Question 1

A major factor that creates and maintains stuttering is

Accepted Answer

Although the etiology is uncertain, genetic factors may be involved. Stuttering appears to have a familial tendency, with the condition occurring more often in males. Parents may also unwittingly cause anxiety in their child by overreacting to mild speech limitation. Anxiety appears to be a major factor that creates and maintains stuttering.

Question 2

The phases of the grief process are

Accepted Answer

The normal grieving process passes through several phases. The most recognized stages are those identified by Elisabeth Kübler-Ross. The first is denial: "No, I don't believe it." Second is anger: "Why did he or she do this to me?" or "Why is God letting this happen?" The third stage is bargaining: "If only this task can be accomplished or I can achieve this goal (live long enough), I will do this." Fourth is depression, in which people retreat within themselves and have little or no involvement with their environment. Finally, in the fifth stage, acceptance comes. Not everyone is able to move through these steps, and not everyone moves through them at the same pace or in the same order. Some people cannot express anger at the dead person or at God and do not move on. Many of these people never complete the grieving process, so they remain in a depressed state and have reduced coping mechanisms. Medical intervention may help during depression, but most people recover with minimal treatment.

Question 3

Excessive use of alcohol is frequently associated with

Accepted Answer

Alcohol acts on the central nervous system as a depressant. Individuals under the influence of alcohol may experience a decrease in activity, tension, and normal inhibitions. Ingestion of a few drinks of alcohol may change behavior, decrease ability to think clearly, slow motor skills, and impair judgment and concentration. Excessive use of alcohol often is associated with anxiety, depression, insomnia, impotence, and behavioral disorders both before and during intoxication. Amnesia often occurs after intoxication. Repeated heavy drinking of alcohol produces symptoms and signs in nearly every organ system (see Figure 14-11). Chronic alcoholism causes pathologic changes in the nervous system. Common physical findings include frequent infections, hypertension, and gastrointestinal (GI) problems. Some individuals experience confusion, abdominal pain, and nausea and vomiting. The patient may report unexplained seizure activity or symptoms of alcohol withdrawal. Prolonged heavy use of alcohol may cause cirrhosis of the liver, pancreatitis, and peripheral neuropathy, resulting in muscle weakness and paresthesia. The risk of cancer of the esophagus, stomach, and other parts of the GI system is also increased. The consequences of chronic alcohol abuse include dysfunction within family and social relationships and disruption in occupational responsibilities. Some people are prone to aggressive or violent behavior, accidents, and threatened or attempted suicide. The patient often denies an inability to control or discontinue alcohol abuse.

Question 4

Anxiety disorders are treated with

Accepted Answer

If the anxiety prevents the person from living a normal life, a psychiatrist or a practitioner trained in treating psychological problems (for example, psychologist or psychoanalyst) should be consulted. These therapists use many forms of treatment, depending on their perspectives. Hypnosis is sometimes used to help the patient and the therapist to gain access to the subconscious mind. If the anxiety is caused by a specific stress (for example, job related), steps should be taken to minimize or eliminate the problem. Various methods of relaxation such as systematic desensitization, progressive relaxation, breathing exercises, and guided imagery can lessen the symptoms. Relaxation exercises (for example, biofeedback) to relax tense muscles or a physical activity, such as brisk walking, jogging, or swimming, may be beneficial. In addition, or as an alternative, the physician may prescribe an anxiolytic drug. Serotonin-specific reuptake inhibitor (SSRIs) (fluvoxamine [Luvox] is U.S. Food and Drug Administration approved for treatment of OCD) are first-line therapy, but many patients with major depression also may have been prescribed a tricyclic amitriptyline/nortriptyline along with the SSRI and recommended psychotherapy. Benzodiazepines are also frequently prescribed. Examples are lorazepam [Ativan], clonazepam [Klonopin], and alprazolam [Xanax]. These medications should be prescribed on an "as needed," short-term basis for severe anxiety because dependence can occur. In severe cases of anxiety, a period of hospitalization may also be necessary. If severe anxiety is not treated, psychotic depression may develop.

