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Psychiatry > Psychotherapies, Misc > Flashcards

Psychotherapies, Misc Flashcards

1
Q

Informed consent not needed in…

A

Lifesaving medical emergency

Suicide or homicide prevention (hospitalization)

Minors—must obtain consent from parents except when giving obstetric
care, treatment for sexually transmitted diseases (STDs), treatment for
substance abuse (laws vary by state). In these cases, consent may be obtained
from the minor directly, and information must be kept confidential
from parents.

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2
Q

Minors are considered emancipated if…

A

Are self-supporting
Are in the military
Are married
Have children

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3
Q

Pt has decisional capacity if…

A
  1. Can communicate a choice or preference
  2. Understands the relevant information regarding treatment—purpose,
    risks, benefits, and alternatives; patient must be able to explain this information
    to you
  3. Appreciates the situation and its potential impact or consequences according
    to his or her own value system and understands the ramifications
    of refusing treatment
  4. Can logically manipulate information regarding the situation and
    reach rational conclusions
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4
Q

Nigrostriatal dopamine system

A

Substantia nigra –> basal ganglia

Control voluntary mvmts

Blocking this causes extrapyramidal symptoms

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5
Q

Tuberohypophyseal dopamine system

A

Controls release of prolactin

Blocking with neuroleptics causes:
gynecomastica
galactorrhea
menstrual irregularities

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6
Q

Mesocorticolimbal dopamine system

A

Mesolimbic

  • ventral tegmental —> limbic system
  • reward and addiction.
  • Excessive dopamine stimulation will cause positive sx of schizophrenia

Mesocortical - attention, working memory. Low dopamine stimulation will cause negative sx

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7
Q

Survivors of sexual assault are at high risk for developing

A

PTSD
Depression
suicidality

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8
Q

Acting out

A

Immature defense mechanism

Avoiding unacceptable feelings by behaving badly

Ex: man is told his therapist is going on vacay “forgets” his last appointment and skips it

Antisocial PD
Borderline PD

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9
Q

Denial

A

Immature defense

Behaving as if an aspect of reality does not exist

Ex: pt dx w/ terminal illness who refuses to accept that he will die soon

Antisocial PD
Narcissistic PD

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10
Q

Dissociation

A

Immature defense

Disrupting memory, identity, and conosciousness to cope w/ an event

ex: pt who was rescued from burning building and denies any memory of the event

Borderlin PD
Dissociative fugue

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11
Q

Distortion

A

Immature defense

Altering perception of upsetting reality to be more acceptable

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12
Q

Fantasy

A

Immature defense

Substituting imaginary scenarios

Schizotypal PD

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13
Q

Projection

A

Immature defense

Attributing one’s own feelings to others

Ex: husband attracted to other women believes wife is having an affair

Paranoid PD
Depression

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14
Q

Regression

A

Immature defense

Reverting to an earlier developmental stage

Ex: Woman brings childhood teddy bear to spend the night

Histrionic PD
Borderline PD

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15
Q

Somatization

A

Immature defense

Transforming emotional conflicts into physical symptoms

Histrionic PD

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16
Q

Splitting

A

Immature defense

Seeing others as all bad or all good

Ex: Woman suffering from borderline could consider current therapist to be ideal and former therapist to be loathsome

Borderlin PD

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17
Q

Altrusim

A

Mature defense

Avoiding negative feelings by helping others

Ex: parent’s child died from ovarian ca; parent donates money to help raise community awareness of sx so other people can be screened

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18
Q

Humor

A

Mature defense

Using humor to avoid uncomfortable feelings without causing discomfort to self or others

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19
Q

Sublimation

A

Mature defense

Channeling impulses into socially acceptable behaviors

Ex: man w/ explosive temper could channel anger into atheletic pursuits

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20
Q

Suppression

A

Mature defense

Putting unwanted feelings aside to cope with reality

Ex: woman focuses on kid’s needs instead of thinking about her father’s dx of cancer

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21
Q

Most significant factors for suicide risk assessment

A

Previous attempts

Clear plan

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22
Q

Introjection

A

immature defense mechanism

assimilating of another person’s attitutde into one perspective

ex: battered woman who believes her husband is right when he says she is worthless

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23
Q

Neuroimaging findings in psych disorders

A

Autism = increased total brain volume

OCD = abnormal orbitofrontal cortex + striatum

Panic d/o = decreased volume of amygdala

PTSD = decreased hippocampal volume

Schizo = enlargement of cerebral ventricles

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24
Q

Pt is Jehova’s witness but bleeding out….when do you give blood? when do you not?

