Mega Quiz 4 Flashcards
1
Q
Elation and euphoria in bipolar can quickly change to…
A
…anger and hostility if behavior is impeded.
2
Q
Mania is a distinct period of:
A
- abnormally elevated or irritable mood
- inflated self esteem/grandiosity
- decreased need for sleep
- pressured speech
- racing thoughts
- distractibility
- increased goal directed activity
- excessively risky but fun activity
3
Q
A manic episode must last at least ______ days, unless psychiatrically hospitalized
A
7 days
4
Q
Mania must NOT be:
A
- not mixed
- not substance induced
- not due to general medical condition
- causes marked significant impairment
5
Q
Hypo mania (think “mania-lite”) involves distinct period of:
A
Elevated mood or irritability
6
Q
Duration of hypo manic episode is atleast
A
4 days long
7
Q
Difference between hypomania and mania
A
Not severe enough to cause MARKED impairment
8
Q
Rates of bipolar increase after….
A
Puberty (when rates are as high as for adults)
9
Q
Bipolar affects males and females…
A
Equally, but boys may show more manic mood and girls may show more depressed mood
10
Q
Diseases that are comorbid with bipolar
A
ADHD, behavior disorders (ODD and CD), anxiety disorders, substance abuse
11
Q
Medical problems that co-occur with bipolar
A
Cardiovascular and metabolic disorders, epilepsy, migraine headaches
12
Q
What percentage of people have their first bipolar episode prior to age 19?
A
60%
13
Q
What is the peak age of onset for bipolar?
A
15 and 19 years of age
14
Q
Risk factors for bipolar
A
- Major depressive episode
- psychomotor retardation
- psychotic features
- family history of mood disorders
15
Q
Early onset and course of bipolar
A
Chronic and resistant to treatment, with poor long term prognosis
16
Q
How many youths were medicated for bipolar in 2001
A
93,000
17
Q
Between 1994 and 2001, there was a ________ % increase in bipolar diagnoses
A
260%
18
Q
In 2003, _______% of hospitalized youth under 12 diagnosed with bipolar
A
50%
19
Q
Between 1994 to 2003, ______x increase in number of office visits for youth with BP
A
40x
20
Q
Bipolar is the ______ leading disability in the world
A
6th
21
Q
_____% of adults with bipolar end their own life
A
18
22
Q
What percentage of people with bipolar are on 2+ meds?
A
85%
23
Q
Lifetime medication exposure for bipolar
A
85% exposed to 4+ mesds
24
Q
Causes of bipolar in children?
A
Few studies have looked at the causes of BP in kids and adolescents
25
Adult research regarding causes of bipolar disorder
Multiple genes (genetic predisposition does not necessarily mean a person will develop BP)
Brain imagining studies suggest mood fluctuations are related to abnormalities in areas of the brain related to emotion regulation
26
What happens if we don't treat bipolar?
- mood episodes recur
- progressively more severe
- progressively more treatment resistant
27
Untreated bipolar disorder at increased risk for:
- substance abuse
- juvenile offending/incarceration
- suicide risk (25% show ideation)
28
Is bipolar curable?
No
29
Treatment goals for bipolar
Stabilize mood and allow for management and control of symptoms
30
Multimodal plan of bipolar treatment includes
| :
- close monitoring of symptoms
- education of the patient and the family about the illness
- medication, usually lithium or risperdal
- psychotherapeutic interventions to address symptoms and related psychosocial impairments
31
Is pediatric bipolar disorder a USA phenomenon?
- clinical presentation appears fairly similar
| - associated features similar
32
Variable rates in pediatric bipolar internationally potentially due to:
- differences in assessment and diagnostic criteria
- differences in treatment seeking
- differences in healthcare system
- different training
33
Asian rates of bipolar vs. USA
Lower Asian rates potentially due to:
- diet? (Fish, obesity)
- genetic risk
- differences in treatment seeking (stigma)
- different training
34
Treated prevalence of bipolar increased _____x in Taiwan from 1996 to 2003
8x
35
Bipolar rates in Singapore
- most adults with bipolar had adolescent on sent
| - first episode depressed in 80%
36
Average rate of pediatric bipolar spectrum
2%
37
Is there a difference in the USA rate of bipolar disorder in kids than the world rates?
