Kk&s Ch.02 Human Dev Through Life Cycle

Front 1

Difference btwn psychosis and neurosis?

Back 1

psychosis impaired reality testing
reality testing intact in neurosis
neurosis covers anxiety

Front 2

How can normality be defined?

Back 2

(1) normality as health (no sx)
(2) normality as utopia (the mind working to create optimal fxn)
(3) normality as average,(bell curve) and
(4) normality as process (end result of going through normal processes), e.g. Erikson 7 stages essential to mature adult fxning

Front 3

In 2005, the National Institute of Mental Health (NIMH) completed a nationwide survey of how many Americans will develop a mental illness at some point in their lives. The findings indicated that more than X percent would do so, up from Y percent in a similar survey done in 1984

Back 3

50%
20%

Front 4

Most common mental disorders and give lifetime prevalence in that NIMH survey of 2005?

Back 4

The most common mental disorder was depression, which had a lifetime prevalence of 17 percent; followed by alcohol abuse, affecting 13 percent; and phobias, affecting 12 percent

Front 5

Do more or less (i.e., 51% or more) people get treatment for mental disorder?

Back 5

More don't or get inadequate tx

Front 6

What are the mature, adatpive defenses?

Back 6

The mature, adaptive defenses, according to Vaillant, are altruism, sublimation, anticipation, and humor. Some also consider asceticism and suppression mature defense

Front 7

What is sublimation?

Back 7

Changing response to impulse from unaccetable to socially accetalbe (e.g. anger expressed through activity/game)

Sublimation. The gratification of an impulse whose goal is retained, but whose aim or object is changed from a socially objectionable one to a socially valued one. Libidinal sublimation involves desexualization of drive impulses and placing a value judgment that substitutes what is valued by the superego or society. Sublimation of aggressive impulses takes place through pleasurable games and sports. Unlike neurotic defenses, sublimation allows instincts to be channeled rather than to be dammed up or diverted. Thus, in sublimation, feelings are acknowledged, modified, and directed toward a relatively significant person or goal so that modest instinctual satisfaction results.

Front 8

What is suppression

Back 8

The conscious or semiconscious decision to postpone attention to a conscious impulse or conflict.

Front 9

What do adaptive defences protect against?

Back 9

less depressed after stressful live events and PTSD

Front 10

The eight conventional stages of development are as follows:

Back 10

(1) the prenatal period (from conception to birth), (2) infancy (from birth to about 15 months), (3) the toddler period (15 months to 2½ years), (4) the preschool period (2½ to 6 years), (5) the middle years (6 to 12 years), (6) adolescence (12 to 19 years), (7) adulthood (20 to 65), and (8) late adulthood (old age).

Front 11

Gender are more vulnerable to developmental damage than GENDER?;

Back 11

Boys more vulnerable
geneticists recognize that in humans and animals, girls show a propensity for greater biological vigor than boys, possibly because of the girls' second X chromosome

Front 12

The human brain weighs about 350 g at birth and 1,450 g at full adult development, a fourfold increase, mainly in the neocortex. This increase is almost entirely because of After birth, the number of new neurons is

Back 12

the growth in the number and branching of dendrites establishing new connections.

after birth, negligible growth

Front 13

Mothers with high levels of anxiety are more likely to have babies who are ???? than are mothers with low anxiety levels

Back 13

hyperactive, irritable, and of
low birthweight and who have

problems feeding
and sleeping

Front 14

Fetal alcohol syndrome (Fig. 2.2-4) affects about ?of all infants born to alcoholic women.

Back 14

33% , 1/3

Front 15

describe features of fasd

Back 15

growth retardation of prenatal origin (height, weight);

minor anomalies, including microphthalmia (small eyeballs), short palpebral fissures, midface hypoplasia (underdevelopment), a smooth or short philtrum, and a thin upper lip; and

central nervous system (CNS) manifestations, including microcephaly (head circumference below the third percentile), a history of delayed development, hyperactivity, attention deficits, learning disabilities, intellectual deficits, and seizures.

Front 16

Why ADHD linked to maternal alcohol use?

Back 16

Animal experiments have shown that alcohol reduces the number of active dopamine neurons in the midbrain area and ADHD is associated with reduced dopaminergic activity in the brain.

Front 17

Smoking during pregnancy is associated with

Back 17

premature births and
below-average infant birthweight

Front 18

Marijuana use in pregnancy is associated with

Back 18

low infant birthweight, prematurity, and withdrawal-like symptoms, including excessive crying, tremors, and hyperemesis (severe and chronic vomiting).

Front 19

Crack cocaine use by women during pregnancy has been correlated with

Back 19

behavioral abnormalities such as increased irritability and crying and decreased desire for human contact. Infants born to mothers dependent on narcotics go through a withdrawal syndrome at birth.

Front 20

MOst common cause of malformations observed during 1st year of life?

Back 20

Autosomal genetic ds

Front 21

Common drugs with teratogenic effects include

Back 21

antibiotics (tetracyclines),
anticonvulsants (valproate [Depakene], carbamazepine [Tegretol], phenytoin [Dilantin]),

progesterone-estrogens,

lithium (Eskalith), and
warfarin (Coumadin).

