Glossary of Psychopathology
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- What are psychosensory features and what are they associated with?
- Sensory Distortions
Assoc w/ limbic system disease, esp temporal lobe epilepsy
- Dysmegalopsia - seeing objects change in size
Dysmorphopsia - seeing objects change in shape
- Derealization - world suddenly seems unreal, as if person in dream
Depersonalization - becoming detached oneself, as if outside own body (ANXIETY disorders)
- Deja vu
- deja vu - feeling like event has been exp before
jamas vu - familiar things seem suddenly unfamiliar
- Define Delusions
- Fixed, false beliefs
not shared with others
based on arbitrary thinking
based on other psychopathology
- Define Ideas of Reference
- delusional interpretations of actions of others in which delusion always is referred to self
- presence of hallucinations, delusions, & unusual behavior that affect daily function
- Reality perception vs. Reality Testing
- Reality Perception - ability to accurately percieve real world
Reality testing - ability to determine if one's perceptions are accurate
(ex if someone hallucinates but knows they are hallucinationg they have poor reality perception but good reality testing)
- When are agitation, hyperactivity, and hypoactivity commonly seen?
- Agitation: delirium, mood disorders, anxiety, intoxication
Hyperactivity: mania, stimulant drugs
Hypoactivity: depression, frontal lobe syndromes, schizophrenia, CNS depressant abuse
- Define flight of ideas
& where seen
- Flight of ideas = rapid, hyperverbal speech, jumping topic to topic (MANIA)
Circumstantiality = unnecessary detail or parenthetical remarks (MANIA,HYPOMANIA, chronic TEMPOROLIMBIC disease, Chronic STIMULANT DRUG USERS, ELDERLY)
- Define formal thought disorder
- fluent, aphasic speech with adequate repetition
Schizophrenia, Hallucinogenic drug induced psychosis
- Emotional Blunting
- loss emotional expression and volition (drive) for any action
Schizophrenia, frontal lobe lesions
- What are the Five axis of the DSM?
- Axis I (state illness with recovery until following acute episode)
Axis II (long lasting unchanging maladaptive behavior not due to underlying pathology)
Axis III psych disorder due to underlying med condition
Axis IV scale of severity of psychosocial stressors over past year
Axis V scale ass. patients overall level functioning
- How do the axis work in the hierarchy?
- Axis I disorders take precendence over Axis II, etc.
- What is the DSM diagnostic procedure (3 steps)?
- 1. Determine behavioral syndrome.
2. Decide if syndrome primary or secondary to neuro/med condition
3. identify comorbid conditions
- What is the typical age of onset for schizophrenia?
- 75% first psychotic episode 15-25
First episode after 40 = probably NOT schizophrenia
(rarely as early as 7/8)
Strong Genetic Predisposition
- How is diagnosis made?
What is lifetime prevalence, and gender differences?
- Periods of psychosis/disturbed behavior for at least 6 mos or greater.
Lifetime prev = 1.5%
equal for males & females, men present earlier
- What are some "first rank" (subcat of positive) symptoms?
- Auditory Hallucinations
Experiences of Control (outside force controlling thoughts)
Experiences of Alienation (external force putting thoughts in head)
Delusional perceptions (important meaning to real but trivial events)
Thought broadcasting (others can hear thoughts)
- What are some speech/language disturbances (generally negative symptoms)
- Paucity of Speech
Poverty of Speech content (vague, stock phrases)
Neologisms (words coined that are meaningless to others)
Disturbances of Affect (reduced emotion)
Disturbed social relations
Loss of volition (no plans for future)
- What are the four A's described by Beuler about schizophrenia?
- Ambivalence (uncertainty)
Autism (self-preocupation, lack of communication)
"5th A" = auditory hallucinations
- Name the five schizophrenia subtypes.
- Define the following schizophrenia subtypes:
- Disorganized =
Poor prognosis, severe impairment
ideas of persecution
Resistance to being moved
Refusal obey verbal instruct.
Eruptions of excitement can occur
- Delusions persecution/grandeur
Ideas of Reference
Less Disorganized, BETTER PROGNOSIS
- mixture of psychosis (delusions and hallucinations)
- In remission after episode, patient still has
subtle cognitive impairment
- What is the common hypothesis of etiology?
- Dopamine excess theory (since antipsychotics are anti dopamine and work to tx)
- Define the following conditions:
Brief Reactive Psychosis
- Brief Reactive Psychosis - less than 1 month hallucinations and delusions w/o emotion expression loss
Usual mood symptoms and psychosocial stressor present.