NOPE
38
Is USA driving the rate increase in pediatric bipolar
NO
39
Rank the bipolar spectrum in order of least common to most common
```
Severe bipolar
Bipolar I
Bipolar II
Cyclothymia
BP NOS
```
40
Bipolar NOS
Manic symptoms don't fit into any of the previous diagnostic categories
41
Some ways to earn a residual diagnosis of bipolar
- manic or hypomania of insufficient duration (very rapid cycling)
- repeated hypomania with a depressive episode
- manic symptoms, but insufficient number co-occurring
42
What happens to bipolar NOS patients
About a 3rd recover, a 3rd remain NOS, and a third progress into more severe bipolar forms
43
BP NOS takes...... To remit?
LONGER
44
Which bipolar type has the most sick days per year?
BP NOS
45
BP NOS as difficult to treat
- less responsive to mood stabilizers
- no RCT for psychotherapy yet
- high rate of progression
- suicide ideation, attempts at same rate as bipolar I
46
Bipolar 1: 1 in ____ in Asian countries
1 in 200
47
BP: 2 in ___ in Europe
2 in 200
48
BP: 3 in ____ for New Zealand
200
49
BP: 3.4 in ____ for USA
200
50
Bipolar spectrum is ___x more likely
5x
51
Clear bipolar in one parent = ___x the risk
5x
52
Bipolar in one grandparent, aunt, uncle =
2.5x risk
53
"Fuzzy" bipolar or mood disorder in parents = ___ risk bipolar
2x
54
Using rating scales for bipolar assessment
CBCL most widely used, though similar performance on BASC, Conners, CASI
Parent report validity > teacher or youth
Can focus on externalizing score; no value added in looking at bipolar profile
55
Bipolar and externalizing scores
- low parent externalizing rules bipolar out
- powerful enough to reduce concerns due to family risk factors etc.
- moderate elevations (60-70) don't change clinical impressions
- Because elevated externalizing could happen for a lot of reasons besides bipolar
56
GRAPES
```
Grandiosity
Racing thoughts
Activity (goal directed activity episodes)
Pressured speech
Elated, expansive, euphoric mood
Sleep-decreased need
```
57
FIND criteria
Frequency: happening more than it should developmentally
Intensity: more severe than age appropriate
Number: excessive amount within episode
Duration: lasts much longer than developmentally appropriate
58
Looking for mood and energy changes in bipolar
Retro and prospective life charting
| Mood and energy check ups
59
Process measures
Response to treatment
60
Outcome measures
Parent report is sensitive to treatment effects
61
What is the third most common illness among adolescent females
Eating disorders
62
Problematic eating habits and picky eating are common in.....
Early childhood (1/3 described as picky eaters)
63
At about age ___, girls are more anxious than boys about losing weight
9
64
What is the most important impact on fundamental biological processes?
Early parent child relationship
65
Second most significant impact on fundamental biological processes
Entering school; pressure to conform to perceptions of desirable body type
66
"Eating pathology"
A continuum that ranges from dieting to clinical syndromes across all ages
67
Drive for thinness
Believe that losing more weight is answer to overcoming problems
But increases negative side effects; weight preoccupation, concern with appearance, and restrained eating
Increases risk of eating disorder
68
Western sociocultural values and preoccupation with weight and dieting may be internalized and expressed as young as....
Age 7-10
69
Feeding disorder of infancy or early childhood
Sudden or marked deceleration of weight gain and a slowing or disruption of emotional and social development prior to age 6
70
Prevalence and development of feeding disorder
Affects ~30% of young kids (both boys and girls), particularly those from disadvantaged environments
71
Multi factorial, and variable outcome of feeding disorder
- onset during first two years of life can lead to malnutrition and serious developmental consequences
- may be related to medical problems or poor caregiving
72
Many interacting risk factors influence child's adaption to a certain level of caloric intake (feeding disorder).....
