NU625 Test 1 Trial 2 Flashcards
What is? The basic cellular unit of the nervous system, the microprocessor of the brain responsible for conducting impulses from one part of the body to another
The Neuron (“Nerve Cells”)
What is? Also known as soma; made up of the nucleus and cytoplasm within cell membrane
Cell body
What is? Transmits signals away from the neuron’s cell body to connect with other neurons and cells
Stem or axon
What is? Collect incoming signals from other neurons and send the signal toward the neuron’s cell body
Dendrites
What is? Composed of two separate, interconnected divisions. What are they called?
Nervous system: Central Nervous system and Peripheral nervous system
What is? Composed of the spinal cord and the brain
Central Nervous system
What is? Composed of the peripheral nerves that connect the CNS to receptors, muscles, and glands. Includes the cranial nerves just outside the brain stem. Comprises the somatic nervous system and the autonomic nervous system.
Peripheral nervous system
What is? Conveys information from the CNS to skeletal muscles; responsible for voluntary movement
Somatic nervous system
What is? Regulates internal body functions to maintain homeostasis; conveys information form the CNS to smooth muscles, cardiac muscle, and glands; responsible for involuntary movement.
Autonomic nervous system
What is? Divided into the sympathetic nervous system and the parasympathetic nervous system.
Autonomic nervous system
What is? The excitatory division ; prepares the body for stress (fight or flight); stimulates or increases activity of organs
Sympathetic nervous system
What is? Maintains or restores energy; inhibits or decreases activity of organs.
Parasympathetic nervous system
What is? Either categorized as white or gray matter?
Brain tissue
What is? composed of nerve cell bodies and dendrites; it is the working area of the brain and contains the synapses, the area of neuronal connection
Gray matter
What is? the myelinated axons of neurons
White matter
What is? Structured to contain grooves and dips of corrugated wrinkles within the brain tissue that provide anatomic landmarks or reference points.
Outermost surface of the brain
What is? Small shallow grooves in the outermost surface of the brain
Sulci
What is? Deeper groves extending into the brain
Fissures
What is? The raised tissue areas of the outermost surface of the brain
Gyri
What is? The brain subdivided into
Cerebrum and the brainstem
What is? The largest part of the brain, which is divided into two halves, the right and left hemispheres.
Cerebrum
What is? This hemisphere of the cerebrum is dominant in most people
Left hemisphere
What is? This hemisphere of the cerebrum controls the left sided body functions
Right hemisphere
What is? Both hemispheres connected by a large bundle of white matter, an area of sensorimotor information exchange between the two hemispheres
Corpus callosum
Each hemisphere of the cerebrum is divided into how many lobes?
four
What is? Largest and most developed lobe of the cerebrum
frontal lobe
What is? Frontal lobe location that is Responsible for controlling voluntary motor activity of specific muscles
motor function
What is? Frontal lobe location that Coordinates movement of multiple muscles
premotor area
What is? Frontal lobe location that Allows for multimodel sensory input to trigger memory and lead to decision-making
Association cortex
What is? Frontal lobe location of Working memory, reasoning, planning, prioritizing, sequencing behavior, insight, flexibility, judgment, impulse control, behavioral cueing, intelligence, abstraction
Seat of executive functions
What is? Frontal lobe location for Expressive speech
Language (broca’s area)
What is? Frontal lobe location of the most focal area for personality development
Personality variables
What is? Problems in this lobe of the cerebrum can lead to personality changes, emotional, and intellectual changes
Frontal lobe
What is? Blank Lobe, functions include:Language (Wernicke’s area): Receptive speech or language comprehensionPrimary auditory areaMemoryEmotionIntegration of vision with sensory informationProblems in this lobe can lead to visual or auditory hallucinations, aphasia, and amnesia
Temporal lobe
What is? Blank lobe, functions include:Primary visual cortexIntegration area: Integrates vision with other sensory informationProblems in this lobe can lead to visual field defects, blindness, and visual hallucinations
Occipital lobe
What is? Blank lobe, functions include:Primary sensory areatasteReading and writingProblems in this lobe can lead to sensory-perceptual disturbances and agnosia
Parietal lobe
What is? This brain area includes the cerebral cortex, limbic system, thalamus, hypothalamus, and basal ganglia
Cerebrum
What is? Controls wide array of behaviorsControls the contralateral side of the body Sensory information is relayed from the thalamus and then processed and integrated in the cortexResponsible for much of the behavior that makes us human: speech, cognition, judgement, perception, and motor function
Cerebral cortex
What is? Essential system for the regulation and modulation of emotions and memoryComposed of the hypothalamus, thalamus, hippocampus, and the amygdala
Limbic system
What is? Plays key roles in various regulatory functions such as appetite, sensations of hunger and thirst, water balance, circadian rhythms, body temperature, libido, and hormonal regulation
Hypothalamus
What is? Sensory relay station except for smell; modulates flow of sensory information to prevent overwhelming the cortex; regulates emotions, memory, and related affective behaviors
Thalamus
What is? Regulates memory and converts short term memory into long term memory
Hippocampus
What is? Responsible for mediating mood, fear, emotion, and aggression; also responsible for connecting sensory smell information with emotions
Amygdala
What is? Also known as the corpus striatumServes as a complex feedback system to modulate and stabilize somatic motor activity (information conveyed from the CNS to skeletal muscles)Plays a role in movement initiation; complex motor functions with association connectionsFunctions in learning and automatic actions such as walking or driving a car
Basal ganglia
What is? Contains extrapyramidal motor system or nerve tractFunctions in involuntary motor activity (e.g., muscle tone, posture, coordination of muscle movement and common reflexes)Many psychotropic medications can affect the extrapyramidal motor nerve track, causing involuntary movement side effectsContains both the caudate and the putamenProblems in this brain area can lead to bradykinesia, hyperkinesia, and dystonia.
Basal ganglia
What is? Made up of cells that produce neurotransmittersIncludes the midbrain, pons, medulla, cerebellum, and reticular formation
Brainstem
What is? Houses the ventral tegmental area and the substantia nigra (areas of dopamine synthesis)
Midbrain
What is? Houses the locus ceruleus (area of norepinephrine synthesis)
Pons
What is? Together with the pons, contains autonomic control centers that regulate internal body functions
Medulla
What is? Responsible for maintaining equilibrium; acts as a gross movement control center (e.g. control movement, balance, posture)
Cerebellum
What is? Each hemisphere of this has ipsolateral control (same side of body)Problems with this can lead to ataxia (uncoordinated and inaccurate movements).Romberg test is important for detecting deficiencies in cerebellar functioning.
Cerebellum
What is? The primitive brainInnervates thalamus, hypothalamus, and cortexRegulation functions include: Involuntary movement, reflex, muscle tone, vital sign control, blood pressure, respiratory rate, critical to consciousness and ability to mentally focus, to be alert and pay attention to environmental stimuli
Reticular formation system
What are the two classes of cells in the nervous system?
Glia and neurons
What is? Structures that form the myelin sheath around axons and provide protection and support
Gila
What is? Nerve cells responsible for conducting impulses from on part of the body to another
Neurons
Components of this include:Cell bodyDendritesAxons
Neuron
What is? Also known as soma; made up of the nucleus and cytoplasm within the cell membrane
Cell body
What is? Receives information to conduct impulse toward the cell body
Dendrites
Sends or conducts information away from the cell body
Axon
What is? The connection site and area of communication between neurons where neurotransmitters are released
Synapse or synaptic cleft
The spirit of motivational interviewing is characterized by what?
Acceptance, partnership,evocation, compassion
The four processes of motivational interviewing are?
Engage, focus, evoked, plan
The enhanced national standards for culturally and linguisticallyappropriate services and health and healthcare from the office of minority health at the US Department of Health and Human Services are composed of 15 standards that provide individuals and organizations with the blueprint for successively implementing and maintaining culturally and linguisticallyappropriate services. Culturally and linguistically appropriate healthcare and services, broadly defined his care and services that are respectful of and responsive to the cultural and linguistic needs of all individuals, are increasingly seen as essential to reducing disparities and improving healthcare quality
C LAS standards
The purpose of this is to provide a blueprint for health and healthcare organizations to implement culturally and linguistically appropriate services that will advance health equity, improve quality, and help eliminate healthcare disparities
C LAS purpose
Standard one: provide effective, equitable, understandable, and respectful quality care and services.standard two: advance and sustain governance and leadership that promotes C LAS and health equity.Standard three: recruit, promote, and support a diverse governance, leadership, and workforce.Standard four: educate and train governance, leadership, and workforce and see LAS.Standard five: offer communication and language assistance.
CLA standards
Standard six: inform individuals of the availability of language assistance.Standard seven: ensure the competence of individuals providing language assistance.Standard eight provide easy to understand materials and signage.Standard nine: infuse CLA’s goals, policies, and management accountabilities out the organizations planning and operations.Standard 10: conduct organizational assessments.Standard 11: collect and maintain demographic data.Standard 12: conduct assessments of community health assets and needs.Standard 13 partner with the community.Standard 14: create conflict and grievance resolution processes.Standard 15: communicate the organization’s progress in implementing and sustaining
C LAS standards
The synapse converts an electrical signal blank from the presynaptic neuron into a chemical signal blank that is transferred to the postsynaptic neuron
Action potential and neuron transmitter
Blank is released at the synaptic cleft as a result of electrical activity known as action potential
Neurotransmitters
The two phases of an action potential are?
Depolarization and repolarization
What is the initial phase of the action potential (an excitatory response)when sodium and calcium ions flow into the cells
Depolarization
What is the restoration phase (an inhibitory response), when potassium leaves the cell or chloride enters the cell.
Repolarization
Problem in either the structure or chemistry of this blank interrupts normal flow of impulses and stimuli, which then contribute to symptoms commonly seen in psychiatric disorders.
Synapse
Chemical synthesized from dietary substrates that communicate information from one cell to another
Neurotransmitters
The neurotransmitter will be released from the blank across the synapse and then bind to a specific receptor on the blank.
Presynaptic neuron and Postsynaptic neuron
- Neurotransmitter must be present in the nerve terminal.
- Simulation of neuron must cause release of neurotransmitter in sufficient quantities to cause an action to occur at postsynaptic membrane.
- Effects of exogenous transmitter on postsynaptic membrane must be similar to those caused by stimulation of presynaptic neuron.
- A mechanism for inactivation or metabolism of the neurotransmitter must exist in the area of the synapse
- Exogenous drugs should alter the dose, response curve of the neurotransmitter in a manner similar to the naturally occurring synaptic potential.
Classification requirements for neurotransmitters
Monoamines, amino acids, cholinergics, neuropeptides
Categories of neurotransmitters
Dopamine, norepinephrine, epinephrine, serotonin all belong to the class of this neurotransmitter
Monoamines
Known as a catecholamine; produced in the substantia nigra and the ventral tegmental area; precursor is tyrosine; removed from the synaptic cleft by monoamine oxidase enzymatic action
Dopamine
This monoamine is produced in these four pathways: mesocortical, mesolimibic, nigrostriatal, tuberoinfundibular
Dopamine
Also known as a catecholamine; produced in the locus ceruleus of the pons; precursor is tyrosine; removed from the synaptic cleft and retuned to storage via an active reuptake process; major neurotransmitter implicated in mood, anxiety, and concentration disorders
Norepinephrine
Also known as a catecholamine; produced by the adrenal glands; and also referred to as the adrenergic system
Epinephrine
Known as an indole; produced in the raphe nuclei of the brainstem; precursor is tryptophan; removed from the synaptic cleft and returned to storage via an active reuptake process; major neurotransmitter implicated in mood and anxiety disorders
Serotonin
Glutamate, aspartate, GABA, and glycine make up this category of neurotransmitters
Amino acids
What is the universal excitatory neurotransmitter; major neurotransmitter involved in process of kindling, which is implicated in seizure disorders and possibly bipolar disorders; balance implicated in mood disorders and schizophrenia
Glutamate
What is Another excitatory neurotransmitter; works with glutamate
Aspartate
Universal inhibitory neurotransmitter; site of action of benzodiazepines, alcohol, barbiturates and other CNS depressants
GABA
What is Another inhibitory neurotransmitter; works with GABA
Glycine
acetylcholine belongs to this category of neurotransmitters
Cholinergics
Synthesized by the basal nucleus of Meynert; precursors are acetylcoenzyme A and choline
Acetylcholine
Non-opioid type and opioid type belong to this category
Neuropeptides
This category of neurotransmitter modulates pain; decreased amount of this category of neurotransmitter is thought to cause substance abuse
Neuropeptides
Decrease acetylcholine causes?
Alzheimer’s disease and impaired memory
Increased acetylcholine causes?
Parkinsonian symptoms
Increase Dopamine causes?
Schizophrenia and psychosis
Decrease Dopamine causes?
