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psychiatry 2023 > Sean hood lectures > Flashcards

Sean hood lectures Flashcards

1
Q

kubler-ross model is commonly known as

A

the five stages of grief

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2
Q

the 5 stages of grief is called

A

the kubler-ross model

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3
Q

what are the 5 stages of grief

A

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

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4
Q

telephone psychiatric referral structure is used when

A

calling a psychiatrist to refer a patient

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5
Q

general heading of structure of telephone psychiatric referral

A

greeting
clarify relevance of consult
clarify intent of the call
headline summary
pause
meta formulation / synopsis
restate purpose of referral

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6
Q

what are defences?

A

automatic psychological processes that protect the individual against anxiety and from awareness of internal or external dangers or stressors

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7
Q

4 levels of defence mechanisms in Valliant’s classification

A
  1. Psychotic (<5 years, adult dreams and fantasy)
  2. Immature (3-15 years, PD, adult psychotherapy)
  3. Neurotic (3-90 years, acute stress, neurotic dis.)
  4. Mature (12-90 years)
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8
Q

4 mature level defences

A

suppression
altruism
sublimation
humour

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9
Q

suppression

A

emotions remains conscious but is suppressed

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10
Q

altruism

A

suppressing the emotion by doing something nice for others

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11
Q

sublimation

A

transmuting the emotion into a productive and socially redeeming endeavour
eg. ill start writing a book about how to cope with rejection

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12
Q

humour

A

expressing the emotion in an indirect and humorous way

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13
Q

5 defences on the neurotic level

A

denial (of internal reality)
repression
reaction formation
displacement
rationalisation

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14
Q

denial (of internal reality)

A

denying that emotion exists
eg. ‘the rejection doesn’t bother me at all’

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15
Q

repression

A

stuffing the emotion out of conscious awareness (unfortunately, the emotion typically returns to haunt the oppressor in unpredictable ways)

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16
Q

reaction formation

A

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’

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17
Q

displacement

A

displacing the emotion from its original object to something or someone else
eg. my boss really has been getting under my skin lately

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18
Q

rationalisation

A

inventing a convincing, but usually false, reason why you are not bothered

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19
Q

6 immature level defence mechanisms

A

passive aggression
acting out
dissociation
projection
splitting (idealisation/devaluation)
(Autistic) fantasy

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20
Q

passive aggression

A

expressing anger indirectly and passively

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21
Q

acting out

A

expression the emotion in actions rather than keeping it in awareness

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22
Q

dissociation

A

dissociating instead of feeling the pain

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23
Q

splitting (idealisation/devaluation)

A

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

24
Q

(autistic) fantasy

A

withdrawal into excessive daydreaming rather than take effective action

25
Q

3 defence mechanisms on the psychotic level

A

denial (of external reality)
distortion (of external reality)
disavowal (of external reality)

26
Q

denial (of external reality)

A

eg. ‘he never left me’

27
Q

distortion (of external reality)

A

eg. he never left me, he’s just off on a business trip

28
Q

disavowal (of external reality)

A

eg. he never left me, in fact I never even met him!

29
Q

what is the difference between coping mechanism vs defence mechanism

A
30
Q

ways of describing Affect on MSE

A

congruent, reactive, range, intensity, mobility CRRIM

31
Q

affect

A

the patient’s present emotional responsiveness, inferred from the patient’s facial expression, including the amount and range of the expressive behaviour

32
Q

quality of affect

A

may be:
dysphoric in depression
euthymic (normal)
elevated/euphoric in mania
flat in schizophrenia
labile (all over the place)
irritable

33
Q

congrruency of affect

A

the affect may or may not be congruent with the mood (when the affect matches the mood)

34
Q

range of affect

A

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

35
Q

when affect range is ‘constricted’

A

the range and intensity of expression are reduced

36
Q

when affect range is ‘blunted’

A

emotional expression is further reduced

37
Q

when affect range is ‘flat’

A

virrtually no signs of expression should be present
patient’s voice is monotonous and face should be immobile

38
Q

what things to point out regarding behaviour for MSE

A

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)

39
Q

things to point out about speech on MSE

A

rate
quantity
tone
volume
fluency and rhythm

40
Q

rate of speech

A

pressure of speech: a tendency to speak rapidly, motivated by urgency, usually a manifestation of thought abnormalities such as flight of ideas

41
Q

quantity of speech

A

minimal or absent speech associated with depression
excessive speech associated with mania or schizophrenia

42
Q

tone of speech

A

monotomous speech - associated with depression, schizophrenia and autism
tremulous speech - associated with anxiety

43
Q

fluency and rhythm of speech

A

stammering or stuttering
slurred speech - may occur in major depression due to psychomotor retardation

44
Q

mood represents

A

the patient predominant subjective internal state as described by them

45
Q

affect represents

A

immediately expressed and observed emotion
eg. patiens facial expression and overall demeanour

46
Q

things to mention in regard to though content

A

delusions
obsessions
compulsions
overvalued ideas
suicidal thoughts
homicidal/violent thoughts

47
Q

thought possession abnormalities

A

thought insertion
thought withdrawal
thought broadcasting

48
Q

thought insertion

A

a belief that thoughts can be inserted into the patient’s mind

49
Q

thought withdrawal

A

a belief that thoughts can be removed form the patients mind

50
Q

thought broadcasting

A

a belief that other can hear the patients thought

51
Q

things to mention about perception on MSE

A

hallucinations
pseudo-hallucinations
illusions
depersonalisation
derealisation

52
Q

pseudo-hallucinations

A

the same as aa hallucination but the patient is aware that it is not real

53
Q

illusions

A

the misinterpretation of an external stimuli eg. mistaking a shadow for a person

54
Q

depersonalisation

A

the patient feels like they are no longer a true self and are someone different or strange

55
Q

derealisation

A

a sense that the world around them is not a true reality

56
Q

what to mention with regard to cognition

A

are they oriented to time, place, person
attention span and concentration
if an MMSE, AMTS, or ACE-III was performed

57
Q

risk factors for suicide

A

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)

psychiatry 2023 (20 decks)

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