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Ego dystonic vs. ego syntonic
- Dystonic is uncomfortable with the self as seen with OCD
- syntonic is comfortable with the self as seen with personality disorders
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primary gain vs. secondary gain
- primary is physical symptoms that prevent deal with emotional issues
- secondary is the attention gained reinforces the symptoms
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Ego functions as they relate to personality: Reality testing
best tool to see if someone is psychotic
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Ego functions as they relate to personality: impulse control
- seen in the dramatic/erratic personality disorders and explosive disorder
- goes along with judgment
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Ego functions as they relate to personality: object relations
seen in dramatic/erratic personality disorders
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State vs. Trait
- State is a time limited status
- trait is persistent across time and situation
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Emotional reasoning
- feelings are facts, I feel therefore it is true
- seen in personality disorders
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Idioms of Distress
- cultural expression of distress
- different cultures express things in different ways
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Sleep apnea vs. hypopnea
- apnea is when breathing stops
- hypopnea is shallow breathing
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define cataplexy
Sudden muscle failure as seen with narcolepsy
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type 1 vs type 2 narcissism
- type 1 is the basic need for admiration as described in the DSM
- type 2 is a need for admiration by way of self-sacrifice or giving to others
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Define malingering
False presentation for a targetable gain
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Disorder and Symptoms: intermittent explosive disorder
- Pressure build to act out
- action releases this pressure build up
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Disorder and Symptoms: Kleptomania
- A sudden urge to take something that is not needed
- most have a mood disorder
- behavior is usually prompted
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Domestic violence: Cycle of violence
- tension building
- acute battering incident
- loving contrition
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Domestic violence: characteristics of batterer
- low self-esteem
- fear of intimacy but dependent
- power/control needs
- anger/hostility
- depression
- low stress tolerance
- defensive
- denial/minimization/justification
- violence in family of origin
- substance abuse
- un or under employed
- child abuse
- poor communication
- negative attitudes towards women
- possessive,suspicious/jealous
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Domestic violence: characteristics of battered women
- does not deserve to be abused or beaten
- conflicting emotions
- isolated, submissive, feels powerless
- trapped and frightened
- needs information
- may have been abused as a child
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Hanks typology of couples: type 1
type 1: acute, situationally reactive violence to partner only.
- man feels guilt and is alarmed at loss of control
- woman has appropriate outrage, expresses intolerance, will leave relationship if necessary
therapy is effective
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Define hypersomnolence disorder
excessive sleep but still tired
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Define narcolepsy
- uncontrollable urge to fall asleep
- has cataplexy
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Define circadian rhythm sleep wake disorder
basically jet lag or a sudden change in sleeping patterns
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Define non-rapid eye movement sleep disorder
basically sleepwalking
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Define rapid eye movement sleep behavior disorder
- acting out while sleeping
- hitting, kicking, flailing, etc...
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Define nightmare disorder
- vivid dreams dealing with life threatening situations
- dreams are clearly remembered
- awake very aroused and vigilant
- could be PTSD
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Stages of sleep
- NREM 1: between sleep and wakefulness
- NREM 2: theta wave activity, more difficult to awaken sleeper
- NREM 3: delta wave (slow wave) sleep, sleeper is less responsive to the environment
- REM: aka paradoxical sleep, very active, lack of REM --> harder to learn complex tasks
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Somatic Symptom Disorder
- Disproportionate worry about the seriousness of one's symptoms
- high level of anxiety
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Illness Anxiety Disorder
- preoccupation with having/acquiring a serious illness
- somatic symptoms not present
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Conversion Disorder
- physical symptoms to emotional trauma
- la belle indifference
- primary and secondary gain
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psychological factors affecting other medical conditions
example: depression with diabetes
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Factitious Disorder
- make themselves ill for attention
- the need to be a patient
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What are other conditions that may be a focus of clinical attention?
- These are not disorders
- these conditions can affect treatment
- these are Z codes
- used in addition to diagnosis
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What are the odd and eccentric personality disorders?
- Schizoid PD
- paranoid PD
- schizotypal PD
- these are the closest to being psychotic
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What are the dramatic, erratic, and over-emotional personality disorders?
- Anti-social PD
- borderline PD
- Histrionic PD
- Narcissistic PD
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What are the anxious and fearful personality disorders?