Schizophreniform = psychotic symptoms gtr 2 wks, less than 6 mos (possibly w/o loss function)
Schizoaffective disorder = schizophrenia plus mood disorder
- What are some adverse affects of antipsychotics employed to tx. schizophrenia?
- Dystonia - tonic, unopposed muscle grp contraction (occur within first 72 hours tx)
Akathisia (inner restlessness)
Parkinsonian syndrome (rigidity, bradykinesia)
Tardive Dyskinesia - choreiform/athetoid mvmnts late in tx or may persist after discontinued. (usually oral/lingual)
- What defines a Major Depressive Episode?
- 5 of following for >2 weeks including 1) depressed mood or 2)anhedonia (SIG E CAPS)
Sleep disturbances (insomnia w/ early morning wakening or excess sleep)
Interest - Loss of Interest
Energy - Loss of energy
Concentration - Loss of Conc
Psychomotor retardation (slow speech/mvmnt)
- Define recurrent major depressive disorder
- 2 or more episodes with symptom free interval 2 months
- What is the lifetime prevalence of depression?
- Men - 5-12%
Women - 10-25%
- Define Dysthymia
- Milder form lasing at least 2 years
- What is melancholia?
- Severe form of depression (profound sad,dysphoric mood w/ vegetative signs suggestin hypothalamic dysfunction)
anorexia w/ 5% wt loss in 3 wks
early morning awakening
diurnal mood swing (worse morning)
More likely DELUSIONAL, COMMIT SUICIDE, evidene brain dysfunction
- What are the criteria for bipolar disorder - specifically for a manic episode?
- Distinct period abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 WEEK.
3 or more of following:
Grandiosity (inflated self)
Flight of Ideas (rapid jumping topic to topic)
Activity,Agitation (increase in goal directed Activity and psychomotor Agitation)
Speech - Pressured
Thoughtlessness (seeks pleasure without regard of consequences)
- Define a hypomanic episode
- Like manic episode except mood disturbance not severe enough to cause marked impairment in social/occupational functioning or to necessitate hospitalization. No psychoses.
- Name some criteria sets used to DEFINE bipolar disorder
- At least one manic or hypomanic episode defines.
Bipolar I - Manic episode (depressive episode not necessary)
Bipolar II - hypomanic episode plus depressive episode
- What is cyclothymic disorder
- Milder form lasting at least 2 years.
- Define pseudodementia and how to diff. from Alzheimers?
- Major depression masked as dementia (intellectual impairment, memory loss, poor concentration)
More depressive features, melancholia, hallucinations, delusions than Alz.
Greater likelihood of family mood disorder history.
P.d. patients maximize complaints while Alz patients minimize theirs.
- List some treatment (pharmacological) options for mood disorders.
- Tricyclics (non-selective mon-amine reputake inhib)
SIDE EFFECTS -
cardiac conduction abnorm.
anticholinergic (dry mouth, blurred vision, decr GI motility - not tolerated by elderly)
SSRI's - depression and anxiety
MAO inhibitors (Phenelzine) Second line depression & anxiety tx
Lithium Carbonate - tx manic episode and prevent recurrence manic & depressive episodes
Anticonvulsants (carbamazepine, valproic acid) tx. bipolar affective disorder, those not resp. to lithium
- Explain ECT
- tx. melancholic depression
5-7 tx needed for typical depressive episode.
General anesthetic before & depolarizing muscle relaxant during.
Ventilated, EKG/EEG monitored
Contraindication: Increased intracranial Pressure
90% patients show immed improvement!
- Define Delirium
- ALTERED state of Consciousness (decreased attention span and altered arousal)
Disturbances in sleep-wake cycle
Waxing and waning consciousness, develops RAPIDLY
- What are some causes of delirium?
What is the classic EEG?
- Substance abuse
Metabolic, fluid, electrolyte
(hypoglycemia, hypoxia, uremia, encephalitis, porphyria)
High voltage slow wave EEG
(delirium tremens low-voltage fast activity)
- Define Dementia
- Normal state of arousal!
Difficulty with memory
aphasia, apraxia, amnesia
Loss abstract reasoning
Language loss/difficulty naming objects
Impaired judgment(innapropr sexual advances/etc)
Increased risk suicide
careful about elderly pseudodementia
- What are the two most common causes of dementia?
- Alzheimers - mid 70s onset
early: difficulty new learning, word finding, visual-spatial/motor coordination
Brain atrophy, ventricular enlargement, plaques/tangles
Multi-infarct Dementia - with focal neurological signs (extremity wknss,dysarthria)
- What are some other causes of Dementia?
