diagnoses and populations Flashcards
Anxiety Disorders
features of excessive fear and anxiety
differ from one another in types of objects or situations that induce fear, anxiety, or avoidance behavior and cognitive ideation
highly comorbid with each other
excessive or persisting beyond dev appropriate periods
persistent (6 months or more)
many dev in childhood and persist
most occur in females 2:1
selective mutism
consistent failure to speak in specific social situation
at least 1 month
associated features: excessive shyness, fear of social embarrassment, social isolation, withdrawal, clinging, compulsive traits, negativism, temper tantrums, mild oppositional behavior
DD: communication disorders, neurodev, schizophrenia, social anxiety
comorbidity: other anxiety disorders
specific phobia
marked fear or anx about specific object or situation
object or situation almost always provokes immediate fear or anx
object or situation is actively avoided or endured with intense fear or anx
fear or anx is out of proportion to actual danger
persistent 6+ months
sometimes dev following traumatic event
DD: agoraphobia, social anxiety, separation anx, panic dis, ocd, trauma and stressor related, eating, schizophrenia
comorbidity: depression, anx, bipolar, substance related, somatic symptom, personality dis
social anxiety disorder (social phobia)
fear or anx about one or more social situations in which ind is exposed to possible scrutiny by others
fear they will act in way or show anx symptoms that will be neg evaluated
social situations almost always provoke fear or anx
multiple DDs
comorbidity: other anx, major dep, substance use
panic disorder
recurrent unexpected panic attacks
persistent concern or worry about additional panic attacks
Risk / prognostic: neg affect, anx, sex and phy abuse, smoaking, poss genes
comorbidity: anx, major dep, bipolar, mild alcohol use
agoraphobia
fear or anxiety about two or five situations:
using public transportation
open spaces
enclosed places
standing in line or being in crowd
being outside home alone
thoughts that escape might be difficult or unavailable
resk / prog:
behavioral inhibition and neurotic desposition, anx sensitivity, ACEs, heritability 61%
comorbidity: anx, depressive, ptsd, alcohol use
generalized anxiety disorder
excessive anxiety and worry occurring more days than for for number of events or activities
difficult to control worry
three symptoms:
restlessness
easily fativured
difficulty concentrating
irritability
muscle tension
sleep disturbance
risk/prog:
behavioral inhibition, negative affect, harm avoidance
comorbidity: anx, unipolar depressive
substance / medication - induced anxiety disorder
panic attacks or anx is predominant
symptoms dev during or soon after substance intoxication or withdrawal
substance/med is capable of producing symptoms
anxiety disorder dure to another medical condition
panic attacks or anx is predominant
disturbance is direct consequence of another med condition
lab assessments / medical exam necessary to confirm diagnosis
other specified anxiety disorder
presentations in which symptoms characteristic of anxity disorder predominate but dont meet full criteria for other disorders
limited symptom attacks
generalized anxiety not occurring more days than not
“wind attacks”
“attack of nerves” ataque de nervios
panic attack
abrupt surge of intense fear or intense discomfort that reaches peak within minutes, and during which time multiple physical symptoms arise
palpitations
sweating
trembling
shortness of breath
choking
chest pain
nausea
dizzyness
chills or heat
parasthesias (tingling)
derealization (unreality)
fear of losing control
fear of dying
separation anxiety disorder
dev inappropriate and excessive fear or anxiety concerning separation from those whom ind is attached
may be associated w/ increased risk for suicide
children: highly comorbid with generalized anxiety and specific phobia
adults: common comorbidities specific phobia, ptsd, panic disorder, generalized anxiety, social anxiety, agoraphobia, ocd, personality disorders, depressive, bipolar
fear
emotional response to real or perceived imminent threat
associated w/ surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviors
anxiety
anticipation of future threat
muscle tension and vigilance
cautious or avoidant behaviors
Depressive Disorders
presenece of sad, empty, or irritable mood
accompanied by somatic and cognitive changes that significantly affect capacity to function
differences: duration, timing, or presumed etiology
Art therapy for depression
greatest challenge is to untangle various symptomatic behaviors of depression because some may be part of the teen’s stage of maturation and others may be reactions to life circumstances, or even physical illness
art offers control of communication
respect
feel omnipotent
externalize problems
disruptive mod dysregulation disorder
severe recurrent temper outbursts manifested verbally and/ or behaviorally that are grossly out of proportion in intensity or duration to situation or provocation
temper outbursts inconsistent with dev level
temper outbursts occur three or more times / week
mood btwn outbursts is persistently irritable or angry
criteria are present in at least two settings and are severe in at least one
first diagnosis between 6 and 18 with age of onset before 10
risk / prog:
chronic irritability, ADHD
comorbidity:
ODD, mood, anx, ASD
major depressive disorder
five or more symptoms during same 2 week period
depressed mood
loss of interest or pleasure
significant weight loss
insomnia or hypersomnia
psychomotor agitation
fatigue
feelings of worthlessness
diminished ability to think
recurrent thoughts of death
risk / prog:
neuroticism, ACEs, genetic, major nonmood disorders
comorbidity: substance related, panic, ocd, anorexia, builimia, borderline
persistent depressive disorder
depressed mood for most of day for more days than not
presence, while depressed of two..
