Term
| What is the purpose of the psychiatric evaluation? |
|
Definition
Establish setting for treatment (Hospitalization vs. outpatient, etc.) Access need for involuntary hospitalization, intensive outpatient or Partial Hospital Program
Evaluate functional impairment and quality of life
Coordinate care with other providers, provide education |
|
|
Term
| what kind of people receive mental health treatment? |
|
Definition
Roughly 3% of the population, married slightly less likely, educated more likely, most therapy is usually in spurts of 10 visits or less
Most often younger (35-54), Caucasian women are more likely to use outpatient psychotherapy |
|
|
Term
| What types of current symptoms are evaluated during the history of present illness? |
|
Definition
| Sleep, appetite, memory, energy, suicide/homicide adeation, hallucinations (sensory), delusions (beliefs), self destructive acts, problems with anger, reckless behavior, mood, obsessions or compulsions, pain, self ocnfidence, libido, other stressors |
|
|
Term
|
Definition
| A misinterpreted external stimulus such as a door squeaking sounding like a chicken |
|
|
Term
|
Definition
| A belief in something pertaining to themselves that is not true |
|
|
Term
|
Definition
| Perception of external stimulus despite the absence of stimulus |
|
|
Term
| During a mental status exam, what should observe based on the patient's appearance? |
|
Definition
| Appropriateness, appearance consistent with age, unusual attire, etc. |
|
|
Term
| During a mental status exam, what should observe based on the patient's alertness and orientation? |
|
Definition
| Are they alert, sleepy, lethargic etc? Do they know their orientation (person, place, date, etc) |
|
|
Term
| During a mental status exam, what should observe based on the patient's speech? |
|
Definition
|
|
Term
| During a mental status exam, what should observe based on the patient's Motor activity |
|
Definition
| Tic or dyskinesias? Psychomotor agitation or retardation? |
|
|
Term
|
Definition
| The way patients convey emotional states as perceived by others. Observe range, stability, appropriateness |
|
|
Term
|
Definition
| The emotional attitude of a patient such as euphoria, depression, anxiousness, etc. |
|
|
Term
| During a mental status exam, what should observe based on the patient's thought content? |
|
Definition
| Delusions, hallucinations, homicide or suicide ideation |
|
|
Term
| During a mental status exam, what should observe based on the patient's thought process? |
|
Definition
| Their goal-orientation, whether answers are tangential or circumferential, loose association answers, disorganization, linear thinking, thought block |
|
|
Term
| During a mental status exam, what should observe based on the patient's intellectual functioning? |
|
Definition
| Their fund of knowledge, verbosity, grammar, problem-solving skills, calculation skills, abstraction skills |
|
|
Term
| During a mental status exam, what should observe based on the patient's judgement? |
|
Definition
| Do they perform acts that normal are avoided by normal people? Ex. smoking in a movie theater, not addressing envelopes, etc. |
|
|
Term
| During a mental status exam, what should observe based on the patient's insight? |
|
Definition
| How realistically does the patient assess his/her illness and life problems? |
|
|
Term
| What are the advantages of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)? |
|
Definition
Improves reliability of diagnosis and clarifies diagnostic process
Facilitates history taking |
|
|
Term
| What are the disadvantages of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)? |
|
Definition
| Physicians may have a false certainty, may sacrifice validity for reliability, may depersonalize the diagnostic process |
|
|
Term
|
Definition
| The extent that an instrument provides consistent measurements across different raters and testing milieus (research should be >.70, clinical 0.85-0.95) |
|
|
Term
|
Definition
| Whether an instrument correctly detects the true underlying condition |
|
|
Term
| What is the function of diagnostic rating scales? |
|
Definition
| Provides objective information about symptoms where the mental status exam is inadequate or inappropriate |
|
|
Term
|
Definition
| A percentile rating relative to normative samples at any given time, represents a person's best level of adaptive function, highly correlated with academic achievement |
|
|
Term
| How does IQ predict vulnerability to mental illness? |
|
Definition
|
|
Term
| 68% of the population has an IQ between what? |
|
Definition
|
|
Term
| 95% of the population has an IQ between what? |
|
Definition
|
|
Term
| 99.7% of the population has an IQ between what? |
|
Definition
|
|
Term
| What is the range of IQs from intellectually disabled to superior? |
|
Definition
| > 70-80-90- Average -110-120-130 < |
|
|
Term
| What are projective tests of personality? |
|
Definition
Psychoanalysis of uncoscious motives, used in children or individuals unable or unwilling to disclose internal states
ex. Rorschach Inkblot, Sentence Completion Tests, etc. |
|
|
Term
| What is the purpose of neuropsychological assessment? |
|
Definition
| Determine whether and to what extent a patient's cognitive statuse has been altered |