Front 22

Premature infants are defined as those with a gestation of less than 34 weeks or a birthweight under 2,500 g (5.5 lb). Such infants are at increased risk for

Back 22

learning disabilities, such as dyslexia,
emotional and behavioral problems,
mental retardation, and
child abuse.

Front 23

Prolonged separation from the mother (or other primary caregiver) during the ?? months of life can lead to depression that may persist into adulthood as part of an individual's character.

Back 23

second 6

Front 24

Describe Secure attachment

Back 24

Children show fewer adjustment problems; however, these children have typically received more consistent and developmentally appropriate parenting for most of their life.

Front 25

Describe Insecure - AVOIDANT Attachment

Back 25

Children become
anxious, clinging, and
angry with the parent. These children typically come from families with adults who were also insecurely attached to their families and, thus, were unable to provide the kind of consistency, emotional responsiveness, and care that securely attached parents could offer. Such parents have a more difficult time with divorce, and are more likely to become rejecting.

Front 26

describe insecure AMBIVALENT attachment

Back 26

Children generally are raised with disorganized, neglecting, and inattentive parenting. The parents are even less able to provide stability and psychological strength for them after a divorce and, as a result, the children are even more likely to become clinging but unconsolable in their distress, as well as to act out, suffer mood swings, and become oversensitive to stress.

Front 27

Unresponsive mothers produce ?babies.

Back 27

anxious

Front 28

What she called the ? effect enables a child to move away from the attachment figure and explore the environment.

Back 28

secured base

Front 29

Inanimate objects, such as a teddy bear or a blanket (called the ?? by Donald Winnicott), also serve as a ?, one that often accompanies children as they investigate the world

Back 29

Inanimate objects, such as a teddy bear or a blanket (called the transitional object by Donald Winnicott), also serve as a secure base, one that often accompanies children as they investigate the world

Front 30

hen the attachment is insecure, the type of insecurity (avoidant, anxious, ambivalent) is determined by

Back 30

infant temperament

Front 31

Overall, gender infants are less likely to have secure attachments and are more vulnerable to changes in maternal sensitivity than are gender infants.

Back 31

male>female

Front 32

The attachment of the firstborn child is decreased by the birth of a second, but it is decreased much more when the firstborn is?years of age when the younger sibling is born than when the firstborn is under 24 months.
the extent of the decrease also depends on

Back 32

2 to 5
the mother's own sense of security, confidence, and mental health.

Front 33

A fear of strangers is first noted in infants at about ? weeks of age, but is not fully developed until about ? weeks (? months)

Back 33

A fear of strangers is first noted in infants at about 26 weeks of age, but is not fully developed until about 32 weeks (8 months)

Front 34

Separation anxiety, occurs between ? months of age

Back 34

10 and 18

Front 35

What are Mahler's stages of seperation-individuation and explain them.

Back 35

1. Normal autism (birth–2 mos)
Periods of sleep outweigh periods of arousal in a state reminiscent of intrauterine life.
2. Symbiosis (2–5 mos)
Developing perceptual abilities gradually enable infants to distinguish the inner from the outer world; mother–infant is perceived as a single fused entity.
3. Differentiation (5–10 mos)
Progressive neurological development and increased alertness draw infants' attention away from self to the outer world. Physical and psychological distinctiveness from the mother is gradually appreciated.
4. Practicing (10–18 mos)
The ability to move autonomously increases children's exploration of the outer world.
5. Rapprochement (18–24 mos)
As children slowly realize their helplessness and dependence, the need for independence alternates with the need for closeness. Children move away from their mothers and come back for reassurance.
6. Object constancy (2–5 yrs)
Children gradually comprehend and are reassured by the permanence of mother and other important people, even when not in their presence.

Front 36

Explain Chess and Thomas temperaments including %

Back 36

Difficult children, who make up 10 percent of all children, have a hyperalert physiological makeup. They react intensely to stimuli (cry easily at loud noises), sleep poorly, eat at unpredictable times, and are difficult to comfort.

Easy children, who make up 40 percent of all children, are regular in eating, eliminating, and sleeping; they are flexible, can adapt to change and new stimuli with a minimum of distress, and are easily comforted when they cry. The other 50 percent of children are mixtures of these two types.

Front 37

Chess and Thomas used the term ? to characterize the harmonious and consonant interaction between a mother and a child in their motivations, capacities, and styles of behavior.

Back 37

goodness of fit

Front 38

most child experts recommend a hearing test if the child is not

Back 38

making two-word sentences by age 2

Front 39

? is often apparent at this age; the child looks to parents and others for emotional cues about how to respond to novel events.

Back 39

Social referencing
Age 2

Front 40

? show exploratory excitement, assertive pleasure, and pleasure in discovery and in developing new behavior (e.g., new games), including teasing and surprising or fooling the parent (e.g., hiding). The ? has capacities for an organized demonstration of love as when the ? runs up and hugs, smiles, and kisses the parent at the same time, and of protest when the ? turns away, cries, bangs, bites, hits, yells, and kicks. Comfort with family and apprehension with strangers may increase. Anxiety appears to be related to disapproval and the loss of a loved caregiver and can be disorganizing.

