DU PA Behavioral Health
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| patients with personality disorders tend to show ___ when pathological coping mechanisms fail | anxiety and depression
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| the more severe cases of personality disorder can decompensate into __ under stress | psychosis
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| halfway houses, and self-help communities utilize ___ to modify self destructive behavior | peer pressure
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| the behavioral techniques used with those with personality disorder are | operant conditioning and aversive conditioning
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| emphasizes the recognition of acceptable behavior and its reinforcement with praise or other tangible reward | operant conditioning
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| can range from a mild rebuke to deprivation of privileges | aversive conditioning
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| an attempt is made not to respond to inappropriate behavior, and the lack of response eventually causes the person to abandon the behavior | extinction
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| blends mindfulness and a cognitive behavioral model to address self awareness, interpersonal functioning, affective lability, and reactions to stress | dialectical behavioral therapy
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| with personality disorders psychological intervention is best conducted | in group settings
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| group therapy is helpful when | specific interpersonal behavior needs to be improved
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| psychiatricdisorders characterized by chronicpatterns of inner experience andbehavior that are inflexible andpresent across a broad range of situations | personality disorders
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| By definition, the symptoms of personalitydisorders cannot be causedby a | major psychiatric disorder
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| Pervasive pattern of mistrust andsuspiciousnessBegins in early adulthoodPresents in a variety of contexts | paranoid
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| Detachment from social relationshipsRestricted range of emotionalexpressions | schizoid
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| Social and interpersonal deficitsCognitive or perceptual distortionsand eccentricities | schizotypal
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| Disregard for rights of othersViolation of rights of othersLack of remorse for wrongdoingLack of empathy | antisocial
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| Instability of interpersonal relationships,self-image, and affectsMarked impulsivity | borderline
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| Excessive emotionalityAttention-seeking behavior | histrionic
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| GrandiosityNeed for admiration | narcissistic
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| Social inhibitionFeelings of inadequacyHypersensitivity to criticism | avoidant
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| Excessive need to be taken care ofSubmissive behaviorFear of separation | dependant
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| Preoccupation with orderliness andperfectionismMental and interpersonal control | obsessive-compulsive
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| Cluster A—odd or eccentric | paranoid, schizoid, schizotypal
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| Cluster B—dramatic, emotional,or erratic | antisocial, borderline, histrionic, narcissisctic
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| Cluster C—anxious or fearful | avoidant, dependant, obsessive-compulsive
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| A change in personality from baselineat any time, but particularly in adults andelderly persons, may indicate | onset of anaxis I psychiatric disorder or a potentiallyserious underlying organic disorder.
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| can present with patterns of symptoms similarto those of a personality disorder, but thesesymptoms usually have an identifiable onset,and remit or improve with appropriate treatment. | axis I disorders
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| Personality disorders are, by definition | chronic conditions
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| Patients in this cluster—the paranoid, schizoid,and schizotypal—are uncomfortable ininterpersonal situations, emotionally distant,difficult to engage, and isolative | CLUSTER A—THE ODD OR ECCENTRIC
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| When interactingwith these patients, physicians shouldrespect their need for interpersonal distanceand adopt a respectful, somewhat distantprofessional stance. | CLUSTER A—THE ODD OR ECCENTRIC
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| with paranoidand schizotypal patients who exhibit distrustor strange ideas, | it is important notto directly challenge these ideas or becomedistracted by them
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| They can be excessivelydemanding, manipulative, emotionally unstable,and interpersonally inappropriate. Theymay attempt to create relationships that crossprofessional boundaries and to place physiciansin difficult or compromising positions | CLUSTER B—THE DRAMATIC, EMOTIONAL,OR ERRATIC
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| Whether it is causedby fears of evaluation by others, abandonment,or loss of order, these patients experienceuncomfortable ideas and sensationsthat cause distress and interfere with theirfunctioning within the physician-patientrelationship. | CLUSTER C—THE ANXIOUS OR FEARFUL
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| These patients are hypersensitive to perceivedcriticism, but have the capacity todevelop appropriate relationships if they feelsafe and accepted | CLUSTER C—THE ANXIOUS OR FEARFUL
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| Psychotropic medications generally areviewed as an ___ in themanagement of personality disorders | adjunctive treatment
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| four types of hateful patients | dependant clinger, entitled demander, manipulative help rejector, self destructive denier
