3/29-3/31 Notes Psych 380
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This 5 page Class Notes was uploaded by Cara Cahalan on Thursday April 7, 2016. The Class Notes belongs to Psych 380 at University of Nebraska Lincoln taught by Rosemary Esseks in Spring 2016. Since its upload, it has received 9 views. For similar materials see Abnormal Psych in Psychlogy at University of Nebraska Lincoln.
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Date Created: 04/07/16
3/29 Eating Disorders Anorexia Nervosa Characteristics o Body weight significantly below healthy minimum for age and height (often BMI < 17) o Intense fear of gaining weight, or behaviors that interfere with weight gain despite underweight status o Distortions in view of body Types include o Restricting type: associated with OCD, higher mortality rate o Binge eating/purging type overeats and/or purges: associated with alcohol abuse, higher suicide rate Prevalence o 0.4% in a year for females, who make up 90% of cases o Many also diagnosed with depression, anxiety, bipolar, and/or OCD Course o Usually begins in mid to late teens o Commonly has a waxing and waning or chronic course o Death rates estimated at 5% per decade due to medical complications (i.e. heart attack) and suicide Bulimia Nervosa Characteristics o Recurrent binges Eating a lot in a short period of time Feels out of control o Recurrent inappropriate behavior to counteract binges i.e. purging, fasting, excessive exercise o Binges and compensatory behaviors occur at least once a week for three months o Selfevaluation unduly associated with weight o Most are normal weight to underweight o Associated with impulsive behavior (i.e. substance abuse) Prevalence o 11.5% oneyear prevalence for females, who represent 90% of cases o Can be 20% in college populations Course o Usually begins in late adolescence or early adulthood o Course is often intermittent or chronic o Can cause dental/throat problems, rectal prolapse, esophageal tears, dehydration, gastric ruptures, death through electrolyte imbalance o Death rate is 2% per decade Binge Eating Disorder Characteristics o Recurrent binges (at least once a week for three months) without any inappropriate behaviors to compensate o Marked distress about binges Prevalence o 1.6% of females and 0.8% of males in one year Course o More likely to remit than anorexia or bulimia Causes of Anorexia and Bulimia Genetic linked to depression/bipolar Neurochemical low NE in anorexia, low serotonin in anorexia and bulimia Social o Occur relatively recently, primarily in industrialized nations o Standard of beauty is tall and thin most women are not o Higher rates in certain occupations/hobbies (i.e. modeling) Psychological o OCD behaviors many are perfectionists o Mood disorders common both preceding and concurrent with eating disorder diagnosis o Family factors Parents often are overly intrusive or neglectful Families emphasize physical appearance o Link to trauma, particularly sexual abuse can use food as coping method Treatment of Anorexia and Bulimia Medical o Hospitalization supervision to treat physical effects/force weight gain o Outpatient monitoring of physical effects (i.e. K levels) o Medications SSRIs Work better for bulimia for anorexia Best when combined with CBT o Consultation with a nutritionist i.e. regarding normal portion sized, healthy weight maintenance Cognitive behavioral therapy (CBT) o Behavioral modification reward weight gain/healthy eating o Cognitive restructuring of thoughts related to eating/body image o Exposure therapy practice eating/gaining weight and confronting associated fears o Relapse prevention explore factors associated with relapse and problemsolve how to address o Response prevention arrange circumstances to make it more difficult for the person to engage in the problem behavior (i.e. avoid being alone after eating) Other psychological interventions o Education about risks of behavior/healthy eating habits o Family therapy to address negative interaction patterns o Group therapy for accountability/support o Interpersonal therapy support/problemsolving through personal issues CBT and interpersonal therapy work well for bulimia and bingeeating disorder only treatment with strong support of efficacy for anorexia is familybased treatment 3/31: SleepWake and Neurocognitive Disorders Effects of lack of sleep: tiredness, discomfort, mental weakness, physical weakness/accidents, weight gain, substance abuse, hallucinations Terms o Rapid eye movement (REM) sleep phase of sleep during which most dreaming takes place o Sleep paralysis Loss of muscle control to prevent us from acting out dreams Up to 50% of normal sleepers have experiences this while awake Dysomnias: Insomnia Dysomnias disruptions in timing, amount, or quality of sleep Insomnia difficulty falling asleep or remaining asleep causing distress/impairment for at least 3 nights a week for three months Prevalence o 610% of adults o More common among women Course o Usually begins in young adults o 4575% have problems that persist for 