Abnormal Flashcards
1
Q
BP I vs ADHD in adolescents
A
BP only Sx: Grandiosity Elation Flight of ideas Decreased need for sleep Hypersexuality
2
Q
ODD vs Disruptive Mood Dysregulation disorder
A
Disruptive Mood is more severe, frequent and chronic
3
Q
Opioids intoxication
A
Drowsiness or coma
Slurred speech
Impaired attention/memory
4
Q
Opiod withdrawal
A
Dysphoric mood Nausea/Vomiting Muscle aches Lacrimation or rhinorrhea Pupillary dilation, piloerection (hair), or sweating Diarrhea Yawning Fever Insomnia
5
Q
Cannabis intoxication
A
Increase appetite
Dry mouth
Tachycardia
6
Q
Stimulant withdrawal
A
Fatigue vivid dreams Increased appetite Insomnia/hypersomnia Psychomotor agitation
7
Q
PTSD Sx Clusters
A
Intrusion
Avoidance
Cog and mood
Arousal and reactivity
8
Q
LD comorbidity with ADHD
A
20-30% have ADHD
9
Q
Inhalant intoxication
A
Dizziness Nystagmus In coordination Slurred speech Unsteady gait Lethargy Depressed reflexes Tremor Blurred vision Euphoria Muscle weakness
10
Q
Schizoid vs Schizotypal
A
Schizoid=NO cog/perceptual distortions
No friends bc no intimacy
“Oh, don’t get intimate with me”
SchizoTYPAL= eccentric, cog/perceptual distortions
No friends bc fear of people
“ODD Type”
11
Q
Substance use disorder
A
Impaired control
Risky use
Pharm criteria
Social impairment
12
Q
Social Anxiety disorder
A
Fear of scrutiny by others in social situations
13
Q
Specific Phobia
A
Fear of specific object or situation
14
Q
Diagnostic uncertainty
OTHER Specified
A
Gives REASON why don’t meet criteria
15
Q
UNspecified
A
Reason NOT GIVEN why didn’t meet criteria
16
Q
What is a negative Sx?
A
RESTRICTION in range/intensity of emotions/other functions
17
Q
Negative Sx
A
Blunted emotional expression Anhedonia Asociality Alogia Avolition
18
Q
Delusions
A
False beliefs despite contrary evidence
19
Q
Types of delusions
A
Persecutory** Referential** Bizarre** ***most common in schizophrenia Erotomanic Grandiose Jealous Somatic Mixed Unspecified
20
Q
Disorganized thinking
A
Loose, incoherent, off-track, one topics to another
21
Q
Grossly disorganized or abnormal motor behavior
A
Unpredictable agitation
Disheveled appearance
Inappropriate sexual behavior
Catatonia
22
Q
Delusional Disorder
A
One or more delusions for one month or more
23
Q
Schizophrenia Dx criteria
A
2+ active phase Sx for at least one month
1 Sx must be delusions, hallucinations, or disorganized speech
Continuous signs for 6 mos.
Significant impairment of functioning
24
Q
Schizophrenia prevalence rates
A
.3-.7%
Slightly less for females
25
Schizophrenia age of onset
Males: early - mid 20s
Females: late 20s
26
Schizophrenia concordance rates
Bio sibs 10%
Fraternal twins 17%
Identical twins 48%
2 parents 46%
27
Dopamine hypothesis
Excessive dopamine, over sensitive receptors
28
Brain abnormalities in schizophrenia
Enlarged ventricles
Smaller hippo, amygdala, globus pallidus
Hypofrontality (negative Sx, poor cognition)
29
Traditional vs atypical antipsychotics
Traditional: reduce + Sx, but risk tar dive dyskinesia
(Haloperidol, fluphenazine)
Atypical: reduce + and - Sx
(Clozapine, risperidone)
30
Schizophreniform disorder
1-6 mos
Social/occupational impairment not necessary
2/3 go on to full Schizophrenia or schizoaffective Dx
31
Brief Psychotic disorder
```
1 DAY - 1 mo. (Often response to overwhelming stressor)
1 or more Sx:
Delusions**
Hallucinations**
Disorganized speech**
Motor Sx or catatonic
```
32
Schizoaffective disorder
Concurrent schizophrenia Sx + major depressive or manic Sx
| At least 2 week period w/o mood Sx
33
BP I
At least 1 manic episode
Marked impairment req hospitalization or includes psychotic feature
MAY include 1 or more hypomanic or major depressive episodes
34
BP II
REQUIRES at least one hypomanic + one major depressive
35
What's the difference between mania and hypomania?
