Exam 3 (Ch 10 to 14)

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Female sexual interest/ arousal  disorder

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Female sexual interest/ arousal  disorder

  • Lack of or significantly reduced sexual interest/arousal 

  • Typically manifesting in 

    • Reduced sexual interest

    • Reduced sexual activity 

    • Fewer sexual thoughts 

    • Reduced arousal to sexual cues 

    • Reduced pleasure or sensations during almost all sexual encounters 

  • And causes significant distress

  • Research suggests 7-46% of women experience low sexual desire

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Male hypoactive sexual desire disorder

  • Little or no interest in any type of sexual activity 

  • Masturbation, sexual fantasies, & intercourse are rare 

  • Affects approximately 5% of men  

  • As w/ other disorders: Not better explained by something else

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Genito-pelvic pain/penetration disorder

  • FEMALE-SPECIFIC

    • In females, difficulty w/ vaginal penetration during intercourse, associated w/ one or more of the following 

      • Pain during intercourse or penetration attempts 

      • fear/anxiety about pain during sexual activity 

      • Tensing of pelvic floor muscles in anticipated of sexual activity

Note:

  • Can be → Actual pain or Anxiety regarding Sex

  • Can also happen w/ pelvic muscle spasms involuntary

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Erectile disorder

  • MALE-SPECIFIC 

    • Difficulty achieving or maintaining an erection 

    • Sexual desire is usually intact 

    • The most common problem for which men seek treatment 

    • Prevalence increases w/ age 

      • 50% of those over 60 experience erectile dysfunction 

        • Only 2% under age 40

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outside factors such as severe relationship stress that could be accounting for symptoms

if there is Relationship stress

if there is a Divorce

Any other outside reasons that could explain less sexual interest

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reasons why healthcare professionals may be less inclined to bring up sexual health in an appointment with a patient/client. 

Why would providers not bring it up?

  • Minimally education 

    • they don’t feel competent in addressing these problems 

  • Time crunch/constraint  -> @ most 15-minute window 

    • Address other/bigger issues 

  • Personal factors

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psychological disorders that may make someone more vulnerable to sexual dysfunction

  • Anxiety regarding Sex

  • Depression can cause less sexual interest

  • Substance Abuse can lead to sexual disfunction

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 social/cultural influences on sexual functioning

  • Learned negative attitudes toward sex & sexuality (Erotophobia)

  • Negative sexual experiences 

  • Relationship challenges; dissatisfaction w/in romantic relationships

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 how physical disorders/disability can impact sexual functioning

  • Physical disability often increases the likelihood of sexual functioning problems 

  • People w/ more severe physical disability report on average lower sexual satisfaction

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 treatment options for sexual dysfunction.

  • Education 

  • Masters & Johnson’s Psychosocial Intervention 

    • Sensate focus & non-demand pleasuring 

      • Sexual activity w/ the goal of focusing on sensation w/out trying to achieve orgasm 

  • Use of dilators to help women w/ painful intercourse 

  • Exposure to erotic material for problems w/ low sexual desire 

  • Medications (oral, injectable), vacuum-pump devices for ED

  • Referral to appropriate medical professionals (ex PCP, PT)

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distinguish between substance use and abuse

  • Substance abuse -> Use in a way that is dangerous and substantial impairment (e.g. affecting job or relationships) 

DIFF - ABUSE is dangerous use affecting you & your functioning (job)  while USE is moderate amounts but doesn’t affect functioning 

  • Substance use -> taking moderate amounts of substance in a way that doesn’t interfere with functioning

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 distinguish between tolerance and withdrawal

  • Tolerance -> needing more of a substance to the same effect/reduced effect from the same amount 

DIFF - Tolerance is needing a higher dosage to get the same effects @ the beginning & Withdrawal is physical discomfort after stopping/not regularly use 

  • Withdrawal -> physical  symptom reaction when a substance is discontinued after regular use 

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 5 main categories of substances  common features of each, and examples of drugs that belong to each category

