Professional Documents
Culture Documents
1 , . . , . . , . .
1. Differentiation of obsessions, overvalued ideas and delusions.-disorders of thoughts!! , .
Delusion - false belief of great value to a patient, cannot be corrected by reasoning Persecutory delusions gap.dc Acute delusion Depressive delusions Grandiose delusions Chronic delusion: I. paranoia (primary systemized idea of persecutions, jealousy without hallucination II. paranoid (hallucination and delusional states with persecutory ideas) III. paraphrenia (hallucination and delusional states with bizarre ideas) Overvalued ideas - sustained ideas of great personal values which is no absolutely false but inadequately significant Obsessions - pathological persistence of an irresistible thought or feeling that cannot be eliminated. Rumination (irrational burdensome operating with thought, symbols, words or numbers) Contrast ideas (irrational painful thought about possibility of dangerous or antisocial actions)
3. The law On psychiatric health care", its main sections. The organizational forms of psychiatric health care.Therightsofthementallyill. , .
Those, who suffer mental disorders, possess all rights and freedoms of citiz ens, provided by constitution RF.
1. 2. 3.
The person, who suffers mental disorder, can be hospitalized into the psychiatric hospital without its agreement to the decision of judge, if his inspection or treatment are possible only under the stationary conditions, and mental disorder is heavy and specifies: its direct danger for itself or surrounding; its helplessness (i.e., the incapacity to independently satisfy basic vital needs); essential harm to its health as a result of worsening in the mental conditio n, if face will be left without the psychiatric aid. Rights of patients, who are found in the psychiatric hospital: - to be turned directly to the head physician or the head. by department on questions of treatment, inspection, extraction; - to give without the censorship of complaint into any organs; - to be met with the attorney and the clergyman in private; - to practice religious rites; - to extract newspapers and periodicals; - to obtain formation, if patient did not reach 18 years; - to obtain reward for the labor, if patient participates in the productive labor. The rights of the patients, who can be limited in the interests of their health or in the interests of health and safety of the others: - to conduct correspondence without the censorship; - to obtain and to send messages, wrappers, money orders; - to use telephone; - to assume visitors; - to have necessities , to use its own clothing.
Ticket 2
2 . . , . . , . , .
1. Korsakoff syndrome.
Syndromes: between memory) failure of registration (minute memory) anterograde and retrograde amnesia amnestic disorientation (time and place but not personality) paramnesia (confabulation (imagined or untrue experiences) which cover the gaps
Diagnostic: Whenever someone has a possible diagnosis of alcoholism, and then has the sudden onset of memory difficulties, it is important to seriously consider the diagnosis of Korsakoff's syndrome. Although the patient's ability to confabulate answers may be convincing, checking the patient's retention of factual information (asking, for example, for the name of the current president of the United States), along with the patient's ability to learn new information (repeating a series of numbers, or recalling the names of three objects ten minutes after having been asked to memorize them) should point to the diagnosis.
2. Recurrent schizophrenia (schizoaffective disorder). Subtypes.Treatment. Progression with acute attacts (Schub)
Def : acute psychosis with bright affect (mania, depression, fear) with specific symptom of schizophrenia (delusion ,paranoia and hallucination) The separate assaults, which are continued from 2-3 weeks to several months, Remissions, with complete (practically temporary recovery) or incomplete (with the signs of schizophrenic defect or the residual symptoms of the past assault), Duration of remissions - from 1-2 weeks to many years. Acute polymorphous syndrome - are developed several days, it lasts week. Special features: The flow by the acute assaults
1.
2. 3. 4.
Subtypes: acute delirious paranoid schizophrenia- (acute paranoiac(he thinks sumone is following him), acute paranoid(someone following u,illusion n hallucination), acute paraphrenic(avatar..pt thinks hes gone into a diff space), acute hallucinosis, the acute syndrome of mental automatism) acute affective simple schizophrenia-(depressive syndrome or maniacal syndrome), acute affective- delirious-hebephrenic (disorganized type)- (combination of depressive or maniacal syndrome with one of the hallucinatory-delirious syndromes) acute catatonic catatonic schizophrenia- (catatonia - catatonic stupor or excitation). Treatment: anti-psychotic, antidepressive, tranquilizing and stimulating action.
Ticket 3
3 . , , , .
. , . . , . , .
1.Asthenia due to a general medical condition. Descriptive features. Treatment. - Weakness , lethargy caused by diseases. Treatment: protein, vitamins, anything that gives energy 2. Recurrent schizophrenia (schizoaffective disorder). Subtypes.Treatment. Progression with acute attacts (Schub)
1. 2. 3. 4. The separate assaults, which are continued from 2-3 weeks to several months, Remissions, with complete (practically temporary recovery) or incomplete (with the signs of schizophrenic defect or the residual symptoms of the past assault), Duration of remissions - from 1-2 weeks to many years. Acute polymorphous syndrome - are developed several days, it lasts week. Special features: The flow by the acute assaults Nature of the assault: acute delirious paranoid schizophrenia- (acute paranoiac, acute paranoid, acute paraphrenic, acute hallucinosis, the acute syndrome of mental automatism) acute affective simple schizophrenia-(depressive syndrome or maniacal syndrome), acute affective- delirious-hebephrenic (disorganized type)- (combination of depressive or maniacal syndrome with one of the hallucinatory-delirious syndromes) acute catatonic catatonic schizophrenia- (catatonia - catatonic stupor or excitation). Treatment: anti-psychotic, antidepressive, tranquilizing and stimulating action.
Main direction of the professional activity of psychiatrist is the rendering of psychiatric aid any to that being needing it, and also assistance to strengthening the mental health of population. Basic condition of the code: the professional competence of doctor- psychiatrist - his special knowledge and skill of doctoring is the necessary condition of psychiatric activity; psychiatrist is not right to disrupt the ancient ethical commandment of the doctor: First of all not to harm "; any abuse by psychiat rist by its knowledge and by the position of doctor is incompatible with the professional ethics; the moral responsibility of psychiatrist - to respect freedom and independence of the personality of patient, his honor and merit, to worry about the observance of his rights and of legitimate interests; psychiatrist is not right to reveal without the permission of patient or his lawful representative of information, obtained in the course of inspection and of treating the patient and the components medical secret; with conducting of scientific studies or of testing of new medical methods and means with the participation of patients the boundaries of permissibility and condition for their conducting must be previously determined; moral right and the debt of psychiatrist - to defend its professional independence; in the interrelations with the associates as main ethical bases serve the honesty, validity, decency, respect for their knowledge and experience, and also readiness to pass on their professional knowledge and experience.
Ticket 4
4 1. . . . 2. . , . . 3. (). . . .
1. The syndrome of Psychic automatism (Kandinsky-Clearambeaur complex). Descriptive features.
Pseudohalusination Mental automatism : alienation of thought, perception n emotion, movement Delusion of control (of distant influence)
Subtypes: alcohol-related disorders amphetamine-related disorders caffeine-related disorders cocaine-related disorders hallucinogen-related disorders inhalant-related disorders nicotine-related disorders opioid-related disorders sedative-, hypnotic-, or anxiolytic-related disorders Risk Factors
Neuroinfections: Encephalitis - acute psychosis with the loss of consciousness according to the type of the exogenous type of reactions, affective, delirious manifestations, psycho-organic and Korsakoff's syndromes. Forms delirious, amential- delirious, maniacal.
Meningitis - asthenia in prodrome (An early symptom indicating the onset of an attack or a disease ), at the peak of disease - the loss of consciousness. Serous meningitis - with epidemic parotitis - sleepiness, apathy, psycho-sensory disorders. Delirium, hallucination Intoxication + clouding of consciousness, organic stupor and coma
Ticket 5
5 . , . . , . . . . . .
1. Symptoms and syndromes of disorders of memory.
Syndromes Korsakov: failure of registration (minute memory) anterograde and retrograde amnesia amnestic disorientation (time and place but not personality) paramnesia (confabulation (imagined or untrue experiences) which cover the gaps between memory)
Symptoms: - Hypermnesia: exaggerated degree of retention and recall, increased memory!! - Hypomnesia: difficulties of registration, retention and recall of memories - Failure of registration: minute memory - Amnesia: gap, loss of memories but not the ability to register Organic amnesia- retrograde amnesia, anterograde amnesia, progressive amnesia Psychogenic amnesia (eg: hysteric) - Paramnesia Allomnesia: filling of gaps in memory by real experiences but of other time Confabulation: imagined untrue experiences between memory gaps
Further development of personality stops, lose previous interests, , tendency toward the contact disappears. Sharply changes the behavior of patient in the family. Sluggish, passive out of the house, patients become cold, rough, hostile to the close ones.(antisocial,apathy)
Ticket 6
6 . , . . . . -10. (), .
