Clinical Psychology AP5104

Objectives

 

  1. Lesson One: Listening and Rapport

Motivation: Letting patients know that you not only hear but understand what they are experiencing is the best way to build rapport. Good rapport helps with patient retention, compliance and referrals.

At the conclusion of the lesson, students should be able to:
    1. Identify these parts of a patient’s communication and explain how each impacts patient health:
    1. experiences
    2. behaviors
    3. emotions
    1. Demonstrate methods of communicating to patients that the doctor is listening.
    1. verbally
    2. non-verbally
    1. Provide examples of empathic statements
    2. List 13 conditions that help communications with the patient in the first exam or report of findings.
    3. Identify situations that interfere with listening and explain how to overcome them.
  1. Lesson Two: Psychological Theories

Motivation: Understanding certain components of psychological theories will help the doctor understand patient behavior and more effectively intervene with patients.

At the conclusion of the lesson, students should be able to:
    1. For psychoanalytic theories
    1. List the stages of development and describe personality characteristics associated with arrest at each stage.
    1. 2. Explain the psychoanalytic structural hypothesis and characteristics of each.
    1. Explain the psychoanalytic levels of consciousness.
    2. Identify psychoanalytic theory defense mechanisms from descriptions of behavior.
    3. Describe Erikson’s eight stages of development.
    1. For the behavior/learning theories

1.Describe classical conditioning.
    1. Identify examples of classical conditioning.
    2. Describe avoidance and give examples of.
    3. Describe operant conditioning and give examples of.
    4. Describe shaping and give examples of.
    5. Describe negative reinforcement and give examples of.
    6. Describe punishment and give examples of.
    7. Identify limitations of punishment.
    8. Identify extinction and give examples of.
    9. Describe observational learning and its application.
    1. For cognitive theories
    1. Describe and give examples of the A-B-C model of functioning.
    2. Define cognitive terms
    1. For humanistic-existential models
    1. Explain basic components of the theories.
    2. List and explain Maslow’s Hierarchy of Needs.
    1. For systems theory
    1. Explain the basic components of the theory
    2. Define basic terms.
    1. For biological theories
    1. Explain the basic components of the theory

 

  1. Lesson Three: Mood Disorders

Motivation: Mood disorders are a common cause of patient suffering. A primary care practitioner can and should identify the basic condition and be able to provide appropriate referrals for concurrent treatment.

At the conclusion of the lesson, students should be able to
    1. For bipolar disorder
    1. List symptoms of manic and depressed phases
    2. Identify symptoms from descriptions of behavior
    3. State incidence rate, and gender differences
    4. Describe course of the disorder
    5. Describe etiology of the disorder
    6. List other possible causes of symptoms (differential diagnosis)
    1. illnesses
    2. medication/substance use
    1. List treatment modalities,

a. the success rate of each,

    1. the benefits of each
    2. potential side-effects

8. Identify the disorder from a patient case description
    1. For cyclothymia
    1. List symptoms of manic and depressed phases
    2. Identify symptoms from descriptions of behavior
    3. State incidence rate, and gender differences
    4. Describe course of the disorder
    5. Describe etiology of the disorder
    6. List other possible causes of symptoms
    1. illnesses
    2. medication/substance use
    1. List treatment modalities,
    1. the success rate of each,
    2. Potential side-effects.
    1. Identify disorder from patient case history

 

    1. For depression
    1. List symptoms of depression

a. Differentiate vegetative symptoms

    1. Identify symptoms from descriptions of behavior
    2. State incidence rate, and gender differences
    3. List unique symptoms in elderly patients
    4. List unique symptoms in child patients
    5. List unique symptoms in adolescent patients
    6. Describe course of the disorder
    7. Describe etiology of the disorder
    8. List other possible causes of symptoms
    1. illnesses
    2. medication/substance use
    1. List treatment modalities,

a. the success rate of each

b. the benefits of each
    1. potential side-effects
    1. Identify the disorder from a patient case history

