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Terms
clinical mood disorders
affect
the display or emotion, particularly facial expression
anhedonia:
lack of interest in previously pleasurable activities
avolition:
lack of drive or ambition to complete goal-directed tasks or activities
dysphoria:
a depressed or negative mood state
euphoria:
highly elevated, exaggerated mood
flight of ideas:
rapidly changing,disconnected thoughts
grandiosity:
inflated sense of self-eesteem or importance
hypomania:
elevated mood that is less intense than full mania
psychomotor agitation:
increased physical movements that are purposeless and reflective of an agitated or anxious state, that is, wringing hands, fidgeting, pacing
psychomotor retardation:
abnormally slowed or reduced movements or speech
psychosis:
the presence of delusions of hallucinations w/o insight
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diagnostic and statistical manual of mental disorders
4th ed
DSM-IV-TR
Axis I
clinical disorders
Axis II
personality disorders & mental retardation
axis III
general medical conditions
axis IV
psychosocial & environmental problems
axis V
global assessment of function(scale 1-100)
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interview:
- patient's history
- chief complaint
- current symptoms
- psychiatric history
- demographics
- socioeconomic
- cultural & religious beliefs
- medication history & physical illnesses
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w/ interview, professional note:
- general appearance
- behavior
- mood
- thought process
- cognitive functioning
- coping mechanisms
- potential for self-destructive behaviors
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tests;
- mini-mental
- blood/urine analysis
- EEG
- CT
- MRI
- PET scans
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Mental retardation AII
Def:
significant subaverage general intellectual function existing concurrently w deficits in adaptive behavior manifesting itself during the developmental period (before 18 yrs of age)
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mental retardation
cause:
specific cause is only identifiable in 25% of people
75% have predisposing factors:
- deficient prenatal/perinatal care
- inadequate nutrition
- poor social environment
- poor child-rearing practices
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mental retardation
stats:
- 1-3% is mentally retarded which includes:
- IQ under 70
dependence on others for daily activities
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signs:
- learning disabilities
- uncontrollable behaviors
- cognitive/motor skill impairment
- cleft lip
- congenital heart defects
- cerebral palsy
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mental retardation
treatment
interdisciplinary team approach
develop patient's strengths through special education/training which are dependent on motivations
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ADHD
difficulty focusing attention
engaging in quiet passive activities or both
present at birth, diagnosis bofore 4-5 is difficult unless child show severe symptoms
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ADHD
cause:
physiologic brain disorder w/ familial tendency
disturbances in neurotransmitter levels caused by reduced blood flow in striated areas of the brain
- several theories advocating:
- biochemical
- sensorimotor
- physiologic
- behavioral correlates
- manifestations have been proposed
tends to occur in familites
common ion first-degree biological relatives
leading hypothesis suggests activity or stimulation in upper brain stems and gfrontal-midbrain tracts.
- other hypothosis include:
- effects of toxins
- neurologic immaturity
- infections
- drug exposure in utero
- head injuries
- environmental factors
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ADHD
stats:
3-5% school aged children
3X more in boys
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ADHD
signs:
- hyperactivity in at least 2 settings along w/:
- distractibility
- impulsiveness
- emotional labile
- explosive/irritable behaviors
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ADHD
treatment:
- bahavior modification
- coaching
- external structure
- psychotherapy
- medications
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ADHD
parents report a history of child being "difficult" or "passive"
- possibly not liking to be held
- cuddled
- bathed
- fed
- demonstrating diff being comforted
- OT's observe:
- decreased motor precision
- varying levels of arousal/alertness
- impaired play dev
- motor planning issues
persistant/prequent pattern of dev inappropriate inattention/impuls-w w/o hyperactivity
ADD(not hyper)/ADHA learning disorders
influence behavior of child at any co0gnitive elvel, except for moderate to profound mental retardation
- boys are affected than girls 10:1
- 5-10 % school-aged affected
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ADHD
- problems occur:
- self-care
- productivity
- leisure
- sensorimotor
- cognitive
- psychosocial
- environmental
- forget AL's
- no close attention to detail
- careless work/school
- poor writing
- illegible printing
- diff leisure activities
- fisgets
- leaves seat
- runs/climbs excessively
- on the go
- talks excessively
- poor perceptual/fine motor skills
- not listen
- not follow through
- fails to finish
- diff organ
- avoids sustained mental effort
- loses things
- distracted
- blurts out
- diff waiting turn
- interrupts
- limited tolerance
- lose temper
- high anxiety
- poor comm
- dissatisfied
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substance abuse-AI
def
need or daily intake of large amounts of alcohol for day to day functioning
70 yrs & up most
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substance abuse-AI
cause:
biological,psychological/sociocultural factors contribute to addiction
not well understood.
