Behavioral Dynamics Exam 1 Cards Flashcards
4 D’s of psychiatric disease
Deviance, Dysfunction, Distress, Danger
What is a Deviant Behavior?
A behavior that is extreme or unusual from social norms
What is a distressing behavior?
A behavior that is considered unpleasant and unsettling to the patient
What is a dysfunctional behavior
A behavior that interferes with the patient’s daily functioning
What is a dangerous behavior
A behavior that poses the risk of harm to self or others
Scope of practice of a Psychology PhD.
Psychologist who participates in clinical counseling and research
Scope of practice of a Psychology PhD.
Psychologist who participates in clinical counseling and research
Scope of practice of a Psy.D.
Psychologist who is closer to a physician but has limited or no prescribing ability
Scope of practice for a Psychiatrist
MD or DO who can write medication, usually in a clinical setting
Scope of practice for a Psychiatrist
MD or DO who can write medication, usually in a clinical setting
Scope of practice of a Psychiatric nurse?
Works with hospitalized psychiatric patients to improve functioning and manages various aspects of treatment
Scope of practice of Psych PA or NP
Works with supervising Psychiatrist assesing clients and prescribing meds
How prevalent is mental illness in the US
50% of adults will experience mental illness during their life, 1 in 5 experience mental illness in a given year
How prevalent is mental illness in the US
50% of adults will experience mental illness during their life, 1 in 5 experience mental illness in a given year
4 Adverse effects of poor mental health on physical health
Decreased use of medical care, Reduced adherence, Higher risks of adverse outcomes, Increased tobacco and alcohol use
2 Concerns with the DSM-V
Too subjective with not enough scientific bases, Diagnoses too closely based on social norms or cultural biases
4 Concerns with the DSM-V
Too subjective with not enough scientific bases, Diagnoses too closely based on social norms or cultural biases, supports chemical imbalance theories without strong evidence, mediation first approach to treatment encouraged
3 Elements that make a psychiatric note different from other notes
More subjectivity, Less validating criteria, Lower diagnostic reliability
4 Parts of a Psych note
General information (Name, Age, Sex, Race, Income, Address)
Chief Complaint
Historical Information (HPI, Psych, Medical, Substance Use, Family, Developmental, Educational, Vocational or Military, Sexual, Legal, Residential)
Objective exam (General, MSK/Neuro, Skin, Psych)
How is a Psychiatric evaluation different from a physical evaluation
It dives deeper into a patient’s history in an attempt to understand how their past has affected their present condition
How is a Psychiatric evaluation different from a physical evaluation
It dives deeper into a patient’s history in an attempt to understand how their past has affected their present condition
Psychodynamics
Collective aggregate of conscious and unconscious factors that influence personality, behavior and attitudes
Psychoanalysis
Method of treating mental and emotional disorders based around revealing and investigating the role of unconscious and conscious desires
Psychotherapy
Use of verbal methods to influence another person’s mental and emotional state
Psychodynamic theory views behavior as the product of a(n) _____________________ ___________________
Internal Discussion
Id
Greedy inner child that acts on primal instincts and desires. Seeks gratification and pleasure no matter the cost
Superego
Image of what one should strive to be, morals and internal conscience that is at odds with the id
Ego
Grown up self which has to balance the id and the superego. May make decisions that either cause or reduce anxiety
How the id, ego, and superego interplay with conscious and unconscious thinking
The Id is mostly subconscious while the super ego is both and the ego is mostly conscious
Mature ego defense mechanisms
Defense mechanisms that do not compromise other functioning
Primitive ego defense mechanisms
Defense mechanisms that do compromise mature functioning
3 factors that determine defense mechanism use
Psychological maturity, Developmental history, Intensity of distress or anxiety
Regression
Retreating to an earlier stage of development
Denial
Behaving as if things are different than they really are, if severe can be described as a delusion
Projection
Attributing one’s own unacceptable feelings to another person, can be used as an excuse for one’s own feelings
Intellectualization
Focusing on minor, often unimportant details of a situation rather than addressing the main central conflic
Repression
Placing disagreeable or unacceptable thoughts in the subconscious mind rather than dealing with them
Displacement
Expressing feelings or impulses toward one group or person onto another group or person that is less threatening (ie. getting made at spouse instead of boss)
Rationalization
