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122 Cards in this Set
- Front
- Back
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Alzheimer's
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Most common cause of dementia-65%
> females higher w/ lower ed gradual onset progressive cognitive function. |
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Stages
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s1-1-3yrs anterograde amnesia-defecits in visuospatial skills
wandering, indifference irritability sadness s2- 2-10yrs >retrograde annesia, flat or labile moods, restlessness- agitation, delusios, ideomotor apraxia cannot translate idea to movement s3 8-12yrs severely deteriorated intellectual functioning, limb rigidity urinary and fecalincontinence |
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etiology/tx
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Genetic component (chromosome 21
low level of ACH use of drugs that increase ACH |
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Vascular Dementia
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Cognitive impairment
Focal Neurological signs-reflexes, weakness in extremities and gait abnormalities. risks-hypertension, diabetes, smoking atrial fibrillation |
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subcortical dementias
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motor slowness
abvsence of aphasia >severe depression and anxiety |
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Dementia/HIV
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forgetfullness
impaired attention slow mental process difficulties problem solving concentration, apatyh socila withdrawl tremor and clumsiness |
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Dementia Parkinson's Disease
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Bradykinesia
masklike facial expression loss of coordination balance pill rolling between thumb and forefinger 20-60% develop dementia loss of dopamine producing cells lewy bodies in substratia nigra >env then genetics L-dopa eases symptoms by increasing levels of dopamine in early stages. |
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Dementia Huntingtons Disease
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Fat\al inherited disease
degeneration of GAba secreting cells in Substrata nigra, basal ganglia and cortex aware of problems in stage 1 1st appear 30-40yrs old affective-irritablility, depression cognitive forgetfulness-to dementia motor-fidgeting and clumsiness. |
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Substance related Disorders
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Dependence
Tolerance withdrawl larger amounts loss of control get and using life affected continued use despite downward spiril craving |
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Treatment Substance
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Aversion Tx?
multicomponent tx self control technigues AA |
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Relapse
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38% negative Emotional
118% interpersonal 18% peer presure Anxiety, Frustration-negative emotions |
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Marlatt- Gordon (85)
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Overlearned habit pattern
abstinence violation effect-self-blame-depression reuse not relapse behavioral-cognitive technigues |
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Depressive Episodes
Course/Prognosis |
symptoms-6 mos or> most cases remit
20%-30% symptoms remain for mos or yrs 50% experience >1 episode |
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Etiology
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Catecholamine Hypothesis-Depression=deficiency in norepinephrine
Indolamine Hypothesis=low levels of Serotonin Permissive Theory Serotonin interacts with norepinephrine and dopamine low leves of serotonin permits the levels of other neurotransmitters to vary Elevated levels of Cortisol sress hormone secreted by adrenal my lower density of serotonin receptors lack of new cell growth esp lt subgenual prefrontal cortex Seligman-Learned Helplessness Model negative event attributed to internal,stable and global factors Rehm-Self Control Model-Self monitoring-self eval and self reinforcement Cognitive Theory-negative statements about oneself, current situation and the future-Cognitive errores dEpressivogenic Schemas |
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Tx
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Antidepressant drugs & psychotherapy
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Antidepressants
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TCA (Tricyclics) Effective for"Classic" Depression involving bodily symptoms-worse AM symptoms an acute onset-short duration-moderate
SSRI-fewer side effects MAI -for pts who do not respond to other meds New Antid's Venlafaxine (Effexor) Mirtazapine (Remeron)-> norepinephrine and serotonin. |
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Tx-Cognative
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Changing Cognitions
Short-term problem oriented 1. identifying automatic thoughts 2. Distancing 3. Neutralizing |
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TX-Interpersonal (IPT)
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Caused by interpersonal problems result of disturbances during early developement-attachment
Focus on current relationships Specific problems addressed Views depression as illness |
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Electroconvulsive TX
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Effective for severeendogenous depressiion that involve delusions
Side Effects-temporary anterograde and retrograde amnesia, confusion |
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Photo TX
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SAD Sessional Affective Disorder Exposure to lity
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Dysthymic Disorder
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Chronically depressed mood for 2 yrs adult 1 yr child
>2 mos symptoms do not meed MDD criteria tx=antidepressant drgs |
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Bi-Polar Disorders
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Bipolar I -Single Manic Episode/most recent manic-currently or most recently in a Manic Episode and at least 1 md, Manic or Mixed
Most recent Hypomanic-at least one Manic or Mixed Mixed-at least one mdd, Manic or mixed Depressed-at least one manic or mixed. |
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Bi-Polar Disorders
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Bipolar II at least 1 mdd and one Hypomanic but never a manic or mixed episode.
