intro to psych - somatic sx and related disorders Flashcards
criminalization of psychiatric illness
As psychiatric patients were de-institutionalized, the number of mentally disturbed homeless increased as did the percent of convicts with psychiatric disorders.
“Psychiatrization” of criminal behavior
Some criminals feign psychiatric symptoms in an attempt to be granted a less severe sentence.
Chlorpromazine (Thorazine):
First medication for psych patients. Initially marketed as an antihistamine, widely used for its sedative effect.
The 1964 Medicare Modernization Act and Medicaid Acts, Title XVIII and Title XIX of the Social Security Act
Together, these acts deinstitutionalized mental hospitals, drove care toward community settings and provided slightly more resources for treatment.
Public Law 102-321 (1992):
Created SAMHSA (Substance Abuse and Mental Health Services Administration) and established block grants for states to fund Community Mental Health services for patients with serious mental illness who are unable to otherwise pay.
-Describe abnormal behavior in terms of the following models: disease
The Disease Model proposes that dysfunction arises in the context of pathology. Primary pathologies affect the brain directly (Alzheimer Disease), Secondary pathologies do not (AIDS associated Dementia).
-Describe abnormal behavior in terms of the following models: dimensional
The Dimensional Model considers the patient’s characteristics and plots them against a normal distribution of the population’s characteristics. 1SD = 68%, 2SD = 95%, 3SD = 99%.
-Describe abnormal behavior in terms of the following models: self
-Self: The Self Model proposes that normality arises due to a combination of the following: developmental social learning behavioral psychoanalytic
-Describe the patient – doctor relationship
It is necessary to build a Rapport and demonstrate Unconditional Positive Regard.
Transference
Patient projects emotions regarding one person/event onto another.
Countertransference
Physician projects emotions regarding one person/event onto the patient.
Maslow’s Hierarchy
Physiological, Safety/Security, Love/Affiliation, Self-Esteem, Self-Actualization.
Jean Piaget developmental guidelines
Sensori-Motor w/Object Permanence, Pre-Operational, Concrete Operational, Formal Operational.
Erik Erikson developmental guidelines
Trust/Mistrust, Autonomy/Shame, Initiative/Guilt, Industry/Inferiority, Generativitiy/Stagnation, Integrity/Despair.
-Margaret Mahler
l Autism, Symbiosis, Differentiation, Practicing, Rapprochement, Object Constancy.
John Bowlby
Normalcy (attachment and bonding) or Abnormality (Failure to Thrive, Separation Anxiety, Avoidant Personality and Depressive Disorders)
-Classical Conditioning:
Establishing a Conditioned Response to a Conditioned Stimulus.
Operant Conditioning:
Positively or Negatively Reinforcing Behaviors
-Freudian Stages
Oral, Anal, Phallic (Oedipal), Latency, Genital.
Id
Irrational Pleasure-Seeking Unconscious Mind. Narcissistic and Uncaring.
Ego
Realistic, Rational and Efficient.
superego
Embodies Parental/Societal Values and Enforces Rules and Guilt.
Denial
Distortion of the Facts of Reality in favor of Wishful Fantasy Fulfilment.
Repression
Denying experiences and forgetting feelings.
most common
Suppression
Undesirable feeling are present but Ignored.
most healthy
Projection
Unacceptable feelings are transferred to someone/something else
Displacement
: Reactions to an Unpleasant Stimulus are taken out on a less threatening target.
Reaction Formation:
Expression of an emotion opposite of the Suppressed emotion.
Regression
Adopting a child-like frame of reference when confronted with conflict, anxiety or frustration.
Fixation
Refusal to progress to the next stage of development due to anxiety.
Identification
Adopting the characteristics of another for fear of losing them.
Rationalization
: Finding a self-serving explanation to justify a behavior and avoid feelings of guilt.
Sublimation
Redirecting unacceptable energies to more acceptable pursuits. (healthiest)
Intellectualization
Trying to “Out-Smart” a problem instead of facing the realities.
Acting Out
Externalizing stress.
Passive Aggression
Outward superficial cooperativeness masks underlying resistance, resentment and hostility.
Understand the psychiatric examination through clinical interview
Information specific to the Psych Exam includes Past Psych Hx, Meds, Providers, Outcomes, Substance Abuse, Sleep Pattern, Family Psych Hx, Infancy/Toddler, Latency, Adolescent Risk Factors, Memories, Current Family Structure, perception of Love, Ambition, Hobbies and Religious Beliefs.
-Understand how Testing works to determine Normality or Abnormality:
-Personality Tests are designed to interpret an individual’s dynamics, modes of behavior and cognitive functioning.
Rorschach Ink Blot Test
The less similar the interpretation is to the popular standard response, the greater the likelihood of psychopathology.
Thematic Apperception Test
Patient creates stories based on 10 stimulus images and reveals drives and emotions.
Incomplete Sentence Blank Test
Patient fills in the blank, often with repressed thoughts/emotions.