Mania: psychosis and/or requires hospital; marked impairment
Hypomania: doesn't cause impairment or req hospital
36
Rx for BP
Lithium 60-90% effective for classic BP I (discrete high/low episodes)
Anti seizure Rxs (carbamazepine or divalproex sodium) effective for rapid cycling or dysphoric mania
Antipsychotics for acute mania (olanzapine, risperidone)
37
Cyclothymic disorder
Numerous periods of hypomanic and depressive episodes
Don't meet full criteria
Not Sx-free for more than 2 mos at a time
Duration: 2 yrs adults, 1 yr child/adolescent
38
Major Depressive Disorder
```
At least 5 Sx for at least 2 weeks:
**depressed mood
**loss interest or pleasure in most/all activities
(**must have one)
Sig weight loss
Weight gain, or up/down appetite
Insomnia/hypersomnia
Psychomotor agitation/retardation
Fatigue/loss of energy
Worthlessness/excessive guilt
Inability to think or concentrate
Recurrent thoughts of death
Suicide ideation or attempts
```
39
MDD comorbidity with anxiety
60%
40
MDD prevalence
7% in USA
Adolescent females 1.5-3 times higher than males
18-29 yo 3xs higher than over 60
41
MDD peak age of onset
Mid 20s
42
Disruptive Mood Disregulation Disorder
- -severe recurrent outbursts (verbal/behaviorally)
- -chronic persistent angry mood between outbursts
- -Sx 12 mos, 2 of 3 settings
- -inconsistent with developmental level
- -Dx: 6-18 yo (onset before 10)
43
Associated features of MDD
EEG abnormalities in sleep - 40-60%
Sleep continuity disturbances, reduced Stage 3/4 (slow wave)
Reduced REM latency (early REM onset)
Increased REM duration
44
Pseudodementia vs neurocognitive disorder
Pseudo--> abrupt onset, patient concerned with impairments
| Neurocog--> gradual onset, patient denies/unaware
45
MDD prevalence
.50 monozygotic twins
.20 dizygotic twins
1.5-3 xs more common in 1st degree relatives
46
Catecholemine hypothesis
MDD = deficit in norepinephrine
47
Indolamine hypothesis
MDD = deficit in serotonin
48
Consequence of untreated MDD
Increased cortisol = atrophy of neurons in hippo
49
Lewinsohn behavioral theory of depression
Operant conditioning -- low rate of response-contingent reinforcement
50
Seligman Learned Helplessness
Attributes events to internal, stable, global factors
| Updated version: HOPELESSNESS is proximal and sufficient cause
51
Rehm Self-Control Model
cannot self-monitor, self evaluate, self reinforce properly
52
Beck Cognitive theory (depressive triad)
Self, world, future
53
MDD differential Dxs
psychotic Sx --> if exclusively during MDD episode (MDD w/psychotic features)
Psychosocial stressor --> Adjustment Disorder w/depressed mood (MDD criteria not met)
normal mood, feelings of loss/emptiness, decreases over days/weeks--> Uncomplicated Bereavement
54
TCAs (imipramine)
Most effective: Classic MDD w/vegetative Sx, worse in am, acute onset, moderate Sx severity
55
SSRIs
Mod to severe MDD
| Low side effects, low risk of fatal OD compared to TCAs
56
MAOIs
Atypical Sx of MDD
57
SNRIs
```
Comparable to TCAs/SSRIs in effectiveness
Differ in side effects
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
```
58
Side effects of ECT
Temporary ant and retro amnesia
Confusion
Disorientation
(Reduced only of unilateral Tx: right, non-dominant side)
59
Persistent Depressive Disorder
| Dysthymia
```
Depressed mood most days (2 yrs adults; 1yr kids)
Not Sx-free more than 2 mos
At least two Sx:
**Poor appetite/overeating
**insomnia/hypersomnia
**low energy/fatigue
low self esteem
**Poor concentration/diff making decisions
Hopelessness
(**same as MDD)
```
60
Tx for Persistent Depressive Disorder
CBT or IPT + SSRIs
61
Premenstrual Dysphoric Disorder
Most cycles, at least 5 Sx week before period
Sx improve few days after onset
Absent or min Sx post-period
Must have one: affect lability/irritability/anger, depressed mood or self-dep thoughts, anxiety/tension
