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95 Cards in this Set
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Schizophrenia Diagnosis
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Must have 2 or more of the characteristic symptoms during a 6 month period (or less if successfully treated)
Positive Symptoms: -Delusions -Hallucinations -Disorganized speech -Grossly disorganized behavior Negative Symptoms: -Flat Affect -Poverty of speech -Inability to initiate goal-directed activity |
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Positive Symptoms of Schizophrenia
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-Delusions
-Hallucinations -Disorganized speech -Grossly disorganized behavior |
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Negative Symptoms of Schizophrenia
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-Flat Affect
-Poverty of speech -Inability to initiate goal-directed activity |
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Major Depression
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Must have 5 or more of the following symptoms (2 of which must include a) depressed mood, and b) loss of interest or pleasure/anhedonia), for a period of at least 2 weeks.
- Depressed mood - Loss of interest or pleasure in all activities - Weight loss/weight gain - Insomnia/hypersomnia - Psychomotor retardation/agitation - Fatigue/Loss of energy - Feelings of worthlessness or guilt - Inability to concentrate/indecisiveness - Recurrent thoughts of death |
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Cluster A of Personality Disorders
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Odd and Eccentric:
Paranoid, Schizotypal, Schizoid |
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Cluster B of Personality Disorders
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Dramatic, emotional, and erratic:
Borderline, Antisocial, Histrionic, Narcissistic |
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Cluster C of Personality Disorders
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Anxious and fearful:
Avoidant, Dependent, and OCD |
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Endogenous Depression
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- Depression caused by a biochemical imbalance.
- Classic symptoms of depression. - Symptoms more severe |
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Exogenous Depression
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- Depression caused by psychosocial stressors.
- Symptoms less severe. |
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Folie a Deux
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Shared delusion
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Hypomanic
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- Elevated, expansive, irritable mood that is less severe than full-blown manic symptoms.
- Not accompanied by psychotic symptoms |
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NAIS
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Wechsler Adult Intelligence Scale
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WISC-R
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Wechsler Intelligence Scale for Children
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Draw-A-Person Test
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Provides information about a child's self image
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MMPI
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Predominant personality traits or behavior
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Rorschach Test
TAT |
Inkblot
Thematic Apperception Test |
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Conversion Disorder
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- Loss of motor functioning
- Involuntary |
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Factitious Disorder
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A patient intentionally produces symptoms for an external reward or goal
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Malingering
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A patient fakes symptoms due to a psychological need to adopt the "sick role"
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Munchausen Syndrome
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When someone with Factitious Disorder produces physical symptoms
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Munchausen's Syndrome by Proxy
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When a caregiver produces deliberate medical symptoms in a child
- Considered child abuse. |
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Schizotypal Personality Disorder
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Magical thinking associated with this disorder
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Delirium
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- Changes in level of consciousness and orientation
- Caused by General medical condition, and/or substance use - Medical emergency - Rapid/acute onset |
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Dementia
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- Disturbance involving memory impairment and other cognitive impairments
- Caused by general medical condition - Can be caused by a series of strokes called vascular dementia, with patchy cognitive symptoms - Becomes progressively worse over time |
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Bipolar I Disorder
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Presence of only one manic episode and no past Major Depressive episodes.
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Bipolar II Disorder
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Presence or history of:
- 1 or more Major Depressive Episodes - At least 1 Hypomanic episode - No history of manic episodes. |
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Manic Symptoms
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- Period of elevated, expansive, or irritable mood, (LASTING AT LEAST 1 WEEK)
- 3 or more of the following: - Inflated self-esteem or grandiosity - Decreased need for sleep - Pressured speech - Flight of ideas or racing thoughts - Distractibility - Increased goal-directed activity or psychomotor agitation - Excessive involvement in pleasurable activities that have a high risk for painful consequences |
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Best Treatment for Bipolar Disorder
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Psychopharmocology treatment
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Antisocial Personality Disorder
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A person with a pervasive pattern of disregard for and violation of the rights of others since the age of 15.
Must have 3 or more of the following: - Repeatedly performing acts that are grounds for arrest - Deceitfulness - Impulsivity - Irritability and aggressiveness - Reckless disregard for safety of self and others - Consistently irresponsible - Lack of remorse Must be at least 18 years-old and have a history of conduct disorder with onset before age 15 |
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Personality Disorder
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An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. The pattern is manifested in two or more of these areas:
- Cognition - Affectivity - Interpersonal functioning - Impulse control Personality disorders are: - Pervasive and inflexible Onset in adolescence or early adulthood Pattern is stable and of long duration - Leads to distress and impairment |
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Borderline Personality Disorder
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Characterized by a pattern of unstable self-image, relationships, emotions, affects, and impulse control.
