PSYCHIATRY I Edwin A. Menguito, MD, FPPA UNIT I – MENTAL HEALTH Mental Health œ The adjustment of individuals to themselves and the world at large with a maximum of effectiveness, satisfactions, cheerfulness and socially considerate behavior, and the ability to fac e and accept the realities of life. - K. Menninger œ If mentally healthy: ¤ Can adjust to yourself & to the world ¤ Can accept the reality of life Mental Hygiene œ The adoption and application of a set of principles directed towards the pr even t io n o f se r i ou s maladjustments and the maintenance and promotion of sound mental Health. œ Branch of preventive medicine œ 2 Objectives: PREVENTIVE & PROMOTIVE Mental Health is NOT: 1. Adjustment under all circumstances There are some things we can’t adjust to, so just accept it 2. Freedom from Anxiety & Tension Can still feel anxious & tense 3. Freedom from Dissatisfaction You can still be dissatisfied, which is important because it is a means of improving one’s self 4. Conformity Don’t have to follow all rules & regulations; if always following rules, t he re ’s so m e th in g wrong 5. Constant Happiness There are a lot of other emotions If always happy: consider Manic Bipolar Disorder 6. Lessening of Accomplishment It doesn’t mean that there is lessening of accomplishments If mentally healthy: Tends to have a lot of accomplishments 7. Absence of Idiosyncrasies A person can still have some peculiar traits (e.g. doing the “sign of the c ro ss” , i t m ay b e peculiar to other religions) 8. Undermining of authority Doesn’t destroy authority 9. Opposed to religion Mental health & Religion has the same objectives: PEACEFULNESS & H AP PI NESS o f t h e person Atheist are not mentally healthy, there should be a God, because it is beyond the capabilities of the human beings to create the world Criteria of Mental Health (by A. Schneiders): 1. Mental Efficiency ¤ Can do what you have to do (studying, etc.) 2. Control & Integration of thought and conduct ¤ What you think about you do it 3. Integration of motives and control of conflict & frustration ¤ Know what you want, control your disappointment 4. Positive, Healthy feelings ¤ Emotions, a lot of (+) emotions & only minimal (-) emotions 5. Tranquility or peace of mind ¤ Can sleep well at night; can be achieved when criteria 1-4 are achieved 6. Healthy attitudes ¤ The way you look at your studies, career, job, family, be an optimist 7. Healthy self-concept ¤ The way you look at yourself, if you believe in yourself 8. Adequate Ego-identity ¤ You know yourself 9. Adequate Relations to reality ¤ You know what is real, don’t spend your time day dreaming (good for children) *Unhealthiest: 1 – Healthiest: 10 *Passing score: 70; <70 = something wrong Program for Health Maintenance 1. Self – Discipline 2. Physical Exercise 3. Food (older = lesser food) 4. Rest & Relaxation (Younger = more hours of sleep) Baby > 20 hours Teenager = 10 hours Growing Child = 12 hours Adult = 8 hours 5. Faith Causes of Mental Illness (Bio – Psycho – Social Theories) 1. Biological – can be inherited *Prevention of Alzheimer’s disease: Exercising your brain (Reading, answering puzzles, etc.) – Infections, Trauma, Endocrine metabolic condition, ageing *Most notorious: Typhoid fever, AIDS 2. Psychological – Frustrations in life 3. Socio-economic – poverty Early Signs Sleep Problems Loss of interest Social Withdrawal Fears & Palpitations Irritability Headaches, numbness, Etc Dizziness & Fainting Suspiciousness Worry & Forgetfulness Warning Signs INSOMNIA LOSS OF APPETITE IRRITABILITY ALCOHOL ABUSE BLANK STARES LOSS OF MEMORY D EPRESSION EMENTIA ELIRIUM ELUSIONAL DISORDER ISORDERS OF SLEEP UNIT II – PSYCHOLOGY AND DEVELOPMENT A. Child Development Infancy – 1 st month of life Partunate 15 – 30 minutes after birth Neonate Up to 4 weeks Characteristics of Infancy SHORTEST RADICAL ADJUSTMENT From intrauterine to post-uterine PLATEAU in DEVELOPMENT No development HAZARDOUS Can Die anytime Babyhood 1. TRUE FOUNDATION AGE 2. RAPID GROWTH AND CHANGE – there is development 3. INCREASED INDIVIDUALITY – all babies are not the same 4. DECREASED DEPENDENCE 5. SOCIALIZATION BEGINS – relationship w/ other people (1 st: mother / surrogate if biological mother is not around) 6. SEX-ROLE TYPING BEGINS – ID of baby as MALE / FEMALE 7. APPEALING AGE – baby is very cute at this age 8. CREATIVITY BEGINS 9. HAZARDOUS AGE – Dangerous because of diseases; low immunity Early Childhood (1 – 6 years old) • Problem or Troublesome Age – Children are stubborn; favorite word is “NO” • Toy Age • Pre-school age – starts going to school • Pre-gang age – hanging out with children not of the same age • Exploratory age – curious about things • Imitative age – imitate what they see or hear (parents should be careful) • Creative age – invent games Developmental Task for Late Childhood (6 – 12 years old) 1. Skills for games 2. Attitudes towards self 3. Getting along with peers (same age & sex) – attitude towards others 4. Appropriate social role 5. Skills in 3Rs – Reading, wRiting, aRithmetic 6. Concepts 7. Conscience 8. Attitudes toward social group and institution (school, church, government) Emotions ¤ All are normal,; part of growing up Anger Envy (sometimes manifested as sibling rivalry) Fear Joy Jealousy Grief Curiosity Affection Socialization (Late Childhood) 1. Associates – classmates 2. Playmates – choose certain people to play with you 3. Friends – closest people, knows about your problems, etc. Play (Late or Early Childhood) • TOYS • DRAMATIZATION • GAMES • READING • TV, RADIO, MOVIES • CONSTRUCTIVE – make your own • COMPUTERS Concepts (Late or Early Childhood) Life Death (usually around 7 years old) Number Weight Sex Roles Self Comic Bodily Functions Space Time Beauty Social Awareness Discipline 1. Authoritarian – “Do as I say, do not complain” 2. Permissive – You can do what you want; WORST type of discipline, child grows up w/o discipline, no respect and tends to end up as criminals 3. Authoritative – or “Democratic”, listen to what the child has to say, discuss the problems w/ the child; BEST type of discipline 4. Neglectful – Parents do not care about the child, more interested in themselves rather than the child, very selfish parents Personality Types (Children) • EASY CHILDREN – respectful, obedient, study their lessons • DIFFICULT CHILDREN • SLOW-TO –WARM UP CHILDREN – not very affectionate Hazards Physical – can produce psychological manifestations ILLNESS OBESITY ACCIDENTS DISABILITIES AWKWARDNESS HOMELINESS – ugly; you don’t look like your parents Speech Development Intelligence Discipline Psychological SPEECH - stammering PLAY EMOTIONAL CONCEPTUAL SOCIAL MORAL Ordinal Position Family Size Socioeconomic Status Sex Role Typing Late Childhood • Troublesome age • Sloppy age – No to taking a bath, No to haircuts • Quarrelsome age – Quarrels with peers • Elementary school age • Gang age – Barkada • Age of conformity – Likes to follow each other’s (friend’s) rules • Play age Adolescence – adult to be, transition between childhood and adulthood • INDEPENDNCE – 2 kinds œ Physical / Financial: Can support oneself financially œ Psychological: Can live on your own • IDENTITY œ Personal – refers to career, what is your choice œ Sex / gender – Male / Female • IMPULSE CONTROL • MORAL VALUES FORMATION œ Conscience formation: from home, school, community, church Optimal Development – can’t be a parent if you can’t provide all these 1. STABLE 2. PREDICTABLE 3. WITH BASIC NEEDS 1. Material 2. Protection 3. Affection 4. Approval 5. Acceptance 6. Discipline 7. New experiences – Best is TRAVEL! B. Theory of the Mind (Sigmund Freud) Topographical Theory Conscious Pre - conscious Unconscious Hypnosis Conscious and pre – conscious are paralyzed Unconscious will tell you everything, it never forgets, in will never sleep Dream analysis Structural Theory ID Ego Super Ego 1. ID – container of basic instincts, principle: Pleasure / Satisfaction Psychological Instinct: Sex (Passive, Reproductive) & Aggressive (Negative, Killing) 2. Ego – self, principle: Reality, whatever is real, ego can recognize Functions: œ Thinking, Emotions, Perceptions, Defense œ Bridge the ID and the Super Ego œ Make decisions 3. Super ego – conscience (right VS. wrong); if you do something wrong, the effect is guilt & shame Conscience œ Moral Value – if violated ➔ GUILT œ Ego Ideal – what you want to become, if not achieved ➔ SHAME C. Defense Mechanisms (Memorize) - Are specific, unconscious, intrapsychic, adjustive efforts which are utilized to resolve emotional conflict and free the individual from anxiety. - Goals: (1) to relieve anxiety, (2) to solve problems, (3) to prevent ego disintegration. - Classification: (1) Adaptive, A (2) Maladaptive, M •Awareness •No awareness •You can remember things w/ some difficulty •e.g. things that happened a few days ago •No awareness •Very difficult to remember •e.g. things that happened a year ago Common Mental Mechanisms: 1. Fantasy (A) ¤ Or daydreams are temporary escapes from the frustrations of reality. The individual’s thwarted desires can be very easily satisfied. Adolescents are particular l y p r o ne t o daydreams and fantasies. The girls usually daydream of beauty, glamo ur an d l ove. Boys frequently daydream of physical strength, courage and adventures. 2. Regression (M) ¤ Means going back. A frustrated individual may seek unconsciousl y t o r et ur n t o a n earlier, more secure period of life. He goes from the painful realities and responsibilities of the present to the protected existence of his childhood. A p e r so n 3. 4. 5. 6. 7. 8. 