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AATBS EPPP 2017 > Abnormal > Flashcards

Flashcards in Abnormal Deck (184):
1

BP I vs ADHD in adolescents

BP only Sx:
Grandiosity
Elation
Flight of ideas
Decreased need for sleep
Hypersexuality

2

ODD vs Disruptive Mood Dysregulation disorder

Disruptive Mood is more severe, frequent and chronic

3

Opioids intoxication

Drowsiness or coma
Slurred speech
Impaired attention/memory

4

Opiod withdrawal

Dysphoric mood
Nausea/Vomiting
Muscle aches
Lacrimation or rhinorrhea
Pupillary dilation, piloerection (hair), or sweating
Diarrhea
Yawning
Fever
Insomnia

5

Cannabis intoxication

Increase appetite
Dry mouth
Tachycardia

6

Stimulant withdrawal

Fatigue
vivid dreams
Increased appetite
Insomnia/hypersomnia
Psychomotor agitation

7

PTSD Sx Clusters

Intrusion
Avoidance
Cog and mood
Arousal and reactivity

8

LD comorbidity with ADHD

20-30% have ADHD

9

Inhalant intoxication

Dizziness
Nystagmus
In coordination
Slurred speech
Unsteady gait
Lethargy
Depressed reflexes
Tremor
Blurred vision
Euphoria
Muscle weakness

10

Schizoid vs Schizotypal

Schizoid=NO cog/perceptual distortions
No friends bc no intimacy
"Oh, don't get intimate with me"

SchizoTYPAL= eccentric, cog/perceptual distortions
No friends bc fear of people
"ODD Type"

11

Substance use disorder

Impaired control
Risky use
Pharm criteria
Social impairment

12

Social Anxiety disorder

Fear of scrutiny by others in social situations

13

Specific Phobia

Fear of specific object or situation

14

Diagnostic uncertainty
OTHER Specified

Gives REASON why don't meet criteria

15

UNspecified

Reason NOT GIVEN why didn't meet criteria

16

What is a negative Sx?

RESTRICTION in range/intensity of emotions/other functions

17

Negative Sx

Blunted emotional expression
Anhedonia
Asociality
Alogia
Avolition

18

Delusions

False beliefs despite contrary evidence

19

Types of delusions

Persecutory**
Referential**
Bizarre**
***most common in schizophrenia
Erotomanic
Grandiose
Jealous
Somatic
Mixed
Unspecified

20

Disorganized thinking

Loose, incoherent, off-track, one topics to another

21

Grossly disorganized or abnormal motor behavior

Unpredictable agitation
Disheveled appearance
Inappropriate sexual behavior
Catatonia

22

Delusional Disorder

One or more delusions for one month or more

23

Schizophrenia Dx criteria

2+ active phase Sx for at least one month
1 Sx must be delusions, hallucinations, or disorganized speech
Continuous signs for 6 mos.
Significant impairment of functioning

24

Schizophrenia prevalence rates

.3-.7%
Slightly less for females

25

Schizophrenia age of onset

Males: early - mid 20s
Females: late 20s

26

Schizophrenia concordance rates

Bio sibs 10%
Fraternal twins 17%
Identical twins 48%
2 parents 46%

27

Dopamine hypothesis

Excessive dopamine, over sensitive receptors

28

Brain abnormalities in schizophrenia

Enlarged ventricles
Smaller hippo, amygdala, globus pallidus
Hypofrontality (negative Sx, poor cognition)

29

Traditional vs atypical antipsychotics

Traditional: reduce + Sx, but risk tar dive dyskinesia
(Haloperidol, fluphenazine)
Atypical: reduce + and - Sx
(Clozapine, risperidone)

30

Schizophreniform disorder

1-6 mos
Social/occupational impairment not necessary
2/3 go on to full Schizophrenia or schizoaffective Dx

31

Brief Psychotic disorder

1 DAY - 1 mo. (Often response to overwhelming stressor)
1 or more Sx:
Delusions**
Hallucinations**
Disorganized speech**
Motor Sx or catatonic

32

Schizoaffective disorder

Concurrent schizophrenia Sx + major depressive or manic Sx
At least 2 week period w/o mood Sx

33

BP I

At least 1 manic episode
Marked impairment req hospitalization or includes psychotic feature
MAY include 1 or more hypomanic or major depressive episodes

34

BP II

REQUIRES at least one hypomanic + one major depressive

35

What's the difference between mania and hypomania?