Back 40

toddler

Front 41

Gender identity, the unshakable conviction of being male or female, begins to manifest at ? months of age and is often fixed by ? months.

Back 41

18months

24 to 30monts

Front 42

?? describes the behavior that society deems appropriate for one sex or another, and it is not surprising that significant cultural differences exist

Back 42

Gender role

Front 43

Most toddlers generally sleep about ? hours a day, including a 2-hour nap

Back 43

12

Front 44

average 2-year-old takes about ? minutes to fall asleep

Back 44

30

Front 45

between 2 and 3 years of age, children reach ?% their adult height.

Back 45

half

Front 46

Age?
use of language expands, and they use sentences. Individual words have regular and consistent meanings at the beginning of the period, and children begin to think symbolically. In general, however, their thinking is egocentric; they cannot place themselves in the position of another child and are incapable of empathy. Children think intuitively and prelogically and do not understand causal relations

Back 46

Preschool: 2.5 to 6

Front 47

?-year-olds are learning to share and to have concern for others.

Back 47

4

Front 48

Children between the ages of ? years are aware of their bodies, of the genitalia, and of differences between the sexes

Back 48

3 and 6

Front 49

they show a preoccupation with illness or injury, so much so that the period has been called “the Band-Aid phase.

Back 49

preschool

Front 50

At the end of the ? stage, the child's conscience is established.

Back 50

preschool

Front 51

Until about ? years of age, children experience rules as absolute and as existing for their own sake.

Back 51

7

Front 52

Between ? years, children commonly engage in parallel play, solitary play alongside another child with no interaction between them

Back 52

2½ and 3

Front 53

. By age ?, play is often associative, that is, playing with the same toys in pairs or in small groups, but still with no real interaction among them.

Back 53

3

Front 54

By age?, children are usually able to share and engage in cooperative play.
Real interactions and taking turns become possible.

Back 54

4

Front 55

Between ?years of age, growth can be traced through drawings.

Back 55

3 and 6

Front 56

Describe preschool drawing of people.

Last to appear is

Back 56

A child's first drawing of a human being is a circular line with marks for the mouth, nose, and eyes

a torso in proportion to the rest of the body

Front 57

Some studies indicate that up to ? percent of children between the ages of 3 and 10 years have imaginary companions at one time or another

Back 57

50%

Front 58

In most instances, imaginary companions disappear by age?, but they can occasionally persist into adulthood.

Back 58

12

Front 59

Heavy tv watching associated with?

Back 59

less language,
violence, more aggressiveness

Front 60

What age is the middle years

Back 60

6 to puberty

Front 61

The ability to concentrate is well established by age ?, and by the end of the period, children begin to think in abstract terms

Back 61

9 or 10

Front 62

Girls who cannot identify with their mothers or whose fathers are overly attached may become

Back 62

fixated at about a 6-year-old level;
as a result, they may fear men or women or both or become seductively close to them

Front 63

Boy who cannot identify with fathers can become?

Back 63

A similar situation can occur in boys who have been unable to identify successfully with fathers who were aloof, brutal, or absent. Perhaps his mother prevented a boy from identifying with his father by being overprotective or by binding the son too closely to her. As a result, boys may enter this period with a variety of problems. They may be fearful of men, unsure of their sense of masculinity, or unwilling to leave their mothers (sometimes manifested by a school phobia); they may lack initiative and be unable to master school tasks, thus incurring academic problems.

Front 64

At age ?, many children believe dreams are shared directly by more than one person, but most ?-year-olds understand that dreams are unique to each person.

Back 64

3
4

Front 65

Disturbing dreams peak when children are ?, ?, and ?years of age

Back 65

Disturbing dreams peak when children are 3, 6, and 10 years of age

Front 66

?-year-old children may dream about being bitten or chased

Back 66

Two

Front 67

at the age of ?, they may have many animal dreams and also dream of persons who either protect or destro

Back 67

4

Front 68

At age ?, dreams of being killed or injured, of flying and being in cars, and of ghosts become prominent; the role of conscience, moral values, and increasing conflicts are concerned with these themes.

Back 68

5 or 6

Front 69

By about the age of ?, children realize that their dreams are not real; before then, they believed them to be real events.

Back 69

5

Front 70

By age ?, children know that they create their dreams themselve

Back 70

7

Front 71

Parasomnias, such as sleepwalking, sleep talking, enuresis (bed-wetting), and night terrors, are common at this age. They usually occur during ? sleep when dreaming is minimal.
Most children grow out of parasomnias by

Back 71

stage 4
adolescence.

Front 72

Periods of REM occur about ?percent of the time during the first few weeks of life, a period when infants sleep ? of the time

Back 72

60%

two thirds

Front 73

The sleep–wake cycle of newborns is about ? hours long

Back 73

3

Front 74

Among adults, the dream-to-sleep ratio is stable: ?percent of sleeping time is spent dreaming.

