Exam 3 Flashcards
(113 cards)
1
Q
Assessment of Anorexia
A
- Refusal to maintain minimal normal body weight
- Intensely afraid of gaining weight
- Significant disturbance in perception of the shape or size of body
2
Q
Features Anorexia
A
- Anorexia is an innacurate term because loss of appetite is rare
- Onset in adolescence (12-18), range from pre-puberty to early 30s (rare)
- Prevalence in young females is 0.4%, much lower for older females and males
- 90% females; 10% male –> 50% are homosexual
- Mostly in whites and higher social classes
- Incidence increased signficantly from 1935-1999
- Highly comorbid with depression and perfectionism
- Excessive dieting, exercise, laxatives, diuretics, some binge eat, some vomit
- Delayed psychosexual development; absence of menstruation
- Most deny illness and are uninterested in therapy
- Most remit within 5 years, 50% relapse after treatment
- Highest mortality rate of all mental disorders (10-15%) (50% from suicide, 50% from starvation or electrolyte imbalance)
3
Q
Mortality Causes for Anorexia
A
- Suicide
- Starvation
- Electrolyte imbalance
4
Q
Causes for Anorexia
A
- Genetic
- Neurobiological
- Cultural Norms
- Desire for thinness due to gender, employment, family norms, and personality traits
5
Q
Anorexia Genetics
A
- Significant heritability
- When animals are restricted to one meal a day and provided a wheel, they exercise extensively
- Historically, when food rations declined, humans adapted to portions until more was accessible
6
Q
Neurobiological Causes of Anorexia
A
- Possible low levels of endogenous opioids cause resistance
- Zinc deficiency can create loss of appetite and depression
7
Q
What are the cultural norms of anorexia?
A
- Obesity is ideal in most developing countries (Indicates fertility)
- Female obesity considered ideal in Western societies until 1900s. Changed with industrialized economy (Similarly how tans became popularized, and how royal colours were fashionable historically)
- Difficult to avoid obesity with very tasty high caloric foods
8
Q
Anorexia is higher in?
A
- Women because of societal standards
- Dancers, models, actresses, athletes, because of professional need to be slim
- Families that place high importance on weight, physical attractiveness
- People with perfectionistic OC traits
9
Q
When does the onset occur?
Anorexia
A
Following a stressful incident
e.g., leaving home for college
10
Q
Anorexia treatment
A
- Treatment resistance
- Hospitalization until reached 85% body weight (Behaviour modification - hospital privileges until food consumption)
- Longterm psychotherapy (CBT useful for some)
- Family therapy
- No medications really effective
11
Q
Bulimia Assessment
A
- Binge eating
- Innapropriate compensatory methods to prevent weight gain
- Self-evaluation unduly influenced by body weight and shape
12
Q
Bulimia Features
A
- Increased after 1950s
- 1-2% teens and young females; 1/10 for males, high rates of homosexuality in bulimic males
- Bingeing foods are usually ‘junk foods’ with high calories
- Bulimics normal or slightly under or overweight
- Self-induced vomiting common (generally after bingeing). This is called purging
-Lifetime rates of mood, anxiety, and drug abuse disorders
Usually intermittently chronic
13
Q
Consequences of Bulimia
A
- Dental erosion
- Swollen infected salivary glands
- Esophagus perforations
- Sore throats
- Muscle weakness and cramps from loss of potassium
- Problems with digestive organs (nausea, cramps, ulcers, colitis, fatal rupturing of stomach)
- Heart problems (electrolyte imbalance and dehydration can cause cardiac arrhythmias and sudden death)
- Liver and kidney damage
- Diabetes
14
Q
Causes of Bulimia
A
- Genetic inheritance
- Neurobiological
- Cultural Norms
- Desire for thinness exacerbated by gender and personal history
15
Q
What is the cultural norm?
Bulimia
A
Desire to be thin in current Western society
16
Q
Bulimia is somewhat higher in _____
ACE
A
History of sexual abuse
17
Q
Onset of Bulimia
A
- A negative mood prior to bingeing
- Symptoms tend to increase in fall and winter, when people need to gain weight
18
Q
Bulimia Treatment
A
- Fairly Treatable
- Cognitive restructuring for unrealistic self-defeating cognitions (negative mindsets)
- Lifestyle changes to replace vomiting as a means of weight reduction
- Education and supportive counselling
- Behaviour moficiation programs
- Desensitization with response prevention
- SSRIs
19
Q
What are some lifestyle changes
Bulimia
A
- Eating behaviour
- Reduce carbs
- Increase exercise
20
Q
What is a Behaviour Modification Program?
