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264 Cards in this Set
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What is the DSM-IV-TR? |
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) Version IV and Text Revision (TR). Published in 2000
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What is the categorical approach to diagnosis of mental disorders?
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It is an approach that divides the mental disorders into types that are defined by a set of a diagnostic criteria and involves determining whether or not the person meets the criteria for a given diagnosis.
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What is the dimensional approach to diagnosis of mental disorders?
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This approach conceptualizes behavior in terms of a continuum that ranges from normal/healthy to pathological and involves rating a person on each symptom or other characteristic (e.g., on a scale 1 to 10)
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What approach to diagnosis is used in the DSM-IV-TR?
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the categorical approach
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How does the DSM-IV-TR take into account potential heterogeneity within categories of diagnoses?
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The DSM-IV-TR includes a polythetic criteria set.
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What is a polythetic criteria set for mental disorders?
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This set requires an individual to present with only a subset of characteristics from a larger list. Thus, two people can have somewhat different symptoms but receive the same diagnosis.
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The DSM-IV-TR uses a multiaxial diagnostic system so that a persons condition is described in (1)__________ that promote the application of the (2)__________ model in clinical, educational, and research settings.
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1. 5 dimensions or axes
2. biopsychosocial model |
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What is the GAF?
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GAF stands for Global Assessment of Functioning Scale and is used to rank the individual's psychological, social, and occupational functioning. Ranges from 0 to 100.
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What do you included on the DSM-IV-TR Diagnostic Axis I?
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Clinical Disorders and Other Conditions That May Be a Focus of Clinical Attention (V codes)
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What do you included on the DSM-IV-TR Diagnostic Axis II?
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Personality Disorders and Mental Retardation
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What do you included on the DSM-IV-TR Diagnostic Axis III?
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General Medical Conditions
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What do you included on the DSM-IV-TR Diagnostic Axis IV?
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Psychosocial and Environmental Problems
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What do you included on the DSM-IV-TR Diagnostic Axis V?
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Global Assessment of Functioning
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Why are Personality Disorders and Mental Retardation included on Axis II instead of Axis I?
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To ensure that consideration will be given to the possible presence of Personality Disorders and Mental Retardation, NOT because pathogenis or range of appropriate treatment is fundamentally different than Axis I
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Diagnostic uncertainity is indicated by one of the following:
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1. Diagnosis Deferred
2. Specific Diagnosis (Provisional) 3. [Class of Disorder] Not Otherwise Specified (NOS) |
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Why would a clinician include the code "Diagnosis Deferred" on Axis I or Axis II?
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The clinician does not have sufficient information needed to make a diagnosis.
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Why would a clinician include the code "Specific Diagnosis (Provisional)" on Axis I or Axis II?
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The clinician has enough information to make a tentative diagnosis, but not enough information to make a firm diagnoses.
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Why would a clinician include the code " [Class of Disorder] Not Otherwise Specified (NOS)" on Axis I or Axis II?
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The clinician has adequate information to know disorders belongs to a particular category but insufficient information to make a more specific diagnosis OR the features do not meet criteria for a specific disorder
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Name the diagnostic criteria for Mental Retardation.
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1. significantly subaverage intellectual functioning (an IQ score of approximately 70 or below)
2. Concurrent deficits or impairments in adaptive functioning in at least two areas (i.e., ineffecitve meeting the standards expected for the person's age or cultural group in terms of communication, self-care, social skills, self-direction, functional academic skills, work, safety, etc.) 3. Onset prior to 18 |
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What are the degrees of severity of Mental Retardation?
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1. Mild Mental Retardation (IQ 50-55 to 70)
2. Moderate Mental Retardation (IQ 35-40 to 50-55) 3. Severe Mental Retardation (IQ 20-25 to 35-30) 4. Profound Mental Retardation (IQ below 20-25) |
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What are the early signs of Mental Retardation?
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1. delays in motor development
2. lack of age appropriate interest in environmental stimuli a. Lack of eye contact during feeding b. Less responsive to voice and movement than would be expected |
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What is the prognosis associated with Mental Retardation?
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It does not have to be a life long condition. With proper intervention, a person may no longer meet criteria or may meet criteria for a less sever form of MR.
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What percentage of Mental Retardation cases have a heredity cause?
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approximately 5%
(tay-sachs, fragile X syndrome, PKU) |
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What percentage of MR cases are due to early alterations of embryonic development?
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approximately 30%
(Down Syndrome, damage due to toxins) |
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What percentage of MR cases are due to pregnancy and perinatal problems?
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approximately 10%
(fetal malnutrition, anoxia, HIV) |
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What percentage of MR cases are due to general medical conditions during infancy or childhood?
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approximately 5%
(lead poisoning, encephalitis, malnutrition) |
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What percentage of MR cases are due to environmental factors and other mental disorders?
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approximately 15 to 20%
(deprivation of nurturance or stimulation, Autistic Dx) |
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What percentage of MR cases are due to unknown causes?
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approximately 30 to 40%
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What are potential causes for Mental Retardation?
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1. heredity (5%)
2. early alterations of embryonic development (30%) 3. pregnancy and perinatal problems (10%) 4. general medical conditions during infancy or childhood (5%) 5. environmental factors and other mental disorders (15-20%) 6. unknown (30-40%) |
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What is PKU?
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It is a recessive gene syndrome that involves an inability to metabolize the amino acid phenylalanine which is found in high protein foods. If phenylalanine builds up in the brain tissue, it affects mental skills and the central nervous system.
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How does one detect PKU?
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via a blood test at birth
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What are early signs of PKU?
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1. A musty odor to the skin, hair, and urine.
2. Vomiting and diarrhea, leading to weight loss. 3. Irritability. 4. Skin problems, such as dry skin, or itchy skin rashes (eczema). 5. Sensitivity to light (photosensitivity). |
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How does one prevent the symptoms of PKU?
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via a low phenylalanine diet
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What are the symptoms of PKU?
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Symptoms can become severe by about 8 weeks of age and may include:
1. Unusual behavior, such as screaming episodes, repetitive rocking, head banging, and arm biting (common in older children). 2. Loss of skills and abilities related to severe intellectual disability. 3. Growth and developmental delays. 4. Seizures. |
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What causes Down Syndrome?
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It is due to the presence of an extra chromosome and is estimated to be the cause of about 10 to 30% of all cases of moderate to severe retardation.
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What are the physical characteristics associated with Down Syndrome?
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1. short, crooked fifth finger
2. slanted almond-shaped syses with epicanthal folds 3. large protuding tongue |
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What are some physical problems associated with Down Syndrome?
