Exam Review Flashcards
define mental health
a state of well-being in which an individual realizes their own abilities, can cope with normal stressors, work productively, and contribute to their community
define mental illness
a syndrome characterized by clinically significant disturbance to a person’s cognition, emotion regulation, or behavior that reflects a biological, psychological, or developmental dysfunction and is associated with distress or impairment
individual determinants of health
- ability to manage feelings and thoughts
- ability to deal with stressful circumstances
community determinants of health
- social supports
- sense of belonging
- experience of participation and citizenship in community
structural determinants of health
- economic, social, and cultural factors such as housing, employment, education opportunities
- access to transport
- political system that emphasizes health
the biomedical model of health and illness
- approaches mental health and illness as binary
- mental illnesses viewed as separate diseases
- believe there is a tangible cause to mental illnesses
the psychological-behavioral model
- acknowledges that mental activity necessarily involves brain function
- understands mental disorders as common patterns of thinking, feeling and behaving that negatively impact an individual
- people don’t have mental disorders but perform mental disorders
Social model
- understands mental health as a social product
- mental health and illness is contextual
biopsychosocial model
assumes that social conditions, individual experiences, and biological factors combine to create mental disorders
3 causes of variations of a disorder in behavior genetics
- heritability - proportion of variance due to genetic differences among individuals
- shared environmental influences
- nonshared environmental influences
Diathesis-stress perspective
- Diathesis: predisposition to developing a psychological disorder
- Stress: physiological or environmental events
stress can be a catalyst for developing a disorder
Category fallacy
applying diagnostic categories where they may not be relevant
Transcultural psychiatry
combines anthropology and psychiatry to examine how culture interacts with mental illness
Ethnocentrism
viewing our own culture’s perception as the right one
Chinese classification of mental disorders
has culturally specific features that do not exist in international models
Penrose theory
o As hospital beds decrease, prison beds increase
o As prison beds decrease, hospital beds increase
Elements of consent
- person must have the capacity to consent
- consent must be informed
- consent must be volluntary
3 components of gender
- identity - sense of self as male, female, or other gendered being
- presentation - behaviours associated with masculinity, femininity
- role - social roles expected of males and females in society
gender dysphoria
the distress caused by an individual’s experienced/expressed gender and their assigned gender
The distress that may accompany the incongruence between one’s expressed/experienced gender and their assigned gender
Four strands of sexuality
- sexual desire or attraction - to whom someone is attracted
- sexual behavior - what a person likes to do sexually
- sexual identity - how someone describes their sense of self as a sexual being (hetero, homo, bi…)
- Sexual experience - education, observations, experiences
Role of culture in relation to mental health
- people’s experiences are structured by their culture - people of different cultures may experience the same affliction in different ways
- behaviors can only be understood within the cultural contexts of which they occur
errors in making assessments
- over-pathologizing - clinician incorrectly judges client’s behaviour as pathological when it is normal in that culture
- under-pathologizing - clinician explains the client’s behaviour as cultural when it is, in fact, an abnormal symptom
define stigma
a label that is deeply discrediting to a person’s sense of self
3 ways to combat stigmatization
- increased contact
- public campaigns
- policies regarding discrimination
symptom overlap and heterogeneity
symptom overlap: many disorders share symptoms
heterogeneity: People diagnosed with the same disorder may exhibit different symptoms
2 views of diagnostic categorization
- dimensional - disorders exist on a continuum
- everyone has a disorder but to a varying degree - categorical - have a disease or don’t
- doesn’t account for the severity of a problem
validity and reliability
- validity: the concept that a measurement captures what is claims to measure
- reliability: consistency in results across measurements
2 main classification systems
- International Classification of Diseases
- most common in Europe
- created by WHO - Diagnostics and statistics manual for mental disorders (DSM)
- most used in N. America
- created by APA
DSM Criteria for schizophrenia
- One of: hallucinations, delusions, disorganized speech
- Pus one of: disorder thinking, negative symptoms
- at least 6 months
- not attributable to something else
Hallucinations
sensory experiences that occur without stimulation
Schizophrenia treatments
- antipsychotics to reduce positive symptoms
- newer antipsychotics have lower rates of extrapyramidal effects
- psychotherapy - CBT - hallucination interpretation and acceptance
Depressive disorders
severely low mood, fatigue,changes in appetite, social/occupational impairment, guilt, shame, worthlessness
MDD - 2 weeks
PDD - 2 years with no more than 2 months symptom-free
Depressive disorders treatment
- antidepressants, SSRIs
- brain stimulation
- CBT
- interpersonal therapy
3 bipolar disorders
- Bipolar I: at least one full panic episode, at least one partial or full depressive episode
- Bipolar II: no full manic episodes, at least one major depressive episodes, at least one hypomanic episode