1. Paranoid disorder. Descriptive features.
Paranoia: chronic delusion, primary systemized ideas of persecution, jealousy on invention without hallucination, fear heading towards delusion.
* treatment: refer to question below 3. Side effects of neuroleptics (antipsychotics), tranquilizers, antidepressants. Treatment and prevention
Neuroleptics Parkinsonism, akathasia and acute dystonia *Treatment :anticholinergics (biperiden-akineton, trihexiphenidil-parkopan) antihistamine (diphenylhidramine) Neuroleptic malignant syndrome *Treatment : symptomatic (antipsychotic, cooling, monitoring vital signs ) Tranquilizers Drowziness, muscular relaxation, stoppage of breathing Antidepressants Anticholinergic effects (urine retention, tachycardia, heart failure, constipation, visual impairment, mydriasis)
Ticket 7
7 , , . , , . . . . . 6
1. Epileptic reaction, epileptic syndrome, epileptic disease. Concepts, diagnostic and prognostic significance, approaches to therapy.
Etiology : endogenous Course : Chronic progressive Symptoms and syndromes Productive symptoms : different but never paroximal Negative symptoms : selfishness, stiffness, emotional rigidity Syndrome : Idiopathic or symptomatic of underlying brain damage or disease seizure syndromes in newborns; febrile convulsions; West syndrome (infantile spasms); Lennox-Gastaut syndrome; childhood absence epilepsy; juvenile myoclonic epilepsy; Rolandic epilepsy; Landau-Kleffner syndrome; Rasmussens encephalitis (syndrome); progressive myoclonic epilepsy; temporal lobe epilepsy, and frontal lobe epilepsy Diagnosis : Laboratory, EEG, MRI, CT Treatment : Seizures (valproate, carbamazepine) Petit mal (valproate, clorazepate) Grand mal (phenobarbital, gabapentin) Focal seizures : carbamazepine
education offered to people who live with a psychological disturbance. Frequently psychoeducational training involves patients with schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, and personality disorders, as well as patient training courses in the context of the treatment of physical illnesses. Family members are also included. A goal is for the patient to understand and be better able to deal with the presented illness
Ticket 8
8 . , , . - . , , . ( ), .
1. Illusions and hallucinations. Definitions.Diagnostic value.
Illusion- misperception or misinterpretation of real external sensory stimuli Hallucination- false memory perception or mental impressions of sensory vividness not associated with real stimuli.
2. Functional mental disorders of elderly age. Subtypes, clinical features, treatment Alzhemers, dementia, delirium, paranoia, depression, anxiety, Picks disease ( progressive dementia) 3. Mental disorders (syndromes and diseases), common in general practice.
Transitory psychosis (loss of consciousness) - Delirium - acute psychosis with illusions and true hallucination, excitement, disorientation in time, place and situation. - Amentia - deep disorder of consciousness with incoherence - Oneiroid state - dream like state with dual orientation, develops basis on fantasy illusion, - Twilight state - action maybe performed without conscious coalition and without any remembrance afterward Korsakov; amnesia ( loss of memory but not the ability to remember), paramnesia (allomnesia- filling gaps with true real experiences but during other time period; confabulation-imagined untrue experiences between memory gaps ) psycho-organic (disorder of attention, memory and intellectual activity, emotional disorder classify as: degenerative cerebral diseases, cerebral arteriosclerosis, tumours, trauma, and infections.).
Ticket 9
9 . , , . . . -. . , . . . .
1. Maniac disorders. Descriptive features, diagnostic value.
Maniacal triad: hyperthymia (elevated glad mood), the acceleration of associative processes (from a certain lightening to the gallop of ideas), motion excitation. Distractedness; patients cannot bring the matter to the end initiated. A sense of self-respect (self overating, mood-congruent delusion, ideas of randuer) is increased; patients are convinced that the large discoveries await them, that they can play role in the solution of serious social problems. In patients vocal excitation is observed (pressure to talk), they speak much, it is rapid, loudly, Patients characteristic: they are animated, face is frequently hyperemized, mimicry living, motion rapid, appetite is increased, and sexual inclination is intensified, insomnia( sleeps shortly but without tiredness), healthy (no somatic complaint)
They separate several versions of the maniacal syndrome: jovial mania, unproductive mania, mania with foolishness, [morii] (frontal symptomatology), hypomania. Treatment: Maniacal states - neuroleptics and mood stabilizer (lithium salt, Carbamazepin)
Ticket 10
10 1. . , , . 2. (). 3. . - -10.
1. Senestopatii. The concept.Differentiation of pathological sensations (senestopaties) and real somatic sensations.
Sensation - such form of mental activity, which reflects only to the separate properties of phenomena and objects, which influence the sensory organs . Perception - the integral reflection of those phenomena or objects, which act on our sensory organs. Recognition and interpretation of sensory stimuli based chiefly on memory. Cenesthopathy: unfounded strange inexplicable sensations in bodily organs Parasthesias: An altered sensation reported by the patient in an area where the sensory nerve has been afflicted by a disease or an injury (is a sensation of tingling, pricking, or numbness of a person's skin with no apparent long-term physical effect) Quantitative disorders of the sensation: a. Anesthesia - the disorders of a feeling of pain, which are characterized by loss or decrease of the painful sensitivity b. Hypaesthesia - reduction in the sensitivity to the external stimuli. (everything under the mute). c. Hyperaesthesia - is a condition that involves an abnormal increase in sensitivity to stimuli of the senses
d. e.
Cenesthesia - the special feature of the sensory reception, which is consisted in the fact that the external stimulus, addressed to one analyzer, causes simultaneously answer from some another or several analyzers. Hysterical anaesthesia- lost of sensory modalities due to emotional conflicts.
Quantitave disorders of the perception: a. Illusions misperception or misinterpretation of real external sensory stimuli b. Hallucination false sensory perceptions or mental impressions of sensory of vividness not associated with real external stimuli. c. Derealization a subjective sense that the environment is strange or unreal d. Depersonalization a subjective sense of being unreal, strange or unfamiliar to oneself
11 . , , . - - . . .
1. Depression. Descriptive features. Subtypes.
Depressive syndrome - lowered, depressed mood, intellectual and motor retardation It is not only characterize by mental suffering, but also is accompanied by the physical painful sensations (vital melancholy): by discomfort in the epigastral region, by gravity or by pains in the region of heart. Depressive syndrome is characterized by the depressive triad: 1. hypothymia (depressed mood, melancholy, melancholy, anxiety, apathy) 2. retarding thinking (depletion of thinking, few thoughts, they they flow slowly, they are riveted to the unpleasant events) 3. motional retardation (slowing of movement and speech). Depression with anxiety up to agitation depression associated with severe anxiety, excitement and motor restlessness, more common for patient of involution age. High suicidal risk Masked depression manifested by somatic symptoms (heartache, headache, stomachache, hypertension)
10
Ticket 12
12 . . . - . . , . . , . .
1. Asthenia. Differentiation of asthenia due to a general medical condition and asthenia due to stress.
Asthenia - can be the only manifestation of a psychic illness - increased fatigue (from the morning itself), the difficulty of the concentration of attention, retarding perception, emotional lability, increased vulnerability, rapid distractedness. Hyperesthesia is characteristic
11
I. II. III.
Reduced tolerance Irreversible changes in internal organs (cirrhosis, cardiomyopathy, neuropathy) Dementia or Korsakovs (creates his own memory) syndrome
Ticket 13
13 . , , , . (). . - . .
1. Masked depression (depression with a predominance of somatic symptoms). Descriptive features. Principles of treatment.
Masked depression manifested by somatic symptoms (heartache, headache, stomachache, hypertension) Diagnose: dexamethasone-supression test (if the concentration of drug is above 5mg meaning pt has masked depression..if the concentration is low the morning after the patient is normal)
Masked depression often manifests itself as headaches, stomach pain, a nagging ache in the lower back and pain in the jaw. The root of the problem is psychological and should be treated with antidepressants
2. Personality disorders (psychopathies). Diagnostic features.Differential diagnosis of personality disorders, personality changes due to a general medical condition andpersonality changes due to schizophrenia.
