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mind brain behaviour 2 > CLINICAL > Flashcards

CLINICAL Flashcards

1
Q

mental health

A

State of well-being in which the individual realises his/her own abilities CAN cope with the normal stresses of life, and is able to make a CONTRIBUTION to his/her community.

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2
Q

mental illness

A

A clinically diagnosable disorder that SIGNIFICANTLY INTERFERES with an individual’s cognitive, emotional or social abilities.

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3
Q

mental disorder

A

clinically significant experience that is definable (diagnosable) within an established classification system, that cognition, emotion and behaviour are impact, and that these impacts are likely to result in impairments in functioning across numerous areas of life.

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4
Q

not mental disorder

A

An expectable / culturally approved response to a common stressor/loss,

(eg: death of loved one, is NOT a mental disorder)

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5
Q

ADS of CATEGORICAL classification system

A
  • simple YES vs NO
  • Better CLINICAL & ADMIN utility - -> clinicians often required to make dichotomous decisions. (yes/no, female/male)
  • Easier communication
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6
Q

ADS of DIMENSIONAL classification system

A
  • Closely model interpersonal differences w/o cut-offs (boundaries)
  • Greater capacity to detect change, facilitate monitoring
  • Can develop treatment-relevant symptom targets—
    not simply aiming at resolution of disorder as most
    treatments actually target symptoms, not disorders.
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7
Q

Why Diagnose / Classify Mental Health Issues?

A

CRECI !!

  1. Communication = among clinicians, btwn science and practice
  2. Clinical = facilitate identification of treatment, and prevention of mental disorders, descriptive of experience, possible etiology and prognosis.
  3. Research = test treatment efficacy and understand etiology (causes)
  4. Education: teach psychopathology (study of mental illness / disorders)
  5. Information Management: measure & pay for care
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8
Q

DSM-5 Diagnostic Groupings EXAMPLES

A

eg:
- Schizophrenia spectrum and
other psychotic disorders
- Depressive disorders
- Anxiety disorders
- Dissociative disorders
- Personality disorders

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9
Q

DSM-5 – > Diagnosis based on:

A

CCDT !!
- Clinical Interview
- Clinician assessment
- Diagnostic criteria.
- Text descriptions
- Currently presenting symptoms & severity ( Rule out disorder due to general medical condition + substance)

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10
Q

DSM-5 Diagnosis – > 3 EXCLUSION criteria

A
  • Currently presenting symptoms & severity (e.g. depressed mood)
  • Rule out disorder due to general medical condition (e.g. due to hypothyroidism - inactive thyroid, unusual hormonal symptoms)
  • Rule out disorder due to direct effects of a substance (e.g.
    alcohol induced)
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11
Q

DSM-5 Diagnostic Approach

A
  1. Establish boundary with no MD:
    - Clinical Significance vs Cultural Sanction — E.g bereavement
    (loss) vs clinically significant depression
  2. Determine specific primary disorder(s)
    - Multiple diagnoses possible
  3. Add subtypes / specifiers
    - severity (mild, moderate, severe – w or w/o psychotic features)
    - treatment relevant (w or w/o knowing of having disorders)
    - longitudinal course (ongoing? seasonal?)
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12
Q

Freudian Paradigm

A

The Freudian paradigm focusses on subconscious processes and posits that obtaining awareness of maladaptive motivations through psychoanalysis is central to recovery

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13
Q

Behavioural Paradigm

A

to interrupt and/or change
stimulus-response associations. (eg: using mices)

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14
Q

Cognitive Paradigm

A

focus on thinking/thoughts & internal mental processes.

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15
Q

Biopsychosocial Paradigm

A

Biopsychosocial approaches to understanding
mental disorder integrates A RANGE of FACTORS:

  • BIOLOGICAL: normal biology, disease processes & genetic influences
  • PSYCHOLOGICAL: thoughts, feelings & perceptions
  • SOCIAL/ENVIRONMENT - culture, ethnicity, social environment
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16
Q

Transdiagnostic model

A

Recognition of shared aetiological (causes of disease/condition) and maintenance factors;
- May explain high levels of comorbidity (2 or more disorders at the same time) between disorders - (eg: anxiety and depressive disorders)

  • May provide explanations on why diagnostic specific therapies are not effective for all clients
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17
Q

Transdiagnostic model EXAMPLES

A
  • repetitive -ve automatic thoughts –> anxiety/depression;
  • perfectionism –> depression, anxiety, eating
    disorders and some personality disorders
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18
Q

Hierarchical Taxonomy of Psychopathology

A

An innovative dimensional approach to classification

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19
Q

Anti-Psychiatry Movement

A

Perspectives include:

-Disorders are not real. A creation to justify inappropriately pathologizing, coercive and harmful treatment practices.

