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Essentials of Human Diseases and Conditions 4th edition

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Title: Essentials of Human Diseases and Conditions 4th edition


1
Essentials of Human Diseases and Conditions 4th
edition
  • Margaret Schell Frazier
  • Jeanette Wist Drzymkowski

2
Chapter 14 Mental Disorders
3
Learning Objectives
  • Name some contributing factors to mental
    disorders.
  • List some of the many causes of mental
    retardation.
  • Describe the characteristic manifestations of
    autism.
  • List some examples of tic disorders.

4
Learning Objectives (contd.)
  • Describe the progressive degenerative changes in
    an individual with Alzheimer disease.
  • Explain important factors in the treatment of
    Alzheimer disease.
  • Explain the cause of vascular dementia.
  • Relate treatment options for alcohol abuse.

5
Learning Objectives (contd.)
  • Name the classic signs and symptoms of
    schizophrenia. Explain what is included in the
    multidimensional treatment plan.
  • Explain why bipolar disorder is considered a
    major affective disorder. Describe the treatment
    approach.
  • Explain the difference between reactive
    depression and a major depressive disorder.

6
Learning Objectives (contd.)
  • Name the distinguishing characteristics of
    personality disorders.
  • Discuss how each type of anxiety disorder
    prevents a person from leading a normal life.
  • Explain how posttraumatic stress disorder (PTSD)
    differs from other anxiety disorders.

7
Learning Objectives (contd.)
  • Explain how a somatization disorder is diagnosed.
  • Discuss the relationship between anxiety and
    conversion disorder.
  • Describe Munchausen syndrome.
  • Contrast insomnia to narcolepsy.

8
Chapter 14 Lesson 14.1
9
Mental Wellness and Mental Illness
  • Mental wellness The capacity to cope and adjust
    to the ongoing stresses of everyday life.
  • Mental illness Difficulty coping with ongoing,
    everyday stresses, which results in psychological
    pain and possibly affects physical health.

10
Mental Wellness and Mental Illness (contd.)
  • mental disorders could be caused by
  • heredity
  • congenital factors
  • accident
  • trauma
  • drug toxicity
  • stress

11
Mental Wellness and Mental Illness (contd.)
  • mental disorders are loosely classified as
  • maladaptive disorders
  • phobias
  • anxiety
  • depression
  • addiction

12
Mental Wellness and Mental Illness (contd.)
  • Diagnostic and Statistical Manual of Mental
    Disorders, fourth edition, is
  • standard reference used in a clinical setting to
    diagnose mental disorders
  • published by the American Psychiatric Association
  • also referred to as DSM-IV

13
Mental Wellness and Mental Illness (contd.)
  • DSM-IV categorizes mental illnesses by using a
    five-axis system to measure different parts of
    the overall diagnosis.
  • Axis I mood and thought disorders
  • Axis II mental retardation and personality
    disorders
  • Axis III medical conditions that contribute to
    the psychological condition
  • Axis IV stressors that contribute to the overall
    psychological condition
  • Axis V GAF (Global Assessment of Functioning)
    assigns a number from 0 to 100 that indicates
    level of functioning

14
Mental Retardation
  • Mental retardation Subnormal intellectual
    development as a result of
  • congenital causes
  • brain injury
  • disease
  • characterized by any of various cognitive
    deficiencies, including impaired learning,
    social, and vocational ability

15
Mental Retardation Causes
  • predisposing factors
  • heredity (genetic or chromosomal disorders)
  • early alterations of embryonic development (Down
    syndrome, toxin exposure)
  • prenatal, perinatal, or postnatal conditions
    (infections, trauma, poisoning, hypoxia)
  • environmental influences

16
Mental Retardation Symptoms
  • few noticeable symptoms during early childhood
  • as child grows and enters school, deficits become
    more obvious and can include
  • delayed development of communication and motor
    skills
  • difficulty with school work and social
    relationships.
  • lack of control of emotions

