Psych Flashcards
What are the types of memory disturbances?
Memory disturbances:
* Topographical - inability to orientate oneself
* Autobiographical/episodic (extrinsic memory) - specific events and issues related to onself
* Procedural (instrinsic memory) - memory/knowledge of “how to do things” aka unconscious motor skills like driving
* Semantic memory - “knowledge base” and is unrelated to specific experiences or events
What do the following mean?
1. Perseveration
2. Confabulation
3. Déjà vu
4. Ganser’s syndrome
5. Jamais vu
- Perseveration - an appropriate response to a stimulus the first time but then giving the same reponse incorrectly to a different second stimulus (almost exclusively in organic brain disease). This can be verbal or motor
- Confabulation - phenomenon whereby false memories occur and results in incorrect answers being given
- Déjà vu - phenomenon whereby the person feels the sense of familiarity of having encountered an event before, even though this is a new experience for them. Can be seen as a feature of frontal lobe epilepsy but can also be present in non-pathological states
- Ganser’s syndrome - unusual phenomenon whereby people give ‘approximate’ answers, among other symptoms, such as, ‘How many legs does a cow have?’ ‘Five’. It has caused considerable debate as to whether it represents an organic psychotic disorder or a dissociative disorder.
- Jamais vu - sensation that a familar event or place has never been encountered before
What is an illusion and what do these specific illusions mean?
- Affect illusion
- Completion illusion
- Pareidolic illusion
An illusion is a misinterpretation of a perception (unlike a halluciation where a new perception is experienced in the absence of a stimulus). These are usually not pathological.
Affect illusion - perception is altered depending on the mood state (i.e. frightened woman waking up from sleep and misinterprets a hanging gown as an attacker)
Completion illusion - lack of attention and a perception is incorrectly interpreted (i.e. skipping over a misprint in a book because you are tired)
Pareidolic illusion - shapes being seen in other objects (i.e. seeing animals in cloud formations). These become more vivid with concentration.
What is a hallucination and what do these specific hallucinations mean?
- Visual hallucination
- Tactile hallucination
- Extracampine hallucination
- Functional hallucination
- Hypnagogic hallucination
- Hypnopompic hallucination
- Reflex hallucination
A halluciation where a new perception is experienced in the absence of a stimulus
Visual hallucination - seeing something in the absence of a stimulus
Tactile hallucination - tactile (touch) sensation in the absence of a stimulus
Extracampine hallucination - false perceptions that occur outside the limits of a person’s normal sensory field (i.e. saying you are hearing other people speaking in another country)
Functional hallucination - where a hallucination is only experienced when an external stimulus is present in the same modality (i.e. hearing voices when listening to classical music)
Hypnagogic hallucination - hallucinations that occur on falling asleep
Hypnopompic hallucination - hallucinations that occur on waking up
Reflex hallucination - similar to functional but the stimulus is a different modality to the hallucination (e.g. woman with schizophrenia hearing voices every time her child looks at her)
How do you differentiate the following?
1. Delusional perception
2. Authochthonous delusion
3. Autoscopy
4. Delusional atmosphere
5. Delusional memory
Delusional perception - occurs when a normal perception is invested with a delusional meaning - gives it a whole new false and bizzare meaning (i.e. seeing a magazine cover and now believing a cult is trying to kill them)
Authochthonous delusion - one that arises out of the blue (and unlike delusional perception is not attached to a real stimulus). It should be distinguished from secondary delusions in which the beliefs are understandable in the context of the sufferer’s mood or history (e.g. a mood-congruent depressive delusion). A primary delusion is by definition un-understandable in any context
Autoscopy - sensation of seeing oneself, although aetiology and psychopathology is controversial
Delusional atmosphere - aka delusional mood. It refers to the state of perplexity or bewilderment in which sufferers feel that something is ‘going on’ but without being able to state exactly what. It often occurs prior to a delusion forming and the sufferer will often describe feeling odd and that everything around them has new ‘meanings’ and significance to them in particular
Delusional memory - when patients recall a memory from the past and interpret it with a delusional meaning
Schneider’s first rank symptoms
Delusional perceptions
Running commentary
Somatic passivity
Thought alienation - withdrawal and insertion
Thought broadcasting
Auditory hallucinations
What do the following speech abnormalities mean?
