Module 2 Week 8 (2)

personality disorder

-When personality rigidity reaches a point where it significantly, consistently, and chronically interferes with daily functioning or causes significant distress to the individual and those around him or her -interpersonal relationships tend to be affected -profound disturbances in sense of self -rratic or contradictory behavior patterns and personality traits, failure to achieve professional success commensurate with level of education or to pursue long-term goals, and chronic unhappiness or dysphoria over many years, often associated with anxiety and depression

bipolar disorder

-When present in a child or adolescent, some examples of manic behavior include defying a teacher, engaging in risky or life-threatening behaviors, masturbating in a public place, and engaging in unsafe sex with multiple partners -Manic children and adolescents tend to be overly confident, unable to sit still, and bothered by thoughts that are hard to organize or "moving too fast." -mood instability, irritability, aggressiveness -family history can be helpful

blood, urine, toxicology, delirium, neurological

-___ and ___ tests are frequently crucial adjunctive data to a thorough history in ruling out other medical conditions as possible causes of psychiatric symptoms as well as in identifying unrelated medical illnesses requiring treatment -____ should always be considered to rule out substance disorders -specialized blood tests, CT, MRI, EEG can be used to screen for possible causes of ___ (fever, metabolic abnormalities) or ____ conditions with behavioral manifestations that could be mistaken for a psychiatric disorder

suspiciousness, avoidant behavior, grandiosity, affective instability, self-criticism

-___ is commonly associated with psychotic disorders -___ ___ with anxiety disorders -____ with mania or hypomania -___ ___ with rapidly cycling bipolar illness -___-___ with depressive disorders

20, 80

-___% of health is related to access to care and quality of services -80% of health is related to physical environment, social determinants, and behavioral factors

communication, understanding, appreciation, rationalization

-____ is impaired in psychiatric disorders -____ is impaired in problems with memory, attention span, and intelligence -____ is impaired in denial and delusion disorder -____ is impaired in depression, psychotic thought disorder, depression, anxiety phobia, delirium, and dementia

dreaming, longer, visual, emotional

-____ occurs in both REM and non-REM sleep stages, but their characteristics differ -dreams that occur during REM sleep tend to be ___ and more __ and ___ than those that occur during non-REM sleep

ascending arousal system

-a complex polysynaptic pathway comprised of monoaminergic, cholinergic, and histaminergic neurons that project to the intralaminar and reticular nuclei of the thalamus, which in turn project diffusely to wide regions of the cortex (frontal, parietal, temporal, occipital) -enabling factor for the state of consciousness/arousal; important for wakefulness

personality traits

-a descriptor of a personality style -normally flexible and not extreme

ADHD

-a neurobiological condition that results in hyperactivity, impulsivity, and inattention -onset of symptoms and related impairment before 12, symptoms of 6 months, impairment in 2 settings, symptoms maladaptive and inappropriate for development age

atomoxetine

-a non-stimulant compound that selectively increases norepinephrine transmission (inhibits reuptake) with little effect on dopamine release -adverse: abdominal pain, decreased appetite -not a controlled substance -may not be as effective as stimulants

interictal spike

-a sharpe waveform recorded in the EEG of patients with epilepsy -asymptomatic, not accompanied by overt change in behavior

intellectual disability

-a state of functioning beginning in childhood, characterized by limitations in intelligence and adaptive skills, and reflects the fit between capabilities of the individual and the structure and expectations of the environment

intellectual disability

-a state of functioning that begins in childhood, is characterized by limitations in both intelligence and adaptive skills, and reflects the "fit" between the capabilities of the indi- vidual and the structure and expectations of the environment

global developmental delay

-a term reserved for individuals with developmental delay under the age of 5 years who cannot be reliably assessed -testing at an older chronological age is indicated to determine the level of intellectual disability more accurately

physical, systemic illness, other, vital, neurological

-a thorough ___ exam should be performed and documented in the case formulation for all psychiatric patients -it should be thorough because a ____ ___ may be present that is producing psychiatric symptoms -patients with clear-cut psychiatric disorders can also have ___ medical conditions that can be missed -____ signs and a detailed ___ examination are of particular importance

informed refusal/withdrawal

-ability to refuse treatment or management strategy when given all of the information

tics

-abrupt, purposeless, recurrent, nonrhythmic motor movements or vocalizations -can mimic voluntary movement or speech and can sometimes be suppressed, but they are generally thought to be involuntary

mental status examination

-an objective description of an individual's current mental state, based on his or her speech and behavior -provides a particular structure for listening, observing, and recording -Detailed descriptions should be included, interspersed with carefully chosen examples and brief patient quotes. -Pertinent negative findings should be included, as they are in the history section.

projective identification

-appears mainly in borderline personality disorder -an aspect of the self is projected onto someone else, the projector tries to coerce the other person into identifying with what has been projected, and the recipient of the projection and the projector feel a sense of union

elimination disorder

-attaining control of bladder and bowel function is a major developmental milestone for children -when wetting or soiling is developmentally inappropriate and persistent, a diagnosis of an ___ ___ may be warranted

informed consent

-authorization by a patient (or surrogate) for clinical management or for participation in human subject research

decisional balance

-balancing the costs and benefits of the status quo with the costs of change -Highlights the individual's ambivalence regarding maintaining vs changing a behavior

frontal, frontal, amygdala

-borderline personality disorder to be associated with reduction in ___ and orbitofrontal volume, areas of the brain that serve an inhibitory function and are involved in affect regulation. -Studies that present individuals with borderline personality disorder with stressful conditions while measuring brain activity using fMRI show decreased levels of activation of ____ and orbitofrontal areas and heightened levels of activation in the ___ in the patients relative to controls.

Tourette's disorder

-both multiple motor and one or more vocal tics at some time during the course of illness -tics persist for more than 1 years

isolation

-characteristic of controlled, orderly persons who are often labeled obsessive-compulsive personalities -unlike histrionic personality, obsessive-compulsive personality remember the truth in fine detail but without affect -should allow patients to control their own care when possible

general epilepsy

-characterized by one or more of the generalized seizure types -account for 40% of all epilepsies -etiology is usually genetic -ex: juvenile myoclonic epilepsy

autism spectrum disorder

-characterized by persistent defects in social communication and social interaction -lack of social-emotional reciprocity, joint attention, facial expression, vocalizations, motivation to share experience

provisional tic disorder

-characterized by single or multiple motor and/or vocal tics that have been present less than 1 year since the onset of the first tic

persistent tic disorder

-characterized by single or multiple motor or vocal tics, but not both, that may wax and wane in frequency but have persisted for more than 1 year since the onset of the first tic

theta, beta, language, learning, depressive

-children and adolescents with ADHD have been shown to have a higher ___ wave to ___ wave ratio (NEBA can be used to calculate this) -ADHD is frequently comoprbid with other disorders like __ and ___ problems (25-35%) and 1/3 get ___ disorder

oppositional defiant disorder

-children have a recurrent pattern of disobedient, defiant, negativistic, and argumentative behaviors toward authority figures that is more intense and frequent than would be expected for a child of similar chronological or developmental age -stubborn, aggressive, and challenging, particularly with parents, but also with teachers -prefer forfeiting a toy or privilege over losing a battle or argument -can frustrate and exhaust parents, who may then relinquish all efforts at discipline or resort to excessively punitive discipline

major depressive disorder

-children manifest sadness in irritability, low frustration tolerance, and temper tantrums -more likely to be argumentative with family and peers than verbalize sadness or low self-esteem -inability to focus on school and dropping grades, refuse to participate in extracurricular activities, hyper focus on negative life events, change in weight, sleep disturbances -multiple somatic complaints (fatigue, headache, stomachaches)

narcolepsy

-chronic neurological disorder caused by the brain's inability to regulate sleep-wake cycles normally

disorganized attachment

-common in abused children and children of severely traumatized mothers -contradictory behavior, infant freezing and showing slowed movements, disorientation, confusion; infant apprehension toward parent -issue in future relationships and risk for depression

synaptic, inhibitory synaptic, excitatory synaptic, GABA, glutamate, GABA, glutamate

-defective ___ function might lead to seizure -reduction of ___ ___ activity or enhancement of ____ ____ activity might be expected to trigger a seizure -antagonists of ___ receptor or agonists of ___ receptors trigger seizures -drugs that enhance ____ synaptic inhibition or ___ receptor antagonists suppress seizures

conduct disorder

-demonstrate a persistent pattern of behavior that violates the rights of others as well as social norms or rules -increased risk of school dropout and failure, adult unemployments, substance abuse

rationalization, understanding, rationalization, rationalization

-depression: impairment in ____ -developmental disability with lowered IQ: impairment in ___ -dementia of the Alzheimer's type: impairment in ____ -delirium: impairment in ___

epilepsy

-disorder of brain function characterized by the periodic and unpredictable occurrence of seizures (spontaneous and unprovoked) -recurring, unprovoked seizures that may result from damage to the brain

disruptive mood dysregulation disorder

-emerged as a diagnostic entity partly from the study of and controversy surrounding pediatric bipolar disorder -diagnosed in children with chronic, severe persistent irritability and frequent temper outbursts -temper outburst occur 3 or more times per week for a least a year, and must occur in two settings (school and home) -persistently negative mood -onset before age 10, diagnosis made between 6-18

Transtheoretical Model of Behavior Change

-emphasizes stages of individual change that occur over time, and are sometimes self-initiated, guided, and motivated, and are sometimes physician initiated or recommended -move through stages in a non-linear fashion -framework for looking at behavior change in clinical practice and in understanding of how individuals may respond to psychosocial factors related to behavior change

ambivalence

-feeling two ways about a thing -Common prior to and during behavior change -It is a communication trap because if you argue one side, the person defends the other

sodium, SCN1B, SCN1A

-generalized epilepsy with febrile seizures is caused by a point mutation in the beta subunit of a voltage-gated ____ channel (___) -spontaneous mutations in ____ that result in truncations and loss of Na+ channel function may be in myoclonic epilepsy or dragnet syndrome

disorganized attachment

-in preschool age 3-6 years presents as role reversing behavior with parent (demanding or parent-like) -fearful of separations

kindling

-induced by periodic administration of brief-low-intensity electrical stimulation of the amygdala or other limbic structures that evoke a brief electrical seizure recorded on the EEG without behavioral change -repeated stimulations result in progressive intensification of seizures, culminating in tonic-clonic seizures that are permanent for life -limited or absent neuronal loss

status epilepticus

-induction of continuous seizures that last for hours -followed weeks later by the onset of spontaneous seizures -overt destruction of hippocampal neurons

suicide

-infrequent in children under age 12 -the most serious consequence of major depressive disorder in children

4, slow, cortical, thalamic, slow

-maximum slowing with large waves is seen in stage ___ of non-REM sleep -Thus, the characteristic of deep sleep is a pattern of rhythmic ___ waves, indicative of marked synchronization of ___ and ___ activity; it is sometimes referred to as ___-wave sleep

capacity

-medical term denoting if a patient understands the material given for informed consent -it is a clinical decision and not a legal one and is legally sanctioned by law for use in informed consent -Clinical decision and not legal

juvenile myoclonic epilepsy

-most common generalized epilepsy -complex genetic disorder due to multiple susceptibility genes -early teens, myoclonic, tonic-clonic, and absence seizures

modafinil

-narcolepsy treatment -psychostimulant -MOA: inhibits norepinephrine and dopamine transporters and increases synaptic concentrations of norepinephrine, dopamine, serotonin, and glutamate and decreases GABA levels -side effects: hypertension and tachycardia

methylphenidate

-narcolepsy treatment -psychostimulant -MOA: inhibits reuptake of dopamine and norepinephrine -side effects: abuse potential

methamphetamine

-narcolepsy treatment -psychostimulant -MOA: reverses action of dopamine transporter -side effects: excessive mood changes, insomnia, abuse potential

orexins, VLPO, awake, orexin

-neurons in the posterior lateral hypothalamus which produce peptides called ___ (also known as hypocretins). -In contrast to the ___, the orexin neurons excite the brainstem and hypothalamic arousals systems and are crucial for the ___ state. -The VLPO inhibits the ____ neurons so that orexin neurons show reduced activity in sleep, further depressing the activity of brainstem and hypothalamic arousal systems

K complexes

-occasional high voltage biphasic waves -stage 2 of non-REM sleep

obstructive sleep apnea

-occurs when breathing ceases for more than 10s during frequent episodes of obstruction of the upper airway due to a reduction in muscle tone

positive, therapeutic alliance, collaborative

-patients are more likely to adhere if the physician-patient relationship is ___ -____ ____ may be the most powerful and reliable factor affecting adherence -physicians should foster a ____ atmosphere between themselves and their patients so they are more likely to be active in the process and adhere

projection

-patients attribute their own unacknowledged feeling to others -excessive faultfinding can occur -strict honesty, concern for patients rights, and maintaining formal distance

acting out

-patients directly express unconscious wishes or conflicts through action to avoid being conscious of either the accompanying idea or the affect -tantrums, child abuse, pleasureless promiscuity are examples -often appears unaccompanied by guilt -getting the patient's attention is important

personality disorder

-personality traits become more rigid and extreme as one moves from normal to pathological personality functioning

splitting

-persons toward whom patient's feeling are, or have been, ambivalent are divided into good and bad -ex: patient may idealize some staff members and hate others -gently confront patient no one is all good or bad

suprachiasmatic nuclei (SCN)

-play a major role in the entrapment process (synchronizing sleep to day-night light cycle in the environment) -receive info about light-dark cycle

selective mutism

-preschool child disorder -the child will not speak in specific social situations but does not have a communication disorder

status epilepticus

-prolonged, continuous seizure activity -a medical emergency associated with activation of the hypothalamus and a massive stress response, metabolic instability, hypoxia, hypotension, hypoglycemia, cardiac arrhythmias, pulmonary edema, muscle breakdown, and may lead to brain injury and death

family life cycle

-provides a template to quickly assess patient and family's developmental concerns -identifies stages of family development that reflect the biological functions of raising children

EEG

-recording that represents the electrical activity of the brain -recorded with scalp electrodes through the unopened skull

extreme personality traits

-refer to an increasingly wide deviation from commonly encountered and culturally normative behaviors, reactions, and ways of functioning

alpha rhythm

-regular pattern of waves at a frequency of 8-12 Hz -amplitude of 50-100uV when recorded from the scalp

dissociation

-replacement of unpleasant affects with pleasant ones -often seen as dramatizing and emotionally shallow (histrionic personalities) -behave like anxious adolescents who carelessly expose themselves to danger to erase anxiety -try to help them remember what they forgot

tic disorder

-simple ones include: grimaces, jerks, coughs, eye blinking, and throat clearing -complex ones include: hitting, touching, obscene gestures -urge precedes and is relieved by the action -commonly have comorbid psychiatric disorders (OCD, ADHD, depression, autism)

sleep spindles

-sinusoidal waves -stage 2 of non-REM sleep -7-15 Hz

parasomnias

-sleepwalking, nocturnal enuresis, night terrors -sleep disorders associated with arousal from non-REM and REM sleep -sleepwalking more common in children than adults -walk with eyes open and avoid obstacles, but can't recall episodes

periodic limb movement disorder

-stereotypical rhythmic extension of the big toe and dorsiflexion of the angle and knee during sleep lasting for about 0.5-10s and recurring at intervals of 20-90s

methylphenidate

-stimulant that blocks the reuptake of dopamine and norepinephrine into the presynaptic neuron, increasing the levels in the synapse

amphetamine

-stimulant that increases the release of dopamine and norepinephrine from the presynaptic neuron via reversal of their respective transporters

inhibitory synaptic, extracellular, voltage

-subtle reductions of ____ ___ function could lead to epileptiform activity and that activation of excitatory synapses could be pivotal in seizure initiation -other important factors include the volume of the ___ space and intrinsic properties of a neurons like ___ gated ion channels

depolarization shift, interictal spike, interictal spike, depolarization, action potentials, depolarization shift, excitatory

-the ____ ____ is correlated to the ___ ___ -although it is asymptomatic, the location of the ____ ___ helps localized the brain region from which the seizure activity originates -the DS consists of a large ___ of the neuronal membrane associated with a burst of ___ ___ -in most cortical neurons, the ___ ___ is generated by a large ____ synaptic current that can be enhanced by voltage gated membrane currents

family life spiral

-the individual life cycles of each family member intertwines with the life cycles of other family members -depicts the oscillations of the family system from developmental periods of family closeness, based on the care of young children or older relatives -centripetal (forces pulling together) and centrifugal (forces pulling apart)

pill burden

-the number of pills required each day, as well as the total number of daily doses -can have profound effects on patients' adherence -Organizing a schedule around a patient's daily activities can help reduce this problem

epileptogenesis

-the process during which changes occur in the brain after a precipitating injury or insult that results in the development of spontaneous recurrent seizure activity or epilepsy

encopresis

-the repeated (once a month for 3 months) passage of feces into inappropriate places in an individual at least 4 years of age -it is involuntary and associated with constipation and overflow in approximately 75% of cases -Avoidance of toileting, especially in school, at a friend's house, or in public restrooms is common

enuresis

-the repeated voiding of urine into bedding or clothing by a child with a chronological or developmental age of at least 5 years -twice a week for 3 months -more than half have combined nocturnal and diurnal

family life cycle

-the socioemotional and cognitive stages you pass through from childhood to retirement years as a member of a family -in each stage, face specific challenges

postictal period

-the time after the seizure until normal neurologic function returns

defense mechanisms

-the unconscious mental processes that the ego uses to resolve conflicts among the four lodestars of inner life (instinct, reality, important persons, conscience)

seizure

-transient alteration of behavior due to the disordered, synchronous, and rhythmic firing of populations of brain neurons -abnormal, highly synchronous neuronal activity

passive aggression

-turn their anger against themselves (masochism) -failure, procrastination, silly or provocative behavior, self-demeaning clowning, and self-destructive acts -wrist cutting -help patients ventilate their anger

rigid personality traits

-unable to change his or her behavior, even when the individual would like to and when it would be highly maladaptive not to do so -activate the same behaviors, emotional responses, and ways of relating across all circumstances

autism spectrum disorder

-verbal and nonverbal impairments in communication (delay or failure to acquire spoken language) -restricted repertoire of behaviors and interested (repetitious and stereotyped behaviors; preference for sameness and inflexibility to change) -demonstrate unusual sensation with extreme insensitivity or extreme sensitivity -abnormal cognitive functioning (lower IQ and verbal and social comprehension skills lower than nonverbal skills)

fantasy

-what schizoid people depend on who are eccentric, lonely, or frightened -creating imaginary lives -because of this, patients come across as aloof -depend on this because of fear of intimacy

support, tangible, emotional, cohesive

-when ___ is present, patients with diseases like cancer, TB, and DM all experience better outcomes with their medical regimens -Adherence to medical regimens is higher if patients have ___ support, ___ support, are married or living with someone, and have a close and cohesive family -___ family patients have 1.74 times higher adherence than conflict families

alpha block (arousal response) (desynchronization)

