CH4 Cardiopulmonary Physiology

8/19/2019 CH4 Cardiopulmonary Physiology

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syndrome- when certain symptoms occur together regularly

Classi*cation +ystem- list of disorders, symptoms, and guidelines for

making diagnoses

$+ Purpose, what it is used for, what it contains and more importantly what it does not contain

entries contain criteria for diagnosis and key features of each disorder

o Has features that are !/(01 23( 1!( &" present with the

disordero Contains info on general trends such as age, culture, general

trends, research *ndingso Contains each disorder's prevalence, risk, course, complications,

predisposition factors, and familial trends

Clinicial ." $%A/#)+%+ must provide categorical info +what type of

disorder- and dimensional info +rating of how severe you are across various

dimensions-o

Categorical- deciding if you are displaying one of the disorders listedin the 6578

aniety, depression, and all the varieties

o $imensional) using scales to assess how severe the case is

o +pecial info - clinical may include other info included i.e. additional

info

$+& "0ectivenesso reliability) di9erent clinicians can agree on the diagnosis

o validity) accuracy of the info the 6578 has

best is predictive validity) when future symptomsevents can be

accurately predicted

5! & 6:&$1!5:5 /!% ; 6:5!%60% :7":05 (! (H0C":1:C:&" (H0 &(:01( :"" 6080"! # &16 <

Changes

o added new categories +&utism 5 6-, combined some disorders,

separated others, changing terms and disorders

isdiagnosis

=udgements may be mistaken because they pay attention to some factors

more, or the patient'so assesment tools may also not be the best

5elf)fullling prophecies occur

reatment

clinicials use idiographic data- info about the patient and nomothetic

data) general data about the disease

empirically supported treatment - therapy based on

evidence1research supported


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rapprochement movement- nding out what specic things from various

therapies work besto because multiple therapy types do work well. so why

psychopharmacologist- psychiatrist who prescribes meds

o as opposed to a psychologist1social worker1therapist of

psychotherapyo patients usually see both

C.

/eneralized Anxiety $isorders

2ear- C15 immediate physiological and emotional response to a serious

real threat

Anxiety- C15 physiological and emotional response to a vague sense of

threat or dangero cannot pinpoint the specic cause, =ust a general feeling.....anticipation

of dread

/eneralized Anxiety $isorder - these ppl experience excessive anxiety and

fear under most circumstances and worry about anything

$x

o > months or more you eperience a lot of aniety

o impairment or distress

o edginess, fatigue, poor concentration, muscle tension, irritability

sociocultural factors may put u at risk for developing more of these

disorders

psychodynamic - kids face aniety at all stages...some types are

o realistic anxiety - when actual danger is present,

o neurotic anxiety when they're prevented from epressing ID impulses

ando MORAL anxiety when they're punished for epressing these :6

impulseso EGO defense mechanisms are used to control anxiety

yet if you are overprotected to the extent that you barely face

anxieties as a childthen your ego defense mechanisms will be

wea to cope with !ORMAL levels of anxiety o eople with $&6 are more likely to use 0$! defense mechanisms???????

psychodynamic therapies - free association, transferance, resistance,

dreams,


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o others are ob=ect relations therapists) focus on the crippling relations

humanist approach- "#$%$ &$O&L$ D$!' "#$M%$L($%)*A!+" A**$&"

"#$M%$L($% OR ,$ #O!$%" o uses client centered therapy- to show positivity to the clients

cognitive approach- people with AD will mae basic irrational

assumptions - and these assumptions mae them overreact and feel fear tocertain events....continuous use leads to AD

o new wave theories

Metacognitiv e- people now worrying is OOD A!D ,AD.

OOD ,)* it eeps you on edge and alert -/ so we always

wanna worry. #O0$($R 0$ 1!O0 "OO M2*# worrying is bad

so you worry that you always worry metaworrying intolerance of uncertainty - they worry about the possibility of

a negative event occuring b)c the future is uncertain...even tho

it+s super small

avoidance theory- some people are prone to being in

unpleasant body arousal states)situations and by worrying theyremove themselves from the real unpleassant arousal)situation

at hand to focus on worries...they feel betterish..

Cognitive therapies-o rational emotive therapy- identify irrational assumptions and

thinking to change themo 3reaking down worrying- therapists break down the worrying and

what role it plays in $&6, then the clients observe their bodily arousal

across various situations clients become better at identifying worrying and their

misguided attempts to control their lives by worrying clients end up seeing the world as less threatening and adopt

better ways to cope with worrying and worry less mindfulness based cognitive therapy- here patients =ust

become aware of their streams of thought, and they have to

accept these thoughts as just processes of the

mind4444due to this acceptance they should be less

anxious1worried

3iological !erspective)

o incorporate family pedigree studies to determine if /A$ can be

inherited1more likely

o benzodiazapene medicines- reduce aniety by binding to receptors "hese receptors originally received GABA- carries inhibitory

messages !ORMAL 3$AR- some neurons 4re rapidly5 creating a state of

fear)anxiety...,2" A,A is released via a feedbac system that

tells these neurons to slow down...thus reducing fear and

anxiety


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#ence AD ppl could have issues with - too few receptors or

inefective receptors E! currently - we now that other !" wor alone or in

con6unction with A,A A"#O$ *ausality issue7 Does A,A issues cause anxiety or

anxiety cause A,A issues88883iological reatments

o antianxiety therapy-

benzodiazaprenes- were initially sold as sedative-hypnotic

drugs) to calm ppl %ssues5

@A after the drugs stop the $&6 comes back stronger than

ever

B. (aking strong doses for too long creates a dependency

. 8arious side e9ects ensue

4. 7i poorly with other substances i.e. alcohol

o 6elaxation training - relies in inducing a physically relaed state toalso bring about a psychologically relaed state

