FMS 4 - Psychiatry
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Most important diagnostic tool of a doctor?
Ears! Listening is key
- The study of the effect mood states (anxiety, depression) have and stress have on the immune system.
- Depression down-regulates the body's immune system
Psychobiological basis for stress's effect on the immune system
Hypothalamus&pituitary glands secrete hormones in response to stress (physical or psychological) --> adrenal gland by kidneys --> cortisol --> immunosuppressive actions
- Integration & interplay between biology, psychology, and sociology.
- Allows MD to view patient's life from multiple perspective simultaneously.
Rat pups that are licked are more resiliant to stress, pass on this resiliance to offspring.
Example of biopsychosocial model.
Example of biopsychosocial phenom
Doesn't account for counfounding variables with respect to health like psychology and sociology
Viewing symptoms along with context in which they appear for dx
Mourning v. depression: based on context & appropriateness
- Diagnostic and Statistical Manual of Mental Disorders
- Diagnoses are based on descriptions (empirical and categorical)
- Etiology is rarely part of the diagnostic cirteria
5 axes of the DSM-IV
- Asix I: Major psychopathology- depression, bipolar disorder
- Axis II: Personality disorders- Antisocial etc.
- Axis III: Medical conditions: side effects of drugs given for medical conditions
- Axis V: Global Assessment of Functioning (10-100)
Candidate v fate genes
- Fate: genetical predisposition
- Cadidate: may undergo epigenetics changes --> manifest as psychopathology
- Important in psychogenomics
- Allows for visualization of the biological impact psych intervention can have on the brain
- fMRI: changes in blood flow or cell metabolites to show change in activity
Suicide - no ? leading COD?
Suicide is the 8th leading COD
No. 1 cause of diability worldwide
Major depressive disorder
Lifestyle & personal habits account for __% of illness/death and __% of healthcare costs
What is mental health?
Successful performance of mental fxn --> productive activities, fulfilling relationships, the ability to adapt to change & cope with adversity
4 ways to define normal/abnormal/pathological
- 1. Professionally: common in all cultures
- 2. Deviation from mean: numerical
- 3. Assessment of function: do thoughts, feeling, and/or behavior have a functional or dysfunctional effect on the individual? i.e. normal anxiety level = good for exam, abnormal anxiety level = debilitating
- 4. Social and political definitions
Normal vs. Healthy
- Normal: usual/expected state
- Healthy: functional, good health
Definition of mental disorder
Clinicall significant behavioral/psychological syndrome or pattern that is associated with present distress/disability or increased risk of suffering death, pain, disability or loss of freedom
How much does genetics contribute to mental illness?
4 domains of psychiatric dysfunctions
- 1. Thought
- 2. Mood/emotion
- 3. Behavior
- 4. Relationships
Percent of psychiatric illness
Explain the continuum between psychiatric health and illness
Psychiatric health and illness are inherently connected and there is a wide range of variability in what can be defined as "normal"
The conscious mind
- I am aware
- Traits: linear, analytical, intellectual, discrete, voluntary, logical, cognitive learning, verbal, limited focus, able to process only limited info at a given moment
- Therapy: Cognitive Behavioral Therapy
The unconscious mind
- Not in immediate field of awareness
- Traits: intuitive, access to a great more deal of info, muti=tasking & multi-modal processing of information, non-linear, non-verbal, non-logical, associative, involuntary, literal, automatic
- Therapy: Psychodynamic
Somatization & somatic equivalents
Unconscious mechanism that creates biological manifstations to cope with mental issues
Defence mechanisms of the unconscious mind
- Serves as a mechanism to cope with setress by providing relief from uncomfortable experiences, usually maladaptive
- Repression: ignoring the issue
- Denial: denying the issue
- Regression: reverting to immature ways of dealing with the issue
- Projection: "he really hates me," projecting one's own thoughts onto others
- Displacement: to take out emotions on an unrelated party
- Reaction formation: passive-sggressive, opposite
- Rationalization: being overly optimistic
- Intellectualization: thinking of a bad event as a cognitive problem i.e. seraching the internet for a reason why someone has cancer
- Sublimation: channeling the unacceptable into the acceptable i.e. someone with a brain tumor starts a foundation
- Humor: using amusement to cope
- Assignment to a person those feelings, attitudes, and expectations originally associated with another person
- i.e. someone expecting Dr. to be mean because parents were
Transference on the part of the clinician to the patient
Prochaska's stages of change
- Understanding where person is with respect to thinking about and undertaking a change
- Clinical response to each stage is unique to that stage
- People live in a simultaneous mix of several stages and don't progress through them sequentially
- 1. Precontemplation: avoidance of problem
- 2. Contemplation: thinking about problem, ambivalence, pros vs cons of making change
- 3. Determination/Preparation: "there is a problem that i need to fix," transition from all talk --> action, considering how to make change
- 4. Action: new behaviors implemented, weak, committment is tested
- 5. Maintenance: intial goal met, behavior is stable
- Relapse: not a stage, returning to an earlier stage, normal
A way of interacting and conversing with patients that has been shown to increase behavior change
3 majors rites of passage in life - Arnold van Gennep
- 1. Separation: from group/society
- 2. Transition: intermediate learning stage
- 3. Incorporation: reentry into group for new status/role
Adapting/coping through life
- Focused on defense mechanisms, showed that coping styles mature over time through development
- Immature: acting out, passive aggressive, regression, somatization
- Mature: altruism, humor, anticipation, sublimation, suppression
- Pathological manifestation of midlife transition (40-45)
- Feeling unwell in context of uncertainty/anxiety/depression
- Bodily changes: decreased fxn = climacterium
- Changes in time perception: how long left
- Career issues: aspirations v. acheivements
- Relationships: spouse, kids, parents etc.
- Social changes: divorce
- Financial pressures: job, money
- Dramatic, ongoing, often impulsive behavior with major changes in life, limited insight
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