Download Study Guide Final 12-13-2005 - Logan Class of December 2011

Dan Judge’s Guide to Psychology
Enjoy
1. Advantages and disadvantages of newer antipsychotic medications
I’m not sure what she means by “newer.” According to some sources, that means
atypical antipsychotics (neuropleptics) only, but she gave info on antipsychotics in
general.
Antipsychotic drugs began being used in the 50’s with the discovery of
chloropromazine (thorazine) in 1952. Drugs in this group are considered “typical” or
“old.” This was the first time that psychotic patients could be in communities rather than
locked away like One Flew Over the Cuckoo’s Nest, so that was a major plus. The big
disadvantage was the extrapyramidal effects, such as tardive dyskinesia, distonia,
akathisisia, etc. These drugs act by blocking various dopamine receptors in the brain.
The limit psychosis, but also affect the motor system, leading to the side-effects.
Typical neuroleptics are separated into three categories, low, medium and highpotency. Low-potency meds tend to be more sedating and are associated with lower
blood pressure, dizziness, dry mouth, blurred vision and difficulty urinating. Examples
of low-potency drugs are promazine, chlorpromazine, chlorprothixene, thioridazine and
mesoridazine.
High-potency drugs are less sedating but are associated with tremors, rigidity,
muscle spasms and restlessness. Examples are thiothixene, trifluoperazine, fluphenazine,
halperidol and pimozide.
Medium-potency drugs have side-effects somewhere in between and include:
droperidol, acetophenazine, loxapine, molindone, perphenazine and prochloroperazine.
The atypical neuroleptics (antipsychotics), also known as the “newer” drugs, all
date from the introduction of Clozaril. These drugs may target specific dopamine
receptors and/or may block or inhibit re-uptake of seratonin. The most dramatic
difference between the typical and atypical drugs the atypicals ability to address negative
symptoms of schizophrenia and cognitive disturbances. There is also thought to be a
lower risk of tardive dyskinesia as a side-effect, as well as lower side-effects in general.
They also have a more stabilizing mood effect and may be used for bi-polar disorder.
These drugs are only available in tablet form and no generic forms are available yet.
Atypicals currently available in the US are Clozaril (Clozapine), Risperdal (Risperidone)
and Zyprexa (aka Lanzac) (Olanzapine).
2. Major side effects of antipsychotic drugs
Sedation, autonomic effects, endocrine effects, skin and eye complications,
neurologic effects (dystonia, pseudo parkinsonism, akinesia, akathisia), tardive
dyskinesia, Neuroleptic Malignant Syndrome, agranulocytosis, seizures, sudden death
(whoops…).
In case you were wondering, like me, here is the definition of akithisia: A
movement disorder characterized by a feeling of inner restlessness and a compelling
need to be in constant motion as well as by actions such as rocking while standing or
sitting, lifting the feet as if marching on the spot and crossing and uncrossing the legs
while sitting. People with akathisia are unable to sit or keep still, complain of
restlessness, fidget, rock from foot to foot, and pace. Apparently it is a pretty common
side-effect of psych meds.
3. Symptoms of panic attacks
Psychos consider it a panic attack if you have “a discrete period of intense fear or
discomfort in which 4 or more of the following symptoms develop abruptly and reach a
peak in 10 minutes or less.” It is not uncommon to see a panic attack person in the ER
because they think they are having a heart attack or other physical disease.
 Palpitation, pounding heart or accelerated heart rate
 Sweating
 Trembling or shaking
 Sensations of shortness of breath or smothering
 Feeling of choking
 Chest pain or discomfort
 Nausea or abdominal distress
 Dizzy, light-headed, faint
 Derealization (feeling of unreality) or depersonalization
 Fear of losing control/going crazy
 Fear of dying
 Paresthesia
 Chills, hot flashes
Imagine how you would feel if I told you they eliminated Diversified, Basic and all
elective techniques from the curriculum and made Logan’s core technique Pro-Adjuster.
You just had a panic attack.
4. Criteria for Panic Disorder with Agoraphobia
Panic disorder can occur by itself or with agorophobia. Criteria for Panic Disorder are:
A. Recurrent, unexpected panic attacks.
B. At least one attack has been followed by one month or more of one of the following:
 Persistent concern about having additional attacks.
 Worry about the implications of the attack or its consequences.
C. Panic attacks not due to substance abuse or med. condition.
D. Not better accounted for by another mental disorder.
Criteria for agorophobia are:
A. Anxiety about being in places or situations where they feel that escape is difficult or
embarrassing or that help would not be available if the panic attack occurs.
B. The situations are avoided or endured with marked distress or anxiety about having a
panic attack, or they require a companion to enter certain situation.
C. The anxiety or phobic avoidance is not better accounted for by another mental
disorder, such as social phobia, specific phobia, obsessive-compulsive disorder, PTSD or
separation anxiety.
A major component of both panic disorder and agorophobia is the fear of another attack.
Symptoms of agorophobia keep getting worse. They are often home-bound becaue they
are so fearful of leaving the safety of their own environment.
5. Comorbidity of Panic Disorder
Comorbid with asthma, mitral valse prolapse….., etc. Age of onset is late teens to mid30s. 1st degree biological relatives are 8x more likely to develop it.
6. Criteria for Conduct Disorder
A. Repetitive and persistent pattern of behavior in which the rights of others or societal
norms are violated and manifested by 3 or more of the following criteria for 12 months:
 Aggression to people or animals
 Destruction of property
 Deceitfulness or theft
 Serious violations of rules
B. Causes significant impairment in social, academic or occupational functioning.
Conduct disorder is coded as mild, moderate or severe and by age of onset.
For anyone who has ever played grand theft auto, conduct disorder is pretty much the
point of the game. Except that conduct disorder usually applies to children or adolescents
and isn’t quite so destructive as GTA.
7. Depersonalization Disorder definition and criteria
This is a disorder in which the person feels detached, or like they are having an “out-ofbody” experience.
1. Persistent experience of feeling detached from ones own body or mental
processes.
2. Reality testing remains intact.
3. causes significant distress or impairment in functioning.
4. Rule out schizophrenia, substance abuse or temporal lobe epilepsy.
8. Differential diagnosis for Pain Disorder
Pain disorder must first be dif. dx. with any actual condition that could be causing
the pain, such as OA, RA, facet syndrome, tumor, diabetic neuropathy, trigger point,
substance abuse, etc. It can also be comorbid with any physical condition, but
psychological factors are judged to be have an important role in the process. When
diagnosing pain disorder it is also important to rule out other mental disorders, such as
mood, anxieity or pyschotic disorders. Pain disorder is also often comorbid with
depression and anxiety.
9. Criteria for Dissociative identity Disorder
This is one of several Dissociative disorders. The others are Dissociative
Amnesia, Dissociative Fugue and Depersonalization Disorder. All of them have some
degree of disruption in the usually integrated function of consciousness, memory, identity
or perception of the environment.
Criteria for Dis. Identity Disorder, formerly called multiple personality disorder, are as
follows:
1) Two or more distinct identities or personality states.
2) At least two of these identities recurrently take control of behavior (uncommon to have
> 10 or 11).
3) Inability to recall important personal info.
4) Rule out substance abuse or medical conditions.
These people almost always have a history of childhood physical or sexual abuse and a
chaotic family background (97-98%). From my notes in class, she said that the more
passive personalities have more restricted memories, whereas the more aggressive
personalities know more details about the person’s life and past.
10. Anxiety Disorders
All of these disorders are marked by intense anxiety and/or fear. Keep in mind that some
degree of anxiety is normal and actually enhances performance, but in these disorders the
anxiety is debilitating. Some of these are discussed elsewhere in the study guide, so I’ll
just list them. If this is their only appearance, I’ll give the definition too. Don’t spend
much time, if any, on specific phobia, GAD or PTSD, since she didn’t ask about them
specifically.
Panic Disorder and Agorophobia
Obsessive-compulsive disorder
Acute stress disorder
Social phobia
Post-traumatic stress disorder
Generalized anxiety disorder
Specific phobia
GAD:
The essential characteristic of Generalized Anxiety Disorder is excessive uncontrollable
worry about everyday things. This constant worry affects daily functioning and can cause
physical symptoms. GAD can occur with other anxiety disorders, depressive disorders, or
substance abuse. GAD is often difficult to diagnose because it lacks some of the dramatic
symptoms, such as unprovoked Panic Attacks, that are seen with other anxiety disorders;
for a diagnosis to be made, worry must be present more days than not for at least 6
months.
The focus of GAD worry can shift, usually focusing on issues like job, finances, health of
both self and family; but it can also include more mundane issues such as, chores, car
repairs and being late for appointments. The intensity, duration and frequency of the
worry are disproportionate to the issue and interferes with the sufferer's performance of
tasks and ability to concentrate. Physical symptoms include:




Muscle tension;
Sweating;
Nausea;
Cold, clammy hands;



Difficulty swallowing;
Jumpiness
Gastrointestinal discomfort or
diarrhea;
Sufferers tend to be irritable and complain about feeling on edge, are easily tired and
have trouble sleeping.
SPECIFIC PHOBIA:
Specific Phobia is characterized by the excessive fear of an object or a situation, exposure
to which causes an anxious response, such as a Panic Attack. Adults with phobias
recognize that their fear is excessive and unreasonable, but they are unable to control it.
The feared object or situation is usually avoided or anticipated with dread.
Specific Phobia is diagnosed when an individual's fear interferes with their daily routine,
employment (e.g., missing out on a promotion because of a fear of flying), social life
(e.g., inability to go to crowded places), or if having the phobia is significantly
distressful. The level of fear felt by the sufferer varies and can depend on the proximity
of the feared object or chances of escape from the feared situation. If a fear is reasonable
it cannot be classed as a phobia.
Specific Phobia may have its onset in childhood, and is often brought on by a traumatic
event; being bitten by a dog, for example, may bring about a fear of dogs. Phobias that
begin in childhood may disappear as the individual grows older. Fear of certain types of
animals is the most common Specific Phobia. The disorder can be comorbid with Panic
Disorder and Agoraphobia.
PTSD: anxiety caused by an extreme stressor
Acute: 3 months or less
Chronic: 3 months or more
Delayed: > 6 months
KEY SYMPTOMS OF PTSD:
1.
Re-experiencing the traumatic event
a. Intrusive, distressing, recollections of the event
2.
3.
4.
b. Flashbacks
c. Nightmares
d. Exaggerated emotional and physical reactions to triggers that remind the
person of the event
Avoidance of activities, places, thoughts, feelings, or conversations related to
the trauma
Emotional numbing
a. Loss of interest
b. Feeling detached from others
c. Restricted emotions
Increased arousal
a. Difficulty sleeping
b. Irritability
c. Difficulty concentrating
d. Hypervigilance
e. Exaggerated startle response
CO-MORBID CONDITIONS WITH PTSD:
1.
2.
3.
4.
5.
6.
7.
Substance abuse or dependence
Major depressive disorder
Panic disorders/agoraphobia
Generalized anxiety disorder
OCD
Social disorder
Bipolar disorder
CAUSES OF PTSD:
1.
2.
3.
4.
5.
6.
7.
8.
Serious accident
Natural disaster
Criminal assault
Military combat
Sexual assault
Sexual/physical abuse or neglect as a child
Hostage/imprisonment/torture
Witnessing or learning about traumatic events (shooting or devastating
accident, sudden unexpected death of a loved one)
THE IMPACT OF THE STRESSOR:
1.
2.
Must be extreme, not just severe (actual or threatened death, serious injury,
rape, or childhood sexual abuse)
Causes powerful subjective responses – intense fear, helplessness, or horror
*The most effective treatment for PTSD is psychotherapy/(EMDR) – Eye Movement
Desensitization and Reprocessing
TREATMENT FOR PTSD:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
SSRI’s and SNRI’s
TCA’s and MAO inhibitors (last line of defense due to the side effects)
Anticonvulsant medications; 2nd generation antipsychotics
Benzodiazepines (addiction is common)
Cognitive and behavioral therapies
Eye Movement Desensitization Reprocessing (EMDR)
Psychodynamic psychotherapy
Psychological debriefing
Psycho-education and support
Stress inoculation, imagery rehearsal, and prolonged exposure
Present-centered and trauma-focused group therapies
11. Chronic pain symptoms, prevalence and comorbidity
For people with chronic pain, life revolves around their pain. It is the #1 complaint of all
older Americans. 1/5 people suffer from chronic pain. 15%/ year due to back pain alone.
It is comorbid with depression, anxiety and drug abuse. Up to 50% of chronic pain
sufferers have reported depression.
12. Diagnosis of Conduct Disorder
I couldn’t find this in her notes anywhere, so this from
http://www.emedicine.com/ped/topic2793.htm. The italicized portions are the most
important to know.
Conduct disorder (CD) is one of the most difficult and intractable mental health problems
in children and adolescents. CD involves a number of problematic behaviors, including
oppositional and defiant behaviors and antisocial activities (eg, lying, stealing, running
away, physical violence, sexually coercive behaviors).
This disorder is marked by chronic conflict with parents, teachers, and peers and can
result in damage to property and physical injury to the patient and others. These patterns
of behavior are consistent over time. Formal classification with the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) defines the essential
characteristics as "a persistent pattern of behavior in which the basic rights of others or
major age-appropriate social norms are violated."
Behaviors used to classify CD fall into the 4 main categories of (1) aggression toward
people and animals, (2) nonaggressive destruction of property, (3) deceitfulness, lying,
and theft, and (4) serious violations of rules.
CD usually appears in early or middle childhood as oppositional defiant behavior. Nearly
one half of children with early oppositional defiant behavior have an affective disorder,
CD, or both by adolescence. Thus, careful diagnosis to exclude irritability due to another
unrecognized internalizing disorder is important in childhood cases. Evaluation of
parent-child interactions and teacher-child interactions is also critical. Even in a stable
home environment, a small number of preschool-aged children display significant
irritability and aggression that results in disruption severe enough to be classified as CD.
The DSM-IV specifies that CD can be diagnosed in children younger than 10 years if
they demonstrate even one of the criterion antisocial behaviors. Diagnosis after 10 years
of age requires the presence of 3 of the criteria behaviors from the categories of (1)
aggression toward people and animals; (2) nonaggressive destruction of property; (3)
deceitfulness, lying, and theft; and (4) serious violations of rules.
Oppositional defiant disorder (ODD) is discriminated from CD based on the defiance of
rules and argumentative verbal interactions involved in ODD; CD involves more
deliberate aggression, destruction, deceit, and serious rule violations, such as staying out
all night or chronic school truancy.
The DSM-IV defines the 2 major subtypes of CD as childhood-onset type and adolescentonset type.
The childhood-onset type is defined by the presence of 1 criterion characteristic of CD
before an individual is aged 10 years; these individuals are typically boys displaying high
levels of aggressive behavior. These individuals often also meet criteria for attention
deficit/hyperactivity disorder (ADHD). Poor peer and family relationships are present,
and these problems tend to persist through adolescence into adult years. These children
are more likely to develop adult antisocial personality disorder than individuals with the
adolescent-onset type.
Adolescent-onset type is defined by the absence of any criterion characteristic of CD
before an individual is aged 10 years. These individuals tend to be less aggressive and
have more normative peer relationships. They often display their conduct behaviors in the
company of a peer group engaged in these behaviors, such as a gang. These patients are
less likely to fit criteria for ADHD; however, the diagnosis of ADHD is still possible.
These individuals are also far less likely to develop adult antisocial personality disorder.
While boys are identified more often, the estimated sex ratio of this type of CD
approaches 50% for girls and boys in some communities. The prognosis for an individual
with adolescent-onset type is much better than for a person with the childhood-onset type.
CD is highly resistant to treatment. It follows a clear developmental path with indicators
that can be present as early as the preschool period. Treatment is more successful when
initiated early and must include medical, mental health, and educational components as
well as family support.
13. Use of SSRI’s and effectiveness
Psychiatrists like to use SSRIs for almost everything, but there a few things even they
admit they are not good for. Their effectiveness does not appear to be higher than
tricyclic antidepressants, which were the most commonly used class of antidepressants
before the development of SSRIs. However, SSRIs have the important advantage that
their toxic dose is high, and, therefore, they are much more difficult to use as a means to
commit suicide. Further, they have fewer or milder side effects. Here is a basic list of
things SSRIs are generally thought to be helpful for, or not.
not helpful:
anorexia, not very helpful with dissociative disorders, not always very effective
with psychotic disorders (like schizophrenia), tendency to promote suicide in adolescence
helpful:
bulimia, anxiety disorders, depression, sometimes IBS, sometimes premature
ejaculation, pain disorder
14. Bulimia symptoms
This is the “binge and purge” eating disorder. These people experience large amounts of
guilt and shame. Criteria are as follows:
A. Recurrence of binge eating
B. Recurrence of inappropriate compensatory behaviors (such as vomiting, use of
diuretics, etc)
C. Self-evaluation process. They are aware that what they are doing is wrong, feel
incredibly guilty and ashamed, but feel out of control over their own eating.
D. 2x/week for 3 months to make the diagnosis.
Symptoms:
 Evaluate body and shape differently than reality. Think they are much fatter than
they really are.
 Behavior does not lead to significant weight loss
 High degree of secrecy, shame and denial
 Evidence of binge eating (wrappers, disappearance of food, etc)
 Frequent trips to the bathroom after meals
 Rigid exercise regiment
 May have unusual swelling in cheeks and jaw area
 Callouses on knuckles from gagging themselves
 Discoloration of teeth (vomit eating away at the teeth)
 Lifestyle changes to accommodate binging and purging
 Withdrawal of friends and peers
 Dehydration
 Often comorbid with depression and poor self-esteem
Many times friends notice the behavior first and address it with the person. These people
can appear functional, allowing the bulimia to last for years without people knowing.
May have these physical signs: electrolyte imbalance, irregular heart beat, dehydration,
loss of Na+ and K+, chronic irregular IBS.
15. Anorexia symptoms
Begins as a restriction of calories and becomes quite obsessional in nature. Patient must
be <= 85% of normal body weight. Criteria are as follows:
A. Refusal to maintain normal body weight.
B. Intense fear of gaining weight.
C. Disturbance in the way in which one’s body weight is experienced.
D. Post-menarchal amenorrhea.
Symptoms:
 Only eating at certain times or certain foods
 Obsession with particular body part (thighs, hips, etc)
 Achievement to lose weight
 Denial
 Depressed mood
 Social withdrawal, irritability
 Preoccupied with food and losing weight
 Fear of eating in public
 Perfectionistic, strong need to control environment
 May be comorbid with a personality disorder
Lab findings:
Anemia, decreased platelets, decr thyroid, decr estrogen, increased liver markers
May also present with dehydration, arrythmias of the heart, decr heart rate, constipation,
abdominal pain, cold intolerance, dental enamel erosion, osteoporosis, cardiac problems
and lanugo (downy, soft hair on trunk and body). Onset is usually 14-18 years of age and
patients are often very resistant to treatment (in denial).
16. Factitious disorder symptoms and diagnosis
Smack these people on their first visit and get it over with, cause you’ll definitely want to
after you’ve been treating them for awhile. They are faking physical signs and symptoms
just because they like being in “the sick role.” They are not in it for money, like someone
trying to play their workers comp or anything like that. Their symptoms are only present
when they are being observed. They have an edge of hostility to them, especially when
you challenge their symptoms. They tend to be passive aggressive too. They also may
present with a flucuating clinical course. As soon as one problem starts getting better,
they suddenly develop a new pathology. Here are the criteria and symptoms:
1.
2.
3.
4.
Intentional production or faking physical signs or symptoms
The motivation for the behavior is to assume the sick role (they are not seeking
any financial gain)
External incentives for the behavior, such as economic gain, or avoiding legal
responsibility are absent
Symptoms:
a. Atypical presentation or drama
b. Symptoms present only when the person is observed
c. Pseudologia fantastica (making up symptoms)
d.
e.
f.
g.
h.
i.
j.
Disruptive behavior
Arguing with nurses and caregivers
Extensive knowledge of medical terminology
Covert use of substances
Evidence of multiple treatment interventions
Fluctuating clinical course with “new pathology”
