Exam 2 Flashcards by Chloe Derks

schizo- positive s/s

change in behavior/thoughts
ex. delusions, hallucinations

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schizo- phase 1-premorbid

poor peer relationships/school performance
shy
first noticed by family

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schizo- phase 2- prodromal

cognitive impairment, OCD, social withdrawal

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schizo- phase 3- schizophrenia

full blown psychosis
delusion, hallucinations, dec functioning

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schizo- phase 4- residual

flat affect
no s/s of active psychotic phase

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schizo- negative s/s

withdrawn, social isolation, risk for suicide (anhedonia) (can’t experience pleasure)
volition (no goal-oriented activity)
waxy flexibility- consistent degree of resistance against passive mvmnt
posturing

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schizophrenia

inability to differentiate btw what’s real and what’s not real
affects speech, affects, motor mvmnts

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depression vs blues

depression questioned when pt unable to adapt and s/s impair daily functioning
*major depressive disorder most common

distress interferes w/ social, occupational, cognitive and emotional functioning

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depression and bipolar

bipolar disorder misdiagnosed as depression

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depression- epidemiology

x2 women v men- less pronounced w/ age
effects low and high socioeconomic
inc risk if single
seasonal (seasonal affective disorder is separate condition)

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depression- biochemical component

inc acetylcholine
dec serotonin (cognition, irritability, appetite)
dec dopamine (regulates mood)
dec norepinephrine (ability to deal w/ stressful situations)

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depression- endocrine disturbances

HPA- excessive cortisol (inc neurotoxicity and reduced neurogenesis)
HPTA- dec TSH= blunts circadian rhythm

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depression- physiological predisposing factors

med side effects, electrolyte disturbance, hormonal disorder, nutritional deficiencies

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depression- childhood depression-

disruptive mood dysregulation disorder
hard to diagnose w/ changing hormones
onset <10 yrs

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depression- adolescence

2nd leading cause death for 15-24 yrs old

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depression- senescence (elderly)

males >85 yrs have 4x national rate

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depression- postpartum

1-2/1000 have severe depression
50-85% have “the blues”
10-20% have moderate depression

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psychoanalytical theory- depression

S. Freud
loss is internalized and becomes directed against the ego
(loss of connection)

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learning theory- depression

Seligman
learned helplessness
depressed bc feel helpless

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object loss- depression

renee spitz
loss of signif other during first 6mo of life
(attachment theory)

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cognitive theory

aaron beck
depression is cognitive v than affective
negative expectations- environment, self, future
Pt is causing the depression bc they are thinking negatively

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major dep. disorder- diagnostic criteria

change in sleeping, eating patterns (dec 5%. body weight in 30 days)
loss of interest in usual activities

s/s must be present for at least 2 weeks

NO hx of manic behavior (bipolar not depression)
s/s represent a change from baseline functioning

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major d d- s/s criteria

sad, lack of interest 2 wks or more and at least 4 other symptoms

changing in eating habits
hypersomnia/insomnia
impaired concentration, decision making/problem solving
worthlessness, hopelessness, despair
thoughts of death/fatigue
overwhelming fatigue, negative thinking

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persistent depressive disorder v MDD

s/s more mild
no evidence of psychotic s/s
not suicidal

depressed for most of the day, more days than not
present for at least 2 YEARS

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premenstrual dysphoric disorder

onset of s/s week b4 start of menses
improve after start menses
s/s present for most cycles the previous yr

lethargy, diff concentrating, anxiety, irritabitli, depressed mood, change in sleep/eating
s/s must interfere w/ ability to function

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substance-induced depressive disorder

can be assoc with withdrawal of seizure and HTN meds

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childhood depression criteria- s/s based on age

<3- feeding problems, lack of playfulness, tantrums
3-5 - accident prone, phobias, self blame
6-8- aggressive beh, clinging beh, physical complaints
9-12 - morbid thoughts, excessive worrying

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childhood depression- trtmnt

precipitated by loss
therapy- alleviate sx and strengthen coping skills
parental/family therapy