12. Differentiate between bereavement and depression

D. For dysthymia
    1. List symptoms and characteristics

2. State incidence rate, and gender differences
    1. 3. Describe course of the disorder
    2. 4. Describe etiology of the disorder
    3. 5. List treatment modalities,

a. the success rate of each,

    1. the benefits of each
    2. potential side-effects

6. Identify the disorder from a patient case history

E. Differentiate between Depression and Dementia in the Elderly

    1. Identify common and reversible causes of cognitive decline
    2. List characteristics of dementia as it relates to memory
    3. List characteristics of depression as it relates to memory
    4. State appropriate treatments for depression in the elderly
    1. For Suicide
    1. List common factors in suicidal patients
    2. List clues to suicidal intent
    3. Assess the risk of a suicidal patient
    1. list questions needed to assess risk
    2. identify answers that are "riskier"
    1. Identify treatment/intervention options with suicidal patient
  1. Lesson Four: Anxiety Disorders

Motivation: Anxiety disorders very commonly cause patient suffering. Patients who suffer from these conditions usually present to their health care doctor suspecting the cause is physical. An alert chiropractor can recognize these emotionally based conditions and provide consultation with an appropriate mental healthcare professional.

At the conclusion of the lesson the student will be able to:
    1. For Panic Disorder
    1. List the three groups of symptoms
    2. Identify symptoms from descriptions of behavior
    3. State incidence rate, and gender differences
    4. Describe course of the disorder
    5. Describe etiology of the disorder
    6. Explain the relationship between agoraphobia and panic disorder
    7. List other possible causes of symptoms
    1. illnesses
    2. medication/substance use
    1. List treatment modalities,

a. the success rate of each,

b. the benefits of each
    1. potential side-effects

9. Identify the disorder from a patient case history
    1. For Social Phobia
    1. Define the disorder
    2. List symptoms
    3. State incidence rate, age and gender differences
    4. Describe the course of the disorder
    5. Describe the etiology of the disorder
    6. List treatments for the disorder
    1. success rates
    2. benefits
    3. side-effects
    1. Identify the disorder from a patient case history
    1. For Specific Phobia
    1. Define the disorder
    2. List symptoms
    3. State incidence rate, age and gender differences
    4. Describe the course of the disorder
    5. Describe the etiology of the disorder
    6. List treatments for the disorder
    1. success rates
    2. benefits
    3. side-effects
    1. Identify the disorder from a patient case history
    1. For Obsessive Compulsive Disorder
    1. List symptoms
    2. Identify symptoms from descriptions of behavior
    3. Differentiate between obsessions and compulsions
    4. State incidence rate, and gender differences
    5. Describe course of the disorder
    6. Describe etiology of the disorder
    7. List treatment modalities,

a. the success rate of each,

b. the benefits of each

c. potential side-effects

8. Identify the disorder from a patient case history
    1. For Generalized Anxiety Disorder
    1. List symptoms
    2. Identify symptoms from descriptions of behavior
    3. State incidence rate, and gender differences
    4. Describe course of the disorder
    5. Describe etiology of the disorder
    6. List treatment modalities,

a. the success rate of each,

b. the benefits of each

c. potential side-effects

7. Identify the disorder from a patient case history
    1. For Post Traumatic Stress Disorder

1. Define PTSD
    1. List symptoms in each of the three areas
    2. Identify symptoms from descriptions of behavior
    3. State incidence rate, and gender differences
    4. List other common complications of the disorder
    5. Identify health complains that patients present with
    6. Describe course of the disorder
    7. List factors which increase the risk of PTSD
    8. List treatment modalities,

a. the success rate of each,

    1. the benefits of each
    2. potential side-effects
    1. Describe prognosis

      2. 11. Identify the disorder from a patient case history

    2. Differentiate PTSD from Acute Stress Disorder
    3. Differentiate PTSD from Adjustment Disorder
    1. list symptoms of adjustment disorder
    2. identify treatment for adjustment disorder

 

  1. Lesson Five: Dissociative Disorders

Motivation: Dissociative Disorders can be a very puzzling condition for practitioners. They reveal the immense capacities of the mind. An alert doctor can recognize the signs and refer the patients for an evaluation and concurrent treatment where appropriate.

