HP412 Final Exam Study Guide Topics 13-17

Chronic Traumatic Encephalopathy (CTE)

History of recognition of disorder

  • history of CTE :: First called “punch drunk,” found in boxers; characterized by unsteady gait, mental confusion, slowing of muscular movements, and tremors. Thought to be caused by multiple concussive hemorrhages; Dementia pugilistica coined in 1937, Then progressive traumatic encephalopathy, Finally CTE in 1957

Aftermath of boxing

  • aftermath of boxing :: First detailed description of the clinical and neuropathological features of retired boxers

CTE versus traumatic encephalopathy syndrome (TES)

  • CTE vs. TES :: Diagnosis of CTE can only occur postmortem because it is defined by the brain structures/ concentrations of Tau in the sulci; TES is a precursor disease

TES diagnostic criteria

  • TES :: Substantial exposure to repetitive head impacts for a minimum of 5 years; Core clinical features including cognitive impairment or neurobiological dysregulation or both and a progressive course; Clinical features must be progressive and behavior symptoms like depression, anxiety, apathy, and paranoia are included; Cannot be fully accounted for by any other disorders; TES has levels of functional dependence/dementia: independent, subtle/mild functional limitation, mild dementia, moderate dementia, severe dementia.

Risk factors for development of CTE

  • CTE risk factors :: Frequency of collisions (football, soccer, wrestling, boxing), Sub-concussive hits, Increased duration of playing sports, Some genetic risk factors

Mechanisms underlying CTE

  • mechanisms underlying CTE :: As your head is knocked, your brain twists. Positive tau feedback loop with tau which fills up torn spaces

Neuroinflammation 

  • Neuroinflammation :: complex response, an important fundamental immune response; It removes damaged tissue, kills infection, and promotes recovery; In normal conditions, it resolves quickly - Repetitive activation after head trauma (chronic inflammation) is bad and creates a positive feedback loop.

 

Eating disorders

Diagnostic criteria and differences between the major disorders:

Anorexia nervosa

  • anorexia nervosa :: Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health -- Significantly low weight is defined as weight that is less than minimally normal or, for children and adolescents, less than minimally expected; Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight; Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
  • anorexia nervosa prevalence :: 0.8% (1.5% women, 0.1% men)

Restrictive anorexia nervosa

  • restrictive anorexia nervosa :: subtype of anorexia nervosa, During the past 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior -- weight loss is accomplished primarily through dieting, fastings, and/or excessive exercise

Binge/purge anorexia nervosa

  • binge/purge anorexia nervosa :: subtype of anorexia nervosa :: During the past 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior

Bulimia nervosa

  • bulimia nervosa :: Binging 1x per week, compensatory behaviors after binding (usually purging), not underweight
  • bulimia nervosa prevalence :: 0.3% (0.5% women, 0.1% men)

Binge eating disorder

  • binge eating disorder :: Recurrent Episodes of binge eating (an episode of binge eating is characterized by by both of the following: eating, in a discrete period of time, an amount of food that is definitely larger than what most people would eat in a similar time period under similar circumstances; a sense of lack of control over eating during the episode (ex: can’t stop eating)); the binge eating episodes are associated with three (or more) of the following: eating much more rapidly than normal, eating until uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of feeling embarrassed by how much one is eating, feeling disgusted with oneself, depressed, or very guilty afterward; marked distress regarding binge eating is present; the binge eating occurs, on average, at least once a week for 3 months'; the binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
  • binge eating prevalence :: 0.85% (1.25% women, 0.5% men)

Behavioral features of eating disorders

  • Binging
    • binging :: Objectively large amounts of food eating in a short time (around 2 hours), Loss of control over eating
  • Restricting
    • restricting :: Intentionally reducing calorie intake/maintaining low intake
  • Compensating
    • compensating :: Purging, fasting, exercising to get rid of calories from eating (binge, normal, or restrictive)

Body mass index (BMI)

  • BMI :: weight/body volume; Measure of how much mass vs. square meters of height someone has — often used as a measure of adiposity (flawed because mass does not distinguish between fat and muscle)

Gender differences in eating disorders

  • gender differences in EDs :: More women than men; “female” EDs usually focus on thinness, “male” EDs usually focus on muscularity.

