Exam 5 Mental Health Flashcards
2 or more people who develop an interactive relationship and share at least on common goal or issue
Therapeutic groups
Treatment intervention in which a trained leader establishes a group for the purpose of treating pts with psychiatric disorders
Group psychotherapy
When members recognize they are not alone, other members have similar thoughts, feelings, & problems
Universality
When you help others
Altruism
When you have accurate info shared
Imparting of information
Corrective recapitulation of the primary family group
Reenact & connect family values
catharsis
sense of relief
maintenance group re-enforce or help maintain good behavior
support groups
name the types of activity groups
recreational
creative
what do educational groups help with
give pts information about medications, coping skills, social skills etc
family becomes involved with therapy
family therapy
what are the goals of family therapy
understanding family dynamics
mobilize family strengths & resources
restructure maladaptive family behavioral styles
help strengthen family problem solving behaviors
assess and treat family and patient
Freud
father of psychology
first to identify personality development by stages, the first 5 years are the most important, all mental disorders stem from issues from childhood that weren’t involved
Levels of awareness
conscious
preconscious
unconscious
material within awareness is only a small part of the mind
conscious
refers to memory that can be recalled to consciousness with some effort
preconscious
all the memories, conflicts, and experiences that have been repressed and cannot be recalled at will without assistance of a therapist
unconscious
cannot tolerate frustration, lacks ability to problem solve, “pleasure principle”, at birth we are all Id, source of all drives, instincts, needs, genetic inheritance
Id
rational self, provides logic & reason, problem solver, and reality tester, strives to maintain harmony
“reality principle”
Ego
represents moral component, last to develop, concerned with right and wrong, opposite of Id
superego or conscience
what side of the brain is conscious mind, logic, reason, math, reading, writing, language, analysis, Ego
left
what side of the brain is unconscious mind, imagery, creativity, synthesis, dreams, symbols, emotions, Id
right
why does the ego develop defense mechanisms?
to deal with anxiety by preventing conscious awareness of threatening feelings, we cant survive without them
covering us a real or perceived weakness by emphasizing a trait one considers more desirable
compensation
refusing to a acknowledge the existence of a real situation or the feelings associated with it
denial
transfer of feelings to another that is considered less threatening or that is neutral
displacement
an attempt to increase self worth by acquiring certain attributes and characteristics of an individual one admires
identification
an attempt to avoid expressing actual emotions association with a stressful situation by using the intellectual processes of logic reasoning and analysis
intellectualization
attributing feelings or impulses unacceptable to ones self to another person
projection
attempt to make excuse or formulate logical reasons to justify unacceptable feelings or behaviors
rationalization
preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opp. thoughts or types of behaviors
reaction formation
responding to stress by retreating to an earlier level of development and the comfort measures associated with that level of functioning
regression
involuntary blocking unpleasant feelings and experiences from ones awareness
repression
rechanneling of drives or impulses that are personally or socially inacceptable into activities that are constructive
sublimation
a voluntarily blocking of unpleasant feelings and experiences from ones awareness
suppression
symbolically negating or canceling out an experience that one finds intolerable
undoing
occurs when emotional conflict or stressors are handled by attributing negative qualities to self or others. when devaluing another, the individual appears good by contrast
devaluation
Eriksons developmental theory stages of personality development
emphasis on stages of development, each stage is an emotional crisis, degree of mastery is related to the degree of maturity that the adult achieves, 8 stages
views abnormal behavior as part of a disease
neurobiological model
cerebrum
largest part of brain, associated with thought and action, divided into 4 sections called lobes
frontal lobe
reasoning, planning, parts of speech, movement, emotions, problem solving
parietal lobe
associated with movement, spatial orientation, recognition, perception of stimuli
occipital lobe
associated with visual processing
temporal lobe
associated with perception and recognition of auditory stimuli, memory, and speech
limbic system
“emotional brain”, found in the cerebrum, regulates emotion and memory. connects the lower and higher brain functions, influences motivation, mood, sensations of pain and pleasure
parts of limbic system
thalamus hypothalamus cingulate amygdala hippocampus basal ganglia
all sensory inputs through it to the higher levels of the brain
