Abnormal Psych Flashcards
Diagnosing an Intellectual Disability: 3 Criteria
- Deficits in intellectual functioning
- Deficits in adaptive functioning
- Onset during the developmental period
DSM 5 distinguishes between 4 degrees of severity, what are they?
Mild, Moderate, Severe, Profound
Severity of intellectual disability is based on adaptive functioning in which 3 ways?
Conceptual, social, practical
Etiology of Intellectual disability is known in about what percentage of cases?
30%
The onset of Child-onset Fluency Disorder (Stuttering) is most-often between which ages?
2 and 7 years old
One effective treatment for COFD (Child-onset Fluency Disorder)
Habit Reversal
Awareness, relaxation, motivation, competing response, and generalization training
A diagnosis of ASD (Autism Spectrum Disorder) requires persistent deficits in ____________.
Social communication and interaction; across multiple contexts, including restricted and repetitive patterns of behavior, interests and activities; symptoms during the early developmental period, and impairments in social, occupational, or other areas of functioning.
A better prognosis for ASD is associated with which 3 factors?
- Ability to communicate verbally by age 5-6
- An IQ of 70 or above
- Later onset of symptoms
Treatment for ASD by Lovaas used to increase communication skills
Shaping and Discrimination Training
3 Levels of ASD severity
Level 1: Requiring support
Level 2: Requiring substantial support
Level 3: Requiring very substantial support
ADHD is characterized by:
Persistent pattern of inattention or hyperactivity-impulsivity that interferes with social, academic, or occupational functioning.
Diagnosis Criteria for ADHD
- Onset of sxs prior to age 12
- Impairment in at least two different settings
- At least 6 symptoms in Inattention and/or Hyperactivity/Impulsivity
The percentage of children with ADHD that continue to meet the diagnostic criteria for the disorder in adolescence:
65-80%
Predominant symptom of adults with ADHD
Inattention
According to this hypothesis, ADHD is due to an inability to regulate one’s behavior to fit the demands of a situation:
Behavioral Disinhibition
One study on ADHD (NIMH Multimodal Tx Study) found these results regarding treatment:
Medication and Medication/Behavioral Treatment produced similar reductions in the core sxs of ADHD.
Specific Learning Disorder (SLD): diagnostic criteria
- Difficulties related to academic skills as evidenced by at least one characteristic symptom that lasts for at least 6 months IN SPITE OF interventions that had targeted those difficulties.
Most frequent comorbid disorder found with SLD (Specific Learning Disorder).
ADHD
Tourette’s Syndrome: diagnostic criteria
- 1 vocal tic
- Multiple motor tics
- Both of the above beginning prior to age 18.
One treatment for Tourette’s Syndrome
Anti-psychotic medications
Regarding medical procedures in children (Behavior Pediatrics), research as shown that these strategies are helpful for reducing anxiety and pain due to medical procedures
- Open communication
- Multi-component CBT
The pediatric behavior study also confirmed that hospitalized children and children with disabilities are at increased risk for ____________.
Emotional and behavioral problems
This population has been shown to have a particularly difficult time complying with medical regimens and adherence:
Adolescents
Delusional Disorder: diagnostic criteria
- Presence of 1 or more delusions that last for at least 1 month. 7 types.
7 subtypes of Delusional Disorder
- Erotomanic
- Grandiose
- Jealous
- Persecutory
- Somatic
- Mixed
- Unspecified
Schizophrenia: diagnostic criteria
- Presence of 2 active phase symptoms for at least 1 month, with one of the sxs being delusions.
- Continuous signs of the disorder for at least 6 months
- Sxs must cause significant impairment in functioning
What are the “active phase” symptoms we are looking for a minimum of 2 of in Dx Schizophrenia?
Delusions, Hallucinations, Disorganized speech
and Grossly disorganized or abnormal motor behavior, Negative symptoms
Negative Symptoms of Schizophrenia
Restriction in the range and intensity of emotions and other functions, and include blunted emotional expression, anhedonia (decreased ability to experience pleasure), a-sociality, alogia (diminished speech output), and avolition (restricted initiation of goal-directed behavior).
Schizophrenia: Onset information
Late teens to early 30’s
Schizophrenia: Prognosis
A better prognosis is associated with an acute and late onset and female gender.
Genetic etiology for schizophrenia; concordance rates
Concordance rates for biological siblings is about 10%; while the rate for identical twins is 48%.
What is the Dopamine Hypothesis?
The first biochemical theory of schizophrenia.
Structural brain abnormality indicators for schizophrenia
Enlarged ventricles have been found in the largest proportion of patients.
