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113 Cards in this Set
- Front
- Back
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addictive behavior
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behavior based on the pathological need for substance or activity
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psychoactive substances
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the most commonly used substance that affect mental functioning in the central nervous system
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substance abuse criteria
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a maladaptive pattern of substance use leading to clinically significant distress of impairment and at least one of the following occurring w/in 12 months
1. recurrent substance use that results in a failure to fulfill some major role obligations at work, school, or home 2. recurrent substance use in situations in which it is physically hazardous 3. recurrent substance related legal problems 4.continued substance use despite persistant or recurrent social or interpersonal problems caused or exacerbated by the effects of sunstance the person has never met criteria for substance dependence |
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substance dependence criteria
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a maladaptive pattern of substance use leading to clinically significant distress or impainment as manifested by at least three of the following within a 12 month period
1. higher tolerance or diminishing effect with continued use of same amount of substance 2.withdrawal as manifested by either the characteristic withdrawal syndrome for the substance or same or closely related substance is taken to relieve or avoid withdrawal symptoms 3.substance taken in larger amounts over longer periods then was intended 4. perseistant desire or unsuccessful effort to cut down or control substance use 5. the persons spendds a great deal of time engaging in activities necessary to obtain the substance use the substance or recover from its effects 6. the person has given up or reduced the amount of important social, occupational, or recreational activities because of substance use 7.continued substance |
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co morbidity of alcohol abuse with other disorders
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over 37 percent suffer from at least one coexisting mental disorder
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prevalence of alcohol abuse
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13.4 percent in the U.S.
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Alcohol amnesic disorder
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a memory defect which can be accompanied by falsification of events
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Alcohol withdrawal delirium
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usually happens following a prolonged drinking spree. slight noises or sudden mov't may cause considerable exitement and agitation
1. full blown symptoms 2. disorienation for time and place 3.vivid hallucinations, particularly small animals 4.acute fear in which these animals change size and form 5.extreme suggestibility in which a person can be made to see almost any animal if presence is even suggested 5. marked tremors of hands, tongur, and lips 6. other symptoms including perspirations, fever and rapid weak heartbeat 6. delirium lasts 3-6 days |
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psychosocial causal factors for substance abuse/dependance
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results in impaired reasoning, poor judgement and gradual personality deterioration. behavior becaome course and inappropriate and the drinker assumes increasingly less responsibility, loss in pride and personal appearance, neglects spouse and family, and becomes generally touchy, irritable, and unwilling to discuss problem.
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biological causal factors for substance abuse/dependence
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mesocortolimbic pathway, the center of psychoactive drug activation in the brain. alcohol and drugs effect this causing pleasure and reinforce tolerance and dependence on substance development
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tx for abuse/dependence
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1. antabuse- cause violent vomiting
2. naltrexone- reduces craving by blocking pleasure effects of alcohol 3. group therapy CBT forces to face problems CBT pair ingestion of alcohol with electric shock 4. control drinking vs abstinence |
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six categories of drugs
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1. narcotics
2. sedatives 3. stimulants 4. anti-anxiety 5. pain meds 6. hallucinogens |
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opium
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mixture of about 18 chemical substances known as alkaloids
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cocaine
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plant discovered in ancient times
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amphetamines
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help people stay alert, awake and functioning at a level beyond normal temporarily
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barbiturates (sedatives)
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aid for sleeping
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withdrawal from sedatives
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anxiety, apprehension, coarse tremors of hands and face, insomnia, weakness, vomiting, rapid heart, elevated bp, weight loss may occur
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Hallucinogens
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drugs thought to induce hallucinations but usually create distorted images and hearing
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schizophrenia
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significant loss of contact with reality, referred to as psychosis
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schiz. epidemiology
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-lifetime risk = 1%
-afro-caribbean -unexpectedly high in western Ireland and Croatia -majority of cases begin in late adolescence and early adulthood |
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schiz. onset
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can develop in middle age or later, but not typical
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gender in schizophrenia
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-begins earlier in men
-peak in new cases 20-24 after about 35 the number of men developing falls and women does not -average age of onset men=25 woman=29 |
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Schizophrenia criteria
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a.two or more of the following during 1 month