thalamus
sits at the top of the brainstem, while small, it controls autonomic nervous system center for emotional response and behavior, regulates body temperature, food intake, water balance, and thirst, and controls endocrine system
hypothalamus
serves as a conduit of messages to and from the inner limbic system
cingulate
appears to be responsible for the influence of emotional states on sensory inputs
amygdala
important in the transition of information from short term to long term memory
hippocampus
plays a role in planning and coordinating motor movements and posture
basal ganglia
acetylcholine
voluntary movement, learning, memory and sleep
too much=depression
too little=dementia
dopamine
correlated with movement, attention, and learning
too much=schizophrenia
too little=Parkinson’s disease
norepinephrine
associated with eating, alertness
too much=schizophrenia
too little=depression
epinephrine
involved in energy and glucose metabolism
too little=depression
serotonin
plays a role in sleep, mood, appetite, and impulsive aggressive behavior
too little=depression, anxiety disorders (esp. OCD)
GABA
inhibits excitation and anxiety
too little=anxiety,
endorphins
involved in pain relief and feelings of pleasure and contentedness
voluntary patients
patient or guardian applies for Tx and can sign out of Tx
involuntary patients
mental illness is not incompetent, state must prove mentally ill and dangerous
evaluation and emergency care (involuntary tx)
72 hours, those who are dangerous to self or others or gravely disabled
certification for observation and tx (short term)
14 days, psychiatrist must see in 24 hours, disorder must be treatable, probable cause required by 4 amendment (search and seizure)
extended or indeterminate commitment (long term)
need prolonged care but refuse voluntarily. 3, 6, 12 months. requires a court hearing
hospital based care
short term, crisis intervention & safety, D/C planning, psychotherapeutic management model
outpatient
mental health clinics, private practices, primarily for counseling
partial programs
day program, structured activity, and tx during the day, pt returns to home in evening
residential services
(stokley center) extended care facilities, group homes, halfway homes, living programs, shelters
eustress
good stress
something that triggers stress to be real or perceived
stressor
natural stimulant made in adrenal gland, epinephrine, affects ANS (increase of HR, pupils dilate, sweat) fight/flight response
adrenalin in action
alarm triggers response; body reacts; return to homeostasis
alarm and adrenaline
results in higher than normal amounts of adrenaline; adrenaline overload takes a toll on the body (insomnia, nausea, dizziness, depression)
prolonged stress
name general stress reduction techniques
relaxation, reframing, sleep, exercise, decrease caffeine
persistent re experiencing with a highly traumatic event that involves actual or threatened death or serious injury to self or others
post traumatic stress disorder
when do Sx of PTSD usually appear
3 months after trauma but a delay of months or years is not uncommon
a dissociative experience during which the event is relived and the person behaves as though he/she is experiencing the even t at that time
flashbacks
what are the major features of PTSD
flashbacks, persistent avoidance, numbing of general responsiveness (diff sleeping, concentrating, hyper-vigilance)
difficulties with relationships, trust, child/spouse, chemical abuse
occurs within one month after exposure to a highly traumatic event, such as those as PTSD
acute distress disorder, must display 3 dissociative sx either during or after the traumatic event, if it resolves within 4 weeks its acute distress disorder, if it persists then it is PTSD
name the dissociative sx of
sense of numbness, detachment, reduced awareness of surroundings, de-realization, depersonalization, dissociative amnesia
a feeling of anticipation, generally unpleasant
anxiety
abnormal anxiety
remains when the danger or stressors are gone
mild anxiety
can id things that are disturbing and are producing anxiety, slight discomfort, restlessness, impatience, foot or finger taping, lip chewing, fidgeting, able to work effectively toward a goal and examine alternatives
moderate anxiety
has narrow perceptual field, grasps less of what is going on, able to solve problems but not at optimal ability, voice tremors, shakiness, diff concentrating, somatic complaints (urinary freq. urgency, HA, insomnia) increase HR, RR, pacing, banging hands on table
severe anxiety
has greatly reduced perceptual field, attention is scattered, absorbed with self, unable to see connections between events or detains, has distorted perceptions, feelings of dread, confusion, sense of impending doom, hyperventilation, tachycardia, loud and rapid speech, threats and demands
panic
unable to focus on environment, experiences the utmost state of terror and emotional paralysis, may have hallucinations or delusions that take the place of reality, may be mute or extreme psychomotor agitation, experience of terror, immobility or severe hyperactivity or flight, severe shakiness, sleeplessness, out of touch with reality