A

Give blood:
Emergency + pt not able to speak + no documentary evidence despite wife saying he is

Don’t give blood:

  • Emergency + pt refuses
  • Emergency + pt not able to speak but have documentation is Jehovah’s witness
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25
Q

How can pt say who to release info to or not?

A

Orally

In writing

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26
Q

Absolute reasons for psych hospitalization

A 
HI
SI
Substance abuse
Mania
Psychosis
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27
Q

Beck Depression Inventory

A

Allows docs to follow severity of prev dx depression

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28
Q

Brown Peterson Task

A

Eval short term memory

good for ECT to see if affected memory

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29
Q

Wisconsin Card Sorting TEst

A

Sort cars with dff pictures among criteria

Assess ability to switch sets, reason abstractly, solve problems
- test executive functions

Ppl w/ schizo perform more poorly on WCST than ppl without

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30
Q

Rorschach Test

A

Inkblot test

Some psychologists use this test to examine a person’s personality characteristics and emotional functioning.

It has been employed to detect underlying thought disorder

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31
Q

Prior infection with what has been assoc w/ several psych illnesses like OCD?

A

Group A strep

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32
Q

Alexia

A

inability to read

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33
Q

Anomia

A

inability to name objects even if pts recognize and can describe object

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34
Q

Agnosia

A

inability to recognize object but can perceive it by intact senses

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35
Q

Apraxia

A

inability to perform learned motor skills despite nl strength and coordination

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36
Q

What happens if family members disagree with living will and pt is not conscious?

A

Discuss

If discussion fails, hospital ethics committee c/s

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37
Q

Assessment of suicidality

A

SAD PERSONS

Sex
Age
Depression
Prev attempt
EtOH
Rational thought loss (psychosis)
Social support (none)
Organized plan
No spouse or partner
Sickness/injury
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38
Q

Management of suicidality

A

High imminent risk (ideation, intent, plan)

  • hospitalize
  • remove objects w/ harm risk
  • 1 to 1

High non-imminent risk (ideation, intent, no plan to act in near future

  • close f/u
  • tx modifiable risk factors
  • recruit family and friends
  • reduce access to potential means
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39
Q

Which psychatric disorder has highest genetic link?

A

Bipolar I

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40
Q

Part of every psych workup

A

TSH

VDRL

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41
Q

Structural theory

A

Id - present at birth, seuxal/aggressive urges

ego - develop after birth, uses dense mech to control instinctual urges; distinguishes fantasy from reality using reality testing

super ego - dev at age 6 (morality, society, parental teaching)

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42
Q

Topographic theory

A

Unconscious

  • repressed thoughts
  • involves primary process thinking –> primitive

Preconscious
- memories easy to bring into awareness

Conscious
- current thoughts and secondary process thinking

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43
Q

Controlling

A

Neurotic defense

Regulating situations and events of external environment to relieve anxiety

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44
Q

Displacement

A

Neurotic defense

Transferring feelings to a more acceptable object

Ex: student angry at mom talks back to teacher tomorrow and refuses to obey instructions

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45
Q

Intellectualization

A

Neurotic defense

Using intellect to avoid uncomfortable feelings

Associated with emotional stress

Ex: recently laid off woman who starts researching political causes of country’s recent downturn; doc dying og ca describes pathophys of disease to son

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46
Q

Isolation of affect

A

Neurotic defense

Separating a thought from its emotional components

Ex: Woman describes recent death of husband w/o emotion

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47
Q

Rationalization

A

Neurotic defense

Justifying behavior to avoid difficult truths

Ex: my boss fired me because he’s short tempered, not because I didn’t do a good job

48
Q

Reaction formation

A

Neurotic defense

Responding in a manner opposite to one’s actual feelings

Ex: Man in love with married coworker insults her

49
Q

Repression

A

Neurotic defense

Blocking upsetting feelings from entering consciousness

PTSD

50
Q

Mature defense mechanisms

A

healthy + adaptive

in nl adults

51
Q

Neurotic defense mechanisms

A

in OCD pts, hypterical pts, and pts under stress

52
Q

Immature defense mechanisms

A

Seen in kids, adolescents, psychotic pts, and non-psychotic pts

Most primitive of defense mech

53
Q

Undoing

A

immature defense mech

Attempting to reverse a situation by adopting new behavior

Man who has brief fantasy of killing his wife by sabotaging her car takes car in for complete checkup

OCPD
OCD

54
Q

Goal of psychoanalysis

A

Resolve UNCONCSIOUS conflicts by bringing repressed experiences and feelings into awareness and integrating them into pt’s conscious experience

Insight oriented

Good for: 
cluster C personality DO
anxiety DO
OCD
Problems coping with life events
Anorexia nervosa
Sexual DO
dysthymic DO
55
Q

