Dx And Pathology Flashcards

0
Q

What are the 5 axis?

A
Axis I   Clinical do;focus of attention 
Axis II mr and pd; borderline iq; traits
Axis III. General medical
Axis IV psychosocial and environmental problems
Axis v global assessment of fx
1 to 100 (superior fx)
Rating usually for current eval
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1
Q
Dsm IV TR is?
Atheoretical
Symptom based classification
Underscores importance of gender, age, and culture
Multiaxial assessment
Categorical approach
Polythetic criteria sets
A

Eliminated gender bias
Cultural diff explained
Glossary w cultural info

Tr…changes only to text accompanying dx

Categorical bc either meet or not meet (dimension is 1 to 10). Works best when homogeneous, clear category boundaries, mutually exclusive. So use polythetic criteria or have to meet a sunset of sx, not all.

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2
Q

Give the degrees of mental retardation.

A
Mild  50 - 70.       85 percent
Discover late childhood in school
6th grade level of education
Independently live in semi skilled jobs
Moderate  35/40 -50/55.  10 percent
2nd grade.  Un or semiskilled w supervision.
Severe.   20/25 - 30/35. 3 or 4 perc
Poor motor.  Limited communication .
Elementary hygiene skills.
Close supervision in home or grp home.
Profound.  Below 20/25.  1 to 2 perc
Constant aid
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3
Q
What is the most common contributing factor to mental retardation?
A.  Environmental influences
B.  pregnancy and perinatal
C.  Hereditary
D.  Embryonic development
A

A. 15 to 20 percent. Cultural-familial retardation; Lack nurturance; or mental do like autism
B. 10 percent. Malnutrition; HIV;premature; anoxia; injury
C. 5 percent. PKU;Tay saks; fragile x;
D. 30 percent. Downs; prenatal use of alcohol/drugs

30 to 40 percent no etiology.

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4
Q

What is borderline iq?

A

71 to 84

Mr may be appropriate at the lower end and significant deficits I’m adaptive fx.

Put under other conditions that mAy be a focus of attention.

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5
Q

What are the important dx criteria for autism?

A

By three..delayed or abnormal fx in social intx, language, or play

6 sx
2 sx re; impaired social fx
1 sx impaired communication
1 sx restricted or repetitive behavior
Other:
Half don't speak ; echolalia, reversals in pronouns
Older more interest in others 
Perseveration play 
4 to 5 timeshare common in males
75 percent codx of mr
Distinct from schizophrenia
No correlation w ses, parent characteristics, education, job, race, religion.
Potential genetic (mono twins hi rate) or neuro factors, rubella, birth probs, hi SE
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6
Q

What is the tx for autism?

A

Neuroleptics, haloperidol for aggressiveness, lability, withdrawal, stereotyped behaviors. other pharmacological do not work.

Intense behavior intervention. Operant techniques . Reinforce all efforts to communicate.
Best when started very very young, involved parents, use at home, intensive, structured environment, uses contract to delineate changes and methods.

2 percent hi fx
40 percent hi fx

Best prognosis..
Early language skills, overall intellectual ability, disorder severity, usable language by age 7.
Iq alone predicts only worst outcome.
Correlation…developmental milestones, social maturity, time in school and comorbidity neuropsychiatric do

No correlation…birthwt, perinatal, age or onset, normal development before, ses, late development of seizures, type of tx, family mental illness.

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7
Q

What are the important criteria for retts?

A

Females only
Developmental regression starting at 4.
Seem normal in prenatal and perinatal pd and for last 5 mo after birth.
Usually life long communicative and behavioral problems.
Initial signs…head growth deceleration, loss hand skills, hand washing/ringing , later gait problems, language problems. Within a few years loses interest in social environment . Eventually epilepsy, mr
Cause..genetic mutation

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8
Q

Childhood disintegrative disorder?

A

Pd of normal development 2 plus yrs
After 2 and before 10
Regression in several areas. At least 2. Language, social or adaptive, bowel/bladder, play, motor

Very rare. But social and communication impairments and behavioral signs look like autism.

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9
Q

Difference between aspergers and autism?

A

No significant deficit in language, self-help, Cognitive development, or curiosity about the environment.
Better prognosis
Many jobs and self sufficient

More in males as well.

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10
Q

What are the two types of dyslexia?

A

Surface or orthogonal dyslexia
Ability to read regularly spelled words but can’t decipher words that are spelled irregularly. This limits the comprehension of written material.

Deep dyslexia…reading errors including semantic paralexia (response related to the word in meaning but not visually or phonoloically).

Differ from lack of opportunity, bad teaching, cultural factors, mr, pdd, sensory deficit.

Can have ld and mr. Must impede achievement or daily living that require the deficient skill.
Etiology..many..neuro, genetics, malnutrition, iron deficiency, allergies, otitis media , underlying cognitive deficit..

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11
Q

Dx of stuttering.

A

Usually begins between 2 and 7.

Often tx emotional pressure bc tension may aggravate it.

60 percent of cases it remits by age 16 on its own

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12
Q

ADHD

A

Onset before age 7
6 mo
2 settings
Not due to another disorder, including mr

3 to 5 percent meet criteria
10 percent some signs
Many have academic problems
Often behavioral issues start by 3
Often delayed dx, when they start school due to look like normal behavior of kids and more apparent in structured setting.

4 to 9x more males
Co dx…conduct…50 percent
Emotional do…25 percent
Learning do….20 percent
Also social maladjustment, motor uncoordination and visual and auditory impairments.
70 percent show signs thruout life
Adults…childhood hx and 12 sx; often passive aggressive or narcissistic traits develop and recede once treated

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13
Q

Etiology and tx of ADHD?

A

Biological cause…abnormal frontal lobe, striatum (b ganglia), cerebellum. Part of parietal lobe has problems. Lower glucose metabolism, decrease bld flow, smaller corpus collosum, globus pallidus, caudate nucleus (this one smaller it is worse on inhibition)
Genetics..offspring of parent 57 percent.
5 to 10 percent implicated in minimal brain dysfx ..normal iq..mild to severe behavior probs, perceptual motor probs, memory probs, EEG abnormalities.

Tx...CNS stimulants 
Low dose..improve attention
Hi dose reduce activity level, improve social (not at peer level)
Cognitive and behavioral interventions 
Young...contingency mgmt
Older ...self monitoring, self talk
Parents participate..rules, structure 
Positive reinforcement w punishment (response cost) and tangible rewards.
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14
Q

What is the behavioral disinhibition hypothesis?

A

Barkley proposed this way of viewing ADHD that suggests the essence of ADHD is a lack of ability to adjust activity levels to the requirements of different settings , not attention deficits.

Came about because some can attend in certain situations and not others. Overall, attention problems in full, repetitious, familiar, very structured and:or irregular reinforcement situations..
Seem to have trouble reducing and increasing their activity level.

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15
Q

Ritalin or methyphenidate has what side effects?