At the conclusion of the lesson, students should be able to
    1. For depersonalization disorder
    1. List symptoms
    2. Describe etiology
    3. List recommended treatment approaches

4. Identify disorder from a patient case description
    1. For dissociative amnesia
    1. Describe condition and its purpose
    2. Contrast "organic" amnesia and dissociative amnesia
    3. Discuss treatment an its purpose
    4. Identify disorder from a patient case description
    1. For dissociative fugue
    1. Describe condition and its "purpose"
    2. Describe etiology and its resolution
    3. List possible treatments
    4. Identify disorder from a patient case description
    1. for dissociative identity disorder
    1. Describe condition
    2. List symptoms
    3. Explain purpose of disorder
    4. List complications of condition
    5. Identify treatment modalities and goals
    6. Identify disorder from a patient case description

 

  1. Lesson Six: Somatoform Disorders

Motivation: A physician is very likely to see a significant number of patients whose symptoms are caused by psychological conflicts. In some cases, these patients may be indistinguishable from other patients. These patients will not respond to treatment, however, and can be very frustrating to work with unless the doctor is able to recognize the condition is one of the somatoform disorders.

At the conclusion of the lesson, students should be able to:

A. For somatization disorder

    1. List characteristics and features of the disorder
    2. Know the prognosis
    3. Know the recommended treatments
    4. Identify disorder from a patient case description
    1. For conversion disorder
    1. Define the disorder
    2. Describe the etiology of the disorder
    3. Contrast primary and secondary gains
    4. Describe treatment alternatives
    5. Identify disorder from a patient case description
    1. For pain disorder
    1. Define the disorder
    2. Differentiate pain disorder from "physically" caused pain syndromes
    3. List common characteristics of patients who suffer from
    4. Report the prognosis
    5. List possible treatments
    6. Identify disorder from a patient case description
    1. For hypochondriasis
    1. Describe the disorder
    2. Describe patient presentation
    3. Explain the background of the patient with this disorder
    4. Report prognosis
    5. List treatment options
    6. Identify disorder from a patient case description
    1. For body dysmorphic disorder
    1. Describe the disorder
    2. Explain the course of the disorder
    3. List treatments
    4. Identify the disorder from a patient case description
    1. For all the somatoform disorders know the best approach for treatment.
    2. For malingering
    1. List typical presentation
    1. For factitious disorders

1. Define the condition
    1. Explain basic motivation of patient
    1. For Munchausen Syndrome
    1. Define the condition
    2. Explain the motivation of the patient
    1. For Munchausen by proxy
    1. Define the condition
    2. Explain motivation of the patient

 

  1. Lesson Seven: Schizophrenia

Motivation: Schizophrenia is a devastating condition which affects about 1% of the population. The doctor should be able to recognize the condition in order to be able to provide the best referrals for concurrent care for the patient.

At the conclusion of the lesson the student should be able to:
    1. For schizophrenia
    1. List symptoms
    1. differentiate between positive and negative symptoms
    2. differentiate between type 1 and type 2 schizophrenia
    3. differentiate between subtypes of the disorder
    1. Identify symptoms from descriptions of behavior
    2. State incidence rate, and gender differences
    3. Describe course of the disorder for each type
    4. Identify prognosis
    5. Describe etiology of the disorder for each type
    1. identify different theories/causes
    2. discuss evidence for causes
    1. List other possible causes of symptoms (differential diagnosis)
    1. illnesses
    2. medication/substance use
    1. List treatment modalities

a. the success rate of each

    1. b. the benefits of each
    2. c. method of action
    3. d. potential side-effects

      4. 8. Identify the disorder from a patient case description

      9. List ways the DC can help the patient

    4. 10. Differentiate schizophrenia from
    1. brief psychotic disorder
    2. schizophreniform disorder
    3. schizoaffective disorder
    1. For delusional disorder
    1. Define delusion
    2. Identify examples of delusions
    3. Identify different types of delusions
    1. erotomanic
    2. grandiose
    3. jealous
    4. persecutory
    5. somatic
  1. Lesson Eight: Sexual Dysfunction

Motivation: Most people with sexual difficulties present to their primary doctors although sometimes without identifying their problem. A primary care doctor should know the basic types of sexual problems and be able to refer that patient for appropriate evaluation and treatment.

