Abnormal Psychology Flashcards
“provisional” on a dx code means what?
confident that full criteria for a dx will be met with more assessment, but not enough information currently
the world health organization disability assessment schedule is used to assess a person’s ___ level in 6 domains
ability level; (understanding and communicating, getting around, self-care, getting along with people, life activities, and participation in society)
one of the 3 diagnostic criteria for intellectual developmental disorder include
1. deficits in Intel functioning (eg reasoning, problem solving, abstract thinking) that are confirmed by a clinical ___ and individualized, ___ ___ testing
assessment; standardized IQ testing
one of the 3 diagnostic criteria for intellectual developmental disorder include
2. defits in ___ functioning that result in a failure to meet community standards of personal ___ and social ___ and impair functioning across multiple environments in one or more ___ of ___ ___ (eg communication, social participation, independent living)
adaptive; independence; responsibility; activities of daily life
one of the 3 diagnostic criteria for intellectual developmental disorder include
3. the onset of iq and adaptive functioning deficits during the ___ period
developmental
Severity for IQ dev disorder is based on adaptive functioning in conceptual, ___, and ___ domains
social, practical
IQ dev disorder may remit in milder cases with proper intervention. T/F
T
motor dev and lack of response to external stimuli (delays in these) suggest what kind of neurodev disorder?
IQ dev disorder
___ ___ ___ is the strongest predictor of severity for IQ dev disorder
Low birth weight
for childhood onset fluency disorder (stuttering), sxs usually begin between the ages of ___ and ___, but most (65-85%) recover with severity of dysfluency at age ___ being good predictor of prognosis
2 and 7; 8
habit reversal training is an effective tool for what communication disorder?
child onset fluency disorder/stuttering (for children, helping parents to mitigate their kid’s stress/frustration and to stop punishing them for stuttering)
people who have never shown symptoms of autism whatsoever could still be diagnosed with autism as adults. T/F
False, symptoms during early dev period are required
the best outcomes for people with ASD are associated with the ability to ___ ___ by age 5 or 6, an IQ over ___, and higher levels of adaptive ___.
communicate verbally; 70; adaptive functioning
ASD has been linked with unusually rapid ___ growth in the 1st year of life, structural brain abnormalities esp. in the ___ and the ___, and serotonin, dopamine, and other NT abnormalities
head growth; cerebellum and amygdala
ADHD must be present before age ___ for at least ___ months
12; 6
Read:
Adults with ADHD are at higher risk for bipolar, depression, anxiety, antisocial behavior, and substance abuse
ADHD prevalence is about ___% for children and ___% for adults
7; 2.5
there is about a ____:1 ratio of ADHD in males vs females (differs for children and adults), but the ___ subtype is more common in males and the ___ subtype is more common in females
2:1 for children or 1.6:1 for adults; combined for males and inattentive for females
most children with ADHD continue to meet criteria as teens, but only about ___% meet full criteria as adults and up to ___% meet criteria in partial remission.
15; 60
genetics and what biological features appear to contribute to etiology of ADHD?
brain abnormalities (less activity in caudate nucleus, globus pallidus, and prefrontal cortex, and smaller size of each of these)
the behavioral disinhibition hypothesis of ADHD states what?
ADHD’s core feature is the inability to regulate behavior to fit situational demands (an alternate theory says that inability to regulate attention to what is not nonrelevant is the core feature)
methylphenidate is what name brand drug for what stimulant used for ADHD?
Ritalin
The MTA study (NIMH Multimodal Treatment Study of ADHD) compared what four groups of ADHD treatment and showed what outcomes including 3 and 8 yr follow ups?
- meds
- intensive bh
- combined
- regular community care
1 and 3 had better outcomes, but all four had similar outcomes in follow ups
the etiology of intellectual dev disorder is unknown in about ___% of cases
30
specific learning disorder criteria include onset during ___ and have persisted for at least ___ months without improvement with interventions
school-age years; 6 months
the most common comorbid disorder with spec learning disorder is ___ with about 20-___% of cases
ADHD; 20-30% (these children are also at higher risk for antisocial behavior and for legal consequences of said behavior)
the gender ratio for spec learning disorders for men to women ranges from ___:1 to ___:1
2:1 to 3:1
T or F, spec learning disorders always have one clear etiology
F (may be genetics, dysfunction in certain parts of the brain or hemispheres, toxin exposure, or deficits in certain processing)
Tourette’s disorder requires at least one ___ tic and multiple ___ tics that have persisted for 1 year or more but began prior to age ___
vocal tic, motor tics, 18 (tics can happen simultaneously and can fluctuate in frequency over time) (sxs tend to decline past childhood)
Tourette’s requires both motor and vocal to meet criteria, but one or the other is persistent motor or vocal tic disorder. T/F
T (provisional tic disorder is when sxs have not been present for a year yet and before 18)
associated sxs with tourette’s include which two categories?
OCD and hyperactive/impulsive/distractible
Tourette’s is linked with elevated levels of what NT and sensitivity to receptors for that NT in what brain part?
dopamine, caudate nucleus
How is Tourette’s usually treated?
with pharmacotherapy (e.g. antipsychotics, SSRI for OCD) and comprehensive behavioral treatment for tics (CBIT)
children between the ages of ___ and ___ tend to have the most negative reactions to hospitalization largely due to ____
1 and 4; isolation from family
physical disabilities are often linked to mental health sxs in youth, especially for folks with major neuropsych disorders. for example the rate of psych problems in kids with hemiplegic cerebral palsy was at least 2, 3, or 4 times higher than the rate for children w/out a physical disability?
3
Read:
chronic medical conditions and their treatments can be associated with impaired school success, neurocog functioning, and learning disabilities in youth
adolescents may lack compliance with medical procedures due to concerns about ___ acceptance, reduced ___ to rules, ___ of the credibility of the healthcare provider, and reduced parental ___.
peer acceptance, conformity to rules, questioning credibility, parental supervision
multicomponent CBT interventions inspired by the stress inoculation model have been shown to benefit children’s anxiety about what according to research?
anxiety about medical procedures (providing info about procedure and doing stress/coping techniques)
Read:
A polythetic criteria set requires that an individual meet only a subset of the criteria for a given disorder to qualify for that diagnosis. Consequently, people with somewhat different symptoms can be assigned the same diagnosis.
