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What is a personality disorder?
Complex patterns of behaviors, thoughts and feelings(Stable across time and situations)
- Traits are maladaptive
- --behaviors, thoughts and feelings interfere with daily life(relationships)
- --Traits persist from adolescence or early adulthood onwards
What are the personality disorders associated with cluster A from the DSM-IV-R?
- Cluster A-Odd eccentric
- -Paranoid PD
- -Schizoid PD
- -Schizotypal PD
What is paranoid PD?
Chronically pervasive mistrust and suspicion of others "out to get me"
What is schizoid Pd?
chronic lack of interest in and avoidance on interpersonal relationships, emotional coldness
What is schizotypal PD?
chronic pattern of inhibited or inappropriate emotional and social behavior, abnormal cognitions, disorganized speech(aura readers)
What are the personality disorders in Cluster B of the DSM-IV-TR?
- Cluster B-dramatic erratic
- -Antisocial PD
- -Borderline PD
- -Narcissistic PD
- -Histrionic PD
What are the personality disorders of Cluster C from the DSM-IV-TR?
- Cluster C-avoidant fearful
- -Avoidant PD
- -Dependent PD
- -Obsessive Compulsive PD
What is Antisocial PD?
pervasive pattern of criminal, impulsive callous or ruthless behavior, disregard for rights of others, no respect for social norms(Ed training bird to swear)
What is borderline PD?
rapidly shifting and unstable mood, self-concept and interpersonal relationships, impulsive, no sense of self, change personality based on who they are with
What is Narcissistic PD?
grandiose thoughts and feelings of one's own worth oblivious to other's needs(cheated on with, don't understand why they don't forgive him)
What is Histrionic PD?
Rapidly shifting moods,unstable relationships, and intense need for attention and approval, dramatic,seductive behavior(Austin Powers)
What is Avoidant PD?
pervasive anxiety, a sense of inadequacy and fearful of being criticized which leads to avoidance of social interactions and nervousness(fearful of dating)
What is Dependent PD?
pervasive selflessness and need to be cared from, fear of rejection, leading to total dependence on self, submission to others(need Bf/Gf)
What is Obsessive compulsive PD?
pervasive rigidity in one's activities and interpersonal relationships, including emotional constructive, extreme perfectionism and anxiety about minor disruptions in one's routine(Sheldon from BBT)
What is the Biopsychosocial model of PD?
>>Biological predisposition to difficult temperament
- >>Harsh Parenting, Critical, unsupportive
- >>Behavioral/emotional deregulation;maladaptive belief about self
- >>Negative reactions from peers and adults
- >>Worsening of temperament, difficulties in controlling emotions and behaviors
What are theories in Anti-social PD?
- - Genetic predisposition
- -Deficits in brain functioning and structure
- -Low level of arousability--adrenaline junkies, need high levels of adrenaline to feel normal
- -High levels of testosterone
- -harsh and inconsistent parenting
- --Unresponsive to pain
- --Muscular/mesomorphic-able to life more
- --Empathy deficient
- --Stimulation seeking
Theories of Borderline Personality Disorder?
- >Fundamental deficit-emotional deregulation, very sensitive to everything
- ---Childhood enviornment-instability, abuse, neglect and parental psychopathy.
- >Physical/sexual abuse->self concept and emotional deregulation
- ---amygdala,prefrontal cortex,serotonin
- >Reliance on others for coping;poor self-confidence decreases ability to ask for help
- >Unable to integrate +/-(vacillate between extremes, naughty or nice)
Treatment for antisocial PD?
- Very few seek treatment and are not good candidates for psychotherapy
- --usually spouses, family, friends
- >Lithium and atypical antipsychotic help with impulsivity and aggression
- >SSRI-questionable efficacy
Treatment for Borderline PD?
- >Dialectical behavior therapy-teach them skills
- ---Distress tolerance
- ---Emotion regulation
- ---Interpersonal effectiveness
- >Drug treatments for reducing symptoms of anxiety, depression and impulsivity(SSRI, atypical antipsychotics)
On what Axis are personality disorders placed?
