Abnormal Flashcards
1
Q
When do neurodevelopmental disorders manifest?
A
Early developmental period; before grade school
2
Q
How many SDs below the man is the IQ of an intellectually disabled person?
A
2 SD
3
Q
What are considered deficits in general mental abilities/intellectual functioning?
A
Reasoning, abstract thinking, learning
4
Q
Under what three domains do you assess for adaptive functioning?
A
Conceptual/academic, social, and practical
5
Q
What are considered deficits in adaptive functioning?
A
Communication, social participation, independent living; how much support is needed
6
Q
What constitutes a language disorder?
A
Academic skills below age level and interference with academic or occupational performance or daily activities
7
Q
Until what age is stuttering considered normal?
A
2 years
8
Q
How do you treat stuttering?
A
Diaphragmatic deep breathing and HRT
9
Q
Childhood onset fluency disorder
A
Impairment in normal fluency and time patterning of speech; stuttering
10
Q
When do symptoms for ASD begin?
A
Typically 2-3 years
11
Q
What is the best prognosis for aSD?
A
1) absence of intellectual impairment and functional language by 5 years 2) IQ over 70 3) later onset of sxs 4) absence of comorbid MH issues
12
Q
ASD etiology
A
Genetics, brain irregularities (cerebellum, amygdala, hippocampus), abnormal levels of norepinephrine, serotonin, and dopamine
13
Q
ADHD differential diagnosis
A
ODD, intermittent explosive disorder
14
Q
Three learning disorder subtypes
A
Reading, written expression, math
15
Q
Comorbid disorder with learning disorders
A
ADHD
16
Q
Diagnostic criteria for Tourette’s
A
Multiple motor tics and one or more vocal tics for at least one year
17
Q
Comorbid disorders Tourette’s
A
Children: OCD, ADHD
Adults: MDD, bipolar, substance use disorder
18
Q
Treatment for Tourette’s
A
Antipsychotics, behavior therapy to manage symptoms, relaxation
19
Q
Erotomatic
A
believes another person of higher status loves them
20
Q
Grandiose
A
remarkable but unrecognized talent or wisdom
21
Q
Jealous
A
believes their partner is unfaithful
22
Q
Persecutory
A
believes they are being conspired against, cheated, spied on
23
Q
Somatic
A
believe they have abnormal bodily functions and sensations
24
Q
Characteristic features of schizophrenia
A
Delusions Hallucinations Disordered thinking Grossly disorganized or abnormal motor behavior Negative symptoms
25
Better prognosis for schizophrenia
```
Late/acute onset
Female
Precipitating event
Good premorbid adjustment
Insight
Brief duration of active phase symptoms
Family history of mood disorder
No family history of schizophrenia
```
26
Rate of schizophrenia: bio sibling
10%
27
Rate of schizophrenia: fraternal twin
17%
28
Rate of schizophrenia: identical twin
48%
29
Rate of schizophrenia: one parent
13%
30
How does a dx of schizophreniform differ from schizophrenia?
Two or more characteristic symptoms; symptoms between one month and six months; no impaired functioning required
31
Brief psychotic disorder
One or more characteristic symptoms; symptom duration 1 day to 1 month w/ return to premorbid functioning; usually after stressful event
32
Schizoaffective disorder
Concurrent psychotic symptoms and symptoms of MDD or mania with two weeks of just psychotic symptoms
33
Bipolar I
one or more manic episodes with or without hx of MDD of hypomanic episode
34
Bipolar II
At least one hypomanic episode and one MDD episode
35
Describe a manic episode.
a. “a distinct period of a. abnormally and persistently elevated, expansive, or irritable mood” and “abnormally and persistently increased goal-directed activity or energy.”
b. Sxs last for one week
c. Need for hospitalization
d. Psychotic symptoms
36
Describe a hypomanic episode.
a. Sxs last for four days
b. No impaired functioning
c. No hospitalizations
d. No psychotic symptoms
37
Treatment for Bipolar disorder
a. Mood stabilizer (lithium)
b. Anti-convulsant drug
c. CBT, family focused therapy, IPT, social rhythm
38
Cyclothymic disorder
a. Sxs of hypomania and MDD that don’t meet full criteria for disorder
b. Can last two years in adults and one year in children/adolescents
39
What are the symptoms of MDD?
Depressed mood or loss of interest/pleasure in activities with distress or impaired functioning for at least two weeks
40
What are the symptoms of MDD with a seasonal pattern specifier?
a. Irritability
b. Hypersomnia
c. Increased appetite
d. Weight gain
e. Craving for carbs
41
Describe the catecholamine hypothesis.
