July 16, 2014

Why is the precise use of terms important in psychiatry?

for communication with other psychiatrist

be aware of colloquial terms e.g. manic should be further elaborated

specific words directs the management e.g. hemoptysis v hematemesis

if precise terms are not used leading to mismanagementlegal consequences

discussion about prognosis

concepts change with time and evidence

respect for specialty!!

psychiatry suffers from the use of terms widely employed, poorly defined and variously
interpreted
nervous breakdown v panic attack v anxiety
obsessed v preoccupied
psychotic
personality disorder
schizophrenic Father of descriptive psychopathology is: Karl Jaspers not Freud, Jung

"biographical model of study - Jaspers

what other history is unique about psychiatry: transference and counter
transference:

talk about how you feel about patients..this pt really irritates me..suggests a
personality disorder
i felt angry, had a hard time interrupting the pt
Principles of diagnosis

The Duck Principle: Walks like a duck talks like a duck then it is a duck: if something
is very clear and obvious then most likely it is that Dx

Suttons law: Go where the money is"

The role of parsimony: "The simplest explanation is usually the best explanation

Study of abnormal experience, cognition, and behaviour without trying to explain its
cause or function

requires knowledge of signs and symptoms and

empathic use of subjective experience

Phenomenology

observation and categorization of abnormal psychological events, the

understanding the meaning of the experience of the patient using empathy

understanding the form (structure) and the content (colouring, perception) of the
experience

form is to diagnose the problem

next is to understand the meaning of the content

how does the content affect the patient (empathy)

Pathology of consciousness

this is the 3rd most common symptom in psychiatry - perculari change in the
awareness of self "as if I am unreal

what is depersonalization?

presents in depression, Churchill call his depression my black dog

dissociative

dissociative identity disorder - memory lapses, DSM V criteria changed

dissociative fugue -

The world is unreal

what is derealization?

PTSD cluster symptom

neurological lesion

substances

delirium

Absorption and trance state are related o change in this mental function

DSM 5 recognizes several types of dissociative states

viligances

what is the ability to be hypnotizes? It is a bell curve

who are most susceptible to be hypnotized? cluster B personality disorders,

somataform disorders are associated with histrionic personality disorders

This term denotes an action taking place in the absence of consciousness

variable quantities of alcohol can cause these states..amnestic episode blackout

so drunk I killed my wife..pathological intoxication e.g. violent behaviour

atomitism

black out- completely loses memory

red out-patchy memory loss.. partially remembers events

"Dream like" state is common in these conditions

in pts with acute psychosis

schizophrenia

intoxication

agitation: pt is moving around similar to akathisia; but not necessarily restricted to

physical walking around or limb movement but can be shouting

akathisia: subjective sense of inner restlessness; propensity to move around; most

commonly associated with antipsychotics or underlying medical condition (neurological)
Disturbances of motor regulation

catatonia - motor immobility that is characterized by a state of stupor

dont respond to hello

doesnt move

seen in severe melancholic depression, schizophrenia but rarely seen today;

mostly seen in third world countries.
bipolar disorder with catatonia tx: benzodiazepam!!!! know
I feel electricity on my body is an example of this sensory disturbance

tactile hallucination
my muscles are constable squeezed and my limbs are twisted

kinaesthetic hallucination
I see you face in my face

autoscopic hallucination
these sensory distortions are common in intoxication with hallucinogens

LSD
I can clearly see the face of my mother in a cloud she died a month ago

normal bereavement
when I wake up I see colours and shapes sometimes like figures of my imagination

hypnopompic hallucination

elementary hallucination are common in these conditions

this is an example of a flashbacks - not very common

PTSD
flashback with a loss of consciousness

cataplexy is a part of narcolepsy; and can be triggered by a flashback

intrusion of REM

I experience pain when certain words are mentioned

pseudohallucinations - a sensory experience triggered by .

Hallucinations:
missing
Auditory hallucinations;
missing
Delusions

definition: a false belief that is unshakeable even in the presence of evidence

my elementary school teacher in Europe is talking to all of my current supervisors. I

am not able to get a job here in kingston.

this person may become very depressed

delusions of reference definition:

I feel soothing incredibly important will happen. I live in fear.

delusional atmosphere: associated with an psychotic event within a week

this person is coughing. this means i am in danger

ideas of reference
when I was 21 years old a magnet was implanted in my brain. I am 45 years old now

delusional memory; bizarre delusion

delusions of infidelity and morbid jealousy are common in these conditions.

very common in chronic alcohol use!!!

very common in Alzheimer's

this is not my wife. She has been replaced with a person that looks like her

capgras
this is an example of overvalued idea

who are people presented with these thoughtscould be statements from

politicians Obama

has to be commensurate with the persons credentials

who are we to say it is an overvalued idea

How do we know it is an bizarre idea

may be there is a person who is trying to ruin their careerthus must get
collateral
Disorders of thinking process

these delusion are commonly seen in psychotic depression and elderly

delusions of property
my think
Disorders of memory

there is a strong feeling familiarity and also a feeling that a emery will arrive

this phenomenon is a pathognomonic sign of an organic brain lesion

perseveration is also present in transient global amnesia

this term describes falsification in clear consciousness

confabulation

alcoholics confabulate; they are not aware they are making up their story

this term describes inaccuracy of recall

descriptive psychopathology

Have to switch on the tap at 6am. If I dont do something right then something is not
going to happen.

OCD