Substance abuse, Anhedonia (inability to feel pleasure), Parkinson’s disease
Decreased norepinephrine causes?
Depression
Increase in norepinephrine causes what mental health condition?
Anxiety
Decreased serotonin causes?
Depression, obsessive-compulsive disorder, anxiety disorders, and schizophrenia
Decrease GABA causes?
Anxiety disorder
Glutamate increase causes?
Bipolar affective disorder, psychosis from escape mixed neurotoxicity or excessive pruning
Glutamate decrease causes?
Memory and learning difficulty, negative symptoms of schizophrenia
Opioid neuropeptides decreases causes?
Substance abuse
Serotonin 5-HT 1A
Regulation of sleep
Serotonin 5-HT1D
Pain perception
Serotonin 5-HT2
Mood states
Serotonin 5-HT2A
Temperature
Serotonin 5-HT3
Regulation/facilitation of aggression
Serotonin 5-HT4
Libido
Disadvantages of this lack sensitivity, cannot differentiate white matter from gray matter, cannot view structures close to the bone tissues, under estimation of brain atrophy, inability to image sagittal and Cornel views
CT
Autosomal dominant conditions may be present in more than one generation and up to what percent of offspring when one parent is affected such as Marfan syndrome
50%
Testing for presence of HLA-B 1502 allele, an inherited variant of HLA-B gene, is required by the FDA in people of blank descent prior to prescribing the anticonvulsant carbamazepine due to the risk of Stevens-Johnson syndrome and toxic epidermal necrolysis
Asian
Painful stick neck and thick tongue are indicated of of what medical term
Dystonia: is a movement disorder in which a person’s muscles contract uncontrollably can result in repetitive movements or abnormal posture
CNS dopamine and acetylcholine have a blank relationship. As dopamine receptors are antagonized by antipsychotic medications, acetylcholine levels increase, giving rise to what?
Reciprocal, extrapyramidal side effects
A positive Babinski or fanning of toes and dorsiflexion of the great toe is normal in infants up to age what
Two years
On old Olympus towering top a fin and German viewed some hops
Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Acoustic, Glossopharyngeal, Vagus, Spinal Accessory, Hypoglossal
What cranial nerve ? Test sense of smell and ensure patency of the nasal passages, have the client close eyes and test each nostril separately while others is occluded, asking the client to identify familiar odors
Olfactory
What cranial nerve? Test vision using Snellen chart or other suitable chart depending on the client’s acuity and ability to cooperate. Examine the inner aspect of the eyes with the ophthalmoscope. Test peripheral vision using the confrontation test.
Optic
What cranial nerve? This is the motor nerve to the five extrinsic eye muscles. Test together with cranial nerve for an cranial nerve six. Test the extraocular movements. Check the equality of pupils, the reaction to light, and their ability to accommodate. Test the corneal light reflex, when shining a light at the bridge of the nose, the light should appear symmetrical in both eyes.
Oculomotor
What cranial nerve? Use the same processes cranial nerve three and cranial nerve six.
Trochlear
What cranial nerve? Palpate the messenger muscles with the fingertips while the client clenches his or her teeth. Look for disparity and tension between the two muscles, which can indicate paralysis on the weak side. Look for tremor of the lips, involuntary chewing movements, and spasm of the masticatory muscles.
Trigeminal motor division
What cranial nerve? Test tactical perception of the facial skin by touching with a wisp of cotton. Test superficial pain of the skin and mucosa with pinpricks. Test the sense of touch in the oral mucosa.
Trigeminal sensory division
What cranial nerve? Use the same processes for cranial nerve three and four.
Abducens
What cranial nerve? Inspect the face in repose for evidence of flaccid paralysis. Test by asking the client to elevate eyebrows, wrinkled forehead, close eyes, frown, smile, and puffed cheeks.
Facial motor division
What cranial nerve? Test taste for sugar, vinegar, and salt
Facial sensory division
What cranial nerve? Check hearing with the audiometer or by the whisper test. Check for hearing loss using the Weber and the Rinne tests.
Acoustic
What cranial nerve? Test together with cranial nerve 10
Glossopharyngeal
What cranial nerve? Tester elevation of the uvula by having the client open his or her mouth and say “ah”. Test the gag reflex by touching the back of the throat with the tongue blade.
Vagus
What cranial nerve? Test the strength of the sternocleidomastoid and trapezius muscles against resistance of your hands.
Accessory spinal
What cranial nerve? Look for tremors and other involuntary movement when the client protrudes his or her tongue.
Hypoglossal
Have the client stand up straight with feet together, arms by sides, and eyes closed. Only slight swaying would be normal, and the client will be able to sustain this post for approximately five seconds. More than slight swing suggests cerebellar ataxia or vestibular dysfunction
Equilibrium by administering the Romberg test
Ability to perform rapid alternating movements such as patting knees alternating palm and back of hands, touching thumb to each finger. The client should be able to smoothly execute these movements and maintain the rhythm.
Diadochokinesia
Inability to discriminate between objects based on touch alone; results of a lesion in the parietal lobe
Astereognsosis
Movement disorder in which a person’s muscles contract uncontrollably. Contraction causes the affected body part the twist involuntary, resulting in repetitive movements or abnormal postures.
Dystonia
Repetitive and rapid, jerky, involuntary movement that appears to be well coordinated; often seen in Huntington’s disease
Choreiform
Inability to recognize letters or numbers drawn on the clients hand with a pointed object
Agraphesthesia
Is movement disorder characterized by subjective feeling of inner restlessness accompanied by mental distress and an inability to sit still.
Akathisia
Greater than blank percentile for body mass index places the child at increased risk for being overweight
85th
The client is presenting with elevated temperature and also is taking psychotropic meds such as Tegretol or clozaril be alert for what
Agranulocytosis
What antipsychotic can cause cataracts
Quetiapine (Seroquel)
Is a milky nipple discharge unrelated to the normal milk production of breast-feeding.
Galactorrhea
Be aware that lithium and anorexia nervosa can cause what
Peripheral edema
Function of what gland is to take iodine from the circulating blood, combine it with amino acid tyrosine, and convert it to the thyroid hormones’ T3 and T4
Thyroid
The thyroid gland also stores T3 and T4 until they are released into the bloodstream under the influence of thyroid stimulating hormone released from what gland?
Pituitary
When T4 and T3 are high, TSH secretion does what?
TSH secretion decreases
When T4 and T3 levels are low, TSH secretion does what?
TSH secretion increases
This cation for the structure of bones and teeth is mediated by interactions among three hormones’: parathyroid, hormone, vitamin D, and calcitonin
CA
Confusion, decreased libido, importance, decreased appetite, memory loss, lethargy, constipation, headaches, slow or clumsy movements, syncope, weight gain, fluid retention, muscle aching and stiffness, slowed reflexes, somatic discomfort, slowed speech and thinking, sensory disturbances, cerebellar ataxia, loss of amplitude and ECG, mimics symptoms of unipolar mood disorders
Systemic effects of hypothyroidism
Mimics symptoms of bipolar affective disorder, motor restlessness, emotional lability, short attention span, compulsive movement, fatigue, tremor, insomnia, importance, weight loss, increase in appetite, abdominal pain, excessive sweating, flushing, elevated upper eyelid leading to decreased blinking, staring, fine tremor of eyelid, tachycardia, dysrhythmias
Systemic effects of hyperthyroidism
Calcium normal values
8.8 to 10.5mg/dl
Free T4 normal values
0.8 to 2.8ng/dl
Normal thyroid stimulating hormone
2 to 10 mU/l
Increased levels of what can cause: acidosis, hyperparathyroidism, cancers, vitamin D intoxication, Addison’s disease, and hyperthyroidism
Calcium
Decreased levels of what can cause alkalosis, hyperparathyroidism, renal failure, pancreatitis
Calcium
Systemic effects of what causes: increase in neuromuscular excitability, confusion, Paris thesis around the mouth and in the digits, muscle spasms in the hands and feet, hyperreflexia, convulsions, tetany, continuous severe muscle spasm, prolonged QT interval, intestinal cramping, and hyperactive bowel sounds
Hypocalcemia less then 8.5
Systemic effects of what causes: fatigue, weakness, lethargy, anorexia, nausea, constipation, behavioral changes, impaired renal function, shortened QT interval, depressed T waves, bradycardia, and heart block
Hypercalcemia Greater then 12
Normal sodium values
135 to 148mEq/l
Increased levels of what can cause: hypovolemia, dehydration, diabetes insipidus, excessive salt ingestion, gastroenteritis
Increase levels of sodium
Decreased levels of what can cause: Addison’s disease, renal disorder, G.I. fluid loss from vomiting, diarrhea, nasogastric suction, alias, diuresis
Decreased levels of sodium
Systemic effects of what causes: lethargic, headache, confusion, apprehension, seizures, coma, hypotension, tachycardia, decreased urine output, weight gain, edema, ascites, jugular vein distention.
Hyponatremia less than 135mEq/l
Systemic effects of what causes: convulsions, pulmonary edema, thirst, fever, dry mucous membranes, hypertension, tachycardia, low jugular venous pressure, restlessness
Hypernatremia greater than 147mEq/l
Normal values for magnesium
1.3 at the 2.1mEq/l
Increase levels of what can cause: Addison’s disease, adrenalectomy, renal failure, diabetic ketoacidosis, dehydration, hypothyroidism, hyperthyroidism
Magnesium
Decreased levels of what can cause: hyperaldosteronism, hypokalemia, diabetic ketoacidosis, malnutrition, alcoholism, acute pancreatitis, GA loss from vomiting, diarrhea, nasogastric suction, and for Sheila, malabsorption syndrome, pregnancy induced hypertension.
Magnesium
Systemic effects of what causes: depression, confusion, irritability, increased reflexes, muscle weakness, ataxia, nystagmus, tetany, convulsions
Hypomagnesemia less then 1.5
Systemic effects of what causes: nausea and vomiting, muscle weakness, hypertension, bradycardia, respiratory depression, depressed skeletal muscle contraction, and depressed nerve function
Hypermagnesemia greater than 2.5mEq/l
Normal chloride values
98 to 106mEq/L
Increased levels are caused by: acidosis, hyperkalemia, hyponatremia, dehydration, renal failure, Cushing’s syndrome, hyperventilation, and anemia
Chloride
Decreased levels are caused by: alkalosis, hypokalemia, hyponatremia, G.I. loss from vomiting, diarrhea, nasogastric suction, and fistula, diuresis, over hydration, Addison’s disease, burns
Chloride
Potassium normal value range
3.5 to 5.1 mEq/l
Increased levels are caused by: acidosis, insulin deficiency, Addison’s disease, acute renal failure, hypoaldosteronism, infection, dehydration
Potassium
Decreased levels are caused by: alkalosis excessive insulin, G.I. loss, laxative abuse, burns, trauma, surgery, Cushing’s syndrome, Hyperaldosteronism, thyrotoxicosis, anorexia nervosa, diet deficient in meat and vegetables
Potassium
Systemic effects of what causes: muscle weakness, paralysis, tingling of lips and fingers, restlessness, intestinal cramping, diarrhea, narrow and taller T waves, shorten QT interval, depressed ST segment, prolonged PR interval, widened QRS complex leading to cardiac arrest.
Hyperkalemia greater than 5.5mEq/l
Systemic effects of what causes: impaired carbohydrate metabolism, impaired renal function, polyurea, polydipsia, skeletal muscle weakness, and smooth muscle atony, cardiac dysrhythmias, paralysis, and respiratory arrest
Hypokalemia levels less than 3.5mEq/l
Normal values of ALT
5 to 35 U/I
Normal values of AST
5 to 40 U/I, AST has less in skeletal muscles, kidneys, pancreas, brain
GGT normal values
10 to 38 IU/I
How many stages in girls breast development
Stage one prepubertal
stage II breast Bud stage with elevation of breast and papillary; enlargement of areola
stage III further enlargement of breast and aerial; no separation of their contour
stage IV Areola and papilla form a secondary mound above level of breast
stage V mature stage projection of papilla only related to recession of a areola
How many stages in boys development of external genitalia
Stage I prepubertal
stage II enlargement of scrotum and testes; scrotum skin reddens and changes and texture
stage III enlargement of penis; further growth of testes
stage IV increase in size of penis with growth and breadth and development of glans; testes and scrotum larger, scrotum skin darker
stage V adult genitalia
How many stages and Boys and Girls Club care
Stage I prepubertal
stage II sparse growth of long, slightly pigmented hair, straight or curled, at base of penis or long labia
stage III darker, coarser, and curly hair, spreading sparsely or junction a few
stage IV adult type pair, but covering smaller area than an adult, no spread to medial surface of thighs
stage V adult type and quantity with horizontal distribution
Plan an exercise routine that last at least blank minutes, and perform the work out at least blank to blank days a week.
