Diagnosis & Psychpathology Flashcards
paresthesias
an abnormal sensation, typically tingling or pricking (“pins and needles”), caused chiefly by pressure on or damage to peripheral nerves
avolition
a significant or severe lack of motivation or a pronounced inability to complete purposeful tasks
panic attack
an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes
obessions
recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress
compulsions
repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
localized amnesia
an inability to recall all events related to a circumscribed period of time
selective amnesia
an inability to recall some events related to a circumscribed period of time
generalized amnesia
a loss of memory for one’s personal identity as well as some semantic and skill knowledge
depersonalization
involves a sense of unreality, detachment, or being an outside observer of one’s own thoughts, feelings, and actions
derealization
a sense of unreality or detachment with regard to one’s surroundings
hypnogogic hallucinations
vivid hallucinations that occur while falling asleep
hypnopompic hallucinations
vivid hallucinations that occur while waking
cataplexy
a brief loss of muscle tone
parasomnia
undesirable motor, verbal, or experiential phenomena that occur in a state that lies between sleep and wakefulness;
occurrs in rapid eye movement (REM) sleep, non-rapid eye movement (NREM) sleep
sleep bruxism
when a person involuntarily grinds or clenches their teeth while sleeping, sometimes leading to wearing down the teeth and jaw discomfort
somnambulism
sleepwalking
REM sleep behavior disorder
a parasomnia that occurs later in the night than NREM disorders;
usually affects middle-aged or elderly individuals, especially males, and sufferers often also have a neurological disorder;
the temporary muscle paralysis that normally occurs during REM sleep doesn’t occur so individuals may act out dreams through potentially violent movements or behaviors during sleep that can cause injuries to themselves or bed partners
synesthesia
a condition in which an involuntary joining of one sense is accompanied by a perception in another sense (a person sees a certain color in response to a certain letter of the alphabet or number)
hypersomnia
a condition in which you feel extreme daytime sleepiness despite getting sleep that should be adequate
post traumatic amnesia (PTA)
a pattern of mental disturbance characterized by memory failure for day-to-day events, disorientation, misidentification of family and friends, impaired attention and illusions resulting from a head injury
alogia
a symptom that causes you to speak less, say fewer words or only speak in response to others
traditional (first-generation) psychotics
chlorpromazine, thioridazine, and haloperidol
newer (second-generation) psychotics
clozapine, risperidone, olanzapine, and ariprazole
tardive dyskinesia
repetitive, involuntary movements, such as grimacing and eye blinking
medication for bipolar I
lithium; valproate, carbamazepine, or other antiseizure medication may be prescribed
atypical feature of MDD
significant weight gain or increase in appetite, hypersomnia, leaden paralysis, pattern of interpersonal rejection sensitivity
hypokalemia
low levels of potassium;
from electrolyte imbalance from bulimia
hyperorexia
excessive appetite
hypalgesia
decreased sensitivity to pain
Voyeuristic Disorder
characterized by recurrent and intense sexual arousal from observing an unsuspecting person who is naked, is disrobing, or is engaged in sexual activity
exhibitionist disorder
recurrent and intense sexual arousal from exposing one’s genitals to an unsuspecting person
Frotteuristic disorder
recurrent and intense sexual arousal from touching or rubbing against a nonconsenting adult
pedophilic disorder
recurrent and intense sexually arousing fantasies, sexual urges, or sexual behaviors involving sexual activity with one or more prepubescent children
fetishistic disorder
characterized by recurrent and intense sexual arousal from using nonliving objects or focusing on one or more nongenital body parts
transvestic disorder
involves recurrent and intense sexual arousal from cross-dressing
covert sensitization
pairing presentation of the object of sexual desire with an aversive stimulus in imagination
orgasmic reconditioning
instructs a client to begin masturbating while fantasizing about the inappropriate stimulus then switch from the paraphilic to more appropriate fantasies at the moment of masturbatory orgasm
satiation therapy
first masturbating to orgasm while imagining appropriate stimuli and then continuing to masturbate while fantasizing about paraphilic images after orgasm
splitting
vacillating between contradictory views of the self and others as “all good” or “all bad”
difference between delirium and dementia
delirium affects mainly attention and awareness;
dementia affects mainly memory and other cognitive function