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adolescent depression- diagnosis/ trtmnt

beh change that lasts for several weeks
results from perception of abandonment (parents or peers)

trtmnt- supportive psychosocial intervene
SSRI

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consideration w/ ssri and kids/ adolescents

inc risk of suicidality

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senescence- depression trtmnt

antidepressant meds, electroconvulsive therapy, psychosocial therapy

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postpartum depresion- trt/ s/s

trt- antidep, psychosocial therapy

s/s- fatigue, dec appetite, sleep disturbances, concern abt inability to care for infant

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transient depression

s/s not impair functioning
tired, self blame, crying

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mild depression

usually assoc. w/ grieving
affective- anger, anxiety
behavioral- tearful
cognitive- preoccupied w/ loss
physiological- anorexia, insomnia

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moderate depression

affective- helpless
behavioral- limited verbalization, slowed movements
cognitive- difficulty concentrating/ critical thinking
physiol- ha, sleep disturbance

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severe depression

inc s/s of MDD and bipolar depression
total despair, flat affect
absence of communication
delusional thinking, confusion, suicidal thoughts
general slow down of the body

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depression disorders trtmnt

individual psychotherapy (interpersonal realtions_
group therapy
family therapy
cognitive therapy (changing thoughts)
transcranial magnetic stim
light therapy
electroconvulsive therapy (initiate a grand mal seizure)
neuromodulation (deep brain stim and vagal nerve stim)

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depression disorders- meds

SSRI
SNRI
MAOI
Tricyclics
ketamine nasal spray

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SSRI

ae- dry mouth, dec libido
do not take w/ MAOI- SS
nsaids, warfarin inc lvls
work 4-8 wks

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SNRI

dry mouth, dec libido
withdrawal s/s
MAOI, haldol, lithium, tramadol, nsaids, warfarin contraindicated - SS
work 4-8 wks

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Noraderenergic -dopaminergic antidepr

ex. wellbutrin
can be used for ADHD or to counteract sexual dysfunction w/ SSRI
ae- dec seizure threshold
contraind w/ MAOI
6-8 wks full effect

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heterocyclics

ex. trazadone
ae- urinary retention, priapism
instant onset- works for sleep aid
MAOI contraind
full effect 3-4 wks

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tricyclics

2nd or 3rd line agent for MDD
ae- wt gain
*do not prescribe for suicidal pts
OD IS LETHAL (monitor cardiac functioning (wide qrs)
avoid MAOI- SS
clonidine- HTN crisis (used for htn or adhd)
frequent EKG- monitor blood lvls
work 3-4 wks

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MAOI

3rd line agent for trtmnt resistant depression
more commonly used for parkinsons (selegiline)
LETHAL OD
HTN crisis w/ tyramine foods, SS
smoked/aged cheese, processed meats, alcohol, chocolate, beef/chicken liver, yeast products, soy beans, diet pills

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bipolar def

mood swings from profound depression to extreme mania
can have delusions and hallucinations
s/s can reflect seasonal pattern

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hypomania- bipolar

period of abnormal and persistent elevated or irritable mood lasting 4 days
no impaired functioning
no psychotic s/s

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bipolar epidemiology

presents in ages 20-30

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bipolar 1- timeline

lows at least 2 wks, extreme highs at least 1 wk
or need for hospitalization
can last 3-6mo

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bipolar 2- def

bouts of MDD w/ episodic hypomania
NOT meet criteria for full manic episode
lows just as low as BP1 but manic episodes are milder

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cyclothymic disorder- criteria

subcat of bipolar
cyclic
mood disturbance
at least 2 yr duration
longest time w/o s/s is 2 mo
many episodes of hypomania and depressed mood

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bipolar- biologic theories

has genetic component
GABA disregu
inc noradrenergic activity
ion channel abnormal
kindling (inc severity of responses w/ recurrent exposure to triggers)

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bipolar- childhood

inc comorbid w/ ADHD
adhd meds can exacerbate mania

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bipolar childhood- trtmnt

lithium, divalproex, atypical antipsychotics
carbamzaepine

family psychoeducation about disorder
communication training
problem-solving skills

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bipolar- mania meds

lithium
anitconvulsants (mood stabilizer)
cardiogenic drugs for vascular effect
histmine blockers for tension
antipsychotics

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bipolar- depressive phase meds

mood stabilizers
SSRI (with care!!! can trigger mania)

