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48 Cards in this Set

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Anaclitic depression
Depression in an infant attributable to continued separation from a caregiver.

Can result in failure to thrive.

Infant becomes withdrawn and unresponsive
Oppositional defiant disorder
child is noncompliant in absence of criminality
Separation anxiety disorder
fear of loss of attachment figure, leading to factitious physical complaints to avoid going to school.

common onset 7-8 years of age.
Rett's disorder
X-linked disorder seen only in girls (affected males die in utero), characterized by loss of development and mental retardation appearing at age 4.

Stereotyped hand-wringing
Childhood disintegrative disorder
marked regression in multiple areas of functioning after at least 2 years of apparently normal development.

Significant loss of expressive or receptive language, social skills, or adaptive behavior, bowel or bladder control, play or motor skills.

Onset age 2-10 years old.
Long-term deprivation of affection
1. Poor muscle tone
2. Poor language skills
3. Poor socialization skills
4. Lack of basic trust
5. Anaclitic depression
6. Weight loss
7. Physical illness

4 W's - weak, wordless, wanting, wary
irreversible after 6 months, can result in infant death
Neurotransmitter change with anxiety
Inc NE
Dec GABA
Dec serotonin
Neurotransmitter change with Depression
Dec NE
Dec 5-HT
Neurotransmitter change with Alzheimer's dementia
Dec ACh
Neurotransmitter change with Huntington's disease
Dec GABA
Dec ACh
Neurotransmitter change with Schizophrenia
Dec dopamine
Neurotransmitter change with Parkinson's disease
Dec dopamine
Inc ACh
Anosognosia
lack of awareness that one is ill
Autotopagnosia
inability to locate one's own body parts
Depersonalization
body seems unreal or dissociated
Dissociative fugue
Abrupt change in geographic location with inability to recall past, confusion about personal identity or assumption of a new identity. Leads to distress or impairment
Sleep patterns of depressed patients
Dec slow-wave sleep
Dec REM latency
Inc REM early in sleep cycle
Inc total REM sleep
Repeated nighttime awakenings
Early-morning awakenings
Risk factors for suicide completion
Male
Age - teenage or elderly
Depression
Previous attempt
Ethanol or drug use
Loss of rational thinking
Sickness
Organized plan
No spouse
Social support lacking

SAD PERSONS
Adjustment disorder
Emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (divorce, moving) and lasting less than 6 months

If > 6 months - generalized anxiety disorder w/ no relation to event
Post-traumatic Stress Disorder
Persistant reexperiencing of a previous traumatic event as nightmares and flashbacks.
Response involves intense fear, helpless, horror, leading to avoidance of stimuli and persistently elevated arousal.

Disturbances last > 1 month anc causes distress or social/occupational impairment.

Often follows acute stress disorder, which lasts 2-4 weeks.
Factitious disorder
Consciously creates symptoms in order to assume "sick role" and to get medical attention (primary gain)

Munchausen's syndrome - chronic history of multiple hospital admissions and willingness to receive invasive procedures

Munchausen's syndrome by proxy - seen when illness in a child is caused by the parent- child abuse
Pseudocyesis
False belief of being pregnant associated with objective physical signs of pregnancy
Personality disorder
When the patterns of perceiving, relating to and thinking about the world become maladaptive.
Causing impairment in social or occupational functioing or subjective distress.
Person not aware of problem.
Disorderd patterns stable by early adulthood, not diagnosed in children
Cluster A personality disorders
Odd or eccentric, cannot develop meaningful social relationships.
No psychosis; genetic assoc w/ schizophrenia

Types:
1. Paranoid - distrust and suspiciousness; projection main defense mechanism.

2. Schizoid - voluntary social withdrawl, limited emotional expression, content w/ social isolation, unlike avoidant

3. Schizotypal - interpersonal awkwardness, odd beliefs or magical thinking, eccentric apperance
Cluster B personality disorders
Dramatic, emotional, or erratic.
Genetic association w/ mood disorders and substance abuse.

Types:
1. Antisocial - disregard for violation of righst of others, criminality; males > females; conduct disorder if < 18 years

2. Borderline - unstable mood and interpersonal relationships, impulsivenss, sense of emptiness; females> males; splitting a major defense mechanism.

3. Histrionic - excessive emotionality, attention seeking, sexually provocative, overly concerned with appearance

4. Narcissistic - grandiosity, sense of entitlement; may react to criticism with rage; may demand top physician, best health care
Cluster C personality disorders
Anxious or fearful
Genetic association with anxiety disorders.

