Diagnostics Flashcards
What is the difference between specific and free-floating anxiety?
Specific anxiety is in response to a certain set of circumstances or triggers, whereas free-floating anxiety is a baseline high level of anxiety about everything/general life.
What is the difference between neurotic and normal anxiety?
Normal anxiety is in response to a real life threat, whereas neurotic anxiety is an out-of-proportion response to a stimulus.
What is reactive depression?
Depression in response to a reasonable negative life event (ie. loss)
What is the main motto of someone with ASPD?
“It’s all about me” / “What’s in it for me?”
True or false: people with ASPD will come across as the perfect gentleman, gregarious, accomplished, etc.
True
Why do people with ASPD use terms like “my children” or “my spouse?”
To show ownership, not love
“The quick response by police forced me to take hostages” is an example of what?
Projection
“Everyone does it” or “Everyone is going to die sooner or later. I just hastened the inevitable” is an example of what?
Rationalization
What is a common opening sentence by someone with ASPD?
“I’ve got XYZ hostage, and if you don’t do exactly what I want, I’ll kill her.”T
True or false: people with ASPD are very impulsive.
True.
What is the link between ASPD and Stockholm Syndrome?
People with ASPD are so charismatic and manipulative that they can convince hostages they are protecting them from the police, for example, thereby inducing Stockholm Syndrome.
What is one reason why hostages might develop Stockholm Syndrome?
They expect evil and torture from their hostage takers, and when they don’t receive that - and maybe even receive kindness like food or water - they feel indebted to the hostage takers.
What are two biological (non-psychological/psychiatric) causes of psychotic symptoms?
Late-stage syphilis (CNS infection by Treponema pallidum) and pellagra (niacin (B3)/protein deficiency).
Note: niacin is found in red meat, bananas, poultry, fish, brown rice, and nuts/seeds.
What 3 diagnoses have the strongest hereditary natures?
ADHD, bipolar disorder, and schizophrenia
What is an endogenous mental illness?
A mental illness that arises in the absence of provoking psychosocial stressors
What is dysthymia?
Persistent depressive symptoms
What is an ego-dystonic symptom?
A symptom perceived by the client as negative
What is an ego-syntonic symptom?
A symptom perceived by others - but not by the patient - as negative
What is a principal disorder?
Major psychiatric symptom disorders that are often acute and/or episodic
What is a personality disorder (as opposed to a principal disorder)?
Long-standing personality traits and behaviors that lead to distress or impairment in social, occupational, and relational domains
Why might a co-occurring diagnosis of borderline personality disorder with depression, PTSD, or a panic disorder be inaccurate?
The impact of the principal disorder results in psychological regression, helplessness, or overly dependent behavior that is diagnosed as borderline but resolves with treatment of the principal disorder.
What should you be suspicious of if a client’s psychiatric symptoms appeared out of the blue and were not connected to a psychosocial stressor?
An underlying medical condition and/or drug side effect
What 3 things must you rule out before making a diagnosis?
Substance use/abuse
Medical illness
Influence of negative personality traits (for example, a borderline person might develop severe depression after a social rebuff, but they don’t necessarily HAVE depression)
Your client presents with abdominal pain, jaundice, constipation, and depression. What might they have?
Pancreatic cancer
Your client presents with weight gain, cold intolerance, dry skin, hair loss, puffy face, fatigue, and depression. What might they have?
Hypothyroidism
Your client presents with weight loss, heat intolerance, sweating, tremors, wide-eyed state, and anxiety. What might they have?
Hyperthyroidism
Your client presents with bad breath, urine odor, frequent urination, and depression. What might they have?
Diabetes
Your client presents with weakness, dizziness, light-headedness, sweating, tremors, and acute-onset anxiety. What might they have?
Hypoglycemia
Your client presents with muscular weakness, fatigue, droopy face, and depression. What might they have?
Myasthenia gravis (autoimmune that attacks the communication between the nerves and muscles)
Your client presents with sensory disturbances, paresthesia (tingling/numbness), transient motor disturbances, depression, and euphoria. What might they have?
Multiple sclerosisY
Your client presents with weakness, fatigue, diffuse pain, incoordination, depression, and impaired memory. What might they have?
Pernicious anemia
Your client presents with abdominal pain, weakness, confusion after ingesting alcohol or barbiturates, and anxiety. What might they have?
Porphyria (build-up of red blood cell proteins)
Your client presents with increased skin pigmentation, weight loss, diarrhea, muscle cramps, low blood pressure, and depression. What might they have?
Hypoadrenalism (Addison’s disease)
Your client presents with muscle weakness, swollen/puffy face, excessive hair around the mouth and chin (hirsutism), hypertension, irritability, depression, and euphoria. What might they have?
Hyperadrenalism (Cushing’s disease)
Your client presents with hypotension, headaches, and anxiety. What might they have?
Pheochromocytoma (adrenal gland tumor)
Your client presents with fever, malaise, depression, and agitation. What might they have?
