Notes on psychiatry

Organic mental

Functional disorders

disorders

Neurosis
Delirium Dementia

Anxiety

disorders

Somatoform
disorders

Personality Psychosomatic

Psychosis
Schizophrenia

Mood

disorders

disorders

Mental

retardation

disorders

Anxiety
Definition

Overview

A feeling of apprehension caused by anticipation of danger, which may be internal or external

It is one of the neurotic disorders

Occurs in both sexes

Age of onset: Young adulthood (15-25 years)

At any socioeconomic status

It is an exaggeration of the normal reaction in quantity (both in reaction and duration)

Interfering with the daily activity and academic performance

Psychosocial factors play the major role in its etiology

The patient is aware about his condition so he seeks medical advice (has insight)

The personality is integrated

Types

Consists of unexpected panic attacks

Panic attack: it is an unexpected sudden severe episode of intense fear (dread) with sense of
impending death or loosing mind associated with hyper-excitable nervous system,

Panic
disorder

agoraphobia

depersonalization and de-realization

The attack reaches its peak within 10 minutes and lasts for 1 hour

It may be accompanied by agoraphobia: fear from being in open overcrowded places (e.g.
supermarket), getting a panic attack and no help can be given to him

In between attacks there is an anticipatory anxiety

A chronic excessive anxiety and worry > 6 months with hyperactive autonomic nervous
system with 2 types of symptoms

Generalized

Mental

anxiety

disorder

Vague fear

Short attention span & diminished concentration

Decreased learning ability

Irritability & restlessness

Early insomnia or interrupted sleep with nightmares

CNS: headache, tremors, dizziness, exaggerated reflexes with increased

muscle tone

Physical

CVS: palpitation, chest pain

Respiratory: chest tightness, dyspnea, tachypnea, chocking sensation

GIT: Dryness of mouth, anorexia, abdominal pain, diarrhea

GUS: premature ejaculation, impotence, menstrual irregularity, frequency of

micturition

Skin: cold clammy sweating (palm, forehead, axillae), pallor

Easy fatigability

It is irrational (out of situation) fear from specific objects or situations which are neutral and
lead to avoidance of these objects or situations
Phobic
disorders

Specific
phobia

Phobia from heights, elevators, natural disasters

Phobia from illness, death.

bathrooms, in which the individual may be exposed to the scruinity of others or

phobia

getting embarrassed or criticized by others

Obsession

compulsive
disorders

Animal phobia, phobia from blood

Irrational fear of public situations e.g. eating, speaking in public or using

Social

Obsessive

Repetitive, intrusive ideas (thought) impulses or images

The patient knows that it is meaningless and absurd and he tries to resist

It is anxiety provoking

Repetitive, intrusive actions

Compulsion

The patient knows that it is meaningless and absurd, he tries to resist

It is usually provoked by obsession

It occurs after exposure to major stress (life-threatening situation) e.g. in war, natural
disaster, rape

Acute stress
disorder

and post-

Acute stress disorder: is the reaction occurring in the 1st 4 weeks after exposure and may
resolve without sequlae

traumatic
stress

disorder

Post-traumatic stress disorder: occurs after 1 month from exposure with 3 groups of
symptoms:

o Intrusive re-experiencing of stressful events: as intensive thoughts flashbacks dreams

with nightmares
o Avoidance of stimuli that remind the patient about the trauma

o Hyper-arousal (irritability, poor concentration, headache, insomnia) & emotional

blunting

Treatment
Hospitalization

Psychotherapy

Especially in panic disorders (psychiatric emergency)

For 1-2 weeks

Supportive psychotherapy

Reassurance, explanation, suggestion, persuasion

Group psychotherapy

Psycho-education
Correct thinking-correction of emotion, positive and negative

Cognitive behavioral
psychotherapy

reinforcement flooding systematic desensitization- in

obsession: thought stopping in compulsion: exposure and

response prevention

Antidepressants
Psychopharmacology

TCA: imipramine (tofranil)

SSRIs: Fluoxetine (Prozac 20-60 mg/dl)

