Abnormal Psychology Flashcards
What are the positive symptoms of schizophrenia? (5)
delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior
What are delusions?
false beliefs that are firmly held despite what almost everyone else believes or despite evidence that it is not true
What are the 3 common types of delusions?
1) persecutory (believe they are being followed, tricked or spied on)
2) referential (believe that books/newspapers/etc are specifically directed at them
3) bizarre (outside the range of normal life experiences)
What are the most common type of hallucinations for people with schizophrenia?
Auditory hallucinations, often in the form of demeaning or threatening voices or a running commentary on the person’s thoughts or actions
What is considered by many to be the key feature of schizophrenia?
Disorganized speech - loosening of associations, incoherent speech, unrelated answers or comments, slipping from one topic to another
A person with schizophrenia with a markedly disheveled appearance, clearly inappropriate sexual behavior or unpredictable agitation is referred to as having:
grossly disorganized behavior
Catatonic behavior in schizophrenia refers to:
less movement and less reactivity to the world - more vegetable-like
What is the difference between positive and negative symptoms in schizophrenia?
Positive symptoms = too much of, or a distortion of normal functions
Negative symptoms = too little, restricted range and intensity of emotions or other functions
What are the negative symptoms of schizophrenia? (3)
1) lack of affect - flat affect, reduced body language
2) lack of speech and thoughts - alogia
3) lack of or restricted initiation of goal-directed behavior - avolition
(lack of thoughts, feelings expression, and behavior)
A person with relatively intact cognition and affect but who is preoccupied with one or more delusions (which are usually organized around a coherent theme - often persecutory or grandiose) and/or has frequent auditory hallucinations related to these delusions would be diagnosed with which subtype of Schizophrenia?
Paranoid Type
What are the symptoms of Disorganized Type Schizophrenia?
disorganized speech and behavior, and flat or inappropriate affect. Delusions and hallucinations may or may not be present; if they are, they are usually fragmentary and not organized around a coherent theme
To be diagnosed with Catatonic Type Schizophrenia, a person must demonstrate:
2 of the following symptoms which include
3 motor, 1 speech, 1 speech OR motor
1) too little motor activity - immobility (waxy flexibility or stupor)
2) too much motor activity - excessive
3) strange motor activity - bizarre postures, stereotyped movements
4) no speech - extreme negativism or mutism
5) repeating speech OR movement - echolalia or echopraxia
When is a person diagnosed with Undifferentiated Type Schizophrenia as opposed to Residual Type?
A person is diagnosed with undifferentiated type when their symptoms do not meet criteria for a particular subtype. A person is diagnosed with residual type schizophrenia when the person is not currently experiencing positive symptoms (delusions, hallucinations, disorganized speech, or disorganized behavior) but has had these symptoms in the past and continues to display negative and/or attenuated positive symptoms (eccentric speech, odd beliefs, etc)
What is the difference between Type I and Type II Schizophrenia proposed by Crow?
Type I = positive symptoms.
Positive (good) premorbid functioning,
Positive response to traditional antipsychotics,
believed to be due to neurotransmitter abnormalities.
Type II = negative symptoms.
Negative (poor) premorbid adjustment,
Negative (poor) response to traditional antipsychotics, and more likely due to structural brain abnormalities
What are the 3 criteria for Mental Retardation?
- IQ < 70
- Marked deficits in 2+ areas of adaptive functioning
- Onset before age 18
What percentage of Mental Retardation cases are MILD?
85%
A child with an IQ of 50-70 would be classified as having what severity level of MR?
Mild
What percentage of Mental Retardation cases are MODERATE?
10%
What percentage of Mental Retardation cases are SEVERE?
4%
What percentage of Mental Retardation cases are PROFOUND?
1%
A child with an IQ of 35-55 would be classified as having what severity level of MR?
Moderate
A child with an IQ of 20-40 would be classified as having what severity level of MR?
Severe
A child with an IQ of <20-25 would be classified as having what severity level of MR?
Profound
A child whose poor cognitive functioning does not show up until they begin school and is able to develop communication and social skills in preschool is likely to have what level of MR?