What are the five dimensions of the five factor model of personality(AKA The Big Five)?
- -Negative Emotionality(Neuroticism)
- -Openness to Experience
What is psychopathy?
- Set of broad personality traits including superficial charm, a grandiose sense of self-worth, a tendency toward boredom and need for stimulation, pathological lying and ability to be cunning and manipulative and a lack of remorse; cold and callous, gain pleasure for competing with and humiliating everyone;NOT an official DSM-IV-TR diagnosis;often confused with Antisocial PD but different-can be charming to get what they want.
- -Key point here, not always criminal, don't respond well to punishment, and not official diagnosis.
What are some of the different problems with the DSM-IV-TR conceptualization of personality disorders?
- Too much overlap between disorders, diagnosing a personality disorder often requires information that is hard for a clinician to obtain; personality disorders are conceptualized as stable characteristics of an individual despite studies showing that people with PD vary over time in how many symptoms they exhibit(going in and out of the diagnosis)
- -Lack of Validity
What is the cases of Hilde(histrionic PD) and Theodore Kaczynski(Shizoid PD)?
According to the Case Book what are the two main factors of Psychopathy?
Affective-cognitive instability and Behavioral Social Deviance
What are the factors that contribute to the development of psychopathy?
>Affective-Cognitive Instability-grandiose sense of self, pathological lying, cunning-manipulative behaviors,lack of remorse, shallow affect, callousness and lack of empathy, failure to accept responsibility
>Behaviors-Social Deviance-High need for stimulation, parasitic lifestyle,poor behavioral controls, early behavior problems, lack of realistic goals,impulsivity, irresponsibility, having been adjudicated delinquent history of violating supervision or probations.
What are the difference between dementia, delirium and amnesia?
- Unlike dementia and delirium, in amnesic disorders only memory is affected.
- --disturbance of consciousness with reduced ability to focus sustain or shift attention
- --change in cognition or development of perceptual disturbance
- --Disturbances develops over a short period of time(hours to days) and tends to fluctuate during the course of the day
- Dementia- Progression increased risk of violence, hallucination and delusions. progressive and fatal disease (8-10 years)
- typically begins with mild memory loss
What is aphasia?
Deterioration of language
What is Echolalia?
the often pathological repetition of what is said by other people as if echoing them.
What is Palilalia?
a speech disorder in which a word or phrase is rapidly repeated
What is apraxia?
A speech disorder in which a word or phrase is rapidly repeated
What is agnosia?
failure to recognize objects or people
What is Alzheimers disease and it's associated abnormalities?
- -Neurofibrillary Tangles-filaments within nerve cells in the brain are twisted and tangled. Made of protein, tau,impede nutrients from moving through cells and the cells eventually die.
- -Plaques-deposits of beta-amyloid that accumulate in the space between cells of cerebral cortex,hippocampus, amygdala and other areas associated with memory.
- -Extensive cell death in the cortex-results in small cortex and enlargement of the ventricles.
What are the etiological theories of Alzheimers?
- -Genetic factors.
- -Deficits of ACh,NE,Serotonin,Somatostatin,Peptide Y
What is Vascular Dementia?
- -Vascular dementia is a decline in thinking skills caused by conditions that block or reduce blood flow to the brain, depriving brain cells of vital oxygen and nutrients.
- -Blockage of blood to the brain
What are medical conditions that can cause dementia?
Parkinsons, HIV,Huntingtons, Pick Disease, Creutzfeldt-Jakob disease, brain tumors, endocrine conditions(hypothyroidism), nutritional conditions deficiencies of thiamine,niacin,vitamin b12,) syphilis.
What is sun-downing?
Symptoms fluctuate over the course of the day and often become worse at night
What are the phases of delirium?
Early phase-mild symptoms such as fatigue, decreased concentration, irritability, restlessness, depression.
Later phase-disrupted orientation(if in hospital may think in childhood home) disorientation towards familiar people. Immediate memory is first to be effect followed by intermediate memory(past 10 minutes) and last the distant memories.
What is anterograde amnesia?
inability to recall previously learned information or past events.
