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Mental Health with C/A Final > Final Study > Flashcards

Final Study Flashcards

1
Q

Anorexia Diagnostic Criteria

A
  1. Restriction of energy intake relative to requirements that leads to significantly low body weight in the context of age, sex, developmental trajectory, and physical condition. Significantly low birth weight is based on what is minimally normally required or expected.
  2. Fear of gaining weight or becoming fat, or engaging in activities that prevent weight gain
  3. disturbance on the way body shape/weight is perceived, undue influence of body shape/weight on self-evaluation, or inability to see serious of low weight.
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2
Q

Anorexia Specifiers

A

a. Type
1. Restrictive Type
2. Binge eating/purging type
b. severity- based on BMI

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3
Q

Anorexia Etiology

A
  1. Genetics
  2. Role of family dynamics
    - Parental discord
    - parenting styles
    - high stress
  3. environmental/societal factors
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4
Q

Anorexia Prevalence

A

1: 20 male to female ration, males may be undiagnosed

- usually developed in adolescence, but seeing it diagnosed earlier now

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5
Q

Anorexia Treatment

A
  1. Assessment necessary- rarely self-referred
  2. work with multidisciplinary team of providers
  3. Hospitalization often necessary with goal of gaining weight
    - offer food with a behavior management plan. Lose privilege’s if you refuse to eat, until all you are doing is lying in bed.
  4. Goals of outpatient therapy are the same.
  5. Adjunctive medication usually helpful
  6. Combine cognitive behavior and psychodynamic approach to change underlying beliefs
  7. Family therapy
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6
Q

Bulimia diagnostic criteria

A
  1. Episode of binge eating that are characterized by both of the following:
    a. eating during a discrete period of time that is more than what a normal individual would eat during the same period of time under similar circumstances
    b. lack of control over eating- can’t stop, can’t control what they are eating
  2. engage in inappropriate compensatory behaviors such as self-induced vomiting, inappropriate use of diareutics, enemas, medications
  3. behaviors occur at least 1x per week for at least 3 months
  4. Does not occur exclusively during a period of anorexia
  5. undue influence of body weight/shape on self-evaluation
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7
Q

Bulimia Specifiers

A

Based on severity

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8
Q

Bulimia Prevalence

A

1-3%, more common in females than males

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9
Q

Bulimia Etiology

A
  1. Environmental factors
  2. Guilt of overeating or fear of becoming fat
  3. Peer Influence
  4. Genetics
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10
Q

Bulimia Treatment

A
  1. Medical evaluation necessary, does not normally require hospitalization
  2. CBT
    a. self monitor of food intake and thoughts and feelings of food and eating
    b. set regular eating schedule and control over food.
    c. identify maladaptive cognitions about food and eating and work with therapist to challenge them
    d. develop coping skills
    e. psychoeducation
    f. use of self-contracts for reinforcement
  3. Group therapy is a good way to do CBT but need to be carful due to group influence
  4. Medications
  5. family therapy
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11
Q

Binge Eating Disorder

A
  1. Episodes of binge eating (discrete period of time, lack of control)
  2. Associated with at least 3 of the following- rapid eating, feeling uncomfortably full, eating in private, periods where does not want to eat, negative feelings afterwards
  3. Feelings of distress about the behavior
  4. Occurs at least 1x per week
  5. No compensatory behaviors
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12
Q

Avoidant/Restrictive Food Intake Disorder

A
  1. Feeding/eating disorder that is characterized by inability to eat nutritional/energy intake requirements and is manifested by at least one of the following:
    a. significant weight loss
    b. nutritional deficiencies
    c. reliance on external feeding tube or oral supplements
    d. impact on psychosocial functioning
  2. Does not occur exclusively during a time period of anorexia, bulimia, or binge eating disorder, and does not have any influence on the way body weight/image is perceived
  3. Not better explained by another mental health or medical disorder
  4. Not better explained by lack of available food or culturally sanctioned practice
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13
Q

