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77 Cards in this Set
- Front
- Back
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Delirium
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lack of awareness of who/where you are and a clouding of consciousness, also inability to focus or pay attention
-caused by a change in the brain's metabolism possibly through substance intoxication or withdrawl, head injury, high fever, and vitamin deficiency -generally rapid onset and brief duration |
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Amnesia
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Unable to recall previously learned information or register new memories
-can result from head trauma, loss of oxygen, or herpes simplex -can be either chronic or transient -if caused by drugs or medications- called substance-induced persisting amnestic disorder -memory loss is a result of damage to the subcorticol regions of the brain responsible for consolidating and retrieving memories Anterograde- cannot lay down new memories Retrograde- losing memory of the past-very rare |
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Cognitive Disorders
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impairment of though, memory, attention (cognitive impairment) arising from brain trauma, disease, or exposure to toxic substances
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Dementia
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Generalized progressive deficits in memory, learning, communication, judgement, and motor coordination
-the first sign of dementia is memory loss -main cause is profuse and progressive brain damage |
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Aphasia
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(symptom of dementia) -loss of the ability to use language, caused by damage to the brain's speech and language area, and this damage influences the production and understanding of language
Wernicke's aphasia- the individual is able to produce words but has lost the ability to comprehend them, so that these verbalizations have no meaning Broca's aphasia- disturbance of language production, but comprehension abilities are intact- they know the rules of sentence construction and can grasp the meaning of language, but they are unable to produce complete sentences |
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Apraxia
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Characterized by difficulty having fluid and well learned movements that he could previously perform without difficulty- impairment not due to physical weakness or decreased muscle tone- but rather to brain deterioration
i.e. trouble picking up a glass of water |
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Agnosia
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Inability to recognize familiar objects or experiences, despite the ability to perceive their basic elements- often caused by lesions in the occipital lobe that cause severe visual defects
-i.e. sometimes blend object together |
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Other symptoms of dementia
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-disturbance in executive functioning (ability to plan things out, abstract thinking, and organizing)
-aggression -depression/anxiety -apathy -sleep disturbance |
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AID's Dementia
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-sometimes first clue that a person has aids
-likely to become forgetful and unable to concentrate or solve problems -tremor, imbalance, and loss of coordination -loss of control over emotions- may become deeply depressed, apathetic and socially withdrawn |
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Pick's Disease
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progressive degenerative disease that affects the frontal and temporal lobes of the cerebral cortex
-memory problems, socially disinhibited -undergo personality changes before they being to have memory problems |
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Parkinson's Disease
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neuronal degeneration of the basal ganglia, the subcortical structures that control motor movements
-characterized by various motor disturbances akinesia= when a person's muscles get rigid and it is difficult to initiate movement bradykinesia=a general slowing of motor activity |
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Vascular Dementia
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cardiovascular disease affecting the supply of blood to the brain
-usually follows a stroke -symptoms include memory impairment as well as aphasia, apraxia, agnosia, and disturbance in executive functioning however, also show physical abnormalities such as walking difficulties and weakness in the arms and legs -certain cognitive functions remain intact and others show significant loss- called patchy deterioration |
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Huntington's Disease
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degenerative neurological disorder that can also affect personality and cognitive functioning
-associated with mood disturbances, changes in personality changes, irritability and explosiveness, suicidality, changes in sexuality, and a range of specific cognitive deficits |
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Alzheimer's Disease
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associated with severe cerebral atrophy as well as characteristic microscopic changes in brain tissue
-marked by changes in cognitive functioning along with changes in personality and interpersonal relationships -Multiple cognitive deficits associated with dementia, probably caused by biological abnormalities involving the nervous system. |
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Causes of Delirium and Amnesia
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-problems w/ blood supply
-thrombosis -hemorrhage- breaking of blood vessel- lethal to neurons -aneurism- swelling in blood vessel -tumors/stroke -open and closed head injuries |
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"The Nun Study"
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Positive Functioning late in life is predicted by grammatical complexity, idea density, and optimism
-those in jobs that required cognitive challenges were less likely to have dementia later in life |
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Pseudodementia
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False dementia, symptoms caused by depression that mimic those apparent in early stages of Alzheimer's.
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Biological features of Alzheimers
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Neurofibrillary tangles: A characteristic of Alzheimer's disease in which the material within the cell bodies of neurons becomes filled with densely packed, twisted protein microfibrils, or tiny strands.
