Mistakes in SPMM - 2nd Round PDF

Mistakes in SPMM - 2nd Round Psychology Group Conformity Typically secoondary to ambiguous tasks, making people feel less certain of their own ideas. Instrumental Aggression...

Mistakes in SPMM - 2nd Round Psychology Group Conformity Typically secoondary to ambiguous tasks, making people feel less certain of their own ideas. Instrumental Aggression Aggression to achieve a particular goal e.g. kidnapping for ransom. Planned and not impulsieve. Hostile Aggression Agression motivated by need to express negative feelings, e.g. anger. Groupthink Definition: supporting the shared consensus. To reduce it: encourage open debate, acknowledge presence of groupthink, seek external opinion, splitting into smaller units, holding last change meetings, reserve leader’s opinion. Normative Influence People do not want to appear off or stick out. We will often sat tes to what others say. Legitamite Power Influential power created by social position. Referent Power Power influenced through identification with the leader. Development of relationships Factors influencing in order of influence: 1. Proxmity 2. Reciprocity 3. Similarity 4. Complementarity Mistakes in SPMM - 2nd Round 1  Cognitive Dissonance Festinger coined the term. Definition: a state of tension or distress that thends to generate three tpes of dissonance-reducing behaviour. Externalising Bias Externalising bias refers to a cognitive tendency where individuals attribute the cause of their problems or negative events to external factors, rather than internal ones. In psychiatry, this is often seen in conditions like paranoid personality disorder or schizophrenia, where individuals may blame others or external circumstances for their difficulties, rather than recognizing their own role. This bias can contribute to difficulties in insight and treatment adherence. Labelling Theory Key Thinker: Howard Becker Deviance is not inherent in an act but is instead the result of society's labels. When someone is labelled as "deviant," they may internalize this label and act accordingly. Primary deviance refers to minor, initial rule-breaking behavior that does not result in a person being labelled as deviant. For example, someone might break a law but not be caught or labelled. Secondary deviance occurs when a person is labelled as deviant after their initial act, and this label influences their identity and future behavior. The individual may adopt the deviant label, leading to further deviant behavior. Jarman Index The Jarman Index is a tool used to measure social deprivation in a community. It helps identify areas with higher healthcare needs by considering factors like unemployment, overcrowding, and single- parent households. It was originally developed to allocate healthcare resources more effectively in the UK. Higher scores indicate greater deprivation and potentially higher healthcare demand. Fathers of Sociology Karl Marx, Emile Kurkheim and Max Weber Mistakes in SPMM - 2nd Round 2  The Life Events and Difficulties Schedule The Life Events and Difficulties Schedule (LEDS) is a structured interview used to assess stressful life events and ongoing difficulties. It was developed by Brown and Harris in the 1970s, primarily for research on depression. Key points: Purpose: To identify life events (e.g., bereavement, job loss) and chronic difficulties (e.g., financial problems) that may contribute to mental health issues. Method: A trained interviewer conducts a detailed interview, asking about events over the past year. Contextual Rating: Events are rated based on their objective impact, considering the person's life context (e.g., social support, personal circumstances). Reliability: It reduces bias by using independent raters and focusing on objective impact rather than subjective perception. It’s often used in research to explore the relationship between life stress and psychiatric disorders, especially depression. Four Prima Facie Ethical Principles Autonomy, non-maleficence, beneficence and justice. Thinker: Beauchamp and Childress Chaining vs Shaping Shaping: Reinforcing successive approximations of a desired behavior. You reward small steps that gradually get closer to the target behavior. Example: Teaching a child to say a word by first rewarding sounds, then syllables, and finally the full word. Chaining: Breaking down a complex behavior into smaller, sequential steps (a "chain") and teaching each step individually. Each step serves as a cue for the next. Example: Teaching someone to brush their teeth by first learning to pick up the toothbrush, then apply toothpaste, and so on. Eureka Moment This is also known as insight learning. Mistakes in SPMM - 2nd Round 3  Reinforcement