Psych Module (Big 3)
Psychodynamic Therapy
Sigmund Freud Works to uncover unconscious recurring patterns of interpersonal relationships, conflicts, and desires with the goal of improved functioning Free Association Dream Analysis Transference: patient redirects an unconscious feeling, desire, or expectation from another person towards their therapist Countertransference: therapists emotional reaction to patient LONGER SESSIONS (Long term treatment) Helpful with Depression, Anxiety, eating disorders, personality disorders, relationship problems, family dynamics
Psych Note/Interview
Social History is incredibly important
NIAAA: Single-Item Screening
Test is positive if response is greater than 1 Do you sometimes drink beer, wine, or other alcoholic beverages? If yes:How many time in the past year have you had ... or more drinks in a day (4 for women) (5 for men)
Exposure-Based Therapy
Type of CBT treatment that works to help patients tolerate distress and confront their fears. Work to decrease reactivity from repeated exposures to a stimulus
Screening for Depression
Universal Screen (Patient Health Questionnaire) USPSTF recommendation for age 12+ PHQ-2 (2 questions) or PHQ-9 (9 questions) Patients testing positive on PHQ9 should be confimed with DSM-V to diagnose depression and be offered treatment Based on symptoms/presentation - sadness, overwhelmed, lack of interest fatigue, chronic pain, insomnia
circumstantiality
a so-called "non-linear thought pattern" and occurs when the focus of a conversation drifts, but often comes back to the point
abstract thought process
abstract thinking "spit it out" as in "say it"
Humanism
assumes that humans have free will, center their own universe people are basically good rejects the scienfitic method of using experiemetns to measure and control variables because it creates an artifical environmetn and has low ecological validity
regression
back in physiological time when one isf aced with stressed
judgement
behavior in response to one's situation. DO they make good decisions with this knowlege?
A 3rd grade teacher is throwing a popcorn party for the students at the end of the week due to their good behavior all week. This is an example of which psychological theory?
behavioral
denial
blocking external events from awareness
interoceptive exposure
bringing on physical sensations deliberately that are harmless yet feared. Ex: Having someone with a panic disorder run in place to raise their heart rate and learn that this sensation is not dangerous
CBT Overall Thought
change the way someone thinks, then we can change the way they interpret world around them
Why is DSM useful?
communication between providers with a common established nomenclature treatment prognosis research billing/insurance
behaviorism
conditioned response (Pavlov's dogs)
echolia
involuntary repetition or words or phrases spoken by others
projection
involves individuals attributing their own unacceptable thoughts, feeling and motives to another person
Concrete thought process
literally "spit it out"
MDQ Mood disorder questionaire
positive screen: "yes" to 7+items, yes to question 2, moderate to severe impairment Positive screen = more comprehensive evaluation ensure not answering qs based on period of substance use better at screening for bipolar I, not as sensitive to bipolar II depending on patient's insight, you may want to ask for examples of behaviors
Flight of ideas
rapidly shifting between conversation topics, making speech challenging or even impossible to follow
History of DSM
Diagnostic and Statistical Manual of Mental Illness, published by the American Psychiatric Association DSM-1 was developed in 1952 Subsequent updates with release of DSM-V in 2013, and most recent text revision in 2022
Carl Rogers (Unconditional Positive Regard)
Humanist kids when developed with praise have more caring attitudes towards themselves
Depression Screening for Older Adults
Can start with PHQ2 if positive move to: - The five-item geriatric depression scale (GDS5) - Or the PHQ-0 or the 15 item Geriatric depression scale Scoring: 2 positive answers suggesting depression (sensitivity 97%, specifically 85%)
Exposure therapy helping with
SAD, OCD, PHobias, panic disorder, PTSD, GAD
Mental Status Exams
SLUMS, MoCA, MMSE
DBT is helpful for
Borderline Personality Disorder Patients with severe emotional regulation challenges suicidal ideation substance use behaviors
DBT (dialectical behavior therapy)
4 parts: Emotional Regulation, Mindfulness, Interpersonal Effective, Distress Tolerance Emotional Regulation (understand how emotions happen) Mindfulness (reduces amplifying emotions and reduces escape and avoidance of emotions) Interpersonal effective (helps improve communication and relationsihp) Distress tolerance (helps learn healthy skills to cope during a crisis and accept the situation as it is)
ACT
Aimed to increase physioloigcal flexibility by using mindfulness- based approaches with behavioral change strategies 6 core therapeutic processes: - contact the present moment - defusion (watch your thinking/observe) - accceptance - self-as-context - values committed action Don't reframe thinking but rather learn to accept their thoughts as part of a normal life
A patient is recently diagnosed with a terminal illness. After hearing this news, they decide to start a year-long remodel of their home. Which defense mechanism is likely at play?
