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72 Cards in this Set
- Front
- Back
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4 Stages of Sleep |
NON-Rem : Stage 1, Stage 2, Stage 3 REM: high frequency, brain waves, paralysis of large muscles |
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Insomnia Disorder |
Difficulty initiating or maintaining sleep or early-morning awakening with inability to return to sleep - At least 3 nights per week, @ 3 months - sig distress of daytime functioning |
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Prevalence and Age of Insomnia |
~25% of 1-3 year olds ~10% of 4-5 year olds |
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Treatment for Insomnia |
Behavioral: graduate extinction, planned ignoring - DRUGS NOT APPROVED FOR KIDS - CBT may help adolescents |
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Narcolepsy |
Recurrent periods of irrepressible need to sleep, lapses into sleep, or naps occuring within the same day (also in animals) One or more of: cataplexy, hypocretin deficiency, rapid entry into REM |
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Prevalence of Narcolepsy |
under 1% |
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Treatment for Narcolepsy |
Structure Support Psychostimulants - Provigil SSRIs |
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Circadian Rhythm Sleep-Wake Disorder |
Sleep disruption leading to excessive sleepiness/insomnia - misalignment between sleepiness and environment/schedule - clinically significant distress or impairment |
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Is REM the deepest stage of sleep? |
No. It's close to the waking stage |
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Does REM time increase or decrease with how long you sleep? |
increase |
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What are the subtypes of circadian rhythm sleep-wake disorder? |
Delayed Sleep Phase type (night owl) Advanced Sleep Phase Type (early bird) Irregular Sleep-Wake Type (serial napper) Non-24 Hour Sleep-Wake Type (sleep drifts day to day) Shift work type |
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Treatment for circadian rhythem sleep-wake disorder |
Light Therapy Chronotherapy |
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Nightmare Disorder |
Repeated awakenings with recall of dysphoric dreams - dreams often involve efforts to avoid threats to survival, security, or physical integrity - rapid alertness after waking from these dreams - clinically signficant distress Mild physiological arousal Body movement and vocalizatiosn not typical Occurs in REM, usually 2nd half of the night |
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Prevalence and Course of Nightmare Disorder |
2-11% of preschoolers have nightmares "often" - peark prevalence in late adolescenece/early adulthood |
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Treatment for Nightmare Disorder |
Nightmare imagery rehearsal therapy Reduce stress Parental soothing |
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Non-Rapid Eye Movement Sleep Arousal Disorders |
Mixing elements of wakefulness and NREM sleep Recurrent episodes of incomplete awakening from sleep, usually occuring during the first third of the major sleep episodes - unresponsive to comm efforts and comfort - little dream imagery, often amnesia for the episode - clinically sig distress or impairment |
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Sleepwalking |
rising from bed during sleep and walking blank, staring face Prevalence and Course: 1-5% Mostly between 4-8 years More common in female children |
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Sleep terrors |
abrupt terror arousals from sleep beginning with a panicky scream; intense fear, autonomic arousal Prevalence and Course: - estimated ~3% ages 18 months-6 years - more common in males - diminishes with age |
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Treatment for NREM Sleep Arousal Disorder |
- Take safety precautions - Reduce stress and fatigue - Add late afternoon nap - Scheduled awakening |
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Enuresis |
Involuntary discharge of urine Clinically Significant Over 5 years of age Subtypes: Nocturnal only Diurnal only Nocturnal and diurnal |
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Enuresis Prevalence |
5-10% of 5 years old 3-5% of 10 year olds 1% >15 Nocturnal enuresis more common in boys Diurnal enuresis more common in girls - declines rapidly with age |
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Effects of Enuresis |
1. Limitations imposed on social activities - Sleeping away from home, preschool 2. Effects on self-esteem - Social ostracism from peers 3. Parental reactions - Punishment, Anger, Rejection |
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Causes of Enuresis |
- Antidiuretic hormone (ADH) Deficiency - Genetics: - both parents: 77% - MZ twins: 68% - Problems with arousal from sleep - Hostile-Coercive parenting - Pull-ups/Fluid Restriction |
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Enuresis Behavioral Treatments |
Full-spectrum home training: - education and behavior contract - urine alarm - retention control training - Overlearning |
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Enuresis Medical Treatment |
Desmopressin Tricyclics - rarely used due to side effects |
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Encopresis |
Repeated passage of feces into inappropriate places - clothing or floor - involuntary or intentionally - must be at least 4 years old |
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Subtypes of Encopresis |
With or without constipation and overflow incontinence |