poor appetite or overeating
insomnia or hypersomnia
low energy or fatigue
low self esteem
poor concentration
feelings of hopelessness
criteria for MDD present for 2 yuears
never been manic episode or hypomanic episode
risk / prog: neuroticism, poorer global function, anx or conduct disorder, parental loss or separation, poss polysomnographic abnormalities
comorbidity: anx, substance use, personality disorders
premenstrual dysphoric disorder
in majority of menstrual cycles, at least 5 symptoms in final week before onset on memses, start to improve w/in few days after, and become min or absent in week post
affective lability
irritability or anger
depressed mood
anxiety
decreased interest in usual activities
difficulty in concentration
easy fatigability
change in appetite
hypersomnia or insomnia
overwhelmed
breast tenderness, joint or muscle pain, bloating, or weight gain
risk and prog:
stress, interpersonal trauma, seasonal changes, oral contraceptives have fewer premenstrual complaints
comorbidity: MDD, wide range of medical or other mental disorders may worsen
substance / dedication - induced depressive disorder
prominent and persistent disturbance in mood
symptoms dev during or soon after substance intoxication or withdrawal
substance is capable of producing symptoms
comorbidity: any mental disorder, pathological gambling and paranoid, histrionic, and antisocial personality disorders
depressive disorder due to another medical condition
prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all or almost all activities
disturbance is direct consequence of another medical condition
other specified depressive disorder
recurrent brief depression
short duration depressive episode
depressive episode with insufficient symptoms
Trauma and Stressor Related Disorders
exposure to a traumatic or stressful event is listed explicitly as diagnostic criterion
close relationship with anxiety, ocd, and dissociative disorders
reactive attachment disorder
consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers
child rarely or min seeks comfort when distressed
“ “ responds to comfort when distressed
persistent social and emotional disturbance
min social and emotional responsiveness to others
limited pos affect
episodes of unexplained irritability, sadness, or fearfulness
child has experienced pattern of extremes of insufficient care
social neglect or deprivation
repeated changes of primary caregivers
rearing in unusual settings
criteria not met for ASD and evident prior to 5 years
risk/ prog: serious social neg, prog depends on quality of caregiving environment following neg
comorbidity: cog delays, lang delays, stereotypies, medical condition, depressive symptoms
disinhibited social engagement disorder
pattern of behavior in which child actively approaches and interact with unfamiliar adults
reduced or absent reticence in approaching and interacting with unfamiliar adults
overly familiar verbal or physical behavior
diminished or absent checking back with adult caregiver
willingness to go off with unfamiliar adult
not limited to impulsivity but include socially disinhibited behavior
child experienced pattern of extremes of insufficient care
social neg
repeated changes of primary caregivers
rearing in unusual settings
risk/prog: serious social neg, caregiving quality moderate course
comorbidity: cog delays, language delays, stereotypies, ADHD
posttraumatic stress disorder
exposure to actual or threatened death, serious injury, or sexual violence in one of following ways…
directly
witnessing
learning it occurred to close family member or friend
repeated or extreme exposure to details
presence of 1+ symptoms
recurrent, involuntary, intrusive distressing memories
recurrent distressing dreams
dissociative reactions
intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble aspect of event
marked physiological reactions to internal or external cues that “”
persistent avoidance of stimuli associated with event
neg alteration in cognitions and mood
inability to remember an important aspect of event
persistent and exaggerated neg beliefs
persistent, distorted cognitions about cause or consequences
neg emotional state
diminished interest or participation in significant activities
detachment or estrangement
inability to experience pos emotions
PTSD risk / prognostic
pretraumatic factors:
emotional problems prior to 6 years
mental disorders - panic, depressive, ptsd, OCD
lower ses
low edu
ACEs
minority
family psychiatric history
female
younger age
peritraumatic factors:
severity
perceived life threat
personal injury
interpersonal violence
dissociation
posttraumatic factors:
neg appraisals
inappropriate coping
scute stress
exposure to repeated reminders
adverse life events
losses
** social support is most protective factor that moderates outcomes **
Acute Stress Disorder
exposure to actual or threatened death, serious injury, or sexual violation
resolve within 1 month after event
presentce of 9+ symptoms within
intrusion (memories, dreams, flashbacks, distress)
neg mood
dissociation
avoidance
arousal (sleep, irritability, hypervigilance, concentration, startle response)
adjustment disorders
dev of emotional or behavioral symptoms in response to identifiable stressors
distress is out of proportion to severity of stressor
stressor may be single, multiple, recurrent, or continuous
increased risk of suicide
Other Specified Trauma - and Stressor - Related Disorder
presentation in which symptoms do not meet full criteria for other disorders
adjustment disorders w/ delayed onset
” “ w/ prolonged duration
ataque de nervios
other cultural syndromes
persistent complex bereavement
Bipolar and Related Disorders
bridge btwn schizophrenia and depressive disorders
Bipolar 1 Disorder
manic episodes (required)
hypomanic episode ( common, but not required)
major depressive episode (common but not required)
risk / prog:
family history
comorbidity: anx disorder
ADHD
conduct
substance use
medical
Bipolar 2 Disorder
Hypomanic episode (required)
Major Depressive Episode (required)
never been a manic episode
risk/prog
genetic factors
high suicide risk
comorbidity: anx disorders, substance use
Cyclothymic disorder
for at least 2 years, hypomanic symptoms and depressive symptoms