Mania: psychosis and/or requires hospital; marked impairment

Hypomania: doesn't cause impairment or req hospital

36

Rx for BP

Lithium 60-90% effective for classic BP I (discrete high/low episodes)
Anti seizure Rxs (carbamazepine or divalproex sodium) effective for rapid cycling or dysphoric mania
Antipsychotics for acute mania (olanzapine, risperidone)

37

Cyclothymic disorder

Numerous periods of hypomanic and depressive episodes
Don't meet full criteria
Not Sx-free for more than 2 mos at a time
Duration: 2 yrs adults, 1 yr child/adolescent

38

Major Depressive Disorder

At least 5 Sx for at least 2 weeks:
**depressed mood
**loss interest or pleasure in most/all activities
(**must have one)
Sig weight loss
Weight gain, or up/down appetite
Insomnia/hypersomnia
Psychomotor agitation/retardation
Fatigue/loss of energy
Worthlessness/excessive guilt
Inability to think or concentrate
Recurrent thoughts of death
Suicide ideation or attempts

39

MDD comorbidity with anxiety

60%

40

MDD prevalence

7% in USA
Adolescent females 1.5-3 times higher than males
18-29 yo 3xs higher than over 60

41

MDD peak age of onset

Mid 20s

42

Disruptive Mood Disregulation Disorder

--severe recurrent outbursts (verbal/behaviorally)
--chronic persistent angry mood between outbursts
--Sx 12 mos, 2 of 3 settings
--inconsistent with developmental level
--Dx: 6-18 yo (onset before 10)

43

Associated features of MDD

EEG abnormalities in sleep - 40-60%
Sleep continuity disturbances, reduced Stage 3/4 (slow wave)
Reduced REM latency (early REM onset)
Increased REM duration

44

Pseudodementia vs neurocognitive disorder

Pseudo--> abrupt onset, patient concerned with impairments
Neurocog--> gradual onset, patient denies/unaware

45

MDD prevalence

.50 monozygotic twins
.20 dizygotic twins
1.5-3 xs more common in 1st degree relatives

46

Catecholemine hypothesis

MDD = deficit in norepinephrine

47

Indolamine hypothesis

MDD = deficit in serotonin

48

Consequence of untreated MDD

Increased cortisol = atrophy of neurons in hippo

49

Lewinsohn behavioral theory of depression

Operant conditioning -- low rate of response-contingent reinforcement

50

Seligman Learned Helplessness

Attributes events to internal, stable, global factors
Updated version: HOPELESSNESS is proximal and sufficient cause

51

Rehm Self-Control Model

cannot self-monitor, self evaluate, self reinforce properly

52

Beck Cognitive theory (depressive triad)

Self, world, future

53

MDD differential Dxs

psychotic Sx --> if exclusively during MDD episode (MDD w/psychotic features)
Psychosocial stressor --> Adjustment Disorder w/depressed mood (MDD criteria not met)
normal mood, feelings of loss/emptiness, decreases over days/weeks--> Uncomplicated Bereavement

54

TCAs (imipramine)

Most effective: Classic MDD w/vegetative Sx, worse in am, acute onset, moderate Sx severity

55

SSRIs

Mod to severe MDD
Low side effects, low risk of fatal OD compared to TCAs

56

MAOIs

Atypical Sx of MDD

57

SNRIs

Comparable to TCAs/SSRIs in effectiveness
Differ in side effects
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)

58

Side effects of ECT

Temporary ant and retro amnesia
Confusion
Disorientation
(Reduced only of unilateral Tx: right, non-dominant side)