|
|
Term
| Neuropsychological assessments are used to evaluate what? |
|
Definition
| Cerebrovascular accidents, traumatic brain injury, dementia, learning disabilities, etc. |
|
|
Term
| What are some kinds of specific neuropsychological assessment tests? |
|
Definition
| Attention tests, executive function tests, memory and language tests, visual processing skills, sensory-perceptual and motor function tests, etc. |
|
|
Term
| What is diagnostic for a learning disability? |
|
Definition
| Academic achievement two standard deviations below than what is predicted by IQ |
|
|
Term
| What is the difference between ADHD and learning disabilities? |
|
Definition
| ADHD is a disability for learning but not a learning disability |
|
|
Term
| How does low intelligence cause learning disabilities? |
|
Definition
| It doesn't, children may be of average or above average intelligence |
|
|
Term
| Learning disabilities are most common among which sex? |
|
Definition
|
|
Term
| What is the most common learning disorder? |
|
Definition
| Dyslexia/Reading disorder |
|
|
Term
|
Definition
| Reading accuracy, speed, or comprehension are below educational or age level |
|
|
Term
| What is a disorder of written expression? |
|
Definition
| Ability to express self in writing falls substantially below expectations for the child's intellectual functioning, age, and educational level |
|
|
Term
| What is dyslexic dysgraphia? |
|
Definition
| Poor spelling and spontaneous work but can copy well |
|
|
Term
| What is motor dysgraphia? |
|
Definition
| Spelling is normal but handwriting is poor, cannot neatly copy work |
|
|
Term
| What is spatial dysgraphia? |
|
Definition
| Poor spelling alignment of written work on lines |
|
|
Term
| What is expressive language disorder? |
|
Definition
| Delayed language acquisition and slow rate of language growth |
|
|
Term
| What is mixed receptive-expressive language disorder? |
|
Definition
| Difficulty understanding words, sentences, and meanings, may be innate or acquired through trauma/infection |
|
|
Term
| What is the difference between ADHD and learning disabilities? |
|
Definition
| ADHD is a disability for learning but not a learning disability |
|
|
Term
| How does low intelligence cause learning disabilities? |
|
Definition
| It doesn't, children may be of average or above average intelligence |
|
|
Term
| Learning disabilities are most common among which sex? |
|
Definition
|
|
Term
| What is the most common learning disorder? |
|
Definition
| Dyslexia/Reading disorder |
|
|
Term
|
Definition
| Reading accuracy, speed, or comprehension are below educational or age level |
|
|
Term
| What is a disorder of written expression? |
|
Definition
| Ability to express self in writing falls substantially below expectations for the child's intellectual functioning, age, and educational level |
|
|
Term
| What is dyslexic dysgraphia? |
|
Definition
| Poor spelling and spontaneous work but can copy well |
|
|
Term
| What is motor dysgraphia? |
|
Definition
| Spelling is normal but handwriting is poor, cannot neatly copy work |
|
|
Term
| What is spatial dysgraphia? |
|
Definition
| Poor spelling alignment of written work on lines |
|
|
Term
| What is expressive language disorder? |
|
Definition
| Delayed language acquisition and slow rate of language growth |
|
|
Term
| What is mixed receptive-expressive language disorder? |
|
Definition
| Difficulty understanding words, sentences, and meanings, may be innate or acquired through trauma/infection |
|
|
Term
| All children with communication disorders should receive what diagnostic? |
|
Definition
| An audiogram to rule out hearing impairment |
|
|
Term
| What are reasonable accommodations for learning disorders? |
|
Definition
| Allowed to learn at own pace, explicit instruction, preferential seating near teacher, extra time on tests, class assistants, special equipment such as recorders, individualized plans designed to meet needs |
|
|
Term
| How prevalent is mental retardation? |
|
Definition
|
|
Term
| What are the diagnostic criteria for mental retardation? |
|
Definition
Significantly sub-average intellectual function with concurrent deficits ir impairments in at least TWO of the following:
Communication, self-care, home living, social skills, use of community resources, self-direction, academic skills, work, leisure, health, safety |
|
|
Term
| When is normal onset for mental retardation? |
|
Definition
|
|
Term
| What are the ranges of retardation from mild to profound? |
|
Definition
Mild: 50/55-70
Moderate: 35/40-50
Severe: 20/25-35
Profound: Below 20-25 |
|
|
Term
| ADHD is a neurobehavioral disorder characterized by what three core symptoms? |
|
Definition
| Inattention, hyperactivity, impulsivity |
|
|
Term
| What must be present for a diagnosis of ADHD? |
|
Definition
| Symptoms must cause greater impairment in affected patients than in age-matched peers, present before age 7, manifests in multiple settings, causes significant impairment |
|
|
Term
| What is the prevalence of ADHD? |
|
Definition
Up to 6% of school-age children
Many continue to have symptoms as adolescents and adults
4% of adults have ADHD |
|
|
Term
| What is the DSM-IV criteria for the combined type of ADHD? |