Infection
Your client presents with fatigue, joint pain, and depression. What might they have?
Rheumatoid disorders like fibromyalgia or chronic fatigue syndromes
Your client presents with headaches, weakness, changes in vision, depression, mania, and personality changes. What might they have?
Brain tumor
What is the main difference between grief and clinical depression?
In grief, self-esteem does not usually erode.
What percentage of people who experience loss develop clinical depression?
25-30%
What is anhedonia?
An inability to experience pleasure
What are the 8 core symptoms of depression?
Mood of sadness, despair, emptiness
Anhedonia
Low self-esteem
Apathy, low motivation, social withdrawal
Excessive emotional sensitivity
Negative, pessimistic thinking
Irritability
Suicidal ideation
What is the suicide rate for someone with depression?
9%
Do more men or women get diagnosed with depression?
Women (2:1)
What are the 8 physiological symptoms of depression, and what do they indicate?
Appetite disturbance/weight changes
Fatigue
Decreased sex drive
Restlessness or agitation
Diurnal variations in mood (often feeling worse in the morning)
Impaired concentration and forgetfulness
Pronounced anhedonia
Sleep disturbances
**These indicate the need for antidepressant medication treatment, not just psychotherapy.
What are mood congruent hallucinations and delusions, and what are they NOT indicative of?
The hallucination/delusion content aligns with the mood (ie. delusions you should be executed because of your filth during a depressive episode)
They are NOT indicative of schizophrenia, whose hallucinations and delusions are usually random.
What is double depression?
Dysthymia with periods of major depression
Why does dysthymia result in high suicide risk?
Most treatment only addresses the superimposed major depression (in double depression), and the client is left feeling depressed - still.
What percentage of women experience premenstrual dysphoric disorder?
5%
What is the period of onset for postpartum depression?
2-6 weeks following birth
What other diagnosis puts women at higher risk for postpartum depression?
Premenstrual dysphoric disorder
Childbirth and its subsequent stressful life changes might precipitate the first episode of what disorder?
Bipolar disorder
What are the eight diagnostic criteria of a manic episode?
Racing thoughts
Pressured speech
Grandiosity
Increased energy and goal-directed activity
Engaging in pleasurable activities (hedonistic triad)
Distractibility
Decreased need for sleep
What is relevant about the relationship among ADHD, schizophrenia, and bipolar disorder?
Manic episodes of bipolar disorder may be confused diagnostically with ADHD and schizophrenia.
What differentiates Stage I and Stage II acute mania?
Presence of hostility, anger, and impulsivity; assaultive or explosive behavior; cognitive disorganization; and/or grandiose or paranoid delusions.
What differentiates Stage II and Stage III acute mania?
Psychosis
Is bipolar disorder more prevalent in high or low socioeconomic classes?
High
Is bipolar disorder more prevalent in men or women?
Equal prevalence for bipolar I, more women for bipolar II
What is the average age of onset for the first symptoms of bipolar disorder?
18-20 years old
What percentage of the population has bipolar disorder?
Less than 5%
What is “mixed features” in terms of bipolar disorder?
A manic episode with depressive features or a depressive episode with manic features
What is cyclothymic disorder?
Alternating depressive and hypomanic symptoms that do not meet the diagnostic criteria for major depression or bipolar disorder
What is the difference between a panic attack and anxiety symptoms?
A panic attack is much more intense and lasts only for up to 30 minutes.
Rates of what are significantly higher in clients with panic disorder?
SUDs (3-9x higher) and suicide attempts (18x higher)
Do people with generalized anxiety disorder have panic attacks?
No
Is generalized anxiety disorder precipitated by a life stressor?
Generally not. These people are chronically worried about everything.
If someone is labeled by friends and family as a worrywart, what disorder might they have?
Generalized anxiety disorder
What raises a general dislike of something to a clinical specific phobia?
Avoidance of the object
What is agoraphobia?
An anxiety disorder that causes people to fear being in situations where they might feel trapped, helpless, or embarrassed, or where escape is difficult or help is unavailable
What is the primary characteristic of panic disorder?
Spontaneous panic attacks not associated with a life stressor
What symptoms might result from panic disorder (not what are the symptoms, but what symptoms might panic disorder cause)?
Anticipatory anxiety, agoraphobia, alcohol abuse, and depression
What often precipitates the development of panic disorder?
A significant interpersonal loss in the 6-12mo before the onset of symptoms
What heart problem often coincides with anxiety?
Mitral valve prolapse
What is the locus coeruleus, and what does it do?
It is the brain structure that presses “go” on the sympathetic nervous system activation process - it is often called the “adrenal gland of the brain”
What is the frequency range of attacks in panic disorder?
A few times a month to a few times per day, including during sleep
What is initial insomnia?
Trouble falling asleep
What is middle insomnia?
Waking up in the middle of the night
Which type of insomnia is associated with depression vs anxiety?
Initial insomnia is indicative of anxiety, middle and terminal insomnia are indicative of depression
What is neurotic anxiety?