- obsessive compulsive PD
- Avoidant PD
- Dependent PD
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Schizoid Personality Disorder
- detachment from social relationships and restricted expression of emotion
- negative symptoms
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Paranoid Personality Disorder
- Distrust and suspiciousness of others
- not usually delusional
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Schizotypal Personality Disorder
- eccentric behavior
- pattern of social and interpersonal deficits
- reduced capacity for close relationships
- positive symptoms
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Anti-Social Personality Disorder
- pattern of disregard and violation of the rights of others
- poor impulse control
- aggressive
- lack of remorse or guilt
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Borderline Personality Disorder
- Unstable relationships, self image, and affect
- impulsive
- dysregulation of emotions
- hot anger
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Narcissistic Personality Disorder
- grandiosity
- need for admiration
- lack of empathy
- cold anger/get even
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Histrionic Personality Disorder
- excessive emotionality and attention-seeking
- seductive
- shallow emotions
- cold anger/get even
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Avoidant Personality Disorder
- Social inhibition
- feelings of inadequacy
- hypersensitive to negative evaluation/rejection
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Dependent Personality Disorder
- excessive need to be taken care of
- leads to submissive behavior
- clinging behavior
- fear of separation
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Obsessive-Compulsive Personality Disorder
- preoccupation with orderliness
- perfectionism
- mental and interpersonal control at the expense of flexibility, openness and efficiency
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sociocentric vs. egocentric characteristics
- sociocentric: identity is centered in the group or extended family. Person's interest are suppressed and strict rules on interdependence. Outside the group membership is not favorable
- egocentric: identity is focused on the self. Perceive oneself as autonomous, and dependence is unfavorable. terminate relationships at will
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Dominance hierarchies
- primary role identification
- stigma
- typical in industrial societies
- can be based on class, race, age, gender, etc...
- allows for systems of discrimination
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What are the adaptations to stigma?
- Internalization (acceptance of status): apt to view environment as hostile
- Passing: hiding the stigma
- Copy dominant group: more apt to focus on rules
- Superlative effort: being better than the average stigmatized group
- violence/resistance: may look anti-social
- violence against the self: could be comorbid with internalization
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Psychological defense for narcissistic
- idealization/devaluation
- projection
- idnetification
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Psychological defense for Anti-social
- controlling
- projective identification
- acting out
- denial
- manipulation
- emotional isolation
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Psychological defense for Borderline
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Psychological defense for Histrionic
- repression
- regression
- dissociation
- somatization
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Psychological defense for Schizoid
- fantasy
- intellectualization
- projection
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Psychological defense for Paranoid
- Denial
- splitting
- reaction formation
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Psychological defense for schizotypal
- projection
- denial
- distortion
- splitting
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Psychological defense for Avoidant
- Repression
- inhibition
- isolation
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Psychological defense for Dependent
- idealization
- reaction formation
- projective identification
- regression
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Psychological defense for Obsessive-Compulsive PD
- isolation of affect
- undoing
- displacement
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Alternative personality disorders model criterion A
- level of functioning with 2 categories
- self: identity and self-direction
- interpersonal (others): empathy and intimacy
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Alternative personality disorders model criterion B
Pathological trait domains
- negative effect
- detachment
- antagonism
- disinhibition
- psychoticism
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What is the difference between the ICD and the ICF?
- ICD = diagnostic nomeclature (whats wrong)
- ICF = specific functional impairment associated with disorders (how bad is it?)
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What is the purpose of the WHODAS 2.0?
- identifies difficulties due to health/mental health within the past month
- measures general areas of impairment
- designed to help with treatment planning
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What areas of functioning does the WHODAS assess?
- understanding and communication
- getting around
- self-care
- getting along with people
- life activities-household
- life activities-school/work
- participation in society
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Hanks typology of couples: type 2
cyclical violent affective storms to partner and family
- man - violence is egosyntonic, accepts limited responsibility, temporary remorse instead of true guilt, violence is chronic and occurs in cycles
- woman- not as much outrage, stays attached to relationship
treatment can be effective if man commits to anger management and woman commits to safety
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Hanks typology of couples: types 3 and 4
treatment is not recommended and is not effective
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general issues surrounding treatment issues re: sexual dysfunction
- most studies are on male dysfunction
- sex therapy is hard to find
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pharmacotherapy vs. psychotherapy re: sexual dysfunction
- medication usually does not address problem
- pharmacological interventions can change sexual script
- pharmacological interventions may also surface unconventional
- issues
- psychological issues interfere with efficacy of meds
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