Abnormal Psychology Flashcards
Mild MR
IQ is 50-55 thru approx. 70; 85% of all MR cases; may not become apparent until child is school age and has difficulty meeting educational demands
Moderate MR
Approx 10% or MR population; IQ between 35-40 and 50-55; usually develop communication skills during early childhood; can be trained to performed unskilled work under close supervision
Severe MR
3-4% of the MR population; IQ between 20-25 and 35-40; communicative speech usually does not develop during early childhood, although it may be acquired during the school-age years; can learn basic self-care, but need more supervision
Profound MR
Approx 1-2% of MR population; IQ of less than 20-25; communication skills and sensorimotor functioning are significantly impaired; need nearly constant supervision and generally benefit from a one-to-one relationship with a caregiver
Assessing MR
WISC has high floor, or minimum score of about 50; this test cannot provide accurate assessment of the level of MR. Stanford-Binet best to assess MR because its floor is much lower (also to assess giftedness).
Causes of MR
Varied and etiology may be undetermined in approximately 30-40% of cases. Clear etiologies easier to ascertain w/severe or profound MR. Most common identifiable cause is abnormalities in embryonic development; maternal illness; maternal consumption of alcohol, maternal use of nicotine or drugs and chromosomal changes.
What is the most common form of LD?
Reading disorder (dyslexia). 80% of LDs and approx. 4% of all children.
What percentage of those with LD do not complete High School?
40%
What percentage of children with LD have comorbid ADHD?
20-30%
What are most cases of reading disorder due to?
Poor sound awareness and sound-symbol correspondence (phonological processing).
What are the two types of dyslexia?
Surface dyslexia (AKA orthogonal dyslexia: difficulty with irregular words, ex. might = mit) and deep dyslexia (probs with many words, even “regular” ones)
Alexia
Dyslexia due to brain damage
What percentage of LD people struggle with significant psychosocial probs as adults?
Approx 33%
Borderline Intellectual Functioning
IQ between 71 and 84
Stuttering
Onset nearly always under 10; approx 3:1 boy:girl ratio; peak onset age 5. Often resolved by age 16, but may persist to adulthood, especially with males. Must cause impairment for a diagnosis. Rarely recommended, but Verpamil may help.
Phonological Disorder
A childhood communication disorder characterized by failure to use developmentally appropriate speech sounds; when speaking, individuals with this disorder may substitute one sound for another, omit sounds, incorrectly order sounds within words of syllables, lisp, or otherwise misarticulate sounds.
Autism and Gender
Boys more likely to have AD, but when girls have it they are more likely to also have MR
What percentage of individuals with autism show MR? Have seizures?
MR - about 70%. 25% develop seizures.
What indicates good prognosis with autism?
Normal range IQ (over 70) and spoken language by age 6.
Rhett’s Disorder
A PDD in which a child demonstrates deceleration in head growth, replacement of purposeful hand skills w/stereotyped hand movements (hand-wringing), severe psychomotor agitation, severe impairment in language development,a nd loss of social engagement. Sx appear between 5 and 48 mths in age, after an apparently normal prenatal and perinatal development. Only occurs in females.
ADHD and nuerology
Frontal lobe functioning and frontal striata pathways are implicated in symptoms
Prevalence of ADHD
5-8% of children and adolescents (slightly lower in adults); sex ratio is 3:1 male:female. Comorbidity with ODD/CD, anxiety disorders, mood disorders, LD; strongly heritable (around 80%)
ODD
A disruptive behavior disorder characterized by negativistic, hostile, and defiant behavior (actively disobeying directions or parents or other caregivers, short temper, spitefulness, irritability, failure to take responsibility for one’s mistakes or misbehavior, frequent arguments w/adults) lasting at least 6 mths.
Conduct Disorder
Disruptive Behavior Disorder characterized by aggression toward people or animals, destruction of property, deceitfulness, theft, and serious rule violations, childhood precursor to Antisocial Personality Disorder.
Pica
Some normality between 18-24 mths. Regular ingetsion of non-nutritive substances, often linked to MR or PDD, can lead to serious medical complications (lead poisoning for example)
Rumination Disorder
25% of these children may die as a result of malnutrition. Repeated regurgitation and often re-chewing of food without apparent distress; may result in malnutrition or death; linked to stress in parent-child relationship, along with lack of stimulation, child neglect.
Feeding disorder of infancy or early childhood (“failure to thrive”).
Causes more probs when occurring before age 2. Failure to eat adequately for at least one month. Linked w/developmental delays, sometimes child abuse or neglect, extreme stress in the family, clear failures in parental “reading” of infant/child hunger cues, or forcing food.
