7153PSY Flashcards
Psychopathology
Understand and explain nature of mental disorders
Person-oriented - their experience, alongside symptomology and nosology (dx)
Normal vs abnormal
Statistical rarity
Subjective distress
Biological disadvantage
Need for treatment
Steps for differential diagnosis
- Rule out malingering and factitious disorder
- Rule out substance aetiology
- Rule out disorder due to general medical condition
- Determine specific primary disorder(s)
- Differentiate adjustment disorder from “other specified/unspecified” disorders
- Establish whether symptoms are severe enough for diagnosis
Transdiagnostic Interventions
Address multiple diagnostic problems linked by a common underlying aetiology or maintaining mechanisms
Exists for a range of psycholoigcal disorders
Increased efficiency, dissemination and applicability
Culture contributes to
prevalence of MH
aetiology and expression,
expression of distress,
diagnostic and assessment issues
coping style and help-seeking
treatment issues
Anorexia Nervosa
- persistent food intake restriction
- intense fear of weight gain
- disturbance in self-perceived weight/shape
Bulimia Nervosa
- recurrent binge-eating episodes
- recurrent compensatory behaviours to prevent weight gain
- self-evaluation unduly influenced by weight/shape
Binge eating disorder
- recurrent episodes of binge eating
First line of treatment for AN (adults)
- CBT-ED
- MANTRA (Maudsley anorexia nervosa treatment for adults)
- SSCM (specialist service clinical management)
If not possible/contra-indicated/ineffective: try one of other three or ED focused psychodynamic
First line of treatment for AN (child/young person)
Anorexia nervosa focused family therapy
If not possible/contra-indicated/ineffective: CBT-E or adolescent focused psychotherapy for AN
First line of treatment for BN (adults)
Guided self-help
If not possible/contra-indicated/ineffective: CBT-E
First line of treatment for BN (child/youth)
BN focused family therapy
If not possible/contra-indicated/ineffective: CBT-E
First line of treatment for BED (child/youth/adults)
Guided self-help
If not possible/contra-indicated/ineffective: CBT-E
Transdiagostic formulation of EDs
Over-evaluation of weight/shape/control -> strict diet -> Sig. low weight OR binge eating -> compensatory behaviour
All impacted by ecents and associated mood changes
CBT-E for EDs
- usually 20 sessions but up to 40 for low BMI
- inpatient or group
- core (psychopathology and mood intolerance) vs broad (incl. clinical perfectionism, low self-esteem, interpersonal difficulties)
- heavy behavioural focus
Contra-indications to CBT-E
compromised physical health
clinical depression
suicide risk
persistent substance misuse
major life crisis
inability to attend therapy
CBT-E phase 1
session 1-2
- therapeutic relationship
- assessment
- goals
- formulation feedback
- rationale for self-monitoring and weekly weigh ins
weeks 3-8
- in session weigh ins, setting agenda, H/W etc - goals is to educate about eating problems and establish regular eating
CBT-E phase 2
- review of progress
- obstacles
- design phase 3 (identify maintaining factors)
- decide if core or broad CBT-E
CBT-E phase 3
targeting maintaining factors
e.g 1) overevaluation of weight/shape/control
- identify overeval. and its consequences
- identify origin
- increase importance of other domains
- address shape checking, avoidance, ‘feeling fat’
- learning to control ED mindset
e.g 2) strict diet
- identify as problematic
- explore need for control
e.g 3) events, mood, eating
- proactive problem solving
- more adaptive coping to mood changes
CBT-E phase 4
Ending treatment
- address concerns abt this
- relapse prevention
- review
Personality disorders
- enduring pattern of inner experience and behaviour that deviates markedly from individual’s culture
- pervasive, inflexible
- began in adolescence or early adulthood
- stable over time
- leads to distress and/or impairment
Cluster A
- paranoid
- schizoid
-schizotypal
Odd, eccentric
Cluster B
- Antisocial
- Borderline
- Histrionic
- Narcissistic
Dramatic, irrational, erratic
Cluster C
- dependent
- avoidant
- obsessive-compulsive
Fearful, anxious
Paranoid PD
pervasive distrust and suspiciousness of others - assume others will harm/deceive/exploit you
Schizoid PD
detatchment from social interactions (social isolation)
restricted range of affect
Brief psychotic episodes (stress-related)
Schizotypal PD
discomfort with closeness, perceptual, and cognitive disturbances (odd beliefs, behaviour, speech)
Suspicious paranoid ideation
Antisocial PD
Deceit, manipulation, disregard for others rights
Borderline PD
unstable self-concept and relationships with others + impulsivity
Histrionic PD
Excessive emotionality and attention seeking
- needs to be center of attention
- sexually seductive/provocative
Aetiology: genetic, lax parenting style, parental modelling, childhood trauma
Narcissistic PD
Self-grandiose and lack of empathy, need for admiration
Obsessive-compulsive PD
Need for perfection (ego-syntonic)
Avoidant PD
Fear of rejection (social inhiition, inadequacy, fear of negative evaluation)
Comorbid: MDD, bipolar, anxiety (SAD), dependent, borderline PD
Differentials: SAD, agoraphobia, other PDs, substance use
Dependent PD
Need for others - to be taken care of (submissive/clingy)
Aetiology: early anxiety experiences and modelling
Differentials: dependency due to panic/agoraphobia, borderline, histrionic, avoidant
Assessment for PD
Clinical interview: thorough developmental and interpersonal history, history of mental health, MSE
Collateral information (informants)
Self report measures (e.g., PAI)
Conceptualisation
Attachment theory
CBT
Psychodynamic
DBT