|
Definition
| At least six symptoms of inattention and six symptoms of hyperactivity-impulsivity for 6 months. This is the most common type among children and adolescents |
|
|
Term
| What is the DSM-IV criteria for the inattentive type of ADHD |
|
Definition
| At least 6 Symptoms of inattention but <6 for hyperactivity-impulsivity for 6 months |
|
|
Term
| What is the DSM-IV criteria for the hyperactive-impulsive type of ADHD |
|
Definition
| At least 6 symptoms of hyperactivity-impulsivity but <6 for inattention for 6 months |
|
|
Term
| What are the diagnostic criteria for inattentive ADHD? |
|
Definition
| Inattention to detail, carelessness, difficulty sustaining attention, seems not to listen, fails to finish tasks, difficulty organizing, avoids tasks requiring attention, loses things, easily distracted, forgetful |
|
|
Term
| What are the criteria for hyperactivity-impulsivity |
|
Definition
| Blurts answers before questions are finished, difficulty wasting time, interrupts or intrudes others, fidgets, unable to stay seated, restlessness, difficulty engaging leisure activities quietly, excessive talking, etc. |
|
|
Term
| How is imaging used to diagnose ADHD? |
|
Definition
| Not valid tools for diagnosis |
|
|
Term
| Can ADHD symptoms overlap with other psychiatric illnesses? |
|
Definition
|
|
Term
| What features are more likely in bipolar disorder than ADHD? |
|
Definition
| Grandiosity, elevated mood, daredevil acts, uninhibited people-seeking, silliness/laughing |
|
|
Term
| ADHD is mostly related to the functioning of what parts of the brain? |
|
Definition
| Prefrontal cortex and basal ganglia |
|
|
Term
| How is ADHD associated with catecholiminergic CNS pathways? |
|
Definition
| Higher incidence of low baseline dopaminergic tone |
|
|
Term
| What kind of genetic component is involved in ADHD? |
|
Definition
| 90% concordance in monozygotic twins, heritability of 0.75 so ther eis a strong genetic component |
|
|
Term
| What are the standard assessment measures used to evaluate ADHD? |
|
Definition
| History from parents/caregivers, information from school, asses for associated conditions related to other disorders, illnesses, or abuse, identify target behaviors, collect previous treatment data |
|
|
Term
| What kind of neuropsychological tests are diagnostic for ADHD? |
|
Definition
| Not diagnostic, gives objective measure but lacks specificity, used for assessment |
|
|
Term
| How are medicines used to diagnose ADHD? |
|
Definition
| They are not. Response to medications does not validate a diagnosis of ADHD |
|
|
Term
| What are some types of non-pharmacologic treatments for ADHD? |
|
Definition
| Cognitive/Behavioral therapy, Behavioral interventions, decreasing workload to match ability, establishing explicit rules, setting time limits |
|
|
Term
| What are some examples of Cognitive/Behavioral therapies used to treat ADHD? |
|
Definition
| Designed to correct negative belief systems: conflict resolution, anger management, interpersonal skills |
|
|
Term
| What are some examples of Behavioral interventional therapies used to treat ADHD? |
|
Definition
| Reinforcement (reward/privilege contingent on performance), time-outs, etc. |
|
|
Term
| What drugs are responsible for most of the observed therapeutic effects of ADHD drugs? |
|
Definition
| D-enantiomers of methylphenidate and amphetamine |
|
|
Term
| What are the benefits of used methylphenidate and amphetamine to treat ADHD? |
|
Definition
| Safe, good tolerability, robust response, equal response rates, no predictors of preferential response to one or the other, helps with ALL 3 core symptoms of ADHD |
|
|
Term
| What are the side effects of methylphenidate and amphetamine? |
|
Definition
| Decreased appetite, insomnia ,headache, stomach aches, irritability |
|
|
Term
| What cautions can be found in the black box box warning for methylphenidate and amphetamine? |
|
Definition
| Amphetamines have high potential for abuse, prolonged administration may lead to drug dependence. Pay particular attention to pts obtaining them for non-therapeutic use or distribution. Misuse can cause sudden death and serious cardiovascular adverse effects |
|
|
Term
| What are the contraindications for using methylphenidate and amphetamines? |
|
Definition
|
|
Term
| Do amphetamines suppress growth? |
|
Definition
| Studies inconsistent, tend to catch up, are slightly delayed |
|
|
Term
| What are the characteristics of IR Methylphenidate? |
|
Definition
| Effects hit 30 min after administration, peaks 1.5-2hrs, fades in 4hrs |
|
|
Term
| What are the characteristics of slow-release Methylphenidate? |
|
Definition
| Gelatin capsule act as rate-controlling membrane, biphasic peaks, effects last 9hrs |
|
|
Term
| What are the characteristics of Concerta |
|
Definition
| Outer coating over an insoluble water permeable shell allows release at a controlled rate, smoother effect, can last 12 hrs |
|
|
Term
| Which ADHD drug is less potential for abuse and drug tampering? |
|
Definition
| Lisdexamfetamine, peaks at 5-6hrs |
|
|
Term
| What are some non-stimulant medications for ADHD? |
|
Definition
| Atomoxetine, peaks in 1-2hrs, symptomatic relief via increasing dopamine in the prefrontal cortex |
|
|
Term
