Behavioral Science Flashcards
Piaget Cognitive Stages:
development from stage to stage relies on maturation of the nervous system and life experiences
Sensorimotor (0-2 y) ->object permanence
Pre-operational Thought (2-5 y) -> immanent justice
Concrete Operations (5-11 y)
Formal Operations (11-18 y)
Freud’s Phases of Psychosexual Development:
The developmental stages progress as the child focuses of libidinal energy changes to different erotic areas
Oral (0-1 y) Anal (1-3 y) Phallic (3-5 y) Latency (5-11 y) Genital (11-18 y)
Erikson’s Psychosocial Stages:
The person is able to achieve a new and higher level of functioning if each stage is successfully resolved.
BasicTrust vs Mistrust (0-1 y) Autonomy vs. Shame & Doubt (1-3 y) Initiative vs. Guilt (3-5 y) Industry vs Inferiority (5-11 y) Ego Identity vs Role Diffusion (11-20 y) Intimacy vs. Isolation (21-40 y) Generativity vs. Stagnation (40-60 y) Ego Identity vs. Despair (60 to death)
age when separation anxiety disorder may occur
after age 3 (failure of sensorimotor object permanence - Piaget)
Note: stranger anxiety begins around 7 months
age when begins to form internal moral sense of right and wrong
begins to understand the finality of death
age 6
infertility
inability of a couple to conceive after 1 year of coitus without use of a contraceptive
Fetal Alcohol Syndrome
Alcohol reduces number of active dopamine neurons in the brain; ADHD is associated with decreased dopaminergic activity in the brain
other characteristics:
growth retardation, microphthalmia, short palpebral fissures, midface hypoplasia, delayed development, learning disabilities, intellectual deficits, seizures
Teratogens
antibiotics, anticonvulsants (carbamazepine, phenytoin), lithium, warfarin, progesterone-estrogens
exposure to SSRIs in last month of pregnancy causes
seizures
startle reflex present at birth and disappears by 4 months
Moro reflex
age when infant smiles in response to human face
2-3 months
age when infant rolls over
5 months
age when infant sits unassisted
6 months
age when infant crawls and pulls up to stand
7-11 months
age when infant walks unassisted
12-15 months
methods of abortion
suction curettage (1st trim)
dilation & extraction (2nd trim)
Induction of labor (2nd trim)
Mifepristone (up to 9 weeks)
symptoms of postpartum depression
depressed mood longer than 2 weeks
excessive anxiety
insomnia
change in weight
unconscious and the root of impulse, pleasure-based
drives libido
Id
the executive organ of the psyche
controls behaviors and thoughts
ego
regulates the ego and is unconscious
formed from the internalization of society standards, moral conscience
superego
BasicTrust vs Mistrust (0-1 y) stressor causes
dysthymia, schizophrenia, depression
Autonomy vs. Shame & Doubt (1-3 y) stressor causes
OCD, delusional or impulsive disorders
Initiative vs. Guilt (3-5 y) stressor causes
showing off, psychosomatic disease, generalized anxiety disorders and phobias, sexual inhibition
Industry vs Inferiority (5-11 y) stressor causes
compensatory drive for money, power, prestige
Ego Identity vs Role Diffusion (11-20 y) stressor causes
conduct disorder, disruptive behavior disorder, gender identity disorder, schizophrenia & other psychotic disorders
Intimacy vs. Isolation (21-40 y) stressor causes
schizoid personality disorder isolating person
Ego Identity vs. Despair (60 to death) stressor causes
psychosomatic illnesses, hypochondriasis, depression
*note suicide rate is highest in age 65+
Mahler: theory of separation-individuation
Normal Autistic Phase (0-4 weeks) Normal symbiotic phase (4w - 5 months) Differentiation (5-10 months) Practicing (10-16 months) Rapprochement (16-24 months) Consolidation & Object Constancy (24 - 36 months)
learning takes place as a result of the contiguity of the environmental events - association by two events happening closely in time
Classic conditioning
learning results from the consequences of one’s actions
Operant conditioning
deficits in cognitive abilities as well as in behaviors for social and personal sufficiency present before age 18
mental retardation
Evaluate with IQ test
IQ 50-70 mild -> can live independently
IQ 35-50 moderate ->semiskilled work as adult
IQ 20-35 severe-> supervised living as adult
IQ <20 profound
causes of mental retardation
chromosomal abnormalities, subclinical lead intoxication, prenatal exposure to drugs, alcohol or other toxins
Prenatal: maternal viral infections, uncontrolled DM,
CMV Inclusion disease (calcification, microcephaly, hydrocephalus), syphilis, herpes, AIDS, prematurity, anoxia/complications with pregnancy