Anxiety born from repressed conflicts/struggles
What is the age of onset for OCD?
Childhood/adolescence
What are 5 common themes of obsessions in OCD?
Germs/filth
Symmetry
Aggression
Sex
Religion
Body dysmorphic disorder and hoarding disorder are under what class of disorders?
Obsessive-compulsive disorders
What is trichotillomania?
Hair-pulling disorder
What is excoriation?
Skin picking
Is OCD more prevalent in men or women?
Equally prevalent
What are the two most common themes of obsessions in OCD?
Cleanliness (66%) and safety (20%)
What is the primary co-occurring mental illness with OCD?
Depression
What is obsessive compulsive personality disorder characterized by?
Perfectionism, stinginess, emotional rigidity, and workaholism
Between OCPD and OCD, which is ego syntonic?
OCPD
Do patients with OCD enjoy their rituals?
Usually not - they are a huge source of distress and hopelessness, even though they mildly reduce the anxiety that stems from the obsession
What is a functional psychosis?
Mental illnesses that include psychosis, like schizophrenia
What is an organic psychosis?
Medical illnesses that cause psychosis, such as dementia
Why is lupus relevant to psychological diagnostics?
It can cause psychosis
What organ failure is most likely to cause psychosis?
Kidney (renal failure)
What do Huntington’s and Parkinson’s diseases have in common from a psychological perspective?
They are both cerebral degenerative diseases that can cause psychosis.
Is hypoglycemia or hyperglycemia more likely to cause psychosis?
Hypoglycemia
What is a bizarre delusion?
A delusion that is not possible/makes no sense
For example, being surveilled by the FBI is a nonbizarre solution because it could technically happen, but being surveilled by Martians is bizarre because Martians don’t exist.
What is an erotomanic delusion?
A delusion that someone is in love with you when they’re not
What are the timelines for brief psychotic disorder, schizophreniform disorder, and schizophrenia
Brief psychotic disorder: up to 1 month
Schizophreniform disorder: 1-6 months
Schizophrenia: 6+ months
Your client presents with flat affect, lack of initiative, disruption of sleep patterns, and a deterioration of performance at work. What stage of schizophrenia are they in?
Prodromal
Your client presents with florid psychosis - disorganized thinking, delusions, and hallucinations. What stage of schizophrenia are they in?
Active
Your client presents with psychological impairment, such as social isolation and peculiar thinking, after a floridly psychotic episode. What stage of schizophrenia are they in?
Residual
What are the three stages of schizophrenia?
Prodromal, active, and residual
What is catatonia?
A movement disorder, often associated with schizophrenia, in which the person is immobile, stiff, or robotic.
What is a delusion of control or an experience of influence?
A belief that someone or something is controlling your actions
What is the problem with combined hallucinations and delusions of control?
If the hallucinations are telling them to hurt themselves and they believe someone else is controlling their body, they may hurt themselves, but it’s “not them” doing it. In short, it’s a risk factor for harm.
What is a schizoid personality?
A preexisting tendency to want to be alone, isolate, not have relationships, and emotionally detach
What is thought broadcasting?
A delusion that one’s thoughts are being broadcasted to the world
What are experiences of alienation?
A delusion that one’s thoughts, feelings, and actions are not your own
What is a delusional perception or an idea of reference?
A normal perception to which someone attaches a bizarre belief (ie. A cloud in the sky is sending them a private message)
In schizophrenia, which primary neurotransmitter is off, and is it hyperactive or hypoactive?
Dopamine, and it is hyperactive
What are extrapyramidal effects?
Motor system symptoms, including stiffness, twitches, and tremors
What is akathisia, and what is it a common side effect of?
An inability to remain still
It is a common side effect of antipsychotics.
When does acute PTSD become chronic PTSD?
When the symptoms last for more than 3 months
At what time is PTSD classified as “delayed onset?”
When symptoms don’t start for at least 6 months after the traumatic event
What symptoms are associated with the intrusion stage of PTSD?
Recurring memories, nightmares, hypervigilance, and the like
What symptoms are associated with the denial stage of PTSD?
Numbness, dissociation, avoidance, social withdrawal, and the like
What is the repetition compulsion?
The tendency for abused individuals to cling to and gravitate toward their abusers, potentially due to the sensitivity of the separation-stress center in the brain
What adulthood symptoms are frequently seen in people who were neglected as children?
Aggression and self-destructive behaviors
What are the 8 core symptoms of borderline personality disorder?
Ego impairment
Emotional instability
Chaotic interpersonal relations
Feelings of emptiness
Low frustration tolerance
Impulsivity
Primitive defenses, such as acting out
Irritability and anger-control problems
What is the key diagnostic criteria that will lead you to a borderline personality disorder diagnosis?
An obvious history of ego impairment dating back to adolescence (“stable instability”)
What defines a hysteroid-dysphoric borderline personality disorder?
Emotional instability and sensitivity to rejection/abandonment, which can result in clinging behavior and manipulative suicidal threats or gestures
What defines a schizotypal borderline personality disorder?