17
Mental Retardation Diagnosis
  • intelligence tests routinely used to develop
    intelligence quotient (IQ)
  • example Stanford-Binet test
  • 110-90 average
  • 90-70 below average
  • 70-50 mild retardation
  • 50-35 moderate retardation
  • 35-20 severe retardation
  • below 20 profound retardation

18
Mental Retardation Diagnosis (contd.)
  • criteria for diagnosis of mental retardation
  • subaverage intellectual functioning
  • limitations in at least two of the following
  • communication
  • home living
  • self-care
  • social or interpersonal skills
  • self-direction
  • health and safety

19
Mental Retardation Treatment
  • No cure or drug therapy is available.
  • Underlying causes should be treated.
  • Training should be provided to teach important
    tasks, foster independence, and prevent further
    delay in development.

20
Learning Disorders
  • Learning disorders Conditions that cause
    children to learn in a manner that is not normal.
  • Performance on standardized tests is lower than
    expected for age, schooling, and intelligence
    level.
  • The person with a learning disorder exhibits
    difficulty in acquiring a skill in a specific
    area of learning, such as reading, writing, and
    mathematics.

21
Learning Disorders Diagnosis
  • A diagnosis is made when the child meets all
    DSM-IV diagnostic criteria.
  • Additional tests are then performed to rule out
    inadequate schooling, language barrier, poor
    teaching, etc.
  • Hearing and vision tests also are given.
  • Other mental disorders are ruled out.

22
Learning Disorders Treatment
  • drug therapy for those with hyperactivity,
    usually with stimulants
  • instructional techniques (tutoring, counseling,
    social skills)

23
Communication Disorders Stuttering
  • Stuttering The frequent repetition or
    prolongations of sounds or syllables.
  • Stuttering appears to run in families and is more
    frequently seen in males.
  • Anxiety appears to be a major factor that creates
    and maintains the behavior.

24
Stuttering Treatment
  • Speech therapy can be very beneficial.
  • The condition can resolve spontaneously.

25
Pervasive Development Disorder
  • Pervasive development disorder Indicates a
    severe impairment in several areas of
    development, including communication and social
    interaction skills.

26
Autistic Disorder
  • Autistic disorder A syndrome of extreme
    withdrawal and obsessive behavior.
  • has its onset in infancy and becomes evident in
    the second or third year

27
Autistic Disorder Symptoms
  • marked impairment in nonverbal communication
  • absent or delayed verbal communication
  • inability to initiate conversation
  • does not initiate age-appropriate play
  • repetitive motions
  • inflexibility toward change
  • failure to establish normal peer relationships

28
Autistic Disorder Treatment
  • behavioral therapy
  • self-instructed training
  • antidepressant (Remeron) infrequently used to
    treat agitation and sleeplessness

29
Attention-Deficit Hyperactivity Disorder (ADHD)
  • ADHD A condition of persistent inattention
    leading to hyperactivity and impulsivity.
  • three subtypes of ADHD
  • combined type (inattention and hyperactivity)
  • predominately inattentive
  • predominately hyperactivity-impulsive

30
ADHD Symptoms
  • these symptoms usually present before age 7
  • difficulty sustaining attention and completing
    tasks (attention deficit)
  • the inability to sit quietly without fidgeting or
    squirming (hyperactivity)
  • (impulsivity) impatience and frequent
    interruptions (impulsivity)

31
ADHD Diagnosis
  • criteria for diagnosis based on observation of
    behavior and evaluation
  • inattention longer than 6 months and in at least
    two of the following settings
  • home
  • school
  • work
  • social activities
  • behavior significantly impairs functioning
  • symptoms must be present by age 7

32
ADHD Treatment
  • drug therapy
  • amphetamines (Ritalin, Adderall XR)
  • behavioral therapy

33
Oppositional Defiant Disorder (ODD)
  • ODD A behavior disorder in which children
    demonstrate behaviors that are oppositional
    toward adults.
  • The presence of ODD is a strong predictor of poor
    outcomes such as early substance abuse, school
    dropout, and major depression.

