Term
|
Definition
5+ symptoms and depressed mood or loss of interest/pleasure
significant distress or impairment
2 weeks or more
represents decline
not accounted for by gmc/bereavement
weight loss/gain, insomnia/hypersomnia, psychomotor agitation/retardation, fatique, guilt, etc |
|
|
Term
|
Definition
| reference to only an episode |
|
|
Term
|
Definition
suicide assessment
somatization of symptoms
personal relativity of normal/decline
rational reaction to situation?
distinguishing from grief |
|
|
Term
|
Definition
most severe with loss of spouse
50% of pop qualify for MDE following death
severity and longevity determine if grief can be coded as MDD: +2 months after death
risk factors for progression: previous MDE, poor coping skills, limited support network |
|
|
Term
|
Definition
| lower level depression for 2+ years |
|
|
Term
| Seasonal Affective Disorder |
|
Definition
| Not currently a DSM diagnosis, just a specifier |
|
|
Term
|
Definition
Mild: symptoms barely meet criteria, little distress, no suicidal ideation
Moderate
Severe: # of symptoms exceed minimum, marked impairment |
|
|
Term
|
Definition
Psychotic features: automatically severe
Mood congruent: consistent with depressed mood
Mood incongruent: not consistent with mood or are more bizarre (very rare) |
|
|
Term
| MDD Specifiers of Most Recent Episode |
|
Definition
Atypical: reactive, higher weight and eating, excessive sleep
Melancholic: somatic, guilt, lack of appetite, weight loss, typically worse in morning and wake up early
Catatonic: rare
Postpartum Onset
Course:
Single episode/recurrent/chronic
With or without full interepisode recovery
With seasonal pattern (SAD) |
|
|
Term
|
Definition
Almost all pts are anxious but not all anxious pts are depressed
Anhedonia, slowing of motor & cognitive function, & feeling "keyed up"-- most common
"Pure" anxiety sx: apprehension, tension, trembling, excessive worry, nightmares
"Pure" depression sx: helplessness, depressed mood, loss of interest, loss of pleasure, suicidal ideation, diminished libido, rumination
Depression= loss of interest, less activity
Anxiety= increased unfruitful activity |
|
|
Term
|
Definition
Related to increased risk for anxiety disorders
*Serotonin transporter gene:
short-short: susceptible w/ stress, decreased serotonin expression, (diathesis-stress model)
long-long: protected, increased serotonin expression |
|
|
Term
|
Definition
Low SE= less regulation of NE & DA
Low NE= less activity
Low DA= less pleasure |
|
|
Term
| MDD, Endocrine System, & Sunlight |
|
Definition
Endocrine sytstem: increased cortisol, DST test bc DXM suppresses cortisol-indicates over-responsiveness of adrenal gland
Sunlight: melatonin suppresses SE, excessive daytime melatonin causes depressed affect, exposure to sunlight suppresses melatonin production (moreso for SAD) |
|
|
Term
|
Definition
| Lewinsohn- depression is related to a decrease in reinforcement and/or an increase in punishment |
|
|
Term
|
Definition
Learned helplessness theory: attribution style to life events related to vulnerability to depression, no perceived control, common with high abuse and low SES situations), internal (thoughts), stable(over period of time), and global(far-reaching)
Negative cognitive styles (Beck):
cognitive errors- distorted thinking that leads to depressed mood
depressive cognitive triad- negative views about self, world, and future
Schemas- enduring negative core belief about some aspect of life which usually form at a young age |
|
|
Term
|
Definition
all-or-nothing thinking
mental filter: over-emphasizing negatives and discounting positives
taking feelings too seriously (as reality)
generalized "should"- should've dones
self-blame
jumping to conclusions: mind-reading, fortune telling |
|
|
Term
| MDD Cognitive Behavioral Tx |
|
Definition
Beck
work on relationship btw thoughts, feelings, and behaviors
10-20 sessions, present-focused
homework given: monitoring thoughts, challenging beliefs, hypothesis testing, tracking symptoms
Eval: most widely studied tx, very effective/ over-simplistic, ignores past |
|
|
Term
| MDD Interpersonal (IPT) Tx |
|
Definition