primary method that our ego uses to control or manage anxiety
defense mechanisms
what is the most common form of psychiatric disorder in US
anxiety
etiology of anxiety
genetic, limbic system, neurotransmitters, behavioral/cognitive (learned behavior)
how does the cingulate act in anxiety
part that is associated with anxiety disorders, stores memories, emotions
how does the frontal cortex act in anxiety
interprets initial threat (threat or not)
how does the hypothalamus act in anxiety
activates fight or flight response
how does the amygdala act in anxiety
registers fear responses and stores it
how does the hippocampus act in anxiety
memory related to fear
serotonin in anxiety
level is decreased which causes anxiety
what is usually given for anxiety
Benzodiazepines
panic attack
sudden onset, feelings of terror, “out of blue” fear of losing control, feels like having heart attack
S/sx of panic attack
CP, palpations, diff. breathing, N/V, hot flashes, chills, feels like choking
intense excessive anxiety or far about being in places or situations from which escape might be difficult or embarrassing
panic attack with agoraphobia
irrational fear of an object or situation that persists although the person may recognize it as unreasonable
phobias
need to control themselves, others, and environment
obsessive compulsive disorder
thoughts, impulses or images that persist and recur so that they cannot be dismissed from the mind, can cause extreme anxiety
obsession
ritualistic behaviors an individual feels compelled to perform to reduce anxiety
compulsion
excessive collecting of items, failure to discard excessive amounts of these items, usually associated with OCD
hoarding
excessive worrying and anxiety about numerous things lasting 6 months or longer
generalized anxiety disorder
Sx of generalized anxiety disorder
restlessness, fatigue, poor concentration, irritability, tension, sleep disturbance
substance induced anxiety disorder is characterized by sx of
anxiety, panic attacks, obsessions, compulsions that develop with the use of a substance or within a month of stopping use of the substance involved
used for disorders in which anxiety of phobic avoidance predominates but the symptoms don’t meet full diagnostic criteria for a specific anxiety disorder
anxiety disorder not otherwise specified (NOS)
SSRI
antidepressants
serotonin reuptake inhibitors
ex. Paxil, Prozac, Zoloft
don’t use with ETOH, may take 4-6 wks to realize full benefit, don’t stop suddenly
why are SSRI’s not given to bipolar pts
bc they can cause manic episodes
SSNRI
serotonin norepinephrine reuptake inhibitors
ex. Cymbalta, Effexor
Anxiolytics (antianxiety)
Benzodiazepines
potentiate GABA decrease neuronal excitability, short term basis bc of dependence, produces calm effect
no ETOH, don’t stop suddenly, don’t take if prego, no caffeine
Ex. Ativan, valium, Xanax, Klonopin
Beta blockers
propranolol
used for GAD or panic, blocks beta adrenergic receptors in sympathetic NS causing a relaxation response
BuSpar
antianxiety
doesn’t cause dependence
need 2-4 wks to reach full effect, long term Rx, should be taken regularly
SE: HA, dizziness, lightheadedness, nauseas, insomnia
Kava Kava
causes liver toxicity
valarian
root, put in tea, causes HA, dizziness, N/V
the expression of psychological stress through physical symptom, convert anxiety into physical symptoms, not caused by substance, possible link to repressed anxiety
somatoform disorders
usually obsessed on how their body is working/effected
“hysterical neurosis”
what is the prevalence of somatoform disorders
est. 30% mostly female
etiology of somatoform
not genetic, but runs in families, pain is r/t repressed anxiety, learned from environment, cognitive: focus on body sensations & misinterpret their meanings
intentionally produced physical or psychological s/sx to assume the sick role, no intent for economic gain
factitious disorder (not a somatoform disorder) *most severe form is Munchausen syndrome
conscious effort to produce symptoms for benefit, usually for economic gain (disability), difficult to prove or disprove, often medication seeking
malingering disorder (not a somatoform disorder)
syndrome of multiple somatic complaints that cannot be explained medically and are associated with psychosocial distress and long term seeking of assistance from healthcare professionals
somatization disorder
characteristics of somatization disorder
vague, dramatized, exaggerated, report significant distress, anxiety & depression in history, report being ill for prolonged time with variety of Sx, chronic and relapsing pain, suicide threats and attempts are not uncommon
prevalence of somatization disorder
females, lower educational levels, rural areas, non white
Sx of somatization
pain, GI (N, V, D), sexual sx (irreg. period, ED), neurological (paralysis, numbness)
*most common
pain in one or more anatomic sites, causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, anxiety usually triggers the pain, not intentionally produced
pain disorder
characteristics of pain disorder
frequent visits to MD to obtain relief, excessive use of analgesics, requests for surgery, Sx of depression, dependence on addictive substances
