Abnormal 2
Terms
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- Types of Dyslexia
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Surface dyslexia – reads without comprehension due to an inability to read words that are irregularly spelled (e.g. light, sword)
• Deep dyslexia – several reading errors including semantic paralexia = substitution of words with similar meanings (e.g. cold for hot)
• Pure Alexia – “word blindness†an inability to read words, even if they were just written by the person.
• Literal Alexia – can read whole words, but not individual letters
Phonological Alexia - be unable to read (pronounce) pseudo-words - Alzheimer's type dementia - Eitology
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*Abnormalities on Chromosome 21 - early-onset familial type
*Abnormalities on Chromosome 19 - Later-onset type
*low level of ACh
*Aluminium deposits in brain tissues - Treatment for Alzheimer type dementia
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Combo of group therapy (esp therapy that emphasizes reality orientation and reminiscence) ;
antidepressant drugs;
behavioral techniques ;
Antipsychotic drugs to reduce agitation;
environmental manipulation
Most effective when family members are included. - Vascular Dementia
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*Cognitive impairments and Focal neurological signs.
*Stepwise and fluctuating pattern with evidence of a cerebrovascular disease.
*Risk factors - cigarette smoking, hypertension, diabetes - Dementia due to HIV
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*forgetfulness, impaired attention, slowed mental processes.
*Problem solving difficulties and concentration, apathy and social withdrawal, tremor and clumsiness and saccadic eye movements.
*Subcortical dementia - Dementia due to Parkinson's disease
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*Bradykinesia
*Pill rolling
*Tremor at resting
*Akathesia (Cruel restlessness)
*Loss of coordination
*Mask like face expression
*Psychiatric symptoms precede these in minority of patients. - Parkinson's disease
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Loss of dopamine producing cells in the substantia niagra
L-Dopa helps alleviate symptoms
More recent treatment - injection of human fetal cells. - Huntington's disease
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Symptoms - affective, cognitive and motor
*Affective - appear first - depression, irritability and apathy
*Cognitive deterioration - forgetfulness and eventually leads to dementia
*Motor - Athetosis (slow writing movements), Chorea (involuntary rapid, jerky movements) - Alcohol-induced Persisting Amnestic Disorder (Korsakoff syndrome)
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*Anterograde amnesia - most severe esp for declarative memories
*Retrograde Amnesia - affects recent long term memories
*Confabulation
Due to thaimine deficiency (affects the thalamus) - Wernicke's Syndrome
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*Ataxia
*Abnormal eye movements
*Confusion
Co occurrence of both is called Wernicke-Korsakoff syndrome - Alochol Intoxication
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*Maladaptive behavioral and psychological changes,
*Slurred speech
*Incoordination
*Unsteady gait
*Impairedattention or memory(esp anterograde amnesia) - Alcoholo Withdrawal
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*Autonomic hyperactivity
*Illusions and hallucinations
*Anxiety
*Hand tremors
*Psychomotor agitation
*nausea and vomiting
*Grand mal seizures - Amphetamine or Cocaine Intoxication
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*Euphoria, anxiety, hyperactivity, confusion, grandiosity, anger, paranoind ideation, auditory hallucinations
*Tachycardia
*Weight loss
*elevated or lowered blood pressure
*Dialated pupils
*Psychomotor agitation
*Seizures - Amphetamine or Cocaine Withdrawal
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8Dysphoric mood
*fatigue
*unpleasant dreams
*insomnia or hypersomnia
*increased appetite - "Crash"
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Withdrawal following an intense high-dose use causes crash
*intense lassitude and depression - Caffeine Intoxication
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*restlessness, nervousness, excitement, insomnia, flushed face - at low doses
*muscle twitching, rambling thoughts and speech, cardia arrhythmias and psychomotor agitation - at high doses - Schizophrenia - Concordance rates
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Biological sibling - 10%
Identical twins - 48%
Fraternal twics- 17%
Child with both parents schizophrenic -46% - Structural brain abnormalities associated with Schizophrenia
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*Smaller than normal hippocampus, amygdala and globus pallidus
*Enlarged ventricles - Functional brain abnormalities associated with schizophrenia
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*hypofrontality - associated with negative symptoms.
*Lower than normal activity in the prefrontal cortex (measured by cerebreal blood flow and glucose metabolism) - Dopamine Hypothesis
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*elevated levels of dopamine
*Oversensitive dopamine receptors - Research shows in addition to dopamine hyp -
- *elevated levels of norepinephrine and serotonin and low levels of GABA receptors in some schizophrenic patients.
- Schizophrenia - Tx - PHARMACOTHERAPY
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*Traditional antipsychotics - positive symptoms but more side effects (tardive dyskinesia)
*Atypical antipsychotics - Negative symptoms, less side effects but atleast two to four weeks to take effect. - Shcizophrenia - Tx - PHARMACOTHERAPY + PSYCHOSOCIAL INTERVENTIONS
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*Family interventions are very useful when they target high levels of Expressed emotion among family members
- High EE characterized by open criticism and hostility toward the patient or overprotection, symbiotic relationships.