Klerman
15-20 sessions, present-focused
identify main interpersonal conflicts: interpersonal role dispute, loss of relationship, acquisition of new relationship/roles, deficits in social skills
identify stage: negotiation, impasse, resolution
better for people whose relationships are contributing to depression |
|
|
Term
|
Definition
MAOIs: older, side effects, diet restrictions, good for depression w/ atypical features
Tricyclics: inhibits reuptake of monoamines, narrow therapeutic window, good for depression w/ insomnia & weight loss
SSRIs: also effective for anxiety, take several weeks to work, weight gain, loss of libido, sleep disturbances, possible increase in suicidal ideation bc of gain in energy |
|
|
Term
| Bipolar Disorder General Features |
|
Definition
can presently meet criteria for:
major depressive, manic, hypomanic, or mixed episode
requires at least one manic/hypomanic episode in lifetime
not mood swings
not 2/2 to psychostimulant |
|
|
Term
| Manic Episode General Features |
|
Definition
1+ week or hospitalized before 1 week
abnormal mood: high, irritable, or expansive
main features (3+):
inflated self-esteem, high energy, low sleep, racing thoughts, pressured speech, impulsivity, poor judgement
*hypomanic episode assoc with less time (3-4 days), less sx, less psychosis
*mixed episode fulfill criteria for both MDE and manic episode nearly every day for at least 1 week. |
|
|
Term
| Bipolar Disorder Specifiers |
|
Definition
Severity: mild, moderate, severe
severe with/without psychotic features
Most recent episode specifiers:
with catatonic features
with postpartum onset
course of recurrent episodes:
with or without full interepisode recovery
with rapid cycling: in 1 yr at least 4 episodes of MD, Mania, Mixed, or Hypomania |
|
|
Term
|
Definition
at least one manic episode in lifetime
typically more time spent in MDE than manic
most common is alternation of MDE and manic episodes |
|
|
Term
| Bipolar Disorder Addtl Features |
|
Definition
mania usually experienced as pleasurable, desirable, and productive (to a point)
medication compliance problem
hypomanic can progress into full manic episode
roller-coaster ride into depression involves biological and psychosocial components
when psychotic features are prominent, difficult to diff from schizoaffective and to separate from substance use |
|
|
Term
|
Definition
MDE and hypomanic episodes w/out history of manic episode
onset slightly later (20s)
risk for developing Bipolar I |
|
|
Term
|
Definition
involves periodic elevation and depression of mood w/out MDE or hypomanic episode
less frequently present to clinic
at risk for MDE or manic episode |
|
|
Term
| Bipolar Disorder Heritability & Biological Issues |
|
Definition
50%, very high
increased glucose metabolism during mania seen in PET scans
low SE and high NE= mania: 'permissive theory'
lesions in right orbitofrontal lobe (stroke)
manic episodes may be damaging to the brain
disordered sleep assoc with high risk of manic episode w/ bipolar |
|
|
Term
| Bipolar Disorder Pharmacological Tx |
|
Definition
Meds necessary to prevent manic episodes
lithium carbonate: naturally occurring salt (poisonous), very effective but narrow window, action unknown
antipsychotics
mood stabilizers: also used in tx of seizures, action unknown, increasingly more common |
|
|
Term
| Bipolar Disorder Psychological Tx |
|
Definition
Psychoeducation
Medication management
IPT/CBT
Family-focused treatment (FTT)
Interpersonal and Social Rhythm Therapy: same components as IPT, grieve loss over 'healthy selves', track social routines and habits to see connections w/ mood states |
|
|
Term
|
Definition
Every mental disorder is linked with suicide
22% psychologists experience cl suicide
Risk Factors:
caucasian, men (for completion), over 70 (60 for men), family history (genetics), psychological disorder, limited social support, adolescents |
|
|
Term
|
Definition
SLAP Domains:
Specificity of plan
Lethality of method
Availability of means
Proximity of helpers
On a continuum |
|
|
Term
|
Definition
Suicidal ideations are common
Risk minimalization:
enlisting support of others, removal of means, hospitalization