Must have 5 or more of the following: - Intense, unstable relationships - Frantic efforts to avoid abandonment - Impulsive behavior - Identity disturbance - Recureent suicidal behavior, gestures, or threats, self-mutilation - Chronic feelings of emptiness - Inappropriate, intense anger - Can have transient, stress-related paranoid ideation or sever dissociate symptoms. People with BPD use splitting as a defense mechanism |
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ADHD
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Condition characterized by a failure to remain attentive in 2 or more settings or situations.
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Oppositional Disorder
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Children with this disorder display their agggressiveness by patterns of obstinate but generally passive behavior. They provoke adults and children by use of:
- Negativism - Stubbornness - Dawdling - Procrastination - Underlying aggressiveness - No symptoms of conduct disorder |
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PTSD in Children, symptoms, and play
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- Re-experiencing
- Repetitive play |
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Autistic Disorder
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- Onset before age 3
- Failure to develop the usual relatedness to parents and other people - May lack social smile - May avoid eye contact - May fail to cuddle - Play schemes are rigid, repetitive, and lack variety - May manifest over or under responsiveness to sensory stimuli - 50% severely retarded - 25% mildly retarded - 25% IQ of 70 or more |
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Major Depressive Episode in Kids
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- Younger kids may fake illness, be hyperactive, cling to parents and refuse to go to school. They may also fear the death of their parents.
- Older kids may be sulky, refuse to cooperate in family and social activities, get into trouble at school, and may abuse drugs or alcohol. |
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Identity Disorder
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A severe distress regarding a youngster's inability to integrate various aspects of his or her acceptable sense of self.
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Rhett's Disorder
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The development of persistent and progressive developmental regression after a period of normal development.
- Onset usually before age 4 - Seen only in females |
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Aspberger's Disorder
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Severe and sustained impairment of social interactions and restricted, repetitive patterns of behavior, interests, and activities.
- More common in boys |
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Side Effects of Antipsychotic Drugs
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- Sedation
- Postural hypotension - Weight gain - Photosensitivity - Sexual dysfunction Breast swelling (gynecomastia) Anticholinergic Side Effects: - Dry mouth - Blurred vision - Urinary hesitation - Constipation - Tardive Dyskinesia: Abnormal involuntary movements of the lips, jaw, face, and twitching Extrapyramidal symptoms: - Parkinsonian syndrome: Tremor, rigidity, and slowed movement Akinesia: Slowness in all natural movements Akathisia: Inner restlessness, purposeful motor movement Acute Dystonic Reactions: Involuntary muscle spasms or tightening of face |
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Tardive Dyskinesia
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Abnormal involuntary movements of the lips, jaw, face, and twitching
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Parkinsonian syndrome
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Tremor, rigidity, and slowed movement
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Akinesia
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Slowness in all natural movements
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Akathisia
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Inner restlessness, purposeful motor movement
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Acute Dystonic Reactions
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Involuntary muscle spasms or tightening of face
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Neuroleptic Malignant Syndrome
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- Medical emergency
- Occurs soon after starting a neuroleptic - Fever - Muscle rigidity - Mental status changes - Tachycardia: Fast heart rate |
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Commonly used (typical) Antipsychotic Drugs
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Usually neuroleptics and major tranqullizers
- Thorazine (Choloromazine) - Prolixin (Fluphenazine) - Haldol (Haloperidol) Others: - Mellaril - Stelazine - Navane |
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What are Atypical Antipsychotic drugs most effective for?
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- Negative symptoms of schizophrenia
- Less extrapyramidal symptoms - Lower risk for Tardive Dyskinesia |
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Atypical Antipsychotic Drugs
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- Clozapine (Clozaril)
- Risperidone (Risperdal) |
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Clozapine
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- Antipsychotic Drug
- 5ht Blocker, affinity of D4 receptor for clozapine Side Effects: - Increased saliva, drooling - Sedation - Nausea - Hypotension and dizziness - Tachycardia - Weight gain - Increased risk of seizures - Increased rick of agranulocytosis. Useful in treatment-resistant patients |
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Risperidone
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Atypical Antipsychotic
- 5HT and D5 antagonist Side Effects: - Sedation ** - Headache, dry mouth, constipation, blurred vision, urinary retention, palpitations, nervousness |
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Antidepressant Drugs
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- TCA's (Trycyclic Antidepressants)
- MAOI's (Miniamine Oxidase Inhibitors) |
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TCA's (Trycyclic Antidepressants)
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- Tofranil *
- Elavil * - Aventyl, Pamelor, Norpramin, Adapin, Sinequan Side Effects: Autonomic, anticholinergic: - Dry mouth, blurred vision, constipation, urinary hesitancy/retention, sweating, sensitivity to heat Cardivascular: - Postural hypotension, tachycardia, change in EKG arrhythmias Percipitation of hypomania in some bipolar patients - Contraindicated for patients with heart disease - Lethal when overdosed - Therapeutic effects take 2-3 weeks to begin |
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MAOI's (Monoamine Oxidase Inhibitors)
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- Nardil
- Parnate - Marplan - Most effective for treating atypical depressions and non-endogenous depressions Side Effects: - Hypertension (if taking a high dose, using with a TCA, or consuming a food with high tyramine) - Adverse drug reactions (Stimulants, appetite suppressants, cold remedies, cocaine derivatives, TCA's, any medicine that raises blood pressure) - Dietary restrictions: Foods with high levels of tyramine (ex: beer, wine, cheese, beef or chicken liver etc.) |
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What are MAOI's most effective at treating?
