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Phase 3A Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What factors make up a formulation?

A

Predisposing
Precipitating
Perpetuating
Protective

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2
Q

What topics would you ask about in a psychiatric history?

A 
Presenting complaint
History of presenting complaint
Past psychiatric history
Past medical history
Drug history/Allergies
Family history
Social history
Forensic history
Personal history
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3
Q

What would you ask about in personal history?

A

Birth - any problems with the birth or as a baby?
Early development - attachment issues? slow developmental milestones
School - social/academic, failure to succeed, why?
Home environment - traumatic events
Qualifications
Relationships and children
Work

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4
Q

What would you ask about in forensic history?

A

Juvenile crime
Court appearances, convictions, length of sentence
Against person/property? Prison experience

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5
Q

MSE - appearance and behaviour

A

Visual description of patient. Eye contact, rapport, self-care, dress, psychomotor agitation/retardation, abnormal movements, distractibility, perplexity, cooperation, over familiar

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6
Q

MSE - speech

A

Speed - slow, fast, hesitant, pressured, flight of ideas
Volume - loud ,soft, muttered, shouted
Language - accented, dysphasia
Neologisms, punning

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7
Q

MSE - affect/mood

A

Mood - subjective (patient’s own words/views)

Affect - objective (euthymic, elated, sad, irritable)

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8
Q

MSE - thoughts and delusions

A

Content - obsession, preoccupation, delusions (unshakeable beliefs), or overvalued ideas?
Form - circumstantial, tangential, looseness of association,
stream - poverty, racing, preservative, thought insertion/withdrawal/broadcast

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9
Q

MSE - perceptions and hallucinations

A

5 senses - auditory, visual, tactile, gustatory, olfactory
True auditory hallucination - voice not in head, sounds like it’s coming from the room
Auditory - content? 2nd/3rd person? command?

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10
Q

MSE cognition

A

AMT/MOCA

orientation in time, place and to person

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11
Q

Symptoms of mania

A 
Pressure of speech
Flight of ideas
Over-familiar
Disinhibited
Punning/neologism
2nd person auditory hallucinations
Grandiose delusions
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12
Q

Symptoms of a depressive disorder

A 
Low mood
Tearful
Reduced energy (anhedonia)
Reduced motivation
Early morning wakening
Loss of appetite/weight loss
Reduced concentration/enjoyment
Reduced self-care
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13
Q

Symptoms of psychosis

A

Persecutory delusions
3rd person auditory hallucinations
Running commentary
Though insertion/withdrawal/broadcast

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14
Q

Hallucination

A

A perception in the absence of external stimuli

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15
Q

Hypnogogic

A

hallucinations experienced when falling asleep

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16
Q

Hypnopompic

A

hallucinations experienced when waking up

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17
Q

Reflex hallucination

A

“when you write, I can hear your pen pressing on my heart”

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18
Q

Extracampine hallucinations

A

hallucinations outside the realm of what is feasible

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19
Q

Over-valued idea

A

a belief or concept that is out of keeping with reality but can be challenged

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20
Q

Delusion

A

a false belief firmly maintained in spite of indisputable and obvious proof to the contrary - not shared with other members of patient’s culture/subculture
Types: persecutory, grandiose, nihilistic

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21
Q

Illusions

A

misinterpretation of actual external stimuli

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22
Q

Misidentification delusions

A

capgras - someone replaced by an imposter
fregoli - various people are the same person
subjective doubles - dopplegangers

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23
Q

Delusional perception

A

a delusion formed from a real perception e.g. “I heard dogs barking last night and from then on I knew that I was going to be the next prime minister”

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24
Q

Thought insertion

A

belief that thoughts are being inserted into your head by an external agency

25
Q

Thought withdrawal

A

belief that thoughts are being removed from your head by an external agency

26
Q

Though broadcast

A

belief that everyone around you can hear your thoughts

27
Q

Thought echo

A

head thoughts echoed in your head or out loud

28
Q

Thought block

A

when a person can’t pick up a train of thought again after losing it

29
Q

Concrete thinking

A

taking thoughts very literally (can’t understand metaphors)