Avoidant/Restrictive Food Intake Disorder Prevalence

A

3%, occurs before age 3

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14
Q

Avoidant/Restrictive Food Intake Disorder Etiology

A
  1. Lack of knowledge
  2. child neglect
  3. Extreme Poverty
  4. Poor temperament/fit
  5. Parental psychopathology
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15
Q

Avoidant/Restrictive Food Intake Disorder Treatment

A

Desensitize Child to Food

a. Food chaining- exposing child to food that is similar to one they already like
b. Exposure- exposing child to food in safe environment until the anxiety decreases

Strategies include

  1. Encouraging but not forcing a child to eat
  2. Ignore resistant/oppositional behaviors
  3. no non-nutrition foods
  4. regular schedule of eating- 3 meals per day, 2 snacks
  5. Engage in calm activity before meal, exciting activity after meal
  6. Give child control over their eating
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16
Q

Rumination Disorder Diagnostic Criteria

A
  1. Recurrent regurgitation of food. Food can be re-chewed, re-swallowed, or spit out
  2. Not better explained by a gastrointestinal or other medical condition
  3. Does not occur exclusively with another eating disorder
  4. If associated with another mental health disorder, symptoms are significant enough to warrant additional clinical attention
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17
Q

Rumination Disorder Etiology

A

No known etiology but associated with lack of stimulation, child neglect, or high stress family situation

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18
Q

Pica Diagnostic Criteria

A
  1. Eating of non-nutritious, non-food substance for the period of at least 1 month
  2. Eating of non-nutritious, non-food substance is developmentally inappropriate
  3. Minimum age of at least 2
  4. Is not a culturally sanctioned or socially accepted practice
  5. If occurs with another mental health condition, the symptoms are severe enough to warrant additional clinical attention
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19
Q

Rumination Treatment

A
  • Diaphragmatic breathing during and after eating
  • extinction and reinforcement
  • based on etiology
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20
Q

Pica Etiology

A

Unknown but associated with poverty, learned behavior, high stress, child neglect, nutritional deficiency, and low SES

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21
Q

Pica Treatment

A
  1. Behavioral Interventions and Environmental modifications are the best:
    - increased supervision
    - decreasing exposure to craved substance
    - overcorrection
    - reinforcement, with tangible reinforcers
    - supplements if nutritional deficiencies
    b. individual treatment with older children
22
Q

Autism Spectrum Disorder Diagnostic Criteria

A
  1. Presence of Symptoms in both the categories below
    a. Deficiencies in social communication and social interactions across multiple contexts that is not better defined by general developmental delays and manifest all 3 of the following:
    - Deficiencies in social and emotional reciprocity
    - deficits in nonverbal communication necessary for social interactions
    - deficient in understanding, developing, and maintain social relationships
    b. Recurrent repetitive, restrictive patters on behaviors, interest or activities that is manifest by at least 2 of the following
    - repetitive motor movements, speech patterns, or use of objects
    - strict adherence to schedule, ritualized patterns of behaviors or excessive reluctance to change
    - hypo or hyper sensitivity to sensory input or drawn to sensory objects in an environment
    - highly restricted, fixated interests abnormal in intensity and focus
  2. Symptoms evident in early development- 1 to 2 years of age
  3. significant impact on functioning
23
Q

Autism Prevalence

A

-1 in 100, more common in males than females

24
Q

Autism etiology

A

No known etiology but seem to be a difference in brain structure and functioning

  • brain scans show difference in size
  • research being done into sensory processing disorder
  • Genetics- patterns across families
  • More common with certain medical conditions (fragile x)
25
Q

ABA Therapy

A
  • Applied Behavior Analysis
  • Behavior intervention that is most effective for treatment of Autism
  • Increased desired/helpful behaviors and decrease unhelpful/behaviors that interfere with functioning
26
Q