Treatment for schizophrenia
Traditional (“1st generation”) Anti-psychotic drugs:
are most effective for eliminating the “positive symptoms” of the disorder, but are associated with tardive dyskinesia.
Atypical (“2nd Generation”) anti-psychotics are less likely to cause tardive dyskinesia, and may be more effective for both positive and negative symptoms.
Positive symptoms of schizophrenia
(AKA “additive sxs”) Delusions, hallucinations, disordered thought.
Other treatments for schizophrenia besides anti-psychotic drugs
CBT, Social Skills Training, psycho-education, and supportive employment. Family therapy has also been shown to be beneficial, especially when they target Expressed Emotion (EE), which have been linked to high relapse and re-hospitalization rates. BUT NOT AS STRONG OF A LINK AS THOSE W/MOOD or ED!!
EE (Expressed Emotion)
High EE in families of people w/schizophrenia is characterized by open criticism and hostility towards the patient, or alternately, over-protectiveness and emotional over-involvement. Higher levels of this in families of schizophrenic patients have been shown to be linked to high relapse and re-hospitalization rates.
Duration of Schizophreniform Disorder
1-6 months
Duration for Brief Psychotic Disorder
1 day to < 1 month
Duration of Schizoaffective Disorder
Psychotic and mood symptoms occur concurrently with a period of 2 weeks without prominent mood symptoms.
Diagnosis of BiPolar I Disorder: diagnostic criteria
At least 1 manic episode that lasts for at least 1 week.
Diagnosis of BiPolar II Disorder: diagnostic criteria
1 Major Depressive episode and one Hypomanic episode.
What psychiatric disorder has most consistently been linked to genetic factors?
Bipolar Disorder
Treatment of Bipolar Disorder (and alternate treatment).
Most-often includes Lithium, which reduced manic symptoms and levels out mood swings. For those who do not respond to that drug, anti-seizure drugs may be effective.
Cyclothymic Disorder: diagnostic criteria
- Numerous periods of hypomanic sxs that do not meet criteria for a hypomanic episode, and numerous periods of depression sxs that do not meet criteria for MD episode.
- Symptom duration at least half of the time over at least 2 years in adults; 1 year in children and adolescents.
- The individual cannot have been symptom-free for more than 2 months at a time.
Major Depressive Disorder: diagnostic criteria
- The presence of at least 5 symptoms of a MDE with at least one sx being either a depressed mood OR loss of interest/pleasure.
- Nearly every day for 2 weeks
- Sxs cause significant distress or impaired f(x)ing.
Peri-partum onset specifier
Applies when the onset of sxs is during pregnancy or within 4 weeks post-partum.
Seasonal Pattern specifier
Applies when there is a temporal relationship between the onset of sxs and a particular time of year.
Symptoms of Seasonal Pattern specifier
- Hypersomnia
- Increased appetite and weight gain
- Craving for carbs
Prevalence rates: MDD in children vs adults
In children, rates are about equal. Beginning in early adolescents, adults, the rate for women is about twice that for men (2x).
Symptoms of MDD in Children vs Adults
In children, somatic complaints and irritability are common. In older adults, cognitive impairments may resemble those seen in mild/major Neuro-cognitive Disorder.
Evidence for genetic contribution to MDD
Studies have shown that the disorder is 1.5 - 3x more common among first-degree biological relatives than among individuals in the general population. Also, in twin studies, concordance rates werecently .20 for dizygotic and .50 for monozygotic twins.
Catecholemine Hypothesis of Depression
States that depression is due to a deficiency of norepinephrine.
Lewinson’s Behavioral Theory of Depression
Links depression to a low rate of Response-Contingent Reinforcment (RCR)
Learned Helplessness Model of Depression
Identifies hopelessness as the proximal and sufficient cause of depression.
Beck’s Cognitive Theory of Depression
Describes depression as involving a “Cognitive Triad”. characterized by negative beliefs about ones Self, the World, and the Future.
Treatment for MDD
Antidepressants
Types:
-TCAs: the most effective for “classic” depression sxs that include vegetative sxs and more severe sxs in the morning.
- SSRIs: considered the First Line drug treatment, and produce fewer side effects than TCAs
-MAOIs: For those who do not respond to TCAs or SSRIs
-SNRIs: (newer, other, increase levels of both norepinephrine and serotonin. Similar to TCAs and SSRIs with differing side effects
Persistent Depressive Disorder (Dysthymia): diagnostic criteria
Requires the presence of a depressed mood for at least 2 years in adults and 1 year in children/adolescents.