30 minutes, 3 to 5 days
The target heart rate during physical activity should be blank to blank of the maximum heart rate
60 the 90%
Physical activity at blank to blank of the maximum heart rate is considered moderate intensity exercise
60 to 70%
CDC recommends blank minutes or more of physical activity each day for children and adolescents
60 minutes
CDC recommends blank minutes of moderate intensity aerobic activity every week and muscle strengthening activities blank or more days a week for adults
Hundred and 50 minutes and two
All SSRIs and some other antidepressants have been implicated in blank. Owing to diminished renal function and frequent polypharmacy, blank is more common in the elderly. Water pills could make it worse.
Hyponatremia
In this condition clients can show up feeling tired, foggy, severe headache owing to cerebral edema
Hyponatremia
What client teaching should be included in preparation for beginning lithium?
The client should be taught about the potential risks and benefits of taking lithium. Women of childbearing age should be educated about the risk of birth defects, including Ebstein’s anomaly. Consideration of lithium dose and maintenance blood level should be included in discussing the relative risk. The client should be taught about the signs and symptoms of lithium toxicity.
What test should be ordered before starting lithium
Baseline labs consisting of a metabolic panel, TSH, and CBC women of childbearing age should have a pregnancy test.
In the elderly what additional test should be ordered before treating with lithium?
Those with heart disease are over the age of 65 should first have a baseline ECG
Patient started on lithium to follow up with the fire G, constipation, and bradycardia what should the provider consider his etiology?
Hypothyroidism or hypercalcemia both of which can because by lithium
What is time needed to clear 50% of the drug from the plasma
Half-life
What is the point at which the amount of drug eliminated between doses is approximately equal to the dose administered
Steady state
It takes how many half-lives to achieve a steady state and how many half-lives to completely eliminate a drug
Five
Approximately 10% of Caucasians are poor metabolizers of this P4 50 enzyme
2 D6 enzyme
Approximately 20% of Asians may have reduced activity of this P4 50 enzyme
2C 19 enzyme
First pass metabolism increase activity of P4 50 enzymes on 2C9, 2C19, 2D6, and 3A4 are common in what age group
Young children
The P4 50 enzyme1A2 pathway is delayed in what age group
Young children
Enzyme inducers can what to the serum level of other drugs that are substrates of that enzyme, thus possibly causing sub therapeutic drug levels
Decrease
Inhibitors or inducers? Bupropion, Clomipramine
Inhibitors
Inhibitors or inducers? Cimetidine and Clairthromycin
Inhibitor
Inhibitors or inducers? Fluoroquinolones and Grapefruit
Inhibitors
Inhibitors or inducers? Ketoconazole and Nefazodon
Inhibitors
Inhibitors or inducers? SSRIs
Inhibitors
Inhibitors or inducers? Carbamazepine
Inducer
Inhibitors or inducers? Hypericum (St. John’s Wort)
Inducer
Inhibitors or inducers? Phenytoin
Inducers
Inhibitors or inducers? Phenobarbital and tobacco
Inducers
Enzyme inhibitors can do what to the serum level of other drugs that are substrates of that enzyme, thus possibly causing toxic levels
Increase
Liver disease will affect liver enzyme activity and first pass metabolism, possibly resulting in what plasma drug levels
Toxic
Kidney disease or drugs that reduce renal clearance, such as NSAIDs, may what to serum concentration of drugs that are excreted by the kidneys such as lithium. Older adults are more sensitive to psychotropics because of their decreased intracellular water, protein binding, low muscle mass, decreased metabolism, and increased body fat concentration.
Increase
Most psychotropics are highly protein bound and older adults have more body fat and less protein they are more likely to develop what as a result of taking medications
Toxicity
What effect? Drug binds to receptors and activates a biological response
Agonist affect
What effect? Drug causes the opposite effect of agonist; binds to same receptor
Inverse agonist affect
What effect? Drug does not fully activate the receptors
Partial agonists affect
What effect? Drug binds to the receptor but does not activate a biological response
Antagonist affect
What kind of response? Depolarization; involves the opening of sodium and calcium channels so these ions go into the cell
Excitatory response
What kind of response? Repolarization; involves the opening of chloride channel so chloride goes into the cell, potassium leaves, or both
Inhibitory response
Another site for drug actions are enzymes, which are important for drug metabolism and play an important role in the chemical alteration of the drug. Some drugs such as what inhibit the actions of a particular enzyme, thus increasing the availability of the neurotransmitter.
MAOIs monoamine oxidase inhibitors
Another site for drug action is carrier proteins or reuptake pumps, which transport neurotransmitters out of the synapse and back into the presynaptic neuron to be recycled or reused. Some drugs, such as what, will inhibit reuptake pumps, thus increasing the synaptic availability of the neurotransmitter
SSRIs
What is the relative dose required to achieve certain effects?
Potency
What is the relative measure of the toxicity or safety of a drug; ratio of the median toxic dose to the median effective dose
Therapeutic index
Drugs with what kind of therapeutic index have a high margin of safety; that is, the therapeutic dose and the toxic dose are far apart.
High therapeutic index
Have a low margin of safety; that is, the therapeutic dose and toxic dose are close together.
Low therapeutic index
What is the process of becoming less responsive to particular drug over time
Tolerance
An acute decrease in the therapeutic response
tachyphylaxis
What schedule of medication? I abuse potential, used for research purposes only, not legally available by prescription, examples include heroin and marijuana
Schedule one
What schedule of medication? Medicinal drugs in current use, high potential for abuse and dependency, written prescription only, no telephone orders allowed, no refills allowed on prescriptions examples include morphine, codeine, methadone Dilaudid oxycodone hydrocodone amphetamine salts, methylphenidate
Scheduled two
What schedule of medications? Medicinal drugs with less abuse potential than schedule two drugs, still greater potential for abuse and schedule for drugs, telephone orders if followed by written prescription, prescription must be renewed every six months, refills limited to five, examples include testosterone, Suboxone, appetite suppressant’s
Schedule three
What scheduled medications? Medicinal drugs with less abuse potential than schedule three drugs. Examples include benzodiazepines
Schedule four
What scheduled medications? Medicinal drugs with the lowest abuse potential includes buprenorphine, codeine, Phenergan and, the Lomotil
Schedule five
Beta blockers, steroids, interferon, accutane, retroviral drugs, antineoplastic, benzodiazepines, and progesterone can induce what medical conditions?
Depression
Steroids, Antabuse, INH, and antidepressants in persons with bipolar disorder can induce what medical condition?
Mania
These drugs can cause a false positive for what: stimulants, Wellbutrin, Prozac, trazodone, ranitidine, nefazodone, nasal decongestants, pseudoephedrine
Amphetamines
This drug can cause a false positive for what: valium
Alcohol
This drug can cause a false positive for what: zoloft
Benzodiazepines
This drug can cause a false positive for what: amoxicillin, most antibiotics, NSAIDs
Cocaine
This drug can cause a false positive for what: quinolones, rifampin, codeine, poppy seeds
Heroin or morphine
This drug can cause a false positive for what: over the counter cough medicines such as nyquil dextromethorphan
Methadone or PCP
Attack of nerves is a syndrome among individuals of Latino descent, characterized by symptoms of intense emotional upset, including acute anxiety, anger or grief; screaming and shouting uncontrollably; attacks of crying; trembling; heat in the chest rising into the head; and becoming verbally and physically aggressive.
Ataque de nervios
Is a term that was going to in South Asia with little more than half a century ago to account for common clinical presentations of young male patients who attributed their various symptoms to semen loss
Dhat syndrome
Wind attacks or a syndrome found among Cambodians in the United States and Cambodia. Common symptoms include those of panic attacks, such as dizziness, palpitations, shortness of breath, and cold extremities, as well as other symptoms of anxiety and autonomic arousal.
Khyal cap
Thinking too much or rumination or upsetting thoughts term used by Zimbabwe
Kufungisisa
Humanly caused illness or sent to sickness is a cultural explanation in Haitian communities for diverse medical and psychiatric disorders.
Maladi moun
Is a common idiom of distress among Latinos in United States and Latin America refers to a general state of vulnerability to stressful life experiences and the difficult life circumstances
Nervios
Is a cultural syndrome that integrates conceptual categories of traditional medicine with the Western diagnosis. Syndrome composed of 3/5 nonhierarchical symptoms cluster weakness, emotions, excitement, nervous pain, sleep, irritability
Shenjing shuairuo
Is a cultural explanation for distress and misfortune prevailing among some Latinos in the United States and among people in Mexico, Central America, and South America. It is not recognized as an illness category among Latinos from the Caribbean. His illness attributed to a frightening event that causes the soul to leave the body and result in unhappiness and sickness, as well as difficulties functioning’s and key social roles.
Susto
Is a cultural syndrome characterized by an anxiety about an avoidance of interpersonal situations due to the thought, feeling, or conviction that one’s appearance and actions in social interactions are inadequate or offensive to others.
Taijin Kyofusho
Absolute neutrophil count is calculated how?
White blood cell count times percentage of neutrophils or segmented neutrophils plus band neutrophils times the white blood cell count
Benign ethnic neutropenia is what?
Condition observed in certain ethnic groups whose average ANC’s are lower than other populations.
General population absolute neutrophil count is?
Greater than 1500
When initiating Clozapine how often do you check a CBC for the first six months, 6 to 12 months, and after 12 months.
First six months weekly, six months to 12 months biweekly, and monthly after 12 months
What is mild neutropenia and is this considered normal for people in the Ben population?
Mild neutropenia is considered 1000 1499 is considered normal for Ben population the general population you continue treatment but check CBC three times weekly until absolute neutrophil count is over 1500
What is moderate neutropenia and is this considered normal for people in the ben population?
500 to 999. In the general population hematology consult, interrupt treatment, resume treatment once absolute neutrophil count is over 1000 check CBC daily once over a thousand then check CBC three times weekly once over 1500 check CBC weekly for four weeks then returned to patient’s last normal range and see monitoring interval
for Ben population check CBC three times weekly until ANC is over a thousand. Once ANC is back over a thousand check weekly for four weeks then returned to patient’s last monitoring interval. Continue treatment and recommend hematology consult
Severe neutropenia in the general population and in the ben population is considered what?
ANC less than 500. General population hematology consult. Stop medication. Do not re-challenge unless prescriber determines benefits outweigh risks. Daily CBC until ANC is greater than 1000 than three times weekly until ANC is greater than 1500. If restarting treat patient as new patient.
Ben population check CBC until ANC is greater than 500 daily. Then check CBC three times weekly until ANC is greater than 1000. If patient stays on med treat as if a new patient.
Blank is typically caused by acute illness or drug toxicity and is often reversible. Blank is typically caused by anatomic changes in the brain, has slower onset, and is generally irreversible.
Delirium and dementia
With blank you may feel very restless or tense and have a constant desire to move. This might show up as physical discomfort, agitation, anxiety, or general irritability. Pacing shaking of legs rocking of feats or rubbing your face.
Akathisia
Blank reactions are involuntary muscle contractions. These movements are often repetitive and might include eye spasms were blinking, twisting head, recruiting tongue, and extended neck. Movements may be very brief but they could also affect posture or stiffen muscles for a period of time. They most often affect the head and neck so they can occur in other parts of the body. Blank can cause painful muscle stiffness and other discomfort. Can choker have trouble breathing.
Acute dystonia
Length describe symptoms that resemble those of rigid muscles in the limbs. Could also cause tremor, increase elevation, slow movements, or changes in posture and gait
Parkinsonism
Generally the first signs are rigid muscles and fever, then drowsiness or confusion. Sometimes seizures in the Tacoma, renal failure, death.
Neuroleptic management syndrome
A late onset symptom involves repetitive, involuntary facial movements, tongue twisting, chewing motions and lipsmacking, cheek puffing, and grimacing. Changes in gait, jerky limb movements, or shrugging usually after six months of taking the medication agent diabetes can increase the risk more typical with first generation antipsychotics
Tardive dyskinesia
The National Institutes of Health guidelines define what as having three or more of the following traits, including traits you’re taking medication to control:
Large waist — A waistline that measures at least 35 inches (89 centimeters) for women and 40 inches (102 centimeters) for men
High triglyceride level — 150 milligrams per deciliter (mg/dL)
Reduced “good” or HDL cholesterol — Less than 40 mg/dL (1.04 mmol/L) in men or less than 50 mg/dL (1.3 mmol/L) in women of high-density lipoprotein (HDL) cholesterol
Increased blood pressure — 130/85 millimeters of mercury (mm Hg) or higher
Elevated fasting blood sugar — 100 mg/dL (5.6 mmol/L) or higher
Metabolic Syndrome
Fear triggers the amygdala that activates the sympathetic nervous system and the Blank.
