Jour 2 Flashcards
Psychodynamic Psychotherapy Technique: Differentiating Features
Focus on affect and expression of emotion
Exploration of attempts to avoid aspects of experience (resistance)
Identification of recurring themes and patterns
Discussion of past experience
Focus on interpersonal relations (internalized object relations)
Focus on therapeutic relationship (working alliance, transference, countertransference)
Exploration of wishes, dreams, and fantasies (intrapsychic dynamics and subjective experience)
Défense primaire vs secondaire: lequel est mature
Primaire: immature
Secondaire: mature
Défenses primaires
Denial – “this isn’t happening”
Extreme idealization and devaluation
Projection, Introjection, and Projective Identification
- Projection -misunderstanding what is coming from the inside as coming from the outside
- Introjection-what is outside is misunderstood as coming from inside (e.g. identification with the aggressor)
- Projective identification – “self-fulfilling prophecy” – interpersonalization of projection/introjection (explicated in Kleinian Theory)
Splitting [of the ego] – all good/bad binary – reveals absence of capacity for ambivalence
Other primary defenses – somatization, extreme withdrawal, acting out, [extreme] dissociation
Défenses secondaires
Repression
Rationalization, intellectualization, isolation of affect, moralization
Compartmentalization
Displacement
Turning against the self
Reaction Formation
Regression
Undoing
Humor
Sublimation
Réponses normales au trauma
Intensity of response varies with severity of trauma
Re-experiencing symptoms (thoughts, dreams, images)
Intense emotional reactions: fear, anger, helplessness, and despair
Increased vigilance and autonomic arousal
Gradual adjustment over weeks
Différence entre honte et culpabilité
Honte: je suis mauvais
Culpabilité: j’ai fait quelque chose de mauvais
Prévalence PTSD
8%
Facteurs augmentant vulnérabilité au PTSD
Female gender
History of psychiatric illness (including depression and anxiety)
Type of trauma
Prolonged or repeated exposure
Childhood trauma
Poor social support system
Genetic-constitutional vulnerability
Recent life stressors or changes
Feeling loss of control (external locus of control rather than internal)
Recent excessive alcohol or drug intake
Rôle nabilone en PTSD
Cauchemars
Première étape psychoTx PTSD
Stabilisation:
Safety
Treatment of comorbid disorders
Sobriety
Management of extreme emotions
Reduction of parasuicidal behaviour
Coping
Stable relationships
Community supports
Psychoeducation
Pharmacotherapy
Anxiety Management
STAIR (Skills Training in Affective and Interpersonal Regulation; Cloitre et al., 2010)
Dialectical Behaviour Therapy adapted for PTSD (for PTSD related to childhood abuse or if PTSD is comorbid with borderline personality disorder; Bohus et al., 2020)
Éléments à regarder pour aptitude à comparaitre
-Comprendre nature des charges
-Comprendre rôle des protagonistes
-Comprendre conséquence d’être déterminé coupable/non-coupable
-Capacité à communiquer avec avocat
-Est-ce que trouble mental impacte la capacité du patient à effectuer sa défense (délirant p/r système judiciaire? est-ce que patient est si déprimé qu’il désire être trouvé coupable et puni?)
Facteurs de risque somatisation
Teens who somatize have an increased risk of diagnosis with SD in adulthood if:
-They are female
-They have comorbid psychiatric disorders
-Their parents had psychiatric disorders
-More negative life events
Survivors of trauma have an increased risk of diagnosis with SD if:
-They have difficulty regulating affect
-Early exposure to sexual abuse> physical abuse (or does it? See MUPS in 2018)
-Recurrent exposures to trauma> single event
Other associated factors with somatization
-Alexithymia
-Attachment disorders
-Chronic or comorbid disease
Efficacité traitement trouble lié à la symptomatologie somatique chez les ados
49% complete remission
32% had some response.
19% had no change
Relation entre trouble factice et self-harm
Choisierons self-harm (ou self-imposed illness, disons), avant forme plus simple de déception
Tendance générale de trouble factice
Dramatic, inconsistent, deceptive presentations
Seeking treatment from various facilities
Course of illness is atypical and doesn’t follow natural history of presumed disease
Pt predicts deteriorations or the timing of these is suspect
Easily agrees to invasive, risky interventions
Tendance de la prévalence de dépression
Pas d’évidence de changement
Réduction de l’espérance de vie si on a une dépression
14 ans chez l’homme
10 ans chez la femme
Les personnes âgées ont-ils un taux plus élevé de suicide
Les hommes, oui
(1 suicide/2 tentatives chez les hommes ainés)
Sx plus présents chez les jeunes vs. vieux déprimés
Jeunes: sensibilité interpersonnelle, irritabilité, hypersomnie, diminution de l’humeur, augmentation de l’appétit
Ainé: réveils précoces, diminution libido, difficulté dormir la nuit, variation diurne (pire le matin), autres Sx corporels
Risques associés aux adverse childhood events
ACEs confer a 2-3 fold increase risk in suicidal behavior in adulthood
* Those with >4 ACEs 2x risk of obesity, diabetes; 3x rate of cancer,
substance abuse and cardiac disease
* ACEs associated with poorer response to psychotherapy and
medications
4 antidépresseurs plus aventageux en raison de balance d’efficacité et acceptabilité
- Escitalopram
- Sertraline
- /4. Bupropion, citalopram
