Psychiatry Flashcards
what is an illusion?
misconception of a real external stimulus
affect driven
what is a hallucination?
disorder of perception
- experienced in the ABSENCE of external stimuli
types of hallucination
- 2nd person auditory- talking to them
- 3rd person auditory- talking about it
- visual
- olfcatory
- hypnogogic (occur on falling asleep)
- hyponopompic (occur on waking up)
- autoscopic- visualising yourself
- reflex- stimulation in one modality produces hallucination in another
what is a pseudo-hallucination?
perceptual experience which originates in space of own mind
what is a delusion?
- disorder of thought
- a belief that if firmly held, not affected by rational argument or evidence, not a conventional belief
what is a persecutory delusion?
believing that you are going to be/ are being intentionally harmed
what are grandiose delusions?
inflated self-importance- e.g. belief that you are a god
what are delusions of reference?
certain events/ actions can have special significance (e.g. believing that black cars are following you)
what is a nihilistic delusion?
delusion of nothingness- believes they have no money, nothing inside of them etc
what is an ertomanic (De Clerambaults) delusion?
belives they are of a high social standing/ everyone is in love with them
what is a morbid jealousy/ orthello delusion?
delusion that a sexual partner is unfaithful, can lead to violence
what is a delusion of misidentification (Capgras)
delusion that a close relative has been replaced by an imposter
what is a cotard delusion?
belief they are dead/ do not exist
what is a folie a deux delusion?
shared delusion with someone else
what is an ekboms delusion?
delusion of infestation
what is psychosis?
a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality
what is neurosis?
symptoms of stress (depression, anxiety, OCD etc) but no radical loss of touch with reality
what is passivity phenomena?
feeling that ones actions/ thoughts are not their own and are controlled by someone else
what is somatic passivity?
belief that they are a recipient of bodily sensations from an external force- e.g. someone else is making their arm hurt
what is catatonia?
significantly excited/ inhibited motor activity
what is stupor?
loss of activity with no response to stimuli
what is psychomotor retardation?
slowing of thoughts/ movements
what are some types of thought alienation?
o Thought Insertion
o Thought Withdrawal - someone/thing removing thoughts from head
o Thought Broadcast - thoughts made available to others
o Thought Echo
o Thought Block - abrupt stop in middle of thought - may not be able to continue idea
what is concrete thinking?
lack of abstract thinking
what is loosening of association?
lack of logical association between thoughts- incoherent speech
what is circumstantiality ?
going into ridiculous detail to make a point
what is perseveration?
repetition of a word, theme or action beyond the point of it being relevant/ appropriate
what is confabulation?
giving a false account to fill gap in memory
what is tangeliality?
wandering off topic
what is flight of ideas?
rapidly skipping from one thought to a distantly related idea
what is echolalia?
meaningless repetition of another persons spoken words
what are clang associations?
ideas that are linked by rhyme or the similarity of words
what is pressure of speech?
rapid speech with unusual associations
what is anhedonia?
inability to experience pleasure from activities that would normally cause this
what is incongruity of affect?
patients emotional response is grossly out of tune with the situation/subject- e.g. smiling when talking about death
what is a flat affect?
no emotion
what is blunting of affect?
reduced emotional expression/ response
what is Belle indifference?
relative lack of concern about the nature/ implication of the patients symptoms
what is depersonalisation?
detached from body- world has become vague/ dream like
can observe themselves
what is derealisation
external world feels unreal
what is conversion?
manifestation of mental illness as a physical order disease
what is dissociation?
disruptions in aspects of conciousness, identity, memory
what are mannerisms?
repeated involuntary movements that are goal directed
what is akathisia?
feeling of inner restlessness- rocking., marching on spot etc
what is tardive dyskinesia?
involuntary, repetitive jerky movement of head/ neck
what are pharmacokinetics?
what the body does to the drug
what are pharmacodynamics?
what a drug does to the body
what are ‘positive’ symptoms?
an excess or a distortion of normal functioning (delusions, hallucinations, disorganised speech/ behaviour, catatonic behaviour)
what are negative symptoms?
decrease/ loss of functioning (e.g. decreased emotions, loss of interest, flat affect, alogia)
what are some positive symptoms that can be seen in Schizophrenia?
delusions (usually persecutory), hallucinations, formal thought disorder
what are some negative symptoms that can be seen in Schizophrenia?
impairment of motivation and loss of volition
loss of awareness of socially appropriate behaviour/ social withdrawal
what are the first rank symptoms in schizophrenia?
- 3rd person auditory hallucinations
- delusional perception- delusions of passivity, influence or control
- thought disorders- withdrawal, insertion, broadasting
- passivity phenomenia
ICD-10 classification in schizophrenia
One or more of
- 3rd person auditory hallucintion
- Thought echo, insertion, withdrawal, broadcasting
- Delusional perception
- Passivity phenomena
Or two or more of
- Any persistent hallucination
- Catatonic behaviour - stupor, waxy flexibility
- negative symptoms
- breaks in train of thought
- impaired sight
- neologisms (making up words)
subtypes of schizophrenia
Paranoid- auditory hallucinations, no thought disorders, grandiose delusions
Hebephrenic- thought disorder and flat affect
catatonic- subject may be immobile
residual- 1 year of chronic negative symptoms which much have been preceded by at least one clear psychotic episode in the past
investigations in schizophrenia
- U&E’s- rule out drug cause
- LFT, FBC- rule out alcohol as a cause
- serological test- rule out syphilis
- CT head- brain lesion
what 4 things are assessed in a psychosis risk assessment?
