Recent Advances in the Approach to Disorders of Thought
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Neuropsychiatric Masquerades: Is It a Horse Or a Zebra NCPA Annual Conference Winston-Salem, NC October 3, 2015
Neuropsychiatric Masquerades: Is it a Horse or a Zebra NCPA Annual Conference Winston-Salem, NC October 3, 2015 Manish A. Fozdar, M.D. Triangle Forensic Neuropsychiatry, PLLC, Raleigh, NC www.BrainInjuryExpert.com Consulting Assistant Professor of Psychiatry, Duke University Medical Center, Durham, NC Adjunct Associate Professor of Psychiatry, Campbell University School of Osteopathic Medicine Disclosures • Neither I nor any member of my immediate family has a financial relationship or interest with any proprietary entity producing health care goods or services related to the content of this CME activity. • I am a non-conformist and a cynic of current medical establishment. • I am a polar opposite of being PC. No offense intended if one taken by you. Anatomy of the talk • Common types of diagnostic errors • Few case examples • Discussion of selected neuropsychiatric masquerades When you hear the hoof beats, think horses, not zebras • Most mental symptoms are caused by traditional psychiatric syndromes. • Majority of patients with medical and neurological problems will not develop psychiatric symptoms. Case • 20 y/o AA female with h/o Bipolar disorder and several psych hospitalizations. • Admitted a local psych hospital due to decompensation.. • While at psych hospital, she develops increasing confusion and ataxia. • Transferred to general med-surg hospital. • Stayed for 2 weeks. • Here is what happened…. • Psych C-L service consulted. We did the consult and followed her throughout the hospital stay. • Initial work up showed Normal MRI, but was of poor quality. EEG was normal. • She remained on the hospitalist service. 8 different hospitalists took care of her during her stay here. • Her presentation was chalked off to “her psych disorder”, “Neuroleptic Malignant syndrome” etc. -
Thoughts and Delusions of Thought Insertion
On the Architecture of Psychosis: Thoughts and Delusions of Thought Insertion A thesis submitted to the University of Manchester for the degree of Doctor of Philosophy in the Faculty of Humanities 2015 Pablo López Silva School of Social Sciences Contents ABSTRACT 5 DECLARATION 6 COPYRIGHT STATEMENT 7 ACKNOWLEDGMENTS 8 INTRODUCTION: MAPPING THE TERRAIN 10 1. WHAT ARE DELUSIONS? 11 1.1. THE TYPOLOGY PROBLEM 12 1.2. THE AETIOLOGICAL PROBLEM 17 1.2.1. BOTTOM-UP VS. TOP-DOWN APPROACHES 17 1.2.2. ENDORSEMENT VS. EXPLANATIONIST APPROACHES 19 2. ON THE HETEROGENEITY OF DELUSIONS: KEY DISTINCTIONS 20 2.1. FUNCTIONAL-ORGANIC / MOTIVATION-DEFICIT DELUSIONS 21 2.2. MONOTHEMATIC VS. POLYTHEMATIC DELUSIONS 22 2.3. CIRCUMSCRIBED VS. ELABORATED DELUSIONS 22 2.4. PRIMARY VS. SECONDARY DELUSIONS 23 2.5. BIZARRE VS. MUNDANE DELUSIONS 23 3. WHAT IS THOUGHT INSERTION? 24 3.1. THOUGHT INSERTION: MAIN SUBJECTIVE FEATURES 25 3.2. DISAGREEMENTS SURROUNDING THE SUBJECTIVE FEATURES OF THOUGHT INSERTION 29 3.3. THE DIAGNOSTIC ROLE OF THOUGHT INSERTION IN PSYCHIATRY 32 4. THE PHILOSOPHICAL RELEVANCE OF THOUGHT INSERTION: MAKING SENSE OF THE COLLECTION 35 5. REFERENCES 39 CONSCIOUS THOUGHTS AND ATTRIBUTIONS OF MENTAL AGENCY: 45 AN AFFORDANCE MODEL 45 1. FROM SELF-ATTRIBUTIONS OF BODILY MOVEMENTS TO SELF-ATTRIBUTIONS OF THOUGHTS 46 2. EXPERIENCING AND SELF-ATTRIBUTING THOUGHTS: A LAND OF DISAGREEMENTS 49 2.1. THE PHENOMENAL CHARACTER OF THOUGHTS: A LIBERAL STANCE 49 2.2. MODALITIES OF MENTAL-SELF ATTRIBUTION: SUBJECTIVITY, OWNERSHIP, AND AGENCY 50 2.3. THE PHENOMENOLOGICAL PASSIVITY OF THOUGHTS 54 3. EXPLAINING SELF-ATTRIBUTIONS OF MENTAL AGENCY 60 3.1. -
Mental Health Disorders: Strategies for Approach & Treatment
