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Delirium
Requires:
a) a disturbance in attention and awareness that develops over a short period of time (hours to a few days), represents a change from baseline, and tends to fluctuate in severity over the course of the day (usually worse at night)
b) at least one additional disturbance in cognition (impaired memory, disorientation, impaired language, deficits is visuospatial ability, or perceptual distortions)
c) evidence symptoms are the direct consequence of a medical condition, intoxication, or withdrawal, and/or exposure to a toxin.
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Delirium - Treatment - two primary goals
Treatment of the underlying cause and reduction of agitated behaviors
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Major Neurocognitive Disorder
Includes Dementia and is diagnosed when there is evidence of significant decline from a previous level of functioning in one or more cognitive domains that interferes with independence in everyday activities and is not delirium
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Mild Neurocognitive Disorder
Includes Cognitive Disorder NOS and is diagnosed when there is evidence of a modest decline from a previous level of functioning in one or more cognitive domains that does not interfere with independence in everyday activities (though might require substantial effort) and is not delirium
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Neurocognitive Disorder Due to Alzheimer's Disease
diagnosed when the criteria for Major or Mild Neurocognitive Disorder are met, there is an insidious onset (gradual subtle way) of symptoms and a gradual progression of impairment in one or more cognitive domains (or two domains for Major), and the criteria for probable or possible Alzheimer's disease are met.
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Alzheimer's Disease - Course - Stage 1
1 - 3 years - anterograde amnesia (can't form new memories, especially for declarative memories); deficits in visuospatial skills (wandering); indifference, irritability, and sadness; and anomia (unable to recall the names of everyday objects)
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Alzheimer's Disease - Course - Stage 2
2- 10 years - increasing retrograde amnesia; flat or labile mood (rapid exaggerated changes in mood/mood swings); restlessness and agitation; delusions; fluent aphasia (loss of ability to understand or express speech); acalculia (loss of the ability to perform simple arithmetic calculations); and ideomotor apraxia (inability to translate an idea into movement).
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Alzheimer's Disease - Course - Stage 3
8 - 12 years - severely deteriorated intellectual functioning; apathy (lack of interest, enthusiasm, or concern); limb rigidity; and urinary and fecal incontinence.
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Alzheimer's Disease - Treatment
A combination of group therapy (especially therapy that emphasizes reality orientation and reminiscence); behavioral techniques and antipsychotic drugs to reduce agitation; antidepressant drugs to alleviate depression; and environmental manipulation and pharmacotherapy to enhance memory and cognitive functioning
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Vascular Neurocognitive Disorder
Diagnosed when the criteria for Major or Mild Neurocognitive Disorder are met, the clinical features are consistent with a vascular etiology, and there is evidence of cerebrovascular disease from the person's history, a physical examination, and/or neuroimaging
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Neurocognitive Disorder Due to HIV Infection
exhibit symptoms characteristic of Neurocognitive Disorders that affect subcortical areas of the brain in a person who has HIV
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Delirium is characterized by a disturbance in ________ and at least one addition disturbance in _________. Symptoms develop over a short period of time and tend to _______ in severity during the course of the day. Treatment involves providing the individual with an environment that is designed to minimize _________ and may include administration of an antipsychotic drug to reduce agitation, delusions, and hallucinations.
attention and awareness
one other cognition
increase
disorientation
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Major Neurocognitive Disorder subsumes the DSM-IV-TR diagnosis of _________ and is diagnosed when there is evidence of a substantial decline in functioning in one or more cognitive domains that interferes with a person's independence in everyday activities.
dementia
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Mild Neurocognitive Disorder subsumes the DSM-IV-TR diagnosis of ____________ and is diagnosed when there is evidence of a modest decline in functioning in one ore more cognitive domains that does not interfere with the person's independence in everyday activities.
Cognitive Disorder NOS
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In terms of etiology, Neurocognitive Disorder Due to Alzheimer's Disease has been linked to the presence of amyloid plaques and neurofibrillary tangles, especially in the _________ structure of the brain and to abnormal levels of several neurotransmitters including _________, which is known to be involved in the formation of memories. During the initial stages of this disorder, the individual exhibits ________ (especially for declarative memories), deficits in visuospatial skills, and anomia.
medial temporal
Acetylcholine (ACh)
Anterograde amnesia
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_________ Neurocognitive Disorder is caused by cerebrovascular disease and is characterized by _________, fluctuating course with a patchy pattern of symptoms, while symptoms of Neurocognitive Disorder Due to HIV Disease are those associated with other Neurocognitive Disorders that involve abnormalities in __________ of the brain - e.g., impaired concentration and memory, slowed psychomotor speed, apathy, and depression, and movement disorders.