The symptoms of ADHD vary somewhat over the lifespan. ___ and ___ decrease over time, while ___ predominates the symptom profile during adulthood.
hyperactivity and impulsivity, while inattention
Does schizophrenia include a catatonia specifier?
yes
having poor insight into one’s illness (of schizophrenia) is called what? It contributes to treatment ___ and predicts ___
anosognosia; treatment noncompliane and predicts relapse
what class of common co-occuring MH disorders happen with schizophrenia?
SU (tobacco use disorder esp. high)
the prevalence rate for schizophrenia is about…
.3% to .7% (.5% acceptable)
the prevalence rate for schizophrenia varies extremely depending on gender. T/F
False (females slightly lower)
Research shows that the apparently high rate of schizophrenia among African Americans is due to ___ since African Americans are more likely to experience ___ and ___ in the context of ___ and other disorders
misdiagnosis; hallucinations and delusions; depression, etc.
Research by WHO shows that folks with schizophrenia in ___ vs. ___ more likely to have had acute onset of sxs, shorter clinical course, and complete sx remission
non-Western developing countries vs. Western industrialized countries
Scizophrenia’s onset is typically from when to when? how does onset differ for males vs. females?
late teens to early 30s; peak onset is early 20s for males and late 20s for females
Better prognosis for schizophrenia:
- ___ premorbid adjustment
- onset that is ___ and ___
- ___ gender
- a ___ event
- a ___ duration of active sxs
- good/bad insight
- family hx of ___ disorder
- no family hx of ___
good premorbid adjustment
onset that is acute and late
female gender
a precipitating event
a brief duration of active sxs
good insight
family hx of mood disorder
no family hx of schizophrenia
Concordance Rates for Schizophrenia (Gottesman, 1991)
Relationship………….Concordance Rate
bio sibling……………….
fraternal twin………….
identical twin………….
child of two parents with schizophrenia……….
10%
17%
48%
46%
name 3 of the five brain areas associated with schizophrenia
enlarged ventricles (most consistent finding), smaller hippocampus, amygdala, and globus pallidus, lower than normal prefrontal cortex activity
the dopamine hypothesis suggests what connections between dopamine and schizophrenia?
too much dop or oversensitive dop receptors
some research suggests a link between birth month and schizophrenia in the northern hemisphere for what reason?
prenatal exposure to influenza during colder months
describe the presence of mood disorder sxs with schizophrenia, bipolar/MDD, and schizoaffective disorder
schizophrenia - mood sxs not present during psychotic sxs and are not full mood episodes
bipolar/MDD - psychotic sxs only occur during episodes of mood disorder
schizoactive - mood occurs with psychotic sxs for most of the time, but also 2+ week periods with only psychotic sxs
In the 1950s, neuroleptic/antipsychotic drugs had a huge impact on the treatment of….
schizophrenia
first gen antipsychotics include which 2 and include what major benefits and potential risks? (schizophrenia)
haloperidol (haldol) and fluphenazine; help with positive sxs; tardive dyskinesia
second gen antipsychotics include which 2 and include what major benefits and potential risks? (schizophrenia)
clozapine and risperidone; less likely to develop TD and helpful for both pos and neg sxs
High levels of ___ ___ from family (schizophrenia) is characterized by open ___ and ___ toward the pt, or ___ and emotional ___. High ___ ___ is associated with increased risk of relapse and rehospitalization
expressed emotion (EE); open criticism and hostility; overprotectiveness and emotional overinvolvement; High EE
how are the diagnostic criteria for schizophreniform disorder different from schizophrenia?
sxs between 1 month and 6 months, impaired functioning may not occur (about 2/3 of people with schizophreniform disorder eventually meet criteria for schizophrenia or schizoaffective disorder)
time line for brief psychotic disorder and what kind of life event typically precipitates it
one day but less than one month, often following an overwhelming stressor
delusions in a delusional disorder last for at least ___ month(s)
1 month
Read:
“active phase” sxs of schizophrenia must be present for 1 month, but there must be signs of the disorder for at least 6 months
Read: The diagnosis of Schizophrenia requires the presence of two or more active phase symptoms for at least one month and continuous signs of the disturbance for at least six months. It also requires at least one active phase symptom to be hallucinations, delusions, or disorganized speech.
hallucinations, delusions, disorganized speech, grossly disorganized behavior, and negative sxs count as active phase symptoms
Read:
the most common associated features of Schizophrenia include inappropriate affect, dysphoric mood, disturbed sleep pattern, and lack of interest in eating
If a manic episode is only 6 days, does it count as a full manic episode?
no, 1 week or more
What are the most common comorbid conditions with bipolar?
anxiety and SU
how much higher is the lifetime risk for suicide for people with bipolar than the general population and what % die by suicide?
20-30 times greater; 5-6% die by suicide
The gender prevalence ratio of bipolar is 2:1 males to females. T/F
F (it’s 1.1:1)
approximately what percent of the US population meets bipolar criteria in a given year?
1.5%
what % of individuals with one bipolar episode have another? 5/25/90/95?
90
The average age for the first episode of a bipolar disorder is what? 19/22/25/28?
22
of the psychiatric disorders, what disorder has been found to have the most consistent genetic link?
bipolar
Lithium has been shown to be effective in 60 to ___% of bipolar cases (with discrete manic/dep episodes), but patients commonly discontinue early because they feel better, do not like the ___ effects, or miss the ___ feelings of mania
60-90%, side effects, “highs” or good feelings
pharmacotherapy has been shown to be effective for bipolar, with ___ interventions shown to help with med compliance and overall outcomes
psychosocial (like CBT, family focused treatment, and interpersonal and social rhythm therapy)
to meet criteria for a hypomanic episode, sxs must be present for 2, 4, or 7 days at least? how many characteristic sxs must be present?
4 days for hypomania; 3 (just like full manic episode or bipolar I)
T/F: the mood symptoms in cyclothymia always meet criteria for a full-blown manic or depressive episode.
F (sxs do not meet criteria for any major mood episode)
how long must sxs last to qualify as cyclothymia? do they differ for children vs. adults? can the person have symptoms for less than half the time or be symptom-free for more than 2 months at a time to still qualify?