| What are the dangers of atomexetine? |
|
Definition
|
|
Term
| What are some antidepresesants used to treat ADHD? |
|
Definition
| Imipramine, desipramine (RCAs_, Bupropoin. Not commonly used |
|
|
Term
| What alpha-adrenergic agents are used to treat ADHD? |
|
Definition
|
|
Term
| What should you prioritize when ADHD patients are comorbid for depression and anxiety? |
|
Definition
| Always the depression and anxiety. Combo therapy often required |
|
|
Term
| Searching for lost object in several places other than place object was last seen and playing with toys in functional way should be seen by what age? |
|
Definition
|
|
Term
| Reenacting familiar activities, being able to imitate actions later, and using one object to stand for another object in play should be seen by what age? |
|
Definition
|
|
Term
| Using imaginary objects in real play, role playing several familiar people, and drawing the face of a person with crude features should be seen by what age? |
|
Definition
|
|
Term
| Planning out a story and assigning roles to self and others should be seen by what age? |
|
Definition
|
|
Term
| Kids should be able to internalize sensory perceptions by what age? |
|
Definition
|
|
Term
| Kids should be able to to acquire language and symbolic functions such as imitation play by what age? |
|
Definition
|
|
Term
| Kids should develop conversational skills and understand concrete objects or evens by what age? |
|
Definition
|
|
Term
| Kids should start thinking abstractly at what age? |
|
Definition
|
|
Term
| What are the three underlying theoretical constructs to social emotional development |
|
Definition
| Attachment, separation, autonomy/mastery |
|
|
Term
| By 3 months, babies should have what social-emotional functions? |
|
Definition
| Can be calm and recover from crying with comfort, able to look at speaker when spoken to |
|
|
Term
| By 5 months, babies should have what social-emotional functions? |
|
Definition
| Can display positive affect toward primary caregiver, displays full range of emotions |
|
|
Term
| By 9 months, babies should have what social-emotional functions? |
|
Definition
| Make purposeful 2-way interactions |
|
|
Term
| By year 1, babies should have what social-emotional functions? |
|
Definition
| Form chains of communicative interactions |
|
|
Term
| By 18 months/1.5yrs, babies should have what social-emotional functions? |
|
Definition
| Elaborate interactions that convey complex emotions |
|
|
Term
| By year 2, babies should have what social-emotional functions? |
|
Definition
| Create mental representations that can be used symbolically |
|
|
Term
| What period is the most crucial for language development? |
|
Definition
|
|
Term
| when should kids start using words, naming objects, using simple sentences, etc.? |
|
Definition
|
|
Term
| When should babies start identifying colors and become understandable to strangers? |
|
Definition
|
|
Term
| When should kids be walk down stairs? |
|
Definition
|
|
Term
| When should kids be able to hop on one foot? |
|
Definition
|
|
Term
| When should kids be able to grasp a pencil and copy a circle? |
|
Definition
|
|
Term
| How do you know if burns on a kid's arms are likely to be abuse? |
|
Definition
| If only on one arm (symmetrical more likely to be an accident) |
|
|
Term
| At what age are children at highest risk for abuse? |
|
Definition
|
|
Term
| We are mandated reporters of suspected child abuse up to what age? |
|
Definition
|
|
Term
| Are we mandated to report domestic violence? |
|
Definition
|
|
Term
| Are we mandated to report suspected elder abuse? |
|
Definition
|
|
Term
|
Definition
| Severe and pervasive impairment in multiple areas of development: reciprocal, social, communication, presence of stereotyped behaviors, interests and activities |
|
|
Term
| What kind of qualitative social interaction impairments are seen in autism?? |
|
Definition
| Impairment in use of nonverbal behaviors such as eye contact, gestures, etc., failure to develop appropriate peer relationships, lack of social or emotional reciprocity, lack of spontaneous seeking of enjoyment, interests, etc. |
|
|
Term
| What kind of qualitative communication impairments are seen in autism? |
|
Definition
Delay or total lack of development is CORE to autism but NOT IN ASPERGER'S
Any present speech is impaired in initiation or sustainment, stereotyped repetitive or idiosyncratic language, lack of make believe or social imitative play |
|
|
Term
| What is childhood disintigrative disorder? |
|
Definition
| Loss of previously acquired skills, seen in autism |
|
|
Term
|
Definition
| Decelleration of head growth between 5 and 48mo, loss of previously acquired hand skills and social skills, poor trunk/gait coordination, severely impaired expression and receptive language with severe psychomotor retardation |
|
|
Term
| Which gender is more likely to have autism? |
|
Definition
|
|
Term
| What is the prevalence of autism? |
|
Definition
| 1 in 88 children, more diagnosed every year than AIDS, diabetes, and cancer combined |
|
|
Term
| What are the gold standards of autism diagnosis? |
|
Definition
Autism Diagnostic Interview-Revised (ADI-R) and the
Autism Diagnostic Observation Schedule (ADOS) |
|
|
Term
