Understanding Conduct Disorder, DMDD, and Substance Use Disorders, Exams of Nursing

Download Understanding Conduct Disorder, DMDD, and Substance Use Disorders and more Exams Nursing in PDF only on Docsity! Maryville NURS 663 Psychiatry Exam 3 Questions and Answers 2024 BEST GRADED A+ 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 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 SPARCS description - SOLUTION -Consists of a group intervention, -16 sessions -focus on the needs of adolescents (12-19 years old) chronic trauma and PTSD. -Utilizes cognitive behavioral techniques, and -incorporates many of the components of TF-CBT -Includes mindfulness techniques and relaxation. TARGET - SOLUTION Trauma Affect Regulation:Guide for Education and Therapy TARGET description - SOLUTION -affect regulation therapy, -combines CBT components, such as cognitive procession, with affect modulation. -adolescents (13-19) exposed to maltreatment and/or chronic traumatic exposure to such things as community violence or domestic violence. -12 sessions, which focuses on past or current situations. TARGET efficacy - SOLUTION --Like SPARCS treatment, gradual exposure may occur in the context of recounting past trauma but is not a core component of treatment. --Reduces anxiety, depression, and PTSD --Promising treatment for girls with h/o delinquency, especially to reduce anger and to enhance optimism and self efficacy. Crisis intervention/Psychological Debriefing - SOLUTION 1. several sessions immediately after an exposure to a traumatic event; encouraged to describe the traumatic event in the context of a supportive environment. 2. Psychoeducation is provided and guidance about the management of initial emotional reactions may be provided. 3. No controlled studies have yet provided evidence that this intervention leads to a more positive outcome PTSD criteria add'l info - SOLUTION 1. Over 6 years old 2. Sx over 1 month duration, or dx criteria may not have occurred until at least 6 months after the trauma 3. Constricted emotions can show up suddenly after major life event, stressor, or accumulated stressors that challenge defenses. 4. Can hide in somatic complaints or co-occur with depression, substance abuse, anxiety or after head injury 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 1. Re-experiencing traumatic event 2. Sustained high level of anxiety, hyperarousal / hypervigilance / exaggerated startle 3. Avoid activities, people, places, situations, objects that arouse memories 4. A numbing of responsiveness, concentration 5. Re-exp. flashbacks, nightmares, intrusive memories 6. Inability to remember aspects of the trauma 7. Chronic negative emotional state, decreased interest / participation in significant activities 8. Depression, survivor's guilt, relationship problems, panic attacks 9. Substance abuse 10. 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. 14. Has run away from home overnight at least twice from home, or once without returning for a lengthy period 15. 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: 1. The child rarely or minimally seeks comfort when distressed. 2. 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: 1. Minimal social and emotional responsiveness to others. Limited positive affect. 2. 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: 1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. 2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care.) 3. 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). DMDD dx - SOLUTION 1. can' t coexist with ODD, IED, or bipolar disorder, 2. can coexist with MDD, ADHD, conduct disorder, and SUD. 3. IF meet criteria for both ________and ODD, then give DX of _________________ DMDD add'l - SOLUTION 1. dx not be made for the first time before age 6 years or after age 18 years. 2. age of onset of Criteria A-E is before 10 years 3. never been a distinct period lasting more than 1 day during which the full symptom criteria, for a manic or hypomanic episode have been met PTSD neuropsych - SOLUTION 1. noradrenergic and endogenous opiate systems, as well as the HPA axis, are hyperactive in at least some 2. increased activity/responsiveness of the autonomic nervous system, AEB elevated HR rates and BP and by abnormal sleep architecture 3. increased 24-hour urine epinephrine concentrations in veterans 4. increased urine catecholamine concentrations in sexually abused girls 5. platelet α2- and lymphocyte β-adrenergic receptors are downregulated in _______ possibly in response to chronically elevated catecholamine concentrations PTSD HPA axis - SOLUTION 1. low plasma and urinary free cortisol concentrations. 2. More glucocorticoid receptors are found on lymphocytes 3. challenge with exogenous corticotropin-releasing factor (CRF) yields a blunted corticotropin (ACTH) response PTSD other neuropsych - SOLUTION 1. hippocampus received increased attention, although the issue remains controversial. 