A guide to success in MBBS study!
Self-written notes based on lecture notes and Uptodate.
The notes cover all materials medical student need to know about psychiatry before they graduate. Detailed coverage on common psychiatric diseases (signs and symptoms, investigations, treatment, pharmacology...
, Psychiatric Block
Mental state examination (MSE)
I. Mental state examination (MSE) (Mnemonics: ASEPTICE)
MSE Description
Appearance General appearance
and behavior • Apparent age
• Personal hygiene (Hairstyle/ Nails/ Dental care)
• Dressing
o Evidence of self-neglect (Unkempt): Alcoholism/ Drug abuse/
Depression/ Dementia/ Schizophrenia
o Inappropriateness: Dementia/ Schizophrenia
o Brightly dressed: Mania
o Dark-colored clothes: Depression
• Body build
o Weight loss or gain: Depression/ Anxiety/ Eating disorders
• Tattoos/ Scars/ Needle injection sites
Facial expression
• Flattened or blunted facial expression
• Eye contact: Good/ Fleeting/ Avoided/ Poor/ Absence/ Looking to ground
• Corrugated forehead: Depression
• Raised eyebrow/ Dilated pupils/ Sweaty forehead: Anxiety disorders
• Wooden: Parkinsonism/ Psuedoparkinsonism
Movements and postures
• Tics/ Twitches/ Gestures/ Stereotypic behaviors/ Dyskinesia
• Stooped and downcast gaze: Depression
• Sit on edge of seat with upright position: Anxiety disorders
Behavior
• Attitude towards examiner: Cooperative/ Friendly/ Attentive/ Frank/
Defensive/ Perplexed/ Apathetic/ Hostile/ Evasive/ Guarded
• Disinhibition: Mania/ Frontal lobe dementia
• Restlessness: ADHD/ Mania/ Schizophrenia/ Akathisia/ Delirium
• Psychomotor retardation: Depression
Speech and Character: Rate/ Volume/ Amount/ Tone/ Articulation/ Spontaneity
language Fluency: Listen to patient’s spontaneous speech
Content: Coherence/ Relevance/ Language errors including neologism
Repetition: Repeat phrases of increasing complexity such as “no ifs, and or buts”
Naming: Name real or pictorial objects
Comprehension: Give sequence of commands such as “close your eyes”
Reading: Read aloud from newspaper or from a list of single words
Writing: Write a sentence spontaneously
Emotions Mood = Pervasive and sustained emotion that colors the individual’s perception of
world
• Euthymic/ Euphoric/ Elated/ Depressed/ Anxious/ Irritable/ Flat/ Tearful
• Fluctuations: Labiality
Affect = Individual’s present emotional responsiveness
• Range: Normal/ Restricted/ Blunted/ Flattened
• Congruence: Incongruity
o Example: Giggling when talking about father’s death which may be
signs of schizophrenia, mania or attempt to hide embarrassment
4
,Perception Hallucinations (幻覺) = Perception without external stimuli
• Auditory/ Visual/ Olfactory/ Gustatory/ Tactile or somatic
• Circumstance: Hypnagogic/ Hypnopompic
Auditory hallucination (AH)
• Elementary: Simple sounds such as phone ringing or door knocking
• Complex: Human voices/ Musical
• Single/ Multiple/ Identity of voices
• 2nd or 3rd person/ Running commentary/ Thought echo/ Commands
• Content of voices: Derogatory/ Threatening/ Pleasant/ Neutral
• Response to voices: Distress/ Frightened/ Following commands/ Resisting/
Planning revenge or action against targets
Thoughts Contents of thought
• Delusions (妄想)
• Obsessions
• Overvalued ideas
Forms of thought
• Flight of ideas: Unable to catch up with logical sequence
• Loosening of association: Breakdown of logical link
• Derailment: Sudden slip and go off track
• Circumstantial thinking: Give answers by wandering around
• Tangential thinking: Understandable sentence but cannot reach the point
• Word salad: Different terms are put together
• Neologisms: Make up new words or use words in a strange way
Stream of thoughts
• Thought block
• Pressure of speech
• Poverty of speech
Possession of thoughts
• Thought insertion
• Thought withdrawal
• Thought broadcasting
Insights Insights = Degree of awareness and understanding of illness (Fair/ Poor)
• Awareness of illness
• Correct labelling of symptoms
• Attribution of symptoms to mental illness
• Perceived treatment as necessary and beneficial or not
• Willingness to receive and maintain continuous treatment
Judgments
• Social judgment
o Example: What to do if he smelled smoke in a cinema?
o Example: How would you handle household emergency?
