final Flashcards
1
Q
what are the modern conceptualizations of sexual dysfunctions (kinsey, masters & johnson) generally speaking
A
masturbation, oral sex, same sex sexual behavior, was engaged in by more people and occured at a much higher frequency than previously believed.
2
Q
what did kinsey, masters & johnson conclude about how often men and women think about sex
A
for never to a few times a week, women selected these options more. for options like every day and several times a day, men selected these options more.
3
Q
what did alexander and fisher (2003) conclude regarding reported sexual behavior with the bogus pipeline (most direct conclusions)
A
gender and sex differences in reported sex differences is smaller than previously thought (for autonomous sexual behaviors, sexual partners, and age of first sex)
4
Q
how does the alexander and fisher (2003) bogus pipeline work
A
pipeline scenario is when they have a fake polygraph that will detect dishonest responding. they ask about autonomous sexual behaviors, sex partners, first age of consensual sexual intercourse
5
Q
what did the bogus pipeline conclude about the challenges in conducting sex research and the implications in clinical practice
A
clinicians can’t make assumptions or use stereotypes to understand each client’s sexual experiences and sexuality. creating a comfy and trusting space for clients to share is important
6
Q
is distress needed for sexual dysfunction diagnoses
A
yes, clinically significant needed
7
Q
is distress needed for treatment in sexual dysfunction
A
no, you can get treatment without a diagnosable sexual dysfunction such as when there is a discrepancy between partner desires.
8
Q
masters and johnson sexual response chart three different levels of arousal
A
excitement, plateu, orgasm
9
Q
masters and johnson excitement
A
genital tissues swelling as they fill with blood (vasoconstriction)
10
Q
masters and johnson plateau
A
consolidation of arousal, additional swelling of genital tissues
11
Q
masters and johnson orgasm
A
rhythmic, muscular contractions in genital region at around 8 sec intervals.
12
Q
masters and johnson refractory period
A
unresponsive to further sexual stimulation. it depends on the person for the time. you label it vertically, as in people must lose a certain amount of arousal before orgasm again
13
Q
masters and johnson resolution
A
body gradually returns to pre aroused state
14
Q
difference between male and female charts for masters and johnson
A
males cannot orgasm during the refractory period but women can orgasm multiple times within a short period of time
15
Q
kaplan sexual response cycle 3 phases
A
desire, excitement, orgasm
16
Q
kaplan defines desire as
A
mental and psychological process defined by interest in sex. happens before arousal
17
Q
kaplan sexual response model flaws
A
you can miss certain parts. you don’t need desire to be aroused
18
Q
basson sexual response cycle
A
emotional intimacy -> (if wanting emotional intimacy, will change attitude about sex) sexual neutrality -> (seeks) sexual stimuli -> sexual arousal -> sexual desire and arousal -> emotional and physical satisfaction -> emotional intimacy
19
Q
what does basson define desire as
A
a response to physical sensations. you feel desire after a physical sensation
20
Q
what does basson mean by sexual neutrality
A
willingness to engage in another sexual activity
21
Q
factors to consider during sexual dysfunction assessment
A
partner focus (health?), relationship factors (communication, aging, desires), individual vulnerability (body image, abuse, comorbidity, other stressors), cultural and religious factors (attitudes towards sex), medical factors (pelvis nerve damage)
22
Q
what three stages does the DSM focus on for sexual dysfunction
A
desire, arousal, orgasm
23
Q
time period subtypes for DSM sexual dysfuction
A
lifelong (always experiences), acquired (recent onset, after dysfunction free time), generalized (dysfunction apparent in all sexual situations), situational (only in a specific situation)
24
Q
is sexual dysfunction considered common
A
yes
25
prevalence of lifetime sexual dysfunction in men
31%
26
prevalence of lifetime sexual dysfunction in women
43%
27
most frequent sexual dysfunction for women
desire and arousal
28
most frequent sexual dysfunction for men
premature ejaculation and erectile disorder
29
sexual dysfunction patients sees therapists usually only when the problem is more complex, how is this an issue
more secondary difficulties. shame, anxiety about sex. relationship issues, low self esteem
30
DSM lists dysfunction for males and females. what are the gender categories for
current reproductive anatomy
31
male hypoactive sexual desire disorder comorbidities
erectile disorder, delayed ejaculation, premature ejaculation, depression, endocrinological factors
32
symptoms of male hypoactive sexual desire disorder
persistent or recurrently deficient or absent sexual/erotic thoughts or fantasies AND persistent or recurrently deficient or absent desire for sexual activity (accounting for age and sociocultural factors)
33
sexual desire and arousal disorders (3 total)
male hypoactive sexual desire, female sexual interest/arousal, erectile disorder
34
female sexual interest/arousal disorder (FSIAD) comorbidities
other sexual differences, depression, alcohol use. sexual distress and abuse.
35
FSAID symptoms
lack of or significantly reduced sexual arousal or interest in at least 3 domains such as: reduced sexual thoughts, interest, initiation, pleasure, sensations for 6 months minimum in 75-100% of sexual occasions with marked distress.
36
issue with FSAID diagnosis
low desire is hard to define. social pressure of having sex may be unrealistic, sexual activity can also be without desire, and many factors affect low desire. could be not enough sexual stimuli
37
erectile disorder etiology and comorbidity
smoking, heart disease, weed, age. depression is comobid
38
symptoms of erectile disorder
difficulties obtaining erection and maintaining until completion AND/OR marked decrease in erectile rigidity in 75-100% of sexual occasions
39
treatments for erectile disorder
medication may suddenly stop working. pelvic floor physiotherapy, but vacuum devices are more common. constriction band when erect.
40
difficulties in diagnosing erectile disorder
connotations with masculinity causing delay in seeking help
41
orgasmic disorders
female orgasmic disorder, delayed ejaculation, premature ejaculation, genito-pelvic pain/penetration disorder (GPPPD)
42
female orgasmic disorder symptoms
delay, infrequency or absence of orgasm, reduced intensity of orgasmic sensations, this must occur 75-100% of sexual occasions, must have distress and no diagnosis if clitoral stimulation solves the issue
43
delayed ejaculation etiology
unrealistic expectations, aging
44
symptoms of delayed ejaculation
delay in ejaculation or infrequency/absense of ejaculation. 75-100% occurence when with partner. can ejaculate alone, edging does not count. must be distressed
45
treatment for delayed ejaculation. when can't you use this treatment
cyclic guanosine monophosphate activity is raised with viagra or cialis. this is first line unless there are cardio issues or nitrate is usedi
46
issues with diagnoses of delayed ejaculation
delay not defined properly
47
IELT (intravaginal ejaculatory latency time)
time from penetration to ejaculation, about 4-10 min for het couples
48
premature ejaculation frequency
very common, 75% experienced at least once. 8-30% have a more extreme version
49
premature ejaculation speed for extreme version
90% w/i 1 min, 60% w/i 15 sec
50
etiology of premature ejaculation
genetics related to sensitivity. inflammation/infection of prostate, younger age. sexual conditioning due to masturbating quickly and efficiently
51
premature ejaculation symptoms
persistent or recurrent pattern of ejaculation during partnered sexual activity within 1 minute of vaginal penetration before a person wants it. must be present in 75-100% of cases. distressing symptoms
52
premature ejaculation for nonvaginal penetrative
can be applied for nonvaginal penetrative sexual activities but no specific diagnostic criteria.
53
what factors affect IELT
voluntary control, satisfaction, and distress
54
behavioral treatment for premature ejaculation
behavioral stop-start where manual stimulation until almost orgasm, stop 40 sec to a minute, repeat 15 mins. squeeze around coronal ridge if stopping is not enough. the goal is to last 15 minutes with 1 to 2 stops.
55
non-behavioral treatment for premature ejaculation
antidepressants
56
genito-pelvic pain penetration disorder eitiology
physical concerns (pelvic floor muscle dysfunction, infections). psychosocial factors (childhood victimization, anxiety/ depression, relationship). cognitive factors (pain sensitivity, negative attributions to pain, catastrophizing.
57
comorbidity of genito-pelvic pain penetration disorder
female sexual interest/arousal disorder
58
what did genito pelvic pain/penetration disorder originate from
dyspareunia: painful sexual intercourse. vaginismus: difficulty with vaginal penetration due to anxiety/fear of pain.
59
most common form of dyspareunia
provoked vestibulodynia: severe, sharp burning pain at the vagina from any sort of pressure. can be from sex, tampon, gynecolical, exam, prolonged sitting, fitted pants
60
symptoms of genito-pelvic pain/penetration disorder
persistent or recurrent difficultues with one or more:
1. vaginal penetration
2. marked vulvovagina or pelvic pain during vaginal intercourse/penetration attempts.