-when attention is focused on something and the alpha rhythm is replaced by an irregular low-voltage activity beta rhythm -can be produced by any form of sensory stimulation or mental concentration

Frued

1) area of focus: psychosexual development 2) important: to understand unconscious conflicts and the impact that early experiences can have on later emotional development 3) example: a toddler refuses to wear a coat in the winter, representative of other struggles over autonomous urges and control seen during the anal phase

Erikson

1) area of focus: psychosocial development 2) important: to understand an individual's development with the social context over the lifespan 3) example: a 10 year old boy develops low self-esteem as a result of failing classes because of a learning disability (industry vs inferiority)

avoidant personality disorder

A 20-year-old college student presented for treatment of anxiety. Though an attractive and intellectually accomplished individual, he quickly communicated his painful feelings of inferiority and self-criticism. He never spoke in class, for fear of making a fool of himself, and often would skip classes and spend the day in his room, anticipating that if he were to go out people would ridicule his appearance, manner, and insecurity.

schizoid personality disorder

A 36-year-old man presented to his internist complaining of fatigue and weight loss. Interacting with his doctor, the patient was cool and aloof. The patient lived an isolated life, working from home editing text for online instruction manuals. He spent at least 6 hours daily playing interactive games on the Web, and many additional hours lost in a fantasy world in which he was one of the characters in the game. He had no complaints beyond those that brought him to treatment, and he made it clear that he had no interest in sharing information about himself with his physician.

separation anxiety disorder

Anxiety, Obsessive-Compulsive, and Stress Disorders: -Somatic sx (HA & gastric distress) become prominent with the anticipation of being separated from the primary caregiver, often the mother -The child expresses significant distress about any type of separation from the parent (i.e. going to school, attending a sleep-over, or even falling asleep alone in their bedroom) -The child may express serious concerns about something bad happening to their parent, such as a serious illness or even death -Parents may attempt to limit their activities and separation to avoid the distress, inadvertently reinforcing the child's behavior

specific phobia

Anxiety, Obsessive-Compulsive, and Stress Disorders: -Sx must be present for at least 6 months to make the dx

generalized anxiety disorder

Anxiety, Obsessive-Compulsive, and Stress Disorders: -These children have MANY worries about everything -Usually, one worry leads to worrying about others (a never-ending black hole) -This leads the child to seek reassurance from the parents -Parents may attempt to accommodate the worries by avoiding certain topics of discussion, limiting the child's exposure to media, and restricting the child's activities

social phobia (social anxiety disorder)

Anxiety, Obsessive-Compulsive, and Stress Disorders: -These sx in children are similar to those in adults -Similar with OCD, the children often do not realize the difficulties the illness is causing -These children usually experience fear or speaking in front of a group

anxiety, early, psychoeducation, cognitive behavioral therapy, SSRIs, sertraline, CBT, substance

Anxiety, Obsessive-Compulsive, and Stress Disorders: -comorbidities among ___ disorders in children and adolescents is extremely common (separation anxiety disorder, generalized anxiety disorder, and social phobia are all found together; ADHD and depressive disorders common) -___ detection and treatment is vital -mild anxiety may resolve with ____ for parents -both ___ __ ___ and ___ are effective for anxiety disorders in children -OCD can be treated with ____ -____ has been shown to significantly reduce the symptoms of anxiety in 80% of children -associated with anxiety, mood, and ____ use disorders later in life

norepinephrine, serotonin, locus coeruleus, raphe nuclei, acetylcholine, pontine, GABA, histamine

1) Awake State: -___ and ___ secreting neurons (___ ___ and ___ ___) is dominant -activity in ___ containing ___ neurons in reduced -wakefulness occurs when ___ release is reduced and ___ release is increased

mood, temper, 6-10, irritability, agitation/hyperactivity, irritability, temper

1) DMDD: ___ disturbance is persistent; ___ outbursts frequent; onset between __-__ years 2) Shared Features of DMDD and PBD: severe ___ 3) Shared Features of ADHD and DMDD: duration of months; age of onset prepubertal 4) Shared Features of ADHD, DMDD, and PBD: psychomotor ___/___; ___/low self-esteem; ___ outbursts

Ainsworth, Bowlby

1) area of focus: attachment 2) important: to understand the early development o attachment and the implications for later relationships 3) example: a 1 year old child who is separated from the mother will protest her departure and cry, then run to her affectionately upon her return (secure attachment)

Gessell

1) area of focus: biological development and milestones 2) important: to monitor for appropriate biological development screen for development disabilities 3) example: a 1 year old child typically can stand, cruise, clap hands, use pincer grip, and say one recognizable word

Piaget

1) area of focus: cognitive development 2) important: to understand cognitive development and the child's abilities and subjective understanding of the world 3) example: a 4 year old girl thought she developed a stomachache because she was bad (lack of appropriate cause and effect)

schizotypal personality disorder

Cluster A Personality Disorders: -the presence of cognitive or perceptual distortions in a person who is not frankly psychotic -aggregate familially and is more prevalent among the first-degree biological relatives of people with schizophrenia than among the general population -a lack of desire for relationships with others, often stemming from social anxiety -ideas of reference, odd beliefs, or magical thinking not consistent with cultural norms, such as belief in clairvoyance or telepathy -appear eccentric or odd and emotionally constricted -speech may be circumstantial, overinclusive, or difficult to follow

mistrust, interest, paranoid, idiosyncratic, rarely,

Cluster A disorder common traits: -profound problems in interpersonal relationships, characterized by severe ___ or lack of ___ in others -a tendency toward ___ or ___ thinking in the absence of frank psychosis -___ seek psychiatric treatment (normally because of treatment for depression or anxiety from frustrated family members)

paranoid, schizoid, schizotypal

Cluster A: odd or eccentric -___: guarded, touchy -___: aloof, isolative -___: eccentric, idiosyncratic in cognition and perceptions

alcohol, depression, mood, mood, histrionic

Cluster B Genetics: -antisocial personality disorder: ____ use disorders -borderline personality disorder: ___ is common in family history of patients -antisocial and borderline personality: have more relatives with ___ disorders and also more likely have a ___ disorder themselves -a strong association between ___ personality disorder and somatization disorder (an extreme focus on physical symptoms)

borderline personality disorder

Cluster B Personality Disorders: -The prevalence is about 6% in primary care settings, about 10% among patients seen in outpatient mental health clinics, and about 20% of psychiatric inpatients. -five times more common among first-degree biological relatives of those with the disorder -more commonly diagnosed in women in clinical populations (because more likely to seek treatment) -tend to be treatment seeking, and they make disproportionate use of psychiatric services in both inpatient and outpatient psychiatric settings

open-ended questions, affirmations, reflective listening, summaries

Basic Skills of Motivational Interview Process: (OARS) 1) ___-___ ____: Use respondent's own worse when possible 2) ____: Statements of recognition of patient strengths; Build confidence in ability to change; Must be genuine 3) ___ ___: Ex: "it sounds like you are unsure about...", "it's been difficult for you to..." 4) ____: Special form of reflective listening; Be concise; Link together and reinforce material already discussed; Accentuate "change talk"; highlight ambivalence

open-ended questions, affirmations, reflective listening, summaries

Basic Skills of Motivational Interview Process: (OARS)?

stressful, emotion, lithium, valproate, antipsychotic, antidepressant

Bipolar Disorder Treatment: -therapies designed to decrease ____ interactions with peers, manage high expressed ___ within family, and regulate sleep-wake patterns -first line agents are traditional mood stabilizes like ___ and ___, as well as typical ___ medications -addition of ___ medication may be necessary when depressive symptoms don't respond

first, depression, depression, mania

Bipolar Disorder: -bipolar disorder in a ___ degree relative confers a four to sixfold increased risk -prepubertal onset of ___ is suggestive of increased risk for ultimate development of bipolar disorder -other features that increase risk include ___ with psychotic features and history of antidepressant induced ___

schizoid personality disorder

Cluster A Personality Disorders: -lack of interest inand an inability to establish meaningful relationships with others -rare in clinical settings -more common among men than women -tend to lead isolated lives, engage in solitary activities, and choose professions that enable them to avoid interactions with others -do not marry and are not interested in sexual activity with another person -tend to pursue cerebral or mechanical activities, such as Web-based games, and they often develop elaborate fantasy lives that substitute for engagement in the world -affective experience is flattened, with a general lack of pleasure resulting in chronic anhedonia -appear aloof and detached

agenda, rationale, demographic, thank

Interview Template: 2) Talk with each Family Member.... -Begin by briefly introducing the ____ for the meeting. This is a restatement of the ____ for involving the family (e.g., "we're here today to discuss your father's diabetes.) -Request general ____ information from each person in their room (age, work/school activity, education, pertinent relationships. For example, "It would help me if I first got some more information about each of you..." -____ the group for coming to discuss the issue at end. Recognize the commitment and strength shown by the family in being willing to come and help the patient or solve the problem at hand.

thought content

Mental Status Examination Category: -Overt signs and symptoms of psychopathology; the themes of the individual's thoughts during the interview should be mentioned only if preoccupations and ruminations are present; presence or absence of delusions, suicidal and homicidal ideation should always be included -normal: No evidence of delusions; denies obsessions and suicidal and homicidal ideation -abnormal: Presence of delusions (specify type—grandiose, paranoid, somatic, religious, reference), overvalued ideas (including paranoid ideation and ideas of reference), obsessions, ruminations, suicidal and homicidal ideation; paucity of thought—describe and give examples

mood

Mental Status Examination Category: -Subjective feeling state of the individual sustained over much of the interview -normal: Euthymic -abnormal: Depressed (dysthymic), sad, irritable, expansive, euphoric, nervous, angry

insight

Mental Status Examination Category: -The individual's understanding of himself or herself in the context of wanting or needing help; also referred to in psychodynamic terms as "observing ego" -normal: Intact, excellent -abnormal: Fair, impaired (include explanation)

thought process

Mental Status Examination Category: -The organization of the individual's thoughts as reflected in his or her verbal productions -normal: coherent and goal directed -abnormal: Tangential, circumstantial, flight of ideas, loosening of associations, word salad, blocking, neologisms

time, place, person, oriented x3, time, place, person

Mental Status Testing: 1) ____: "What time of the day is it?" "Do you know what day of the week it is?" "What is the date today?" "What year is it?" "Do you know the current season?" 2) ____: "Do you know exactly where we are right now?" "What is the name of this place?" "In what institution, city, state, and country are we currently located?" 3) _____: "What is your name? What do you do for living? Who is in your family?" 4) correct answers are summarized as ___ ___ 5) disorientation occurs with ___ lost first, ___ second, and ___ third (different sequencing suggests primary psychiatric disorder)

immediate recall, short-term, intermediate-term, long-term

Mental Status Testing: Memory 1) ___ ___: introduce yourself and see if they remember your name; repeat span of digits 2) ___-___: test 1: three words to remember, Ask the patient to repeat the three words immediately and then after 5 minutes; test 2: three objects look at and recall after 5 mins 3) ____-___: Ask the patient to recall events that have happened over the last day or week. Ask the patient what was for dinner the day before (if what the patient had can be confirmed). 4) ___-___: Ask the patient to recall events that happened years ago.

level of consciousness, delirious, sundowning

Mental Status Testing: ___ __ ____ 1) observe if awake and alert or confused 2) not whether this remains the same of fluctuates (fluctuations suggests patient is ___) 3) if level fluctuates, note length of cycles 4) note whether they occur at certain times of day (___: geriatric patients alert during day, delirious at night) 5) asses ability to learn new info

cognitive ability

Mental Status Testing: ___ ___ -tested by asking the patient to do a complex operation (e.g., solve a mathematical problem) that can be performed accurately only if the sensorium is clear and the patient is fully conscious and oriented, has an intact memory, and is able to concentrate

preoperational, concrete operational

Piaget demonstrated the concept of conservation with the following experiment: children of various ages watch a fixed amount of liquid being poured from a beaker into either a taller, thinner container or a shorter, wider container, causing the height of the water level to change. When asked whether the amount of water had changed, children of 4-5 years of age said that there was more water in the beaker with the higher water level (___ thinking). Children who had attained ___ ____ thinking knew that the amount of water had not changed

formal operations

Piaget's Stages of Cognitive Development: -12+ years -abstract thinking -concepts: make and test hypotheses, think about possibilities, introspective

preoperational stage

Piaget's Stages of Cognitive Development: -2-7 years -intelligence is symbolic, but thought processes are intuitive rather than logical -concepts: egocentrism

concrete operations

Piaget's Stages of Cognitive Development: -7-11 years -intelligence is symbolic and logical, but concrete -concepts: conservation of mass, creating categories, and reversibility, de-centering (multiple perspectives to solve a problem)

sensorimotor

Piaget's Stages of Cognitive Development: -birth-2 years -intellectual development arises from infants' actions on objects -use of reflex patterns and chance discoveries, followed by repetition of an act to cause a desired outcome

synapse

defective ____ function can lead to seizures

developmental age, chronological age, gross motor, fine motor, communication, problem solving, personal-social, 5

developmental delay -reflects a ___ ___ that lags behind ___ __ or a quotient DA/CA that equals less than one -5 domains of function considered: ___ ___, ___ ___, ___, ___ ___, and ___-___ -used to classify those under ___ who can't be reliably assessed, but when older tested to determine level of ID

intellectual disability, 18

diagnosis of ___ ___ is reserved for people with significantly sub-average intelligence and impairments in adaptive functioning that present before age ___

insomnia

difficulty in initiating and/or maintaining sleep several times a week

MMR, ethylmercury

recent research regarding vaccinations has found no correlation between ___ or ___ and autism spectrum disorder

culture

refers to the systems of knowledge, ideas, beliefs, and practices that are inherited, recreated, and molded from generation to generation, within families and other social institutions

orexin

released by hypothalamic neurons to play a role in switching between sleep and wakefulness

impulsivity, aggressive, substance, history, firearms

risk factors for suicide with major depressive disorder: -____ -___ behavior -___ abuse -family ___ of suicidal behavior -access to ___

non-REM, dreaming

sleep begins with stage 1-4 of progressively deep ___-___ sleep followed by REM sleep, during which most ___ typically occurs

focal

some common forms of ___ epilepsy arise months to years after cortical injury sustained as a consequence of stroke, trauma, infection, or other factors

lethal, negative

suicide from major depressive disorder: -access to ___ means should be removed from the home of a depress child -the physician should ask about past or present exposure to ___ life events (bullying, physical or sexual abuse, domestic violence)

tonic

sustained contractions of muscles throughout the body

suprachiasmatic nuclei, melatonin

the ___ ___ and ____ from the pineal gland play roles in regulating circadian rhythm

thalamocortical

the ____ circuits are involved in the generation of primary generalized seizures

SCN, retinohypothalamic fibers, circadian rhythms

the ____ receive information about the light-dark cycle via the ___ ___, and efferent fibers from these nuclei initiate neural and hormonal signals that entrain ___ ___

greet, shake, importance, rationale, emotions, specific, empathetic, pause, summarize, strengths, thank

Interview Do's: -____ and ____ hands with each family member (including children) -Affirm the ____ of each person's contribution -Establish ____ for family interview -Recognize and acknowledge any ____ expressed -Encourage family members to be ____; ask for examples -Maintain an ____ and noncritical stance with each person -Routinely ____, paraphrase, & ____ what the patient has said -Emphasize individual and family ____ -____ the patient and family for spending time -express the importance of every person's participation in the patient's health

monopolize, sides

Interview Don'ts: -Do not let any one person ____ the conversation. If necessary, interrupt and ask for another person's opinion on the topic. -Avoid taking ____ whenever possible. Even when one member has a good point, taking sides will draw you into a family conflict and may render you unable to resolve the conflict.

