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101 Cards in this Set
- Front
- Back
Axis I - V
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I Clinical
II Personality/MR III Medical IV Psychosocial/Environmental V GAF |
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MR Criteria
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IQ less than or equal to 70
Impaired adaptive functioning Onset before 18 |
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Degrees of MR
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Mild: 50-55 to 70
Moderate: 34-40 to 50-55 Severe: 20-25 to 35-40 Profound: < 20-25 As adults, individuals with Moderate MR can contribute to their own support by performing unskilled or semi-skilled tasks under supervision -- in sheltered workshops or in the competitive job market. They constitute 10% of the mentally retarded population, they are unlikely to progress beyond the second grade level in academic skills, and they can talk or learn to communicate during the preschool years. |
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Etiology
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5% - Heredity
30% - Early alt in embroyonic dev 10% - Pregancy and perinatal problems 5% - General med problems 15-20% - Environmental factors 30-40% Unknown |
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PKU
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Inability to metabolize PKU, which causes MR if untreated/improper diet.
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DS/Trisomy 21
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5th finger
Large protruding tongue Heart lesions Respirator and intestinal defects Risk for AD |
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Borderline IQ
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IQ of 71-84
MR; 71-75 with poor adaptive functioning |
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LD
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20-30% of children w/ LD have ADHD
Greater risk of antisocial beh More males |
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Comm DIs
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Exp, Exp-Rec, Phono, Stuttering (stress reduction)
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PDD
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Impairments in:
1. Comm 2. Social Int 3. Stereotyped Beh |
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Autism
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Prior to 3
1. Comm 2. Social Int 3. Stereotyped Beh 70% have MR Atrophic cerebellum and enlarged ventricles |
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Rett's
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Normal until 5+ months
Deceleration of head growth Loss of motor Language impairment Less social interest ONLY IN FEMALES |
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Childhood Disintegrative Disorder
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After 2 normal years, regression in 2 areas.
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Asperger's
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Social imp & restriced interests w/o comm diff
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ADHD
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Onset before 7
Duration of 6 months Lower IQ, yet ave/high ave 25-30; 50% have LD 30-90% have Conduct Dis Inattentive = equal gender Hyper = more males 60% of children cont as adults w/ CONDUCT PROBLEMS being a good predictor of issues. |
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ADHD and Beh Disinhibition Hypothesis
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Core ADHD feature is the inability to regulate behavior to fit situational demands.
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ADHD Treatment
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Methylphenidate (Ritalin)
Atomoxetine (Strattera; non stimulant) Classroom management Parental involvement |
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Conduct Disorder
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W/in the past 12 months:
1. Agg to people or animals 2. Destruction of property 3. Deceitfulness or theft 4. Violation of rules |
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CD
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Childhood onset = prior to 10
Adolescent onset = after 10 |
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Moffitt's CD Types
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Life-course-persistent
Adolescence-limited |
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CD Treatment
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Target preadolescents + family intervention
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Pica
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12-24 months
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Tourette's Disorder Treatment
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Antipsychotics = Haloperidol and pimozide (80% effective)
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Enuresis
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Clinical after 5 years of age
Night alarm |
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Separation Anxiety
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Lasts 4 weeks
Onset before 18 |
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RAD
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Inappropriate social relatedness before 5.
Parental neglect or family chaos Inhibited and Disinhibited |
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Behavioral Pediatrics (Pediatric Psy)
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In response to increased mental disorders in children w/ medical conditions.
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Behavioral Ped Recommendations
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Disclose asap
Cog-Beh anxiety reduction for med procedures Allow family to visit often Reduced compliance School adjustment |
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Delirium
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Disturbance in consciousness
Change in cog and/or perceptual abnormalities |
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Dementia
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Memory + 1
Pseudodementia = intact rec w/ poor procedual memory. |
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AD
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Course until death = 8-10 years
> Females |
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HIV Dementia
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Motor slowness, absence of aphasia, severe dep/anx.
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Substance Dependence
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12 months of 3 criteria:
Tolerance Withdrawal Larger amounts Can't stop Time spent Impacts activities Continued use despite issues |
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Substance Dependence Treatment
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Covert sensitization
Aversion therapy Social skills training Stress management AA |
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Most common precipitant of relapse...
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...anxiety, frustration, and depression.