2. Structural changes in the amygdala, an area of the brain associated with fear, have also been demonstrated ODD neuropsych - SOLUTION 1. No specific laboratory tests or pathological findings 2. may share some characteristics with people with high levels of aggression, such as low central nervous system serotonin 3. Brain imaging studies suggest may have subtle differences in the part of the brain responsible for reasoning, judgment and impulse control PTSD timeline - SOLUTION greater than one month Drug route SUD - SOLUTION inhaled, snorted, or injected, thus entering the brain in a sudden explosive manner, are usually much more reinforcing than when those same drugs are taken orally--slower absorb Dopamine (DA) - SOLUTION 1. has long been recognized as a major player in the regulation of reinforcement and reward 2. mesolimbic pathway from the ventral tegmental area (VTA) to the nucleus accumbens seems to be crucial for reward Drugs of abuse - SOLUTION 1. cause DA release in the mesolimbic pathway 2. increase dopamine in a manner that is more explosive and pleasurable than that which occurs naturally. 3. activation caused by drugs of abuse can eventually cause changes in reward circuitry that are associated with a vicious cycle vicious cycle of drug preoccupation, - SOLUTION craving, addiction, dependence, and withdrawal ETOH w/d - SOLUTION 1. tremulousness 2. psychotic and perceptual symptoms (e.g., delusions and hallucinations), 3. seizures, and 4. the symptoms of delirium tremens (DTs), called alcohol delirium in DSM- 5. 5. general irritability, 6. gastrointestinal symptoms (e.g., nausea and vomiting), and 7. sympathetic autonomic hyperactivity 8. alert but may startle easily. ETOH w/d autonomic hyperactivity - SOLUTION anxiety, arousal, sweating, facial flushing, mydriasis, tachycardia, and mild hypertension ETOH w/d time - SOLUTION Tremulousness develops 6 to 8 hours after the cessation the psychotic and perceptual symptoms begin in 8 to 12 hours seizures in 12 to 24 hours, and 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 2. Dizziness 3. Incoordination 4. Unsteady gait 5. Nystagmus 6. Impairment in attention or memory: anterograde amnesia 7. Stupor or coma 8. 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 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); 2. 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 cocaine respiratory - SOLUTION Freebasing and smoking crack can damage the bronchial passages and the lungs cocaine IV - SOLUTION infection, embolisms, and the transmission of human immunodeficiency virus (HIV cocaine neurological - SOLUTION acute dystonia, tics, and migraine-like headaches cocaine major complications - SOLUTION cerebrovascular, epileptic, and cardiac: two thirds of these acute toxic effects occur within 1 hour of intoxication, about one fifth occur in 1 to 3 hours, and the remainder occurs up to several days later cocaine high doses - SOLUTION seizures, respiratory depression, cerebrovascular diseases, and myocardial infarctions—all of which can lead to death Speed ball - SOLUTION Deaths have also been reported with the ingestion of ___________________ which are combinations of opioids and cocaine Nicotine dependence - SOLUTION is among the most prevalent, deadly, and costly of substance dependencies. Nicotine - SOLUTION 1. decreases the blood concentrations of some antipsychotics. 2. increased prevalence in smoking is due, at least in part, to brain abnormalities in ____________receptors. 3. A specific polymorphism in a __________receptor has been linked to a genetic risk for schizophrenia nicotine administration - SOLUTION 1. improve some cognitive impairments and parkinsonism in schizophrenia, possibly because of ________________dependent activation of dopamine neurons. 2. ______________ may decrease positive symptoms such as hallucinations in schizophrenia patients by its effect onreceptors in the brain that reduce the perception of outside stimuli, especially noise. nicotine w/d - SOLUTION intense craving for _____________, tension, irritability, difficulty concentrating, drowsiness and paradoxical trouble sleeping, decreased heart rate and blood pressure, increased appetite and weight gain, decreased motor performance, and increased muscle tension nicotine w/d timeline - SOLUTION W/d within 2 hours of last use generally peak in the first 24 to 48 hours and can last for weeks or months nicotine MOA - SOLUTION 1. agonist at the________________subtype of acetylcholine receptors. 2. 25 % reaches the bloodstream, within 15 seconds. 3. activating the dopaminergic pathway projecting from the ventral tegmental area to the cerebral cortex and the limbic system. 