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122 Cards in this Set

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Alzheimer's
Most common cause of dementia-65%
> females
higher w/ lower ed
gradual onset progressive cognitive function.
Stages
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
etiology/tx
Genetic component (chromosome 21
low level of ACH
use of drugs that increase ACH
Vascular Dementia
Cognitive impairment
Focal Neurological signs-reflexes, weakness in extremities and gait abnormalities.
risks-hypertension, diabetes, smoking atrial fibrillation
subcortical dementias
motor slowness
abvsence of aphasia >severe depression and anxiety
Dementia/HIV
forgetfullness
impaired attention
slow mental process
difficulties problem solving concentration, apatyh socila withdrawl tremor and clumsiness
Dementia Parkinson's Disease
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.
Dementia Huntingtons Disease
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.
Substance related Disorders
Dependence
Tolerance
withdrawl
larger amounts
loss of control
get and using
life affected
continued use despite downward spiril
craving
Treatment Substance
Aversion Tx?
multicomponent tx
self control technigues
AA
Relapse
38% negative Emotional
118% interpersonal
18% peer presure
Anxiety, Frustration-negative emotions
Marlatt- Gordon (85)
Overlearned habit pattern
abstinence violation effect-self-blame-depression
reuse not relapse
behavioral-cognitive technigues
Depressive Episodes
Course/Prognosis
symptoms-6 mos or> most cases remit
20%-30% symptoms remain for mos or yrs
50% experience >1 episode
Etiology
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
Tx
Antidepressant drugs & psychotherapy
Antidepressants
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.
Tx-Cognative
Changing Cognitions
Short-term problem oriented
1. identifying automatic thoughts
2. Distancing
3. Neutralizing
TX-Interpersonal (IPT)
Caused by interpersonal problems result of disturbances during early developement-attachment
Focus on current relationships
Specific problems addressed
Views depression as illness
Electroconvulsive TX
Effective for severeendogenous depressiion that involve delusions
Side Effects-temporary anterograde and retrograde amnesia, confusion
Photo TX
SAD Sessional Affective Disorder Exposure to lity
Dysthymic Disorder
Chronically depressed mood for 2 yrs adult 1 yr child
>2 mos
symptoms do not meed MDD criteria
tx=antidepressant drgs
Bi-Polar Disorders
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.
Bi-Polar Disorders
Bipolar II at least 1 mdd and one Hypomanic but never a manic or mixed episode.
Gender/Age
=in Male and females
Bipolar >females
Average age=20's
Course/prognosis
Ids oftenretuneto premorbid functioning between episodes
rapid cycling-poorprognosis
Etology
65% for idential twins 14% fraternal wtisn
stressfullife events precepitate 1st few episodes less likely w/ later ones.
Tx
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.
cyclothymoic disorder
fluctuating hypomanic symptoms w/ periods of depressive symptoms
At least 2 yrs adults
1 yr children
Suicide-History
60-80% prior attempt
Higher risk=plan-lethal weapon-hx of suicide in 1st degree relatives
ambivalent
Suicide-Age
Highest attempts 23-44
Highest complete 55-64
Increase in suicidal rate ages 10-19
largest > 10-14
Suicide-Gender
Males 4-5 X's > likely to commit use more lethal methods
females 3Xs more likely to attempt more likely to use drgs..
Suicide-Race
Higher whites (all ages except teens-highest native American Tribes)
African-Ams have increased still<whites.
Suicide-Marital Status
Divorced (greatest 1st yr) separated and widowed Highest rates followed by singles
lowest-married people
Suicide-Cognative Correlates
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.
Suicide-Life Stress
Failing school-work and rejection
Suicide-Psychiatric Disorders
MDD and Bipolar
50-80% hx of severe depression
Alcoholism-Schizophrenia 2nd-3rd most common disorders
Suicide-Physical Illness
Contributes to 50%
Cancer-Head Trauma-Huntingtons Disease-MS and Aids
Biological
Low levels ofSerotonin and 5HIAA a serotonin Metabolite
Suicide-Teens
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.
Suicide Prevention
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.
Anxiety Disorder
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.
Panic Disorder
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
Agorphobia
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
Anxiety-Gender/age
> common females-75% w/ agoraphobia are females
age of onset=teens or mid 30's
Anxiety-TX
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.
Differential DX
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.
Specific Phobia
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
Phobia-Etiology
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
Phobia TX
In Vivo Exposure
In Vivo Desensitization
Participant modeling
Cognitive Self Control-relaxation-visualization-positive self statements.
Social Phobia
Marked and PErsisten fear of social performance situations
embarrassment or humiliation
immediate panic attack
Social Phobia TX
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)
Obessive-Compulsive Disorder
Recurrent obessive and or compulsions
cause significant distress
time-consuming >1hr/d
interfere with daily life
person is aware of symptoms
Obessions
Persistent thoughts-impulses-images that person experiences as intrusive and cause distress
more than excessive life worries
person may attmept to ignore
Compulsions
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
Gender
Equal with Males and females w/ early onset
OCD > Males
Etiology
Low levels of Serotonin
Over active Right Caudate Nucleus(Converts sensory input into cognition)
Tx
Exposure w/ repsonse prevention
Meds-TCA's and SSRI's
90% exhibit significant reduction in symptoms.
