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Basics of Assessment
Assessment: Process of gathering information about symptoms and possible causes
.Also: Current symptoms, ways of stresscoping, recent events, substance abuse
cognitive functioning, sociocultural background.
Diagnosis: Label for a set of symptoms
Assessment Tools
5. Orientation to place, time, person.
Structured interview: Format and sequence of questions is standardized
Self-monitoring: Individuals keep track of the number and circumstances in which a specific
behaviour occurs (eg. Alcohol use)
Computerized tomography CT:
- Function: Narrow X-Ray beams pass through head in diff. angles. Amount of absorption
of each beam is measured à slice of brain
- Limitations: X-Ray
Image of brain structure, not activity
Positron-emission tomography PET:
- Function: Injection of radioactive isotope (eg. Fluorodeocyglucose FDG).
à accumulates in active parts of brain. Isotop decause, emits positrons which
collide with electrons. Both get annihilated à into photons.
Scanner detects photons at point of annihilation
- Limitation: Immage
- Variation:
Single photon emission computed tomography SPEC: Different tracer substance
à less accurated / expensive
Magnetic resonance imaing MRI fMRI:
- Advantages: No radiation, detailed pictures, any angle,
Structural MRI: Static image of brain structure
Functional MRI: Brain activity
- Function: Creates magnetic field, Hydrogen realigns. On/Off à hydrogen changes position
and emit magnetic signals
Electroencephalogram EEG:
- Function: Measures electrical activitiy on scalp, (firing of neurons below)
Measure reponse to stimuli. Evoked potentials, event-related potentials
- Use: To detect seizures, tumors, strokes.
Lie detector:
- Function: Measures electrodermal response (electrical conductivity on the skin)
Challenges in assessment
- Major difference of cultures: Reporting symptoms of psychopathology in emotions or
somatic (physical) symptoms.
Diagnosis
- Label for symptoms
- Cultural variation in symptoms and presentation (emotional, somatic)
Syndrome: Several symptoms form a syndrome
- are not list of symptoms that occur in all disorders but co-occur
Classification System: Set of syndromes and rules of determining if patients symptoms are
part of this set.
Diagnostic and Statistical Manual of Mental Disorders, DSM: APA
International Classification of Disease, ICD: Rest of the world
Reification of diagnoses: People tend to see it as real and existing, rather than a concept
made out of judgement.
Comorbidity: Criterias for one disorder are present in other disorder and lead to confusion
which disorder is actually present (eg Schizophrenia/Depression and irritability)
à not preventable because symptoms reflect problems in fundamental human
experience (sleep, emotion, cognition)
à Leads to several diagnosis (primary/secondary) and problem with which to
deal first
à nonaxial approach: - To be more in line with ICD-System published by WHO
- Axes I-III integrated in overall diagnostic scheme
- Former Axes IV-V are no longer diagnostic criteria
à To provide index of global functioning, use WHODAS
à WHO Disability Assessment Schedule
- Benefits: Good communication between clinicians, facilitates research by standardization.
Fight or flight response:
PTSD: Result of experiencing expreme stress, traumatic experiences
à death, injury, sexual abuse
- women greater risk than men (gender related cultural experiences)
- Withdrawal from activies that resemble event
- Memory amnesia of details from event
- Hypervigilance, chronic arousal
- 20% of Vietnam veterans
- 50% of sexual assault develop it
Accute Stress Disorder /PTSD with prominent dissociative (depersonalization/derealization) symptoms
- Symptoms within 1 month after stressor and duration of symptoms = 4+ weeks
- Flashbacks, nightmares
- dissociative symptoms: Feeling that everything is unreal, a dream.
Theory of PTSD:
- Predictors: Severity, duration, proximity, social support
- Chronic exposure to straining situations
- Maladaptive coping styles (dissociation)
- Culture influences manifestation: e.g. attaque de nervios
Biological:
- PET + MRI Scan = different brain activity (fight or flight), amygdala, hippocampus, PFC.
à bad emotion regulation, overexposure to neurotransm. = shrinkage of hippocampus à bad sympathicus
regulation.
- Cortisol: Usually high levels à higher stressresponse, more time spend in reaction
- Higher neurotransmitter use: epinephrine + norepinephrine. à HPA axis cant shut down
- Genetics: Low cortisol is heritable
Treatment of PTSD:
CBT:
- systematic desensitization
- integration of events in self-concept
stress-inoculation therapy: Therapist helps to cope with other problems that increase stress. à when
client is unable to expose to stimulus
Drugs:
- SSRI
- Benzodiapezines
Specific Phobia: Irrational fear towards specific object or situations à most common disorder
- 5 cathegories: animal, environment, situational, blood-injection-injury, other
Agoraphobia:
- Fear places where one cannot escape from or has trouble finding help
- Fear that others can see nervousness or embarrass oneselve during panic attack.
- more women than men. Start at early 20s.
Theories of Phobias:
- Freud = unconscious anxiety is displaced onto neutral object.
