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72 Cards in this Set
- Front
- Back
What are the key features of the psychiatric functional inquiry?
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Mood
Anxiety Psychosis Suicide / Homicide Organic |
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What must you include in past psychiatric Hx?
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Previous psychiatric diagnoses
Contact with psychiatrists Treatments Hospitalisations Suicide Attempts |
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What are the 5 axes of diagnosis?
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I - DSM-IV Disorders
II - Personality Disorders + Mental Retardation III - General Medical Conditions IV - Psychosocial Issues V - Global Assessment of Function (GAF) |
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What are the features of the MMSE?
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Orientation, memory, attention & concentration, language, spatial ability
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How is MMSE interpreted?
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<24/30 abnormal
20-24 mild cognitive dysfunction 10-19 moderate <10 severe |
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What is psychosis?
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Significant impairment in reality testing. Evidence:
a) Delusions or hallucinations without insight into their pathological nature b) Disorganised behaviour |
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What are the common Ddx for psychosis?
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General Medical Condition
Affective disorder Drug/EtOH intoxication/withdrawal Personality disorder Psychotic disorder (e.g. Schizophrenia) |
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How long must person have psychotic symptoms to be diagnosed with Schizophrenia?
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1 month
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What are the subtypes of Schizophrenia?
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Paranoid
Catatonic Disorganised Undifferentiated |
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What are the key features of the MSE?
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Appearance
Behaviour Conversation Mood Affect Thought Process (TP) Thought Content (TC) Perception Cognition Insight Judgment |
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What are the negative symptoms of schizophrenia?
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Affect flattening
Alogia Avolition |
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What is necessary for the diagnosis of schizoaffective disorder?
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At least 2 weeks of psychotic features without prominent mood symptoms.
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What are the major mood disorders?
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Depression
Bipolar I & II |
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What must be included in the medical workup of mood disorders?
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Physical Examination
CBE, TSH, electrolytes Urinalysis, urine drug screen |
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What are the risk factors for depression?
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Female
Age 25-50 FHx depression EtOH abuse Early childhood losses Recent stressors Social isolation |
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What are the anxiety disorders?
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Panic disorder +/- agoraphobia
Generalised Anxiety Disorder Simple phobia Social Phobia Obsessive Compulsive Disorder Post-Traumatic Stress Disorder |
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Important medical Ddx of anxiety?
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Hyperthyroidism
Pheochromocytoma Hypoglycaemia (DM) Arrhythmia Asthma Drug / EtOH intoxication/withdrawal Myocardial Infarction |
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How long does it take for a panic attack to peak?
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10 minutes
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How does one distinguish OCD from OC Personality Disorder?
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OCD is ego-dystonic
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What are the 3 C's of substance dependence?
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Compulsive use
(loss of) Control Consequences of use |
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What is the CIWA-A protocol?
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A scoring system to monitor the management of AWS. Includes assessment of:
Nausea / vomiting Tactile, auditory & visual disturbances Tremor Agitation, sweats, anxiety Headache Orientation |
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Which medication is commonly used to treat EtOH withdrawal?
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Benzodiazepine (e.g. Diazepam)
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Which vitamin is commonly administered in the management of EtOH withdrawal?
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Thiamine (Vitamin B1)
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What is the treatment for toxic reaction to opioids / opioid OD?
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ABC's
IV glucose Naloxone Intubation + Mechanical Ventilation |
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What are some drugs of abuse that are screened for?
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MDMA ("Ecstasy" "E")
GHB Ketamine Methamphetamine THC |
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What is important in the assessment of suicidality?
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Suicidal ideation
Intent / Plan Past attempts Lethality of past attempts |
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What are key features of anorexia nervosa?
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Refusal to maintain body weight at or above minimally normal weight for age
Intense fear of gaining weight Disturbance in perception of one's body weight Absence of >/= 3 menstrual cycles |
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What are the key features of bulimia nervosa?
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Recurrent episodes of binge eating and inappropriate compensatory behaviour (i.e. purging)
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What are three components of autism?
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Impaired social interaction
Delay in communication skill development Restricted and repetitive behaviours |
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What are the side effects of "typical" antipsychotics?
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Sedation
Cardiovascular Anticholinergic & Antiadrenergic Movement disorders Neuroleptic Malignant Syndrome (NMS) Extrapyramidal side effects |
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What are the features of Neuroleptic Malignant Syndrome?