Introduce, shake, formal, children

Interview Template: 1) Greet the family... -____ yourself. ____ hands and greet each person attending the meeting. Use ____ names for adults unknown to you; be sure to greet and make contact with all ____.

formal operations

Adolescent Cognitive: (11-17) -____ ___ (ability to plan; make and test hypotheses; abstract thought; consider various possibilities in the future; introspection)

Lacosamide

-MOA: enhance (prolong) the slow inactivation of voltage gated Na channels and to limit sustained repetitive firing -Adverse Effects: brief prolongation of PR interval, headache, dizziness, double vision, nausea, vomiting, fatigue, tremor, loss of balance, and somnolence, possibly contribute to suicidal ideation and suicide

benzodiazepines

-MOA: enhance GABA mediated synaptic inhibition reducing sustained high frequency firing of neurons -effects: drowsiness, lethargy, hypotonia, dysarthria, dizziness -treat absence and myoclonic seizure in children, but tolerance develops quickly

dopamine, serotonin

-Studies point to the role of abnormal ___ activity in schizotypal personality disorder -impulsive and aggressive personality traits have been linked to abnormalities in ___ activity in patients with antisocial and borderline personality disorders.

phenolbarbital

-MOA: inhibits seizures from potentiation of synaptic inhibition through an action on the GABA A receptor -Adverse Effects: sedation, nystagmus and ataxia at excessive doses, irritability and hyperactivity in children, confusion in the elderly -low toxicity, is inexpensive, and is effective and widely used

phenytoin

-MOA: limits repetitive firing of action potentials evoked by a sustained depolarization; slows rate of recovery of Na+ from inactivation -effective against all types of focal and tonic-clonic seizures but not absence seizures -metabolized by CYP enzymes and can lead to problems with oral contraceptives -side effects: cardiac toxicity, gingival hyperplasia, increased seizures, GI symptoms, osteocalcin, megaloblastic anemia

10-11, 11-13, 12-16, 13-17

Adolescent Neurodevelopmental: (11-17) -female __-__ years: onset of puberty, growth spurt, breast growth -female __-__ years: menstruation, pubic and axillary hair -male __-__ years: onset of puberty -male __-__ years: enlargement of penis, voice change, period of maximal physical growth

Carbamazepine

-MOA: limits the repetitive firing of action potentials; mediated by slowing of the rate of recovery of voltage-activated Na channels from inactivation -Adverse Effects: intoxication can result in stupor or coma, hyperirritability, convulsions, and respiratory depression, nausea, vomiting, hematological toxicity -Long term: drowsiness, vertigo, ataxia, diplopia, and blurred vision -treats trigeminal neuralgia

Oxcarbazepine

-MOA: limits the repetitive firing of action potentials; mediated by slowing of the rate of recovery of voltage-activated Na channels from inactivation but less potent enzyme inducer -Adverse Effects: same as carbamazepine, hyponatremia occurs more commonly with oxcarbazepine

ethosuximide

-MOA: reduces low threshold type Ca currents in thalamic neurons and inhibition of T-type currents is likely mechanism -Adverse Effects: most common is GI related - nausea, vomiting, anorexia and CNS effects- drowsiness, lethargy, euphoria, dizziness, headache and hiccup, rash

post traumatic stress disorder

Anxiety, Obsessive-Compulsive, and Stress Disorders: -In children, intrusion sx may take form of: repetitive play that express themes or aspects of traumatic events, Frightening dreams with content that is not clearly related to traumatic events -This differs from adults whose intrusion sx present in the form of memories and dissociative reactions

panic disorder

Anxiety, Obsessive-Compulsive, and Stress Disorders: -Rarely occurs prior to puberty -Sx are the same as those in adults -Adolescents may also have difficulty articulating what they are experiencing, resulting in maladaptive behaviors such as refusing to go to school or other defiant behaviors

50/55-70, 35/40-50/55, 20/25-35/40, 20/25, low IQ, adaptive functioning

Intellectual Disability: -mild IQ ranges? -moderate IQ ranges? -severe IQ ranges? -profound IQ ranges? -a significantly ___ ___ is necessary but not sufficient for a diagnosis if ID; impaired ___ ___ is also requisite -most cases are mild

intelligence, adaptive functioning, 18

Intellectual disability is for individuals with significantly subaverage ___ and impairments in ___ ___ that present before age ___

actions, words, changes

Major Depressive Disorder in kids vs adults: -Children often manifest sadness in irritability, low frustration tolerance, and temper tantrums, preferring ____ over ___ -a child may not understand the idea of depression, so it is important to look for ___ in behaviors

parents, mourning

-The major psychological tasks of adolescence involve what has been referred to as the second phase of separation-individuation, one goal of which is to achieve psychological autonomy from the ___. -The adolescent's de-idealization of the parents and the accompanying growing autonomy and emergence of sexual identity may cause a ___ reaction in parents, who may long for the latency years. -Parents' abilities to work through their own adjustment are important to the adolescent's successful passage through these years. -Healthy parents are able to relish their adolescent's achievement without having their own self-esteem compromised and without trying to quash the process of separation.

rating scales, severity,

-To assess depression severity, researchers use standardized numerical _____ ____ (e.g., the Hamilton Rating Scale for Depression, Beck Depression Inventory, the Young Mania Ratings Scale). -Each symptom of depression and each area of impaired functioning are rated on a scale of ___, and the total is added.

encopresis

constipation, change in diet, or dehydration usually precedes _____ (pain so avoids bowel movements)

mood, anxiety, eating, substance, all, extreme, maladaptive, presumptive

-Patients with personality disorders have an elevated risk of many other psychiatric conditions, including ____, ___, ____, and ____ use disorders. -In patients with comorbid diagnoses, it is important to comprehensively evaluate and identify ___ active disorders. -Other psychiatric disorders can cause personality traits to become even more ___ and ___ in the patient with a personality disorder and, similarly, the presence of a personality disorder will predict poorer prognosis and complicate management in the patient being treated for an acute psychiatric disorder. -Often the physician will make a ___ diagnosis of a personality disorder in a patient with an active acute disorder and then reevaluate the nature of personality pathology and functioning as those symptoms remit.

sympathomimetic, hypertensive, antidepressants, closed-angle glaucoma

-Stimulants should not be administered with other ___ compounds in order to prevent increased blood pressure and heart rate, or with monoamine oxidase inhibitors, in order to prevent a ___ crisis. -Stimulants should not be taken with phenobarbital, phenytoin, or tricyclic ___, as stimulants inhibit the metabolism of these compounds, leading to increased side effects/toxicity. -Finally, because stimulants increase a-adrenergic receptor activation (and thus lead to pupillary dilation), they should not be used in ___-___ ___.

motivational interviewing

-Has been shown to promote behavior change in healthcare settings and can improve doctor-patient relationships and efficiency of consultations -Uses a guiding style to (1) engage with patients, (2) clarify strengths and aspirations, (3) evoke their own motivation for change, (4) promote autonomy of decision making

competence

-Legal term used by judges to declare someone able or not to enter into contracts

Lamotrigine

-MOA: blocks sustained repetitive firing of spinal cord neurons and delays the recovery from inactivation of recombinant NA channels; mechanisms similar to phenytoin and carbamzepine -effects: dizziness, ataxia, blurred vision, nausea, vomiting, rash; few cases of Stevens-Johnson syndrome

delta rhythm

-0.5-4 Hz

beta rhythm

-13-30 Hz low-voltage activity

theta rhythm

-4-7 Hz low-voltage, mixed frequency pattern

focal epilepsy

-60% of all epilepsies -characterized by focal seizure types -cortical lesion, developmental malformation, damage due to trauma or stroke

concrete operations

-7-11 years -joining (e.g., mother and father together equal parents) -ordering (i.e., the ability to arrange numbers in a sequence or objects in order of increasing size) -conservation (i.e., the understanding that the properties of an object are not changed if its location or position is changed) -classification (i.e., the ability to arrange objects according to color or shape) -understand the concept of reversibility of operations, that operations have opposites (e.g., subtraction is the reverse of addition). -Children are able to understand the concept of numbers instead of only being able to recite them. -The concepts of spatial measurement (e.g., the length of a line), time, and speed also fall into the category

50, 90, symptoms

-About ___% of patients with chronic illness and up to ___% of patients with acute illness do not take their medications as prescribed -Adherence to taking medications tends to be particularly low when the patient does not have ___ of a disease (as is often the case with antihypertensive or prophylactic medications)

communication disorders

-Disorders characterized by marked impairment in language and/or speech -language disorder, speech sound disorder, childhood-onset fluency disorder, social communication disorder -generally impair both academic and social functioning

pontine, VLPO, norepinephrine, serotonin, orexin, silent, inhibition, cholinergic, thalamus, waking, PGO, visual, eye

-During REM sleep, activity in these ___ GABAergic REM-on cells together with neurons in the ___ inhibit monaminergic transmission, particularly ___ release from the locus ceruleus and lateral tegmental area, and ___ release from the raphe nuclei -Activity in ___ neurons is reduced as well. -Noradrenergic and serotonergic cells show progressively reduced firing during stages 1 through 4 of nonREM sleep, and these neurons are virtually ___ during REM sleep. This silence leads to removal of ____ from cholinergic neurons in the pedunculopontine and laterodorsal tegmental nuclei, resulting in increased ___ transmission to the ___ during REM sleep -These activating changes are thought to underlie the appearance in REM sleep of EEG activity closely resembling the ___ state. -In addition, brainstem cholinergics produce intermittent waves of activation passing from pons-to-thalamus- to-cortex called ___ (pontogeniculo-occipital) waves, thought to induce the ___ imagery of dreams and associated rapid ___ movements.

absence seizure

-EEG: generalized spike-and-wave discharges at a frequency of 3 Hz -oscillations between the thalamus and neocortex

REM Sleep

-Except for eye movement, there is almost a complete loss of skeletal muscle tone in REM sleep -Threshold for arousal from sleep by sensory stimuli is elevated during this time -Characteristic is the occurrence of large phasic potentials that originate in the cholinergic neurons in the pons and pass rapidly to the lateral geniculate body and from there to the occipital cortex (pontogeniculo-occipital (PGO) spikes)

team, teeth, hair, breast, menarche, recognition, reading, routines, directions

School-Age Child (6-12 years): -begins against skills for ___ sports -begins to lose baby ____ -girls begin to show growth of ____ and ___ development -____ may occur -peer ___ becomes important -___ skills develop further -___ important for daytime activities -understands and is able to follow several ___ in a row

decreased, increased

2) REM Sleep: -norepinephrine and serotonin ____ -acetylcholine ____

snore, apnea, snort

Sleep Apnea: -begins to ___ soon after falling asleep -snoring gets louder until it is interrupted by an episode of ____, which is followed by a loud ___ as they try to breath

normal, problematic, stigma, response, similarities,

3 Ways Culture Frames Experience of Mental Health: 1) what is ___, expected, and acceptable with regard to thoughts, feelings, and behavior may differ across cultures, families, and social institutions, therefore the level at which a patient's experience is considered ___ or pathological varies 2) cultural factors contribute directly both to the degree of ___ associated with mental illness and to the social and familial ___ (may affect treatment plans patient wants) 3) cultural ___ or differences between physician and patient can contribute to the accuracy of diagnosis as well as to the patient's acceptance of a diagnosis and engagement in treatment (They may implicitly assume an understanding of each other, and this can lead to overidentification, erroneous or incomplete assumptions, and shorthand manners of speaking that obscure communication, as well as to conscious or unconscious avoidance of certain questions)

aminergic, cholinergic, increase, decrease, thalamus, cortex, orexin

3) Non-REM Sleep: -occurs when there is a more even balance between the activity of ___ and ___ neurons -likelihood of this type of sleep is increased with a ____ in release of GABA and a ____ in release of histamine (via deactivation of the ___ and ___) -____ may regulate the changes in activity of these brainstem neurons

intellectual disability

cormorbid psychiatric diagnoses are 3-4 times more common among individuals with ___ ___ than in the general public (behavior therapy is the choice of treatment)

initial spike, second, tonic, clonic

cortical EEG

transient, chronic

Sleep Disorders Associated with Disruption of Circadian Rhythm: -____ sleep disorders: jet lag, altered sleep cycle because of work shift, illness -____ sleep disorders: delayed or advanced sleep phase syndrome

narcissistic personality disorder

A 45-year-old businessman was preoccupied with accruing massive wealth; he spent all of his time thinking about his business plans, about how much money he had, and about how much money he would have someday. He chose to associate only with people who were extremely wealthy or well connected. He was chronically angry at his wife, an attractive and well-educated woman who had put him through graduate school, feeling that she should be doing more to help him climb socially and resenting that she did not have better social connections. Although he had insisted she leave her career as a lawyer to devote herself to decorating their home and maintaining their lifestyle, he was contemptuous of her for not working, and he spoke openly with her of his admiration for and sexual interest in the female bankers he came into contact with.

paranoid personality disorder

A 45-year-old shopkeeper was known throughout her small town to be bizarrely irritable and suspicious. She constantly and unpredictably snapped at customers for being rude or ignorant, often while angrily mumbling to herself. It seemed that even the most innocuous question or gesture on the part of a customer could set her off, causing her to be suspicious, accusatory, and even verbally assaultive. She had been married briefly, but became convinced that her husband was having an affair, and divorced him.

schizotypal personality disorder

A 62-year-old schoolteacher lived alone and had never married. She had no close friends. In the teacher's lounge she would talk at length and in ways sometimes difficult to follow about her belief in faith healing and about various "crystals" that could be used to predict the future. Her colleagues and students viewed her as "weird but harmless."

children

what age group sleeping?

elderly

what age group sleeping?

young adults

what age group sleeping?

revise genogram, revise hypotheses, document meeting

what are the 3 postconference interviewing tasks?

cultural

A detailed inquiry into ____ factors is indicated when significant differences in cultural, religious, or socioeconomic backgrounds between physician and patient cause difficulty in conducting the evaluation, or when the interviewer is uncertain about the fit between the patient's culturally distinctive symptoms and the DSM diagnostic criteria.

obsessive-compulsive personality disorder

A partner in a law firm was meticulous and detail-oriented to a fault; it took him twice the expected time to prepare a document. He described himself as losing sight of the big picture at these times, getting lost in detail. He micromanaged and would not delegate to his associates, feeling that their work was sloppy and inadequate. To compensate for his inefficiency and perfectionism, he consistently worked 14-hour days. Though a faithful husband and a responsible father, he rarely showed any warmth toward his family. He experienced himself as cut-off and remote, and when at home often felt that he just wanted to be left alone.

greeting, clarify and develop goals, discuss problem, identify resources, establish plan

what are the 5 conference interview tasks?

antisocial personality disorder

A respected trial lawyer came under scrutiny for tax evasion. As the government began to look into his background, it emerged that he was not a member of the bar and, in fact, had been expelled from law school 20 years earlier and never received a diploma. Yet he had built a career over the course of 10 years, posing as a graduate of an Ivy League school. He had assumed an alias, gotten jobs, gone to court, represented clients, and built a reputation for being a clever litigator, always cool under fire. To sustain his deception and generate sympathy, he had told everyone that he had no family, that both of his parents had been murdered when he was a teenager. In fact, his parents were alive and well but had not heard from him for over 20 years.

histrionic personality disorder

A young woman consulted a psychiatrist because of a crisis in her romantic and professional life. She arrived to the first meeting wearing an attractive, tight-fitting outfit and heavy makeup. In the interview, she alternated between weeping dramatically and then behaving seductively with the male psychiatrist who was evaluating her. She explained that the reason she was so upset was that her live-in boyfriend was pushing for marriage. She was very fond of him, and happy living with him, but she often treated him unkindly and had no sexual feelings for him. Meanwhile, she had been maintaining a flirtation with her married boss for several years, and had spent a handful of drunken evenings in bed with him while traveling together on business. She found her boss sexually exciting and loved the attention he secretly gave her in the office. She had been quite happy maintaining the two relationships, but now felt that her situation had been destabilized by the boyfriend's insistence that they either move ahead or move on.

dependent personality disorder

A young woman was dating a man who treated her poorly, devaluing her in front of others and frequently threatening to leave her. Though her friends were outraged to witness her boyfriend's behavior, the young woman's response was to appease and cajole him. Her friends told her she would be much better off without the boyfriend, but the young woman was preoccupied with the possibility that he might leave her, believing that she could not make it on her own, and that she loved him too much to live without him.

leaving home, joining families through marriage, families with young children, families with adolescents, launching children and moving on, families in later life

what are the 6 stages of the family life cycle?

narcissistic, avoidant, dependent

ACUTE SYMPTOMATOLOGY: For example, hypomania can mimic the grandiosity of ___ personality disorder, agoraphobia can present with socially avoidant behavior suggestive of ____ personality disorder, and panic disorder can be associated with clinging behavior that resembles that seen in ___ personality disorder.

heterogenous, history, heritability, 7, weight, TBI, smoking, lead

ADHD Etiology: -a ___ syndrome (precise etiology unknown) -a family ___ of ADHD, learning disorders, conduct disorders, antisocial personality disorder, and substance use disorders are present -twin studies show ____ component of 76% and at least ___ genes associated with ADHD -environment risks include low birth ___, perinatal complications, ___, maternal ___ during pregnancy, exposure to ___

hyperactivity, fewer, accidents, psychosocial, behavior

ADHD Prognosis: -majority of children suffer with the disorder during their teenage years, but the ___ tends to lessen -most have ___ symptoms when they enter adulthood -adults with childhood ADHD have higher rates of ___, employment or marital problems, and antisocial or criminal behavior -effective ___ interventions include psychotherapy, educational interventions, and family interventions -___ therapies can help

frontal, caudate nucleus, cerebellar vermis, norepinephrine, dopamine

ADHD: -imaging studies have demonstrated anatomic differences in ___ lobe volume, symmetry of the ___ ___, and volume of the __ ____ -neurotransmitters most notably involved are ___ and ___

mental health issues, health literacy, self-efficacy, incentives and rewards for behavior change, individual health beliefs, individual coping styles, personality

what are the 7 individual factors that may affect behavior change?

genetic, lower, basal ganglia

Tic Disorders Etiology: -strong ___ component of tic disorders -presence of discordant monozygotic pairs suggest existence of non genetic factors as well (____ birth weight) -the ___ ___ has been implicated in the pathogenesis of tics on the basis that their neurophysiological function in integrating sensorimotor information and motor control, richness in dopamine, and neuroimaging data

appearance/behavior/speech/attitude, mood, affect, thought process, thought content, perception, cognitive, insight, judgement

what are the 9 mental status examination categories?

precontemplation

Transtheoretical Model of Behavior Change Stages: -Individuals resist change -The defense mechanism often utilized are denial, projection, and acting out, however it is important to think about the resistance in terms of external factors, rather than blaming the patient

maintenance

Transtheoretical Model of Behavior Change Stages: -The individual needs to consolidate the changes to avoid relapse

consciousness, 3, spike, wave, T, Ca2+, auras, postictal

Absence Seizure: -characterized by a momentary loss of ____ -associated with ___/s doublets, ___ and ___ pattern of activity that lasts for 10 s generated by low threshold ___-type ___ channels in thalamic neurons -not accompanied by ____ or ____ periods

spike, wave, 3, thalamus, neocortex, T-type, Ca2+,

Absence Seizure: -generalized ___ and ___ discharges at a frequency of ___ Hz -oscillations between the ____ and ____ -low threshold __-___ ___ current channels are activated at a much more negative membrane potential than most other channels in the brain, and they amplify thalamic membrane potential oscillations

puberty, individual, difference, criticism, identity, role confusion, identity, intimate, formal operations, creativity, risk, gray, synaptic pruning

