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65 Cards in this Set

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What is the estimated fiscal cost of schizophrenia in the United States? (234)
The estimated cost in the U.S. was $62.7 billion in 2002.
What does your text estimate to be the percentage of homeless persons who have schizophrenia? (235)
10 to 20% of homeless people have schizophrenia
What are the most common types of symptoms of schizophrenia? (235)
The most common types of symptoms are:
• Positive symptoms (hallucinations,, delusions, disorganization)
• Negative symptoms (social withdrawal, apathy, anhedonia, poverty of speech)
• Cognitive impairments (memory difficulties, planning ability, abstract thinking)
• Problems with mood (depression, anxiety, anger)
What is the lifetime prevalence of schizophrenia? (237)
Between .55% and 1% per 100 persons.
Describe the “social drift” hypothesis and the “environmental stress” hypothesis. (238)
• SD- Debilitating effects of schizophrenia on capacity to work result in a lowering of socioeconomic means, and hence poverty.
• ES- High levels of stress associated with poverty precipitate schizophrenia in some individuals who would not otherwise develop the illness.
What “cognitive impairments” are associated with schizophrenia? (239)
Cognitive impairments are so commonplace that they are now considered a core feature of schizophrenia. Cognitive impairments may interfere with the person's ability to focus for sustained periods on work or recreational pursuits, interact effectively with others, perform basic activities of daily living, or participate in conventional psychotherapeutic interventions. Cognitive impairments also result in difficulties generalizing training or knowledge to other areas.
What is the difference between positive symptoms and negative/cognitive symptoms with regards to course and response to treatment? (240)
The positive symptoms of schizophrenia tend to fluctuate over the course of the disorder and are often in remission between episodes of the illness. Positive symptoms tend to be responsive to the effects of the antipsychotic medication.
In contrast, negative symptoms and cognitive impairments tend to be stable over time and are less responsive to antipsychotic medications.
What are common comorbid disorders associated with schizophrenia? (240)
Depression, Anxiety, and substance use disorders.
Compared with the general population, what is the likelihood that someone with schizophrenia will have a substance abuse disorder? What is the approximate percentage of persons with schizophrenia that have a lifetime history of substance use disorder and that have a recent history of such a disorder? (241)
They are more than 4 times as likely to have substance abuse disorder
50% have a life time history of substance
25-35% have recent history
What are some clinical features of schizophrenia that interfere with treatment? (241)
Most are unaware that they have disorder or complications
Problems with paranoia or distrust can contribute to noncompliance
Some medications have side effects that contribute to noncompliance.
What percentage of persons with schizophrenia will relapse with medication noncompliance? (241)
50-75%. Most who discontinue medication use will relapse within one year.
Comment on schizophrenia’s association with violence. (242)
• Rates of violence have been found to be relatively higher in people with schizophrenia and other sever mental illnesses.
• violence with the schizophrenic is actually lower when compared with clients with depression and bipolar disorder
• However, most people with schizophrenia are not violent. When violence does occur....it is usually associated with substance abuse.
What are the onset, course, and prognosis for individuals with schizophrenia? (243-244)
a.onset-late adolescence or early adulthood, ages 16-25. However, the sings can be seen in children with impairments in sociability, emotional expressiveness, and neuromotor functioning.
b.course-early intervention programs, medications
c.prognosis- the earlier antipsychotic medications are initiated the better the outcome; women have a better prognosis than men
What are some general predictors of the course and outcome of schizophrenia? (245)
a.the ability to predict outcome is poor, this is because there are many variables that one must factor in to each individual (every person experiences schizophrenia differently)
What are the advantages of using a structured clinical interview rather than a more open format when assessing for schizophrenia? (247)
a.they provide definitions of the key symptoms, which helps in making a diagnosis
b.they are in a standardized format which make them easier to compare with other diagnostic assessments.
What are the common disorders that overlap with symptoms of schizophrenia and what methods are used to differentiate them from schizophrenia? (247-251)
substance use disorder- (methods) maintain a high index of suspicion of current substance abuse, use multiple assessment techniques, be alert of signs that may be subtle indicators of the presence of a substance-use disorder
What area important interactions between the family and the person with schizophrenia should be considered in assessment and intervention? (257)
It has repeatedly been found that critical attitudes and high levels of emotional over involvement on the part of the relatives toward the individual with schizophrenia are strong predictors of the likelihood that persons with schizophrenia will relapse. Also family members with of persons with schizophrenia typically experience a wide range of negative emotions related to coping with the illness, such as anxiety, depression, guild, and anger. Burden is even associated with negative health consequences for relatives.