At least one: decreased interest in usual activities, impaired concentration, lethargy, change in appetite, insomnia/hypersomnia, overwhelm/out of control, physical Sx
62
Suicide risk factors
```
Age: 45-54 highest (both sexes combined)
75 and up (males)
Gender: 4xs more males complete, 2-3 xs more females attempt
Race: highest for whites (except NAmer 15-34 2xs higher)
Divorced, separated, widowed - highest
Single
Married
60-80% commit tried before
80% give definite warning
```
63
Life stressors Assoc with risk of suicide
Failed at work or school
Rejected by loved one
Living alone
Absence of social support
64
Perfectionism and suicide risk
Socially-prescribed==> increased depression, low suicide risk
Self-oriented==> high suicide risk only with increased life stress
65
Suicide interventions
*Hospitalization: attempt or imminent risk
*Outpatient crisis unit: mod risk (intention, lack of means)
(Goals: decrease social isolation, removing lethal means, expressing anger other ways, red anxiety/sleep problems, focusing on ambivalence re: making attempt until crisis has passed)
*Outpatient therapy: follow up to hospital or outpt clinic, or if low risk
(CBT, IPT, DVT, problem-solving therapy)
66
How does anxiety differ from depression?
both have neg affect, but anxiety has higher positive affect and autonomic arousal
67
Anxiety vs depression Sx
```
"Pure" Anxiety Sx:
Apprehension
Tension
Trembling
Excessive worry
Nightmares
```
```
"Pure"depression Sx:
Poor mood
Anhedonia
Loss of interest in activities
Suicide ideation
Loss of libido
```
```
Overlapping Sx:
Poor concentration/memory
Irritability
Fatigue
Insomnia
Hopelessness
```
68
Separation Anxiety
Child: 4 weeks
Adult: 6 months
69
Causes of school refusal (by age)
5-7 yo -- beginning school
10-11 yo -- change of schools; social phobia
14-16 yo -- social phobia; depression; POOR prognosis
70
Tx for Separation Anxiety
Systematic desensitization
| Cognitive approaches -- for older kids/adolescents
71
Specific Phobia
Intense fear/anxiety re: SPECIFIC object or situation
| Typically lasts 6 mos or more
72
Specifier for Specific Phobia
```
Animal
Natural environment
Blood-injection-injury
Situational
Other
```
73
Etiology of Specific Phobia
Biological : abnormal serotonin, norepinephrine, GABA)
74
Two-factor theory of Specific Phobias
Classical conditioning + operant conditioning
Operant (learned fear neutral stimulus CS when paired with fear arousing US)
Classical (due to avoidance cond, avoidance of CS)
75
Tix for Specific Phobias
Exposure with response prevention
| Invivo exposure is best
76
Social Anxiety Disorder (Social Phobia)
- -fear of social situations
- -fear of Sx in front of others
- -avoids situations or endures with anxiety/fear
- -fear, anxiety, avoidance for 6 mos or more
77
Etiology of social phobia
Behavioral inhibition -- fear of unfamiliar people/situations
Selective attention to socially threatening info
Overestimation of likelihood of neg outcomes
78
Tx for Social Anxiety Disorder
Exposure w/response prevention
Social skills training
Cognitive restructuring
SSRIs, SNRIs (beta blocker propranolol: less physical Sx)
79
Panic Disorder
Recurrent, unexpected panic attacks
At least one attack followed by 1 mo concern about it
Or consequences
Or significant maladjust behavior related to attack
80
Definition of panic attack
```
4 Sx:
Palpitations
Sweating
Trembling
Derealization/depersonalization
Feeling choked
Chest pain
Parasthesias
Fear losing control
```
81
Prevalence of panic disorder
2-3% adults
| Females 2xs more likely
82
Tx for Panic Disorder
Panic Control Therapy (PCT)=psychoeducation + relaxation+ cognitive restructuring + introceptive exposure
Imipramine
SSRIs/SNRIs
Benzos
***30-70% relapse once discontinued Rx
83
Agoraphobia
```
At least 2:
Public transportation
Open spaces
Enclosed spaces
In line or part of crowd