Adolescence: (11-17) -begins with ___: period of sexual maturation -lack of coherent sense of ___ identity: identify with groups in order to deal with these anxieties -lack of tolerance for ____: cliques and prejudices -rely on external praise so vulnerable to ___ -____ vs ___ ___: searches for meaning in skills mastered earlier -___ is consolidated: behavior and motivation becomes more consistent and future career plans may be embraced -establishment of ___ relationships: stable identity is necessary to establish before -___ ___: hypothesize about things that have not happened yet and taking pleasure in ideas -____: develops and manifests itself predominately during adolescence -tend to engage in ___-taking behaviors -the ___ matter begins to thin in a process called ___ ___

height, weight, sexual, hair, voice, enlarge, hair, breast, menstrual, acceptance, recognition, abstract

Adolescent (12-18 years): -adult ___, ___, ___ maturity -boys grow ___, ___ changes and penis ____ -girls grow ___, ___ develop, ___ periods start -peer ___ and ___ is of vital importance -understands ___ concepts

individuation, intimacy

Adolescent psychosexual: (11-17) -second phase of ___ (separation from parents; identity formation; same-sex peer group; sexual exploration) -late adolescence has ___ with romantic partner

mood, anxiety, schizophrenia, personality, eating

Adulthood Psychopathology: -Many psychiatric disorders appear initially during the period of young adulthood through the 30s, including the __ and __ disorders. -___ typically begins in late adolescence but can also occur in the 20s. -The manifestations of ___ disorders and ___ disorders are generally present by early adulthood, although patients may not present for treatment until years after the problem begins.

work, intimate, work, relationships, parenthood, ego, self-reflection, time

Adulthood: -social development tasks are in ___ and ___ relationships -achieving a successful ___ life is one of the ultimate tests of an individual's ability to join society as a productive member (failure can have frustration) -establishment of mature, committed, intimate love ____ -____: milestone of becoming a parent for psychological growth and mastery -evolution of ___ strengths (unconscious deployment of defense mechanisms to maintain emotional stability) -____-____: formal operational thinking -major shifts in the perception of ____ occur

secure

Ainsworth Attachment Infants: -____ attachment: cry for mother when separated from her, consoled upon return

informed consent

All adults are presumed to have the capacity to comply with ___ ___ unless proven otherwise through an examination by the physician or others authorized to do so

obsessive-compulsive disorder

Anxiety, Obsessive-Compulsive, and Stress Disorders: -Children experience both obsessions and compulsions -The most common obsessions are concerns with contamination & germs and fears of something bad happening to self & others -The most common compulsions are hand washing, cleaning, touching, repeating & counting -Children often do not realize their sx are causing difficulties and their parents may be in denial

parietal, occipital, decreased

Alpha rhythm is most marked in the ___ and ___ lobes and is associated with ___ levels of attention

increased, decreased, decreased, increased

An ___ release of GABA and ____ release of histamine increase the likelihood of non-REM sleep via deactivation of the thalamus and cortex. Wakefulness occurs when GABA release is ___ and histamine release is ____.

bonding

An impaired infant (e.g., an autistic infant who avoids eye contact) may not elicit the same degree of ___ from the caretaker.

borderline personality disorder

An undergraduate seeing a counselor at Student Health Services filled her therapy session with rapturous praise of her new "boyfriend," a young man she had met at a bar the previous evening while drunk whom she had taken home to her apartment. The next afternoon, the therapist received a call from the emergency room. When the emergency room physician put the patient on the phone, the patient unleashed a tirade about how the man she had met the previous day had not wanted to see her again; he was cold and heartless and her entire life situation was hopeless. She saw nothing to live for and had taken a Tylenol overdose while on the phone with him, at which point he had called 911 and she had been brought to the emergency room.

Na+, K+, Ca2+, GABA, GABAa, SV2A, Ca2+, glutamate

Antiseizure Drug Actions: 1) modulation of cation channels (___, ___, ___) to prolong inactivated state 2) enhancement of ___ neurotransmission through actions on ____ receptors, modulation of metabolism, and inhibition of reuptake 3) modulation of synaptic release through actions on the synaptic vesicle protein ___ or ___ channels with a2gamma 4) diminishing synaptic excitation mediated by ionotropic ___ receptors

norepinephrine, locus coeruelus, serotoninergic, raphe nuclei, cholinergic, histaminergic, tuberomammilary nucleus

Ascending Arousal System: -____ containing neurons in the pontine ___ ___ -____ containing neurons in the brainstem ___ ___ -____ neurons in the pontine and midbrain pedunculopontine and laterodorsal tegmental nuclei -____ neurons in the hypothalamic ____ ___

intralaminar, reticular, frontal, parietal, temporal, occipital, sensory

Ascending Arousal System: -a complex polysynaptic pathway comprised of monoaminergic, cholinergic, and histaminergic neurons that project to the ___ and ___ nuclei of the thalamus which, in turn, project diffusely to wide regions of the cortex including the ___, ___, ___, and ___ cortices -Collaterals funnel into it not only from the long ascending ___ tracts but also from the trigeminal, auditory, visual, and olfactory systems

intralaminar, cerebral cortex, attention-demanding

Ascending Arousal System: -the ascending arousal system in the brainstem has projections to the ____ nuclei of the thalamus and the output from the intralaminar nuclei to many parts of the ___ ____. -Activation of these areas can be shown by positive emission tomography scans when subjects shift from a relaxed awake state to an ___-___ task.

beta, awake, alpha, drowsy, theta, 1, spindles, k complexes, 2, delta, 3/4, beta, awake

BATS Drink Blood: 1) ____ waves (___) 2) ___ waves (___) 3) ___ waves (stage ___) 4) ___ and ___ ___ (stage ___) 5) ___ waves (stage __/__) 6) than back to ___ waves (___)

sympathomimetic, psychomotor, dopamine, nucleus accumbens

Atomoxetine has less severe ___ effects and does not increase ___ activity, because it does not increase ____ in the __ ___ (associated with reward and addictive behaviors)

stranger anxiety, secure, avoidant, resistant, disorganized

Attachment Infant: 1) 7-9 months: ___ ___ 2) 12+ moths: four attachment styles... a) ___ b) ___ (avoid parent upon reunion) c) ____ (anxious, not easily soothed) d) ___ (inexplicable, odd, disoriented)

collateral, tasks, scales, NEBA

Attention Deficit Disorders: -making the diagnosis requires ____ information from adults as well as careful clinical examination -Symptoms are more likely to be noted in settings where specific ___ are required of the child. -The use of standardized ___ from caregivers and teachers coupled with clinical evaluation is the best diagnostic approach. -____ system is now used to diagnosis 6-17 year olds (recognizes higher theta to beta wave ratio)

combined, ADD, hyperactive-impulsive

Attention Deficit Disorders: 1) ___ type: criteria met for both inattention and hyperactivity-impulsivity 2) predominately inattentive type: _____, identified as daydreamers and tend to have fewer behavioral problems 3) predominately ____-___ type

2 (moderate), 3 (severe)

Autism Spectrum Disorder Levels ___ and ___ demonstrate significant delays in verbal and nonverbal communication and restricted interested and repetitive behaviors

mild (level 1)

Autism Spectrum Disorder Levels: -language acquisition is timely -cognitive impairment is rare -intact phonological processing and master vocabulary, but some delays with visuomotor and visuospatial coordination -social deficits less apparent in preschool years, but become impairing with maturity -develop relationships with people who are much younger or older -restricted interested and repetitive behaviors

gross motor, fine motor, communication, problem solving, personal-social

what are the five domains of function that are considered for assessment of developmental delay?

communication, understanding, appreciation, rationalization

what are the four key components of capacity?

communication

Capacity Components: -express a treatment choice -ask patient which treatment option they prefer

appreciation

Capacity Components: -identify illness, treatment options, and probable outcomes as it relates to them -ask patient to describe disease, treatment, outcomes, and probabilities as they apply to them

understanding

Capacity Components: -recall information, link causal relationships, process general probabilities -ask the patient to paraphrase their view of the situation

rationalization

Capacity Components: -weight risks and benefits to come to a conclusion in keeping with patient's goals -ask patient to compare risks vs benefits of the proposed treatment and alternatives

fragile X, down syndrome, FAS, metabolism, weight, prematurity

Causes of Intellectual Disability: -1/2 of cases of mild ID have identifiable causes (genetic syndromes, fetal stressors, perinatal complications) -75% of severe have identifiable cause (___ ___ and ___ ___ are the most common) -other causes of ID: ____, abnormalities in brain development, inborn errors of ___, low birth ___, ___

precontemplation, contemplation, preparation/determination, action, maintenance, termination

what are the six stages of change in the Transtheoretical Model of Behavior Change?

10, ODD, ADHD

Childhood onset of conduct disorders is diagnosed if at least one criterion is present before age ____, and is usually comorbid with ___ and ___

80, 50

Children Sleep: -premature infant: total REM sleep time is ___% -full-term neonates: total REM sleep time is ___%

delayed, advanced

Chronic Sleep Disorders: -____ sleep phase syndrome: inability to fall asleep in evenings and awaken in the mornings; normal total sleep time -____ sleep phase syndrome: consistently fall asleep in early evening and awaken in early morning; elderly and depressed

schizophrenia, schizotypal, paranoid, schizoid

Cluster A Genetics: -more common in the biological relatives of patients with ____ -more relatives with ____ personality disorder occur in the family histories of people with schizophrenia than in control groups -less correlation exists between ___ or ___ personality disorder and schizophrenia

paranoid personality disorder

Cluster A Personality Disorders: -an angry mistrust of others that is pervasive, persistent, and inappropriate -a prevalence of 2.3% to 4.4% of the general population, and it is more common in men than women -incorrectly interpret the motives of others to be malevolent, suspecting that others are exploiting, deceiving, or harming them -endlessly question the loyalty and trustworthiness of friends and romantic partners -suspicious, irritable, easily angered, and exquisitely sensitive to slights -do not confide in others, and they tend to read demeaning and threatening meanings into benign remarks or events

narcissistic personality disorder

Cluster B Personality Disorders: -a grandiose sense of self, fantasies of unlimited success and power, and excessive need for admiration from others -diagnosed more commonly in men (50%-75%), but it is unclear if this reflects a higher prevalence in men or diagnostic bias -often plagued by painful feelings of inferiority and envy -present with chronic, treatment-refractory depression -sense of superiority in the degree of their suffering, a "moral superiority," and thus need their suffering to bolster their self-esteem in a somewhat perverse way. -appear self-centered, arrogant, and haughty, and they can be exploitative and strikingly lacking in empathy in their relationships with others -Because their sense of self depends on feeling superior to others, setbacks, slights, and criticism are poorly tolerated, often leading to emotional collapse and depression or, alternatively, rage and devaluation of others (this is when they go into a depressive crisis and seek treatment)

histrionic personality disorder

Cluster B Personality Disorders: -a need to be the center of attention along with rapidly shifting, dramatic, and superficial expression of emotion -more common among women than men -use their physical appearance to gain attention, often in a sexually provocative or seductive fashion -impressionistic in their speech and cognition, self-dramatizing, and emotional; they often consider relationships to be more intimate than they are -tend to be engaging initially, but over time they often come to seem superficial and excessively demanding of attention -often seek treatment and generally have a positive prognosis -Severe impairment in functioning may be largely limited to the realm of romance and sexual intimacy

antisocial personality disorder

Cluster B Personality Disorders: -a pervasive pattern of behavior reflecting disregard for and violation of the rights of others -more common among the first-degree biological relatives of those with the disorder -more common among men than among women (highest prevalence among men with alcohol use disorders and adverse socioeconomic factors) -engaging in repeated illegal acts, lying, conning or the use of aliases, reckless disregard for the safety of self and/or others, and a lack of remorse for unlawful, dishonest, destructive, or exploitative acts -live in a "dog-eat-dog" world -show evidence of impulsivity, irritability, aggressiveness, and lack of concern for the consequences of their actions -a group of con men, embezzlers, imposters, and white-collar criminals with antisocial personality who present as charming, seductive, and clever

borderline personality disorder

Cluster B Personality Disorders: -emotional dysregulation, pathology of interpersonal relationships, and poor impulse control, often associated with recurrent self-destructive behavior and a poorly integrated and unstable sense of self -severely compromised in their ability to form secure attachments with others, and their relationships are typically quickly formed and unstable, often associated with frantic efforts to avoid perceived abandonment -self-destructive behavior in the setting of disruption of a relationship (if you leave I'll kill myself) -Faulty affect regulation (referred to as "affective instability") leads to rapid and wide swings of emotion (alternate between intense feelings) and also sense of self splits -relationships are stormy, highly affectively charged, and unstable, often marked by idealization of the other person that is associated with clinging behavior, alternating with hatred and devaluation -prone to a host of chronic self-destructive behaviors, such as superficially cutting or burning themselves, and many patients with borderline personality disorder make frequent suicide attempts or gestures -Drug and alcohol abuse, eating disorders, and sexual promiscuity are other forms of self-destructive behav- ior commonly encountered in this population

emotional, impulse, identity, aggression, extroverted, often

Cluster B disorder common traits: -____ reactivity -poor ____ control -unclear sense of ___ -often have high levels of ___ -In contrast to individuals with cluster A disorders, individuals in cluster B are generally more ___, although their relationships tend to be highly charged, stormy, and problematic -___ seen by psychiatrists, typically for treatment of depression as well as for anxiety, substance use, and eating disorders, along with problems with relationships, impulsivity, and affective dysregulation

antisocial, borderline, histrionic, narcissistic

Cluster B: dramatic, emotional, or erratic -___: disregards the rights of others, lacks remorse -___: unstable, impulsive -___: dramatic, attention-seeking -___: grandiose, feeling entitled

anxiety, monozygotic, depression

Cluster C Genetics: -patients with avoidant personality disorder often have high ____ levels -obsessive-compulsive traits are more common in ___ twins -obsessive-compulsive personality disorder patients show signs associated with ___ (shortened REM latency period)

avoidant personality disorder

Cluster C Personality Disorders: -a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to criticism -more common in certain cultures and in women -avoidant behavior often starts in infancy or childhood with shyness, isolation, and fear of strangers or new situations -become increasingly shy during adolescence and early adulthood -fearful and uncomfortable in social situations and in intimate relations -have strong wishes to have relationships with others, yet anticipate being ridiculed, rejected, or humiliated, so they avoid social settings -risk-averse and are plagued by feelings of inferiority and shame -tend to be anxious, awkward, and timid, and they often display an attitude of self-derision

obsessive-compulsive personality disorder

Cluster C Personality Disorders: -a preoccupation with orderliness, perfectionism, and control, in the setting of severe emotional constriction -one of the most common personality disorders -diagnosed about twice as often among men -excessively devoted to work, to the exclusion of friendships and leisure activity, so much so that they may avoid taking vacations -overly conscientious in their morals, and they are miserly with regard to spending money -often experience themselves as "living machines" or robots; their emotional lives are constricted and flattened, and they value self-control above all else -tend to be controlling of others, and they have difficulty delegating tasks, feeling that no one can do the task the way they want it done -appear stiff, excessively controlled, and emotionally distant and constricted

dependent personality disorder

Cluster C Personality Disorders: -an excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation -exaggerated and unrealistic fears of being unable to take care of themselves; they tend to devalue their own abilities and decision-making, while viewing others as much more powerful and able -not only look to others to make decisions and take care of them but will also go to excessive lengths to seek out and maintain dependent relationships with partners they feel can provide nurturance and guidance -They feel panicked at the prospect of being left to care for themselves, and if a relationship ends, they will quickly initiate a new one -often become submissive and childlike, while experiencing a desperate need to maintain the relationship in the face of fear of losing their partner

anxiety, fearful, criticism, least, obsessive-compulsive, often

Cluster C disorder common traits: -propensity toward ____ -____ of other people in general, and of ___ in particular -tend to be the ___ severe of the personality disorders -individuals with ___-____ personality disorder tend to be the highest functioning, followed by avoidant and dependent personality disorders -Patients in the cluster C group ___ seek treatment, and they have a relatively positive prognosis.

avoidant, dependent, obsessive-compulsive

Cluster C: anxious or fearful -___: fearful, self-denigrating -___: clinging, fears autonomy -___-___: emotionally constricted, detail-oriented

1-4, 4-6, 7-12

Cognitive Infant: 1) __-__ months: repetition of simple acts for own sake; objects out of sight, out of mind 2) __-__ months: repetition to produce desired effects 3) __-__ months: object permanence; repetition of past actions; simple problem solving

trial, error, spatial, internal representations, object constancy, conceptual

Cognitive Toddler: (1-3) 1) 11-18 months: ___ and ___ exploration, develops ___ relations 2) 18-24 months: ____ ___ of the external world; ___ ___; beginning of ___ thought

language disorder

Communication Disorders: -Main impairments are in acquisition and use of spoken or signed language to communicate. -Delayed language acquisition and slow rate of language growth are hallmark features -Impaired articulation and phonological errors are common, particularly in children under the age of 3 years, and do not necessarily suggest a diagnosis -relatively restricted vocabulary, make more grammatical errors, and struggle to verbalize (or sign) what they desire to express in a timely fashion -often ashamed to express themselves in classroom

childhood-onset fluency disorder

Communication Disorders: -a dysfluency stuttering that creates significant psychological distress for an affected child -increased physical tension when speaking and have multiple monosyllabic or whole-word repeats that disrupt the timing and rhythm of their utterances -shame and social avoidance

speech sound disorder

Communication Disorders: -characterized by a child's failure to recognize and subsequently utilize speech sounds -Difficulties may reside in the accurate production of speech sounds, the omission of speech sounds, and in the cognitive and semantic aspects of language processing that are necessary for building vocabulary and linguistic maturation -Some expressive phonological problems, such as lisping, are common

social (pragmatic) communication disorder

Communication Disorders: -persistent difficulty in the social use of verbal and nonverbal communication, without the behavioral stereotypies and restrictive interests of autism spectrum disorder -difficulty with social greetings, conversational dialogues that involve turn taking and rephrasing, and other nonscripted interactions -result in functional limitations of communication and socialization

histrionic

Compared with the other cluster B personality disorders, ____ personality disorder is associated with a greater capacity to establish stable and meaningful relationships and with better work functioning

odd or eccentric, dramatic or emotional or erratic, anxious or fearful

what are the three clusters of personality disorders?