symptoms present for at least half time
dont fit criteria for bipolar
risk/prog: genetic
comorbidity: substance use, sleep disorders
Substance / Medication-induced Bipolar and Related Disorder
symptoms dev during or soon after substance intoxication or withdrawal
manic episode
period of abnormally and persistently elevated, expansive, or irritated mood
increased goal directed activity or energy
last at least 1 week and present most of day, nearly every day
3+ of symptoms
inflated self-esteem
decreased need for sleep
talkative
racing thoughts
distractibility
involvement in activities with potential for painful consequences
Hypomanic Episode
period of abnormally and persistently elevated, expansive, or irritable mood
abnormally and persistently increased activity or energy
lasting at least 4 consecutive days
same symptoms as manic
Major Depressive Episode
5+ symptoms during 2-week period
depressed mood
diminished interest or pleasure in activates
significant weight loss
insomnia or hypersomnia
psychomotor agitation
fatigue
feelings of worthlessness
indecisiveness
recurrent thoughts of death
Disruptive, Impulsive Control and Conduct Disorders
problems in self control or emotions and behaviors
underlying causes can vary greatly
more common in males
first onset in childhood or adolescence
Oppositional Defiant Disorder
pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months
exhibited during interaction with at least one individual who is not a sibling
symptoms may be confined to only one setting (most freq home)
more prevalent in families where child care is disrupted
risk/prog
harsh, inconsistent, or neglectful child-rearing practices
comorbidity
ADHD
anx
MDD
Intermittent Explosive Disorder
failure to control aggressive impulses (verbal or behavioral)
magnitude is grossly out of proportion to stressors
outbursts not premeditated or committed to achieve some tangible objective
often less severe episodes in between more severe
risk/prog
physical and emotional trauma during first two decades of life
genetic influence
comorbidity
depressive disorders
anx
substance use
antisocial personality
borderline personality
Conduct Disorder
repetitive and persistent pattern of behavior where rights or others or societal norms or rules are violated
aggression to people and animals
destruction of property
deceitfulness or theft
serious violations of rules
specify:
- childhood, adolescent, or unspecified onset
- limited prosocial emotions: lack of remorse, callous, unconcerned about performance, shallow or deficient
- mild, moderate, severe
risk/prog
difficult under controlled infant
most ACEs
some genetic factors
comorbidity
ADHD
ODD
Pyromania
deliberate and purposeful fire setting on more than one occasion
tension or arousal before act
fascination with, interest in, curiosity about, or attraction to fire
pleasure, gratification, or relief when setting fires or witnessing
not done for monetary gain, expression of sociopolitical ideology, or conceal criminal activity
may wax and wane in frequency
comorbidity
substance use disorder
gambling
depression and bipolar
disruptive, impulse, and conduct disorders
Kleptomania
failure to resist impulses to steal objects that are not needed for personal use or for monetary value
increasing sense of tension immediately before
pleasure, gratification, or relief at time
not committed to express anger or vengeance and not response to delusion or hallucination
risk/prog
OCD
substance use
comorbidity
depressive and bipolar disorders
anx
eating disorders
personality disorders
substance use
disruptive, impulse, and conduct
Personality Disorders
enduring pattern of inner experience and behavior that deviates markedly from expectations of individual’s culture
pervasive and inflexible
onset in adolescence or early adulthood
stable over time
cluster A: odd or eccentric
cluster B: dramatic, emotional, or erratic
cluster C: anxious or fearful
clusters not consistently validated and serious limitations
General personality disorder
enduring pattern of inner experience and behavior that deviates from expectations of culture
- cognition
- affectivity
- interpersonal functioning
- impulse control
inflexible and pervasive
paranoid personality disorder
cluster A
distrust and suspiciousness of others such that their motives are interpreted as malevolent
assume others will exploit, harm, or deceive them
persistently bear grudges
risk/prog
relatives of probands with schizophrenia
Schizoid personality disorder
cluster A
detachment from social relationships and restricted range of expression of emotions in interpersonal settings
risk/prog
relatives od individuals with schizophrenia or schizotypal personality disorder
Schizotypal personality disorder
cluster A
pattern of social and interpersonal deficits
discomfort and reduced capacity for close relationships
cognitive or perceptural distortions and eccentricities of behavior
risk/prog
genetic
Antisocial personality disorder
cluster B
pattern of disregard for and violation of the rights of others
at least 18 years old
evidence of conduct disorder with onset before 15 years
risk/prog
genetic
may be misapplied where behavior is survival strategy
Borderline Personality Disorder
Cluster B
pattern of instability of interpersonal relationships, self-image, and affects
impulsivity
-avoidance of abandonment
- unstable and intense relationships
- identity disturbance
- suicidal behavior
- reactivity of mood
- feelings of emptiness
- difficulty controlling anger
risk/prog
genetic, substance use, antisocial, depression
75% females
Histrionic personality disorder
cluster B
excessive emotionality and attention seeking
present in variety of contexts
- uncomfortable in situations where not center of attention
- inappropriate sexually seductive or provocative behavior
- rapidly shifting and shallow expression of emotions
- uses physical appearance to draw attention to self
- impressionistic and lacking detail in speech
- suggestible
Narcissistic Personality Disorder
cluster B
pattern of grandiosity, need for admiration, lack of empathy
- self importance
- fantasies of unlimited success, power, beauty
- requires excessive admiration
- sense of entitlement
- interpersonally exploitative