Question 5

_____ involves a progressive, general deterioration of the mental capacities of perceiving, thinking, and remembering.

Accepted Answer

Dementia brings a progressive, general deterioration of mental faculties, including deterioration of perceiving, thinking, and remembering. Cognitive functioning declines abnormally. Dementia, not a part of normal aging, represents a pathologic development. The irreversible brain damage may be the result of compromised blood flow to the brain resulting from atherosclerosis, thrombi, or trauma. In addition, toxins, metabolic conditions, organic disorders, infections, tumors, or Alzheimer's disease (AD) may be responsible for the deterioration (see Figure 13-19). The onset may be slow and insidious or may be sudden, depending on the cause.

Question 6

A tic disorder that includes multiple motor tics coupled with vocal tics is

Accepted Answer

Tourette's disorder, also known as Gilles de la Tourette syndrome, is a syndrome of multiple motor tics coupled with one or more vocal tics, which may appear simultaneously or at different times.

Question 7

The somatoform disorder previously called hysteria is

Accepted Answer

Conversion disorders formerly were termed hysteria. Anxiety is changed (converted) to a physical or somatic symptom. The anxiety is too difficult to face, and as a defense mechanism, the physical symptoms allow the person to escape or avoid a stressful situation.

Question 8

Criteria for the diagnosis of mental retardation include limitation in at least which two of the following?

Accepted Answer

Criteria for the diagnosis of mental retardation include subaverage general intellectual functioning accompanied by significant limitations in adaptive functioning. The diagnosis requires limitations in at least two of the following areas: communication, home living, self-care, social or interpersonal skills, self-direction, and health and safety. Onset must be before 18 years of age.

Question 9

Prolonged, heavy use of alcohol may result in

Accepted Answer

Alcohol acts on the central nervous system as a depressant. Individuals under the influence of alcohol may experience a decrease in activity, tension, and normal inhibitions. Ingestion of a few drinks of alcohol may change behavior, decrease ability to think clearly, slow motor skills, and impair judgment and concentration. Excessive use of alcohol is often associated with anxiety, depression, insomnia, impotence, and behavioral disorders both before and during intoxication. Amnesia often occurs after intoxication. Repeated heavy drinking of alcohol produces symptoms and signs in nearly every organ system (see Figure 14-11). Chronic alcoholism causes pathologic changes in the nervous system. Common physical findings include frequent infections, hypertension, and GI problems. Some individuals experience confusion, abdominal pain, and nausea and vomiting. The patient may report unexplained seizure activity or symptoms of alcohol withdrawal. Prolonged heavy use of alcohol may cause cirrhosis of the liver, pancreatitis, and peripheral neuropathy, resulting in muscle weakness and paresthesia. The risk of cancer of the esophagus, stomach, and other parts of the GI system is also increased. The consequences of chronic alcohol abuse include dysfunction within family and social relationships and disruption in occupational responsibilities. Some people are prone to aggressive or violent behavior, accidents, and threatened or attempted suicide. The patient often denies an inability to control or discontinue alcohol abuse.

Question 10

A child who experiences extreme withdrawal and obsessive behavior along with lack of social interaction suffers from

Accepted Answer

The autistic child will exhibit a notable impairment in socialization, communication, activities, and other interests. The impairment is noted in nonverbal behaviors, such as eye-to-eye gaze, facial expressions, and other forms of nonverbal communication. In addition, the child fails to establish normal peer relationships and to seek shared enjoyment. Communication impairments include delayed or absent verbal communication, inability to initiate a conversation, and repetitive use of inappropriate language. The child does not initiate age-appropriate play activities. Repetitive motions, often self-destructive, may be noted along with inflexibility toward change and a compulsion for sameness. These youngsters display a persistent preoccupation with objects and may have a memory for certain lists or facts. Four symptoms that are nearly always present are social isolation, cognitive (based on knowledge) impairment, language deficits (shortages or missing), and repetitive naturalistic motions. Aversion to physical contact or cuddling can also be a sign. The autistic child resists any change or transition or has difficulty transitioning.