3. fear/anxiety about vulvovaginal/pelvic pain in anticipation of, during, or as a result of vaginal penetration (tamponss/gyno count)
4. tensing of pelvic floor muscle during attempted vaginal penetration
5. distress.
61
treatment for genito-pelvic pain and penetration disorder
vaginal dilation (insertion of dilators to relax opening. done during general body/pelvic floor muscle relaxation exercises to normalize muscle tone). pelvic floor physiotherapy
62
psychosocial problems that come with gpppd
reduced femininity and relationship
63
hypersexuality is present in:
ICD-11. not DSM
64
etiology of hypersexuality
impulse control
65
symptoms of hypersexuality
loss of control over sexual urgers. fantasies, behaviros, engaging in sexual activity to regulate negative emotions
66
treatment for hypersexuality
atheroretical treatment where concerns are treated without worrying about the nature of a disorder.
67
characteristics that affect hypersexuality diagnoses
paraphilia, porn/masturbation can change concern, infidelity leads a double life, whether client's partner indicates issue, norms present
68
general sexual disorder etiology
physical: hormones and medical conditions. psychological: development and maintanence of things such as performance anxiety
69
performance anxiety
etiology for sexual desire and arousal disorder. patient does not pay attention about arousing aspects, more worried about messing up, maintenance factors targetted in treatment. sympathetic activated, decreasing arousal
70
what does it mean to become a spectator
monitor sexual performance, caring about percieved responses of partner
71
meds that cause orgasmic disorders
SSRIs and other meds.
72
orgasmic disorders general causes
limited sexual techniques and understanding, cannot let go
73
are sexual disorders diagnosed if problems are situational and disappear with situation
no
74
general treatment for sexual disorders
communication and exploration (sex education, accept own sensations first, then exercises to become more aware). often psychoeducation is all that's needed. sensate focus to focus on predetermined stages of sexual interaction. physical treatment best in conjunction with psychological
75
sensate focus
desensitation applied to sexual fears, redirect attention toward sexual interaction instead of specific sexual response.
1. undress with light on
2. touch (no erogenous)
3. touch (yes erogenous without penetration)
4. slowly engage in intercourse
76
paraphilia
intense, persistent sexual interest in anything other than genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners
77
paraphilic disorder. what cognitive and behavioral features needed
paraphilia with distress or impairment to individual, or causes harm/risk of harm to others when acted upon. **fantasies, urges, behaviors needed**
78
what is the requried length of time for all paraphilic and sexual dysfunction disorders
6 months
79
two broad types of paraphilias
erotic activities, erotic targets (objectum mentioned???!)
80
fetishistic disorder
recurrent/intense sexual arousal from the use of nonliving objects or a highly specific focus on a nongenital body part or parts. can be object or behavior. begins in childhood
81
pedophilic disorder
predominant sexual interest in or preference for prepubescent children. 13 or younger target, 16 or older offender, 5 years older than victim. EXCLUSIVE: must have acted on urges, or urges caused marked distress or impairment. denial theory applies.
82
exclusive pedo disorder
only children
83
child offender
sexual act on child, don't need pref for child. contact or noncontact (CP) all count.
84
how many of male child molesters are pedos
40-50%
85
do pedo disorder need sexual offense
no
86
predisposing factors of sexual offenders
sexual deviance (paraphilias), antisocial traits, intimacy deficits (identification with children).
87
treatment for sexual offenders
CBT and medical treatment (medical is less supported)
88
when are sadism and masochism diagnosed
when on nonconsenting people or distress/impairment
89
exhibitionistic disorder frequency in sexual offenses
most common sexual offense, high rates of reoffending
90
exhibitionist disorder diagnoses
arousal from exposing one's genitals to unsuspecting and nonconsenting individual. can be diagnosed if in denial but there is objective evidence otherwise
91
voyerustic disorder
aroused by looking at unsuspecting individuals that are naked, undressing, or having sex. do not seek sexual relations. masturbate during or after. only 18+ diagnoses to avoid pathologizing normal behavior. denial theory applies.
92
frotteuristic disorder
touching or rubbing up on a nonconsenting person for arousal. in busy places. brief contact in some cases, some do not care about detection, tend to be more intensive and aggressive.
93
diagnostic criteria for gender dysphoria
incongrience between one's experienced/expressed gender and assigned gender. 6 months duration minimum, manifested by 2 of:
1. significant incongruence between one's experienced or expressed gender and one's sexual characteristics
2. strong desire to be rid of one's sexual characteristics due to incongruence
3. desire for sexual characteristics of a not assigned gender
4. desire to be a gender not assigned
5. desire to be treated as a gender not assigned
6. conviction that one has typical reactions and feelings of a nonassigned gender.
needs clinically significant distress/impairment
94
do all people wiht gender dysphoria want HRT
no
95
four factors that makes working with children different from working with adults
developmental considerations, role of caregivers and environment. presenting issues differ, legal and ethical considerations
96
what are some developmental considerations for working with children
brain development impacts behavior and emotions. age appropriate assessment and treatment is required. age appropriate communication needed
97
why do you need to account for caregivers and environment when working with children
parents, teachers, and peers play a crucial role in treatment. need collaboration with families and schools
98
why do presenting issues differ in children compared to adults
more externalizing behaviors like tantrums because they cannot cognitively conceptualize. adolescents may struggle with identity, peer pressure, and risk taking.
99
legal and ethical considerations regarding working with children
consent and confidentiality. this varies by age and jurisdiction. navigating custodial challenges, balancing child's righs with parent's concerns
100
what percent of youth have a psychological cisoder
20%
101
internalizing presenting mental health issues
inward focused symptoms like anxiety or low mood. overcontrolled emotions
102
externalizing presenting mental health issues
outward directed behaviors such as aggression and rule breaking. disorders of under controlled emotions.
103
exclusively externalizing diagnoses in youth examples
ADHD, ODD, CD (conduct)
104
both externalizing and internalizing diagnoses in youth examples
DMDD(disruptive mood dysregulation disorder), OCD, PTSD
105
internalizing diagnoses in youth examples
anxiety disorders, mood disorders, selective mutism
106
cormorbidity generally, determined by NSC-A study regarding 13-18 year olds
40% of those with one psychiatric disorder met criteria for another
107
estimates of prevalence of any mental disorders in youth 2002
15%
108
order of prevalence: any anxiety, conduct, ADHD
any anxiety 6.5%. adhd and conduct around the same 3.3%
109
impact of covid on hospitalization for mental health disorders
2% more out of all hospitalizations. 23% of hospitalizations for children and youth 5-24 were for mental health
110
covid impacts on female hospitalization due to mental health between 15-17
2x more likely than males of the same age
111
which two disorders peak around 10-14 as max prevalance
ADHD and conduct
112
mental disorder onset compared to other pathology
earlier
113
ACEs. what is it and examples
adverse childhood experiences. stressful and potentially traumatic, such as poverty, maltreatment, bullying, interparental conflict. associated with increased risk of mental disorders/suicidality (obciously)
114
how much do ACEs increase mental disorders and suicidality
around 2x. suicidality 2.33
115
psychological factors for biopsychosocial model
mental health, cognition, trauma, development, attachment
116
biological factors for biopsychosocial model
physical health, aging, illness, ability, meds, alcohol, drugs
117
sociocultural factors for biopsychosocialmodel
values, family of origin, religious beliefs, societal norms, gender role/socialization, relationship factors
118
the 5 ps to understand a presenting issue
predisposing, precipitating, perpetuating, protective
119
predisposing
what do you know about yourself that makes you more likely to have this problem (ACEs, cognitive delays, more emotion felt)
120
precipitating
what prompted you to reach out to tend to this issue now (i.e. what triggered the phobia)
121
perpetuating
what is keeping the problem going, or fueling it
122
protective
what are your strengths and resources in managing this issue
123
ADHD general criteria (not referring to subtypes)
persistent pattern of inattention or hyperactivity/impulsivity that inferferes with functioning or development, prior to age 12, severe symptoms present in 2 or more settings. symptoms interfere with or reduce quality of social, academic, occupational functioning. cannot be better explained by another mental health condition. inconsistent with developmental level
124
when is ADHD usually diagnosed
school age. younger kids tend to be more hyperactive, diagnostic criteria does not apply yet
125
inattention symptoms ADHD (6 or more needed)
careless mistakes (lack of attention to detail). inattentive. doesn't listen when spoken to directly. doesn't finish work. unorganized. don't like mental effort. loses things. easily distracted. forgetful
126
hyperactivity symptoms ADHD (6 or more needed)
fidgets. leaves seat. runs/climbs. leisure activity loudness. on the go/driven by motor. talks excessively. blurts answers. can't wait turn. interrupts or intrudes
127
ADHD etiology: 4 big aspects
brain structure and function, genetics, prenatal risk factors, psychosocial risk factors
128
brain structure and function etiology regarding ADHD (neurotransmitters, brain part?)
