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Maryville NURS 663 Psychiatry Exam 3
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Difference in conduct disorder and ODD - SOLUTION Conduct try to control others, ODD doesnt. Conduct disorder often progresses to - SOLUTION Antisocial disorder This diagnosis does not include torchering animals - SOLUTION ODD This is a screening tool for OPIOIDs - SOLUTION COWS Drugs for Opioid withdrawal - SOLUTION Clonidine, Methdaone, Naltrexone This drug causes paranoia, hallucinations, sensory disorientation, sweating, dehydration, increased body temp - SOLUTION LSD What part of the brain does PTSD have an effect on - SOLUTION Amygdala, Prefrontal cortex, hippocampus, hypothalmus Best treatment for ODD - SOLUTION Family Therapy-reinforce positive behaviors Medication treatment for PTSD - SOLUTION SSRI, Sertraline Paroxetine, Prazosin for nightmares PTSD symptoms in children - SOLUTION Crying headache thumb sucking Therapy for PTSD - SOLUTION Trauma focused CBT and EMDR This type of substance causes respiratory depression - SOLUTION Opioid Medication to reverse Opioid - SOLUTION Narcan
Stimulant withdrawal causes what physical life threatening issue - SOLUTION Cardiac sx Difference in Alcohol and Heroin withdrawal - SOLUTION Heroin feels like dying, Alcohol can actually cause death What neurotransmitter is the reward pathway - SOLUTION Dopamine Kids who have lack of remorse have this disorder - SOLUTION Conduct Disorder By what age most teens tried alcohol - SOLUTION 13 With Alcohol consumption, Vitamin B1 or thiamine deficient causes what - SOLUTION Wornicke-Korsakoff syndrome Heroin withdrawal - SOLUTION peaks 1-3 days, subside in 1 week Cocaine withdrawal begins - SOLUTION within 90 minutes Cocaine and Nicotine have an effect on this - SOLUTION Dopamine reward feeling Example of date rape drugs - SOLUTION Rohypnol, GHB, Ketamine, Chloral hydrate This drug is known as ice - SOLUTION meth Most common reason adolescent has eval - SOLUTION Suicidal What is the origin of ADHD - SOLUTION Hereditary, Biological Best treatment for borderline personality - SOLUTION DBT For diagnosis of ODD the symptoms must be present for how long - SOLUTION 6 months This parenting style relates to conduct disorder - SOLUTION Harsh/ Punitive
Risperidone and aripiprazole - SOLUTION FDA approval for use in children and adolescents with aggression, severe behavioral dyscontrol, and severe psychiatric disorders Antiadrenergic agents - SOLUTION treat dysregulation of the noradrenergic system in adults and youth with PTSD clonidine and guanfacine - SOLUTION Alpha2-agonists examples Alpha2 agonists - SOLUTION decrease norepinephrine release, such as, are propranolol - SOLUTION centrally acting β-antagonists example prazosin - SOLUTION α-1-antagonists example propranolol use - SOLUTION hypothesized to improve hyperarousal and intrusive thoughts through attenuation of norepinephrine postsynaptically prazosin use - SOLUTION nightmares associated with trauma Modify PTSD sx - SOLUTION Off-label medications including antidepressants, atypical antipsychotics, adrenergic modulators/sympatholytics, and anticonvulsants/mood stabilizers clonidine and propanolol - SOLUTION nightmares and exaggerated startle response: some evidence in adults, but children case report only guanfacine and clonidine - SOLUTION __________ may reduce nightmares in children with PTSD and ____________may diminish symptoms of reenactment of traumatic events in children Mood-stabilizing agents - SOLUTION divalproex, carbamazepine, topiramate, and gabapentin have been utilized for adults with PTSD with modest improvement; some clonidine with dosage ranges of 0.05 to 0.1 mg twice daily - SOLUTION may provide some relief for the symptoms of hyperarousal, impulsivity, and agitation in young children with PTSD; in children some evidence
