Quiz 12 Ch14-15

"I'm no fool, no sirree! I'm gonna live to be 103..." sang the Disney character Jiminy Cricket decades ago. If Jiminy Cricket had been a human (most crickets live only a few weeks), what's the BEST advice you could have given him to live a very long life?

"Accept life's challenges with optimism, have good health habits, and inherit 'longevity' genes."

Which of the following is MOST likely to be said by an elderly person regarding long-term care?

"I'm worried about how my life will change."

Delirium

+ "clouding of consciousness" Difficulties orienting to time and place Develops over short period of time (hours, days) Might occur in ANY age group, but is more prevalent in the elderly Diseases & medication can cause it (Important differential diagnosis in medical settings)

Gender Differences in Conduct Disorder

+ Boys 3x as likely to be diagnosed as girls + Boys with CD more aggressive than girls with CD + Girls' antisocial behavior manifested differently? Relational aggression? (often verbal, indirect, involves character defamation)

Discuss treatments for neurocognitive disorders

- Drug treatment - Cognitive techniques - Behavioral interventions - Support for caregivers - Sociocultural factors: day care facilities

Delirium

- difficulty concentrating, focusing attention, thinking in ordered way - happen in few hours/days Caused by: - fever - poor nutrition - head injuries - stroke

Characteristics of AD behavior problems?

-Behavior is unpredictable. -Can be challenging for caregiver -Behaviors are not intentional and are difficult to control. -Often lead to placement in institutional settings

Behavior of patient with AD?

-Recent events and new information cannot be recalled. -Behavioral manifestations are not intentional or controllable because of ongoing loss of neurons. -Some develop psychotic manifestations. *Behavioral manifestations of AD (e.g., agitation, aggression) result from changes that take place within the brain. They are neither intentional nor controllable by the individual with the disease.

Externalizing disorder examples

1. ADHD 2. Conduct disorder 3. Oppositional Defiant Disorder 4. Substance use

Pharmacology for CD/ODD

1. Antidepressants (SSRIs) 2. Neuroleptics 3. Stimulants 4. Mood Stabilizers Mixed Results

Cognitive disorder examples

1. Learning disorders 2. Motor skill disorders 3. Communication disorders 4. Mental retardation

Biological Perspective on CD/ODD

1. Brain circuitry 2. Neurotoxins 3. Low arousal to punishment and rewards (low cortisol in response to stress) 4. High serotonin (linked to violent crimes) 5. High testosterone 6. Genetics/family history

Aggression Symptoms

1. Bullies, threatens, intimidates other people 2. Often initiates physical fights 3. Uses weapons that can cause serious harm 4. Has stolen while confronting a victim 5. Physically cruel to people/animals 6. Forced someone into sexual activity

Two main types of disorders

1. Those common across age groups (anxiety, depression, etc.) - have different manifestations in the elderly 2. Disorders of cognition (delirium, dementia, Amnestic disorders)

Other examples

1. Tic disorders 2. Feeding disorders 3. Elimination disorders

Day center

A program that offers hospital-like treatment during the day only

Caregivers SUPPORT in AD?

AD disrupts all aspects of personal and family life. Very stressful Caregivers also exhibit adverse consequences. Work with caregiver to -Assess stressors -Identify coping strategies -Find a support group -Local Alzheimer Association chapter

Your daughter is MORE likely than your son to be diagnosed with:

separation anxiety

Of the following parents, the ones LEAST likely to have children who receive effective treatment for ADHD are:

African Americans who are Medicaid-insured

Late onset (sporadic)

After age 65 Combination of genes and environment Gene apolipropotein E (ApoE) produces protein that carries fat into bloodstream 30% population have variation ApoE-4 might suggest vulnerability

Behavioral- Systematic Desensitization (type of exposure therapy). Patient creates a hierarchy

After confessing to your therapist that you are horribly afraid of bees, he works with you to construct a hierarchy of stimuli that are increasingly fearful to you. Lowest in the hierarchy is reading the word buzz and the highest on the list is seeing a bee flying close to your face. Once the hierarchy is completed, he teaches how to feel relaxed to these stimuli, starting first with the stimuli to which you are least afraid.

Cognitive- Rational-Emotive Behavior Therapy

After seeking help for feelings of anxiety and depression, your therapist counsels you that it is impossible for you to be loved and cared for by all people who are significant at your job and in your community. She further urges you to abandon the irrational approach you take to interpreting the events that occur in your life.

What disorder is unique to childhood?

separation anxiety disorder

Alzheimer's Dementia

Alzheimer's accounts for 50-70% dementia cases 5.1 million Americans Risk increases over 40% after age 84

The MOST feared psychological problem among the elderly is:

Alzheimer's disease

The MOST frequent cause of irreversible dementia in the elderly is:

Alzheimer's disease

The most feared psychological problem among the elderly is:

Alzheimers

Obsessive-Compulsive Disorder (OCD) (anxiety disorders)

An anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions).

Phobias (Specific) (anxiety disorders)

Are anxiety disorders in which an irrational fear causes the person to avoid some object, activity, or situation.

As a nurse how do we handle behavioral problems in AD patient?

Assess patient's -Physical status -Environment -Reassure patient about his or her safety. **When these behaviors become problematic, you must plan interventions carefully.

Major (clinical) depression

Becky's psychiatrist has prescribed as selective serotonin reuptake inhibitor (SSRI) to help Becky feel better. Becky has most likely been diagnosed with what disorder?

Early onset (familial)

Before age 65 Fewer than 5% cases Mutations in genes that produce beta-amyloid precursor protein (beta-APP), presenlin 1, presenlin 2

How is AD categorized? Progression?

Categorized similarly to those for dementia -Mild -Moderate -Late Progression is variable from person to person and ranges from 3 to 20 years.

How are Cholinesterase inhibitors used?

Cholinesterase inhibitors -Used to treat mild and moderate dementia -Block cholinesterase, enzyme responsible for breaking down acetylcholine -Improve or stabilize cognitive decline but do not cure or reverse

Nuerocognitive disorder

Decline in cognitive functioning, language, memory loss, planning, decision making, personality changes More severe than delirium

A clouding of consciousness that develops over a short period of time and can often be reversed if its underlying cause can be found is called:

Delirium

LBD con't..extrapyamidal signs include?

Dementia plus two of the following indicates a possible diagnosis: -Extrapyramidal signs such as bradykinesia, rigidity, and postural instability, but not always a tremor Fluctuating cognitive ability Hallucinations **This disease has features of both AD and Parkinson's disease, and it is imperative that a correct diagnosis be reached.

nations that pioneered "normalization" in the treatment of mental retardation include

Denmark and Sweden

Of the following alternatives, the one least likely to contribute to inequities between African Americans and white Americans in receiving long-acting stimulant drug treatment for ADHD is:

Differences in drug tolerance

The LEAST likely contributor to the differences between African Americans and white Americans in receiving long acting stimulant drug treatment for ADHD is?

Differences in drug tolerance

Paula has moderate intellectual developmental disorder, a small head and flat face, as well as a protruding tongue. Her condition is MOST likely:

Down syndrome

A reading proficiency level that is much lower than would be expected based on the measure of general intelligence is called

Dyslexia

Earliest Symptoms of Creutzfeldt-Jakob disease (CJD)

Earliest symptoms -Memory impairment -Behavior changes

Controversies around ADHD

Epidemic? Overdiagnosis or underdiagnosis? Adult ADHD? Childhood ADHD actually bipolar disorder?

Hypochondriasis (Illness anxiety disorder) (somatoform disorders)

Excessive anxiety and concern with having or getting a serious medical condition.

Diagnostic Label: Dissociative Fugue Recommended Treatment(s): Free-association

George T., a 35-year-old auto mechanic, on several occasions found himself in a motion picture theater after having left home to report for work. He would "come to" in a bewildered fashion and would go to a bar for a few drinks. Eventually he would go home. As a child, George had a pattern of wandering away from home. He came from a very unhappy family; his parents were divorced, and he was left at home with housekeepers. His father was very harsh with him and on several occasions gave him such severe whippings that the neighbors called the police. His mother was a highly emotional person and tried to discipline George by screaming at him and threatening to place him in a boarding home. In adolescence, he twice found himself going off to school and eventually, "coming to" in a park about two miles from home. In school, George got along well with the teachers and other students. He was a poor student and failed both the second and seventh grade. He quit school at 16. Diagnostic Label: Recommended Treatment(s):

Dissociative Amnesia (dissociative disorders)

Inability to recall important personal information, usually of a traumatic or stressful nature.

Can Vaccines Cause Autism Spectrum Disorders?

Initial study showing association with MMR vaccine and autism retracted by the Lancet in 2010

Interalizing Disorders - differences between kids and adults

Kids - more somatic/behavioral symptoms (less cognitive) Treatment - kids have play therapy and sessions with parents

Are we overmedicating children?

Long-term safety and effectiveness of drugs still to be fully determined At the same time, they do provide symptom reduction

Antisocial personality disorder

Luke is superficially charming and skilled at exploiting people for his own gain. He is also impulsive, irresponsible, and he generally disregards social norms. Luke would most likely be diagnosed with which psychological disorder?

Thoroughly evaluate patient history, what 3 areas specifically?

Medical Neurological Psychological

Costs of Alzheimer's

Medicare Costs (2000) Hospital: Alz $7000, Non $2000 Nursing Home: Alz $2000, Non $100 Home Health: Alz $1000, Non $100

What are Neurofibrillary tangles? main component?

Neurofibrillary tangles Abnormal collections of twisted protein threads inside nerve cells Main component is a protein called tau. -Tau proteins in the CNS are involved in providing support for intracellular structure through their support of microtubules. -Tau proteins hold the microtubules together, like railroad ties hold railroad tracks together. In AD, the tau protein is altered, and as a result, the microtubules twist together in a helical fashion.

Collaberation management of AD aimed at?

No cure Collaborative management aimed at -Improving or controlling decline in cognition -Controlling undesirable behavioral manifestations -Providing care for the caregiver

Aging Population in the US

Number of people aged 65+ has increased 11-fold since the beginning of the 20th century 4% increase in 1900 13% increase in 20100 Expected 20% in 2030

Are an AD's patient's way of responding to precipitating factor?

Pain Frustration Temperature extremes Anxiety

Parent Management Training (PMT)

Parent Management Training (PMT) Parents learn to identify, define, and observe problem behaviors from a behavioral perspective Taught to use positive reinforcement, prompting, shaping, mild punishment, negotiation, and contingency contracting Techniques modeled by therapist and practiced by parent in session

Child Maltreatment Interacts with Genes

Percentage with Low MAOA activity and SEVERE maltreatment - 80% CD (with high MAOA activity - only 40%)

Which of the following diseases involving degeneration of the frontal and temporal lobes?

Pick's disease

A child whose therapist asks her to draw pictures about her life, then introduces games and stories to help the child work through her conflicts and change her emotions and behavior is MOST likely receiving:

Play therapy

This is a treatment approach that helps children express their conflicts and feelings indirectly by drawing, interacting with toys, and making up stories

Play therapy

Catatonia (schizophrenia)

Remain motionless for periods of hours at a time.

Cholinesterase inhibitors include

donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). Rivastigmine is available as a patch.

Predisposed risks of dementia

Smoking Cardiac dysrhythmias Hypertension Hypercholesterolemia Diabetes mellitus Coronary artery disease Metabolic syndrome

Alzheimer's disease

The most common type of neurocognitive disorder, usually occurring after the age of 65, marked most prominently by memory impairment onset death: 8-10 years cause of death is normally: - pneumonia - stroke

Conversion Disorder (somatoform disorders)

Typically results from extreme stress or anxiety. Individual will "convert" psychological stress into a physical ailment.

Trouble swallowing can lead to?

Undernutrition problem in middle and late stages Loss of interest in food Decreased ability to self-feed Co-morbid conditions -In long-term care facilities, inadequate assistance with feeding may add to the problem.

Describe Vascular dementia

Vascular dementia Loss of cognitive function due to brain lesions caused by cardiovascular disease Ischemic lesions Ischemic-hypoxic lesions Hemorrhagic brain lesions

Mania (manic episode) (mood disorders)

When an individual goes hyper crazy and happy. This can lead to poor decision making and has a lot to do with one's impulse

Where do the plaques develop?

