What are the 5 most common psychological problems patients bring into primary care?
What is depression?
A disorder of emotion (affective disorder)
What are the two main types of depression?
Unipolar: depressive state. Patients have constant tiredness and low moods. Once experienced, it is likely to happen again due to stressful triggers.
Bipolar: involves rapid transition between depressive and manic phases.
5% of population will suffer at lease one episode of unipolar depression. Prevalence of depression is especially high in clinical populations.
What is the ABC of depressive symptoms?
Symptoms of depression are clustered
Affect - persistently lowered mood, diminished interest or pleasure in activities
Behaviour - loss of appetite, disturbed sleep, lowered libido, social withdrawal
Cognition - depressive ideation (guilt), suicidal thoughts, fatalastic (hopelessness)
What is the step-care model for depression?
1. Known and suspected presentation of depression - assessment, support, education, monitoring (referral and sessment for interventions)
2. Persistent subthreshold depressive symptoms or mild depression - low-intensity phychological interventions, psychological interventions, medication and referral
3. Persistent subthreshold depressive symptoms or mild/moderate depression with inadequate response to initial interventions - medication, high intensity psychological interventions, combined treatments
4. Severe complex depression, risk to life, severe neglect - medication, high-intensity psychological interventions, combined treatments, multiprofessional inpatient care
What are the criteria for major depression?
Substantial weight loss/gain
Insomnia or hypersomnia
Feelings of worthlessness or inappropriate guilt
Recurrent thoughts of death or suicide attempts
Decreased interest or pleasure
Psychomotor retardation or agitation
Fatigue or loss of energy
Diminished ability to think or concentrate
Five or more in the same two week period - which is a change from normal
What two questions could you use to screen for depression?
During the past month, have you been bothered by feeling down, depressed or hopeless?
During the past month have you been bothered by little interest or pleasure in doing things.
Symptoms should be present for at least 2 weeks
Following a positive screen for depression, what else do you need to assess?
Detailed assessment to determine symptom severity and suicide risk.
Name four key approaches used in psychological medicine
Egan's 3 stage model
Cognitive behavioural therapy
Outline Egan's 3 stage approach to counselling
Explore - what is the problem?
Understand - how has the problem arisen? what does it mean to the patient? what change is sought?
Action - how can the change be acheived? what strengths and resources does the patient have?
Review and evaluate the outcomes of the strategies for change
What are the aims of CBT?
Acheive positive change in behaviour which has been negatively affecting an individual's functioning.
Identify thinking that causes problematic feelings and behaviour
Question the individual's negative thinking to enable positive change in their thought process
Identify unwanted behaviour patterns
Plan behavioural goals and the step by step process for the acheivement of those goals
Name four areas where the use of CBT can be beneficial?
Anxiety and panic attacks
Addictions (pathological gambling)
Chronic fatigue syndrome
Name four techniques used in CBT
Challenging irrational beliefs
Reframing/replacing irrational beliefs with alternative rational thoughts
Social skills training
Problem solving training
What are the benefits of CBT?
No medication required (no side effects)
What are they key aspects of the psychodynamic approach?
Assumption that a patient's current difficulties have their origins in earlier experiences (particularly childhood).
Explores issues from the past which produce defence mechanisms.
Assumes that the patient may not have a conscious awareness of the real motives or impulses which influence their actions (motivational drives, biological, psychological, relationship behaviour needs to be understood)
Name three psychological conditions that psychodynamic therapy can be used for
Post-traumatic stress disorder
What are defence mechanisms?
Psychological strategies brought into play by the unconscious mind to help protect an indiviual's sense of self.
e.g. denial, regression, withdrawal
What techniques are used in psychodynamic intervention?
Encourage the patient to explore and reflect on significant issues
Interpret behaviour or feelings (present alternative perceptions)
Challenge the patient with important consequences of their behaviour which the patient may be avioiding (consciously or subconsciously)
Convey empathy (show patient their feelings are recognised and understood)
Reinforce positive change made by patient with approval
What is the humanistic approach?
Humanistic approach focuses on choice, values and purpose in life.
Person centred, and non-judgemental
Emphasis is on positivism and the wholeness that an individual can acheive
Focuses on the impact of self-evaluation of life experiences (particularly the the extent of unconditional love and acceptance that has been experienced)
What are the key stages of the humanist approach?
Intimacy, so the patient is able to share deep levels of experience
Mutuality between the therapist and the patient (therapist is experienced as a real person)
How can you convey positive regard (unconditional acceptance) to patient?
Giving positive attention
Giving your time
Remembering the person's name
How can you convey empathy?
Reflecting back to the other person feelings that you are picking up
Behavioural mirroring (smiling when the other person smiles etc)
In what situations can humanistic therapy be useful?
When addressing factors which may lie behind substance abuse disorders e.g. lack of meaning in a person's life, anxiety about failure, fear of death, alienation from others, spiritual emptiness.
To address a person's self-awareness. Attempts to help people gain control of their lives and make positive choices about their future e.g. self-esteem, bereavement, assertiveness
What are the key concepts of the systems approach?
Suggests that as family, work and social group dynamics change, an individual's identity and sense of purpose can change.
Views problems as contextual and interpersonal - emphasises relationships and networks. Patient's family, work and community relationships are taken into account when considering options for the patient.
In what clinical situations would the systems approach be useful?
Working with patients and their failies
Recognising the significance of supportive networks in aiding recovery (what does the illness mean to the patient and their fmaily?)
Recognising the aspects of the environment where a patient lives/works that negatively affects health and well-being.
What are the key concepts of transactional analysis?
Uses concepts from humanistic, psychodynamic and cognitive approaches.
TA is a theory of personality that describes how people function and express thier personality in their behaviour.
Explores how values and attitudes learnt from parents and other significant people in childhood can exert a strong influence on an adult (adult patterns developed in childhood that we continue to replay)
How can transactional analysis be useful?
Helps patients to:
reflect on their ways of thinking and behacing
be more aware of the impact we have on others
improve the clarity and directness of communication with others