Logoclonia
Alogia
Dysarthria
Echolalia
Neologism
Logoclonia - the repetition of the last syllable of a word repeatedly (often seen in Parkinson’s). This is different aetiology to stammering or tics seen in Tourette’s
Alogia - extreme poverty of speech with “not having any words”. Commonly seen in severe negative schizophrenia or dementia
Dysarthria - difficulty in the manufacture of speech, commonly due to structural lesions to the vocal cords or brainstem
Echolalia - phenomenon where words/sentences that the patient hears are repeated back, sometimes continuously and incessantly. Often seen in organic causes like dementia or brain injury but also functional disorders like schizophrenia
Neologisms - creation of new words with specific meaning to them, usually linked to delusional beliefs
What are night terrors?
They are not the same as nightmares and they do not occur in REM sleep.
The sufferer (usually children) does not remember any bad dreams but will awake from sleep in a state of abject terror and confusion, often shouting and sometimes lashing out.
What is catatonia and what are its associations?
Catatonia is a state of either stupor in which the patient is entirely unresponsive or excited - it is associated with schizophrenia and many other conditions.
Catalepsy - limbs become rigid and some limbs move into unusual positions even if they are extremely uncomfortable (NOT TO BE CONFUSED WITH CATAPLEXY which is when there is a sudden and transient loss of muscle tone resulting in collapse)
Echolalia
Negativism - patients do the automatic opposite of what they are asked to do - patients are not ususally resisting instructions/movements but are actually attempting to perform the opposite instruction/movement
Do delirium tremens patients experience formication?
No, they may complain of visual hallucinations of small insects but formincations (the sensation of insects crawling over one’s skin) is usually seen in cocaine intoxication
What is chronic alcohol dependence associated with?
Vitamin B12 deficiency as a result of poor nutritional intake and a direct toxic effect of alcohol on bone marrow.
It is also associated with thrombocytopenia (as a result of vitamin B12 and folate deficiency), hypoglycaemia and hypokalaemia
How do you mange delirium?
There is usually an acute confusional state with a recognised cauitive factor (i.e. infection), the patient is usually older age and has fluctuating confusion
The first step is conservative management (i.e. side room, keeping light levels appropriate to the time of day, repeated reassuring - anything that would improve orientation of the patient)
If medication is needed, then you would consider low-dose antipsychotics like haloperidol (typical antispychotics with fewer anticholinergic effects)
Bezodiazepines are 2nd line agents but patients are prone to respiratory depression and “paradoxical excitation”
What are the psychiatric side effects of corticosteroid use?
Mania is the main side effect (steroid psychosis) but there can also be depression (less common), and the two can co-exist.
Depression can result from acute or chronic use, or discontinuation of corticosteroids - mediation by the HPA axis (for example depression is a common symptom in Cushing’s disease, as a result of chronic hypercotisolism)
*It can also cause delirium
What are signs of frontal lobe injury?
The frontal lobe is extremely vulnerable in traumatic brain injury - it often involves personality changes:
1. Inappropriate or “fatuous” affect
2. Lability and irritability of mood
3. Hypersexuality
4. Hyperphagia or overeating
5. “Childishness” or prankish josking (akak Witzelsucht)
*There is usually no insight into this change in behaviour
Other changes include poor concentration and “forced utilisation” - a strange phenomenon when patients will use objects they see in front of them irrespective of whether they need to use them or not, e.g. patients may get undressed and go to bed on entering a bedroom in the middle of the day despite not being tired. There may also be the emergence of primitive reflexes, such as the grasp reflex.
What is the role of the basal ganglia?
It is the deep grey matter (subcortical) structure with strong connections to the cortex and thalamus. It is mostly involved in complex roles in motor behaviour, but can present with neuropsychiatric symptoms due to their strong connections to the frontal cortex.
However, these are usually associated with ‘negative’ symptoms such as slowing of movement and lack of spontaneity. There is also an increase in obsessional symptoms (basal ganglia are thought to be heavily involved in the pathogenesis of OCD)
Contusions are unlikey given the anatomical location but it is very susceptible to cerebral hypoxia
What is the limbic system and what is its function?
The limbic system involves deep structures such as the hippocampus, parahippocampal gyrus, the amygdala, the fornix, cingulate gyrus and the thalamus.
They have varied functions, but are principally involved in pleasure responses and memory. Injury to the limbic system would usually result in amnesia.
What are lesions of the parietal lobe associated with?
They are associated with visuo-spatial deficients:
Agnosia - inability to recognise objects
Dyspraxia - inability to coordinate motor activites
*There may also be dysphasias (motor or sensory)
Grestmann’s syndrome is a parietal lobe injury with 4 components:
‘Left-right’ disorientation
Dyscalculia (inability to perform arithmetical tasks)
Finger agnosia (inability to distinguish the fingers on the hand)
Agraphia (inability to write)
Non-dominant parietal lobe injuries may lead to body image disturbances, such as ‘anosognosia’ (inability to recognise injury to a particular limb) or ‘hemisomatognosia’ (the feeling that one side of the body is missing)
How do occipital lobe injurys present?
