Abnormal Psych Flashcards
(118 cards)
1
Q
DSM 5-
A
Catergorical approach that divides the mental disorders into types that are defined by diagnostic criteria and whether client meets minimum criteria for diagnosis
2
Q
Polythetic Criteria
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allows for individual differences, requires client to present with only a subset of characteristics from a larger list , two clients can have somewhat different symptoms but receive same diagnossi
3
Q
Diagnostic Uncertainty
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indicated by either
Other Specified Disorder: coded when clinician wants to specify why clients symptoms do not meet criteria for a specific diagnosis
Unspecified Disorder: coded when the clinician does want to indicate the reasons why the clients symptoms do not meet criteria for a specific diagnosis
4
Q
Outline for Cultural Formulation:
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guidelines for assessing four factors: clients cultural identity, the clients cultural conceptualization of distress, psychosocial stressors, and cultural factors that impact clients vulnerablity and resilence, and cultural factors relevant to relationship between client and therapist
5
Q
Cultural Formation Interview:
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CFI semi structured interview consisting of 16 questions designed to obtain information on clients view of social cultural context of problems,
Four domains: cultural perceptions of cause, context, support,
6
Q
Cultural Syndromes:
Cultural Idioms:
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Cultural syndromes- clusters of symptoms and attributions that co occur among individuals from a particular culture
Cultural Idioms of distress: members of different cultures to express distress and provide shared ways of talking about personal and social concerns
7
Q
Intellectual Disability :
A
deficits in intelluctual functioning
Deficits in adaptive functioning
Onset during developmental period
Severity based on conceptual, social and practical domains
8
Q
Intellectual Disability Etiology
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5% due to hererdity( Tay sachs, Fragile X syndrome, PKU)
30% chromosomal changes and exposure to toxins 10% to pregnancy and prenatal problems, 5% to acquired medical conditions, and unknown in 30% -low birth weight strongest predictor of severity in unknown cases
9
Q
Childhood Onset Fluency Disorder( Stuttering)
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begins around 2-7 and symptoms become worse when pressure to communicate
65 to 85% of children recover, with severity of dysfluency at age 8 being a good predictor of prognosis
10
Q
Childhood Onset Fluency Treatment:
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reducing psychological stress at home in young children,
Habit reversal treatment for adults and adolescents - awareness, relaxation, motivation, competing, and generalization training
competing response is regulated breathing, deep diaphragmatic breath
11
Q
Autism Spectrum Disorder Criteria:
A
Persistent deficits in social communication and interaction across mutiple contexts as manifested in nonverbal communication, social emotional reciprocity, and development of relationships
Restricted repetitive patterns of behavior, interests, manifeted by repepitive motor movements, use of objects or speech, insistence on sameness, inflexible adherence to routines, or ritualized by behavior,
Symptoms during developmental period
12
Q
Autism Spectrum prognosis
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Generally poor. Best outcome is associated with an ability to communicate verbally by age 5 or 6 an IQ over 7, later onset of symptoms
13
Q
Autism Spectrum Etiology:
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unusually rapid head growth during first year of life abornormalities in amygdala and cerebellum, higher among biological siblings of individuals with this disorder
14
Q
Autism Spectrum Disorder Treatment:
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parent management training, social interaction skills, shaping and discrimination training
15
Q
Attention Deficit Hyperactivity Disorder Criteria;
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characterized by pattern of inattention and hyperactivity that has lasted at least 6 months has an onset prior to age 12 and occurs in at least 2 settings and requires at least 6 symptoms of inattention or hyperactivity
Inattention- fails to give close attention to detail, sustaining attention to tasks, doesnt listen to when spoken to directly, fails to finish schoolwork or chores, is easily distracted by extraneous stimuli, often forgetful in daily activities
Hyperactivity- impulsivity- frequently fidgets or squirms in seats, often leaves seat at inappropriate times, frequently runs or climes in inappropriate situations, talks excessively, difficulty waiting his or her turn
16
Q
ADHD associated features:
A
test lower on IQ tests than other children although their intelligence is average or above average,
Social adjustment, peer rejection, low self esteem, poorer health outcomes,
Adults with ADHD elevated risk for Bipolar disorder, anxiety, antisocial behavior and substance abuse
17
Q
Prevalence and Gender of ADHD
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5% for children and 2.5% for adults,
Gender: overall more prevalent in males than females, inattentive more common for females
18
Q
ADHD course prognosis:
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65 to 80% of children with ADHD continue to meet criteria in adolescence.
In adults impulsivity takes the form of impatience and irritability, problems related to management of time and money, reckless driving, and impulsive sexuality
19
Q
ADHD treatment
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Methyphenidate( Ritalin) and other CNS stimulants have benefical effects on core symptoms of ADHD in 75% of cases,
Parent training, and teacher training,
*studies indicate that medication management alone and and combined treatment of medication and behavioral management produce similar reduction in core symptoms of ADHD, however follow up in 3 and 8 years showed that the superior benefits of medication alone or combined did not persist and outcomes were comparable to those for children who only had behavioral management
20
Q
Specific Learning Disorder:
A
diagnosed when a person exhibits difficulties related to academic skills indicated by presence of at least one characteristic symptom that persists for at least 6 months despite the provision of interventions targeting those difficulties , also require individual academic skills are below those expected, began during the school age years and impair functioning
Comorbid ADHD in 20 to 35% of children with SLD
More common in males than females
Etiology: cerebellar vestibular dysfunction, incomplete dominance and other hemisphere abnormalities, and exposure to toxins.