Complex of endogenous, biological, physiological and social factors Functional structure deterioration ICD 10: severe disturbance in the characterological constitution and behavioural tendencies of the individual involving severe areas of personality and associated with considerable personal and social disruption. F 20 * 0 (continuous progression) F 20 * 1 (progression with acute attacks) F 20* 3 (periodic or recurrent) F 21 (special type with sluggish or slow progression) Diagnosis Marked disharmonious attitude and behavior (affectivity, arousal, impulse control) Abnormal behavior pattern Appear during childhood and adolescence Dysadaptation Personal distress Personal changes General medical conditions Mental weakness, increase fatigue Disorder of attention, memory and intellectual Psychosis Schizophrenia Introversion, low interest Indifferent to either praise or critism Strange mixture of emotional coldness Marked sensitivity Progressive
12
Consultative-therapeutic aid: - by doctor- psychiatrist (with patient agreement and without the patients agreement in case of danger for the patients or their surrounding due to their illness) Clinic observation Tasks of psychoneurological dispensaries and psychiatric offices: - Consultative, diagnostic, therapeutic, psycho prophylactic rehabilitative aid under the extra hospital conditions; all forms of the psychiatric examination of forensic, military, temporary disablement; social-welfare aid and assistance in job placement of those, who suffer mental disorders; resolve questions about guardianship; consultation on lawful questions and other forms of juridical aid.
Ticket 14
14 . . , , . . , .
1. Differentiation of true hallucinations and pseudohallucinations.
True hallucination: - bright vivid perception, natural way of perception, confidence with the fact that other people have it (perception) too Pseudohallucination:- lack of vividness, other perception( internal vision of hearing), perceptions only for the patients himself.
2. Mental disorders due to syphilis and progressive paralysis. Clinical features, course, treatment.
Syphillis (exogenous) syphilitic psychosis General paralysis of insane (GPI) appears in some patient in 10-15 years after infection Symptoms of encephalitis 1. Euphoria 2. Dementia 3. Severe personality changes Neurological signs 1. Pupil not constrict 2. Asymmetrical tendon reflex Treatment : antibiotic, iodotherapy, bismuth drugs Endogenous (progressive paralysis) Alzheimers and Picks Disease Spontaneous onset Autochronous course Chronic progressive Asthenia (increase fatigue, difficulty of concentration, retarding perception) Neuroses-like disturbances Delirious state
3. The course and outcome of mental illness. Clinical, diagnostic and prognostic significance of these characteristics.
1. 2. 3.
Course and prognosis : Process : acute, chronic with progressive/regress, recurrent, indulating Stable defect Pathogenic development Outcome : recovery, death, personality changes, stable defect
Ticket 15
15 1. .
, 13
2. . . , . 3- , . .
1. Disorders of will, desire, attention. Attention Deficit Hyperactivity Disorder.
Disorders will: - Hyperbulia - Hypobulia - Abulia Parabulia
- reinforcement, intensification of drives - weakening of drives - the loss of will and energy, laziness, reduced impulse to act and think, often associated with emotional indifference (apathy) - Abnormality of volition or will, as when one impulse is checked and replaced by another. (disorder of behavior and impulse control)
Disorders of the inclinations a. Disturbance of inclinations to the food: - Bulimia - pathologic, sharply intensive feeling of hunger, which is frequently accompanied by general weakness and abdominal pains followed by feelings of guilt, depression, and self condemnation. - Anorexia - loss of a feeling of hunger, the absence of appetite with the presence of the physiological need for the nourishment. - Polydipsia - Excessive or abnormal thirst. - parorexia - Abnormal or inappropriate appetite, especially a craving for items unsuitable as food; pica ( persistent craving and compulsive eating of non-food substances). - coprophagy, scatophagy Disturbance of the instinct of the self-preservation: - Weakening the reflex of self-preservation. - Strengthening the reflex of self-preservation. Disturbances of the sexual inclination: onanism( happily masturbates without caring about surrounding),promiscuity (sex between many partners), group sex, hyper sexuality, erotomania entire life in the sex, impotence,vaginism, homo and transsexual, pedophilia, incest.
b.
c.
Disorder of attention. Attention occurs active and passive Distractedness, (with the depression), exhaustion (with the organic diseases and the aesthetic states)
3. Age crises and their significance for clinical psychiatry. Disorders usually first diagnosed in childhood, adolescence and elderly age.
14
They begin from 45-60 years Psychoses of the senile age - after 60-65 years Senile dementia (senile dementia) - are developed into 65-85 years
Ticket 16
16 1. . , , . 2. . , , . 3. (, ). . .
1. Overvalued ideas. Descriptive features.
Concept: sustained ideas of great personal value, which are not absolutely false but inadequately significant un such way that it disturbs the adaptation of individual. Clinical: true ideas, poor insight, poor behavior control but possible, diagnosis subpsychotic states (initial period of psychoses), paranoid personality.
acute psychosis induced by severe alcohol withdrawal syndrome (illusion, true hallucinations) - Treatment: sedative (benzodiazepines, barbiturates), treatment of withdrawal syndromes-fluids, diuretics, nootrops, vitamins, adequate nutrition
b.
alcohol hallucinosis - acute psychosis induced by severe alcohol withdrawal syndromes (abundance true hallucinations) - treatment: antipsychotics, benzodiazepines Delusional alcohol psychosis - encephalopathy induced by severed alcohol delirium (amnestic syndromes with peripheral neruropathy) - treatment: vitamin B1, nootrops Gayet-wernicke encephalopathy - acute alcohol encephalopathy (ataxia, vestibular dysfunction, ocular motility abnormalities disorder of consciousness) - treatment: thiamin, treat cerebral oedema(diuretics, corticosteroid hormones, anticoagulant)
c.
d.
e. karsakov (filling in the gaps with previous past memories) 3. Differentiation of psychotic and non-psychotic disorders. Positive symptoms and negative symptoms.
Psychotic: psychogenous, the result of acute irresistible stressors concerning the primary personal needs (safety, health, honour, freedom. Functional structure deterioration.
15
Serious mental derangement characterized by defective or lost contact with reality. The primary psychoses are schizophrenia and the delusional disorders (e.g., megalomania), but extreme cases of depression and bipolar disorder, substance-induced delirium, and certain varieties of dementia are also understood to share important features with the psychoses. The major symptoms, aside from delusions and hallucinations, are disorganized speech and behaviour and, often, mood disturbances * severe mental disorders, construct false environment, poor insight, cant tell their ill Productive symptoms: rather prominent (psychotic level) often with dangerous (or suicidal) behavior - severe mental disorders - construct a false environment (hallucinations, delusion) - dangerous behaviors (aggression, suicide, excitement) - poor insight (no sense of illness) Negative symptoms: no Any of various mental or emotional disorders, such as hypochondria or neurasthenia, arising from no apparent organic lesion or change and involving symptoms such as insecurity, anxiety, depression, and irrational fears, but without psychotic symptoms such as delusions or hallucinations. - Spectrum of illness appeared with mild mental or somatic symptoms, which production is unconscious and originated from unconscious motives and conflicts. *mild mental, can tell real environment, isnt assume rash/dangerous/antisocial actions, realize their mentally ill Productive symptoms: - rather different but ever mild - mild mental disorders - apprehend the real environment and situation without significant mistakes - do not assume rush, dangerous or antisocial actions - realize that they are mentally ill (have good insight) Negative symptoms: - no Neurotic -
Ticket 17
17 . , . , . - - .
1. Disorders of sensations. Differentiation of pathological sensations (senestopaties) and real somatic sensations. Methamorphopsia.
Sensation - such form of mental activity, which reflects only to the separate properties of phenomena and objects, which influence the sensory organs . Perception - the integral reflection of those phenomena or objects, which act on our sensory organs. Recognition and interpretation of sensory stimuli based chiefly on memory. Cenesthopathy: unfounded strange inexplicable sensations in bodily organs Parasthesias: An altered sensation reported by the patient in an area where the sensory nerve has been afflicted by a disease or an injury (is a sensation of tingling, pricking, or numbness of a person's skin with no apparent long-term physical effect) Quantitative disorders of the sensation: f. Anesthesia - the disorders of a feeling of pain, which are characterized by loss or decrease of the painful sensitivity g. Hypaesthesia - reduction in the sensitivity to the external stimuli. (everything under the mute). h. Hyperaesthesia - is a condition that involves an abnormal increase in sensitivity to stimuli of the senses i. Cenesthesia - the special feature of the sensory reception, which is consisted in the fact that the external stimulus, addressed to one analyzer, causes simultaneously answer from some another or several analyzers. j. Hysterical anaesthesia- lost of sensory modalities due to emotional conflicts.
16
Quantitave disorders of the perception: e. Illusions misperception or misinterpretation of real external sensory stimuli f. Hallucination false sensory perceptions or mental impressions of sensory of vividness not associated with real external stimuli. g. Derealization a subjective sense that the environment is strange or unreal h. Depersonalization a subjective sense of being unreal, strange or unfamiliar to oneself
2. Differentiation harmonic, accented and psychopathic personalities. The meaning of premorbid features for the development of mental disorders.