What is the hypothalamic pituitary adrenal axis (HPA Axis).
The HPA axis releases Blank, activating secretion of Blank, causing secretion of cortisol.
What is the Corticotropin releasing factor (CRF) and Adrenocorticotropic hormone (ACTH). Board Vitals PMHNP Review Questions
In situations of chronic stress, excessive blank release may eventually cause hippocampal atrophy. The hippocampus inhibits the HPA axis, atrophy in this region may lead to chronic activation of the HPA axis, likely increasing risk of developing psychiatric illnesses
What is Glucocorticoid/Cortisol Release.
Neurons from what two areas of the brain normally suppress the hypothalamic-pituitary-adrenal axis?
What is the hippocampal area and amygdala
While proper functioning of the HPA axis is essential for dealing with stress, when the HPA axis is stimulated too much it can lead to what physical and psychiatric problems?
What is Type 2 diabetes, obesity, CVS disease, anxiety, depression, mood disorders, and cognition.
P450 enzyme pathways inhibited will raise or lower substrates (medications)?
What is raises.
P450 enzymes pathways induced by medications will raise or lower other substrates (medications)?
What is lower.
Caffeine is an inducer of what Cytochrome P450 enzyme pathway?
What is CYP 1A2.
Cytochrome P450 1A2 enzyme can be induced, or increased in activity, by what legal substance? Often requiring a higher antipsychotic drug dose outpatient then what they would need inpatient.
What is Cigarettes.
This anticonvulsant/mood stabilizer’s induction and autoinduction by the hepatic enzyme CYP450 (3A4) pathway occurs in 2 to 3 weeks; slightly higher doses may be needed or tolerated at that time.
What is Carbamazepine
This Cytochrome enzyme pathway metabolizes several psychotropic drugs as well as several of the statins for treating high cholesterol. Potentially increasing risk of muscle damage and rhabdomyolysis.
What is CYP 3A4
Fluvoxamine (SSRI, FDA approved for OCD) is an inhibitor for these two common Cytochrome P450 enzyme pathways (1A2, 2D6, 2C9, 2C19, or 3A4)?
What is 1A2 and 3A4
This anticonvulsant/mood stabilizer’s induction of the Cytochrome P450 3A4 pathway when added to patients previously stable on clozapine, iloperidone, lurasidone, or zotepine does what to their medication concentration? requiring a dose increase or decrease?
Carbamazepine, reduces them, increase
Excitatory neurotransmitter that is being implicated more and more in schizophrenia. In excess, may be responsible for kindling and apoptosis.
Glutamate
The brain releases this neurotransmitter during pleasurable activities. Too much is associated with schizophrenia. Too little is associate with depression, muscular rigidity and Parkinson’s disease.
Dopamine
Excitatory neurotransmitter that elevates mood, modulates attention and fatigue. Too much is linked to anxiety and hyperactivity. Too little is linked to depression, low energy, and fatigue.
Norepinephrine
Projections from this neurotransmitter affect mood, depression, movement, obsessions, compulsions, appetite, sleep, and sexual response. Too little is linked to depression. Too much can be potentially fatal.
Serotonin
This neurotransmitter is involved in voluntary movement, learning, memory & sleep. Too much is associated with depression. Too little has been associated with dementia.
Acetylcholine
All antagonize H1 receptors. Often used to treat movement disorders associated with neuroleptics. Also used for sleep and anxiety.
Antihistamines
Dopamine and serotonin antagonist used to treat both positive & negative symptoms in schizophrenia. Associated with lower risk of EPS and higher risk of metabolic side effects.
Atypical, Second Generation Antipsychotics
Used to treat depression. Also used for anxiety disorders, PMDD, and eating disorders.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Used to speed up the central nervous system to increase neural activity in the brain. Acts by increasing NE and DA in the prefrontal cortex. Balances tonic versus phasic firing. Used for ADHD and Narcolepsy. Used as an adjunct for depression, obesity, chronic fatigue.
Stimulants
Reduce inactivation of acetylcholine and potentiate neurotransmission. Indicated for mild to moderate Alzheimer’s disease. Often combined with Memantine (Namenda).
Cholinesterase Inhibitors
“One sick _______ in a neuronal circuit can affect the whole circuit, from the GABA interneuron and the glutamate neurons it innervates, to downstream dopamine neurons and beyond.”
What is a synapse
I am the circuit considered to be the “final common pathway of reward.”
What is the mesolimbic dopamine circuit
This circuit can create fear and panic leading to phobias.
What is the amygdala-centered circuit
Ascending serotonergic projections in the brain regulate these 3 things.
What are mood, anxiety, & sleep
This circuit is considered the “worry loop” and can lead to problems with anxiety/obsessions.
What is the cortico-striato-thalmo-cortico loop
This can be the outcome when an exogenous substance is introduced to the mesolimbic dopamine pathway.
What is addiction
These two pathways are considered as the cause of schizophrenic symptoms.
What are the dopamine pathways and the glutamate pathways
There are 4 main circuits which are “out of tune.” These include the ACC, dorsolateral PFC, the prefrontal motor cortex, and the orbital prefrontal cortex. I am the mental illness caused by abnormal firing in these areas.
What is ADHD
Underactivity of this system leads to negative, cognitive, and affective symptoms of schizophrenia.
What is the mesocortical dopamine system
Blocking the action of the natural neurotransmitter agonist. The substance is by itself inactive.
What is an antagonist
These are found at opposite ends of the agonist spectrum
What are agonists and inverse agonists
This causes partially enhanced signal transduction
What is a partial agonist
A conformational change in the G-protein linked receptor that turns on the synthesis of a second messenger to the greatest extent possible
What is the action of a full agonist
This happens when neurotransmitter inactivation mechanisms are blocked by a drug
What is indirect full agonism
Antacids reduce bioavailability of this anticonvulsant/CNS depressant
What is gabapentin (Neurotin)
Drugs that should be given with caution when a patient is on lithium
What are NSAID’s, ACEI’s, and ARB’s
What are NSAID’s, ACEI’s, and ARB’s?
What are St. John’s wort, ginseng, and nutmeg?
Constipation caused by this atypical antipsychotic may cause reduced if administered at the same time as these
What is clozapine and: bulk laxatives, magnesium-based antacids, lactulose
These meds used to treat migraines can cause serotonin syndrome if combined with SSRI’s
What are triptans- [sumatriptan (Imitrex), almotriptan, naratriptan (Amerge)], carbamazepine (Tegretol), and valproic acid (Depakene)
In the case of G protein link systems, the second messenger is a blank, but in the case of an ion channel link system the second messenger can be a blank such as calcium.
Chemical and ion
G-protein linked systems, ion channel linked systems, hormone linked systems, and neurotrophic linked systems what are these?
These are the four important signal transduction cascades in the brain
How many states of ligand-gated ion channels?
Five: channel in resting state, channel open, channel closed, channel desensitized, channel inactivated.
There are two major classes of ion channels what are they?
Ligand-gated ion channels and voltage sensitive ion channels
The opening of ligand-gated ion channels is regulated by what?
Neurotransmitters
Voltage sensitive ion channels is regulated by the blank across the membrane in which they reside
Charge, numerous anticonvulsants bind various sites on these channels and may exert their anticonvulsant action by this mechanism as well as their actions as mood stabilizers, treatments for chronic pain, anxiety, and sleep medications.
Agonists do what to the channel?
They open it. Partial agonists open it but not as much as a full agonist. The antagonist can cause the channel to go back to its resting state which is the same state the channel is in prior to the presence of the agonist.
What does the inverse agonists due to the channel?
The inverse agonist binds to the channel and causes it the close
The normal stress response involves activation of the hypothalamus and the resultant increase in what, which in turn stimulates the release of what from the pituitary. This then causes what to be released from the adrenal gland, which feeds back to the hypothalamus and inhibits what release, terminating the stress response
corticotropin releasing factor, adrenocorticotropic hormone, glucocorticoid, corticotropin
Is it neuroleptic malignant syndrome or serotonin syndrome?
Serotonergic agents
Abrupt onset
HTN, Tachycardia, tachypnea, hyperthermia
Course is rapidly resolving
Skin Diaphoretic
Muscles increased tone, tremors, choreathetoid movements
Reflexes hyperreflexia, clonus (uncontrolled flexion)
Pupils mydriasis (dilation of the pupil of the eye)
Bowel sounds hyperactive
Serotonin Syndrome
Is it neuroleptic malignant syndrome or serotonin syndrome? Dopamine antagonists Gradual HTN, Tachycardia, tachypnea, hyperthermia Prolonged course diaphoretic defuse rigidity "lead pipe" decreased reflexes normal pupils bowel sounds normal to decrease
neuroleptic malignant syndrome
The neurotransmitters acetylcholine, histamine, and epinephrine are involved in _______ pathways that can influence _______ in mood disorders?
What are arousal pathways and cortical arousal?
The mesocortical pathway is a dopaminergic pathway that connects the ventral tegmentum to the blank.
prefrontal cortex
The mesolimbic pathway, sometimes referred to as the blank, is a dopaminergic pathway in the brain. The pathway connects the ventral tegmental area in the midbrain to the ventral striatum of the blank in the forebrain
reward pathway, basal ganglia
The nigrostriatal pathway is a bilateral dopaminergic pathway in the brain that connects the substantia nigra pars compacta in the midbrain with the blank in the forebrain
dorsal striatum (caudate nucleus and putamen)
the tuberoinfundibular pathway refers to a population of dopamine neurons that project from the arcuate nucleus in the tuberal region of the hypothalamus to the blank. It is one of the four major dopamine pathways in the brain.
median eminence
Blank is the major excitatory neurotransmitter in the nervous system…..Blank is the chief inhibitory neurotransmitter in the brain. The major difference between the two is the latter is synthesized from the former
Glutamate and GABA
Chapter 8
what are the most blank for individual therapy: losses, interpersonal conflicts, symptomatic presentations such as panic, phobias, negativity, unfulfilled expectations at life transitions, characterological issues such as narcissism or aggressiveness.
Individual therapy
What can be broken when there is an increased potential for self harm or harm to others; abuse of children, older adult, or person with disabilities; when the therapist determines that the person needs hospitalization; and when clients request that their information be released to 3rd party.
Confidentiality
What therapists believe that behavior is determined by unconscious motivations and instinctual drives. Promotes change by the development of greater insight and awareness of maladaptive defenses. Attends to pass developmental and psychodynamic factors, which shape present behaviors.
Sigmund Freud
What is? Suggests that external events do not cause anxiety or maladaptive responses. States that a person expectations, perceptions, and interpretations of events cause anxiety. Allows clients to view reality more clearly through an examination of their central distorted cognitions. Goals the change clients irrational belief, faulty conceptions, and negative cognitive distortions.
Cognitive therapy
Who is? Credited with conception of the cognitive therapy
Aaron Beck
What is? Focuses on changing maladaptive behaviors by participating in active behavioral techniques such as exposure, relaxation, problem-solving, and role-playing
behavioral therapy
who is, the originator of behavioral therapy?
Arnold Lazarus
What is? Commonly used with people with borderline personality disorder. Focuses on emotional regulation, tolerance for distress, self-management skills, interpersonal effectiveness, and mindfulness, with an emphasis on treating therapy interfering behaviors.
Dialectical behavioral therapy
Who is, the originator of dialectical behavioral therapy
Marsha Linehan
What therapy goals fits this kind of therapy? Decreases suicidal behaviors, decreases therapy interfering behaviors, decreases emotional reactivity, decreases self invalidation, decreases crisis generating behaviors, decrease passivity, increase realistic decision-making, increase accurate communication of emotions and competencies.
Dialectical behavioral therapy
What type of therapy? A philosophical approach in which reflection on life and self confrontation is encouraged. If this is accepting freedom in making responsible choices. States that a basic dimension of humans including finding meaning and purpose in life. Such as why am I here? What is my purpose? Goals are to live authentically and to focus on the present and on personal responsibility.
Existential therapy
Who is credited with Existential therapy
Viktor Frankl
What therapy? Also known as person centered therapy. Concepts include self-directed growth and self actualization; people are born with the capacity to direct themselves toward self-actualization. Each person has potential to actualize and find meaning.
Humanistic therapy
Who is credited with humanistic therapy?
Carl Rogers
What therapy? Evidence-based therapy with focus on interpersonal issues that are creating distress. Time-limited, active, focused on the present and on interpersonal distress. Developed to treat aspects of depression and is effective for adults and adolescents. Has been applied to treat interpersonal distress related to other disorders, including bipolar, substance use, and eating disorders.
Interpersonal therapy
Who is credited with interpersonal therapy?
Gerald L Klerman
What therapy? A form of behavioral and exposure therapy. Involves use of bilateral stimulation in other words moving the ice back and forth, alternating tapping on hands or knee, or sounds and ear. Most commonly used in posttraumatic stress disorder. Goals to achieve adaptive resolution.
