Abnormal Psychology Final Flashcards
7 Disorders characterized under Somatoform Disorders
- Somatization Disorder
- Undifferentiated Somatoform Disorder
- Conversion Disorder
- Pain Disorder
- Hypochondriasis
- Body Dysmorphic Disorder
- Somatoform Disorder not otherwise specified
What is… presence of physical symptoms that suggest a general medical condition and are not fully explained
Somatoform Disorder
Hysteria
Briquets Syndrome
Characterized by 4 symptoms
Somatization Disorder
4 symptoms of Somatization Disorder
- Pain
- GI
- Sexual
- Pseudo Neurological
Characterized by unexplained physical complaints lasting at least 6 months
Undifferentiated Somatoform Disorder
Affects voluntary motor or sensory function that suggest a neurological or other general medical condition. Psychological factors are judged to be associated with the symptoms or deficits
Conversion Disorder
All psychological, ex: cannot speak
Characterized by pain
Psychological factors are also judged to have important role in onset
Pain Disorder
Preoccupation with the fear of having, or the idea that one has a serious disease based on misinterpretation of bodily symptoms or functions
Hypochondriasis
Preoccupation with imagined or exaggerated defect in physical appearance
Body Dysmorphic Disorder
AKA BDD
4 Subtypes of Conversion Disorder
- With motor symptom or deficit
- With sensory symptom or deficit
- With seizures or convulsions
- With mixed presentations
Subtype includes: impaired coordination or balance, paralysis, localized weakness, aphonia, urinary retention, difficulty swallowing
Conversion Disorder with Motor Symptom or Deficit
Subtype includes: loss of touch or pain sensation, double vision, blindness, deafness and hallucinations
Conversion Disorder with Sensory Symptom
Subtype includes: Seizures or convulsions with voluntary motor or sensory components
Conversion Disorder with Seizures or Convulsions
Subtype used if symptoms of more than one category are evident
Conversion Disorder with mixed presentations
What is the relative lack of concern about the nature or implications of the symptom?
La Bella Indifference* NBCE
(it doesn’t both pt that they are causing their seizures or are paralyzed)
CONVERSION DISORDER
Patients with _____ ______ of ______ ______ (umbrella/header term) sometimes forget where the pain was?
Pain Disorder
Somatoform Disorder
Very Common
Actually Show Symptoms
Fear of having a serious disease
Hypochondriasis
5+ symptoms present during same 2 week period. Must include Depressed mood or loss of interest in pleasurable activities
Criteria for Major Depressive Episodes
3 Associated descriptive features and mental disorders for what?
- Panic Attacks
- Suicide
- Increase in Premature death
Major Depressive Episode
What are the 3 Associated descriptive features and mental disorders for Major Depressive Episode?
- Panic Attacks
- Suicide
- Increase in Premature death
EEG Abnormalities
Deregulation of Neurotransmitters
Hormone Disturbances
Major Depressive Episode Associate Lab Findings
Elevated, expansive or irritable mood lasting at least 1 week
Manic Episode
Symptom of Grandiosity Increased/ Excessive involvement in Pleasurable Activities Pressure of speech Flight of ideas Decreased need for sleep
Manic Episode
Hypomanic Episode
Mixed Episodes must last how long?
At least 1 week
What must be met to have a mixed episode?
Criteria for BOTH
Major Depressive Episode
Manic Episode
Nearly everyday
Abnormally and persistently elevated, expansive, or irritable mood that lasts at least 4 days
Hypomanic Episode
Psychomotor Retardation
Diminished ability to think/ concentrate
Significant weight loss
Insomnia or hypersomnia
Major Depressive Episode
Increased cortisol secretions
Abnormalities in Neurotransmitters (ie. norepinephrine)
Manic Episode Associated Lab Findings
Characterized by 1 or more Major Depressive Episode without a history of Manic, Mixed or Hypomanic
Major Depressive Disorder
4 Main Treatments of Major Depressive Disorder
- Antidepressants- TCA’s (tricyclics antidepressants)
- SSRI’s (Selective Serotonin Reuptake Inhibitor)
- MAOI’s (Monoamine oxidase inhibitors)
- NRI’s/ SNRI’s (norepinephrine and serotonin-norepinephrine reuptake inhibitors)
4 Non-Drug related Treatments of Major Depressive Disorder
- St. John’s Wort
- ECT (Electroconvulsive therapy)
- TMS (Transcranial Magnetic Stimulation)
- Exercise
Depressed mood for most of the day for at least 2 years
Dysthymic Disorder
Associated Features are similar to Major Depressive Disorder
Dysthymic Disorder
Lab findings of Dysthymic Disorder show….