MDD due to low levels of norepinephrine and serotonin
42
What is Lewinsohn’s Behavioral Therapy and how does it differ from the learning helpless model?
a. depression is caused by a combination of stressors in a person's environment and a lack of personal skills.
b. More specifically, the environmental stressors cause a person to receive a low rate of positive reinforcement.
c. Positive reinforcement occurs when people do something they find pleasurable and rewarding.
d. Learned helplessness repeated exposure to uncontrollable life events
43
What is Beck's Cognitive Triad?
Negative beliefs for self, future, and world
44
How does persistent depressive disorder vary from MDD?
Symptoms consistent for two years
45
What is the diagnostic criteria for disruptive mood dysregulation disorder?
a. Severe recurrent temper outbursts inconsistent with age
b. Chronic and persistent irritable or angry mood most days for a year in two settings
i. Onset before 10
ii. Diagnosis between 6 and 18 years
46
What is the prevalence of ADHD?
Children: 5%
Adults: 2.5%
47
What is the treatment for a phobia?
Exposure with response prevention
48
What is exposure and response prevention?
Extinguishing the fear by exposing the person and preventing them from engaging in usual avoidance
49
What's the differential diagnosis for social anxiety?
Hyperthyroidism, hypoglycemia, cardiac arrhythmia, and other medical conditions
50
Diagnostic criteria for panic disorder.
a. Recurrent unexpected panic attacks
b. One followed by one month of concern about additional attacks, consequences, or maladaptive change in behavior related to attack
51
Diagnostic criteria agoraphobia
a. Fear or anxiety in 2 or 5 situations
| i. Public transportation, open spaces, being in enclosed spaces, in line or part of a crowd, outside the home alone
52
Treatment for agoraphobia.
In vivo exposure with response preventions
53
OCD etiology
Low levels of serotonin
| Genetics
54
Treatment for OCD.
a. Exposure with response preventions, meds, or combo
| b. Antidepressant that increases serotonin (clomipramine or an SSRI)
55
How does OCD differ from OCPD?
a. OCPD is a pervasive preoccupation with orderliness, perfectionism, and interpersonal control
b. Both repetitive rituals
56
Non-pathological anxiety
Easier to control, no physical symptoms
57
How long must symptoms be present for a diagnosis of PTSD?
More than one month
58
What types of symptoms are present for PTSD?
a. Intrusion
b. Avoidance
c. Negative change in thoughts and mood
d. Changes in arousal and reactivity
59
How do you treat PTSD?
a. CBT
b. Cognitive Processing Therapy (CPT)
c. EMDR—Benefit due to exposure and other non-specific factors
60
How does PTSD differ form acute stress disorder?
Exposure to actual or threatened death, severe injury, or sexual violation through: direct experience, witnessing, repeated or extreme exposure to aversive details of the event
i. Symptoms have a duration of three days to one month
61
Adjustment disorder
a. Development of emotional or behavioral symptoms in response to one or more identifiable psychosocial stressors within three months of onset of the stressors
b. Symptoms must remit within six months
62
Dissociative amnesia
Inability to recall important personal information, related to the exposure to one or more traumatic events
63
Localized amnesia
All events related to a circumscribed period of time
64
Selective amnesia
Some events related to a circumscribed period
65
Generalized amnesia
Loss of memory that encompasses the person’s entire life
66
Continuous amnesia
Recall events subsequent to a specific time and through the present
67
Systematized amnesia
Memories related to a certain category of information
68
Conversion disorder
Disturbance in voluntary motor or sensory functioning that suggests a neurological or medical condition
o Incompatibility between symptoms and known neurological or medical conditions
o Onset usually follows a stressor or trauma
69
Factitious disorder diagnostic criteria
Falsification of physical symptoms in oneself or another person with symptoms related to identified deception
Engages in deception in the absence of obvious external incentive for doing so
70
How does factitious disorder differ from malingering?
a. Intentional production of false or exaggerated symptoms for the purpose of obtaining an external reward
b. Considered when seeking an evaluation, antisocial personality disorder, discrepancy between symptoms and findings
71
What is somatic symptom disorder?
One or more somatic symptoms that are distressing or cause disruption in daily life
o With excessive thoughts, feelings, or behaviors related to the symptoms
o May or may not have a medical diagnosis
72
Define illness anxiety disorder
Preoccupation with having or acquiring a serious medical condition for at least 6 months without physical symptoms or only mild symptoms
o Perform health related behaviors or avoid situations and maladaptive avoidance
73
What is the diagnostic criteria for anorexia nervosa?