34
ODD Symptoms
  • is argumentative (especially with adults)
  • refuses to comply with rules
  • deliberately annoys others
  • blames others for mistakes
  • is angry/resentful
  • is irritable
  • is vindictive

35
ODD Causes
  • negative child temperament and ADHD
  • negative parent temperament
  • ineffective child management
  • parent and family stress events

36
ODD Treatment
  • mood stabilizers (Risperdal, Zyprexa)
  • parent training
  • individual psychotherapy for child

37
Tic Disorders
  • Tic disorders Sudden, recurrent motor movement
    (facial grimacing, coughing, eye blinking) or
    vocalizations (repetition of ones own words,
    using words out of context or in a socially
    unacceptable manner).

38
Tourette Disorder
  • Tourette disorder Consists of multiple motor
    tics coupled with one or more vocal tics, which
    can appear simultaneously or at different times.
  • also known as Gilles de la Tourette syndrome

39
Tourette Disorder Symptoms
  • vocal tics
  • clicks
  • grunts
  • yelps
  • barks
  • snorts
  • obscenities

40
Tourette Disorder Diagnosis
  • Both motor and vocal tics are present, although
    not necessarily at the same time.
  • Tics occur several times a day over a period of
    at least 3 months.
  • The patient has significant impairment in
    functioning at work or in social situations.
  • The condition is not a result of substance abuse
    or another medical condition.

41
Tourette Disorder Treatment
  • Some patients improve with medication (Haldol,
    clonidine) to manage symptoms and/or produce calm.

42
Chapter 14 Lesson 14.2
43
Dementia
  • Dementia A progressive deterioration of mental
    faculties that causes cognitive decline.
  • Irreversible brain damage may be the result of
    compromised blood flow to the brain caused by
    plaque in the arteries (atherosclerosis), blood
    clot (thombus), or trauma.

44
Alzheimer Disease
  • Alzheimer disease A progressive degenerative
    disease of the brain that causes a gradual loss
    of mental and physical functioning.
  • It is the most common cause of dementia and
    occurs more frequently in adults over 65 years of
    age.

45
Alzheimer Disease Symptoms
  • early stage
  • loss of short-term memory
  • inability to concentrate
  • impairment of reasoning
  • subtle changes in personality
  • as progression continues
  • communication skills decline

46
Alzheimer Disease Symptoms (contd.)
  • late stage
  • becomes increasingly dependent for care
  • response to outside stimulus decreases
  • becomes emotionally detached
  • becomes restless
  • suffers sleep disturbances
  • becomes disorientated
  • becomes hostile/combative

47
Alzheimer Disease Cause
  • The cause is not known, but it is suspected to be
    age-related and have a genetic link.
  • theories include
  • biochemical changes in brain growth
  • autoimmune reaction
  • infection with a slow-acting virus
  • blood vessel defects
  • deficiency of neurochemical factors in the brain

48
Alzheimer Disease Diagnosis
  • Diagnostic criteria include evidence of memory
    and cognitive disturbances.
  • As the disease progresses, neurological
    examination reveals sensory and motor deficits.
  • In later stages, diagnostic studies include brain
    scans, which can detect atrophy.

49
Alzheimer Disease Diagnosis (cont'd.)
50
Alzheimer Disease Treatment
  • No cure is known.
  • Treatment is geared toward management of symptoms
    and includes
  • drug therapy to help control cognitive decline,
    anxiety, depression, and delusions
  • general management of fluid intake, adequate
    nutrition, and personal hygiene
  • protection against injury
  • emotional support for patient and caregiver(s)

51
Vascular Dementia
  • Vascular Dementia A reduction in blood flow to
    the brain from narrowed arteries can result in
    reduced oxygen and nourishment to the brain cells
    and cause a general loss of intellectual
    abilities.