Sleep abnormalities/ Disorders
Occurence of a major depressive episode accompanied by one or more Manic Episodes or Mixed Episodes
Bipolar I Disorder
3 categories of Bipolar Disorder
Bipolar I
Bipolar II
Cyclothymic
Completed suicide Child Abuse Spousal Abuse School/ Occupational Failure Associated with alcohol
Bipolar I
Associated mental disorders include: Anorexia nervosa, Bulimia Nervosa, ADHD, Panic Disorder and Social Phobia
Bipolar I
Imaging studies show increased rates of right-hemispheric lesions, or bilateral sub cortical or periventricular lesions
Brain Lesions
Bipolar I Associated Lab Findings
Differential Diagnosis of... Major Depressive Manic Mixed Hypomaic
Must be distinguished from episodes of a mood disorder due to a general medical condition
Bipolar I
Bipolar II
Occurence of one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode
Bipolar II
Completed suicide
School/occupational failure
Borderline Personality Disorder (Common)
Substance abuse/dependence
Bipolar II
60-70% of the Hypomanic Episodes in _______ __ Disorder occur immediately before or after a Major Depressive Episode
Bipolar II
Distinguished by the presence of one or more Manic or Mixed Episodes in the latter
Bipolar I distinguished from Bipolar II
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Chronic, Fluctuating mood disturbance
Cyclothymic Disorder of Bipolar Disorder
Short term treatment of Bipolar Disorders (3)
- Rapidly acting Antimanic and sedating doses of benzodiazepine
- Lithium
- ECT (electroconvulsive therapy)
Long term treatment of Bipolar Disorders (4)
- Litium salts- major reduction in risk of suicide by 80%
- Anticonvulsants- FDA approved as only mood-stabilizing agent not indictated for acute mania
- Antipsychotics- FDA approved 4 in this category
- Antidepressants- potentially lethal
Include: Carbamazepine, Valproic Acid Salts, Oxcarbazepine and lamotrigine
Anticonvulsants= treatment of Bipolar Disorder
Include: Chlorpromazine, Olanzapine, Quetiapine and Risperidone
Antipsychotics= treatment of Bipolar Disorder
2 Non-Pharmaceutical treatments of Bipolar Disorder
- Biological rhythms and hygiene measures: attention to sleep hygiene and maintaining regular daily rhythms of activity, meals, rest and avoiding alcohol/stimulants
- Psychosocial interventions: interpersonal psychotheraphy has increasing positive results
Interpersonal psychotheraphy has increasing positive results
Psychosocial interventions of Non-Pharm. treatments of Bipolar Disorder
Attention given to sleep hygiene and maintaining regular daily rhythms of activity, meals, rest as well as avoiding alcohol and substances
Biological Rhythms and Hygiene Measures of Non Pharm. treatment of Bipolar Disorder
Caused by Genetic and Non-Genetic Factors
Schizophrenia
Factors vary from insults during early brain development as well as social stressors
Schizophrenia Non-Genetic Factors
4 Major Categories of Schizophrenia
- Delusions
- Hallucinations
- Disorganized speech- derailment or incoherence
- Grossly disorganized or Catatonic Behavior
2 or more of the symptoms are present for a significant portion of time during a 1 month period
Schizophrenia
Inappropriate affect (smiling, laughing in absense of appropriate stimulus)
Depersonalization
Derealization
Anxiety and Phobia
Increased incidence of assultive and violent behavior
Nicotene dependence
Schizophrenia Associated Descriptive Features and Mental Disorders
City boy’s disease
Schizophrenia
Shows enlargement of the lateral ventricles, decreased brain tissue, decreased volumes of gray and white matter
Schizophrenia Assocaited Lab Findings
Temporal lobe is decreased in volume while frontal lobe is least implicated
Schizophrenia Assocaited Lab Findings
Focal abnormalities within temporal lobe
Schizophrenia Assocaited Lab Findings
Decreased thalamic volume and increased basal ganglia size
Schizophrenia Assocaited Lab Findings
Neuropsychological deficits- memory, psychomotor, attention and changing response set
Schizophrenia Assocaited Lab Findings
Neurophysiological abnormalities- difficulty in perception and processing of sensory stimuli= slow reaction time
Schizophrenia Assocaited Lab Findings
Water Intoxication- too much water intake resulting in abnormalities in urine specific gravity or electrolyte imbalances
