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Abnormal > Chapter 9 > Flashcards

Chapter 9 Flashcards

1
Q

Eating disorders

-onest

A

Characterized by disturbed pattens of eating and maladpative ways of controlling weight. Often comorbid with depression, anxiety, and substance abuse disorders
-typically begin during adolescence or early adulthood

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2
Q

Anorexia

-prevalence & onset

A

maintenance of an abnormally low body weight, distorted body image, and intense fears of gaining weight. Most common sign is weight loss. Two subtypes: binge eating/purging and restrictive type

  • 0.9% women (9 in 1,000) , 0.3% men
  • onset between 12 and 18 common after puberty
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3
Q

Subtypes of anorexia

A

Binge eating /purging type- frequent episodes during the prior three month period of binge eating or purging through use of vomitting, laxatives ect. Impulse control problems and sub abuse or stealing

Restrictive type- no binging/ purging. Obsessive

  • distinction between the two is the personality patterns.
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4
Q

Medical complication of anorexia

A

Anemia (caused by losing 35% body weight), dermatological problems, amenorrhea

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5
Q

Death and suicide stats on anorexia (3)

A

5-20% of those with anorexia die due to suicide or malnutrition.
Women with anorexia 8x more likely to commute suicide
Anorexic study, 1 in 5(17%) made suicide attempt; 95% were females.

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6
Q

Bulimia

  • to diagnose
  • prevalence
  • onset
A

Recurrent binge eating followed by self-induced purging accompanied by over concern with weight. Binges last between 30-60minutes consuming 5,000-10,000 cals.

  • Requires binge episodes and compensatory behaviors occurring at avg freq of at least once a week for three months.
  • 0.9-1.5% in women; 0.1%-0.5% men
  • affect those in late adolescence or early adulthood
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7
Q

Medical complications in bulimia (10)

- suicide rate

A

Skin irritation around mouth, blockage of salivary ducts, decay of tooth enamel, damage taste receptors, Hiatal hernia, pancreatitis, lose of bowl eliminatory response, convulsions from salty binges, potassium deficiency, death (especially when diuretics are used)
- 25-35% attemept suicide

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8
Q

Social cultural theory of eating disorders (10)

A
  1. Girls as young as 8 dissatisfied with bodies more than boys
  2. 1 in 7 (14%) college women embarrassed to buy choc bar
  3. 4 out of 5 women dieted by 18th birthday
  4. 80% college students reported dieting
  5. ED’s less common in Non western countries
  6. However still in East Africa, Korean children, Taiwan
  7. African Ghana fast for religion; can explain ED’s
  8. ED’s higher in Whites than blacks but expected to raise
  9. Disturbed eating in Indians
  10. Same factors assoc with Girl’s ED’s as boys
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9
Q

Emotional factors of ED’s

  • Anorexia
  • Bulimia (3)
A
  1. Anorexics may restrict in attempt to relieve upsetting emotions by seeking mastery control
  2. Bulimics tend to be shy
  3. Bulimia often comorbid with others suggesting that binging is attempt at coping with emotional distress
  4. Bulimics more likely than any other women to have been abused.
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10
Q

Learning perspective of ED’s

-Reinforcment in bulimia and anorexia

A

View ED’s as type of weight phobia; relief from anxiety is negatively reinforced. Binge/purge cycle arises after strict dieting and when strict dietary controls fail it leads to loss of inhibitions which prompts binges. Binges induce fear of weight gain which prompt vomittig.
-Purging negatively reinforced by relief from anxiety. Anorexics food rejecting reinforced by relief from anxiety.

