Abnormal Psychology DSM-IV (OLD) Flashcards

Question

Pervasive Developmental Disorders

Answer 1

Involve severe & pervasive impairments in communication & social interaction &/or the presence of stereotyped behaviors & activities. Included in this category are: * Autistic Disorder, * Rett's Disorder, * Childhood Disintegrative Disorder, * Asperger‘s Disorder.

Answer 2

(Pervasive Devel. D/O) Dx criteria includes 6 characteristic Sx's by age 3: * 1. Impairment in social interactions* (Min. 2 Sx's) * Babies avoid eye contact; limited facial expressions (dont smile); resist physical contact Older children have trouble interpreting meaning of gesture & facial expressions, indifferent to other ppls feelings, impaired nonverbal behavior that helps regulate social interactions, fail to devel. normal peer rel. & may seem oblivious to others). * 2. Impairment in communication* (Min. 1 Sx) (Do not speak at all or varying degree of limited speech that contains a # of abnormalities. Such as: Pronoun reversal - saying "you" insted of "I", Echolalia - echoing words/phrases of others, inappropriate tone of voice). * 3. Restricted, repetitive, & stereotyped behavior, interests & activities* (Min. 1 Sx) (Preoccupied w/narrow interests, parts of an object instead of entire object, & engage in repetative body movements - arm flapping or rocking). * Course/Prognosis:* (poor but best) outcomes as adults assoc. with: * Ability to communicate verbally by age 5/6, * IQ over 70, & * Later onset of Sx. (Small % of adults able to live/work independently) *Etiology:* * Biogenic D/O & has a genetic component * Linked to CNS brain abnormalities including: A smaller-than-normal cerebellum, enlarged ventricles; corpus collosum & limbic system * Assoc. w/abnorm. levels of norepinephrine, serotonin, & dopamine. * 4-5 x more common in males

Answer 3

Most effective are: * Behavioral techniques (e.g., shaping & discrimination training for communication) by Lovaas. * improving daily living, communication, and social skills * Reducing undesirable behaviors

Answer 4

Used behavioral technique for Autism, one found to be most effective: * *Shaping & discrimination training* to teach non-speaking children to immitate others verbally & improve communication skills. * Originally described by Lovaas (1960) & continue to be used to improve communication skills.

Answer 5

(Pervasive Devel D/O) Characteristic devel. pattern of multiple Sx following a period of normal devel. for 5 + mos. Sx's include: * *Head growth deceleration;* * *Loss of previously acquired purposeful hand skills* * *Loss of expressive language* * *Devel. of stereotypical movements (e.g., hand-wringing);* * Impairments in the coordination of gait or trunk movements; - * Loss of interest in the social environment; * Severely impaired language development; and * Psychomotor retardation. DSM-IV-TR states that this D/O “_has been reported only in females_"; yet is evidence it's occasionally occurs in males but that males w/this D/O often die shortly after birth (e.g., Kerr, 2002).

Answer 6

(Pervasive Developmental D/O) is characterized by distinct pattern of developmental regression after 2 yrs. of normal devel. in at least 2 areas of Fx. Sympotms include: * Loss of previously acuired language (expressive or receptive), motor, social skills, play, self-help skills & bowel or bladder control * Characteristic abnormalities in social interactions, communication & adaptive behaviors

Answer 7

(Pervasive Developmental Disorder) Essential features include: * Severe impairment in social interactions * Restrictive, repetative paterns of behavior, interests & activity, w/no substantial delays in cognitive, language, or self-help skills.

Answer 8

(Disruptive Behavior D/O) Dx criteria includes Sx in at lease 2 settings (Ex home & School): * Onset of some Sx prior to age 7 * Persistent Sx 6 mos. or more * Developmentally-inappropriate: * *Inattention* may involve forgetfulness, distracability, difficulty w/organization, completing tasks, & following instructions and/or * *Hyperactivity-impulsivity* may include difficulty remaining seated, inappropriate running & jumping, excessive talking & frequently interrupting others * _3 sub-types_: * *Predominatly Inattentive:* 6+ Sx of inattention, but less than 6 Sx of Hyperactivity-impulsivity. * *Predominatly Hyperactive-Impulsive:* 6+ Sx of Hyperactivity-impulsivity, but less than 6 Sx of Inattention. * *Combined Type:* 6+ Sx of both. *Etiology:* * Bio. basis but may be exacerbated by env. factors; unknown. * Strong genetic component that increases w/genetic similarity * Linked to lower than normal levels of activity in prefrontal cortex (Frontal lobe/Processing) & basal ganglia, reduced size in region of cerebellum, smaller-than-normal caudated nucleus (Striatum/Motor), globus pallidius & * Abnormalities in dopamine & serotonin levels. * In children, 4-9 x more common in boys than girls; In adults rates are similar * Prognosis:* Even w/Tx up to 60% of children w/ADHD continue to have Sx's as adults & the primary adult Sx is inattention * Tx:* Involves CNS stimulant (e.g., methylphenidate), social-academic skill techniques, CBT, & family intervention. * Prevalence:* 3 to 7%; CDC (2005) 7.8% of US children between 4 to 17 have received a diagnosis of ADHD...lowest rates for kids 4-8

Answer 9

* At least 60% of children w/ADHD continue to have some Sx as adults. * For most adults, inattention is the predominant Sx & includes inconsistency in the ability to concentrate, difﬁculty establishing and maintaining routines, and an inability to prioritize and complete important tasks & activities. * Hyperactivity is less apparent & manifests itself as fidgiting & restlesness. * Similar associated Sx's as child/adolesc. related to social relations & ED & Occupational Fx * Prevalence of ADHD in Adults 1-5%

Answer 10

* conduct disorder (30 to 90%) * learning disorder (up to 50%) * oppositional defiant disorder * anxiety disorder * major depression

Answer 11

Dx criteria requires the presence of at least 3 Sx during the past 12 mos.: * **T**heft or decitfulness * **R**ules; serious violation of rules * **A**gression to people or animals * **P**roperty destruction * Other charateristics include: * _Persistent pattern of behaviors that violate the rights of others_ &/or age appropriate social rules * _Little concern for well-being of others_ * Blame others for own misbehaviors * Little or no guilt or remorse * In ambiguous situations may misinterpret actions of others as hostile/threatening 2 sub-types of Conduct D/O: 1. *Childhood-Onset Type* - Dx when the onset of Sx is prior to age 10. (Assoc. w/ a higher degree of aggressivness & greater risk of a Dx of Antisocial Personality D/O &/or Substance related D/O.) 2. *Adolescent-Onset Type* - Dx when Sx begin at age 10 or later.

Answer 12

Moffitt’s (1993) distinguishes btwn 2 types of Conduct D/O: 1. *Life-course persisting type* - Begins early (Age 3), involves a pattern of increasingly serious transgressions, & is due to a combo of neurological deficits, a difficult temperament, & adverse environmental circumstances. * Offenders engage in a wider range of crimes including more victim oriented offenses. 1. *Adolescence-limited type* - A temp. form of antisocial behavior that reﬂects a _“maturity gap”_ btwn the adolescent’s biological maturation & lack of opportunities for adult privileges. * Offenders are limited to those that represent adult privilege or autnomy from parents.

Answer 13

Essential features are a recurrent pattern of: * Negativistic, deﬁant, & hostile behaviors toward authority figures. Sx include (Min. 4 Sx's - BAD AVATAR): * **B**lames others for own mistakes or misbehaviors; * **A**rgues with adults; * **D**eliberately annoys people; * **A**ngry & resentful * **V**indictive or spiteful * **A**ctively defies or challenges the rules or requests of adults; * **T**emper; often losses temper; * **A**ntagonistic * **R**ule Refusal

Answer 14

(Tic D/O) Characterized by at least: * 1 vocal tic (Clicks, grunts or barks) & * Multiple motor tics (Deep knee bends, facial grimaces & eye blinks). * Onset of Sx's before 18 * Duration of Sx's 1yr. + * Onset:* 6-7 years old; more common in males * Etiology:* * May share a genetic basis w/OCD & abnorm. in the basal ganglia & frontal lobes. * Linked to abnorm. (elevated) levels of dopamine. *Comorbidity:* * Most common assoc. Sx are obsessions & compulsions * Sx of ADHD, reason they often do poorly in school. * Tx:* * Antipsychotic drugs - Haloperidol & compliance a problem due to adverse side effects.

Answer 15

Transient Tic Disorder Sx's began before age 18

Answer 16

An individual w/tics that do not meet the criteria for a specific Tic disorder & onset after 18 w/ a duration less than 4 weeks.

