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sem 1 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is mental illness?

A

Subjectively distressing experiences to a person.
Can involve abnormal perceptions, beliefs and behaviour
Much of this is on a continuum and involves a degree of subjective clinical/professional judgement.
Women and black ppl have higher incidence of a common mental disorder (CMD)
Service user is the preferred term and not patient

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2
Q

Mental health assessment involves…

A

Symptoms, experiences, feelings, thoughts and actions
Physical health
Housing and finances, work/education
Social relationships, culture and ethnicity
Gender and sexuality
Use of drugs/alcohol
Past experiences, risks to self or others
Carer responsibility
Strengths, coping strategies, hopes and aspiration

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3
Q

Why are diagnoses useful?

A

Help to frame difficulties and gives an explanation for a person’s experiences
Helps signpost to assessment and treatment using the best available evidence
Provides prognosis
Creates communication w colleagues via shared language and approaches

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4
Q

What are the disadvantages of diagnoses?

A 
Can be reductionist
Stigma and pejorative labelling
Attribution of blame
Some ppl may not have a clear diagnosis
Some ppl may have several diagnoses
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5
Q

Give the criteria which can be used to classify mental health conditions

A 
Phenomenology – direct experience(s)
Symptoms/Syndrome (group of consistent symptoms occurring juntos)
Aetiology (cause)
Duration
Diagnostic criteria
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6
Q

What are the 2 main diagnostic manuals?

A

1: ICD-10 by the WHO uses numbers from F0-F99 to classify the different types of mental disorders into different diagnoses
2: DSM-V which doesn’t have a numbering system but also classifies the different mental disorders

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7
Q

Give some of the most common mental disorders in clinical practice

A

Substance misuse
Schizophrenia, schizotypal and delusional disorders
Mood disorders (hypomania, bi-polar, depression)
Anxiety and behavioural disorders (panic disorders, phobias)
Personality disorders, Dementias, Eating disorders
Reactions to severe stress (PTSD, adjustment/ dissociative disorders)
Self-harm/suicide

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8
Q

Describe dementia

A

Dementia is the umbrella term for a range of progressive brain conditions:
Alzheimer’s disease, vascular dementia, dementia with Lewy Bodies, Fronto-temporal dementia, Mixed dementia
Dementia
Patients can struggle w: new info, cognitive abilities, processing info, making decisions, concentration and communication.

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9
Q

Describe Schizophrenia and Psychosis

A

Prevalence= ~1% in the UK, typically affecting young adult males and 25-35yr old females
Often needs anti-psychotic medication, can involve CBT/psychological interventions. Early intervention is key, relapse is possible
Symptoms: hallucinations, delusions, thought disorder, negative symptoms
E.g. Bipolar affective disorder, schizophrenia, post partum psychosis

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10
Q

Describe the main mood disorders

A

Bipolar affective disorder: episodes of elevated mood and irritability. Can inc psychosis, depressed mood. Often co-morbid w anxiety, substance misuse, personality disorders and ADHD. Peak onset is 15-19

Depression: V broad diagnosis which depends on the number/severity of symptoms. Depressed mood, functional impairment, loss of pleasure in most activities.

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11
Q

Describe anxiety disorders

A

Agoraphobia (fear of being in situations where escape might be difficult), social phobia or other specific phobia.
Panic disorder, OCD, PTSD

Anxiety disorder:
Excessive worry, hyperarousal, counterproductive and debilitating fear

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12
Q

Describe personality disorders

A

Personality disorders: maladaptive patterns of relating to self, others and the world. It relates to the characteristics and traits developed from child to adulthood
Associated w other mental health co-morbidities, suicide, homelessness, unemployment, crime, substance abuse. Stress worsens symptoms.
Difficulties w social, family relationships, their own distress, avoiding trouble/crime, controlling feelings or impulses. Treatable

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13
Q

What are the symptom clusters?

A
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14
Q

What risk factors are associated with suicide?

A

Risk factors associated with suicide can include:
Societal- difficulties access or receiving care, stigma
Community- poverty, trauma or abuse
Individual factors- previous attempts, self-harm, drugs/alcohol, physical and financial problems, family history of suicide
Relationships- isolation, lack of support, loss or conflict within a relationship

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15
Q

Describe self harm

A

Self-harm: intentional act of self poisoning or self injury regardless of motivation. Can be a way to communicate intolerable distress, inability to cope, stress.
Can be suicidal or non-suicidal, but can be a strong predictor.
Girls self harm more than boys
Causes: past abuse, depression, insecurity, relationship or work problems. V common in people w borderline personality disorder.

