Dynamic Psychopathology Flashcards
Who organised Freudian defences?
Anna Freud
Who classified defences into mature, immature and neurotic?
Vaillant (1977)
Who created psychotic defences?
Klein
How are defence mechanisms formed?
Prohibitions lead to wish/impulse, or signal anxiety, by which defence operation is formed and symptoms occur
What are the mature defences?
Altruism Humour Anticipation Sublimation Suppression
What is the conflict in altruism?
Defeat in a situation
What is the conflict in humour?
Failure, loss or destruction of belongings
Importance of Anticipation?
Goal-orientated
Conflict in Anticipation?
Sudden threat event
Describe suppression
Consciously or semiconsciously postponing attention to a conscious impulse or conflict.
Discomfort acknowledged but minimised
Conflict in suppression?
Painful event or sexual impulse
What are neurotic defences?
Act at level of mental inhibition and thereby patient is deprived of freedom in decision-making but retains insight
Name the neurotic defences
Displacement Dissociation Isolation Rationalisation Reaction formation Repression Intellectualisation Identification with aggressor Undoing
What is isolation?
Splitting an idea from the affect that accompanies it but is now repressed
Which disease is isolation seen in?
OCD
Conflict in isolations?
Painful emotions or memories
Result of isolation?
Talking about emotional events without feeling
What is reaction transformation?
Transforming an unacceptable impulse into its exact opposite
Clinical affect of reaction formation?
If used at early state of ego development, can become permanent character trait - obsessional personality
Conflict in reaction formation
Hostility and disinterest
Result of reaction formation
Devotion, self-sacrificing, correctness
What is primary repression?
Curbing ideas and feelings before they have attained consciousness
What is secondary repression?
Excludes from awareness what was once experienced at a conscious level
Difference between repression and suppression
Suppression is mere postponement, not loss of thoughts from conscious perception
Result of repression?
Gaps in memory - often unnoticed
Difference in result between intellectualisation and rationalisation
Intellectualisation: deals with inanimate objects (emphasises facts rather than emotions)
Rationalisation: provides excuses
Conflict in intellectualisation
Disturbing feelings and thoughts
What is undoing associated with?
OCD - magic thinking and rituals
Conflict in Undoing
Sadistic wishes
Unacceptable impulses
Result of Undoing
Superstitions
Name the narcissistic defences
Projection
Denial
Name the Kleinian defences
Splitting Introjection Projective identification Denial Omnipotence Grandiosity
When might projective identification be seen?
Psychotic paranoid states
What does Ogden’s model divide projective identification into?
Three steps
Step one of projective identification?
Projection of oneself to an external object. 1a is the blurring of self
What is step 2 of projective identification?
Interpersonal interaction in which projector actively pressures recipient to think, feel and act with the projection
What is step 3 of projective identification?
Reinternalization of projection after the recipient has psychologically processed it
What is omnipotence?
Belief that one can transform or influence the external world through ones thoughts
Which disease is omnipotence seen in?
OCD
Conflict in omnipotence
Helplessness
Name some immature defences
Acting out Passive aggression Somatisation Regression Somatosensory amplification
Which defence mechanism is considered part of the creative process?
Regression
What is somatosensory amplification?
Experiencing bodily sensations as unusually intense or distressing
Defences used in alcoholism
Denial
Rationalization
Defences used in anorexia
Denial
Rationalization
Defences used in depression
Regression
Defences used in dissocial personality
Acting out
Defences used in hysteria
Repression
Conversion
Defences used in OCD
Isolation of affect
Undoing
Reaction formation
Magical thinking
Defences used in paranoid delusions
Projection
Defences used in phobias
Displacement
Avoidance
Where was the Topographical theory of the mind mentioned?
Interpretation off Dreams (1900)
Structure of the mind in the Topographical theory?
Conscious
Preconscious
Unconscious
Where does the conscious system receive information from?
Outside world
How are the contents of the topographical theory communicated?
Via speech and behaviour
What does the conscious system operate
Secondary process thinking
What is attention cathexis?
Investment of psychic energy on a particular idea or feeling to process it consciously
What does the unconscious system contain?
Contents of censored or repressed wishes
What type of thinking is involved in the unconscious?
Primary-process
What governs the unconscious?
PLeasure principle
How is the unconscious evident?
Parapraxes
Dreams
Describe cathexis in the unconscious
Happens often and quickly
What does the preconscious do?
Acts when needed
Maintains repressive barrier to censor unacceptable wishes and desires
What does the preconscious interface with?
Both unconscious and conscious
How do thoughts go from the unconscious to the conscious?
Via the preconscious
What are the characteristics of an instinct?
Source
Impetus
Aim
Object
What is the impetus of an instinct?
Intensity or force of it
What does the dual instinct theory state?