Reinterpreting the facts/lying to ourselves
Dissociation
Disconnecting from a stressful situation by pursuing an alternate reality, lying to ourselves
Reaction Formation
A person goes into denial by acting opposite to the way that they truly feel
Suppression
Thoughts are put into the subconscious and are dealt with at a future date
Sublimation
Channeling unacceptable impulses into socially appropriate activities, allowing one to use their energy in better ways
Six expanded roles of the ego in Ego psychology
Reality testing, impulse control, Affect regulation, judgement, Synthetic functioning, defense mechanisms
Erik Erikson theory of development
8 stages of development from child to adult
Object relations psychology
Humans are shaped in relation to the significant other surrounding them; primary motivators are relationships rather than sexual or aggressive impulses
Self Psychology
The “self” is derived from their perception of their identity, personal awareness and personal experiences including self esteem
Strengths of Psychodynamic theory (3)
Focuses on how the past influences the present, Acknowledges the subconscious, Does seem to help patients
Weaknesses of Psychodynamic theory (4)
Ignores biological components, Depends on therapist interpretation, Can focus too much on the past and under emphasize the present, Not scientifically proven
Humanistic persepctive
Humans are basically good, well nurtured children with develop into emotionally healthy adults. Problems are the result of caregiver failure
Client centered therapy
Unconditional positive regard that encourages patient to generate ideas rather than decoding their mind
Behaviorist perspective
Belief that behavior is determined by the environment. People are born as a blank slate and develop as the result of external stimuli
Goal of behaviorist therapy
To alter offensive stimuli or recondition oneself to constructive behaviors
Goal of humanistic therapy
Self-Actualization
Cognitive-Behavioral Perspective
Automatic thoughts lead to irrational assumptions which shape behavior
Arbitrary Inference
Drawing unwarranted conclusions on the basis of little or no evidence
Selective abstraction
Drawing conclusions on the basis of a single piece of data while ignoring contradictory data
Personalization
Taking the blame for something that is clearly not one’s fault
Overgeneralization
Drawing a general conclusion on the basis of a single, sometimes insignificant event
Goal of CBT
To discover faulty thinking processes through a therapeutic relationship with the patient and allow them to become aware of the maladaptive cognition and change it
Maslow’s Needs
Physiological, Safety and Security, Love and Belonging, Self Esteem, Self Actualization
Classical conditioning
Conditioning as seen with Pavlov’s dogs
Unconditioned stimulus
Stimulus that produces a response without any need for conditioning
Unconditioned response
Response to unconditioned stimulus
Conditioned stimulus
Neutral stimulus that later comes to elicit a response
Conditioned response
Response to a conditioned stimulus
What determines the speed of classical conditioning?
The strength of the unconditioned response: people learn fears quickly and unlearn them slowly
Generalization of Stimuli
Similar stimuli to the conditioned stimulus also produce the conditioned response
Extinction of CR
The process of unlearning a conditioned response
Operant conditioning
Learning occurs as the result of positive or negative repercussions to our actions
4 Types of reinforcement
Positive reinforcement: Reward for good behavior
Negative reinforcement: Removal of noxious stimulus for good behavior
Punishment: Application of averse stimulus
Response cost: removal of positive stimulus for unwanted behavior
What determines time to extinction of operant conditioning
Whether it is continuous or Intermittent
Continuous reinforcement leads to more rapid extinction
Secondary reward conditioning
Instrumental behavior to get a stimulus is useless but associated with a significant stimulus
Avoidance conditioning
Response cue is instrumental in avoiding a painful or negative experience
Habituation
Decrease in response to a stimulus after constant exposure, strong stimuli result in slower habituation, some stimuli are not subject to habituation
Skoliosexual
Someone who is specifically attracted to non-gender conforming persons
Sexual Behavior
Specific actions and behaviors involving sexual activities, may or may not align with someone’s sexual identity or orientation
Gender expression
How one presents one’s gender to others
Gender discordance/dysphoria
Discrepancy between assigned biological gender and gender identity
Transgender or Transsexual
Gender discordant people who make changes to their perceived gender or anatomic sex in order to conform with their gender identity
Normal stages of sexual stimulation (4)
Desire, Excitement, Orgasm, Resolution
Sexual Arousal
Second sexual stage brought on by psychological OR physiological stimulation
Orgasm
