stethoscope

When to begin studying?  Where to start?

If you’re unsure of  where to begin or how to get started follow along as we cover the NCCPA blueprint.

Play

Drug abuse

Click here to get your psych activity book!

Substance Dependence

Things you should know

  • Use of one or more substances leads to a clinically significant impairment or distress

Signs and Symptoms

  • See Diagnosis below

Diagnosis

  • Physical assessment
  • Laboratory test
    • Toxicology screening – using either blood or urine sample
  • Psychological assessment using Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
    • One may have a substance use disorder if at least two of these issues occur within a 12-month period:
      • Tolerance – Takes larger amounts of the drug over a longer period of time than intended
      • Failed attempts and unable to stop using the drug
      • Spends a good deal of time getting the drug, using the drug or recovering from the effects of the drug
      • With intense urges for the drug that block out any other thoughts
      • Unable to meet obligations and responsibilities because of substance use
      • Keeps using the drug, despite awareness that it’s causing problems
      • Gives up or cuts back important social, occupational or recreational activities because of substance use
      • Uses the substance in situations that may be unsafe, such as when driving or operating machinery
      • Uses the substance despite knowing it causes physical or psychological harm
      • Experiences physical or psychological withdrawal symptoms on attempts to stop taking the drug
      • Takes the drug (or a similar drug) to avoid withdrawal symptoms

Treatment

  • Detoxification
    • Goal: stop taking the addicting drug as quickly and safely as possible
    • “Detox” or Withdrawal Therapy
    • May involve gradually reducing the dose of the drug or temporarily substituting other substances, such as methadone
    • Tailoring Treatment
  • Counselling
    • Talk therapy or psychotherapy
    • Done by a psychologist, psychiatrist, or licensed drug counselor with an individual, family or group.
  • Self-help groups
    • Alcoholics Anonymous
    • Narcotics Anonymous
    • The self-help support group message is that addiction is a chronic disorder with a danger of relapse.
    • Can decrease the sense of shame and isolation that can lead to relapse

Substance Withdrawal

Things you should know

  • A group of symptoms that occur upon the abrupt discontinuation or decrease in intake of medications or recreational drugs

Signs and Symptoms

  • Mild
    • Intense worry
    • Nausea or vomiting
    • Shakiness
    • Sweating
    • Restlessness/Feeling a little tense or edgy
    • Poor concentration
    • Headaches
    • Irritability
  • Severe
    • Being extremely confused, jumpy, or upset
    • Hallucinations (visual, audio, tactile)
    • Severe trembling
    • Insomnia
    • Depression
    • Social Isolation
    • Palpitations
    • Muscle tension
    • Chest pain
    • Difficulty breathing
    • Tremors
  • Life-threatening
    • Grand mal seizures
    • Heart attacks
    • Strokes
    • Hallucinations
    • Delirium tremens (DTs) – begin about 3 days after last drink

Diagnosis

  • Thorough physical and detailed history

Treatment

  • Goals of treatment:
    • Reduce immediate withdrawal symptoms
    • Prevent complications
    • Beginning long-term therapy to promote abstinence.
  • Medications
    • Prescription drugs of choice:
      • Benzodiazepines – for alcohol withdraw
        • Diazepam (Valium)
        • Chlordiazepoxide (Librium)
        • Lorazepam (Ativan)
        • Oxazepam(Serax).
      • Antipsychotic drug – to help relieve agitation and hallucinations
      • Beta-blocker
        • to treat tachycardia and elevated blood pressure related to withdrawal
        • reduce the strain of alcohol withdrawal in people with coronary artery disease
  • 12-Step Group
    • Alcoholics Anonymous
    • Narcotics Anonymous
  • Cognitive and Behavioral therapy
  • Family Therapy

Acute Reaction to Stress (Acute Stress Disorder)

Things you should know

  • A psychological condition arising from a mentally healthy individual in response to a terrifying or traumatic event
  • Psychological shock
  • Lasts from 3 days to 1 month. If symptoms persist past 1 month, diagnosis is changed to Posttraumatic Stress Disorder

Symptoms

  • See Diagnosis below

Diagnosis

  • Exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways:
    • Directly experiencing the traumatic event
    • Witnessing, in person, the event as it occurred to others.
    • Learning that the traumatic event occurred to a close family member or close friend.
    • Experiencing repeated or extreme exposure to aversive details of the traumatic event, such as first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
  • Presence of nine (or more) of the following symptoms from any of the five categories:
    • Intrusion Symptoms
      • Recurrent, involuntary, and intrusive distressing memories of the traumatic event
      • Recurrent distressing dreams
      • Dissociative reactions, such as flashbacks
    • Negative Mood
      • Persistent inability to experience positive emotions
    • Dissociative Symptoms
      • An altered sense of the reality of one’s surroundings or oneself, such as seeing oneself from another’s perspective, being in a daze, time slowing
      • Inability to remember an important aspect of the traumatic event
    • Avoidance Symptoms
      • Efforts to avoid distressing memories, thoughts, or feelings
      • Efforts to avoid external reminders
    • Arousal Symptoms
      • Sleep disturbance
      • Irritable behavior and angry outbursts
      • Hypervigilance
      • Problems with concentration
      • Exaggerated startle response