anterograde amnesia
type of memory loss that occurs when you can’t form new memories
retrograde amnesia
the inability to remember past events or experiences
iatrogenic condition
one that is produced by the treatment
avoidant personality
combination of social avoidance, fear of humiliation, and loneliness
tonic phase
extension of the limbs
clonic phase
violent rhythmic contractions
idiopathic
of unknown cause
homeopathic
a more natural approach to healing in which the patient is given small doses of substances, which in larger doses, cause the same symptoms that they are suffering from
allopathic
the typical biomedical treatments which are practiced by most physicians in North America and Europe today
autoplastic
adaptation through altering one’s own behavior
coprolalia
involuntary utterances of obscenities
Korsakoff’s syndrome
dementia caused by a lack of thiamine in the brain, which is usually caused by chronic alcoholism and sometimes by severe malnutrition;
characterized by anterograde and retrograde amnesia and confabulation (fabrication of memories to compensate for memory loss)
Briquet’s syndrome
AKA somatization disorder
identity foreclosure
characterized by a commitment to an identity (e.g., career) that was defined or suggested by a parent of other significant person
structural abnormalities in ASD
amygdala and cerebellum; and abnormalities in serotonin, GABA, and other neurotransmitters
best prognosis for ASD
development of functional language by age five, an IQ over 70, a later onset of symptoms, and an absence of comorbid mental disorders
ADHD prevalence rate
5% for children and 2.5% for adults;
male-to-female gender ratio of about 2:1 for children and 1.6:1 for adults
drug of choice for Tourette’s
clonidine
structural abnormalities in schizophrenia
increased volume in the lateral and third ventricles;
reduced size of the hippocampus and amygdala;
decreased cerebral blood flow in the prefrontal cortex;
elevated dopamine levels or oversensitive dopamine receptors (dopamine hypothesis), which has been expanded to include other neurotransmitters, especially norepinephrine, serotonin, and glutamate
delusion of reference
in which the person believes that objects or events in the immediate environment have an unusual and particular significance to him or her
sensate focus
nondemand pleasuring
characteristics linked to successful smoking cessation
age 35 or older, married or living with a partner, later age when started smoking, being male
Cluster A
Cluster B
Cluster C
odd or eccentric behaviors;
dramatic, emotional, or erratic behaviors;
anxiety or fearfulness
illusion
misperception of a real stimulus
specifier “provisional” is used when
the clinician believes the full criteria for a diagnosis will eventually be met but does not currently have sufficient information for a firm diagnosis
etiology of ID
30% to chromosomal abnormalities (e.g., Down Syndrome, damage from toxins);
15 to 20% to environmental factors and other mental disorders (severe deprivation, autism);
10% to pregnancy and perinatal complications (fetal malnutrition, anoxia, HIV);
5% to heredity (Tay-Sachs disease, PKU, fragile X syndrome);
5% to general medical conditions during infancy or childhood (lead poisoning, malnutrition);
In 30 to 40% of cases, the cause is unknown, but low birth weight has been identified as the strongest predictor of these cases
differential diagnosis of ID
SLD, ASD, Neurocognitive Disorder, and Borderline Intellectual Functioning
brain abnormalities in ADHD
prefrontal cortex (mediates higher-order cognitive functions);
cerebellum (coordinates motor activity);
caudate nucleus and putamen (part of the basal ganglia and are involved in the control of movement)
behavioral disinhibition hypothesis
the essential characteristic of ADHD is an inability to adjust activity levels to the requirements of the situation
common co-diagnoses of SLD
ADHD (20 to 30%), ODD, conduct disorder, MDD
possible contributors to SLD
exposure to toxins (especially lead), early malnutrition, food allergies, hemispheric abnormalities (e.g., incomplete dominance or mixed laterality), and cerebellar-vestibular dysfunction due, for example, to otitis media (inflammation of the middle ear)
Clonidine side effects
dry mouth, headache, hypotension (low blood pressure), vomiting, dizziness, irritability, sedation
medication for Tourette’s and ADHD
clonidine or the antidepressant desipramine
delusions
false beliefs that are maintained despite conflicting evidence
delusion subtypes
1) Erotomanic: believes that another person (usually of higher status) is in love with them
2) Grandiose: believes that they have remarkable but unrecognized talent or wisdom or made a meaningful discovery
3) Jealous: believes spouse or lover is unfaithful
4) Persecutory: believes that they are being conspired against, cheated, spied on, or maliciously maligned
5) Somatic: believes that they have abnormal bodily functions or sensations
