Mental Health Flashcards
What are the main theories used to understand mental health disorders (and their causes, treatments & limitations)
- Supernatural
- Medical/biological
cause: internal biological dysfunction
treatment: target biological deficiencies e.g. medication
limitations: extreme reductionism - Psychoanalytic
cause: maladjustment from excessively/rigidly applied defence mechanisms i.e. repression, denial, projection, displacement, regression, sublimation
treatment: gaining insight into unconscious processes e.g. dream analysis
limitations: lacks empirical evidence (unfalsifiable), unreliable - Behavioural
cause: all behaviour is shaped by learning history
treatment: habituation to feared stimuli, extinguish old responses, reward systems
limitations: no focus on cognition, fails to explain observed or indirect behaviour - Cognitive/Behavioural
cause: maladjustment, negative core beliefs lead to automatic negative thoughts which shape behaviour
treatment: cognitive challenging, behavioural experiments, exposure
What are the differences between the DSM and ICD
ICD - used in Europe, currently 10th edition
DSM - used in Australia/USA (English-speaking world), currently 5th edition
Outline the important advances of the DSM throughout history
- Homosexuality removed (1973)
- Generalised anxiety disorder added (1987)
- Binge eating disorder added(2013)
- Asperger’s reclassified (2013)
Outline the benefits and limitations of diagnosis & the DSM5
Benefits of classification - identifying diagnostic categories can lead to specific treatment
Benefits of diagnosing - improved communication & understanding, reduced stigma
Limitations of classification & diagnosis - constantly increasing number of disorders (reification), extreme reductionism, harmful (limiting opportunities and self-beliefs), doesn’t explain comorbidity
Describe the main diagnostic criteria and symptoms of depressive episodes vs. depressive disorder
Depressive episode
A. At least 5+ symptoms
affective symptoms: depressed mood, anhedonia
somatic symptoms: fatigue, sleep/appetite change
cognitive symptoms: feelings of guilt, lack of concentration
B. Clinically significant distress/impairment
C. Not attributed to substance use or another medical condition
Depressive disorder - single or recurring depressive episodes
Describe features of hypomanic, manic episodes & cyclothymia
Bipolar Disorder I (Manic episode)
A. at least 1 week abnormally elevated/expansive/irritable mood AND increased goal-directed behaviour
B. At least 3+ symptoms
inflated self-esteem/grandiosity, decreased need for sleep, rapid/ pressured sleep, flight of ideas/racing thoughts, distractibility, increase in goal-directed activity, excessive involvement in high risk activities
C. Mood disturbance causes marked impairment, requires hospitalisation to prevent self-harm, includes psychotic features
Bipolar Disorder II (Hypomanic) - same as BPI but to as lesser extent, no psychotic features & not severe enough to cause marked impairment/hospitalisation
Cyclothymia - chronic, less severe form of bipolar disorder, numerous cycles of hypomanic & depressive symptoms, but not severe enough to meet the criteria for a manic or major depressive episode, at least 2 years, no more than 2 months without symptoms
Outline the epidemiology of bipolar disorder (POCC)
Prevalence - 1 in 50 Australians, men = women for BP1, women > men for BP2
Onset - emerges in late adolescence/early adulthood
Course - predominantly depressive, 10-20 year delay in seeking treatment
Comorbidity - 50% anxiety disorders, 39% substance misuse, 25% attempt suicide
Outline the aetiological factors of bipolar disorder (GBEP)
Genetic - 10% chance if parent has it, high heritability
Biological - neurobiological disorder as the 3 “reward-system NT’s (serotonin, dopamine, noradrenaline) malfunction
Environmental - manic & depressive episodes likely follow a change in environment (e.g. manic - disrupted routine/sleep cycles, excessive focus on goal attainment… depressive - low social support/self-esteem)
Psychological - negative core beliefs, perfectionism & sociotrophy (extreme need for approval)
Describe the difference between normal & abnormal anxiety
Both activate same 3 inter-related systems in response to a perceived threat (physical, cognitive, behavioural)
Normal anxiety - evolutionary value (survival & social stability)
Abnormal anxiety - overestimation of threat appraisal, deviant, distressing & dysfunctional
Outline the main diagnostic criteria for Social Anxiety Disorder
A. Marked fear of situations where social scrutiny may occur
B. Fear that one will be negatively evaluated based on their actions
C. Social situations almost always provoke anxiety/fear
D. Social situations are avoided or endured with intense anxiety/fear
E. Anxiety is disproportional to the actual threat
Describe the epidemiology of Social Anxiety Disorder (POCC)
Prevalence - 1 in 12 Australians, lower rates in European & Asian countries as they are more collectivistic, men more likely to seek treatment (women in clinical samples < general population) -> signs of weakness
Onset - childhood/adolescence
