Abnormal Psychology DSM 5

Question 1

<p>Major Depression</p>

Answer 1

<p>2 wks.(to exclude normal lows)
5 symptoms -- must include depressed mood and loss of pleasure (universal symp)
- Core symptoms- mood-sadness, despair and emptiness, anhedonia, low self esteem, apathy-low motivation, excessive emotional sensitivity, neg. pessimistic thinking, irritability, Suicidal ideation
- appetite; loss, gain weight. decrease appetite
sleep early wake (reduce stage 3 and 4: slow wave sleep, decreased REM latency-earlier onset of REM and increase during of REM in early night)
Fatigue: expressed as tiredness, low energy; slowed speech and physical movement, pause before answering
Psychomotor retardation: quiet speech, stop talking completely unless directly questioned
agitation (become anxious) handwringing, pacing, inability to sit.
low self esteem, guilt
poor concentration (sometimes misdiagnosed with dementia
Suicidal thoughts
(other symptoms: crying spells, phobias, obsessions and compulsions, feeling hopeless, helpless worthless, Anx symp. panic attack: increase drinking, loss of reality-mood congruent (feelings of quilt-imagined he committed a sin) mood incongruent</p>

Question 2

<p>Types of Depression</p>

Answer 2

<p>Reactive: Mild to moderate: occurs in response to an identified stressor, acute/intense, insidious - gradual (poor relationship) or past abuse.
Biological_ no stressor
medical or illness
female sex hormone- post partum
medication/drug
Bio genes: limbic
-sym appetite, fatigue, decrease sex, restlessness agitation, poor concentration</p>

Question 3

<p>Depression

| Theories</p>

Answer 3

<p>Lewinsohn's behavioral theory of depression operant conditioning - low rate of response-contingent reinforcement for social and other behaviors. Reduced frequency of adjustive behavior-or behavior that maximizes reinforcement increases escape and avoidance behaviors in situations where positive reinforcement is attainable. thus failing to escape punishment
Seligman: Avoidance/escape of shock: those that couldn't became passive and accepted : learned helplessness: circumstances of reinforcement contingency-inescapable punishment Attribute it to internal, stable and global factors
Beck" negative cognitive biases-selective abstraction, over generalization negative self attributes. depressive cognitive triad: interpret their interactions with the environment as defeating, deprivation or disparagement. view self as deficient, inadequate or unworthy and attribute unpleasant experiences to physical, mental and moral defects in themselves and tend to reject themselves because of it. . View the future in a negative way and anticipate current sufferings will continue indefinitely</p>

Question 4

<p>Etiology of Depression</p>

Answer 4

<p>genetic component: 1.5 to 3 times more common among first degree relatives; does not matter if one or two parents have the diagnosis.
link between depression and neurotic personality trait.
-catecholamine hypothesis- deficiency in norepinephrine.
-indolamine hypothesis: Low Serotonin (sensitive receptors)
-high cortisol (stress hormone) cause atrophy of neurons in hippocampus</p>

Question 5

<p>Treatment for Depression</p>

Answer 5

<p>Tricyclics: "classic depression" veg body symptoms worsening symptoms on the AM, acute onset and short duration, symptoms of moderate severity.
-Amitriptyline/Elavil; Doxepin/ Adapin, Sinequan/Silenor ( most sedating; insomnia); Trimipramine/Surmontil; Nortriptyline, Pamelor/Aventyl; Desipramine/Norpramin; Protriptyline/Vivactil; Clomipramine/Anafranil (OCD too)
SSRI (moderate to severe) Fluoxetine/Prozac, Serafem (MDD, OCD, bulimia, PMDD, panic, BPD-depressive) Sertraline/ Zoloft (OCD, Panic, PTSD, PMDD, social anxiety); Paroxetime/ Paxil (GAD, OCD, PMDD, PTSD, pain &amp;amp; Social anxiety)Fluvoxamine/Luvox (OCD, Social anxiety, MDD, Anx., PTSD, panic); Citalopram/Celexia (Depression; SE); Escitalopram/ Lexapro (MDD, GAD, SE: insomnia, Sex dys. nausea)
-Others: Trazodone/Desyrel, Nefazodone/Serzone, Vilazodone/Viibryd, Bupropion/Wellbutrin (smoking, soc. anx, )
(SNRI) Venlafaxine/Effexor (GAD, Soc. Anx., Panic)
Duloxetine/Cymbalta (MDD, GAD, chronic pain, fibromyalgia) Desvenlafaxine/Pristiq; Milnacipran/Remeron,
ECT: delusions/hallucinations; temp. anterograde, retrograde amnesia</p>

Question 6

<p>Premenstrual Dysphoric Disorder</p>

Answer 6

<p>week before and symp improve few days after the onset of menses and absence or presence of minimal symptoms during the week post Menses. At least one symptom-affective lability, and one -loss of interest, concentration, appetite, insomnia/hypo. feeling out of control, or physical (breast swelling)</p>

Question 7

<p>SSRI's</p>

Answer 7

<p>Fluoxetine (Prozac), Fluvoxamine, Paroxetine, Sertraline
Melancholic Dep, OCD, Bulimia, Panic, PTSD
Blocks reuptake of Serotonin
less cardiotoxic, safer overdose, less cognitive deficits, improve depressive symptoms,
Linked to suicide and violent act -Fluoxetine-
MAOI (monoamine oxidase inhibitors_ isocarboxazid, phenelzine and tranylcypromine)- results on serotonin syndrome-headache, nystagmus, tremor, dizziness, unsteady gait; irritability, confusion, delirium_ cardiac arrhythmia and coma/death</p>

Question 8

<p>MAOI</p>

Answer 8

<p>isocarboxazid, phenelzine, tranylcypromine
non-endogenous and atypical depression that involves anx, reverse vegetative symptoms and interpersonal sensitivity.
MAOI inhibits enzyme monoamine oxidase-deactivates dopamine, norep, serotonin.
SE: Hypertensive Crisis-when in conjunction with barbiturates, amphetamines antihistamines, or with foods containing tyramine (cheeses, meats, beer, red wine, avocados, bananas,</p>

Question 9

<p>Treatment for ADHD</p>

Answer 9

<p>neurofeedback (EEG biofeedback) is effective for inattention and impulsivity and ok for hyperactivity and effects are similar to stimulants ( Methylphenidate (Ritalin) CNS
Behavioral interventions
Teacher training and classroom management: positive reinforcement, time out, ect. Parent Training in Behavioral Management
Medication treatment alone and combined community and intensive behavioral treatment produced similar reduction in core symptoms.</p>

Question 10

<p>ADHD</p>

Answer 10

<p>6 mos. before 12 yrs. in two settings 6 to 6 subtypes
Cognitive Control theory _ Top Down Theory -Delay aversion (dopamine: BX. reinforcement-delayed aversion) - inhibition, self-awareness, working memory, self directed attention.
impaired reward learning, difficulties adaptively processing rewards, and heightened delay discounting motivational control-executive dysfunction- cog to em/</p>

Question 11

<p>ADHD Differential D/O</p>

Answer 11

<p>An att. Hyperactivity, and impulsivity can be found in Anx., Stress, and in Mood D/o
Learning D/o- poor concentration
Substances Adult/adolescence- impair exe. func. mild cognitive impairment and increases with age.
Health Conditions: Inatt. and impulsive-seizures-autoimmune, thyroid, concussion
Chronic sleeplessness
Co-occur- 44% with Disruptive BX
ODD (against authority, interpersonal sensitivity and EM. reactivity)
Learning D/O
Anx, and Dep. (Dep. earlier onset)
Tic_core inhibitory
Autism: imp. communication, social reciprocity and stereotype. / repetitive Bx.
Personality_ Borderline. Antisocial</p>

Question 12

<p>Tics</p>

Answer 12

<p>Tourette's D/O multiple vocal and motor tics occur frequently throughout the day
Persistent (chronic) motor or vocal tic: patient has either motor or vocal tics but not both
Provisional tic D/O tics occur for no longer that 1 year
--Appear early around 2 yrs. mean onset 5 to 7 yrs.
vocal begin sometime later- barks, coughs, throat clearing, sniffs, and single syllables-can be suppressed more so in adulthood, disappear during sleep -they are persistent but can disappear entirely for weeks - frequency increases when one is sick, tired, or stressed.10% boys and 15% girls most motor tics disappear in adulthood, -poor prognosis_ comorbid MH, chronic physical illness lack of support at home and drug use. - strong familial and concordance rate over 50% in mono twins and 10% in Dis. twins- Fam. Hx for OCD
Typically begins by age 6- most severe by ages 10 to 12, AFTER IMPROVE 75% 25% WILL CONTNIUE TO HAVE TICS that ARE mod. or worse-comorbid OCD and ADHD
TD-Both at least 1 vocal and 2 motor-
Persistent Motor or Vocal
--longer than a yr.
Before 18 yrs.
-elevated Dop. antipsychotic drugs - haloperidol and pimozide
SSRI left OCD hyperactivity and inattention treated by clonidine and desipramine</p>

Question 13

<p>Communication D/O</p>

Answer 13

<p>Childhood Onset Fluency D/O Stuttering-begins in early childhood, distress, diff. speech motor deficits, neurological cond. Ex. stroke, or other mental D/O</p>

Question 14

<p>Gender differences between rates of Major Depressive D/O</p>

Answer 14

<p>does not become evident until puberty. Prior to that time, the rates between boys and girls are equal.
Adults rates females are 1.5 to 3.0 times the rate for men
Unipolar depression: .5 or 50% in Mono and .2 or 20% in diz. both or one parent with the D/O does not matter.</p>

Question 15

<p>Panic Attack</p>

Answer 15

<p>recurrent unexpected panic attack with at least one being followed by concern about having another or consequences and change in adaptive behavior.
prepubertal children may experience physical symptoms of panic (hyperventilation) they rarely receive the diagnosis. belief that children do not make catastrophic interpretations of their body symptoms.</p>

Question 16

<p>Differentiate Panic and agoraphobia</p>

Answer 16

<p>-All involve avoidance

- how many panic attacks and what type (cued, uncued, situationally predisposed) uncured attack suggest panic. cued attacks suggest specific phobia or social anx. (but can be intermixed)
- in how many situations did they occur? Limited situations suggests specific phobias or social anxiety; attacks that occur in a variety of situations suggest panic D/O and agoraphobia
- Does the Pt. awaken at night with panic attacks? This is more typic of panic d/o
- what is the focus of the fear? having a subsequent attack then it's panic D/O, unless it occurs only in one situations suggest as riding a horse then specific phobia situational type.
- Does the pt. constantly worry about having a panic attack even when in no danger of facing a feared situation- this would suggest panic and agoraphobia,</p>

Question 17

<p>Most effective intervention for GAD</p>

Answer 17

<p>CBT
SSRI or SNRI ( Venlafaxine (Effexor) Duloxetine (Cymbalta) if not benzo an anxiolytic ( Diazepam, alprazolam, oxazepam, triazolam, chlordiazepoxide, lorazepam) stimulate the inhibitory action of GABA= enhance GABA
-</p>

Question 18

<p>Rates of OCD for males and females</p>

Answer 18

<p>Common for males and females, but onset earlier in males -OCD is more prevalent in males</p>

Question 19

<p>How does medication and behavioral therapies treat OCD?</p>

Answer 19

<p>SSRI block the reuptake of Serotonin that is believed to be low in OCD PT.
reduces activity in the caudate nucleus that involves converting sensory input into cognitions and actions, and is overactive in people with OCD- other areas include, orbitofrontal cortex, and cingulate cortex which mediates emotional reactions.</p>

Question 20

<p>How does medication and behavioral therapies treat OCD?</p>

Answer 20

<p>SSRI or Tricyclic (Clomipramine) block the reuptake of Serotonin that is believed to be low in OCD PT.
reduces activity in the caudate nucleus that involves converting sensory input into cognitions and actions, and is overactive in people with OCD- other areas include, orbitofrontal cortex, and cingulate cortex which mediates emotional reactions.
Exposure with Response Prevention</p>