| The most stable diagnosis of autism occurs at what age? |
|
Definition
| 2-3yo, critical to understand typical early childhood before 3 years of age |
|
|
Term
| What are the behavioral markers in the 1st year of life for autism? |
|
Definition
| Regression, poor visual orientation, limited response to name, lack of socially directed looking, excessive mouthing of objects, aversion to social touch |
|
|
Term
| When do you refer a child for autism screening? |
|
Definition
| Any time you suspect a child is developing communication/social skills atypically |
|
|
Term
| What is a conduct disorder? |
|
Definition
| A repetitive and persistent pattern of behavior in which the basic rights of others or other major societal norms or rules are violated |
|
|
Term
| What is diagnostic for conduct disorder? |
|
Definition
Presence of 3 or more of the following criteria in the past 12 months with at least one criterion present in the past month:
Aggression to people or animals
Destruction of property
Deceitfulness or theft
Serious violation of rules |
|
|
Term
| Under what circumstance may a person meet the diagnostic criteria for conduct disorder yet not have antisocial personality disorder? |
|
Definition
|
|
Term
| What are the subtypes of conduct disorder? |
|
Definition
| Childhood onset (1 criterion before 10), adolescent onset (absence of criterion before 10), unspecified onset (age of onset unknown) |
|
|
Term
| Which type of conduct disorder has the most favorable prognosis/ |
|
Definition
|
|
Term
| Describe the prevalence of conduct disorder? |
|
Definition
Boys > girls but is increasing in girls
Less aggressive children have better outcomes
1/3 with ADHD also have conduct disorder
1/3-1/2 with conduct disorder have ADHD
PTSD and history of abuse may occur
Substance abuse exacerbates problems |
|
|
Term
| How does female conduct disorder differ from male conduct disorder? |
|
Definition
| More covert and difficult to detect, higher rates of tobacco, alcohol, marijuana, higher STD and early pregnancy, more medical problems, poorer self ratings of overall ealth |
|
|
Term
| What kind of impaired cognition do children with conduct disorder experience? |
|
Definition
Lack of or distorted connection between prior events and consequences
Limited problem-solving ability |
|
|
Term
| What type of medications are used for conduct disorder? |
|
Definition
Not typically used unless substantial aggression is present
Can use lithium, psychostimulants, 2nd gen antipsychotics
Useful for ADHD comorbidity |
|
|
Term
| When would you use psychotherapy to treat conduct disorder? |
|
Definition
| Focused on improving communication and problem solving skills as well as impulse and anger control |
|
|
Term
| What is Oppositional Defiant Disorder? |
|
Definition
A pattern of negativistic, hostile, and defiant behavior lasting at least 6mo during which 4 or more diagnostic criteria are present and occurs more often than is seen in peers
Does not apply for over 18yo |
|
|
Term
| What are the diagnostic criteria for oppositional defiant disorder? |
|
Definition
| often loses temper, argues with adults, actively defies or refuses to comply with adult rules/requests, deliberately annoys people, blames others for his/her mistakes, touchy or easily annoyed by others, angry and resentful, spiteful or vindictive |
|
|
Term
| What distinguishes conduct disorder and oppositional defiant disorder? |
|
Definition
| ODD does not commit serious violations of other's rights |
|
|
Term
| A child that would rather forfeit a toy than lose an argument or a battle likely has what? |
|
Definition
| Oppositional defiant disorder |
|
|
Term
| Which is more common, anorexia or bulimia? |
|
Definition
|
|
Term
| What kind of psychological factors are common in those suffering from eating disorders? |
|
Definition
| Cognitive distortions about self, black and white thinking, significant comorbidity with personality disorders |
|
|
Term
| What is the typical age of onset for anorexia? |
|
Definition
|
|
Term
| What is the typical age of onset for bulimia? |
|
Definition
| Late teens or early twenties |
|
|
Term
| What factors predict a poor prognosis in eating disorders? |
|
Definition
| Longer duration of illness, older age of onset, prior psychiatric hospitalizations, poor premorbid adjustment, prevalence of comorbid personality disorder |
|
|
Term
| What are the diagnostic criteria for anorexia? |
|
Definition
| Refusal to maintain normal body weight for age/height, intense fear of weight gain even though underweight, disturbance in the way one's body weight is experienced, amenorrhea |
|
|
Term
| What comes first in treatment of anorexia patients? |
|
Definition
| Nourishment, then focused on behavior management |
|
|
Term
| When should an anorexic patient be hosipitalized? |
|
Definition
| <75-85% expected body weight, vomiting 10+ times a day, bradycardia, severe symptoms |
|
|
Term
| What is diagnostic for bulimia nervosa? |
|
Definition
recurrent episodes of binge eating characterized by eating in a discrete period an amount of food that is larger than most people would eat and a sense of lack of control over eating during these episodes, followed by recurrent inappropriate compensatory behavior in order to prevent weight gain.
