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116 Cards in this Set
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Axis II disorders
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MR and Personality DO, also defense mechanisms and/or maladaptive personality traits not sufficient for personality DO
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DSM-IV-TR approach
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categorical - divides DOs based on criteria sets with defining features. Meets or doesn't meet criteria.
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polythetic criteria sets
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To receive a DO, ind only has to present with a subset of symptoms from a longer list
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Mild MR
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IQ - 50-55 to 70
"Educable MR" Majority (85%) Not noticed until late childhood Up to 6th grade level educ. Live/work independently |
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Moderate MR
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35-40 to 50-55 IQ
"trainable" 10% of MR 2nd grade level live/work under supervision |
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Severe MR
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20-25 to 35-40
3-4% MR poor motor skills, limited communicative speech live with others under close supervision |
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Profound MR
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below 20-25
1-2% of MR severe limitations motor/sensory highly structured environ/constant aid & sup |
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MR etilogy, two most common
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1. Developmental alteration in embryo 30% (ex. Down's/FAS)
2. Environmental influences & other d/o (ex. deprivation or Autism) |
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Autism
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Before age 3
social interaction communicative language repetitive/stereotyped beh 75% get co-dx of MR poor prognosis |
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echolalia
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echoing words/phrases of others. Common in Autism
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Autism rates/gender
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2-5 in 10,000
2-5x more in males unrelated to schizophrenia |
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Autism etiology
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-NOT related to SES or parental characteristics
-genetic/neurological explanations more valid |
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Autism Tx
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-Behavioral therapy (operant) found effective
-Most effective when initiated young age & intensive -Drugs little effect, except Haloperidol for certain beh |
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Rett's DO
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-Developmental regression before age FOUR (# letters)
-Normal development for at least 5 mos -Females only |
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Childhood Disintegrative DO
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-Normal dev. until 2+ yrs
-Before age 10 significant loss of developed skills in two areas -very rare |
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Asperger's DO different from Autism
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no delay in:
language, self-help skills, cognitive dev, or curiosity about environ |
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Frequent Co-Dx in learning disorders
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ADHD (20-50%)
Also: conduct, ODD, MDD |
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Phonological DO
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Does not use speech sounds expected for age and dialect
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Stuttering
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-abnormalities in fluency/time pattering of speech
-Remits on own by age 16 in 60% of cases |
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ADHD onset, duration, gender
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onset before age 7
duration at least 6 mos 4-9x more common in boys |
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Co-Dx for ADHD
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Conduct 50%
Emotional Dx 25% Learning Dx 20% 70% exhibit signs through life |
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ADHD etiology
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biological
Abnormalities in prefrontal cortex Caudate Nucleus 57% parent to offspring twin studies show .80 heritability for hyper/impuls |
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Behavioral disinhibition hypothesis
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Barkley
ADHD not attention deficits but inability to adjust activity levels to setting |
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TX for ADHD
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TX suppress symptoms not cure
Typically drugs (stimulants) and cog/beh modalities |
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Ritalin (Methylphenidate) side effects
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somatic complaints
motor and vocal tics obsessive compulsive symptoms growth suppression |
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Conduct DO vs. Oppositional Defiant DO
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defy society rules/norms vs. defiance to authority figures, negativistic
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Conduct DO Dx
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-3 signs, for at least 12 mos, with one sign in past 6 mos
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Conduct DO childhood vs. adol onset
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-childhood: 1 sign prior 10yo, more overt aggression, more likely antisocial
-Adol: signs after age 10, less severe & better prognosis |
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ODD DO Dx
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4 signs persist for at least 6 mos
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Pica
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Eat nonnutritive subs persistently for at least 1 mo.