Medical consequences

  • medical consequences of Anorexia nervosa :: highest mortality rate of any psychiatric condition; Cardiac, organ failure as well as infectious disease; 20% of people w/ anorexia nervosa die from suicide.
  • medical consequences of Bulimia nervosa :: dental problems and esophagus damage due to purging, bowel injuries from laxatives; High rate of suicide and comorbidity with substance use.
  • medical consequences of Binge eating disorder :: elevated risk of overweight/obesity, diabetes, risk of anorexia or bulimia nervosa.
  • medical consequences of Low weight :: bone density loss, heart problems, muscle wasting, gastroparesis.
  • medical consequences of Bigorexia :: steroid abuse and excessive protein intake (kidney damage)

Family based treatment (FBT) for anorexia nervosa

  • FBT for anorexia nevosa :: effective treatment for anorexia nervosa, family psychoeducation and support therapy

Enhanced CBT for eating disorders

  • enhanced CBT for EDs :: effective therapy for eating disorders focused on thoughts and behaviors

Proposed new diagnoses:

  • Bigorexia nervosa :: Currently a diagnostic for body dysmorphic disorder; Extremely high protein intake, high caloric intake to compensate for excessive exercise; Steroid abuse, distress and impairment from time spent eating, injuries or pain from exercise, drug use, body dysmorphia.
  • Orthorexia nervosa :: An extreme preoccupation with healthy eating; Rigid, compulsive eating behaviors; Distress about breaking rules; Psychosocial impairment caused by avoidance of eating opportunities, preoccupation with food; Medicinal impairment from weight loss or nutritional deficiencies; Not explicitly about weight loss or driven by body dissatisfaction

Obesity (definition)

  • obesity :: BMI >24

Dieting and treatments for obesity

  • dieting :: does not work very well; food restriction leads to increased food craving and intake; When dieting does work, weight loss outcomes are modest and not maintained over a long follow-up period.
  • treatments for obesity :: surgery, dieting, lifestyle changes

How body fights against weight loss

  • how body fights against weight loss :: After weight loss, the body produces more ghrelin (hungry hormone) than before, metabolism also slows

Role of social class in obesity

  • role of social class in obesity :: the poorer you are, the more likely you are to be obese. This is due to food insecurity, food deserts, unhealthy food is cheaper on a per-calorie basis and often more accessible than healthy food, Eating healthy takes time and effort beyond the food itself, stress associated with poverty leads to weight gain via eating behavior and inflammation/disease, Lack of daily exercise, regular eating, and access to medical care

Lifestyle changes as alternatives to dieting

  • lifestyle changes :: changes made without the goal of losing a specific amount may be more sustainable, less demoralizing, and less likely to lead to disordered eating; Adopting a hea;thier diet and lifestyle may not lead to immediate weight loss; Can improve relationships with food/reduce the frustration of constant dieting; May lead to modest weight loss (5-10% of starting weight) over a long period of time

Recovery

Definition of recovery

  • recovery :: deeply personal, unique process of changing one’s attitudes, values, goals, skills, and roles; a way of living a satisfying, hopeful, contributing life, even with limitations caused by illness.

Evidence for recovery

  • evidence for recovery :: diagnosis does not predict life outcome, treatment results in better outcomes for person, many pathways and neural plasticity, I am the evidence (ITE).

