Pre Midterm Behavior science Flashcards
What is a mental disorder?
A disturbance in an individuals mood, associated with stress or impairment.
What is Intermittent Explosive disorder?
IED is catorized by either; Recurrent behavior outbursts representing an inability to control ones emotions occurring twice weekly, on average, for a period of 3 months. -or-
2. Three behavioral outbursts involving damage or
destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period.
What is Provisional diagnosis used for?
When the Pt is expected to have the disease but duration criteria has not yet been made or the Pt information is not available. e.g. “Bulimia Nervosa. Provisional”
What is the difference between unspecified and other specified?
“Unspecified”: Clinician chooses not to specify why a patient fails to meet criteria for a specific disorder.
“Other specified”: Clinician DOES choose to specify why a patient fails to meet criteria for a
specific disorder.
All anxiety disorder share what in common?
The anxiety is excessive in duration and free from reasonable cues.
What is the physiological cause of anxiety?
Stimulation of the Hypothalamic-pituitary-adrenal axis by the amygdala, causing the release of cortisol
Panic Disorder
Recurrent and unexpected panic attacks. For at least one month the individual must show fear of future attacks or avoidance behavior.
Agoraphobia
Because of fear that escape may be difficult, an
individual excessively fears at least 2 of the following situations: Agoraphobia situations:
•Using public transportation
•Being in open spaces
•Being in enclosed spaces
•Standing in line or being in a crowd
•Being outside of the home alone
Generalized Anxiety Disorder
Uncontrolled anxiety about multiple events
occurring the majority of days for > 6 months.
Several (at least 3) of the following*
• restless, on edge • fatigued
•↓concentration
• irritability
• muscle tension
• insomnia
Usually pts are seen by physicians due to physical symptoms.
OCD
Unwanted recurrent thoughts, images or actions that increase anxiety.
Recurrent actions that reduce anxiety.
May be the result of reduced serotonin levels.
OveractivePrefrontal-striatal overactivity
•orbital prefrontal→ant. cingulate→caudate nucleus→thalamus “loop”
What is PANDAS?
In rare cases, OCD begins after a streptococcal infection, known as PANDAS*
*Pediatric Autoimmune Neuropsychiatric Disorders
Associated with Streptococcal Infections
What are two additional therapies to treat OCD?
Psychosurgery: Surgical (or radiation) lesioning
of either the:
•ant. cingulate gyrus (cingulotomy)
•ant. limb of the internal capsule (capsulotomy).
Deep Brain Stimulation:
Electrical impulses are delivered by an indwelling brain electrode attached to an implanted thoracic pacemaker
Excoriation disorder
Recurrent skin picking resulting in skin lesions
•Attempts to stop picking
•Picking results in significant distress/functional
impairment
Tricholtillomania
Obsessive pulling out of ones hair, pulling causes significant distress and impairment.
PTSD
Exposure to traumatic event results in any of the following symptoms at ANY time: 1) Intrusion Symptoms •dreams •recollections •feeling event reoccur •psychological or physiological distress when encounters symbols 2) Avoidance Symptoms avoidance of thoughts, places, or conversations, that are reminders of event. 3) Negative Alterations in Cognition and Mood •negative beliefs/expectations •negative emotional state •anhedonia or inability to experience positive emotion •detachment from others •dissociate amnesia 4) Alterations in Arousal and Reactivity •sleep disturbance •irritable and angry •reckless or self-destructive behavior •concentration problems •hypervigilance •exaggerated startle response
Acute stress disorder
PTSD symptoms for a duration of 3 days to 1 month after exposure to stress. Symptoms start and resolve within 30 days after event.