Question 21

<p>Logan was an 12 yr old boy who was reffered for long standing anxiety about losing his parents and recent fear about getting sick. Recently Logan watched a TV show about deadly diseases. He had 3 panic attacks in the past, has frequent headaches and stomachaches. Insists he is not scared about having another panic attack. His physical complaints are caused by fears of being ill and is petrified about being left sick and alone. Logan had intense separation difficulties starting in kindergarten. His most persistent fear centered around the safety of his parents. He was fine when they were both at work but in transit or somewhere else, he was afraid they would get in a car accident. What is the diagnosis?</p>

Answer 21

<p>Separation Anx with panic
Fear since young child. requires 3 of 8 symptoms.
-long standing excessive and disturbing fears of anticipated separation, to harm to his parents or event that could lead to separations, and of being left alone. physicals complaints that are traced to fear of dying or separation.</p>

Question 22

<p>This brief treatment that incorporates psychoeducation, relaxation training, cognitive restructuring, and interoceptive exposure (exposure to physical symptoms) treats what disorder</p>

Answer 22

<p>Panic disorder-
Named Panic Control Therapy.
Also treatment includes, TCA, SSRI, SNRRI and benzo. high relapse with discontinued use (70%)</p>

Question 23

<p>Agoraphobia requires marked fear or anxiety about at least two of the following.. because escape might be difficult and help unavailable in case he/she develops panic like symptoms, incapacitating, or embarrassing symptoms.</p>

Answer 23

<p>using public transportation, being in open spaces, standing in line or being part of a crowd, and being outside the home alone.
Requires presence of a companion
persistent 6 mo.</p>

Question 24

<p>How do you differentiate Specfic Phobia situational type and social anxiety from Agoraphobia?</p>

Answer 24

<p>Specific Phobia involves fear or anxiety about a single situation that is characteristic of Agoraphobia and is related to something other than concern of experiencing panic like symptoms, incapacitating and embarrassing symp.
Social Anxiety i is anxiety related to being scrutinized by others and increases in the presence of others particularly family or friend while Agoraphobia decreases when accompanied by a family or friend.</p>

Question 25

<p>What are the clinically significant symptoms of PTSD that one experiences for at least 1 mo ?</p>

Answer 25

<p>intrusion, avoidance, negative alterations of cognition and mood and alterations in arousal and reactivity.</p>

Question 26

<p>Specific phobias are characterized by intense fear or anxiety about a specific object or situation that persists (6 m. or longer) what are the subtypes?</p>

Answer 26

<p>animal, natural environment (heights, storms), blood-injection-injury, situational and other (loud noises, costumed characters)</p>

Question 27

<p>What are the causes of Specific Phobias and other anxiety disorder?</p>

Answer 27

<p>Biological factors- abnormal levels of serotonin, norepinephrine and GABA
cognitive factors
Classical Conditioning. Mower's two factor theory: avoidance conditioning (classical and operant conditioning) learn to fear a neutral stimulus (conditioned) stimulus (loud noise and bunny) because it is paired with an intrinsically fear-arousing stimulus and avoidance is negatively reinforcing because it eliminates anxiety</p>

Question 28

<p>What differentiates PTSD and Acute Stress Disorder?</p>

Answer 28

<p>PTSD requires the presence of symptoms from each of 5 symptoms clusters: intrusion symptoms(re-experiencing, dissociation ect.) avoidance symptoms, negative alterations in cognition and mood and arousal.
ASD can have at least 9 of 14 symptoms meaning that one person could have all 4 intrusion symptoms while another might have one.
Duration PTSD persists at least 1 mo after the external event and ASD lasting no more that 1 mo.</p>

Question 29

<p>Adriana was a 4.5 yr old girl referred for mental health evaluation of dangerous behaviors particularly poor boundaries, impulsivity, and "too quick to trust strangers." Adriana was adopted from an Eastern Europe orphanage at age 29 mo. Medical records at that time were normal. After adoption, Adriana would seek out her mother for comfort when distressed, however, she did not distinguish between strangers and family. In the grocery store she would hug who ever was in line next to them. Once in a mall she tried to leave with another family. She had trouble taking turns and sitting in a circle. She interrupted, intruded in classmate's space and occasionally hit others. she had trouble self soothing and could generally calm down when held by her teacher or mother. What is the D/O?</p>

Answer 29

<p>Disinhibited social engagement disorder
Preschool aged child with dangerous behaviors that related primarily to excess physical familiarity with strangers= risk for predation
trouble regulating her proximity to other people- going too far away from her mother and getting too close to stranger.
2 symptoms are required out of 4 core symptoms
-reduced or absent reticence in approaching and interacting with unfamiliar adults: overly familiar behavior; diminished or absent checking back with an adult caregiver after venturing away. and willingness to go off with an unfamiliar adult with minimal or no hesitation.
developmental age of at least 9 mo
Child with this disorder can approach caregivers when stressed or hurt.
Comorbid ADHD is common but DSED is specific to relationships.</p>

Question 30

<p>Traumatic event Bethany and Charles witnessed a shooting at a movie theatre. two days later both Bethany and Charles considered themselves nervous and on edge. They jumped at the slightest noise and kept watching TV for the latest information on the shooting but every time they saw footage, they experience panic attack, brake out in sweats, unable to calm down and couldn't stop thinking about the traumatic event. they both had nightmares and had intrusive thoughts of the shootings
2 wks later. Bethany reclaimed her peritraumatic thoughts, feelings and behaviors. Although reminders of the event resulted in brief panic or physiological reactions these did not dominate her life. Charles did not recover, but felt emotionally constricted and unable to experience positive emotions, he jumped at the slightest sound and was unable to focus, poor sleep with nightmares. He avoided reminders and recalled the sound of shootings, He felt disconnected from his surroundings and self.</p>

Answer 30

<p>Betheny- no diagnosis
Charles - Acute Stress disorder

Normal response to traumatic event- transient reactions will resolve within 2 to 3 days.
Normal response usually presents with emotional reaction- shock, fear, grief, resentment. guilt. shame. helplessness, hopelessness and numbing
Cognitive reactions: confusion, disorientation, dissociation, indecisiveness, difficulty concentrating, memory loss, self blame and unwanted memories
physical reactions-tension, fatigue, insomnia, startle, racing pulse, nausea. loss of appetite.
Interpersonal reaction
Acute is more intense and occur during the month after the event. - minimum of 9 of 14 symptoms spread across 5 categories.
When evaluated individually symptoms may look like, Panic, anxiety, depression, dissociation, and intrusive, obsessional thoughts,</p>

Question 31

<p>What disorder involves the inability to remember autobiographical information that is not caused by normal forgetfulness and is often related to a trauma?</p>

Answer 31

<p>Dissociative Amnesia
The core symptom of Dissociative Amnesia involves memory loss for periods that extend well beyond the actual trauma. Ex. Sexual abuse with a 6 year memory deficit.</p>

Question 32

<p>What are the four forms or dissociative amnesia</p>

Answer 32

<p>Di</p>

Question 33

<p>If you were to do an assessment on an individual with Alzheimer's during the 4th or 5th year of the disorder, you will most likely find?
What symptoms would you most likely see in the first to second year?</p>

Answer 33

<p>-Stage 2 (2 to 10 years) Severe impairments in recent and remote memory. Fluent aphasia indifference or irritability (flat labile mood, restlessness and agitation, acalculia, ideomotor apraxia, (inability to translate a idea to movement, delusions)
- Stage 1 ( anterograde: declarative) Deficits in new learning with remote memory mildly to moderately impaired, anomia, sadness, deficits in visuospatial (wandering) indifference, irritability.</p>

Question 34

<p>An individual experiencing symptoms of severely deteriorated intellectual functioning, apathy, limb rigidity, and urinary and fecal incontinences has what disorder and what area's of the brain are being affected?</p>

Answer 34

<p>Alzheimer's stage 3

severe neuron loss and the presence of an amyloid-predominant neuritic plaques and tau-predominant neurofibrillary tangles esp. in the--
=medial temporal structures (amygdala, hippocampus, entorhinal cortex) responsible for memory, navigation and the perception of time/ main interface between the hippocampus and neocortex; which system plays an important role in declarative memories particularly spatial including memory formation, consolidation and memory optimization in sleep hippocampus)
--abnormal levels of Ach which is involved in memories. ---</p>

Question 35

<p>Is there a genetic component to Alzheimer's and what abnormalities indicate early onset and late onset?</p>

Answer 35

<p>Yes. abnormalities in the chromosome 1,14,21 which is linked to familial type early onset and
abnormalities on the ApogeneE4 on chromosome 19 indicating later onset</p>

Question 36

<p>What is the risk factors to Alzheimer's ?</p>

Answer 36

<p>lower level of education, adult onset (type 2) diabetes, depression, traumatic brain injury, down syndrome</p>

Question 37

<p>When an individual demonstrates high levels of interoceptive avoidance and fear of interoceptive cues what are they struggling with?</p>

Answer 37

<p>Panic Disorder

| interception (sense of the internal state of the body</p>

Question 38

<p>Mower's two stage theory of fear acquisition and maintenance notes that?</p>

Answer 38

<p>Fears are originally acquired through classical conditioning and maintained through operant.
Why? The first part of a two-stage theory for acquiring and maintaining fear and avoidance behavior posits that an otherwise neutral event acquires the capacity to provoke fear because of its pairing with an aversive experience, much as a dog phobia might develop from being bitten (Dollard &amp;amp; Miller, 1950; Mowrer, 1960).
In the second stage of the two-factor model, any actions (escape or avoidance behavior, compulsions) that relieve obsessive anxiety/ discomfort are negatively reinforced because they result in reduction of discomfort. Their demonstrated ability to terminate unpleasant experiences renders them very likely to be repeated in future situations</p>

Question 39

<p>What is the difference between illness anxiety and somatic symptom disorder?
If they engage in deceptive behavior by presenting themselves as sick even in the absence of an external reward are struggling with what disorder?
What is happening if they are doing it for a reward?
What is the best treatment?</p>

Answer 39

<p>illness anxiety is a preoccupation with having a serious illness (family has cancer fear that they have cancer) when you don't (6 mo health checks that suggest no illness; symptoms need to persist for at least 6 m.) and having high anxiety about one's health and perform excessive health related behaviors (care seeking or care-avoidant type). (minimal if any concern over somatic symptoms)
Somatic symptom: presence of a somatic symptom

Factitious disorder
Malingering

Supportive therapy and therapeutic relationship.</p>

Question 40

<p>Major Depression has been linked to what sleep disturbances</p>

Answer 40

<p>reduced stage 3 and stage 4 sleep (slow wave sleep/delta)
decreased slow wave (non-REM) sleep, decreased REM latency (define: the state of existing but not yet fully developed) ( earlier onset of REM/ 30 to 60 mins after falling asleep instead of 90 mins) and decreased sleep continuity, decreased REM sleep early in the night.</p>

Question 41

<p>A person does not like their neighbor, does not experience strong emotions, disinterested in marriage and was a loner in school who was teased by his peer. What is his diagnosis</p>

Answer 41

<p>schizoid personality disorder: a lack of desire for interpersonal relationships and restricted range of emotional expression in social settings, doesn't desire or enjoy close relationships. chooses solidarity, little interest in sexual relationships lack close friends except close relatives, indifferent to praise or criticism, exhibits emotional coldness.</p>

Question 42

<p>Research on the treatment of pediatric acute lymphoblastic leukemia with cranial radiation or chemotherapy have found that</p>

Answer 42

<p>either treatment alone is associated to decrease intellectual ability and academic achievement</p>

Question 43

<p>PET scam shows that an individual has increased activity in the orbitofrontal cortex, cingulate cortex, and caudate nucleus has what disorder</p>

Answer 43

<p>OCD
caudate nucleus is part of the basal ganglia which is involved in movement, and the orbitofrontal cortex and cingulate cortex are involved in emotional reactions. drug and behavioral treatments lower activity in these areas,</p>

Question 44

<p>What is the best interventions for cigarette smoking?</p>

Answer 44

<p>nicotine replacement therapy and support from a clinician and skills training that focuses on avoiding and dealing with relapse.</p>

Question 45

<p>What are the key features to Bulimia Nervosa?</p>

Answer 45

<p>Binge eating and recurrent inappropriate compensatory behaviors (purging, diuretic use, excessive exercise that occur 1 time a wk) for at least 3M</p>

Question 46

<p>What is the difference between anorexia and bulimia? Over half individuals with Anorexia and Bulimia with the onset usually preceding the diagnosis</p>

Answer 46

<p>Anorexia- restriction of energy that leads to low body weight; intense fear of getting fat, disturbance in how one experiences body weight or lack of recognition of the seriousness of weight loss.
Bulimia is a binge with a lack of control and compensatory behaviors to prevent weight gain. self evaluation that is influenced by body shape and weight
-Anxiety ( Social phobia OCD)</p>

Question 47

<p>Research on Phototherapy and Seasonal Affective disorder shows?</p>

Answer 47

<p>That is an effective treatment for this disorder and is as effect as antidepressants for reducing symptoms.</p>

Question 48

<p>Conversion Disorder</p>

Answer 48

<p>A diagnosis of Conversion Disorder requires the presence of symptoms that involve a disturbance in voluntary motor or sensory functioning and suggest a serious neurological or other medical condition with evidence that the symptoms are incompatible with recognized neurological and medical conditions.</p>

Question 49

<p>The psychoanalyst Adolph Stern provided the first organized clinical description of the borderline patient. Of the ten basic characteristics Stern delineated, which of the following did he consider to be the most primary?