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1. heart lesions
2. respiratory deficits 3. intestinal defects 4. cataracts |
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People with Down Syndrome tend to age (1)_______ than other people, their life expectancy is (2)________, and they are at (3)______ for Alzheimer's Disease.
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1. more rapidly
2. below normal 3. higher risk |
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When is Borderline Intellectual Functioning the appropriate diagnosis?
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For those with IQs in the 71 to 84 range , but the deficit is not as severe as mental retardation (70 or below).
Persons who fall into this categorization have a relatively normal expression of affect for their age, though their ability to think abstractly is rather limited. Reasoning displays a preference for concrete thinking. Others may describe such a person as "simple" or "a little slow". They are usually able to function day to day without assistance, including holding down a simple job and the basic responsibilities of maintaining a dwelling |
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When is a diagnosis of Mental Retardation appropriate for persons with IQs between 71 to 75?
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If s/he has substantial deficits in adaptive functioning.
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When would you diagnose someone with a Learning Disorder?
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When a person's achievement on a standardized test in reading, mathematics or written expression is SUBSTANTIALLY BELOW that expected by his/her age, schooling, and level of intelligence AND the discrepancy cannot be explained by a sensory deficity
(substantially below=2 or more standard deviations between achievement and IQ scores) |
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What are the associated features of Learning Disorders?
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1. typically IQ is in the average to above average range
2. higher than normal rates of other problems/disorders (including language development, motor coordination, attention and memory deficits, and low self-esteem 3. Most frequent comorbid disorder = ADHD (20-30%) 4. higher risk for antisocial behavior and for arrest and conviction for antisocial behavior |
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What is the prognosis for those who struggle with Learning Disorders?
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1. People with reading and other LDs continue to have learning difficulties through adolescence and adulthoods, especially if severe
2. 1/3 of children with reading disorders have psychosocial problems as adults |
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What most likely causes Learning Disorders?
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1. cerebellar-vestibular dysfunction (due to otitis media)
2. incomplete dominance and other hemisphere abnormalities 3. exposure to toxins (lead) 4. deficit in phonological processing (for Reading Disorders) |
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Do more men or more women having Reading Disorders?
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Men
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How is Stuttering classified in the DSM-IV-TR?
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as a communication disorder
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What is Stuttering?
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It is characterized by a disturbance in normal fluency and time patterning of speech that is inappropriate for the individual's age
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When does stuttering typically begin?
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between the ages of 2 and 7
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Men are how many times more likely to struggle with stuttering than women
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3 times more likely
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In about 60% of cases, stuttering remits spontaneously. It does so by what age?
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usually by age of 16
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What treatments have been successfully in helping people who stutter?
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1. reduction of psychological stress at home
2. regulated breathing 3. habit reversal, which combines regulated breathing, awareness training, and social support |
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What do regulated breathing treatments for stuttering consist of?
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1. involves reassuring the individual that s/he can speak without stuttering
2. incorporates breathing and vocalization exercises and graded speech assignments |
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Pervasive Development Disorders include at least one of two symptoms. These two symptoms are:
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1. severe and pervasive impairments in communication and social interaction
2. presence of stereotyped behaviors and activities |
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What are the three categories of symptoms associated with Autistic Disorder?
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1. Qualitative impairment in social interactions
2. Qualitative impairment in communication 3. Restricted, repetitive, and stereotyped behavior, interests, and activities |
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To diagnosis Autistic Disorder, what requirements need to be meet?
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Such a diagnosis requires:
1. the presence of at least 6 characteristic symptoms 2. a minimum of 2 symptoms associated with qualitative impairment in social interactions and 1 symptom associated with qualitative impairment in communication and restricted, repetitive, and stereotyped behavior, interests, and activities |
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What qualitative impairments in social interactions are associated with Autistic Disorder?
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1. marked impairment in nonverbal behavior, including eye to eye gaze, facial expressions, body posture, and gestures
2. absence of developmentally appropriate peer relationships 3. lack of social or emotional reciprocity |
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What qualitative impairments in communication are associated with Autistic Disorder?
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1. delay (or total lack) of development of spoken language (when not accompanied by attempt to compensate via gestures)
2. marked impairment in ability to initiate or sustain conversations (if they have adequate speech) 3. stereotyped and repetitive use of language or idiosyncratic language (e.g., echolalia and pronoun reversal) |
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What restricted, repetitive, and stereotyped behavior, interests, and activities are associated with Autistic Disorder?
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1. preoccupation with one or more stereotyped and restricted patterns of interest
2. Inflexible adherence to nonfunctional routines or rituals 3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, complex body movements) 4. persistent preoccupation with PARTS of objects |
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Delays or abnormal functioning in at least one of the following areas--social interaction, language used in social communication, and symbolic or imaginative play--are necessary to what age in order to diagnosis Autistic Disorder?
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age 3
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What other disorders by explain delays in social interaction, language used in social communication, and symbolic or imaginative play besides Autistic Disorder?
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1. Rett's Disorder
2. Childhood Disintegrative Disorder |
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What are early signs of Autistic Disorder?
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1. lack of normal responsiveness to caregivers
a. often refuse to cuddle when held b. do not smile c. seem to "look through" people d. do not respond to parents' voices 2. no babbling or pointing by age 1 3. no single words by 16 mos or 2-word phrases by age 2 4. no response to name 5. excessive lining up of toys and objects |
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Sometimes the early signs of Autistic Disorder are misinterpreted as:
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hearing problem
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What are later signs of Autistic Disorder?
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1. impaired ability to make friends with peers
2. absence or impairment of imaginative and social play 3. stereotyped, repetitive, or unusual use of language 4. restricted patterns of interest that are abnormal in intensity and focus 5. preoccupation with certain objects or subjects 6. inflexible adherence to specific routines or rituals |
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What is the prognosis associated with Autistic Disorder?
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generally very poor
1. 1/3 of individuals achieve some degree of partial independence as adulats 2. very few are able to live and work independently |
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Best outcomes for those with Autistic Disorder are associated with:
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1. ability to communicate verbally by age 5 or 6
2. IQ of over 70 3. later onset of symptoms |
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What is the etiology of Autistic Disorder?
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1. structural brain abnormalities (smaller than normal cerebellum, enlarged ventricles)
2. abnormal levels of norepinephrine, serotonin, and dopamine (neurotransmitters) 3. Genetic links |
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What evidence points to a genetic etiology for Autistic Disorder?