Amyloid plaques: A characteristic of Alzheimer's disease in which clusters of dead or dying neurons become mixed together with fragments of protein molecules. Deficits in neurotransmitter acetylcholine. 40 to 50 percent twin concordance rate. |
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Alzheimer's treatment
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Treatments are aimed at (1) slowing progression of the disorder, and (2) managing the patient’s behavior and quality of life.
Medications: Slow breakdown of acetylcholine. Antioxidants target free radicals that may damage neurons. BEHAVIORAL MANAGEMENT Target both patient and caregiver to: -Increase patient independence. -Eliminate wandering and aggression. -Provide social support for caregivers. |
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Blood Supply
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Constant blood supply is absolutely critical to the healthy functioning of the brain
Loss of Blood Supply -Anoxia-hyperventilation, then compression; asphyiation with laughing gas, overcome by monoxide -Head injury -Stroke (cerebral vascular accident) Two major blood suppliers Vertebral (caudal or back) Internal Carotid (rostral or front) Interruptions to the blood supply: thrombosis or embolism: clot hemorrhage: bleeding aneurysms: vascular dilations tumors, head injury, anoxia, etc sclerosis |
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Stroke
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Infarcts and lesions
Factors associated with stroke severity Size of vessel Health of remaining vessels Pre-existing lesions Serial lesion effect Location of tissue damage |
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Tumors
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Def: growing mass of cells with no function
Malignant Benign Tumors are caused not by nerve cells caused by glia or metastestas from other parts of the body Metasteses come from cancer from other parts of the body: usually lung or breast, lung cancer often detected first by brain tumor. Damage can occur through compression and infiltration. |
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Head Injury
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Sources of damage
Direct damage to the brain Disruption of blood supply Hemorrhaging Swelling Infection Scarring Open Head Injuries Penetrating wound due to missile, object, or bone fragment Closed head injuries Coup-countercoup effects Axonal shearing and disconnection syndromes Bleeding leads to hemotoma (bruises) Edema Symptoms: Unconsciousness/coma Length of coma is a good indicator of prognosis Coup/countercoup damage effects General lesions Reduced mental speed Inability to concentrate Apathy, poor judgement, irritability, low frustration tolerance, inability to sustain activity. Head Injury "Syndromes": Frontal Lack of foresight and concern, irresponsible, loss of insight Temporal Irritable and hostile Post Concussive Headache, dizzy, fatigue, poor concentration, memory deficit, irritable, anxiety Posttraumatic Psychosis Depression, mania, hallucinations, delusions |
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Substance
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A chemical that alters a person's mood or behavior when it is smoked, injected, drunk, inhaled, snorted, or swallowed in pill form
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substance intoxication
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temporary behavioral or psychological changes due to substance accumulation
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tolerance
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after repeated use of a substance, state in which the individual would have to increase amount used to achieve the same effect
-happens in order to maintain homeostasis through compensatory mechanisms that oppose the effects of the drug i.e. morphine tolerance= increased pain sensitivity and increased respiration |
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substance withdrawal
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Set of physical and psychological disturbances experienced when substance is discontinued.
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substance abuse
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Maladaptive substance use that leads to significant impairment or distress.
evidence by (1) failure to meet obligations, (2) use of substances in physically hazardous situations, (3) legal problems, or (4) interpersonal problems |
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substance dependence
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-addiction
-manifested by cognitive, behavioral, and physiological symptoms during a 12-month period and caused by continued use of substance |
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Types of Tolerance
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Drug Processing: 1.) metabolism 2.) target tissue
Metabolic/Dispositional: dealing with the drug, metabolizing/ eliminating the drug, less drug makes it to the target tissue Functional/Behavioral: dealing with the drugs' effects, drug makes it to the target tissue, the organism learns to decrease the effect of the drug on its behavior. |
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How is tolerance learned
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Pavlovian Conditioning
i.e. sight of the needle (C.S)-> effects of drug (U.S), compensatory reaction opposing the drug effects (U.R) -later effects- sight of drug or associated stimuli (CS)--> compensatory conditioned reaction (C.R) |
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Situational Specificity of Tolerance
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examples of decreased tolerance in different room with morphine/alcohol in rats
-when situational cues (CS's) are absent, we see less of a tolerant response -i.e. the story of N.E's uncle- morphine tolerance in the same room- died when took morphine in another room -in novel settings, tolerance fails -70% of overdoses occur in unfamiliar settings |
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Conditioning of Tolerance
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-Each drug usage is a learning trial
-The “pre-drug” cues (CS’s) begin to elicit the CCR (tolerant response). -The CCR(tolerant response) attenuates the drug affect -Repetitions strengthen the association -the CCR gets bigger and bigger -The attenuation of the drug effect (in the presence of these “pre-drug cues”) becomes more pronounced. What happens when drug cues evoke a CCR, but: There’s no drug available? Drug is available? -Drug taking behavior moves from voluntary to involuntary. |