Reactive Attachment Disorder
Child displays significantly disturbed social relatedness, linked directly to grossly pathological care (and not MR or PDD). Onset before age 5.
Two types of RAD
Inhibited Type: Children do not engage in many interactions, are hypervigilant, wary of letting other people come close to or make eye contact with them (“frozen watchfulness”), and often resistant toward physical affection. and Disinhibited Type: Children are indiscriminately sociable and fail to make selective attachments, act overly familiar (i.e. overly affectionate) with strangers.
Transient Tic Disorder
1+ motor or vocal tics daily for between 4 weeks and 12 months
Chronic Tic Disorder
Involves at least 12 months of daily motor OR vocal tics, but not both
Tourette’s Disorder
Involves at least 12 mths of daily motor AND vocal tics
Essential Tremors
A neurological disorder characterized by rhythmic tremors in the hands or other body parts that only occur during intentional movements (i.e. not while at rest)
Stereotypic Movement Disorder
A disorder usually first diagnosed in infancy, childhood, or adolescence characterized by repetitive, seemingly driven, and nonfunctional motor behaviors that significantly interferes with normal activities or cause self-inflicted physical injuries; often associated with MR
Percentage of children with enuresis by age
5-10% of 5-year-olds; 3-5% of 10-year-olds, and 1% of individuals aged 15 and older.
Separation Anxiety Disorder
Refusal to attend school is one of the characteristics, but only three need to be present for dx. Children under 8 more likely to worry about catastrophes befalling the attachment figure. 9-12 year olds may experience significant distress at separation or anticipation of separation.
Selective Mutism
Indicative of anxiety; not of abuse or neglect. Majority of those dx will also have sx of social phobia. Occurs in less than 1% of individuals seen in outpatient setting. Slightly more common in females than males. Onset usually between the ages of 5 and 7.
Delirium
Major disturbance in consciousness and in cognitive/perception, usually resulting from medical condition or substance intoxication or withdrawal. Sudden onset. Alternating agitation and lethargy common; emotional lability often present (anger at family; fearful during hallucination)
Who is at risk for delirium?
Adults over 60 highest risk (60% of nursing home residents over age 75 may experience delirium). Also surgery, burn patients, stroke or HIV and drug users. Children are at increased risk, especially with high grade fevers or medication reactions; may co-occur with demential. Delirium involves reduction of consciousness while those with dementia remain alert.
Brief Psychotic Disorder
A disorder characterized by presence of delusions, hallucinations, disorganized speech, or catatonic behavior. Sx last for at least a day, but for less than a month, after which individual returns to pre-morbid functioning.
Vascular Dementia
A cognitive disorder caused by a cerebrovascular disease (stroke). Sx include memory impairment, aphasia, apraxia, agnosia, and disturbed executive functioning; characterized by a sudden onset and fluctuating course with rapid changes in cognitive functioning.
Two types of CVAs
Hemmorrhagic CVA involve bleeding into brain from weakened blood vessels (often linked to hypertension). Ischemic CVAs involve obstructed blood flow related to clots or dislodged tissues; these account for 85% of CVAs.
Recovery and mortality rate for CVAs
Mortality rate is around 30%; only 10% make a full recovery.
What percentage of CVAs occur while a person is sleeping?
Approximately 1/3
Which resolves first after a CVA: physical difficulties or cognitive difficulties?
Usually physical
Stages of Demential due to HIV disease:
Subclinical (Sx result in minimal impairment without deficits in activities of daily living); Mild (unequivocal evidence of functional, intellectual, or motor impairments, but pts able to perform most ADLs and are fully ambulatory); Moderate (pts unable to work or perform demanding ADLs, but are able to perform basic self-care, require some assistance walking); Severe (pts demonstrate significant intellectual impairments and cannot walk unassisted); End Stage (pts are nearly vegetative)
What percentage of pts with Parkinson’s will eventually develop dementia?
20-60%
Parkinson’s and depression
Year before dx, those taking anti-depressants are 2x as likely to receive diagnosis of Parkinson’s.
Onset of Parkinson’s
Typically after 65 years of age
How often do those going through alcohol withdrawal experience delirium tremons?
Fewer than 10%. When it does happen, 1-5% have a fatal outcome.
Sx of alcohol withdrawal
Autonomic hyperactivity, tremors, insomnia, short-lived hallucinations or illusions, agitation, grand mal seizures
Sx or amphetamine withdrawal
Dysphoria, fatigue, vivid dreams, insomnia or hypersomnia, increased appetite, and psychomotor agitation or retardation. Sx appear within hours or days after discontinued use.
