Psych 2 Flashcards
What is stigma?
A social construction that devalues people to a distinguishing characteristic or mark
What are the methods to reduce stigma?
Good manage managment
Consider own attitudes
Personal experience
>The more exposure the less likely to stigmatise that thing
What is psychosis?
A severe form of psychosis
Often with a lack of insight
Inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality
What are Hallucinations?
Have the full force and clarity of true perception
Located in external space
No external stimulus
Not willed or controlled
What is a delusional belief?
Unshakeable idea or belief which is out of keeping
>Which is out of keeping with the person’s social and cultural background
Held with extraordinary conviction
How commin is schizophrenia and who gets it?
1%
Males and females equally
Age of onset 15-35 years
What are the symptoms of schizophrenia?
+ve
Hallucinations
Delusions (paranoia, somatic, reference)
Disordered thinking/speech
-ve
Apathy
Lack of interest
Lack of emotions
How do you diagnose schizophrenia?
1 month history in absence of organic affective disorder
+1 main criteria
+2 other criteria?
What are the main criteria for schizophrenia?
Alienation of thought
Delusions of control, influence or passivity
Hallucinatory voices
Persistent delusions of other kind that are outwith cultural norms + impossible
What are the secondary criteria for schizophrenia?
Peristent hallucinations
Neologisms, breaks or interruptions in train of thought
Catatonic behaviour
Negative symptoms
What biological factors are implicated in causing schizophrenia?
Obstetric complications Maternal influenza Malnutrition and famine Winter birth Substance misuse
What is What are the biological factors of schizophrenia?
Familial genetics link, stronger in twins
Certain syndromes
GABA/glutamate
What are the social/psychological factors of schizophrenia?
Occupation and social class
Migration
Social isolation
Life events as preciptants
What are the differentials for schizophrenia?
Delerium
Depressive episode with psychotic symptoms
Manic episode with psychotic symptoms
What are the symptoms of delerium?
Prominent visual experience, hallucinations and illusions
Affect of terror
Delusions are persecutory and evanescent
Fluctuating, worse at night
How do you treat resistant schizophrenia?
Clozapine
What are the good prognostic factors for schizophrenia?
No family history Good premorbid function Clear precipitant acute onset Mood disturbance Prompt treatment Maintenance of initiative and motivation
What are the poor prognostic factors for schizophrenia?
Slow, insidious onset
Prominent negative symptoms
Starting in childhood
How does the mental hjealth act define a mental disorder?
Any mental illness
Personality disorder
Or learning disability
However caused or manifested
What are the civil compulsory power, how long do they last?
Emergency detention - 72 hours Short term detention - 28 days Compulsory treatment order - up to 6 months Nurses holding power >Detention up to 3 hours
What are the criteria for detention certificates?
Must have mental health disorder Decision making impaired/lacks capcity Risks to health Treatment is available/necessary for treatment Least restrictive option
Who is able to authorise the civil detention certificates?
Emergency - Any registered medical practitioner
Short-term - any approved medical practitioner (APM)
Compulsory - APM + GP or APM unkown to department
>Taken before tribunal and mental health officer
Who is an adult in:
1) adults with incapacity?
2) mental health act?
Incapcity = 16
Mental health act - 18
What determines incapabable in the incapacity act?
Incapable of: Acting Making decisions Communicating decisions Understanding decisions Retaining memory of decisions
(However, if human/mechanical aid can help with this, they are not then incapable ie sign language with deaf person)
What are the crieria for the incapacity act?
Intervention must benefit adult
Least restrictive
Must take into account past/present wishes of adult
When practicable, relatives/carers account taken
NO mental health disorder
For/detention not to be used unless necessary
Action must be consistient with what a competent court would decide
What are the powers of the court?
Intervention order - one time
Guardianship order - full time person appointment to make decisions on behalf of individual
What are the criteria of police powers for mental disorders?
Removal from public space
Appears to be in immediate need of care/treatment to place of safety
Detain for up to 24 hours
To allow for assessment and make arrangements for care and treatment
What determines criminal responsibility with mental health?