Where plaques develop in the parts of the brain used for Memory & Cognitive function which occur in the Hippocampus -Eventually develops in the cerebral cortex esp areas responsible for language and reasoning

treatment foster care

a sociocultural approach to help children with conduct disorder; children are assigned to a foster home in the community and, while there, children, foster parents, and birth parents receive training and treatment

echolalia

a speech abnormality common in autism spectrum disorder; the individual repetitively echos (repeats) exact phrases spoken by others, but with no sign of understanding or intent of communicating

Among the likely causes of ADHD are all of the following EXCEPT:

abnormal serotonin activity and parietal damage

rubella

also known as the "German measles," if a mother experiences this viral infection during pregnancy it may lead to childhood problems and intellectual disability in her unborn child

cerebellum

an area of the brain that coordinates movement in the body and perhaps helps control a person's ability to shift attention rapidly

treatment foster care

approach to treat conduct disorder in which delinquent boys and girls are assigned a foster home in community. Foster parents, birth parents, and children all receive training and treatment interventions including family therapy, individual therapy for child, and meetings.

parent management training

approach to treat conduct disorder in which parents are again taught more effective ways to deal with their children and parents and children meet together in behavior-oriented family therapy. Use of written manuals, therapy rehearsals and practice, homework. Learn to reward proper behaviors consistently.

MOST children with intellectual developmental disorder live:

at home

The mockingbird gets its name from the fact that it often imitates the call of other birds, without conveying any particular message. A child who imitates others' speech without any sign of understanding it, MOST likely would be diagnosed with:

autism spectrum disorder

One of the MOST frequent reasons for the institutionalization of Alzheimer's patients is:

because home caregivers are overwhelmed

The two MOST common treatments for attention-deficit / hyperactivity disorder have been:

behavioral and drug therapies

A particular concern among children and adolescents would be:

bullying

A person who has an excess of plaques due to Alzheimer's would be likely to have:

cell breakdown and death

juvenile delinquents

children 8-18 that break the law

recidivists

children with a history of being arrested

Critics believe that bipolar disorder has become a catch-all diagnosis for children who display uncontrollable rage. DSM-5 addressed this concern by:

creating a new disorder called disruptive mood dysregulation

Which of the following is an example of a sociocultural approach to treating Alzheimer's?

day-care facilities

With Alzheimer's, physical health usually:

declines less rapidly than mental health

As people age, the incidence of alcohol abuse and other forms of substance abuse:

decreases

A 16-year-old teenager has just been arrested for the third time for shoplifting. He would MOST likely be labeled with:

juvenile delinquency

Which one of the following people would MOST correctly be diagnosed with intellectual developmental disorder?

one with an IQ of 69 having problems coping with life

Diagnosis for Alztheimer's is confirmed...

post-mortem (shrunken brain, more holes) massive cell loss

An elderly individual has just been diagnosed with depression. In the future, that individual would be expected to:

recover more slowly than average for both injuries and illnesses

If one knew nothing more than that the person with intellectual developmental disorder also had extensive and severe neurological dysfunction and physical handicaps, the MOST likely estimate of that person's level of mental retardation would be:

severe or profound

methylphenidate (Ritalin)

stimulant drug used to treat ADHD. Helps them focus, solve complex tasks, perform better at school, and control aggression. Undesired effects may include insomnia, stomachaches, headaches, loss of appetite.

Women who want to reduce their risk of developing Alzheimer's should:

take estrogen for years after menopause

You would suspect a problem in the ________ for someone experiencing difficulty with long-term memory

temporal lobes

mainstreaming

the placement of children with intellectual disability in regular school classes; also known as inclusion

normalization

the principle that institutions and community residences should provide people with intellectual disability types of living conditions and opportunities that are similar to those enjoyed by the rest of society

bullying

the repeated infliction of force, threats, or coercion in order to intimidate, hurt, or dominate another less powerful person

MMR vaccine

vaccine for measles, mumps, and rubella that might produce autistic symptoms in some children.

A person quite suddenly begins to show specific cognitive impairment and difficulty in speaking, yet other cognitive functions appear normal. MOST likely, that person is experiencing:

vascular neurocognitive disorder

An individual who demonstrates a severe anterograde amnesia may still demonstrate evidence of:

verbal skills

"Grandma is 65 years old, and there's no sign of neurocognitive disorder," says a friend of yours. Your MOST accurate reply is:

"That's wonderful --- about 1 to 2 percent of people that age do have signs of neurocognitive disorder."

Internalizing disorder examples

1. separation anxiety disorder 2. other anxiety disorders (phobia, panic, PTSD, OCD) 3. Mood disorders 4. Somatization 5. Eating disorders

Caregivers

10 million Americans care for people w/dementia Bathing, feeding, toileting, keeping them safe Estimated 16-25 hours/week Mental health toll on caregivers Day-care facilities Nursing homes

Of 100 typical elderly patients entering a hospital for a general medical condition, about how many would initially be diagnosed with delirium, and about how many more would develop delirium while in the hospital (in that order)?

10 percent, 10 percent

Mild cognitive impairment affects how many? what age?

10% to 20% of individuals >65 years old have MCI. 15% of those with MCI will develop dementia.

The percentage of the U.S. population aged 65 and older today is:

13 percent

Depression in the Elderly

20% people experience depression in old age + More common in women + Associated w/medical illnesses, loss of loved ones + Psychotic symptoms might be common Treatment: similar as for younger adults 1. Psychotherapy (esp. CBT) 2. Medications (but some cannot be used safe or effectively b/c they are metabolized differently) 3. ECT (electro-convulsive therapy)

What percentage of adults have mental disorders who also have a history of ODD/CD?

25-60%

ADHD Statistics

4-9% of schoolchildren 70% are boys 80% receive treatment Lessening of symptoms into adolescence Difficult to assess -- observations across contexts (parent, teacher, etc.)

The ratio of females to males over 65 years old is:

40 percent

Survey research shows that alcohol-related disorders affect about:

5 percent of the elderly, more often men

Dementia is due to treatable and non-treatable conditions, the two most common causes are?

Due to treatable and nontreatable conditions Two most common causes: 1.)Neurodegenerative conditions (AD) (60% to 80% of cases) 2.) Vascular disorders, also called multiinfarct dementia is a loss of cognitive function resulting from ischemic, ishemic hypoxic, or hemarrhagic brain lesions caused by CVD. Decreased blood supply to brain. VD can be caused by a single stroke (infarct) or by multiple strokes.

Dissociative Identity Disorder- amnesia

During an academic trip to China, a 29-year-old female was found in a hotel bathroom unconscious, with no signs of structural or neurologic abnormalities or alcohol or chemical consumption. The woman was sent home but could not remember her name, address, family, or any facts about her home life. She was taken to the local hospital where she remained for nearly 10 months, until the feeling of blood on the woman's fingers triggered the recollection of events from her time in China in which she finally remembered having witnessed a murder on the last night of her trip. She recalled being unable to help the victim out of fear for her own safety. Eventually, she came to remember other aspects of her life; however, some memories remain irretrievable.

Range of Functioning

Some individuals do poorly in tests of intelligence; others do very well Some individuals become independent adults; others do not

Geropsychology

The field of psychology concerned with the mental health of elderly people

A child is receiving problem-solving skills training as a treatment for conduct disorder. You can reasonably sure that:

The interventions used are cognitive-behavioral

neurodevelopmental disorders

a group of disabilities in the functioning of the brain that emerge at birth or during very early childhood and affect a person's behavior, memory, concentration, and/or ability to learn

fetal alcohol syndrome

a group of problems in a child, including lower intellectual functioning, low birth weight, and irregularities in the hands and face, that result from excessive alcohol intake by the mother during pregnancy

"Will that program really help? I keep hearing bad things about how kids act once they leave." Based on research, the person who said this would be MOST accurate if she or he were expressing reservations about:

a juvenile training center

profound ID

a level of intellectual disability (IQ below 20) at which people need a very structured environment with close supervision

severe ID

a level of intellectual disability (IQ between 20 and 34) at which people require careful supervision and can learn to perform basic work in structured and sheltered settings

moderate ID

a level of intellectual disability (IQ between 35 and 49) at which people can learn to care for themselves and can benefit from vocational training

mild ID

a level of intellectual disability (IQ between 50 and 70) at which people can benefit from education and support themselves as adults

phenylketonuria (PKU)

a metabolic disorder leading to intellectual disability (if untreated) caused by recessive genes; afflicted individuals are born normal but cannot break down the amino acid phenylalanine, resulting in eventual poisoning if not placed on a diet that avoids phenylalanine

The MOST common and successful treatments for encopresis are:

behavioral and medical treatments

LEAP (Learning Experiences: An Alternative Program)

behavioral program for preschoolers with autism. Combining autistic and nonautistic children in classroom and helping them integrate and learn social, communication, play, and other skills.

A child awakens suddenly to the sound of a bell, and heads for the bathroom. MOST likely the child is receiving:

behavioral therapy for enuresis

augmentative communication systems

a method for enhancing the communication skills of people with autism spectrum disorder, intellectual disability, or cerebral palsy by teaching them to point to pictures, symbols, letters, or words on a communication board or computer

state school

a state-supported institution for people with intellectual disability; a typical approach to care prior to the 1960s & 70s

methylphenidate

a stimulant drug, known better by the trade name Ritalin, commonly used to treat ADHD

According to one psychological view of autism, the awareness that other people base their behaviors on their own belief, and not on information they have no way of knowing, is NOT present in children with autism spectrum disorder. This inability is called:

a theory of mind

play therapy

a treatment approach that helps children express their conflicts and feelings indirectly by drawing, playing with toys, and making up stories

The fact that Alzheimer's disease resembles Creutzfeldt-Jakob disease suggests that Alzheimer's may be caused by:

a virus

Compared to younger people, those over 65 are:

about as likely to experience depression if not living in a nursing home, and more likely to experience depression if living in a nursing home

What is the BEST educational treatment for a child with a serious level of dysfunction on the autism spectrum?

being sent to a special school that combines treatment and education

An indvidual is extremely sad, can't sleep well, and experiences very low, and decreasing, self-esteem. These are features of depression among:

both the elderly and the young

Attention-deficit hyperactivity disorder is more common in ______ than ______.

boys; girls

The MOST recent research has provided evidence that the primary causes of autism spectrum disorder include:

brain abnormalities

A child has has received the diagnosis of developmental coordination disorder. You would expect that he would have a problem:

buttoning his shirt and dressing in general

special education

an approach to educating children with intellectual disability in which they are grouped together and given a separate, specially-designed education

theory of mind

an awareness that other people base their behaviors on their own beliefs, intention, and other mental states, not on information that they have no way of knowing. Failure to develop this may be a psychological cause of autism.

theory of mind

an awareness that other people base their behaviors on their own beliefs, intentions, and other mental states, not on information that they have no way of knowing

parent management training

an family intervention to treating behavior disorders among school-age children wherein 1.) parents are taught more effective ways to deal with their children and 2.) parents and children meet together in behavior-oriented family therapy

The specific symptoms associated with dyslexia include:

an impairment of the ability to recognize words and to comprehend what is being read

parent-child interaction therapy

approach used with preschoolers in which therapists teach parents to work with child positively, set appropriate limits, act consistently, be fair in discipline, teach child better social skills. Also can be done in video modeling, which is same thing but with video tools.

echolalia

exact echoing of phrases spoken by others. Exhibited by those with autism spectrum disorder. May be delayed - which means it is repeated days after phrase has been heard.

You read a case study about a ten-year-old girl from a poor background who was sexually abused. This case is:

fairly common; girls, regardless of their socioeconomic group, are the most common victims of sexual abuse

neurodevelopmental disorders

group of disabilities including ADHD, autism spectrum disorder, and intellectual disability. Problem in functioning of the brain that emerge during birth or during very early childhood and affect a person's behavior, memory, concentration, and/or ability to learn.

Research has shown that, during infancy and early childhood, autistic children are MORE likely to:

have parents who divorce than are "normal" children be raised in a family with financial difficulties have cold, rejecting parents None of the answers are true

Individuals with Down syndrome:

have the same range of personality characteristics as do those in the general population without Down syndrome

To date, research shows that anxiety among the elderly is related to:

health

juvenile training centers

institutional treatment centers for juvenile delinquents

juvenile training centers

institutionalization of children. Frequently serve to strengthen delinquent behavior rather than resocialize the young offenders.

