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70 Cards in this Set
- Front
- Back
Carl Rogers' fully functioning person
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open to all experience
able to live existentially (in the moment), is trusting in his/her own self, expresses feelings freely, acts independently, creative and lives "the good life" |
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Epigenetic
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Outcome is based on, but not determined by genetic unfolding
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Erikson's Identity Formation
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Life is not fixed nor is life course determined
8 Stages of Life - Identity formation Successful negotiation of each stages is a crisis for ego development and leads to a basic strength or basic pathology |
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Intimacy vs. Isolation
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18-30s
Goal: to learn to interact on a deeper level, revealing self to others, find companionship with similar others, love relationship with member of the opposite sex Disruption: inability to create strong social ties, loss of self in isolation and loneliness, becoming a loner/superficial |
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Generativity vs. Stagnation
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20s-60s
GOAL: value giving self to others, parenting is prized, community service (give back to the world), ensure success of future generations Disruption: feelings that life is worthless and boring, life is meaningless - not enjoying worldly success Care or rejectivity |
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Ego integrity vs. Despair
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60s +
Goal: in old age to derive wisdom from life experiences, look back on life and see meaning, order and integrity, pleasant reflections and present pursuits Wisdom or distain |
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DSM-IV
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Diagnostic Statistical Manual 4
Disorder is defined in terms of behavioral signs and symptoms and not a theory regarding optimal personality Condition must cause significant clinical distress Does condition impair functionality in a socially important way? (family, employment, etc.) Only diagnostic consideration for age is diff. criteria for kids & adults epidemiological data provided for diff. ages if available |
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Leading causes of disability ages 15-44 in 2000
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1. Unipolar depression
2. Alcohol use disorders 3. Schizophrenia 4. Iron-deficiency anemia 5. Bipolar 6. Hearing loss, adult onset 7. HIV/AIDS 8. Chronic obstructive pulmonary disease 9. Osteoarthritis 10. Road traffic accidents |
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Adjustment disorders
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-mild
-reactive episodes -short lived |
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Dysthmia (short)
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-depressed mood for 2+ years
-not severe -chronic depression -unhealthy lifestyle associations |
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Dysthmia (DSM-IV)
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-On the majority of days for 2+ years, depressed mood for most of day
-2 or more of (on depressed day) --appetite increase/decrease --sleep decrease/increase --fatigue --poor self-image --reduced concentration/decisiveness --hopeless feeling -above symptoms not absent for more than 2 months -for first 2 years, no major depressive episode |
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Major Depressive Episode
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5/9 Criteria for >2 weeks
-depressed/irritable mood (required) -interest/pleasure absent -weight/appetite decrease/increase -sleep disturbances -agitation/retardation -fatigue -worthlessness/guilt -concentration lack -suicidal acts/ideas |
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What percentage of men/women between 60 and 64 have depression?
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11% men
10% women |
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How much depression is diagnosed?
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About half
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Ages of major depression
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18-29 – 2.7%
30-44 – 4% 45-64 – 2.3% 65+ - 1% |
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Ages of Dysthymia
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18-24 – 2.1%
25-44 – 4.1% 45-64 – 3.8% 65+ - 1.8% |
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What percentage of ppl over 65 years have depressive symptoms?
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16%
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What percentage of older adults have major depression?
