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84 Cards in this Set
- Front
- Back
DSM Axes
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I Focus of clinical attention
II Mental retardation and personality disorders; also traits and defenses III Relevant medical conditions IV Psychosocial and environmental problems V GAF |
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Expression of diagnostic uncertainty in DSM
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Diagnosis / condition deferred
not enough information Provisional tentative diagnosis NOS when class but not specific disorder can be identified or insufficient features for a specific diagnosis |
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Def: polythetic criteria sets
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Criteria sets from which the patient need only present with n of m
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Criteria for mental retardation
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IQ < 70
Impairments in adaptive functioning in at least 2 areas Onset < 18 |
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Criteria for autism
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Qualitative impairments in social interaction and communication
Narrow repetitive and stereotyped behavior, interests and activities Before 3: abnormal social interaction, social language or imaginative play |
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Difference between Asperger's and autism
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Like autism but with no significant delay in language development
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Def of learning disorder
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2 SD difference between IQ and achievement
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Difference between Conduct disorder and Oppositional Defiant Disorder *
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Both involve hostile, negative or defiant behavior,
but Conduct Disorder is associated with more severe violations of the rights of others, eg stealing or fire-setting, breaking major rules before age 13 such as staying out late, picking fights, lying |
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Def: pica
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persistent eating of non-nutritive substances for at least a month
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Def: rumination disorder
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Repeated regurgitation ond rechewing of food that begins after a period of normal eating
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Degrees of mental retardation *
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Mild IQ 50-70
85% of retarded population Top out at 6th grade ability Can live independently and do semi-skilled jobs Moderate 35-50 10% of retarded population Top out at 2nd grade ability Need supervision in semi-skilled jobs Severe 20-35 3-4% of retarded population Poor motor skills, limited speech Closely supervised living Profound <20 1-2% of retarded population Severely limited motor and sensory functioning Closely supervised living |
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Autistic language deficits
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Rarely speak (~50% never speak)
Echolalia Pronoun reversals (I for you) |
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Indicator for favorable prognosis in Autism
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Higher early functioning,
eg some pre-school langugage |
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Symptoms of ADHD *
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Symptom classes:
inattention hyperactivity impulsivity Subtypes combined: 6+ inattention; 6+ hyper inattentive 6+ inattention; <6 hyper hyperactive-impulsive: <6 inattention; 6+ hyper onset of symptoms before age 7 min 6 mo duration symptoms present in 2 settings |
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adult ADHD
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decrease in activity level
often delinquint or antisocial common: restlessness, low frustration tolerence, emotional lability, low self-esteem, impulsivity, difficulty concentrating |
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side effects of Ritalin (methylphenidate)
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anorexia, insomnia, stomach aches
tics, exacerbates Tourette's ocd symptoms growth retardation |
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Tourette's comorbidity *
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obsessions / compulsions
ADHD learning disorders depression social problems |
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Treatment of enuresis
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In order of efficacy
Bell (rings) and pad (when wet) Antidepressants Hypnosis Bladder control exercises |
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Desc pseudodementia
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Cognitive impairment as a result of depression
Cognitive symptoms improve with mood Acute onset Self-conscious about cognitive deficits Deficits mostly in procedural memory and recall |
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Alzheimer's progression
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Recent memory
Lost procedural facility Aphasia, apraxia, agnosia Personality changes, delusions, hallucinations Incontinent, unintelligible, unable to walk or sit Lack of disease awareness |
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AIDS dementia progression *
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Loss of concentration; confusion, general forgetfulness
Apathy, social withdrawal, depression Seizures, incontenence, etc Also includes: Slowed motor and thought processes Visuospatial defects But language function is intact ability to acquire new information is intact |
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Def: confabulation
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Filling memory gaps with imaginary events
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Symptoms of alcohol withdrawal
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agitation
hand tremor insomnia depression grand mal seizures nausea or vomiting anxiety hallucinations or illusions convulsive seizures |
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Desc: delirium tremens
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characteristic delirium (disturbance of consciousness) plus:
hallucination, delusions agitation < %5 of people in withdrawal |
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Desc: cocaine and amphetamine intoxication *
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euphoria
interpersonal sensitivity talkativeness hypervigilence impaired judgement vomiting confusion pupil dilation |
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Desc: cocaine / amphetamine withdrawal
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dysphoric mood
fatigue, insomnia, vivid dreams etc |