Vascular
stepwise
subcortical
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Personality Disorders - What are cluster A disorders?
odd or eccentric
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Paranoid Personality Disorder
a pervasive pattern of distrust and suspiciousness that entails interpreting the motives of others as malevolent (having or showing a wish to do evil to others)
- requires at least 4 symptoms
- suspects that others are exploiting, harming, or deceiving without a sufficient basis for doing so; is preoccupied with unjustified doubts about the trustworthiness of others; is reluctant to confide in others; reads demeaning content into benign remarks or events; persistently bears grudges; perceives attacks on his/her character and quickly reacts with anger or counterattacks; is persistently suspicious about the fidelity of a spouse or sexual partner without justification
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Schizoid Personality Disorder
When a person displays a pervasive pattern of detachment from interpersonal relationships and a restricted range of emotional expression in social settings.
- At least 4 symptoms
- doesn't desire or enjoy close relationships; almost always chooses solitary activities; has little interest in sexual relationships; takes pleasure in few activities; lacks close friends or confidants other than first-degree relatives; seems indifferent to praise or criticism; exhibits emotional coldness or detachment
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Schizotypal Personality Disorder
The presence of pervasive social and interpersonal deficits involving acute discomfort with and reduced capacity for close relationships and eccentricities in cognition, perception, and behavior
- At least 5 symptoms
- exhibits ideas of reference; has odd beliefs or magical thinking that influences behavior; has bodily illusions and other unusual perceptions; exhibits odd thinking and speech; is suspicious or has paranoid ideation; has inappropriate or constricted affect; has peculiarities in behavior and appearance; lacks close friends or confidents other than first-degree relatives; has excessive social anxiety.
People with this disorder may express a desire for close personal contact, but they have few friends and seem to prefer being alone
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Personality Disorders - What are cluster B disorders?
dramatic. emotional, erratic
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Antisocial Personality Disorder
A pattern of disregard for an violation of the rights of others that has occurred since age 15
- at least 3 symptoms
- failure to conform to social norms with respect to lawful behavior; deceitfulness; impulsivity; irritability and aggressiveness; reckless disregard for the safety of self and others; consistent irresponsibility; lack of remorse
at least 18 and a history of conduct disorder before 15
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Borderline Personality Disorder
a pervasive pattern of instability in interpersonal relationships, self-image, and affect, and mark impulsivity that began by early adulthood and is apparent in multiple contexts.
- at least 5 symptoms
- frantic efforts to avoid abandonment; pattern of unstable intense, interpersonal relationships that are marked by fluctuations between idealization and devaluation; an identity disturbance involving a persistent instability in self-image or sense of self; impulsivity in at least two areas that are potentially self-damaging (e.g., sex, substance use); recurrent suicide threats or gestures; affective instability; chronic feelings of emptiness; inappropriate intense anger or difficulty controlling anger; transient stress-related paranoid ideation or severe dissociative symptoms
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Borderline Personality Disorder - ages for most common diagnosis
19-34 and symptoms most chronic during young adulthood
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Borderline Personality Disorder - Treatment
Dialectical Behavior Therapy (DBT) - combines cognitive-behavioral techniques with the Rogerian assumption that acceptance of the client is necessary for change to occur
- Uses 3 basic strategies
- a) group skills training to help clients regulate their emotions and improve social and coping skills
- b)individual outpatient therapy to strengthen clients' motivation and newly-acquired skills
- c) telephone consultations to provide additional support and between-sessions "coaching"
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Histrionic Personality Disorder
a pervasive pattern of emotionality and attention-seeking
- at least 5 symptoms
- discomfort when not the center of attention; inappropriately sexually seductive or provocative; rapidly shifting shallow emotions; consistent use of physical appearance to gain attention; excessively impressionistic speech that is lacking in detail; exaggerated expression of emotion; easily influenced by others; considers relationships to be more intimate than they are.
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Narcissistic Personality Disorder
A pervasive pattern of grandiosity, a need for admiration, and a lack of empathy
- at least 5 symptoms
- has a grandiose sense of self-importance; is preoccupied with fantasies of unlimited success, power, beauty, love; believes he/she is unique and can be understood only by other high-status people; requires excessive admiration; has a sense of entitlement; is interpersonally exploitative; lacks empathy; is often envious of others or believes other are envious of him/her; exhibits arrogant behaviors and attitudes
The pattern of behavior began by early adulthood and is apparent in various contexts
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Personality Disorders - What are cluster C disorders?