#ou're taught the muscle groups and how to tenserela them to

ultimately control and rela yourself o 3iofeedback-

3sing an electromycrograph "/ ) patients are able to gure

out when they tensen up or heartrate speeds up...ultimately

they learn to voluntarily control these processes which can help

them reduce anxiety in stressful situations

!hobia

!hobia

a persistent irrational fear of something

speci*c phobia- severe and persistent fear of an ob=ect or situationo 6 A

ecessive irrational fear for > months and up

3sually immediate reaction ensues after eposure

Causes avoidance

Causes 5:$1:/:C&1( distress

o 3emales have it more

o It+s normal to have multiple phobias

o "0O AR$ I!!A"$

A*ROO,IA 9#$I#"%: and OIDIOO,IA 9%!A1$%:

Agoraphobia


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o 2ear of public places or situations where escape or getting

help isn't feasible, should they experience panic and become

incapacitatedo $x5

/ear of being unaccompanied, in a public space, public places,

conned spaces +with hard to nd eits-

7ain reason is due to a fear of embarrasment or concern about

diDculty escaping should a panic attack ensue

&voidance of such publicindividualconned situations

> months at least continuining

&gain as any phobia) signicant distress or impairment

o 7sually happens alongside panic attacks - the 8 diagnoses are

side by sideo Comorbid with

other aniety disorders

(56 +if an initial event in public caused this-

alcohol disorder

depression

9hat causes !hobiaso 3ehavioral odel of Classical conditioning supports this

o odeling5watching others ) you pick up their fears and become

fearful yourself of thoseo %o why don+t you grow out of phobias- you don+t get close to the

stimuli to learn that they+re harmless and hence it+s maintained via

avoidance;;;;;;;;;;o +timulus generalization- responses to @ stimulus are generaliEed to

other stimuli similar to that

"#I% M$A!% that you have multiple phobias 9cats5 tigers5 lionsetc: and this may develop into GA%

o !reparedness- 0volutionarily speaking humans are more inclined to

develop certain phobias...may have genetic roots or simply

environmental roots

!&EA!ME'! o "xposure treatments- behavioral treatments with exposure to

the stimuluso systematic desensitization - people learn to relax with muscle

relaxation training )))so they can rela at will ...while gradually facing

what they fear...uses a fear heirarchy system which uses feared items

from mild to etreme

while relaed you face your mild fears and work ur way up

live exposure is called in vivo desensitization

covert desensitization - imaged exposure to the stimulus

o :ooding- repeated eposure to a stimulus to make someone realiEe

that they are not harmless

also in vivo or covert


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o modeling- therapist confronts the feared ob=ect and the patient

watcheso O(E&A"" actual eposure to the stimulus gives greatest success in

overcoming the phobia

Agoraphobia reatment

o similarly involves exposure to stimulus but also involves supportgroups

support groups move out together and encourage ea other to

do stu< alone and move away from the group

home based self help- clinicians give instructions to the

family on how to deal with the issue at hand

+ocial Anxiety $isorder

severe irrational fear of social1performance situations where

embarrassment may occuro

mostly in situations where they can be =udged by others i.e. eatingoutsideo people rate themselves as performing worse than they actually did

o because it involves personal evaluation as well as fear of

social situations )!# A %)#O&%E& 'O! A *+OB)A

%x

o fear of being negatively evaluated or 3"%#/ )22"#+%&" )

)."6+o irrational overwhelming fear of social situations

o > months or more

o avoidance of feared situations

o

impairment or distress

+tatso (ypical onset is at @ yo ) development of adolescence....usually F)

@Gyrs GIo 7en seek treatment more cause this disorder isn't macho

o men and women e;ually a0ected

6easons behind +A$ are mostly cognitive instead of behavioral like

/A$o fear of disapproval or negative evaluation ) people have ideas about

social situations that work against themo childhood maltreatment biological

o

genetic predispotiion - biologicalo behavioral - socially anious modeling by parents

ore infoo avoidance- not talking to strangers

o etc- ppl typically review events that occurred5 thining they did worse

than they did...and in reviewing these they eep the event alive and

mae the fear worse

reatment


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o antidepressants are the best medications for this------&"6%2 o exposure therapy or cognitive therapy

o social skills training - roleplaying to get people to ac=uire or

improve social sills

!anic Attacks

periodic short bursts of panic that occur suddenly and reach pea and

pass

any physiological symptoms

o **J often leads to a fear that people will die or lose control or

go crazy

Attacks happen in the absence of a real threat

"xpected !anic attacks- there's an obvious cue, and they've typically

occured in these situations

7nexpected - #) )3&%)7+ C7" )6 6%//"6 i.e. happens when you're

eating food and 2&7 outta nowhereo !octurnal &anic attac ) waking up from sleep in panic