A

Somatic sx..decrease appetite, insomnia..mild. Change does or administration

Movement abnormalities…tics
30 to 70 percent
Don’t use if have Tourette’s

Obsessive compulsive sx.
30 to 50 percent.. Reduce dose

Growth suppression
Holidays

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16
Q

Conduct do

A

3 or more signs for 12 mo
At least 1 sign in last 6 mo
1 sx before 10 yrs if childhood onset
After 10 for adolescent onset..less severe prognosis; more linked to peers

Below peers on verbal subtests not nonverbal
Associated w nicotine, drug, alcohol
Majority it remits
Others move on to antisocial pd

Related to biology…low levels of arousal; genetics; environment
Tx..multi systemic tx. Long term decrease in criminal behavior by working on social network..use family tx and parent training . Best tx before teens and includes parent education

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17
Q

Pica

A
Ingested on a persistent basis for 1
Month
Onset 1 to 2 years
Remits early childhood.
May go to adolescence
Equally 
Associated w mental retardation
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18
Q

Rumination disorder

A

3 to 12 mo
After period normal development
Regurgitate and rechew for at least one month after a period of normal fx
Mortality 25 percent

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19
Q

Feeding do of early infancy

Failure to thrive

A

Chronic failure to eat enough
Wt loss or failure to gain for at least one month
Onset before 6 years, usually 1st yr

Malnutrition can develop
Most eventually gain wt

General medical condition, mental do, or lack of available food are ruled out..

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20
Q

Tic do

A

Tourette’s onset in childhood. B4 age 18.
Less 10 percent vulgar
Tics must occur multiple times a day, almost daily, for at least one year.
No more than 3 mo without tics
Chronic but may remit for brief pds

Often coexist w obsessive and compulsive behaviors, ADHD, ld, depression, social probs

Most co occuring w ADHD. Even don’t meet dx often have attention and over activity that interferes w academics. Same iq range as pop
Tx..school interventions, meds (haloperidol and pimozide anyipsychotic that r fast acting; clonodine..fewer side effects; reduce ocd w antidrpressants), family tx, individual tx

Chronic motor or vocal tic
Do…one or more tic. Only 1 kind. Sx and impairment less severe.

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21
Q

Enuresis vs encopresis

A

Encopresis..feces
Age 4 plus or develop age equivalent
Voluntary or intentional
1 x per mo for 3 mo

Enuresis
Age 5 plus
2 x per week for 3 mo or marked distress or impaired fx
Most bladder fx by 3. Daytime wetting higher chance of physical problem
More in males at age 5 (7 vs 3 percent). Difference shrinks w age
Think due to late mature fx plus self esteem and motivation
Bell and pad best long term result
Meds Antidepressants. Sterm use
Hypnosis..less expensive and gives power
Diurnal or awake or nocturnal

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22
Q

Separation anxiety do vs reactive attachment do

A

Separation anxiety do
4 weeks in response to separation from home or attachment figure
Somatic complaints
Fantasies of danger
School phobia can be a sx (ESP if develops between 5 and 7; start in adolescence it is depression)
Causes..overprotection, insecurity due to trauma, dependency issues
Tx..individual, family tx; behavioral interventions

Reactive attachment do
Before 5
Inhibited…fail to initiate or respond in age expected way in most social situations
Disinhibited..indiscriminate sociability Too familiar

Pathogenic care…chronic neglect, multiple caregivers..

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23
Q

Fetal alcohol syndrome

What structures impacted?

