Psych Quiz 1
Terms
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- Axis 1
- Psychiatric Disorders
- Axis 2
- Personality disorders
- Axis 3
- Medical Conditions
- Axis 4
- Psychosocial stressors (1-6)
- Axis 5
- Global assessment of functioning score (GAF)
- What are some components of the Mental Status Exam?
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General appearance/attitude.
Behavior
Cognitive functioning.
Thought process, content and perception. - What is mood?
- An emotion that determines an individual's view of the world.
- What are the 5 levels of mood?
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Depression
Dysthymia (Low grade depression)
Euthymia
Hypomania
Mania - What is affect and how is it determined?
- Assesses the patients emotional responsiveness, determined by patient's facial expressions and tone of voice.
- What are the four levels of affect?
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Flat
Blunted
Constricted
Normal Range - What are Thought Content problems (name 4 of them)
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1.Delusions
2.Obsessions
3.Ideas of reference
4.Ideas of influence - Describe delusions
- Fixed, false beliefs, can be grandiose, paranoid or somatic
- Describe obsessions
- Unwanted thoughts
- Describe ideas of reference
- Believe object is talking to them
- Describe ideas of influence
- Higher force is causing something.
- Describe a CIRCUMSTANTIAL thought process
- Lack of a clear thought direction due to unnecessary extra information, but individual eventually returns to original thought.)
- Describe a TANGENTIAL thought process.
- Thread of conversation is lost, and the individual is pursuing other thoughts (does not return to original thought)
- Describe a word salad thought process
- Incoherent connections or thoughts
- What is a neologism?
- New word
- Describe two types of perception disturbances
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Hallucinations
Illusions - Describe hallucinations
- Auditory (schizo), visual/tactile (drugs), olfactory, gustatory. THING THEY SEE IS NOT ACTUALLY THERE
- Describe Illusions
- Visual misinterpretation of visual stimuli (something ACTUALLY there)
- What is orientation?
- Person's ability to know who they are, where they are and what date/time it is.
- What is sensorium?
- Refers to alertness of patient
- What is Judgement?
- Patient's ability to understand the outcome of their behavior.
- What is Insight?
- Patient's degree of awareness that they are ill. Often impaired when psychotic, may lead to non-compliance.
- What is a Histrionic patient?
- Seductive
- What are narcissistic patients?
- Know more than you do, or so they think
- Describe some general techniques for dealing with these nut cases
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Establish rapport early.
Open ended questions (unless paranoid/schizo)
Don't touch.
Set limits.
Don't stare. - When it is important to obtain collateral sources?
- If patient has impaired insight or patient requires a high degree of assistance.
- Which typically has a faster onset, psychiatric illness or medical illness?
- Medical is faster.
- What are the typical ages of medical conditions versus psychiatric conditions?
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Medical >40 yo
Psychiatric <40 yo - Who can perform psychotherapy?
- Psychologists, Psychiatrists or psychotherapists.
- What is the general procedures for psycho therapy?
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-Short term
-Patient's history normally acquired before therapy. - What is therapeutic alliance?
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1.Work together to establish goals of therapy.
2.Adjust therapist activity level to match the severity of the illness/phase of treatment.
3.Encourage self-help/monitoring
4.Recognized and manage transference - What is Transference?
- Passing on good or bad traits of someone on to therapist... can go both ways...
- Name some C/O to Psychotherapy
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1. Sadists, seriously violent (just kill 'em)
2.Total lack of remorse (assholes)
3.Superior intelligence or retards.
4.Inability to attach to others (historically)
5.Countertransference - Describe Psychodynamic therapy
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Discuss unconcious or unclear material with therapist. Patient develops understanding as to why problems exist and how to avoid.
Improves self-understanding and ego strength.
MUST HAVE INSIGHT, MOTIVATION AND TOLERANCE FOR FRUSTRATION AND A JOB. - For what conditions is Cognitive therapy useful?
- Depression, bipolar, OCD
- Describe cognitive therapy
- Based around concept that there are errors in information processing in these patients. Maladaptive and distorted thoughts lead to maladaptive and distorted behavior.
- What is dichotamous thinking? What axis?
- Axis 1: Sith - one way or the other, black and white
- What is overgeneralizing? What axis?