4. increase in the concentrations of circulating norepinephrine and epinephrine and an increase in the release of vasopressin, β-endorphin, adrenocorticotropic hormone (ACTH), and cortisol. These hormones contribute to the basic stimulatory effects on the CNS nicotine immediate risks - SOLUTION highly toxic alkaloid. Doses of 60 mg in an adult are fatal secondary to respiratory paralysis average dose is 0.5 mg nicotine toxicity--low dose - SOLUTION nausea, vomiting, salivation, pallor (caused by peripheral vasoconstriction), weakness, abdominal pain (caused by increased peristalsis), diarrhea, dizziness, headache, increased blood pressure, tachycardia, tremor, and cold sweats nicotine toxicity--also - SOLUTION inability to concentrate, confusion, and sensory disturbances nicotine--other risks - SOLUTION 1. decrease in the user's amount of rapid eye movement (REM) 2. increased incidence of low birth weight babies 3. increased incidence of newborns with persistent pulmonary hypertension. 4. Increased BP, pulse, stroke, HA. Cannibus - SOLUTION 1. most popular illicit drug, with 14.6 million people using it (6.2 percent of the population), 2. two thirds being under the age of 18. DBT stages 4 - SOLUTION aims to assist clients in developing a sound sense of self, with capacity for joy and peace DBT Group Therapy - SOLUTION 1. behavioral, emotional, cognitive, and interpersonal skills. 2. observations about others in the group are discouraged. 3. didactic approach, using specific exercises taken from a skills training manual: control emotional dysregulation and impulsive behavior. DBT Individual Therapy - SOLUTION 1. skills learned during group training reviewed 2. life events from the previous week are examined. 3. Particular attention is paid to pathological behavioral patterns that could have been corrected if learned skills had been put into effect. 4. Patients record their thoughts, feelings, and behaviors on diary cards, which are analyzed in the session. DBT telehphone - SOLUTION 1. meant to avert crisis and redirect injurious behavior to themselves or others. 2. brief and usually last about 10 minute DBT weekly consultation team - SOLUTION provide support for one another and maintain motivation in their work. The meetings enable them to compare techniques used and to validate those that are most effective Drug dependence - SOLUTION the continued use of a drug even though it harms the body, mind, and relationships Need drug in order to function Experience physical, psychological, social probs Denies dependence Can't quit tolerance - SOLUTION needs to use more and more of the drug to get the desired effects drug abuse - SOLUTION 1. Risk-taking behavior, illegal activity, interpersonal problems and a loss of interest in your usual activities 2. putting you in dangerous situations, jeopardizing your health or making you neglect important commitments at home, school or work drug intoxication - SOLUTION a syndrome (e.g., alcohol intoxication or simple drunkenness) characterized by specific signs and symptoms resulting from recent ingestion or exposure to the substance 1. reversible 2. clinically signification maladaptive beh or psych changes 3. Sx not d/t medical or other condition biopsychocial model addiction - SOLUTION inherited and an induced biological component to addictive disorders but also psychological- behavioural and social-cultural factors that have a role in the cause, course, and outcome of substance dependence biological factors addiction - SOLUTION Genetic vulnerability (accounts for 40-60%). Birth. Adoption. Diet and nutrition. Mental disorders. Disease and illness or other medical disorder. Withdrawals and cravings. psychological factors addiction - SOLUTION Childhood influences. Attachment. Anxiety (fears, cognitive distortions). Depression. Defence mechanisms (rationalization, denial, projection, etc). Psychosis. Self awareness. social factors addiction - SOLUTION Upbringing/parenting. Education. Housing Urban/rural areas. Employment. Social and cultural norms. Behaviour should be considered in the context from which the person comes. Ethnic background. Socioeconomic status. Law. Political situation. Social network characteristics. Religion. Media. Environmental factors, weather or drought. biopsychosocial advantages - SOLUTION Accounts complicating, contributing factors Encourages a complex yet individualized understanding Encourages a broader treatment perspective. Involve addressing more than one problem at a time. Changes at one level influence the other levels, therefore interventions at one level also influence other levels. It is comprehensive. It is the model most widely endorsed by treatment researchers because it can most adequately explain the intricate nature biopsychosocial disadvantages - SOLUTION Emphasis may be placed on one aspect of the model without a solid integration of the three aspects. It is difficult to provide interventions on all three aspects at the same time. Some factors, such as risk and protective