*Social skills training
*Supported employment - Schizophreniform disorder
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identical to schizophrenia but
*disturbance is present for atleast one month, but less than six months
*impaired social or occupational functioning (mite occur) is not required.
*2/3rd ppl with this diagnosis ultimately receive a diagnosis of Schizophrenia or Schizophreniform disorder - Brief Psychotic Disorder
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Presence of
*hallucniations,
*delusions
*disorganized speech, behavior
*grossly disorganized/ catatonic behavior
for atleast one day but less than one month
Return to premorbid functioning
Usually involves an overwhelming stressor - Manic episode
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*One week period or longer
*prevailing mood is abnormally and persistently elevated, expansive or irritable
*atleast three of the following
psychomotor agitation
flight of ideas
decreased need for sleep
grandiosity
restlessness
distractibility
if mood is only irritable, then four symptoms are required (versus three) - Hypomanic episode
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*atleast four days of elevated mood irritability, expansive mood
*three of the symptoms associated with manic episode - Mixed episode
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*lasts for one week
*rapidly alternating symptoms of manic and major depressive episodes. - Bipolar 1
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*one or more manic or mixed episode with or without a Hx of one or more Major depressive episode
*subtype will depend on the most recent episode
*equally common in males and females - Bipolar 2
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*atleast one majo dep episode and one hypomanic episode
*never had a manic or mixed episode
*more common in females
*avg age is 20yrs - Bipolar Tx
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*Lithium - treatment of choice - effective in 60 - 90 % of cases
*reduces manic symptoms, and also manages the mood swings
*Lithium compliance is a frequent problem
*Good results with combined pharmacotherapy and psychotherapy - Suicide
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*60 - 80 % of ppl have had prev attempts
*25-44 - most common for attempts
10- 19 - greatest increase in suicide rates
*4 - 5 times as many males COMMIT suicide as females
females ATTEMPT suicide abt 3 times more often than males.
*Whites - greatest for all age grps
Native americans - greatest for adolescence
*Divorced, separated and widowed > single > married
*Hoplessness - best predictor
*Life stress
*Early warning signs
*comorbid disorders
*low levels of serotonnin and 5 H1AA - Post Concussional Disorder
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Impaired memory and attention
headaches
irritability
fatigue
for atleast three months - Premature Ejaculation - Tx
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Sensate focus
SSRI (dapoxetine)
Start and squeeze technique - Tx for paraphilias
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In vivo aversion therapy- but this has only short term effects.
More recently, trend has been to use covert sensitization (aversive conditioning in imagination), stiation therapy, and teaching of alternative desirable behaviors. - Primary Insomnia
- difficulty initiating or maintaining sleep, or no restorative sleep for atleast one month
- Primary Hypersomnia
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Excessive sleepiness for atleast one month as evidenced by either prolonged sleep episodes or daytime sleep episodes that occur almost daily.
recurrent- if the sleep episodes occur for 3 days , several times a year for atleast 2 yrs
Males > females - Narcolepsy
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Irrestible attacks of refreshing sleep that occurs daily over atleast 3 months
presence of
cataplexy (bilateral loss of muscle tone)
recurrent intrusions of elements of REM sleep in to the transition between sleep and wakefulness, seen by hypnogogic hallucinations or sleep paralysis at the beginning or end of sleep episodes. - Dyssomnias
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abnormalities in amount, quality, or timing of sleep
Primary Insomnia
Primary Hypersomnia
Narcolepsy
Breathing related sleep disorder
Circadian rhythm sleep disorder - Parasomnias
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abnormal behavioral or physiological events occurring in association with sleep, specific sleep stages or sleep-wake transitions.
Nightmare disorder ~ dream anxiety disorder
Sleep terror disorder
Sleepwalking disorder - Nightmare disorder
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repeated awakenings from the major sleep period with detailed recall of extremely frightening dreams, usually involving threats to survival, self-esteem.
generally occur duing second half of sleep.
on awakening, person becomes immediately oriented and alert - Sleep Terror disorder
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recurrent episodes of abrupt awkening from sleep, usually occurring during the first third of the major sleep episode and beginning with a panicky scream
intense fear and signs of autonomic arousal like tachycardia, rapid breathing
reltive unresponsiveness to efforts of others to comfort the person during the episode
no detailed dream is recalled
amnesia for the entire episode - Sleepwalking disorder
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repeated episodes of rising from bed during sleep and walking about usually occurring during the first third of the majoe sleep cycle
person has a blank staring face, relatively unresponsive to efforts of others to communicate with him, awakened only with great difficulty
amnesia for the episode
after awakening , no impairment in mental activity or behavior , but short period of confusion - Epilepsy
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best treated with biofeedback and individual psychotherapy (anxiety and depression).
Most common kind is Tonic-Clonic (formerly Grand-Mal)