Review Notes Psyche
Review Notes Psyche
Review Notes Psyche
SIGMUND FREUD
Components of Personality
1. ID- part of a person that reflects BASIC or innate DESIRES, INSTINCT and SURVIVAL impulses
2. EGO- represents the REALITY aspect
3. SUPER-EGO- part that reflects MORALITY and ethical concepts, and values
ERIK ERIKSON
EPIGENETIC PRINCIPLE - STAGES OF DEVELOPMENT
Trust vs Mistrust birth, HOPE view world as safe and secure Psychosis, Addiction, Depression
Autonomy vs Shame & doubt 18mos Achieves sense of control & Paranoia, Obsession, Compulsion,
WILL well-being Impulsive
Initiative vs Guilt 3yrs Development of conscience & Phobia
PURPOSE manage conflict Psychosomatic
Inhibition
Conversion d/o
Industry vs Inferiority 5yrs Confidence in own abilities Creative inhibition
COMPETENCE
Identity vs Role confusion 13 yrs Formulating a sense of self and Borderline, Delinquency
FIDELITY well-being Gender-identity
Intimacy vs isolation 20’s Forming adult, being creative & Schizoid, Distantiation
LOVE productive
Generativity vs stagnation 40’s Establishing the next generation Midlife crisis
CARE Premature invalidism
Integrity vs despair 60’s Accepting one’s responsibilities Extreme alienation & despair
WISDOM for self & life
DESENSITIZATION
• Desensitization is the reduction of intense reactions to a stimulus by repeated exposure to the stimulus in a weaker and
milder form.
• Gradually over a period of time, exposure is increased until the fear of the object or situation has ceased.
ELECTROCONVULSIVE THERAPY
An effective treatment for depression that consists of inducing a grand mal (tonic-clonic) seizure by passing an electrical current
through electrodes that are attached to the temples
• Usual course is 6 - 12 treatments given 2-3 times per week
• Maintenance ECT once a month may help to decrease the relapse rate for the client with recurrent depression
Contraindications:
1. Angina pectoris
2. Congestive heart failure
3. Severe pulmonary disease
4. Fractures
5. Glaucoma
6. PREGNANCY
7. Use of MAOIs and clozapine
Uses
• Manic clients whose conditions are resistant to lithium and antipsychotic medications and clients who are rapid cyclers (a
client with a bipolar disorder who has many episodes of mood swings close together)
• Clients with schizophrenia (especially catatonia), those with schizoaffective syndromes, and psychotic clients.
Notes in conducting
• Oxygen is given by mask
• Tongue guard may be placed on the mouth
• 110-150 volts of electricity is delivered for 0.5 to 2 seconds to initiate a tonic clonic seizure, usually lasting for 1-minute
POST procedure
• Continue monitoring of VITAL SIGNS • The patient is returned to the room after all vitals are
• Patient is usually brought to the recovery room where stable
emergency drugs and equipments are available • Mental status examination
• RE-ORIENT the client when he is awake • NPO temporarily and introduce foods once GAG
• Provide reassurance that the amnesia is ONLY reflex will return
temporary
ANXIETY FEAR
State of mental uneasiness Emotion of apprehension
Vague Definite
MILD
• Mild anxiety is associated with the tension of everyday • The perceptual field is increased.
life. • Mild anxiety can be motivating, produce growth and
• The individual is ALERT. creativity, and increase learning.
MODERATE
• The focus is on IMMEDIATE CONCERNS. • SELECTIVE INATTENTIVENESS occurs.
• Moderate anxiety narrows the perceptual field. • Learning and problem-solving still take place.
SEVERE
• Severe anxiety is a feeling that something bad is about to • All behaviors is directed at relieving the anxiety.
happen. • Learning and problem-solving are not possible.
• A significant occurs reduction in perceptual field occurs. • The individual needs direction to focus.
• Focus is on specific details or scattered details.
PANIC
• associated with dread and terror and a sense of impending • Increased motor activity occurs.
doom. • Loss of rational thoughts with distorted perception occurs.
• The personality is disorganized. • Inability to concentrate occurs.
• The individual is unable to communicate or function • If prolonged, can lead to exhaustion and death.
effectively.
