disease psychiatric

  1. 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
  2. diagnostic and statistical manual of mental disorders
    4th ed
    DSM-IV-TR
    • C
    • P
    • G
    • P/E
    • G

    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)
  3. interview:
    • patient's history
    • chief complaint
    • current symptoms
    • psychiatric history
    • demographics
    • socioeconomic
    • cultural & religious beliefs
    • medication history & physical illnesses
  4. w/ interview, professional note:
    • general appearance
    • behavior
    • mood
    • thought process
    • cognitive functioning
    • coping mechanisms
    • potential for self-destructive behaviors
  5. tests;
    • mini-mental
    • blood/urine analysis
    • EEG
    • CT
    • MRI
    • PET scans
  6. 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)
  7. 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
  8. mental retardation
    stats:
    • 1-3% is mentally retarded which includes:
    • IQ under 70

    dependence on others for daily activities
  9. signs:
    • learning disabilities
    • uncontrollable behaviors
    • cognitive/motor skill impairment
    • cleft lip
    • congenital heart defects
    • cerebral palsy
  10. mental retardation
    treatment
    interdisciplinary team approach

    develop patient's strengths through special education/training which are dependent on motivations
  11. 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
  12. 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
  13. ADHD
    stats:
    3-5% school aged children

    3X more in boys
  14. ADHD
    signs:
    • hyperactivity in at least 2 settings along w/:
    • distractibility
    • impulsiveness
    • emotional labile
    • explosive/irritable behaviors
  15. ADHD
    treatment:
    • bahavior modification
    • coaching
    • external structure
    • psychotherapy
    • medications
  16. 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
  17. 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
  18. substance abuse-AI
    def
    need or daily intake of large amounts of alcohol for day to day functioning

    70 yrs & up most
  19. 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
  20. 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
  21. 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)
  22. 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.
  23. 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
  24. 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
  25. 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
  26. 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
  27. 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
  28. 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
  29. schizophrenia
    3 types
    • paranoid-best type to have
    • disorganized
    • catatonic

    most disabling of disorders
  30. 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
  31. schizophrenia
    onset
    • usually during adolescenes/early childhood
    • always had it-something triggers it
  32. 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
  33. 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
  34. schizophrenia
    treatment
    • meeting the physical/psychosocial needs:
    • medical intervention
    • medications
    • psychotherapy
    • rehabilitation
    • vocational training
    • community resources
  35. 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
  36. 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
  37. 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
  38. Bipolar(manic-depressive)
    • expansiveness
    • elation
    • agitation
    • hyperexcitability
    • increased speed of thought
    • speech(flight of ideas)
  39. 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
  40. bipolar
    • type1:
    • alternating mania and depression

    most common

    • type 2:
    • recurring depressive episodes and mild manic episodes(functional periods of time)
  41. 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
  42. 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
  43. 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
  44. 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
  45. bipolar
    treatment
    lithium

    • problems occur in self-care
    • productivity
    • leisure
    • sensorimotor
    • cognitive
    • psychosocial
  46. major depression
    def
    • persistently sad
    • dysphoric mood
    • disturbance in sleep
    • appetite
    • lethargy
    • inability to exp pleasure
  47. major depression
    cause
    • genetic
    • family hereditary
    • biochemical
    • physical
    • psychological
    • social causes
    • depression as 2nd diagnosis w/ serious medical conditions
  48. major depression
    signs
    • worthlessness
    • guilt
    • hopelessness
    • loss of interest
    • "down in the dumps"
    • decreased appetite
    • insomnia
  49. major depression
    treatment
    • medication/drug therapies
    • psychotherapy
    • cognitive-behavioral therapy
  50. 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
  51. Generalized Aniety Disorders
    cause:
    • conflict
    • intrapsychic
    • sociopersonal/interpersonal
    • promotes an anxiety state
  52. Generalized Anxiety Disorder
    stats:
    more common in women

    half of all cases begin in childhood/adolescence

    treatment:

    • drug therapy
    • psychotherapy
  53. 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
  54. 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
  55. 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
  56. obsessive-compulsive disorder
    cause:
    unknown

    • brain lesion
    • major depression
    • organic brain syndrome
    • schizophrenia
    • possibly linked to eating disorders
  57. obsessive-compulsive disorder
    stats:
    affects 203%

    7 mil people

    symptoms noticed around 20-30 yrs

    70% display symptoms prior to 30
  58. 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)
  59. obsessive-compulsive disorder
    treatment:
    improvement can occur 60-70% of patients who obtain treatment

    combination of medication and cognitive behavioral therapy
  60. 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.
  61. 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
  62. 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
  63. 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
  64. 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
Author
joyjohnson
ID
149027
Card Set
disease psychiatric
Description
disease psychiatric
Updated