> Person is not criminally responsible for offence if at the time was due to mental health disorder was unable to distinguish wrongfullness of situation
Not if disorder is a personality disorder which is characterised by abnormallyy aggressive or irresponsible conduct
What can cause unfitness for trial?
Incapable of mental or physical condition of participating effectively in a trial
Ability to:
>Understand nature of charge
>Requirement to tender a plea to charge and effect of such plea
>Understand evidence
>Understand purpose + follow the trial
>Instruct/communicate with legal defence
Unable to remember doesn’t count
What setermines diminished responsibility?
Murder becomes culpable homicide if person’s ability to determine/control conduct at the time was impaired by abnormality of mind
>A mental disorder
?Alcohol/drugs are not in themselves enough
What are the forensic sections?
Compulsion order Restriction order Assessment order Treatment order Interim compulsion order Transfer for treatment direction Hopital direction
What are the criteria for a forensic section?
Mental disorder
Detention is needed
Treatment avialable
Risks to self/others
In regards to an assesment order:
How long does it last?
When is it used?
Lasts 28 days
When court think you are ill
>Whilst waiting for trial
In regards to a treatment order:
How long does it last?
When is it used?
Who authorises it?
Lasts until you are acquited or convicted
Waiting for trial and court thinks you are ill
Need two doctors, one being a psychiatrist and you to agree
In regards to a temporary compulsion order:
How long does it last?
When is it used?
Who authorises it?
Mo fixed time
Used when too ill to continue with trial because of mental illness
Two doctors have examined and agree
In regards to an interim compulsion order:
How long does it last?
When is it used?
Who authorises it?
Convicted of offence + prison
12 weeks
Needs 2 doctors, they must state you need to go to hospital
In regards to a compulsion order:
How long does it last?
When is it used?
Who authorises it?
Convicted of offence and sentence prison >Sent instead to treatment in hospital >Must have mental disorder + treatable + risk + necessary Lasts up to 6 months 2 doctors, with 1 being a psychiatrist
In regards to a restriction order:
How long does it last?
When is it used?
Who authorises it?
If person serious risk to public
>On top of compulsion order
No time limit
Scottish minster musct give approval
>For any periods out of hospital, or moving between hospitals
Reviewed every 2 years or on psych evidence
What is a personality disorder?
Enduring patter of following areas: >Cognition >Affectivity >Interpersonal feeling >Impulse control Pattern inflexible and pervasive Clinically significant distress or impairment in a range of areas needed for functioning Pattern is stable and traced back to early adulthood Not explained by a different diagnosis Not attributable to phsiological change
What are the cluster A personality disorders?
Characterised by profound concern about basic safety of any human relationship:
Schizoid
Schizotypal
Paranoid
What is paranoid personality disorder?
No-one expected to have anything but malign intent No hallucinations/delusions Suspects exploitation/harm from others Hidden meanings Bears grudges Recurrent suspicion Not due to anything else
What is schizoid personality disorder?
Pervasive pattern of detatchment from social relationships
Restricted range of expression of emtion in interpersonal settings
Doesn’t want to have close relationships/family
Solitary activites
Lacks close friends/confidants
Indifferenant to praise/critism of others
What are the cluster B personality disorders?
Inability to hold certain feelings without acting upon them Narcissistic personality disorder Borderline personality disorder Antisocial personality disorder Histronic personality disorder
What is antisocial/dissocial personality disorder?
Repeated disregard + violate rights of others Failure to conform to social norms with respect to lawful behaviours Deceitfulness Impulsibity Irritability + aggressiveness Reckless disregard for self/others Consistient irresponsibility Lack of remorse
What is borderline personality disorder? AKA emotionally unstable personality disorder
Uncertain sense of safety of relationships
>Prone to feeling abandoned
Try to manage by hurtin/killing self
Frantic effort to avoid abandonment
Persistiently unstable self-image /sense of self
Recurrent suicidial behaviour
Chronic feelings of emptiness
Inappropriate anger/controlling anger difficulties
What is narcissistic personality disorder?