6) Mixed: The person’s delusion incorporates more than one theme
7) Unspecified: The person’s delusional belief cannot be determined or does not match one of the specific types
pjsegmu
better prognosis for schizophrenia
late and acute onset, a precipitating event, female gender, good premorbid adjustment, insight into the illness, a brief duration of active-phase symptoms, a family history of a mood disorder, and no family history of schizophrenia
concordance rates for the biological relatives of a person who has received a diagnosis of Schizophrenia
Biological sibling: 10%
Dizygotic (fraternal) twin: 17%
Monozygotic (identical) twin: 48%
Child of one parent with Schizophrenia: 13%
Child of two parents with Schizophrenia: 46%
manic episode
a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy
12-month prevalence rate for Bipolar I Disorder
0.6% in the United States, and the lifetime male-to-female prevalence ratio is approximately 1.1:1
interpersonal and social rhythm therapy (IPSRT)
focuses on helping clients recognize the impact of interpersonal activities and relationships on social and circadian rhythms and regularize those rhythms so they can gain control over their mood cycles
classic, or “vegetative” signs of depression
persistent problems with appetite, weight loss or gain, sleep difficulties, reduced energy level, and changes in sexual desire or function
MDD with seasonal pattern (AKA seasonal affective disorder, SAD)
applied when the mood episode consistently occurs at a particular time of the year, most often beginning in the fall and continuing into the winter months;
symptoms include a lack of energy, hypersomnia, increased appetite and weight gain, and carbohydrate craving
explanation for SAD
related to reduced exposure to sunlight which disrupts the body’s normal circadian rhythms, resulting in an increased production of melatonin (a hormone that causes drowsiness) and a lower-than-normal level of serotonin
depression and sleep
associated with decreased slow-wave or non-REM sleep;
early morning waking, decreased sleep continuity;
earlier onset of REM sleep or decreased REM latency
type of memory affected by depression
recall memory
12-month prevalence rate for MDD
7%, with the rate for individuals ages 18 to 29 being 3 times the rate for individuals ages 60 and older;
rates are about equal for males and females before puberty but, starting in early adolescence, the rate for females is 1.5 to 3 times the rate for males
etiology of MDD
genetic factors that predispose a person to both neuroticism and depression;
low levels of norepinephrine (the catecholamine hypothesis);
low levels of norepinephrine and serotonin (permissive theory);
linked to a high level of cortisol (stress hormone released by the adrenal gland), which causes degeneration of cells in the hippocampus
Seligman’s (1978) learned helplessness model of depression
the result of repeated exposure to uncontrollable negative life events with a tendency to attribute those events to stable, internal, and global factors;
revised version of this model places less emphasis on attributions and identifies a feeling of hopelessness as the proximal and sufficient cause of depression
Lewinsohn’s (1974) behavioral theory of depression
result of a low rate of response-contingent reinforcement for adaptive behaviors, which causes extinction of those behaviors as well as pessimism, low self-esteem, social isolation, and dysphoria that, in turn, are reinforced by the sympathy and concern of others
Beck’s (1976) cognitive theory of depression
emphasizes the role of negative self-statements about oneself, the world, and the future (AKA the negative or depressive cognitive triad)
Rehm’s (1987) self-control model of depression
attributes depression to problems related to self-monitoring, self-evaluation, and self-reinforcement;
people who are depressed attend more to negative than positive life events, have strict standards of self-evaluation and make internal attributions for negative events, and provide themselves with insufficient reinforcement and excessive punishment
3 major types of antidepressants are prescribed
tricyclics (TCAs), selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs)
electroconvulsive therapy (ECT) and depression
not a preferred treatment for depression b/c of adverse side effects (disorientation and anterograde and retrograde amnesia) but these effects are reduced when ECT is administered only to the right (nondominant) hemisphere;
ECT is effective for severe endogenous depression that is resistant to antidepressants
specific phobia specifiers
animal, natural environment, blood-injection-injury, situational (cued), and other
ABSNO
most common psychiatric disorder in older adults
GAD
12-month prevalence rate of OCD
1.2% - equally common in male and female adults;
but male children have higher rates than female children;
* For males, the peak onset is between 6 and 15.