Answer 17

(Elimination D/O) Characterized by: * Incontinence by a child that has reached an age where continence would be expected or * Repeated voiding of urine during the day or night into the bed or clothes that is usually involuntary & * Not due to a general medical condition or substance use. *Tx*: * Bell-and-pad (aka night alarm) w/ * Pharmacotherapy: * Antideprssant *Imipramine* (reduces wetting frequency in 85% of cases, suppresses wetting entirely in 30% of cases--most kids relapse within 3 mos. after discontinuing the drug) * Desmopressin (synthetic version of an antidiuretic hormone, good short term, but poor long term effects). * The research has shown that bell & pad is most effective while drug therapy have good short-term effects the relaps rates are higher than the bell & pad.

Answer 18

* Bell-and-pad (aka night alarm) effective in up to 80% of cases; -causes a bell to ring when the sleeping child begins to urinate * 1/3 of kids exhibit some degree of relapse within six months of the initial treatment * effectiveness increased when combined with other behavioral techniques (e.g., behavioral rehearsal or overcorrection)

Answer 19

(Anxiety D/O) of childhood that involves: * Developmentally inappropriate, excessive levels of anxiety related to separation from home or attachment ﬁgures. * Anxiety Sx's beyond what is normal for child's developmental level * Duration of Sx's for at lease 4 weeks * Onset befor 18 y.o. * Recurrent & ongiong distress when separated from caregiver * Persistent fear something terrible will happen to caregiver during separation * Repeated nightmares related to separation * Persistent fears of being alone * Frequent physical complaints when separation occurs or is anticipated including headaches, stomach aches or other physical sx's * It is often manifested as school refusal, or refusal to go to bed w/out someone staying w/them * Often develops after an experience of a life stressor (Parental divorce or death of family relative or pet)

Answer 20

Early childhood D/O involving: * Developmentally inappropriate social relatedness caused by pathogenic care, * Evidence the Sx's are the result of pathogenic care. * Begins before age 5. * There are 2 subtypes: 1. *Inhibited* - Persisiten failure to initiate & respond to most social interactions in a developmentally approp. way (Excessively inhibited, hypervigilant or highly ambivalent response). 2. *Disinhibited* - Indescriminate sociability or lack of selectivity in choice of attachment figures (doesn't discriminate btwn familiar & unfamiliar ppl & act in excessively familiar way toward strangers)

Answer 21

* ***D**isclosure* - Open communication w/child about illness; cope better if told early on in Devel. appropriate way. * ***H**ospitalization* - Hospitalized children are at increased risk for emotional & behavioral problems (Dependency, disrputive behaviors, anxiety, depression or severe withdrawl). * ***P**hysical Disabilities* - Children with physical disabilities are at increased risk for emotional & behavioral problems. * ***S**chool-Related Problems* - Children & adolescents with chronic medical conditions have higher rates of school-related problems (e.g., CNS irradiation & intrathecal chemotherapy for leukemia have been linked to impaired neurocognitive functioning and learning disabilities). * ***C**ompliance* - with medical regimens is a particular difficulty for adolescents.

Answer 22

Involves: * Persistent eating of nonnutritive substances (e.g., paint, plaster, insects, and clay) for at least 1 month w/out an aversion to food. * Behavior is inappropriate for the person‘s developmental level & * Is not part of a culturally-sanctioned practice. *Onset:* Btwn ages of 12-24 months; occasionally found in pregnant women.

Answer 23

* A maladaptive reaction to 1 + psychological stressors in excess of what would be expected given nature of stressor(s). * Sx's devel. w/in 3 mos.. of onset of stressor * Sx's do not persist for more than 6 mos. after the stressor has ended Types: * Adjustment D/O w/ Anxiety * Adjustment D/O w/ Depressed Mood * Adjustment D/O w/Disturbance of conduct * Adjustment D/O w/mixed anxiety & depressed mood * Adjustment D/O w/mixed disturbance of emotion & conduct Specifiers: * Acute (less than 6 mos.) * Chronic (6 + mos.)

Answer 24

Dx Criteria: * *Disturbance in consciousness* involving * Reduced clarity/awareness of the env., * Excessive distractability & * Inability to appropriatly focus/shift attention * Accompanied by *cognitive changes or perceptual disturbances* * Cog. changes include lang. & memory impairment & disorientation especially to time & place. * Perceptual disturbances include illusions & hallucinations *Causes:* By a # of conditions including: * fever, * nutritional dificencies & * head injuries, * Sx's usually develop rapidly & fluctuate over time. * It is most common in children & older adults & older age especially when combined w/medical illness & change in Meds. * Memory impairment, & disorientation can be caused by a general medical condition or substance use * Certain substances such as alcohol, cocaine & PCP = Substance Intoxication Delirium or Sub. w/drawl Delirium. *Tx:* Tx has 2 primary components: 1. Target the underlying cause 2. Reduction in agitation & disorientation by a combo of environmental manipulation (providing an environment that min. disorientation) & psychosocial interventions (e.g., having a calm, friendly family or staff member stay with the patient). Haloperidol or other antipsychotic drugs may help reduce agitation, delusions, and hallucinations.

Answer 25

Involves: * Disturbance in consciousness & other Cog. Fx * Autonomic Hyperactivity * Tremors * Insomnia * Nausea & vomiting * Confusion * Vivid Hallucinations & Delusions * Seizures potentially fatal form Following a period of prolonged heavy use.

Answer 26

Dx Criteria includes: Onset is deceptive (insidious) & course progressive 1. *Multiple cognitive deficits* including: * *Some degree of memory impairment (*loss); * Both *anterograde* (Diff. acquiring new info) & *retrograde* (Inability to recall previously learned info) amnesia. (Retrograde may not be apparent in early stages of D/O) * Denial of cognitive problems * Impairment in recall & recognition memory & greater impairments in declarative memory 2. *At least 1 other cognitive impairment* including: * *Aphasia* - Inability to express oneself thur speech * *Apraxia* - Inability to carry out voluntary purposeful movements not due to motor deficits, lack of understanding or motivation. * *Agnosia* - Inability to recognize familiar objects, tastes, sounds (sensations) 3. *Impaired executive functioning* (Abstraction). * Causes:* General Medical Condition or Substance use Various types of Dementia categorized as: * Cortical dementias - Anterograde Amnesia apparent initally (Dementia of the Alzheimer’s type) * Subcortical dementias - Retrograde amnesia more prominent initally (Dementia Due to Huntington‘s/Parkinson's Disease) * Diff. btwn 2 types most apparent in early stages of D/O. * Vascular Dementia - caused by arteriosclerosis or cerebrovascular disease

Answer 27

Major Depressive Disorder that involves prominent cognitive Sx that may be mistaken for Dementia (especially in older adults) & is referred to as pseudodementia. *Onset:* * Usually abrupt, * Exaggeration of cognitive problems * Person is concerned about his/her impairments, * Greater impairment in recall & procedural memory (vs. declarative) but intact recognition memory * Person is likely to emphasize failures & be uncooperative during testing. .

Answer 28

Dx criteria Involves (cortical Dementia): * A gradual onset of Sx & * Slow, progressive decline in memory/cognitive Fx that can be described in terms of 3 stages: * *Stage 1: (1-3yrs.)* Anterograde amnesia, impaired visuospatial skills, anomia, changes in personality that include irritability, indifference or sadness. * *Stage 2: (2-10 yrs.)* Increased retrograde amnesia, flat/liable mood, restlesness & agitiation, delusions, wandering aphasia, agnosia & idiomotor apraxia. * *Stage 3: (9-12 yrs.) S*everely *d*eteriorated cognitive Fx & communication, apathy, limb rigidity & urinary & fecal incontinenece. * Due to a degeneration of cells in the medial temporal lobe that includes the amygdala, hippocampus & enthrhinal cortex (memory & sense of location & direction) * A definitive Dx requires an Atopsy or brain biopsy to confirm neuron loss & plaques & tangles. * *Memory impairments have been linked to low levels of Actetylcholine (ACh) *in the hippocampus. * More common in Females than Males Average Duration 8-10 yrs. * Late onset after 65 yrs old most common *Tx combo:* * Group therapy (emphasizes reality orientation & reminiscence); * Antidepressant to alleviate depression & drugs that slow memory loss by increase Ach. * Behavioral techniques & antipsychotic drugs to reduce agitation; * Environmental manipulation & pharmacotherapy to enhance memory & cognitive Fx. * Most effective when include family members.