Back 74

20%

Front 75

Studies have shown when a child is born ? years after a previous birth, health risks are reduced for both mother and child

Back 75

3 to 5

Front 76

Studies of children from large families (of four or five children) show that they are more likely to have ??than children from small families.

Back 76

conduct disorder and to have a slightly lower level of verbal intelligence

Front 77

Infant response to divorce

Back 77

Infants do not understand anything about separation or divorce; however, they do notice changes in their parents' responses to them and may experience changes in their eating or sleeping patterns, have bowel problems, and seem more fretful, fearful, or anxious

Front 78

Child 3 to 6 response to divorce

Back 78

Children 3- to 6-years of age do not understand what is happening, and those who do understand often assume that they are somehow responsible for the divorce

Front 79

Divorce in child between 7 and 12 years

Back 79

If divorce occurs when a child is between 7 and 12 years, school performance generally declines.

Front 80

Divorce views of teen?

Back 80

Older children, especially adolescents, comprehend the situation and believe that they could have prevented the divorce had they intervened in some way—had they, in effect, served as surrogate marriage therapists—but they are still hurt, angry, and critical of their parents' behavior.

Front 81

Recovery from, and adaptation to, the effects of divorce usually take ?years
about ?of all children from divorced homes have lasting psychological trauma

Back 81

3 to 5
one third

Front 82

Signs of non-divorce recovery in boys?

Back 82

Among boys, physical aggression is a common sign of distress.
Adolescents tend to spend more time away from the parental home after the divorce.
Suicide attempts may occur as a direct result of the divorce; one of the predictors of suicide in adolescence is the recent divorce or separation of the parents.

Front 83

Children who adapt well to divorce do so if

Back 83

each parent makes an effort to continue to relate to the child despite the child's anger

Front 84

Daycare +/-

Back 84

better academic skills
poorer (but still in normal range) work habits and social skills

Front 85

Parenting styles?

Back 85

Authoritarian
Permissive
Neglectful
Authoritative

The authoritarian style, characterized by strict, inflexible rules, can lead to low self-esteem, unhappiness, and social withdrawal. The indulgent-permissive style, which includes little or no limit setting coupled with unpredictable parental harshness, can lead to low self-reliance, poor impulse control, and aggression. The indulgent-neglectful style, one of noninvolvement in the child's life and rearing, puts the child at risk for low self-esteem, impaired self-control, and increased aggression. The authoritative-reciprocal style, marked by firm rules and shared decision-making in a warm, loving environment, is believed to be the style most likely to result in self-reliance, self-esteem, and a sense of social responsibility

Front 86

Children who do not use words by ?months or phrases by ? years may need assessment

Back 86

Children who do not use words by 18 months or phrases by 2½ to 3 years may need assessment
particularly if they do not appear to understand normal verbal cues or much language at al

Front 87

Psychological maladjustment, self-loathing, disturbance of conduct, substance abuse, affective disorders, and other impairing psychiatric disorders emerge in approximately ?percent of the adolescent population.

Back 87

20%

Front 88

The psychoanalytic developmentalist Erik Erikson characterizes the normative task of adolescence as

Back 88

identity versus role confusion

Front 89

The integration of past experiences with current changes takes place in what Erikson terms

Back 89

ego identity.

Front 90

Describe key parts to ego identity formation

Back 90

heroes, idols
Adolescents explore various aspects of their psychological selves by becoming fans of heroes, or other well-known musical or political idols. Some adolescents appear consumed by their identification with a particular idol, whereas others are more moderate in their expression. Adolescents who feel accepted by a peer group and are involved in a variety of activities are less likely to become consumed by adoration of an idol. Adolescents who are socially isolated, feel socially rejected, and become overly identified with an idol to the exclusion of all other activities are at greater risk for serious emotional problems and require psychiatric intervention.

Front 91

Erickson uses the term ? to describe that interim period between the concrete thinking of childhood and a more evolved complex ethical development

Back 91

moratorium

Front 92

Erikson defines ?? as a normative part of adolescence in which adolescents pursue alternative behaviors and styles and, then, successfully mold these different experiences into a solid identity.
What happens if fail to achieve solid identity?

Back 92

identity crisis

A failure to do so would result in identity diffusion, or role confusion, in which the adolescent lacks a cohesive or confident sense of identity.

Front 93

Piaget:
The central cognitive change that occurs gradually during adolescence is the shift from

Back 93

concrete thinking
(concrete operational thinking, according to Jean Piaget) to the ability to think abstractly (
formal operational thinking, in Piaget's terminology).

Front 94

Lawrence Kohlberg integrated Piaget's concepts and described three major levels of morality. T

Back 94

he first level is
preconventional morality, in which punishment and obedience to the parent are the determining factors. The second level is
morality of conventional role-conformity, in which children try to conform to gain approval and to maintain good relationships with others.
The third and highest level is
morality of self-accepted moral principles,
in which children voluntarily comply with rules on the basis of a concept of ethical principles and make exceptions to rules in certain circumstances.

