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179 Cards in this Set
- Front
- Back
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affect |
the subjective and immediate experience of emotion attached to ideas or mental representations of objects. Has outward manifestations that may be classified as restricted, blunted, flattened, broad, labile, appropriate or inappropriate |
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agnosia |
Inability to understand the import or significance of sensory stimuli; cannot be explained by a defect in sensory pathways or cerebral lesion; the term has also been used to refer to the selective loss or disuse of knowledge of specific objects because of emotional circumstances, as seen in certain schitzophrenic, anxious, and depressed patients. Occurs with neurological deficit |
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agoraphobia |
Morbid fear of open places or leaving the familiar setting of the home. May be present with or without panic attacks |
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anhedonia |
loss of interest in and withdrawal from all regular and pleasurable activities; often associated with depression |
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aphasia |
any disturbance in the comprehension or expression of language caused by a brain lesion |
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ataxia |
lack of coordination, physical or mental. 1) in neurology refers to loss of muscle coordination 2) in psychiatry, the term intrapsychic ataxia refers to lack of coordination between feelings and thoughts; seen in schizophrenia and in severe OCD |
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bereavement |
feeling of grief or desolation, especially at the death or loss of a loved one |
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chorea |
movement disorder characterized by random and involuntary quick, jerky, purposeless movements; seen in Huntington's disease |
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compulsion |
pathological need to act on an impulse that, if resisted, produces anxiety; repetitive behavior in response to an obsession or performed according to certain rules, with no true end in itself other than to prevent something from occurring in the future |
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confusion |
disturbances of consciousness manifested by a disordered orientation in relation to time, place or person |
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consciousness |
state of awareness, with response to external stimuli |
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delirium |
acute reversible mental disorder characterized by confusion and some impairment of consciousness; generally associated with emotional liability, hallucinations or illusions, and inappropriate, impulsive, irrational, or violent behavior |
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delirium tremens |
acute and sometimes fatal reaction to withdrawal from alcohol, usually occurring 72 to 96 hours after the cessation of heavy drinking; distinctive characteristics are marked autonomic hyperactivity (tachycardia, fever, hyperhidrosis, and dilated pupils), usually accompanied by tremulousness, hallucinations, illusions, and delusions |
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delusion |
false belief, based on incorrect inference about external reality, that is firmly held despite objective and obvious contradictory proof or evidence and despite the fact that other members of the culture do not share the belief |
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dementia |
mental disorder characterized by general impairment in intellectual functioning without clouding of consciousness; characterized by failing memory, difficulty with calculations, distractibility, alterations in mood and affect, impaired judgement and abstraction, reduced facility with language and disturbance of orientation. although irreversible when it is due to underlying progressive degenerative brain disease, dementia may be reversible if the cause can be treated |
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depression |
mental state characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs include psychomotor retardation or, at times, agitation, withdrawal from interpersonal contact, and vegetative symptoms, such as insomnia and anorexia. the term refers to a mood that is so characterized or a mood disorder |
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dissociation |
unconscious defense mechanism involving the segregation of any group of mental or behavioral processes from the rest of the person's psychic activity; may entail the separation of an idea from its accompanying emotional tone, as seen in dissociative and conversion disorders |
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dyskinesia |
difficulty in performing movements, seen in extrapyramidal disorders |
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dyslexia |
specific learning disability syndrome involving an impairment of the previously acquired ability to read; unrelated to the person's intelligence |
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dysphoria |
feeling of unpleasantness or discomfort; a mood of general dissatisfaction and restlessness. occurs in depression and anxiety |
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dystonia |
extrapyramidal motor disturbance consisting of slow, sustained contractions of the axial or appendicular musculature; one movement often predominates, leading to relatively sustained postural deviations; acute dystonic reactions (facial grimicing and torticollis) are occasionally seen with the initiation of antipsychotic drug therapy |
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egocentric |
self-centered; selfishly preoccupied with one's own needs; lacking interest in others |
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emotion |
complex feeling state with psychic, somatic, and behavioral components; external manifestation of emotion is affect |
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enuresis |
incontinence of urine during sleep |
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expressive aphasia |
disturbance of speech in which understanding remains but the ability to speak is grossly impaired; halting, laborious, and inaccurate speech (also known as Broca's, nonfluent, and motor aphasia) |