Outside home alone
```
- -fear escape difficult or no help if has Sx
- -actively avoid situations, REQUIRES A COMPANION, or endures intensity
84
Specific Phobia vs Social Anxiety vs Agoraphobia
```
Specific phobia
--only SPECIFICsituation/ object
--related to something other than concern about Sx
Social Anxiety
--related to scrutiny of OTHERS
--INCREASED in presence of others
--companion not wanted
Agoraphobia
--requires companion
```
85
Tx for Agoraphobia
In Vigo exposure w/response prevention (intensive or graded)
| Intensive better for long term effects
86
GAD
```
At least 6 mos
Difficult to control, constant
3 or more Sx (1 Sx kids):
Restlessness
Easily fatigued
Diff concentrating
Irritability
Muscle tension
Sleep disturbance
```
87
GAD comorbidity with other disorders
50%
88
Tx for GAD
CBT
SSRIs/SNRIs
Benzos
Anxiolytics (busperone -- Buspar)
89
OCD
Obsessions: persistent thoughts/impulses
Compulsions: reptile and deliberate behaviors/mental acts driven to perform as attempt to relieve stress
90
OCD prevalence
1.2%
Equal in adults
Earlier onset in males
91
OCD etiology
Low serotonin
Rat caudate nucleus -- converts sensory input into cognitions/actions -- overactive in OCD
Cingulate cortex--mediate emotional reactions
92
Diff Dx
| OCD vs OCPD
OCD
rituals are to reduce anxiety
```
OCPD
rituals due to perfectionism
no obsessions/compulsions
Preoccupation with orderliness, perfection, control
"Anal retentive"
```
93
OCD Tx
exposure w/response prevention
TCA clomipramine
SSRIs
thought stopping
94
Reactive Attachment Disorder
At least 2:
- -min SE response to others
- -limited + affect
- -episodes of unexplained irritability, sadness, fear of interacting with adult caregivers
Due to extreme weather insufficient care (at least 1):
- -basic emotional needs not met (comfort, stimulation, affection)
- -repeated change in primary caregiver - limited attachment
- -rearing in unusual environment
Before age 5
95
Disinhibited Social Engagement Disorder
Inappropriate interaction with unfamiliar adults
At least 2:
- -reduced/absent reticence in approaching/interacting w/unfamiliar adults
- -overly familiar behavior
- -low or absent checking with caregiver after venturing away
- -willingness to accompany unfamiliar adult (little/no hesitation)
Devel age at least 9 mos
Extreme insufficient care
96
PTSD Sx categories (adults/kids over 6)
Exposure to actual or threat death, injury, sex violence
Intrusive symptoms
Avoidance of stimuli
New changes in cognition/mood
97
PTSD Sx Cateogries (under 6 yo)
All same except neg changes cog and mood is:
| Alterations in arousal/reactivity to event (2 Sx)
98
PTSD Tx
CBT: exposure, cog restructuring, anxiety management
| SSRIs
99
Acute Stress Disorder
3 days - 1 month
| 9 Sx from PTSD
100
Adjustment Disorder
Response to psychosocial stressor
Within 3 months
Remits in 6 months
101
Dissociative Disorders
Disruption or discontinuity of consciousness, memory, identification, emotion, perception, body representation, motor control and behavior
102
DID
2 or more distinct personality states or experience of possession
Recurrent gaps in memory (ordinary events, personal info, or traumatic event)
R/O cultural influences
103
Dissociative Amnesia
Inability to recall important personal information
| Usually due to a Traumatic event
104
Types of dissociative amnesia
Localized --> ALL events related to circumscribed period
selective --> SOME events related to circumscribed period
generalized --> loss of memory for ENTIRE LIFE
continuous --> subsequent to a period of time thru present
systematized --> certain CATEGORY of info
105
Dissociative Fugue
Purposeful travel without recall some or all of the past
106
Depersonalization/Derealization Disorder
Depersonalization=sense of unreality, detachment, being outside observer of SELF
Derealization=sense of unreality about SURROUNDINGS