9. who is regressing may start to act in a childish way, may pout or frown or have temper tantrums when he does not get what he want. ¤ Acting like a child Repression (A) ¤ The process of excluding from conscious awareness an undesirable thought, feeling or memory that causes pain, shame or guilt. Serves to protect the self from the pai n o f certain thoughts and memories. For instance, unpleasant incidents and aggr e ssive thought could easily be forgotten through the process of repression. ¤ Most basic, 1 st defense mechanism that you will use Reaction Formation (A) ¤ May unconsciously repress his socially unacceptable desires and devel op co nsc io us attitudes and overt behaviour patterns which are the opposite of his real, unconscious wishes. For instance, a mother who rejects her child may b eh ave t o war d h im w / oversolitude. At times conscious attitudes which develop are high ly e xagge r ate d, extreme and intolerant. ¤ When you feel guilty, you do something good Displacement (M) ¤ A feeling is transferred from its actual object to a substitute. The feel in g o r igi nal ly directed toward a certain person, object or situation is transferred to another person, object or situation which becomes invested with the emotional significance originally associated with the former ¤ “Scapegoating”, “Kicking the Dog” defense mechanism Projection (M) ¤ Individual unconsciously convinces himself that others have the undesirable th ou gh t and motives that he actually has himself. When a person finds his thoughts or feelings and then attributes those thoughts and feelings to others aroun d h i m. Fo r example, if a person harbors feelings of hate toward a person he is supposed to love, he may be unable to admit those emotions to himself. So he may convinc e h i mse lf that it is the other person who hates him. ¤ Basis for paranoia, suspect that other people are angry a with you Sublimation (A) ¤ Indirect expression of a need which cannot be satisfied directly, through acceptan ce of an alternate goal which provides a socially acceptable o ut let o f ex p r essio n . I t usually refers specifically to indirect of the sexual urge. For example, the sexual drive could be sublimated through artistic activities while sublimation of hostility is through competitive sports. ¤ Most adaptive; Kundiman – songs about frustrrations Substitution (A) ¤ Expression of frustrated impulses indirectly with no change in the conscious quality of the desires. It often involves socially unacceptable activities and guide feelin gs. Fo r example, frustrated sexual impulses may be substituted by masturbation or undesirable language behaviour, such as telling risqué stories, writing obscene poetry and singing dirty songs Compensation (A) ¤ Attempt to disguise the presence of a weak or undesirable trait b y em ph asi zin g a desirable one. Compensation involves behaviour that is socially desirable and acceptable. For example, a person who is physically unattractive may attempt to gain 10. 11. 12. 13. 14. 15. 16. popularity by developing a charming manner and learning to be an interesting conversationalist. Rationalization (A) ¤ Which seemingly logical explanations are devised to explain and ju sti fy b eha vio ur which might result in loss of social approval and self – esteem ¤ Sour grapes mechanism: make a nice thing look bad ¤ Sweet lemon mechanism: make bad thing look good Isolation (A) ¤ Remove the emotion from what happened; MOVING ON Undoing (M) ¤ Individual divests himself of painful feelings by making use of a cleansing ritual aft er doing something which causes him to feel guilty. For example, a perso n w h o h as i s guilty may wash his hands to cleanse away his guilt. ¤ Making rituals to remove your guilt ¤ Compulsion: Sign of mental illness Fixation (M) ¤ Arrest of psychosexual development. Such personality will show lack of har mo n io us integration; emotional organization remains at an immature level. Restitution (A) ¤ Relieving the mind of a load of guilt by restitutive acts (making up for or reparatio n) . It may become the main motive of life. Denial (A) ¤ Operating unconsciously, used to resolve emotional conflict an d al lay an x ie ty b y denying a though, feeling, wish, need or external reality factor which is con sc io usl y intolerable. ¤ Not accepting Identification (A) ¤ The child takes over the attitudes and behaviour patterns of his parents a n d o t her s significant to him. The child admires or aspires to the strength and q ual it ies o f h i s elders and their associates and attempts to gain for himself their patterns of success by acquiring their modes of behaviour. ¤ Model for identification figure D. Personality Development (Freudian Theory) Drives / Needs Psychic Conflict Anxiety Coping Mechanisms Sexual Extra Normal Adaptive Maladaptive Aggressive Intra Pathological Defense Mechanisms Drives / Needs ¢ Instincts, if not satisfied, will lead to psychic conflict ¢ Sexual (life); Aggressive (death) Psychic Conflict ¢ Extra-psychic: outer factors ¢ Intra-psychic: within self, morals ¢ Layman’s term: PROBLEM ¢ Leads to anxiety Anxiety ¢ Normal: Child going to school for the first time, does not want to separate from mother ( Sepanx) ¢ Pathological: Intensity (too strong), Duration (>6mos.) Effect (paralyzing) Coping Mechanisms ¢ Adaptive / Problem Solving Technique: BEST ➔ Scientific Method 1. ID your problem 2. Hypothesis 3. Methodology (Observation, Consultation, Experimentation) 4. Test the hypothesis 5. Solution ¢ Maladaptive – mental disorders ¢ Defense mechanisms Stages Psychoanalytic Theory of Personality Development ORAL ANAL PHALLIC LATENCY Age 0 – 1½ y.o 1½ - 3 y.o 3 – 6 y.o 6 - puberty Mouth Anus, Urethra Sex organs --- --- Development al Task Trust, body image, feelings Control Elimination, Ambivalence , Mixed Emotions Resolve Oedipus Complex (Temporary) School, Peers, Ego - ideal Final Resolution of OC, Mature Heterosexu ality Psychic Apparatus Defense Mechanism Ego -------------------------------Developing-----------------------------→ Mature Beginning Conscience Ego - ideal Mature Super Ego Object Relation 1 °socialization Mother Mother Oral or dependent personality Oral or OC personality Erogenous Zone Fixation & Adult Characteristi cs Legend: GENITAL Puberty old I D E N T I F I C A T I O N Child F OC – Oedipus Complex; M Histrionic Sexual Orientation Disturbance F – Female; 2° socialization Many Many None None M – Male Personality Development Oral Phase • First 12-18 months of life • Pre-occupation with feeding experience • Pleasure derived mainly through mouth • Tension relieved by sucking and swallowing • Oral sucking stage –passive phase • Biting stage – aggressive phase • Most important developmental tasks: 1. Trust Formation – by mom, will lead to SOCIAL SMILE ¤ Smile due recognition of other person ¤ Around 2 months or 8 weeks ¤ Before 2 months, smiling is due to dreams, which can start during fetal life or due to satisfaction 2. Body Image – baby will recognize himself in front of a mirror 3. Feelings – feels whether the pain is his or other person’s Anal Phase • 18 th month until end of third year • Stubborn; Age of Toilet Training & Discipline • Centered on bowel and excretory functions • Tension relieved by evacuation of the bowels and the bladder • Learns to adjust to the demands of others • Ego and foundation of superego development is laid • Pre-genital or narcissistic phase – oral +anal phase • Anlage – Beginning of something • Too little toilet training ➔ dirty / undisciplined people • Too much toilet training ➔ Obsessive Compulsive people Phallic Phase • End of 3 yrs to 6 years • Awareness of genitalia; Phallus ➔ Penis • Stage of sexual awakening, recognize their own sexuality • Penis Envy – Girl gets mad at mom for not giving her a “penis” • Child’s libido is directed outward and requires others for its satisfaction • OEDIPUS COMPLEX Child’s sexual attraction to the parent of opposite sex • ELECTRA COMPLEX • CASTRATION ANXIETY • Resolution of Oedipus Complex around 5 – 6 y.o, the child will accept the parent of opposite sex & starts following them; 2 mechanisms: Repression & Identification • Histrionic Personality – characterized by exhibitionistic, very attention seeking, narcissistic, “igat”, “biga-on”; attracts attention of the opposite sex, very emotional – easily angry or sad • Sexual Orientation Disturbance – Homosexuality, disturbance in personality development Latency Phase (Late Childhood) • 6 to 12 years old • Interest in new task experiences and personalities • Sexual impulses utilized in intellectual curiosity, sexual energy redirected to play activity • Group play and group acceptance • Normal homosexual phase of development • Puberty – appearance of 2° sexual characteristics • • • Developmental Task: School, Learning the 3 R’s Peers: same sex, same age, normal sexual phase Identification with people outside of the family Genital Phase • Begins with puberty • Capacity for object love and mature heterosexuality • Concerned primarily with love object • Longest stage of development, but not the most important (1 st 6 years of life, oral, anal & phallic phases) • Most important event: Final resolution of Oedipus Complex, results in mature heterosexuality • Mature ego: when ego is performing its job very well, thinking, emotions, reality testing, doing job well • Mature Super ego: uses guilt & shame ➔ drives you to doing the appropriate behaviour E. Personality Disorders ¤ An inflexible, pervasive pattern of self-perception and behaviour that deviates markedly from ones usual culture ¤ DSM –IV-TR: enduring subjective experiences and behaviour that deviate from cultural standards, are rigidly pervasive, have an onset in childhood, adolescence or early adulthood, are stable through time, and lead to unhappiness, distress and impairment. ¤ Traits – are characteristic personality ¤ Characteristics: ¢ Alloplastic o Able to adapt, to alter or to manipulate the external environment ¢ Ego-syntonic o Being acceptable to ego, happy about their personality disorder ¤ Etiology ¢ Genetic Factors (can inherit disorders) ¢ Biological Factors o Hormones: high levels of testosterone, 17-estradiol and estrone links to impulsive traits o Platelet Monoamine Oxidase: low levels associated with schizotypal o Neurotransmitters: high endogenous endorphins maybe associated with persons who are phlegmatic o Electrophysiology: changes in the electrical conductance on EEG, common in antisocial and borderline types appearing as slow-wave activity ¢ Psychoanalytic Factors o Oral character: passive and dependent o Anal character: stubborn, parsimonious and highly conscientious o Disorder Paranoid Schizoid Schizotypal Disorder Antisocial Borderline Histrionic Narcissistic Reich’s character of armor: defensive styles for protecting themeselves and from internal impulses and from interpersonal anxiety on significant’s relationship CLUSTER A Odd, Eccentric