- Cyclothymia: episodes of hypomania and full or partial depression on and off for at least 2 years, no full manic episodes
Obsessions
recurrent, unwanted thoughts, images, or impulses that cause distress or impairment and may be time-consuming
compulsions
repetitive behaviours that people feel they must perform to avoid something bad from happening or to reduce anxiety
Define a “problem” in relation to child mental health
abnormal in relation to:
- child’s age and gender
- developmental stage
- frequency and severity
- culture
- extent of disturbance
- persistence
Impairment: (regarding childhood mental health
- causes suffering to child/distress to family
- social restriction
- impedes child’s development
- effects on others
common childhood mental health problems
- problems with socialization
- pre-school behavioural problems
- conduct disorders
- attachment disorders and abuse
- disorders of activity and attention - problems with development
- emotional and/or adjustment disorders
- failures of normal development - emotional, cognitive, or behavioural problems
- adult-type disorders
experiences unique to childhood
- brain development
- puberty
- significant life transitions/changes
most prevalent mental health issues under 25 in BC
- any anxiety disorder
- ADHD
- conduct disorder
- any depressive disorder
2 features shared by all neurodevelopmental disorders
- the idea that the root of such disorders is neurological dysfunction that affects the individual’s capacity for intellectual, emotional, social, and sometimes physical development
- the fact that individuals diagnosed with such disorders often struggle to fit into society
DSM Diagnosis of ADHD
at least 6 of 18 symptoms including:
- difficulty waiting for turn
- excessively talking
- fail to give close attention to detail or makes mistakes
- often do not follow through on instructions and fails to finish schoolwork or workplace duties
definition of recovery
staying in control of one’s life while managing a mental illness. Does not always refer to being completely recovered and symptom-free
things that support recovery
good relationships hope satisfying work personal growth right living environment developing cultural or spiritual perspectives developing resilience
Things that are helpful in recovery
- being believed in
- being listened to and understood
- getting explanations for problems and experiences
- having the opportunity to temporarily resign from duties in the time of crisis
7 components of recovery
- the Mental Health Commission of Canada 2009
- active support
- promotion of mental health and prevention of mental illness
- addressing diverse individual and group needs and disparities
- recognizing and including the role of families
- ensuring equitable and timely access to treatment programs
- using evidence to inform care
- ensuring people with mental illness are included as active members of society
Active vs Inert Placebo
Active placebo - no therapeutic value but produces side effects
Inert Placebo - produces side effects
mechanisms for change - if a client improves, why do they improve?
- insight: awareness and knowledge
- non-specific therapy factors: therapeutic relationship with therapist
- specific, theory-driven interventions:
o Cognitive: in CB, we can show that improvement happens as cognitions begin to change
o Affective: in emotion-focused therapies, we can show that improvement happens as emotional awareness and emotion regulation skills improve
o Behavioural: in behavioural therapies, we can show that improvement happens as behaviours begin to change
define psychotherapy
- used to assist people to overcome difficulties or achieve personal growth
- treatment based on talking and thinking based on psychological techniques derived from psychological perspectives
- explores how we understand ourselves
define biomedical therapy
treatment with medical procedures such as drugs or other biological treatment
goals and techniques of psychoanalysis
goals:
- bring patient’s repressed feelings to conscious awareness
- help patients release energy devoted to if-ego-superego conflict to achieve better health and reduce anxiety
Techniques:
- historical reconstruction, through hypnosis then free association
- interpretation of resistance, transference
Goals and Techniques of Psychodynamic Therapy
goals:
- to understand current symptoms
- to explore and gain perspective on defended-against thoughts and feelings
Techniques:
- client-centered face-to-face meetings
- exploration of past relationship troubles to understand origins of difficulties
How psychodynamic differs from psychoanalysis
Psychodynamic Therapy:
- briefer, less expensive
- lack of belied in id-ego-superego
- helps clients understand how past relationships affect current relationships
Describe Humanistic Therapies
Theme: emphasis on people’s potential for self-fulfillment; to give people new insights
Goals: reduce inner conflicts that interfere with natural development and growth
- help clients grow in self-awareness and self-acceptance promoting personal growth
Techniques: focus on taking responsibility for own actions; and on present and future rather than the past
Insight Therapies
humanistic and psychodynamic
- attempt to improve functioning by increasing client’s awareness of motives and defenses
Behaviour therapies - goal
not insight therapies
- goal is to apply learning principles to modify problem behaviours
Behavioural Therapies - techniques
classical conditioning techniques
- exposure therapy: treat anxieties by exposing people to the things that make them anxious
Systematic desensitization: associates a pleasant, relaxed state with gradually increasing, anxiety-triggering stimuli
Critics and Proponents of Behaviour therpies
critics:
- do people become dependent on extrinsic rewards?