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fugue |
dissociative disorder characterized by a period of almost complete amnesia, during which a person actually flees from an immediate life situation and begins a different life pattern; apart from the amnesia, mental faculties and skills are usually unimpaired |
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guilt |
emotional state associated with self-reproach and the need for punishment. in psychoanalysis, refers to feeling of culpability that stems from a conflict between the ego and the superego (conscience). Guilt has normal psychological and social functions, but special intensity or absence of guilt characterizes many mental disorders, such as depression and anti-social personality disorder, respectively. Psychiatrists distinguish shame as a less internalized form of guilt that relates more to others than to the self |
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hallucination |
false sensory perception occurring in the absence of any relevant external stimulation of the sensory modality involved |
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hypersomnia |
excessive time spent asleep. may be associated with underlying medical or psychiatric disorder or narcolepsy, may be part of the Kleine-Levin syndrome, or may be primary |
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hyperventilation |
excessive breathing, generally associated with anxiety, which can reduce blood carbon dioxide concentration and can produce lightheadedness, palpitations, numbness, tingling periorally and in the extremities, and, occasionally, syncope |
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hypnosis |
artificially induced alteration of consciousness characterized by increased suggestibility and receptivity to direction |
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hypochondria |
exaggerated concern about health that is based on real medical pathology, but on unrealistic interpretations of physical signs or sensations as abnormal |
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insomnia |
difficulty in falling asleep or difficulty in staying asleep. it can be related to a mental disorder, can be related to a physical disorder or an adverse effect of medication, or can be primary (not related to a known medical factor or another mental disorder) |
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malingering |
feigning disease to achieve a specific goal, for example, to avoid unpleasant responsibility |
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mania |
mood state characterized by elation, agitation, hyperactivity, hypersexuality, and accelerated thinking and speaking (flight of ideas); seen in bipolar I disorder |
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melancholia |
severe depressive state. used in the term involutional melancholia as a descriptive term and also in reference to a distinct diagnostic activity |
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mental disorder |
psychiatric illness or disease whose manifestations are primarily characterized by behavioral or psychological impairment of function, measured in terms of deviation from some normative concept; associated with distress or disease, not just an expected response to a particular event or limited relations between a person and society |
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mood |
pervasive and sustained feeling tone that is experienced internally and that, in the extreme, can markedly influence virtually all aspects of a person's behavior and perception of the world. distinguished from affect, the external expression of the internal feeling tone. |
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mourning |
syndrome following loss of a loved one, consisting of preoccupation with the lost individual, weeping, sadness, and repeated reliving of memories |
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narcissism |
in psychoanalytic theory, divided into primary and secondary types: Primary: the early infantile phase of object relationship development, when the child has not differentiated the self from the outside world, and all sources of pleasure are unrealistically recognized as coming from within the self, giving the child a false sense of omnipotence; secondary: when the libido, once attached to external love objects, is redirected back to self |
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negative signs |
in schizophrenia: flat affect, alogia, abulia and apathy |
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obsession |
persistent and recurrent idea, thought, or impulse that cannot be eliminated from consciousness by logic or reasoning; obsessions are involuntary and ego-dystonic |
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panic |
acute, intense attack of anxiety associated with personality disorganization; the anxiety is overwhelming and accompanied by feelings of impending doom |
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paranoia |
rare psychiatric syndrome marked by the gradual development of a highly elaborate and complex delusional system, generally involving persecutory or grandiose delusions, with few other signs of personality disorganization or thought disorder |
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phobia |
persistent, pathological, unrealistic, intense fear of an object or situation; the phobic person may realize that the fear is irrational but, nonetheless, cannot dispel it. |
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positive signs |
in schizophrenia: hallucinations, delusions, and thought disorder |
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pseudocyesis |
rare condition in which a nonpregnant patient has the signs and symptoms of pregnancy, such as abdominal distension, breast enlargement, pigmentation, cessation of menses, and morning sickness |
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psychosis |
mental disorder in which the thoughts, affective response, ability to recognize reality, and ability to communicate and relate to others are sufficiently impaired to interfere grossly with the capacity to deal with reality; the classical characteristics of psychosis are impaired reality testing, hallucinations, delusions, and illusions |
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psychotic |
1) person experiencing psychosis 2) denoting or characteristic of psychosis |
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regression |