Sx of opioid withdrawal
Dysphoria, nausea or vomiting, muscle aches, excessive tears of nasal mucus, restlessness, diarrhea, yawning, fever, or insomnia. Sx appear within hours of days of discontinued use or after the administration of an opioid antagonist following opioid use.
Sx of Alcohol-Induced Persisting Dementia
Memory impairment, one of more of the following: ataxia, apraxia, agnosia, or executive functioning deficits; significant impairment in social, occupational functioning and decline from prior functioning. (Aphasia less likely to appear than in other dementias)
Alcohol-Induced Persisting Demential associated with what physiologically and nuerologically?
Frontal lobe atrophy, malnutrition, vitamin deficiencies (especially vitamin B1 or thiamine), head trauma, Wernicke’s encephalopathy, and cirrhosis of the liver. Most often damage is permanent even in alcohol use is stopped.
Development of Alcohol-Induced Amnestic Disorder
Usually preceded by Wernicke’s encephalopathy, which produces symptoms of confusion, loss of muscle coordination, and nystagmus (rapid, involuntary eye movements). If treated early w/large doses of thiamine, the progression to Alcohol-Induced Persisting Amnestic Disorder may be slowed or stopped; otherwise Wernicke’s encephalopathy recedes but more permanent Korsakoff’s Syndrome emerges.
Alcohol-Induced Sleep Disorder
Characterized by the insomnia type; leads initially to increased somnolence, leading to deep sleep and decreased REM first half of night’s sleep but increased REM sleep during the second half of a night’s sleep.
Nicotine withdrawal
Occus within 24 hours with abrupt cessation; dysphoric/depressed mood, insomnia, irritability, frustration/anger, anxiety, difficulty concentrating, restlessness, decreased heart rate, increased appetite/weight gain.
Nicotine abstinence success most predicted by:
Being male, over 35, married with a partner, later age at onset of smoking
Substance-Induced Psychotic Disorder
Presence of hallucinations or delusions during or within a month of substance intoxication or withdrawal. Hallucination must not be recognized as a product of the substance. Intoxication or withdrawal may lead to Substance-Induced Psychotic Disorder. May also be produced by OTC meds.
Type I Schizophrenia
Believed to result from dopamine abnormalities, linked to positive/excess sx, less likely to experience intellectual deficits, associated with good response to medication, including traditional antipsychotics, better prognosis, and more positive outcomes overall.
Type II Schizophrenia
Beleived to be caused by structural brain abnormalities (i.e. atrophy in the prefrontal and temporal lobes), linked to negative symptoms, less positive outcomes, negative/deficit symptoms, worse prognosis.
Cluster A Personality Disorders
Paranoid, schizoid, schizotypal
Cluster B Personality Disorders
Antisocial, borderline, histrionic, narcissistic
Cluster C Personality Disorders
Avoidant, dependent, OCPD
Schizophreniform Disorder
A psychotic disorder similar to schizophrenia, but with (a) the duration criterion between one and six months, and (b) without the severe impairment criteria found in schizophrenia. About 2/3 go on to schizophrenia or shizoaffective. May be higher rates in developing nations than in US or developed nations.
Schizoaffective Disorder
A psychotic disorder in which major depressive, manic, or mixed episode occurs in the presence of symptoms of schizophrenia
Schizoid Personality Disorder
A personality disorder characterized by detachment from interpersonal relationships and a restricted range of emotional expression.
Schizotypal Personality Disorder
Characterized by extreme discomfort with and difficulty maintaining close interpersonal relationship, cognitive or perceptual distortions (paranoia, ideas of reference, magical thinking), and odd behaviors.
Prognosis for schizoaffective disorder
Better for the bipolar type than the depressed type
Bipolar I Disorder
Characterized by one or more Manic or Mixed Episodes; Major Depressive Episodes may also be present
Magical Thinking
The belief that one’s thoughts or actions will cause or prevent a specific outcome in a way that defies or does not adhere to the normal laws of cause and effect.
In cases of cohabitation, who is more likely to have Shared Psychotic Disorder?
Sisters are more likely than brothers
Lifetime prevalence rates of Major Depressive Disorder
10-25% in women, 5-12% in men. Sex difference begins during adolescence. Average onset in mid-20s, but may appear at any point in life-cycle.