- Axis 1: One instance taken as representative
- What is Mind reading? What axis?
- Axis 1: When other's attitudes are assumed
- "I am helpless" What axis?
- Axis 2: Dependent cognitive distortion
- "I might get hurt" What axis?
- Axis 2: Avoidant cognitive distortion
- "People are out to get me" What axis?
- Axis 2: Paranoid Cognitive Distortion
- "I am special" What axis?
- Axis 2: Narcissistic Cognitive distortion
- "I need to impress" What axis?
- Axis 2: Histrionic cognitive distortion
- "People are there to be taken" What axis?
- Axis 2: Antisocial cognitive distortion
- What are 3 cognitive techniques?
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1. Identify automatic thoughts.
2. Modify automatic thoughts.
3.Identifying and modifying schemas - Behavior therapy is most useful in what conditions?
- Anxiety
- Describe overall BT
- Patient develops new and adaptive ways of behaving through changing the environment that produces the behavior.
- What is Systemic Desensitization?
- BT that is not common, a phobia treatment
- What is Exposure Therapy?
- BT that conissts of implosion and flooding. Used commonly for treatment of phobias. Toss them right in.
- What is Reinforcement?
- BT that is used in children/adolescents with conduct or eating disorders.
- What is Extinction?
- BT technique that removes positive reinforcement, may lead to increase in unwanted behavior briefly
- What is Aversion therapy?
- BT technique where patient may experience a bad situation when they perform unwanted behavior
- What is relaxation therapy?
- BT used as part of many therapies. Teaches patients to tense and then relax groups of muscles.
- What is modeling?
- BT where the therapist performs the desired behavior and the patient then performs the same function.
- What is Social Skills training?
- BT that helps patients overcome social deficits. Particular deficit is first identified then more appropriate behavior is developed through modeling and /or positive reinforcement. (Schizo/autism works well)
- CBT is useful in what Dz states?
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D
Bi
GAD
PD
OCD
B
Phobias - Describe Crisis intervention information
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Developed as a structured intervention meant to decrease risk of PTSD following overwhelming experiences.
Debriefing can be done individually or as a group.
Try to begin within 72 hours of event.
May be series of sessions.
CAUTION in recommendation. Newer shit. - What is Group Psychotherapy?
- Allows opportunities for modeling behaviors and motivating patients. Researchers in the field believe groups tend to act as if certain basic assumptions are true: Dependency group, Fight/Flight group, pairing group.
- Describe the Sex risk factor for suicide
- Women attempt more, men succeed
- Describe the age risk factor for suicide.
- Older increased risk, young attempt more
- Describe Race risk factor for suicide.
- Whites more
- Describe Religion risk factor for suicide
- Jews/Protestants much more than catholics
- Describe marital status risk factor for suicide
- Single, divorced, separated, widowed have increased risk.
- Describe occupation risk factor for suicide
- Job decreases risk
- Describe Methods risk factor for suicide
- Owning a gun increases
- Describe climate risk factor for suicide
- No effect
- Describe Physical Health risk factor for suicide
- Chronic conditions (i.e. MS, AIDs CVD...) increase risk. Loss of mobility, disfigurement and chronic pain are factors strongly associated.
- When is the suicide risk highest for admitted patients?
- During the 1st week
- Describe why ADs tend to have a risk factor for depression
- Due to the sequence of symptomatic improvement, Increased energy but not mood, so now they may do it.
- Describe Symptoms that may serve as precursors to emerging suicidality in AD users
- New onset agression, irritability, akathisia, anxiety, hostility, hypomania, mania
- 4 Protective factors for suicide
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1. Social support
2. Pregnancy
3. Parenthood
4. Religion - Describe factors that would lead to inpatient treatment of attempted suicide
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Absence of social suppport.
Impulsive behavior.
Suicidal plan of action.
Unable to contract for safety - Describe factors that would lead to outpatient treatment of attempted suicide
- Presence of strong social support system. Lacks a h/o of impulsive behavior, able to contract for safety.
- What drug has indication for recurrent suicidal attempt?
- Clozapipne
- What drugs to avoid in suicide risk patients?
- TCAs and MAOi's