Dx And Pathology Flashcards
What are the 5 axis?
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
Dsm IV TR is? Atheoretical Symptom based classification Underscores importance of gender, age, and culture Multiaxial assessment Categorical approach Polythetic criteria sets
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.
Give the degrees of mental retardation.
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
What is the most common contributing factor to mental retardation? A. Environmental influences B. pregnancy and perinatal C. Hereditary D. Embryonic development
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.
What is borderline iq?
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.
What are the important dx criteria for autism?
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
What is the tx for autism?
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.
What are the important criteria for retts?
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
Childhood disintegrative disorder?
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.
Difference between aspergers and autism?
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.
What are the two types of dyslexia?
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..
Dx of stuttering.
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
ADHD
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
Etiology and tx of ADHD?
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.
What is the behavioral disinhibition hypothesis?
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.
Ritalin or methyphenidate has what side effects?
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
Conduct do
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
Pica
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
Rumination disorder
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
Feeding do of early infancy
Failure to thrive
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..
Tic do
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.
Enuresis vs encopresis
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
Separation anxiety do vs reactive attachment do
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..
Fetal alcohol syndrome
What structures impacted?
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…
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
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
- 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 - Mental disturbance can’t be better explained by another mental do
- 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.
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.
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
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
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.
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.
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
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.
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
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
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
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)
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
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
What substance does not qualify for a dependence disorder?
What 2 substances do not qualify for an abuse disorder?
Caffeine
Caffeine and nicotine
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
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
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
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.
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
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
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
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.
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.
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
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
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
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
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
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
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.
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.
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..
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)
What is a mixed episode?
One week plus
Almost everyday person had both manic and major depressive episode. Change rapidly
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
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
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.
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.
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
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.
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.
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.
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
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
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.
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
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
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
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.
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…
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
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
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.
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
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
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
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.
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
One of the negative associated features of somatization do is Paranoia Anxiety Panic do Addiction to analgesics
Anxiety and depression
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)
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
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.
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
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)
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
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.
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.
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
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
What are the behavioral signs of bulimia?
- Frequent Wt fluctuations of 10 lbs plus
- Emotional instability and impulsivity
- Social adjustment problems
- Depression
- Perfectionism motivated by need for approval.
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.
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 .
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.
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
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
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.
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
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
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
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
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
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
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
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
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.
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
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
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.
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
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
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
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.
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.
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
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
Ct was normal until 2 but regressed in many areas is: Childhood disintegrative do Autistic do Severe mental retardation Aspergers
A
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
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
Lack of which neurotransmitters has been implicated in depression? D, SE E, SE Ne, E Ne, SE
D
Etiology of ADHD is unknown, but recent research suggests in most cases Is responsible. Genetics Family factors Environmental factors Underlying biological cause
D
Schizophrenia is associated w all but: Enlarged ventricles Abnormal blood flow in frontal lobes Decrease levels of d Increase levels of d
C
What is the catecholamine hypothesis?
Theory of depression due to deficiency of ne at certain receptor sites in the brain.
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
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.
What is iatrogenic?
Condition produced by the treatment. Ie. erroneous med dose or sx arising in response to therapist s suggestions.
What percent of those with a mental disorder (ADHD, conduct, odd, MDD) have a learning disability? 15 25 33 8
25
What sx does a hi and low dose of Ritalin target?
Low dose…helps attention
Hi dose…improves social skills and reduces anxiety level
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.
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
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.
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.