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16
Q

What is the The Diathesis-Stress Model

A

The diathesis-stress model recognises that genetics (nature) and developmental experiences (nurture) contribute to a person’s lifetime risk of developing mental health problems.

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17
Q

What are the 4 Ps?

A

Factors which influence the course of mental illness.
•Predisposing (genetics, early developmental experience)
•Precipitating (psychosocial stress, significant life event, spliff)
•Perpetuating (sick role, learned helplessness)
•Protective (the good stuff – family, meaningful work, religion)

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18
Q

Describe illness behaviour and sick role

A

Illness Behaviour describes the way in which symptoms are perceived, evaluated, and acted upon.

The Sick Role: a temporary medically sanctioned form of deviant behaviour. Parsons suggested conflicting drives to recover and to continue to enjoy the ‘secondary gains’ of attention/exemption from duties.

19
Q

What is the link between socio-economic status and mental illness?

A

The following disorders are more common in lower social classes: Schizophrenia, personality disorder, alcohol dependence, major depression
Anorexia nervosa is consistently associated with higher social classes.

20
Q

What is the link between culture and emotion?

A 
Primary emotions: Happiness, fear, disgust, sadness, anger, surprise
Secondary emotions (e.g. shame and guilt) display cultural variation. Diff languages can have v different emotional vocabulary
This questions how applicable Western models of mental health and illness are to other cultures
21
Q

Describe the systemic model

A

Relevant for children/young people
Is the problem in the individual or in the family system?
Suggests ‘high expressed emotion’ triggers psychotic relapse
Role of family dynamics in eating disorders, etc.
Family therapy interventions are based on this model.

22
Q

Describe Classical conditioning:

A

Neutral stimulus (e.g. sound) paired w unconditional stimulus (e.g. food) elicits a conditioned response (e.g. salivation). The neutral stimulus now becomes a “conditioned stimulus” – Ivan Pavlov, ringing a bell and his dogs
Classical conditioning introduces predictability eg: Patient attending hospital for chemo gets nauseous on just entering hospital
Taste aversion→cancer patients develop aversion to food encountered during chemo
Conditioned fatigue→clinical cues make cancer patients tired

23
Q

give therapeutic uses of classical conditioning

A

Systematic desensitisation→ Gradual exposure of a fearful participant to the object of their fear.
E.g. arachnophobia – present small spiders, and as the person becomes more confident you get a larger spider and so on.

24
Q

Compare classical vs operant conditioning.

A

Classical conditioning looks at responses to stimuli.
Operant conditioning looks at responses to behaviour.
In classical conditioning our intervention (e.g. the bell) is the antecedent- it comes before the behaviour (e.g. drooling)
In operant conditioning our intervention (e.g. food) is the consequence- it comes after the behaviour (pressing the button)

25
Q

What is reinforcement?

A

A consequence that increases the likelihood that a behaviour will be repeated is called a reinforcer
Reinforcement can be either positive or negative
In both positive and negative reinforcement the behaviour is strengthened

26
Q

Describe positive versus negative reinforcement.

A

Positive reinforcement: presenting a motivating stimulus to a person after they exhibit desired behaviour makes the behaviour more likely to happen in future.
Negative reinforcement: when aversive stimulus is removed after a particular behaviour is exhibited. This makes the behaviour more likely to happen in future bc of removing/avoiding the negative consequence.

27
Q

Explain punishment

A

Punishment: A consequence that decreases the likelihood that a behaviour will be repeated

Positive punishment: when a behaviour is reduced in Hz by adding an unpleasant stimulus. eg if a dog growls at someone who pets them (an unpleasant stimulus), they won’t pet again (reducing behavioural frequency)

Negative punishment: eg if a parent takes a child’s toys (removal of a pleasant stimulus) for bad behaviour, the child is less inclined to repeat the behaviour

28
Q

What does Skinner argue?