* For females, the peak onset is between 20 and 29
etiology of OCD
heredity;
low level of serotonin;
brain structure abnormalities: orbitofrontal cortex and caudate nucleus
medication for OCD
clomipramine (a TCA), fluvoxamine, sertraline (Zoloft), and several other SSRIs
eye movement desensitization and reprocessing (EMDR) and PTSD
found to be an effective treatment, but there is evidence that its effects are due to exposure to feared stimuli and that eye movements are unnecessary
Dissociative Identity Disorder (DID)
diagnosis requires the presence in one person of two or more distinct personalities or the experience of possession, accompanied by recurring gaps in the recall of ordinary events, personal information, or traumatic events that can’t be explained by normal forgetfulness
dissociative amnesia
characterized by an inability to recall important autobiographical information that can’t be explained by ordinary forgetfulness and causes significant distress or impaired functioning;
increased risk for this disorder is associated with exposure to one or more traumatic events (esp childhood physical or sexual abuse, interpersonal violence)
Somatic Symptom Disorder
involves one or more somatic symptoms that cause distress or a significant disruption in daily life with excessive thoughts, feelings, or behaviors related to the symptoms as manifested by at least one of 3 characteristic symptoms:
Disproportionate and persistent thoughts about the seriousness of the symptoms; persistently high level of anxiety about one’s health or symptoms; excessive time and energy devoted to symptoms or concerns about health
somatization disorder comorbidities
personality disorder (61%), MDD (55%), GAD (34%), and panic disorder (26%)
illness anxiety disorder
preoccupation with having a serious illness, an absence of somatic symptoms or the presence of mild symptoms, a high level of anxiety about one’s health, and either performance of excessive health-related behaviors or maladaptive avoidance of medical care
Conversion Disorder (Functional Neurological Symptom Disorder)
diagnosed in the presence of at least one symptom that involves an alteration in voluntary motor or sensory function and is incompatible with known neurological and medical conditions
treatment for factitious disorder
symptom management rather than “curing” the disorder and is most effective when it includes establishing a strong therapeutic alliance and providing supportive therapy and consistent care;
use of confrontational techniques is usually contraindicated because they tend to increase the person’s defensiveness and denial and the likelihood that he or she will terminate therapy prematurely
insomnia treatment
benzodiazepine, antihistamine, or other drug;
CBT intervention that includes:
Sleep restriction (restricting time in bed to improve sleep continuity)
Stimulus control (strengthening the bed and bedroom as cues for sleep)
Sleep-hygiene education (providing information on healthy sleep behaviors and environmental conditions conducive to sleep)
Relaxation training, and/or cognitive restructuring
Non-Rapid Eye Movement Sleep Arousal Disorders
characterized by recurrent episodes of incomplete awakening that occur most often during Stage 3 or 4 sleep in the first third of a major sleep episode and that involve:
Sleepwalking: associated with low levels of autonomic arousal and is characterized by prominent, organized motor activity such as walking around, talking, and eating
Sleep terrors: sudden awakening from sleep that usually starts with a panicky scream and is accompanied by intense anxiety and autonomic arousal - motor activity is less organized and usually involves resisting being touched or held and sitting up
The person has little or no recall of the episode when he or she wakes up.
The person has similar sleep and EEG patterns
sex therapy is most effective for which sexual dysfunction?
Premature Ejaculation
sex therapy includes
sensate focus and the start-stop or squeeze technique
paraphilia
any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners
10 classes of substances
alcohol; caffeine; cannabis; phencyclidine and other hallucinogens; inhalants; opioids; sedatives, hypnotics, and anxiolytics; stimulants; tobacco; and other/unknown (this category includes Gambling Disorder)
ACCHHOOSST
substance use disorders
presence of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems
substance use disorders specifiers
1) Early: there is more than 1 month but less than 12 months of remission
2) Sustained: there is 12 months or longer of remission
3) Full: the person no longer meets any of the criteria for substance dependence of abuse
4) Partial: one or more of the criteria for substance dependence are still met but the full criteria are no longer met
incentive-sensitization theory
repeated activation of the dopaminergic reward system in the brain by the substance and cues related to the substance sensitizes this system, resulting in a craving for and a compulsion to use the substance
tension-reduction hypothesis (Conger, 1956) and the self-medication hypothesis
people use alcohol and other drugs to alleviate stress and enhance their mood and that repeated use of a drug for these reasons eventually leads to addiction;
addiction is the result of negative reinforcement (alleviation of stress) and positive reinforcement (mood enhancement).
