retardation

Answer 86

1. Psychomotor retardation - it includes a delay in the start of a movement, slowness in its implementation and reduction of the total amount of movements.

it may cause a visible slowing down of physical and emotional reactions including speech and affect.

it occurs in cases of depression and as a side effect of certain medicines such as benzodiazepine.

Question 87

Group therapy.

Answer 87

• form of psychotherapy conducted in group settings.
• Found to be highly effective in substance abuse and alcohol dependence.
• Open and close.
• Open groups allow members to enter or leave the group at any time.
• Close. all members start and finish therapy together.

Question 88

BD alternative. Pregabalin

Answer 88

• Is used in treatment of GAD and is considered to have a low potential for dependence and abuse.

Question 89

Methods of BT. Positive reinforcements

Answer 89

• Reinforcement to help change of problematic behaviour.
• The therapist follows the operant conditioning principles,, establishing a link between the patient’s behaviour and its consequences. EX: “token economy” - distribution of tokens in psychiatric patients with severe mental disorders, after performing a desired behaviour;
• Token are then exchanged for other rewards (listening to music, going to cinema)

Question 90

What is disturbance of sensorial synthesis (Dissociative phenomena)

Answer 90

These include depersonalisation and derealisation. They occur as separate disturbance or as syndromes in dissociative disorders such as: fugue, trans, multiple personality

Question 91

BD alternative. SSRIs

Answer 91

• Are effective in most treatment of anxiety disorders.

- Compared with BDs, they have a slower onset of action, are non addictive and cause fewer withdrawal symptoms.

Question 92

Describe nigrostriatal pathway.

Answer 92

It is part of the extrapyramidal system and connects substantia nigra with the striatum.

• These neurons regulate muscle movements and tone.
• By blocking D2 receptors in the nigrostraiatal, APs can produce extrapyramidal side effects, including Parkinsonism, Akathisia, dystonias and tardive dyskinesia.

Question 93

Clozapine indications

Answer 93

• It has superior efficacy but numerous adverse effects
• It is used primarily in treatment-resistant Schizophrenia (in which psychotic symptoms do not respond satisfactorily to other 2 courses of other antipsychotic)
• It is also used in patient at high risk for aggression and/or suicide because of its specific anti-aggression and anti suicidal effects.
• Clozapine may also be useful in patients whose sensitivity to the EPS caused by other APs impedes effective antipsychotic treatment.

Question 94

What is consciousness.

Answer 94

Consciousness is the ability to place oneself correctly in the world by time, space and social reality and to be aware of one’s own personality.

Question 95

What is the duration of action of BDs?

Answer 95

Depending on their duration of action BDs can be categorised as either:

• short-acting or minimally accumulating BDs (Alprazolam, lorazepam, oxazepam, bromazepam)
• Long-acting or accumulating BDs (diazepam, clorazepat, chlordiazepoxide, nitrazepam, medazepam, clonazepam)

Question 96

What is psychiatric rehabilitation?

Answer 96

• Activities aiming the restoration of functioning of patients with severe mental disorders.
• Primary goal of psychosocial rehabilitation is to help individuals with mental disorders to establish emotional, social and intellectual skills, needed to live, learn and work in the community

Question 97

BD alternative. Hydroxyzine

Answer 97

• Is a first generation antihistamine commonly used in clinical practice.
• It is not superior to BDs in the long term treatment of anxiety.
• Hydroxyzine has much lower potential for dependence and abuse.

Question 98

Qualitative disturbances of emotions (part 1) - Parathymia, Euphoria, Dysphoria, Anhedonia

Answer 98

1. Parathymia (inappropriate effect) - an emotional state in which reaction is highly irrelevant to the stimulus that caused it or to the circumstances in general (laughter instead of tears, fear instead of anger) - observed together with paramimia (inappropriate mimic expression) or parabolic (inappropriate volition activity) in Schizophrenia.
2. Euphoria - excessive cheerfulness inappropriate to the circumstances, accompanied by poor insight and judgement. Observed in substance intoxication (alcohol, amphetamines). Moria is variant of euphoria occurs in front lobe organic disorder and is characterised by cheerful mood with deposition of silliness, flat humour, silly jests and decrease in insight and initiative.
3. Dysphoria - semantically and phenomenologically opposite of euphoria. It is gloomy mood accompanied with irritability or anger that easily escalate in aggression. It can be observed in organic brain impairment, epilepsy, mania and schizophrenia.
4. Anhedonia - an inability to feel pressure, there is lack of interest in withdrawal from usual pleasurable activities such as hobbies, sex, social interactions etc. It is common in depression.