What other theories?</p>

Answer 49

<p>-Stern considered the difficulties experienced by the borderline patient to be secondary to narcissism and viewed narcissism as arising from a serious disturbance in the early mother-child relationship. (Note that other psychoanalytically-oriented theorists have identified other factors as being primary: Kernberg, for example, emphasizes the role of excessive aggression.)

- Object Relations: Mahler: fixation in the reapproachement phase of separation-individuation--need for separation with overwhelming fear of abandonment
- Kerberg: adverse, unpredictable caregiver-child interactions that alternate between rejection and smothering, that produce an insecure ego, that relies on primitives defenses-splitting-all good and all bad
- Linehan's biosocial model: emotional dysregulation as the core. -excessive emotional vulnerability, inability to modulate strong emotions, end exposure to invalidating environment.</p>

Question 50

<p>Borderline Disorder has a pattern of</p>

Answer 50

<p>A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)

A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

Identity disturbance: markedly and persistently unstable self-image or sense of self. (here may be an identity disturbance characterized by markedly and persistently unstable self-image or sense of self (Criterion 3). There are sudden and dramatic shifts in self-image, characterized by shifting goals, values, and vocational aspirations. There may be sudden changes in opinions and plans about career, sexual identity, values, and types of friends. These individuals may suddenly change from the role of a needy supplicant for help to that of a righteous avenger of past mistreatment.)

Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)

Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). (Individuals with borderline personality disorder may display affective instability that is due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

Chronic feelings of emptiness. (boredom)

Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

Transient, stress-related paranoid ideation or severe dissociative symptoms.
-onset: 19 through 34 most severe in young adult. impulsive symptoms resolve in 40 (75%) affective most chronic and cognitive and interpersonal were intermediately resolved.</p>

Question 51

<p>General Personality Disorder</p>

Answer 51

<p>An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:

Cognition (i.e., ways of perceiving and interpreting self, other people, and events).

Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response).

Interpersonal functioning.

Impulse control.

The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.

The enduring pattern is not better explained as a manifestation or consequence of another mental disorder.

The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).</p>

Question 52

<p>Recent research has shown that single-session Psychological Debriefing (PD):

What is the treatment of choice? what does it incorporate?

What is usually prescribed?</p>

Answer 52

<p>review of the research that there is sufficient empirical evidence to indicate that PD should not be provided to individuals immediately after a trauma. The studies they reviewed showed that one-session PD is not effective and, in some cases, actually increases the likelihood of PTSD symptoms: Cognitive Incident stress debriefing: within 72 hours, whether or not they show symptoms and is long-bad.

- Comprehensive Cognitive behavioral intervention- incorporates exposure, cognitive restructuring, and anxiety management
- SSRI to reduce depressive symptoms and anxiety</p>

Question 53

<p>For people with Specific Phobia, blood-injection-injury type</p>

Answer 53

<p>For people with the blood-injection-injury type, feared stimuli produce an initial increase in heart rate and blood pressure, which is immediately followed by a drop in both and fainting. In contrast, people with other types of Specific Phobia experience only an increase in heart rate and blood pressure. Because of the physiological response associated with the blood-injection-injury type, treatment involves tensing (rather than relaxing) muscles in the presence of feared stimuli. - relaxation techniques are contraindicated</p>

Question 54

<p>What is the difference between an illusion and an hallucination?</p>

Answer 54

<p>An illusion is a misperception of reality (e.g., misperceiving a coffee mug as a rodent).
Answer B is incorrect: A delusion is a false belief about reality that is firmly held regardless of evidence to the contrary.
Answer C is incorrect: While an illusion is elicited by an actual stimulus, an hallucination is a sensory perception in the absence of an external stimulus</p>

Question 55

<p>When do you ECT to treat Depression?

What is the primary undesirable effect of ECT?</p>

Answer 55

<p>-when severe enough and involves delusions, and suicidal ideation or have not responded to antidepressants. -

Temporary anterograde and retrograde amnesia, confusion, and disorientation - this can be reduced by administering ECT unilaterally to the right (nondominant) hemisphere - less retrograde amnesia but also less anterograde amnesia for verbal and nonverbal tasks.</p>

Question 56

<p>A DSM-5 diagnosis of Schizophrenia requires the presence of two or more active-phase symptoms during a one-month period with at least one symptom being \_\_\_\_\_\_\_\_\_\_\_\_ plus continuous signs of disturbance for least six months.</p>

Answer 56

<p>Hallucinations, delusions, and disorganized speech
(Schizophrenia spectrum and other psychotic disorders include schizophrenia, other psychotic disorders, and schizotypal (personality) disorder. They are defined by abnormalities in one or more of the following five domains: delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms. Avolition- reduced drive to pursue goal-directed behavio)

Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

Delusions.

Hallucinations.

Disorganized speech (e.g., frequent derailment or incoherence).

Grossly disorganized or catatonic behavior.

Negative symptoms (i.e., diminished emotional expression or avolition).

For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).

Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).</p>

Question 57

<p>What ADHD symptoms decrease in adolescents.</p>

Answer 57

<p>Hyperactivity typically decreases in adolescence, while impulsivity (especially verbal and emotional impulsivity) and inattention continue. In addition, during adolescence, ADHD is often masked by other problems such as oppositionality, learning difficulties, low self-esteem, and deficits in social skills.
-- Faraone and colleagues concluded that the rate of persistence of ADHD into adulthood depends on how persistence is defined. The results of their meta-analysis indicated that about 15% of children with ADHD continue to meet the full diagnostic criteria for the disorder in early adulthood and that between 40 and 60% meet the criteria for ADHD in partial remission.</p>

Question 58

<p>What are the associated features of Schizophrenia?

What is the prevelance rate? and is it higher in females or males?</p>

Answer 58

<p>Individuals with schizophrenia may display inappropriate affect (e.g., laughing in the absence of an appropriate stimulus); a dysphoric mood that can take the form of depression, anxiety, or anger; a disturbed sleep pattern (e.g., daytime sleeping and nighttime activity); and a lack of interest in eating or food refusal. -Depersonalization, derealization, and somatic concerns may occur and sometimes reach delusional proportions. -Anxiety and phobias are common(Tandon et al. 2009). -Cognitive deficits in schizophrenia are common and are strongly linked to vocational and functional impairments. These deficits can include decrements in declarative memory, working memory, language function, and other executive functions, as well as slower processing speed(Mesholam-Gately et al. 2009). -Abnormalities in sensory processing and inhibitory capacity, as well as reductions in attention, are also found. -Some individuals with schizophrenia show social cognition deficits, including deficits in the ability to infer the intentions of other people (theory of mind)(Bora et al. 2009), and may attend to and then interpret irrelevant events or stimuli as meaningful, perhaps leading to the generation of explanatory delusions. These impairments frequently persist during symptomatic remission.
Some individuals with psychosis may lack insight or awareness of their disorder (i.e., anosognosia). This lack of “insight” includes unawareness of symptoms of schizophrenia and may be present throughout the entire course of the illness
-The lifetime prevalence of schizophrenia appears to be approximately 0.3%–0.7%.
-The sex ratio differs across samples and populations: for example, an emphasis on negative symptoms and longer duration of disorder (associated with poorer outcome) shows higher incidence in males whereas definitions allowing for the inclusion of more mood symptoms and brief presentations (associated with better outcome) show equivalent risks for both sexes</p>

Question 59

<p>There is a higher reported rate of African Americans to Caucasians but this is due to a misdiagnosis due to the fact that African Americans are more likely to experience \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_?
Also patients in developing countries are more likely to experience \_\_\_\_\_\_,\_\_\_\_\_\_, \_\_\_\_\_\_\_\_</p>

Answer 59

<p>Hallucinations and delusions as symptoms of depression and other disorders.

acute onset, shorter clinical course, complete remission.</p>

Question 60

<p>Good prognosis for Schizophrenia

What brain abnormalities?</p>

Answer 60

<p>good premorbid adjustment, acute and late onset, female, presence of precipitating event, brief active phase, insight, family history of mood, no family history of schiz.
Psychotic symptoms tend to diminish over the life course, perhaps in association with normal age-related declines in dopamine activity (dopamine hypothesis: elevated levels of dopamine)
Negative symptoms are more closely related to a poor prognosis than are positive symptoms and tend to be the most persistent. Furthermore, cognitive deficits associated with the illness may not improve over the course of the illness possibility due to hypofrontal land lower than normal activities in the prefrontal cortex
Enlarged Ventricles is the most common</p>

Question 61

<p>Concordance Rates for schizophrenia</p>

Answer 61

<p>Identical (mon) twins 48%
Child or two parents with D/O 46%
Fraternal twins 17%
Biological siblings 10%</p>

Question 62

<p>What is the best treatment for Bulimia Nervosa
What is the typical triggers
How is it characterized/symptoms?</p>

Answer 62

<p>Cognitive-behavioral therapy is considered the most effective treatment for Bulimia Nervosa. However, several experts have suggested that the effectiveness of a traditional approach to CBT is improved if it includes a greater focus on other issues such as emotional responding and interpersonal relationships. Fairburn's CBT-E incorporates interventions that target perfectionism, low self-esteem, interpersonal factors, and emotional factors.

- Triggers are interpersonal stress and dysphoric mood.
- recurrent episodes of binge eating accompanied by a lack of control, inappropriate compensatory behavior to prevent weight gain, self evaluation that is influenced by body weight and shape, binge eating and compensatory behaviors have to occur at least 1/week for 3 Months</p>

Question 63

<p>What is a risk factor for mania?

What qualifies as a manic episode? what is the duration and what three characteristic symptoms must it include?

People with this diagnosis are \_\_\_\_ more likely to commit suicide.

12 month prevalence rate in the US is \_\_\_\_\_\_\_\_\_\_\_\_ and lifetime male to female \_\_\_\_\_\_\_\_

At what age do people usually experience their first episode? And about \_\_\_\_\_ % experience another.

Highly genetic with \_\_\_ to \_\_\_ for monozygotic twins and \_\_\_ for dizygotic.

What are some effective treatment for Bipolar1</p>

Answer 63

<p>Goal dysregulation and reward sensitivity

distinct period of abnormality and persistent elevated, expansive, or irritable mood and abnormally and persistently increased goal directed activity or energy.

Must Last for At Least 1 WEEK
include: inflated self esteem, or grandiosity, decreased need for sleep, excessive talkativeness, and flight of ideas. Marked impairment and requires hospitalization.