59

Persistent Depressive Disorder
(Dysthymia)

Depressed mood most days (2 yrs adults; 1yr kids)
Not Sx-free more than 2 mos
At least two Sx:
**Poor appetite/overeating
**insomnia/hypersomnia
**low energy/fatigue
low self esteem
**Poor concentration/diff making decisions
Hopelessness
(**same as MDD)

60

Tx for Persistent Depressive Disorder

CBT or IPT + SSRIs

61

Premenstrual Dysphoric Disorder

Most cycles, at least 5 Sx week before period
Sx improve few days after onset
Absent or min Sx post-period
Must have one: affect lability/irritability/anger, depressed mood or self-dep thoughts, anxiety/tension
At least one: decreased interest in usual activities, impaired concentration, lethargy, change in appetite, insomnia/hypersomnia, overwhelm/out of control, physical Sx

62

Suicide risk factors

Age: 45-54 highest (both sexes combined)
75 and up (males)
Gender: 4xs more males complete, 2-3 xs more females attempt
Race: highest for whites (except NAmer 15-34 2xs higher)
Divorced, separated, widowed - highest
Single
Married
60-80% commit tried before
80% give definite warning

63

Life stressors Assoc with risk of suicide

Failed at work or school
Rejected by loved one
Living alone
Absence of social support

64

Perfectionism and suicide risk

Socially-prescribed==> increased depression, low suicide risk

Self-oriented==> high suicide risk only with increased life stress

65

Suicide interventions

*Hospitalization: attempt or imminent risk

*Outpatient crisis unit: mod risk (intention, lack of means)
(Goals: decrease social isolation, removing lethal means, expressing anger other ways, red anxiety/sleep problems, focusing on ambivalence re: making attempt until crisis has passed)

*Outpatient therapy: follow up to hospital or outpt clinic, or if low risk
(CBT, IPT, DVT, problem-solving therapy)

66

How does anxiety differ from depression?

both have neg affect, but anxiety has higher positive affect and autonomic arousal

67

Anxiety vs depression Sx

"Pure" Anxiety Sx:
Apprehension
Tension
Trembling
Excessive worry
Nightmares

"Pure"depression Sx:
Poor mood
Anhedonia
Loss of interest in activities
Suicide ideation
Loss of libido

Overlapping Sx:
Poor concentration/memory
Irritability
Fatigue
Insomnia
Hopelessness

68

Separation Anxiety

Child: 4 weeks
Adult: 6 months

69

Causes of school refusal (by age)

5-7 yo -- beginning school
10-11 yo -- change of schools; social phobia
14-16 yo -- social phobia; depression; POOR prognosis

70

Tx for Separation Anxiety

Systematic desensitization
Cognitive approaches -- for older kids/adolescents

71

Specific Phobia

Intense fear/anxiety re: SPECIFIC object or situation
Typically lasts 6 mos or more

72

Specifier for Specific Phobia

Animal
Natural environment
Blood-injection-injury
Situational
Other

73

Etiology of Specific Phobia

Biological : abnormal serotonin, norepinephrine, GABA)

74

Two-factor theory of Specific Phobias

Classical conditioning + operant conditioning
Operant (learned fear neutral stimulus CS when paired with fear arousing US)
Classical (due to avoidance cond, avoidance of CS)

75

Tix for Specific Phobias

Exposure with response prevention
Invivo exposure is best

76

Social Anxiety Disorder (Social Phobia)

--fear of social situations
--fear of Sx in front of others
--avoids situations or endures with anxiety/fear
--fear, anxiety, avoidance for 6 mos or more

77

Etiology of social phobia

Behavioral inhibition -- fear of unfamiliar people/situations
Selective attention to socially threatening info
Overestimation of likelihood of neg outcomes

78

Tx for Social Anxiety Disorder

Exposure w/response prevention
Social skills training
Cognitive restructuring
SSRIs, SNRIs (beta blocker propranolol: less physical Sx)