1.delusions 2.hallucinations 3.disorganized speech 4.grossly disorganized or catatonic behavior 5.negative symptoms -one one symptom is required if the delusions are bizarre or if the hallucination consist of a voice keeping up a running commentary on the person's behavior or thoughts or two or more voices conversing b. dysfunction at work c. signs of disturbance for at least 6 months with at least 1 month of symptoms listed above |
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delusion
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essentially an erroneous belief that is fixed and firmly held despite contradictory evidence
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schiz. prevalence of delusions
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90% of patients
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schiz. delusions (made feelings or impulses)
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ones thought, feelings, or actions are being controlled by external agents
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schiz. delusions (thought broadcasting)
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thoughts that one's private thoughts are being broadcast-ed to others
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schiz. delusions (thought insertion)
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thought being inserted into one's brain by some external agency
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schiz delusions (thought withdrawal)
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some external agent has robbed one of ones thoughts
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hallucinations
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sensory experience that seems real to the person having it, but occurs in the absence of any external perceptual stimulus
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schiz. hallucinations
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can be auditory, visual, olfactory, tactile or gustatory
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schiz. hallucinations auditory
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most common
-present in up to 75% of patients -occur when patients misinterpret their own self generated and verbally meditated thoughts |
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disorganized speech
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external manifestation of a disorder in thought form
-loose association -jumping from idea to idea |
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disorganized speech-paralogic
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jesus=man
i=man i=jesus |
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disorganized speech-word salad
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words not associated
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disorganized speech-neologisms
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made up words
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schiz. disorganized and catatonic behavior
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goal directed activities- universally disrupted
-hygiene: doesnt maintain minimal standards -catatonia: virtual absence of all mov't and speech and be in a catatonic stupor --at other times may hold unusual posture for extended time with no discomfort |
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schiz. negative symptoms
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reflect absence or deficit of behaviors that are normally present
-emotional flattening -poverty of speech -a sociality -apathy-anhedonia |
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schiz. positive symptoms
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those that reflect an excess or distortion in a normal repertoire of behavior and experience such as delusions and hallucinations
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subtype schiz: paranoid
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a history of increasing suspiciousness and of severe difficulties in interpersonal relationships
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subtype schiz. disorganized
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usually occurs at an early age and has gradual, insidious onset
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subtype schiz. catatonic:
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central feature is pronounces motor signs, either of an excited or a stuporous type
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subtype schiz. undifferentiated
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(wastbasket catigory)
meets usual criteria for schiz. but does not clearly fit into one of the other subtypes |
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subtype schiz. residual
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for people who have suffered at least one episode of schiz but do not show any prominent positive symproms such as hallucinations
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paranoid schiz criteria
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a. preoccupation with delusions or frequent auditory hallucinations
b. no evidence of marked disorganized speech, disorganized or catatonic behavior , flat or inappropriate affect |
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paranoid schiz. delusions of grandeur
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i am god
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paranoid schiz prognosis
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generally better then that for other parients with schiz
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disorganized schiz criteria
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a. disorganized speech
b. disorganized behavior c. flat or inappropriate affect d. no evidence of catatonic schiz -prognosis=poor |
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catatonic schiz criteria
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the clinical picture is dominated by at least two or the following
-immobile body or stupor -excessive motor activity that is purposless and unrelated to outside stimuli -extreme negativism or mutism -assumprion of bixarre postures, or stereotyped mov't pr mannerisms -echolalia or echpraxia |
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echolalia
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mimics other's words
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echopraxia
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mimics other's actions
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undifferentiated schiz criteria
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a. symptoms of schiz. that do not meet criteria for the paranoid, disorganized, or catatonic subtypes
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residual schiz criteria
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a. absence of prominent delusions, hallucinations, disorganized speech, or catatonic behavior
b. continued evidence of schiz. or mild psychotic symptoms |
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schizoaffective disorder and criteria
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used to describe people who have features of sciz. and sever mood disorder.
