Chapters 21, 22, 23, 24 Flashcards
Oppositional defiant disorder impacts..
both emotions (anger and frustration) and behaviors (argumentative and defiance)
Patients with Oppositional defiant disorder prefer
Preference for large rewards and little attention to penalties
Oppositional defiant disorder DSM-5 criteria
4 symptoms of angry/irritable mood, argumentative/defiant behavior or vindictiveness lasting at least 6 months during an interaction with a person that is not a sibling
Oppositional defiant disorder in children
- Impairs the child’s life
- Makes it extremely difficult for him and her to attend school, to have friends or be functioning member of the family
- Behaviors can be confined to one setting or in severe case multiple setting
- Usually outgrown but those who don’t have difficulties with authority figures and academic problems
Intermittent explosive disorder characterized by
a pattern of behavioral outbursts characterized by an inability to control aggressive impulses.
Intermittent explosive disorder symptoms
Aggression can be verbal or physical and targeted towards another person, animals, property, or even themselves
What trigger an aggressive reaction in someone with Intermittent explosive disorder
anything as little as unable to locate favorite video game can trigger the aggressive reaction
Stages of Intermittent explosive disorder
- tension and arousal because of an environmental stimuli such as someone driving too slow in the passing lane
- explosive behavior and aggression immediately after the person feels a sense of relief and release, taking satisfaction
- delayed consequences include feeling of remorse regret and embarrassment over the aggressive behavior
Intermittent explosive disorder DSM-5 criteria
- recurrent behavioral outburst representing a failure to control aggressive impulses as manifested by either of the following
- verbal aggression or physical aggression occurring twice weekly over a three month. That does not result in damage to a person or property
- three behavioral outbursts involving damage or destruction of property and or physical assault involving injury against animals or other individuals occurring within 12 months
- Aggressive outbursts are not in proportion to the stressor
- aggressive outbursts are not premeditated
- Aggressive outbursts cause either marked distress in the individual or impairment in occupational or interpersonal functioning
- chronological age is at
- recurrent aggressive outbursts are not better explained by another mental disorder
Physical problems that could result from Intermittent explosive disorder
physical problems could include hypertension and diabetes
Relationships with Intermittent explosive disorder
can impair a person’s functioning by leading to problems with interpersonal relationships and occupational difficulties
emotional pattern for patient with Intermittent explosive disorder
- a pattern that commonly emerges is going from rage to remorse
- emotional dysregulation and explosive anger
Pyromania
- Repeated deliberate firesetting
- person experiences tension or becomes excited before setting a fire and shows fascination with or unusual interest in fire and its contents such as matches
- Experiences pleasure or relief when setting a fire, witnessing a fire, or participating in the aftermath
- done to satisfy pleasure and not for other reasons like to cover up a crime
Kleptomania
- Repeated failure to resist urges to steal objects not needed for personal use or monetary value
- the person experiences a buildup of tension before taking the objects and a relief or pleasure after the theft follows
Conduct disorder is characterized by
Characterized by a persistent pattern of behavior in which the rights of others are violated, and societal norms or rules are discarded
Behavior of patient with conduct disorder
- Behavior is abnormally aggressive and can frequently lead to destruction of property or physical injury
- With this disorder initiate physical fights and bully and they may steal or use a weapon to intimidate or hurt others
- have normal intelligence but tend to skip class or disrupt schools so much that they fall behind may fail be expelled or drop out
- Manipulate people against their own will
- crave excitement and do not worry much about consequences
Child onset of conduct disorder
- Occurs before age 10
- Commonly in males
- Physically aggressive have pores peer relationships little concern for others and lack of feeling of guilt or remorse, interrupts others interprets as hostile and believe their aggression responses are justified
- Low self esteem
- Limited frustration tolerance irritability and temper outburst are hallmarks of this disorder
- Need intensive treatment or else may develop antisocial personality disorder as adults
Adolescent onset of conduct disorder
- No clinically significant symptoms are present before age 10
- Tend to act out in peer groups through sexual behavior substance use or risk taking behaviors
- Males: fight, steal, vandalize, and have school disciplinary problems
- Girls: lie be truant, runaway, abuse substances, engage in promiscuity
DSM-5 criteria of conduct disorder
- A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated manifested by the presence of at least three symptoms in the past 12 months with at least one symptom present in the last six months
- Aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rule.
DSM-5 criteria for alcohol addiction
Problematic pattern of alcohol use leading to clinically significant impairment or distress manifested by at least two of the following occurring within a 12 month.
- Alcohol taken in larger amounts over a long period of time than was intended
- Persistent desire or unsuccessful efforts to cut down or control alcohol use
- A great deal of time spent in activities necessary to obtain alcohol use alcohol or recover from its effects
- Craving or a strong desire or urge to use alcohol
- recurrent alcohol use resulting in a failure to fulfill major role obligations at work school or home
- Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused by the effects of alcohol
- Important social, occupational, or recreational activities are given up or reduced because of alcohol use
- Recurrent alcohol use in situations in which it is physically hazardous
- Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem likely to have been caused by alcohol
- Tolerance
- Withdrawal
Opioid overdose
Death attributed to opioids usually stems from respiratory arrest due to the respiratory depressant effect of the drug
Symptoms of opioid overdose
- Symptoms include unresponsiveness, slow respirations, coma, hypothermia, hypo tension, and bradycardia
- Coma, pinpoint pupils, and respiratory depression are strongly suggestive of overdose
Delirium is..