Types -
1. Avoidant - sensitive to rejection, socially inhibited, timid, feelings of inadequacy

2. Obsessive-compulsive - preoccupation with order, perfectionism and control

3. Dependent - submissive and clinging, excessive need to be taken care of, low self-confidence

Worried.
Alcohol
Intoxication

Disinhibition, emotional lability, slurred speech, ataxia, coma, blackouts.

Serum g-glutamyltransferase GGT - sensitive indicator of alcohol use
Withdrawl

Tremor, tachycardia, hypertension, malaise, nausea, seizures, delirium tremens, tremulousness, agitation, hallucinations
Opioids
Intoxication

CNS depression, nausea, vomiting, constipation, pupillary constriction (pinpoint pupils), seizures (overdose is life threatening)
Withdrawl

Anxiety, insomnia, anorexia, sweating, dilated pupils, piloerection, fever, rhinorrhea, nausea, stomach cramps, diarrhea, flulike symptoms, yawning
Amphetamines
Intoxication

Psychomotor agitation, impaired judgement, pupillary dilation, HTN, tachycardia, euphoria, prolonged wakefullness and attention, cardiac arrhythmias, delusions, hallucinations, fever
Withdrawl

Post-use "crash" including depression, lethargy, HA, stomach cramps, hunger, hypersomnolence
Cocaine
Intoxication

Euphoria, psychomotor agitation, impaired judgment, tachycardia, pupillary dilation, HTN, hallucinations, including tactile, paranoid ideations, angina, sudden cardiac death
Withdrawl

Post-use "crash" including severe depression and suicidality, hypersomnolence, fatigue, malaise, sever psychological craving
PCP
Intoxication

Belligerence, impuslivenss, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia, homicidality, psychosis, delirium
Withdrawl

Recurrence of intoxication symptoms due to reabsorption in GI tract, sudden onset of severe, random, homicidal violence
LSD
Intoxication

Marked anxiety or depression, delusions, visual hallucinations, flashbacks, pupillary dilation
Withdrawl
Marijuana
Intoxication

Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawl, inc appetite, dry mouth , hallucinations
Withdrawl

Can be detected in urine up to 1 month after last use
Barbituates
Intoxication

Low safety margin, respiratory depression
Withdrawl

Anxiety, seizures, delirium, life-threatening cardiovascular collapse
Benzodiazepines
Intoxication

Greater safety marjing,

Amnesia, ataxia, somnolence, minor respiratory depression.

Additive effects w/ alcohol
Withdrawl

Rebound anxiety, seizures, tremor, insomnia
Caffeine
Intoxication

Restlessness, insomnia, inc diuresis, muscle twitching, cardiac arrhythmias
Withdrawl

Headache, lethargy, depression, weight gain
Nicotine
Intoxication

Restlessness, insomnia, anxiety, arrhythmias
Withdrawl

Irritability, HA, anxiety, weight gain, craving
Heroin addiction
At risk for hepatitis, abscesses, overdose, hemorrhoids, AIDS, right-sided endocarditis

Naloxone and naltrexone competitively inhibit opiods and are used in cases of overdose

Methadone - long-acting oral opiate is used for heroin detoxification or long-term maintenance
Dissociation
Termporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress.

Extreme forms can result in multiple personalities - dissociative identity disorder.
Displacement
Process whereby avoided ideas and feelings are transferred to some neutral person or object

e.g. mother yells at child because she is angry at her husband
Identification
Modeling behavior after another person who is more powerful, though not necessarily more admired.

Abused child becomes an abuser
Isolation
Separation of feelings from ideas and evens.

Describing a murder in graphic detail w/ no emotional response
Projection
An unacceptable internal impulse is attributed to an external source.

A man who wants another woman thinks his wife is cheating on him.
Reaction formation
Process whereby a warded-off idea or feeling is replaced by an unconsciously derived emphasis on it's opposite.

A patient w/ libidinous thoughts enters a monastery.
Splitting
Belief that people are either all good or all bad.

A patient says that all nurses are cold and insensitive but that the doctors are warm and friendly.
Altruism
Guilty feelings alleviated by unsolicited generosity toward others.

Mafia boss makes a large donation to charity.

Mature ego defense.
Sublimation
Process whereby one replaces an unacceptable wish with a course of action that is similar to the wish but does not conflict with ones' value system.

Aggressive impulses used to succeed in business ventures.

Mature ego defense.
Suppression
Voluntary (unlike repression) whiholding of an idea or feeling from conscious awareness.

Mature ego defense.