Agorphobia
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
Anxiety-Gender/age
> common females-75% w/ agoraphobia are females
age of onset=teens or mid 30's
Anxiety-TX
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.
Differential DX
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.
Specific Phobia
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
Phobia-Etiology
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
Phobia TX
In Vivo Exposure
In Vivo Desensitization
Participant modeling
Cognitive Self Control-relaxation-visualization-positive self statements.
Social Phobia
Marked and PErsisten fear of social performance situations
embarrassment or humiliation
immediate panic attack
Social Phobia TX
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)
Obessive-Compulsive Disorder
Recurrent obessive and or compulsions
cause significant distress
time-consuming >1hr/d
interfere with daily life
person is aware of symptoms
Obessions
Persistent thoughts-impulses-images that person experiences as intrusive and cause distress
more than excessive life worries
person may attmept to ignore
Compulsions
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
Gender
Equal with Males and females w/ early onset
OCD > Males
Etiology
Low levels of Serotonin
Over active Right Caudate Nucleus(Converts sensory input into cognition)
Tx
Exposure w/ repsonse prevention
Meds-TCA's and SSRI's
90% exhibit significant reduction in symptoms.
Posttraumatic Stress Disorder
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.
Symptoms
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.
TX
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)
Acute Stress Disorder
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.
Generalized Anxiety Disorder
Excessive Anxietyh and worry about multiple eventsor activities.
at least 6 mos
Symptoms
Restlessness
Feeling Keyed up or on edge
Being easily fatigued
Difficulty concentrating
Irritability
Muscle Tension
Sleep Disturbance
Differential Diagnosis
Nonpathological anxiety
cna controll anxiety to some degree
anxious about a fewer number of events
<likely to have associated physical symptoms
Treatment
CBT+Meds (SSRI & Buspar)
Somatoform Disorders
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
Somatization Disordre
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
Conversion Disorder
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
TX
Suggesting to client that symptoms will gradually remit.
Etiology
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.
Differential Diagnosis
Factitious & Malingering (Symptoms are voluntarily produced) vs somatoform disorders (Symptoms are not intentionally produced.
Hypochondriasis
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.
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.
Factitious Disorders
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
Differential diagnosis
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.
Dissociative Disorders
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.
Dissociative Amnesia
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.
Dissociative Fugue
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.
Dissociative Id Disorder
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.
Depersonalization Disorder
Feelings of Detachment or estrangemnt from one's mental processes or body. Reality testing remains intact.
TX
Hypnosis or Amytal Facilitated.
Help person recall forgetton events and learn to control undesirable symptoms.
Sexual Dystfunctions
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
Male Erectile Disorder
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
Female Orgasmic Disorder/Male Orgasmic Disorder
Delay in or absence of Orgasim following normal sexual excitement phase.
Premature Ejaculation
Orgasm and ejaculation w/ minimal sexual stimulation, before on or shortly after penetration and before the person desires it.
Dyspareunia
Genital pain associated w/ sexual intercourse.
Vaginismus
Involuntary Spasms of the Pubococcygeus muscle in the outer third of the vagina that interferes w/sexual intercourse.
Sexual Dysfunctions-TX
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
Paraphillias-TX
Non-normative sexual arousal
TX-Covert sensitization-Satiation TX-Orgasmic Reorientation-Relapse Prevention
Gender Identity Disorder
Strong persistent cross-gender identification and discomfort w/ ones sex
75% Males w/ onset and a report of homosexual or bisexual orientation
Differential Diagnosis
Gender Identity Disorder vs tomboy vs Transvestic Fetishism-Men who cross-dress for the purpose of sexual excitement
Dyssomnias
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.
Parasomniasor
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.
Sleep Disorders/Adjustment Disorders
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.
Gender
90% female
Etiology
Middle or upper class
Competitive
difficult mothers concernedabout diet and weight
father's emotionally absent
TX
Increase weight to normal
Id & grp tx
Stuctural family tx
CBT-Correct cognitive errors about weight.
Bulimia Nervous
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.
Gender
90% female
Etiology
Fm hx
Low levels of serotonin/norepinephrine.
TX
Gain control over eating
Modify dysfunctional beliefs
CBT
Nutritional Counseling
Anxiety reducing meds
Adjustment Disorders
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.
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.
Cluster B
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
Cluster B
Histrrionic
Emotional attention seeking
center of attention
inappropriate sexually seductive provocative
rapid emotions
speech lacking details
influenced by others
draw attentions to others.
Cluster B
Narcistic
Grnadiosity
Self importance
fantasies of power
unique
entitlement
explotative
Cluster C
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.