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AATBS EPPP 2017 !! > Abnormal > Flashcards

Abnormal Flashcards

1
Q

BP I vs ADHD in adolescents

A 
BP only Sx:
Grandiosity 
Elation
Flight of ideas
Decreased need for sleep
Hypersexuality
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2
Q

ODD vs Disruptive Mood Dysregulation disorder

A

Disruptive Mood is more severe, frequent and chronic

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3
Q

Opioids intoxication

A

Drowsiness or coma
Slurred speech
Impaired attention/memory

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4
Q

Opiod withdrawal

A 
Dysphoric mood
Nausea/Vomiting
Muscle aches
Lacrimation or rhinorrhea
Pupillary dilation, piloerection (hair), or sweating
Diarrhea 
Yawning
Fever
Insomnia
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5
Q

Cannabis intoxication

A

Increase appetite
Dry mouth
Tachycardia

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6
Q

Stimulant withdrawal

A 
Fatigue
vivid dreams
Increased appetite
Insomnia/hypersomnia
Psychomotor agitation
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7
Q

PTSD Sx Clusters

A

Intrusion
Avoidance
Cog and mood
Arousal and reactivity

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8
Q

LD comorbidity with ADHD

A

20-30% have ADHD

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9
Q

Inhalant intoxication

A 
Dizziness
Nystagmus 
In coordination
Slurred speech
Unsteady gait
Lethargy
Depressed reflexes
Tremor
Blurred vision
Euphoria
Muscle weakness
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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”

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11
Q

Substance use disorder

A

Impaired control
Risky use
Pharm criteria
Social impairment

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12
Q

Social Anxiety disorder

A

Fear of scrutiny by others in social situations

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13
Q

Specific Phobia

A

Fear of specific object or situation

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14
Q

Diagnostic uncertainty

OTHER Specified

A

Gives REASON why don’t meet criteria

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15
Q

UNspecified

A

Reason NOT GIVEN why didn’t meet criteria

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16
Q

What is a negative Sx?

A

RESTRICTION in range/intensity of emotions/other functions

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17
Q

Negative Sx

A 
Blunted emotional expression
Anhedonia
Asociality
Alogia 
Avolition
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18
Q

Delusions

A

False beliefs despite contrary evidence

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19
Q

Types of delusions

A 
Persecutory**
Referential**
Bizarre** 
***most common in schizophrenia 
Erotomanic
Grandiose
Jealous
Somatic
Mixed
Unspecified
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20
Q

Disorganized thinking

A

Loose, incoherent, off-track, one topics to another

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21
Q

Grossly disorganized or abnormal motor behavior

A

Unpredictable agitation
Disheveled appearance
Inappropriate sexual behavior
Catatonia

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22
Q

Delusional Disorder

A

One or more delusions for one month or more

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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

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24
Q

Schizophrenia prevalence rates

A

.3-.7%

Slightly less for females

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25
Q

Schizophrenia age of onset

A

Males: early - mid 20s
Females: late 20s

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26
Q

Schizophrenia concordance rates

A

Bio sibs 10%
Fraternal twins 17%
Identical twins 48%
2 parents 46%

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27
Q

Dopamine hypothesis

A

Excessive dopamine, over sensitive receptors

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28
Q

Brain abnormalities in schizophrenia

A

Enlarged ventricles
Smaller hippo, amygdala, globus pallidus
Hypofrontality (negative Sx, poor cognition)

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29
Q

Traditional vs atypical antipsychotics

A

Traditional: reduce + Sx, but risk tar dive dyskinesia
(Haloperidol, fluphenazine)
Atypical: reduce + and - Sx
(Clozapine, risperidone)

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30
Q

Schizophreniform disorder

A

1-6 mos
Social/occupational impairment not necessary
2/3 go on to full Schizophrenia or schizoaffective Dx

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31
Q

Brief Psychotic disorder

A 
1 DAY - 1 mo. (Often response to overwhelming stressor)
1 or more Sx:
Delusions**
Hallucinations**
Disorganized speech**
Motor Sx or catatonic
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32
Q

Schizoaffective disorder

A

Concurrent schizophrenia Sx + major depressive or manic Sx

At least 2 week period w/o mood Sx

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33
Q

BP I

A

At least 1 manic episode
Marked impairment req hospitalization or includes psychotic feature
MAY include 1 or more hypomanic or major depressive episodes

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34
Q

BP II

A

REQUIRES at least one hypomanic + one major depressive

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35
Q

What’s the difference between mania and hypomania?