A

Basal ganglia, hippocampus, frontal lobes most effected

Also cerebellum, corpus collosum, hypothalamus

Ave iq is mild mr. 68

No effects at less than 2 drinks per day…

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24
SIDS. Occurrence and causes
5 in 10,000 births 3rd most frequent cause of death for infants one mo and 1 yr Constitutional factors complicated by adverse perinatal conditions Respiratory difficulties, apnea, at birth, low birth wt, shorter body length
25
What criteria need to be met for mental do due to a general medical condition? Personality change due to medical Catatonic do due to medical
1. Do due to direct physiological consequence of a general medical condition. 3 factors to consider: Onset together in time If signs rep primary mental do or are atypical If medical condition produces such sx 2. Mental disturbance can't be better explained by another mental do 3. Can't occur during delirium. Personality change.. Due to direct medical condition Cause marked distress or impairment and depart from usual Aggression, impulse etc out if proportion to trigger, Different types...labile, aggressive, disinhibited, apathetic, paranoid, unspecified, combo Causes...CNS neoplasms, cerebrovascular disease, Huntington's, epilepsy, HIV, endocrine probs Catatonic due to medical Head trauma, cerebrovascular, encephalitis, metabolic Record medical condition on axis 1 and 3.
26
Substance induced disorders
Can develop during intoxication, withdrawal, or long after Substance intoxication...includes maladaptive behavioral or psychological changes and specific signs of the substance effects on the CNS. Substance withdrawal ...result of reducing or terminating use; associated distress or impairment. Develop w in few hrs or days Usually associated w dependence Differential dx..hx, timing of drug use and sx onset, if sx atypical If psychotic do ruled out, dx of intox and withdrawal are sufficient to account for most presentations where sx caused by substance. If in excess of what is usually associated w intox or withdrawal then gets independent class sunstance induced psychotic do Hallucinogen persisting do Flashbacks. First when using then when not.
27
Or has Huntington's and significant personality change. Mental do due to Huntington's ? A. Change just after dx B. personality change and dx related thru physiological mechanism C. Nature and duration do not meet personality do dx D. No evidence use substances.
B. by definition due to direct physiological consequences of the medical condition
28
Signs of mania after use if cocaine. Which inclined to dx of cocaine induced mood do? A. Sx typical during cocaine intox B. hx of hospitalizations due bipolar C. Used only small amt of cocaine D. Manic sx severe enough to require hospitalization.
D. Differential of primary mood do, cocaine intox, cocaine induced mood do. D allows for dx because the mood sx are significant enough to warrant independent clinical attention
29
All of the following are true about mental do due to a general medical condition except: A. Dx whenever mental sx connected by a physical factor B. sometimes emerge years after medical condition C. Involve variety of diff sx D. Name condition on axis 1 and 3
A. Need more than a physical sx. Must be evidence that they are a direct physiological consequence of medical condition.
30
Who is vulnerable to developing delirium and what are the differentiating criteria?
Delirium is a disturbance of consciousness. Plus Either a change in Cognition (memory, disoriented, language prob) or Perceptual disturbance Caused by direct effects of medical condition or substance. At risk: Old Ppl w decreased cerebral reserve (HIV, stroke, dementia..) Postcardiotomy pts (ESP increasing age, time since bypass, complexity of surgery) Pts in drug withdrawal ....ESP rapid withdrawal from alcohol or benzodiazepines. Tx...multimodal Eval for suicidality. Meds if needed. Underlying problem addressed, modify environment re disorientation.
31
Dx criteria for dementia?
``` Dementia is a deterioration in multiple cognitive impairments. Always memory (new and/or recall) One of: Aphasia (language) Apraxia (motor prob but is intact) Agnosia (ident obj; sensory fx intact) Executive fx ``` Serious enough to impede normal fx Decline from previous fx
32
How is dementia different than delirium?
``` Dementia...relatively alert Variable course Usually late in life onset 20 percent of 85 yr olds Rare in kids; due to medical ``` Delirium...apparent confusion and clouding of consciousness Sx fluctuate in a day or may remit few hrs or go on for weeks Rapid onset Vs pseudodementia.... Retest. If dementia will see progressive decline vs improvement w better mood. Pseudodementia ...can date onset, Concerned abt deficits....not true of dementia. Nature of cognitive sx different Depression..transitory; procedural memory and recall memory Dementia...progressive memory, recall and recognition. Early sx of do is impaired declarative (semantic and episodic). Procedural intact.
33
Describe Alzheimer's type of dementia.
Most common in older adults Half of the cases Increases w age 20 percent over 85 have it Gradual onset and progressive decline. 3 stages. 8 to 10 yrs Women overrepresented. Biggest risk factor..first degree relative w hx 3 to 4 Stage 1: 2 to 4 years Short term memory loss (may notice in retrospect). Usually recent memory probs...forget tasks, repeat ?, lose tread of convo Stage 2: 2 to 10 yrs Increase severity Further memory prob (mostly explicit)..result retro and anterograde amnesia Restless, flat affect, labile, aphasia, diff w complex tasks. Apathetic and lost in familiar places. Stage 3: 1 to 3 yrs Serious impairment in most areas Lose ability to speak, unable recognize, can't care for selves ``` Tx.. Optimize environment Family support Train not to over or understimulate Provide structured environment Meds ```
34
Dx criteria for vascular dementia.
10 to 20 percent of cases. Second leading cause. Due to cerebrovascular disease..stroke or infarction that causes a decrease in blood supply to brain Patchy cognitive impairment..some affected and not others Abrupt onset Stepwise and fluctuating course Signs depend on where damage is
35
What are the significant factors that impact HIV progression and prognosis?
More rapid progression of HIV to aids, HIV related dementia and death: Intellectual fx (lower iq) Age (older) Somatic sx ``` Dementia due to HIV occurs 2/3 cases First sx...loss concentration Mild memory deficits Often motor probs and behavioral probs Later seizure, paralysis, in continence, severe psychiatric sx Death 1 to 6 mo after these sx ```
36
What is dx if substance induced dementia?
Substance induced persisting dementia ``` Caused by effects of substance Sx continue after intox and wdrawl Persisting effects (not direct) ```
37
Define amnestic do, etiology and tx
Memory impairment and no other cognitive impairments. Anterograde...diminished ability to learn new info Retrograde..recall learned info or events from past Early stages...confab, imaginary events to fill in Apathy, bland, personality changes Decline from previous fx Etiology..trauma, surgery, cerebrovascular disease, hypoxia, herpes, encephalitis, seizure Or substances...alcohol, sedatives, hypnotics, anxiolytics. Hx long term use. Korsakoffs. Meds..anticonvulsants, mercury... Memory loss continues after substance is gone Tx...depends on cause
38
Define post traumatic amnesia
Head injury Memory failure for day to day events, disorientation, misidentification of family and friends, impaired attention and illusions Duration is reliable index of severity. Longer..more extensive damage. Better name may be post traumatic confusional state. Recovery...duration of retrograde declines while anterograde is the last to return. Mild injury improve 3 to 6 mo. Increased risk of long term Impairment...female, previous head trauma, hx neuro or psychiatric problem
39
What substance does not qualify for a dependence disorder? What 2 substances do not qualify for an abuse disorder?
Caffeine Caffeine and nicotine
40
What are the criteria for substance dependence?
3 of the following over a 12 mo pd Tolerance Withdrawal or keep using to avoid it Taken in greater amts or over longer pds of time Persistent desire or unsuccessful try to control or reduce Lots of time getting, using, or recovering from effects. Activities reduced or stopped due to use Cont use despite aware of probs caused or exacerbated by use
41
Dx criteria for substance abuse?
One sx over 12 mo: Repeated use results in failure to full obligations Use in physically hazardous situations Repeated use related legal problems Cont use despite probs caused or intensified Never met criteria for dependence
42
What are the treatments for alcoholism?
AA, Antabuse Naltrexone..blocks rewarding effects and craving Acamprosate..reduces withdrawal like insomnia, anxiety, restlessness, dysphoric Individual and family tx When there is a relapse...restructuring their thoughts and attributions from internal to external, stable to unstable, global to specific shows higher recovery rates and better coping