factors, cannot be changed. Its eclectic freedom has at times been accused of leading to anarchic thinking. Lithium - SOLUTION reduces suicide in patients with bipolar disorder Clozapine - SOLUTION antisuicidal, anti aggressive effects and efficacy in schizophrenic patients, evidence is not as strong as with lithium, considering the smaller number of large studies. Ketamine - SOLUTION very rapidly acting antidepressant and is reported to also have a profound therapeutic benefit for suicidal ideation AMPA receptor antagonist and raises GABA levels and perhaps those properties contribute to its rapid and profound reduction in suicidal ideation No-Suicide contract - SOLUTION provide a false sense of assurance to the clinician Suicide safety plan - SOLUTION 1. prioritized written list of coping strategies and resources for use during a ______ crisis, 2. provides a sense of control/framework, brief process, accomplished via an easy-to-read format using the patient's own words, 3. involves a commitment to the treatment process (and staying alive). 4. It is developed collaboratively by the clinician and the youth in any clinical setting 5. overpressuring through excessively advanced expectations, 6. enc/instruct to engage in antisocial activities severity of emotional abuse - SOLUTION (1) intent to inflict harm (2) whether behaviors are likely to cause harm Physical abuse defined - SOLUTION 1. any act that results in a nonaccidental physical injury, such as beating, punching, kicking, biting, burning, and poisoning 2. result of unreasonably severe corporal punishment or unjustifiable punishment Phys abuse risk factors - SOLUTION 1. poverty and psychosocial stress, parental substance abuse, and mental illness. 2. less parental education, underemployment, poor housing, welfare reliance, and single parenting. 3. domestic violence, social isolation, parental mental illness, and drug and alcohol abuse. 4. prematurity, intellectual disability, and physical handicap. 5. families with many child Phys abuse signs - SOLUTION 1. organized by damage to the site of injury: skin and surface tissue, the head, internal organs, and skeletal; evidence of repeated suspicious injuries 2. unusually fearful, docile, distrustful, and guarded, disruptive and aggressive. 3. wary of physical contact, show no expectation of being comforted 4. on the alert for danger and continually size up the environment 5. afraid to go home. Physically abused children psychopathology - SOLUTION depression, conduct disorder, ADHD, oppositional defiant disorder, dissociation, and PTSD psychological consequences of physical abuse and neglect - SOLUTION affect dysregulation, insecure and atypical attachment patterns, impaired peer relationships involving increased aggression or social withdrawal, and academic underachievement. Neglect - SOLUTION most prevalent form of child maltreatment failure to provide adequate care and protection withholding of physical, emotional, and educational necessities. Physical neglect - SOLUTION abandonment, expulsion from home, disruptive custodial care, inadequate supervision, and reckless disregard for a child's safety and welfare Medical neglect - SOLUTION refusal, delay, or failure to provide medical care Educational neglect - SOLUTION failure to enroll a child in school and allowing chronic truancy. Conduct disorder pathophys - SOLUTION decreased dopamine response to reward and increased risk-taking behaviors related to abnormally disrupted frontal activity in the anterior cingulate cortex (ACC), orbitofrontal cortices (OFC), and dorsolateral prefrontal cortex (DLPFC) that worsens over time due to dysphoria activation of brain stress systems and increases in corticotropin-releasing factor (CRF). RAD pathophys - SOLUTION amygdala and insula appear to exhibit abnormal function reflected in overall decreases in brain structure RAD pathophys - SOLUTION amygdala and insula appear to exhibit abnormal function reflected in overall decreases in brain structure conduct disorder pathophys - SOLUTION Decreased dopamine repsonse to reward and increased risk taking behaviors r/t abnormally disrupted frontal activity in the Ant Cingulate Cortex (ACC), orbital frontal cortices (OFC) and dorsolateral prefrontal cortex (DLPFC) that worsens over time due to dysphoria activation of the brain stress systems and incr in coritcotropin-releasing factor (CRF) What is conduct disorder? - SOLUTION Conduct disorder is an enduring set of behaviors in a child or adolescent that evolves over time, usually characterized by aggression and violation of the rights of others - hostile and sometimes physically violent behavior and a disregard for others What behaviors do children with CD exhibit? - SOLUTION cruelty, from early pushing, hitting and biting to, later, more than normal teasing and bullying, hurting animals, picking fights, thefts, vandalism, and