Abnormal Psychology Flashcards
1
Q
Categorical approach
A
The approach the DSM takes to defining and describing mental illness.
Illnesses are also categorized by general symptom clusters and the clinician decides if the patient meets the diagnostic criteria laid out
2
Q
Polythetic Criteria
A
Criteria in the DSM don’t all have to be met to achieve a diagnosis
Allows for two people to have the same diagnosis with slightly different presentations. Accounts for heterogeneity of presentations
3
Q
Nonaxial Assessment System
A
The DSM-5 got rid of the Axis system of diagnosing. Just list all medical and mental diagnoses together, with the primary diagnoses listed first
4
Q
How to handle diagnostic uncertainty
A
Other specified - when you want to indicate why someone doesn’t meet criteria
Unspecified - when you don’t want to indicate why someone doesn’t meet criteria
Provisional - when person doesn’t meet full criteria but you believe they will in the future
5
Q
Other specified disorders
A
When you want to list the reasons why someone doesn’t meet full criteria for another disorder
6
Q
Unspecified disorders
A
When the clinician doesn’t want to list the reasons why a person doesn’t meet criteria
7
Q
Provisional diagnoses
A
When someone is not meeting criteria for a disorder, but you believe they will in the near future
8
Q
Assessment strategies for the DSM
A
Cross-cutting measures
Severity measures
WHODAS
Personality inventories
9
Q
Cultural Formulation
A
Provides guidelines for assessing the clients cultural identity, cultural conceptualization of distress, stressors and cultural factors that contribute to distress, and cultural factors relevant to rapport
10
Q
Neurodevelopmental Disorders
A
Intellectual Disability Autism Spectrum Disorder ADHD Specific Learning Disorders Tourette’s Communication Disorders
11
Q
Presentation of neurodevelopmental disorders typically manifest…
A
Early in development, often before the child enters grade school
12
Q
Three diagnostic criteria for Intellectual Disability
A
Deficits in intellectual fxning, confirmed by standardized testing
Deficits in adaptive functioning
Must have onset in developmental period
13
Q
Early signs of intellectual disability include…
A
Delays in motor development
Lack of age-appropriate interest in environmental stimuli
(May not make eye contact during feeding, less responsive to voice)
14
Q
Etiology of Intellectual Disability
A
30% unknown 30% chromosomal and exposure to toxins 15-20% environmental 10% perinatal issues 5% acquired medical 5% heredity (Tay-Sachs, fragile X...)
15
Q
Primary communication disorder
A
Childhood onset fluency disorder
Stuttering
16
Q
Characteristics of Child-Onset Fluency Disorder
A
Disturbance in normal language fluency and time pattering
Involves repetition of sound and syllables, broken words, etc.
Inappropriate for the persons age
17
Q
Course of child onset fluency disorder
A
Onset 2-7 years
Symptoms become more pronounced when speech performance matters
Severity of issue by age 8 is a good indicator of prognosis, 65-85% of children recover
18
Q
Treatment for childhood onset fluency disorder
A
Reducing stress at home
Help child cope with frustration
Habit reversal training - relax muscles in throat and diaphragm
19
Q
Diagnostic criteria for Autism Spectrum Disorder
A
Persistent deficits in social communication (reciprocity, difficulty understanding relationships, nonverbal comm issues)
Restrictive and repetitive interests or patterns of behavior
Early developmental period onset, impairments in many domains
20
Q
Associated features with ASD
A
Intellectual deficits
Self-injurious behavior
Language abnormalities
21
Q
Onset of ASD
A
Earliest signs are abnormalities of social orienting and responsivity
Apparent around 12 months of age
22
Q
Prognosis of ASD
A
Generally poor
One third may obtain some independence as an adult
23
Q
Best outcomes of ASD are associated with…
A
IQ above 70
Later onset of symptoms
Development of verbal communication abilities by age 5 or 6
24
Q
Etiology of ASD
A
Associated with rapid head growth in first year of life
Brain abnormalities in amygdala and cerebellum
NT abnormalities (dopamine, serotonin)
25
Treatment for ASD
Special education
Parent management training
Social interaction and vocational skills
For communication: shaping and discrimination training
26
Diagnostic criteria for ADHD
At least six sx, last six months, onset before age 12, more than two settings
Hyperactivity
Inattention
27
Three specifiers in ADHD
Hyperactive type - six or more hyperactive sx, less than six inattentive sx
Inattentive type - six or more inattentive sx, less than six hyperactive sx
Combined - six or more inattentive, six or more hyperactive
28
Associated features of ADHD
| For children
Intelligence is often avg to high average, but perform lower on IQ or standardized tests
Academic and social difficulties
29
Associated features of ADHD
| For adults
Low self-esteem
Lower educational or occupational attainment
Problems related to social relationships
30
Prevalence of ADHD
5% for children
2.5% for adults
Males > females
(Males combined, females inattentive
31
Etiology of ADHD
Genetic component
Brain abnormalities in globus pallidus, caudate nucleus, and prefrontal cortex (lower than normal activity)
32
Behavioral disinhibition hypothesis for ADHD
Core feature of ADHD is an inability to regulate behavior to fir situational demands
(An alternative hypothesis said that it was an inability to regulate attention)
33
Treatments for ADHD
Methylphenidate or CNS stimulants are effective in 75% of cases
Behavioral treatments - parent and teacher training, positive reinforcement
Medical only and medical/tx have higher outcomes but only for short-term (similar improvement long term when compared to tx only)
34
Three domains of adaptive functioning deficits in Intellectual Disability
Conceptual
Social
Practical
35
Diagnostic criteria for Specific Learning Disorder
Deficit in an academic area for at least six months despite the provision of interventions
Academic abilities must be substantially below what’s expected given age
Begin during school years
Not attributed to other conditions or disorders
36
Three subtypes of SLD
Reading
Writing
Mathematics
37
Most frequent comorbid disorder with SLD
ADHD
20-30%
Also have a higher risk for antisocial behavior
38
Course and prognosis of SLD
Continue to struggle from childhood through to adulthood
One third have psychosocial problems as adults
39