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lithium contraindications

nsaids and etoh
need to maintain consistent blood volume lvls

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lithium range

0.5-1.2 mEq/L
draw a trough 12 hrs post dose
toxicity dependant upon each person

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lithium ae

polyuria, polydipsia, wt gain, sexual dysfunction

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lithium lab tests

TSH, PTH, UA, CBC, EKG, Na, Ca, phosphorus

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lithium toxicity

ae- n/v, tremor, seizures
trtmnt- IV fluids, whole bowel irrigation

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SILENT- lithium

syndrome of irrev lithium effectuated neurotoxcicity
truncal ataxia, scanning speech, incoord

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lithium- pt ed

notify dr if diarrhea or vomiting occur
check lvls every 1 to 2 months
maintain consistent diet
don’t skimp on dietary sodium intake

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anticonvulsants (mood stabilizer) pt ed

do not discont abruptly
report rash, brusing, sore throat, fever, malaise, dark urine
avoid use of etoh

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Ca channel blocker pt ed

take if GI upset occurs
orthostatic hypotension
blurred vision, dizziness, drowsiness

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antipsychotics pt ed

use sunscreen
orthostatic hypotension
avoid etoh
report- sore throat, persistent n/v, ha, rapid hr, change in urination, yellow skin, muscular incoordination

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suicide-def

BEHAVIOR (not diagnosis or disorder)
15x inc in ppl w/ bipolar or depression vs normal pop

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suicide risk factors- marital, age, religion, socioeconomic and ethnicity

martial status (single 2x)
gender (men more successful, women attempt more)
Age (inc risk w/ age, espec men) (white men >80 highest risk)
religion (dec risk if have a religion)
Socioeconomic status (high and low classes greater risk than middle) (higher rates in unemployed) (if employed- dr., dentist, artist, lawyers and insurance agents)
ethnicity (whites have highest risk) then indians, black, hispanic, asian

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suicide r/factors- other

substance abuse, mood disorder
(schizo, personality disorder, anxiety, trauma)
insomnia, etoh abuse, psychosis w/ command hallucinations
fam hx of suicide
chronic disease
LGBTQ

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physical dependence v psychological dependence

physical- need for inc amnts to produce same effects
psychological- desire to repeat use of a particular drug for pleasure

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substance-induced disorder- subst. intoxication

reversible syndrome
s/s after excessive use of substance
direct effect on CNS
social and occupational functioning disturbed
100-200 mg/dl
death at 400-700 mg/dl

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substance-induced- withdrawal

s/s after stopping substance
s/s specific to substance used
disrupts beh, thinking and feeling
w/in 4-12 hrs after cessation
monitor for seizures for up to 10 days
give gabapentin

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substance abuse- personality factors

low self-esteem
freq depression
inability to relax/defer gratification
inability to communicate

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phases of alcoholism

1- prealcoholic- use to relieve everyday stress
2- early alcoholic- blackouts, etoh required
3- crucial phase- no control, physiological dependence
4- chronic phase- (IV)- emotional/physical disintegration

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alcoholic myopathy

from vitamin B (thiamine) deficiency
acute- sudden onset muscle pain, weakness, reddish tinge to urine
chronic- graduate wasting of muscles

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Wernicke’s encephalopathy

most severe form of thiamine deficiency in alcoholics

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ae of alcohol abuse

esophagitis,
gastritis,
cardiomyopathy,
pancreatitis (epigastric pain),
cirrhosis (portal htn, esophageal varicies, ascites, hepatic encephal- cannot covert ammonia to uria),
hepatitis (can cause ascites- use fluid centesis, monitor bp, r/f infection)

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ae of alcohol abuse

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alcohol and preg- ae

FASDs fetal alch. spectrum disorders
FAS- fetal alch syndrome
alterations in memory, learning, hearing, vision, communication
s/s- abnormal facial features, sleep and sucking problems, hyperactive beh, poor coordination

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etoh withdrawal s/s

tremors, irritability, seizures, hallucinations, delirium
autonomic act is worst in the first 5 days

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alcohol assessment tools

drug hx and assessment
CIWA clincial institute w/drawal assessment of etoh scale
cage questionnaire