Most colleges and universities now require students to have a meningitis vaccination before enrolling. Untreated meningitis can lead to:

intellectual development disorder

If your child is diagnosed with a conduct disorder, you could be confident in providing all of the following treatments EXCEPT:

juvenile training centers

Sources of discrimination in the mental health care of the elderly include:

language barriers that interfere with medical and mental health care

In poor inner-city neighborhoods, children sometimes eat paint that is flaking off walls. This can sometimes lead to intellectual developmental disorder due of:

lead poisoning

juvenile delinquent

legal term for a child between the ages of 8 and 18 who breaks the law

Compared to white American children, African American and Hispanic American children with similar levels of activity and attention problems are:

less likely to be assessed for ADHD, and less likely to be diagnosed with ADHD

Studies of the one use of cognitive-behavioral techniques in the treatment of autism spectrum disorder have shown that cognitive-behavioral techniques can produce:

long-term gains in school achievement and intelligence test performance

Mild mental retardation is MOST common in which socioeconomic class?

lower

About 17 percent of individuals with Alzheimer's disease also experience:

major depressive disorder

An individual with Alzheimer's disease is no longer able to function independently. The MOST appropriate diagnosis for this person's condition is:

major neurocognitive disorder

Most effective treatment for ADHD

combination therapy 579 children with ADHA - 8yo 14 months treatment Four conditions: 1. Routine community care (control) - 25% improved 2. Behavioral therapy only -35% improved 3. Stimulants only -55% improved 4. Behavior therapy + stimulants -70% improved

An 80-year-old hospitalized individual is recovering from surgery, but now has gotten an infection. Over the course of a few days, the person shows increasing confusion, and consistently misinterprets what others are trying to communicate. The MOST probable diagnosis for this condition would be:

delirium

Among the elderly, psychotic cognitive symptoms are usually due to:

delirium and dementia

Someone who has AIDS is also at risk for developing:

dementia

A child is awakened during the night, uses the toilet, and receives a sticker and praise from a parent. Later in the week, accumulated stickers may be turned in for a highly desired toy. This child is undergoing:

dry-bed training for enuresis

A reading proficiency level that is much lower than would be expected based on the measure of general intelligence is called:

dyslexia

One speech problem displayed by many autistic children is that they repeat everything said to them. This is called:

echolalia

An individual seeking help from a geropsychologist is MOST likely:

elderly

Childhood disorders for which there are no direct adult counterparts are:

elimination disorders.

Among the goals of parent-child interaction therapy are all of the following EXCEPT:

encouraging parents to not change how they act with their child

Joey has been wetting his bed since he was a baby. He is 10 years old now. As a result, he will not stay over at his friend's house or go to camp. His condition is called:

enuresis

fragile X syndrome

second most common chromosomal cause of intellectual disability (caused by an X chromosome that is prone to breakage and loss); associated with mild to moderate levels of intellectual dysfunctioning, language impairments, and (in some cases), behavioral problems

When a child with autism spectrum disorder jumps, flaps her arms, twists her hands and fingers and makes unusual faces, the child is engaging in:

self-stimulatory behavior

Sphere-shaped deposits of a small molecule in spaces between neurons in the hippocampus in individuals with Alzheimer's disease are called:

senile plaques

A female child is diagnosed with autism. Later, as an adult, she is unable to hold a job and has very limited communication skills. Her case is:

uncommon; most people diagnosed with autism spectrum disorder are males, and their symptoms usually remain severe into adulthood

Studies have shown that misuse of medication in US nursing homes occurs MOST often when staff members:

use antipsychotic drugs to control the behaviors of those who don't show psychotic symptoms

In controlled studies, nursing home patients given placebos instead of antipsychotic drugs often showed substantial improvement. MOST likely, this is because those receiving placebos:

were responding positively to the attention and extra care they received in the study

A 65-year-old in otherwise very good health typically will experience occasional:

memory difficulties

In people with Alzheimer's disease, memory problems appear to be caused by disruption of the production of:

memory-linked proteins

augmentative communication system

method for enhancing communication skills of people with autism by teaching them to point to pictures, symbols, letters, or words on a communication board of computer. Can also be used to help with cerebral palsy.

Biological factors are NOT the most important causes of which level of intellectual developmental disorder?

mild

An individual with Alzheimer's disease is able to function independently. The MOST appropriate label for this person's condition is:

mild neurocognitive disorder

Imagine that I just stubbed my toe and cried "Ouch." A child with autism, when asked if I was hurt, said, "No," because he wasn't hurt. This inability to take the perspective of another is referred to as:

mind-blindness

A particular problem often found more prominently in the elderly that is related to substance abuse is:

misuse of prescription drugs.

The term "double jeopardy" describes people who may develop psychological problems because of being:

old and members of an ethnic minority

A child is openly hostile toward her parents. She argues with them constantly and will not do anything they say. They cannot control her. The diagnosis she is MOST likely to receive is:

oppositional defiant disorder

An intervention in which parents and their children who have been diagnosed with conduct disorder do behavior therapy targeting and rewarding desired behavior is called:

parent management training

relational aggression

pattern of aggression found in certain cases of conduct disorder in which individual is socially isolated and primarily engages in social misdeeds such as slandering others, spreading rumors, and manipulating friendships. More common among girls than boys.

overt-destructive

pattern of behavior in conduct disorder wherein children display openly aggressive and confrontational behaviors

overt-nondestructive

pattern of behavior in conduct disorder wherein children display openly offensive but nonconfrontational behaviors (such as lying)

covert-destructive

pattern of behavior in conduct disorder wherein children display secretive destructive behaviors such as violating other people's property, breaking and entering, and setting fires

covert-nondestructive

pattern of behavior in conduct disorder wherein children secretly commit non-aggressive behaviors, such as being truant from school

covert-destructive pattern

pattern of conduct disorder characterized by secretive destructive behaviors such as violating other people's property, breaking and entering, and setting fires.

overt-nondestructive pattern

pattern of conduct disorder dominated by openly offensive but non-confrontational behaviors such as lying.

overt-destructive pattern

pattern of conduct disorder in which individuals display openly aggressive and confrontational behaviors

covert-nondestructive pattern

pattern of conduct disorder in which individuals secretly commit nonaggressive behaviors such as being truant from school.

Individuals with autism spectrum disorder may react with tantrums if an object is moved to a different part of the room. This is known as:

perserveration of sameness

child-initiated interactions

program in which teachers try to identify intrinsic reinforcers rather than trivial ones like food or candy. They are first encouraged to choose items they are interested in and then learn to initiate questions in order to obtain items.

When a child with autism spectrum disorder says "You want a drink when he really means that he wants a drink, he is displaying

pronominal reversal

This pattern of aggression is found more commonly in girls than boys

relational aggression

Alzheimer's disease is diagnosed on the basis of:

neurofibrillary tangles and senile plaques evident at autopsy.

Paula was moderate intellectual developmental disorder, a small head and flat face, as well as a protruding tongue. Her condition is MOST likely:

Down syndrome

Individuals with Down syndrome:

Have the same range of personality characteristics as do those in the general population without Down syndrome

"What should I look for in an effective ADHD treatment program?" a friend asks. Your BEST answer among the following alternatives is:

"Drugs work best."

Diagnostic Label: Schizophrenia Recommended Treatment(s): Antipsychotic Drugs

"They are following me. Quick, hide behind the stacks." Beth, a nineteen year-old college freshman, dragged her startled classmate by the sleeve as she peered between some books on the library shelves. "What are you talking about?" asked her friend. Beth cupped a hand over her friend's ear and whispered, "They watch me all the time. They don't think I recognize them just because they disguise themselves as teachers or students. But I can tell. I see right through their tricks." The other girl backed off and tried to gauge Beth's seriousness. Beth stepped close to her and said in an insistent whisper, "It's the Soviet KGB and the radical terrorists who are out to get me. They shoot electronic waves into my house to try to brainwash me. They douse us all with impulses to soften our brains and our resistance, and then they pipe preprogrammed thoughts into our heads. It's all part of their conspiracy to gain worldwide mind control." The other girl was backed into the far corner of the stacks by now, and, a little frightened by Beth's vehement accusations, she avoided her penetrating gaze. "You," muttered Beth, pointing a finger. "They already own you. I see it in your eyes." "Beth, I have to get to class," said the girl as she tried to squeeze past. "I knew it all along," said Beth, fleeing from the girl. "They've got you in their power just like they have seventy-five percent of the kids in this school." Diagnostic Label: Recommended Treatment(s):

Useful questions for the patient and informant are?

"When did you first notice the memory loss?" and "How has the memory loss progressed since then?"

A friend says, "My 70-year-old grandmother is in good physical health, but has been diagnosed with depression. Should my grandmother even bother getting therapy? She is pretty old, after all." Your best research-based answer is:

"Yes, over half of elderly patients show improvement with treatment."

Acute nursing intervention for AD

-Nurse should assess for depression and suicidal ideation. -Counseling and antidepressants may be indicated. -Family members may be in denial, delaying critical early care.

"In dealing with Alzheimer's disease, exercise is the key," says a friend of yours. Which of the following would be your BEST reply?

"You're right --- exercise may reduce the chances of developing Alzheimer's, and it may help treatment if the disease does develop."

Rhett's Disorder

+ Characterized by normal development until a certain point + Loss of previously acquired skills, such as language + Severe motor difficulties and trouble interacting w/others + Thought to be genetic + No language impairments, according to chart...? (difference from childhood) + Hypotonia/microephaly/seizures + Mutation of X chromosome + 1 in 12,500

Costello experiment and SES

+ Costello (2003) - natural experiment with 1420 kids in rural NC; casino opened, leading to increase in income for many families, + decrease in rates of ODD/CD after casino opened + Parental supervision improved

Negative Outcomes Associated with ODD and CD

+ History of ODD/CD present in 25-60% adults w/mental disorders + 75-85% chronically unemployed, engaged in impulsive, aggressive behavior +30-40% will be diagnosed with antisocial personality disorder as adults

Bipolar Disorder in Children?

+ used to be considered an "adult" mood disorder + But 40-fold increase in number of cases from 1994 to 2003 + Controversial...many children do not display "true mania" + Treated with powerful mood stabilizers and antipsychotics + DSM-V - disruptive mood dysregulation disorder?

What is sun-downing? How do you handle as a nurse?

-AD patients can experience sundowning. -Specific type of agitation -Patient becomes more confused and agitated in late afternoon or evening. Cause is unclear. -Remain calm and avoid confrontation. **Sundowning behaviors commonly exhibited include agitation, aggressiveness, wandering, resistance to redirection, and increased verbal activity such as yelling.

Lewy body dementia (LBD)

-Characterized by presence of Lewy bodies in brainstem and cortex Common cause of dementia Often unrecognized Symptoms of LBD- -Parkinsonism -Hallucinations -Short-term memory loss -Unpredictable cognitive shifts -Sleep disturbances

Alzheimer's Disease

-Chronic, progressive, degenerative disease of the brain Most common form of dementia ~5.3 million Americans suffer from AD.It is estimated that 5% of people ages 65 to 74, and nearly 50% of those over age 85, have AD. -Ultimately, the disease is fatal, with death typically occurring 4 to 6 years after diagnosis, although some patients live for 20 years.

What is involved in a Comprehensive patient evaluation regarding AD?

-Complete health history -Physical examination -Neurologic assessment -Mental status assessment -Laboratory tests

When is a LT care facility a good idea?

-Demands on caregiver can exceed resources, and total care is needed. -Person may need to be placed in a long-term care facility. -Special units for AD patients are growing in long-term care facilities. Emphasis is on safety. **For example, many facilities have designated areas that allow the patient to walk freely within the unit while the unit is secured, so the patient cannot wander outside of it.

What type of diagnosis is AD?

-Diagnosis of exclusion No single clinical test -Made once all other possible conditions causing cognitive impairment have been ruled out

Significant in final state of AD? Causes what?

-Gradual loss of connections between neurons Leads to damage and then death of neurons Affected parts of brain shrink. Brain atrophy

AD patients subject to other health care problems because? as a nurse you facilitate this by?

-Inability to communicate symptoms places responsibility on caregiver and health care professionals. -Hospitalization can precipitate a worsening of disease or delirium. **Patients with AD hospitalized in the acute care setting will need to be observed more closely because of concerns for safety, frequently oriented to place and time, and given reassurance.

How does AD present?

-Initial sign is subtle deterioration in memory. -Inevitably progresses to more profound memory loss -Manifestations easier to recognize when family member or patient seeks medical help.

Overall goals for AD patient

-Maintain functional ability as long as possible. -Maintain safe environment. -Personal care needs met -Dignity maintained

Mild cognitive impairment what does that pt look like?

-May be able to compensate, making diagnoses difficult American Academy of Neurology recommends =Cognitive evaluation =Ongoing clinical monitoring due to increased risk of developing dementia

Early signs of Alzheimer's disease

-Memory loss that affects job skills -Difficulty performing familiar tasks -Problems with language -Disorientation to time and place -Poor or ↓ judgment -Problems with abstract thinking -Misplacing things -Changes in mood or behavior -Changes in personality -Loss of initiative

What are the nursing implementations of AD

-No known method to reduce risk of AD -Antioxidants may be of benefit. -Promote safety in physical activities and driving. -Recognize and treat depression. -Genetic testing not performed on a regular basis

Pain mtg in AD patient

-Pain should be recognized and treated promptly. -Monitor patient's response. -Patients can have difficulty communicating complaints. -May exhibit changes in behavior -Because of difficulties with oral and written language associated with AD, patients may have difficulty expressing physical complaints, including pain.

