Behavioral Health Exam 1 Study Guide PDF

Behavioral Health Exam 1 Study Guide (what is in red is what the previous class made red, not me) Introduction Mental disorders defined by DSM 5 o Clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in...

Behavioral Health Exam 1 Study Guide (what is in red is what the previous class made red, not me) Introduction Mental disorders defined by DSM 5 o Clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning o Associated with significant distress or disability in social, occupation, or other important activities Leading cause of psychiatric disability in the world (Class Q) o Depression is the leading cause of disability worldwide, and is a major contributor to the global burden of disease Majority of mental illness begins by what age (Class Q) o 24 1 in 5 US adults experience mental illness (Highlighted Stat) ½ of chronic mental illness by age 14, ¾ by age 24 (Highlighted Stat) 19% of common mental illnesses are anxiety disorders (Highlighted Stat) 32% of adults who report mental illness are mixed/multiracial (Highlighted Stat) LGBTQ diagnosis of psychiatric illness compared to the general population o LGBTQ individuals are 2 or more times more likely as straight individuals to have a mental health condition (Class Q) o LGBTQ youth are 2 - 3 times more likely to attempt suicide than heterosexual youth (We don’t have this) o 11% of transgender individuals reported being denied care by mental health clinics (we don’t have this) o 44% of lesbian, gay, and bisexual adults report mental illness (Highlighted Stat) o Lesbian, Gay, bisexual group has highest prevalence of mental illness (Class Q) o 42% of LGBTQ youth seriously considered attempting suicide, including >50% of transgender and nonbinary youth (Highlighted Stat) Potential problems with using DSM 5 o Pathologizes normal, expected behavior ▪ Disruptive mood disorder (temper tantrum vs. mental disorder) ▪ Normal grief vs. major depressive disorder ▪ Minor neurocognitive disorder vs. mild cognitive impairment ▪ Binge eating vs. enjoying food ▪ GAD vs. worries of everyday life o Encouraging Medication use w/ pressure from pharmaceutical companies ▪ Misuse of stimulants in ADD o Under-diagnosing ▪ New definition of autism lead to funding loss d/t less people being dx o Over-diagnosing ▪ Possible inflation of PTSD in court o The DSM era has not deceased large-scale reduction in the morbidity associated w/ major mental disorders (cardiovascular disease, colon cancer, chronic respiratory disease)  7. Chronic substance abusers lumped with one time drug user 8. Behavioral addiction dx overused Specifiers in the DSM 5 o Syntonic vs. Dystonic ▪ Ego syntonic vs dystonic definition Syntonic: heavily defensive, rationalized behaviors and no motivation to change, angry about being told what to do, resign to his/her fate, sees benefits in current behaviors, lacks insight into the condition-typical for children, resistant to therapy/treatment and often has to be motivated to do so o Pt doesn’t think there is a problem Dystonic: experience significant distress, disability or impairment in functioning. Has no capacity to cope with the condition at the current time. Is motivated for treatment/therapy to improve the situation and condition o Pt knows there is a problem Good/fair insight = Dystonic Poor insight = ambivalence Absent insight = syntonic ▪ A mental health pt who is ego dystonic is more likely to: Be motivated for treatment/therapy (Class Q) o Correlated Disorders and Suicide Risk: each diagnosis will comment of correlation among disorders o Respect for age, gender, and culture: each diagnosis will incorporate developmental symptom manifestation, gender specific disorders, cultural sensitivity in regard to certain behaviors ▪ Cultural Formulation Review (CFI): way to interact w/ people culturally Exploring the pts way of being in the world (religion, culture, preferences) o Severity Index Across Time & Circumstances: time and circumstances essential specifiers, will assure that individual does qualify for mental disorder from definition. Severity ranges are mild, moderate, severe, in partial remission, in full remission, *prior history ▪ Coding Specifiers: F31.9 = Unspecified (He put this in red?) Behavioral Health Intro ➔ Mental Disorder- clinically significant disturbance in an individual's cognition, emotion regulation or