Psychosocial test 2 Flashcards
Addiction
Repeated involvement with a substance or activity, despite current harm, because the substance or activity is pleasurable or valuable
“Addictive Personality”
not a diagnosis, an indicator. think addictions –>concern for substance abuse
Impulsivity
Sensation-seeking
Nonconformity to social standards
Social alienation and tolerance for deviance(may not fit into society and ok with others who are)
Heightened stress with poor coping skills (situations other would find tollerable)
substance abuse qualities
Impaired Control (doesnt feel in charge)
Social Impairment (causes)
Risky Use Patterns (even when know dangerous)
Pharmacological Indicators
substance abuse: social impairment
Substance use despite interference with work, social, or family obligations (missing work, isolation, loss of income)
Interpersonal impairment (fighting, withdrawal from social groups or hobbies)
substance abuse -Risky Use Pattern
Continued use in risky circumstances (driving, operating machinery, business transactions)
Continued use despite physical, medical, or financial impairments resulting from use. can include losing a job or cirrhosis.
Sleep Cycles
Proceed through stages of brain activity measured by EEG
REM - brain activity increased, physical paralysis
NREM - “deeper” stages of sleep characterized by increasing amounts of delta wave activity
“Average” adult sleep cycle is approximately 90 minutes
REM Sleep
“Rapid Eye Movement” Sleep
Lighter stage of sleep with dreams, partial or complete physical paralysis
Contributes less to feeling of restful sleep
Non-REM Sleep
Characterized by increasing delta wave frequency
Associated with increased feeling of restfulness
Divided into three, increasingly “deep” stages
How Other Creatures Sleep
Length of sleep cycle varies among species, roughly correlated with metabolic rate
Faster metabolism = shorter sleep cycles (high=short ex:rats)
Most animals have REM and NREM cycles
hemispheric sleep, can you see rem sleep in pets?
fish/some land animals, sleep one hemisphere at a time so that one half of brain is awake and aware (for possible risk). rem sleep: yes (when animals react to stuff not there when sleeping, dreams maybe)
what phase is the theta wave and what stage is the sleep spindkle and k complex and what state is the detla waves and how does rem sleep differ
theta waves = stage one, sleep spindle and k complex = stage 2 , stage 3 or 4 is delta waves, rem sleep is restful looks like awake
Insomnia
Dissatisfaction with quantity or quality of sleep
May be initial, middle, or late in sleep cycle
Non restorative sleep - complaint that the person does not feel rested upon awakening
May be associated with physical or other psychiatric disorders
pt says” cant sleep” : ask questions? challges: falling asleep, staying asleep, restlesness, pattern of where issue is this clues into what’s going on?
what disorders relate to falling asleep? aka sleep latency
normal is 30 minutes or less,
psychiatric disorders, such anxiety.
insomnia disorder qualifications
at least three nights a week for three months, causes distress or impairment, may not be explained by coexisting mental disorder
early wake sleep disorder associated with
major depressive disorder
sleep and wake up odd times?
dimensia or alzheimer disorder. loss of sarcadium rythuym.
Insomnia Disorder generally
Dissatisfaction with quantity or quality of sleep that may be:
Difficulty initiating sleep
Frequent awakenings or problems returning to sleep after awakening
Early awakening with problem returning to sleep
At least three nights a week for three months
Causes clinically significant distress or impairment
Not fully explained by a coexisting mental disorder
Differentials to Consider of insomnia disorder
Normal variations - age related changes, situational variables
Circadian disturbances - late shift work, day-night reversals
Medications, drugs, or beverages (a sign can be weight gain or loss)
shift jobs may cause sleep disterbences, meds/drugs/beverages/food can affect sleep.
Hypersomnolence Disorder
Excessive sleepiness despite adequate sleep time (7 hours)
Recurrent sleep periods during the day or slow awakening (fall asleep easily at wrong times)
Three times per week for three months
Not related to another sleep disorder or substance use
Sleep Disorders names
Insomnia/Hypersomnia
Narcolepsy
Breathing-related sleep disorders
Parasomnias
what psych disorder relates to poor sleep
most of them. major depress other psych, treat by hyponotic meds.