Describe the stress-vulnerability model. (259).
The stress vulnerability model assumes that symptom severity and related impairments of psychiatric disorders such as schizophrenia have a biological basis (psychobiological vulnerability) determined by a combination of genetic and early environmental factors.
• Medications decrease vulnerability
• Substance use disorders increase vulnerability
• Stress impinges on vulnerability, precipitating relapse and worsened outcomes
• Coping resources (coping skills and social support) minimize effects of stress on relapse and the need for acute care.
What are some gender differences in regards to the course and treatment of schizophrenia? (259)
Women:
• later onset
• milder overall course
• more likely to marry and have children
• treatment plan needs include: relationship, family planning, parenting
• report more sexual assault

Men:
• more likely to receive treatment for the disorder
• research based on this population
• skills training more helpful for men
What are the nine possible symptoms of a major depressive episode? How many must an individual have in order to qualify for a MDE? (287)
• Depressed mood
• Diminished interest or pleasure in all, or almost all, activities (one is required)
• Significant weight loss or weight gain or a decrease or increase in appetite
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthless or excessive or inappropriate guilt
• Diminished ability to think or concentrate, or to make decisions
• Recurrent thoughts of death, suicidal, ideation, plans, or attempts
What are some of the provisionary depressive conditions covered under the category of “depressive disorder NOS”? (289)
Minor depressive disorder
-recurrent brief depressive disorder
-postpsychotic depressive disorder of schizophrenia
- premenstrual dysphoric disorder
-depression due to general medical condition
What are some diagnoses that share symptoms with depression? (289)
This could be sadness brought on my grief or the loss of a loved one or an adjustment disorder. Also if a person suffers from depression and has a medical condition known to cause symptoms of depression, the symptoms are classified as depression due to a general medical condition.
What is known about the prevalence of depression in older adults? (293)
• It has been 30 years since there has been a national survey of the prevalence of psychiatric disorders in older adults.
• rates for all psychiatric disorders are increasing with each decade, indicating that disorders like depression may be influenced by cohort effects.
• the rates of depressive disorders in older adults in the ECA studies are thought to be underestimated.
What are likely causes of higher rates of depressive disorders in nursing home facilities? (294)
The causes for higher prevalence of depressive disorders in nursing home facilities may vary but most likely include loss of functional independence, loss of familiar surroundings, decreased access to pleasant activities or loved ones, and comorbid physical illnesses.
What is negativistic thinking, and what are some characteristics of individuals with this cognitive style? (295)
Most people with a depressive disorder exhibit what is called negativistic thinking. Negativistic thinking is best described as a style of thinking that is overly pessimistic and critical. People with negativistic thinking also have poor self-esteem and are passive when difficulty arises. (Think depressive symptoms = negativistic thinking).
Why is social isolation a common feature of depressive disorders? (295)
Negativistic thinking is primarily responsible for why depressed people find it difficult to engage in and enjoy activities that once gave them pleasure, and thus social isolation is a common feature of depressive disorders. Many people with a depressive disorder will report that they have stopped socializing or engaging in pleasant activities, largely because they anticipate no enjoyment from the activity.
How does learned helplessness or passive coping skills exacerbate depressive symptoms? (296)
Most often, after people become depressed, they avoid proactive attempts to solve problems because they anticipate that they are not capable of implementing a successful solution. This avoidance often results in more problems; for instance, avoiding marital problems potentially results in divorce.