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1. rates of Autistic Disorder are 50 to 100 times higher among biological siblings of Autistic individuals than among members of the general population
2. higher concordance rates for identical than fraternal twins |
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Treatment for individual with Autistic Disorder focuses on:
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1. enhancing daily living, communication, and social skills
2. reducing undesirable behaviors |
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What type of treatment has been generally found to be most effective in assisting those with Autistic Disorder?
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Behavioral techniques
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What treatment techniques did Lovaas (1960) use to improve communication with Autistic patients?
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shaping and discrimination training
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What treatment of type targets the occupational needs of those with Autistic Disorder?
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vocational training and placement
(job coaching and sheltered workshops) |
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What disorder has a characteristic pattern of symptoms following a period of normal development for 5 months or more?
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Rett's Disorder
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What are the symptoms associated with Rett's Disorder?
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1. head growth deceleration
2. loss of purposeful hand skills 3. development of stereotypical hand movements (hand wringing) 4. impairments in the coordination of gait or trunk movements 5. a loss of interest in social environment 6. severely impaired language development 7. psychomotor retardation |
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Are more males or females diagnosed with Rett's Disorder?
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DSM-IV-TR reports that Rett's disorder is only diagnosed in females. However, there is some evidence that it occasionally occurs in males but they often die shortly after birth (Kerr, 2002)
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What disorder is characterized by a distinct pattern of developmental regression in at least two areas of functioning following at least 2 years of apparently normal development?
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Childhood Disintegrative Disorder
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What areas of functioning are examined in the diagnosis of Childhood Disintegrative Disorder?
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1. motor skills
2. social skills/adaptive behaviors 3. play 4. language |
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What are the characteristics/symptoms associated with Asperger's Disorder?
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1. severe impairment in social interactions
2. restricted repertoire of behaviors, interests, and activities without substantial delays in language, self help skills, cognitive development, or curiosity about the environment 3.usually normal levels of intelligence (with stronger verbal skills than other skills) |
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What may lead to lack of recognition or mislabeling of Asperger's Disorder?
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the individuals' verbal skills
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What characteristics are associated with ADHD?
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a persistent developmentally inappropriate pattern of inattention and/or hyperactivity-impulsivity
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To diagnose ADHD, the following must be true
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onset of symptoms prior to age 7
persistence of symptoms for at least six months some degree of impairment in at least two setting presence of 6 characteristic symptoms of inattention or hyperactivity-impulsivity |
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What constitutes "inattention" when assessing for ADHD?
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difficulty sustaining attention to tasks or play activities
not listening when spoke to directly failing to finish school work, chores, duties easily distracted by extraneous stimuli often forgetful |
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What constitutes "hyperactivity-impulsivity" when assessing for ADHD?
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frequent fidgeting or squirming in seat
often leave seat at inappropriate times frequent runs or climbs in inappropriate situations frequent difficulty in playing quietly excessive talking often interrupts/intrudes on others |
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what are the 3 subtypes of ADHD?
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Predominately Inattention Type
Predominately Hyperactive-Implusive Type Combined Type |
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When would you make a diagnosis of ADHD Predominately Inattentive Type?
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in the presence of 6 or more symptoms of inattention AND fewer than 6 hyperactive-impulsive symptoms
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When would you make a diagnosis of ADHD Predominately Hyperactive-Impulsivity Type?
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in the presence of 6 or more symptoms of hyperactivity-impulsivity AND fewer than 6 inattentive symptoms
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When would you make a diagnosis of ADHD Combined Type?
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in the presence of 6 or more symptoms of hyperactivity-impulsivity AND 6 or more inattentive symptoms
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What type of tests do children and adolescents with ADHD typically test lower on?
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Test of IQ even though intelligence is average or above average
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What type of academic difficulties do some with ADHD face?
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being held back a grade, suspended, expelled, or to drop out of school
(more likely than those without ADHD) |
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What type of social adjustment issues are faced by those with ADHD?
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few friends
victim of peer rejection |
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What are common co-diagnoses for those also diagnosed with ADHD?
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conduct disorder (30 to 90%)
learning disorder (up to 50%) oppositional defiant disorder anxiety disorder major depression |
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What is the prevalence of ADHD in school-aged children?
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3 to 7%
CDC (2005) 7.8% of US children between 4 to 17 have received a diagnosis of ADHD...lowest rates for kids 4-8 |
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What is the prevalence of ADHD in adults?
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1-5% of adults (not well established)
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ADHD is ___ to ___ times more common in _____ than in ______.
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4
9 boys girls |
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The gender balance is ______ in adulthood. This may be due to _______.
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equal
underreporting |
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What percentage of children with ADHD continue to have symptoms in adulthood?
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approximately 60%, but symptoms vary across the lifetime
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How does hyperactivity manifest itself for adults with ADHD?
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fidgeting, excessive talking, and an inner sense of restlessness and being overwhelmed.
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What forms does impulsivity take for adults with ADHD?
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impatience, irritability, problems related to time management and money management, reckless driving, impulsive sexuality
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What does the adult profile of the predominate Inattention Type ADHD look like?
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inconsistency in ability to concentrate
difficulty establishing and maintaining routines inability to prioritize and complete important tasks and activities |
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What are common issues faced or experienced by adults with ADHD?
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low self-esteem
problems related to social relationships poorer health outcomes lower educational/occupational achievement higher than normal risk for bipolar disorder, depression, anxiety, antisocial behavior, and substance abuse (greatest for male, lower ses and comordid disruptive behavior disorder) |
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What is the potential etiology of ADHD?
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genetic (higher rates of ADHD among biological relatives than general population; higher concordance for identical vs. fraternal twins)
Brain structure abnormalities (smaller than normal and lower than normal activity in the caudate nucleus, globus pallidus, and prefrontal cortex) |
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According to Barkley (1990), a core feature of ADHD is:
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an inability to regulate behavior to fit situational demands. This is called the Behavioral Disinhibition Hypothesis
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In contrast to Barkley's (1990) Behavioral Disinhibition Hypothesis, Montauk and Mayhall (2002) suggest that a core feature of ADHD is:
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an inability to regulate attention, which is manifested as problems in inhibiting attention to nonrelevant stimuli and focusing to intensely on certain stimuli to the exclusion of others
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What are some effective treatments for ADHD?
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Pharmcotherapy (CNS stimulants (Ritalin/Methylphenidate)
Behavioral Interventions Combine of the two above |
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What pharmacotherapy is suggested for ADHD?
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CNS Stimulants such as Ritalin/Methylpenidate, which have been shown to have beneficial effects on core symptoms in about 75% of the cases and effective for both kids and adults
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What behavioral interventions have been effective for reducing symptoms of ADHD?