Prevalence of SLD (gender)
Males > females
40
Etiology of SLD
Genetic component
Incomplete hemispheric dominance or other abnormalities
Cerebellar-vestibular dysfunction
41
Criteria for Tourette’s Disorder
At least one vocal tic
Multiple motor tics
Onset before age 18, lasts at least one year
Less than 1yr = provisional // over 1yr = persistent (chronic)
42
Prognosis of Tourette’s
Frequency, severity, and disruptive ness of symptoms often decline in adolescence and adulthood
43
Most common associated symptoms with Tourette’s
Obsessive compulsive symptoms
44
Etiology of Tourette’s
Increase of dopamine, hypersensitivity to dopamine
In caudate nucleus
45
Treatment for Tourette’s
Antipsychotics (80% effective, bad SEs)
Antidepressants, stimulants
Comprehensive behavioral treatment for tics (CBIT)
(Habit reversal training, relaxation skills, psyched)
46
Comprehensive Behavioral Treatment for Tics
| CBIT
Habit reversal
Relaxation training
Psychoeducation
47
Behavioral Pediatrics
Aka pediatric psychology
Concerned with the psychological aspects of children’s medical illnesses
(Compliance with medical regimens, coping with painful procedures)
48
Disclosure in behavioral pediatrics
Open communication with children about their medical issues is advisable (leads to better coping)
MUST be done with developmentally appropriate
49
Behavioral pediatrics and medical procedures
Stress inoculation techniques to help children cope with anxiety and stress
Ex. Modeling, reinforcement, breathing exercises, distraction, imagery, behavioral rehearsal
50
Impact of hospitalization on medically ill children
Ages 1-4 are at highest risk of distress due to separation from family
Can be prevented by “rooming in” programs (where parents are allowed to stay at the hospital)
51
Impact of medical illness on children’s academic adjustment
Children with chronic medical conditions have higher rates of school-related issues
Can be due to the medical treatments themselves, or the constant absences from school
52
Reason for medical noncompliance in children
Lack of knowledge or skill
Parent-child conflict or communication deficits
Developmental issues
53
Reasons for medical noncompliance specific to adolescents
Fear of peer rejection
Desire for nonconformity
Reduced parental supervision
Questioning credibility of medical provider
54
Delusions
False beliefs that are firmly held in the face of contradictory evidence
In schizophrenia, they are often persecutory or bizarre
55
Hallucinations
Perception-like experiences that occur without an external stimulus
Auditory are most common and take the form of pejorative or threatening messages, or are a running dialogue of the persons actions
56
Disorganized thinking
Loosening of associations (incoherence, answers to questions that are unrelated, or slipping from topic to topic)
57
Grossly disorganized or abnormal behavior
Unpredictable agitation
Catatonia
Markedly disheveled appearance
Clearly inappropriate sexual behavior
58
Negative symptoms
A restriction in the range or intensity of emotional expression
Alogia - diminished speech output
Anhedonia - inability to feel pleasure
Asociality - lack of interest in social interactions
Avolition - decrease in goal-directed behavior
59
Diagnostic criteria for delusional disorder
Presence of one or more delusions for at least one month
Functioning is otherwise fine, save for functional impairment relatives directly to the delusion
Erotomanic, grandiose, jealous, persecutory, somatic, mixed, unspec.
60
Types of delusions
Erotomanic - believes someone is romantically in love with them
Grandiose - great but unrecognized talent or discovery
Jealous - partner is being unfaithful
Persecutory - being conspired against, spied on
Somatic - has abnormal body functions or sensations
Mixed
Unspecified
61
Diagnostic criteria for schizophrenia
At least two active symptoms for one month
(Delu, halu, disorganized speech, disorganized behavior, neg sx)
Duration for at least six months
One of the symptoms must my disorganized speech, del, or halu
62
Associated features of Schizophrenia
Inappropriate affect
Dysphoric mood
Disturbed sleep
Lack of interest in eating
63
Prognosis of schizophrenia
Chronic condition, with full remission being rare
64
Indicators of better outcomes in patients with schizophrenia
```
Later onset
Good premorbid functioning
Insight
Being female
Presence of a precipitating event
Brief duration
No family hx of schizophrenia
```
65
Prevalence of schizophrenia
0.3-0.7%
66
Predictors of relapse in schizophrenia
Family with high EE
Treatment noncompliance
67
Comorbid diagnosis commonly seen with schizophrenia
Substance abuse disorders
| Tobacco Use disorder being particularly high
68
Onset of schizophrenia
Late teens to early 30s
Earlier onset for men, later onset for women
69
Concordance rates for schizophrenia
Identical twin with schizophrenia 48%
Both bio parents have schizophrenia 46%
Fraternal twin with schizophrenia 17%
Biological sibling with schizophrenia 10%
70
Strong evidence that schizophrenia is highly genetic
Relatives of individuals with schizophrenia aren’t just at a higher risk for schizophrenia, but for other schizophrenia spectrum disorders
(Especially schizotypal personality disorder)
71
Dopamine hypothesis for schizophrenia
Overabundance of DA or oversensitivity of DA receptors
| Role of DA May differ for the expression of positive and negative symptoms though
72
Brain abnormalities in schizophrenia
Enlarged ventricles
Decrease activity in the frontal cortex and prefrontal cortex
Smaller globus pallidus, amygdala, and hippocampus
73
Prenatal exposure to the influenza virus may be connected to what diagnosis
Schizophrenia
74
Schizophrenia vs Schizoaffective vs Mood w psychotic features
Schizophrenia - mood symptoms are brief, do not meet full criteria, and are not present during active phase
Schizoaffective - predominant mood sx will occur with psychosis and at least two week period where psychotic sx only
Mood w psychotic features - psychotic symptoms only occur during the course of a mood episode (MDD or BD)
75
First generation vs second generation antipsychotics
First gen - fluphenazine and haloperidol - positive sx only - bad SEs (tardive dyskinesia)
Second gen - risoeridone and clozapine - positive and negative sx - loss likely to develop TD
76
Psychotherapy for schizophrenia
Good results when paired with medical treatment
Family interventions (if high EE), psychoed, CBT, social skills training, vocational work...