anxiety and/or fearfulness
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Avoidant Personality Disorder
a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
- At least 4 symptoms
- avoids work activities involving interpersonal contact due to fear of criticism, rejection, or disapproval; is unwilling to get involved with people unless certain of being liked; exhibits restraint in intimate relationships due to fear of being ridiculed; is preoccupied with concerns about being criticized or rejected; is inhibited in new relationships due to feelings of inadequacy; views self as socially inept, inferior, or unappealing to others; is usually reluctant to engage in new activities because they may be embarrassing
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Dependent Personality Disorder
A pervasive and excessive need to be taken care of, which leads to submissive, clinging behavior and a fear of separation
- at least 5 symptoms
- has difficulty making decisions without advice and reassurances from others; needs others to assume responsibility for most aspects of his/her life; fears disagreeing with other because it might lead to a loss of support; has difficulty initiating projects on his/her own; goes to great lengths to gain nurturance and support from others; feels helpless or uncomfortable when alone; urgently seeks another relationship for support when a close relationship ends; is unrealistically preoccupied with fears of being left to care for him/herself
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Obsessive-Compulsive Personality Disorder
A persistent preoccupation with orderliness, perfectionism, and mental and interpersonal control that severely limits his/her flexibility, openness, and efficiency
- At least 4 symptoms
- is preoccupied with details, rules, etc. so that the major point of the activity is lost; exhibits perfectionism that interferes with task completion; is excessively devoted to work and productivity to the exclusion of leisure activities and friendships; is overconscientious and inflexible about morality, ethics, and values; is unable to discard worn-out or worthless objects; is reluctant to delegat3e work to others unless they are willing to do it his/her way; adopts a miserly spending style toward self and others; exhibits rigidity and stubbornness
Does not involve true obsessions and compulsions
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Cluster A Personality Disorders are all characterized by _________ behavior.
odd and/or eccentric
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The essential feature of Paranoid Personality Disorder is a pervasive pattern of ________ that involves interpreting the motives of others as malevolent.
distrust and suspiciousness
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Schizoid Personality Disorder involves a pervasive pattern of ________ and a restricted range of _______ in social settings
detachment
emotional expression
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Schizotypal Personality Disorder is diagnosed in the presence of pervasive social and interpersonal deficits that involve acute discomfort and reduced capacity for close relationships and eccentricities in __________
cognition, perception, and behavior
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Cluster B Personality Disorders involve _________ behavior.
dramatic, emotional, erratic
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Antisocial Personality Disorder is characterized by a pattern of disregard for and the violation of the _________ that has occurred since the age of 15. For the diagnosis the individual must be at least ______ years old and have a history of Conduct Disorder by age 15. Although ASPD is chronic, its symptoms often become less evident and pervasive in the _______ decade of life
rights of others
18
4th
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Borderline Personality Disorder is characterized by a pattern of _________ in interpersonal relationships, self-image, and affect and marked impulsivity. Symptoms are usually most chronic and severe during ________, and up to 75% of people no longer meet the full diagnostic criteria by age ______.
instability
young adulthood
40
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Linehan describes __________ as the core feature of BPD, and her DBT combines _________, individual outpatient therapy, and telephone consultations.
emotion dysregulation
group skills training
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Histrionic Personality Disorder involves a pervasive pattern of emotionality and __________, while the essentially feature of Narcissistic Personality Disorder is a pattern of _________, a need for admiration and a lack of empathy
attention-seeking
Grandiosity
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Cluster C Personality Disorders all involve _________.
anxiety and/or fearfulness
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Avoidant Personality Disorder is characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to __________
negative evaluation
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Dependent Personality Disorder involves an excessive need to _________, which leads to submissive, clinging behavior, and a fear of separation.
be taken care of
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Obsessive-Compulsive Personality Disorder entails a pervasive preoccupation with orderliness, perfectionism, and mental and interpersonal _________
control
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A psychologist is using Linehan's dialectical behavior therapy to treat a patient with Borderline Personality Disorder. The essential components of her intervention will be:
A.individual inpatient therapy and the token economy.
B.individual outpatient therapy and group skills training.
C.family therapy and psychotropic medication.
D.residential treatment and a self-help group.
B
Dialectical behavior therapy (DBT) includes three components—group skills training that focuses on the acquisition of social skills; individual outpatient therapy that targets motivational issues and the strengthening of social skills; and telephone consultations that help the client apply new skills to situations outside of therapy. Other techniques may also be used, but these three make up the core of DBT.
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The progression of Alzheimer's disease can be described in terms of three stages. A person in the second (middle) stage of the disease is most likely to exhibit:
A.retrograde amnesia for recent long-term events, indifference or irritability, and anomia.