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Fever
Autonomic changes Rigidity of muscles Mental status changes |
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What are the four types of Extrapyramidal side effects?
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Dystonia
Akathisia Pseudoparkinsonism Dyskinesia |
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How might tardive dyskinesia present?
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Involuntary:
Grimacing, Tongue Protrusion, Lip Smacking, Rapid Eye Movement |
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What needs to be done for a patient on clozapine?
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Weekly blood counts for 1 month, then every two weeks after.
Why? Risk of agranulocytosis. |
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What are the symptoms of Serotonin Syndrome?
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Nausea, diarrhoea, palpitations, chills, restlessness, confusion, and lethargy.
CAN PROGRESS TO: Myoclonus, hyperthermia, rigor & hypertonicity. |
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What are the side effects of Lithium?
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Leukocytosis
I (diabetes) Insipidus Tremor, Teratogenicity Hypothyroidism Increased weight U(vomiting & nausea) Misc. (ECG changes, acne) |
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Which benzodiazepines are appropriate for the geriatric population & why?
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Lorazepam, Oxazepam & Temazepam because they are not metabolised in the liver.
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What do you understand by the term "Major Depression"?
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5/9 for 2/52
Behaviour change (psychomotor retardation / agitation) Appetite (decreased / increased) Depressed mood - persistent & pervasive Concentration difficulties Ruminations Interest/pleasure (loss of) anhedonia Sleep disturbance Energy (loss of) Suicidal Ideation |
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What do you understand by the term "Melancholic Depression"?
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Anhedonia
Retarded or agitated Anorexia Non-reactive Mood Guilty ruminations Diurnal mood variation Distinct quality of mood |
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What do you understand by the term "Dysthymic Disorder"?
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Most days for 2 years depressed mood for most of the day.
Never absent for >2/12 |
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What do you understand by the term "Double Depression"?
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People with dysthymic disorder who occasionally lapse into a MDE, then when MDE resolves return to chronic dysthymic state
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What do you understand by the term "Bipolar Mood Disorder"?
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BPAD I - 1 or more manic / mixed episodes with or w/o MDE.
BPAD II - at least 1 MDE and at least 1 hypomanic episode, no past manic / mixed episodes. |
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What do you understand by the term "Bipolar Spectrum Disorder"?
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Does not meet DSM-IV criteria for BPAD I or II but exhibit cyclothymia (cyclical changes in mood).
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What do you understand by the term "Schizoaffective Disorder"?
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Psychotic symptoms for the majority of 1/12
AND at least 1 MDE, manic / mixed episode MUST have had psychotic symptoms present for at least 2 weeks w/o prominent mood Sx |
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What do you understand by the term "Mania"?
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>1/52 abnormally elevated, expansive or irritated mood
Distractibility Indiscretion Grandiosity Flight of Ideas Activity Increased Sleep (decreased need for) Talkativeness (pressured speech) |
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What do you understand by the term "Hypomania"?
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As mania BUT is NOT severe enough to cause a marked impairment in social or occupational functioning
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What do you understand by the term "Psychotic Depression"?
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One of the most SEVERE forms of depression in which person experiences psychotic symptoms (usually paranoid / mood-congruent delusions & hallucinations)
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What do you understand by the term "Mood Congruent Delusions"?
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Delusional content is consistent with mood.
e.g. Depressed "world is ending" Manic "possess magical talents or abilities" |
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What are the risk factors for suicide?
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Sex male
Age 15-24, 75-84 Depression (45-70% of all attempts) Previous attempts Ethanol abuse Relationship issues Social support lacking Organised plan No spouse Sickness Psychosis with demand hallucinations Hopelessness a better indicator of suicide than mood |
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What are the symptoms associated with suicide?
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Hopelessness
Anhedonia Severe anxiety, panic attacks Sleep disturbances Impaired concentration Psychomotor agitation |
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How do you assess suicidal intent?
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Risk factors
Onset Precipitating, aggravating, relieving factors Frequency of thoughts How much control of thoughts What keeps them alive |
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How do you assess suicidal lethality?
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Access to means e.g. firearms, hanging, gases, drugs
Funeral plans Practised suicide Changed life-insurance / will Given away possessions |
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How do you manage the suicidal patient?
