Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
217 Cards in this Set
- Front
- Back
|
what is the Biopsychosocial model? and what are the assumptions involved?
|
biological - psychological - social all connected via overlapping circles
-most illnesses are inlfuenced and determined by biological, psychological, and social factors; these 3 factors influence the predisposition, onset, course, and outcome of most illnesses; understanding the difference between disease and illness physicians who are able to evaluate the relationship of these 3 factors in their patients illnesses will provide more therapeutic interventions and better outcomes |
|
|
What 3 components play into the biological basis of the biopsychosocial model?
|
genetics
biochemisty/neurochemisty structural |
|
|
What 3 components play into the psychological basis of the bps model?
|
behavioral
cognitive affective |
|
|
What 4 components play into the sociological basis of the bps model?
|
stressors
supports roles developmental state |
|
|
What is the social readjustment scale?
|
Realtive stressfulness related to life events
Very High: death of spouse, divorce, marital separation High: major personal loss of health, marriage, job loss, retirement, birh/adoption Moderate: mortgage, promotion/demotion, child leaving home Low: changing residence, vacation, major holiday |
|
|
What did the nine year mortality rate of Alameda, CA show about social ties?
|
people with the least connections, fewest social ties always had the highest mortality rate and people with the most connections and social ties had the least mortality rate
|
|
|
What is the connection between hostility and mortality by city?
|
increased hostility based on adjustment for race, education, age, income, and gender, will have an increased mortality, cities with low hostility scores will have lower mortality rates
|
|
|
How did job title relate to mortality?
|
the higher the ranking the lower the mortality rate, social ranking plays a role in mortality
|
|
|
What is the clinical application of understanding the biopsychosocial model?
use example of quitting smoking: |
with each treatment you need to consider how biological, psychological, and social aspects are influences the individual
smoking- Biologic: COPD (-), nic depend (+), genetics (+/-) Behavioral: Peers smoke (+), social gatherings (+), social censure (-), stress reduction (-) Cognitive: Knowledge of smoking risks (-), belief in invulnerability (+) Cultural: Value systems (+/-), gender models (+), social sanctions (+) Environmental: Accessible (+), inexpensive (+), advertising (+) |
|
|
What does a multiaxial diagnosis mean?
and how are they ranked in level of understanding that will influence diagnosis? |
understanding each condition the patient has will help you treat each individual condition as well as the patient as a whole
I: psychiatric disorders II: personality disorders, III: general medical conditions IV: stressors V: global assessment of function |
|
|
What are the leading activity limitation conditions in children?
|
speech problems, asthma, mental retardation, other mental problems, ADHD, learning disability
speech problems is the leader in ages 0-11 and learning disability is leader from 12-17 |
|
|
What have the trends of drugs in children been recently?
|
antidepressants have increased nearly equally in boy and girls while stimulant drugs for ADHD have increased in both boys and girls but boys are prescribed them 4x as often as girls
|
|
|
What are the leading activity limiting conditions in adults?
|
mental illness, fractures, lungs, diabetes, heart/vascular, arthritis/musculoskeletal, mental retardation
arthritis it the to limitating condition |
|
|
what is the leading cause of death in infants?
|
congenital anomalies, SIDS, and RDS
|
|
|
what is the leading cause of death in:
children 1-4 children 5-14 adolescent/adult adults 25-44 adults 45-64 adults 65+ |
1-4: accidents, congenital anomalies, cancer
5-14: accidents, cancer, homicide 15-24: accidents (MVA), homicide, suicide 25-44: accidents, HIV, cancer 45-64: cancer, heart disease, stroke 65+: heart disease, cancer, stroke |
|
|
What medical conditions can mimic anxiety?
|
hyperthyroidism
cardiac arrhythmias pulmonary disease |
|
|
what medical conditions can mimic depression?
|
chronic pain
hypothyroidism parkinson's disease |
|
|
What medical conditions can mimic personality changes?
|
dementia
brain neoplasms huntington's disease |
|
|
what medical conditions can mimic Mania/Psychosis?
|
neoplasms
AIDS Huntington's Disease |
|
|
What medication induced psychiatric symptom can arise from each:
analgesic anti-asthmatic anti-convulsants anti-hypertensives peptic ulcer drugs steroid hormones antineoplastics |
analgesic - psychosis
anti-asthmatic - confusion, anxiety anti-convulsants- mood symptoms, confusion anti-hypertensives - depression, fatigue peptic ulcer drugs- depression steroid hormones - aggression, depression, fatigue, anxiety, psychosis antineoplastics - confusion, disorientation, mood changes |
|
|
what are the 4 models of behavior change?
|
1. health belief model
2. theory of reasoned action 3. transtheorectical/stages of change model 4. social learning theory |
|
|
What is the health belief model?
|
likelihood of health-related action as a function of perceived:
1. susceptibility 2. severity 3. benefits 4. barriers perceived susceptibility and barriers most strongly associated with preventive health behavior |
|
|
What is the theory of reasoned action model?
|
emphasizes interntion to commit a behavior as determined by :
attitude to behavior subjective norms about behavior degree of control over behavior: internal and external |
|
|
What is theory of reasoned action model most used for?
|
good predictive power for wide range of heatlh behaviors:
addiction sexual practices receiving screening |
|
|
What did Ivan Pavlov discover? and describe what this is
|
classical conditioning paradigm - respondent behavior is a physiological or emotional response elicited by a stimulus
|
|
|
What happens in the preconditioning phase of the classical conditioning model?
|
neutral stimulus elicits no response (bell)
and unconditioned stimulus elicits unconditioned response (food --> mouth watering) |
|
|
What happens in the conditioning phase of the classicla conditioning model?
|
neutral stimulus gets tied to an unconditioned stimulus (bell with food) and unconditioned response still occurs
|
|
|
What happens in the post-conditioning phase of the classical conditioning model?
