Psychiatry Flashcards
Phenomenology
What is phenomenology?
Objective description of abnormal states of mind avoiding, as far as possible, preconceived ideas or theories, and limited to the description of conscious experiences and observable behaviour.
Elucidate the essential qualities of morbid mental experiences and to understand each patient’s experience of illness.
Required ability to elicit, identify and interpret symptoms of psychiatric disorders.
Phenomenology
What is an illusion?
When stimuli from a perceived object are combined with a mental image to produce a false perceptions
Phenomenology
What are the 5 types of hallucinations?
Visual, auditory, somatic and tactile, gustatory, olfactory
Phenomenology
What are the 4 types of thought disorders?
Disorders of the stream of thoughts
Disorders of the possession of thoughts
Disorders of the content of thoughts
Disorders of the form of thought
Phenomenology
What are the 2 types of disorders of the stream of thoughts?
Disorders of tempo
Disorders of continuity of thought
Phenomenology
Give some examples of disorders of thought tempo
Flight of ideas, inhibition or slowness of thinking, circumstantiality
Phenomenology
Give some examples of the disorders of continuity of thought
Perseveration
Thought blocking
Phenomenology
What is flight of ideas?
Disorder of the stream of thought and tempo of thought.
Thoughts follow each other rapidly.
Connections between successive thoughts appear to be due to chance factor, can be understood.
Phenomenology
What is circumstantiality?
Irrelevant wandering in conversation
Talking at great length around the point
Phenomenology
What is perseveration?
Repetition of a word, theme or action beyond that point at which it was relevant and appropriate
Phenomenology
What is thought blocking?
A sudden interruption in the train of thought, leaving a blank
Commonly experienced when one is exhausted or very anxious
Phenomenology
What are the 2 types of disorders of possession of thought?
Obsessions and compulsions
Thought alienation
Phenomenology
What are the 3 types of thought alienation?
Thought insertion
Thought withdrawal
Thought broadcasting
Phenomenology
What are primary delusions?
When a new meaning arises in connection with some other psychological event
Phenomenology
What are the 3 types of primary delusions?
Delusional mood
Delusional perception
Sudden delusional idea
Phenomenology
What is a secondary delusion?
An idea than can be understood as arising from some other morbid experience
Phenomenology
What is a delusion?
A false, unshakable belief that is out of keeping with the patient’s social and cultural background
Phenomenology
What are the 7 types of content of delusions?
Persecutory
Infedility
Love (someone is in love with them)
Grandiosity
Guilt (believes they are a bad/evil person)
Nihilistic (denies existence of their body, mind, loved ones and the world around them)
Poverty (convinced they are impoverished and believe that destitution is facing them and their family)
Phenomenology
Give an example of disorders of the form of thinking
Loosening of association
Phenomenology
What is loosening of association?
Lack of logical association between succeeding thoughts.
Results in incoherent speech
Impossible to follow the patient’s train of thought (knight’s move thinking/derailment)
Phenomenology
Give two examples of disorders of memory
Dissociative amnesia
Confabulation
Phenomenology
What is dissociative amnesia?
Sudden amnesia that occurs during periods of extreme trauma and can last for hours or days
Phenomenology
What is confabulation?
Falsification of memory occuring in clear consciousness in association with organic pathology.
It manifests itself as the filling-in of gaps in memory by imagined or untrue experiences that have no basis in fact.
Phenomenology
What are the 4 types of disorders of emotion?
Normal emotional reactions
Abnormal emotional reactions
Abnormal expressions of emotion
Morbid expressions of emotion
Phenomenology
What is anhedonia?
Inability to experience pleasure from activities usually found enjoyable
Phenomenology
What is apathy?
Emotional indifference with a sense of futility
May manifest as lack of motivation
Phenomenology
What is incongruity of affect?
Emotional responses which seem grossly out of tune with the situation or subject being discussed
Phenomenology
What is blunting of affect?
An objective absense of normal emotional responses, without evidence of depression or psychomotor retardation
Phenomenology
What is conversion?
An unconscious mechanism of symptom formation, which operares in conversion hysteria, is the transposition of a psychological conflict into somatic symptoms which may be of a motor or sensory nature
Phenomenology
What is Belle Indifference?
Lack of concern and/or feeling of indifference about a disability or symptom. Links to conversion.
Phenomenology
What are the 3 types of disorders of experience of self?
