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Phase 3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What are the 3 core symptoms of depression

A

Low mood
Lack of pleasure (Anhedonia)
Loss of energy

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2
Q

Name other symptoms of depression

A 
Low mood
Anhedonia/lack in pleasure
Reduced libido
Weight change
Insomnia
Psychomotor agitation or retardation
Feelings of worthlessness, guilt
Reduced concentration span, indecisiveness
Recurrent thoughts of death or suicide
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3
Q

Name the somatic symptoms of depressive illness

A 
Loss of emotional reactivity
Diurnal mood variation
Anhedonia
Early morning waking
Psychomotor agitation or retardation
Loss of appetite or weight
Loss of libido
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4
Q

What psychotic symptoms can manifest in depression?

A

Delusions - poverty, personal inadequacy, nihilistic, responsibility for natural disasters, wars, accidents

Hallucinations - auditory: accusatory, defamatory voices, cries for help, screaming
Olfactory: bad smells, rotten flesh, food, faeces
Visual: tormentors, demons, the devil, dead bodies, scenes of death, torture

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5
Q

What other subtypes of depressive disorder are there? (Not including major depressive disorder)

A

Atypical depression
Postnatal depression
Seasonal affective disorder
Premenstrual dysphoric disorder

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6
Q

What types of antidepressants are there?

A

Selective serotonin re-uptake inhibitors
Monoamine oxidase inhibitors
Tricyclic antidepressants

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7
Q

Why are SSRIs more commonly used?

A

Side effects better tolerated

Less dangerous if overdosed

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8
Q

Name 3 SSRIs and side effects

A

Sertraline
Citalopram
Fluoxetine

Nausea, diarrhoea, GI upset, headache, agitation, anxiety

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9
Q

Name 2 TCAs and their side effects and contraindications

A

Clomipramine hydrochloride
Imipramine hydrochloride

Dry mouth, blurred vision, drowsiness, constipation, urinary retention
Contraindications: acute MI, heart block, arrhythmia, IHD, pregnancy, severe liber disease

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10
Q

Name 3 MAOIs and side effects

A

Tranylcypromine
Phenelzine
Isocarboxazid

Risk of hypertensive crisis - avoid foods high in tyramine - cheese, marmite, avocados
Hepatotoxicity, insomnia, anxiety, appetite suppression, weight gain

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11
Q

Define illusion

A

A false perception of a detectable stimulus (something is there by misinterpreted)

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12
Q

Define hallucination and give different types

A

A sensory experience involving the apparent perception of something not present

Auditory - hearing a voice speak ones thoughts out loud, hearing a voice narrating ones actions, hearing 2+ voices arguing
Olfactory
Visual - associated with organic disorders of brain and drug/alcohol intoxication
Lilliputian - things/people/animals smaller than would be in real life
Extra campine - beyond possible sensory modality eg seeing someone stood behind
Hypnagogic/hypnopompic - occur falling asleep or waking up
Elemental - flashes of light or unstructured noises
Reflex - hallucinations in one modality after experiencing a normal stimulus in another modality

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13
Q

What is an over-valued idea?

A

Non delusional, non obsessional abnormal belief.
It is acceptable and comprehensible but is preoccupying and comes to dominate their thinking and behaviour.
Held with rigidity but can be changed.

Concern over physical appearance in dysmorphophobia
Concern over weight in anorexia nervosa
Concern over personal rights in paranoid PD

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14
Q

What is a delusion and give examples

A

A pathological belief which is held with absolute subjective certainty and cannot be rationalised away, requires no external proof and may be held in face of contradictory evidence. Has personal significance and importance to the individual concerned.

Persecutory - external agency will cause you harm
Grandiose - believe you are super
Self referential - constructing links between random things
Nihilistic - am dead, everything dead, world no longer exists, smells rotting
Misidentification - replaced by imposter
Religious
Hypochondriac - believe they have illness
Guilt

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15
Q

What is a delusional perception?

A

A true perception to which a patient attributes a false meaning - schizophrenic trait

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16
Q

What is a thought disorder and give examples

A

Thought disorder - any change in form or content of thought

Thought alienation - patient feels that their own thoughts are no longer in their control (Sx of psychosis)

Thought insertion - delusional belief that thoughts are being placed in the patient’s own head by external agent

Thought withdrawal - thoughts are disappearing by external agent

Thought broadcast - thoughts are accessible directly to others, broadcast to everyone around you

Thought echo - experience of auditory hallucination in which the context is individuals own thoughts - an internalised running commentary (1st rank Sx schizophrenia)

Thought block - patient experiences a sudden break in chain of thought. Thought, sentence, idea stops even if someone reminds you what it was about.

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17
Q

What is concrete thinking?

A

The loss of ability to understand abstract concepts and metaphorical ideas leading to a strictly literal form of speech and inability to comprehend allusive language

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18
Q

What is loosening of association?

A

A lack of meaningful connection between sequential ideas so hard to follow in conversation. Nothing links but they do make sense

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19
Q

Define circumstantiality

A

A disorder of the form of thought where irrelevant details and digressions overwhelm the direction of the thought process. This abnormality may be reflected in resultant speech. Gets to point eventually but takes a very long time. Spirals round with random back story

20
Q

What is perseveration?

A

Continuing with a verbal response or action which was initially appropriate after it ceases to be appropriate

Eg. Do you know where you are? In the hospital
Do you know what day it is? In the hospital

Occurs in organic brain disease and occasionally schizophrenia

21
Q

What is confabulation?

