Psychiatry Flashcards
Disorders of consciousness
3 forms of upset consciousness
1) changed consciousness
-are in healthy people
-pt cannot get information from the outside world but gets information from the object he is concentrating at the moment.
2) deterioration of consciousness
-has 3 sub groups;
A-obnubilation- cloudy consciousness, drowsy & reacts incompletely to stimuli eg- sleepwalking (somnambulism), sleepiness (somnolence)
B-sopor- pathologic sleep, opens eyes if name called out several times & loudly
C-coma- absences of any mental activity other than breathing
3) obscured consciousness
- seen in acute psychosis
Hyperkinesis
Maniac excitement Depressive agitation Halucinosis Twilight states Amentive state Oneroid excitement Hysterical excitement
Maniac excitement
-mimic of pt shows happiness, wants to talk a lot. May run to get bed sheets for everyone in the ward. Wants to keep watch of other patients & bring them drugs
Depressive agitation
-mimics suffering. Characteristic sign is crying without tears. Afraid of punishment but craves it.
Halucinosis
-of experiences verbal hallucinations, roams about in his room, puts furniture in front of the door to block the entrance.
Twilight states
-pt runs away from hallucinatory form but also tries to fight it.
Amentive state
-pt is exhausted & can’t get up from the bed. Movement is chaotic & uncoordinated
Oneroid excitement
-is the most dangerous, impulsive brutal aggression
Hysterical excitement
- it is characterized by ambivalent (having mixed feelings or contradictory ideas about something or someone)
- Only in oneiroid, there is double personality symptom, i.e. the patient may simultaneously think that he is a normal patient and also a king
- There also can be double orientation – patients simultaneously hold two contradictory beliefs, both the correct and the incorrect notions about time and place.
- occurs after a psychotromatic situation
catatonic syndrome
A mental disorder dominated by impairment of motor activity.
The syndrome is in schizophrenia and psychosis resulting from poisoning or infection or organic brain damage.
Two alternate phases:
Stupar and excitement
Stupar–dramatic reduction in activity to the point that voluntary movement stops. The patient may maintain a pose in which someone places them, this is also known as waxy flexibility.
Catatonic Stupor
is a catatonic condition in which the patient is immobile, mute, and unresponsive but appears to be fully conscious, usually because the eyes are open and follow external objects.
Depressive stupor
presence of affective melancholy.
The patient answers the question after a big pause and in one word, temporarily speechless,
Apathic stupor
Facial expression has no mimic. He can simply sit on a chair for hours doing nothing
Tics Catalepsy Cataplexy Mannerism Motor stereotypies Posturing Echolalia Echopraxia Negativism Automatic obedience Ambitendency
Tics- irregular repeated sudden twitches involving a single muscle or muscle group, e.g. sideways movement of the head or the raising of one shoulder.
Catalepsy- patient’s limbs can be passively moved to any posture which will then be held for a prolonged period of time whilst at the same time muscle tone is uniformly increased.
Cataplexy- symptom of narcolepsy in which there is sudden loss of muscle tone leading to collapse. Usually occurs following emotional stress.
Mannerism- occasionally bizarre performance of a voluntary, repeated movements, goal-directed activity e.g. saluting
Motor stereotypies- repetitive and bizarre movements which are not goal directed
Posturing- is the adoption and maintenance of bizarre and uncomfortable limb and body positions of unusual bodily postures continuously for a long time. The posture may appear to have a symbolic meaning or may have delusional significance to the patient, e.g. standing with both arms outstretched as if being crucified
Echolalia- repetition of phrases or sentences spoken by the examiner.
Echopraxia- patient mirrors the doctor’s body movements automatically even when asked not to do so
Negativism- patient resists carrying out the examiner’s instructions and his attempts to move or direct the limbs
Automatic obedience- patient obeys the examiner’s instructions unquestioningly. This cooperation may be «excessive», with the patient going beyond what is asked (e.g. raising both arms and both legs when asked to raise an arm)
Ambitendency- alternating mixture of automatic obedience and negativism. e.g. putting out the arm to shake hands, then withdrawing it, extending it again, and so on.
Psychological pillow Akinetic mutism Extra-pyramidal side-effects (EPSE) Tardive dyskinesia Hemiballismus Logoclonia Micrographia Dyspraxia Dyskinesia Chorea Akathisia Ataxia
Psychological pillow- The patient holds their head several inches above the bed while lying and can maintain this uncomfortable position for prolonged periods of time.
Akinetic mutism- medical term describing patients who tend neither to speak (mutism) nor move (akinesia).
Extra-pyramidal side-effects (EPSE)- Side-effects of rigidity, tremor, and dyskinesia caused by the anti-dopaminergic effects of psychotropic drugs, particularly neuroleptics.
Tardive dyskinesia- a neurological disorder characterized by involuntary movements of the face and jaw.