|
neutral stimulus becomes a conditioned stimulus which elicits the conditioned response
(bell triggers salivation) |
|
|
What is extinction in classical conditioning model?
|
CR decreases if the CS is never agin paired with the UCS
|
|
|
What is stimulus generalization in the classical conditioning model?
|
a new stimulus that ressembles the CS causes a CR
|
|
|
What are 4 clinical examples of classicl conditioning processes?
|
development of fears/phobies
treatment of fears/phobies treatment of enuresis anticipatory nausea/vomiting |
|
|
What did J.B watson come up with? and elaborate on what this means
|
fear conditioning
infants have only two unconditioned stimuli that will elicit an observable fear respones: loud sound and sudden loss of support, then unconditioned response to these is catching of the breath, stiffening, crawling or running away, and crying all other stimuli come to that come to elicit fear is through classical conditioning |
|
|
What did Watson's Little Albert and Fear conditioning do?
|
at first the infant was not afraid of the rat and other furry animals, but then the rat was paired with a loud noise and albert responds fearfully to the rat and other furry animals from classical conditioning.
This then can undergo generalization in which all furry animals elicit fear but could also take the road of extinction if the loud noise is never paired with the furry animal again |
|
|
What did Mary Cover Jones discover?
and what did she do experimentally? leading to what understanding |
mother of behavior therapy
a 3 yo afraid of white rabbit and other similar stimuli, had pleasant stimulus (food) and favored adult paired with rabbit overall she came up with: reciprocal inhibition and systematic desensitization |
|
|
What did B. F. Skinner come up with and describe what this is about?
|
Operant Conditioning:
to condition a behavior that is not normally present, you must reward behaviors that are close to the desired end behavior --> shaping is establishing a new response by reinforcing successive approximations to it |
|
|
What is the definition of operant/instrumental responses?
|
a response that operate on the environment to produce an effect
(push a lever --> get a piece of food) |
|
|
What is the definition of operant conditioning?
|
learning process by which the consequences of a response affect the probably that the response will recur in the future
|
|
|
Reinforcement -
|
an event that increases the probability that a response will be repeated - positive and negative reinforcement
|
|
|
Punishment -
|
an event that decreases the probably of a response
-positive and negative punishment |
|
|
Positive reinforcement -
|
the PRESENTATION of a stimulus following a behavior that strengthens or increases the likelihood of that behavior being performed again
|
|
|
Negative Reinforcement -
|
the REMOVAL of a stimulus follwing a behavior that strengthens or increases the likelihood of that behavoir being performed again
usually removal of an adverse stimulus that was previously there |
|
|
Positive punishment -
|
decreasing the probability of a behavior by presenting a punisher following occurrence of the behavior
|
|
|
Negative punishment -
|
decreasing the probability of a behavior by removing a positive reinforcer or the opportunity for positive reinforcement following occurrence of the behavior
|
|
|
How does the schedule of reinforcement influence the response?
|
wil determine the rate and durability of the response
|
|
|
Describe each schedule and what the overall purpose is?
continuous - Fixed Interval Fixed ratio Variable Interval Variable Ratio |
continuous : every time --> this elicits a rapid response with short pause after reinforcement but lower resistance to extinction
fixed interval: every Nth sec/min: longer pause after reinforcement leads to scalloping effect; lower resistance to extinction, the shorter the interval the higher the response rate will be Fixed ratio: every Nth response: rapid responding very short pause after each reinforcement, higher ratio generates higher response rate, lower resistance to extinction Variable interval: on average, every Nth sec/min: shorter intervals generate higher rates overall, low, steady rate without pauses, higher resistance to extinction variable ratio: on average, every Nth response: high steady rate without pauses, higher ratios generate higher response rates, higher resistance to extinction |
|
|
What did Albert Bandura discover and explain what this is:
|
Social cognitive theory
personality develops through observational learning of other's behavior -observe the actions and consequences of other's behavior -store a mental representation |
|
|
What is reciprocal determinism?
|
person watches/ evaluates others in a situation, while ther other react to the situation in a certain manner
Then a new situation arises, the person watches/evaluates the situation again and see a new behavior in response to the new environmental situation |
|
|
Classical vs Operant Conditiong
stimulus timing type of response learning connection inventor of theory |
Classical:
stimulus precedes the response elicited response learning as a result of association Pavlov Operant: stimulus follows response (strengthens) emitted response learning as a result of consequence Skinner |
|
|
What did Piaget come up with?
|
learning capabilities
|
|
|
What did Kohlberg come up with?
|
moral learning
|
|
|
what did Erikson come up with?
|
Psychosocial
|
|
|
What are the 4 factors that influence cognitive development?
|
1. maturation of the nervous system
2. experience 3. social transmission of information, or teaching 4. equilibration |
|
|
What is involved in Neural development?
and what is neural dawrinism? |
grow, then prune neurons
neural darwinism - make too many neurons, then prune the ones you're not using (30-60% more neurons in the fetus than the adult brain) |
|
|
What role does Myelinization play in Neural development?
|
basic sensory and motor areas become myelinated early - most essential, primary
then association areas become myelinated later, these are more for complex thought |
|
|
What are 7 reflexes present at birth that can check neural development?
|
rooting
sucking swallowing crying breathing eyeblink withdrawal form pain |
|
|
What are the milestones in motor development?
|
2 months: lifts head up
2 1/2 months: rolls over 3 months: sits propped up 6 months: sits without support 6 1/2 months: stands holding on 9 months: walks holding on 10 months: stands momentarily 11 months: stand alone 12 months: walks alone 14 months: walks backwards 17 months: walks up steps 20 months: kicks ball forward |
|
|
What are the social developmental tasks from birth to 15 months?