21
Q
Tourettes Disorder Diagnostic Criteria
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Presence of at least one one vocal tic and multiple motor tics that appear together or at different times, persist for more than 1 year and began prior to age 18.
*linked to elevated levels of dopamine in the caudate nucleus
common features related are obsessions and compulsions and the rate of OCD is not only higher for individuals with Tourettes Disorder but also biological relatives, also hyperactivity, impulsivity, and distractibility
22
Q
Tourette’s Disorder Treatment
A
pharmacotherapy of antipsychotic drugs including haloperidol and pimozide have been effective in 80% of cases.
*drawback is negative side effects,
SSRI can be helpful for alleviating the obsessive compulsive symptoms, clonidine or desipramine
CBIT- evidence based treatment for tics and incorporates habit reversal, relaxation training, and psychoeducation
23
Q
Behavioral Pediatrics Hospitalization
A
hospitalized children are at increased risk for emotional and behavioral problems that range from mildly disruptive behaviors to anxiety, depression, or severe withdrawn
Children 1-4 have most negative reactions to hospitalization due to child’s seperation
24
Q
Behavioral Pediatrics Compliance
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lack of compliance with medical regimens includes lack of knowledge or skill, parent child conflict, and developmental issues, studies have shown that compliance in adolescent is due to concerns about peer acceptance, reduced conformity to rules and reduced parental supervision
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Delusional Disorder Diagnostic Criteria
presence of one or more delusions that least at least 1 month
26
Delusional Disorder Types:
Erotomanic- person believes someone is in love with him or her
Grandiose: person believes he or she has great but unrecognized talent
Jealous: person believes spouse is unfaithful
Persecutory: person believes that he or she is being conspired against
Somatic: person believes that he or she has an abnormal bodily function or sensation
Also, mixed and unspecified
27
Schizophrenia Diagnostic Criteria
Presence of at least 2 active phase symptoms:delusions, hallucinations, disorganized speech, grossly disorganized behavior or negative symptoms for at least 1 month with continuos signs of the disorder for at least 6 months and significant impairment in functioning
*prevelance is .3 to .7% for population, and slightly lower for females than males
common comorbid disorders are Substance Use Disorder, and Tobacco Use disorder
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Schizophrenia Prognosis
onset is usually between late teens and early 30s with the peak being between early to mid 20s for males and late 20s for females.
*better prognosis is associated with good premorbid adjustment, an acute and late onset, female gender, presence of a precipitating event, brief duration of active phase symptoms, family history of mood disorder, and no family history of schizophrenia
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Schizophrenia concordance rates
```
Risk for Schizophrenia
Biological Sibling 10%
Fraternal Twin 17%
Identical twin ( 48%
Children of two parents with schizophrenia 46%
```
30
Schizophrenia Etiology/Dopmaine Hypothesis
Enlarged ventricles is the most common structural brain abornmality , hypofrontality has been linked to the negative symptoms of schizophrenia
*dopamine hypothesis- attributes it to elevated dopamine levels
31
Schizophrenia Treatment:
traditional antipsychotics- haloperidol and fluphenazine, most useful for eliminating positive symptoms ( hallucinations, delusions and disordered thoughts)
side effects- tardive dyskinesia
Atypical antipsychotics: clozapine, and risperidone, less likely to cause tardive dyskinesia, and may be affective for both positive and negative symptoms
effctiveness of antipsychotic is enhanced with CBT, psychoeducation, social skills, training,
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Schizophrenia Expressed emotion
expressed emotion is open criticism, hostility toward the patient, over involvement, and high levels of expressed emotions in families have bee linked to high relapse and rehospitilization
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Schizophreniform Diagnostic Criteria
- same symptoms as schizophrenia, but present for at least 1 month but less than 6 months
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Brief Psychotic Disorder Diagnostic Criteria:
presence of one or more of four symptoms( delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, with one symptoms being delusions, hallucinations or disorganized speech.