Adjustment disorder
Development of significant (and disproportional)
emotional/behavioral symptoms Due to an identifiable psychosocial stressor (often
an ordinary life experience)
•acute onset (symptoms develop within 3 months of stressor onset)
•brief duration (symptoms resolve within 6
months after stressor termination)
Somatic symptom Disorder
at least 1 distressing/disruptive somatic symptom
at least 1 of the following indicators of excessive thoughts/feelings/behaviors about the somatic symptom:
Disproportionate thoughts about the seriousness of the symptom
•High levels of anxiety about the symptom
•Excessive time/energy devoted to the symptom
•Persistent symptomatology (usually >6 mos)
Illness anxiety disorder
Preoccupation with having/acquiring a serious
illness despite NOT having somatic symptoms
(or, if present, symptoms are only mild in
intensity).
•There is high anxiety about health, and the
person is easily alarmed about personal health
status.
•Excessive health-related behaviors are
performed or health care is avoided.
•Illness preoccupation has been present >
6 mos.
Specify whether:
•Care-seeking type
•Care-avoidant type
Conversion Disorder
Medically unexplained symptoms, altered voluntary motor or sensory fxn, incompatibility between symptoms and neurological findings.
Sudden onset after trigger, La Belle Indifference.
Usually short duration without recurrence.
There is usually a motivation to having the symptoms.
Factitious disorder
Pts fakes symptoms in absence of reward, can be done on self or imposed on another individual, “by proxy” Can be detected by dramatic symptoms and incomplete/inconsistent medical Hx.
Malingering
Factitious disorder with the goal of achieving a benefit.
Dissociative Amnesia (Psychogenic amnesia)
Memory loss for autobiographical information,
which doesn’t occur as part of another disorder.
Localized: Total loss of personal memory during a circumscribed period.
Selective: Some (but limited) recall of personal
memories during a circumscribed period of time.
Generalized: Loss of personal memory of entire life up to and including event.
Physical amnesia is usually retrograde, psychogenic is usually retrograde.
Dissociative Fugue
Fugue: Purposeful travel or bewildered
wandering associated with amnesia for identity or
other autobiographical information.
Dissociative Identity disorder
Diagnostic Criteria
1) Disruption of identify characterized by >2
distinct personalities states:
•The Primary (host)
•An Alter
2) Inability to recall personal information
(as evidenced by frequent memory gaps in host while alters take control)
Depersonalization/derealization disorder
Either (or both) of the following:
Depersonalization: Experiences of unreality,
detachment or being an outside observer with
respect to one’s thoughts, feelings, sensations, body or actions.
Derealization: Experiences of unreality or
detachment with respect to surroundings (e.g.,
objects seem unreal or dreamlike)
Continued drug use and relapse is due to 5 factors, what are they?
1) Drugs stimulate the brains Dopaminergic reward pathway.
2) Stimulation of the reward pathway stimulates the pre-frontal cortex, altering self control.
3) Drug use may cause brain changes that result
in physical withdrawal symptoms upon drug
cessation. This discomfort may drive relapse.
4)Repeated drug use decreases the availability
of dopamine. This is associated with feelings
of anhedonia, which often leads to relapse.
(AKA the “protracted abstinence syndrome”)
5) Drug use has been paired with environmental
(and internal) cues, and these cues cause
physiological changes that trigger drug-
seeking behavior.
What are the CAGE and FOY questions of alcohol abuse?
C: Do you feel the need to CUT back on your drinking?
A: Do you get ANNOYED with others for criticizing your drinking?
G: Do you ever feel GUILTY about drinking?
E: Do you ever need an EYE opener (a drink in the
morning)?
yes to 2 or more is very suspicious
FOY “Has concern about your drinking behavior
been expressed by your Family, Others, or Yourself?”
What are the acceptable drinking limits for Men and Woman?