77
Examples of high EE
Being over emotional or overprotective
Being openly critical or hostile towards the person
78
Diagnostic criteria for Schizophreniform Disorder
Same as for schizophrenia, but for less than six months and more than one month
79
Prognosis of schizophreniform disorder
Two thirds eventually meet criteria for schizophrenia or Schizoaffective disorder
80
Diagnostic criteria for Brief Psychotic Disorder
One or more of delu, halu, disorganized speech, disorganized behavior (one must be one of the first three)
More than one day, less than one month
81
Prognosis of brief psychotic disorder
Return to premorbid functioning common
Usually occurs after a significant life stressor
82
Schizoaffective criteria
Concurrent schizophrenia and mood symptoms
For at least a two week period, there should be psychosis only (without any mood symptoms)
Mood symptoms are depression or mania that meet diagnostic criteria
83
Age as a suicide risk factor
Highest number of suicides in 45-54 age range
| This is highest in women, in men it’s 75+
84
Gender as a risk factor for suicide
Men 4x more likely to die by suicide
(More lethal means)
Women 2-3x more likely to attempt
85
Ethnicity/Race as a risk factor for suicide
Alaskan Natives and American Indians age 15-34 have the highest rates (2.5x higher than the national average)
Then whites
86
Marital status as a risk factor for suicide
Divorced, separated, widowed are highest
Then single
Lowest rates for married persons
87
Statistics for suicidal thoughts and behaviors
60-80% have had a previous attempt
80% give a definite warning of their intention
88
Early warning signs of suicide
Threatening self harm or suicide
Talking or writing about death or suicide
Seeking means for suicide
Making preparations (will, giving away possessions, saying goodbye)
89
Among adolescents, completed suicide is often mmediately preceded by...
Interpersonal conflict (social or romantic rejection, argument with a parent)
90
Psychological disorders and suicide
MDD or BD dx are 15-20x more likely than the general population
With depression, suicide is most commonly seen after about three months of symptom improvement
91
Personality correlates of suicide
Hopelessness biggest predictor
Perfectionism may also be a predictor when coupled with high life stress
92
Biological predictors of suicide
Low levels of serotonin and 5-HIAA (serotonin metabolite)
93
How to decide appropriate intervention for someone who is suicidal
Outpt psychotherapy, outpt crisis intervention, or inpatient hospitalization
Depends on the level of risk, clients preference, and the potential benefits of each approach
94
When is hospitalization an appropriate intervention for suicide
When someone has just attempted or has a plan with access to lethal means
(+ impaired judgment, no social support, SMI or chemical dependency, history of previous attempts)
Always encourage voluntary first, then initiate a hold if need be
95
When is outpatient crisis intervention appropriate for suicide
Moderate risk clients - plan with a lack of access
Fair judgement, social support, decision making abilities, willingness to comply with treatment recommendations
Tx will focus on decreasing isolation, relieving sleep issues, coping skills for anger, addressing ambivalence about suicide
96
When is outpatient psychotherapy appropriate for suicide
Follow-up to hospitalization, or
For initial interventions for those who are at low risk (no prev attempts, good judgement, adequate support...)
Tx: CBT, CBT, IPT, Problem-Solving Therapy
97
Diagnostic criteria for Bipolar I Disorder
At least one manic episode
Marked impairment in functioning, requires hospitalization, may include psychotic symptoms
May include one or more episodes of depression or hypomania
98
Manic episode
For at least one week
At least three of: inflated self esteem or grandiosity, decreased need for sleep, excessive talkativeness, flight of ideas
99
Associated diagnoses with Bipolar I Disorder
Anxiety
Substance abuse
100
Prevalence of bipolar I disorder
0.6 percent
Men:women
1.1:1
101
Concordance rates for Bipolar I
0.67 to 1.0 for monozygotic twins
.2 for dizygotic twins
(Strongest genetic loading out of all the disorders)
102
Treatment of Bipolar I
60-90% effectiveness with Lithium
(Noncompliance due to mania highs and side effects)
May also use anti-seizure meds
TCAs may trigger mania if taken with a mood stabilizer (not so much with an SSRI)
103
Diagnostic criteria for Bipolar II Disorder
At least one hypomanic episode and one depressive episode
104
Hypomanic episode
Lasts at least four consecutive days
At least three of the criteria for mania, but not severe enough to cause marked dysfunction or hospitalization
105
Diagnostic criteria for Cyclothymic Disorder
Symptoms of hypomania (without meeting criteria)
Symptoms of depression (without meeting criteria)
Cause significant distress or impaired functioning
Sx last for at least two years (adults, one year for youth)...cannot be symptom free for longer than two months at a time
106
Diagnostic criteria for Disruptive Mood Dysregulation Disorder
Severe temper outbursts
Out of proportion to the situation (and not developmentally appropriate)
At least 12 months, in at least two settings
Onset: before age 10, can’t dx before 6yo or after 18yo
107
Diagnostic Criteria for Major Depressive Disorder
At least five sx of SPACERAGS for at least two weeks
At least one symptom being depressed or sad mood, or loss of interest or pleasure
Sad, psychomotor, appetite, concentration, energy, recurring thoughts, anhedonia, guilt, sleep
108
SPACERAGS
```
Sadness
Psychomotor
Anhedonia
Concentration
Energy
Recurring thoughts
Appetite
Guilt
Sleep
```
109
Specifies of MDD, BD I, and BD II
Peripartum Onset - before baby or up to four weeks after
Usually includes anxiety about the baby, or delusions
Seasonal Pattern - temporal relationship between the sx and the seasons
SAD most common in the winter in North America
110
Percentage of women who experience depression after giving birth
10-20%
| .1-.2% postpartum psychosis
111
MDD vs Baby Blues
80% of women experience mild mood symptoms
MDD is more disabling and severe
112
Sleep disturbances and MDD
Sleep continuity disturbances