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ciwa

mild, mod or severe
q3h
bp,hr,rr
clonidine for high bp

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cage

cut
annoyed
guilty
eye-opener (drink first thing in the morning)

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barbiturates, nonbarbit hypnotics, antianxiety and club drugs- priority assessment

CNS depression
respiratory rate
hr
bp
(all are dec)

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sedative/ hypnotic affects on the body

respir depression
hypotension
jaundice
dec body temp
rebound insomnia

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intoxication vs withdrawal of hypnotics

intox- can be aggressive or comatose
w/drawal- can be fatal

stimulant affects on the body

tremor, inc motor activity
inc bp, hr, arrhythmias (inc contracitlity= inc 02 requirements)
pneumonia- relaxes bronchial smooth music
GI- anorexia

stimulant intoxication

euphoria, impaired judgement, confusion

stimulant w/drawal

DO NOT die
n/v, muscle pain, fatigue, irritability

inhalant- trtmnt

supportive care
most common in 12-17 yrs old

inhalant affects on the body

CNS depressant, ataxia, tremor, encephalopathy, parkinsons
dyspnea
renal failure

inhalant intoxication

during or shortly after use
ataxia, dizziness, hypoactive reflexes, blurred vision, slurred speech

opioid intox

last several hrs- depends on half life of drug
euphoria, followed by agitation and apathy
respiratory depression

opioid withdrawal- shrt v long acting

shrt acting (heroin) w/in 6-8hrs, peak 1-3 days and subside in 5-10days

long acting (methadone) 1-3 days, peak 4-6d and dec 14-21 days
COWS

opioid withdrawal- s/s

n/v, muscle aches, pupil dilation, sweating, yawning, fever, abdominal cramping

hallucinogen intoxication

dec thermoregulation
metabolic brain injury
depersonalization, tachydardia, synesthesia (experience one sense through another)
formication (bugs on skin)
can be assaultive

cannabis- intox v withdrawal

intox- impaired motor skills can last 8-12 hrs
withdrawal- occur w/in a week, irritability, dec hunger, tremors, anxiety (rebound syndrome), depressed mood

substance abuse management

coping skills
nutrition
problem solving
relaxation skills (deep breathing)

substance abuse at work- clues

high absenteeism, discrepancies in documentation

gambling- trtmnt

first ID underlying cause (mental illness)
CBT, psychoanalysis, gamblers anonomys
meds- SSRIs, clomipramine (tricyclic antidep for OCD), lithium (mood stabil )carbamazepine (anticonv), naltrexone

codependecy steps

survival- let go of denial
reidentification- accountibility
core issues- recog things beyond indiv control
reintegration- get power back

meds for alcoholism

disulfiram (antabuse) IM
causes sevre illness, flusing, n/v and dizziness if used w/ etoh
naltrexone IM
SSRIs

meds for substance intoxication and withdrawal

benzodiazepines (lower brain act.) (seizures, anxiety etc)
anticonvul
multivitmains
thiamine (etoh)

meds for opioid abuse

naloxone, naltrexone (prevents relapse)
methadone (opioid agonist that reduces s/s of withdrawal)
buprenorphine (partial opioid agonist)

meds for stimulant abuse

antidep
tranquilizers
anticonvulsants

WRAP model

6 steps
develops safety plan at DC
wellness recovery action plan

s/s/ of thiamine deficiency

ataxia, peripher neuropathy

benzodiazepine withdrawal s/s

anxiety, tremors, tachycardia

anxiety def

emotional response to anticipation of danger
not the same as stress! (stress leads to the disorder)
stimulus is unidentifiable

mild anxiety

inc sensory stimulation

moderate anxiety

nervous, difficulty concentrating
still able to utilize coping skills

severe anxiety

inc vital signs, restless, irritable, angry

panic anxiety

enlarge pupils, focused on defense

anxiety- epidemiology

most common disorder
inc in women
minority children and children with low SES at risk
dysregulated family orientation

panic disorder

recurrent panic attacks
onset unpredictable
impending doom

s/s panic attack

sweating, SOB, chest pain, dizziness, numbness, fear of losing control (going crazy

panic attack- trtmnt

safety number one priority
use anxiolytics
benzodiaz, buspirone (take 4x day)
SSRI
Clonidine, propranolol

agoraphobia

fear of being in situations where can’t escape easily
ex. cinema, crowds, traveling in public transportation

causes of anxiety- medical v substance

medical- CHF, MI, low BG, asthma, seizures
substance intoxication or withdrawal- all (incl caffeine)