Free association

A

part of psychoanalysis

pt asked to say whatever comes to mind so therapist can interpret and unconscious feelings

56
Q

Dream interpretation

A

part of psychoanalysis

dreams = conflict between urges adn fears

57
Q

Therapeutic alliance

A

part of psychoanalysis

therapist + pt bond to work together toward goal

58
Q

Transference

A

part of psychoanalysis

Feelings and attitudes about the doctor coming from the patient

59
Q

Countertransference

A

part of psychoanalysis

Feelings originating from the doctor that are evoked by the patient

60
Q

Psychoanalysis vs psychoanalitically oriented psychotehrapy

A

POP is shorter but is pretty much same as psychoanalysis

61
Q

Interpersonal therapy

A

Focuses on dev of social skills to help psych DO

62
Q

Supportive psychotherapy

A

Goal = help pt feel safe during difficult time

absence of interpretations and the focus on helping the patient function in the real world.

Not insight oriented; focus on empathy, understanding, education

Concrete suggestions about improving functioning in the outside world are appropriate in this kind of therapy, which is often reserved for those patients with severe psychopathology.

63
Q

Behavioral therapy

A

Change behaviors that contribute to s

based on learning theory - behaviors can be learned by condition and unlearned by deconditioning

64
Q

Operant conditioning

A

Behaviors learned when followed by + or - reinforcement

refers to the concept that behavior can be modified by changing the antecedents or the consequences of the behavior (contingency management)

65
Q

Positive reinforcement

A

give reward for desired behavior

66
Q

Negative reinforcement

A

Encourage behavior by removing averse stimulus

Punishment is NOT negative reinforcement; it is an averse response to behavior

67
Q

Types of behavioral therapy

A 
Systemic desensitization
Flooding and implosion
Aversion therapy
Token economy
Biofeedback
68
Q

Cognitive therapy

A

Goal - correct faulty assumptions and negative feelings that exacerbate psych symptoms

Pt is to ID maladaptive thoughts and replace with positive ones

Good for depressive and anxiety DO

69
Q

Cognitive behavioral therapy

A

Focuses on pt’s current sx and problems by examining the connection between thoughts and behaviors

70
Q

Dialectal behavioral therapy

A

1x individual and group tx can diminish self destructive behaviors in borderline ppl

71
Q

Group therapy

A

good for

  • substance abuse
  • adjustment DO
  • personality DO
72
Q

Family therapy

A

Good adjuvant in many psych conditions

goals:

  • reduce conflict
  • help members understand each others needs
  • help unit cope

Boundaries should be addressed
Triangles should be broken up

73
Q

Tarsoff duty

A

Obligation of physician to report pts who are potentially harmful to others

74
Q

Elements of informed concent

A

4 Rs

Reason for tx
Risks and benefits
Reasonable alternatives
Refused tx consequences

75
Q

Situations not needing informed consent

A

Lifesaving emergency
Prevention of homicidal or suicidal behavior
Unempancipated minors getting OB care, STD tx, or substance abuse tx

76
Q

M’Naghten test

A

Person does not understand what he was doing or its wrongfulness

Most stringent test

77
Q

Tarsoff duty

A

Obligation of physician to report pts who are potentially harmful to others

78
Q

Elements of informed concent

A

4 Rs

Reason for tx
Risks and benefits
Reasonable alternatives
Refused tx consequences

79
Q

Situations not needing informed consent

A

Lifesaving emergency
Prevention of homicidal or suicidal behavior
Unempancipated minors getting OB care, STD tx, or substance abuse tx

80
Q

M’Naghten test

A

Person does not understand what he was doing or its wrongfulness

Most stringent test

81
Q

CSF finding predicting suicidal behavior

A

Low 5-HIAA

82
Q

What neurotransmitter has stimulation of appetite?

A

Neuropeptide Y

83
Q

Hyperventilation physio results

A

–> hypocapnia + respiratory alkalosis –>
decreased cerebral blood flow + decrease in ionized serum Ca –>

Dizziness + derealization + lightheadedness from cerebral vasoconstriction

Circumoral tingling, carpopedal spasm, and paresthesias from hypocalcemia

84
Q

Lab value to tell difference between generalized seizure and nonepileptic seizure

A

Generalized seizure has high prolactin levels after it happens

Nonepileptic seizure prolactin levels are normal

85
Q

Ppl best for insight oriented psychotherapy

A

Strongly motivated

Can tolerate lots of frustration

Good capacity for insight

NOT ok: low intelligence, cognitive dysfunctinos

86
Q

Abreaction

A

reenactment

Used in hypnosis for traumatic events

87
Q

Projective identification

A

the patient attributes unacceptable thoughts or feelings to those around him; the patient also recognizes the
feeling in himself.