3/20/2019 Mental Health Disorders: Strategies for Approach & Treatment Transform 2019: OPTA Annual Conference Columbus, Ohio April 6th, 2019 Dawn Bookshar, PT, DPT, GCS Ian Kilbride, PT Marcia Zeiger, OTRL Objectives Participants will: • Understand the prevalence and impact of mental health disorders in client populations • Understand clinical conditions, and associated characteristics of common mental health diagnoses • Apply effective treatment approaches for clients with mental illness. • Produce effective clinical documentation to support intervention for clients with mental illness Mental Illness (MI) www.schizophrenia.com 1 3/20/2019 Mental Illness (MI) The term mental illness refers collectively to all diagnosable mental disorders defined as sustained abnormal alterations in thinking, mood, or behavior associated with distress and impaired functioning which substantially interferes with or limits one or more major life activities. National Institute of Mental Health Prevalence of MI • More than 50% will be diagnosed with a mental illness or disorder at some point in their lifetime. • 1 in 5 Americans will experience a mental illness in a given year. • 1 in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression. Centers for Disease Control & Prevention Prevalence of MI in LTC • 2/3 of people in nursing homes have a mental illness. • Nursing home residents with a primary diagnosis of mental illness range from 18.7% among those aged 65-74 years to 23.5% among those aged 85+ years. • Dementia, Alzheimer disease, and mood disorders are the most common diagnoses of mental illness in long-term care settings. Centers for Disease Control & Prevention 2 3/20/2019 Prevalence of MI in LTC Ohio • Residents with a diagnosis of schizophrenia and bipolar disorder increased from 9% to 16% between 2001 to 2016. -
The Clinical Presentation of Psychotic Disorders Bob Boland MD Slide 1
The Clinical Presentation of Psychotic Disorders Bob Boland MD Slide 1 Psychotic Disorders Slide 2 As with all the disorders, it is preferable to pick Archetype one “archetypal” disorder for the category of • Schizophrenia disorder, understand it well, and then know the others as they compare. For the psychotic disorders, the diagnosis we will concentrate on will be Schizophrenia. Slide 3 A good way to organize discussions of Phenomenology phenomenology is by using the same structure • The mental status exam as the mental status examination. – Appearance –Mood – Thought – Cognition – Judgment and Insight Clinical Presentation of Psychotic Disorders. Slide 4 Motor disturbances include disorders of Appearance mobility, activity and volition. Catatonic – Motor disturbances • Catatonia stupor is a state in which patients are •Stereotypy • Mannerisms immobile, mute, yet conscious. They exhibit – Behavioral problems •Hygiene waxy flexibility, or assumption of bizarre • Social functioning – “Soft signs” postures as most dramatic example. Catatonic excitement is uncontrolled and aimless motor activity. It is important to differentiate from substance-induced movement disorders, such as extrapyramidal symptoms and tardive dyskinesia. Slide 5 Disorders of behavior may involve Appearance deterioration of social functioning-- social • Behavioral Problems • Social functioning withdrawal, self neglect, neglect of • Other – Ex. Neuro soft signs environment (deterioration of housing, etc.), or socially inappropriate behaviors (talking to themselves in -
Understanding the Mental Status Examination with the Help of Videos
Understanding the Mental Status Examination with the help of videos Dr. Anvesh Roy Psychiatry Resident, University of Toronto Introduction • The mental status examination describes the sum total of the examiner’s observations and impressions of the psychiatric patient at the time of the interview. • Whereas the patient's history remains stable, the patient's mental status can change from day to day or hour to hour. • Even when a patient is mute, is incoherent, or refuses to answer questions, the clinician can obtain a wealth of information through careful observation. Outline for the Mental Status Examination • Appearance • Overt behavior • Attitude • Speech • Mood and affect • Thinking – a. Form – b. Content • Perceptions • Sensorium – a. Alertness – b. Orientation (person, place, time) – c. Concentration – d. Memory (immediate, recent, long term) – e. Calculations – f. Fund of knowledge – g. Abstract reasoning • Insight • Judgment Appearance • Examples of items in the appearance category include body type, posture, poise, clothes, grooming, hair, and nails. • Common terms used to describe appearance are healthy, sickly, ill at ease, looks older/younger than stated age, disheveled, childlike, and bizarre. • Signs of anxiety are noted: moist hands, perspiring forehead, tense posture and wide eyes. Appearance Example (from Psychosis video) • The pt. is a 23 y.o male who appears his age. There is poor grooming and personal hygiene evidenced by foul body odor and long unkempt hair. The pt. is wearing a worn T-Shirt with an odd symbol looking like a shield. This appears to be related to his delusions that he needs ‘antivirus’ protection from people who can access his mind. -