Front 95

The most important correlates of good self-esteem are

Back 95

one's perception of positive physical appearance and
high value to peers and family

Secondary features of self-esteem relate to academic achievement, athletic abilities, and special talents.

Front 96

Prescription drug abuse by people ages 18 to 25 has ? percent

Back 96

increased 15

Front 97

Homicides are the ?leading cause of death among persons aged 15 to 25
What is first, what is 3rd?

Back 97

2nd
Accidents are first;
suicides, third

Front 98

The factor most strongly associated with violence among adolescent boys is

Back 98

growing up in a household without a father or father surrogate; this factor aside, race, socioeconomic status, and education show no effect on the propensity toward violence.

Front 99

Approximately ?percent of 6th through 10th grade students are involved in some aspect of moderate-to-frequent bullying, either as a bully, the target of bullying, or both.

Back 99

30%

Front 100

At least ?percent of suicide deaths in teens involve the use of a handgun.

Back 100

60%

Front 101

Development Tasks of Young Adulthood

Back 101

To develop a young-adult sense of self and other: the third individuation
To develop adult friendships
To develop the capacity for intimacy; to become a spouse
To become a biological and psychological parent
To develop a relationship of mutuality and equality with parents while facilitating their midlife development
To establish an adult work identity
To develop adult forms of play
To integrate new attitudes toward time

Front 102

Name some issues of a developmental theme in middle adulthood

Back 102

prime of life: responsible power use vs winner-lose
stock taking: what to do with the rest of one's life - possibility vs closure
fidelity and commitments: commitment vs hypocrisy, self-deception
growth-death: naturality vs frenetic preoccupation with youthfulness
communication &socializaiton: rooted in persons, places, ideas vs confused

Front 103

Erikson middle adulthood stage?

Back 103

generativity vs stagnation
guiding oncoming generation, improve society
vs stagnation: stop developing "being a cocoon of self-concern and isolation".

Front 104

Valliant found those with the poorest psychological adjustment during college years had a high incidence of ?? in middle age

Back 104

physical illness

Front 105

No single factor in childhood accounted for adult mental health, but an overall sense of stability in ? predicted a well-adjusted adulthood

Back 105

the parental home

Front 106

?? during college years was correlated with emotional and physical well-being in middle age

Back 106

A close sibling relationship

Front 107

What help sustains a marriage?

Back 107

goodness-of-fit between their individual needs, wishes, and expectations

Front 108

Middle adulthood: 3 things to help sexual intimacy continue?

Back 108

For sexual intimacy to continue, the participants must (1) accept the appearance of the partner's middle-aged body, (2) continue to find it sexually stimulating, and (3) accept the normative changes that occur in sexual functioning

Front 109

key sx of menopause

Back 109

vasomotor instability, hot flashes

Front 110

Describe different types of divorce

Back 110

Psychic Divorce: love object given up with grief of relationship death
Legal Divorce: no fault most common
Economic Divorce: conflict re: division of property
Community Divorce: change in social network
Coparental Divorce: seperation of parents

Front 111

List some reasons for divorce:

Back 111

Unrealistic Expectations

Front 112

maturity definition?

Back 112

maturity can be defined as a mental state found in healthy adults that is characterized by detailed knowledge of the
parameters of human existence, a sophisticated level of
self-awareness based on an honest appraisal of one's own experience within those basic parameters, and the ability to
use this intellectual and emotional knowledge and insight caringly in relation to one's self and others.

Front 113

age categories of old age?

Back 113

young-old 65 to 74
old old 75 over and over
85 and over = oldests

Front 114

Developmental Tasks of Late Adulthood

Back 114

To maintain the body image and physical integrity
To conduct the life review
To maintain sexual interests and activities
To deal with the death of significant loved ones
To accept the implications of retirement
To accept the genetically programmed failure of organ systems
To divest oneself of the attachment to possessions
To accept changes in the relationship with grandchildre

Front 115

The research about longevity reveals that ?? is the best indicator of a long life

Back 115

a family history of longevity;
; of persons who live past 80, half of their fathers also lived past 8

Front 116

The ? years of age, is the most rapidly growing segment of the older population.

Back 116

oldest old, persons over 85

Front 117

The leading causes of death among older persons are

Back 117

heart disease, cancer, and stroke.

Front 118

Biological changes with aging:
cellular changes

Back 118

Cellular Level
Change in cellular DNA and RNA structures: intracellular organelle degeneration
Neuronal degeneration in central nervous system, primarily in superior temporal precentral and inferior temporal gyri; no loss in brainstem nuclei
Receptor sites and sensitivity altered
Decreased anabolism and catabolism of cellular transmitter substances
Intercellular collagen and elastin increase
Immune System
Impaired T-cell response to antigen
Increase in function of autoimmune bodies
Increased susceptibility to infection and neoplasia
Leukocytes unchanged, T lymphocytes reduced
Increased erythrocyte sedimentation (nonspecific)