Mild
An adult who can be trained to perform unskilled work under close supervision and who developed communication skills in early childhood is likely to have what level of MR?
Moderate
A child who does not develop speech and language skills in early childhood buy who may develop them in school and can learn basic self-care is likely to be classified as having what level of MR?
Severe
A child who has significantly impaired communication and sensorimotor skills and who needs constant supervision would be classified as having what level of MR?
Profound
An infant who fails to make eye-contact during feeding, lacks age-appropriate interest in the environment, shows delays in motor development, is less responsive to voice or movement or may interact less with a caregiver is showing early warning signs of…?
Severe Mental Retardation
What test is best to use to assess for Mental Retardation and why?
Standford Binet - lower floor (and higher ceiling)
WISC is poor due to min possible score of 50
What is the most common cause of MR?
Abnormal embryonic development - 30% of cases
Includes mother having severe illness during pregnancy, substance exposure, and Down’s Syndrome/other chromosomal disorders
What are less common causes of MR? (3)
Environmental influences (neglect/deprivation) and other Mental disorders (e.g. Autism) - 15-20 % Prenatal or birth complications (prematurity, fetal trauma, fetal malnutrition, hypoxia) - 10% Genetic Disorders (Tay-Sachs, Fragile X, PKU) - 5%
Childhood illness or injury can lead to what cognitive disorder?
Mental Retardation (due to head trauma, near drowning, measles, meningitis, etc.)
Comorbid disorders for MR (5)
AAMMM
Autism Spectrum Disorders, ADHD, Mood Disorder, Stereotypic Movement Disorder, Mental Disorder due to GMC
People with MR are __ times more likely to have other mental disorders
3-4
A child who has difficulty understanding school work, is slow to understand game rules and social rules, but may do better socially than academically may be diagnosed with?
Borderline Intellectual Functioning
What is the IQ range for Borderline Intellectual Functioning?
71 - 84
In what percentage of cases of MR is the etiology unknown?
30-40%
A person with an IQ of 71-75 with substantial deficits in adaptive functioning would be diagnosed with…?
Mild Mental Retardation. Although IQ of 71-75 could also be Borderline Intellectual Functioning, when adaptive functioning deficits are severe, Mental Retardation may be the more appropriate diagnosis.
What is the criteria for Learning Disorders?
Achievement on academic testing is 2 SD below IQ
What is the most common learning disorder?
Reading disorder, usually due to poor phonological processing
What is the male to female ratio of Learning Disorders
Close to 1:1
What percentage of children with Learning Disorders do not complete high school?
40%
What percentage of children with Learning Disorders also have ADHD?
20-30%
Treatment for learning disorders focuses on…?
Direct remediation rather than underlying sensorimotor deficits
What is the main difference between a person with Borderline Intellectual Functioning and a person with Mild Mental Retardation?
Lack of adaptive functioning deficits in Borderline Intellectual Functioning (ability to cope with common life demands)
For those with this disorder, anxiety or pressure to communicate may increase ____?
Stuttering
What is the age of onset for stuttering?
almost always before age 10
What is the male to female ratio for stuttering?
3:1
What is the treatment for stuttering?
Teaching caregivers to be patient, reducing demands and tension, teaching regulated breathing, and habit reversal (regulated breathing + awareness training + social support).
What is the criteria for Autistic Disorder?
Onset before age 3 Impairment in: 1) social interaction 2) language and communication 3) repetitive/restricted/unusual/stereotypic interests
What percentage of people with Autistic Disorder have MR?
up to 70%
What proportion of children with Autistic Disorder develop seizures by late adolescence?
1 in 4
What factors are associated with good prognosis for Autistic Disorder?
Normal IQ and speech
What is the most effective treatment for Autism?
ABA (Applied Behavioral Analysis) in early childhood
Medications can help support treatment
A child who demonstrates slowed head growth, stereotypical hand movements in place of purposeful hand movements, severe psychomotor agitation, severe impairment in language development, and loss of social engagement between 5 and 48 months of age after normal development would be diagnosed with…?
Rett’s Disorder
What percentage of males are diagnosed with Rett’s Disorder?