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Marlatt & Gordon (1985)
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Dep is an "overlearned habit pattern" w/ a "abstinence violation effect" that invokes anxiety and self-blame.
Decrease relapse when relapse is blamed on external factors. Marlatt's model of substance dependence holds that addicts learn to associate substance use with relief of self-criticism and guilt through a variety of cues and reinforcers, such as advertisements depicting people feeling cheerful when drinking and social occasions in which a carefree attitude is reinforced. In other words, there are a variety of cues and mediators that serve to encourage and reinforce use. Contrary to the person's expectations, however, excessive substance use only exacerbates problems, such as interpersonal or work-related problems. This leads to more self-criticism and guilt, which the person again attempts to relieve by using. In other words, substance use is self-reinforcing -- it is the cause of and the expected solution to the same problems. And it is "over-learned" in that, due to the multiplicity of its antecedents, it becomes a strongly ingrained behavior. According to Marlatt, a slip is likely to lead to a full-blown relapse when the person makes dispositional attributions for it, such as when the person blames him or herself. Relapse prevention involves teaching the person to make non-dispositional attributions, such as blaming the situation or the nature of the disease. |
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Relapse Prevention Program
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Id environmental cues and coping with them.
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Nicotine Dependence
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Only 7.5% quit long term
91% of them do it alone Treatment: Nicotine replacement Beh therapy Clinical support |
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Substance Abuse
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1 criteria in the last 12 months:
Impacts life Use of sub Recurrent legal issues Continued use despite issues |
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ETOH withdrawal
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Autonomic hyperactivity (e.g., sweating tachycardia), tremor, insomnia, nausea, hall, anxiety, seizures.
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Schizophrenia
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6 months or more w/ 2 or more:
Delusions Hall Dis Speech Disorganized or catatonic beh Neg symptoms |
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Schizophrenia Subtypes
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Paranoid - most fav prognosis
Catatoic Disorganized Undifferentiated Residual |
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Type I & II Schizophrenia (Crow; 1985)
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Type I = Positive symptoms; responds well to antipsychotics; neurotransmitter based
Type II = Negative symptoms; poor premorbid functioning; brain structure based |
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Schizophrenia Prevalence
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Males>Females
Male onset (18-25) Female onset (25-35) A-A>Majority Patients from developing countries more often exhibit an acute onset of symptoms, a shorter clinical course, and a complete remission of symptoms. |
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Etiology
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Gen pop = .5%-1.5%
Concordance rate Bio sib = 10% Fraternal twin = 17% Identical twin = 48% Child (both parents schiz) = 46% |
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Dopamine Hypothesis
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Schizo is the result of elevated dopamine.
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Antipsychotics
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Reduce positive symptoms
Tardive dyskenesia |
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Atypical Antipsychotic
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Clozapine = less likely to cause TD and help neg symptoms
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Expressive Emotion
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High EE is associated with relapse
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Schizophreniform Disorder
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1 month, but less than 6 for impairment
2/3 convert to Schizo |
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Delusional Disorder
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"Nonbizarre"
Poisioned Betrayed Followed |
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Delusional Subtypes
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Erotomanic
Grandiose Jealous Persecutory Somatic |
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Brief Psychotic Disorder
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1 day, but less than 1 month
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MDE
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2 weeks
5 criteria |
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Manic Episode
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1 week or longer
3 criteria Hosp, impairment, psychotic |
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Hypomanic
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4 days
3 symptoms of manic increased productivity, increased efficiency, and increased creativity |
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Mixed Episode
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1 week
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MDD
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10-20% after childbirth
2x more likely for females than males beginning in adolescence Onset = mid 20's W/ psychotic features (higest suicide rate) A rapid onset of REM sleep Decreased percentage of slow wave sleep Increased REM sleep No prior history of depression but rapid REM onset have an increased risk of developing depression |
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MDD Course
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May last 6 months or longer, but usually w/ remission
20-30% w/ residual 50% remission rate |
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Catecholamind Hypothesis
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Depression = low norepinephirne levels
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Indolamine Hypothesis
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Depression = low dopamine levels
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Antidepressants
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1. Tricyclics (TCA's) - "classic" depression w/ vegative symptoms
2. SSRI - fewer SE/melancholic dep 3. Monoamine oxidase inhibitors (MAOI's) - phobia |
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Dysthymic Disorder
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Chronic low grade depression over 2 years for adults and 1 year for children.