Eye movement desensitization and reprocessing
What phase of EMDR? The client visualizes the trauma, verbalizes the negative thoughts or maladaptive beliefs, every maze and attentive to physical sensations. This process occurs for limited time what the client maintains rhythmic eye movements. He or she is then instructed to block out negative thoughts; to breathe deeply; and then to verbalize what he or she is thinking, feeling, or imaging.
Desensitization phase
What phase of EMDR? The client installs and increases the strength of the positive thought that he or she has declared as a replacement of the original negative thought.
Installation phase
What phase of EMDR? The client visualizes the trauma along with the positive thought and then scans his or her body mentally to identify any tension within.
Body Scan
Benefits of this kind of therapy? Increases insight about oneself. Increases social skills. It is cost-effective. Develop sense of community.
Group therapy
What are? Installation of hope, universality, altruism, increased development of socialization skills, imitative behaviors, interpersonal learning, group cohesiveness, catharsis, existential factors, and corrective refocusing
10 therapeutic factors that differentiate group therapy from individual therapy
Participants develop hope for creating a different life. Members are at different levels of growth; thus, they gain hope from others that change is possible.
Installation of hope
Participants discover that others have similar problems, thoughts, or feelings and that they are not alone.
Universality
This results from sharing oneself with another in helping another
Altruism
New social skills are learned, and maladaptive social behaviors are corrected. The group can provide a natural laboratory.
Increase development of socialization skills
Participants are able to increase their skills by imitating the behaviors of others
Imitative behaviors
Interacting with others increases adaptive interpersonal relationships
Interpersonal learning
Participants developed an attraction to the group and other members as well as a sense of belonging.
Group cohesiveness
Participants experience catharsis as they openly express their feelings, which were previously suppressed
Catharsis
Groups enable participants to deal with the meaning of their own existence
Existential factors
Participants reexperience family conflicts in the group, which allows them to recognize and change behaviors that may be problematic
Corrective refocusing
What phase? The leader considers the direction and framework of the group. Purpose, goals, membership criteria, membership size, pre-group interview, informed consent.
Pre-group phase
What phase? Members are concerned about self-disclosure and being rejected. Goals and expectations are identified, and boundaries are established. The development of trust or rapport is very important.
Forming phase
What phase? Members are resistant and may begin to use testing behaviors. Issues related to inclusion, control, and affection begin to surface. Leaders tasks are to allow expression of both positive and negative feelings, assist the group in understanding the underlying conflict, and it examine nonproductive behaviors.
Storming phase
What phase? Resistance to the group is overcome by members. A strong attraction to the group and others emerge. Open and spontaneous communication occurs, and the group norms are established.
Norming phase
What phase? The group’s work becomes more focused. Creative problem-solving and solutions begin to emerge. Experiential learning takes place. Group energy is directed towards completion of goals.
Performing phase
Preparation is made to in the group. Remember that the work of termination begins during the first stage of the group. Both members and leaders express their feelings about each other and termination. A discussion and overview of what is been learned as well as what issues still need to be worked on, takes place.
Adjoining face
What kind of therapy? Characterized by progressive return of memories of past experiences. Used with older adults. Enables participants to search for meaning in their lives and strive for some resolution of past interpersonal and intrapsychic conflicts.
Reminiscence therapy
What kind of therapy? The system is any unit structured on feedback. The process by which all members operate together. Based on the idea that one could not understand any part without understanding how all parts operate together. Operates based on a set of rules that may be overt or covert.
Family system theory or concepts
What is? Protect and enhance the functional integrity of families, individuals, and subsystems. Can be physical or psychological.
Boundaries
What type of boundary? Maintain person separateness while emphasizing belongingness
Clearly defined boundaries
What type of boundary? May lead to distant relationships into disengagement
Rigid or inflexible boundaries
What type of boundary? Blurred and indistinct boundaries; lead to enmeshment
Diffuse boundaries
What is? An ongoing feedback loop; a series of actions and reactions that maintain a problem. Individuals and emotional problems are best understood when the context of relationships and through assessing interactions within entire family
Circular causality
What is? Tendency of families to resist change and to maintain a steady state
Family homeostasis
What is? A family’s tendency to adapt to change when changes are necessary
Morphogensesis
What is? A family tendency to remain stable in the midst of change
Morphostasis
Originated by Murray Bowen who believe that a person’s problematic behavior may serve the function or purpose for the family or be a symptom of dysfunctional patterns. Focus is on chronic anxiety within families. Treatment goals are to increase the family’s awareness of each member’s function within the family and to increase levels of self differentiation.
Family systems therapy
What is? The level at which one’s self of self worth is not dependent on external relationships, circumstances, or occurrences.
Self differentiation
What is? Dyads that form triads to decrease stress; the lower the level of family adaptation, the more likely a blank will develop.
Triangle
What is? Level of differentiation of the parents is usually equal to the level of differentiation for the entire family.
Nuclear family emotional system
What is? Dysfunction present over several generations
Multigenerational transmission process
What is? Parents transmitting their own level of differentiation on the most susceptible child
Family projection process
What is? Attempting to break contract with the family of origin
Emotional cutoffs
What is? Influences interactions and personality characteristics
Sibling position
What type of therapy? Originated by Salvador Minuchin who placed emphasis on how when and to whom family members relate in order to understand and then change the family structure. A person symptoms are rooted in the context of family transaction patterns. The symptom is a function of the health of the whole family and is maintained by structural problems in the system. The main treatment goal is to produce a structural change in the family organization to more effectively manage problems, changing transitional patterns, and family structure.
Structural family therapy
What is? An invisible set of functional demands that organize the way members interact of each other, made up of subsystems, coalitions, and boundaries.
Family structure
What is? Mapping relationships using symbols to represent overinvolvement, conflict, coalitions, and so forth
Structural mapping
What is? Distribution of power
Hierarchies
What therapy? Originated by Virginia Satir. Behavior is determined by personal experience and not by external reality. Focuses on being authentic, on freedom of choice, on human validation, and on experiencing the moment. Treatment goals are to develop authentic, nurturing communication and increased self-worth of each family member; overall goal is growth rather than symptom reduction alone. It does not focus on particular techniques.
Experiential therapy
What therapy? Originated by Jay Haley. Symptoms are viewed as metaphors and reflect problems in the hierarchal structure. Symptoms are a way to communicate metaphorically with the family. Treatment goals to help family members behave in ways that will not perpetuate the problem behavior. Interventions are problem focused. This therapy is more symptom focus than structural therapy. Therapist are concerned mainly with those techniques that change the sequence of interactions that is maintaining the problem. Techniques are straightforward directives, paradoxical directives, and reframing belief systems.
Strategic therapy
What is? Tasks that are designed in expectation of the family member compliance
Straightforward directives
What is? Negative task that is assigned when family members are resistant to change the member is expected to be noncompliant.
Paradoxical directives
What is? Problematic behaviors are relabeled to have more positive meaning in other words jealousy reframed to caring.
Reframing belief systems
What therapy? Originated by Steve deShazer, Bill O’Hanlon, and Insoo berg. Focus is to rework for the present situation solutions that have worked previously. Treatment goal effective resolution of problems through cognitive problem-solving and use of personal resources and strengths. Techniques include the use of miracle questions, exceptional finding questions, and scaling questions.
Solution focused therapy
What is? If a miracle were to happen tonight while you were asleep, and tomorrow morning you woke to find that the problem no longer existed, what would be different? How would you know the miracle took place? How would others know?
Miracle questions
What is? Directing clients to a time in their lives when the problem did not exist, which helps them move toward solutions by assisting them in searching for any exceptions to the pattern. Was there a time when the problem did not occur?
Exception finding questions
What is? On a scale of 1 to 10, with 10 being very anxious and depressed, how would you rate how you are feeling now? This is useful for highlighting small increments of change.
Scaling questions
What kind of therapy? Deal with the connection between the mind of the body and are viewed as holistic healthcare.
Complementarity and alternative therapies
What is? Used in addition to traditional medical practices.
Complementarity therapies.
What is? Used in place of traditional medical practices.
Alternative therapies
What is? Recent term used to describe the use of traditional complementarity therapies
Integrative therapies
White people use this kind of therapy? Desire for more control over decision-making, decreased insurance coverage for traditional medical therapies, therefore making the use of this therapy cheaper, preference for natural rather than synthetic medications, increase cost of prescriptions and services, failure of conventional medications.
Complementary and alternative therapies
What are these kind of interventions, guided imagery, meditation, yoga, biofeedback
Mind-body interventions
What type of therapies? Herbal products, vitamins, supplements, aromatherapy
Biologically based therapies
What type of therapies? Utilizes acupressure and acupuncture, massage, reflexology
Manipulatives and body-based therapies
What is? Based on the basic tenets of Chinese medicine that vital energy Chi flows along specific pathways that of many points of access and that manipulating these points, by either hands or needles, corrects imbalances by stimulating or removing blockages to energy flow. Thought to produce effects by regulating the nervous system and aiding the activity of endorphins and immune system cells at different sites in the body. Also thought to alter brain chemistry by changing the release of neural hormones and neurotransmitters.
Acupressure and acupuncture
What is? A process providing a person with visual or auditory information about the autonomic physiologic functions of his or her body, such as blood pressure, muscle tension, and brainwave activity. The person learns to consciously control these processes which were previously regarded as involuntary. Uses and stress related symptoms, pain, insomnia, neuromuscular problems, neurobehavioral disorders, enhancement of healing, athletic and work performance.
Biofeedback
What is? Therapeutic use of plants or oils to obtain many therapeutic effects, such as analgesic, psychological, and antimicrobial benefits. In psychiatry, olfactory stimulation used to elicit feelings or memories during psychotherapy.
Aromatherapy
What is? Practice of herbal medicine originated in China and is the oldest system of medicine. Relies on plant secure illnesses and maintain health. Similar to prescription medications, many plants contain active compounds that produce physiological effects. FDA approval is not required thus no uniform standards ensure quality control or potency.
Herbal products and supplements
What is? Used for attention deficit hyperactivity disorder, dyslexia, cognitive impairment, dementia, cardiovascular disease, asthma, lupus, and rheumatoid arthritis. Interacts with warfarin, increases anticoagulant effect.
Omega-3 fatty acids
What is? Use for depression, osteoarthritis, and liver disease. May cause hypomania, hyperactive muscle movements, and possible serotonin syndrome
Sam-e
What is? Used for depression, obesity, insomnia, headaches, and fibromyalgia. Found in high concentrations in Turkey. Increased risk of serotonin syndrome with use of selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, and St. John’s wort.
Tryptophan
What is? Used for enhancing the immune system in protecting cells against the effects of free radicals. Use for neurological disorders, diabetes, and premenstrual syndrome. Interacts with warfarin, increasing coagulate affect, antiplatelet drugs, and statins, increasing additive effect and risk of rhabdomyolysis
vitamin E
What is? Use for insomnia, jet lag, shiftwork, and cancer. Set timing of circadian rhythms and regulate seasonal responses. Interacts with aspirin, nonsteroidal anti-inflammatory drugs, beta-blockers, corticosteroids, valerian, kava kava, and alcohol. Can inhibit ovulation in large doses.
melatonin
What is? Use for bipolar disorder, hypertension, lowering triglycerides, and decreasing blood clotting. Interacts with warfarin, aspirin, NSAIDs, garlic, and ginkgo. May alter glucose regulation.
What is fish oil
What herbal? Menopausal symptoms, premenstrual syndrome, dysmenorrhea
Black cohosh
What herbal? For anxiety
Belladonna
What herbal? For sedation
Catnip
What herbal? Sedation and anxiety
Chamomile
What herbal? Delirium, dementia, sexual dysfunction caused by SSRIs
Ginkgo
What herbal? Depression and fatigue
Ginseng
What herbal? For sedation
Valerian
What is? Believed to increase blood circulation, improve lymph flow, improve musculoskeletal tone, and have a relaxing effect on the mind
Massage
What is? Consciously directing one’s attention to alter one state of consciousness. Produces physiological effects such as decreased heart rate, blood pressure, and respiratory rate; decreased anxiety; and increased alpha brain waves
Meditation
What is? Stimulates the body’s natural healing power through massaging the feet, hands, and years. It alleviates tension by cleaning crystalline deposits under the skin that may interfere with the natural flow of the body’s energy. Based on the mapping of body parts on the souls inside the feet, hands, and ears. Treats disorders related to the represented body parts by application of pressure. Use for back pain, migraine, infertility, sleep disorders, digestive disorders, and stress related conditions.
Reflexology
What is? Foods classified as yin and yang. Goals to keep the dietary yin and yang in balance and attempt to live in harmony with nature.