Lovaas Discrete Trials

A
  • ABA that is performed in a clinical setting by a therapist
  • Short training sessions- discrete trials
  • Steps
    a. Instruction- usually verbal, must be concise, consistent, and clear.
    b. Prompt or response- prompt is an action that ensures learner will answer correctly. Can be physical, model, gestural, verbal, ect. Goal is to slowly fade the prompt
    c. Reinforcement or correction- if the answer is correct, provide reinforcement right away. Reinforcement should be varied, exciting. If answer is incorrect, use informational no in a neutral voice and then provide instruction again with a prompt.
27
Q

Pivotal Response Training

A
  • Therapist provides support, training, and modeling to parents who carry out the intervention
  • Happens in the home or other setting
  • can occur in multiple settings so working with school personnel is key
  • combines a natural developmental approach with ABA
  • Focuses on 4 key areas that will impact functioning
    1. Responding to natural environment or social cues
    2. Responding to multiple stimuli at once
    3. Self management
    4. Self initiation of social interactions
28
Q

Social (Pragmatic) Communication Disorder

A

Symptoms include

  1. Difficulties in social use of verbal and nonverbal communication
    - words for greeting and sharing are not appropriate for context
    - can not adapt language to the need of the listener
  2. Difficulties impact the development of social relationships and are not just due to low use of grammar and sentence structure
  3. May be present in early functioning but not noticeable until social demands exceed social capabilities
29
Q

Difference between social pragmatic communication disorder and autism

A

No restricted repetitive patterns of behavior

30
Q

Schizophrenia Diagnostic Criteria

A

A. 2 or more of the following
a. Delusions: false beliefs that are not based in reality
b. Hallucinations: involve seeing or hearing things that don’t exist
c. Disorganized speech (e.g. incoherence)- alogia/poverty of speech, blocking, latency of response- putting together meaningless words
d. Grossly disorganized or catatonic behaviors- resistance to instructions, inappropriate and bizarre posture, complete lack of response, useless and excessive movement
e. Negative symptoms- diminished emotional expression or avolition, apathy, decrease in the motivation to initiate and perform self-directed purposeful activities
B. At least one (of the 2 symptoms) must be delusions, hallucinations, or disorganized speech and present for a significant portion of time during a 1-month period
C. For a significant portion of time since the onset of the disturbance, level of functioning in one or more major areas (work/school, interpersonal relationships, self-care) is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning)
D. Duration: continuous disturbance for at least 6 months and active psychotic symptoms for at least 1 month, unless treated
E. Consider brief psychotic disorder with/without marked stressors if has psychotic behaviors for between 1 day-1 month
F. Exclusions: schizoaffective disorder and mood disorder with psychoses
G. Not due to the effects of substance use or a medical condition (organic cause)
H. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations
I. Specifiers
a. Specify first or multiple episodes and whether in acute episode, partial remission, full remission
b. Specify if with catatonia
c. Specify symptom severity if possible

31
Q

Schizophrenia Etiology

A
  1. Combination of both environmental and genetic factors
  2. Stress-diathesis model
  3. Genetic factors- supported by twin and adoption studies, risk increases by 40-88% with relative
  4. Difference in brain structure and central nervous system
  5. In-utero exposure to viruses, toxins, and malnutrition
32
Q

Typical Onset of Schizophrenia

A
  • adolescents or during the 20’s

- very uncommon before adolescents

33
Q

Schizophrenia Treatment

A
  • Most effective treatment is antipsychotics with supportive, psychosocial therapist
  • Antipsychotics are used to treat psychoses associated with schizophrenia. However, 3/4 of patients stop taking their medication because it is not helping or due to intolerable side effects. Clozapine is most effective but blood monitoring needed.