disorders, Weirdo, Pre-psychotic Characteristics Essential Features Distrust: persistent suspiciousness, A pervasive distrust and suspiciousness of others secretive, withholding, hypervigilant, such that their motives are interpreted as jealous, envious, suspects without malevolent, beginning in early adulthood and sufficient basis that others are present in a variety of contexts exploiting, harming or deceiving them Social detachment: self-absorbed; A pervasive pattern of detachment from social restricted emotionality; cold and relationships and a restricted range of indifferent; neither desires nor enjoys expression of emotions in interpersonal settings, close relationships; anhedonic, beginning in early adult-hood indifferent from others; less disturbed than Schizotypal Interpersonal deficits; cognitive A pervasive pattern of social and interpersonal distortions; eccentricities; paranoid; deficits marked by acute discomfort with difficulty feeling understood and disorder and reduced capacity for close accepted; odd beliefs, magical relationships and by cognitive and perceptual thinking, unusual perceptual distortions and eccentricities of behaviour, experiences; social isolation beginning in early adulthood and present in a variety of contexts CLUSTER B Dramatic, Emotional, Erratic disorders, OA Characteristics Essential Features Disregard for rights of others; lies; manipulates; exploitive; seductive; repeatedly performs acts that are grounds for arrest Instability; impulsivity; hypersensitivity; self-destructive behaviour; profound mood shifts; unstable and intense interpersonal relationships Excessive emotionality; attention seeking, superficial and stormy relationships; lively; uncomfortable when not the center of attention. Arrogance; need for admiration; lack of empathy; seductive; socially exploitive; manipulative; grandiose sense of selfimportance A pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years A pervasive pattern of instability of interpersonal relationships, self-image, & affects, & marked impulsivity beginning by early adulthood & present in a variety of contexts A pervasive pattern of excessive emotionality and attention-seeking, beginning by early adulthood and present in a variety of contexts A pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration, and lack of empathy beginning from early adulthood and present in a variety of contexts. Disorder Avoidant Dependent Obsessivecompulsive disorder CLUSTER C Anxious, Fearful disorders, easily upset Characteristics Essential Features Social inhibition; withdraw from social and A pervasive pattern of social inhibition;, occupational situations that involve feeling if inadequacy, and significant interpersonal contact; longs for hypersensitivity to negative evaluation, relationships; inadequacy; hypersensitivity beginning by early adulthood and to negative criticism, rejection or shame present in a variety of contexts Submissive behaviour; low self-esteem; dependency in relationships; extreme selfconsciousness; urgently and indiscriminately seeks another relationship ends; inadequate; helpless Unable to express affection; overly cold and rigid; crippling preoccupation with trivial detail, orderliness, perfectionism & control(attend to rules, list s organization, schedules, to the extent that the major point of activity is lost); superior attitude Management: Psychotherapy – between treatments A pervasive & excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation, beginning by early adulthood & present in a variety of contexts A pervasive pattern of preoccupation with orderliness, perfectionism & mental & interpersonal control at the expense of flexibility, openness & efficiency, beginning by early adulthood & present in a variety of contexts. UNIT III – PSYCHOPATHOLOGY (Study of mental illness) A. Etiology of Mental Disorders œ Biological – Infections, heredity, trauma, ageing œ Psychological – Interpersonal problems œ Socioeconomic – Poverty, malnutrition œ Spiritual – Possessions, etc. œ Usually, there’s no single cause, most likely a combination of 2 etiologies B. Symptomaotology œ All 7 are ego functions, if disturbed, mental illness is possible 1. Thinking a. Form Autism – self-centered thinking Schizophrenia Dereism – out of this world thinking, unrealistic b. Flow Incoherence – thinking cannot be understood, not logical, can be organic (from the brain) or schizophrenia Flight of Ideas – connected with one another but said at the same time, very talkative; Bipolar Manic (very talkative), Bipolar Depressed (doesn’t talk at all) c. Content Delusion – false fixed beliefs, you don’t want to give it up (those beliefs) ➢ Delusion of Persecution – thinking that other people are talking about you (produced by drugs) Delusion – name of symptom Paranoia – name of disease, severe mental illness ➢ Grandeur – thinking that you are more handsome / superior than others ➢ Obsession – thinking of the same thing over and over again, you dream about it, you can’t drive the thought away, it distracts you and your concentration ➢ Pre-occupation – thinking of the same things, but