|
bonding: parent to infant
attachment: infant to parent visual tracking - newborns can track face like stimuli |
|
|
What was the sucking response when performed in a social context?
|
newborns suck more when they hear their native language and suck more when they hear their mom's voice
|
|
|
Social development for Toddlers: 15m - 2.5 years
|
attachment: child learns to separate from mother - usually complete by age 3
|
|
|
What did Harlow's Attachment studies show?
|
the requirement for maternal bonding to a warm, soft body is more influential in dictating where the monkey spends most of its time than the fact that the something non-nurturing can provide food (wire mother, with food vs cloth mother without)
|
|
|
what qualities did the monkey's have that were raised in isolation?
|
fearful, depressed, not social with others, males affected> females, can be rehabilitated if < 6 months
|
|
|
What over all did Harlow's attachment studies reveal?
|
attachment more related to contact comfort than feeding
|
|
|
What did Bowlby say about attachment? what experiments did he do and what did he find out?
|
attachment is universal, makes sense evolutionarily, supported this through visual cliff experiements:
infants ducks using social referencing would not cross road if mother appeared fearful but would cross if mother was happy and interested |
|
|
What was the visual cliff experiment? and what were the results?
|
try to get babies to crawl over the glass to get to mom, the part with glass appears to drop off
mobile infants won't crawl over glass, but when pre-mobile infants were placed on glass did not appear bothered all babies have a perception of depth by the time they are able to take up independent locomotion, this might by the incentive to crawling |
|
|
what was the Ainsworth strange situation test? and what conclusions came from it?
|
mother-child pairs were observed in a playroom
-initial mother child interaction -mother leaves infant alone in playroom -mother returns and greets child found that there are three kinds of attachment: secure attachment - ambivalent-insecure attachment, avoidant-insecure attachment |
|
|
What does secure attachment mean -
|
child explores the room when mother is present, child becomes upset and explores less when mother is not present, child shows pleasure when mother returns
|
|
|
What does Insecure avoidant attachment mean?
|
child is not upset by mother's departure and ignores her when she comes back
|
|
|
What does insecure anxious resistant attachment mean?
|
child is clingy when mother is there, becomes inconsolably upset when she leaves and remains distressed when she returns
|
|
|
What did Konrad Lorenz do and describe what this is and how he discovered this:
|
imprinting period in development is when an event can have a long lasting influence on the brain and behavior that it would not have if it occurred outside that period
found this out by observing that baby ducks and goslings will follow on the first individual they encounter, even if its a human rather than the mother, their imprinting period is within five days after hatching |
|
|
What is the cognitive development level of preschoolers: (2.5y - 6 years)?
|
attachment completed - separation anxiety disorder if after age 3
can distinguish fantasy from reality conscience develops by 6y |
|
|
What was Piaget's approach to cognitive development in preschoolers?
|
cognitive disequilibrium stimulates growth
studied this by primarily asking children to solve porblems and to question them about the reasoning behind their solutions, discovered that children think in radically different ways than adults, proposed that development occurs as a series of stages differing in how the world is understood |
|
|
What 3 parts are involved in equilibration of childrens' cognitive development?
|
equilibrium - occurs when child's existing mode of thought and existing chemas are adequate for confronting and adapting to the challenges of environment
assimilation - incorporating new information into the child's existing schemas accommodation - changing the existing schemas to fit the relevant new information about the environment |
|
|
What are the stages of cognitive development? and describe each
|
sensorimotor- (0 - 2) : physics, senses, movement, object permanence (understand life through senses, but no reasoning thought)
preoperational (2-7): symbolic, egocentric, no conservation (represents things with words and images but lacks logical reasoning, can think symbolically, but no real reasoning) concrete operations( 7-12): conservation of number (age 6), length, volume, mass (age 7), weight (age 9); can take others perspective; become more logical;(concrete operational, coherent organization of thoughts, still not abstract reasoning) formal operation (12+): scientific thought, abstract reasoning: (can think logically about abstract propositions and test hypotheses systematically, can understand hypothetical propositions, can understand perspectives of others) |
|
|
What does object permanence mean?
|
if can't see it, its not there
big transition is from 0-9 months and then from 9+ months, before 9 months object permanence is the level of understanding for the infant, after 9 months the infant will learn to expect things to come back, when peek-a-boo is fun, can follow a train through a tunnel |
|
|
what does directed groping mean?
|
child varies movements and observes the results (part of sensorimotor stage of congitive development)
|
|
|
What are the characteristics of formal operational stages of cognitive thought?
|
hypotheticodeductive thinking
metacognition real vs possible systematic thought abstract concepts formal logic |
|
|
What does quality of communication in the history taking influence?
|
-emotional health
-symptom resolution -function -pain control -physiologic measures (BR, BG) |
|
|
What is a frequent cause of litigation in the medical field?
|
failure to be honest:
-did not disclose an error -insensitive handling and poor communication afterward -more likely to sue if patient believed there was a cover-up or if they wanted more information and litigation was seen as the only option |
|
|
What did Levinson, Roter, Mullooyl, Dull and Frankel research and conclude?
|
compared claims vs no claims surgeons and FP
they found that no differences in surgeons who were sued/not sued but no claims FP used more statements about what to expect, laughed and used humor, and more facilitation, also spent longer in visits |
|
|
What do we look to find out in the medical interview?
|
-adherence
-practitioner and patient satisfaction -health outcomes |
|
|
What did Helfer et al. study and what was the results?
|
studied student interpersonal skills with patients:
1st year: very good skills an dinterest 2nd year: begin to decline 3rd: significantly worse 4rth: terrible PGY 1-3: gradual improvement |
|
|
What two general forms of communication are there?
|
language
paralanguage |
|
|
What is language broken down into?