Restriction of energy intake that leads to a significantly low body weight
Intense fear of gaining weight or becoming fat or behavior that interferes with weight gain
A disturbance in the way the person experiences their body weight or shape or a persistent lack of recognition of the seriousness of their body weight
74
What the specifiers for AN?
Binge-eating/purging, course, and severity (based on BMI)
75
AN etiology
```
Biological factors (NT abnormalities and high levels of serotonin)
Psychological factors (perfectionism)
Environmental factors
```
76
Treatment for AN
First priority = gain weight
Individual, group, and/or family therapies used to ensure that initial weight gains are maintained
CBT is generally considered the treatment-of-choice
Family based therapies
77
What is the diagnostic criteria for bulimia nervosa?
Recurrent episodes of binge eating that are accompanied by a sense of a lack of control
Inappropriate compensatory behavior to prevent weight gain
Self-evaluation is unduly influenced by body shape and weight
Symptoms occur, on average, at least once a week for three months
Binges are typically triggered by interpersonal stress or a dysphoric mood
• Usually high in calories
78
Cognitive incident stress debriefing (CISD) and single sessions for PTSD
Not effective and may actually worsen symptoms
79
Most common comorbid condition for BN
Depression
80
BN etiology
low levels of endogenous opioid beta-endorphin and NT abnormalities (low serotonin)
81
Treatment BN
Gain control over eating
Modify dysfunctional beliefs
Nutritional counseling/CBT
Meds: imipramine and fluoxetine
82
Enuresis
Repeated voiding of urine into the bed or clothes at least twice a week for three or more consecutive months
Usually involuntary but can be intentional
Individual is @ least 5 years old
83
Treatment enuresis
Bell and pad (80% effective)
1/3 children relapse in first 6 months
Imipramine, desmopressin
84
Insomnia dx
Dissatisfaction with sleep quality of quantity
3 nights/week for at least 3 months
85
Narcolepsy
Attacks of an irresponsible need to sleep with lapses into sleep or daytime naps
At least 3X/week, present for at least 3 months
Requires episodes of cataplexy (loss of muscle tone), a hypocretin deficiency, or a rapid eye movement latency less than or equal to 15 minutes
May try to prevent sleep attacks by controlling their emotions
86
Non-rapid eye movement sleep arousal disorders
Recurrent episode of incomplete awakening that usually occur during the first third of the major sleep episode (most often during stage 3 or 4 sleep)
Accompanied by sleepwalking and/or sleep terror
Has limited or no recall of an episode upon awakening
Occurs most often in children
Often remits spontaneously during adolescence
87
Erectile disorder
Presence of at least 1 of 3 symptoms (difficulty maintaining an erection, difficulty maintaining an erection until completion, marked decrease in erectile rigidity) on all or almost all occasions of sexual activity
Symptoms present for at least 6 months
88
Genito-Pelvic Pain/Penetration Disorder
Persistent or recurrent difficulties involving one or more:
vaginal penetration during intercourse
marked genito-pelvic pain
marking anxiety before, during, or as a result of penetration
marked tensing of pelvic floor muscles
Sxs 6 months
89
Treatment for premature ejaculation
Sex therapy
Sensate focus: Helps reduce performance anxiety
Start-stop and squeeze techniques; Designed to increase the man’s control over the ejaculatory reflex
Linked to low serotonin levels = SSRIs have been effective for some
90
Paraphilic disorders
“Intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners” causing distress, or has entailed personal harm, or risk of harm, to others.
91
Frotteuristic disorder
Sexual arousal from touching or rubbing against a non-consenting adult
Begins in adolescence, behaviors associated with it often decline with increasing age
92
Oppositional defiant disorder
Angry/irritable mood
Argumentative/defiant behavior
Vindictiveness
Exhibited in interactions with at least one person who is not a sibling
o Symptoms persists for at least 6 months
93
Conduct disorder
Behavior that violates the basic rights of others and/or age-appropriate social norms or rules
o 3 characteristic symptoms during the past 12 months, and at least one symptom in the past 6 months
94
How are ODD and CD different?
