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PS1110 > clinical examples > Flashcards

clinical examples Flashcards

1
Q

what are phobias?

A

excessive or unreasonable fears of objects, places or situations

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2
Q

when is the phobic stimulus avoided or endured?

A

with intense anxiety or distress

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3
Q

specific phobia DSM-5 critera

A

marked or fear anxiety about a specific object or situation

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4
Q

types of phobias

5 types

A
  • animal (spiders, insects)
  • natural environment (heights, water)
  • blood-injection-injury (needles)
  • situational (planes, elevators)
  • other
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5
Q

social phobia DSM-5

A

marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others

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6
Q

types of social phobia

A
  • performance situations (public speaking)
  • general (eating in public)
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7
Q

prevalence and gender ratio

lifetime prevalence & specific phobias

4 points

A
  • lifetime prevalence around 12%
  • more common in women than men
  • most patients with specific phobia have at least one other excessive specific fear
  • most patients with social phobia suffer from on ore more additional anxiety disorders
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8
Q

theories

psychodynamic (Freud)

A

phobias result when unconsious anxiety is displaced onto a neutral or sympolic object
e.g. Hans Oedipal fears of his father - desire to kill his father - became unbearble and was displaced onto horses

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9
Q

theories

behavioural: Ost and Hugdhal 1981: phobic clients

A

58% of phobic clients cited traumatic conditioning experiences as the source of phobia

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10
Q

theories

behavioural: McCabe et al 2003: teasing

A

92% socially phobic adults reported a
history of severe childhood teasing

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11
Q

Mowrer’s two factor theory of phobia acquisition/maintenece (1947)

A

1) Classical conditioning: rat paired with loud noise -> conditioned fear.
2) Operant conditioning: individual avoids rats.
* Prevents extinction
* Reduces anxiety, produces relief, thus avoidance is reinforced.

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12
Q

evolutionary preparedness

what is prepared learning

A

when primates seem evolutionarily prepared to rapidly associate certain objects with frightening or unpleasant events

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13
Q

evolutionary preparedness

what are prepared fears?

A

they are not innate but easily acquired and resistant to extinction

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14
Q

what is tryphobia?

A

when individuals have an aversion towards clusters of roughly circular shapes

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15
Q

treatment: exposure therapy

A

e.g. someone with a fear of snakes may be instructed to handle a snake or someone with social anxiety might be instructed to giva speech in front of an audience

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16
Q

treatment: CBT (cognitive behavioural therapy)

A

e.g. to treat social phobias

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17
Q

what is obsessive-compulsive disorder (OCD)

A

occurrence of unwanted and intrusive obsessive thoughts or distressing images

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18
Q

what does a person with OCD feel?

A
  • they feel driven to perform a compulsive ritualistic behaviour in response to an obsession
  • they need to follow very rigid rules regarding how the compulsive behaviour should be performed
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19
Q

classification controversy

DSM-IV & 5 OCD

A
  • in the DSM-IV OCD was categorised under ‘anxiety disorders’
  • it was then removed from this category and was grouped under “obsessive-compulsive and related disorders” in the DSM 5
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20
Q

DSM-5 obsession definitions

A
  • recurrent and persistant thoughts/impulses that are experienced as intrusive, disturbing, inappropriate and uncontrollable
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21
Q

how do individuals try and suppress obsessions

A

with some other thought or action

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22
Q

frequent types of obsessions

3 types

A
  • contamination
  • repeated doubts
  • odering
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23
Q

obsessions

agressive or blasphemous impulses

A
  • to shout an obscenity in a church
  • to hurt a loved one
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24
Q

obsessions

sexual thought and imagery

A

a reccurent pornographic image - that violates one’s morals

25
Q

DSM-5 compulsions definition

A

repetitive behaviours or mental acts the person feels driven to perform in repsonse to an obsession, or according to rigid rules

26
Q

compulsions: repetitive behaviours

4 examples

A
  • hand washing
  • ordering
  • cleaning
  • hoarding
27
Q

compulsions: mental acts

4 examples

A
  • counting
  • praying
  • saying words silently
  • thinking good thoughts to undo bad ones
28
Q

compulsion: washing rituals

2 rituals

A
  • washing hands for about 20 minutes after using the toilet
  • washing hands for hours with disinfectants up to the point of bleeding
29
Q

compulsions: checking

2 examples

A
  • all the lights, appliances, and locks 2-3 times before leaving the house
  • going back to a junction where one thinks one may have run over a pedestrian
30
Q

compulsions and obsessions DSM-5 critera

A
  • obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important ares of functioning
31
Q

insight specifier DSM-5 criteria good/fair insight

A

individual recognises obsessive-compulsive disorder beleifs are definitely or probably not true or that they may or may not be true

32
Q

insight specifier DSM-5 criteria poor insight

A

individual thinks O-C disorder beliefs are probably true

33
Q

insight specifier DSM-5 criteria absent insight

A

individual is completely convinced that O-C disorder beliefs are true

34
Q

insight and executive functions DSM-5 criteria

A

Recent work on the neuropsychological and cognitive characteristics of OCD patients with poor insight has highlighted the role played by the executive functions in insight.