Denial
PHQ-9
Designed for use in primary care setting (2 to 5 min) Sensitivity and specificity 88% for scores 10+ Multipurpose Tool: - Screening - Measuring severity - Diagnosis - Monitoring response to treatment Often repeated every 4 to 6 weeks
Diagnosing anxiety
GAD-7 helps determine if they meet DSM-V criteria for anxiety - anxiety and worry more days than MDQnot for 6 months difficult to control the worry associated with 3+ other symptoms Symptoms cause clinically significant distress or impairment in social, occupational, or other areas of functioning symptoms are not due to another medical condition symptoms are not due to the physiological effects of a substance/drug
Psychodynamic
Id: Instinctual Drives. Fully unconscious - pleasure principle - comes fully from within us Ego: mediates the id's drive with reality - reality principle - ego defenses Superego: internal moral compass - judges right from wrong - comes from parents and society
Cognitive Restructuring (CBT)
Identifying negative thoughts/assumptions/beliefs and changing them
Single Item and DAST
Illicit Substance Test Do they need further investigation or not based on score?
Barriers to Screening?
Lack of Time Lack of Knowledge
PH-9 Scoring Range
Lower more mild depression Higher score more severe depression (need meds and therapy)
A patient is not able to reduce their hemoglobin A1C (for Diabetes type 2), even with the appropriate medications and education. You find that the patient is having trouble affording the medication due to loss of their job, which is causing financial concerns. Which of the following psychodynamic theories best relates to this situation?
Motivational
Does screening tool=diagosis?
NO
C-A-G-E Questions
Not recommended for screening anymore but can use these questions in discussion
Diagnosing Depression
PHQ-9 helps determine if they meet DSM-V criteria for depression (need 5+ in same two-week period). One must be depressed good or anhedonia (lack of interest) Symptoms cause clinically significant distress or impairment in social, occupational, or other areas of functioning Symptoms are not due to another medical condition. Hypothyroid, anemia, sleep disorder, etc. Symptoms are not due to the physiological effects of a substance/drug not experiencing manic signs or symptoms
Somatic Thearpy is good for..
PTSD, history of trauma, complicated grief, depression, anxiety, trust, intimacy issues
Why Screen for Mental Health Conditions
Patients may be willing to endorse different items on paper Screening sends a message to your patient that this is a matter you care about 45% of patients who died by suicide had contact with PCP in prior month High prevalence Leading cause of disability Patients with untreated mental health conditions have poorer outcomes They are treatable
AUDIT-C (Alcohol use Disorder Identification test)
Positive: Women: 3+ Men 4+
MIndfulness
Practice that develops the capacity for a calm and focused mind/ Focus on self regulation of attention. Being present in a nonjudgemental way. (5-4-3-2-1 grounding exercise)
Which of the following psychodynamic theories suggests that we have an unconscious drive that helps to steer our choices?
Psychodynamic
CBT Therapy
Psychoeducation: teach that our thoughts about a situation affect how we feel and how we behave in that situation Cognitive Restructuring: identifying distorted thinking, processing, and teaching skills to reframe thoughts Exposure: to anxiety-provoking and avoided situations
Psychotherapy
Variety of treatments that help an individual identify and change thoughts, emotions, and behaviors that are troubling to the individual. Typically takes place individually but can also be in a group setting. There is also couple or family therapy. Goal is to reduce symptoms, maintain or enhance functioning, and improve quality of life
PHQ-2 and PHQ-9
When you have at least one yes in PHQ-2 then use PHQ-9. Or if symptoms then use PHQ-9 starting out. Important for following up with Patients. Good to track patient.
word salad
a confused or unintelligible mixture of seemingly random words and phrases, specifically as a form of speech indicative of advanced schizophrenia
confabulation
a memory error defined as the production of fabricated, distorted, or misinterpreted memories about oneself or the world, without the conscious intention to decieive
clanging
a mode of speech characterized by association of words based upon sound rather than concepts. For example, this may include compulsive rhyming or alliteration without apparent logical connection between words
Hallucinations
a perception in the absence of external stimulus (hearing seeing something that doesn't exist)
Illusions
a perception that occurs when a sensory stimulus is present but incorrectly perceived/misinterpreted (ex: hearing the wind as someone crying)
insight
degree of awareness and understanding fo their situation. Does the person understand what is causing their symptoms?"
