mental status examination
mini mental status exmination
mood affect
coprolalia
echopraxia
psychoanalytic theory
psychosis
neurosis
basics of psychiatry revision notes based on lecture notes and previous year questions
2. Term psychiatry Johaann Christian reil
Dementia precox Benedict morel
4 AâS of schizophrenia Bleuler
ECT Cerletti & Bini
Cognitive therapy Aaron beck
Defense mechansism Anna freud
TONY SCARIA 2010 KMC
3. ⢠There are three basics in psychiatry â
⢠cognition (is also a higher mental function) means thought;
⢠conation means action &
⢠affect meaning mood.
TONY SCARIA 2010 KMC
4. 2 major classificatory systems in psychiatry
⢠ICD -10
⢠Chapter V (F)
⢠DSM-5
⢠By American psychiatric association
TONY SCARIA 2010 KMC
10. MSE
TONY SCARIA 2010 KMC
⢠GENERAL APPEARANCE & BEHAVIOUR
⢠General appearance
⢠Attitude towards examiner
⢠Comprehension
⢠Gait and posture
⢠Motor activity
⢠Social manner
⢠rapport
15. Mood and affectď describe emotions
⢠Affect ď cross sectional emotional state
⢠Mood is sustained or longitudinal emotional state
TONY SCARIA 2010 KMC
18. Neuroanatomic substrate of emotions
⢠Generated in Limbic system
⢠Hippocampus ,amygdala,hypothalamus,cingulate gyrus,thalamic and corticalb
areas
⢠Regulation is done by frontal lobe
TONY SCARIA 2010 KMC
20. Quality of mood
⢠Predominant affective (mood)
⢠Euphoric mood (elevation of mood)
⢠Excessive happiness with out any reason
⢠In hypomania / mania
⢠Depressed mood
⢠Excessive sadness
⢠In depression
TONY SCARIA 2010 KMC
21. Fluctations
⢠Refers to change in mood / affect
⢠Labile mood /emotional lability
⢠Excessive variations in mood with out any apparent reason
⢠Mania
⢠Affective flattening
⢠Absence of changes in mood irrespective of the situation
⢠Does not experience any emotions hence affect remains the same
TONY SCARIA 2010 KMC
22. Appropriateness & congruency
⢠Appropriateness
⢠In relation to social situation
⢠Eg : sadness in funeral ď appropriate mood
⢠Congruency
⢠Emotional state of patient in sync with his thought or
speech
⢠Eg : appearing sad while describing dead person
TONY SCARIA 2010 KMC
23. Other disturbances in emotion
⢠Alexithymia
⢠Lack of words to describe emotions
⢠Inability to describe and recognize emotions
⢠Anhedonia
⢠Loss of capcity to experience pleasure
⢠Unable to enjoy / loss of interest and withdrawal
⢠a/w depression
⢠Abreaction
⢠Emotional release or discharge after recalling a painful experience
TONY SCARIA 2010 KMC
24. Perception
⢠Receiving information using one of the sensory modalities
⢠Disturbances in perception
⢠Hallucination
⢠Illusion
TONY SCARIA 2010 KMC
25. Illusion
⢠Altered perception of real object
⢠Misinterpretation of stimulus (sensory input)
⢠Sensory input in ext environment
⢠Perception is in internal mind (inner subjective space)
⢠Mistaking a rope as a snake
⢠Seen in delirium
TONY SCARIA 2010 KMC
26. Hallucination
⢠False perception with out stimulus
⢠Clear/ 3 dimensional/ vivid
⢠Absence of corresponding external stimuli
⢠Occurs in outer objective space
⢠Pseudohallucination ď originating from with in mind
⢠Insight is absent
⢠Not under willful control of patient (no voluntary control)
TONY SCARIA 2010 KMC
28. Types
⢠Visual ď organic psychiatric ds (delirium)
⢠In organic disorders
⢠Auditory ď most common hallucination in psychiatric disorders