arson What are the 4 categories of behaviors that children with CD exhibit? - SOLUTION physical aggression or threats of harm to others thefts or acts of deceit destruction of their own property or that of others frequent violation of age-appropriate rules What adult personality disorder may conduct disorder turn into? - SOLUTION Adult antisocial personality disorder therefore, it is important to treat conduct disorder as early as possible Who is more likely to develop conduct disorder? - SOLUTION Children with a parent (biological or adoptive) or a sibling with conduct disorder Children whose biological parents have ADHD, alcohol use disorder, depression, bipolar or schizophrenia are also at risk Children who experience abuse, parental rejection or neglect, and harsh or inconsistent parenting are more at risk, as are those exposed to neighborhood violence, peer rejection, and peer deliquency What complicates treatment for conduct disorder? - SOLUTION Treatment for conduct disorder is complicated by the negative attitudes the disorder instills in the child What is the treatment for conduct disorder? - SOLUTION Psychotherapy and behavioral therapy (usually for long periods of time and involves the entire family and support network of the child) Early sustained preventative interventions can significantly alter the course and prognosis of aggressive behavior when it is administered starting at kindergarten age. Pharmacologic interventions include anti-psychotics such as haldol or risperdone What is the most commonly used illicit drug amount high schoolers in the USA? - SOLUTION Marijuana What is the strongest predictor of future cocaine use during adolescents? - SOLUTION Frequent use of marijuana during adolescence Substance use refers to? - SOLUTION A maladaptive pattern leasing to clinically significant impairment or distress. Which receptors are involved with nicotine use? - SOLUTION cholinergic that enhances acetylcholine, serotonin, and B-endorphin release. True or False: Young teens that smoke cigarettes are exposed to other drugs more frequently than nonsmoking peers? - SOLUTION True marijuana withdrawal symptoms - SOLUTION insomnia, irritability, restlessness, drug craving, depressed mood, and nervousness followed by anxiety, tremors, nausea, muscle twitches, increased sweating, myalgia, and general muscle malaise How long after cessation of Marijuana use do withdrawal symptoms start? - SOLUTION 24 hours after last use When do Marijuana withdrawal symptoms peak? - SOLUTION 2 to 4 days after last use How long do Marijuana withdrawal symptoms last? - SOLUTION diminish after two weeks What is the most important reward pathway in the brain? - SOLUTION mesolimbic dopamine system What is a key detector of a rewarding stimulus? - SOLUTION VTA-NAc circuit mild substance use disorder - SOLUTION 2-3 symptoms moderate substance use disorder - SOLUTION 4-5 symptoms severe substance use disorder - SOLUTION 6 or more symptoms What can substance abuse be the first step to? - SOLUTION Substance dependence What constitutes substance dependence? - SOLUTION Using the drug in greater quantities or for a longer period of time than intended Spending a lot of time getting, using, and recovering from the drug Using the drug despite the knowledge of related problems LSD (lysergic acid diethylamide) - SOLUTION a powerful hallucinogenic drug; also known as acid True of False: There is a way to predict the amount of LSD that might be in a particular form for use. - SOLUTION False-there is no way MDMA (Ecstasy or X, or Molly) - SOLUTION designer drugs that can have both stimulant and hallucinatory effects cocaine withdrawal symptoms - SOLUTION Characteristic withdrawal syndrome occurring within 1 hr to several days of cessation of drug use. Not life-threatening, but possible occurrence of suicidal ideation Cocaine withdrawal symptoms include - SOLUTION difficulty concentrating; slowed thinking; slowed activity of physical fatigue after activity; exhaustion; restlessness; lack of sexual arousal; anhedonia; depression; anxiety; suicidal thoughts or actions; vivid, unpleasant dreams or nightmares; chills, tremors, muscle aches, nerve pain, increased craving for cocaine, increased appetite Heroin withdrawal symptoms - SOLUTION restlessness, insomnia, muscle/bone pain; stomach issues; cold flashes; uncontrollable kicking movements Heroin withdrawal symptoms will peak in ____ hours to ____ hours and remit within about ___ week. - SOLUTION 48,72; one Wernicke-Korsakoff syndrome is? - SOLUTION Organic brain syndrome resulting from prolonged heavy alcohol use, involving confusion, unintelligible speech, and loss of motor coordination. Wernicke-Korsakoff syndrome is caused from? - SOLUTION deficiency of thiamine (vitamin B1), a vitamin metabolized poorly by heavy drinkers. Thiamin deficiency reduces the brain's ability to convert sugar