2 years in adults, 1 year for youth; no
in disruptive mood dysregulation disorder, ___ outbursts manifest verbally or physically at least ___ times a week on average, and between outbursts a chronically ___ mood is present on most days.
temper; 3x; irritable or angry
in disruptive mood dysregulation disorder, sxs must be present for at least ___ months and are exhibited in at least 2/3 settings (school, home, with peers). dx must be assigned between ages ___ and___ with onset before age ___
6 months; 6 and 18; onset before age 10
peripartum onset of a bipolar or depressive disorder occurs during ___ or within ___ weeks pospartum
during pregnancy or within 4 weeks postpartum
The “baby blues” consists of transitory mood sxs and affects up to ___% of women during the first 2 weeks following delivery, while about ___-___% of women experience depression during or w/in several months after pregnancy, and .___ to .___% of women develop postpartum psychosis
80%; 10-20%; .1-.2%
Read:
women with postpartum depression with psychosis will have a 30-50% in subsequent pregnancies of it recurring
seasonal affective disorder is associated with ___somnia, craving ___, and ___ appetite and ___ gain
hypersomnia, craving carbs, increase appetite, and weight gain
Read:
melatonin levels changing, circadian rhythm delays, and serotonergic dysfunction have all been linked to seasonal affective disorder
Abnormalities in what major physical process is highly correlated with major depression?
sleep (early morning awakening, less slow wave and early/more REM)
What is the 12 month prevalence for MDD in the US? 7/14/21/28%?
7%
beginning in puberty, the rates of depression are higher or lower for girls than boys?
higher for girls (1.5 to 3 times higher)
T/F: the prevalence rates for depression are the same for 18 to 29 yr olds as it is for those over 60.
F: 3x higher for 18-29
what age range is the peak age of onset of MDD?
mid-20s
as the number of previous episodes of depression increases, the risk for subsequent episodes is related more to the ___ of ___ ___ than to the occurrence of a life stressor
number of prior episodes
in distinguishing between depression (“pseudodementia”) from mild neurocognitive disorder in elders, what is different about the onset and insight between the two presentations?
in mild neurocognitive, onset is gradual and progressive and the person has little insight into their difficulties, while pseudodementia has rapid onset and concern for impairment is clear
somatic complaints, irritability, and withdrawal in children are common manifestations of….
MDD
cog sxs such as memory loss, distractibility, disorientation, etc. are common manifestations of MDD in what age range?
elders
the concordance rates of MDD in fraternal twins is the same as identical twins. T/F
False (.2 in dizygotic twins and .5 in monozygotic twins)
the relationship between dep and neuroticism is largely due to what according to Kendler et al. (1993)?
genetics
evidence suggests that total duration of untreated depression correlates with the amount of shrinkage in what brain structure?
hippocampus (possibly due to cortisol, which can cause atrophy or neurons to hippocampus)
T/F. the indolamine hypothesis says that MDD is due to low serotonin, and the catecholamine hypothesis suggests something similar but with acetylcholine
F. indolamine hy is serotonin, but the catecholamine hy is norepinephrine (and dopamine)
The behavioral theory of depression but Lewisohn says that dep is due to lack of what?
positive reinforcers in environment (e.g., death of loved one and their related reinforcers leads to extinction in behaviors to achieve rewards, leading to pessimism, low SE, and isolation)
Seligman’s 1978 learned helplessness model suggests that dep is due to what 2 things?
exposure to uncontrollable negative events + attributions of those events to internal, immutable factors (a more recent version of this model says that hopelessness is the only primary cause)
Read: self control model
Rehm’s model says that depression is due to stringent self standards, low self reward, and attention to neg events and immediate outcomes.
Although studies confirm Beck’s cognitive triad of depression, Lewinsohn found that low self-evaluations by depressed individuals about their social skills were more consistent with what?
judgments of others/reality (compared to non-depressed people)
in distinguishing MDD from uncomplicated bereavement (UB), a person with UB experiences their mood as ___. They tend to feel ___ or experiencing ___, which ___ over days to weeks and comes in waves with reminders of the deceased
normal; empty or experiencing loss, which decreases
What class of antidepressant appears to be the most effective for “classic” sxs of MDD, including vegetative sxs, worse sxs in the AM, acute onset and short duration of sxs, and moderate severity?
tricyclics (TCAs)
What advantages exist for SSRIs?
fewer side effects and lower risk for fatal overdose than TCAs (also are typically first line option for moderate to severe dep)
what class of drugs are recommended for dep when TCAs and SSRIs are ineffective or a person has atypical sxs, such as anxiety, hypersomnia, hyperphagia (eating too much/appetite high), or interpersonal sensitivity?
monoamine oxidase inhibitors (MAOIs)
SNRIs such as Effexor, Pristiq, and Cymbalta increase levels of what 2 NTs?
serotonin and norepinephrine (both indolamine and catecholamine hypotheses!)
In treating dep, CBT is associated with lower risk of relapse than what other kind of therapy according to research from study materials?
pharmacotherapy
primary undesirable effects of ECT include confusion, disorientation, and what 2 kinds of amnesia? Effects can be reduced by administering ECT how?
anterograde and retrograde amnesia; applying it unilaterally to the right (nondominant) hemisphere
Persistent Dep disorder has at least 2 of the following: poor appetite or ___ing, ___ energy, low self-___, poor concentration or difficulty making ___, or feelings of ___.
overeating, low energy, low SE, difficulty making decision, feelings of hopelessness
for persistent dep disorder, how long can a person go without sxs and still qualify for the dx?
2 months
for premenstrual dysphoric disorder, the presence of at least 5 characteristic sxs when in relation to onset of menses with improvement when and the absence of sxs when?
sxs during the week before onset of menses, sxs improve w/in a few days after onset of menses, and sxs go away entirely or mostly during the week postmenses
Individuals with a ___ disorder are 17 more likely to be at-risk of suicide
depressive disorder (and about 60% of individual who complete suicide have a mood disorder dx at the time of their death)
Between 1991 and 2003 and after 2021, rates of suicide were highest among elders (like 65 or 85 or older), but between those periods, for men and women the rates of suicide were higher between the ages of ___ to ___
45 - 54
In 2020, suicide was the ___th leader cause of death in the US.
12th leading cause of death in the US.
by race/ethnicity, the groups with the highest rates of suicide are 1) ___ and 2) ___.
