Page 1204 - TNFlipTest

PS40 Psychiatry
Psychotherapy Toronto Notes 2019
■ violation of rules: out all night before age 13, often truant from school before age 13, runaway ≥2 times at least overnight or for long periods of time
■ disturbance causes clinically significant impairment in social, academic, or occupational functioning
■ if ≥18 yr, criteria not met for ASPD • diagnostictypes
■ childhood onset: at least one criterion prior to age 10
• poorprognosis:associatedwithODD,aggressiveness,impulsiveness
■ adolescent onset: absence of any criteria until age 10
• betterprognosis;leastaggressive,gang-relateddelinquency
■ mild, moderate, severe
Treatment
• earlyinterventionnecessaryandmoreeffective;long-termfollow-uprequired
• psychosocial:parentmanagementtraining,angerreplacementtraining,CBT,familytherapy,education/
employment programs, social skills training
• pharmacotherapyforcomorbiddisorders
Prognosis
• poorprognosticindicatorsincludeearly-ageonset,highfrequency,varietyofbehaviours,pervasiveness (i.e. in home, school, community), comorbid ADHD, early sexual activity, substance abuse
• 50%ofCDchildrenbecomeadultASPD
Intermittent Explosive Disorder
Diagnosis
• recurrentbehaviouraloutburstsrepresentingafailuretocontrolaggressiveimpulsesinchildrenage≥6, manifested as either
■ verbal or physical aggression that does not damage others or property, occurring ≥2 times per wk for3mo
■ 3 outbursts involving physical damage to another person, animal or piece of property in the last 12 mo
• outburstsareoutofproportiontotriggersorprovocation,arenotpremeditated,andnotforprimary gain
• outburstscauseclinicallysignificantdistressorimpairmentinsocial,academic,oroccupational functioning
See Pediatrics
• ChildAbuse,P14
• ChronicAbdominalPain,P40 • DevelopmentalDelay,P22
• IntellectualDisability,P22
• LearningDisabilities,P24
• SleepDisturbances,P12
See Neurology
• TicDisorders,N33
• Tourette’sSyndrome,N34
Psychotherapy
• treatmentinwhichapersonwithmentalorphysicaldifficultiesaimstoachievesymptomaticrelief through talks with another person
• psychotherapyisdeliveredbyaspeciallytrainedcounsellor,socialworker,nurse,psychologist,general practitioner, or psychiatrist
• varioustypesoftherapyexistbasedondiversetheoriesofhumanpsychologyandmentalillness etiology
Common Factors of Psychotherapy
• goodevidencethateffectivepsychotherapycreatesobservablechangesinbraincircuitryand connectivity, but these changes are different from those observed with successful pharmacologic and other treatment modalities
• studiessuggestthatupto60-90%oftherapyoutcomeisduetocommonfactorswithonly10-40%due to specific factors
• commonfactorsare:warmth(unconditionalpositiveregard),accurateempathy,genuineness,goodness of fit
Conduct Disorder Diagnosis
TRAP
Theft: breaking and entering, deceiving, non- confrontational stealing
Rule breaking: running away, skipping school, out late
Aggression: people, animals, weapons, forced sex
Property destruction
Freudian Psyche
id: instinctual drives, unconscious
superego: person’s conscience, formed by societal/parental norms
ego: latin “I”, sense of self, conscious actions, attempts to satisfy drives of id within confines of reality and demands of superego