into? - SOLUTION energy for fuel to function Wernicke-Korsakoff syndrome may lead to the development of symptoms of? - SOLUTION dementia including confusion and memory loss; significantly affects life-expectancy and requires immediate treatment Wernicke-Korsakoff syndrome consists of two separate conditions including: - SOLUTION Wernicke encephalopathy and Korsakoff syndrome Which develops first, Wernicke encephalopathy or Korsakoff syndrome? - SOLUTION Wernicke encephalopathy What often presents a the symptoms of Wernicke encephalopathy are subsiding? - SOLUTION Korsakoff syndrome Modifiable and nonimodifiable risk factors of suicide - SOLUTION Adolescence and late life · Bisexual or homosexual gender identity · Criminal behavior · Cultural sanctions for suicide · Delusions · Disposition of personal property · Divorced, separated, or single marital status · Early loss or separation from parents · Family history of suicide · Hallucinations · Homicide · Hypochondrasis · Impulsivity · Increasing agitation · Increasing stress · Insomnia · Lack of future plans · Lack of sleep · Lethality of previous attempt · Living alone grossly disorganized or catatonic behavior negative symptoms, i.e., affective flattening, alogia, or avolition B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement). C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6- month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences). D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods. E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance DSM-5 OCD - SOLUTION A. Presence of obsessions, compulsions, or both: Obsessions are defined by (1) and (2): 1. Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress. 2.The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion). Compulsions are defined by (1) and (2): 1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. 2.The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. DSM-5 ADHD - SOLUTION Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person's developmental level: Often fidgets with or taps hands or feet, or squirms in seat. Often leaves seat in situations when remaining seated is expected. Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless). Often unable to play or take part in leisure activities quietly. Is often "on the go" acting as if "driven by a motor". Often talks excessively. Often blurts out an answer before a question has been completed. Often has trouble waiting their turn. Often interrupts or intrudes on others (e.g., butts into conversations or games) word salad - SOLUTION flow of unconnected words that convey no meaning to the listener poverty of thought - SOLUTION A lack of ability to produce new thoughts or follow a train of thought loose associations - SOLUTION disorganized thinking that jumps from one idea to another with little or no evident relation between the thoughts Blunt affect - SOLUTION reduced or minimal emotional response Delusions - SOLUTION false beliefs, often of persecution or grandeur, that may accompany psychotic disorders paucity of speech - SOLUTION Excessively brief speech with few elaborations that occurs in schizophrenia or occasionally in a major depressive episode. It is distinct from poverty of content of speech, in which the quality of speech is diminished. Anhedonia - SOLUTION inability to experience pleasure palilalia - SOLUTION continuous repetition of sounds and words Echopraxia - SOLUTION Mimicry or imitation of the movements of another person. coprolalia - SOLUTION involuntary utterance of obscenities or inappropriate remarks persecutory delusions - SOLUTION false, persistent beliefs that one is being pursued by other people grandiose delusions - SOLUTION false, persistent beliefs that one has superior talents and traits Religious hallucination - SOLUTION Hearing voices which the sufferer may interpret as messages from God or saints. Grandiose hallucination - SOLUTION Auditory hallucinations, which advise the patient that they are significant. Gold standard treatment for bipolar disorder type I - SOLUTION First-line treatment for Bipolar disorder in children and adolescents is SGA's Examples: Acute and mixed mania- Aripiprazole (Abilify), Risperidone, Olanzapine (Zyprexa 13+) Quetiapine (Seroquel- acute only) (Asenapine 10+) Earliest signs of schizophrenia - SOLUTION Depression, social withdrawal Hostility or suspiciousness, extreme reaction to criticism Deterioration of personal hygiene Flat, expressionless gaze Inability to cry or express joy or inappropriate laughter or crying Oversleeping or insomnia; forgetful, unable to concentrate Odd or irrational statements; strange use of words or way of speaking Increased sensitivity to light, sounds, smells or touch Concept that people are "out to get them" Fearfulness or suspicion that isn't warranted Withdrawal from others Severe problems in making and keeping