|
speech and writing
|
|
|
What makes up paralanguage?
|
-auxillary communications
-prevents the wrong message from being passed on -60%+ of what we communicate when we talk with other is through paralanguage -non-verbal: pitch, volume, intonation -kinesics -proxemics -clothing, makeup |
|
|
What is proxemics? and what are some measurements of them?
|
the study of the measurement of distance between people as they communicate
Very close: 3-6'' - soft whisper - secret or sensual close: 8-12'' - audible whipser - very confidential neutral 20-36'' - soft voice, low volume - personal subject matter neutral 4.5-5' - full voice - non-personal information across the room - loud voice - talking to a group |
|
|
What are kinesics?
|
the study of body movements, in this context particularly relating to communication
-gestures -expressions -postures |
|
|
What are the interview aims and techniques to get each?
|
establish rapport:
-support and empathy -validation maximize information gathering -facilitation -reflection -silence clarify information -confrontation -recapitulation |
|
|
What are the 9 rules for the doctor in getting information?
|
-sit at eye level
-no table/desk between -open ended questions -avoid leading questions -don't be judgmental -support and empathy -clarify and summarize -anticipate unspoken questions -anticipate unspoken fears |
|
|
What are the 8 rules for a doctor in giving information?
|
-tell adult patients the truth
-use appropriate vocabulary -speak directly to the patient, not through relatives, staff -be midnful of confidentiality -do not offer premature reassuring statements -do not attempt to frighted patients into adherence -tell the patient what to expect before beginning a procedure -do not order a course of action; provide information and let the patient decide |
|
|
What are 6 rules for the doctor that are miscellaneous?
|
-do not blame the patient for being difficult or nonadherent
-respect the patient's autonomy -set limits on inappropriate patient behavior -do not abandon the patient -refer to another health professional only for medical reasons -follow the patient's wishes or advance directives as closely as possible |
|
|
What is transference?
|
expectation, beliefs and emotional responses that the patient brings to the doctor-patient relationship based on important relationship in the patient's past
|
|
|
What are positive transferences?
|
-idealization of the doctor can lead to having sexual feelings towards the doctor
-patient views doctor as good and has confidence in his or her ability -can lead to over idealization and tremendous disappointment when doctor can't solve all problems or is not always available |
|
|
What are negative transferences?
|
-patient views doctor as harsh punitive parent or authoritative figure who doesn't care about well being and patient may be nonadherent
-patient with experience with untrustworthy parent may seek many consultations and may be provocative to doctors |
|
|
What is countertransference?
|
refers to doctor's reaction towards patient based on their own earlier experience
|
|
|
What are special student issues that can happen in student patient interaction?
|
-patient asks the student to leave
-patient seeks reassurances about diagnosis or treatment -patient offers information only if the student promises not to reveal it -patient asks the student on a date -patient is verbally, physically, or sexually abusive towards the student |
|
|
What are the 8 barriers to communication?
|
-sensory impairments
-language differences -cognifitve differences in understanding illnesss -age effects -gender effects -altered mental status -medication effects -physician or patient time constraints |
|
|
What did detmar et al. 2000 investigate and what did they find?
|
they looked at how often health related quality of life was discussed in clinical practice.
-90% of patients wanted to discuss physical and emotional functioning with physician -25% of patients would do so only if initiated by physician -20% expressed no desire to discuss fmaily or social issues with physician -100% of physicians reported that they generally defer to patients to initiate discussion of psychosocial issues |
|
|
What did detmar et al. 2002 investigate and what did they find out?
|
examined the efficacy of using standardized Health related quality of life assessments to facilitate patient-physician communications and to increase physician's awareness of their patients HRQL-related problems
they used the EORTC-QOL and the results were given to patient and physicians: HRQL issues discussed more frequenctly in intervention group; intervention group physicians identified more patients with mod-severe health problems: 100% or physicians and 87% or patients rated intervention was beneficial |
|
|
What type of illnesses is nonadherence very common in?
|
all chronic illnesses:
-arthritis -seizure disorders -asthma -diabetes -hypertension |
|
|
What did the Harris interactive poll show?
|
adults with income >$75,00, 12% avoided filling script due to cost
individuals with disabilities: -35% did not fill script due to cost -28% took medicine less often than prescribed -27% took smaller doses than prescribed |
|
|
What did the disability supplement and disability follow-back survey 1994/95 show?
|
younger adults (18-34) 10x more likely to be nonadherent as older adults (75+)
uninsured were 4x less likely to be adherent health status, psychiatirc diagnosis, severity of disabilit, and # of prescriptions all related to nonadherence |
|
|
What seems to be the reason why young people are non adherent vs why older people are non adherent?
|
Young people have cost associated noncompliance
older people have multiple medications non compliance |
|
|
What are psychiatric conditions that lead to nonadherence?
|
bipolar disorder: 20-60%, increasing over time, sonsequence is high relapse rate
depression:33% in 1st month 44% in 3 months side effects main reason for nonadherence in first 3 mos, responsible for majority of relapses, educational interventions minimally helpful |
|
|
what are the factors associated with adherence?
|
-doctor-patient relationship
-symptoms and impairment -waiting room time -beliefs about the benefits of care -writeen material -illness duration -regimen complexity -physician age -peer support |
|
|
Factors NOT associated with adherence?
|
-intelligence
-education -gender -religion -race -socioeconomic status -marital status |
|
|
What are the consequences of psychiatirc nonadherence?
|
-exacerbation of symptoms
-increased family/caregiver stress -homelessness -increased ED/crisis intervention -increased hospitalizations -viewed as a treatment failure |
|
|
What are the predictors of nonadherence to psychiatric treatments?
