Abnormal Psych Test 3 (Part 1)

Front 1

What are the three major eating disorders? How does obesity relate to these disorders?

Back 1

1-bulimia nervosa.

2-Anorexia nervosa

3-Binge eating disorder

-Obesity: not considered an official disorder in DSM, excess of body fat resulting in a BMI of 30 or more.

Front 2

What necessary clinical information should one collect to inform the treatment of eating disorders?

Back 2

Current and past:

–Weight and feelings about weight
–Eating patterns
–Feelings about food
–Appetite
•Unusual eating rituals
•History of dieting
•Medical illnesses
•Current medications and abused substances
•Psychiatric illnesses (Schizophrenia, Major Depression, etc.)
•Psychiatric symptoms (mania, depression, anxiety, thought disorder, etc.)
•Episodes of binge eating
•Psychological conflicts related to self-evaluation
•Relationship between weight and self-esteem
•Family history of Eating Disorders

Front 3

To what is self-evaluation tied in eating disorders?

Back 3

-Self-evaluation is unduly influenced by body shape or weight. (bulimia nervosa)

Front 4

What are the defining diagnostic features of Bulimia Nervosa? What are the two subtypes?

Back 4

2 Subtypes
1.Purging: Vomiting, laxatives, diuretics, enemas

2.Nonpurging: (6-8%)
Excess exercise, fasting

-Recurrent episodes of binge eating. Characterized by both:
1)eating, in a discrete period of time (e.g., within any 2-hour period) an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
2)a sense of lack of control over eating during the episode (e.g., a feeling you cannot stop eating or control what or how much one is eating)

Front 5

List and define the compensatory behaviors tied to Bulimia.

Back 5

Self-induced vomiting, diuretics, laxatives, excessive exercise, fasting

Front 6

What is the lifetime prevalence for Bulimia? What percentage of college women suffer from bulimia?

Back 6

Lifetime prevalence: 1.1% for females, 0.1% for males

6-8% of college women suffer from bulimia

Front 7

How is bulimia effectively treated?

Back 7

Antidepressants:
-Help reduce binging and purging
-Not efficacious in the long-term

Psychological Treatment
Cognitive-behavior therapy: Treatment of choice

Targets problematic eating behavior & attitudes about body weight/shape

Interpersonal psychotherapy: Gains similar to CBT
-Focuses on interpersonal relationships and functioning

Front 8

What types of physical or medical issues may arise with Bulimia?

Back 8

-Significant and permanent loss of dental enamel
-Front teeth may become chipped & appear ragged & “moth-eaten”
-Increased cavities
-Salivary gland enlargement
-Calluses or scars on the hand from trauma from the teeth
-Serious cardiac and skeletal myopathies
-Menstrual irregularity or amenorrhea
-Laxative dependence
-Fluid and electrolyte imbalances
-Esophageal tears
-Gastric rupture
-Cardiac Arrhythmias
-Renal Failure
-Kidney failure
-Seizures
-Intestinal problems
-Permanent colon damage

Front 9

What are the defining diagnostic features of Anorexia Nervosa? What are the two subtypes?

Back 9

2 subtypes:
1.Restricting subtype: Limit caloric intake via diet and fasting

2.Binge-eating-purging subtype:
Small amounts of food more consistently (50% of anorexics)


A.Refusal to maintain body weight at or above a minimally normal weight for age and height (85%)
B.Intense fear of gaining weight or becoming fat, even though underweight.
C.Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current low body weight.
D.In postmenarcheal females, amenorrhea (3 consecutive menstrual cycles)

Front 10

What is the major difference between bulimia and anorexia?

Back 10

those with anorexia are so successful at losing weight and put their lives in considerable danger.

Front 11

What percentage of those with anorexia die as a result of their disorder? What percentage from suicide?

Back 11

20% die as a result of their disorder (50% are suicide)

Front 12

What are the basics of prevalence and course for anorexia nervosa?

Back 12

– Onset: 13 to18 years
– 0.5-1.0% in females in late adolescence and early adulthood
– More chronic and treatment resistant than bulimia
– Far more common in industrialized societies where “thin is in”
•US, Canada, Europe, Australia, Japan, New Zealand, South Africa

Front 13

Is there a high comorbidity with anorexia and other psychological disorders?