Schizophrenia Assocaited Lab Findings
Presence of Neurological “soft signs”- left and right confusion, poor coordination or mirroring
Schizophrenia Associated Physical Examination findings and general medical conditions
Most common physical findings are motor abnormalities
Schizophrenia Associated Physical Examination findings and general medical conditions
Nicotine Dependence is common
Schizophrenia Associated Physical Examination findings and general medical conditions
Onset btw late teens and mid 30’s
18-25 men
25-mid 30’s women
Schizophrenia
Women have better prognosis, express more affective symptomology, paranoid delusions and hallucinations whereas men tend to express more negative symptoms (withdrawl)
Schizophrenia
Higher rates and risks are seen in urban born individuals compared to rural born individuals
Schizophrenia
Higher rates of having it in family members of women with it than those for men
Schizophrenia
Psychotic Disorder due to a general medical condition, or delerium or dementia- there has to be a history, physical exam, or lab findings
Schizophrenia Differential Diagnosis
Substance induced psychotic disorder, substance induced delirium and substance induced persisting dementia- must be substance of cause
Schizophrenia Differential diagnosis
Mood Disorder with Psychotic features and schizoaffective disorder define…
Schizophrenia Differential Diagnosis
Must be a mood episode that is concurrent with the active-phase symptoms over a period of time
Must have a Major Depressive Episode, Manic Episode (Mood Episode)
Schizoaffective
Symptoms are the same as Schizophrenia but they last a month not 6 months and need not have social/occupational impairment
Schizophreniform Disorder
4 Subtypes of Schizophrenia
- Paranoid
- Disorganized
- Catatonic
- Residual
Characterized by presence of prominent delusions or auditory hallucinations
Paranoid Type Schizophrenic
Characterized by disorganized speech, behavior and flat or inappropriate affect- silliness/laughter unrealted to content
Disorganized Type Schizophrenic
Characterized by a marked psychomotor disturbance that may involve motor immobility or excessive motor activity, echolalia (repeating words spoke by someone else) or echopraxia (repeating movement of someone else)
Catatonic Type Schizophrenic
Has had at least one episode of Schizophrenia but the current clinical picture is without prominent positive psychoic symptoms (ie hallucinations, delusions and disorganization of speech)
Residual Type Schizophrenic
Treatment of Schizophrenia? (2)
- Antipsychotic drugs
2. Psychotropic medication
Clozapine, olanzapine, risperidone, quetiapine, ziprasidone an daripiprazole
Antipsychotic drugs used to treat schizophrenia
Include mood stabilizers such as valproic acid and lithium, tranquilizers such as benzodiazepines, and novel approaches, such as glycine
Psychotropic medication for treatment of schizophrenia
2 types of eating disorders
- Anorexia Nervosa
2. Bulimia Nervosa
Individual refuses to maintain a minimally normal body weight
Anorexia nervosa
Has depressive symptoms and Obsessive compulsion features
Anorexia Nervosa
Concerns about eating in public, control issues and perfectionism
Anorexia Nervosa
Semi-Starvation affects most major organ systems
Anorexia nervosa Lab finding
Hematology: mild anemia, dehydration reflected by elevated blood urea nitrogen
Anorexia nervosa Lab Finding
Hypercholesterolemia
Anorexia nervosa Lab finding
Elevated liver function tests
Anorexia nervosa Lab finding
Hypomagnesaemia, hypozincemia, hypophosphatemia, hyperamylasemia
Anorexia nervosa Lab finding
Induced vomiting may lead to metabolic alkalosis and laxative abuse may lead to metabolic acidosis
Anorexia nervosa Lab finding
Decreased levels of T3 + T4
Anorexia nervosa Lab finding
Females have low estrogen
Males have low serum testosterone
Anorexia nervosa Lab finding
Electrocardiography: sinus bradycardia and sometimes, arrhythmias are observed
Anorexia nervosa Lab finding
Electroencephalography: metabolic encephalopathy seen due to fluid and electrolyte imbalances
Anorexia nervosa Lab finding
Brain Imaging: increase in ventricular-brain ratio secondary to starvation are seen
Anorexia nervosa Lab finding
Resting energy expenditure is often reduced
Anorexia nervosa Lab finding