|
-duration of treatment
-poor therapeutic alliance -poor insight -negative attitude toward medication -history of nonadherence -substance abuse -inadequate discharge planning -presence of side effects -complexity of treatment -barriers to treatment |
|
|
what are some facotrs minimally associated with adherence to psychiatric treatments?
|
-age
-gender -marital status -ethnicity -educational level -type of antipsychotics -urban vs rural setting -type of living situation |
|
|
What are the 5 reasons most patients stop taking medications?
|
side effects
didn't like didn't need reason didn't work forgot |
|
|
What are the 6 consumer perceptions of antipsychotic side effects?
|
-low motivation
-restlessness -tremor -unusual movements: face/body -rigidity -grimacing/tongue protrusion |
|
|
What are the major reasons for nonadherence for individuals on disability?
|
cost and side effects
|
|
|
What are the core ethical priciples?
|
-autonomy
-nonmaleficence -beneficence -justice |
|
|
What is the confidentiality oath?
|
all that may come to my knowledge in the exercise of my profession or outside of my profession or in the daily commerce with men, which ought not to be spread aborad, I will keep secret and never reveal
-the ID of a person as a patient must be protected with extreme care. A psychiatrist may release confidential information only with the authorization of the patient or under proper legal compulsion |
|
|
When can you compromise a patient's confidentiality? and what duty does this fall under?
|
-likely suicide attempt
-suspected child/eld abuse -serious threat to another -duty to warn/ protect |
|
|
What is the duty to warn/protect?
|
refers to the responsibility of the professional to breach confidentiatliy if an identifiable person is in clear or imminent danger
|
|
|
What did Tarasoff v Regents of the University of Cali establish?
|
duty to warn/protect - if an identifiable person is in clear or imminent danger
|
|
|
What are the rules with involuntary hospitalizations?
|
in certain situations patients with psychiatric disorders who are a danger to themselves or others may be hospitalized against their will
|
|
|
What are the rules on involuntary hospitalization in WV?
|
-Petitioner, licensed examiner, and mental hygiene commissioner, can demand the individual to be taken into custody for examination
-if there is addiction or mental illness and likelihood to cause serious harm to self/others, a probable cause hearing will be held -can be committed for up to 30 days |
|
|
What are the questions that have to be answered in order to deem someone likely to harm self/others due to mental illness?
|
- inflicted/attempted bodily harm on another
-placed others in reasonable fear of physical harm -presented danger to others in his/her care -threatened or attempted suicide or serious bodily harm to self -unable to care for self (nutrition, medical, shelter, self-protection) such that there is a substantial likelihood of death or serious injury |
|
|
What are the 7 components of the mental health bill of rights?
|
1. to recieve appropriate treatment
2. to refuse treatment unless it is determined to be necessary to protect the patient or others 3. to privacy 4. to manage one's own finances 5. to receive visitors 6. to communicate with the outside world 7. to be paid for work done in the facility |
|
|
What was Zipkin vs Freeman about and what happened as a result?
|
-mrs. zipkin developed a strong positive transference with dr. freeman and fell in love with him
-dr. freeman begant to take mrs. zipkin on social outings, overnight trips and swimming parties with other patients and without clothes -dr. freeman engaged in sexual relations with mrs. zipkin -dr. freeman convinced mrs. cipkin to purchase a farm for him and work as a manual laborer, to leave her husband, and to steal her hustband's suits for dr. freeman to wear -mrs. zipkin sued for psychological damages based on his negligent handling of the transference |
|
|
What are the 4 D's of malpractice?
|
dereliction or a
dute causing damages directly to the patient |
|
|
What happened in Williamson vs. liptzin?
|
myron liptzin what the MD, wendell williamson was the patient
Wendell stopped taking his medicines and shot two students to death at UNC. williamson sued liptzin in the premise that his psychiatrist was responsible for the murders due to his negligence liptzin was found negligent for failing to adequately inform williamson about the gravity of his illness and the absolute need to continue treatment. Although liptzin had told williamson that he was retiring and that williamson would need to see another psychiatrist on staff, liptzin was criticized for failing to refer williamson to a specific therapists and insuring that an appointment was set up. case went to trial and NC jury awarded williamson 500,000 in damages. appeals later found in favor of liptzin |
|
|
What are the 4 leading reasons for malpractice in child and adolecent psychiatry?
|
failure ot protect child inpatient from assault or sexual interaction with another patient
adolescent suicide medication erros issues related to child abuse |
|
|
What is the insanity defense?
|
not guilty by reason of insanity - due to insanity at the time of the crime person should not be held responsible and thus acquitted
|
|
|
Whta is guilty but mentally ill?
|
found legally guilty of crime and can be incarcerated, but needs clinical help
|
|
|
How do NGRI and GBMI compare:
-responsibility for crime -where committed -given sentence -when released |
responsibility:
-NGRI - not repsonsible -GBMI - responsible where committed: -NGRI - forensic hospital -GBMI - prison sentence -NGRI - no -GBMI - yes when released -NGRI - when no longer dangerous and mantially ill -end of sentence, can be civilly committed |
|
|
What are three tests for statutory criteria for legal insanity?
|
M'Naughten
American law Institute Model Penal Code Durham |
|
|
What is the definition of insanity for the M'Naughten test? and what are some additional qualitites?
|
did person undrestand the nature and quality of actions, and if so, did person known the actions were wrong?
strictest test standard criterion in most jurisdictions |
|
|
What is the definition of insanity for American law insitute model penal code?
and what are additional comments? |
did person appreciate the wrongfulness of behavior and is person able to conform conduct to the requirements of the law
most jurisdictions have dropped volitional prong |
|
|
What is the definition of insanity for Durham and what are the additional comments?
|
evaluates whether the person's criminal behavior is the product of a mental illness
most lenient test droped by mos jurisdictions |
|
|
What are the evidences of knowledge of wrongfulness?