A
A program that rewards positive behaviour
21
Q
Assessment Gender Dysphoria
A
- Strong/ persistent identification with opposite gender
- Strong/ persistent discomfort with current gender
- Previously known as ‘Gender Identity Disorder’
- Homosexuality distinguishable from Gender dysphoria (Homsexuals comfortable with their gender)
22
Q
Gender Dysphoria Features
A
- Historically rare (less than 0.01%) but increased in recent years
- Children with gender dysphoria persist into adolescense. If so, gender dysphoria is permanent
- Transgender adults almost all had gender dysphoria when they were younger
- Historically 2-5x more common for bio boys having female identity, but ratio now reversed
- Girls = tomboy Boys = feminine. Dressing as opposite gender is common
- Females wanting to be males prefer females; 50% of males wanting to be females are attracted to males
- Anxiety and depression
23
Q
____ Normative in several cultures
A
3
24
Q
Samoa
Gender
A
Fa-afafine
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N.A. Indigenous Societies
| Gender
Two-Spirit
26
Causes of Gender Dysphoria
- Genetic
- Neurobiological
- Environmental
27
Genetics
| Gender Dysphoria
- Twin studies show significant heritability
- Sex chromosome abnormalities sometimes present
- Boys with gender dysphoria more commonly have older brothers (competition)
28
Neurobiological Causes
| Gender Dysphoria
- Prenatal androgen exposure, hormonal problems due to drug use, stress or immunological complications during pregnancy
- Brains of boys with GD tend to resemble that of female, especially in **Hypothalamus** (associated with sexual orientation)
29
Environmental Causes
| Gender Dysphoria
Genetic and neurobiological causes are likely the primary, but parenting can influence gender expression (but not gender identity)
30
Gender Dysphoria Treatment
- Hormone therapy
- Sexual reassignment surgery
- Behavioural (conversion therapy banned in many jurisdictions
31
Paraphilias Assessment
Unusual imagery or acts necessary for sexual excitement
32
Types of Paraphilias
- Fetishes (arousal to objects)
- Transvestite (arousal when dressing as opposite sex)
- Zoophilia (arousal with animals)
- Exhibitionism (arousal from exposing oneself)
- Voyeur (Peeping tom
- Masochism (arousal from receving pain)
- Sadism (arousal when administering pain)
- Frotteurism (arousal from rubbing up against other people)
- Pedophilia (arousal to prepubescent children)
33
Paraphilia Features
- Typically males
- Typically chronic
- Most have 1+ paraphilia
- Unknown prevalence but not uncommon
34
Causes of Paraphilias
- Genetic/ Evolutionary
- Associative Learning
35
Treatment of Paraphilias
- Difficult to treat (association has been reinforced)
- Orgasmic reorientation
- Psychotherapy not effective
- Medication
36
What medications can treat paraphilias
- Antiandrogens
- SSRIs
37
Psychotherapy is ____
| Paraphilias
Ineffective for paraphilia treatment
38
Addiction Assessment
- Difficulty controlling involvement in pleasurable activity causing significant problems
- OCD no pleasure derived from compulsions
- Dependence (synonymous)
- Substance use disorder (mild, moderate, and severe)
39
Elements of Addiction Assessment
1. Personal Interview
2. Standardized Psychometric Tests
3. Third Party Report (Spouse, employer)
4. Biochemical Testing (urine analysis, breathalyzer)
40
Features of Addiction
| Types of Addictions
- Drugs (~25%; 60% male) - Most common addiction in Canada and every country
- Work (~10%; most male)
- Eating/ Food (~7%; 70% female)
- Shopping (~4%; 85% female)
- Social Media (~3%; equal ratio)
- Sex/ Pornography (~2%; 65% male)
- Gambling (~1%; 65% male)
- Exercise (~1%; equal sex ratio)
40
DSM-5 Criteria
| Addiction
1. Substance taken in large amounts over long period of time
2. Persistent desire or unsuccessful effort to control use
3. Great deal of time spent to obtain susbtance, using, or recovering from effects
4. Cravings
5. Reccurent use in failure to fulfill major role obligations at work, school, or home
6. Continued use despite associated problems