multidisciplinary, communication, problem-solving, family, stimulants

Conduct Disorder Treatment: -treatment is ____ (involvement with caregivers, school, etc) -psychosocial treatment develops ___ and ___-___ skills and enhances anger management -___ focused treatment positively reinforce acceptable social behavior and decrease power struggles -pharmocopatherapy can target comorbid disorders and aggression, if the ADHD is treated with ____ the aggression declines

greeting, goals, discuss, resources, plan

Conference Tasks: 1) ___- The goal of this first phase of the family conference itself is to welcome the family, get to know them better, build rapport, and help them become comfortable in the setting of the conference. 2) Clarify and further develop ____- The purpose of this second phase of the family conference is to clarify the reason for the meeting and establish the group's agenda for the session 3) __ the problem or issues-The goal of this third phase of the conference is to exchange information with the family 4) Identify ___- The goal of this fourth phase of the conference is to recognize the available resources to bring to bear on the issue(s) of concern 5) Establish a ___- The purpose of this last phase of the conference is to develop a mutually agreed upon treatment plan, and to clarify each person's role in carrying out the treatment plan

thinks, behaves, culture, personal

Culture and Psychiatric Interview: -A person's cultural background, beliefs, and ideals shape to varying degrees how he or she characteristically ___ and ___. -The interpretive framework provided by his or her ___ determines a person's experience and expression of psychiatric signs and symptoms. -Since individuals create ___ beliefs out of diverse cultural influences in their lives, the cultural dimension of a patient's illness must be considered on an individual, personalized basis

projective identification

Defense Mechanism: -a complex operation that involves projection and acting out and has multiple steps. -Person C imagines that person D is regarding and treating person C in a particular way (e.g., contemptuously). Person C is actually feeling and behaving toward person D as he imagines person D is regarding and treating him. Person C's behavior frequently provokes person D into doing unto person C what person C already imagines is happening. In other words, person C unwittingly brings about the very reaction he or she dreads (i.e., contemptuous treatment).

suppression

Defense Mechanism: -a partly conscious mechanism by which the individual wishes to put something unpleasant out of his or her own awareness and does so.

reaction formation

Defense Mechanism: -acting opposite to one's own desires, which one wants to disavow -(e.g., a person who is conflicted over his or her own dependency yearnings who spends all of his or her time taking care of others).

rationalization

Defense Mechanism: -attributing one's behavior to a cause that one finds more acceptable than the actual cause, which one does not want to face or admit -(e.g., a man who says that he lives with his mother because she needs him when the true reason is that he fears being separated from her).

projection

Defense Mechanism: -attributing one's own thoughts, feelings, or impulses to another individual. -Person A is sexually attracted to person B, but person A's ego blocks the desire from entering his own conscious awareness because of guilt. Person A tries to disavow the sexual desire by projecting it onto person B (i.e., by imagining that person B is attracted to Person A, rather than vice versa).

repression

Defense Mechanism: -blocking a thought, feeling, or memory from conscious awareness -(e.g., forgetting a painful experience).

acting out

Defense Mechanism: -expressing thoughts and feelings in actions rather than words -(e.g., missing an appointment because one is afraid of becoming too dependent on the physician rather than keeping the appointment and discussing this fear with the physician).

devaluation

Defense Mechanism: -maintaining an entirely negative view of another person by ignoring the person's virtues.

idealization

Defense Mechanism: -seeing another person as perfect and ignoring the faults of that individual.

splitting

Defense Mechanism: -seeing others in black or white terms -(e.g., all good or all bad). -It occurs when contradictory sets of thoughts and feelings are dissociated from each other. -At any given time, the individual is under the influence of only one of the contradictory mental sets.

denial

Defense Mechanism: -the refusal to perceive or register as significant external events -(e.g., the destructive consequences of one's own behavior).

dissociation

Defense Mechanism: -the splitting off of thoughts and associated feelings from conscious awareness, as if to place them in a separate mental compartment. -This occurs in amnesia, fugue states, multiple personality disorder, and splitting.

intellectualization

Defense Mechanism: -thinking or talking about an emotion-laden subject in an unemotional way -(i.e., while experiencing and expressing no feelings).

sense of self, interpersonal relationships, affect regulation

what are the three core domains of personality functioning?

modafinil, methylphenidate, methamphetamine

what are the three drug treatments for narcolepsy?

SES, distal, proximal, lower, minority, low, poverty, age, older

Demographic Factors that Affect Behavior Change: -Health behavior differs across populations of individuals, with ___ serving as a strong predictor of health behavior differences -___ factors (poverty) can drive the more ____ factors (smoking, eating habits) affecting adherence -Poor health behaviors and outcomes (obesity, smoking, sedentary lifestyles) are more common in ___ SES populations and racial and ethnic ___ populations -___-income patients may not make recommended changes to their behavior or medication regimen because of financial concerns or challenge in fitting the change into their lifestyle -Patients in ___ tend to be less adherent than those who are not -___ patients show higher rates of adherence

ADHD, antipsychotics, parent, low, major depressive, anxiety

Disruptive Mood Dysregulation Disorder Treatment: -While disruptive behaviors of DMDD may not be better explained by another mental disorder, can certainly be exacerbated by a # of them (___, specific learning disorder, autism spectrum disorder, separation anxiety disorder, dysthymic disorder). -For treatment of disruptive behaviors and mood dysregulation: mood stabilizers, ___, psychostimulants, and atomoxatine and alpha-agonists (guanfacine, clonidine) all can be helpful -___ management training is indicated for behavior modification -rates of conversion to bipolar disorder are ____ -have a greater risk of developing ___ ___ and ___ disorders

voluntary, informed, capacity

what are the three elements required for informed consent?

dendrites, wave, negative, postsynaptic, action

Diagrammatic comparison of the electrical responses of the axon and the dendrites of a large cortical neuron. -Current flow to and from active synaptic knobs on the ___ produces ____ activity, while all-or-none action potentials are transmitted along the axon. -When the sum of the dendritic activity is ___ relative to the cell body, the neuron is depolarized; when it is positive, the neuron is hyperpolarized. -The electroencephalogram recorded from the scalp is a measure of the summation of dendritic ___ potentials rather than ___ potentials.

bipolar, irritability, temper, 3, 1, irritable, 10, 6, 18,

Disruptive Mood Dysregulation Disorder: -emerged as a diagnostic entity partly from the study and controversy surrounding pediatric ___ disorder -diagnosis in children with chronic, severe, persistent ___ and frequent ___ outbursts -temper outbursts occur ___ or more times per week for at least ___ year -between temper outbursts, children are observed by others to have a persistently ____ mood -onset of illness must be made before age ___ -diagnosis cannot be made before age ___ or after age ___

set stage, review genogram, develop hypotheses

what are the three preconference interview tasks?

before, chronic, stable, history, episode, another

Distinguishing Between Personality Pathology and Another Psychiatric Disorder -personality disorders by definition have an onset ___ early adulthood, are ___, and are relatively ___ -careful ___ and evaluation of symptoms, complemented if possible by history from a family member, is an essential diagnostic tool when it comes to ruling out or ruling in a personality disorder -A personality disorder should not be diagnosed if the relevant symptoms are present only during an ___ of another psychiatric disorder or can be attributed to ___ psychiatric condition

CNS, medical, changes, CNS, chronic, older, medical, change, disorder

Distinguishing Between Personality Pathology and Physiological Manifestations of Another Medical Condition -Medical disorders that affect the ____ can cause personality changes on a physiological basis and may appear to present as personality pathology. -a complete ___ history and evaluation should always be part of the clinical assessment of patients being evaluated for personality pathology -Strokes, brain tumors, demyelinating diseases, and Alzheimer's disease can at times present with personality ___ that may mimic a personality disorder -Suspicion of an underlying medical cause for personality changes should be elevated in patients already carrying a diagnosis of a ____ disorder or a ____ systemic medical condition, as well as in ___ patients, who are at elevated risk for medical illness. -When enduring changes in personality arise as a result of the direct physiological effects of a ____ condition, personality ____ due to another medical condition should be diagnosed rather than a personality ____

stimulants, high, low, insomnia, weight, tics

Drugs for ADHD: -____ such as methylphenidate and amphetamine are the most common drugs -___ doses of these drugs results in hyperactivity -____ doses can focus attention, improve executive function, and reduce motor activity -adverse effects: ___, ___ loss, motor or vocal ___

sleep spindles, K complexes

EEG Rhythm: -both are seen in stage 2 of non-REM sleep -muscle tone is reduced during this time

theta

EEG Rhythm: -can be seen during stage 1 non-REM sleep -transition stage from wakefulness to sleep

delta

EEG Rhythm: -characteristic of stage 3 non-REM sleep -reflecting a further reduction in arousal and muscle tone

beta

EEG Rhythm: -occurs when attention is focused on something -produced by any form of sensory stimulation or mental concentration (solving math problems)

alpha

EEG Rhythm: -occurs when you are awake but at rest with the mind wandering and the eyes closed -decreased levels of attention

dendritic postsynaptic potentials, action

EEG is a measure of the summation of ___ ___ ___ rather than ___ potentials

dendrites, propagated potentials, dendrites, potential fluctuations, negative, depolarized, hyperpolarized

EEG: -The ___ of the cortical neurons are a forest of similarly oriented, densely packed units in the superficial layers of the cerebral cortex -___ ___ can be generated in dendrites -recurrent axon collaterals end on ___ in the superficial layers -flow into and out of the dendrites produces wavelike ___ ___ in a volume conductor -When the sum of the dendritic activity is ___ relative to the cell body, the neuron is ___ and hyperexcitable; when it is positive, the neuron is ___ and less excitable.

perception

Mental Status Examination Category: -Assessment of perceptual symptoms: illusions, depersonalization, derealization, hallucinations -normal: Denies auditory and visual hallucinations -abnormal: specify type of hallucination and describe

20

Elderly Sleeping: -total REM sleep time is ___%

primary, secondary

Encopresis is "___" in a child who has never achieved bowel control; it is "___" in a child who has previously had regular toileting behavior.

cognitive

Mental Status Examination Category: -Assessment of the individual's abilities with regard to attentionand orientation as well as intellectual functions, including memory, calculations, fund of knowledge, and capacity for abstract thought -normal: altert, attentive, and oriented X3 -abnormal: describe findings of each

rapport, communication, emotional, decision, respected

Interpersonal Factors and Behavior Change: -The established ___ between the patient and the physician determines whether the patient will willingly follow a physician's recommendations -Physician ___ improves rapport with patients, predicting how patients will adhere -When patients feel that their ___ needs as well as their physical needs are being attended to by their physicians and that they are active participants in the ___-making process, they feel more ___, making them more satisfied and more likely to follow recommendations

behavior therapy, diurnal, nocturnal, desmopressin, TCA, 15

Enuresis Treatment: -___ ___ with positive reinforcement (taught to recognize urge to urinate and exercise muscles) -___ component should be addressed first -____ enuresis can be treated by restricting fluid intake, waking the child a few hours after falling asleep -if behavioral approaches not working, child may benefit from ___ or a ___ like imipramine -has a spontaneous remission rate of ___% per year -most do not go into adulthood

nocturnal only

Enuresis Types: -the most common type -refers to urination that occurs exclusively during sleep -takes place during first third of sleep cycle -do not diagnosis before 6 years

diurnal only

Enuresis Types: -urge incontinence and voiding postponement -urge incontinence: sense the need to void urgently and accidents ensue -voiding postponement: often too preoccupied with other activities to attend to bodily cues

pathogenic experiences, aggression, abuse, abandonment, family, emotional, trauma, abuse

Environment and Personality Disorders: -in borderline and narcissistic personality disorder, ___ ___ (excessive frustration, parental unresponsiveness) early in life are thought to amplify an inborn propensity toward ___, leading to chronic rage and the development of pathological or "primitive" defense mechanisms that attempt to diminish anxieties -high frequency of physical and sexual ___ as well as ___ and traumatic neglect in the early lives of adults with borderline personality disorder -___ dysfunction, ___ neglect, and parental psychopathology are cited as risk factors that may interact with a history of abuse in the etiology of the condition -Studies of antisocial personality disorder also point to a high frequency of early ___ and ___, often at the hands of caretakers who themselves may have impulsive and antisocial traits as well as high rates of substance abuse.

identity vs role confusion

Erikson's Stages of Pyschosocial Development: -12-18 years -adolescence -who am I and what is my role?

autonomy vs shame and doubt

Erikson's Stages of Pyschosocial Development: -18 months-3 years -toddler -with increased independence, will I be able to do things by myself and develop self-control?

intimacy vs isolation

Erikson's Stages of Pyschosocial Development: -19-40 years -adulthood -how will I contribute to the next generation?

initiative vs guilt

Erikson's Stages of Pyschosocial Development: -3-6 years -preschool -can I engage and succeed in challenging tasks without becoming overly frustrated and then guilty?

generativity vs stagnation

Erikson's Stages of Pyschosocial Development: -40-65 years -adulthood -how will I contribute to the next generation?

industry vs inferiority

Erikson's Stages of Pyschosocial Development: -6-12 years -school-age -do I have the ability to do the work that I need to succeed?

ego integrity vs despair

Erikson's Stages of Pyschosocial Development: -65 years+ -adulthood -have I lived a good life? am I fulfilled and do I accept my life as I have lived it?

basic trust vs mistrust

Erikson's Stages of Pyschosocial Development: -birth-18 months -infancy -is my world trustworthy and dependable?

judgement

Mental Status Examination Category: -Closely related to insight but refers specifically to actions the individual will take based on insight; usually reflects impulse control -normal: intact, excellent -abnormal: Fair, impaired (include explanation)

comorbidity, affect, personality, after

Evaluating the Patient for Comorbid Personality Disorders -There is a high rate of ___ among the personality disorders. -The presence of comorbid personality disorders will often profoundly ___ prognosis and treatment planning. -As a result, in the same way that it is important to do a complete review of systems in every medical patient, it is important to do a complete evaluation of ___ functioning in every psychiatric patient. -This remains true even ___ a patient has met the diagnostic criteria for a particular personality disorder.

acute, acute, premorbid, substance, posttraumatic stress disorder

Evaluating the Patient with Other Psychiatric Disorders and Comorbid Personality Pathology -Because other psychiatric disorders can mimic and complicate the presentation of personality disorders, it can be difficult to make a reliable personality disorder diagnosis in a patient presenting with ___ symptomatology -even though it is customary to defer diagnosing personality disorders until ___ symptoms resolve, it is clinically useful to attempt to evaluate ___ personality functioning if at all possible, especially if the physician is able to obtain a clear, detailed, and accurate description of the patient's baseline functioning from others -When evaluating patients with a history of ___ use disorders, it is necessary to distinguish between baseline personality pathology and behaviors that are sequelae of substance use or efforts to obtain drugs -If personality pathology appears to have emerged or have been exacerbated after an individual has been exposed to extreme stress, a diagnosis of ____ ___ ___ should be considered.

hearing

Every child with a speech delay should receive an audiogram to rule out a ___ impairment

affect

Mental Status Examination Category: -Objective description of the individual's emotional state as observed by the clinician -normal: full range -abnormal: Constricted, blunted, flat, inappropriate, labile

agenda, goals, priorities

what are the three things that need to be set in an interview?

developmental disability with lowered IQ

what condition results in problems with understanding of consent?

attachment

what is Ainsworth/Bowbly's area of focus?

develop discrepancy, avoid argumentation/roll with resistance, express empathy, support self-efficacy

Five Key Elements of Motivational Interviewing: (DARES)?

aggression, destruction, deceitfulness, lying, rules

Four Categories of Conduct Disorder: 1) ___ toward people and animals (bullying, fighting, cruelty) 2) ____ of property 3) ____ or ____ (lying, conning, stealing, breaking into homes) 4) serious valuation of ___ (failure to adhere to social norms and expectations)

psychosocial development

what is Erikson's area of focus?

psychosexual development

what is Freud's area of focus?

biological development and milestones

what is Gessell's area of focus?

girls, somatic, anxiety, more, avoidance

General Features of Anxiety, Obsessive-Compulsive, and Stress Disorders: -___ are more likely to report anxiety -___ complaints are very common among children with anxiety disorders -____ can manifest as crying, tantrums, freezing, or clinging -adolescents worry ___ about appearance and social skills and academic performance -___ of social, academic, and generally independent settings can adversely impact development

rapport, know, interpersonal, safe, communication, goals discussion, information, strengths, resources, supports

General Principles for Interviewing Families: 1) Socialize and develop _____ with the family; get to ____ each member; accommodate the ____ style of family members; create an environment in which each family member feels _____ and supported. 2) Organize the group so that _____ is clear; establish _____ for the interview that are concrete, mutual, and attainable. 3) Gather information and facilitate ____ from each person present about the issue of concern; transmit ____ about the medical issues involved, as is appropriate. 4) Identify ____, _____, and ____ that are available to the family.

thalamus, cerebral cortex, thalamic

Generalized Onset Epilepsies: -generalized-onset seizures arise from the reciprocal firing of the ___ and ___ ___ -stimulation of midline ___ structures triggered EEG rhythms in the cortex similar to spike and wave discharges of absence seizures

rare, susceptibility, 70, channels, de novo

Genetics Epilepsy: -genetic causes are solely responsible for ___ forms inherited in autosomal dominant or recessive manner -genetic causes can also cause common forms like dragnet syndrome, JME, or childhood absence epilepsy, most from inheriting two or more ___ genes -mutations in more than ___ genes are known to contribute to epilepsy (many in genes that encode voltage or ion ___) -many of the mutations arise ___ ___

cognitive development

what is Piaget's area of focus?

disruptive mood dysregulation disorder

what is an alternative to pediatric bipolar disorder?

why, how, side effects, afford, religious, depressive, anxiety, neurocognitive, maladaptive

High Risk Groups for Poor Adherence: -those patients who do not know ___ a particular medication is being prescribed or ___ they are supposed to take it. -Patients who do not know in advance what ___ ___ can be expected are also less likely to be adherent. -patients who cannot ___ medications -those who have family cultural or ___ biases against taking medications -Patients with psychiatric disorders due to another medical condition; patients with primary psychiatric disorders, including psychotic, ___, and ___ disorders; as well as patients with ___ disorders may also be especially vulnerable to nonadherence -Patients with ___ emotional and psychological reactions to illness, such as extreme denial, regression, and anger, can also be at risk.