43
What is the abstinence violation effect? AVE
Initial relapse leads to feelings of guilt and failure. Leads to more relapses or slips. Called abstinence violation effect.
44
What are the factors most important to nicotine cessation?
Most stop w minimal help. Factors...strong desire to quit, awareness of negative health consequences of smoking and social support to quit. Rec...multimodal...social skills and relapse prevention training, stimulus control, rapid smoking Barrier...fear of withdrawal . Use gum, patch, inhaler...this nicotine replacement helps reduce withdrawal (anxiety, irritability, depression, impatience, impaired concentration). Maximized w behavioral intervention. ``` Greater dependence, harder to stop Amt of smoking determines dep Other things linked to success: 35 plus Married or live w partner, later age when started, male ```
45
What is relapse prevention therapy by marlatt and Gordon?
Cognitive behavioral approach used for substance dependence. View dependence as a collection of maladaptive or over learned habit patterns (vs physiological response to substance). Doesn't subscribe to disease model, label as alcoholics not blame them for over learned responses. Ppl viewed as responsible for learning and practicing more adaptive habits. 3 hi risk situations related to 75 percent of relapses: Negative emotional states Interpersonal conflict Social pressure Goal...build coping mechanisms or alternative habits to deal w sit
46
Dx criteria for schizophrenia, schizophreniform do and schozoaffective do.
Schizophrenia Active phase for 1month Signs rep deterioration from previous fx for 6 mo ``` Schizophreniform Identical to schizophrenia At least 1month Less than 6 mo Impaired fx not required ``` Schozoaffective do Sx of mood do (depression, manic or mixed) and schizophrenia (active phases) but not meet criteria for either. Psychotic features more prominent than on mood do w psychotic Pd of 2 weeks w psychotic sx but no mood sx
47
What are the active sx vs the negative sx of schizophrenia?
Active/positive sx...distortions or exaggerations of normal fx include perceptions (hallucinations), inferential thinking (delusions), language and communication (disorganized speech) and behavior (catatonic or grossly bizarre). Most common hallucinations are auditory. Delusions are usually bizarre and persecutors. Can be referential (song is referring to me). Negative sx include a diminished or loss of fx that are normally present. such as flat affect, alogia (poverty of speech), avolition. Anhedonia.
48
What is the prevalence and age of onset for schizophrenia? Premorbid fx?
1/100 ppl world wide ``` Late teens or early adulthood Before 18 less common Males earlier onset 18 to 25 Females 25 to 30; after 40 Equal rates in surveys Hospital rates..more males No more aggressive than general pop Die earlier age, often unnatural..suicide, harmed, accident ``` Premorbid personalities. Suspicious, introverted, withdrawn, Eccentric. Schizotypal pd.
49
What is associated with a better prognosis re: schizophrenia?
``` Late onset Female Acute onset Precipitating event Good premorbid fx Brief active phase Family hx mood do No family hx schizophrenia ```
50
What is the criteria for residual type of schizophrenia?
``` At least one schizophrenic episode Continue to display negative signs Or attenuated positive sx (odd beliefs, mildly disorganized speech, eccentric). Ie. circumstantial No prominent positive psychotic sx No strong affective displays ```
51
Etiology of schizophrenia
Genetic Biological factors. Dopamine ho...excess D or increase sensitivity to it Neurological irregularities: 1. Structural brain abnormal..increased volume in lateral and 3rd ventricle 15-30 perct 2. Functional brain abnormal Smaller increase bld flow to prefrontal cortex w poor performance on cognitive tasks, ESP in those w negative sx 3. Neurotransmitter imbalance NE, (SE, and glutamate too) 4. Genetics..closer related more likely Unrelated 1 perct, sibs. 10 perct Fraternal 16 perct,identical. 48 perct Psychosocial factors. Diathesis stress or vulnerability theory ...physiologically predisposed confronted w adverse and stressful environment
52
What are the ethnic differences in schizophrenia. | What are the differences for industrialized and non industrialized countries?
Ethnic..originally thought black higher prevalence. Confounding. Recently found white significantly more symptomatic Third world countries...more acute onset, shorter clinical course, more often than not a complete remission. Possibly bc extended families, more support, more tolerance
53
What is the treatment of schizophrenia?
Meds most effective for positive sx Antipsychotics...phenothiazines (chlorpromazine) or butyroohenonen (haloperidol). But may aggravate negative sx and serious side effects ``` Atypical antipsychotics. As effective but more effective at relieving negative sx. Used if newly dx Risperidone (risperdel) Clozapine (clozaril) Aripiprazole (abilify) Meds best w social skills ``` Day tx forstalls relapse, reduces sx, improves community fx Best if associated w occupational tx Family education if return home Relapse associated w critical, hostile, overinvolved and unempathetic attitudes
54
Dx delusional do
``` Persistent delusion 1 mo plus Not bizarre Not due other mental do Behavior not otherwise odd Fx not markedly impaired If hallucinations not prominent ``` ``` Erotamaniac (higher status in love w) Grandiose Jealous Persecutory Somatic Mixed...more than one Unspecified ```
55
Brief psychotic do
At least one psychotic sx Very sudden onset Last cpl hours to one month If after stressful event is brief reactive psychosis. With marked stressors is used Wout stressors than without marked stressor With postpartum onset..if w in 4 wks Folie a deux. Shared psychotic do....develops in second person due to close relationship w psychotic w prominent delusions.
56
Difference between bipolar I and II
Bipolar I Present or past of at least one manic or mixed episode Often hx of depressive ``` Bipolar II One or more depressive episodes At least one hypomanic episode Never a manic or mixed episode Mood sx lead to significant distress ``` Cyclothymic. Over 2 yrs alternate hypomanic and pds of depression (not major). More mild. Daily fx not ordinarily impaired.
57
What is the etiology of depression and mania?
Genetic..all mood do but ESP bipolar. 60 to 65 percent of bipolar have bio relative w unipolar or bipolar do. Bio parent w depression increases offspring a chance for MDD. Environment..greater impact earlier in course of bp and mDD. More likely related to the onset of first or second episode; less role later episodes. Depressed ppl say have 3 x as many stressful events (work, marriage, ill, death...) Biochemical Depression..NE deficiency (catecholamine ho) Or nE, SE deficiency (permissive theory) Mania...NE excess Or NE excess plus low SE (permissive) Sleep disturbance...irregularities such as short delay onset to rem, reduced slow wave sleep, early waking. Psych Analytic...hostile impulses turned in, Learned helplessness, Cognitive theories..distortions, automatic thoughts Self control model by rehm Deficits in selective attention to negative events, to immediate (vs long range outcomes), stringent stds for self eval, neg attribute for own behavior, insufficient self reinforcement, excessive self punish Group structured tx w education, hw, self reinforce..
58
What is the difference between mania and hypomanic?
``` Hypomanic is not as severe. No impairment in social/job fx No need for hospitalization Never psychotic features Duration 4 days (vs 1 week for mania) ```
59
What is a mixed episode?
One week plus | Almost everyday person had both manic and major depressive episode. Change rapidly
60
Dx criteria for major depressive episode.
Sx 2 plus weeks (5sx) Change in fx One sx must be depressed mood or Notable loss of interest in pleasure
61
Differentiate between all the bipolar I disorders. 10 to 15 percent of bp I die by suicide. 15 percent of major depressive do die by suicide. Just a bit higher
Bp I, single manic...no depression Bp I, recent hypomanic Current/recent hypomanic At least 1 manic or mixed in pAst Sx cause significant distress Bp I, most recent manic (or mixed) At least one depressed, mixed, manic episode in past. Bp I, most recent depressed At least one manic or mixed in past Bp I, most recent unspecified Sx but not duration are presently or most recently met. Note: only one requires a depressive episode is bp I, most recent depressed
62
How many individuals who have a single depressive episode have another? What predicts relapse?
50 to 60 percent within 2 years High expressed emotion Absence of social support and/or hostility, criticism, over involvement. Also other mental disorders present do impact recurrence. Especially dysthymia or chronic medical conditions.
63
Prevalence of major depression? Coping between men and women Women risk factors