Contracting for safety:
written, signed, collaborative project
time-oriented |
|
|
Term
| Somatoform Disorder Types |
|
Definition
*Hyesterical Type (Physical Change):
Somatization Disorder
Conversion Disorder
Pain Disorder
*Preoccupation Type (No Physical Change):
Hypochondriasis
Body Dysmorphic Disorder
Psychophysiological disorders |
|
|
Term
| Somatoform Hysterical Type Disorders |
|
Definition
Shared features:
Physical sx/ concerns without physiological/ rational basis
Prominent relationship btw psychosocial stressors and symptoms
Secondary gain aspects (attention, excuse)
Family & employment complications
NOT INTENTIONALLY FAKING
(not malingering/ factitious disorder) |
|
|
Term
| Common Presenting Features Hysterical Somatoform Disorders |
|
Definition
Disability status + utilization of health care svcs= high societal cost
experience physical symptoms w/out identifiable physical cause:
referral for psychological help after exhausting everything else
many meds
frustrated w/ physicians and visa versa
Psychiatric sx typically expressed in relation to physical sx |
|
|
Term
| Somatization Disorder Features |
|
Definition
extensive history of sx
life revolves around sx
multiple and varied sx req'd:
pain x4
gi x2
sexual/reproductive
pseudoneurological
onset before age 30, chronic course- personality disorder? |
|
|
Term
| Somatization Disorder Demographics |
|
Definition
DSM diagnosable rare, but subclinical w/ distress & disfunction common
(undifferentiated somatoform requires only 1 physical complaint)
typical= low SES, unmarried women; generally starts in teens
anxiety, depression, & substance abuse co-morbid |
|
|
Term
| Somatization disorder Psychological Components |
|
Definition
Impulsivity, poor delay of gratification:
short-term gain from somatic problems and yeilds long-term isolation
pleasure seeking (sex, drugs)
manipulative behavior prominent:
sick role, parasuicidal |
|
|
Term
| Somatization Disorder Biological Components |
|
Definition
genetic component w/ link to anti-social pd
low SE yields increased pain reception |
|
|
Term
|
Definition
Difficult to treat, similarities to Cluster B personality disorders, no empirically-supported tx
Psychological Treatment Components:
accept somatic complaints as valid
stable level of contact regardless of symptom exacerbation
goal of minimizing utilization of health care services (exams, tests, meds, etc)
No Pharmacological Tx |
|
|
Term
| Conversion Disorder Features |
|
Definition
at least one symptom or deficit of sensory or voluntary motor function
DSM specifiers:
motor symptom or deficit
sensory sx or deficit
with seizures or convulsions
with mixed presentation
Sx presentation assoc with significant psychosocial stressor-episodic
Presented dramatically w/out corresponding concern |
|
|
Term
| Conversion Disorder Demographics |
|
Definition
relatively rare
much higher in developing countries |
|
|
Term
| Conversion Disorder Psychological Components |
|
Definition
Primary gain- relief of anxiety "the symptom binds anxiety"
secondary gain- "sick role"
sexual abuse history
inability to cope with emotional distress
modeling relatives
personality disorders common (histrionic, passive-aggressive/dependant)
more short lived= easier to treat |
|
|
Term
|
Definition
no empirically-supported tx
psychological tx components:
emotional support for precipitating stressor
explaining that not all sx have definite physical cause
expectation that sx will quickly wane
reinforce improvements & symptoms reduction
removal of secondary gain
Pharmacological:
anxiolytics or antidepressants for associated problems |
|
|
Term
|
Definition
Psychological factors have "important role in onset, severity, exacerbation, or maintenance of pain"
DSM Specifiers:
"with associated psychological factors" when psych factors have major role
"with both psych factors and a general medical condition" when both play important roles
Acute/chronic= -/+ 6 months |
|
|
Term
| Pain Disorder Considerations |
|
Definition
Current Meds: potential for abuse/dependence?, how long taking, motivation for pain relief, addicted?
legal issues?
