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70 Cards in this Set

  • Front
  • Back
Carl Rogers' fully functioning person
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"
Epigenetic
Outcome is based on, but not determined by genetic unfolding
Erikson's Identity Formation
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
Intimacy vs. Isolation
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
Generativity vs. Stagnation
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
Ego integrity vs. Despair
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
DSM-IV
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
Leading causes of disability ages 15-44 in 2000
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
Adjustment disorders
-mild
-reactive episodes
-short lived
Dysthmia (short)
-depressed mood for 2+ years
-not severe
-chronic depression
-unhealthy lifestyle associations
Dysthmia (DSM-IV)
-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
Major Depressive Episode
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
What percentage of men/women between 60 and 64 have depression?
11% men
10% women
How much depression is diagnosed?
About half
Ages of major depression
18-29 – 2.7%
30-44 – 4%
45-64 – 2.3%
65+ - 1%
Ages of Dysthymia
18-24 – 2.1%
25-44 – 4.1%
45-64 – 3.8%
65+ - 1.8%
What percentage of ppl over 65 years have depressive symptoms?
16%
What percentage of older adults have major depression?
2-5%
Risk factors for depression
-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
Treatment for Depression
-Cognitive behavioral therapy
-interpersonal therapy
-acceptance and commitment therapy
-Medication - SSRIs
-psychotherapeutic management
SSRIs
-Prozac
-Zoloft
-Paxil
-Lexapro
Atypical antidepressants
-Wellbutrin
-Effexor
Hypomanic episode (DSM-IV)
-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
Symptoms of mania
-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
Manic Episode (DSM-IV)
-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
Bipolar I Disorder, Single Manic Episode
-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
Bipolar I Disorder, Most Recent Episode Manic
-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
Bipolar II Disorder
-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
Cyclothymia
-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
Characteristics of Unipolar depression
-only depression, no mania
-family history less prominent
-after age 25 onset usually
-onset more insidious
Characteristics of Bipolar Depression
-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
Causes of Bipolar
-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
Thalamus
relay station to the cerebral cortex
ventral brain system
automatic, motor function, sleep/wake cycle, reticular formation
Treatment of Bipolar
-Cognitive behavioral therapy
-interpersonal therapy
-acceptance and commitment therapy
-medications - SSRIs less frequent, anti-psychotics, lithium, depakote, Lamictal, Symbyax
-psychotherapeutic management
Community Choice
-10 counties in PA
-provides streamlined access to home and community based services
-
Nursing Home Transition
-available statewide
-assists ppl in nursing homes to relocate to community
-CMS Money Follows the Person Grant helps to facilitate this in 5 counties
Cash & Counseling
-enhanced, consumer-based model which allows customer's choice, flexibility, and control over their services
Who use the majority of Medicaid funds?
Elderly and disabled
Long-Term Living Reform Agenda
-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
Percentage of deaths occuring in a hospital
50%
Optimal arrangement of LTC
-placement fits need
-provides choice for customers
-money follows the consumer
Continuum of Need - Least Restrictive to Most Restrictive
-Home/apartment
-adult care home
-adult foster home
-assisted living/residential care
-nursing facility
-special unit within a nursing facility
Long Term Care
-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
Home/Community Base Care
-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
Acute Care
medical services that address a recent illness or injury or a necessary preventative procedure
Long-Term institutional Care
encompasses services provided in residential facilities like nursing homes, hospitals, and intermediate care facilities
Medicare parts
-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
Medicare in general
-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
History of Medicare
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
Medicare Part D
-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
Percentage of seniors with/without coverage who skip doses to make meds last longer
About 1/3 of those w/o coverage, 15% of those w/coverage
Out-of-pocket prescription drug costs increasing/decreasing?
Increasing rapidly
information processing perspective
-assumes that ppl are reflective and act on what they know (in constrast to strict behavioral model)
-information processed through stages
Sensory memory
-first level of processing (primary appraisal)
-large capacity
-limited duration
Selective attention
-process of choosing what we give attn to
-how do we decide - secondary appraisal involves novelty and relevance
divided attention
-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
sustained attention
-focus in task performance
-ADD burns out? - not necessarily
-relates to practice and experience
-secondary and reappraisal require sustained attn
effortful processing
-focusing all resources on a task
-reappraisal
Age-related differences in attn
-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
divided attn diff. w/age
-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
sustained attn diff. w/age
experience enhances ability to attend by disregarding irrelevant cues (driving
-novelty can overwhelm attn capacity
-may prefer automated tasks with age
processing speed diff. w/age
reaction time slows w/age
physical/mental/both?
Why slowing with age?
visual and auditory acuity changes
neural networks need more bypasses
inefficiency of neural networks
activity levels improve speed
Who has more crashes, teens or older adults?
teens
who has greater fatal crash rate - teen or older adult?
still teen - but much closer than just regular crash rate
Reasons for danger driving for older adults
-loss of contrast sensitivity
-less brightness
-glare sensitivity
-night vision
-color fading
-less peripheral vision
-macular degeneration (dark spots in vision)
Language processing diff. w/age
-speech recognition and discrimination slows beyond hearing loss - 10 seconds to process
-this is the only significant change
Post-Traumatic Stress Disorder
reminders of a traumatic event produce a physical response
-amygdala doesn't stop sending signals - over-sensitive
-beta blockers help
Amygdala
-recruits part of the brain to respond to stressful events - protective response to keep ppl alive