Trivia and Psychotherapy Flashcards
Drug toxicity that causes nystagmus
PCP (and lithium)
EtOH dependence tx
Naltrexone, Disulfuram, Acamprosate
Sensitive tests for Delirium
Serial 7’s, orientation, 3 item recall
Benefit of IV haldol (over PO, etc.)
No EPS
Term for when you move a patient and they stay in that position
Waxy flexibility (seen in catalepsy)
Drugs that increase lamotrigine level
VPA (via glycuronidation?) and sertraline
ADHD in children is difficult to distinguish from what?
Bipolar disorder (mania)
PTSD criterion categories
- Intrusive symptoms
- Avoidance
- Hyperarousal
- Negative mood or Cognitive change
Atomoxetine BBW
SI (and hepatotoxicity)
Main symptom of childhood MDD
Irritability
TD risk
5% per year, highest in women with affective disorder
Dystonia risk is highest in whom
Young males
Violence risk is 30x higher in what demographic?
Substance use disorder
Venlafaxine
- Short half-life, fast renal clearance (no build-up, good for old people)
- Minimal DDI and minimal P450 activity
- Dose dependence DBP increase up to 10-15mm Hg
- QT prolongation
- Sexual SE in 30%
- Bad DC syndrome
- Nausea, especially with IR tabs
Resistance
Ideas unacceptable to conscious; prevents therapy from proceeding
Free association
Patient says what comes to mind uncensored. Clues to unconscious
Mature defense mechanisms
Suppression; Altruism; Anticipation; Affiliation; Sublimation; Humor
Neurotic defense mechanisms
RRIDE: Repression (expel from consciousness); Reaction formation (do opposite); Intellectualization (details to distance from emotions); Displacement; Externalization (blame on another)
Primitive defense mechanisms
PPPAADS: Projection (falsely attribute unacceptable feelings to another); Projective identification (falsely attribute to another who projects back); Passive-aggressive (indirectly express aggressive feelings); Autistic fantasy (day-dreaming); Acting out (inappropriate beh without consideration of consequences); Denial (refusing to acknowledge reality); Splitting (compartmentalize opposite affective states)
Lambert and Tallman in psychotherapy
- Quality of relationship affects outcome more than specific therapy
- Lambert: 40% motivation or severity of problem; 30% relationship; 15% expectancy (placebo); 15% techniques
- Tallman: Outside therapy people rarely have friends to listen >20 minutes; People close are often involved in problem and cannot provide safe impartial perspective
Two conditions associated with decreased density/volume of hippocampus
MDD and PTSD
Mindfulness based stress reduction (MBSR) program for 8 weeks -> brain changes
Changes in grey matter concentration in brain regions involved in learning and memory processes, emotional regulation. Self-referential processing and perspective taking.
* Left hippocampus increase
Psychotherapist versus therapist
Psychotherapist: Psychiatrist, Psychologist, SW, NP, PA, Minister/Priest
Therapist: anyone!
Psychotherapy continuum
Psychoanalytic Behavioral
Psychoanalysis (Freud, Jung)
- Focus on unconscious, insight by interpretation of unconscious conflict
- Most rigorous: 3-5/week, years, $$
- Patient on couch, analyst unseen
- Patient must be stable, highly motivated, verbal, psychologically minded, able to tolerate stress without overly regression/distraught/impulsive
- Analyst neutral
- Goal is STRUCTURAL REORGANIZATION OF PERSONALITY
- Techniques: Interpretation, clarification, working through, dream interpretation
Psychoanalysis terms
Transference, Countertransference, Therapeutic alliance, Resistance, Free association
Psychodynamic psychotherapy
- AKA “expressive,” “insight-oriented”
- Based on modified psychoanalysis
- No couch, less focus on transference and dynamics
- Interpretation, encouragement to elaborate, affirmation and empathy important
- 1-2/week, open-ended duration
- Limited goals
Supportive Psychotherapy
- Support of authority figure during period of illness/turmoil/decompensation
- Warm, friendly, non-judgmental, leadership
- Supports ultimate DEVELOPMENT INDEPENDENCE
- Expression emotion encouraged
Types of psychotherapy
- Psychoanalysis
- Psychodynamic
- Supportive
- CBT (IPT, CBT, DBT, behavioral)
- Other: Group, Family, Couples
CBT
- Manualized, time limited, coach-like, homework
* IPT, CBT, DBT, behavioral therapy
IPT
(CBT)
- Time-limited tx for MDD developed in the 70’s, for a variety of populations (old, young, HIV, marital)
- Assumes connection b/t onset mood d/o and interpersonal context in which they occur
- 12-16 weeks
- RCTs: IPT v. venlafaxine showed increased bloodflow to R. basal ganglia. IPT group also increased posterior cingulate. Underscored importance of limbic/paralimbic recruitment in psychotherapy-medication changes
CBT
- Derived from theories of normal/abnormal development and of emotion/psychopathology
- Utilizes cognitive model, operant conditioning, classical conditioning
- Approach focuses on here and now
- Tx is empowering-gaining psychological and practical skills
- Homework
- Techniques: identify cognitive distortions, test automatic thoughts, identify maladaptive assumptions
- Therapist takes active, problem oriented, directive stance
- Used for wide range problems: depression, anxiety, bulimia, anger, adjustment to illness, phobias, chronic pain
Psychotherapy in which techniques include: identify cognitive distortions, test automatic thoughts, identify maladaptive assumptions
CBT
Psychotherapy derived from theories of normal/abnormal development and of emotion/psychopathology
CBT
CBT and IPT in Major Depression
16-20 sessions as effective as imipramine for less severely depressed patients
Glucose metabolism with CBT and venlafaxine
Decrease everywhere, Increase in Lateral inferior occipital
CBT in panic disorder
16x = medication
Better tolerated and more durable
CBT in OCD
Cue exposure and response prevention
As effective as medication
DBT
Developed to tx BPD
- Based on behaviorist theory w/cognitive therapy elements
- Incorporated “mindfulness” (from Zen) as central component
- Therapist specially trained
- Individual and group sessions
- Focuses on self-destructive behaviors, esp suicidality
- Learn core mindfulness, emotion regulation, interpersonal effectiveness, distress tolerance
Psychotherapy using Zen mindfulness as central component
DBT
Psychotherapy teaching core mindfulness, emotion regulation, interpersonal effectiveness, distress tolerance
DBT
CBT (DBT) in BPD
Superior to “tx as usual” for reducing parasuicide, medical severity of parasuicide, treatment drop-out, number of inpatient hospitalization days
Group psychotherapy
- Carefully selected patients, trained leader, immediate feedback
- Self-help groups enable members to give up patterns of unwanted behavior; Therapy groups help patients understand why
- Encompasses theoretical spectrum of therapies: supportive, time-limited, CB, psychodynamic, IP, family, client-centered based on nonjudgmental expression of feelings
Family therapy
- Interrupt rigid patterns causing distress
- Family systems theory: family unit acts as though homeostasis must be maintained
- Therapy: discover hidden patterns and help understand behaviors
- Many treatment models, schedule and duration flexible
Couples therapy
- Different than “marriage counseling,” because more limited in scope
- Couple or in group
- Indicated when individual tx fails to resolve relationship difficulty
- Geared toward enabling each to see other realistically