|
efforts to avoid detection
disposing of evidence efforts to avoid apprehension |
|
|
What makes a person leagally incompetent to stand trial?
|
if individual does not understand the charges or cannot cooperate with counsel
|
|
|
What is the purpose of trantheoretical/stages of change model?
|
other models considered too static, this is good because individual moves along different stages of readiness to engage in a behavior based on assessment of pros and cons
|
|
|
What are the stages of the transtheoretical/stages of change model?
|
1. precontemplation - not planning to quit in next 6 months
2. contemplation - planning to quit in next 6 months 3. preparation - had cut back and planning to quit in next 1 month 4. action - begun to quit but not completed 5. maintenance - quit smoking less than 1 year |
|
|
What is the social learning theory state?
|
basis for many school and media campaigns, social modeling - behavior is demonstrated then applied and practiced by observers
|
|
|
In Operant condition what is extinction?
|
gradual disappearance of a learned behavior when reinforcement is withheld
|
|
|
In operant conditioning what is importance of consequences?
|
affect the probability that the response will recur in the future
|
|
|
What is reciprocal inhibition?
|
the occurrence of one thing inhibits the other
|
|
|
What is systematic desensitization?
|
gradual imaginal exposure to fear-provoking stimuli
|
|
|
What are some examples of transitional objects? and what will people often do if they don't use these?
|
soft toy or blanket
|
|
|
What is true of solitary sleepers?
|
more likely to use complex rituals at sleep time and to rely on transitional objects
|
|
|
What are the tempermental clusters that fall under easy?
|
postitive modd
regular biological rhythms adaptable low intensity positive approach to novelty |
|
|
What are the tempermental clusters that fall under difficult?
|
negative mood
irregular biological rhythms slow to adapt intense reactions negative response to novelty |
|
|
What are the tempermental clusters that fall under slow to warm up?
|
negative response to new stimuli
mild intensity gradual adaptation after repeated contact |
|
|
What are the 8 psychosocial stages of Erikson?
|
1. trust vs mistrust
2. autonomy vs self-doubt 2. initiative vs guilt 4. competence vs inferiority 5. identity vs role confusion 6. intimacy vs isolation 7 generativity vs stagnation 8 ego integrity vs despair |
|
|
What are the age ranges of Erikson's psychosocial stages?
|
1. birth to 1 year
2. 1-3 years 3. 3-5 4. 5-12 5. adolescence 12-18 6. early adult 19-40 7. middle adulthood 40-65 8. late adulthood 65 years to death |
|
|
What are the major task at each erikson's psychosocial stage?
|
1. children rely on caregiver to meet needs
2. children discover their independence 3. children are given greater interactions and responsibility 4. children gain knowledge and skills 5. teens develop sense of self and goals "who am i?" 5. young adults test out relationships and friendships, learn to compromise independence, and accept responsibility 7. start thinking about contributions to future generations 8. look back on life, crises, aspirations, accomplishments |
|
|
What are the important events in each erikson's psychosocial stage?
|
1. feeding
2. toilet training 3. independence 4. school 5. peer relationships 6 love relationships 7. parenting 8. reflection on acceptance of one's life |
|
|
What are the successes of eash erikson psychosocial stage?
|
1. sense of safety, trust
2. feeling of self-control 3. self-confidence 4. basic social and intellecutal skills, feelings of competence 5 comfortable with self, roles 6. capacity for closeness and commitment with another 7. focus beyond oneself 8. wholeness, satisfaction with life |
|
|
What are the failures at each erikson psychosocial stage?
|
1. insecurity anxiety
2. feelings of lack of control, shame and doubt 3. feel lack of self worth, guilt 4. feeling of ailure 5. identity confusion, negative identity 6. feeling of aloneness, separation 7. self-indulgent concerns, existential angst 8. feeling of futility, disappointment, incompleteness |
|
|
What are Kohlber's theory of moral development?
|
everyone is born without morals, ethics, or honesty
|
|
|
What are the levels of development of morals? according to Kohlber
|
Level 1: preconventional: values in external events,Stage 1. punishment avoidance; Stage 2. getting what you want by trade-off
level 2: conventional - performing right roles: Stage 3. meeting expectations of others; Stage 4. fulfilling duties and upholding laws Level 3 Postconventional - shared standards, rights, and duties : Stage 5. sense of democracy and relativity of rules; Stage 6. self-selection of universal principles preconventional - punishment driven conventional - disapproval (socially) driven Postconventional - rationally driven |
|
|
What did the Asch Experiment test and what were the results?
|
looking at group conformity:
most subjects answered correctly: -many showed extreme discomfort -33% conformed to the erroneous majority view -more likely to conform when confederate were unanimous in their judgement -control subjects had no trouble giving the correct answer |
|
|
What are the JOnestown, Guyana in 1978?
|
jim jones a cult leader of the people's temple, persuaded his follwers to drink kool-aid laced with cyanide
|
|
|
What are the 8 psychosocial stages of Erikson?
|
1. trust vs mistrust
2. autonomy vs self-doubt 2. initiative vs guilt 4. competence vs inferiority 5. identity vs role confusion 6. intimacy vs isolation 7 generativity vs stagnation 8 ego integrity vs despair |
|
|
What are the age ranges of Erikson's psychosocial stages?
|
1. birth to 1 year
2. 1-3 years 3. 3-5 4. 5-12 5. adolescence 12-18 6. early adult 19-40 7. middle adulthood 40-65 8. late adulthood 65 years to death |
|
|
What are the major task at each erikson's psychosocial stage?
|
1. children rely on caregiver to meet needs
2. children discover their independence 3. children are given greater interactions and responsibility 4. children gain knowledge and skills 5. teens develop sense of self and goals "who am i?" 5. young adults test out relationships and friendships, learn to compromise independence, and accept responsibility 7. start thinking about contributions to future generations 8. look back on life, crises, aspirations, accomplishments |
|
|
What are the important events in each erikson's psychosocial stage?