A

Mania: psychosis and/or requires hospital; marked impairment

Hypomania: doesn’t cause impairment or req hospital

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36
Q

Rx for BP

A

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)

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37
Q

Cyclothymic disorder

A

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

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38
Q

Major Depressive Disorder

A 
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
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39
Q

MDD comorbidity with anxiety

A

60%

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40
Q

MDD prevalence

A

7% in USA
Adolescent females 1.5-3 times higher than males
18-29 yo 3xs higher than over 60

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41
Q

MDD peak age of onset

A

Mid 20s

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42
Q

Disruptive Mood Disregulation Disorder

A
  • -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)
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43
Q

Associated features of MDD

A

EEG abnormalities in sleep - 40-60%
Sleep continuity disturbances, reduced Stage 3/4 (slow wave)
Reduced REM latency (early REM onset)
Increased REM duration

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44
Q

Pseudodementia vs neurocognitive disorder

A

Pseudo–> abrupt onset, patient concerned with impairments

Neurocog–> gradual onset, patient denies/unaware

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45
Q

MDD prevalence

A

.50 monozygotic twins
.20 dizygotic twins
1.5-3 xs more common in 1st degree relatives

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46
Q

Catecholemine hypothesis

A

MDD = deficit in norepinephrine

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47
Q

Indolamine hypothesis

A

MDD = deficit in serotonin

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48
Q

Consequence of untreated MDD

A

Increased cortisol = atrophy of neurons in hippo

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49
Q

Lewinsohn behavioral theory of depression

A

Operant conditioning – low rate of response-contingent reinforcement

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50
Q

Seligman Learned Helplessness

A

Attributes events to internal, stable, global factors

Updated version: HOPELESSNESS is proximal and sufficient cause

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51
Q

Rehm Self-Control Model

A

cannot self-monitor, self evaluate, self reinforce properly

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52
Q

Beck Cognitive theory (depressive triad)

A

Self, world, future

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53
Q

MDD differential Dxs

A

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

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54
Q

TCAs (imipramine)

A

Most effective: Classic MDD w/vegetative Sx, worse in am, acute onset, moderate Sx severity

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55
Q

SSRIs

A

Mod to severe MDD

Low side effects, low risk of fatal OD compared to TCAs

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56
Q

MAOIs

A

Atypical Sx of MDD

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57
Q

SNRIs

A 
Comparable to TCAs/SSRIs in effectiveness
Differ in side effects
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
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58
Q

Side effects of ECT

A

Temporary ant and retro amnesia
Confusion
Disorientation
(Reduced only of unilateral Tx: right, non-dominant side)

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59
Q

Persistent Depressive Disorder

Dysthymia

A 
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)
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60
Q

Tx for Persistent Depressive Disorder

A

CBT or IPT + SSRIs

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61
Q

Premenstrual Dysphoric Disorder

A

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

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62
Q

Suicide risk factors

A 
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
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63
Q

Life stressors Assoc with risk of suicide

A

Failed at work or school
Rejected by loved one
Living alone
Absence of social support

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64
Q

Perfectionism and suicide risk

A

Socially-prescribed==> increased depression, low suicide risk

Self-oriented==> high suicide risk only with increased life stress

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65
Q

Suicide interventions

A

*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)

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66
Q

How does anxiety differ from depression?

A

both have neg affect, but anxiety has higher positive affect and autonomic arousal

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67
Q

Anxiety vs depression Sx

A 
"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
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68
Q

Separation Anxiety

A

Child: 4 weeks
Adult: 6 months

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69
Q

Causes of school refusal (by age)

A

5-7 yo – beginning school
10-11 yo – change of schools; social phobia
14-16 yo – social phobia; depression; POOR prognosis

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70
Q

Tx for Separation Anxiety

A

Systematic desensitization

Cognitive approaches – for older kids/adolescents

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71
Q

Specific Phobia

A

Intense fear/anxiety re: SPECIFIC object or situation

Typically lasts 6 mos or more

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72
Q

Specifier for Specific Phobia

A 
Animal
Natural environment 
Blood-injection-injury
Situational 
Other
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73
Q

Etiology of Specific Phobia

A

Biological : abnormal serotonin, norepinephrine, GABA)

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74
Q

Two-factor theory of Specific Phobias

A

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
Q

Tix for Specific Phobias

A

Exposure with response prevention

Invivo exposure is best

76
Q

Social Anxiety Disorder (Social Phobia)

A
  • -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
Q

Etiology of social phobia

A

Behavioral inhibition – fear of unfamiliar people/situations
Selective attention to socially threatening info
Overestimation of likelihood of neg outcomes