!anic $isorder

some people have recurrent and unpredictable panic attakcs ) this is

panic disorder

$x

o 7nexpected and repeated panic attacks

o Attacks lead to at least a month of worrying or dysfunctional

behavior in anticipation1worry of a future attack

3iological !erspectiveo Antidepressant drugs work best instead of benzodiazeprines

o locus coreulus- brain area rich in norepenephrine using neurons, and

regulates emotions when stimulated electrically panic attacks ensue

more norepenephrine


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disorder interpret them as being dangerous and get way more upset

than the other people who don+t feel as upsetted by the sensationso anxiety sensetivity- a tendency to focus on5 and misinterpret one+s

bodily sensations as being harmful and then becoming upset as a

result

)bsession-Compulsive $isorder

)bsessions- the persistent thoughts that invade ur conceous and

don't go away

Compulsions- the ritualistic actions that need to be completed or

else u experience anxiety

)C$

o when the obsessions and compulsions are excessive and

unreasonable

$xo repeated obsessions, compulsions !% 2!(H

o considerable time is lost due to the obsessions and compulsions

o signi*cant distress or impairment

)bsessions

o often take the form of wishes, impulsesurges, images, doubts...(H050

% &"" (H!3$H(5o attempts to avoid them cause anxiety

Compulsions

o are voluntary but ppl feel like they got little say and (H0# $!((& 6! :(

!sychodynamic !erspective

o !+E#E !+EO&)#!# BE")E(E !+A! #.C+ A'/)E! %)#O&%E

+A**E' ,+E' )%# 0EA& !+E)& )% )M*."#E# A'% .#E EGO

MEC+A')#M# !O CO.'!E& !+EM !O "E##E' !+E A'/)E! o +O,E(E& 0O& A'/)E! (# OC% !+E %)00E&E'CE )# !+A! !+)#

BA!!"E )#'1! .'CO'C)O.# B.! CO'C)O.#o )% )M*."#E# A&E OB#E##)(E !+O.G+!# A'% !+E EGO

%E0E'#E# A&E CO.'!E& !+O.G+!# O& COM*."#)(E AC!)O'#o @ $"2"#+" "C.A#%++ A6" &%A

o isolation - unconsiously isolate and disown undesirable

unwanted thoughts, and *nd them to be intrusionso undoing- unconciously cancels out an unacceptable desire by

performing another acti.e you repeatedly wash ur hands to get rid of an id impulse

o reaction formation - supressing an innapropraite desire by

taking on a lifestyle completely opposite to that desire

i.e. a nympho wil become a nun


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o #)GM.'% 0&E.% !&ACE% OC% !O !+E A'A" #!AGE ,+E&E +E

#A)% )%# +A% 'EGA!)(E *O!! !&A)')'G E/*E&)E'CE# A'%

0E"! &AGE O& #+AME222 +E'CE !+E ,A''A E/*&E## !+E#E AGG&E##)(E )%

)M*."#E# B.! 'O, !+A! %O)'G #O )# 'O! O B3C O0

!+E EGO2

!+)# CO'!)'O.# EGO3)% CO'0")C! ,)"" "EA% !O

OC% %E(E"O*ME'!

3ehavioral !erspective >obsessions not really targeted?

o compulsions are rewarded or thought to be superstitosuly

lucky so theyre continuously repeated5 and they+re done to bring

about good outcomes aa superstitiono exposure and response prevention - epose them to whatever is

causing them the aniety, obsessions, or compulsions, and tell them to

resist the action

Cognitive !erspectiveo everyone has obsessions but most are able to dismiss them with

ease. "hose who can+t turn to compulsive actions or obsessive

thoughts to #"76A%B" them4 neutralization brings about temprary comfort which is

why the compulsive actions or obsessive thoughts are

continued they+re convinced that they+re intial obsession 9that led to the

neutrali?ation action: is harmful....and they continue to do the

neutrali?ation action over and over...more and more

3iological !erspective

o family pedigrees hinted towards this for )C$

o +eratonin- antidepressant drugs worked best444."+"

%#C6"A+" +"6A)#%# 2)9o lack of seratonin :ow causes ocd

o orbitofrntal cortex

o caudate neucli

o biotherapies revolve around meds

)C$ related disorders- these disorders too have obsessive like

concernso hoarding

o trichotillomania- hair pulling4444this is a compulsion

o excortation - pick at your skin causing sores and wounds4444this

is a compulsiono body dysmorphia image- beleving that you've :aws in your

body's image44this is a constant and reoccuring thought that u

can't get out


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CH4 Cardiopulmonary Physiology