benzodiazepines - SOLUTION no controlled trials supporting use in children Trauma-Focused CBT - SOLUTION 10-16 treatment sessions, including 9 components itemized in the acronym PRACTICE PRACTICE elements - SOLUTION Psychoeducation on typical reactions to PTSD. Parenting skills- praise, time-out, reinforcement Relaxation- muscle, breathing, cognitive tech Affective Expression and Modulation- ID feelings Cognitive Coping and Processing Cognitive Triangle Trauma Narrative:developed over time by child, In Vivo Exposure and Mastery of Trauma Reminders- how to deal with reminders Conjoint Child-Parent Sessions- this component may involve several sessions in which the child and parent share their understanding Enhancing future safety-family changes EMDR - SOLUTION exposure and cognitive reprocessing interventions are paired with directed eye movements, alternating tones or tapping CBITS - SOLUTION Cognitive Behavioral Interventions for Trauma in Schools CBITS description - SOLUTION intervention that administers treatment in the school setting for children who screen positive for PTSD and whose parents agree to treatment in school. CBITS elements - SOLUTION Consists of 10 weekly group sessions 1-3 individual imaginal exposure sessions 2-4 optional sessions with parents 1 parent education session. Similar to trauma-focused CBT, incorporates psychoeducation, relaxation, training, cognitive coping skills, gradual exposure to traumatic memories SPARCS - SOLUTION Structured Psychotherapy for Adolescents Responding to Chronic Stress
PTSD differential diagnosis: Medical - SOLUTION hyperthyroidism, caffeinism, migraine, asthma, seizure disorder, and catecholamine or serotonin-secreting tumors. Some prescription medications and even some OTC medications may have similar effects, such as antiasthmatics, sympathomimetics, steroids, SSRIs, and antipsychotics, diet pills, antihistamines, and cold medicines PTSD differential diagnosis - SOLUTION anxiety disorders, such as separation anxiety disorder, obsessive-compulsive disorder (OCD) or social phobia, depressive disorders, bereavement trauma, disruptive behavior d/o PTSD-associated psychosis - SOLUTION does not respond well to neuroleptic (antipsychotic) medication; may respond better to psychosocial interventions. The hallucinations and delusions connect to the traumatic situation and perpetrators. Older kids show symptoms like adults. PTSD criteria - SOLUTION Trauma: occured, witnessed, learned about Harm or threat of harm to self, loved one
- Re-experiencing traumatic event
- Sustained high level of anxiety, hyperarousal / hypervigilance / exaggerated startle
- Avoid activities, people, places, situations, objects that arouse memories
- A numbing of responsiveness, concentration
- Re-exp. flashbacks, nightmares, intrusive memories
- Inability to remember aspects of the trauma
- Chronic negative emotional state, decreased interest / participation in significant activities
- Depression, survivor's guilt, relationship problems, panic attacks
- Substance abuse
- Anger, aggressive, reckless, thrill-seeking, or self-destructive behavior PTSD stats - SOLUTION 20 to 76% _________ children in inpt psych units endorse hallucinations. Psychosis is present in up to 75 to 95% of those diagnosed with dissociative disorders. Traumatized C/A - SOLUTION 1. Hear perpetrators frightening them, making derogatory remarks, or announcing / threatening new victimization.
- See the perpetrator, smell them, fear victimizer will follow them, or feel they will come hurt them again.
- Hear command hallucinations (by the perpetrator) telling them to harm themselves or others.
- Hallucinations (PTSD type) are frequently nocturnal. Occur in 9% of abused children.
- Nightmares are frightening, recurrent PTSD under 6 yo - SOLUTION alterations in arousal and reactivity associated with the traumatic event(s) including: irritable behavior and anger outbursts, hypervigilance, exaggerated startle response, problems with concentration, and sleep disturbance. PTSD under 6 yo add'l - SOLUTION 1. May have enuresis after they were toilet trained
- Developmental regression-Stop speaking or forget how to talk -
- Become very clingy
- Act out trauma through play or re-enactment
- Egocentric theory of causality: blame self ODD - SOLUTION oppositional defiant disorder ODD criteria - SOLUTION A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from the categories, and exhibited during interaction with at least one non-sibling ODD categories - SOLUTION Angry/Irritable Mood
- Often loses temper.
- Is often touchy or easily annoyed.