- Parkinson's - 20-40% develop subcortical dementia (more characterized by motor signs)
Huntingtons - mid 30s-40s
early stage: depression, impulsiveness, personality changes, suicide risk
Late: subcortical dementia, choreiform mvmnts
- Some more causes dementia?
- Wilsons' - defect ceruloplasmin, reduced copper excretion. Build up in basal ganglia =
wing beating mvmnt
mental retardation in kids
dementia in adults
Normal Pressure hydrocephalus - blocked foramen of Monro
Normal spinal P, buildup ventricular P
Hugely dilated ventricles
Causes: alcoholism, subarachnoid hem, vitamin def, Syphilis
(tx with shunt)
Pick's disease - schizophrenia like psychosis & frontal lobe problems can precede dementia
- Somatization disorder
- Complaints in multiple organ systems
Begins before age 30, women more than men, familial, assoc w/ antisocial pers/alcoholism in men
4 pain symptoms
2 GI symptoms
1 Sexual symptom
1 pseudoneurologic (muscle wkness, sensory loss)
- Conversion disorder
- neurologic-like complaints
paralysis, blindness, tunnel vision, pain, seizures, etc
PATIENT ACTUALLY EXPERIENCES
conversion allows "primary gain" (keep conflict from awareness)
and "secondary gain" - avoid anxiety provoking activities, gain sympathy
- Psychogenic Pain
- Chronic Pain disorder
Psychologic stress or conflict results in pain
- 40s-50s, equal male/female
substitute physical symptom for emotional one
Misinterpret normal physical findings, preocupation with disease dispite medical reassurance
- Body Dysmorphic Disorder
- patient convinced part of anatomy malformed
- Dissociative Amnesia
- Women 15-30
Lost memory for personal events
Threats of physical harm/death/stress may precipitate
- Dissociate Fugue
- Person suddenly travels away from customary place of daily activities
Brief, limited to unexpected travel
- Dissociative Identity Disorder (formerly multiple personality disorder)
- Rare, usually malingering or misdiagnosed borderline personality disorder
Two or more personalities alternate in control of a person, original personality not aware of others except for "lost time"
- Depersonalization Disorder
- Person feels like observing themself from afar, mechanical feeling, may be accompanied by derealization (alteration in perception of external reality)
- Psych theories for dissociative disoders?
- Massive repression of unacceptable sexual impulses, response is splitting of person
Protecting person from stressful event
- Specific Phobia:
- Fear excessive or unreasonable to specific entity
Gamophobia= fear of marriage
Algophobia=fear of pain
Acrophobia= fear of heights
Agoraphobia=fear of being in public places where escape difficult
- Post Traumatic Stress Disorder
- Re-experiencing trauma through recurrent recollections,dreams
Reduced responsiveness to external world
Psychic Numbing - feeling detached from others
Loss of interest in activities
Symptoms if increased arousal (hyperalert, disturbed sleep, difficulty concentrating, memory probs)
Avoidance of returning to scene or things that remind them of it
- Differentiate levels of PTSD and contrast it to Acute Stress Disorder
- Acute stress disorder = 2-4 weeks
Acute PTSD = less then 6 mos
Chronic PTSD = greater than 6 mos
- Panic Disorder
- Sudden, spontaneous episodes increased anxiety.
Attacks last 20-30 minutes
C=Chest Pain, Chills, Choking
often misdiagnosed as CV event
Can be triggered by sodium lactate infusion.
- Generalized Anxiety Disorder
- Lower constant anxiety not triggered by anything in particular
- Define following therapies:
- Flooding = patient has to imagine most anxiety provoking situation and hold image for extended time
Desensitization=person placed in feared situation
Systematic Desensitization=mental imagery of feared situation systematically increased (sometimes actual situation used)
- Adjustment Disorder
- emotional symptoms (anxiety, depression) causing impairment following identifiable psych stressor and leasting less than 6 most (exp is NOT relived like in PTSD)
- What are the criteria for personality disorders?
- Inflexible, maladaptive, long-standing behaviors beginning in childhood or adolescence that lead to interpersonal distress and affect several areas of life
CANNOT be diagnosed until person is 18
- What are the Cluster A personality Disorders?
What are they genetically associated with?
- Odd or Eccentric
Paranoid- distrust, suspiciousness (vigilance to environment, concern with hidden meanings, sensitive to criticism) Cold, lack humor, unwilling seek help
Schizoid - loners, cold, voluntary social withdrawal, limited emotions
Schizotypal - emotionally cold/awkward, display magical thinking (ideas reference, perceptual illusions, depersonalization, suspicion)respond to low dose neuroleptics
Genetic assoc w/ schizophrenia
- Cluster B personality disorders?