107
Somatic Sx Disorder
PRESENCE of one or more somatic Sx
Causes distress
Excessive thoughts, feelings, behaviors re: Sx
Usually 6 mos or more
At least 1 (can change):
Persistent and disproportionate thoughts re: seriousness of Sx
Persistently high level of anxiety about health or Sx
Excessive time/energy devoted to health concerns/Sx
108
Illness Anxiety Disorder
```
Preoccupation with serious illness
ABSENCE of Sx (or mild)
High anxiety about health
Excessive health-related behaviors
Illness of concerns may change over time
6 mos or more
```
109
Conversion Disorder
Presence of Sx of voluntary motor or sensory functioning
Suggests serious neuro or medical condition
**evidence of incompatibility between Sx and medical condition
Specifiers: Sx type; course; psycho stressor (present/absent)
110
Factitious Disorder
```
Falsify Sx associated with deception
--feigning
--exaggeration
--simulation
--induction (ingestion, self-injury)
Presents self to others as ill/impaired
Deception in ABSENCE OF REWARD
```
Imposed on self/Imposed on an other
No specific Tx
111
Pica (Sx duration)
One mo or more
112
Anorexia Nervosa
Restriction of energy intake leads to sit low body weight
Intense fear of gaining weight
---OR---
Behavior interferes with weight gain
Disturbed perception of body weight/shape
---OR---
Lack of recognition of low weight
113
Anorexia specifiers
Course
Severity based on BMI
Type: restrictive eating or binge/purge
114
Anorexia Tx
CBT
115
Etiology of Anorexia
Bio factors: genetic, neurotramsmitter abnormalities, high serotonin (relieved by starvation)
Perfectionism
90% female
50% anxiety disorder (usually comes first)
116
Differential Dx: Bulimia vs Anorexia binge/purge type?
???????
Bulimia--weight not low
Anorexia--very low body weight
117
Bulimia
1x/week for 3 mos:
--recurrent episodes of binge eating (lack of control)
--inappropriate compensatory behavior
Self eval based on body shape/weight
118
Bulimia Tx
CBT
nutrition counseling
TCA (imipramine)
SSRI (fluoxetine--Prozac)
119
Bulimia etiology
LOW serotonin
| Low beta-endorphin
120
Binge Eating Disorder
Binging, no purging
| Once/week for 3 mos
121
Enuresis
2xs/week for 5 mos
| 5 yo or older
122
Encopresis
1/mo for 3 mos
| 4 yo or older
123
Insomnia Disorder
difficulty initiating sleep
Difficulty maintaining sleep
Early morning awakening/ no return to sleep
3xs/week for 3 mos
124
Insomnia Tx
sleep hygiene Ed
Stimulus control
Relax training
Cog therapy
125
Hypersomnolescence Disorder
At least seven hours sleep, still sleepy
At least one:
Recurrent to sleep periods in same day
Difficulty feeling awake after abrupt awakening
Prolonged but non-restorative sleep more than nine hours a day
126
Narcolepsy
3xs/week, 3 mos or more
Cataplexy
Hypocretin deficiency
REM latency less than 15 min
127
Obstructive Sleep Apnea Hypopnea
(1) at least 5 obstructive apneas or hypopneas per hour of sleep plus:
(A) nocturnal breathing disturbances OR
(B) Daytime sleepiness
---OR---
(2) 15 or more apneas or hypopneas per hour of sleep regardless of other symptoms
128
Non-REM sleep arousal disorders
Incomplete awakening (stage 3/4)
Sleepwalking
Sleep terror
129
Erectile disorder
At least one on all/almost all sex occasions:
Marked difficulty obtaining erection
Mark difficulty maintaining erection
Marked decrease in erectile rigidity
130
Premature ejaculation
Within one minute of penetration
Or before desires it
At least 6 months
131
Tx for Premature Ejaculation
Sensate focus
Start stop technique
Squeeze technique
SSRIs - treats low serotonin
132
Rx for Paraphillic Disorders
In vivo aversion therapy - done in past, only short-term benefits
Now:
CBT
Behavior strategies--covert sensitization (aversive cond in imagination) or orgasmic conditioning (replace fantasy while masturbating)
Rx: DepoProvera shot
133
ODD