Question 11

Anxiety disorders include

Accepted Answer

Anxiety disorders, previously known as neuroses, include four specific disorders or syndromes that are different in behavioral manifestations but share the fact that the person's behavior is dominated by anxiety. The four disorders are generalized anxiety disorder, panic disorder, phobic disorder, and OCD.

Question 12

Identifiable causes of mental retardation include

Accepted Answer

Mental retardation has a variety of causes, many of which are unidentifiable. The predisposing factors include heredity (inborn errors of metabolism, genetic disorders, or chromosomal abnormalities); early alterations of embryonic development (Down syndrome or damage from toxins); prenatal, perinatal, or postnatal conditions (prematurity, hypoxia, viral infections, or trauma); general medical conditions (infections, trauma, or poisoning); and environmental influences. Any condition that compromises the blood supply to the developing brain, depriving it of oxygen and nutrients, can result in neurologic damage and mental retardation. Some examples are placental insufficiency, cord or head compression during the perinatal period, failure to breathe at birth, premature birth, and viral infections in the mother in the prenatal period or in the infant or child after birth. Trauma of any type that causes hypoxia or anoxia may also contribute to the deficit. Fetal alcohol syndrome may also result in mental retardation.

Question 13

Personality disorders (PDOs) include

Accepted Answer

A PDO is a pattern of behavior that deviates from society's norms. In addition, a person with a PDO typically has thoughts about the self and the world that cause inappropriate behavior. Signs of a PDO become evident in adolescence. There are 10 named PDOs, categorized into three clusters: cluster A, patients who appear odd or eccentric; cluster B, patients who appear dramatic, emotional, or erratic; and cluster C, patients who appear anxious and fearful. A PDO influences the mental affect of a person and produces chronic, ingrained, maladaptive behavior. Disordered patterns of relating, thinking, and perceiving impair social and occupational performance. PDOs typically begin to appear in adolescence, but should not be diagnosed until adulthood. A history of long-standing problems in interpersonal relationships and occupational difficulties is likely. Personality traits may give the person with a PDO a reputation of arrogance or painful shyness and of rejecting responsibility for his or her behavior. The person tends to project negative feelings and blame others. Many types of PDOs are recognized, each with unique distinguishing characteristics. Examples of PDOs include paranoid, schizoid, antisocial, histrionic, and narcissistic disorders.
Antisocial Disorder
Behavior patterns of the antisocial personality can cause frequent conflicts with societal values. Troublesome conduct usually emerges by 15 years of age, including truancy, fighting, stealing, a history of running away, or cruel behavior. Antisocial persons often do not express guilt or learn from their mistakes. Other traits include a propensity for irresponsible and impulsive actions.
Cluster A
Cluster A PDOs should be assessed and distinguished from delusional disorders and psychotic disorders.
Paranoid Personality Disorder (PPD)
Those with PPD often do not trust others and are suspicious of others. They often assume others will exploit, harm, or deceive them. Individuals with PPD often misinterpret the meaning behind others' behaviors by thinking others are deliberately trying to exploit them.
Schizoid Personality Disorder (SPD)
Individuals with SPD often appear to lack, or show emotions of, pleasure or pain. They tend to be loners and do not enjoy relationships with others. They often appear to be indifferent, flattened, or detached.
Schizotypal Personality Disorder
Persons with schizotypal personality disorder are similar to those with SPD in that they often have difficulty with social relationships. Individuals with schizotypal personality disorder, however, typically have ideas of reference; they may be superstitious or preoccupied with paranoid phenomena. In addition, they may believe they have magical control over others. More often, they seek treatment for associated symptoms of anxiety or depression.
Cluster B
Antisocial Personality Disorder (APD)
Individuals with APD often have a disregard for, and tend to violate, the rights of others. They often fail to conform to societal norms and engage in behavior that could be grounds for arrest. These individuals are often aggressive, manipulative, and reckless. They generally do not show remorse or make amends for their behavior.
Borderline Personality Disorder (BPD)
A person with BPD often has a pattern of unstable interpersonal relationships, self-image, and affects (feelings). Impending separation or rejection are often central concerns for individuals with BPD. When those with BPD believe they are being rejected or abandoned, they often react with extreme emotions, such as anger, panic, or despair. They may display extreme sarcasm and verbal outbursts. They are often impulsive and manipulative with their behavior.
Histrionic Disorder
Histrionic individuals often display overly dramatic and theatrical mannerisms. They may have a conscious or unconscious pervasive need to be the center of attention. People with this disorder are often immature and dependent, constantly seeking approval and reassurance. Behavior or appearance may be inappropriately seductive.
Narcissistic Disorder
The narcissistic personality often demonstrates pathologic self-love or grandiose self-admiration. When criticized, the person often reacts with rage or humiliation, based on an exaggerated sense of self-importance. These individuals typically lack empathy and tend to exploit others. They often exhibit a preoccupation with fantasies of unlimited success.
Cluster C
Avoidant Personality Disorder
The avoidant personality typically avoids social situations because of fear of criticism, disapproval, or rejection. Individuals with avoidant personality disorder often view themselves as socially inept, personally unappealing, and inferior to others. They are often preoccupied with being judged or criticized by their peers.
Dependent Personality Disorder (DPD)
Individuals with DPD typically have patterns of excessively relying on others to make decisions for them. They are usually passive and have trouble disagreeing with others because they fear losing support or approval.
Obsessive Compulsive Personality Disorder
Individuals with obsessive compulsive personality disorder usually have extreme patterns of preoccupation with orderliness, perfection, and mental and interpersonal control. They are often preoccupied with details or lists to the point that they never finish tasks.