Course - chronic without treatment but 60% recover after 5+ years without treatment, only 50% seek treatment
Comorbidity - other anxiety disorders, depression, substance use, avoidant personality disorder
Describe the treatment for Social Anxiety Disorder
- CBT: to reduce inflated threat appraisal
- Psychoeducation: “anxiety is normal… threat appraisal… avoidance is a reinforcer”
- Cognitive techniques: challenging & modifying unhelpful/inaccurate thoughts
- Behavioural techniques: exposure therapy (flooding < systemic desensitisation), behavioural experiments
Outline the main diagnostic criteria for schizophrenia
A. 2+ symptoms & at least 1 psychotic symptom for at least 1 month
B. Clinically significant distress/disturbances in functioning
C. Disturbances in functioning for > 6 months + at least 1 month of psychotic symptoms
D-F. Not better accounted for by: schizoaffective, substance use disorder, autism spectrum disorder
Describe the core symptoms of schizophrenia
Positive symptoms - presence of problematic behaviour
- psychotic symptoms (delusions, hallucinations, disorganised speech)
- grossly disorganised/catatonic behaviour
Negative symptoms - absence of healthy behaviour
- affective flattening (social withdrawal, anhedonia)
- avolition (amotivation, apathy, self-neglect)
- alogia (poverty of speech, poverty of content)
Describe the epidemiology of schizophrenia (POC)
Prevalence - 1-2%, 3:2 male:female
Onset - late adolescence/early adulthood
Course - highly variable (normal behaviour between psychotic episodes), chronic condition (50% unable to work, homelessness, low income etc.)
Describe the aetiology of schizophrenia (GNN)
Genetic - higher risk with closer genetic similarity (e.g parents more likely than grandparents)
Neurochemical - dopamine hypothesis (treatment for Parkinson’s with dopamine induced psychotic symptoms, anti-dopaminergic medication was effective in 60% of patients with more impact on positive symptoms
Neuroanatomical - enlarged ventricles & loss of brain tissue in pre-frontal cortex in schizophrenic patients
What are the prognostic features of schizophrenia
Early onset -> poorer outcomes
Early treatment -> better outcomes
Describe the treatments used for schizophrenia
Medication - 60% of patients with positive symptoms respond, but high relapse rates & non-compliance (paranoia)
Psychological - targeted to the stage of illness, targeting specific deficits (e.g. social skills, medication compliance, stress management, family conflict, reducing delusions)
Describe the diagnostic criteria & core symptoms of substance use disorders
A. 2+ symptoms for at least 12 months
Impaired control
- using larger amounts than intended
- persistent desire/unsuccessful attempts to cut back
- excessive time obtaining/using/recovering from substances
- craving
Social impairment
- failure to meet obligations
- social or interpersonal difficulties
- social/occupational/recreational activities reduced/given up
Risky use
- use in physically hazardous situations (e.g. driving)
- persistence despite awareness of physical/psychological problems exacerbated by use
Pharmacological indicators
- tolerance
- withdrawal
Describe the epidemiology of substance use disorders (PC)
Prevalence - 1 in 15 Australians (alcohol use disorder), 1 in 45 (any other substance use disorder), males > females
Comorbidity - 60% patients have a comorbid disorder, anxiety > depression > PTSD (due to overlapping genetic & environmental triggers)
Describe the aetiology of substance use disorders (GBEP)
Genetic - strong poly-genetic component
Biological - dopamine hypothesis (speed of reward system activation determines effectiveness)
Environmental - family history, peer pressure, low parental monitoring, harsh disciplining approaches
Psychological - behavioural factors (classical/instrumental conditioning, cue elicited craving), cognitive factors (negative core beliefs & cognitive distortion)
Describe the core treatment issues when treating substance use disorders
- No single treatment is effective
- Needs to be readily available & accessible
- Dual diagnosed patients need to have both disorders treated in an integrated fashion
- Recovery can be long term & require multiple episodes of treatment
Describe the main medical and psychological interventions used to treat substance use disorders
Medical - detoxification (doesn’t target maintaining factors, relapse rates don’t change), pharmacological (antagonists & agonists)
Psychological - motivational interviewing (MI, used in contemplation stage), cognitive-behavioural therapy (CBT, challenging dysfunctional thoughts etc.)
Describe the main types of psychotherapy
- Psychoanalysis (Sigmund Freud, ego, superego, id)
- Behaviour therapy (Skinner/Pavlov, based on conditioning)
- Cognitive therapy (Aaron Beck, identify/challenge dysfunctional cognitions
- MBSR, MBCT, ACT, DBT (mindfulness, values)
- CBT & 3rd wave CBT (more humanistic/spiritual)
- Mindfulness based approaches
Outline the main factors to consider when assessing psychotherapy effectiveness
Delivery
Generic factors - little/no specific effect of different treatments (general counselling skills, client motivation)
Placebo effect
