Psychiatry

What are the differences between mental and physical illness?

• Mentally ill people often do not perceive themselves to be ill

  • Reluctant to accept treatment as they don't think they're ill

  • no scientific basis to diagnose mental illness so may result in incorrect diagnosis

What can symptoms of psychiatric disorder be understood as?

• Adaptations:

  • In order to survive/continue surviving

  • In the context of developmental environment

• Communications:

  • To internal/external environment

  • Organisation of the social environment

What are ruminations/obsessional thoughts?

Thoughts that come unbidden into your mind- you know the thoughts are yours and that they're senseless but they come anyway

What are obsessions associated with? (5)

1. ego-dystonic thoughts → go against your beliefs

2. repetitive, circular ruminations

3. may be bizarre and sound delusional

4. insight maintained → you’re aware these thoughts are senseless

5. resistance leads to anxiety

What are compulsions?

The strong urge to repeat a behaviour even in the knowledge that it is harmful

• It is a motor response to obsessional/ thoughts

• Often ritualistic, stereotyped, precise

• Person tends to start again if interrupted or doubt

What are obsessions and compulsions symptoms of?

OCD - obsessive compulsive disorder

What is anxiety?

psychological and physiological symptoms in response to potential/uncertain threat

what is the psychic symptom of anxiety?

Feeling of fear or dread (impending doom)

list physical symptoms of anxiety

• Sweating

• Dry mouth

• Palpitations

• Splanchnic vasoconstriction (butterflies)

• Tremor

• Paraesthesia (pins and needles)

• Depersonalisation

What causes anxiety?

• Anxiety can be classified as positive feedback loops from normal adaptive responses

• It's normal (helps us survive) but becomes pathological when it interferes with our daily lives and is excessive and out of context

state the 5 types of anxiety:

1. generalised anxiety disorder

2. panic disorder

3. agoraphobia

4. simple phobia

5. social phobia

what is generalised anxiety disorder?

• Long term anxiety that you feel all the time

• May become milder and stronger at times but generally stable

what is panic disorder?

• Short bursts of panic attacks

• Can occur alongside generalised anxiety disorder

what is agoraphobia?

Fear of leaving environments you know are safe

what is simple phobia?

• e.g. fear of snakes, spiders

• This one is common

what is social phobia?

Related to perception of scrutiny e.g. stage fright

What is the physiology of anxiety?

• Caused by adrenaline release- it contributes to flight and fight response but those with anxiety disorder have oversecretion of it

• Positive feedback- adrenaline released, heart beats faster and you recognise this so body releases more etc

How is anxiety treated/managed?(2)

• Course of cognitive behaviour therapy (CBT) to manage symptoms

• Clomipranine for OCD

• Talking therapy - iAPT is the largest open access talking therapies programme in the world

core features of depression:

• Pervasive low mood/sadness

• Loss of energy (anergia)

• Loss of enjoyment (anhedonia)

How many of the core features are required to diagnose depression?

2/3 for 2 weeks

physical symptoms of depression:

1. Loss of appetite

2. Weight loss

3. Diurnal variation of mood (worse in morning, better at night)

4. Poor sleep

5. Loss of libido

6. Constipation

7. Psychomotor slowing or agitation

psychological symptoms of depression:

1. Poor concentration

2. Feelings of guilt

3. Feelings of hopelessness

4. Low self-esteem

5. Indecisive

6. Suicidal ideation

7. Delusions

How is depression treated?

• 12 session CBT

• Antidepressants → venlafaxine or citalopram

• social prescribing

What are the symptoms of mania?

1. Elated mood

2. Irritability

3. Over-energised

4. Grandiose

5. Little need for sleep

6. Poor concentration

7. Poor judgement

8. Over-spending

9. Rapid speech

10. Psychomotor agitation

11. Pressure for speech

What is a delusion?

A belief that is totally fixed, false and unshakeable not shared by the same culture/society

What are persecutory delusions?

The thought that a person/group of people wants to harm you

What are grandiose delusions?

Patient has exaggerated sense of authority/importance/significance

What are grandiose psychotic beliefs?

Patient is convinced of their greatness/importance

What is extracampine hallucination?

Hallucination arising outside the normal field of perception e.g. thinking you hear someone talking 1 mile away

What are tactile hallucinations?

Feeling something that is not real

What are the different forms of auditory hallucinations?

• First person = thought echo (you to yourself)

• Second person = someone talking to you

• Third person = people talking about you (comments)

What are the symptoms of schizophrenia? (5)

1. hallucinations

2. delusions

3. abnormal behaviours

4. disorganised speech

5. disturbance of emotions

what are hallucinations?

Hearing, feeling or seeing things that aren't there (auditory, visual and somatic)

what are passivity delusions?

believing external agency is controlling their feelings, thoughts and action.

what is though alienation → delusions

• believing external agency is messing with their mind. Has 3 parts :

  • Thought insertion

  • Thought broadcast

  • Thought deletion/withdrawal

what is abnormal behaviour?

Disorganised behaviour like wandering aimlessly, mumbling or laughing to self, strange appearance, self-neglect or appearing unkempt

what is disorganised speech?

Incoherent or irrelevant speech

Neologisms - making up words

what is formal thought disorder?

Failing to follow the semantic and syntactic rules of language

what is disturbance of emotions?

Marked apathy or disconnect between reported emotion and what is observed like facial expression or body language

what are negative symptoms of schizophrenia?

• apathy

• social withdrawal

• poor self care

• more in chronic schizophrenia

What are the treatments for schizophrenia?

• Antipsychotics

• Psychological therapies

• Family therapy

• Arts therapies

what is SMI?

• Severe Mental Illness:

  • Schizophrenia and bipolar affective disorder (BPAD) together are described as SMI

• They are typically episodic and well-managed in many cases

Why is SMI important?

life expectancy is reduced by 15-20 years in patients with SMI

What is the mental health act used for?

To detain people against their will if they are an acute threat to themselves or others

What is the brains job?

• organise sensory input

• make sense of sensory + social information and organise it into predictive models

• motivate survival (avoid harm, physical or social)

• maximise efficiency

• constantly adapting

What is anxiety?

Mix of psychological and physiological processes to potential/uncertain threat which exists to automatically help us avoid harm

What is the difference between trait and state anxiety?

• State anxiety:

  • The state of being anxious, feeling unsafe, trapped, no control at times

• Trait anxiety:

  • Adaptive modulations of automatic threat response i.e. how much it takes different people to become stressed

How is state anxiety linked to avoidance?

There is a perpetuation of conditioned fear (so feedback loop) so avoid thing you fear

How does state anxiety affect attentional and cognitive bias?

Changes the way you perceive info and make sense of it (another feedback loop)

What can anxiety disorder be conceptualised as?

self-perpetuating network of positive feedback loops, arising from normally adaptive responses

How can self-harm be divided up?

• Suicidal

• Non-suicidal self-injury (NSSI)

  • done to reduce distress

When does self-harm occur?

In the context of low self-worth and persistent distress

• It can help people feel in control of their punishment and feel safe, mainly occurs to reduce the distress

• negative reinforcement

What are 4 symptoms of eating disorders?

• Diet restrictions

• Purging

• Laxative abuse

• Excessive exercise

What is psychosis?

Psychosis is a complex syndrome which represents a large group of different disease processes grouped together due as the end result looks broadly similar

Psychosis and Schizophrenia have a wide variety of biological causes and social determinants, these experiences are real for them

Essentially a reality failure

Who is more likely to develop psychosis?

Victims of abuse or violence

Symptoms of psychosis?

Hallucinations,

Delusions

and / or Thought Disorder