Depersonalisation
Derealisation
Passivity phenomena
Phenomenology
What is depersonalisation?
A feeling of some change in the self, associated with a sense of detachment from one’s own body
Perception fails to awaken a feeling of reality, actions seem mechanical and the patient feels like an apathetic spectator of his own activities
Phenomenology
What is derealisation?
A sense of one’s surroundings lacking reality, often appearing dull, grey and lifeless
Phenomenology
What is passivity phenomena?
Somatic passivity
Feeling as if the person has lost control over their thoughts, feelings and actions.
These may also be experienced as being foreign or manufactured against their will by some foreign influence
Phenomenology
What is somatic passivity?
Delusional belief that one is a passive recipient of body sensations from an external agency
Phenomenology
What is catatonia?
A state of excited or inhibited motor activity in the absence of a mood disorder or neurological disease
May include waxy fliexibility, echolalia, echopraxia, logoclonia, negativism, palilalia and verbigeration.
Phenomenology
What is waxy flexibility?
The patient’s limbs when moved feel like wax or lead pipe, and remain in the position in which they are left.
Found (rarely) in catatonic schizophrenia and structural brain disease
Phenomenology
What is echolalia?
Automatic repetition of words heard
Phenomenology
What is echopraxia?
Automatic repetition by the patient of movements made by the examiner
Phenomenology
What is logoclonia?
Repetition of the last syllable of a word
Phenomenology
What is negativism?
Motiveless resistance to movement
Phenomenology
What is palilalia?
Repetition of a word over and over again with increasing frequency
Schizophrenia
What are the risk factors for schizophrenia?
Genetic, environmental (urban living, migration, stress and traumatic life events, cannabis use, perinatal complications, intrauterine infections)
Previous diagnosis of schizotypal personality disorder
Schizophrenia
How does schizophrenia present?
One of:
* thought disorder (echo, withdrawal, insertion, broadcasting)
* delusions (control, influence, passivity, delusional perception)
* third person auditory hallucinations
* persistent delusions
OR
Two of:
* persistent hallucinations
* thought disorder: incoherent or irrelevant speech or neologisms
* catatonic behaviour
* negative symptoms (marked apathy, little speech, blunting/incongrous affect, social withdrawal)
* persistent change in behaviour: loss of interest, aimlessness, self-absorbed attitude, social withdrawal
Schizophrenia
What is the pharmacological management of schizophrenia?
Atypical antipsychotic: olanzapine, quetiapine
Clozapine for treatment resistant schizophrenia
Depot antipsychotic
Personality disorders
How does paranoid personality disorder present?
- hypersensitivity and an unforgiving attitude when insulted
- unwarranted tendency to question the loyalty of friends
- reluctance to confide in others
- preoccupation with conspirational beliefs and hidden meanings
- unwarranted tendency to preceive attacks on their character
Personality disorders
How does schizoid personality disorder present?
- indifference to praise and criticism
- preference for solitary activities
- lack of interest in sexual interactions
- lack of desire for companionship
- emotional coldness
- few interests
- few friends or confidants other than family
Personality disorders
How does schizotypal personality disorder present?
- ideas of reference
- odd beliefs and magical thinking
- unusual perceptual disturbances
- paranoid ideation and suspiciousness
- odd, eccentric behaviour
- lack of close friends other than family members
- inappropriate affect
- odd speech without being incoherent
Personality disorders
How does antisocial personality disorder present?
- failure to conform to social norms with respect to lawful behaviours
- more common in men
- deception, repeated lying, use of aliases, conning others for personal profit or pleasure
- impulsiveness or failure to plan ahead
- irritability and aggressiveness, physical fights or assaults
- reckless dissregard for the safety of self or others
- consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations
- lack of remorse, being indifferent to or rationalising having hurt, mistreated or stolen from others
Personality disorders
How does borderline/emotionally unstable personality disorder present?
- efforts to avoid real or imagined abandonment
- unstable interpersonal relationships which alternate between idealization and devaluation
- unstable self image
- impulsivity in potentially self-damaging area (spending, sex, substance abuse)
- recurrent suicidal behaviour
- affective instability
- chronic feelings of emptiness
- difficulty controlling temper
- quasi psychotic thoughts
Personality disorders
How does histrionic personality disorder present?