Occurs at least 2x a week for 3 months |
|
|
Term
| Is it possible to have both anorexia and bulimia? |
|
Definition
| No, anorexia criteria supercedes |
|
|
Term
| What are the criteria that determine binge eating disorder? |
|
Definition
| Consuming large amounts of food in a short time subjective to loss of control and rapid eating until uncomfortable, despite lack of hunger. Reluctance to eat with others due to embarrassment, episodes followed by guilt or upset feelings. Occurs at least once a week for at least 3 months |
|
|
Term
| Why should bariatric surgery be a close to last resort? |
|
Definition
| Procedure takes away a coping mechanism, behavioral or psychotherapy recommended before surgery |
|
|
Term
|
Definition
| Physical and emotional pain precipitated by a significant loss |
|
|
Term
|
Definition
|
|
Term
| What is complicated grief? |
|
Definition
| Grief that reaches extremes of intensity, duration or tenacity (unresolved grief) plus physical symptoms or other complications that interfere with daily function |
|
|
Term
| What are the stages of normal bereavement? |
|
Definition
1) shock, denial, disbelief
2) mourning that involves physical and emotional symptoms and social isolation
3) reorganization of life that achnkowledges but is not defined by the loss of a loved one |
|
|
Term
| How long should you wait before diagnosing major depressive disorder following a death? |
|
Definition
|
|
Term
| What are the symptoms of complicated grief? |
|
Definition
| Sense of bitterness, anger, resentment, preoccupation with thoughts of the lost loved one, regression |
|
|
Term
| What are the risk factors for complicated grief? |
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Definition
| Not attending the funeral, violent/stigmatized/unexpected death, multiple prior bereavements, history of psychiatric illness, ambivalence toward deceased, or of dependence on the deceased, lack of social support |
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Term
| What should you avoid in treatment of grief? |
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Definition
| Do not try to get the grieving to put the loss behind them |
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Term
| What is the primary agent of treatment in helping patients deal with dying? |
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Definition
| The physician and his/her relationship with the patient |
|
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Term
| What are the goals in the treatment of dying patients? |
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Definition
| Give patients a sense of control, control of the disease, control of the symptoms, attempting to predict what symptoms will occur and when, attempt to smooth relations within the family |
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Term
| What are some reasons for telling the truth to a dying patient? |
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Definition
| Reduce uncertainty, improve ability to act in his/her own best interest, improve doctor-patient relationship |
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Term
| Is suicidal ideation the same as a wish to hasten death? |
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Definition
| No, a wish to hasten death may result from untreated psychological or physical symptoms |
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Term
|
Definition
| redirection of feelings and desires, especially of those unconsciously retained from childhood toward a new object (such as the therapist) |
|
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Term
| What is counter-transference? |
|
Definition
| Transference from the therapist toward the patient? |
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Term
|
Definition
| Based on pleasure principle and immediate gratification without societal consequence or internal guilt |
|
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Term
|
Definition
Societal expectations of behavior
Learned from parents, teachers, etc. |
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Term
|
Definition
Balance between the Id and the Superego, viewed as the negotiator
Defense mechanisms stem from anxiety or emotional threats, designed to protect the individual |
|
|
Term
| How do the stages of psychosexual development progress according to Freud? |
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Definition
| Oral, Anal, Phallic, Oedipal |
|
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Term
|
Definition
| Negative and positive emotions are not integrated, patients seen in marked idealization or devaluation |
|
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Term
|
Definition
| Undesirable impulses or feelings placed onto another so one doesn't have to deal with them (I want to cheat on my wife so I accuse her of being unfaithful) |
|
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Term
|
Definition
| Negative feelings turned inward inthe form of pain or illness |
|
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Term
|
Definition
| Shifting the negative emotional threat to a more accepting or less dangerous area, involves separating emotion from its real object |
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Term
|
Definition
| Temporary but marked modification of identity or reality to avoid trauma |
|
|
Term
| What is intellectualization? |
|