Answer 29

Dx Criteria: * Caused by cognitive impairments plus * Evidence of Arteriosclerosis or other cerebrovascualr disease * Abrupt onset of Sx followed by a stepwise or fluctuating decline in Fx & a "patchy" pattern of Sx that is determined by the location of brain damage. * Cognitive impairment include: * Focal neurological signs - Behavioral & perceptual impairments due to lesions in the brain & take the prom of weakness in 1 side of the body, abnormal reflexes ro sensory deficits. * Labrastory signs including CT or MRI scan showing liesons in cortical or subcortical areas of the brain. Recovery depends on cause. Ex: Recover from cerebrovascular accident (stroke) improvement occurs in 1st 6 mos., w/physical disabilities resolving more quickly than cognitive deficits. *Risk factors include*: hypertension, diabetes, cigarette smoking, & atrial ﬁbrillation.

Answer 30

(Subcortical Dementia) Includes: * Retrograde Amnesia initally prominent * Parkinsonism * Hallucinations * Frontal & visospatial deficits * Fluctuating course

Answer 31

Sx depend on location & extent of brain injury. Usually the subcortical type & likely to involve: * Changes in personality, * Deficits in executive cognitive Fx, * Altered experience & * Expression of emotion (Frank, 2005). If Head Trauma is cause of a single brain injury, it is usually non-progressive; yet, repeated injury (e.g., from boxing) can result in a progressive form of dementia referred to as dementia pugilistica.

Answer 32

Early signs include: * forgetfulness * impaired attention * psychomotor slowing Sx include: * Cognitive impairment (forgetfulness, impaired attention/concentration, prob. solving skills), * Psychomotor slowing, * Psychiatric Sx (depression & anxiety), * Motor Sx (ataxia, tremors & clumsiness), * Apathy & social withdrawal, * Loss of initiative, & * Saccadic eye movements. Involves 6 stages: * *Stage 0 (Normal):* Indiv. mental & motor Fx; normal. * *Stage 0.5 (Equivocal/Subclinical):* Indiv. has min. or equivocal Sx w/no impairment in performance of work/activities of daily living (ADL). Mild signs may be present (e.g., slowed ocular or extremity movements). * *Stage 1 (Mild):* Unequivocal evidence of Fx, intellectual, or motor impairment, but indiv. is able to perform all but the most demanding aspects of Work/ADL & can walk w/out assistance. * *Stage 2 (Moderate):* Indiv. can't work but can perform basic activities of self-care & is ambulatory but may require assistance. * *Stage 3 (Severe):* Indiv. exhibits signs of major intellectual incapacity (e.g., cannot sustain complex conversations) or motor disability (e.g., cannot walk without assistance). * *Stage 4 (End Stage):* Indiv. is nearly vegetative. Intellectual & social fx are rudimentary & the indiv. is nearly or completely mute, has paraparesis or paraplegia, & has urinary and fecal incontinence.

Answer 33

*Dx criteria:* * Memory impairment w/some degree of Anterograde amnesia (Inability to acquire & recall new info.) w/or w/out Retrograde amnesia (impairment in the ability to recall previously acquired info. * Appropriate Dx when memory loss is known to be due to a general medical condition or substance use & usually has no difficulty learning new info. or recalling personal info. from prior to the occurrence of the trauma/stressor. * Does not occur exclusively during the course of Delirium or Dementia

Answer 34

Alcohol-Induced Persisting Amnestic Disorder (Korsakoff Syndrome) is characterized by: * Due to alcohol/sibstance abuse * Retrograde amnesia, * Anterograde amnesia, and * Confabulation (Fill in memory gaps w/inaccurate or imagined info & believe it's real) * Effects recent long-term memory more than remote memory (trouble recalling events that happened before D/O than events earlier in life) * Believed to be due to a thiamine deficiency.

Answer 35

* involves 1 or more episodes of an inability to recall important personal info. that cannot be attributed to ordinary forgetfulness * The gaps in memory are often related to a traumatic event * Most common types are localized & selective * Retrospective gaps in the recall of aspects of the indiv. past often related to a trauma/stressor

Answer 36

Alcohol withdrawal involves: * Autonomic hyperactivity, * Hand tremor, * Insomnia, * Nausea or vomiting, * Anxiety, * Transient illusions or hallucinations, and * Grand mal seizures following cessation of prolonged or heavy alcohol use. Alcohol-Induced Sleep Disorder is usually of the Insomnia Type and can be the result of Alcohol Intoxication or Withdrawal.

Answer 37

Dx criteria: * Involves the continued use of a substance despite signiﬁcant substance-related problems as evidenced by the presence of at least 3 characteristic Sx during a 12-mo. period. Sx's Include: * It may or may not involve tolerance & withdrawal (physiological dependence). * substance frequently taken in larger amounts or over longer periods of time than intended * persistent desire or unsuccessful attempts to control or cut down substances use * a great deal of time spent in activities related to obtaining the substance, using the substance, or recovering from its effect * important social, occupational, or recreational activities reduced or stopped because of substance use * continued use of the substance despite persistent or recurrent psychological or physical problems caused or exacerbated by its use The term "addiction" is sometimes used to refer to condition that involves a compulsion to use a drug w/the devel. of tolerance for the drug & withdrawal Sx when the drug is not taken.

Answer 38

Conger (1956) Proposed that alcohol reduces anxiety, fear & other states of tension & ppl drink alcohol to reduce tension which leads to addiction. Thus, the addiction is the result of negative reinforcement.

Answer 39

(substance Dependence/Addiction) They proposed that addictive behaviors are acquired and that addition is an _"overlearned, maladaptive habit pattern"_ and focus on relapse prevention which involves teaching strategies for dealing w/high-risk situations (Env. cues that elicit strong negative emotions) Refer to the typical reaction to relapse as an “abstinence violation effect” that involves: * Self-blame, * Guilt, * Anxiety, and * Depression, * Lead to an increased susceptibility to further drinking. *Propose the potential for future relapse is reduced when the person views the episode of drinking as a mistake resulting from speciﬁc, external, and controllable factors.* 38% of incidents of relapse are due to _negative emotional states_ *The Relapse Prevention Therapy (RPT)* involves: * ID circumstances that increase the indiv. risk for relapse (situations that elicit negative emotional states, expose the indiv. to alcohol/alcohol-related cues, or cultivate social pressure to drink) * Then implementing a variety of behavioral & cognitive strategies that will help the indiv. prevent future lapses & deal more effectively w/them if they occur (e.g., coping skills training, cognitive restructuring, self-efficacy enhancement, and lapse management).

Answer 40

Predictors of successful smoking cessation attempts include: * Male gender, * Older age (35+) * Later age at the initiation of smoking, and * Low nicotine dependence. * Live in girfriend or Married Interventions are most effective when they include a combo of: 1. Nicotine replacement therapy; 2. Multicomponent behavior therapy; and 3. Support & assistance from a clinician.

Answer 41

Sx include: * Resemble a moderate-severe case of the ﬂu (e.g., sweating, nausea, abdominal cramps, and fever) * Occur following cessation of or a substantial reduction in the use of an opioid following prolonged or heavy use.

Answer 42

Sx occur following abrupt cessation of or reduction in the use of nicotine after daily use for at least several weeks and include: * Depressed mood, * Insomnia, * Irritability, * Anxiety, * Restlessness, * Impaired concentration, * Decreased heart rate, and * Increased appetite.