Question 99

Describe the EPS adverse effets. 4. Tardive dyskinesia

Answer 99

• These are repetitive, involuntary, purposeless movements which develop late (month or years) after the initiation of treatment
• Most commonly they affect the facial muscles and present with grimacing, tongue movements, smacking and protrusion of the lips.
• They are often refractory to treatment
• They respond partially to a switch from offending AP to clozapine but also paradoxically to an AP dosage increase.

Question 100

What is perseveration?

Answer 100

Type of flow of thought (continuity)

Multiple senseless repetitions of the same words, parts of sentences or whole sentences, it is observed in epilepsy, obsessions and organic damages to the central nervous system.

Question 101

What are grandiose delusions? Types

Answer 101

1. Grandiose: patient feels like they are gifted with exceptional abilities. They believe they are beautiful and people are in love with them. They believe they are good at music, literature and they have good future ahead of them.
2. Delusions of invention and reformation: patients believe they have had major discoveries and inventions. Absurd theories for radical transformation of the society
3. Delusions of deity and reformation: are usually absurd- patients are direct descendants of God, they identify themselves as Jesus Christ and Virgin Mary, they are of royal lineage.

Question 102

Paranoid delusions. Persecutory and Reference

Answer 102

1. Persecutory delusions: most frequent, Patients convinced they are persecuted by personal enemies, terrorist organisation, government authorities, foreign intelligence agents. Pursuers watch them, spy on them, discredit them in eyes of society, put poison in their food, prepare assaults, plan executions
2. Reference: (“self-referential”, sensitive delusions) are expressed in the morbid suspicion that certain events concern the patient. It seems to the patient that strangers on the street talk about them. “Exchange peculiar glances” “wink at each other” , make signs and mimic them. They are discussed in the newspaper and television.

Question 103

Describe the EPS adverse effects. 3. Acute dystonias

Answer 103

• They also occurs hours to days after the initiation or a rapid increase in the dose of an AP medication.
• Dystonias are sustained involuntary contractions of muscle groups in regions of the face, neck, torso, pelvis, extremities and sometimes even the larynx.
• They experienced subjectively as extremely stressful
• Usually resolves within 30mins of IV application of biperidene and require preventive treatment with oral anticholinergic medications, reassessment of choice of AP and its dosage regimen.

Question 104

What is emotional intelligence?

Answer 104

It is the ability to identify, assess and control the emotions of oneself, of others and of groups. It includes both interpersonal intelligence (the capacity to understand the intentions, motivations and desires of other people) and interpersonal intelligence (the capacity to understand oneself, to appreciate one’s feelings and fears and motivations)

Question 105

Techniques for exploration of unconscious. FREE ASSOCIATION

Answer 105

FREE ASSOCIATION:

• One of the principle tools in psychoanalysis
• It consists of saying anything that comes to client’s mind such as thoughts, feelings, memories, associations, without concerns, for logic or appropriateness.
• Freud believed that free association method allows to avoid conscious censorship and push unconscious material to appear in consciousness
• Ideas obtained by free association can be discussed with the therapist at a conscious level.

Question 106

How is BDs discontinuation done?

Answer 106

• it should be carried out slowly with biweekly reduction of 1/8 or 1/10 of the total daily dose
• Switching to longer acting BDs may be considered because SA BDs are associated with more withdrawal symptoms.
• Discontinuation should be attempted in time periods of low stress.
• Patient should be warmed in advance about temporary discomfort lasting several days after BD cessation is to be expected and that gradual dose reduction is the best practice not only with BDs but with any medication.

Question 107

What are the target groups for psychiatric rehabilitation?