Narcolepsy
Sudden!! and recurrent episodes of an irrepressible need to sleep!!! can be driving a car or any activity–>during the day accompanied by two of the following:
Cataplexy - sudden loss of muscle tone with full consciousness, frequently precipitated by laughter (goes limp and fall, may have a cry before this)
–>Hypocretin deficiency in CSF
Brief sleep latency on EEG
controling when falling asleep, not the latency, still sleep at night. (not from being tired)
Associated Features of narcolepsy
May appear “hazy” or like an automaton
Vivid hypnogogic (falling asleep) or hypnopompic (awakening) hallucinations (during twilight zone)
Vivid dreams or nightmares
Appears sleepy most of the time
During episodes of cataplexy, reflexes abolished
Obstructive Sleep Apnea
On polysomnography (sleep study) at least 15 episodes of apneas (=x breath) or hypopnea (shallow breath) accompanied by snoring, gasping, or breathing pauses Excessive daytime sleepiness, fatigue, or unrefreshing sleep
hallucinations during twilight zone
narcolepsy Vivid hypnogogic (falling asleep) or hypnopompic (awakening) hallucinations (during twilight zone)
crazy vivid dreams associated with
narcolepsy
pickwicks syndrome
dude who fell asleep in chairs, character in dickins story
Circadian Rhythm Disorders
Sleep disruptions due to misalignment between endogenous circadian rhythm and the person’s sleep-wake cycle
Frequently results from physical environment or social/work schedules
Leads to excessive sleepiness or insomnia
Causes clinically significant impairment
-pineal gland sends sleepy time melatonin to brain to say time to sleep–>if dont do this then can get cardadian rythm distrubance
can a circadian rythm disorder show up in another disorder?
yes! any social reason or other issues.
Parasomnias
Abnormal behavioral, experiential, or physiological events associated with sleep
Associated with both REM and NREM sleep
-while alseep, in REM sleep and NON rem.
NREM Arousal Disorders (non rem)
Associated with incomplete awakening, usually during the first one-third of the sleep cycle
Sleepwalking - rising from bed and walking around, staring gaze, minimally responsive, difficult to awaken (really asleep!)
Sleep terrors - abrupt awakening in terror, usually crying out, signs of intense fear, minimally responsive
Minimal recollection for dreams or events during episode
“stuck inbetween states–>sleep walking”
Sleepwalking
rising from bed and walking around, staring gaze, minimally responsive, difficult to awaken (really asleep!), Minimal recollection for dreams or events during episode
in a non normal stage of sleep, on eeg abnormal.
Sleep terrors
abrupt awakening in terror, usually crying out, signs of intense fear, minimally responsive
Minimal recollection for dreams or events during episode
in a non normal stage of sleep, on eeg abnormal.
REM Sleep Disorder
(last 15-20 miniutes of REM ~90 min sleep cycle), wake up with full awareness. REM sleep but brain =x send parylitic sleep muscle.
Repeated episodes of arousal during sleep with vocalizations or complex motor behaviors
Usually occur in last part of sleep cycle, 90 minutes or so after sleep onset
Upon awakening, person becomes completely alert and not confused or disoriented
Polysomnography reveals REM sleep without atonia
May occur in Parkinson’s Disease or other motor system diseases
sleep issue, if not medication related but meets sleep disorder then what is it?
primary sleep disorder
Restless Legs Syndrome
Urge to move the legs accompanied by uncomfortable and unpleasant sensations that:
Begins or worsens during rest or inactivity
Primarily or completely relieved by movement
Worse in, or exclusive to, evening or night
At least three times a week for three months
almost exclusively when going to sleep to interefere with this.
“Sleeping It Off”
Alcohol induces somnolence quickly followed by wakefulness, vivid dreams, and restless sleep
Reduces NREM sleep (stages 3-4) and increases REM sleep
Light, fragmented sleep may persist long after sobriety is established in chronic users
-helps fall alseep, but as liver processes to aldehydes =stimulating=hurts sleep, chronically=x REM=non rested=chronically sleepy)
Sexual Disorders - related to sleep, generally
Functional disorders
Gender Dysphoria
Paraphilias
Functional Sexual Disorders and how effects sleep
Delayed or Premature Ejaculation (male) Female Orgasmic Disorder Erectile Disorder Genito-Pelvic Pain/Penetration Disorder Hypoactive Sexual Desire Disorder
DO NOT ASSUME THAT THIS IS PRIMARILY A PSYCH DISORDER (maybe related to sleep meds or many disorders, and antidepressants)
Gender Dysphoria
Marked distress associated with incongruence between assigned gender and experienced or expressed gender
Strong desire to be rid of assigned gender
Strong desire for primary or secondary sex characteristics of experienced gender
Strong desire to be of experienced gender and be treated as such
Strong conviction that one has typical feelings and reactions of experienced gender
Significant emotional distress and functional impairment
-upset about dysphoria of gender qualifies this
Paraphilic Disorders
halmark of all of these–>illegal or culturally unacceptable. and is patients primary form of sexual arousal.