an unrealistic or inaccurate interpretation of physical sx or sensations, leading to preoccupation and fear of having serious illness
hypochondriasis
characteristics of hypochondriasis
over exaggeration, fear of disease/illness, preoccupation with sx, extreme worry, refuse to see mental health professional, chronic & relapsing, sx worsen with stress, convinced not receiving good care, MD shopping, OC traits, read about disease or hear about someone they know with the disease and causes alarm on their part
loss of or change in body function resulting from a psychological conflict, the physical sx of which cannot be explained by any known medical disorder or pathophysiological mechanism. Ex. blindness, numbness, loss of hearing
conversion disorder (very rare)
La belle indifference
lack of concern, often a clue to MD that the problem may be psychological rather than physical, affect voluntary motor or sensory functioning suggestive of a neurological disease, pseudoneurologial (seizures, paralysis, anosmia, pseudocyesis), not fabricated
prevalence
more common in females
commonly seen in community, psychiatric, cosmetic surgery and dermatological settings
body dysmorphic disorder
prevalence with body dysmorphic disorder
common in women, usually have OCD, may avoid work/school, low self esteem, commonly involves face
what is the primary gain for a pt with somatoform disorder
conversion sx enable the individual to avoid difficult situations or unpleasant activities about which he/she is anxious
(get out of something they don’t want to do)
what is the secondary gain for a pt with somatoform disorder
gaining attention or support not otherwise forthcoming
what is the communication style for a pt with a somatoform disorder
hard time talking about feelings, but they can talk about their S/Sx, always focus on physical, become dependent on Rx to relieve the anxiety
Key point about somatoform disorder symptoms
not intentional or under the conscious control of the PT, unlike factitious disorders
what is the hallmark of dissociative disorders
disturbances in the normally well-integrated continuum of consciousness, memory, identify, and perception
unconscious defensive mechanism to protect the pt against overwhelming anxiety
dissociation
prevalence of dissociative disorders
rare, occur at any age group , often seen in military or POW camps
etiology of dissociative disorders
unknown but r/t stress (traumatic events)
limbic system is involved, traumatic memories are processed through limbic system and stored in hipocampus
persistent or recurrent alteration in PERCEPTION OF THE SELF while reality testing remains intact
depersonalization disorder
reality testing
oriented to person, place and time (not hallucinating)
depersonalization/derealization disorder is characterized by
fell mechanical or dreamy, sense of unreality slow movement, detached from body, may see oneself from a distance or outside of the body, may perceive limbs to be larger or smaller than normal
persistent or recurrent experience of UNREALITY OF SURROUNDINGS while reality testing remains intact, often dream like, or disoriented in familiar surroundings
derealization
an inability to recall important personal information, usually after a severe physical or psychological stressor, too pervasive to be explained by ordinary forgetfulness not due to substance use or neurological or medical condition
dissociative amnesia
types of dissociative amnesia
localized: selective, continuous, generalized
inability to recall incidents associated with traumatic events for a specific time period following the event, usually few hours or days, most common
localized dissociation amnesia
inability to recall only certain incidents associated with traumatic event for a specific period after the event
selective dissociation amnesia
inability to recall events occurring after a specific time up to and including the present
continuous dissociation amnesia
not being able to recall anything that happened during the individual entire lifetime, including his/her identity
generalized dissociation amnesia
behaviors of dissociative amnesia
appears alert, clouding of consciousness, often brought to ED by police who find them wondering & confused, onset follows severe psychosocial stress, termination is abrupt followed by full recovery, recurrences are unusual
sudden unexpected travel away from the customary locale and inability to recall ones identity and information about some or all of the past
dissociative fugue
behaviors of a pt with dissociative fugue
contacts with others are minimal, assumed identity, don’t behave normally, often picked up by police, present to ED, able to provide details of their earlier life situation but have no recall from the beginning of the fugue state, duration is brief, recovery is rapid & complete, recurrence is not common, excessive alcohol use
most severe form of dissociative disorders and formerly known as multiple personality disorder, usually caused by severe psychological trauma (sex abuse)
dissociative identity disorder
prevalence of dissociative identity disorder
90% are women, uncommon
