Abnormal Flashcards
BP I vs ADHD in adolescents
BP only Sx: Grandiosity Elation Flight of ideas Decreased need for sleep Hypersexuality
ODD vs Disruptive Mood Dysregulation disorder
Disruptive Mood is more severe, frequent and chronic
Opioids intoxication
Drowsiness or coma
Slurred speech
Impaired attention/memory
Opiod withdrawal
Dysphoric mood Nausea/Vomiting Muscle aches Lacrimation or rhinorrhea Pupillary dilation, piloerection (hair), or sweating Diarrhea Yawning Fever Insomnia
Cannabis intoxication
Increase appetite
Dry mouth
Tachycardia
Stimulant withdrawal
Fatigue vivid dreams Increased appetite Insomnia/hypersomnia Psychomotor agitation
PTSD Sx Clusters
Intrusion
Avoidance
Cog and mood
Arousal and reactivity
LD comorbidity with ADHD
20-30% have ADHD
Inhalant intoxication
Dizziness Nystagmus In coordination Slurred speech Unsteady gait Lethargy Depressed reflexes Tremor Blurred vision Euphoria Muscle weakness
Schizoid vs Schizotypal
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”
Substance use disorder
Impaired control
Risky use
Pharm criteria
Social impairment
Social Anxiety disorder
Fear of scrutiny by others in social situations
Specific Phobia
Fear of specific object or situation
Diagnostic uncertainty
OTHER Specified
Gives REASON why don’t meet criteria
UNspecified
Reason NOT GIVEN why didn’t meet criteria
What is a negative Sx?
RESTRICTION in range/intensity of emotions/other functions
Negative Sx
Blunted emotional expression Anhedonia Asociality Alogia Avolition
Delusions
False beliefs despite contrary evidence
Types of delusions
Persecutory** Referential** Bizarre** ***most common in schizophrenia Erotomanic Grandiose Jealous Somatic Mixed Unspecified
Disorganized thinking
Loose, incoherent, off-track, one topics to another
Grossly disorganized or abnormal motor behavior
Unpredictable agitation
Disheveled appearance
Inappropriate sexual behavior
Catatonia
Delusional Disorder
One or more delusions for one month or more
Schizophrenia Dx criteria
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
Schizophrenia prevalence rates
.3-.7%
Slightly less for females
Schizophrenia age of onset
Males: early - mid 20s
Females: late 20s
Schizophrenia concordance rates
Bio sibs 10%
Fraternal twins 17%
Identical twins 48%
2 parents 46%
Dopamine hypothesis
Excessive dopamine, over sensitive receptors
Brain abnormalities in schizophrenia
Enlarged ventricles
Smaller hippo, amygdala, globus pallidus
Hypofrontality (negative Sx, poor cognition)
Traditional vs atypical antipsychotics
Traditional: reduce + Sx, but risk tar dive dyskinesia
(Haloperidol, fluphenazine)
Atypical: reduce + and - Sx
(Clozapine, risperidone)
Schizophreniform disorder
1-6 mos
Social/occupational impairment not necessary
2/3 go on to full Schizophrenia or schizoaffective Dx
Brief Psychotic disorder
1 DAY - 1 mo. (Often response to overwhelming stressor) 1 or more Sx: Delusions** Hallucinations** Disorganized speech** Motor Sx or catatonic
Schizoaffective disorder
Concurrent schizophrenia Sx + major depressive or manic Sx
At least 2 week period w/o mood Sx
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
BP II
REQUIRES at least one hypomanic + one major depressive
What’s the difference between mania and hypomania?