Reduced stage 3/4 sleep
Decreased REM latency
More REM in early night sleep
113
Prevalence of MDD
7%
18-29 years most prevalent
114
Age of onset of MDD
Mid-20s
May initially be caused by severe psychosocial stressors
(However with repeated episodes, the need for the stressor drops off)
115
Presentation of MDD as a function of age
Youth - somatic complaints, social isolation, irritability
(Aggression and destructiveness in preadolescent boys)
Older adults - memory loss, distractibility, disorientation, other cog sx
(Distinguishes from neurocog because onset is abrupt and distressing)
116
MDD in older adults vs Neurocognitive Disorder
MDD onset cognitive symptoms are abrupt, and the person is usually concerned about their functioning and deficits
True neurocognitive symptoms usually come on gradually, and the person is unaware or denies their impairments
117
Two biochemical theories of depression
Indolamine Hypothesis - low levels of serotonin cause depression
Catecholamine Hypothesis - low levels of norepinephrine
118
Lewinsohn’s Behavioral Theory of Depression
Depression is caused by a low rate of response-contingent reinforcement for social or other behaviors
Results in isolation and pessimism
119
Seligman’s Learned Helplessness Model of Depressin
A series of uncontrollable negative events is attributed to internal, stable, and global factors
Hopelessness is the proximal cause
120
Rehm’s Self-Control Model of Depression
Depression is a result of problems with self-monitoring, self-evaluation, and self-reinforcement
121
Beck’s Cognitive Triad Model for depression
Negative and irrational thoughts about the self, world, and the future
122
When psychotic symptoms occur exclusively within the context of a mood episode...
MDD (or BD) with psychotic features
123
MDD vs Adjustment Disorder
MDD criteria are not met with true adjustment disorder
124
MDD vs Uncomplicated Bereavement
UB typically presents with normal mood, but added feelings of emptiness or loss
UB tends to decrease over days to weeks - May occur in waves that are triggered by reminders of the deceased
125
Drug treatment for MDD
TCAs - for vegetative, classic depression that is worse in the morning
SSRI - first-line treatment that does not have the risk of overdose that TCAs do
MAOIs - last line for people who do not respond to other meds, and have atypical sx
126
Psychotherapy for MDD
Combine it with medication for a better effect than meds or psychotherapy alone
127
ECT for MDD
Severe, treatment-resistant depression
With sx of delusions or severe SUI
Side effects: temporary amnesia, confusion, disorientation
128
Diagnostic Criteria for Persistent Depressive Disorder
For at least two years (one for youth)
At least two CHEESE symptoms
Concentration, hopelessness, esteem, energy, sleep, eating
Cannot be sx-free for more than two months
129
Treatment for Persistent Depressive Disorder
SSRI, CBT, IPT
130
Similarities between anxiety and depression
```
Impaired concentration and attention
Irritability
Fatigue
Insomnia
Hopelessness
```
131
Dissimilarities between depression and anxiety
Anxiety - higher levels of positive affect and autonomic arousal
Pure depression - low mood, anhedonia, suicidal ideation, low libido
Pure anxiety - apprehension, tension, worry, nightmares
132
Diagnostic criteria for Separation Anxiety
Developmentally inappropriate fear or anxiety related to separation from home or an attachment figure
excessive distress when anticipating or experiencing separation
persistent fear of being alone
physical symptoms
At least four weeks in children, six months in adults
133
School Refusal
A manifestation of separation anxiety in children
Stomachache, headache, nausea, other physical sx
Typically occurs 5-7yrs, 10-11yrs, 14-16yrs
May be associated with social phobia, depression, change of schools...
134
Etiology of Separation Anxiety
Frequently precipitated by a major life stress (death of a relative or pet, divorce, or move to a new place)
135
Treatment for separation anxiety
Systematic desensitization
Cognitive approaches
When the sx include school refusal, the primary goal is immediate return to school to prevent academic failure and social isolation
136
Diagnostic Criteria for Specific Phobia
Intense fear or anxiety about a specific situation or object
Object or situation is avoided or endured with marked distress
Subtypes: animal, blood/injection/injury, environmental, situational, other
137
Subtypes of specific phobia
```
Animal
Blood/injection/injury
Environmental
Situational
Other
```
138
Two-factor theory for Specific Phobia
Avoidance conditioning
Learn to fear a neutral (conditioned) stimulus because of its pairing with a fear-arousing (unconditioned) stimulus
Avoidance of the conditioned stimulus is negatively reinforced because it because it keeps the from experiencing the anxiety
139
Treatment for Specific Phobia
Exposure with response prevention
(Especially in vivo exposure)
Exposes the person to the feared object while preventing them from engaging in behavioral or cognitive avoidance
140
Exposure therapy is most effective when...
It is paired with APPLIED TENSION
Involves repeatedly tensing and releasing the muscles in the body’s major muscle groups (to increase blood pressure)
141
Diagnostic criteria for Social Anxiety Disorder (Social Phobia)
Fear of one or more social situations where you may be exposed to the scrutiny of others
Fears they will exhibit symptoms and will be negatively evaluated
Typically lasts at least six months
142
Situations commonly association with Social Anxiety Disorder...
Public speaking
Attending parties
Initiating conversations
Speaking to authority figures
143
Treatment for Social Anxiety Disorder (Social Phobia)
Exposure with response prevention
Social skills, cognitive techniques
SSRI, SNRI, beta blocker propranolol
144
Diagnostic criteria for Panic Disorder
Recurrent, unexpected panic attacks
At least one attack being followed by a period of concern about having additional attacks (lasting at least a month)
PA sx: heart race, sweating, trembling, choking, chest pain, paresthesias, derealization, fear of losing control
145
Medical rule outs before a diagnosis of Panic Disorder can be rendered...