79

Panic Disorder

Recurrent, unexpected panic attacks
At least one attack followed by 1 mo concern about it
Or consequences
Or significant maladjust behavior related to attack

80

Definition of panic attack

4 Sx:
Palpitations
Sweating
Trembling
Derealization/depersonalization
Feeling choked
Chest pain
Parasthesias
Fear losing control

81

Prevalence of panic disorder

2-3% adults
Females 2xs more likely

82

Tx for Panic Disorder

Panic Control Therapy (PCT)=psychoeducation + relaxation+ cognitive restructuring + introceptive exposure

Imipramine
SSRIs/SNRIs
Benzos
***30-70% relapse once discontinued Rx

83

Agoraphobia

At least 2:
Public transportation
Open spaces
Enclosed spaces
In line or part of crowd
Outside home alone

--fear escape difficult or no help if has Sx
--actively avoid situations, REQUIRES A COMPANION, or endures intensity

84

Specific Phobia vs Social Anxiety vs Agoraphobia

Specific phobia
--only SPECIFICsituation/ object
--related to something other than concern about Sx
Social Anxiety
--related to scrutiny of OTHERS
--INCREASED in presence of others
--companion not wanted
Agoraphobia
--requires companion

85

Tx for Agoraphobia

In Vigo exposure w/response prevention (intensive or graded)
Intensive better for long term effects

86

GAD

At least 6 mos
Difficult to control, constant
3 or more Sx (1 Sx kids):
Restlessness
Easily fatigued
Diff concentrating
Irritability
Muscle tension
Sleep disturbance

87

GAD comorbidity with other disorders

50%

88

Tx for GAD

CBT
SSRIs/SNRIs
Benzos
Anxiolytics (busperone -- Buspar)

89

OCD

Obsessions: persistent thoughts/impulses
Compulsions: reptile and deliberate behaviors/mental acts driven to perform as attempt to relieve stress

90

OCD prevalence

1.2%
Equal in adults
Earlier onset in males

91

OCD etiology

Low serotonin
Rat caudate nucleus -- converts sensory input into cognitions/actions -- overactive in OCD
Cingulate cortex--mediate emotional reactions

92

Diff Dx
OCD vs OCPD

OCD
rituals are to reduce anxiety

OCPD
rituals due to perfectionism
no obsessions/compulsions
Preoccupation with orderliness, perfection, control
"Anal retentive"

93

OCD Tx

exposure w/response prevention
TCA clomipramine
SSRIs
thought stopping

94

Reactive Attachment Disorder

At least 2:
--min SE response to others
--limited + affect
--episodes of unexplained irritability, sadness, fear of interacting with adult caregivers

Due to extreme weather insufficient care (at least 1):
--basic emotional needs not met (comfort, stimulation, affection)
--repeated change in primary caregiver - limited attachment
--rearing in unusual environment

Before age 5

95

Disinhibited Social Engagement Disorder

Inappropriate interaction with unfamiliar adults

At least 2:
--reduced/absent reticence in approaching/interacting w/unfamiliar adults
--overly familiar behavior
--low or absent checking with caregiver after venturing away
--willingness to accompany unfamiliar adult (little/no hesitation)

Devel age at least 9 mos
Extreme insufficient care

96

PTSD Sx categories (adults/kids over 6)

Exposure to actual or threat death, injury, sex violence
Intrusive symptoms
Avoidance of stimuli
New changes in cognition/mood

97

PTSD Sx Cateogries (under 6 yo)

All same except neg changes cog and mood is:
Alterations in arousal/reactivity to event (2 Sx)

98

PTSD Tx

CBT: exposure, cog restructuring, anxiety management
SSRIs

99

Acute Stress Disorder

3 days - 1 month
9 Sx from PTSD

100

Adjustment Disorder

Response to psychosocial stressor
Within 3 months
Remits in 6 months

101

Dissociative Disorders

Disruption or discontinuity of consciousness, memory, identification, emotion, perception, body representation, motor control and behavior