At the conclusion of the lesson the student should be able to:
    1. Identify the four parts of the sexual response cycle
    2. Identify disorders that relate to each of the parts of the sexual response cycle
    3. List causes of sexual dysfunction
    4. Define paraphilias
    5. Identify treatments for sexual dysfunction

 

  1. Lesson Nine: Eating Disorders

Motivation: Eating disorders are increasingly common and deadly conditions. Although most patients do not complain of eating disorders, an alert physician can identify symptoms and recommend potentially life-saving treatment.

At the conclusion of the lesson the student should be able to:
    1. For Anorexia Nervosa
    1. Define the condition
    2. Identify contributing causes of the condition
    3. Describe the course of the disorder
    4. Identify prognosis (outcomes)
    5. List good prognostic indicators
    6. List physical side-effects of condition
    7. Differentiate between restricting type and binge-eating purging type
    8. Identify treatments for condition
    1. For Bulimia Nervosa
    1. Define the condition
    2. Differentiate between purging and non-purging type
    3. Describe the course of the disorder
    4. List characteristic behaviors of patient
    5. Explain restraint theory
    6. List treatments for the condition
    7. Identify success rates of treatment
    8. Identify patient from case description
    1. List common characteristics of men with eating disorders
    2. For binge-eating disorder
    1. Define and describe the disorder
    2. Describe the course of the disorder
    3. Identify treatments for the disorder

E. Identify family dynamics common to eating disorder patients
    1. differentiate between family types
    1. perfect
    2. overprotective
    3. chaotic
    4. critical
  1. Lesson Ten: Childhood disorders

Motivation: Disorders that begin in childhood often are very subtle and can have the same behavioral signs for very different etiologies. An understanding of basic disorders, classification, and treatment can give the doctor additional resources to suggest to the parents. Children rarely receive the mental health treatment they need which is unfortunate considering that early treatment is available, reduces suffering and costs less in the long run. Treating the cause of the symptoms, not just the symptoms is the goal.

At the conclusion of the lesson, the student should be able to:

A. For Autism

1. Define autism
    1. List symptoms in each of the three areas
    2. Identify symptoms from descriptions of behavior
    3. State incidence rate, and gender differences
    4. List theories of causes
    5. Describe course and prognosis of the disorder
    6. List treatment options
    7. Identify the disorder from a patient case history
    8. List suggestions for working with autistic patients

B. For Mental Retardation

    1. Describe disorder
    1. criteria for
    2. classification system
    3. features of
    4. causes of
    5. treatment approaches
    1. Identify disorder from patient case description
    1. Learning Disorders
    1. For Reading Disorder
    1. Describe symptoms of the disorder
    2. State incidence rate and gender differences
    3. Describe associated characteristics
    4. Describe how prognosis differs with age at intervention
    5. Know optimal age for diagnosis
    1. For Attention Deficit/Hyperactivity Disorder
    1. Define the disorder
    2. List symptoms
    1. of inattention
    2. of hyperactivity-impulsivity
    1. Identify symptoms from case description
    2. Identify features of the disorder
    1. incidence rate
    2. gender differences
    1. List features affecting symptom severity
    2. List hypothesized causes
    3. Identify comorbid conditions
    1. emotional disorders
    2. school/cognitive problems
    3. social skills problems
    1. Describe process for making diagnosis
    2. Describe common outcomes for patients
    3. List treatments
    1. potential side-effects
    2. potential benefits
    3. success rates
    1. Identify patient from case description
    1. For Pyromania
    1. Define the disorder
    2. Describe features of the disorder
    3. List associated conditions
    4. Describe treatment
    5. Identify prognostic outcome by age
    1. For Trichotillomania
    1. Define the disorder
    2. List characteristics of disorder
    3. Describe treatment
    4. List prognosis by age level
  1. Lesson Eleven: Personality Disorders

Motivation: Patients who suffer from personality disorders blame their situations and misfortunes on others and are very difficult to work with. These patients quite possibly account for an inordinate share of complaints against and suits involving doctors. The ability to recognize the behavior patterns and treat these patients in more careful ways may lesson the doctor’s liability.