- 3 factors usually exist:
- 1. addictive substance
- 2. predisposing condition
- 3. personality/disposition of user
- low self-esteem
- peer pressure
- inadequate coping skills
- curiosity
- personality char:
- few mental or emotional resources against stress
- overdependence on others
- low tolerance for frustration
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subatance abuse
stats:
children who have 1 parent w/ alcohol related disorder-7-8X more likely to develop alcohol dependence
- genetic
- biological
- biochemical
- nutritional deficiencies
- endocrine imbalances
- allergic responses
15% american adults have problem w alcohol use
- 5-10% male
- 3-5% females are alcohol dependent
- overal: 12.5 million people
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substance abuse
signs
may try to hid/deny addiction
temporarily manage to maintain functional life
inability to discontinue or reduce alcohol use
- episodes or amnesia(blackouts)
- episodes of violene
- interference w social & family relationships
- malaise
- mood swings
- depression
- increased infection rate
- w/d symptoms if w/o for 5-7 days
- poor motor skills
- seizures
dependent on drug type.
- person usually ends up seeking treatment for:
- emergency reasons due to injury from drug-related activities such as motor vehicle accidents,burns,overdoses, physical deterioration, malnutrition or symptoms of withdrawals(uncontrollable seizures)
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substance abuse
treatment
- total abstinence from alcohol
- detoxification
- rehab
- long term AA
there are also meds to combat symptoms and deter alcohol consumptom
- legal toxi-0.08
- thoughts/judge/restrain loosened-0.05
- motor skills decrease-0.2
- confusion-0.3
- coma-0.4-0.5
medications to address symptoms of ingestion and w/d, charcoal and hemodialysis to remove drug from system, dexotificaation, rehabilitation, psychotherapy and long term follow up.
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substance abuse
- dev Korsakoff's syndrome
- wernicke's encephalopathy due to thiamine def.
fetal alcohol syndrome is leading cause of dev disabil in US
substance-related disorders become a problem when the person is unable or unwilling to modify behavior to avoid adverse life events
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substance abuse
maladaptive
patterns of substance use leading to clinically significant impairment or distress,manifested by one or more of the following problems occurring in a one-year period:
1. failure to fulfill major role obligations at work, school, or home
2. recurrent substance use in situations that can be physically hazardous
3. recurrent alcohol-related legal problems
4. continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
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substance abuse:
- other substances abused:
- opioids
- stimulants
- depressants
- anxiolytics
- hallucinogens
- chronic abuse leads to:
- cardiac/respiratory arrest
- intracranial hemorrhage
- AIDS
- tetnus
- infective endocarditis
- hepatitis
- vasculitis
- septicemia
- pulmonary emboli
- gangrene
- malnutrition
- FI(Functional independence) disturbances
- respiratory iinfection
- musculoskeletal dysfunction
- trauma
- depression
- risk of suicide
- psychosis
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substance abuse
problems occur in:
- neglect of ADL's
- neglect IADL's
- irregular job history
- irregular school attendence
- organizing/performing job duties
- few leisure interests
- low physicl endurance
- peripheral neuropathy(diabeticsymptoms)
- reduced ROM
- impairments in balance/posture
- poor muscle tone
- impaired coordination/dexterity
- slower that normal reaction time
- pain in lower back
- cog disorder assoc w/ brain damage
- diff following dir
- poor time management
- poorlly defined goal-oriented behavior
- poor self-concept
- low self-esteem
- immaturity compared to chronological age
- depression
- hostility/self destruction
- suicidal
- immature/impaired social interaction skills
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Schizophrenia(psychotic disorder) Axis I
characteristics:
- 2 or more of the following:
- delusions
- hallucination
- disorganized speech
- grossly disorganized
- catatonic behavior(mute)
- negative symptoms such as affective flattening alogia(can't tell if happy or sad) or avolition(no preplanning/no time reference) that have been present for a significant portion of the time during a one-month period with some signs of the disorder persisting for at least 6 months
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schizophrenia
cause
- unknown
- complex interaction of inherited and environmental factors,
including disturbances of brain circuitry
and chemical imbalances in the brain.