15 times
0.6%, Male to female 1:1.1
Age 18, 90% experience another.
.67 to 1.0 mono twins and .2 dizygotic

Treatments: Lithium "classic"
Antiseizure: Carbamazepine or divalproex - rapid cycling/dysphoria
SSRI not Tricyclic- be careful you don't trigger mania
Psychosocial interventions, CBT, family focused treatment, interpersonal and social rhythm therapy.</p>

Question 64

<p>What replaced Alcohol Dependence in the DSM 5?
This is manifested by at least\_\_\_ symptoms for \_\_\_\_ months
How many classes are in this disorder?
What are the four groups of symptoms?</p>

Answer 64

<p>In the DSM-5 now called Substance Use Disorder (direct activation of the brain reward system)
2 symptoms for 12 months
10 classes: Alcohol, caffeine, cannabis, phencyclidine and other hallucinogens, inhalants, opioids, hypnotics or anxiolytics
-Impaired control: unsuccessful effort to cutdown or control use, great deal of time finding and recovering from the substance, craving.
-Social Impairments: failure to fulfill role obligations, recurrent use despite social problems, and important activities are given up.
-Risky use
-Pharmacological criteria-tolerance need increase, withdrawal</p>

Question 65

<p>What are the Alcohol-Induced Disorders?</p>

Answer 65

<p>-Alcohol Intoxication involves maladaptive behavioral and psychological changes with at least one characteristic symptom (e.g., slurred speech; unsteady gait; nystagmus; impaired attention or memory).

- Alcohol Withdrawal (Delirium) as involving the development of at least two characteristic symptoms within several hours to a few days following cessation or reduction of alcohol consumption (e.g., autonomic hyperactivity, hand tremor, insomnia, transient illusions or hallucinations, seizures)
- Alcohol-induced Major Neurocognitive Disorder significant decline in one or more cognitive domains that interferes with independence in everyday activities.-- Korsakoff Syndrome: anterograde and retrograde amnesia, confabulation, thiamine deficiency
- Alcohol-induced Sleep Disorder: intoxication-immediate sedation, increased 3 and 4 and reduced REM followed by increase wakefulness, increased REM and anxiety arousing dreams, Withdrawal- vivid dreams, severe disruption.</p>

Question 66

<p>Does OCD require a higher or lower dose of SSRI compared to Depression</p>

Answer 66

<p>a higher dose is required when treating OCD than when treating depression</p>

Question 67

<p>Oppositional Defiant Disorder requires the presence of?

A DSM-5 diagnosis of Intermittent Explosive Disorder requires the presence of:

A DSM-5 diagnosis of Disruptive Mood Dysregulation Disorder requires the presence of ?

What is the difference?</p>

Answer 67

<p>Oppositional Definite Disorder: recurrent pattern of angry irritable mood, argumentative, defiant behavior or vindictiveness' as evident be at least 4 characteristics that is exhibited during an interaction with at least one person who is not a sibling: loses temper, argues with authority actively refuses to comply with authority, blames others- persist for 6 months and distress others. 4 symptoms for 6 months

The DSM-5 diagnosis of Intermittent Explosive Disorder requires recurrent behavioral outbursts that reflect a failure to control aggressive impulses as manifested by either verbal aggression or physical aggression toward property, animals, or other people that does not result in destruction or injury or behavioral outbursts that do result in destruction of property or injury of people or animals. not premeditated, can not diagnose before 6 occurs 2/week and has persisted for at least 3 months (verbal aggression) : with damage or destruction of property and/or physical assault that injured a person/animal within 12M (physical aggression)

Disruptive Mood Dysregulation Disorder: Temper outbursts manifested verbally or behaviorally-aggression towards people/property, that are grossly out of proportion, -chronic persistent irritable mood, 12 month- 3 times a week can not diagnose before 6 or after 18. age of onset must be before 10yrs. (12M. 3/WK)

ODD- pattern of angry irritable mood with behavior
Intermittent Explosive: incontrollable angry outbursts
Disruptive mood: more severe tantrums and negative mood state</p>

Question 68

<p>What is the difference between localize, selective, anterograde and retrograde amnesia?</p>

Answer 68

<p>The loss of memory for personal information limited to a circumscribed period of time is referred to as localized amnesia.

Selective amnesia refers to a loss of memory for some, but not all, events during a circumscribed period.

Anterograde amnesia is a general term that refers to the inability to form new memories and does not refer specifically to memory loss associated with Dissociative Amnesia

Retrograde amnesia refers to a loss of memory for information already stored in long-term memory.</p>

Question 69

<p>A diagnosis of Substance Use Disorder can be applied to all classes except?</p>

Answer 69

<p>Caffeine</p>

Question 70

<p>What are the two theories that explain Substance Use Disorder?

What treatments are used for Substance Use Disorder?

What is the biggest precipitant of relapse? What leads to increased susceptibility of further alcohol use according to Marlatt and Gordan?</p>

Answer 70

<p>-Conger: reducing tension and is based on negative reinforcement (drinking at a party to reduce anxiety)

- Marlatt and Gordan: addiction is an overlearned maladaptive habit pattern and are acquired
- Biopsychosocial models: initiation, maintenance, and progression as involving an interaction between physical, psychological, and sociocultural.

CBT_contingency management, motivational interviewing, relapse prevention training, family and couples, 12-step,
Medication: naltrexone or disulfiram, Tobacco: antidepressant Bupropion

-anxiety, depression, frustration or negative emotion. Further relapse- abstinence violation effect that involves self-blame and guilt</p>

Question 71

<p>Successful tobacco quitters are more likely to be ?

What are the three elements in a smoking cessation intervention?

Tobacco Withdrawal is characterized by 4 symptoms within 24 hours of cessation or reduction</p>

Answer 71

<p>Males, age 35, educated, come from a non smoking house, have strict no smoking policies at work, are married or live with a partner, started smoking at a later age, abstained from smoking for longer than 5 days on previous attempts to quit.

1- nicotine replacement therapy 2- behavioral therapy 3- support

irritability and anger, anxiety impaired concentration increased appetite, restlessness, depressed mood, insomnia.</p>

Question 72

<p>The DSM-5 requires the presence of characteristic symptoms for a minimum duration of about \_\_\_ months for all of the Sexual Dysfunctions except Substance/Medication-Induced Sexual Dysfunction for which no minimum duration is specified.</p>

Answer 72

<p>6</p>

Question 73

<p>Perceptual distortions (depersonalization and derealization) are potential symptoms of a \_\_\_\_\_\_, which is the essential feature of \_\_\_\_\_\_\_\_\_\_.</p>

Answer 73

<p>Panic Attack, Panic Disorder</p>

Question 74

<p>Compared to OCD, hoarding is Ego-syntonic or Ego-dystonic?

And what is the difference?</p>

Answer 74

<p>Hoarding is ego-syntonic for people with Hoarding Disorder - i.e., they consider their behaviors normal (for them) and are not particularly disturbed by their hoarding. For people with OCD, symptoms are ego-dystonic and experienced as disturbing and unacceptable.

Ego-syntonic refers to instincts or ideas that are acceptable to the self; that are compatible with one's values and ways of thinking. They are consistent with one's fundamental personality and beliefs. Ego-dystonic (distress) refers to thoughts, impulses, and behaviors that are felt to be repugnant, distressing, unacceptable or inconsistent with one's self-concept.</p>

Question 75

<p>What is an important difference between social phobia and agoraphobia</p>

Answer 75

<p>The effects of having a companion in anxiety-arousing situations can help distinguish the two disorders. In Agoraphobia, the presence of a trusted companion often alleviates anxiety. In Social Anxiety Disorder, a companion can actually increase anxiety.
Fear of humiliation or embarrassment in social situations is characteristic of both disorders (although the fear is not necessarily limited to social situations in Agoraphobia).</p>

Question 76

<p>What is a risk factor to schizophrenia?</p>

Answer 76

<p>Prenatal viral infection and lack of oxygen to the fetus</p>

Question 77

<p>What are the symptoms of avoidant personality disorder?</p>

Answer 77

<p>Avoidant Personality Disorder, which entails sensitivity to criticism, avoidance of social activities, embarrassment, and distress at the inability to form close personal relationships.</p>

Question 78

<p>For the diagnosis of Schizoaffective Disorder, there must be a combination of psychotic and mood symptoms except for a distinct period of at least \_\_\_\_ weeks during which delusions and hallucinations (psychotic symptoms) are present without prominent mood symptoms.</p>

Answer 78

<p>2 weeks</p>

Question 79

<p>What is a co-dependent?</p>

Answer 79

<p>The term co-dependent was originally applied to people who are emotionally involved with alcoholics, but is now more widely used to refer to people who support any addiction of another person.
Definitions of co-dependence vary from author to author, but this description comes closest to most currently accepted definitions. Co-dependents overtly or covertly support, and thereby help maintain, the addiction of another person.</p>

Question 80

<p>Marlatt and Gordon"s (1985) "abstinence violation effect" (AVE) model considers recovery after relapse to be related to attributions about the cause of the relapse - i.e., successful recovery is more likely when the person attributes relapse to?</p>

Answer 80

<p>external, unstable, and specific (high-risk) factors than when he/she attributes it to internal, stable, and global factors.</p>

Question 81

<p>According to the DSM, what are the most common associated symptoms of Tourette's Disorder.</p>

Answer 81

<p>ADHD and obsessive-compulsive and related disorders being particularly common. The obsessive-compulsive symptoms observed in tic disorder tend to be characterized by more aggressive symmetry and order symptoms and poorer response to pharmacotherapy with selective serotonin reuptake inhibitors. Children with ADHD may demonstrate disruptive behavior, social immaturity, and learning difficulties that may interfere with academic progress and interpersonal relationships and lead to greater impairment than that caused by a tic disorder. Individuals with tic disorders can also have other movement disorders and other mental disorders, such as depressive, bipolar, or substance use disorders.</p>

Question 82

<p>What disorder is characterized by a dissatisfaction with sleep, quality and quantity that is associated with at least one of the following: difficulty initiating sleep, difficulty maintaining sleep, early morning awakening with inability to return to sleep . The sleep disturbance occurs at least \_\_\_ nights each week, has been present for \_\_\_\_ months and occurs despite sufficient opportunities to sleep.</p>

Answer 82

<p>3, 3: Insomnia Disorder</p>

Question 83

<p>Either (1) or (2):

Evidence by polysomnography of at least five obstructive apneas or hypopneas per hour of sleep and either of the following sleep symptoms:

- Nocturnal breathing disturbances: snoring, snorting/gasping, or breathing pauses during sleep.
- Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep that is not better explained by another mental disorder (including a sleep disorder) and is not attributable to another medical condition.

Evidence by polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep regardless of accompanying symptoms.

Specify current severity:

- Mild: Apnea hypopnea index is less than 15.
- Moderate: Apnea hypopnea index is 15–30.
- Severe: Apnea hypopnea index is greater than 30

What is the treatment for this disorder?</p>

Answer 83

<p>Obstructive Sleep Apnea Hypopnea

-Treatment: continuous positive airway pressure
-oral treatment for mild
tracheostomy for severe</p>

Question 84

<p>This disorder is characterized by:
Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day. These must have been occurring at least three times per week over the past \_\_\_ months.

The presence of at least one of the following:

Episodes of \_\_\_\_\_, defined as either (a) or (b), occurring at least a few times per month:
-In individuals with long-standing disease, brief (seconds to minutes) episodes of sudden bilateral loss of muscle tone with maintained consciousness that are precipitated by laughter or joking.

In children or in individuals within 6 months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without any obvious emotional triggers.

Hypocretin deficiency, as measured using cerebrospinal fluid (CSF) hypocretin-1 immunoreactivity values (less than or equal to one-third of values obtained in healthy subjects tested using the same assay, or less than or equal to 110 pg/mL). Low CSF levels of hypocretin-1 must not be observed in the context of acute brain injury, inflammation, or infection.