OCD- obsessions v compulsions

O- thoughts/images cannot stop by logic or reasoning
repeat the activity to avoid anxiety

C- ritualistic beh to prevent distress or dreaded situation

can be associated w/ hallucinations (crash if take eyes of the road)

OCD trtmnt-meds

meds- 2nd line
SSRI, tricylic antidep, SSRI+ atypical antipsycho, SSRI+ lithium

hoarding trtmnt

difficult, relapse high
assoc. w/ unorganized thoughts, perfectionsim, depression

OCD- psychoanalytic theory

Freud
egos are underdeveloped (anxiety and fraught with guilt)

OCD- learning theory

conditioned response to traumatic event
produce actions that lead to less resistance

OCD and serotonin

possible dec

OCD trtmtn

cogn behavioral therapy (beh modification) GOLD STANDARD
behavioral therapy - desensitization
exposure therapy to dev coping skills
implosion therapy- flooding - continue to do anxiety-provoking actions repeatedly until desensitized

anxiety meds- action

block serotonin, norephinephrine
potentiate GABA
depress lvls CNS

anxiety meds- ae

lethargy, orthostatic hypoten, n/v, inc CNS effects

buspirone

trts anxiety
does not affect cns
works on serotonin, norepin, dopamine
used for chronic trtmnt 60-80% effective
dec lvls w/ caffeine and smoking
10-14 delayed onset

anxiety meds- shrt v long term

“am”s- short term/acute
bridge meds

Chronic trtmnt- SSRI/ Busiprone

antianxiety and caffeine

dec serum drug lvls
r/f dependence w/ benzos (Xanaxz)

pattern of abuse

cyclical
abusers were abused as children

abuse predisposing factors

toxic stress
alt in norepinep, serotonin and dopamine
alterations in neurophysical and neurocognitive dis

abuse- psychodynamic theory

Freud
underdev ego
poor self concept
unmet needs for satisfaction

violence gives power to person and inc self esteem

abuse- learning theory

children learn how to behave by imitating role models
more likely to abuse if physically disip as. achild

abuse- societal influences

american cult
violence means of solving problems

intimate partner violence- def

battering
pattern of coercive control founded on violence of threat of violence

IPV- predisposing victim factors

women (affects all age, race, relgion, cult and socioecon)
low self-esteem
inadeq support systems
abusive childhood

IPV abuser profile

low self-esteem
limited coping
severe stress rxns
views spouse as personal possession
controls through intimidation

cycle of battering- phases

1- tension building- can take wks to yrs
2- acute incident (24hrs), victim can try and hide
3- calm, loving, (honeymoon phase)- victim thinks perosn will change

child abuse- emotional

pattern of beh by caretakers that results in serious impairment of child’s social, emotional or intellectual functioning

indicators-
extremes of beh
delayed dev (phys/emotional)
dec attachment to parent
suicide attempts

child abuse- beh indicators of neglect

freq absent from school
begs/steals
lacks medical care
consist dirty
abuses drugs/alcohol

child abuse- sexual indicators

nightmares
bedwetting
sudden change in app
attaches quickly to strangers
suddenly refuses. to particip in physical activities

child abuse general influences

substance abuse inc risk for neglect/abuse
numerous stresses
poverty
social isolation
lack of knowledge abt child care needs

child incest characteristics

lack. trust
low self esteem
poor sense of id
absence of pleasure w/ sexual act

child incest- complications (at r/f)

PTSD
sexual dysfunc
depression, anxiety
eating dis
substance dis
alteration in response to intimacy

rape epidemiology

any age
16-34 yrs
single women
attacked near own neighborhoods
degree of resistance by women depends on if abuser has a weapon

rape response patterns

expressed or controlled

rape reactions

compounded reaction (ass. w/ mental illness and substance abuse, suicide)
silent (don’t tell anyone)

rape- long term v short term goals

long-dev coping skills
short- guide through initial shock
provide shelter, promote reassurance of safety

crisis intervention

focus of initial interview and follow-up w the client who has been sexually assaulted is alone