- combination of:
- genetic
- biological
- cultural
- psychological factors usually w/ family history
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schizophrenia
3 types
- paranoid-best type to have
- disorganized
- catatonic
most disabling of disorders
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schizophrenia
symptoms
- positive:
- addition to one's personality and include delusions and hallucinations
- negative:
- take away from one's personality such as lack of motivation
- flat affect
- poverty of speech
- characterized by disturbances(6 months):
- 1. thought content/form
- 2. perception
- 3. affect
- 4. sense of self
- 5. volition
- 6. interpersonal relationships
- 7. psychomotor(step 9over cracks) behavioral skills
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schizophrenia
onset
- usually during adolescenes/early childhood
- always had it-something triggers it
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schizophrenia
stats
1/3 patients exp 1 psychotic episode
some have no disability between periods of exacerbations
some patientsw need continuous institutional care
prognosis worsens w/ each episode
affects 1-2% population
both male/female
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schizophrenia
signs
varies greatly depending on phase of illness
- ambivalence
- apathy
- clang or rhyme owrd assoc
- concrete assoc(inability to understand abstract thoughts)
- delusions
- echolalia
- echopraxia
- flight of ideas
- hallucinations
- loose assoc/tangential thoughts
- magical thinking
- neologisms(made up words by patient)
- regressionh
- thought blocking
- w/d from normal activites
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schizophrenia
treatment
- meeting the physical/psychosocial needs:
- medical intervention
- medications
- psychotherapy
- rehabilitation
- vocational training
- community resources
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schizophrenia
problemsoccur:
- self-care
- productivity
- leisure
- sensorimotor
- cognitive
- psychosocial
- performing ADL's/IADL's
- obs
- few leisure interests
- catatonia/stupor/immobility
- poorly dev groos motor skills
- repetitive movement patterns
- auditory hallucinations
- figure-grounddyskinesia
- slow process of info
- arousal level
- distractible
- problem solving
- decision making
- judgement
- safety skills
- blunt
- abnormal response to stress
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Bipolar(mood disorder): A I
- a group of heterogeneous
- typically recurrent illnesses including: unipolar(depressive) and
- bipolar(manic-depressive) disorders that are characterized by:
- pervasive mood disturbances
- psychomotor dysfunction
- vegetative symptoms
- classified as an:
- affective disorder
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Unipolar(depression)
- pathologial state in which the disturbances of mood or affect is characterized by: agitation
- weight loss
- guilt
- insomnia
- decreased activity
- an inability to experience pleasure
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Bipolar(manic-depressive)
- expansiveness
- elation
- agitation
- hyperexcitability
- increased speed of thought
- speech(flight of ideas)
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Bipolar
multiple theories
- psychoanalytical
- behavioral
- biochemical
- sociologic
- existential
severe pathologic mood swings that include hyperactivity and euphoria to sadness and depression
cyclical relationship around 60 days
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bipolar
- type1:
- alternating mania and depression
most common
- type 2:
- recurring depressive episodes and mild manic episodes(functional periods of time)
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bipolar
cause:
- hereditary
- biological
- psychological factors
- higher incidence among family members
- identical twins have 66096% of inheriting bipolar disorder
- circadian rhythms and hormone secretion
- emotional and physical trauma
- heredity
- serious accidental injury can precede onset
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bipolar
stats
- 0.4-1.2 % adults exp bipolar disorder
- affects men/women equally
more common in higher socio-economical groups
begins after adolescences, with onset usually between 20-35 yrs of age
reoccurs w/ 80% of patients and as they age the episodes occur more frequently and last longer.