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- Atypical depressions
- Non-endogenous depressions |
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Second-Generation Antidepressants
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- Similar effectiveness to TCA's and MAOI's, but reduced side effects.
- Asendin - Desyrel - Ludiomil - Wellbutrin - Effexor - Serzone - SSRIs |
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SSRI's (Selective Serotonin Reuptake Inhibitors)
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- Prozac
- Zoloft - Paxil - Effect comparable to TCA's Side Effects (dose-related): - Weight loss - Nausea - Diarrhea - Nervousness (Floxetine/Prozac) - Insomnia - Less toxic to the heart and safer in overdose than TCA's |
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What are Mood Stabilizers Used to Treat?
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Bipolar Disorder
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Mood Stabilizers
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- Lithium (Li)
- Anticonvulsants (Tegretol, Depakote) |
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Lithium (Li)
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- Small difference between toxic and therapeutic levels
- Need to periodically check blood levels, thyroid, and kidney) Side Effects: - Thyroid Gland: Enlarging, and making it underactive - Renal/Kidney: Increased drinking and urination - Gastrointestinal: Gastric irritation, anorexia, cramps, nausea, vomitting, diarrhea - Central Nervous System (CNS) and Neuromuscular: Mental dullness, decreased memory and concentration, headache, fatigue, muscle weakness, hand tremor - Weight gain - Avoid during 1st trimester of pregnancy - Requires 2 or more weeks to see therapeutic effects, fully contain an episode of mania - Most effective in preventing recurrences of mania and depression |
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Carbamazepine (Tegretol)
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- Mood stabilizer
- Avoid taking it during pregnancy (particularly during 1st trimester) - May depress bone marrow function - Requires monitoring of blood count |
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Valproic Acid (Depakote)
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- Mood Stabilizer
- Most effective for rapid cycling and mixed bipolar disorders - Avoid taking it during pregnancy (particularly during 1st trimester) |
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What meds are used to treat Panic Disorder With or Without Agoraphobia?
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- TCA's
- MAOI's - Xanax - SSRI's |
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What meds are used to treat OCD?
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- TCA's (Anafranil)
- MAOI's - SSRI's (Luvox, Zoloft) |
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What meds are used to treat specific phobia and Social Phobia?
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- Beta Blockers (Propanolol) for somatic symptoms of stage fright.
- Paxil (Social Phobia) |
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What meds are used to treat Generalized Anxiety Disorder?
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Benzodiazepines
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Benzodiazepines
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- Useful for symptoms of Generalized Anxiety Disorder
- Safer than barbiturates - Benzodiazepines commonly used as minor tranquilizers: Valium, Librium, Ativan, Tranxene - Difficult to discontinue - Drug most commonly used in overdoses Side Effects: - Impaired muscle coordination (psychomotor functions) - Impairment in short-term memory (anterograde memory) |
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Anxiolytic Drugs (Minor Tranquilizers)
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- Barbituates
- Formerly used: Methaqualone (Quaaludes, Sopors), Hydroxyine (Atarax, Visaril), Meprobamate (Miltown) - Anti-psychotic drugs For Generalized Anxiety Disorder, can use BuSpar, but it takes 2 weeks to see effects) |
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Barbituates
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- Minor tranquilizer
- High abuse potential - Dangerous when combined with alcohol |
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Drugs used to induce sleep (Hypnotic Drugs)
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- Benzodiazepines: Dalmane, Halcion, Restoril
- Barbituates, Chloral hydrate - Trazadone (Desyrel) |
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Drugs that are Used to Treat Hyperactivity in Children
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- Psychostimulants:
- Ritalin - Aderall (amphetamine) |
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Side Effects of Psychostimulants
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- Insomnia
- Decreased appetite - Stomachaches - Headaches - Jitteriness |
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What is the strongest predictor for developing an alcohol problem?