- Rett’s Disorder only occurs in females
What is the key difference between Asperger’s and Autism?
No language delay or communication problems in Asperger’s
What is the treatment for Asperger’s?
social skills training and/or group behavioral interventions
What differentiates Schizoid Personality Disorder from Asperger’s?
Detachment from and restricted range of affect in social situations in Schizoid Personality Disorder. A person with Asperger’s does not show a restricted range of affect; may have difficulty with social situations but is not necessarily detached
According to DSM-IV, symptoms of ADHD must be present before age:
7
Symptoms of ADHD must have a duration of at least _ months to meet criteria for diagnosis
6
What is the prevalence rate of ADHD in children and adolescents?
9.5%
What is the ratio of males to females with ADHD?
3:1
What are the most common comorbid disorders for ADHD?
Learning Disorders (50%) ODD/Conduct (40%) Anxiety (25-40%) Mood (10-30% in children, 47% in adults) Bipolar (20%)
What percent of ADHD is due to genetics?
Close to 80%
What parts of the brain are associated with ADHD?
Frontal lobe/pre-frontal cortex, basal ganglia, striatum, cerebellum
What are EBTs of ADHD?
Medications (stimulants, SNRIs) and behavioral strategies (parent management and school consultation)
A child exhibiting aggression towards people and animals, destruction of property, lying, stealing, and/or serious rule-breaking would be diagnosed with?
Conduct Disorder
Associated symptoms of Conduct Disorder include:
Irritability, low frustration tolerance, substance abuse, sexual promiscuity, and reckless behavior
Children diagnosed with Childhood-Limited Conduct Disorder may show what kinds of difficulties as adults?
depression, anxiety, social isolation, financial dependence on others
Children with child onset type Conduct Disorder show symptoms before what age?
10
Adolescents with Adolescent onset type Conduct Disorder show symptoms after what age?
10
Children/adolescents with what type of Conduct Disorder are most likely to develop Antisocial Personality Disorder?
Child-onset type
What is the difference in risk factors for Child-onset vs. Adolescent-onset Conduct Disorder?
Multiple, interactive early-onset risk factors for child-onset type; fewer risk factors for adolescent-onset
What is the male to female ratio of Conduct Disorder?
Child-onset - 5:1
Adolescent-onset - close to 1:1
Do most adolescents with Conduct Disorder develop Antisocial Personality Disorder?
No, only a minority develop Antisocial Personality Disorder
What disorders are highly comorbid with Conduct Disorder?
ADHD (30-80%), Major Depression (21-50%)
What are the risk factors for developing Conduct Disorder? (4)
- Individual: Difficult temperament
- Family: harsh and inconsistent discipline, family history of mental illness, abuse
- Social: peer rejection
- Community: exposure to violence in the community
Usually an interaction of a multitude of factors
What is Patterson’s Coercive Family Interaction Process?
Theory regarding development of conduct disorder: conduct disorder due to an interaction between ineffective parental discipline and child non-compliance
Treatment for Conduct Disorder:
Systematic, behavioral/CBT interventions such as MST, parent management training, anger management training. May use meds but not primary intervention
For a child to be diagnosed with ODD, they must show:
negative, hostile, and defiant behavior toward authority figures for at least 6 months
What fraction of children with ODD develop Conduct Disorder?
1/3
True/False: the vast majority of cases of Conduct Disorder are preceded by ODD
True
What is the age of onset for ODD?
usually before age 8
Are girls or boys more likely to be diagnosed with ODD?
Boys are more likely in childhood; in adolescence it’s about the same
Causes of ODD
Inconsistent, neglectful or overly harsh parenting
ODD is highly comorbid with:
ADHD
Treatment for ODD
- Parent management training (behavioral)
- CBT for anger management
- Social skills training (but beware of contagion in groups)
- No primary med tx, but stimulants can help reduce defiance and impulsive/retaliatory aggression
Pica is often linked to what other DSM disorders?
MR or PDD
What are the possible physical consequences of Rumination Disorder?
malnutrition or death
Rumination Disorder is linked to what environmental factors?