Schedules Continuous Reinforcement: Every behavior is rewarded, leading to fast learning but also quick extinction if the reward stops. Example: vending machines that deliver a drink every time money is inserted. Partial Reinforcement: Only some instances of behavior are rewarded, and this can be based on ratio (number of behaviors) or interval (time passed). Partial reinforcement can make behaviors more resistant to extinction. Fixed Ratio (FR): A reward is given after a set number of responses (e.g., every 3rd response). This produces a high rate of responding but with short pauses after rewards. Variable Ratio (VR): A reward is given after an unpredictable number of responses, which creates a constant, high rate of responding and is highly resistant to extinction (e.g., gambling). Fixed Interval (FI): A reward is provided after a fixed time interval, regardless of response rate (e.g., monthly salary). Responses often slow after reinforcement, with a surge near the next reward time. Variable Interval (VI): Rewards are given at unpredictable time intervals, leading to a steady response rate (e.g., random checks at work). Intermittent schedules, especially variable ratios, are the most resistant to extinction. Theories of Emotion 1. James-Lange Theory: Emotions are caused by bodily changes that feedback to the brain, which interprets these sensations as emotions. A key critique is that bodily responses are not specific enough to differentiate emotions. 2. Cannon-Bard Theory: Emotional experience is triggered by signals from the thalamus to the cortex and bodily systems. Unlike James- Lange, Cannon-Bard argues that emotion and bodily reaction happen simultaneously, with emotion preceding feedback from the body. Mistakes in SPMM - 2nd Round 4  3. Lazarus and Folkman's Transactional Model: Psychological stress arises when an individual appraises a situation as exceeding their resources. This involves two stages: cognitive appraisal (evaluation of the situation) and coping. The theory suggests that appraisal precedes emotional response, opposing affective primacy. 4. Schachter-Singer Theory (Two-Factor Theory): Emotions result from physiological arousal and cognitive labeling based on context. If no appropriate label is found, arousal is typically interpreted negatively. Emotion is therefore seen as an attribution of arousal based on situational cues. Key Points: James-Lange: Emotions from bodily sensations. Cannon-Bard: Emotion and bodily reaction occur together. Lazarus and Folkman: Stress from appraisal of taxing situations. Schachter-Singer: Emotion as labeled arousal based on context. Acculturation Model Assimilation - rejecting origin culture, embracing host culture. Seperation - embracing origin culture, rejecting host culture. Marginalisation - rejecting both cultures. Integration - embracing both cultures. Covert Sensitization Covert sensitization is a behavioral therapy technique used to reduce unwanted behaviors, such as addictions or harmful habits. In this method, the person imagines engaging in the undesirable behavior (e.g., smoking) and then immediately visualizes an unpleasant consequence (e.g., feeling nauseous or vomiting). Over time, this pairing of the behavior with negative imagery helps reduce the desire to engage in the behavior. It’s a form of aversion therapy, but it happens in the person's imagination rather than in real life. Operant Conditioning Mistakes in SPMM - 2nd Round 5  Positive Reinforcement - behaviour is followed by a desirable outcome e.g. giving candy. Negative Reinforcement - behaviour is followed by removing an aversive stimulus e.g. avoiding drinking to not experience the Dilsulfiram reaction. Personality Tests Eysenck - this tests on the scale of extraversion and neuroticism. Minnesota - this tests on the scale hypochondriasis, depression, hysteria, ppsychopathic deviate, masculinity, feminitiy, paranoia, psychasthenia, schziophrenia, hypomania and social introversion. Thematic apperception test - black and white pictures, ambiguous persons and scenes. National Adult - premorbid intelligence. Cued Memory Cued recall is remembering items with the help of a cue e.g. the first letter of the item. Stigma There are two main types. 1. Enacted Stigma - Refers to perceived act of discrimnation against individuals with stigmatising condition. 