Macrobiotics
What is? Originated in Indian religious practices. Combines mind and body connection. Uses breathing, physical movements, and meditation.
Yoga
What is? A 21 item self reporting questionnaire for evaluating the severity of depression in normal and psychiatric populations.
Beck Depression inventory
What is? It assesses which of the early maladaptive characteristics of patient probably has
Schema questionnaire
What is this an example of? This three question technique example 1. Evidence for her negative belief. 2. How else can she interpret the situation? 3. If it is true, what are the implications?
Cognitive behavioral therapy
Chapter 9
Blank disorders of the most common of all psychiatric illnesses.
Mood disorders
These type of disorders have high degree of somatic symptomology that accompanies these disorders.
Mood disorders
What is? What are the most common human emotions, exists on a continuum ranging from the absence of depression at one into pathological levels that produce significant symptoms of psychiatric disorder called major depression at the other.
Sadness
What is? Can be a healthy reaction to life stressors that motivates a person to deal with events and emotions.
Mild depression
Blank can be pathological if: it is disproportionate to events and sustained over significant time. It significantly impairs normal social functioning. It significantly impairs normal somatic functioning. It is apparently unrelated to any identifiable event or situation in a person’s life
Sadness
What is? one of the most common psychiatric disorders; the primary unipolar affective disorder. A complex brain-based illness with a primary characteristic of a persistent disturbance in mood. An excessive or distorted degree of sadness that manifests with behavioral, affective, cognitive, and somatic symptoms. May have a known precipitating event, situation, or concern but often occurs without any precipitating stressor identified. Significantly interferes with daily functioning and goal attainment. Has complex genetic, biochemical, and environmental etiological factors.
Major Depressive Disorder
What theory? This theory assumes that early psychological development issues lay the foundation for depressive responses and later in life; that the accomplishment of the first stage of development in which the child is able to form relationships is normal; that during the second stage of development, the child experiences the loss of significant mothering person. Loss can be a real or imagined and is unexpected and overwhelming. The loss may be related to maternal death, illness, or emotional lack of availability or the birth of new sibling in the child’s perception of losing undivided, individualized attention from the mother. The child’s initial reaction is anger; however, the child feels unsafe to express his anger openly and directly. This may relate to the child’s fearing for their loss if he or she responds with anger or his or her subjective perception that anger is unacceptable. The child uses defense mechanisms to deal with conflict created by desire for the love object by co-occurring with anger for the love object. Instead of anger being express outward at the maternal figure, it turns inward because it is more acceptable and safer to be angry at oneself and at the mother. Anger at oneself is rationalized that the child assumes that loss of the mother was related to something bad that he or she did rather than to the caregivers action. Excessive guilt becomes a manifestation of the process of dealing with aggression experience with the loss of the mother’s attention. A similar emotional reaction such as low self-esteem, excessive guilt, and ability to cope with anger, self-destructive impulses occurs as an adult whenever a loss is experienced.
Aggressive turned inward theory Sigmund Freud
What theory? This theory represents a diathesis stress model in which developmental experiences sensitize a person to respond to stressful life events in a depressed manner. This theory assumes that people with a tendency to be depressed think about the world differently than nondepressed people in that depressed people are more negative and believe that bad things are going to happen to them because of their own personal shortcomings and inadequacies. This thinking promotes low self-esteem and beliefs that the person deserves to have bad things happen to him or her and promotes pessimistic perceptions about the world at large and about his or her future, as well as globalize the negativity to all events, situations, and people in his or her life. When confronted by stressful events, these people tend to appraise them and the potential consequence in a negative, hopeless manner and therefore more depressed than people of different styles.
Cognitive theory by Aaron Beck
What theory? This theory is a modified aspect of cognitive theory, which assumes that a person becomes depressed due to perceptions of lack of control over life events and experiences. These perceptions are learned over time, especially as the person perceives other seeing him or her as inadequate. Perceptions of lack of control lead to the person not adapting or coping. The person’s behavior becomes passive and nonreactive because the self-perceptions of personal characteristics of being helpless, hopeless, and powerless.
Learned helplessness and hopelessness. Martin Seligman
What is a genetic predisposition termed SNP?
Single nucleotide polymorphism disorder a clear genetic predisposition to depressive disorder
Having a depressed blank is the single strongest predictor of depression?
Parent
Children of depressed parents are how many times more likely to experience MDD in their lifetime? Have a blank chance of having a depressed episode before age 18
- 40%
The earlier the age of onset for MDD and the more severe the symptoms, the more likely it is that a person has a strong genetic predisposition for depression.
Neurovegetative symptoms commonly seen in major depressive disorder are related to functions of what two glands?
hypothalamus and pituitary
Dysphoria is often triggered by changes in levels of blank that occur during the menstrual cycle.
sex steroids
In response to stress, the hypothalamus releases blank, which then stimulates the pituitary to release blank. This then stimulates the adrenals to release blank.
corticotropin releasing hormone (CRH), adrenocorticotropic hormone (ACTH), Cortisol
Hyperactivity of the HPA has been shown to be present in people with blank, as have possible elevated blank levels
Major Depressive Disorder and cortisol
Evidence supports that major depression may be associated with what?
proinflammatory cytokine activation
Hypovolemic hippocampus and hypovolemic prefrontal cortex-limbic striatal regions is common in what mental health condition?
Major Depressive Disorder
Major depressive disorder is the leading cause of disability in the United States and is the most common psychiatric illness seen in primary care practices; however, only blank of people with major depressive disorder ever receive treatment
50%
Major depressive disorder can occur at any age; however, the average age of onset is what?
Mid-20s
Major depressive disorder is a greater source of morbidity for who than any other illness.
Women
Major depressive disorder is associated with high mortality; blank of people with MDD will die by suicide. People with MDD have a blank greater risk of premature death than normal control population.
15%, four
If left untreated, an episode of major depressive disorder usually lasts blank months or longer.
Four
People with first episode of major depression have approximately a blank risk of a second episode. People who experience a second episode have approximately a blank risk of 3rd episode. People who experience 3rd episode have approximately a blank risk of 4thepisode.
60%, 70%, 90%
Risk factors for what mental illness? Genetic loading especially a 1st degree relative, prior episode, female gender, postpartum., Medical comorbidity, single marital status, significant environment stressor especially multiple losses.
Major depressive disorder
These questionnaires are common for what mental illness?
Patient health questionnaire 9, Edinburgh postnatal depression scale, Beck Depression Inventory, Hamilton Depression rating scale.
Major depressive disorder
Typical somatic complaints for what mental illness? Bodily aches, pains, headaches, muscle pains, lack of energy, gastrointestinal problems.
Major depressive disorder
Women often reports depressive symptoms occurring in fixed pattern around blank days before onset of menses, so assess menstrual history.
Several days
Symptoms of depression that begin within 2 months of a significant loss such as death of a loved one and do not persist beyond 2 months are generally considered or not considered bereavement?
Considered. Beyond 2 months would be symptoms of MDD
Mental status exam findings of what mental health condition? Appearance: unkempt, tired looking, clothing showing little attention or care about how the person looks, dark-colored, loose fitting clothing, significant weight change from baseline. Mood: sad, depressed, anxious, irritable. Affect: constricted or blunted, sad, tearful, anxious, irritable. Speech: nonproductive, slow response times, monotonal intonation. Thought process: usually organized but may be disorganized if psychosis is present, slowing, distractible, ruminative. Thought content: morbid preoccupation, suicidal ideation exist on continuum of severity.
Major depressive disorder
Research evidence supports that it is or is not possible to predict accurately whether or when a person will attempt suicide?
Is not possible
List of what? Presence of psychotic symptoms, history of past suicide attempts, history of 1st degree relative who committed suicide, concurrent substance abuse or dependency, current serious health problem.
Suicide risk especially high for persons with the symptoms or history
Endocrine disorders common in what mental health condition? Hypothyroid, diabetes, hyperaldosteronism, Cushing’s or Addison’s disease
Major depressive disorder
Neurological disorders common in what mental health condition? Stroke, epilepsy, dementia, Huntington’s disease, sleep apnea, Wilson’s disease, neoplasms, head trauma, multiple sclerosis, Parkinson’s disease
Major depressive disorder
Cardiac disorders common in what mental health condition? Myocardial infarction, congestive heart failure, hypertension
Major depressive disorder
Infectious and inflammatory states common in what mental health condition? Mono nucleus, AIDS, pneumonia, lupus, temporal arteritis, tuberculosis
Major depressive disorder
Nutritional disorders common in what mental health condition? Pernicious anemia and pellagra
Major depressive disorder
Other disorders common and what mental health condition? Fibromyalgia, chronic fatigue syndrome, bereavement or grief reaction, electrolyte imbalance, uremia and other renal conditions
Major depressive disorder
Medications that can cause what mental health condition? Steroids, estrogen compounds, antihypertensive agents, anti-Parkinson’s agents, antineoplastic agents, antibacterial and antifungal agents, analgesics, Accutane, benzodiazepines
Major depressive disorder
How many episodes of depression before considering continuing antidepressants indefinitely?
More than two prior episodes of MDD
What are these in MDD?
Depressed mood, sleep rest disturbances, anxiety, irritability, impaired concentration, impaired memory, appetite disturbance, agitation, anhedonia, impaired energy and motivation
Target symptoms of antidepressant treatment
What class of antidepressants? Act primarily to increase serotonin levels in central nervous system by inhibiting their presynaptic reuptake
Selective serotonin reuptake inhibitors
What class of antidepressants? Elevate serotonin and norepinephrine levels primarily by inhibiting their presynaptic reuptake
Tricyclic acids
What class of antidepressants? Elevate serotonin and norepinephrine levels primarily by inhibiting MAO, the enzyme that breaks down monoamine neurotransmitters
Monoamine oxidase inhibitors
What class of antidepressants? Inhibit dual reuptake of norepinephrine and serotonin. Action very selective on neurotransmitters. Elevate serotonin and norepinephrine levels by inhibiting their presynaptic reuptake.
Serotonin norepinephrine reuptake inhibitors
What class of antidepressants? Inhibit dual reuptake of norepinephrine and dopamine. Action very selective on neurotransmitters. Elevate dopamine and norepinephrine levels by inhibiting their presynaptic reuptake.
Norepinephrine and dopamine reuptake inhibitors
What class of antidepressants? Dual action. Agonist of serotonin 5HT-2 receptors. Action very selective on neurotransmitters. Elevate serotonin levels by inhibiting serotonin reuptake.
Serotonin agonist and reuptake inhibitors
Specific foods to avoid for which drug group? Aged cheeses, such as blue, brie, camembert, and Roquefort. Meat: smoked, aged, and cured meats such as sausages, pastrami, and salami. Fish: Smoked, aged, and cured fish such as pickled herring and salted fish. Any aged and fermented beverages such as red wine, aged liquors, whiskey (gin and vodka permissible), beer (bottled and pasteurized permissible). Being incurred (tofu), soy products, sauerkraut, miso, yeast extract, MSG, right bananas, avocado
Tyramine free dietary considerations with monoamine oxidase inhibitors medications
What class of medications, first-line treatment for first episode of major depression with mild to moderate symptoms. Serious side effects are rare. Much safer in overdose than TCAs. Also effective for panic disorder, obsessive-compulsive disorder, bulimia, general anxiety disorder, social phobia, posttraumatic stress disorder, and premenstrual dysphoric disorder.
SSRIs
What class medications? Considered the second line drugs for treatment of major depressive disorder. Affect many neurotransmitters, leading to more side effects and possibly poor adherence. Anticholinergic: dry mouth, blurred vision, constipation, memory problems from muscarinic receptor blockade. Anti-adrenergic: orthostatic hypotension from alpha-1 receptor blockade. Antihistaminergic: sedation and weight gain from histamine receptor blockade. Electrocardiogram changes in cardiac dysrhythmias possible; avoiding clients known as susceptibility. Monitor EKG before treatment and annually in older adults. Unsafe and many co-occurring disorders such as cardiac disease. Known to induce hypomania and susceptible clients. Anticholinergic properties may be highly problematic but may also be useful in those who have significant bowel irritability. Adhere to a two week washout. Five weeks for fluoxetine before switching between the two classes of medications.
Tricyclic acids
Muscarinic receptor blockade side effects
Dry mouth, blurred vision, constipation, memory problems
alpha 1 receptor blockade side effects
Orthostatic hypotension
histamine receptor blockade side effects
sedation and weight gain
What class of medications? Not first or second line agents for major depressive disorder because of dangerous food and drug interactions. Hypertensive crisis occurs when taken in conjunction with foods containing tyramine a dietary precursor to norepinephrine. When inhibited tyramine exerts a strong vasopressin or affect stimulating the Reese of catecholamines, epinephrine, and norepinephrine, which can increase blood pressure and heart rate.