Voyeuristic Disorder - arousal from observing an unsuspecting person naked or engaging in sex
Exhibitionistic Disorder - arousal from exposing one’s genitals to an unsuspecting person
Frotteuristic Disorder - arousal from touching or rubbing against a non consenting person
Sexual Masochism Disorder - arousal from being humiliated or made to suffer
Sexual Sadism Disorder - arousal from inflicting physical or psychological suffering on another person
Paraphilic Daisorders
Pedophilia - arousal from fantasies or actions involving prepubescent children
Fetishistic Disorder - arousal from use or focus on nonliving objects or non-genital body parts
Transvestic Disorder - arousal from cross-dressing
“Other”
Fantasies and Arousal
Paraphilias involve both fantasies and actions
Involvement in these activities causes distress, interpersonal difficulties, and legal problems
Sexual fantasies tend to increase in complexity over time, with arousal or climax more difficult to reach without elaboration of fantasies
Voyeuristic Disorder
arousal from observing an unsuspecting person naked or engaging in sex
non rem vs rem sleep disorder
if non rem, can walk around. if rem then unilkely to walk because paraylitic signal sent.
drugs: statins side effects can have what kind of effect
insomnia
Physiological Impairment (of addictive personality)
Tolerance - requiring higher doses of substance to achieve desired effect or to avoid withdrawal
Withdrawal - physiological symptoms associated with reduction or cessation of substance use
what can help with sleep quality
consistency bed times and no tv while bed
patients measure sleep how
by hours
docs measure sleep by
different cycle, mostly by REM
impaired control for addictive personality
Use in larger amounts or for longer than intended
Unsuccessful attempts to cut down or stop
Spending excessive time obtaining, using, or withdrawing from substance
Intense cravings that occupy attention
frustration to family and substance runs their life
what can cause change in sexual disfunction
LPE, DM, HTN, cardiac, metabolic disorders etc.
antidepressants most common side effects
delayed ejaculation and ed –>cause interpersonal issues
Genito-Pelvic Pain/Penetration Disorder and how to find out ?
pain with penetration, can ask if side effect of drugs.
gender identity and when a psych disorder
not considered psych issue –> emotional disfunction over the mental issue of pain associated with gender dysphoria.
Paraphilic Disorders: Voyeuristic Disorder
arousal from observing an unsuspecting person naked or engaging in sex
Paraphilic Disorders: Exhibitionistic Disorder
arousal from exposing one’s genitals to an unsuspecting person
Paraphilic Disorders: Frotteuristic Disorder -
arousal from touching or rubbing against a non consenting person
Paraphilic Disorders: Sexual Masochism Disorder
arousal from being humiliated or made to suffer
Paraphilic Disorders : Sexual Sadism Disorder
arousal from inflicting physical or psychological suffering on another person
Paraphilic Disorders: Pedophilia
arousal from fantasies or actions involving prepubescent children
Paraphilic Disorders: Fetishistic Disorder
arousal from use or focus on nonliving objects or non-genital body parts
Paraphilic Disorders: Transvestic Disorder -
arousal from cross-dressing
Disorders: Substance Intoxication
Alcohol : Common substance abuse due to pleasurable effects, legal status, wide availability
Symptoms: Slurred speech, incoordination, unsteady gait, nystagmus, impaired attention or memory, stupor or coma
Occur during or shortly after alcohol use
Cause clinically significant behavioral or psychological changes (aggression, mood lability, impaired judgment)
Alcohol Use Disorder
At least two of the following within a 12-month period:
Increased consumption of alcohol
Unsuccessful efforts to cut down or control use
Excessive time spent obtaining, using, or recovering from alcohol use
Craving for alcohol (feel out of control if dont have)
Recurrent use despite repeated negative consequences
Social, occupational, or recreational activities reduced or given up
Recurrent use in hazardous situations
Continued use despite awareness of physical or psychological problems
Tolerance - increased amounts or decreased effect of use
Withdrawal - physiological symptoms when use is curtailed or eliminated
Alcohol Withdrawal
Following reduction or cessation of alcohol use, two or more of these develop:
Autonomic hyperactivity (sweating, tachycardia)
Tremor, especially in the hands
Insomnia
Nausea or vomiting
Transient visual, tactile, or auditory hallucinations
Psychomotor agitation
Anxiety
Generalized tonic-clonic seizures
-classic: visual hallucinations-walls are waiving. alcohol lowers siezure threshold.