Front 119

MSK and aging

Back 119

Musculoskeletal
Decrease in height because of shortening of spinal column (2-inch loss in both men and women from the second to the seventh decade)
Reduction in lean muscle mass and muscle strength; deepening of thoracic cage
Increase in body fat
Elongation of nose and ears
Loss of bone matrix, leading to osteoporosis
Degeneration of joint surfaces may produce osteoarthritis
Risk of hip fracture is 10% to 25% by age 90
Continual closing of cranial sutures (parietomastoid suture does not attain complete closure until age 80)
Men gain weight until about age 60, then lose; women gain weight until age 70, then lose
Integument

Front 120

Integument and aging

Back 120

Integument
Graying of hair results from decreased melanin production in hair follicles (by age 50, 50% of all persons male and female are at least 50% gray; pubic hair is last to turn gray)
General wrinkling of skin
Less active sweat glands
Decrease in melanin
Loss of subcutaneous fat
Nail growth slowed

Front 121

GU and Repro and aging

Back 121

Genitourinary and Reproductive
Decreased glomerular filtration rate and renal blood flow
Decreased hardness of erection, diminished ejaculatory spurt
Decreased vaginal lubrication
Enlargement of prostate
Incontinence

Front 122

Senses and aging

Back 122

Special Senses
Thickening of optic lens, reduced peripheral vision
Inability to accommodate (presbyopia)
High-frequency sound hearing loss (presbyacusis)—25% show loss by age 60, 65% by age 80
Yellowing of optic lens
Reduced acuity of taste, smell, and touch
Decreased light-dark adaption
Neuropsychiatric

Front 123

Aging and cognitive fxn

Back 123

Takes longer to learn new material, but complete learning still occurs
Intelligence quotient (IQ) remains stable until age 80
Verbal ability maintained with age
Psychomotor speed declines
Memory
Tasks requiring shifting attentions performed with difficulty
Encoding ability diminishes (transfer of short-term to long-term memory and vice versa)
Recognition of right answer on multiple-choice tests remains intact
Simple recall declines

Front 124

Aging and Neurotransmitters

Back 124

Neurotransmitters
Norepinephrine decreases in central nervous system
Increased monoamine oxidase and serotonin in brain

Front 125

Aging and Brain changes?

Back 125

Brain
Decrease in gross brainweight, about 17% by age 80 in both sexes
Widened sulci, smaller convolutions, gyral atrophy
Ventricles enlarge
Increased transport across blood–brain barrier
Decreased cerebral blood flow and oxygenation

Front 126

Aging and CVS changes

Back 126

Cardiovascular
Increase in size and weight of heart (contains lipofuscin pigment derived from lipids)
Decreased elasticity of heart valves
Increased collagen in blood vessels
Increased susceptibility to arrhythmias
Altered homeostasis of blood pressure
Cardiac output maintained in absence of coronary heart disease

Front 127

Aging and GI changes

Back 127

Gastrointestinal (GI) System
At risk for atrophic gastritis, hiatal hernia, diverticulosis
Decreased blood flow to gut, liver
Diminished saliva flow
Altered absorption from GI tract (at risk for malabsorption syndrome and avitaminosis)
Constipation

Front 128

Aging and Endocrine changes

Back 128

Endocrine
Estrogen levels decrease in women
Adrenal androgen decreases
Testosterone production declines in men
Increase in follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in postmenopausal women
Serum thyroxine (T4) and thyroid-stimulating hormone (TSH) normal, triiodothyronine (T3) reduced
Glucose tolerance test result decreases

Front 129

Aging and Respiratory changes

Back 129

Respiratory
Decreased vital capacity
Diminished cough reflex
Decreased bronchial epithelium ciliary action

Front 130

Erikson last developmental stage
how successfully resolve?

Back 130

Erikson termed the crisis of the last epoch of life integrity versus despair and believed that successful resolution of this crisis involved a process of life review and achieved a sense of peace and wisdom through coming to terms with how one's life was lived

Front 131

Signs of having resolved last stage of life?

Back 131

Erikson proposed that successful resolution of this crisis would be characterized by a sense of having lived one's life well, whereas a less successful resolution would be characterized by feeling that life was too short, that one did not choose wisely, and bitterness that one will not have a chance to live life over.

Front 132

Personality changes with aging?

Back 132

Some studies found slight
decreases in extraversion and
slight increases in agreeableness as individuals move into the oldest-old category,

Front 133

+ benefits of exercise

Back 133

Increases
Strength of bones, ligaments, and muscles
Muscle mass and body density
Articular cartilage thickness
Skeletal muscle ATP, CRP, K+, and myoglobin
Skeletal muscle oxidative enzyme content and mitochondria
Skeletal muscle arterial collaterals and capillary density
Heart volume and weight
Blood volume and total circulating hemoglobin
Cardiac stroke volume
Myocardial contractility
Maximal CO2(A-V)
Maximal blood lactate concentration
Maximal pulmonary ventilation
Maximal respiratory work
Maximal oxygen diffusing capacity
Maximal exercise capacity as measured by the maximal oxygen intake, exercise time, and distance
Serum high-density lipoprotein concentration
Anaerobic threshold
Plasma insulin concentration with submaximal exercise
Decreases
Heart rate at rest and during submaximal exercise
Blood lactate concentration during submaximal exercise
Pulmonary ventilation during submaximal work
Respiratory quotient during submaximal work
Serum triglyceride concentration
Body fatness
Serum low-density lipoprotein concentration
Systolic blood pressure
Core temperature threshold for initiation of sweating
Sweat sodium and chloride content
Plasma epinephrine and norepinephrine with submaximal exercise
Plasma glucagon and growth hormone concentrations with submaximal exercise
Relative hemoconcentration with submaximal exercise in the heat

