Exam 3 Content Flashcards
(127 cards)
1
Q
PTSD used to be included in
A
the anxiety disorders chapter
2
Q
PTSD is now included in
A
trauma and stressor related disorder
3
Q
the rate of exposure to trauma far ….. the prevelence of ptsd
A
outweighs
4
Q
do most people develop ptsd after trauma
A
no?
5
Q
true or false : PTSD is the only possible psychological consequence of trauma
A
FALSE
6
Q
what is criterion A
A
stressor
7
Q
what is the stressor
A
person was exposed to death, threatened, actual or threatened serious injury or sexual violence
witnessing in person
indirect exposure to aversive details of event usually in professional duty
8
Q
what is criterion B
A
intrusion symptoms
- recurrent involuntary and intrusive memories
- traumatic nightmares
- dissociative reactions
- intense or prolonged distress
- marked physiologic reactivity after exposure to trauma related stimuli
9
Q
what are the four distinct symptom clusters of PTSD
A
intrusion
avoidance
negative alterations in cognitions and mood
alterations in arousal and reactivity
10
Q
is ptsd diagnosed in the first month
A
NO
not within first month as immediate aftermath is high and normal
11
Q
example of dissociative reaction
A
vetern at wedding story
wanted to be present
was taken out when reminded of vietnam war
12
Q
what is critera c
A
avoidance
- trauma related thoughts or feelings
- trauma related external reminders that arouse recollections of the trauma ( people, places, conversations)
13
Q
example of avoidance of thoughts or feelings
A
description was in war
nice day when event happened
driving to next destination
something happened and had to pull over
new lead vehicle
hit and improvise explosive device
therefore avoidant of anything joyful happy and light
if youre laughing your not paying attention people die
14
Q
avoidance can look like
A
resilience
15
Q
what is criteron d
A
negative alterations in cognitions and mood
- inability to recall key features
- persistent and often distorted negative beliefs
- distorted blame of self for causing it
-negative trauma related emotions
- markedly diminished interest in pre traumatic significant activity
- alienated
persisten inability to experience positive emotions
16
Q
what is citerion e
A
alterations in arousal and reactivity
-irritable or aggressive behavior
- hyper vigilance
- exaggerated startle response
- problems in concentration
- sleep disturbance
17
Q
what is cirteion f
A
persistance for more than one month
18
Q
what is criterion g
A
- symptom related getting in the way
19
Q
what are ptsd specifications
A
dissociative depersonalization or derealization
delayed expression: full diagnosis is not met until at least 6 months after the trauma although onset symptoms may occur immediately
20
Q
what is complex ptsd
A
people who have diagnosis
pervasive traumatic event
coercive control and not being able to escape
sense of self is destroyed
“nothing I can do”
shame or guilt is more common
21
Q
example of complex ptsd
A
torture, concentration camps, slavery, genocide, and other forms of organized violence
22
Q
electrocompulsive therapy
A
not first resort
very effective
useful in people who have severe depression
23
Q
electrocompusive thereapy is most useful in people
A
with severe depression or depression with delusions
24
Q
what does ect do
A
formulate a sezuire
2-3 times a week
for 3-4 weeks
25
side effects of ect
memory deficit
26
what is psilocybin
works faster than lex a pro
27
what is a manic episode
period of abnormal elevated or irritable mood, increased goal-directed activity
28
negative symptoms of schiz?
flat affect
alogia
asociality
avolition
anhedonia
29
what does neg symptoms mean
too little of an experiance
postive is opposite
30
what is flat affect
blank or vacant
facial expression; no outward
expression of emotion
31
what is algoia
poverty of speech
(quantity or information)
not intentional
concrete reasoning
32
what is asociality
socially withdrawn
(ignore family/friends but not
lonely)
33
why is schiz stimatized to be dangerous
flat affect, no facial feedback is off putting
34
what is avolition
lack of drive or of
goal-directed behavior; sitting
for hours despite physical ability
to complete tasks
despite having energy and wanting to do something else they will not
lack of goal directed behavior or drive
35
Anhedonia
Anhedonia: diminished interest
36
what percent of population has schiz
.2% to 1.5%
37
when is schiz diagnosed
often diagnosed in early adulthood
can emerge at any age child is rare
37
males vs females schiz?
