Behavioral Dynamics Flashcards
Psychiatrist characteristics - degree, what they do?
- MD
- diagnostic evals
- psychotherapy
- med management
- speciality areas
Clinical psychologist - What do they do?
Counseling psychologist?
- PhD or PsyD
- admin and interpret psych testing
- development of prevention and tx programs
- psychotherapy
- expert testimony
- counseling psychologist: PhD - counseling, psychotherapy, assessments and consultation
Educational psychologist - what do they do?
- masters in ed. psychology
- dx and psych assessments
- counseling
- mediation, co-ordinates with and refers to other professionals
Licensed clinical professional counselor - training?
- masters training in counseling
- therapists
Psych social worker - training and work?
- masters or doctorate in social work
- mental health assessments
- case management
- group facilitators
What does counseling entail? Therapy?
- counseling: personal guidance, std psych methods - collect case history data, and test for interests and aptitudes
- therapy: relieving or curing a disability or illness
Psychotherapy - psychodynamic/psychoanalytic?
- freudian traditions: unconscious conflicts family issues from early life difficulties with current relationships - severe and chronic personality disorders - persistent problems in coping with life events - few months to a few years - rarely used today
Behavioral therapy- entails what, used for?
- reducing sxs by:
relaxation techniques
changing factors that reinforce sxs, graduated exposure to distressing stimuli - anxiety disorders, depression, psychomatic complaints - OCD, phobias
- generally brief: 6-12 sessions
- guided imagery - learning how to relax while imagining feared situation
Cognitive thinking (CBT)- what is it used for?
- assumption that negative thoughts promote anxiety or depression
- pt taught to challenge negative thoughts
- depression, anxiety, problems related to substance abuse issues
- 10-20 sessions
What is dialectical behavior therapy? used in what?
- CBT and mindfulness (in the here and now)
- acceptance and change
- 1st therapy to show positive change in borderline personality disorder
Use of group therapy?
- support group - cancer, grief
- education
- can be open ended, or time-limited
- any theoretical orientation
- personality disorders, grief work, physical health issues
Sign vs symptom?
- sign: what you see
- sx: is what pt says that they are experiencing
What is consciousness? Emotion? motor behavior?
- consciousness: awareness of self and environment, orientation to person, place and time
- emotion: psychic feeling with physiological response
- motor behavior: physical agitated (restless); motor slowed
Cognitive process of thinking?
- fomring mental images or concepts
- can be concrete or abstract
- linear, goal directed vs Tangential/flight of ideas
Perceptions?
- recognition and interpretation of sensory stimuli
- hallucinations: responding to internal stimuli
- illusion: perception from an external stimulus, usually auditory (voices on wind)
- delusion: fixed belief not basd on reality
Definition and components of intelligence?
- potential ability and capacity to: acquire retain apply: understanding knowledge reasoning judgement
Diff b/t psych and medical-surgical interview?
- rather than just trying to determine what their sxs are - find out what they are experiencing
- insight oriented instead of sx oriented
- psych interview involves:
obtaining hx, eval mental status, collecting auxillary data, summarizing principle findings, dx, making prognosis, determining tx plan
Diff methods of psych interview?
- want to make pt feel comfortable, foster trust, and develop expectation that tx will help
- reflection: pick up feeling of pt’s message and repeats it back to pt, encourages pt to clarify
- silence: giving pt time to communicate feelings
- confrontation: presenting their behaviors and apparent feelings back to them
Components of the mental status exam? appearance, behavior, speech, mood, congruency, perception?
- describe:
behavior
speech
emotions
cognition
perceptual processes - objective report
- appearance: clothes, posture, grooming, degree of alertness
- behavior: motor activity - hyper motor/slowed, impulse control, gestures, gait
- speech: volume, rate, accents, clarity
- mood: how are they feeling
- affect: what expressions you observe: lability - go from crying to laughing
stability: mood stable?
congruency: is affect congruent with what they are saying - perception: hallucinations (hearing, seeing, smelling, feeling things), illusions
MSE - thought process, thought content?
thought process: continuity - linear and goal directed or flight of ideas/loose associations
- thought content:
word usage -
neologisms: saying things that make no sense at all
approximations: dementia - can’t name a clock but can describe it
content: logical vs illogical (my body conforms to my clothes)
MSE - concentration, attention, orientation, memory, judgement?