- risk to self
- risk to others
- risk from others
- risk of criminal damage to property
epidemiology of Schizophrenia
- 15/100,000
- slightly more common in men
- age of onset- late-teens/ mid- twenties, can be a bit later in women
- increased prevalence in lower socio-economic classes
what are some motor symptoms seen in schizophrenia?
- catatonic rigidity (maintaining a fixed position and resisting being moved)
- catatonic posturing (adopting an unusual position for a period of time)
- catatonic negativism (patients resist all instructions to move)
- catatonic excitement (excitable motor activity with no external stimulus)
- catatonic stupor (presentation of akinesis, mutism and extreme unresponsiveness)
how is schizophrenia caused?
excess dopamine
overactivity of neurones- mesolimbic- results in hallucinations and delusions
under activity fo neurones- mesocortical- blunted, anhedonia, apathy
what do mesolimbic and mesocortical mean?
mesolimbic= positive symptoms
mesocortical= negative symptoms
what are some extra-pyramidal side effects of the treatment of schizophrenia?
- acute- acute dystonic reaction (muscle spasms)
- few weeks- Parkinsonism
- 6-60 days- akasthesia (inner restlessness)
- long term use- tardive dyskinesia
how are the extra-pyramidal side effects of schiophrenia treatment treated?
procycladine
propanolol +/- cyproheptadine
tetrabenazine
in schizophrenia what is procycladine used for?
EPSE- treatment of acute dystonia/ parkinsonism
in schizophrenia what is propanolol/cyproheptadine used for?
EPSE- treatment of akathesia
in schizophrenia what is tetrabenazine used for?
EPSE- treatment of tardive dyskinesia
what 1st generation antipsychotics are used in schizophrenia?
haloperidol
chloropromazine
what are some atypical/ new antiphyscotics used in schizophrenia?
olanzapine, risperidone, quetiapine, clozapine
what are the main dopamine and serotonin receptors?
Dopamine- D2
serotonin- 5HT2a
what does dopamine inhibit?
prolactin
what are some symptoms of hyperprolactinaemia?
- galactorrhoea
- amenorrhoea
- infertility
- sexual dysfunction
which antipsychotics can cause weight gain?
- all atypical
- clozapine/ olanzapine
side effects of clozapine
- weight gain
- agranulocytosis- high risk of infection
- reduced seizure threshold
- sedating
- postural hypotension
- extreme salivating
- cardiomyopathy
- toxic megacolon
which pathway causes excess proclactin?
tuberoinfundibulnar
which pathway causes movement disorders?
nigrostriatal
schizophrenia- signs and symptoms of neuroleptic malignant syndrome?
- reduced activity
- fever, altered mental status, muscle rigidity, autonomic dysfunction
- signs- elevated creatine Kinase, raised WCC, metabolic acidosis
schizophrenia- what drugs can cause neuroleptic malignant syndrome?
haloperidol
chloropromazine
what is schizoaffective disorder?
presentation of both schizophrenic and mood (depressed/ mania) symptoms that present in the same episode of illness
what are the 3 ‘phases’ of schizophrenia?
- prodromal- withdrawn
- active- severe symptoms- positive
- residual phase- cognitive symptoms
what is generalised anxiety disorder (GAD)?
anxiety that is generalised and persistent- not isolated to any specific environmental circumstance
what are some risk factors of GAD?
- early/ middle age
- more common in females
- divorced/ separated
- live alone
what are clinical features are needed for a diagnosis of GAD?
3 of:
- restlessness
- irritability
- easily fatigued
- difficulty concentrating
- muscle tension
- sleep disturbance
+4 symptoms of someone with anxiety (imagine typical patient- palpitations, increased HR, sweating, difficulty concentrating, numbness etc)
investigations in GAD
- exclude physical illness- hyperthyroid, pheochromocytoma, cardiac disease
- medication review- salbutamol, theophylline, corticosteroids
- rule out withdrawl symptoms of alcohol and benzodiazepines
- exclude PTSD, OCD, depression, schizophrenia, dementia, personality disorder
how is GAD managed?
1- lifestyle- exercise etc
2- low intensity psychological support, guided self help
3- CBT, medication
4- specialist input
what medications are used in GAD?
rapid response- benzodiazepines (lorazepam etc)
long-term- SSRI sertraline, clomipramine
what is a panic attack?
period of intense fear characterised by a group of symptoms that develop rapidly
dont last longer than 20-30 minutes
what is panic disorder?
recurrent panic attacks not secondary to substance misuse, medical conditions, another psychiatric disorder
what comorbidities can correlate with panic disorder?
agoraphobia
anxiety
bipolar
differential diagnosis of a panic attack
- anxiety/ anxiety related disorders
- substance/ alcohol misuse and withdrawal
- mood disorder
- psychiatric disorder secondary to a medical condition