1) non-Hispanic American Indian/Alaskan Native people, 2) non-Hispanic white people
for marital status, what 3 groups have the highest rates of suicide followed by those who are single? (hint: 2 of these groups are categorically similar) what group has the lowest rates?
divorced, separated, and widowed have the highest rates, lowest rates are married
T/F. rates of suicide never vary by employment in certain industries such as construction or mining
F
Read:
as many as 60-80% of people who die by suicide have made at least one previous attempt, and about 80% give a definite warning of their intention
among teens, suicide is often immediately preceded by what kind of conflict?
interpersonal, such as a fight with a parent or rejection by a significant other
individuals with a mood dx are about 1___-2___% more likely to attempt suicide, and MDD and bipolar are the most common for those who die by suicide
15-20%
when suicide is associated with depression, it is most likely to occur within ___ months after dep sxs begin to ___
3 months, begin to improve
when dep occurs with conduct disorder, SU disorder, or ADHD, risk for suicide dramatically increases in what age group?
adolescents
low levels of what NT and one of its metabolites have been linked to increased risk for suicide and violent SI attempts?
serotonin and 5-HIAA
Read:
in terms of personality correlates for suicide, hopelessness and perfectionism have shown to be associated with relatively higher risk
apprehension, tension, trembling, excessive worry, and nightmares are “pure” ___ sxs, while low mood, anhedonia, loss of interest in usual activities, SI, and decreased libido are “pure” ___ sxs
anxiety, depressive
separation anxiety disorder requires 1) distress when unconnected from attachment figure/home, 2) fear of being alone, and 3) complaints of ___ ___ when unconnected from attachment figure/home
physical sxs
how many weeks are required for separation anxiety disorder in youth and how many months for adults?
4 weeks in youth; 6 months in adults
school refusal usually takes place in youth at 3 ages: 5 to ___, ____ to 11, and 14 to ___
5-7, 10-11, 14-16 (starting school, transitioning schools, and social anxiety disorder/dep/other)
kids with sep anxt disorder often come from ___ families and the disorder is often triggered by what kind of circumstance?
warm families, major life stressor or change
Mower’s two factor theory for specific phobia attributes the condition to a combination of what 2 psychological processes?
classical and operant conditioning (first learn to pair stimulus with unconditioned scary stimulus and then avoid the conditioned stimulus to reduce anxiety, which reinforces the avoidance)
exposure with response prevention is the best line of defense for OCD only. T/F
False (also best for specific phobia, social anxiety disorder, and agoraphobia) (In vivo exposure with response prevention is the treatment of choice for Agoraphobia.)
anxiety about exposure to ___ by others is the hallmark of social anxiety disorder
scrutiny by others
to qualify for panic disorder, a person must have had 2+ unexpected panic attacks and then have at least one month/six months/1 year of persistent concern about multiple attacks.
1 month
the 12 month prevalence of panic disorder is roughly what %?
2 to 3 %
panic disorder frequency by gender: males or females tend to be about 2x as likely to receive the dx?
females are more likely
relapse with panic disorder is low/medium/high when pharmacotherapy is used alone
high (30-70% of patients have return of sxs within months of stopping their drug)
Agoraphobia requires fear about ___-like, incapacitating, or ___ sxs
panic-like, incapacitating, or embarrassing sxs (anxiety is reduced when with a trusted person) (In vivo exposure with response prevention is the treatment of choice for Agoraphobia)
Of the anxiety disorders, ___ is associated with the highest comorbidity rates.
generalized anxiety disorder (GAD is highly comorbid with other psychiatric disorders, with studies reporting comorbidity rates ranging from about 80 to 90%.)
folks with nonpathological anxiety tend to have a ___ number of things they stress over, less likely to have ___ sxs, and feel they can ___ their anxiety to some degree
fewer number of things; physical sxs; control their anxiety
OCD has a 12 month prevalence of #.#%
1.2%
age of onset of OCD is earlier/later for boys than girls, which leads to prevalence rates being higher for males/females among youth
earlier for boys, so rates are higher among male youth (but among adults, rates are slightly higher among women
there is a hypothesis that OCD is caused by low levels of what NT?
serotonin (which drug effectiveness seems to support)
the brain structure implicated in OCD is what? (and what two others appear to be implicated too?)
right caudate nucleus (also the orbitofrontal cortex and the cingulate cortex)
the P in OCPD could also stand for what personality trait that is more associated with OCPD than OCD?
perfectionism (as opposed to obsessions/compulsions like OCD)
sxs of reactive attachment disorder must be present before age ___ and the child must be at least nine months old developmentally
age 5
differences in timeline for PTSD vs. acute stress disorder: what is the cutoff time for acute stress disorder to then be considered for PTSD?
1 month
Read:
PTSD and GAD are best treated with multi-component CBT, with exposure and other C&B interventions
Read:
The correct number of characteristic symptoms of anxiety for a diagnosis of GAD in children is 1. For adults it is 3.
Read:
A diagnosis of Persistent Depressive Disorder involves a depressed mood on most days for at least two years in adults or one year in children and adolescents. The diagnosis requires the presence of at least two of the following symptoms: poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; impaired concentration or decision making; and feelings of hopelessness.
dissociative identity disorder is characterized by the existence in 1 person of 2 or more distinct ___ states or the experience of ___.
personality states; possession
dissociative amnesia: can’t remember ___ information
personal information
___ and ___ amnesia are most common in dissociative amnesia, as opposed to generalized, continuous, or systematized amnesia
localized and selective amnesia as opposed to other amnesias (localized is all events in specific period and selective is some events in a specific period)
Read:
amnesia:
generalized is a person’s whole life
continuous is events following a specific time through the present
systematized is memories related to a certain category of information in one’s life
depersonalization is a sense of…while derealization is a sense of…
sense of unreality, detachment, or being an outside observer of one’s thoughts, feelings, etc.;
sense of unreality or detachment involving one’s surroundings
(reality testing stays intact during depersonalization or derealization)
Read:
somatic symptom disorder is when a person suffers from a somatic sx that causes distress or disruption in one’s daily life with excessive thoughts/feelings/behaviors related to it
Read:
with illness anxiety disorder, physical sxs are minimal or nonexistent, but a person is concerned with their health excessively
key difference between illness anxiety and somatic sx disorder:
the presence of a physical symptom
a functional neurological sx disorder (conversion disorder) involves a disturbance in voluntary ___ or ___ functioning and suggest a serious ___ or other medical condition with evidence of incompatibility between the sx and recognized medical condition
motor or sensory; serious neurological or other medical condition (big medical sxs that cannot be explained medically)
explain the key difference between malingering and a factitious disorder
with malingering there is a clear external reward, but with factitious disorder the motivation is a not a clear external reward
T/F: Pica is most common in elders.