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11
Q

Cognitive perspective of ED’s

  • factors in ED’s
  • Bulimic thoughts
A

Biggest factors are perfectionism and over concern of making mistakes. Dieting gives sense of control they lack. Women with ED tend to blame self for negative events
-Bulimics tend to have dichotomous thoughts (one mistake and they think they have failed)

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12
Q

Psychodynamic perspective of ED’s

A

Anorexics have difficulty separating from their families and making separate identity. Represents girls unconscious efforts to remain pubescent

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13
Q

Family factors in ED’s (5)

A
  1. Some suggest child refuses to eat to punish parents for feelings of loneliness.
  2. Parents tend to be overprotective and less nurturing.
  3. Humphrey suggest binge eating is metaphoric effort to gain nurturance and comfort thru food that child is lacking
  4. Families are systems that regulate themselves in ways that minimize open expression of conflict and reduce need for change. Therefore child with anorexia may help maintain balance in dysfunctional family by displacing attention and being identified patient.
  5. Social reinforcement thru family paying attention to them.
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14
Q

Biological factors in ED’s

A

Abnormalities in brain structures controlling hunger and satiety involved in bulimia due to serotonin. Serotonin regulates appetite and controls cravings for carbs. Antidepressants like prozac and zoloft help decrease binges

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15
Q

Behavioral therapy for ED’s

A

Used in hospitalization; offers rewards to adherence of refeeding. Reinforcers are ward privileges and social opportunities; high relapse rate (50% of inpats rehospitalized within year of discharge)
- psychodynamics therapy sometimes combined to probe fore psych conflicts

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16
Q

CBT therapy for ED’s

A

Recent support for CBT in treating bulimia; CBT cured 2 out of 3 ppl in study. Helps them challenge self defeating thoughts which causes them to purge. ERP used to prevent vomiting by exposing them to fear foods.

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17
Q

ITP

A

Used for those that fail to respond to CBT; focuses on resolving interpersonal issues based on beliefs that effective interpersonal functioning will lead to healthier food habits and attitudes.

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18
Q

Binge-eating disorder

  • to diagnose
  • prevalence
  • comorbid
  • treatment
A

recurrent eating binges without purging

  • occur on avg at least once a week for period of three months
  • more common than anorexia or bulimia; affects 3.5% of women and 2% of men (most freq ED in men), 8 million struggle with it
  • older ppl; develops around 30’s or 40’s
  • depression and gambling or sub abuse
  • CBT best; better than meds
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19
Q

Sleep-wake disorders

- major sw disorders

A

Persistent and recurrent probs that cause distress or impaired functioning; replaced term sleep disorder; freq occurs with depression or med conditions like CVD; accounts for 250 million sick days and 63 billion loss
- insomnia, hypersomnolence, narcolepsy, breathing realted, circadian rythym, parasomnias

20
Q

Sleep centers

A

provide comprehensive assessment and diagnosis of sleep problems, track physio responses during sleep. Use of polysomnographic recording which is an assessment during sleep that simultaneously measures phyiso responses like brain waves, eye movements, muscle movements, and respiration.

21
Q

Insomnia disorder

  • to diagnose
  • prevalence
  • onset
A

Chronic or persistent insomnia; AKA primary insomnia

  • requires at least three months that it occurs at least three nights per week
  • 6-10%
  • Freq affects those over 40
22
Q

Affects of insomnia

A

unable to concentrate, difficulty remembering, hyperactivity, impulsivity, aggression.
May lead to poor immune system functioning; those who slept less than 7 hours a night had threefold risk of developing cold.

23
Q

Psychological factors of insomnia

A

Tendency to bring anxiety to bed which raises arousal preventing natural sleep; performance anxiety is pressure felt from thinking you must get full nights sleep.

24
Q

Learning perspective of insomina

A

Classical conditioning explains chronic insomnia: pair anxious, sleepless nights with bedroom, by entering bedroom you elicit bodily arousal impairing sleep; Heightened arousal becomes CR elicited by the bedroom(CS)

25
Q

Hyper somnolence disorder

  • to diagnose
  • prevalence
  • causes (2)
  • treatment
A

AKA primary hypersomnia; persistent pattern of excessive sleepiness during the day; Naps last an hour or more but does not leave you refreshed; not linked to inadequate sleep at night

  • Occurs at least three days a week for period of at leas three months
  • 1.5%
  • defect in sleep-wake mechanism in brain; in some cases a substance in brain acts as natural sleeping pill increasing activity of GABA
  • treated with stimulant med to help person maintain daytime wakefulness
26
Q