- associated with family disadvantage, poverty, unemployment, social isolation, parental mental illness
- when there is no medical reason, it is often associated with poor caregiving, including maltreatment
- failure to thrive is associated with mothers who have a history of disturbed eating habits/attitudes
73
Treatment of feeding disorder
Detailed assessment of feeding behavior and parent child interactions plus allowing parents to play a role in the infant's recovery
74
Pica
Eating inedible, non nutritive substances for a period of at least one month
75
Pica affects mainly....
Very young children and those with mental retardation
76
Prevalence and development of pica
- more prevalent among those with severe impairments and mental retardation
- especially among institutionalized children and adults
77
Causes of pica
Poor stimulation/supervision; vitamin/mineral deficiency; no evidence of genetic factors, except indirectly
78
Risks of pica
Lead poisoning or intestinal obstruction
79
Treatments for pica
Operant conditioning procedures and teaching caregivers to keep environment safe
80
Failure to thrive
Weight is below the 5th percentile for age and/or deceleration of weight gain from birth to present of at least 2 SDs
81
Causes of failure to thrive
Poor caregiver-child attachment, poverty, family disorganization, and limited social support as well as child's temperament and acute physical illness
-outcome highly related to home environment: improved quality of care results in better adult adjustment
82
Controversial theory of cause of failure to thrive
-deprivation of maternal stimulation and love --> emotional misery --> developmental delays --> physiological changes
83
Average girl needs ____to ____ calories per day
1800-2400
84
Average boy needs ____ to ____ calories per day
2200 to 3200
85
At peak spurt, adolescents use _____x as much C, iron, Zinc, magnesium, and Nitrogen as other years of adolescence
2x
86
Adolescents often have too little ____, _____, and _____ in their diet and too much ____, _____, and ______.
Too little vitamin A, thiamine, and iron; too much fat, sugar, and sodium
87
By mid adolescence, __/___ girls report being on a diet during the previous year, and ___% of those girls, but only ____% of boys, are chronic dieters
2/3 girls; 10% of those girls; 2% of boys
88
Metabolic rate
Balance of energy expenditure; based on individual genetic and physiological makeup, eating and exercise habits
89
Body weight
An individual's natural weight is regulated by his or her own set point-the biological and genetically determined range of body weight that the body tries to defend and maintain
90
Growth
Major hormonal determinants of physical growth rate during child hood are growth hormone and thyroid hormone; additional gonadal steroids kicking in during adolescence to produce a further growth spurt and skeletal maturation
91
Obesity
BMI > 95th percentile
92
From the early 1980s to mid 1990s, the obesity rate nearly _____ for boys age 7-13 and more than ____ for girls
Tripled for boys, doubled for girls
93
Is obesity stable from infancy to childhood?
No; more persistence from childhood to adolescence or adulthood
94
Causes of overweight
- heredity (metabolic set point)
- modeling (overweight parents)
- environment and role of TV (sedentary, food commercials)
95
Between one in ___ and one in ____ kids and adolescents are overweight
One in six (16%); one in four (25%)
96
Most overweight children become...
Overweight adults
97
Overweight children are likely to be
- rejected by peers
- poor at sports
- less likely to be seen as attractive
- greater risk of health problems throughout life
98
Bulimia is a culture bound syndrome, arising predominantly....
In western regions or those exposed to western culture
99
Increasing SES associated with increased body image....
Dissatisfaction; until high SES achieved, then relationship weakens
100
Risk factors of obesity
- cardiovascular problems, elevated cholesterol, and triglycerides
- later emergence of eating disorders
- major factor in 10% of deaths in North America
101
Of industrialized nations, US has the ______ percentage of overweight kids
Highest
102
Problems for low SES kids
- low cost of fast food and junk food
| - limited physical activities due to living in unsafe neighborhoods
103
Consequences of obesity
- more heart disease
- more of some cancers
- more brain disease (bipolar, depression?)
- greater health care costs
- social stigma
104
Heritability of obesity
Obesity gene that predisposes a resistance to leptin (hunger suppressor)
105
Individual and family related risk factors for obesity
- improper diet
- unhealthy lifestyle
- family disorganization
- poor communication
- lack of support
- maltreatment
106
Female to male ratio of anorexia is _____ to ____
10 to 1
107
Sensitive periods in adolescence for eating disorders
Early passage into adolescence
| Translation from later adolescence to young adulthood
108
Which score higher on measures of eating disorders: non western or western participants?