78
Q

Tx for Social Anxiety Disorder

A

Exposure w/response prevention
Social skills training
Cognitive restructuring
SSRIs, SNRIs (beta blocker propranolol: less physical Sx)

79
Q

Panic Disorder

A

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
Q

Definition of panic attack

A 
4 Sx:
Palpitations 
Sweating 
Trembling 
Derealization/depersonalization 
Feeling choked
Chest pain
Parasthesias 
Fear losing control
81
Q

Prevalence of panic disorder

A

2-3% adults

Females 2xs more likely

82
Q

Tx for Panic Disorder

A

Panic Control Therapy (PCT)=psychoeducation + relaxation+ cognitive restructuring + introceptive exposure

Imipramine
SSRIs/SNRIs
Benzos
***30-70% relapse once discontinued Rx

83
Q

Agoraphobia

A 
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
Q

Specific Phobia vs Social Anxiety vs Agoraphobia

A 
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
Q

Tx for Agoraphobia

A

In Vigo exposure w/response prevention (intensive or graded)

Intensive better for long term effects

86
Q

GAD

A 
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
Q

GAD comorbidity with other disorders

A

50%

88
Q

Tx for GAD

A

CBT
SSRIs/SNRIs
Benzos
Anxiolytics (busperone – Buspar)

89
Q

OCD

A

Obsessions: persistent thoughts/impulses
Compulsions: reptile and deliberate behaviors/mental acts driven to perform as attempt to relieve stress

90
Q

OCD prevalence

A

1.2%
Equal in adults
Earlier onset in males

91
Q

OCD etiology

A

Low serotonin
Rat caudate nucleus – converts sensory input into cognitions/actions – overactive in OCD
Cingulate cortex–mediate emotional reactions

92
Q

Diff Dx

OCD vs OCPD

A

OCD
rituals are to reduce anxiety

OCPD
rituals due to perfectionism
no obsessions/compulsions
Preoccupation with orderliness, perfection, control 
"Anal retentive"
93
Q

OCD Tx

A

exposure w/response prevention
TCA clomipramine
SSRIs
thought stopping

94
Q

Reactive Attachment Disorder

A

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
Q

Disinhibited Social Engagement Disorder

A

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
Q

PTSD Sx categories (adults/kids over 6)

A

Exposure to actual or threat death, injury, sex violence
Intrusive symptoms
Avoidance of stimuli
New changes in cognition/mood

97
Q

PTSD Sx Cateogries (under 6 yo)

A

All same except neg changes cog and mood is:

Alterations in arousal/reactivity to event (2 Sx)

98
Q

PTSD Tx

A

CBT: exposure, cog restructuring, anxiety management

SSRIs

99
Q

Acute Stress Disorder

A

3 days - 1 month

9 Sx from PTSD

100
Q

Adjustment Disorder

A

Response to psychosocial stressor
Within 3 months
Remits in 6 months

101
Q

Dissociative Disorders

A

Disruption or discontinuity of consciousness, memory, identification, emotion, perception, body representation, motor control and behavior

102
Q

DID

A

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
Q

Dissociative Amnesia

A

Inability to recall important personal information

Usually due to a Traumatic event

104
Q

Types of dissociative amnesia

A

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
Q

Dissociative Fugue

A

Purposeful travel without recall some or all of the past

106
Q

Depersonalization/Derealization Disorder

A

Depersonalization=sense of unreality, detachment, being outside observer of SELF

Derealization=sense of unreality about SURROUNDINGS

107
Q

Somatic Sx Disorder

A

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
Q

Illness Anxiety Disorder

A 
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
Q

Conversion Disorder

A

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
Q

Factitious Disorder

A 
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
Q

Pica (Sx duration)

A

One mo or more

112
Q

Anorexia Nervosa

A

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
Q

Anorexia specifiers

A

Course
Severity based on BMI
Type: restrictive eating or binge/purge

114
Q

Anorexia Tx

A

CBT

115
Q

Etiology of Anorexia

A

Bio factors: genetic, neurotramsmitter abnormalities, high serotonin (relieved by starvation)
Perfectionism
90% female
50% anxiety disorder (usually comes first)

116
Q

Differential Dx: Bulimia vs Anorexia binge/purge type?