Symptoms present for 1 day but less than 1 month - may develop following exposure to overwhelming stressor
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Bipolar 1 Diagnostic Criteria
Requires at least one manic episode which is a period of abnomally expansive and irritable mood and increased goal directed behavior or energy , for at least 1 week and present most of the day, with three symptoms such as inflated self esteem, decreased need for sleep, flight of idea, excessive talkiveness
* most common comorbid disorder is anxiety, and substance abuse,
* lifetime risk for completed suicide for bipolar disorder is 15 times the risk for general population
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Bipolar 1 Etiology
genetic factors have been linked to bipolar disorders, twin studies have found concordance rates ranging for .67 to 1.0 for monozygotic twins and about .20 for dizygotic twins,
Family studies have found that first degree relatives for individuals with bipolar disorder are at elevated risk for bipolar and depression
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Bipolar 1 treatment:
includes pharmacotherapy, Lithium has reported effective in 60 to 90 % of cases with classic bipolar 1 disorder,
*lithium compliance is a problem, pts discontinue because they think they feel better, dont want to give up the highs of mania,
Patients who do not respond to lithium or have rapid cycling , anti seizure drug such as carbamezepine, or divalproex sodium may be effective,
Psychophamacotherapy is enhanced when combined with CBT, family focused therapy or interpersonal therapy
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Bipolar II Diagnostic Criteria
requires at least one hypomanic episode and one major depressive episode,
Hypomanic episode is a distinct period of abnormally and elevelated, irritable mood that lasts for at least 4 consecutive days and is presently most of the days nearly everyday
Major depressive disorder- lasts at least two weeks with at least 5 symptoms with one being depressed mood, or lost of interest in all activities
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Cyclothymic Disorder: Diagnostic Criteria
numerous periods of hypomanic sysmptoms and numerous periods with depressive symptoms that do not meet criteria for hypomanic or depressive epidosde
*last at least 2 years in adults and 1 year in and adolescents, present at least half the time with individual not being symptom free for more than two months at a time
40
Major Depressive Disorder Diagnostic Criteria
```
presence of five symptoms of MDD nearly every day for at least two weeks with one symptom being depressed mood or loss of interest in activities,
*depressed mood
*diminished interest in activities
* weight loss or weight gain
*decrease or increase in appetitie
*insomnia or hypersonmia
Fatigue or loss of energy
Feelings of worthlesssness or guilt
recurrent suicidal ideation or attempt
```
* EEG abnormalities during sleep are experienced by 40 to 60% of ppl experiencing MDD, include sleep contuinity disturbances, reduced stage 3 and 4 sleep, decreased rem latency, and increased duration of REM sleep
* comborbid disorder include 60% of people experience anxiety who have MDD
12 month prevelance is 7%, 18-29 year olds is 3x the prevelance of 60 years and older.,
Early adolescent the rates for females are 1.5 to 3 times the rates for males
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Major Depressive Disorder: specifiers: peripartum and seasonal pattern
Peripartum onset- applied to MDD, Bipolar 1 and Bipolar 2 disorder when the onset is during pregancy or wihin four weeks postpartum, include anxiety, preoccupation with infants well being, 10 to 20% excperience depression during pregnancy or few months after
Seasonal pattern: relationship btween mood disorder and time of the year, seasonal affective disorder, include hypersonmia, increased appetitie, and weight gain. linked to season related changes increase melatonin levels, phase delay in circadiam rhythms, and seterogenic dysfunction
*phototherapy involves exposure to bright light and is an effective treatment
42
Major Depressive Disorder Etiology
strong genetic component , concordance rate for unipolar depression is about .50 in identical twins and .20 in fraternal twins,
MDD is 1.5 to 3 times more common among first degree relatives of individuals with this disorder,
* link between MDD and neuroticism
Catecholamine hypothesis- due to a defiencency in norephinephrine,
43
Major Depressive Disorder Treatments
three classes of antidepressants
Tricyclics: (TCAS) most effective for classic depression that involves vegatative symptoms, worsening of symptoms in the morning, and short duration
SSRI- first line drug for moderate to sever depression and fewer side effects
MAOI's- benefical for individuasls who do not respond to other classes and have atypical symptoms
combination of CBT and medication is better, CBT is associated with a lower risk for relaspe
44
Persistent Depressive Disorder Diagnostic Criteria
depressed mood for most days for at least 2 years in adults and 1 year in children and adolescents
45
Suicide Risk Factors:
Age- highest rates combined are ages 45-54
Highest rate for female is 45 to 54 and males 75 and older
Gender: 4x as many males as females commit suicide but females attempt two to three more times than males
Race: Suicide rates highest for whites, exception is American Indians/Alaskan Natives age 15 to 34 which are 2.5 times higher than national average
Marital Status: divorced, separated and widowed have the highest rates
Suicidal behaviors: 60 to 80% of people who commit suicide have had at least one previous attempt and 80% give a warning
Psychiatric Disorders: MDD and bipolar are most common, mood disorder being about 15 to 20% more likely than the rest of the population,
Adolescents the risk for suicide increases when depression co occurs with conduct disorder, substance abuse, or ADHD
Biological: low levels of serotonin and 5 HIAA
46
Separation Anxiety Disorder
developmentally inappropriate and excessive fear and anxiety related to separation from home or attachment figures evidenced by three symptom, recurrent excessive distress when experiencing separation from home or major attachment figures, repeated complaints of physical symptoms, persistent fear of being alone,
*must last 4 weeks in children and adolescents, or six months in adults
*manifests as school refusal and manifests at three ages 5 to 7, 10 to 11, and 14 to 16
Treatment: Systematic desentisatizion cognitive approaches, and for school refusal is immediate return to school
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Specific Phobia Diagnostic Criteria
characterized by intense fear of a specific object or situation and individual avoiding it, or enduring it with marked distress
*lasts at least 6 months,
linked to several biological factors abnormal levels of serotonin, norephineprhine, and GABA
Mowers two factor theory- attributes phobias to avoidance conditioning ,which involves classical and operant conditioning.