Peaking of sexual pleasure and releasing of sexual tension involves rhythmic contraction of perineal muscles and pelvic reproductive organs increase in BP, pulse, and respiratory rate
3 Hormones that increase sexual desire
Dopamine, Testosterone, Estrogen (in women only)
2 hormones that decrease sexual desire
Serotonin and Progesterone
Normal stimuli for sexual desire in males and females
Predominantly physical for males predominantly psychologic for females
Hypoactive sexual desire disorder
Deficiency or absence of sexual fantasies or desire for sexual activity. Prevalence estimated at 20%, more common in females
Sexual aversion disorder
Characterized by an aversion to and avoidance of genital sexual contact
Treatments for Sexual desire disorders Pharm and non-Pharm
Therapy - CBT, Sex, or couples therapy
Drugs:
Serotonergic (different from SSRIs) - Flibanserin (Addyi)
Melanocortin agonists - bremelanotide (Vyleesi)
Testosterone and Estrogen
Female Sexual Arousal Disorder
Difficulty of the lubrication and swelling response of sexual excitement can occur in otherwise happy couples and may result from psychological factors
Treatment for female sexual arousal disroder (4)
Therapy for psych factors, Testosterone (10% standard dose for men, Bupropion if SSRI related, Sildenafil (Viagra)
Male Erectile Disorder
Same as erectile dysfunction, 10-20% of all men and increases with age although not universally
3 factors that play a role in halting Male ED
Available sex partner
History of consistent sexual activity
Absence of vascular disease
Assessing cause of ED
Usually more psychological with younger patients, important to not whether problems are universal or circumstantial (ie does it happen at night, etc.)
Female orgasmic disorder
A recurrent delay in or absence of orgasm after a normal sexual excitement phase, 30-35% of women
Physiologic factors that contribute to female orgasm disorder
Pelvic complaints such as Endometriosis, childbirth and atrophy of genital tissue
Insufficient Clitoral stimulation
Male orgasmic disorder
Ejaculation only achieved after great difficulty if at all, 5% prevalence. Psychological if lifelong
Treatment for male orgasmic disorder
Therapy and potentially dopamine agonsits
Premature ejaculation
Generally when a man ejaculates before or immediately after entering his partner. Second most common CC in men w/ sexual disorders
Treatment for Premature Ejaculation
May have a psych cause, May resolve on its own with the inexperienced, Squeeze technique, SSRI can be considered
Dyspareunia
Genital pain occuring in either men or women before, during or after intercourse
Vaginismus
Vaginal spasm of the distal 1/3 of the vagina that can have a physiologic cause or be the result of sexual abuse or trauma. Most common in the highly educated
Physiologic diagnostics for male ED (3)
Lab studies (glucose, A1c, hormone, liver, lipid, thyroid)
Nocturnal penile tumescence
Assessing blood flow to the pudendal artery
Affect of antipsychotics and antidepressants on sexually relevant hormones
Antipsych - reduces dopamine
Antidepressants - Increase serotonin
Anticholinergic effect of sexual activity
May result in dry mucous membranes
Hormonal medications that can interfere with sexual activity and how (2)
Contraceptives (increase estrogen, progesterone, LH)
Anti androgen therapy - Lowers testosterone (ie. spironolactone)
4 Diagnostic criteria for a Sexual Dysfunction disorder
Experience disorder 75-100% of the time
Experience for at least 6 months
Have significant distress due to disorder
Lack of alternate explanations
Persistent Genital Arousal Disorder Presentation and Treatment
Sexual arousal NOT associated with psychological desire - spontaneous, persistent, and difficult to control
Physical arousal that lasts from hours to weeks at a time
SSRI’s, psychotherapy, topical or injected anesthetic agents
4 different therapy options for treating sexual disorders
Dual sex therapy, Behavior therapy, Group therapy, Analytically oriented sex therapy
Exhibitionism
Achievement of arousal by exposing genitalia to strangers
Transvestitism
Cross-dressing in a heterosexual man - often part of masturbation foreplay
Voyerism
Attaining arousal watching an unsuspecting person or people esp. while engaged in sexual activities
Pedophilia
Use of a child to achieve sexual arousal and gratification
Incest
Sexual relationship with a member of ones immediate family - often a child
Sexual sadism
Inflicting pain upon the sexual object as a means of arousal
Sexual masochism
Erotic pleasure achieved by being humiliated, enslaved, bound or physically restrained
Fetishism
Erotic fantasies, sexual urges or behavior involving non-living objects
Frotteurism
Sexual arousal derived from touching or rubbing against a non-consenting person. Commonly done in crowded public areas
4 potential treatments for paraphilias
Behavioral therapy, SSRIs, Gonadotropin antagonists, Progesterone therapy
How should risk be related to patients in a numerical sense?
