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Define anhedonia.
Loss of interest in and withdrawal from all regular and pleasurable activities, often associated with depression.
What is the term for a feeling of apprehension caused by anticipation of danger?
What disorder is characterized by a brief psychotic episode lasting less than 1 month?
Brief psychotic disorder
Define echopraxia: Pathological imitation of movements of one person by __________.
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Which of the following is the correct order of prognosis from best to worst?
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Extrapyramidal symptoms may include resting tremor and rigidity.
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Match the delusion type with its description:
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What is the first step in the treatment for shared psychotic disorder?
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Delusions are fixed, false beliefs that can change easily.
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Match the neuroleptic group with the types of symptoms they are classically better at treating:
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What is the single most important skill required in psychiatry?
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What are some of the functions served by the psychiatric interview?
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Poor interviewing skills do not have any consequences.
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The ________ describes the sum total of the examiner's observations and impressions of the psychiatric patient at the time of the interview.
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Match the following components of the psychiatric assessment with their descriptions:
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What is the term 'psychiatry' derived from?
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Psychiatric assessment may involve psychological tests, but physical examinations are not conducted.
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Who theorized in the 4th century BC that physiological abnormalities may be the root of mental disorders?
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The first psychiatric hospitals in the medieval Islamic world were built starting from the ___ century.
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Match the following classification systems with their descriptions:
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What is the study of events, either psychological or physical, involving the observation and categorization of abnormal psychic events and the internal experiences of the patient?
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What are some sensory modalities in which hallucinations can occur?
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Depersonalization is a feeling that the external environment is abnormal and unreal.
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______ are misperceptions of external stimuli that occur under various conditions such as reduced sensory stimulation and consciousness.
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Match the following formal thought disorders with their descriptions:
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What is the lifetime prevalence of bipolar disorder?
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Which age group does bipolar disorder usually onset before?
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Bipolar I disorder has the highest genetic link among all major psychiatric disorders. (True/False)
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______ remains the gold standard mood stabilizer for treating bipolar disorder.
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Match the disorder with its description:
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Which disorder is characterized by strong genetic factors and persistent avoidance of various scenarios like open spaces?
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Generalized Anxiety Disorder symptoms must last at least 3 months. (True/False)
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What is the prevalence of Selective Mutism in community samples?
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What are the four main symptom categories of PTSD?
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What are common triggers for developing PTSD? Select all that apply.
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Symptoms of PTSD usually begin within 1 year after the trauma.
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Phobias are the most common psychiatric disorder in __________ and second most common in men.
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Match the following OCD components with their definitions:
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What is a common side effect of Tricyclic Antidepressants related to the 3Cs?
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Which neurotransmitters are affected by Monoamine Oxidase Inhibitors?
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Buspirone has a high potential for abuse and addiction.
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Benzodiazepines work by potentiating the effects of ____________.
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What is the personality disorder characterized by excessive preoccupation with details, lists, and organization, with symptoms being ego-syntonic and lacking insight?
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Which neurotransmitters are imbalanced in anxiety disorders?
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SSRIs work on histamine, adrenergic, and muscarinic receptors.
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_______ has the highest risk for GI disturbances among SSRIs.
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Match the pharmacotherapy with their corresponding anxiety disorder:
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Study Notes
Here are the study notes in markdown format:
Introduction to Psychiatry
- Psychiatry is a medical specialty that studies, prevents, and treats mental disorders in humans.
- The term "psychiatry" comes from the Greek "psyche" (soul or mind) and "iatros" (healer or doctor), coined by Johann Christian Reil in 1808.
History of Psychiatry
Ancient Times
- Mental disorders were considered supernatural in origin from the 5th century BC to ancient Greece and Rome.
- Hippocrates (4th century BC) theorized that physiological abnormalities may be the root of mental disorders.
- Early manuals on mental disorders were written by the Greeks.
Middle Ages
- The first psychiatric hospitals were built in the medieval Islamic world from the 8th century (Baghdad, Fes, and Cairo).