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positive reinforcers, time outs, and other behavioral strategies
parent training in child behavior management teacher training in classroom management |
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What are the benefits to combining pharmacotherapy and behavioral interventions for those struggling with ADHD?
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despite inconsistent findings, overall seems to be more effective than either alone
combined treatment showed improvement in social skills, parent-child interactions, and academic performance note. long term follow ups don't show continued superior outcomes (may be due to early benefits of being in a study or simply natural reduction of symptoms over time) |
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What disorder is characterized by a persistent pattern of behaviors that violate the rights of others and/or age-appropriate social rules?
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Conduct Disorder
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What are associated characteristics of Conduct Disorder?
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little concern for the wellbeing of others
tend to blame others for their own misbehavior show little or no guilt or remorse in ambiguous situations, often misinterpret the actions of others as threatening or hostile |
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The diagnosis of Conduct Disorder requires:
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the presence of at least 3 characteristic symptoms during the last 12 months for the following categories:
1) aggression to people and animals 2) destruction of property 3) deceitfulness or theft 4) serious violation of rules |
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According to Moffitt (1993), there are two types of Conduct Disorder that differ in terms of onset, symptom severity, and etiology. They are:
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1) life course persistent type
2) adolescent limited type |
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The diagnosis of Conduct Disorder can denote one of two subtypes which are:
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1) childhood onset (prior to age 10)
2) adolescent onset (10 or later) |
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What are the characteristics of Moffitt's (1993) Lifecourse persistent type of Conduct Disorder?
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-begins early in life (sometimes before 3)
-pattern of increasingly serious transgressions -combination of neurological impairments (e.g., verbal skills, executive functioning, and memory), a difficult temperament, and adverse environmental circumstances |
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What are the characteristics of Moffitt's (1993) Adolescent Limited type of Conduct Disorder?
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-temporary form of antisocial behavior that reflects a "maturity gap" between the adolescents' biological maturation and lack of opportunities for adult privileges and rewards
-antisocial acts usually committed with peers and are inconsistent across situations (eg. shoplifting, but adhere to school rules) |
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The treatment of Conduct disorder is most effective when:
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targeting preadolescents and when it includes family interventions
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Patterson and colleagues (1992) developed a parent management training that:
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teaches parents to reward positive behaviors and replace punishments with time-out, response cost, etc.
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______ is a recurrent pattern of negativistic, defiant, and hostile behaviors toward authority figures
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Oppositional Defiant Disorder
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The following symptoms characterize what disorder:
-often loses temper -argues with adults -actively defies or challenges the rules/requests from adults -blames others for own behavior/mistakes -angry and resentful -spiteful and vindictive |
Oppositional Defiant Disorder
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What disorder involves persistent eating of nonnutritive substances (e.g., paint, plaster, insects, clay) for at least 1 month without an aversion to food and such behavior is inappropriate based on age an dis not part of a culturally sanctioned practice
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Pica
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The onset of Pica is usually between the ages of _____ and _______ _____ and occasionally is found in ________.
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1. 12 to 24 months
2. Pregnant women Pica is seen more in young children than adults. Between 10% and 32% of children ages 1 - 6 have these behaviors.ica can occur during pregnancy. In some cases, conditions due to a lack of certain nutrients, such as iron deficiency anemia and zinc deficiency, may trigger the unusual cravings. Pica may also occur in adults who crave a certain texture in their mouth. |
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A sudden, rapid movement, nonrhythmic, stereotyped motor movement or vocalization......[that] is experienced as irresistible but can be suppressed for varying lengths of time
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a tic
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What are some examples of tics?
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eye blinking
facial grimacing and gestures jumping smelling objects echokinesis (imitating someone's movements) grunting snorting barking echolalia coprolalia (repeating, socially undesirable words) palialia (repeating one's own grounds or words) |
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Tic Disorders include:
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Tourette's Disorder
Chronic Motor or Vocal Tic Disorder Transient Tic Disorder Tic Disorder NOS |
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The presence of at least 1 vocal tic and multiple motor tics that may appear simultaneously or at different times and that begin prior to age 18 denotes which disorder?
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Tourette's Disorder
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What is the duration of Tourette's Disorder?
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may be life long although symptoms typically wax and wane in severity over time and there may be periods of remission lasting from weeks to years. For many, frequency, severity, and disruptiveness of symptoms decline in adolescence or adulthood.
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What is the typical age of onset for Tourette's Disorder?
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6 to 7 years
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Tourette's is most common for persons of what gender?
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males
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What are some associated symptoms of Tourette's Disorder?
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1) obsessions and compulsions (rates of OCD is higher not only for individuals and their biological relatives)
2) hyperactivity, impulsivity, and distractibility (cause of high rates of school problems) |
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What is the etiology of Tourette's Disorder?
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higher than normal levels of dopamine and/or sensitivity of dopamine receptors in the caudate nucleus (Segawa, 2003; Wolf et al, 1996)
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The treatment of Tourette's Disorder includes pharmacotherapy utilizing which drugs or classes of drugs?
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1) antipsychotic drugs (haloperidol and pimozide)
-effective in 80% of the cases -potential for negative side ffects 2) clonidine (used to treat hypertension) or disipramine (an antidepressant used to treat hyperactivity and in attention) 3) SSRIs (used to alleviate the OCD symptoms) |
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What class of drugs is not recommended for those with Tourette's Disorder and why?
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Psychostimulant drugs, may increase tics in some individuals
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What should you examine when distinguishing Tourette's Disorder from other Tic Disorders (Chronic Motor or Vocal Tic Disorder. Transient Tic Disorder, and Tic Disorder NOS)?
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type of tics
duration of tics age at onset |
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If a person only has Motor OR Vocal tics, what would the diagnosis be?
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Chronic Motor or Vocal Tic Disorder
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If an individual has had one ore more motor and/or vocal tics for at least 4 weeks but no loner than 12 consecutive months, the diagnosis would be?
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Transient Tic Disorder
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If an individual has tics that do not meet the criteria for a specific Tic disorder and onset after 18, the diagnosis would be?
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Tic Disorder NOS
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Enuresis
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-repeated voiding of urine during the day or night into the beds or clothes at least two times a week for three months or more
-usually involuntary but can be intentional -diagnosed only if the individual has reached the developmental level or age (usually 5 years old) when continence is expected and when the disorder is not due to a general medical condition or the use of diuretics or other substances |
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What is the most common treatment for Enuresis?