102

DID

2 or more distinct personality states or experience of possession
Recurrent gaps in memory (ordinary events, personal info, or traumatic event)
R/O cultural influences

103

Dissociative Amnesia

Inability to recall important personal information
Usually due to a Traumatic event

104

Types of dissociative amnesia

Localized --> ALL events related to circumscribed period
selective --> SOME events related to circumscribed period
generalized --> loss of memory for ENTIRE LIFE
continuous --> subsequent to a period of time thru present
systematized --> certain CATEGORY of info

105

Dissociative Fugue

Purposeful travel without recall some or all of the past

106

Depersonalization/Derealization Disorder

Depersonalization=sense of unreality, detachment, being outside observer of SELF

Derealization=sense of unreality about SURROUNDINGS

107

Somatic Sx Disorder

PRESENCE of one or more somatic Sx
Causes distress
Excessive thoughts, feelings, behaviors re: Sx
Usually 6 mos or more

At least 1 (can change):
Persistent and disproportionate thoughts re: seriousness of Sx
Persistently high level of anxiety about health or Sx
Excessive time/energy devoted to health concerns/Sx

108

Illness Anxiety Disorder

Preoccupation with serious illness
ABSENCE of Sx (or mild)
High anxiety about health
Excessive health-related behaviors
Illness of concerns may change over time
6 mos or more

109

Conversion Disorder

Presence of Sx of voluntary motor or sensory functioning
Suggests serious neuro or medical condition
**evidence of incompatibility between Sx and medical condition
Specifiers: Sx type; course; psycho stressor (present/absent)

110

Factitious Disorder

Falsify Sx associated with deception
--feigning
--exaggeration
--simulation
--induction (ingestion, self-injury)
Presents self to others as ill/impaired
Deception in ABSENCE OF REWARD

Imposed on self/Imposed on an other

No specific Tx

111

Pica (Sx duration)

One mo or more

112

Anorexia Nervosa

Restriction of energy intake leads to sit low body weight

Intense fear of gaining weight
---OR---
Behavior interferes with weight gain

Disturbed perception of body weight/shape
---OR---
Lack of recognition of low weight

113

Anorexia specifiers

Course
Severity based on BMI
Type: restrictive eating or binge/purge

114

Anorexia Tx

CBT

115

Etiology of Anorexia

Bio factors: genetic, neurotramsmitter abnormalities, high serotonin (relieved by starvation)
Perfectionism
90% female
50% anxiety disorder (usually comes first)

116

Differential Dx: Bulimia vs Anorexia binge/purge type?

???????
Bulimia--weight not low
Anorexia--very low body weight

117

Bulimia

1x/week for 3 mos:
--recurrent episodes of binge eating (lack of control)
--inappropriate compensatory behavior
Self eval based on body shape/weight

118

Bulimia Tx

CBT
nutrition counseling
TCA (imipramine)
SSRI (fluoxetine--Prozac)

119

Bulimia etiology

LOW serotonin
Low beta-endorphin

120

Binge Eating Disorder

Binging, no purging
Once/week for 3 mos

121

Enuresis

2xs/week for 5 mos
5 yo or older

122

Encopresis

1/mo for 3 mos
4 yo or older

123

Insomnia Disorder

difficulty initiating sleep
Difficulty maintaining sleep
Early morning awakening/ no return to sleep
3xs/week for 3 mos

124

Insomnia Tx

sleep hygiene Ed
Stimulus control
Relax training
Cog therapy

125

Hypersomnolescence Disorder

At least seven hours sleep, still sleepy
At least one:
Recurrent to sleep periods in same day
Difficulty feeling awake after abrupt awakening
Prolonged but non-restorative sleep more than nine hours a day

126

Narcolepsy

3xs/week, 3 mos or more
Cataplexy
Hypocretin deficiency
REM latency less than 15 min

127

Obstructive Sleep Apnea Hypopnea

(1) at least 5 obstructive apneas or hypopneas per hour of sleep plus:
(A) nocturnal breathing disturbances OR
(B) Daytime sleepiness
---OR---
(2) 15 or more apneas or hypopneas per hour of sleep regardless of other symptoms