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Specific Phobia Treatment
exposure with response prevention that exposes the individual to the feared object or situation while preventing him from engaging in avoidance,
Blood injection type- produces a vasovagal reponse that involves brief increase in heart rate and blood pressure followed by decrease in heart rate and blood pressue that may cause fainting. Exposure is most effective when combined with applied tension , repeatedly applying tension and releasing the body large mucle groups to increase blood pressure
*children who are afraid of the dark, cognitve self control to be effective such as relaxation, visualation of a pleasant scene, positive self statements, and parental reinforcement
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Social Anxiety Disorder Diagnostic Criteria:
intense fear or anxiety about one or more social situations in which the individual may be exposed to scruinity by others, fears that he or she will be negatively evaulated, avoids the situation, not proportional to situation
*lasts at least 6 months
*linked to behavioral inhibition, temperament trait characterized by social avoidance and fear of unfamiliar people and situations
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Social Anxiety Treatment:
Exposure with response prevention, may be enhanced when combined with social skills training, or cognitive restructuring techniques. Treatment may also include an SSRI or SNRI , or beta blocker propranolol
51
Panic Disorder Diagnostic Criteria
by recurrent unexpected panic attacks with one attack being followed by at least one month of persistent concern of having additional attacks,
*adrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and involves palpitations, parethesias, derealization or deperosnalization, fear of losing control,
Females twice as likely as males to receive the diagnosis
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Panic Disorder Treatment
CBT techniques such as Panic Control therapy- which is a brief treatment that incoporates psychoeducation, relaxation training, cognitive restructuring and interoceptive exoposure, Also reponsive to imipraminine, and other TCAS, SSRIS, and benzodiazepines, risk for relapse is high when drug treatment is used alone 30 to 70% report a return of symptoms within months
53
Agoraphobia Diagnostic Criteria
marked fear or anxiety about at least two of the following situations, using public transportation, being in open spaces, being in enclosed spaces, standing in line, or being part of a crowd. avoids the situations due to concern that escape might be difficult or help will be unavailable in case he or she develops panic like symptoms
*lasting at least 6 months
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Agoraphobia Treatment
in vivo exposure with response prevention
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Generalized Anxiety Disorder Diagnostic Criteria
excessive worry and anxiety about a number of events or activities, for at least 6 months and must include three additional symptoms, (one in children) restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
50% of individuals with anxiety disorder have one or more additional diagnosis
90% of people with lifetime GAD have another lifetime psychiatric diagnosis
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Generalized Anxiety Disorder treatment:
CBT, combination of CBT and pharmoctherapy may be beneficial, such as SSRI, and SNRI
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Obsessive Compulsive Disorder Diagnostic Criteria:
recurrent obsessions and compulsions,
Obsessions- persistent thoughts, impulses, images that the person experiences as intrusive and unwanted, and he or she attempts to ignore or suppress,
Compulsions: repetitious and deliberate behaviors or mental acts that the person feels driven to perform either in response to an obsession or according to rigid rules,
1.2% prevelance,
Gender: OCD is equally common in males and females in adulthood, but the average onset is earlier for males, OCD is more prevalent in males in childhood and adolescent
OCD- low levels of serotonin, and the caudate nucleus appears to be overactive, orbitofrontal cortex, cingulate cortex
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Obsessive Compulsive Disorder Treatment;
Combination of exposure with response prevention and the tricyclic clompirpramine or an SSRI is treatment of choice
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Reactive Attachment Disorder:
chacterized by consistent pattern of inhibited and emotionally withdrawn behavior toward adult caregivers as lack of seeking or responding to comfort when distressed, and persistent social and emotional disturbance, limited positive affect, episodes of unexplained irritability,
*requires that the child has experienced extreme insufficient care that is believed to be the cause of the behavior, symptoms must be evident before child is 5 and the child must have developmental age of at least 9 months
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Disinhibited Social Engagement:
chacterized by pattern of behavior that involves inappropriate interactions with unfamiliar adults by two of the following ; diminished or absence of checking with adult caregiver after venturing away, willingness to accompany an unfamiliar adult with little or no hestitsation, overly familiar behavior with unfamiliar adults
*child must have developmental age of 9 months and have experienced extreme insufficient care
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Posttraumatic Stress Disorder Diagnostic Criteria:
For adults, adolescents and children older than 6, the diagnosis of PTSD requires the following:
* Exposyure to actual or threatened death, serious injury or sexual violence, in either direct experience, witnessing the event in person, learning event occured to close family member or friend, repeated exposure to aversive details of an event( except when it is through the media)
* presence of one of the following intrustion symptoms , recurrent involvuntary distressing memories of the event ( in children repetitive play related to event) recurrent distressing dreams, dissoacative reactions, intense psycholgoical distress when exposed to reminders,
* persistent avoidance of stimuli associated with the event as one or more of the folowing, avoidance of thoughts feelings, realted to event, avoidance of external reminders,
* negative changes in cognition or modd associated with two of the following, inability to remember important aspect of the event, negative beliefs about oneself, others or the world, diminished interest, feeling of detachment,
* marked changes in arousal and reactivity with two of the followng, irritable behavior, angry outburts, reckless or destructuve behavior, hypervigialance, impaired concentraion, sleep distrubance
* *must have at least one month
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Postraumatic Stress Disorder treatment:
comprehensive CBT intervention, involves exposure, cognitive restructuring, and anxiety management, SSRI is used to reduce comorbid depression or anxiety,