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| Enduring pattern of inner experience and behavior. Inflexible and pervasive. Stable and long duration. Not due to another disorder. Significant distress or impaired function. | Personality disorders as classified by the DSM-IV-TR
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| social treatment for patients with personality disorders | day hospital, halfway house, self-help community - structured settings with intensified social pressure
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| behavioral treatments for patients with personality disorders | operant conditioning, aversive condition
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| psychological treatments for patients with personality disorders | group therapy
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| medical treatments for patients with personality disorders | Hospitalization if suicidal or homicidal, Antipsychotics if transient psychoses, severe impulsivity, or severe behavioral dyscontrol (“decompensation”), Antidepressants to improve depression, anxiety and emotional lability/sensitivity/impulsivity
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| Axis I disorders | Clinical disorders
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| Axis II disorders | personality disorders and mental retardation
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| cognitive/perceptive distortion | schizotypal personality disorder
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| Disinterested in people, aloof, detached, Cool, unemotional | schizoid personality disorder
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| Mistrustful, expects harm, Easily slighted, bears grudges, argumentative, Trouble with authority figures | paranoid personality disorder
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| For a Diagnosis must have three or more: failure to conform to lawful social normsDeceitfulness, Impulsivity, Irritability and aggressiveness, Disregard for safety, Consistent irresponsibility, Lack of remorse | antisocial personality disorder
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| Don’t prescribe controlled substances to patients with | antisocial personality disorders
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| must have five or more: Center of attention, Inappropriately seductive, Rapid shifting and shallow emotion expression, Physical appearance to draw attention, impressionistic and lacking in detail, theatrical, Suggestible, Quickly seems intimate | histrionic disorder
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| Unstable and intense relationships, Identity disturbance, Impulsivity, Recurrent suicidal behavior or self-harm, Affective instabilityChronic feelings of emptiness, Inappropriate, intense anger, Transient paranoid ideation or dissociation | borderline personality disorder
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| avoid benzodiazepines in patients with | borderline personality disorder
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| Grandiosity, Preoccupied with self-serving fantasies, Belief in own specialness, Requires excessive admiration, Entitlement, Exploitative, Lacks empathy, Envious , Arrogant | Narcissistic Personality disorder
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| Fear of rejection, Hyper-reactivity to failure, Poor social endeavors, Low self-esteem | avoidant personality disorder
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| Passive, Over accepting, Unable to make decisions, Lacks confidence, Poor self-esteem | dependant personality disorder
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| Perfectionistic, Egocentric, Indecisive, Rigid thought patterns,Rigid need for control | obsessive-compulsive personality disorder
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| mood and affect both refer to __ | emotional states
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| The prevailing, underlying emotional tone; it is also what the patient feels | mood
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| The objective, observed component of emotion. It is also the variability of emotion as thoughts change | affect
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| encouragement, reassurance, acknowledgeing emotion, nonverbal communication | the four supportive interventions
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| A change in a patient’s condition attributable to the symbolic import or therapeutic intent of a treatment. | the placebo effect
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| __ is not the same thing as doing nothing | giving a placebo
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| This is a formal, systematic format for recording findings about thinking, feeling, and behavior. Observations are objective and noninferential | mental status examination
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| appearance, speech, emotional expression, thinking and perception, sensorium | components of the mental status examination
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| Alertness, Orientation to person, concentration, Memory - - remote, recent and immediate, Concentration, Calculations, Fund of knowledge, Abstract reasoning | sensorium
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| clinical disorders | Axis I
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| most Psychiatric disorders, and other Psychiatric conditions that are a focus of clinical attention are referred to as __ disorders | Axis I
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| Personality Disorders and Mental Retardation | Axis II
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| General medical conditions | Axiss III
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| Psychosocial and Environmental Problems | Axis IV
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| Global Assessment of Functioning | Axis V
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| Gestures or words that encourage communication, but don’t lead the patient | facilitation
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| Examples: “I can see this is upsetting to you.” “You look sad.” “This is obviously painful for you to talk about.” | reflective listening
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| Examples: “Facing this surgery would make anyone anxious.” “Crying is a normal reaction to such a loss.” “Of course you are angry.” | legitimization
