Introductory Lectures Flashcards
Multifinality
various outcomes may stem from similar beginnings
equifinality
similar outcomes may come from different early experiences
Etiology
the manner of causation of a disease or condition
Nolosogy
disease classification system
Epidemiology
study of illness or diseases in populations
Purpose of the DSM
some effort of classification of psychiatric disorders
DSM I
- 1952
- All disorders of psychogenic origin or without clearly defined physical cause were considered “reactions”
- Anxiety is at the core of all diagnoses (Freud’s psychosexual development”
- Homosexuality = “sexual deviation disorder”
DSM II
- 1968
- Provided brief descriptions of characteristic signs and symptoms of disorders but no criteria as such
- Homosexuality removed but changed to “sexual orientation disturbance”
DSM III
- 1980
- Now clear diagnostic criteria for EVERYTHING
- Specified a group of disorders as “usually first evident in infancy, childhood, or adolescence”
- “ego dystonic homosexuality” homosexuality removed
- same two people should come up with the same diagnosis (inter reliability)
- elimination of the term neurosis
DSM IV
- 1994
- more clarified diagnoses and criteria
- multiaxial system
DSM V
GOAL: TO MOVE AWAY FROM CATEGORICAL DIAGNOSES AND TOWARDS DIMENSIONAL DIAGNOSES
- not exclusive….a lot of crossover…a spectrum
- frequency of NOS (not otherwise specified diagnoses)
- organized developmentally and by internalizing and externalizing features
Criticisms of the DSM V
Allen Frances article
- premature and unrealized goal
- APA dependence on publishing profits
- Disruptive Mood Dysregulation Disorder (DMDD): turning temper tantrums into a mental disorder, based off of only one research group
- BInge Eating Disorder
- normal grief = major depressive disorder
Most common causes of mortality in adolescence
Accident
Homicide
Suicide
Health paradox of adolescence
morbidity and mortality go up when the body is most healthy
- make bad choices they wouldn’t make when younger or older (risk taking behavior)
- problems with cognitive thinking because of emotional instability (romeo and juliet)
Mental health service delivery
child services underserved
- how early mental illness sets on
50% by 14 years of age
Maturation of brain neural tracks and networks
- cognitive development correlates more strongly with age and experience than with sexual and physical maturation
- frontal lobes may not be fully developed until mid 20s
- prefrontal cortex vs striatum (limbic system including the hippocampus and amygdala)
- network between pfc and striatum increases with age
Neonatal/childhood differences between males and females
- Girls
- more internalizing problems
- recognizes faces better
- acquire skills better (over their body, etc)
- mature faster than boys
- Boys
- more externalizing problems
- recognize items more than girls
- greater spurt in testosterone in utero, more prone to anger than girls are by nature
Theories of Development: Freud
- fully developed when you reach sexual maturity
- drive theory
- oral
- anal
- phallic- oedipal
- latency phase
- puberty and adolescence
Theories of Development: Mahler
when kids learn to separate and identify themselves from others as an individual
- separation individuation (people to objects)
- relationships are the primary force in life
- normal autism
- symbiosis
- differentiation
- practicing sub-phase
- rapprochement
- object constancy (2-5 years)
Theories of Development: Erikson
Psychosocial stages of development
-never fully mature until death
- basic trust vs mistrust
- autonomy vs shame and doubt
- initiative vs guilt
- industry vs inferiority
- identity vs role confusion
- intimacy vs isolation
- generativity vs stagnation
- integrity vs dispair
Theories of Development: Piaget
Cognitive Development
Fully mature with cognitive intelligibility
- sensorimotor stage (reflexes)
- preoperational stage (symbols, mental representations)
- concrete operational stage (logic, classification)
- formal operational stage (reasoning, abstraction)
Theories: Pavlov, Watson, Skinner)
Pavlov- Classical conditioning
Skinner- operant conditioning
Attachment Theory
Bowlby and Ainsworth
an infant needs at least one person whom they can securely attach in order for the social and emotional development to occur normally
- infant well attached when adult figure is sensitive and responsive to needs
previous theories
mental health practitioners = alienists
Humoral Theory: disease followed an excess of any humors: yellow bile, blood, vomit
- kept in cellars and cages
- john locke: social conscience
pinel: mental health no longer because of demonic possession
Rush: first american textbook on psychiatry
Dix: started mental hospitals so no longer in cellars
Adolescent Risk Taking Behavior
they think theyre invincible
starting the engine like an unskilled driver = adolescence
WHY THE RISKS?
- overestimate the benefits
- think the risks aren’t as bad as adults say they are
- engage in optimistic bias ( bad things won’t happen to me)
- “just this once” mentality. they can get away with it
5/ risk quantitiatively not qualitatively - social exclusion hurts
Basic Diagnostic Domains on the Psychiatric Diagnostic Evaluation and their Purposes
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Basic Categories of the Psychiatric Diagnostic Evaluation Template
- Basic Information (DOB, informants, chief complaint)
- History of Present Illness (rule out symptoms, description, stressors)
- Past Medical History
- Pasty Psychiatric History
- Current Medications
- Allergies to Medications
- Substance Abuse/Toxic Exposure
- Psychosexual History
- Developmental History
- Educational History
- Family History
- Review of Systems (current physical concerns)
- Physical/Neurological Examination
- Mental Status Examination
- Additional Assessments
- Biopsychosocial Assessment
- Diagnosis
- Treatment Plan
What is on the Mental Status Examination
- General Observations
- Behavior
- Appearance
- Speech
- Mood
- Affect
- Perceptual Disturbances ( measure against developmental level)
- Thought Processes
a. range (ex perserveration vs broad in scope, etc) - Thought Content
a. Creative play
b. age appropriate ideas and comprehension
c. Flexibility - Sensorium and Cognition
- Judgement and Insight
- Reliability and Impulse Control
Key aspects of a child developmental history
- mother’s fertility
- use of tobacco, alcohol and/or drugs
- post natal complications
- milestones
- motor
- language
- toileting
- social
Rule out Symptoms
Psychosis
Anxiety Disorders
Mood Disorders
ADHD
Tics and Tourettes
Externalizing Disorders
Pervasive Disorders
Eating Disorders
Self Injurious Behavior
Trauma