Narcolepsy

- prevalence

A

Sudden, irresistible episodes of sleep; person falls asleep for about 15 mins; attacks assoc with transition form awake to REM (sleep stage assoc with dreaming) Can involve cataplexy episodes and hypnagogic hallucinations. Most common type is narco/hypocretic deficiency syndrome

  • at least 3x a week for 3 months
  • 0.02-0.04%, affects both genders equally
27
Q

Narcolepsy/hypocretin syndrome

A

deficiency in brain of hypocretin (orexin)- a protein like molecule produced by hypothalamus that plays role in sleep wake cycle

28
Q

Cataplexy

- cause

A

often assoc with narcolepsy; medical condition were person experiences a loss of muscle tone ranging from mild weakness in legs to complete loss causing person to collapse; triggered by emotional reactions like laughing or crying. Person slumps to floor unable to move with blurry vision but able to hear.
- deficiency in hypocretin

29
Q

Sleep paralysis

A

temporary state following awakening in which they feel incapable of moving or talking

30
Q

Hypnagogic hallucinations

A

frightening hallucinations occurring before onset of sleep or upon awakening

31
Q

Breathing-related sleep disorders

- prevalence

A

Sleep is repeatedly disrupted by difficulty with breathing normally and respiration problems; results in insomnia or daytime sleepiness

  • 3 subtypes distinguished by underlying cause: obstructive sleep apnea hypopnea syndrome, central sleep apnea, and sleep related hypo ventilation
  • 1-2% in children; more than 20% in older adults
32
Q

Obstructive sleep apnea hypopnea syndrome

  • meanings of hypoapnea/apnea
  • prevalence/ onset/most common in?
A

Most common type of breathing sleep disorder; AKA obstructive sleep apnea; Involves repeated episodes during sleep of snoring or gasping for breath, pauses of breath, or abnormally shallow breathing. Breathing difficutly cause by blockage of air in upper airways caused by structural defect like overly thick palate or enlarged tonsils or adenoids. Complete obstruction may keep sleeper from breathing for 15-90 seconds as many as 500 times per night.

  • Apnea means “without breath”
  • Hypoapnea refers to shallow or reduced breathing that is not as severe as full apnea (means under breathing)
  • affects 28 million, most common in middle age men up to age 50 then even in women; most common in obese due to large soft tissues
33
Q

Obstructive Sleep Apnea Medical complications (3)

- succesful treatments?

A
  1. Tend to cause depression
  2. Leads to increased risk of hypertension and deaths due to CVD.
  3. Repeated lapses of Oxygen during episodes of apnea may lead to subtle forms of brain damage that affect functioning and thinking ability and may have higher risk of cancer
    - Three out of four cases left untreated
34
Q

Central sleep apnea

A

Breathing problems during sleep are less dependent on respiratory resistance (blocked ariways) and may involve heart related problems or chronic use of opioid drugs

35
Q

Sleep-related hypo ventilation

A

hypoventialtion refers to low breathing and is characterized by breathing problems that trace to lung diseases or neuromuscular problems affecting lungs

36
Q

Circadian Rhythm Sleep-wake Disorders

  • Ciracdian rhythm
  • treatment
A

Mismatch between the body’s normal sleep-wake cycle and the demands of the environment. Leads to insomnia or hyper somnolence.