Dysthymic Disorder Prevalence Rates
Women are 203 times more likely than men to exhibit dysthymia (though before adolescence, boy-to-girl ratio approximately 1:1). Prevalence is approximately 6%.
Postpartum Blues vx. Postpartum Depression
50-80% get the blues within 3-4 days of birth and last for about 2 weeks. Postpartum Depression more severe, could effect development of child, episode of major depression within four weeks of delivery, and affects 10-15% of mothers.
Major Depressive Episode, with Postpartum Onset, with Psychotic Features
Extremely rare, one to two per 1,000. More likely w/previous bipolar dx, prev postpartum psychosis, and first-time mothers.
Bipolar II Disorder
At least one Hypomanic Episode as well as one or more Major Depressive Episodes
Bipolar disorders and prevalence rates
Bipolar I disorder is 1% of population. Bipolar II is 0.5% of population. Men and women equally likely to develop Bipolar I; women are more likely than men to develop Bipolar II
Three stages of mania
I - Hypomania. May be difficult to recognize. Seem cheerful.
II - Full Mania
III - Disorganized Mania
Prevalence rates of agoraphobia
3:1 female-to-male ratio; agoraphobia is likely to be comorbid with other anxiety disorders
Treatment for Agoraphobia
Behavioral therapies (exposure, desensitization, in vivo exposure with response prevention), and SSRIs
Prevalence rates for specific phobia
Onset for situational type typically childhood or mid 20s. Estimated that 7-11% will experience specific phobia some time in their lives. Incidence declines with age. Women-to-men 2:1 ratio. 50-80% in a community sample had a concurrent dx.
Prevalence rates of social phobia
Lifetime prevalence rates between 3-13% making it one of the most prevalent. Age of onset typically during mid-teens. In community samples, women slightly outnumber men. In outpatient samples, pretty equal.
Dx comorbid with social phobia
Bulimia, mood disorders, substance-related disorders, and other anxiety disorders
OCD prevalence rates
Up to 3% of population: equal between men and women. Childhood onset more likely to occur in boys (ages 6-15). In females, onset typically between ages of 20 and 29.
OCD Treatment
Most effective treatment is Exposure and Response Prevention therapy (ERP), bx strategy of exposure to distressing stimulus and prevention of compulsive response. SSRI meds also effective. Combo particularly effective.
What percentage of people exposed to traumatic events will develop PTSD?
30-50%
Specifiers for PTSD
Acute (sx span more than one, but fewer than 3 mths).
Chronic (more than three mths).
Delayed Onset (sx do not appear for more than 6 mths after traumatic event).
Debriefing and PTSD
All in all, not helpful
Top two treatments for PTSD
Prolonged/Imaginal Exposure and Cognitive Processing
Comorbidity and GAD
Usually not an independent disorder, more so than others. Comorbidity rates high with major depression and dysthymia; substance abuse also seen. Also comorbid with disorders in the anxiety group
Prevalence Rates for GAD
5% of the population; twice as prevalent in women as men
Somatization Disorder
Involves a hx of multiple medical complaints that cannot be fully verified medically. Onset by age 30, with multiple years of symptoms and significant impairment. Not feigning or malingering. Pain shoudl be related to four different sites: head, abdomen, joints, chest, or bodily functions like menstruation or urination (gastrointestinal, sexual or reproductive, psedoneurological)
Somatization Disorders are comorbid with:
Histrionic, borderline and antisocial. Approx 61% of those with somatization disorder also have a personality disorder.
Conversion Disorder
Condition in which an individual develops motor or sensory symptoms that are not faked, yet do not have an identifiable neurological cause. Usually linked with a psychosocial stressor.
Prognosis for conversion disorder
Good with above-average intelligence, identifiable psychosocial stressor, treatment and presence of sx of aphonia (loss of ability to speak through disease or damage to larynx or mouth), blindness, and paralysis. Poor with seizures or tremors in symptom picture.
Maintenance of conversion disorder related to:
Primary gain (reduction of anxiety) or secondary gain (attention; avoidance of responsibility)
Conversion Disorder Comorbidities
Dissociative Disorders, major depressive disorder, antisocial personality disorder, histrionic personality disorder, borderline personality disorder, and dependent personality disorder
Factitious Disorder
Intentional production of physical or psychological signs or symptoms, motivated by desire to assume sick role (and not for direct secondary gain). Sx may be exaggerated or actually fabricated.
Factitious Disorder by Proxy
AKA Münchausen syndrome by proxy. Intentionally causing another to be sick (usually a child). Chronic Factitious Disorder: typically middle-aged men, estranged from the family.