Sexual and aggressive energy are dual insticts. Libido if the force by which sexual instinct in presented in the mind. Aggression is an instinct with destruction as aim
Where does the aggression instinct originate?
Skeletal muscles
According to Freud, what is the dominant force in Biology?
Thanatos - death
What is the hierarchy of anxiety?
Signal anxiety Disintegration/annihilation Stranger Separation Fear of object loss Castration Superego
What is signal anxiety?
Unconscious perception of external/internal threat which leads to resource mobilization and aversion of threat.
What is disintegration anxiety?
Concerns about fusion with external object
When does stranger anxiety occur?
7-9 months of age
What is separation anxiety?
When mother is recognized as an independent object
When does fear of object loss occur?
Often in girls during phallic stage
What is superego anxiety?
Id vs ego conflicts
What is Analytical Psychology known as?
Jungian Model
What is the personal unconscious as per Jung?
Collection of repressed individual memories
What is archetype a part of?
Collective unconscious
What is an archetype?
Representational images with universal symbolic meanings
What is complex a part of?
Personal unconscious
What are complexes?
Toned ideas developing due to interactions of complexes with archetypes
What is persona?
Mask covering ones personality - presented to outside world
What is anima?
Unconscious feminine aspect of man
What is animus?
Unconscious masculine aspect of woman
What is shadow?
An archetype?
Describe shadow?
Personificatino of unacceptable aspects of oneself symbolised as a dark internal alien
What is individuation?
Ultimate goal of life where an individual develops a sense of self-identity
Who introduced the terms Extra and introversion?
Jung
What is abreaction?
Process of recovering and verbalizing suppressed feelings that cause symptoms
What is resistance?
When patients cannot recall significant memories
What did Freud suggest resistance was due to?
Unconscious forces involved in repression
What is Freud’s wish fulfilment theory?
Dreams are attempts to fulfil unconscious wishes in a surrogate manner
What are the content of dreams made up of?
Nocturnal sensory stimuli (thirst etc)
Daytime residue (from waking life)
Repressed impulse
What are the two layers of dream content according to Freud?
Manifest content
Latent content
What is the manifest content?
That which is recalled by the dreamer
What is the latent content?
Unconscious thoughts and wishes that threaten to awaken the dreamer
What is dream work?
Unconscious mental operation by which latent content is transformed into manifest content
what is condensation?
Several unconscious impulses combined into a single image in dream cnotent
What is irradiation/diffusion?
Converse of condensation - multiple images in dreams represent one unconscious impulse
What is symbolic representation in dreams?
Highly charged objects represented by using innocent images that are in some way connected
What characterizes the primary process of thinking in dreams?
Condensation
Displacement
Symbolic representation
What is the primary process of thinking in dreams?
Defies logic, lacks a sense of time and space, can accept presence of contradictory items simultaneously and often incoherent
Modus operandi for Id
What is secondary revision of dreams?
When the more mature aspect of the ego helps to organise primary aspects of dreams more coherently
How does secondary revision occur
Via secondary process
What is the secondary process?
Logical, intact with time and space, mature
What do anxiety dreams represent?
Failure in protective function of dream-work mechanism
Importance of punishment dreams?
Defy wish fulfilment theory
Freud explained these existed as a compromise between conscience and repressed wish
What is Bell mania?
Disorganized hyperactivity that can be fatal is untreated
Why is Bell mania rare?
Widespread use of antipsychotics
What is Binswanger disease?
Type of multi-infarct dementia (vascular) in which infarcts selectively affect white matter
What is Briquet syndrome?
Somatization disorder - disorder of multiple somatic complaints across different organ systems due to anxiety
What is Brueghel syndrome?
Trigeminal dystonia that affects mouth
What may provoke Brueghel syndrome?
Antipsychotics
What is Charcot-Wilbrand syndrome?
Loss of all or part of dreaming after brain injury
What is Clerambault-Kandinsky syndrome?
Any paranoid psychosis in which thought insertion predominates
What is Cornelia de Lange syndrome?
Congenital mental retardation Patients self-injure Hyperactivity Sleeplessness Aggression
What is Da Costa syndrome?
Panic disorder - debilitating anxiety attacks accompanied by atetmpts to avoid such attacks
What is Fahr disease?
Idiopathic calcification of basal ganglia
Signs in Fahr disease?
Abnormal extra movements
Comorbid with obsessive-compulsive and mood symptoms
What is Ganser syndrome?
Symptom of answering all questions approximately, e.g. 2+7=27
What is Gardner-Diamond syndrome?
Purpura associated with psychological stress.
What reproduces the rash in Gardner-Diamond syndrome?
Subcut injection of patients own blood
What is Gelineau syndrome?
Narcolepsyl daytime sleepiness Cataplexy Sleep paralysis Hypnagogic hallucinations
What is Gerstmann-Straussler-Scheinker?