unconscious defense mechanism in which a person undergoes a partial or total return to earlier patterns of adaptation; observed in many psychiatric conditions, particularly schizophrenia |
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rumination |
constant preoccupation with thinking about a single idea or theme, as in OCD |
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sensorium |
hypothetical sensory center in the brain that is involved with clarity of awareness about oneself and one's surrounds, including the ability to perceive and to process ongoing events in light of past experiences, future options, and current circumstances; sometimes used interchangeably with conciousness |
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somnolence |
pathological sleepiness or drowsiness from which one can be aroused to a normal state of conciousness |
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stereotypy |
continuous mechanical repetition of speech or physical activities; observed in catatonic schizophrenia |
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stupor |
1) state of decreased reactivity to stimuli and less than full awareness of one's surroundings; as a disturbance of consciousness, it indicated a condition of partial coma or semicoma 2) in psychiatry, it is used synonymously with mutism and does not necessarily imply a disturbance of consciousness; in catatonic stupor, patients are ordinarily aware of their surroundings |
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tic disorders |
predominately psychogenic disorders characterized by involuntary, spasmodic, stereotyped movement of small groups of muscles; seen most predominantly in moments of stress and anxiety, rarely as a result of organic disease |
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trance |
sleep-like state of reduced consciousness and activity |
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unconsciousness |
1) one of three divisions of Freud's topographic theory of the mind (the others being the conscious and the preconscious) in which the psychic material is not readily accessible to conscious awareness by ordinary means; its existence may be manifest in symptom formation, in dreams, or under the influence of drugs 2) in popular (but more ambiguous) usage, any mental material not in the immediate field of awareness 3) denoting a state of unawareness, with lack of response to external stimuli, as in a coma |
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vegetative signs |
in depression, denoting characteristic symptoms such as sleep disturbance (especially early-morning awakening), decreased appetite, constipation, weight loss and loss of sexual response |
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Mental Health |
State of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with challenges - Essential to personal well-being, family and interpersonal relationships, and the ability to contribute to community or society |
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Mental disorders |
Health conditions characterized by alterations in thinking, mood, and/or behavior that are associated with distress and/or impaired functioning |
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Mental illness |
Term that refers collectively to all diagnosable mental disorders |
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Rapport |
- Therapeutic alliance based on understanding, trust - Spontaneous conscious feeling of harmonious responsiveness - Implies an understanding and trusts |
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Empathy |
- the ability of blurring the line between self and other - a way of increasing rapport, understanding |
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Transference |
Expectations for patient's perspective |
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Contertransference |
Expectations from provider's perspective |
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Difficult patients |
- Defeat attempts to help themselves - Uncooperative - Request a second opinion - Fail to recover in response to treatment - Use physical or somatic complaints to mask emotional problems (somatization disorder) - Chronic cognitive disorders (dementia, Alzheimer's) - Professional "failure": dying, chronic pain |
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Non-verbal encouragement |
eye contact, smile, lean in closer to show interest |
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Barely verbal encouragement |
"Yes"or "mm-hmm" |
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Straightfoward encouragement |
"Please explain more" or "Please tell me more about that" |
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Identifiers for MH problems |
- Medically unexplained physical symptoms - Multiple physical or somatic symptoms - Chronic pain - Symptoms >6 weeks - Provider rated as "difficult encounter/patient" - High use of healthcare providers |
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Schizophrenia |
- Neologisms - Incoherence - Blocking - Echolalia - Perservation - Clanging - Loose associations |
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Suicide Risk Factors "SADPERSONS" |
S: Sex (male) A: Age less than 19 or greater than 45 years D: Depression (patient admits to depression or decreased concentration, sleep, appetite, and/or libido P: Previous suicide attempt or psychiatric care E: Excessive alcohol or drug use R: Rational thinking loss: psychosis, organic brain syndrome S: Separated, divorced, or widowed O: Organized plan or serious attempt N: No social support S: Sickness, chronic disease |
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Depression Screening "SIGECAPS" |
S: Sleep I: Interest G: Guilt/ Worthlessness E: Energy C: Concentration A: Appetite P: Psychomotor Retardation S: Suicide |
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Endocrine Screening/Lab tests |
Thyroid Function (TFT)- hypothyroid r/0 (Lithium can also cause hypothyroidism) Dexamethasone supression test (DST)- dx major depressive d/o Prolactin- may become elevated in response to administration of antipsychotic agents or after a seizure (helps differentiate a seizure from pseudoseizure) |
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Catecholamines (serotonin metabolite 5HIAA) |
Anxiety, phenothiazine meds, PTSD (postmortem low in CSF in patients with violent suicide - Low 5HIAA is associated with violence in general |