nature of overt pain behavior: consistency, level of drama, contextual? |
|
|
Term
| Pain Disorder Demographics/Co-morbidity |
|
Definition
Psychiatric co-morbidity very common:
Acute pain assoc w/ anxiety disorders
Chronic pain assoc w/ depressive disorders |
|
|
Term
| Pain Disorder Psychological Components |
|
Definition
Pre-existing psychiatric condition as risk factor
Related to guilt- experience of pain is atonement for sins
"sick role"
coping strategies-helpful vs maladaptive
conversion of emotional distress to physical distress b/c more acceptable? |
|
|
Term
| Pain Disorder Biological Components |
|
Definition
Gate control theory: pain signals from body entering spinal cord are modulated by signals sent from brain- SE modulates signals from brain
Endorphins:
levels are lower in Pain Disorder pts
levels are related to sense of self-efficacy |
|
|
Term
| Pain Disorder Gender Differences |
|
Definition
Source of pain:
Women- fibromyalgia, migraines, arthritis, carpal tunnel, TMJ
Men- cardiac pain, backache
women report more pain, greater severity |
|
|
Term
| Pain Disorder Psychotherapeutic Tx |
|
Definition
CBT effective for disability & distress:
support and validation of pain as real
relaxation training
activity scheduling
reinforcement of non-pain behaviors
cognitive restructuring
Biofeedback for migraines, tension headaches, and muscle tension states
Physical therapy for pain
Hypnosis: used for altered perceptual experiences, images assoc w/ pain modified to be less distressing |
|
|
Term
| Pain Disorder Pharmacological Tx |
|
Definition
Analgesics not effective & assoc w/ serious potential for abuse
TCA's better than old SSRIs
Cymbalta very effective (SE & NE)
Neurontin/ Tegretol for neuropathic pain |
|
|
Term
|
Definition
anxiety surrounding fears of having a serious illness 2/2 misinterpretation of bodily sx
cannot be convinced that nothing is wrong
frequent visits to doctor
usually comorbid w/ anxiety/depression
relationship to Panic Disorder:
misinterpretation of physical sx
panic has fear of immediate consequences, Hypochondriasis has fear of long-term consequences |
|
|
Term
| Hypochondriasis Biological Components |
|
Definition
Non-specific genetic contribution for anxiety
deficit in autonomic down-regulation
aberrant cortisol levels |
|
|
Term
| Hypochondriasis Cognitive Components |
|
Definition
focused attn on physical sensations
hypersensitivity to threat
espousal of Western concept of health as being "free from sx(sensations)"
Possible learned component:
modeling from parents
benefits of "sick role" |
|
|
Term
| Hypochondriasis Contextual Components |
|
Definition
onset during stressful life event
high incidence of verifiable medical illness in family
psychological sx
increasing prevalence w/ age related to fear of aging and dying |
|
|
Term
|
Definition
Not well studied
Psychotherapy:
CBT
Reassurance/Explanation
(similar to tx for anxiety)
Pharacological:
antidepressants and anxiolytics |
|
|
Term
| Body Dysmorphic Disorder (BDD) Features |
|
Definition
preoccupied w/ something being wrong or misshapen about body part (usually involves face)
not delusional, but overvaluing
not a phobia (no irrational fear)
often seek dermatologist or plastic surgery to "correct"
rates of suicide are high
overlap with OCD
PDs common |
|
|
Term
| Evolutionary Aspects of Eating |
|
Definition
humans are opportunistic eaters
survival required exercise
body developed to process rough food
natural draw toward calorie dense food |
|
|
Term
| Biological Aspects of Eating |
|
Definition
Neuroscience view is that the "resting state" of system is hunger and food consumption provides temporary satiety
Satiety signals to brain **hypothalamus*:
stomach distension and emptying food into small intestine release CCK
*Ghrelin secreted when stomach is empty
*Leptin secreted when stomach is full
Vomiting:
natural rxn to over-eating, consuming spoiled food
enorphin release- sense of relief |
|
|
Term
| Psychological Aspects of Eating |
|
Definition
provides breaks/structure to the day
Classical conditioning/learning:
family gathering for meals, pleasnat sensation when eating and full
Modeling behavior:
parent & children, peers |
|
|
Term
|
Definition
| focal point of celebrations, context for developing interpersonal relationships- distractor/ barrier, age and gender expectations |
|
|
Term
| Modern Society and Eating |
|
Definition
Body image:
trend over last 50 years for thinner, ideal physique
mass media
Modern society promotes obesity:
processed calorie-dense food
sedentary lifestyle
less time- more meals out & less exercise |
|
|
Term
| Anorexia & Bulimia Nervosa Shared Elements |
|
Definition
Intense preoccupation with food
Intense fear of weight gain
Obsessive thinking & Compulsive behavior
Lack of interoceptive awareness/body cues:
-I get confused about what emotion I'm feeling
-I don't know what's going on inside me
I get confused as to whether or not I'm hungry
Serious health consequences: high rates of death |
|
|
Term
| Anorexia & Bulimia Nervosa Frequent Family Dynamics |
|
Definition
Perfectionistic parents