Nursing strategies to address difficult behaviors

-Redirection -Distraction -Reassurance Do not threaten or restrain patient if frustrated. ** Use reality orientation to orient to time, place, and person. Do not ask the confused or agitated patient challenging "why" questions. -Ways to distract the agitated patient may include providing snacks, taking a car ride, sitting on a porch swing or rocker, listening to favorite music, watching videotapes, looking at family photographs, or walking. -Use of repetitive activities, songs, poems, music, massage, aromas, or a favorite object can be soothing to patients.

Overall goals for caregiver of a patient

-Reduce caregiver stress. -Maintain personal, emotional, and physical health. -Cope with long-term effects associated with caregiving.

SSRI? Antidepressant? Antiseizure?

-SSRIs include fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), and citalopram (Celexa). -The antidepressant trazodone (Desyrel) may help with problems related to sleep. However, this agent may result in hypotension. -Antiseizure drugs have been shown to increase the risk of death in elderly dementia patients. The FDA has warned that antipsychotics are not indicated for the treatment of dementia-related psychosis. However, the warning does not mean that the drugs cannot be used for these patients with dementia.

Describe Mild cognitive impairment?

-State of cognitive and functional ability below defined norms that does not meet criteria for dementia -Memory impaired but function normally *Symptoms are not severe enough to interfere with activities of daily living. To the casual observer, an individual with MCI may seem fairly normal. However, the person with MCI is often aware of a significant change in memory, and family members may observe changes in the individual's abilities.

AD incidence is slightly higher in?

-The incidence of AD is slightly higher in African Americans and Hispanic Americans. -AD has been associated with lower socioeconomic status and educational level and poor access to health care. -Women are more likely than men to develop AD, primarily because they live longer.

Describe treatable conditions?

-The treatable conditions are potentially reversible. Initially these conditions may be reversible. However, with prolonged exposure or disease, irreversible changes may occur. ie) folate deficiency, vitamin b deficiency etc see box 60-2

Urinary/incontinece problems in AD?

-Urinary and fecal incontinence during middle to late stages -Habit or behavioral retraining may ↓ episodes -Constipation may relate to immobility, dietary intake, ↓ fluids **The combination of aging, other health problems, and swallowing difficulties may increase the risk of complications associated with the use of mineral oil, stimulants, osmotic agents, and enemas.

Describe servere depression, and related to demetia?

-When the depression is severe, poor concentration and attention may result, causing memory and functional impairment. -When dementia and depression occur together (which may occur in up to 40% of patients with dementia), the intellectual deterioration can be extreme.

Memantine (Namenda) how does this drug work?

-protects nerve cells against excess amounts of glutamate. *The attachment of glutamate to N-methyl-D-aspartate (NMDA) receptors permits calcium to flow freely into the cell, which in turn may lead to cell degeneration. Memantine may prevent this destructive sequence by blocking the action of glutamate.

Psychosocial Treatment for Autism

1. CBT approach + Skills training + Operant conditioning to teach speech, social skills, self-help 2. Communication training + Augmentative communication systems 3. Parent training 4. Community integration

Family and Environment Risk Factors for CD/ODD

1. Chaotic/disrupted family environments 2. Low SES (Socioeconomic Status) - Costello 3. Parenting practices (lack of involvement, harsh, physical abuse, severe neglect) 4. Exposure to deviant peers (deviants child tends to associate with deviant peers, escalating behavioral problems)

Subtypes of ADHD

1. Combined types (6+ symptoms of inattention and 6+ of hyperactivity/impusivity) 2. Predominantly inattentive type (6+ symptoms of inattention and less than 6 of hyperactivity) 3. Predominantly hyperactive impulsive

Two Types of Alzheimer's

1. Early onset (familial) 2. Late onset (sporadic)

Genetics of Alzheimer's

1. Family history (2-4 greater risk among relatives) 2. Concordance rates in twins 58% MZ vs. 45% DZ 3. APOE regulates ApoE protein

The daughter of a patient with early familial Alzheimer's disease (AD) asks how AD can be detected. The nurse describes early warning signs of AD, including:

1. Forgetting a colleague's name at a party. 2. Repeatedly misplacing car keys or a wallet. 3. Leaving a pot on the stove that boils dry and burns. 4. Having no memory of preparing a meal and forgetting to serve or eat it. ANSWER= 4. Rationale: Memory loss that affects job skills: Frequent forgetfulness or unexplainable confusion at home or in the workplace may signal that something is wrong. This type of memory loss goes beyond forgetting an assignment, a colleague's name, a deadline, or a phone number. Difficulty performing familiar tasks: It is not abnormal for most people to become distracted and to forget something (e.g., leave something on the stove too long). People with Alzheimer's disease (AD) may cook a meal but then forget not only to serve it but also that they made it. Misplacing things: For many individuals, temporarily misplacing keys, purses, or wallets is a normal albeit frustrating event. Persons with AD may put items in inappropriate places (e.g., eating utensils in clothing drawers) but have no memory of how they got there.

Causes of ADHD

1. Genetics 2. Dopamine dysregulation 3. Disrupted functioning of frontal lobes, caudate nucleus, corpus callosum 4. Prenatal and birth complications 5. Family environment

Types of Childhood and Adolescence Disorders (7, but 4 main ones)

1. Internalizing Disorders 2. Externalizing Disorders 3. Pervasive developmental disorders 4. Cognitive disorders 5. Tic disorders 6. Feeding disorders 7. Elimination disorders

A patient with Alzheimer's disease has a nursing diagnosis of impaired memory related to effects of dementia. An appropriate nursing intervention for the patient is to:

1. Let the patient know what behavior is socially appropriate. 2. Assist the patient with all self-care to maintain self-esteem. 3. Maintain familiar routines of sleep, meals, drug administration, and activities. 4. At every encounter with the patient, ask the day, time, and place to promote orientation. ANSWER=3. Rationale: The nurse should maintain familiar routines by identifying usual patterns of behavior for activities such as sleep, medication use, elimination, food intake, and self-care.

Subtypes of Conduct Disorder

1. Life-course persistent (develops early in childhood, more likely to continue having problems into adulthood) 2. Adolescent limited (onset in adolescence; LESS likely to have problems into adulthood)

Why is classifying bipolar disorder in children controversial?

1. Many children do not display true mania 2. Treated with powerful medications (mood stabilizers and antipsychotics)

Cognitive Changes in Alzheimer's

1. Massive cell loss 2. Damage to nerve cells (protein called beta-amyloid accumulates in the spaces between cells) 3. Plaques and tangles (plaques block cell-to-cell signaling at the synapses; neurofibrillary tangles) 4. Acetylcholine Transport (APP is important in transport of acetylcholine)

Distinctions between Oppositional Defiant Disorder and Conduct Disorder

1. ODD milder than CD (Oppositional mild) 2. ODD has earlier onset (Oppositional early) 3. Subset of children with ODD go on to meet criteria for CD (about 43% of boys 9-13yrs with ODD meet CD over next three years) 4. If a child meets criteria for CD, they CANNOT be diagnosed with ODD

Behavioral Therapy for CD/ODD

1. Problem Solving Skills Therapy (PSST) 2. Parent Management Training (PMT)

Causes of Autistic Disorders

1. Psychodynamic perspective: "refrigerator parents" (cold and closed off?) 2. Social and environmental stress 3. Failure to develop theory of mind 4. Genetics 5. Neurocircuitry + Abnormal development of the cerebellum +Increased brain volume, structural abnormalities in limbic system, brain stem nuclei

Pervasive development disorder examples

1. Rhett's 2. Childhood disintegrative disorder 3. Asperger's 4. Autism

Pervasive Developmental Disorders: Autism Spectrum

1. Rhett's disorder Normal development through first 5 months, then losses of skills 2. Childhood disintegrative disorder Normal development thorough first 2 years, then losses for function 3. Asperger's disorder Deficits in social interactions and activities, but NOT in language or communication 4. Autistic disorder Deficits in social interaction, communication, activities, and interests

Pharmacology for Autism

1. SSRIs reduce repetitive behaviors, aggression, depression, anxiety, and improve social interactions 2. Antipsychotics reduce compulsive behavior and improve self-control 3. Naltrexone reduces hyperactivity 4. Stimulants improve attention

Property Destruction Symptoms

1. Sets fires w/the intention of causing serious damage 2. Deliberately destroys property of another person

Violation of Rules Symptoms

1. Stays out at night (in spite of parents' rules), starting before the age of 13 2. Has run away from home overnight at least twice 3. Has run away from home once but for an extended period of time 4. Often truant from school, starting before the age of 13

ADHD Pharmacological Treatments

1. Stimulants (Ritalin, Adderall - 2.2 million children in the US take stimulants) 2. Drugs that affect norepinephrine (Clonidine, guanfacine, atomoxetine) 3. Antidepressants

Describe the issues affecting the mental health of the elderly

1. The problems of elderly members of racial and ethnic minority groups 2. Inadequacies of long-term care 3. The need for health maintenance by young adults

Other Types of Dementia (5)

1. Vascular dementia (Follows a vascular accident) 2. Pick's disease (Affects frontal lobes) 3. Creutzfeldt-Jakob disease (Slow acting virus) 4. Huntington's disease (Memory & motor problems) 6. Parkinson's disease (Tremors, rigidity, unsteadiness)

About what percentage of those diagnosed with intellectual disability fall into the category of mild intellectual disability?

80-85%

Dissociative Amnesia with fugue

A 35-year-old businessman was brought to the police station after he was found wandering around downtown Baltimore in a confused state. The man was unable to recall important personal information or any facts about his past. Eventually, the police were able to identify him through a missing person's report that his brother filed ten months earlier. According to the report, the man, Harold, disappeared from his home in New York nearly one year earlier following the unexpected death of both his wife and children in a car accident when they were hit by a drunk driver.

Hypochondriasis

A 45-year-old white male, presents to a primary care clinic armed with multiple internet searches on the topic of cancer. He states that he "just knows" he has a GI cancer, "probably the colon or maybe the pancreas." When asked how long this concern has bothered him he says "for years I have been concerned that I have cancer." When asked about relevant symptoms, the patient is a bit vague, saying "I get some pain or pressure right here (he points to the left upper quadrant) but it is not there all the time." The patient reveals that he has had ultrasounds and colonoscopies in the past, but they could find anything. He then admits that he was initially relieved but a couple of weeks later he started to think that they must have just missed something and believes that he needs another colonoscopy and abdominal CT scan. When the doctor suggests a less invasive approach, the patient ends the encounter by stating that he will "find another doctor who sees my point and will get me what I need."

Creutzfeldt-Jakob disease

A form of neurocognitive disorder caused by a slow-acting virus that may live in the body for years before the disease unfolds

Schizophrenia

A man, aged 32, was admitted to a psychiatric hospital. Two months before commitment the patient began to talk about how he had failed, had "spoiled" his whole life, that it was now "too late." He spoke of hearing someone say, "You must submit." One night his wife was awakened by his talking. He told her of having several visions but refused to describe them. He stated that someone was after him and trying to blame him for the death of a certain man. He had been poisoned, he said. In the admission office of the hospital he showed many mannerisms, lay down on the floor, pulled at his foot, made undirected violent striking movements, again struck attendants, grimaced, assumed rigid postures, refused to speak, and appeared to be having auditory hallucinations. He was at once placed in a continuous bath where, when seen later in the day, he was found to be in an unresponsive state. His face was without expression, he was mute and rigid, and paid no attention to those around him or to their questions. His eyes were closed and the lids could be separated only with effort by a doctor. There was no response to pinpricks or other painful stimuli. For five days he remained mute, negativistic, and inaccessible, at times staring vacantly into space, at times with his eyes closed.

Diagnostic Label: Generalized Anxiety Disorder Recommended Treatment(s): Cognitive-Behavioral Therapy, Antianxiety Drugs

A married woman, whose life was complicated by her mother's living in their home, complained that she felt tense and irritable most of the time. She was apprehensive for fear that something would happen to her mother, her husband, her children, or herself. She has no definite idea what it was that she fears might happen. She suffers from occasional attacks in which her heart pounds with irregular beats; she cannot seem to catch her breath when this happens. Often she breaks out in a profuse perspiration. Her mouth seems to be always dry, even though she drinks a great deal of water, and because of this and her diffuse anxiety she cannot sleep. Diagnostic Label: Recommended Treatment(s):

Seasonal Affective Disorder (SAD) (mood disorders)

A mood disorder characterized by depression that occurs at the same time every year. This occurs around the same time every year can be triggered by that particular time.