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personality disorders
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pervasive and inflexible patterns of emotional reactions and behaviors that interfere with an individual's functioning
-respond to problems in the same way -generally do not think they have a problem |
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Treatment Dilemmas of Personality Disorders
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-many people find their disorder ego syntonic- don't see their behavior as a problem
-these disorders are (by definition) chronic and inflexible -many people with a disorder are more interested in relieving symptoms than in changing their personality |
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DSM Axis II Personality Disorders
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Cluster A= Odd/Eccentric
i.e. paranoid, schizoid, schizotypical Cluster B= Dramatic i.e. antisocial, borderline, histrionic, narcissitic Cluster C= Anxious/Fearful i.e. avoidant, dependent, and obsessive-compulsive -Personality disorder not otherwise specified |
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Antisocial Personality Disorder
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characterized by a pervasive pattern of disregard for the rights of others
-also called psychopathy or sociopathy -sometimes hard to separate from substance abuse-often related Associated Behaviors: -deceitfulness, impulsivity, unlawfulness, recklessness, aggressiveness, manipulative(-characterisitc of psychopath- very bright like a serial killer), lacking remorse |
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Diagnostic Criteria of Antisocial PD
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-must be 18
-but similar patterns present in youth -3.5% of pop -75% of prison pop -male>female -caucasion> others |
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Treatment of Antisocial PD
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-about 25% will seek RX, but mandated
-lack of conscience and desire to change -few treatments have been effective -high level of skepticism -never give excess medication GOALS: -help them think through consequence of actions -use capacity to think ahead -boost client's self esteem Techniques: -confrontational: Refute the client’s fabrications, point out selfish and self-defeating behaviors. -group therapy- may be helpful because peers are not easily accepted by client. |
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Psychodynamic perspective on antisocial p.d
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absence of parental love
Low self-esteem leads to need to prove competence by aggression |
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Behavioral perspective on antisocial p.d.
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learned
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Biological perspective on antisocial pd
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-lower levels of trait anxiety and arousal which lead to behavior
-Originally the fearlessness hypothesis, the response modulation hypothesis holds that psychopaths are able to learn to avoid punishment when this is their main goal. However, if their attention is focused elsewhere, they do not pay attention to information that would let them avoid aversive consequences. -explains many of the core psychopathic traits- such as the inability to think about someone else's needs when one if focused on one's own personal interests, also lack of remorse when causing pain to victims -Lack of emotional reactivity -amygdala dysfunction |
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Cognitive perspective on antisocial pd
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cognitions that trivilaize outcomes to others
Unable to process information not relevant to their primary goals |
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Borderline Personality Disorder
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characterized by a pervasive pattern of unstable and intense relationships
symptoms: -intense interpersonal relationships -splitting- perceiving other people as being all good or all bad, and splitting their own personalities (normal, then psychotic) -feelings of emptiness- leads to cutting -anger, rage -identity confusion- shifting goals for themselves, also shifting plans + partners -poor boundaries with others- sometimes break boundaries w/ friendships/ relationships depending on how they are feeling -risky-taking, self-injurious behaviors -parasuicidal- threat of suicide but not intent on killing themselves- considered a gesture to get attention from family, a lover, or professionals |
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Treatment of Borderline p.d
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-very difficult as those w/ the disorder tend to push the limits
-termination is problematic -balance b/w care+ firmness -dialectical behavior therapy- very behaviorally focused, focus on the here and now -group session- helps w/ interpersonal skills, rules everyone has to follow -also individual treatment |
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Histrionic personality disorder
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characterized by excessive emotionality and an attention seeking behavior pattern
-very dramatic- even when happy or sad -about 2% of pop -men=women -What differentiates people with this disorder from those who show appropriate emotionality is their low emotional stability, shown in the fleeting nature of their emotional states and their use of excessive emotions to manipulate others rather than express their true feelings. -Histrionic people are determined to be the center of attention and will behave in whatever way necessary to ensure that this happens. -They seek attention and approval from others and become furious if they don’t get it. -Often seen as vain, self centered, and demanding |
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Narcissistic personality disorder
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characterized by a pervasive pattern of acting grandiose, having a constant need for admiration, and appearing to lack empathy for others
-1% of pop -men>women -1st born children- more common -treatment is difficult bc not motivated to change |
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Avoidant personality disorder
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-characterized by a pervasive pattern of shyness, social inhibition, and hypersensitivity to negative emotion