a. an illness during which at some time, there is either major depressive episode, manic episod, or a mixed episode that co-occurs with symptoms of schiz. b.during the illness, there must be a period of at least two weeks where delusions and hallucinations have been present without mood symptoms c. the mood symptoms are present for a substantial proportion of total illness time |
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schizophreniform disorder and criteria
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schiz-like psychodid that last at least a month but do not last for 6 months and so do not warrant diagnosis of schiz criteria
a. symptoms of schiz. b. an episode of the disorder that lasts at least 1 month but less then 6 mon. |
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delusional disorder and criteria
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holds beliefs that are considered completely false and absurd by thought around them
a. nonbizarre delusions that last for at least 1 month b. no evidence of full blown schiz. c. apart from the delusion the persons functioning is not marked impaired neither is the behavior obviously odd or bizarre |
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brief psychotic disorder and criteria
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sudden onset of pschotic symptoms or gross disorganized or catatonic behavior
a. presence of one or more of the folloing delusions, hallucinations, disorganized speech or grossly disorganized or catatonic behavior b the episode lasts for at least 1 day, but less than 1 mon. with eventual full return to normal functionsing |
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shared psychotic disorder and criteria
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delusions that develops in someone who has a very close relationship with another person who is delusional
a. a delusion develops in the context of a close relationship with another person who already has an established delusion b. the delusion is similar in content to that of the person who already has the established delusion c. other psychotic delusions are ruled out |
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causes of schiz-genetic
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close genetic relations can be caused by difficult birth oxygen deprivation or prenatal viral infection
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causes of schiz- brain structures
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enlarged cerebral ventricles and reduces neural tissue around the ventricles
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causes of schiz- dopamine theory
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too much dopamine or receptors in the brain
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tx of schiz- medication
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biological=neuroleptic meds
meds=traditional anti-psychotics psycho social-psycho social education and relapse prevention |
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delirium and criteria
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a state of acute brain failure that lies between normal wakefulness and stupor or coma
a. disturbance of consciouness b. a change in cognition that is not related to dementia c. the disturbance develops over a short period of time and tends to fluctuate over the course of the day |
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dementia
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implies loss and it is characterized by a decline from a previously attained level of functioning
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dementia- Alzheimer type
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multiple cognitive deficits, slow onset, deteriorating course termination in delirium or death
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dementia-vascular type
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results from a series of cerebral strokes that destroy neurons
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amnestic disorder
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memory impairment, hard to form new memories, confabulation occurs, immediate recall intact, may or may not be able to recall past.
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delirium associated features
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1. disturbance in sleep cycle
2. disturbance in consciousness 3. info processing is impaired 4. hallucinations |
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dementia criteria
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A. the development of multiple cognitive deficits manifested by both
1. memory impairment 2. one or more of the following a.aphasia b. apraxia c. agnosia d. disturbance in executive functioning B. the cognitive deficits cause significant impairment in functioning and represent significant decline from a previous level of cognitive functioning C. the onset of this disorder is gradual and there is continuing cognitive decline |
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aphasia
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language disturbance
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apraxia
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motor impairment
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agnosia
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failure to recognize objects
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personality disorder- cluster A, Odd Eccentric
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cluster A- paranoid personality DX, criteria
1. pervasive suspiciousness of being deceived, harmed or exploited 2. unjustified doubts about loyalty or trustworthiness of friends or associates 3. reluctance to confide on others because of doubts of layalty 4. hidden demeaning or threatning meanings read into benign remarks or events 5. bears grudges, doesnt forgive insults, injuries, or slights 6. anger reactions to perceived attacks on his or her character or reputation 7. recurrent suspicions regarding fidelity of spouse of partner. |
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cluster A- paranoid personality DX, criteria
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1. pervasive suspiciousness of being deceived, harmed or exploited
2. unjustified doubts about loyalty or trustworthiness of friends or associates 3. reluctance to confide on others because of doubts of layalty 4. hidden demeaning or threatning meanings read into benign remarks or events 5. bears grudges, doesnt forgive insults, injuries, or slights 6. anger reactions to perceived attacks on his or her character or reputation 7. recurrent suspicions regarding fidelity of spouse of partner. b. does not occur exclusively during the course of schiz. mood disorder with psychotic features, or toher psychotic disprder, or pervasive developmental disorder |
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cluster A-schizotypal personality DX
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individuals are excessively introverted and ahve pervasive social and interpersonal deficits, but in addition they have cognitive and perceptual distortions, as well as oddities and eccentricities in their communication behavior.
