common psych problems Flashcards
psychosis
A state in which a person’s mental capacity to recognize reality; communicate; and relate to others is impaired
Person moves in and out of reality Reality for the person is the world as that person perceives it- not necessarily as it exists
most common psychosis diagnosis
schizophrenia
two types of psychosis
functional and organic
Current research emphasizes both biological and psychosocial factors
functional psychosis
results from interpersonal conflict, stress->psychogenic origin
organic psychosis
results from physiological damage/dysfunction
psychotic behavior
Person attempts to adapt, attempts to explain experiences and/or attempts to structure a “crazy” world
Ex. Schizophrenic person may cut himself for reassurance that he is “real” because he bleeds and feels pain
cognitive factors of psychopathology
what a person knows/believes about self, others, principles, places, objects, actions, etc.
Cognitive disruptions of psychopathology
Thinking Distortions
Communicating Distortions
Delusions
Hallucinations
Thinking distortions of psychopathology
Selective Abstraction
Overgeneralization
Magnification
Superstitious thinking
Dichotomous thinking
selective abstraction
“I’m still too fat – look how big my hands and feet are.”
overgeneralization
“You don’t see fat people on TV. So you have to be thin to be successful at anything in life.”
magnification
“If I gain 2 pounds, I know everyone will notice it.”
superstitious thinking
“If I wear all black I’ll lose weight”
dichotomous thinking
“If I’m not thin I’m fat” (black and white thinking)
communications distortions
loose associations
flight of ideas
word salad
loose associations
“Don’t you think my stomach is getting bigger? Fall is when lots of food is harvested like corn and pumpkins.”
flight of ideas
“The weather looks like it’s changing. These pants make me look thin Lunch was really bad. I don’t think I should be taking all those pills.”
(speech is rapid and there is a continuous flow of words)
word salad
“animals, cars, bedtime, dark, prayers closets…”
Delusions
Fixed, firm beliefs contrary to reality
examples of delusions
grandiosity persecution control religious sin/guilt somatic ideas of reference thought broadcasting thought withdrawal thought insertion
grandiosity
I’ve been a member of the President’s Cabinet since the Reagan years. No president can do without my advice.”
persecution
See those people in the hall? They’re not really visitors, they’re from the CIA. They’re here to spy on me.”
control
“I have a wire in my head. My family had it implanted so they can control me. They control everything I say. I can’t do anything on my own.”
religious
“I can’t stop to talk with you I have to keep reading this Bible out loud so God will hear me and make sure nobody can hurt me.”
sin/guilt
“I am being punished now because when I was growing up I was a bad kid. That’s why I when I get a job and start doing good I have to quit to make up for my bad behavior. I shouldn’t be happy, not after as bad as I was”
somatic
“My esophagus is being torn apart because there’s a rat in my stomach and sometimes he comes up to my throat. He eats away at my esophagus. Look in my throat you can probably see him.”
ideas of reference
That doctor and nurse at the desk are talking about me. You say they aren’t but I know they are. You people talk about me all the time.”
thought broadcasting
“I’m afraid to think anything because I know you can read my mind and know exactly what I’m thinking.”
thought withdrawal
“I can’t tell you what I’m thinking. Somebody just stole my thoughts.”
thought insertion
“You think what I’m telling you is what I’m thinking but it isn’t. My father keeps putting all these thoughts in my head. There’s no room for my thoughts. These aren’t mine.”