friends Difficulty speaking, writing, focusing or managing simple tasks DSM-5 Early onset bipolar disorder - SOLUTION extreme mood dysregulation, severe temper tantrums, intermittent aggressive or explosive behavior, and high levels of distractibility and inattention Often characterized by extreme irritability, that is severe and persistent May include aggressive outbursts DSM-5 Bipolar I - SOLUTION Often more severe type of bipolar and often requires inpatient. Typically starts at an earlier age than type 2. Requires manic episode. DSM-5 GAD - SOLUTION Excessive anxiety and worry occurring more days than not for at least 6 months about a number of events or activities (work, school, performance). The individual will find it hard to control the worry. Persistent all day long "what ifs". Anxiety and worry are associated with at least 3 of the following 6 symptoms that have been present most days over the last 6 months. Restlessness or feeling on the edge Being fatigued Irritable Difficulty concentrating or mind going blank Muscle tension Sleep disturbance The anxiety or worry will cause impairment in school, work, social aspects of life. DSM-5 Bipolar II - SOLUTION Bipolar type II disorder is characterized by recurring mood episodes consisting of one or more major depressive episodes and one or more hypomania episode. The major depressive disorder must last two weeks and the hypomania episode four days. During these episodes, the symptoms must occur a majority of the time and will show a noticeable change in behavior and functioning. The patient will often have impulsive behavior. Suicide ideation and substance abuse is often increased. This will often be worse if the patient struggles with another diagnosis such as anxiety, or personality disorders. Bipolar Type 2 typically does not affect activities of daily living and will not require hospitalization like Bipolar Type 1 often does. DSM-5 Cyclothymic Disorder - SOLUTION Disorder that involves periods of symptoms of depression and periods of symptoms of hypomania. These symptoms however are not sufficient to be a major depressive episode or a hypomanic episode. SCARED Purpose - SOLUTION 41-item inventory rated on a 3 point Likert- type scale. It comes in two versions; one asks questions to parents about their child and the other asks these same questions to the child directly.The purpose of the instrument is to screen for signs of anxiety disorders in children. Clonidine - SOLUTION MOA: Alpha 2 receptor in prefrontal cortex. Indication: HTN, ADHD, Tourette's, Substance withdrawal, PTSD, anxiety. Education: Do not crush or chew. Can cause rebound HTN when stop. Can become tolerant. Desmopressin (DDAVP) - SOLUTION MOA: Limits amount of water that is eliminated in the urine. Replaces vasopressin. Indication: bed-wetting. Education: Sodium levels. Do not drink water for 8 hours after taking. Sertraline (Zoloft) - SOLUTION MOA: Increases serotonin, decreases serotonin reuptake. Indication: MDD, PMDD, Panic disorder, PTSD, SAD, OCD, GAD. Education: Watch for SI. Takes 2 weeks to work. Causes sexual dysfunction. GI upset. Sedation, sweating, hyponatremia, SIDAH. Risperidone (Risperdal) - SOLUTION atypical antipsychotic Clozapine - SOLUTION Blocks dopamine and serotonin receptors When nothing else works. Must use REMS program. Works well and does help with SI thoughts as well. But have to get labs a lot (every week/6 months, two weeks/6 months, then monthly after 1 year if stable). WBC/absolute neutrophil count most important to look at. DSM-5 criteria for a hypomanic episode - SOLUTION A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree: 1. Inflated self-esteem or grandiosity 2. Decreased need for sleep (eg, feels rested after only 3 hours of sleep) 3. More talkative than usual or pressure to keep talking 4. Flight of ideas or subjective experience that thoughts are racing 5. Distractibility (ie, attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 7. Excessive involvement in activities that have a high potential for painful consequences (eg, engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. D. The disturbance in mood and the change in functioning are observable by others. E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features present, the episode is, by definition, manic. F. The episode is not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication, other treatment) or to another medical condition. Therapy for eating disorder - SOLUTION Support group, Cognitive behavioral therapy, Dialectical behavior therapy, Counseling psychology, Interpersonal psychotherapy, Family therapy, Behavior therapy, Psychotherapy, Brief psychotherapy, and Group psychotherapy meds for eating disorders - SOLUTION Selective Serotonin Reuptake Inhibitor (SSRI) and Antipsychotics GAD brain structure - SOLUTION Amygdala bipolar brain structure - SOLUTION Hippocampus