2. Felt Stigma - Refers to the embarassement and shame associated with the condition. Free Association Developed by Freud. A psychoanlytic technique. This is when the patient is encouraged to say whatever comes to mind. This allows to uncover the unconscious. Defence Mechanism: Identification This is when people actively take on the characteristics, feelings and behaviours of someone else as one’s own. Mistakes in SPMM - 2nd Round 6  This is different to Introjection where someone may perceive themselves as being like someone else. Mnemonic: SIPDOG Developed my Melanie Klein. S - Splitting. I - Introjection. P - Projective Identification. D - Denial. O - Omnipotence. G - Grandiosity. The Repressive Barrier The repressive barrier prevents distressing unconscious material from reaching the conscious mind, maintaining psychological stability. This barrier is maintained by the preconscious mind which stops the unconsious entering the conscious. Psychotic Denial In mania, psychotic denial can act as a manic defense by protecting the person from painful emotions or realities. The individual may deny negative feelings, vulnerabilities, or problems, and instead, exhibit grandiosity, inflated self-esteem, or unrealistic optimism. This defense mechanism helps them avoid confronting distressing thoughts or situations, maintaining their elevated mood. Dream Content There are two main types. Manifest Content - what is recalled by the dreamer. Latent Content - the unconscious thoughts and wishes. Dream working is latent being transformed into manifest. Freud and Repression Mistakes in SPMM - 2nd Round 7  Freud viewed repression as a critical function of the mind that protects individuals from psychological harm, but he also recognized that it could lead to complications if these repressed elements are not eventually addressed. Condensation Mechanism where several unconscious wishes combines into single image in manifest dream content. Development Child Play Solitary Play comes first. Parallel Play - 2 years old. Co-operative play - 3 years old. Rule-governed play - 5 years old. Child Progression 6-8 weeks - child start cooing. 6 months - babbling. Three Stage Bereavement 1. Stage 1: Disbelief, Shock, Denial 2. Stage 2: Discomfort, social withdrawal. 3. Stage 3: Restituion and Reorganisation Pathognomic Symptoms of Grief This includes: somatic distress (somatic signs and symptoms), preoccupied with images of deceased, hostile reactions, loss of conduct, behaving like the deceased. Anaclitic Depression This is when children became depressed following seperation from their mother for varying times. Children became depressed, withdrawn, nonresponsive and vulnerable to physical illness. They however recovered when their mothers returned or when surrogate mothering was available. Adaptation of the Infant Mistakes in SPMM - 2nd Round 8  Thinker: Piaget There are two forms of adaptation: 1. Assimilation = exisiting experiences used to solve new problems. 2. Accommodation = exisiting experuences are MODIFIED first to solve new problems. Transitional Objects A pcifier, blanket or teddy bear - acting as a substitue for the mother. Infants are helpless Bowlby described infants as having an innate state of helplessness and would perish without their caregiver. Post Conventional Stage The post-conventional stage described by Kohlberg is the morality of self-accepted moral principles. This is when children voluntarily comoply with rules based on a concept of universal ethical principles and make exceptions to rules in certain circumstances. Only 10-15% of people are capable of this level of abstract thinking. Primary Emotion Development 6 months - 3 years = joy, sadness, anger, fearfullness, disgust, surprise. 3 years+ = jealousy, shame, guilt, empathy (the self conscious) Ambivalence Klein Definition: Ambivalence refers to experiencing mixed or contradictory feelings towards the same person or object, such as love and hate simultaneously. In Klein's Depressive Position, ambivalence is a key feature. The infant realizes that the loved and hated object (usually the mother) is the same person. This leads to anxiety and guilt because the child fears that their aggressive feelings might harm the loved object. The depressive position involves working through these conflicting emotions and developing the capacity for concern and reparation. Centration Mistakes in SPMM - 2nd Round 9  Centration is a cognitive tendency in children, where they focus on one aspect of a situation or object while ignoring other important features. It is commonly seen in Piaget's preoperational stage of development. For example, a child might focus only on the height of a liquid in a glass and ignore the width, leading them to think a taller glass has more liquid, even if both glasses hold the same amount. Measuring intelligence in Children Their ability to draw human figures. Intelligent children have detail in their drawing. Fear of the Dark The fear of the dark is not an actual fear characteristic in infancy. Privation If the child fails to develop an attachment, this is privation. This will lead to