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cluster A-schizotypal personality DX criteria
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A. a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive perceptual distortions and behavioral eccentricities as indicated by at least five of the following
1. ideas of reference 2. odd beliefs or magical thinking 3. unudual perceptual experiances 4. odd thinking and speech 5. suspiciousness or constricted affect 7. behavior or appearance that is off, eccentric, or peculiar 8. lack of close friends or confidants 9. excessive social anxiety that does not diminish with familiarity B. does not occur exclusively during the course of schiz, mood disorder with psychotic feature or other pychotic disorder, or pervasive development |
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cluster A- schizoid personality disorder
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usually unable to form social relationships and usually lack much interest in doing so
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cluster A- schizoid personality disorder, criteria
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A. evidence of a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings shown in at least four of the following ways
1. neither desires nor enjoys close relationships 2. almost always chooses solitary activities 3. has little, if any, interest in sexual experiences with another person 4. takes pleasure in few, if any, activites 5. lacks close friends of confidants 6. appears indifferent to the praise or criticism of others 7. shows emotional coldness, detachment, or flat effect B. does not occue exclusively during the course of any other disorder |
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Cluster B- Histronic personality DX, criteria
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a pervasive pattern of excessive emotionalism and attention seeking as indicated by at least five of the following
1. discomfort in situations in which they are not center or attention 2. inappropriate sexually seductive or provocative behavior 3. displays rapidly shifting and shallow expression of emotions 4. consistently uses physical appearance to draw attention to self 5. has an excessively impressionistic style of speech 6. show self dramatization and exaggerated expressions of emotion 7. is overly suggestible 8. considers relationships to be more intimate then they actually are |
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Cluster B- Narcissistic personality disorder, criteria
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a pervasive pattern of grandiosity, need for admiration, and lack of empathy, as indicated by at least five of the following
1. grandiose sense of self importance 2. preoccupation with fantasies of unlimited success, power, brilliance, beauty 3. belief that they are special and uniquw 4. excessive need for admiration 5. sence of entitlement 6. tendency to be interpersonally exploitative 7. lacks empathy 8. is ofter envious of others ot believes that others are envious of him or her 9. shows arrogant, haughty behaviors or attitudes. |
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cluster B- antisocial personality disorder
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continually violate and shows disregard for the rights of others through deceitful, aggressive, or antisocial behavior, typically without remorse of loyalty to anyone
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cluster B- antisocial personality disorder, criteria
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A. pervasive pattern of disregard for and violation of the rights of others occurring since age 15, as indication by at least 3 of the following
1. failure to conform to social norms and repeared law breaking 2. deceitfulness 3. impulsivity or failure to plan ahead 4. irritability and aggressiveness 5. reckless disregard for safety of self or others 6. consistent irresponsibility 7. lack of remorse B.the individual is at least 18 C.there is evidence of conduct disorder with onset before age 15 |
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Cluster B- borderline personality disorder, criteria
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a pervasive pattern of instability in interpersonal relationships, self image, and affects, and marked impulsiveness as indicated by at least five of the following
1. frantic effors to avoid real or imagined abandonment 2. a pattern of unstable and intense inerpersonal relationships 3. identity disturbance characterized by persistently unstable self image or sense of self 4. impulsivity in at least two potention self damaging areas (spending, sex, substance abuse, reckless driving) 5. recurrent suicidal behavior, gestures, or self mutilating behavior 6. affective instability due to a marked reactivity of mood 7. chronic feelings of emptiness 8. inappropriate, intense anger 9. transient, stress related paranoid ideation or severe dissociative symptoms |
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Cluster C- avoidant personality Dx, criteria
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A. pervasive pattern of social inhibition, feelings of inadaquacy, and hypersensitivity due to negative evaluations, as indicated by at least four of the following
1. avoids occuparional activities that involve significant interpersonal contact 2. unwillingness to get involved with people unless certain of being liked 3. restraint within intimate relationships because of the fear of being shamed or ridiculed 4. preoccupatrion with being criticized or rejected 5. is inhibited in new interpersonal situations because of feeling inadequacy 6. views self as socially inept of inferior to others 7. extreme reluctance to take personal risks or engage in any new activities for fear of embarrassment |
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cluster C-dependent personality disorder
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A. a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation as indicated by at least five of the following
1. difficulties making everyday decisions without excessive advice and reassuance from others 2. needs others to take responsibility for most major areas of life. 3.difficulty expressing disagreement with others because of fear of loss of approval 4. difficulty initiating projects or doing things on his or her own 5. goes to excessive lengths to obtain nurtutanve and support from others 6. feels uncomfortable or helpless when alone because of fears of being unable to care for self 7. urgently seeks another relationship for care and support when a close relationship ends 8. unrealistic preoccupation with fears of being left to take care of himself of herself. |
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cluster C- obsessive compulsive personality disorder
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A. a pervasive pattern of preoccupation with orderliness, perfectionalism, and mental interpersonal control, indicated by at least four of the following:
1. preoccupation with details, rules, order or schedules to the extent that the major point of activity is lost 2. extreme perfectionism that interferes with task completion 3. excessive devotion to work to the exclusion of leisure and friendships 4. overly inflexible and over conscientious about matters of morality, ethics, or values. 5. inability to discard worn out or worthless objects 6. reluctance to delegate tasks or work with others unless others so exactly the same things 7. miserliness in spending style toward both self and others 8. shows rigidity and stubbornness |
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depressive personaility DX
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pattern of depressive cognitions and behaviors that is pervasive in nature
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ADHS assessment issues
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no test for it