Minor tranquilizers
(anxiolytics)

Beta-blockers

Diazepam (Valinil): 2 mg TDS

Alprazplam (Xanax): 0.25-0.5 mg TDS
Propranolol (Inderal) 20-80 mg/day to control ANS symptoms

Schizophrenia

Chronic deterioration in the whole mind (intellect, affect and behavior) which doesnt
act in co-operation, leading to splitting of the personality (Mind)

Definition

Usually occurs in adolescents

Age of onset between 15-25 years, onset in males tend to be earlier than females

Gradual onset, progressive course

Male: 15-25 years female 25-35 years (better prognosis)

Black > white

Down drift hypothesis to lower socio-economic status

Female of expressed emotions
Give message and do its opposite

Family

impact

Family with

frequent double
bind
communication

Communication: Digital Analogue (body language)

Message received by body language doesnt resemble
the verbal one
Logico-mathematical double bind give message like
opposite meaning e.g. you must travel, you are running
away

Migration
theory

Etiology

Neuro-

transmitter
abnormalities

Normally, cerebral cortex is 6 layers, intrauterine it is 1 layer, then

migration and differentiation from below upwards occurs

Many cells that should be present in layers 2 & 3 are still present in
layers 5 & 6; failure of migration (60% of patients only)

Biological markers not biological test

Increased dopamine: all dopaminergic drugs increase psychiatric

symptoms, while dopaminergic blocking drugs improve them

Serotonin: agents that re-uptake serotonin: increase risk for
schizophrenia

Acetyl choline: anti cholinergic drugs (block muscarinic receptors)

increase symptoms

Infectious

In CNS, 2ry trimester differentiation occurs

Increased risk of schizophrenia:

o In the north, those who were born in 8th/9th month (last days in

theory

summer)

o In south, those who are born in 1st and 2nd month

Nutritional
theory

Pregnant women suffered from severe nutritional deficiency; childen

developed increased risk of schizophrenia (average caloric intake <
1000 kcal); failure of migration/role in brain development

Ventricular

60% of schizophrenia; lateral ventricle enlarged due to atrophy of the

dilatation

surroundings or it enlarges compressing them


Notice

Schizophrenia is more common in low socio-economic classes (may be due to

unemployment)

Outcome of schizophrenia in developing countries is better because:

o Life is more complicated in developed countries
o Family support is more evident in developing countries
Process

(type of

Concrete thinking autistic thinking

thinking)

Thought

Loosening of association leading to incoherent speech

Formal

Neologism

thought

Poverty of speech or thought (Alogia)

disorder

Tangentially

disturbance

Thought block

Paranoid delusions
Disorder of
content

Delusions
concerning the
possession of

thoughts (passive
phenomena)
Clinical picture

Perception

Delusions of persecution, reference,

jealousy, grandoise

Delusions of influence

Thought insertion

Thought broadcasting

Thought withdrawal

Hallucination, mainly auditory, commenting in the patient or

commanding the patient (direct orders) or threatening the patient

It may be a second/third person auditory hallucination

Visual, olfactory and tactile hallucination may be present

Quantitative
Affect

Decreased affect as apathy, blunt or flat affect

Increased affect as anxiety, depression

Indifference (loss of emotional expression with

preserved emotional experience)

Qualitative

Ambivalence: 2 contraindication effects

Inappropriate or incongruent affect

Detachment, isolation and social withdrawal

Loss of will power (avolition)
Behavior

Motor

activity

Serotypy Mannerism Negativism stupor resistance

posturing bouts of excitement echopraxia waxy
flexibility automatic obedience

Suicide and aggressive behavior

Clinical types

Dis-

Age of onset: <20 years = bad prognosis

organized

Disorganized speech with loosing of association, incoherent speech,

(affectbehavior)