Other interventions:

  • behavior treatment for odd or aggressive behaviors
  • Structure and routine to reduce stress
  • Family psychoeducation
34
Q

Stress-diathesis Model

A

Symptoms of a diagnosis arise when an individual with vulnerabilities (typically genetic predisposition) experiences a stressful or negative life event

35
Q

Etiology for Anxiety Disorders

A
  1. Temperament
  2. Family Factors (anxious parents, resistant attachment, child neglect)
  3. Low SES (except PTSD)
  4. Genetics
  5. Neurotransmitters differences (especially serotonin with OCD)
36
Q

Anxiety Disorder Prevalence

A
  • 6-20%

- More common for females than males

37
Q

Generalized anxiety disorder

A
  • excessive worry or anxiety, occurring more days than not, for at least 6 months, about different situations and events
  • Difficult to control the worry
  • associated with at least 1 of the following (3 in adults)
  • Irritability
  • muscle tension
  • sleep disturbances
  • Feeling restless/keyed up
  • easily fatigued
  • difficulty concentrating or mind goes blank
38
Q

Separation Anxiety Disorder

A
  1. Developmentally inappropriate and exaggerated worry about separation from attachment figure
  2. Associated with at least 3 of the following:
    a. Reluctance or refusal to school
    b. Refusal to sleep
    c. distress when separated from attachment figure or in anticipation of separation
    d. nightmares
    e. Worry about unexpected event such as kidnapping or getting lost
    f. Worry about harm befalling attachment figure or losing them
  3. For children, last for 4 weeks, adults 6 months
  4. Child often complains about physical complaints
39
Q

Social Anxiety Disorder (Social Phobia)

A
  1. Excessive fear of a situation when one will be exposed to scrutiny, fear that they will do something that is humiliating or embarrassing
  2. Look like crying, tantrums, freezing, shrinking, failure to speak, clinging
  3. Duration of at least 6 months
  4. for child, most occur in interactions with peers, not just with adults
40
Q

Panic Disorder

A
  1. Recurrent and unexpected panic attacks
  2. characterized by at least 4 of the following
    a. Shortness of breath
    b. Palpitations
    c. Pounding Heart
    d. Dizziness
    e. Lightheadedness
    f. Nauseous, abdominal issues
    g. fear of losing control
    h. numbing, tingling
    i. sweating
    j. shaking/trembling
    k. feeling of chocking
    l. chest pain
    m. chills/heat sensation
    n. Depersonalization, derealization
    o. Fear of dying
  3. In the month following the attack, associated with at least one of the following
  4. Significant change in behavior due to the attack
  5. Fear that the attack will occur again
41
Q

Specific Phobia

A
  1. Marked fear or worry that is excessive and is cued by a specific object or situation
  2. exposure to that situation triggers immediate anxiety response
  3. Duration for at least 6 months
  4. May or may not know that the worry is excessive
  5. Avoidance interferes with normal functioning
42
Q

Agoraphobia

A
  1. Fear of at least 2 of the following
    a. Public Transportation
    b. Open space
    c. close space
    d. Being in a crowd or a line
    e. Being outside the home
  2. Fear is based on the thought that it will be difficult to escape or help will not be readily available if you start to panic
  3. Avoidant events, go with a companion, or your endure the event with an extreme amount of stress that makes it difficult to concentrate/perform well
  4. Duration of at least 6 months
43
Q

Selective Mutism

A
  1. Consistent failure to speak, in a situation when it is expected one speak, even though they speak in other situations
  2. Duration of at least one month, and it is not just the first month of school
  3. Not due to lack of knowledge
  4. Interferes with social communication/education
44
Q

Obsessive-Compulsive Disorder

A
  1. Precense of obsessions, compulsions, or both
  2. Obsessions
    a. recurrent thought, image, impulse, that is inappropriate and intrusive that cause anxiety or stress
    b. try to suppress, ignore or neutralize the thought through specific behaviors
    c. obsessions thinking is not typically found in children
  3. Compulsions
    a. Repetitive behavior or mental acts that the person feels compelled to do in response to an obsession, according to rigid rules
    b. aimed at reducing or preventing distress or a dreaded event
    c. children often are not able to articulate the aim of the compulsion
  4. Cause marked distress, time consuming, cause impairment on functioning
45
Q