Draw a Person, House-Tree-Person Test:
The quality, size, proportion, angulations, perspective and themes of patient’s drawings are interpreted.
Minnesota Multiphasic Personality Inventory II:
Most widely used, with built in measures to detect deception, specifically Lying, Infrequency and Suppression.
Mellon Clinical Multiaxial Inventory:
Shorter test, identifies Personality Disorders and Sociopaths.
intelligence tests
-Intelligence Tests are designed to assess thinking, analyzing, synthesizing, aptitude and decision making.
IQ test
-IQ = (Mental Age/Chronological Age) * 100, developed by William Stern based on the work of Simon and Binet.
David Wechsler defines intelligence
as the capacity to act purposefully, to think rationally, and to deal effectively with the environment.
Stanford-Binet Test
Fluid Reasoning, Quantitative Reasoning, Visual-Spatial Processing and Short Term/Working Memory.
Neuropsychological Tests assesses
Memory, Attention and Executive Functioning
Bender Visual Motor Gestalt Test:
Assesses perceptual maturation and neurological impairment.
Benton Visual Retention Test
Assesses visual perception, visual memory, visual-constructive abilities.
Halstead-Reitan Test
Designed to determine the location and effects of specific brain lesions.
Biological Model
Patient’s psychosis is precipitated by organic disease. Tx: Medical
Psychosocial Model:
Patient has relational problems or has suffered abuse/neglect. Tx: Psychotherapy, Cognitive Behavioral Therapy.
- Distinguish normal moods from Depressive/Bipolar Disorders
Normal Moods exist on a spectrum with some days being happier than others.
-Abnormal Mood shifts are exaggerated and last for prolonged periods. Tend to occur when an individual’s coping strategies become ineffective.
SIGECAPS
Dx for severe depression: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide.
DIGFAST
(For Dx of Mania) Distractability, Indiscretion, Grandiosity, Flight of Ideas, Activity Increase, Sleep Deficit, Talkativeness.
Manic
A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy lasting 1 week and present most of the day. Mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning.
Hypomanic
A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy lasting at least 4 days and present most of the day. The episode is not severe enough to cause marked impairment in social or occupational function or to necessitate hospitalization.
Major depressive:
A) 5 or more of the following symptoms over a 2-week period. Sx: Depressed Mood, Loss of Interest or Pleasure, Significant Weight Loss, Insomnia/Hypersomnia, Psychomotor Agitation/Retardation, Fatigue, Feelings of Worthlessness or Inappropriate Guilt, Diminished Ability to Concentrate and Recurrent Thoughts of Death. B) Sx must cause Clinically Significant Distress or Impairment. C) Episodes must not be Attributable to Physiological Effects of a Substance or Medical Condition.
-Bipolar I Disorder
Hx of >1 Manic Episode not better explained by other disease
Bipolar II disorder
Hx of Hypomanic (not Manic) Episodes and Major Depression. Patients generally present during a Major Depressive episode and are unlikely initially to complain of Hypomania. Although they don’t progress into mania, this disease is more debilitating.
Cyclothymia
Numerous periods of Hypomania and Depression for >2 years that don’t meet the criteria for Hypomanic and Major Depressive Episodes.
Rapid cycling:
Presence of at least 4 Mood Episodes in the Past 12 months with full remissions of at least 2 months in between episodes. The Kindling Phenomenon suggests that these patients may have a biological defect of the HPA Axis, lowering their tolerance for stress.
seasonal pattern
Mood disorders are observed to come or resolve during certain times of the year.
Peripartum depression (PPD):
Any mood disorder arising in Pregnancy or up to 4 weeks after delivery
-Melancholic features:
Loss of Pleasure and Lack of Reactivity to Pleasurable Stimuli in the deepest part of a Depressive Episode.
Best practice
According to NIMH, the best treatment for Severe Major Depressive Episodes is Pharmacotherapy in combination with Psychotherapy.
Serotonin Syndrome
Excessive Serotonin from OD of Meds.
Serotonin Discontinuation syndrome:
Patients experience deficit of Serotonin if meds are stopped without tapering.
Electroconvulsive therapy indications
Usefult when 1st line Meds or Psychotherapy are not effective or are too slow. AE: Confusion, Memory Loss (30 Mins), Muscle Aches and HA.
Bright light Therapy
Indicated in Mood Disorders w/Seasonal Pattern. Light is shone on the patient to suppress production of Melatonin.
Somatic Symptom Disorder
One or more Somatic Sx that are Distressing or Significantly Disrupt daily life and Excessive Worry/Anxiety/Time devoted to Health Concerns.
Illness Anxiety Disorder
Preoccupation with having or acquiring a serious illness leads to high anxiety, excessive health-assurance activities and maladaptive avoidance. Ex: Hypochondriacs.
Conversion Disorder
Sudden loss of Motor or Sensory function following a Stressor.
Factitious Disorder
Falsification of Physical or Psychological Signs/Sx. Consciously presenting oneself as Ill, Impaired or Injured.