COPING MECHANISMS
• Compensation - extra effort in one area to offset real or • Denial - treating obvious reality factors as though they do
imagined lack in another area not exist because they are consciously intolerable
• Conversion - A mental conflict is expressed through
physical symptoms
• Displacement - transferring unacceptable feelings • Projection - unconsciously projecting one's own
aroused by one object to another, more acceptable unacceptable qualities or feelings onto others
substitute • Rationalization - JUSTIFYING BEHAVIORS, emotions,
• Dissociation - WALLING OFF specific areas of the motives, considered intolerable through acceptable
personality from consciousness excuses
• Fantasy - a conscious distortion of unconscious wishes • Reaction Formation - expressing unacceptable wishes or
and need to obtain satisfaction behavior by opposite overt behavior
• Fixation - becoming stagnated in a level of emotional • Regression - retreating to an earlier and more
development in which one is comfortable comfortable emotional level of development
• Identification - subconsciously attributing to oneself • Repression - unconscious, deliberate forgetting of
qualities of others unacceptable or painful thoughts, impulses, feelings or
• Intellectualization - use of thinking, ideas, or intellect to acts
avoid emotions • Sublimation - diversion of unacceptable instinctual drives
• Introjection - incorporating the traits of others. into personally and socially acceptable areas.
CRISIS
• Crisis is a temporary state of severe emotional disorganization caused by failure of coping mechanisms and lack of support.
• Decision making and problem solving are inadequate.
• Treatment is immediate, supportive, and directly responsive to the immediate crisis to assist the client and the family through
the stressful situation.
TYPES OF CRISES
• Maturational—relates to developmental stages and associated role changes
• Situational—arises from an external source and is associated with a life event that upsets an individual or a group’s
psychological equilibrium.
• Adventitious—relates to a crisis of disaster or an event that is not a part of everyday life and is unplanned and accidental.
PSYCHOSIS NEUROSIS
• POOR contact with reality • any long term mental or behavioral d/o in which
• PRESENCE of delusions, hallucinations, severe thought contact with reality is retained the condition is
disturbances, alteration of mood, poverty of thought recognized by the patient as abnormal.
and abnormal behavior • features anxiety or behavior exaggerated designed to
• (schizophrenia , major disorder of affect (mania – avoid anxiety
depression), major paranoid states and organic mental • (anxiety d/o ; hysteria to conversion d/o, amnesia,
disorder fugue, multiple personality and depersonalization-
• Benefits fr: PSYCHOANALYSIS and Antipsychotics dissociative d/o ; oc d/o)
• Benefits from Behavior Therapy
Severe • Little understanding of written • Spoken language is quite • Requires support and
IQ - expression limited supervision
Profound • Physical world rather than • Limited understanding • Dependent on others for all
IQ - symbolic process aspects
▪ Associative Looseness – lack of logical thought leading to chaotic and disorganized thinking
▪ Affective Disturbances – flat, blunted, and socially inappropriate affect of feeling tone
▪ Ambivalence – presence of strong conflicting feelings leading to psychic immobility and confusion
▪ Autism – extreme retreat from reality, preoccupation with self, leading to psychotic thought processes
DEPRESSIVE DISORDERS
Characterized by disturbances in feelings, thinking and behavior that tend to occur in a continuum, ranging from severe depression
to severe mania.
ANXIETY DISORDERS
no longer includes obsessive-compulsive disorder (which is included with the obsessive-compulsive and related disorders) or
posttraumatic stress disorder and acute stress disorder (which is included with the trauma- and stressor-related disorders)
ASSESSMENT STARS
Agoraphobia, Specific Phobia, and Social Anxiety Disorder (Social deletion of the requirement that individuals over age 18
Phobia) years recognize that their anxiety is excessive or
unreasonable.
Panic Attack
essential features of panic attacks remain unchanged
Panic Disorder and Agoraphobia Panic disorder – RECURRENT UNEXPECTED PANIC
Panic disorder and agoraphobia are unlinked in DSM-5 ATTACKS
Specific Phobia
core features of specific phobia remain the same
Selective Mutism
diagnostic criteria are largely unchanged from DSM-IV
Hoarding Disorder
• new diagnosis in DSM-5. DSM-IV
• as one of the possible symptoms of obsessive-compulsive
personality disorder
PERSONALITY DISORDERS
2 or more present: cognition, affectivity, interpersonal functioning, impulse control
CLUSTER A (THE MAD) CLUSTER B (THE BAD) CLUSTER C (THE SAD)
ODD, ECCENTRIC DRAMATIC, EMOTIONAL, ERRATIC ANXIOUS, FEARFUL
Ego Syntonic - comfortable for the Histrionic: center of attention, self-dramatization, poses Obsessive-complusive:
indiv. but not to others (maintain consistent rlxp; inc self-worth, adaptive preoccupied w/ perfectionism,
coping) control of situation (accept the
Schizoid: lacks personal & social r; rituals, enc. Diversion, decrease
detached from others & withdraws Narcissistic: sense of grandiose + importance, excessive anxiety, distractive behavior)
from interactions (maintain comfy self-admiration, lacks empathy, arrogant, fantasies of
distance; initiate structured social unlimited power, beauty, brilliance (set clear realistic Dependent: submissive &
interaxn) expectations, assist in building self-esteem) clinging behavior associated
with an excessive need to be
Schizotypal: almost similar to schiz Borderline: disturbed rlxp, impulsive & unpredictable, cared for by others (facilitate
but psycho episodes are infreq chronic sense of boredom, expected to be alone w/ expression of assistance when
(comfy distance, structured social unstable moods (decrease self-destructive behavior, enc. needed)
interaxn) Verb.)