Stress in parent-child relationship, lack of stimulation, neglect
Feeding Disorder of Infancy or Early Childhood (aka Failure to Thrive) requires persistent failure to eat adequately for how long?
at least 1 month
Feeding Disorder of Infancy or Early Childhood (aka Failure to Thrive) is linked to what other factors?
"DEAF" Developmental delays Extreme family stress Abuse/neglect Failures in parental "reading" of infant/child hunger cues
What is the age of onset for Reactive Attachement Disorder?
before age 5
Criteria for Transient Tic Disorder:
daily motor or vocal tics between 1 to 12 months
Criteria for Chronic Tic Disorder:
daily motor OR vocal tics for at least 12 months (not both)
Criteria for Tourette’s Disorder:
daily motor AND vocal tics for at least 12 months
Disorders highly comorbid with Tourette’s:
OCD, ADHD
Treatment for Tic Disorders:
Medication and behavioral techniques both effective
To meet criteria for enuresis, a child must demonstrate inappropriate wetting for (duration)?
at least twice a week for 3 consecutive months
A child must be at least how old to be diagnosed with enuresis?
5
What are the causes of enuresis?
involuntary: recurrent urinary tract infections, underdeveloped bladder, severe stress
intentional: other mental diagnoses, premature toilet training
What is the best treatment for enuresis?
bell-and-pad (classical conditioning) most long lasting - 80% success rate
can also use medications (e.g. desmopressin) however enuresis usually returns when medication is discontinued
75% of children with Separation Anxiety Disorder also present with?
school refusal
What is the required age of onset for Separation Anxiety Disorder?
before age 18
Is Separation Anxiety Disorder more common in males or females?
Slightly more common in females
How does Separation Anxiety usually manifest in adolescents?
denial regarding separation anxiety
complain of physical symptoms, such as dizziness, rapid heart rate, etc.
What risk factors are associated with Separation Anxiety?
over protective parent, family history of anxiety, immigration, moves, family stress, separation/divorce
What are the best treatments for Separation Anxiety?
CBT/behavior - must return to school
involve parents, as parents may be reinforcing child’s fears and anxiety
Majority of children diagnosed with Selective Mutism show symptoms of what other disorder?
Social Phobia
Excessive fear or worry, need to be in control, inflexibility, heightened sensitivity to sensory stimulation is associated with what childhood anxiety disorder?
Selective Mutism
Is selective mutism more common in males or females?
selective mutism is slightly more common in females
What is the age of onset for selective mutism?
usually between ages 5 and 7
Treatment for selective mutism:
CBT/behavioral, and/or SSRI’s
A person showing major disturbances in consciousness and in cognition or perception is likely showing symptoms of…?
Delirium
Delirium is usually due to…
a general medical condition or substance intoxication or withdrawal
Delirium onset is usually sudden or slow?
Sudden onset - within hours to days
Disturbance of consciousness in delirium is marked by:
- decreased awareness of the environment
2. impaired focus, shifting attention (easily distracted, mind often wanders)
Disturbance of cognition in delirium is marked by:
- memory problems (usually short-term memory)
- disorientation (to time and place)
- language problems (dysarthria - articulation, dysnomia - naming objects, dysgraphia, aphasia - spoken/understood language, pressured/rambling/incoherent speech)
Perceptual disturbances in delirium usually take the form of:
- illusions
- hallucinations
- misinterpretations of sensory stimuli
In addition to disturbances in consciousness, cognition, and perception, people with delirium may also show signs of:
alternating agitation and lethargy emotional lability (often present, e.g. angry that family is trying to harm them, or fear with respect to visual hallucinations)
Who is at greatest risk for developing delirium?
Older adults (60+); most nursing home residents over age 75 are experiencing delirium at any one time (60%)
What groups are at risk for developing delirium?
- Older adults
- People with medical conditions or who are withdrawing from alcohol or a benzo
- Children - high fevers or medication reactions
- People with dementia - half of dementia cases also experience some delirium
What is the main difference between delirium and dementia?
Delirium involves reduction of consciousness, whereas dementia patients remain alert
Treatment for delirium
- alleviating underlying condition
- reducing factors that increase disorientation
- decreasing agitated behaviors (by providing a safe, consistent environment, meds)