What are the three main tenets of positive psychology? (296)
• the pleasant life
• the good life
• the meaningful life
Compared to nondepressed persons, what is the number of disability days reported by people with depressive disorders? (296)
fivefold increase
What are the differences in course between early-and late-onset major depression? (297)
Early onset depression
-tends to appear before age 20
-has a more malignant course than late onset
-Associated w/ a family history of depression & other mood disorders
Late onset depression
-tends to emerge in the mid-30s
-Associated w/ fewer recurrent episodes, comorbid personality disorders, &
substance abuse disorders relative to early onset
What are the three delineating features of MDD? (297)
1. Age of Onset
2. Course of MDD tends to be time limited.
3. MDD tends to be a recurrent disorder
What is the mean duration of dysthymia? (297)
30 years and half develop Major depressive disorder
Compared to major depression or depression NOS, what is the prognosis of someone with dysthymia? What number of those with dysthymia will receive treatment? (297)
Worse clinical prognosis
As disabled as those with depression
Fewer than half
What are factors that help in the recovery from a depressive disorder? (297-298)
Early diagnosis
Treatment with therapy, medication or both
Quicker recovery
Higher self-esteem levels
What are areas to assess before making a diagnosis of a depressive disorder? (298-300)
Complete physical (ruling out medical conditions)
Determine alcohol and drug usage (rule out substance abuse or dependence)
List of medications used (helps to lower side effects of medication used in depression)
What is currently the most common theory about the origin of depressive disorders? (304)
• Most scientists now believe that depressive disorders are multifaceted, with causes resulting from the interactions of psychological, social, and biological factors.
• Genetics, learning, and life experiences all work together to cause depression.
What are three psychological variables related to depressive disorders? (305)
. People's cognitive appraisals of themselves, their lives and others.

2. Whether people productively solve problems or avoid them.

3. The degree to which proactive attempts to cope with stress have been successful
What are factors that mediate the development of depressive symptoms during negative life events? (307)
The social and psychological resources available to the person facing the stressful life event generally mediate the impact of mood.
What can the resurgence of interest in bipolar affective disorder be attributed to? (317)
• People's cognitive appraisals of themselves, their lives and others.
• Whether people productively solve problems or avoid them.
• The degree to which proactive attempts to cope with stress have been successful.
What was bipolar disorder formerly known as? How is it defined? (317)
Manic-depressive illness
b. Defined by manic symptoms
Elated, expansive, or irritable mood + 3 of the following
1. Decreased need for sleep
2. Racing thoughts or flight of ideas
3. Rapid speech
4. inflated self-esteem/grandiosity
5. Impulsive, reckless behavior
6. increased energy and activity
7. Distractibility
According to the National Comorbidity Survey, what percentage of the general population suffer from bipolar I or II disorder? What percentage of the general population suffer from cyclothymia? (320)
a.Bipolar I & II Disorder – 4% of the general population.
b.Cyclothymia – 4.2% of the general population.
When is the peak age of onset for bipolar disorder? What is earlier age of onset associated with? (320)
a.Peak age of Onset – between 15 and 19 years old.
b.Earlier age of onset is associated with rapid cycling and other negative outcomes in adulthood.
How are women and men typically different in how they present bipolar disorder? (321)
a.Women and men are equally likely to develop Bipolar I.
b.Women report more depressive episodes and are more likely to develop Bipolar II.
c.Women are more likely to meet criteria for rapid cycling Bipolar Disorder, and especially with repeated depressive episodes.
What are the rates of recurrence at 1 year, over 2 years, and over 5 years? (322-323)
Rates of recurrence, even when patients are treated with mood stabilizers average 37% in 1 year, 60% over 2 years, and 73% over 5 years.
Approximately how many patients are characterized as rapid cyclers? What does this mean? (323)
Approximately one in 5 patients can be characterized as rapid cycles, meaning they have 4 or more distinct episodes of mania, hypo mania, mixed or depressive disorder within a year.
What do findings of prospective studies indicate about bipolar depression? What does this suggest? (324)
that negative life events are precipitants of bipolar depression
What is the optimal treatment for bipolar disorder? What treatment often occurs instead and why? (326)
Combinations of pharmacological and psychosocial interventions. Often managed care cost containment, drug treatments are often the only treatment provided
Distinguish between acute pharmacological treatment and maintenance treatment. (326)
The goal of acute treatment is to stabilize an existing manic or depressive episode, while maintenance treatment is used to minimize residual symptoms and prevent recurrences
What medicine combination is common in current pharmacotherapy for mania? (326)
• mood stabilizers
• atypical antipsychotic medications
What percentage of bipolar patients become fully or partially medicinally noncompliant after a major episode of illness? What are the risks for discontinuing pharmacotherapy abruptly? (326)
• As many as 60%
• Patience who discontinue their pharmacotherapy abruptly are at a high risk for recurrence and suicide attempts
What are some characteristics of patients with subsyndromal forms of bipolar disorder? (328)
• More likely to have family histories of BD
• Higher rates of hypomania induced by anti-depressants
• Higher rates of suicide
• Marital disruption
• Mental health service utilization
What two categories of risk for bipolar disorder were defined for youth? Briefly describe each. (330)
• Episodic irritability: predicts the onset of mania by age 16, parents and children answer questions to “Are there times when the child feels irritable or jumpy?”