A

Process of describing plausibly false memories for a period for which the patient has amnesia. Giving a false account to fill in a gap in a memory.

Korsakoff psychosis, dementia, Wernicke’s, schizophrenia

22
Q

What is somatic passivity?

A

Sensory feeling caused by external source, belief that one is no longer in control of own body, feelings or thoughts.

Patient believes sensation are imposed upon their body by external agent

23
Q

What are made acts and feelings?

A

Made to act, feel or get a drive or impulse to do something by external agent, feels alien to them

24
Q

What is delirium?

A

A clinical syndrome of confusion, variable degree of clouding of consciousness, visual illusions or hallucinations, labilits of affect and disorientation.

A stereotyped response by brain to a variety of insults and is similar in presentation whatever primary cause.

25
Q

What is catatonia and what is it a motor symptom for?

A

Increased resting muscle tone which is not present on active or passive movement.

Schizophrenia

26
Q

Define stupor?

A

An absence of movement and mutism where there is no impairment of consciousness. Complete loss of activity with no response to stimuli, progression from motor retardation.

Functional from psychiatric illness and organic from lesion in midbrain.

27
Q

What is psychomotor retardation?

A

Decreased spontaneous movement and slowness in instigating and completing voluntary movement with subjective retardation of thought

Moderate to severe depressive illness, Parkinson’s

28
Q

Define flight of ideas

A

Subjective experience of one’s own thoughts being more rapid than normal. Each thought has a greater range of consequent thoughts than normal.

Meaningful connections between thoughts are maintained.

Rapidly skipping from one thought to distantly related ideas - rhyming, puns, clanging

Excessive volume, excessive rate

29
Q

What is poverty of speech? What type of symptom is it for which condition?

A

General lack of additional, unprompted content seen in normal speech

Negative symptom in schizophrenia

30
Q

What is poverty of thought?

A

Reduction of quantity of thought

Negative symptom in schizophrenia
Also seen in severe depression and dementia

31
Q

What is pressure of speech?

A

The speech pattern consequent upon pressure of thought. Speech is rapid, difficult to interrupt.
With increasing severity of illness, the connection between sequential ideas may become increasingly hard to follow.

Seen in mania

32
Q

What is Anhedonia? What is it a feature of?

A

The feeling of absent or significantly diminished enjoyment of previously pleasurable activities.

Core symptom in depression
Negative symptom in schizophrenia

33
Q

Define flattening of affect and give examples

A

Lack of response to emotional stimuli

Negative symptom in schizophrenia

Neutral facial expression, monotone voice, lack of eye contact

34
Q

Define incongruity of affect

A

An objective impression that the displayed affect is not consistent with current thoughts or actions.

Emotional response opposite to situation or subject

Laughing whilst discussing traumatic experiences

Symptom of schizophrenia

35
Q

What is blunting of affect?

A

Loss of normal degree of emotional sensitivity and sense of appropriate emotional response to events.

Absence of normal emotional responses with no depression or psychomotor retardation.

36
Q

Define belle difference

A

A surprising lack of concern for or denial of apparently severe functional disability.

Lack of concern or feeling indifferent about symptoms.

37
Q

What is depersonalisation?

A

An unpleasant subjective experience where the patient feels as if they have become unreal.

Detachment from body, perception does not wake feeling of reality, patient feels like a witness to rest of the world.

38
Q

Define derealisation

A

An unpleasant subjective experience where the patient feels as if the world has become unreal.

Surroundings lack reality and are seen as grey, dull or lifeless

39
Q

What is conversion?

A

The development of features suggestive of physical illness but which are attributed to psychiatric illness or emotional disturbance.

Unconscious mechanism of symptom formation. Psychological trauma turns into physical symptoms.

40
Q

What is dissociation?

A

Separation of unpleasant emotions and memories from consciousness awareness with subsequent disruption to the normal integrated function of consciousness and memory

41
Q

What is stereotypy?

A

A repetitive and bizarre movement which is not goal directed.

The action may have delusional significance to patient.

Uniform, repetitive, no goal directed actions.

42
Q

What are mannerisms?

A

An abnormal and occaisonally bizzare performance of a voluntary, goal directed activity

Eg. Twirling hair when talking, fidgeting with necklace

43
Q

What is an obsession?

A

An idea, image or impulse which is recognised by the patient as their own but is experienced as repetitive, intrusive and distressing.

The return of obsession can be resisted for a time at the expense of mounting anxiety.

Recurrent, persisted thought, image or impulse that enters consciousness unabidden and is recognised as own

44
Q

Define compulsion

A

A behaviour or action which is recognised by the patient as unnecessary and purposeless but which they cannot resist performing repeatedly.

Drive to perform action is recognised by patient as their own but is associated with subjective sense of need to perform the act in order to avoid the occurrence of an adverse event.

The patient may resist carrying out the action for a time at the expense of mounting anxiety.

Repetitive, apparently purposeful behaviour performed in a stereotyped way.

45
Q

Biopsychosocial management of depression?

A

Bio - antidepressants: SSRIs - sertraline, paroxetine, escitalopram. Tricyclics - amitriptyline. Tetracyclic - mirtazapine

Psycho - CBT, psychotherapy, counselling

Social - housing, benefits, education, employment

Phase 3a (8 decks)

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