Cognitive incident stress debreifing: involves providing treatment to the victims of a trauma within 72 hours of the event and is single lenghty session, research shows it may worsen the symptoms
*EMDR- benefical effects found to be due to exposure rather than eye movements
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Acute Stress Disorder
Similar symptoms to those of PTSD and require 9 symptoms from any 5 categories but duration of 3 days to 1 month
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Adjustment Disorder
development of emotional or behavioral symptoms in response to one or more identifiable psychosocial stressors within 3 months of the onset of the stressors, marked distress that is not proportional to situation and does not reflect normal bereavement, symptoms must remit within 6 months after termination of stressor
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Dissociative Amnesia:
inability to recall important personal information that cannot be attributed to ordinary forgetfulness , usually related to exposure to one or more traumatic events, localized and selective amnesia being most common
Localized amnesia : involves inability to remember all events related to a circumscribed period of time
Generalized Amnesia: loss of memory that encompasses a persons whole life
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Somatic Symptom Disorder:
presence of one or more somatic symptoms that cause significant distress by excessive thoughts, feelings, or behaviors, persistent thoughts of symptoms of disorder, excessive time and energy related to health concerns, persistent around 6 months
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Illness Anxiety Disorder:
preoccupation with having a serious illness, an absence of somatic symptoms, high anxiety about ones health, present for at least 6 months
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Conversion Disorder:
presence of symptoms that involve disturbances in voluntary motor or sensory functioning and suggest serious neurological or other medical condition with evidence of an incompatibility between symptoms and recognized neurological or medical conditions,
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Factitious Disorder Diagnostic Criteria
Imposed on self: falsify physical or psychological symptoms that are associated with deception ( falsify symtpoms of depression after death of spouse even thought the death did not occur) present themselves as being ill or impaired, and engage in behaviors even in the absence of an obvious external reward
Imposed on others: falsify physical or psycholgical symptoms in another person, present the person as being ill or impaired, and engaged in behavior even in the absence of external reward
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Factitious Disorder Differential Diagnosis
Malingering: characterized by intentional production of physical or psychological symptoms for the purpose of obtaining an external reward such as avoiding work, financial compensation, obtaining drugs, marked discrepancy between symptoms and objective findings, or person has antisocial personality disorder
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Anorexia Nervosa Diagnostic Criteria
Restriction of energy intake that lead to significant low body weight, intense fear of gaining weight or becoming fat that interferes with weight gain, disturbance in the way the person experiences his or her body weight or shape or a persistent lack of recognition of the seriousness of his or her own low body weight
Associated features: may engage in excessive exercise, self induced vomiting , preoccupied with thoughts of food,
half of individuals with Anorexia Nervosa meet criteria for anxiety disorder at some time during their life with it usually preceding onset of AN.
90% of individuals with this disorder are female, and begin in adolescents or young adulthood
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Anorexia Nervosa Diagnostic Criteria
Restriction of energy intake that lead to significant low body weight, intense fear of gaining weight or becoming fat that interferes with weight gain, disturbance in the way the person experiences his or her body weight or shape or a persistent lack of recognition of the seriousness of his or her own low body weight
Associated features: may engage in excessive exercise, self induced vomiting , preoccupied with thoughts of food,
half of individuals with Anorexia Nervosa meet criteria for anxiety disorder at some time during their life with it usually preceding onset of AN.
90% of individuals with this disorder are female, and begin in adolescents or young adulthood
Etiology: increased risk among first degree relatives and higher rates among identical twins
*higher than normal levels of serotonin that cause restlessness anxiety and obsessive thinking and food restriction lowers serotonin levels,
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Anorexia Nervosa Treatment:
first priority is get individual to gain weight, hostpilization or contingency management strategies
individual therapy- CBT , garner and colleagues emphasize modifying the dysfunctional beliefs about food, establishing a + theraputic alliance, normalizing clients eating patterns and body weight, identfying, modifying clients beliefs by using socratic questioning, preparing client for termination
*family based therapy effective, however high level of expressed emotion among family members is associated for an increased risk in relapse
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Bulimia Nervosa Diagnostic Criteria:
recurrent episodes of binge eating accompanied by a sense of lack of control, inappropriate compensatory behaviors to prevent weight gain such as vomitting, laxatives, fasting or excessive exercise, self evaluation of body shape and weight , must occur on average once a week for 3 months
* anxiety disorders often precede bulimia, medical complications include fluid and electrolyte disturbances, metabolic alkalosis, can cause arrthymia and cardiac arrest
* linked to low levels of serotonin
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Bulimia Nervosa Treatment:
nutritional counseling and CBT techniques such as self monitoring, stimulus control., cognitive restructuring, problem solving,
Imipramine and fluoextine have been effective for reducing binge and purging, however CBT is assoiacted with lower levels of relapse and treatment dropouts
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Enuresis Diagnostic Criteria:
repeated voiding or urine into the bed or clothes at least twice a week for 3 or more consecutive months, has to be at least 5 years old
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Enuresis Treatment:
Bell and pad( night alarm)- causes a bell to ring when the sleeping child begins to urinate, night alarm is found to be effective in 80% of cases, althought 1/3 of children show some degree of relapse within 6 months of initial treatment , may be increased when combined with behavioral rehearsal or overcorrection, imipramine reduced bed wetting in 85% of cases, most children relaspe within 3 months of discontiuining the drug
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Insomnia Disorder:
disastification with sleep quality or quanity, and aossicated with difficulty initiating sleep, maintaing sleep, early morning wakening with an inability to return to sleep , occurs three nights each week for at least 3 months
Treatment: CBT- sleep hyegine education,
Stimulus control- strengthen the bed and bedroom as cues for sleep
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Narcolepsy
chacterized by attacks of need for sleep with laspes into sleep or daytime napes that occur 3 times a week present for at least 3 months,
requires evidence of cataplexy( loss of muscle tone), a hypocretin defienceny, or rapid eye movement latency, experience hynogogic or hynopompic hallucincations which are vivid hallucinations before or upon falling sleep or just after awakening,
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Non Rapid Eye Movement Sleep Arousal Disorder
recurrent episodes of incomplete awakening that occur during first third of the major sleep episode are accompanied by sleep walking- getting out of bed during sleep and walking around and
sleep terror- an abrupt arousal from sleep that begins with a panicky scream and intense fear and signs of autonomic arousal - no or limited recall of episode
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Erectile Disorder:
presence of at least one of three smyptoms9 marked dificulty in obtaining an erection during sexual activity, difficulty in maintaining erection until completion, marked decrease in erectile ridgidty) on all or almost al occasional of sexual acvitity for at least 6 months - medical conditions such as diabetes, kidney disease, Ms, should be ruled out
TreatmneT:
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Erectile Disorder:
presence of at least one of three smyptoms marked dificulty in obtaining an erection during sexual activity, difficulty in maintaining erection until completion, marked decrease in erectile ridgidty) on all or almost al occasional of sexual acvitity for at least 6 months - medical conditions such as diabetes, kidney disease, Ms, should be ruled out
Treatment: referral for a medical evaulation, complete absense of erections during REM sleep suggest organic etilogy, if determined due to psychogeneic factors, treatment involves CBT work- dysfunctional beliefs, anxiety, deficent knowledge and skills, viagra ( sildenafil citrate) , increases ability to maintain an erection
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Genito Pelvic Pain/Penetration Disorder:
persistent or recurrent difficulties involving vaginal pentertration during intercourse, marked genito pelvic pain during intercourse, marked anxiety about pain before during, or after, marked tensing of pelvic flooor, must occur for at least 6 months,
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Premature Ejaculation
recurrent pattern of ejaculation during partnered sexual activity within about 1 minute of vaginal penetration or before the person desires it, present for at least 6 months, almost all occasions of sexual activity
Treatment: sex therapy found to be most successful for Premature ejaculation and Genito pelvic pain, sensate focus- help reduce performance anxiety and start squeeze stop method- increase mans control over the ejaculatory reflex, premature ejaculation has bee linked to low serotonin levels, and SRRIS have found to be effective in some individuals
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Gender Dysphoria
marked incongruence between ones assigned gender at birth and ones expressed gender by strong desire to be opposite sex and at least 6 of the following symtpoms, strong preference for wearing clothes of the other gender, cross gender roles during play, toys and acitivities related to other gender, strong desire for secondary sex chacterstics of other gender, strong rejection of games associated with ones assigned gender, occur at least 6 months,
* * for children, adults, and adolescents all need 6 months of symptoms,
* onset usually between 2-4 years olf, natal females range from 12 to 50%
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Paraphillic Disorders:
intense and persistent sexual interest other than normal sexual interest that is currently causing distress or impairment to individual or risk of harm to others
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Frotteuristic Disorder:
intense sexual arousal from touching or rubbing against a nonconsenting adult by fantasies, urges or behvaiors and history of acting on urges with a non consenting person
*begins in adolescence and decline with increasing age
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Transvestic Disorder:
Tranvestic disorder: cross dressing for the purpose of sexual arousal as manifested by fanatasies, urges , almost exclusively in males and most identify as heterosexual
89
Oppositional Defiant Disorder:
recurrent pattern of angry irritable mood, argumentative/defiant behavior, or vindictiveness, during interactions with at least one person who is not a sibling, and persisted at least 6 months
90
Conduct Disorder Diagnostic Criteria:
persistent pattern of behavior that violates the basic rights of others and age appropriate norms or rules at least 3 symtpoms during past 12 months and 1 symptom in past 6 months, four catergories: agression to people and animals, destruction of property, deceiftfulness or theft, serious violation of rules, cannot be assigned to individuals over 18, more common in males than females,
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Conduct Disorder Etiology/Moffitt
Motifft distinguishes between two types of conduct disorder
life persistent course type- begins early ( sometimes apparent at age 3) and involves pattern of increasingly serious transgression that continues to adulthood, attributes this type to neurological impairments, difficult temperment and adverse environmental circumstances
Adolescence limited type- temporary form of antisocial behavior that reflects a maturity gap between the adolescents biological maturation and lack of opportunities for adult privileges and rewards
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Conduct Disorder Treatment:
most effective for preadolescents, and include family interventions
Patterson- parent management training- teaches parents to reward positive behaviors, replace physical punishment for time out, response cost,
MST- Multisystematic treatment- targets the individual, family, school and community, CBT, family systems, and case management
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Substance Use Disorder Diagnostic Criteria:
manifested by at least 2 symptoms during a 12 month period, four groups: Impaired control, social impairment, risky use, and pharmacological criteria
Etiology: tension reduction hypothesis- people drink alcohol to relieve tension which leads to addiction , result of negative reinforcement
Marlatt & Gordon- addictive behaviors are acquired and over learned maladaptive habit pattern
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Substance Use disorder Marlatt and Gordon/relaspe prevention therapy
CBT techniques( contingency management, motivational interviewing, relapse prevention training ) medication includes naltrexone, or disulfriam.