Formal Thought Disorder in First-Episode Psychosis
Available online at www.sciencedirect.com ScienceDirect Comprehensive Psychiatry 70 (2016) 209–215 www.elsevier.com/locate/comppsych Formal thought disorder in first-episode psychosis Ahmet Ayera, Berna Yalınçetinb, Esra Aydınlıb, Şilay Sevilmişb, Halis Ulaşc, Tolga Binbayc, ⁎ Berna Binnur Akdedeb,c, Köksal Alptekinb,c, aManisa Psychiatric Hospital, Manisa, Turkey bDepartment of Neuroscience, Dokuz Eylul University, Izmir, Turkey cDepartment of Psychiatry, Medical School of Dokuz Eylul University, Izmir, Turkey Abstract Formal thought disorder (FTD) is one of the fundamental symptom clusters of schizophrenia and it was found to be the strongest predictor determining conversion from first-episode acute transient psychotic disorder to schizophrenia. Our goal in the present study was to compare a first-episode psychosis (FEP) sample to a healthy control group in relation to subtypes of FTD. Fifty six patients aged between 15 and 45 years with FEP and forty five control subjects were included in the study. All the patients were under medication for less than six weeks or drug-naive. FTD was assessed using the Thought and Language Index (TLI), which is composed of impoverishment of thought and disorganization of thought subscales. FEP patients showed significantly higher scores on the items of poverty of speech, weakening of goal, perseveration, looseness, peculiar word use, peculiar sentence construction and peculiar logic compared to controls. Poverty of speech, perseveration and peculiar word use were the significant factors differentiating FEP patients from controls when controlling for years of education, family history of psychosis and drug abuse. © 2016 Elsevier Inc. All rights reserved. 1. Introduction Negative FTD, identified with poverty of speech and poverty in content of speech, remains stable over the course of Formal thought disorder (FTD) is one of the fundamental schizophrenia [7]. -
Ulsd730704 Td Luis Madeira.Pdf
UNIVERSIDADE DE LISBOA FACULDADE DE MEDICINA BASIC-SELF DISORDERS BEYOND SCHIZOPHRENIA: ULTRA-HIGH-RISK STATES AND PANIC DISORDER Luis António Proença Duarte Madeira Orientadores: Prof. Doutora Maria Luísa Caruana Canessa Figueira da Cruz Filipe Prof. Doutor Louis Arnorsson Sass Tese especialmente elaborada para obtenção do grau de Doutor em Medicina Especialidade em Psiquiatria e Saúde Mental 2017 A impressão desta dissertação foi aprovada pelo Conselho Científico da Faculdade de Medicina da Universidade de Lisboa em reunião de 23/11/2016 UNIVERSIDADE DE LISBOA FACULDADE DE MEDICINA BASIC-SELF DISORDERS BEYOND SCHIZOPHRENIA: ULTRA-HIGH-RISK STATES AND PANIC DISORDER Luis António Proença Duarte Madeira Orientadores: Prof. Doutora Maria Luísa Caruana Canessa Figueira da Cruz Filipe Prof. Doutor Louis Arnorsson Sass Tese especialmente elaborada para obtenção do grau de Doutor em Medicina Especialidade em Psiquiatria e Saúde Mental Juri: Presidente: Prof. Doutor José Luis Bliebernicht Ducla Soares, Prof. Catedrático em regime de tenure e Vice-Presidente do Conselho Científico da Faculdade de Medicina da Universidade de Lisboa Vogais: Prof. Doutor Carlos Manuel Moreira Mota Cardoso, Professor Catedrático da Faculdade de Psicologia e Ciências da Educação da Universidade do Porto Prof. Doutor João Eduardo Marques Teixeira, Professor Associado da Faculdade de Psicologia e Ciências da Educação da Universidade do Porto Prof. Doutor Manuel Gonçalves Pereira, Professor Auxiliar da Faculdade de Ciências Médicas da Universidade Nova de Lisboa Prof. Doutor Daniel José Branco de Sampaio, Professor Catedrático Jubilado da Faculdade de Medicina da Universidade de Lisboa Prof. Doutora Maria Luísa Caruana Canessa Figueira da Cruz Filipe, Professora Catedrática Jubilada da Faculdade de Medicina da Universidade de Lisboa (orientador) Prof. -
Chapter 4, and 2) the “Form” of Thought