abnormalities in metabolism of or genes that regulate dopamine and noradrenergic neurotransmitters. abnormalities with prefrontal cortex affecting executive functions. abnormalities of basal ganglia (affecting motor control, learning memory and cognition, emotional regulation)
129
heritability of ADHD
77%
130
prenatal risk factors of ADHD
prenatal toxin exposure, comprised of poor diet, mercury, and lead. pregnancy and delivery complications. exposure to alcohol and maternal smoking
131
psychosocial risk factors for ADHD
higher prevalence of ACEs, because struggling with attention may cause ACEs
132
controversies in ADHD, general 4 categories
gender differences, over or under diagnoses, role of environment. psychosocial risk factors
133
gender differences in ADHD diagnoses
boys diagnosed more than girls (3:1), girls underdiagnosed. girls more likely to be inattentive, leading to misdiagnosis or late diagnosis
134
over or under diagnosis of ADHD
concerns about ADHD being overdiagnosed esp in young children. underdiagnosis in minorities, females, high IQ
135
influence of the environment on ADHD
diet, screen time, parenting style. some say ADHD may be due to external factors. but correcting for the influence of external effects will return symptoms to a normative level for non ADHD people
136
psychosocial issues in ADHD diagnoses
can be a natural variation in attention and activity levels. expanding diagnostic criteria in DSM has increased diagnoses
137
ADHD assessment
parent, teacher, child interviews for behavioral history (clinical interview). assess symptom severity based on population norms (behavioral rating scales). rule out other conditions for a comprehensive assessment (cognitive, academic, socioemotional assessment). DSM 5 criteria assessment and clinical report
138
adhd treatment (meds and therapies)
stimulant medications work for vast majority of children (ritalin, dexedrine). psychoeducational interventions, educating careagivers and teachers about symptoms. parent training or family therapy (emotionally focused family therapy). academic skill facilitation and remediation. family therapy. CBT, individual psychotherapy, social training to not interrupt.
139
oppositional defiant disorder symptoms
angry or irritable mood: lose temper, easily annoyed, touchy, angry, resentful / argumentative or defiant behavior: argue with authority, refuses to comply with authority, deliberately annoy others, blames others / vindictiveness: spiteful or seeking revenge at least twice in past 6 months. distress to individual or others directly, negative impacts. rule out psychotic, substance use, depressive, bipolar, disruptive dysregulation
140
how many symptoms needed for ODD
4 out of 8
141
how many symptoms needed for conduct disorder
3 symptoms in 12 months and 1 symptom in 6 months
142
conduct disorder general 4 symptoms
repetitive, persistent violation of rights of others/breaking of age norms. aggression, destruction of property, decietfulness and theft, violation of rules. cannot meet ASPD if greater than 18. significant impairment in social, academic, occupational functioning.
143
aggression in CD
aggression: billies, threatens, intimidates, physical fights, uses weapon, physically cruel to people and animals, robbery, rape.
144
destruction of property in CD
destruction of property: deliberate fire setting, destroying others' property.
145
decietfulness and theft in CD
decietfulness and theft: broken into others house/building/car, cons people, steals.
146
violation of rules in CD
violates rules: stays late before 13, runs away twice or once for long time. often truant, beginning before age 13.
147
conduct disorder subtypes by age
childhood onset is less than 10 years old. more severe and persistent. adolescent onset is more than 10 year old. peer influenced and less severe. can have adult or uknown onset
148
severity of conduct disorder, what is severe
mild, moderate and severe, severe is violence/weapon use
149
trait specifiers for limited prosocial emotions
lack of remorse or guilt. callous: lack of empathy. unconcerned about performance. shallow or deficient affect
150
prevalence of ODD, general population and adolescence
9-12% in general population, 3-6% in adolescence.
151
CD prevalence
1-10% across general population
152
ODD worsening can progress into
CD
153
sex differences in ODD and CD
OD has more boys, CD has 3-4x more likely boys
154
etiology of ODD and CD, 4 big factors
brain function and structure, genetics, prenatal, psychosocial
155
brain structure and function influence on ODD and CD (structures and neurotransmitters)
damage to prefrontal cortex and amygdala (impulse and decision). aggression leading to lower heart rate and skin conductance (decreased reaction to punishment). early difficult temperament, poor social cognition, lower IQ, lower executive functioning. low noepinephrine for CD
156
what are ODD and CD comorbid with
ADHD
157
genetic risk factors for ODD and CD
CD heritability is 71%. strong link between CD and family because of parenting and ACEs
158
prenatal risk factors of CD and ODD
maternal stress and smoking (similar to ADHD)
159
psychosocial risk factors for ODD and CD
poor parenting (harsh, inconsistent, abuse, low monitoring). harsh discipline more commonly used with difficult children. explains high ODD in low SDS/minorites
160
therapy treatments for ODD and CD
CBT (cognitive restructuring, emotion regulation, problem solving), DBT (distress tolerance, emotion regulation, interpresonal skills training), famil focused interventions ( EFFT)
161
pharmacological treatments for CD and ODD
mood stabilizers, typical, atypical neuroleptics and stimulatns
162
school and community based treatments for CD and ODD
behavior intervention plans (BIPs), and individual education plans (IEPs). after school activities that promote teamwork and responsibility
163
issues with CD and ODD diagnoses
some behaviors described are normal developmentally. may be over pathologizing. higher rate of diagnoses in POC (diagnoses depend on cultural epectations?) other mental health challenges worsen ODD. does not explain why a kid is labelled as "bad"
164
neurodevelopmental disorder onset
before school, early in development.
165
comorbidity for neurodevelopmental disorders
frequent comorbidity within the category, can co-occur with childhood onset conditions
166
degree of neurodivergencce assessed with
developmental stage and milestones
167
intellectual disability
intellectual (reasoning, problem solving, planning, abstract thinking, judment, academic learning, learning from experience, confirmed by IQ test and clinical assessment) and adaptive functioning deficits in conceptual, social, and practical domains (adaptive deficits limit functioning in one more more activities of daily life, such as communication, social participation, independent living).
168
estimated prevalence for intellectual disability
0.8-3%
169
IQ tests assess what domains
verbal comprehension, working meory, perceptual reasoning, quantitative reasoning, visual spatial skills, abstract thought.
170
why do you need clinical training and jugement help assess performance for IQ tests to diagnose intellectual functioning
individuals with intellectual disabilities may have not been as exposed to test environments. suseptible to practice ffects. problems with validity of lower scores. does not sufficiently assess reasoning in many real life situation sor mastery or practical tasks.
171
aside from an intelligence evaluation, what else does an assessment of intellectual functioning do
identify strengths and weaknesses which can impact academic and job planning
172
three domains of adaptive functioning
conceptual (academic), social, practical
173
what does adaptive functioning determine, what is it influenced by
overall level of support, influenced by intellectual capacity, education, motivation, socialization, personality features, vocational opportunity, cultural experience, medical conditions
174
conceptual (academic) domain of adaptive functioning
competence in memory, language, reading, writing, math reasoning, acquisition of practical knowledge, problem solving, judgement of new situations
175
social domain of adaptive functioning
awareness of others thoughts, feelings, and experiences. empathy, interpersonal communication skills, friendship abilities, social judgement
176
practical domain of adaptive functioning
learning and self management across life settings, including personal care, job responsibilities, money, recreation, school, and work
177
severity levels for adaptive functioning
stated as mild, moderate, and severe, can be different for each domain.
178
assessment of adaptive functioning (psychometrically sound measures)
vineland adaptive behavior scales (3rd ed), adaptive behavior assessment system (3rd ed), scales of independent behavior-revised
179
targets of adaptive functioning interviews
client, parents, teachers, counselors, caregivers, other family members
180
info outside of interviews for diagnosing adaptive functioning
educational, developmental, medical, mental health evaluations
181
cloak of competence
tendency to underestimate some clients with disabilities because they appear normal or have generally good functioning. clients feel like they have to pass as normal due to stigma
182
acquiescence. how to prevent
answers provided affirmatively or when intellectually disabled person is suggestible. allow "i don't know" and drawing as answers can help
183
etiology of intellectual disabilities
many causes.
184
genetic etiology of intellectual disabilities
minor and major chromosomal differences/deletions. inherited and spontaneous.