⢠Tactile hallucination ď cocaine poisoning
⢠Olfactory ď temporal lobe epilepsy
TONY SCARIA 2010 KMC
29. ⢠Imagery ď incomplete not clear subjective and can be controlled
⢠Lesions of temporal lobe can cause all type of hallucination and
formed visual hallucination
TONY SCARIA 2010 KMC
30. Auditory hallucination
⢠Most common hallucination
⢠Voices talking to the patient or ordering him (second person)
hallucinations and voices talking to one another referring the patient
(third person) hallucination ď commonly in schizophrenia
⢠Echo de la pensee
⢠Repeat his thoughts immediately he has thought of them
⢠Gedankenlautwerden
⢠Voice seem to anticipate what the patient thinks afew moments later or speak his own
thoughts as she speaks them
TONY SCARIA 2010 KMC
31. Visual hallucination
⢠unFormed
⢠Flashes
⢠In disorders of visual cortex or visual pathway
⢠formed
⢠Objects people
⢠Organic mental disorders
⢠Temporal lobe lesions
⢠Prominent visual hallucination in the absence of auditory
⢠ď organic brain ds
⢠Extracampine
⢠Hallucination beyond possible sensory field
⢠Seeing somebody standing behind you
TONY SCARIA 2010 KMC
33. Autoscopic hallucination
/phantom mirror image
⢠Seeing ones own body projected in
to space
⢠May convince the person that he
has a double (doppelganger)
⢠Visual hallucination
⢠In patients with temporal lobe
epilepsy
TONY SCARIA 2010 KMC
34. ⢠When person does not see his
own mirror image
TONY SCARIA 2010 KMC
35. Olfactory hallucination
⢠Unpleasasnt smell or tastes
⢠Depressive disorders
⢠Schizophrenia
⢠Irritation of olfactory bulb
⢠Temporal lobe epilepsy
TONY SCARIA 2010 KMC
36. Tactile hallucination
⢠Insects crawling in the body or under the skin
⢠In cocaine poisoning
⢠Amphetamine abuse
⢠Delirium tremens
⢠Opiod withdrawal
TONY SCARIA 2010 KMC
37. Few specific hallucinations
⢠Hypnagogic
⢠In narcolepsy
⢠While Going to sleep
⢠Hypnompic hallucination
⢠While getting up from sleep
TONY SCARIA 2010 KMC
38. Reflex hallucination / synaesthesia
⢠Cannabis & LSD poisoning
Stimulus in one sensory
modality (white bulb)
Hallucination in another sensory
modality (hearing voices of god)
TONY SCARIA 2010 KMC
41. Constituents of normal thought
⢠Constancy
⢠Stick to the topic
⢠Continuity
⢠Connected properly with proper meaning
⢠Organisation
⢠Organised properly
Clarity is not
constituent of normal
thinking
TONY SCARIA 2010 KMC
42. Disorders of thought in
⢠Stream
⢠Possession
⢠Content
⢠Form
TONY SCARIA 2010 KMC
44. Disorders of stream of thought
Tempo
⢠Flight of ideas
⢠Rapid speech move from idea to
idea abruptly
⢠Pressurised speech
⢠Inhibition
⢠Thought comes very slowly and
thought progresses with a slow
rate
Continuity
⢠Thought block
⢠Sudden arrest of train of thought
TONY SCARIA 2010 KMC
45. Clang association
⢠Disorder of stream of thought
⢠Refers to sequence of thoughts stimulated by sound of preceding
words rather than by their meaning
⢠Based on rhyming
⢠In mania
TONY SCARIA 2010 KMC
46. Loose association
⢠Involves shifting of ideas from one subject to
another in an oblique or unrelated manner
⢠In schizophrenia
TONY SCARIA 2010 KMC
47. Flight of ideas
⢠Flight of ideas is a disorder
of thinking in which the
patient expresses
thoughts very rapidly, with
constant shifting from one
idea to another, though
the ideas are often
connected.