Answer 43

*Dx criteria:* * Involves 2 or more characteristic Sx's (disturbance) for at least 6 mos. or more that includes * At least 1 mo. of 2 or more *active-phase Sx*. into 2 types: * *Positive Sx (Type 1) - *Excess of Norm Fx (THREAD): * Delusions (False beliefs, firmly held despite what others believe/evidence to contrary; Persecatory/referential/bizarre) * Hallucinations (Auditory most common and are threatening/pujorative voices) * Disorganized speech (Range from mild to incoherent/word salad) * Grossly disorganized/catatonic behavior (Diff. w/ADL or aggitation) * *Negative Sx (Type 2) - *Restriction in range & intensity of emotions & other Fx (LESS): * Restriction in the range & intensity of emotions & other Fx that include: * Affective flatenning, * Alogia - poverty of thought & speech, * Avolition - a reduction in goal directed behavior. For the remainder of the 6 mos. prodromal (- Sx's only or active phase Sx's in a less severe form) or residual (No active phase Sx's) * 5 subtypes:* 1. *Paranoid* - (assoc w/best prognosis & strongest family link) Pre-occupation w/1+ delusion &/or frequent Auditory hallucinations usually of a persecutory or grandiose nature, 2. *Disorganized* - Disorganized speech & behavior, flat or inappropriate affect, if present hallucinations/delusions fragmented & not org. into themes; often take form of silliness. 3. *Catatonic* - 2 Sx's of motoric immobility/excessive motor activity, mutism, abnormal movements, echolalia or ecopraxia. Indiv. may stay in same position for hrs., exhibit facial contortions or mimic movement of other ppl. 4. *Undifferentiated* - When do not meet criteria for specific type (have prominent Sx's of 2 or more types) 5. *Residual* - Dx when indiv. not currently exhibiting prominent delusions, hallucinations, disorganized speech or behaviors but has had Sx's in the past & continue to display negative &/or attenuated positive Sx's. * Tx multi-modal & includes*: * A neuroleptic (antipsychotic) drug, * CBT & psychoed * family therapy/intervention to reduce expressed emotions (since neg. emotion such as hostility/criticism toward CT increases risk for re-lapse), and * social skills training. *Etiology:* * Genetic concordance rates increase w/genetic similarites; Identical twins 48%, Fraternal twins 17%; relative may display oddities in behavior & thinking & recieve a Dx of another schizophrenic spectrum D/O. * *Dopamine Hypothesis*: Due to excessive level or oversensitivity to Dopamine * Possible causes include structural brain abnormalities (e.g. enlarged ventricles & Hypofrontalitiy - lower than norm activity in frontal lobes) * Abnormalities in neurotransmitters (elevated dopamine, norepinephrine, and/or serotonin). *Prevalence rate:* * More common in males than females & * Incidence rate: Adult population 0.5% to 1.5% * Higher rate for African-Americans may be due to misdx's bc more likely to exp. hallucinations/delusions as a Sx of depression & other D/O's *Onset:* btwn late teens to mid-thirties (18-35); modal age of onset is * 18-25 for males & * 25-35 for females.

Answer 44

+ Sx's (Type 1) - Excess of Normal Fx includes: * **T**hinking may become disturbed (*Delusions*) * ***H**allucinations* (usually Auditory) * **R**educed contact w/reality * **E**motional control affected (*Incongruent Affect*) * **A**rousal may lead to worsening Sx's * ***D**isorganized Speech* (word salad) & Behavior Appears to reflect an excess/distortion of normal Fx including delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. (Type I) THREAD

Answer 45

- Sx's (Type 2) - Restriction in ramge & intensity of emotions & other Fx's: * **L**oss of volition (*Avolition*: reduction in goal directed behavior) * **E**motionally Flat (*Affective flattening*) * **S**peech Reduced * **S**lowness in movement & thought; psychomotor agitation (*Alogia*: poverty of thought/speech) Involve a restriction in the range & intensity of emotions & other Fx & includes affective flattening, alogia (poverty of thought & speech), and avolition (restricted initiation of goal directed behavior). (Type II) LESS

Answer 46

Rates of Schizophrenia are higher among those with genetic similarity, more similarity = higher concordance rates. * Bio. siblings 10% * Identical twins 48% * Fraternal twins 17%

Answer 47

A better prognosis for Schizophrenia is associated with: * Later age at onset * Presence of a precipitating event * Good premorbid adjustment * An acute & late onset, * *Female gender*, * Absence of structural brain abnormalities * Brief duration of active-phase symptoms, * Insight into the illness, * A family Hx of a Mood Disorder, and * No family Hx of Schizophrenia * Prognosis better when indiv. is aware of thier illness

Answer 48

Attribute Schizophrenia to elevated levels/oversensitivity in dopamine receptors. Also can be abnormalities on other neurotransmitters such as elevated dopamine, norepinepherine &/or serotonin

Answer 49

High levels of expressed emotions by family members (open criticism and hostility toward the patient, or alternatively, overprotective, symbiotic relationships) are associated with a high risk for relapse and rehospitalization for individuals with Schizophrenia.

Answer 50

From best (1) to worst (5) prognosis: 1. Schizoi**_D_** Personality D/O = **_D_**istant (Avoi**_d_**s) 2. Schizo**_T_**ypal Personality D/O = Magical **_T_**hinking ^{(Not your Typical)-ME PECULIAR} 3. Schizophreni**_FORM_** D/O = **_Form_** from stress ^{(1-6mos.; 6+ mos. Schizophrenia}) 4. Schizophrenia D/O = +(THREAD)/-(LESS) ^{(6+ mos. w/1 mo. 2 active phase Sx's)} 5. Schizoaffective D/O = ^{Schizophrenia(psychotic) + Mood D/O (Except 2 weeks w/psychotic; no mood Sx's)}

Answer 51

(Psychotic D/O) identical to Sx of Schizophrenia except for: * Involving active-phase psychotic Sx with * A duration of symptoms for at least 1 month but less than 6 months.

Answer 52

Involves delusions, hallucinations, disorganized speech, &/or grossly disorganized behavior that has: * a duration btwn 1 day to 1 month & * Eventually returns to premorbid Fx. Onset follows an overwhelming stressor.

Answer 53

Characterized by: * An uninterrupted period of active phase illness involving (Psychotic & Mood Sx) * Concurrent Sx of Schizophrenia & symptoms of Major Depressive, Manic, or Mixed Episode that includes: * A period of at least 2 weeks w/out prominent mood Sx * Onset:* Early adulthood * Prognosis:* Somewhat better than for Schizophrenia, but worse than a Mood D/O. Schizophrenic + Mood D/O

Answer 54

Involves 1 or more nonbizarre delusions that last for at least 1 month & do not substantially impair functioning. 2 types: * Erotomanic (belief that someone is in love with the individual of higher status) and * Unspecified (which is appropriate when the indiv. dominant delusions do not clearly fit the criteria for a specific type; delusions of reference). Other Types: * Grandiose (inflated sense of self worth, power, knowledge) * Jealous * Persecutory (belief one is being attacked, harrased, persecuted, etc) * Somatic

Answer 55

Dx criteria Involves (DEAD SWAMP): * 1 or more Major Depressive Episodes w/out a Hx of Manic, Hypomanic, or Mixed Episodes * Presenceof charaterized Sx's such as: * Depressed mood &/or * Loss of interest/pleasure in ones usual activities * for at least 2 weeks * **D**epressed Mood most of the day * **E**nergy Loss or Fatigue * **A**nhedonia (inability to exp. pleasure from activities usually found enjoyable). * **D**eath or Suicide (thoughts or act of) * **S**leep Disturbances (insomnia/Hypersomnia) * **W**orthlessness or Guilt * **A**ppetite or weight changes * **M**entation Decrease (inability to think/concentrate) * **P**sychomotor Aggitation or Retardation Age-related Sx: * In children Dep. accompanied by anxiety & may involve irritability, aggression, social withdrawl & somatic complaints. * In Adolesc. Dep. w/aggression & other anti-social behaviors are prominent and may lead to a mis-Dx of conduct D/O. * Older adults Dep. w/prominent cognitive Sx., anxiety, aggitation & feelings of hopelessness , along w/physical Sx's. Etiology: * *Catecholamine Hypothesis:* Depression due to low levels of norephinepherine, * Linked to several neurotransmitter abnormalities, including low levels of norepinephrine & serotonin. * Highly linked to genetic components * In adults 2x as common in females as males; begining in adolesc. * In children equal among boys and girls Tx: Commonly involves the use of antidepressant &/or CBT or interpersonal therapy

Answer 56

Depression has been linked to a number of alterations in sleep quality & quantity: * Assoc. w/ decreased sleep continuity * Reduced slow-wave sleep * Shortened/*_Decreased REM Latency_* (Earlier onset of REM sleep) * *_Increased REM Density_* (Increased frequency of rapid eye movements)

Answer 57

Requires the presence of characteristic symptoms: * Depressed mood and/or * Loss of interest or enjoyment in customary activities * For at least 2 weeks * That represents a change from previous functioning w/sufficently severe impaired Fx * Episode can last 3-6 months, Sx's remit at 6 months & may or may not return

Answer 58

* Prior to puberty, rates are about equal for males and females * In adolescence, the rate for females is about 2x the rate for males and continues into adulthood * Lifetime risk of D/O in community samples ranges from 10-25% for women & 5-12% for men. Strong genetic component: * Twin Studies Identical .50 & Fraternal .20 * 1.5 to 3 times more common in 1st degree bio. relatives

Answer 59

Dx Criteria (DIG FAST): * Involves a period of 1 week or longer w/psychotic features w/*_significantly impaired functioning (occupational/social) or need for hospitalization:_* * The prevailing mood is abnormally & persistently elevated, expansive or irritable. * **D**istractibility * **I**ndiscrection (excessive involvement in pleasurable activities) * **G**randiosity * **F**light od Ideas * **A**ctivity Increases * **S**leep Deficit (Decreased need for sleep) * **T**alkativness (Pressured Speech)

Answer 60

Dx Criteria (TAD HIGH): * Characterized by a distinct period of abnormally & persistently elevated, expansive or irritable that: * lasts for 4 days & * Accompanied by 3 Sx of a Manic Episode. * There is a clear change in mood & Fx but not severe enough to cause marked impairment in (occupational/social) Fx or require hospitalization & absence of psychotic Sx. * **T**alkative * **A**ttention Deficit * **D**ecreased need for sleep * **H**igh self-esteem/Grandiosity * **I**deas the race * **G**oal directed activity increased * **H**igh-risk activity

Answer 61

Dx Criteria: * Lasts for 1 week and * involves rapidly alternating Sx of Manic & Major Depressive Episodes. * Disturbance is severe enough to cause marked impairment in social & occupational Fx or requires hospitalization or alternatively includes psychotic Sx.