At the conclusion of this lesson the student should be able to:
    1. Define personality disorders
    2. List the hallmarks of personality disorders
    3. Describe the proposed causes of personality disorders
    4. Discuss prognosis for personality disorders
    5. Discuss treatment options
    6. Differentiate between the following 10 personality disorders
    1. paranoid PD
    2. schizoid PD
    3. schizotypal PD
    4. histrionic PD
    5. narcissistic PD
    6. antisocial PD
    7. borderline PD
    8. avoidant PD
    9. dependent PD
    10. obsessive-compulsive PD
    1. List symptoms for each of the personality disorders
    2. List characteristics for each
    3. List suggestions for the doctor caring for each
    4. Identify each PD from a case description

XII. Lesson Twelve: Compliance

Motivation: Patient compliance with treatment makes a significant impact on results. Half of patients comply with treatment. Some doctor characteristics and behaviors can lead to more (or less) compliant patients. Learning how to encourage patient compliance will lead to a more successful practice.

At the conclusion of the lesson students should be able to:

    1. List 7 factors associated with compliance
    2. List 7 factors commonly assumed to be associated that are not associated
    3. List 6 factors associated with noncompliance
    4. Explain three step approach to increase compliance
    5. List 4 questions to ask patients to increase their compliance
    6. Explain the behavioral model of habits
    1. Consequences
    1. positive or negative
    2. magnitude
    3. certainty
    4. immediacy
    1. Differentiate between common factors of "bad" habits versus "good" habits
    2. Explain how to expedite behavior change
    1. Discuss 3 barriers to compliance
    2. Define self-efficacy
    3. Explain how to boost self-efficacy
    4. Explain how to work with difficult patient situations
    1. resistant patient
    2. reluctant patient
    3. restrictive patient
    4. angry patient
  1. Lesson Thirteen: Stress

Motivation: Stress, a constant in life, can have a severe impact on health and well being. Patients can learn more productive ways of dealing with stress that will help them maximize their treatments. Recognizing signs of stress in patients and pointing them toward more healthy approaches will improve patients’ success.

At the end of the lesson, students should be able to:

    1. Differentiate between those people who are impacted most physically or mentally (Mind verses Body) and recommend different stress reduction techniques for each.
    2. List several general causes of stress
    3. Define repressive coping style
    4. Discuss several effects of stress
    5. Discuss unhealthy ways in which patients attempt to deal with stress
    6. Discuss four approaches to improve coping with stress
    7. Define Hardy Personality
    8. Discuss how to teach hardiness
  1. Lesson Fourteen: Professional Burnout

Burnout is an expected process in professionals. Recognizing the causes of burnout and preventing it can help the doctor function more effectively. Significant impairment can be avoided.

At the conclusion of this lesson, the student should be able to:
    1. List causes of professional stress/burnout
    2. Identify the 5 step process of stress development
    3. Identify 4 stages of burnout
    1. Symptoms of each
    2. Intervention steps at each
    1. Discuss general prevention techniques

 

  1. Lesson Fifteen: Clear Communication/Assertiveness

Motivation: Communicating clearly with colleagues and patients improves understanding and relationships. Communication is most difficult when we are angry, although the following steps with improve most conversations.

At the conclusion of the lesson, the student should be able to:
    1. Describe 3 ways of dealing with anger
    1. Differentiate 3 ways of dealing with anger
    2. Give examples of each of the ways of dealing with anger
    3. Identify the goal of each style
    4. Identify the basic message of each style
    1. Demonstrate an assertive message using 3 parts
    1. Identify key components to each part of the message

 

    1. Discuss strategies of handling anger
    1. cognitive changes
    2. reflection
    3. empathy
  1. Lesson Sixteen: Handling Crisis

Motivation: A physician is going to encounter patients in crisis. Although anxiety provoking, the doctor can help the patient by following the guidelines presented.