Answer 107

Patients with:

• Prolonged illness duration
• Frequent relapse
• Maladaptation in the society and role incapacity

Question 108

BD alternative. NON-BD hypnotics

Answer 108

• Zolpidem, Zaleplon, Zopiclone, Eczopiclone
• Differ from BDs in molecular structure but act on the same benzodiazepine receptors, cause similar adverse effects and may be subject to abuse and addiction.

Question 109

Techniques for exploration of unconscious. RESISTANCE

Answer 109

• Is probably the most common defence employed by clients in therapy, as therapist’s interventions can be perceived as threatening.
• Some truths about the client are unwelcome and the only way of dealing with the anxiety, would be by turning away and avoiding them.
• Resistance contributed to the development of Freud’s concept of repression and defence mechanisms.

Question 110

What are the types of pathological hypermnesia?

Answer 110

Permanent - occurs in milder form of intellectual disability, where it makes a strong impression because it contrasts with low intellect. Here it comes to “mechanical memory” with retention and reproduction of numbers (e.g. telephone, house numbers etc), poems and excerpts from speeches (without understanding the content)

Transient - manic states. Patients keep constantly remembering yet other and other things from the past. It occurs very rarely following concussion.

Question 111

How does FT works?

Answer 111

• Often a families enter the therapy process with a so called “identified patient or client” - family member with symptoms that are most obvious
• They may believe that the problem is contained within the identified person - son, daughter etc
• The family format gives the therapist a view of the way the identified client interact with others and provides a forum for discussion.
• Many varieties of families have been developed.

Question 112

What is Pseudophilosophising?

Answer 112

Occupies intermediate position between disturbances of form and content

It is tendency to talk “turgidly”, “pseudo-philosophically”, pseudo-scientifically, using foreign words

A politician

Question 113

What is qualification?

Answer 113

• is attributing of certain quality to a given object of observation.
• This quality for medicine is regarded “pathology” or “abnormality” as a deviation from referent borders of normal values for biological measures. e.g. values of glucose above 5.5mmol/l is considered pathological condition.

Straight paradigm and reverse paradigm (absence of pathology - mental health)

Question 114

What are depression delusions? Types:

Answer 114

1. Delusions of guilt: they constantly feel guilty before their relatives, society, team and whole mankind. They feel that they have committed serious crimes which cannot be redeemed in through severe punishment. They find fatal mistakes in them, feel like criminals.if they are religious they feel like they have sinned. E.g. DEPRESSION
2. Hypochondriacal delusions: patients are convinced that they are suffering from severe incurable diseases (cancer, AIDS) and no medical examinations can possibly dissuade them.
3. Nihilistic delusions: extreme versions of hypochondriacal delusions. They say their organs (heart, liver) have disappeared or melted and even sometimes deny their existence.
4. Impoverishment and destitution: see themselves as being extreme material deprivation, they are doomed together with their families to starve to death - major depression.
5. Theft - old age patients their neighbours and thieves, break into their homes and steal their belongings, food, clothes and pension money.

Question 115

Disturbances of active attention.

Answer 115

Hyperprosexia - A morbid enhancement of active attention. it is observed in hypochondriac and obsessive syndromes, depression etc

Hypoprosexia - a morbid weakening of active attention. The affected individual can’t “remain with purpose” focus on a particular activity or particular content for enough time - occurs in mania, anxiety disorders, mental retardation and some personality disorders.

Aprosexia - an underdevelopment or a complete loss of active attention - dementia, severe catatonic stupor or excitement.

Question 116

Disturbance of pyschomotorics. 2. Agitation

Answer 116

It is a condition of excessive motor activity (of involuntary and purposeless movements), accompanying the tension and anxiety. Experienced by depressive patients.

e.g. patient knocks on door, asking about something, but suddenly cuts the question short and walks away then repeats same sequence of actions as soon as door is closed.

may also occur in OCD disorders, mania and it may be as a result of excessive use of stimulants.