rare, = boys&girls associated with MR |
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Tourette's DO
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onset 2-18 yo
motor AND vocal tics tics must occur multiple times/day, daily or periodically for at least one year (no more than 3 mos break from tics) |
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Chronic Motor or Vocal Tic
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either motor or vocal tics, not both like Tourette's
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Encopresis (not due GME)
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passage of feces
1x month for 3 mos At least age 4 |
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Enuresis (not due GME)
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passing of urine (awake-diurnal or sleep-nocturnal)
2x week for 3 mos At least age 5 more common boys than girls, but shrinks with age |
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Reactive Atachment DO of infancy or early childhood
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extremely disturbed and dev inappropriate social relatedness
-onset before age 5 -inhibited and disinhibited type |
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Stereotypic Movement DO
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-repetitive, apparently driven motor behaviors
-cause harm -often resist behaviors -assoc. w/MR |
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Childhood Depression (how presents)
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-young children show separation anxiety resulting in school phobias
-adol (esp. boys) antisocial behaviors |
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Differential diagnosis between Substance Intox/Withdrawal and Substance-Induced disorder
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Intox/Withdrawal tend to account for most presentations but when symptoms are IN EXCESS of typical intox/with than warrant substance-induced do diagnosis and therefore independent clinical attn.
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Hallucinogen Persisting Perception DO
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hallucinogen flashbacks that occurred during hallucinogen intox. Occurs when s.o. is not currently using.
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DO caused exclusively by GME or substance use, with impairment in cognition or memory
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Delirium
Dementia Amnestic DO |
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Delirium def
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disturbance of consciousness
marked change in cognition or perception Rapid and usually brief (less than 1 mo) Typicallly 60+, but children more vulnerable than adults |
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Risk groups for Delirium
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1. older Px 60+
2. Px with decreased "cerebral reserve" (ex. stroke, dementia etc.) 3. Postcardiotomy Px 4. Px in drug withdrawal, esp. alcohol and benzos |
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Dementia def
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multiple cognitive impairments:
1. memory and 1 of following: 2. aphasia 3. apraxia 4. agnosia 5. disturbance exec function |
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Dementia vs. Delirium
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Dementia Px are alert, course is more variable, tend be 85+, rare in adol/children
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Dementia vs. pseudo-dementia (depression impairs cognitive functioning)
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In pseudo-dementia px tend to show improved functioning as mood improves.
Can date the onset of cognitive deficits more precisely (more sudden). More concerned with cognitive deficits than in dementia. |
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Dementia vs. depression as related to cognitive symptoms
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Depression: transitory
involve only procedural & recall (not recognition). Dementia: widespread involve recall AND recognition |
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Alzheimer's Dementia
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impaired declarative memory(semantic & episodic) but procedural is intact
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Alzheimer's Disease
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50% of Dementia Px
duration from onset to death: 8-10 yrs clinical course: gradual & progressive Women overrepresented 3-4x likely to have first degree relative with illness |
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Vascular Dementia
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10-20% of Dementia Px
due to cerebrovascular disease (stroke or infarction) tha causes decreased blood supply to brain clinical course: variable and progressive onset is abrupt |
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Substance-Induced Persisting Dementia/Amnestic DO
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PERSISTING effects of substance use, not direct effects of intox/with - develops long after substance has been eliminated from body
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Anterograde amnesia
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inability to learn new information
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Retrograde amnesia
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inability to recall learned info or events from past
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Substance Dependence
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use despite significant substance-related problems
12-month period tolerance and withdrawal N/A for caffiene |
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Substance Abuse
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less severe than dependence
maladaptive pattern of use 12-month period N/A for caffiene or Nicotine |
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Korsakoff's Syndrome
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a.k.a. Alcohol-induced persisting Amnestic DO
due to thiamine deficiency causing damage to thalamus impairment in recent memory (ability to txfr short to long term) confabulation |
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Cannabis
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No physical dependence
no sig withdrawal symptoms inhibits aggression |
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Abstinence Violation Effect (AVE)
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Marlatt & Gordon:
Attributions for cause of relapse affect abstinence. i.e. if internal and stable - hinder recovery, if external and unstable than higher recover rates and coping w/lapses |
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Tx for Nicotine Dependence
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Most stop on own or with minimal professional help
-multimodal behavioral approach -replacement tx effects maximized w/behavioral intervention |
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Relapse Prevention Therapy
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Marlatt and Gordon
-not disease model -maladaptive, over-learned habit patterns -include cognitive therapy, coping skills training, lifestyle mods (meditation/exercise) |
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According to Marlatt and Gordon, name 3 high-risk situations associated with 75% of relapses
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1. negative emotional states
2. interpersonal conflict 3. social pressure |
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Duration Schizophrenia vs. Schizophreniform
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Schizophrenia - active phase for 1 month, signs persist fofr at least 6 months