TONY SCARIA 2010 KMC
49. ⢠Flight of idea â is a disorder in which two successive thoughts are
connected by superficial association.
⢠Prolixity â is ordered flight of ideas (Milder variey of flight of ideas) ,
found in hypomaniA.
TONY SCARIA 2010 KMC
50. Thought blocking
⢠In thought blocking, the patient suddenly
stops talking, usually in the middle of a
sentence, and cannot complete his or her
thoughts. Affect is said to be incongruent
when what is observed by the examiner
(affect) does not match the subjective
statement of how the patient feels (mood).
⢠Schizophrenia
⢠Severe anxiety disorder
TONY SCARIA 2010 KMC
51. Disorders of thought content
⢠Delusions
⢠obsessions
⢠An obsession is the ego-dystonic
persistence of a thought or feeling that
cannot be eliminated from
consciousness voluntarily
⢠ideas of reference
⢠belief that an object, event, or person in
oneâs environment (commonly the
television or radio) has particular
personal significance
TONY SCARIA 2010 KMC
52. ⢠Delusion
⢠False fixed belief
⢠Idea
⢠False fluctuating belief
TONY SCARIA 2010 KMC
53. Delusionsď disorder of content of thought
Firm unshakable belief that is not accepted by other members of
patients culture & society
⢠Somatic type
⢠Jealous type
⢠Grandiose type
⢠Persecutory type
⢠Erotomanic type
⢠Late paraphrenia
⢠Shared psychotic disorder
⢠Acute paranoid disorder
TONY SCARIA 2010 KMC
54. Superstition
⢠Superstition
⢠A false belief unexplained by reality shared by a number of people.
⢠Delusion
⢠false belief unexplained by reality not shared by a number of people.
TONY SCARIA 2010 KMC
55. Delusion of persecution ď a beautiful mind
⢠Most common
⢠Patient believes someone wants to harm him
TONY SCARIA 2010 KMC
56. Delusion of reference
⢠Patient believes that events happening around him are some how
related to him
TONY SCARIA 2010 KMC
57. Delusion of infidelity / Othello syndrome
/morbid jealousy
⢠False belief that his partener or spouse is having an affair
⢠Othello syndrome
TONY SCARIA 2010 KMC
58. Delusion of misidentification
⢠Capgras syndrome
⢠Delusion of double
⢠Fregoli syndrome
⢠Complete stranger is a familiar person
TONY SCARIA 2010 KMC
59. Capgras syndrome in schizophrenia
⢠A familiar person has been replaced by impostor
⢠Delusion of double
TONY SCARIA 2010 KMC
60. ⢠Fregoli syndrome
⢠in which a person holds a
delusional belief that different
people are in fact a single person
who changes appearance or is in
disguise
TONY SCARIA 2010 KMC
61. Delusion of grandeur
⢠The patient believes that he has some exceptional identity or power
⢠In mania
TONY SCARIA 2010 KMC
62. Nilhilistic delusion
⢠Cotards syndrome
⢠Accompnied by ideas concerning bodily fns
⢠Putrefaction of eyes / intestine
⢠Depression
⢠Deny existence of body mind or world in general
TONY SCARIA 2010 KMC
63. Delusion of guilt
⢠Committed unpardonable sins
⢠In severe depression
TONY SCARIA 2010 KMC
64. Delusion of love / fantasy lover syndrome
⢠False belief that some one is in love with them
⢠In schizophrenia
⢠De clerambaults syndrome
⢠A woman usually beleves that a man
frequently older & of higher status is
TONY SCARIA 2010 KMC
65. ⢠Somatic type:
⢠This disorder is characterized by a single hypochondriacal delusional system
distinct from the personality. Delusions may be sometimes associated with
tactile or olfactory hallucinations or illusional misinterpretation.