  1. Depressants 

    1. Behavioral sedation -> alcohol, sedative, anxiolytic drugs

    2. Depress CNS -> reduce anxiety & make us sleepy 

  2. Stimulants 

    1. Speed up body systems 

    2. Increase alertness & elevate mood -> cocaine, nicotine, caffeine 

  3. Opiates 

    1. Produced analgesia (masking of pain) and euphoria 

      1. heroin, morphine, codeine, oxycodone 

    2. Opioids, narcotics, pain killers -> same category 

  4. Hallucinogens 

    1. Alter sensory perception 

      1. LSD, Marijuana

  5. Other drugs of abuse 

    1. Include inhalants, anabolic steroids, medications

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 clinical features of substance use disorders

  • Pattern of substance use leading to significant impairment & distress

  • Symptoms (need 2+ w/in year)

    {side note: 2-3 Mild, 4-5 Moderate, 6+Severe} 

    • Taking more of substance than indented 

    • Desire to cut down use 

    • Excessive time spent using/ acquiring/recovering 

    • Craving for the substance 

      • Took the place of legal problems related to substance 

    • Role disruption (eg can’t perform @ work 

    • Interpersonal problems 

    • Reduction of important activities 

    • Use in physically hazardous situations

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common comorbid diagnoses with substance use disorders

  • Approx 75% of ppl in addition to treatment meet the criteria for at least 1 other psychiatric disorder 

    • Mood disorder (40% or more) 

    • Anxiety disorder & PTSD (25% or more) 

  • When other psychiatric symptoms occur in the context of active substance use, clinicians must proceed carefully w/the diagnosis

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 long-term effects of heavy drinking.

  • Tremors 

    • In hands 

    • Withdrawal 

  • Nausea/vomiting

    • Part of withdrawal 

  • Hallucinations 

  • Agitation

  • Insomnia 

  • Seizures 

  • Delirium tremens (DTs) in severe cases 

    • Small %’s  -> 3-5% w/ severe hx 

    • Involves disorientation

      • Mental confusion

      • Hallucinations 

      • The body starts shutting down

        • Effect regulation 

          • HR & respiration 

  • Liver disease 

    • Cirrhosis  of the liver 

      • Permanente scarring of the liver 

  • Pancreatitis 

  • Cardiovascular disorders 

  • Depression 

  • Certain cancers 

    • Esophageal 

    • Colon 

    • Breast 

  • Brain damage 

    • Dementia 

      • Cognitive decline 

    • Wernicke-Korsakoff Syndrome

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Describe what delirium tremens (DTs) are.

  •  the most severe form of alcohol withdrawal. It causes your sympathetic system to go into overdrive which then causes an irregular cardiovascular system. As a result people get really bad confusion, shaking, high blood pressure, fever, and hallucinations. This can be fatal. 

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what counts as a standard drink for beer, wine, and liquor.

  • 12 fl oz of regular beer 

    • Assuming 5% proof

  • 5 fl oz of table wine

    • Assuming 12%  proof

  • 1.5 fl oz shot of distilled spirits (liquor)

    • gin, rum, tequila, vodka, whiskey, etc. 

    • Assuming 40% proof

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 what is meant by moderate, heavy drinking, and binge drinking for men and women.

  • Moderate

    • no more than 2 drinks/day (men) 

    • No more than 1 drink/day (women) 

    • Some ppl (e.g pregnant women) should not drink 

  • Heavy drinking according to NIAAA 

    • For MEN consuming > 4 drinks on any day or more than 14/week

    • For WOMEN consuming > 3 drinks on any day or more than 7/week 

  • Binge-drinking 

    • 4+ drinks for women

    •  5+ for men w/in 2 hr period 

      • Amt of alcohol blood level gets to 0.80

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questions asked on the CAGE alcohol use disorder screening tool

  • Cutting down 

    • Ex: have you ever felt that you should CUT down on your drinking 

  • Annoyed

    • Ex: Have you ever become ANNYOYED by criticisms of your drinking  

  • Guilty 

    • Ex: Have you ever felt GUILTY about your drinking 

  • Eye opener 

    • Ex: Have you ever had a morning EYE OPENER to get rid of a hangover

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what is meant by prescription drug misuse/abuse

Taking medication in a way that it was not originally intended

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Describe how opioids have their effect