-found in 1-2% of population -Have few close friends, Similar to social phobia but social phobics fear social situations- Avoidant fear close social relationships. |
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dependent personality disorder
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characterized by a pervasive pattern of clinging behavior coupled with a fear of separation
-cannot make decisions on their own -psychodynamic- regressed or fixated at the oral stage of development bc of parental overindulgence or parental neglect -behaviorist- kids were rewarded for "loyal" behavior -different than other p.d bc motivated change- easier to treat |
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obsessive-compulsive personality disorder
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characterized by a preoccupation with orderliness, perfectionism,and control that often reduces a person's flexibility and efficiency-egosyntonic
-different from OCD b/c a person with OCPD sees this as who they are and nothing wrong it is- OCD recognizes it as a problem -also not as severe- slowly develops while OCD may just appear |
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Treatment of anxious/fearful disorders
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there is little or no controlled research on the treatment of these disorders
-usually do not come to therapy bc they are egosyntonic -social skills training and anxiety management tools may be effective |
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Cluster A- Odd/Eccentric
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characterized by a pervasive distrust and suspicion of other people and their motives
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Schizoid Personality Disorder
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characterized by a pervasive pattern of detachment from social relationships and an apparent lack of interest in such relationships
-prefer to be by themselves rather than with others -not likely to seek psychotherapy |
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Schizotypical personality disorder
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an oddness of thought, perception, and social interactions
-peculiar ideas may include magical thinking and beliefs in psychic phenomena -often suspicious of others people and thus difficult to establish close relationships -same biological anamalies as people with schizophrenia such as memory deficits, enlarged brain ventricles, and abnormalities of eye movements -subtle differences in thalamic area of the brain |
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paranoid personality disorder
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extremely suspicious of others and are always on guard against potential danger or harm
-characterized by: suspicuousness, guardedness, projection of negativity and damaging motives onto others, attribution of their problems to others (defense mechanism) |
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Treatment for paranoid p.d
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-counter erroneous thinking
-establish a trusting relationship -insight into other's perspectives -approach conflict assertively -improve interpersonal skills *rarely medication, almost always psychotherapy*- long term treatment needed -supportive therapy may be the most effective treatment |
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anorexia nervosa
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eating disorder characterized by an inability to maintain normal weight, an intense fear or gaining weight and distorted body perception
-core feature is distorted body image |
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bulimia nervosa
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eating disorder involving alternation between eating large amounts of food in a short time, then compensating by vomiting or other extreme actions to avoid weight gain.
-have accurate body image |
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Restricting type anorexia
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severely limits the amount of food consumed in order to lose weight
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binge-eating-purging
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type engages in binges (large amount of food consumed) following by purging (vomiting or use of laxatives)
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symptoms of anorexia
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-Refuse/unable to maintain 85 % of expected weight for frame, height.
-Intense fear of gaining weight, though underweight. -Distorted perception of weight or body shape. -Amenhorrhea- the absence of at least three consecutive menstrual cycles. |
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effects of anorexia
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as self-starvation continues, bodily signs of physical disturbance become more evident-i.e. yellowing of the skin, impaired organ func., death (1 in 10), also Throat problems
Hair loss Broken blood vessels Faintness Loss teeth, cavities |
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binges
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episdoes of eating large amounts of food
characterized by: 1. in a 2 hr period, eating an amount much greater than others would eat 2. feeling a lack of control over what or how much is being eaten. |
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compensating behaviors of bulimia
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-purging type: try to force out of their bodies what they've just eaten by
-vomiting -administering enemas -taking laxatives or diuretics non-purging type- try to compensate by fasting or overexercising |
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effects of bulimia nervosa
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-IPECAC syrup-if used regularly to induce vomiting, has toxic effects
-dental decay -enlarged salivary glands -skin calluses on hands that brush against teeth in the vomiting process -menstrual irregularity is common -laxatives, diuretics, and diet pills also have toxic effects over time -gastrointestinal damage may be permanent |
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evolutionary factors of eating disorders
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-dietary restriction hypothesis- hypothesis that dieting predisposes one to bulimia/anorexia
-radical dieting triggers famine survival mechanisms -these may be individuals who are "adapted to flee"- starving well and being on the move may have been adaptive, weight loss seems to precipitate the cycle be it dieting, depression, or illness |