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Kidney Function |
Lithium (Serum BUN and creatine) |
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Liver Function Tests (LFT) |
Multiple meds (phenothiazine or tricyclic meds) - Delerium/ disorientation can be a sign of liver dysfunction - Impaired liver function can increase half-life of meds - Hepatocellular damage/ intrahepatic bile stasis can increase both total and direct bilirubin - Monitor LFTs: Carbemazepine (Tegretol), valproate (Depakene)
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Lumbar Puncture |
- Especially if they have sudden changes in cognition - Especially if acute onset psychiatric sx Red flag: new onset seizure, fever - Rule out CNS infection such as meningitis |
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VDRL (Venereal Disease Research Lab) |
Screen for syphilis - If positive confirm with FTA-ABS (fluorescent treponemal antibody absorption)
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Renal Labs |
Cr clearance (detects early kidney damage) BUN- elevated in renal disease (lithium) If serum BUN or Cr elevated, consider: 2 hour Cr clearance and 24 hr. Cr clearance |
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Lipids, FBS and HbA1c |
- Atypical antipsychotic agents: associated with abnormal blood glucose levels (DM) - Screen with FBS, HbA1c ( q 3 months) - Delerium: can be sx of extremes in blood glucose - Agitation/Anxiety: can be sx of low blood glucose (hypoglycemia)
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Psychotherapy |
A general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group Commonalities between all forms: Hope, new perspective, empathetic, caring and trusting relationship |
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Psychoanalysis |
Was the first practice to be called a psychotherapy - Encourages the verbalization of all the patient's thoughts, including free associations, fantasies and dreams, from which the analyst formulates the nature of the unconscious conflicts which are causing the patient's symptoms and character problems - developed by Sigmund Freud |
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Free association |
A method developed by Sigmund Freud designed to unravel the unconscious mind and all its conflicts |
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Psychodynamic |
Form of depth psychology, whose primary focus is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension - tends to be briefer and less intensive than traditional psychoanalysis |
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Behavior therapy |
Therapy that applies learning principles to the elimination of unwanted behaviors - Do not dive deeply below the surface looking for the inner causes - Want to hit on the problem and move forward - Focuses on changing maladaptive patterns of behavior to improve emotional responses, cognitions, and interactions with others |
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Counterconditioning |
A procedure that conditions new responses to stimuli that trigger unwanted behaviors - Based on classical conditioning and includes exposure therapy and aversive conditioning |
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Exposure therapy |
- Expose patients to things they fear and avoid - Through repeated exposures, anxiety lessens because they habituate to the things feared |
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Cognitive behavior therapy |
Generally seeks to identify maladaptive cognition, appraisal, beliefs and reactions with the aim of influencing destructive negative emotions and problematic dysfunctional behaviors - often combine the reversal of self-defeated thinking with efforts to modify behavior - alter the way people act and alter the way they think |
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Existential |
Based on the existential belief that human beings are alone in the world. This isolation leads to feelings of meaninglessness, which can be overcome only by creating one's own values and meanings - Philosophically associated with phenomenology |
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Humanistic |
- Known as the third force in the development of psychology - Concerned with the human context of the development of the individual with an emphasis on subjective meaning, a rejection of determinism, and a concern for positive growth rather than pathology - Each individual has the ability to choose good vs evil |
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Humanistic Therapy |
Therapist engages in active listening and echoes, restates, and clarifies the patient's thinking, acknowledging expressed feelings |
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Brief therapy |
an umbrella term for a variety of approaches to psychotherapy. It differs from other schools of therapy in that it emphasizes 1) focus on specific problem and 2) direct intervention - Solution based rather than problem oriented - less concerned with how the problem arose
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Systemic |
Seeks to address people not at an individual level - Relationships, dealing with the interactions of groups, patterns and dynamics (family therapy, marriage counseling) - Community psychology is a type of systemic psychology |
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Transpersonal |
Address the client in the context of a spiritual understanding of consciousness |
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Body psychotherapy |
Address the problems of the mind as being closely correlated with bodily phenomena, including a person's sexuality, musculature, breathing habits, physiology etc. - This therapy may involve massage and other body exercises as well as talking |
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Client's perceptions |
they often overestimate its effectiveness; critics remain skeptical
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Clinician's perceptions |
Believe the client is better off after therapy |
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Outcome Research |
Research shoes that treated patients were 80% better than untreated ones |
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which psychotherapy would be most effective for treating Depression? |
Behavior, cognition, interpersonal therapies |
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which psychotherapy would be most effective for treating Anxiety |