Avoidant: feeling of
Paranoid - distrust (interprets other Antisocial: exploitation of others, violation of laws/rights inadequacy, social inhibition,
motives as threat), suspicious, of others, impulsive + risky behaviors, lacks honesty, sensitivity to potential
secretive loyalty (use firm & consistent limit setting, facilitate tx rejection or criticism (establish
(establish rapport, risk for rlxp in a structured environment) a trusting relationship)
aggression, support adaptation)
Posttraumatic Stress Disorder reexperiencing, avoidance/numbing, and arousal—there are now four symptom clusters in
DSM-5, because the avoidance/numbing cluster is divided into two distinct clusters
DISSOCIATIVE DISORDERS
ASSESSMENT IMPLEMENTATION
1) derealization is included in the name and symptom structure of
what previously was called depersonalization disorder and is now called
depersonalization/derealization disorder,
2) dissociative fugue is now a specifier of dissociative amnesia
rather than a separate diagnosis, and
3) the criteria for dissociative identity disorder have been changed to
indicate that symptoms of disruption of identity may be reported as well
as observed, and that gaps in the recall of events may occur for everyday
and not just traumatic events
Dissociative Identity Disorder
expanded to include certain possession-form phenomena and
functional neurological symptoms to account for more diverse
presentations of the disorder
Anorexia Nervosa The core diagnostic criteria for anorexia nervosa are
conceptually unchanged from DSM-IV with one exception: the
requirement for amenorrhea has been eliminated
Bulimia Nervosa The only change to the DSM-IV criteria for bulimia nervosa is a
reduction in the required minimum average frequency of binge
eating and inappropriate compensatory behavior frequency
from twice to once weekly
Elimination Disorders
No significant changes have been made to the elimination
disorders diagnostic class from DSM-IV to DSM-5
WEIGHT Less than 85% of normal weight for age and Normal or near-normal weight for age and
height height
CARDIO Bradycardia, hypotension, arrhythmias Bradycardia, hypotension, arrhythmias
(d/t FVD, low muscle tone)
SLEEP-WAKE DISORDERS
SLEEP: described as neurobiologic window into the pathophysiology of psychiatric disorders
Sleep switch: located in the hypothalamus
Front: regulates sleep
Back: wakefulness center
Varity of structure: ranging from the brain stem to the cerebral hemispheres
Circadian Clock: regulated by a specific group of brain cells in the hypothalamus; Works in sync with the external environment to
coordinate sleep and wakefulness.
