Liaison psychiatry and mood disorders

Therapy (CBT).

o This involves: identifying negative automatic thoughts (keeping a diary to

monitor them), testing and correcting automatic thoughts (real‐life

experiments), cognitive rehearsals, anticipating critical difficulties that maybe

encountered and using rehearsals to counter them. Problem solving is taught.

Behavioural techniques such as activity scheduling are done to help the client

gain mastery/pleasure from succeeding at graded tasks.

o There is evidence to show that it is as effective as antidepressants in the

treatment of mild to moderate depression and there is some evidence to

support its use even in more severe disorders.

o The effects of CBT are longer lasting than antidepressant treatment.

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I. Schizophrenia
II. Disorders related to schizophrenia
III. Mood disorders
A. Brief History1
19th Century ­ All serious mental disorders seen as expressions of a single entity
(Einheitpsychose, Griesinger) i.e. a unitary psychosis
Morel (1852) ­ proposed mental illnesses could be separated and classified, based on
cause. Described…

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Voices discussing the patient (3rd person hallucinations)
Alien thoughts
Thought insertion
Thought withdrawal
Thought broadcasting
Passivity phenomena
Made will (impulses)
Made acts
Made affect (feelings, emotions)
Somatic passivity (bodily sensation or function imposed by external
Delusional perception
Kasanin (1933) described schizoaffective disorder
Leonard (1957) ­ Separated schizophrenia from cycloid…

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Characterised by:
Difficulty in focusing attention or thinking clearly
Minor perceptual disturbances
Anxiety, depression
Perplexity, suspiciousness
`Negative' symptoms ­ reduced drive, amotivation, anergia, social withdrawal,
decline in functioning
Sleep disturbance
Reduced sense of control
Delusional mood/atmosphere
Individual delusions and hallucinations
The Acute Syndrome
Characterised by:
Delusions, variable in type and…

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The Chronic Syndrome
Characterised by:
Reduced intensity of delusions and hallucinations
Underactivity, social withdrawal, lack of drive and volition
Inappropriate dress
Neglect of appearance and self care
Deterioration of social behaviour
Thought disorder
Blunted affect
Cognitive impairment
Movement disorder
Clinical Syndromes in Schizophrenia
Factor analysis of the symptoms…

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important in introducing concepts of neurobiology in schizophrenia10
Three clinical syndromes
Liddle (1987), using factor analysis, described 3 overlapping clinical syndromes which he
linked with patterns of neuropsychological deficit and to regional cerebral blood flow (see
Table 2). The most reproducible finding relates to psychomotor poverty.
Table 2: Cerebral and…

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Cognitive deficits can be discerned from early childhood.
Impairments become more marked at time of illness and can partially resolve after
resolution of the acute episode 11
Can develop into Alzheimer's type picture in late life in minority of cases
Within the first few years of the illness, patients show…

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i. Social Factors
Social Class
Schizophrenia is overrepresented in lower social classes but is this cause (i.e. social
causation) or an effect of the illness itself (so called `downward drift'). Goldberg and
Morrison (1963) found that people with schizophrenia were of lower social class than their
fathers and they had…

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disorders in first degree relatives.
Table 3: Risk of schizophrenia in first degree relatives
Patients Increased risk in first degree relatives of patients
Schizophrenia Schizophrenia, schizo affective & Schizotypal personality
Schizophrenia & Mood disorders.
N.B: The risk of bipolar illness is not increased in the first degree…

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copy of 22q11 and leads to a range of physical abnormalities and cognitive
impairment. It is also associated with high rates of psychosis (schizophrenia like
and affective) of about 30%. This is one of the loci associated with schizophrenia and
is associated with the COMT gene (see below).
With regards…

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influenza epidemics and by case control studies. Brown et al (2004) recently showed that
serological evidence of influenza infection during early pregnancy was associated with a 7
fold increased risk of schizophrenia in the offspring but note that confidence intervals were
wide and included unity (ie. the results may be…


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