Back 13

YES

Front 14

14. How is anorexia treated? What is the most efficacious treatment?

Back 14

Medical Treatment
None exist with demonstrated efficacy

Psychological Treatment
–Weight restoration – First and easiest goal to meet
–Psychoeducation – Food, weight, nutrition, health
–Behavioral and cognitive interventions
–Treatment often involves the family
–Long-term prognosis – Poorer than bulimia

Front 15

15. How do psychological and behavioral considerations play a role in bulimia and anorexia?

Back 15

1. Low sense of personal control and self-confidence
2. Perfectionistic attitudes
3. Distorted body image
4. Preoccupation with food and appearance
5. Mood intolerance

Front 16

16. What percentage of persons with binge-eating disorder tried dieting first? Where is the diagnosis in the DSM-IV?

Back 16

-50% tried dieting first. DSM-IV-TR Appendix

Front 17

17. How does psychopathology related between binging and non-binging obese people?

Back 17

- More psychopathology vs. non-binging obese people

Front 18

18. How is binge-eating disorder treated medically and psychologically?

Back 18

Medical Treatment
Sibutramine (Meridia)

Psychological Treatment
–CBT for bulimia appears efficacious.
–Interpersonal psychotherapy has been as effective as CBT.
–There is some evidence to suggest self-help techniques are also effective.

Front 19

19. Is obesity a formal DSM disorder? Why should concern be given to obesity?

Back 19

•No

•Concern arises because of related medical complications social and occupational impairments

Front 20

20. How is obesity related to technological advancement? How do genetics play a role?

Back 20

people do less work with technology

Genetics account for about 30% of the cause
contribute as well

Front 21

21. What is the treatment progression for obesity? Know the four steps.

Back 21

1.Self-directed weight loss programs

2.Commercial self-help programs

3.step Behavior modification programs

4.Bariatric surgery

Front 22

22. Define dyssomnia. What six disorders are under this heading?

Back 22

- Dyssomnias: Initiating or maintaining sleep or of excessive sleepiness characterized by a disturbance in the amount, quality or timing of sleep.

1.Primary Insomnia
2.Primary Hypersomnia
3.Narcolepsy
4.Breathing-Related Sleep Disorder
5.Circadian Rhythm Sleep Disorder
6.Dyssomnia NOS

Front 23

23. Define parasomnia. What three disorders are under this heading?

Back 23

- Parasomnias: Abnormal behavioral & physiological events during sleep

1. Nightmare Disorder (Dream Anxiety Disorder)
2. Sleep Terror Disorder
3. Sleepwalking Disorder

Front 24

24. How many hours do we sleep a year, what percentage of our life?

Back 24

- We sleep one third of our lives (3000 hours a year)

Front 25

25. Know the basic diagnostic criteria for insomnia. How do insomnia and primary insomnia differ?

Back 25

-not related to other medical psychiatric problems (ex. Anxiety depression).
1.difficulty initiating or maintaining sleep, or nonrestorative sleep, for at least 1 month
2. The sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in functioning
3. The sleep disturbance does not occur exclusively during the course of another Sleep Disorder
4. Doesn’t occur exclusively during the course of another mental disorder
5. Not due to the direct physiological effects of a substance or GMC

Front 26

26. What are the basic demographics for Insomnia

(gender, prevalence with age, difference between young/old adults

Back 26

– One of the most common sleep disorders (30-40%)
– Affects females twice as often as males
– More prevalent with increasing age
• Young adults – falling asleep
• Midlife to Elderly – staying asleep
– Associated with medical and/or psychological conditions (pain, inactivity)

Front 27

27. How do expectations about sleep influence sleep disorders?

Back 27

-Unrealistic expectations about sleep. Believe lack of sleep will be more disruptive than it is

Front 28

Know the basic diagnostic criteria for hypersomnia. How does this differ from primary hypersomnia?

Back 28

1. excessive sleepiness for at least 1 month (or less if recurrent) as evidenced by either prolonged sleep episodes or daytime sleep episodes that occur almost daily
2. The excessive sleepiness causes clinically significant distress or impairment in functioning
3. The excessive sleepiness is not better accounted for by insomnia or during the course of another Sleep Disorder
4. Does not occur exclusively during the course of another mental disorder
5. Not due to the direct physiological effects of a substance or GMC
Recurrent: period lasting at least 3 days occurring several times a year for at least 2 years
-primary means that it is once again unrelated to any other condition.

Front 29

29. What is the prevalence (%) of hypersomnia presenting at sleep clinics and in the general population?

Back 29

1. 5-10% of people at sleep clinics; 0.5-5% of general population

Front 30

30. In the diagnostic criteria of narcolepsy, name the two aspects (1 of which must be present).

Back 30

1. Cataplexy - sudden loss of muscle tone while awake lasting up to minutes
(cataplexy attacks-Sudden REM sleep, triggered by strong emotion)

2.Recurrent intrusions of elements of REM sleep into the transition between sleep and wakefulness, as manifested by either hypnopompic or hypnagogic hallucinations or sleep paralysis at the beginning or end of sleep episodes.