Emphasis of the nature ()- the excessive strengthening of separate features Psychopathy () - the pathologic structure of personality with the uniqueness of the affective (anomalous type of reaction to the stress situations) (provoke interpersonal conflict) Premorbid (Preceding the occurrence of disease) special features of the personality of the patient: temperament, nature, the personality. Nature is the basis of personality. 1. Temperament - the individual method of reaction, which is inherited, the dynamics of mental activity. 2. Nature - individual style of contact and behavior, manufactured on the basis of temperament, the individual steady uniqueness of man (nature - this always act). 3. Personality - the united entire education of the properties of personality, which consists of the constitutional and acquired qualities.
Ticket 18
18 . , . , . ( ). , , . .
1. Hysterical neurosis (Dissociative Disorders). Somatoform Disorders. Descriptive features.
IV. V. VI. F44 in ICD-10 Characterized by physical or psychological symptoms for which no physical cause can be identified but which are linked to meaningful physiological stressors Symptoms : Neurological (loss or change in sensory or motor function, blindness,seizures) Somatic (headache, stomachache, painful extremities, diff swallowing, dysmenorrhea) Psychological (amnesia, false visions, fears, crying/laughing, substance abuse)
2. Acute and chronic mental disorders due to a general infection. Clinical features, course, treatment.
General paralysis of Insane (GPI)- syphilitic psychosis which appears in some patient in 10-15 years after infection. (encephalopathy) Symptoms of encephalitis: lost of insight, euphoria, dementia, severe personality changes, delusion of grandeur (Nobility or greatness of character)
17
Neurological sign: Argyll-Robertson symptoms (pupil not constrict), asymmetry tendon reflexes, positive Wassermann test ( 95%) Treatment: antibiotics, iodotheraphy, bismuth drug
Maniacal
Hysterical - stress induced - reactions to the act of spectators demonstrative behavior (loud cries, sobbing
Ticket 19
19 1. , . . 2. , . , , , . 3- . . . .
1. Subtypes of epileptic seizures.Differential Diagnosis ofepileptic seizure and hysterical attack.
Primary generalized Abrupt loss of consciousness (up to coma) Total amnesia Simultaneous changes in all areas in EEG e.g. Petit mal (absence of myoclonic seizures) grand mal (tonic, clonic, tonic-clonic, atonic) Partial (focal) seizures No loss of consciousness or partial changed consciousness Partial or no amnesia Focal changes in EEG e.g. abrupt attacks of hallucination, delusion Secondary generalized seizures Differential diagnosis Grand mal Abrupt spontaneous onset with self injury. Nocturnal seizures are common The face is pale at the beginning and then cyanotic No deep reflexes Stereotypical tonic and clonic expression Meaningless facial expression Duration 30s to 2 min Spikes, pathological waves on EEG Total amnesia Hysterical convulsions
18
Induced by emotional stress Careful falling without injury Flushing or no changes in face colour Deep reflexes Non stereotyped asynchronous body movements Facial expression of suffering, fear or delight Long duration (several min up to an hour) No specific EEG changes Partial amnesia
Ticket 20
19
20 . , . . 3- .
1. Catatonia. Descriptive features.
Catatonic -
purposeless, impulsive absence or poor reaction to the acts of spectators (muteness stereotypical manneristic posture and facial expression echolalia (involuntary repetition of speech) and echopraxia (imitation)
Ticket 21 21 . , , .
.. , , , . .
1. Psychoorganic syndrome (organic disorders due to a general medical condition). Descriptive features.
Watlter-bleuler triad: memory liability, emotional incontinence and disturbances and decrease intelectuallity. (difficulties in registration, difficulties in understanding, difficulties in keeping feeling) Patients become helpless, having difficulty to adapt to the new situation, bad understanding. Stages: asthenic, plosive, euphonic, insensitive (apathetic) Organic disorder include trauma, tumour, intoxication (alcohol), epilepsy, degenerative disease (Alzheimer, Pick disease), as a consquencs of somatic diseases (atheroskerosis, endocrine pathology) Clinical: delirium, paroxysmal disorders, impairment of memory and intelligence. Irreversible disorders. Diagnostic: based on symptoms and syndromes. In 1st stage: increase manifestations of mental weakness and increased fatiagability Later: disorder of attention, memory and intellectual activity, emotional disorder.
20
Classification: degenerative cerebral diseases, cerebral arteriosclerosis, tumours, trauma, and infections.
The general criteria of reactive psychoses were proposed by K Jasper: a. Agreement in the time of the beginning of disease with the psycho-injury situation b. The reflection of this situation in the clinical picture of disease, in the experiences of patient c. Recovery in proportion to the permission of the psycho-injury situation.
Ticket 22
22 . , . . . , . . , .
1. Hypochondria. Subtypes.
Concept: The persistent conviction that one is or is likely to become ill, often involving symptoms when illness is neither present nor likely, and persisting despite reassurance and medical evidence to the contrary
Subtypes : Somatoform pain disorder Somatization Hypochondrial
2.
21
3. Mood stabilizers. Subtypes, side effects, practical applications, indications and contraindications.
A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts. Usage : bipolar affective (mood) disorder, resistant mania, resistant depression, epilepsy, trigeminal neuralsia Types : Anticonvulsants (Valproic acid, lamotrigine, carbamazepine) Lithium salt Side effects increased thirst and urination, nausea, weight gain and a fine trembling of the hands tiredness, vomiting and diarrhea, blurred vision, impaired memory, difficulty concentrating, skin changes dizziness, drowsiness, blurred vision, confusion, muscle tremor, nausea, vomiting or mild cramps, increased sensitivity to sun, skin sensitivity and rashes and poor co-ordination. Contraindications : pregnancy, brestfeeding
Ticket 23
23 . , ( , , ). . ( ). , , . . , , .
1. Delusion. Definition.Classification according to the content and structure of syndromes.
Delusion - false belief of great value to a patient, cannot be corrected by reasoning Primary delusion independent disorder of thought which are not associated with other mental dysfunction Secondary delusion secondary disorder of thought which represent the disturbance of other mental function. Systemized delusion false idea confirm with some logic associations Nonsystematised delusion fragmentary, not associated with false ideas - Persecutory delusions - Acute delusion - Depressive delusions( - Chronic delusion: cotard-thinks hes dead) - paranoia (primary systemized idea of persecutions, jealousy - Grandiose delusions without hallucination - paranoid (hallucination and delusional states with persecutory ideas) - paraphrenia (hallucination and delusional states with bizarre ideas)
22
rational emotive behavior therapy multimodal therapy Indications o Anxiety disorders o Mood disorders o Insomnia o Severe mental disorders
Ticket 24
24 . . , , . . , , , . . . , .
1. The concept of consciousness in psychiatry. Jaspers criteria of the pathology of consciousness.
Concept: indicate a state of awareness of self and environment Found deficiencies of: Grasp/ comprehension/ attention, orientation, thinking, retention Syndromes : a. Deterioration : - clouding of consciousness - organic stupor - coma b. Obscured consciousness - Delirium - acute psychosis with illusions and true hallucination, excitement, disorientation in time, place and situation. - Amentia - deep disorder of consciousness with incoherence - Oneiroid state - dream like state with dual orientation - Twilight state - action maybe performed without conscious coalition and without any remembrance afterward
23
d.
The persons, noted in the use of narcotic drugs, need the consultation of psychiatrist and the dynamic observation of the doctor of part.
Ticket 25
25 1. , , . 2. , (). , . 3. . .
1. Intellectual Disabilities. Descriptive features.
Dementia: the acquired dementia (total, partial). Special forms: schizophrenic, epileptic,psychopathic. Loss of intelligence after a period of its normal development Symptoms: deterioration of memory, reduction in other cognitive abilities is characterized by weakening criticism and thinking, Absence of the loss of consciousness on the duration of the period of the time, reduction in the emotional control or motivation (emotional liability; irritability; apathy) a. Organic: Dysmnestic (arteriosclerotic)
primary marked disorder of memory Slight deficiency in understanding Mild personality changes Good insight (sadness due to illness)
b.