52
Vascular Dementia Symptoms
  • Changes include disturbances in
  • memory
  • judgment
  • abstract thinking
  • personality
  • apathy
  • disorientation
  • depression
  • restlessness
  • psychotic tendencies as condition progresses

53
Vascular Dementia Cause
  • Atherosclerotic plaque grows in the carotid and
    cerebral arteries, reducing blood flow to brain.
  • This starves the brain for needed oxygen.
  • Brain cells die, impairing cognitive function.

54
Vascular Dementia Treatment
  • to increase blood supply to the brain by means
    of
  • drug therapy (low-dose aspirin, Plavix)
  • surgical intervention to remove plaque from
    carotid arteries

55
Dementia Caused by Head Trauma
  • Dementia caused by head trauma A traumatic
    insult to the head may reduce blood flow to the
    brain and result in dementia.
  • Type of head injuries that could reduce blood
    flow include
  • open and closed head injuries
  • hematomas (localized swelling filled with blood
    resulting from a break in a blood vessel)
  • skull fractures

56
Dementia Caused by Head Trauma Diagnosis
  • physical and neurological examination
  • imaging studies
  • skull radiographic films
  • CT scan of brain
  • MRI scan of brain and cerebral vessels

57
Dementia Caused by Head Trauma Treatment
  • correction
  • reduce intracranial pressure
  • repair vessel damage
  • therapy and training to retain the remaining
    functions

58
Substance-Related Disorders Alcohol Abuse
  • Alcohol abuse A disorder causing physical and
    psychological dependence through daily and
    excessive use of alcoholic beverages.
  • Excessive use is often associated with anxiety,
    depression, insomnia, impotence, and behavior
    disorders.

59
Alcohol Abuse Symptoms
  • social (family disruption, violence, accidents,
    etc.)
  • physical
  • frequent infections
  • hypertension
  • gastrointestinal problems
  • seizures
  • alcohol withdrawal problems
  • prolonged use may cause
  • cirrhosis of liver
  • pancreatitis
  • peripheral neuropathy
  • risk of cancer (esophagus, stomach, and parts of
    GI tract)

60
Alcohol Abuse Diagnosis
  • screening tests
  • physical examination (includes medical history)
  • blood test shows high level of an enzyme called
    gamma-glutamyltransferase or GGT

61
Alcohol Abuse Treatment
  • detoxification
  • psychotherapy
  • group therapy and/or 12-step program (AA)
  • Antabuse causes violent nausea and vomiting when
    alcohol is consumed.

62
Other Drugs of Abuse
  • Many types of drugs can modify mood or behavior
    and possibly harm the body when abused.
  • The main classifications of drugs include
  • stimulants (amphetamines, ecstasy, cocaine)
  • opiates (heroin)
  • hallucinogens (LSD)
  • volatile substance (inhalants, vapors)
  • cannabanoid (marijuana, hash)
  • steroidal (steroids)
  • tobacco
  • prescription drugs

63
Other Drugs of Abuse (contd.)
  • general treatment guidelines
  • must meet individuals needs and be tailored to
    drug of abuse
  • individual should have a medical, psychological,
    and social assessment
  • behavior therapy and adequate support crucial for
    recovery and abstinence

64
Schizophrenia
  • Schizophrenia Any of a group of psychotic
    disorders usually characterized by withdrawal
    from reality, illogical patterns of thinking,
    delusions, and hallucinations, and accompanied in
    varying degrees by other emotional, behavioral,
    or intellectual disturbances.