7. Important socia, occupational, recreational activities given up because of recurrent use
8. Recurrent use in physically hazardous situations
9. Use continued despite knowledge of having persistent or reccurrent physical or psychological problem caused by susbtance
10. Tolerance define by (a. Need for increased amounts of intoxication to achieve effect, b. Diminished effect with continued use of the same amount)
11. Withdrawal as manifest (a. Characteristic withdrawal syndrome, b. substance taken to relieve withdrawal)
41
Features of Addiction
| Facts
- Addictions most common mental disorder worldwide
- Drug addictions in Canada result in ~70,000 deaths per year (Primarily from tobacco, alcohol, opioids, and benzodiazepines)
- Major contributor to health care costs, crime, and family violence and disruption
- Highest rates in 18-30 yr olds
- High co-occurence with other addictions
- High co-occurence with depression
- Episodically chronic (Many recoveries and many relapses, you remain at risk for relapse your entire life)
42
Problem Behaviours in Addiction
- Addictive behaviour
- Substance use
- Mental health problems
- Interpersonal problems
- Poor health practices
- School/ Work problems
- Antisocial Behaviour
- Addictive Behaviour
43
Main Drugs of Abuse Worldwide
- Alcohol
- Tobacco
- Cannabis
- Opiates/ Opioids
- Ecstasy (MDMA)
- Cocaine
- Amphetamines
- Benzodiazepines
(Variation between countries)
44
Main problematic forms of gambling worldwide
| Features
- Electronic Gambling Machines (slots, VLTs)
- Casino Table Games (Blackjack, baccarat, roulette)
- Online Gambling
45
Worldwide Prevalence of problem gambling
- High (~5%) Asia
- Moderate (1-2$) North America, Australia
- Low (<1%) Europe
46
Gambling is _____
Significantly higher in males
47
Causes of Gambling
1. Genetic Propensity (~50%)
- Direct and Indirect Inheritance
2. Environmental Contributions
48
Features of Direct Inheritance
Altered reward pathways in the brain, making person more susceptible
49
Features of Indirect Inheritance
- Impulsivity
- Risk-Taking
- Mental health problems
- Vulnerability to stress
50
Neurobiology of Addiction
- Neuronal network in brain (reward pathway)
- Reward is associated with food, water, and sex
- Reward pathway can artificially be activated artificially by certain drugs (Alcohol, benzodiazepines, opiates, and opioids)
51
Reward Pathway
| Components and pathways
- Ventral tegmental area, nucleus accumbens, prefrontal cortex
- Mesolimbic and mesocortical
- Dopamine
52
The primary neurochemical involved is?
Dopamine
53
Environmental Contributions of Addiction
- ACEs
- Youth
- Lack of education/ knowledge
- Availability of addictive agent
- Cultural demographic norms promoting use
- Stress/ Trauma
- Mental Health Problems
- Poor coping skills
- Frequency of redministration
54
In Canada, for every 10 people an Addiction Therapist sees
| Most popular addictive agent to the least popular
- 3 are adults with alcohol problems
- 2 are adults with alcohol and drug problems
- 2 are adults with drug problems
- 2 are adolescents with cannabis problems
- 1 is an adult with gambling problems
55
Addiction Treatment
- Effective in short-term, less long-term
- 1 year after treamtnet 1/3 are abstinent, reduced substance use, and are unchanged
- Most addicts will have periods of abstinence followed by periods of abuse; only small minority will be unremittingly chronic or perpetual abstainers
56
41% will still relapse after
2 yrs abstinence
57
25% will relapse
after 4 yrs abstinence
58
7% will relapse
after 6 yrs abstinence
59
Treatment Options for Addiction
- Sel-help brochures
- Detox centres
- Outpatient individual counselling
- Day treatment programs
- Short-term residential programs
- Outpatient group counselling
- Long-term residential programs
60
Factors related to positive treatment outcome
- Client motivation to change
- Premorbid functioning
- Empathetic and engaging therapist
- Receiving and staying in treatment
- Commitment to total abstinence
- Receiving comprehensive services
- Behavioually oriented approaches (contigency management)
- Provision and participation in ongoing support services/ groups