stimulants, dopamine, norepinephrine, prefrontal cortex, presynaptically, normal

Neurobiological Basis of ADHD Treatment: -the ability of ___ to decrease hyperactivity and increase attentional focus is due to modulation of ___ and ___ neurotransmission in the ___ ___ -the drugs act on the transporters located ___ in the terminals -when ___ individuals takes these drugs, they DA/NE transmission is increased to above the normal range, resulting in hyperactivity

social referencing

INFANCY Affect Regulation: -infants realize they can share a subjective state with their caregivers -begin to read the emotional signals of others to modify their behavior

intersubjectivity

INFANCY Affect Regulation: -infants share their inner emotional experiences with others -involves coordination and synchronization of affective and mental states

joint attention

INFANCY Affect Regulation: -share a focus of attention -infant's eyes follow a pointing finger and look back at adult for facial cue to validate that he or she is looking at the correct location

basic trust

INFANCY Affect Regulation: -the feeling of the self and others being essentially all right -adequate responsiveness by the caregiver necessary for the child to develop -precursor to the development of a sense of identity and mastery -groundwork for development of empathy

ion channels, hyperexcitability, GABA, SCN1A, SCN1B

Idiopathic Epilepsies: -genetic in origin -mutations in ___ ___ have been linked, leading to neuronal ____ -the mutated gene responsible for childhood absence epilepsy is mutations in a gene of the ____ receptor -____ and ____ mutations have been identified with generalized epilepsy with febrile seizures (sodium channel subunit genes)

metabolic, thermal, immune

Importance of Sleep: -sleep is needed to maintain ___-caloric balance, ___ equilibrium, and ___ competence

low, high

In general, serotonin appears to play a role in behavioral inhibition such that ___ serotonin activity is linked to impulsivity and aggressive behavior, while ___ levels of serotonin activity have been linked to behavioral inhibition and the personality traits of compulsiveness and conscientiousness associated most prominently with obsessive-compulsive personality disorder.

orexin

In narcolepsy, because ____ tends to stabilize the awake state by stimulating arousal, it has been proposed the decreased levels lead to unstable repeated transitions in and out of REM

nonaderence, mental health, depression, mental

Individual Factors that Affect Behavior Change: 1) mental health issues: -Mental health problems are a predictor of ___ and difficulty with lifestyle change -There is a lack of appropriate diagnosis and recognition of ___ ___ problems by healthcare providers -There is poor adherence in patients with ___ due to cognitive difficulties of lack of motivation relative to their health -___ distress of varying forms reduce adherence to treatment and likelihood of successful health behavior change

volume, temporal, fear

Neurobiology: -antisocial personality disorder have reductions in whole brain ___, particularly in the ___ lobe -antisocial personality disorder has been associated with deficient brain activation in response to ___ conditioning

sleep

what is needed to maintain metabolic-caloric balance, thermal equilibrium, and immune competence?

literacy, chronic, mortality, preventative

Individual Factors that Affect Behavior Change: 2) health literacy -Adherence and health behavior change require that patients have adequate levels of health ___ so they can understand instructions from their physicians and follow through with those directions and recommendations -___ illnesses may be especially difficulty to manage in patients with low health literacy, due to the need for problem solving and active collaboration with the physician -Low health literacy is linked to increased ___, worse health status, poorer clinical outcomes, and chronic illnesses -People with low health literacy use ___ services less often than those with greater health literacy and have more preventable hospitalizations and ER visits

Self-efficacy, adherence, accepts

Individual Factors that Affect Behavior Change: 3) self-efficacy -___-___ may determine an individual's ability to follow through with recommendations or make behavior change a permanent feature of their life -Self-efficacy is linked to ___ and lifestyle changes in patients with rheumatoid arthritis, MS, and DM -People are most likely to change in the presence of a person who ___ them as they are

perceptions, negative, harmful, attitudes, physician

Individual Factors that Affect Behavior Change: 5) individual health beliefs -Patients' health ___ reflect feelings, attitudes, and beliefs about their health status -Patients with poor health perceptions often have ___ emotional states, leading to decreased adherence -If patients believe nonadherence will be ___, they are more likely to adhere to it -Patients' ____ can present barriers to their willingness to change or adhere to a behavior change regimen -When a behavior change regimen in primarily ___-directed, it can be harder for patients to accept and implement lifestyle changes

coping, constructive, control

Individual Factors that Affect Behavior Change: 6) individual coping styles -___ style factors into how an individual will respond or adhere to medication and lifestyle change regimens -People with ___ problem solving styles will be more likely to adhere than those with avoidant or destructive coping styles -How much ___ a patient is given in their treatment regimen can also impact their adherence

personality, hostile, conscientious, conscientious

Individual Factors that Affect Behavior Change: 7) personality -___ may influence adherence and behavior change -___ people tend to have poor adherence, whereas those who are ___ are more likely to adhere -___ individuals pay closer attention to their bodies, get more routine care, and take more preventative measures related to health

insomnia, insomnia, depression, corticotropin

Individuals with persistent episodes of ____ are more likely to experience accidents, a diminished work experience, and a poorer overall quality of life. ____ is often comorbid with ___, and both disorders show abnormal regulation of ___-releasing factor.

basic trust, identity, mastery, empathy, attention, social smile, egocentric, sensorimotor, object permanence, stranger anxiety

Infancy: Birth to 12 months: -Adequate responsiveness by the caregiver allows child to develop ___ ___, which is a precursor to the development of a sense of ___ and ___. This reciprocal relationship also lays the groundwork for the development of ___. -The nature of the newborn infant's first task is social: to ensure the devoted ___ of a loving caretaker. -___ ___: develops at 2 months along with increased eye contact and vocalizations -infants see themselves in an "___" way, as if all events were determined by their own thoughts and actions -___ period of the first 2 years, when children are preoccupied with exploring objects with their hands and mouth -The attainment of ___ ___ at approximately 8 months of age is a major cognitive achievement (out of sight is not out of mind) -___ ___ develops at 7-9 months caused by the ability to recognize someone who is unfamiliar, and thus infants now may react with distress when their caregivers leave or a stranger approaches

cup, sit, babbles, social smile, tooth, peek-a-boo, standing, rolls, no, walks

Infant (birth-1 year): -able to drink from a ___ -able to ___ alone -___ -displays ___ ___ -gets first ___ -plays ___-__-___ -pulls self to ___ position -____ over by self -says mama and dada -understands ___ and stops in response -___ while holding furniture

attachment, motor, communication, autism spectrum, depressive

Infant Developmental Vulnerabilities: -Since the crucial task of the first year of life is the development and solidification of the ___ between infant and caretaker, this relationship is the most vulnerable area with regard to possible disruption by physical illness, developmental disability, or parental psychopathology. -The developmental disorders observed in infants include ___ disorders, in which activities requiring motor coordination, such as crawling or walking, are delayed; ___ disorders, in which speech or expressive or receptive language is delayed; and ___ ___ disorders -Disruption of the parent-infant bond due to parental impairment or loss can lead to a ___ response in the infant, which may be manifested by feeding and eating disorders or by attachment difficulties in infancy or early childhood

stranger anxiety

Infant: -emotional reaction to strangers -after 7-9 months -distress when caregivers leave or a stranger approaches

ventrolateral preoptic area (VLPO)

what promotes non-REM sleep by inhibiting the ascending activating systems that project to the forebrain?

voluntary, informed, capacity

Informed consent is ____ and without restrain or undue influence, provides all the information needed to be truly ____, and is based on patient or surrogate mental ____ to understand.

mild ID

Intellectual Disability Prognosis: -Can usually learn to read but less commonly read to learn, so often undiagnosed in early elementary school (when academic focus is learning to read) and most commonly dx between ages of 10 and 14 (by which time children are reading to learn) -Adolescents tend to be concrete in thinking and, as subtle humor and innuendo become more socially normative, often become isolated from chronological peers -Adults generally can be gainfully employed and live independently, but may need guidance to negotiate social, economic, and other life events.

severe ID

Intellectual Disability Prognosis: -Commonly have significant delays in language and other forms of communication -Have restricted repertoire of words, and signing may play an important role in communication. -Skills rarely exceed the preschool level -Can attend to their own hygiene, toileting, and self-care but, in need of close supervision, commonly live with family or in a community-based group setting.

moderate ID

Intellectual Disability Prognosis: -Demonstrate developmental delay in early childhood -Do not learn to read beyond a second-grade level -Relatively effective communicators and can maintain conversations about daily activities and other concrete topics -Can maintain unskilled or semiskilled jobs and take care of themselves, but generally require a supervised living arrangement.

profound ID

Intellectual Disability Prognosis: -Demonstrate significant impairments in infancy that will persist throughout life. -Depend on others for hygiene, feeding, and other aspects of self-care is the rule. -Require highly structured living environments with constant supervision.

accomplish, ideas, translate, write, propose, priorities

Interview Template: 3) Clarify and Further Develop the Goals... a) Ask the group, "What would you like to make sure we ____ today?" Solicit ____ from each person who wishes to speak. b) ____ each goal so it is clear, concise, and realistic. (e.g., "Today we'll focus on Donna's recent depression and how we can all help her," or, "Today we've agreed to focus on your upcoming move and how to handle your son's diabetes, given the new situation.") c) It is sometimes useful to ____ the goals up on an easel or blackboard so everyone can see and participate. d) ____ any goals you feel are important that the family has not mentioned. Be careful not to propose goals the family is not yet ready to deal with. Take your cue from the family's goals and their reactions to your suggestions. e) Set ____ among the goals. If there are more than two or three, suggest the other goals be addressed at a later time.

concerns, differences, address, concrete, specific, changes, patterns

Interview Template: 4) Solicit each participant's view of the issue or the problem.... A) Allow the family to discuss their shared _____ or _____ with each other (e.g., "Family members often have different views about what the problem is. Today I would like to hear from each of you about how you see the problem"). B) _____ each member of the family, usually beginning with the adult who appears most distant to the issue at hand (e.g., with a child behavior problem, you might address the father first because you have not had contact with him to date about this and because the mother has complained he is uninvolved with the child). C) Help family members to be more _____ and _____ by asking such questions as, "How is this a problem for you?" or "When did this first become an issue?" D) Ask about other recent _____ in the family that could impact on the issue of concern (e.g., moves, illness, death, occupational shifts, marriages, divorces, or births).While keeping focused on the issue at hand, be aware of changes in the family system that influence and are influenced by the presenting concern. E) Observe repetitive family interactional _____: Who talks first? Who contradicts whom? Who provides leadership? Final treatment plans should not go against these patterns, unless specifically planned for and negotiated.

contract, understanding, involvement, repeat, questions, thank

Interview Template: 5) Establish a Plan a) Negotiate a formal or an informal ____ with the family regarding their concerns. Check for each person's ____ of and ____ with the suggested plan. Have each person ____ back what they will contribute. b) Ask if family members have any ____. c) ____ everyone for participating and conclude the encounter.

depression, dementia (alzheimer), delirium

what three conditions result in problems with rationalization of consent?

preoptic neurons, GABA, tuberomamilary neurons, histamine

what two neurons and their neurotransmitter released are in the forebrain that control sleep-wake cycles via these hypothalamic neurons?

historical, subjective

Like the physical examination, the mental status examination does not include ___ information, nor does it include ____ complaints (with the exception of mood, see definition).

Levitiracetam

MOA: Thought that SV2A transmembrane glycoprotein mediates the anticonvulsant effects (GABA release or vesicle recycling) Adverse Effects: somnolence, asthenia, ataxia, and dizziness

Valproate

MOA: produces effects on isolated neurons similar to those of phenytoin and ethosuzimide; inhibits sustained firing induced by depolarization appears to be mediated by a prolonged recovery of voltage activated Na channels from inactivation -Hepatic metabolism Adverse Effects: GI symptoms (anorexia, nausea, vomiting), sedation, ataxia, and tremor -Rash, alopecia, stimulation of appetite have occurred occasionally -Fulminant hepatitis= fatal complication and rare -Acute pancreatitis and hyperammonemia -The most teratogenic of all anti-seizure drugs

Topiramate

MOA: reduces voltage gated Na currents in cerebellar granule cells and may act on the inactivated state of the channel similarly to phenytoin; activates hyperpolarizing K current enhancing postsynaptic GABA A receptor currents and inhibits subtype of glutamate receptor Adverse Effects: somnolence, fatigue, weight loss, and nervousness, can precipitate kidney stones, cognitive impairment

defenses

when ____ are most effective, especially in those with personality disorders, they can abolish anxiety and depression at the conscious level, explaining why they may be reluctant to abandon this behavior

pineal pinealocytes, dark, light, norepinephrine, sympathetic, pineal

Melatonin: -enzymes responsible for its synthesis are found in ___ ___ -secreted into the bloodstream during the ____ period and maintained at a low level during the ___ period, due to ___ released from postganglionic ___ nerves that innervate the ___ gland

appearance/behavior/speech/attitude

Mental Status Examination Category: -A detailed description of the individual as he or she appears during the clinical encounter, including grooming and clothing; motor behavior; the rate, volume, and modulation of speech and interactions with the interviewer

alpha, 13-30, beta

when attention is focused on something, the ___ rhythm is replaced by an irregular ___-___ Hz low-voltage activity ___ rhythm

read, 10, 14, concrete, isolated, social, employed, independently

Mild IQ (50-55 to 70): -can usually learn to ___ but can less commonly read to learn. -often undiagnosed in early elementary school (when the academic focus is learning to read) and is most commonly diagnosed between the ages of ___ and ____ (by which time children generally must be reading to learn) -tend to be ___ in their thinking and, as subtle humor and innuendo become more socially normative, often become ___ from their chronological peers. -They require guidance and supervision to develop appropriate vocational skills and facilitate ___ adaptation. -Adults with mild intellectual disability generally can be gainfully ___ and live ___, but they may need guidance to negotiate social, economic, and other life events.

norepinephrine, dopamine, increases, decreases, hypertension, tachycardia

Modafinil: -MOA: inhibits ___ and ___ transporters and ___ synaptic concentrations of norepinephrine, dopamine, serotonin, and glutamate and ___ GABA levels -side effects: ___ and ___

early, second, communicators, unskilled, supervised

Moderate IQ (35-40 to 50-55): -demonstrate developmental delay in ___ childhood -do not learn to read beyond a ___-grade level but are relatively effective ___ and can maintain conversations about daily activities and other concrete topics. -With appropriate vocational training, individuals with moderate intellectual disability can maintain ___ or semiskilled jobs and take care of themselves, but generally they require a ___ living arrangement.

engage, clarify, own, autonomy

Motivational Interviewing uses a guiding style to (1) ___ with patients, (2) ___ strengths and aspirations, (3) evoke their ___ motivation for change, (4) promote ___ of decision making

change, speech, competence, chronic

Motivational Interviewing: -Purposeful conversation directed at a particular ___ goal -Pays careful attention to ___ and language -Aims to elicit ____ in a well-defined set of skills -Well matched for ___ care

1-2, 2-4, 4-6, 7-12

Neurodevelopmental Infant: 1) __-__ months: visual attentiveness to others; increased vocalization; supports head and chest 2) __-__ months: depth perception; smiles; primitive reflexes decrease; babbling; reaches for object 3) __-__ months: smiles to mother's face/voice; hand-eye coordination; increased vocalizations; sits with support; prehensile grasp 4) __-__ months: cruising; grasp with thumb and finger; first word

cataplexy, daytime, paralysis, sudden, REM, MHC, II, hypocretin (orexin)

Narcolepsy: -sudden loss of voluntary muscle tone (____), an eventual irresistible urge to sleep during ____, and possibly brief episode of total ___ at the beginning or end of sleep -characterized by a ___ onset of ____ sleep (no non-REM and slow-wave sleep) -familial incidence for ___ class ___ antigen (HLA-DR2 or HLA-DQW1) -brains of people with narcolepsy contain fewer ___ (____) producing neurons in the hypothalamus

extreme, flexibly

Normal Personality traits are not ___, and they are ___ and adaptively activated in different settings

fragmented, 10, obstruction, muscle, arousals, total, 1, non-REM, neuromuscular, central

Obstructive Sleep Apnea: -the most common cause of daytime sleepiness due to ___ sleep at night -24% of middle aged men and 9% of women -breathing ceases for more than ___ s during frequent episodes of ___ of the upper airway due to a reduction in ___ tone -the apnea causes brief ___ from sleep in order to reestablish upper airway tone -no reduction in ___ sleep time, but greater time in stage ___ ___-___ sleep -causes are reduction in ____ tone and change in ___ respiratory drive

dementias, 40-50, suicide

Old Age Psychopathology: -The most prevalent psychiatric disorders in elderly persons are the neurocognitive disorders, particularly the ___. -It is a misperception that the elderly are more susceptible to mood and anxiety disorders than are middle-aged adults. -Most psychiatric disorders appear by age ___-___ years. -However, perhaps because of an increase in chronic medical illnesses and a lack of social supports, which are two risk factors for suicide, the incidence of ___ increases among the elderly.

change, retirement, deaths, changing roles, decline

Old Age: -the stability they have achieved over the preceding 40-50 years gives way to great ___ -____: leaves the elderly more involved with and reliant on family and friends -deal with the ___ of family members and friends -___ ___: social configuration affecting elderly; no longer boss or family wage earner -physical and cognitive capacities continue to ___ during old age

improve, conductive disorder, antisocial personality disorder, psychosocial

Oppositional Disorder Treatment: -symptoms generally ___ over time -1/3 develop ___ ___ and as may as 10% ultimately develop ___ __ ___ -____ interventions are first line treatments (problem solving skills and training)

sensorimotor, object permanence, 8

Piaget Cognition Infant: -____ period: first 2 years, when children are preoccupied with exploring objects with their hands and mouth -____ ____: objects exist even when the object is not visible, occurs at ___ months

risk factors

Perhaps most important in terms of overall health costs, adherence to a physician's recommendations for modifying ___ ___ tends to be exceedingly low.