Prevalence of Factitious Disorder
Often associated with Axis II, particularly borderline. Most likely dx in females, but “by proxy” most often in males, unmarried, middle-aged, estranged from family of origin.
Five Types od Dissociative Amnesia
Localized Type: Memory is lost for specific time period following event. Selective Type: Only some aspects of events are recalled. Generalized Type: Person cannot recall entire life. Continuous TypePerson forgets events from time of trauma until present. Systemized Type: Person forgets one category of information (related to specific person)
What are the two most frequently occurring types of Dissociative Amnesia?
Localized and Selective
Prevalence rates of DID
90% are victims of abuse, 2/3 incest
Comorbiditites of DID
Borderline, mood disorders, substance disorders, eating disorders, sleep disorders
Medication treatment for male orgasmic disorder
Non-SSRI antidepressants
Frotteurism
Rubbing against or touching a non-consenting person in a sexual manner
Pedophilia
Attraction to prepubescent children
Sexual Sadism
Infliction of pain, humiliation, or suffering
Sexual masochism
Experiencing pain, humiliation, or suffering
Treatment for paraphilias
Covert sensitization (taught to associate the sexually arousing stimulus with its negative consequences, inducing aversive conditioning in the imagination rather than in vivo). Orgasmic Reconditioning (masturbation to typical, inappropriate stimulus, but after ejaculation switches fantasy to appropriate sexual stimulus). Satiation Therapy (Masturbation past the point of pleasure to inappropriate stimulus).
GID
Transsexualism. Usually referred for treatment between 2 and 4 years of age. Etiology is unknown.
Prevalence rates and outcomes for GID
3/4 of young boys will grow up to be homosexual or bisexual but without persisting GID. Vast majority of adults adjust well after sex-reassignment surgery. The majority of women with GID are attracted to females.
Bulimia Nervosa
Binge eating and compensatory behaviors that occur at least twice a week for at least three months. Within purging type, 80-90% purge by vomiting.
Prevalence rates for Bulimia Nervosa
1-3% of population. 9:1 female-to-male ratio. Typical onset in late teen years. Hx of sexual abuse in 30%.
Narcolepsy
To be dx, must have the cataplexy, or recurrent infiltration of REM sleep elements into the transitional period between waking and sleeping.
Hypnagogic hallucinations
Vivid dreamlike imagery experienced just before falling asleep
Hypnopompic hallucinations
Vivid dreamlike imagery experienced just after awakening
Prevalence rates for narcolepsy
About 1% of population. Equal in men and women. About 50% cases preceded by acute psychological stressor or change in sleep-wake cycle.
Parasomnias
Sleep disorders in which an individual experiences abnormal behavioral or physiological events in association with sleep.
Sleep Terror Disorder
Recurrent episodes of sudden awakening, with intense arousal and extreme fear; individual resistant to being comforted and may react violently if touched; little memory of any dream content; amnesia for event in the morning. Onset usually 4-12 years of age (males predominate) or during 20s (equal male-female ratio). Sleep terror in adults usually associated with emotional stressors or alcohol consumption.
Age of onset for sleepwalking disorder
Initial episode occurs between ages of 4-8; peak prevalence around 12. Often co-occurs with Sleep Terror Disorder.
Nightmare Disorder
Repeated awakening after vivid and frightening dreams related to personal threat, which can be recalled in detail. Occur during REM sleep, usually without movement or vocalizations. Onset usually between 3-6 years old; 2-4 times more common in girls. Often related to severe stress.
Avoidant Personality Disorder
These people desire contact with others but avoid it due to fears of criticism or rejection.
Prevalence of antisocial behaviors amongst males and females
30-40% of males and 16-32% of females have committed a serious act of violence by 17 years of age. More severe outcomes for those who do so earlier.
Prevalence rates of bereavement
In US, grief usually resolves within a few months. Pathological grief occurs in 10-20% of bereaved individuals. Children between 3-5 and early adolescents are more vulnerable to pathological grief.
Suicide Stats
30,000 annually. Men 4x more likely than women to die by suicide, but women 3x more likely to attempt. Third leading cause of death among pple ages 10-24 and 2nd leading cause of death among college students. Rates highest among Whites with exception of between ages 15-24, American Indians and Native Alaskans highest rate of completed suicide. Lower in AA males than White males in adolescents. Lowest among Hispanics, Asian and Pacific Islanders and AA. Individuals 24-44 most likely to attempt, 65+ most likely to complete. Greatest increase in last 10 yrs amongst 10-14 year-olds (especially girls)