- lacks empathy
- envious of others
- arrogant, haughty behaviors
Avoidant Personality Disorder
cluster C
social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
- avoids occupational activities
- unwilling to get involved
- restraint within intimate relationships
- preoccupied with being criticized or rejected
- reluctant to take personal risks
Dependent Personality Disorder
cluster C
need to be taken care of, submissive and clinging behavior, fear of separation
- difficulty making everyday decisions
- needs others to assume responsibility
- difficulty expressing disagreement
- “ initiating projects
- feels uncomfortable or helpless when alone
Obsessive-Compulsive Personality Disorder
cluster C
preoccupation with orderliness, perfectionism, and mental and interpersonal control
- preoccupied with details, rules, lists, order
- perfectionism
excessively devoted to work and productivity
- overconscientious and inflexible
- unable to discard objects
- reluctant to delegate tasks
- adopts miserly spending
- rigidity and stubbornness
Neuro developmental Disorders (e.g., ASD, ADHD)
onset in developmental period
produce impairments of personal, social, academic, or occupational functioning
intellectual disability
(intellectual Developmental Disorder)
*art therapy goals: expanding skills, socialization, sense of mastery, tactile stimulation
includes intellectual and adaptive functioning deficits in conceptual, social, and practical domains
deficits in intellectual functions (reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience)
adaptive functioning deficits (personal independence and social responsibility
mild, moderate, severe, or profound
IQ scores approximations of conceptual functioning but insufficient
gullibility and lack of awareness often present
risk and prog:
genetic, labor and delivery events, severe and chronic social deprivation
comorbidity:
mental, neurodevelopmental, medical, and physical conditions
communication disorders, ASD, motor, sensory, ADHD, depressive, bipolar disorders
Global Developmental Delay
under age of 5
fails to meet expected dev milestones in several areas
too young to participate in standardized testing and undergo systematic assessments
Language Disorder
difficulties in acquisition and use of language across modalities
reduced vocab
limited sentence structure
impairments in discourse
onset in early dev period
risk/prog
more resistant to treatment
difficulties with reading comprehension
heritable
comorbidity
neurodevelopmental disorders, learning disorder, ADHD, ASD, coordination disorder, social disorder
Speech Sound Disorder
difficulty with speech sound production
childhood-onset fluency disorder (stuttering)
disturbances in normal fluency and time patterning of speech
sound and syllable repetitions
risk/prog:
genetic
Social (Pragmatic) Communication Disorder
difficulties in social use of verbal and nonverbal communication
risk/prog
family history of ASD, communication disorder, learning disorer
Autism Spectrum Disorder
art therapy goals: enhancing interactions and communication
persistent deficits in social communication and social interaction
restricted repetitive patterns of behavior, interests, or activities
severity based on social communication impairments and restricted, repetitive patterns of behavior
risk/prog
epilepsy, advanced parental age, low birth weight, fetal exposure, genetic
comorbidity
intellectual impairment and structural language disorder, ADHD
Art Therapy for ASD
Areas of strength for people with ASD include good rote memory and visual–spatial/problem-solving skills
- Art media, tools, and activities can be used to interest and engage
- to build on their visual–spatial strengths
- develop foundation academic, art, play, and social skills
Awareness of the sensory needs and issues can guide therapist in choosing materials and activities to redirect socially inappropriate sensory activities to those that promote positive social interaction
motor skills
cognitive skills
social/communication skills
Attention-Deficit / Hyperactivity Disorder
persistent pattern of inattention and/or hyperactivity-impulsivity
inattention: wandering off task, lacking persistence, difficulty sustaining focus, disorganized
hyperactivity: excessive motor activity when not appropriate, excessive fidgeting, tapping, or talking
impulsivity: hasty actions that occur in the moment w/out forethought and have high potential for harm
risk/prog
very low birth weight, smoking during pregnancy, genetic, history of child abuse, neglect, multiple foster placements, neurotoxin exposure
comorbidity
ODD, conduct disorder, anxiety, MDD
Art Therapy for ADHD
art provides the child with an immediate and visual record of feelings or ideas
Assessments:
Kinetic Family Drawing
House–Tree–Person-Drawing
the Silver Drawing Test
Levick Emotional and Cognitive Art Therapy Assessment
require predictability, consistency, and structure to be successful
goals: learn more about their disorder through drawings / self-esteem
Specific Learning Disorder
difficulties learning and using academic skills
inaccurate or slow word reading
difficulties understanding meaning of what is read, spelling, written expression, poor understanding of numbers
mild, moderate, or severe
risk/prog
prematurity, low birth wieght, genetic
Developmental Coordination Disorder
acquisition and execution of coordinated motor skills is substantially below expected
risk/prog
prenatal exposure to alcohol
low birth weight
impairments in neurodevelopmental processes
comorbidity
speech and language, learning, ADHD, ASD
Stereotypic Movement Disorder
repetitive, seemingly driven, and apparently purposeless motor behavior
with or without self-injurious behavior
mild, moderate, severe
risk/pro
social isolation, low cognitive, low stimulating environment
comorbidity
common manifestation of variety of neurogenetic disorders
Tic Disorders
tic: sudden, rapid, recurrent, nonrhythmic motor movement or vocalization
Tourette’s Disorder: both multiple motor and one or more vocal tics
persistent motor or vocal tic disorder: single or multiple motor or vocal tics
provisional tic disorder: single or multiple motor and/or vocal tics
risk/prog
worsened by anxiety, excitement, and exhaustion