extension, ankle, knee, 20-90, arousal, 1, 3, 4

Periodic Limb Movement Disorder: -rhythmic ____ of the big toe and dorsiflexion of the ___ and ___ during sleep lasting for about 0.5-10 s and recurring at intervals of ___-___ s -EMG shows bursts of activity during the first hours on non-REM sleep and brief signs of ___ -the duration of stage ___ may be increased in stage ___ and ___ decreased

maladaptive, inflexible, broad, expectations, social, adolescence

Personality Disorder Criteria: -presence of an enduring pattern of experience and behavior that is ___, ___, and pervasive, affecting the individual across a ___ range of personal and social situations and deviating markedly from the ___ of an individual's culture -these rigid and maladaptive patterns must lead to clinically significant distress or impairment in ___, occupational, or other important areas of functioning -By definition, personality disorders begin by ___ or young adulthood and are persistent across time

distress, interpersonal, self, success, long, unhappiness, frustration, stress, exacerbate, blame

Personality Disorder Traits: -Causes significant ___ to the person or those around them -___ relationships often profoundly affected -Disturbances in their sense of ___ -Erratic/contradictory behavior patterns and personality traits -Failure to achieve professional ___ in accordance to level of education -Cannot pursue ___-term goals -Chronic ___/dysphoria over many years -Low ___ tolerance -Difficulty coping with ____ -Tendency to respond to adverse events in ways that ___ their problems -Tend to ___ others

rigid, extreme

Personality pathology exists on a spectrum, with traits becoming more ___ and more ____, and interfering with the individual's functioning more profoundly and more broadly, as personality pathology becomes more severe

SSRIs, SSRIs, antidepressants, antipsychotics

Pharmacotherapy for Personality Disorders: -impulsivity and aggression may respond to ____ -Instability of mood may also respond to ___, as well as to other ___ and mood stabilizers. -Psychotic-like experiences may respond to low-dose ___, as may symptoms of anxiety in patients with schizotypal personality disorder.

genogram, hypotheses, chart

Postconference Tasks: 1) revise the ___ (record any new information or correct any previous misconceptions 2) revise the ___ (use info the refine plan for future treatment) 3) document the meeting in the patient's ___

contact, rationale, who, discussed, set, genogram, cycle stage, goals, hypotheses, strategy

Preconference Tasks: 1) set the stage: -choose your person of ___ (capable adult) -establish a ___ (purpose of conference) -establish ___ in the patients network will attend -clarify with the patient what may be ___ in the conference -___ the appointment 2) review the ___: -represent the most up-to-date picture of patient and family (names, ages, marital status, children, illness, occupations) -note the patient and family ___ ___ 3) develop hypotheses: -set your own ___ for the interview -develop tentative ___ (acute grief reaction in middle aged man with chest pain from best friend funeral) -develop a ___ for conducting the conference (prepare questions and tasks)

preoperational

Preschool 3-6 Years Cognitive: -2-4 years: ____ thought (intuitive rather than logical, egocentric)

3-4, 4-5

Preschool 3-6 Years Neurodevelopmental: 1) __-__ years: examines picture books, hops on one foot; rules of grammar; draws a square 2) __-__ years: understands 2000 words; draws a triangle

oedipal

Preschool 3-6 Years Psychosexual: -___ stage: competitive relationships

control, initiative, guilt, oedipal, triadic, imaginative, cooperatively, superego, internal moral, preoperational, sexual

Preschool Child: (3-6) -enhanced sense of mastery and ___ -____ vs ____ and the ___ stage -____ relationships: understanding that people may have relationships with each other outside of the child's relationship with them -____ play and being able to play ___: -permitting the emergence of the ___: an internal agency that guides them morally and produces guilty feelings when they have done something wrong -____ ___ standards start to take shape, accompanied by a sense of self-discipline -____ level of cognition: child becomes aware of time as a continuum with past, present, and future -____ behavior is not uncommon in preschoolers and may include a wide continuum of behaviors, including touching their own genitalia or those of others, interest in looking at naked people, inquiring about sexual organs and acts, watching people on the toilet, expressing interest in pregnancy and birth

communication, ADHD, anxiety, adjustment, elimination, gender dysmorphia

Preschool Developmental Vulnerabilities: -psychopathology includes ____ disorders (entry into school allows language problems to be identified because child in environment w/ ppl not familiar with ways of talking) -children with ___ may begin to clearly differentiate themselves from other children who are better able to tolerate the transition into more structured class settings -____ disorders may manifest themselves (specific phobias seen at this age/PTSD) -___ disorders: may result for a specific event, such as an illness, parental divorce, move, or birth of new sibling, and may be manifested in mood or behavioral changes -____ disorders: occur in this age group -___ ___: may have its onset during this time period

circle square, stick figures, skip, balances, written, bounced, independently, rhymes, school, size, time

Preschooler (3-6 years): -able to draw ___ and ___ -able to draw ___ ___ -able to ___ -___ better, may begin to ride bicycle -begins to recognize ___ words -catches a ___ ball -enjoys doing most things ___ -enjoys ___ and word play -starts ___ -understands ___ concepts -understands ___ concepts

schizophrenia, B, avoidant

Schizotypal personality has been found to be genetically associated with ___, while traits such as impulsivity, affective instability, stimulus seeking, hostility, and callousness, many of which are associated with the cluster ___ personality disorders, appear to be highly heritable. In addition, harm avoidance, physiological arousal, trait anxiety, and social anxiety are seen in family members of individuals with ___ personality disorder.

infancy, Dependence, structured, constant

Profound IQ (below 20-25): -demonstrate significant impairments in ___ that will persist throughout life. -___ on others for hygiene, feeding, and other aspects of self-care is the rule. -With intensive intervention some improvement in self-care may occur, but these individuals require highly ___ living environments with ___ supervision.

pons, amygdala, cingulate gyrus, prefrontal, parietal, visual association, primary visual cortex, emotion

REM sleep: -increased activity in ___ area, ___, and anterior ___ ___ -decreased activity in ___ and ___ cortex -activity in ___ ___ areas is increased, but activity is decreased in the ___ ____ ___ -this is consistent with increased ___ and operation of a closed neural system cut off from the areas that relate brain activity to the external world

pineal pinealocytes

where are melatonin and enzymes responsible for its synthesis from serotonin found?

strengths, vulnerabilities, vulnerabilities, cultural, cultural

Psychiatric Diagnosis: -The biopsychosocial approach describes the patient's ___ and ___ and helps to convey the patient's uniqueness. -____ can also be labeled as possible predisposing or precipitating factors. -In recent years, the biopsychosocial approach has been expanded to include a ___ formulation, which considers the patient's symptoms, stressors, supports, vulnerability, and resilience in relation to his or her ___ reference group.

anal, separation, individuation, oppositional

Psychosexual Toddler (1-3): -___ stage: issues of emerging control and autonomy symbolically enacted in ambivalence over toilet training -___ and ____ -____ stage: terrible twos, everything is no, battle of the potty

reduce, glutamte, pontine, glycine, medulla, spinal cord, LMN, motor, pontine reticular formation

REM Sleep: -Brainstem cholinergic neurons also activate another class of REM-on cells in the pons that markedly ___ muscle tone during REM sleep -These presumably ___ REM-on cells, located in the ___ reticular formation, ACTIVATE circuits involving the inhibitory transmitter ___ in the ___ and ___ ___. As a result, ___ are inhibited, causing markedly decreased muscle tone -Lesions or degeneration of this system (sometimes seen as a precursor of parkinsonism or related disorders) abolishes the normal inhibition of ___ activity during REM sleep, resulting in complex activities during dreaming, a condition called REM sleep behavioral disorder. -Although tonic muscle activity is inhibited during REM sleep, there are brief phasic movements during REM sleep, such as rapid eye movements that occur during the waking state as well and are activated by neurons located in the ___ ___ ___.

eye, EOG, eye, skeletal, increased, pons, LGN, occipital, PGO spikes

REM Sleep: -gets its name from the characteristic rapid, roving ___ movements that occur during this stage of sleep and are recorded as an ____ -except for ___ movement, there is almost a complete loss of ___ muscle tone -the threshold for arousal from sleep is ____ during this time -there are large phasic potentials that originate in the cholinergic neurons in the ___ and pass rapidly to the ___ and to the ___ cortex called ___ ___

pontine, GABA, VLPO, norepinephrine, locus coerulus, lateral tegmental area, serotonin, raphe nuclei, orexin, silent, cholinergic, thalamus

REM Sleep: -located in the _____ reticular formation -activation of these ___ REM cells with neurons from the ___ inhibit monaminergic transmission (particularly ___ release from ___ ___ and ___ ___ ___, and ___ release from ___ ___) -activity in ___ neurons is reduced as well -noradrenergic and serotonergic cells are ____ during REM sleep, increasing ___ transmission to the ____ during REM sleep (making it resemble wake state)

less, serious, more, worse

Regimen-Related Factors that Affect Behavior Change: 3) The disease condition itself -Patients who are ___ healthy are more adherent, but only when their disease conditions are less ___ -Patients whose conditions are ____ serious, and are in ___ health, are less likely to be adherent, likely due to the nature of their illnesses (physical and psychological limits) and their health beliefs (personal control, causes, prognosis)

weight, down syndrome, PKU, survive, HIV, drugs

Reflecting a combination of improved child health and the emergence of new disease, the prevalence of severe intellectual disability has changed little since the 1940s.... -On the one hand, morbidity for low-birth-___ infants has improved, the incidence of ___ ___ has decreased, and ___ has all but been eradicated. -On the other hand, more extremely low-birth-weight infants (with high rates of disability) ___, and ___ and exposure to ___ of abuse are more prevalent.

routine, habits, instructions, disease, lifestyle change

Regimen-Related Factors that Affect Behavior Change: 1) The degree to which the change affects the individual's daily ___ and ___ of living 2) The ___ patients are given when initiating a new regimen 3) The ___ condition itself 4) ___ ___ regimens, as opposed to simple medication regimens, can be a challenge for many patients because such changes can affect the individual's lifestyle and established behavior patterns

major, complex, long, simpler

Regimen-Related Factors that Affect Behavior Change: 1) The degree to which the change affects the individual's daily routine and habits of living -When treatment regimens require ___ lifestyle changes or are ___, nonadherence can be as high as 70% -Patients may try to follow their regimens and may do so in the short term, but with regimens involving physical therapy and ___-term lifestyle changes, new habits may not lead to long-term adherence -___ medication regimens have been shown to be associated with improved adherence

clear, native, questions, personalized, cultural

Regimen-Related Factors that Affect Behavior Change: 2) The instructions patients are given when initiating a new regimen -When patients are not given ___ instructions, in their ___ language, and with the opportunity to ask ___, they may not understand the reasons, procedures, and doing of their regimens -Improving patient understanding and ultimately patient adherence must involve a regimen and behavioral lifestyle plan that is ___ and tailored to the patient's ___ background

increase, decrease, increase, increase, decrease, decrease, decrease, increase, decrease, increase

Reticular Activity System: 1) Waking: -___ norepinephrine and serotonin, ___ acetylcholine -___ activation of thalamus and cortex -___ histamine -___ GABA 2) Non-REM Sleep: -___ activation of the thalamus and cortex -___ histamine -___ GABA 3) REM Sleep: -____ norepinephrine and serotonin -____ acetylcholine

GABA, pineal, MT1, sleepiness, MT2, synchronize

SCN: -____ neurons in the SCN inhibit neurons in the hypothalamic paraventricular nucleus that eventually goes to the ___ gland -activation of ___ receptors inhibits adenylyl cyclase and results in ___ -activation of ___ receptors stimulates phosphoinositide hydrolysis and may function to __ the light-dark cycle

generalized myoclonic

SEIZURE TYPE: -a brief shock-like contraction of muscles that may be restricted to part of one extremity or may be generalized

generalized absence

SEIZURE TYPE: -abrupt onset of impaired consciousness associated with staring and cessation of ongoing activities -typically lasting less than 30 sec

focal aware

SEIZURE TYPE: -diverse manifestations determined by the region of cortex activated by the seizure lasting approximately 20-60 seconds -preservation of awareness -ex: motor cortex representing left thumb causes clonic jerking of left thumb; somatosensory cortex of left thumb causes paresthesia of left thumb

focal with impaired awareness

SEIZURE TYPE: -impaired consciousness lasting 30 sec - 2 min -often associated with purposeless movements such as lip smacking or hand wringing (automatism)

focal to bilateral tonic-clonic

SEIZURE TYPE: -simple or complex focal seizure evolves into a tonic-clonic seizure with loss of awareness and sustained contractions (tonic) of muscles throughout the body, followed by periods of muscle contraction alternating with periods of relaxation (clonic) -lasting 1-2 min

generalized tonic-clonic

SEIZURE TYPE: -tonic-clonic seizure with loss of awareness that is not preceded by a partial seizure

independence, judgement, concrete operations, latency, industry, inferiority

School Age 6-11 Years: 1) neurodevelopment: mastery of games; increasing ___; academic skills; capacity for ___ 2) cognitive: ___ ___ (rules of logic, categories, serial ordering, reversibility, conservation of mass) 3) psychosexual: ___ stage (strengthened conscience, same-sex peers, new adult role models, empathy, altruism) 4) psychosocial: ___ vs ___

industry, inferiority, self-esteem, flexible, temperamental, idealization, group affiliations, conscience, empathy, concrete operations, gender, latency

School-Age Child: (6-11) -sustained sense of mastery and competence, morality, and stable self-esteem -must either achieve ___ or suffer from ____ -the manner in which important people react to the child's growing abilities and successes. Responses that affirm and validate these developing skills facilitate ___-___ -more emotionally ____ and better able to take care of themselves -____ characteristics: shy, activity, persistence, resilience, quality of mood, follow children from this period and beyond -____ of OTHER role models: sports heroes and teachers (switching from parental figures) -____ ____: need for independence and attachment -___ evolves during this period, developing ___, internal guilt, and concern for what is morally right -___ ___: joining, ordering, classification, reversibility, numbers, measurement -further development of ___ identity; usually prefer same sex peers, develop boy vs girl characteristics -____ phase: sexual curiosity present in earlier childhood becomes dormant, not to be reactivated until adolescence

academically, socially, learning, ADHD, communication, OCD, anxiety, mood, adjustment, tic

School-Age Developmental Vulnerabilities: -Potential dangers during this phase of life are related to the child's ability to successfully navigate pressures to perform ___ and ___. -Children who have specific ___ disorders or ___ often first manifest problems when they enter school (if not addressed, problems with self-esteem) -____ disorders: interfere with mastery of academic tasks -____ is likely to be first diagnosed in this age group -___ disorder may be seen in children at this age -disorders affecting ____ can have their onset -____ disorders: which can be associated with mood and behavioral changes as well as anxiety, can also occur -___ disorders occur in this age range. Simple tics are particularly common in school-age boys and are usually transient.

suprachiasmatic nucleus, melatonin, retina, retinohypothalamic, GABA, paraventricular, sympathetic, intermediolateral, sympathetic, superior cervical, melatonin, pineal

Secretion of melatonin. -The cyclic activity of the ___ ___ sets up a circadian rhythm for ___ release. -This rhythm is entrained to light/dark cycles by neurons in the ___. -Light signals are relayed via the ___ fibers to the SCN. -___ neurons in the SCN inhibit neurons in the hypothalamic ____ nucleus (PVN) which then reduces the activity of ____ preganglionic neurons in the spinal ___ nucleus (IML). -These ___ preganglionic neurons innervate postganglionic neurons in the ___ ___ ganglion (SCG) that regulate release of ___ from the ____ gland.

brainstem, hypothalamus, norepinephrine, serotonin, acetylcholine, histamine, forebrain, preoptic neurons, GABA, tuberomamilary neurons, histamine, orexin

Sleep and Arousal: -nuclei in the ___ and ___ are critical for the transition between states of consciousness -the brainstem ascending arousal system is comprised of several groups of neurons that release ___, ___, ___, or ___ -the ____ is also involved in the control of the sleep-wake cycles via hypothalamic ___ ___ that release ___ and ___ ___ that release ___ -hypothalamic neurons release ___ to play a role in switching between sleep and wakefulness.

therapeutically, educational, individualized, social interaction, counseling

Treatment of Intellectual Disability: -associated impairments in hearing, vision, speech, and language must be assessed and ___ addressed -appropriate ____ program to maximize academic and social potential -all child should have an ___ educational plan -opportunities to facilitate ___ ___ with chronological and mental age peers -families require education, support, and ____ to address special needs

language, restricted, preschool, hygiene

Severe IQ (20-25 TO 35-40): -commonly have significant delays in ___ and other forms of communication -Children who do learn to talk have a ___ repertoire of words, and signing may play an important role in communication. -Academically, skills rarely exceed the ___ level. -Most individuals with severe intellectual disability can attend to their own ___, toileting, and self-care but, in need of close supervision, commonly live with family or in a community-based group setting.

ascending arousal system, wakefulness, REM sleep

Sleep to Wakefulness Transition: -involves alternating reciprocal activity of different groups of neurons in the ___ ___ ___ -___ and ___ ___ are at opposite extremes

T, Ca2+, negative, T

Thalamic Neurons, Absence Seizure: -low threshold ___-type ___ current that are activated at a much more ___ membrane potential than most other voltage-gated Ca2+ channels in the brain -___-type currents amplify thalamic membrane potential oscillations, with one oscillation being the 3-Hz spine and wave discharge in absence seizures

responsibility, self, intimate, independence

Stages of the Family Life Cycle: 1) leaving home: single young adults -accepting emotional and financial ___ for self a. Differentiation of ___ in relation to family of origin b. Development of ___ peer relationships c. Establishment of self rework and financial ___

commitment, marital, include,

Stages of the Family Life Cycle: 2) the joining of families through marriage: the new couple -___ to new system a. Formation of ___ system b. Realignment of relationships with extended families and friends to ___ spouse

accepting, marital, relationships

Stages of the Family Life Cycle: 3) families with young children -____ new members into the system a. Adjusting ___ system to make space for child(ren) b. Joining in childrearing, financial, and household tasks c. Realignment of ___ with extended family to include parenting and grandparenting roles

flexibility, adolescent, issues, older

Stages of the Family Life Cycle: 4) families with adolescents -increasing ___ of family boundaries to include children's independence and grandparents' frailties a. Shifting of parent child relationships to permit ___ to move in and out of system b. Refocus on midlife marital and career ___ c. Beginning shift toward joint caring for ___ generation

exits, entries, adult, grandchildren, disabilities, death,

Stages of the Family Life Cycle: 5) launching children and moving on -accepting a multitude of ___ from and ___ into the family system a. Renegotiation of marital system as a dyad b. Development of adult to ___ relationships between grown children and their parents. c. Realignment of relationships to include in-laws and ___ d. Dealing with ___ and ___ of parents (grandparents)

generational, decline, middle, wisdom, death

Stages of the Family Life Cycle: 6) families in later life -accepting the shifting of ____ roles a. Maintaining own and/or couple functioning and interests in face of physiological ___; exploration of new familial and social role options b. Support for a more central role of ___ generation. c. Making room in the system for the ___ and experience of the elderly, supporting the older generation without over functioning for them d. Dealing with loss of spouse, siblings, and other peers and preparation for own ___. Life review and integration