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Def: abstinence violation effect (AVE) (Marlatt and Gordon)
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Relapse leads to feelings of guilt and failure leading to further relapse
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Marlatt and Gordon addiction treatment model
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Change attributions for failure from:
internal to external stable to unstable global to specific |
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Factors in treatment for nicotine dependence *
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Time without intervention
Strong desire to quit Awareness of consequences Social support Also: relapse prevention training stimulus control Patch works best when combined with behavioral intervention, especially for long term abstinence of 6 months or more |
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Difference between schizophrenia and schizophreniform disorder
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6 months
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Positive symptoms of schizophrenia
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delusions
hallucinations (usually auditory) disorganized speech grossly disorganized behavior |
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Negative symptoms of schizophrenia
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alogia - restricted speech/thought fluency/production
avolition anhedonia |
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Positive prognostic factors for schizophrenia
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late and acute onset
precipitating event being female good premorbid adjustment brief active phase family history of mood disorder, but not schizophrenia positive symptoms - which can be medicated prompt treatment with medication right after onset good medication compliance |
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Types of schizophrenia
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Disorganized
Paranoid Catatonic Undifferentiated Residual |
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Treatment for schizophrenia
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Anti-psychotics
chlorpromazine haloperidol plus family therapy interpersonal skills training not individual insight oriented therapy |
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Schizoaffective disorder vs schizophrenia
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symptoms of both mood disorder and schizophrenia, not meeting full criteria for either
psychotic features must be present for at least 2 weeks without mood symptoms mood symptoms must otherwise be generally present |
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Differences among PTSD, Acute Stress Disorder and and Adjustment Disorder
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PTSD and ASD are both responses to extreme stressors, with a specific set of symptoms:
most noteably flashbacks, and dissociative symptoms (amnesia, being in a daze, depersonalization) while symptoms an Adjustment Disorder are less severe and more various 4 weeks difference between PTSD and ASD |
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Def: agoraphobia
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Anxiety about being in places or situations from which excape might be difficult or embarassing
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Desc: dissociative disorder
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Dissociative amnesia
inability to remember important personal information Dissociative fugue - abrupt, unanticipated travel away from home, inability to remember one's past and identity confusion Dissociative Identity Disorder multiple personality disorder Depersonalization disorder repeated episodes of depersonalization, characterized by feelings of unreality |
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Desc: narcolepsy
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Irresistible episodes of refreshing sleep nearly every day for 3 mo
Either of: abrupt loss of muscle tone REM sleep while going to sleep or waking 20-40% experience hypnagogic or hypnopompic hallucinations |
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Desc: dyssomnias
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Disturbances in sleep amount, quality or timing
insomnia hypersomnia narcolepsy breathing-related sleep disorder circadian rhythm sleep disorder |
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Desc: parasomnias
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Aberrant sleep event, where the focus is the event, not the sleep quality
nightmares sleep terrors - intense, anxious awakening without dreams sleepwalking |
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Parasomnias by stage of sleep
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Stages 3&4: sleep terror and sleepwalking
REM: nightmares and sleep paralysis |
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Family characteristics in anorexia according to Minuchin
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Parental over-control
Lack of power or autonomy for the anorexic |
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Location of complex-partial seizures
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temporal or frontal lobes
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Defining characteristic of substance dependence
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a maladaptive pattern of use, including cognitive, behavioral and psychological symptoms, usually including tolerance and withdrawal that is distressing or impairs functioning
at least 3 symptoms over a 12 month period Tolerance Withdrawal Excessive use Inability to quit Time consuming acquisition Severe personal impact |
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Time constraints on adjustment disorder
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Must occur within 3 mo of stressor and last no more than another 9
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Duration of a brief psychotic disorder
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1 psychotic symptom for at least 1 day and no more than 1 month, with return to permorbid condition
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Def: delirium
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syndrome with a disturbance of consciousness and either a change in cognition or perceptual disturbance
caused by medical condition and / or substance abuse |
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Def: obsessive compulsive disorder
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Recurrent, persistent, intrusive, distressing thoughts (obsessions) OR compulsive actions (compulsions) recognized as irrational or excessive
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Def: functional disorder
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Mental disorders not clearly caused by a physiological factor
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Wolpe's explanation of depression
