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.
Suicide Statistics
~60% of people who commit suicide have a diagnosis of a mood disorder at the time of their death.
- Whites highest rates
- MDD and Bipolar most -often linked to suicide
Beck found this to be a bigger predictor of suicide than intensity of depressive sxs.
Hopelessness
Biological predictors of suicide/attempts
Low levels of serotonin
Separation Anxiety Disorder : diagnosis criteria
- Developmentally inappropriate and excessive distress as evidenced by 3 Characteristic sxs.
- 6 mos in adults; 4 weeks in children
- cause sig distress or impairment in f (x)ing
Treatment for Separation Anxiety Disorder
Systemic desensitization; cognitive approaches. Return to school for kids to avoid academic failure, etc….
Specific Phobia: diagnostic criteria (and treatment)
-Intense fear or anxiety about a SPECIFIC object or situation.
-The person avoids or endure w/marked distress.
-Not proportional to situation.
-6 Months in duration.
-Multiple sub-types.
DDx: SINGLE SITUATION vs Agr
Treatment: exposure therapy
Social Anxiety Disorder
Characterized by intense fear of social situations that may result in scrutiny by others.
Treatment for Specific Phobia and Social Anxiety Disorder
Exposure with Response Prevention
Panic Disorder: diagnosis criteria
Trauma & Stressor-Related Disorder vs Anxiety disorder
Recurrent, unexpected panic attacks, with at least one being followed by persistent concern of having another OR the consequences of one, OR significant maladaptive beh.
Agorapgobia: diagnostic criteria and treatment
- Marked fear or anxiety about at least 2 specified situations. (Public transp; open/enclosed spaces; crowds/standing in lines; outside alone.
- exposure treatment of choice
Disruptive Mood Dysregulation Disorder: diagnostic criteria
(DMDD; A Depressive Disorder) a.)Severe recurrrent temper outbursts manifested verbally or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation. b.)Chronic, persistently irritable or angry mood between temper outbursts on most days.
-Sxs for 6 months across at least 2 settings; average 3 days per week; not developmental in nature; Onset by 10 years old, Dx not until 6 years old.
Panic Disorder: Treatment
Trauma & Stressor-Related Disorder vs Anxiety disorder
PCT (Panic Control Tx); integrates psychoed, relax, cog restructuring, exposure; also TCFAs SSRIs SNRIs and Benzos. * Relapse high with meds-only tx.
General Anxiety Disorder (GAD)
- Excessive anxiety and worry about multiple events or activities
(At least 3 of the following: restlessness/on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance) - relatively constant for at least 6 months
- Difficult for person to control
- Causes clinically sig distress or impaired f(x)ing
Obsessive-Compulsive Disorder (OCD)
Characterized by recurrent obsessions and or compulsions that are time-consuming and cause significant distress or impaired functioning.
Obsessions- persistent thoughts, impulses, or images that the person experiences as intrusive and unwanted and that cause marked anxiety and distress.
Compulsions- repetitious and deliberate behaviors or mental acts that are performed in response to an obsession or according to rigid rules.
OCD VS OCPD (Obsessive-Compulsive Personality Disorder)
OCDP does not involve obsessions and compulsions, but instead, a pre-occupation with orderliness, perfection, and control.
Reactive Attachment Disorder
- Consistent pattern of inhibited and emotionally withdrawn behavior towards adult caregivers
(I.E. lack of seeking or responding to comfort when distressed; - A persistent social and emotional disturbance that includes at least 2 of the following SXS: minimal soc and emot responsiveness to others, limited positive affect, episodes of unexplained irritability, sadness or fearfulness w/adult caregivers
- Child has to have experienced extreme insufficient care such as unmet needs, repeat change in caregivers, unusual environment that limits opportunities to form attachments
Disinhibited Social Engagement Disorder
- Pattern of behavior that involves inappropriate interactions with unfamiliar adults IE: overly familiar behavior w/unknown adults, diminished/absent of checking in w/adult caregiver, willingness to accompany unknown adult caregiver w/out hesitation.
- Child has to have experienced extreme insufficient care such as unmet needs, repeat change in caregivers, unusual environment that limits opportunities to form attachments
Post Traumatic Stress Disorder (PTSD): diagnostic criteria
- Exposure to actual death, serious injury, or sexual violence
- Presence of at least one of the following intrusive sxs:
(recurrent, involuntary, distressing memories of the event; dissociative reactions which the person feels or reacts as if the event is recurring’ intense or prolonged psychological distress when exposed to reminders of event; marked physiological reactions to reminders of event) - Persistent avoidance of stimuli associated with the event (memories, thoughts, feelings, external reminders that illicit reminders)
- 2 Negative changes in cognition or mood associated with the event
- 2 Marked changes in arousal and reactivity associated with the event (irritable beh and angry outbursts, hyper-vigilance, exaggerated startle response, reckless or destructive beh’s, impaired concentration; sleep disturbance.
