BIPC Final (based on study guide)

Erickson

social development (series of social changes)

Piaget

cognitive development (learn thru interaction w environment + others)

Freud

psychosexual/psychosocial development (unconscious memories, thoughts, + urges)

Kohlberg

moral development (stages of moral reasoning)

Maslow focused on positive qualities

as opposed to thinking that people were ill

Undeniable human needs (maslow)

(bottom) physiological needs --> safety --> love/belonging --> esteem --> self-actualization (top)

Acetylcholine

Alzheimer's, myasthenia gravis, Parkinson's

Dopamine

schizophrenia, Parkinson's, ADHD, addiction

GABA

Huntington's, addiction

NE

depression, ADHD, anxiety

Serotonin

depression, anxiety

Transference

pt feelings --> therapist

Countertransference

therapist feelings --> pt

Types of stigmas

affiliate, courtesy, institutionalized

Internalized (self) stigma

occurs when one internalizes negative stereotypes assoc w mental illness

Internalized stigma outcomes

poor self esteem, unemployment, decreased med compliance, decreased social sport, delay in seeking tx, self-medication, misdiagnosis of mental illness

Courtesy stigma

family members + social support may be ostracized for other's mental illness

Courtesy stigma effect

can exacerbate sx severeity as pts may feel like they may have to isolate themselves

Affiliated stigma

when caregivers internalize courtesy stigma

Affiliated stigma example

"bc my fam member has this, I feel X, Y, Z"

Institutionalized stigma

employers less likely to offer jobs to those with mental illness, those w mental illness are placed in jails

Burnout

job related stress syndrome resulting in emotional exhaustion, depersonalization, decr personal accomplishment

Thought content

compulsions, obsessions, phobias, anxieties, suicidal ideation, feelings of unreality, feelings of depersonalization, hallucinations, delusions

Blocking

abrupt interruption in train of thought, pause, + no recall of what was being said

Echolalia

persistent repeating of words or phases of another person

Flight of ideas (in mania)

these ideas are CONNECTED - rapid, continuous verbalization w constant shifting

Loose associations (in schizophrenia)

flow of thought in which ideas shift from one subject to another in an UNRELATED way

Trauma informed care

direct understanding of profound neuro, biological, psych, + social effects trauma has on an individual. Realizes the widespread impact of trauma.

PTSD non-pharm tx

Trauma-informed counseling + therapy, support groups, young, meditation, mindfulness

PTSD pharm tx

SSRIs = escitalopram, citalopram, fluoxetine, sertraline, paroxetine

Somatic Symptom Disorder

Physical symptoms that are NOT explained by physical disorder (pt is not faking it... have the sx and obsess over them)

Somatic Symptom Disorder - Epi

Females < 30yo; 80% of psych comorbidity (anxiety, depression)

Somatic Symptom Disorder - Risk factors

Low SES, low education, unemployment, early life trauma (ACEs)

Somatic Symptom Disorder - Clinical features

Many somatic complaints; long complicated, vague, disorganized medical hx; multiple health providers; anxiety; depression; can be dramatic but not delusional

Illness Anxiety Disorder (IAD)

Preoccupation w having or getting a serious illness

IAD - Somatic symptoms

Somatic sx are NOT present (or are mild)

IAD - Epi

male = female, ~20-30yo

IAD - Clinical features

Fear or concern about having an illness; debilitating avoidance + excessive health-related activities; some avoid healthcare

Functional Neurologic Disorder

Deficits in voluntary motor control or sensory fx with NO clinical findings. worse when thinking about it

Functional Neurologic Disorder - Epi

Females in teens + 20s

Functional Neurologic Disorder - Most common symptoms

paralysis, weakness, blindness, mutism

Functional Neurologic Disorder - Primary gain

relief of anxiety, stress, psych conflicts beyond conscious awareness

Functional Neurologic Disorder - Secondary gain

avoid obligations, exert control

Functional Neurologic Disorder - Signs

(+) hoover sign in functional leg weakness; (+) drift without pronation in functional arm weakness

Functional Neurologic Disorder - Course

Acute onset + symptoms typ. resolve spontaneously ~ 2 wks

Factitious Disorder

Falsification of physical or psych signs or sx, or induction of injury or dz with intent to deceive

Factitious Disorder - External rewards

NO obvious external rewards

Factitious Disorder - Epi

Physical signs + sx . WOMEN; psych signs + sx . MEN; often white males who are unemployed, unmarries, + middle ages; hx of employment in healthcare field

Factitious Disorder - Clinical features

Purposeful infection, poisons, insulin to induce hypoglycemia; hallucinations, depression, sx of psychosis or functional neurologic disorder

Malingering

NOT attributed to mental illness

Malingering - External gain

money, pain meds, time off work

Malingering - Types

faking an illness; sx exaggeration; deliberate attribution of actual sx to the compensable event

CAGE questions

Cut down; Annoyed; Guilty; Eye-opener

Alcohol detox

Benzo taper --> Diazepam (Valium), Librium, Ativan, Serax

Valium + Librium

long acting, more sedating, hepatic metabolized (avoid in elderly/liver dz)