Projective identification occurs mostly in borderline personality disorder and consists of three steps:

(1) an aspect of the self is projected onto someone else,
(2) the projector tries to coerce the other person to identify with what has been projected, and
(3) the recipient of the projection and the projector feel a sense of oneness or union

Ex: a patient avoids becoming conscious of his anger by
projecting it onto another person, then acts in a way that triggers the other person’s angry feelings

88
Q

Desensitization

A

is based on the concept that when the feared stimulus is presented paired with a behavior that induces a state incompatible with anxiety (eg, deep muscle relaxation), the phobic stimulus loses its power to create anxiety (counterconditioning).

reciprocal inhibition = pairing of feared stimulus with a state incompatible with anxiety is called .

For desensitization to work, the anxiety elicited by the exposure has to be low

89
Q

Hypnosis not recommended for

A

Paranoid pts

Those who experienced trauma

Psychotic pts

90
Q

psychoanalytic psychotherapy

A

Interpretations are corner- stone

  • explanatory statements made by the analyst that link a symptom, a behavior, or a feeling to its uncon- scious meaning.
  • Ideally, interpretations help the patient become more aware of unconscious material that has come close to the surface.

Confrontation
- the analyst points out to the patient something that the patient is trying to avoid.

Clarification refers to putting together the information the patient has provided so far and reflecting it back to him or her in a more organized and succinct form

91
Q

Biofeedback

A
  • therapeutic process in which information about the individual’s physiological functions, such as blood pressure and heart rate, are monitored electronically
    and fed back to the individual by means of lights, sounds, or electronic gauges.
  • Biofeedback allows individuals to control a variety of body responses and in turn to modulate pain and the physiological component of unpleasant emotions such as anxiety.
92
Q

Extinction

A

a learned response to removal of a stimulus.

93
Q

Harm avoidance temperament traits

A

heritable bias toward inhibition of behavior in response to signals of punishment or nonreward

Usually uncertain, shy, pessimistic worry

94
Q

Novelty seeking temperament traits

A

Impulsive
curious
easily bored
disorderly

95
Q

Reward dependence temperament traits

A

tender hearted
socially dependent
sociable

96
Q

Persistent temperament traits

A

hard working
ambition
overachievers

97
Q

Cacodemonomania

A

delusion that one is poisoned by an evil spirit

98
Q

Koro

A

Traumatic fear that the penis is shrinking into the body cavity

99
Q

Fornication

A

type of tactile hallucination

Sensation of bugs crawling on or under skin

Can be seen in cocaine intoxication or EtOH WD

100
Q

Haptic hallucination

A

tactile hallucination in which one feels as if he is being touched

101
Q

Synesthesia

A

secondary sensation following actual perception (sensation of color associated with taste)

Usually 2/2 neuro dz, or LSD use

102
Q

Hyperemnesia

A

abnormal recall of details

103
Q

Derealization

A

sense that one’s surroundings are strange or unreal

104
Q

Depersonalization

A

Sense that one’s identity is lost or the feeling of being unreal or strange

105
Q

Dereism

A

mental activity no in accordance with reality

106
Q

Prosopagnosia

A

inability to remember faces despite being able to recognize that they are faces

107
Q

Asterognosis

A

inability to recognize an object by touch despite the tactile sensations being intact

108
Q

Zar

A

Delusional posession by a spirit

109
Q

Fortteurism

A

syndrome of recurrent, intense sexual fantasies and behaviors involving touching or rubbing against a nonconsenting adult.

110
Q

Voyeurism

A

involves secretly watching someone involved in disrobing, nudity, or sexual behavior.

111
Q

Locus ceruleus

A

Hyperactive in anxiety states

Center of most of Norepi neurons in brain

112
Q

Raphe nucleus

A

In brain stem

Makes serotonin

113
Q

What type of therapy is not indicated in pts with difficulty with reality testing

A

Psychoanalysis

  • not good for psychotic pts!
114
Q

Flooding

A

exposure technique that is commonly used
in behavior therapy. The premise is confrontation
with the feared symptom

115
Q

establishing medical malpractice cases

A

The 4 Ds of establishing medical malpractice cases involve proving that a dereliction of duty directly causes damage.

The plaintiff must

  • establish the presence of a fiduciary relationship (a duty), - negligence (dereliction of duty),
  • damages directly caused by that negligence.

burden of proof in medical malpractice cases (civil cases) is by a preponderance of the evidence (greater than 50%).

Psychiatry (9 decks)

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