M1 recap

Question 1

Freud personality structures

Answer 1

Id = drives/instincts/reflexes
- The id lacks the ability to problem-solve; it is not logical and operates according to the pleasure principle.

Ego = link with reality/ personality
- The ego develops because the needs, wishes, and demands of the id cannot be satisfactorily met.
- It is the problem solver and reality tester.

Superego = morality initially brought on by parents and parental figures
- The superego represents the ideal rather than the real; it seeks perfection, as opposed to seeking pleasure or engaging reason.

Levels of awareness (memories, emotions, perceptions, etc.)
Conscious = accessible able to be conscious of
Preconscious = accessible with effort
Unconscious = inaccessible / dont know where your behaiour comes from

Question 2

freud

psychoanalytic theory + role of the therapist

Answer 2

Psychoanalytic theory:
Traumatic memories and emotions “placed” in unconscious = too painful

Role of therapist:
Through talk therapy, help the patient ‘move’ unconscious material to the conscious

Question 3

examples of defence mechanisms

acting out, affiliation, altruism, compensation

Answer 3

1. Acting out: Exaggerated response to a stimulus that is directed to self, others or objects in the person’s environment
2. Affiliation: Accepting help and support from other
3. Altruism: The individual handles stressors by helping others. (adaptive)
4. Compensation: Dissimulation of weaknesses by leveraging desirable characteristics.

Question 4

examples of defence mechanisms

denial, devaluation, displacement, diassociation

Answer 4

1. Denial: Not admitting or aware of what’s happening
2. Devaluation: Attributing negative or inferior traits to self or others.
3. Displacement: When you take your emotions out on another person unrelated to the situation.
4. Dissociation: Separation between a memory/thought and the emotion to which it should be associated. Often described as an ‘out of body experience’

Question 5

examples of defence mechanisms

humour, identification, intellectualization, projection

Answer 5

1. Humour: Choosing to focus on the comical aspects of the situation.
2. Identification: Acquisition of attributes from another admirable person to increase on self’s self-worth.
3. Intellectualization: Avoiding painful emotions by generalizing and/or dealing with the problem through abstract thinking.
4. Projection: Putting your own attributes/faults on to someone else.

Question 6

examples of defence mechanisms

rationalization, transference, counter transference, reaction formation

Answer 6

1. Rationalization: Justifying experiences.
2. Transference: Patient develops emotions towards nurse that were previously held toward other significant others.
3. Counter-transference: Unconscious personal emotional response from nurse towards the patient.
4. Reaction formation: Doing the opposite of what is expected out of your own will

Question 7

examples of defence mechanisms

regression, repression, splitting, suppression

Answer 7

1. Regression: In reaction to stress, a person may regress to an anterior stage of development or to coping strategies associated with this stage
2. Repression: Discomfort is blocked from conscious awareness. The emotional aspect may remain, minus the related thought.
3. Splitting: The individual is unable to integrate two conflicting feelings.
4. Suppression: The individual deliberately avoids thinking about the unpleasant feeling or thought.

Question 8

REBT

aim, therapist role

Answer 8

Relational Emotive Behaviour Therapy (REBT) thoughts → emotion

Aim: Eradicate current irrational beliefs that cause negative emotions

Therapist’s role: Help recognize and challenge distorted thoughts (should, ought, must, etc.)

Question 9

CBT

Aim, therapist role

Answer 9

Cognitive Behavioural Therapy (CBT) thoughts → actions

Aim: Identify, challenge and correct automatic thoughts (cognitive distortions) based on assumptions developed from previous experiences

Therapist’s role: Teaching patients to autonomously challenge and replace distorted thoughts

Question 10

DBT

aim, role of therapist, target population

Answer 10

Dialectical Behavioural Therapy (DBT) manage emotions

Particularity: Teach persons methods to manage “swings” in emotions, tolerate distress and acceptance.

Target population: Persons with behavioural disorders with emotional dysregulation

Question 11

3 types of control delusions

Answer 11

thought insertion
- The belief that thoughts are being inserted into one’s mind by someone else

thought broadcasting
- The belief that one’s thoughts are obvious to others or are being broadcast to the world

ideas of references
- The belief that other people, objects, and events are related to or have a special significance for one’s self.

Question 12

paranoid, bizzare, somatic, grandieur, religious, erotomania

Answer 12

Paranoid delusions
- An irrational distrust of others and/or the belief that others are harassing, threatening,

Bizarre delusions
- An absurd or implausible belief. Ex - the electricity is making me gain weight

Somatic delusions
- A false belief involving the body or bodily functions.

Delusions of grandeur
- An exaggerated belief of one’s importance or power (reference to sovereignty or super powers)

Religious delusions
- The belief that one is an agent of or specially favoured by a greater being.

Erotomania
- The belief that someone (often a public figure) unknown to the individual is in love with them or in a relationship with them.