Definition
| Focusing on rational components of a situation to avoid the threatened emotion |
|
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Term
|
Definition
| Convincing oneself there was not a negative action or negative emotion through faulty reasoning |
|
|
Term
| What is reaction formation? |
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Definition
| Converting the geniuine wish into its opposite |
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Term
|
Definition
| Process of repelling the desires toward the pleasurable act by simply trying to deny its existance |
|
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Term
|
Definition
| Transforming negative emotions into positive actions (mature response) |
|
|
Term
| What is the function of the cultural assessment? |
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Definition
| Determination of cultural identity, cultural explanations, and relationships between the physician and patient |
|
|
Term
| Which ethnicitis have lower levels of CYP450 enzyme activity? |
|
Definition
| Asians and hispanics, primarily indians and mexicans, possibly due to diet |
|
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Term
| What are the 3 components that define cognitive psychotherapy? |
|
Definition
The "relationship" or therapeutic bond,
problems that can be emotional, cognitive, behavioral, or any combination
A trained professional that implies a model of pathology and mechanism for change |
|
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Term
| What are some general considerations for psychotherapy? |
|
Definition
| Acceptance vs. change, accept the problem in order to try and make the problem less dramatic |
|
|
Term
| What are the attributes of therapists? |
|
Definition
| Common sense, empathy, trustworthiness, confidence, investment in the relationship |
|
|
Term
| What are negative therapist factors? |
|
Definition
| Over structured therapy, too much self disclosure, silence |
|
|
Term
| What are patient factors? |
|
Definition
| motivation, psychological status, intra-personal factors (hopelessness and psychological mindedness) |
|
|
Term
| What is a therapeutic alliance? |
|
Definition
"Conscious collaborative rational agreement between a therapist and client"
All therapy occurs in this context, is important to a good outcome |
|
|
Term
| What are the major schools of psychotherapy? |
|
Definition
| Psychodynamic, behavioral, cognitive, strategic, interpsonal, growth oriented, supportive |
|
|
Term
| Describe psychodynamic psychotherapy |
|
Definition
| "Old school" - Freud, Jung, long term and intensive, theory driven, more focused on restructuring fundamental relationships |
|
|
Term
| Describe behavioral therapy |
|
Definition
| Classical learning theory, all behavior is learned, can be changed |
|
|
Term
| Describe interpersonal therapy |
|
Definition
| No assumptions about etiology, focuses on connection between current symptoms and interpersonal problems, initially developed for depression |
|
|
Term
| Describe growth oriented therapy |
|
Definition
| Less directional, relies on the natural healthiness of the person nurtured by unconditional support |
|
|
Term
| Describe Supportive therapy |
|
Definition
Used for grief and trauma, run by lay people in group format
ec. AA, survivors of suicide, etc. |
|
|
Term
| Describe strategic therapy |
|
Definition
The system that generates the problem behavior is the target for intervention
Excellent for family therapy, based around problem solving and identification |
|
|
Term
| Describe Cognitive therapy |
|
Definition
Based on theory that thoughts influence feelings
Event -> Thoughts -> Feelings -> Actions -> results
Personal core beliefs about self, others, and the world are called schemas. Schemas filter how we experience the world and may cause cognitive distortions |
|
|
Term
| What is cognitive distortion? |
|
Definition
Must turning into should
All or nothing thinking, overgeneralizing, mental filter and special case of disqualifying the positive, labeling, magnefying |
|
|
Term
| Melatonin is secreted by what? |
|
Definition
| The pineal gland behind the third ventricle |
|
|
Term
| How does melatonin modulate the circadian cycle? |
|
Definition
| Light strongly inhibits secretion of melatonin by the pineal gland. Darkness triggers a permissive secretion signal. Peaks from 2am-4am |
|
|
Term
| The sleep system is activated in what part of the brain? |
|
Definition
| Ventrolateral preoptic nucleus (VLPO) |
|
|
Term
| What are the dual actions of melatonin? |
|
Definition
Inhibits SCN neuronal firing
Acts in concert with light to keep the circadian rhythm syncronized |
|
|
Term
|
Definition
| 75% of the night, makes up stages 1-3 of sleep |
|
|
Term
| What are the stages of NREM sleep |
|
Definition
1: lightly asleep
2: onset of sleep
3-4: deepest and most restorative sleep |
|
|
Term
|
Definition
| 25% of the night, provides energy to brain and body, brain is active and dreaming, muscle shut down |
|
|
Term
| What are the characteristics of adjustment insomnia? |
|
Definition
Transient or short-term, lasts 1 night to a few weeks
May be stress associated, resolves with removal of stressors or adaptation |
|
|
Term
| What are the characteristics of chronic insomnia? |
|
Definition
Lasts 1mo to years, often waxes and wanes, may be an isolated disorder or comorbid condition