Hyperthyroidism, hypoglycemia, cardiac arrhythmia
146
Prevalence of Panic Disorder
2-3% in a twelve month period
Females twice as likely as males
147
Treatment for Panic Disorder
CBT
Panic Control Therapy (PCT) - psychoed, relaxation, cognitive restructuring, interoceptive exposure (expose to physical sensations of panic)
Also responsive to TCAs, SSRIs, SNRIs, and benzos
But if med only you have a 30-70% chance of sx rebound once you discontinue
148
Diagnostic criteria for Agoraphobia
Fear or anxiety about being in at least two spaces:
Public transportation, open spaces, enclosed spaces, standing in line, crowd, being outside of the home alone
Fears or avoids because escape may be difficult or help will not be available if panic occurs
At least six months
149
Agoraphobia vs Specific Phobia vs Social Anxiety
Specific - anxiety only for a single situation, concern is related to something other than experiencing panic
Social anxiety - anxiety is related to being scrutinized, may increase sx when in the presence of family or friends
Agoraphobia - anxiety is related to panic, in multiple situations, may be helped by the presence of a family member or friend
150
Treatment for Agoraphobia
In vivo exposure with response prevention
Graded vs nongraded have similar effects in the short term
Nongraded exposure has better effect in the long term
151
Diagnostic criteria for Generalized Anxiety Disorder
Excessive worry about multiple events
At least six months
Difficult to control
At least three (1 for children): restlessness, fatigue, muscle tension, irritability, difficulty with concentration, sleep disturbance
152
Cormorbid diagnoses with GAD
50% of patients with GAD have a second diagnosis
MDD, PDD, SUD, Phobia, Social Anx
153
Age-related anxiety features
Children and adolescents - performance in school, sport, natural disasters
Young Adults - work, family, finances, future
Older Adults - personal health, minor or routine matters
154
Treatment for GAD
CBT and pharmacotherapy
SSRIs, SNRIs, and benzos or Buspar when those don’t work
155
Obsessions
Persistent thoughts, impulses, or images that a person experiences as intrusive or unwanted, that they cannot ignore or suppress
Ex. Repeated thoughts of contamination, repeated doubts of one’s abilities
156
Compulsions
Repetitious and deliberate behaviors or mental acts that a person feels driven to perform (either in response to an obsession or according to rigid rules)
Goal of the behavior is to reduce distress or prevent a dreaded situation from happening (but the behavior is excessive or not logically connected)
157
Diagnostic criteria for Obsessive-Compulsive Disorder
Recurrent obsessions and/or compulsions
Time consuming
Cause impairment in functioning
158
Gender and OCD
Equal prevalence in males and females
More prevalent in younger males because onset is earlier in males
159
Etiology in OCD
OCD is caused by low levels of serotonin
| Increased activity in the right caudate nucleus
Responsible for conversing sensory input into actions
160
OCD vs OCPD
OCPD does not involve obsessions or compulsions
(Preoccupation with perfection, control, orderliness)
Rituals are performed to
- reduce anxiety (OCD)
- gain perfection (OCPD)
161
Treatment of OCD
Exposure with response prevention
SSRI
Don’t just medicate without therapy, the risk of relapse is really high for medication-only patients
162
Body Dysmorphic Disorder
(Obsessive-Compulsive and Related Disorders)
Preoccupation with a perceived defect or flaw in appearance
That is minor or unobservable to others
163
Hoarding Disorder
Persistent difficulty discarding or parting wit possessions
| Regardless of their actual value
164
Reactive Attachment Disorder
Emotionally withdrawn behavior with adult caregivers
(At least 2) irritability, low positive affect, limited emotional responsiveness, sadness, fearful...when with caregiver
Must have experienced extreme insufficient care
Developmentally older than 9mo, sx must present before 5yo
165
Disinhibited Social Engagement Disorder
Inappropriate actions with unfamiliar adults
(At least 2) absence of hesitance with unfamiliar adults, overly familiar with unfamiliar adults, diminished checking for approval from caregiver, following unfamiliar adult with little/no hesitation
Child must have experienced extreme insufficient care
Must be developmentally older than 9mo, sx onset must be before 5yo
166
Acute Stress Disorder diagnostic criteria
Nine sx from PTSD categories
Three days to one month
167
PTSD criteria
Exposure to actual or threatened death/injury/violence
(In one of four ways)
At least one intrusion sx
Avoidance of stimuli associated with event
Two negative changes or affect or mood
Two changes to arousal or reactivity
More than one month
168
Four ways to meet PTSD criteria for exposure to events
Direct experience
Witnessing the event
Learning the event occurred to a loved one
Repeated exposure to adverse effects of the event
169
Treatment for PTSD
CBT - exposure, cognitive restructuring, anx mgmt
SSRI - for comorbid depression or anxiety - may lead to relapse without psychotherapy
170
Two controversial treatments for PTSD
Eye movement desensitization and reprocessing (EMDR)
- beneficial, but nothing to demonstrate this is something special
Cognitive incident stress debriefing (CISD)
- one lengthy session within 72 hours of trauma, regardless of whether or not the person is evidencing trauma sx
- may actually worsen symptoms
171
Adjustment Disorder
Emotional or behavioral sx after one or more identifiable psychosocial stressors
Must occur within three months of the stressor
Must remit after six months of the stressor or its consequences
Not diagnosed when symptoms represent normal bereavement
172
Delayed onset specified for PTSD
When full diagnostic criteria are not met until at least six months after the traumatic event
173
Diagnostic criteria for dissociative identity disorder
One individual experiencing two or more distinct personality states
Gaps in recall of ordinary events, personal information, or traumatic events that are not consistent with ordinary forgetfulness
174
Important ruleout for dissociative identity disorder
Cultural considerations
May be acceptable form of religious expression
175
Dissociative Amnesia criteria
Inability to recall personal information that cannot be attributed to ordinary forgetfulness.