Medical workups are negative
An extreme version of this is something called Munchausen Syndrome. They are
typically male, young-mid aged adult and often have a comorbid personality disorder.
Also related to this is Munchausen by Proxy. These people get attention by making
someone else seem sick. Often it is a parent who makes up an illness for her child, or
even goes so far as to poison the child to actually make the kid sick. This counts as child
abuse. Here are some highlights:
1.
Suspect child abuse when the parent brings the child in to the doctor
complaining of sickness
2.
Inappropriate or incongruent symptoms
3.
Symptoms disappear when the caregiver is not present
4.
Over attachment of the parent towards the child (they never want to let the child
out of his/her sight)
5.
The parents will take the child to several doctors expressing their concern for a
variety of disorders
6.
Patient may present with, or the caregiver may tell stories about: bleeding,
seizures, poisoning of CNS drugs, depression, hypoglycemia, diarrhea, and
vomiting
17. Positive vs negative symptoms of schizophrenia
Schizophrenia can have positive or negative signs. The positive are considered more
disruptive and include delusions, hallucinations, disorganized speech and grossly
disorganized or catatonic behavior. Negative symptoms are more difficult to treat and
include affective flattening, alogia (not talking) and avolition (not wanting to get up and
do things).
I found a very detailed description online if you need some more bathroom reading.
from http://www.schizophrenia.com/diag.html#common:
Schizophrenia is characterized by profound disruption in cognition and emotion,
affecting the most fundamental human attributes: language, thought, perception, affect,
and sense of self. The array of symptoms, while wide ranging, frequently includes
psychotic manifestations, such as hearing internal voices or experiencing other sensations
not connected to an obvious source (hallucinations) and assigning unusual significance or
meaning to normal events or holding fixed false personal beliefs (delusions). No single
symptom is definitive for diagnosis; rather, the diagnosis encompasses a pattern of signs
and symptoms, in conjunction with impaired occupational or social functioning (Source:
DSM-IV -available for purchase on Amazon.com Diagnostic and Statistical Manual of
Mental Disorders DSM-IV-TR).
Symptoms are typically divided into positive and negative symptoms because of their
impact on diagnosis and treatment. Positive symptoms are those that appear to reflect an
excess or distortion of normal functions. The diagnosis of schizophrenia, according to
DSM-IV, requires at least 1-month duration of two or more positive symptoms, unless
hallucinations or delusions are especially bizarre, in which case one alone suffices for
diagnosis. Negative symptoms are those that appear to reflect a diminution or loss of
normal functions. These often persist in the lives of people with schizophrenia during
periods of low (or absent) positive symptoms. Negative symptoms are difficult to
evaluate because they are not as grossly abnormal as positives ones and may be caused
by a variety of other factors as well (e.g., as an adaptation to a persecutory delusion).
However, advancements in diagnostic assessment tools are being made.
Diagnostic criteria for schizophrenia (USA criteria)
A.
Characteristic symptoms: Two (or more) of the following, each present for a
significant portion of time during a 1-month period (or less if successfully treated):
1.
Delusions - false beliefs strongly held in spite of invalidating
evidence, especially as a symptom of mental illness: for example,
1.
Paranoid delusions, or delusions of persecution, for
example believing that people are "out to get" you, or the thought
that people are doing things when there is no external evidence that
such things are taking place.
2.
Delusions of reference - when things in the environment
seem to be directly related to you even though they are not. For
example it may seem as if people are talking about you or special
personal messages are being communicated to you through the TV,
radio, or other media.
3.
Somatic Delusions are false beliefs about your body - for
example that a terrible physical illness exists or that something
foreign is inside or passing through your body.
4.
Delusions of grandeur - for example when you believe that
you are very special or have special powers or abilities. An
example of a grandiouse delusion is thinking you are a famous
rock star.
2.
Hallucinations - Hallucinations can take a number of different
forms - they can be:
1.
Visual (seeing things that are not there or that other people
cannot see),
2.
Auditory (hearing voices that other people can't hear,
3.
Tactile (feeling things that other people don't feel or
something touching your skin that isn't there.)
4.
Olfactory (smelling things that other people cannot smell,
or not smelling the same thing that other people do smell)
5.
Gustatory experiences (tasting things that isn't there)
3.
Disorganized speech (e.g., frequent derailment or incoherence) these are also called "word salads".
4.
Grossly disorganized or catatonic behavior (An abnormal
condition variously characterized by stupor/innactivity, mania, and either
rigidity or extreme flexibility of the limbs).
5.
Negative symptoms, these are the lack of important abilities.
Some of these include:
1.
lack of emotion - the inability to enjoy acitivities as much
as before
2.
Low energy - the person sits around and sleeps much more
than normal
3.
lack of interest in life, low motivation
4.
Affective flattening - a blank, blunted facial experession or
less lively facial movements or physical movements.
5.
Alogia (difficulty or inability to speak)
6.
Inappropriate social skills or lack of interest or ability to
socialize with other people
7.
Inability to make friends or keep friends, or not caring to
have friends
8.
Social isolation - person spends most of the day alone or
only with close family
Note: Only one Criterion A symptom is required if delusions are
bizarre or hallucinations consist of a voice keeping up a running
commentary on the person’s behavior or thoughts, or two or more
voices conversing with each other.
B.
Cognitive Symptoms of Schizophrenia
Cognitive symptoms refer to the difficulties with concentration and memory. These can
include:
1. disorganized thinking
2. slow thinking
3. difficulty understanding
4. poor concentration
5. poor memory
6. difficulty expressing thoughts
7. difficulty integrating thoughts, feelings and behavior
C.
Social/occupational dysfunction: For a significant portion of the time s+ince the
onset of the disturbance, one or more major areas of functioning such as work,
interpersonal relations, or self-care are markedly below the level achieved prior to the
onset (or when the onset is in childhood or adolescence, failure to achieve expected level
of interpersonal, academic, or occupational achievement).
D.
Duration: Continuous signs of the disturbance persist for at least 6 months. This
6-month period must include at least 1 month of symptoms (or less if successfully
treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of
prodromal or residual symptoms. During these prodromal or residual periods, the signs of
the disturbance may be manifested by only negative symptoms or two or more symptoms
listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual
experiences).
E.
Schizoaffective and mood disorder exclusion: Schizoaffective disorder and mood
disorder with psychotic features have been ruled out because either (1) no major
depressive, manic, or mixed episodes have occurred concurrently with the active-phase
symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their
total duration has been brief relative to the duration of the active and residual periods.
F.
Substance/general medical condition exclusion: The disturbance is not due to the
direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a
general medical condition.
G.
Relationship to a pervasive developmental disorder: If there is a history of autistic
disorder or another pervasive developmental disorder, the additional diagnosis of
schizophrenia is made only if prominent delusions or hallucinations are also present for at
least a month (or less if successfully treated).
18. Symptoms of Acute Stress Disorder and diagnosis
I couldn’t find any info about this in her library file either, so once again I am giving you
way too much info from the internet. Symptoms are in italics in the first paragraph and
riddled throughout the diagnostic criteria.
From http://www.mental-health-matters.com/disorders/dis_details.php?disID=1:
Description
Acute Stress Disorder is a variation of Post-Traumatic Stress Disorder (PTSD) that
lasts for a minimum of 2 days, but lasts a maximum of 4 weeks, and occurs within 4
weeks of the initial stressor. The initial traumatic event must have involved actual or
threatened death or serious injury or a threat to the physical integrity of self or another
person, and the person must have felt fear, helplessness or horror. During the event or
immediately after, they must have experienced some of the following: numbing,
detachment, derealization, depersonalization or dissociative amnesia. They must
continue to re-experience the event through such methods as thoughts, dreams, or
flashbacks, and avoid stimuli that remind them of the stressor. During this time, they
must have symptoms of anxiety, and significant impairment in at least one essential
area of functioning.
From http://www.mentalhealth.com/dis1/p21-an08.html:
Diagnostic Criteria
A. The person has been exposed to a traumatic event in which both of the following
were present:
1. the person experienced, witnessed, or was confronted with an event or
events that involved actual or threatened death or serious injury, or a threat
to the physical integrity of self or others
2. the person's response involved intense fear, helplessness, or horror
B. Either while experiencing or after experiencing the distressing event, the
individual has three (or more) of the following dissociative symptoms:
1. a subjective sense of numbing, detachment, or absence of emotional
responsiveness
2. a reduction in awareness of his or her surroundings (e.g., "being in a
daze")
3. derealization
4. depersonalization
5. dissociative amnesia (i.e., inability to recall an important aspect of the
trauma)
C. The traumatic event is persistently reexperienced in at least one of the following
ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense
of reliving the experience; or distress on exposure to reminders of the traumatic
event.
D. Marked avoidance of stimuli that arouse recollections of the trauma (e.g.,
thoughts, feelings, conversations, activities, places, people).
E. Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping,
irritability, poor concentration, hypervigilance, exaggerated startle response,
motor restlessness).
F. The disturbance causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning or impairs the individual's
ability to pursue some necessary task, such as obtaining necessary assistance or
mobilizing personal resources by telling family members about the traumatic
experience.
G. The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and
occurs within 4 weeks of the traumatic event.
H. The disturbance is not due to the direct physiological effects of a substance (e.g.,
a drug of abuse, a medication) or a general medical condition, is not better
accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a
preexisting Axis I or Axis II disorder.
Differential Diagnosis
Mental Disorder Due to a General Medical Condition; Substance-Induced Disorder; Brief
Psychotic Disorder; Major Depressive Episode; exacerbation of a preexisting mental
disorder; Posttraumatic Stress Disorder; Adjustment Disorder; Malingering.
19. Autistic Disorder symptoms
 Impairment in social interaction and communication
 Restricted, repetitive, and stereotyped patterns of behavior, interest, and activities
 Involves poor language comprehension, they don’t understand simple instructions
 They become preoccupied with phone numbers or dates
 Rocking and swaying, clapping, may become preoccupied with opening and
closing doors
 Manifested by age 3
 Impulsive, self-injurious behavior
 Oversensitivity to things that are normally non-problematic (phone ringing, radio)
 Child doesn’t want or need to be touched, doesn’t smile or orient to the face or
make eye contact
 Seizure activity, EEG abnormalities
 Non-specific neurological signs, altered reflex patterns
 Fragile X syndrome (inherited form of mental retardation)
 4-5 times more common in males
 20/10,000 kids
 Lack of social imitative play
20. Dependent Personality Disorder symptoms
Pervasive need to be taken care of that leads to submissive and clinging behavior and
fears of separation. Indicated by at least five of the following:








Difficulty making everyday decisions without an excessive amount of advice and
reassurance.
Needs others to assume responsibility for most major areas of his or her life.
Has difficulty expressing disagreement with others because of fear of loss of
support or approval.
Has difficulty initiating projects or doing things on his of her own.
Goes to excessive lengths to obtain nurturance and support from others.
Feels uncomfortable or helpless when alone because of exaggerated fears of being
unable to care for himself or herself.
Urgently seeks another relationship as a source or care and support when a close
relationship ends (when a loved one dies).
Is unrealistically preoccupied with fears of being left to take care of him or herself
As a patient, these people will turn over care to you and expect you to do everything for
them.
*For those of you who just can’t get enough psycho, I thought I should stick the generic
definition of personality disorders and their grouping into clusters into the study guide
somewhere, since she asks a lot of questions about them and there is a chance it could
show up on the test. (How’s that for a run-on sentence?) For everyone else, feel free to
ignore the next bit. Courtesy of Adam Bordes:
PERSONALITY DISORDERS:
These patients have an enduring pattern of inner experience and behavior that deviates
markedly from expectations of the culture. Their loved ones are coming in for help in an
attempt to deal with them; the individual is not aware of the distress that they are causing
others. It is manifested in two or more of the following:
1.
2.
3.
4.
Cognition: thoughts
Affectivity: mood
Interpersonal functioning
Impulse control
 Inflexible and pervasive pattern across social and personal situations.
 Pattern leads to clinically significant distress or impairment.
 Behaviors are stable and of long duration, and are usually diagnosed in
adolescence or young adulthood.
PERSONALITY DISORDER LIST:


Enduring pattern of how one relates to other people
Persistent and difficult to change
CLUSTER A: (odd and eccentric personalities)
1.
Paranoid
2.
3.
Schizoid
Schizotypal
CLUSTER B: (dramatic and unstable personalities)
1.
Antisocial
2.
Borderline
3.
Histrionic
4.
Narcissistic
CLUSTER C: (anxious, reactive, and fearful personalities)
1.
Avoidant
2.
Dependent
3.
Obsessive-compulsive
21. Borderline Personality Disorder symptoms
This is a pervasive pattern of instability of interpersonal relationships, self-image, and
affect. Marked impulsivity beginning in early adulthood and presents in a variety of
contexts. It is indicated by the following symptoms:
 Frantic efforts to avoid real or imagined abandonment.
 A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation.
 Identity disturbance: markedly and persistently unstable self-image or sense of
self.
 Impulsivity in at least two areas that is potentially self-damaging.
 Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
 Affective instability due to a marked reactivity of mood.
 Chronic feelings of emptiness.
 Inappropriate intense anger or difficulty in controlling anger.
Relationships with these people are very exhausting. They epitomize the love/hate
relationship.
22. Risk of developing alcoholism and common lab findings for alcoholism
Alcoholism, also known as alcohol dependence, is a disease that includes the following
four symptoms:




Craving--A strong need, or urge, to drink.
Loss of control--Not being able to stop drinking once drinking has begun.
Physical dependence--Withdrawal symptoms, such as nausea, sweating,
shakiness, and anxiety after stopping drinking.
Tolerance--The need to drink greater amounts of alcohol to get "high."
There are many risks for developing alcoholism and we have probably all heard them
before. Effort to cut down is a big red flag. Familial patterns are a strong influence.
From http://pubs.niaaa.nih.gov/publications/FamilyHistory/famhist.htm:
Many scientific studies, including research conducted among twins and
children of alcoholics, have shown that genetic factors influence
alcoholism. These findings show that children of alcoholics are about four
times more likely than the general population to develop alcohol
problems. Children of alcoholics also have a higher risk for many other
behavioral and emotional problems. But alcoholism is not determined only
by the genes you inherit from your parents. In fact, more than one–half of
all children of alcoholics do not become alcoholic. Research shows that
many factors influence your risk of developing alcoholism. Some factors
raise the risk while others lower it.
Genes are not the only things children inherit from their parents. How
parents act and how they treat each other and their children has an
influence on children growing up in the family. These aspects of family
life also affect the risk for alcoholism. Researchers believe a person's risk
increases if he or she is in a family with the following difficulties:




an alcoholic parent is depressed or has other psychological problems;
both parents abuse alcohol and other drugs;
the parents' alcohol abuse is severe; and
conflicts lead to aggression and violence in the family.
Other risks are underage drinking, depression, loss of self control, diminishing sphere of
friends, etc. The CAGE questionnaire and one that she likes, the Michigan Alcohol
Screeing Test (MAST) are good resources.
23. Addiction potential of drugs
Neuroleptics are generally not thought to be addictive, nor are SSRIs, although
some research is beginning to point to SSRI addiction. Tricyclics, MAOs, barbiturates
and narcotics all have the potential for addiction. Ritalin is in the same drug class as
cocaine, so it also has potential for addiction.
Any drug can be psychologically addicting because the person becomes
dependent on the drug and fearful that they will not be able to function without it.
Physically addictive drugs demonstrate tolerance and withdrawal symptoms as described
later in the study guide.
24. Narcissistic Personality Disorder
A narcissist displays a pervasive pattern of grandiosity, need for admiration and a lack of
empathy, beginning by early adulthood. They are very demanding, think all of your time
should be spent on them and are constantly talking about their own accomplishments.
They have a great sense of entitlement; they think they deserve the best of everything.
We have probably all known someone like this in our lives. They seem pretty great at
first, then you begin to realize they only care about themselves. It is important to set
boundaries with these patients or they will monopolize your time.
Signs/symptoms:
 Grandiose sense of self-importance
 Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal
love.
 Believe they are special and unique and can only be understood by, or should
associate with, other special or higher-status people.
 A sense of entitlement with unreasonable expectations of especially favorable
treatment.
 Takes advantage of others to achieve his or her own needs.
 Lacks empathy, is unwilling to recognize or identify with the feelings and needs
of others.
 Often envious of others.
 Displays arrogant or haughty behavior with others.
25. Statistics on schizophrenia, prevalence, % recovering, age of onset
Onset is usually in the mid 20’s and it is thought that there is a strong degree of genetic
basis. First-degree biological relatives are 10x more likely to develop it. After a person
has been diagnosed with schizophrenia the chance for a sibling to be diagnosed is 7-9%.
If a parent has it, their children have a 10-15% chance of getting it. There is a 48%
increased risk in identical twins. Prevalence estimates range from 0.81%-1.3% of the US
population, or 2-2.2 million adults. Schizophrenia sufferers have a high risk of suicide at
10%. Teens with schizophrenia have a 50% risk of suicide attempts. Females have a
better prognosis than males and they have a later onset. Each year approximately 1/4000
people will be diagnosed with schizophrenia.
I couldn’t find any information in any of the notes about % recovering, but I found this
online from http://www.schizophrenia.com/szfacts.htm:

After 10 years, of the people diagnosed with schizophrenia:
o 25% Completely Recover
o 25% Much Improved, relatively independent
o 25% Improved, but require extensive support network
o 15% Hospitalized, unimproved
o 10% Dead (Mostly Suicide)
After 30 years, of the people diagnosed with schizophrenia:
o
o
o
o
o
25% Completely Recover
35% Much Improved, relatively independent
15% Improved, but require extensive support network
10% Hospitalized, unimproved
15% Dead (Mostly Suicide)
Bonus Material for the truly geeky:

Where are the People with Schizophrenia?
Approximately:
o
o
o
o
o
o
o
6% are homeless or live in shelters
6% live in jails or prisons
5% to 6% live in Hospitals
10% live in Nursing homes
25% live with a family member
28% are living independently
20% live in Supervised Housing (group homes, etc.)
26. Social Phobia symptoms
Social phobia is an intense, irrational and persistent fear of being scrutinized or
negatively evaluated by others. It is considered by some to be underrecognized.
Symptoms:
 Marked or persistent fear of one or more social or performance situations.
 Exposure to feared situation invokes anxiety or panic attacks.
 Person recognizes fear is excessive.
 Feared situation avoided or endured.
 Avoidance or distress interferes significantly with person’s normal routine.
 Fear or avoidance is not due to substance abuse, general medical condition or
other mental disorder.
 If medical condition is present the fear is unrelated to the medical symptoms.
Common fears are: meeting or talking with strangers, being watched while doing
something, using public restrooms, public speaking, interacting with important people
and test taking. These people will avoid certain careers or fail classes to avoid the social
embarrassment. Very shy in childhood or adolescence. Hypersensitive to criticism, low
self-esteem and bad in social situations. Caffeine greatly augments the anxiety.
27. Atypical antipsychotics
The atypical neuroleptics (antipsychotics), also known as the “newer” drugs, all date
from the introduction of Clozaril. These drugs may target specific dopamine receptors
and/or may block or inhibit re-uptake of seratonin. The most dramatic difference
between the typical and atypical drugs the atypicals ability to address negative symptoms
of schizophrenia and cognitive disturbances. There is also thought to be a lower risk of
tardive dyskinesia as a side-effect, as well as lower side-effects in general. They also
have a more stabilizing mood effect and may be used for bi-polar disorder. These drugs
are only available in tablet form and no generic forms are available yet. Atypicals
currently available in the US are Clozaril (Clozapine), Risperdal (Risperidone) and
Zyprexa (aka Lanzac) (Olanzapine).
28. Potential for violence
I asked her about this one and she said what she wants to know is which mental disorders
have a higher or lower potential for violence. I had to hunt through all the notes for this
and it doesn’t always say, so I might have missed something. Also, the following
categories are simply made up by me. Take it or leave it.
Higher potential for violence:
 Conduct disorder
 oppositional defiant disorder
 substance abuse
Medium potential for violence:
 Possibly other pervasive developmental disorders, although with things like
autism or asperger’s the potential for violence might exist but they do not usually
have an intention of harm. They might hit you if you are stressing them out, but
they are not hostile like conduct disorder and ODD.
 Personality disorders, especially Cluster B. They are not necessarily hostile like
CD and ODD, but they have low impulse-control and aren’t exactly playing with
a full deck.
Lower potential for violence:
 Schizophrenia. They may act crazy, but not likely to hurt you.
 Anxiety disorders. This is a mixed bag. Some of them might belong in the
medium or even high potential group, but usual it is co-morbid with other things.
In general, these people are to afraid and anxious to hurt other people. Unless you
try to make the social phobic give a speech. They might punch you just so they
can run away. Also, PTSD sufferers often become alcoholic and violent without
treatment.
29. Addiction cycle, tolerance withdrawal etc.
OK, so I don’t have any notes on the addiction cycle from her, but I did find a
wonderfully cheesy website that talks about the cycle of addiction. I’ll spare you the
pictures, but here is the text from
http://www.friendsofnarconon.org/drug_rehab/drug_addiction/how_it_happens/the_cycle
_of_addiction/:
(Is anyone else tired of learning about addiction and alcoholism? I mean, DARE was
great and all in 6th grade, but it’s getting a little old now. Yes, I know it is a real serious
problem and I’m not trying to make light of that; I’m just saying that at least I have been
taught about addiction umpteen-billion times and we all know where to find information
if we need it, so can we please stop being tested on it?)
The first thing you must understand about addiction is that mind-altering drugs are
basically painkillers. For drugs to be attractive to a person, there must first be some
underlying unhappiness, sense of hopelessness, or physical pain.
Drug addiction follows a cycle like this:
A person has some problem, sense of unhappiness or hopelessness, or physical
discomfort. It could be a teenager experiencing his first romantic rejection, or a
grandmother with arthritis, or it could be a man in his prime, wondering why he keeps
failing on the job. Or it could be someone at any age in between.
This person drinks or tries drugs. The alcohol or drugs APPEAR to solve his problem.
He feels better. Because he now SEEMS better able to deal with life, the drugs become
valuable to him.
The person gradually increases his usage of his drug of choice. He is then trapped.
Whatever problem he was initially trying to solve by using drugs or alcohol fades from
memory. At this point, all he can think about is getting and using drugs. He loses the
ability to control his usage and disregards the horrible consequences of his addiction.
The addict will now attempt to withhold the fact of his drug use from friends and family
members. He will begin to suffer the effects of his own dishonesty and guilt. He may
become withdrawn and difficult to reason with. He may behave strangely.
The more he drinks and uses drugs, the more guilty he will feel, and the more depressed
he will become. He will sacrifice his personal integrity, possibly lying and stealing to
finance his drinking or drug habit. His relationships with friends and family and his job
performance will go drastically downhill.
Addiction and Tolerance
The drugs and alcohol are now the most important thing in his life. He has thrown away
his job, his life-savings, his dreams and ambitions, all in an effort to maintain the
painkilling and emotion killing effects he once obtained from the drugs. But ironically,
his ability to get "high" from the alcohol or drugs gradually decreases as his body adapts
to the presence of foreign chemicals. He must take more and more, and he now has to
have them to be able to function at all.
Adam has some nice notes on presentation of alcoholism and substance dependence.
PRESENTATION OF ALCOHOLISM:
1.
2.
Social drinkers: one in every 16 drinkers will become alcoholic.
Warning signs: drinking more frequently; drinks for confidence or to tolerate or
escape problems. No party or occasion is complete without a couple of drinks.
SUBSTANCE DEPENDENCE:
A maladaptive pattern of substance abuse, leading to clinically significant impairment or
distress as manifested by 3 or more of the following, occurring at any time in the same 12
month period:
1.
2.
3.
4.
5.
6.
7.
Tolerance: either a need to increase amounts to achieve intoxication, or
diminished effect with continued use of the same amount.
Withdrawal: either a characteristic withdrawal syndrome for the substance, or the
substance (or something close) is taken to relieve withdrawal.
The substance is often taken in larger amounts or over a longer period than was
intended.
There is a persistent desire or unsuccessful effort to cut down or control the
substance.
A great deal of time is spent in activities necessary to obtain the substance.
Important social, occupational, or recreational activities are given up or reduced
because of a substance.
Substance use is continued despite knowledge of having a persistent physical or
psychological problem.
30. Symptoms of cannabis and cocaine and alcohol dependence
See “Substance Dependence” above. You might want to find more specific information
about these, but I don’t have it in the notes except for marijuana. She spoke a while
about marijuana and listed these symptoms:
 Anxiety and paranoid thoughts, impaired driving.
 Cardiac problems, lung problems (3-5x the tar and CO than in cigarettes)
 Regular use makes it harder to learn and retain information
 Decreases hormone and sperm count
 Motivation and initiative lowered
 Tolerance builds up fast
 Gateway drug
31. Avoidant Personality Disorder and Schizoid Personality Disorder
Avoidant Personality Disorder is from cluster C of the personality disorders (anxious and
fearful). It has a pervasive pattern of social inhibition, feelings of inadequacy, and
hypersensitivity to negative evaluation. Indicated by four or more of the following:
1.
2.
3.
4.
5.
6.
7.
Avoids occupational activities that involve significant interpersonal contact,
because of fears of criticism, disapproval, or rejection.
Is unwilling to get involved with people unless of they are certain of being
liked.
Shows restraint within intimate relationships because of fear of being shamed
or ridiculed.
Is preoccupied with being criticized or rejected in social situations.
Is inhibited in new interpersonal situations because of feelings of inadequacy.
Views self as socially inept, personally unappealing, or inferior to others.
Is unusually reluctant to take personal risks.
Schizoid Personality Disorder is from Cluster A (odd and eccentric) of the personality
disorders. It is a pervasive pattern of detachment from social relationships and a
restricted range of expression of emotions in interpersonal settings. Indicated by at least
four of the following:
1.
2.
3.
4.
5.
6.
7.
Neither desires nor enjoys close relationships.
Almost always chooses solitary activities. (George McFly)
Has little interest in sexual experiences with another person.
Takes pleasure in few activities.
Lacks close friends or confidants.
Appears indifferent to praise or criticism of others.
Shows emotional coldness, detachment or flat affect.
32. OCD vs. Obsessive Compulsive Personality Disorder
Once again, I couldn’t find the info in the library packet. I’m starting to think that some
of it might be missing, because there is no criteria or anything for this. I’ve got a bit from
my notes and some from the internet.
Definition of OCD from http://www.nimh.nih.gov/healthinformation/ocdmenu.cfm:
Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by
recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions).
Repetitive behaviors such as handwashing, counting, checking, or cleaning are often
performed with the hope of preventing obsessive thoughts or making them go away.
Performing these so-called "rituals," however, provides only temporary relief, and not
performing them markedly increases anxiety.
Symptoms:
People with OCD may be plagued by persistent, unwelcome thoughts or images, or by
the urgent need to engage in certain rituals. They may be obsessed with germs or dirt, and
wash their hands over and over. They may be filled with doubt and feel the need to check
things repeatedly.
The difference between this and obsessive-compulsive personality disorder (OCPD) is
that in OCPD it is more of a long-term personality style that is the problem. OCPD
people do not know that they have a problem. They are the perfectionistic, judgmental
type. OCD sufferers, on the other hand, know just how weird they are. They often try to
hide their behaviors from others because they are ashamed of them. They feel very
anxious and have a lot of fear and anxiety about their rituals. They know they shouldn’t
be doing the rituals, but feel compelled to do so anyway. Cognitive behavioral therapy
and teaching greater self-efficacy work great with treating OCD.
OCPD:
Pervasive pattern of preoccupation with orderliness, perfectionism and mental and
interpersonal control, at the expense of flexibility, openness and efficiency.
Indicated by at least 4 of the following:
1. Is preoccupied with details, rules, lists, order, organization or
schedules.
2. shows perfectionism that interferes with task completion
3. excessively devoted to work and productivity to the exclusion of
leisure activities and friendships
4. over conscientious, scrupulous and inflexible about morality,
ethics or values
5. unable to discard worn-out or worthless objects even when they
have no sentimental value.
6. reluctant to delegate tasks or to work with others unless they
submit exactly to his/her way of doing things.
7. adopt a miserly spending style.
8. rigid and stubborn
33. How to diagnose ADHD
 Present before age 7 and in 2 or more settings
 The prefrontal cortex does not develop as fully
 Inattention
 Hyperactivity: fidgets with hands and feet, leaves seat in class, runs around and
climbs on things in inappropriate situations, difficulty engaging in quiet activities,
always on the go, talks excessively
 Impulsivity: often blurts our answers, has difficulty waiting their turn, interrupts
others
 Stress and nicotine (in the mother) has been linked
 Research does not support the link with refined sugars and head trauma
 Medication use is controversial
34. Criteria for Oppositional Defiant Disorder
This is a type of pervasive developmental disorder, along with conduct disorders, autism,
ADHD, Asperger’s, Rett’s and Childhood Disintegrative.
Criteria:
A. Pattern of negativistic, hostile, and defiant behavior lasting at least 6 months during
which 4 or more of the following are present:
9. often loses temper
10. often argues with adults
11. often actively defies or refuses or comply with adult requests
12. often deliberately annoys people
13. often blames others for his or her misbehavior
14. is often touchy or easily annoyed by others
15. is often angry and resentful
16. is often spiteful or vindictive
B. The disturbance in behavior causes clinically significant impairment in social,
academic or occupational functioning.
35. Primary Insomnia criteria
Person can’t sleep, and when they do it is not for long and is not restful. Criteria:
 Difficulty initiating or maintaining sleep, must be > 1 month
 Sleep causes distress, is non-restorative
 History of light sleeping
 Lots of verbalized distress about sleep
o Afraid it will happen again, they become obsessed with not sleeping.
These people have very high levels of muscle tension. Their own evaluation about their
sleep is worse than data suggests. They usually have poor sleep habits (go to bed late and
not at any regular time, etc). It may last for over a year. ¼ of elderly suffer from
insomnia.
36. Neuroleptic malignant syndrome
Basically, you’re screwed up in the head so you take some antipsychotic drugs.
Unfortunately, the drugs screw you up even more and you almost die. Dang.
from http://www.emedicine.com/emerg/topic339.htm:
*I would learn the first paragraph for the test. If you want to know more, I copied a lot
from the website, but let’s be serious here, do you really want to read it?*
Background: The neuroleptic malignant syndrome (NMS) is a rare, but life-threatening,
idiosyncratic reaction to a neuroleptic medication. The syndrome is characterized by
fever, muscular rigidity, altered mental status, and autonomic dysfunction.
Although potent neuroleptics (eg, haloperidol, fluphenazine) are more frequently
associated with NMS, all antipsychotic agents, typical or atypical, may precipitate the
syndrome. For example, these agents have been associated with NMS: prochlorperazine
(Compazine), promethazine (Phenergan), clozapine (Clozaril), and risperidone
(Risperdal). NMS has also been associated with non-neuroleptic agents that block central
dopamine pathways, eg, metoclopramide (Reglan), amoxapine (Ascendin), and lithium.
Pathophysiology: All medications implicated in NMS have dopamine D2-receptor
antagonist properties. NMS has also been noted following withdrawal of anti-Parkinson
medication. The clinical syndrome is thought to be secondary to decreased dopamine
activity in the central nervous system (CNS), either from blockade of dopamine D2receptors or decreased availability of dopamine itself, and shares similarities with
malignant hyperthermia and the serotonin syndrome. Blockade of dopamine
neurotransmission in the nigrostriatum and hypothalamus results in muscular rigidity and
altered thermoregulation, respectively. There is evidence that sympathetic nervous
system activation or dysfunction may play a significant role in the pathogenesis of NMS.
Frequency:

In the US: Incidence is uncommon, with rates ranging from 0.02-12.2% of
patients treated with a neuroleptic medication. Prospective studies and pooled
data from the literature report an incidence of 0.07-0.2%. Because of increased
awareness of this syndrome and efforts at prevention, the incidence is probably
less now than in the past.
Mortality/Morbidity:

The incidence of mortality, once reported at 20-30% is now estimated at 5-11.6%.
Death usually results from respiratory failure, cardiovascular collapse,
myoglobinuric renal failure, arrhythmias, or diffuse intravascular coagulation
(DIC).

Morbidity from NMS includes rhabdomyolysis, pneumonia, renal failure,
seizures, arrhythmias, DIC, and respiratory failure.
Sex: NMS has been reported to be more common in males most likely because of
increased use of neuroleptics in males. Male-to-female ratio is 2:1.
Age: No age predilection for NMS exists. NMS may occur in patients of any age who are
receiving neuroleptics or other precipitating medications.
History:

Neuroleptic malignant syndrome (NMS) is more likely to develop following
initiation of neuroleptic therapy or an increase in the dose.

The onset can be within hours, but on average, it is 4-14 days after initiation of
therapy. However, NMS can occur at any time during neuroleptic use, even years
after initiating therapy.

Of those patients who develop NMS, 90% of them will do so within 10 days.

NMS is a heterogenous syndrome that spans a broad severity continuum. The
diagnosis is made on clinical grounds based on the presence of certain historical,
physical, and laboratory findings. The diagnosis is confirmed, but not necessarily
excluded, by the presence of the following 5 criteria:
o
Recent treatment with neuroleptics within past 1-4 weeks
o
Hyperthermia (above 38°C)
o
Muscular rigidity
o
At least 5 of the following:
 Change in mental status
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Tachycardia
Hypertension or hypotension
Diaphoresis or sialorrhea
Tremor
Incontinence
Increased creatinine phosphokinase (CPK) or urinary myoglobin
Leukocytosis
Metabolic acidosis
Exclusion of other drug-induced, systemic, or neuropsychiatric
illness
Clinical signs
o
Hyperthermia
o
Profuse diaphoresis
o
Generalized rigidity (lead pipe)
o
Mental status changes
o
Autonomic instability
Physical:

Hyperthermia

Diaphoresis

Generalized muscular rigidity (lead pipe)

Tachycardia

Hypertension or hypotension

Tremor

Incontinence

Altered mental status

Tachypnea
Causes:
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All classes of neuroleptics (dopamine D2-receptor antagonists) are associated
with NMS, and dopamine receptor blockade is considered the cause of NMS.
o
Experimental blockade of dopamine in the striatum can cause rigidity,
tremor, and rhabdomyolysis.
o
Blockade of dopamine in the hypothalamus can cause impaired
temperature regulation and hyperthermia.
o
This theory does not explain why only some patients develop NMS. It also
does not explain why patients rechallenged with neuroleptics do not
always redevelop NMS.
Risk factors for developing NMS include the following:
o
Increased ambient temperature
o
Dehydration
o
Patient agitation or catatonia
o
Rapid initiation or dose escalation of neuroleptic
o
Withdrawal of anti-Parkinson medication
o
Use of high-potency agents and depot intramuscular preparations
o
History of organic brain syndrome or affective disorder
o
History of NMS
o
Concomitant use of predisposing drugs (eg, lithium, anticholinergic
agents)
37. Psychological aspects of persistent pain
Factors that increase pain, psychological distress and disability are: pain catastrophizing,
pn related anxiety and fear, feeling of helplessness.
Factors that decrease pain, psychological distress and disability are: increased selfefficacy, pn coping strategies, readiness to change, and acceptance.
38. Symptoms of Somatization Disorder
This is a type of Somatoform Disorder. Somatoform disorders are similar to anxiety
disorders. The person does not realize that their concerns are excessive or unreasonable.
Reassurance of normal functioning from others, including physicians, is not helpful. The
distinguishing characteristic of somatization disorder is a group or pattern of symptoms in
several different organ systems that cannot be accounted for by medical illness. In order
to understand the symptoms, you probably will need the criteria too.
Criteria:
A. History of many physical complaints beginning before age 30 that occur over a period
of several years and result in treatment sought.
B. Significant impairment in social, occupational or other important areas of functioning:
C. Each of the following criteria must have been met, with individual symptoms
occurring at any time during the course of the disturbance:
a. Four pain symptoms: Hx of pn related to at least 4 different sites
or functions (such as head, abdomen, back, joints, extremities,
chest, rectum, during sex, urination or menstruation).
b. Two GI symptoms: Hx of at least two GI symptoms other than
pn (such as nausea, diarrhea, bloating, vomiting or intolerance to
several foods).
c. One sexual symptom: Hx of at least one sexual or reproductive
symptom other than pn (such as sexual indifference, erectile or
ejaculatory dysfunction, irregular menses, excessive menstrual
bleeding, vomiting throughout pregnancy).
d. One pseudoneurologic symptom: Hx of at least one symptom or
deficit suggesting a neurological disorder not limited to pain
(conversion symptoms such as blindness, double vision, deafness,
loss of touch or pain sensation, hallucinations, aphonia, impaired
coordination or balance, paralysis or localized weakness, difficulty
swallowing, difficulty breathing, urinary retention, seizures;
dissociative symptoms such as amnesia; or loss of consciousness
other than fainting).
Remember, in order to have somatization disorder the person needs to have met all of the
above symptom criteria.