Question 117

ADHD -

Answer 117

• The individual exhibits inattention and/or hyperactivity-impulsivity, in many settings (home, school, work) beginning in childhood and often persisting into adulthood
• inattention to a degree that is inconsistent with his/her age and often:
  
  • fails to give close to attention to details or makes careless mistakes
  • Has difficulty sustaining attention
  • Does not seem to listen when spoken to directly
  • does not follow through instructions
  • avoids and dislikes tasks that need mental
  • has difficulty organising tasks and activities
  • forgetful in daily activities

Question 118

Define Possession trance

Answer 118

an alteration of consciousness, with the replacement of customary sense of personal identity by a new possessing identity, usually spiritual in nature (e.g. spirits of dead, supernatural entities, Gods, demons) which the individual can hear or see.

These possessing entities have entered the body, control and command the individual, who performs stereotyped and culturally determined behaviours.

There is full or partial amnesia for the event.

Question 119

BD alternative. Etifoxine

Answer 119

• Is the only selective non-BD anxiolytic which does not cause attention and memory impairments and is not addictive.
• It is also not associated with discontinuation symptoms.

Question 120

What is sociotherapy? “relationship therapy”

Answer 120

• Sociotherapy is a process of relearning of social roles and interpersonal behaviour through the experiencing of social interactions, it requires behavioural change, coming from exerpeinces of new, satisfactory ways of interpersonal interactions.
• Is a term used for any treatment emphasising modification of the environment and improvement in interpersonal relationships rather than intrapsychic factors.
• This requires efforts of specialists to help chronically distressed individuals adapt to an environment where they can learn, live, work and grow.
• Multidisciplinary activity,

Question 121

Disturbances in thought content - 2. Obsessions? Types?

Answer 121

1. Obsessions

2. Compulsions

Question 122

Types of psychogenic amnesia.

Answer 122

1. Localised - the individual fails to recall events that occurred during a circumscribed period of time, usually the first few hours following a profoundly disturbing event (e.g. a survivor of accident with a family member who has been killed may not remember things for next 2 days)
2. Selective amnesia - the person can recall some but not all of the events during a circumscribed period of time. (Combat veteran can only recall certain moments of their combat experience)
3. Generalised amnesia - failure to recall encompasses the persons entire life. Individuals with this rare disorder usually present to police or emergency rooms.
4. Systematised amnesia - is loss of memory for certain categories of information, such as memories relating to ones family or to a particular person

Question 123

Disturbances of passive attention.

Answer 123

1. Morbid enhancement - characterised by prominent distractibility. Every casual or new stimulus attracts the attention of the patient and distracts it. Combined with weakening of active attention - Mania
2. Morbid weakening - It is observed in the disturbances of consciousness e.g. delirium, obnubilation or somnolence. it can be temporarily surmounted by over-straining active attention.

Question 124

What is achieved from FT?

Answer 124

• To reduce the resistance of the family to change
• To help family learn new patterns and new communication interaction.

Its proven efficacy in schizophrenia, personality, bipolar and eating disorders.

Question 125

Types of disturbance of volition. Catatonia

Answer 125

The essential feature of catatonia is a marked psychomotor disturbance that may involve decreased motor activity, decreased engagement during interview or excessive and peculiar motor activity.

Question 126

Kinds of flow of thought - continuity

Answer 126

Circumstantial thinking - patient’s account is full of unnecessary details and numerous repetitions that do not facilitate but obstruct comprehension and make the listener weary

Individual is unable to separate main idea from the secondary one, the significant from the insignificant.

Combined with “viscosity” - they keep refusing to close current topic and shift to a new one, they keep repeating same thing again and again

Question 127

Mechanism of action of Benzodiazepines?

Answer 127

• Enhance the inhibitory effect of gamma-aminobutyric acid (GABA) on neuronal excitability resulting in sedative, hypnotic (sleep inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties.

Question 128

What is autistic thinking

Answer 128

Intermediate between form and content of thought

Characterised by a detachment from reality, closing in one’s own abstract, unreal inner world. The individual focuses on a narrow range of issues that are “elaborated” without actually checking the facts, often based on symbolic and delusional interpretations.