Total (atrophy, frontal lobe tumors) - primary marked impairment of understanding - severe personality changes - poor insight Epileptic - severe personality changes (abulia, autism, apathy) - marked impairment of cognitive and memory - poor vocabulary and preservatives thinking Schizophrenic dementia : - severe personality changes - Marked cognitive difficulties - Absence or mild memory disorders
Oligophrenias - congenital or early (till 3 years old) states of mental underdevelopment with the preferred defeat of intellect. Retarded intellectual and cognitive development. Causes: genetic (chromosomal and inherited) embryopathy (intoxication, Rubella) fetopathy and perinatal pathology (hypoxia, trauma, infections) Level : based on IQ Moronic 50 69 Imbecile35 20 Idiocy below 20
24
Diagnostic triad Jaspers K: - close temporary relation between stressor and the development of the disease - symptoms show the reflection of the nature of the traumatic experiences - generally benign course of the disease with the complete recovery after psychological problems solved. Clinical classification: - acute stress induces psychoses a. Acute stress reaction b. Hysterical psychoses c. Reactive depression d. Reactive paranoid e. Posttraumatic stress disorder neuroses a. Neurasthenia symptoms of asthenia (fatigability with irritability) linked to meaningful psychological stressors. b. Hysteria (somatic disorder characterize by physical or psychological symptoms for which no physical cause can be identified but which are linked to meaningful psychological stressor) c. Obsessive-phobic neurosis (a spectrum of illness appeared with the symptoms of anxiety, unreasonable fears, obsessions and rituals, associated with internal conflict)
Ticket 26
26 . . . . , , . . . . , .
1. Paraphrenia. Descriptive features.
Paraphrenia is a group of psychotic illnesses distinct from paranoia and from schizophrenia.The onset occurs around age 40. Characterized by hallucination and delusional states with bizarre ideas of grandeur or persecution, delusional memories, falsification of memory usually associated with mental automatism, often non -systemized
25
Treatment: - Basic PrinciplesBarbiturate dependences: a. Detoxification is a prerequisite in the treatment of these disorders. b. barbiturates must be withheld from a comatose or grossly intoxicated patient until these symptoms clear. c. Diazepam (Valium,15 to 25 mg four times daily) may be substituted for the abused barbiturate. barbiturate detoxification can be accomplished in a 14 day period, but longer detoxification may be required. - Medical Treatment Of Benzodiazepine Dependence a. Start withdrawing the patient on diazepam (Valium), 15 to 25 mg four times daily. Administer sufficient additional diazepam to suppress signs of increased withdrawal (e.g., increased pulse, increased blood pressure, or increased perspiration). Once a diazepam dose is reached which suppresses signs of withdrawal, continue for 2 days then start decreasing by 10% per day. When the diazepam dose approaches 10%, reduce the dose slowly over 3 to 4 days and then discontinue. b. Generally, benzodiazepine detoxification can be accomplished in a 14 day period, but longer detoxification may be required. - Psychosocial Treatment - Psychotherapy - Behavior Therapy (teaches the sedative abuser other ways to reduce anxiety) by relaxation training, assertiveness training, self-control skills, and new strategies to master the environment are emphasized.
3. Iatrogenic disorders (doctor-induced disorders). Mental disorders condition (nosogenic reactions). Definition, treatment, prevention.
refer to inadvertent adverse effects or complications caused by or resulting from medical treatment or advice. In addition to harmful consequences of actions by physicians, iatrogenesis can also refer to actions by other healthcare professionals, such as psychologists, therapists, pharmacists, nurses, dentists, and others. Examples of iatrogenesis: medical error wrong prescription illegible handwriting negligence faulty procedures, techniques, information, or methods failure in life support instruments prescription drug interaction adverse effects of prescription drugs over-use of drugs leading to antibiotic resistance in bacteria nosocomial infection blood transfusion harmful emotional distress from the ascription of mental pathology nomenclature for transient personal problems
Ticket 27
27 1 . , . 2. . . . , . 3. . , , .
1. Memory disorders. Clinical forms, diagnostic value.
Hypermnesia :exaggerated degree of retention and recall Hypomnesia : difficulties of registration, retention and recall of memories Korsakovs syndrome : failure to register minute memory, anterograde and retrograde amnesia, amnestic disorientation, paramnesia Amnesia : gap, loss of memories but not the ability to register Organic amnesia Retrograde amnesia
26
Anterograde amnesia Progressive Psychogenic Paramnesia Allomnesia : filling of gaps in memory by real experience but of the other time period Confabulation : unconscious filling of gaps in memory by imagined or untrue experiences that patient believes but have no basis in fact.
therapy.Practical
applications,
indications
and
psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Today, ECT is most often used as a treatment for severe major depression which has not r esponded to other treatment, and is also used in the treatment of mania (often in bipolar disorder), catatonia and schizophrenia. Electroconvulsive therapy can differ in its application in three ways: electrode placement, length of time that the stimulus is given, and the property of the stimulus. The variance of these three forms of application have significant differences in both adverse side effects and positive outcomes. After treatment, drug therapy can be continued, and some patients receive continuation/maintenance ECT. Effects: o Effects on memory o Controversy over long-term effects on general cognition o Effects on brain structure o Effects in pregnancy
Ticket 28
28 1. . , . , . . , , . . . , , .
1. Depression. Descriptive features. Criteria of severity of depression.
Depressive syndrome - lowered, depressed mood, intellectual and motor retardation It is not only characterize by mental suffering, but also is accompanied by the physical painful sensations (vital melancholy): by discomfort in the epigastral region, by gravity or by pains in the region of heart. Depressive syndrome is characterized by the depressive triad: hypothymia (depressed mood, melancholy, melancholy, anxiety, apathy) retarding thinking (depletion of thinking, few thoughts, they they flow slowly, they are riveted to the unpleasant events) motional retardation (slowing of movement and speech). Depression with anxiety up to agitation depression associated with severe anxiety, excitement and motor restlessness, more common for patient of involution age. High suicidal risk Masked depression manifested by somatic symptoms (heartache, headache, stomachache, hypertension)
1. 2. 3.
2. Mental disorders associated with pregnancy and childbirth. Psychotic disorder due to an operation. Clinical features, course, treatment.
Postnatal blues
27
Transitory emotional disturbances, including short-lived episodes of irritability, crying, depression and emotional lability, occurring in the first postpartum week. Onset : 3rd day of postpartum Puerperal psychosis Can occur following childbirth : affective schizophrenic and acute organic Onset : between day 3 and day 14 postpartum Treatment : bonding with baby, ECT
3. Help with single seizures. Serial seizures and status epilepticus. Clinical features, treatment.
Status epilepticus (SE) is a life-threatening condition in which the brain is in a state of persistent seizure. defined as one continuous unremitting seizure lasting longer than 30 minutes, or recurrent seizures without regaining consciousness between seizures for greater than 30 minutes (or shorter with medical intervention). Treatment : anticonvulsant (diazepam, valproates, eclampsia)
Ticket 29
29 . . . . , , . . , .
1. Delirium. Descriptive features.
Delirium - acute psychosis with illusions and true hallucination, excitement, disorientation in time, place and situation Disturbance of consciousness (that is, reduced clarity of awareness of the environment, with reduced ability to focus, sustain, or shift attention) Change in cognition (e.g., problem-solving impairment or memory impairment) or a perceptual disturbance Onset of hours to days, and tendency to fluctuate.
Applications o o o
28
GABA blockers Glutamate activators cAMP o Serotonergics o Anti-depression, adaptogenic (antistress), and mood stabilization o Blood flow and metabolic function o Nerve growth stimulation and brain cell protection E.g. pyracetam, GABA, pyriditol, ACTH, acetylcholinesterase inhibitors
Contraindications :should not be taken by patients with serious renal insufficiency (creatinine clearance lower than 20 ml/min).
Ticket 30
30 . . . . . . . . . ( ), .
1. Psychosensory disorders. Disorders of the body scheme. Clinical features.
Illusion - misperception or misinterpretation of real external sensory stimuli Hallucination - false memory perception or mental impressions of sensory vividness not associated with real stimuli. True hallucination : - bright vivid perception, natural way of perception, confidence with the fact that other people have it (perception) too Pseudohallucination:- lack of vividness, other perception( internal vision of hearing), perceptions only for the patients himself. Derealisation : a subjective sense that the environment is strange or unreal Depersonalisation : a subjective sense of being unreal, strange or unfamiliar to oneself
2. Alcohol abuse. Stages of Alcohol Dependence.Age, and gender features.The concept of symptomatic alcohol dependence.
A disorder characterized by the excessive consumption of and dependence on alcoholic beverages, leading to physical and psychological harm and impaired social and vocational functioning. Classification by E.M Jellinek Alpha, beta, gamma, delta, epsilon alcoholism Russian: stage 1- only psychological dependences Stage 2- psychological and physiological dependence Stage 3- reduced tolerance Alcohol withdrawal syndromes - Symptoms: desire for alcohol, affective instability (dysphoria, depression, anxiety), neurologic symptoms (nystagmus, tremor, atxia), malaise, sleep disorder, arterial hypertension, tachycardia - Treatmnent: detoxication fluids by mouth or intravein, diuretics, vitamins, nootrops. Alcohol psychoses e. Delirium tremens acute psychosis induced by severe alcohol withdrawal syndrome (illusion, true hallucinations) - Treatment: sedative (benzodiazepines, barbiturates), treatment of withdrawal syndromes-fluids, diuretics, nootrops, vitamins, adequate nutrition f. alcohol hallucinosis - acute psychosis induced by severe alcohol withdrawal syndromes (abundance true hallucinations) - treatment: antipsychotics, benzodiazepines Delusional alcohol psychosis - encephalopathy induced by severed alcohol delirium (amnestic syndromes with peripheral neruropathy)
g.