an inability to keep rules, form lasting relationships or feel guilt. Visual Acuity Visual acuity to adult levels are reached at 6 months of age. Assessing Adult Attachment Hour-long, semi-structured interview. Assess’ adult attachment styles. Egocentrism Children in the pre-operational stage of development are unable to comprehend the world from other people’s viewpoint. This is illustrated via the mountain task experiment. This is seen in the pre-operational stage. Telegraphic Speech Telegraphic speech is seen where meaningful words are used without connecting words. Age: 18-30 months. Object Relation Theory Mistakes in SPMM - 2nd Round 10  Object reltations refer to emotional bonds that people form with instinctual objects. It is that the primary motivational drive of an individual is to seek relationships. Monotropy Bowlby coined this term that refers to infants attaching to one person. Infants Multiple Attachments 87% of infants by the age of 18 months have multiple attachments. Assessment Mental diseases are diseases of the brain Key Thinker: Wilhelm Griesinger Schizophrenia The person who coined this termw as Blueler PTSD Symptoms occur within 6 months of the traumatic event. Symptoms: autonomic hyperarousal, re-experiencing aspects of event, active avoidance of cues, anhedonia, insomina. Bizarre Delusions and Delusional Disorder In delusional disorder, delusions are non-bizarre, meaning they involve situations that could happen in real life, like being followed or poisoned. Bizarre delusions, which are clearly implausible (e.g., aliens controlling thoughts), are more characteristic of schizophrenia. Delusional disorder is defined by the presence of these more realistic, non-bizarre delusions. Poor Prognostic Factors of Schizophrenia This includes: insiduous onset, young onset, cognitive impairment, enlarged ventricles, male sex, negative symptoms. Depression and Schizophrenia Mistakes in SPMM - 2nd Round 11  When psychotic, depression secondary to hallucinations. When post-psychotic, depression secondary to shame and loss. Operationalised Approach This approach involves developing clear clinical definitions, with explicit inclusion and exclusion criterias, detailing the number and duration of symptoms. This is what is formulated for a diagnosis. Narcolepsy Symptoms: excessive sleepiness, cataplexy, sleep paralysis, hypnagogic and hypnopompic hallucinations. OCD Feature Checking is the most common feature. ADHD Age Onset ADHD core symptoms must occur before the age of 12. Autism Age Onset Typically can be diagnosed during the second year of life. Duration Criterion for PD There is no specific time for diagnosis but the description refers to a 2 year time-frame of symptoms. Acute Stress Disorder or PTSD Acute stress disorder is similar to PTSD but it is diagnosed for the first 4 weeks of symptoms. Dissociative Disorder The most common symptom is that of loss of personal identity. Dimensional Descriptors of Schizophrenia This includes: Positive Symptoms Negative Symptoms Depressive Mood Symptoms Manic Mood Symptoms Mistakes in SPMM - 2nd Round 12  Psychomotor Symptoms Cognitive Symptoms Recovery of Delirium Delirium normally recover within 4 weeks. Schizoaffective Disorder Key Thinker: Jacob Kasanin Diagnosis involves mood disorder and schizophrenia. Core Symptoms of ADHD 1. Inattention 2. Hyperactivity 3. Impulsiveness Kinaesthetic Hallucination Can occur in alcohol intoxication and during benzodiazepine withdrawal. This affects the muscles and joint, in that the patient feels their limbs are being twisted, pulled or moved. Bipolar III Disorder This is known as substance induced bipolar. This is related to hypomania symptoms caused by antidepressant use. Untreated Mania Untreated mania normally lasts 4 months. Chronic Fatigue Syndrome Also known as myalgic encephalomyelitis. Patients must have: Persistent or relapsing unexplained chronic fatigue. Fatigue lasting for at least 6 months. Not alleviated by rest. Wernicke Encephalopathy Cause: Thiamine deficiency. Mistakes in SPMM - 2nd Round 13  Triad: Confusion, ataxia, ophthalmoplegia/nystagmus. Hallmark of Schizophrenia Hallmark symptom is lack of insight. This is a defining feature. Ganser Syndrome Known as approximate answer syndrome. What is the difference between psychosis and first rank symptoms? Salience This refers to the neglect of all leisure and alternate forms of pleasure apart from alcohol. Alcohol becomes more important than retaining a job or relationship. Continuous Schizophrenia If the first episode duration is more than 1 year, the continuous specifier should be used instead. Assessment Part 2 Anterior Cerebral Artery Stroke The inability to move voluntarily or spontaneously with