Nocturnal sleep polysomnography showing rapid eye movement (REM) sleep latency less than or equal to 15 minutes, or a multiple sleep latency test showing a mean sleep latency less than or equal to 8 minutes and two or more sleep-onset REM periods.

Many individuals experience\_\_\_ or \_\_\_\_\_ hallucinations which are vivid and occur before or upon falling asleep or just after awakening.</p>

Answer 84

<p>3 Months
cataplexy: In most cases, an episode of cataplexy is triggered by anger, surprise, laughter, or other strong emotion. Full consciousness and people may try to prevent sleep attacks by controlling their emotions.</p>

Question 85

<p>Chronic otitis media in early childhood has been linked to?</p>

Answer 85

<p>Otitis media is an infection of the middle ear. It can cause hearing loss and speech and language problems and has been linked to reading and other learning disorders.</p>

Question 86

<p>Dissociative Amnesia is characterized by?</p>

Answer 86

<p>Dissociative Amnesia is characterized by an inability to recall important personal information that is often related to a traumatic event.

Dissociative Amnesia involves gaps in the recall of aspects of the individual's past, often aspects related to a traumatic event or severe stressor.</p>

Question 87

<p>What are the requirements for a Agoraphobia diagnosis?

Symptoms typically last for how many months?

What is the likely diagnosis when an individual's anxiety involves a single situation that is characteristic of agoraphobia and is related to something other than a concern about experiencing panic-like incapacitating or embarrassing symptoms?

What is the likely diagnosis when an individual's anxiety is related to being scrutinized by others and increases in the presence of a family member or friend.</p>

Answer 87

<p>The DSM-5 diagnosis of Agoraphobia requires that the individual experiences marked fear or anxiety in at least two (2) of the following situations: using public transportation, being in open spaces, being in enclosed spaces, standing in line or being part of a crowd, and being outside the home alone. In addition, the individual must fear or avoid these situations due to a concern that escape might be difficult or help will be unavailable in case he or she develops panic-like, incapacitating, or embarrassing symptoms.

- Specific phobia: situational type
- Social anxiety</p>

Question 88

<p>Generalized anxiety disorder involves excessive worry or concern about multiple events or activities that are relatively constant for \_\_\_ months, the person finds it difficult to control and cause significant distress: anxiety and worry must include at least 3 of what symptoms? How many symptoms for children?</p>

Answer 88

<p>6 months
- feeling keyed up or on edge,
fatigue, difficulty concentrating
irritability,
muscle tension and sleep disturbance, 
Children at least one</p>

Question 89

<p>What Withdrawal symptoms involves a dysphoric mood, increased appetite, and insomnia, irritability, anxiety, impaired concentration, and restlessness?

What withdrawal involves a dysphoric mood, nausea and vomiting, muscle aches, diarrhea, and fever.

Dysphoria, vivid and frightening dreams, insomnia or hypersomnia, fatigue, psychomotor agitation or retardation, and increased appetite are most suggestive of \_\_\_\_\_\_\_\_\_\_ Withdrawal.

What drug is not associated with a withdrawal?</p>

Answer 89

<p>Tobacco

Opioid Withdrawal

Stimulant Withdrawal

Phencyclidine use is not associated with a withdrawal syndrome.</p>

Question 90

<p>What is the first line drug to treat Mania? If this doesn't work than what is prescribed?

What is Propranolol used to treat?

What is Lorazepam used for?

Donepezil is a cholinesterase inhibitor and used to treat?</p>

Answer 90

<p>Lithium is ordinarily the first-line drug treatment for Bipolar I Disorder. However, when an individual is lithium intolerant or has symptoms that are non-responsive to lithium, an anticonvulsant drug (e.g., carbamazepine, valproic acid, gabapentin) is often prescribed.

Propranolol is a beta-blocker and is used to treat hypertension, angina, and other cardiovascular disorders and to alleviate the physical symptoms of anxiety.

Lorazepam is a benzodiazepine and is used to treat anxiety, alcohol withdrawal, and chronic insomnia.

Donepezil is a cholinesterase inhibitor that is used to treat cognitive impairment experienced by individuals with mild to moderate Alzheimer's disease.</p>

Question 91

<p>Children with a learning disorder often have a co-diagnosis of?

What percentage of children also receive a diagnosis of ADHD</p>

Answer 91

<p>Children with a learning disorder often have a co-diagnosis of ADHD, Tourette's Disorder, and/or a mood disorder.
The studies have found that the most common co-diagnosis is ADHD, with about 20 to 30% of children with a learning disorder also receiving a diagnosis of ADHD.</p>

Question 92

<p>Schizoid personality disorder is characterized by what? At least 4 of what symptoms must be present?

And does this include Grandiosity?</p>

Answer 92

<p>Grandiosity involves an exaggerated sense of self-importance. It is characteristic of three of the four disorders listed in the answers to this question.
-Schizoid Personality Disorder is characterized by restricted emotional experience and expression. Pervasive pattern of detachment form interpersonal relationships and a restricted range of emotional expression in social settings.
-- doesn't desire or enjoy close relationships. prefers solitary activities, has little interest in sexual relationships, takes pleasure in few activities, lack close friendships other than first degree relatives, seems indifferent to praise or criticism exhibits emotional coldness or detachment.</p>

prefer spending time alone and are looked at as “loners” prefer mechanical or abstract tasks such as computer or mathematical games
Usually a reduced experience of pleasure from sensory, bodily or interpersonal pleasures such as walking on the beach. Have no friends except possible first-degree relatives.
Are indifferent to criticism of others and do not care what others think. oblivious to normal subtleties of social interactions and do not respond appropriately to social cues. may seem socially inept, , superficial, or self absorbed. Have a bland exterior and do not reciprocate gestures of facial expressions such as smiles. do not experience strong emotions and often display a constricted affect and appear cold and aloof. Most often cooccur with schizotypal, paranoid, and avoidant personality D/O

Question 93

<p>Habit reversal is used to treat?</p>

Answer 93

<p>Habit reversal combines three strategies - awareness training, regulated breathing, and social support. It is used to treat stuttering, tics, and nervous habits</p>

Question 94

<p>hypofrontality in Schizophrenia has been linked to?</p>

Answer 94

<p>Some brain imagining studies have linked hypofrontality (decreased activity in the prefrontal cortex) to the negative symptoms of Schizophrenia and suggest that this link is most likely to be found in patients with chronic Schizophrenia.</p>

Question 95

<p>OCD is characterized by?

And is caused by?

The gender ratio for Obsessive-Compulsive Disorder is related to age.</p>

Answer 95

<p>Obsession- persistent thoughts, impulses or images that is experienced as intrusive and unwanted and that he/she attempts to ignore.
Compulsions: repetitive, deliberate behaviors or mental acts that the person feels driven to perform either in response to an obsession or rigid rules.

Caused by low levels of serotonin, reduced activity in the right caudate nucleus (converts sensory input into actions and cognitive and appears to be overactive)
and orbitofrontal cortex and cingulate cortex-mediates emotional reactions.

In adults, the gender ratio for this disorder is about equal. However, in children, it is more common in boys than in girls because the average age of onset is earlier for males than for females.</p>

Question 96

<p>The gender ratio for MDD is?</p>

Answer 96

<p>The gender ratio for Major Depressive Disorder is related to age: In adolescents and adults, the disorder is more common in females than in males but, in prepubertal children, the rates are about equal for boys and girls.</p>

Question 97

<p>The psychologist's theory views alcohol abuse as the result of a combination of biological and environmental factors.</p>

Answer 97

<p>diathesis-stress model reflects a biopsychosocial perspective and conceptualizes disorders as the result of a combination of biological, psychological, and environmental (social) factors. More specifically, it proposes that disorders are due to a combination of predispositional factors (the diathesis) and exposure to certain life stressors.</p>

Question 98

<p>What is the SORC model and who uses it?</p>

Answer 98

<p>The SORC model is used by cognitive-behavioral therapists as the framework for assessment. Use of this model involves considering the situation in which the problem occurs (S); the observations (thoughts, assumptions, and beliefs) made by the client in response to the situation (O); the client's emotional, psychological, and behavioral responses to his/her observations (R); and the consequences of those responses (C).</p>

Question 99

<p>According to the DSM, Alcohol-Induced Sleep Disorder is usually of the insomnia type and usually involves?</p>

Answer 99

<p>According to the DSM, Alcohol-Induced Sleep Disorder is usually of the insomnia type.
Although alcohol initially produces sleepiness, this is followed by insomnia, restless sleep, and increased REM sleep, often with vivid, anxiety-laden dreams.</p>

Question 100

<p>For a diagnosis of ADHD, the DSM-5 requires that "several inattentive or hyperactive-impulsive symptoms were present prior to age \_\_\_" and that symptoms are present in at least two settings.</p>

Answer 100

<p>12</p>

Question 101

<p>What differentiates binge eating from Bulimia Nervosa?

How do you differentiate Anorexia Nervosa, binge eating/purging type with Bulimia Nervosa?</p>

Answer 101

<p>Compensatory behavior is a diagnostic criterion for Bulimia Nervosa but not for Binge Eating Disorder and, therefore, differentiates the two disorders.
Binges can be severe in both disorders and, therefore, is not a distinguishing characteristic.
The disturbance in body image associated with Bulimia Nervosa involves an excessive emphasis on body shape and weight in self-evaluation.
A sense of a lack of control is characteristic of both disorders.

Anorexia: Low weight
Bulimia prevent weight gain; when weight returns to normal and there is still compensatory behaviors- change diagnosis to Bulimia</p>

Question 102

<p>DBT is the treatment for ? and explicitly targets?

Stress inoculation training focuses on what?

Self Control therapy is a behavioral intervention that is used primarily to?</p>

Answer 102

<p>DBT was developed as a treatment for Borderline Personality Disorder and explicitly targets parasuicidal behaviors, a common feature of this disorder. For example, skills training is one component of DBT and includes teaching the client strategies to help regulate his/her emotions and better tolerate distress, which decreases the likelihood of parasuicidal behaviors.

As its name implies, stress inoculation training focuses on helping individuals acquire the skills they need to deal more effectively with stress.

Self-control therapy is a behavioral intervention that is used primarily to reverse undesirable habits (e.g., overeating, smoking) and has also been found to be an effective treatment for depression. Self-control therapies are strategies for teaching people skills and techniques for controlling their own behavior when striving to achieve long-term goals. It is usually assumed that people employ self-control strategies implicitly in their efforts to change behavior, such as when starting a diet or exercise program or attempting to quit smoking. Self-control therapies attempt to teach these strategies in an explicit way. A number of self-control models are used as the basis for self-control theories. One example is the self management therapy (SMT) program for depression developed by the author</p>

Question 103

<p>Can the use of Haloperidol or other dopamine blocking agents be effective for Tourette's disorder? What is the main concern for using these medications to treat Tourette's?</p>

Answer 103

<p>About 50% of people with Tourette's Disorder who take Haloperidol or similar drugs develop intolerable side effects.
Antipsychotic drugs are effective in about 80% of cases of Tourette's Disorder.
Antipsychotic drugs are useful for alleviating tics in most cases.
can be problematic in many cases because of the severe side effects of these drugs</p>

Question 104

<p>Butzlaff and J. M. Hooley looked at studies investigating the impact of expressed emotion on outcomes for schizophrenia, mood disorders, and eating disorders and found that high expressed emotion by family members was \_\_\_\_\_\_\_ predictive of relapse for mood and eating disorders than for schizophrenia, although all effect sizes for all three were significant. Specifically, they obtained weighted mean effect sizes for mood disorders, eating disorders, and schizophrenia of, respectively,</p>

Answer 104

<p>more strongly</p>

Question 105

<p>what is the difference between Brief Psychotic, Schizophrenia, Schizophreniform and Schizoaffective?</p>

Answer 105

<p>The diagnosis of Brief Psychotic Disorder requires the presence of ONE or more of four characteristic symptoms with at least one symptom being delusions, hallucinations, or disorganized speech and with symptoms being present for at least one day but less than one month. Symptoms often develop after exposure to an overwhelming stressor but this is not required for the diagnosis.