treatment of sexual issues
training to not follow impulse, may not be able to get impulse to leave.
are all fantasies what people actually want or are they somethingn they are aroused by but may or may not actually do
2nd option
Delirium Tremens (DTs), and do most people experience these?
Historical term for delirium associated with alcohol withdrawal
Disorientation, confusion, wandering, “picking”, vivid hallucinations (especially visual) - at stuff not there.
May require intensive care management
Associated with prolonged use and poor prognosis (sign)
not common. can be earlier age, depends on how much over a few years aka can be younger
Wernicke’s Encephalopathy
Result of thiamine (vitamin B1) deficiency and results effects on the central nervous system
Ophthalmoplegia (eye movement disorder, usually lateral nystagmus)
Ataxia or other cerebellar signs
Confusion and/or memory impairment
Can be treated with thiamine supplementation
most common sign is the eye movement, ataxia aka unsteady on feet test by finger to nose =encephalopathy. related to drinking. alcoholic.
Wernicke’s Encephalopathy pathology
toxic to nerve cells and society center so dont feel hungry and lower dietary consumption so vitamin levels lower so these B vitamins lacking for Brian
when to report an issue
if there’s an imminent risk
Korsakoff’s Syndrome, is it irreversible and whats going on
irreversible, common with alcoholism, results from untreated Wernicke’s encephalopathy..
Results from untreated Wernicke’s Encephalopathy
Global Amnesia (anterograde, retrograde, fixation) –>can’t form new memories/old memories
Confabulation (blackouts and invented memories) –>reasonable sounding answer w/e actual memory /make up
Apathy, lack of interest in conversation (like demensia)
Lack of insight
Not reversible with thiamine
may hallucinate
Medical Complications of alcoholism
Hepatic cirrhosis Cerebral Atrophy Cerebellar Atrophy Bone marrow impairment (anemia resulting) Vascular disease
issue: with cirrhosis, body function with 7o% byt then not turn food into what you need, toxic to liver cells –>cehck LFT and liver cells in blood stream
Treatment of Alcohol Withdrawal
standard: Benzodiazepines (ativan, oxazepam, chlordiazepoxide) - act as alcohol to receptors such as gabapent.
Anticonvulsants (phenobarbital, carbemazepine)
Symptomatic treatments for nausea, vomiting, cramps, diarrhea, pain, insomnia (w/OTC)
Caffeine Intoxication
Consumption of caffeine followed by five or more: Restlessness Nervousness Excitement Insomnia Facial flushing Diuresis (pee) GI disturbance Muscle twitching Rambling flow of speech or thought Tachycardia or arrhythmia Periods of inexhaustibility Psychomotor agitation
Caffeine Withdrawal
After cessation of prolonged daily use of caffeine, three or more of the following:
Headache
Marked fatigue or drowsiness
Dysphoric, irritable, or depressed mood
Nausea, vomiting, or muscle pain/stiffness
Cannabis Intoxication
Two or more within 2 hours of cannabis use:
Conjunctival injection
Increased appetite
Dry mouth
Tachycardia
Physiological (coordination problems) or psychological (euphoria, anxiety, sensation of slowed time, impaired judgment, social withdrawal) following use
Cannabis Use Disorder
Problematic pattern of cannabis use over a 12 month period, with two or more signs (same as Alcohol Use) including either tolerance or withdrawal
Clinically significant impairment
Cannabis Withdrawal
Three or more symptoms develop after cessation of prolonged, heavy cannabis use: Irritable, angry, or aggressive episodes Nervousness or anxiety Insomnia or disturbing dreams Decreased appetite or weight loss Restlessness Depressed mood One physical symptom: abdominal pain, shakiness/tremors, sweating, fever, chills, headache
“short/self limited after stop, also use may induce underlying bipolar”
Hallucinogens
Phenylcyclidine (“angel dust”, PCP) : (hyeractivity and siezure possible) Ketamine (“Special K”) MDMA (“Ecstacy”) Psilocybin (“Mushrooms”) LSD
all illegal except ketamine, all make ppl feel good and some new field of research for tx depressed.