Mania: psychosis and/or requires hospital; marked impairment
Hypomania: doesn’t cause impairment or req hospital
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)
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
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
MDD comorbidity with anxiety
60%
MDD prevalence
7% in USA
Adolescent females 1.5-3 times higher than males
18-29 yo 3xs higher than over 60
MDD peak age of onset
Mid 20s
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)
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
Pseudodementia vs neurocognitive disorder
Pseudo–> abrupt onset, patient concerned with impairments
Neurocog–> gradual onset, patient denies/unaware
MDD prevalence
.50 monozygotic twins
.20 dizygotic twins
1.5-3 xs more common in 1st degree relatives
Catecholemine hypothesis
MDD = deficit in norepinephrine
Indolamine hypothesis
MDD = deficit in serotonin
Consequence of untreated MDD
Increased cortisol = atrophy of neurons in hippo
Lewinsohn behavioral theory of depression
Operant conditioning – low rate of response-contingent reinforcement
Seligman Learned Helplessness
Attributes events to internal, stable, global factors
Updated version: HOPELESSNESS is proximal and sufficient cause
Rehm Self-Control Model
cannot self-monitor, self evaluate, self reinforce properly
Beck Cognitive theory (depressive triad)
Self, world, future
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
TCAs (imipramine)
Most effective: Classic MDD w/vegetative Sx, worse in am, acute onset, moderate Sx severity
SSRIs
Mod to severe MDD
Low side effects, low risk of fatal OD compared to TCAs
MAOIs
Atypical Sx of MDD
SNRIs
Comparable to TCAs/SSRIs in effectiveness Differ in side effects Venlafaxine (Effexor) Desvenlafaxine (Pristiq) Duloxetine (Cymbalta)
Side effects of ECT
Temporary ant and retro amnesia
Confusion
Disorientation
(Reduced only of unilateral Tx: right, non-dominant side)
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)
Tx for Persistent Depressive Disorder
CBT or IPT + SSRIs
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
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 warningLife stressors Assoc with risk of suicide
Failed at work or school
Rejected by loved one
Living alone
Absence of social support
Perfectionism and suicide risk
Socially-prescribed==> increased depression, low suicide risk
Self-oriented==> high suicide risk only with increased life stress
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)
How does anxiety differ from depression?
both have neg affect, but anxiety has higher positive affect and autonomic arousal
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
Separation Anxiety
Child: 4 weeks
Adult: 6 months
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
Tx for Separation Anxiety
Systematic desensitization
Cognitive approaches – for older kids/adolescents
Specific Phobia
Intense fear/anxiety re: SPECIFIC object or situation
Typically lasts 6 mos or more
Specifier for Specific Phobia
Animal Natural environment Blood-injection-injury Situational Other
Etiology of Specific Phobia
Biological : abnormal serotonin, norepinephrine, GABA)
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)
Tix for Specific Phobias
Exposure with response prevention
Invivo exposure is best
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
Etiology of social phobia
Behavioral inhibition – fear of unfamiliar people/situations
Selective attention to socially threatening info
Overestimation of likelihood of neg outcomes
Tx for Social Anxiety Disorder
Exposure w/response prevention
Social skills training
Cognitive restructuring
SSRIs, SNRIs (beta blocker propranolol: less physical Sx)
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
Definition of panic attack
4 Sx: Palpitations Sweating Trembling Derealization/depersonalization Feeling choked Chest pain Parasthesias Fear losing control
Prevalence of panic disorder
2-3% adults
Females 2xs more likely
Tx for Panic Disorder
Panic Control Therapy (PCT)=psychoeducation + relaxation+ cognitive restructuring + introceptive exposure
Imipramine
SSRIs/SNRIs
Benzos
***30-70% relapse once discontinued Rx
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
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
Tx for Agoraphobia
In Vigo exposure w/response prevention (intensive or graded)
Intensive better for long term effects
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
GAD comorbidity with other disorders
50%
Tx for GAD
CBT
SSRIs/SNRIs