A diagnosis of Schizophrenia requires the presence of at least TWO active-phase symptoms for at least one month with at least one symptom being delusions, hallucinations, or disorganized speech plus continuous signs of the disorder for at least SIX months.

Schizophreniform Disorder has symptoms that are similar to those of Schizophrenia but with a duration between one and six months.

\: Schizoaffective Disorder is the appropriate diagnosis when the individual has a history of concurrent symptoms of Schizophrenia and a manic or major depressive episode with at least two weeks without prominent mood symptoms.</p>

Question 106

<p>Nystagmus, numbness, and muscle rigidity is a symptom of what type of substance disorder?

blurred vision, tremor, unsteady gait, slurred speech, stupor or coma, euphoria and depressed reflexes?

pupillary dilation, nausea, and muscular weakness?

fatigue, increased appetite, and vivid dreams?</p>

Answer 106

<p>These symptoms are characteristic of Phencyclidine Intoxication.

These symptoms are characteristic of Inhalant Intoxication.

Symptoms of Stimulant Intoxication include tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, muscular weakness, respiratory depression or cardiac arrhythmias, confusion, seizures, and coma.

These are symptoms of Stimulant Withdrawal, not Stimulant Intoxication.</p>

Question 107

<p>Neuronal degeneration in the medial temporal structures (entorhinal cortex, hippocampus, and amygdala) has been linked to? On a PET scan, this is manifested as reduced metabolism in these structures.

Increased metabolism in the frontal lobes and basal ganglia has been linked to?

Decreased metabolism in the prefrontal cortex and thalamus has been linked to?

Increased metabolism in the hippocampus and amygdala has not been linked to?</p>

Answer 107

<p>Alzheimer's disease.

Obsessive-Compulsive Disorder

Schizophrenia

Alzheimer's disease</p>

Question 108

<p>AIDS dementia complex (ADC) has been estimated to affect up to one-third of adults and one-half of children with AIDS. 
A person in Stage 0.5
Stage 1 ?
Stage 2?
Stage 3</p>

Answer 108

<p>Stage 0.5 is characterized by minimal or equivocal signs of impairment with no deficits in work or activities of daily living.

a person in Stage 1 has unequivocal evidence of functional, intellectual, or motor impairment but is able to perform all but the most demanding aspects of activities of daily living and can walk without assistance

A person in Stage 2 cannot work or perform demanding activities of daily living and may require assistance when walking.

A person in Stage 3 has significant intellectual impairments and cannot walk unassisted</p>

Question 109

<p>Common withdrawal symptoms include nausea, vomiting, diarrhea, abdominal and muscle cramps, runny nose and eyes, chills, and insomnia. from what substance?

Rebound anxiety and rebound insomnia are associated with withdrawal from?

Delirium tremens (confusion and visual hallucinations) are severe symptoms that may result from?</p>

Answer 109

<p>Common withdrawal symptoms include nausea, vomiting, diarrhea, abdominal and muscle cramps, runny nose and eyes, chills, and insomnia. (flu-like symptoms). syndrome associated with morphine and other opioids

Rebound anxiety and rebound insomnia are associated with withdrawal from a benzodiazepine. ("Rebound" occurs when the initial symptom - i.e., the symptom for which the drug was prescribed - returns in a more severe form when the drug is withdrawn.)

Delirium tremens (confusion and visual hallucinations) are severe symptoms that may result from abrupt withdrawal from alcohol.</p>

Question 110

Conger’s (1956) tension reduction hypothesis emphasizes the role of which of the following in substance addiction

Answer 110

Anxiety and negative emotions
According to J. J. Conger, people drink to alleviate anxiety, fear, and other negative emotions and are reinforced for doing so because alcohol does, in fact, reduce tension (Reinforcement theory and the dynamics of alcoholism, Quarterly Journal of Studies on Alcohol, 17, 296-306, 1956).

Question 111

Obsessive-Compulsive Disorder is more common in males than in females among those aged:

Answer 111

The rates of OCD for males and females are about equal among adolescents and adults. However, because the onset of the disorder is earlier for males than for females, OCD is more prevalent among male children than female children.
8 to 12.

Question 112

The research suggests that about _____ percent of children who receive a diagnosis of ADHD continue to meet the diagnostic criteria for the disorder in adolescence.

Answer 112

Estimates vary but most studies indicate that between 65 and 80% of children who receive a diagnosis of ADHD continue to exhibit symptoms that meet the criteria for the diagnosis in adolescence.

Question 113

a 26-year-old man who says he’s unhappy about having no close friends but doesn’t attempt to make friends with others because he believes he has telepathy and hears other people’s thoughts
This is an example of what type of personality disorder?

Which personality disorder is characterized by detachment of social relationships and a restricted range of expression of emotions?

Answer 113

Schizotypal Personality Disorder is characterized by a pattern of social and interpersonal deficits involving acute discomfort with and reduced capacity for close relationships and eccentricities in cognition, perception and behavior. Individuals with Schizotypal Personality Disorder may express unhappiness with their lack of relationships but don’t pursue friendships because of their discomfort around other people and belief that they are different from others.

Schizoid

Question 114

A physician is most likely to prescribe ______ for a 36-year old man who has just received a diagnosis of Premature Ejaculation?

Answer 114

: SSRIs (e.g., dapoxetine) are currently used to treat premature ejaculation.

Question 115

As defined in the DSM, the primary difference between a manic episode and hypomanic episode is that, in the latter:

Answer 115

there is no marked impairment in social or occupational functioning.

Question 116

What are the subtypes of a delusional disorder and what is the duration?
If hallucinations are present then they must not be prominent and are related to what?

Answer 116

Subtypes of the delusional Disorder include:
Erotomaniac type: delusion that another person is in love with the individual
Grandiose: having some great talent, insight or discovery
Jealous: spouse, lover is unfaithful
Persecutory: spied on, cheated, conspired against, harassed, drugged, maliciously malign or obstructed in the pursuit of long-term goals,
— no delusion of referent: no specific subtype of Delusional Disorder is provided in the DSM for delusions of reference, and a person with this kind of delusion would be assigned the unspecified subtype.
Duration: 1 M or longer
Hallucinations are related to the delusional theme: sensation of being infested with insects)

Question 117

Dysphoria, vivid and frightening dreams, insomnia or hypersomnia, fatigue, psychomotor agitation or retardation, and increased appetite are most suggestive of __________ Withdrawal.

What withdrawal involves a dysphoric mood, increased appetite, and insomnia, but its other characteristic symptoms are irritability, anxiety, impaired concentration, and restlessness.

________ also involves a dysphoric mood, but its other symptoms include nausea and vomiting, muscle aches, diarrhea, and fever.

Answer 117

1. Stimulant Withdrawal.
2. Tobacco Withdrawal
3. Opioid Withdrawal

Question 118

For a diagnosis of Panic Disorder, the individual must have experienced:

Answer 118

For a DSM diagnosis of Panic Disorder, the individual must have had two or more unexpected panic attacks.

Question 119

Children with a learning disorder often have a co-diagnosis of ADHD, Tourette’s Disorder, and/or a mood disorder.

The studies have found that the most common co-diagnosis is ADHD, with about ____ to ____% of children with a learning disorder also receiving a diagnosis of ADHD.

Answer 119

20 to 30%

Question 120

______________ involves a preoccupation with a defect or flaw in appearance that appears minor or is unobservable to others. The person performs repetitive behaviors or mental acts related to the defect or flaw (e.g., mirror checking, excessive grooming), and his/her preoccupation causes clinically significant distress or impaired functioning.

People with ___________ Disorder are preoccupied with having or acquiring a serious illness. Although Janice is overly concerned about her skin, she does not seem to be concerned that the flaws she perceives are signs of a serious illness.

People with __________Disorder have one or more somatic symptoms that cause distress or a significant disruption in daily life and are accompanied by excessive thoughts, feelings, or behaviors that are related to the symptoms. As noted in the DSM-5, a person with Somatic Symptoms Disorder is concerned that an illness underlies his/her somatic symptoms, while a person with Body Dysmorphic Disorder is concerned about a flaw or defect in appearance.

Answer 120

Body Dysmorphic Disorder

Illness Anxiety

3. Somatic Symptom

Question 121

Who identified a depressive cognitive triad consisting of negative self-statements about oneself, the world, and the future as a contributor to depression?

The tendency to attribute negative events to global, stable, and internal factors was identified as a causal factor by whose original learned helplessness model of depression?

Answer 121

Beck

Seligman’s

Question 122

Lovaas and his colleagues used what method to teach nonspeaking children with autism to talk?

Answer 122

Shaping and discrimination training

Lovaas’s method for teaching nonspeaking children to talk combined modeling, shaping, and discrimination training. Modeling and shaping were used to gradually teach a child to say a word or simple sentence, and discrimination training was then used to teach the child when to use the word or sentence.

Question 123

Many individuals with Major Depressive Disorder have EEG abnormalities during sleep that include?

Answer 123

EEG abnormalities during sleep are experienced by 40 to 60% of outpatients experiencing a major depressive episode (APA, 2000) and include decreased REM latency (i.e., an earlier onset of REM sleep).

People with Major Depressive Disorder often experience decreased slow-wave sleep, increased duration of REM sleep early in the sleep period, and increased REM density (increased frequency of rapid eye movements during REM sleep).

(MDD-2Wk duration)

Question 124

Moffit distinguished between two types of Conduct D/O what are they?

The limited type reflects a? and is a temporary form of antisocial behavior

While life-course persistent is attributed to?

Answer 124

Moffitt (1993) distinguishes between two types of Conduct Disorder - life-course persistent and adolescent-limited.

Moffitt describes the adolescent-limited type of Conduct Disorder as a temporary form of antisocial behavior that reflects a “maturity gap” between the adolescent’s biological maturity and lack of opportunities for adult privileges and rewards.

Moffitt attributes the life-course persistent type of Conduct Disorder to neurological impairment, a difficult temperament, and certain adverse environmental circumstances.

Question 125

Narcissistic, Borderline, and Histrionic Personality Disorders share what common characteristics?

Answer 125

Affective instability is a characteristic shared by all three disorders.

Question 126

Orgasmic reconditioning is considered to be an effective treatment for what disorders?

Answer 126

Orgasmic reconditioning is based on the assumption that orgasm reinforces sexual fantasies, and it is used to replace the stimuli that produce an organism. It is one of the techniques used to treat Paraphilic Disorders and involves having the individual replace an unacceptable sexual fantasy with a more acceptable one while masturbating.

Question 127

Recent research investigating treatments for Generalized Anxiety Disorder suggests that the most effective intervention is:

Answer 127

The studies have consistently found that a multicomponent cognitive or cognitive-behavioral approach is most effective for Generalized Anxiety Disorder

Question 128

Jacob, age 14, is being seen by a school clinician for repeated angry outbursts at school. He is persistently irritable, constantly argues with adults, has a history of behavioral referrals, and recently changed schools after being expelled for threatening a teacher. Jacob is failing in school, and his parents are thinking of sending him to a wilderness camp where he can “get some sense knocked into him.” The most likely DSM-5 diagnosis for Jacob is which of the following?

Answer 128

Disruptive Mood Dysregulation Disorder involves severe, recurrent temper outbursts with a persistent irritable or angry mood between outbursts on most days. (should not be made before 6 and after 18: age of onset 10): chronic irritability)
For at least a year, several times a week, on slight provocation a child has severe tantrums— screaming or actually attacking someone (or something)—that are inappropriate for the patient’s age and stage of development. Between outbursts, the child seems mostly angry, grumpy, or sad. The attacks and intervening moods occur across multiple settings (home, school, with friends). These patients have no manic episodes.