Men= 4 drinks/day or 14/week Woman=3/day or 7/week
When do withdrawal effects take place?
within 72 hrs of cessation of drug and may last up to 2 weeks
Substance use disorder
A maladaptive pattern of substance use as manifested by >2 of the following 11 symptoms n a 12-month period:
(1) Taken in a larger amount (or for longer) than
intended
(2) Persistent unsuccessful attempts to cut back
(3) Time consuming (obtaining, using, recovering)
(4) Cravings for the substance
(5) Reduction of important activities
(6) Failure to fulfill major obligations
(7) Use in physically hazardous situations
(8) Social/interpersonal problems related to
substance
(9) Use despite having physical/psychological
problem related to substance
problem related to substance
(10) Tolerance (↓effect of a dose due to repeated use)
(11) Withdrawal syndrome
What is the difference between drug Abuse and dependance?
Abuse is a pattern of use despite negative consequences. Dependance is a pattern of drug use involving compulsive drug seeking behavior.
Explain the Schedule of drugs?
Schedule I: Drugs with a high harm risk and NO
safe, accepted medical use.
•Examples: heroin, marijuana, LSD, and Ecstasy
Schedule II: Drugs with a high harm risk but with
safe and accepted medical use. These drugs are
highly addictive. Examples: most opioids and stimulants and some barbiturates.
Schedule III, IV, V: Drugs with a harm risk less
than Schedule II drugs with safe and accepted
medical uses in the U.S.
What are the major sedatives?
Alcohol, Benzo’s, Barbituates: Sedatives result in dis-inhibition, and repository depression. Withdraw can result in extreme ANS hypersensitivity
What is formication?
The sensation of Bugs crawling under your skin from alcohol withdrawal.
What two drugs are commonly given to combat alcoholism?
Disulfiram (Antabuse) inhibits the enzyme that
breaks down acetaldehyde.
•After alcohol consumption, acetaldehyde
accumulation causes a toxic reaction (e.g.nausea) lasting 30-60 min.
Naltrexone (Revia): An opioid receptor
blocker that reduces the pleasurable effects of
alcohol.
Acamprosate
(Campral): An NMDA receptor
blocker that reduces craving for alcohol by
decreasing the uncomfortable feelings associated
with protracted abstinence.
What are the signs of Inhalants?
Rashy, red and runny nose, chemical smell, face discoloration
• Inhalants can result in significant morbidity
(organ failure) and mortality (“sudden
sniffing death”).
• No withdrawal syndrome is recognized.
What are the key symptoms of Stimulants?
PSYCHOLOGICAL • euphoria and grandiosity • psychomotor acceleration & stereotypes •paranoia & hallucinations •paranoia & hallucinations PHYSICAL • elevated heart rate & bp (life threatening) • appetite loss and insomnia • mydriasis • seizures
What are the major symptoms of stimulant withdrawal?
- dysphoric mood (MUST BE SEEN)
- fatigue and psychomotor slowing
- hypersomnia with vivid unpleasant dreams
- increased appetite
What are the Sx of Opiod intoxication?
• initial intense rush followed by: ■euphoria and drowsiness ■dysphoria (as the high dissipates) ■dysphoria (as the high dissipates) • miosis • unconscious • respiratory depression
What drug can be used for Tx of opiod overdose?
What about long term Tx for Opioid abstinence therapy?
Naloxone; short acting opioid antagonist
naltrexone: (a long-acting opioid receptor blocker) to block opioid effects if relapse occurs.
Sx of Opioid withdrawal?
- dysphoria
- nausea, vomiting, diarrhea
- muscle aches, lacrimation and rhinorrhea
- piloerection, sweating, fever
- yawning
- pupillary dilation
What are two replacement therapy drugs for Opioid addiction?
Methadone (schedule II) and Buprenorphine (Schedule III) Buprenorphine can be available from a Dr’s office, vs Methadone which needs a federal Tx program for dispersal.
Gender Dysphoria
•A marked incongruence between one’s assigned (natal) gender and one’s experienced gender. •The incongruence results in clinically significant distress or functional impairment. •Symptoms endure at least 6 months. Often detected at 2-4 yrs of age, much more common male to female then female to male.
Gender Dysphoria physical etiology?