-Maintain wealth and power of institutions.

-Enforcement of cultural norms.
Systematically disempowering for people with lived experience

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20
Q

Findings of Dunedin Cohort study findings

A

The majority (86%) of people are likely to have met criteria for AT LEAST one psychological disorder by the time they reach middle age

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21
Q

Origin of “Stigma”

A

originated w ancient Greeks, who physically branded criminals, slaves or traitors in order that they may be identified as undesirable and avoided

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22
Q

Public stigma

A

stigma exhibited by the public towards those with a mental disorder

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23
Q

3 ways “Public Stigma” manifests in:

A
  1. STEREOTYPED attitudes & beliefs. (e.g. someone is ‘less than’ – manifest thru devaluing language)
  2. PREJUDICIAL (detrimental) affective responses
    (e.g. fear.)
  3. DISCRIMINATORY behaviours
    (e.g. avoidance of interaction / social exclusion)
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24
Q

Structural Stigma

A

ingrained stigma manifested at
the societal level (gov, religious, and private)

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25
Q

Ways in which Structural Stigma Manifest

A
  • thru policies, laws, and prescribed ideologies that restrict opportunities for particular groups (minorities)
  • varies considerably across societies, time, and topics.
  • applies to mental illness but also extends beyond it to other issues. (eg: HIV-AIDS in the 1980’s)
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26
Q

Attribution questionnaire

A

A measure of stereotyped beliefs & prejudicial (harmful) emotional responses to a person living with mental
illness

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27
Q

6 factors of Attribution questionnaire

A
  • Fear / Dangerousness
    – Help / Interact
    – Responsibility
    – Forcing Treatment
    – Empathy
    – Negative Emotion
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28
Q

Social Distance Scale (link, 1987)

A

Measures of stigma in terms of
willingness to interact w another
person in settings of varying intimacy
and social context.

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29
Q

Jorm and Wright (2008)

A

Social Distance Scale adapted for YOUTH.

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30
Q

Perceived stigma

A

individuals’ awareness & perception of public stigmatised stereotypes, prejudicial (harmful) emotions, discriminatory behaviours/practices, and/or stigmatised
structural practices.

  • experienced by public living either w or w/o mental illness
  • Individuals with mental illness are reported to show higher levels of perceived stigma than those unaffected by mental illness.
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31
Q

Experienced stigma

A

the experience of having been the target of expressed -ve stereotypes, prejudices and manifest discrimination related to one’s mental ill-health

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32
Q

Characteristics of “Experienced Stigma”

A
  • May occur in subtle terms such as chronic (long-term) exposure to commonplace stigmatising
    people with mental ill-health (eg: in mass media, or past experiences of being denied of housing /
    employment cuz of their mental ill-health
  • can contribute to withdrawal from future opportunities and shares a relationship with the anticipation of stigma
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33
Q

Anticipated stigma

A

the extent to which individuals
living with mental ill-health expect to experience stereotyping, prejudice, and discrimination in the future because of their mental health status

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34
Q

Characteristics of “Anticipated Stigma”

A
  • an awareness of public & structural stigma, and how this affects people living with mental ill-health in contexts that are relevant to the self
  • commonly results in withdrawal fr opportunities for ppl living with mental ill-health
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35
Q

Corrigan’s model of Self Stigma (4 stages of internalizing stereotypes of mental illness)

A
  • stereotype awareness,
  • personal agreement,
  • self-concurrence ([I have a mental illness, so I am… (e.g., dangerous)],
  • harm to self
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36
Q

contact-based intervention

A

Designed to reduce stigma typically involving being in contact with someone with mental
illness. Positive for both parties and particularly effective for addressing stigma in adulthood

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37
Q

psychoeducation

A

Designed to reduce stigma by being educated about mental illness

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38
Q

How does the wrong type of psychoeducation lead to an increase in stigma?

A
  • Psychosocial explanation: leads to increased blame.
  • Biomedical explanation: leads to increased perception of uncontrollability and immutability
39
Q

Stereotyping about mental illness / specific mental disorders is a process involving…

A

A process of making RAPID social attributions about people showing signals of mental illness based on LIMITED
information

40
Q

The National Stigma Report Card investigated the experience of stigma and discrimination for Australians living with complex mental illnesses. In which of the 14 life areas investigated was the highest levels of stigma and discrimination observed?