F (most common in children)
severity specifier for anorexia are based on what variable?
weight
over half of individuals with anorexia develop what kind of disorder that often appears before the ED?
anxiety disorder (usually OCD or soc anxiety) (dep is also common comorbid) (similar findings are true for bulimia)
what is the typical age of onset for anorexia? bulimia?
adolescence or early adulthood for both
bulimia is often preceded by an episode of dieting, whereas anorexia is often associated with a stressful life event. T/F
T
Read: Anorexia involves restricting food, a fear of gaining weight and distorted body image. Bulimia involves bingeing with large amounts of food and then purging by vomiting, laxative use, fasting or compulsive exercising (or other inappropriate compensatory behavior).
The main difference between diagnoses is that anorexia nervosa is a syndrome of self-starvation involving significant weight loss of 15 percent or more of ideal body weight, whereas patients with bulimia nervosa are, by definition, at normal weight or above.
T/F about 60% of those diagnosed with anorexia or bulimia are female.
F. Over 90% are female
Research finds a strong ___ component to the etiology of anorexia
genetic (supported by concordance rates among twins and first degree relatives) (perfectionism is also strongly supported, and environmental factors are inconsistent)
higher than average of this NT has been linked to anorexia (hint: think of food and gut)
serotonin (for bulimia, low serotonin is associated)
the study materials list high expressed emotion (EE) as a particular concern for what 2 disorders?
schizophrenia, anorexia
the length of time and frequency for symptoms of bulimia or binge eating disorders are at least 1 binge per ___ for how many months?
1 per week; 3 months of sxs
T/F. Enuresis can be diagnosed when a child is 5 years old.
T (must be at least 5 (developmentally))
the most common treatment for enuresis is the ___-and-___ method that causes an ___ to sound when the sleeping child begins to ___ themselves
bell-and-pad; alarm; wet themselves
Enuresis refers to disturbance in which bodily function, while encopresis refers to disturbance in which other bodily function?
Number 1; number 2
a dx of insomnia disorder requires sleep disturbance at least ___ nights per week with a pattern that has occurred for at least ___ months, causing significant impairment to functioning
3 nights; 3 months (similar pattern for hypersomnolence disorder and narcolepsy)
hypersomnolesnce disorder involves excessive ___ despite a main sleep period of at least ___ hours with at least one other sleep symptom
sleepiness; 7 hrs
many individuals with narcolepsy experience what kinds of hallucinations? (describe or name)
hypnagogic (before falling asleep) (Vivid dreamlike images) or hypnopompic (while waking up)
cataplexy (loss of muscle tone) is often triggered by strong ___, so people with narcolepsy often try to control their sleep attacks.
strong emotions (such as anger, surprise, etc.)
non-rapid eye movement sleep arousal disorders are characterized by what two classes of behavior?
sleepwalking and sleep terrors
non-rapid eye movement sleep arousal disorders typically occur when during the night’s sleep?
first third, usually during stage 3 or 4 sleep
night terrors typically happen in ___ and involve an abrupt arousal from ___ that often begins with a ___y ___ and is accompanied by intense ___ and autonomic ___. The individual often remembers everything about the event - T/F?
childhood; arousal from sleep; panicky scream; intense fear and autonomic arousal; F - they usually forget it all
assigning a sexual dysfunction dx requires that sxs not be better explained by a ___ mental disorder, ___ distress or other stressor, or a biological reason
nonsexual mental disorder; relationship distress (and referral for medical evaluation is always first step in treatment)
a complete absence of erections during REM sleep suggests what kind of etiology in erectile disorder?
organic etiology
the length of time required for early ejaculation, genito-pelvic pain/penetration, and erectile disorders are all how many months?
6 months (The DSM-5 requires the presence of characteristic symptoms for a minimum duration of approximately six months for all Sexual Dysfunction diagnoses except Substance/Medication-Induced Sexual Dysfunction.)
premature ejaculation has been linked to what NT and what class of drug has been shown to be helpful?
serotonin; SSRIs
According to the DSM-5-TR, rates of persistence of gender dysphoria for individuals assigned male at birth are generally lower than for those assigned female at birth. T/F
T (for AMAB, it ranges from 2.2%-30% and for AFAB, it ranges from 12%-50%)
frotteuristic disorder involves sexual arousal from ___ing or ___ing against (consenting or non-consenting) adults with a history of acting on urges. The disorder often starts in ___ and bxs associated with it often decline with age
touching or rubbing against non-consenting adults; adolescence
Read: ODD
those with oppositional defiant disorder frequently have troubles with anger/irritability, argumentativeness, defiance of authority or rules, and blaming others for their mistakes
T/F Intermittent Explosive Disorder can be assigned to a person as young as 5
F. Person must be at least 6 or equivalent dev age
The four categories of characteristic sxs of conduct disorder are 1) ___ to people and animals, 2) destruction of ___, 3) ___ or theft, and 4) serious ___ of ___.
aggression to people or animals, destruction of property, deceitfulness or theft, and serious violation of rules
if a person is over 18, can they still be assigned a conduct disorder diagnosis? what if they also meet criteria for antisocial personality disorder?
generally yes, but not if meet criteria for APD
explain basic differences between Moffitt’s (1993) two types of conduct disorder
life-course- persistent type: present at an early age, increasingly serious transgressions, Neuro impairments + difficult temperament + adverse enviro circumstances
adolescent-limited type: temporary, represent maturity gap between bio development and access to more adult privileges and rewards, acts committed with peers and are inconsistent across contexts
Read:
Rumination Disorder involves the repeated regurgitation of food, which may be re-chewed, re-swallowed, or spit out.