Benzos
Anxiolytics (busperone – Buspar)
OCD
Obsessions: persistent thoughts/impulses
Compulsions: reptile and deliberate behaviors/mental acts driven to perform as attempt to relieve stress
OCD prevalence
1.2%
Equal in adults
Earlier onset in males
OCD etiology
Low serotonin
Rat caudate nucleus – converts sensory input into cognitions/actions – overactive in OCD
Cingulate cortex–mediate emotional reactions
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"
OCD Tx
exposure w/response prevention
TCA clomipramine
SSRIs
thought stopping
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
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
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
PTSD Sx Cateogries (under 6 yo)
All same except neg changes cog and mood is:
Alterations in arousal/reactivity to event (2 Sx)
PTSD Tx
CBT: exposure, cog restructuring, anxiety management
SSRIs
Acute Stress Disorder
3 days - 1 month
9 Sx from PTSD
Adjustment Disorder
Response to psychosocial stressor
Within 3 months
Remits in 6 months
Dissociative Disorders
Disruption or discontinuity of consciousness, memory, identification, emotion, perception, body representation, motor control and behavior
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
Dissociative Amnesia
Inability to recall important personal information
Usually due to a Traumatic event
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
Dissociative Fugue
Purposeful travel without recall some or all of the past
Depersonalization/Derealization Disorder
Depersonalization=sense of unreality, detachment, being outside observer of SELF
Derealization=sense of unreality about SURROUNDINGS
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
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
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)
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
Pica (Sx duration)
One mo or more
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
Anorexia specifiers
Course
Severity based on BMI
Type: restrictive eating or binge/purge
Anorexia Tx
CBT
Etiology of Anorexia
Bio factors: genetic, neurotramsmitter abnormalities, high serotonin (relieved by starvation)
Perfectionism
90% female
50% anxiety disorder (usually comes first)
Differential Dx: Bulimia vs Anorexia binge/purge type?
???????
Bulimia–weight not low
Anorexia–very low body weight
Bulimia
1x/week for 3 mos:
–recurrent episodes of binge eating (lack of control)
–inappropriate compensatory behavior
Self eval based on body shape/weight
Bulimia Tx
CBT
nutrition counseling
TCA (imipramine)
SSRI (fluoxetine–Prozac)
Bulimia etiology
LOW serotonin
Low beta-endorphin
Binge Eating Disorder
Binging, no purging
Once/week for 3 mos
Enuresis
2xs/week for 5 mos
5 yo or older
Encopresis
1/mo for 3 mos
4 yo or older
Insomnia Disorder
difficulty initiating sleep
Difficulty maintaining sleep
Early morning awakening/ no return to sleep
3xs/week for 3 mos
Insomnia Tx
sleep hygiene Ed
Stimulus control
Relax training
Cog therapy
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
Narcolepsy
3xs/week, 3 mos or more
Cataplexy
Hypocretin deficiency
REM latency less than 15 min
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
Non-REM sleep arousal disorders
Incomplete awakening (stage 3/4)
Sleepwalking
Sleep terror
Erectile disorder
At least one on all/almost all sex occasions:
Marked difficulty obtaining erection
Mark difficulty maintaining erection
Marked decrease in erectile rigidity
Premature ejaculation
Within one minute of penetration
Or before desires it
At least 6 months
Tx for Premature Ejaculation
Sensate focus
Start stop technique
Squeeze technique
SSRIs - treats low serotonin
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
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
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
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
Types of conduct disorder
Childhood onset: 1Sx before age 10
Adolescent onset: no Sx prior to age 10
Unspecified onset: Unknown onset
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
Tx for CD
Parent Management Training (PMT)
Reward for + behavior replaces physical punishment
Multi-systemic Treatment (MST)
Substance Use Disorders
2 Sx in 12 mos: --impaired control --social impairment --risky use --pharmacological criteria (tolerance/withdrawal) All classes of drugs except caffeine
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
Tx for substance use disorder
Naltrexone (opiod antagonist)
Disulfiram (Antabuse)