Histrionic - excessive emotionality, somatization, attention seeking, sexually provocative (shallow, exagg affect, dramatic, constant attn)
Narcissistic- Grandiosity, sense entitlement, demand top physician/hcare, alternates with unworthiness, lack of empathy, rct poorly to criticism
Antisocial - disregard and violate rights of others, deceitful/impuslive/reckless/irresponsible/remorseless. Delinquency,lying,substance abuse, criminal behavior IF LESS THAN 18=CONDUCT DISORDER
Rare after 55 (mellow or don't make it)
Borderline - unstable mood/behavior, impulsive, sense emptiness (problems with identity, anger, impulse control) Emotional labile, destructive behavior, micropsychotic episodes, difficulty being alone, also meet mood disorder criteria often
Genetic assoc w/ mood disorders
- What is childhood conduct disorder?
- Childhood antisocial personality like disorder.
Triad: fire setting, cruelty to animals, enuresis.
- Cluster C Personality Disorders?
Avoidant - sensitive to rejection, socially inhibited, timid, feel inadequate
Obsessive-Compulsive - preoccupation with order, perfection, control (rigid, conformist, perfectionis)
Tight range of affective expression, compulsive=workaholic
(Distinguise from OCD)
Dependent - submissive, clinging, need to be taken care of, low self-esteem
- Obsessions= recurrent, persistent, intrusive thoughts
Compulsion= repetitive, stereotyped behavior performed in ritualistic fashion
- Define the following disorders of impulse control:
Intermittent Explosive Disorder
- Intermittent explosive disorder - enraged from time to time over trivial matters
Trichotillomania-compulsive pulling of hair
- What are symptoms of alcohol intoxication?
- Intoxication -
(2-5 days post)
(first autonomic hyperactivity-tachycardia,anxiety,tremors)
(second psychotic symptoms - visual/tactile hallucinations, delusions, confusion)
- Symptoms of Barbiturate Intoxication? Tx?
- Intoxication - low safety margin, respiratory depression
Similar to alcohol intox.
TX=gastric lavage followed by charcoal load
Delirium (increased REM sleep, nightmares, seizures)
Life threatening CV collapse
- Opiod (Heroin,morphine, meperedine, methadone) intoxication? Tx?
CNS depression (sleepy, slurred speech, non-combative)
seizures (OD life threatening)
TX - naloxone
Piloerection (cold turkey)
- Intoxication -
Hallucinations (tactile, formication)
Sudden Cardiac Death
Sweating, chills, nauseau/vomiting
TX - urine acidification to enhance excretion
phentolamine/nifedipine for arrythmias
Withdrawal - Post use Crash
Severe Psycho craving, hyperphagia
Tx- antidepressants can reduce craving
- Intoxication - similar to cocaine
Withdrawal: within 3 days cessation
Post use crash:
hypersomnolence (Incr REM sleep, disturbed sleep)
usually gone in few days = rarely persists, depression
- What is Stimulant Delusional Disorder?
- psychosis caused by chronic use of stimulants
ideas of reference
- PCP (phencyclidine)
- Intoxication - Belligerence
Higher doses: catatonia, seizures
Tx: acidify urine
benzos for sedation
neuroleptics for psychosis
Withdrawal: Recurrence intoxication due to reabs. in GI tract, sudden onset severe, homicidal violence
- LSD (or DMT,psilocybin,mescaline)
anxiety or depression
tx: single dose benzo or neuroleptic for more severe cases
acute intox and chronic use?
perception slowed time
Chronis use: memory problems
- What medicines can lead to anticholinergic toxicity
flushed, hot skin
(dry as a bone, red as a beet, etc)
Most allergy/cold preps
over the counter sleep meds
TX - 1-2 days physostigmine
- What is malingering?
- patient consciously fakes a disorder to attain specific secondary gain (financial, avoid military, etc)
- Factitious disorder?
- creates symptoms to get into sick role.
Munchhausen's: chronic history multiple admissions/invasive procedures
Munchhausens by proxy: moter induces symptoms in kid (or parent on a kid, or somebody in someone else)
- Chromosomal disorders that cause Mental Retardation
- Genetic Recessive Conditions that cause MR
Maple Syrup Urine
- Infectious Conditions causing Mental Retardation
- Rubella (+deafness, blindness, heart defects)
Congenital Syphilis (+8th nerve deafness)
Toxoplasma Gondii (+encephalitis, hepatosplenomegaly, intracranial calcifications, chorioretinitis)
CMV (+deafness, chorioretinites, microcephaly)
- Misc causes Mental Retardation
- Rh factor
Malnutrition during pregnancy
Anoxia at birth (MR plus cerebral palsy)
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