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A family history of alcoholism
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Risk factors for alcoholism
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- Demographic: Male/poor/unemployed
- Family: Family history of alcoholism - Social: Peers, cultural norms - Genetic: Inherited predisposition - Psychiatric: Depression, anxiety, low self-esteem, low tolerance for stress Behavioral: Use of other substances, conduct disorder, antisocial personality disorder, impulsivity etc. |
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Biopsychosocial Model (Substance Abuse)
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Holistic model that incorporates: -
- Hereditary predisposition, - Emotional/psychological problems - Social influences - Environmental problems. |
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Medical/Biological Model (Substance Abuse)
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- Addiction is considered a medical disease
A) Genetic causes: Inherit vulnerability to addiction B) Brain Reward Mechanisms: Substances act on parts of brain and reinforce continued use by producing pleasurable feelings C) Altered Brain Chemistry: Habitual use of substances alter brain chemistry and continued use of substances is required to avoid feeling discomfort from the brain imbalance |
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Clinical Model (Substance Abuse)
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Substances are used to escape painful problems of life.
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Alcohol Assessment Instruments
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- CAGE-AID
- TWEAK TEST: To screen pregnant women - (MAST) Michigan Alcoholism Screening Test |
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What should you do if a client with a long-standing substance abuse problem comes in for psychotherapy?
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Refer for substance abuse treatment before beginning psychotherapy
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What should a person with alcoholic problems be assessed for?
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- Acute intoxication and/or withdrawal potential
- Biomedical conditions and complications - Emotional/Behavioral conditions (Psychiatric evaluation) - Treatment acceptance or resistance - Relapse potential or continued use potential - Recovery/Living environment |
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Wernicke's Encephalopathy and Korsakoff's Syndrome
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Disorders associated with chronic abuse of alcohol. They are caused by a thiamine (Vitamin B1) deficiency resulting from the chronic consumption of alcohol.
- A person with Korsakoff's Syndrome has memory problems - Treatment is administration of thiamine - Korsakoff's syndrome is also called Alcohol-Induced Persisting Amnestic Disorder Due to Thiamine Deficiency - Found under Amnestic Disorders rather than substance abuse disorders |
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Substance Abuse
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A maladaptive pattern of abuse leading to significant impairment in functioning or distress.
- The person continues to abuse substances despite persistent or recurrent negative consequences and problems related to employment, school, interpersonal relationships, social situations, and legal issues. |
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Substance Dependence
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May involve a physiologic tolerance in which increasing amounts of substances are required to achieve intoxication and withdrawal symptoms occur.
- The person takes larger amount of the substance while trying to cut down or control substance use. - Life centers around obtaining and using the substance despite ongoing negative consequences associated with its use |
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What is required to make a diagnosis of substance dependence?
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- You do not need to have tolerance or withdrawal symptoms to make a diagnosis (tolerance and withdrawal are only 2 of the 7 criteria)
- You do need evidence of a significant impairment in functioning or distress, such as family, legal, or employment problems. |
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Goals of Treatment for Substance Abuse
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1. Abstinence from substances
2. Maximizing life functioning 3. Preventing or reducing the frequency and severity of relapse |
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Symptoms of Alcohol Withdrawal Delirium
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- Delirium
- Hallucinations - Delusions - Agitated behavior - Autonomic hyperactivity (sweating and rapid pulse) |
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Stages of Substance Abuse Treatment
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1. Stabilization: Focus is on establishing abstinence, accepting substance abuse problem, and committing self to making changes
2. Rehabilitation/Habilitation: Focus is on remaining substance free by establishing a stable lifestyle, developing coping and living skills, increasing supports, and grieving loss of substance use 3. Maintenance: Focus is on stabilizing gains made in treatment, relapse prevention, and termination |
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Which three categories of substance require detoxification?
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- Central Nervous System depressants such as Alcohol, Barbiturates, and Benxodiazapines
- Opiates (Heroine) - Cocaine |
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What are the Physiological and Behavioral Signs of Cocaine Intoxication?
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- Dilated pupils
- High feeling - Euphoria - Hyperactivity - Restlessness - Anxiety - Impaired Judgment - Tachycardia - Perspiration or chills - Nausea or vomitting Muscle Weakness - Increased blood pressure With chronic cocaine use, you might see: - Depression of pulse, blood pressure, mood, and psychomotor activity |
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Biologically Based Treatment Modality for Substance Abuse
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Replace an illict drug with a prescribed medication:
- Antabuse - Methadone - Nalterxone |
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Antabuse
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A medication which produces highly unpleasant side effects if the patient drinks alcohol, such as: flushing, nausea, vomiting, Hypotension, and anxiety
- A form of aversion therapy |
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Methadone
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Synthetic narcotic taken instead of opiates
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Naltrexone
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Drug used to reduce cravings for alcohol
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Treatment Setting Goal for Substance Abuse Treatment
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The goal is to match the patient's needs with the least restrictive treatment environment that is safe and effective
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Continuum of care settings for Substance Abuse from most intensive to least intensive
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- Inpatient hospitalization (including inpatient detox and rehab)
- Residential treatment - Intensive outpatient treatment - Outpatient treatment |