Odd thinking with transient psychosis - essentially, combine schizophrenia and borderline personality disorder
What defines an angry-impulsive borderline personality disorder?
Hostility, aggression, and a low frustration tolerance
What are the two most common comorbid psychiatric disorders with borderline personality disorder?
Depression and SUDs
Match the three borderline personality disorder subtypes with their accompanying neurotransmitter dysregulation.
Hysteroid-dysphoric: norepinephrine
Angry-impulsive: serotonin
Schizotypal: dopamine
How long does someone need to be sober to see remission of alcohol-related depression?
1-2 weeks
What three psychiatric diagnoses are associated with an increased risk of alcoholism?
Schizophrenia, mania, and ASPD
How many hours of sleep per night does the average person need?
8-9 hours
What is terminal insomnia?
Waking up before your alarm (such as 3-4am) and struggling to go back to sleep
What is the difference between insomnia and the sleep disturbances experienced during mania?
People with insomnia want to sleep but can’t, whereas people experiencing mania don’t feel the need to sleep.
What therapy is most effective at reducing nightmares?
Imagery rehearsal therapy
If someone sleeps alone and reports being tired all the time, what might they have?
Sleep apnea
What is obstructive apnea?
Collapse of the muscles of the throat during sleep
What is central apnea?
Failure of the respiratory center in the brain to tell the lungs to breathe
What is the most effective treatment for sleep apnea, and which type of sleep apnea does it fix?
CPAP machine, obstructive apnea
What is coprolalia?
Sudden yelling of obscenities, most often associated with Tourette Syndrome
What are the hallmark symptoms of Tourette Syndrome?
Motor and verbal tics
People with Tourette Syndrome are at higher risk for which three mental illnesses?
ADHD, OCD, and learning disabilities
What is the relationship between dementia and Alzheimer’s disease?
Alzheimer’s is a type of dementia
Your patient presents with seizures, high fever, and psychosis without diagnosis. What might they have?
Benzodiazepine withdrawal
What is tardive dyskinesia, and what is it associated with?
Involuntary movements, and it is a side effect of long-term use of first generation antipsychotics.
Your patient presents with a diagnosed psychotic disorder, hyperthermia after exercise, fever, and grand mal seizures.
Dangerous side effects from first-generation antipsychotics
Your patient presents with slowed movements, decreased facial expressions, resting tremors, and a shuffling gait. Aside from Parkinson’s disease, what might your patient have?
Side effects from first-generation antipsychotics
What is torticollis, and what is it associated with?
Stiffening of the neck muscles so the head tilts to one side. It is a side effect of first-generation anti-psychotics.
What is agranulocytosis, and what is it associated with?
A deadly blood disorder that is a side effect of clozapine (Clozaril)
Your patient presents with a history of depression and current electric shock sensations. What might they have?
Antidepressant withdrawal symptoms
Your patient presents with a bipolar diagnosis, confusion, incoordination, and sedation. What might they have?
Anticonvulsant (carbamazepine, divalproex, or lamotrigene) overdose
What is the kindling model of disease progression?
Progressive neurological impairment stemming from lack of treatment and subsequent recurrent episodes of symptoms
What 3 diagnoses are most likely created by the kindling model of disease progression?
Bipolar disorder, schizophrenia, and ADHD
What percentage of children have ADHD?
5-7%
Your client presents with hyperactivity, impulsivity, impaired attention, and lack of intrinsic motivation. What might they have?
ADHD
What are the 3.5 core symptoms of ADHD?
Impulsivity
Impaired attention
Lack of intrinsic motivation
Hyperactivity (in youth)
Your adolescent client presents with hypersexuality, decreased need for sleep without daytime fatigue, and rage attacks that last 2-4 hours. Are they more likely to have ADHD or bipolar disorder?
Bipolar disorder
What two diagnoses in youth often have similar presentations?
Bipolar disorder (mania) and ADHD
Your adolescent client presents with a family history of suicide, substance abuse, multiple marriages, and starting multiple businesses. What might this client have?
Bipolar disorder
What is the most common disorder in children?
Anxiety
What is the biggest cause of clinical anxiety in youth?
Life stress (such as parents going through a divorce, domestic violence, or abuse)
What are two severe consequences of untreated social phobia in youth?
Depression and substance abuse
What percentage of children with specific phobias have another comorbid psychiatric disorder?
70%
Are tactile hallucinations more closely associated with schizophrenia or substance abuse?
Substance abuse - 90% of tactile hallucinations are caused by substance abuse
Your patient presents with polypharmacy, frequent falls, and delirium. What should you suspect?
Adverse drug-drug interactions
Your patient presents with a depression diagnosis, headache, nausea, sweating, high BP, hyperthermia, agitation, and seizures. What might they have?
Adverse reaction between an antidepressant (SNRI or SSRI) and diet pills
Your patient presents with a depression diagnosis, high BP, high HR, and a very high fever. What might they have?