Front 134

Describe major concepts of old age:

Back 134

Freud: increased control of id and ego= increased autonomy; regression can happen
Erikson:central conflict = integrity (productive life) vs despair (life little purpose)
Kohut: narcissitic injury = major conflict
Neugarten: conflict=giving up authority and evaluating past achievements
Levinson: preocupation with body = preoccupation with death, creative mental life = substitute for reduced physical life

Front 135

The most robustly aging individuals report

Back 135

greater social contact,
better health and vision, and
fewer significant life events in the past 3 years than their less robustly aging counterparts

Front 136

George Vaillant followed up a group of Harvard freshmen into old age and found the following about emotional health at age 65:

Back 136

Having been close to brothers and sisters during college correlated with emotional well-being;

undergoing early traumatic life experiences, such as the death of a parent or parental divorce, did not correlate with poor adaptation in old age;

being depressed at some point between ages 21 and 50 predicted emotional problems at age 65;

and possessing the personality traits of pragmatism and dependability as a young adult was associated with a sense of well-being at age 65.

Front 137

Several forms of transference, some of them unique to adulthood, are present in older adults. Describe 2

Back 137

parental transference, in which the patient reacts to the therapist as a child to a parent
Peer or sibling transference, expressions of experiences from a variety of nonparental relationships, is also common. In this form of transference, the patient looks to the therapist to share experiences with siblings, spouses, friends, and associates.

In son or daughter transference, quite common in middle-aged individuals and the elderly, the therapist is cast in the role of the patient's child, grandchild, or son-in-law or daughter-in-law.

sexual transferences in older individuals are frequent, intense, and the therapist needs to be able to accept them and manage his or her countertransference responses.

Front 138

Most common chronic conditions in elderly?

Back 138

4 H's
1. Hard joints: arthritis then
2. HTN
3. Hearing impairment
4. Heart disease

Front 139

Issues of counter-transference in young?

Back 139

Older individuals are dealing with illness and signs of aging, the loss of spouses and friends, and the constant awareness of time limitation and the nearness of death. These are painful issues that are just beginning to come into focus for younger therapists who would prefer not to confront them with great intensity on a daily basis.

A second source of countertransference responses centers on the older patient's sexuality.

Front 140

The most important factors in determining the level of sexual activity with age are

Back 140

the health and survival of the spouse,

one's own health, and
the level of past sexual activity.

Front 141

Do men or women provide more support for elderly?

Back 141

women
average 12 hours a week of care

Front 142

As percentage, who provides most care?

Back 142

Daughters (and daughters-in-law) 29%
Wives 23%
Other women 20%
Sons 8%
Other men 7%
Husbands 13%

Front 143

Is MDD, Dysthymia > or less in older than younge people? Explain

Back 143

Less

Several explanations for this phenomenon have been proposed: rarity of late-onset depression,

higher mortality among persons with depression, and

a general decrease in disorders caused by emotional upheavals or substance abuse in older persons.

Front 144

The incidence of suicide among older persons is (low or high) and is highest for ?

Back 144

The incidence of suicide among older persons is high (40 per 100,000 population) and is highest for older white men.

Front 145

Kubler-Ross Stages of Death and Dying?

Back 145

1. Shock and Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Front 146

Almost half of the children who die between the ages of 1 and 14 and nearly 75 percent of those who die in late adolescence and early adulthood die from

Back 146

accidents,
homicides, and
suicides

Front 147

What type of reassurance do preschool children need?

Back 147

They need reassurance that they are
loved,
have done nothing wrong,
are not responsible for their illness, and
will not be abandoned.

Front 148

Preschool view of death?

Back 148

At the preschool, preoperational stage of cognitive development, death is seen as a temporary absence, incomplete and reversible, like departure or sleep. Separation from the primary caretaker(s) is the main fear of preschool-age children. This fear surfaces as an increase in nightmares, more aggressive play, or concern about the deaths of others, rather than in direct discourse. Terminally ill children may assume responsibility for their death, feeling guilty for dying. Preschool children may be unable to relate the treatment to the illness, instead viewing treatment as punishment and family separation as rejection

Front 149

School age view of death?

Back 149

School-age children manifest concrete-operational thinking and recognize death as a final reality. They, however, view death as something that happens to old people, not to them.

Front 150

How help preschool child with death?

Back 150

Facilitating open discussion and updating children with important information, including prognostic changes, can be very helpful. In addition, children may need help coping with peers and school demands. Teachers should be informed and updated. Classmates may need education and assistance to help them understand the situation and respond appropriately.