Parkinson's disease

A slowly progressive nuerological disease marked by tremors and rigidity that may also cause dementia

Autistic Disorder (6 total of impaired social interaction & communication; repetitive behavior)

A total of at least 6 of the following Impairment in social interaction, as manifested by at least 2 of the following 1. Marked impairment in the use of multiple nonverbal behaviors (e.g., eye contact) 2. Failure to develop peer relationships appropriately 3. Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people 4. Lack of social or emotional reciprocity Impairment in communication, as manifested by at least 1 of the following 1. Delay in, or total lack of, development of spoken language 2. In individuals w/ adequate speech, marked impairment in the ability to start/sustain a conversation 3. Stereotyped and repetitive use of language, or idiosyncratic language 4. Lack of varied, spontaneous make-believe play or social imitative play Restrictive repetitive and stereotyped patterns of behavior, interest, and activities, as manifested by at least 1 of the following 1. Abnormal preoccupation w/one or more stereotyped and restricted patterns of interest 2. Inflexible adherence to specific nonfunctional routines or rituals 3. Stereotyped and repetitive motor mannerisms (e.g., finger flapping) 4. Persistent preoccupation w/parts of objects + Sensory problems/Seizures + Average to below average IQ + 1-2 in 1000

ADHD (Attention Deficit Hyperactive Disorder) - two groups

A. 6 symptoms of inattention (persisting for at least 6 months) - 66 devil child 1. failure to pay attention to detail/careless mistakes 2. difficulty sustaining attention 3. failure to listen 4. failure to finish work 5. difficulty with organization 6. avoidance/dislike of tasks with mental effort 7. Loss of items 8. Easily distracted 9. Forgetfulness B. 6 symptoms of hyperactivity/impulsivity for 6 months 1. fidgeting/squirming 2. wandering from seat 3. running about/climbing when inappropriate 4. difficulty being quiet 5. frequent on the go activity (driven by a motor) 6. excessive talking 7. blurting out answers 8. difficulty waiting for turn 9. interrupts others

Areas of the brain affected by Alzheimer's

ALL OF THEM 1. Frontal lobe 2. Hippocampus/amygdala (deep within) 3. Temporal lobe 4. Parietal lobe 5. Occipital lobe 6. Cerebellum 7. Spinal cord?

Humanistic- client-centered therapy (active listening, unconditional positive regard)

After spending some time with your therapist, it becomes obvious to you that she believes you are making unrealistic comparisons between the person you are and the person that you would like to be. You find that she mirrors many of your statements, as if asking you to reflect upon what you have just said. At the same time, you are convinced that she holds you in high esteem, no strings attached.

The most frequent cause of irreversible dementia in the elderly is:

Alzheimer's disease

Your elderly grandfather is deteriorating. At first he seemed only mildly forgetful, but lately he has had trouble recalling the names of close relatives and cannot remember where he is. He used to be very loving and patient, but now he is very unpleasant at odd moments. This condition is getting worse. He is probably experiencing:

Alzheimer's disease

Post-Traumatic Stress Disorder (PTSD) (anxiety disorders)

An anxiety disorder characterized by haunting memories. Nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience.

Generalized Anxiety Disorder (anxiety disorders)

An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.

Panic Disorder (anxiety disorders)

An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking ar other frightening situations.

Huntington's disease

An inherited disease, characterized by progressive problems in cognition, emotion and movement, which results in neurocognitvie disorder

Which of the following is the correct ordering of ethnic groups in the United States in terms of the percentage of the elderly living with their children (from highest percentage to lowest percentage)?

Asian American, African American, Hispanic Americans, white American

Twenty-five percent of children with this disorder do not graduate from high school

Attention-deficit/hyperactive disorder

Behavioral Therapy Outcomes

Behavioral problems decrease in all cases Decreases from atoung 70% to 60% Fastest decrease in combined PSST+PMT (lowest in the end too) PSST (Problem Solving) - second quickest decrease PMT - takes a bit longer but same effect

The child most likely to show the first symptom of autism spectrum disorder would be a

Boy under 3 years old

Comorbidity of CD

Boys - 20% ADHD, 45% Anxiety, 35% Depression, 45% Alcohol Dependence, 40% Marijuana dependence (Boys = anxiety, alcohol, marijuana, depression) Girls - 70% Anxiety, 70% Depression, 30% Alcohol Dpendence, 27% Marijuana Dependence (Girls - Anxiety, depression, alcohol, marijuana)

What allows for monitoring in early stages and treatment response?

Brain imaging tests CT MRI SPECT PET -**A CT or an MRI scan may show brain atrophy and enlarged ventricles in the later stages of the disease, although this finding occurs in other diseases and can also be seen in persons without cognitive impairment. SPECT, magnetic resonance spectroscopy (MRS), and PET allow for detection of changes early in the disease, as well as monitoring of treatment response. {See next slide for figure.}

Discuss the issues of old age and stress

Cause by: - losses - feeling no purpose in life - biological 2 groups: 1) Disorders seen in all ages (depression, anxiety, drug use) 2) Disorders of cognition (delirium, neurocognitive)

Recent studies show that autistic children are more likely than other children to have abnormalities in which section of the brain?

Cerebellum

What changes in the brain structure occure bc of AD?

Changes in brain structure and function -Amyloid plaques -Neurofibrillary tangles -Loss of connections between cells and cell death

treatment for autism spectrum disorder

Cognitive-behavioral - modeling and operant conditioning. LEAP. Communication training involving sign language and simultaneous communication (combination of sign language and speech). Also use of augmentative communication systems and child-initiated interactions. Parent training, group homes, and sheltered workshops.

Common infections in AD?

Common Urinary tract infection Pneumonia Ultimate cause of death in many AD patients Manifestations need prompt evaluation and treatment. **Because of feeding and swallowing problems, the patient with AD is at risk for aspiration pneumonia. Reduced fluid intake, prostate hyperplasia in men, poor hygiene, and urinary drainage devices (e.g., catheter) can predispose to bladder infection.

Vascular brain lesions can be seen by neuroimaging such as,?

Computed tomography (CT) Magnetic resonance imaging (MRI) To characterize central nervous system (CNS) changes: Single-photon emission computed tomography (SPECT) Positron emission tomography (PET) **these tools are not routinly used as an intital diagnosis of dementia, generally used as evaluation

Dementia often gets mistaken for what? and vice versa?

Depression often mistaken for dementia and vice versa Manifestations of depression, especially in older adults -Sadness -Difficulty thinking and concentrating -Fatigue -Apathy -Feelings of despair -Inactivity

How/why are depression drugs used?

Depression often treated with selective serotonin reuptake inhibitors -May help with sleep problems -Antiseizure drugs -Manage behavioral problems -Stabilize mood

Describe the disorders of depression, anxiety, substance abuse and psychotic disorder in later life

Depression: losses, illness; linked with increased risk of medical problems Anxiety: declining health Psychotic disorders: Schizophrenia or delusional disorders Substance abuse: - alcohol/drug use usually decline after age 60 - often look at those whose use is lifetime vs. new - new use may start because of death, retirement, etc

How might a pt/family respond to a diagnosis of AD?

Diagnosis traumatic for patient and family Patient often responds with -Depression -Denial -Anxiety and fear -Isolation **In the early stages of AD, patients are often aware that their memory is faulty and do things to cover up or mask the problem. What Happens Next? is a booklet specifically for people dealing with the beginning stages of dementia. Website.

Progression of CJD?

Disease progresses rapidly. Mental deterioration Involuntary movements Weaknesses in limbs Blindness Eventual coma No treatment -Only autopsy and examination of brain tissue can confirm the diagnosis.

Dissociative Identity Disorder (DID) (dissociative disorders)

Disruption of identity characterized by two or more distinct personality states. Involves marked discontinuity in sense of self with related alterations in behavior, memory, perception, cognition, etc. (multiple personality disorder)

Schizophrenia- delusions of reference

During an interview, the 50-year old female patient expressed beliefs covering almost the entire range of delusions. She felt that her niece was in on a plot with other relatives to take away the property she owned in 106 countries, which she was planning to use, after training religious missionaries, to establish missions to convert heathens. In spite of the fact that her husband was alive and visited her weekly, she maintained that her husband was dead and that he had been killed by the FBI. The FBI had 6 agents assigned to her alone and had killed her husband. She had learned of their spying and talking about her from the television where they were portraying her life in several of the continuing series programs. She had learned other things about the plot from the voices that came between the television programs and the commercials. She was convinced that the hospital attendants were in on the conspiracy and that poison was being placed in her food. She was also concerned about the electrical waves that were "messing up" her mind.

Warning signs of AD

Early recognition and treatment important Nurse should inform patients and family regarding early warning signs. (table 60-6) -Memory loss that affects job skills -Diff preforming fam tasks -Problems with language -Disorientation to time and place -Poor or decreased judgment, sweater in the summer -Problems with abstract thinking, basic calculations -Misplacing things, eating utensil in clothes drawer -Changes in mood/behavior -Changes in personality -Loss of iniative

Cause of AD? Risk factors?

Exact cause is unknown. Age is most important risk factor. Familial Alzheimer's disease -Persons in whom a clear pattern of inheritance within a family is established have familial Alzheimer's disease (FAD). -FAD is associated with earlier onset (before 60 years of age) and a more rapid disease course.

Long-term care

Extended personal and medical support provided to elderly and other persons who may be impaired (may range from partial support in a supervised apartment to intensive support at a nursing home

Home and LT care facility care of AD patitents involves? Nursing care is focused on?

Family members and friends care for most AD patients in their homes. -Various facilities should be evaluated. -Consider stage of AD patient when choosing. -Nursing care intensifies over time. **Nursing care is focused on decreasing clinical manifestations, preventing harm, and supporting the patient and caregiver throughout the disease process.

Agoraphobia (anxiety disorders)

Fear or avoidance of situations in which escape might be difficult or help unavailable when panic strikes.

Geropsychology

Field of psychology dedicated to the mental health of the elderly (65+)

Major Clinical Depression Persistent depression; key is that it lasted longer than two weeks

Following the breakup of her engagement, Martha has become very despondent. She shows little interest in her job (which previously she found exciting) and often calls in sick. She spends a great deal of time alone in her room, sitting idly by the window or listening to the radio. When friends call to invite her out Martha usually refuses, pleading illness or fatigue. She complains that she feels continually tired, has to force herself to undertake such simple tasks as getting dressed or fixing a meal, and cannot concentrate enough to read a newspaper or magazine. Tears flow at the slightest provocation, and she admits that she feels worthless and inadequate. Her condition does not improve after several months have passed.

Disorganized Thinking (Schizophrenia)

Fragmented and bizarre thinking that is distorted with false beliefs.

Objective Data to be taken in assessment

General: Disheveled appearance, agitation Neurologic -Early, loss of recent memory, disoriented to day/time -Middle,agitation, impaired ability to rec close fam member, lossing speak, muscle control -Late, inabiltiy to do self care, incontinence, inmobile, flexor posturing

Gene and Environment

Genes may predispose to specific disorders or more generally to a resilient or vulnerable temperament Environment can enhance resiliency / worsen vulnerability

Diagnostic Label: Social Phobia Recommended Treatment(s): Exposure Therapy, Systematic Desensitization, Antianxiety Medication

Heather, a 19 year old college junior, has an intense fear of speaking to people she does not know very well. During her first and second years, she chose large lecture courses, which allowed her to hide in the back of the lecture hall and not speak to other students or to participate in the class discussions. Heather received high marks in all of her courses, earning a place on the dean's list and the honor roll. In her third year, Heather is now required to take some smaller upper level courses in which class participation and small-group discussions are mandatory. She is sure that she will do something embarrassing, such as vomit, and others will judge negatively. Because of these fears, Heather has trouble sleeping at night and is considering dropping out of school. Diagnostic Label: Recommended Treatment(s):

Phobia

Hilda, a 32-year old mother of two small children, is admitted to the hospital following a panic attack that occurred while she was watching a local weather report in which the meteorologist predicted 3-4 inches of snow the following day. While being treated, Hilda admits that she has been terrified of snow for as long as she can remember and this fear severely restricts her day-to-day behavior. Following months of therapy, Hilda eventually remembers a ski trip she and her family took when she was 9-years old. During the trip, Hilda was buried briefly by a small avalanche of snow while playing at the ski lodge. Hilda is amazed by the revelation as she had no recollection of this experience until it was recovered in therapy.