Hemiballismus- Involuntary, large-scale, «throwing» movements of one limb or one body side.
Logoclonia- Symptom of Parkinson’s disease where the patient gets «stuck» on a particular word of a sentence and repeats it
Micrographia- Small «spidery» handwriting seen in patients with Parkinson’s disease; a consequence of being unable to control fine movements.
Dyspraxia-Inability to carry out complex motor tasks (e.g. dressing, eating)
Dyskinesia- impairment of voluntary motor activity by superimposed involuntary motor activity
Chorea- Sudden and involuntary movement of several muscle groups with the resultant action appearing like part of a voluntary movement
Akathisia- A subjective sense of uncomfortable desire to move, relieved by repeated movement of the affected part (usually the legs)
Ataxia- Loss of coordination of voluntary movement. Seen in drug and alcohol intoxication
Schizophrenia
a group of severe mental disorders that affects approximately 1% of the population, characterized by reality distortions resulting in unusual thought patterns and behaviors.
Schizophrenia history
it was knwown as dementia praecox, meaning early dementia.
Later a Swiss psychiatrist Eugen Bleuler corrected Kraepelin’s theory that the disease was an organic brain deterioration and thus incurable
symptoms of Schizophrenia
Positive symptoms:
Such as delusions or hallucinations—which are also known as seeing or believing things that are not real.
Negative symptoms:
Such as social avoidance, emotional withdrawal—which are also known as a lack of feeling, or expression.
Disorganized symptoms: Confused in thinking and speech. Acting in ways that do not make sense.
causes of schizophrenia
its idiopathic but they are risk factors;
genetics and brain structure, excessive and aslo low levels of dopamine. Underactive frontal lobes and overactive parietal lobes are thought to cause some of schizophrenia’s associated symptoms.
The Dopamine Hypothesis of schizophrenia
Biochemical research suggests that high levels of the neurotransmitter dopamine, or excessive numbers of receptors for dopamine, may be at the root of schizophrenia. Antipsychotic medications, which are used to treat schizophrenia, block dopamine receptors.
drugs that increase levels of dopamine, like amphetamines, often cause psychotic symptoms and a schizophrenic-like paranoid state.
Risk Factors for schizophrenia
Genetics Abnormalities in brain structure Abnormal brain chemistry Birth trauma Environmental conditions
5 major types of schizophrenia
1) Paranoid Schizophrenia-
delusions of persecution, reference, exalted birth, special mission, bodily change, or jealousy;
hallucinatory voices that threaten the patient or give commands, or auditory hallucinations.
clinical picture is dominated by relatively stable, often paranoid, delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances.
Its the commonest type of schizophrenia in most parts of the world.
2) Hebephrenic Schizophrenia- The mood is shallow and inappropirate and often accompanied by giggling or self-satisfied, self-absorbed smiling, or by a lofty manner, grimaces, mannerisms, pranks, hypochondriacal complaints, and reiterated phrases. Thought is disorganized and speech rambling and incoherent.
3) Catatonic Schizophrenia-Prominent psychomotor disturbances are essential and dominant features and may alternate between extremes such as hyperkinesis and stupor, or automatic obedience and negativism. postures may be maintained for long periods.
4) Simple Schizophrenia- there is an insidious (subtle) but progressive development of oddities (a strange or peculiar person) of conduct, inability to meet the demands of society,
5) Undifferentiated Schizophrenia- mixed up types but dosent clearly conform to any.
Post-Schizophrenic Depression.
A depressive episode, which may be prolonged, arising in the aftermath of a schizophrenic illness. This depressive disorder is associated with an increased risk of suicide
Eidetic imagery & pareidolia
is a visual image which is so intense and detailed that it has a ‘photographic’ quality.
Occasionally, imagery is so vivid that it persists when the person looks at a poorly structured background such as plain wallpaper. This condition is called pareidolia, a state in which real and unreal percepts exist side by side.
Pareidolia can occur in acute organic disorders caused by fever, and in a few people it can be induced deliberately.
Synesthesia
the stimulation of one sensory modality reliably causes a perception in one or more different senses.
It denotes the rare capacity to hear colors, taste shapes.
Synesthesia is “abnormal” only in being statistically rare
Hypoesthesia / Hyperesthesia
Hyperesthesia is general decrease of sensory threshold described by the patients as emotional discomfort which leads to agitation. pt says can’t sleep coz of clock or hears water dripping from the tap.
Hypoesthesia is an increase in sensory threshold leading decrease in feelings & senses
Hysteric anesthesia
generally after a psychological trauma. In hysteria, they can be a subjective loss of tactile, auditory or optic feelings.
Paresthesia
paraesthesias, is a sensation of tingling, tickling, pricking, or burning of a person’s skin with no apparent and obvious long-term physical effect.
e.g. during sleeping in an odd position, Alcoholic polyneuropathy
Illusions & the types of illusions
Illusions are misperceptions of external stimuli.
