CH 4, A/B Sleep-Wake Disorders, Sexual Dysfunctions, & Psychiatric Rehabilitation

Comprehensive practice flashcards covering DSM-5-TR sleep-wake disorders, sexual dysfunctions, paraphilias, gender dysphoria, psychiatric treatment settings, deinstitutionalization, and community rehabilitation models.

Insomnia Disorder

A sleep disorder characterized by dissatisfaction with sleep quantity or quality, involving difficulty falling asleep, difficulty maintaining sleep, and/or early-morning awakening with an inability to return to sleep.

Inadequate Sleep Hygiene

An insomnia subtype caused by daily habits and behaviors that disrupt sleep, including late caffeine or nicotine consumption, excessive evening stimulation, daytime naps, and variable sleep-wake routines.

Psychophysiological Insomnia

An insomnia subtype marked by conditioned arousal and anxiety triggered by the thought of sleep or the bedroom environment, leading to genuine physical inability to sleep despite feeling tired.

Paradoxical Insomnia

An insomnia subtype in which a client perceives that they are awake and not sleeping, despite objective brain wave activity confirming normal physiological sleep patterns.

Behavioral Insomnia of Childhood

An insomnia subtype where a child depends on specific parental stimulation, objects, or rituals (such as extra stories, drinks, or bedtime stalling) to fall or return to sleep, managed primarily by caregiver limit-setting.

Idiopathic Insomnia

A chronic, lifelong inability to obtain adequate sleep that begins in early life and is attributed to an underlying neurological deficit in the sleep–wake cycle.

Hypersomnolence Disorder

A disorder marked by excessive sleepiness persisting for at least $1\text{ month}$, characterized by prolonged nocturnal sleep episodes ($8$ to $12\text{ hours}$) or daily daytime sleep that leaves the client unrefreshed.

Narcolepsy

A neurological condition marked by chronic excessive daytime sleepiness and recurrent, irresistible sleep attacks lasting $10$ to $20\text{ minutes}$, after which the individual awakens briefly refreshed.

Cataplexy

Sudden, reversible episodes of bilateral loss of muscle tone lasting seconds to minutes, typically triggered by intense emotion such as laughter, and serving as a hallmark feature of narcolepsy.

REM Sleep Intrusions

Abnormal intrusions of rapid eye movement sleep into sleep–wake transitions seen in narcolepsy, presenting clinically as voluntary muscle paralysis or vivid dream-like hallucinations.

Obstructive Sleep Apnea

A sleep-related breathing disorder characterized by repetitive episodes of upper airway collapse and obstruction during sleep, commonly occurring in individuals with obesity.

Central Sleep Apnea

A sleep-related breathing disorder involving episodic cessation of ventilatory effort without mechanical airway obstruction, occurring more frequently in older adults.

Central Alveolar Hypoventilation

A sleep-related breathing disorder involving sustained hypoventilation during sleep that produces low arterial oxygen levels, commonly identified in obese individuals.

Circadian Rhythm Sleep–Wake Disorder

A persistent or recurrent sleep disturbance resulting from an internal alteration of the circadian timing system or a mismatch between the circadian clock and external schedule demands.

Parasomnias

A group of sleep disorders characterized by abnormal behavioral, physiological, or experiential events occurring during sleep, specific sleep stages, or sleep–wake transitions.

Nightmare Disorder

A parasomnia involving repeated, elaborate frightening dreams that awaken the client, with full orientation upon waking and vivid recollection of the disturbing dream content.

Sleep Terror Disorder

A parasomnia marked by abrupt awakenings with panicky vocalizations (screams/cries) and autonomic arousal; the individual is confused, difficult to console, and retains no memory of a dream.

Sleepwalking Disorder

A parasomnia involving complex motor behaviors performed during sleep, such as getting out of bed and walking around while appearing disoriented; it peaks between ages $4$ and $8$ and typically resolves by adolescence.

Sexual Response Cycle

The four-phase physiological sequence of human sexual response consisting sequentially of desire, excitement, orgasm, and resolution.

Male Hypoactive Sexual Desire Disorder

A sexual dysfunction characterized by a persistent or recurrent deficiency or absence of sexual thoughts, fantasies, and desire for sexual activity, causing significant distress.

Female Sexual Interest/Arousal Disorder

A sexual dysfunction involving a persistent or recurrent inability to achieve or sustain an adequate lubrication-swelling response during sexual activity.

Male Erectile Disorder

A sexual dysfunction defined by a persistent or recurrent inability to attain or maintain an erection adequate for the completion of sexual activity.

Female Orgasmic Disorder

A sexual dysfunction marked by persistent or recurrent delay in, or absence of, orgasm in females following a normal sexual excitement phase.

Delayed Ejaculation Disorder

A sexual dysfunction marked by persistent or recurrent delay in, or absence of, orgasm and ejaculation in males following a normal excitement phase.

Early (Premature) Ejaculation

A sexual dysfunction defined by persistent or recurrent ejaculation occurring with minimal stimulation before, on, or shortly after penetration and prior to the client's wish.

Genitopelvic Pain/Penetration Disorder

A sexual pain disorder characterized by difficulties with intercourse, genitopelvic pain, fear of penetration, or pelvic floor muscle tension; previously classified as dyspareunia and vaginismus.

Paraphilias

Recurrent, intense sexually arousing fantasies, urges, or behaviors involving nonhuman objects, the suffering or humiliation of oneself or a partner, or nonconsenting persons, diagnosable when acted upon without consent or when causing marked distress.

Exhibitionistic Disorder

A paraphilic disorder characterized by sexual arousal derived from exposing one's genitals to an unsuspecting, nonconsenting stranger, most often presenting in men in their 20s.