There are complex visual disturbances with vivid visual hallucinations
Anton’s syndrome = bilateral occipital lobe injury that renders the patient cortically blind but they have no insight and continue to affirm adamantly that they can see
What are signs of Wilson’s disease?
Neuropsychiatric signs:
* Aggression
* Reckless behaviour
* Disinhibition
* Self-harm
* Tremor
* Writhing arm movements
General signs:
* Jaundice
* Kayser-Fleischer rings (also seen in PBC)
How does young onset Parkinson’s present?
It is extremely rare (~5/100,000 under 40y)
Patient swill present with classic PD but will have more dystonic symptoms
Depression may occur but dementia is extremely rare (unlike in classical PD)
What is the most common psychiatric manifestation following a stroke?
Depression
*Make sure not to miss in aphasic patients
What are the typical symptoms of third ventricle wall/floor tumours?
Amnesia
Confabulation
You also ger symptoms of hypersomnia, hyperphagia, pyrexia and polydipsia (due to close proximity of the thalamus and hypothalamus)
How does niacin - B3 (pellagra) deficiency present?
Triad of:
* Gastrointestinal disturbnace - anorexia, diarrhoea and gastritis
* Dermatological symptoms - symmetrical, bilateral bullous lesions in sun-exposed areas
* Heterogenous constellation of psychiatric symptoms - apathy, depression, irritability (in later stages it can resemble delirium, psychosis or Korsakoff-like presentation)
How does Pick’s disease present?
It is a frontotemporal dementia that presents in the sixth decade of life (much earlier than other neurodegenerative disorders).
It presents with behaviour and personality changes before amnesic symptoms. These can include disinhibition, aggression, antisociality or the reverse of apathy
How does acute intermittent porphyria present?
Abdominal pain
Arm weakness
Diminished reflexes
Agitation
Auditory hallucinations
*It is a haem metabolism disorder resulting in the build-up of porphyria and their precuroses.
Attacks can be precipitated by menstruation, alcohol, poor nutrition and certain drugs like OCP
What are the different common types of schizophrenia?
Hebephrenic (aka disorganised) - predominance of thought disorder and affective symptoms (usually fatuous and childlike). Social withdrawal is common. Delusions and hallucinations are present but these are usually fragmented and not the most striking feature. Negative symptoms tend to develop early and quickly, and for this reason this subtype is considered to have a poor prognosis.
Catatonic - characterised as psychomotor disturbances or catatonic behaviour. This is often stupor or florid over-activity. There are often unusual symptoms such as automatic obedience, in which people will follow a command without questioning, or the opposite (negativism). In severe cases, people may take on odd postures for long periods, or the limbs may be moved into positions and will remain there (waxy flexibility).
Paranoid (“classical” type) - dominated by delusions and hallucinations. Thought disorder is less common.
Residual - late-stage schizophrenia in which the syndrome of ‘positive’ symptoms (delusions, hallucinations, thought disorder) are replaced by predominately ‘negative’ symptoms (apathy, social withdrawal, avolition, blunting of affect, poverty of speech, self- neglect).
Simple - efined by ICD-10 as ‘the insidious development of oddities of conduct, inability to meet the demands of society, and decline in total performance’. There are usually no overt psychotic symptoms.
What is the pathophysiology of neuroleptic malignant syndrome (NMS)?
It is as a result of antipsychotic medication use and is thought to be the result of dopamine blockade in the hypothalamus (pyrexia) and nigrostriatal pathway (extrapyramidal symptoms such as tremor and rigidity).
Peripheral blockade can cause changes in skeletal muscle contractility, which may exacerbate stiffness and cause muscle breakdown (with the consequent risk of rhabdomyolysis and renal failure).
It is an emergency where the antipsychotic should be stopped and supportive treatment (especially to ensure cardiovascular stability) needs to be considered
Which one confers with a positive prognostic feature of schizophrenia?
* Absence of mood symptoms
* Being male
* Being young
* Poor initial response to treatment
* Rapid onset of symptoms
* Lack of social networks
* Being single
* Poor pre-morbid educational attainment
* Predominately negative symptoms
* Long duration of illness before treatment
Rapid onset of symptoms
*All the others are poor prognostic features of schizophrenia!!
Which of the following is a not side effect of antipsychotic treatment?