Catatonic

Paranoid

Undifferentiated

neologism

Blunt or inappropriate affect, giggling

Delusions and hallucination

Disorganized behavior, stereotypy

Age of onset: 15 years

Mainly catatonic features: stupor, excitement, negativism, posturing

Age of onset = 30-35 years

More preserved personality so better prognosis

Good prognosis on antipsychotic & ECT

Consistent systemized so paranoid delusions

No disorganized or catatonic features

Age of onset = <25 years, bad prognosis

Prominent hallucinations and delusions with other evidences active

psychosis (incoherency or disorganized behavior) but no diagnostic
features of other types

Residual

The patient in remission from active psychosis (absence of the following:

(negative

delusions, hallucinations, incoherency or growth disorganized behavior)

symptoms

but there is residual phase: social withdrawal, flat or inappropriate affect,

only)

According
to
symptoms
Clinical

classification
According
to duration

apathy

Positive

Delusions & hallucination catatonic features Bizarre

symptoms behavior
Negative

Blunt affect social withdrawal poverty of speech poverty

symptoms of thought - avolition

Brief psychotic disorder

1-30 days, return to full formed function

Shizophremiform

If symptoms last 1-<6 months

Shizophrenia
Schizoaffective disorder

Acute if 6m 2 years
Chronic if > 2 years
schizophrenia + depression or mania

Predictors of

Pranoid or catatonic Late onset (female) quick onset positive symptoms no family

good prognosis

history family history of mood disorders absence of organic lesions

Occupational dysfunction (self-care, interpersonal relationships, work performance)

for at least 6 months

Diagnosis of
schizophrenia

Acute phase should be present for at least 1 month

Acute phase = 2 of these symptoms:

o Delusions Hallucinations (Psychotic access)

o Disorganization (Bizarre behavior)

o ve symptoms (Asociality, avolition [doesnt do anything unless provoked], alogia

[doesnt say anything unless provoked], affect binding)

Only one symptom is enough for diagnosis if: Auditory hallucinations hallucination
in 3,4 persons bizarre delusions

Hospitalization Especially in acute stages

Conventional

Phenothiazines

(dopaminergic
Drugs

antagonist)

phenothiazines
Novel

Treatment

Non-

antipsychotic

Aliphatic

Chlorpromazine

Piperidine

Thioridazine

Piperazine

trifluoperazine

Butyrophenones

Haloperidol

Sulpride

Dogmatil

Pimozide

Serotonergic-

Clozapine, resperidone,

dopaminergic antagonists

olanzapine

Dopamine stabilizers

aripiprazole

In non-compliant patients, long-acting antipsychotic injection (depot) used: e.g. clopixol

depot or resperidone depot
Electroconvulsive

therapy (ECT)
Psychological
treatment
Relapse rates
Prognosis
Prognosis

Acute stage suicide or homicide failure of medical

Indications

treatment contraindication to drugs non

compliant patient

Psycho-education to the patient and his family

Supportive psychotherapy

Group psychotherapy

40% in 2 years if on medication

80% in 2 years if off medication

33% lead normal life

33% experience symptoms but function in society

If no 1st year relapse and on medication, 10% relapse

33% require frequent hospitalization

Organic brain syndrome

Delirium
Disturbed consciousness,

Consciousnes
s

Perception

Not impaired

Short term memory is

Early: loss of recent memory

affected

Late: loss of remote memory

Orientation

Disorientation, first: place & time, then person

Attention

Inattention

Thought

Delusions

Inattention + poor concentration (acalculia)

Slow retarded and poor content+ delusions +
mis-identification

Speech, motor skills, recognition

Deteriorated: agnosia, apraxia, dysphasia

Insight and Judgement

Absent late in the course of the disease

Visual + Auditory hallucinations + Illusions

Fear, anxiety, apprehension

Depression: brain/retroperitoneal

Elation: SLE

Late: Apathy

Apathy

Restlessness and anxiety

Hyperactivity and elation, irritability

Restlessness, wandring

Stupor (impaired response to

Sun downing syndrome

Affect

Behavior

confusion, drowsiness,
cloudiness

Memory
Cognition

Dementia

cancer

stimulation)

Early: Depression with crying spells +

emotional liability

Lack of initiation (Avolition)