observing gesture or sound may result in making similar gesture or sound
older paternal age, lower birth weight, maternal smoking
comorbidity:
ADHD, OCD
Obsessive Compulsive and Related Disorders
presence of obsessions and/or compulsions
obsessions: recurrent and persistent thoughts, urges, or images
compulsions: repetitive behaviors or mental acts that individual feels driven to perform
persisting beyond developmentally appropriate periods
Obsessive-Compulsive Disorder
presence of obsessions, compulsions, or both
specify: good or fair insight, poor insight, or absent insight/delusional beliefs
risk/prog
greater internalizing symptoms, highter neg emotionality, physical and sex abuse, stressful or traumatic events, genetic factors
comorbidity
anxiety, depressive or bipolar, PTSD, tic disorder
Body Dysmorphic Disorder
preoccupation with one or more perceived defects or flaws in physical appearance that not observable or appear slight to others
high rates of suicidal ideation and attempts
comorbidity
MDD, social anxiety, OCD, substance use
Hoarding Disorder
persistent difficulty discarding or parting with possessions
due to perceived need to save items
specify: with excessive acquisition/ good or fair insight, poor insight, or absent insight/delusional beliefs
risk/prog
indecisiveness, stressful/traumatic life events, familial
comorbidity
anxiety, MDD, social anxiety, OCD
Trichotillomania
(Hair-Pulling Disorder)
recurrent pulling out of ones hair
repeated attempts to decrease or stop hair pulling
risk/prog
genetic, OCD
comorbidity
MDD, excoriation (skin-picking)
Excoriation
(skin-picking) disorder
recurrent skin picking resulting in skin lesions
repeated attempts to decrease or stop skin picking
risk/prog
OCD, genetic
comorbidity
OCD, trichotillomania, MDD, other body focused symptoms
Substance Related and Addictive Disorders
all drugs taken in excess have direct activation of brain reward system
primary relationship is with a substance not with other people
Shame is an issue at the core of all addiction
Addictive use of substances or behaviors becomes conditioned response to
stress and pain
Theories that embrace concepts of emotional health, self-actualization, enrichment, and expansiveness are helpful for treatment
- establish safety with self and group
- understanding Nature of Addictive Illness
- Breaking through Denial
- Surrendering to the Process of Recovery
- Understanding the Origins of Shame
art therapy
- break down denial
- increases insight
- access affect
- draw self in relation to substance
- depict self before and after sobriety
- take care with materials which emit toxic fumes
substance use disorders
cluster of cognitive, behavioral, and physiological symptoms
individual continues using substance despite problems
underlying change in brain circuits that may persist beyond detoxification
- impaired control
- social impairment
- risky use of substance
Alcohol Use Disorder
problematic pattern of alcohol use
risk/prog
cultural attitudes, availability of alcohol, stress, genetic, high levels of impulsivity
comorbidity
bipolar, schizophrenia, antisocial, anxiety, depression
alcohol intoxication
recent ingestion of alcohol
clinically significant problematic behavioral or psychological changes
risk/prog
sensation seeking, impulsivity, heavy drinking environment
comorbidity
conduct disorder
antisocial personality disorder
alcohol withdrawal
cessation of or reduction of alcohol use with two or more symptoms
autonomic hyperactivity
hand tremor
insomnia
nausea or vomiting
hallucinations or illusions
psychomotor agitation
anxiety
seizures
risk/prog
drinking daily, consuming large amounts, medical conditions, family histories
Caffeine intoxication
recent consumption of caffeine (in excess of 250mg)
5+ symptoms
restlessness
nervousness
excitement
insomnia
flushed face
diuresis
gastrointestinal disturbance
muscle twitching
rambling
cardiac arrhythmia
inexhaustibility
psychomotor agitation
risk/prog
use caffeine less frequently, oral contraceptives, genetic
comorbidity
exacerbate anxiety, seizures, depression, bipolar, eating disorder, psychotic, sleep disorders, substance use
Caffeine withdrawal
prolonged daily use of caffeine
abrupt cessation of or reduction in caffeine use
3+ symptoms
headache
fatigue
depressed mood or irritability
difficulty concentrating
flu-like symptoms
risk/prog
eating disorders, smokers, substance use, unavailability of caffeine
comorbidity
MDD, anxiety, panic disorder, antisocial, other substance use
Cannabis use disorder
problematic pattern of cannabis use
cannabinoids have diverse effects in brain - cardiovascular, immune, neuromuscular, ocular, reproductive, respiratory, appetite, cognition/perception
risk/prog
history of conduct disorder, academic failure, unstable or abusive family situation, family history, genetic
comorbidity
other substance use, depression, anxiety, suicide attempts, bipolar, antisocial, OCD, paranoia
cannabis intoxication
conjunctival injection (blood shot eyes)
increased appetite
dry mouth
tachycardia (increased heart rate)
cannabis withdrawal
irritability, anger, aggression
nervousness or anxiety
sleep difficulty
decreased appetite
restlessness
depressed mood
abdominal pain, shadiness, sweating, fever, chills, headache
Psychotic Disorders
abnormalities in
delusions
hallucinations
disorganized thinking (speech)
grossly disorganized or abnormal motor behavior
negative symptoms
Delusions
fixed beliefs that are not amenable to change in light of conflicting evidence
Persecutory: one is going to be harmed, harassed (most common)
Referential: certain gestures, comments, cues directed at oneself
Grandiose: believes they have exceptional abilities, wealth, or fame
erotomanic: believes falsely another person is in love with them
Nihilistic: conviction that major catastrophe will occur
somatic: preoccupations regarding health and organ functions
Hallucinations
perception-like experiences that occur w/out external stimulus
vivid and clear
disorganized thinking (speech)
switch from one topic to another - derailment or loose associations
answers to questions obliquely related or unrelated - tangential
incomprehensible - incoherence / word salad