Pervasive pattern of grandiosity
Lack of empathy
Precoccupied with fantasies of unlimited success, power, brilliance etc
Believes speical/unique
Interpersonally exploitative (takes advantage of others)
Envious of others
Arrogant
What is histrionic personality disorder?
Pervasive pattern of excessive emotionality + attention seeking
Uncomfortable when not centre of attention
Interaction with others inapproriately sexually seductive/provaocative
Rapidly shifting shallow emotions
Consientious use of apperance to draw attention to self
Style of speech excessively impressionistic
Self dramatisation
Suggestible
Consideres relationships more intimate then actually are
What are the cluster C personality disorders?
Prominent problems relating to anxiety + how it is managed
Dependent personality disorder
Obsessive compulsive personality
Avoidant personality disorder
What is dependent personality disorder?
pervasive + excessive need to be taken care of leading to submissive/clinging behviour
Difficulty making everday decisions without advice
Needs others to assume responsibility for most major areas of life
Has difficulty expressive disagreement with others for fear of loss of support
Difficulty initiating projects /doing things by self
Excessive lengths to obtain nurturance + support from others
Uncomfortable/helpless when alone
Uregently seeks another relationship for support/care after previous has ended
What is obsessive compulsive disorder?
Pervasive pattern of preoccupation with orderliness, perfectionism and mental/interpersonal control
>At expense of flexibility, openness and efficiency
Preoccupied with details/lists/rules etc to major point of activity is lost
Perfectionism that interferes with task completion
Excessively devoted to work/productivity
Overconscientious + inflexible about morals/ethics
Reluctant to delegate unless done to their standard
Misery spending style to be hoarded towards future
Rigidity or stubbornness
What is Avoidant personality disorder?
Pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation
Avoids occupational activities that involve significant interpersonal contact due to fears or criticism
Unwilling to get involved unless certain of being liked
Restraint in intimate relationships for fear of shame/ridicule
Preoccupied with being rejected in social situations
Views self as socially inept/unappealing/inferior
Reluctant to take personal risks because may be embarrassing
What is tolerance?
Reduced responsiveness to drug caused by revious administration
What are the mechanisms of tolerance?
Dispositional - less reaches active site
- decreased absorption, metabolism
Increased rate of metabolism to inactive metabolites
Increased excretion
Pharmacodynamic - site less affected by drug
>Down-regulation
>Reduced signalling etc
What is the withdrawl phenomena?
The withdrawl effect of a drug is the reverse of the acute affect of the drug
Eg - opiates cause constipation, when withdrawn can cause diarrhoea
What is cocaine?
Natural stimulant (from coca plant)
>Coca leaves can be chewed/brewed
>Cocain hydrochloride snorted/injected
Smoking/injecting gives fastest response
What are the effects of cocaine?
Stimulant and euphorant
Increased alertness and energy
Increased confidence + impaired judgement
Lessens appetite + desire for sleep
What are the side effects of cocaine?
Damage to nose and airways Convulsions with respiratory failure Cardiac arrhytmias/MI Hypertension Toxic confusion Paranoid psychosis
What are the withdrawl effects of cocaine?
Depression Irritability Agitation Craving Hyperphagia Hypersomnia
What is amphetamine?
“speed”
Stimulant, like cocaine but longer lasting
Sniffed, swallowed or injected
Amphetamine sulphate
What are the optiates?
Opium Morphine Heroin Methadone Coedine/dihydrocodeine
What is heroin?
Opiate
Taken by smoking, snorting and injection
Injection most dangerous, smoking least
What are the side effects of heroin?
Analgesia Drowsiness/sleep Mood change Respiratory depression Cough reflex depression Sensitisation of labryinth Decreased sympathetic outflow Lowering of body temp Pupillary constriction Consitpation
What are the side effects of opiates?
Nausea/vomiting + headache first time
Phlebitis
Anorexia
Constipation
Long term
Tolerance
Withdrawl
Social/health problems
What is opiate withdrawl syndrome?
Craving Insomnia Yawning Muscle pain/cramps Increased salivary, nasal + lacrimal secretions Dilated pupils Piloerection
What are the benfits of methadone maintenance?