In vivo exposrue
directly facing the feared situation, activity or object in real life. Ex a person with social anxiety may engage in a social situation
incoherence:
disjointed, unintelligible speech
self-psychology
empathy as an essential aspect of the therapeutic process of addressing human development and growth psychology should be seen as a science to be studied in scientific manner observable behavior, as opposed to internal events like thinking stimulus-response behavior is determined by environment
Somatic Therapy
focuses on how the body and emotions appear within the body. Centers arund the concept that unresolved emotional issues can become trapped inside the body and expresses as physical expressions. Teach the patient to increase their awareness of body sensations
Hierarchy of needs (Humanism) Abraham Maslow
hierarchy of needs is motivation! basic needs must be more or less met prior to higher needs order of needs is not rigid most behaviro is multi-movivated self-acutalization (top) esteem love/belonging safety physiological (bottom)
object relations
humans are primarily motivated by the need for contact with others- the need to form relationships (mother-infant bond; splitting and transference)
Operant Conditioning (Behaviorism)
reinforces: likely to do again punishment: unlikely to do behavior again positive: addition of something negative: removal of stimulus positive reinforcement: getting praise after doing dishes
compulsions
repetitious, purposeful physical or mental actions that the individual feels compelled to engage in according to their own strict rules or in a sterotyped manner
Existentialism
roots in philosophy/literature of 19th century people struggle with meaninglessness, lack of purpose, isolation, death and freedom best match for contemporary therapeutic approach is ACT which focuses on helping a person live in line with their values depressed patient may have ennui and distress, get them to talk about personal meaning and values
displacement
satisfying an impulse with a substitute object
sublimation
satisfying an impulse with a substitute object. in a socially acceptable way
Limitations for all surveys?
self report-under or over reporting concern for stigma health literacy-reading, understanding, answering, accurately PHQ9 and GAD7 are available in 50 languages, but there may be variation in interpretation tests have high sensitivity/specificity overall, but none are perfect
denial
someone unaware of their own mental health condition or that they can't perceive their own condition accurately
When to consider a referral to psychotherapy
symptoms start to impair functioning, symptoms are in the mild, moderate, or severe phase symptoms are not controlled with medication alone increasing a patients capacity to make a change significant life events theyh are struggling to cope with the patient expresses a desire for getting therapy to change maladaptive thoughts, behavior, or relationships
perserveration
the repetition of a particular response (such a word, phrase, or gesture) regardless of the absence or cessation fo a stimulus
What is in the DSM
three main components - The classification system-a listing of all the disorders including the DSM - Diagnostic criteria - Text descriptions Additional sections on assessment measures and conditions being studied
repression
unconscious mechanism employed by teh ego to keep disturbing or threatening thoughts from becoming conscious
Delusions
unshakable beliefs in something untrue
Virtual reality exposrue
use of virtual reality technology to have exposure when in real life exposure is not practical
imaginational exposure
vividly imaginging a feared situation, activity, or object. Ex: a person with PTSD may be asked to describe their experience to reduce feelings of fear
Dementia Screenign?
we are trying to evaluate cognitive impairment Using the SLUMs, MoCA, or mini mental status exam (MMSE)
Generalized Anxiety Disorder 7 item GAD-7
when used as a screening tool, a score of 8+ reprsents likely GAD Using the thresold score of 8, the GAD-7 has sensitivity of 92% and a specificityof 76% of diagnosing GAD Moderately good at screening three other Anxiety disorders - Panic disoder SAD PTSD
Why Screen for Bipolar Disorder
you are getting clear indicators of mood instability patients are difficult to interview in a linear fashion Hx of failed antidepressant trials severely disrupted sleep cycle significant agitation, irritability, anger on presentation family history of bipolar disorder