Front 31

31. What percentage of the population is affected with narcolepsy? How many are female?

Back 31

1. Rare – Affects .03% to .16% of the population
2. Affects males and females equally

Front 32

1. Sleep paralysis

Back 32

brief period after awakening when one cannot move/speak

Front 33

2. Hypnagogic hallucinations

Back 33

vivid and often terrifyingly realistic sensory experiences that begin at sleep onset

Front 34

33. Research in dogs with narcolepsy have identified a gene cluster on which chromosome?

Back 34

chromosome 6

Front 35

34. On what axis should sleep-related breathing disorders be coded?

Back 35

axis 3

Front 36

Sleep apnea

Back 36

Restricted air flow and/or brief cessations of breathing

Front 37

What are the 3 types of Sleep Apnea?

Back 37

1.Obstructive sleep apnea (OSA) – Airflow stops, but respiratory system works

2.Central sleep apnea (CSA) – Respiratory system stops for brief periods

3.Mixed sleep apnea – Combination of OSA and CSA

Front 38

36. Are breathing-related sleep disorders more common in males? How are age and obesity related?

Back 38

1. More common in males


2. Associated with obesity and increasing age

Front 39

37. How does disturbed sleep play a role in circadian rhythm disorders? What problem is the brain having

Back 39

1. A persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia that is due to a mismatch between the sleep-wake schedule required by a person’s environment and his or her circadian sleep- wake pattern
2. The sleep disturbance causes clinically significant distress or impairment in functioning
3. The sleep disturbance does not occur exclusively during the course of another Sleep Disorder or mental disorder
4. Doesn’t occur exclusively during the course of another mental disorder
A. Disturbed sleep – Insomnia or excessive sleepiness
B. Problem – Brain unable to synchronize day and night

Front 40

4 Types of Circadian Rythyms

Back 40

1. Delayed Sleep Phase: sleep onset and awakening and inability at other time

2. Jet lag: Problems related to crossing time zones

3. Shift work : – Problems related to work schedule

4. Unspecified

Front 41

What environmental interventions are used?

Back 41

Environmental Intervention

1.Phase delays – Moving bedtime later (best approach)
2. Phase advances – Moving bedtime earlier (more difficult)
3. Use of bright light – Trick the brain’s biological clock

Front 42

What are the medical and psychological interventions used for the dyssomnias?

Back 42

• Insomnia
– Benzodiazepines and over-the-counter sleep medications
– Prolonged use can cause rebound insomnia, dependence
– Best as short-term solution
• Hypersomnia and Narcolepsy
– Stimulants (i.e., Ritalin)
– Cataplexy is usually treated with antidepressants
• Breathing-Related Sleep Disorders
– Include medications, weight loss, or mechanical devices
Psychological Interventions
∙ Relaxation and Stress Reduction
– Reduces stress and assists with sleep
– Modify unrealistic expectations about sleep
• Stimulus Control Procedures
– Improved sleep hygiene – Bedroom is a place for sleep
– For children – Setting a regular bedtime routine
• Combined Treatments
– Insomnia – Short-term medication plus psychotherapy
– Combined treatments – Lack data with other dyssomnias

Front 43

Is the problem with parasomnias tied to sleep? What are the two types of parasomnias?

Back 43

- The problem is not with sleep itself
1. Those that occur during REM (i.e., dream) sleep
2. Those that occur during non-REM (i.e., non-dream) sleep

Front 44

41. What are the defining diagnostic features of nightmare disorder? When does it happen? How is it treated?

Back 44

-Repeated awakenings from the major sleep period or npas with detailed recall of extended and extremely frightening dreams, usually involving threats to survival, security, or self-esteem. The awakenings usually occur during the second half of the sleep period
-On awakening from the frightening dreams, the person rapidly becomes oriented and alert
-The dream experience, or the sleep disturbance resulting form the awakening, causes clinically significant distress or impairment in functioning
-The nightmares do not occur exclusively during the course of another mental disorder and are not due to substances or a GMC
1. Occurs during REM or dream sleep
2. May involve antidepressants and/or relaxation training

Front 45

42. What are the defining diagnostic features of sleep terror disorder? How does it begin? How is it treated?

Back 45

1. Recurrent episodes of abrupt awakening from sleep, usually occurring during the first third of the major sleep episode and beginning with a panicky scream
2. Intense fear and signs of autonomic arousal, such as tachycardia, rapid breathing, and sweating, during each episode
3. Relative unresponsiveness to efforts of others to comfort the person during the episode
4. No detailed dream is recalled and there is amnesia for the episode
5. The episodes cause clinically significant stress or impairment in functioning
6. Not due to the direct physiological effects of a substances or GMC
A. -Occurs during non-REM sleep
Often noted by a piercing scream
Person looks extremely upset
Experiences sings of elevated arousal (e.g., sweating)
B. -Often involves a wait-and-see posture
-Severe cases – Antidepressants or benzodiazepines
-Scheduled awakenings prior to the sleep terror