Over-involved parents: father domineering, high sense of importance placed on external evaluation, restrictive eating and purging as means of exerting control, child's sense of self enmeshed w/ parents- lack of body cues
Lack of conflict resolution:
open/expressed conflict levels low, not ok to talk about feelings, etc
*family tx important |
|
|
Term
| Anorexia & Bulimia Nervosa Sociocultural Components |
|
Definition
relatively new phenomenon
most are female, caucasian, upper-middle class- this is changing
onset age for anorexia (13), bulimia (17)
almost non-existent in non-western societies- but this is changing |
|
|
Term
| Anorexia Nervosa Primary Criteria |
|
Definition
Failure by choice to maintain adequate weight "Refusal"
85% of normal weight
due to restricted eating, purging, and exercise
weight loss does not reduce fear of gaining weight
distorted perception of body weight and size
amenorrhea for at least 3 months (DSM V proposed to remove this) |
|
|
Term
| Anorexia Nervosa Subtypes |
|
Definition
Restricting Type: dieting, fasting, exercise (most typical)
Binge-eating/Purging type: vomiting, laxatives, diuretics, enemas & 85% normal body weight (less common) |
|
|
Term
| Anorexia Nervosa Physiological Fallout |
|
Definition
damage to brain & heart=death
lethary
lower calcium=brittle bones
hypothyroidism
brittle nails & hair
lunago (tiny hairs to warm)
dehydration=constipation
mild anemia
swollen joints
2-6% die* |
|
|
Term
| Anorexia Nervosa Psychological Issues |
|
Definition
depression (either first or 2/2 starvation)
shame: baggy clothes, hiding food, etc
frequent co-morbidities:
anxiety disorders
intermittent explosive disorder
personality disorders
substance-abuse disorders
suicide risk
Perfectionistic |
|
|
Term
| Bulimia Nervosa Primary Criteria |
|
Definition
binge eating
sense of loss of control while eating
compensating action: vomiting, laxatives, diuretics, enemas, fasting, excessive exercise ( last two non-purging type)
at least twice/week for 3 months (DSM V change to once/week)
self-eval unduly influenced by body shape & weight
normal or higher weight (not anorexia)
specify purging and non-purging types (DSM proposed removal of subtypes) |
|
|
Term
| Bulimia Nervosa Biological Fallout |
|
Definition
From purging (also in Anorexia Nervosa Purging Type)
stomach rupture
loss of vital minerals (e.g., potassium)=heart failure
stomach acid corrodes teeth and esophagus
scarring to backs of hands
irregular menstruation |
|
|
Term
| Bulimia Nervosa Psychological Issues |
|
Definition
shame/secretiveness:
multiple binges in different groups, hiding food, hiding laxatives, hiding vomit
frequent co-morbidities:
anxiety disorders
depression
OCD
substance abuse
impulsivity problems
cluster B personality
suicide risk |
|
|
Term
| Biological Perspective Bulimia Nervosa |
|
Definition
genetic component
dysfunction in hypothalamus
hypersensitivity to endorphins from purging-yields net gain in pleasure
low levels of SE and NE: assoc w/ binging, ssris increase SE activity and counter binging and purging |
|
|
Term
| Bulimia Nervosa Specific Psychological Perspectives |
|
Definition
Learning:
binge-eating associated with relief from anxiety & negative affect
pleasant sensation following purging
purging regains sense of control
Modeling Behavior:
learning techniques from friends, teammates, TV
websites w/ techniques |
|
|
Term
|
Definition
Goals:
healthy eating habits
healthy weight
resolve psychological problems
venues:
majority outpatient (freq w/ hospitalizations)
inpatient |
|
|
Term
| Anorexia Nervosa Outpatient Tx |
|
Definition
cognitive-behavioral
interpersonal
family-based therapy:
behavioral family systems therapy- control over eating, cognitive restructuring, problem-solving, communication
individual based therapy produces improved family functioning
Educational |
|
|
Term
| Anorexia Nervosa Inpatient Tx |
|
Definition
Effective for restoring weight
Behavioral psychotherapy- token economies
Short-term improvement not predictive of long-term outcome |
|
|
Term
| Anorexia Nervosa Pharmacological Tx |
|
Definition
usually co-morbid disorders
MUST restore weight first
not effective by itself
antidepressants (ssris)
antipsychotics (severe OCD) |
|
|
Term
| Bulimia Nervosa Psychological Tx |
|
Definition
Cognitive Behavioral Therapy:
preferred by pts over antidepressants
superior to antidepressants
may not be better w/ antidepressants
Interpersonal psychotherapy: similar results as CBT after 1 yr |
|
|
Term
| Bulimia Nervosa Pharmacological Tx |
|
Definition
Antidepressants: ssris, high doses prozac
Mood stabilizers: lithium
other meds for co-morbidities |
|
|
Term
|
Definition
proposed for DSM V
recurrent episodes of binge eating & 3+:
eating more rapidly
until uncomfortably full
large amounts when not hungry
alone out of embarrassment
feeling disgusted or guilty over eating
a sense of loss of control when binging
distress over binge eating
occurs at least 1/week for 3 months
no compensatory bx |
|
|
Term
| Substance Use Levels of Involvement |
|
Definition
Use
Intoxication
Abuse-less serious, but will become..