- Medieval Muslim physicians relied on clinical observations and made significant advances in psychiatry.
- They provided psychotherapy, moral treatment, baths, drug medication, music therapy, and occupational therapy for mentally ill patients.
11th Century
- Avicenna (Persian physician) recognized "physiological psychology" in the treatment of illnesses involving emotions.
- Avicenna also developed a system for associating changes in pulse rate with inner feelings, a precursor to the word association test.
13th Century
- Psychiatric hospitals were built in medieval Europe but were only used as custodial institutions, providing no treatment.
19th Century
- Universities played a part in the administration of asylums in Germany, leading to a competitive environment for psychiatrists.
- The Brattleboro Retreat (1834) in the US was the country's first financially stable private asylum, marking the beginning of private psychiatric hospitals.
Development of Biological Treatment in the 20th Century
- ECT, brain surgery, neuroleptics, and benzodiazepines were developed.
Why Study Psychiatry?
- Psychiatric disorders are prevalent and often go untreated.
- Depression is diagnosed in only 50% of those with depression who present to GPs.
- Half the patients who commit suicide sought treatment in a primary care setting within 1 month of dying.
Barriers to Diagnosis and Treatment in Primary Care Settings
- Patient factors: somatic complaints, denial, stigma, and shame.
- Physician factors: lack of time, fear of embarrassment, uncertainty, and lack of knowledge.
Classification Systems
- Categorical, dimensional, and multiaxial types.
- ICD-10 (World Health Organization) and DSM-5 (American Psychiatric Association) are the two main classification systems in international use.
ICD-10
- International Classification of Disease, 10th edition.
- Covers the whole of medicine, with a specific chapter for mental and behavioral disorders.
DSM-5
- Diagnostic and Statistical Manual of Mental Disorders, 5th edition.
- Comprises the official classification system of the American Psychiatric Association.
Psychiatric Interview
- The single most important skill required in psychiatry.
- Serves various functions, including collecting clinical information, eliciting emotions, and establishing a doctor-patient relationship.
Components of Psychiatric Assessment
- Identifying data, chief complaint, history of present illness, past psychiatric history, past medical history, medications, allergies, family history, social history, medical review of systems, and mental status exam.
Mental Status Examination
- Describes the sum total of the examiner's observations and impressions of the psychiatric patient at the time of interview.
- Includes general appearance and behavior, speech, mood and affect, thought process and content, perception, and cognitive functions.### Presentation Status
- Informal presentation
History of Presenting Complaint
- Nature of problem
- Chronology of each symptom
- Onset and duration
- Severity of symptoms and degree of functional impairment
- Precipitating factors
- Perpetuating factors
- Protective factors
- Factors worsening or improving
Past Psychiatric History
- Similar or other symptoms in the past
- Psychiatric diagnosis
- Psychiatric admission
- Any treatments (drugs, psychotherapy, psychosocial interventions, from primary care, counselling)
- ECT (Electroconvulsive therapy)
- Outcomes of treatment, any recovery, remission
- Suicide, DSH (Deliberate self-harm) attempts
Past Medical History
- Full medical history
- Endocrine, CNS, systemic illness
- Chronic medical conditions: diabetes, ischemic heart disease, epilepsy, asthma (use of steroids), stroke
- Chronology of illnesses, hospitalizations
- Recovery
Medications History
- Current medications
- All drugs taken for psychiatric or medical illness: dose, duration, and outcome
- Drugs that may precipitate psychiatric disorders
- Side effects of psychiatric medication
- Allergies
- May need to check with the GP
Family History
- Family tree to include patient's siblings and parents (e.g., adoptees, biological, separation, divorce, steps)
- Pt's nature of relationship with the family and among family
- Nature of death if anyone not alive
- Known or suspected Hx of mental illness
- Suicides, suicidal behaviors, or Hx of DSH in relatives
- Hx of substance misuse
Personal History
- Mother's pregnancy
- Neuro-developmental milestones: birth, walking, talking, sitting, and socializing age
- Childhood separation or emotional problems
- Home and school environment (Bullying, school refusal, shyness, conduct disorders)
- Schooling and academic achievements
- Relationships with friends and family
Social History
- Profession and employment record, current employment
- Financial situation in general
- Current and past debt problems, spending, etc.