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the night alarm
-effective in up to 80% of cases -causes a bell to ring when the sleeping child begins to urinate -1/3 of kids exhibit some degree of relapse within six months of the initial treatment -effectiveness increased when combined with other behavioral techniques (e.g., behavioral rehearsal or overcorrection) |
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Besides the night alarm, what is another treatment used for those with Enuresis?
|
Pharmacotherapy
-imipramine (reduces wetting frequency in 85% of cases, suppresses wetting entirely in 30% of cases--most kids relapse within 3 months after discontinuing the drug) -desmopressin (synthetic version of an antidiuretic hormone, good short term, but poor long term effects) |
|
|
Developmentally inappropriate, excessive anxiety related to separation from home or attachment figures
|
Separation Anxiety Disorder
|
|
|
To diagnose Separation Anxiety Disorder, the following criteria must be meet:
|
1) disturbance must last for at least 4 weeks
2) onset of symptoms must be before age of 18 3)at least 3 characteristic behaviors must be present, including -excessive distress when separated from home or attachment figures -persistent fear of being alone -frequent physical complaints when separation from attachment figures occurs or is anticipated |
|
|
Those who struggle with Separation Anxiety Disorder often come from what type of families?
|
close and warm families
|
|
|
What typically precipitates symptoms associated with Separation Anxiety Disorder?
|
-major life stress such as the death of a relative or pet OR a move to a new neighborhood
|
|
|
Separation Anxiety Disorder sometimes manifests as school refusal and is associated with the following symptoms
|
-intense anxiety about going to school
-stomachache, headache, nausea, and other physical symptoms |
|
|
School refusal that occurs at what ages signifies Separation Anxiety Disorder
|
5 to 7 years (first begin school)
|
|
|
School refusal at what ages may be a sign of depression
|
11 to 12 years (change in school)
or 14 years or older (also may be a more severe disorder) |
|
|
Any treatment focused on reducing school refusal should include
|
immediate return to school
|
|
|
this disorder includes a marked disturbed and developmentally inappropriate social relatedness in most setting that begins prior to age 5
|
Reactive Attachment Disorder
|
|
|
The diagnosis of Reactive Attachment Disorder requires what?
|
evidence of pathogenic care (neglect or frequent changes in caregivers that prevented the development of attachment)
|
|
|
What are the two types of Reactive Attachment Disorder?
|
1) Inhibited Type
2) Disinhibited Type |
|
|
The Inhibited Type of Reactive Attachment Disorder is associated with the following:
|
-persistent failure to initiate and respond to most social interactions
-pattern of inhibited, hypervigilant, or highly ambivalent responses |
|
|
The Disinhibited Type of Reactive Attachment Disorder os associated with the following
|
-indiscriminate sociability or a lack of selectivity in the choice of attachment figures
|
|
|
What is Behavioral Pediatrics?
|
a branch of behavioral medicine concerned with the psychological aspects of children's medical illness
|
|
|
Hospitalized children are at an increased risk for:
|
emotional and behavioral problems, including dependency to anxiety/depression to severe withdrawal
|
|
|
Multicomponent cognitive-behavioral interventions are useful for reducing children's anxiety about medical procedures and associated pain. These interventions are based on:
|
Meichenbaum's Stress Inoculation Model
|
|
|
Multicomponent cognitive-behavioral interventions used with children in hospital and clinic settings includes:
|
-providing children with information about the impending medical procedures
-using a variety of techniques to help the child cope with anxiety and stress (including filmed modeling, reinforcement, breathing exercises, emotive imagery/distraction, and behavioral rehearsal) |
|
|
When communicating openly with a child about his/her illness, it is important to:
|
use developmentally-appropriate language and procedures (Bearison & Mulhern, 1994)
|
|
|
Children who are told about their cancer diagnosis in early stages of treatment tend to:
|
cope better than those who learn about their diagnosis later
|
|
|
What led to increased visitation hours in hospitals and rooming-in (allowing parents to stay with hospitalized children 24 hours a day)?
|
Research showing that children between 1 to 4 have the most negative reactions to hospitalization as a result of being separated from family
|
|
|
What children with disabilities are at the greatest risk for emotional and behavioral disorders?
|
kids with major neurological disorders
for example, rate of psychiatric problems in children with hemiplegic cerebral palsy is three times higher than the rate of children without a physical disability |
|
|
Youth with chronic medical conditions have higher rates of school related problems than other youth. What are some causes?
|
-sometimes results of a illness
-sometimes caused by treatment itself -sometimes caused by frequent school absences |
|
|
What are the effects of CNS irradition and intrathecial chemotherapy (injected in spinal cord), common treatment for Luekemia)?
|
impaired cognitive functioning and a higher than normal rate of learning disabilities
|
|
|
Lack of compliance with medical regimens is a common problem and is linked:
|
-lack of knowledge or skill
-parent-child conflict and communication issues -developmental issues |
|
|
Why do adolescences have a difficult time complying to medical regimes?
|
-concerned with peer acceptance
-reduced conformity to rules -questioning of the credibility of health care provider -reduced parental supervision |
|
|
For all of these disorders, there is evidence from history, physical exam, and/or lab results that the condition is the direct physiological consequence of a general medical condition, a substance, or a combination of the two
|
Mental Disorders Due to a General Medical Condition
|
|
|
Which disorders are characterized by a clinically significant deficit in cognition or memory that represents a substantial change from a previous level of functioning?
|
Delirium, Dementia, and Amnestic Disorder
|
|
|
To diagnose Delirium, the following is required:
|
1) a disturbance in consciousness
2) a change in cognition and/or the development of perceptual abnormalities |
|
|
What constitutes a disturbance in consciousness associated with Delirium?
|
-reduced awareness of environment
-shifts in attention -distractibility |
|
|
What constitutes changes in cognition associated with Delirium?
|
-loss of memory
-disorientation to time and place -impaired language |
|
|
What constitutes perceptual abnormalities associated with Delirium?
|
-illusions
-hallucinations -other misperceptions |
|
|
Symptoms associated with Delirium develop over________, ____________________, and ____________.
|
1. develop over a few hours or days
2. fluctuate during the course of the day 3. may cease within a few hours or persist for weeks (depending on the cause) |
|
|
Who is at high risk for Delirium?
|
-older adults
-people with decreased cerebral reserve due to Dementia, Stroke, or HIV DIsease -postcardiotomy patients -burn patients -people with drug dependence/withdrawal (especially alcohol or benzodiazepine) |
|
|
What are some general medical conditions that may cause Delirium?
|
-systemic infections
-metabolic disorders -fluid and electrolyte imbalances -postoperative states -head trauma |
|
|
What are the targets of treatment for Delirium?
|
1) underlying cause of the disorder
2) reduction of agitated behaviors |
|
|
What are the potential treatments for Delirium?