Insufficient exposure to androgens in Utero, sexually dimorphic nucleus is smaller then should be for males, closer to size of womans
Gento pelvic pain/Penetration disorder
Difficulties with vaginal penetration or vulvovaginal/pelvic pain during vaginal intercourse
or penetration attempts.
What is a paraphilia?
An intense and persistent (>6 mos) deviant sexual interest.
Transvestitism
sexual arousal from wearing the opposite-sex’s clothing
Frotteurism
Sexual arousal from touching or rubbing
against a non-consenting person
Sexual Masochism
Sexual arousal from
receiving
psychological/
physical suffering
Binge Eating Disorder
(as per bulimia criteria) at least
1/wk for 3 mos.
2.Binging is associated with >3 of the following:
•Rapid eating
•Rapid eating
•Eating until uncomfortably full
•Eating when not physically hungry
•Eating alone due to shame about quantity
•Feeling disgusted/guilt/depressed after binge.
3.No inappropriate compensatory behavior
What is the diagnostic questions for eating disorders?
SCOFF
S: Sick (induce vomiting?)
C:Control (lose control?)
O: One (1 “stone” loss in 3 mos?)14lbs (6.5kgs)
F:Fat (believe fat?)
F: Food(food dominates?)
Yes to >2 items suggests an eating problem
What is polysomnography (PSG)?
PSG involves measuring a variety of physiological parameters including brain waves, muscle contractions, breathing, etc. during sleep
Insomnia Disorder
Difficulty initiating or maintaining sleep for >3 mos.
Hypersomnolence Disorder
Excessive sleepiness despite sufficient sleep for
>3 mos.
►Etiology: Non-specific (and unidentified brain
causes)
►Treatment: Stimulants (e.g.,methylphenidate) to promote wakefulness.
What is central sleep Apnea?
Central sleep apnea is a series of cessation of breathing per night from CNS dysregulation. Whereas Obstructive sleep apnea is from obstruction of the airway from excess tissue in the throat.
How do we distinguish Obstructive sleep apnea form constructive sleep apnea?
A PSG distinguishes OSA from CSA based on
whether thoracic movements occur at the start of
apneic episode:
•OSA (thoracic effort occurs)
•CSA (no thoracic effort occurs)
Tx=Acetazolamide
Non REM sleep arousal disorder
Repeated episodes of incomplete awakening
from sleep with either of the following
a) Sleep Walking: Rising from bed and walking
about with a blank and staring face,
unresponsiveness, and difficulty awakening.
b) Sleep Terrors: Abrupt terror arousal’s (usually
with panicky scream), intense fear and autonomic
arousal, and unresponsiveness to comforting by others.
Episodes occur within the first 1/3 of sleep
REM Sleep Behavior Disorder (RSBD)
Vocalizations and/or complex motor
movements occur during REM sleep.
►REM sleep atonia is confirmed by PSG.
►The disturbance is not induced by a substance.
RSBD Features
•Typically action-filled, violent dreams
•Immediately awake, oriented and alert with
detailed dream recall
•Most common in males >50 years old
•Course is progressive and associated with
neurodegenerative disease (e.g., Parkinson’s disease, Lewy body dementia)
Restless leg syndrome
Urge to move legs in response to uncomfortable sensations with all the following features:
•occurs/worsens during inactivity
•nocturnal worsening of symptoms
•temporary relief from discomfort by moving
•Patient is aware of symptoms and complains of
insomnia
Paranoid personality disorder
•suspicion that others are being exploitative or
deceptive
•unjustified doubts about loyalty/trustworthiness
•unjustified doubts about loyalty/trustworthiness
•reluctance to confide
•reads hidden threatening meanings into remarks
•reacts angrily to perceived insults
What is a delusional disorder?
A psychotic disorder characterized by:
•A psychotic disorder characterized by:
•>1 month of a delusion
•No other psychotic symptoms
What are the subtypes of delusional disorder?