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| Implies an understanding of the patient’s feelings (Doesn’t necessarily imply agreement), Gives patient feeling of being supported | legitimization
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| B in BATHE | background
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| A in BATHE | affect
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| T in BATHE | trouble
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| H in BATHE | handling
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| E in BATHE | empathy
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| BATHE; tell be how your job loss is affecting taking care of yourself | background
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| BATHE; what is that like for you? | affect
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| BATHE; what is the hardest part? | trouble
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| BATHE; how are you coping with the situation? | handling
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| BATHE; I can't even imagine how hard this all is | empathy
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| overall suicide rate is __ per 100,000 | 12
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| __% of men die from suicide attempts | 80
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| __% of suicide attempts by women do not end in death | 77
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| the best predictor of death by suicide | previous attempt
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| paranoia is a warning sign for | violence
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| acute psychosis, suicidality, violence, and mania are all considered | types of psychiatric crises
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| No improvement (despite treatment), Psychiatric co-morbidities, Suicidal or homicidal (serious or continuing), Questions about drug therapies, Time and expertise (more needed to resolve problems than you can provide) | when to make a mental health referral
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| __ is a psychological and physiological state characterized by cognitive, somatic, emotional, and behavioral components.[1] These components combine to create an unpleasant feeling that is typically associated with uneasiness, fear, or worry | anxiety
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| characterized by excessive, uncontrollable and often irrational worry about everyday things that is disproportionate to the actual source of worry. This excessive worry often interferes with daily functioning | generalized anxiety disorder
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| is a psychological method of treatment for GAD, which involves a therapist working with the patient to understand how thoughts and feelings influence behavior.The goal of the therapy is to change negative thought patterns,replacing them with positive ones | cognitive behavioral therapy
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| characterized by recurring severe attacks. It may also include significant behavioral change lasting at least a month, and of ongoing worry about the implications or concern about having other attacks | panic disorder
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| Medication is often not required to treat __ effectively | panic disorder
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| characterized by intrusive, repetitive thoughts resulting in compulsive behaviors and mental acts that the person feels driven to perform, according to rules that must be applied rigidly, aimed at preventing some imagined dreaded event | obsessive compulsive disorder
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| Recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and that cause marked anxiety or distress. The thoughts, impulses, or images are not simply excessive worries about real-life problems | obsession
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| Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing distress or preventing disaster | compulsion
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| behavioral therapy (BT), cognitive therapy (CT), and medications are first-line treatments for | obsessive compulsive disorder
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| anxiety disorder that can develop after exposure to one or more terrifying events that threatened or caused grave physical harm.It is a severe and ongoing emotional reaction to an extreme psychological trauma | post traumatic stress disorder
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| excessive social anxiety (anxiety in social situations) [2] causing abnormally considerable distress and impaired ability to function in at least some areas of daily life | social phobia
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| irrational, intense, persistent fear of certain situations, activities, things, or people. The main symptom of this disorder is the excessive, unreasonable desire to avoid the feared subject. | phobia
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| External signs of __ may include pale skin, sweating, trembling, and pupillary dilation | anxiety
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| can be accompanied by physical effects such as heart palpitations, fatigue, nausea, chest pain, shortness of breath, stomach aches, or headaches | anxiety
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| Neural circuitry involving the amygdala and hippocampus is thought to underlie | anxiety
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| choices of treatment for __ include psychotherapy (such as cognitive behavioral therapy); lifestyle changes; or pharmaceutical therapy (medications). | anxiety
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| Meta-analysis indicates that psychotherapeutic interventions have superior long-term efficacy when compared to pharmacotherapy for treatment of | anxiety
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| is a mental disorder characterized by a pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities | major depression
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| mood disturbance of at least 2 weeks' duration, with between two and five symptoms of depression | minor depression
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| is a mood disorder that falls within the depression spectrum. It is considered a chronic depression, but with less severity than major depressive disorder. | dysthymia