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Gender/Age
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=in Male and females
Bipolar >females Average age=20's |
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Course/prognosis
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Ids oftenretuneto premorbid functioning between episodes
rapid cycling-poorprognosis |
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Etology
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65% for idential twins 14% fraternal wtisn
stressfullife events precepitate 1st few episodes less likely w/ later ones. |
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Tx
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Lithium-60-90% effective Classic Bipolar
Reduces Manic Symptoms and prevents recurrentmood swings Med compliance always an issue-better in in TX Anti-seizure may work if not responsive to lithum. |
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cyclothymoic disorder
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fluctuating hypomanic symptoms w/ periods of depressive symptoms
At least 2 yrs adults 1 yr children |
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Suicide-History
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60-80% prior attempt
Higher risk=plan-lethal weapon-hx of suicide in 1st degree relatives ambivalent |
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Suicide-Age
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Highest attempts 23-44
Highest complete 55-64 Increase in suicidal rate ages 10-19 largest > 10-14 |
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Suicide-Gender
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Males 4-5 X's > likely to commit use more lethal methods
females 3Xs more likely to attempt more likely to use drgs.. |
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Suicide-Race
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Higher whites (all ages except teens-highest native American Tribes)
African-Ams have increased still<whites. |
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Suicide-Marital Status
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Divorced (greatest 1st yr) separated and widowed Highest rates followed by singles
lowest-married people |
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Suicide-Cognative Correlates
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Hopelessness-more predictive than intensity of depressive symptoms
More rigid and constrictive in thinking Self oriented and perfectionistic tied to elevated risk of depression and suicide. |
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Suicide-Life Stress
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Failing school-work and rejection
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Suicide-Psychiatric Disorders
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MDD and Bipolar
50-80% hx of severe depression Alcoholism-Schizophrenia 2nd-3rd most common disorders |
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Suicide-Physical Illness
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Contributes to 50%
Cancer-Head Trauma-Huntingtons Disease-MS and Aids |
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Biological
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Low levels ofSerotonin and 5HIAA a serotonin Metabolite
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Suicide-Teens
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Impulsive-desire to influence others gain attention or affection-express anger or escape undesirable situation
exposure to other suicides preceded by interpersonal conflict early signs-talking about death-reunion w/ deceased person-giving away prized possessions. |
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Suicide Prevention
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Hotlines-use > by white fems
Prevention programs targeting at risk ids direct questioning-no contract-24/7 clinical backup strategies to > compliance removal of firearms and danger. |
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Anxiety Disorder
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Symptoms and Avoidance Behaviors
Overlap w/ Depression-Negative affect -concentration/memory/irritability/fatigue/insomnia/hopelessness. depressed people exdp anxiety symptoms no the opposite pure anxiety-apprehension-tension-trembling-excessive worry nightmares pure depression-anhedonia-loss of interest inusual activities-suicidal ideation and decreased libido. |
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Panic Disorder
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rule out medical conditions-hyperthyroidism-hypoglycemia-cardiac arrhythmia-mitral valve prolapse
2 or> panic attacks one attack followed by concern of another attack or change in behavior after attack period of intense apprehension fear or terror develops abruptly peaks at 10 minutes. 4 characteristics-palpitations-acceleratged heart rate, sweating chest pain-nausea, dizzness-etc |
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Agorphobia
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Anxiety of situations or places where escape might be difficult or embarrassing-fear of being outside of home-being in a crowd or traveling
feared situations are avoided or endured w/ marked distress or only w/ a companion |
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Anxiety-Gender/age
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> common females-75% w/ agoraphobia are females
age of onset=teens or mid 30's |
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Anxiety-TX
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in vivo exposure with Response prevention-flooding