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genetic factors of eating disorders
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anorexia- 58% heritability, highly co-morbid with major depression, homogenous- people behave in similar ways
bulimia- 23% of female mz twins concordant for bulimia, 9% of female dz twins concordant for bulimia |
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biological factors of eating disorders
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-associated with disturbances in hormonal and serotonin systems- starvation is likely to change NT availability, thus minimizing anxiety- thus starvation is negatively reinforced
-anorexics have high levels of serotonin, dopamine, and cholecystokinin which indicate satiety. -they also have low levels of appetite promoters like norepinephrine |
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cultural factors for eating disorders
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-societal pressure- almost 2/3 of playboy centerfold and Miss America contestants meet the weight criteria for anorexia
-Styles” of what is considered attractive change over the years and across cultures -bilateral symmetry -muscular development (in men) -an appropriate waist to hip ratio (in women) are universally attractive Family Environment: In sisters discordant for anorexia, the sister that developed the disorder had: a higher level of parental expectation and a greater likelihood of sexual abuse |
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Psychological Factors of eating disorders
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control is a major theme in the lives of people with eating disorders
low self-esteem and negative affect-> dieting to feel better about self->food intake is restricted too severely->diet is broken-> binge-> compensating behaviors (i.e. vomiting) to reduce fears of weight gain |
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Body Image (in eating disorders)
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Visual Component: How you “see” yourself when you look in the mirror
With poor body image, you might have a distorted, unrealistic perception of your shape. You might perceive parts of your body as larger or smaller than they actually are Mental Component: What you believe and think about your appearance. With poor body image, you might believe yourself to be ugly or unattractive because you are convinced that only certain types of features are attractive. Or you believe that what you like is irrelevant, and all that matters are the characteristics of which others approve. Emotional Component: How you feel about your body, including your height, weight, and shape. With poor body image, the combination of your distorted perceptions and your self-rejecting ideals leads you to feel ashamed, self-conscious, and anxious about your body. Kinesthetic Component: How you feel in your body, not just about your body. With poor body image, you might not feel comfortable in your body. You do not express yourself with and through your body, for example in sports or dance. |
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Barriers to treatment of Eating Disorders
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- overall low incidence
-lack of consensus on best treatment -considerable variability in age of onset -high cost -complex interaction of medical/psychological issues |
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biological treatment of eating disorders
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medical stabilization
-to avoid life threatening medical problems, the weight loss i addressed via and intense feeding program medications -amisulpride facilitates weight gain, as do SSRIs -fluoxetine (prozac) reduces bingeing and purging- help control relapse, maintain weight gains, and reduce other symptoms. Regardless of the potential usefulness of medications, though, psychotherapy is clearly needed. |
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some conclusions on anorexia
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1. can be roughly divided into:
-acute (generally adolescent) -chronic (generally adult) 2. recovery rates -50% recover -30% have residual symptoms -20% become chronic 3. a.n is better treated closer to onset 4. role of treatment is unclear 5. there is some evidence for a family approach for adolescents |
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psychological treatments of anorexia
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Cognitive/behavioral: Establish good eating patterns; self-monitoring techniques; learn self-control, problem-solving, cognitive-restructuring.
Interpersonal therapy: Therapy focuses on helping the client cope with stress in interpersonal situations and with feelings of low self-esteem. Family therapy: A review of research indicates that involvement of the parents and the teen is sufficient to bring about positive change. -behavior therapy, c.b.t, and interpersonal therapy were all effective in reducing bingeing in people: -IBT- best in long run- deals w/ underlying psychological problem |
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Should Abstinence Be the Goal for Treating People with Alcohol Problems?
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Yes: most direct approach, 1/2 of indiv. able to achieve abstinence, experts cannot precisely determine what kinds of people are capable of moderating their alcohol use
no: pressuring people to abstain ignores the fact that drinking problems exist on a continuum, from mild to life threatening, studies show people offered controlled drinking approaches fare better than those offered abstinence approaches, people achieve success in controlling their drinking w/ professional guidance and safeguards to monitor their progress, characeristics of people who succeed with moderate drinking-i.e. being psychologically stable, well-educated, steadily employed |
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Should Individuals with Anorexia Nervosa Have the right to refuse treatment?
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yes: competent to refuse therapy- it was thus be unlawful to force them to undergo therapy that they choose to refuse, professionals should respect an indiv. autonomy, force-feeding may actually make the underlying condition worse, patients better off when the clinican agrees to work within their frame of reference
No: individuals w/ a.n can be considered to be a thought disturbance, not competent to make decisions regarding treatment, increases the risk of serious health deterioration |