Diagnosed in males and
females about equally
Onset slightly earlier for
males
37
what are the three varying duration of schiz
prodromal - beginning of deterioration mild symptoms
active - symptoms become increasingly apparent
residual - a gradual return to prodromal levels
38
which symptoms are slower to remit in schiz
NEGATIVE
39
PSYCHOSIS IS A LATE EVENT IN A
PROCESS THAT
STARTS MANY YEARS
EARLIER
40
what are some of the early signs of schiz
Social withdrawal
Hostility or
suspiciousness
Deterioration of personal
hygiene
Flat, expressionless gaze
Oversleeping or insomnia
Odd or irrational
statements
Forgetful; unable to
concentrate
Extreme reaction to
criticism
Strange use of words or
way of speaking
41
when do poeple with schiz receive treatment
greater than 10 months of serious symptoms
42
what is anosgnosia
lack of insight especially in diseased state, lack of awareness about having some disease or disorder
- typically people have insight they are forgetting things
- example smack in the middle of manic episode
NOT NEGATIVE SYMPTOM
43
what are some causes of psychotic experiances - neurochemical
Neurochemical
- Dopamine hypothesis of positive symptoms
- Antipsychotic medications diminish
hallucinations and delusions (dopamine (D2)
antagonists)
- Symptoms worsen with drugs that increase
dopamine
- L-Dopa for Parkinson’s (low dopamine in
substantia nigra)
- Amphetamines, cocaine can precipitate
psychotic-like symptoms
44
what are some causes of psychotic experiances - brain structure
Enlarged cranial ventricles
Fewer neurons in frontal
cortex
45
what are some causes of psychotic experiances - methodological limitations
Cross-sectional studies
(one point in time)
Medications
Clinical settings with more
severe patients limit
generalizability of findings
46
do males or females have better prognosis for schiz
females
47
how does estrogen impact schizophrenia
Females have later
onset and less severe
course
- Low estrogen phase=
worsening of symptoms
- Second peak of first
onset during menopausal
transition
- postmenopausal
exacerbation of
psychotic symptoms
- Increase in antipsychotic
medication
- Decreased effectiveness of
medications
48
How does cannabis impact stressor in the diathesis stress model
Cannabis exposure alone does not cause schizophrenia.
- Cannabis use worsens the
course of psychosis.
- Heavy (daily) cannabis use
is over-represented among
new cases of
schizophrenia.
- Dose-response
relationship between
frequency of cannabis use
at baseline and risk of
schizophrenia during
follow-up.
49
T or F Associations strongest for
males with cannibis and schiz
TRUE
50
51
what is family focused therpay
Understanding vulnerability to future episodes
Learning role of mood-stabilizing medications for symptom control
Reducing expressed emotion in communication
Distinguishing between the patient’s personality and his/her bipolar
disorder
Recognizing and learning to cope with stressful life events that
trigger recurrences of bipolar disorder
Two year follow-up 52% of patients In FFT did not relapse compared
with 17% in psychoeducation group (control group)
52
what in interpersonal and social rythm therapy
adress disruptions in or improve existing relationships
53
when hospitalized with schiz what symptoms are present
postive
54
how does social rhythm therapy work
SENSITIVITYENSITIVITY TOTO PERTURBATIONSPERTURBATIONS ININ CIRCADIANCIRCADIAN RHYTHMRHYTHM,, APPEARSAPPEARS TOTO
BEBE ONEONE MAJORMAJOR CHARACTERISTICCHARACTERISTIC OFOF BIPOLARBIPOLAR DISORDERSDISORDERS..
** IMPROVEIMPROVE CIRCADIANCIRCADIAN RHYTHMSRHYTHMS THROUGHTHROUGH LIFESTYLELIFESTYLE REGULARITYREGULARITY
** UUSESE OFOF PERIPHERALPERIPHERAL CLOCKSCLOCKS ((ENVIRONMENTALENVIRONMENTAL SIGNALSSIGNALS)) TOTO ENTRAINENTRAIN
CIRCADIANCIRCADIAN RHYTHMRHYTHM
** MEALMEAL TIMESTIMES
** EXERCISEEXERCISE ROUTINESROUTINES
** SCREENSCREEN TIMETIME ((ANDAND WHENWHEN TOTO SHUTSHUT OFFOFF THETHE SCREENSSCREENS))
** MORNINGMORNING SUNLIGHTSUNLIGHT TIMETIME..
55
what is schiz
Two of these five symptoms are
required AND at least one symptom
must be one of the first three
(delusions, hallucinations,
disorganized speech)
Disorganized or catatonic
behavior
Negative symptoms
56
for schiz how long must symptoms be present
Duration: Continuous signs of the
disturbance persist for at least 6
months
57
what are postive symptoms for schiz
presence rather than absence of symptoms
delusions and hallucinations
58
what are schiz delusions
firmly held beliefs that are unfounded, unrealistic, and
idiosyncratic (tendency for these beliefs to influence social
relationships and/or behavior)
--- Thought insertion/broadcasting, reference, grandeur
59
what are hallucinations in schiz
(sensory experience in absence of environmental
stimuli or input)
Auditory, visual, olfactory, gustatory, tactile
60
what is disorganization in schiz
Disorganized
thought seems to be
at the core of
schizophrenia
Typically evidenced
through disorganized
behavior and speech
61
what are symptoms of disorganized speech
Loose associations
neologisms
word salad
preservation
62
what is loose associations in schiz
derailment)
* “I went to the store to buy milk. The cows make milk. I like cows
because they eat grass. Grass is green. The color green reminds
me of money."