128

Non-REM sleep arousal disorders

Incomplete awakening (stage 3/4)
Sleepwalking
Sleep terror

129

Erectile disorder

At least one on all/almost all sex occasions:
Marked difficulty obtaining erection
Mark difficulty maintaining erection
Marked decrease in erectile rigidity

130

Premature ejaculation

Within one minute of penetration
Or before desires it
At least 6 months

131

Tx for Premature Ejaculation

Sensate focus
Start stop technique
Squeeze technique
SSRIs - treats low serotonin

132

Rx for Paraphillic Disorders

In vivo aversion therapy - done in past, only short-term benefits
Now:
CBT
Behavior strategies--covert sensitization (aversive cond in imagination) or orgasmic conditioning (replace fantasy while masturbating)
Rx: DepoProvera shot

133

ODD

angry/irritable mood, argumentative/defiant behavior, vindictiveness
At least 4 Sx w/at least one non-sibling:
--often loses temper
--often argues with authority figures
--often refuses to comply with the rules or requests from authority figures
--blames others for mistakes

134

Intermittent Explosive Disorder

Lack of control aggressive impulses, we current behavioral outbursts
Outbursts are not premeditated
6 yo or more
(A) verbal/physical aggression: two times a week, three months or more
--OR--
(B) 3 behavior outburst, damage to property and/or physical assault during a 12 month

135

conduct Disorder

Violates the rights of others
Need 3 Sx past 12 months and one symptom past six months:
--aggression to people/animals
--destruction of property
--deceitfulness or theft
--serious violation of rules

136

Types of conduct disorder

Childhood onset: 1Sx before age 10
Adolescent onset: no Sx prior to age 10
Unspecified onset: Unknown onset

137

Moffitt etiology of CD

Life course persistent type:
--begins early (sometimes by age 3)
--neurological difficulties + difficult temperament + adverse impact

Adolescence limited type:
--temporary
--reflects "maturity gap" (bio maturation and lack of opportunities for adult privilege and rewards)
--usually committed with peers, and consistent across situations

138

Tx for CD

Parent Management Training (PMT)
Reward for + behavior replaces physical punishment

Multi-systemic Treatment (MST)

139

Substance Use Disorders

2 Sx in 12 mos:
--impaired control
--social impairment
--risky use
--pharmacological criteria (tolerance/withdrawal)
All classes of drugs except caffeine

140

Etiology of Substance Use Disorder

Conger: tension-reduction hypothesis=alcohol reduces anxiety and fear thru neg reinforcement
Marl att & Gordon: over learned, maladaptive behavior/habit
Relapse Prevention Therapy

141

Tx for substance use disorder

Naltrexone (opiod antagonist)
Disulfiram (Antabuse)
Nicotine replacement or bupropion (tobacco)

142

Sedation, hypnotic or Anxiolytic Intoxication

Slurred speech
Incoordination
Unsteady gait
Nystagmus
Impaired cognition
Stupor/coma

143

Sedation, Hypnotic or Anxiolytic withdrawal

Hyperactivity
Hand tremor
Insomnia
Anxiety
Nausea/vomiting
Transient hallucinations
Grand mal seizures
Psychomotor agitation

144

Inhalant Intoxication

Drowsiness
Nystagmus
In coordination
Stupor/coma
Euphoria
Slurred speech
Unsteady gait
Lethargy
Blurred vision
Depressed reflexes
Psychomotor retardation
Tremor
General muscle weakness

145

Tobacco withdrawal

Irritability/anger
Anxiety
Poor concentration
Increased appetite
Restlessness
Low mood
Insomnia

146

Neurocognitive disorders 6 domains of (poor) cog functioning

Complex attention
Executive functioning
Memory and learning
Language
Perceptual- motor
Social cognition

147

Delirium

Disturbance in attention/awareness over short period
Tends to fluctuate in severity thru day
At least one additional cog disturbance