Adverse reaction between an antidepressant (SSRI or tricyclic) and amphetamines
If your client describes a physical restlessness as opposed to an emotional agitation, is it more likely they have akathisia secondary to antipsychotics or a worsening of their anxiety/psychosis?
Akathisia secondary to antipsychotics
Your patient presents with confusion, disorientation, tactile and visual hallucinations, increased HR, and dilated pupils. What might they have, and what do you do about it?
Anticholinergic delirium, and you should stop or decrease the dose of whatever anticholinergic agent they’re on
What are the 5 symptoms of anticholinergic delirium?
Confusion, disorientation, visual or tactile hallucinations, increased HR, and dilated pupils
What are 5 examples of tardive dyskinesic movements?
Writhing of the trunk or pelvis, jerking or flailing extremities, lip smacking, wormlike tongue movements, and chewing motions
What are 7 examples of acute dystonia?
Oculogyric crisis, torticollis, opisthotonos, trismus, grimacing, difficulty swallowing, and difficulty breathing
What is acute dystonia associated with?
Negative side effects of starting or increasing a first-generation antipsychotic
What is an oculogyric crisis?
Fixed upward gaze (side effect of first-generation anti-psychotic)
What is opisthotonos?
Arching of the head backwards (side effect of first-generation anti-psychotic)
What is trismus?
Clenched jaw (side effect of first-generation anti-psychotic)
For the teenager, what is “self” defined by?
The peer group
What is an accurate caricature of someone with Dependent Personality Disorder, according to Strentz?
A loser - life always goes wrong for them, and it’s always someone else’s fault. They believe everyone else is okay, and they are the one person that’s messed up/failing.
What are three crisis situations you’ll often see someone with Dependent Personality Disorder in?
A poorly planned or executed robbery, a cult, and a DV
Your hostage taker poorly executed a robbery, has outrageous demands, and doesn’t talk much. What diagnosis might he have?
Dependent personality disorder
When do children start displaying antisocial tendencies, if they’re a future ASPD?
6 or 7 years old
What is the triad of negative behaviors indicative of a conduct disorder?
Enuresis, arson, and cruelty to animals
If someone, specifically a male, misinterprets friendship as homosexual advances, what might they have?
Schizophrenia
Which diagnosis is more prevalent in Scandinavians more than any other ethnic group?
Bipolar disorder
Color blindness is correlated to be comorbid with which psychiatric disorder?
Bipolar disorder
What are the two differences in mood swings between normal people and people with bipolar disorder?
The degree and the reason
People with bipolar swing from a 1 to a 10, whereas normal people swing from a 3 to a 7. Also, normal people swing in response to external events, whereas bipolar people swing in response to internal chemical changes.
What can the mania of bipolar disorder sometimes be confused with?
Delusions of grandeur in schizophrenia
What symptom is most indicative of a repeat suicide attempt?
Hopelessness
What method of first suicide attempt is most likely to result in a later successful suicide?
Asphyxiation (hanging, suffocation, etc)
If a hostage incident occurs at a targeted place versus a random place (the subject’s high school vs a random airplane), which is more likely to result in violence?
A targeted place
What is London syndrome?
A mutually antagonistic relationship between a hostage and a hostage taker (opposite of Stockholm Syndrome)
What is the id?
The part of the human psyche driven by base desires, such as pleasure - it is our animalistic tendencies
What is the ego?
The part of the human psyche driven by personality. It keeps peace and harmony and allows us to function in the external world.
What is the superego?
The part of the human psyche driven by conscience
According to Freud’s theory of personality, what are defense mechanisms?
The ego’s attempt at surviving difficult situations and protecting itself in the process
What two questions do you want to answer when doing an Emotional Age Estimate?
How emotionally old is the person in this present crisis, and how emotionally old is the person on a typical day?
What two words are most often associated with someone operating at the emotional age of 2?
“No!” and “Mine!”
If someone is throwing things against the wall, screaming unintelligible profanities, and firing a weapon indiscriminately, what emotional age are they at in this present crisis?
2
If someone pushes imposed limits from authority figures and is very boastful, what emotional age are they at in this present crisis?
4
What phrase is commonly heard in someone with an emotional age of 4?
“Go away!”
If someone has built rapport with the negotiator but refuses to take any responsibility for the situation (engages in a lot of projection), what emotional age are they at in this present crisis?
6
If family and friends report that the subject has a history of true care and empathy for others, what emotional age are they at least at on a typical day?
4
What does a typical-day emotional age of less than 4 suggest?
The presence of a personality disorder
If family and friends of your subject report them being a 9-10 out of 10 on the “selfish” scale, what might that indicate?
The presence of a personality disorder
If your subject has a history of keeping basic agreements and has an acceptable work history, what emotional age are they at least at on a typical day?
15
If your subject has a bad financial history due to “irresponsibility” and family and friends describe them as “undependable,” what emotional age are they at on a typical day?
Between 4 and 15
If your subject has a history of keeping complex agreements and has a positive relationship history, what emotional age are they at least at on a typical day?