Amenorrhea
Constipation, Abdominal pain, cold intolerance, lethargy and excess energy
Emaciation
Hypotension, hypothermia, dryness of skin, peripheral edema
Hypertrophy of salivary glands (esp. parotid)
Anorexia nervosa Lab finding
More common in industrialized societies
Anorexia nervosa Course and prevalence
Bulimia Nervosa
More than 90% of cases are found in females
Anorexia nervosa Course and prevalence
Bulimia Nervosa
Onset is 14-18 years and rare after 40
Anorexia nervosa Course and prevalence
Onset is associated with stressful living
Anorexia nervosa Course and prevalence
Death usually occurs from starvation, suicide or electrolyte imbalance
Anorexia nervosa Course and prevalence
Occult Malignancies
Brain Tumors
GI disease
AIDS
Anorexia nervosa Differential Diagnosis
Superior Mesenteric Artery Syndrome
Anorexia nervosa Differential Diagnosis
Recurrent episodes of binge eating
Bulimia Nervosa
Self evaluation unduly influenced by body shape and weight
Bulimia Nervosa
2 subtypes of Bulimia Nervosa
- Purging type
2. Non-purging type
Individual engages in self induced vomiting or misuses laxatives, diuretics or enemas
Purging Type Bulimia Nervosa
Uses other inappropraite compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas
Non-Purging Type Bulimia Nervosa
Individuals are within normal weight range
Bulimia Nervosa
Is uncommon among moderate to morbidly obese peope
Bulimia Nervosa
Increased depressive symptoms as well as anxiety issues which remit after effective treatments
Bulimia Nervosa
Lifetime prevalence of substance abuse or dependence
Bulimia Nervosa
Hypokalemia, Hypoatremia and Hypochloremia from fluid imbalance
Bulimia Nervosa Lab Findings
result of purging
Metabolic acidosis from loss of stomach acid
Bulimia Nervosa Lab Findings
thru vomiting or induction of diarrhea through laxative abuse
Teeth appear “moth eaten”
Bulimia Nervosa
Increased dental cavaties
Enlarged salivary glands
Serious cardiac and skeletal myopathies
Bulimia Nervosa
Esophageal tear, gastric rupture, cardiac arrhythmias
Rectal prolapse
Menstral irregularities or amenorrhea
Bulimia Nervosa
Onset is late adolescence or early adulthood
Bulimia Nervosa
Binge episodes occur after periods of fasting
Only occurs when binge eating and purging is involving anorexia nervosa pts (it can be hard to differentiate)
Anorexia Nervosa, Binge-Eating/Purging Type Differential Diagnosis Bulimia Nervosa
Usually a neurological syndrome involving disturbed eating behavior but characteristic trends of Bulimia Nervosa such as over concern with body shape and weight are absent
Kleine-Levin Syndrome Differential Diagnosis Bulimia Nervosa
Over eating is common but there are no compensatory behaviors or over concerns with body shape and weight
Major Depressive Disorder, with atypical features Differential Diagnosis Bulimia Nervosa
Essential feature is a cluster of cognitive, behavioral, and physiological symptoms
Substance related disorder
Cluster of 3 or more symptoms of substance abuse occurring in the same 12-month period
Dependence of Substance related disorder
Need for greatly increased amounts of the substance to achieve intoxication or a markedly diminished effect with continued use of the same amount of the substance
Tolerance of Substance related disorder
Maladaptive behavioral change, with physiological and cognitive concomitants, that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance
Withdrawl of substance related disorder
3 requirements for substance abuse?
Dependence
Tolerance
Withdrawal
Criteria for substance dependence
Tolerance
Withdrawl
Persistent desire or unsuccessful efforts to cut down or control substance use
Substance is continued despite knowledge
Substance taken in larger amounts or over a longer period than was intended
Maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances
Substance Abuse
Individual repeatedly demonstrates intoxication or other substance-related symptoms when expected to fulfill major role obligations at work, school or home
Substance Abuse
Development of a reversible substance-specific syndrome due to the recent ingestion of a substance
Substance Intoxication
Common changes include disturbance of perception, wakefulness, attention, thinking, judgement, psychomotor behavior and interpersonal behavior.
