Intro Flashcards
Mental Disorder (definition)
Illness with psychological or behavioral manifestations associated with significant distress and impaired functioning
Caused by biological, social, psychological, genetic, physical or chemical disturbance
Measured in terms of deviation from some normative concept
Ea. Illness has characteristics signs and symptoms
Official classification system used by mental health professionals to diagnose psychiatric illness
Diagnostic and Statistical Manual of Mental Disorders *DSM) 5th ed. (2013)
Has diagnostic criteria for 22 major categories of mental disorders (727 discrete illnesses)
Major Categories of Psychiatric Illnesses (9 in class)
- Schizophrenia Spectrum +
- Bipolar and related
- Depressive
- Anxiety
- Obsessive-compulsive +
- Trauma and stressor related
- Feeding and eating
- Substance related and addictive
- Personality disorders
Schizophrenia Spectrum and other Psychotic disorders
Defined by abnormalities in which domains:
- Delusions
- Hallucinations
- Disorganized thinking/speech
- Grossly disorganized or abnormal behavior
- Negative/positive symptoms
Bipolar and related disorders
defined by “manic episodes” and “depressive episodes”
Depressive disorders
Defined by presence of sad, or empty, or irritable mood
Accompanied by somatic and cognitive changes
Affects individuals capacity to function
Anxiety disorders
Excessive fear, anxiety and behavioral disturbances
Fear
Emotional response to real or perceived imminent threat
Anxiety
Anticipation of a FUTURE threat
Obsessive compulsive and related disorders
Presence of obsession and/or compulsion
Obsessions
Recurrent and persistent thoughts, urges, or images that experienced as intrusive and unwanted
Compulsions
Respective behaviors or mental acts that an individual feels driven to perform in response to an obsession
Trauma and stressor related disorders
Requisite exposure to trauma or stressful event
Variable symptoms (anxiety, anhedonia, dysphoria, externalized anger, aggressiveness, dissociativeness)
May have more than one
Somatic symptom and related
Prominence of somatic symptoms associated with significant stress and impairment
Abnormal thoughts, feelings, and behaviors in response to the symptoms
Feeding and eating disorders
Characterized by a persistent disturbance of eating and or eating-related behavior that results in the consumption or absorption of food that significantly impairs physical health or psychosocial functioning
10 classes of drugs – substance related and addictive disorders
- Alcohol
- Caffeine
- Cannabis
- Hallucinogens
- Inhalants
- Opioids
- Sedative, hypnotics, anxiolytics
- Stimulants
- Tobacco
- Other/unknown
Personality disorders
Enduring pattern of inner experience and behavior that deviates markedly from expectations of culture
Pervasive and inflexible
Onset in adolescence or early adulthood
Stable over time
Leads to distress or impairment
Psychotic
Loss of reality testing with delusions and hallucinations
Neurotic
No loss of reality testing
Based mainly on intrapsychic conflicts or life events that cause anxiety
Symptoms include obsessions , phobia, and compulsion
Functional
No known structural damage or clear cut biological cause to account for impairment
Organic
Illness caused by specific agent producing structural changes in the brain
Associated with cognitive impairment, delirium or dementia
NOT used in DSM
Primary
No known cause
Aka idiopathic
Secondary
Known to be a symptomatic manifestation of systemic, medical, or cerebral disorder (i.e. Delirium from fever)
Tangentially
Oblique, digressive, or even irrelevant manner of speech in which central idea is never communicated
Circumstantiality
Disturbance in associative thought and speech process in which a patient digresses into unnecessary details and inappropriate thought before communicated in the central idea
Seen in schizophrenia, obsessional disturbances, and certain cases of dementia
Thought blocking
Abrupt interruption in training of thinking before a thought or idea is finished
After a brief pause, the patient indicates no recall of what is being said or was going to be said
Often indicates presence of mental illness such as schizophrenia
Loosening of associations
Thinking or speech disturbance involving a disorder in logical progression of thoughts, manifested as a failure to communicate verbally adequately
Unrelated and unconnected ideas shift from one subject to another
Flight of ideas
Rapid succession of fragmentary thoughts or speech in which content changes abruptly and speech may be incoherent
Seen in mania
Word salad
Incoherent, essentially incomprehensible, mixture of words and phrases
commonly seen in far-advanced cases of schizophrenia
Hallucinations
False sensory perception occurring in the absence of any relevant external stimulation of the sensory modality involved
Delusions