Answer 62

The specifier with Postpartum Onset is applied to Major Depressive D/O, Bipolar I Disorder, Bipolar II Disorder, or Brief Psychotic Disorder when: * Onset of Sx is w/in 4 weeks postpartum. * 10-20% of women experience Sx that are sufficiently severe to meet the Dx criteria for Major Depressive D/O & * Addl. Sx's include preoccupation w/infant's weel-being that can range from excessive concern to unplesant fears & thoughts about harming the child * Up to 70%-85% experience milder symptoms ("baby blues").

Answer 63

In Northern Hemisphere, Major Depressive D/O is linked to winter mos. for some CT's. Sx include: * Decreased activity * Hypersomnia (Sleep disturbances) * Loss of libido, * Increased appetite & weight gain, and * Cravings for carbohydrates. Tx: Phototherapy - exposure to bright light that mimics sunlight is an effective.

Answer 64

Seligman's original (1970) model proposes that: * Depression is due to repeated exposure to uncontrollable negative life events & * attributions of the negative events are internal, stable, & global (Attribution theory - believe his/her own fault). Abramson, Metalsky, and Alloy (1980) revised the original theory to: * emphasize the role of hopelessness * predicts that exposure to negative life events leads to depression and attributions of those events to internal, stable & global factors contribute to a sense of helplessness and an inability to control those events.

Answer 65

(Beck) Depression is related to a negative cognitive triad that consist of negative beliefs about: * onself, * the world (situation), & * the future * that devel. during childhood as the result of negative life experiences. Ex: A Dep. person may believe that she is a failure, that no one can do anything to help her suceed & nothing is going to change in the future.

Answer 66

Dx criteria (HES 2 SAD): * presence of a chronically depressed mood present most of the time * that is not severe enought to meet the criteria for a Major Dep. Episode & * lasts for at least 2 years in adults or 1 year in children/adolescents. * **H**opelessness * **E**nergy loss or fatige * **S**elf-esteem low * **2** years min. of Depressed mood most of day for more days than not * **S**leep (increased/decreased) * **A**ppetite (increased/decreased) * **D**ecision-making or concentration impaired Tx: Interpersonal therapy & CBT are both useful but may be less effective than for Major Dep. D/O. Outcome improve when CT goes for maintenence session & Tx combined w/antidepressants.

Answer 67

Lewinsohn (1974) operant conditioning. Attributes Dep. to a low rate of response-contingent reinforcement for social & other behaviors (e.g. as the result of the death of a partner or change in social environment), which results in: * extinction of those behaviors as well as * pessimism, * low self-esteem, * social isolation, & * other features of depression that tend to reduce the likelihood of positive reinforcement in the future

Answer 68

Compared 3 Tx types: 1. CBT, 2. Interpersonal therapy (IPT), & 3. The tricyclic imipramine for depression. Inital res. results found all 3 were effective & their effects did not differ significantly overall, but imipramine was somewhat better for CT's w/severe Sx. A follow up study indicated that only 30% of CT's receiving CBT remained Sx free 18 mos. later compared to: * 26% receiving IPT, * 19% receiving imipramine, and * 20% in the placebo group

Answer 69

Dx criteria requires (BI-POLAR FAMILY): * 1 or more Manic or Mixed Episodes w/or w/out a Hx of 1 or more Major Depressive Epsiode. * **B**revity of episodes * **I**mpulsivity * **P**re-morbid Hyperthymic Personality (polarity switch in response to anti-dep) * **O**vereating & over sleeping * **L**iability of mood * **A**nxiety D/O & Sub. Use D/O usually comorbid * **R**elatively resistnat to Tx * **F**amily Hx of Schizophrenia or Bi-Polar D/O * **A**brupt onset, aggitation & behavioral abnorm * **M**ixed episode * **I**nstability in job & marriage relationships * **L**ithium recommended 1st line of Tx * **Y**oung age (onset early 20's) Strong evidence of a genetic component, 2/3 of ppl w/Dx have a relative w/Bi-polar D/O Gender: Equally common in males and females Tx: Lithium or anti-seizure drug is usually effective for reducing mania/hypomania

Answer 70

Dx criteria (BI-POLAR FAMILY): * Combo 1 or more Major Depressive Episodes & 1 or more Hypomanic Episodes w/out a Manic or Mixed Episode * **B**revity of episodes * **I**mpulsivity * **P**re-morbid Hyperthymic Personality (polarity switch in response to anti-dep) * **O**vereating & over sleeping * **L**iability of mood * **A**nxiety D/O & Sub. Use D/O usually comorbid * **R**elatively resistnat to Tx * **F**amily Hx of Schizophrenia or Bi-Polar D/O * **A**brupt onset, aggitation & behavioral abnorm * **M**ixed episode * **I**nstability in job & marriage relationships * **L**ithium recommended 1st line of Tx * **Y**oung age (onset early 20's) Gender: More common in females Strong evidence of a genetic component, 2/3 of ppl w/Dx have a relative w/Bi-polar D/O Tx: Lithium or anti-seizure drug is usually effective for reducing mania/hypomania

Answer 71

Dx criteria: * Periods of fluctuating hypomanic Sx (periods) & * numerous periods of depressive Sx for * at least 2 years in adults or 1 year in children/adolescence.

Answer 72

High risk for suicide is associated with: * A warning, * Previous attempts, * A plan (especially involving a lethal weapon), * Male gender, * Being divorced/separate and * Feelings of hopelessness Rates are highest for Whites, an exception is for American-Indian/Alaskan Native adolescents & young adults Related to mental D/O's the highest risk is associated w/Major Dep. Suicide attempters (vs. completers) are most likely to be female & under the age of 35

Answer 73

Dx criteria includes alterations in perception, depersonalization & derealization(PANICS): * Involves 2 or more unexpected panic attacks * w/at least 1 of attack followed by 1 mo. of persistent concern about having another attack, * worry about the consequences of the attack &/or * a significant change in behavior related to the attack * 4 Sx's for 10-25 min. * **P**alpitations Heart * **A**pprehension, or terror that devel. abruptly & usually peak w/in 10 min. * **N**ausea, Numbness * **I**ntense *fear* of death, terror * **C**hocking, chest Pain, chills * **S**hortness of breath, sweating, shaking * Must be able to rule out being due to a medical condition * Sx may mimic a heart attack or hyperthyroidism 3 Types: 1. Unexpected (uncued) 2. Situationally Bound (cued) 3. Situationally Pre-disposed Tx Includes: * in vivo exposure with response prevention most effective, & * in some cases, a TCA or SSRI or benzo. relapse increases when only drugs are used. PANICS

Answer 74

Dx Criteria: * Involves excessive anxiety about being in situations or places from which escape might be difficult or embarrassing or in which help might not be available in case of panic attack or if other Sx's occur * If a panic attack or other symptoms occur - it can occur with or without panic attacks * Indiv. restrict places willing to go & eventually wont leave the house * More common in females Tx of choice: * *_in vivo exposure with response prevention_* - involves exposing the person to the feared stimulus while preventing usual avoidance response * Exposure can be gradual or can involve *_flooding_* - whic involves initally exposing the person to stimuli that produce maximal anxiety * Indiv. may want a friend to accompany them in order to help alleviate anxiety

Answer 75

Characterized by: * Persistent fear of of being in social/performance situations that may cause embarrassment or humiliation as the result of scrutiny or evaluation by others * In adults, there is a realization that the fear is excessive and unreasonable * Situations commonly associated w/Social Phobia include: * public speaking, * attending parties, * initiating conversations, and * speaking to authority figures Tx: * In-vivo exposure, enhanced w/social skills training * Cognitive techniques