Non western! South Korean and Chinese
109
BMI of Korean women is the _____ compared to other countries, but percentage of women who want to lose weight is the _______
Lowest, highest (73-81%)
110
Risk factors for eating disorder may be higher in Korea
Attachment styles may influence disordered eating indirectly through personality traits
Resistant attachment more likely to have ED if they have more neurotic personality traits
111
Women with anorexia drop ____% of their body weight within a year
25%
112
Consequences of extreme weight loss in anorexia
- abnormalities in endocrine system that prevent ovulation
- general health declines
- every system in the body is affected
- risk premature development of osteoporosis
113
Mortality rate of anorexia
4 and 5%
114
Major feature of anorexia
Distortion of body image
115
Bulimia
Cyclical binge eating and purging; may include strict dieting, fasting, laxatives, and demanding exercise regime
-tends to afflict women during adolescence and young adulthood, connected with depression (all eating disorders are)
116
Primary feature of bulimia
-recurrent binge eating (consuming a large amount of food and lack of control; attempt to conceal binge eating, and although not planned may involve rituals
117
Binges followed by compensatory behaviors intended to prevent weight gain:
- purging (vomiting or laxatives)
- non purging compensation (fasting, excessive exercise)
- about 2/3 purge
118
Thinking in ED is rigid and absolutistic:
- either feel completely in control or completely out of control
- dissatisfaction with body proportions and distort true body size
119
Medical consequences of bulimia
- fatigue, headaches, puffy cheeks, loss of dental enamel, menstrual irregularity or amenorrhea, electrolyte imbalances
- anorexia is even worse
120
Mortality less common in bulimia or anorexia?
Bulimia
121
Binge eating disorder
Similar to bulimia without the compensatory behaviors
DSM proposes to make it a separate category
122
____% of females and ____% of males have binge eating disorder
3.5%, 2%
123
Negative health correlates of binge eating disorder
- low body satisfaction and self esteem
- high depressive mood
- weight and shape are very important to their overall feelings about themselves
- 25% suicide attempts
124
Prevalence of anorexia
0.9% females, 0.3% males
125
Prevalence of bulimia
1.5% females, 0.5% males
126
Persons with anorexia are ___% or more below normal weight and engage in binge eating only _______
15%; occasionally
127
Those within bulimia are within ___% of normal weight and binge _____ then purge to control their weight
10%, frequently
128
ED NOS
Diagnosis of eating disorders difficult for young people who are still maturing physically, cognitively, and emotionally
129
Eating disorders among boys
-less preoccupied with food or a drive for thinness, place more emphasis on athletic appearance or attractiveness
130
Sexual orientation and EDs
-gay men at greater risk; more susceptible to media images promoting thinness, more likely to experience poor body image and body dissatisfaction
131
Onset of anorexia between ages
14 and 18
132
Developmental course of anorexia
Highly variable course and outcome
133
Outcome of anorexia
- fewer than half show full recovery
- third show fair improvement
- fifth continue on chronic course
- most common in fluctuation between recovery and relapse
134
Onset of bulimia
Late adolescence to early adulthood; binging and purging and preoccupation with weight begin much earlier
135
Binge eating often develops after.....
Period of restrictive dieting
136
Course of bulimia
-may follow a chronic course or occur intermittently; between 50-75% show full recovery over several years
137
Best predictors of favorable bulimia outcome
- younger age at onset
- higher social class
- treatment that disrupts its cyclical course
138
Single best predictor/risk for developing an eating disorder is ....