185
what percent of moderate/severe intellectual disability is due to a genetic cause
55-70%
186
dominant genetic inheritance examples
tuberous sclerosis, neurofibromatosis
187
recessive genetic inheritance examples
phenylketonuria, tay sachs
188
x linked or sex linked inheritance examples
fragile x syndrome, lesch-nyah
189
chromosomal changes mutations. how do they occur. example?
down syndrome. not inherited. spontaneously at conception.
190
metabolic disorders that cause intellectual disability. examples
phenylketonuria (PKU) which is too much phenylalanine in brain due to enzyme not working. congeital hypothyroidism, hyperammonemia, gaucher's disease, hurler's syndrome
191
preventing genetically caused intellectual disabilities
prenatal screening
192
down syndrome intellectual impairment
nonverbal cognitive, verbal, auditory short term memory, particularly affected in young children. impairment can be from mild to severe, most are mild and moderate functioning impairment
193
causes of down syndrome
trisomy 21 95% of the case
194
comorbidities with down syndrome
various infections, congenital heart disease, alzheimer' type dementia (50% get it, 75% die)
195
can ppl with down syndrome gain normal social functioning
ye
196
down syndrome characteristics
shorter tongue, decreased muscle, almond eyes
197
increasing life expectancy of ppl with down syndrome
early intervention and education. antibiotics and congenital heart disease surgery
198
fragile x syndrome cause. gene affected
weakened or fragile site on x chromosome affecting FMR-1 gene, which is larger.
199
two types of fragile x syndrome
full mutation means larger gene and more severe cognitive difficulties. premutation is when the gene is not as large but larger than individuals without fragile x syndrome
200
fragile x is more common in what sex
AMAB
201
what is the most common hereditary cause for intellectual disability and autism
fragile x
202
physical features of fragile x
large ears and forehead
203
fragile x in males
sequential processing and expressive language affected. good at spatial processing and simultaneous processing of holistic information, recieving language
204
fragile x in females
about 1/3 experience a mild intellectual disability. learning difficulties involve attention, short term memory, problem solving.
205
fragile x cognitive and psychological symptoms
ADHD, autistic symptoms. anxiety, aggression.
206
IQ of fragile x
35-70
207
what percent of AMAB with full fragile x mutation will be affected, what about AFAB
almost all. AFAB 50%
208
female with premutation for fragile x passes it to son, chance of becoming full mutation?
80%
209
how to alleviate fragile x symptoms
structured programs that limit distractions, with regular routines, visually or experientially based
210
prenatal environment causes for inellectual disability
maternal infections (e.g. rubella) in first 3 months of pregnancy. HIV, developmental delays happens in 75-90% of children (growth, feeding, cogntive, motor). fetal alcohol spectrum disorder (FASD). other drugs (thalidomide, smoking)
211
vaccine for rubella
MMR
212
birth related causes for intellectual disability
extreme prematurity, lack of oxygen during prolonged or complicated labour and delivery.
213
fetal alcohol spectrum disorder rates of occurence. how many pregnant women consume alcohol
1/13 pregnant women consume alcohol. 8/1000 kids have FASD
214
effects of fetal alcohol syndrome
small eye opening, smooth philtrum, thin upper lip. intellectual disabilities, behavioral challenges. secondary disabilities that continue into adult hood. may have poor judgement and unsafe sex.
215
iq range for fetal alcohol syndrome
below 3rd percentile, so below 55
216
postnatal psychosocial disadvantage for intellectual disability
psychological and social deprivation, can be due to poverty, poor nutrition, large family size, lack of structure in the home, low expectations for academic success.
217
dsm 4 diagnoses for autism like things
called "pervasive developmental disorder", including autistic disorder, asperger's, pervasive not specified
218
heterogenous presentation of modern autism diagnoses
difficulties and/or differnces in broad areas of social interaction, verbal and nonverbal communication, behavioral interests. social communication differentiate autistic individuals
219
autism criterion a
deficits in social communication and interaction across multiple contexts, indicated by the following illustrative: cannot reciprocate social-emotionally (failure of back and forth convo, reduced sharing of interests, emotions, affect. fail to repsond/initiate to social interactions, one sided language). nonverbal behavior deficits. deficits in developing, maintaining, and understanding relationships.
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autism criterion b
restricted, repetitive patterns of behaivor, interest, or activities by two or mroe: stereotyped/repetitive motor movements/use of objects/speech. insistence on sameness, adheres too much to routines. restricted, fixated interests abnormal in intensity of focus. hyper or hypo reactivity to sensory input
221
echolalia
repeating another person's words or phrases using the same or similar intonation. may be only present in childhood
222
repetitive movements in autism is why
coping with environments
223
autism C D E criterion
symptoms must be present in early developmental period (can fully manifest later due to masking, severity, age gender etc.). cause clinically significant impairment, not explained better by intellectual disability, or global developmental delay.
224
when can you diagnoseboth intellectual developmental disorder and autism
when social communication is below that of a general developmental level
225
level 1 autism
some support. full sentences with conversation, but difficulty switching activities.
226
level 3 autism
few words, rarely interact. resistant to change and interferes with daily life.
227
can support needs be different for different domains for autism
yes
228
can autism be below level 1, can the severity vary across time and contexts
yes to both
229
environmental etiology of ASD
environmental: older parental age, extreme prematurity, drug in utero. not vaccines. genetic influences indicate common among siblings. link present between autism and other genetically influecned conditions.
230
heritability of autism
37-90%. 25% of cases, there is an identifiable genetic cause. usually polygenic. but this one cause does not mean 100% autism
231
autism medication treatment
no meds specifically developed for it. antidepressants for repetitive behavior, antipsychotics for hyperactivity, impulsivity, irritability, aggression. stimulants for distractability and hyperactivity. older age and psychiatric comorbidity associated w/ higher rates of med use
232
behavioral interventions for autism
focus on positive reinforcement, natural contingencies (child yells for mom and mom is continent on needs), collaboration. most widely used intervention. AAV (augmentative and alternative communication) systems, including sign language and pictures
233
learning disabilities
range of disorders that affect acquisition, retention, understanding, organization, or use of verbal and/or nonverbal information.
234
how are intellectual disabilities and learning disabilities different
intellectual disabilities are more general and consider two main areas of intellectual functioning and adaptive functioning, but does not consider specific areas like dyslexia does
235
specific learning disorder diagnostic criteria A
reading (inaccurate, slow, effortful). meaning (hard to understand meaning of read text). spelling. writing (writing expression). stats (number sense, number facts, calculation, counting). calc (mathematically reasoning). these issues must have ONE present for at least 6 months persistently
236
how persistent do specific learning disorder criteria have to be
retricted progresss in learing for at least 6 months despite recieving extra help at home or at school
237
specific learning disorder diagnostic criteria B
academic skills below chronological age, interfere with academic/occupational performance. interfere with daily living. confirmed via standardized achievement measures and clinical assessment
238
alternative way for individuals under 18 to be diagnosed with specific learning disorder criteria B
history of impairing learning difficulties
239
learning difficulties onset for specific learning disorder
begin during school age but may not fully manifest until demands have exceeded capabilities
240
criterion d for specific learning disorder (what to account for)
learning difficulties are not better accounted for by intelletual disabilities, uncorrected visual or auditory acuity, mental/neurological disorders, psychosocial adversity, language barrier, poor instruction
241
from what aspects of the individual's life do you diagnose specific learning disorder
history (developmenta, med, fam, education), school reports, psychoeducational assessment
242
can intellectual ability be ok despite specific learning disorder
yes
243
reading impairment specifier under specific learning disorder symptoms
word reading accuracy, reading rate or fluency, reading comprehension affected
244
dyslexia
impairment in phonological processing, causing disconnection between phonemes and actual letters. may have trouble discerning rhyming, syllables, and deleting individual speech sounds. poor decoding and spelling. reading is effortful and slow. not necessarily comprehension issues
245
least researched specifier for specific learning disorder
written expression
246
written expression specifier for specific learning disorder symptoms
spelling accuracy, grammar and punctuation, clarity of written expression (includes dysgraphia)
247
dysgraphia (causes of issues (core deficits) and symptoms)
difficulties in writing, visual-motor impairments. impairment in composing text are due to processing speed, working memory, executive functioning
248
dyscalculia (core deficits and symptoms)
difficulties processing numbers, calculating, reasoning, memorizing of arithmetic facts. core deficit: processing numerical quantities, working memories
249
etiology of learning disabilities
genetic, environmental risk, and protective factors.
250
heredity of reading variance for learning disabilities
50-67% of variance in reading explained by genetics
251
interventions for learning disabilities
plasticity means environmental changes can influence neural systems. new communication, coping, explicit instruction. monitoring of progress, supervised practice. promote resiliency, clear knowledge of condition, compensatory strategies. understanding, positive, supportive school environment.
