Psychiatric History

Question 1

mood vs affect?

Answer 1

mood = what they tell you they are feeling like right now during examination, subjective
affect = what you actually observe during examination (e.g hunched over, looking down, looking unhappy), more variable than mood over, changes time

Question 2

history vs mental state examination?

Answer 2

history = patient's own account (e.g "I hear voices commenting on what I do saying they're going to get me")
MSE = based on doctor's observation, an objective assessment/technical description (e.g 3rd person auditory hallucinations, threatening in nature, thought withdrawal, secondary delusions, perplexity of affect)

Question 3

perception without insight describes what?

Answer 3

hallucination

Question 4

what is perception in psychiatry terms?

Answer 4

describes sensory perception

i.e hearing, seeing, smelling things

Question 5

illusion vs hallucination?

Answer 5

illusion = mis-perception of a real stimulus
hallucination = no stimulus there at all

Question 6

what is passivity experience?

Answer 6

general term for things which would normally e under your control do not feel under your control (thoughts/behaviours controlled by external agency)
e.g - thought broadcasting, thought insertion, thought withdrawal etc (your own thoughts are not under your control)

Question 7

what is a nihilistic delusion?

Answer 7

..

Question 8

what is a delusion?

Answer 8

false belief held on false grounds, persistent despite evidence to the contrary
belief rather than experience (hallucination)
firmly held despite logical argument or evidence of contrary

Question 9

persecutory delusion?

Answer 9

about other people doing harmful things to them

….

Question 10

reactive affect?

Answer 10

range of emotion fluctuates between high and low (normal)

Question 11

flattened affect?

Answer 11

range of emotion fluctuates but never reaches much above neutral

Question 12

blunted affect?

Answer 12

range of emotion hovers around neutral

Question 13

unreactive affect?

Answer 13

range of emotion fluctuates around very low

Question 14

what is insight?

Answer 14

dos patient recognise they are unwell
do they attribute it to mental health problem
do they accept need for treatment etc

Question 15

hallucinations are only significant in the context of other symptoms, true or false?

Answer 15

true

hallucinations can be induced in normal people (e.g sensory deprivation)

Question 16

describe the pathophysiology of auditory hallucincations

Answer 16

brain activity similar to normal people generating inner speech
except supplementary motor area (which monitors self generated actions) and hippocampus/parahippocampal gyrus are activated

Question 17

what are the 3 types of auditor hallucinations?

Answer 17

second person - voices which directly address the patient
third person - voices which discuss the patient or provide running commentary on their actions
thought echo - the patient experiences his own thoughts spoken or repeated out loud

Question 18

types of hallucinations?

Answer 18

visual (simple - flashes of light/complex - faces or figures)
olfactory
gustatory
somatic (body sensations like insects crawling under skin etc)

Question 19

how does passivity appear on PET scanning?

Answer 19

shows abnormality in parietal and cingulate cortices (areas involved in interpretation of sensory information)

Question 20

what is disorder of form of thought?

Answer 20

evidence from the patients speech or writing that there is an abnormality in the way their thought are linked together
disturbance in organisation, control and processing of thoughts
includes flight of ideas and loosening of associations

Question 21

what is flight of words?

Answer 21

words are associated together inappropriately because of their meaning or rhyme etc
causes speech to loose its aim and patient goes off on a tangent

Question 22

2 examples of thought disorders?

Answer 22

loosening of associations
- speech is muddled, difficult to follow and cannot be identified
- patient talks freely but so vaguely that no real information is given
- can jump from topic to topic with no connection
neologism
- abnormality of speech in which patient makes up new words or phrases or uses existing words/phrases in bizarre ways

Question 23

what is a secondary delusion?

Answer 23

attempt to explain anomalous experiences (e.g hallucinations, passivity, depression etc)
- i.e my thoughts aren’t my own, theyre being transmitted by the mafia