Often related to the exposure of a traumatic event
5 types: localized (all events around a period of time), selective (some events around a period of time), generalized (encompasses whole life), continuous (from a certain point until present), systematized Ed to a certain caregory)
176
Five types of amnesia
Localized - all events within a circumscribed period of time
Selective - some events within a circumscribed period of time
Generalized - whole life
Continuous - from a period open time until present
Systematized - can’t remember reacted to a specific category
177
Depersonalization and Derealization Disorder
Depersonalization - sense of detachment, unreality
Derealization - detached from one’s surroundings
More than six months in duration
178
Somatic Symptom Disorder criteria
One or more somatic sx that cause distress
Accompanied by excessive thoughts, feelings, behaviors, related to the symptoms
Disproportionate worry about seriousness, excessive time devoted to health, high anx about medical...
More than six months in duration
179
Illness Anxiety Disorder
Preoccupation with having a serious illness
No somatic symptoms (or very mild)
High level of anxiety about one’s health
For at least six months
180
Conversion disorder
Incompatibility between your symptoms and the medical issues they may represent
Ex. Paralysis, blindness, seizures, etc.
181
Two subtypes of factitious disorder
Imposed in self
Imposed on another
182
Criteria for Factitious disorder
Falsify physical or psychological conditions
Present self or other as being impaired
Engage in the deceptive behavior without an external reward
Falsification can include: feigning, exaggerating, simulating, induction
183
Differential diagnosis for Factitious Disorder
Malingering
For secondary gain, external rewards
Should be considered when someone is being evaluated for legal reasons
184
Pica
Eating nonnutritive food items
At least one month
Most common during childhood
Not part of a culturally sanctioned practice
185
Criteria for Anorexia Nervosa
RESTRICTION
Intense fear of gaining weight or becoming fat
Disturbance in the way a person views their body shape
Levels of severity based on BMI
186
Associated diagnoses with AN And BN
Anxiety and depression
Anxiety is commonly a precursor to the feeding disorder, and depression can have onset before or after
187
Physical symptoms of anorexia nervosa
```
Cold intolerance
Constipation
Abdominal pain
Lethargy
Bradycardia
```
188
Prevalence and onset of eating disorders
Adolescence and young adult
90% females
189
Biological etiology of Anorexia
Genetics
High serotonin
190
Psychological etiology for anorexia nervosa
Highly correlated with perfectionism
191
Environmental etiologies for anorexia nervosa
Inconsistent results related to family functioning
Maybe high levels of family conflict, rigid parents, concern in home with thinness, domineering dads...
192
Treatment of anorexia nervosa
Primary goal is weight gain!
(Hospitalization, contingency management with weight maintenance)
Garner’s CBT
Est positive alliance, normalize eating and weight, modify negative beliefs about weight and food, relapse prevention
193
Family therapy for the treatment of anorexia nervosa
May be beneficial
If family has high EE, then do family therapy without the patient and treat them separately... family treatment with the patient and a high EE family could lead to increased risk of relapse
194
Diagnostic criteria for Bulimia Nervosa
Binging (sense of lack of control)
Compensatory behavior
Self-evaluation is unduly influenced by weight and body shape
Binging and compensation need to occur at least once a week for three months
195
What can commonly trigger a binge eating episode
Interpersonal stress
Dysphoric mood
196
Difference between BN and AN binge/purge type
AN bpt - still has restriction as a component, no insight
BN - no restriction, realizes there’s a problem, not necessarily underweight
197
Medical complications associated with BN
Fluid and electrolyte imbalances...
Can cause cardiac arrhythmia and arrest
Dental problems, metabolic acidosis or alkalosis, menstrual abnormalities
198
Narcolepsy
Attacks of irresistible needs for sleep
At least three times per week, for three months
Includes: cataplexy (muscle weakness), hypocretin deficiency, REM latency
199
What can trigger narcolepsy
Anger, surprise, or other strong emotions
| Can trigger cataplexy more specifically
200
Non-REM Sleep Arousal Disorders
| 2 types
Sleep walking
Sleep terrors
No recall of the episode
Occurs most commonly in children
201
Non-REM sleep issues usually occur during what sleep stages
3 and 4
202
Rule out conditions for Sexual Dysfunctions
Nonsexual mental disorders
Relationship distress or other stressor
Effects of substances, medication, or other medical condition
203
Erectile disorder
Problems maintaining an erection during sexual activity
Maintaining an erection until the completion of sexual activity
Marked decrease in erectile rigidity
Occurs during all or nearly all sexual encounters
For at least six months
204
Premature Ejaculation
Persistent pattern of premature ejaculation
(Within one minute of penetration, or before the person desires it)
Occurs during all or nearly all sexual encounters
For at least six months
205
Treatment methods for premature ejaculation
Viagra
Senate focus - reduce performance anxiety
Squeeze techniques - control the ejaculatory reflex
206
Gender Dysphoria
Marked incongruence between assigned gender at birth and one’s expressed or perceived gender
Manifests as intense desires or urges to dress like, look like, be treated like, engage in social interests like the gender you are identifying as
Must meet criteria (and marked distress) for at least six months
207
Oppositional Defiant Disorder
Angry/irritable behavior
Defiant/argumentative
Vindictiveness
At least six months
With at least one person who is not a sibling
Cause distress to person or individuals in immediate social environment
208
Intermittent Explosive Disorder
Inability to control aggressive impulses...