mutism. Constructional Apraxia Copying intersecting polygons is a test for this. This is achieved using the parietal lobe of the brain. This is typically a right cerebral hemisphere problem. Repetition preservation in Broca and Wernicke Broca and Wenicke have impaired repetition. However, if it is preserved then… Broca = Transcortical Motor Aphasia Wernicke = Transcortical Sensory Aphasia ADHD and Brain Region There is underfunctioning of the frontostrital pathways. The frontal cortex has the most prominent changes observed during neuroimaging. Mistakes in SPMM - 2nd Round 14  Cognitive Testing in Schizophrenia MMSE testing is usually intact in Schizophrenia. Higher-order functioning tests typically mean patients perform more poorly. Balint Syndrome Region: Parieto-Occipital Region 3 Main Symptoms: 1. Simultanognosia - intability to perceive more than one object. 2. Optic Ataxia - inability to reach for objets with normal motor function. 3. Oculomotor Apraxia - inability to voluntarily move eyes. Cannabis in Urine Acute use present for up to 3 days. Chronic use present for up to 4 weeks. Lewy Body Dementia This is the presence of lewy bodies - these are inteneuronal inclusions consisting of alpha-synuclein and ubiquitin. Schizophrenia and Brain Region Consistently reduced in size is the insula. Reduced aygdala, thalamus, nucleus accumbens. Increased lateral ventricle size. Magnetic Resonance Spectroscoy Biochemistry of tissues, comparing tissue changes following strokes or tumors. Synthetic Radionucleotide SPECT and PET scans involve using a measurable tracer via a synethetic radionucleotide and track around the system. Simultanagnosia and Prosopognosia Simultanagnosia: Inability to perceive multiple objects at the same time. A person can only focus on one object in their visual field, Mistakes in SPMM - 2nd Round 15  even if other objects are present. It is a key feature of Balint syndrome. Prosopagnosia: Also known as "face blindness," it is the inability to recognize familiar faces, even though vision and other cognitive functions are intact. It is often associated with damage to the fusiform gyrus in the temporal lobe. Cerebellar Signs Symptoms: Hypotonia, Dysdiadokinesia, Ataxia, Past Pointing. Pronator Drift This is a right cerebral hemisphere lesion. Alexia without Agraphia Pure word blindness. Able to write, unable to read. Posterior cerebral artery. T1 Imaging in MRI The assessment of normal brain structure. Fine details of the figure Left hemispheric damage. Assessing white matter fibres Modality used diffusion tensor imaging. Emotional and Intellectual Insight Emotional insight = emotional understanding + change. Intellectual insight = logical understanding without emotional connection. Executive function texting Winconsin card sorting test, category test, trail making test, stroop test. Assessment Part 3 Parapraxis This is what is known as slip of the tongue. Freud ascribed this to the unconscious motive. Mistakes in SPMM - 2nd Round 16  Autochthonous Delusion This is a type of primary delusion. This is a delusion that suddenly enters the patient mind. Schnauzkrampf Snout Spasm. Thought Broadcasting This is when peoples thoughts are accessible. Capgras Syndrome This is when a patient belief that a person has been replaced by a double. This is most commonly seen in Schizophrenia. Negativism This is when patient resists the examiners instructions. This is a catatonic sign. Stupor There is no reaction to external stimuli. Most common cause is depression. Semantic Jargon This is when ordinary words are strung together to form unintelligible utterances. Phonemic Jargon This is speech involving neologism. Alexithymia A person has difficulty recognizing and expressing their emotions. Types of sensory distortion Hyperacusis - sounds appear louder Micropsia - objects appear smaller Macropsia - objects appear larger Dysmegalopsia - size and shapes differ Mistakes in SPMM - 2nd Round 17  Hyperaesthesia - increased sensitivity to tactile Couvade Syndrome Conversion symptom, seen in partners of pregnant mothers. The fathers have pregnancy symptoms but know they are not pregnant. Coenesthesia Hallucination This is deep visceral pain, twisting and tearing. Delusion of Reference Delusional belief that external events have conveyed a message to affected individual. It can also mean external events reference themselves e.g. the Bible is speaking about them. Ganser Syndrome This is a dissociative thought form disorder where people give nonsensical answers to questions. They seem to speak in approximates. They approximate answers, appear confused, stressed and this is all non-deliberate. It is thought to relate to severe stress or brain injury. Therapy is the mainstay of