65
Schizophrenia Symptoms
  • classified in two ways
  • positive manifestations an excess or distortion
    of normal functioning
  • negative manifestations a loss of normal
    functioning

66
Schizophrenia Symptoms (contd.)
  • positive
  • delusions
  • hallucinations
  • disorganized speech
  • catatonic behavior (bizarre posturing rigid)
  • negative
  • flat affect (no emotional expression)
  • inability to speak (alogia)
  • inability to make choices

67
Schizophrenia Symptoms (contd.)
  • early stage
  • withdrawal or isolation
  • disheveled appearance
  • loss of interest school or work
  • confusion
  • anxiety/fear
  • active phase
  • marked social and occupational dysfunction

68
Schizophrenia Diagnosis
  • psychological tests (MMPI and some projective
    tests)
  • brain scans (PET, FMR, MEG)

69
Schizophrenia Treatment
  • acute phase
  • antipsychotic drugs
  • long-term multidimensional treatment combines
  • supportive psychotherapy
  • drugs
  • family involvement

70
Mood Disorders Bipolar Disorder
  • Bipolar disorder A major affective disorder with
    abnormally intense mood swings from a
    hyperactive, or manic, state to a depressive
    syndrome.

71
Bipolar Disorder Symptoms
  • during manic episodes
  • rapid speech
  • frequent changes of topic
  • minimal sleep
  • excessive amount of energy
  • impulsive choices
  • delusions or auditory hallucinations possible

72
Bipolar Disorder Symptoms (contd.)
  • during depressive episodes
  • sad or indifferent mood
  • slow thoughts and speech
  • avoid communication
  • loss of interest in life
  • loss of appetite
  • sleep disturbance
  • feelings of guilt
  • threatened or attempted suicide

73
Bipolar Disorder Treatment
  • drug therapy
  • Lithium carbonate is the drug of choice during an
    acute phase.
  • Depakote and Tegretol are add-on drugs that may
    help stabilize manic episodes.
  • antidepressants
  • psychotherapy to encourage personal
    responsibility, set goals, and establish limits

74
Major Depressive Disorder
  • Major depressive disorder A mood disorder
    characterized by one or more serious depressive
    episodes that include deep and persistent
    sadness, despair, and hopelessness.

75
Major Depressive Disorder Symptoms
  • empty or heavy feeling inside
  • vague sense of loss
  • self-blame
  • remorse
  • guilt
  • loss of self-esteem
  • sleep disturbance (insomnia or hypersomnia)
  • loss of concentration and interest in activities
  • social withdrawal

76
Major Depressive Disorder Diagnosis
  • Medical and psychological assessments are needed.
  • It is important to distinguish between reactive
    depression, which results from a difficult or
    stressful life experience, and MDD.
  • Depressive mood must be prominent and persistent
    for a period of at least two weeks with at least
    four of the previously mentioned symptoms.

77
Major Depressive Disorder Treatment
  • antidepressants
  • psychotherapy
  • electroconvulsive therapy
  • family support and education

78
Chapter 14 Lesson 14.3
79
Anxiety Disorders
  • Anxiety disorder Anxiety moves from the realm of
    normal to abnormal when it persists and
    prevents the person from leading a normal life.
  • Four classifications of anxiety disorders
  • generalized anxiety disorder
  • panic disorder
  • phobic disorder
  • obsessive-compulsive disorder

80
Generalized Anxiety Disorder
  • Generalized anxiety disorder a constant state
    of anxiety about most things.
  • not situation-specific

81
Generalized Anxiety Disorder Symptoms
  • avoids making decisions or worries about ones
    that have been made
  • panic attacks
  • physiologic symptoms might include
  • diarrhea
  • elevated blood pressure
  • sustained muscular tension
  • inability to sleep nightmares common

82
Panic Disorder
  • Panic disorder Anxiety begins suddenly and
    unexpectedly, reaching a peak within 10 minutes.
  • The attack is often accompanied by a sense of
    impending doom, going crazy, losing control, or
    dying.

83
Panic Disorder Symptoms
  • heart pounding
  • rapid pulse
  • sweating
  • trembling
  • shortness of breath
  • chest pain
  • nausea
  • dizziness
  • hot flashes

84
Phobic Disorder
  • Phobic disorder Marked by excessive, persistent,
    and irrational fear and the avoidance of phobic
    stimulus.
  • The source of anxiety can be an object or
    situation, but it poses no actual danger.