grossly disorganized or abnormal motor behavior
may manifest in variety of ways…
- childlike silliness
- unpredictable agitations
- catatonic behavior
negative symptoms (psychotic disorders)
diminished emotional expression: reductions in expression of emotions in face, eye contact, intonation of speech, movements of hand
Alogia: diminished speech output
Anhedonia: decreased ability to experience pleasure from positive stimuli
Asociality: lack of interest in social interactions
Schizotypal (Personality) Disorder
delusional disorder
presence of one + delusions with duration of 1 month or longer
significant familial relationship
Brief Psychotic Disorder
presence of 1+
-delusions
- hallucinations
- disorganized speech
- grossly disorganized or catatonic behavior
at least 1 day, less than 1 month
risk and prog
temperamental, preexisting personality disorders and traits
Schizophreniform Disorder
2+ present for significant portion of time for 1 month period, less than 6 months
- delusions
- hallucinations
- disorganized speech
- grossly disorganized or catatonic behavior
- negative symptoms
risk and prog
genetic and physiological
Schizophrenia
2+ of following present for significant portion of time during 1 month period
- delusions
- hallucinations
- disorganized speech
- grossly disorganized or catatonic behavior
- negative symptoms
persist for at least 6 months
risk and prog
environmental: season of birth - lake winter/early spring, urban environment, some minority ethnic groups
genetic and physiological: pregnancy and birth complications, greater paternal age
comorbidity
substance-related disorders, mostly tobacco
art therapy
- monitoring process and reality testing
- self expression and mastery
- enhance authentic relationship
- clubhouse model: advocacy, empowerment, and rehab
- studio approach
Schizoaffective disorder
uninterrupted period of illness during major mood episode
delusions or hallucinations for 2+ weeks
Risk and prog:
first degree relatives
Art Therapy for Medical Conditions
art expression is used by young patients to communicate perceptions, needs, and wishes
Theories of personality and cognitive development are fundamental
Most young children believe that death is reversible
Rubins diagnostic art interview
Ulmans personality assessment
child diagnostic drawing series
Person Picking an Apple from a Tree
bridge drawing
engineering hope
gaining a sense of mastery
Creating art can also be a powerful component of caring for oneself
Feeding and Eating Disorders
persistent disturbance of eating or eating-related behavior that results in altered consumption or absorption of food
significantly impairs physical health or psychosocial functioning
art therapy
- opportunity to embody issues, feelings, and experiences
- art as transitional object
- art replace food as symbolic form of communication
- focus on clients experience and sense of self rather than “food intake”
- goal: balance in relationship to self and food, identifying underlying feelings, developing healthier and realistic body image
Pica
persistent eating of nonnutritive, nonfood substances over period of at least 1 month
inappropriate to development level
not part of culturally supported or socially normative practice
risk and prog
neglect, lack of supervision, developmental delay
comorbidity
ASD, ID, schizophrenia, trichotillomania, excoriation
Rumination Disorder
repeated regurgitation of food over period of at least 1 month
may be re-chewed, re-swallowed, or spit out
risk / prog
lack of stimulation, neglect, stressful life situations, problems in parent-child relationship
comorbidity
medical condition, GAD
Avoidant / Restrictive Food intake disorder
persistent failure to meet appropriate nutritional and/or energy needs associated with 1+
- significant weight loss
- significant nutritional deficiency
- dependence on enteral feeding or oral nutritional supplements
- marked interference with psychosocial function
risk / prog
anx, asd, ocd, adhd, familial anxiety, gastrointestinal conditions, other medical problems
comorbidity
anxiety, ocd, neurodevelopmental disorders
anorexia nervosa
restriction of energy intake relative to requirements, leading to significantly low body weight
intense fear of gaining weight or becoming fat
disturbance in way ones body weight or shape is experienced
risk / prog
anxiety, OCD, cultures and settings where thinness is valued, first degree relatives ,
comorbidity
bipolar, depressive, anxiety, substance use
Bulimia Nervosa
recurrent episodes of binge eating with
- eating an amount of food larger than what most individuals would eat
- sense of lack of control during episode
inappropriate compensatory behaviors in order to prevent weight gain
occurs at least once a week for 3 months
self evaluation unduly influenced by body shape and weight
risk / prog
weight concerns, low self esteem, depression, social anx, overanxious, sexual or physical abuse, childhood obesity and early maturation
comorbidity
depression, bipolar, anxiety
Binge-Eating Disorder
recurrent episodes of binge eating with
- eating amount of food larger than what most people would eat
- sense of lack of control over eating
marked distress is present
occurs once a week for 3 months
risk / prog
runs in families, poss additive genetic influences
comorbidity
bipolar, depression, anxiety, substance use
Enuresis
repeated voiding of urine into bed or clothes
at least twice a week for 3 months
at least 5 years old
risk / prog
delayed or lax toilet training, psychosocial stress, delays in dev of circadian
comorbidity
behavioral symptoms, dev delays, UTI
Encopresis
repeated passage of feces into inappropriate places
at least once a month for 3 months
age 4 years old
risk / prog
some medications
Neurocognitive Disorders
impaired cognition has not been present since birth or very early life
decline from previously attained level of functioning
primary clinical deficit is in cognitive function
acquired rather than developmental
Delirium
disturbance in attention
develops over short period of time
change from baseline attention and awareness
fluctuate in severity during day
could be consequence of another medical condition or intoxication
risk / prog
