the highly sensitive person (elaine aron, phd, 1996)

Re: “The Highly Sensitive Person (HSP)”

Fr: Dr. Elaine Aron (1996) https://hsperson.com/test/highly-sensitive-test/

 

--also scientifically called “Sensory-Processing Sensitivity” (SPS)

--15-20% of population

 

>easily overwhelmed by strong SENSORY INPUT

>seem to be aware of subtleties in my environment

>other people’s MOODS affect ME

>tend to be very sensitive to PAIN

>need to WITHDRAW during busy days, to have some privacy & relief from stimulation

>particularly sensitive to the effects of CAFFEINE

>easily overwhelmed by things like bright LIGHT, strong SMELLS, coarse FABRICS, OR SIRENS close by

>has rich, complex INNER LIFE

>made uncomfortable by loud NOISES

>deeply moved by the ARTS or MUSIC

>NERVOUS SYSTEM feels so frazzled that I just have to go off by myself

>conscientious

>STARTLE easily

>get RATTLED when I have a lot to do in a short time

>tend to know what needs to be done to make an uncomfortable physical environment COMFORTABLE (e.g. light or seating)

>annoyed when people try to get me to do too MANY THINGS at once

>try hard to avoid making MISTAKES or FORGETTING things

>avoid VIOLENT movies and TV shows

>unpleasantly AROUSED when a lot is going on around me

>being very HUNGRY creates a strong reaction in me, disrupting my concentration or mood

>CHANGES in my life shakes me up

>notice & enjoy DELICATE or FINE scents, tastes, sounds, works of ART

>find it unpleasant to have a LOT going on at once

>high priority to ARRANGE my life to avoid upsetting or overwhelming situations

>bothered by INTENSE STIMULI, like loud noises or chaotic scenes

>when I must COMPETE or be OBSERVED while performing a task I become so nervous or shaky that I do much worse than I would otherwise

>as a child, my parents or teachers seemed to see me as SENSITIVE or SHY

 

Scoring: >14 = probably HSP

case formulation (george engel)

Re: "Biopsychosocial Model & Case Formulation"

Fr: PsyDB https://www.psychdb.com/teaching/biopsychosocial-case-formulation

>definition: (in psychiatry) a way of UNDERSTANDING a patient as more than a diagnostic label by generating HYPOTHESES about the ORIGINS & CAUSES of a patient's SYMPTOMS

>importance: "The BSP approach is the MOST COMMON & CLINICALLY PRACTICAL way to formulate (c/o George Engel, 1980) & guide treatment and prognosis

>NB: like cooking, no right or wrong way to do things

>CASE FORMULATION

--is NOT a diagnosis = "a group of consistent symptoms in a population"

--"tells HOW the person acquired the symptoms as a result of their GENETICS, PERSONALITY, PSYCHOLOGICAL FACTORS, BIOLOGICAL FACTORS, SOCIAL CIRCUMSTANCES, & their ENVIRONMENT."

--"asks WHAT is wrong [PRESENT], HOW it got that way [PAST], & WHAT can be done about it [FUTURE]"

--the 4Ps of case formulation

(1) PREDISPOSING Factor = areas of VULNERABILITY that increases the risk for the presenting problem, e.g. genetic predisposition, prenatal exposure to alcohol

Q: "What is is their 'SET UP?" "What were they working with initially?"

(2) PRECIPITATING Factor = typically thought of as STRESSORS or other events (positive or negative) that may be precipitants of the symptoms, e.g. identity conflict, relationship conflicts, transitions

Q: "What ACUTE event happened & how did it affect them?"

(3)  PERPETUATING Factors = conditions in the patient, family, community, or larger systems that EXACERBATE rather than solve the problem, e.g. unaddressed relational conflicts, lack of education, financial stresses, occupational stress (or lack of employment)

Q: "What CHRONIC tings are going on?"

(4) PROTECTIVE Factors = includes the patient's own areas of COMPETENCY, skills, talents, interest, & supportive elements which COUNTERACT the 3 other "Ps"

Q: "What is protecting them & keeping them WELL?"