85
Obsessive-Compulsive Disorder (OCD)
  • Obsessive-compulsive disorder Marked by
    obsessions (persistent intrusions of unwanted
    thoughts) and compulsions (uncontrollable urges
    to carry out certain action).
  • Both features usually occur together, but not
    always.

86
Obsessive-Compulsive Disorder Symptoms
  • common obsessions
  • harming others
  • suicide
  • performing immoral sexual acts
  • common compulsions
  • excessive hand washing
  • repeatedly checking door locks

87
Obsessive-Compulsive Disorder Treatment
  • psychotherapy
  • hypnosis
  • biofeedback
  • relaxation therapies
  • exercise
  • antidepressants (SSRIs)
  • hospitalization in severe cases

88
Posttraumatic Stress Disorder (PTSD)
  • PTSD A delayed response to an external traumatic
    event that produces symptoms of extreme stress.
  • PTSD differs from other anxiety disorders because
    the cause of the stress is an external event of
    an overwhelmingly painful nature.

89
PTSD Symptoms
  • painful recollections
  • nightmares
  • insomnia
  • irritability

90
PTSD Cause
  • PTSD caused by human actions (rape, acts of war,
    abuse) tends to precipitate more severe reactions
    than PTSD caused by natural disasters
    (hurricanes, floods, earthquakes).

91
PTSD Diagnosis
  • distressing recollections of the event
  • recurrent dreams and flashbacks
  • avoidance of stimuli associated with the
    traumatic experience
  • hyperarousal (rapid heartbeat, panic) when
    thinking about or exposed to stimuli related to
    event

92
PTSD Treatment
  • centers on restoring individuals sense of
    control
  • counseling (helps victims accept the overwhelming
    memories instead of avoid them)
  • drug therapy (antianxiety, antidepressants, or
    medications to aid sleep)

93
Somatoform Disorders
  • Somatoform disorders A group of mental disorders
    in which the person experiences physical symptoms
    without the underlying organic cause.
  • Symptoms are real to the affected person and not
    feigned.
  • No confirmed, diagnosable, medical condition
    accounts for the symptoms of somatoform disorders.

94
Somatization Disorder
  • Somatization disorder, also known as Briquet
    syndrome, consists of a number of recurring
    somatic symptoms that have no underlying clinical
    basis.
  • The symptoms appear before the age of 30 and
    continue for several years.

95
Somatization Disorder Symptoms and Diagnosis
  • presence of four pain symptoms anywhere in the
    body
  • two GI symptoms (nausea, vomiting, blood in
    stool) without presence of pain
  • one sexual or reproductive symptom
  • one neurologic symptom
  • clinical basis for symptoms

96
Somatization Disorder Treatment
  • psychotherapy that includes behavior modification
  • prognosis for cure very poor.

97
Conversion Disorder
  • Conversion disorder When anxiety is too
    difficult to face, it may be unconsciously
    converted to a physical or somatic symptom to
    allow the person to escape or avoid the
    situation.
  • Usually precipitated by a highly stressful
    situation.

98
Conversion Disorder Symptoms
  • deficits in voluntary motor functions (paralysis,
    tremor, tics)
  • sensory symptoms (oversensitivity to pain, touch,
    or sound)
  • speech disturbances (loss of voice)
  • physical symptoms (headaches, difficulty
    swallowing or breathing, choking, etc.)

99
Conversion Disorder Treatment
  • psychotherapy
  • hypnosis
  • The course of the disorder is usually short, and
    recurrence is common.

100
Pain Disorder
  • Pain disorder Manifested by pain that causes
    significant distress and physical and social
    impairment to such a degree that it takes control
    of the persons life.