Schizophreniform - less than 6 months |
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alogia
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restricted fluency/productivity of thought and speech
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Schizophrenia age onset/gender/course
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onset late teens to mid-30's
equally common in males/females (community) males>females in hospital course is chronic |
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Factors associated w/better prognosis for Schizophrenia
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1. late and acute onset
2. precipating event 3. female 4. good premorbid adjustment 5. brief duration of active-phase symptoms 6. family history of mood disorder 7. NO family history of Schizophrenia |
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General Etiology of Schizophrenia
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genetics and biological factors, but also psychosocial factors
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Dopamine hypothesis (neurotransmitter imbalance)
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Schizophrenic reactions associated w/excess or sensitivity to dopamine (imbalance of norepinephrine and dopamine)
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Lifetime probabilities for developing schizophrenia
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unrelated 1%
Biological siblings 10% Dizygotic twins 16% Monozygotic twins 48% |
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Author diathesis-stress theory of Schizophrenia
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Mednick
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Schizophrenia in industralized vs. non-industralized (developing) countries
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industralized countries had higher rate of continuous or episodic illness w/o full remission (65%) vs. developing countries (39% - hypothesize more family/community support
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Tx for Schizophrenia
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1. antipsychotic meds with social skills training during acute
2. day tx following acute that includes occupational therapy 3. education of family (familiy therapy and meds more effective than meds alone) |
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Schizoaffective DO
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both mood disorder and schizophrenia (active phase symptoms)
-period of two weeks where psychotic symptoms are present AND mood syms are absent (otherwise Mood DO w/psychotic features) |
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Delusional DO, types
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non-bizarre delusions persistent for at least 1 mo
1. erotomanic 2. grandiose 3. jealous 4. persecutory 5. somatic 6. unspecified/mixed |
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Brief Psychotic DO
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one psychotic symptom
Sudden onset/brief hours to NOT exceed one month full return to premorbid level w/ or w/o marked stressor, postpartum onset |
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Loose associations vs. circumstantiality
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loose assoications more vague, unfocused and bizarre. Main point is lost.
Circumstantiality is more excessive detail but main point never lost. |
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% Bipolar I/Unipolar depression die by suicide
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10-15%/15%
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Cyclothymic D/O
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lasts at least 2 yrs
hypomanic/depression cycles both milder than MD or Mania daily functioning not impaired |
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% of those with one major depressive episode experience another
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50-60% within a 2 year period
change diagnosis to MDD, recurrent |
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Women and depression
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2x higher than men
onset with menses in adol. different coping than men (brood/dwell vs. action/mastery) multiple roles lowers risk women more extreme levels of well-being (neg and pos) |
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Postpartum Depression, % and course
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50-80% "baby blues"
onset first few days through 2-8 wks, could last 1 year only 10-20% develop into Mood D/O |
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catecholamine hypothesis for depression
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depression=low norepinephrine
mania=excess norepinephrine (while dopamine is a catecholamine this theory only addresses norepi) |
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permissive theory for depression
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implicates serotonin and norepinephrine
dep= low both mania=high norepi, low sero |
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Rehm Self-Control Theory of depression
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structured group therapy
help px self-monitor mood/activity, self-evals, and administer healthy self-reinforcement |
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MAO inhibitors vs. tricyclics/SSRI's in treating depression
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MAO = atypical depression including anxiety, OC, hypochondria
Tricyclics/SSRI's = classic symptoms |
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Cognitive therapy vs. IPT for depression
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cognitive therapy most effective for mild dep
IPT with meds most effective with severe dep |
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TX for depression
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combination of therapy and drugs greater than either alone
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Bipolar I vs. II
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BI does NOT require a Major Depressive Episode, but BII does
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Panic D/O vs. Social/Specific Phobia
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In Panic D/O the panic attacks are not bound to a specific situation
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Tx phobias
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agoraphobia - antidepressant & in-vivo w/response prevention (flooding, group therapy w/imp. people
Specific phobias - longer periods of exposure more effective (either in-vivo or imaginal) Social Phobia - meds, beta-blockers |
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Tx OCD
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In-vivo exposure w/response prevention
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PTSD vs Acute Stress D/O
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PTSD symtptoms must last for >1 mo, Acute Stress symptoms occur w/i 1 month and last from 2 wks to 1 mo - beyond 1 mo consider PTSD
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Acute vs. Chronic PTSD
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symptoms last <3mos=Acute
>3mos=Chronic |
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EMDR efficacy in PTSD
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more effective compared to no tx or non-exposure tx, but no more effective than exposure techniques
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Conversion d/o vs. somatization d/o
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Conversion symptoms are motor or sensory and appear to be due to psychological need/conflict.