29
- treatment: vitamin B1, nootrops h. Karsakov i. Gayet-wernicke encephalopathy - acute alcohol encephalopathy (ataxia, vestibular dysfunction, ocular motility abnormalities disorder of consciousness) - treatment: thiamin, treat cerebral oedema(diuretics, corticosteroid hormones, anticoagulant)
Ticket 31
31 . - , . P , . , . 3. . - , .
1. Asthenia (Chronic fatigue syndrome). Subtypes.Treatment.
CFS is a multi-systemic disease and is relatively rare by comparison. Symptoms of CFS include widespread muscle and joint pain; cognitive difficulties; chronic, often severe, mental and physical exhaustion; and other characteristic symptoms in a previously healthy and active person. CFS patients may report additional symptoms including muscle weakness, hypersensitivity, orthostatic intolerance, digestive disturbances, depression, poor immune response, and cardiac and respiratory problems Subtypes benign myalgic encephalomyelitis, chronic fatigue immune dysfunction syndrome, chronic infectious mononucleosis, epidemic myalgic encephalomyelitis, epidemic neuromyasthenia, myalgic encephalomyelitis, myalgic encephalitis, myalgic encephalopathy, post-viral fatigue syndrome
2. Differentiation harmonic, accented and psychopathic personalities. The meaning of premorbid features for the development of mental disorders.
Emphasis of the nature ()- the excessive strengthening of separate features Psychopathy () - the pathologic structure of personality with the uniqueness of the affective (anomalous type of reaction to the stress situations) (provoke interpersonal conflict)
30
Premorbid (Preceding the occurrence of disease) special features of the personality of the patient: temperament, nature, the personality. Nature is the basis of personality. 4. Temperament - the individual method of reaction, which is inherited, the dynamics of mental activity. 5. Nature - individual style of contact and behavior, manufactured on the basis of temperament, the individual steady uniqueness of man (nature - this always act). 6. Personality - the united entire education of the properties of personality, which consists of the constitutional and acquired qualities.
Ticket 32
32 1. . , . 2. . . 3. . .
1. Jaspers criteria of the pathology of consciousness. Syndromes of clouded consciousness.Subtypes.
a. b. c. Agreement in the time of the beginning of disease with the psycho-injury situation The reflection of this situation in the clinical picture of disease, in the experiences of patient Recovery in proportion to the permission of the psycho-injury situation.
*Retention. Orientation.Thinking. Attention 2. Classification of schizophrenia according to the course (by Mental Health Scientific Center, Russia).Subtypes of schizophrenia in ICD-10
a. b. c. d. Continous progression Pregression with acute attacks Periodic (recurrent) with slow progression Slow (sluggish) progression
31
Ticket 33 33
1. () . , . 2. (), , , . 3. . .
1. Psychomotor disorders. Types of stupor and excitation. Descriptive features.
Stupor: strange non-convenient posture, waxy flexibility (catalepsy), negativity (active and passive), automatic obedience. Catatonic - bizarre inconvenient posture - manneristic facial expressioin - muteness - negativism (often eating is absolutelu refused) - echolalia and ecoipraxia Depressive posture of suffering facial expression of sadness or anguish poor associations one word answers but not muteness the loss of appetite but no active resistance while eating
Excitement: purposeless actions, impulsive, brutality, stereotypic speech and movement (verbigerations, perseverations) Catatonic - purposeless, impulsive - absence or poor reaction to the acts of spectators (muteness - stereotypical - manneristic posture and facial expression - echolalia and echopraxia Maniacal - purposeful - Marked striving to personal contacts - increase drives - Facial expression of happiness (sometimes anger) Hysterical - stress induced - reactions to the act of spectators - demonstrative behavior (loud cries, sobbing) - histrionic posture and facial expression Non adaptive movements: echo symptoms (echopraxia, echolalia, echomimia), manneristic behavior Diagnose: amorbital (Amytal) interviews
2. Bonheoffer exogenous type of reaction. Etiological factors, subtypes. 3. Indicators of severity of depressive states. Care for depressed patients
Quantitative and qualitative alterations in cognitive processes (learning, memory, attention, perception and speed of cognitive responses). The Beck Depression Inventory (BDI, BDI-II): instruments for measuring the severity of depression consisted of twenty-one questions about how CF CFC VVVV the subject has been feeling in the last week. Each question has a set of at least four possible answer choices, ranging in intensity. For example: (0) I do not feel sad. (1) I feel sad. (2) I am sad all the time and I can't snap out of it. (3) I am so sad or unhappy that I can't stand it. When the test is scored, a value of 0 to 3 is assigned for each answer and then the total score is compared to a key to determine the depression's severity. The standard cut-offs are as follows: 09 indicates that a person is not depressed, 1018 indicates mild-moderate depression, 1929 indicates moderate-severe depression and 3063 indicates severe depression.
32
Ticket 34
34 1. , , . . 2. . , , , . 3. . . .
1. The distinction of illusions, hallucinations, pseudohallucinations.
Illusion- misperception or misinterpretation of real external sensory stimuli Hallucination- false memory perception or mental impressions of sensory vividness not associated with real stimuli. True hallucination: - bright vivid perception, natural way of perception, confidence with the fact that other people have it (perception) too Pseudohallucination:- lack of vividness, other perception( internal vision of hearing), perceptions only for the patients himself.
3. Stages of ontogenesis of the psyche and its clinical significance. Disontogenesisof the psyche.
(,., 1969) 1. Somato-vegetative stage - 0-3 years 2. Psycho-motor -4-10 of the years 3. Affective -7-12 of the years 4. Emotional- ideational - 12-16 years (.., 1973) 17. Motor - up to 1 year 18. Sensorimotor - of up to 3 years 19. Affective - from 3 of up to 12 years 20. Ideational - from 12 of up to 14 years
Ticket 35
35 . , , . - . , , . .
1. Mania. Descriptive features, diagnostic value.
Characteristics of mania include rapid speech, racing thoughts, decreased need for sleep, hypersexuality, euphoria, impulsiveness, grandiosity, and an uncontrollably intense interest in goal-directed activities Indicator of mania would be if a noticeably clinically depressed person becomes suddenly cheerful, optimistic, happy, and full of energy. Other elements of mania can and often do include delusions (of grandeur, potential, or otherwise), hypersensitivity, hypersexuality, hyper-religiosity, hyperactivity, impulsiveness, talkativeness, an internal pressure to keep talking (over-explanation) or rapid speech, grandiose ideas and plans, and decreased need for sleep.
2. Mental disorders due to cerebral trauma and neuroinfections. Clinical features, course, treatment.
Trauma : Acute or chronic regressive course. Stages : Loss of consciousness (up to coma) Acute period (acute psychosis delirium) Convalescence (until asthenia) Consequences :cerebrasthenia, Korsakovs syndrome, dementia, epileptic seizures, personality disorder
33
Infection : General paralysis of insane syphilitic psychosis which appears in some patients in 10-15 years after infection. Symptoms : loss of sight, euphoria, dementia, severe personality changes, delusions of grandeur. Neurological signs : Argyll-Robertson symptom, asymmetry tendon reflexes Treatment : Antibiotics, iodotherapy, bismuth drugs
Ticket 36
36 . , . . . . . , , . .
1. Depersonalization and derealization. Descriptive features, diagnostic value.
There should be found deficiencies in Grasp, comprehension, attention (difficulties or loss of contact) Orientation (In time, situation) Thinking (poor association up to incoherence) Retention (congrade amnesia) Deterioration : - clouding of consciousness - organic stupor - coma Obscured consciousness - Delirium - acute psychosis with illusions and true hallucination, excitement, disorientation in time, place and situation. - Amentia - deep disorder of consciousness with incoherence - Oneiroid state - dream like state with dual orientation Twilight state action maybe performed without conscious coalition and without any remembrance afterward
34
2. Mental retardation. Mental infantilism.The value of biological and situational factors in their formation.Treatment, rehabilitation, prevention.