Substance Intoxication
Maladaptive behavioral change, with physiological and cognitive concomitants, that occurs when blood pressure or tissue concentrations of a substance decline
Substance withdrawal
Blood and urine analysis help to determine recent use of substance
Blood concentration reveals amount of product still in body, withdrawal patterns and tolerance level
Substance abuse lab findings
Presence of clinically significant maladaptive behavioral or psychological changes usually accompanied by evidence of slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, or stupor or coma
Alcohol Intoxication
Most frequently used brain depressant and cause of considerable morbidity and mortality in most cultures
Alcohol
Presence of a characteristic withdrawal syndrome that develops after the cessation of heavy and prolonged alcohol use
Alcohol Withdrawal
Includes: autonomic hyperactivity, increased hand tremor, insomnia, psychomotor agitation, anxiety, nausea/ vomiting, grand mal seizures, tactile or auditory hallucinations
Alcohol Withdrawal
Class includes all substances with a substituted-phenylethylamine structure, such as amphetamine, dextroamphetamine, and methamphetamine (speed)
Amphetamine
Also incudes: methylphenidate or agents used as appetite suppressants (diet pill), snorting pills, ice, crack
Amphetamine
May be obtained by prescription
Amphetamines
Treatment of obesity, ADHD and Narcolepsy
Amphetamines
Begins with a “high” feeling, followed by symptoms such as euphoria with enhanced vigor, hyperactivity, restlessness, hypervigilance, interpersonal sensitivity, talkativeness, anxiety, tension, and impaired judgement
Amphetamine Intoxication
Behavioral and phycological changes are accompanied by tachycardia or bradycardia, papillary dilation, elevated or lowered BP, perspiration or chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, muscle weakness, respiratory depressive, chest pain, confusion, seizures, coma, etc
Amphetamine (Intoxication)
6 sources for caffeine
- Tea
- Coffee
- Caffeinated soda
- OTC analgesics +Cold remedies
- Weight loss aids
- Antidrowsiness pills
Symptoms include: restlessness, nervousness, excitement, insomnia, flushed face, diuresis, gastrointestinal disturbance, muscles twiching, rambling flow of thought and speech, tachycardia or cardiac arrhythmia, psychomotor agitation
Caffeine Intoxication
Substances derived from the Cannabis plant and chemically similar synthetic compounds
Cannabis related disorders
Upper leaves, tops, and stems of the plant are cut, dried, and rolled into cigarettes, the product is called…
marijuana
bhang
… is the dried resinous exudate that seeps from the tops and undersides of cannabis leaves
hashish
Concentrated distillate of hashish
Hashish oil
Primary cannabis responsible for the psychoactive effects
Delta-9-Tetrahydrocannabinol
THC
Delta-9-THC
Used for certain general medicaitons (nausea and vomiting caused by chemo., anorexia, and weight loss in AIDS pts)
Synthetic Delta-9-THC
Develops within minutes. Symptoms include: maladaptive behavioral or psychological changes such as impaired motor coordination, euphoria, anxiety, sensation of slowed time, impaired judgment, social withdrawal, conjunctival injection, increased appetite, dry mouth and tachycardia
Cannabis intoxication
Contains larger amounts of known carcinogens than tobacco
Marijuana smoke
Most commonly used illicit substance
Cannabis
“gateway drug”
Users later go on to develop dependence on other substances
Cannabis
Actions on CB1 and CB2 cannabinoid receptors that are found throughout the CNS. Endogenous ligands for these regeptors, anandamide and N-palmitoethanolamide, behave essentially like neurotransmitters
Cannabis
Urine tests show metabolites since they are fat soluble, they persist in body fluids
Cannabis Lab findings
7-10 days for casual users
2-4 weeks for heavy users
Cannabis Lab findings
Suppressed immunological function
Suppressed secretion of testosterone and luteinizing hormone (LH)
Cannabis Lab findings
Naturally occurring substance produced by the cocoa plant
Cocaine
Consumed in several preparations- leaves, paste, hydrochloride and alkaloids such as free base and crack that differ in potency due to varying levels of purity and speed of onset
Cocaine
Commonly used term for cocaine in US
Crack
Extracted from its powdered hydrochloride salt by mixing it with sodium bicarbonate and allowing it to dry into small rocks
Crack
Differs from other forms of cocaine in that it is easily vaporized and inhaled thus effects have an extremely rapid onset
Crack
Begins with a “high” feeling and includes: euphoria with enhanced vigor, hyperactivity, restlessness, hypervigilance, interpersonal sensitivity, talkativeness, anxiety, tension, altertness, grandiosity, stereotyped and repetitive behavior, anger and impaired judgement
Cocaine Intoxication
Symptoms are accompanied by: tachycardia/bradycardia, papillary dilation, elevated or lowered blood pressure, perspiration or chills, muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias, confusion, seizures or coma
Cocaine Symptoms
Short acting drug that produces rapid and powerful effects on the CNS, especially when taken intravenously or smoked.