*most common precipitant of relapse is anxiety, frustration, depression,
Marlatt and Gordon- typical reaction to relaspe as "abstinence violation effect" involves self blame, guily, anxiety, depression, which leads to an increased sucepsibility
*relapse is reduced when people view episode as result of specific, external and controllable factors
RPT- identifying circumstances that increase risk for relapse, situations, expose them to alcohol related cues and implement behavior strategies to help prevent relapses
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Tobacco Use Disorder/Smoking Cessation Intervention
health risks decrease dramatically when person quits smoking, * cigeratte smokers are 3 to 4 times more likely to experience cardiac arrest, stroke, however within 1 to 5 years after smokers quit, their risk for these disorders is the same as those who have never smoked
* number of barriers such as weight gain, average is 5 to 6 pounds ,
* sucessful quitters most likely to be male, age 35 or older, have college education, live in a smoke free home, non smoking policy at work, be married or living wiht a partner, starting smoking at a later age,
Smoking Cessation Intervention- increases the likelihood of long term abstinence when it includes three elements a) nicotine replacement therapy, b) multicomponent behavioral therapy, that includes skills training, relaspe prevention, c) support and assistance from clinician
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Alcohol Withdrawal/Diagnostic Criteria
presence of at least two symptoms within several hours to a few days following cessation or reduction of alcohol consumption, hand tremor, autononomic hyperactivity, hand tremor insomnia, vomitting, hallucinations, generalized tonic clonic seizures, anxiety,
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Alcohol Induced Major Neurocognitive Disorder Koraskoff Syndrome
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characterized by evidence of a significant decline in one or more cognitive domains that interferes with independence in everyday activities
Korsakoff Syndrome( anmestic confabulatory type) antergroade and retrograde amnesia, and confabulation linked to thiamine deficiency
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Alcohol Induced Sleep Disorder Diagnostic Criteria
usually insomnia type and result of intoxication or withdrawal, when produced by intoxication, it involves immediate sedation accompanied by increased stage 3 and 4 sleep, and reduced REM sleep followed by increased wakefulness, increased REM sleep and reduced stage 3 and 4 sleep
When withdrawal- severe disruption in sleep continuity with vivid dreams
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Opiod Withdrawal
occurs following cessation or reduction in the use of an opiod following prolonged or heavy administration of an opiod antagonist following a period of opiod use ,
at least three of the following: dysphoric mood, nauseaa or vomitting, muscle aches, lacrimation, pupilary dialtion, sweating, dirrehea, fever, insonmia
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Tobacco Withdrawal
by development of at least 4 characteristic symptoms within 24 hours of abrupt cessation or reduction in the use of tobacco, irritability or anger, anxiety, impaired concentration, increased appetite, depressed mood, insomnia
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Delirium Diagnostic Criteria
requires a disturbance in attention and awareness that develops over a short period of time ordinarily few hours to a few days, represents a change from baseline functioning, and tends to fluctuate in severity over the course of a day, and one additional disturbance in cognition, impaired memory, disorientation, impaired language, deficits in visuospatial ability, or perceptual distortions.
Etiology: five groups of people who are at high risk for Deliruim a) older adults, b) people with decreased cerebral reserve due to demnita, stroke or HIV c) poscardiotonomy patients d) burn patients E) people with drug dependence,
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Delirium Treatment:
Treatment: treatment of the underlying cause of the disorder and reduction of agitated behaviors, second goal is addressed by combination of environmental manipulation, and psychosocial interventions
*haloperidol may help reduce agitation, delusions, and hallucinations
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Neurocognitive Disorder Due to Alzheimer's Diease Diagnostic Criteria
diagnosed when criteria for major or minor neurocgonitive disorder are met, insidious onset, and gradual progress of impairment in one or more cognitive domains
Major Neurocognitive Disorder- evidence of a causative gene mutation, clear evidence of a decline in memory, and gradual decline in cognition without extended platueas, and no evidence of a mixed etiology.
Definitie diagnosis requires an autospy or brain biopsy that confirms extensive neuron loss, especially in the medial temporal structures
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Alzheimer's course and 1 stage
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single most common cause of dementia and accounts for 60 to 90% of all cases, with a late onset being more common than early onset
Stage 1 (1-3) - antererograde amnesia, ( especially for declarative memories ) deficits in visuospatial skills, indifference, irritability, and sadness, anomia
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Alzheimer's etiology
genetic contribitions with abnormalities on chromosomes 1, 14 and 21 being linked to the early onset familial type, abnormalities on APoE4 on chromosome 19 being associated with later onset,
*abnormal levels of acetylcholine(ACH) - known to be involved in formation of memories, elevated risk linked to lower education, adult onset type 2 diabetes, depression, down syndrome, traumatic brain injury
Treatment: behavioral techniques, group therapy and antipsychotic drugs, and antidepressants
low levels of ACH led to the use of cholinesterase inhibitors which reduce the breakdown of ACG in the brain, and include tacrine, donepezil, galantamine, rivastigime,
*outcomes best for pts when they remain at home with families and families less likely to institutionalize when provided with adequate support, psychoeducation, skills, training and other individual or family interventions
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Vascular Neurocognitive Disorder Diagnostic Criteria
criteria for major or mild neurocognitive disorder are met, consistent with vascular etiology and evidence of cerberovascular diease from history, psychical examination and neuroimaging.