60-70% effective Panic Control Tx's (PCT) expose ids to interoceptiv (bodily) sensations w/ panic attacks supplemented w/ cognitive tx or relaxation and breathing retraining Imipramine (TCA) SSRI's benzodiazepines-risk for relapse high w/ meds alone 30-70% return symptoms w/in1 monthof discontinuing meds. |
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Differential DX
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Panic D w/ Agoraphobia VS social Phobia
Panic D. Panic attacks fre unexpected occur in other contexts during sleep-reduced symptoms w/ trusted friend. Socila phobia-panic attacks are restricted to social performance situations-> symtoms w/ a friend. |
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Specific Phobia
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Marked/persistent fear of a specific object or situation
exposure always produces a panic attack recognition that fear is unreasonable or excessive subtypes-animal-blood tx-relaxiation techniques injection injury-tx tensing techniques |
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Phobia-Etiology
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Mowrer (1947)-2 factor theory-Phobias are a result of avoidance conditioning combination of classical and operant conditioning
1st learened neutral stimulus paired w/ anxiety stimulus and their avoidance response then negatively reinforced no opportunity to extinquish because of avoidance. Social Learning Theory Vicarious learning by observation |
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Phobia TX
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In Vivo Exposure
In Vivo Desensitization Participant modeling Cognitive Self Control-relaxation-visualization-positive self statements. |
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Social Phobia
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Marked and PErsisten fear of social performance situations
embarrassment or humiliation immediate panic attack |
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Social Phobia TX
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Exposure
CBT Group exposure to anxiety situations w/ cognitive resturcturing Meds-Phenelzin (MAOI) SSRI (Fluoxetime (Prozac/paroxetine (Paxil), SNRI (Venlafaxine (effexor)-BETA Blocker Propanal (Inderal) |
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Obessive-Compulsive Disorder
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Recurrent obessive and or compulsions
cause significant distress time-consuming >1hr/d interfere with daily life person is aware of symptoms |
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Obessions
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Persistent thoughts-impulses-images that person experiences as intrusive and cause distress
more than excessive life worries person may attmept to ignore |
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Compulsions
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Repetitious and deliberate behaviors or mental acts person feels driven to perform in response to obession or rigid rules
Goal-reduce distress preventing situation from happening resistance >'s anxiety and tension |
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Gender
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Equal with Males and females w/ early onset
OCD > Males |
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Etiology
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Low levels of Serotonin
Over active Right Caudate Nucleus(Converts sensory input into cognition) |
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Tx
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Exposure w/ repsonse prevention
Meds-TCA's and SSRI's 90% exhibit significant reduction in symptoms. |
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Agorphobia
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Anxiety of situations or places where escape might be difficult or embarrassing-fear of being outside of home-being in a crowd or traveling
feared situations are avoided or endured w/ marked distress or only w/ a companion |
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Anxiety-Gender/age
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> common females-75% w/ agoraphobia are females
age of onset=teens or mid 30's |
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Anxiety-TX
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in vivo exposure with Response prevention-flooding
60-70% effective Panic Control Tx's (PCT) expose ids to interoceptiv (bodily) sensations w/ panic attacks supplemented w/ cognitive tx or relaxation and breathing retraining Imipramine (TCA) SSRI's benzodiazepines-risk for relapse high w/ meds alone 30-70% return symptoms w/in1 monthof discontinuing meds. |
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Differential DX
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Panic D w/ Agoraphobia VS social Phobia
Panic D. Panic attacks fre unexpected occur in other contexts during sleep-reduced symptoms w/ trusted friend. Socila phobia-panic attacks are restricted to social performance situations-> symtoms w/ a friend. |
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Specific Phobia
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Marked/persistent fear of a specific object or situation
exposure always produces a panic attack recognition that fear is unreasonable or excessive subtypes-animal-blood tx-relaxiation techniques injection injury-tx tensing techniques |
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Phobia-Etiology
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Mowrer (1947)-2 factor theory-Phobias are a result of avoidance conditioning combination of classical and operant conditioning
1st learened neutral stimulus paired w/ anxiety stimulus and their avoidance response then negatively reinforced no opportunity to extinquish because of avoidance. Social Learning Theory Vicarious learning by observation |
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Phobia TX