significant mortality w/ people diagnosed w/bipolar
20% commit suicide as depression is transitioning to mania
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bipolar
signs/manic
varies widely depending on stage
- mania:
- grandiose
- euphoric
- expansive
- irritable w/ little control over activities/responses
- hyperactive
- excessive behaviors
- buying sprees
- promiscuity
- colorful or strange clothing
- excessive make-up
- inflated sense of self
- accelerated/pressured speech
- tangential thoughts
- malnutrition
- poor hygiene
- problems occur:
- excessive $$$ spending
- foolish investments
- sexual indiscretion
- decreased sleep
- complete work in little time
- interested in many things at same time
- psychomotor agitation
- impression of physical fitness
- auditory/visual hallucination
- interest in new activities
- short atten
- very distractible
- inflated self-esteem
- elated
- irritable
- inappropriate interactions
- delusions of wealth
- no responsibility for actions/behaviors
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bipolar
signs/depressive
- loss of self-esteem
- social w/d
- feeling of hopelessness
- apathy
- "deserves to be punished"
- sadness
- guilt
- negativity
- fatigue
- slow responses
- difficulty w/ concentration
- reduced psychomotor activity
- lethargy
- low muscle tone
- weight loss
- slowed gait
- constipation
- sleep disturbances
- headaches
- chest pains
- symptoms are worse in the morning
- subsides as the day goes on
- problems occur:
- disinterested in ADL's
- refusal to eat
- insomnia
- unable to complete task
- lose interst in leisure
- psychomotor retardation/agitation
- lack of physical endurance
- auditory/visual hallucination w/ tactile/olf
- diff attending to task
- recurrent thoughts of death/suicide
- diff making decisions
- solving problems
- poor self-concept
- helplessness
- hopelessness
- feelings of guilt
- fear of going insane
- irritable
- agitation
- dependent
- socially w/d
- may not speak
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bipolar
treatment
lithium
- problems occur in self-care
- productivity
- leisure
- sensorimotor
- cognitive
- psychosocial
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major depression
def
- persistently sad
- dysphoric mood
- disturbance in sleep
- appetite
- lethargy
- inability to exp pleasure
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major depression
cause
- genetic
- family hereditary
- biochemical
- physical
- psychological
- social causes
- depression as 2nd diagnosis w/ serious medical conditions
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major depression
signs
- worthlessness
- guilt
- hopelessness
- loss of interest
- "down in the dumps"
- decreased appetite
- insomnia
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major depression
treatment
- medication/drug therapies
- psychotherapy
- cognitive-behavioral therapy
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Generalized Anxiety Disorders
group of disorders in which anziety or anziousness are central features
- feeling of apprehension that is exaggerated feeling of impending doom
- dread
- uneasiness.
the feelings are produced by an internal threat.