Recovery-oriented language guidelines

  • language guidelines :: promote respectful use of language based on fundamental recovery values, consider psychiatric disability and avoid dehumanizing or pejorative words, use the word person rather than patient, client, or member, and often use person first language

4 types of stigma

  • 4 types of stigma :: anticipated, experienced, perceived, internalized

Common myths told to people with mental illness

  • 5 myths we tell people with mental illness :: (1) your diagnosis is predictive of your life outcomes, (2) your ability to function in one environment is predictive of your capacity to function at work, (3) compliance to treatment and singularly impact your rehabilitation and recovery, (4) you will always need help in managing your life, (5) we know what is best for you, your brain is broken

Dimensions of wellness

  • dimensions of wellness :: education, work/purpose, community, health

Peer support

  • peer support :: empowers people to make the best decisions for the, and to strive towards their goals in their communities; improve quality of life, improve engagement and satisfaction with services and supports, improve whole health, including chronic conditions like diabetes, decrease hospitalizations and inpatient days, reduce overall cost of services.

Wellness management evidence-based practices 

  • wellness management EBPs :: illness management and recovery, whole health action management
  • Illness management and recovery :: knowledge and skills necessary to cope with aspects of a mental illness while maintaining and achieving goals in recovery; psychoeducation, behavioral tutoring, relapse prevention training, coping skills training
  • whole health management :: teaches skills o better self manage chronic physical health conditions and mental illnesses and addictions

Somatic disorders

Somatic symptom disorder

  • somatic symptom disorder :: one or more somatic symptoms that are distressing and/or result in significant disruption in daily life, excessive thoughts, feelings, and behaviors related to these somatic symptoms or associated health concerns (one of the following must be present -- disproportionate and persistent thoughts about seriousness of symptoms, persistently high level of anxiety about health or symptoms, excessive time and energy devoted to these symptoms or health concerns), the state of being symptomatic lasts >6months.

Illness anxiety disorder

  • illness anxiety disorder :: formerly known as hypocondriasis, worried by the idea that one was either ill, or developing and illness, no real symptoms, high levels of health anxiety, reassurances from numerous doctors has little affect

  • Treatment for illness anxiety disorder :: CBT -- identify and challenge misinterpretations, symptom creation, stress reduction, more effective than SSRIs or other meds

Conversion disorder

  • conversion disorder :: physical malfunctioning, such as paralysis, blindness, or difficulty speaking, without any physical or organic pathology -- physical malfunctioning in sensory-motor areas, lack physical or organic pathology, lack awareness, intact functioning

Factitious disorder

  • factitious disorder :: repeated, intentional simulation of disease for the purpose of obtaining medical treatment
  • factitious disorder imposed on another :: parent feels the need for attention but expresses it by inducing illness in the child and presenting the child for medical attention

Treatment for somatic disorders

  • treatment for somatic disorders :: attend to trauma and reduce rewards (focus on resolving impact of trauma, remove secondary gain, reduce supportive consequences, reward positive health behaviors, no cures), CBT interventions (initial reassurance, stress reduction, reduce frequency of help seeking behaviors), gatekeeper physician (reduce visits to numerous specialists).

 

Dissociative disorders

Depersonalization-derealization disorder

  • depersonalization-derealization disorder :: repeated episodes of either or both depersonalization or derealization, episodes are characterized by feelings of detachment from one’s thoughts, feelings, or sensations, or from one’s surroundings, episodes may have the quality of seeming to be an outsider observer of oneself, episodes may have a dreamlike quality, during these episodes, the person can still distinguish reality from unreality
  • depersonalization :: experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions
  • derealization :: experiences of unreality or detachment with respect to surroundings

Dissociative amnesia

  • generalized type dissociative amnesia :: inability to recall anything, including identity

  • local or selective type dissociative amnesia :: failure to recall specific (usually current traumatic) events

  • dissociative amnesia :: a person experiences memory loss without any identifiable organic cause, reversible memory loss

  • Dissociative fugue

    • dissociative fugue :: during flight or travel, memory loss, assumption of new identity

Dissociative identity disorder

  • DID :: amnesia and dissociation of personality, adoption of several new identities or “alters” -- disruption of identity characterized by 2+ distinct personality states, recurrent gaps in the recall of everyday events, important, personal, and traumatic events that are too extensive to be explained by other forgetfulness, symptoms cause clinically significant distress of impairment in social occupational or other important areas f functioning,
  • DID prevalence :: 1.5%
  • DID age of onset :: chldhood
  • DID course :: chronic