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In Vivo Exposure
In Vivo Desensitization Participant modeling Cognitive Self Control-relaxation-visualization-positive self statements. |
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Social Phobia
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Marked and PErsisten fear of social performance situations
embarrassment or humiliation immediate panic attack |
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Social Phobia TX
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Exposure
CBT Group exposure to anxiety situations w/ cognitive resturcturing Meds-Phenelzin (MAOI) SSRI (Fluoxetime (Prozac/paroxetine (Paxil), SNRI (Venlafaxine (effexor)-BETA Blocker Propanal (Inderal) |
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Obessive-Compulsive Disorder
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Recurrent obessive and or compulsions
cause significant distress time-consuming >1hr/d interfere with daily life person is aware of symptoms |
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Obessions
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Persistent thoughts-impulses-images that person experiences as intrusive and cause distress
more than excessive life worries person may attmept to ignore |
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Compulsions
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Repetitious and deliberate behaviors or mental acts person feels driven to perform in response to obession or rigid rules
Goal-reduce distress preventing situation from happening resistance >'s anxiety and tension |
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Gender
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Equal with Males and females w/ early onset
OCD > Males |
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Etiology
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Low levels of Serotonin
Over active Right Caudate Nucleus(Converts sensory input into cognition) |
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Tx
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Exposure w/ repsonse prevention
Meds-TCA's and SSRI's 90% exhibit significant reduction in symptoms. |
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Posttraumatic Stress Disorder
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Development of Characteristic symptoms after exposure to extreme trauma.
Experiencing or witnessing event that involves actual or threatened death, serious injury to self or another person or learning about an unexpected or violent death of or serious harm to a family member. Elicits a reaction of intense fear, helplessness or horror. |
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Symptoms
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Persistent re-experiencing of the trauma
Persistent avoidance of stimuli associated with trauma. Persistent symptoms of increase arousal. Children-repetitive play and a sense of a foreshortened future. |
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TX
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Acute State-Debriefing
Brief Prevention Program Chronic PTSD-CBT with In Vivop or imaginal exposure w/ stress inoculation or anxiety mgmt training. Meds EMDR-(Eye Movement Desensitization and Reprocessing) |
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Acute Stress Disorder
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Onset within 4 wks lasting 2 days-no longer than 1 month
Sissociative symptoms -numbing or emotional detachment-derealization-dissociative amnesia Persistent reexperiencing of the trauma. |
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Generalized Anxiety Disorder
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Excessive Anxietyh and worry about multiple eventsor activities.
at least 6 mos |
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Symptoms
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Restlessness
Feeling Keyed up or on edge Being easily fatigued Difficulty concentrating Irritability Muscle Tension Sleep Disturbance |
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Differential Diagnosis
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Nonpathological anxiety
cna controll anxiety to some degree anxious about a fewer number of events <likely to have associated physical symptoms |
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Treatment
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CBT+Meds (SSRI & Buspar)
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Somatoform Disorders
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Physical symptoms suggest a medical disorder.
no explained by a medical condition, substance use or other mental disorder cause distress or impairment not intentionally produced |
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Somatization Disordre
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Recurrent multiple somatic complaints
begin prior to age 30 Includes 4 pain symptoms 2 gastrointestinal symptoms 1 sexual problem 1 pseudoenurological symptoms describe pain in dramatic, overstatement or ambiguous ways seek tx several docs may have undergone numerous surgeries and other med procedures consequence of meds may have substance-related disorder |
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Conversion Disorder
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symptoms of voluntary motor or sensory functioning that suggest a serious neurological or other medical condition.
Initiated or exacerbated by conflicts or stressors do not conform to physilogical mechanism LA Belle Indifference lack of concern for symptoms or respond to their symptoms in a dramatic or histrionic manner |
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TX
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Suggesting to client that symptoms will gradually remit.