Numbers rather than percentages
Bio-Psycho-Social Model
The idea that biological, social, and psychological factors all play a role in a persons condition
5 core concepts of a patient-provider relationship
Attentiveness, Support, Partnership, Respect, Empathy
Haptics
Communication through touch
Kinesics
Nonverbal communication that involves body movement
Proxemics
Non-verbal communication through spatial relation to others (being close or far away)
Paralanguage
Nonverbal speech patterns such as pitch, tone, volume, speed, and rhythm
Autonomic Nonverbal Communication
ANS responses such as sweating that might be picked up by the patient
Safe pattern
patient’s body is relaxed and in an open position
Fight pattern
Patient’s body is engaged but has increasing tension response due to feeling unsafe
Flight pattern
Patient’s body is not engages and has increased tension - guarding or pulling away
Withdrawal pattern
Patient is not engaged, withdrawn and unable to mount a response
4 common clinical patterns
Safe, Fight, Flight, Withdrawal
Word you should avoid when talking about patient constraints
ONLY
Two approaches to agenda setting with a patient
Ask open ended questions to figure out patient priorities and create flow
Indicate time available and figure out what can be addressed and what needs to be put off
Clinician vs. Patient Centered HPI
Clinician centered - More direct/closed ended questions
Patient centered - More open ended questions - letting the patient talk
Method of patient education - Ask Ask Tell Ask
Ask for permission to explain information
Ask what the patient already knows
Customize message to level of patient understanding
Ask the patient to repeat back key elements
Medical Family Concept vs. Social Family Concept
Medical - Biological relationships
Social - People they live with/support system
Hierarchical control
Team with a pyramid like structure where there is one leader and others are in lower tiers of authority
Relationship centered teamwork
Team in which the center of authority may shift based upon the situation
Plenary discussion
Facilitator leads a discussion with opportunities for group comment
Report/Presentation Meeting
One person gives a report with an opportunity for Q&A at the end
Brainstorm meeting
Members volunteer ideas
Go-round meeting
Go around the table and let everyone speak
Heterogenous fishbowl
People representing different points of veiw participate
Homogenous fishbowl
One point of view discusses at a time
5 A intervention model
Ask
Advise
Assess
Assist
Arrange
Precontemplation stage
Stage where a person is not even considering change. May not believe change is possible because of failure or may not believe behavior is harmful
Contemplation stage
Ambivalent about change - giving up behavior makes them feel a sense of loss - I know I need to but
Preparation stage
Experiment with small changes as determination increases to change - Preparation stage
Action stage
Actively pursuing change - often patient needs support
Maintenance stage
Change becomes incorporated, patient may still need support with relapses
5 stages of change
Precontemplation
Contemplation
Preparation
Action
Maintenance
(Relapse)
Adherence
Extent to which the patients behavior correlates with agreed upon recommendations from a healthcare provider
Adherence by patients with chronic disease in developed countries
About 50%
SPIKES protocol for giving bad news
Setup, Perception, Invitation, Knowledge, Empathize, Summarize and Strategize
Death Technical definition
Irreversible cessation of vital functions OR irreversible cessation of all functions of the entire brain
Bereavement
Reaction to the loss of a close relationship
Mourning
Process by which a bereaved individual undoes bonds to the deceased and settles into their grief
Attitude towards death at 5, 5-10, and 10+
5 - Separation similar to sleep
5-10 Inevitable human mortality, fear of parents dying
10+ Realize that death can happen to them and that it is universal and irreversible
Minimum criteria for a prolonged grief disorder
At least one year has elapsed since the bereavement and grief is excessive in relation to cultural norms and give significant distress
Suicide in grief versus depression
Grief - Life is unbearable but don’t want to die
Depression - More likely to threaten suicide
