Psychiatry

Question 1

Formal Thought disorders (7)

Answer 1

Circumstantial speech
Tangential speech
Flight of ideas
Loosening of association ( knight's move)
Neologisms/Metonyms
Thought blocking 
Perserveration/ echolalia

Question 2

Define Circumstantial speech

Answer 2

(round the houses) excessive detail, digressions, but eventually gets to the point

Question 3

Define Tangential speech

Answer 3

multiple digressions, never gets to the point

Question 4

Define flight of ideas

Answer 4

rapid sequence of related concepts

Question 5

Define Loosening of association

Answer 5

rapid sequence of unrelated concepts

Question 6

What is a Knights move

Answer 6

Presentation of unrelated concepts but may actually have a link that wasn’t presented

Question 7

Define: Neologism and Metonyms

Answer 7

New words

New meanings for words

Question 8

What happens in Thought blocking

Answer 8

Sudden cessation esp. mid sentence, no recall, then digress

Question 9

What happens in perseveration

Answer 9

continuous repetition of word or phrase

Question 10

Term for parroting speech

Answer 10

echolalia

Question 11

Term for when there is a preoccupation with plausible belief causing distress

Answer 11

Overvalued idea

Question 12

Define Delusion

Answer 12

fixed false belief not inline with patient’s cultural or religious beliefs; may be mood-congruent or bizarre

Question 13

Types of Delusion (11)

Answer 13

Primary or secondary
Grandiose
Persecutory
Reference
Erotomania (de Clerambault's)
Infidelity (Othello's)
Misidentification
Nihilistic
Hypochondriacal (somatic)
Infestation (Ekobm's)
Control

Question 14

Define Primary & Secondary delusion

Answer 14

Primary- spontaneous

Secondary- related to existing mental illness

Question 15

Define Grandiose delusion

Answer 15

exaggerated self-importance e.g. god, messiah, superpowers

Question 16

Define persecutory delusion

Answer 16

others wish to dethrone / besmirch / harm / cheat the patient

Question 17

Define Reference delusions

Answer 17

phenomena have intense personal significance

Question 18

Define erotomania delusion

Bonus: alt name

Answer 18

high-status person is in love with patient

de Clérambault’s

Question 19

Define Infidelity delusion

Bonus: alt name

Answer 19

high-status person is in love with patient

Othello’s

Question 20

Define misidentification delusion

Two Types

Answer 20

Capgras (familiar is impostor)

Fregoli (stranger is familiar)

Question 21

Define Nihilistic delusion

Answer 21

the patient / others / the world is dead / non-existent

Question 22

Define Hyochondrial delusion

Answer 22

concerning patient’s body e.g. organs rotting

Question 23

Define delusional parasitosis

Bonus: alt name

Answer 23

belief they are infested with parasites, insects, or bugs, associated with formication
Ekbom’s

Question 24

Define control delusion

Answer 24

thought insertion, withdrawal, broadcasting

Question 25

What is a Hallucination

Answer 25

perception in the absence of external sensory stimuli

Question 26

Types of Hallucintation

Answer 26

Auditory: elementary (noise), complex (thought narration / echo, command, dialogue) Visual: usually in organic brain disease, substance misuse, Charles-Bonnet Hypnagogic: before sleep Hypnopompic: after waking

Question 27

Define Pseudo-hallucination

Answer 27

perceptual experience subjectively arising from within the mind (PTSD)

Question 28

Illusions are the

Answer 28

misperception / distortion of external sensory stimuli

Question 29

How should you administer rapid tranquilisation

Answer 29

lorazepam (PO / IM) - alone if non-psychotic, with olanzapine if psychotic, consider haloperidol (with antimuscarinic procyclidine if IV)

Question 30

Complications of Rapid Tranquilisation

Answer 30

LOC, airway obstruction, respiratory / cardiac arrest, seizure, EPSEs

Question 31

List the Anxiety disorders

Answer 31

Generalised anxiety disorder Panic disorder Post traumatic distress disorder

Question 32

GAD summary

Answer 32

chronic continuous (non-situational) anxiety / worry, symptoms for >6 months, patient recognises anxiety is excessive but difficult to control

Question 33

GAD symptoms

Answer 33

restlessness, easy fatigue, impaired concentration, irritability, muscle tension

Question 34

What should you ask when discerning Auditory Hallucinations (12)

Answer 34

Do you ever hear noises or voices when there is nobody else there? Are the voices like you hear mine right now? Can you hear them in your ears, or are they in your mind? How many voices are there? Do you recognise the voices? What do they say? Do they tell you to do things? (Do you obey?) Do they tend to comment on what you are doing/thinking? Are they present all the time? Does anything make them better/worse? Do you ever find yourself having a conversation with them? Do you smell or see anything at the same time that you hear these voices?

Question 35

First Frank symptoms

Answer 35

Auditory hallucinations Thought withdrawal, insertion and interruption Thought broadcasting Somatic hallucinations Delusional perception Passivity

Question 36

What should you ask to identify Thought interruption?

Answer 36

Do you feel able to think clearly? Do you ever experience your thoughts suddenly stopping as though there were no thoughts left? What is it like? How do you explain it?

Question 37

What should you ask to identify Thought withdrawal?

Answer 37

Is there anything like hypnosis or telepathy going on? Is there anyone or anything taking thoughts out of your head?

Question 38

What should you ask to identify Thought insertion?

Answer 38

Are your thoughts your own? Is there anyone/anything putting thoughts into your head that you know are not your own? How do you know they aren’t yours? Where do they come from?

Question 39

What should you ask to identify Thought broadcasting?

Answer 39

Can anyone hear your thoughts? For example, can I hear what you are thinking right now? Do you ever hear your own thoughts echoed or repeated?

Question 40

What should you ask to identify Somatic hallucinations?

Answer 40

Do you ever feel that someone or something is touching you when there is nobody there? Do you ever think there are insects crawling about inside your body?

Question 41

How would you explore delusional perceptions

Answer 41

Do you ever feel that somebody or something is paying particular attention to you and what you are doing? When you watch the television/listen to the radio/hear something, do you feel that the stories are referring to you or something that you have done?

Question 42

How should you explore Passivity?

Answer 42

Do you ever feel as though you are being controlled by someone or something? Do you ever think that someone or somebody is controlling you? Are your thoughts/mood/actions under your control or is someone forcing you to behave in this way?