======================================================================================

on major depressive disorder (dr cheng)

 source: notes taken during the webinar by dr cherryrich m cheng, part-time psychiatrist at the DJNRMHS

>depression vs sadness

>mood = pervasive & sustained F (feeling) that leads to A (actions) & T (thoughts)

>diagnostic criteria: (a) 1 core symptom (depression &/or anhedonia), (b) 4 associated features (sleep, weight, negative thoughts, suicidality) & (c) poor functioning

>3 types of sleep problem: (a) initial = difficulty falling asleep, (b) intermittent, (c) terminal = wakes up early & can't sleep anymore (the most common type)

>normal range of sleep for ages 25-60: 6-10 HRs 

>non-purposeful activity = agitated, unfocused

>weight problem = weight loss of ~2 lbs/wk without purposeful effort

>2 types of suicidality: (a) active, (b) passive (e.g. "i wish i would not wake up anymore")

>untreated: can last from 6 to 13 months vs treated: up to 3 months

>treatment by medications can last from 6 months to a year

>average number of episodes = 5-6 over a 20-year period for unipolar depressives

>hospitalization: 50% recover; 50% relapse

>etiology: bio-psycho-social

--bio: (a) low serotonin, norepinephrine, dopamine; (b) 1 parent with depression = 10-25% chance in children; if both parents with depression = 20-50% chance for children; NB: however, it's nature vs nurture

--psycho: beck's CBT model: (a) self: "I AM WORTHLESS." (b) future: "NOTHING WILL EVER CHANGE." & (C) others: "EVERYONE IS AGAINST ME."

--social: actual &/or symbolic LOSS; NB: esp actual loss of a parent before age 11; symbolic = e.g. missed opportunity

>treatment: (a) meds, (b) psychotherapy: 1-2x/wk for 12 or more sessions

 
 

auditory hallucination

source: https://www.rethink.org/advice-and-information/about-mental-illness/learn-more-about-symptoms/hearing-voices/

>stats: 1/10

>types:
- people talk TO you
- people talk ABOUT you
- hearing music
- hearing animal voices
- hearing background noises, e.g. people chat

>quality:
- positive
-- help understand more about your emotions
-- encourage & comfort
-- help, e.g. remind of to-do things

- negative
-- threaten you
-- tell you to hurt yourself or others
-- say hurtful or cruel things about you or others
-- frightening

NB: can be more upsetting during difficult or stressful times

>differential (vs intrusive thoughts)
-- auditory hallucination -- you hear a SOUND
-- intrusive thoughts = "an unwelcome thought or image that enters your mind & mostly out of your CONTROL"

anxiety vs panic disorder

as can be seen above, panic is more severe than anxiety :-)

source: instagram.com/healthline

Schneiderian (1959) First-Rank Symptoms (FRS) of Schizophrenia

https://carnets2psycho.net/dico/sens-de-schneider.html

https://www.researchgate.net/figure/First-Rank-Symptoms-of-Schizophrenia-Initially-Described-by-K-Schneider-1959_tbl1_11999334

re: who is kurt schneider (+ 1967)
fr: wikipedia

>a german psychiatrist

>known for the DIAGNOSIS & understanding of Schizophrenia & Personality Disorders (then known as "psychopathic personalities" -- based on personality traits of prostitutes)

>mentor: philosopher MAX SCHELER (co-founder of the phenomenological movement in philosophy) who guided him in his postgraduate philos studies in 1921; schneider used scheler's THEORY OF EMOTIONS in his study

>significant contributions:

-- re: diagnosis of mood disorders
-->applied PHENOMENOLOGY in Psychiatry in "The stratification of emotional life & the structure of depressive states" (1920) where he distinguished (1) endogenous / melancholic (biological) vs (2) reactive DEPRESSION (more seen on OPD service users)

-- re: diagnosis of psychosis
-->defined DELUSION in form [s] vs content [o], i.e., by the way the belief is held vs the belief itself (like Karl Jaspers)

>lived through WWI (as a soldier) & WWII (as MD)

>director of the German Psychiatric Research Institute in Munich, but RESIGNED due to Nazi's eugenics project!