- will behaviours stop when rewards stop?
proponents:
- positive rewards more ethical than punishment or institutionalization
Cognitive Therapies
- teach people new, more adaptive ways of thinking
- based on the assumption that thoughts intervene between events and our emotional reactions to them
Beck’s therapy for depression
- gentle questioning seeks to reveal irrational thinking then to persuade people to change their perceptions of their own and other’s actions as dark, negative, and pessimistic
- people trained to recognize and modify negative self-talk
Cognitive-Behavioural Therapy
combines cognitive therapy (changing self-defeating thining) with behavioural therapy (changing behaviour)
- aims to alter the way people act and think
focuses on trying to change a person’s underlying thought process
Dialectical Behaviour Therapy
Two components:
- weekly skills group
- individual sessions
Skills learned:
- mindfulness
- emotional regulation
- interpersonal effectiveness
- distress tolerance
- validation
interpersonal psychotherapy
for depression
- theory: environmental events and stressors have considerable influence on an individual’s well-being
- therapist guides patient through life events and interpersonal issues related to the onset and maintenance of their depression
- helps patient understand the connection between their mood and the current situation
Mindfulness
the practice of noticing your attention has shifted and refocusing it to the present moment in a nonjudgmental way
- consciously bringing awareness to the here and now
clinical decision-making based on:
- patient’s values, characteristics, preferences, circumstances
- clinical expertise
- best available research evidence
4 types of biomedical drug therapies
antipsychotics
antianxiety drugs (anxiolytics)
antidepressants
mood-stabilizing medications
Antipsychotic drugs
- thorazine
- mimic neurotransmitters ( block or release dopamine)
- successfully used with life-skills programs and to treat schizophrenia
Antianxiety drugs
- xanax, Ativan
- depress the CNS
- slow synaptic vacuuming of serotonin (SSRIs)
Mood-stabilization drugs
- depakote: controls manic episodes
- lithium: levels out emotional highs and lows of bipolar disorder
Antidepressant drugs
- not very effective in treating mild depression
- generally effective for moderate to severe depression
- no significant difference than active placebo
Polypharmacy
- medications combined in a pharmacological cocktail
- increases risk of side effects
Electroconvulsive Therapy
- manipulates brain by shocking it
- electrical current through the brain to induce a seizure
- used for severe depression after all other treatments have been tried and failed
Transcranial Electric Stimulation
- weak current to scalp
- current likely to weak to be beneficial
Repetitive transcranial magnetic stimulation
- magnetic energy to brain surface through wire close to brain
- few side effects
- modest effectiveness
Deep brain stimulation
- manipulates brain with a pacemaker
- stimulate inhibition activity related to negative emotions and thoughts
resilience
personal strength that helps most people cope with stress and recover from adversity and trauma
Humoral Theory
four fluids make up the body - illness results from too much:
- blood
- black bile
- yellow bile
- phlegm
Middle Ages
“the age of faith”
- religion overtakes science
- illness caused by possession or punishment from god
18th century
mental illnesses seen as a moral weakness or result of divine disfavour
Integrated primary health care - what is needed for it to work
- professionals with adequate training
- an understanding of the biopsychosocial cultural interactions that may result in mental health
- adequate capacity of the primary health are system
the “disordered Aboriginal”
interpretations of an inability of Indigenous people to “deal with their problems”