|
1) combination of environmental manipulation and psychosocial interventions (environments that minimize disorientation, having a calm, friendly family or staff member to stay with patient)
2) haloperiodol or other antipsychotic drugs to reduce agitation, delusions, and hallucinations |
|
|
What can cause Dementia?
|
It can be caused by a number of substances and medical conditions, including but not limited to alcohol, head trauma, or vascular disease
|
|
|
What disorder to characterized by multiple cognitive deficits including some degree of memory impairment, aphasia, apraxia, agnosia, and/or impaired executive functioning?
|
Dementia
|
|
|
True or False: Cognitive deficits are progressive and irreversible when associated with Dementia; however, the course and prognosis depend on the disorder's etiology and availability of effective treatment
|
True
|
|
|
Aphasia
|
a condition that robs you of the ability to communicate.
can affect your ability to express and understand language, both verbal and written. The amount of disability depends on the location and the severity of the brain damage that is the cause. |
|
|
Apraxia
|
a disorder caused by damage to specific areas of the cerebrum, characterized by loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements.
|
|
|
Agnosia
|
inability to recognize and identify familiar objects and people
|
|
|
Impaired executive functioning
|
impairments in abstract functioning, planning, initiating, and stopping complex behaviors
|
|
|
Anterograde amnesia
|
difficulty acquiring new information
|
|
|
Retrograde amnesia
|
an inability to recall previously learned materials
|
|
|
People with Dementia experience:
|
some degree of memory impairment, aphasia, apraxia, agnosia, impaired executive functioning, anterograde amensia, and/or retrograde amensia
|
|
|
Dementia can be categorized as ___________ or ______________.
|
cortical
subcortical |
|
|
Cortical dementias
|
characterized by an early appearance of aphasia and impaired calculation ability and deficits in both recall and recognition memory
(e.g., dementia of the Alzheimer's type) |
|
|
Subcortical dementias
|
early appearance of deficits in executive functioning that are disproportionate to other impairments, a greater impairment of recall (vs. recognition) memory, dysartria (poorly articulated speech), slowed motor speed and control AND personality change
(e.g., dementia due to huntington's or parkinson's disease) |
|
|
Pseudodementia
|
onset of dementia-like symptoms is abrupt. The person is concerned (or overly concerned) with impairments and likely uncooperative during testing. The person also has impaired recall but intact recognition memory (procedural memories are most affected)
|
|
|
Mild Cognitive Impairment
|
ongoing memory problems, but do not have language, executive functioning, and other impairments associated with Dementia
|
|
|
In what disorder are cognitive deficits usually have a gradual onset and progressive course AND the person denies or is unaware of his/her impairments, is likely cognitive but inaccurate in responses during cognitive testing, and has deficits in both recall and recognition memory
|
Dementia
|
|
|
What is the single most common cause of Dementia and accounts for 65% of the cases of Dementia, and involves a gradual onset of symptoms and a slow progressive decline in cognitive functioning?
|
Dementia of the Alzheimer's Type
|
|
|
Describe the first stage of Dementia of the Alzheimer's Type
|
1 to 3 years
anterograde amnesia (especially for declarative memories) deficits in visuospatial skills (wondering) indifference irritability sadness anomia |
|
|
Dysnomia
|
refers to a less severe form of this word-recall dysfunction.
|
|
|
anomia
|
a severe problem with recalling words or names. It is also known as:
nominal aphasia amnesic (or amnestic) aphasia |
|
|
Describe the second stage of Dementia of the Alzheimer's Type
|
increasing retrograde amnesia
flat or liable mood restlessness and agitation delusions fluent aphasia acalculia ideomotor apraxia (inability to translate an idea into movement) |
|
|
acalculia
|
acquired impairment in which patients have difficulty performing simple mathematical tasks, such as adding, subtracting, multiplying and even simply stating which of two numbers is larger.
often acquired late in life |
|
|
Dyscalculia
|
math disability is a specific learning disability involving innate difficulty in learning or comprehending mathematics. It is akin to dyslexia and includes difficulty in understanding numbers, learning how to manipulate numbers, learning math facts, and a number of other related symptoms.
|
|
|
Describe the third stage of Dementia of the Alzheimer's Type
|
severely deteriorated intellectual functioning
apathy limb rigidity urinary and fecal incontinence |
|
|
A definitive diagnosis of this disorder can only be made after an autopsy or brain biopsy that confirms extensive neuron loss and the presence of amyloid (neuritic) plaques and neurofibrillary tangles, especially in the medical temporal structures (entorhinal cortex, hippocampus, and amygdala)
|
Dementia of the Alzheimer's Type
|
|
|
This disorder usually has an average duration of 8 to 10 years (from symptom onset to death), a late onset (after age 65), and is more common in women than men.
|
Dementia of the Alzheimer's Type
|
|
|
What are the risk factors associated with Dementia of the Alzheimer's Type?
|
lower levels of formal education
adult onset (type 2) diabetes depression |
|
|
What evidence points to a genetic compentent to some types of Alzheimer's Disease?
|
abnormalities on Chromosome 21 (early onset familial type)
abnormalities on Chromosome 19 (late onset type) abnormal levels of several neurotransmitters including Acetylcholine (ACh) |
|
|
What neurotransmitter has a role in memory and other cognitive impairments?
|
Acetylcholine (ACh)
|
|
|
What are some of the cholinesterase inhibitors that reduce breakdown of Acetylcholine in the brain?
|
tacrine (Cognex)
donepezil (Aricept) galantamine (Reminyl) rivastigmine (Exelon) Note these drugs are useful for reversing cognitive impairments and improving some behavioral symptoms--temporarily |
|
|
What are the different aspects of treatment for Alzheimer's Disease?
|
1) group therapy (emphasizes reality orientation and reminiscence)
2) antidepressant druges (alleviates depression) 3) behavioral techniques & antipsychotic drugs (reduce agitation) 4) environmental manipulation and pharmacotherapy (enhance memory and cognitive functioning) |
|
|
When are interventions for Alzheimer's Disease most effective?
|
when they include family members and patients remain in the home.
families are less likely to institutionalize a family member with Dementia when they are provided with adequate individual and family therapy and support |
|
|
The diagnosis of Vascular Dementia requires:
|
1) cognitive impairment and focal neurological signs, including exaggerated reflexes, weakness in an extremity, and gait abnormalities
or 2) lab evidence of cerebrovascular disease |
|
|
Which disorder has a stepwise, fluctuating course with a patchy pattern of symptoms that is determined by the location of the brain damage?
|
Vascular Dementia
|
|
|
What are the risk factors of Vascular Dementia?