MAOIs or monoamine oxidase inhibitors
List of medications associated with what?
Meperidine, decongestants, TCAs, atypical antipsychotics, st. john’s wort, l-tryptophan, stimulants and other sympathomimetics, asthma medications
Hypertensive crisis with MAOIs
Medication to be given during a MAOI hypertensive crisis?
Phentolamine
List of symptoms associated with what? Agitation, restlessness, rapid heart rate, elevation of blood pressure, headache, sweating, shivering, goosebumps, mild clonic jerking, loss of coordination, confusion, fever, seizures, unconsciousness
Serotonin syndrome
List of clinically significant side effects of what drug class? Insomnia, hypertensive crisis, weight gain, anticholinergic side effects, lightheadedness, dizziness, and sexual dysfunction
MAOIs
What is? Grand mal seizure induced in an anesthetized person. Usual courses 6 to 12 treatments. Mechanism of action neurotransmitter theory increases dopamine, serotonin, and norepinephrine. Releases hormones such as prolactin, thyroid stimulating hormone, pituitary hormones, endorphins, and adrenocorticotropic hormone
Electroconvulsive therapy
What is? Involves placement of a small wire coil on scalp to conduct electrical current, creating a magnetic field through the tissues of the head. Sessions typically last 40 minutes in typical course is five sessions per week for six weeks.
Transcranial magnetic stimulation
What is? Pacemaker -like device implanted in left side of chest the stimulate left branch of nerve; transcutaneous device being tested
Vagal nerve stimulation
What is? 2500 to 10,000 lux light for 30 minutes up to two hours 1 to 2 times daily
Phototherapy
What type of therapy? Modifies perceptions, decreases negativity, increased sense of internal control, enhance coping skills, modify environmental factors contributing to illness.
Cognitive behavioral therapy
What type of therapy? Focus on precipitant stressor, cope with immediate impact of major depressive disorder on personal life, modify contributory environmental factors
Brief therapy a.k.a. solution focused therapy
What type of therapy? Improve decision-making, improve socialization skills, improve assessment of individual strengths, gain new coping skills
Group therapy
What type of therapy? Enhance family coping, improved knowledge base, plan for relapse, gain insight into effects of major depressive disorder on family unit, undertake psychoeducation for family members about the illness state of major depressive disorder.
Family therapy
What type of therapy? Modifies perceptions, decreases negativity, increased sense of internal control, enhance coping skills, modify environmental factors contributing to illness.
Cognitive behavioral therapy
What type of therapy? Focus on precipitant stressor, cope with immediate impact of major depressive disorder on personal life, modify contributory environmental factors
Brief therapy a.k.a. solution focused therapy
What type of therapy? Improve decision-making, improve socialization skills, improve assessment of individual strengths, gain new coping skills
Group therapy
What type of therapy? Enhance family coping, improved knowledge base, plan for relapse, gain insight into effects of major depressive disorder on family unit, undertake psychoeducation for family members about the illness state of major depressive disorder.
Family therapy
Risk factors for what? Ages 45 or older if male, ages 55 or older if female, divorce, single, or separated, white, living alone, psychiatric disorder, physical illness, substance abuse, previous suicide attempt, family history of suicide, recent loss, male gender
Risk factors for suicide
What is? A disorder similar to major depressive disorder but with less acute symptoms; with a more protracted, chronic disease course; and without any manifestation of psychotic symptoms. Less discrete episodes of illness than major depressive disorder. Symptoms often go undetected and therefore untreated for years. Vegetative symptoms much less common in this disorder when compared to major depressive disorder
Persistent depressive disorder also known as dysthymia
Some core symptoms are less common in this age group before onset of puberty: psychosis, motor retardation, hypersomnia, increase appetite
Children
Major depressive disorder often has a strong separation anxiety component and what age group
Children
What percentage of elderly are more likely to die within the first year in a long-term care facility?
65%
Cognition and memory symptoms of major depressive disorder in the older adult population often are confused with dementia related symptoms called what?
Pseudo-dementia
Clients with dementia usually have a premorbid history of what declining condition?
Slowly
A major depressive disorder, cognitive changes have a relatively what onset and are significant when compared to premorbid functioning?
Acute
Symptoms of what syndrome? Autonomic instability, altered sensorium, restlessness, myoclonus, hyperreflexia, hypothermia, diaphoresis, tremor, chills, diarrhea and cramps, ataxia, headache, and insomnia
Serotonin syndrome
SSRIs and MAOIs, drug and herbal interactions, SSRIs and St. John’s wort. These drug combinations can cause what?
Serotonin syndrome
Clients who have had blank or more episodes of major depressive disorder usually require lifelong medications
Three
Common in this mental health diagnosis: chronically depressed mood that occurs for most of the day, more days than not, for at least two years. Prominent presence of low self-esteem, self-criticism, and a perception of general incompetence compared to others.
Persistent depressive disorder or dysthymia
What mental health diseases associated with these personality disorders: borderline, histrionic, narcissistic, avoidant, and dependent
Persistent depressive disorder or dysthymia
This mental health disease is associated with several childhood disorders: attention deficit hyperactivity disorder, conduct disorder, anxiety disorder, and learning disorders.. Symptoms required for diagnosis is only one year compared with two years for adults. In children, the mood usually described as irritable rather than sad but may report both irritability and sadness. Low self-esteem, poor social skills, and pessimism.
Persistent depressive disorder or dysthymia
Unlike in major depression, blank is usually preserved in the grieving person.
Self-esteem
In the absence of other significant clinical symptoms, blank usually is classified as adjustment disorder
Grief
Blank percent of older adults who lose a spouse experience depression within the first year that loss
20%
Grief occurs in blank percent of clients after cardiac surgery
50%
What mental health diagnosis? Dysphoric symptoms that occur in response to changing sex steroid hormones which occurred during the ovulatory menstrual cycle. Symptoms generally began during the luteal phase, approximately one week before onset of menses, and generally left within a day or two after menses has begun. Common symptoms include: marked lability, irritability, depressed mood, anxiety, low energy, sleep disturbance. Symptoms occur repeatedly during each menstrual cycle and there must be a symptom free. In the follicular phase, after menses has occurred. Symptoms may worsen as the woman becomes perimenopausal. Symptoms cause marked impairment in functioning and sense of well-being. A careful evaluation must be completed to rule out other mood disorders. Treatment may consist of hormonal contraceptives, SSRI antidepressants, or both.
Premenstrual dysphoric disorder
What mental health diagnosis? Complex brain-based illness with the primary characteristic of disturbance and mood. Mood disturbance often of both polarities: depressive, expansive or manic. Several patterns: single polarities symptoms only, distinct symptom patterns of alternating polarity, manic symptoms alternating with depressive symptoms. Mixed co-occurring symptoms. Presents with excessive or distorted degree of sadness or relation, or both. Manifests with behavioral, affective, cognitive, and somatic symptoms. May have precipitating event, situation, or concern but often occurs without any precipitating stressor identified. Has complex genetic, biochemical, environmental etiological factors
Bipolar disorder
Biological theories for what mental health disorder? GABA deregulation, increase noradrenergic activity, voltage gated ion channel abnormalities, brain becomes overly sensitive to electrical stimuli, Neuronal misfiring occurs, process becomes automatic; neuronal firing occurs even without stimuli.
Bipolar disorder
Blank increased risk is relative has bipolar disorder1
24%
Blank increased risk if relative has bipolar disorder type II
5%
What mental health diagnoses? Period of abnormally or persistently elevated, expansive, or irritable mood, lasting for at least one week. Mood episode has rapid development and escalation of symptoms over a few days. Often precipitated by significant environmental stressor. Mood disturbance may result in brief psychotic symptoms. Manic episodes last days of several months. Brief duration and ending more abruptly the major depressive episodes. In 60% of people, major depressive episode immediately precedes or follows manic episode. Persistent of other suggestive symptoms: decreased need for sleep, feels rested after three hours sleep on average, usually a marked difference from normal baseline sleep pattern, inflated self-esteem, grandiosity, increase goal-directed activities, excessive involvement in pleasurable activities with a high potential for painful consequence, unrestrained buying sprees, sexual indiscretions, unsound business ventures, excessive substance use or abuse, and highly recurrent depressive episodes. Recurrent shifts in polarity referring to major depressive episodes to manic episodes or mixed episodes.
Bipolar disorder
What is? Similar to mania, more brief in duration, episode not as severe as mania, does not require hospitalization, does not cause significant functional impairment.
Hypomania
Common symptoms and what mental status exam findings? Psychomotor restlessness or agitation, frequent change of dress, prone to bright colored, often sexualized dress, dramatic or flamboyant dress usually out of character for person when compared to non-symptomatic periods. Speech is rapid loud pressured difficult interop joking relevant amusing word clanging and severely ill clients. Affect is often labile, irritable, overly theoretical and dramatic. Mood is euphoric cheerful high expensive irritable. Thought process is thought racing flight of ideas thoughts disorganized incoherent and severely ill clients. Thought content often inflated, indiscriminate enthusiasm, inflated sensibilities bordering on delusional, increase sexual content. Orientation usually fully. Memory impaired short-term and care to recall. Concentration highly distractible. Judgment is poor prone to imprudent behavior choices for potential for negative consequences. Insight the person usually does not recognize that he or she is ill. Resist treatment options.
Mania typical for bipolar.
If first onset of manic symptoms occur after age 40, most likely symptoms are or are not caused by another medical condition.
Are caused by another medical condition.
This list of medical conditions can mimic what symptoms? Endocrine disorders, hyperthyroidism, intoxication or withdrawal from illicit drug use, medications, and even some antidepressants.
Manic symptoms
These medications can cause what?
Captopril, cimetidine, corticosteroids, cyclosporine, disulfiram, hydralazine, isoniazid
Manic symptoms
What medication is the gold standard for treating manic episodes, evidence of anti-suicidal effects,
Lithium
What drugs therapeutic serum range is 0.5 to 1.2 and when do you draw the level?
Lithium, 12 hours post dose
Clinical findings with toxicity of what medication? Weight gain, impaired thyroid functioning, hand tremors, fatigue, mental cloudiness, headaches, nystagmus, maculopapular rash, pruritus, Acme, G.I. upset, diarrhea, vomiting, cramps, anorexia, polyuria, diabetes insipidus, edema, t wave inversions, dysrhythmias, leukocytosis.
Lithium
Black’s box warning for what anticonvulsant medication: agranulocytosis and aplastic anemia
carbamazepine
Black box warning for what medication: hepatotoxicity and pancreatitis
valproic acid/divalproex
Black box warning for what medication: serious rash
Lamotrigine
When should labs be drawn after start of Tegretol, Depakote and what labs?
One week, standardize rating scales help to monitor clinical status or, 12 hour trough serum drug level, CBC, LFTs
Signs and symptoms of what life-threatening syndrome? Facial swelling, tongue swelling, macules, papules, confluent erythematic rash, burning rash, prodromal headache, malaise, arthralgia, and painful mucous membranes may occur before rash occurs.
Steven Johnson syndrome
Standardized rating scales help monitor clinical status, establish baseline functioning, and monitor disorder course over time. What is one used for mania?
Young mania rating scale
Routine evaluation of CBC, renal function, and thyroid and parathyroid function including thyroid stimulating hormone calcium levels is needed for clients taking what long term?
Lithium
What mental health diagnoses? Chronic/fluctuating mood disorder with symptoms similar to but less severe than bipolar disorder. Numerous periods of hypomanic and dysthymic symptoms
Cyclothymic Disorder
What mental health diagnosis? Fluctuating mood episodes, affected people can function well during hypomanic episodes, may experience clinically slipped into stress or impaired function related to cyclicity, unpredictable mood changes, often regarded by others as temperamental, moody, unpredictable, inconsistent, and unreliable. No psychotic episodes.
Cyclothymic disorder
What level of anxiety? Normative level experienced by all, which functions to motivate. Vital signs normal, pupils constricted, minimal increase in muscle tone. Perceptual field broadened, heightened awareness of environment.
Level 1 mild anxiety
What level of anxiety? Normative level experienced by most in response to significant stressors. Vital signs normal, mild increased heart rate, moderate increase in muscle tone. Subjective feeling of tension or worry, narrowed perceptions.
Level 2 mild anxiety
What level of anxiety? Pathological level. Autonomic nervous system triggered, fight or flight response, pupils dilated, vital signs increased, diaphoresis, muscles rigid, hearing decreased, pain threshold increase, urinary frequency, diarrhea. Perceptual field greatly narrowed, difficulty with problem solving, distorted perception of time, selective inattention, dissociative sensations, autonomic behavior. Scattered perceptions
Level III Severe Anxiety.
What level of anxiety? Pathological level. Your symptoms markedly increased. Client is pale, hypotensive, as poor eye hand coordination, muscle pains, marked decrease in hearing, dizziness, shortness of breath. Scattered perceptions, unable to attend to environmental stimuli, logical thinking, may exhibit hallucinations or delusions.