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2-5%
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Risk factors for depression
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-life-threatening, limited chronic illness
-unpleasant/demanding treatment -low social support -adverse social circumstances -personal/family history of depression/other mental illness -substance misuse -anti-hypertensive/corticosteriod/chemotherapy use |
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Treatment for Depression
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-Cognitive behavioral therapy
-interpersonal therapy -acceptance and commitment therapy -Medication - SSRIs -psychotherapeutic management |
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SSRIs
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-Prozac
-Zoloft -Paxil -Lexapro |
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Atypical antidepressants
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-Wellbutrin
-Effexor |
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Hypomanic episode (DSM-IV)
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-Persistently elevated mood for 4 days
-3 or more symptoms, persistent and relatively severe -unequivocal change not characteristic of the person -changes in functioning observable by others -episode is not severe enough to cause marked social/occupational functioning or to necessitate hospitalization, and no psychotic features |
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Symptoms of mania
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-inflated self-esteem/grandiosity
-decreased need for sleep -more talkative, pressured to keep talking -flight of ideas/thoughts racing -distractibility -increase in goal-oriented activity -psychomotor agitation -excessive involvement in pleasurable activities which may have painful consequences |
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Manic Episode (DSM-IV)
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-abnormally and persistently elevated, expansive, or irritable mood lasting at least one week or any duration if hospitalization is necessary
-three or more symptoms of mania (four if irritable) persistent and relatively severe -symptoms don't meet criteria for mixed episode -sufficiently severe to cause impaired functioning in social activities, relationships, or to require hospitalization to protect self and others, or psychotic features |
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Bipolar I Disorder, Single Manic Episode
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-Presence of only one Manic Episode and no Major Depressive Episodes
-recurrence is defined as either a change in polarity from depression or an interval of at least 2 months w/o manic symptoms -Manic Episode can't be better explained by Schizoaffective Disorder or superimposed on Schizophrenia, Schizophreniform disorder, Delusional disorder, or psychotic Disorder not otherwise specified |
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Bipolar I Disorder, Most Recent Episode Manic
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-Currently or most recently in a Manic Episode
-there has been at least one previous manic, major depressive, or mixed episode -not better accounted for by those other things |
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Bipolar II Disorder
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-Presence/history of one or more major depressive episodes
-presnce/history of one or more hypomanic episodes -never a manic or mixed episode -can't be better accounted for by those other crazy things -symptoms cause clinically significant distress or impairment in social, occupational, or other areas of functioning |
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Cyclothymia
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-for 2+ years, periods of presence of hypomanic symptoms and periods of depressive (but not major depressive) symptoms
-in kids/teens it's one year -for the above time period, person has not been w/o above symptoms for more than 2 consecutive months -No major depressive episode, manic episode, or mixed episode in 2/1 year |
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Characteristics of Unipolar depression
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-only depression, no mania
-family history less prominent -after age 25 onset usually -onset more insidious |
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Characteristics of Bipolar Depression
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-depression w/episodes of mania
-family history prominent -early onset more common -onset tends to be sudden -duration 3-6 mths, recurrence 95%, psychotic depression more frequent -higher suicide attempt rate 25% attempt 20% commit -antidepressant may not cause change or may cause mania |
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Causes of Bipolar
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-greater number of cells in thalamus and ventral brain regions
-leads to abundance/inconsistency in release of serotonin, dopamine, and nonrepinephrine -symptoms activate with trigger |
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Thalamus
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relay station to the cerebral cortex
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ventral brain system
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automatic, motor function, sleep/wake cycle, reticular formation
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Treatment of Bipolar
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-Cognitive behavioral therapy
-interpersonal therapy -acceptance and commitment therapy -medications - SSRIs less frequent, anti-psychotics, lithium, depakote, Lamictal, Symbyax -psychotherapeutic management |
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Community Choice
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-10 counties in PA
-provides streamlined access to home and community based services - |
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Nursing Home Transition
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-available statewide
-assists ppl in nursing homes to relocate to community -CMS Money Follows the Person Grant helps to facilitate this in 5 counties |
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Cash & Counseling
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-enhanced, consumer-based model which allows customer's choice, flexibility, and control over their services
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Who use the majority of Medicaid funds?