Question 129

Dream analysis

Answer 129

• Is central feature of psychoanalytic therapy.
• Psychoanalysts believe that the dreams express impulses, fantasies and wishes, kept unconscious during waking hours by the dreamer’s defence mechanisms.
• Freud considered the dreams “the royal road to the unconscious”
• He asserted that the dream has two levels - 1. Manifest level (surface of the dream) and 2. Latent level (meaning of the dream, forbidden wish)

Question 130

Define trance

Answer 130

Is an alteration of consciousness, with the replacement of customary sense of personal identity with narrowing of awareness of immediate surroundings and stereotyped behaviours that are experienced as being beyond one’s control

It is half-conscious state characterised by an absence of response to external stimuli, typically as induced by hypnosis or entered by a medium.

Question 131

Stages of group therapy.

Answer 131

THREE STAGES.

• Initial stage: clients are concerned about whether they will be accepted into the group
• second stage: in which there is some competition for position within the social pecking order
• Third stage: In which members feel closely connected and trusting of one another (cohesiveness)

Question 132

Indications of atypical antipsychotics.

Answer 132

• Schizophrenia and treatment of psychotic symptoms in schizoaffective and delusional disorders, bipolar and depressive disorders, neurocognitive disorders, substance induced psychosis disorders and psychotic disorders due to somatic diseases.
• Effective as mood stabilisers in diff phases of bipolar disorders.
• Also used in non-psychotic mental disorders such as autism spectrum disorders, tick disorders, OCD, anxiety, personality disorders, behavioural disturbances in major neurocognitive disorder (dementia)
• Can be used in nausea and vomiting

Question 133

Qualitative disturbances of emotions. Part 3. Phobia, emotional lability, emotional retention and emotional ambivalence.

Answer 133

9. Phobia - a persistent, pathological, unrealistic, intense fear of objects or situations that results in their avoidance. Phobic person realises that the fear is irrational but, nonetheless less cannot control it. Phobic anxiety grow in intensity to the level of panic attack. It is cardinal symptom of specific and social phobias.
10. Emotional lability - mental state of excessive emotional responsiveness characterised by unstable and rapidly changing emotions (e.g. fluctuations between despondency and elation). Patients are unable to control their emotions (crying for no reason)
    Organic brain damage, anxiety, personality disorders and in healthy people due to fatigue or excitement.
11. Emotional retention - inability to give outward expression of subjectively experienced emotions, observed in depression and in some personality disorders.
12. Emotional ambivalence - mental state characterised presence of co-existing or quickly alternating conflicting emotions toward an object or situation. Occurs in combination with ambitendency. Mild version can be experienced in healthy individuals too

Severe in psychotic patients who have no insight in the nature of the opposing emotions and may experience a harrowing sense of identity loss.

Question 134

Define feeling, affect, mood, euthymia and synthymia.

Answer 134

Feeling - conscious subjective experience of emotions

Affect - the external expression of the internal emotional tone

Mood - a long-lasting pervasive emotional tone. It is more persistent and less intense.

Euthymia - A state full of emotional balance

Synthymia - a state in which emotions are appropriate to and in proportion with the circumstances as well as with the individual’s thoughts and actions.

Question 135

Qualitative disturbance of consciousness. Delirium

Answer 135

Delirium - The individual has disturbance of consciousness (i.e. reduced awareness of the environment) with impaired ability to focus, sustain, or shift attention.
Questions must be repeated because the individual’s attention wanders. the person is easily distracted by irrelevant stimuli. it may be impossible to engage in conversation.

The individual manifests cognitive (memory impairment, disorientation, language disturbance) and perceptual disturbances.

recent memory is impaired.

Individual is disoriented for time and place (believing to be at home rather than hosp) if mild, disorientation for time is common.

Speech may be rambling and pressured or incoherent with unpredictable switching from subject to subject.

Question 136

Example of disease in slowed thinking - Bradipsychia

Answer 136

Depression

Question 137

Methods of BT. Therapeutic punishment

Answer 137

• Punish a dangerous or disruptive behaviour with an unpleasant but not harmful stimulus, after the behaviour takes place (Ex: mild electric shock)

Question 138

What is psychomotorics?