features of Dissociative identity disorder
alternate identities under stress, existence of at least 2 or more personalities in a single individual, only one personality evident at any given time, each personality (alter) is unique, transition from one alter to another is sudden, usually precipitated by stress, usually not aware of alters
if you have a pt that wakes up in a unfamiliar situation with no idea of how they got there, or who people are around them, what disorder might they have
dissociative identity disorder
what Tx options are available for pts with dissociative identity disorder
psychotherapy
hypnosis
creative art therapy
enduring patterns of perceiving, r/t and thinking about the environment
personality
what are the 4 biological humors
yellow-bile
black-bile
blood
phlegm
yellow bile
irritable and hostile
black bile
pessimistic and melancholic
blood
overly optimistic and extroverted
phlegm
apathetic
what axis is a personality disorder done on
axis 2
what are some characteristics of personality disorders
have problems with changes, unable to cope with stress, have difficulty responding flexibility and adaptively to the environment and to the changing demands of life, believe they are normal and others have a problem
reasons for relationship problems with pts with personality problems
blurring of boundaries, inability to trust, avoidance of fear or rejection, passive aggressive traits, have capacity to “get under skin”
Ex. Sam
etiology of personality traits
environment, genetics, abuse in childhood
prevalence
between 9-16%
Cluster A personality disorders
paranoid personality, schizoid personality, schizotypal personality
general characteristics of paranoid personality disorders
pervasive distrust and suspiciousness of others such that their motives are interpreted as spiteful, beginning in early adulthood and present in a variety of contexts, tense and irritable, notice rank and power
prevalence in paranoid personality
more common in men, but difficulty to known # bc most don’t seek help with their problem
who maintains their self esteem by attributing their shortcomings to others
paranoid personality
etiology of the paranoid personality
environment, defense mechanism, r/t continuum with psychotic disorders such as schizophrenia
eccentric, isolated or lonely, profound defect in the ability o form personal relationships or to respond to others in any meaningful, emotional way
schizoid personality
characteristics of schizoid personality
classic loner, doesn’t show much emotion, appear cold or indifferent to others, inappropriately serious about everything, often attached to animals
graver from of schizoid personality pattern, once described as “latent schizophrenics”
schizotypal personality
prevalence of schizotypal
common in females, 3% of population
characteristics of schizotypal personality
bizarre speech pattern, often unkempt, magical thinking, overly superstitious, isolated, excessive social anxiety, may talk to themselves
what can happen to a pt with schizotypal personality who is under stress
decompensate and demonstrate brief psychotic symptoms (delusional thoughts, hallucinations, bizarre behaviors, magical thinking)
etiology of schizotypal personality
schizophrenia spectrum and genetically linked, PET scans show structural changes of the brain
what structural changes in the brain are seen with schizotypal personalities
ventricular enlargement, volume reduction
behaviors described as dramatic, emotional, or erratic, pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a general disregard for the rights of others
antisocial personality
Cluster B disorders
antisocial personality
borderline personality
narcissistic personality
histrionic personality
characteristics of antisocial personality
deceitful, manipulative, absent of remorse for hurting others, without conscious, feel entitled, not responsible for their actions, seductive, can be charming
etiology of antisocial personality
environment, genetic, often abused as children, as kids they are described as bully, have temper tantrums, don’t respond to punishment, usually have substance abuse problems, cling (see others as all good or all bad)
characterized by a pattern of intense and chaotic relationships with affective instability, and fluctuating attitudes toward other people
borderline personality
prevalence of borderline personality
high mortality rate of 10%, extensive use of mental health services, 75% are women and victims of childhood sexual abuse
characteristics of borderline personality
don’t tolerate being alone, frantic efforts to avoid real or imagined abandonment, cutters, impulsive with sex, spending, substance abuse, show separation anxiety, engage in splitting
etiology of borderline personality
rapprochement phase: 16-24 months, neg feedback from caregivers, sexual abuse
characterized by a persons grandiose sense of personal achievements
narcissistic personality
characteristics of narcissistic personality
consider themselves special, attention seeking, arrogant, takes advantage of others to achieve their goals, blames others for their problems, but they have a fragile self esteem, handle aging poorly