A

RELATIONSHIPS were identified as the key problem area, with 95.6% of the sample reporting having experiences stigma and discrimination in the previous 12 months.

41
Q

The concept of social distancing from someone with lived experience of mental illness involves…

A

Limiting the degree of intimacy with another person we are willing to accept - a form of social discrimination

42
Q

Depression

A

A prolonged feeling of helplessness, hopelessness, and sadness

43
Q

Mood

A

A person’s SUSTAINED experience of
emotion

44
Q

Affect

A

Immediate experience and expression of emotion

45
Q

Mood Disorders

A

Involves a depression / elevation of mood as the primary disturbance. (m they’re v sensitive)

46
Q

Unipolar vs. Bipolar

A

Unipolar (one extreme) : normal and depressed
Bipolar: manic, depressed, a little time spent in normal

47
Q

DSM-5 Major Depressive Episode CRITERIA

A

(5 or more symptoms present for ≥ 2 weeks)

Appearance:
- Depressed mood
- Anhedonia (lack of pleasure)
- ↓/↑ appetite or sleep

Emotional:
- Fatugue
- ↓ concentration
- suicidal thoughts
- hopelessness

48
Q

DSM-5 Major Depressive Episode SPECIFIERS (extension to criteria)

A
  • Psychotic features (mood congruent or mood incongruent)
  • Melancholic features
  • Catatonic features (can’t move)
    *Postpartum onset
    *Anxious distress
    *Seasonal pattern (Seasonal Affective Disorder [SAD] or winter depression)
49
Q

DSM-5 Major Depressive DISORDER Criteria

A
  • Presence of a major depressive episode
  • Episode not better explained by another diagnosis
  • NO HISTORY of mania, hypomania, or mixed episode (unless substance or medical illness related)
50
Q

Epidemiology

A

The study of the distribution of mental or physical disorders in a population:
- Females ↑ risks than Males
- more prevalent at younger ages
- 20-25% of ppl w major comorbidity (Diabetes, cancer, cardiovascular disease) ↑ risks of major depressive disorder
- often comorbid (1 or more) w anxiety

51
Q

Panic disorder

A

RECURRENT !! UNEXPECTED !! panic attacks and for a 1-month period or more of:
- PERSISTENT worry about having PERSISTENT attacks
- Worry about the implications of the attacks
- Significant CHANGE in BEHAVIOUR because of the attacks

52
Q

DSM-5 Panic Attack Criteria

A

Abrupt (peak within 10 min)
At least 4 of these symptoms:
1. Palpitations
2. Sweating.
3. Trembling or shaking.
4. Shortness of breath
5. Feelings of choking
6. Chest pain
7. Nausea
8. Feeling dizzy
9. Chills or heat sensations.
10. Numbness or tingling sensations.
11. Derealization or depersonalization
12. Fear of losing control or “going crazy.”
13. Fear of dying

53
Q

Panic disorder epidemiology of general population

A
  • 1-3% of general population;
  • 5-10% of primary care patients
  • Onset in teens/early 20’s
  • ↑ risks in females
54
Q

Panic disorder epidemiology of people w panic disorder

A
  • 30-50% people affected will have agoraphobia (fear of leaving safe space)
  • 50-60% would develop lifetime major depression (1/3 current depression)
  • 25% have history of substance dependence
55
Q

Generalized Anxiety Disorder (GAD)

A

experience of anxiety of worry that maps onto a range of things in general life

56
Q

People living with GAD experience:

A

EXCESSIVE worry more than
- 6 months
- about a number of events
- DIFF to control the worry.

3 or more of the following symptoms:
- restlessness
- easily fatigued
- difficulty concentrating
- irritable
- muscle tension
- sleep disturbance

57
Q

GAD Epidemiology

A
  • 4-7% of general population
  • onset in childhood or adolescence
  • ↑ risks in females
58
Q

Generalized Anxiety DisorderCo-Morbidity

A
  • 90% of people with GAD have at least one other lifetime disorder at the same time (panic disorder/depression)
  • 66% have another current disorder
  • Worse prognosis (prediction of improv) over 5 years than panic disorder.
59
Q

The Tripartite Model of Depression and Anxiety (Clark & Watson, 1991)

A

-There are underlying latent commonalities to both anxiety and depression:
- Common in both = negative affect (emotions)
- Typically for anxiety = Anxious arousal
- Typically for depression = ↓ +ve affect (emotions)

60
Q

Biopsychosocial approach

A

An integrated approach that incorporates biological, psychological, and social-cultural levels of analysis

61
Q

Behavioural Model of Depression

A

a viscous cycle:

when we’re depressed –> ↓ rates of behaviour –> ↓ opportunity for reinforcement –> don’t get enforced
–> show less behaviour

62
Q

Beck’s Cognitive Model of Depression

A

–> impacts of SCHEMAS & NEGATIVE EVENTS in governing future responses, leading to negative automatic thoughts.