(1) manifested as verbal or physical aggression
(2) occurring at least 2x/week for at least three months
(3) or, three outbursts that cause damage/destruction in 12mo
Agitation is not proportional to the triggers
Must be at least six years old
209
Diagnostic criteria for conduct disorder
Aggression to people or animals
Destruction of property
Deceitfulness or theft
Serious violation of rules
Cannot be assigned to individuals over the age of 18
210
Specifiers for Conduct Disorder
Childhood-onset
(At least one symptom prior to age 10)
Adolescent-onset
(No symptoms prior to age 10)
Unspecified onset
211
Two types of Conduct Disorder
| Per Moffitt
Life-course persistent type
(Begins as early as 3yo, with increasingly serious issues into adulthood...related to neuro impairment, temperament, poor env)
Adolescent-limited type
(Caused by maturity gap between developmental maturity and the opportunities for adult behaviors and rewards, temporary, usually done with peers)
212
Treatment for Conduct Disorder
Best when delivered to preadolescents through family interventions
Parent management training (PMT) - replace punishing negative behaviors with reinforcing positive ones
Multisystemic therapy (MST) - targets multiple levels of people in multiple different ways
213
General criteria for Substance Use Disorder
At least two criteria within 12 months
```
Four major categories...
Impaired control (can’t quit or reduce), social impairment, risky use, and pharmacological criteria (tolerance and withdrawal)
```
Can be applied to all drugs except caffeine
214
Tension-Reduction Hypothesis for substance use disorder
Substances (alcohol) reduces fear, anx, etc. causing people to drink to avoid those feelings, eventually leading to addiction.
Addiction is the result of negative reinforcement
215
Most common precipitation of substance relapse
Experience of anxiety, frustration, depression, or other negative emotional state
216
Abstinence Violation Effect
| Mariatt And Gordon
Reaction to a relapse is shame, guilt, anxiety, depression...
Those negative feelings leads to another increased risk for relapse
Reduce the potential for another relapse by viewing the episode of substance use as a mistake resulting from specific, external, controllable factors
217
Relapse Prevention Therapy
Mariatt and Gordon
RPT involves identifying the circumstances that increase the risk of relapse for the person, and then implement behavioral and cognitive strategies to prevent future lapses and cope more effectively if they do occur
218
Difficulty on treating Tobacco Use Disorder
People are addicted to the nicotine...
...so they smoke for its inherent reinforcing effects and to avoid nicotine withdrawal
Cravings for nicotine can also last months or years
219
Smoking Cessation Intervention
Posits that the likelihood of ling-term smoking cessation increases when...
(1) there is nicotine replacement therapy
(2) behavioral therapy includes skills training and stimulus control
(3) there is support and assistance from a clinician
220
Substance-Induced Disorders
Potentially severe, usually temporary, but somewhat persisting CNS syndromes that develop in the context of the effects of substances of abuse, medication, or toxins
Must have developed within one month of the intoxication
Cannot be better explained by another medical condition or mental disorder
221
Criteria for Alcohol Withdrawal
2+ of the following, within several hours to a few days of abrupt cessation or reduction...
```
Anxiety
Autonomic hyperactivity
Generalized tonic-clonic seizures
Hand trembling
Insomnia
Nausea or vomiting
Psychomotor agitation
Transient hallucinations
```
222
Alcohol-Induced Major Neurocognitive Disorder
Aka. Korsakoff Syndrome
Evidence of a significant decline in one or more cognitive domains that interferes with independence in everyday activities
Also includes anterograde or retrograde amnesia and confabulation (attempts to falsify memories to make up for memory loss)
223
Alcohol-Induced Sleep Disorder
Typically insomnia that occurs in the intoxication or withdrawal phase
Intox - immediate sedation, increased stage 3/4 sleep, decreased REM
followed by increased wakefulness, increased REM with anxiety-provoking dreams, and decreased stage 3/4 sleep
With - vivid dreams and severe disruption in sleep continuity
224
Opioid withdrawal symptoms
```
Diarrhea
Dysphoric mood
Fever
Insomnia
Lacrimation (watery eyes)
Muscle aches
Nausea or vomiting
Pupil dilation or sweating
Yawning
```
225
Tobacco withdrawal symptoms
```
Irritability or anger
Anxiety
Impaired concentration
Increased appetite
Restlessness
Depressed mood
Insomnia
```
Occurs within 24 hours of abrupt cessation or reduction in tobacco use
226
Areas of cognitive functioning impacted by neurocognitive disorders...
(Six domains)
```
Complex attention
Executive function
Learning and memory
Language
Perceptual motor
Social cognition
```
227
Criteria for delirium
Disturbance in attention and awareness that develops over a short period of time
Represents a change in baseline functioning
Tends to fluctuate in severity (worsening at night usually)
At least one additional cognitive domain must show impairment
228
Five groups of people identified to be at high risk for delirium
(Per Wise)
Older adults
People with decreased cerebral reserve (dementia, stroke, HIV)
Postcardiotomy patients (heart surgery)
Burn patients
People with drug dependence experiencing withdrawal
229
Treatment goals for Delirium
Treat the underlying cause of the delirium
```
Reduce agitation
(Environmental manipulation, meds, psychosocial interventions (Family or friend stay with patient))
```
230
Major Neurocognitive Disorder criteria
(Dementia)
Significant decline from previous level of functioning
One or more cognitive domains
Interferes with ability to perform everyday activities independently
231
Mild Neurocognitive Disorder criteria
(Cognitive Disorder NOS is included here)
Modest decline from previous functioning
One or more cognitive domains
Does not interfere with independently performing everyday activities
(But may require greater effort and compensatory strategies)
232
Neurocognitive Disorder d/t Alzheimer’s
| Major
Evidence of a causative genetic mutation
Clear decline in memory and another cognitive domain
Steady and gradual decline without extended plateaus
233
Neurocognitive Disorder d/t Alzheimer’s
| Mild
May or may not be evidence for causative genetic mutation
Clear evidence of decline in memory and learning
Steady and progressive decline in cognition without extended plateaus
234
How to definitively diagnose Alzheimer’s
Autopsy or brain biopsy
Confirms extensive neuron loss and the presence of:
Amyloid plaques and tau tangles
235
Three stages of deterioration in Alzheimer’s...