Pridmore S. Download of Psychiatry, Chapter 6. Last modified: February, 2020. 1 CHAPTER 6 FORM OF THOUGHT Introduction In the psychiatric examination, two aspects of thought are considered: 1) “content” - abnormal the content of thought (delusions) is described in Chapter 4, and 2) the “form” of thought. Form means the “arrangement of parts”. When the “arrangement of the parts” of thought are out of order, the logical connections between the ideas are lost – the thought is difficult to follow. Disorder in the form of thought (or formal thought disorder – FTD) is frequently, for the sake of brevity, referred to as ‘thought disorder’. Theoretically, ‘thought disorder’ could refer to disordered content (delusions), but in practice it is generally used to refer to FTD. [For the sake of convenience, “flight of ideas” and “poverty of thought”, which strictly speaking are not disorders of connection, but disorders of speed or amount of thought, will also be described in the paragraphs of this chapter.] FTD is diagnostically significant, and detection is important. While many health and social services workers can give a good account of some aspects of the mental state of a patient, the assessment of FTD requires special training and experience. The general public may comment that the patient’s speech is “odd”, he/she is ‘difficult to follow’, or ‘gets off the track’. The form of thought is mainly assessed by examining the speech of the patient. It is necessary to take the conventions of conversation into account when examining ‘form’. In everyday conversation we tend to ignore changes of subject and direction; we pay more attention to content and ‘the bottom line’. -
Syllabus Psychiatry Clerkship
OM 7080 June 2021 Syllabus Psychiatry Clerkship Course No.: OM 7080 Course Title: Psychiatry Credit Hours: 4 weeks, 4 credit hours for each Course Director: Yadi Fernandez Sweeny, rotation Department Chair: PsyD, MS, CRNA CRNA-UCLA School of Medicine Term - Variable in OMS III academic year Level: OMS III Dates: Department of Clinical Education Contact Information POMONA CAMPUS: OREGON CAMPUS: Stephanie White, DO Derrick Sorweide, DO Assistant Dean of Clinical Education, Pomona Director of Clinical Education, Oregon Email: [email protected] Email: [email protected] Phone: (909) 469-8414 Phone: (541) 259-0243 Marisa Orser, M.Ed. Kim Ketcham Associate Director of Clinical Education Assistant Director of Clinical Education Phone: (909) 469-5253 Phone: (541) 259-0666 Students contact Rotations Department staff by Students contact Rotations Department staff by submitting a TDX ticket submitting a TDX ticket Preceptors may email: [email protected] Preceptors may email: [email protected] Educational Goal Description: The onsite and/or virtual rotation in Psychiatry will be offered during the third year and may, in rare instances, be taken later, or as an elective. Successful completion will be required for graduation with the D.O. degree. This will be a four-week onsite or online/virtual rotation during which the student will 1 OM 7080 June 2021 demonstrate and apply concepts of diagnosis and treatment to virtual patients with mental/emotional disorders. The course is intended as a practical application and demonstration of concepts cover in the first and second year courses of classroom study in Behavioral Science and Psychiatry. Purpose of the Rotation: The purpose of the clinical psychiatric rotation is to provide the student both didactic and virtual experience in the recognition and management of the patient with psychiatric illness. -
PATTERNS of LANGUAGE USE in MANIA by BESS SIRMON
PATTERNS OF LANGUAGE USE IN MANIA by BESS SIRMON FJORDBAK (Under the Direction of William A. Kretzschmar, Jr.) ABSTRACT This dissertation investigated the patterns of language use in mania using corpus linguistic methodology. The data were drawn from a collection of journals composed over a twenty eight year period by an individual diagnosed with mania, yielding a Master Corpus of 242,589 words which was subjected to an array of analyses, including comparison to patterns of ‘typical’ language use as represented in the Freiberg-Brown Corpus of American English (FROWN). The Master Corpus was also compared to a reference corpus composed of journals produced by other writers for a within-genre analysis. Multiple intra-individual analyses were conducted in order to test hypotheses concerning differences in language behavior during medicated versus unmedicated conditions, manic versus non-manic writing, and more versus less severe episodes of mania. A final analysis investigated changes in patterns of language use relative to variation in content and frequency of entries across early, middle, and late phases of a single manic episode. The data were analyzed