characterized by colorful, dramatic, and extroverted behavior, uncomfortable when not center of attention, will manipulate through their dramatic, charming, flamboyant, and sexually seductive behavior, shallow
histrionic personality
cluster C disorders
dependent personality
avoidant personality
obsessive compulsive personality
difficulty making everyday decisions without excessive advice and reassurance from others, need others to assume responsibility for most major areas of their life, believe they are incapable of surviving if left alone
dependent personality
characteristics of dependent personality
excessively clinging, self sacrificing, submissive, needy, gets others to care for him or her
what do you need to be aware of with dependent personality
countertransference
extremely sensitive to rejection which may lead to being socially withdrawn, want to be around people, but don’t want to be judged so they withdraw
avoidant personality
characteristics of avoidant personality
avoids activities, unwilling to get involved with people unless certain of being liked, views self as being inferior, high levels of anxiety, most have social phobia, desires social interaction but fear of rejection
preoccupied with details, rules, lists, order, organization, or schedules to the point that the purpose of the activity is lost, perfectionist, inflexible, difficulty expressing emotions
obsessive compulsive personality
what are the most common defense mechanisms for OCD
rationalization, reaction formation, isolation, undoing
primary gain
avoiding
secondary gain
gaining something
terror of gaining weight, less than 85% of expected weight, appear emaciated
anorexia nervosa
name characteristics of anorexia nervosa
preoccupation with thoughts of food, views self as fat even when emaciated, peculiar handling of food, judges self worth by weight, terror of gaining weight, may have compulsive behaviors such as hand washing, may have rigorous exercise regimen, self induced vomit, laxatives
clinical presentation of anorexia nervosa
cachectic, lanugo, mottled, cool skin, low HR, BP, Temp
2 types of anorexia
restricting
binge/purging
during anorexia nervosa, the person has not regularly engaged in binge eating or purging behavior
restricting anorexia
has regularly engaged in binge eating or purging behavior
binge/purge anorexia
complications with anorexia nervosa
bradycardia, cardiac murmur, sudden cardiac arrest, leukopenia, , electrolyte imbalance
binge and purge, may not physically appear to be ill, often slightly above or below ideal body weight
Bulimia nervosa
binge eating behaviors
food consumed rapidly, usually terminated by self induced vomiting
what does self induced vomiting lead to
erosion of tooth enamel, dehydration, electrolyte imbalance and gastric/esophageal tears
what follows bingeing
self degradation and depressed mood
clinical presentation of bulimia nervosa
normal to slightly low weight, dental caries, tooth erosion, parotid swelling, gastric dilation, calluses on hand, EKG changes
Russell’s sign
scars on hand from self induced vomiting
Bulimia criteria
at least twice a week for 3 months
regularly engages in self induced vomiting, or the use of laxatives, diuretics, or enemas
purging
regularly uses fasting or vigorous exercise but does not regularly engage in self educed vomiting, laxative use, diuretics, or enemas
nonpurging
what treatment is used for bulimia
long term cognitive behavioral therapy is most effective, Tx for co-existing depression, substance abuse, personality disorder, individual, group therapy
is there a medication specifically for anorexia nervosa
no
what labs would you do for anorexia nervosa
electrolyte, glucose, thyroid function tests, CBC
what is the first priority for anorexia nervosa
medical stabilization
at what % of weight below normal is immediate stabilization needed
75%
demands of replenished circulatory system overwhelm the capacity of a nutritionally depleted cardiac muscle, which results in cardiovascular collapse
refeeding syndrome
a single event affects unrelated situations
overgeneralization
reasoning is absolute and extreme
all or nothing thinking
the consequences of an event are magnified
catastrophizing
events are over-interpreted as having personal significance
personalization
subjective emotions determine reality
emotional reasoning
prevalence in bulimia nervosa
more prevalent than anorexia nervosa, 1.5% in women, 0.5% men, onset is late adolescence, occurs where thinness is emphasized
Etiology of eating disorders
altered brain serotonin, SSRI increased levels of serotonin do not improve mood sx until after an underweight pt has been restored to 90% of optimal weight
are eating disorders issues with food
no, based more on serious psychological problems
prevalence in anorexia nervosa
has increased, 1.0% in women, 0.3% in men, onset occurs early to middle adolescence females
enmeshment
boundaries between the members are weak, minimal privacy, interactions are intense
etiology of eating disorders
genetic, psychological (aversion to sexuality), learned behavior, controlling/enmeshment family, environment (western cultural ideal)
What medication is effective in relieving pain
SNRI’S
