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What is the difference between primary, secondary and tertiary prevention?

Primary...prevent onset and therefore reduces incidence of d/o.
Furthest from illness. Before onset.
Vaccination, prenatal nutrition for low SES ppl,sex Ed, parenting class, community wide Aids education, head start

Available for all members of all members vs secondary...identify hi risk individuals (primary is identify high risk populations!)

Secondary..early identification and prompt tx of d/o already exists.
Goal cure or improve illness.
Mammogram. Often identify hi risk group and then screen. Suicide hotlines, crisis intervention. Keep from getting worse.

Tertiary.. reduce residual effects or optimize pt fx with chronic d/o . Closest to illness. Prevent recur, reduce long term consequences.
After onset and tx
AA, day tx, social skills after rehab, half way house..

1

What is the incidence of child abuse in the USA?

2 to 4 thousand children die per year
Over one million mistx per yr by parents
1/22 murders in our country is a child killed by a parent
Once returned from hospital 1/2 end up dead.

2

What are the characteristics of abused children?
Age
Gender
Re sexual abuse

Younger more abused. Ie. 63 percent under 2yrs old; ave age admitted to hospital 15.5 mo

Boys more abuse in early childhood and girls more in teens.

Sexual abuse the trend is reversed.

Overall, girls victims of sexual abuse 2x to 3x more; boys and girls physically abused at same rate

Premature or difficult births linked to higher rates of child abuse.

Physically abused kids ..poorer achievement, cognitive delays, aggressive, behavior problems, fewer friends own age more problems on relationship w adults.

Ho...mildly rejecting parents offer intermittent reinforcement that strengthens dependency behavior

3

What is secondary prevention and give some examples.

Early detection and treatment to prevent a full blown illness.
Keep from getting worse.

Examples...suicide hotlines, screening tests when have no symptoms, walk in crisis intervention

4

What is the best predictor of AiDS risk behavior among high school and college kids?
How does this compare to homosexual men?

Community Ed regarding AIDS is a primary prevention strategy.

High school and college kids...perceived peer norms, which is perceived at risk behaviors and attitudes of ones peers, are a better predictor of risk behaviors (vs Knowledge)
Homosexual men hi knowledge equals less risky behavior
Suggests education should target peer norms (peer education, meet peers with aids, peer discussion grps).

5

What are the risk factors for suicide?

History of attempts is risk for completed suicide.
Over 65 increase risk
Over 85 highest rate
Greatest increase among 15 to 24 yr olds, especially males
Greater number of attempts for younger ppl (100 to 200 per completed) vs 4:1 attempts for elderly

6

Suicide risk differences between males and females?

Males commit 4 times more.
Males use more lethal means (gun, hanging) vs females (od, poisen)

Females try 3 times more

7

Who commits suicide more often?

Whites. But peaks after 65
Rates for nonwhites is increasing, especially in 15 to 24 yr olds..
For Native American males..highest rate 15 to 24 age grp. For Black..highest rate is 15 to 44 males.

8

How does marital status impact suicide?

Marriage lessens risk.
Single, never married higher risk
Even higher for widows..greatest after first ur of loss.
Higher still for divorced.

9

How does mental health status impact suicide?

Past attempt increases risk of completion.
40 percent of depressed who commit made a previous attempt
Family hx of suicide increases risk
95 percent commit have dx
Dx in order who complete..depressive, substance, schizophrenia.
15 percent with mood do commit.
Mood with psychotic features 5x risk to commit vs other mood do
Highest risk when sx improve

10

Other suicide risk factors.

State intention to commit.
More if specific plan and means
Behaviors consistent with decision to die..will, give away
Hopelessness central factor
Recent life stress, loss person, job
Lack support
Elderly..physical illness most common reason.

11

What are the factors regarding adolescent suicide?

Rate has increased among 15 to 19 year olds.
Now second leading cause of death after accidents.
Most often use firearms...increases with intoxication and availability in the home.
Teen boys 3 to 5 times more likely to complete
Teen girls 4 times likely to attempt.

Teens..depression, substance use, antisocial behavior increase risk.
Previous suicidality, exposure direct or indirect to suicide, loss (especially humiliation)
Often impulsive and attempt at manipulation, for attention, express anger, or benefit (avoid obligation).
Most ominous signs..talking about own death, reunion with dead person, giving prized possessions.
Plus withdrawal, poor coping, self destructive behaviors.

12

What are the factors of suicide among older adults?

Rates increase 65 to 85. 85 yr old white men 4 times more likely than 65 yr olds.
Less likely communicate intent, more likely use violent means, less likely for attention or help.
Risk factors...poor health (70 percent visit doc within month of committing).
Depression sx in 60 to 80 percent who commit but they don't report and docs didn't detect.
Schizophrenia, alcohol depend, organic brain do
Warning signs..recent death of spouse, relative, or friend; self destructive behaviors, alter will, negative/hostile interpersonally

13

When is hospitalization indicated re: suicide?

Hi risk, psychotic, intoxicated, debilitating medical condition, no support system

14

What are the differences between supervision and consultation?

Supervision- continuous, administrative authority, focus on supervises work related problems

Consultation- voluntary, ad hoc basis (time limited, as needed) can reject suggestions, not usually member of organization, focus on specific problem, voluntary relationship that can be terminated at any time. Help providers give better services.

15

What are the forms of mental health or psychodynamic consultation?