Somatization - multiple physical complaints not fully explained medically |
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Genetic basis for personality d/o
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Antisocial well-established - 5-10x greater w/1st degree relatives
Also, schizoid, schizotypal and paranoid genetic component. |
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What not predictive of personality d/o
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level of education
social class alcoholism (what is? poor childhood adaptive behavior) |
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schizotypal vs. schizoid personality d/o
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schizotypal - deficits interpersonally but also peculiar thoughts & behaviors (t in typal=thoughts).
schizoid - indifference socially, limited emotional expression (no t =no thought concerns) |
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Who pioneered use of "family lunch" for tx of Anorexia?
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Minuchin
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Ganser's syndrome
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"syndrome of approximate answers" - answers close to truth but not completely true
Dissociative Disorder NOS assoc w/hallucinations, disorientation, amnesia and lack of insight |
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hynopompic vs. hypnagogic hallucinations
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hypnopompic - awakening
hypnagogic - "go-ing" to sleep |
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Primary vs. Secondary impotence
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"secondary" means impotence occurs after period of normal functioning
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Dissociative Fugue vs. Amnesia
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Fugue involves travel away from home or adoption of new identity.
Amnesia involves forgetting important personal info |
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delusions
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false beliefs firmly held despite clear evidence to contrary.
represent beliefs not widely accepted by one's culture |
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illusions vs. hallucinations
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misperceptions of actual external stimulus vs. perceptions seemingly real but w/o presence of external stimulus
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magical thinking
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belief one's thoughts/actions can control specific outcome
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generalized tonic-clonic seizures
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a.k.a. grand mal
last up to 1 hour followed by deep sleeep |
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generalized absense seizures
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a.k.a. petit-mal
brief, no deep sleep after |
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complex-partial seizures
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confused, stare blankly, walk like in a daze
a.k.a. psychomotor seizures or temporal lobe seizures (tori lynn) |
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simple partial seizures
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affect one side of body
uncontrollable jerking/trembling of arm/leg tonic-clonic seizure may follow |
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Types of biofeedback tx for tension vs. migraine headaches
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muscle/tension = EMG
migraine = thermal hand warming |
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tx for tension and migraine headaches
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relaxation as effective as biofeedback therefore relaxation is recommended because easier to apply
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Tx for pain
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-operant treatments which reorganize environ rewards/pun so pain behavior is no longer reinforcing
-cognitive tech -relaxation training |
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essential or primary vs. secondary hypertension
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secondary - result of known GME
primary - cause is unknown, 80% of cases |
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general adaption syndrome (Selye)
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Alarm reaction - mobilization of sympathetic nervous sys
Resistance - defenses stabilizes, symptoms disappear Exhaustion - depletion of energy, organ failure, collapse from prolonged resistance (ARE) |
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Aspects of Type A linked to medical disorders (including heart disease)
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anger, hostility and aggression more predictive than job involvement or time urgency.
depession equally associated w/heart disease |
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Sickness Impact Profile (SIP)
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Quality of life measurement used to assess impact of disease on physical and emotional functioning.
higher score, greater level dysfunction |
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Schizophrenia disorganized vs. undifferentiated
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disorganized - disorganized behavior/speech and flat or inappropriate affect (laughter/grimaces etc.)
Undifferentiated - can have aspects of other types (ex. paranoid delusions and inappropriate affect) or not clear |