Cognition Alertness and level of consciousness (GCS)
Orientation (Time/ Place/ Person)
Memory
Concentration/ Attention
Executive Motor programming
functioning Mental flexibility
Abstract thinking
• Ability to deal with concepts and interpret similarities and differences
5
, Mini mental state examination (MMSE)
Assessment Questions Points
Orientation Q: 依家係乜野日子? (年份)、(季節)、(月份)、(幾號)、(星期幾) 5
Q: What is the date? (year)/ (season)/ (month)/ (day)/ (date)
Q: 我地依家係邊度? (九龍/新界/香港)、(九龍/新界/香港既邊區) 、(邊條 5
街/邊個屋村)、 (中心名字)、(邊層樓)
Q: Where are we: (state)(county)(town)(hospital)(floor)
Registration Q: 依家我會講三樣野既名，講完之後，請你重複一次。 請記住佢地，因 3
為幾分鐘後，我會叫你再講番俾我聽。 ［蘋果］、［報紙］、［火
車］。依家請你講番呢三樣野俾我聽。 （以第一次講的計分，一個一
分；然後重複物件，直至全部三樣都 記得住）
Q: Name three objects: Ask the patient all three after you have said them. Give
one point for each correct answer. Then repeat them until he/she learns all
three. Count trials and record. The first repetition determines the score, but if
the patient cannot learn the words after six trials then recall cannot be
meaningfully tested.
Attention and Q: 請你用一百減七，然後再減七，一路減落去，直至我叫你停為止。 5
calculation (減五次後便停) （ ）（ ）（ ）（ ）（ ） 或
Q: 依家我讀幾個數目俾你聽，請你倒轉頭講番出黎。 ［4 2 7 3 1］
Q: Serial 7s, beginning with 100 and counting backward: one point for each
correct; stop after five answers (OR)
Q: Spell WORLD backwards: one point for each letter in correct order.
Maximum score - 5 points
Recall Q: 我頭先叫你記住既三樣野係乜野呀? 3
Q: Ask for the three objects repeated above: one point for each correct
Language Q: 哩樣係乜野？ (鉛筆) (手錶) 2
(Naming) Q: Show and ask patient to name a pencil and wrist watch
Language Q: 請你跟我講呢句話。 (姨丈買魚腸) 1
(Repetition) Q: Repeat the following, "No ifs, ands, or buts." Allow only one trial
Language Q: 依家檯上面有一張紙，用你既右手拿起張紙，用兩隻手一齊將張紙 摺 3
(3-stage 成一半，然後放番張紙係檯上面。
command) Q: Follow a three stage command, "Take a paper in your right hand, fold it in
half, and put it on the floor." Score one point for each task executed
Language Q: 請讀出哩張紙上面既字［拍手］，然後照住去做 1
(Reading) Q: On a blank piece of paper write "clap your hands;" ask the patient to read
and do what it says
Language Q: 請你寫任何一句完整既句子俾我。如:［我係一個人］、［今日天氣好 1
(Writing) 好］
Q: Give the patient a blank piece of paper and ask him/her to write a sentence.