anziety:
- apprehension of danger and dread accompanied by restlessness
- tension
- tachycardia
- dyspnea
- unattached to a clearly identifiable situation
- 5 categories:
- 1. panic
- 2. phobic
- 3. obsessive-compulsive
- 4. post traumatic stress
- 5. anxiety
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Generalized Aniety Disorders
cause:
- conflict
- intrapsychic
- sociopersonal/interpersonal
- promotes an anxiety state
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Generalized Anxiety Disorder
stats:
more common in women
half of all cases begin in childhood/adolescence
treatment:
- drug therapy
- psychotherapy
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Generalized Anxiety Disorder
Signs:
- unusual self-awareness and alertness
- selective inattention
- unintelligible speech
- trembling
- muscle aches
- headaches
- inability to relax
- along w/ difficulty earting and sleeping
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Generalized Anxiety Disorders
problems
- self-care
- productivity
- leisure
- sensorimotor
- cognitive
- psychosocial
due to:
- cardiovalscular symptoms
- GI concerns
- respiratory symptoms
- automatic symptoms
- \sleep disturbances
- inability to work
- rituals
- confusion
- memory
- poor concentration
- distractibility
- fears
- helplessness
- agitation
- feeling of being overwhelmed
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obsessive-complsive disorder
def
- obsessive thoughts and compulsive behaviors in effort to control overwhelming anxiety
- guilt
- unacceptable impulses that enter consciousness
obsession:
- a recurrent idea
- tought
- imulse or
- image
- that's intrusive and inappropriate causing anziety and stress
compulsion:
- ritualistic
- repetitive
- involuntary defensive behavior that follows obsessions to decrease anxiety and stress
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obsessive-compulsive disorder
cause:
unknown
- brain lesion
- major depression
- organic brain syndrome
- schizophrenia
- possibly linked to eating disorders
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obsessive-compulsive disorder
stats:
affects 203%
7 mil people
symptoms noticed around 20-30 yrs
70% display symptoms prior to 30
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obsessive-compulsive disorder
signs:
- history of obsessive thoughts
- images or words
- compulsive behaviors to cope w/ obsessions
common ob:
- violence
- contamination
- doubts
- worries of counting
common compulsions:
- repetitive touching
- counting
- doing and undoing
- washing
- checking(keep checking if sotve off)
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obsessive-compulsive disorder
treatment:
improvement can occur 60-70% of patients who obtain treatment
combination of medication and cognitive behavioral therapy
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PTSD- Axis I
post traumatic stress disorder
dev of characteristic symptoms following:
exposure to an extreme traumatic stressor involving direct personal experience of an event (actual or threatened death)
or serious injury;
a threat to the physical integrity of another person;
- or learning about unexpected or violent death
- serious harm
- threat of death or injury experienced by a family member or other close associate.
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PTSD
cause:
psychological consequences that last for minimum 1 month after a traumatic event outside the range of usual human experiences.
- such as:
- natural/manmade diseaster
- physical/sexual abuse
- assault
- rape
- violent crimes
- war experience
- fire
- flood
- tornado
- hurricane
- earthquakes
- witnessing violent crimes
- motor vehicle accident
- plane accident
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PTSD
signs:
psychological/psychosocial history of patient will reveal early life experiences that are outside of usual human experiences.
- pangs of painful emotion
- unwelcome thoughts
- intrusive memories
- dissociative episodes (flashbacks)
- difficulty falling or staying asleep
- frequent nightmares
- emotional numbing
- chronic anxiety
- panic attacks
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PTSD
treatment:
- reduce the target symptoms
- prevent chronic disability
- promote occupational/social rehab
- medication
- psychotherapy
- support groups
- treatment for substance abuse since self-medication is usual
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PTSD
problems occur:
- self-care
- productivity
- leisure
- sensorimotor
- cognitive
- psychosocial
- due to:
- sleep disturbances
- insomnia
- nightmares
- flashbacks
- unsafe tech in work
- loss of skills in leisure
- anziety
- distress (high heart rate)
- flushed face, sweating
- exaggerated startle
- exp intrusive/thoughts
- feeling of detachment
- verbal/physical/sexual abuse
- guilt/shame
- sense of helplessness
- socially w/d
- isolated
- avoiding contact w/ others
- loss of coping skills
- lask of social supports
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