Ativan + Serax

short acting, less sedating, safe in liver disease

Opiate withdrawal symptoms

Dilated pupils, hot/cold flashes, BP, HR, RR, temp; cravings, anxiety, tremors, muscle/body aches, restless, insomnia, yawning, sweats, rhinorrhea, piloerection, loss of appetite, N/V, diarrhea

Seizures in opiate withdrawal

NO seizures

Alzheimer dementia

60-80% of dementia cases; FEMALE > male; beta-amyloid plaques outside neurons + tau protein inside neurons lead to neuron dysfunction + death

Alzheimer early stage

progressive memory loss disturbing ADLs, difficulty planning or completing routine tasks, confusion, impacted judgement, personality + mood changes

Alzheimer late stage

behavior changes, disorientation, difficulty speaking, swallowing (aspiration), + walking

Vascular dementia

Caused by vascular damage or blockage (CVA, TIA, atherosclerosis)

Vascular dementia symptoms

stepwise decline, impaired judgment, planning, decision making, slow gait, poor balance, language impairment, focal neuro signs

Frontotemporal dementia

Age 45-60 yo; frontal + temporal lobe atrophy; upper layers of cortex soften + show protein accumulation

Frontotemporal early signs

Behavioral disinhibition, loss of empathy, personality changes, hyperphagia, hyperorality, difficulty producing or understanding language

Lewy body dementia

Alpha-synuclein aggregations in neurons in cerebral cortex

Lewy body early stage

dream enactment behavior, visual hallucinations, visuospatial impairment, marked cognitive fluctuations, possibly unimpaired memory

Lewy body late stage

parkinsonian features

Lewy body timing

Cognitive + psych sx occurs >1yr before parkinsonism

Parkinson disease dementia

Alpha-synuclein aggregations in neurons in substantia nigra

Parkinson disease dementia early

Parkinson's motor sx (rigidity, tremor, gait changes)

Parkinson disease dementia later

sx similar to Lewy body

Parkinson disease dementia timing

Parkinsonism occurs >1 yr before cognitive impairment

Dementia

Progressive, persistent, affects attention, executive functioning, learning + memory, language/word finding

Delirium

Acute, fluctuating course, causes deficits in attention but NOT memory

Onset

Dementia: slow + gradual, uncertain beginning point; Delirium: sudden, definite beginning point

Duration

Dementia: permanent; Delirium: days to weeks

Cause

Dementia: chronic brain disorder; Delirium: almost always another condition

Course

Dementia: slowly progressive; Delirium: reversible

Effect at night

Dementia: often worse; Delirium: almost always worse

Attention

Dementia: unimpaired until severe; Delirium: greatly impaired

Level of consciousness

Dementia: unimpaired until severe; Delirium: variably impaired - confused, disturbed, bizarre mental status

Orientation to time + place

Dementia: impaired; Delirium: varies

Use of language

Dementia: sometimes difficulty finding right word; Delirium: slow, often incoherent + inappropriate

Memory

Dementia: lost, especially for recent events; Delirium: varies

Hallucinations

Dementia: rare; Delirium: frequent visual or tactile hallucinations, occasionally olfactory

Judgement + social skills

Dementia: poor and varies by brain area; Delirium: impaired

Need for medical attention

Dementia: required but less urgent; Delirium: immediate

Sexuality in older age

More direct stimulation + more time needed for arousal, erections less rigid, urge to ejaculate less intense, longer refractory period

Sexual health

state of physical, mental, + social well-being in relation to sexuality. Requires a positive + respectful approach to sexuality + sexual relationships

**takes the idea of reproduction out of the definition

Reproductive health

addresses the reproductive processes/fx/system at all stages of life

implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so

Anorexia nervosa

Significantly low body weight; intense fear of gaining weight or becoming fat

Anorexia - Epi

females, avg age of onset 18yo

Anorexia - Complications

Primarily cardiac complications + suicide; medical complications account for > 50% of deaths; mortality rate 5-10%

Anorexia - Symptoms

Marked wt loss, delayed pubertal development, cold intolerance, hypothermia, weakness, fatigue or lethargy, presyncope or syncope, difficulty concentrating, amenorrhea

Anorexia - Signs

BMI < 17.5; bradycardia, QTc prolongation, heart blocks, MVP; amenorrhea, hypothermia, lanugo, stress fractures, cachectic; orthostasis, hair thinning, erosion of teeth enamel, GI issues, bony prominences, parotid gland enlargement

Anorexia - Labs

Leukopenia, anemia, T3 can be low, low electrolytes, DEXA = osteopenia (late sign)

increased: amylase (vomiting), BUN (dehydrated), cholesterol

Bulimia

Normal - overweight; recurrent episodes of binge eating + recurrent compensatory behaviors; self eval is dependent on wt + shape

Bulimia - Symptoms

Similar to anorexia PLUS oral + dental issues including parotid gland enlargement, periodontal dz, dental caries

Russel's sign

calluses on knuckles from self-induced vomiting