Psychiatry Flashcards
1
Q
List & describe the 9 headings of the Mental State Exam?
A
- Appearance: physical condition, suitable dress, cleanliness, self neglect, restlessness, odd appearance
- Behaviour: activity & arousal levels, lack of movement, eye contact, gait, aggressive, agitated, over-familiar, distractibility
- Speech: content, form, rate, rhythm, volume, tone, coherence, relevance, quantity and fluency, flight of ideas, tangential (one thought unrelated to the next), neologisms (new words/new definitions)
- Mood/Affect: subjective (patients view) and objective (doctors view) assessment, anxiety/panic Sx, obsessional thought/ruminations. Deep in thought/perplexed/confused
- Thoughts: delusions, thought disorder, persecutory, over-valued ideas, preoccupations, obsessive thoughts/impulses
- Perception: experiences may be distorted (illusions), hallucinations
- Cognition: poor attention span & conc, unshakable belief, fully alert to clouded, orientation to time/place/person, short-term memory
- Insight: aware of illness/ impaired insight
- Risk assessment: suicidal ideation (intent/plan/urge to act/reasons for and against/protective factors/auditory hallucinations influencing them), deliberate self-harm, harm to others
2
Q
Describe the Sx of Schizophrenia?
A
- +ve Sx: Delusions, Hallucinations, Thought Disorder, Disorganised speech and behaviour
- -ve Sx (worse prognosis): alogia (decreased level of thinking), poverty of speech, poverty of content of thought, blunting of affect (lack of emotion), abolition (lack of interest), slowness of thought and movement
- Other Sx: depression, anxiety, agitation, inappropriate eating behaviour, self-harm, incontinence, water intoxication, post-psychotic depression
3
Q
What are Schneiders first rank Sx of Schizophrenia?
A
- Auditory Hallucinations: 3rd person/running commentary, 2 or more voices discussing/arguing about oneself, thought echo
- Thought insertion/withdrawal/broadcasting
- Made feelings, actions or somatic passivity
- Delusional perception (patient interprets a normal event with a false meaning)
4
Q
Describe the diagnosis of Schizophrenia:
A
- ICD-10: Sx lasting >1m. At least 1: thought echo/insertion/broadcasting, hallucinatory voices, persistent delusions, delusions of control/passivity. Or at least 2 of: persistent hallucinations, bizarre thoughts/speech, catatonic behaviour, -ve Sx, significant behaviour changes
- ICD-10 Schizophrenia sub-types: 1. Paranoid (delusions & hallucinations). 2. Hebephrenic (thought disorder & affective disturbance). 3. Catatonic. 4. Undifferentiated. 5. Residual (-ve Sx)
- DSM V: lasting 6m. At least 2 of: delusions, hallucinations, disorganised speech, grossly disorganised/catatonic behaviour, -ve Sx. Also considers social/occupational dysfunction, duration, schizoaffective & mood disorder exclusion, substance/gen medical condition exclusion
5
Q
Describe the Pathology of Schizophrenia?
A
- Excess dopamine & Glutamate
- CT/MRI: Increased lat ventricles, reduced brain size (temp lobes), -ve Sx often have reduced blood flow & abnormalities in frontal cortex
- EEG: Reduced connections between different brain areas