Question 14

A progressive degenerative disease of the brain most common in individuals over the age of 60 with symptoms that include loss of short-term memory, inability to concentrate, and changes in social skills and personality is called

Accepted Answer

AD is a progressive degenerative disease of the brain that produces a typical profile of lost mental and physical functioning. It is the most common cause of deterioration in intellectual capacity, or dementia. It is most common in people older than 65, and its incidence increases in people older than 80. The onset of AD is gradual and insidious, with early signs including loss of short-term memory, inability to concentrate, and incapacity to learn new information, impairment of reasoning, and subtle changes in personality. Progression of symptoms corresponds with stages ranging from very mild decline (patients note memory lapses) to severe decline (patients frequently lose their capacity for recognizable speech, lose ability to walk without assistance or sit without support). Staging provides useful frames of reference for making future plans of care. As its course continues, communication skills decline, and the patient struggles to find the right words, uses meaningless words, or interjects nonsensical phrases. Over a span of 5-10 years, there is profound deterioration of intellectual and physical ability. The patient becomes increasingly dependent on a caretaker. The response to stimulation by the outside world diminishes, and the patient seems emotionally detached. The patient may exhibit restlessness, sleep disturbances, disorientation, hostility, or combativeness. The patient is eventually bedridden and ultimately dies of undercurrent infection or other complications.

Question 15

The psychosis that is characterized by distortions of perception, emotions, and thoughts and that often includes bizarre behavior is

Accepted Answer

Schizophrenia is a mental disorder characterized by the presence of either positive manifestations (an excess or distortion of normal functions) or negative manifestations (a loss of normal functions). Positive symptoms include delusions (fixed, False beliefs), hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. Negative symptoms are affective flattening, alogia, and avolition.
Schizophrenia is very disabling for the affected individual. In most cases, a person with schizophrenia will have difficulty finishing their education, maintaining employment, and participating in relationships. Many experience trouble with activities of daily living. Schizophrenia is rarely seen in children. Most symptoms begin to manifest in the mid to late 20s. Careful consideration must go into the diagnosis of schizophrenia because some cultures and religions may regard some symptoms as normal. The onset of schizophrenia is usually insidious during adolescence or young adulthood.
Prodromal signs, such as withdrawal, odd behavior, disheveled appearance, and loss of interest in school or work may be noted. The patient may report feeling confused, isolated, anxious, and afraid. In the active phase of schizophrenia, a vast range of severe behavioral and perceptual manifestations is present, with notable social and occupational dysfunction.
One important feature is disorganized thinking, usually reflected by the patient's speech and by disturbances in language and communication. For example, the patient may switch from one topic to another, speak incoherently, give an unrelated answer to a question, or experience difficulty in speaking at all.
Distortions in perception called hallucinations are a common characteristic of schizophrenia. Hallucinations may be auditory, visual, olfactory, or sensory. The patient with auditory hallucinations acknowledges hearing voices that may be threatening, instructive, or conversational. Delusions, which are erroneous beliefs, represent exaggerations or distortions of perceptions or experiences. In persecutory delusion, for instance, people may believe that they are being mistreated, deceived, or stalked. More bizarre delusions may include belief that one's thoughts are controlled by an "alien."
Inappropriate affect (feeling) is another identifying characteristic of schizophrenia. Lack of emotional expression (flat affect) or unreasonable outbursts of emotions may be noted. Eye contact is minimal.
Behavior may be bizarre or grossly disorganized, unpredictable, agitated, or violent. The patient may assume rigid posturing (catatonic posturing), dress in an odd manner, and neglect self-care. Any of these behaviors can stem from the patient's delusional thinking. As the symptoms and signs persist, the patient's ability to function in interpersonal, social, or occupational relationships deteriorates.

