Psychiatric Disorders

Question 1

Define PTSD

Answer 1

Post-traumatic stress disorder is a severe psychological disturbance following a traumatic event, characterised by involuntary re-experiencing elements of the events with HYPERAROUSAL, AVOIDANCE and EMOTIONAL NUMBING

Question 2

What features do you NEED to confirm a diagnosis of PTSD?

Answer 2

Symptoms arise WITHIN 6 months of the traumatic event
OR
Symptoms are present >= 1 month with clinically significant distress or impairment in social, occupational or other aspects of function
(2 or more PERSISTENT symptoms)

Question 3

What are some key clinical features of PTSD?

Answer 3

difficulty falling ans staying asleep, irritability, recklessness, poor concentration, hypervigilance, exaggerated startle response, reliving incident, avoidance, inability to recall aspects of incident

Question 4

What proportion of males develop PTSD after a traumatic incident?

Answer 4

8-13%

Question 5

What proportion of females develop PTSD after a traumatic incident?

Answer 5

20-30%

Question 6

Risk Factors for PTSD

Answer 6

1. Vulnerability
   Low education, female, Afro-Caribbean, Hispanic, low self-esteem, previous Hx or FHx of psychiatric disorder
2. Peri-Traumatic
   trauma severity, risk to life, high emotions, dissociation
3. Protective
   High IQ, high social class, Caucasian, male, psychopathic traits

Question 7

Causes of PTSD

Answer 7

Neuroimaging shows reduced hippocampal volume and dysfunction of the amygdala, hippocampus and pre-frontal cortex

There is high concordance in MZ compared to DZ twins

Question 8

Management of PTSD

Answer 8

1. Psychological
2. Medical
3. Social

Question 9

What does social management of PTSD include?

Answer 9

1. Assessing and addressing current stressors
2. Strengthen coping and social supports
3. Psychological First Aid

Question 10

What does medical management of PTSD include?

Answer 10

SSRI use is validated for PTSD

Specific symptoms are generally targeted:

• Sleep disturbance: mirtazapine, Z drugs
• Anxiety: BDZ, buspirone, SSRI, beta-blocker
• Intrusive throughts: ? carbamazepine
• Psychotic thoughts: olanzapine, risperidone, clozapine

Question 11

What does psychological management of PTSD include?

Answer 11

Psycho-education for PTSD
Cognitive Behavioural Therapy- self monitoring, anxiety management, cognitive restructuring
Eye Movement Desensitization and Reprocessing Therapy (EMDR)
Psychodynamic therapy: resolving unconscious conflicts, exploring the meaning of the event
Stress Management
Hypnotherapy
Supportive therapy

Question 12

Define unilateral visual neglect?

Answer 12

A condition where patients fail to notice stimuli that appear on the side of space contralateral to a lesion in the parietal lobe.

Question 13

Define blindsight

Answer 13

Residual visual capability supported by subcortical mechanisms following removal or damage to cortical visual areas

Question 14

Define Balint’s syndrome

Answer 14

An attentional disorder where the patient loses the ability to voluntarily shift visual attention to new locations. It is associated with damage to both sides of the brain. Difficulty identifying overlapping figures

Question 15

Define prosopagnosia

Answer 15

Difficulty recognising faces

Question 16

What are two main problems of vision?

Answer 16

1. We are taking two 2D representations of the world and reconstructing it into a 3D mental image. There is no consistent explanation how this is done
2. We know of the blind spot- the brain is filling in gaps . What we perceive may not be accurate

Question 17

What is Capgras syndrome?

Answer 17

People who experience this syndrome will have an irrational belief that someone they know or recognize has been replaced by an imposter

Question 18

How to assess neglect?

Answer 18

LINE BISECTION (Albert, 1973)
Patient is presented with a straight line and asked to bisect it. Left neglect patients tend to place the mark closer the the right side. Paradoxically, if multiple lines of various lines are presented, the amount of error to the right is proportional to the length of the line i.e. some awareness of total length

DRAWING (Smith et al., 2007)
When asked to draw a clock face, left neglect patients squeeze all in the numbers in the right half. They produce distorted representations of the world

ONE-TOUCH

PERSONAL NEGLECT TEST

Question 19

Fun findings on neglect?

Answer 19

BISIACH AND LUZZATI, 1978
Italian neglect patients were asked to visualise a famous Milanese square and to report what they saw standing from the cathedral. Saw everything on the right. And then they were asked to report what they saw standing on the opposite side of the square, facing the cathedral. Again saw everything on the right, which was originally not seen. They fail to register the contralateral aspects of the world,

MARSHALL AND HALLIGAN, 1988
Two houses, identical except that the one of the neglected side had fire coming through one of the windows. When asked which house they would prefer, they chose the one without the fire, without ever reporting seeing the flames.

Question 20

Rationale for blindsight?

Answer 20

Superior colliculus is responsible for automatic ref;exes and orienting movements of the head and eyes, especially when new stimuli are presented in the visual field. It is faster than V1 and thus it is possible to unconsciously perceive something without realising its importance.