⢠(Subtypes includes: Delusional infestation, Delusional halitosis, Delusional
dysmorphophobia)
TONY SCARIA 2010 KMC
67. Delusion of infestation
⢠One is infested with small but visible organism
⢠As a monosymptomatic delusiona disorder ď EKBOM SYNDOME
⢠a/c confusional state
⢠In schizophrenia
⢠Secondary to fomication
TONY SCARIA 2010 KMC
68. Delusion of control
⢠His actions impulses or thoughts are controlled by external agency &
accordingly called as made action made impulse made affect
⢠PASSIVITY PHENOMENON
⢠In schizophrenia
TONY SCARIA 2010 KMC
70. Mood congruent delusions
⢠Mood and delusions are
congruent
⢠Mood disorders
Mood incongruent delusions
⢠Mood and delusions are
incongruent
⢠In schizophrenia
TONY SCARIA 2010 KMC
71. delusions
Primary
⢠Morbid psychological process
which arise as a result of morbid
psychological process
Secondary
⢠d/t some other
psychopathological
phenomenon
TONY SCARIA 2010 KMC
72. Depersonalization
Sense of unrealityor strangeness to
self manifested by feeling detached
from & being an outside observer of
ones mental process or body
TONY SCARIA 2010 KMC
76. Disorders of possession of thought
⢠Insertion
⢠Thought alienation
⢠Withdrawal
⢠Thought possession disorder is seen in
schizophrenia OCD
TONY SCARIA 2010 KMC
80. Thought broadcasting
⢠Patient experiences that thoughts are escaping from their minds and
other people are able to access them
TONY SCARIA 2010 KMC
81. Obsessionsď disorder of thought possession
⢠Thought comes repeatedly in to the mind of patient against his will
TONY SCARIA 2010 KMC
83. Ego syntonic thoughts
⢠Ego in liason
⢠Patient himself knows his
thoughts are correct
⢠Homosexuality
Ego dystonic thought
⢠Ego not in liason
⢠Patient himself knows his
toughts are Irrational thoughts
⢠OCD
TONY SCARIA 2010 KMC
84. Disorders of form of thought
⢠Derailement
⢠Circumstantiality
⢠Tangentility
⢠Loosening of associations
⢠Incoherence
⢠Neologism
⢠Word approximation
⢠preservation
Although certain forms of formal thought disorder are more
frequently associated with specific psychiatric disorders (for
example, tangentiality, flight of ideas, and clang association in
mania, and illogical thinking and loose association in
schizophrenia), no form of thought dis order appears to be
disorder specific.
TONY SCARIA 2010 KMC
85. looseness of associations,
⢠flow of thought is disconnectedâideas shift from one subject to another in
a completely unrelated way
⢠Unrelated and unconnected ideas shift from one subject to another
⢠In schizophrenia
⢠In flight of ideas there are rapid, continuous verbalizations or plays on words that
produce constant shifting from one idea to another. Ideas tend to be connected.
⢠4 types
⢠Derailement / knights move
⢠Word salad
⢠Verbigeration
⢠Vorbeireden
TONY SCARIA 2010 KMC
86. ⢠Derailement / knights move
⢠Refers to transition from one topic to another either b/w sentences or in mid
sentences with no logica; relation ship b/w sentences
⢠Word salad /incoherence ď common in schizophrenia
⢠Extreme from of derailement
⢠Where grammatical structure is also affected
⢠Verbigeration
⢠Senseless repetition of words or phrases over and over again
⢠Vorbeireden
⢠Subject seems always about to get near to matter but never reaches it
TONY SCARIA 2010 KMC
87. Circumstantialityđľ
⢠Pattern of speech which progresses
with inclusion of lots of unnecessary
details and goes round & round before
reaching final goal
⢠Boring details
TONY SCARIA 2010 KMC
88. ⢠Circumstantiality
⢠pt will reply to question but include unnecessary details before coming to
final answer
⢠loss of a goal-directed thought process: the patient brings in many irrelevant
details and comments, but eventually will get back to the point.