Loss of control, regression + Childish acts

Diminished self-hygiene

Onset

Acute

Gradual

Course

Fluctuating/worsen by night

Progressive

Reversibility Reversible
Consciousness

Irreversible

Disturbed

Intra-

cranial

Intact
-

Infection (meningitis)

Space-occupying lesion

Subarachnoid hemorrhage

Drug + alcohol toxicity

Endocrine: hypo/hyper-

Causes
Extra-

cranial

Head trauma

1ry

idiopathic

Metabolic: DM

memory change

Picks disease: starts by behavior

disturbance

Epilepsy (Todds paralysis)

thyroidism

Alzheimers disease: start by

2ry

Vascular (multi-infarct
dementia)

Infection (syphilis, TB, HIV)

Brain tumor, brain trauma

Systemic infection- post

operative

Normal pressure hydrocephalus

(Hakims disease)

Liver/renal failure

Vitamin B12/Folate deficiency

I.H.D

Parkinsons + Huntingtons +

SLE/RA

Prions
Aim = stabilize + prevent deterioration

Treatment

Treatment of the cause

Good nursing care

Nutritional support

Environmental: quite calm room

Symptomatic treatment: low dose of

highly potent anti-psychotic:

haloperidol (1.5-5 mg), resperidone (1

mg)

Anti-choline esterase: Rivastigmine

(cognitive enhancer)

Anti-inflammatory/oxidant

Nerve growth factors

Ach precursors: lecithine, choline

Glutamine antagonist: memantine

Anti-psychotic: to treat psychosis

SSRIs: depression treatment

Good nursing care

Care givers

Mood disorders
Definition

Disorders characterized by elation or depression that could be associated with psychotic

disorders
A person who suffers from a major depressive disorder (MDD), sometimes
also referred to as clinical depression or major depression

Must either have depressed mood or a loss of interest or pleasure in daily

activities consistently for at least a 2 week period

Definition

This mood must represent a change from the persons normal mood

Social, occupational, educational or other important functioning must

also be negatively impaired

A depressed mood caused by substances (such as drugs, alcohol,

medications) not considered a major depressive disorder, nor is the one
that is caused by general medical condition

Major

Typically the diagnosis of major depression is also not made if the person
is grieving over a significant loss in their lives

depressive

disorder

Clinical depression is characterized by presence of at least 5 of these

symptoms

Symptoms

MDD with melancholic

features

MDD with psychotic

features

Other subtypes include

Depressed mood most of the day

Markedly diminished interest or pleasure in all daily activities

Significant weight loss when not dieting or weight gain

Decrease or increase in appetite nearly every day

Insomnia or hypersomnia nearly every day

Psychomotor agitation or retardation nearly every day

Fatigue or loss of energy nearly every day

Feelings of worthlessness or excessive or inappropriate guilt

Diminished ability to think or concentrate or indecisiveness

Recurrent thoughts of death

Depressed mood show a prominent diurnal rhythm

Prominent late insomnia (Early insomnia = anxiety, late insomnia =

depression especially with melancholic features)

Severe loss of appetite with significant weight loss

Severe psychomotor retardation or agitation

Prominent lack of pleasure sense (anhedonia)

Delusions (particularly: nihilistic, guilt and reference)

Hallucinations

Psychotic symptoms may be congruent or incongruent with the mood

MDD with atypical features MDD with seasonal pattern MDD with
postpartum onset

It is a sort of chronic mild depression

The same diagnostic criteria for MDD apply, but only 2 rather than 5

Definition
Dysthymia
Management

depressive symptoms are required

Symptoms may be present most of days for continuous 2 years

Occupational dysfunction is not as severe as in major depression

Pharmacotherapy psychotherapy electroconvulsive therapy

It is important to remember that anti-psychotics should be utilized if

psychotic symptoms are present during a major depressive disorder

The manic episode may include the following symptoms:

Elevated mood // Racing thoughts // hyperactivity // increased energy // lack

of self-control // inflated self-esteem // over-involvement in activities and
Manic
episode

reckless behavior // sexual promiscuity // impaired judgment // tendency to

be easily distracted // little need for help

Symptoms should last for at least 1 week either

o Elated mood + at least 3 manic symptoms should be present

o Irritable mood + at least 4 symptoms should be present

Symptoms shouldnt be due to drug abuse, general medical condition,

structured brain lesions

Psychotic

symptoms

Delusions (particularly grandiosity)