63
what is neologisms in schiz
made up words
ex:"flusterated"
64
what is word salad in schiz
A jumble of words that have no logical connection or
grammatical structure.
-“Purple banana jumps swiftly over the sleepy telephone."
65
what is preservation in schiz
Involuntary repetition of a particular word, phrase,
or idea, even when it’s no longer relevant.
* Mary: “What do you like to do for fun?”
* Bob: “I like to run. Running is fun. Fun is running. Running fun.”
66
what are symptoms of disorganized behavior
Range from simple problems sustaining goal-directed self-
care behaviors (e.g., personal hygiene) to unpredictable &
bizarre or socially inappropriate actions.
Redundant clothing (wearing several layers of clothes,
wearing a heavy coat in middle of summer)
Unpredictable agitation: shout at people for no apparent
reason
Unusual social interactions: talking or muttering to
themselves continuously in public, staring at people without
explanation
67
catatonia in disorganized behavior
Pathobiology poorly
understood
May be present in psychotic
disorders or diagnosed
alone
Unusual motor responses,
particularly immobility, waxy
flexibility, staring, mutism
Excited catatonia is a less
common presentation in
which patients develop
prolonged periods of
psychomotor agitation
68
sleep and bipolar disorder
been implicated in the onset, course,
and treatment of bipolar disorder.
* Reduced need for sleep or
difficulties falling/staying asleep
observed in most manic episodes
* Hypersomnia, subjective daytime
sleepiness, or insomnia are common
features of depression
* The majority (70%) of people with a
diagnosis of BD report persisting
sleep problems between mood
episodes
69
genetic link in bipolar?
one of the most heritable psychiatric disorders
can not be used to predict individual risk for course of disorder meds effects
70
schiz course
deteriorating course
lag time between treatment
psychosis is a late event that started in a process way earlier
71
how many genes are involved in bipolar
many each with a small effect little evidence for BD specific gene
72
what are genes related to the regulation
calcium ion channels (CACNA1C and CACNB2)
circadian rhythm
(PER2 and PER3)
73
early intervention
improves the course of the disorder
74
some part of schiz is
neurotoxic
75
calcium ion channels in BD
When genes like CACNA1C don’t
work as expected, neurons
might send signals too strongly,
too weakly, or at the wrong
times—possibly contributing to
mood episodes in bipolar
disorder.
* Measures of intracellular calcium
signaling are increased in people
with a diagnosis of bipolar
disorder
76
Circadiam rythm in BD
Dysregulation of circadian
rhythms has been hypothesized
to be a central mechanism in the
pathophysiology of bipolar
disorders.
* Life events can disrupt daily
activity schedules or social
rhythms (e.g., bedtime, wake
time, mealtimes, start of work)
* schedule changes disturb circadian
rhythms and can precipitate mood
episodes
77
what is circadian disruption in BD
vulnerability to people to fly across multiple time zones
east to west may be delay and can develop depression
west to east advance and can develop mania
78
what are medications in BD
mood stabilizers
antidepressents
antipsychotics
79
what happens when we over treat parkinsons
enduce psycosis usually paranoia
80
when over medicate someone in schiz
tremmors
81
what are the goal of BD meds
STABILIZE CURRENTEPISODE
PREVENT RELAPSE (MAINTENANCE THERAPY)
RREDUCE
SYMPTOM SEVERITY& IMPROVE
FUNCTIONING BETWEEN EPISODES
82
BD mood stabilizers
LITHIUMITHIUM CARBONATECARBONATE ((FIRSTFIRST--LINELINE TXTX))
(L(LAMOTRIGINEAMOTRIGINE (L(LAMICTALAMICTAL), V), VALPROICALPROIC AACIDCID (D(DEPAKOTEEPAKOTE)
83
BD antidepressents
CONTROVERSIAL//CANCAN INDUCEINDUCE MANIAMANIA
OROR ACCELERATEACCELERATE RAPIDRAPID CYCLINGCYCLING ININ BP-1.BP-1.