35
Q

OCD examples from celebs: Leo DiCaprio

A

Leo would step on cracks on the way to school and would have to walk back a block and step on that same crack/gum stain

36
Q

what causes OCD?

A

risk factors and cognitive aetiology

37
Q

OCD prevalence

A

estimated prevalence 1-2% of general population

38
Q

OCD gender

A

equally common in men and women

39
Q

when does OCD begin?

A

usually begins in late adolescence or early adulthood
* in childhood disorder is more common in boys than girls

40
Q

how many sufferers have another psychological disorder with OCD

A

50%

41
Q

Gender and OCD types:

A
  • themes of sexuality, exactness and symmetry are more common in men
  • contamination and cleaning more in women
42
Q

OCD and culture

A

culture may influence themes of obsessions and compulsions
* example: religious obsessions and compulsions more common in cultures that emphasise the importance of religious observance

43
Q

what causes OCD: psychological factors (cognitive intrusions)

A
  • unwanted cognitive intrusions are experienced by most people i.e. unpleasant thoughts
  • these intrusions typically have similar contents to clinical obsessions
44
Q

what causes OCD: appraisals

A

unwanted cognitive intrusions are experienced by most people
* interpretation or appraisal of a thought is critical

45
Q

what causes OCD: dysfunctional beliefs

1 point 2 examples

A

misapprasials are due to dysfunctional beleifs
e.g.
1. beleifs about inflated personal responsibility over one’s own and other’s safety
2. thought-action-fusion - thinking about an unacceptable or disturbing event makes it more likely to happen

46
Q

what are obsessional thoughts equivalent to?

A

forbidden actions

47
Q

OCD: dysfunctional beliefs evidence

A

Tolin et al. 2003: dysfunctional beliefs were associated with OCD symptoms in both clinical and non-clinical samples

48
Q

what causes OCD: if thought supression works it should…

A

if thought supression works, it should leave no mark of the unwanted thought at all

49
Q

what causes OCD: thought supression

Wegner et al. 1987 white bear study

A
  • 5 minute supression session, participants had to ring a bell each time a white bear came to mind
  • participants signaled more than one white bear thought per minute
    Participants had to supress any thoughts of a bear
50
Q

what causes OCD: thought supression

what is the paradoxical rebound effect?

A

attempts to supress thoughts can ‘rebound’ and result in an increased occurence of the thoughts

51
Q

what do thought supression attempts lead to?

A

it results in more rather than less intrusions
* the paradoxical effect of thought supression may result in full blown obsessions

52
Q

results of white bear effect

A

OCD patients showed faster responses to the word bear than to other words. this effect was not seen in controls

53
Q

what causes OCD: distress as a motivators

A

distress -> attempts to suppress the thought -> attempts to prevent any harmful consequences
EXAMPLE:
by avoiding knives and continually asking other people to
check on the safety of the child

54
Q

what causes OCD: psychological factors (compulsions)

A

compulsive rituals develop as efforts to remove intrusions and to prevent any perceived harmful consequences

55
Q

what do comuplsions prevent people with OCD to do?

A

prevents people with OCD from learning that their appraisals are unrealistic
EXAMPLE:
the affected individual fails to learn that unwanted harm-related images do not lead to acts of harm

56
Q

TREATMENT

OCD: exposure

A

systematic, repeated, and prolonged confrontation with stimuli that provoke anxiety and the urge to perform compulsive rituals

57
Q

TREATMENT

OCD: response prevention

A

person refrains from performing compulsive rituals

58
Q

what do individuals learn from exposure and response preventions?

4 key points

A
  • anxiety is temporary
  • the feared catastrophic consequence never transpires
  • their interpretation of the obsession weakens
  • obessional thoughts are harmless
59
Q

what have randomised controlled trials demonstarted about exposure and response prevention?

A

RCT have demonstrated that E/RP is more effective than any other forms of psychotherapy and placebos
* However E/RP provokes anxiety in patients: approx 25% drop out of treatment

PS1110 (12 decks)

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