Client centered case consultation--
Help consultee (tx) w plan for pt
Ie. difficult case..discuss or examine ct

Consultee centered case consultation --focus on bring about change in the consultee (not pt)
With one or across cases
Lack knowledge, ability, skill, emotional issues. Theme interference (transference)

Program centered administrative --
Work w administrators to suggest actions for clinic program

Consultee centered administrative--
Focus on consultee (tx) that limit ability to administer program or change or organizational effectiveness

16

What are the rates of inpatient hospitalization?

Females have more mental illness.
Males higher rates of county inpt hospitalization bc act out.

Both men and women..most inpt are 25 to 44.
Then males 18 to 24.
Females second grp 45 to 64.

Never married highest rate inpt
Then divorced/separated, married, widowed.

Majority white but minorities overrepresented.

17

What is involuntary commitment based on?

Parens patriae or rt of state to regulate life if incapable of doing

Wyatt v Stickney-- federal court ruled if commit then must give tx

Supreme ct--expanded to need for treatment is no longer enough. Mental illness alone not enough. Donaldson v oconner.

2 pc--2 physician certificate. Pts have rights.

18

What is the most common legal issue that psychologist input is requested?
Competency
Insanity defense
Custody
Fact witness

Competency to stand trail.
Dusky v US--set guidelines
--must understand nature of proceedings and able to cooperate

Of those evaluated, 30 percent found incompetent
Then committed usually 6 mo in order get tx and back to trial.
Jackson hearing--not expected to regain competency in foreseeable future. Drop charges and can only be retained on civil commitment procedures.

19

Describe not guilty by reason of insanity.

From MNaghten test--must have known wrongfulness at time of offense to be sane. Later added act result of irresistible impulse.

Durham test said product of mental illness...overturned and replaced by
AIL rule. American institute rule..unable to appreciate criminality (cognitive) and unable to conform to law (behavioral).
Later added...by clear and convincing evidence.
Successful less than 1 percent of cases.

20

What are the characteristics of abusive parents?
Ses
Ethnicity
Parent hx
Psychological characteristics
Other

Lower ses some say reporting bias
Rich can hide abuse
White (3:1 w:b). Other study found non white but may be due to poverty and reporting factors
Hx of abuse themselves(deprivation or loss of parent)
Wide range of disorders (10% psychotic)
Low tolerance for infant behaviors, ignorant normal development, interpret negatively, harsh punishment to control

Increased risk with stress..poverty,
Isolation, marital problems

Puts kids risk for pathology and abusive themselves

One parent abuser. One passive

Sexual abuser..known to victim

21

Use of anatomically correct dolls is recommended with whom:
First go through drawing exercise of private parts.

Mentally retarded, preverbal, embarrassed, unable to discuss.

Sex abuse victims respond different to dolls ...more aggressive, more private part touching

Dolls facilitate memory for details but not forgotten incidents
Dolls don't increase likelihood of stories.

Many questions not answered like how many dolls to use, ethnically matched, # sessions...need to justify what tx does

22

What is the cycle of violence?

Wide range of estimates of spousal abuse. 2 to 12 million and 26 to 30 million.

Tension building..batterer is moody;victim on eggshells; minor incidents occur

Acute battering..can't predict/control

Honeymoon...remorse, apology. Difficult for ppl to leave. Professionals tend to be involved.

Battered women 3 times more likely to be pregnant

23

What are the stats on rape?

10 percent report
1 in 30 prosecuted
1 in 50 convicted

24

What are the 4 categories of male rapists?

Sexual sadists (like pain )
Exploitative predators (impulsive gratification)
Inadequate men obsessed w sex
Displaced anger/rage

Most planned and in rappers neighborhood. Performance impaired during. Often married.
Rapists between 25 and 44. Alcohol 34 percent of cases. Often w other crimes like assault.

25

What are the characteristics of rape victims?
Age
Race

15 to 24
Same race as offender
Low ses

Get back on feet 6 mo to yr but often lasting effects. Best w immediate support. If withdraw it may be worse (can't extinguish the fear).

26

Discuss teen pregnancy in US:
Decline due to sex prevention programs
Decline of 20 percent
Decline by 15 percent
Decline due to reduced sexual activity

Highest of any industrial nation
Declined by 15 percent due to decrease in sex activity, condoms, other contraceptives

Sex prevention doesn't effect activity they do but did increase contraceptive use and decrease prego. Best if contraception knowledge, sex Ed and skills training.

Sex Ed and HIV info has not increased activity

Abstinence only ineffective. No increase in HIV w Ed.

27

What r the characteristics of married people?
Dissatisfaction happens for women when children are born
U shapes relationship between length of time married and satisfaction with marriage
Unhappily married more depressed, drink more, feel more isolated and report more physical illness

All true...

Married are satisfied and more healthy than non married. Except if unhappily married...they r less happy then those not married.

U shaped relationship between length of marriage and satisfaction with marriage. Satisfaction declines for 10 yrs, men show earlier. Satisfaction increases later when kids leave and at retirement.

Marital break up..increase risk of pathology, illness, suicide. Divorced, separated overrep among inpt. Distress worse amongst elderly, especially men.

28

What is economic status associated with?

Pathology
Unemployment increases risk of alcoholism, homocide, violence, suicide, mental illness.
Medical do..more cardiovascular and higher mortality rate. Cigs, obesity and hypertension more prevalent.
Alcoholism and mood do more in lower ses. May be due to drift. Other do equal across classes.

Adequacy of how to cope with stress may be third variable.

29

Is child sexual abuse more or less severe when a stranger commits the abuse?

Less severe when committed by a stranger.

More severe if by family member or other familiar person.