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Prevalence of Encopresis |
3% of school-aged children 4-6 x more common in boys |
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Course of Encopresis |
- decreases rapidly with age - may feel ashamed and try to avoid situations -more likely to occur during the day than enuresis - when copresis is intentional, usually comorbid with ODD or CD |
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Causes of encopresis |
megacolon defecation dynamics inadequate, inconsistent toliet training psychological stress |
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Treatment for Encopresis |
Fiber, enemas, laxatives or lubricants, diet change Behavioral methods: - scheduled toliet sitting -cleanliness training |
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Rumination Disorder |
- repeated regurgitation of food @ 1 month - repeated regurgitation is not bc of other reasons - doesn't occur only during eating disorders - if symptoms occur in the context of another mental disorder they are sufficiently severe to warrant additional clinical attention |
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Causes of Rumination Disorder |
- Physical illness or severe stress - Neglect - To gain attention Positive Reinforcement (attention) Negative Reinforcement (avoid tasks) Automatic Reinforcement (Self- stimulation) |
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Prevalence of Rumination Disorder |
Most often occurs in infants and very young children (b/n 3 and 12 months) - in children with severe or profound intellectual disability - 5x mroe common in males - it is rare in older children and adolescents |
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Possible Complications of Rumination |
Malnutrition lowered resistance to infections and diseases stomach diseases (ulcers) dehydration bad breath and tooth decay aspiration pneumonia and other respiratory problems (vomit breathed into lungs) choking and death |
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Pica |
Persistent eating of nonnutritive substance @1m -The eating of NN, Nonfood substances is inappropriate to the developmental level - Eating behavior is not part of a cultural practice - if the eating behavior occurs in the context of another disorder or pregnancy, it is sufficiently severe enough to warrant additional attention |
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Things Pica Eat |
sand, dirt, clay, hair, gravel, stones, leaves, grass, plant stems, feces, paint, plaster, string, cloth, coffee grounds, paper, insects, metal, needles, glass, plastic items |
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Complications of Pica |
malnutrition intestinal obstruction intestinal infections or parasites from soil anemia mercury poisoning liver and kidney damage constipation and abdominal problems |
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causes of pica |
stimulation (severe ID) iron, zinc, or mineral deficiency some substances are intrinsically reinforcing (cigarette butts) |
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treatment for Pica |
caregiver reinforcing appropriate behavior encouraging positive attention and interaction with child vitamin supplements |
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Avoidant/Restrictive Food Intake Disorder DSM-5 Criteria |
Eating/feeding disturbance as manifested by persistent failure to meet appr nutrition: weight loss, nutri deficiency, dependence on enteral feeding, markered interference with psysoc func -not bc of lack of food or cultural practice - doesn't occur during anorexia or mia - NOT attributable to concerruent med condition or explaiend by another mental disorder, severe |
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Avoidant/Restrictive Food Intake Disorder |
Lack of interest + Sensory Food Aversion |
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lack of interest in A/R Food Intake Disorder |
HIgh physiological arousal, activity, need for stimulation - less sensitive to hunger signals -parents anxious about child's eating and growth and over-regulate eating Treatment: teach child to recognize hunger and satiety signals |
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Sensory Food Aversion A/R Food ID |
-trouble transitioing from breast to bottle and pureed to texture baby foods - unusually sensitive to certain tastes, esp bitterness, spiciness and fattiness - classical condition (pair food + neg reaction) - maintained thru operant conditioning (neg ref) - generalization Treatment: break the cycle |
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Continuum of Eating Pathology |
Around age 9 girl begin to have weight and appearance concerns Drive for thinness - the individual believes that losing more weight is the answer to overcoming troubles and to ahcieving success |
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Anorexia Nervosa |
Restriction of energy intake relative to requirement, sig low body weight Intense fear of gaining weight/ fat Disturbance in the way in which one's body weight is experienced |
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Restricting Type |
during the last 3 months, has not engaged in recurrent episodes of binge eating or purging behavior. describes presentations in which weight loss is accomplished primarily through dieting, fasting and/or excessive exercise |
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Binge-eating/purging type |
during the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (self induced vomiting/misuse of laxative, diuretics or enemas) |
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Danger Signs of Anorexia Nervosa |