148

Delerium high risk groups

Older adults
Low cerebral reserve
Post cardiotomy patients
Burn patients
Drug dependent but in withdrawal

149

Tx goals for Delerium

Treat cause
Reduce agitated behaviors thru environ manipulation + psychosocial interventions
Haloperidol

150

Major vs Mild Neurocognitive Disorder

Major--
SIGNIFICANT decline in one or more cog domains
INTERFERES with independence

Minor--
MODEST decline in one or more cog domains
DOES NOT INTERFERE with independence

151

Neurocognitive Disorder -- 13 types

Alzheimer's
Parkinson's
Huntington's
Lesley body disease
Vascular disease
Frontotemporal lobar degeneration
TBI
HIV infection
Prion disease
Substance or Rx use
another medical condition
Multiple etiologies
Unspecified

152

Types of conduct disorder

Childhood onset: 1Sx before age 10
Adolescent onset: no Sx prior to age 10
Unspecified onset: Unknown onset

153

Moffitt etiology of CD

Life course persistent type:
--begins early (sometimes by age 3)
--neurological difficulties + difficult temperament + adverse impact

Adolescence limited type:
--temporary
--reflects "maturity gap" (bio maturation and lack of opportunities for adult privilege and rewards)
--usually committed with peers, and consistent across situations

154

Tx for CD

Parent Management Training (PMT)
Reward for + behavior replaces physical punishment

Multi-systemic Treatment (MST)

155

Substance Use Disorders

2 Sx in 12 mos:
--impaired control
--social impairment
--risky use
--pharmacological criteria (tolerance/withdrawal)
All classes of drugs except caffeine

156

Etiology of Substance Use Disorder

Conger: tension-reduction hypothesis=alcohol reduces anxiety and fear thru neg reinforcement
Marl att & Gordon: over learned, maladaptive behavior/habit
Relapse Prevention Therapy

157

Tx for substance use disorder

Naltrexone (opiod antagonist)
Disulfiram (Antabuse)
Nicotine replacement or bupropion (tobacco)

158

Sedation, hypnotic or Anxiolytic Intoxication

Slurred speech
Incoordination
Unsteady gait
Nystagmus
Impaired cognition
Stupor/coma

159

Sedation, Hypnotic or Anxiolytic withdrawal

Hyperactivity
Hand tremor
Insomnia
Anxiety
Nausea/vomiting
Transient hallucinations
Grand mal seizures
Psychomotor agitation

160

Inhalant Intoxication

Drowsiness
Nystagmus
In coordination
Stupor/coma
Euphoria
Slurred speech
Unsteady gait
Lethargy
Blurred vision
Depressed reflexes
Psychomotor retardation
Tremor
General muscle weakness

161

Tobacco withdrawal

Irritability/anger
Anxiety
Poor concentration
Increased appetite
Restlessness
Low mood
Insomnia

162

Neurocognitive disorders 6 domains of (poor) cog functioning

Complex attention
Executive functioning
Memory and learning
Language
Perceptual- motor
Social cognition

163

Delirium

Disturbance in attention/awareness over short period
Tends to fluctuate in severity thru day
At least one additional cog disturbance

164

Delerium high risk groups

Older adults
Low cerebral reserve
Post cardiotomy patients
Burn patients
Drug dependent but in withdrawal

165

Tx goals for Delerium

Treat cause
Reduce agitated behaviors thru environ manipulation + psychosocial interventions
Haloperidol

166

Major vs Mild Neurocognitive Disorder

Major--
SIGNIFICANT decline in one or more cog domains
INTERFERES with independence

Minor--
MODEST decline in one or more cog domains
DOES NOT INTERFERE with independence

167

Neurocognitive Disorder -- 13 types

Alzheimer's
Parkinson's
Huntington's
Lesley body disease
Vascular disease
Frontotemporal lobar degeneration
TBI
HIV infection
Prion disease
Substance or Rx use
another medical condition
Multiple etiologies
Unspecified