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ADHS diagnostic criteria
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A. if six or more of the following symptoms of inattention ahve persisted for at least 6 moth and are maladaptive for the childs developmental levels
1. inattention including -often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activites 2. often has difficultyy attending in tasks or play activities, 3. often does not seem to listen when spoken to directly 4.often doesnt follow through on instructions and fails to finish schoolwork and chores 5. engage in tasks that require sustained mental effort 6 easily distracted by extraneous stimuli 7. fogetful in daily activities B. if six or more of the following symptoms of hyperactivity implusicity have persisted for at least 6 mons: fidgets with hands or feet, or squirms in seat or talks excessively, often leaves seat in classroom or other situations |
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ADHS prevalenve
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-3-5% of school aged children
-6-9 times more prevelent in boys -usually before age 8 |
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ADHD comorbidity and associated problems
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oppositional defiant disorder, residual effects
-attention difficulties |
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ADHD TX
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-drugs: ritalin, pemoline, and strattera
-behavioral therapy with meds -psychosocial tx |
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Oppositional defiant disorder
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-apparent by age 8
-recurrent pattern of negativism, defiant, disobedient, and hostile behavior towards authority figures that persist for at least 6 months |
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conduct disorder criteria
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A. the disorder is a repetitive and persistant pattern of behavior in which the basic rights of others or major age-appropriate societal norms or ruls are violated, as manifested by the presence of three or more of the following
1. aggression to people or animals 2. destruction of property 3.deceitfulness of theft 4.serious violations of rules B. the disturbance in behavior causes clinically significant impairment in social, academic, or occpational function C. if the individual is age 18 yrs or older criteria are not met for antisocial personality dx |
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conduct disorder vs. oppositional defiance
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-conduct disorder persistant antisocial acts where the rights of others are violated
-oppositional : less serious pranks carried out by normal children |
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autistic disorder criteria
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A. six or more of the following criteria from 1, 2, and 3 with at least 2 from 1 and one each from 2 and 3
1. qualitative impairment in social interaction a. marked impairment in the use of multiple nonverbal behaviors such as eye to eye gaze, facial expression, body postures, and gestures to regulate social interaction b. failure to develop perr relationships appropriate for developmental levels c. lack of spontaneous seeking to share enjoyment, interest, or achievements with other people 2. impairments in communications such as a. delay in the development of language b. marked impairment in the ability to initiate or sustain a conversation with others c. stereotyper and repetitve use of language or idiosyncrativ language d. lack or varied, spontaneous make believe play 3. stereotyped patterns of behavior, interests and activites as manifested by at least one of the following a. encompassing preoccuparion with one or more stereotyped and restricted patterns of in |
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prevelance in autism
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30-60 in 10000
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reactive attachment disorder
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inhibited type failure to initiate and respond to some interactions appropriately
-disinherited type lack a selectively in choice of attachment figures |
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patients rights A.
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right to treatment
-treatment=human care and decreasing symptoms -cannot commit patiant without providing tx |
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patients right B.
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right from custodial confinement, freedom from custodial confinment if they are not dangerous to themselves or others and if they can survive outside of custody
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patients rights C.
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right to compensation from work, that a patient who performed work in a nonfederal mental institution must be paid according to fair labor act
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patients rights D.right to live in a community
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released state mental patients have the right to live in adult homes in the community
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patients rights e-right to legal counsel
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an individual has the right to legal counsel during commitment process
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patient rights f.- right to the least restricted environment
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rights on inv. to receive treatment in less restrictive facilities then mental institution
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patients rights g- right to refuse tx
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often in cases incolving medical or drugs
-persons cannot be forced to become competent for trial -refuse treatments such as ECT ans psychosurgery |
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patients rights h-need for confinement must be shown by clear convincing evidence
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persons need to be kept in an institution must be based on demonstabel evidence
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patients rights i- right to confidentiality
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-protect disclosure of info limits to patients rights
1dangerous to themselves or others 2. incapable of providing basic physical needs 3. unable to make responsible decisions about hospitalization 4. in need of tx or care in hospital |
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insanity defense
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a. NGRI plea- (not guilty by reason of insanity): in an attempt to escape legally prescribed consequences of their crimes
b. GBMI (guilty but mentally ill): in these cases a defendant may be sentenced but placed in a treatment facility rather then in prison |
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axis I
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clinical diagnosis
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axia II
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personality diagnosis and mental retardation
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axis III
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general medical
-only related conditions (Alzheimer's disease) |
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axis IV
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psychological and environmental
-current stressors contribution or resulting |
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axis V
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GAF
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