PTSD epidemiology

more common in women
10% of ppl that have traumatic event will develop

PTSD v adjustment disorder

adjustmnt- difficul w/ stress rxns to less extreme events
common
usually dev depression
s/s occur w/in 3 mo and last no longer than 6 mo

PTSD def

rxn to extreme trauma
s/s- reexperi traumatic event
sustained high lvl anxiety
intrustive thoughts
amnesia
substance abuse
guilt
anger/aggression

PTSD onset

can by delayed yrs after event
s/s must be present for 1+ mo, sign interference w/ social, occupational functioning

factors for dev PTSD

duration, severity, exposure, or location

acute stress disorder

s/s do not last more than 1 mo

trauma disorder trtmnt

cognitive therapy
prolonged exposure ther
group/family therapy
eye mvmnt desensitization and reprocessing (don’t use if seizures or suicidal)
SSRI

adjustment disorder trtmnt

goal to reduce triggers, relieve s/s
regular therapy
crisis intervention
SSRI
self-help groups

trauma informed care

safety, trustworthiness/ transparency, peer support

trauma response- beh

reckless, freq seeking attention, reverting to younger beh, fighting when critized, resisting change

trauma response- emotional/physical

nightmares, sensitive to stimuli, fear of separation, dec trust, emotional swings, unexplained medical problems

trauma response- psychological

confusing safe v dangerous
trouble focusing
diffic imagining future

personality disorders trtmnt

no curative
only supportive

predisposing factors- personality disorder

established psychiatric and medical disorders
s/s of personality dis manifest from

cluster A- odd, eccentric (unconventional)

paranoid, schizoid, schizotypal

trtmnt- exposure therapy- guided
exposed to normalcy

cluster B- dramatic, impulsive, self-destructive

antisocial (socipath)
borderline
histrionic
narcissistic

are aware of own actions
trt w/ CBT, group therapy, Dialectal Behavior T (mindfulness, meditation)

cluster c- anxious, avoidant, dependent

avoidant, dependent, obsessive-compulsive (anxiety dis)

Trt w/ group therapy (learn from like-minded others) in moderation, CBT (restructuring thinking patterns), exposure therapy

paranoid personality dis

can be seen in schizo and PTSD
more common in en
mimic PTSD- less hyperarousal
trusts no one
magnifies/distorts environment
does not accept responsibility for own beh
attributes shortcomings to others
insens/oversen to ppl’s feelings

schizoid personality dis def

profound defect in the ability to form personal relationships
do not respond in emotional way
can be misinterpreted for autsim

schizoid personality dis– clincial

emotionally cold, avoids ppl, aloof, no close friends
inapprop serious

schizoid personality dis- predisp factors

epigenetics
childhood cold, unempathetic, lack nuture

schizoid personality dis– clincial

emotionally cold, avoids ppl, aloof, no close friends
inapprop seriouss

schizotypal disorder

same as schizoid but have more concerning positive s/s
graver
magical thinking, illusion, depersonalization, withdrawal
same as schizo but no negative s/s

schizotypal disorder- clinical

medication not trt s/s- only alters LOC
bizarre speech pattern, demonstrate psychoic s/s
bland affect

schizotypal disorder- pre d

family dynamics (indifference, impassivity, formality)
causes discomfort w/ affection/closeness

antisocial def

manipulative beh w/NO REMORSE
disregards rights of others
rules don’t apply (law, jobs, relationships)
see themselves as victims

antisocial- development

onset 3-4yrs old- impairment in fear conditioning
1% in pop
16% in jail
clinically overdiagnosed

antisocial- behaviors

exploitation/manipu for peronsal gain
unable to delay gratification
reckless
gaslighting

antisocial- predisposing f

possible genetic factors
hx of severe physical abuse
removal from home
inconsistent parental discipline
extreme poverty
ADHD, conduct disorder as a child

borderline personality disorder-def

intense, chaotic relationships w/ affective instability
rapid change in beh from one extreme to another
impulsive
response to learned beh/emotional response to trauma/neglect when little