Question 16

Treatment of Tourette's disorder may include which of the following medications?

Accepted Answer

Pharmacologic treatment is the only proven effective treatment for tics. Some patients with Tourette's disorder have improved with the administration of haloperidol lactate [Haldol]. Other treatment options include clonidine or clonazepam for their calming effects. Additionally, fluoxetine [Prozac] may be helpful in treating repetitive and obsessive behaviors found with Tourette's disorder.

Question 17

The individual experiencing sleep disturbances, fatigue, loss of concentration, appetite changes, despair, and hopelessness suffers from _____ disorder.

Accepted Answer

Major depressive disorder is a serious alteration in mood that may be described as deep and persistent sadness, despair, and hopelessness (see Figure 14-15). Symptoms develop gradually over several days, during which an anxious or brooding appearance may be noted. The person may experience an empty or heavy feeling inside, accompanied by a vague sense of loss. The person may also have an attitude of self-blame, remorse, guilt, or loss of self-esteem. Other symptoms include sleep disturbance (insomnia or hypersomnia), physical sluggishness or fatigue, loss of concentration, and inability to experience pleasure. In addition, a depressed person may have a variety of physical symptoms. Appetite disturbance produces a change in weight. The patient withdraws socially and may admit to having suicidal thoughts; suicidal behavior is common in major depression (see Table 14-4).

Question 18

The anxiety disorder that results from an external event of an overwhelming painful nature is called

Accepted Answer

PTSD is a delayed response to an external traumatic event that produces signs and symptoms of extreme distress. PTSD caused by human actions (for example, rape, acts of war, and continued abuse) tends to precipitate more severe reactions than PTSD caused by natural disasters (for example, hurricanes, earthquakes, and floods). In the case of natural disasters, the greater the threat of death and the greater the number of people affected, the greater the likelihood of severe PTSD. The overwhelming experience of a threat to the individual's life is a causative factor.

Question 19

Treatment of vascular dementia may include

Accepted Answer

Treatment aims to increase the blood supply to the brain. Low-dose aspirin, clopidogrel [Plavix], prasugrel [Effient], and cilostazol [Pletal] are all used for their antiplatelet effect in preventing stroke or its recurrence, especially with patients who are hypertensive or have had a myocardial infarction. Drug therapy may help increase the blood flow. When the carotid arteries are compromised, surgical intervention in the form of carotid endarterectomy may limit the progress of the condition. Brain cell death is irreversible. As the condition progresses, the patient may need to be institutionalized to ensure his or her safety and care.

Question 20

A major affective disorder with abnormally intense mood swings from manic state to depressive syndrome is

Accepted Answer

Bipolar disorder is a major affective disorder with abnormally intense mood swings from a hyperactive, or manic, state to a depressive syndrome (see Figure 14-14). In some cases, symptoms of hyperactivity and depression may coexist. This is known as a mixed episode. The patient may remain manic for days, weeks, or months before experiencing depression. Assessment findings vary with the type of episode (manic, depressive, or mixed) that the patient is experiencing at the time of medical evaluation.

Quiz 14: Mental Disorders