Hallucination (particularly auditory)

Psychotic symptoms may be either congruent or incongruent with the mood,

it indicates a severe manic episode

Bipolar
disorder

Mixed

episode

Sometimes both criteria of major depression and mania are present

during the same episode, a picture that designates Mixed episode

N.B. in bipolar disorder: fluctuation between depressive and manic

episode. In mixed episode: both criteria of major depression and mania
present during the same episode

Patient present with the same criteria as those of manic episode but:
Hypomanic
episode

Shorter duration (at least 4 days)

Less severe (doesnt lead to severe impairment in occupational

dysfunction)

Absence of psychotic features

Bipolar disorder: Fluctuation between major depressive episodes and manic episodes with
remitting and relapsing course

Bipolar I: Manic phase alternating with depressive phase, patient is usually normal in
between attacks

Bipolar II: hypomanic phase alternating with depressive phase, patient is usually normal
in between attacks

Single manic episode is enough to label the patient with diagnosis of bipolar I disorder

Mood

Lithium: therapeutic level = 0.5-1.5 mEq/L

Anti-epileptic: valproate, carbamazepine, lamotrigine

Uses:

Main line of treatment of bipolar disorders, they are used with antidepressants; since the use of anti-depressants alone may precipitate mania

stabilizers

and worsen the course of bipolar disorder

-

Valproate & carbamazepine are effective in manic phase

Lamotrigine is effective in depressive phase of bipolar disorder

Chlorpromazine, haloperidol, resperidone

Used if psychotic symptoms are present during manic or major depressive

Antipsychotics
Management

Anti-

Mood stabilizers should be used for acute phase as well as for prophylaxis

disorders

TCAs, SSRIs

Uses

depressants

o Major depressive disorder

o Bipolar disorders but must be combined with mood stabilizers

Anti-depressants and mood stabilizers should be continued for at least a year after remission

of episode or even for longer duration depending on frequency of relapses and recurrence of
episodes
The modality is reserved to:

Patients having suicidal thoughts

Electro-

Patients with severe psychomotor agitation resistant to treatment

convulsive

Failure of other therapeutic modalities

therapy

(ECT)

The main side effect is a temporary state of confusion and amnesia

(impaired memory) following ECT sessions

It is difficult to apply psychotherapies during the acute manic phase,

however, psychotherapy may be logically more useful in between episodes

Somatoform disorder

Physical or somatic complaint without any demonstrable organic finding to account for
the complaint, or without any known physiological mechanism to explain

Definition

The finding is associated with psychological factors or unconscious conflicts to account

for these symptoms

It is diagnosed by exclusion

Definition

It is a neurological-like symptoms associated with psychological conflict or need

Motor

Paralysis (hemiplegia, paraplegia etc)

abnormalities

Dysphasia ataxia vomiting - mutism

Disturbance of
Clinical

consciousness

picture
Sensory

Conversion

disturbance

disorder

Unconsciousness pseudo-seizures or convulsions

Blindness Deafness anosmia

Anesthesia diplopia

Glove and stocking anesthesia

All symptoms are bizarre (dont follow any known

sensory pathway)

1. Mostly female with histrionic personality (Fragile, immature, childish, easily

suggestible, exhibitionistic but frigid in her sexual life)

Diagnostic 2. Labelle indifference i.e. inspite of the disability, the patient is mostly
criteria

laughing or normal

3. Primary gain = relief of anxiety by appearance of symptoms

4. Secondary gain = to get sympathy and care from the others

1. Psychotherapy

Supportive psychotherapy as: Reassurance explanation suggestibility persuasion

Treatment

The aim is to remove the conversion symptoms

of

To strengthen the personality of the patient to find a proper healthy solution to her

disorders

2. Galvanization

conversion

conflict other than the illness

3. Psychopharmacotherapy: minor tranquilizers (due to habituation we can give low doses

of anti-depressants)