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| a mild, reactive, depression which last only a few months. The disorder occurs in response to some specific stressful situation or circumstance. | adjustment disorder with depressed mood
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| a brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function | bipolar disorder
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| a severe medical condition characterized by extremely elevated mood, energy, unusual thought patterns and sometimes psychosis. | mania
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| __ is characterized by persistent and pervasive elevated or irritable mood. People experiencing __ symptoms typically have a flood of ideas, and sometimes mildly grandiose thoughts and visions | hypomania
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| is a mood disorder; a very mild form of bipolar disorder | cyclothymic disorder
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| lifetime risk of depression for men __% | 7-12
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| lifetime risk of depression for women __% | 20-25
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| markedly diminished interest or pleasure in almost all activities, reported or observed | Anhedonia
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| Major Depressive Episode mnemonic | Sig E Caps(s)
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| Sadness, Interest, Guilt, Energy, Concentration, Appetitie, Psychomotor activity, Sleep, Suicide | Sig E Caps(s)(depression mnemonic)
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| Symptoms of a major depressive episode must last at least __ weeks | 2
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| mania mnemonic | DIGFAST
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| Distractibility, Insomnia, Grandiosity, Flight of ideas, Activities, Speech, Thoughtlessness | DIGFAST (mania mnemonic)
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| obstructive sleep apnea may cause __ | executive dysfunction, impaired vigilance, and depression
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| __ is more predominant in depressed men than depressed women | substance abuse
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| insomnia increases the risk of depression __ times | 4
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| Involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration | vaginismus
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| Inflammation at the entrance of the vagina characterized by a burning sensation | vestibulitis
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| vaginismus, vestibulitis | dyspareunia
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| compulsive masturbation, fetish, transvestism | paraphilia
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| characterized by shame, and secretiveness, not interactive, not transferable to partner sex | variant arousal patterns
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| implies that the belief is pathological (the result of an illness). As a pathology it is distinct from a belief based on false or incomplete information or certain effects of perception which would more properly be termed an apperception or illusion. | delusion
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| paranoid, grandiose, religious, nihilistic, somatic | types of delusions
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| Thought insertion, Thought withdrawal, Thought broadcasting, Ability to read, others’ thoughts, Ideas of reference | Delusions: Schneider’s “first rank symptoms”
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| do you feel that others can read your thoughts | Thought broadcasting
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| is the person on TV/radio sending you special messages or talking directly about you. Do things out in the public relate to you in a unique way | ideas of reference
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| behaviors that have no explanation, the patient doesn't know why they are doing it. Present in Psychosis | Automatisms
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| Blunted or flat, Bizarre, Incongruent with content | abnormalities of affect associated with psychosis
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| Substance induced and due to general medical condition | 2 most common causes of psycosis
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| schizophrenia affects __% of the population worldwide | 1
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| __% of those suffering from schizophrenia will commit suicide | 10-15
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| typical onset of schizophrenia is __ | late teens to early 20's
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| Hallucinations, Delusions, Disorganized speech and behavior,Agitation, Respond fairly well to conventional antipsychotic medications. | positive symptoms of schizophrenia
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| Avolition, Withdrawal/autism, Anhedonia, Blunted affect,Poverty of speech, May respond somewhat better to ‘atypical’ antipsychotic medications. | Negative symptoms of schizophrenia
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| Choreoathetoid movements (irregular, writhing), May involve tongue, cheeks, lips, trunk, extremities, Develops after months to years of antipsychotic med use in up 25% in patients on chronic therapy. May be irreversible. | Tardive dyskinesia
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| akathisia, acute dystonias, parkinsonism | acute extrapyramidal effects of antipsychotics
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| subjective inner restlesness | akathisia
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| bradykinesia, shuffling gait, regular resting tremor | parkinsonism
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| a psychiatric diagnosis that describes a mental disorder characterized by abnormalities in the perception or expression of reality. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking | schizophrenia
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| Negative symptoms of __ are so-named because they are considered to be the loss or absence of normal traits or abilities | schizophrenia
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