pharm treatment for mental retardation
methylphenidate for ADHD comorbidity
lithium for aggression & self-injurious behavior
SSRIs for depression
haldol & chlorpromazine for repetitive self-stimulating behaviors
beta-blockers for explosive rages
symptoms in 3 categories:
-qualitative impairment in social interaction
-impairment in communication
-restrictive, repetitive & stereotyped patterns of behavior or interests
delayed development of language
obsessive desire for sameness & dread of change
poor eye contact
male> female
70% mentally retarded with 1/3 being mild-mod
Assoc with maternal bleeding, meconium in amniotic fluid, high incidence neonatal resp distress,
Increased head circumference
Autism disorder
Pharm tx:
escitalopram
methylphenidate for hyperactivity
risperidone for aggression, hyperactivity, self-injurious behavior
progressive encephalopathy at 6 months to 2 years
age of onset: 3-4 yr
predominantly in females
hand-wringing, licking & biting fingers, tapping & slapping
disorganized breathing during wake but normal during sleep
seizures in up to 75%
wheelchair bound after 10 years from muscle wasting
dx: loss of skills in 2 areas
-language, social or adaptive behavior
-bowel or bladder control
-play
-motor skills
Abnormalities in at least 2 of the following:
-reciprocal social interaction
-communication skills
stereotypes or restricted behavior
Rett’s disorder
Pharm tx:
treat the symptoms
anticonvulsants for seizures
Characterized by impairment & oddity of social interaction & restricted interest & behavior similar to autism disorder
- no delays in language, cognitive development, or age-appropriate self-help skills
- unknown cause
- markedly abnormal nonverbal communicative gestures
- failure to develop peer relationships
- lack of social or emotional reciprocity
- impaired ability to express pleasure in another person’s happiness
- children & adolescents rely on rigid rules & routines
Asperger’s disorder
Tx: supportive and encourage social behaviors & peer relationships
age when gender identity manifests
18 months, fixed by 24-30 months
* note: largely innate
period characterized by decreased biological and physiological functioning
climacterium
biology of aging
senescence
severe memory loss and a loss of intellectual functioning
senility
discrimination toward old persons and to negative stereotypes about old age that are held by young adults
ageism
best indicator of a long life (longevity)
family history of longevity
the ability or inability of an individual to make decisions, whether concerning medical, financial, or legal matters of the estate or person
capacity
legal term that reflects the decision of a court or judge and is based on the findings of a professional
competency
irretrievable cessation of circulatory and respiratory functions
irretrievable functions of the entire brain, including brainstem
death
Stages of Death and Dying (5)
- Shock and Denial
- Anger
- Bargaining
- Depression
- Acceptance
the clinical syndrome characterizing the acute psychological and physiological reaction of human beings to significant losses
grief
- note: pathologic grief occurs when the person is unable to fully comprehend or work through the loss
- narcotics interfere with normal grief process & grief therapy is effective
complex intrapsychic process in which a person withdraws attachment from a lost object and works through the emotional pain and injury of that loss
mourning
mental disorder characterized by grossly impaired reality testing
psychosis
mental disorder that is chronic and characterized by anxiety, obsession, compulsion, phobia or sexual dysfunction
neurosis
individual’s characteristic pattern of affect, emotional regulation, behavior, motivation, cognition about self, and interactions with others that are longstanding, present since adolescence or early adulthood
personality
defense mechanism in which facts or logical implications of external reality are refused recognition in favor of internally generated wish-fulfilling fantasies
denial
defense mechanism: repression of an individual’s unacceptable desires and impulses, instead attributing them to another person
projection
defense mechanism: partial return to an earlier stage in development and to become more childlike in behavior to escape anxiety and return to an earlier level of adjustment in which gratification was ensured
regression
- common in hospitalization
- can be precipitated by fatigue, drugs, chronic pain, stress or any situation that deprives a person of autonomy