•Persecutory (belief of malevolent treatment)
•Grandiose (belief of having some great [but
unrecognized] talent or insight or having made some important discovery)
•Erotomanic (belief of somebody being in love
with the individual)
•Jealous (belief of infidelity by partner)
•Somatic (belief involving bodily functions or sensations)
Schizoid Personality Disorder
•lacks desire for close relationships/intimacy •lacks close friends •prefers solitary activities •prefers solitary activities •derives pleasure in few activities •indifference to praise/criticism •emotional coldness, detachment or flat affect Interpersonal detachment is a theme
Schizotypal Personality Disorder
•social and interpersonal deficits with acute discomfort for close relationships
•odd speech/thinking
•beliefs in paranormal phenomenon
•beliefs in paranormal phenomenon
•ideas of reference
•odd appearance/behavior
•unusual perceptual experiences
•suspiciousness (often results in social anxiety)
Theme is eccentric: considered premorbid personality of schizophrenic
Histrionic Personality Disorder
- needs to be center of attention
- uses physical appearance to draw attention
- inappropriately seductive/provocative behavior
- shallow and rapidly shifting emotions
- impressionistic speech but lacks detail
- exaggerated emotional expression
- considers relationships more intimate than they are. EXCESSIVE emotionality
Borderline personality disorder
•unstable intense relationships with alternating idealization and devaluation (“splitting”). •frantically avoids abandonment •intense uncontrolled anger •marked reactivity of mood •chronic feelings of emptiness •unstable self-image self-damaging impassivity •suicidal gestures/self-mutilation •transient stress-related dissociative/paranoid Sx Theme Instability
Narcissistic Personality Disorder (NPD)
•grandiose sense of self-importance •preoccupied with success •requires admiration •sense of entitlement •interpersonally exploitative •lacks empathy and has haughty attitudes Theme=grandiosity, a narcissistic blow to personality may result in rage
Antisocial Personality Disorder (ASPD)
•repeated unlawful acts •deceitfulness •irritability and aggressiveness •irritability and aggressiveness •reckless disregard for safety of self or others •irresponsibility (employment or financial) •lack of remorse Theme=disregard for others
Avoidant Personality Disorder
•avoids interpersonal and occupational
activities for fear of criticism
•unwilling to start relationship unless certain of
being liked
•restraint within relationship for fear of ridicule
•reluctance to engage in new activities
•negative self-image
Dependent Personality Disorder
- indecisive
- others must take responsibility for life
- difficulty disagreeing
- difficulty initiating due to low confidence
- excessive lengths to keep/gain support
- feels helpless when alone
- urgently seeks another relationship if one ends
Obsessive-Compulsive Personality Disorder (OCPD)
- preoccupation with details, rules, lists, orderliness, or schedules until point of activity is lost
- perfectionism interferes with task completion
- excessive devotion to work
- rigid and stubborn
- over conscientious, scrupulous
- reluctance to delegate or to work with others
- hoarding and miserly behavior
What is Papez circuit?
mamillary bodies, MTT,
Ant nuc of thalamus,
Cingulate gyrus, cingulum,
hippocampus, fornix
What are the three areas of the association cortex?
Cingulate – just above the corpus callosum
–Temporal lobe
–Orbital prefrontal
– just above the eyes, near midline
Stages of play
- Solitary Play <18 mos of age (sensorimotor)7
- Parallel Play 18 mos - 2 yrs (symbolic)
- Cooperative Play 3 - 4 yrs (associative or imaginary)
What was the diff between Locke and Jean Jacques Roussea
Locke=Tabula rossa
Roussea=The child is endowed with an innate moral sense – a noble savage
What did John B. Watson and B.F. Skinner believe
Human nature was completely malleable
Richard J. Herrnstein & Charles Murray
There are substantial individual and group differences in intelligence; these differences profoundly influence the social structure and organization of work in industrial societies; and
they defy easy remediation.