A

In his book, “beyond freedom and dignity” Skinner argues against free will and moral autonomy of the individual
He promotes using scientific methods to modify behaviour in order to build a happier society

29
Q

Describe the Learned Helplessness Model For Depression

A

Based on Seligman’s work: dogs in electrified cage initially unable to escape shock. This later changed so they could easily escape but they didn’t try. The dogs had learned (by conditioning) that they were helpless

Depression occurs when people ‘learn’ outcomes are outside their control and they’ll continue to fail regardless of what they do

30
Q

Describe the concept of behavioural therapy

A

Behavioural Therapy: the problem is a learned maladaptive behaviour, which should be unlearned.
Maladaptive behaviours can be self-reinforcing, e.g. avoidance (ppl w anxiety avoid social situations, this reduces their anxiety levels so they avoid social settings even more.)
Patients can be ‘trained’ to respond with more adaptive behaviours

31
Q

give examples of behavioural therapy

A

Flooding or graded exposure (for phobias)
Exposure and response prevention (for OCD- eg getting a patient to touch dirt and not wash their hands)
Behavioural activation and activity scheduling (for depression- pushing someone to do an activity several times until they start to enjoy it)

32
Q

What is the cognitive model of depression?

A

In depression patients typically experience ‘automatic negative thoughts’ relating to:
The self>worthlessness
The world>helplessness
The future>hopelessness
Automatic negative thoughts (ANTs) lead to “Hot Thoughts”, which lead to underlying Core beliefs (eg
I am worthless)

33
Q

Draw a hot cross bun diagram relating to a panic attack

A
34
Q

Give strengths and weaknesses of CBT

A

Strengths of CBT: It’s quick, cheap and works well

But: it doesn’t address attachment problems, relationship problems, it can be overused.

35
Q

What is attachment and why is it important?

A

Attachment begins w mother and baby and is key.
The importance of attachment from developmental psychology has been incorporated into the psychodynamic model
The patient-therapist dyad creates a space where attachment issues can be worked through
Insecure attachment=basis for Personality disorder

Bonding concerns the mothers feelings for her infant and differs from attachment!!

36
Q

What is the attachment theory?

A

Attachment theory was developed by John Bowlby
He suggested children have an innate tendency to form attachments w people around them to increase their chance of survival

37
Q

What is imprinting?

A

Imprinting: the phase-sensitive attachment seen in some animals and in humans
Demonstrated by Lorenz working with Greylag geese, who will follow the 1st they see as a mother figure.

Harlow’s Monkey expt demonstrates the need for closeness over food: young monkeys spent more time w soft terrycloth mum who gave no food, rather than wire mum who provided food.

38
Q

Outline basic concepts in the psychodynamic model

A

The topographical model:
The conscious: what ur aware of
The preconscious: not immediately in ur awareness but can be retrieved with some effort
The unconscious: things we’re not aware of and can’t easily retrieve

The structural model:
The ego, The id
The superego: an internalisation of authority figures like parents or teachers

39
Q

Outline Freuds psychosexual development

A

Oral: needs explored thru sucking, swallowing, biting
Anal: needs explored through bowel and bladder, through both elimination and retention
Phallic: Pass through Oedipus complex
Latency: The sexual drive remains latent
Genital: Independence from parents; desire intimate relationships with others

40
Q

What is repression?

A

Involves dealing with stress by removing disturbing thoughts or experiences from conscious awareness.

Repressed issues may return or manifest itself in other ways

One of many unconscious ‘defence mechanisms’

41
Q

What is the aim of therapy?

A

Making the unconscious conscious and give insight

42
Q

Describe the Oedipus complex today

A

The Oedipus complex: the transition from being a baby with a mother in an idyllic dyad, to a triad – not just Mum and baby anymore- other factors are in the eqn. Can evoke rivalry and jealousy.

43
Q

What is transference and countertransference?

A

Transference: patient transfers feelings/expectations from past relationships (e.g. w father) into the present (e.g. the relationship with the therapist)

Countertransference – the therapist has an emotional response to their patient which may yield useful diagnostic info

44
Q

Describe the depressive vs paranoid-schizoid positions

A

The depressive position: Concerned about ur actions towards others, aims at repairing relationships
The paranoid-schizoid position: concerned about actions other people might do to u, evoking anxiety

sem 1 (14 decks)

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