PCP Intoxication
Vertical or horizontal nystagmus Hypertension or tachycardia Numbness or diminished pain response Ataxia Dysarthria Muscle rigidity Seizures or coma Hyperacuity
Hallucination Intoxication
Vivid hallucinations in all sensory modes Pupillary dilation Tachycardia Sweating Palpitations Blurring of vision Tremors Incoordination
“sns on max”
Inhalant Abuse
Inhaled volatile hydrocarbons - glue, paint thinner, computer cleaner, etc.
Short-term effects of intoxication (a few minutes)
Can lead to sustained neurological changes
Demonstrates two or more of the symptoms of inhalant intox
Inhalant Intoxication
Dizziness Nystagmus Incoordination Slurred speech Unsteady gait Lethargy Depressed reflexes Psychomotor retardation Tremor Generalized weakness Blurred or double vision Stupor or coma Euphoria
toxic to neurons and brain problems “chronically stoned”
Opioid Use Disorders
Increasing prevalence, going national public health crisis
Related to both prescription and illegal opiates
Problematic use of opiates not solely under medical supervision
Demonstrates common symptoms of substance use disorder (see Alcohol Use)
History of Dope
Derivative of the poppy plant, known for euphoric and analgesic properties since antiquity. Morphine, heroin, opium were early derivatives. Late 18th Century, British East India Company began smuggling opium into China as a way to force opening of trade (“Opium Wars”). Heroin was sold for many years as a pain killer, then banned due to high abuse potential. Prescriptions for opiates soared in 1990s causing overconsumption and dependence
Oxycontin - extended release formulation of oxycodone became popular drug of abuse
Reformulation to reduce inhalation abuse prompted attention from drug cartels, which initiated return of heroin trade
Opiate Intoxication
Euphoria, apathy, dysphoria, motor changes, impaired judgment
Pupillary constriction, plus one of these:
Drowsiness or coma
Slurred speech
Impaired attention or memory
May have perceptual disturbances
Opiate Withdrawal
Three or more withdrawal symptoms: Dysphoric mood Nausea or vomiting Muscle aches Lacrimation or rhinorrhea Pupillary dilation, piloerection, or sweating Diarrhea Yawning Fever Insomnia
Treatment of Opiate Withdrawal
Alpha-2 blockers (clonidine)
Gabapentin
Symptomatic medications for nausea, vomiting, abdominal cramping, insomnia, diarrhea
Maintenance Treatment of opiates
Replaces opiates of abuse with longer acting substitutes that produce less euphoria, gradually tapered in conjunction with psychological treatments
Methadone
Buprenorphine (Suboxone, Subutex)
Naloxone (Revia, Vivitrol)
aka medically asissted
Sedative Abuse
May include sedatives, hypnotics, or anxiolytics
Typically benzodiazepines
Sedative Intoxication
Mood lability, impaired judgment, or aggression One or more: Slurred speech Incoordination Unsteady gait Nystagmus Cognitive impairment (attention, memory) Stupor or coma
Sedative Withdrawal
Two or more symptoms: Autonomic hyperactivity (sweating, tachycardia, etc) Hand tremor Insomnia Nausea or vomiting Transient hallucinations or illusions Agitation Anxiety Grand mal seizures
Stimulant Abuse
Prescription medications - Ritalin, Adderall, Dextrostat
Methamphetamines
Stimulant Intoxication
Euphoria, blunt affect, hyper vigilance, anger or tension, stereotyped behaviors, impaired judgment
Two or more physical symptoms:
Tachy or bradycardia
Pupillary dliation
Abnormal blood pressure
Sweating or chills
Nausea or vomiting
Weight loss
Agitation
Muscle weakness, respiratory depression, or cardiac arrhythmias
Confusion, seizures, dyskinesias, dystonias, or coma
Stimulant Withdrawal
Dysphoric mood, and two of the following: Fatigue Vivid, unpleasant dreams Insomnia or hypersomnia Increased appetite Psychomotor retardation or agitation
Tobacco Use
21% of US adults are active smokers
22% of US adults are former smokers
More than 80% are able to quit for a period but 60% of those relapse
Use provides mild stimulation, reduces nausea, and in chronic smokers calms anxiety
Tobacco Withdrawal
Cessation of use is followed within 24 hours by four or more: Irritability, frustration, or anger Anxiety Difficulty concentrating Increased appetite Restlessness Depressed mood Insomnia
Behavioral Addictions
Persistent and problematic behavior leading to clinically significant impairment, with four or more of the following:
Need to engage in behavior with increasing intensity
Restless or irritable when trying to cut down
Has made repeated unsuccessful attempts to reduce or eliminate behavior
Preoccupied with the behavior
Engages in behavior as a way to deal with stress
In competitive behaviors, “chases” losses
Lies to conceal the extent of their involvement with the behavior
Has jeopardized a significant relationship, job or opportunity due the behavior
Relies on others to “rescue” them from the consequences of the behavior
Eating and Feeding Disorders
Persistent disturbance of feeding or eating that altered consumption or absorption of food, leading to physical and psychological impairments
Seen in both children and adults
Eating and Feeding Disorders: Pica
Persistent eating of nonnutritive, nonfood substances for at least one month
Inappropriate to developmental age (at least two years old)
Not a culturally normative practice
Eating and Feeding Disorders:Rumination Disorder
Persistent regurgitation of food for at least one month. Regurgitated food may be spit out, re-chewed, or re-swallowed.
Not resulting from a gastrointestinal problem or another eating disorder
Anorexia Nervosa
Restriction of energy intake relative to requirements, resulting in significantly low body weight for age and developmental expectations
Intense fear of gaining weight or becoming fat, resulting in persistent behaviors that prevent weight gain despite low body weight
Disturbance in the experience of body weight or shape, and undue influence of body weight or shape on self-evaluation; or, persistent lack of recognition of the seriousness of current low body weight
Anorexia Subtypes
Restricting type: During last 3 months, individual has not engaged in binge eating or purging episodes
Binge-Purge type: During the last 3 months, individual engaged in recurrent episodes of binge eating or purging behavior (forced vomiting, misses of laxatives, diuretics, or enemas)
Medical Compications of eating disorder of anerexia
Leukopenia
Elevated liver and kidney lab functions
Loss of serum magnesium, zinc, phosphorous
Prolonged vomiting can cause hypokalemia and alkalosis
Reduced thyroid hormone levels
Bradycardia, arrhythmias, prolonged QTc interval
Low bone mineral density with increased fracture risk
Amenorrhea
Suicide risk
Bulimia Nervosa
Recurrent episodes of binge eating
Compensatory behaviors such as forced vomiting, fasting, laxative or diuretic abuse, excessive exercising
At least once a week for three months
Self-evaluation is unduly influenced by body shape and weight
Not exclusively occurs as part of anorexia nervosa
Binge-Eating Disorder
Recurrent episodes of binge eating, at least once a week for three months
Three of more of the following:
Eating more rapidly than normal
Eating until uncomfortably full
Eating more than hunger requires
Eating alone to avoid embarrassment at amount of food consumed
Feeling disgusted, depressed, or guilty afterwards
Marked distress about binge eating behaviors
Not accompanied by compensatory behaviors as in Bulimia Nervosa
Treatment of Eating Disorders
Primarily focused on psychotherapy and education
May include empiric pharmacology - appetite stimulants, antidepressants
Prolonged therapy usually required
Significant medical complications may require inpatient servicesa
should primary care put pt on benzos long term
no, only for severe refractoryu anxiety
propanaolol
event related anxiety (off label) blocks cardiac beta receptor, can lower bp, cause fatigue, cold extremities can pass out
Dissociation
Psychological condition of detachment from normal state of consciousness
Disconnection between thoughts, feelings, memories, or surroundings
Associated with a history of physical and psychological trauma
Dissociative Responses
Increased stress in relationships, work
Impaired coping skills
Depression, anxiety, suicidal thoughts
Dissociative Amnesia
Episodes of amnesia, especially surrounding traumatic events and not due to other medical conditions
Less commonly, intimate personal information or even identity can be impaired
May travel or even take new identities (fugue state)
Occurs suddenly and may last between a few minutes to years
uncanny
feels weird because closed to reality but not quite. can be seen with dissociatative disorder.