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Etiology
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Primary Gain-the symptoms keeps an internal conflict or need out of conscious awareness
Secondary Gain-Symptoms help the id avoid unpleasant activity or obtain support from the env. Evidence that psychological factors are involved is required for the diagnosis. |
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Differential Diagnosis
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Factitious & Malingering (Symptoms are voluntarily produced) vs somatoform disorders (Symptoms are not intentionally produced.
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Hypochondriasis
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Unrealistic preoccupation w/ serious illness based on themisinterpretation of bodily symptoms despite lack of medical evidence
Doctor shopping Resist referrals for mental health tx Doctors overlook actual medical conditions because of pts hx. |
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Undifferentiated Somatoform
Disorder |
1 or> physical complaints lasted at least 6 mos.
not explained by Doctors. Does not meet other Somatoform Disorders Criteria Common complaints include chronic fatigue, appetite loss-gastrointestinal symptoms. |
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Factitious Disorders
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Presence of physical or psychological symptoms intentionally produced-interpsychic needto adopt a sick role.
hx presented in overly dramatic way vague & inconsistent details deny when confronted numerous surgeries and other medical procedures Munchausen's syndrome by Proxy intentional production of symptoms in a child by care giver. lack of symptoms when parent absent inconsistent Dx |
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Differential diagnosis
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Factitous vs Malingering
person seeking medical attention for legal reasons-marked discrepancy bt symptoms and objective findings. Person does not cooperate w/ the eval or tx Person has ASPD. |
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Dissociative Disorders
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Disruption in Consciousness-Identity, memory or perception of the env. not due to substance or medical condition.
Take into account Cultural influences okay in some cultures. |
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Dissociative Amnesia
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1 or > episodes of inability to recall personal info that cannot be attributed to ordinary forgetfulness.
Memory Gaps not related to Traumatic or stressful event Localized-Inability to remember all events related to circumsribed period of time Selective-cannot recall events related to circumscribed period of time Generalized-Loss of Memory encompasses their entire life Continuous-Inability to recall events following specific time through the present Systematized-Unable to recall memories related to a certain category of info. |
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Dissociative Fugue
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Abrupt travel away from home or work and inability to recall one's past
Person will appear normal to people who don't know them. Following recovery-Person may not recall the events that took place. |
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Dissociative Id Disorder
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2 or > distinct identities or personality states
Each personality has its own pattern of perceiving-relating to- and thinking about env or self. At least 2 personalities take full control of the person's behavior. Alter's typicallly have unique behaviors, memories, relationships and personal histories. transitions bt personalities usually abrupt May have experienced severe physical or sexual abuse during childhood. Self Mutilation, suicidal behaviors and Postraumatic or conversion symptoms are common. |
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Depersonalization Disorder
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Feelings of Detachment or estrangemnt from one's mental processes or body. Reality testing remains intact.
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TX
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Hypnosis or Amytal Facilitated.
Help person recall forgetton events and learn to control undesirable symptoms. |
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Sexual Dystfunctions
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Disturbances in sexual response cycle or pain rleated to sexual intercourse
Maked distress or interpersonal difficulty Psychological and or physical factors lifelong or acquired and generalized or situational Primary-Always existed-Secondary-Developed after a period of normal functioning |
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Male Erectile Disorder
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Inability to attain or maintain an Erection.
Diabetes, Mellitus, Liver Kidney disease, MS, Antidepressant and hypertensive drgs. Organic etiology in the complete absence of erections during REM |
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Female Orgasmic Disorder/Male Orgasmic Disorder
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Delay in or absence of Orgasim following normal sexual excitement phase.
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Premature Ejaculation
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Orgasm and ejaculation w/ minimal sexual stimulation, before on or shortly after penetration and before the person desires it.
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Dyspareunia
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Genital pain associated w/ sexual intercourse.
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Vaginismus
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Involuntary Spasms of the Pubococcygeus muscle in the outer third of the vagina that interferes w/sexual intercourse.