No symptom free periods |
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Bipolar I
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Manic is focus
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Bipolar II
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Depression w/ Hypomania (no mania)
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Bipolar Demographics
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BP I = M/F
BP II F>M Onset in early 20's |
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BP Genitic Links
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65% Mono twins
14% Di twins |
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Cyclothymic Disorder
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Hypomania and depressive symptoms
Dep must be at least 2 years in adults and 1 year in children |
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Suicide
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60-80% who complete have made previous attempts
80% warning signs Attempts 24-44 Complete 65+ Highest for Whites Divorce, separation, widowed Hopelessness Socially-prescribed perfectionism Life stress 3 months after MDD improves Low serotonin |
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Panic Disorder
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2+ PA's w/in 1 month
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Panic Disorder Demographics
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Females > Males
Onset adolescence - mid 30's |
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Treatment for PA
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Flooding (60-70% effective)
Drugs alone have a high relapse rate (30-70%) |
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Types of Specific Phobia
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Animal
Natural Environment Situational - flying, elevators, bridges; most common Blood-Injection-Injury Other |
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Social Phobia
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Fear of social performance or sit that may cause embarrassment or humiliation as the result of scrutiny or evaluation by others.
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OCD
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Males=Females
Ave onset is earlier in males (@ 6 more males) Low serotonin Due to hyperactive right caudate Treated with tricyclic/SSRI and exposure/prevention |
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PTSD
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Experience and react to stress
Symptoms last > 1 month Treatment = Cog-Beh, exposure, anx man w/ SSRI |
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Acute Stress Disorder
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Onset w/in 4 weeks and last for 2-3 weeks
Emotional detachment Derealization Diss amnesia |
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GAD
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6 months
3 criteria: Keyed up Easily fatigued Diff concentrating Irritability Muscle tension Sleep distrubance Treated with Cog-Beh SSRI or anxiolytic |
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Somatization Disorder
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Prior to age 30 and persist for several years
4 pain 2 gastrointestinal 1 sexual 1 pseudoneurological Research indicates that 61% of Somatization Disorder patients have one or more co-occurring personality disorders. The next most frequent co-diagnoses are Major Depression (55%), Generalized Anxiety Disorder (34%), and panic disorder (26%). |
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Conversion Disorder
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Voluntary motor or sensory functioning that suggests a serious condition. Symptoms reduce under hypnosis or amytal interview.
Primary gain = psychological conflict remains intact Secondary gain = avoid activity or gain support |
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Fictitious Disorder
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Intentional feigning to be in a "sick role"
Internal reward (Malngering is external reward) |
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Dissociative Amnesia Subtypes
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1. Localized - all events; specific time
2. Selective - some events; specific time 3. Generalized - entire life 4. Continuous 5. Systematized - category specific |
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Dissociative Fugue
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Travel
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Depersonalization Disorder
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"Out of body"
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Dyspareunia
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Genital pain w/ intercourse
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Vaginismus
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Involuntary spasms that interferes w/ intercourse
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Paraphilias
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Intense sexual urge or fantasy involving obj, suffering/humiliation, or children
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Gender Id Dis
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Discomfort w/ sex and desire to be the opp.
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Dyssomnia
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Disturbance in amount, quality, and timing of sleep
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Parasomnias
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Beh or psychiological abn during sleep
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Bulimia
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Binging and compensation 2x/week for 3 months
Genetic Low levels of opioid beta-endorphins, serotonin, and norepinephrine |
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Paranoid Personality Disorder
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Distrust
4 criteria |
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Schizoid PD
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Lack of interpersonal relationships
4 criteria |
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Schizotypal PD
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Low social and odd behaviors
5+ criteria |
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Antisocial PD
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Must be 18
Conduct disorder by 15 3 criteria |
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Borderline PD
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5 characteristics
Treated w/ Dialectical Behavior Therapy |
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Histrionic PD
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Attention-seeking
5 criteria |
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Narcissistic PD
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Grandiosity
Lack of empathy Need for admiration 5 criteria |
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Avoidant PD
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Social ingibition
Feelings of inadequacy Hypersensitivity to neg eval 4 criteria |
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Dependent PD
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Excessive need to be taken care of which leads to submissive, clinging beh, and fear of separation.
5 Criteria |
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OC PD
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Order!
4 criteria |