- *Note: this is involuntary! Suppression is voluntary
defense mechanism: persistent inability to give up infantile or childish patterns for more mature ones
fixation
defense mechanism: the traits or attributes of another individual are taken on as the individual’s own
identification
defense mechanism: seal off feelings or “affects” allowing the cognitive idea to remain but repressing the emotional component
isolation and intellectualization
defense mechanism: redirecting emotion from its original object to a more acceptable substitute
displacement
defense mechanism: negate an unacceptable thought
-believing that one can magically reverse past events caused by “incorrect” behavior by now adopting “correct” behavior
undoing
defense mechanism: displacing various instincts or converting them into socially acceptable outlets
Ex: turning teenage rage into professional prize fighting
sublimation
most common behavioral symptom of epilepsy
change in personality
person has some conscious control over mimicking symptoms of a seizure
pseudoseizure
part of the brain active during sexual stimulation
orbitofrontal cortex
part of the brain with inhibitory or excitatory control over sexual reflexes
brainstem
neurotransmitter that increases libido
dopamine
neurotransmitter that inhibits sexual function
serotonin in upper midbrain and pons
part of the nervous system responsible for sexual arousal and climax
spinal cord
hormones which depress sexual desire (3)
progesterone, prolactin & cortisol
Freud’s view on homosexuality
- inhibition of masculine development by the parents
- strong fixation on the mother
- lack of effective fathering
- female homosexuality is the result of penis envy
sexual stimuli or acts that are deviations from normal sexual behaviors but are necessary for some persons to experience arousal and orgasm
paraphilias (perversions)
observing persons who are naked or engaged in grooming or sexual activity
voyeurism (scopophilia)
act of being humiliated, beaten, bound or made to suffer during sex
sexual masochism
autoerotic asphyxiation classified as sexual masochism
hypoxyphilia
involuntary muscle constriction of the outer third of the vagina, interfering with penile insertion
-can be psychological from hx of sexual trauma
vaginismus
FICA: how to address religion of patient
Faith or Beliefs
Influence of Beliefs
Community
Address -> how do these beliefs need to be addressed in health care
herbal remedy regulation
only need to prove safety and truth in labeling not efficacy to be sold
-not subject to FDA approval
presence of significant physiological or psychological threat resulting in acute or persistent strain on the body’s compensatory systems
stress
Bottom-up physiologic regulation of stress
the body’s compensatory mechanisms start at the cellular level and follow a level of complexity, with more complexity as move to higher levels (brain)
-Ex: baroreceptor response in orthostatic blood pooling
factors that increase adherence to medical regimen
- disease severity is high
- personal susceptibility to disease is high
- can manage the treatment regimen (self-efficacy)
- confidence treatment will be effective (response-efficacy)
- have the intention to perform the behavior (behavior intention)
- note: self-judgment is the most influential element over adherence
sustained diminished attention and higher levels of impulsivity in a child or adolescent than expected for someone of that age and developmental level
- symptoms must be present before age 7 but isn’t typically diagnosed until creates problems at school
- more prevalent in boys than girls
- higher risk if first-degree relative has
- explosive and emotionally labile
- lack of organization
- learning disabilities
- associated with parental: hyperkinesia, sociopathy, alcohol use, conversion disorder
- perinatal contributors: prenatal toxic exposures, prematurity, prenatal mechanical insult to fetal nervous system
- September birth
- 50% have symptoms that persist into adult life
ADHD
Pharm: methylphenidate dextroamphetamine amphetamine dextromethylphenidate atomoxetine (NE reuptake inhibitor) bupropion (DA, 5-HT and NE reuptake inhibitor) clonidine (alpha2 receptor antagonist)
Disruptive behavior disorder characterized by:
- enduring patterns of negativistic, disobedient and hostile behavior toward authority figures, as well as inability to take responsibility for mistakes
- argues with adults and becomes easily annoyed by others
- difficulty in classroom and with peers
- typically girls