Transmissible prion disease causing dementia
Who does Gerstmann-Straussler-Scheinker occur in?
Only those with particular AD defect of chromosome
What is Geschwind syndrome?
Interictal behaviour including hyposexuality, hyperreligiosity, hypergraphia and viscosity (not observing social boundaries in conversation)
In which patients is Geschwind syndrome seen in?
TLE
What is Gjessing syndrome?
Periodic catatonia - disorganized state of withdrawl or agitation that fluctuates
What is Hakim-adams syndrome?
Normal pressure hydrocephalus
What is Heller syndrome?
Childhood disintegrative disorder - loss of milestones in multiple domains after age
What is Hoover sign?
Unconsciously exerting downward pressure with healthy leg when paretic leg is challanged
What does absence of Hoover sign suggest?
Feigned deficit
What is Kahlbaum syndrome?
Catatonia; syndrome of waxy posturing or purposeless agitation or speech
How is Kahlbaum syndrome treated?
Benzos
ECT
What is Kanner syndrome?
Autism
What is Kozhevnikov syndrome?
Continuous partial epilepsy leading to progressive cognitive deterioration
What is Landau-Kleffner syndrome?
Continuous partial simple epilepsy causing loss of language development in children
What is Langfeldt psychosis?
Psychosis without declining curse of schizophrenia
What is Marchiafava-Bignami disease?
Dementia due to callosal degeneration, related to chronic alcohol (wine) abuse
What is Marinescu reflex?
Palmomental reflex;
Movement of chin after stroking palm
What is an abnormal Marinescue reflex?
If movement of chin is unilateral, suggests frontal or diffuse brain damage
What is Martin Bell syndrome?
Fragile X
What is Meige syndrome?
Dystonic blepharospasm
What is morvan disease?
Involuntary fiber activity, hyperhidrosis and sleeplessness that leads to death in weeks if not treated
What is Rasmussen syndrome?
Unilateral brain atrophy and continuous epilepsy resulting in cognitive decline until affected portion of brain is removed
What is Sanfilippo syndrome?
Congenital mental retardation
Aggression
Insomnia
Cause of Sanfilippo syndrome?
Chromosone 12 deletion
What is Smith-Magnes syndrome?
Congenital mental retardation
Severe self-injury
Self-hugging behaviour
What is Steele-Richardson-Olszewski disease?
Dementia with ataxia, loss of ability to look up or down and Parkinsonism
What is Strauss syndrome?
ADHD
What is Sydenham chorea?
Movement disorder that follows rheumatic fever
Preceded by obsessive-compulsive symptoms
What is Von Economo?
Encephalitis Lethargica;
lethargy
obsessive-compulsive symptoms
What causes Wolfram syndrome?
AR syndrome caused by defect in chromosome 4
How does Wolfram Syndrome present?
Diabetes
Bilateral optic atrophy
Diversive psych disorders
What are heterozygotes for Wolfram syndrome at risk of?
Psych illness
Who coined the term schizophrenia?
Blueler
Who coined the term hebephrenia?
Hecker
Who coined the term catatonia?
Kahlbaum
Who coined the term dementia precoce?
Morel
Who coined the term schizoaffective?
Kasanin
Who coined the term neurasthenia?
Beard
Who coined the term unipolar and bipolar?
Kleist
Who coined the term hypnosis?
Braid
Who coined the term group dynamics?
Lewin
Who coined the term group psychotherapy?
Moreno
Who coined the term psychopathic inferiority?
Koch
Who coined the term Psychiatry?
Reil
Who coined the term institutional neurosis?
Barton
Duration of sx for diagnosis of alcohol dependence for ICD 10?
12months
How many sx needed for diagnosis of alcohol dependence under the ICD 10?
At least 3
Sx for alcohol dependence under ICD 10
- intense desire to drink alcohol
- difficulty in controlling the onset, termination and the level of drinking
- experiencing withdrawal symptoms if alcohol is not taken
- use of alcohol to relieve from withdrawal symptoms 5. tolerance as evidenced by the need to escalate dose over time to achieve same effect
- salience - neglecting alternate forms of leisure or pleasure in life
- A narrowing personal repertoire of alcohol use.
Who suggested that psychiatric diseases were brain diseases?
Greisinger
Edwards and Gross criteria (1976) for alcohol dependence?
- narrowed repertoire
- salience of alcohol seeking behaviour
- increased tolerance
- repeated withdrawals
- Drinking to prevent or relieve withdrawals.
- subjective awareness of compulsion
- reinstatement after abstinence
Atypical anorexia in ICD?
Normal body image perception
Atypical anorexia in DSM?
Normal body weight
At what developmental stage is OCD?
Anal stage
At what developmental stage are people with alcohol abuse?
Oral stage