  • Opioid drugs bind to opioid receptors in the CNS 

    • Bind to receptors 

  • Inhibit production of GABA 

    • GABA -> neurotransmitter -> helps regulate amt of dopamine 

  • Allows more dopamine to be available in the brain 

    • Feel good, pleasure, ect (when it’s active in body)

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why someone would be at high risk of overdose from a relapse after a period of abstinence

They lose tolerance -> become too much (dose)

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relevant biological treatments (like Naltrexone and Methadone) for opioid use disorder and alcohol use disorder

  • Naltrexone 

    • FDA-approved for opioid & alcohol use disorders 

    • Blocks pleasant effects of drugs; reduces cravings 

    • Pt must complete the detox (medically managed withdrawal) prior to initiating 

  • Methadone 

    • FDA-approved for opioid use disorders 

    • Blocks pleasant effects of drugs; reduces cravings 

    • Potentially addictive 

  • Suboxone

    •  FDA-approved for opioid use disorders 

    • Blocks pleasant effects of drugs; reduces craving 

    • Potentially addictive 

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 some of the positive outcomes of medication-assisted treatment for opioid use disorder

  • Lower the risk of fatal overdoses by approx 50%

  • Lower risk of non-fatal overdoses 

  • Reduce drug-injecting 

  • Reduce HIV transmission 

  • Reduce criminal activity by opioid users 

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general nature of personality disorders (PDs)

  • The nature of personality disorders

    • Enduring, inflexible predispositions

    • Maladaptive, causing distress and/or impairment

    • High comorbidity 

    • Poorer prognosis 

Don’t tend to show up for treatment on own or stick with  

More likely to show from other paths (ordered, fam)

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 3 personality clusters and be able to identify PDs belonging to each cluster

  • Cluster A 

    • Personality disorders 

      • Odd or eccentric cluster 

      • includes paranoid, schizoid, schizotypal 

  • Cluster B 

    • personality disorders 

Intense, unpredictable

  • dramatic, emotional, erratic cluster 

  • Includes antisocial, borderline, histrionic, narcissistic 

  • Cluster C 

    • Personality disorders 

Diff than anxiety -> stable across time ingrained personality 

  • Fearful or anxious cluster 

  • Includes avoidant, dependent, obsessive-compulsive 

    • Ob-comp -> diff than OCD

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 common focus of treatment for Cluster A PDs.

 

  • Focus on interpersonal skills

    • Using cognitive strategy to combat 

      • What's the evidence 

  • Building trust where paranoia is a factor 

  • Address comorbid conditions

Targeting interpersonal, and social skills, basically trying to reduces paranoia

CBT - focus on positive behaviors & reduce anxiety

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 clinical features of antisocial PD.

  • Antisocial PD  -> CLUSTER B 

    • Failure to comply w/ social norms 

    • Violation of the rights of others 

    • irresponsible, impulsive, and deceitful 

    • Lack of a conscience, empathy, & remorse 

      • Lack of remorse -> Engage in deceitful but don’t feel guilty 

    • May be very charming, interpersonally manipulative 

      • Likable -> until known 

      • Used car sales men (idea -> want the sale) 

    • Most often diagnosed in males 


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common features of early/family history of antisocial PD

  • Common of Early & Fam hx 

    • Relation w/ early behavior prob & conduct 

      • Early hx of behavioral problems, including conduct d/o 

        • “Callous-unemotional” type of conduct disorder more likely to evolve into antisocial PD 

Youth-> set fire, hurt animals -> NEED TO HAVE EVIDENCE CONDUCT DISORDER BEFORE AGE 18 -> to meet criteria to have antisocial personality disorder 

  • Families w/ inconsistent parental discipline & support

  • Families often have hx of criminal & violent behavior 

Can run on families

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clinical features of borderline PD

  • Borderline PD  - CLUSTER B 

More women than men have/been diagnosed 

  • Unstable moods and relationships

    • Have a pattern of rocky short-lived relationships

  • impulsivity, fear of abandonment, poor self-image 

    • Instability in moods (affect) 

      • Think of walking on eggshells 

    • Chronically feeling of emptiness 

      • Mood disorders -> MDD common (comorbidity)

  • Self-mutilation & suicidal gestures

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treatment options for borderline PD