- Is often angry and resentful. Argumentative/Defiant Behavior
- Often argues with authority figures or, for children and adolescents, with adults.
- Often actively defies or refuses to comply with requests from authority figures or with rules.
- Often deliberately annoys others.
- Often blames others for his or her mistakes or misbehavior. Vindictiveness
- Has been spiteful or vindictive at least twice within the past 6 months.
- Has run away from home overnight at least twice from home, or once without returning for a lengthy period
- Is often truant from school, beginning before age 13. CD onset - SOLUTION childhood before 10 yo adolescent after 10yo Over 18 yo: antisocial personality disorder CD with limited prosocial emotions - SOLUTION Lack of remorse or guilt Callous-lack of empathy Unconcerned about performance Shallow or deficient affect Reactive attachment disorder - SOLUTION --children: received grossly negligent care and do not form a healthy emotional attachment with their primary caregivers before age 5. --absence of emotional warmth during the first few years of life can negatively affect a child's entire future Attachment - SOLUTION --develops when a child is repeatedly soothed, comforted, and cared for, and when the caregiver consistently meets the child's needs --creates love and trust others, to become aware of others' feelings and needs, to regulate his or her emotions, and to develop healthy relationships and a positive self-image RAD criteria A - SOLUTION Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers:
- The child rarely or minimally seeks comfort when distressed.
- The child rarely or minimally responds to comfort when distressed. RAD criteria B - SOLUTION A persistent social and emotional disturbance characterized by at least two of the following:
- Minimal social and emotional responsiveness to others. Limited positive affect.
- Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interaction with adult caregivers. RAD criteria C - SOLUTION The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
- Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
- Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care.)
- Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g. institutions with child-to-caregiver-ratios.) RAD add'l - SOLUTION The criteria are not met for autism spectrum disorder. The disturbance is evident before age 5 years. The child has a developmental age of at least 9 months. Specify if: Persistent: The order has been present for more than 12 months. Specify current severity: specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels DMDD - SOLUTION disruptive mood dysregulation disorder DMDD developed to - SOLUTION Addresses concerns of over diagnosing or over treating bipolar disorder in children DMDD def - SOLUTION Pattern of mood dysregulation, chronic and persistent irritability, and frequent extreme behavioral dyscontrol in children who do not present with typical, classic, distinct episodes of mania or hypomania. Should not be made for the first time before age 6 years or after age 18 years. Onset of sx of temper outbursts and chronic irritable/ angry mood has to be before age 10 DMDD criteria - SOLUTION A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. B. outbursts inconsistent with developmental level. C. outbursts occur three or more times per week. D. The mood persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers).
ODD heredity - SOLUTION tends to occur in families with a history of Attention Deficit Hyperactivity Disorder (ADHD), substance use disorders, or mood disorders such as depression or bipolar disorder. Explanatory models of ODD/CD - SOLUTION focus on executive functions (EFs) Hot EF - SOLUTION 1. comprises motivational, affective, and emotional aspect of cognition
- The amygdala, anterior cingulate cortex, insula, and orbitofrontal cortex are responsible for ____ EF functioning Cold EF - SOLUTION 1. focuses on inhibition, planning, working memory, and flexibility, which are basically top-down control mechanisms of cognition
- dorsolateral prefrontal cortex and cerebellum control _____ EF CD neuropsych - SOLUTION 1. decreased gray matter in limbic brain structures, and in the bilateral anterior insula and left amygdala compared to healthy controls
- Neurotransmitter studies suggest low level of plasma dopamine β- hydroxylase, an enzyme that converts dopamine to norepinephrine, leading to a hypothesis of decreased noradrenergic function
- juvenile offenders have found high plasma serotonin levels in blood cerebrospinal fluid (CSF) - SOLUTION blood serotonin levels correlate inversely with levels of 5-HIAA in the _______________and that low 5- HIAA levels in __________correlate with aggression and violence aggressive children - SOLUTION had significantly greater relative right frontal brain activity at rest comparitively. Frontal resting brain electrical activity has been hypothesized to reflect the ability to regulate emotion RAD neuropsych - SOLUTION 1. no single specific laboratory test is used to make a diagnosis,
- Many have disturbances of growth and development
- If incoming early sensory input is inadequate or creates pandemonium, neural org will reflect this disarray.