Oligophrenias - congenital or early (till 3 years old) states of mental underdevelopment with the preferred defeat of intellect. Retarded intellectual and cognitive development. Causes: - genetic (chromosomal and inherited) - embryopathy (intoxication, Rubella) - fetopathy and perinatal pathology (hypoxia, trauma, infections) Level : Mild mental retardation , Moderately retarded, Severe mental retardation, Profound mental retardation Level : based on IQ (clinically) Moronic -50 69 Imbecile - 35 20 Idiocy below 20 Treatment: Train retarded children in such basic skills as bathing and feeding themselves. Training in independent living and job skills is often begun in early adulthood. The level of training depends on the degree of retardation. Mildly retarded people can often acquire the skills needed to live independently and hold an outside job. Moderate to profoundly retarded persons usually require supervised community living in a group home or other residential setting. Family therapy can help relatives of the mentally retarded develop coping skills.
Ticket 37
37 . . . , , . . , , .
1. Depression.Indicators of suicidal risk.
Depressive syndrome is characterized by the depressive triad: hypothymia (depressed mood, melancholy, melancholy, anxiety, apathy) retarding thinking (depletion of thinking, few thoughts, they they flow slowly, they are riveted to the unpleasant events) motional retardation (slowing of movement and speech). Suicidal ideation Post-traumatic stress disorder (PTSD) Major depression, which is often associated with social isolation Bipolar disorder Substance abuse (particularly alcohol) Schizophrenia Borderline personality disorder
35
Additionally, in adolescents: impulsive, aggressive and antisocial behavior; presence of family violence and disruption Past history (History of previous suicide attempt,Family history of suicide attempt)
Ticket 38
38 . , , . . , . . , .
1. Emotionaldisturbances.Descriptive features.
Depression - hypothymia (stable unreasonable feeling of sadness) - Anaesthesiapsychadolorosa (painful feeling that patient lost his feeling) Mania - hyperthymia (stable unreasonable elevation of mood) Apathy (dulled emotional tone) and abulia
36
Euphoria elevated but careless mood Dysphoria unpleasant mood up to anger abd irritation Anxiety feeling of tension of uncertain danger Ambivalence coexistence of two opposing impulses toward the same thing in the same person at the same time Emotional stiffness pathologic steadfastness Emotional liability fast changes in mood from sad to happy Emotional incontinence burst to tears for little for no reason
Ticket 39
39 . . . . , , . () . , .
1. Twilight states of consciousness. Descriptive features.
Syndrome : Sudden onset Symptoms : Brutal aggression or automatic behavior, paroxysmal state with local amnesia Duration : Several minutes to hours Ending : Sudden Amnesia : Total Nosology : Epilepsy or other organic paroxysmal disorder
3. Disorders usually accompanied by suicidal thoughts and attempts. Principles of treatment of patients with suicidal thoughts.
37
The most common cause is an underlying psychiatric disorders which include depression, bipolar disorder, schizophrenia, alcoholism and drug abuse. Treatment : antidepressant, psychotherapy
Ticket 40
40 , , . . , , . . (, , ).
1. Differentiation of dementia and mental retardation. Etiological factors.Descriptive features.
Dementia: the acquired dementia (total, partial). Special forms: schizophrenic, epileptic, psychopathic. Loss of intelligence after a period of its normal development Symptoms: deterioration of memory, reduction in other cognitive abilities is characterized by weakening criticism and thinking, Absence of the loss of consciousness on the duration of the period of the time, reduction in the emotional control or motivation (emotional liability; irritability; apathy) Organic: Dysmnestic (arteriosclerotic) Primary marked disorder of memory Slight deficiency in understanding Mild personality changes Good insight (sadness due to illness) Total (atrophy, frontal lobe tumors) primary marked impairment of understanding severe personality changes poor insight Epileptic severe personality changes (abulia, autism, apathy) marked impairment of cognitive and memory poor vocabulary and preservatives thinking Schizophrenic dementia : Severe personality changes Marked cognitive difficulties Absence or mild memory disorders Oligophrenias - congenital or early (till 3 years old) states of mental underdevelopment with the preferred defeat of intellect. Retarded intellectual and cognitive development. Causes: genetic (chromosomal and inherited) embryopathy (intoxication, Rubella) fetopathy and perinatal pathology (hypoxia, trauma, infections) Level : based on IQ Moronic 50 69 Imbecile 35 20 Idiocy below 20
38
Panic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. Common symptoms of an attack include rapid heartbeat, perspiration, dizziness, dyspnea, trembling, uncontrollable fear, hyperventilation, etc. Some individuals deal with these events on a regular basis, sometimes daily or weekly. Treatment Antidepressants Anti-anxiety (benzodiazepine) Psychotherapy
3. Institutional and legal issues of involuntary hospitalization. The problem of information about diagnosis (the patient, relatives, third parties).
The person, who suffers mental disorder, can be hospitalized without its agreement or agreement of its lawful representative to the decision of judge, if his inspection and treatment are possible only under the stationary conditions, For 48 hours face must be examined by psychiatrists If hospitalization is recognized as that substantiated, then conclusion about this for 24 hours is sent for the law court for the location of psychiatric establishment. Assuming statement, judge simultaneously gives sanction to a stay of face in the psychiatric hospital for the period, necessary for examining the statement in the law court.
Ticket 41
41 . , . . , . () .
1. Disorders of sensations. Differentiation of pathological sensations (senestopaties) and real somatic sensations.
Sensation - such form of mental activity, which reflects only to the separate properties of phenomena and objects, which influence the sensory organs . Perception - the integral reflection of those phenomena or objects, which act on our sensory organs. Recognition and interpretation of sensory stimuli based chiefly on memory. Cenesthopathy: unfounded strange inexplicable sensations in bodily organs Parasthesias: An altered sensation reported by the patient in an area where the sensory nerve has been afflicted by a disease or an injury (is a sensation of tingling, pricking, or numbness of a person's skin with no apparent long-term physical effect) Quantitative disorders of the sensation: k. Anesthesia - the disorders of a feeling of pain, which are characterized by loss or decrease of the painful sensitivity l. Hypaesthesia - reduction in the sensitivity to the external stimuli. (everything under the mute). m. Hyperaesthesia - is a condition that involves an abnormal increase in sensitivity to stimuli of the senses n. Cenesthesia - the special feature of the sensory reception, which is consisted in the fact that the external stimulus, addressed to one analyzer, causes simultaneously answer from some another or several analyzers. o. Hysterical anaesthesia- lost of sensory modalities due to emotional conflicts. Quantitave disorders of the perception: i. Illusions misperception or misinterpretation of real external sensory stimuli j. Hallucination false sensory perceptions or mental impressions of sensory of vividness not associated with real external stimuli. k. Derealization a subjective sense that the environment is strange or unreal l. Depersonalization a subjective sense of being unreal, strange or unfamiliar to oneself
39
Duration of effect 3-6h Symptoms of intoxication i. Drowsiness ii. Motor retardation iii. Altered mood iv. Pupillary constriction v. Bradycardia vi. Bradypnoe Withdrawal syndrome i. Dysphoric mood ii. Nausea iii. Muscle ache iv. Rhinorrhea v. Pupillary dilatation vi. Insomnia vii. Diarrhea
Treatment
i.
ii.
Ticket 42
42 . , . . ( , , ). . . .
1. Depression. Differentiation of endogenous depression (depressive episode) and psychogenic depression (grief reactions).Principles of treatment.
Depressive episode: Triads :Hypothymia, retarded thinking, retarded motion Psychogenic depression : Depression as a result of irresistible loss (death, divorce, victim of crime) Suicidal behavior is possible, often with dangerous behavior, sometimes obscured consciousness
40
2. Mental disorders due to epilepsy (paroxysmal disorders, acute, chronic and prolonged psychoses).
Personality changes and dementia due to epilepsy. Treatment. Epilepsy : group of related disorders characterized by tendency for recurrent seizures Course : chronic progressive Outcome : epileptic dementia Paroxysmal disorders With deterioration of consciousness (grand mal, petit mal, twilight states) Without deterioration of consciousness (dysphoria, paroxysmal derealisation, hallucination and delusion) Epilepsy can lead to psychiatric symptomatology (complex partial seizures of the temporal lobe) cause the symptomatology of schizophrenia and mood disorders Treatment : anticonvulsants, neuroleptics
Ticket 43
43 . , . . , , . , , .