Nicotine replacement or bupropion (tobacco)
Sedation, hypnotic or Anxiolytic Intoxication
Slurred speech Incoordination Unsteady gait Nystagmus Impaired cognition Stupor/coma
Sedation, Hypnotic or Anxiolytic withdrawal
Hyperactivity Hand tremor Insomnia Anxiety Nausea/vomiting Transient hallucinations Grand mal seizures Psychomotor agitation
Inhalant Intoxication
Drowsiness Nystagmus In coordination Stupor/coma Euphoria Slurred speech Unsteady gait Lethargy Blurred vision Depressed reflexes Psychomotor retardation Tremor General muscle weakness
Tobacco withdrawal
Irritability/anger Anxiety Poor concentration Increased appetite Restlessness Low mood Insomnia
Neurocognitive disorders 6 domains of (poor) cog functioning
Complex attention Executive functioning Memory and learning Language Perceptual- motor Social cognition
Delirium
Disturbance in attention/awareness over short period
Tends to fluctuate in severity thru day
At least one additional cog disturbance
Delerium high risk groups
Older adults Low cerebral reserve Post cardiotomy patients Burn patients Drug dependent but in withdrawal
Tx goals for Delerium
Treat cause
Reduce agitated behaviors thru environ manipulation + psychosocial interventions
Haloperidol
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
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
Types of conduct disorder
Childhood onset: 1Sx before age 10
Adolescent onset: no Sx prior to age 10
Unspecified onset: Unknown onset
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
Tx for CD
Parent Management Training (PMT)
Reward for + behavior replaces physical punishment
Multi-systemic Treatment (MST)
Substance Use Disorders
2 Sx in 12 mos: --impaired control --social impairment --risky use --pharmacological criteria (tolerance/withdrawal) All classes of drugs except caffeine
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
Tx for substance use disorder
Naltrexone (opiod antagonist)
Disulfiram (Antabuse)
Nicotine replacement or bupropion (tobacco)
Sedation, hypnotic or Anxiolytic Intoxication
Slurred speech Incoordination Unsteady gait Nystagmus Impaired cognition Stupor/coma
Sedation, Hypnotic or Anxiolytic withdrawal
Hyperactivity Hand tremor Insomnia Anxiety Nausea/vomiting Transient hallucinations Grand mal seizures Psychomotor agitation
Inhalant Intoxication
Drowsiness Nystagmus In coordination Stupor/coma Euphoria Slurred speech Unsteady gait Lethargy Blurred vision Depressed reflexes Psychomotor retardation Tremor General muscle weakness
Tobacco withdrawal
Irritability/anger Anxiety Poor concentration Increased appetite Restlessness Low mood Insomnia
Neurocognitive disorders 6 domains of (poor) cog functioning
Complex attention Executive functioning Memory and learning Language Perceptual- motor Social cognition
Delirium
Disturbance in attention/awareness over short period
Tends to fluctuate in severity thru day
At least one additional cog disturbance
Delerium high risk groups
Older adults Low cerebral reserve Post cardiotomy patients Burn patients Drug dependent but in withdrawal
Tx goals for Delerium
Treat cause
Reduce agitated behaviors thru environ manipulation + psychosocial interventions
Haloperidol
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
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
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
Stages of Alzheimer’s
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
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
Personality Disorders – clusters
Cluster A–> Odd/Excentric
Cluster B –> Dramatic, emotional, erratic
Cluster C –> Anxiety, fearfulness
Age of onset for PDs
Adolescence or early adulthood
If under 18, need Sx for 1 yr
Antisocial PD no Dx under 18
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
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
Schizotypal PD
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
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
ASSOCIATED Sx of Antisocial PD
Inflated sense of self
Lack of empathy
Superficial charm
Borderline PD ages
most common ages 19-34
By age 40: 75% DNQ
features of DBT
group skills training
Individual outpatient therapy
Telephone consult
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
Narcissistic PD
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
Avoidant PD
social inhibition, inadequacy
Dependent PD
Need to be taken care of
Submissive
Clingy
Obsessive-Compulsive PD
Preoccupied with order
PERFECTIONISM
Does NOT involve obsessions or compulsions