TONY SCARIA 2010 KMC
90. Vorbeireden
⢠Failure to reach central idea of discussion
⢠Skirts around it & infact never reaches it
⢠Approximate answers
⢠In ganser syndrome
⢠Schizoprenia
⢠Ganser syndrome
⢠Syndrome of approximate answers
TONY SCARIA 2010 KMC
91. Word approximations (metonyms)
⢠Old words are used in a new or unconventiontal way
⢠Meaning is easily evident
⢠Though the word appears strange
TONY SCARIA 2010 KMC
92. neologism
⢠A neologism is a fabricated word made up by the patient, which is
usually a combination of existing words.
⢠Most common characteristic of schizophrenia
TONY SCARIA 2010 KMC
93. Perseveration
⢠Perseveration, often associated with cognitive disorders,
⢠patient displays an inability to change the topic or gives the same
response to different questions.
⢠Perseveration is repetition beyond point of relevance in response to
stimulus pt will give same answers to different questions asked like
what is your father name RAM, what is your mother name RAM,
where do you live RAM.
⢠refers to a response that persists even after a new stimulus has been
introducedââfor example, a patient asked to repeat the phrase âno
ifs, and, or butsâ responds by saying, âno ifs, ifs, ifs, ifs.â
TONY SCARIA 2010 KMC
95. Magical thinking
⢠Magical thinking is a form of
thinking similar to that of
preoperational-phase children
(Jean Piaget) in which thoughts
and ideas are believed to have
special powers (eg, to cause or
stop outside events).
TONY SCARIA 2010 KMC
99. DĂŠjĂ vu Familiarity feelings to an event which has never
happened
Deja pence The feeling of recognising a new thought as having
already previously occupied
JAMAIS VU UNFAMILIARITY FEELINGS TO AN EVENT WHICH HAS
BEEN EXPERIENCED IN PAST
echo de la pense Thought echo
First person auditory hallucination
Hearing ones own thought louder (heard aloud)
DEJA ENTENDU FEELING OF AUDITORY RECOGNITION TO AN EVENT
WHHICH HAS NEVER HAPPENED
TONY SCARIA 2010 KMC
115. ⢠Amnesia ď inability to recall past things
⢠Paramnesia ď distorted or falsified recall of events in relation to
details or their temporal relationship
⢠Hypermnesia ď extreme degree of retension
TONY SCARIA 2010 KMC
116. Amnesia
Retrograde
⢠Amnesia for events before in a
point of time
Anterograde
⢠Amnesia for event after a point
in time
TONY SCARIA 2010 KMC
117. Paramnesia
Confabulation Unintentional filling of gaps with material that are
untrue & fanciful
False memory syndrome Memory of trauma or event that actually did not
occur
DĂŠjĂ vu
Jamais vu
Deja pense
Deja endendu
TONY SCARIA 2010 KMC
118. Abstract thinking
⢠Ability to understand essence of ehole / hidden meaning
⢠Assessed by interpretation of common proverbs
⢠Loss of abstract thinking is referred to as concrete thinking
⢠Can occur in organic disorders /mental retardation/schizophrenia
TONY SCARIA 2010 KMC
120. Disorders of motor activity
Mannerism Odd repetitive goal directed movements
stereotype ⢠Odd repetitive non goal directed movements
⢠With out any stimulus
Perseveration ⢠Persistent repetition of movement or speech
beyond fulfilment of purpose
⢠In
Echopraxia Senslessly repeats movements of others around
Tic Sudden involuntary rapid recurrent rhythmic
movement
TONY SCARIA 2010 KMC
121. Catatonia
⢠Disorders of movement & posture a/w psychiatric disorders
⢠In bipolar disorderes & schizophrenia
⢠Organic ď encephalitis midline lesions
⢠Waxy flexibility
⢠Patient can be moulded like wax in to a position that is then maintained
⢠Catatonic mutism
⢠Automatic obedience â
⢠Catatonic excitement
⢠Excited uncontrolled motor activity
TONY SCARIA 2010 KMC
122. Decreased psychomotor activity In depression & in parkinsonism
Increased Manina ADHD
Repetitive stereotyped Autism
TONY SCARIA 2010 KMC