L16 - Lower Prevalence Conditions Flashcards
What does OCD refer to?
Obsessive Compulsive Disorder
What are the two main features of OCD?
Obsessions and Compulsions
What do obsessions refer to in OCD?
- Recurrent and persistent thoughts, urges, or images that are experienced as intrusive, unwanted and inappropriate or distressing
- The person attempts to ignore or suppress these thoughts, urges or images, or to neutralize them with some other thought or action (i.e., performing compulsion).
What do compulsions try to do for people with OCD?
A way to try and neutralise the obsessive thoughts.
What type of behaviours do we see in compulsions in OCD?
Repetitive Behaviours
(e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rigid rules
Why do people with OCD engage in compulsive behaviours?
The behaviours or mental acts are aimed at preventing or reducing anxiety / distress or preventing some dreaded event or situation;
but the behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
According to the DSM-5, what do the obsessions/compulsions have to impact on in order for the subject to be classified with OCD?
Obsessions / compulsions are time-consuming (take more than 1 hour per day) or cause clinically significant distress / impairment in social, occupational / other important areas of functioning.
What are some examples of common obsessions for people with OCD?
• Fear of contamination/germs, fire, robbery, rape or assault, becoming ‘insane’, insulting others, impulsive swearing, harming another person by acting on a sudden impulse (e.g., stabbing a friend), engaging in an inappropriate sexual act, blasphemy…
• Checking (e.g., power points, door locks), counting, washing/cleaning, ritualistic
thoughts/mantras, tapping a surface, leaving and re-entering a room, arranging objects
in a certain order…
What is the lifetime prevalence of people with OCD in Australia?
4%
What % of adults with OCD report that their symptoms began before the age of 18?
80%
How do we assess whether someone has OCD?
Yale-Brown Scale of Obsessive-Compulsive Symptoms (Y-BOCS)
• Child version (CY-BOCS)
and
• Clinical assessment/interview
Describe the OCD cognitive model.
- People experience an obtrusive thought
- Overinflation of the feared experience
- This generates a negative emotion
- In order to neutralise the negative emotion they feel like they need to do something
In the OCD cognitive model, what stage do clinicans focus on to try and stop the behaviour?
Maladaptive Appraisal
What treatment do we use to treat OCD?
A Cognitive Behavioural Therapy Techniques called Exposure and Response Prevention
How does exposure and reponse prevention work?
Develop a structured hierarchy with the specific phobia using Subjective Units of Distress (SUDS) ratings (i.e. how distressed would you be in this situation from 1-100)
Work with the person which you have a trusted relationship with
Gradually work up hierarchy of feared situation (lowerst SUDS to highest SUDS)
Why do we use exposure and response prevention
Cognitive Restructuring
Trying to restructure that negative appraisal.
Addressing maladaptive appraisal of intrusive thoughts with the use of behavioural experiments (in E&RP) to assist with restructuring
Does medication work for OCD?
Only for some people, for most ERP (exposure response prevention) is the best method to use.
How do responsibility pies help people with OCD?
By showing them that they are not entirely control of the outcomes and their compulsions are most likely not helping.
Restructuring cognitive beliefs
If someone with OCD has a ‘fear of contamination’, how might exposure therapy help?
By slowly exposing them to the contamination so that they realise that it is not as harmful as they believe.
Slowly altering their behaviour to reduce the amount that they engage in the compulsion.
What are the two key features of psychotic disorders?
- Disturbances in perception of reality (i.e., delusions/hallucinations)
- Disturbances in organization of thoughts and/or behaviour
What is the lifetime prevalence of psychotic disorders?
0.5-2%
For psychotic disorders is there a higher prevalence in males or females?
Males - 3:2 ratio
When is the age of onset for psychotic disorders?
Usually late adolescence or early adulthood
What % of individuals with psychotic disorders experience a severe impact on their ability to function in daily life?
90%
What % of people with a psychotic disorder are employed in comparison to the general population?
- 5% - Psychotic Disordered Individuals
(72. 4% general population)
What % of people with psychotic disorders have experienced homelessness in the previous year?
13%
What % of people with psychotic disorders are able to find a married partner?
17%
(61% for the general population)
How did psychotic disorders change from the DSM-4 to the DSM-5?
A shift from subtypes of schizophrenia to a spectrum approach
“Schizophrenia spectrum and other psychotic disorders”
What is the most prevalent type of psychotic disorder?
Schizophrenia
Name and describe the 4 phases of psychotic disorders.
In the 4 phases of psychotic disorders, which phase would we call the person “actively psychotic”?
Acute Phase
What does Aetiology mean?
The cause, set of causes, or manner of causation of a disease or condition
What is the aetiology of psychosis?
i.e. What are the risk factors?