ODD: angry, argumentative and vindictive
CD: violates rights of others and social norms
95
Moffitt: two types of CD
Life-course-persistent type begins early and involves a pattern of increasingly serious transgressions that continue into adulthood
Attributed to neurological impairments, a difficult temperament, and adverse environmental circumstances
Adolescence-limited type: temporary, reflects a “maturity gap”
o Usually committed with peers and are inconsistent across situations
96
Treatment for CD
Family interventions
Parent management training
Multisystemic treatment
97
Substance use disorder dx
```
2 symptoms during a 12-month period, characteristic symptoms can be categorized into 4 groups:
Impaired control
Social impairment
Risky use
Pharmacological criteria
```
98
Marlatt and Gordon
* The typical reaction to relapse as an “abstinence violation effect” that involves self-blame, guilt, anxiety, and depression, which lead to an increased susceptibility to further alcohol consumption
* The potential for future relapse is reduced when the person views the episode of drinking as a mistake resulting from specific, external, and controllable factors
99
Relapse prevention therapy
Identifying circumstances that increase the individual’s risk for relapse and then implementing behavioral and cognitive strategies that help the individual prevent future lapses and deal more effectively with them if they occur
100
Successful tobacco quitters traits
```
Male
35+
College educated
Smoke-free home/work
Married/live with partner
Started smoking later
Low nicotine dependence
Abstained longer than 5 days in the past
```
101
Smoking cessation intervention
Nicotine replacement therapy
Multicomponent behavior therapy that includes skills training, relapse prevention, stimulus control, and/or rapid smoking
Support and assistance from a clinician
102
Alcohol withdrawal
Symptoms within several hours to a few days after stopping or reducing alcohol consumption
103
Alcohol-Induced Major Neurocognitive Disorder
Significant decline in one more cognitive domains that interferes with independence in everyday activities
104
Korsakoff's syndrome
Characterized by anterograde and retrograde amnesia and confabulation and has been linked to a thiamine deficiency
(memory disorder due to lack of thiamine aka vitamin b1)
105
Alcohol-induced sleep disorder
Usually of the insomnia type, result of either intoxication or withdrawal
106
Alcohol-induced sleep disorder
Intoxication
Involves immediate sedation accompanied by increased Stages 3 and 4 sleep and reduced REM sleep followed by increased REM sleep (w. vivid anxiety-arousing dreams) and reduced Stages 3 and 4 sleep
107
Alcohol-induced sleep disorder
Withdrawal
A severe disruption in sleep continuity with vivid dreams
108
Delirium
Disturbance in attention and awareness
Develops over a short period of time severity fluctuates over the course of the day
An additional disturbance in cognition—memory impairment, language, or perceptual disturbances
Evidence that there is a direct physiological consequence
109
Treatment for delirium
Resolving underlying cause and environmental manipulation
Medication: Haldol and/or Benzodiazepine
110
Delirium risk factors
Existing brain disorder
Older adults, young children
111
Major Neurocognitive Disorder
Evidence of a significant decline from previous functioning in one more or more neurocognitive domains that interferes with independence
112
Mild Neurocognitive Disorder
Evidence of a modest decline from previous functioning in one or more cognitive domains, does NOT interfere with independence, but requires greater effort or compensatory strategies
113
Stages of Alzheimer's Disease
Stage 1: Memory loss, difficulty with complex tasks, indifference, sadness, and irritability
Stage 2: Severe memory problems, disorientation, mood swings, difficulty with daily living tasks
Stage 3: Severe disorientation, confusion, hallucinations/delusions, need supervision and care
114
Etiology of Alzheimer's disease
Reduced acetylcholine in the hippocampus has been linked to memory loss
Large numbers of neurotic plaques and neurofibrillary tangles, especially in the medial temporal structures
115
Vascular neurocognitive disorder
Symptoms consistent with vascular etiology and evidence of cerebrovascular disease
Risk Factors: Hypertension, diabetes, heart disease, high cholesterol, and cigarette smoking
116
Stages of neurocognitive disorder due to HIV
Stage 0 –Normal: Mental and motor functions are normal
Stage 0.5 –Equivocal/Subclinical: Minimal or equivocal symptoms with no impairment
Stage 1 –Mild: Unequivocal evidence of functional, intellectual, or motor impairment
Stage 2 –Moderate: Cannot work but can perform basic activities of self-care
Stage 3 –Severe: Major intellectual capacity or motor disability
Stage 4 –End Stage: Nearly vegetative
117
Conditions needed to diagnose personality disorder before 18
Sxs present for one year (antisocial exception)
118
Cluster A Personality disorders
Odd and eccentric behaviors
Paranoid, schizoid, schizotypal
119
Paranoid personality disorder
Distrust and suspiciousness with the belief that the intentions of others are hostile and malevolent
Extremely jealous
120