30
Q

Loosening of association

A

when someone has such a loss of connectivity between their thoughts that it is very difficult to understand what they are saying (seen in severe mania)

31
Q

Circumstantiality

A

when a person is asked a question that will talk around different subjects until getting to the answer

32
Q

Perseveration

A

the answer to an initial question is correct but further questions will all receive the same answer which won’t make sense

33
Q

Confabulation

A

The misrepresentation of memory wherein holes in recollection are filled in by manufactured tellings that the person believes to be the truth

34
Q

Somatic passivity

A

delusional belief that physical sensations are being caused by an external agency

35
Q

Made act/feel/drive

A

belief that actions/feelings/drive are being influenced by an external agency

36
Q

Psychomotor retardation

A

slowing down of thoughts and movements

37
Q

Pressure of speech

A

the urge to speak is so overwhelming that you have to keep on speaking - often interrupt

38
Q

Flight of ideas

A

thoughts move very quickly, thoughts and ideas connected

39
Q

Anhedonia

A

loss of pleasure in activities used to find enjoyable (key symptom of depression)

40
Q

Incongruity of affect

A

when a person’s affect doesn’t fit with what they are saying e.g. laughing whilst talking about the death of a loved one (associated with thought disorders)

41
Q

Blunting of affect

A

where there is little change in facial expression, non-responsive (seen in depression/schizophrenia)

42
Q

Conversion disorder

A

When the brain manages an emotional trauma by converting it into a physical symptom e.g. unexplained blindness

43
Q

Belle indifference

A

When a person suffers from a conversion disorder by is completely indifferent to it

44
Q

Depersonalisation

A

where a person’s consciousness is removed from the forefront and their actions become mechanical, as if on auto-pilot

45
Q

Derealisation

A

when it feels like nothing is real

46
Q

Dissociation

A

when a person removes their consciousness from a situation, can be conscious or unconscious (e.g. trauma)

47
Q

Obsession

A

thought component of OCD
recurrent unrelenting thought
thought recognised as own

48
Q

Compulsion

A

action component of OCD

recurrent action e.g. hand-washing

49
Q

Akathisia

A

urge to move, common side-effect of anti-psychotic medication

50
Q

Core symptoms of depression

A

Low mood
Loss of energy (anergia)
Loss of enjoyment (anhedonia)

51
Q

Physical symptoms of depression

A

Change in sleep (characteristically early morning waking)
Change in appetite
Change in libido

52
Q

Psychological symptoms of depression

A 
Diurnal mood variation
Agitation
Loss of confidence
Loss of concentration
Guilt
Hopelessness
Suicidal ideation
53
Q

Classification of mild depression

A

Core symptoms + 2-3 others

54
Q

Classification of moderate depression

A

Core symptoms + 4 others + functioning affected

55
Q

Classification of severe depression

A

without psychotic symptoms - several symptoms, suicidal, marked loss of functioning
with psychotic symptoms - typically mood congruent (nihilistic and guilty delusions, derogatory voices)

56
Q

Symptoms of hypomania

hypomania vs mania

A 
Elevated mood (can be euphoric/dysphoric/angry)
Increased energy
Increased talkativeness (POS)
Poor concentration
Mild reckless behaviour e.g. overspending
Sociability/overfamiliarity
Increased libido/sexual disinhibition
Increased confidence
Decreased need for sleep
Change in appetite
57
Q

Symptoms of mania

hypomania vs mania

A 
Extreme elation - uncontrollable
Over activity
Pressure of speech
Impaired judgement
Extreme risk-taking behaviour e.g. spending spree, booking holidays
Social disinhibition
Inflated self-esteem, grandiosity
Addition of psychotic symptoms
Mood incongruent
58
Q

Cyclothymia

A

A less severe version of bipolar which involves cycling between hypomania and moderate depression

59
Q

What are the 1st rank symptoms of schizophrenia?

A

Thought alienation
Passivity phenomena
3rd person auditory hallucinations
Delusional perception

Phase 3A Medicine (2 decks)

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