Hallucinations
Perceptual experiences occurring in the absence of any appropriate sensory stimuli
Do not confuse with illusions which result from
misinterpretation of sensory experience-magicians
Most frequent types of hallucination = visual and
auditory- but can arise from any of five senses
Often hallucinations have religious content
Assessed at different levels of intensity
hallucinations levels of intensity
comforting
condemning
controlling
conquering
comforting hallucinations characteristics
Pt has intense emotions like anxiety, loneliness, guilt, fear-tries to focus on comforting thoughts to anxiety; knows thoughts & sensory experiences are controllable if anxiety is managed
comforting hallucinations behaviors
Grinning, laughter that seems inappropriate; moving lips without making sound; rapid eye movement; slowed verbal responses as if preoccupied
condemning hallucinations characteristics
Sensory experience repulsive & frightening; pt begins to feel loss of control; may attempt to distance self from perceived source; may feel embarrassed by experience and withdraw from others
condemning hallucinations behaviors
autonomic nervous system signs of anxiety; attention span narrows; preoccupation with sensory experience; loss of ability to differentiate hallucination from reality
comforting hallucinations
Moderate level of anxiety
Hallucination generally pleasant in nature
condemning hallucinations
Severe level of anxiety
Hallucination generally repulsive
controlling hallucinations
Severe level of anxiety
Hallucination becomes omnipotent
hallucinations can be
auditory
visual
(are most frequent)
but they can be tactile
controlling hallucination characteristics
Pt gives up trying to combat experience & gives in to it; content of hallucination may become appealing; pt may experience sadness/loneliness if hallucination ends
controlling hallucination behaviors
Directions given by hallucinations will be followed rather than objected to; difficulty relating to others; attention down to only a few minutes at best, may be only seconds; unable to follow directions; sx of intense fight or flight response
conquering
Panic level of anxiety
Hallucination becomes elaborate & interwoven with delusions
conquering hallucination characteristics
Sensory experiences may become threatening if pt doesn’t follow commands; without therapeutic intervention hallucinations may last for hours or days
hallucinations, what to ask patient
are you hearing/seeing something. i can't hear it, what do you hear what are you hearing, what do you see describe what are you are seeing/hearing are they soft, or loud
conquering hallucination behaviors
Terror-stricken behavior such as panic; strong potential for suicide/homicide; physical activity reflects content of hallucination i.e. violence, agitation, withdrawal, catatonia; unable to respond to most directions; unable to respond to more than one person
schizophrenia
18-22 is normally when a schizophrenics first psychotic break happens
they start hearing voices in their teens maybe even earlier
affect
How a person feels - Mood
Assessment data/conclusions about patient’s affect come, in part, from cognitive and behavioral assessment
descriptors of affects
Appropriate Inappropriate Stable Labile Elevated Depressed Overreactive Blunted Flat
appropriate affect characteristics
Mood in agreement with immediate situation
inappropriate affect characteristics
Mood not related to immediate situation
stable affect characteristics
Mood resistant to sudden change when there is no provocation in milieu
Labile affect characteristics
Mood shifts suddenly in a way that cannot be understood in the context of the situation
Elevated affect characteristics
Mood is euphoric not necessarily related to immediate situation
depressed affect characteristics
Mood is despondent no necessarily related to immediate situation
overreactive affect characteristics
Mood is appropriate to the situation but out of proportion
blunted affect characteristics
Mood is dulled response to the immediate situation
flat affect characteristics
No visible clues to the person’s mood
Behavior
How a person acts, what a person does
Freud: all behavior has meaning
Behavioral assessment may give valuable information about cognitive clarity and/or affect
Examples of Behavioral Assessment Factors
Insomnia/hypersomnia – marked sleep disturbances
Inappropriate social contacts – behaviors may range from
hyperactivity, excessive talking, (laughing, joking) ->
complete withdrawal from voluntary contacts
Marked impairment in personal hygiene – noticeable change
Impaired role functioning – noticeable difference in performance
of role (s) i.e. spouse, employee
Congruency/Consonance
Cognitive, affective and behavioral aspects all
operating together = congruency/consonance
Beliefs, feelings and behavior toward a given ”thing” are all positive/negative
If one aspect is out of “sync” the person will attempt to change that aspect to achieve congruency
Ex.: A paranoid person believes (delusionally) that all store clerks want to destroy him. He feels afraid and may act out against a store clerk (behavior) to make all aspects congruent.