smoking cessation interventions
most successful when they combine therapy (e.g., behavior therapy, CBT, self-guided therapy), pharmacotherapy (nicotine replacement therapy and/or the antidepressant Wellbutrin), and advice and support from medical or mental health professionals
Marlatt and Gordon (1985) found that 3 high-risk situations are associated with nearly 75% of all lapses
negative emotional states, interpersonal conflict, and social pressure
relapse prevention therapy (RPT)
describes addiction as an “overlearned habit pattern” and proposes that the risk for relapse is reduced when a person views a lapse as the result of specific, external, and controllable factors;
encourages clients to believe that a lapse will not necessarily lead to total relapse and to view a lapse as a learning experience;
clients helped to identify the circumstances that increase the risk for a lapse (e.g., situations that elicit negative emotions or expose them to alcohol or alcohol-related cues) and to use CBT to help prevent lapses and cope more successfully with lapses when they occur;
focuses on minimizing the abstinence violation effect (continue to engage in prohibited behavior following the violation to abstain) and help the client to develop “positive addictions”
features of Substance/Medication-Induced Mental Disorders
(a) involves a clinically significant symptomatic presentation of a mental disorder
(b) evidence from a history, a physical exam, or lab results confirms that the disorder developed during or within 1 month of substance intoxication or withdrawal
(c) cannot be better accounted for by another mental disorder or medical condition
(d) doesn’t occur exclusively during an episode of delirium
(e) symptoms cause significant distress or impairment in functioning
best predictor for alcoholism is
family history of alcoholism
symptom onset of alcohol withdrawal
begin within 4-12 hours after stop drinking, peak during the 2nd day of abstinence, and decrease markedly by the 4th or 5th day
delirium tremens (DT’s)
severe alcohol withdrawal symptoms that may include vivid hallucinations, delusions, autonomic hyperactivity, and agitation
2 medications to treat opioid withdrawal
buprenorphine (Subutex) and buprenorphine/naloxone (Suboxone)
Paranoid Personality Disorder
pervasive pattern of distrust and suspiciousness of others that involves interpreting their motives as malevolent
Schizoid Personality Disorder
pervasive pattern of detachment from interpersonal relationships and a restricted range of emotional expression in interpersonal settings
Schizotypal Personality Disorder
pervasive social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships and cognitive or perceptual distortions and behavioral eccentricities
etiology for antisocial PD
heredity (prevalence rates 5-10X higher in ppl with first-degree relatives with the disorder);
family characteristics (parenting behavior characterized by high negativity, low warmth, and inconsistency);
personality traits (lack empathy, lower-than-normal autonomic response to threatening stimuli)
antisocial personality disorder
pervasive pattern of disregard for and violation of the rights of others since age 15
BPD
pervasive pattern of instability of interpersonal relationships, self-image, and affect plus marked impulsivity
BPD theories
1) Mahler’s object relations theory: abnormalities in the separation-individuation process that led to fixation at this stage and vacillation between a need for separation and a fear of abandonment;
2) Kernberg: caregiver behaviors that alternate unpredictably between being nurturing/gratifying and depriving/punitive produces a weak ego that relies primarily on the primitive defense mechanism of “splitting”;
3) Linehan: pervasive emotion dysregulation:
* (a) biologically based vulnerability to high emotionality, inability to regulate intense emotional responses
* (b) exposure to an invalidating environment in which communication of private experiences is responded to by significant others in erratic and negative ways
main strategies of DBT
(a) group skills training to develop mindfulness, emotion regulation, and interpersonal effectiveness;
(b) individual outpatient psychotherapy to maintain motivation and strengthen newly acquired skills;
(c) telephone coaching to provide between-session support and promote generalization of skills
Histrionic Personality Disorder
pervasive pattern of emotionality and attention-seeking
Narcissistic Personality Disorder
pervasive pattern of grandiosity in fantasy or behavior, a need for admiration, and a lack of empathy
Avoidant Personality Disorder
pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
Dependent Personality Disorder
pervasive and excessive need to be taken care of that leads to submissive, clinging behavior and fear of separation
OCPD
pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control that limit flexibility, openness, and efficiency
akesthesia