Dependence: physiological
psychological='without physiological' |
|
|
Term
|
Definition
Maladaptive pattern of substance use leading to significant impairment &/or distress during same 12 month period, includes 1+ from recurrent use:
failure to fulfill major role obligations
use in situations when it is physically dangerous
despite legal problems
despite persistent social/interpersonal problems caused by substance |
|
|
Term
| DSM-IV Criteria Dependence |
|
Definition
maladaptive pattern of substance use leading to significant impairment &/or distress
includes 3+:
tolerance
withdrawals (substance specific)
substance taken in larger amts than intended
unsuccessful efforts to cut down/control
sig time spent acquiring, using, recovering
social, occupational, recreational activities sacrificed
continued use despite physical & psychological problems caused/exacerbated by substance |
|
|
Term
| Substance Use Disorder Proposed for DSM V |
|
Definition
encompasses both abuse and dependence
maladaptive pattern of substance use leading to significant impairment &/or distress during 12 month period, includes 2+:
failure to fulfill major role obligations
use in physically hazardous situations
despite persistent social/interpersonal problems caused
tolerance
withdrawal
substance taken in larger amts than intended
unsuccessful efforts to control use
sig time spent acquiring, using, or recovering
social, occupational, recreational activities sacrificed |
|
|
Term
|
Definition
increased release of DA in mesolimbic area of brain (learning, reward, motivation)
-psychological dependence may involve 2/2 elevations in DA
Adaptive physiological changes in brain and organ systems to accommodate use:
tolerance
withdrawal (symptoms opposite primary effects)
conditioned compensatory response |
|
|
Term
| Substance Use Disorder Common Presenting Issues |
|
Definition
tremendous co-morbidity w/ axis-I and II disorders (chicken-egg)
polysubstance disorder very common
may not be presenting issue/complaint
?s:
current intoxication
acute withdrawal symptoms
honesty/accuracy in reporting
motivation for tx
legal issues
financial instability
primary soical support network: using/non-using, instability or lack of, co-dependency issues
restricted social/recreational activities
cognitive impairments |
|
|
Term
| Substance Use and Genetics |
|
Definition
may be more important in males: males w/ adhd and alcoholic father at highest risk
reciprocal gene-environment
environment plays role in use, genetics important for abuse/dependence
physiological response to substances
everyone reacts differently bc of different brain structures, genes |
|
|
Term
| Substance Use Brain Systems |
|
Definition
DA critical in use/abuse/dependence:
pleasure pathway=VTA-NA-frontal lobe
stimulated by most abused drugs
natural experiences cannot cause same effects
GABA system:
reduces fear/inhibition
increased GABA-increased DA in Pleasure Pathway |
|
|
Term
| Substance Use Psychological Perspectives |
|
Definition
Positive reinforcement:
direct from substance
perceived psychosocial benefit
Negative reinforement:
removal of negative state (affect/anxiety)
removal of withdrawal symptoms
Cues for cravings: relapse part of disorder |
|
|
Term
| Substance Use Cognitive Perspective |
|
Definition
Cognitive abilities:
recognize problem, problem-solve, flexibility all impaired w/ usage
risk vs. reward perception |
|
|
Term
| Substance Use Social Perspectives |
|
Definition
availability/acceptability in community
parental use:
limited supervision of children, justify parent's lifestyle
co-dependency in relationships
social sphere: social network activities formed around use |
|
|
Term
|
Definition
Prochaska & Diclemente- Stages of Change:
pre-contemplation, contemplation, preparation, action, maintenance--relapse or stable behavior
inpatient:
detox (often in jail or hospital)
rehab- usually after acute detox, stay 2-6 weeks, wide range in effectiveness, theoretical orientation, professional staffing, costs |
|
|
Term
| Motivation Interviewing/Enhancement for Substance Use |
|
Definition
idea is enhance intrinsic motivation for change in behavior
focus on ambivalence
central tenets:
subtly directive, acknowledge benefits of use "devil's advocate", non-confrontational
evidence suggests very effective, occasionally w/ single session |
|
|
Term
| Alcoholism & Narcotics Anonymous |
|
Definition
12 step program
central tenets:
abstinence-based
no professional oversight or political affiliations
anonymity
sponsorship
effective when followed, but high dropout rate |
|
|
Term
| Cognitive-behavioral Tx Substance Use |
|
Definition
Cognitive:
objective evaluations of benefits of use vs abstinence, identifying & challenging thoughts, slowing down "rush to recovery"
Behavioral:
avoidance of "high-risk" situations/relationships
encourage activities incompatible w/ use
rewarding abstinence
develop refusal skills via role-playing
typically, AA involvement |
|
|
Term
| Alcohol Tx Pharmacological |
|
Definition
| Antabuse (disulfram): disrupts metabolism of ETOH-produces flushing, throbbing headache, nausea, etc. |
|
|
Term
| Pharmacological Tx Other Substances |
|
Definition
Opiates: Methadone, buprenorphine
Cocaine: ssris for dysphoria
Methamphetamine: Buproprion (Wellbutrin)
Nicotine: Nicotine replacement, chantix very effective
Marijuana: n/a |
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Term
| definition of schizophrenia |
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Definition
"split-mind"
splitting of personality
emotion and intellect incongruent