Being an adolescent female
139
Neurobiological factors play a _____ role in precipitating anorexia and bulimia
Only a minor role
| -likely contribute to their maintenance because of effects on appetite, mood, perception, and energy regulation
140
Heritability of anorexia
- 58-76%
- negligible contribution by shared environment, although 38% may be attributable to unique environment (or error)
- inherit a biological vulnerability that interacts with social and psychological factors
141
Neurobiological factors in eating disorders
- serotonin imbalances
- similarities to other types of addictions raise question about whether anorexia and bulimia are food addictions
- biochemical similarities found between people with eating disorders and those with OCD
142
Features of western culture potentially contributing to EDs
-personal freedom, instant gratification, availability of food at any time, lack of supervision, cultural ideal of diet and exercise for weight loss
143
Family influences on eating disorders
-dysfunction/conflict
-parent psychopathology
*child may be trying to direct attention away from basic family conflicts
-overemphasis on weight and dietary control
Physical abuse, child sexual abuse (esp. Bulimia)
144
Psychological factors related to bulimia
- struggle for autonomy, competence control, self respect
| - phobic avoidance where phobic object is normal adult body weight and shape
145
Personality characteristics associated with anorexia
-avoidance of harm, low novelty seeking, reward dependence
146
Bulimia psychological dimensions
```
-mood swings
Poor impulse control
OC behaviors
Depression
Anxiety disorders
Substance abuse
```
147
Almost 90% of persons with eating disorders have other _____ disorders, usually ____, ______, and _____.
Axis I disorders: depression, anxiety, OCD
148
Psychological interventions EDs
- psychotherapy; sometimes accompanied by medical interventions
- mostly outpatient
- hospitalization (usually brief) for those with serious complications
149
Pharmacological treatment for ED
SSRIs (not for initial treatment) may be helpful for bulimia, but not anorexia (should be used alongside CBT, not alone)
150
Psychosocial interventions for ED
Comprehensive treatment plans with psychotherapist, nutritionist, psychopharmacologist, and internist are more affective than medications alone
-resolution of family and interpersonal problems are crucial
151
Anorexia more or less responsive to treatment than bulimia?
Anorexia
152
BFST for anorexia
-behavioral family systems therapy:
| Emphasizes parental control over eating, cognitive restructuring, and problem solving communication training
153
EOIT for anorexia
-ego oriented individual therapy: builds ego strength, adolescent autonomy, and insight
154
Individual or family oriented CBT for bulimia
- to change eating behaviors with rewards and modeling
- help patients change distorted/rigid thinking patterns
- cues that trigger the urge to binge or vomit
- underlying interpersonal issues
155
Interpersonal therapy for bulimia
Addresses situational personal issues contributing to the disorder
156
Healthy parenting includes:
- knowledge of child development and expectations
- adequate coping skills
- healthy parent child attachment and communication
- home management skills, shared parental responsibilities, adn provision of social services
157
Neglect accounts for ____% of all documented incidents
64%
158
Sexual abuse is more prevalent for ______, while physical abuse is more prevalent for ________
Females, males
159
Age as a characteristic of victimized kids
Younger more at risk
Sexual abuse more common among kids over 12
Victimization rate is inversely related to kids age (except for sexual abuse)
160
Gender difference in victimized kids
80% of sexual abuse victims are females
Similar rates of overall maltreatment
Boys more likely to be sexual abused by male non family members; girls by male family members
Both more likely to be by someone they know
161
Resilience to abuse factors include:
Good self esteem and sense of self
| Good relationship with consistent person of support and protection
162
Attachment and abuse
Insecure disorganized attachment characterized by a mixture of approach and avoidance, helplessness, apprehension, and general disorientation
163
Emotion regulation and abuse
Difficulty understanding, labeling and regulation internal emotional states
Poor emotion regulation, which may lead to internalizing and externalizing problems
164
Cognitive factors resulting from abuse
- Negative representational models of self and others
- feelings of betrayal and powerlessness, which may become central to identity
- sometimes internal attributions of blame for the maltreatment
- maltreated girls tend to show more internalizing signs of distress such as shame and self blame, while maltreated boys show heightened levels of verbal and physical aggression
165
Neglected children
Most severe and wide ranging problems in school and interpersonal adjustment
166
Sexually abused kids
Anxious, inattentive, and unpopular
Less autonomy and self guidance in completing school work
167
Bipolar disorder
-a striking period of abnormally and persistently elevated, expansive, or irritable mood, alternating with or accompanied by one or more major depressive episodes