21
If your subject has a history of tumultuous personal relationships and a history of substance abuse, what emotional age are they at on a typical day?
Between 15 and 21
What is a risk you run when you challenge someone’s paranoid delusions (such as that they’re being monitored by the CIA)?
They might believe you’re now part of the party out to get them.
What is a persecutory hallucination?
A hallucination, usually an auditory one, that degrades and demeans the client
What are 4 physical behavioral indicators of imminent suicide/violence?
Side-to-side visual scanning
Rapid breathing
Counting up or down
Repetitive cadences like rocking or humming
What is the underlying goal of someone with histrionic personality disorder?
To be liked, admired, and cared for by others
What is a common three-pronged descriptor of someone with avoidant personality disorder?
Someone who feels inadequate, strongly fears criticism, and avoids social interaction because of that fear
What is aphasia, and what is it associated with?
Difficulty understanding speech or verbally expressing oneself, and it is associated with organic brain disorders
What are the 3 most common causes of organic brain syndromes in the elderly?
Alzheimer’s, Parkinson’s, and strokes
What are 4 causes of organic brain syndromes in younger people?
AIDS, concussions, drugs, and kidney/liver disease
At what two ages in youth is attachment-based conflict, and why?
2 (separating individuality from primary caregiver) and 12 (separating individuality from primary into the peer group)
True or false: some people with hallucinations will start giggling uncontrollably during a conversation with you.
Yes. It’s not that the voices are telling them funny things, per se, it’s just the ludacry of the entire situation.
What is the difference between moral injury and PTSD?
Moral injury has guilt and shame, whereas PTSD has hypervigilance symptoms.
Are SUDs more prevalent in perpetrators of planned or unplanned violent attacks?
Unplanned
What type of mental illness is most indicative of an increased risk of violence?
Psychotic disorders
What is fixation warning behavior?
When someone has an increased negative pre-occupation with a person or cause, sometimes at the detriment to other areas of their lives like work or relationships. This is a warning sign of violence.
What is identification warning behavior, and what are 4 observable signs?
When someone adopts a commando/warrior mentality. Observable signs include a pre-occupation with guns/military/LE, immersion in aggressive or violent materials, obsession with first-person shooter games, and conversations or writings about copycatting or one-upping previous attacks. It is a warning sign of violence.
What is novel aggression warning behavior, and what are six examples?
When someone is testing out violence and aggression to see their ability to engage in violence. Examples include arson, cruelty to animals, property crimes, assault, firearm discharge, and rehearsed violence with inanimate objects fantasized as human targets.
What is energy burst warning behavior?
When someone increases their pace of activities (purchases, communications, etc) related to settling affairs prior to an assault.
What is leakage?
When someone drops hints to a third-party that they plan on committing an act of violence.
“Don’t come to school tomorrow, but watch the news.”
Is past or present tense in leakage more dangerous?
Past
What is a legacy token?
An artifact, like a note, designed to take credit for or explain the motivations behind an act of violence or suicide
What is directly communicated threat warning behavior?
A direct threat of “I’m going to kill this person”
What is approach behavior?
When someone attempts to gain proximity to their violence target, such as through stalking, trespassing, or burglarizing
What is end of life planning as it pertains to violence risk?
Acts like writing a will or giving away one’s possessions that indicates impending suicide or other forms of violence
What is a time imperative as it pertains to violence risk?
Statements like “time is running out” or a looming deadline
What is a violent action imperative?
Statements that indicate all non-violent options have failed and therefore violence is the last resort
What are 2 broad examples of last resort warning behavior?
Dramatic changes in one’s personal appearance and hygiene habits
Hedonistic triad behavior, suggesting a lack of concern for future consequences
Why is a history of head trauma relevant for crisis situations?
Head injuries can increase impulsivity, which might make subjects more likely to suddenly and angrily hurt a hostage or themselves during a crisis.
What is a pronoid pseudocommunity?
A (generally online) community of people who support and uplift violent ideations
What does pronoid mean?
A belief that people are saying good things about you (opposite of paranoid)
Why do pronoid pseudocommunities increase violence risk?
Because they will validate violent ideations in someone whose real-life connections discourage it and because they provide a safe place to vent about grievances and discuss attacks
You receive communication about a potential violent event where the author uses terms like “This is no joke,” makes unrealistic or impossible threats of violence, shows little or inaccurate research about the target, and is delivered via USPS mail. What level of concern is this threat?
Low
Your potentially violent offender is seeking peaceful or legal resolutions to his grievance, has no time imperative, has no risk factors or warning signs of violence, and is incapable of carrying out his threat (perhaps because he’s incarcerated). What level of concern is this person?
Low
You receive communication about a potentially violent event where a clear grievance is articulated; risk factors, warning signs, and preparation are articulated; ambivalence is present; and there’s no deadline or sense of urgency. What level of concern is this threat?
Moderate
Your potentially violent offender is causing concern in others, beginning basic research, is experiencing one or more life stressors, and has a few risk factors. What level of concern is this person?