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Sexual Dysfunctions-TX
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Medical Eval
Behavioral Cognative-Behavioral Techniques-Masters & Johnson 1970 Target of TX dysfunctional behaviors, anxiety,faulty beliefs attitudes and lacking knowledge Couples tx Sex TX Sensate Focus Start-stop Squeeze Technique Klegal Exercises Viagra |
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Paraphillias-TX
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Non-normative sexual arousal
TX-Covert sensitization-Satiation TX-Orgasmic Reorientation-Relapse Prevention |
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Gender Identity Disorder
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Strong persistent cross-gender identification and discomfort w/ ones sex
75% Males w/ onset and a report of homosexual or bisexual orientation |
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Differential Diagnosis
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Gender Identity Disorder vs tomboy vs Transvestic Fetishism-Men who cross-dress for the purpose of sexual excitement
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Dyssomnias
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Disturbances in sleep
Narcolepsy-Loss of sleep accompanied by Cataplexy-Loss of Muscle tone-trigger by strong emotion hypnagognic or hypnopompic Hallucinations Vivid Dreams during transition from waking to sleep. Breathing Related Sleep Disorders Sleep Apnea -Cessation of breathing Central Alveolar hypoventilation -labored breathing. |
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Parasomniasor
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Behavioralor physiological abnormalities during sleep
Nightmare Disorder-nightmares that involve threats to self-esteem,l survival or security. Sleep Terror Disorder -abrupt aswakening-don't remember in AM Sleepwalking Disorder-Complex motor behaviors during sleep unresponsive attempts to awaken them occurs during slow-wave (non-Rem) Sleep. |
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Sleep Disorders/Adjustment Disorders
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Anorexia Nervosia-Refusal to maintian a normal body weight 85% or<
Intense fear of gainingweiight disturbances in perception of the shape or size of one's body weight loss acheived by excessive exercise self induced vomiting laxatives feeling too fat depressive-obsessions-compulsions etc denial restricting type-dieting etc binge-eating/purging type. |
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Gender
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90% female
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Etiology
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Middle or upper class
Competitive difficult mothers concernedabout diet and weight father's emotionally absent |
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TX
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Increase weight to normal
Id & grp tx Stuctural family tx CBT-Correct cognitive errors about weight. |
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Bulimia Nervous
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Recurrent binge eating
purging to prevent weight gain obsessed w/ body shape and weight triggered by stress w/in normal weight range co-diag dysthmyic/mdd medical complications-electrolyte disturbances-cardiac arthythmias and arres-dental problems. |
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Gender
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90% female
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Etiology
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Fm hx
Low levels of serotonin/norepinephrine. |
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TX
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Gain control over eating
Modify dysfunctional beliefs CBT Nutritional Counseling Anxiety reducing meds |
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Adjustment Disorders
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Maladaptive reaction to psychosocial stressors
w/in 3 mos of stressor impairments in functioning Symptoms remit w/in 6 mos Adjustment can be triggered by any stressor. |
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Personality Disorders
Cluster A |
Paranoid
Distrust/suspiciousness Schizoid indifference to relationships restricted emotional range loners Schizotypal Relationship deficits and eccentric cognition/perception Social anxiety Misinterpret events prefers being alone. |
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Cluster B
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Antisocial
Disregard and violation of rights of others at least 18 w/ hx of conduct disorder before 15 inflated sense of self-lack of empathy. Borderline Instablity of relationships Frantic efforts to avoid abandonment no limits TX CBT |
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Cluster B
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Histrrionic
Emotional attention seeking center of attention inappropriate sexually seductive provocative rapid emotions speech lacking details influenced by others draw attentions to others. |
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Cluster B
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Narcistic
Grnadiosity Self importance fantasies of power unique entitlement explotative |
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Cluster C
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Avoidant
Social withdrawl Fear of Rejection Sees Self as inept and inferior Dependent Excessive need to be taken care of Cannot make decisions Rejects responsibility Fears disagreeing Obsessive-Complusive Preoccupation with perfection Details-rules Perfection interfers w/ completion Excessive devotion to work Inflexible-morality-ethics-values. |