• Chronic irritability: associated with ADHD: unique predictor of mania by age 22
What are the comorbid disorders highly associated with bipolar disorder? (330)
mania/hypomania and ADHD followed by ODD, agoraphobia, panic disorder, GAD, alcohol dependence, and drug abuse.
16. How are patients with bipolar disorder diagnosed? What are two forms of assessment for bipolar disorder? (331)
Most patients with BD are diagnosed by a clinical interview.
Structured Diagnostic Interview for DSM-IV (SCID) & National Institute of Mental Health Life Charting Method
What is the range of heritability estimates for bipolar disorder? What is the risk for developing bipolar disorder in children of bipolar parents as compared to children of healthy parents? (332)
• Estimates of the heritability of BD range from 59% to 87%
• The risk of BD among children of bipolar parents is four times greater than the risk among children with healthy parents.
Given the complex interactions between neurotransmitter systems, what does current research focus on? (332)
Current research focuses on the focuses on the functioning of neurotransmitter systems rather than simply models of neurotransmitter levels being either high or low.
What key structures does neuroimaging implicate in the pathophysiology of bipolar disorder? (333)
amygdala, prefrontal cortex, anterior cingulated, and hippocampus
Define delusion, illusion, & hallucinations.
• Illusion- sensory misperception that is common
• Hallucination- a sensory misperception that is not seen by everyone
• Delusion- not perception related, has to do with thoughts or beliefs, but is not common
➢ Bizarre: Impossible delusions; in a category with hallucinations*
➢ Non-Bizarre: Not impossible delusions
Describe and distinguish between the Schizophrenic Spectrum
a) Brief Psychotic Disorder
i) Criteria A (1 day to a month)
b) Schizoprhenoform Disorder
i) Criteria A (1-6 months)
ii) Always coded as provisional (until it’s not true)
c) Schizophrenia
i) Criteria A (more than 6 months)
d) Schizoaffective Disorder
i) Criteria A and Mood Disorder
ii) At least 2 weeks of hallucinations and delusions
e) Delusional Disorder
i) Non-bizarre symptoms of delusions (it’s plausible)
ii) Criteria A has never been met
f) Schizotypal Personality Disorder
i) Type of schizophrenia that does not meet full criteria.
ii) Social and interpersonal deficit
iii) No psychotic symptoms (2 year window)

• Criteria A:
➢ Two or more of the following:
• Delusions*
• Hallucinations disorganized speech*
• Grossly disorganized or catatonic behavior
• Negative symptoms
• *NOTE: bizarre delusions or hallucinations are enough to meet criteria A
Define (what is the category about) and list positive and negative symptoms of schizophrenia (there are four of each).
Positive symptoms (hallucinations,, delusions, disorganization)
Negative symptoms (social withdrawal, apathy, anhedonia, poverty of speech)
Describe Mood States (Based off of normal level)
a) Hypomania- Little above
b) Mania- Above
c) Dysphoria- Little Below
d) Depressed- Below
Define and distinguish between Major Depressive Disorder and Dysthymic Disorder.
a) The time period is different. Two year time period for Dysthymic Disorder
b) Major Depressive Disorder is more severe.
How are Bipolar I, Bipolar II, and Cyclothymia differentiated using the mood states?
a) Bipolar I- requires full blown Mania
b) Bipolar II- does not require full blown mania (hypomania), but Major Depressive Disorder
c) Cyclothymia- hypomania and almost having major depressive disorder
What is Double Depression?
Major Depressive Episode superimposed on a preexisting Dysthymic Disorder
What drug is often used for Bipolar disorder? Why is it managed carefully?
a) Lithium
b) Used to treat mania and has a small therapeutic window; it may become toxic.