Front 46

43. What are the defining diagnostic features of sleepwalking disorder? When does it happen?

Back 46

1. Repeated episodes of rising from bed during sleep and walking about, usually occurring during the first third of he major sleep cycle
2. While sleepwalking, the person has a blank, staring face, is relatively unresponsive to the efforts of others to communicate with him or her nad can be awakened only with great difficulty
3. On awakening, the person has amnesia for the episode
4. Within several minutes after awakening from the sleepwalking episode, there is no impairment of mental activity or behavior
5. The sleepwalking causes clinically significant stress or impairment in functioning
6. Not due to the direct physiological effects of a substances or GMC
A. -Occurs during non-REM sleep
-Usually during first few hours of deep sleep
-Person must leave the bed

Front 47

44. Where are physical disorders coded on the DSM? Define behavioral medicine. Define health psychology

Back 47

-AXIS 3

-Behavioral medicine: Prevention, diagnosis, treatment of medical illness

-Health psychology: Psychological factors in promotion of health

Front 48

46. What percentage of the 10 leading causes of death in the U.S. can be linked to lifestyle behaviors?

Back 48

50%

Front 49

Stress

Back 49

Physiological response of an individual to a stressor

Front 50

Stressor

Back 50

Event that evokes the stress response

Front 51

Stress Response 3 Phases

Back 51

– Phase 1 – Alarm response (sympathetic arousal)

– Phase 2 – Resistance (mobilized coping and action)

– Phase 3 – Exhaustion (chronic stress, permanent damage, death)

Front 52

48. What is the hippocampus’ role in emotional memories

Back 52

– Hippocampus is involved in emotional memories and responsive to cortisol
• When stimulated, it helps turn off the stress cycle
• Chronic stress may damage hippocampal cells

Front 53

happens during HPA activity?

Back 53

Hypothalamus (stimulated) → pituitary gland (secreted) → adrenal gland (corticosteriods)

Front 54

49. What does primate research say regarding cortisol and high and low social status?

Back 54

1. High cortisol in baboons is associated with low social status
2. Low status – Fewer lymphocytes and weak immune system
3. High status – Benefit from stability and controllability

Front 55

50. What is the immune system?

Back 55

• Body’s means of identifying and eliminating any foreign materials (antigens) that enter
• Leukocytes are the primary agents of the immune system

Front 56

• Divisions of the Immune System

Back 56

– Humoral branch – Operates in the blood and other bodily fluids
– Cellular branch – Protects against viral and parasitic infections

Front 57

Macrophages

Back 57

First line of defense
1. Surround identifiable antigens and destroy them
2. They also signal lymphocytes

Front 58

52. What are T cells? Name and describe the features of the four T cell subtypes.

Back 58

- Lymphocytes: Consist of two groups
1. B cells (humoral branch) produce antibodies (immunoglobins) which seek out and destroy antigens in the blood and bodily fluids

2. T cells (cellular branch) do not produce antibodies.
Subgroups are:
Killer: destroy viral infections and cancerous processes
Memory: created by killer to do the same job
T4 (helper): enhance immune system response. Signals B cells to produce antibodies and tells other T cells to destroy. If too many then the immune system becomes overactive and attacks normal cells.
Suppressor: suppress production of B cells antibodies when no longer needed. Too many and the body becomes susceptible to antigen invasion.

Front 59

53. What disorder is considered the highest priority in our health system?

Back 59

The highest priority in our health system
i. In 2000, those living with HIV was 34.3 million
ii. In South Africa, between 15-36% of adults are HIV positive

Front 60

54. When can AIDS be diagnosed? What is the median time from infection to AIDS? How can stress hurt?

Back 60

1. -Diagnosis is not made until severe physical illness is present

-Median time from infection to AIDS is 7.3 to 10 years
–
Stress of getting an AIDS diagnosis can be devastating
– High stress and low social support speed AIDS progression
– Goals – Reduce stress, improve immune system function

Front 61

55. How many people die within the first year of an AIDS diagnosis? Five years?

Back 61

-Most die within 1 year of diagnosis

-15% survive 5 years or longer

Front 62

56. Define oncology and psychoncology. What 5 psychological & behavioral contributions were given?

Back 62

• Oncology: Study of cancer
• Psychoncology:Study of psychological factors and their relation to cancer

1.Perceived lack of control
2.Inadequate/inappropriate coping responses (e.g., denial)
3. Overwhelming stressful life events
4. Life-style risk behaviors
5. Psychological factors are also involved in chemotherapy

Front 63

57. What is considered high and borderline blood pressure?

Back 63

-Hypertension – High Blood Pressure

HIGH: 160/95

LOW: 140/90