Psychiatry Flashcards
Delusion of Reference
A false belief that insignificant remarks, events, persons, or objects in one’s
environment have personal meaning.
Examples,
◙ A person thinks that a TV show presenter/ female newscaster is directly
communicating to him when she looks at the camera and when she says some
words.
◙ A person thinks that someone constantly gives him special messages through
the newspaper.
◙ A person believes that another person on the billboard outside his window is
sending messages that are meant specifically for him.
Delusion of Control
A false belief that another person or group of people or external force controls
his actions, thought, behaviour, feelings, or impulses.
Examples,
◙ A man says that his friend had made his own right arm to swing out to hit a
stranger. His friend was at home.
Delusion of Guilt
Feeling guilty or remorseful for no valid reason (for something that a person
has not committed).
Examples,
◙ I am responsible for the war/ hurricane/ floods that occurred in the city or in
another country and thus I need to be punished!
Grandeur Delusion = (Delusion of Grandiosity)
A person he/ she is famous, powerful, wealthy, have exceptional abilities and
talents, and keep praising themselves.
Examples,
A person thinks he is powerful and helps the prime minister.
A person thinks he will become a king or god later in life.
Persecutory Delusion
One believes that he is treated with malicious intent, hostility “unfriendly
way”, or harassment.
Examples,
They hate me, they meant to spy on me, they are plotting to harm me, they are
following me to harm me.
Psychological Conditions related to [Unexplained Symptoms]
There are a wide variety of psychiatric terms for patients who have symptoms
for which no organic cause can be found
Somatisation disorder
√ Multiple physical SYMPTOMS
SoMatisation = So Many symptoms and investigations with no physical cause”
√ Patient refuses to accept reassurance or negative test results.
A 30 YO ♀ complains of abdominal pain, headache, shortness of breath,
unsteadiness, palpitations, and numbness of lower limbs for several months.
ECG, X ray, Neurological examinations, and abdominal ultrasounds show
normal findings.
→ Somatisation disorder.
Examples,
◘ A woman persists that she has pancreatic cancer just like her dead husband.
◘ A woman persists that she has HIV despite several negative screening tests
◘ A person believes that his benign lump is a cancer despite all reassuring
investigations.
◘ A minor headache is caused by a brain tumour.
◘ Tiredness is caused by HIV.
◘ A mild rash is the start of skin cancer.
Hypochondrial disorder (Hypochondriasis)
Persistent belief in the presence of an underlying SERIOUS DISEASE, e.g. Cancer, HIV
Hypo=under → underlying SERIOUS DISEASE.
Patient again refuses to accept reassurance or negative test result
A person holds a delusional belief that different people (more than one) are in
fact a single person who changes appearance or is in disguise (
Masked).
→ “A Young man thinks that every old man he meets is actually his
father even though they look different but he is sure that they are his father
but wearing a different disguise “!
Fregoli
Not him
♣ You look like him and pretend you are him but you are fake (not him)
→ Capgras
√ An alcoholic wants a medication to help reduce withdrawal symptoms
√ Acute alcohol withdrawal symptoms (sweating, agitations, tremors, altered mentation
√ If with “seizure” or “Hallucination” [i.e., Delirium Tremens]
√ Wernicke’s encephalopathy (CAS: Confusion, Ataxia, Squint: ophthalmoplegia,
Nystagmus, diplopia
Important Scenarios and Medications Related to Alcohol-Cessation
√ An alcoholic wants a medication to help reduce withdrawal symptoms
→ Chlordiazepoxide.
Chlordiazepoxide “First” then Thiamine (Vit. B1) in acute alcohol withdrawal
→ IV Lorazepam. Or Diazepam of with seizure or hallucination
√ Wernicke’s encephalopathy
(CAS: Confusion, Ataxia, Squint: ophthalmoplegia,
Nystagmus, diplopia),
→ IV Vitamin B1 = (Thiamine) = (IV Pabrinex) = (High potency Vitamin B Complex).
An alcoholic wants a medication to serve as a Deterrent when he takes alcohol
“Abstinence”
√ An alcoholic wants a medication to reduce his Craving for alcohol
An alcoholic wants a medication to serve as a Deterrent when he takes alcohol
“Abstinence” → Disulfiram.
√ An alcoholic wants a medication to reduce his Craving for alcohol
→ Acamprosate
3 days post-hernioplasty,
a 55 YO patient has become agitated, aggressive,
confused and developed auditory hallucination.
Hb (normal), MCV 112 (high), Gamma-GT (high), ALP (normal).
The most appropriate management
Give lorazepam
√ Since the patient has NOT been drinking for 3 days, he developed Delirium
tremens (Hallucination is the clincher).
→ √ Although this stem does not
mention a Hx of chronic alcoholism, we can spot
this from the raised MCV and GGT.
Note, in a stem with post-operative patient develops confusion, aggressiveness,
suspect → chronic alcohol consumption
√ If the symptom developed in 6-24 hours after the surgery and there was no
hallucination or seizures, it would only be “Acute Withdrawal Symptoms” such
as sweating, tachycardia, anxiety, tremors.
We would give
→ Chlordiazepoxide in this case.
√ If CAS (Confusion, Ataxia, Squint: ophthalmoplegia/ Diplopia), this would be
Wernicke’s encephalopathy. We would give iv thiamine
Acute alcohol withdrawal vs wernicke encephalopathy
On the fourth day post-operative day, a woman has become confused and she
sees spiders on her bed.
The likely Dx
Delirium tremens
→ (She is likely a chronic alcoholic and now develops hallucinations -seeing
spiders- which indicate delirium tremens for which IV Lorazepam is used)
Anorexia Nervosa
BMI < 17.5 kg/m2
◙ Significant Weight Loss due
to self-food restrictions, excessive exercise, self-induced
vomiting, laxative/ diuretic misuse
Thickened calluses can be
hand injury during self-induced vomiting)
found on the back of hands
(due to induced vomiting)
Intense drive for thinness
the patient always seeks to
become thin and terrified of being obese
Management of Anorexia Nervosa