Schizoid personality disorder
Detachment from social relationships and restricted range of emotions
Prefer to be alone
Choose jobs that allow them to work by themselves
121
Schizotypal personality disorder
Interpersonal deficits and eccentricities in cognition, perception, and behavior
May be unhappy with lack of close relationship but uncomfortable in relationships and behavior suggests not interested
122
Cluster B personality disorders
Dramatic, emotional, or erratic
Antisocial, borderline, histrionic, narcissistic
123
Antisocial personality disorder
Disregard for and violation of the rights of others
At least 18 years old, characteristics since 15 years old, and conduct disorder before 15 years old
Illegal behavior and lack of remorse
Symptoms diminish in severity and pervasiveness by mid-life
124
Borderline personality disorder
Instability in interpersonal relationships, self-image, and emotions, and marked impulsivity
Sensitive to rejection and abandonment
Idealization and devaluation mark relationships
125
Treatment for borderline personality disorder
DBT:
* Prevents early drop-out from treatment and reducing SI and SIB
* Combines individual therapy, group skills training, and telephone support
* Based on assumption that BPD core feature is emotion dysregulation
126
BPD commonly diagnosed age group
19-34 year olds, 75% do not meet criteria by age 40
127
Histrionic personality disorder
Excessive emotionality and attention seeking behaviors in a variety of contexts
Easily influenced by others
Consider relationships more intimate than they actually are
128
Narcissistic personality disorder
Grandiosity, need for admiration, and lack of empathy
Attention-seeking and superiority/sense of entitlement
129
Cluster C personality disorders
Anxiety and fearfulness
avoidant, dependent, ocpd
130
Avoidant personality disorder
Social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluations
View self as inferior to others, desire close relationships, but avoid them over fear of rejection
131
Dependent personality disorder
Excessive need to be taken care of that leads to submissiveness, clingy behavior, and fear of separation
Need reassurance from others
132
Obsessive-compulsive personality disorder
Preoccupation with orderliness, perfectionism, and mental and interpersonal control
Attention to details
Devoted to work
Frugal
133
Meds for enuresis
Imipramine, desmopressin
134
Confabulation
Gaps in a person's memory are unconsciously filled with fabricated, misinterpreted, or distorted information
135
Circumstantiality
Delay in getting to the point because of the interpolation of unnecessary details and irrelevant remarks; seen in persons with schizophrenia and obsessive-compulsive disorders
136
Loosening of associations
a thought disturbance demonstrated by speech that is disconnected and fragmented, with the individual jumping from one idea to another unrelated or indirectly related idea
137
Derailment
frequent interruptions in thought and jumping from one idea to another unrelated or indirectly related idea
138
Stage 0 HAND
Normal: Mental and motor functions are normal
139
Stage 0.5 HAND
Equivocal/Subclinical: Minimal or equivocal symptoms with no impairment
140
Stage 1 HAND
Mild: Unequivocal evidence of functional, intellectual, or motor impairment
141
Stage 2 HAND
Moderate: Cannot work but can perform basic activities of self-care
142
Stage 3 HAND
Severe: Major intellectual capacity or motor disability
143
Stage 4 HAND
End Stage: Nearly vegetative
144
Stage 1 Alzheimer's ND
Memory loss, difficulty with complex tasks, indifference, sadness, and irritability
145
Stage 2 Alzheimer's ND
Severe memory problems, disorientation, mood swings, difficulty with daily living tasks
146
Stage 3 Alzheimer's ND
Severe disorientation, confusion, hallucinations/delusions, need supervision and care
147
Primary gain
emotional arousal to physical symptoms
148
Secondary gain
external benefits that may be derived as a result of having symptoms
securing support from the environment or avoiding an unpleasant activity.
149
Example of primary gain and secondary gain in conversion disorder
the patient whose sudden onset of paresis (primary gain) causes his or her spouse to stay in an otherwise failing relationship (secondary gain)
150
The “hallmark” of substance addiction
tolerance and withdrawal
151
Cataplexy
sudden, brief loss of voluntary muscle tone triggered by strong emotions such as laughter
152
Conduct disorder categories
aggression to people and animals; destruction of property; deceitfulness or theft; and serious violation of rules
153
Dopamine hypothesis
attributes Schizophrenia to elevated levels of or oversensitivity to dopamine.
154
A high level of expressed emotion
Associated with a high risk for relapse and rehospitalization
open criticism and hostility toward the patient or, alternatively, overprotectiveness and emotional over involvement.
155
Sxs for MDD
```
depressed mood
diminished interest
significant weight loss/ weight gain
decrease or increase in appetite
insomnia or hypersomnia
psychomotor agitation or retardation
fatigue or loss of energy
feelings of worthless or excessive guilt
diminished ability to think or concentrate
recurrent thoughts of death/SI
```