Front 151

Teen view of death?

Back 151

Capable of formal cognitive operations, adolescents understand that death is inevitable and final but may not accept that their own death is possible
The major fears of dying teenagers parallel those of all teenagers—losing control, being imperfect, and being different. Concerns about body image, hair loss, or loss of bodily control can generate great resistance to continuing treatment. Alternating emotions of despair, rage, grief,
bitterness, numbness, terror, and joy are common. The potential for withdrawal and isolation is great, as teenagers may equate parental support with loss of independence or may deny their fears of abandonment by actually repulsing friendly gestures

Front 152

How support teens in dying?

Back 152

Teenagers must be included in all decision-making processes surrounding their deaths. Many are capable of great courage, grace, and dignity in facing death.

Front 153

Some of the most often expressed fears of adult patients entering hospice care, listed in the approximate order of frequency, include fears of

Back 153

(1) separation from loved ones, homes, and jobs;
(2) becoming a burden to others;
(3) losing control;
(4) what will happen to dependents; (5) pain or other worsening symptoms;
(6) being unable to complete life tasks or responsibilities;
(7) dying;

Front 154

Describe normal bereavement

Back 154

The first response to loss,
protest, is followed by a longer period of
searching behavior. As hope to reestablish the attachment bond diminishes, searching behaviors give way to
despair and
detachment before bereaved individuals eventually
reorganize themselves around the recognition that the lost person will not return.

Front 155

Describe depressive symptoms due to bereavement vs MDD?

Back 155

According to DSM-IV-TR, if the symptoms of a major depressive episode begin within 2 months of the loss of a loved one and do not persist beyond those 2 months, they are generally considered to result from bereavement, unless they are associated with marked functional impairment or include morbid

preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or
psychomotor retardation.

Front 156

Three patterns of complicated, dysfunctional grief syndromes have been identified

Back 156

chronic, hypertrophic, and delayed grief.

Front 157

Describe chronic Grief?

Back 157

The most common type of complicated grief is chronic grief, often highlighted by bitterness and idealization of the dead.


Chronic grief is most likely to occur when the relationship between the bereaved and the deceased had been extremely close, ambivalent, or dependent or when social supports are lacking and friends and relatives are not available to share the sorrow over the extended period of time needed for most mourners.

Front 158

Describe hypertrophic grief?

Back 158

Most often seen after a sudden and unexpected death, bereavement reactions are extraordinarily intense in hypertrophic grief. Customary coping strategies are ineffectual to mitigate anxiety, and withdrawal is frequent. When one family member is experiencing a hypertrophic grief reaction, disruption of family stability can occur. Hypertrophic grief frequently takes on a long-term course, albeit one attenuated over time.

Front 159

Delayed Grief?

Back 159

Absent or inhibited grief when one normally expects to find overt signs and symptoms of acute mourning is referred to as delayed grief. This pattern is marked by prolonged denial; anger and guilt may complicate its course.

Front 160

Describe Traumatic Bereavement

Back 160

Traumatic bereavement refers to grief that is both chronic and hypertrophic.

This syndrome is characterized by recurrent, intense pangs of grief with persistent yearning, pining, and longing for the deceased; recurrent intrusive images of the death; and a distressing admixture of avoidance and preoccupation with reminders of the loss. Positive memories are often blocked or excessively sad, or they are experienced in prolonged states of reverie that interfere with daily activities. A history of psychiatric illness appears to be common in this condition, as is a very close, identity-defining relationship with the deceased.

Front 161

Negatives consequences of bereavement?

Back 161

medical complications: worsening of disease, increased somatic sx, increased doctors visits, ischemic heart disease
Psych: depression, anxiety, PTSD, substance, Suicide

Front 162

Compare bereavement and depression

Back 162

Grief is stimulus bound (reminders); fluctuates vs persistent
mdd wrse fxn

Front 163

Unnatural and violent deaths, such as homicide, suicide, or death in the context of terrorism, are much more likely to precipitate ?

Back 163

PTSD

Front 164

Grief and immune fxn?

Back 164

Grief is also accompanied by impaired immune functioning: decreased lymphocyte proliferation and impaired functioning of natural killer cells.

Whether the immune changes are clinically significant has not been established, but the mortality rate for widows and widowers following the death of a spouse is higher than that in the general population. Widowers appear to be at risk longer than widows.

Front 165

Recommendations for bereaved child

Back 165

Bereaved children must be treated with respect to their own levels of emotional and cognitive maturity. They need to be told that the death is real and irreversible and that they are blameless. Feelings and concerns should be expressed, and questions should be invited and answered with simplicity, candor, and clarity. Children, as with adults, need rituals to commemorate their loved ones; attendance at the funeral and participation in mourning may be beneficial first steps.

Front 166

Rx for normal bereavement?
PsychoRx ?

Back 166

perhaps sleeping agent temp
Self-help groups offer companionship, social contacts, and emotional support; they eventually enable their members to reenter society in a meaningful way