behavior that reflects dysfunction in psychological, biological or developmental processes underlying mental functioning. A/w significant distress or disability in social, occupational or other activities. ➔ DSM 5 Diagnoses Caveats ◆ Not caused by drug unless it’s substance use disorder dx ◆ Not caused by medical condition or better explained by other condition ◆ All psych disorders are caused by combination of genetic, physical, environmental & psychosocial influences ➔ Mental Illness- an imbalance, lack of peace/well being, mostly unknown cause ➔ NOT a mental disorder ◆ Culturally approved/expected response to stressor ◆ Socially deviant behavior & conflicts primarily b/t individual & society unless deviance results from dysfunction ➔ Half of care received for common psych disorders provided by PCPs, Internal/Emergency medicine or general practice ➔ Depression is leading cause of disability worldwide ➔ Majority of chronic illnesses begins @ 24 y/o ➔ 1 in 5 adults experience mental illness ➔ Anxiety is the most prevalent mental illness in the US (19%) ➔ LGBTQIA are 2x more likely to have a mental condition ➔ 32% multiracial adults & 44% LGBTQIA adults have a mental illness ➔ 50% or less people don’t get treated for their mental illness ➔ 42% LGBTQ youth considered attempting including >50% of transgender & nonbinary youth ➔ DSM 5 provides: common language understood by healthcare providers, Assist in clinical documentation, information to 3rd party payers, relief vs burden of diagnosis ➔ Ego-Dystonic: significant distress/disability/impaired function ◆ Little to no capacity to cope w/ condition ◆ Motivated for tx/therapy to improve situation ◆ Good/Fair insight- ‘I need help’ ➔ Syntonic Patients ◆ Defensive ◆ No motivation to change ◆ Rationalizes behavior ◆ Angry about being told what to do ◆ Resigned to his/her fate ◆ Resistant to therapy ◆ Lacks insight into the condition (usually children) ➔ Poor insight- Ambivalence ➔ Subtypes & Specifiers for DSM 5 Diagnoses: ◆ Syntonic vs dystonic ◆ Associated features & Suicide risk ◆ Respect for age, gender, culture Age: Some diagnoses can’t be done 5 positive to 1 negative ratio Systematic Desensitization or Exposure Therapy o For phobias, fears, aversions o Training to replace feelings of anxiety w/ feelings of relaxation o Cognitive Behavioral Therapy (CBT) The present is more important than the past, how one thinks of an event/situation determines how one feels, which influences behavior Our feelings do not have to be dictated by the event but can be changed by the way we think about our situation. Automatic strong feelings are made aware Thought→Behavior→Emotion all connected Therapy lasts 12-20 weeks, time efficient  Used for a variety of disorders: anxiety, insomnia, depression, phobias Effective, sometimes superior to meds Promotes pt autonomy Psychoanalytic Concepts: o Transference: patients begin to transfer their feelings of a particular person in their lives to the therapist/provider (patient falls in love with their therapist), feelings could be positive or negative, part of the therapeutic process and therapist facilitates patient “working through” unresolved feelings. You could use the role-playing technique or the “chair technique” to help with this o Countertransference: The therapist develops positive or negative feelings toward the patient. Therapist’s unconscious feelings are stirred up during therapy which the therapist directs toward the patient. Therapist starts feeling unhappy with the way therapy is going, or unhappy with themselves. Very common: the therapist seeks “supervision” to process their feelings o Resistance: a disruptive response by the client to some topic they find sensitive which is the source or close to the source of anxiety o Example the client might make an off-handed remark or joke, claim they forgot the information, or pick a fight with the therapist o The therapist is getting closer to the root of the problem o Attachment Theory: quality of a child’s attachment during the formative years affects the quality of relationships throughout life. As the caregiver affects the child, the child also affects the caregiver. o Proximity maintenance: wanting to be physically close to the therapist o Separation distress: separation anxiety o Safe haven: retreating to the therapist when sensing danger/feels anxious o Secure base: exploration of