  • The internal bodily rhythm that lasts about 24 hours
  • Program of adjustments in sleep schedule to allow the system to become aligned
37
Q

Parasomnias

A

Abnormal patterns assoc with partial or incomplete arousals. Sleep typically runs in cycles of about 90 minutes that progress in stages from light sleep to deep REM where dreams occur. For some sleep is interrupted by partial aoursals where person may appear confused or detached
Two types: non-REM sleep and REM sleep

38
Q

Non-REM disorders

A
  1. sleep terrors

2. sleep walking

39
Q

Sleep terrors

  • cause?
  • gender rates
  • adults vs. children
  • episode prevalence
A

a non-REM disorder; repeated episodes of terror induced arousals that begin with screams. signs of rapid heart and sweating, talking incoherently, upon awakening may not recognize parent. Tend to occur during first third of nightly sleep and during deep non REM sleep. Cause unknown

  • More boys affected; among adults equal
  • Children typically outgrow but adults follow chronic course
  • Episodes occurring in 37% of 18 month olds; 20% in 30 month olds and 2% in adults
40
Q

Sleepwalking

  • Cause?
  • Prevalence of disorder
  • Prevalence of episode (2)
A

Non-REM disorder; repated episodes of sleepwalking; partially awake and can perform complex motor responses without conscious awareness; occures during deeper non-REM sleep where dreaming is absent.

  • unknown but may be due to environment and genetics combined
  • Disorder most common in children; 1-5%
  • 10-30% of children are believed to have had at least one episode. 4% of adults report episode
41
Q

REM disorders

A
  1. Rapid eye movement sleep behavior disorder

2. Nightmare disorder

42
Q

Rapid eye movement sleep behavior disorder

  • Prevalence
  • Causes (2)
  • Treatment
A

A REM sleep disorder; repeated episodes of acting ones dreams out during REM sleep in form of vocalizing or thrashing. Normally muscle movement is blocked but in this disorder muscle paralysis is absent.

  • Affects 0.5% of adults; mostly affects older adults
  • Generally a result of neurodegenerative disorders like parkinson’s. May also be caused by alchohol withdrawl or adverse reaction to drugs.
  • Medications
43
Q

Nightmare disorder

  • prevalence
  • cause
A

A REM sleep disorder; recurrent awakenings due to frightening nightmares; lengthy nightmares; story-like and recalled vividly upon awakening. Dreams more intense in later half of night and towards morning. Paralysis of movement

  • Rates unknown
  • often occur in assoc with trauma and stress
44
Q

Treatment of sleep-wake disorders

A

Most common method is sleep meds however CBT is coming into action. CBT is treatment of choice for insomnia.

45
Q

Biological approaches to sleep-wake disorders

  1. insomnia
  2. Disadvantages of treatment
  3. deep sleep disorder treatment
  4. narcoleptic treatment
A
  1. Antianxiety drugs often used for insomnia ( benzo’s valium and ativan) others include ambien which reduces length of time it takes to fall asleep and increases duration of sleep. Sleep meds work by increasing GABA which inhibits central neuro activity.
  2. Tend to suppress REM sleep which may interfere with restorative sleep; leads to hangover; leads to rebound insomnia. May become psych dependent on drug.
  3. TCA’s used for deep sleep disorders like sleep terrors. Reduces amount of time spent in deep sleep and partial aorusals between sleep stages
  4. Stimulant drugs used for narcoleptics
46
Q

Psychological approaches and techniques

A

Psy treatments limited to treatment of primary insomnia.

  • CBT are short term in emphasis and focus on lowering bodily arousal, establishing good sleeping habits, replacing anxious thoughts. Uses stimulus control, relaxation, rational restrcturing.
  • Stimulus control involves changing the evnironment sassoc with sleeping. Bed may be assoc with other activites and becomes CS for anxiety. Restrict all activities on bed not spending more than 10-20 mins on bed.
  • Sub rational alternitives for self-defeating thoughts (belief that failing to get good night sleep with lead to diseaster consequences)
47
Q

Obesity

  • 5 rates
  • key to prevention
  • set point
A

Classifed as med condition but psych factors play role in development and treatment.
- More Americans overweight today that at any time since 1960s
-1/3rd of Americans are obese and another 1/3rd are overweight
-Current trends will lead to 200 million Americans being obese by 2030
- One in three children and teens in Us obese or overweight
- accounts for more than 16,000 deaths in US and shaves 6-7 years off avg life expectancy
Bring energy expenditure in line with energy intake
- brain mechansims that keep body weight around genetically influence point

Abnormal (18 decks)

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