- acute cognitive disturbance and often reversible condition that is common in hospitalized patients, especially older patients
- Medical emergency that requires immediate attention to prevent irreversible and serious damage
What is delirium characterized by
a syndrome that is a constellation of symptoms rather than disorder
Symptoms of delirium are
inability to direct, focus, sustain, and shift attention; an abrupt onset with clinical features that fluctuate with periods of lucidity; and disorganized thinking and poor executive functioning, disorientation, anxiety, agitation, poor memory, and delusional thinking
DSM-5 criteria of delirium
- Disturbance in attention and awareness
- Develops over a short period of time usually hours to days and represents a change from baseline
- Additional disturbance in cognition such as memory deficit, disorientation, language, visuospatial ability, or perception
- Disturbances cannot be better explained by another pre-existing established or evolving neurocognitive disorder
- Evidence from the history, physical exam, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdraw, exposure to toxin
Dementia is..
- used to describe progressive deterioration of cognitive functioning and global impairment of intellect
- collection of symptoms not a disease
Dementia is characterized by
cognitive impairments that signal a decline from previous functioning
DSM-5 criteria of dementia
- Evidence of significant cognitive decline from previous level of performance in one or more cognitive domains such as complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition
- The cognitive deficits interfere with independence in everyday activities
- The cognitive deficits do not occur exclusively in the
- The cognitive deficits are not better explained by another mental disorder
Mild Alzheimer’s symptoms
: loses energy, drive, and initiative and has difficulty learning new things
Severe Alzheimer’s symptoms
agnosia (inability to identify familiar objects or people), apraxia (needs repeated instructions and directions to perform simple tasks)
How does the person with Alzheimer’s see the world
very frightening and nothing makes sense they’re agitated, paranoid and have delusions
DBT (Dialectical behavior therapy)
Combines cognitive and behavioral techniques with mindfulness, which emphasizes being aware of thoughts and actively shaping them
What does DBT focus on
- Focuses on behavioral targets, beginning with identification of and interventions for suicidal behaviors and then progressing to focus on interrupting destructive behaviors
- Address his quality of life behaviors across a hierarchy of care
DBT goals
increase patient ability to manage distress and improve interpersonal effectiveness skills
What does DBT treat
Treats chronically suicidal individuals with borderline personality disorder
Antisocial is a pattern of
Pattern of disregard for, and violation of, the rights of others
Antisocial is also called
sociopaths
When do symptoms for antisocial disorder begin?
Symptoms are evident by the mid-teens and peak in the late teen years into the mid- 20s around 40 symptoms may improve without treatment
What is antisocial disorder characterized by?
Characterized by antagonistic behaviors such as being deceitful and manipulative for personal gain or hostile if needs are blocked and disinhibited behavior such as risk taking, disregard for responsibility, and impulsivity
DSM-5 criteria for antisocial disorder
- A pervasive pattern of disregard for and violation of the rights of others occurring since age 15 and indicated by three or more of the following
- Failure to conform to social norms
- Deceitfulness as indicated by repeated lying, use of aliases, and conning others
- Impulsivity or failure to plan ahead
- Irritability and aggressiveness
- Reckless disregard for safety of self or others
- Consistent irresponsibility
- Lack of remorse
- Individuals at least 18 years old
- Evidence of conduct disorder with onset before age 15
- Occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder
Symptoms of antisocial disorder
- Little to no capacity for intimacy and will exploit others if it benefits them in relationships
- Profound lack of empathy (callousness), resulting in the absence of remorse or guilt
- Individuals tend to be shallow, unexpressive, and superficial affect
- May be able to act witty and charming and be good at flattery and manipulating emotions of others
What is the goal of people for antisocial disorder?
Mostly concerned with gaining personal power or pleasure, and in relationships they focus on their own gratification to an extreme
Borderline disorder is characterized by
Characterized by severe impairments in functioning, Feelings of antagonism, manifested in hostility, anger, and irritability in relationships
What are the symptoms of borderline disorder?
- major features include patterns of marked instability in emotional control or regulation, impulsivity, identity or self-image distortions, unstable mood, and unstable interpersonal relationships
- impulse activity: acting quickly in response to emotions without considering the consequences resulting in damage relationships and even suicide attempts
- often have self-destructive behaviors
- often harmful self-soothing habits like cutting, promiscuous sexual behavior, and numbing with substances are common and may result in an unintentional death
- chronic suicidal ideations
- Splitting
borderline disorder: what is emotional liability?
moving from one emotional extreme to another
borderline disorder: Splitting
primary defense or coping style that refers to the inability to view both positive and negative aspects of others as a part of a whole resulting in viewing someone as either a wonderful person or horrible person
Does the feelings toward a person change quickly with borderline disorder?
At the first disappointment or frustration individuals’ status quickly shifts to one of devaluation, and the other person is despised
DSM-5 criteria for borderline disorder
Pervasive pattern of instability of interpersonal relationships, self-image, affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts as indicated by five or more of the following
- Frantic efforts to avoid real or imagined abandonment
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
- Identity disturbances such as unstable self-image or sense of self
- Impulsivity in at least two areas that are potentially self-damaging
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- Affective instability due to marked reactivity of mood
- Chronic feeling of emptiness
- Inappropriate, intense anger or difficulty controlling anger
- Transient, stress related paranoid ideations or severe dissociative symptoms