Pharmacology
Anti-

Dependence: sudden withdrawal = anxiety + convulsions

Day time sedation

convulsants e.g.
benzodiazepine

Anxiety amnesia ataxia

Excess CNS effects in old age
Depression of respiratory and CVS function

TCAs
Antidepressants
N

SSNR
SSRI
NDRI
MAOI

Antipsychotic

Anticholinergic: blurred vision, dry mouth, urine retention, tachycardia

Alpha blocker: orthostatic hypertension reflex tachycardia arrhythmia

Sedation, confusion, motor incoordination

Weight gain and sexual dysfunction

Toxicity: antichole + increased temp + respiratory depression

No antihistaminic alpha blockage - anticholinergic

Sexual dysfunction (delayed ejactulation) insominia or sedation GI irritation +
weight fain
Bupropion

When with TCAs: hypertensive crisis - + SSRIs = serotonin syndromes

Substituted by RIMA

Typical (Chlorpromazine haloperidol): movement disorder dystonia tardive

dyskinesia akathesia + sedation + antichole + alpha 1 blockage

Atypical (resperidone): weight gain + increased prolactin + allergic reaction + decrease

threshold to seizres

Mood

Neurological: tremors ataxia confusion

Renal: polyuria polydipsia

stablilizers

Cardiac: bradycardia tachycardia syndrome

(lithium)

Edema

Enlarged thyroid + decreased function

Investigations of a case of dementia:

o Radiological: CT and MRI to exclude structural lesions may show brain atrophy
o EEEG
o Lab: Thyroid functions B12 serum level
o Routine lab investigations: Liver function tests, renal function tests CBC electrolytes

Asking the patient to name the days of the week backwards is an examination of attention

The patient who is sitting staring in front of you with lack of reaction to both external and internal stimuli
is said to be: stuporous

Perception of a non-existing stimulus: hallucination

Psychotic illness: the patient can say that aliens will insert thoughts in his mind insight is absent
personality disintegration schizophrenia is an example

Abnormal behavior that can be complained by the patient himself is: compulsion

Asking at noon about what the patient had for breakfast in the same day: recent memory

One of the following manifestations is a delusion: sustained immobility during night as the patient is
newly convinced that sun is the only thing that let him move

Not a psychotic feature: repeated hand washing due to repetitive and intrusive thoughts of being
contaminated after touching any object. The patient considers these thoughts wrong but irresistible (not
seeing non-existing worms in his hand or hearing non-existing ordering voice to do that repeated hand
washing as the patient is convinced that this washing is a secret method to communicate with the CIA)

A patient, who doesnt eat because he is convinced that his family is poisoning his food, is said to have:
delusion

Asking to repeat 6 digits after the examiner: immediate recall

Phobia: fear of closed places fear of harmless insects fear of talking in front of the public BUT NOT fear
of sakes

Meaning of a proverb: type of thinking

Time place and time: orientation

A 22 year old female patient came to the ER with her family as she developed acute muteness following a
quarrel with her fianc. The most immediate appropriate management: proper history taking and
thorough examination and if they are free, Ill assure the family and treat the patient with suggestion

Obsession: repeated thoughts of fear of contaminations, repeated images of killing a beloved person,
repeated ideas about losing virginity BUT NOT repeated hand washing

loss of emotional experience and expression is: apathy

intrusive repetitive thoughts, impulses or images patient try to resist is: obsessions

Hallucination: hearing voices that others dont hear

Manifestations of catatonia: sterotypy, posturing, echopraxia, waxy flexibility BUT NOT anhedonia

Obsession: the patient sees obsession as a wrong thought

Ambivalence: 2 contradictory emotions to the same thing at the same time

A 35 year old female presented with hypoactivity, diminished appetite, and depressed mood since 2 mood
since 2 months for the 1st time in her life, she has a previous history of thyroidectomy since 4 months
without replacement. The most important management to start with: request thyroid levels