Twice as common in industrial countries among adolescent and adult women then men in same (some day underdx in men) Onset in teens coincides w period ``` Women risk factors: Passive Dependent Pessimistic Poverty Children...ESP young kids; more kids more likely depressed ``` Marriage protects against depression, ESP for men Coping styles may make difference Men...action and mastery..distract and give them power and control Women brood and dwell. Women w multiple roles less risk...diff sources of support and outlets for competence Women tend to express more extremes senses of well being..positive or negative.
64
Criteria and incidence of postpartum depression?
10 to 20 percent Most sx last 2 to 8 weeks and up to a year Onset w in 4 weeks if delivery
65
Tx for seasonal depression often includes light therapy before or after sun for 2 hours. What predicts good response?
Carb cravings, hypersomnia predict good response. Clear onset w complete remission in spring and summer mo. Melancholic sx such as insomnia and wt loss are less responsive to lt. Chronic forms or incomplete remission less responsive but may benefit.
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Treatment for depression
Lithium for bipolar...prevents recurrence of manic and depressive episodes Unipolar...antidepressants Tricyclics, ssri Classic depression Maoi. Atypical depressions w anxiety, hypochondria, oc 60 percent improve w meds. Many relapse...half w in a year if stopping 50 percent don't follow regimine. Cognitive behavioral tx..may be better than meds at preventing relapse Combo cognitive behavioral is best. Some day social skills training as effective as amitryptyline. Cbt plus antidepressant meds equal Cbt better for milder forms so EEC meds for moderate to severe first Interpersonal therapy. Early disturbances..attachments. Address interpersonal deficits, medial model, meds, illness Ect rx severe endogenous depression w delusions, suicidal, and unimproved depressions Right unilateral ECT doesn't cause much, if any, retrograde or anterograde amnesia or is gone in 6 mo. Memory and learning if nonverbal equally impaired.
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Define social phobia. How is it different than specific phobia?
Social phobia is debilitating and chronic fear of one or more social or performance situations that expose the person to evaluation or scrutiny. Exposure to the situation creates panic or anxiety; results in avoidance or intense distress Ie. fear of public speaking , start conversations, eating in public. Situationally bound panic attacks Recognize fear unreasonable. Shy, stage freight not this unless clinically significant distress or impairment. Adolescence onset usually St after event Chronic and life long 5 percent 3 rd most common do Specific phobia is a persistent and intense fear of a specific stimulus like a snake, closed places. Excessive fear Situationally bound panic attacks Under 18...must last at least 6 mo Disease phobia feature of hypochondriasis..fear of disease exposure. Blood injection injury or health phobia cued by blood, injury, injection. Vasovagal response. Early childhood onset. Hx of fainting.
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Distinguishing characteristic of pathological anxiety? Differences re anxiety in older vs younger adults?
Out of proportion to an actual threat or is not directly related to a threatening stimulus at all. Anxiety is the most commons do in older adults. Often also have depression. Generalized anxiety do is most common. Under dx and tx for older adults Also attribute more to medical probs compared to younger adults. See medical professional instead. All benefit from meds and CBT
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What are the types of panic attacks and which disorders are they associated with?
Unexpected panic attacks.. No trigger Panic do with and w out agoraphobia must have 2 plus Situational bound/cued panic... Exposure to or anticipation of cue or trigger Social and specific phobias Situationally predisposed panic More likely occur upon exposure to situational cue or trigger and not necessarily immediately after exposed Panic do Also do occur w social phobia, specific phobia
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Panic disorder
1 to 2 percent in community samples and 1/3 to 1/2 also have agoraphobia Repeated unexpected attacks At least one is followed by at least one mo of chronic worry about another attack, marked change in behavior, worry about effects of attack With agoraphobia is more severe More comorbidity GAD most; some social and specific; PTSD less likely Children w do is controversial due to limited cognitive abilities.
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What is the etiology of panic? | Tx?
Biological High levels of sodium lactate Genetic More in first degree relatives Tx.. CBT Exposure to internal cues (or train to control hyperventilation) Alter interpretations of sensations Antidepressants Imipramine and MAOIs Benzodiazepine, alprazolam eliminates panic and anxiety Exposure therapy. Expose to sensations and bc less fearful and more control
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How is agoraphobia without hx of panic do different.
Agoraphobia w fear of panic like sx Dizzy and diarrhea commonly feared Alcohol and drug dependence associated
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What is the etiology and tx for anxiety disorders?
Analytic...paralyzingly conflict; displace fear to object can reduce anxiety by avoiding Behavioral cc. Little Albert Biology. Biologically prepared stimuli that at one time were true threat . Tx Tricyclics (imipramine) reduces anxiety re agoraphobia, ESP panic SSRIs Behavioral. Invivo exposure modality. Extinguish fear. Modeling, hypnosis (specific phobia) For agoraphobia..in vivo exposure w response prevention/flooding. Prevent relapse drug plus behavioral. Specific. Debate. In vivio vs imaginal. Longer exposure better no matter what. Rid fears w cognitive. Social. Meds best. No results other tx Grp tx adjunct
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Features of obsessions and compulsions.
Obsessions are urgent or recurring thoughts experienced as intrusive. Other than real life worries. Compulsions are repetitive rituals or behaviors in response to obsessions or rigid set if rules. Excessive. Not practical or functional in any way to what they are to prevent or offset. Appear in adolescence or early adulthood. Equal onset Early onset. Compulsions first, about one or two years, the obsessions. Male preponderance. Higher rate of comorbid dx, ESP tic do Greater family loading for OCD Higher frequencies of repeating compulsions and higher frequencies of hoarding obsess and compulsions. Washing, checking, ordering common ESP in kids ``` Typically depressed moods as well Disproportionately hi economic class and intelligence. ```
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What is the etiology of OCD?
Ego and superego outstripped id. Over reliance on rx formation and displacement Behavioral. Two factor theory..anxiety response due to cc and then compulsive rituals to avoid stimulus. Biological Abnormal basal ganglia, frontal lobes...
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What is the treatment for OCD?
Behavioral...in vivo exposure best For obsessions (harder to get rid of) habituation (expose for an hour) and thought stopping effective Behavioral don't reduce accompanying depression, sexual dysfx, problematic family relationships. Use supportive tx. Biological...meds SSRIs that target SE Recovery rates higher w response prevention than meds
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Criteria for PTSD? Criteria for acute stress disorder?
``` Trauma Reacted w extreme fear, helplessness, or horror Re experience of event Avoidance of stimuli/numbing Sx of heightened arousal ``` Last more than 1 mo Acute..less than 3 mo Chronic...over 3 mo Can have delayed onset 6 mo after Acute stress do.. Dx only for sx that occur w in 1 mo of stressor Sx last 2 days to 1mo At least 3 dissociative sx either urging event or after
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Tx for PTSD?
Crisis intervention...prevents delayed or chronic sx and reduces distress Cognitive behavioral and behavioral interventions Prolonged exposure Systematic desensitization Meds...antidepressants Brief dynamic tx ...help integrate Hypnosis and relaxation to help tension and arousal Remission likely if time between trauma and sx is short. If more 6 mo after and last more than 6 weeks remission is lower. EMDR..cognitive behavioral, client ctr and lateral eye movements . First describe memory that has anxiety, follow fingers 20x. Ask what comes up, another set eye movements, cont til memory has no more anxiety w it. Conflicting..better than no tx, or better than tx don't use exposure Not found better than exposure techniques. Eye movements not needed.
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Difference between conversion do, factitious do, and malingering.