>& because of his non-eugenics stand, he was made Dean of the Medical School, Heidelberg University till his retirement in 1955

>co-founded Heidelberg school of Psychiatry with philosopher KARL JASPERS

=================================================
re: interesting additional notes on FORMS OF AUDITORY HALLUCINATIONS: voice/s...

1. repeating service user's (SU's) thoughts OUT LOUD
2. discussing SU or arguing about SU referring to S in THIRD PERSON
3. discussing SU's thoughts AS or BEFORE they OCCUR
4. COMMENTING on SU's thoughts & actions

re: 2 kinds of DELUSIONS

1. primary delusion = belief arising suddenly "out of a clear blue sky" form a NORMAL perception [o]

2. delusional perception = belief that a NORMAL perception has a specific SIGNIFICANCE or MEANING [s]

=================================================

critique:
>reliability of the FRS has been questioned (Bertelsen 2002, pp. 89-93); but may be experienced more by SUs with DID (dissociative identity disorder) than Schiz (Spiegel et al. 2011, pp. 824-853); though they lack the negative symptoms of Schiz & normally do not mistake hallucinations for reality (Cardena & Gleaves 2007, [[/ 473-503).

thought alienation

source: dictionary.apa.org >thought alienation

= psychotic symptom in which patients feel their thoughts are in some way no longer within their CONTROL, including:

1. thought INSERTION*

2. thought WITHDRAWAL**

3. thought BROADCASTING***

all these are considered Schneiderian first-rank symptoms highly indicative of Schizophrenia
-----------------

1. source: dictionary.apa.org >thought-insertion
*thought insertion. a delusion in which the individual believes that thoughts have been irresistibly forced into his or her mind and ascribes these thoughts to outside sources.

2. source: en.wikipedia.org >thought-withdrawal
**In psychiatry, thought withdrawal is the delusional belief that thoughts have been 'taken out' of the patient's mind, and the patient has no power over this. It often accompanies thought blocking. ... This delusion is one of Schneider's first rank symptoms for schizophrenia.

3. source: en.wikipedia.org
**thought BROADCASTING = belief that others can HEAR or are AWARE of one's thoughts (mild form: service user DOUBTS such a perception) 

types of OCD

source: northpintrecovery.com >blog >types-ocd-get-bre

1. checking

2. contamination

3. mental contamination

4. hoarding

5. rumination

6. INTRUSIVE THOUGHTS

===============================================================
my comment: i can relate to # 6, which is a symptom of PTSD (posttraumatic stress disorder)! :-)

4As of Schizophrenia by Paul Eugen Bleuler

source: behavenet.com >paul-eugen-bleuler (swiss psychiatrist, student & self-analyzed by freud, taught jung as doctoral student, resigned from the international psychoanalytic association in 1911 because he did not believe in the"all-or-nothing" principle in psychiatry)

1. disturbance of A = affect
2. disturbance of A= association
3. A = ambivalence
4. A = autism

source: wikipedia

1-3 = directly caused by underlying biological process

>known for coining the word SCHIZOPHRENIA (1908) to replace Emil Kraeplin's "dementia praecox", also SCHIZOID, & AUTISMA

>believed that no one ever completely gets "cured" from schiz, but progressively deteriorates vs mere recurrence

>as a "eugenicist," he advocated for the STERILIZATION of patients diagnosed with or were predisposed to schiz (citing natural selection)

>dynamics involved in schiz, SPLIT BETWEEN FEELING AND THINKING FUNCTIONS of the personality (Gregory 2004, p. 697).

>he was also against INSTITUTIONALIZATION, instead encouraged integration with the community

>author: Textbook of Psychiatry (1916)

>critique: "Bleuler is not credited of ever having healed a single patient. Like Sigmund Freud, he EXPERIMENTED on patients in his care, many were (1) sterilized & many (2) committed suicide (Huevns & Ghaemi 2004, p. 353).