Sean hood lectures Flashcards
kubler-ross model is commonly known as
the five stages of grief
the 5 stages of grief is called
the kubler-ross model
what are the 5 stages of grief
denial - temporary defence for the individual
anger - any individual that symbolises life or energy is subject to projected resentment and jealousy
bargaining - hope that the individual can postpone or delay the problem.
depression - silent, refusing visitors, spending much time crying and grieving. It is not recommended to attempt to cheer up a person in this stage, as it is important time for grieving and processing.
acceptance - individual comes to terms with the event
telephone psychiatric referral structure is used when
calling a psychiatrist to refer a patient
general heading of structure of telephone psychiatric referral
greeting
clarify relevance of consult
clarify intent of the call
headline summary
pause
meta formulation / synopsis
restate purpose of referral
what are defences?
automatic psychological processes that protect the individual against anxiety and from awareness of internal or external dangers or stressors
4 levels of defence mechanisms in Valliant’s classification
- Psychotic (<5 years, adult dreams and fantasy)
- Immature (3-15 years, PD, adult psychotherapy)
- Neurotic (3-90 years, acute stress, neurotic dis.)
- Mature (12-90 years)
4 mature level defences
suppression
altruism
sublimation
humour
suppression
emotions remains conscious but is suppressed
altruism
suppressing the emotion by doing something nice for others
sublimation
transmuting the emotion into a productive and socially redeeming endeavour
eg. ill start writing a book about how to cope with rejection
humour
expressing the emotion in an indirect and humorous way
5 defences on the neurotic level
denial (of internal reality)
repression
reaction formation
displacement
rationalisation
denial (of internal reality)
denying that emotion exists
eg. ‘the rejection doesn’t bother me at all’
repression
stuffing the emotion out of conscious awareness (unfortunately, the emotion typically returns to haunt the oppressor in unpredictable ways)
reaction formation
forgetting the negative emotion by transforming it into it’s opposite
eg. ‘we’ve become so close since he cheated on me, he really is a wonderful person’
displacement
displacing the emotion from its original object to something or someone else
eg. my boss really has been getting under my skin lately
rationalisation
inventing a convincing, but usually false, reason why you are not bothered
6 immature level defence mechanisms
passive aggression
acting out
dissociation
projection
splitting (idealisation/devaluation)
(Autistic) fantasy
passive aggression
expressing anger indirectly and passively
acting out
expression the emotion in actions rather than keeping it in awareness
dissociation
dissociating instead of feeling the pain
splitting (idealisation/devaluation)
defining the rejecting person as being all bad, verses having seen him as all good before the rejection, thereby transforming pain into anger and accusation
(autistic) fantasy
withdrawal into excessive daydreaming rather than take effective action
3 defence mechanisms on the psychotic level
denial (of external reality)
distortion (of external reality)
disavowal (of external reality)
denial (of external reality)
eg. ‘he never left me’
distortion (of external reality)
eg. he never left me, he’s just off on a business trip
disavowal (of external reality)
eg. he never left me, in fact I never even met him!
what is the difference between coping mechanism vs defence mechanism
ways of describing Affect on MSE
congruent, reactive, range, intensity, mobility CRRIM
affect
the patient’s present emotional responsiveness, inferred from the patient’s facial expression, including the amount and range of the expressive behaviour
quality of affect
may be:
dysphoric in depression
euthymic (normal)
elevated/euphoric in mania
flat in schizophrenia
labile (all over the place)
irritable
congrruency of affect
the affect may or may not be congruent with the mood (when the affect matches the mood)
range of affect
may be within normal range, constricted, blunted or flat
the normal range of affect should include variation of facial expression, tone of voice, use of hands, and body movement
when affect range is ‘constricted’
the range and intensity of expression are reduced
when affect range is ‘blunted’
emotional expression is further reduced
when affect range is ‘flat’
virrtually no signs of expression should be present
patient’s voice is monotonous and face should be immobile
what things to point out regarding behaviour for MSE
engagement and rapport
eye contact
facial expression
body language (eg. threatening, withdrawn, mannerisms)
psychomotor activity (fidgeting, pacing, paucity of movement)
abnormal movements or postures (involuntary movements, tremor, tics, lip-smacking, akathiasis, rocking)
things to point out about speech on MSE
rate
quantity
tone
volume
fluency and rhythm
rate of speech
pressure of speech: a tendency to speak rapidly, motivated by urgency, usually a manifestation of thought abnormalities such as flight of ideas
quantity of speech
minimal or absent speech associated with depression
excessive speech associated with mania or schizophrenia
tone of speech
monotomous speech - associated with depression, schizophrenia and autism
tremulous speech - associated with anxiety
fluency and rhythm of speech
stammering or stuttering
slurred speech - may occur in major depression due to psychomotor retardation
mood represents
the patient predominant subjective internal state as described by them
affect represents
immediately expressed and observed emotion
eg. patiens facial expression and overall demeanour
things to mention in regard to though content
delusions
obsessions
compulsions
overvalued ideas
suicidal thoughts
homicidal/violent thoughts
thought possession abnormalities
thought insertion
thought withdrawal
thought broadcasting
thought insertion
a belief that thoughts can be inserted into the patient’s mind
thought withdrawal
a belief that thoughts can be removed form the patients mind
thought broadcasting
a belief that other can hear the patients thought
things to mention about perception on MSE
hallucinations
pseudo-hallucinations
illusions
depersonalisation
derealisation
pseudo-hallucinations
the same as aa hallucination but the patient is aware that it is not real
illusions
the misinterpretation of an external stimuli eg. mistaking a shadow for a person
depersonalisation
the patient feels like they are no longer a true self and are someone different or strange
derealisation
a sense that the world around them is not a true reality
what to mention with regard to cognition
are they oriented to time, place, person
attention span and concentration
if an MMSE, AMTS, or ACE-III was performed
risk factors for suicide
SADPERSONS
sex (women > men attempts vs. success)
age (teenagers and elderly)
depression
previous attempt
ethanol
rational thinking loss (10% schizophrenia)
social support problems
organised plan
no spouse
sickness (chronic illness)