angry/irritable mood, argumentative/defiant behavior, vindictiveness
At least 4 Sx w/at least one non-sibling:
--often loses temper
--often argues with authority figures
--often refuses to comply with the rules or requests from authority figures
--blames others for mistakes
134
Intermittent Explosive Disorder
Lack of control aggressive impulses, we current behavioral outbursts
Outbursts are not premeditated
6 yo or more
(A) verbal/physical aggression: two times a week, three months or more
--OR--
(B) 3 behavior outburst, damage to property and/or physical assault during a 12 month
135
conduct Disorder
```
Violates the rights of others
Need 3 Sx past 12 months and one symptom past six months:
--aggression to people/animals
--destruction of property
--deceitfulness or theft
--serious violation of rules
```
136
Types of conduct disorder
Childhood onset: 1Sx before age 10
Adolescent onset: no Sx prior to age 10
Unspecified onset: Unknown onset
137
Moffitt etiology of CD
Life course persistent type:
- -begins early (sometimes by age 3)
- -neurological difficulties + difficult temperament + adverse impact
Adolescence limited type:
- -temporary
- -reflects "maturity gap" (bio maturation and lack of opportunities for adult privilege and rewards)
- -usually committed with peers, and consistent across situations
138
Tx for CD
Parent Management Training (PMT)
Reward for + behavior replaces physical punishment
Multi-systemic Treatment (MST)
139
Substance Use Disorders
```
2 Sx in 12 mos:
--impaired control
--social impairment
--risky use
--pharmacological criteria (tolerance/withdrawal)
All classes of drugs except caffeine
```
140
Etiology of Substance Use Disorder
Conger: tension-reduction hypothesis=alcohol reduces anxiety and fear thru neg reinforcement
Marl att & Gordon: over learned, maladaptive behavior/habit
Relapse Prevention Therapy
141
Tx for substance use disorder
Naltrexone (opiod antagonist)
Disulfiram (Antabuse)
Nicotine replacement or bupropion (tobacco)
142
Sedation, hypnotic or Anxiolytic Intoxication
```
Slurred speech
Incoordination
Unsteady gait
Nystagmus
Impaired cognition
Stupor/coma
```
143
Sedation, Hypnotic or Anxiolytic withdrawal
```
Hyperactivity
Hand tremor
Insomnia
Anxiety
Nausea/vomiting
Transient hallucinations
Grand mal seizures
Psychomotor agitation
```
144
Inhalant Intoxication
```
Drowsiness
Nystagmus
In coordination
Stupor/coma
Euphoria
Slurred speech
Unsteady gait
Lethargy
Blurred vision
Depressed reflexes
Psychomotor retardation
Tremor
General muscle weakness
```
145
Tobacco withdrawal
```
Irritability/anger
Anxiety
Poor concentration
Increased appetite
Restlessness
Low mood
Insomnia
```
146
Neurocognitive disorders 6 domains of (poor) cog functioning
```
Complex attention
Executive functioning
Memory and learning
Language
Perceptual- motor
Social cognition
```
147
Delirium
Disturbance in attention/awareness over short period
Tends to fluctuate in severity thru day
At least one additional cog disturbance
148
Delerium high risk groups
```
Older adults
Low cerebral reserve
Post cardiotomy patients
Burn patients
Drug dependent but in withdrawal
```
149
Tx goals for Delerium
Treat cause
Reduce agitated behaviors thru environ manipulation + psychosocial interventions
Haloperidol
150
Major vs Mild Neurocognitive Disorder
Major--
SIGNIFICANT decline in one or more cog domains
INTERFERES with independence
Minor--
MODEST decline in one or more cog domains
DOES NOT INTERFERE with independence
151
Neurocognitive Disorder -- 13 types
```
Alzheimer's
Parkinson's
Huntington's
Lesley body disease
Vascular disease
Frontotemporal lobar degeneration
TBI
HIV infection
Prion disease
Substance or Rx use
another medical condition
Multiple etiologies
Unspecified
```
152
Types of conduct disorder
Childhood onset: 1Sx before age 10
Adolescent onset: no Sx prior to age 10