101
Pain Disorder Symptoms
  • severe and lasting pain (can be associated with
    musculoskeletal disorders, neuropathies, and
    malignancies)
  • condition not intentionally produced

102
Pain Disorder Treatment
  • underlying clinical conditions identified and
    addressed
  • psychotherapy
  • relaxation techniques
  • narcotics (if pain relief cannot be achieved any
    other way)

103
Hypochondriasis
  • Hypochondriasis fear of having a serious
    disease, even though medical causes cannot be
    found to substantiate the fear.

104
Hypochondriasis Symptoms
  • preoccupation with illness
  • abnormal fear of disease
  • symptoms often described in vague terms
  • typically last more than 6 months

105
Hypochondriasis Treatment
  • psychotherapy
  • helps person live with symptoms or reframe them
    in such a way that extreme conclusions are not
    drawn

106
Munchausen Syndrome
  • Munchausen syndrome Considered a factitious
    disorder occurs when people simulate symptoms of
    illness, knowing they are not ill and they seek
    medical attention as a way to draw attention to
    themselves.
  • Malingering, or the feigning of symptoms for
    financial or personal gain, is also a factitious
    disorder.

107
Munchausen Syndrome by Proxy
  • Munchausen syndrome by proxy A parent projects
    symptoms to the child (usually a preschooler),
    which stimulates the illness in the child and
    causes the child to present for treatment.
  • The parent denies any knowledge of the actual
    cause and relates the symptoms to be GI,
    genitourinary, or something else.

108
Gender Identity Disorders
  • Gender identity disorders Conditions in which
    individuals feel a powerful connection with the
    opposite sex and want to be the opposite sex.
  • Individuals believe their current gender roles
    are inappropriate.

109
Gender Identity Disorders Symptoms
  • boys
  • preoccupation with feminine activities (dressing
    in female clothes, playing with dolls)
  • avoidance of competitive sports
  • some remark they dont want male genitalia, but
    rather female genitalia

110
Gender Identity Disorders Symptoms (contd.)
  • girls
  • display a dislike for feminine attire and prefer
    boy-type clothing and short hair
  • prefer boys as playmates
  • engage in typically, male sports and games
  • many remark they will eventually grow male
    genitalia and do not want breasts

111
Gender Identity Disorders Treatment
  • psychotherapy (to help individuals either feel
    more comfortable in their assigned sex or accept
    the feelings they have)
  • hormonal or surgical intervention

112
Sleep Disorders Insomnia
  • Insomnia A disorder associated with having
    difficulty falling or staying asleep.
  • As a result of poor or interrupted sleep, the
    individual wakes feeling physically tired,
    groggy, tense, irritable, and anxious.

113
Insomnia (contd.)
  • possible causes
  • medical problem/pain
  • time zone change or jet lag
  • high altitudes
  • stimulants (coffee, amphetamines, steroids,
    alcohol, nicotine)
  • psychological causes (anxiety, stress, fear of
    sleeplessness)

114
Insomnia Diagnosis
  • To be diagnosed with insomnia, the sleeplessness
    must
  • have a duration of longer than 1 month
  • interfere with normal functioning in social,
    occupational, or other areas
  • Polysomnography, or the recording of physiologic
    variables during sleep, might be used.

115
Insomnia Treatment
  • Identify and remove source of sleeplessness.
  • Change lifestyle to relieve tension and reduce
    stress.
  • Keep regular sleep schedule.
  • Eliminate noise and disruptions.
  • Use bedroom for sleeping only and not work.
  • Avoid caffeine, nicotine, and stimulants late
    afternoon and evening.
  • Avoid strenuous exercise several hours before
    bedtime.
  • Use medications as last resort for short periods
    to aid sleep.

116
Parasomnias
  • Parasomnias A group of sleep disorders that
    include sleepwalking, night terrors, and
    nightmares.
  • Parasomnias usually occur in children early in
    the night.