  • Schema = when we’re young, we develop ways of thinking based on beliefs, rules and assumptions
  • Negative events establish negative
    schemas
  • Activation of -ve schemas leads to -ve automatic thoughts (NATs) –> depression
63
Q

Beck’s ABC Cognitive Model of Emotion and Behaviour

A

A= Activating Event
B= Belief
C= Consequence
(Feelings, Behaviour performed)

64
Q

Euthymia (unipolar vs bipolar graph)

A

Euthymia is a state involving NO mood disruption. The state involves feelings of calm, contentment, and moderate levels of happiness and positive emotion.

65
Q

Anhedonia

A

↓ ability to experience pleasure fr activities & experiences.

66
Q

According to the Hi-TOP model of psychopathology, anxiety and depressive disorders have what in common?

A

Internalisation of stress and psychological problems

67
Q

Avolition

A

total LACK OF MOTIVATION that makes it hard to get anything done

68
Q

Psychosis

A

out of touch with reality

  • variety of clusters of symptoms (NOT ONLY in schizophrenia spectrum disorders, but also in a range of disorders (eg: dementia/substance used))
69
Q

Psychosis at disorder level

A

a group of disorders distinguished from one another in terms of:

  • symptom configuration (non-bizarre /bizarre delusion)
  • duration (< or > 6 months)
  • relative pervasiveness - (duration & clinical picture of psychotic vs affective (impactful) symptoms).
    Which is the core?
70
Q

+ve symptoms of Psychosis

A
  • hallucinations
  • delusions
71
Q

-ve symptoms of Psychosis

A
  • Avolition
  • Alogia (cognitive impairments that are observable through speech)
  • Anhedonia
  • Affective flattening (dull emotions)
  • Inattention
72
Q

Schizophrenia

A

“split mindedness”

  • involves DISRUPTION in VARIOUS ASPECTS of perceiving, thinking, feeling and behaviour.
  • classified into 2 major groups of symptoms (+ve and -ve symptoms)
73
Q

DSM-5 Schizophrenia Diagnostic Criteria

A
  1. two or more of the following AND SIGNIFICANT in a 1-month period:
    - Delusion
    - Hallucination
    - Disorganized speech
    - disorganized or catatonic (abnormal movements, immobility, abnormal behaviors, and withdrawal) behaviour
    - negative symptoms
  2. For a significant proportion of time since onset, disturbance in FUNCTIONING (self-care, interpersonal, work etc).

C. Continuous signs of disturbance for at least 6 months, w at least 1 month of active symptoms

D. Schizoaffective disorder/Bipolar ruled out
– No mania/mood disturbance or only briefly.

74
Q

DSM-5 Schizophrenia Diagnostic Specifiers

A
  • 1st episode, currently in acute ep, partial or full
  • Multiple eps, currently in acute eps, partial or full
  • Continuous

and, bseverity of PRIMARY symptoms

75
Q

Schizophrenia Epidemiology

A
  • 1% in general population
  • 1:1 female to male
  • but males have an earlier onset in later teens to early 20s
  • Carries significant disability and handicap in many domains of functioning
76
Q

Schizophrenia History

A

-1860 –> ‘demence prococe’ (early onset): they thought symptoms were arly onset & deteriorating course (dementia)

  • 1898 –> ‘dementia precox)
    differentiated that early onset & deteriorating course were fr manic-depressive psychosis & other psychotic illnesses
  • 1911 –> ‘schizophrenia’
    not necessarily display early onset &
    deteriorating course, hence not dementia.
    core of disorder = breaking of associative threads in thought, affect and action (in 5 As; association, affect, Ambivalence (conflicting thoughts/feelings, Autism, Avolition)
  • 1959
    emphasised ‘first rank symptoms’ and made the diagnosis on cross section (DURATION DOESN’T MATTER)
    Problems: these symptoms
    are not specific to schizophrenia, found in bipolar disorder
    too!
  • 1980 –> DSM-III
    EXClusion and INClusion rules, and duration criteria. PLUS very importantly, MUST interfere with LIFE domain functioning
  • late 1980s
    Over-focus on chronic samples who are only representative of very poor outcome patients and are contaminated by institutionalisation, medication side-effects, etc. - biased view of disorder
    = not wait for things to get bad (focus on 1st EP)
  • present
    Need to study psychotic symptoms INDIVIDUALLY, not only schizophrenia
77
Q