Question 13

form 1

Answer 13

The law gives every physician in Ontario the right to sign an Application for Psychiatric Assessment (Form 1)

A Form 1 authorizes the admission and involuntary admission of a person for up to 72 hours at a psychiatric facility for the purpose of assessment

Expires 7 days after being signed

Form 42: provided to the patient once the Form 1 is signed.
Without the Form 42, the Form 1 is invalid

Question 14

form 42

Answer 14

Notice to Patient (Signed by a physician)

Given promptly when a person is detained at a psychiatric facility for the purpose of an assessment under a Form 1

No right to appeal

Question 15

form 2

Answer 15

Same as form 1 except it can be filled out by anyone and needs to be signed by a justice of the peace
Expires 7 days after being signed

Authorizes the police to bring a patient to the hospital to be examined by a physician

A physician X at the hospital conducts an initial assessment if a psychiatric assessment is necessary

If yes, Form 1 is signed – because the Form 2 doesn’t authorize the involuntary admission / only the transportation to the hospital

Once the Form 1 is signed, the patient is admitted for 72h

Question 16

form 3

Answer 16

Certificate of Involuntary Admission
Filled out by attending physician - different than the physician who completed the Form 1

Must be completed 72 hours from start of detention period under a Form 1

A Form 3 is valid for 2 weeks from and including the date it is signed

If the Form 3 expires, the person is considered to be a ‘voluntary patient’

Question 17

form 4

Answer 17

Certificate of Renewal
Initiated by the attending physician before the expiry date of the previous Form 3 or 4.
1st Form 4 is valid for 30 days
2nd Form 4 is valid for 60 days
3rd Form 4 is valid for 90 days

must have a form 30 (someone comes to explain situation and informs them they have the right to appeal)

Question 18

form 5 and section 17

Answer 18

Change from Involuntary to Informal or Voluntary Status
- Initiated by attending physician

Whenever deemed appropriate to end a Form 3 or Form 4
- No expiration or renewal

Question 19

form 9

Answer 19

Order for Return from escaped person (form 3 or 4 must have a 9 bc 1/2 have a return policy)

Initiated by the officer in charge of a psychiatric facility.

Whenever the absence of a person who is subject to involuntary admission becomes known to the officer in charge.

Expires one month after absence becomes known

Question 20

anger vs rage

Answer 20

Anger: normal emotional response that can be released appropriately or inappropriately, suppressed over periods of time (bullying, cyberbullying, oppression), or controlled in its release.

Rage: Uncontrollable state of anger. Thinking is illogical and unclear. Behavioural interventions are useless.

Question 21

agression vs violence

Answer 21

Aggression: Emotion that results in a verbal or physical attack.

Violence: Aggression with the intent to harm. It includes psychological, emotional, damage to property, suicide and self-harm.

Question 22

anxiety related disorder

panic disorder

Tx and interventions?

Answer 22

Panic Disorder (Panic Attacks)
- Discrete episodes of intense anxiety that begin abruptly and reach a peak within minutes.
- Intense feeling of impending doom, apprehension.

tx/ interventions
- CBT
- benzos
- SSRI
- reassurance, positive self talk, allow them to talk feelings through

Question 23

GAD tx and interventions

Answer 23

psychotherapy
- CBT

pharmacotherapy
- benzos
- ssri and ssnri

interventions
- reassurance, support
- short sentences
- identify illogical thinking patterns (offer altrernate interpretations)

Question 24

somatic symptom disorders

illness anxiety disorder, conversion disorder

interventions?

Answer 24

expression of anxiety through physical symtpms
Treatment: Address underlying cause of anxiety

Illness Anxiety Disorder (previously: hypochondria)
- Anxiety secondary to believing one has a serious illness / imminent death
- Extreme worry about having a disease

Conversion Disorder
- Neurological symptoms in absence of neurological disorder

interventions
- Teach stress reduction techniques
- develop coping strageties

Question 25

Dissociative disorders

depersonalization
dissociative amnesia
DID

Answer 25

Depersonalization/Derealization Disorder
- Person feels detached from their body (or parts of their body) = “out of body experience” = they can see their body from above
- Derealization: Person feels their surrounding are unreal

Dissociative Amnesia
- Inability to recall autobiographical information (pieces of it - feelings, activities, persons, etc.)
- may be accessible with retrieval cues

Dissociative Identity Disorder
- Presence of two or more ‘personality states’ –
severe childhood trauma
(1) fixated on the traumatic experience
(2) avoidant of it
- Host personality’ unaware of others

Question 26

OCD

tx and interventions

Answer 26

OCD = Severe obsessions and compulsions that significantly interfere with normal daily living

Obsessions: Unwanted, intrusive and persistent thoughts, impulses, or images that cause anxiety and distress.

Compulsions: Behaviours that are performed repetitively, in a ritualistic fashion, with the goal of preventing or relieving anxiety and distress caused by obsessions.

tx
- CBT, SSRI

interventions
- consistent care plan
- response prevention (give stimulus and ask to refrain from doing such a ritual)

Question 27

PTSD

tx and support

Answer 27

Acute emotional response to a traumatic event or situation involving severe environmental stress

Re-experiencing the event – to which the person responded with intense fear, helplessness or horror

Symptoms may appear within 3 months of trauma, but delay may also occur (several months to years)

Tx
- CBT
- antidepressants and antianxiety meds

interventions
- support
- saftey plan