1) semantic (verbal, auditory)
2) pareidolic (visual)
Hallucinations & the types of hallucinations
misperceptions in the absence of external stimuli
- According to complexity
a) Elementary hallucinations are the simplest kind and they are unstructured hallucinations and bear no relation to anything in the natural world. They sub divide into phonemes (articulate) & akoasms (non articulate)
In the visual modality, a person with elementary hallucinations might see multicoloured spots, flying dots or microscopic “flies”.
b) Complex hallucination is used for experiences such as hearing voices or music, or seeing faces and scenes
- According to sensory modality
a) auditory
b) visual
c) olfactory & gustatory-are frequently experienced together, often as unpleasant smells or tastes.
d) somatic (tactile and deep) - According to special features
a) Extracampine- visual hallucinations are experienced as located outside the field of normal perception, that is, behind the head.
b) Visual hallucinations may appear normal or abnormal in size; if the latter, they are more often smaller than the corresponding real percept. Visual hallucinations of dwarf figures are called lilliputian. These can occur with alcohol withdrawal.
c) Visceral Hallucinations may occur as feelings of a foreign object or an animal (usually a frog) contained inside the body.
d) reflex hallucinations- a stimulus in one sensory modality results in a hallucination in another
e) hypnagogic and hypnopompic hallucinations occur at the point of falling asleep and of waking respectively
f) Psychomotor verbal hallucinations (Seglas’ hallucinations)-involuntary movements of his tongue and lips in a conscious pt. may unintentionally insult their relatives, making use of obscene language, blasphemies.
g) Tactile hallucinations (haptic hallucinations) may be experienced as sensations of being touched, pricked, or strangled
h) Cenestopathy -diffuse bodily sensations with indefinite, indeterminate localization, often transient and ambulant, moving or shifting
i) Autoscopic hallucinations- the experience of seeing one’s own body projected into external space, usually in front of oneself, for short periods
j) Functional Hallucinations is where an external stimulus provokes hallucination e.g. hearing a voice when the tap is running.
true hallucination & pseudo hallucinations
A true hallucination is experienced as originating in the outside world.
-intoxication, syphilid
A pseudo hallucination is experienced as originating from within one’s own body
-schizophrenia
Depersonalization and derealization
Depersonalization is a change of self-awareness such that the person feels unreal. pt often speaking of being detached from their own experience and unable to feel emotion.
derealization- objects appear unreal and people appear as lifeless, two-dimensional ‘cardboard’ figures
Anosognosia
Anosognosia is a lack of awareness of disease, Most often it occurs briefly in the early days after acute hemiplegia but occasionally it persists. The patient does not complain of the disability on the paralysed side and denies it when pointed out to him.
Anton–Babinski syndrome, also known as visual anosognosia, is a rare symptom of brain damage occurring in the occipital lobe.
why pt deny blindness:
Visual imagery is received but cannot be interpreted; the speech centers of the brain confabulate a response.
Korsakov’s syndrome
Vitamin B1 deficiency causing damage to the thalamus & hypothalamus as well as generalized cerebral atrophy.
Caused by alocholism
Progressively worsening anterograde amnesia.
denial of amnesia manifested with confabulation of events.
Korsakoff’s syndrome is an acute onset of severe memory impairment without any dysfunction in intellectual abilities.
Pain asymbolia
Pain asymbolia is a disorder in which the patient perceives a normally painful stimulus but does not recognize it as painful.
Autotopagnosia
Autotopagnosia is the inability to recognize, name, or point on command to parts of the body.
Reduplication phenomenon
Reduplication phenomenon is the experience that part or all of the body has doubled. Thus the person may feel he has two left arms, or two heads, or that the whole body has been duplicated.
Metamorphopsia & its types
changes in percieved form of the object.
a) macro- and micropsia
b) dysmegalopsia – objects seem to be broken, over-winded, twisted, distorted
c) porropsy - objects seem to be closer or far (further) away from an onlooker than they really are
d) polyopia - the condition in which one object appears as two or more objects.
e) tachy- and brady-chronia - distortion of sense of time
Body scheme distortion
feeling of changes of one’s own body or of its part – lessening or growing in size. Distorted awareness of size and shape includes feelings that a limb is enlarging, becoming smaller, or otherwise being distorted.
Coenestopathic states
localized distortions of body awareness, for example the nose feels as if it is made of cotton wool.
Delirium
is an acute psychosis with obscured consciousness, and is accompanied by illusion, hallucination scenario
The cause of delirium is exogenous and somatic or organic defect of brain (intoxication, infection with hyperthermia, trauma, and vascular insufficiency)
Delirium tremens
an acute episode of delirium that is usually caused by alcohol. Delirium tremens commonly affects those with a history of habitual alcohol use or alcoholism