252
what does the jessica down syndrome case study indicate
integration into community and society, highlight strengths, interventions, reduce social isolation, recieve support, support relatives. diagnosis of comorbid disorder if applicable
253
schizophrenia prevalence
1% of poulation
254
schizophrenia onset
15-45 years of age
255
schizophrenia gender differences in diagnoses
same rates. men tend to have younger diagnoses
256
early conceptualizations of schizophrenia
punishment and posession related to spiritual interpretations
257
initial modern conceptualization of schizophrenia, when did it start
1800s
258
Kraepelin's take on schizophrenia
dementia praecox. cognitive behavioral decline
259
bleuler's take on schizophrenia
schizein was greek for "to split" and phrenos "mind". noted heterogenous presentation of schizophrenia, differentated positive symptoms from other symptoms
260
who first used the term schizophrenia
bleuler
261
diagnoses for schizophrenia and adjacent diagnoses in the dsm
schizophrenia spectrum and other psychotic disorders
262
schizophrenia criterion A
two or more in a 1 month period: delusions, hallucinations, disorganized speech, disorganized or catatonic. negative.
263
can schizophrenia criteron A symptoms be lesssened if treatment is successful
yes
264
definition of delusion
implausible beliefs resistant to change even with disconfirming or contradictory evidence
265
types of delusions
persecutory/paranoid, referential, grandeur
266
persecutory/paranoid delusions
will be harmed, targetted, ridiculed by others.
267
referential delusions
certain gestures, comments, cues are directed at a person
268
delusions of grandeur
belief in having special/divine powers
269
most common delusion
persecutory/paranoid
270
bizarre delusions
not understandable to same culture peers and not an ordinary life experience. basically: can this possibly be a jojo stand? if yes, it is a bizarre delusion.
271
non bizarre delusions
things that can occur but unlikely. things that are too boring to be jojo stands
272
hallucinations must occur within what state
clear sensorium (clear mental state without fatigue, substance abuse or a specific neurological condition that makes one think unclearly)
273
hallucinations are defined as
perceptual experiences that ocur without an external stimulus
274
command hallucination
voices provide instructures to do certain things.
275
two most common modes of hallucinations
auditory, then visual
276
what do visual hallucinations look like, feel like
partially formed objects (like cornerthing!). disappear when interacting with it
277
disorganized speech in schizophrenia
loosening of associations (shifts in topic with no connection), tangentialty (unrelated answers to questions), perseveration (repeat word or idea), neologisms (made up words or weird usage of real words), word salad (completely impossible to understand)
278
grossly disorganized or catatonic behaivor in schizophrenia
hard to start ad sustaining appropriate goal directed behaviors, such as unpredicable movements/agitation and lack of self care. inappropriate clothes. catatonia is waxy flexibility. can be unaware of surroundings, ignoring instructions, staring and grimacing.
279
is catatonia schizophrenia unique
no
280
negative symptoms of schizophrenia
avolution (lower motivation to do things), affective flattening, anhedonia (difficulty experiencing pleasure), asociality, alogia.
281
criteria b of schizophrenia (disturbance level)
for a significant portion of time since onset of disturbance, level of functioning in one or more major areas is markedly below the level prior to onset.
282
how do people know if one has lower functioning from schizophrenia if it is childhood or adolescence onset
failure to achieve the expected level of interpersonal, academic, or occupational functioning
283
schizophrenia criterion C (length of time)
6 months. at least 1 month of symptoms, may have prodromal periods
284
prodromal periods in schizophrenia
only negative symptoms, OR by two or more symptoms in an attenuated form
285
schizophrenia criterion D
schizoaffective, depressive, and bipolar with psychotic features have been ruled out. no major depressive or manic episodes concurrent with active phase symptoms. if present during active phase symptoms, it must take up a minority of TOTAL duration of illness
286
can schizophrenia be diagnosed if there are physiologicla effects of substance
no. schizophrenia crition E
287
how can schizophrenia be diagnosed if there was a history of autism or a communication disorder
only if prominent delusions or hallucinations in addition to other symptoms
288
schizophrenia phases
premorbid, prodromal, progression/clinical deterioration, chronic residual
289
premorbid phase of schizophrenia
mild impairment with delays in mildstones (gross motor movements, speech acquisition, relationships). depression and social isolation.
290
how long is the premorbid phase of schizophrenia
0-15
291
prodromal phase of schizophrenia
clinical deterioration begins here and occurs throughout the 5-10 years before first episode.
292
schizophrenia prodromal phase age range
15-20ish
293
progression/clinical deteroiration of schizophrenia
late adolescence to earl adulthood, nnumber of relapses may be related to greater deterioration.
294
chronic residual phase of schizophrenia
chronic negative cognition. decline plateus. negative symptoms but not positive ones. cognitive, motivation, social, concentration difficulties
295
what percent of people with schizophrenia recover after first psychosis
20-40%
296
what percent of people experience extended remission from schizophrenia, what is extended remission
when symptoms go away or lessen for months to years. 40-60% of people
297
what percent of people experience functional recovery in schizophrenia, what is functional recovery
13-31%. restoration of social skills, daily living skills
298
schizophreniform disorder
same diagnostic criteria as schizophrenia but symptoms for 1-6 months, no decline in functioning needed. if symptoms do not improve after 6 months, it is changed to schizophrenia or schizoaffective
299
what percent of people with schizophreniform disorder worsen into schizophrenia
2/3
300
brief psychotic disorder symptoms
only positive symptoms. delusions, hallucinations, disorganized speech, disorganized and catatonic behavior
301
how long is brief psychotic disorder, what happens after the disturbace
1 day to one month. they will return to premorbid level of functioning
302
rate of brief psychotic disorder relapse
50%
303
criterion c of brief psychotic disorder
disturbance not better explained by major depressive or bipolar disorder or another psychotic disorder. not related to substances or other medical condition
304
schizoaffective disorder symptoms
uninterrupted period of illness where there is a major mood episode (major depressive or manic) concurrent with criterion A of schizophrenia. delusions or hallucinations for 2 or more weeks in the absense of a major mood episode during lifetime duration. symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness, not attributable to effects of illness.
305
which of the schizophrenia symptoms are required regardless of other ones present for criterion A
delusions, hallucinations, disorganized speech (one at least out of 3)
306
two types of schizoaffective disorder
bipolar type; manic episode is part of presentation with possibly major depressive. depressive type' only major depressive episodes
307
what if mood disorder symptoms are not present the majority of the time for schizoaffective disorder (considering both active and residual symptoms)
then its schizophrenia
308
typical timeline of schizoaffective disorder must have:
2 weeks without mood disorder and only psychotic symptoms, mood episode that happens with psychotic symptoms which encompasses the majority of time (including residual and active)
309
difference between MDD with psychotic features (or bipolar with psychotic features) and schizoaffective disorder
for depressive/bipolar with psychotic features, you only experience psychotic features during mood episodes. schizoaffective requires you have 2 weeks of psychotic without mood
310
when would you switch diagnosis from schizoaffective to schizophrenia
if the proportion of mood to psychotic becomes not majority of time mood is present. then schizophrenia instead of schizoaffective
311
are cogntive symptoms a diagnostic factor for schizophrenia
no
312
why is cognitive impairement tested for schizophrenia
because functional impairment is closely related
313
when are schizophrenia cognitive symptoms present
before full psychosis, distinct from positive and negative symptoms. it is consistent and stays after remission
314
lee et al 2013 concluded what
schizophrenia patients have about 1-2.5 STD lower nonsocial and social cognition across all domains. it
315
diathesis stress model for schizophrenia. what is it, flaws?
biological vulnerability inherited or acquired early plus environmental stressors causes psychosis. can't explain development of psychosis in all clients
316
genetic vulnerability for schizophrenia
it is heritable but it is polygenic and causality is uncertain.
317
life stressors associated with schizophrenia
relationship break up, death in family, job loss, poverty, marginalization, childhood and other trauma. urban environment, cannabis use
318
pregnancy complications associated with schizophrenia
birth related complications like hypoxia, maternal infections during pregnancy
319
neurodevelopmental etiology of schizophrenia
many small changes during development result in increased likelhood of development of schizophrenia.
320
CT and MRI tell you what about schizophrenia
larger ventricles, reduced grey matter volume in schizophrenia patients. so less neuron cell bodies
321
where is grey matter most significantly reduced in schizophrenia patients, what does this cause
temporal lobe, where there are auditory hallucinations
322
findings from fMRI for schizophrenia
default mode network is active when doing tasks. the activation is opposite from normal.