(1) 1-3 years - anterograde amnesia (esp for declarative memories), wandering and visuospatial deficits, indifference, irritability, sadness, and anomia (word finding deficits)
(2) 2-10 years - increasing retrograde amnesia, flat or labile mood, restlessness and agitation, delusions, fluent aphasia (receptive), acalculia, ideomotor apraxia (inability to translate an idea into movement)
(3) 8-12 years - severely deteriorated intellectual functioning, apathy, incontinence, limb rigidity
236
Stage one of Alzheimer’s decline
1-3 years
Anterograde amnesia (esp for declarative memory)
Deficits in visuospatial skills (wandering)
Indifference, apathy, and sadness
Anomia (word finding trouble)
237
Stage 2 of Alzheimer’s decline
2-10 years
```
Increasing retrograde amnesia
Flat or labile mood
Restlessness and agitation
Delusions
Fluent aphasia (receptive)
Acalculia
Ideomotor apraxia (inability to transform an idea into movement)
```
238
Stage 3 of Alzheimer’s decline
8-12 years
Severely deteriorated intellectual functioning
Limb rigidity
Incontinence
239
Cluster A Personality Disorders are characterized by what general traits?
Odd or eccentric behavior
240
Name the three Cluster A personality disorders
Paranoid PD
Schzoid PD
Schizotypal PD
241
Paranoid Personality Disorder
Pervasive pattern of suspiciousness that entails interpreting the motives of others as malevolent
(4+) suspects others are harming without sufficient evidence, preoccupied with unjustified doubts about the trustworthiness of others, reluctant to confide in others, reads demeaning content from benign interactions, bears grudges, perceived attacks on character and responds with hostility, perceived infidelity from sexual partner
242
Symptoms of Schizoid Personality Disorder
Displays a pervasive detachment from interpersonal relationships with a restricted range of emotion in social settings
(4+) doesn’t enjoy close relationships, chooses solitary activities, no interest in sexual relationships, little pleasure from activities, indifferent to praise or criticism, emotional coldness, lack of friends other than first degree relatives
243
Criteria for Schizotypal Personality Disorder
Pervasive social deficits and eccentricities in cognition, perception, and behavior
(5+) ideas of reference, odd beliefs that influence behavior, unusual perceptions, odd thinking and speech, paranoia, inappropriate affect, peculiarities in behavior or appearance, social anxiety, lack of friends other than first degree relatives
244
General characteristics of Cluster B Personality Disorders
Dramatic, emotional, erratic
245
List the four Cluster B personality disorders
Borderline PD
Histrionic PD
Narcissistic PD
Antisocial PD
246
Antisocial Personality Disorder
Pattern of disregard for, and the violation of the rights of others that has occurred since age 15 (w prev dx of Conduct Disorder)
(3+) failure to conform to norms or laws, deceitfulness, aggressive, reckless disregard for safety of self or others, irresponsibility, lack of remorse
247
Prognosis for ASPD
Symptoms (especially involvement with criminal behavior) typically become less severe by the fourth decade of life
248
Borderline Personality Disorder diagnostic criteria
Instability in interpersonal relationships, sense of self, and affect
(5+) frantic attempts to prevent abandonment, unstable relationships, disturbance in identity, impulsivity in at least two areas, recurrent SUI threats or gestures, affective instability, chronic emptiness, inappropriate and intense negative emotions, stress-related paranoia or dissociation
249
Treatment for BPD
DBT
Group skills training
Individual therapy to maintain motivation
Phone calls for consultation
250
Prognosis for BPD
Symptoms begin to remit into the 40s, with more than half no longer meeting criteria
Impulsivity remits fastest, affective symptoms were most pervasive
251
Etiology of BPD
| Per Linehan
Biosocial model
Genes
Invalidating environment
Excessive emotional vulnerability
Inability to modulate distressing emotions
252
Histrionic Personality Disorder criteria
High levels of emotionality and attention-seeking behavior
(5+) discomfort when not the center of attention, inappropriately sexually provocative, rapidly shifting of shallow emotions, physical appearance changes to garner attention, impressionistic speech, exaggerated emotional expression, easily influenced by others, considers relationships to be much more serious than the actually are
253
Narcissistic Personality Disorder criteria
Pattern of grandiosity, a need for admiration, and a lack of empathy
(5+) grandiose self-importance, requires excessive admiration, beliefs uniqueness can only be understood by important others, preoccupied with unlimited success, entitlement, lacks empathy, envious of other or believes others are envious of them, arrogant
254
General traits consistent with Cluster C Personality Disorders
Anxiety and fearfulness
255
Three clusters for personality disorders
A - odd and eccentric
B - dramatic, erratic, emotional
C - anxious and fearful
256
Avoidant Personality Disorder criteria
Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
(4+) avoids activities due to fear of criticism, unwilling to get involved with others for fear of not being liked, restraint in relationships for fear of rejection, overly concerned with criticism, inhibited in new relationships due to inadequacy, views self as inept, reluctant to try new things for fear of embarrassment
257
Dependent Personality Disorder criteria
Pervasive and excessive need to be taking care of, leading to submissive, clinging behavior and fear of separation
(5+) difficult making decisions without reassurance, needs others to assume responsibility for many aspects of life, fears disagreement, difficulty initiating things on their own, goes to great lengths to obtain support from others, urgently seeks new relationships when old ones end, unrealistically occupied with having to fend for self
258
Three Cluster C Personality Disorders
Dependent PD
Avoidant PD
Obsessive-Compulsive PD
259
Obsessive-Compulsive Personality Disorder criteria
Preoccupation with orderliness, perfectionism, and the mental control severely limits their flexibility, openness, and efficiency
(4+) preoccupation with details and rules so that the point of the activity is lost, perfectionism interferes with task completion, devoted to work at cost of friends and leisure, overconscientious and inflexible about ethics and values, cannot discard worthless objects, reluctance to delegate work, miserly about spending time with others, stubborn