An SU disorder dx requires at least 2 characteristic sxs during a 12 month period. These characteristic sxs can be categorized in terms of 4 groups, which are…
impaired control (more use than intended, can’t cut back, lots of efforts to obtain/recover from SU, cravings)
social impairment (SU impairs roles or social relationships, giving up impt activities)
risk use (use in spite of phys effects, use at risky times)
pharmacological (tolerance or withdrawal)
Conger (1956) proposed that alcohol use occurs to reduce ___ that a person experiences and that SU is ___ly reinforced. But, Marlatt and Gordon (1985) contended that addictive behaviors, like other behaviors, are ___ed, maladaptive habit pattern.
tension; negatively reinforced
overlearned, maladaptive habit
Marlatt and Gordon’s (1985) relapse prevention therapy focuses on identifying ___ that increase risk for relapse and implementing ___ and ___ strategies that help a client prevent and cope effectively with lapses (which are viewed as the result of external, controllable circumstances)
IDing circumstances; cognitive and behavioral strategies
a smoking cessation intervention that includes what 3 parts are more likely to abstain long-term?
nicotine replacement therapy, multicomponent behavioral therapy (skills training, relapse prevention, stim control, rapid smoking), and support/assistance from a clinician
what SU-induced disorder likely represents the following sxs? sweating, tachycardia (heartbeat too fast), hand tremor, insomnia, nausea or vomiting, transient illusions or hallucinations, anxiety, psychomotor agitation, generalized tonic-clonic seizures?
alcohol withdrawal
alcohol-induced major neurocognitive disorder is characterized by significant decline in major cog domains interfering with functioning. There are 2 specifiers for this disorder: non-amnestic/amnestic-confabulatory type. Name and describe the amnestic-confabulatory type
Korsakoff syndrome; retro/anterograde amnesia and confabulation (filling in memory blanks) (has been linked to a thiamine deficiency)
alcohol intoxication creates immediate ___ with increased stages ___ and ___ sleep and reduced ___ sleep, but later in the night ___ sleep increases with wakefulness and vivid dreams and stages ___ and ___ decrease (alcohol-induced sleep disorder)
immediate sedation, increased stages 3 and 4, reduced REM, REM increases, stages 3 and 4 decrease
when alcohol-induced sleep disorder is induced by withdrawal, severe disruption in sleep ___ and ___ dreams occur
sleep continuity and vivid dreams
If a person had at least three of the following, what SU-induced disorder would they likely have? [dysphoric mood, nausea or vomiting, muscle aches, teariness or runny nose, pupillary dilation, goose bumps, sweating, diarrhea, yawning, fever, insomnia]
opioid withdrawal
name four characteristic sxs associated with tobacco withdrawal (there are 7 total)
irritability or anger, anxiety, impaired concentration, increased appetite, restlessness, depressed mood, or insomnia
Read: delirium entails…
A) a disturbance in attention and awareness that develops over a short period of time, is a change from baseline functioning, and tends to fluctuate in severity over the course of a day
B) one more cog disturbance (memory, disorientation, language, visuospatial ability, perception)
(has to have physio/medical cause)
Wise (1995) identified 5 groups at higher risk for delirium:
1) older/younger adults
2) people with decreased ___ reserve (due to HIV/dementia/stroke)
3) recent open-___-surgery pts
4) eye surgery/infection/burn pts
5) people withdrawing from drugs, esp. alcohol/benzos/meth [pick 2]
1) older adults
2) decreased cerebral reserve
3) open-heart-surgery
4) burn pts
5) ETOH and benzo withdrawal
what antipsychotic drug can help delirium pts with agitation, delusions, and hallucinations?
haldol or haloperidol
major neurocognitive disorder subsumed what other neurocog disorder from the DSM4TR?
dementia (significant (not just modest) decline from previous functioning in 1 or more cog domains, YES interfering with independence and not just delirium)
mild neurocognitive disorder subsumed what other neurocog disorder from the DSM4TR?
cognitive disorder NOS (modest (not significant) decline from previous functioning in 1 or more cog domains, NOT interfering with independence and not just delirium)
Read: 13 types of neurocog disorders mild and major
Alzheimer’s disease, vascular disease, traumatic brain injury, HIV infection, Huntington’s disease, frontotemporal lobar degeneration, Lewy body disease, SU/medication use, prion disease, Parkinson’s, another medical condition, multiple etiologies, and unspecified
alzheimer’s is diagnosed (major or mild neurocog disorder) when there is ___ onset of sxs and a ___ progression of impairment in one or more cog domains, and criteria for probable or possible alzheimer’s is met
insidious onset of sxs and a gradual progress of impairment
for alzheimer’s to count as a major neurocognitive disorder, can possible alzheimer’s be present or does it have to be probable?
must be probable (for mild neurocog, it could be probable or possible)
for probable Alzheimer’s, there must be causative genetic ___, clear evidence of decline in ___ and at least one other cog domains, a steadily progressive and gradual decline in cog without extended ___s, and no evidence of mixed ___ogy
genetic mutation (key difference between probable/possible alzheimer’s), decline in memory, extended plateaus, mixed etiology
difference between probable and possible alzheimer’s
evidence or no evidence of causatic genetic mutation
what key area in the brain are found significant neuron loss and neuritic plaques and neurofibrillary tangles upon autopsy/brain biopsy in alzheimer’s patients?
medial temporal structures (entorhinal cortex, hippocampus, amygdala)
what is the single most common cause of dementia and accounts for 60-90% of all cases?
alzheimer’s
T/F: 70s-80s (late onset) is more common in alzheimer’s and dementia than early onset
T
how many stages of alzheimer’s are there?
3
what are the year ranges for the 3 stages of alzheimer’s?