323
what does a default mode network do, when is it supposed to be on
when not doing demanding tasks, it is supposed to promote introspection, self referential thinking and self reflection
324
problems with physical brain structure and function to understand schizophrenia
lesss than 50% of people who have schizophrenia show these patterns. no direction of causality, and confounding factors present. not a diagnostic criteria
325
dopamine hypotheses for schizophrenia
high dopamine confirmed by chlopromazine blocking dopamine recepts decreasing positive symptoms.
326
howes and kapur (2009) on dopamine in schizophrenia
multiple hits result in dopamine dysregulation causing abberant salience that explains possitive symptoms
327
antipsychotic medication for schizophrenia what do they do
chlopromazine (fiirst antipsychotic, first gen and typical, can result in neurological side effects like tardive dyskinesia. D2 dopamine receptor is blocked to decrease positive symptoms) and clozapine (second gen atypical, symptom control with fewer side effects, may cause agranulocytosis, type 2 diabetes and increased weight gain. increases serotonin and decreased dopamine).
328
what is the first choice antipsychotic med
clozapine
329
under what cases are clozapine not prescribed
not enough white blood cell
330
psychotreatment for schizophrenia
CBT for psychosis to deal with positive symptoms and maintain symptom development. cognitive remediation (computerized stimulated cognitive tasks). family therapy (for psychoeducation, dentify expressed emotion in family, and learning skills such as social skills). skills training
331
early intervention for psychosis, implementation and how helpful?
can be helpful, some predictors have been identified. no reliable predictors of psychosis symptoms, however.
332
what are subthreshold synptoms of psychosis
attenuated psychosis
333
what portion of clinical high risk people experience psychosis
1/3 clinical high risk
334
10 drug classes for substance abuse
alcohol, caffiene, cannabis, hallucinogens, inhalants, opiods, sedatives/hypnotics/anxiolytics, stimulants, tobacco.
335
only behavioral addition
gambling
336
polysubstance use consequences
synergistic (2+2>>>4), potetiation (0 + 2 >2). cross tolerance (tolerance for specific substance via continued use of another substance with similar physiological effects. more likely to be anxious or depressed
337
polysubstance use is common?
yes
338
general diagnostic symptoms for substance use
2 out of 11
impairment of control
1. taking a shit ton
2. wanting to cut
3. tries hard to get it
4. really craves the drug
social impairment
5. does not fulfill obligations
6. continues despite social/interpersonal problems
7. social/occupational/recreational activities given up
risky use:
8. use in dangerous cases (drunk driving)
9. use despite knowing its bad for you
pharmacological dependence
10. tolerance (reduced effect when usual dose consumed) (naturally being a lightweight doesn't count)
11. withdrawal
339
substance use disorder severity scale
2-3 is mild, 4-5 is moderate, 6+ is severe
340
substance induced disorders symptoms
symptoms caused by heavy use of specific substances that resolve when substance is no longer used.
341
substance induced disorders examples
intoxication and wihdrawal. must be problematic for both. other substance induced or medication induced mental disorders like psychotic or depressive disorders
342
alcohol use disorder symptoms
at least 2:
1. more alcohol than intended
2. desire or unsuccessful efforts to cut down/control
3. spend a lot of time to get alcohol, use alcohol, or recover from it
4. crave alcohol
5. recurrent alcohol use resulting failure to fulfill major role obligations
6. alcohol use despite persistent/recurrent social problems
7. give up social, occupational, recreational activities
8. recurrent alchol use in hazardous situations
9. use knowing it is dangerous
10. tolerance
11. withdrawal
343
tolerance symptoms
need more to get same effect or less effect with same amount of alcohol
344
withdrawal symptoms
symptoms when substance is removed from the body. does not count if symptoms are after medical treatment with prescribed medication (me with duloxetine)
345
why are hallucinogens special
they don't have substance use, intoxication, and withdrawal disorders somehow
346
why is caffiene special
no substance use disorders
347
what doesn't have substance intoxication
tobacco
348
what doesn't have substance withdrawal
phencyclidine, other hallucinogens, inhalants
349
alcohol withdrawal symptoms
A. stopping or reducing heavy prolonged alcohol use
B. 2 or more of:
1. sweating, 100 bpm heart rate
2. increased hand tremor
3. insomnia
4. nausea or vomiting
5. hallucinations/illusions (visual, tactile, auditory)
6. psychomotor agitation
7. anxiety
8. tonic-clonic seizures
distress/impairment, not explained by other
350
alcohol intoxication symptoms
a. consumed alcohol
b. problematic behavioral/psych changes (sexual/aggressive behavior) during or shortly after alcohol ingestion
c. one of more of:
1. slurred speech
2. incoordination
3. unsteady gait
4. nystagmus (rapid uncontrollable eye movement)
5. impairment in attention or memory
6. coma or stupor (near unconsciousness)
not other condition explainable
351
absorption of ethyl alcohol
small intestine. can go directly into bloodstream
352
blood alcohol level (BAL)
level of alcohol in blood
353
when is BAL stable
rate if intake is the rate of metabolism, then BAL is stable.
354
what does metabolism of alcohol depend on
leanness of a person because not fat soluble. also being women due to less alcohol dehydrogenase
355
what percent of alcohol is removed by the liver at a constant rate
95%
356
how many drinks do you need to consume to have BAL increase
more than a standard drink every two hours
357
short term effects of ethyl alcohol
biphasic effect, memory blackouds, sleep (suppress REM decreasing sleep quality), unpleasant hangovers
358
what is a biphasic effect
lower doses are stimulating and higher doses are depressants
359
what does a shit ton of alcohol do for short term
affect breathing, leading to death
360
what happens at 0.01 BAL
deficits in hand eye coordination first occur
361
0.05 BAL effects
driving begins to be affected,
362
0.06 BAL effects
40% decrease in steadiness
363
0.08 BAL effects
decreased visual acuirt, sensitivity to pain, taste, smell. impaired driving (legal limit). reaction time slows by 10%, intelligence test decrease, poor memory, under or overestimate passage of time
364
long term effects of ethyl alcohol
decreased nutrient absorption, damage to thalamus and hypothalamus. low protein diet in addition damages pancreas. cancer. wernicke-korsakoff syndrome
365
wernike-korsakoff syndrome
thiamine (B1) deficiency from alcohol abuse, decreasing carbohydrate utilization for energy, decreasing neurotransmitters and myelination. chronic impairment of memory and loss of contact with reality
366
alcohol use disorder pharmacotherapy
benzodiazepines, naltrexone, acamprosate, antabuse
367
benzodiazapines
to detox and reduce severity, will taper off.
368
naltrexone for alcohol
antagonist to reduce pleasurable parts of alcohol to decrease craving
369
acamprosate
agonist to faciliate GABA activity, reduce distress early and craving
370
antabuse
blocks breaking down of acetaldehyde, results in unpleasant effects when drinking after taking drug, makes drinking aversive
371
residential treatment for alcohol use (alcohol anonymous)
abstinence, meetings to prevent relapse, 12 step treatment that relies on spirituality
372
behavioral approach for substance use
contingency management where you reward behavior to maintain abstinence. CBT for substance abuse and gambling
373
cognitive behaivoral approach for substance use
self monitoring patterns of use and triggers, observing behavioral triggers, cognitive unhealpful thoughts
374
relapse prevention treatment for substance use
reduced shame. avoid and manage. learning coping skills, identify cravings, unhelpful thoughts and beliefs
375
why does relapse happen
not having coping strat and self defeating thoughts
376
marital and family therapy for substance use
find patterns that increases substance abuse, like codependency, conflict, scapegoat. communication skills, positive reinforcement
377
brief interventions for substance use
1-3 sessions, time limited and specific advice/feedback. self directed interventions use CBT and motvational strats
378
motivational interviewing
psychological method to relieve substance use for clients with ambivalence regarding change
379
CNS depression caused by
inhibiting neurotransmitter activity in the central nervous system
380
what meds tense the CNS
tranquilizers, anti-anxiety meds, anxiolytics
381
what meds make the CNS a bit drowsy but not a lot
sedatives (reduce desire for physical activity)
382
what meds make the CNS sleepy as fuck
hypnotics
383
what type of drug are barbituates and benzodiazepines, what are they for
depressants. for sedation, tranquilization, sleep med, or anti anxiety
384
effects of benzodiazapines and barbituates
mild euphoria in small doses. slurred speech, poor motor coordination, impaired judgement and concentration like alcohol for larger. long term causes depression, chronic fatigue, mood swings and paranoia.
385
treatment of barbituate and benzodiazepine usage
taper off of it.. can require hospitalization. abstinence syndrome
386
abstinence syndrome
insomnia, headache,body ache, anxiety, depression. can last for months
387
dependency of barbituates
tolerance develops fast. widely prescribed until 1940s until addictiveness became known. shorter acting means more addicting
388
dependency of benzodiazepines
anxiolytic effects appear at lower doses, so less addictive and tolerance develops slower (this is all compared to barbituates)
389
amphetamines and designer drug effects
stimulants similar to adrenalin (concerta, bitch).