Conversion disorder Sx not under voluntary control Affects sensory (blind) or motor (paralysis) fx suggests neuro or medical condition. But can't be explained by physiological factors. Stimes when conflict or stressful event shortly before onset or increase in sx. Not deliberate sx. Due to psych conflicts/needs Etiology...primary and secondary gain. Eliminate sx w hypnosis, Amytal, dramatic placebo Factitious do Physical and mental sx voluntary or intentionally produced or faked for the sick role Behaviors are deliberate but can't be controlled (like compulsion). Tx...sx mgmt( strong alliance, supportive, consistency in care Family and grp for family Malingering (focus clinical attn) Voluntarily faking or exaggerating physical or psych sx to avoid responsibility or gain a reward. Clear external goal. Under cts control and may stop
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What is somatization disorder? Another name for it?
``` Briquets syndrome Chronic and recurrent sx w no physical cause. Onset before 30, often teens 4 pain sx 2 GI sx 1 sexual sx 1 pseudo neuro sign ``` Often have anxiety, depression, and unsuccessful suicide attempts Often dramatic presentation and see many docs
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Undifferentiated somatoform do, somatoform do nos, pains do
Undifferentiated somatoform disorder. 1 physical complaint for at least 6 mo Can not be explained by medical or substance problem. Most common..chronic fatigue, appetite loss, GI prob Sx less than 6 mo is somatoform do nos. Pain do Preoccupied w pain but no physical condition Cognitive and cognitive behavioral tx shown effective to reduce pain and improve positive behavior expression, appraisal and coping
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What type of coping is associated with worse pain?
Passive coping...focus on where it is, how much it hurts, restricting or canceling activities, thoughts nothin will help.... Have worse pain and adjustment w chronic pain and may serve as reinforcers of pain. Active coping..physical tx, active, relaxation, ... Include or taking responsibility for the pain or fx in spite of it...less pain and better adjustment.
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Hypochondriasis dx criteria Body dysmorphic dx criteria
``` Hypochondriasis... Preoccupation w or fear of having or belief have serious disease despite contrary evidence Chronic No delusions Know fears are exaggerated Predisposing factor..past disease of self or family Often doctor shop Depression Anxiety Obsessive compulsive sx ``` Body dysmorphic do Preoccupied w nonexistent or slight physical flaw Concern unreasonable, causing distress and interferes w fx Often seek excessive plastic surgery or derm tx
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``` One of the negative associated features of somatization do is Paranoia Anxiety Panic do Addiction to analgesics ```
Anxiety and depression
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``` In which of the following conditions is there a clear secondary gain? Malingering Factitious do Body dysmorphic do Somatization do ```
Malingering is intentional to get external incentives. This is condition not a do (Also conversion do)
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Personality disorder characteristics.
Inflexible, maladaptive Either significant impairment in daily fx or subjective distress Adolescence Chronic but may wane by middle age Severe do have hx of childhood developmental problems...inability to cope, poor ego fx, low iq, disorganized family Probably genetic influence, ESP antisocial which are 5 to 10 % higher w first degree relatives
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Paranoid personality do
4 signs. Typically hypervigilent and take precautions against threats. Not delusions. May have transient psychotic episodes , mins to hours, but not enough for a dx Tx..supportive tx Don't confront Behavioral and cognitive behavioral to reduce anxiety and oversensitivity to criticism and strengthen interpersonal skills.
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Difference between schioid and schizotypal pd?
Schizoid may fx adequately if social contact is not required. Schizotypal. May want social contact Peculiar and odd thoughts, behaviors or appearance Transient psychotic sx and not dx
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Etiology of narcissistic personality?
Kernberg ...chronically envious w defenses against like devaluation, exploitation, isolation..opinions are easily altered to impress others Thwarted by unresponsive mother. Anger, ambivalence projected and libido turned inward givin rise to grandiose self. Intense drive for attention defends against emptiness. Kohut..arrest in development (not defense)
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Borderline personality do and it's etiology
Mood dysphoric with pds of intense anger, despair, panic usually triggered by interpersonal conflict or abandonment. 8 to 10 % who have attempted suicide do kill themselves. Majority remit by mid age; impulsive sx quickest to resolve then cognitive and interpersonal, the affective Etiology.. Fixation at 3rd stage of development...of normal internalized representations. Kernberg defensive structure protects from conflict caused by anxiety abt destroying good obj reps. Splitting, projective id, idealization protect against anxiety Obj relations...abnormal separation individuation. Clingy or lack of support.experiences abandonment depression Splitting main defense..all good/all bad 80% victims of physical or sexual abuse Cognitive ...can't acknowledge wants and discriminate between that and needs Tx.. Meds...neuroleptics decrease cognitive disturbance; lithium for mood swings; antidepressants , anxiolytics for depression and anxiety Cognitive behavioral..decrease destructive behaviors, improve problem solving, self perceptions Disagree if confront vs supportive (avoids transference) ``` Dialectical behavior therapy. Linehan. Cog beh that uses self soothing, social skills training, group Individual and grp sessions Here and now Teach regulate affect. Less dichotomous way to think Meditation and mindfulness ```
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Antisocial pd Predisposing factors Etiology Tx
Present since 15..hx conduct do Must be 18 More common in males 3 to 7% male population Predisposing factors Conduct do ADHD Absence of family discipline Over time criminal behaviors decline Other sx persist..interpersonal prob Past mid age bio drives abate Before that..fear of future punishment, loyalty to spouse/family counters impulses Etiology.. Family..rejection, inconsistent, no parenting, lack parent affection, parent pathology. Genetic influence on psychopathic personality factor as well as callous/unemotional and impulsive/irresponsible factor. More common w relatives Biological..abnormal brain waves...slower Lower than normal levels of arousal and anxiety Fail to learn to avoid punishment . Will do so when relevant such as loss of money Tx...lots doesn't work; resistant and manipulative Behavioral tx shows modest success ESP in an institution. Must withdraw reinforcements for inappropriate behavior. Punish wrong acts. Model. Shape w graded reinforcement. Gradual fade of external rewards. Best to help impulsivity, anger and specific behaviors. Must have control over reinforcers and punishments.
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Anorexia nervosa Specifiers Vs bulimia nervosa
Refusal to maintain body wt over minimal normal wt (85% or less for age, ht) Most on adolescent females 90 % females Types: Restricting ...no binge or purge pattern Binge eat/purge.
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Etiology and tx of anorexia
Family factors Upper middle class Domineering, over involved, insensitive mom Affectively uninvolved dad Home where food or wt greater than ordinary significance. Facade of nurturance, support but kids needs for individuation neglected and ignored. Viewed as way to get control and independence from the family. Fear of increasing sexuality, wt phobia, fear of growing up, early deficits result in poor ego development Bio factors...endocrine, hypothalamus abnormalities Genetic. Increase rates Cultural preoccupation w thinness Tx..normal wt; perhaps hospital Behavioral and cognitive behavioral to maintain normal patterns Faulty thinking, beliefs Family tx...family lunch Bio...neurotransmitters..low SE Prozac or fluoxetine and other SSRIs effective
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What is the prevalence rate of bulimia? | Binging?
``` Bulimia is 1 % Majority women (90 to 95%) Onset usually 16 to 19 yrs Affects young, educated White women; upper/middle class ``` Thought to have low self esteem, external locus of control, fear of interpersonal intimacy, perfectionistic. Report families low on intellectual and cultural pursuits and overly hi on achievement expectations Up to 50% overwt women binge
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What are the behavioral signs of bulimia?