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Neurocognitive Disorder due to HIV
symptoms of Neurocognitive disorder that affect subcortical areas of the brain, concentrain and memory, slowed psychomotor speed, apathy, depression,
Stages
Stage 0- normal
Stage .5 individual has minimal symptoms with no impairment in performance or ADLS, mild signs
Stage 1 - Mild- evidence of functional, intelluctual or motor impiarment but individual is able to perform all but the demanding apectss of work or ADL and can walk without asistance
Stage 2 Moderate- individual cannot work but can perform basic self care and may require assistance
Stage 3 - Severe- major signs of intelluctual incapacity, or motor diasbilty cannot walk without assistance
Stage 4- end stage- vegetative, mute,
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Paranoid personality disorder
pervasive pattern of distrust and suspiciousness that entails interpreting the motives of others as evil, least four of the following: suspects that others are exploiting, harming or deceiving him or her without sufficient evidence, preoccupied with unjustified doubts about the trustworthiness of others, reluctant to confide in others, reads demeaning content into neutral events, hold grudges, quick to attack with anger
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Schizoid Personality Disorder
person displays a pervasive pattern of detachment from interpersonal relationships and a restricted range of emotional expression in social setting, least 4 symptoms, doesn't desire close relationships, chooses solitary activities, little interest in sexual relationships, pleasure in few activities, lacks close friends, seems indifferent to praise, coldness or detachment
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Schizotypal personality disorder
pervasive social and interpersonal deficits involving acute discomfort with and reduced capcity for close relationships in cognition, perception, and behavior. Least 5 symptoms, exhibits ideas of reference, odd beliefs or magical thinking, suscipious or parannoid, inappropriate affect, peculiar behavior and apperance, lacks close friends, excessive social anxiety
*may have desire for close friends, but have few friends and prefer to be alone
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Antisocial Personality Disorder
pattern of disregard for and violation of the rights of others that has occurred since age 15 and involves at leas 3 symptoms, failure to conform to social norms with respect to law, impulsivity, decietfulness, irritability, aggressiveness, reckless disregard for the safety of others, lack of remorse, must be 18 years old and have history of conduct disorder before age 15.
** associated features- inflated sense of self, lack of empathy for others, superficial charm, less severe by fourth decade of life
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Borderline Personality Disorder
pervasive pattern of instability in interpersonal relationships, self image and affect, marked impulsivity that began by early adulthood and apparent in mutiple settings, at least 5 must be present, frantic efforts to avoid abandonment, pattern of unstable, intense interpersonal relationships that fluctuate between idealization and devaluation, identity disturnace by instability in self image, impulsivity in two areas that are potentially damaging, reuccrent suicide threats, chronic feelings of emptiness, difficulting controlling anger, severe dissociative symptoms
*most common in individuals age 19- 34 most chronic during young adulthood , affective symptoms most chronic
Etology: mother child relationships, Mahler seperation individuation seperation along with fear of abondaonment,
Kernberg- splitting- all good or all bad aspects
Linehans- emotion dysregulation is the core feature of BPD, excessive emotional vulnerability, inability to modulate strong emotions,
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Borderline DBT
Linehans Dialectical Behavior Therapy : combines CBT techniques with the rogerian assumption that acceptance of the client is necessary for change to occur, a) group skills training to help clients regulate their emotions and improve social and coping skills B) individual outpatient therapy to strengthen clients motivation and newly acquired skills
C) telephone consulations to provide additional support between session coaching
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Histrionic Personality Disorder
pervasive pattern of emotionality and attention seeking, five symptoms must be present , discomfort when not the center of attention, inappropriately sexual seductive or provactive, rapidly shifting and shallow emotions, consistent use of phsycial apperance to gain attention , exaggerated expression of emotion, easily influenced by others,
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Narcissistic Personality Disorder
pervasive pattern of grandiosity, need for admiration, lack of empathy as indicated by five of the followng: grandiose sense of self importance, reoccupied with fantasies of unlimited sucess , power, beauty, love, believes he or she is unqiue, requires excessive admiration, sense of entitilment, lacks empathy, envious of others, arrogant behaviors,
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Avoidant Personality Disorder
pattern of social inhibition, feelings of inadequacy, and hypersenstivity to negative evaulation at least 4 of the following: avoids work activities involving interpersonal contact due to fear of criticism, rejection, is unwilling to get involved with people unless certain of being liked, restraint in initimate relationships due to fear of being judged, preoccupied with concerns of being rejected, view self as inferior to others, hesitant to engage in new activities because they may be embarrassed
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Dependent Personality Disorder
pervasive need to be taken care of, clinging behavior and fear of separation, least five symptoms; difficulty making decisions without reassurance, needs others to assume responsbility for most of his or her life, fears disagreeing with others, difficulty initiating projects , feels helpless of uncomfortable when alone, seeks another relationship for support when one ends,
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Obsessive Compulsive Personality Disorder
-preoccupation with orderliness, perfectionism, mental and interpersonal control that limits flexibilty, openess and effeciency at least four of the following symptoms: preoccupied with rules, details, perfectionism that interferes with task completion, excessively devoted to work, inflexibile about morality , ethics and values, reluctant to delegate work to others,