Note: Oppositional Defiant Disorder differs from Disruptive Mood Dysregulation Disorder primarily in terms of the severity, frequency, and chronicity of the temper outbursts, with Disruptive Mood Dysregulation Disorder having more severe, frequent, and chronic symptoms. When the criteria for both disorders are met, a diagnosis of Disruptive Mood Dysregulation Disorder is assigned.( Disruptive mood : differentiate by its severe frequent outbursts and persistent disruption in mood: requires severe impairment in one setting (school expulsion, failing) and moderate impairment in a second setting)

Question 129

Wyatt was a 12-year-old-boy referred by his psychiatrist to an adolescent partial hospitalization program because of repeated conflicts that have frightened both classmates and family members.

According to his parents, Wyatt was generally moody and irritable, with frequent episodes of being “a raging monster.” It had become almost impossible to set limits. Most recently, Wyatt had smashed a closet door to gain access to a video game that had been withheld to encourage him to do homework. At school, Wyatt was noted to have a hair-trigger temper, and he had recently been suspended for punching another boy in the face after losing a chess match.

Wyatt had been an extremely active young boy, running “all the time.” He was also a “sensitive kid” who constantly worried that things might go wrong. His tolerance for frustration had been less than that of his peers, and his parents quit taking him shopping because he would predictably become distraught whenever they did not buy him whatever toys he wanted.

Grade school reports indicated fidgetiness, wandering attention, and impulsivity. When Wyatt was 10 years old, a child psychiatrist diagnosed him as having attention-deficit/hyperactivity disorder (ADHD), combined type. Wyatt was referred to a behavioral therapist and started taking methylphenidate, with an improvement in symptoms. By fourth grade, his moodiness became more pronounced and persistent. He was generally surly, complaining that life was “unfair.” Wyatt and his parents began their daily limit-setting battles at breakfast while he delayed getting ready for school, and then—by evening—continued their arguments about homework, video games, and bedtime. These arguments often included Wyatt screaming and throwing nearby objects. By the time he reached sixth grade, his parents were tired and his siblings avoided him.

According to Wyatt’s parents, he had no problems with appetite, and although they fought about when he would go to bed, he did not appear to have a sleep disturbance. He appeared to find pleasure in his usual activities, maintained good energy, and had no history of elation, grandiosity, or decreased need for sleep lasting more than a day. Although they described him as “moody, isolated, and lonely,” his parents did not see him as depressed. They denied any history of hallucinations, abuse, trauma, suicidality, homicidality, a wish to self-harm, or any premeditated wish to harm others. He and his parents denied he had ever used alcohol or drugs. His medical history was unremarkable. His family history was notable for anxiety and depression in the father, alcoholism in the paternal grandparents, and possible untreated ADHD in the mother.

On interview, Wyatt was mildly anxious yet easy to engage. His body twisted back and forth as he sat in the chair. In reviewing his temper outbursts and physical aggression, Wyatt said, “It’s like I can’t help myself. I don’t mean to do these things. But when I get mad, I don’t think about any of that. It’s like my mind goes blank.” When asked how he felt about his outbursts, Wyatt looked very sad and said earnestly, “I hate when I’m that way.” If he could change three things in his life, Wyatt replied, “I would have more friends, I would do better in school, and I would stop getting mad so much.”

Answer 129

Disruptive mood dysregulation disorder

Attention-deficit/hyperactivity disorder, combined presentation

If the patient meets criteria for intermittent explosive disorder or oppositional defiant disorder but also meets criteria for DMDD, the patient should only be diagnosed with DMDD.

In assessing this 12-year-old boy, it would be important to attend to the quality, severity, frequency, and duration of the outbursts. Are they outside the range of “developmentally normal” children? What are the provocations? Do the outbursts occur at home, at school, with peers, or in more than one setting? How are they affecting his life? What is this boy’s general mood between the outbursts? Do the outbursts reflect a lack of control over his emotional reactions, or are they a behavior calculated to achieve an intended outcome? At what age did these emotional and/or behavioral outbursts begin? Are there corresponding neurovegetative depressive symptoms? Has he ever exhibited manic-like symptoms such as grandiosity, decreased need for sleep, pressured speech, or racing thoughts? If so, have these symptoms persisted long enough to meet criteria for a manic episode? Does he abuse substances? Has he ever experienced psychotic symptoms such as paranoia, delusions, or hallucinations of any kind?

Question 130

Yvonne Perez was a 23-year-old woman who presented for an outpatient psychiatric evaluation 2 weeks after giving birth to her second child. She was referred by her breast-feeding nurse, who was concerned about the patient’s depressed mood, flat affect, and fatigue.

Ms. Perez said she had been worried and unenthusiastic since finding out she was pregnant. She and her husband had planned to wait a few years before having another child, and her husband had made it clear that he would have preferred that she terminate the pregnancy, an option she would not consider because of her religion. He had also been upset that she was “too tired” to do paid work outside of the home during her pregnancy. She had then become increasingly dysphoric, hopeless, and overwhelmed after the delivery. Breast-feeding was not going well, and she had begun to believe her baby was “rejecting me” by refusing her breast, spitting up her milk, and crying. Her baby had become very colicky, so she felt forced to hold him most of the day. She wondered whether she deserved this difficulty because she had not wanted the pregnancy.

Her husband was gone much of the time for work, and she found it very difficult to take care of the new baby and her lively and demanding 16-month-old daughter. She slept little, felt constantly tired, cried often, and worried about how she was going to get through the day. Her mother-in-law had just arrived to help her care for the children.

Ms. Perez was an English-speaking Hispanic woman who had worked in a coffee shop until midway through her first pregnancy, almost 2 years earlier. She had been raised in a supportive home by her parents and a large extended family. She had moved to a different region of the country when her husband had been transferred for work, and she had no relatives nearby. Although no one in her family had seen a psychiatrist, several family members appeared to have been depressed. She had no prior psychiatric history or treatment. She denied illicit drug or alcohol use. She had smoked for several years but stopped when she was pregnant with her first child. Ms. Perez had a history of asthma. Aside from a multivitamin with iron, she took no medications.

On mental status examination, Ms. Perez was a casually dressed, cooperative young woman. She made some eye contact, but her eyes tended to drop to the floor when she spoke. Her speech was fluent but slow, with increased latency when answering questions. The tone of her speech was flat. She endorsed low mood, and her affect was constricted. She denied thoughts of suicide and homicide. She also denied any hallucinations and delusions, although she had considered whether the current situation was punishment for not wanting the child. She was fully oriented and could register three objects but only recalled one after 5 minutes. Her intelligence was average. Her insight and judgment were fair to good.

Answer 130

Major depressive disorder, single episode, moderate severity, without psychotic features, with peripartum onset
The case report is not clear, but it appears that Ms. Perez had significant depressive symptoms throughout the pregnancy and that she was referred to a psychiatrist at this particular time not because she was dramatically more depressed but because she was seen by a health professional, the breast-feeding nurse. If Ms. Perez became depressed only after delivery, she may not have had symptoms for the 2 weeks that are required for a major depression. In that case, adjustment disorder with depressed mood might be a more appropriate diagnosis. A postpartum onset might also increase her risk of having bipolar disorder rather than unipolar depressive disorder. Arguing against a diagnosis of bipolar disorder in this patient is the lack of any known manic or psychotic symptoms as well as the absence of a history of mood episodes or a family history of bipolar disorder. Still, the fact that she experienced precipitous worsening after delivery would increase the risk that she might develop bipolar disorder.

If Ms. Perez had low mood throughout the pregnancy and a brief worsening after delivery, then her symptoms might be viewed as a minor depressive disorder (in DSM-5, diagnosed as other specified depressive disorder) rather than major depressive disorder.

From the available history, it appears more likely that Ms. Perez had significant depressive symptoms throughout the pregnancy. She said she felt “worried and unenthusiastic” and had felt “too tired” to work. This would not be an unusual depression trajectory, because half of women who are found to be depressed after delivery were already depressed during pregnancy. DSM-5 now includes a specifier, “with peripartum onset,” for women who develop a mood disorder during or soon after a pregnancy. Ms. Perez also worries that her infant is rejecting her and that her current situation is a punishment. These appear to be overvalued ideas rather than delusions, but it would be reasonable to do ongoing assessments for psychotic thinking.

Question 131

Stead et al.’s (2012) review of the literature found that ________ is the most effective form of nicotine replacement therapy for treating cigarette smoking.

Answer 131

These investigators found that, of the nicotine replacement therapies, nicotine nasal spray was most effective and nicotine gum was least effective (

Question 132

Epidemiological studies on rates of various mental disorders in urban and rural areas in the United States have found that:

Answer 132

Overall, the best conclusion that can be drawn is that there are few consistent (or statistically significant) differences in the rates of mental disorders in urban and rural areas. For example, a recent Healthcare for Communities (HCC) survey of 9,585 individuals living in rural and urban areas found no significant differences in the prevalence of the major types of mental illness (L. Tang et al., Report on the Survey Method for the Household Survey of Healthcare for Communities, 1997-1998, Los Ang. This lack of significant differences between rates in rural and urban areas is consistent with the findings of the Epidemiologic Catchment Area Study and the National Comorbidity Survey.

The correct answer is: some disorders are more common in rural or in urban areas, but the differences in rates are usually not statistically significant.

Question 133

Project MATCH compared motivational enhancement therapy (MET), cognitive-behavioral coping skills therapy (CBT), and twelve-step facilitation (TSF) as treatments for alcoholism and found that:

Answer 133

MET, CBT, and TSF had similar effects on drinking.

Project MATCH was a five-year longitudinal study conducted by the National Institute on Alcohol Abuse and Alcoholism in the 1990s. It compared the effectiveness of MET, CBT, and TSF on two measures of alcohol consumption (percentage of days abstinent and average number of drinks per day) and tested the hypothesis that treatments are most effective when they are matched to certain patient characteristics.

The study found that the three treatments had nearly identical positive effects on both outcome measures but that few patient-treatment matches resulted in an improvement in outcomes. Also, a subsequent analysis of the data by R. B. Cutler and D. A. Fishbain suggested that the apparent treatment effects were actually the result of selection effects - i.e., were due to the fact that individuals who were more likely to continue drinking dropped out of the study, while individuals who were more likely to stop drinking stayed in the study (Are alcoholism treatments effective? The Project MATCH data, BMC Public Health, 5, 75, 2005).

Question 134

The mother of a 35-year-old man says that, for the past five weeks, he has been acting very uncharacteristically. He seems perplexed and nervous much of the time, his tone of voice varies between flat and shrill, and his speech is sometimes like “word salad.” The mother says that sometimes it seems like he is listening to voices or sounds that she cannot hear. Based on this information, the most likely diagnosis is:

Answer 134

Symptoms of Schizophreniform Disorder are similar to those associated with Schizophrenia but have a duration of less than six months.

Question 135

A dimensional approach to diagnosis is based on a(n) ________ of attributes.

Answer 135

There are two basic approaches to diagnosis - categorical classification and dimensional classification. The DSM utilizes a categorical approach, which involves determining whether or not a person meets the criteria for a given diagnosis.

When using a dimensional approach, the individual is ranked on a quantitative dimension (e.g., on a scale from 1 to 10) on each symptom or other characteristic.

Question 136

The nocturnal-only subtype of Enuresis:

Answer 136

The nocturnal-only subtype of Enuresis requires that the repeated voiding of urine into bed or clothes occurs only during nighttime sleep. It also requires that the individual have a chronological age of at least five years or an equivalent developmental level and that symptoms occur at least twice a week for at least three consecutive months or cause clinically significant distress or impairment in functioning.

Answer D is correct: The nocturnal-only subtype occurs most often during the first third of the night during non-REM, slow-wave sleep and is more common in boys than girls.

Question 137

For individuals with Schizophrenia, the poorest prognosis is associated with which of the following?

Answer 137

Schizophrenia has been linked to a number of factors including gender, age, type of onset, predominant symptoms, the presence of a precipitating event, and family history.
A better prognosis is associated with female gender, later age at onset, and positive symptoms (which are more responsive to drug treatment).

