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Wellness 3 Test Exam 3

Terms in this set (42)

Neurotransmitters that are effected by Depression?
´ Serotonin ↓
´ Norepinephrine ↓
´ Dopamine ↓
´ Glutamate levels unbalanced
´ Memory impairments, feelings of worthlessness, hopelessness, guilt
Alteration is the Hippocampus cause
----remembrance of guilt + worthless ness
Anhedonia "inability to feel pleasure in life activities", Anxiety,
*reduced motivation
Alteration is the Amygdala cause
´ alterations in sleep and appetite; decreased energy and libido "sex drive"
Alteration is the Hypothalamus cause
---Adenocorticoids; TSH
Depressed mood; problems "concentrating"
Frontal cortex:
": Psychomotor retardation/agitation
Cerebellum "psychomotor activity":
What areas of the brain are impacted by depression?
Hippocampus
Amygdala
Hypothalamus
limbic structures
Frontal cortex
Cerebellum
Effects on other Neuroendocrine Disturbances of ------Hypothalamic-pituitary-adrenocortical axis?
increased cortisol levels

results in hypersecretion of cortisol-----causes increased cortisol due to STRESS associated w/ depression causing physical issues: low WBC, inc. glucose production etc.
Effects on other Neuroendocrine Disturbances of ------Hypothalamic-pituitary-thyroid axis?
Low Thyroid levels-----

body responds less to TRH "thyroid releasing hormone">diminished TSH response to TRH hypothyroidism
Depressed patients will have s/s of hypothyroidism---since body responds less to TRH "thyroid releasing hormone"

Give S/S
Hypothermia
Puffy Face + legs
weight gain
loose hair
low energy
Types of Bipolar Disorder
Bipolar I
Bipolar II
Cyclothymia (Hypomania to mild depression; no loss of function which occurs in sever depression; no hospitalization required)
most common type of amnesias are
localized, selective, and generalized
Hospitalization is required when loss of function occurs; name where this occurs on Mood Spectrum?
1. Severe depression- suicidal depression pshychosis

2. Mania- mania psychosis
What is this?
*Euthymia to Mild depression---No loss of function
"Hallmark"= Chronic Sadness--- Most of the days, More days than not for at least 2 years
*Persistent Depressive Disorder
* CHRONIC-- Adult bereavement for 2 years; 1 year for teen
´ Most of the day
´ More days than not
´ No presence of hypomania or mania----(Euthymia to mild depression)
*Dysthymia (Normal Bereavement)
What is this?
*Hallmark--C"hronic for atleast 2 years; mood disturbance; like Dythymia (Euthymia to Mild depression—2 years for adult; 1 year for teen—"bereavemnet")
*´ Hypomania to Mild depression -----No severe (major) depression (loss of function begins); No mania
*No Hospitalization required
"C"yclothymia
Cyclothymia and Mania are both Chronic conditions---2 years......
...
What is this?
*Euthymia - Depressive suicidal psychosis
*´ feeling of sadness, despair, pessimism
*Anhedonia is the inability to feel pleasure.
´ AND at least four other symptoms:
1. Changes in eating habits → weight gain or loss
2. Hypersomnia "sleep too much" or insomnia "sleep to little"
3. Impaired concentration, decision making, or problem solving
4. Worthlessness, hopelessness, despair, guilt
5. Thoughts of death/suicide
6. Overwhelming fatigue, negative thinking
Major Depressive Disorder
What is this?
* Client has at least one episode of mania altering with major depression (suicidal depression "psychosis" to mania "psychosis")
*Experienced Mania and are Bi-polar
Bi-polar I disorder
What is this?
Client has one or more hypomanic episodes alternating with major depressive episodes (hypomania to suicidal/ severe depression with "psychosis")
* Never experienced mania and are Bi-polar
Bi-polar II disorder
acceptable to be hypomanic for extended periods
HINDUISM + BUDISM
-ECT and TMS more commonly used for treatment b/c Increased intolerance to medications
-Psychotic features common
´ Suicide increased
Elderly
Mania characteristics
Inflated sense of self-importance
Extreme Energy
Excessive Talking with Pressured Speech
Indiscriminate Spending
Reckless Sexual Encounters
Risky Investments
sucidal risk
-prevalence of this disorder is unknown; thought that single brief episodes may occur in as many as half of all adults

-particularly when under severe psychosocial stress, when sleep-deprived, during travel to unfamiliar places, or when intoxicated with hallucinogens, marijuana, or alcohol;

