M1 recap Flashcards
Freud personality structures
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
freud
psychoanalytic theory + role of the therapist
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
examples of defence mechanisms
acting out, affiliation, altruism, compensation
- Acting out: Exaggerated response to a stimulus that is directed to self, others or objects in the person’s environment
- Affiliation: Accepting help and support from other
- Altruism: The individual handles stressors by helping others. (adaptive)
- Compensation: Dissimulation of weaknesses by leveraging desirable characteristics.
examples of defence mechanisms
denial, devaluation, displacement, diassociation
- Denial: Not admitting or aware of what’s happening
- Devaluation: Attributing negative or inferior traits to self or others.
- Displacement: When you take your emotions out on another person unrelated to the situation.
- Dissociation: Separation between a memory/thought and the emotion to which it should be associated. Often described as an ‘out of body experience’
examples of defence mechanisms
humour, identification, intellectualization, projection
- Humour: Choosing to focus on the comical aspects of the situation.
- Identification: Acquisition of attributes from another admirable person to increase on self’s self-worth.
- Intellectualization: Avoiding painful emotions by generalizing and/or dealing with the problem through abstract thinking.
- Projection: Putting your own attributes/faults on to someone else.
examples of defence mechanisms
rationalization, transference, counter transference, reaction formation
- Rationalization: Justifying experiences.
- Transference: Patient develops emotions towards nurse that were previously held toward other significant others.
- Counter-transference: Unconscious personal emotional response from nurse towards the patient.
- Reaction formation: Doing the opposite of what is expected out of your own will
examples of defence mechanisms
regression, repression, splitting, suppression
- Regression: In reaction to stress, a person may regress to an anterior stage of development or to coping strategies associated with this stage
- Repression: Discomfort is blocked from conscious awareness. The emotional aspect may remain, minus the related thought.
- Splitting: The individual is unable to integrate two conflicting feelings.
- Suppression: The individual deliberately avoids thinking about the unpleasant feeling or thought.
REBT
aim, therapist role
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.)
CBT
Aim, therapist role
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
DBT
aim, role of therapist, target population
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
3 types of control delusions
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.
paranoid, bizzare, somatic, grandieur, religious, erotomania
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.
form 1
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
form 42
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
form 2
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
form 3
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’
form 4
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)
form 5 and section 17
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
form 9
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
anger vs rage
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.
agression vs violence
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.
anxiety related disorder
panic disorder
Tx and interventions?
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
GAD tx and interventions
psychotherapy
- CBT
pharmacotherapy
- benzos
- ssri and ssnri
interventions
- reassurance, support
- short sentences
- identify illogical thinking patterns (offer altrernate interpretations)
somatic symptom disorders
illness anxiety disorder, conversion disorder
interventions?
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
Dissociative disorders
depersonalization
dissociative amnesia
DID
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
OCD
tx and interventions
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)
PTSD
tx and support
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