Answer 76

Characterized by: * A marked & persistent fear of a specific object or situation other than those associated w/Agoraphobia or Social Phobia * In adults, there is recognition that the fear is unreasonable or excessive * 5 Types * *Blood-Injection-Injury Type* differs from the other types in terms of physical reaction to feared stimuli. * For ppl w/this type, feared stimuli produce an initial increase in heart rate & blood pressure that is immediately followed by a drop in both &, as a consequence, fainting * *Other Specific Phobias* experience only an increase in heart rate and blood pressure * *Animal* * *Natural Environment* * *Situational*

Answer 77

(Anxiety D/O) Dx criteria: * Recurrent obsessions &/or compulsions that are severe enough to cause significant distress & are time consuming or interfere w/a indiv. Fx * *Obsessions*: persistent thoughts, impulses or images the person expreiences as senseless/intrusive (ex: repeated thoughts about contamination) * *Complulsions*: repititious,deliberate mental acts or behaviors that the person feels driven to perform in response to an obsession or rigid set of rules (ex: repeated hand washing bc think contaminated) * In adults, must recognize at some point that the Sx's are excessive/unwarranted * In adults, D/O is about equally common in males and females * In children & adolescents, it is more prevalent in males * Low levels of serotonin, over active caudated nucleus Tx: * In vivo exposure w/response prevention for compulsions & often combined w/participant modeling * the antidepressant tricyclic clomipramine or an SSRI that increase serotonin levels (block serotonin reuptake) have good short-term benefits in conjunction w/exposure. The purpose of a complusion is to reduce distress or to prevent a feared situation/consequence from occuring & the alternative is excessive or illogical

Answer 78

Dx criteria (TRAUMA): * Characteristic Sx's for more than 1 month following exposure to an extreme trauma that * Elicits an immediate reaction of intense fear, helplessness, or horror causing the indiv. to be unable to Fx; * followed by characteristic Sx that fall into 3 categories after exposure to a: * **T**raumatic event that entails actual or threatened death or serious injury to self or others. * **R**e-experiencing of the trauma (Dreams/flashbacks) * **A**voidance; Persistent avoidance of stimuli associated w/the trauma that causes recollection of trauma, feel detached from others, restricted range of enotions * **U**nable to Fx * **M**onth or more of Sx’s * **A**rousal Increased (Persistent Sx of increased arousal; Diff falling asleep, hypervigilance, exaggerated startle response, outbursts of anger) * 3 Specifiers: * Acute (Duration less than 3 mos.) * Chrpnic (Duration 3 mos. +) * Delayed Onset (Onset of Sx's 6 mos. after stressor) Tx: Most effective is comprehensive multicomponent cognitive-behavioral approach that incorporates exposure, cognitive re-structuring and anxiety management. PTSD only one is caused by direct result to exposure to trauma & Lowest comorbidity with panic D/O w/agorophobia Effectiveness of EMDR appears to be due to exposure rather than to eye movements

Answer 79

Dx Criteria: * Similar to PTSD (exposure to a trauma) except that Sx must have an: * onset w/in 4 weeks of the trauma & * must last for at least 2 days but no longer than 4 weeks. * The person has 3 or more dissociative symptoms including: * sense of numbing or emotional detachment, * derealization, * depersonilazation, * dissociative amnesia in addition to * Persistent reexperiencing of the trauma, * Marked avoidance of stimuli that cause recollections of the trauma, and * Marked anxiety or increased arousal

Answer 80

1. *_Acute Stress D/O_* (2 dys to 4 weeks) 2. *_Post-Traumatic Stress D/O (PTSD)_* 1+ months w/3 specifiers: * Acute (less than 3 mos) * Chronic (3 mos. +) * Delayed Onset (Sx onset 6 mos. after stressor) 3. *_Generalized Anxiety D/O (GAD) _* At least 6 months

Answer 81

Dx criteria includes (WATCHERS 6): * Excessive anxiety & worry about multiple events/activities on most days for at least **6 months** * **W**orry (Excessive constant worry about multiple events/activites) * **A**nxiety (Anxiety/worry difficult to control & disproportinate to feared event or potential impact: Anxiety/worry entail 3 Sx's:) * **T**ension in Muscles for most of day * **C**oncentration Difficulty * **H**yperarousal (Irritability) * **E**asily fatigue * **R**estlesness * **S**leep Disturbances * **6** Months (Sx's last at least 6 Mos.) Tx: * Most effective comprehensive cognitive-behavioral intervention (CBT) that incorporate applied relaxation, exposure & cog. restructuring. * A combo of CBT & Pharmacotherapy w/SSRI's or SNRI's Fluoxetine (currently a 1st line drug) for best long-term outcomes GAD must be distinguished from nonpathological anxiety, which is easier to control, has a shorter duration, is in proportion to feared events & less likely to be accompanied by physical symptoms such as excessive fatigue & restlessness.

Answer 82

Dx Criteria: * At least 1 Sx of impaired sensory/voluntary motor Fx that suggests a serious neurological or other serious medical condition (e.g. paralysis, blindness, loss of pain sensation), but for which no medical explanation can be found * Believed to be related to psychological factors often exposure to a severe conflict/stressor * 2 psychological mechanisms cause or mainatin the Sx's: * *Primary gain* - Sx reduces anxiety by keeping a trauma out of the conscious awaerness. * *Secondary gain* - Sx help the individual avoid an unplesant activity, gain support or obtain some other external benefit. * These Sx are not voluntarily produced & are usually alleviated under hypnosis or in an amytal interview

Answer 83

Characterized by: * At least 8 recurring physical Sx's that began prior to 30 & have occured for several years * Must include at least * 4 pain Sx's, * 2 gastrointestinal Sx's, * 1 sexual Sx & * 1 psudoneurological Sx. * The Sx's are not being intentionally produced or feigned & medical attention has been sough but no physical explanation has been found . * Medical exams & tests have not found a physical explanation & no evidence of faking

Answer 84

Dx Criteria: * 1 or more physical Sx's for less than 6 months Dx assigned when the person has somatoform Sx that do not meet the criteria for a specific Somatoform D/O (e.g. for a woman with symptoms of pseudocyesis - i.e. believes she is pregnant and has physical signs of pregnancy but is not pregnant)

Answer 85

Dx Criteria: * 1 or more physical Sx's for at least 6 mos. * That can not be explained by a medical condition or substance * Not intenitanally produced/feigned * Do not meet criteria for another mental D/O

Answer 86

Dx Criteria: * 1 or more pain Sx's only * Not intentionally produced/feinged * Can't be explained by another D/O * Appear to be related to psychological factors

Answer 87

Characterized by: * Presence of physical or psychological Sx that are intentionally produced or faked apparently for the purpose of fulfilling an intrapsychic need to *_adopt the sick role._* * Have extensive medical knowledge & have undergone multiple painful medical procedures & * When the causes of Sx are not found they respond with denial or seek medical 2nd opinion. * No Tx ID, but good theraputic rel and consistent care best way to manage Sx

Answer 88

- aka Munchausen's Syndrome by Proxy - involves the intentional production of physical symptoms in an individual by a caregiver Ex: Mom deliberatly produces Sx's in thier child

Answer 89

(In DSM under other conditions that may be a focus of clinical attention) * Involve an intentional production or feigning of physical or psychological Sx's * For the purpose of obtaining an obvious external reward such as avoiding work, receiving financial compensation, or obtaining drugs (Avoid undesireable activity)

Answer 90

(Mower's) For Specific Phobias are the result of avoidance conditioning, which involves a combo of classical & operant conditioning: * 1st ppl learn to fear a neutral (conditioned) stimulus because its pairing w/an intrinsically anxiety-arousing (unconditioned) stimulus, & * Thier avoidance response is then negativly reinforced because it keeps them from experiencing anxiety. Since ppl consistently avoid the conditioned stimulus, they never have an opportunity to extinguish the conditioned fear.

