Notes

Psychoanalysis

1. Connect (anyway, find anything to agree on, even agreeing on nothing)

2. Listen!

3. Have list of diagnosis in head - Achilles heel is not having a framework in place to pull from.

Do not interrupt!!! If you interrupt to clarify, sure you get your answers, but you won't see how they think!!

Psychoanalysis Metaphor:

Anatomy is what the person thinks

Physiology is how the person thinks

Hallucination- real sensory event in absence of stimuli

Hallucinosis - patient hallucinating but knows it, almost always a form of organic brain injury. Acute!! probably an emergency

Illusion - incorrect conclusion about real sensory stimulus, the chair in the dark looks like a monster

Attitude- a persons attitude is a reflection of their way of organizing social information into a theme.

Psychosis - loss of reality testing involves two categories

-ideas (reference, religiosity, grandeur...)

-sensations (bugs crawling on skin)

Near delusion - almost completely fixed false belief, a little room for doubt (e.g. - i am willing to entertain the notion that the CIA may not be controlling my mind from my microwave)

Overvalued idea - on the same spectrum as a near delusion, a little less fixed.

Somatic delusion - a healthy body w/subjective pain symptoms (back pain w/no medical explanation)

Panic disorder - SSRI 1st line treatment, can have paradoxical response so start extra low and uptitrate, if you're gonna prescribe meds for panic disorder patient will have to be on them longer, clinically looking for "1 year of feeling good"

Panic disorder - cognitive behavior therapy, psychodynamic therapy - just don't harp on physical symptoms (if present)

Buspirone: non benzo anxiolytic, an adjunct - big plus: NO SIDE F/X, takes time to work

Tricyclics can be very sedating, start low. They can also create a conduction block so clear an EKG. The most sedating is amitriptyline (Elavil), lots of anticholinergic side F/X, dry mouth, constipation, urinary retention, vision problems