|
1. feeding
2. toilet training 3. independence 4. school 5. peer relationships 6 love relationships 7. parenting 8. reflection on acceptance of one's life |
|
|
What are the successes of eash erikson psychosocial stage?
|
1. sense of safety, trust
2. feeling of self-control 3. self-confidence 4. basic social and intellecutal skills, feelings of competence 5 comfortable with self, roles 6. capacity for closeness and commitment with another 7. focus beyond oneself 8. wholeness, satisfaction with life |
|
|
What happens in the waco texas in 1993?
|
david koresh, cult ldeader of the branch davidians, maintained an armed standoff with the government for 51 days until he and cult members died in a fire of unknown origin
|
|
|
What was the setup in the Milgram obedience experiments?
|
participants introduced to a tall stern looking experimenter wearing a white lab coat and to a friendly co-participant
instructed that experiment is about punishment in learning, student is strapped in chair with electrodes, participant is in control of delivering punishment and experimenter is watching |
|
|
What were the reasons as to why there was such high obedience in the Milgram experiment?
|
Proximity:
-situationism -entrapment -objectivity -authority structures |
|
|
What were changes made to the experiment that were effective in decreasing obedience? (Milgram)
|
reduced E legitimacy
increased distance from authority decreased distance from victim add dissenting voices |
|
|
What were some changes made to the experiment that did not decrease the obedience in the Milgram experiment?
|
reduce prestige of the school holding experiments
nicer experimenter |
|
|
What was the setup in the stanford prison experiment?
|
25 people selected for 15$/day for 2 weeks, half were going to be guards and 1/2 would be prisoners in this mock setup.
The research assistant was the warden and Zimbardo was the superintendent. Guards had batons, uniforms, and mirrored sunglases, workied in shifts and volunteered for overtime without pay. They were just told to run the prison with no formal guidelines. prisoners worse loose fitting smocks and sandals and were assigned numbers, |
|
|
What happened in the stanford prison experiment?
|
quickly got out of hand: prisoners suffered and accepted, sadistic and humiliating treatment from the guards, and in the end many showed severe emotional disturbances. day two the prisoners rioted,
then bathroom and food was withheld prisoners slept on concrete floors without clothes, there was forced nudty and simulated sexual acts. Several guards became more sadistic particularly at night with no cameras. Uncontrollable crying and disorganized thinking were common; two prisoners were severely traumatized and had to be replaced. The experiment was shut down after 6 days, after planning for 14. |
|
|
What were the findings of the stanford prison experiment?
|
demostrates the impressionability and obedience of people when provided with a legitimizing ideology and social and institutional support
supports the situational influences of behavior rather than the dispositional nature of humans |
|
|
What is reciprocity and inequity aversion?
|
give monkey 1 a rock, gives back and gets cucumber
give monkey 2 a rock, gives back and gets cucumber then give monkey 2 grape instead and monkey 2 throws out rock and cucumber and won't perform the exchange |
|
|
Id -
|
source of biological needs, seeks immediate pleasure
|
|
|
Superego -
|
embodies societal rules and values; blocks inappropriate behavior of the id
|
|
|
Ego-
|
mediator of the personality; finds pleasure that is acceptable to both id and superego
|
|
|
What did freud think were the functions of defense mechanisms?
|
objective anxiety: threats from the world or from other peopel that may overpower the ego
neurotic anxiety: irrational demands of the id threaten to overwhelm the ego moral anxiety: irrational demands of the superego might overcome the ego |
|
|
What are defense mechanisms?
|
unconscious mental techniques that are used by the ego to keep conflicts out of consciousness, thus decreasing anxiety and maintaining the individual's sense of safety, equilibrium, and self-esteem
|
|
|
What are the 7 defense mechanisms?
|
repression
intellectualization denial reaction formation projection displacement sublimation |
|
|
Describe repression -
|
unacceptable thoughts are kept away from sonsciousness, forgetting an upsetting childhood event such as a death
|
|
|
Describe intellectualization -
|
the mind is used to explain away frightening feelings or conflicts, a physician, after learning he has lupus, learns everything he can about the disease
|
|
|
Explain Denial -
|
unacceptable thoughts are ignored, alcoholics ignore their problems
|
|
|
reaction formation -
|
behaving in the opposite way to how you really feel because the true feelings produce anxiety, pretending you like somebody that you can't stand
|
|
|
projection -
|
denying your faults but finding them in others, an unemployed father yells at his son for being lazy
|
|
|
Displacement -
|
redirection of an impulse away from the person who caused it and towards another, a boy who is angry with his father beats on his little brother
|
|
|
Sublimation -
|
creating an assceptable justification for an unacceptable behavior, a gambler says he lost a lot of money because he was trying to win some for his family
|
|
|
What are freuds psychosexual stages? and describe each
|
Oral: ages 0-2
-oral fixation: improper weaning, excessive mouth behaviors, Anal: 2-4 -anal expressive: child enjoys expelling feces, messy wasteful -anal retentive - child enjoys retaining feces, obsessively clean and organized, stingy Phallic: 4-6 -Oedipus complex: castration anxiety, fixation leads to a pre-occupation of manliness -Electra complex: penis envy, fixation leads to feelings of inferiority to men, flirting, seeking father figures to overpower Latent: middle childhood, sexual instinst are submerged Genital: adolescence through adulthood - sexual attachments |
|
|
What is manifest of dream content?
|
what the dream actually contains
|
|
|
What is latent dream content?
|
what the elements of the dream actually represent
|
|
|
What is transference?
|
unconscious displacement of feelings, attitudes, and expectations from important persons in the patient's childhood to current relationships
|
|
|
What is countertransference?