Biological Vulnerability
Psychosocial Vulnerability
Describe the aspects of psychosocial vulnerability for psychosis?
Psychological and Social factors that make you vulnerable to psychosis.
Social: Urban Environment, migration, social exclusion, childhood abuse
Psychological: Interpreting intrusive thoughts as external phenomena, unhelpful responses (e.g., avoidance, thought suppression)
Describe the biological vulnerability in the aetiology of psychosis
Increased risk of psychosis if it is present in families.
- 3% risk if both parents have a psychotic disorder
- 4% if one parent affected
What is this graphic us?
That if you have a predisposition to psychosis it is the stressors on top that mean whether you will get the disorder.
Explain the DSM-5 diagnostic criteria for Schizophrenia.
What is the difference between Schizophrenia and Schizophreniform disorder?
Schizophrenia = symptoms for over 6 months
Schizophreniform disorder = symptoms for less than 6 months
If someone has a lot of risk factors for a psychotic disorder (Prodromal phase) what techniques can we use to intervene?
Cognitive Behavioural Therapy
What is the best time to intervene for someone who we is on the path to psychosis?
Prodromal Phase
CBT interventions when they are at high risk but haven’t developed psychosis yet
Experiment for CBT intervention in prodromal phase
Didn’t get CBD = 20-30% had active psychosis
Those who experienced CBT = < 5% developed psychosis
If someone with psychosis is in the acute phase (has developed psychosis) explain the three methods we can use to treat the disorder?
Medication
Psychological
Social
Why is medication important for treatment of people with psychosis?
Its very hard to engage in therapy when people are actively psychotic.
Engage in medication to reduce the severity in the acute phase.
There is a high risk of relapse with psychosis.
How do you prevent relapse into psychosis?
Ongoing medication
Psychosocial Approaches
What is the risk of using ongoing medication for psychosis?
Side-effects of the medication
They include: Weight gain, side effects like tardive dyskinesia (restless movements where they cant control facial movements)
What four psychosocial approaches can you use to prevent relapse into psychosis?
What is the prevalence of eating disorders in Australia?
9%
Do men or women experience eating disorders more?
10x more women have eating disorders than men
What group of women are most likely to have eating disorders?
Those in high school and tertiary education have higher prevalence than non-students
What are the 3 risk factors or influences for developing eating disorders?
What is the Minnesota experiment?
Study of human starvation by Keys et al. (1950).
How long were participants starved for in the Minnesota experiment?
6 months
What were some of the effects noted by participants after the Minnesota experiment?
- They experienced many of the symptoms that people have when they develop eating disorders.*
- Starvation is very impactful and people can’t engage in therapy when starving.*
How do you assess an eating disorder?
Do questionnaire and clinical interview
What are the two most common types of eating disorders for underweight individuals?
Anorexia Nervosa
Bulimia Nervosa
What are the 3 features of Anorexia Nervosa according to the DSM-5?
What are the two sub-types of Anorexia Nervosa?
Restricting Type
Binge-eating/purging type
Describe the DSM-5 criteria for the restricting type of Anorexia Nervosa
Describe the DSM-5 criteria for the binge eating/purging type of Anorexia Nervosa
What is the difference between the binge eating/purging Anorexia and Bulemia?
Anorexia tend to restrict their food intake a lot and have the low body weight.
When does Anorexia Nervosa usually onset?
Early to Late Adolescence
Which mental health disorder has the highest mortality rate?
Anorexia Nervosa
- Due to the medical complications of starvation or suicide*
- 5-10% of people with AN die per decade of illness*
Why is it considered difficult to treat Anorexia Nervosa?
(4 reasons)
What are the 5 classifications for Bulimia Nervosa in the DSM-5?
What are the associated medical conditions that come with Bulimia Nervosa?
What treatments can you use to treat Bulimia Nervosa?
CBT
- Treatment of choice but many still don’t respond, indicating a need for improvement
Interpersonal Psychotherapy (IPT)
- Helps identify and change current interpersonal problems (e.g. conflict) that are assumed to be maintaining the disorder
Which disorder has a higher treatment effectiveness, Anorexia Nervosa or Bulimia Nervosa?
Bulimia Nervosa has a higher treatment effectiveness
Who is Martin Seligman?
Famous for studying ‘learned helplessness’ in depression
Founder of Positive Psychology
Describe the 5 stages of the PERMA framework of wellbeing
What is Positive Psychology’s PERMA?
Used as a ‘framework for wellbeing’
What are 6 factors that are believed to be involved in positive mental health?
- Gratitude
- Self-compassion
- Social Relationships and Connections
- Optimism, sense of meaning, hope
- Mindfulness
- Exercise