- Medication and drug substitution
61
Examples of Drug Substitution
- Alcohol and Benzodiazepines
- Nicotine - e-cigarettes, patches, gum, inhalers, nasal spray
- Opiates/ Opioids methadone buprenorphine
- Amphetamines and Vyvanse and Methylphenidate
62
Examples of Buprenorphine
- Sublocade
- Suboxone
63
Medication Treatments for Alcohol
- Naltrexone
- Acamprosate
- Disulfram
64
Nicotine Medications
- Varenicline
- Buproprion
65
Gambling Medications
- Naltrexone
- SSRIs
66
Harm Minimizations for Addiction
- Supervised injection sites/ Supervised consumption sites
- ARCHES (Lethbridge safe injection site)
- Safe Legal Supply
- Drug Courts
67
Issues with Safe Consumption Sites
- Increased local crime
- Time and effort impedes person's ability to reintegrate into society
68
Benefits of Safe Legal Supply
- Reduces crime
- Improves health and wellbeing
- Improves social reintegration
69
Portugal and Harm Minimization
1. Decriminalized personal use of all drugs in 2001 (still some offense and fines)
2. Significantly expanded free treatment
3. Incentivized treatment by waiving penalties for drug posession if person accessed treatment
--> Successful
70
What is personality?
- A stable and enduring pattern of relating to onesefl and the evironment, exhibited in a wide range of contexts
- 5 primary dimensions of personality
71
Definition of Personality Disorders
Enduring patterns of perceiving, relating to, and thinking about the environment and onself that are exhibited in a wide range of social and personal contexts and are inflexible and maladaptive.
72
Personality Disorders...
- Reflect different combinations of the big 5 personality traits, usally maladaptively extreme variants
- First evident in adolescence, less evident in middle and old age
- Low reliability diagnosis
- These are types based on clinical experience and not empirical study
- Not uncommon to have more than one personality disorder
- Common
- Difficult to treat
73
What is the Classification of Personality Disorders
Cluster, A, B, and C
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Cluster A
Odd or eccentric behaviour
- Paranoid
- Schizoid
- Schizotypal
75
Cluster B
Dramatic, Emotional, or Erratic Behaviour
- Histrionic
- Narcissistic
- Borderline
- Antisocial
76
Cluster C
Anxious or Fearful Behaviour
- Avoidant
- Dependent
- Obsessive-compulsive
77
Explain Paranoid Personality
- Pattern of distrust and suspiciousness such that the motives of other people are interpreted as malevolent
- 2-4% prevalence; more males
78
Explain Schizoid Personality
- Pattern of detachment from social relationships and a restricted range of emotional expression
- 3-5% prevalence; slightly more males
- Predisoposing personality for schizophrenia
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Name the 5 Personality Dimensions
1. Extraversion
2. Agreeableness
3. Conscientiousness
4. Emotional Stability
5. Openness to Experience
80
Explain Schizotypal Personality
- Pattern of acute discomfrot in close relationships and cognitive or perceptual distortions and eccentricities of behaviour
- 0.5-4% prevalence
- Predisposing personality for schizophrenia
81
Explain a Histrionic Personality
- A pervasive pattern of excessive emotionality and attention seeking
- 2% prevalence; more females (perhaps female version of antisocial personality)
82
Explain a Narcissistic Personality
- Grandiosity, need for admiration, lack of empathy
- 0.5-6% prevalence; more males
83
What is Antisocial Personality Disorder
- AKA sociopathy, psychopathy
- Pervasive pattern of disregard for and violation of the rights of others that begins in childhood and continues in adulthood
- Moderate heritability
84
What are childhood signs of ASPD
- Lying
- Cheating
- Stealing
- Truancy
- Resisting authority
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What are adult signs of ASPD
- Excessive sexuality
- Drug use
- Aggressiveness
- Poor work history
- Poor interpersonal relationships
- Criminality
- Inability to tolerate boredom
- Reckless disregard for others' safety
- Impulsivity and failure to plan ahead
86
How is ASPD distinguished?