Question 138

The National Institute of Mental Health Multimodal Treatment Study of ADHD (MTA) compared the effectiveness of four treatments - medication management alone, behavioral treatment alone, combined medication and behavioral treatment, and routine community care. The results of the initial study indicated that:

Answer 138

Overall, the initial MTA results indicated that the combination treatment or medication management alone were significantly more effective than intensive behavioral treatment alone or routine community care.
Of the answers given, this is the best one. The initial results (which is what this question is asking about) found that medication management alone and the combined treatment had similar effects (and better effects than behavioral treatment alone or routine community care) for alleviating the core symptoms of ADHD. However, follow-up studies found that the superiority of medication alone and the combined treatment was true for short-term effects but not long-term effects. See, e.g., P. S. Jensen et al., Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and applications for primary care providers, Journal of Developmental and Behavioral Pediatrics, 2001, 22(1), 60-73.

Question 139

The psychologist’s theory views alcohol abuse as the result of a combination of biological and environmental factors.

_________ model focuses on the psychological contributions to a disorder.

___________l focuses on societal factors that contribute to a disorder, such as societal norms, stereotypes, and institutional biases.

__________model reflects a biopsychosocial perspective and conceptualizes disorders as the result of a combination of biological, psychological, and environmental (social) factors. More specifically, it proposes that disorders are due to a combination of predispositional factors (the diathesis) and exposure to certain life stressors.

_________ is used by cognitive-behavioral therapists as the framework for assessment. Use of this model involves considering the situation in which the problem occurs (S); the observations (thoughts, assumptions, and beliefs) made by the client in response to the situation (O); the client’s emotional, psychological, and behavioral responses to his/her observations (R); and the consequences of those responses (C).

Answer 139

The psychologist’s theory views alcohol abuse as the result of a combination of biological and environmental factors.

As its name implies, the psychogenic model focuses on the psychological contributions to a disorder.

The sociogenic model focuses on societal factors that contribute to a disorder, such as societal norms, stereotypes, and institutional biases.

The diathesis-stress model reflects a biopsychosocial perspective and conceptualizes disorders as the result of a combination of biological, psychological, and environmental (social) factors. More specifically, it proposes that disorders are due to a combination of predispositional factors (the diathesis) and exposure to certain life stressors.

The SORC model is used by cognitive-behavioral therapists as the framework for assessment. Use of this model involves considering the situation in which the problem occurs (S); the observations (thoughts, assumptions, and beliefs) made by the client in response to the situation (O); the client’s emotional, psychological, and behavioral responses to his/her observations (R); and the consequences of those responses (C).

Question 140

The symptoms of Oppositional Defiant Disorder are categorized in three groups in the DSM-5. These groups are:

-intermittent explosive disorder

Conduct disorder

Answer 140

(oppositional defiant disorder) Angry or irritable mood, argumentative or defiant behavior, and vindictiveness are the three categories of symptoms included in the DSM-5 for Oppositional Defiant Disorder.

(intermittent explosive disorder) aggressive impulses manifested as 1) verbal and physical aggression 2) behavior: damage destruction of property and physical assault that injures people and animals.

Conduct: persistent pattern that violates the rights of others 3 characteristic symptoms 12/6 most recent. aggression towards people and animals, destruction of property, deceitfulness and theft; serious violation of rules

Question 141

Longitudinal studies of individuals who receive a diagnosis of Borderline Personality Disorder in adolescence or early adulthood indicate that these individuals often exhibit a reduction or remission in symptoms over time. However, recovery varies for type of symptom, with _________ symptoms showing the least amount of improvement with increasing age.

Answer 141

Of the Personality Disorders, Borderline Personality Disorder (BPD) has been found to have the best prognosis, with the majority of patients showing a significant improvement in or remission of symptoms over time.

Answer C is correct: Longitudinal studies have found that, by middle age or sooner, most individuals with BPD no longer meet the diagnostic criteria for the disorder. The resolution of symptoms varies, however: For example, in a six-year prospective study of 290 patients with BPD, Zanarini et al. found that impulsive symptoms resolved most quickly, affective symptoms were the most chronic, and cognitive and interpersonal symptoms were intermediate in terms of resolution (M. C. Zanarini, F. R. Frankenburg, J. Hennen, and K. R. Silk, The longitudinal course of borderline pathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder, American Journal of Psychiatry, 160, 274-283, 2003).

Question 142

Project MATCH compared motivational enhancement therapy (MET), cognitive-behavioral coping skills therapy (CBT), and twelve-step facilitation (TSF) as treatments for alcoholism and found that:

Answer 142

Project MATCH was a five-year longitudinal study conducted by the National Institute on Alcohol Abuse and Alcoholism in the 1990s. It compared the effectiveness of MET, CBT, and TSF on two measures of alcohol consumption (percentage of days abstinent and average number of drinks per day) and tested the hypothesis that treatments are most effective when they are matched to certain patient characteristics.

Answer A is correct: The study found that the three treatments had nearly identical positive effects on both outcome measures but that few patient-treatment matches resulted in an improvement in outcomes. Also, a subsequent analysis of the data by R. B. Cutler and D. A. Fishbain suggested that the apparent treatment effects were actually the result of selection effects - i.e., were due to the fact that individuals who were more likely to continue drinking dropped out of the study, while individuals who were more likely to stop drinking stayed in the study (Are alcoholism treatments effective? The Project MATCH data, BMC Public Health, 5, 75, 2005).

Question 143

Delirium shares many symptoms with Schizophrenia, Schizophreniform Disorder, and certain other psychotic disorders, such as disordered thinking, hallucinations, and delusions. Thus, the differential diagnosis of these disorders is often difficult. Generally speaking, however, Delirium can be distinguished from the psychotic disorders because:

Answer 143

Delirium is almost always caused by a general medical condition or substance use, and its symptoms include disturbances in attention and awareness and other cognitive abilities.

-A difference between Delirium and the psychotic disorders is that the symptoms of Delirium tend to be random and haphazard while the symptoms of the psychotic disorders are often systematized.

Note:
The onset of Delirium is usually rapid.

Delirium is associated with a clouding of consciousness and a fluctuating course.

Hallucinations and delusions may be present in Delirium; however, they are less systematized (i.e., more random and haphazard) than those associated with the psychotic disorders.

Question 144

In contrast to most organic forms of amnesia, Dissociative Amnesia usually:

Answer 144

Dissociative Amnesia is a type of functional (psychogenic) amnesia that is often associated with a traumatic event and is characterized by an inability to remember important personal information with gaps in memory being related to the traumatic event.

• Memory loss in Dissociative Amnesia is most often anterograde - i.e., it typically involves the trauma and, in some cases, other events that occurred during a circumscribed period following the trauma. Retrograde amnesia (loss of memory for events prior to the trauma) is rare in Dissociative Amnesia; and, when it occurs, the loss of past memories is often reversed through hypnosis.

Note
In most cases of Dissociative Amnesia, the individual does not have trouble acquiring new information once the trauma that precipitated the memory loss is over. In other words, the anterograde amnesia is usually related to the traumatic event and for events that occurred during a circumscribed period following the trauma.
The correct answer is: affects memory for events that occurred at the time of the trauma that precipitated the amnesia and for a circumscribed period following the trauma.

Question 145

Renaldo, age 20, is afraid he’s going to be fired from his job as an inventory stocker at a large warehouse because he frequently “loses track” of inventory and does not follow-through on his boss’s instructions. He says he’s always been forgetful and never did well in school because he had a hard time focusing on his schoolwork. Based on this information, the best DSM-5 diagnosis for Renaldo is which of the following?

Answer 145

Of the diagnoses listed in the answers, Other Specified Attention-Deficit or Hyperactivity Disorder is the best since Renaldo’s symptoms involve problems related to attention but it’s unclear if he has the minimum number of symptoms (at least six for children and five for individuals ages 17 and older) required for a diagnosis of Attention-Deficit or Hyperactivity Disorder, predominantly inattentive presentation.

Note 5 for adults

Question 146

The National Institute of Mental Health Multimodal Treatment Study of ADHD (MTA) compared the effectiveness of four treatments - medication management alone, behavioral treatment alone, combined medication and behavioral treatment, and routine community care. The results of the initial study indicated that:

Answer 146

Overall, the initial MTA results indicated that the combination treatment or medication management alone were significantly more effective than intensive behavioral treatment alone or routine community care.

Answer C is correct: Of the answers given, this is the best one. The initial results (which is what this question is asking about) found that medication management alone and the combined treatment had similar effects (and better effects than behavioral treatment alone or routine community care) for alleviating the core symptoms of ADHD. However, follow-up studies found that the superiority of medication alone and the combined treatment was true for short-term effects but not long-term effects. See, e.g., P. S. Jensen et al., Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and applications for primary care providers, Journal of Developmental and Behavioral Pediatrics, 2001, 22(1), 60-73.

The correct answer is: medication alone or the combined treatment is more effective than behavioral treatment alone or routine community care.

Question 147

Two weeks after witnessing the murder of a co-worker, Mrs. Cee develops a number of symptoms including a sense of detachment, flashbacks of the event, sleep problems, impaired concentration, a depressed mood, and an unwillingness to talk about the murder. She has had these symptoms for seven days. Based on these symptoms, the most likely diagnosis is:

Answer 147

Mrs. Cee’s symptoms followed (and were apparently the result of) exposure to a traumatic event that is outside the range of normal human experience.

Because the duration of the woman’s symptoms are less than one month (the minimum duration required for PTSD), Acute Stress Disorder is the most likely diagnosis.

Question 148

Research comparing the personality characteristics and psychiatric symptoms of women reporting repressed versus continuous memories of childhood sexual abuse has found that:

Answer 148

This issue was addressed by R. J. McNally et al. [Personality profiles, dissociation, and absorption in women reporting repressed, recovered, or continuous memories of childhood sexual abuse, Journal of Consulting and Clinical Psychology, 68(6), 1033-1037, 2000]. Individuals in this study reporting repressed memories said they believed they had been sexually abused as children but had no autobiographical memories of the abuse.

McNally et al. found that women with repressed memories scored higher on measures of absorption and dissociation and reported more symptoms of depression and PTSD than did women with continuous memories of childhood abuse. (Women with continuous memories did not differ significantly from non-abused women on these measures.)

the two groups of women show significant differences with regard to both personality characteristics and psychiatric symptoms.

Question 149

For _____ of individuals with Parkinson’s disease who are depressed, the depression preceded the onset of motor and other physical symptoms.

Answer 149

Answer 20%

According to the National Parkinson Foundation (NPF), about 40% of patients with Parkinson’s disease are depressed. In some cases, the depression is endogenous (due to the disease process itself); in others, it is a reaction to the diagnosis and its symptoms.

Question 150

For nearly two years, a 30-year old woman has had several physical complaints that apparently do not have a physical cause. Her symptoms have changed over time and have included headaches and backaches, joint pain, and weakness in her hands and fingers. She says that she spends a lot of time worrying about her health and that her symptoms have made her miss work and that she’s afraid she’s going to get fired. This woman’s symptoms are most suggestive of:

Answer 150

The essential feature of Somatic Symptom Disorder is the presence of one or more somatic symptoms that cause distress or a significant disruption in daily life accompanied by excessive thoughts, feelings, or behaviors related to the symptoms.

Question 151

Obsessive-Compulsive Disorder and Obsessive-Compulsive Personality Disorder share which of the following symptoms?

Answer 151

Both disorders involve rituals, but the goal of rituals is different for OCD and OCPD. In OCD, rituals are performed to reduce anxiety; in OCPD, rituals are related to perfectionism.

Question 152

With regard to the DSM, the term “polythetic” refers to:

Answer 152

The DSM uses a categorical diagnostic system and allows for heterogeneity (the quality or state of being diverse in character or content.
“the genetic heterogeneity of human populations”) within each diagnostic category through its use of a polythetic criteria set that requires an individual to meet only a subset of characteristic symptoms.

The correct answer is: the fact that a diagnosis can be assigned to an individual when he/she exhibits only a subset of the characteristic symptoms for that diagnosis. result two clients can have somewhat different symptoms but receive the same diagnosis.