What is retrograde amnesia(most common)?
inability to learn or retain new information.
amnesia disorder caused by damage to the thalamus-usually the result of alcohol abuse
Most common psychological disorders among older adults?
Anxiety disorders, depression and substance abuse disorder
Reasons why is it difficult to assess and diagnose psychological disorders in older adults?
Frequently co-occur with other medical issues
Most common anxiety disorders diagnosed in older adults?
Generalized anxiety Disorder (7.3%) PTSD, Acute stress disorder
What makes medication management of anxiety disorders in older adults more challenging than in younger adults?
Side effect may cause issues(unsteadiness may cause falls) tolerance can develop leading to severe withdrawal effects,other medication that can interact with psychotropic drugs.
How common is depression in older adults and how does it reduce quality and length of life among this population?
- >1-5% can be diagnosed with major depression. If living in acute or chronic care setting can be as high as 12-20%
- > May hasten the progression of several medical diseases. Among people who have had a heart attack, depression increases risk of death 5x. in nursing homes increases death rate by 59%
Loss of interest, loss of energy,hopelessness, helplessness and psychomotor retardation.
What is complicated grief?
grief diagnosed as major depression,profound guilt thoughts that one could be better off dead, profound inactivity, persistent impairment in functioning and hallucinations.
What disorders can easily be mistake for depression in older adults?
Multiple sclerosis,cushing disease, parkinson's disease, huntington's, Addisons, cerebrovascular disease,hypothyroidism,chronic obstructive pulmonary disease, vitamin deficiency.
What are some ways that depression can be differentiated from dementia?
Depressed people often complain about memory issues, tend to have cognitive deficits less severe than those with dementia, are mroe aware of their cognitive issues. Noncognitive symptoms(hopelessness, fatigue, loss of motivation) tend to be less severe in people with primary depression. Depressed people have issues with free recall memory tests but can recognize things they know when shown. Depress people are more likely to have rapid onset of symptoms.
What substance disorders do older adults tend to develop?
Alcohol-related problems and misuse of prescription drugs
What is the case of Muhammad Ali?
What is the case of Ronald Reagan?
What are the symptoms of Parkinsons and Pseudo-Parkinsons disease from Case book?
Marked Tremors while active and while resting, muscular stiffness or rigidity, weakness in facil or throat muscles, stiffnesss in legs, neck and other muscles, talking as well as swallowing may be taxing on individual, gait disturbances, slowness in goal-directed movement, poor balance and postural instability, reduced dexterity, speech difficulty urinary and digestive problems, involuntary motor activity drooling, sleep disturbance, flat affect,fatigue.
What neurotransmitters system is associated with Parkinsons and Pseudo Parkinsons?
What is presenile dementia and senile dementia?
Presenile dementia-Occurs in younger usually 65 years or younger even before the age of 50. most cases are due to Alzheimer's(early onset)
Senile Dementia occurs in older people over 65. Alzheimers (late onset)
What the the three ways psychological assessments are helpful for people with Alzheimers disease?
1-Subtle change in memory,mood,and cognition that can frequently be detected via testing. May provide some early indications of the impending changes in mental status that result from disease.
2-Thorough assessment can help both patient and family develop coping strategies. Employment status and disability determination must be confronted and assessments can be useful in making informed decisions in those areas.
3-Periodic assessment can be useful in helping evaluate the patients ongoing status.
Prevention of Dementia?
- -Aerobic exercise and mental activity may have some protective value.
- -Reducing the risk factor for stroke, for example,avoiding smoking, obesity and hypertension, may reduce the risk for vascular dementia.
- -Protect your brain:wear helmets.
- -Nun study-Demonstrating a link between intellectual activity beginning early in life and reduces risk of Alzheimers disease.
What is the Snowden Nun Field study?
Study of 93 cloistered nuns found to decrease the risk of dementia.
What are some recommendations Snowden makes for postponing the onset of Alzheimers?
Keep mentally stimulated, avoid head trauma,keep blood folate levels high by taking folic acid supplements, stay emotionally positive and physically active.