117
Parasomnias Causes
  • possible genetic link
  • developmental, psychological, and organic factors
  • brain tumors or fevers
  • lithium and certain other drugs

118
Parasomnias Treatment
  • Protection from injury is primary for the
    sleepwalking person.
  • Minimizing exposure to terror (especially from
    movies, television, etc.) reduces occurrence of
    night terrors.
  • Adults can be treated with sleep medications.

119
Narcolepsy
  • Narcolepsy A chronic neurological condition in
    which a person has an irresistible tendency to
    sleep during the daytime for a few seconds to
    half an hour.
  • This is usually precipitated by sedentary,
    monotonous activity.

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Narcolepsy Treatment
  • therapeutic naps
  • establishing a normal night sleep pattern
  • drug therapy (daytime stimulant to remain awake)

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Sleep Apnea
  • Sleep apnea Intermittent short periods when
    breathing ceases during sleep and can be
    potentially life-threatening.
  • categorized as either
  • obstructive, when air is unable to flow in or out
    of the upper airway
  • central, when the brain does not send appropriate
    messages to initiate the breathing process

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Sleep Apnea Causes
  • obesity and hypertension
  • nasal obstruction
  • alcohol ingestion
  • smoking-related bronchitis
  • sleep deprivation

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Sleep Apnea Diagnosis
  • Diagnosis begins with a sleep history.
  • Onset is usually during middle age.
  • Daytime sleepiness, sleep attacks, snoring, and
    snorting episodes suggest sleep apnea.
  • Sleep lab studies help confirm breathing patterns
    during sleep.

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Sleep Apnea Treatment
  • weight loss
  • underlying pathological conditions corrected
    (nasal obstruction, etc.)
  • special appliances to continuously feed air or
    keep airway open
  • avoidance of drugs that suppress CNS (sedative,
    alcohol, nicotine)
  • surgery to remove portion of the uvula soft palate

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Personality Disorders
  • Personality disorder A pattern of behavior that
    deviates from societys norms and is typically
    rooted in a persons thoughts about him-or
    herself.
  • often produce chronic, ingrained, and maladaptive
    behavior

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Personality Disorders Symptoms
  • disordered patterns of relating, thinking, and
    perceiving
  • impaired social and occupational performance
  • might appear arrogant, shy, or blaming

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Personality Disorders
  • Ten personality disorders categorized into three
    clusters

Cluster C avoidant dependent obsessive-compulsive
Cluster A paranoid schizoid schizotypal Cluster
B antisocial borderline histrionic narcissistic
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Personality Disorders (contd.)
  • Cluster A
  • paranoid personality disorder
  • no trust in others suspicious others intend to
    hurt or exploit
  • schizoid personality disorder
  • lacking emotional expression of pleasure or pain
    seem indifferent and socially detached
  • schizotypal personality disorder
  • similar to schizoid socially, but can have
    paranoid tendencies superstitious, believing
    others have magical control

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Personality Disorders (contd.)
  • Cluster B
  • antisocial personality disorder
  • disregard others violates others rights,
    aggressive, no remorse
  • borderline personality disorder
  • unstable relationships and self-image, fears
    rejection prone to be manipulative and to verbal
    outburts
  • histrionic personality disorder
  • overly dramatic needs to be center of attention
    appears immature and dependent and seek approval
    from others
  • narcissistic personality disorder
  • displays an absorption with self and lacks
    empathy for others

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Personality Disorders (contd.)
  • Cluster C
  • avoidant personality disorder
  • avoids social situations for fear of criticism or
    disapproval,views self as inept or inferior
  • dependent personality disorder
  • pattern of excessive reliance on others, feels
    reluctant to disagree for fear of losing support
  • obsessive personality disorder
  • extreme concern with orderliness and control

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Personality Disorders Treatment
  • depends on symptoms of particular disorder, but
    usually includes
  • psychotherapy
  • drug therapy (anxiety, depression)
  • family therapy
  • prognosis very poor overall due to degree that
    traits are ingrained into individuals way of
    living
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