inability to remain still
comorbidity of ADHD
Conduct Disorder – between 30% and 50%, with the highest comorbidity rates among hyperactive-impulsive and combined types
structural abnormalities in ADHD
prefrontal cortex (which mediates higher-order cognitive functions);
cerebellum (which coordinates motor activity);
caudate nucleus and putamen (which are part of the basal ganglia and are involved in the control of movement)
dyslexia
reading disorder that involves impaired word recognition, decoding, and spelling ability;
attributed to deficits in phonological processing, ability to associate sounds with letters or combinations of letters
comorbidity of Tourette’s
OCD, ADHD
1.5 and 3 times more common in males than in females
systematized delusions
ones organized around a coherent theme
active phase symptoms of schizophrenia
delusions, hallucinations, disorganized speech, grossly disorganized behavior
most common diagnosis for inpatients in the age 18 to 44 range
schizophrenia
WHO study factors believed to contribute to the shorter course and better outcomes for patients with schizophrenia in developing countries
presence of extended families, greater social support, and greater tolerance and acceptance by family members
characteristic symptoms of manic episode
inflated self-esteem or grandiosity, decreased need for sleep, flight of ideas
difference between Bipolar I and II
I: at least one manic episode that lasts a week or longer, marked impairment; doesn’t need hypomania or depression
II: presence of at least one hypomanic episode (4 days, less severe) and one major depressive episode
pseudodementia
occurs when a person is so slowed down from depression or another psychiatric illness that they present as intellectually or cognitively impaired
most effective treatment for agoraphobia
flooding
with reports of long-term improvement for up to 75% of treated patients
most effective therapy for OCD
in vivo exposure combined with response prevention
specifier “with dissociative fugue”
applied to dissociative amnesia when it includes purposeful travel or wandering away from home with amnesia for one’s identity or other important personal information
malingering
intentional production of false or grossly exaggerated physical or psychological symptoms for personal gain (e.g., to avoid work or receive financial compensation)
anorexia
restriction of energy intake that leads to a significantly low body weight;
intense fear of gaining weight or becoming fat or persistent behaviors that interfere with weight gain;
disturbance in the experience of one’s body weight or shape or persistent lack of recognition of the seriousness of one’s low body weight
etiology of enuresis
higher for children of previously enuretic fathers than previously enuretic mothers
gender affirmation surgery outcomes
vast majority no longer expressed gender dysphoria and were psychologically, socially and sexually functioning well;
female-to-male functioned better in many respects than male-to-female;
greater psychopathology and body dissatisfaction reported the worst post-operative outcomes
best therapeutic intervention for smoking cessation
behavioral
common barriers for individuals with Tobacco Use Disorder
fear of gaining weight (especially among women), fear of withdrawal symptoms, and a fear of failure
best predictor for of treatment outcome for substance abusers
psychiatric severity and problem severity
3 stages of Major or Mild Neurocognitive Disorder Due to Alzheimer’s Disease
1) early stage: anterograde amnesia, impaired attention and judgment. becoming lost even in familiar places, apathy, depression, irritability, inability to recall familiar words and names (anomia)
2) middle stage: both anterograde and retrograde amnesia, problems with reading and writing, inability to remember the names of or recognize family members and friends, mood swings and personality changes, sleep disturbances, aphasia, restlessness and wandering, difficulty performing sequential and complex tasks
3) late stage: need for assistance in all basic activities of daily living - unable to communicate or walk, urinary and fecal incontinence, bedridden
2 types of hypertension
1) primary (essential) hypertension (most common) - diagnosed when the cause is unknown
2) secondary hypertension - secondary to another disorder or condition
psychological stress
an individual perceives that environmental demands tax or exceed his or her adaptive capacity
Selye’s general adaptation syndrome (GAS)
1) alarm: hypothalamic-pituitary-adrenal (HPA) axis is activated by the stressor, releasing epinephrine and norepinephrine - causes individual with the energy needed to cope with the stress after being made aware of it
2) resistance: if stress continues, hypothalamus signals pituitary gland to release ACTH - signals the adrenal cortex to release cortisol and stress hormones - maintains responding to the stressor - summon resources to meet the challenge