Aetiological (causes of illness/disease) Theories of Psychosis

A
  • Expressed Negative Emotion
  • Biological models (EG: Genetics including gene-environment interactions –> the closer the rs of twins, the greater risks of developing schizophrenia)
78
Q

Alogia

A

-ve symptom of psychosis. It represents cognitive impairments that are observable through SPEECH

79
Q

3 ways personality relates to mental
health issues and disorder (clinical):

A
  1. Vulnerability
  2. Personality disorder itself
  3. Other personality-RELATED disorder
80
Q

Vulnerability in personality and mental health disorders

A

= RISK of developing a personality disorder
- People differ in susceptibility to mental health issues and disorders:
- Genes
- Environmental stress
- Personality
(all related to one another)

81
Q

Diathesis-stress models

A
  • Most mental disorders involve the
    COMBINED action of PERSONALITY VULNERABILITY (‘diathesis’) and environmental stress.
  • With Stress coming in different forms
  • Traumatic experiences
  • Major life changes (including +ve ones)
  • Accumulation of ‘hassles’
82
Q

Specific diatheses (personality vulnerability): DEPRESSION

A
  • DEPENDENCY - -> (interpersonal sensitivity)
  • AUTONOMY –> (personal achievement sensitivity)
  • SELF-CRITICISM
  • Pessimistic (-ver) attributional style
    Internal = low self-Specific diatheses: schizophrenia
    Stable = hopelessness
    Global = helplessness
83
Q

Specific diatheses (personality vulnerability): schizophrenia

A

–> schizotypy (no hallucinations/delusions)
- Social anhedonia (↓ pleasure)
- Physical anhedonia
- Perceptual aberration (abnormality)
- Magical thinking

But this diathesis may be typological (diff for case to case)

84
Q

Personality disorders

A

Personality attributes that are extreme, inflexible & maladaptive (can’t adapt properly)

85
Q

Personality Disorders
1. “Odd” Cluster
(psychosis)

A
  • Paranoid
  • Schizoid (consistent pattern of detachment/no interest in socializing)
  • Schizotypal
86
Q

Personality Disorders
2. “Dramatic” Cluster
(–> acting out)

A
  • Antisocial
  • Borderline (inconsistent moods/actions)
  • Histrionic (constantly seeking attention)
  • Narcissistic
87
Q

Personality Disorders
3. “Anxious” Cluster
(–> anxiety/depression)

A
  • Avoidant
  • Dependent
  • Obsessive-compulsive (perfectionistic, indecisive, inflexible…)
88
Q

Dissociative Experiences Scale

A

self-report measure that asks people directly how often they have experienced various perceptions / behaviors characteristic of dissociation

89
Q

Dissociative Identity Disorder, DID (multiple personalities)

A

≥ 2 distinct personalities that switch
(1 host, 1 or more alters)

Alters may differ in many ways
- Usually relatively uninhibited, often child-like
- May have different allergies, optical
prescriptions, handedness

90
Q

Dissociative Experiences Scale (sample items)

A

For Amnesia:
- finding themselves in a place and having no idea how they got there

Depersonalization/derealization
- experience of feeling as though they are standing next to themselves

Absorption
- staring off into space, thinking of nothing
- being so involved in a daydream that it feels as though it were really happening

91
Q

Different approaches of DID

A
  1. Dominant theory: (“traumatic”)
    - People with DID usually report suffering extreme trauma
    - Dissociation (consciousness is split during traumatic stress)
    - Patients become rehearsed and skilled in this defence & construct alter personalities
  2. “sociocognitive”
    - caused by therapists and culture
    - Therapists (poorly skilled): use leading questions, unstable people may create distinct personalities: iatrogenic.
    - Culture: media and news.
92
Q

iatrogenic

A

Inadvertently using leading questions in suggestible, unstable people may create apparently distinct personalities

93
Q

Trait perfectionism is thought to be a diathesis for which of the following disorders?

A

Anorexia Nervosa

94
Q

Differences btwn personality disorders and other disorders in the DSM-5

A
  • Personality disorders are more enduring over time and across situations
  • The other disorders in DSM-5 are typically experienced as more episodic in nature.

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