Stage 1 - 1-3 years
Stage 2 - 2-10 years
Stage 3 - 8-12 years
what kind of amnesia is most prominent in stage 1 alzheimer’s? it is accompanied by deficits in ___ skills (wandering); indifference, irritability, and sadness, and anomia, meaning what?
anterograde amnesia (esp for declarative memories) accompanied by deficits in visuospatial skills; anomia means trouble with finding the right words
Stage 2 of alzheimer’s has ___ amnesia that increases; flat or ___ mood; restlessness and ___; delusions; fluent ___; acalculia; and ideomotor apraxia, meaning what?
retrograde amnesia; flat or labile mood; restlessness and agitation; fluent aphasia (Wernicke’s aphasia, where person has fluent grammar and makes sense to themselves but speaks nonsense); ideomotor apraxia means they cannot translate an idea into movement
Stage 3 of alzheimer’s involves severely deteriorated ___ functioning; apathy/labile mood; ___ rigidity; and urinary and fecal ___
Intellectual functioning; limb rigidity; fecal incontinence
name 2 major biological contributions to alzheimer’s etiology generally speaking
genetics and abnormal levels of NTs
what NT is most associated with alzheimer’s? it is known to be involved in the formation of ___
acetylcholine; formation of memories
interventions for alzheimer’s include ___ and ___ therapy as well as various kinds of what medical interventions?
group therapy and behavioral therapy; pharmacotherapies
outcomes for Alzheimer’s are best when pts stay with their families as opposed to going to homes. T/F
T (and when families are provided with adequate support, education, skills training, and other indiv and family interventions)
vascular neurocognitive disorder can exist with mild or major neurocog disorder but are consistent with a ___ etiology and ___vascular disease from the pt’s history, a phys examination, and/or neuroimaging sufficient to account for sxs
vascular etiology and cerebrovascular disease (risk factors are biological, and course and extent are dependent on etiology)
Read: Neurocognitive disorder due to HIV infection…
causes sxs characteristic of neurocog disorders affecting subcortical areas of the brain (concentration, memory, mood, tremor, clumsiness, saccadic eye movements, other movement issues)
Neurocog disorder due to HIV disease is also known as ___ ___ ___ (ADC) and is described as having 6 stages reflecting progressive deficits in neurocog and neuropsych functioning
Stage 0 [___]
Stage 0.5 [___]
Stage 1 [___]
Stage 2 [___]
Stage 3 [___]
Stage 4 [___]
AIDS Dementia Complex
Stage 0 (normal)
Stage 0.5 (equivocal/subclinical)
Stage 1 (mild)
Stage 2 (moderate)
Stage 3 (severe)
Stage 4 (end stage)
vascular neurocog disorder may involve an acute/extended onset with partial recovery, ___ decline, fluctuating symptom ___ and ___s that vary in duration
acute onset, stepwise decline, fluctuating sx severity and plateaus that vary in duration
a personality disorder has on onset during ___ or early ___
adolescence or early adulthood
can antisocial personality disorder be diagnosed before age 18?
No (other PDs possibly yes but must be present for at least one year according to the DSM)
Cluster A PDs involve ___ or ___ behavior. Cluster B PDs involve ___, ____, or ___ behaviors. Cluster C PDs involve ___ and/or ___.
odd or eccentric behavior; dramatic, emotional, or erratic behaviors; anxiety and/or fearfulness
schizoid PD: person displays a pervasive pattern of ___ from interpersonal relationships and a ___ range of ___ expression in social settings
detachment from interpersonal relationships and restricted range of emotional expression
Schizoid: at least 4 of the following sxs must be present:
doesn’t ___ or ___ close relationships;
almost always chooses ___ activities; has little interest in sexual relationships; takes pleasure in few/many activities; lacks close friends or confidants other than first-degree relatives; seems ___ to praise or criticism; exhibits emotional ___ness or detachment
doesn’t desire or enjoy close relationships; choose solitary activities; few activities; indifferent to praise/criticism; emotional coldness
between schizotypal and schizoid PD, which are more likely to convey a desire for close personal contact?
schizotypal
Read:
Symptoms of Opioid Withdrawal are very uncomfortable but usually not life-threatening and are similar to those associated with a bad cold or the flu (e.g., muscle pain and cramps, diarrhea, chills, sneezing, lethargy)
Researchers have found that sex therapy is the most effective treatment for ___ Ejaculation and ___ Disorder. Commonly used sex therapy techniques include sensate focus and the start-stop and squeeze technique.
Premature Ejaculation and Genito-Pelvic Pain/Penetration Disorder
antisocial PD is characterized by a pattern of disregard for and violation of the rights of others that has occurred since age ___ with what disorder having had started prior to that age?
15; conduct disorder
T/F: A 17 yr old can be diagnosed with antisocial PD
F (must be 18 at least with hx of conduct disorder before age 15)
characteristic sxs of antisocial PD include
1. failure to conform to social ___s with respect to ___ behavior
2. deceitfulness/bold truth
3. impulsivity/calculating behavior
4. irritability and ___ness
5. reckless disregard for the safety of ___ and ___s
6. consistent ___ty
7. lack of ___
- social norms with respect to lawful behavior
- deceitfulness
- impulsivity
- irritability and aggressiveness
- safety of self and others
- consistent irresponsibility
- lack of remorse
Common associated sxs with antisocial PD (not necessarily diagnostic) include
1. an ___ sense of self
2. lack of ___ for others
3. superficial ___
- inflated sense of self
- lack of empathy for others
- superficial charm
T/F by the fourth decade of life, antisocial PD sxs, esp. involvement in crime, tend to increase
F: they tend to become less severe and pervasive by a person’s 30s
substantial improvement in sxs have been found for BPD in 15 yr follow up studies; by age 40, up to ___% of individuals no longer meet all of the diagnostic criteria
75%
(Borderline PD) Zanarini et al. (2003) found that, at 6 yr follow up with BPD patients, ___ sxs resolve most quickly, cognitive and interpersonal sxs were intermediate for resolution, and ___ sxs were the most chronic
impulsive resolve most quickly, cog and interpersonal sxs were intermediate, and affective sxs were most chronic (73.5% of patients met criteria for remission at 6 yr follow up)
Which of the following theorists attributed BPD to both biological and environmental factors? Kernberg, Linehan, Mahler, or Adolph Stern?
