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Grossman - Abnormal
| Question | Answer |
|---|---|
| Mental Status Exam | We organize symtoms in a structure we call the mental status exam. |
| What are the 6 categories of the MSE? | Conciousness, Behavior, Affect, Thought, Perception, Physical Complaints |
| Symptom | An unusual aspect or feature of the mind that causes problems in living. |
| Problems in Living | Significant personal distress, Social/Occupational Dysfunction, Danger to self or others |
| Consciousness - Orientation | Does the person know who and where they are, as well as what time it is (3 spheres place, person, time) |
| Consciousness - Insight | The extent's of a person's understanding of the origin, nature, and mechanisms of attitudes and behavior; the degreee of awareness and understanding the patient has that he or she is ill when they have obvious symptoms. |
| Perception | abnormal aspects of a person's sensory awareness of objects in the environment |
| Perception - Illusion | misinterpretation of stimulus |
| Perception - Hallucination | perception of an object when no corresponding real object exists |
| Thought | Abnormal aspects of flow of ideas and associations as reflected in the speech or writing of the patient |
| Thought - Content | used when topic of a person's thought is unusual |
| TC-Delusion | a false belief system that is clearly implausible, not understandable, or held despite clear contradictory evidence. |
| TC-Neologism | made-up words that usually have meaning only to the patient |
| Thought - Form | Abnormal aspects of the speed and structure of the flow of ideas; slowed-blocked; speeded-flight of ideas; normal-loose associations |
| physical complaints | usually seen in expressions of pain but could be pratically any complaint that a person would typically bring to their medical doctor. |
| Affect | abnormal aspects of the mood, feelings, or emotional tone of a person |
| Expressive Behavior | something unsual that another person can see or hear a patient do. |
| 7 types of Delusions | Grandeur, Control, Thought Broadcasting & withdrawal, Persecution, Reference, Erotmaniac & Jealous, Somatic |
| Grossly Disorganized Behavior (UCPDB) | a. childlike silliness, b. public masturbation, c. unpredictable agitation, d. dress in an unsual manner, e. behaviors must lead to clear difficulty performing daily activities |
| Disorganized Speech (Thought-Form)- A. | a. Successive thoughts are so disconnected they impair communication - shifting topics w/o apparent logical connection loose association (clear shift), tangential thoughts (obliquely related), incoherence/word salad (impcomprehnsible) |
| Disorganized Speech (Thought-Form) - B. | b.speed is so unusual it's hard to comprehend too fast - flight of ideas too slow-blocked |
| Phases of Schizophrenia | 1. Prodomal - leads into 2. Acute - most intense 3. Residual - afterphase P+A+R > 6 months *A must be 1 month (exception if given treatment) |
| Criteria for Schizophrenia | Key symptoms (2 or more, unless bizarre)(significant time - 1 month unless given treatment) 1. Delusions 2. Hallucinations 3. Disorganized Speech 4. Grossly Disorganized or Catatonic Behavior 5. Negative Hallucinations |
| Types of Hallucinations | 1.Auditory, 2.Gustatory, 3.Tactile, 4.Pain, 5.Negative Hallucinations, 6.Kinesthetic, 7.Visual, 8. Olfactory, 9. Temperature |
| Catonic Behaviors (MEEEP) | marked decrease in reactivity to the environment a. motoric immobility b. excessive motor activity c. extreme negativism or mutism d. pecularities of voluntary movement e. echolalia, echopraxia |
| Negative Symptoms | a. Affective Flattening - lack of emotional response, face immobile, unresponsive, poor eye contact b. alogia - lack of thought fluency and productivity c. avolution - lack of initiation of actions d. social isolation |
| Subtypes of Schizophrenia 1-3 | 1. Catatonic - must DOMINATE the "clinical picture" 2. Disorganized [Hebephrenic]-must have prominent disorganized speech behavior and flat or inappropriate affect 3. Paranoid - preoccupation with one or more delusions or frequent auditory hallucination |
| Subtypes of Schizophrenia 4-5 | 4. Undifferentiated - A met but not 1, 2, or 3 5. Residual or Prodomal |
| Criteria for Prodomal (2 of 9) WIIIPOUL | W-withdrawal I-impaired role functioning I-inappropriate/blunted affect I-impaired hygiene P-poverty of speech O-odds beliefs U-unusual perceptions L-lack of initiative |
| Other Related Diagnoses | 1. Brief Psychotic Reaction (1day-1month) 2. Schizophreniform (1-6months) 3. Delusional Disorder 4. Shared Psychotic Disorder 5. Schizoaffective Disorder |
| Dissociate Fugue Checklist | 1. Sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past. 2. confusion about personality identity, or the assumption of a new identity. 3. significant distress or impairment. |