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<3 RF consider sending home with family.
>3 RF hospitalize 1. Make the patient feel safe 2. OACIS, case notes & collateral Hx to determine previous Mental Illness. 3. If attempt has been made, attend to medical consequences 4. Define stressors 5. Arrange inpatient treatment +/- detainment 6. Suicide is a Sx of mental illness, treat underlying illness & Sx will resolve. |
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Name 4 current antipsychotic medications + commonly used dosages.
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Risperidone (2-8mg)
Quietapine (300-900mg) Olanzapine (10-20mg) Clozapine (200-600mg) |
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Name 3 common long lasting antipsychotic depot injections + commonly used dosages.
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Haloperidol decanoate (25-300mg 4 wkly)
Risperidone (25-50mg 2 weekly) Zuclopenthixol decanoate (200-400mg 4 weekly) |
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Immediate acting depot injection + dosages.
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Zuclopenthixol acetate (acuphase) (50-150mg) every 2-3 days max. 4 doses
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Common side-effects of antipsychotic medication.
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Weight gain (esp. atypical)
Sedation Hypertension Extrapyramidal effects (e.g. akathisia, dystonia, tardive diskinesia) Elevation of the hormone prolactin (rediced libido, disturbance of menstrual cycle, galactorrhoea) |
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Name a tricyclic antidepressant medication + dosage.
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Amitriptyline (Endep) 100-200mg
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Name 4 SSRIs + common dosages.
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Fluoxetine (20-60mg)
Paroxetine (20-40mg) Sertraline (50-200mg) Escitalopram (10-20mg) |
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Name a reversible MAOi + common dosages.
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Moclobemide (300-900mg)
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Name a SNRI + usual dosage range.
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Venlafaxine (75-375mg)
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Name 3 mood stabilisers + usual dosage range.
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Lithium carbonate (500-1500mg)
Sodium valproate (500- 2000mg) Carbamazepine (400-1200mg) |
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Name 5 commonly used benzodiazepines + usual dosage range.
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Clonazepam (0.5-6mg)
Diazepam (2-25mg) Lorazepam (1-6mg) Oxazepam (7.5-90mg) Temazepam (10-20mg) |
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Name an anti cholinergic medication + dosage.
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Benztropine (0.5-6mg)
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Define "personality disorder"
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An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual's culture.
Manifested in two or more of; cognition, affect, interpersonal functioning, impulse control Inflexible and pervasive across a range of situations. Causes distress & impaired occupational and social functioning. >18 y.o. for diagnosis Associated with many complications mental illness, violence, substance abuse etc. |
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What is delirium?
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Acute confusional state with global dysfunction of CNS with underlying GMC.
Consciousness is disturbed Cognition is disturbed Develops quickly hours - days |
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What are the causes of delirium?
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Infectious (encephalitis, meningitis, pneumonia, UTI)
Withdrawal (drug / EtOH) Acute metabolic disorder Trauma (head) CNS pathology Hypoxia Deficiencies (B12, folate, thiamine) Endocrinopathy Acute vascular (shock, vasculitis) Toxins, substance abuse, MEDICATION Heavy metal (Pb, Hg etc.) |
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What is pseudodementia?
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Cognitive deficits accompanying depression or other psych illness. Usually resolve with Rx, but risk of progressing to real dementia esp. w/o Rx
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What medications can be used as an adjunct therapy in alcohol dependence?
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Disulfiram - Inhibits metabolism of EtOH in liver -> excess acetaldehyde
Naltrexone - mu opioid antagonist reduces pleasure effect of alcohol Acamprosate - Modulation of glutamate & GABA NT system |
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What do you understand by the terms transference & counter-transference?
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Transference: Phenomenon where a patient's perceptions, feelings, behaviour towards the therapist are subconsciously influenced by their past relationships & experiences.
Counter-transference: Phenomenon where the therapists perceptions, feelings and behaviours towards the patient are influenced by previous experiences with patients (in response to patient's transference) |
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How can transference and counter-transference affect clinical practice?
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Can undermine therapeutic process
Cloud clinical judgment Therapist must remain non-judgmental and assume an empathetic & professional stance. |
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What is CBT?
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Combines cognitive and behaviour therapies to teach the patient to weaken connections between thinking patterns, habitual behaviours and mood and anxiety problems.
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