Answer 91

* Interfere w/normal human sexual response cycle or * Assoc. w/pain during sexual intercourse * Types: * Lifelong or acquired * Generalized or situational * Due to psychological or physiological facotrs or to combined factors * Due to general medical condition or substance induced

Answer 92

* Dx when persisitent & casues marked distress or causes interpersonal difficulty * Affects both Males & females * Indiv. is unable to experience orgasm following adequate sexual excitement & stimulation or * Persistent delay in experienceing orgasm

Answer 93

* characterized by involuntary contractions of the outer 3rd of the vagina that interfere with sexual intercourse when penetration is attempted * its onset is often preceded by exposure to a sexual trauma * More common in younger women & women who have negative attitudes toward sex

Answer 94

* Involves a persistent or recurrent inability to attain or maintain an adequate erection until completion of sexual activity * Presence of erection during sleep can help rule out a physiological cause * Dx only when can not be explained by a medical condition or substance use * Physical factors that have been linked to this disorder include diabetes mellitus, liver and kidney disease, multiple sclerosis, and antipsychotic antidepressant, and hypertensive drugs

Answer 95

* Dx when orgasm & ejaculation occur w/minimal sexual stimulation, before, on, or shortly after penetration & before the person desires it * Linked to low serotonin levels and may be effectively treated with an SSRI

Answer 96

Male/female who exp. persistent genital pain during sexual intercourse

Answer 97

* Been found most effective for Premature Ejaculation & Vaginismus * Techniques include: * *Sensate focus* (a series of graded exercises that begin with nongenital pleasuring and gradually build to genital stimulation with a ban on orgasm and intercourse) and * *The start-stop & squeeze techniques* (which are used to increase a man's control over his ejaculatory reflex) * Use SSRI's to sucessfully treat as has been linked to low serotonin levels.

Answer 98

Characterized by: * Intense recurrent sexual urges, fantasies, or behaviors involing either nonhuman objects, * the suffering or humiliation of oneself or one's partner, or children or other nonconsenting partners Tx: * In-vivo aversion therapy has short-term effects & has been repalced w/: * *Orgasmic reconditioning* - Involves having the indiv. replace a deviant sexual fantasy w/a more appropriate one while masturbating * *Satiation Therapy* - Involves having the person masturbate while imagining the object or activity until it no lopnger produces sexual arousal * *Covert sensitization*

Answer 99

Involves having the indiv. replace a unacceptable (deviant) sexual fantasy w/a more acceptable one while masturbating Tx for paraphilia

Answer 100

Dx assigned only when involves cross-dressing for the purpose of sexual arousal & causes significant distress or impairment Dx Criteria: * Intense sexually arousing fantasies, sexual urges or behaviors involving cross dressing * Basic pref. for men w/D/O is heterosexual, but may have occasionally engaged in homosexual acts.

Answer 101

Characterized by: * Intense sexually arousing fantasies, sexual urges, or behaviors that involve touching or rubbing against a nonconsenting person * Begins in early adolescence * Sx's usually decline after age 25

Answer 102

(Transsexualism is an Alt. term for Gender ID D/O) Dx Criteria: * Strong, persistent cross-gender identification & sense of inappropriateness or discomfort w/the gender role assoc. w/one's bio. sex * Dx assigned only when the indiv. cross-gender ID represents a profound disturbance in his/her identity * Children: Typically perfer wearing clothes & participating in activities assoc. w/the opposite sex & state a desire to be the opposite sex * Adults: Often preoccupied w/desire to live as a member of the opposite sex & to acquire the physical charteristics of the opposite sex & believe they were born the wrong sex. * Prognosis: Most children display less overt cross-gender behavior over time & most boys no longer meet criteria by late adolesc. or early adulthood & report a bisexual or homosexual orientation.

Answer 103

a. the majority of patients no longer expressed gender dysphoria following surgery - CORRECT Smith and colleagues found that the 162 adults in their study reported that they no longer experienced gender dysphoria following sex reassignment surgery, and the majority were functioning well psychologically, socially and sexually. The outcomes of this study are consistent with the findings of other recent research.

Answer 104

characterized by (**W**eight **F**ears **B**other **A**norexics): * **Weight** (a refusal to maintain a minimally normal body weight; below 85% ideal) * **Fears** (an intense fear of gaining weight) * **Bother** (**B**ody image distortion - a significant disturbance in the perception of the shape or size of one's body), and * **Anorexics** (in women, **a**menorrhea) * There are 2 types: * *Restricting Type* - Dx when weight loss thru dieting/restricting, fasting or excessive exercise & absence of binging & purging * *Binge-Eating/Purging Type *- Dx when engage in episodes of binge eating &/or purging * Onset of D/O is most often in mid-to-late adolescence & is often associated w/exposure to a stressful life event * Assoc. w/higher than norm serotonin levels & food restriction lowers serotonin levels CBT Tx (Garner & Bemis, 1982): * 1st priority give the CT graded task assignments designed to increase food intake * Foster doubt about her belief that she is accomplishing something by staying thin. * Addressing the validity of the CT's beliefs regarding the consequences of becoming fat & the conviction that thinness is a primary determinant of self-worth & personal value.

Answer 105

Dx Criteria (**B**ulimics **O**ver **C**onsume **P**astries): * *Binge & Purge (compensatory behavior) average at least 2 time a week for 3 mos.* * **Bulimics** (**B**inging -recurrent episodes of binge eating that are accompanied by... * **Over** (**O**ut of control - a sense of lack of control) * **Consume** (Inappropriate **C**ompensatory behavior to prevent weight gain such as...) * **Pastries** (**P**urging - self-induced vomitting, excessive exercise, or laxative or diuretic use); * Self-evaluation that is unduly influenced by body shape and weight * Onset is usually in late adolescence or early adulthood & often occurs during or after a period of dieting; 90% female * Assoc. w/low levels of serotonin & norephinepherine * Tx: includes nutritional counseling, cognitive-behavioral therapy, family therapy, and in some cases, antidepressants

Answer 106

Involves disturbances in the amount, quality, and timing of sleep

Answer 107

Characterized by irresistible attacks of restorative sleep accompanied by either cataplexy or an intrusion of REM sleep during the transition between sleep & wakefulness Cataplexy is usually triggered by a anger, suprise, laughter or a strong emotion (occurs at onset of sleep attack)

Answer 108

Due to abnormal breathing during sleep & characterized by a disruption in sleep that leads to insomnia & excessive sleepiness Most common type is obstructive sleep apnea

Answer 109

Vivid dream like images that occur at the begining of sleep

Answer 110

Involve behavioral or physiological abnormalities during sleep or in the sleep-wakefulness transition

Answer 111

Characterized by repeated episodes of abrupt awakening from sleep, *_usually beginning with a panicky scream or cry_* and accompanied by intense autonomic arousal and behavioral signs of fear

Answer 112

Repeated episodes of complex motor behaviors during sleep that include getting out of bed & walking around the room, walking up or down stairs, etc.

Answer 113

Characteristics: * Involve a stable, enduring patter of behavior that: * deviates from the expectations of the person's culture * pervasive & inflexible * onset in adolesc. or early adulthood * causes significant distress or impairment * 10 Personality D/O's grouped into 3 clusters based on primary characteristics: * Cluster A (Odd/Eccentric Behaviors) * Cluster B (Dramatic/emotional or erratic) * Cluster C (Anxiety & fearfulness) To assign the Dx to anyone under 18 years old the Sx's must be present for at least 1 yr except for antisocial which can not be Dx until 18

Answer 114

Essential feature is a pervasive pattern of distrust & suspiciousness that entails interpreting the motives of others as hostile or malicious. 4 charatersistic sx's: * **S**pousal infidelity suspectd * **U**nforgiving (bears grudges) * **S**uspicious (pre-occupied w/unjust doubt about trust worthness of others) * **P**ercieves attacks (reacts quickly) * **E**nemy or friend? (suspects associate or friends are exploiting, harming or decieving them) * **C**onfiding in others is feared * **T**hreats percieved in benign events (reads into harmless events or comments) Irrational suspiciousness & mistrust of others

Answer 115

A pervasive pattern of indifference to interpersonal relationships (lack of interesst in social rel) & a restricted range of emotional expression in social situations. At least 4 Sx's: (DISTANT) * **D**etached or flattened affect (exhibits emotional coldness/detachment) * **I**ndifferent to criticism or praise * **S**exual Expereiences of little interest * **T**asks done solitarily (almost alwyas chooses solitary activities) * **A**bsence of close friends * **N**either desire nor enjoy close relationships * **T**akes pleasure in few activities Ppl w/this D/O say they lack close relationships but say they niether enjoy or desire them

Answer 116

Pervasive social & interpersonal deficits & eccentircities in cognition, perception & behavior (odd behavior or thinking; not your typical) Dx in the presence of 5 Sx's: (ME PECULIAR) * **M**agical Thinking (odd beliefs) * **E**xpericnces unusual perceptions (bodily illusions or other unusual perceptions) * **P**aranoid Ideation * **E**ccentirc Behavior or appearance (peculiar) * **C**onstricted or inappropriate affect * **U**nusual thinking or speech 9dd) * **L**acks close firends * **I**deas of reference * **A**nxiety in social situations * **R**ule out psychotic or pervasive devel. D/O