treatment. Ego-syntonic and Ego-dystonic In short, ego syntonic refers to thoughts and behaviors that feel consistent with one's identity, while ego dystonic refers to those that feel alien or in conflict with it. Understanding this distinction can help in recognizing how people experience their thoughts and behaviours. Delusions are often considered ego syntonic because they align with a person's self-image and beliefs. Musical hallucinations Left parietal lobe dysfunction. Dysfunctional temporal cortex. Type-token ratio (TTR) This is an assessment of the diversity of one’s vocabulary. High TTR indicates greater diversity. This is reduced in schizophrenia. Overinclusion Thinking Where a person includes too many categories or examples when trying to make sense of information or experiences. This can lead to broad Mistakes in SPMM - 2nd Round 18  generalizations or misinterpretations. This can be tested using sorting test. Alexithymia This is difficulty in describing your feelings. Types of Primary Delusions Autochthonous - arising out of the blue. Perception - normal percept. Memory - on recall of memory. Atmosphere/Mood - on experience. Thought Echo This is a type of auditory hallucination. The patients thoughts are repeated by voices. The German name for this is Gedankenlautwerden. Age Disorientation This is misstating one’s age. Typically, it is about 5 years. Test for Concrete Thinking This is the inability to understand abstract thoughts - they might easily discuss a specific object but struggle with discussing ideas like love or freedom in an abstract way. Typical in young children and autism. This is tested with proverb testing. Mannerism This is voluntary, bizarre, goal directed behaviour. Stereotypy is voluntary, bizarre, non-goal directed behaviour. Autoscopic Hallucination This is also known as phantom mirror image. Experience of seeing a visual hallucination of oneself. Associated with parietal tumours, toxic infective states, temporoparietal lesions and epilepsy. Also seen in depression, schizophrenia and dissociative disorders. Mistakes in SPMM - 2nd Round 19  Pareidolic Illusions This is when you see faces in a fire or clouds. Paraschemazia This is distortion of body image to which parts of the body are distorted, twisted. Occurs with drug use, epilepsy or migraines. Logoclonia Meaningless repetition of the last syllable. Psychomotor Retardation This essentially means slowness in movements. This is commonly seen in depression. Increased resting muscle tone is… characteristic of Catatonia. Auditory and Visual Hallucinations Auditory = functional disease. Visual = organic disease. Delusional Mood Sometimes referred to as delusional atmosphere. This is known as a prodrome to delusions or psychosis. This typically feels to the patient that something is about to happen. The formation of a delusion then comes as a relief. Synaesthesia The experience of a stimulus in modality, producing a sensory experience in another. For example, hearing colours. This is purely based on the senses. Do not get it confused with reflex hallucinations which goes further. Epileptic Automatisms These are repetitive, involuntary movements occurring during seizures. They last seconds to minutes. They can be oral (lip smacking) or can be manual (scratching). Mistakes in SPMM - 2nd Round 20  Recognised Motor Symptoms of Schizophrenia Catatonia - A state of immobility and stupor Catalepsy - Rigid body posture maintained for long periods Negativism - Resistance to instructions or attempts to move Ambitendency - Alternation between opposing actions Psychological Pillow - Lying with head raised as if on a pillow Mannerism - Odd, exaggerated gestures or behaviors Stereotypy - Repetitive, purposeless movements Echopraxia - Mimicking others' movements Mitmachen - Limbs can be positioned by examiner Mitgehen - Exaggerated cooperation with examiner's movements Automatic Obedience - Excessive compliance with instructions Asyndesis This is in regard to loosening of associations. There is a lack of connection between thoughts. Dysmorphophobia This is an over-valued idea in that one’s body is abnormal. This is characteristic of body dysmorphic disorder. Depression is seen in 80%. Cotard Syndrome This like corpse. It is of nihilistic delusion with the patient feeling already dead. Neologisms These are new words that are made up or ordinary words used in a new way. Metonymy Metonymy is a figure of speech in which one word or phrase is substituted for another with which it is closely associated. Jamais Vu and Deja Vu Mistakes in SPMM - 2nd Round 21  Jamais means never in French. Therefore, it means never experienced. Familiar things that feel new or strange. Autoscopy This is viewing one’s own body. Anhedonia This is the inability to enjoy anything in life. This term was coined by Ribot. One Way Amnesia One-way amnesia is when you can remember some things but not others, like having gaps in your memory. This is associated with dissociative identity disorder. Dereistic Thinking This is essentially unrealistic thinking. Made Act vs Made Impulse Made Act: A conscious, planned action. Made Impulse: A spontaneous, unplanned action driven by immediate feelings or urges. Voices heard in Schizophrenia Voices often similar to people known. 