Treatment

  • Psychological Treatment
    • Cognitive prolonged exposure
    • Behavioral exposure to safe situations which illicit fear.
    • Eye movement desensitization and reprocessing (EMDR)
  • Pharmacological Treatment
    • Antidepressant Medication:
      • Recommended as first-line medication treatment for Acute Stress Disorder
        • Selective serotonin reuptake inhibitor (SSRI)
        • Tricyclic
        • Monoamine Oxidase Inhibitor (MAOI)
    • Benzodiazepines:
      • May be useful in reducing anxiety and improving sleep
      • Carry a high risk for dependence

Conduct Disorder

Things you should know

  • Childhood diagnosis otherwise see antisocial personality disorder
  • Repetitive pattern behavior in which the basic rights of others or major age-appropriate norms are violated
  • Causes
    • Biological
    • Genetics
    • Environmental
      • Dysfunctional family life
      • Childhood abuse
      • Traumatic experiences
      • A family history of substance abuse
      • An inconsistent discipline by parents
  • Prevalence rate among incarcerated youth or youth in juvenile detention facilities: 23% and 87%
  • More common in boys than in girls
  • Often occurs in late childhood or the early teen years

Symptoms

  • Aggressive behavior
    • Threats or causes physical harm
      • fighting
      • bullying
      • being cruel to others or animals
      • use of weapons
      • forcing another into sexual activity
  • Destructive behavior
    • Intentional destruction of property
      • Arson
      • Vandalism
  • Deceitful behavior
    • Lying
    • Shoplifting
  • Violation of rules
    • Going against accepted rules of society or engaging in behavior that is not appropriate for the person’s age
      • Running away
      • Skipping school
      • Playing pranks
      • Being sexually active at a very young age
  • Irritable
  • Low self-esteem
  • Tends to throw frequent temper tantrums
  • Drug and alcohol abuse
  • Inability to appreciate how their behavior can hurt others
  • Generally have little guilt or remorse about hurting others

Diagnosis

  • Diagnostic basis: prolonged pattern of antisocial behaviour such as serious violation of laws and social norms and rules
  • DSM-5 criteria for conduct disorder categories:
    • aggression to people and animals
    • destruction of property
    • deceitfulness or theft
    • serious violation of rules

Treatment

  • Multisystemic Treatment
    • An intensive, integrative treatment that emphasizes how an individual’s conduct problems fit within a broader context.
    • The individual is viewed functioning within a series of interconnected systems that reinforces their behavior.

 

Study Tips

Attitude is extremely important!

 

Key Terms and Ideas

 

  • A patient exhibits behavior that fits the diagnosis of conduct disorder, but he is 20 years old.  What is the diagnosis?
    • Antisocial personality disorder
  • How long after a patient enters the hospital may Delirium Tremens begin
    • 2-3 days.
  • How long do symptoms have to occur for the diagnosis of acute stress reaction to change to post traumatic stress disorder?
    • 1 month

 

 

 

Click here to get your psych activity book!

{ 0 comments }

Personality Disorders

by Brian Wallace PA-C on December 2, 2014

Play

Personality disordersThings to know

  • Inflexible patterns of behavior which cause significant difficulty with social interactions
  • Ego-syntonic

Cluster A  (Mad – weird)

Paranoid Personality Disorder

Characteristics

  • Very suspicious of others.
  • Patients tend to blame problems on others.
  • Preoccupied with the trustworthiness and loyalty of others
  • Feels threatened by others
  • Holds grudge

Treatment

  • Psychotherapy
  • Anti Anxiety meds

Schizoid Personality Disorder

Things you should know

  • Voluntary social withdraw with no desire for close relationships
  • They will choose to be alone and have no interest in others
  • No interest in praise or criticism.

Treatment

  • Group therapy
  • Psychotherapy

Schizotypal Personality Disorder

Things you should know

  • Patients exhibit “magical thinking” – believing in telepathy, clairvoyance and other fantasies
  • Most likely personality disorder to progress to schizophrenia
  • Severe social anxiety

Treatment

  • Psychotherapy
  • Low dose antipsychotics if necessary

[Click here to finish this topic…]

{ 0 comments }

Psychotic Disorders

Schizophrenia  Things you should know Patient exhibits abnormal behavior and is unable to differentiate real from imaginary. Chronic and debilitating Disruption of the usual balance of emotions and thinking M>F Signs and Symptoms Positive symptoms – Extra feelings or behaviors which are usually not present Delusions and paranoia Hallucinations Irrational, bizarre or odd statements or […]

Read the full article →

No show this week

Sorry, but it’s not gonna happen this week.     The kids, my wife and I all have had bronchitis / sinus infection / pnuemonia who knows for about 2 weeks now.  No end in site and I can’t speak long enough without coughing to do the show.   I’ll have one up as soon […]

Read the full article →