Cognition, exposure, stress inoculation therapies |
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which psychotherapy would be most effective for treating Bulimia |
Cognitive- behavior therapy |
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which psychotherapy would be most effective for treating Phobia |
Behavior therapy |
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which psychotherapy would be most effective for treating Bed wetting |
Behavior modification therapy |
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reflection |
repeat, paraphrase "parrotting back" |
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facilitation |
to make easy, verbal/non verbal nodding head "un huh" "go on" |
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silence |
allows for contemplation, expression |
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confrontation |
help patient face an issue |
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clarification |
getting details |
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interpretation |
use only after rapport established, links interrelationships |
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summation |
brief summary of patient statements thus far |
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explanation |
easy, understandable language |
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transition |
sufficient information obtained |
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self revelation |
sharing about you be cautious |
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positive reinforcement |
implied acceptance |
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reassurance |
be honest |
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advice |
ensure its wanted before giving |
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ending the interview |
any questions, plan thank you |
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key considerations for psychiatric evaluation |
acknowledge pt anxiety make an attempt to relieve anxiety though open-ended questions speak plainly with compassion empathy make sure you always understand the pts speech maximize personal dignity focus on pts interests and needs avoid politics and religion no personal contact - stay strictly professional |
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key consideration of encouragement during interview |
non verbal barely verbal straight forward repeads the pts own last words briefly summarize sometimes |
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time management |
controlling the interview
"lets focus on this..." "our time is short today..." |
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identifiers for MH problems |
medically unexplained physical symptoms multiple physical or somatic symptomes chronic pain symptoms > 6 wks provide rated as a difficult pt high use of health care services |
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chief complaint |
why are they here - on the patient's own words
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HPI |
snapshot of pt |
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all mediciation |
OTC herbs changes summplemets compliance
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social hx |
dugs, alcohol, tobaco, education, employment, home support, religion, sexual hx |
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family history |
mental illness psychiatic hospitalization suicide attempts |
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mental status exam components |
appearance and behavior speech and language mood thoughts and perceptions cognition |
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speech and language |
quantity rate volume articulation fluency |
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labile |
changing , roller coaster |
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kinesics |
body language |
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thoughts and perceptions |
logical? relevant? organized? coherent?
abnormalities of thought |
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echolalia |
repeating everything that you said |
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loose association |
" i skied off a mountain and thats how i got my degree" |
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neologisms |
making new words |
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MME |
screen for dementia
can see changes |
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lab tests |
basic screening tests [EKG, LFT, TFT, CBC, CMP, iron]
psychotropic drugs - specific tests to monitor toxicities and adherence
urine drug screening
lumbar puncture
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basic screening labs |
endocrine
catecholamines
kidney function
liver function tests |
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VDRL (Venereal Disease Research Lab |
screen for spyhilis |
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adherence |
measure concentration of drug |
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toxicity |
many drugs have specific toxicities and both baseline testing and interval testing may be necesarry |
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conclusion of psychiatric |
always observe (with your eyes) much more detailed and extensive document everything set boundaries think before you speak |
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three commonalities shared by all forms of psychotherapies |
1. a hope for demoralized people 2. a new perspective [empower] 3. an empathic, trusting and caring relationship |
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clinical psychologists |
have PhDs mostly experts in research assessment and therapy |
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clinical or psychiatric social worker |
Masters of social work postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems |
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counselors |
pastoral counselors or abuse counselors work c problems arisiing form family relations, spouse and child abusers |
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psychiatrists |
physicians who specialize in the treatment of psychological very little training in therapy can prescribe medications |
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the first formal psychoterhapy to emerge |