|
feelings and attitudes of the therapists towards the patient, which may arise from activation of conflicts from the therapist's own past, or which may be a result of the patient's projections onto th etherapists
|
|
|
What is free association?
|
technique used in psychoanalysis in which the patient speaks whatever comes to mind without censoring thoughts. Psychoanalysts must be able to recognize the subtle signs that something important has just been mentioned
|
|
|
What is primary process?
|
type of thought occuring in the unconscious, characterized by irrationality, wistfulness, and domination by emotions and instinctual drives
|
|
|
pleasure principle -
|
obtain immediate gratification of desires
|
|
|
Parapraxes -
|
freudian slips
|
|
|
Hysteria -
causes symptoms treatments |
psychogenic: due to an unknown psychological cause rather than a physiological cause
symptoms - paralysis of some body part or loss of one of the senses with no apparent physiological cause treatments: hypnosis |
|
|
Conversion disorders -
and what is the treatment? |
manifestation of a psychic conflict as a physical symptom
treatment: catharsis |
|
|
What are the highest age bracket for suicide?
|
elderly
|
|
|
What gender is more likely to commit suicide?
|
males are 4x more likely to commuit suicide than females
|
|
|
What ethnicity is more likely to commit suicide?
|
-whites/native american > african american, hispanics, asians
>70% white males |
|
|
What are the two highest methods of suicide?
|
1. firearms : 60% of all suicides, 80% by white males
2. hanging (males), poisoning/overdose (females) |
|
|
What do international suicide rates look like?
|
US falls in the middle with worldwide suicide rates
wolrdwide suicide rates by gender show that elderly males are more likely to kill themselves Asia had the highest rates of suicide as a continent, and Australia |
|
|
What is the peak incidence ages for suicide in the US?
|
65+ males
|
|
|
general polulation surveys about suicidal ideation:
|
1/3 of the gernal population reports suicidal ideation
|
|
|
What has recent MD contanct and suicide shown?
|
-nearly 20% people who committed suicide had seen MD that day, and 40% had seen MD in last week
-nearly every 2 our of 5 people who comitted suicide saw their doctor in the last week -60% of these saw doctor for psychiatric complaint, 40% for somatic complaints -30% communicated any suicidality at last visit -boston study: 42% of MD's who had been names as a defendant in suicide claim were not psychiatrists |
|
|
What are the risk factors for attempted suicide?
|
female
<30 perceived threat to an intimate relationship living alone unemployed or financial problems recent adverse event clinical depression or personality disorder substance abuse psychiatric diagnosis family hx hopelessness presence of firearm int he house social failure - rejection by peers -previous attempts older age 60+ caucasian |
|
|
sociaodemographic Risk factors for suicide:
|
male
60+ widowed or divorces white or native american living alone female MD at increased risk. -high risk professions for both generders include: dentists, police, attorney's and musicians unemployed or financial problems recent adverse event |
|
|
What are clinical risk factors for suicide?
|
clinical depression or schizophrenia
substance abuse history of suicide attempts or ideation feeling of hopelessness panic attacks severe anxiety severe anhedonia (lack of pleasure) |
|
|
What do almost all people who kill themselves suffer from?
|
diagnosable mental disorder, substance use disorder or both
|
|
|
What mental disorder do the majority of suicides have?
|
depressive disorder:
-psychotic depression high risk -bipolar disorder less common than unipolar |
|
|
What % of people with disorders commit suicide and what % of completed suicides does this make?
|
15% of individuals with diagnosed disorder commit suicide, this is about 60% of suicides
|
|
|
What % of individuals with schizophrenia commit suicide?
|
about 10%
|
|
|
What % of alcoholics commit suicide and what % of total suicide does this make up?
|
3-5% of alcoholics for around 25% of total suicides
|
|
|
What are the top reasons for suicide?
|
-altruistic/heroic
-philosophical -religious -escape from an unbearable situation -excess ETOH/drug use -romantic suicide -anniversary -contagion -manipulative -distress signal -magical thinking and punishment -cultural approval |
|
|
What is Durkheim's sociological theory regarding suicide?
|
reflects social integration:
-egoistic, anomic, altruistic, and fatalistic types |
|
|
What did freud think about suicide?
|
pyschological agreesion turned inward
|
|
|
What are the psychological fantasies?
|
revenge, power, control, punishment
atonement, sacrifice escape, sleep rebirth, reunion with dead |
|
|
What are teh suicide rates for children adolescents and young adults?
|
3rd leading cause of death for 15-24 yo, after accient and homicides
10-14 was 1.5/100,000 15-19: 8.2/100,000 20-24: 12.8/100,000 |
|
|
What are the general risk factors for youth in suicide?
Psychosocial biological sociocultural environmental |
psychosocial: poor interpersonal problem-solving ability, poor coping skills, impulsive/aggressive tendencies, legal/disciplinary problems, previous suicide attempts, family history of suicide
biological: mental disorders, particularly mood disorders, schizophrenia, anxiety disorders, and certain personality disorders, genetics (Fx), neurochemistry: serotonin deficiency sociocultural factors: lack of social support and sense of isolation, stigma associated with help-seeking, barriers to accessing health care environmental factors: difficulty in school, neither working nore going to school, relational or social loss, easy access to lethal means, local clusters with contagion |
|
|
What are the firearm storage practices amoung parents and parents views on firearms?
|
28% keep a gun hidden and unlocked
54% of parents would be very concerned about their child's safety if they knew there was a gun in the home of their child's friends -73% beliebe that it is not at all likely that their child would find and handle a gun without permission |
|
|
What was the firearm study in 8-12 yo boys resulting in?
|
72% found the hidden gun
76% handled the gun 48% pulled the trigger |