A

???????
Bulimia–weight not low
Anorexia–very low body weight

117
Q

Bulimia

A

1x/week for 3 mos:
–recurrent episodes of binge eating (lack of control)
–inappropriate compensatory behavior
Self eval based on body shape/weight

118
Q

Bulimia Tx

A

CBT
nutrition counseling
TCA (imipramine)
SSRI (fluoxetine–Prozac)

119
Q

Bulimia etiology

A

LOW serotonin

Low beta-endorphin

120
Q

Binge Eating Disorder

A

Binging, no purging

Once/week for 3 mos

121
Q

Enuresis

A

2xs/week for 5 mos

5 yo or older

122
Q

Encopresis

A

1/mo for 3 mos

4 yo or older

123
Q

Insomnia Disorder

A

difficulty initiating sleep
Difficulty maintaining sleep
Early morning awakening/ no return to sleep
3xs/week for 3 mos

124
Q

Insomnia Tx

A

sleep hygiene Ed
Stimulus control
Relax training
Cog therapy

125
Q

Hypersomnolescence Disorder

A

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
Q

Narcolepsy

A

3xs/week, 3 mos or more
Cataplexy
Hypocretin deficiency
REM latency less than 15 min

127
Q

Obstructive Sleep Apnea Hypopnea

A

(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
Q

Non-REM sleep arousal disorders

A

Incomplete awakening (stage 3/4)
Sleepwalking
Sleep terror

129
Q

Erectile disorder

A

At least one on all/almost all sex occasions:
Marked difficulty obtaining erection
Mark difficulty maintaining erection
Marked decrease in erectile rigidity

130
Q

Premature ejaculation

A

Within one minute of penetration
Or before desires it
At least 6 months

131
Q

Tx for Premature Ejaculation

A

Sensate focus
Start stop technique
Squeeze technique
SSRIs - treats low serotonin

132
Q

Rx for Paraphillic Disorders

A

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
Q

ODD

A

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
Q

Intermittent Explosive Disorder

A

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
Q

conduct Disorder

A 
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
Q

Types of conduct disorder

A

Childhood onset: 1Sx before age 10
Adolescent onset: no Sx prior to age 10
Unspecified onset: Unknown onset

137
Q

Moffitt etiology of CD

A

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
Q

Tx for CD

A

Parent Management Training (PMT)
Reward for + behavior replaces physical punishment

Multi-systemic Treatment (MST)

139
Q

Substance Use Disorders

A 
2 Sx in 12 mos:
--impaired control
--social impairment
--risky use
--pharmacological criteria (tolerance/withdrawal)
All classes of drugs except caffeine
140
Q

Etiology of Substance Use Disorder

A

Conger: tension-reduction hypothesis=alcohol reduces anxiety and fear thru neg reinforcement
Marl att & Gordon: over learned, maladaptive behavior/habit
Relapse Prevention Therapy

141
Q

Tx for substance use disorder

A

Naltrexone (opiod antagonist)
Disulfiram (Antabuse)
Nicotine replacement or bupropion (tobacco)

142
Q

Sedation, hypnotic or Anxiolytic Intoxication

A 
Slurred speech
Incoordination 
Unsteady gait
Nystagmus 
Impaired cognition
Stupor/coma
143
Q

Sedation, Hypnotic or Anxiolytic withdrawal

A 
Hyperactivity 
Hand tremor 
Insomnia 
Anxiety
Nausea/vomiting
Transient hallucinations
Grand mal seizures
Psychomotor agitation
144
Q

Inhalant Intoxication

A 
Drowsiness
Nystagmus 
In coordination 
Stupor/coma
Euphoria
Slurred speech
Unsteady gait
Lethargy
Blurred vision
Depressed reflexes
Psychomotor retardation
Tremor
General muscle weakness
145
Q

Tobacco withdrawal

A 
Irritability/anger
Anxiety
Poor concentration 
Increased appetite 
Restlessness 
Low mood
Insomnia
146
Q

Neurocognitive disorders 6 domains of (poor) cog functioning

A 
Complex attention
Executive functioning
Memory and learning
Language
Perceptual- motor
Social cognition
147
Q

Delirium

A

Disturbance in attention/awareness over short period
Tends to fluctuate in severity thru day
At least one additional cog disturbance

148
Q

Delerium high risk groups

A 
Older adults
Low cerebral reserve
Post cardiotomy patients 
Burn patients
Drug dependent but in withdrawal
149
Q

Tx goals for Delerium

A

Treat cause
Reduce agitated behaviors thru environ manipulation + psychosocial interventions
Haloperidol

150
Q

Major vs Mild Neurocognitive Disorder

A

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
Q

Neurocognitive Disorder – 13 types

A 
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
Q

Types of conduct disorder

A

Childhood onset: 1Sx before age 10
Adolescent onset: no Sx prior to age 10
Unspecified onset: Unknown onset