1. Formal thought disorder. Subtypes.
Disorders of the form and stream of thought Disorder of the possession and the content of thought a. Delusion - false belief of great value to a patient, cannot be corrected by reasoning Persecutory delusions Acute delusion Depressive delusions Chronic delusion: Grandiose delusions paranoia (primary systemized idea of persecutions, jealousy without hallucination paranoid (hallucination and delusional states with persecutory ideas) paraphrenia (hallucination and delusional states with bizarre ideas) b. Overvalued ideas- sustained ideas of great personal values which is no absolutely false but inadequately significant Obsessions - pathological persistence of an irresistible thought or feeling that cannot be eliminated. Rumination (irrational burdensome operating with thought, symbols, words or numbers) Contrast ideas (irrational painful thought about possibility of dangerous or antisocial actions)
c.
2. Mental disorders due to a general medical condition (nosogenic reactions). Definition, treatment, prevention.
Transitory psychosis (loss of consciousness) Delirium acute psychosis with illusions and true hallucination, excitement, disorientation in time, place and situation. Amentia deep disorder of consciousness with incoherence Oneiroid state dream like state with dual orientation Twilight state action maybe performed without conscious coalition and without any remembrance afterward Korsakov; amnesia ( loss of memory but not the ability to remember), paramnesia (allomnesia- filling gaps with true real experiences but during other time period; confabulation-imagined untrue experiences between memory gaps ) Psycho-organic (disorder of attention, memory and intellectual activity, emotional disorder classify as: degenerative cerebral diseases, cerebral arteriosclerosis, tumours, trauma, and infections.).
41
Ticket 4 4
44 (). . . . , . 3- () . , .
1. Obsessive-compulsive disorder. Descriptive features. Subtypes in ICD-10. Treatment.
Mental disorder characterized by intrusive thoughts that produce anxiety, by repetitive behaviors aimed at reducing anxiety, or by combinations of such thoughts (obsessions) and behaviors (compulsions). The symptoms of this anxiety disorder range from repetitive hand-washing and extensivehoarding to preoccupation with sexual, religious, or aggressive impulses. ICD-10 :F60.5 Anankastic (OCD) Treatment 1. Psychotherapy 2. SSRI : Paroxetine, Sertraline, Fluoxetine, Escitalopram 3. Tricyclic Antidepressant : Clomipramine
2. Mental disorders due to vascular diseases of the brain. Clinical features, treatment.
Systemic disease with slow progression and evident waving course. Cerebral symptoms coexist with features of ischemia of heart or extremities. The first symptoms are asthenia and hypomnesia Dementia appears later, insight is rather good (partial dementia-F01)
3. Psychiatry and clinical psychology. The subject, common features and differences.
Psychiatry - these are the medical science, which studies the disturbances of mental activity, their clinical manifestations, the special feature of flow, outcome, etiology and pathogenesis, epidemiology, etc Tasks of psychiatry: 1. Diagnostics of mental disorders. 2. Study of clinic, etio-protogenesis, flow and outcome of psychic illnesses. 3. Study of epidemiology of mental disorders. 4. Study of the action of medicines on the pathomorphosis of psychic illnesses. 5. Development of the methods of treating the mental pathology. 6. Development of the methods of the rehabilitation of patients with psychic illnesses. 7. Development of the methods of prophylaxis of mental pathology among the population. 8. Questions of the organization of psychiatric aid to populati on.
42
Ticket 45
45 . . , , . . . . . .
1. Disorders of attractions.
Disorders of the inclinations Disturbance of inclinations to the food: Bulimia - pathologic, sharply intensive feeling of hunger, which is frequently accompanied by general weakness and abdominal pains followed by feelings of guilt, depression, and self-condemnation. Anorexia - loss of a feeling of hunger, the absence of appetite with the presence of the physiological need for the nourishment. Polydipsia - Excessive or abnormal thirst. parorexia - Abnormal or inappropriate appetite, especially a craving for items unsuitable as food; pica ( persistent craving and compulsive eating of non-food substances). coprophagy, scatophagy Disturbance of the instinct of the self-preservation: Weakening the reflex of self-preservation. Strengthening the reflex of self-preservation. Disturbances of the sexual inclination: onanism, promiscuity (sex between many partners), group sex, hyper sexuality, erotomania - entire life in the sex, impotence, vaginism, homo and transsexual, pedophilia, incest
2. Senile and presenile dementia. Dementia of the Alzheimer's Type.Clinical features, course, treatment.
Early onset or presenile dementia is a term used to describe a range of illnesses or diseases affecting memory, thinking and other cognitive functioning in people under the age of 65. Although most dementias affect people who are mature aged and therefore less likely to be participating in the workforce, occasionally younger people (those in their 40s and 50s) are diagnosed with dementia. Senile dementia is a disease caused by degeneration of the brain cells. It is different from normal senility in the elderly in that the patient's brain function will gradually deteriorate resulting in progressive loss of memory and mental abilities, and noticeable personality changes memory impairment (impaired ability to learn new information or to recall previously learned information) one (or more) of the following cognitive disturbances: aphasia (language disturbance) apraxia (impaired ability to carry out motor activities despite intact motor function) agnosia (failure to recognize or identify objects despite intact sensory function) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting) The course is characterized by gradual onset and continuing cognitive decline Treatment: Ach-esterase inhibitor (donepezil, galantamine) Excitatory neurotransmitter (memantine) Antipsychotic Psychotherapy
3. The conception of internal picture of disease: description, clinical significance and meaning for general practice doctors. Treatment. Ticket 46
43
46 . . . , , . - . . .
1. Depression. Differentiation of endogenous depression (depressive episode) and psychogenic depression (grief reactions).Principles of treatment.
Endogenous depression is a mood disorder that affects some people from birth and is believed to be a genetic condition. A sufferer is prone to become depressed on the advent of traumatic events, exhaustion or when under high levels of stress and may not be aware of the disorder until confronted by symptoms of depression for the first time.
47 . , . . , , . .
1. Oneyroid. Descriptive features.
catatonic form of schizophrenia and presents with a dream-like or nightmare-like state as a background of intensive psychopathological experiences (1) initial general-somatic and vegetative disorder; (2) delusional mood, (3) affective-delusional depersonalisation and derealisation, (4) fantastic-delusional and affective depersonalisation and derealisation, (5) illusional depersonalisation and derealisation, (6) catatonic-oneiroid state in the culmination
44
persistent and distressing symptoms of exhaustion after minor mental or physical effort including general feeling of malaise, combined with a mixed state of excitement and depression. Accompanied by one or more of these symptoms: muscular aches and pains, dizziness, tension headache, sleep disturbance, inability to relax and irritability. Inability to recover through rest, relaxation or enjoyment. Disturbed and restless, unrefreshing sleep, often troubled with dreams. Duration of over three months. Treatment : Symptomatic treatments Nonsteroidal anti-inflammatory drugs Ibuprofen Nonsedating antihistamines Balanced diet Rest Exercise - if feasible without fatigue. Antidepressants - if appropriate Low-dose tricyclic antidepressants Benzodiazepines Serotonin reuptake inhibitors Treatment of sleep problems
48 . . . . . . , , .
1. Overvalued ideas. Descriptive features.
Concept: sustained ideas of great personal value, which are ot absolutely false but inadequately significant un such way that it disturbs the adaptation of individual. Clinical: true ideas, poor insight, poor behavior control but possible, diagnosis subpsychotic states (initial period of psychoses), paranoid personality.
45
Ticket 49
49 1. -. , , . . - . .
1. Bodydysmorphicdisorder (dysmorphomania).Descriptive features. Treatment. The delusional conviction that one is physically deformed or otherwise abnormal .
1. A reference to a mental disorder characterized by a normal person's obsession with an imagined defect in physical appearance; also called muscle dysmorphia, dysmorphophobia, reverse anorexia. 2. Characterized by a fear of being deformed; also called body dysmorphic disorder. 3. Relating to a persistent complaint of a perceived bodily defect that is not noticeable to others; occasionally several parts of the body are involved. Treatment : Cognitive behavioral therapy, SSRI
Ticket 50
50 . , , . . (), . .
1. Masked depression (depression with a predominance of somatic symptoms). Descriptive features. Principles of treatment
Masked depression manifested by somatic symptoms (heartache, headache, stomachache, hypertension) Diagnose: dexamethasone-supression test Masked depression often manifests itself as headaches, stomach pain, a nagging ache in the lower back and pain in the jaw. The root of the problem is psychological and should be treated with antidepressants
2. Mental disorders due to vascular diseases of the brain. Clinical features, treatment.
Vascular dementia
46
Memory problems; forgetfulness Dizziness Leg or arm weakness Lack of concentration Moving with rapid, shuffling steps Loss of bladder or bowel control Treatment : physiotherapy, occupational therapy, and speech therapy treating the underlying disease such as hypertension, hyperlipidemia, and diabetes mellitus. Antiplatelet agents are indicated Pentoxifylline increase cerebral blood flow Neuroprotective drugs such as nimodipine, propentofylline, and posatirelin
47