Cocaine
Erratic criminal behavior, social isolation, sexual dysfunction are seen in long term dependence
Cocaine
Associate with rambling of speech, headache, tinnitus, auditory and tactile hallucinations, aggressive behavior, mood changes such as depression, suicidal ideation, irritability and attention disturbances
Cocaine
Tactile hallucinations of Cocaine AKA
Coke Bugs
Remains in urine for 1-3 days after a single dose
Cocaine Lab findings
May be present in urine for 7-12 days in those using repeatedly
Cocaine Lab findings
Mild elevation of liver function tests
Cocaine Lab findings
Hepatitis, STD (HIV), and TB may be associated with this
Cocaine Lab findings
Diverse group of substances includes Ergot and related compounds (lysergic acid diethylamide-LSD, morning seeds), phenylalkylamines (STP, Ecstasy)
Hallucinogen Dependence
Induced by inhaling the aliphatic and aromatic hydrocarbons found in substances such as gasoline, glue, paint thinners and spray paints
Inhalant Related Disorders
Active ingredients include Toluene, benzene, acetone, tetrachloroethylene and methanol
Inhalant related disorders
Typically, a rag is soaked with the substance and applied to mouth and nose as the vapors are breathed in (Huffing)
Inhalant related disorders
Symptoms include: confusion, assaultiveness, apathy, impaired judgement, dizziness, visual disturbances, blurred vision, nystagmus, incoordination, slurred speech, unsteady gait, tremor, euphoria, and psychomotor retardation
Inhalant Related Disorders
Dependence and withdrawal resulting from all forms of tobacco
Nicotine Related disorders
55-90% of the population with mental illnesses has this disorder…
Nicotine Related disorders
Bronchitis or chronic obstructive lung disease are the result of
Nicotine Related disorders
Dry or productive cough, decreased heart rate, increased appetite or weight gain
Nicotine Related disorders Lab Findings
Most common signs of dependence include: odor, cough, evidence of chronic obstructive pulmonary disease and excessive skin wrinkling
Nicotine Related disorders Lab Findings
Increases risk of lung, oral and other forms of cancer, cardiovascular and cerebrovascular conditions due to the presence of carcinogens and carbon monoxide
Nicotine Related disorders Lab findings
Include Natural, Synthetic and Semisynthetic
Opioids
Morphine
Natural Opioids
Heroin
Semisynthetic Opioids
Morphine like action include: Codeine, hydroorphone, methadone, oxycodone, meperidine, fentanyl
Synthetic Opioids
Prescribed as analgesics, anesthetics, antidiarrheal agents or cough suppressants
Opioids
Most commonly misused drug in the opioid class
Heroin
Commonly associated with a history of drug related crimes, such as distribution of drugs, forgery, burglary or robbery
Opioid dependence
Lack of secretions, causing dry mouth and nose, slowing of GI activity and constipation are common
Opioid Lab Findings
Impaired visual activity as a result of papillary constriction, presence of sclerosed veins in those who use it intravenously
Opioid Lab findings
Include Phencyclidine (PCP, Sernylan) and less potent Ketamine (Ketalar, Ketaject), cyclohexamine and dizocilpine
Phencyclidine (Phencyclidine-Like) Related disorder
First developed as dissociative anesthetics in 50’s and became street drugs in the 60’s
Phencyclidine (Phencyclidine-Like) Related disorder
Most commonly abused drug in the Phencyclidine (Phencyclidine-Like) Related disorder group
Phencyclidine
Sold illicitly under names such as PCP, Hog, Tranq, Angel Dust and Peace Pill
Phencyclidine
Cause Schizophrenia and cause Vertigo, ataxia, nystagmus, hypertension, nausea, slow reaction time, slurred speech and abnormal involuntary movements
Phencyclidine (Phencyclidine-Like) Related disorder
Creatine phosphokinase (CPK) and serum glutamic-oxalo-acetic transaminase (SGOT) are often elevated, reflecting muscle damage
Phencyclidine (Phencyclidine-Like) Related disorder lab findings
Extensive cardiovascular and neurological toxicity- seizures, dystonias, dyskinesia, hypothermia, hyperthermia
Phencyclidine (Phencyclidine-Like) Related disorder lab findings
Almost half of individuals with this intoxication present with nystagmus or elevated BP, these physical signs can be useful in identifying this kind of user