B.anterograde and retrograde amnesia, flat or labile mood, restlessness, and fluent aphasia.
C.anterograde amnesia, indifference or sadness, and urinary incontinence.
D.severely deteriorated intellectual functioning, apathy, and urinary and fecal incontinence.
B
The symptoms listed in this answer are characteristic of the second stage.
Answer A: Indifference or irritability and anomia are more characteristic of the first stage.
Answer C: Anterograde amnesia and indifference or sadness are characteristic of the first stage, and urinary incontinence is characteristic of the third stage.
Answer D: Severely deteriorated intellectual functioning, apathy, and urinary and fecal incontinence are characteristic of the third stage.
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Symptoms of which of the following diagnoses are least likely to persist throughout adulthood?
A.Schizotypal Personality Disorder
B.Paranoid Personality Disorder
C.Avoidant Personality Disorder
D.Antisocial Personality Disorder
D
Symptoms of Antisocial Personality Disorder usually become less evident and pervasive in adulthood, beginning in middle age.
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For several years, a 26-year-old woman has exhibited cycles of over-idealization and devaluation in interpersonal relationships, uncertainty about career plans, reckless driving, drug use, and frequent suicide attempts. The most likely diagnosis is:
A.Histrionic Personality Disorder.
B.Borderline Personality Disorder.
C.Schizotypal Personality Disorder.
D.Narcissistic Personality Disorder.
B
The essential feature of Borderline Personality Disorder is a pervasive pattern of instability in interpersonal relationships, self-image, and affect, and marked impulsivity.
Answer A: Histrionic Personality Disorder is characterized by a pervasive pattern of emotionality and attention-seeking.
Answer C: Schizotypal Personality Disorder involves a pervasive pattern of social and interpersonal deficits, including acute discomfort with, and reduced capacity for, close relationships and eccentricities in cognition, perception, and behavior.
Answer D: Narcissistic Personality Disorder involves a pervasive pattern of grandiosity, a need for admiration, and a lack of empathy.
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Magical thinking, depression, ideas of reference, paranoia, discomfort in social situations, and inappropriate affect are most characteristic of which of the following disorders?
A.Schizoaffective Personality Disorder
B.Schizoid Personality Disorder
C.Schizotypal Personality Disorder
D.Borderline Personality Disorder
C
Schizotypal Personality Disorder involves pervasive social and interpersonal deficits and eccentricities in cognition, perception, and behavior.
Answer A: Schizoaffective Personality Disorder is not a DSM-5 diagnosis.
Answer B: Schizoid Personality Disorder involves a pervasive pattern of detachment from interpersonal relationships and a restricted range of emotional expression in social settings.
Answer D: The essential features of Borderline Personality Disorder are marked impulsivity and a pervasive pattern of instability in interpersonal relationships, self-image, and affect.
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Researchers have most consistently linked early memory impairment associated with Neurocognitive Disorder due to Alzheimer's disease to a loss of neurons that secrete __________, especially in the hippocampus and certain areas of the cortex.
A.GABA
B.norepinephrine
C.serotonin
D.acetylcholine
D
Although researchers have linked Neurocognitive Disorder due to Alzheimer's disease to several neurotransmitter abnormalities, early memory loss has been most consistently associated with a loss of cells that secrete acetylcholine (ACh).
Answer A: GABA is a neurotransmitter associated with regulating anxiety, not memory impairment.
Answers B and C: Abnormal levels of norepinephrine and serotonin are correlated with symptoms of depression rather than memory impairment.
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Delirium involves a disturbance in attention and awareness that develops over:
A.a few hours to a few days.
B.a few days to a few weeks.
C.one week to one month.
D.one to six months.
A
Delirium involves a disturbance in attention and awareness that develops over a short time (usually hours to a few days). The disturbance represents a change from baseline functioning and tends to fluctuate in severity throughout the day.
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Early signs of Neurocognitive Disorder due to HIV infection are most likely to be:
A.forgetfulness and impaired concentration.
B.focal neurological signs.
C.emotional over-reactivity and psychomotor agitation.
D.vertigo and tinnitus.
A
Early signs of Neurocognitive Disorder due to HIV infection include forgetfulness (e.g., difficulty keeping track of daily activities), impaired concentration, impaired judgment, psychomotor slowing, and irritability.
Answer B: Focal neurological signs are symptoms associated with damage to specific areas of the brain and are characteristic of Vascular Neurocognitive Disorder.
Answer C: Emotional over-reactivity and psychomotor agitation are not symptoms associated with Neurocognitive Disorder due to HIV infection.
Answer D: Vertigo and tinnitus are associated symptoms of Neurocognitive Disorder due to traumatic brain injury.
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