-High Risk under combat or war camps or endured near death experiences
Depersonalization-derealization disorder
u Rare
u More prevalent in women (5-9x more likely in women) than in men
u Single brief episodes may occur in as many as half of all adults when under severe psychosocial stress,when sleep-deprived, during travel to unfamiliar places, or when intoxicated with hallucinogens, marijuana, or alcohol.
u Onset likely occurs in childhood but Manifestations/ Clinical Symptoms usually not recognized until late adolescence or early adulthood....seems to occur in all disorder around this age!!
Dissociative disorders
Defined as an inability to recall important personal information that is "too extensive" to be explained by ordinary forgetfulness

NOT due to the direct effects of substance use or

NOT due to neurological or other medical condition

caused by severe psychosocial stress
Dissociative Amnesia
u Onset usually follows severe psychosocial stress

u Usually appear alert and UNAWARE of amnesia

u Termination is typically ABRUPT and followed by COMPLETE RECOVERY

u DSM states most common type of amnesias are: (localized, selective, and generalized)

included subgroup
Dissociative Fugue
dissociated Amnesia
u Characterized by a Sudden, unexpected travel away from customary places

u Bewildered wandering

u Inability to recall some or all of one's past
Dissociative Fugue
u associated only with the stressful event.....unable to recall ALL incidences associated with a stressful period;

may be broader than just a single event such as the inability to remember MONTHS or YEARS of child abuse
Localized amnesia
u only recall certain incidents associated with event for a specific period AFTER the event
Selective amnesia
unable to recall any identity and/or total life history
Generalized amnesia
*most have been through childhood sexual or physical abuse

*u Characterized by the existence of two or more personality states in a single individual (alternate personalities)

*u Transition from one personality state to another may be sudden or gradual, and is sometimes quite dramatic

*u Not always incapacitating, some maintain responsible positions, have graduate degrees, and are successful spouse and parents before their diagnoses and treatment!!

*u Often misdiagnosed with other disorders suchs as depression/ anti-social personality disorders/ schizophrenia/ or bi-polar disorder
Dissociative Identity Disorder (formally called Multiple Personality Disorder)
Treatment for Dissociative identity disorder?
*integration of personalities is desirable; may settle for collaboration;
*treatment is very intense and takes years; includes:

1. abreaction ("remembering with feeling") the experience that caused the split during the traumatic event
treatment for dissociative amnesia?
most resolve spontaneously;

medication-induced hypnosis to help retrieve memories;

psychotherapy to re-integrate the memories
A young man is brought into the emergency department by the police. He gives his identity and home address (which is several hundred miles away) to the admissions clerk.

He tells the nurse he is frightened, because he doesn't know when or how he came to be in this place.
Dissociative amnesia with dissociate fugue "travel"---traveling 4rm where they live w/o knowing how they got there because of a trauma
Most common psychiatric disorder
1. depression
2. ???
3. Depersonalization-Derealization Disorder
u Characterized by a temporary change in the quality of self-awareness, which often takes the form of:
u Feelings of unreality
u Changes in body image
u Feelings of detachment from the environment
u A sense of observing oneself from outside the body

...u Age of onset is late adolensence and early adult hood; 2-4x more common in women than men
Depersonalization-Derealization Disorder
.......u perceived as disturbing and anxiety, fear of going insane, somatic thoughts

.....u Half of all adults have experiences Transient episodes of these symptoms ........very common....3rd most commonly reported psychiatric problem
is defined as a disturbance in the PERCEPTION OF ONESELF.....dreamlike thought the bodies physical characteristics have changed
Depersonalization---SELF
u described as an alteration in the perception of the EXTERNAL ENVIRONMENT ......objects in the environment are perceived as altered in size and shape, other people in the environment may seem automated or mechanical
Derealization----OTHERS/ENVIRONMENT
Treatment for depersonalization- derealization therapy?
treatment information is sparse and inconclusive;

limited success with a variety of psychiatric meds with hypnotherapy or CBT "cognitive behavioral therapy"
Observations is dissociative disorders
*hyperalertness, anxiety, restlessness (Deperonalization/derealization)u These distorted perceptions are perceived as disturbing and anxiety, fear of going insane, somatic thoughts

increased personal space, or

*fetal positioning (dissociative identity disorder)
Assessment for Dissociative Disorders
>u Alcohol and drug use is common......

>u Problems with relationships, work, social, or authority

>u Experience nightmares, flashbacks, intrusive thoughts, hallucinations, self-destructive thoughts, fantasies

>u Can range from passive to angry, frightened, agitated, hostile (disscositive disorder)
what are some u Grounding techniques used for Dissociative Disorders
u Remind the person that he/she is present, is an adult, and is safe.
u Increases contact with reality
u Diminishes the dissociative experience by focusing on current senses:
u Can you see me and the room we are in?.....reorient them to reality
u Can you feel the watch on your wrist?.....derealization
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