- Duration > 1 month
- Causes clinically significant distress or impaired f(x)ing
PTSD: Treatment
The treatment of choice for PTSD is a Comprehensive CBT intervention that encorporates exposure, cog restructuring, anxiety management. + SSRI for accompanying dep and anxiety.
Acute Stress Disorder
- Exposure to actual or threatened death, severe injury, or sexual violation in at least one of 4 ways
- 9 sxs from any one of 5 categories
- Duration: 3 Days to 1 month
- Causes clinically significant distress or impaired functioning
Adjustment Disorders
- Emot or beh sxs in response to onset of psycho-social stressor(s)
- Must be clinically significant, or not proportional to the severity of of the stressor or cause sig impairment in f(x)ing
- Onset within 3 months of of one or more identifiable stressors
- Emot and Beh sxs must remit within 6 months after termination of stressor(s)
Dissociative Identity Disorder
- Existence in one individual of two or more distinct personality states; note cultural exceptions.
- Gaps in recalling information, personal events, or traumatic events that is not consistent w/ordinary forgetfulness.
- Sxs cause clinically sig distress or impaired functioning.
Dissociative Amnesia
- Inability to recall important personal information that cannot be attributed to ordinary forgetfulness.
- Causes clinically significant distress or impaired functioning
- Most-often takes the form of Localized or Selective Amnesia
- ## Often related to exposure to one or more traumatic events
Depersonalization/Derealization Disorder
- Depersonalization - unreality, detachment, or being an outside observer ot one’s thoughts/feelings
- Derealization disorder - unreality, detachment involving one’s surroundings
Conversion Disorder: Dx requirements
-sxs involving disturbances in voluntary motor or sensory functioning that suggests serious neurological or other medical condition.
Conversion Disorder: Dx requirements
-sxs involving disturbances in voluntary motor or sensory functioning that suggests serious neurological or other medical condition.
Facticious Disorder
- individual falsifies physical or psychological symptoms associated with their deception in themselves for another person in absence of an external reward for doing so
Malingering
Intentional production of symptoms for the purpose of obtaining a reward.
Anorexia Nervosa
- Restriction of energy intake that leads to significantly low body weight
- an intense fear of losing weight
- A disturbance in the way the person experiences their body weight and shape
- Onset most-often in adolescence or young adulthood
One theory of anorexia
Higher than normal level of serotonin- which causes restlessness, anxiety, and obsessive thinking, resulting in food restriction which lowers the level of serotonin and therefor decreases unpleasant feelings.
First priority in treatment of Anorexia
Getting the individual to gain weight
Bulima Nervosa
- characterized by recurrent episodes of binge-eating that are accompanied by a sense of a lack of control;
- compensatory behaviors to prevent weight gain;
- a self-image that is unduly influenced by body shape and weight.
Studies conducted in various countries suggest that cultural and social factors play the most significant role in the causation of which of the following disorders?
Examples:
- Prevalence of schizophrenia is pretty consistent throughout the world, while
- Depression, post traumatic stress disorder, and suicide rates have been shown to be more attributed to cultural and social factors.
Schizotypal (Personality) Disorder
- Acute discomfort in close relationships
- Cognitive or perceptual distortions
- Eccentric behavior
Schizoid Personality Disorder
- Detachment from social relationships and RESTRICTED RANGE OF EMOTIONAL EXPRESSION
ADHD Criteria
Onset prior to age 12
2 different settings
Meet 6 diagnostic criteria
Stimulant Intoxication
Pupil dilation, nausea, and muscular weakness are symptoms
Double-bind communication has been attributed to the etiology of which condition?
Schizophrenia
Persistent Depressive Disorder
2+ years of feeling depressed mood, low concentration, low appetite (previously Dysthymia)
Which of the following substances would be least likely to produce a Substance-Induced Psychotic Disorder
Opiods (vs alcohol, marijuana, and cocaine)
What does Bipolar I disorder look like?
Ie: A 15 year old girl suddenly has a change in behavior that includes irritability, concentration problems at school, decreased need for sleep, and sexual promiscuity
Conduct Disorder
- Pattern of behavior that violates basic rights of others and/or age appropriate social norms or rules
- Displays 3 or more Characteristic symptoms: bullying, threatening, intimidating others, frequent truancy from school; running away from home at least twice, and vandalizing school property
Oppositional Defiant Disorder
Recurrent pattern of angry/irritable mood, argumentative/defiant behavior, or VINDICTIVENESS;
Verbal rather than physical aggression; conflict with parents, blaming others for mistakes, and losing temper are more common behaviors.