MELATONIN: secreted by the pineal gland = promotes sleep in the lower light; excretion occurs when it is dark; daylight suppresses
melatonin
STAGES OF SLEEP:
REM: increased level of brain activity
NREM: composed of 4 stages
Stage 1 NREM: occurs right after the awake stage; 4-5% of total sleep time = considered light sleep
Stage 2 NREM: also considered light 40-50% accounts for total sleep time
Stage 3 NREM: deep sleep; comprises 4-6% of total sleep time and s known as slow wave sleep or delta sleep
Stage 4 NREM: comprises 12-15% of total sleep time; during this stage that sleep terror d/o or sleepwalking d/o occurs
DYSSOMNIAS: d/o of quantity or timing; difficulty initiating or maintaining sleep or excessive sleepiness
• Insomnia: (1 month) diff maintaining or initiating sleep; non restorative
• Primary Hypersomnia: (1 month) excessive sleepiness; prolonged sleep episodes or daytime sleep episodes that occur
almost daily
• Breathing Related D/O:
o Common form is sleep apnea; common type: obstructive
• Narcolepsy: almost irresistible urge to sleep followed by brief episodes of deep sleep followed by sense or refreshment
o Associated with: CATAPLEXY (sudden collapse of muscle tone), SLEEP PARALYSIS (total inability to move for a brief
period), HYPNAGOGIC HALLUCINATIONS (vivid dreamlike images)
• Circadian Rhythm Sleep Disorders: sleep-wake disturbance through internal cues
Delayed sleep phase type
Jet lag type
Shift-work type: normal endogenous sleep-wake cycle
Parasomnia NOS
• Bruxism (teeth-grinding = dental bite plate)
• Somniloquy (sleep talking)
• Jactatio capitis nocturna (head-banging)
• Sleep paralysis (inability to execute voluntary movements)
SEXUAL DYSFUNCTIONS
characterized by a disturbance in the sexual response cycle or by pain associated with sexual intercourse/ inhibition of sexual
appetite that compromise sexual response cycle
Orgasmic disorder Can’t compete response d/t inability to achieve orgasm (anorgasm; retired)
Female orgasmic disorder: Male orgasmic disorder:
fear of impregnation; Rigid/puritanical background
rejection by partner Sex: “sinful”
damage to the vagina Vagina: “dirty”
hostility to men
PARAPHILIC DISORDERS
PARAPHILIA: condition in which the sexual instinct is expressed in ways that are socially prohibited or unacceptable/biologically
undesirable/ individual doesn’t consider sexual activities as disorder/ activities last over a period of 6 months/ excitement happens
during anticipation
may be coercive or non-coercive (Coercive paraphilia: bandage, sensory deprivation, intense stimulation, discipline)
Exhibitionism Posing one’s genitalia
Fetishism Non-living objects
Frotteurism Non-consenting person
Pedophilia 13 or lower = VICTIM; 16 or 5 older = PERPETRATOR
Incest: relationships by blood or marriage
Masochism Coined after Leopold von Sucher Masoch
Act of being humiliated, beaten, suffer
Hypoxyphilia: act of strangulation or O2-depleting activity
Coercive paraphilia; 6 months
GENDER DYSPHORIA
Gender dysphoria is a new diagnostic class in DSM-5 and reflects a change in conceptualization of the disorder’s defining features by
emphasizing the phenomenon of “gender incongruence” rather than cross-gender identification per se, as was the case in DSM-IV
gender identity disorder.
Conduct Disorder
The criteria for conduct disorder are largely unchanged from
DSM-IV
SUBSTANCE ABUSE:
Pattern of repeated abuse of substance that is maladaptive in that significant adverse consequence
occurring within a 12-month period manifested by one more
• recurrent substance abuse =
• recurrent substance use in situations =
• recurrent substance-related legal problems
• continued use despite =
SUBSTANCE INTOXICATION: reversible syndrome of maladaptive physiologic and behavioral changes that are d/t the
effects of substance to person’s CNS
• syndrome includes -
SUBSTANCE WITHDRAWAL: the development of maladaptive physiologic, behavioral and cognitive changes that are the
result of reducing or stopping the heavy and regular use of substance
• syndrome includes clinically significant DISTRESS or IMPAIRMENT in social
ALCOHOLISM
ALCOHOL: one of the most widely used substances n the world; sedative anesthetic = absorbed in the mouth, stomach and SI
= 95% broken down by liver
= generally a person can metabolize 10 ml of alcohol/90mins
= intoxication occurs when a person’s BAL (blood alcohol level) is 0.10% or more
Gambling Disorder
An important departure from past diagnostic manuals is that the substance-related disorders chapter has been expanded
to include gambling disorder. This change reflects the increasing and consistent evidence that some behaviors, such as
gambling, activate the brain reward system with effects similar to those of drugs of abuse and that gambling disorder
symptoms resemble substance use disorders to a certain extent.
NEUROCOGNITIVE DISORDERS
Key concepts
• Cognition: based on a system of interrelated abilities such as perception, reasoning, judgment, intuition and
memory that allow one to be aware of one’s self.
• Memory: facet of cognition concerned w/ retaining and recalling past experiences
• Delirium: condition of acute cognitive impairment and is caused by a medical condition, substance abuse or
multiple etiologies
• 3 disrupted components of cognition: perception (decreased ability to distinguish and integrate sensory info),
thinking (process is fragmented and disorganized), memory (impaired in 3 aspects: register, retain, recall)
• Dementia: chronic cognitive impairments and is diff by underlying cause not symptoms patterns
May be cortical/subcortical