- Lower brain region disorganization automatically compromise higher brain regions
Attachment Neuropsych - SOLUTION 1. right hemispheres forge neural connections between infants subcortical, bodily-based affective states with conscious emotional states in the higher brain regions of the right hemisphere;
- these circuits are vital to emotional processing, empathy and development of self
- Right hemisphere and limbic system develop rapidly during the first year and responsible for habitual responses to stress Play - SOLUTION vital to brain development Brain stem - SOLUTION 0-9mo, critical role in regulation of arousal, sleep, heart rate, body temp, fear states Diencephalon - SOLUTION 6mo-2yrs fine motor skills, promoting sensory integration, controlling motor functioning and facilitating flexibility in relational exchanges. Limbic system - SOLUTION 1-4yrs regulate emotions, interpret non-verbal information, experience empathy for others, feel a sense of social connectedness, tolerate distress and differences Cortex - SOLUTION 3-6yrs, highest and most complex, abstract cognitive processing and integration of social-emotional information. Violence - SOLUTION seems to originate in the prefrontal cortex DMDD neuropsych - SOLUTION 1. no study has yet been conducted specifically on children meeting the diagnostic criteria for ________
- abnormally reduced activation in neural regions associated with emotional salience, spatial attention, and reward processing in response to frustration tasks
- facial affect recognition task, the participants' level of irritability correlated with amygdala activity across all intensities for all emotions (happy, fearful, and angry faces) in the _________ group
- Event-related potential study: impairment in reward processing may be more salient than just excessive reactivity to loss for ______________ Acute stress disorder dx timeline - SOLUTION 3 days to one month
DTs anytime during the first 72 hours; watch for the for the first week of w/d; unpredictable ETOH MOA - SOLUTION Activates 5 HT3, GABA, dopamine, and serotonin receptors in CNS and inhibits glutamate receptors and voltage gated Ca channels. Potent CNS depressant. ETOH long term effects - SOLUTION Wernicke's encephalopathy is completely reversible with treatment, only about 20 percent of patients with Korsakoff's syndrome recover BCA 0.05 % - SOLUTION thought, judgment, and restraint are loosened and sometimes disrupted. BCA 0.1% - SOLUTION voluntary motor actions usually become perceptibly clumsy BCA 0.1 to 0.15 - SOLUTION In most states, legal intoxication ranges BCA 0.2 % - SOLUTION the function of the entire motor area of the brain is measurably depressed, and the parts of the brain that control emotional behavior are also affected BCA 0.3% - SOLUTION a person is commonly confused or may become stuporous BCA 0.4 to 0.5 % - SOLUTION the person falls into a coma. At higher levels, the primitive centers of the brain that control breathing and heart rate are affected, and death ensues secondary to direct respiratory depression or the aspiration of vomitus. ETOH Tolerance - SOLUTION Persons with long-term histories of can tolerate much higher concentrations than can _________-naïve persons; their tolerance may cause them to falsely appear less intoxicated than they really are ETOH intoxication sx - SOLUTION 1. Slurred speech
- Dizziness
- Incoordination
- Unsteady gait
- Nystagmus
- Impairment in attention or memory: anterograde amnesia
- Stupor or coma
- Double vision benzodiazepines w/d - SOLUTION anxiety, dysphoria, intolerance for bright lights and loud noises, nausea, sweating, muscle twitching, and sometimes seizures Benzos w/d states - SOLUTION recurrence: return of the original anxiety sx rebound: worsening of the original anxiety sx rue withdrawal emergence of new sx Benzo w/d mood and cognition - SOLUTION Anxiety, apprehension, dysphoria, pessimism, irritability, obsessive rumination, and paranoid ideation Benzo w/d sleep - SOLUTION Insomnia, altered sleep-wake cycle, and daytime drowsiness Benzo w/d phys s/sx - SOLUTION Tachycardia, elevated blood pressure, hyperreflexia, muscle tension, agitation/motor restlessness, tremor, myoclonus, muscle and joint pain, nausea, coryza, diaphoresis, ataxia, tinnitus, and grand mal seizures Benzo w/d perception - SOLUTION Hyperacusis, depersonalization, blurred vision, illusions, and hallucinations Hyperacusis - SOLUTION debilitating hearing disorder characterized by an increased sensitivity to certain frequencies and volume ranges of sound. difficulty tolerating everyday sounds Benzo w/d timeline - SOLUTION onset of withdrawal symptoms usually occurs 2 to 3 days after the cessation of use, but with long-acting drugs, the latency before onset can be 5 or 6 days Benzo MOA - SOLUTION Stimulation of the inhibitory GABAergic activity, either by endogenous ligands or _______ or results in sedation, amnesia
Heroin add'l - SOLUTION 1. 90 percent of persons with ________________ dependence have an additional psychiatric disorder.