A false belief, based on incorrect inference about external reality
Held firmly despite objective and obvious contradictory proof or evidence and despite the fact that other members of the culture do not share the belief
Orientation
State of awareness of onself and one’s surroundings in terms of person, place, time and situation (Ox4)
Insight
Conscious recognition of one’s own condition
In psychiatry refers to conscious awareness and understanding of one’s own psycho dynamics and symptoms of maladaptive behavior
Highly important in effecting changes in the personality and behavior of the person
Judgement
Mental act of evaluating or comparing choices within the framework of a given set of values for the purpose of electing a course of action
If the course of action is consonant with reality or with mature adult standards of behavior, judgment is said to be intact or normal
Judgment is impaired if course is maladaptive, results from impulsive decisions based on need for immediate gratification, or is otherwise not consistent with reality as measured by mature adult standards
Two sections of the psychiatric exam
- Complete medical history, pertinent PE
2. Psychiatric history
Screening lab tests used in psych exams
Can’t determine specific psychiatric disorders
CBC
Renal and liver panel (creatinine/BUN/LFTs)
TSH
Lyres, blood sugar, RPR (syphilis), vitamin B12, UA, tox screen
Thyroid function test
Depression with hypothyroidism
Lithium therapy can cause hypothyroidism
Subclinical hypothyroidism can cause depression (order TRH)
Dexamethasone-suppression test
Used to confirm major depressive disorder
1mg p.o. At 11PM, blood level measured at 8a, 4p, 11p)
(Level >5mg/dl= + result or non-suppression (abnormal))
Not perfect — many false -/false +
Catecholamines
5-HIAA elevated w/carcinoid tumors (urine)
+/- when on phenothiazines (urine)
In CSF: low in suicidal depressed patients
Decreased in all violent behaviors but increased in PTSD
Renal function tests
Need to monitor in patient taking lithium
Creatinine/BUN
LFTs
Need to monitor on patients taking phenothizine, tricyclic antidepressants, phenobarbital/carbamezpine (Tegretol) and valproate (Depakene)
Lab tests related to medications
Plasma levels - lithium
Clozapine (clozaril) – WBC (risk of agranulocytosis)
Tricyclics/tetracycl drugs – EGC (conduction delays), blood levels for therapeutic range
Drugs that you order plasma levels for
Imipramine/Tofranil
Nortriptyline/Pamelor
Desipramine/Norpramin
Lithium lab tests
Thyroid function
Lytes
WBC
Renal function
ECG
Sodium lactate
Can precipitate panic attack with sodium lactate IV
Can be used to confirm dx
Types of psychotherapy
- Psychoanalysis
- Group therapy
- Family therapy
- Marital therapy
- Biofeedback
- Cognitive therapy
Cognitive therapy
Patient’s problem is based on perception of their environment
Individual therapy sessions aimed at changing these perceptions
Cognitive therapy is used in patients with which disorders
Depression
Panic disorder
OCD
Personality disorders
Somatoform disorders
Cognitive triad of depression
Negative self perception
View world in negative manner
Expects world will not change
8 main topics of mental status exam
- Appearance and behavior
- Speech
- Mood
- Thoughts
- Perception
- Cognition
- Insight
- Judgment
Biofeedback
Brings autonomic nervous system under voluntary control
Patients then learn relaxation techniques
EMG often used
Martial therapy goal
Alleviate emotional distress and disability
Promote levels of well being of both partners together and of ea. As an individual
Martial therapy
Conflicts between married people involving social, emotional, sexual, or economic problems
Can be individual, couples, groups
CI if one person involved has psychosis
Doesn’t always result in couples remaining together
Family therapy
Focused on improving relationships within family structure
Therapist trained for family therapy
Uses interview technique, sessions held weekly (1-2 hrs/session)
Group therapy
8-10 patients with mental health disorders (can be a variety of disease, heterogeneous situations work best)
Meet weekly with a therapist present to change behavior
Can be inpatient or out patient
Contraindicated if social anxiety
Psychoanalysis
Used by psychiatrists
Based on sigmund Freud
Patient lies on couch
Psychoanalysis
Goals
Bring suppressed memories into present personality
Main emphasis on conflict between unconscious drives and moral judgments patient makes regarding their behavior
Psychoanalysis
Indication
Psychoneuroses (anxiety disorders, compulsive behavior, conversion disorder, sexual dysfunction, personality disorders)
Patient indications
Psychoanalysis
Genuine desire to gain self understanding of behavior
Able to handle emotions that emerge with psychoanalysis
Must be honest with analysis
Psychoanalysis
Fundamental principle (second principle)
Free association
Second principle - analyst must remain neutral