Answer 138

It refers to the motor effects of mental activity. it involves the complex movements of the mimic muscles and the body, which reflect a person’s mental experiences and overall mental life; volitional activity and emotional reactivity find expression in psychomotorics

It includes detailed description of patient’s appearance (posture, gait, facial expression, mimics, gestures and manner of speaking and tone of voice)

Question 139

Types of organic amnesia

Answer 139

1. Retrograde amnesia - loss of memory for different periods of time before CNS injury with loss of consciousness - mins, hours, days, weeks or rarely months/years. Reproduction then is mostly affected. Observed in organic brain diseases accompanied by transient
   Loss of consciousness - craniocerebral/head trauma, asphyxia, poisoning, inflammation, intoxication, epileptic seizure. Recovery occurs from farthest to closest set of events
2. Congrade: is due to inability of registration during the loss of consciousness. Resulting in lack of memory traces for this period.
3. Anterograde - is loss of memory for events after regaining consciousness. It is therefore due to an impairment of the registration. I.e the ability to memorise.

Question 140

Family therapy.

Answer 140

• Broad term for methods for working with families with many different problems.
• begins by working with families that have schizophrenia.
• therapists believe that psychological symptoms are also product of dysfunctional families in which the client lives
• FT treats the family as a system in which each person’s actions trigger reactions from others and this is the way an individual’s behaviour is influenced by other family members.
• Family therapists have explored unhealthy communication patterns among family members as a factor that significantly contributes to psychological problems.

Question 141

Types of disturbance of volition. Abulia

Answer 141

is a complete underdevelopment or loss of voluntary activity. Underdevelopment of voluntary is observable in severe mental retardation.

Abulia in severe organic diseases of CNS, particularly of the frontal lobes, is frequently accompanied by apathy- the so called apathy abulia syndrome.

also observed in Schizophrenia with severe negative symptoms.

Question 142

Define disturbances in thought?

Answer 142

This is disturbance in 1. Flow (speed and continuity) 2. Form and 3. Content of thinking may be observed

Question 143

Types of disturbance of volition. Hyperbulia

Answer 143

1. Hyperbulia - is morbidly increased volitional activity; intensification of urges, increased impulsiveness, initiative and mobility.

characteristic of mania
The purpose changes fast and they are often contraindicatory.

decisions are made with almost no struggle of conflicting motives and when combined with extremely weakened social inhibitions are quickly acted out.

loss of inhibitions, leads them to inappropriate actions, like squandering money or sexual desires.

can also occur in personality disorders, addictions, paranoia syndrome (religious, inventive etc)

Question 144

What are delusions?

Answer 144

It’s a disturbance in thought content

Erroneous mental reflections of reality. They are impaired judgments and conclusions that cannot be corrected in a logical way. Can only be overcome biologically - TREATMENT

Characteristics: outright discrepancy with reality, they have confidence in their credibility and twisted logic (paralogical reasoning) which they use to justify them

Question 145

Intervention strategies within psychiatric rehabilitation.

Answer 145

1. Individual-centred - With principle aim the development of patient’s skills for interaction in a stressful environment
2. Ecological - Directed towards developing enviornemntal resources to reduce potential stressors

All patients with severe and chronic mental illness require rehabilitation. Many of them also have a history of substance abuse and of attempted suicide.
Psychiatric rehabilitation is often carried out under real life conditions, helping disabled persons to identify their personal goals.
It is also necessary to assess the individuals readiness for change, irrespective of the degree of psychotherapy, the practitioner must work with the patient’s “well part of the ego” trying to restore hope.

Question 146

What is derealisation?

Answer 146

Disturbance of perception of environmental realities, and it is experienced as a sense that the external world is strange or unreal for example:

• uncanny alteration in size or shape of objects - reduced, enlarged or distorted
• disturbance of one sense of time- time is perceived to pass very slowly reaching a complete stop or conversely to pass very fast up to a “run of time”
• disturbance of perception of movements.

Everything is alienated and distanced.

Question 147

Describe the EPS adverse effects. 2. Akathisia

Answer 147

• It usually occurs hours to days after initiation or increase in the dose of an AP medication.
• Patients experience an unpleasant sensation of inner restlessness that manifests itself with an inability to sit still or remain motionless.
• Akathisia responds to AP dose reduction to treatment with propranolol, benzodiazepine and anticholinergic medications.

Question 148

Describe amnesia and its types.