Moderate
You receive communication about a potentially violent event that was delivered via multiple methods, indicates a high level of target research, is fixated on a target, invokes a special authority for violent action (ie. divine sanction), has a time imperative, and is an escalation from previous communications. What level of concern is this threat?
Elevated
Your potentially violent offender is engaging in time-consuming research, procuring weapons and training, desires recognition or fame, is experiencing SI or HI, and has multiple life stressors and warning signs. What level of risk is this person?
Elevated
You receive communication about a potentially violent event that has action-oriented (as opposed to emotional) language, suggests the relationship between the writer and the target will soon be over, conveys intent and ability to take action to end the grievance, and conveys the writer’s willingness to accept the consequences of violence. What level of concern is this threat?
High
Your potentially violent offender has rehearsed the attack, has the means to carry out the attack, is willing to accept the consequences, and has a combination of multiple warning signs and risk factors. What level of concern is this person?
High
You receive communication about a potentially violent event that includes a time imperative and hints that an attack may have already begun or been completed (such as taking credit for an attack, explaining the rationale behind an attack, or stating that the author has died). What level of concern is this threat?
Imminent
Are suicide-by-cop scenarios more common with men or women?
Men
What age is most likely to attempt suicide-by-cop?
Mid-30s
When someone, especially a kid, tells you they know all about sex (for example), how should you respond?
That’s great! Tell me what you know and where you picked it up?
When someone, especially a kid, tells you they know all about sex (for example), how should you respond?
That’s great! Tell me what you know and where you picked it up?
What common mental health challenge is frequent with cannabis use?
Anxiety
True or false: cannabis-induced psychosis is only possible with people with a genetic history of psychotic disorders.
False
When is the most common time for someone to develop cannabis-induced psychosis?
When someone is reducing their cannabis use
What % of cases of schizophrenia in young men may be attributable to cannabis use?
25-30%
What % of cases of schizophrenia in young men may be attributable to cannabis use?
25-30%
What age and gender are most at risk for cannabis-induced psychosis?
Young men
Does cannabis help with depression?
Depends on the study - some say it helps, some say it makes it worse.
Does cannabis help with depression?
Depends on the study - some say it helps, some say it makes it worse.
What % of people with first-episode psychosis are using cannabis?
64%
What is the aberrent salience model of psychosis?
The theory that psychosis starts when chaotic dopamine transmission attributes meaning to stimuli
Does cannabinoid hyperemesis syndrome occur with acute or chronic cannabis use?
Chronic
Does cannabinoid hyperemesis syndrome occur with acute or chronic cannabis use?
Chronic
What non-medical treatment is most effective for short-term management of cannabinoid hyperemesis syndrome?
A hot shower or bath
What non-medical treatment is most effective for short-term management of cannabinoid hyperemesis syndrome?
A hot shower or bath
True or false: severe abdominal pain occurs with cannabinoid hyperemesis syndrome?
True
What is the only long-term treatment for cannabinoid hyperemesis syndrome?
Abstinence from cannabis
Is DARE effective at decreasing drug use in adolescents?
No. Some studies show it increases drug use.
How long does it take for cannabis-induced psychosis to dissipate (for people who can return to baseline without permanent damage)?
1-2 weeks
Is permanent cannabis-induced psychosis more prevalent in chronic or acute cannabis use?
Chronic, especially chronic use of high-% THC products
What % of people with cannabis-induced psychosis experience permanent psychosis?
20-70% (studies are kind of all over the place)
What type of criminal history might indicate empathy impairment?
Repeat persons crimes, especially sex offenders or serial abusers
If a person is worried about what will happen to their dog if they go to jail, what might that tell you about their ability to give and receive empathy?
They likely are able to do so.
True or false: autism and TBIs can result in empathy impairment in individuals.
True
Note: with autism, it’s more about lack of awareness of social cues than it is a true lack of empathy like in ASPD
What are two other names for Stockholm Syndrome?
Hostage-captive effect and survival identification syndrome
Is Stockholm Syndrome helpful for hostages?
Stockholm Syndrome is, by definition, reciprocated empathy, so the empathy from the subject to the hostage is helpful in preserving the lives of hostages. Empathy from the hostage to the subject is not helpful for us, though, because they can intervene negatively in the negotiation process.
What are the three elements of Stockholm Syndrome?
Negative feelings towards the police from hostages, positive feelings towards the subject from hostages, and positive feelings towards the hostages from the subject
What is a counter-phobic reaction in a hostage situation, and what type of people are most prone to it?
When hostages physically or verbally confront the subject. People who are used to being in control are most prone to this reaction.
What is formation in a hostage situation, and what effect can that have on LE?
When hostages adopt the attitudes of the subject and/or engage in actions that are not consistent with their own personal beliefs. It can muddle LE’s interpretation of the situation.
True or false: humor is a psychological defense mechanism for hostages, and sometimes their humor can seem inappropriate to negotiators.