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Depression is linked to anxiety and should be treated with systematic desensitization
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Factor associated with negative prognosis for ADHD
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Conduct disorders
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Cognitive impairments as a result of chronic alcoholism
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More effects visuospatial skills than verbal skills
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Core requirements of a diagnosis of separation anxiety disorder
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Three symptoms including:
Fear that harm will come to a major attachment figure But not necessarily an excessive need for attention |
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Strategies for treating OCD
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deliberate exposure and thought stopping
relaxation training paradoxical intent covert sensitization systematic desensitization |
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IQ criterion for borderline intellectual functioning
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1-2 SD below the mean
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Types of headache pain *
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Migraine - unilateral throbbing pain
Cluster - intense pain behind the eye Tension |
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Side effects of ECT
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Largely reversible memory deficits, though problems with autobiographical memory may persist for months
Unilateral ECT to the right hemisphere is associated with far fewer adverse side effects However bilateral ECT is more potent |
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Def: dyspareunia
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painful intercourse
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Brain abnormalities in schizophrenia
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Enlarged ventricles
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Organic disorders that may cause a Mood Disorder
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hallucinogens
PCP hyper / hypo thryroidism pancreatic CA viral illness stroke but NOT pot |
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Wechsler IQ standard scoring
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mean = 100
sd = 15 |
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Defense mechanisms used by people with narcissistic personality disorder (Millon)
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Repression
Rationalization Projection |
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Rate of post-partum major depression
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10-20%
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Diagnostic criteria for Tourette's Disorder *
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Multiple motor tics
One or more vocal tics For at least a year |
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Diagnostic criteria for Somataform Disorders *
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Physical symptoms not explained by a medical disorder
Undifferentiated - If fewer than 3 symptoms present for more than 6 mo NOS if symptoms present for less than 6 mo |
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Gender prevalence of OCD *
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Equal in adult males and females, but higher incidence in young boys
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Primary difference between obese and non-obese people
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Inherited differences in metabolism
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Substances causing substance induced delirium *
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Alcohol or sedatives
Hypnotics Anxiolytics |
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IPT accounting of depression
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Interpersonal relations
Personality Symptom formation (but treated with medication) |
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Symptoms of cannabis intoxication
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dry mouth
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Symptoms of caffeine intoxication
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diuresis
flushed face periods of inexhaustability |
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Symptoms of alcohol intoxication
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slurred speech
memory impairment nystagmus (rapid, involuntary, oscillatory motion of the eyeball) |
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Psychological correlates of smoking
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80% of quitters gain weight
Average weight gain is 7-9 lbs Fear of weight gain inhibits attempts at quitting, and signs of weight gain trigger relapse Higher depression rate Cessation can trigger a depressive episode in smokers with depression history |
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Def: cataplexy
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Episodes of sudden bilateral loss of muscle tone resulting in collapse, often in association with intense emotions
Occurs in about 70% of people with narcolepsy |
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Defining characteristic of antisocial personality disorder
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Lack of remorse
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Depression vs dementia
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In depression only free recall is affected
In dementia both recall and recognition are affected |
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Treatment of choice for PTSD
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Prolonged exposure
Not much added by stress inocculation training |
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Desc: PET scan (Positron Emission Tomography)
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Functional brain imaging technique providing information about metabolic and chemical activities of the brain such as blood flow
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Symptoms of hypoglycemia
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Acute phase includes panic and anxiety
Chronic phase includes depression, psychosis and/or personality change |
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Learning disorder comorbitity
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ADHD - 20-25% of children with learning disorder are also diagnosed with ADHD
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Concordance rates for schizophrenia
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1% in general population
10% among biological sibs |
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Incidence of Generalized Anxiety Disorder
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Diagnosed more frequently in females
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