functional impairment, immobility, history of falls, low levels of activity, drug use, NCDs, older individuals
Mild Neurocognitive Disorder
modest cognitive decline from previous level of performance in one or more domains
deficits do not interfere with capacity for independence
risk / prog
age is strongest risk factor
comorbidity
age related diseases, delirium
Major or Mild Neurocognitive Disorder Due to Alzheimer’s Disease
insidious onset and gradual progression of impairment in one or more cognitive domains
family history of Alz or genetic testing
all 3 present
- decline in memory and learning
- progressive, gradual decline in cognition
- no evidence of mixed etiology
risk / prog
TBI, age, Down’s syndrome
comorbidity
medical conditions, cerebrovascular disease
Major or Mild Frontotemporal Neurocognitive Disorder
insidious onset and gradual progression
Behavioral variant
- apathy or inertia
- loss of sympathy or empathy
- perseverative, stereotyped or compulsive behavior
- hyperorality and dietary changes
language variant
- decline in language ability in speech production, word finding, object naming, grammar, or word comprehension
sparing of learning and memory and perceptual motor function
risk / prog
family hist, genetic factors
Major or Mild Neurocognitive Disorder w/ Lewy Bodies
insidious onset and gradual progression
fluctuating cognition w/ pronounced variations in attention and alertness
recurrent visual hallucinations
features of parkinsonism
REM disorder
neuroleptic sensitivity
risk / prog
familial aggregation, most cases no family history
comorbidity
Alzheimers, cerebrovascular
Major or Mild Vascular Neurocognitive Disorder
onset related to cerebrovascular events
prominent in complex atention
risk / prog
neuroplasticity factors - education, physical exercise, mental activity, hypertension, diabetes, smoking, obesity, hereditary
comorbidity
Alzheimers
Other causes of Major or Mild Neurocognitive Disorder
Traumatic Brain Injury
- loss of consciousness, posttraumatic amnesis, disorientation
Substance / Medication - Induced
HIV Infection
Prion Disease
Parkinsons Disease
Huntington’s Disease
Another Medical Condition
Multiple Etiologies
General Population
Trauma/Victims of Crime/Violence
Although abused children share common symptoms - unique and idiosyncratic responses
assessment process that is nondirective, is play based, and does not rely exclusively on verbal communication
Grief, Loss, and Bereavement
Multi-cultural families
transcultural-specific perspective - ADDRESSING
A ge and generational influences
D evelopmental and acquired
D isabilities
R eligion,
E thnicity
S ocioeconomic status
S exual orientation
I ndigenous heritage,
N ational origin
G ender.
genograms can be imperative to sifting through complexities
Lesbian, Gay, Bi-sexual, Transgender, Queer, Questioning, Intersex, Ally (LGBTQQIA)
Employee Assistance Programs (EAP)
BIPOC
Adoption
Intimate Partner Abuse/Violence
Military (active duty, dependents, partners, veterans)
Religious/Spiritual
Immigrants/Refugees
Housing Insecurity
Community Mental Health
Corrections
Inpatient Psychiatric Setting
Intensive Outpatient Program (IOP)
Medical Setting
including drawing as a way to provide a subjective measure of how an individual is dealing with illness and to assist patients in participating in their own treatment
personal empowerment
stress reduction
social support
opportunity to reauthor one’s life story
Older Adult Care Setting
age related changes:
- physical–biological: hair, visual and hearing acuity declines; skin wrinkles; muscles and bones weaken; joints become inflamed; and sexuality changes with menopause and impotence. Cognitive impairment, memory loss, reduced rate of response, and organic bodily ills
- psychosocial losses and crises: loss of income and social connections
Choice of art media merits careful consideration, as well as adaptation with materials
Goals:
- release of pent-up emotions and expression of underlying psychosis, problems, and organicity
- sense of pride and dignity
- reminiscence and life review
- visual focus for reality orientation
- nonverbal, visual means of communication
- socialization and group support
- sense of self-worth and integrity
- elf-esteem
- stimulation
late style artwork: soft broken lines, dissolution of boundaries
Common psychiatric disorders:
major depression
bipolar disorder
dysthymic disorder
schizophrenia
paranoia
anxiety disorder
somatoform disorder
dissociative disorder
sexual and gender disorders
personality disorders
Alzheimer’s disease and other dementias
delirium
amnestic disorder
physical illnesses
Open Studio/Art Studio
therapists become facilitators and collaborators rather than treaters
offer artist-quality materials that provide dignity and respect
avoid suggesting themes, providing only enough guidance to prevent excessive anxiety
Partial Hospitalization Program (PHP)
Private Practice/ Outpatient
Residential Care
School-Based Setting
Telehealth
Forensic Art Therapy
integrates art therapy practice and theory within a legal context and with standard forensic procedure and protocol
used for fact-finding purposes and is investigative in nature rather than
interventive
Violent Imagery
Violent imagery and horror evoke a level of emotional surrender and provide a way to embody deep fears and desires that must be sublimated in order for an individual to function as an adult in our society
adolescents are vulnerable to such imagery as it addresses their growing existential awareness and their questions about their future
Most if not all adolescents engage in fantasies of retribution, harm, and ill will toward those they feel have treated them unfairly
Home and family dysfunction, presence of a diagnosable conduct or other mental disorder, and the presence of specific and clear threats are all significant factors linked to adolescent violence
allowing repetitive violent expression without some reflection or direction poses inherent risks
Sublimation: typically, an unconscious process
rehearsal: has an element of conscious awareness and planning
determining the source of the imagery may be more important than the content of the imagery itself
“If someone were to walk in here and see your picture, what message do you think they might get?”