- Behavioural: - classical conditioning leads to fear, operant conditioning maintains it. Negative reinforcement
- prepared classical conditioning: Through evolutionary past. Conditioning can occur faster
- Biological: First degree realtives = 4-5x more likely
Treatment for Phobias:
- Behavioural: systematic desensitization, modelling, flooding (injection inj. Blood= teach to rise blood pressure)
à applied tension technique
- Drugs:
- Benzodiapezines
Social Anxiety Disorder
- anxious and avoidant of social situations – fear of embarrassment, humiliation
à somato experiences of stress à evtl panic attack
- women more than men
- develops in adolescence
- Many comorbid disorders – Mood + other anxiety disorders
Theories of Anxiety Disorder:
- Genetic component
- Cognitive perspective: irrealistically high standards for social performance, focus on negative aspects, self-evaluating
misinterpret everything in a self-defeating way, attention on own body sensations, ruminate
Treatment of Social Anxiety Disorder:
- SSRI
- SNRI
- CBT: exposure, relaxation, challenge beliefs, group therapy?
- Mindfullnes based: less judgement
- ACT: Acceptance and commitment
- Future: Virtual reality exposure
Panic attacks: Short period of extreme physical stress response without environmental trigger or with specific trigger
- 28 percent of adults at one time
- Fear of life threatening illness or to go crazy
- Co-occurrence with other disorders
Theory of Panic Disorder:
- Biological:
- Heritability 50 %
- Poor regulation of neurotransmitters à flight or fight response is poor
- General arousal can trigger panic attacks
- Dysregulation of neurotransmitters in the locus ceruleus: Can cause panic attacks cause connected to limbic system
- Occurs postpartum or premenstrual periods
- Cognitive:
- Focus on bodily sensations
- Misinterpret these
- Engage in snowball catastrophic thinking
- anxiety sensitivity: belief that bodily symptoms have harmful consequences
- interceptive awareness: awareness of bodily cues
- interoceptive conditioning: bodily cues occurred at beginning of previous panic attack are now a cue.
even if not conscious
- felt controllability decreases risk of panic attack
Treatment for Panic Disorder
- Drugs:
- SSRI
- SNRI
- Benzodiapezines à influence GABA
- CBT:
- 1. Relaxation techniques
- 2. Identification of cognitions
- 3. Practice relaxation techniques during experience of symptoms with therapist
- 4. Challenge of catastrophizing cognitions
- 5. Systematic desensitization
- 90 % relief after 12 weeks
GAD: Excessive worry
- more women than men
- mostly chronic
- beginning in childhood or adolescence
- goes with comorbid disorders
Theories of GAD:
- Cognitive:
- experience more intense negative emotions
- highly reactive to negative events
- feel that emotions are not controllable
- chronicically high stress levels
- maladaptive cognitions
- hypervigilant
- experienced high stress in past that was uncontrollable
- cognitive avoidance model: worrying helps them to become aware of threats. This constant level of anxiety is better
than a sudden jump in anxiety and reduces reactivity to negative events
- Biological:
- Higher general activity of sympathetic system
- Abnormality in GABA regulation (lack of thought inhibition)
- heritable
Treatments of GAD:
CBT:
- Challenge of cognitions
- Development of coping strategies
Drugs:
- Benzodiapezines
- Tricyclic antidepressants
- Occurs most often in childhood
- physical symptoms in abdomen, nightmares, crying
Theories of Separation Anxiety:
Biological:
- heritable. Behavioural inhibition: shy, fearful, irritable, cautious, quiet, introverted children
Psychological:
- Controlling and intrusive parents, + critical and negative
- Give little control to children
Treatment for Separation Anxiety:
- Coping skills
- Relaxation techniques
- Parents need to learn it as well, also to teach their children
Drugs:
- Antidepressants
- SSRI
- Antianxiety: Benzodiapezines
- Antihistamines
Compulsion: Repetitive acts that the individual “must” perform to get rid of obsessions or bad feelings
Obsession: Intruding and disturbing thoughts (mostly aggressive, sexual, religious) (magical thinking)
3 types: sexual-aggressive, order-symmetry, contamination
subtypes: hoarding, hair-pulling, skin-picking, body dysmorphic disorder.
- Begins at young age
- Comorbid disorders: Panic attacks, phobias, substance abuse.
Hoarding: cant throw away possessions, emotionally related to them (delusions)
Hair pulling: relive of tension or pleasure. Automatic
Body dysmorphic disorder: believe part of body is defective, preoccupied with hiding this. Bizarre, surreal.
Theory of OCD:
- Circuit in the brain: PFC à Basal Ganglia (striatum) à Hypothalamus à PFC
- Hippocampus
à inable to turn off primitive impulses
- Children: Strep infection
- genetical components
Cognitive theory:
- inability to control or disregard thoughts
- Rigid, moralistic thinking
- feel very responsible for everything
- Belief they should be able to control every thought
- Convulsions develop through operant conditioning
Treatment of OCD:
- Drugs:
- Antidepressants: SSRI
CBT:
- exposure and response prevention: expose clients to stimulus but prevent response. Habituation.
- Challenge negative cognitions à 60-90% success
- habit reversal training: become aware of unhealthy behaviour, replace with more healthy one
Je vertrek voorbereiden of je verzekering afsluiten bij studie, stage of onderzoek in het buitenland
Study or work abroad? check your insurance options with The JoHo Foundation
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