Possible NDX for AD

Impaired memory Self-care deficit Risk for injury Grief Wandering

Pharmacology for Alzheimer's (3)

Improve cognitive functioning Do not prevent disease progression 1. Cholinesterase inhibitors + Prevent breakdown of acetylcholine + Cognex, Aricept, Exelon, Reminyl 2. Gluatamate regulation + Memantine 3. Antipsychotics & antidepressants + To reduce agitation, improve mood and sleep, control hallucinations

Cognitive Changes with Age

In 60s - dramatic decrease in speed of processing, working, and LTM In 50s - increased Word Knowledge [Neurons die, amyloid deposits/tangles - Alzheimer's] 1. Hypothalamus/Thalamus - selected neurons shrink or die 2. Cerebral cortex - large neurons shrink (amyloid deposits develop in spaces between cells) 3. Basal forebrain - acetylcholine-secreting neurons shrink or die 4. Locus ceruleaus - neurons die 5. Amygdala/Hippocampus - amyloid deposits develop in spaces between cells (neurofibrillary tangles develop within neurons)

As AD progresses, the patients are more likely to exhibit?

In AD that has progressed, -Dysphasia ( difficluty swallowing) -Apraxia (inability to execute learned purposeful movements) -Visual agnosia (inability to identify objects by sight) -Dysgraphia (inability to write) -Some long-term memory loss -Wandering

Early stages of AD?

In early stages, memory aids may provide benefit. -Drugs must be taken regularly. -Drug compliance can be challenging. -Adult day care can provide -Caregiver respite -Stimulation for AD patient ** An example of a memory aid is a calendar. -Patients often develop depression during the early-stage phase. -The drugs must be taken on a regular basis. Because memory is one of the key functions to be altered in AD, adherence to drug therapy may be challenging. -During the early and middle stages of AD, the person can still benefit from stimulating activities that encourage independence and decision making in a protective environment.

Skin care in AD pt.?

In late stages, patient are at risk for skin breakdown. Incontinence, immobility, and undernutrition Tend to rashes, areas of redness. Keep skin dry and clean. Change patient's position regularly.

Oral care in AD patient?

In late stages, patient will be unable to perform oral self-care. -Dental problems are likely to occur. -Patient may pocket food, adding to potential tooth decay. -Inspect mouth regularly, and provide mouth care. **Dental caries and tooth abscess can add to patient discomfort or pain and subsequently may increase agitation.

What are the intital symptoms seen in dementia? often reported by whom?

Initial symptoms are related to changes in cognitive function. -Family members often report to doctor -Memory loss -Mild disorientation -Trouble with words and/or numbers **Often it is a family member, in particular the spouse, who reports the patient's declining memory to the health care provider.

Imagine that you see a video on YouTube designed to encourage young people who are gay and being bullied. It is probably part of a program called:

It Gets Better

Diagnostic Label: Major Depressive Disorder (need to have two or more chronic depressive symptoms for at least a few years) Recommended Treatment(s): Selective Serotonin Reuptake Inhibitor, Rational-Emotive Behavioral Therapy, Cognitive-Behavioral Therapy

It takes the greatest effort to get out of bed in the morning. I am tired all day, yet when night comes, sleep evades me. I stare at the ceiling, wondering what has happened to my life, and what will become of me. Nothing is getting done at work. I have projects to complete, but I can't think. I try to focus on my work, and I get lost. I keep wondering when the boss will discover how little I have accomplished. My wife does not understand. She keeps telling me to "snap out of it." I'm irritable all the time. I often yell at the kids, and then I feel terrible later. Nothing is fun anymore. I can't read, and the music I used to enjoy so much does nothing for me. I am bored, but I feel like doing nothing. There are times that I think that life is hopeless and meaningless, and I can't go on much longer. Diagnostic Label: Recommended Treatment(s):

Generalized anxiety

Jane, a 43-year old female, has been referred to a psychiatrist by her local physician, who can find nothing physically wrong with her. She complains, however, of feeling tense and apprehensive most of the time; she has difficulty sleeping and experiences frequent headaches. Minor stresses that she once handled with ease, such as driving in traffic or presenting a paper in class, now make her extremely nervous. In addition, she has moments of terror during which she feels that something dreadful is about to happen to her. Jane has no idea of the source of her fears.

Obsessive Compulsive Disorder Key symptoms are persistent obsessions that are unwanted and repetitive thoughts; compulsions are the repetitive behaviors .

Janet, age 29 and the mother of a 6-year-old girl and an 8-year-old boy, has come to the community mental health center alone. She tells the psychiatric nurse practitioner that she is here because her husband said he would leave her if she didn't get some help. She describes her problem as, "my nerves are shot." When asked to explain, she states that she likes everything to be "in order." She says she cleans her house "from top to bottom" every day. Then when her husband and children come home, she "has to go along behind them and clean as they mess up!" She explains that she can't leave the house without checking and rechecking locks on all doors and windows, and checking and rechecking all electrical outlets and appliances. Sometimes, this routine takes most of an hour before she feels satisfied and ready to leave the house. She said she had to get started getting ready to come to the clinic this morning about 3 hours before she left. "We seldom go out anymore, because my husband says it's just not worth the effort. I'm driving everyone crazy, and I don't know how to stop. I can't stop!"

Diagnostic Label: Post-Traumatic Stress Disorder Recommended Treatment(s): Exposure Therapy, Cognitive-Behavioral Therapy, Antidepressant/antianxiety drugs

Joe saw a good deal of active combat during his service in the military. Some incidents in particular had never left his mind - like the horrifying sight of Gary, a close comrade and friend, being blown-up by a land-mine. Even when he returned to civilian life, these images haunted him. Scenes from battle would run repeatedly through his mind and disrupt his focus on work. Filing up at the gas station, for example, the smell of diesel immediately rekindled certain horrific memories. At other times, he had difficulty remembering the past — as if some events were too painful to allow back in his mind. He found himself avoiding socializing with old military buddies, as this would inevitably trigger a new round of memories. His girlfriend complained that he was always pent-up and irritable - as if he were on guard, and Joe noticed that at night he had difficulty relaxing and falling asleep. When he heard loud noises, such as a truck back-firing he literally jumped, as if he were readying himself for combat. He began to drink heavily. Diagnostic Label: Recommended Treatment(s):

Eye Tracking Studies

Klin et al. (2003) 15 males w/autism and 15 healthy controls Researchers coded fixations on mouth, eyes, body, and objects +++ Best predictor of autism was eye region fixation time (vew low by comparison; higher fixation percentage on mouth and body)

Meds for LBD

LBD (cont'd) -Medications determined on an individual basis -Standard treatment plan has not been determined. -Nursing care for LBD patients relates to management of dementia. -Medications may include levodopa/carbidopa and acetylcholinesterase inhibitors.

If you were trying to learn a new language and you could understand it better than you could speak it, you would be showing symptoms most like

Language Disorder

Late Stage AD

Late stages -Long-term memory loss -Unable to communicate -Cannot perform activities of daily living (ADLs) -Patient may be unresponsive and incontinent, requiring total care.

Dissociative Fugue (dissociative disorders)

Length of fugue ranges anywhere from a few hours to several months or longer.

Diagnostic Label: Conversion Disorder Recommended Treatment(s): Cognitive-Behavioral Therapy, Psychoanalysis

Manny, a twenty-year-old male, was driving home from a long road-trip when he fell asleep at the wheel and crashed his car into the nearby embankment. One of his best friends, Nick, was fatally injured and killed as a result of the accident. In the following weeks, Manny began to develop a marked contracture of his right hand and a partial paralysis of his arm which consequently left him unable to drive. Although he was examined by numerous physicians, and many different medical treatments were tried, Manny did not respond and the symptoms remained unaltered. Diagnostic Label: Recommended Treatment(s):

Phobia- agoraphobia- fear of being in public

Margaret, a 52-year old female, has become increasingly fearful of leaving the house by herself. She insists that a family member accompany her when she goes to the store or even walks as far as the mailbox. The thought of being in a crowd so terrifies her that she no longer attends concerts or church (activities she once enjoyed) regardless of whether someone accompanies her. Her life is confined within the walls of her home.

Diagnostic Label: Seasonal Affective Disorder Recommended Treatment(s): Light Exposure Therapy

Melanie Johnson is a 35-year-old accountant who moved to Green Bay, Wisconsin, two years ago from her hometown of Sarasota, Florida. Beginning this past November, for the first time in her life, Melanie began experiencing periods of depression, lethargy, and excessive sleeping. In addition, she noticed that she was eating more than she had previously, and as a result, had gained 10 pounds. Melanie's condition remained unchanged for several months until she began to notice an improvement in her mood the following March. Diagnostic Label: Recommended Treatment(s):

Characteristics of mild cognitive impairment?

Memory complaint Abnormal memory for age Intact activities of daily living Normal general cognitive functioning -freq misplaces things -freq forgets peoples names -begins to forgot important events, appts -may forget recent events or newly learned info -worries about mem loss, friends/fam notice lag

Type of Mental status testing?

Mental status testing Mini-Mental State Examination Commonly used tool Assesses cognitive functioning -can be hard bc pts with mild dementia will try to compensate

Diagnostic Label: Obsessive Compulsive Disorder Recommended Treatment(s): Antianxiety drugs, exposure therapy, cognitive-behavioral therapy

Mike, a 32 year-old man, performed many acts that were preceded by a fear of harming other people. When driving, he had to stop the car often and return to check whether he had run over people, particularly babies. Before flushing the toilet, he had to check to be sure that a live insect had not fallen into the toilet, because he did not want to be responsible for killing a living thing. At home he repeatedly checked to see that the doors, stoves, lights, and windows were shut or turned off. . . . Mike performed these and many other checking behaviors for an average of 4 hours a day. Diagnostic Label: Recommended Treatment(s):

Bipolar Disorder Key symptom is a manic episode that lasts seven days Mrs.

Miller was first admitted to a state hospital at the age of 38, although since childhood she had been characterized by swings of mood, some of which had been so extreme that they had been psychotic in degree. At one point she became depressed and asked to return to the hospital where she had been a patient. She then became overactive and exuberant in spirits and visited her friends, to whom she outlined her plans for reestablishing different forms of lucrative business. She purchased many clothes, brought furniture, pawned her rings, and wrote checks without funds. For a period thereafter she was mildly depressed. In a little less than a year Mrs. Miller again became overactive, played her radio until late in the night, smoked excessively, took out insurance on a car she had not yet bought. On the day prior to her second admission to the hospital she purchased 57 hats.

DSM Criteria for Alzheimer's Dementia

Multiple cognitive deficits including both 1. Memory impairment 2. One or more of the following Aphasia (language disturbance) Apraxia (impaired motor functioning) Agnosia (failure to recognize objects) Poor executive functioning (e.g., planning, organizing) Course characterized by gradual onset and continued decline

Diagnostic Label: Panic Disorder Recommended Treatment(s): Antianxiety Medication, Rational-Emotive Behavioral Therapy

My breathing starts getting very shallow. I feel I'm going to stop breathing. The air feels like it gets thinner. I feel the air is not coming up through my nose. I take short rapid breaths. Then I see an image of myself gasping for air and remember what happened in the hospital. I think that I will start grasping. I get very dizzy and disoriented. I cannot sit or stand still. I start pacing. Then I start shaking and sweating. If feel I'm losing my mind and I will flip out and hurt myself or someone else. My heart starts beating fast and I start getting pains in my chest. My chest tightens up. I become very frightened. I get afraid that these feelings will not go away. Then I get really upset. If feel no one will be able to help me. I get very frightened I will die. I want to run to some place safe but I don't know where. Diagnostic Label: Recommended Treatment(s):

What is Neuropsychologic testing?

Neuropsychologic testing can help document degree of cognitive impairment. Mini-Mental State Examination (MMSE) Also used to determine a baseline from which to evaluate change over time

A child's distracting behaviors occur only in a school setting, and include failure to following instructions and finish work, answering questions before they have been completed, and a lot of seat squirming and fidgeting. Could ADHD be a diagnosis of this child?

No; the child's symptoms occur in only one setting

Childhood Disintegrative Disorder

Normal development until age 2 - 10; then loss of acquired skills Language Social skills Self care Control over bowel & bladder Play skills Motor skills + Seizures + Regression at under 2 years + 1 in 50,000

Statistics of dementia

Not a normal part of aging Affects 15% of older Americans ~100 causes of dementia >60% of patients with dementia have Alzheimer's disease (AD). Half of the patients in most long-term care facilities have dementia.

How can nurses help decrease safety risks to AD patients?

Nurse can help caregiver in assessing home environment for safety risks. Wandering is major concern. AD patient can register with Safe Return. **Wandering may be related to loss of memory or to side effects of drugs, or it may be an expression of a physical or emotional need, restlessness, curiosity, or stimuli that trigger memories of earlier routines. -The Safe Return program includes identification products (e.g., bracelet, necklace, wallet cards), a national photo/information database, a 24-hour toll-free emergency crisis line, local chapter support, and wandering behavior education and training for caregivers and families.