- most common: major depressive disorder, alcohol use disorders, antisocial personality disorder, and anxiety disorders.
- 15 % attempt to commit suicide at least once κappa-opioid receptors, - SOLUTION κ--with analgesia, diuresis, and sedation; delta-opioid receptors - SOLUTION Δ--with analgesia. endorphins - SOLUTION are involved in other addictions, such as alcoholism, cocaine, and cannabinoid addiction. naltrexone - SOLUTION opioid antagonist--has shown value in mitigating alcohol addiction. Heroin immediate risk - SOLUTION 1. Overdose: respiratory depression.
- intoxication includes maladaptive behavioral
- changes and specific physical sx altered mood, psychomotor retardation, drowsiness, slurred speech, and impaired memory and attention in the presence of other indicators Cocaine/stimulants - SOLUTION Persons aged 18 to 25 (0.9 percent) had the highest rate of past year use/abuse Follow cocaine use disorder - SOLUTION development of mood disorders and alcohol-related disorders Precede cocaine use disorder - SOLUTION anxiety disorders, antisocial personality disorder, and ADHD comorbid with cocaine use disorder - SOLUTION major depressive disorder, bipolar II disorder, cyclothymic disorder, anxiety disorders, and antisocial personality Cocaine w/d immediate - SOLUTION "crash" occurs with symptoms of anxiety, tremulousness, dysphoric mood, lethargy, fatigue, nightmares (accompanied by rebound rapid eye movement [REM] sleep), headache, profuse sweating, muscle cramps, stomach cramps, and insatiable hunger
cocaine w/d most serious - SOLUTION depression, which can be particularly severe after the sustained use of high doses of stimulants and which can be associated with suicidal ideation or behavior cocaine w/d self-medicate - SOLUTION alcohol, sedatives, hypnotics, or antianxiety agents such as diazepam (Valium). cocaine w/d timeline - SOLUTION generally peak in 2 to 4 days and are resolved in 1 week cocaine w/d from 661 - SOLUTION Crash period: 9hrs to 4 days: opposite of stimulant effects: sleep, increased appetite, depressed and agitated. Acute W/D: 1-3 wks: irritability, fatigue, depression, insomnia, anxiety, drug cravings. Extinction: Cravings, depression moods potentially suicidal thoughts for months afterward cocaine crash period - SOLUTION 9hrs to 4 days: opposite of stimulant effects: sleep, increased appetite, depressed and agitated. cocaine acute w/d - SOLUTION 1-3 wks: irritability, fatigue, depression, insomnia, anxiety, drug cravings. cocaine extinction - SOLUTION Cravings, depression moods potentially suicidal thoughts for months afterward cocaine MOA - SOLUTION 1. competitive blockade of dopamine reuptake by the dopamine transporter. This blockade increases the concentration of dopamine in the synaptic cleft and results in increased activation of both dopamine type 1 (D1) and type 2 (D2). felt almost immediately and last for a relatively brief time (30 to 60 minutes);
- metabolites of ____________ can be present in the blood and urine for up to 10 days cocaine immediate risks - SOLUTION nasal congestion; serious inflammation, swelling, bleeding, and ulceration of the nasal mucosa can also occur cocaine long term use - SOLUTION perforation of the nasal septa