- inappropriate sexual seductiveness
- need to be the centre of attention
- rapidly shifting and shallow expression of emotions
- suggestibility
- physical appearance used for attention-seeking purposes
- impressionistic speech lacking detail
- self dramatization
- relationships considered to be more intimate than they are
Personality disorders
How does narcissistic personality disorder present?
- grandiose sense of self-importance
- preoccupation with fantasies of unlimited succes, power or beauty
- sense of entitlement
- taking advantage of others to achieve own needs
- lacking empathy
- excessive need for admiration
- chronic envy
- arrogant and haughty attitude
Personality disorders
How does obsessive-compulsive personality disorder present?
- occupied with details, rules, lists, order, organisation or agenda to the point that the key part of the activity is gone
- perfectionism that hampers with completing tasks
- extremely dedicated to work and efficiency to the point of elimination of spare time activities
- meticulous, scrupulous and rigid about etiquettes of morality, ethics or values
- not capable of disposing worn out or insignificant things even when they have no sentimental meaning
- takes on a stingy spending style towards self and others, shows stiffness and stubbornness
Personality disorders
How does avoidant personality disorder present?
- avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism or rejection
- unwillingness to be involved unless certain of being liked
- preoccupied with ideas that they are being criticised or rejected in social situations
- restraint in intimate relationships due to the fear of being ridiculed
- views self as inept and inferior to others
- social isolation accompanied by a craving for social contact
Psychopharmacology
What foods should patients avoid when taking monoamine oxidase inhibitors?
Cheese
Psychopharmacology
What are the side effects of tricyclic antidepressants?
Anticholinergic effects: can’t pee, can’t see, can’t spit, can’t shit
Psychopharmacology
What are some examples of SSRIs?
Fluoxetine and sertraline
Psychopharmacology
What are SSRIs used for?
Depression, anxiety, PTSD, eating disorders, OCD
Psychopharmacology
What are some examples of SNRIs?
Mirtazapine, venlafaxine, duloxetine
Psychopharmacology
What are the side effects of SSRIs?
Nausea, headache, GI upset
Agitation, akathisia, anxiety
Sexual dysfunction
Insomnia
Hyponatraemia
Psychopharmacology
How long should antidepressants be taken for?
6-9 months after symptoms improve
Psychopharmacology
What is the classic triad of seratonin syndrome?
Neuromuscular abnormalities
Altered mental state
Autonomic dysfunction
Psychopharmacology
What is the management of seratonin syndrome?
Supportive or cyproheptadine (5-HT2 antagonist)
Psychopharmacology
What are the positive symptoms of psychosis?
Hallucinations and delusions
Psychopharmacology
What are the negative symptoms of psychosis?
Flattened affect, cognitive difficulties, poor motivation, social withdrawal
Psychopharmacology
What do antipsychotics do?
Dopamine antagonists
Act on the mesolimbic pathway, reducing positive symptoms of psychosis but also reduce ability to feel pleasure
Psychopharmacology
What are some examples of typical antipsychotics?
Haloperidol
Chlorpromazine
Psychopharmacology
What are some examples of atypical antipsychotics?
Aripiprazole
Olanzapine
Quetiapine
Risperidone
Clozapine
Psychopharmacology
What is an important side effect of typical antipsychotics?
Extrapyramidal symptoms: dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia
Psychopharmacology
What is an important side effect of atypical antipsychotics?
Metabolic abnormalitied: elevated glucose, lipids, weight gain
Psychopharmacology
How does neuroleptic malignant syndrome present?
- shortly after starting a new antipsychotic
- pyrexia
- muscle rigidity
- autonomic lability: hypertension, bradycardia, tachypnoea
- agitated delirium with confusion
- raised creatinine kinase
- reduced reflexes
- AKI if severe
- leukocytosis
Psychopharmacology
What is an important adverse effect of clozapine?
Agranulocytosis
Psychopharmacology
What are the side effects of lithium?
- nausea/vomiting
- diarrhoea
- fine tremor
- nephrotoxicity: polyuria, diabetes insipidus
- thyroid enlargement and hypothyroidism
- ECG T wave flattening/inversion
- weight gain
- idiopathic intracranial hypertension
- leukocytosis
- hyperparathyroidism and resultant hypercalcaemia
Psychopharmacology
How should lithium be monitored?
Check 12 hours after dose
* initially weekly until concentrations stable
* then 3 monthly
* thyroid and renal function checked every 6 months