At the conclusion of the lesson, the student will be able to:
    1. Define and give examples of crisis
    2. List the 3 areas affected in crisis and give examples of each
    3. List the 4 step process to handling a patient in crisis
    4. List approaches to avoid
  1. Lesson Seventeen: Recovery from Rape

Motivation: A physician will encounter patients who have been raped and still suffering from the experience. A basic knowledge of the incidence rates, basic information about rape and the consequences should help the doctor to understand the patient and provide appropriate referrals for treatment.

At the conclusion of the lesson, the student should be able to:
    1. State the following about rape
    1. definition
    2. incidence rates
    3. identify perpetrators
    4. describe consequences
    5. list reasons for underreporting
    1. Explain the "blaming the victim" phenomenon
    2. Describe the 3 phases to rape trauma syndrome
    3. Identify recovery process/referral options
  1. Lesson Eighteen: Domestic Violence

Motivation: The chiropractor will have patients who are being battered by a loved one. Advice for the patient seems clear-cut, but is rarely helpful. Instead, the doctor needs to understand the battering etiology and process so that a more effective intervention strategy can be planned.

At the conclusion of the lesson, the student should be able to:
    1. State the following about domestic violence
    1. definition
    2. incidence rates
    3. identify perpetrators
    4. describe consequences
    5. reasons for underreporting
    6. consequences for the children
    7. causes of
    8. describe other controlling behaviors
    9. explain the differences between cobras and pit bulls
    1. Explain 4 reasons women stay in violent relationships
    1. describe the Stockholm syndrome
    2. know that the most dangerous time for a woman in a violent relationship
    1. List options for intervention
    1. list available treatment options for the victim
    2. list available treatment options for the batterer
    1. Discuss breaking through the shock/denial of patient
  1. Lesson Nineteen: Alcohol Abuse

Motivation: Alcohol abuse is a common condition and a significant health concern. A better understanding of the abuse process of alcohol will generalize to other substances abused. The doctor will also come away with ideas of how to handle problems related to substance abuse in their patients.

Following the lesson, the student should be able to:
    1. For alcoholism
    1. define
    2. list warning signs
    3. give incidence rates
    4. explain etiology
    1. Discuss treatments available
    1. explain when is the best time to get help
    2. explain when hospitalization is necessary
    3. explain what stands in the way of treatment
  1. Lesson Twenty: Chronic Pain

Motivation: Chronic pain patients can become painful for the doctor to treat! Understanding the condition and some basic techniques to handling the patient who suffers from pain can alleviate both the patient’s and the doctor’s pain.

At the conclusion of the lesson, the student will be able to:
    1. For chronic pain
    1. explain differences in perception
    2. explain characteristics of
    3. list psychological consequences of
    4. list factors which affect response to treatment
    1. In treating patients in chronic pain
    1. list what patients want
    2. discuss how to communicate with patients
    3. list strategies to deal with pain
    4. list co-treatment options
  1. Lesson Twenty-One: Psychological Assessment

Motivation: Frequently collaboration with a psychological professional is important to helping a patient. At other times, patients may report to the doctor information from an assessment. A general understanding of psychological tests available and what they can tell us will help the doctor integrate the information.

At the conclusion of the lesson, the student will be able to:
    1. List the types of tests and what information can be obtained for each of the following areas
    1. intelligence
    2. achievement
    3. neuropsychological
    4. adaptive functioning
    5. emotional
    1. personality
    2. projective

 

  1. Lesson Twenty-two: Psychological Referrals

Motivation: Research has shown that 40-50% of patients suffer from at least one psychological condition. Effective treatments are available for most of these but doctors shy away from discussing emotion problems or treatment options with patients. A basic approach to discussing referrals should make the doctor more comfortable with this process and better meet the needs of patients in all areas of health.

At the conclusion of the lesson, the student should be able to:
    1. know the difference between different mental health professionals
    2. discuss ways to generate a list of referrals in a geographic area
    3. know important information to get from different professionals/centers
    4. list phrases which can introduce the topic with patients
    5. understand logistics of referring to mental health professionals and how that referral differs from other health professionals