Unspecified onset: Unknown onset
153
Moffitt etiology of CD
Life course persistent type:
- -begins early (sometimes by age 3)
- -neurological difficulties + difficult temperament + adverse impact
Adolescence limited type:
- -temporary
- -reflects "maturity gap" (bio maturation and lack of opportunities for adult privilege and rewards)
- -usually committed with peers, and consistent across situations
154
Tx for CD
Parent Management Training (PMT)
Reward for + behavior replaces physical punishment
Multi-systemic Treatment (MST)
155
Substance Use Disorders
```
2 Sx in 12 mos:
--impaired control
--social impairment
--risky use
--pharmacological criteria (tolerance/withdrawal)
All classes of drugs except caffeine
```
156
Etiology of Substance Use Disorder
Conger: tension-reduction hypothesis=alcohol reduces anxiety and fear thru neg reinforcement
Marl att & Gordon: over learned, maladaptive behavior/habit
Relapse Prevention Therapy
157
Tx for substance use disorder
Naltrexone (opiod antagonist)
Disulfiram (Antabuse)
Nicotine replacement or bupropion (tobacco)
158
Sedation, hypnotic or Anxiolytic Intoxication
```
Slurred speech
Incoordination
Unsteady gait
Nystagmus
Impaired cognition
Stupor/coma
```
159
Sedation, Hypnotic or Anxiolytic withdrawal
```
Hyperactivity
Hand tremor
Insomnia
Anxiety
Nausea/vomiting
Transient hallucinations
Grand mal seizures
Psychomotor agitation
```
160
Inhalant Intoxication
```
Drowsiness
Nystagmus
In coordination
Stupor/coma
Euphoria
Slurred speech
Unsteady gait
Lethargy
Blurred vision
Depressed reflexes
Psychomotor retardation
Tremor
General muscle weakness
```
161
Tobacco withdrawal
```
Irritability/anger
Anxiety
Poor concentration
Increased appetite
Restlessness
Low mood
Insomnia
```
162
Neurocognitive disorders 6 domains of (poor) cog functioning
```
Complex attention
Executive functioning
Memory and learning
Language
Perceptual- motor
Social cognition
```
163
Delirium
Disturbance in attention/awareness over short period
Tends to fluctuate in severity thru day
At least one additional cog disturbance
164
Delerium high risk groups
```
Older adults
Low cerebral reserve
Post cardiotomy patients
Burn patients
Drug dependent but in withdrawal
```
165
Tx goals for Delerium
Treat cause
Reduce agitated behaviors thru environ manipulation + psychosocial interventions
Haloperidol
166
Major vs Mild Neurocognitive Disorder
Major--
SIGNIFICANT decline in one or more cog domains
INTERFERES with independence
Minor--
MODEST decline in one or more cog domains
DOES NOT INTERFERE with independence
167
Neurocognitive Disorder -- 13 types
```
Alzheimer's
Parkinson's
Huntington's
Lesley body disease
Vascular disease
Frontotemporal lobar degeneration
TBI
HIV infection
Prion disease
Substance or Rx use
another medical condition
Multiple etiologies
Unspecified
```
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Alzheimer's major vs mild Neurocognitive disorder
Major: evidence of causative genetic mutation
Clear evidence of memory loss
Steady progressive and gradual decline in cog without plateaus
AND at least ONE OTHER COG DOMAIN
Minor: same, but no other cog domain
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Stages of Alzheimer's
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1-3 yrs:
Antegrade amnesia (declarative memories)
Poor visuospatial skills (wandering)
Indifference
Irritability
Sadness
Anomia
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```
2-10 years:
Increased retrograde amnesia
Flat/labile mood
Restlessness/agitation
Delusions
Fluent aphasia
Acalculia
Ideology apraxia
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8-12 years:
Severe deterioration intellect functioning
Apathy
Limb rigidity
Incontinence
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Stages of Neurocognitive disorder due to HIV
Stage 0 --> normal