Nurses should assess family members by?

Nurse should also assess family members and their ability to cope and accept diagnosis. -Ongoing monitoring important -Work in collaboration with patient's caregiver. -Teach caregiver how to manage care. **An important nursing responsibility is to work collaboratively with the patient's caregiver to manage clinical manifestations effectively as they change over time.

Behavioral problems in AD?

Occur in 90% of AD patients These problems include -Repetitiveness -Delusions -Illusions -Hallucinations -Agitation -Aggression -Altered sleep patterns -Wandering -Resisting care

Major (Clinical) Depression (mood disorders)

Occurs when at least five signs of depression (including lethargy, feelings of worthlessness, or loss of interest in family, friends, and activities) last two or more weeks and are not caused by drugs or a medical condition.

Tips to avoid malnutrition?

Offer liquids frequently. Finger foods may allow self-feeding. Short-term possibilities Nasogastric (NG) feedings Percutaneous endoscopic gastrostomy (PEG) tube

Physical examination to rule out other medical conditions include screening for?

Screen for Cobalamin (vitamin B12) deficiencies Hypothyroidism Possibly neurosyphilis

What generally happens in the thalamus and the hypothalamus of an individual with Alzheimer's disease?

Selected neurons die

Internalizing Disorders (definition)

Similar to those experienced by adults BUT not exactly the same More somatic and behavioral symptoms (less cognitive) Some disorders are unique to childhood (e.g., separation anxiety disorder) Differences in treatment Play therapy Sessions w/parents

Conversion Disorder

On admission to a psychiatric hospital, a 42-year-old, married male was bent forward at the waist (at a 45-degree angle) unable to straighten his body or move his legs. For 15 years, he had complained of lower back pain. Despite two orthopedic surgeries, his complaints continued. Every four to six weeks, he had 10- to 14-day episodes of being totally unable to walk. The patient had been hospitalized many times and treated with heat and muscle relaxants. He had been retired for five years and had taken on household duties while his wife went to work to support the family. Orthopedic and neurological evaluations revealed no abnormalities. Behavioral assessment, however, indicated that the patient received considerable reinforcement for his physical complaints, such as being served breakfast in bed and not having to do household chores. Moreover, a number of stressors in his life coincided with periods of being unable to walk. These included problems with his children and difficulty adjusting to the role reversal with his wife.

What are additional characteristics that can manifest from dementia?

Other characteristics that can manifest -Personality changes Behavioral problems such as -Agitation -Delusions -Hallucinations

An individual suffering from a neurological disorder shows no evidence of infection or poisoning, but experiences tremors, rigidity, and unsteadiness. The MOST probable diagnosis is:

Parkinson's disease

Patient goals in AD

Patient goals -Functions at highest level of cognitive ability -Performs self-care, bathing, dressing, and toileting with assistance as needed -Experiences no injury -Uses assistive devices appropriately for ambulation support -Uses effective coping strategies to manage grief related to diagnosis of AD -Verbalizes reality of health situation -Remains in restricted area during ambulation and activity

Oppositional Defiant Disorder (ODD) - need 4 symptoms

Pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, and characterized by four or more of the following: 1. Loses temper 2. Argues 3. Refuses to follow rules/requests 4. Deliberately annoys others 5. Blames others 6. Easily annoyed 7. Angry 8. Spiteful/vindictive (holds a grudge)

Describe brain plaques in AD?

People develop some plaques in their brain tissue. In AD plaque is greater in certain parts. Clusters of insoluble plaque β-amyloid, other proteins, remnants of neurons, non-nerve cells, and other cells

What is the treatment for MCI?

Presently no widely accepted guidelines for treatment Insufficient evidence Research is being conducted. Primary treatment consists of ongoing monitoring. -Observe for warning signs *Research is being conducted to determine whether patients with MCI would benefit from the medications used in AD (e.g., acetylcholinesterase inhibitors).

Krosakoff's Syndrome

Primarily anterograde amnesia Caused by excessive drinking: lack of thiamine in the brain (alcohol)

Dissociative Identity Disorder

Sharon, a 27 year-old female who had been physically and sexually abused by her father throughout her childhood and adolescence, has been receiving intensive therapy sessions for the past three years. Throughout her adulthood, Sharon has exhibited at least four personalities. Each personality was of a different age, representing the phases of the woman's experience - a fearful child, a rebellious teenager, a protective adult, and the woman's primary personality. Only one of the personalities, the protective adult, was consciously aware of the others, and during therapy sessions was realized to have been developed to protect the woman during the abusive experiences. When one of the secondary personalities took over, Sharon would often act out according to the nature of the dominating personality.

Diagnostic Label: Bipolar Disorder Recommended Treatment(s): Mood-stabilizing medication

Prior to being admitted to the hospital, Archie, a forty-year-old male, provided the following description of how he had been feeling over the last several months. "There is a particular a kind of pain, elation, loneliness, and terror involved in this kind of madness. When you're high, it's tremendous. The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the ability to captivate others a felt certainty. There are interests found in uninteresting people. Feeling of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one's marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption upon friends' faces are replaced by fear and concerns. Everything previously moving with the grain is not against -you are irritably, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end for madness carves its own reality." Diagnostic Label: Recommended Treatment(s):

According to recent research, should patients with Alzheimer's disease by encouraged to repeat --- day after day --- activities that they enjoyed doing when they were younger?

Probably; they would tend to be happier, even after forgetting they did the activity

Problem Solving Skills Therapy (PSST)

Problem Solving Skills Therapy (PSST) (Alan Kazdin) Child uses the following steps to engage in better social problem solving What am I supposed to do? I have to look at all my possibilities I have to consider the consequences I have to make a choice "I did a good job" or "I made a mistake"

What problems can arise from dementia, when do drs diagnose it?

Problems disrupt individual's -Work -Social responsibilities -Family responsibilities Physicians usually diagnose when two or more brain functions are significantly impaired. (such as memory loss or language skills are sig impaired)

A teenagers parents are down on her all of the time. When they are not criticizing her, they ignore her. This is an example of:

Psychological abuse

Asperger's Disorder (2 impairment in social interaction & 1 repetitive behavior)

Qualitative impairment in social interaction, as manifested by at least 2 of the following: 1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction 2. failure to develop peer relationships appropriate to developmental level 3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) 4. lack of social or emotional reciprocity Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least 1of the following: 1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus 2. apparently inflexible adherence to specific, nonfunctional routines or rituals 3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) 4. persistent preoccupation with parts of objects + Average IQ + 1 in 3,000

Antisocial Personality Disorder Doesn't feel guilt or anxiety

Ralph is a highly impulsive person who has difficulty making plans or sticking to a job for any length of time. He has been fired from several jobs because he was caught stealing or because of frequent absences due to periodic drinking and gambling sprees. He always blames his employer for his dismissal and will not admit that his own behavior is responsible for his poor job history. Women tend to find him charming and personable, but they soon tire of his irresponsible behavior, frequent financial sponging, and general lack of consideration. His quick temper and disregard for social regulations have brought him intro frequent brushes with the law, but he usually manages to charm his way out and has never been convicted of a crime. He appears to feel little guilt or anxiety regarding his behavior.

Creutzfeldt-Jakob disease (CJD)

Rare and fatal brain disorder Caused by a prion protein **A prion is a small infectious pathogen containing protein but lacking nucleic acids. The source of infection for a variant form of CJD (vCJD) is beef obtained from animals contaminated with bovine spongiform encephalopathy, which is also called mad cow disease.

How do reserachers think that inflammation is linked to AD?

Researchers interested in link between inflammation and AD -Theory suggests that formation of free radicals damages neurons loss of function -Oxidative damage leads to inflammation.

Amnestic Disorders

Retrograde Amnesia: inability to remember events from the past (retro = before) Anterograde amnesia: ongoing inability to form new memories (can't remember things AFTER trauma)

Safety risks to AD patients?

Risks -Injury from falls -Ingesting dangerous substances -Wandering -Injury to others and self -Fire or burns -Inability to respond to crisis

A preadolescent child who has not received a clinical diagnosis participates in a program designed to stop the development of an antisocial pattern of behavior. MOST likely, that program is:

Scared Straight

Stages of Alzheimer's (7)

Stage 1: no impairment Stage 2: very mild cognitive impairment Forgetfulness + Misplace every day objects + Can't find names Stage 3: mild cognitive decline noticed by family + Can't remember new names or info + Decline in ability to plan or organize + Loss of valuable objects + Trouble recalling words or names Stage 4: mild cognitive decline + Decrease knowledge of recent events + Impaired ability to do math + Decline in ability to perform complex tasks (e.g., pay bills) + Reduced memory of personal history + May become subdued or withdrawn Stage 5: moderately severe cognitive decline + Can't recall own address or phone number + Confused about where s/he is, what day of the week it is + Need help choosing proper clothing + Still recognize close other and retain substantial information about the self + Usually require no help eating or in the toilet Stage 6: severe cognitive decline + Unaware of recent experiences, surroundings + Occasionally forget names of spouses but can distinguish familiar from unfamiliar + Disruption of sleep / wake cycle + Significant personality changes, hallucinations + Wander and become lost Stage 7: very severe cognitive decline + Lose capacity for speech + Need help eating or in the toilet + Lose ability to walk / sit w/o assistance + Can't smile or hold head up + Swallowing is impaired

Autism Spectrum Statistics

Steady increase in prevalence + 1 in 600 children and perhaps as many as 1 in 150 + No reliable diagnosis until age 3 + YET, treatment can be very effective if begun early enough

The drug Ritalin is classified as a

Stimulant

The drug Ritalin is classified as a(n):

Stimulant

Subjective data to be taken in AD evaluation

Subjective data -Past health history, repeated head trauma, stroke, exposure to metals (mercury,aluminum) prev CNS infection, fam history of dementia) -Medications, use of any drug to decrease symptoms (tranquilizers, hypnotics, antidepressants, antipsych) (Functional Health Pattern) -Health perception, health mtg., positive fam history, emotional lability) -Activity/exercise- poor personal hygiene, gait instability, weakness, inability to preform ADL's -Nutritional state, anorexic, malnourished, weightloss, -Eliminating properly—incontinence Sleep-Rest, daytime napping, freq night wakings -Cognitive-Perceptual- forgetfulness, inabiltiy to cope with complex situations, diff with prob solving (early sign) depression, withdrawl

How is dementia characterized?

Syndrome characterized by dysfunction or loss of -Memory -Orientation -Attention -Language -Judgment -Reasoning

An infant is diagnosed with a biological disorder. As she ages, her physical and mental conditions deteriorate steadily so that she loses vision and motor control, and at the age of 3, she dies. Most likely, she was suffering from:

Tay-Sachs disease

Mania

Terrance O'Reilly, a single 39-year old transit authority clerk, was brought to the hospital by the police after his increasingly hyperactive and bizarre behavior and nonstop talking alarmed his family. He loudly proclaimed that he was not in need of treatment, and threatened legal action against the hospital and police. The family reported that a month prior to admission Mr. O'Reilly took a leave of absence from his civil service job, purchased a large number of cuckoo clocks and then an expensive car which he planned to use as a mobile showroom for his wares, anticipating that he would make a great deal of money. He proceeded to "tear around town" buying and selling the clocks and other merchandise, and when he was not out, he was continuously on the phone making "deals." He rarely slept, and, uncharacteristically, spent every evening in neighborhood bars drinking heavily and according to him, "wheeling and dealing." Two weeks before admission, his mother died suddenly of a heart attack. He cried for two days, but then his mood then began to soar again. At the time of admission, he was $3000 in debt and had driven his family to exhaustion with his excessive activity and over talkativeness. He said, however, that he felt "on top of the world".

Elimination disorders are diagnosed when which of the following criteria has been met?

The children have reached an age at which they are expected to control their bodily functions

"Relational aggression" is a term used to describe a pattern of aggression MOST common among:

girls diagnosed with conduct disorder

Health maintenance

The principle that young adults should act to promote their physical and mental health to best prepare for the aging process

Two children --- one, African-American and the other, white American --- display exactly that same symptoms of overactivity. What is MOST likely to happen?

The white American will be diagnosed with ADHD, and the African American will be diagnosed with possibly a lower IQ or substance abuse

Imagine a child who neglects studies, work, friends, and family in order to be on the Internet. Which of the following about Internet addiction disorder is FALSE?

There is no such diagnosis as Internet addiction disorder

Which is NOT a criticism of the use of IQ test results to diagnose intellectual disability

They are not valid predictors of school performance

Bipolar Disorder (mood disorders)

This disorder is one one will be experience severe depression for multiple weeks but their mood will change into a manic state where they would feel elated. This would last for a week or so as well.

Doesn't appear to cause him distress or dysfunction in his day-to-day functioning.