weight loss in short period of time, dissatisfication w/ looks, diet altho bones, diet in isolation, loss of periods, strange eating rituals, obsessive exercising, socially withdrawn, impaired concentration, lasting depressions, irritability, binging/purging, severe and selective restriction of food intake, maintained low body weight, think eating habits are fine |
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Prevalence of anorexia nervosa |
among adolescents: 0.4% disporportionately females: 10:1 |
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Development of Anorexia Nervosa |
onset b/n 16-19 years old - especially common during life transitions -often preceeded by dieting |
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Course of Anorexia Nervosa |
rate of mortality: 5% 50% recover, 30% improve but still meet criteria, 10-20% have chronic symptoms early treatment is associated with best outcomes |
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Bulimia Nervosa |
Recurrent binge eating: eating LOTS of food, little time and a sense of lack of control of eating Recurrent inappr compensatory behaviors in order to prevent weight gain The binge + behaviors both occur 1 wk/3months Self-eval is influenced by body shape/weigth Does not occur only during anorexia |
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Signs of Bulimia nervosa |
Regular bingeing (uncontrolled, secret eating) Regular purging Mood swings Weight not changing despite frequent exercise or consumption of large amounts of food Use of bathroom for long periods of time after meals |
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Prevalence of Bulimia Nervosa |
1.5%-4% lifetime prevalence for females Disproportionately female May be underreported in males (exercise) |
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Development of Bulimia Nervosa |
Onset usually late adolescence and young adulthood - slightly later than AN (18-20) Usually starts in same way as AN Subsequent Course: 50-70% fully recover |
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Biological Causes of Anorexia and Bulimia Nervosa |
Genetics: 4-5 times more likely if the individual has a relative with AN or BN - if twin has BN< 59-83% chance of developing - inherited personality traits Neurobiological: - serotonin imbalance |
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Causes of AN & BN |
Family weight history Contribution of authoritarian or chaotic parenting Negative self-evaluation Social: - belief that appearance is key to happiness, self-worth, femininity, success - cultural ideals |
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Personality traits of AN |
over-achievers, conscientious, over-controlled, rigid with obsessive tendencies, black or white thinking |
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Personality traits of BN |
impulsive emotion regulation problems |
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Associated Characteristics of AN & BN |
Sometimes individuals can cross b/n subtypes and between AN and BN High comorbidity with depression, anxiety disorders, OCD, Substance Use Disorders |
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Treatment for AN |
help patient realize the need for help Weight Restoration - 30-50% relapse within one year - outpatient therapy helps Family Therapy and CBT |
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Treatment for BN |
CT - reduce anxiety over eating, prevent compensatory behavior, create relapse plan Interpersonal therapy - BN as a medical illness, work through grief, role transitions, role disputes, interpersonal deficits Combine with antidepressants |
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AN vs BN and control |
AN - resisting tempt to eat provides sense of control - dieting often reinforced -treatment may represent a loss of control and reduction in self-worth BN - complete feeling of being out-of-control often leads to treatment |
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Binge-Eating Disorder DSM-5 Criteria |
Episodes are associated with 3 or more: eating more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone bc of feeling embarrased by amount, feeling disgust C. marked distress when bingeing and D. @ 1 week/3 months E. not associated to AN/BN only |
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Prevalence of Binge-Eating |
1-1.5% among children and adolescents Onset b/n adolescence and young adulthood - may be realted to depression and anxiety, eating to avoid dysphoria -unlike adults w/ do, kids with BED typically begin bingeing before dieting |
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Recovery Rate for BED |
67-85% have recovered in 5 years better rate than AN or bN |
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BED is often associated with ______ |
Obesity |
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comorbidites of BED |
•bipolardisorders, depressive disorders, anxiety disorders, substance use disorders AssociatedProblems: obesity, diabetes, hypertension, cardiac problems, asthma, insomnia,early menarche |
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Causes of BED |
- associated with less fullness following food intake - those with BED have more distress/perceived lack of control regarding binges than those w/o -BED heritability is ~0.57 - assoc w/ low ghrelin suppresion after a meal |
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Gherlin |
peptide that stimulates hunger and promotes food ingestion |
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Treatment for BED |
Cogntive-Behavioral Interventions - break the pattern, monitor eating habits, avoid binge-triggers, alt stress management techniques Interpersonal Therapy Prozac (less effective than CBT) -may help w/ depression and obsession w/ weigh. |
