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Psychiatry (Psych Symptoms & Definitions (Perceptual symptoms…
Psychiatry
Psych Symptoms &
Definitions
Perceptual symptoms
Hallucination= Perceptions in the absence of an external stimuli, can be auditory/visual/olfactory
Pseudo-hallucination= Arise from ptx. inner mind not external organs
Over-valued idea= false/exaggerated idea sustained beyond logic or reason
Delusions
Def: unshakeable belief held with extraordinary conviction not in keeping with ptx. educational/cultural/social background
Examples: Self (pos- grandiose/religous, neg- hypochondriac/nihilistic) Others (persecutory, misidentification, self-referential)
Illusion= misperception of real external stimuli
Speech
Loose association= lack of association between succeeding thoughts
Circumstanciality= irrelevant wandering in conversation
Perseveration= repeated word, theme or action
Confabulation= false account given to fill a gap in one's memory e.g dementia
Sensory
Somatic passivity= delusion that one is a passive recipient of body sensations from an external agency
Motor symptoms
Psychomotor retardation= Slowing of thoughts and movements e.g depression/ parkinson's
Akathisia= motor restlessness ranging from anxiety to inability to sit still
Affect
Def: pattern of observable behaviour, variable, in response to changing emotional state
Blunted- absence of normal emotional response
Incongruity= emotions out of tune with situation/subject being discussed
Self and Surroundings
Depersonalisation= sense of detachment from one's own body, of being a spectator of one's own activities,
Derealisation= sense of one's surroundings lacking reality e.g being dull, grey, lifeless
Dissociation: feeling of being disconnected from oneself +/- your surroundings
Obsessions/Compulsion
Obsession
recurrent, persistent + thought / image / impulse + remains despite efforts to resist
Compulsion
repetitive purposeful behaviour + sense that has to be done + remains despite resistance / recognition of senselessness
Affective Disorder
Depression
Ix/ diagnosis
(Sx > 2wk)
DSM-IV
(9 criteria)
5= mild depression
<5 subthreshold
Assessment tools
HAD (Hospital Anxiety and Depression) Scale /21
PHQ-9 (Patient Health Questionnaire)
S&S
Low mood, Anhedonia, Lack of energy
Poor sleep / appetite / libido
Guilt, hopelessness, self-harm, suicide
PPh:
Decreased 5-HT --> Decreased Noradrenaline --> Decreased Dopamine
Mx:
First line meds- SSRI Fluoxetine
First line Hx CVD (Citalopram/Sertraline/Paroxetine)- all SSRIs
First line- CBT
Anti-depressant medications
Tricyclic
E.g. Amitriptyline/Lofepramine
SE: Arrhythmias
CI: Heart Failure
Monoamine Oxidase Inhibitors (MAOi)
E.g phenyzine
Indication: resistant depression
Advice: avoid tyramine-containing foods e.g cheese/red wine/broad beans
MoAction: prevent breakdown of serotonin
SSRIs
SE: GI Disturbance, Increased risk of suicide <30
CI: MAOi- risk of serotonin syndrome, Epilepsy- increased risk of convulsions
E.g Fluoxetine/Sertaline/Citalopram/Paroxetine
SNRI (Serotonin Noradreanline Reuptake Inhibitor)
E.g Duloxetine, Velnafaxine
SE: Serotonin Syndrome
Sx: CAN: Cognitive (agitation/confusion/hallucinations/euphoria), Autonomic (Tachycardia+pnoea, HTN, Arrhythmias, Fever, Diaphoresis) Neuromuscular (Tremor, Hyperreflexia, Ataxia, Clonus)
Tx: Cyproheptadine (5-HT antagonist)
Bipolar (?Mania)
PPh:
S&S:
Ix and Diagnosis: ICD-10: Hx 2 mood disorders. At least 1 hypomania (<4 days) / mania (>7 days)
Ix / Diagnosis:
Mania
S&S: energetic, impulsive, pressured speech, delusions, overfamiliarity
Definitions
Psychoses- loss of contact with reality
Neuroses e.g phobias/OCD
Mood- pervasive sustained emotions
Psychoses
Schizophrenia
S&S:
First rank sx:
3rd person auditory hallucinations, thought alienation, delusional perception, passivity
Second rank sx:
2nd person auditory hallucinations, thought disorder, delusions negative sx
Types of psychoses
Schizophrenia / Schizotypal disorder
Organic / Manic / Depressive Psychoses
Delusional psychosis
Conduct
persistent antisocial behaviours e.g lying, stealing, fire-setting, truancy, cruelty to animals, property destruction
Psych History / Assessment
Mental State Exam
Appearance
Kempt /Neglect / Dress
Behaviour
Paranoid/ Irritable / Aggressive
Speech
Volume / Rate (Pressured/Slow Monotonous)
Mood
Depression +/- Risk self&others / Euthymic (stable/normal / elated)
5Ps
Presenting problem, factors that : Predispose, Precipitate, Perpetuate or Protect
Concepts
Concrete = physical things e.g tremor
Defined= classes of concepts e.g delusions
Systems= set of related concepts e.g Schizophrenia