1. Frequent Wt fluctuations of 10 lbs plus 2. Emotional instability and impulsivity 3. Social adjustment problems 4. Depression 5. Perfectionism motivated by need for approval.
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Etiology and treatment of bulimia?
Physiological Psychological. Disturbed body image and wish to be thinner, low self esteem and emotional instability Family factors. Chaotic. Highly conflicted and neglectful; parents who emphasize outward appearance (proper) and over concern w dieting and body shape/wt 30% ppl w eating problem sexually abused Tx..restore normal eating patterns, maintain them, address family or intrapsychic problems in long term Help control over eating behavior, alter beliefs re eating, shape, wt Use Cognitive or cogn-beh tx like self monitoring, cogn restructuring Imipramine and other antidepressants, SSRIs, decrease impulse to binge and purge.
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Difference between anorexia and bulimia?
Bulimia maintain body wt above minimally normal wt. maintain a facade of normalcy Lives restricted to some extent More aware behavior is disordered and abnormal. More likely to do tx .
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Differential dx f dissociative do.
Dissociative amnesia..one or more episodes of an inability to recall important personal info, usually of a traumatic or stressful nature. Not just forgetful. Localized and selective most common. Usually gaps in hx. Typically full recovery. Dissociative fugue Sudden and unexpected travel away, inability to recall past, Confusion about identity and:or partial or total assumption of new. Usually temporary absence and isolated. War. Heavy alcohol use. Dissociative identity do At least 2 separate identities Transitions abrupt and often due to stress. Distinct personalities. Associated w severe childhood trauma, secrecy. 1 to 3% population. Dissociative do nos Gansers syndrome...syndrome f approximate answers. Answers close to the truth. Can have hallucinations, disorientation, amnesia, lack insight.
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Dx of paraphillas? Tx Types
Repeated, powerful sexually arousing fantasies or urges re nonhuman things, suffering humiliation Persistent ; Experienced as compulsions with little or no control. Must cause marked distress or impairment Often other do, especially pd Tx..behavioral Aversive counter conditioning ie shock voyeur while describe peeping behavior Covert sensitization pair in imagination Orgasmic reconditioning...masturbate w appropriate stimulus Social skills, assertiveness, cognitive restructuring Skills to cope w urges Types; Fetsihism, sadism, masochism, transvestism, exhibitionism, voyeurism, pedophilia, frotteurism
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Four stages of the sexual response cycle?
``` Desire Hypo active Sexual aversion do Excitement ..pleasure and physiological changes Female sexual arousal do (no lubrication or swelling response and/or subjective lack of excitement) Orgasm Female orgasmic do Male orgasmic do Premature ejaculation Resolution. No do ``` Orgasm Resolution
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Sexual dysfunctions Not acct for by medical, substance or other mental do All classified 1. Due to psychological or combo factors (medical, substance play relevant but too small roll to acct for dysfx) 2. Life long (primary) o Aquired (after pd of normal fx) 3. Situational (limited to sit, ppl, types of stimulation) Generalized What is most common? What are the pain dysfx?
Males most common is premature ejaculation Females...orgasmic do Sexual Pain do Vaginismus. Involuntary contractions of muscles in outer third of vagina when penetration tried. Penetration difficult. Not generalized. (Have sex, not exam) No clear etiology. ? Trauma More common in young, ESP w negative attitudes toward sex Dyspareunia Sexual pain (can be in males) not due to vaginismus.
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Tx of sexual do
Ro Medical, substance Behavioral Cause of most is performance anxiety, faulty info, early conditioning, faulty expectations, ignorance of sexual physiology. Multimodal tx. Masters and Johnson. Pre counseling, relationship counseling, sensate focus, cogn restructuring. Both partners and male female team. Hw Sensate focus. M and j success rates 82% at 2 weeks. Premature ejac 98%. Primary dysfx only 60%. Failure rate after 5 yrs about 25%. Success varies w relationship happiness. Vaginismus..relaxation, progressive dilation Premature ejac..squeeze technique 30 to 40 %males have premature ejac . Primary..sx thruout adulthood Secondary..begins adulthood who hasn't had it; perhaps neuro prob Most frequently used tx...SSRIs (fluoxine or Prozac) and some tricyclics..induce delayed ejac by increasing central SE transmission. May prolong ejac by 5'or 10 min Docs rec SSRIs daily or 4 hrs before
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What do the primary sleep do include?
Dyssomnias. Amt, quality, timing of sleep ``` Parasomnias. Behavioral or physiological event during sleep or betwn sleep and awake. Complaint is abt event not effect on sleep or wakefulness. 2 types...during REM Nightmare do During non rem. during stages 3 and 4 Sleep terror do Sleepwalking do ```
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Dysomnia do Insomnia Hypersomnia Narcolepsy
Insomnia..diff falling or staying asleep or not rested after sufficient sleep 1 mo plus Distress or impairment ``` Hypersomnia Daytime sleepiness Sleep attacks Extreme sleepiness 1 mo plus Not due lack of sleep Impair fx, distress Either idiopathic (nocturnal sleep prolonged, genetic) secondary (variable; neuro, medical, intox, psychiatric) or periodic. ``` Narcolepsy Irresistible sleepiness Sleep attacks of brief duration r unpredictible Almost daily for 3 mo Cataplexy (loss some or all muscle tone) distinguishes Rem intrusions into sleep transitions such as hypnopompic (while wakening) or hynagogic (while falling) hallucinations or sleep paralysis. Nite sleep distrupted Genetic ``` Breathing related sleep do Causes extreme sleepiness or insomnia Sleep apnea. More men, overwt, smoke, over 40 Obstructive Central..brain fails to signal muscles Mixed..both Hyponeas..slo and shallow breathing Hypoventilation ``` Circadian rhythm sleep do Poor match environ w rhythm
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Dx of parasomnia do
Nightmare do Repeated waking w recollection of bad dreams..threatening Sign distress , impedes fx Often after major life stressor ``` Sleep terror do Repeated sudden awakening w a scream No dream remembered Intense anxiety, autonomic arousal Resist being touched and sit up ``` ``` Sleep walking do Unaware and don't remember Assoc low levels of arousal Prominent organized motor behavior Onset 6 to 12 ``` ``` Last 2 often occur together Both in non rem Both movement, diff waking, amnesia Both linked family hx Differ...terror...greater arousal, fear and less motor activity ```
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Impulse control do nos
Growing tension before the act and when doing the act, experience release, fulfillment May or may not feel guilt Include pathological gambling Pyromania (no $ gain, no cover crime, improve circumstances, due hallucinations or delusions, expression of anger) Kleptomania (not needed or due conduct do) Intermittent explosive do Several episodes of loss of control result in aggressiveness or vandalism. Out of proportion. No signs of aggressiveness in between episodes Trichotillomania
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Criteria for adjustment do
Emotional or behavioral sx in response to ident stressor W in 3 mo Single, multiple stressors Recurrent, continuous Impairment, distress Once stressor gone, can't last more 6 mo; usually remits when stressor gone Diff types
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Definition of illusion
Misperception or misinterpretation of actual stimulus Ie sound of wind mistaken for whispering Ideas of reference...persons belief that external events have particular meaning to him
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Causes of obesity Behavior therapy treatment
Genetic predisposition Small relationship between food intake and body wt Mediator effects of metabolism Obese ppl metabolism is slower Current thought is heterogeneous disorder w multiple etiologies. ``` Behavior therapy: Better than tx, diets, meds Involves: Self monitoring Reinforcement of increase activity Slow eating rate Stimulus control Adhere low fat, hi fiber Reinforce and self reinforce short term goals Cognitive and group adjunct ```
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Types of epilepsy .5 %