Answer 148

It is a partial or complete loss of memory of what has been experienced over a period of time or event. 2 types

1. Psychogenic: develops as psychological reaction of individual to traumatic events. It is characterised by a gap in recall for aspects of the individual’s life history that is too extreme to be explained by normal forgetting. These gaps are related to stressful events like sexual abuse, combat experience.
2. Organic amnesia - observed in various impairments of the central nervous system. Can be retrograde, congrade and anterograde.

Question 149

Disturbances in the thought content? 1. Delusions

Answer 149

1. Paranoid - Persecutory, Reference, Influence and destruction, Litigious
2. Grandiose (grandeur) - Gradiose, Invention and reformation, gentility
3. Sexual - infidelity, erotomanic (love)
4. Depressive (melancholic) - Guilt, hypohondrical, Nihilistic, improverishment and destitution, theft

Question 150

Taxonomy

Answer 150

• Is an aggregate of units of observation, in ascendant nd descendant hierarchical order and systematised according to selected principle and criteria. example is phylum, class, order,family, genus, species etc in biology
• In psychiatry H.Order is not strictly established and is liable to any modifications due to the influence of various theoretical paradigms, cultural and professional traditions.
• Because of this psychiatric taxonomy is mainly syndrome-based.

Question 151

Disturbances of thought content? 3. Over valued ideas

Answer 151

1. Positive

2. Negative

Question 152

Forms of sociotheraphy?

Answer 152

• Therapeutic society: specific hospital treatment programs based on partnership between patients and medical staff
• Patients clubs and sociotherapeutic groups (alcoholic anonymous)
• Occupational therapy - enables personal to participate in activities of everyday life

Question 153

Adverse effects of APs 3. Metabolic syndrome

Answer 153

• MS and CV disease are among the leading cause of death in patient with major mental disorders.
• Atypical APS (clozapine and olanzapine notably) are associated with an increased risk of obesity and abnormalities of glucose and lipid metabolism.
• AP treated patients should be assessed regularly for the emergence of metabolic syndrome.
• Management includes a switch to an AP with a more favourable metabolic profile, behaviour modification of patient’s diet and physical activities and sometimes medication treatment (e.g. metformin)

Question 154

What conditions are dissociative phenomena common in?

Answer 154

Temporal lobe epilepsy, organic damages to the central nervous system, depression, schizophrenia, dissociation, personality disorders

They can occur in milder forms in people in good mental health usually precipitated by severe stress

Question 155

Transference

Answer 155

• The feelings, that are projected or transferred from the client onto the therapist
• This term is central to psychodynamic theory
• Counterconference is used to describe the feelings in the therapist, brought about by the feelings and behaviour of the therapist.

Question 156

BD alternatives. Beta blockers.

Answer 156

• Are considered to exert most of their beneficial effects in anxiety through reducing many of the peripheral manifestations of anxiety such as tachycardia, sweating, flushing.
• These drugs can be useful in situational and performance anxiety.

Question 157

Define illusions and their types:

Answer 157

Illusions are distorted perceptions of actually existing objects and phenomena that are impinging (negative effect) on the sense

Types:

1. Physical
2. Physiological
3. Pathological

Question 158

Describe qualitative memory disturbances.

Answer 158

1. Alomnesias (memory illusions) - are very common in healthy people as well as in patients. They reveal the great plasticity of human memories and how they might change under the influence of basic attitudes of individual. Actual events are reproduced in modified manner or inaccurate manner, depending on individuals interest and emotional state at that precise time.
2. Pseudomnesias - unlike alomnesias, pseudomnesias are always pathological. Occur in Schzophrenia.
3. Confabulations - are invented, false memories which patients use to fill the gaps in their own memory. They are part of Korsakoff’s syndrome

Question 159

What are auditory hallucinations?

Answer 159

Simple - acoasms (chattering, gunfire, noise of water)

Complex - verbal (hearing voices)

Individuals hear footsteps, punches, crying, moaning, music, singing, whispering, screams, voices

Question 160

What is symbolic thinking?

Answer 160

Intermediate between form and content of thought

It is a symbolic interpretation of the spoken and written language of people, and/or a symbolic expression of one’s own thoughts. Words and expressions are attributed other random content, a new meaning, known only to the patient.

Schizophrenia.