fundamental break w/ reality that is out of the rang of "normal"--psychotic
NOT more violent
DSM-IV:
6+ months with 1+ month active phase
2 or more Positive/Negative symptoms
social/occupational dysfunction
subtypes |
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Term
| positive symptoms schizophrenia |
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Definition
delusions
hallucinations: usually auditory
disorganized speech: loose associations, tangentiality, derailment, neologisms, "clang"
bizarre/disorganized behavior: appearance, affect, actions |
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Term
| negative symptoms schrizophrenia |
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Definition
alogia: not speaking
affect flattening
avolition: no motivation
anhedonia: lack of pleasure |
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Term
| other common problems w/ schizophrenia |
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Definition
attention
dysphoria
memory
poor emotion recognition
absence of insight
sleep disturbance
suicide attempts |
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Term
| Paranoid subtype schizophrenia |
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Definition
most common
appear the most "normal"
later average onset
absence of disorganized speech/behavior
symptoms tend to wax and wane |
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Term
| disorganized (hebephrenic) subtype |
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Definition
problems present at early age
most obviously psychotic
must have disorganized speech/behavior and flat affect
less symptom fluctuation |
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Term
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Definition
rare
motor immobility, mutism or marked negativism, peculiar behavior, echolalia |
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Term
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Definition
| meets crit for none of the other subtypes |
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Term
| residual criteria schizophrenia |
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Definition
pt no longer meets criteria
rarely used; better to use original diagnosis w/ "episodic w/ interepisode residual symptoms" or "single episode in partial remission"
*DSM-V to remove subtypes |
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Term
| schizophrenia course specifiers |
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Definition
*used only after one year since onset:
continuous
episodic with interepisode residual symptoms
episodic with no interepisode residual symptoms
single episode in partial remission
single episode in full remission |
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Term
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Definition
Prodromal: peculiar behavior, social isolation/withdrawal, decreased role function, not unlike social phobia
Active
Residual: decreased positive symptoms, negative symptoms remain* |
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Term
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Definition
more severe in men
greater in lower SES and blacks
age onset: late teens, early 20s
-related to stress of emancipation
-"prodromal period"-time from initial presentation of symptoms to diagnosis (usually first psychotic break)
generally seen as lifetime disorder |
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Term
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Definition
individual: interruption of education, loss of independence, loss of social network, employment difficulties, substance abuse, homelessness, imprisonment, suicide
family: economic & emotional burden, guilt, stress, "friction", mood disorders
society: unemployment, extended and chronic hospitalizations, imprisonment, homelessness, loss of valuable contributing members
$20,000-$100,000+ patient/yr |
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Term
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Definition
clear genetic & environmental issues
mz twins 50% concordance
17% parent-child transmission
risk increases w/ increased number of affected family members |
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Term
| brain differences schizophrenia |
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Definition
increase in size of ventricles
decrease in size of subcortical structures
asymmetry
altered neurochemistry: DA most widely known, but not sole precipitant |
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Term
| etiology DA schizophrenia |
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Definition
higher # of D2 receptors: positive symptoms
underactive D1 in prefrontal cortex: negative symptoms |
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Term
| etiology other neurochemicals schizophrenia |
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Definition
SE: well-supported, explains efficacy of atypical antipsychotics
Glutamate: explains cognitive deficits & developmental changes, provides causal mechanism for DA
GABA: explains glutamate dysfunction
Neurotensin: master modulator for all systems |
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Term
| etiology neurodevelopment schizophrenia |
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Definition
childhood: extensive white matter tracts and synapses from connecting gray matter
*synaptic pruning: process occurring in adolescence where number of synapses decrease based on use...