Thomas is 30 years old and is very shy. He tends to avoid social situations and rarely leaves his home. However, he writes a very successful internet blog and is usually content while working at home. Why would psychologists not label his behavior as a disorder.

Outcomes of Boys with CD at Age 21

Those with CD: 1. Crime (1.0) 2. Violence (0.8) 3. Jail (0.63) 4. Alcohol Dependence (0.62) 5. Unemployment (0.62) 6. Welfare (0.4) 7. Physical Abuse Perpetrator (0.15)

In this approach, delinquent boys and girls with conduct disorder are assigned to a foster home in the community by the juvenile justice system

Treatment foster care

Psychoanalytic- free association (goal is for transference to occur)

Upon entering his office, your therapist asks you to sit down and be comfortable. He then tells you that you should speak freely, and not to worry about censoring any thoughts you may have during the therapy session. He sits behind you to minimize any eye contact--he does not wish to serve as an authority figure during your session. At one point, he cautions you about becoming defensive and suggests that you might be unconsciously attempting to block his access into gaining insight into the inner workings of your thought processes.

Interventions to reduce risk of malnutrition?

When chewing and swallowing become difficult, use -Pureed food -Thickening liquids -Nutritional supplements Quiet and unhurried environment Easy-grip utensils **Distractions at mealtimes, including the television, should be avoided. Low lighting, music, and simulated nature sounds may improve eating behaviors.

Conduct Disorder (CD)

[bad conduct -- violating rules] Persistent pattern of behavior violating basic rights of others and societal rules, manifested by three or more symptoms in the following classes: 1. Aggression to people and animals 2. Destruction of property 3. Deceitfulness or theft 4. Serious violation of rules

encopresis

a childhood disorder characterized by repeated defecating in inappropriate places, such as one's clothing

oppositional defiant disorder

a childhood disorder in which children are repeatedly argumentative and defiant, angry and irritable, and in some cases vindictive. More common in boys than girls (equal after puberty though). Might develop into conduct disorder.

conduct disorder

a childhood disorder in which the child repeatedly violates the basic rights of others and displays aggression, characterized by symptoms such as physical cruelty to people or animals, the deliberate destruction of other people's property, and the commission of various crimes.

enuresis

a childhood disorder marked by repeated bed-wetting or wetting of one's clothes

disruptive mood dysregulation disorder

a childhood disorder marked by severe recurrent temper outbursts and a persistent irritable or angry mood

problem-solving skills training

a cognitive-behavioral intervention for children with conduct disorder; therapists use modeling, practice, role-playing, and systematic rewards to help teach children constructive thinking and positive social behaviors

An elderly person who believes falsely that others are conspiring against her, cheating her, or spying on her and who behaves in angry, irritable, and depressed ways is exhibiting:

a delusional disorder

autism spectrum disorder

a developmental disorder marked by extreme unresponsiveness to others, severe communication deficits, and highly repetitive and rigid behaviors, interests, and activities

conduct disorder

a disorder in which a child repeatedly violates the basic rights of others and displays significant aggression; some children with this disorder are later diagnosed with antisocial personality disorder (as adults)

oppositional defiant disorder

a disorder in which children are persistently argumentative, defiant, angry, irritable, and perhaps vindictive

separation anxiety disorder

a disorder marked by excessive anxiety, even panic, whenever the person is separated from home, a parent, or another attachment figure

intellectual disability

a disorder marked by intellectual functioning and adaptive behavior that are well below average

attention-deficit/hyperactivity disorder (ADHD)

a disorder marked by the inability to focus attention, or overactive and impulsive behavior, or both

parent-child interaction therapy

a family intervention to treat conduct disorder among preschoolers; parents are taught to work with their children positively, to set appropriate limits, to act consistently, and to set appropriate expectations

Among the "oldest old," those who are over 95 years old, the MOST common concern is:

a fear of losing mental abilities

Down syndrome

a form of intellectual disability caused by an abnormality in the 21st chromosome

autism spectrum disorder

a neurodevelopmental disorder marked by extreme unresponsiveness to others, severe communication deficits, and highly repetitive and rigid behaviors, interests, and activities. Lack of responsiveness and social reciprocity. Improper eye contact. Exhibit echolalia and prenominal reversal. Preservation of sameness. Do self-stimulatory behaviors.

ADHD (attention-deficit/hyperactivity disorder)

a neurodevelopmental disorder marked by the inability to focus attention, or overactive and impulsive behavior, or both. May have learning or communication problems. May be caused by abnormal dopamine activity in frontal-striatal regions of brain. Linked to high levels of stress and family dysfunctioning and a negative self-image. Treated with drug therapy and behavioral therapy (operant conditioning in school). Best results with both together. More often diagnosed in white Americans.

A woman in a facility for those with intellectual developmental disorder. She has her own apartment, dresses herself, and goes to the dining room, where she orders breakfast off a menu. She then goes to work in a sheltered workshop. At the end of the day, she goes home to her apartment and gets ready for dinner. This arrangement is part of:

a normalization program

relational aggression

a pattern of aggression found in certain cases of conduct disorder; individual primarily engages in misdeeds such as slandering others, spreading rumors, and manipulating friendships

A child has autism spectrum disorder and does not like much variation in his life. He puts his toys on a shelf in a particular order and throws a tantrum if his mother moves any of them. Any one of several trivial changes in his daily routine can set him off. This is an example of:

a perseveration of sameness.

sheltered workshop

a protected and supervised workplace that offers job opportunities and training at a pace and level tailored to people with various psychological disabilities

intelligence quotient (IQ)

a score derived from intelligence tests that theoretically represents a person's overall intellectual capacity

syphilis

a sexually-transmitted infection; if untreated in pregnant mothers, it may lead to childhood problems and intellectual disability in the unborn child

self-stimulatory behaviors

autistic individuals perform these. Acts such as repeatedly lunging into or banging their head against a wall, pulling their hair, or biting themselves.

Coping Power Program

child-focused approach to treat conduct disorder in which children participate in group sessions that teach them to manage their anger more effectively, view situations in perspective, solve problems, become aware of their emotions, build social skills, set goals, and handle peer pressure.

problem-solving skills training

child-focused approach to treat conduct disorder in which therapists combine modeling, practice, role-playing, and systematic rewards to help teach children constructive thinking and positive social behaviors. May play games and learn to solve tasks so can apply them to real-life situations.

A child is extremely aggressive. She is always fighting with her peers and is frequently very cruel to them. She never tells the truth. He MOST likely diagnosis is:

conduct disorder

prenominal reversal

confusion of pronouns. Asking "Do you want dinner?" when hungry. Exhibited by those with autism spectrum disorder.

An iodine deficiency in the diet of a pregnant woman may lead to a condition in which the baby was dwarflike appearance and a defective thyroid gland. The disorder is called:

cretinism

Depletion of the neurotransmitter acetylcholine has been implicated as a:

critical factor in Alzheimer's disease

Early symptoms of Alzheimer's disease include:

denial of symptoms

Alzheimer's is a brain ______ while stroke is a brain ______.

disease; injury

How might the DSM-V classify bipolar disorder in children?

disruptive mood dysregulation disorder

If a young person is taking a health-maintenance approach to aging, the person would be:

doing things that promote physical and mental health

Intelligence test results should not be the only things used to determine intellectual developmental disorder, because intelligence test scores:

don't indicate level of adaptive behavior

Regarding treatment of depression in the elderly, studies show that:

drug treatments may need to be altered because drugs are broken down differently in the older body

"Beattitudes," a facility that offers long-term inpatient care for individuals with Alzheimer's disease, provides controls for patients by:

focusing on individualized care, such as allowing occasional access to alcohol or chocolate

Quentin is 25, has an IQ of 60, and never did well at schoolwork. However, he now lives on his own, has a job, and is able to perform the routine chores of life. He would not be considered to have intellectual developmental disorder because:

his daily functioning is adequate

Alzheimer's is named for the first person to __________ the disease

identify

Early home intervention programs for those in the "mild" intellectual developmental disorder category:

improve both overall functioning, and later performance in school and in adulthood

A person with Alzheimer's disease is taking a drug designed to affect acetylcholine and glutamate and may experience:

improvement both in short-term memory and in ability to cope under pressure

Behavioral and somatic symptoms, such as clinginess, sleep difficulties, and stomach pain rather than cognitive ones, are MORE characteristic of anxiety disorders:

in children rather than in adults

All of the following have been used as cognitive techniques for the treatment of Alzheimer's disease EXCEPT:

increasing the capacity of short-term memory by memorizing strings of random numbers

treatment for conduct disorder

most effective if done before the age of 13 and before aggressive behavior is locked in with age. Include parent-child interaction therapy, video modeling, parent management training, and treatment foster care. Child-focused approaches include problem-solving skills training and Coping Power Program. Also use of stimulant drugs to reduce aggressive behavior.

Alzheimer's disease is diagnosed on the basis of:

neurofibrillary tangles and senile plaques evident in autopsy

A person with Alzheimer's disease shows decreased brain activity in the diencephalon. This decreased activity should be related to:

no change in the function of short-term memory, but problems in the conversion of short-term memories to long-term memories

recessive genes

non-dominant genes that, when paired with a normal gene, would have no influence on development

Samuel, who is over 65, reports taking six prescription drugs, in addition to regularly taking two over-the-counter drugs. Among the elderly, Samuel is:

normal; the average elderly individual takes about this amount of drugs

Assume a nursing home director is trying to decide whether to use antipsychotic drugs for treating symptoms of Alzheimer's disease. Research shows that the director generally should:

not use antipsychotic drugs; they don't work any better than placebos do

Boys and girls have about the same percentage chance of being diagnosed with:

oppositional defiant disorder if they are postpubertal

A child is openly hostile toward her parents. She argues with them constantly and will not do anything they say. They cannot control her. The diagnosis she is most likely to receive is:

oppositional defiant disorder.

Lisa Mosconi and her associates administered PET scans to research participants to measure activity int he hippocampus. They found that participants with low hippocampus activity were more likely to develop neurocognitive disorders later in life. How accurate were their predictions?

over 70 percent accurate for mild neurocognitive impairment, and over 80 percent accurate for major neurocognitive impairment

"That kid is pleasant enough, but will lie about practically anything, even things that don't seem to matter much." This behavior MOST closely fits which pattern of conduct disorder?

overt-nondestructive

For which of the following anxiety disorders would you expect the childhood pattern to be MOST similar to the adult pattern?

phobias

Conduct disorder has most often been associated with:

poor parent-child relationships.

causes of conduct disorder

possibly linked to genetic and biological factors. Exposure to drugs, poverty, traumatic events, violent peers or community violence. Most often due to troubled parent-child relationships, inadequate parenting, family conflict, etc. If parents are antisocial or display excessive anger, usually leads to child developing this disorder.

Hormonal changes, life demands, and body dissatisfaction are all reasons to explain why:

postpubertal girls have higher rates of depression than postpubertal boys

Hormonal changes, life demands, and body of dissatisfaction are all reasons to explain why:

postpubertal girls have higher rates of depression than postpubertal boys.

A person diagnosed with autism spectrum disorder listens to a piano piece at a concert. Later at home, the person plays the piano piece without the music, and without making a mistake. This behavior is best described as a:

savant skill

A similarity among children with separation anxiety and those with school refusal is that they both fear going to school and often stay home. The difference in the symptoms of these diagnoses is that:

school refusal often involves fear of others at school, academic fear, and separation anxiety

causes of autism spectrum disorder

sociocultural - family dysfunction and social stress are primary causes of this. Particular parental personality created unfavorable climate for development and contributed to childhood disorder. Cold parents. Research hasn't supported this. Psychological - central perceptual or cognitive disturbance that makes normal communication and interactions impossible; lack of development of theory of mind - "mind-blindness". Biological - gene or prenatal difficulties/birth complications (rubella or exposed to toxic chemicals), abnormal development of cerebellum, leading to inability to adjust level of attention and follow verbal and facial cues, possibly increased brain volume and reduced activity of temporal and frontal lobes. Possibly MMR vaccine (heavily refuted).

MOST cases of mild intellectual developmental disorder seem to be related to:

sociocultural and psychological factors

A person who has Alzheimer's although there is no family history of the disease is said to be experiencing:

sporadic Alzheimer's

The MAIN concern over the rise in diagnosis of bipolar disorder in children, and in particular, the treatment of bipolar disorder in children is:

the use of adult medications

The LEAP program for treating children with autism spectrum disorder is unique because it involves the use of:

typical children as models and "teachers"

Research on the cause of Alzheimer's disease has led to the conclusion that:

there appears to be a significant hereditary component, but this does not fully explain its onset

Surveys show that ________ is a common experience for close to half all children in the United States

worry