|
hypertension
diabetes cigarette smoking atrial fibrillation |
|
|
What are the early signs of Dementia Due to HIV Disease?
|
forgetfulness
impaired attention psychomotor slwoing |
|
|
What are the later signs of Dementia Due to HIV Disease?
|
difficulties in problem solving and concentration
apathy and social withdrawal loss of initiative tremor and clumsiness saccadic eye movements |
|
|
What are the six stages of Dementia due to HIV disease?
|
Stage 0 (normal)
Stage 0.5 (Equivocal/subclinical) Stage 1 (mild) Stage 2 (moderate) Stage 3 (severe) Stage 4 (end stage) |
|
|
Describe Stage 0 of Dementia due to HIV Disease
|
Stage 0 (Normal): The individual's mental and motor functions are normal
|
|
|
Describe Stage 0.5 of Dementia due to HIV Disease
|
Stage 0.5 (Equivocal/ subclinical): the individual has minimal or equivocal symptoms with no impairment in performance of work or activities of daily living (ADL)
mild signs may be present (slowed ocular or extremity movements) |
|
|
Describe Stage 1 of Dementia due to HIV Disease
|
Stage 1 (Mild): unequivocal evidence of functional, intellectual, or motor impairment, but able to perform all but the most demanding aspects of work or activities of daily living (ADL) and can walk without assistance
|
|
|
Describe Stage 2 of Dementia due to HIV Disease
|
cannot work but can perform basic activities of self care and is ambulatory but may require assistance
|
|
|
Describe Stage 3 of Dementia due to HIV Disease
|
Stage 3 (Severe) signs of major intellectual incapacity(eg cannot sustain complex conversations) or motor disability (e.g., cannot walk without assistance)
|
|
|
Describe Stage 4 of Dementia due to HIV Disease
|
Stage 4 (end stage): nearly vegetative
intellectual and social functioning are rudimentary and the individual is nearly or completely mute has paraparesis or paraplegia has urinary and fecal incontinence |
|
|
The symptoms of Dementia Due to Head Trauma usually depend on:
|
the location and extent of brain injury
|
|
|
Dementia due to Head Trauma is usually subcortical and usually involves:
|
changes in personality, deficits in executive functioning, and altered experience and expression of emotions
|
|
|
What is the prognosis of Dementia due to Head Trauma?
|
Depends on the number of brain injuries
If single injury, usually nonprogressive If repeated injury (eg boxing), progressive form of dementia (dementia puglistica) |
|
|
Amnestic Disorder due to a general medical condition is the appropriate diagnosis when:
|
memory impairment is known to be a direct physiological consequence of a general medical condition
does not occur only during the course of delirium or dementia causes a significant impairment in social or occupational functioning (or represents a substantial decline in previous functioning) |
|
|
Which disorder involves an inability to acquire and recall new information (anterograde amnesia) and may involve some impairment in the ability to recall previously acquired information (retrograde amnesia)?
|
Amnestic Disorder due to a general medical condition
|
|
|
What is Dissociative Amnesia?
|
a type of functional or psychogenic amnesia characterized by an inability to recall important personal information and is often related to a traumatic or very stress event.
usually there is no difficulty in learning new information or recalling personal information form prior to the occurrence of the trauma or stressor |
|
|
Substance-related disorders include those that:
|
are associated with drugs of abuse, side effects of medications, and exposure to toxins.
|
|
|
What are the two categories of Substance-related disorders?
|
1. Substance-Use Disorders
2. Substance-Induced Disorders |
|
|
What are examples of Substance-Use Disorders?
|
1. Substance Dependence
2. Substance Abuse |
|
|
What are examples of Substance-Induced Disorders?
|
1.Intoxication
2. Withdrawal 3. Withdrawal Delirium 4. Persisting Perception Disorder 5. Persisting Amnesic Disorder |
|
|
What are the eleven classes of substances covered by the specific substance-related disorders?
|
1. alcohol
2. amphetamines 3. caffeine 4. cannabis 5. cocaine 6. hallucinogens 7. inhalants 8. nicotine 9. opioids 10. phencyclidine (PCP) 11. sedatives, hypnotics, and anxiolytics |
|
|
When is Substance Dependence diagnosed?
|
when a person continues to use a substance despite significant substance-related problems as evidenced by a presence of at least three associated symptoms during a 12-month period.
|
|
|
What are the symptoms associated with Substance Dependence?
|
-tolerance
-withdrawal -substance frequently taken in larger amounts or over longer periods of time than intended -persistent desire or unsuccessful attempts to control or cut down substances use - a great deal of time spent in activities related to obtaining the substance, using the substance, or recovering from its effect - important social, occupational, or recreational activities reduced or stopped because of substance use -continued use of the substance despite persistent or recurrent psychological or physical problems caused or exacerbated by its use |
|
|
Explain Conger's (1956) tension-reduction hypothesis associated with alcohol dependence.
|
alcohol reduces anxiety, fear, and other states of tension and that people drink alcohol to reduce tension, which eventually leads to addition. Thus, the addiction is the result of negative reinforcement.
|
|
|
What is Marlatt and Gordon's (1985) perspective on addictive behaviors?
|
They proposed that addictive behaviors are acquired and that addition is an overlearned, maladaptive habit pattern
|
|
|
How do biopsychosocial models view substance dependence?
|
They view the initiation, maintenance, and progression of addiction as involving an interaction between physical, psychological, and sociocultural factors.
|
|
|
What are some treatments for Substance Depedence?
|
1. covert sensitization and other forms of aversion therapy
2. multicomponent interventions (combining social skills training, stress management, moderation training, contingency management, and other tx) 3. training in coping skills and other self control techniques |
|
|
True or False:
Interventions that incorporate the use of Alcoholic Anonymous and other self-help programs tend to have no effect on abstinence when used in conjunction with other interventions. |
False
|
|
|
What is the most common predictor of relapse among people with Alcohol and other types of Substance Dependence?
|
the experience of anxiety, frustration, depression, or other negative emotional states
|
|
|
What do Marlatt and Gordon call the typical reaction to relapse given it involves self-blame, guilt, anxiety, and depression and leads to further use?
|
an abstinence violation effect
|
|
|
Explain Relapse Prevention Therapy
|
this therapy involves:
1. identifying circumstances that increase the individual's risk for relapse (i.e., situations that elicit negative emotional states, expose the individual to alcohol or alcohol-related cues or cultivate social pressure to drink) 2. implementing a variety of behavioral and cognitive strategies that will help the individual prevent lapses and deal more effectively with them if they occur (e.g., coping skills training, cognitive restructuring, self-efficacy enhancement, and lapse management) |
|
|
What are the predictors of successful smoking cessation?