Stage 0.5 --> Equivocal/subclinical: minor Sx, no impairment, mild signs
Stage 1--> Mild: evidence of impairment, can perform all but most demanding ADLs, can walk without assistance
Stage 2--> Moderate: cannot work, can do basic self care, ambulatory but needs assistance
Stage 3--> Severe: major intellectual incapacity or motor disability
Stage 4--> End Stage: nearly vegetative, nearly mute, paraparesis/ paraplegia, incontinence
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Personality Disorders -- clusters
Cluster A--> Odd/Excentric
Cluster B --> Dramatic, emotional, erratic
Cluster C --> Anxiety, fearfulness
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Age of onset for PDs
Adolescence or early adulthood
If under 18, need Sx for 1 yr
Antisocial PD no Dx under 18
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Paranoid PD
others exploiting, harming or deceiving
Preoccupation with doubts of trustworthiness of others
Reluctant to confide in others
Reads demeaning content into benign remarks/events
Bears grudges
Perceives attacks on character- reacts w/anger and counterattacks
Suspicious of partners fidelity
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Schizoid PD
Detach from interpersonal relationships & restricted range of emotion in social settings
No desire or enjoyment from close relationships
Almost always chooses solitary activities
Lacks close friends
Indifferent to praise/criticism
Emotional coldness/detachment
Little interest in sexual relationships
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Schizotypal PD
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Reduced capacity for close relationships
ECCENTRICITIES in cognition, perception, and behavior
Ideas of reference
Odd behavior/magical thinking
Bodily illusions/unusual perceptions
Odd thinking/speech
Suspicious, paranoid ideation
Inappropriate/constricted affect
Peculiar behavior/appearance
Lacks close friends
Excess social anxiety
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Antisocial PD
Failure to conform to social norms, respect lawful behavior
Deceitfulness
Impulsivity
Irritation/Anger
Reckless disregard for safety of self/others
Consistent irresponsibility
Lack of remorse
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ASSOCIATED Sx of Antisocial PD
Inflated sense of self
Lack of empathy
Superficial charm
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Borderline PD ages
most common ages 19-34
| By age 40: 75% DNQ
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features of DBT
group skills training
Individual outpatient therapy
Telephone consult
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Histrionic PD
Emotionality and attention-seeking
Discomfort when not center of attention
Inappropriate sex provocative
Rapid shifting and shallow emotions
Consistent use of physical appearance to gain attention
Excessive impressionistic speech, lacking detail
Exaggerated e press ion of emotion
Easily influenced by others
Considers relationships to be more intimate than they are
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Narcissistic PD
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Grandiose sense of self importance
Fantasies of unlimited success, power, beauty, love
Believes (s)he is unique, only understood by other high-status people
Requires excessive admiration
Sense of entitlement
Interpersonally exploitative
Lacks empathy
Envious of others
Arrogant behaviors/attitudes
**starts in early adulthood
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Avoidant PD
social inhibition, inadequacy
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Dependent PD
Need to be taken care of
Submissive
Clingy
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Obsessive-Compulsive PD
Preoccupied with order
PERFECTIONISM
Does NOT involve obsessions or compulsions