Asking the patient if he is convinced that he is ill or not: insight

A 21-year-old female came to the hospital with her parents. She is severely scared, she was moving her
hands in the space as if she was pushing unseen objects away from her, and she was screaming loudly.
Her parents told you that for the previous 4 days, she was extremely sad after refusal of getting engaged to
her beloved colleague. Her parents add that for these days she was always crying, she stopped eating, she

refused sitting with them and yesterday at night, her current condition started: proper examination and
she may need toxicological assessment and other investigations

Panic attack reach its peak within 10 minutes, last for about 1 hour

Phobia: fear from object or situation

Fear from snake of lion is not a phobia

Stupor = complete cessation of whole mental and physical function in fully conscious patient

Excitement: physical and mental hyperactivity

Catatonic schizophrenia: age > 20 years, prominent feature is disorganized behavior

Disorganized schizophrenia: age 18-20 years bad prognosis

Paranoid schizo: age 30-35 years, presence of delusion and hallucination, normal cognition and affect;
persecutory, reference, grandusity

Thought disturbance in schizophrenia: thought block (stream), incoherent speech, neologism, alogia,
echolalia, concrete thinking, delusins (paranoid-somatic religious or nihilistic), thought insertion,
thought withdrawal and thought broadcasting are diagnostic

Auditory hallucinations is commonest in schizophrenia

The patient in schizophrenia: oriented but decreased attention and concentration, poor memory and
learning

Affect in schizophrenia: blunted indifference apathy incongruous anhedonia ambivalence

Behavior in schizophrenia: detached, hypo/hyper-activity, negativism, aggression (others/self)

Bipolar II: full mania alternating with major depression

Only mania is unipolar mania

Bipolar II: major depression + hypomania

In major depression: depressed mood, sad, anhedonia, diurnal rhythm (worse in morning), difficult
thinking, poverty of thought, feeling of guilt, hopelessness, delusion of guild, poverty, persecution,
nihilistic, hallucination is uncommon, impaired attention, NO (cloudy concentration, disorientation,
memory or intellectual defect) insight, retarded motor activity, lack of will power (volition), hesitating,
aggression to himself + physical manigestation

In mania: marked elation, pressure of talk, flight of ideas, self-esteem, grandiose delusion, delusion of
persecution, distractability, good memory, rare hallucination, decreased insight, spend lots of money,
irritability, wears bright clothes, motor over-activity, increased sexual desire, insomnia, neglect eating and
personal hygiene

Early insomnia in anxiety late in major depression refuse to sleep in mania

Anorexia in depression increased appetite in mania

Increased sexual desire in mania decreased in depression

Elation: happiness without cause

Euphoria: wellbeing without obvious cause

Anhedonia: loss of behavior

Incoherent speech, neologism, flight of ideas occur in mania

In mania: delusion of grandiosity

In depression: guilt nihilistic delusion

Obsession = idea compulsion= urge to do it

Hallucination: false perception without external stimulus: auditory in schizophrenia, dementia mania

Visual in delusions

Disorientation occurs in OBS (organic brain syndrome) to time, place, person

Immediate memory: 6 numbers and repeat immediately

Recent: breakfast

Remote: primary school date of revolution

Recent amnesia = dementia

Distractable attention: mania: name then comment on clothes

Inattention: days of the week backwards

Judgement

Intelligence: 100 + 15 = , + 15 etc

Apathy: loss of all sensations (experience, expression)

Indifference: loss of emotional experience)

Incongruity: disharmony between affect and though (bad news while laughing)

Ambivalence: 2 contradictory emotions to same object

Agitation: inner thought and motor activity (mania + agitated depression)

Catatonia: schizophrenia depression OBS (Rigidity stupor excitement catalepsy)

Sterotype: repeated words/actions that have no meaning

Mannerism: repeat words/actions that have meaning

Preservation: same response to different stimuli

Negativism: resist stimulus or do its opposite

Automatic obedience

Waxy flexibility

Echolalia Echopraxia

Mental block: schizophrenia anxiety

Talkative: mania

Delusion: false belief not accepted by person of same social standard: more in schizophrenia