you can drive it away, you are not distracted by 2. Perception Illusion – external stimulus present, distortion of perception Hallucination – no external stimulus, but there is distortion of perception FOR HALLUCINATION Visual Delirious patients (DKA, organic, alcoholics undergoing withdrawal) Auditory Schizophrenic patients (hallucination) Olfactory VERY SEVERE mental illness, because these are the most basic senses (in cl ud in g Gustatory tactile) Very common in alcoholics undergoing withdrawal Tactile 3. Affect / Emotions Positive (+) Affect / Pleasurable ➢ Euphoria – Mild exaggeration of affect, from euphorian drug ➢ Elation – Most severe form of affect, Bipolar Manic – very happy / high ➢ Exaltation – Elation + high position (feeling on top of the world) ➢ Ecstasy – Elation + a feeling of sexual satisfaction Negative (-) Affect / Non – pleasurable ➢ Anxiety – Produced by internal factors, different from fear, which Is a normal reaction & objective ➢ Depression – abnormal sadness for >6 months; Normal = grief / mourn ➢ Inadequate ➢ Inappropriate 4. Memory Mnesia – root word meaning memory or remembrance Amnesia – loss of memory, 1 st stage of Alzheimer’s disease (not curable & hereditary), the more recent memory loss, the worse the condition Hypermnesia – excessive memory, photographic, girls have better memory than boys Paramnesia – distorted memory (De ja vu) 5. Orientation – state of awareness to time, place, person → none of these = disorientation 6. Personality 7. Intelligence Below Average: <90 Mental Retardation: <70 Average: 90 – 110 Genius: >140 Above Average: 111 – 139 C. Evaluation / Assessment 1. Psychiatric Interview (done by doctors) 1.1 History (ID data, CC, HPI, Past, Family, Personal & Social Histories) ➢ Make the patient feel comfortable, don’t stay close (at least 3 feet away), develop trust to gain more information, know the story of the patient, usually takes at least 1 HOUR ➢ Personal hx – biography / life story, longest part, includes pre-morbid personality (before consultation) 1.2 Physical Exam & Nuerological Exam (refer to Bate’s) 1.3 Mental Status Examination (assessed as POOR, FAIR, GOOD) a. Appearance – describe the appearance of the patient, clean, dirty, sick, etc. b. Interview Behaviour – smiling or not c. Mood & Affect – happy, sad, angry, etc. d. Sensorium, Mental grasp & capacity – orientation, time, place, person e. Memory & Thinking Recent memory Abstraction ability – highest mental function, similarity test (if answer is concrete, there’s something wrong) or proverb interpretation f. Insight & Judgement Judgement – give a problem and judge the answer Insight – self awareness 1.4 Diagnosis 1.5 Treatment Plan 2. Psychological Testing (done by psychiatrists) UNIT IV – PSYCHIATRIC DISORDERS IN CHILDREN & ADOLESCENCE Childhood Disorders in Psychiatry 1. Autism Spectrum Disorders ¤ Autistic Disorder / Infantile Autism – most common among the spectra ¤ Does not know how to relate to others; Very bright ¤ Starts even at babies, they don’t want to be held, they don’t want connection, they don’t want to look at you Tx: none, Play therapy – for children, since they cannot talk very well Best Instrument: DOLL HOUSE (dolls would represent different people, mom, etc.) Other toys: sandbox, scrabble, simple games, table games 2. Attention Deficit / Hyperactivity Disorder (ADHD) ¤ Most common among disorders in children ¤ Usually seen in males during elementary school (when symptoms usually begins to show) ¤ Attention deficit / hyperactivity ➔ 2 types, usually combined ¤ Cannot pay attention, hyperactive, walk around the classroom ¤ If not treated, they will develop Conduct Disorders (alcohol & drug abuse) CONDUCT DISORDERS Don’t attend classes ➔ Juvenile Delinquency ➔ Anti – social Personality Disorder Tx: Hyperactive – Methylphenidate (Ritalin) Atomoxetine Coffee – let the child drink coffee before going to school, in ADHD, a stimulant can have a depressant effect 3. Post – Traumatic Stress Disorder ¤ Younger than 6 y.o ¤ Victims of disasters and child abuse 4. Specific Learning Disorders ¤ Reading, Writing, Arithmetic ¤ When they go to school 5. Eating Disorders ¤ Pica ¤ Rumination (Vomit, eat vomit, vomit, eat vomit, cycle goes on) 6. Internet Gaming Disorder 7. Intellectual Disability in DSM V (5) ¤ Mental Retardation (17% in the Philippines) Mechanical Classification (IQ) Educational Classification Mild 50 – 70 Educable Mild, can reach up to 2 nd year HS / Grade 8 Brainable Moderate, can reach up to Grade 6 (Down Moderate 25 – 50 Syndrome) 20 – 35 Severe Profound <20 Severe, Profound ¤ Most Common: Down Syndrome / Trisomy 21 / Mongolism Short, chubby, chinky eyes, flat nose, narrow forehead ¤ Causes: Prenatal ➢ If mother will have infection (e.g. Rubella) ➢ Age of mother (chances of having a mentally ill baby s as you age) ➢ Drugs taken by the mother, including alcohol ➢ Malnutrition Perinatal ➢ Prolonged delivery / Anoxia ➢ Accidents during delivery (e.g. infant fell into the trash bin) Postnatal ➢ Infection, trauma ➢ Lack of intellectual stimulation (e.g. child living in the mountainous areas, no proper education, etc.) ¤ Management of MR – SPEd ( Special Education) EXAM POINTERS Unit I 5 questions Unit II 30 questions (9 from psychoanalytic table) Unit III 6 questions Unit IV 9 questions Total 50 questions PSYCHIATRY RECALLS 1ST EXAM 1. The promotive and preventive aspect of mental hygiene includes? • Dissemination of knowledge regarding mental health to the general public 2. The most basic defense mechanism according to Freud, is: • Repression 3. Hereditary and genetics is an example of which cause of mental health? • Biological 4. Which criteria of mental health is considered the least important? • Constant Happiness 5. Which of the following is an example of repression? • Forgetting bad memories or current thoughts that cause anxiety 6. (NONE) 7. What is a defense mechanism? • A mechanism designed to remove stress and conflict 8. MATCHING TYPE • Mental Health Law – R.A. 11036 • Magna Carta for disabled person – R.A. 7277 9. Which of the following is a warning sign of mental illness? • Alcohol and Drug abuse 10. Ramon, a 42 yr old, married, bank employee, having a problem with his immediate supervisor for the last six months, he began to have insomnia, loss of pleasure and poor appetite. Lately he began thinking of suicide. The best thing to do is? • Consult a psychiatrist 2ND EXAM (October 30, 2020) 1. A man troubled by homosexual urges starts a very active community campaign to remove gay bars. • Reaction formation 2. A woman harassed by her boss in the office, argues and quarrels with her husband at home. • Displacement 3. A smoker concludes that the evidence linkin cigarette use to a health problem is scientifically worthless. • Denial 4. Juan, an aggressive boy by nature, engages himself in playing vigorous sports, like basketball. • Sublimation 5. Boyet at age 3 years, continues to talk like a baby • Fixation 6. Carla admired her older sister Mary. She assumed some of the mannerisms of her sister. • Identification 7. An expansionist-minded dictator of a totalitarian country is convinced that neighbouring countries are planning to invade his country. • Projection 8. A 25 year old male make three complete turns around the breakfast table. He says he is reminded of the death of his father. • Undoing 9. Fred, a shy boy in class, excels during examinations. • Sublimation 10. A 23-year-old man whose self-esteem has been shot down exhibits his penis to young girls. • Regression 3rd EXAM (November 23, 2020) 1. Identify the age in which of the following events occurs – Beginning independence from family. • Genital 2. The SuperEgo • Is derived from the ID in early infancy 3. Consistent and affectionate maternal behavior during infancy provides the child with a continuing sense of? • Trust 4. The parents of a 26 year old woman say that they are concerned about her because she has no friends and spends most of her time hiking in the woods and working on her computer. The doctor examines her and finds that she is content with her solitary life and has no evidence of thought disorder. • Dependent 5. Identify the stage in which of the following events occurs – MATURE HETEROSEXUALITY • Genital 6. A 38 year old man asks his doctor to refer him to a physician who attended a to a top-rated medical school. He says that he knows the doctor will not be offended because she will understand that he is “better” than her other patients. • Paranoid 7. Identify the stage in which of the following evens occurs. – PERMANENT RESOLUTION OF OEDIPUS COMPLEX. • Genital 8. The adult is expected to: • (AOTA) i. Handle problems realistically ii. Have a meaningful relationship with others iii. Have a job 9. All of the following traits are characteristic of the anal character, EXCEPT? • Punctuality 10. Identify the stage in which of the following events occurs: MOST QUIET STAGE • (NOTA) i. Genital ii. Anal iii. Latency iv. Oral v. Phallic 11. A 22 year old medical student is unable to stop studying until she has memorized the entire set of notes for each of her courses. Making comprehensive lists of all the subjects she must study also takes up her study time. Because of this, she is constantly behind of her work and in danger of failing her courses. • Obsessive-compulsive 12. The principal psychological task of infancy is: • The formation of an intimate attachment to the mother. 13. Identify the stage in which of the following events occurs: TRUST FORMATION IS THE DEVELOPMENT TASK • Oral 14. Identify the stage in which of the following events occurs: FORMATION OF SELF-IMAGE IS A DEVELOPMENT TASK • Oral 15. SuperEgo • (NOTA) i. Serves as reservoir of biologic drives ii. One that punishes and rewards iii. Integrator of the personality iv. Interacts with the outside world 16. Which of the following statements concerning the EGO is NOT TRUE? • Some ego functions are unconscious, some are not 17. Identify the stage in which of the following events occurs: INTERNALIZATION OF THE SUPEREGO • Anal 18. Identify the stage in which of the following events occurs: IDENTIFICATION IS THE MOST IMPORTANT • Oral 19. Identify the following events occurs: - A METICULOUS, THRIFTY AND ORDERLY ADULT • Genital 