3 different voices on average. Male voices more common than females. Frequently speak in an accent. Ranges from continuous to once a week. Racing vs Crowded Thoughts If described as racing, this is typically mania. If described as crowded, this is typically depressive. Lilliputian Hallucination This is when the patient sees miniature people or animals. Associated with delirium tremens. Mistakes in SPMM - 2nd Round 22  Negative Symptoms of Schizophrenia Flattened Affect - limited affective responsiveness. Alogia - poverty of speech. Anhedonia - inability to experience pleasure. Social Withdrawal - lack of desire to form relationships. Lethargy Avolition - lack of motivation. Auditory stimulus leads to a hallucination is… a functional hallucination. Direct and Indirect Priming Priming: Direct influence (e.g., "doctor" → "nurse"). Indirect priming: Influence through a less obvious or more distant connection (e.g., "doctor" → "hospital"). Indirect priming is commonly seen in Schizophrenia. Types of Illusion Affect Illusion - combination of heightened emotion and misinterpretation. Completion Illusion - brains tendency to fill in presumed missing parts to produce meaninful percept. Pareidolic Illusion - seeing faces in a fire or clouds. Emotional Incontinence This is increased emotional beahviour from minmal stimuli. People do not have control of these emotions. Elemental Hallucinations Simple hallucinations - simple noies. Telelogical Hallucination This is also known as a command hallucination. This is not a first rank symptom. Vorbeireden This means talking past the point. Mistakes in SPMM - 2nd Round 23  Formal Thought Disorders Schneider described 5 features. 1. Derailment - Abrupt shift in topic or loss of train of thought 2. Substitution - Replacing one word or idea with an unrelated one 3. Omission - Leaving out essential parts of speech or thought 4. Fusion - Combining unrelated ideas or words inappropriately 5. Drivelling - Incoherent, rambling speech with little meaning Rating Scales Clifton Assessment Procedure This is to assess level of care in elderly residential people. BPRS Used as an outcome measuring tool in schizophrenia patients. Beck Depression Self-rated depression scale. 21 statement. >13 = moderate >30 = severe Aged 13 and over. Types of Validity Criterion Validity - how well test predicts the real-world outcomes that test is associated with. Construct Validity - if a test is truly testing for what it is designed for. Predictive Validity - how well a test can predict future outcomes. SAWS This is used for alcohol withdrawal. Cut-off score of 12 points is used. Test-Retest Reliability Correlation between 1st and 2nd test on the same subject. Mistakes in SPMM - 2nd Round 24  SCID Structured Clinical Interview for DSM This is one of the most used diagnostic instruments in clinical research worldwide. Simpson Angus Scale This scale is used for extrapyramidal symptoms. AIMS Scale A scale used in particular to look at tardive dyskinesia. Young Mania Rating Scale 11 item, clinician rated. >20 = manic state. Montgomery Asberg Depression Scale 10 item version. Requires a clinical interview. This test is highly sensitive to change. Gold Standard for Intelligence Scale Wechsler Adult Intelligence Scale GHQ Self-rated questionnaire. Patient reports presence of symptoms. PANSS This assess’ for positive and negative symptoms. This aids in diagnosing schizophrenia. HoNOS A scale used to monitor clinical recovery. Pharmacology Buspirone This is a azapirone. 