talk to it, ask it questions
adult art therapy
serves as a form of nonverbal communication
allows expression of feelings, thoughts, and world views
provides an opportunity to explore problems, strengths, and possibilities for change
emphasis on understanding that drawings, paintings, and collages do not necessarily have to have esthetic value to be therapeutic
view problems in new ways and to tangibly create solutions to those problems
adults with severe mental illness
therapist’s attitude is even more essential than what she says or does because authentic and sincere engagement with people, and the art materials themselves, are the basic curative elements in art therapy with this population
some people with mental illness consider artistic creativity to be a compensatory benefit of their illness
focus on hopeful long-term prognoses rather than pessimistic medical diagnoses
key to successful treatment of severe mental illness is understanding its impact and course from the viewpoint of the person experiencing it
Hospitalization:
phase 1: overcoming crisis
phase 2: developing coping skills
phase 3: strengthening selfhood
Groups, Familys, Couples
naturally create the opportunity for communication, interaction, negotiation, and other types of personal exchange
Irving Yalom
- instilling hope
- interaction
- universality
- altruism
opening discussion, an experiential process, and a postexperiential discussion
Interactive group art therapy
Harry Stack Sullivan
- individual’s history influences every moment of life
focuses on the actions, reactions, and characteristic patterns of interaction which constrain people in their everyday lives
fundamental processes: projection, mirroring, scapegoating, parataxic distortion, and projective identification
group has the resources to find its own solutions and will support any attempts to do this
role of the therapist is primarily to maintain the therapeutic task of the group
important for any client to have some readily available backup between groups
sexually abused children
four things on which to base confirmation of abuse:
(1) the child’s sexual behavior and knowledge of sex
(2) the child’s nonsexual behavior commonly associated with abuse
(3) medical evidence
(4) disclosure
attempts to find a unified pattern of signs indicating abuse have been inconsistent
Children’s drawings alone are not sufficient to diagnose child sexual abuse
helpful assessments
- perception of self (portrait/draw a person)
- perception of environment (HTP / favorite day)
- free drawing
betrayal of trust is most traumatic
depression, anger, anxiety very common
attachment coupled with abuse is a more severe stress trigger than abuse with no attachment
issues are enacted symbolically through repetition of themes that are idiosyncratic to each child
Through repetition of themes, the child begins to gain mastery over the over-
whelming feelings
group therapy helps the child feel less alone, guilty, and responsible
Family art therapy
- allows every generation to have an equal voice
- simultaneously express their thoughts and feelings
- simple drawing or collage can be the means by which the client “brings the family in”
- enhances communication among family members and uncovers family patterns of interaction and behavior
- means to communicate with each other in a new way
couples
find small moments of cooperation or caring that provide a base from which we can build
co-construct with the couple a vision of what they hope to find in a more satisfying relationship
SSRIs
Prozac, Zoloft, Pazil, Luvox, Celexa, Lexapro
selective serotonin reuptake inhibitor
wide range of disorders
TCAs
tricyclic antidepressants
tofranil, elavil, norpramin
for severe major depression
harder to tolerate and can be toxic
mood stabilizers
lithium, depakote, tegretol
for bi polar and stabalize mood swings
stimulants
ritalin, dexedrine, adderall, concerta
for ADD
effects similar to cocaine
lasts 3-6 hours
antipsychotics
thorazine, haldol, mellaril, stelazine, navane, risperdal, zyprexa, seroquel, clozapine
treat hallucinations, delusions, and loose associations
reduce high aggitation
benzodiazapines
ativan, valium, klonopin, librium, xanax, halcion
for anxiety and sleep
highly addictive
Adolescents
goal: develop identity / prepare to become productive part of society
adapting to physical changes, sexual identity, personal values
pseudo-naturalistic art phase: naturalistic, detailed artwork
art therapy
-bypass resistance to therapy
- vehicle to express worldview and experience
- give sense of control
- stick with metaphores