  • Antidepressant medications provide some short-term relief 

  • Dialectical behavioral therapy

Marsha Linehnd - orig for Borderline PD 

4 main models -> can be done as a group or individually

  • Mindfulness: the practice of being fully aware and present 

  • Distress Tolerance: how to tolerate pain in different situations 

    • How can I ride a wave of intense emotion w/out being harmful (to others or myself)

  • Interpersonal Effectiveness: how to ask for what you want & say no while maintaining self-respect and relationships with others 

    • Learn skills to more effectively relate w/ other ppl 

  • Emotion regulation: how to decrease vulnerability to painful emotions & change emotions that you want to change  

    • How can help ppl stay grounded & stable

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 clinical features of obsessive-compulsive PD and how it differs from OCD.

  • Obsessive-Compulsive PD  -> CLUSTER C 

    • Excessive & rigid fixation on doing things the right way 

      • This is the way it should be done and will always be done 

    • Highly perfectionistic and orderly 

    • Obsessions and compulsions are rare 

DIFF -> OCPD -> NOT HAVING OBSESSIONS & COMPULSIONS

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DSM-5 criteria for schizophrenia

A. Two (or more)

  • (1) delusions

  • (2) hallucinations

  • (3) disorganized speech

  • (4) grossly disorganized or catatonic behavior

  • (5) negative symptoms

B. level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset.

C. at least six months.

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 what hallucinations are

  • Hallucination 

    • Experience of sensory events w/out environmental input 

    • Can involve all senses 

      • Tasting something when not eating 

      • Having skin sensations when not being touched 

    • Most common: Auditory

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types of hallucinations

  • Auditory - hearing things that aren’t there 

    • Subtype: command hallucinations -> more safety risk -> voice telling to do something 

    • Feeding negative beliefs 

    • Running commentary 

      • Narration of daily behaviors 

  • Visual - seeing things that aren’t there 

    • Animals or people 

  • Olfactory - smelling things that aren’t there 

    • Smelling rotten eggs (common)

  • Tactile - feeling things that aren't there 

    • A sensation of bugs crawling under the skin (common)

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what delusions are and be able to recognize examples of delusions of grandeur and persecution

  • Delusions 

    • Gross misrepresentations of reality 

    • Most common 

      • Delusions of grandeur 

        • having this special skill, talent, etc. 

          • I am the king of England 

          • I can speak directly to God 

      • Delusions of persecution 

        • Out to harm and get them 

          • “CIA is tracking me”

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positive symptom clusters in schizophrenia

  • Hallucination 

    • Experience of sensory events w/out environmental input 

    • Can involve all senses 

      • Tasting something when not eating 

      • Having skin sensations when not being touched 

    • Most common: Auditory 

  • Delusions 

    • Delusions of grandeur 

      • having this special skill, talent, etc. 

        • I am the king of England 

        • I can speak directly to God 

      • Delusions of persecution 

        • Out to harm and get them 

          • “CIA is tracking me”

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negative symptom clusters in schizophrenia

  • The negative symptoms 

    • Absence or insufficiency of normal behavior 

  • Spectrum of negative symptoms 

    • Avolition (or apathy)

      • lack of initiation and persistence

    • Alogia

      • relative absence of speech

    • Anhedonia  

      • lack of pleasure or indifference

    • Affective flattening

      • little expressed emotion

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disorganized symptom clusters in schizophrenia

  • Disorganized speech

    • Tangentiality - “going off on a tangent” 

      • Start in one place & ends at another 

    • Loose associations - a conversation in unrelated directions 

    • Blocking Speech -> halting, interrupted speech -> Robot reading, minor 2 pauses between thoughts 

  • Disorganized affect

    • Inappropriate emotional behavior

      • someone says they feel one way but the face says something else

  • Disorganized behavior

    • Includes a variety of unusual behaviors 

      • Pacing, inappropriate eye contact

    • Catalonia

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clinical descriptions for schizophreniform

  • Psychotic symps lasting btwn 1 & 6 months 

  • Need 2+ symp 

    • Delusions, hallucinations, disorganized speech or catatonic behavior, neg symptoms

Note: Can develop into schizophrenia -> if symptoms keep occurring 6+months

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clinical descriptions for  brief psychotic disorder

  • Psychotic symptoms lasting less than 1 month 

  • Need 1+ symptoms(s) 

    • Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior

Note: Some ppl can recover and never have another, others not so much

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clinical descriptions for schizoaffective disorder

Note: mood disorder [depression type]  meets psychotic symptoms [schizophrenia] & Timeline & order matters  

NEED TO HAVE STANDALONE PSYCHOTIC SYMPTOMS

  • Psychotic symptoms need to happen outside the mood disturbance 

  • Prognosis symptoms must also occur outside the mood disturbance 

  • Such persons don’t tend to get better on their own

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clinical descriptions for catatonia

  • Unusual motor responses, particularly immobility or agitation, and odd mannerisms

  • Tends to be severe & quite rare 

  • May be present in psychotic disorders or diagnosed alone 

  • May include 

    • Stupor, mutism, or maintaining the same pose of hours 

    • Opposition to lack of response to instruction 

    • Repetitive, meaningless motor behaviors 

    • Mimicking others’ speech or movement

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differential diagnoses for schizophrenia (disorders we would need to rule out because they share similar clinical features)

  • Personality disorders 

    • Cluster A 

  • Substance use disorder 

  • Bipolar disorder

    • Type I -> more severe 

  • Major Depression Disorder 

    • Might have psychotic symptoms during a severe episode 

  • Medical condition 

    • Parkinson’s Disease 

    • Lewy Body Dementia

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 prevalence rate of schizophrenia, demographic patterns in the age of onset, and the relationship between schizophrenia and life expectancy

  •  prevalence of schizophrenia worldwide 

    • Abt 1% of population 

    • Often in early adulthood 

  • Demographic 

    • Males -> early 20s  

    • Females -> (bimodal) -> late 20s & mid 40s 

  • Lower life expectancy 

    • Due to increased risk of suicide, accidents, & poorer self-care

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what is meant by the “prodromal” phase of schizophrenia.

Is the stage before diagnosis when there are psychotic behaviors that have developed but not enough to warrant a psychological disorder

alternative:

This is a phase of schizophrenia where individuals have intense mood swings, trouble with memory, depression, thoughts of suicide. This is basically a lot of the aspects of schizophrenia but no psychosis or hallucinations.

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 causal factors and correlates of schizophrenia

  • Genetics vs environment 

    • Pretty high genetic -> risk increase depending on how close they are (mom vs cousin, mom - the child has higher risk)

    • BUT a healthy environment is a protective factor

  • Dopamine hypothesis 

    • Schizophrenia is partially caused by overactive dopamine 

      • Drugs that increase dopamine (agonists) result in schizophrenic-like behavior 

      • Drugs that decrease dopamine (antagonists) reduce schizophrenic-like behavior

  • Neurobiological 

    • structural & functional abnormalities in the brain

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treatment options for schizophrenia and describe what “tardive dyskinesia” is

  • antipsychotic medication + psychosocial interventions 

    • Social skills/living skills training 

    • Family therapy 

    • Vocational rehab 

  • Noncompliance w/ meds is common issue 

  • Meds have major & permanent side effects

    • Tardive dyskinesia -> a drug-induced side effect that causes involuntary muscle movements

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inattentive symptoms of ADHD

  • Not giving close attention to details 

  • Difficulty maintaining attention 

  • Trouble w/ follow-through

  • Avoids tasks that require sustained mental effort 

  • Often lose things necessary for tasks/activities 

  • Easily distracted &/or forgetful

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hyperactive/impulsive symptoms of ADHD

  • Fidgeting in seat 

  • Often unable to engage in leisure activities quietly 

  • “Driven by a motor” 

  • Running/climbing in situations where inappropriate (or feelings of restlessness in adults) 

  • Blurting out answers before questions in completed 

  • Difficulty waiting their turn

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recognize someone with ADHD, predominately inattentive type

Inattentive type of ADHD is when a person has the symptoms

ex: Trouble focusing, Trouble with time management, ect.

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recognize someone with ADHD, predominately hyperactive/impulsive type

Hyperactive/impulsive ADHD type is when only hyperactive symptoms are present

ex: “Driven by a motor”, blurting out answers, ect.