Linehan (emot dysregulation is core feature of BPD, resulting from excessive emotional vulnerability, inability to modulate strong emotions, and exposure to invalidating environment)
Histrionic PD is characterized by a persistent pattern of ___ and ___-seeking
emotionality and attention-seeking
characteristic sxs of histrionic PD include
1. ___ when not the center of attention
2. inappropriately sexually ___ or ___
3. rapidly ___ing and ___ emotions
4. consistent use of ___ ___ to gain attention
5. excessively ___ speech that is lacking in ___
6. exaggerated expression of ___
7. easily ___ by others
8. considers relationships to be more ___ than they are
- discomfort when not center of attention
- sexually seductive or provocative
- shifting and shallow emotions
- use physical appearance to gain attention
- excessively impressionistic speech that is lacking in detail
- expression of emotion
- influenced by others
- relationships to be more intimate than they are
Those with narcissistic personality disorder may, among other tendencies, believe they are ___ and can only be understood by other ___-status people; have a sense of ___ment; be interpersonally ____tive; lack ___; and ___ others and believe others are ___ous of them
believe they are unique and can only be understood by other high-status people; have a sense of entitlement; be interpersonally exploitative; lack empathy; and envy others and believe others are envious of them
avoidant personality disorder is characterized by a pervasive pattern of social ___, feelings of ___, and ___ to negative evaluation
social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation (can affect work, meeting new people, intimate relationships, self-view, new activities, and preoccupations with criticism/rejection)
those with dependent personality disorder have a pervasive and excessive need to be ___ ___ of, which leads to ___sive, ___ing behavior and a fear of ___
pervasive and excessive need to be taken care of, which leads to submissive, clinging behavior and a fear of separation
OCPD does involve true obsessions and compulsions just like OCD. T/F
F (OCPD does not involve true obsessions and compulsions)
OCPD is characterized by a persistent preoccupation with ___ness, ___ism, and mental and interpersonal ___ that severely limits their flexibility, openness, and efficiency.
orderliness, perfectionism, and mental and interpersonal control
Read:
Research results have demonstrated that family therapy is more effective than individual therapy as an intervention for schizophrenia.
Read:
According to the DSM, Disruptive Mood Dysregulation Disorder (DMDD) is characterized by chronic, severe, and persistent irritability with frequent temper outbursts that are out of proportion to the situation. It is typically diagnosed in children and adolescents between ages 6-18.DMDD cannot coexist with Bipolar Disorder. This is because DMDD was created to differentiate chronic irritability in children from Bipolar Disorder, which is characterized by episodic mood changes (mania/hypomania). DMDD cannot coexist with Intermittent Explosive Disorder (IED) because IED involves episodic aggression, whereas DMDD is characterized by chronic irritability with recurrent temper outbursts. DMDD cannot coexist with Oppositional Defiant Disorder (ODD) unless the mood symptoms in DMDD (e.g., persistent irritability) are significantly more severe than typical ODD symptoms. Otherwise, DMDD takes precedence.
Read:
dysphoria (low mood), vivid and frightening dreams, sleep disturbances (insomnia or hypersomnia), fatigue, psychomotor agitation or retardation, and increased appetite—are classic features of stimulant withdrawal, particularly from substances like cocaine and amphetamines.
Read: Intoxication due to amphetamine or other stimulant use is generally characterized by hypervigilance, psychomotor agitation, tachycardia, elevated blood pressure, and nausea and vomiting.
Cannabis Intoxication may involve anxiety, impaired judgment, social withdrawal, tachycardia, and increased appetite.
Use of Sedative, Hypnotic, or Anxiolytic Intoxication may produce Intoxication, which is characterized by mood lability, impaired judgment, slurred speech, impaired coordination, and deficits in memory and attention.
Opioid Intoxication shares some symptoms with Sedative Intoxication; however, it is also characterized by initial euphoria followed by apathy, dysphoria, and psychomotor retardation or agitation.
Chronic otitis media (middle ear infections) in early childhood has been linked to Specific ___ Disorder.
Specific learning disorder
Read:
A dissociative fugue is characterized by apparently purposeful travel or wandering that is associated with an inability to recall one’s past. In the DSM-5, dissociative fugue is a specifier for Dissociative Amnesia.
Read:
Negative symptoms of schizophrenia include restrictions in range and intensity of emotional expression (affective flattening), restrictions in fluency and productivity of thought and speech (alogia), and restrictions in the initiation of goal-directed behavior (avolition).
___ tests would be most useful for monitoring the progression of Alzheimer’s disease out of all other options.
Cognitive tests
Read:
Although its effects are still not understood, ECT continues to be used to treat depression, especially severe forms involving suicidal preoccupation and vegetative symptoms.
Read:
Perceptual distortions (depersonalization and derealization) are potential symptoms of a panic attack (among other conditions/disorders)
Read: Culture may influence the experience and manifestation of depression and other mental disorders. “Nervios” is a common idiom of distress for Latinos and may be indicative of depression or another diagnosis. It is manifested primarily in terms of somatic complaints such as headaches, sleep problems, and nervousness.
Individuals from Middle Eastern cultures may describe depression as a “problem of the heart.”
Weakness, tiredness, and an imbalance - terms that may be used by members of Chinese and other Asian cultures to describe depression.
Read:
The DSM-5 requires that Adjustment Disorder symptoms develop within three months of the onset of the stressor and that symptoms do not persist for more than six months after the stressor or its consequences have ended.
Read:
Some brain imagining studies have linked hypofrontality (decreased activity in the prefrontal cortex) to the negative symptoms of Schizophrenia.
Read: depression and sleep
Approximately 40 to 60% of outpatients who meet the criteria for a major depressive episode demonstrate EEG abnormalities during sleep, including decreased REM latency (i.e., an earlier onset of REM sleep). People who are diagnosed with Major Depressive Disorder often experience decreased slow-wave sleep. A diagnosis of Major Depressive Disorder has been correlated with increased REM density.
Read:
Lithium is ordinarily the first-line pharmacological treatment for Bipolar I Disorder. However, an anticonvulsant (e.g., carbamazepine, valproic acid, gabapentin) is often prescribed when an individual is intolerant to Lithium or has non-responsive symptoms.
The severity level (mild, moderate, severe, or extreme) for a DSM-5 diagnosis of Bulimia Nervosa is based on what?
Average number of weekly episodes of inappropriate compensatory behavior
Read: There are some age-related differences in the symptoms of Generalized Anxiety Disorder. Children diagnosed with GAD most commonly worry about school and sports performance or natural disasters and other catastrophic events.
Worry about family relationships is more common among adults with GAD. Illness and injury are also more common sources of worry among adults with symptoms of this disorder.
Read (bulimia):
Electrolyte imbalances caused by vomiting and the use of laxatives and diuretics can have serious consequences, including, in extreme cases, cardiac arrhythmia and arrest.