The sentence must contain a noun and verb and be sensible
Constructional Q: 哩處有幅圖［相交五角形］，請你照住呢畫啦 1
praxis Q: Ask the patient to copy a design (intersecting pentagons). All 10 angles
must be present and two must intersect
Interpretation of MMSE
• 24 – 30: Normal
• 21 – 23: Mild dementia
• 10 – 20: Moderate dementia
• 0 – 9: Severe dementia
6
, Psychiatry 01: Psychopathology
I. Psychopathology
1. General features
Study of symptoms (abnormal states of mind)
Systemic study of abnormal experience, cognition and behavior
3 Types of psychopathology
(1) Descriptive psychopathology
• 2 main components: Observation + Empathic assessment of subjective experience
• Precise description and categorization of abnormal experiences as recounted by
patients or observed in their behaviors
• Objective description of abnormal states of mind
o Avoidance of pre-conceived ideas or theories
(2) Psychodynamic psychopathology
(3) Experimental psychopathology
• Put forward hypothesis or mechanism to bridge symptoms and underlying cognitive
processes
2. Importance of psychopathology
Unit of analysis in clinical interview and mental state examination
“Language” coding for the abnormalities of mind manifesting via subjective experience or
behaviors
3. Elements of psychopathology
Form VS Content of symptoms
• Form is the description of its structure in phenomenological term
o Example: Delusion/ Hallucination
• Content is the description of experience so physicians can identify the form
o Example: Being pinpointed by classmates
Primary VS Secondary symptoms
• Temporal
o Auditory hallucination leads to subsequent persecutory delusion
• Causal
Normal VS Abnormal
• Statistical (Normal distribution)
• Cultural or social standard
Significance of individual symptoms
• Key symptoms defining specific syndrome
• Example
o Depressed mood is key defining feature of depressive disorder
o First rank symptoms** are specific features for diagnosing schizophrenia
Cultural variations
• Content of delusions derived from cultural and ethnic background
• Example: Possessed by evil spirits
7
,II. Disorders of mood (Mood disorders)
1. General features
Nature
• Depressed
• Anxiety
• Elation
o Key sign of mania
• Irritability
Variation
• Increased range of variation: Labile mood as in mania
• Extreme range of variation: Emotional incontinence
• Blunted affection: Lack of emotional sensitivity
• Flattening of affection: Reduced range of emotion
• Apathy: Absence of variation of emotion
• Anhedonia: Loss of ability to experience pleasure as in depression
Congruity
• Whether mood is consistent with person’s circumstance and thoughts
• Incongruous affection
o Feature of schizophrenia
o Example: Patient laughed when talking about husband’s death
2. Anxiety
Psychological component
• Apprehension and worries
• Free-floating anxiety in GAD
Somatic component
• Muscle tension
• ↑ Respiratory rate
Autonomic component
• Palpitation
• Dry mouth
• ↑ Sweating
Avoidance of danger (phobia)
• Social phobia refers to phobia about social situations
• Agoraphobia refers to phobia towards a particular condition or situation
o Example: Crowded places in bus or supermarket
• Specific phobia including claustrophobia and acrophobia
o Example: Claustrophobia in MRI scan
• PTSD with avoidance of reminders of event
o Example: Road traffic accident
8
,III. Disorders of perception
1. General features
Process of being aware of what is presented via sense organs
Perception can be attended to or ignored but cannot be terminated by an effort of will
Abnormal perception
• Sensory distortion
o Heightened intensity (Hyperacusis)
o Objects appear smaller than real size (Micropsia)
• Illusion
o Misperception of external stimuli
• Hallucination
• Pseudo-hallucination
2. Hallucination
Definition
• Perception without external stimulus to the corresponding sense organs (3 requirements)
o Quality of perception is real as perceived by the person
o Perception is originated from external environment
o Unable to stop or initiate the perception
• Does NOT equate imaginary which is under full control
Characteristics
• Healthy people can experience hallucination occasionally and is benign as long as it is not
frequent and not debilitating
• Hallucination can occur after sensory deprivation such as blindness and deafness
Types of sense organs
• Auditory: Musical hallucination
• Visual: Charles Bonnet Syndrome
• Tactile: Insect crawling under skin in formication (formite) in cocaine intoxication
• Olfactory: Rubber burning smell in temporal lobe epilepsy (TLE)
Elementary and complex hallucination
• Elementary (e.g. AH)
o Example: Banging sounds/ Noises
• Complex (e.g. AH)
o Example: Verbal/ Conversation/ Musical
Auditory verbal hallucination (AVH)