Fetishistic Disorder

A chronic paraphilic disorder beginning in adolescence, involving intense sexual arousal and gratification derived from inanimate objects (e.g., shoes, lingerie) or specific nonsexual body parts (e.g., feet).

Frotteuristic Disorder

A paraphilic disorder characterized by sexual arousal achieved through touching or rubbing one's genitals against a nonconsenting person, typically in crowded venues that permit rapid escape.

Pedophilic Disorder

A paraphilic disorder involving sexual fantasies, urges, or activities directed toward a prepubescent child (generally $\le 13\text{ years}$ of age) by an individual who is at least $16\text{ years}$ old and at least $5\text{ years}$ older than the child.

Sexual Masochism Disorder

A paraphilic disorder characterized by recurrent, intense sexual arousal from being humiliated, beaten, bound, or otherwise made to suffer physically or psychologically.

Sexual Sadism Disorder

A paraphilic disorder involving recurrent sexual arousal derived from inflicting physical or psychological suffering on another individual, who may be consenting or nonconsenting.

Voyeuristic Disorder

A chronic paraphilic disorder usually beginning before age $15$, characterized by sexual arousal achieved through secretly observing unsuspecting individuals who are naked, disrobing, or engaging in sexual activity.

Gender Dysphoria

A distinct clinical diagnosis defined by a marked, persistent incongruence between experienced or expressed gender and natal (assigned-at-birth) sex, accompanied by clinically significant distress or functional impairment.

Deinstitutionalization

A nationwide mental health policy shift in the 1970s driven by client rights legislation and changes in commitment laws, leading to the emptying of state psychiatric hospitals in favor of community care in the least restrictive environment.

Milieu Therapy

A therapeutic modality prominent in 1980s inpatient psychiatry that utilizes the total environment—including daily unit structure, social interactions, and activities—as an active tool for healing.

Managed Care

A healthcare system rising in the 1990s that introduced utilization review, case management, and admission recertification, drastically shortening psychiatric hospital stays to a few days and increasing inpatient acuity.

Boarding

The practice of clients in psychiatric crisis remaining in the hospital emergency department for prolonged periods, often while waiting for an inpatient bed or attempting to access less intensive services.

Hostel / Hospital Hostel

A homelike, noninstitutional residential unit located near or within a hospital (developed in Canada and the UK) where clients with severe mental illness practice normal activities like cooking and cleaning.

Crisis Resolution / Respite Care

A community-based crisis service where the sole criterion for access is the client's own perception of being in crisis and needing structured, supportive housing to prevent hospitalization.

Dual Diagnosis

The simultaneous presence of a mental illness and a comorbid substance use disorder (or developmental disability), which increases hospital readmission rates and requires integrated treatment.

Case Management

A service framework across inpatient and outpatient settings that assists clients and families in accessing, coordinating, and managing community resources, healthcare, housing, and social services.

Discharge Planning

An individualized nursing and interdisciplinary process that must begin at the time of admission, whose adequacy in establishing community and environmental supports directly predicts successful reintegration.

Partial Hospitalization Program (PHP)

A structured, multimodal psychiatric treatment program attended during day or evening hours, functioning as an intermediate step between 24-hour inpatient hospitalization and independent outpatient living.

Transitional Relationship Model

A community reintegration model implemented in Canada and Scotland built on two foundational components: peer support from individuals with lived experience and bridging staff who maintain relational continuity from hospital to community.

SSI Employment Disincentive

A systemic barrier where earning income above allowable thresholds risks reducing or terminating Supplemental Security Income and associated Medicaid coverage, inadvertently discouraging clients from seeking employment.

Psychiatric Rehabilitation

A holistic, strengths-based approach focused on helping individuals with severe and persistent mental illness develop community living skills, social roles, and quality of life, rather than focusing solely on symptom reduction.

Recovery

A client-defined journey of living a satisfying, hopeful, and contributing life in the community despite the presence of ongoing mental illness, distinct from a medical 'cure' which requires symptom elimination.

Peer Counselors / Consumer Providers

Formally trained mental health workers who possess personal lived experience with mental illness and recovery, providing empathetic support, advocacy, and guidance to clients.

Clubhouse Model

An intentional community psychosocial rehabilitation model originated by Fountain House in 1948 in NYC, featuring member-driven decision-making, staff and members working side-by-side, and a focus on health and strengths.

Four Guaranteed Clubhouse Rights

The foundational membership guarantees of the Clubhouse Model: a place to come to, meaningful work, meaningful relationships, and a place to return to (lifetime membership with no graduation or discharge).

Rehabilitation Alliance

The clubhouse principle describing a collaborative, nonhierarchical partnership between clinician and client, replacing traditional provider-patient power dynamics with mutual respect and shared decision-making.

Assertive Community Treatment (ACT)

An intensive, multidisciplinary community model developed in 1973 in Madison, Wisconsin that delivers 24-hour direct, mobile, in vivo services to clients with severe mental illness with small caseloads and high staff-to-client ratios.

PATH Program

Projects for Assistance in Transition from Homelessness; a federally funded program administered by SAMHSA providing outreach, engagement, and coordinated support services specifically for individuals experiencing homelessness alongside serious mental illness.

Decarceration

A criminal justice and mental health reform effort seeking to divert individuals with serious mental illness away from jails and prisons into community-based psychiatric treatment.

Brief Jail Mental Health Screen (BJMHS)

A validated screening tool utilized during the correctional intake and booking process to rapidly identify symptoms of serious mental illness and initiate clinical intervention.

Military Sexual Trauma (MST)

Sexual assault or severe sexual harassment experienced during military service; it affects both male and female service members and elevates long-term risks for PTSD, depression, and substance misuse.