Criteria for Substance Use Disorder
- Control impairment
- Social impairment
- Risky Use
- Pharmocological Criteria
Treatment for Raynaud’s Disease
Biofeedback more effective than relaxation training
Antisocial Personality Disorder characteristics
- Disregard for and violations of the rights of others (pervasive pattern)
- High score neuroticism, high score disagreeableness, low score on conscientiousness
- Diagnostic feature (3 of 7 needed for Dx) including: lack of remorse
- Associated features: Inflated sense of self, Lack of empathy, Superficial charm
Excessive activity in what brain region has been linked to Tourettes disorder?
Caudate Nucleus
Effective Treatment of Conduct Disorder shows which outcomes?
Parental Management Training and Multi-Systems Therapy are more effective than “tough love” and bootcamps.
Separation Anxiety Disorder Criteria
Fear, anxiety ,and avoidance for 4 weeks in kids and 6 months in adults
What is Malingering??
Pretending to have a physical symptom for some type of financial gain
What skill is being assessed on the Symbol Search, Coding, and Cancellation?
Processing Speed :)
In early stages of Alzhiemer’s Disease, what are characteristics that are the same as those in Korsakoff’s Syndrome?
Anterograde amnesia (form new memories, remember recent past) that effects declarative but NOT procedural memory.
Difference between PTSD and Acute Stress Disorder
PTSD requires 1 month of symptoms; ASD
If a constant is added to each score, what will happen?
Increase the mean
Tobacco Withdrawal Syndrome symptoms
- Irritability and Anger
- Increased appetite
- Impaired concentration
Exposure to what circumstances are the first criteria for both PTSD and Acute Stress Disorder?
- Actual or threatened death, serious injury, or sexual violence
Binge eating disorder criteria
Binge eating once per week for 3 months
Separation Anxiety Disorder
Anxiety triggered by separation (ie from mother) usually triggered by the death of a family member or pet
Reactive Attachment Disorder
Markedly disturbed and developmentally inappropriate SOCIAL RELATEDNESS
Acute Stress Disorder
Exposure to extreme stressor AND derealization, avoidance of reminders, and distressed memories of the event
A practitioner of Motivational Interviewing would most likely use what?
Techniques that help the therapist promote empathy
Schizophreniform Disorder
Symptoms for less than 6 months
Schizophrenia
Symptoms for 6 months
Schizoaffective Disorder
NOTE: Schizophrenia symptoms PLUS MOOD Disorder
Schizoid Personality Disorder
Long-standing symptoms of persistent dysfunctional behaviors
Rosenhan’s Pseudopatients Experiment
- Faked symptoms to be admitted to psychiatric hospitals, behaved “normally” when inside
- Patients more-often recognized as being “normal” by other patients verses staff
What is NOT an anxiety disorder?
w/ Trich, Hoarding, Body Dysmporphic Disorder
Neurofeedback as treatment for ADHD?
It’s an effective approach especially for inattention and impulsivity
What is the “proband” referring to in the research study that looked at possible genetic transition of ADHD?
The individual who has been diagnosed with ADHD- the person for which we re interested in genetics of ADHD
Frotteurism
Rubbing up against in a sexual way without the consent of the individual
What symptoms would help establish a diagnosis of Inhalant Toxication?
Unsteady gate, slurred speech, and tremor
What is Akasithia
Unpleasant feelings of restlessness; sometimes a side effect of antipsychotics or antidepressants
Tactile Agnosia
Inability to recognize objects by touch; caused by damage to the parietal lobe
PTSD is grouped into 4 Clusters: what are they?
(All experience traumatic event)
Intrusion; Avoidance; Cognition & Mood; Arousal & Reactivity
Prevalence of Schizophrenia in general population
.5 %
Common disorders that co-occur with Tourette’s Syndrome
OCD, ADHD, and/or a Learning Disorder (LD)
“Hallmarks” of addiction
Tolerance and Withdrawal
Adolescence and suicide attempts: fact regarding repeat attempters?
That their real purpose is to exert power in situations in which they feel powerless
Histrionic Personality Disorder
Center of attention; flirt/seduce to remain center of attention; feelings easily hurt; approval seeking
If an individual is diagnosed with Alcohol Use Disorder, which personality disorder is most likely to co-occur?
Antisocial Personality Disorder
Panic Disorder in children?
Common and treatable- shortness of breath, not wanting to go to school, tachychardia, chest pain
Symptoms of hyperthyroidism
Unexplained weight gain, forgetfulness, sensitivity to cold, constipation
Research on expressed emotion and mental health disorders found out what about relapse?
That high expressed emotion may be more predictive of relapses for those with a MOOD or ED than for patients with schizophrenia.
Dx of Bulimia Nervosa takes symptoms of what for how long?
Binge eating and compensatory behavior for 3 months
Illusions
Distortions of what is really there, a misperception of reality
Delusion
A false belief about reality regardless of evidence to the contrary
Hallucination
A perception in the absence of a stimulus
Depersonalization
Detachment from oneself
If a psychologist does not want to specify the reason why a patient doesn’t meet criteria for a disorder, what classification is used?
UNSPECIFIED