- Marital status: single, married, divorced, widowed
- Children: ages if dependent, parental responsibility
- Housing situation, past and present-living alone
- Stressors
- Social supports
- Typical day
Forensic History
- Past and present charges, penalties, arrests, and convictions (Violence/Anger, sexual offences, etc.)
- Pending court cases
- Unrecorded offences
- Relationship to symptoms and substance misuse
Pre-morbid Personality
- Life-long persistent characteristics prior to illness
- Moral and religious beliefs
- Leisure activities and hobbies
- How would others (e.g., relatives/friends) describe them
Multiaxial System
- Axis I: Clinical Disorders and Other Conditions That May Be a Focus of Clinical Attention
- Axis II: Personality Disorders and Mental Retardation
- Axis III: General Medical Conditions
- Axis IV: Psychosocial and Environmental Problems
- Axis V: Global Assessment of Functioning
Phenomenology
- Study of events, either psychological or physical
- In psychiatry, it involves the observation and categorization of abnormal psychic events
- The internal experiences of the patient and their consequent behavior
Perception
- Awareness of objects and interpretation of sensory information
- Disorders of perception:
- Illusions
- Hallucinations
- Depersonalization
- Derealization
Thought Disorders
- Formal thought disorders (FTD)
- Serious problems with thinking, feeling, and behavior
- Components of thought:
- Flow/stream
- Form of thought
- Content
- Possession
- Disorders of flow:
- Pressure of thought
- Poverty of thoughts
- Thought blocking
- Loosening of association (derailment)
- Flight of ideas
- Perseveration
- Word salad
- Circumstantialities
- Tangentiality
- Echolalia
- Neologism
Schizophrenia
- Definition, diagnosis, epidemiology, and pathophysiology
- Terminology:
- Psychosis
- Delusion
- Perceptual disturbances
- Delusions:
- Fixed, false beliefs that remain despite evidence to the contrary
- Categorized as:
- Bizarre
- Non-bizarre
- Referential delusion
- Persecutory or paranoid delusion
- Delusion of control
- Delusions of grandeur
- Delusions of guilt
- Somatic delusion
- Erotomanic delusion
- Religious delusion
Classification of Delusions
- According to special feature:
- Systematized
- Non-systematized
- Shared
- According to theme:
- Persecutory (paranoid)
- Delusion of reference
- Grandiose (expansive)
- Religious
- De Clerambault's syndrome
- Delusion of jealousy
- Delusion of guilt and worthlessness
- Nihilistic delusion
- Hypochondriacal delusions### Symptoms of Schizophrenia
- Hallucinations: the 5 A's (Anhedonia, Affect, Attention, Avolition, Alogia)
- Delusions
- Bizarre behavior
- Disorganized speech
- Catatonia
Phases of Schizophrenia
- Prodrome
- Active psychotic
- Residual
Diagnosis of Schizophrenia (DSM-5)
- Two or more symptoms must be present for at least 1 month:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
- Significant social, occupational, or functional deterioration
- Duration of illness for at least 6 months
- Exclude other causes of psychosis
Epidemiology of Schizophrenia
- Approximately 1% of the population
- More likely to be victims of violent crime (14x)
Types of Schizophrenia
- Paranoid type: highest functioning type, older age of onset
- Disorganized type: poor functioning type, early onset
- Catatonic type: rare
- Undifferentiated type: characteristic of more than one subtype or none of the subtypes
- Residual type: prominent negative symptoms
Dopamine Hypothesis of Psychosis
- The exact cause of schizophrenia is unknown, but it appears to be partly related to increased dopamine activity in certain neuronal tracts
- Evidence supporting: cocaine and amphetamines increase dopamine activity and can lead to schizophrenic-like symptoms
- Evidence against: dopamine-inhibiting drugs modify dopamine within minutes, associated with improvement taking several days
Other Neurotransmitter Abnormalities
- Elevated serotonin
- Elevated norepinephrine