• Signs and symptoms (** = First rank symptoms)
o 2nd or 3rd person** (You/ he/ she)
o Thought echo** (Repetition of your thoughts by voices)
o Running commentary** (Commentary of your actions by voices)
o Discussing among themselves or conversing with each other
o Commands (Obeying commands from voices)
o Derogatory (貶低性) (Being insulted by voices)
• Neural networks
o Internal monitoring: SMA/ Dorsal lateral prefrontal cortex (DLPFC)
o Language area: Broca’s area/ Wernicke’s area/ Arcuate fasciculus/ Bilateral
temporal lobe/ Inferior parietal lobe/ Second-stage auditory area
o Limbic system: Anterior cingulate cortex (ACC)/ Insula/ Hippocampus/
Parahippocampus
9
,IV. Disorders of thinking
1. General features (** = First rank symptoms)
Kinds of thought (i.e. content)
• Delusions
• Obsessions
• Over-valued ideas
Form of thoughts
• Flight of ideas (unable to catch up with logical sequence)
• Loosening of association (breakdown of logical link)
• Word salad (different terms are put together)
• Circumstantial thinking (gives answer after wandering around unrelated stuff)
• Tangential thinking (understandable in each sentence but cannot reach the point)
• Neologisms (make up new words or use existing words in a strange way)
• Derailment (sudden slip and go off track, back to the point but slip again)
Stream of thoughts
• Thought block
• Pressure of speech (keeps talking)
• Poverty of speech (no idea)
• Preservation
Possession of thoughts
• Thought insertion**
• Thought withdrawal**
• Thought broadcasting**
2. Delusions (妄想)
Definition
• Ideas and belief that is firmly held on inadequate ground
o NOT affected by rational argument or evidence to the contrary
o NOT a conventional belief that the person is expected to hold given his
educational and cultural background (e.g. Religion/ Political dogma/ Tradition
scientific theory)
Dimension of delusion
• Degree of conviction (信念)
o Partial delusion or decreasing intensity of delusion under anti-psychotic treatment
• Emotional distress
o Persecutory delusion (被逼害妄想) leading to agitation and distress
• Preoccupation
o Keep thinking over the delusion over and over again
• Acting-out
o Low risk of acting-out in persecutory delusion such as taking revenge
• Pervasiveness (普遍性)
o Whether the delusion apply to any other circumstances
o Narrow or wide network of delusions
• Systematization
o Whether delusions have close associations such as being prosecuted by neighbors,
colleagues or family members
• Encapsulation
o Delusion is confined to a particular topic
o Normal functioning unless being touched upon on the delusion theme
• Bizarreness
o Delusion are not understandable
• Functional level
o Delusion affect daily functioning
10
, Primary and secondary delusion
• Primary delusion (Not occurring due to other psychopathological form such as
hallucination)
o Delusional perception**
o Delusional intuition
o Delusional atmosphere (mood)
o Delusional memory
• Secondary delusion (Attributable to present circumstance)
o Delusion due to auditory hallucination
Content of delusion
• Persecutory delusion
• Referential delusion
o Pick up signs from others and believe the signs are referring to him or herself
• Delusion of control** (Passivity)
o Example: Believe the action that he is undertaking is not initiated by himself
• Thought alienation**
o Believe the thought does not belong to him or her
o Thought insertion: External agency insert idea into his or her mind
o Thought withdrawal: Someone take away his belief
o Thought broadcasting: Believe his thought is conveyed to public via media
• Grandiose (雄偉) delusion
o Associated with capability or identify
o Example: Believe he or she is on the top of the world
• Delusion of infidelity or jealousy
o Example: Believe his wife is having external affairs
• Delusion of love or erotomanic delusion
o Example: Believe that someone is deeply falling in love with him or her
• Delusion of poverty or guilt
o Associated with depression
o Example: Believe he or she is poor and become guilty by it
• Nihilistic delusion (Cotard’s syndrome)
o Example: Believe internal organs are dead or decayed
• Hypochondriacal delusion
o Example: Believe he or she has a medical condition or disease
• Dysmorphophobic delusion
o Example: Believe his or her appearance has deformity or abnormality
• Delusion of misidentification (Capgras & Fregoli delusion)
o Example: Misidentify someone else
• Shared delusion
o Example: A dominant person influences the follower with his or her delusion due
to close relationships
11
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller carlcarl546. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $24.49. You're not tied to anything after your purchase.