* Akathisia
* Convulsions
* Hypotension
* Renal failure
* Tachycardia
Renal failure (most antipsychotics are hepatically metabolised - kidneys only affected in rhabdomyolysis caused by NMS)
Pathophysiology of side effects:
Akathisia - EPSEs
Convulsions - seizure threshold lowered
Hypotension - adrenergic blockade
Tachycardia - alongisde cardiac arrythmias and prolonged QT intervals
What is depressive stupor?
It is a rare presentation of depressive disorder where there is mutism and akinesis (lack of movements).
Depression with severe psychomotor retardation can lead to dehydration and pressure sores and should be treated urgently.
What are the signs and symptoms of brucellosis?
Fevers
Headaches
Fatigue
Pain
Depression
It is a contagious zoonosis transmitted via unpasteurised goat’s milk or through contact with infected animals
Which of the following is most likely to cause depression?
- Methyldopa
- Atenolol
- Ibuprofen
- Prednisolone
- Amlodipine
Methyldopa - The side effects of methyldopa include depression, suicidal ideation and nightmares
Corticosteroids such as prednisolone, hydrocortisone and dexamethasone are associated with mania but may also cause depression. Some beta-blockers which cross the blood–brain barrier, such as propranolol, may cause depression but atenolol does not. Ibuprofen is a non-steroidal anti-inflammatory drug and is rarely associated with depression. Amlodipine is a calcium-channel blocker, indicated for the treatment of hypertension. Depression is an occasional side effect of calcium channel blockers.
What are the psychiatric associations of neurosyphilis?
Psychosis
Mania
Depression
What are risk factors for depression?
Family history
Female gender
Childhood abuse
Poverty
Social isolation
*No relation with old age. Higher education is a protective factor
What is nihilism?
It is a psychological feature of depression characterised by an overwhelming feeling of hopelessness and negativity, which may amount to delusional intensity
Other psychological features of depression that can occur concurrently are low mood, anhedonia, hopelessness, guilt, poor concentration, irritability, low self-esteem and suicidal thoughts
What are the symptoms of anxiety?
Somatic (physical) - due to autonomic arousal:
* gastrointestinal - dry mouth, epigastric discomfort, diarrhoea
* respiratory - SOB, hyperventilation
* CVS - palpitations, tachycardia
* genitourinary - urgency, impotence, menstrual disturbances
* neuro - tremor, sleep disturbance, headache
Psychological:
* intense worries or fear
* irritability
* hypersensitivity to noise
* poor concentration
What is the role of beta blockers in social phobia?
Despite not having any role in tackling the source of the phobia, they are used for symptomatic relief in unavoidable stressful social situations
What is PANDAS?
Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections - an autoimmune reaction following from beta-haemolytic streptococcal infections in children.
The neuropsychiatric consequences include obsessive-compulsive symptoms and tic disorders
What pathological finding on brain MRI is most inkeeping with Alzheimer’s disease?
Hippocampus atrophy is the main finding
- You can also get generalised cerebral atrophy and enlarged ventricles
Which compound has an effect on the symptoms of dementia?
- Serotonin
- Dopamine
- Acetylcholine
- Histamine
- GABA
Acetylcholine - has an effect on cognition in dementia
What is the common presenting triad in Lewy body dementia?
Visual hallucinations
Fluctuating cognitive impairment
Parkisonism
Which of the following would suggest a diagnosis of depression rather than dementia in a patient presenting with memory loss?
- Delusions
- Fluctuating conscious level
- Low mood
- Poor verbal fluency
- Excessive worry over memory loss
Excessive worry over memory loss
What is somatisation?
It is the dispacement of psychological distress such as depression into physical symptoms. This is commonly seen in the depressed elderly as a way of alleviating their distress.
What are relative contraindicatiosn for ECT?
There are very few but some contraindications include:
* heart disease
* raised ICP
* Poor anaesthetic risk
How does late-onset bipolar affectve disorder present?
It is commonly in patients above the age of 50, presenting latently following many years of severeal depressive episodes
What is very late-onset schizophrenia-like psychosis (VLOSLP)?
It typically affects women more than men, and sufferers often have no personality or congnitive problems.
Delusions can take any form, but it is very common for sufferers to describe ‘partition delusions’, in which solid structures become permeable to people or substances.
Antipsychotic response is relatively poor, with formal psychological interventiosn offering more relief.
How does chronic alcohol use and dependence present?
Alcohol dementia with many different pathologies:
* Irreversible cognitive problems
* Predisposition to cerebrovascular disease, head injury (and subsequent Alzheimer’s disease)
* Korskoff’s syndrome
What should you be weary of in new presentation of hypercalcaemia?
Malignancy where there is producted or PTHrp
Which of the following statements is true about medicines in older age?