|
1. male
2. age 35 or older 3. college educated 4. live in a smoke-free home 5. a non-smoking policy at work 6. be married or living with a partner 7. stated smoking at a later age 8. low level of nicotine dependence 9. have abstained for longer than five days during previous attempts 10. a comprehensive intervention |
|
|
What are the components of the most successful smoking cessation intervention?
|
1. nicotine replacement therapy
2. multicomponent behavioral therapy (skills training, relapse prevention, stimulus control, and/or rapid smoking) 3. support and assistance from a clinician |
|
|
the interest in identifying effective interventions for Nicotine Dependence has been fueled by:
|
studies showing that health risks decline dramatically once a person quits smoking
|
|
|
smokers are 3 to 4 times more likely than nonsmokers to experience ________, _______, or ________.
|
myocardial infarction, cardiac arrest, or stroke
|
|
|
If a smoker quits, the health risks of myocradial infarction, cardiac arrest, or stroke are ________ of those that have never smoked within one to five years of quiting
|
approximately the same
|
|
|
Substance abuse is characterized by:
|
a maladaptive pattern of substance use that involves clinically significant impairment or distress as manifested by the presence of at least one of the associated symptoms during a 12 month period
|
|
|
The symptoms associated with Substance Abuse are:
|
1. recurrent substance use resulting in a failure to fulfill major role obligations at home, school, or work
2. repeated use of a substance in situations in which use is known to be physically hazardous 3. recurrent substance-related legal problems 4. continued use despite having persistent or recurrent social or interpersonal problems that are caused or exacerbated by the substance |
|
|
To diagnose Substance-Induced Disorders, there must be evidence that symptoms are related to substance use. This can be ascertained by:
|
1. direct physical evidence
2. consideration of the temporal relationship between substance use and the onset of symptoms 3. cessation of symptoms after a period of abstinence 4. the presence of symptoms that are atypical for other mental disorders 5. empirical evidence of a relationship between the substance and the observed symptoms |
|
|
Alcohol is associated with all of the Substance-Induced Disorders except:
|
Persisting Perception Disorder
|
|
|
Alcohol Intoxication
|
-maladaptive behavioral and psychological changes (e.g., inappropriate sexual or agressive behaviors, impaired judgments, emotional liability)
-slurred speech -incoordination -unsteady gait -nystagmus -impaired attention or memory (especially anterograde amnesia or blackouts) -stupor or coma |
|
|
Alcohol Withdrawal
|
-autonomic hyperactivity
-illusions or hallucinations -anxiety -psychomotor agitation -grand mal seizures all following the cessation of alcohol consumption after a period of prolonged or heavy use |
|
|
Alcohol Withdrawal Delirium
|
disturbances in consciousness and other cognitive functions, autonomic hyperactivity, vivid hallucinations, delusions, and agitation following a period of prolonged or heavy use
|
|
|
Alcohol-Induced Persisting Amnestic Disorder (Korsakoff Syndrome)
|
characterized by retrograde amnesia, anterograde amnesia, and confabulation (attempts to compensate for memory loss by fabricating memories) and is believed to be due to a thiamine deficiency
anterograde amnesia is most severe, especially for declarative memories retrograde amnesia affects recent long term memories more than remote memories |
|
|
Wernicke Syndrome
|
involves ataxia, abnormal eye movements (e.g., nystagmus, double vision), and confusion
often is comes before Korsakoff Syndrome Wernicke-Korsakoff Syndrome is the co-occurence of the two |
|
|
Alcohol-Induced Sleep Disorder
|
usually of the Insomnia Type and can be the result of either Intoxication or Withdrawal
|
|
|
Alcohol-Induced Sleep Disorder associated with Intoxication
|
involves a period of increased sleepiness followed by increased wakefulness, restlessness, and vivid anxiety-arousing dreams
|
|
|
Alcohol-Induced Sleep Disorder associated with Withdrawal
|
severe disruption in sleep continuity with vivid dreams
|
|
|
Amphetamine or Cocaine Intoxication
|
1. maladaptive behavioral and psychological changes (euphoria, anxiety, hyperactivity, grandiosity, confusion, anger, paranoid ideation, auditory hallucinations)
2. tachycardia 3. elevated or lowered blood pressure 4. dilated pupils 5. perspiration or chills 6. nausea or vomitting 7. weight loss 8. psychomotor agitation 9. muscular weakness 10. confusion 11. seizures |
|
|
Amphetamine or Cocaine Withdrawal
|
dysphoric mood
fatigue vivid and unpleasant dreams insomnia or hypersomnia increased appetite psychomotor agitation or retardation after prolonged or heavy use "crash" |
|
|
Caffeine Intoxication
|
restlessness, nervousness, excitement, insomnia, flushed face, diuresis, gastrointestinal problems with low doses
with high doses, muscle twitching, rambling thoughts or speech, cardiac arrhythmias, and psychomotor agitation |
|
|
Sedative, hypnotic, or anxiolytic Intoxication Diagnosis
|
maladaptive behavioral and psychological changes, including inappropriate aggressive or sexual behaviors, impaired judgement, mood liability
at least one characteristic symptom as the result of drug use: slurred speech, incoordination, unsteady gait, nystagmus, impaired memory or attention, stupor or coma |
|
|
Opioid Intoxication
|
an initial state of euphoria that is followed by apathy or dysphoria, psychomotor agitation or retardation, and impaired judgement
other signs: pupillary constriction, drowsiness, impaired attention or memory, and slurred speech severe intoxication = pupillary dilation, respiratory distress, coma or death |
|
|
Opioids include:
|
heroin, morphine, codeine, methadone, oxycodone, fentanyl
|
|
|
Opioid Withdrawal
|
occurs following cessation of or a substantial reduction in the use of an opioid following prolonged or heavy use. symptoms resemble a severe case of the flu and include seating, goose bumps, fever, pupillary dilation, nausea and vomitting, abdominal cramps, diarrhea, agitation and restlessness, insomnia, and dysphoric mood
|
|
|
Nicotine Withdrawal
|
symptoms include depressed mood, insomnia, irritability, anxiety, restlessness, impaired concentration, decreased heart rate, and increased appetite
|
|
|
Hallucinogen Persisting Perception Disorder (Flashbacks)
|
re-experiencing of one or more perceptual symptoms (e.g., trailing images, afterimages, halos around objects) that were experienced during one or more episode of Hallucinogen Intoxication (currently not intoxicated and is aware that the perception is a drug effect)
|