True
In what percentage of OISs was suicidal ideation involved?
36%
What is a source of medical records for someone with a criminal history?
Jail/prison/DOC
What percentage of SBC subjects were under the influence of drugs or alcohol?
36%
True or false: if someone is a jumper, you don’t have to worry about SBC.
False. Some jumpers will jump if SBC fails.
What is orthorexia nervosa?
An eating disorder characterized by a preoccupation with eating healthy food
True or false: ADHD is positively associated with hypersexuality in men and women.
True, but studies differ on whether the hypersexuality rises to a clinical level
For which gender is ADHD positively associated with problematic pornography usage?
Men
Why do men with ADHD engage in problematic pornography usage?
As a method of self-soothing anxiety, depression, and stress, especially relationship stress
What is the clinical name for hypersexuality?
Compulsive sexual behavior disorder
Is compulsive sexual behavior disorder a DSM diagnosis?
No, but it’s in the ICD-11
What is compulsive sexual behavior disorder?
A persistent pattern of inability to control intense and repetitive sexual impulses, fantasies, or drives resulting in repetitive or compulsive sexual behavior that generates significant distress or impairment
Is ADHD-driven hypersexuality more severe in men or women?
Men
In which gender does ADHD result in risky sexual behaviors?
Women
What is the definition of resilience?
The ability to overcome adversity
What is the definition of resilience?
The ability to overcome adversity in pursuit of a goal
What is the definition of grit?
The ability to see that you’ve grown from overcoming hard things
What type of stress leads to burnout?
Organizational stress (not operational stress)
What is long-term potentiation?
The encoding of short-term memories into long-term memories
When does long-term potentiation occur?
During REM sleep
True or false: chronic poor sleep can lead to memory impairment because you’re not giving your body enough REM sleep for long-term potentiation.
True
What is revenge bedtime procrastination?
Putting off going to sleep at night for entertainment/relaxation because the rest of your day was so stressful and busy
Why are bedtime routines helpful for sleep?
It cues your brain into the fact that you’re going to bed soon, so your brain is already producing melatonin by the time you get into bed.
What are sleep spindles?
The spikes in brain activity in Stage 2 sleep (lightest stage of actual sleep) that act as background noise modulators so you don’t wake up to every little sound
What two places in your body do you hold the most stress?
Shoulders and pelvic floor
How does childhood trauma lead to adverse health outcomes (6-step path)?
ACE –> disrupted neurodevelopment –> social, emotional, and cognitive impairments –> adoption of risky/unhealthy behaviors –> disability, disease, and social problems –> early death
What are the five steps on the arousal continuum?
Calm, alert, alarm, fear, and terror
What stage of the arousal continuum are you on while you’re at work?
Alert
At what stage of the arousal continuum does fight-flight-freeze kick in?
Fear
What is someone’s cognitive style when they’re at the “calm” stage on the arousal continuum?
Abstract
What is someone’s cognitive style when they’re at the “alert” stage on the arousal continuum?
Concrete (task lists)
What is someone’s cognitive style when they’re at the “terror” stage on the arousal continuum?
Reflexive
What is someone’s cognitive style when they’re at the “alarm” stage on the arousal continuum?
Emotional
What is someone’s cognitive style when they’re at the “fear” stage on the arousal continuum?
Reactive
What part of the brain is someone working from when they’re at the “calm” stage of the arousal continuum?
Neocortex
What part of the brain is someone working from when they’re at the “alert” stage of the arousal continuum?
Cortex
What part of the brain is someone working from when they’re at the “alarm” stage of the arousal continuum?
Limbic
What part of the brain is someone working from when they’re at the “fear” stage of the arousal continuum?
Midbrain
What part of the brain is someone working from when they’re at the “terror” stage of the arousal continuum?
Brainstem
What is someone’s sense of time like when they’re at the “calm” stage of the arousal continuum?
Extended future
What is someone’s sense of time like when they’re at the “alert” stage of the arousal continuum?
Days to hours
What is someone’s sense of time like when they’re at the “alarm” stage of the arousal continuum?
Hours to minutes
What is someone’s sense of time like when they’re at the “fear” stage of the arousal continuum?
Minutes to seconds
What is someone’s sense of time like when they’re at the “terror” stage of the arousal continuum?
No sense of time
What is the dissociative and arousal responses of someone at the “calm” stage on the arousal continuum?
N/A - they’re at rest
What is the dissociative and arousal responses of someone at the “alert” stage on the arousal continuum?
Dissociative: avoidance
Arousal: vigilance
What is the dissociative and arousal responses of someone at the “alarm” stage on the arousal continuum?
Dissociative: robotic compliance
Arousal: resistance (ie. crying)
What is the dissociative and arousal responses of someone at the “fear” stage on the arousal continuum?
Dissociative: dissociation (ie. fetal rocking)
Arousal: defiance (ie. tantrums)
What is the dissociative and arousal responses of someone at the “terror” stage on the arousal continuum?
Dissociative: fainting
Arousal: aggression