**in schizophrenia: excessive/inappropriate synaptic pruning may take place-
frontal lobes=problem solving, organized thought
temporal lobes=auditory hallucinations
thalamus=sensory gating |
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Term
| etiology environmental influences schizophrenia |
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Definition
cold mother=NO
double-bind communication: inconsistent messages=NO
viral infection: exposed during 2nd trimester
childhood exposure to toxoplasma gondii, cat feces
major life stressors/trauma
parental influences |
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Term
| etiology symptom relapse schizophrenia |
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Definition
social withdrawal early warning sign, isolation as precipitant
high psychosocial stressors
much higher risk when alcohol/drugs involved
can be effectively managed w/ meds to avoid fallout |
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Term
| treatment schizophrenia meds |
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Definition
Typical antipsychotics/neuroleptics: mechanism of action- block DA
reduce positive symptoms but ignore or make worse negative symptoms
side effects- difficulty initiating movement, tardive dyskinesia (involuntary facial movements)
used in severe cases and for crisis intervention
cigarette smoking assoc w/ better outcome and med compliance
Atypical antipsychotics:
mechanism of action- decrease sensitivity of DA & SE in specific pathway, may alter physiology of neurons
reduce positive symptoms, indirectly reduce negative symptoms
less risk for tardive dyskinesia
VAST improvements for many patients, less side effects, de-institutionalization |
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Term
| treatment schizophrenia inpatient |
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Definition
very expensive
temporary (7-30 day) stays for psychotic breaks
many facilities are state-funded, house 30-1000+ patients
strict rules, various levels of security
mixed-gender community activities, token economies |
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Term
| treatment schizophrenia residential homes |
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Definition
typically non-descript in residential neighborhoods
state/local funds to house patients previously hospitalized
idea is to teach patients skills necessary for independent living: cooking, cleaning, meds, hygiene, communication, problem-solving, etc |
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Term
| treatment schizophrenia family-based- history I |
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Definition
first family therapies in 1950s
negative change in patient behavior when interacting w/ family=family system as pathological entity
results:
family contact prohibited, confrontational approach to therapy
poor-negative outcome, dangerous |
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Term
| treatment schizophrenia family-based history II |
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Definition
renewed interest in 70's due to inability of meds to prevent relapse
*Expressed Emotion (EE) in family and relapse
theory shift: family environment affects course rather than onset, family beliefs, interactions, and behaviors as target for tx
medication improvements especially Atypicals, many patients living w/ family |
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Term
| family-based tx general description (schizophrenia) |
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Definition
main goals: psychoeducation & stress reduction
treatment length: 9+ months, weekly to monthly
setting: clinic & home
group: single & multi-family
inclusion of extended family |
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Term
| family-based tx major issues (schizophrenia) |
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Definition
beliefs & attitudes toward patient and mental illness
reduce shame & guilt
stress management
family interaction style-EE
coping skills
community resources |
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Term
| family-based tx benefits (schizophrenia) |
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Definition
patient:
symptom reduction
med compliance, less meds needed
improve social functioning
family:
increase knowledge of illness & change beliefs
decrease EE
change in interaction style
improve problem solving skills |
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