Answer 117

Characterized by a pattern of disregard for and violation of the laws/rights of others since 15. Dx Criteria: (CORRUPT) * Indiv. must be at least 18 yrs old, * Hx of Conduct Disorder before the age of 15, * Exhibit at least 3 Sx's since age 15: * **C**an’t conform to Law (failure to conform to social norms w/respect to lawful behavior) * **O**bligations ignored (consistent irresponsibility) * **R**eckless disregard for safety (of self & others) * **R**emorseless * **U**nderhanded (decietful) * **P**lanning Insufficient (impulsive) * **T**emper (irritable/aggressive) Assoc. Sx's inflated sense of self, superfical charm & lack of empathy. Although it is chronic, its symptoms often become less evident and pervasive in the fourth decade of life

Answer 118

A pervasive pattern of instability in interpersonal relationships, self-image, affect, and marked impulsivity. 5 Sx's present: (IMPULSIVE) * **I**mpulsive (in at least 2 areas self-damaging/unsafe sex, reckless driving, financial irresponsibility & Sub. abuse) * **M**oodiness (affective instability) * **P**aranoia or dissociation under stress * **U**nstable self-image (or sende of self, manifests as frequent changes in career goals & sexual ID) * **L**iable intense relationships (patterns of unstable, intense interpersonal rel. marked by fluctuating btwn idealization & devaluation) * **S**uicidal jestures (recurrent threats) * **I**nappropriate anger * **V**ulnerability to abandonment (frantic efforts to avoid abandonment & engage in impulsive & extreme behaviors to keep others w/them) * **E**mptiness (chronic feelings of) Most commonly Dx in individuals aged 19-34, and its symptoms are typically most chronic and severe during young adulthood. By 40+ years old up to 75% of indiv. dont meet all criteria

Answer 119

Linehan's (1987) DBT was designed as a treatment for BPD and incorporates 3 strategies: 1. *Group skills training* to help clients regulate their emotions & improve their social & coping skills; 2. *Individual outpatient therapy* to strengthen clients' motivation & newly-acquired skills; and 3. *Telephone consultations* to provide additional support & between-sessions "coaching" which combines CBT w/rogerian therapy and that the assumption of acceptance of the CT necessary for change to occur. Research has confirmed that DBT reduces premature termination from therapy, psychiatric hospitalizations, & parasuicidal behaviors

Answer 120

Characterized by a pervasive pattern of excessive emotionality, expression of emotion, need for admiration and attention-seeking behaviors in a variety of contexts. Requires 5 Sx's: (ACTRESS) * **A**ppeararance used to draw attention to self * **C**enter of attention (discomfort when not the center of attention) * **T**heatrical **R**elationship (believed to be more intimate than are) * **E**asily influenced (by others/overly trusting) * **S**eductive behaviors (inapprop. or provacative) * **S**hallow emotions (Rapidly shifting) * **S**peech (impressionistic or vauge)

Answer 121

Pervasive pattern of grandiosity, need for admiration & Lack of empathy. 5 Sx's: (GRANDIOSE) * **G**randiose (sense of self-importance) * **R**equires attenition(Req. excessive admiration) * **A**rrogant (believes s/he is unique) * **N**eed to be special * **D**reams of success & power (pre-occupied w/fantasies of unlimited sucess, power, beauty, love) * **I**nterpersonally explotative * **O**thers (unable to recognize feelings/needs of others; lack of empathy) * **S**ense of Entitlement * **E**nvious

Answer 122

Pervasive pattern of social inhibition, feelings of inadequacy & hypersensitivity to negative evaluations. 4 Sx's: (CRINGES) * **C**riticism or rejection pre-occupy thoughts in social situations * **R**estraint in relationships due to fears of shame (Desires close rel. but avoids them bc of feeling inadequate, rejection & hypersensitive to criticism) * **I**nhibited in new relationships * **N**eeds to be sure of being liked before engaging socially (In intimate rel. demand constant re-assurance they are desired & loved) * **G**et's around/avoids jobs that require interpersonal contact * **E**mbarrasment prevents new activities or taking personal risks * **S**elf-viewed as unappealing or inferior

Answer 123

Pervasive & excessive need to be taken care of (psychological dpendence on others) which leads to submissive, clinging behavior & fear of separation. At least 5 Sx's: (RELIANCE) * **R**eassurance required (difficulty making decisions w/out advice & reassurance from others) * **E**xpressing disgreement difficult (Fears dissagrements bc fears might lose suppport) * **L**ife responsibilites assumed by others * **I**nitiating projects difficult * **A**lone (feels helpless & uncomfortable when alone) * **N**urturance (goes to excessive lengths to obtain) * **C**ompanionship sought urgently when a relationship ends * **E**xaggerated fears of being left to care for self

Answer 124

Involves a persistent preoccupation with orderliness, perfectionism, & mental & interpersonal control, which have the effect of severely limiting flexibility, openness, & efficiency. At least 4 Sx's: (SCRIMPER) * **S**tubborn * **C**an't Discard worthless objects (or worn-out objects) * **R**ule obsessed (peroccupied w/details, rules, etc. to where point of activity lost) * **I**nflexible (overcontientious & inflexible about morals, ethics & values) * **M**iserable * **P**erfectionism (interferes w/task completion) * **E**xcludes leisure due to devotion to work (& friendship) * **R**eluctance to delegate to others (unless willing to do his/her way) OCPD does NOT involve true obsessions & compulsions Spens an excessive amt of time paying attention to rules/procedures & trivial details when working on a task, unrealistic high standards for thier perfection.

Answer 125

A misperception or misinterpretation of a real external stimulus Ex: trickling of water as voices

Answer 126

Belief that events, objects or other ppl have special or unusual significance for oneself.

Answer 127

Disruption in the usually integrated Fx's of consciousness, memory, ID or perception of environment

Answer 128

An alteration in the perception or experience of the self so that one feels detached from & as if one is an outside observer of ones mental processes or body. Feeling that one is an outside oberver of ones own mental processes or body

Answer 129

Predicts the same inital circumstance may lead to different outcomes Inital Same = Different (multiple) outcomes Same to different

Answer 130

Predicts that different circumstances may lead to same outcomes Inital different = Same (Equal) outcomes Different to same

Answer 131

Multi-modal Cognitive Behavioral Therapy (CBT): * Primary Sx Chronic Arousal use Stress Innoculation * Primary Dissociative Sx's use Prolonged Exposure * All Sx's Present use both: * ***Stress Innoculation***: Help CT cope w/stress & other adversive states by enhancing coping strategies w/3 overlapping stages: * ***C**ognitive Preparation* - Help Ct understand behavior & cog.responses. * ***S**kill acquisition & Rehersal* of coping skills * ***A**pplication & follow thru* apply what learned to imagined, filmed or in-vivo situations * ***Prolonged Exposure (PE): ***Help CT process traumatic event & reduce Sx's includes: * *In-vivo exposure* * *Imaginal exposure*

Answer 132

Refers to speech that is indirect & delayed in getting to the point bc of unnecessary, tedious details & parenthetical remarks.

Answer 133

(AKA Derailment) A complete lack of connectedness btwn utterances & the loss of the original point.

Answer 134

A fabrication of facts or events to compensate for memory loss.

Answer 135

Inability to recall or remember names of familiar objects, words or ppl Sx of Delirium

Answer 136

Inability to write Sx of delirium

Answer 137

Language D/O Inability to express onself thru speech (produce language) & understand language written or spoken. Sx of Dementia

Answer 138

Inability to carry out voluntary purposeful movements not due to motor deficits or lack of understanding Sx of Dementia

Answer 139

Inability to recognize familiar * objects * sounds * tastes * other sensations Sx of Dementia

Answer 140

Lack of voluntary coordination of muscle movement

Answer 141

Characterized by unpleasant feelings of physical restlessness (Motor restlessness) & need to move in the arms & legs. (Extrapyramidal side effect of neuroleptic drugs & Sx's of Parkinson's disease)

Answer 142

Difficulty swallowing or eating

Answer 143

Speech D/O that involves probs. related to articualtion resulting from muscle waekness or a loss of muscle control involving the muscles of the mouth, tongue, jaw, larynx, & vocal cords. * Speech is slow, garbled & difficult to understand (Stroke)

Answer 144

Inability to perform skilled movements.

Answer 145

Disturbance in the stress, pitch, melody, cadence & rhythm of speech