- symptoms observed at home before in public
- friendless
- do poorly in school or fail
- low self-esteem, depressed mood, temper outbursts
- often evolves into mood disorder or conduct disorder
- may abuse alcohol and illegal substances
- may be present with ADHD, mental retardation & cognitive disorders
Oppositional defiant disorder
tx: family intervention and child management skills
Disruptive behavior disorder characterized by:
- severe acts of repeated aggression that can cause physical harm to themselves or violate the rights of others
- aggression toward animals, destruction of property, deceitfulness or theft, multiple violations of the rules
- emerges in boys age 10-12; girls age 14-16
- associated with ADHD, depression, learning disorders, harsh punitive parenting, family discord, lack of parental supervision, lack of social competence, low socioeconomic level
- truancy from school before age 13
- bullying, threatening and intimidation
- children of parents who abuse alcohol or with antisocial personality disorder
- hx of child abuse or witness parental abuse
Conduct disorder
Lab: low 5-HIAA (serotonin metabolite)
EEG: increased activity in right frontal lobe during rest
Pharm: haldol, risperidone, olanzapine, quetiapine, aripiprazole
Psych: social skills training, family education and therapy, removal from home that is abusive/chaotic
Defense mechanism: create imaginary lives, especially imaginary friends
Fantasy
*fear of intimacy
Defense mechanism: denial; replacing something unpleasant with something pleasant
-often seen with inadvertent liars
Dissociation
Defense mechanism:some people are “all good” and some are “all bad”
Splitting
Defense mechanism: person turns his/her anger against himself/herself
-masochism
Passive aggression
Defense mechanism: patients directly express unconscious wishes or conflicts through action to avoid being conscious of either the accompanying idea or the affect (tantrums, assaults, child abuse, pleasureless promiscuity)
Acting out
Defense mechanism with 3 steps:
- aspect of oneself projected onto another
- projector tried to coerce the other person into identifying with what has been projected
- recipient of the projection and the projector feel a sense of oneness or union
Projection identification
- appears in borderline personality disorder
Fear vs anxiety
fear is a response to something known, and anxiety is a response to something that is unknown
excessive fear of a specific object, circumstance or situation
phobia
acute intense attack of anxiety accompanied by feelings of impending doom
panic disorder
tx: alprazolam
paroxetine
fluoxetine (long-term)
fear or anxiety regarding places from which escape might be difficult
agoraphobia
fear that self will fragment because others are not responding with needed affirmation and validation
disintegration anxiety
perception that the self is being invaded and annihilated by and outside malevolent force
persecution anxiety
- coordinates adaptive behavior with physiological changes that happen during stress
- inhibits food intake, sexual activity, endocrine programs for growth & reproduction
corticotropin-releasing hormone
treatment for specific phobia
beta blockers (propanolol) behavior therapy
treatment for social phobia
fear of being the focus of attention or behaving in a way that will be embarrassing or humiliating
SSRIs
alprazolam
clonazapam
atenolol & propanolol
period of 6 months with prominent tension, worry, feelings of apprehension about everyday events and problems
-associated symptoms: muscle tension, irritability, difficulty sleeping, restlessness
generalized anxiety disorder
Tx: psychotherapy
Pharm; benzo, SSRIs, buspirone, venlafaxine, tricyclics, antihistamines, beta blockers
less severe form of major depressive disorder
-2 years of depressed mood
dysthymia
- mood symptoms and clouding of consciousness
- similar to schizophrenia but symptoms last at least 1 month but less than 6 months
- in adolescents and young adults
schizophreniform
tx: hospitalization
risperidone
features of both schizophrenia & mood disorders
more common in married women
schizoaffective disorder
tx: mood stabilizers
motivated forgetting, the process by which memories, feelings, and drives associated with painful and unacceptable impulses are excluded from consciousness
-represents internal struggle
repression
the ability to fit an experience with an existing cognitive structure
(Piaget)
assimilation
the process of adapting the existing cognitive structure to new experiences
(Piaget)
accommodation