the world knowing that the therapist will protect them o Dependence, then healthy independence, interdependence, and connection Other Therapies o Meditation: paying attention in a particular way, on purpose, being present in the moment. o 3 core skills: concentration, sensory clarity, equanimity o Mindfulness Meditation is for 8 weeks associated with changes in gray matter concentration in brain regions involved in learning and memory processes. o PTSD and MDD associated with decreased density or volume of the hippocampus o *helps brain, improves brain function, changes it physiologically o Guided imagery + Hypnosis: a suggestion given during a time of receptivity and focused attention, a relaxed-trusting state or given in a stressed state o Useful in giving injection or burn patients o Disadvantages: painful, distressing memories o Avoid in: actively psychotic pts, depersonalization, derealization o Spiegel eye roll test for hypnotic susceptibility o Metaphors: stories, images, idioms, analogies, which describe a person’s feelings or situation o What you don’t say is as important as what you do say o Body therapy biofeedback: behavior therapy involving relation and the power of suggestion. Uses biometrics to monitor the patients progress so they know they are accomplishing their goals (migraines, asthma, chronic pain, GI)  o Talk therapy that is combined with physical “work” (yoga, breathing) o Eye Movement Desensitization and Reprocessing (EMDR) o Uses eye movements to facilitate brain retraining and reprocessing o Bibliotherapy: literature which explains psychological issues and dealing effectively o Affirms the patient and their condition and “normalizes,” decreasing a sense of isolation and being “different,” can be done on their own or in conjunction with therapy. Offers solutions, one time cost o Family therapy: focuses on the family as a unit, systems theory, development of individual insights and the development of skills to promote communication, empathy, roles, responsibilities and the success of the family unit o Role playing, assignments o Marriage/ Couples/ Relationship Therapy: to improve communication, identify shared goals, confront concerns honestly, honor individual needs. Develop plans to continue, change, modify, or dissolve the relationship in a respectful manner that reduces harm and collateral damage o Group Therapy: effective for persons dealing with the same issues, being with others who may better understand the problem (drug abuse, loss of loved one), peer support, confrontation, recognizes ineffective behavior and practices effective. Can be topic driven, time limited or ongoing. Focuses on education, skill development, emotional support, support independent and well being Class Q o Which therapy should be avoided in psychotic patients? (hypnotherapy) o Which therapy is based on systems theory? (family therapy) o Changing one’s thoughts and taking different actions are characteristic of which therapy? (cognitive behavioral therapy) Defense Mechanisms Defense Mechanisms o Defense Mechanisms: process of thinking and acting developed by the “ego” to protect from physical and/or emotionally painful/dangerous situations ▪ Can be unconscious or partially conscious (mostly unconscious) ▪ Automatic ▪ Used when one is not able to cope/did not learn how o What Triggers Defense Mechanisms ▪ external pressures, tensions with one’s personality, fear of losing respect, other people’s judgment, fear of violence o Everyone uses defense mechanisms; they are identified as mature or neurotic/primitive o Under duress people tend to use less mature defense mechanisms Coping Mechanisms o Conscious and intentional (M&Ms), flexible, health promoting: well-being, quality of life, net reduction of suffering, better able to handle future conflicts, honest, deals with source of anxiety Defense Mechanisms o Primitive/Neurotic: ▪ Affiliation: turn to others for support (healthy), being “right” or superior (unhealthy) ▪ Acting out: engage in inappropriate behavior without consideration of consequences, usually as a reaction to a situation (unprotected sex, rock and roll persona, unapproved relationships, self-demeaning) ▪ Autistic fantasy: excessive daydreaming, unwilling /unable to sequester resources to create reality (actor or fantasy). Thinking about doing something but never doing anything to make it happen. ▪ Compensation: build up other aspects of themselves to adjust for any perceived/real shortcomings (a person who believes that they are not good at sports may throw themselves into studying) ▪ Compliance: acquiescing to the desires of someone else to “keep the peace” ▪ Controlling: trying to make a person act/think/feel a certain way (rejected lover homicide, arguing, micromanaging) ▪ Denial: refuse to acknowledge aspect of reality (HIV/STDS, Alcoholism) ▪ Displacement: transfer negative feelings about one object to another (Kicking the dog or spouse) ▪ Dissociation: lack of connection in a person’s thoughts, memory and sense of identity (Movies, PTSD, severe abuse, driving somewhere and you don’t know how you got there) ▪ Externalization: blame problems on another (applicants + low grades) ▪ Intellectualization: rely excessively on details/facts to maintain distance from painful emotion (“a great case”) ▪ Inhibition: Involuntary decrease or loss of motivation to engage in goal directed activity to prevent arising anxiety from conflicts with “unacceptable” impulses (religious prohibitions against sex, become a lawyer instead of an actor) ▪ Introjection (or Identification): internalizing the qualities of an object or person. Advertising strategy. (Identify w/ the quality of something else) Can be healthy if quality is integrated. ▪ Isolation: being alone to avoid uncomfortable feelings and interactions (“I need some down time”) ▪ Passive-aggressive: indirectly express aggressive feelings/anger towards other (walking in late on purpose) ▪ Projection: falsely attribute unacceptable feelings to another (falling in love, scapegoat) ▪ Projection identification: the person accepts and “takes on” the projection of another- positive or negative (“dumb blonde”) ▪ Rationalization: not getting the job à it didn’t pay enough ▪ Regression: acting like a younger, less mature person (baby talk) ▪ Repression: expel disturbing thoughts from consciousness, act like something else is going on bc they don’t even know it (repressed memories of sexual abuse) ▪ Reaction formation: do opposite of what you feel (older sibling becomes loving to younger baby, but wants to kill them/ Helga bullying Arnold even though she likes him) ▪ Ritual and undoing: superstitious behavior and thoughts (pregame rituals, full moon, “you’re gonna jinx it”, OCD)  ▪ Sexualization: inappropriate imposition of sexuality on a person, through objectification or emphasizing the person’s appearance ▪ Splitting: “good” or “bad”, no middle ground (politics, Hallmark of Borderline Personality Disorder) o Mature (Defense Mechanisms/Coping Skills: ▪ Oh, I have a healthy SA2SH (usually conscious or somewhat conscious) Objectivity, Integration, Sublimation, Altruism/Anticipation, Suppression, Humor ▪ Sublimation: channeling of an unacceptable and potentially disruptive impulse, thoughts or emotions, into a socially acceptable behavior. Dealing with emotional stressors by using energy (punching bag to channel anger impulses) ▪ Altruism: deal with stress or conflict through dedication to meeting others (sponsor in AA, enneagram- need to be needed, volunteer) ▪ Affiliation: turn to other for support (sports teams) ▪ Anticipation: think about and prepare for possible adversity (boy scout motto à be prepared) ▪ Suppression: avoid thinking about a stressor (trauma patient) ▪ Humor: deal with stress by seeing ironing, dark humor (medical talk) Defense Mechanisms VS Coping o Defense Mechanism: what parts of the distressing events, feelings, and “Self” story must be distorted o Coping: how the events/feelings can be managed Medical causes of psychiatric illnesses (this is from the previous class) What factors make it more likely for a psychiatric illness to be caused by a physical condition? o Cancer; Cancer treatments, including interferon; Cushing syndrome; Dementing illnesses; Huntington disease; Hypothyroidism; Multiple sclerosis; Parkinson disease; SLE; Sleep apnea; Stroke; traumatic brain injury; hypo/hyperglycemia, DM, Electrolyte abnormality, Meningitis, vitamin B12 insufficiency, UTI How would one work up a patient for a medical cause of a psychiatric illness? o Thorough H and P: Family history, including (controversial) race/ethnicity, Social history, Environmental exposures; work/hobbies/home; History of abuse/trauma/military experience; Sleep apnea screen: Epworth sleepiness scale