17 years o More common with advancing age Narcolepsy: Characteristics recurrent irresistible attacks of sleep, including cataplexy (loss of muscle tone) Prevalence 0.020.04% Course o Usual onset in childhood/adolescence o Chronic BreathingRelated Sleep Disorder Characteristics sleep disruption due to breathing difficulties (i.e. obstructive or central sleep apnea; sleeprelated hypoventilation) Prevalence o Estimated 22 million Americans o Higher rates in males, the elderly, and the overweight Course o Usually begins between age of 40 and 60 and is chronic o Can cause death o Can remit with weight loss Circadian Rhythm Sleep Disorder Disruption of circadian timing system, or a poor match between the circadian clock and the demands of environment o Delayed sleep phase type sleep/wake cycle persistently later than desired o Other types: advanced sleep phase, shift work, and irregular sleepwake type Prevalence o Up to 10% of night shift workers o Delayed sleep phase is relatively common in adolescents Course o Delayed sleep phase type usually begins in adolescence o Older individuals have more difficulty with night shift work Parasomnias: Nightmare Disorder Parasomnias involve abnormal behavior or physiological functioning during sleep Characteristics dysphoric (unpleasant) dreams that wake up the sufferer, causing distress/dysfunction Prevalence o 12% of adults report frequent nightmares o Higher rates in PTSD Course o Generally peaks late adolescence then declines o Some adults have chronic nightmares NonREM Sleep Arousal Disorders Characteristics “repeated occurrence of incomplete arousal” causing distress/dysfunction and involving either o Sleep walking repeated episodes of walking while asleep o Sleep terrors abrupt awakening from sleep with screaming and apparent intense fear, although no nightmare (or not much of one) is remembered Prevalence o Isolated incidents common in general population o 15% of children meet criteria for the disorder, with lower rates in adults Course begin in childhood and decreases with age Causes: Insomnia often begins due to stress or medical issues, then continues due to classical conditioning Psychological factors stress, trauma, anxiety, and depression Substances in body both legal and illegal o Most medications affect sleep quality or quantity o Alcohol/marijuana can trigger onset of sleep but quality is poor Genetic link for narcolepsy, insomnia, sleep apnea, sleep terror, sleep walking, and circadian rhythm disorder Neurological abnormalities Hypocretin (type of protein) deficiency for narcolepsy Treatment: Insomnia: o Medications all are addicting/sedating and should only be used shortterm o Cognitive behavioral treatment for insomnia Education regarding normal sleep patterns Sleep hygiene get up at the same time each day regardless of quality of sleep, avoid caffeine and naps, don’t look at clock Stimulus control use bed for sleep (and sex), get out of bed if unable to sleep Sleep restriction limit time spent in bed to hours you are actually likely to sleep Changing sleeprelated through “I’ve worked a full day lots of time with little sleep” o 7080% success rates for behavioral interventions Sleep apnea: o Weight loss o CPAP (continuous positive airway pressure) o Avoid other sedatives (alcohol, narcotics, benzos) Narcolepsy: o Stimulants to reduce unwanted sleep o Planned naps Circadian rhythm problems bright lights Nightmare disorder imagery rehearsal therapy, involving practice of rewritten form of dream during day Types of Neurocognitive Disorders Delirium Fluctuating disruption in cognition and/or consciousness due to medical condition (TBI, medication interaction, diabetic crisis) Usually involves disorientation, possibly fear/aggression Prevalence overall just 12%, but 14% of those over 85 Course develops rapidly and resolves in hours or weeks Types of Neurocognitive disorders Neurocognitive disorders—involve deficits such as problems with memory, language, motor function, attention, and executive function. o Caused by a medical condition, substance of abuse, or multiple causes. o Major neurocognitive disorder—disruption usually in several domains of cognitive functioning with significant impact on functioning/independence o Minor neurocognitive disorder disruption usually in one cognitive domain that does not interfere significantly with activities (independence is preserved) o Prevalence 12% over 65 and 30% over 85 o Course may be stable, progressive, or remitting Treatment of Neurocognitive Disorders Medications may address some symptoms, but don’t reveres disease process Behavioral interventions o Use memory aids i.e. daily planner, postit notes, and checklists, alarms to keep track of time o Communication limit distraction and speak clearly, simply o Don’t argue reorient briefly if necessary, and distract if client persists o Keep the client check household for hazards, monitor medications, TAKE CAR KEYS o Reminiscing can be enjoyable, especially as long term memory is retained longer
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