Cycle of Anxiety

A

a. Experience high levels of physiological arousal involving the autonomic nervous system in selected situation or in anticipation of encountering those situations
b. Accompanying the physiological arousal, children will experience cognitive events that indicate the arousal is a signal of danger or likely harm that is connected to the situation
c. Children will either engage in behaviors that lead to avoidance or escape in ways that hinder their functioning or will tolerate the situation with high levels of distress/discomfort that hinder concentration or effective performance in the situation

46
Q

Treatment for Anxiety

A
  1. Physical Arousal
    a. Identify and understand the physical arousal
    b. Develop internal coping strategies
  2. Cognitive restructuring
    a. Identifying and understanding maladaptive/incorrect cognitions and working with a therapist to challenge those cognitions and replace them with more accurate ones
  3. Gradual Exposure
    a. guidance and support through exercises that expose one to their fears while using coping skills until a level of calm is reached, not allowing avoidance
47
Q

Major Depressive Disorder

A
  1. 5 or more of the following symptoms, that occur in the same 2 week period and interfere with functioning. At least one symptoms has to be depressed mood or decrease in pleasure of activities
    - Decreased mood, for most of the day, self-reported or observed by others. In children, can be irritability
    - Decreased pleasure or interest in all or almost all activities activities for most of the days, almost all days
    - significant weight loss or gain, or increase or decrease in appetite
    - feeling of worthlessness or inappropriate feelings of guilt
    - psychomotor agitation or retardation
    - thoughts of death/dying, suicidal ideation, attempts
    - Fatigue or loss of energy
    - Diminished ability to think, concentrate or indecisiveness
  2. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  3. Episode is not attributable to physiological effects of a substance or to another medical condition
  4. occurrence of major depressive episode is not better explained by schizoaffective disorder, schizophrenia, delusional disorder, or other specified schizophrenia spectrum and other psychotic disorders
  5. There has never been a manic episode or a hypomanic episode
48
Q

Persistent Depressive Disorder

A
  1. Depressed mood for most of the day, for more days then not, as indicated by subjective account or observation by others for at least one year (2 in adults)
  2. Presence, while depressed of two or more
    a. Poor appetite
  3. Overeating
  4. Insomnia or hypersomnia
    d. Low energy or fatigue
    e. Poor concentration or difficulty making decisions
    f. Feelings of hopelessness
  5. Never without symptoms for more than 2 months at a time
  6. Never a manic episode, mixed episode, or hypomanic episode, criteria not met for cyclothymic disorder, does not occur during the course of chronic psychotic disorder
49
Q

Differences between MDD and PDD

A

Differ in intensity and time

  • An individual with PDD has experienced symptoms over a long period of time. Symptoms usually not sever to reach that of MDD.
  • PDD for 2 years, MDD for 2 weeks
  • MDD have a baseline for mood when not depresses, those with PDD don’t remember what it is like to not be depressed
50
Q

Difference between how children and adults experience depression

A
  1. Children are more likely to report irritability
  2. Children have a harder time verbalizing their feelings.
  3. Changes in school- decrease in grades, no longer have desire to attend school
  4. Loss of interest in other activities
  5. Picky eaters- changes in appetite
  6. Somatic symptoms- headaches, stomach aches
  7. social withdrawal, but peer relations may be more of a risk factor for depression, than depression causing social withdrawal
  8. Agitation as a result of irritability
51
Q

Etiology of Depressive Disorders

A

A. Genetics (stress-diathesis model)
B. Environmental Factors
-Traumatic experience
-Family, peer, school conflicts
-lack of support for sexuality
C. Maternal depression (impacts parenting)
D. Depression while pregnant- impacts brain development
E. Rule of neurotransmitters- balance of neurotransmitters
F. Individual cognitive distortions

52
Q

Course of Depressive Disorders

A
  1. For most people, depression will remit
  2. But for 70%, depression will come back in at least 5 years
  3. Most people who experience depression as C/A, will experience it as an adult
  4. Comorbidity with substance use, anxiety, ADHD, learning disabilities, conduct problems, ect.

Mental Health with C/A Final (1 decks)

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