| Dopamine Hypothesis 1-3 | 1. Phenothiazine effectiveness is highly correlated w/ their capacity to block DA 2. "" often cause Parkinson's symptoms which come from too little DA 3. L-Dopa which relieves Parkinson's sometimes produces schizo. like symptoms |
| DA Hypothesis 4-5 | 4. Amphetimines increase DA and can create paranoid schizophrenic like symptoms 5. DA rich areas of the brain are where the phenothiazines bind |
| Evidence against DA Hypothesis | 1. Phenothiazines not helpful to 1/4 of Schizophrenics 2. "" are nonspecific for schizophrenia 3. "" do their DA blocking w/in hours of administration but symp. relief often take weeks 5."" are often effective only when they get DA levels below normal |
| Twin Studies Concordance Rate | Mz- 48% & 24% Dz- 17% & 8.5% Sibling - 9% & 4.5& Nephew- 4% & 2% Unrelated - 1% & 1% |
| Abreaction | the mental process of bringing repressed memories or ideas to the surface in a way that allows them to be dealt with. |
| Catharsis | the bodily aspect of an abreaction ie. discharge of emotional energy attached to a repressed memory. |
| Intellectual Insight | understanding which doesn't result in undoing a bit of repression |
| Emotional Insight | leads to a release of some quantum of affect/affective experience blended with cognitive factors |
| drive derivative | notice what new feelings or desires are involved in the abreaction, catharasis, and emotional insight. |
| working through | drive derivatives discovered from abreaction and emotional insights become permanently available to patient's ego. |
| TOC | Task Oriented Cognitions |
| TIC | Task Interfering Cognitions |
| melancholic A. | A. 1)loss of pleasure in all or almost all activities 2)lack of reactivity to usually pleasurable stimuli |
| melancholic B. | B. 3 or more 1)depressed mood distinctly different from bereavement 2)worse in the morning 3)early morning awakening 4) marked psychomotor retardation or agitation 5)significant anorexia or weight loss 6) excessive or inappropriate guilt |
| Seasonal Pattern | a. Regular temporal relationship b. full remissions at a characteristic time c. last 2 years 2 occurrences d. seasonal outnumber nonseasonal |
| Schizoaffective Disorder A | A. An uninterpreted period of illness during which, at some time, there is either a MDE, a ME, or a Mixed DO concurrent with symptoms that meet Criterion A for Schizophrenia - Note MDE must include depressed mood |
| Major depressive episode A. | A. 5 or more, 2 wk period, at least 1 or 2 1. depressed mood most of the day, NED - report or observation 2. markedly diminished interest or pleaseure in all, or almost all activities most of the day |
| MDE B-E | B.Not meet criteria for Mixed episode C.Cause sig. distress or impairment in functioning - social or occupational D.Note due to physiological E.Not better accounted for by Bereavement |
| Dysthymic Episode A. | depressed mood for most of the day, for more days than not - 2 years (never without symptoms for more than 2 months at a time) |
| Manic-Elevated | may be described as euphoric, unusually good, cheerful or high |
| Manic-Expansive | is characterized by unceasing and indiscriminate enthusiasm for interpersonal, sexual, or occupational interactions. |
| Manic-Irritable | is described as angry or annoyed (occurs especially when one's wishes are thwarted) |
| Hypomanic Episode | a. at lease 4 days (vs. 1 week) e. the episode is NOT severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features |
| Psychoanalytic View of Depression, real 1. | Real separation and "Symbolic loss" 1.normal loss leads to flooding of anger and then guilt for feeling the anger toward the loved one who is lost |
| Psychoanalytic View of Depression, real 2. | -in depression the feeling are repressed and the anger get turned inward (away from the loved "object" toward the self) surface in the form of self reproaches, often for being selfish and selfcentered or not being good enough for the lost "object" |
| Psychoanalytic View of Depression, real 3. | 3.Remember the unconscious roots of anger are a death wish so urges to kill self are frequently a part of depression and occasionally murderous impulses occur and surface |
| Psychoanalytic View of Depression part 2 | Use free association, dream analysis and interpretation to get at the unconscious dynamics |
| Gender and Depression - Nolen | Females 2x's likely to be diagnosed (26 vs. 12) -Women tend to ruminate and amplify -Men tend to dampen and minimize -when rumination controlled differences in duration disappeared |
| Axis I | Clinical syndromes that are the focus of clinical attention |
| Axis II | Personality DO and mental retardation |
| Axis III | General medical conditions relevant to treating the person |
| Axis IV | Psychosocial and environmental problems that may affect diagnosis |
| Axis V | Global assessment of functioning |
Created by:
leemcal
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