- Decrease in gamma-aminobutyric acid (GABA)
Genetics
- Schizophrenia has a large genetic component
- If one identical twin has schizophrenia, the risk of the other identical twin having schizophrenia is 50%
- A biological child of a schizophrenic person has a higher chance of developing schizophrenia, even if adopted
Prognosis
- Better prognosis: later onset, good social support, positive symptoms, mood symptoms, female sex
- Worse prognosis: early onset, poor social support, negative symptoms, family history +ve, male sex, many relapses
Schizophreniform Disorder
- Diagnosis: same criteria as Schizophrenia
- Symptoms last between 1 and 6 months
- Prognosis: 1/3 recover, 2/3 develop Schizoaffective/Schizophrenia
- Treatment: hospitalization, antipsychotics, supportive psychotherapy
Brief Psychotic Disorder
- Diagnosis: same criteria as Schizophrenia
- Symptoms last from 1 day to 1 month
- Prognosis: 50-80% recovery
- Treatment: hospitalization (brief), psychotherapy, antipsychotics +/- benzodiazepines
Schizoaffective Disorder
- Clinical Diagnosis: challenging
- Criteria: Schizophrenia + mood disorder
- Prognosis: better than schizophrenia, worse than mood disorder
- Treatment: hospitalization, psychotherapy, medical (antipsychotics, mood stabilizers, antidepressants, ECT)
Comparing Time Courses and Prognoses of Psychotic Disorders
- Time Course:
- < 1 month: brief psychotic disorder
- 1-6 months: schizophreniform disorder
- 6 months: schizophrenia
- Prognosis from best to worst: mood disorder, brief psychotic disorder, schizoaffective disorder, schizophreniform disorder, schizophrenia
Shared Psychotic Disorder
- Diagnosis: patient shares delusional symptoms of a person they are in a close relationship with
- Prognosis: 20-40% recover upon removal from inducing person
- Treatment: separate patient from inducing person, psychotherapy, antipsychotics if symptoms persist
Antipsychotic Drugs
- Typical neuroleptics: dopamine antagonists, better at treating positive symptoms
- Atypical neuroleptics: antagonize serotonin and dopamine receptors, better at treating negative symptoms
- Side effects: extrapyramidal symptoms, anticholinergic symptoms, tardive dyskinesia, neuroleptic malignant syndrome
Mood Disorders
- Definition: abnormal range of moods and loss of control over them
- Distress: caused by the severity of their moods and the resulting impairment in social and occupational functioning
- Investigate medical or substance-induced causes of mood episodes before making a primary psychiatric diagnosis
Mood Episodes
- Manic Episode: abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy
- Hypomanic Episode: abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy
- Depressive Episode: characterized by symptoms of major depressive disorder
Bipolar Disorder
- Definition: a serious mental illness in which common emotions become intensely and often unpredictably magnified
- In DSM-5, Bipolar and related disorders are separated from the depressive disorders and placed between the chapters on schizophrenia spectrum and other psychotic disorders and depressive disorders
- Specifiers: anxious distress, mixed features, rapid cycling, melancholic features, atypical features, psychotic features, catatonia, peripartum onset, seasonal pattern
Diagnosis and DSM-5 Criteria
- At least one lifetime manic episode is required for the diagnosis of bipolar I disorder
- Hypomanic episodes are common in bipolar I disorder but are not required for the diagnosis
- Depressive episodes are common in bipolar I disorder but are not required for the diagnosis
- The occurrence of the manic and depressive episode(s) is not better explained by another psychotic disorder
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Description
This quiz covers the basics of psychiatry, its definition, and its role in studying and treating mental disorders. It also touches on the assessment process, including mental status examinations and psychological tests.