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Elderly and disabled
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Long-Term Living Reform Agenda
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-enhance efforts to help ppl move from nursing facilities back to the community
-make sure there are enough nursing home beds for the demand and help nursing homes develop continuum of care -ensure consistent eligibility criteria for LTL services and waivers for home/community care -maximize waiver resources for high quality care |
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Percentage of deaths occuring in a hospital
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50%
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Optimal arrangement of LTC
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-placement fits need
-provides choice for customers -money follows the consumer |
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Continuum of Need - Least Restrictive to Most Restrictive
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-Home/apartment
-adult care home -adult foster home -assisted living/residential care -nursing facility -special unit within a nursing facility |
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Long Term Care
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-necessary ongoing care for seniors and persons w/disabilities
-Services: -medical care -therapy -rehabilitation -care coordination -protective supervision -assistance w/ADLs -meal preparation -shopping -transportation |
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Home/Community Base Care
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-allows professional nursing and therapy services that are usually provided in a hospital or other health facility to be provided in the home/community
-Services: nursing, personal care, physical/speech therapy, medical social services, dietary counseling |
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Acute Care
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medical services that address a recent illness or injury or a necessary preventative procedure
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Long-Term institutional Care
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encompasses services provided in residential facilities like nursing homes, hospitals, and intermediate care facilities
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Medicare parts
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-Part A: Hospital Insurance for hospitals, nursing homes, home health, and hospice care
-Part B: Medical Insurance for physician visits, equipment, and outpatient care (option) -Part C: Medicare Advantage Medicare Health Plan -Part D: Prescription Drug Coverage |
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Medicare in general
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-Created in 1965 as America's National Health Insurance
-Original Medicare fashioned after traditional medical insurance - Fee for Service -Completely funded and and administered at the federal level -eligibility based on age/disability status - age 65 or older or disabled after a waiting period |
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History of Medicare
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1965: Medicare established under SSA - Social Security
1972: eligibility extended to disabled 1977: Health Care Financing Adminitration set up to administer Medicare/caid but enrollment still through 1980: Medigap insurance comes under federal oversight - HCFA goes under new Department of Health 1997: Balanced Budget Act establishes Part C - managed care under Medicare 2001: HCFA becomes Centers for Medicare and Medicaid Service (CMS) 2003: medicare part D established, Medicare part C named Medicare Advantage 2006: medicare prescription drug coverage begins |
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Medicare Part D
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-Beneficiary has to pay $100 of $250 deductible
-prescription costs $251 - $2,250 covered 75% -After annual out-of-pocket amount ($3600) Medicare pays 95% -all beneficiary payments count for out of pocket amount -out of pocket amount reached after total drug costs >$5100 -no coverage for drug costs from $2251 to $5100 |
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Percentage of seniors with/without coverage who skip doses to make meds last longer
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About 1/3 of those w/o coverage, 15% of those w/coverage
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Out-of-pocket prescription drug costs increasing/decreasing?
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Increasing rapidly
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information processing perspective
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-assumes that ppl are reflective and act on what they know (in constrast to strict behavioral model)
-information processed through stages |
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Sensory memory
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-first level of processing (primary appraisal)
-large capacity -limited duration |
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Selective attention
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-process of choosing what we give attn to
-how do we decide - secondary appraisal involves novelty and relevance |
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divided attention
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-how much info can be processed at one time
-secondary appraisal and reappraisal count on this -processor speed decreases with age -multi-tasking ability decreases with age -too much stress erodes multi-tasking -self-handicapping erodes multitasking |
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sustained attention
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-focus in task performance
-ADD burns out? - not necessarily -relates to practice and experience -secondary and reappraisal require sustained attn |
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effortful processing
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-focusing all resources on a task
-reappraisal |
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Age-related differences in attn
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-reduced processing resources
-reduced visual acuity may impact ability to switch tasks rapidly -irrelevant info inhibits processing when more than one modality is in use |
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divided attn diff. w/age
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-older ppl don't multitask as well
-novel info takes longer to integrate and automate -heightened emotional sensitivity impairs ability to automate -need more use of context strategies w/age |
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sustained attn diff. w/age
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experience enhances ability to attend by disregarding irrelevant cues (driving
-novelty can overwhelm attn capacity -may prefer automated tasks with age |
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processing speed diff. w/age
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reaction time slows w/age
physical/mental/both? |
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Why slowing with age?
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visual and auditory acuity changes
neural networks need more bypasses inefficiency of neural networks activity levels improve speed |
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Who has more crashes, teens or older adults?
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teens
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who has greater fatal crash rate - teen or older adult?
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still teen - but much closer than just regular crash rate
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Reasons for danger driving for older adults
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-loss of contrast sensitivity
-less brightness -glare sensitivity -night vision -color fading -less peripheral vision -macular degeneration (dark spots in vision) |
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Language processing diff. w/age
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-speech recognition and discrimination slows beyond hearing loss - 10 seconds to process
-this is the only significant change |
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Post-Traumatic Stress Disorder
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reminders of a traumatic event produce a physical response
-amygdala doesn't stop sending signals - over-sensitive -beta blockers help |
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Amygdala
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-recruits part of the brain to respond to stressful events - protective response to keep ppl alive
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