390
examples of amphetamines and designer drugs
methamphetamine, detroamphetamine, methylphenidate, methylated amphetamines, MDMA
391
dependency of stimulants
develops very quickly, effects of the drug don't last long. there is often a crash, apathy and sleepiness when withdrawing. dependence on depressants can happen to deal with effects of withdrawal
392
effects of stimulants (different levels?)
low doses increase alertness and attention, cognition. high doses cause exhilaration, extraversion, confidence. very high doses cause restlessness and anxiety, seizures, confusion, coma. chronic causes fatigue, sadness, periods of social withdrawal, anger, weight loss, permanent depletion of serotonin. toxic psychosis on high doses
393
toxic psychosis
hallucinations, delirium, paranoia
394
treatment of amphetamine and designer drug use
medications like naltrexone used in addition to psychological, but mixed evidence for medications
395
cocaine use treatment
same as amphetamines and designer drugs
396
cocaine actions
stimulant, restricted in 1900s. comes from coca, sold as powder, can be snorted, rubbed into skin, injected, smoked
397
dependency of cocaine
smoked, crystallized form called crack is more addictive (think about how baldurs gate 3 is like crack for you). intense psychological dependence, severe withdrawal. short effects. craving takes more than a month to completely disappear. similar to amphetamines.
398
effects of cocaine
small doses lead to feelings of euphoria, confidence, alertness, talkativeness, reduced appetite, increased excitement and energy. high doses lead to overstimulated CNS, poor muscle control, confusion, anger, anxiety, aggression. chronic use leads to mood swings, loss of interest in sex, weight loss, insomnia, toxic psychosis.
399
opioid actions
depressants that reduce pain and sleep.
400
opioid effects
mimic endogenous opiates
401
types of opiods and origins
natural opiates (morphine and codeine) come from opium. semi-synthetic (heroin and oxycodone) come from natural opiates. synthetic (methadone, demerol, percocets) are manufactured to have similar effects. taken as tablets, capsules, syrups, injections. pure herin can be snorted or injected
402
opiod dependency, when does withdrawal hapen, symptoms
some of the most addictive, withdrawal starts 8 hours after last dose: pain sensitivity, dysphoria, dulling of senses, anxiety, increased bodily secretions, pupil dilation, fever, sweating, muscle pain. 36 hours: muscle twitching, cramps, hot flashes, changes in heart rate and blood pressure, sleeplessness, vomiting. symptoms diminish after 5-10 days. relapse common due to intensity
403
effects of opioids
one minute after: pleasurable rush, euphoria, dulled sensations, dreamlike sedation. small doses can cause restlessness, nausea, vomiting. higher can lead to pupil constriction, blue, cold, clammy skin, slow breathing. can lead to coma and respiratory depression. chronic use leads to heart and breathing issues. small synthetic traces can kill you
404
unsterilized needles effects, where would this be an issue
opiod injection, things like endocarditis, abscesses, cellulitis, liver disease, brain damage, hepatitis C and HIV
405
treatment of opioid addiction
usually meds. opiod antagonists like naltrexone for initial withdrawal, clonidine, methadone (heorin replacement) or naloxone after initial withdrawal.
406
cannabis actions
generally a depressant but increases heart rate like as timulant and can cause hallucinations. THC acts on cannabinoid receptors mimicing naturally occuring substances. marriage iguana and hashish (resin) come from hemp plant. smoked in cigarette form, can be chewed, added to baked goods or tea.
407
dependency of weed
regular use results in tolerance and MILDER withdrawal symptoms. impaired control over use and stronger cravings. starting use earlier increases risk of addiction. symptoms of dependency include irritability, nervousness and anxiety, loss of appetite, restlessness, sleep disturbances, anger/aggression
408
cannabis effects for different doses, short term
small doses means mild euphoria and sociality, sense of well-being and relaxation for up to 2-3 hours. sometimes panic or anxiety. high doses cause hallucinations, deficits in motor skills, short term memory, reaction time, attention, ability to drive. increased blood pressure and appetite.
409
long term cannabis effects
lung problems, fertility problems, amotivational syndrome, depression, psychosis.
410
medicinal use for cannabis
alleviate nausea and encourage eating for cancer and AIDs patients
411
hallucinogens action
change mental state by causing perceptual and sensory distortions or hallucinations. excitatory effect on CNS, mimicing effects of serotonin. derived from plants, can be manufactured
412
types of hallucinogens, method of consumption
lysergic acid diethylamide (LSD), mescaline, psilocybin, phencyclidine (PCC), ketamine, salvia. placed on tongue, chewed, smoked, injected, or snorted
413
dependency for hallucinogens
little addictive potential. tolerance develops after a few days of continuous use but it is not often used daily. abstinence lowers tolerence. no noticable withdrawal
414
which hallucinogens can be addictive
PCP and similar drugs like ketamine
415
effects of hallucinogens. how long for effect to kick in, duration, symptoms
usually begin within an hour of ingestion, 6-12 hour duration. subjective effects depend on personality, amount ingested, expectations, setting. small number of users left with prolonged psychotic disorder. hallucinations, synethesia, excitatory effects. most are not physiologically dangerous. can risk injury depending on distortion. PCP may cause coma convulsions and death. flashbacks may occur
416
what are flashbacks in hallucinogen use, what might they cause
unpredictable, frightening recurrences of physical/perceptual distortions experienced. may cause hallucinogen persisting perception disorder
417
genetic etiology of substance abuse
it runs in families., vulnerabilities in reward system, alcohol dehydrogenaze levels.
418
hereditability of substance abuse disorders
33-79%
419
neurotransmitter influences for substance use disorders
all classes of addictive drugs related to dopamine, and brain regions linked to reward. low serotonin may be present, especially in poly substance use
420
EEG results regarding substance abuse indicates
P300 amplitudes, worse attention in children of parents with alcohol use disorder
421
parts of the brain in dopaminergic signalling
amygdala, hippocampus, ventral tegmental
422
personality influences of substance use disorders
behavioral disinhibition (rebellious aggressive, risk taking), associated with low serotonin
423
self medication hypothesis. any flaws?
use of substances to relieve symptoms of other mental disorders. reinforcement to reduce unpleasant emotions. cannot explain all reasons why individuals start to use substances
424
alcohol expectancy theory
drinking determined by reinforcement of what individual expects to recieve (social/physical pleasure, improved social skills, reduced tension). pharmacological effects can have opposite effect of expectation (depressant). behavioral tolerance. learning and experience are important for alcohol and drug tolerance. so familiar environments means drug tolerance higher.
425
sociocultural factors for substance use disorders
family values, attitudes, expectations (rite of passage, encouraged drinking, acceptable, symbol of maturity). individuals learn observed and reinforced behaviors.
426
personality/personality traits
patterns of acting, thinking, feeling that characterize a person and distinguish them. consistent, which is the basis of describing a personality
427
are personality disorders egosyntonic or egodystonic
egosyntonic, not viewed as problematic
428
what does it mean for personality disorder diagnostic criteria to be polythetic
diagnoses is possible with only a certain subset of symptoms. much heterogeneity is present.
429
DSM currently used approach vs proposed one in emerging measures and models
currently categorial approach is used. emerging measures and models has dimensional
430
what does personality disorder affect in an individual
style of interacting with the world around them
431
most common PD diagnoses
unspecified
432
symptomatic remission of PD
symptoms are not permanent
433
why are PDs not well researched
assumed to be not treatable. contributes to lack of treatments and stigma (reluctant to diagnose)
434
which of the personality disorders are fairly well researched despite the others not being researched
borderline and antisocial personality
435
personality disorder prevalence
6-9% of population but may differ by culture
436
assessment for personality disorders
long term functioning pattern evaluation. personality traits must not be from transient mental states and must be stable. so often more than one interview is needed, spaced out over time
437
general PD criterion A
enduring pattern of inner experience/behaivor different from cultural expectations in the following areas:
1. cognition (perception of self, others and events)
2. affectivity
3. interpersonal functioning
4. impulse control
438
non criterion A PD criteria
B. inflexible, across wide range of situations. C. distress or impairment D. stable, long duration. E. not explained by other. F. not drug induced
439
other specified PD
criteria met for general PD and has many PD symptoms but does not meet criteria for one of the PDs
440
cluster A PD
odd and eccentric in thinking and behavior, leading often to social problems. paranoid, schizoid, schizotypal. does not occur exclusively during any disorder with psychotic features. all experience negative symptoms of schizophrenia
441
paranoid personality disorder
pervasive mistrust, suspisciousness, hostile to others. hypersensitive to interpersonal cues, special meaning for innocuous stimuli, misinterpret others' motivations as spiteful or malevolent. hypervigilant.
