psych vol 3 Flashcards
phobias definition
marked fear of specific situation/ thing that results in attempt to avoid or limit exposure to it.
symptoms are the same in GAD but 3 distinguishing features
anxiety occurs in particular circs
avoidance of circumstances that provoke.
anticipatory anxiety- when the prospect of encountering the phobic circumstance
can interfere with normal functioning
need to exclude other disorders, drugs and alcohol misuse.
risk factors for phobia, key diagnostic factors and invesigations + management
somatisation disorder, anxiety disorder, mood disorder, 1st degree relative with disorder, twin with phobia.
key diagnostic factor: anticipatory anxiety, behavioural avoidance
Ix: self-report
behavioural observation and approach tests- sufficient for diagnosis.
Rx is CBT, exposure therapy, benzoz if severe and interfering with function
what are functional disorders and the types
no identified cause
can have conversion- patient presents with neuro symptoms which cant be explained. unconsious motivation, symptoms are unintentional.
factitious - faking of symptoms without obvious incentives.
malingering- faking with incentive.
discuss somatoform disorder, Ix, aetiology, clinical features
chronic consition 2 years + - somatic symptoms (pain, weakness, SOB) + hyperfixation of bodily sensations and refusal to accept that they are no significant- even after medical advice has been sought.
Ix: thourough history, physical exam, full psych history.
aetiology: may be consious or unconsious, fulled by a disre to assume the role of a sick patient.
Clin features: prominent somatic symptoms exacerbated by stress, depression and conflict.
somatoform disorder epidemiology diagnostic criteria + Mx
13-23% of gen pop
female more common
if raised in environment where emotion expression is suppressed are highly at risk.
also childhood trauma/ sexual abuse
doagnostic: 1 or more somatic symptom (heartburn, fatigue, headache,) causing sig distress or impairment.
excessive thoughts, feelings, behaviours related to the symptoms.
disproportionate + constant thinking about symptoms
constant anxiety about symptoms/ health
excessive amounts of time attending symptoms or health.
Mx: psychotherapy
antidepressants
reg visits with single primary care physician to avoid over exposure of other tests.
discuss hypochondriacal disorder- what is it, what precipitates it, diagnostic criteria and management
persistant preoccupation with having/ developing a serious illness.
absent or mild somatic symptoms- but obsessing over the possibility of developing it.
strongly assoc with comorbid anxiety/ depressive disorder.
diagnostic crit:
preoccupation with acquiring an illness
absent/ mild somatic symptoms
sig anxiety over health
excessive health related behav (constant checking) maladaptive/ avoidant behaviours (avoiding dr/hospitals)
6/12 +
not better explained by another mental disorder.
Mx:
CBT
one primary care physician with reg visits
treat comorbid disorders.
dissociative disorders
characterised by disruption/ discontinuity of normal consciousness, memory, identity and perception. 10% of gen pop will have.
you see abnormalities in behaviour, motor control + body representation.
can be either pathological or non pathological
non-path: a psych defence mechanism to traumatic experiences. disruption of normal integration of mems, Identity, perception, experiences + emotions to cope with stress/ stimulation overload.
detachment from self/ surroundings.
Path: excessive reaction to trauma/ stress.
Diagnosis made via structured clinical interview and DSM-5. heavily linked to child stressful experiences.
what are the 3 main types of dissociation disorder and their Rx.
dissociative amnesia:- the most common
inability to recall autobiographical into (of stressor usually).
can be localised (one event) or selective (similar aspects of multiple events) or generalised (personal history + identity)
cause sig occupational/ social impairment.
depersonalisation-derealisation disorder:
recurrent / persistent episodes of disassociation or derealisation (detachment from the environment)
reality testing is intact.
not caused by anything (e.g drugs, other condition)
dissociative identity disorder:
alteration of at least two identity states with separate personalities.
common in child abuse/ sexual abuse.
frequent gaps in recall, one personality will know the others, but other personalities might not.
Mx: psychotherapy
for depersonalisation-derealisation - hypnotherapy and psychodynamic therapy may also help.
what is psychosis
a thought disorder +/- delusions and abnormal perceptions
primary–> mental illness
2’ –> as a result of a disorder (e.g thyroid)
it is a loss of contact with reality.
signs and symptoms–>
delusions (bizarre/ non bizarre)
hallucinations (perceptions without stimulus)
thought disorders (e.g blocking, insertion, deletion)
agitation/ aggression
management of psychosis
1st generation- haloperidol etc- Dopamine blockage. can induce Parkinson’s.
2nd gen- clozapine, olanzapine, risperidone. - bind to D2 and D4 + 5HT-2 and alpha1 muscarinic receptors.
discuss scitzophrenia. discuee predisposin, precipitating and perpetuating factors for it.
severe psych disorder, characterised by persistant or recurrent psychosis. decreaced volume in in medial and temporal areas of the brain.
several subtypes: paranoid, catatonic, hebephrenic, simple, undiffernetiated
predis: affected 1st degree fam/ twin.
maternal flu infection, poor placentation + obstetric emergency.
immigrant pops, espesh afro-carribien.
personality + substance abuse
child abuse/sexual abuse
Precipitating:
stress/ life events.
substance misuse (cannabis)
Perpetuating:
adverse social conditions, high expressed emotion, substance/ medication compliance issues.
age of onset of schizophrenia, signs and symptoms .
initial presentation of symptoms in 20s
around 1% in gen pop but up to 50% in mental health inpatient institutions. - 2-3X likely to die early than gen pop- 50% attempt suicide.
signs and symptoms= psychosis signs, thought disorders, inattention, memory issues, poor executive function, depression.
catatonia- (abnormal movements = reactivity to environment) - retarded, excited or malignant.
passivity phenomena
diagnosis and investigations of schizophrenia
blood- anaemia, infection, thyroid, alcohol misuse.
urine- drug analysis
pregnancy (many meds for Rx are tetrogenic)
lipid levels- (baseline for Rx starting)
neuroimaging
diagnosis- need one clear major criterion, or 2 less clear. for 1/12
or 2 minor
Major: thought echo, insertion, withdrawal, broadcasting
delusions of control, passivity, hallucinatory voices (commentary, discussion between themselves)
persistent delusions that are culturally/ physically inappropriate and impossible.
minor:
other persistent hallucinations occurring daily for number of weeks - with delusional thinking or sustained overvalued ideas
formal thought disorder
catatonic behaviours
apathy, blunting
management of schizophrenia + prognosis
psychoeducation - CBT + supportive social measures
- acute psychotic episodes- short acting anti-psychotics (olanzapine +/- mood stabiliser
hospitalisation
Longer term Rx:
2nd gen antipsychotics (olanzapine, risperidone)
or 1st gen- e.g haloperidol
Clozapine for treatment resistance. + another 2nd gen
avoid validation of delusions, but avoid confronting patients about the delusional nature of complaints.
Prognosis-
50% will attempt suicide.
fav course indicators- late onset, acute, female, good social support, mood symptoms.
Negative course indicators: fam history, early onset, slow onset, male, substance use disorder.
discuss intellectual disability
can be either general- cognitive impairment
or specific- learning disability
cognitive impairment = IQ less than 70.
cog impairment affects 2-3% of children, downs + foetal alcohol syndrome the most common.
LD about 10%
diagnosis- clinical psychologist is to identify cognitive ability
speech therapist identifies expressive and receptive ability.