Phencyclidine (Phencyclidine-Like) Related disorder lab findings
Phencyclidine user
Also present with apnea, brochospasm, bronchorrhea, hyper salivation, aspiration during coma and Rhabdomyolysis with renal impairment is seen in cases seeking emergency care
Phencyclidine (Phencyclidine-Like) Related disorder Lab Findings
Group includes: Benzodiazepines, Carbamates, Barbiturates, Barbiturate like hypnotics and Benzodiazepine like drugs
Sedative, Hypnotic or Anxiolytic Related Disorders
Glutethimide and meprobamate are examples of
Carbamates
Zolpidem and Zaleplon are examples of
Benzodiazepine like drugs
Secobarbital example of
Barbiturates
Glutethimide and Methaqualone are examples of
Barbiturate like hypnotics
Like alcohol these substances are brain depressants
Sedative, Hypnotic or Anxiolytic Related Disorders
Associated with dependence on, or abuse of other substances
Sedative, Hypnotic or Anxiolytic Related Disorders
Diagnosis is reserved for individuals who use at least three groups of substances repeatedly in the same 12 month period but not caffeine and nicotine
Polysubstance Dependence
The primary diagnostic tool available to the psychiatrist is the ….
Clinical Interview
The interview used to gather information and to understand how the person feels is part of the…. which helps you offer correct and….
Diagnostic Evaluation
Effective Treatment
18 Parts of the Interview
- Place
- Meeting the Patient
- Take notes of the Interview
- Focus on Time
- Define the goals of the Interview
- Help you patient tell you what is wrong
- Begin with general questions
- Provide structure
- Invite the patient to talk
- Avoid leading questions
- Elaborate
- Echoing the tone
- Summarize what the patient has said
- Avoid Why Questions
- Address what is going on in the room
- Set limits on inappropriate behavior
- Monitor your reactions to the patient
- Closing the interview
2 major forms of treatment in modern psychiatry are….
1 Psychotherapies
2. Somatic Therapies
Include those means by which a therapist attempts to provide new interpersonal experience for anther human being
Psychotherapies
Psychotherapy has 2 major models
- Psychodynamic Therapy
2. Behavior Therapy
Focuses on Childhood Experiences
Psychotherapies
Conflicts and deficits are key concepts in the psychodynamic model
Psychotherapies
Refer to the opposition between seemingly irreconcilable forces
Conflicts
Make one incapable of certain activities most people take for granted
Deficits
Behavior Therapy focuses on observable actions rather than inferred mental states and aims to eliminate maladaptive behaviors using techniques that are based largely on learning theory
Psychotherapies
6 Models of Behavior Therapy
- Systematic Desensitization
- Flooding
- Positive Reinforcement
- Negative Reinforcement
- Extinction
- Aversive Conditioning
This is mastering anxiety-provoking situations by approaching them gradually and in a relaxed state that inhibits anxiety
Systematic Desensitizaiton
Confronting the fearing stimulus for prolonged periods until it is no longer frightening
Flooding
Strengthening positive behavior and causing it to occur more frequently by rewarding
Positive Reinforcement
Making behavior occur more frequently by removing a noxious stimulus when the desired behavior occurs
Negative Reinforcement
Decreasing behavior by not responding to it
Extinction
Applying a noxious stimulus to make a behavior occur less frequently
Aversive Conditioning
Are Physiologically based therapies used in modern psychiatry (2 forms of treatment)
- Psychotropic Medications
- ECT
Fall under Somatic Therapies
Treatments include: hydrotherapy, insulin shock, neurosurgery, and sedation with narcotics, barbiturates and bromides
Somatic Therapies
4 Major groups of Psychotic Medications
- Antipsychotic Agents
- Antidepressant Meds
- Antimanic Agents
- Anticonvulsant Meds
3 Major disadvantages of using psychotropic medications
- They do not cure
- They have side effects and toxicity
- They are generally slow to action
Axis II
Personality Disorders
Mental Retardation
Axis III
General Medical Conditions
Axis IV
Environmental Problems
Psychosocial Problems
Axis I
Clinical Attention NOT Mental Retardation
Axis V
Global Assessment of Functioning Scale
