Session 11 L1: Psychiatry

Question 1

What is neurology?

Answer 1

Disorders of nervous system with established aetiologies, demonstrable anatomical pathology and physical symptoms e.g. Parkinson’s, stroke, epilepsy, Huntington’s Disease, brain injury, etc

Question 2

What is psychiatry?

Answer 2

Disorders of mood, thought & behaviour with no or only minor physical signs with no visible pathology.

Question 3

What are functional disorders?

Answer 3

Neurotic disorders, e.g. depression, anxiety, phobias; or psychotic disorders e.g. schizophrenia, bipolar disorder

Question 4

What are examples of organic disorders?

Answer 4

Examples are dementia, psychiatric manifestations of epilepsy or Parkinson’s or stroke, acquired or traumatic brain injury, Huntington’s disease, drug-induced states, etc.

Question 5

What is dualism?

Answer 5

Set of views about the relationship between mind and matter which begins with the claim that mental phenomena are in some respects non-physical

Question 6

What is a diagnosis?

Answer 6

Knowing the underlying cause of symptoms & signs about which the patient complains but rarely can do in psychiatry except in organic conditions

Question 7

What is a disorder?

Answer 7

A clinically recognisable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions. Social deviance or conflict alone, without personal dysfunction, should not be included in mental disorder as defined here

Question 8

Why do we need classification?

Answer 8

• To enable clinicians to communicate with each other about patients
• To understand implications of diagnosis (Sx, prognosis, treatment, etc.)
• To facilitate research
• To relate research findings to everyday practice

Question 9

What are the criticisms of classification?

Answer 9

• Categorisation denies consideration of unique personal difficulties
• Labels deviant behaviour as an illness
• Individuals do not fit neatly into categories
• (stigma)

Question 10

What is categorisation?

Answer 10

Agreed definitions improve reliability but criteria are often arbitrary. Many patients do not fit descriptions or they criteria for 2 or more categories

Question 11

What are causes of schizophrenia?

Answer 11

• Psychoanalytic theories - a severe breakdown of the ego, which has become overwhelmed by the demands of the id and results in childish, infantile behaviour.
• Behaviourists reinforcement, observational learning, and shaping affect the development of the behavioural symptoms of schizophrenia.
• Cognitive theorists see schizophrenia as severely irrational thinking.
• Biological explanations dopamine, structural defects in the brain, and genetic influences in schizophrenia
• Stress-vulnerability model is a biological sensitivity or vulnerability to a certain disorder will develop under the right conditions of environmental or emotional stress

Question 12

What are examples of study designs?

Answer 12

• Family Study: Familial aggregated suggest shared diseased gene &/or environment
• Twin Study: If genes important then MZ.DZ concordance
• Adoption studies (with twins) – Genes VS environment

Question 13

What are the uses of psychiatric genetics?

Answer 13

• To aid classification
• Risk estimation
• To assist in the development of new treatments

Question 14

What increases the risk of psychosis in schizophrenia?

Answer 14

• Lifetime risk of 1% in the general population
• Risk in siblings (& DZ twins) is around 8–10%
• Risk increases as more relatives are affected
• Monozygotic (MZ) twin pairs have ~45% concordance

Question 15

What are conclusions about aetiology of schizophrenia according to studies?

Answer 15

• Over 50% of MZ co-twins are unaffected, despite being virtually identical genetically, indicates that non-inherited risk factors are also important
• Likely that the aetiology is multi-factorial, i.e. many genetic and environmental factors act together to influence risk, and a single risk factor is unlikely to cause the disorder on its own