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recognize someone with ADHD,  combined type

When both inattentive and hyperactive/ impulsive symptoms are present

ex. losing things & fideting ing seat

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other diagnostic features of ADHD

  • Several sympt must be present before age 12 

    • If older -> psych asks abt childhood 

  • Symptoms present in 2 or more settings 

  • Significant distress or impairment 

  • Not better explained by another condition

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prevalence rates/trends for ADHD

  • This occurs in approx 5% of school-aged children

  • Symptoms are usually present around the age of 3-4

  • Children w/ ADHD have similar probs as adults 

    • Same criteria except hyper activity (restlessness) 

Gender diff

  • Boys outnumber girls 3:1 

Childhood prevalence by Race or Ethnicity, according to large national sample 

  • White, non-hispanic 78.8% 

  • Hispanic 9.1% 

  • Black 6.0%

  • Asian 3.2% 

  • Other 3.0%

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prevalence rates/trends autism spectrum disorder (ASD)

Prevalence 

  • 1 in 44 children in US meet criteria 

  • More commonly in males 

    • 4x more common 

  • IQ interaction 

    • Approx. 35% show intellectual disabilities 

    • Most are fine

  • Worldwide prevalence = 1%

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main areas of impairment in ASD and be able to recognize examples

  • Communication & social interaction

  • Restricted, repetitive patterns of behavior, interests, or activities

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Be familiar with relationship between ASD and intellectual disability.

Those w/ ASD can have intellectual disability bc of their slower development 

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 Be familiar with risk factors of ADHD

  • ADHD seems to run in the family

  • DAT1- Dopamine transporter gene has been implicated 

    • Some ADHD drugs work by inhibiting DAT1

  • Neurobiological correlates of ADHD  

    • Smaller brain volume 

      • Hippocampus 

      • Amigdla 

    • Inactivity of the frontal cortex and basal ganglia (movement- voluntary- coordination)

    • Abnormal frontal lobe development & functioning  

      • Decision making 

      • Organization 

      • Planning

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Be familiar with risk factors of ASD

Biological dimensions of autism 

  • Significant genetic componet 

    • Familial component: if 1 child w/ austism, the 2nd w/ autism is 20% greater 

      • 100x greater risk than general population 

  • Possible link btwn autism & levels of oxytocin (feel good/cuddle) receptor genes 

  • Older pairent associated w/ increased risk 

    • Particularly fathers @ time of conception


Neurobiological influences 

  • Amygdala - fear response  

    • Larger size @ birth = higher anxiety, fear 

    • Elevated cortisol 

    • Neuronal damage in the amygdala results from high stress, whch may affect processing social situations 

  • Oxytocin 

    • Lower levels 

      • Bonding hormone -> might explain why might not need ppl in same sense as avg person

  • Vaccinations do not increase risk od autism 

    • Mercury in some vaccinations was rumored to increase ausitm risk 

    • Large-scale studies do not support this 

    • High rates of vaccinations do not increase the risk for autism in the community at large 

    • The health risk of not vaccinating is substantial

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Be familiar with treatment options for ADHD

  • Biological Treat.

    • Stimulant medications

      • Currently prescribed for approximately 4 million American kids 

      • Low doses of stimulants improve focusing abilities 

      • Ex include 

        • Ritalin, Dexedrine, Adderall 

  • Behavioral treatment

    • Reinforcement programs 

      • To increase appropriate behaviors/decrease inappropriate behaviors 

        • Positive reinforcement -> token for good behavior

        • If bad -> token gets taken away  (neg reinforcement for bad)

      • May also involve parent training

  • Combined bio-psycho-social treat 

    • Often recommended 

    • Maybe superior to medication or behavioral treatments alone

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 Be familiar with treatment options for ASD

  • Psychological 

    • Behavioral approaches 

      • Skill building 

      • Reduce problem behaviors 

      • Communication & language training 

      • Increase socialization 

    • Early intervention is critical - may “normalize” the functioning of the developing brain 

  • Biological treat 

    • Medical intervention has had little positive impact on core dysfunction

      • Sometimes in conjunction w/ psych-social

      • Manage symptoms -> if the child is causing harm to self -> banging head 

    • Some drugs decrease agitation 

      • Tranquilizers 

      • SSRIs 

    • Indicators or good prognosis 

      • High IQ, good language ability 

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