153
Q

Moffitt etiology of CD

A

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
Q

Tx for CD

A

Parent Management Training (PMT)
Reward for + behavior replaces physical punishment

Multi-systemic Treatment (MST)

155
Q

Substance Use Disorders

A 
2 Sx in 12 mos:
--impaired control
--social impairment
--risky use
--pharmacological criteria (tolerance/withdrawal)
All classes of drugs except caffeine
156
Q

Etiology of Substance Use Disorder

A

Conger: tension-reduction hypothesis=alcohol reduces anxiety and fear thru neg reinforcement
Marl att & Gordon: over learned, maladaptive behavior/habit
Relapse Prevention Therapy

157
Q

Tx for substance use disorder

A

Naltrexone (opiod antagonist)
Disulfiram (Antabuse)
Nicotine replacement or bupropion (tobacco)

158
Q

Sedation, hypnotic or Anxiolytic Intoxication

A 
Slurred speech
Incoordination 
Unsteady gait
Nystagmus 
Impaired cognition
Stupor/coma
159
Q

Sedation, Hypnotic or Anxiolytic withdrawal

A 
Hyperactivity 
Hand tremor 
Insomnia 
Anxiety
Nausea/vomiting
Transient hallucinations
Grand mal seizures
Psychomotor agitation
160
Q

Inhalant Intoxication

A 
Drowsiness
Nystagmus 
In coordination 
Stupor/coma
Euphoria
Slurred speech
Unsteady gait
Lethargy
Blurred vision
Depressed reflexes
Psychomotor retardation
Tremor
General muscle weakness
161
Q

Tobacco withdrawal

A 
Irritability/anger
Anxiety
Poor concentration 
Increased appetite 
Restlessness 
Low mood
Insomnia
162
Q

Neurocognitive disorders 6 domains of (poor) cog functioning

A 
Complex attention
Executive functioning
Memory and learning
Language
Perceptual- motor
Social cognition
163
Q

Delirium

A

Disturbance in attention/awareness over short period
Tends to fluctuate in severity thru day
At least one additional cog disturbance

164
Q

Delerium high risk groups

A 
Older adults
Low cerebral reserve
Post cardiotomy patients 
Burn patients
Drug dependent but in withdrawal
165
Q

Tx goals for Delerium

A

Treat cause
Reduce agitated behaviors thru environ manipulation + psychosocial interventions
Haloperidol

166
Q

Major vs Mild Neurocognitive Disorder

A

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
Q

Neurocognitive Disorder – 13 types

A 
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
168
Q

Alzheimer’s major vs mild Neurocognitive disorder

A

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

169
Q

Stages of Alzheimer’s

A 
1-3 yrs:
Antegrade amnesia (declarative memories)
Poor visuospatial skills (wandering)
Indifference 
Irritability 
Sadness
Anomia 
2-10 years:
Increased retrograde amnesia
Flat/labile mood
Restlessness/agitation
Delusions 
Fluent aphasia
Acalculia
Ideology apraxia
8-12 years:
Severe deterioration intellect functioning 
Apathy
Limb rigidity 
Incontinence
170
Q

Stages of Neurocognitive disorder due to HIV

A

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

171
Q

Personality Disorders – clusters

A

Cluster A–> Odd/Excentric
Cluster B –> Dramatic, emotional, erratic
Cluster C –> Anxiety, fearfulness

172
Q

Age of onset for PDs

A

Adolescence or early adulthood
If under 18, need Sx for 1 yr
Antisocial PD no Dx under 18

173
Q

Paranoid PD

A

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

174
Q

Schizoid PD

A

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

175
Q

Schizotypal PD

A 
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
176
Q

Antisocial PD

A

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

177
Q

ASSOCIATED Sx of Antisocial PD

A

Inflated sense of self
Lack of empathy
Superficial charm

178
Q

Borderline PD ages

A

most common ages 19-34

By age 40: 75% DNQ

179
Q

features of DBT

A

group skills training
Individual outpatient therapy
Telephone consult

180
Q

Histrionic PD

A

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

181
Q

Narcissistic PD

A 
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
182
Q

Avoidant PD

A

social inhibition, inadequacy

183
Q

Dependent PD

A

Need to be taken care of
Submissive
Clingy

184
Q

Obsessive-Compulsive PD

A

Preoccupied with order
PERFECTIONISM
Does NOT involve obsessions or compulsions

AATBS EPPP 2017 !! (10 decks)

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