3) exhaustion: with prolonged stress, the pituitary and adrenal glands lose ability to maintain elevated hormone levels and physical reserves become depleted - leading to mental and physical exhaustion, illness, and, in extreme cases, collapse or death
cortisol’s effect on the body
increased risk for heart disease, diabetes, gastrointestinal problems, asthma, etc.;
cortisol suppresses the immune system
transactional model of stress
events are not inherently stressful or nonstressful and that how people respond depends on their cognitive appraisal of the event
3 types of cognitive appraisal
1) primary appraisal: evaluation of the relevance of a potentially stressful event to their well-being - the event is irrelevant, positive-benign, or challenging-harmful (threatening)
2) secondary appraisal: evaluation of whether one’s resources/ abilities are sufficient to cope with the threatening situation - if not, stress response
3) cognitive reappraisal: person’s continuous monitoring of the situation and use of new information to modify their primary and secondary appraisals - can result in an increase or decrease in the stress response
electromyogram (EMG) biofeedback
measures impulses in the muscles and indicates the degree of relaxation or contraction/tension;
stress, tension headaches, chronic pain, muscle stiffness, incontinence, urinary urgency and frequency, and when muscles are feeling
electrodermal response (EDR) biofeedback
AKA galvanic skin response training (GSR)
measures skin surface changes, giving feedback on the relation between emotional state and the activity of the sympathetic system via sweat gland activity;
stress and hyperhidrosis (excessive sweating)
electroencephalogram (EEG) or neurofeedback
provides information on brainwave activity and patterns;
ADHD, MDD, epilepsy to improve attention, reduce impulsivity, and promote recovery from head injuries and strokes
heart rate variability (HRV) biofeedback
AKA electrocardiogram (ECG)
monitors heart rate and cardiac reactivity from sensors placed on a person’s fingers or wrist
stress, high blood pressure, anxiety, and heartbeat irregularities
which dementia causes rapid and abrupt changes in cognitive functioning?
vascular dementia (Vascular Neurocognitive Disorder)
possible causes of organically-based (TBI, disease, toxins, etc.) mood symptoms
hallucinogens and PCP;
endocrine disorders (hypo- or hyperthyroidism);
carcinoma of the pancreas; viral illness;
structural disease of the brain (stroke)
field independent cognitive style
tend to prefer autonomy; like direction of their own learning
field dependent cognitive style
tend to rely on information provided by the outer world;
tend to rely on structure and on receiving direction
child of parent with PTSD demonstrates
depression, anxiety, self-blame, aggression, hyperactivity, and social withdrawal
circumstantiality
pattern of speech that is delayed in reaching the point due to much irrelevant detail or many parenthetical remarks - eventually, however, the point is reached
role of psychosocial stressors in the course of MDD
initial episodes are often triggered by exposure to a stressful life event;
as the number of previous episodes increases, the occurrence of additional episodes is related more to the number of prior episodes than to the presence of a stressor;
typically play a more significant role in triggering the first or second episodes than subsequent episodes
abstinence violation effect
the negative cognitive (i.e., internal, stable, uncontrollable attributions; cognitive dissonance) and affective responses (i.e., guilt, shame) experienced by an individual after a return to substance use following a period of self-imposed abstinence from substances
highest risk factor for childhood depression
family history of depression increases the risk of childhood depression more than any other one factor;
other risk factors include substance abusing parents, a divorce, parental unemployment, frequent moves, and illness
alcohol withdrawal is characterized by:
autonomic hyperactivity (e.g., sweating, increased pulse), hand tremor, insomnia, nausea or vomiting, transient hallucinations or illusions, psychomotor agitation, anxiety, and grand mal seizures
2 major factors in the maintenance of anorexia (according to CBT)
an extreme need to control eating;
an extreme tendency to judge self-worth on the basis of body shape and weight
typical interventions for Gender Dysphoria
focus on social skills and self-esteem
offspring with a parent with depression is at higher risk for
depression (earlier onset, more severe course), substance use, anxiety
parasuicide
intentional, non-fatal, serious, self-harming behaviors such as cutting or burning
stress inoculation training
help people acquire the necessary skills to cope more effectively with stress
negative symptoms of schizophrenia