Dissociative Identity Disorder
Switching between distinct personalities
“Alter” personalities may not be aware of each other and may be very distinctive “fragments” of primary personality (“host”)
Frequently comorbid with dissociative amnesia
Severe trauma response
Symptoms of Dissociation
Gaps in memory or time loss
Sense of detachment from self or emotions
Distorted perceptions of persons or situations
Blurred sense of identity
Dissociative Identity Disorder
Switching between distinct personalities
“Alter” personalities may not be aware of each other and may be very distinctive “fragments” of primary personality (“host”)
Frequently comorbid with dissociative amnesia
Severe trauma response
Depersonalization and Derealization Disorders
Feeling of detachment from identity or reality
Surroundings seems unreal and indistinct
“Out of body” experiences and changes in experience of time are common
Treatment of Dissociation
Long-term psychotherapy is key treatment
Psychopharmacology can help with associated symptoms (depression, anxiety)
“Integrative” therapy controversial
Somatization
Concept of physical complaints arising from emotional conflicts
“Conversion” - sudden physical disabilities thought to be caused by unresolved psychiatric conflicts
“Hysteria” - traditional name for uncontrolled emotional symptoms accompanied by unexplained physical symptoms
“Studies in Hysteria”
Breuer and Freud (1895) -studied
Based on treatment of Bertha Pappenheim (“Anna O.”)
“Talking cure”, decided can cure by talking to them
Somatic Symptom Disorder
Multiple, possibly unexplained physical symptoms for at least six months
Cause significant disruption in daily life and significant emotional distress
May be associated with chronic illness
Somatic Symptom Disorder
Multiple, possibly unexplained physical symptoms for at least six months
Cause significant disruption in daily life and significant emotional distress
May be associated with chronic illness
Factitious Disorders
Imposed on Self - “Munchhausen’s Syndrome”
Imposed on Another - “Munchhausen’s by Proxy”
Factitious Disorders
Imposed on Self - “Munchhausen’s Syndrome” - faking for yourself.
Imposed on Another - “Munchhausen’s by Proxy” - faking symptoms in child, parent wants sympathy. A PROBLEM (considered harming another person)
(internal motivation, psychological comfort of being a cared for sick person)
Malingering
Should be considered in following contexts:
Medical-Legal referrals, jails, prisons
Marked discrepancy between reported distress and objective findings
Lack of cooperation with evaluation and treatment
Presence of Antisocial Personality Disorder
(external gain, pretend ill)
Motivations of patient of medications
In emergency settings, most common motivation is to obtain drugs or housing
In office settings, common motivations include prescription medications and financial compensation (disability, etc)
how was freud different?
“frued’s fault”, psych problem presenting as physical problem, developed psychoanalysis… during process free associate (stream of consciousness)
how was freud different?
“frued’s fault”, psych problem presenting as physical problem, developed psychoanalysis… during process free associate (stream of consciousness).. and his theory dismissed girls being sexually abused, and satanic movement was overboard after took the sexual abuse seriously.
“Conversion” (somatic symptom disorder)
“Conversion” sudden physical disabilities thought to be caused by unresolved psychiatric conflicts.
(ex: military guy who couldnt move until men came home)
“Hysteria”
traditional name for uncontrolled emotional symptoms accompanied by unexplained physical symptoms
somatic symptom disorder moral of the story?
dont give up on diagnosis processes, ilkely a known but undiagnosed disorder
unexplained GI problems, failure to thrive, wasting, but docs cant find anything wrong with patient…
proxy
symptoms that don’t make sense and don’t go together or are exadurated to what you are obserbing
malingerer possiblity. knowing diseaes and presentation so that detect faking one.
malingerers are ____
bad actors,
“Munchhausen’s by Proxy” suspected for kid but parent’s wont get test
if parents won’t follow through, avoid tests for kid, then can report them (if dangers kid), suspecting the proxy