SCN, hypothalamus

The ___ of the ___ receives retinal inputs and is crucial for setting circadian rhythms and synchronizing them with the light-dark cycle.

dopamine, norepinephrine, prefrontal cortex, ventral tegmental area, locus coeruleus, deficient,

Stimulants: -The ability of stimulants to decrease hyperactivity and increase attentional focus in both normal and ADHD subjects is thought to be due to modulation of ___ and ___ neurotransmission in the ___ ____ -Specifically, DA inputs to the prefrontal cortex arise from the ___ ___ ____, while NE inputs arise from the ___ ___ -It is thought that those that suffer from ADHD most likely have ___ DA/NE transmission in the prefrontal cortex, resulting in poor attention, diminished executive function and increased hyperactivity

simplify, lifestyle, simple, mental, self-efficacy, beliefs, attitudes, coping, resources, social, communicate

Strategies Clinicians can use to Address Psychosocial Barriers to Health Behavior Change and Adherence: -____ regimen or plan -adjust change to fit individual's ____ -provide clear, ___ instructions -be aware of undiagnosed ___ health issues -encourage ____-____ -uncover health ____ and ____ -promote active, problem-focused ____ -identify ____ to support low SES individuals -endorse the receipt of ___ support -____ openly and collaboratively

informed, side effects, praise, problems, simple, again, family,

Strategies to Improve Adherence: -Patients should be ___ that poor adherence is extremely common and that they must work with the physician to combat this almost inevitable intrusion into the treatment. -Patients should be educated about the risks and ___ ___ that can occur from irregular use of medications. -physician should ___ favorable results and explore adherence ___ with the patient without reprimanding the patient or making moral judgments -The regimen should be made as ___ as possible. -before leaving, the physician should check ___ to make sure that the patient understands how to take the medication and that the patient's questions about it have all been answered -It is helpful to review information about medications when a ___ member is present.

autonomy, tantrums, anal, autonomy, shame and doubt, symbolic, internal representations, contradictory, object constancy, transitional object, 2-3

TODDLER: (1-3) -emergence of ____: become a socially detached, separate, autonomous being, terrible twos contrary behavior -alternates between clinging to and pushing away caregivers -___: if child becomes frustrated when attempting to comply with the plethora of adult demands and requests -____ stage: child's growing mastery over his or her body and actions -____ vs ___ __ ___ (children shamed may develop self-esteem problems) -____ thought in function and play occurs, as well as language -___ ____: stable images in memory; contributes to separation anxiety -children view people as completely good or completely bad and cannot reconcile ___ feelings toward the same person -___ ___: 24-36 months; carry more stable image of parent in mind and recognize people can be nice and mean and they are the same person -____ ____: stuffed animal or blanket to serve as an intermediary the represents the parents -gender identity is established by __-__ years and can recognize themselves in the mirror

language, family, social, health, religion

The components of a person's culture that are relevant to the psychiatric interview include ___, ___ structure, ___ and community structure, concepts of ___ and illness, ___ and spirituality, ways of seeing and understanding the world, as well as general beliefs about the stages of the life cycle.

cognitive, functional impairment, mild, severe, communication

The course of intellectual disability is contingent upon the degree of ___ and ___ ___. In ___ intellectual disability, adaptive functioning is highly variable and does not correlate with IQ, but in ___ intellectual disability, adaptive functioning and IQ tend to be closely correlated. Across subtypes of intellectual disability temperament varies, but significant impairments in ___ may generate frustration and aggressive behavior.

borderline

The predominant cognitive-behavioral view of the development of ____ personality disorder emphasizes an early environment that consistently invalidates the subjective experience of children who have inborn difficulties with emotional regulation.

habit reversal training, haloperidol, pimozide

Tic Disorder Treatment: -___ ___ ___: a modified form of cognitive-behavioral therapy, has been shown to be efficacious -___ and ___ are FDA approved for the treatment of Tourette's disorder, but they can produce significant adverse effects, including sedation, cognitive dulling, and extrapyramidal symptoms

self-esteem

There are "late developers" in both sexes, which can have profound consequences for ___-___, as adolescents place great importance on body image, comparisons with peers, and sexual attractiveness.

avoidant

There is a high co-occurrence of ___ personality disorder with social phobia, as well as with a broad spectrum of other anxiety disorders

stress, early adulthood, OCD

Tic Disorder Prognosis: -tics worsen during ___ -Frequently, tics are most severe between 10 and 12 years of age, but diminish or disappear by ___ ___ -as tics diminish, other psychopathology, most commonly ___, may emerge

feed, line, run, name, stairs, tricycle, name, dresses, imitates, share, color, males, females, words

Toddler (1-3 years): -able to ___ self neatly -able to draw a ___ -able to ___, pivot, walk backwards -able to say first and last ___ -able to walk up and down ___ -begins pedaling ___ -can ___ pictures of common objects and point to body parts -___ self with little help -___ speech of others -learns to ___ toys and take turns -recognizes and labels ___ -recognizes differences between ___ and ____ -uses more ___ and understands simple commands

attachment, bedtime, behaviors, vulnerable, motor, communication, autism spectrum, reactive attachment, intellectual disability, hyperactivity

Toddler Developmental Vulnerabilities: -As during infancy, the main area of vulnerability in the toddler's emotional development is the caretaker-child relationship and ___ -___ fears are frequent in toddlers and may be exacerbated by nightmares. Fears of monsters, robbers, or of being alone are especially common -Children are more likely to manifest anxiety in ___, such as increased oppositional or clinging behavior, moodiness, and sleep or appetite disturbances. -___ sense of bodily security and may be upset by the inevitable skin cuts and scrapes -see ___ disorders, ____ disorders, ____ ___ disorders, and ____ ____ disorder -an ___ ___ may also first be suspected in young children -___, impulsivity, and heightened distractibility (compared with same-age peers) may also become apparent during the toddler years. Some children with these traits may later be diagnosed with attention-deficit hyperactivity disorder.

13-18, 16-24, 24-36

Toddler Neurodevelopmental: (1-3) 1) ___-___ months: mouthing stops; first spoken language; gestures to communicate needs; walks and runs independently 2) ___-___ months: horizontal pencil stroke; ongoing toilet training; throws ball overhead 3) ___-___ months: understands 800 words; draws a circle; rides a tricycle

convulsive, tonic, clonic, fast, slow waves, spike, slow waves

Tonic-Clonic Seizures: -most common ___ generalized seizure -associated with sudden onset of contraction of limb muscles (___ phase) lasting 30 seconds, followed by symmetric jerking of the limbs from contraction and relaxation (____ phase) lasting 1-2 mins -there is ____ EEG activity during the tonic phase -____ ____, each preceded by a ____, occur at the time of each clonic jerk -___ ___ persist for a while after the attack

circadian rhythm

Transitions between sleep and wakefulness manifest a ___ ___ consisting of an average of 6-8 h of sleep and 16-18 h of wakefulness

action

Transtheoretical Model of Behavior Change Stages: -Behavior change takes places

contemplation

Transtheoretical Model of Behavior Change Stages: -Individuals acknowledge that they have a problem and are considering change

termination

Transtheoretical Model of Behavior Change Stages: -Individuals have complete confidence in the healthy behavior changes and do not fear relapse

preparation/determination

Transtheoretical Model of Behavior Change Stages: -Individuals plan to take action within the next month, but still are ambivalent about the changes

comorbid

When ___ psychopathology is successfully treated, personality pathology may become less severe or disabling, and treatment for underlying personality pathology may become more effective.

non-REM, 1, 2, 70-100, 3, 4, REM, 90, 25

Young Adults Sleep: -a young adult first enters ___-___ sleep, passes through stage __ and __, and spend __-___ mins in stages __ and ___ -sleep then lightens, and ___ period follows -this cycle is repeated at intervals of ___ minutes throughout the night -REM is ___% of sleep time

speech sound disorder

___ ___ ___ should not be diagnosed if poor articulation is secondary to a medical condition, such as chronic ear infections, hypotonic or incomplete palate, and neurological problems.

language disorder

___ ___ is not diagnosed if the difficulty is secondary to autism spectrum disorder, a speech or hearing impairment, or environment deprivation

developmental delay, developmental, chronological

___ ___ reflects a ___ age that lags behind a ____ age in a child's failure to meet neurodevelopmental milestones

depolarization shift

____ ____ is the intracellular correlate of the interictal spike

gamma hydroxybutyrate

____ ____ is used to reduce the frequency of cataplexy attacks and the incidences of daytime sleepiness in narcolepsy

tics

____ are a side effect of ADHD medication stimulants like amphetamine and methylphenidate

carbamazepine

____ causes a decrease in phenytoin concentration due to CYP enzyme interactions (which also messes with birth control)

anxiety, depression

____ disorders in children, especially those comorbid with ___, have been prospectively shown to decrease the likelihood of living independently, working regularly, and attending school in early adulthood

genetic

____ factors play at least some role in the etiology of all the personality disorders

capacity

____ is a decision hospitalists can make independent of consultants

narrow-band

____ rating scales: -measures symptoms that are relatively specific to a diagnostic entity or category -results help to confirm the diagnosis and ensure that specific features of the disorder or criteria for diagnosis are not overlooked -ex: vanderbilt ADHD scale, anxiety scale, beck depression inventory for youth

broadband

____ rating scales: -screen tests -identify issues in an individual that merit further evaluation -inexpensive and quick -ex: child behavior checklist

generalized

____ seizure: -associated with widespread electrical activity and involve both hemispheres simultaneously

focal

____ seizure: -originate in a small group of neurons and can result from head injury, brain infection, stroke, or tumor -can have localized jerking movements in one hand progressing to arm for 60-90 seconds -auras typically precede onset

general, focal

____ seizures are those that involve both hemispheres widely from the outset; ___ seizures are partial seizures

developmental delay

a child's failure to meet neurodevelopment milestones in the first few years of life

capacity

a functional assessment and a clinical determination about a specific decision that can be made by any clinician familiar with a patient's case

competency

a global assessment and legal determination made by a judge in court

GABAa, Cl-

activation of _____ receptor inhibits the postsynaptic cell by increasing the inflow of ___ ions into the cell, which tends to hyperpolarize the cell (benzodiazepines, barbiturates)

disruptive mood dysregulation disorder

although ___ __ __ __ is in many ways similar to severe mood dysregulation or pediatric bipolar disorder, rates of conversion to bipolar disorder are very low, but they can develop major depressive and anxiety disorders

increases release of dopamine and norepinephrine (reverses transporters)

amphetamine MOA?

regimen

an important area of influence of behavior change involves factors related to an individual's ____ (complicated dietary plan is more difficult for a patient to incorporate into their lifestyle than simple recipes)

motivation

an intrinsic process that arises out of discrepancy when the values/goals conflict with the current behavior

Na+, Ca2+

anti-FOCAL seizure drugs inhibit voltage-activated ____ channels; anti-ABSENCE seizure drugs inhibit voltage-activated ____ channels

inhibits reuptake of norepinephrine

atomoxetine MOA?

bipolar disorder

between 20-40% of prepubertal children who present with a major depressive episode later develop ___ ___

OCD, ADHD, major depressive disorder, autism spectrum disorder

children with TICS commonly have comorbid psychiatric disorders like ___, ___, ___ ___ ___, ___ __ ___, and symptoms of impulsivity and aggression

reduce, raise

drugs that enhance GABA mediated synaptic inhibition ____ neuronal excitability and ___ the seizure threshold

suprachiasmatic nuclei, melatonin

efferent fibers from the ____ ____ initiate neural and humoral signals that entrain circadian rhythms like the sleep-wake cycle and ___ release from the pineal gland

feces, 4

encopresis is the repeated passage of ___ into inappropriate places in an individual at least ___ years of age

control, constipation, social, educate, retraining, early puberty

encopresis treatment: -promoting an internal sense of ____ for toileting is the goal -when ___ is present, GI can assist with bowel excavation -recognition and discussion of the ___ difficulties with soiling -___ the child about the GI system -bowel ____ with positive reinforcement -usually resolves by ___ ___

primary, secondary

enuresis is ___ in a child who has never achieved bladder control (most common) and ___ in a child who previously has for at least 3 months

urine, 5

enuresis is the repeated voiding of ___ into bedding or clothing by a child with a chronological or developmental age of at least ___ years

consciousness, orientation, memory, cognitive ability

full mental status testing includes the assessment of level of ___, ___ (to time, place, and person), ___ (immediate recall, short-term memory, intermediate memory, long-term memory), and ___ ___

4-6

how many REM periods occur per night?

increased

if humans are awakened every time they show REM sleep and then permitted to sleep without interruption, they show ____ REM sleep for a few nights

language

in autism spectrum disorder, ___ development and ability are the best predictors of functioning outcome, and early interventions has significant improvements by age 5

6-11, react

in children __-___ years of age, a major determinant in the development of a sense of competence is the manner in which important people ___ to the child's growing abilities and successes. Responses that affirm and validate these developing skills facilitate self-esteem

limited prosocial emotions

in conduct disorder, ___ __ ___ is specified when an individual persistently displays over at least 12 months in multiple settings and relationships lack of remorse of guilt, lack of empathy, absence of concern of performance, shallow affect

localized, thalamus, cerebral cortex

in contrast to focal seizures, which arise from ___ regions of the brain, generalized-onset seizures arise from the reciprocal firing of the ___ and ___ ___

conduct disorder

in oppositional defiant disorder, there is not serious violation of other's rights like in ___ ___

counterprojection

in situations where the patient uses projection, the technique of ___ is especially helpful where clinicians acknowledge and give paranoid patients full credit for their feelings and perceptions and do not dispute patient's complaints or reinforce them

easier

it is ____ to awake an individual from REM sleep than from stage 3 or 4 of non-REM sleep

birth-18, 18-3, 3-6, 6-12, 12-18, 19-40, 40-65, 65

list Erikson's stages in order? 1) basic trust vs mistrust 2) autonomy vs shame and doubt 3) initiative vs guilt 4) industry vs inferiority 5) identity vs role confusion 6) intimacy vs isolation 7) generativity vs stagnation 8) ego integrity vs despair

reverses dopamine transporter (increases dopamine)

methamphetamine MOA?

blocks reuptake of dopamine and norepinephrine

methylphenidate MOA?

inhibits reuptake of dopamine and norepinephrine

methylphenidate MOA?

dopamine, norepinephrine, deficient

moderate levels of ___ and ___ in the prefrontal cortex are needed for optimal cognitive and behavioral function, but in ADHD individuals, they are ___

the righting reflex

most patients are ambivalent about unhealthy behaviors and when a physicians see an unhealthy/risky behavior, the natural instinct is to point it out and advise change, but the patient's natural response is to defend the opposite (no change) side of ambivalence

clonic

muscle contraction alternating with periods of relaxation

high, Na+, inactivation

neurons during focal seizures: -neurons undergo depolarization and fire action potentials at ___ frequencies -drugs can inhibit this by reducing the ability of ___ channels to recover from ___

medullary, nucleus solitarius, hypothalamus, GABA, VLPO

non-REM sleep: -___ reticular formation and ___ ___ in medulla, anterior ____, and basal forebrain -____ neurons in the ____ of the anterior hypothalamus send inhibitory projections to histaminergic neurons in the posterior hypothalamus, as well as to brainstem serotoergic, noradrenergic, dopaminergic, and cholinergic arousal systems

adherence

patient ____ is an aspect in relation to medical advice or treatment issues when medications are prescribed, tests are indicated, ongoing follow-up is needed, and high-risk behaviors need to be modified

depression

prepubertal onset of ____ suggests an increased risk for ultimate development of bipolar disorder

rapport, communication, discussion, strengths, resources, supports

principles for interviewing families: -Describe how to develop ____ with the family, -organize the group so that ____ is clear, -facilitate ____ from each person, -and identify ____, ____, and ____ available to the family

monozygotic

the concordance for personality disorders among ____ twins was higher than dizygotic twins, supporting that genetic factors contribute to personality disorders

personality

the enduring and habitual patterns of behavior, cognition, emotions, motivation, and way or relating to others that are characteristic of the individual

psychiatric

the general problem of ___ symptoms are that many people do not see past the symptoms as anything other than a disorder unless look deeper through history, lab tests, and thorough physical exam

REM

the high-amplitude slow waves during non-REM sleep are replaced by rapid, low-voltage EEG activity in ___ sleep

ion channels

the implication of genes encoding ___ ___ in facial epilepsy is interesting because episodic disorders involving other organs also result from mutations in these genes (cardiac arrhythmias, periodic paralyses, episodic ataxia)

social support

the individual's perception or experience that he or she is loved and cared for by others, esteemed and valued, and included in a social network of mutual assistance

temporal

the majority of focal seizures originate from the ___ lobe

prepubertal, 18

the onset of tic disorders is often ____, and all tic disorders have their onset before ___ years of age

3, 4, REM

there is less stage __ and ___ sleep and more ___ sleep toward morning

valproate, lamotrigine, carbamazepine, phenytoin, levetiracetam, topimirate, oxcarbazepine, lacosamide

treatment for focal aware and focal with impaired awareness? (8)

phenolbarbitol

treatment for focal to bilateral tonic-clonic only different drug from other focal?

ethosuximide, valproate, clonazepam (peds only), lamotrigine

treatment for generalized absence? (4)

valproate, clonazepam, levetiracetam

treatment for generalized myoclonic? (3)

valproate, lamotrigine, carbamazepine, phenytoin, levetiracetam, topiramate, phenobarbital, primidone

treatment for generalized tonic-clonic? (8)

GABA transaminase

valproate can decrease GABA metabolism through ___ ___, resulting in increased GABA concentrations and increasing signaling via the GABAa receptor