reduction in emotional expression or emotional and social withdrawal; lack of motivation and energy; avolition (lack of goal-directed activities); alogia (lack of spontaneous speech); poverty of thought, flat affect or ambivalence, anhedonia (loss of enjoyment and interest in activities, including social interaction)
positive symptoms of schizophrenia
hallucinations (often critical or threatening voices), delusions, disordered thought, disorganized speech (inability to maintain a conversation, difficulty staying on topic), agitation, disorganized or catatonic behavior (unusual and bizarre, difficulty planning and completing activities in an organized fashion)
guide to the extensiveness of the damage for post-traumatic amnesia (PTA)
duration - sensitive and reliable index of severity, with the longer the PTA the stronger the probability of extensive damage
Galveston Orientation and Amnesia Test (GOAT)
assesses temporal orientation primarily;
measures orientation to person, place, and time, and memory for events preceding and following the closed head injury
inappropriate affect
lack of congruence between an individual’s feelings and expression of those feelings
effect of multi-component cognitive-behavior therapy (CBT) for rheumatoid arthritis
CBT has positive effects on psychological and social functioning and, in some cases, there is a positive effect on joint inflammation and pain intensity
Rancho Los Amigos scale
provides a descriptive guideline of the various stages a brain injury patient will experience as he/she progresses through recovery and is most helpful in assessing the patient in the first weeks or months following an injury because it is based on observations of the patient’s response to external stimuli and does not require cooperation from the patient
Mini Mental Status Exam (MMSE) overestiimations
overestimate cognitive deficits among African Americans and other minority groups;
overestimates cognitive deficits for individuals with lower socioeconomic backgrounds and lower levels of education
radiation and chemotherapy effects on cognitive ability in children with cancer
affect cognitive ability in children due to damage to the tiny blood vessels that carry nutrition and oxygen to the brain, resulting in calcifications;
interference with the growing and thickening of the myelin, along with the growth and development of connecting nerve structures over time
predictors of HIV progression and prognosis
lower IQ, older age and the presence of somatic symptoms of depression are associated with a more rapid progression from HIV infection to AIDS, HIV-related dementia, and death
light therapy for SAD
carbohydrate craving, hypersomnia, remission in spring and summer are responsive to light;
insomnia, weight loss, and yearlong depression are less responsive to light
passive coping strategies
giving responsibility for pain management to an outside source or allowing other areas of life to be adversely affected by pain
active coping strategies
patient taking responsibility for pain management including attempts to control the pain or to function in spite of it
Symptoms of Nicotine Withdrawal
have a rapid onset and are characterized by insomnia, decreased heart rate, increased appetite and depressed or dysphoric mood
Secondary impotence
when a man persistently or recurrently fails to attain or maintain an erection even though in the past he has successfully achieved an erection
most to least effective smoking cessation treatments
hypnosis, acupuncture, aversive techniques, nicotine gum, no help
memory UNaffected & affected by long-term heavy alcohol consumption
unaffected: procedural, remote, STM;
affected: severe anterograde amnesia along with retrograde amnesia for events that occurred in the relatively recent pas
panic attacks in children look like
chest pain, tachycardia, shortness of breath, and refusal to go to school
Wolpe’s classical conditioning perspective on depression
depression is a response to anxiety and can, therefore, be alleviated by using systematic desensitization to eliminate the anxiety
Somatoform Disorders
Somatization Disorder, Conversion Disorder, Somatoform Pain Disorder, Hypochondriasis, and Body Dysmorphic Disorder
most effective treatment for depression
cognitive therapy, interpersonal therapy, and anti-depressant medications are about equal in efficacy
memory affected by ECT
nonverbal memory problems;
continue to complain about loss of memory for personal (autobiographical) information for many months
Theodore Millon’s NPD defense mechanisms
when narcissistic people experience personal failure and public humiliation, they resort to defense mechanisms – first repression, and if that fails, then rationalization and projection
optimal treatment for PTSD
prolonged exposure
smoking cessation treatments effective for long-term abstinence
hypnosis, acupuncture, aversive techniques, nicotine gum;
nicotine gum by itself is not very effective in the long-term, but is effective when combined with other treatment interventions