20. Freud’s topographical theory deals with • (AOTA) i. Object relations ii. ID, EGO, SuperEgo iii. Erogenous Zones iv. The Unconcious v. Infantile sexuality 21. The Oedipus complex is a concept introduced by? • S. Freud 22. Identify the stage in which of the following events occurs: STAGE OF DEPENDENCY • Oral 23. About a week after her final exams in biochemistry, a medical student’s knowledge about the Kreb’s Cycle is most likely to reside in her: • Preconcious Mind 24. The Ego seeks to achieve and maintain a homeostatic state by: • (AOTA) i. Mediating between external reality and internal demands ii. Mediating between ID demands and SuperEgo standards. iii. Using defense mechanisms 25. Personality development is largely shaped by: • (AOTA) i. Genetic accidents ii. Cultural stereotype iii. Frustration Tolerance iv. Childhood experience 26. The latency period is characterized by: • (AOTA) i. Need for the peer group ii. Normal quiescence of the drives iii. Normal homosexual relationships 27. Identify the stage in which of the following events occurs: AN ADULT WHO TAKES BUT DOES NOT GIVE • Oral 28. What is the ID? • A description of innate instinctual needs 29. Identfy the stage in which of the following events occurs: TASK IS TO RESOLVE AMBIVILENCE TOWARDS MOTHER • Phallic 30. Identify the stage in which of the following events occurs: STAGE OF SECONDARY SOCIALIZATION • Latency 31. According to the psychoanalytic approach, an attempt to integrate values learned from parents and society is called? • The SuperEgo 32. Identify the stage in which of the following events occurs: HISTRIONIC PERSONALITY IS FIXATED • Phallic 33. Identify the stage in which of the following events occurs: EXTERNAL SUPEREGO • Latency 34. Identify the stage in which of the following events occurs: THE ID EXERTS A STRONG FORCE • Phallic 35. Identify the stage in which of the following events occurs: STAGE OF TOILET TRAINING & DISCIPLINE • Anal 36. All of the following are true about latency. EXCEPT? • Girls begin to identify with their mothers 37. Which of the following develops first in the infant? • Core gender identity 38. Which of the following structures of the mind work on an unconscious level? • The ID, EGO and SuperEgo 39. A 15 year old steals from family members and friends. When no one is watching, he also tortures the family cat. Which aspect of mind is deficient in this teenager? • The Concious mind 40. Identify the stage in which of the following events occurs: STAGE OF FRIENDSHIP • Latency 41. The term that describes all the rational aspects of the human personality is called? • The Ego 42. All of the following characteristics are typical of the oral personality, EXCEPT? • Stubbornness 43. Identify the stage in which of the following events occurs: STAGE OPF PEER-GROUP FORMATION • Latency 4th EXAM (January 11, 2021) 1. A 27-year-old man comes complaining that his thoughts are being controlled by the CIA. Such thinking is: • Delirious 2. An Interviewer asks what the similarity is between a chair and a table. The interviewee replies that both have legs. This response is an example of? • Concrete Thinking 3. A delusion of persecution is produced by what defense mechanism? • Projection 4. In Documenting the mental status exam, all will be reported EXCEPT? • Sleep patterns 5. “Tell me more about your marriage is an example of which type of question?” • Open-Ended 6. Sensory experiences in the absence of external stimuli are called? • Hallucinations 7. Obsession is defined as: • Persistent thoughts, Impulses and images that are experienced causing distress 8. (NONE) 9. An abnormal sense of well-being is known as? • Euphoria 10. A delusion is? • A false belief not in accord with a person’s culture and intelligence 11. Compensating for loss of memory by fabrication, distortion and untruth is called? • Confabulation 12. When she gets into her house, she prepares a meal but later phones the police to complain that the neighbours are poisoning her food. Her Behavior is a manifestation of? • Delusion 13. Patients are asked to interpret proverbs to test: • Abstract thinking 14. In disorder of orientation, the impairment that is first to go and the last to return is orientation to? • Time 15. The state of awareness of one’s self and one’s surrounding in terms of time, place and person is called? • Orientation 16. Average intelligence is the I.Q. range • 90-110 17. All of the following ae characteristics of a paranoid personality disorder, EXCEPT? • Reluctance to seek treatment 18. Borderline personality disorder manifest all of the following characteristics, EXCEPT? • (AOTA) i. Identity diffusion ii. Below-average intelligence iii. Manipulative Behavior iv. Unpredictability 19. The etiology of personality disorder has been attributed to? • (AOTA) i. Social deprivation ii. Psychological trauma during infancy and early childhood iii. Pathological style of family interaction iv. Biological abnormalities 20. As she walks home at night, an elderly woman becomes convinced that those shadows moving under her neighbour’s tree are really watching man. Her Belief is based on? • Hallucination