borderline personality disorder- beh

threaten self harm- only way they know how to get needs met
unstable self image
overly concerned w/ abandonment- don’t like to be alone
fall btw border of neuroses (very anxious) and psychoses (visual/auditory hallucinations)
depression, clinging,
splitting

borderline personality disorder- predi f

biochem- serotonergic defect- trt w/ ssri
genetic- assoc. w/ depression, learned beh from trauma (neglect, parents emotionally unstable)
psychosocial- truma/abuse
16-24 mo old child fails to reach task of autonomy (rapprochement phase)- don’t complete tasks by themselves

histrionic personality dis def-

more common in women
2-3%
extroverted, emotional, dramatic
don’t usually engage in self harm

histrionic- clincial

ex. dennis rodman
attention seeking
seductive
self-dramatizing
very distractable
easily influenced by others (rely on reactions)

narcissistic def

exagg sense of self worth
no empathy
rules do not apply to them

narcissistic- behaviors

exploit others to fulfill own desires
grandiose, cheerful, optimistic
fragile self-esteem
can be triggered by criticism

narcissistic- predis p

dependency needs responded to w/ neglect/criticism as kids
parents narcissistic themselves
parents have no limits, or give in to child to avoid conflict

avoidant personality- def

extreme sensitivity to rejection
avoid social situations
social withdrawal
1%

avoidant- clinical

want connection- are often lonely
timid
self doubt

avoidant- pre disp

no clear cause
parental rejection, reinforced by peers

dependent personality- def

rely on others for emotional support/sense of self
common in the youngest and midlife crisis
lack self-confidence (stooped posutre, small voice)
passive and submissive roles in relationships
overly generous

dependent personality- pre di

hereditary, nurture from one exclusive source (mom)
singular attachment as an infant

OC personality disorder- def

inflexibility, rigid, rank conscious
must be done a certain way
common in oldest child
men
relatively common

ocd v ocpd

ocd= aware that actions are irrational but repeat to relieve discomfort

ocpd- unaware, optimize utility vs pleasure

oc personality disorder- pre d

overcontrolled by parents
lack positive reinforcement for good beh
freq punishment for undesirable beh

general trtmnt- mood disorders

interpersonal psychotherapy
psychoanalytical pscyhother
cbt
dialectical beh therapy
psychopharmacology
* antisocial disorder- therapy does not work

somatic s disorders- def

disorders w/ no pathological reason
common in women, less educated ppl, rural areas

dissociative disorders- def

disruption in integrated fun of consciousness, memory and identity
very rare
no medication
person is on autopilot- don’t remember daydreams
brief periods common in young adults w/ lots of stress (brain not fully dev)
form of survival star. for child in traumatic environment

somatic s disorder

mult dis w/ no explanation
anxiety, depression, drug abuse, dependence and suicide common

illness anxiety dis

somatic
fear of having serious dis
OCD traits accompany
frm past experi w/ physical illness (family, friends etc)

conversion dis

somatic
precip by stress
timing unpredictable (1 yr v 30 yrs onset)
usually effect lower half of body
mimic s/s of neurologic dis

factitious dis

somatic
intentional pretending of physical/psych s/s
make self sick for attention
“Munchausen syndrome

somatic dis- family dynamics

child can pretend to become ill
shifts focus to child and not fighting parents
brings stability

somatic dis- learning theory

somatic complaints reinforced
person uses to get out of responsibilities (primary)
shift focus to themselves (secondary gain)
relieve conflict - shift focus to person (tertiary)

dissociative amnesia

onset follows severe stress
can’t remember events even though conscious
localized (all incidents for specific amnt time), selective (certain incidents), generalized (all events during the lifetime)

dissociative fugue

sudden need to travel away from home w/ inabil to recall past

dissociative identity disorder

2+ personalities w/in 1 person
transition btw personalities is sudden, precip by stress
beh bizarre, contradict true self
trtmnt- hypnosis
integration therapy (inc predictability of actions)

depersonalization derealization disorder

tempor change
ureality reelings
detachment from environment
obsering oneself from outside body

depersonal v derealization

deperson- can’t feel sensations (altered perception of self)
derealization- can’t process event is happening (altered percep of environ)

dissociative amnesia- psychodynamic theory

repression
invol blocking of unpleasant feelings

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