Simple criminality by the lack of remorse and loyalties
87
ASPD Prevalence
0.2-3% prevalence, much higher in males, younger ages, and incarcerated populations
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Borderline Personality Disorder
- A pervasive pattern of unstable interpersonal relationships, self-image, and mood
- Marked impulsivity
- 1-6% prevalence; 75% female
- Associated with mood disorders
- Substantial overlap with other mental health disorders; poor reliability of diagnosis
89
Avoidant Personality Disorder
- Pattern of social inhibiton, feelings of inadequacy, and hypersensitivity to negative evaluation
- 2% prevalence; equal sex ratio
90
Dependent Personality Disorder
- Pervasive psychological dependence on other people
- 0.5% prevalence; equal sex ratio
91
Obsessive Compulsive Personality Disorder
- Pattern of preoccupation with orderliness, perfectionism, and control
- 2-8% prevalence; more males
- Hoarding related
92
Intellectual Disability Assessment
- IQ<70 (2 standard deviations below the 100 average)
- Impairment in adaptive functioning
- Deficits evident prior to adulthood
- 4 levels: mild, moderate, severe, profound
93
What are the 4 Levels of Intellectual Disability
1. Mild (55-69 IQ)
2. Moderate (40-54 IQ)
3. Severe (25-39 IQ)
4. Profound (<25 IQ)
94
Amrican Association on Intellectual & Developmental Disabilities Criteria allows...
IQ as high as 75 and age of onset up to 21
95
Features of Intellectual Disability
- 1-2% prevalence
- 1.6x males
- Developmental delay rather than deficit
96
Common Comorbidities of Intellectual Disability
- Epilepsy (15-30%)
- Neuromuscular disorders (20-30%) (Cerebral Palsy)
- Sensory impairment (10-20%)
- Behavioural/ psychiatic disorders (25-40%) (autism, ADHD, schizophrenia, and alzheimer's)
97
Percentage of Institutionalized Individuals with Intellectual Disability
- ~50% institutionalized on psychiatric medication
- ~25% non-institutionalized on psychiatric medication
98
Behavioural Features of Intellectual Disability
- Low frustration tolerance
- Aggressiveness
- Impulsivity
- Stereotyped self-stimulatory and self-injurious behaviour
99
Causes of Intellectual Disability
- 30-40% unknown
- Genetic (Chromosomal, genetic & polygenetic abnormalities account for 40% od moderate, severe and profound, 20% for mild)
- Down's Syndrome most common chromosomal cause
100
What is the Cause of Fragile X Syndrome?
Trinugleotide repeat in the FMR-1 Gene on the X Chromosome
101
What are the neurobiological causes of intellectual disability?
- 20% moderate, severe, profound, 10% mild
- Prenatal influences (Maternal infection, poor maternal health, poor maternal nutrition, Rh incompatability, maternal drug use)
102
What is FASD
- CNS dysfunction
- Growth deficiency
- Facial features
103
Environmental Causes of Intellectual disability
- Accounts for majority of intellectual disability
- Lack of sensorimoto stimulation as infant
- Lack of intellectual stimulation, support, and structure as a child (maternal educational attainmnet tends to be the strongest predicotr of person's educational achievement)
104
Treatment for Intellectual Disability
- no cure, but can incorporate interventions to improve quality of life
- Behaviour modification
- Deinstitutionalization and Mainstreaming
- Medications
105
Institutionalization began...
1960s
106
Which Medications are Used for Intellectual Disability?
- Anti-Convulsants for epilepsy
- Anti-psychotics for aggression, self-stimulation, agitation, psychosis
- Mood stabilizers (Lithium) for aggression
107
What is mainstreaming?
Integrating students in normal classrooms. Does not improve academic performance, but improves social skills, self-esteem, behavioural problems, etc.
108
Assessment of Majaor Neurocognitive Disorder
- Significant cognitive decline from previous level in 1+ domains
- Dementia in DSM-IV
109
What are some of the domains relevent to cognitive decline?
- Learning and memory
- Language
- Executive function
- Attention
- Perceptual-motor
- Social cognition
110
Causes of Major Neurocognitive Disorder
- Traumatic brain injury
- Neurodegenerative disorders
- Vascular disorders
111
List some Neurodegenerative Disorders
- Alzheimer's
- Creutzfeld-Jakob disease
- Lewy body disease
- Huntington disease
- Multiple Sclerosis
- Parkinson's disease
- Pick's disease
112