Various medical disorders can cause chronic insomnia from HTN, parkinson's, fibromyalgia, MS, arthritis, allergies, memnopause, etc. as well as psychiatric or psychotic disorders |
|
|
Term
| How much sleep should normal adults get? |
|
Definition
|
|
Term
| What are the impacts of insomnia? |
|
Definition
| Impaired cognition, negative quality of life, increased bodily pain, poorer general health, increased risk of psychiatric disorders, 4x increase of new depression, increased risk of accidents and health care costs |
|
|
Term
| How is insomnia associated with psychiatric disorders? |
|
Definition
| Cannot be seen solely as a byproduct of psychiatric illness. May contribute to both etiology and course of psychiatric illness |
|
|
Term
| What is the DSM-IV-TR Criteria for primary insomnia? |
|
Definition
Essential feature is difficulty initiating or maintaining sleep or nonrestorative sleep for at least ONE MONTH
Also causes significent distress or impairment, dos not occur exclusively during another disorder and is not due to substances or medicine |
|
|
Term
|
Definition
| Disturbance in the amount, quality, or timing of sleep |
|
|
Term
| What are some precipitating factors of insomnia? |
|
Definition
| Medical or psychiatric illness, medicine or drug use, shift work, stressful life events |
|
|
Term
| What is the first step in managing insomnia? |
|
Definition
|
|
Term
| When would you refer to a sleep specialist? |
|
Definition
| History of treatment failure, another primary sleep disorder is suspected, atypical psychological or behavioral symptoms are present |
|
|
Term
| Which is more common, hypersomnia or insomnia? |
|
Definition
|
|
Term
|
Definition
| Prolonged nocturnal sleep and continued daytime sleepiness that lasts at least one month and causes impairment or distress |
|
|
Term
|
Definition
Irestiible attacks of refreshing sleep that occur daily over at least 3 months
Can be either cataplexy, recurrent REM, or both |
|
|
Term
|
Definition
| Narcolepsy defined by brief episodes of sudden bilateral loss of muscle tone, most often associated with intense emotion |
|
|
Term
| What is recurrent intrusion of elements of REM? |
|
Definition
| Sleepinto the trnasition between sleep and wakefulness, manifested either by hypnopompic or hypnogognic hallucinations or sleep paralysis at the beginning or end of sleep episodes |
|
|
Term
| How long do sleep attacks last? |
|
Definition
|
|
Term
| How is Narcolepsy treated? |
|
Definition
| Brief naps, use of stimulants, Modafanil, TCA's, sodium oxybate for cataplexy |
|
|
Term
|
Definition
| Can be central, obstructive, or mixed, involves episodes of breathing cessation for 10sec or more with frequency of about 10-15/hr |
|
|
Term
| How do you treat restless leg syndrome? |
|
Definition
|
|
Term
| What is periodic limb movements of sleep? |
|
Definition
| Short burts of muscle activity in the anterior tibialis accompanied by a leg jerk or kicking movement once about ever 30 sec |
|
|
Term
| What is the difference between sleep terror disorder and nightmares? |
|
Definition
| Night terrors not accompanied by vivid dreams, not remembered, my co-occur with sleep walking, is familial |
|
|
Term
| What is used to treat sleepwalking disorder? |
|
Definition
| Safegaurds and possibly benzodiazepines |
|
|
Term
| What is REM behavior disorder? |
|
Definition
| Patients act out their dreams |
|
|
Term
| What is retrograde amnesia? |
|
Definition
| Memory loss of prior events? |
|
|
Term
| What is anterograde amneisa? |
|
Definition
| INability to form new memories |
|
|
Term
| What is transient global amnesia? |
|
Definition
| Sudden onset of anterograde amnesia and retrograde amnesia for recent events preceding symptoms |
|
|
Term
| What usually causes retrograde amnesia? |
|
Definition
| Trauma, most commonly to temporal lobes and hippocampus |
|
|
Term
| What brain areas may be damaged to producing anterograde amnesia? |
|
Definition
| Medial temporal lobe and hypothalamus, basal forebrain, and the fornix |
|
|
Term
| What is normal dissociation? |
|
Definition
Common/normal part of consciousness
Daydreaming, hypnosis and meditation, allows the mind to process the vents of daily life |
|
|
Term
| What is dissociative amnesia? |
|
Definition
| One or more episode of inability to recall IMPORTANT PERSONAL INFORMATION usually of a traumatic or stressful ntature that is too extensive to be explained by ordinary forgetfulness |
|
|
Term
| What is dissociative fugue? |
|
Definition
Sudden unexpected travel away from home or one's customary place of work with an inabilit yto recall on's past. Confusion about identity or assumption of a new identity occurs
Can last for months |
|
|
Term
| How do you treat dissociative amnesia and fugue? |
|
Definition
No clear treatment established
Hypnosis or sodium amobarbital may help recover memory |
|
|
Term
| What is dissociative identity disorder? |
|
Definition
| Multiple personality disorder characterizzed by the presence of two or more distinct identities or personality states, predominantly women, onset usually before 9yo, most have borderline personality disorder |
|
|
Term
| What is depersonalization disorder? |
|
Definition
| Persistent or recurrent experience of feeling detached from one's mental processes or body as if one is an outside observer. Feeling is as though one is in a dream. Reality testing remains intact, begins as adolescent, may be triggered by substance abuse |
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