Partial or focal...initially starts w part not all of body Generalized tonic clonic seizure Grand mal..convulsions, uncs, rigidity Increase hr and bp Last up to hr; deep sleep Generalized absence seizures Petit mal Similar to above but only brief loss of cs with few or no sx and no sleep Complex partial seizures Psychomotor seizures or temporal lobe Impaired cs, involuntary chewing, lip smacking, fidget, walk circles Appear confused, clumsy, acts intoxicated May follow simple directions Simple partial seizures. Jacksonian No altered cs One side body jerking arm or leg Tonic clonic may follow Generalized seizures are bilateral without local onset Complex, simple partial have focal onset May tx w anticonvulsant meds to prevent or reduce. May adjust repeatedly.
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Tension headaches
Contraction of muscles in forehead, scalp, neck. Constant pain both sides Tightening Band Tx...biofeedback EMG Train to decrease muscle tension As effective as relaxation
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Migraine headaches
Throbbing pain One side of head Often nausea, GI sx, aura precedes Irregular frequency but correlated w stress Due to dilation of cerebral bld vessels (tend to have epilepsy) Tx..thermal hand warming biofeedback More effective than relaxation
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Pain treatment
Operant techniques to deal w social and interpersonal contingencies Pain reinforced positively w attention and negatively..get out of stuff So reorganize environmental contingencies so no longer reinforcing. Ie. meds every 4 hrs vs wait for pain; praise well behavior Cognitive techniques and relaxation Hi pain tolerance and outcome associated w belief in ability to have control over pain. So hi internal locus of control report less pain in general. Meds Antidepressants and other meds 50 to 90% get at least 50% pain relief w antidepressants Tricyclics like elavil (amitryptyline) good for neuropathic pain or one of headache syndromes. SSRIs prevent headaches, including migraines but less effective. Can use w analgesics. ESP helpful w cancer or who have multiple pain sites.
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Hypertension 2 categories
``` Primary or essential largest category. 80% Unknown cause Associated variables...family hx Obese, high resting heart rate Chronic stress Risk increases w age Black 2x ``` Secondary hypertension From known do. Such as adrenal glands, constructed aorta, prego Treat causative factor Tx...relax, meds, biofeedback Use EKG readings Psych tx good adjunct to meds
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PMS vs premenstrual dysmorphic do
Similar but dysmorphic do is more serious and interfere w fx, activities, relationships Less common than pms Both may have higher rate of depressive do. No hormone, personality factors found to differentiate Use antidepressants prior to and during pd for both
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What is stress? | General adaptation syndrome?
Consequence is a threat of potential or actual lack of resources General adaptation syndrome is a set of characteristic responses over time under stress. Adaptation, break down leading to Exhaustion and even death. This provokes identical neurological responses. ARE Alarm. Pituitary adrenal system mobilizes body's sympathetic nervous system. Sx Resistance occurs...defenses stable and sx disappear at a price. Body's energies depleted..collapse Exhaustion
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What is the treatment for stress?
``` Learn voluntary control over physiological sx Change environment creating problems Change way respond to stressors Cognitive reappraisal of stress New coping skills...assertiveness ``` Gain control or think have control, adjustment improves.
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Type A
Jenkins activity survey is a short assessment to identify Distinguishing characteristics between risk and non risk for disease are emotional and temperamental. Anger, hostility, and aggression more predictive of medical do than job involvement and time urgency Depression is also associated w coronary heart disease.
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What is the sickness impact profile?
Quality of life measure that assesses the impact of disease on both physical and emotional fx 136 items Self or interviewer 20 to 30 min Higher score greater dysfx
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``` Which do are sx under conscious control of individual? Somatization do Hypochondriasis Conversion do Factitious do ```
D. Intentionally produced or simulated in order to take the sick role
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``` Ct was normal until 2 but regressed in many areas is: Childhood disintegrative do Autistic do Severe mental retardation Aspergers ```
A
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``` Schizophrenic sx: incoherence, inappropriate giggling, repeated reference to idea aliens taking over the country. Dx Disorganized type Paranoid type Catatonic type Undifferentiated type ```
D. Both disorganized..incoherent and inappropriate affect Paranoid..delusion So meet criteria for more than one category and is undifferentiated
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``` Which not associated with a good prognosis in cases of schizophrenia? Abrupt onset Onset at young age Associated mood disturbance Precipitating events ```
B. later onset had better prognosis
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``` Lack of which neurotransmitters has been implicated in depression? D, SE E, SE Ne, E Ne, SE ```
D
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``` Etiology of ADHD is unknown, but recent research suggests in most cases Is responsible. Genetics Family factors Environmental factors Underlying biological cause ```
D
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``` Schizophrenia is associated w all but: Enlarged ventricles Abnormal blood flow in frontal lobes Decrease levels of d Increase levels of d ```
C
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What is the catecholamine hypothesis?
Theory of depression due to deficiency of ne at certain receptor sites in the brain.
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What is the leading cause of death for children infancy thru 15?
Cancer Radiation and chemo affect cognitive Factors increase long term effects Dx young age, tx results in reduced energy, affects hearing or vision, results in physical disabilities, tx to CNS, school absences, hx learning probs Young girls more vulnerable Kids w acute lymphoblastic leukemia and non Hodgkin lymphoma are at higher risk if cognitive probs
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What are the types of conduct do defined by moffitt?
Adolescent limited type. Temporary antisocial behavior results from a gap in biological maturity and limited opportunities for adult privileges Life course persisting type Starts young with a progressively pattern of wrong doings and result of temperament, adverse environment and neuro deficits.
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What is iatrogenic?
Condition produced by the treatment. Ie. erroneous med dose or sx arising in response to therapist s suggestions.
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``` What percent of those with a mental disorder (ADHD, conduct, odd, MDD) have a learning disability? 15 25 33 8 ```
25
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What sx does a hi and low dose of Ritalin target?
Low dose...helps attention Hi dose...improves social skills and reduces anxiety level
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What is the diathasis stress model?
Rosenthal developed regarding etiology of schizophrenia. Interaction of genetics and specific life stresses. Tx often combine several strategies..drug and psychosocial more effective then tx alone.
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What are the classes of antidepressants and what are their uses?
Tricyclics Help w classic depression that involve vegetative sx, sx worse in am, acute onset, short duration and moderate severity. MAOIs Helps those who don't respond to tricyclics. Atypical depressions Increase appetite, wt gain, hypersomnia, mood that worsens late in the evening. SSRIs most prescribed Prozac, Zoloft, Paxil Fewer and less severe side effects Safer in event of overdose
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What risk factors contribute to the progression and prognosis of HIV to AIDS to HIV dementia and death?
Lower iq Older Somatic depression sx 2/3 those w aids have dementia due to HIV disease.
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Rehms self control therapy: Depression viewed as deficits in looking at negative events in environment, attend to immediate events, strict self evaluation, own behavior viewed negatively (positive due to external and negative outcomes viewed as internal), not enough self reinforcement, excessive self punishment. Therapy:
Structured group therapy involves education, exercises, homework that help to self monitor mood, activity, self evaluations, and give self positive reinforcement.