- Antipsychotics are the drugs of choice for behavioural disturbance in dementia
- Fat-soluble drugs (such as diazepam) will have a longer duration of action because of increased body fat in older people
- Lithium doses in older people should generally be lower because the liver cannot excrete it as efficiently
- Older people are less sensitive to the effects of benzodiazepines
- Tricyclic antidepressants will not cause constipation in older people because of a general increase in gut motility
Fat-soluble drugs (such as diazepam) will have a longer duration of action because of increased body fat in older people - older people have a higher body fat content and less body water so there is an increased volume of distribution
In personality disorders, what does ICD-10 state is required?
ICD-10 specifies that the individual’s inner experiences or behaviour must be manifest in more than one of the following areas (but not necessarily all):
* Cognition
* Affectivity
* Control over impulses
* Manner of relating to others
How many factors are there to describe personality?
5 (OCEAN)
Openess to experience
Conscientiousness
Extraverson/intraversion
Agreeableness
Neuroticism
Which of the following is least likely to predict dangerous behaviour?
- Co-morbid mental disorder
- Co-morbid substance abuse disorder
- Juvenile delinquency
- Pathological lying
- Superficial charm
Co-morbid mental disorder
Even though co-morbid mental disorder can increase dangerouness (i.e. the presence of violent command hallucinations, high levels of
perceived threat in paranoid states), overall there is very little violence directly attributable to mental illness
How is Freud’s model to understand our instincts and drives divided?
Id - unconscious part of the mind that contains innate instincts such as sexuality and aggression
Ego - conscious part of the mind that composes rational thinking and balances the needs of the individual against the demands
of the outside world
Superego - analagous to what we might call ‘conscience’ and contains
our moral rules. Freud believed it developed from our identification with
authority figures and is part conscious, part unconscious
What different types of defence mechanisms are there?
Denial - refusal to accept reality despite all logical evidence.
Repression - unconscious exclusion of painful desires, thoghts or fears.
Idealisation - perceiving another individual as having more positive traits or qualities than they may actually possess (part of splitting)
Splitting - an individual perceives things as either all good (idealisation), or all bad (devaluation). Often seen in EUPD
Regression - the individual revers to an earlier stage of development in order to avoid stressful events. This is thought to occur in those stuck at a particular stage of psychosexual development
Sublimation (mature defence mechanism) - transformation of negative emotions or situations into positive feelings or behaviours
Dissociation - modification of one’s personality or identity in order to avoid distress (in severe forms, known as dissociative identity disorder)
Projection - ascribing one’s own thoughts, fears, attributes or emotions to the external world, usually another person, while denying them as one’s own (used to decrease anxiety)
Projective identification - ‘self-fulfilling prophecy’ whereby in projected emotions or feelings, the recipient begins to alter their behaviour in order to make the behaviour ‘real’
What is CBT?
Cognitive behavioural therapy
A type of talking therapy usually short-term and practical that aims to change the way individuals think or behave with regrds to themselves and others, by exploring erroneous patterns of thoughts, feelings and behaviours
Focuses on ‘here and now’ to a greater extent than psychodynamic psychotherapy, with the therapist uncovering ‘core beliefs’ the individual may hold about themselves or the world
This differs from psychotherapy which focusses on looking at deep-rooted problems as a result of past trauma or stresses, including in the individual’s childhood development
Which of the following statements regarding CBT is false?
* CBT may be carried out without a full qualification in CBT
* CBT may make reference to early childhood experiences
* CBT is more effective than medication for generalised anxiety disorder
* CBT is not useful in dementia
* CBT may involve family members
CBT is not useful in dementia
What is the difference between erectile dysfunction, sexual aversion disorder and hypoactive sexual desire disorder?
Erectile dysfunction - inabibility to develop or maintain an erection during intercourse. Causative factors include previous negative experiences (leading to performance anxiety), drugs, alcohol, stress and fatigue
Sexual aversion disorder - depressed sexual desire
Hypoactive sexual desire disorder - milder version of aversion disorder, associated with a lack of interest in sex
What is Wittmaack-Ekbom syndrome?
Also known as Restless Leg Syndrome
There are uncomfortable, often painful sensations in the legs, which are relieved by movement. The condition is either idiopathic or familial in most cases. It is associated with a number of medical conditions including rheumatoid arthritis, uraemia and iron deficiency anaemia.
What is Kleine-Levin symdrome?
It is characterized by distinct periods of extreme somnolence and excessive hunger. Males are far more affected than females. Other symptoms which may manifest include sexual disinhibition,
confusion, irritability, euphoria, hallucinations and delusions.