Level IV panic
What is? A Latino cultural syndrome usually provoked by disruptions and family bonds and may be manifested by trembling, crying, and screaming. The attacks are usually variance in the presence of others in the person often feels relief afterwards
Ataques de nervios
What is the first-line treatment for children at a tour diagnosed with an anxiety disorder.
Psychotherapy
What is this theory? This theory is based on work of who, who believed that anxiety initially occurs in response to the stimulation of birth in need of the input to adapt to the changed environment. Subsequent anxiety results from intrapsychic conflict. The process of unconscious repression of sexual drive is at the core of much of the conflict. Conflict exists between instinctual needs of the id and the superego a.k.a. conscience; anxiety signals the person of the need to deal with the id superego conflict. Conflict is unconscious, but anxiety is consciously perceived. Conflict entails spirit of punishment and of doing wrong. Defense mechanisms are unconsciously used by the person that the conflict. The behavioral manifestations of anxiety disorder stem from the pathological overuse of defense mechanisms.
Sigmund Freud, psychodynamic theory
What theory? This theory is based on work of who, who believe that humans are goal directed toward attainment of satisfaction and security needs. Satisfaction and security needs are normally met in interpersonal interactions. Anxiety arises when a person’s needs are unmet. Anxiety is first experience in infants interactions with his or her mother. When anxiety arises because of interpersonal conflict. Conflict occurs when a person perceives his or her needs will not be met because read action, feelings of inferiority, or inability to engage with significant others. Sense of self becomes based on the person’s perception of how others view him or her.
Interpersonal theory
What theory? Pathological levels of anxiety result from neurobiological deficits in normal brain functioning. Deficits are genetically mediated by and involve predominantly the limbic system, midline brain system area, and sections of the cortex. Deficits predispose a person to abnormal stress responses, with hyperactivity of autonomic nervous system causing symptoms such as increased heart rate and pressure, diaphoresis, papillary dilation, tremors, and increased respiratory rate.
Neurobiological theory
Threat is perceived, and blank signals the hypothalamus to secrete blank.
Amygdala and corticotrophin-releasing hormone.
The amygdala also activates the what to start the fight or flight response.
Sympathetic nervous system
The pituitary is stimulated to release what?
Adrenocorticotropic hormone
The adrenal glands stimulated by the what and stimulates the release of what which in turn off the alarm system and restores the body to homeostasis.
Adrenocorticotropic hormone and cortisol in
In anxiety disorders, the amygdala may not be able to shut off the response or there may not be enough what the stop the fight or flight response.
Cortisol
Neurobiological deficits results in low levels of the neurotransmitter gamma aminobutyric acid, chemical responsible for inhibitory responses neurons in high levels of norepinephrine, the chemical associated with what response?
Fight or flight
Neurotransmitters involved in suppressing the HPA axis are what and what?
Serotonin and GABA
A first degree relative of a person with panic disorder is up to blank times more likely than general population to develop panic disorder
8 times
If a first-degree relative of a person developed panic disorder before age 20, that person is up to blank times more likely than general population to develop panic disoder
20 times
This disorder is common, with the lifetime surveillance of 28.8% among the general US population. Except for obsessive-compulsive disorder and social phobia, this disorder is common in girls and women more so than boys and men. This disorders manifest in adolescence and early adulthood. Median age is 11.
Anxiety
Is it pathological level of anxiety or not? Anxiety is perceived of as distressing and out of control, anxiety is not seen as caused by life events, anxiety is accompanied by somatic complaints, anxiety interferes with social, occupational, and recreation activities and with activities of daily living.
Pathological level of anxiety
What is the Hamilton rate scale used for?
Establishing and monitoring the client’s anxiety level over time.
Most of the medications known to improve symptoms of anxiety act directly or indirectly on the blank systems
GABA system
Standardized rating scales used for what? Zung’s Self-rating Scale, Hamilton Rating Scale, and Yale-Brown Scale
Anxiety.
What mental health disorder is experienced as discrete episodes or attacks with sudden onset of intense apprehension, fearfulness, or terror, often associated with sense of impending doom. Attacks occur without warning and in the absence of any real danger. Attacks build the peak of intensity without a short, self-limiting time, usually within 10 minutes of onset. Is more common in women than in men.
Panic disorder
Diagnostic criteria of what disorder? Discrete episode in which client experiences 4 or more of the following symptoms having a sudden onset and peaking within 10 minute of onset: Paresthesia, chills or hot flushing, fear or losing control or of going crazy, fear of dying, shortness of breath or smothering sensation, palpitations, pounding, or accelerated heart rate, chest pain, tightness, or discomfort, sweating, trembling or shaking, nausea or abdominal distress. After first attack, persistent concern over having another attack, worry over the consequences of initial attack, or a significant behavioral change related to attack. With high somatic sensations, clients are often sensitive to new somatic experiences or perceptions. Often intolerant of or concerned with common side effects of medication treatments. Discouraged or ashamed about “failure” to control emotions and over concern about dying when no other pathology identified.
Panic Disorder
What mental health disorder is experienced as discrete episodes or attacks with sudden onset of intense apprehension, fearfulness, or terror, often associated with sense of impending doom. Attacks occur without warning and in the absence of any real danger. Attacks build the peak of intensity without a short, self-limiting time, usually within 10 minutes of onset. Is more common in women than in men.
Panic disorder
Diagnostic criteria of what disorder? Discrete episode in which client experiences 4 or more of the following symptoms having a sudden onset and peaking within 10 minute of onset: Paresthesia, chills or hot flushing, fear or losing control or of going crazy, fear of dying, shortness of breath or smothering sensation, palpitations, pounding, or accelerated heart rate, chest pain, tightness, or discomfort, sweating, trembling or shaking, nausea or abdominal distress. After first attack, persistent concern over having another attack, worry over the consequences of initial attack, or a significant behavioral change related to attack. With high somatic sensations, clients are often sensitive to new somatic experiences or perceptions. Often intolerant of or concerned with common side effects of medication treatments. Discouraged or ashamed about “failure” to control emotions and over concern about dying when no other pathology identified.
Panic Disorder
What mental health diagnosis is characterized by avoidance of places or situations from which escape may be difficult or embarrassing or in which help may not be available in the event of perceived need, such as a panic attack. Up to 50% of people meeting criteria for this report panic attacks or panic disorder preceded onset of this. The anxiety usually leads to avoidant behavior that impairs a person’s ability to travel, to work, or to carry out responsibilities of daily living. Differential diagnosis is assisted by the awareness that people with agoraphobia feel better and report less significant concerns with anxiety when accompanied by a trusted companion. When people meet criteria for this and panic or other anxiety disorder, both diagnoses should be assigned.
Agoraphobia
If first episode of panic attack symptoms occur after age 45 consider what?
Consider general medical disorder
Agoraphobia subtype; examples include driving, enclosed spaces, tunnels or bridges, or flying
Situational Type
Agoraphobia subtype; examples include driving, enclosed spaces, tunnels or bridges, or flying
Situational Type
Agoraphobia subtype; cued by seeing blood or an injury or by receiving an injection or other invasive medical procedure
blood injection injury type
Agoraphobia subtype; cued by seeing blood or an injury or by receiving an injection or other invasive medical procedure
blood injection injury type
Agoraphobia subtype; fear cued by choking, vomiting, or fear of a specific illness
other type.
What mental health diagnosis is a marked and persistent fear of social or performance situations in which embarrassment may occur. Levels often are sufficient to fit criteria for a situationally bound panic attack. The disorder has an estimated 3 to 13% prevalence rate amongst the U.S. population. Rates are equal for the genders. Should be diagnosed only if symptoms persist for longer than 6 months.
Social Anxiety Disorder
Common descriptive features of this mental illness:
Hypersensitivity to criticism, negative self evaluations, sensitivity to rejection, low self esteem, inferiority feelings, lack of assertiveness. Common physical exam findings sweating, tremors, palpitations, muscle tension, diarrhea, blushing
Social Anxiety Disorder
What mental health illness? Excessive worry, apprehension, or anxiety about events or activities occurs more days than not for a period of at least 6 months. The person finds it hard to control it. No clear link exists to life events or stressors. Worry and anxiety interfere with activities of daily living. The nature and focus of worry shift frequently. A pattern of waxing and waning of symptoms exists. Symptoms worsen as life events stress the person.
General Anxiety Disorder
What mental health illness? Anxiety and worry are out of proportion to the actual likelihood or effect of the feared event. People report subjective distress caused by the constant worry but do not always describe the worry as excessive. Excessive anxiety and worry last for more days than not for at least 6 months. The person finds it difficult to control.
General Anxiety Disorder.
What mental health illness? Anxiety and worry are out of proportion to the actual likelihood or effect of the feared event. People report subjective distress caused by the constant worry but do not always describe the worry as excessive. Excessive anxiety and worry last for more days than not for at least 6 months. The person finds it difficult to control.
General Anxiety Disorder.
What mental health illness? Developmentally inappropriate and excessive distress occurring after the age of four when faced with separation from a major attachment figure.
Separation anxiety disorder
What mental health illness? Is the presence of anxiety provoking obsessions or compulsions that function to reduce the person subjective anxiety level. Defined as recurrent and persistent thoughts, impulses, or images that are experiencing cause anxiety and distress. Experienced as intrusive and inappropriate. Ego dystonic experience in which a person feels the content of the session is alien to his or her belief structure and not the kind of common thought, impulse, or image here she usually experiences
Obsessive-compulsive disorder and definition of accession
What mental health illness? Disease rates higher in people with a 1st degree relative who has this versus the general population. Rates are also higher in people with a 1st degree relative who has Tourette’s syndrome than in the general population. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections or pandas should be considered in all children with sudden onset of the symptoms.
Obsessive-compulsive disorder
What mental health disease? Is the reexperiencing of an extremely traumatic event accompanied by symptoms of increased arousal and avoidance of stimuli associated with the trauma. Trauma includes military combat, violent personal assaults such as robbery or rape, kidnapping or hostage situation, terrorist attack, torture, prolong sexual abuse, natural or human made disasters, observing the death of or significantly injury to another, unexpectedly witnessing of any of the above traumas, learning of the sudden or unexpected death of a significant injury to family member or close friend. Symptoms cannot predate exposure to trauma.
PTSD
What mental health disease? Is the reexperiencing of an extremely traumatic event accompanied by symptoms of increased arousal and avoidance of stimuli associated with the trauma. Trauma includes military combat, violent personal assaults such as robbery or rape, kidnapping or hostage situation, terrorist attack, torture, prolong sexual abuse, natural or human made disasters, observing the death of or significantly injury to another, unexpectedly witnessing of any of the above traumas, learning of the sudden or unexpected death of a significant injury to family member or close friend. Symptoms cannot predate exposure to trauma.
PTSD
Duration of symptoms less than three months for this mental illness
Acute PTSD
At least six months between traumatic event and the onset of symptoms for this mental illness
Delayed onset PTSD
At least six months between traumatic event and the onset of symptoms for this mental illness
Delayed onset PTSD
What mental health illness? Depersonalization or derealization and amnesia. Defense mechanism that protects a person from overwhelming anxiety by emotionally separating. Causes gaps or interruptions in the person’s memory. Persistent feeling of oneself not being real or in the environment not being real reality testing remains intact. Perceived as uncomfortable. Characterized by two or more distinct personality states.
Dissociative disorders
What mental health illness? Depersonalization or derealization and amnesia. Defense mechanism that protects a person from overwhelming anxiety by emotionally separating. Causes gaps or interruptions in the person’s memory. Persistent feeling of oneself not being real or in the environment not being real reality testing remains intact. Perceived as uncomfortable. Characterized by two or more distinct personality states.
Dissociative disorders
What mental health diagnosis? Preoccupation with one or more perceived defects or flaws in physical appearance. Engages in repetitive behaviors in response to appearance concerns. Preoccupation causes considerable distress. Insight ranges from good to poor to absent.
Body dysmorphic disorder
What mental health diagnosis? Persistent difficulty discarding possessions, regardless of actual value. Experiences marked distress in response to pressure to discard. Results in accumulation of possessions that compromise living space or ability to function, including maintaining a safe environment for self or others. Insight ranges from good to poor to absent.
Hoarding disorder
What mental health diagnosis? Recurrent pulling out of one’s hair despite repeated attempts to stop. Causes significant distress or impairment in functioning. Her bowling is not an attempt to improve perceived deficit or flaw.
Trichotillomania
What mental health diagnosis? Recurrent skin picking that results in lesions despite attempts to stop. Results in significant distress or impairment. Behavior not better explained by physiological response the substance or intentional attempt at self harm.
Excoriation Disorder