168

Alzheimer's major vs mild Neurocognitive disorder

Major: evidence of causative genetic mutation
Clear evidence of memory loss
Steady progressive and gradual decline in cog without plateaus
AND at least ONE OTHER COG DOMAIN

Minor: same, but no other cog domain

169

Stages of Alzheimer's

1-3 yrs:
Antegrade amnesia (declarative memories)
Poor visuospatial skills (wandering)
Indifference
Irritability
Sadness
Anomia

2-10 years:
Increased retrograde amnesia
Flat/labile mood
Restlessness/agitation
Delusions
Fluent aphasia
Acalculia
Ideology apraxia

8-12 years:
Severe deterioration intellect functioning
Apathy
Limb rigidity
Incontinence

170

Stages of Neurocognitive disorder due to HIV

Stage 0 --> normal
Stage 0.5 --> Equivocal/subclinical: minor Sx, no impairment, mild signs
Stage 1--> Mild: evidence of impairment, can perform all but most demanding ADLs, can walk without assistance
Stage 2--> Moderate: cannot work, can do basic self care, ambulatory but needs assistance
Stage 3--> Severe: major intellectual incapacity or motor disability
Stage 4--> End Stage: nearly vegetative, nearly mute, paraparesis/ paraplegia, incontinence

171

Personality Disorders -- clusters

Cluster A--> Odd/Excentric
Cluster B --> Dramatic, emotional, erratic
Cluster C --> Anxiety, fearfulness

172

Age of onset for PDs

Adolescence or early adulthood
If under 18, need Sx for 1 yr
Antisocial PD no Dx under 18

173

Paranoid PD

others exploiting, harming or deceiving
Preoccupation with doubts of trustworthiness of others
Reluctant to confide in others
Reads demeaning content into benign remarks/events
Bears grudges
Perceives attacks on character- reacts w/anger and counterattacks
Suspicious of partners fidelity

174

Schizoid PD

Detach from interpersonal relationships & restricted range of emotion in social settings
No desire or enjoyment from close relationships
Almost always chooses solitary activities
Lacks close friends
Indifferent to praise/criticism
Emotional coldness/detachment
Little interest in sexual relationships

175

Schizotypal PD

Reduced capacity for close relationships
ECCENTRICITIES in cognition, perception, and behavior
Ideas of reference
Odd behavior/magical thinking
Bodily illusions/unusual perceptions
Odd thinking/speech
Suspicious, paranoid ideation
Inappropriate/constricted affect
Peculiar behavior/appearance
Lacks close friends
Excess social anxiety

176

Antisocial PD

Failure to conform to social norms, respect lawful behavior
Deceitfulness
Impulsivity
Irritation/Anger
Reckless disregard for safety of self/others
Consistent irresponsibility
Lack of remorse

177

ASSOCIATED Sx of Antisocial PD

Inflated sense of self
Lack of empathy
Superficial charm

178

Borderline PD ages

most common ages 19-34
By age 40: 75% DNQ

179

features of DBT

group skills training
Individual outpatient therapy
Telephone consult

180

Histrionic PD

Emotionality and attention-seeking
Discomfort when not center of attention
Inappropriate sex provocative
Rapid shifting and shallow emotions
Consistent use of physical appearance to gain attention
Excessive impressionistic speech, lacking detail
Exaggerated e press ion of emotion
Easily influenced by others
Considers relationships to be more intimate than they are

181

Narcissistic PD

Grandiose sense of self importance
Fantasies of unlimited success, power, beauty, love
Believes (s)he is unique, only understood by other high-status people
Requires excessive admiration
Sense of entitlement
Interpersonally exploitative
Lacks empathy
Envious of others
Arrogant behaviors/attitudes
**starts in early adulthood

182

Avoidant PD

social inhibition, inadequacy

183

Dependent PD

Need to be taken care of
Submissive
Clingy

184

Obsessive-Compulsive PD

Preoccupied with order
PERFECTIONISM
Does NOT involve obsessions or compulsions