Decriminalises drug use
Allows for normalisation of lifestyle
Reduces IV misues
>However, leakage onto ilicit market
What is ecstasy?
MDMA
Tablet form
Causes relaxed euphoric state without hallucinations
What are the effects of ecstasy?
Euphoria followed by harm
Increased sociability
Inability to distinguish between desirable and not
20 mins to 2-4 hours
What are the side effects of ectasy?
Nausea and dry mouth increased blood pressure and temperature in clubs users risk dehydration large doses can cause anxiety and panic drug induced psychosis ? liver and brain cell damage
What is cannabis?
Tetrahydrocannabinol psychoactive agent
Usually smoked, sometimes eaten
Relaxing/stimulating euphoriant
What are the effects of cannabis?
Increased sociability + hilarity
Increased appetite
Changes in time perception
Synaesthesia
In higher doses causes: Anxiety Panic Persecutory ideation Hallucinatory activity
What are the side effects of canabis?
Respiraoty problems, like tabacco
Toxic confusion
Exacerbation of major mental illness
Psychosis - linked
What are anabolic steroids?
Family of drugs consisting of testosterone and synthetic analogues Legitimately prescribed in hypogonadism Muscular dystophy Some anaemias And wasting in AIDs
Muscle hypertrophy particularly marked in upper body - pecs, deltoids, trapezius + biceps
What are the side effects of steroids?
Acne, strech marks, baldness Feminisation in males with hypogonadism/ gynaecomastia Virilisation in women Growth deficits because of premature closure of epiphyses Liver disease (jaundice + tumours) Increased cholesterol + hypertension Anger Hypomania + mania Depression/suicidality on withdrawl
What mental health leads to poor school attendance?
Learning difficulties CO-morbid specific learning problems Difficulty controlling emotion Anxiety Lack of energy/motivation Difficulties joining in Sensory problems - too noisy Preoccupations - eg germs
What is autism?
Syndrome with distinctive behavioural abnormalities
Associated with low IQ
Pervasive and present across lifespan + settings
Heritable
Male more than female
What is theory of mind?
The ability to be able to imagine what others might be thinking based on their knowledge and not your own.
Eg - A person will look for an object where they last remember it being, even if you know as a spectator that it is not there.
What is truancy?
The act of staying away from school with good reason
What is the out of school matrix?
Compares the motivation for not going to school
Eg - is it because they are afraid of school, unwilling or have a good reason?
What are the changes in the amygdala in anxiety disorders?
Activity suppressed by right ventrolateral amygdala when labeling emotions
Reduced connectivity between right ventrolateral cortex and amygdala in GAD in adolescents
How do you treat kids avoiding school because of anxiety?
Behavioural:
Desensitise
Help overcome fear
Manage feelings
SSRIs
How should you manage CBT with children and their families?
Don't expect children to have cognitive awareness Parents should be collaborators Step-wise processes Externalisation - do not blame them Problem solving to overcome barriers
What are the clinical features of autism spectrum disorder?
Decreased sharing Decreased social understanding Decreased percepctive of others Increased technical understanding Increased rigidity/fixed learning patterns
What are teh clinical complications/problems that can arise from someone being autistic?
Learning disabilities Disturbed sleep Hyperactivity High levels of anxiety/depression OCD School avoidance Aggression Self-injury Suicidal behaviour
What are the causes of autism?
Strongly genetic
Congenital causes as well (downs, rubela)
How do you manage autism?
Acknowledge Establish needs Appreciating can't vs won't Decrease demands -> reduce stress -> improve coping Psychopharmacology
What are the key features of oppositional defiance?
Refusal to obey with adults request Often argues Often loses temper Deliberately annoys people Touchy or easily annoyed by others Spiteful/vindictive
How does Opositional defiance differ from ADHD?
ODD behaviour is learned, and enacted to obtain a result
ODD likely to be from impaired functioning and adversity
Whereas ADHD is impulsive and poor cognitive control/ability to sustain a goal
ADHD stronger genetic component
What is parent training?
Groups/indivual/self taught
A strucutred program informed by social learning theory
Focuses on positive reinforcement ofdesired behaviour and developing positive parent-child relationships