5-HT1A partial agonist. (Aripiprazole is a D2 partial agonist) Mistakes in SPMM - 2nd Round 25  It is a noradrenergic and dopaminergic reputake inhibitor. This drug does not cause withdrawal effects. Discovery of Lithium Use John Cade. Use of Lofexidine This is used to relieve symptoms of opiod withdrawal. It is an alpha 2 agonist. What is the metabolite of risperidone… Paliperidone is the metabolite. How does Acomprosate work… Acamprosate works by reducing craving and preventing relapse with alcohol dependance. It does this by being a synthetic analogue of taurine. How to treat hypersexuality and paraphilias… Cyproteterone acetate is an anti-androgen. It is a testerone antagonist. Which antipsychotic caused sudden death? Thioridazine. This was pulled from global market in 2005. Class of Paliperidone and Risperidone Major metabolite of risperidone. It i a benzoxsazoles. Class of Olanzapine It is a thienobenzodiazepine. First SSRI introduced to market… Zimeldine. Bupropion - class and mechanism. The class is aminoketone. Mistakes in SPMM - 2nd Round 26  It is a SNRI. A drug associated with weight loss. Rapidly absorbed sedation Zolpidem has a half life 2.6 hours. Which drugs do not go through hepatic metabolism? Gabapentin, sulpiride, amisulpride and lithium. Therapeutic Index This is the difference between therapeutic effects to toxic effects when dosing. Overcounter medication like paracetamol have much higher index. The most selective serotonin re-uptaker? Citalopram and ecitalopram. What is the least sedating TCA? Lofepramine. What are some zero order kinetic drug examples? Ethanol, phenytoin, high dose salicylates, high dose fluoxetine, high dose omeprazole. What is the half life of Aripiprazole? The half life is 3 days. What is special about carbamzepine ? The metabolite induces its own metabolism. There is autoinduction. Steady state takes 2 weeks to get to. Paroxetine also has autoinduction behaviour. How do you work out bioavailability? You have to work out the dose of when given by IV. Ways to improve absorbtion of medication? 1. Slower intestinal motility. 2. Balance of water and lipid permability. Mistakes in SPMM - 2nd Round 27  3. Inhibition of P Glycoprotein. Grapefruit juice does this which is why it increases absorbtion of some drugs. 4. Reduced particle size. Managing alcohol withdrawal in impaired liver function? Use oxazepam or lorazepam. Diuretics to control polyuria by lithium explanation In lithium-induced polyuria, the kidneys lose the ability to concentrate urine, leading to excessive urine output. Diuretics, like thiazides, reduce polyuria by causing mild dehydration. This dehydration signals the kidneys to retain more water, which paradoxically reduces urine output. However, thiazides can increase lithium levels, so careful monitoring of lithium levels is essential. Donepezil - Urinary retention or urinary incontinence? This causes urinary retention. Which receptor causes weight gain? 5HT-2C atagonism. What is the most toxic benzo? Alprazolam. Which drug is associated with renal stones? Topiramate. SSRI and MI - which one to watch out? Citalopram. Which EPS can Botox be used? Tardive dystonia. Which drugs do TCAs interact with? Alcohol, hyponotics, anxiolytics and antipsychotics - these are drugs that TCAs increase the effects of. Anaesthetics and MAO Inhibitor When on an MAOI, ensure the use of opiod analgesic drugs used in anaesthetics are not used. Mistakes in SPMM - 2nd Round 28  This includes meperidine - can cause serotonin toxicity. RFs for Tardive Dyskinesia Risk factors include: chronic antipsychotic use, change of treatment, anticholnergic use, elderley, females, organic disorders, head injury before, alcoholics, negative symptoms, diabetics, parkinosims symptoms. Antipsyhotics causing QTc prolongation Watch out for: serindole, thioridazine and haloperidol. How to treat the urinary retention associated with SSRI/SNRI? Use tamsulosin or doxasocin. Reduce Akathisea Symptoms Managment Use: propanolol, cloazepam, diazepam, mirtazpine, mianserin, benzatropine, clonidine. Which antidepressant has been linked with glaucoma? Paroxetine. How does memantine work? Memantine works by being a non-competitive NMDA receptor antagonist. It is neuroprotective. It protects neurons from glutamate mediated excitotoxicity. It is used in Alzheimers. How do TCAs affect receptors in the brain Chronic TCA use results in down-regulation of beta-adrenergic receptors, contributing to therapeutic effects and hypotension. Citalopram and CYP450? This is an inhibitor of the system. Receptors on Cyproheptadine and its use. It is a histamine H1 receptor antagonist and a 5-HT2 antagonist. It can be used in the treatment of sexual dysfunction from SSRIs. It is also used in the treatment of Serotonin Syndrome. Which antipsychotic to start in Parkinson Disease? Mistakes in SPMM - 2nd Round 29  Quetiapine is best. All others have motor function issues. Risperidone should be avoided completely - it has a high D2 and 5HT2 activity. Which antiD to use with MAOI? Use amitryptiline. What is so special about trazodone? Trazodone is both an agonist and antagonist at the seroternegic receptors. Trazodone itself is an antagonist by blocking serotonin receptors and inhibiting serotonin reuptake. Its metabolite is an agonist at 5HHT2. Which receptor does galantamine work? On the nicotinic receptors. Mistakes in SPMM - 2nd Round 30