psychoanalysis
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Id, ego, super ego |
id - impulses - sexual thought and feelings ego - here and now super ego - conscious , moral compass, represses impulses |
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behavior therapy |
therapy that applies learning principles to the elimination of unwanted behaviors
** changing the maladaptive response **
to treat phobias or sexual disorders, behavior therapists do not delve deeply below the surface looking for inner causes |
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behavior therapy |
focuses on changing maladaptive patterns of behavior to improve emotional responses, cognition, and interaction with others |
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who do people turn to for help with psychological difficulties? |
physicians mental health specialities other professionals |
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its better to ___ psychological disorders than to____ them |
prevent; cure |
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Basic DSM features |
1. descriptive approach 2. diagnostic criteria 3. systematic description 4. diagnostic uncertanities |
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descriptive appraoch |
lists the definitions of the disorders and usually consists of desciptions of clinical features |
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diagnostic critersia |
includes a list of features that must be present for the diagnosis to be made |
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systematic description |
describes d/o in terms of its associated features including specific age, culture, gender, prevalence, incidence |
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diagnostic uncertainities |
explicit rules to be used when the information is insufficient or the patient's clinical presentation and history do not meet the full criteria of a prototypical category |
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major depressive disorder |
5 or more of the 9 in a two week time period 1. depressed mood 2. loss of interest 3. change in weight or appetite 4. insomnia or hypersomnia 5. psychomotor retradation or agitation 6. loss of energy or fatigue 7. worthlessness or guilt 8. imapired concentration 9. thoughts of death or suicide |
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persistent depressive disorder |
depressed mood for most of the day, more days than not, for 2 years of longer |
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axis I |
clinical disorders
major depression, recurrent severe, mood disorders, somatoform do, factitious disorders, eating, sleeping do |
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axis II |
personality disorders & mental retardation - habitual use of a particular defense mechanism
all PERSONALITY d/o |
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axis III |
general medical conditions
hypothyroidism, disease of circulatory system, digestive system, neoplasma, infectious and parasitic disease |
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axis IV |
psychosocoial and environmental problems
abusive family, recently lost job, educational problems, housing problems, problems with primary support group |
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axis V |
global assessment of functioning
score is used to descrive on a treatment paln and then measure the plans effectiveness
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functioning is considered on 3 major areas |
1. social 2. occupational 3. psychological functioning |
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somatoform |
a group of disorders that are characterized by having a bodily signs and symptoms |
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somatoform do |
early onset with chronic course
involvement of multiple organ systems
non of the symptoms can be explained by physical or lab exams |
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separation anxiety do |
three of more of the following - when separation from home of major attachment figure - excessive worry about losing, or possible harm befalling - worry that an untoward event will lead to separation - reluctance or refusal to go to school due to separation - excessively fearful or reluctant to be alone or without major attachment - refusal to go to sleep without being near - nightmares involving the theme of separation - complaints of physical symptoms
** lasting 4+ weeks in children ** lasting 6 months in adults |
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when is the highest prevalance of depression in women? |
highest during reproductive age |
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why is depression difficult to diagnosis during pregnancy |
pregnancy is a "happy time" most women are reluctant to report symptoms |
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risk factors of depression during pregnancy |
age, marital status, low SES, history of depressive illness, FH of depression, psychiatric do, pregnancy complications, detection of a fetal anatomy |
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impact of untreated depression during pregnancy
on the mother |
post prenatal care and health behaviors poor self-care and nutrition distrubed sleep postpartum depression self-medication suicide
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impact of untreated depression during pregnancy
on the child |
effects on prenatal development premature birth low birth weight small for gestational age negative effects on binding |
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baby blues |
common and normal - approx 50% of women symptoms: depressed mood, irritability, anxiety, confusion, cyring spells, mood lability, disturbances in sleep and appetite |
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impact on child |
more negative attitude toward child infant is less responsive infant more likely to show anger behavioral problems cognitive deficiets at risk of developing depression later
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treatment for perinatal depression |
early identification be proactive if mom is at risk similar treatment for MDD in general support mom |
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apraxia |
inability to perform a voluntary purposeful motor activity; cannot be explained by paralysis or other motor or sensory impairment |