442
schizoid personality disorder
fewest intimate relationships out of all personality disorders. detached from social relationships and less emotion. appear socially inept or aloof, trouble picking up social cues, do not reciprocate gestures. reduced sensitivity to pleasure, prefer solitary activities and work well alone
443
schizotypal personality disorder
social and interpersonal deficits marked by acute discomfort wth and reduced capacity for close relationships. cognitive or perceptual distortions, eccentric behavior. inaccurately attributing unusual meaning to events, malleable when challenged. clairvoyance or beliefs of magic powers. overly concrete or abstract responses, unusual phrasing. unusual mannerisms, unconventional attire. can be paranoid. uncomfortable relating to others. excessive social anxiety. feeling of not fitting in
444
which personality disorder is considered also schizophrenia adjacent
schizotypal. they can develop schizophrenia
445
cluster B personality disorders
antisocial, narcissistic, borderline, histrionic
446
antisocial personality disorder A symptoms
violation of the rights of others:
1. failure to conform to lawful behavior (arrest)
2. decietfulness for conning
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, indicated by repeated physical fights/assaults
5. disregard for safety of self or others
6. consistent irresponsibility regarding work
7. lack of remorse
447
how many symptoms in ASPD A are required
3 at least
448
othe requirements for ASPD aside from criterion A
at least 18, conduct disorder before 15. not during schizophrenia or bipolar
449
ASPD prognosis
chronic course, but may become less evident or remit (often by 40)
450
criminal behavior in ASPD, frequency?
not necessary or sufficient for diagnosis, but ASPD is common in incarceration (47% of males, 21% of females)
451
difference between ASPD and psychopathy
psychopathy focuses on callous-unemotional personality traits and fearlessness. they meet ASPD requirements. ASPD focuses behavior insead of fearlessness. but you can also be a psychopath without being ASPD
452
differential diagnoses for ASPD
narcissistic personality disorder, borderline personality disorder, substance use disorder
453
ASPD etiology: heredity, why?
50% of variance in ASPD accounted for by genetic factors. behavioral inhibition and externalizing behavior is inherited
454
ASPD etiology with respect to conduct disorder
youth with CD experience multiple risk factors for ASPD early in life (ACE, bad parenting, neurological differences)
455
dispositional characteristics for ASPD etiology
negative affectivity (more likely to experience negative emotional states, associated with poor impulse control, emotional lability and aggression). heightened emotional reactivity to threat.
456
etiology of psychopathy dispositionally
psychopathy associated with low emotional reactivity to threat and low autonomic arousal.
457
dispositional etiology of psychopathy and ASPD in a combined presentation
high threshold for detecting threat and experiencing fear
458
borderline personality disorder criteria A
pervasive pattern of instability of interpersonal relationships, self image, and affects. marked impulsivity.
1. frantic efforts to avoid real or imagined abandonment
2. pattern of intense and unstable interpersonal relationships (alternate between idealization and devaluation)
3. identity disturbance (unstable self image)
4. impulsivity in at least two areas that are potentially self-damaging (spending, sex, substance abuse)
5. recurrent suicidal behavior, self harm
6. affective instability
7. chronic feelings of emptiness
8. anger issues (inappropriate or difficulty controlling)
9. transient, stress-related paranoid ideation, dissociative
459
how many need to be fulfilled for borderline personality disorder
5 or more
460
borderline personality disorder most commonly endorsed criteria
affect dysregulation and identity instability
461
attachment issues in BPD
fear of abandonment or rejection
462
relationship turmoil in BPD cause
functional impairment and less social support
463
self image issues in BPD tend to be related to
a feeling of "being a bad person"
464
self sabotage in BPD
pattern of undermining self when goal is about to be met
465
differential diagnoses for borderline personality disorder
ASPD is also characterized by manipulative behavior, dependent PD also has fear of abandonment. depressive or bipolar disorders.
466
identity disorder vs BPD
BPD is not associated with developmental phase (aka identity problem)
467
difference between ASPD and BPD regarding manipulative behavior
ASPD is to gain profit, power, material gratification, ASPD is to gain concern of caretakers
468
difference beteen fear of abandonment in DPD and BPD
DPD is bottom energy, BPD is top energy SKULL EMOJI
469
difference between BPD and depressive and bipolar disorders
earlier onset and longer time period for affective symptoms for BPD
470
differences between paranoid and narcissistic PDs, and BPD
angry reactions to minor stimuli in all of them, but only BPD has physical self destructiveness, repetitve impulsivity, profound abandonment issues
471
prevalence of BPD (general population, primary care, outpatient, inpatient settings)
present in 2% of general population. fairly equal diagnoses across genders. 6% in primary care, 10% in outpatient mental health clinics, 20% in psychiatric inpatient settings
472
why do people with BPD make threats of separation or rejection
to increase responsibility of the partner, engage to help feelings of emptiness or with emotion regulation
473
what percent of people with BPD die by suicide
6%, suicidal behavior decreases over time.
474
remission of BPD symptoms (time period, which first?)
over 1-8 years. impulsive symptoms go away the fastest, affective slowest
475
etiology of BPD
trauma (physical, sexual abuse, emotional neglect; not necessary for development of BPD), familial/genetic, biological vulnerability (impulsivity and negative affectivity, similar to ASPD), linehan's biosocial theory
476
linehan's biosocial theory
dysfunction of emotional regulation system due to invalidating environment that punishes emotional expression. either over express or repress emotions.
477
linehan's biosocial theory on helping emotional regulation
DBT
478
genetic etiology for BPD
five times more common among first degree bio relatives. BPD and underlying traits have a heritabel component ~0.40
479
histrionic persionality disorder
flamboyant. excessive emotionality and attention seeking beginning early adulthood. draw attention to self, spend shit ton of effort on impressing others, impressionistic speech, shallow, rapid shifting emotions. dramatic displays of emotions. interpersonal impairment. easily influenced by others or circumstances. considers relationships to be more intimate than they actually are
480
narcissistic personality disorder
grandiosity. pervasive pattern of grandiosity, need for admiration, lack of empathy.
1. grandiose sense of self importance
2. preoccupied with fantasies of unlimited success/beauty
3. believes self is special
4. requires excessive admiration
5. sense of entitlement
6. exploitative
7. lacks empathy
8. envious of others
9. arrogant/haughty behaviors or attitudes
481
how many symptoms for narcissitic personality disorder
5 or more
482
emotional and cogntive empathy in narcissistic personality disorder
not willing to be empathetic (emotional empathetic) but high cognitive empathy
483
two primary presentations for narcisstic personality disorder
grandiose: strong sense of entitlement, intentions to control or harm others. vulnerable: less overtly grandiose behaviors, hypersensitivity to negative evaluations, more co-occuring internalizing symptoms. both can be expressed simultaneou or fluctuate
484
cluster c PD
anxious and fearfu. avoidant, dependent, obsessive compulsive
485
avoidant personality disorder
pervasive pattern of social inhibition,feelings of inadequacy, hypersensitivity to negative evaluation. avoids occupational activites and people. shows restraint with intimate relationships, preoccupied with being rejected.
486
are avoidant personlaity disorders related to lack of social motivation
no
487
dependent personality disorder
need to be taken care of leading to submissive and clinging behavior and fears of separation. difficulty making everyday decisions wihout others. difficulty expressing disagreement, need others to be responsible, lack of self confidence means trouble initiating projects. goes to excessive lengths to get nurturance and support. uncomfy or helpless alone, seeks relationship when close one ends. percieves self to be unable to function without others
488
can DPD be competitive
yes if it is to impress authority.
489
OCPD diagnosis criteria
pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control at the expense of flexibility, openness, efficiency
1. preoccupied by details so the major point is lost
2. perfectionism intefering with task completion
3. devoted to work and productivity to not have friends
4. overly conscientious, inflexible about morality ethics or values
5. can't throw useless things out
6. hates delegation
7. miserable spending style, hoards money
8. rigidity and stubornness
490
social functioning aspect of OCPD
dismiss other's annoyance, trouble relating, trouble going along with others' ideas
491
OCPD required number of symptoms
4
492
OCPD and OCD comorbidity
23-47%
493
OCPD and OCD differences
people with OCPD don't view their symptoms as problematic (egosyntonic). people with OCD are ecodystonic and distressed. obsessions are OCD specific. rigidity and excessive perfectionism is OCPD specific
494
cluster c PDs and attachment styles
avoidant PD with fearful, dependent with anxious. OCPD with authoritarian parenting styles, some indicate fearful attachment style.