- concentration: ability to focus
- attention: ability to sustain focus
- orientation: person, place, time, situation
- memory: remote(last to go), recent, immediate
- judgement - social situations
MSE - insight, intelligence?
- insight: complete denial
dim awareness
awareness but inappropriate blame
awareness with knowledge of internal source - intelligence: average, below average, above average - what you perceive it to be
MMSE - orientation, registration, attention and calculation, recall?
- MMSE: possible to get 30 pts, anything unde 24 - abnormal, avg for dementia is 10
- orientation - possible 10
- registration: attention and concentration - spelling backward
- attention and calculation - serial 7s backwards
- recall: immed memory: ask for 3 objects told in registration
MMSE - language, visual motor integrity, level of consciousness along continuum?
- language: 6 steps - understangin, following instructions - write a sentence, folllow commands
- visual motor integrity: copy design of intersecting shapes
- level of consciousness along a continuum
SLUMS intrument?
- dementia: orientation executive fxning - making change memory - repeat list language - name animals calculation visuoconstructive skills: draw clock
MOCA?
- Montreal cognitive assessment - rapid screening for mild cog impairment
- over 26 is normal (out of 30):
attention and concentration
executive fxning
memory
language
calculations
orientation
visuoconstructive skills
Zung self-rating depression scale?
- pt fills it out
- avg score for depression 50-69, over 69 is severe depression
Hamilton rating scale for depression?
- rating severity and progress or lack of progress, performed by health professional (psychiatric)
21 ?s - score first 17 ?s - use when pt is already dx with depression
- 0-7 WNL
- 8-19 mild depression
- over 20 moderate to severe
Beck anxiety inventory?
- pt fills this out
- 0-7 WNL
- 8-15 mild
- 16-25 mod
- 26-63 severe
Mood disorder questionnaire is used when?
- used in bipolar disorder
- answer yes to 7 or more items in question 1
- yes to 2 and 3 - positive for bipolar
DSM I?
- 1952
- diagnoses were loosely defined
- psych etiologies - depressive reaction, paranoid rxns
DSM II?
- 1968
- conformity to WHO international classification of disease
- diagnostic criteria vague and open to bias - african americans
DSM III? multiaxial diagnoses?
- 1985
explicit, readily verifiable and specific diagnostic criteria - multiaxial system of diagnoses
- diff classes of meds developed and correct diagnoses were needed to choose appropriate meds
- multiaxial diagnoses:
axis 1: chief psychiatric diagnoses
axis 2: personality disorders, intellectual disabilities
axis 3: medical
axis 4: social issues
axis 5: global assessment of fxning
DSM IV?
- 1994
- scientific evidence determined diagnostic categories
- descriptive approach
- clearly delineated, objective, verifiable criteria
- pts don’t have identical clinical characteristics
updated- IV-TR in 2000
DSM V?
- 2013
- ICD 10
- developmental and lifespan considerations: begins with early life through later life
- gender differences: express diff
- diagnoses: ex - autism spectrum disorder
- enhanced specificity: major and mild neurocog. disorders that were previously lumped under dementia
- section III - new disorders requiring further study
- online enhancements available
Psych charting components - progress note?
progress note: - Hx of current illness: reason for admission - current status - suicidal ideation? response to tx - MSE - medical status - plan
Admit note (or H&P)?
- Identifying info (age, appearance)
- HPI: suicidality?
- psych hx:
previous diagnoses
hospitalizations
professionals
meds - substance abuse hx
- past medical hx (any self harm?)
- family hx - good response to med?
- developmental/social hx:
family life: relationships, marital status
education
occupation
housing
physical, mental, emotional abuse - MSE
- plan: testing - labs, xrays, CT scans, MRI, neuro eval, referrals, meds, therapy
Everything that is included in the MSE - goes in note?
- appearance
- mood
- orientation
- intellect
- thought processes
- speech
- perceptions
- judgement
- insight