NNOTOT GREATGREAT//CANCAN MAKEMAKE THINGSTHINGS WORSEWORSE ASAS
MONOTHERAPYMONOTHERAPY
WWORKSORKS WELLWELL WHENWHEN COUPLEDCOUPLED WITHWITH ANTIANTI--
PSYCHOTICPSYCHOTIc
84
BD antipsychotics
QUETIAPINEUETIAPINE (S(SEROQUELEROQUEL),), LURASIDONE
(LATUDA), OLANZAPINE (ZYPREXA), CCARIPRAZINEARIPRAZINE
((VRAYLARVRAYLAR),),
DOSES ARE SUBSTANTIALLY LOWER THAN THE
DOSES USED TO TREAT ACUTE PSYCHOSIS OR ACUT MANIA
85
Brain structure lecture story
some people with schiz have enlarged central ventricals
CSF comes in to fill the space due to loss of grey matter
86
how are lithium and other mood stabilizers used in BD
most have fewer episdoes when taking
prophylactic drugs that prevent symptoms developing
help with overcome and depression but less
greater than 80% liekly to engage in suicidal behaviors
87
how does lithium work
stabilze mood via circadian clock
internal rythym sync
sensitivit yto light dkar increase
reduce calcium signlaing
88
is there a genetic component in schiz
strong gentic link but 80% do not have relatives with conditions
89
take home message of quads with schiz
turns out it matters how yo treat people
sisters who were treated better had better outcome
90
did the sisters have different brain scans in schiz quad example
no
91
sisters quad
strong geneitc in onset
condition path based on treatment by parents
92
not the virus.....
moms immune system
93
where does expressed emotion come up in diagnosis
BPD
94
what are treatements for schiz
neuroleptcs
atypicas
third generation
clozapine
95
what are neuroleptics
antipsycotic meds (first generation)
rare but life threatening
adverse side effects made it difficult to stay on
helped positive side effects of schiz
96
what is akinesia
inability to initate movement, motnotonous speech and expressions in face
97
what deminis QOL in schiz
negative
98
what is akathisia
subjective feeling of inner restlessness and the urge to move
99
what is tardive dykinesia
lick smakcing, chewing etc.
100
101
what are atypicals
second gen antipsychotics
metabolic SE
adverse ones include weight gain diabetes high blood cholestorol
102
what are third gen meds schiz
helps both depression and symptoms of psychosis
103
pros of clozapine
Clear advantage for treatment-resistant schizophrenia
Virtually no extrapyramidal symptoms or tardive dyskinesia
Advantages in reducing hostility, suicidality
Increased social and cognitive function, leading to marked improvement in overall quality of life
104
cons of clozapine
Associated with severe neutropenia/agranulocytosis
Neutrophil monitoring required every week for initial 18 weeks of treatment (95% of cases occur within this timeframe)
Seizure risk (1-5%)
Warning for myocarditis
Significant weight gain, sedation, orthostasis, tachycardia, sialorrhea, constipation
105
what are CBT in addition to meds in schiz
may be useful in reducing frequency or distress with positive symptoms - auditory hallucinations
adherrance to meds and healthcare provider communication
help with weekly goals
mixed evidence for CBT provifin any clinical meaningful benefit
105
what are psychosocial treatments for schiz
Build social and self care skills (establishing routines)
Family education
Modify family communication
Community support Programs
Independent living skills (symptom management/med management)
106
what do meds treat in schiz
positive symptoms
107
eating disordres who are underdiagnosed
men
108
high ed in
young white females (diagnosed)
109
ed take home
important to notice who is not being diagnosed along with who is being diagnosed
110
anorexia step one
dangeroulsy low body weight
restriction of calories in what is typical for health
111
is anorexia and anorexia nervosa the same
no!
anorexia is just underweight not an ED
112
anorexic is an intense fear of
gaining weight of obseity or persistant behavior that interfears with weight gain
113
most importatn critera anorexia
distrubance in the wya ones body weight or shape is experienced
undue influence of body shape and weight on self evaluation
lack of recognition
114
people can dip in and out of
anogsinosia
115
binge episode
subjective feeling of a loss of control
don't know ehn they will stop eating
116
signs of anorexia
aviod eating with others
unusual eating habits
trying to be healthy
food as expression of autonomy
compulsive exercise
social withdrawal from family or friends
117
what is driven exercise
driven to control weight or shape
pathological excersie behavior
elevate anciety and si
harmful symptom
118
medical complications from anorexia
heart muscle atrophy
bradycardia
amenorrhea
constipation
brittle hair nails purple nail beds
sensitivity to intolerance of cold
lanugo
119
amenorrhea
not having your period
120
lanugo
fine downy hair
121
Highest mortality rate?
anorexia
10-20%
1-5 is suicide
122
minnesota experiment
starving emancipated cities
healthy men selected for churches
ate normal for first 3 months
6 months semi starve
changes during restrictive phase
reoccupation with food
social pyshical emotional changes
123
take home minnesota
many symptoms may be reuslt of food restriction
importnat to understand to treat and support people with ED
124
risk facotrs of ed
perfectionism
ancierty
early puberty
illness with unintended weight loss
athletics
like
diet
self esteem