with WordSmith Tools to determine patterns of word frequency and collocation, and for the derivation of keyness statistics between corpora. Results confirm all hypotheses, which postulated there would be significant differences between language as observed during manic episodes and the respective reference corpora, and likewise intra- individual differences in all the previously described experimental conditions. Corpus analysis showed sensitivity in detecting language behavior that correlated with the diagnosis of mania, and also the language effects of treatment with medication. According to the DSM-IV, clinical diagnosis of mania and other mental illnesses relies substantially upon the presence of anomalous patterns of language use in a constellation of psychological, emotional and behavioral manifestations. -
Identifying Schizophrenia and Bipolar Disorder from a Sea of Mimics
Identifying Schizophrenia and Bipolar Disorder from a Sea of Mimics Michael Sean Stanley, MD Assistant Professor OHSU Department of Psychiatry Identifying Schizophrenia and Bipolar Disorder from a Sea of Mimics No Disclosures. • Objectives: – Understand the clinical presentation and approach to treatment of Schizophrenia and Bipolar Disorder Psychotic disorders are: Mood Disorders are: • primarily problems of • Primarily problems of sensory processing prolonged extreme and association, not emotional tone (mood). emotion • Exhibit excessive high or • Exhibit profound low mood/motivation disconnection from from normal state sensory reality Psychosis Schizophrenia • a neurodevelopmental syndrome • associated with functional impairments Schizophrenia • no single unifying cause • emerges when environmental accelerants act upon genetic predisposition • May be at the more severely impairing end of a spectrum of disorders. + - C Positive Symptoms Negative Symptoms Cognitive Symptoms New abnormal sx Loss of normal fxn Accompany and likely - Hallucinations - Affective flattening precede +/- sx (auditory most - Anhedonia - Attentional problems commonly) - Asociality - Slower processing - Delusions - Alogia - Difficulty with - Significant planning/prob disorganization of solving thought/behavior - Memory problems May come and go A stable loss, do not Prodromal sx? fluctuate significantly once lost. May decrease to some May be responsive to Minimally responsive to degree with tx of pos sx, antipsychotic meds antipsychotic meds if at but rarely completely. -
73 the Neurological Examination Evan D
73 The Neurological Examination Evan D. Murray, MD, and Bruce H. Price, MD KEY POINTS ered most effective when the clinician has formed a hypothesis that is based on observation and history and is prepared to • Cognitive impairment, behavioral changes, and fluidly adapt both the examination and the hypothesis as new psychiatric symptoms occur frequently in association information and findings appear. A well-rehearsed examina- with neurological conditions. tion prevents omissions and ensures consistency of technique. A well-reasoned examination with an array of alternative • A well-performed mental status and neurological techniques that verify findings ensures greater accuracy and examination are essential for the identification of confidence in those findings. The complexity of planning, medical and neurological conditions that impact performing, and interpreting the neurological examination is cognition, behavior, and mood. a challenge that persists throughout the entirety of a physi- • The objective of the neurological examination is to cian’s career. verify the integrity of the central and peripheral The neurological examination is performed routinely for nervous systems and to achieve neuroanatomical most psychiatric admissions but is uncommonly performed localization of signs and symptoms. Localization is a in outpatient psychiatric settings. In some circumstances, a crucial step for the generation of a rational careful history alone may establish a neurological diagnosis; differential diagnosis. however, this is often not the case. The examination is helpful • The neurological examination can be conceived of as for corroborating the history, establishing the severity of a being conducted along a continuum of complexity condition, and directing treatment. The overall assessment that builds on information acquired during its approach should use a reproducible methodology for obtain- performance.