Abnormal Psychology DSM-IV (OLD) Flashcards
DSM-IV-TR
The American Psychiatric Association’s Diagnostic & Statistical Manual of Mental Disorders (DSM) Version IV & Text Revision (TR). Published in 2000
DSM-IV-TR: (Categorical Approach, Polythetic Criteria Set, Multiaxial Diagnostic System)
The DSM-IV-TR is a diagnostic system that:
- Uses a categorical approach (divides the mental D/O’s into types that are defined by a set of Dx criteria) & polythetic criteria sets (for most D/O’s requires the indiv. to present only w/a subset of characteristics from a larger list);
- Predominantly a theoretical w/regard to etiology; &
- Makes use of a multiaxial classification system that involves describing a person’s condition in terms of 5 dimensions.
Categorical Approach
The DSM-IV-TR utilizes a categorical approach that divides mental D/O’s into types that are defined by a set of diagnostic criteria:
- Involves determining whether or not a person meets the criteria for a given Dx.
- Works best when all members of each category are homogeneous, which does not always apply to people w/mental D/O’s.
Used by the DSM-IV-TR
What is the dimensional approach to diagnosis of mental disorders?
This approach conceptualizes behavior in terms of a continuum that ranges from normal/healthy to pathological & involves rating a person on each Sx or other characteristic (e.g., on a scale 1 to 10)
Polythetic Criteria
The DSM includes a Polythetic criteria set for most D/O’s to allow for heterogeneity that requires an indiv. to present w/only a subset of characteristics from a larger list.
Ex: 2 ppl can have somewhat different Sx but receive the same Dx.
How does the DSM-IV-TR take into account potential heterogeneity within categories of diagnoses?
The DSM-IV-TR includes a polythetic criteria set.
The DSM-IV-TR uses a multiaxial diagnostic system so that a persons condition is described in (1)__________ that promote the application of the (2)__________ model in clinical, educational, and research settings.
- 5 dimensions or axes
- biopsychosocial model
GAF (Global Assessment of Functioning) Scale
The GAF scale is used to rank the indivs. psychological, social, & occupational Fx on a scale from 0 to 100 (w/100 representing superior functioning) on Axis V.
Two factors are considered when assigning a GAF score:
- Sx severity and
- Level of Fx.
Multiaxial Diagnostic System of the DSM
(5 Axes)
The multiaxial diagnostic system describes a person’s condition in terms of 5 dimensions/axes that “promote the application of the biopsychosocial model in clinical, educational, & research settings” (p. 27):
- Axis I:* Clinical Disorders & Other Conditions that may be a Focus of Clinical Attention (v codes).
- Axis II:* Personality disorders & Mental Retardation.
- Axis III:* General Medical Conditions
- Axis IV:* Psychosocial and Environmental Problems
- Axis V:* Global Assessment of Functioning (GAF scale) a scale used to rank the individuals psychological, social, and occupational functioning on a scale that ranges from 0 to 100.
Why are Personality Disorders and Mental Retardation included on Axis II instead of Axis I?
To ensure that consideration will be given to the possible presence of Personality Disorders & Mental Retardation, NOT because pathogenis or range of appropriate Tx is fundamentally different than Axis I
Diagnostic Uncertainty
In the DSM-IV-TR, diagnostic uncertainty about the indivs. condition is indicated by coding on Axis I or II:
- Dx (or Condition) Deferred - coded when there is not enough info. to make a definite Dx.
- Specific Dx (Provisional) - used when there is sufficient info. for a tentative, but not firm, Dx.
- (Class of D/O) Not Otherwise Specified - Class of Dx’s used when there is adequate info. to know that a D/O belongs to a particular category but not enough info. to make a more specific Dx or when features of the D/O do not meet the criteria for a more specific Dx.
Outline for Cultural Formulation & Glossary of Culture-Bound Syndromes
The Outline for Cultural Formulation recommends that clinicians consider five elements:
- The client’s cultural identity;
- The cultural explanation for the CT’s illness;
- Cultural factors relevant to the CT’s psychosocial environment & level of Fx;
- Cultural factors relevant to the relationship between the client and therapist; and
- How cultural factors may impact the client’s Dx & care.
Know
Mental Retardation
Developmental D/O involving:
- Significantly subaverage intellectual Fx (IQ = 7O or below on IQ test)
- Impaired adaptive Fx in 2 Areas (Does not meet expected standard of personal Independence for culture/age in at least 2 areas of Fx: communication, self-care, self-direction, social skills, Fx academic skills, work or safety, etc.)
- An onset prior to age 18.
Correct Dx: if ppl w/IQ of 71-75 & level of adaptive Fx is subtantially impaired.
4 degrees of severity are:
- Mild Mental Retardation (IQ 50-55 to 70):
- Moderate Mental Retardation (IQ 35-40 to 50-55);
- Severe Mental Retardation (IQ 20-25 to 35-40);
- Profound Mental Retardation (IQ below 20-25).
Mental Retardation - Severity Levels
4 degrees of severity are:
1. Mild Mental Retardation (IQ 50-55 to 70): 6th grade level & Adults live independently w/min. sup.;
2. Moderate Mental Retardation (IQ 35-40 to 50-55): 2nd grade level & Adult perform skilled/semi-skilled work w/reg. sup.;
3. Severe Mental Retardation (IQ 20-25 to 35-40): Basic self-care skills & Adults perform simple tasks while closely supervised;
4. Profound Mental Retardation (IQ below 20-25): Need highly structured env. & Indiv. sup.
What are the early signs of Mental Retardation?
- Delays in motor development
- Lack of age appropriate interest in environmental stimuli
a. Lack of eye contact during feeding
b. Less responsive to voice & movement than would be expected
What are potential causes for Mental Retardation?
- Heredity Causes - 5% (Tay-sachs, Fragile X Syndrome, PKU)
- Early alterations of embryonic development - 30% (Down Syndrome, Damage due to toxins)
- Pregnancy & perinatal probs - 10% (Fetal malnutrition, anoxia, HIV)
- General medical conditions during infancy or childhood - 5% (lead poisoning, encephalitis, malnutrition)
- Environmental factors and other mental D/O’s - 15-20% (deprivation of nurturance or stimulation, Autistic Dx)
- Unknown causes (Approx. 30-40%)
PKU (Phenylketonuria)
A rare recessive gene syndrome due to an inability to metabolize the amino acid phenylalanine, found in high-protein foods.
If untreated, produces:
- irreversible moderate to profound retardation,
- impaired motor & language devel., &
- unpredictable, erratic behaviors.
Sx’s include:
- Mental retardation
- Microcephaly (condition in which a person’s head is significantly smaller than normal for their age and sex)
- Vomiting & Diarrhea
- Movement D/O’s
- Seizures
D/O can be detected at birth by a blood test & its Sx prevented by a diet low in phenylalanine (milk/dairy,meat, fish)
Down Syndrome (“trisomy 21”)
Due to the presence of an extra 21st chromosome & is estimated to be the cause of 10-30% of all cases of moderate to severe retardation.
Characterized by:
- Moderate to severe Mental Retardation
- Delayed motor devel. & physical growth
- Assoc. w/physical abnormalities including:
- Slanted, almond-shaped eyes,
- Broad flat face
- Cataracts,
- Respiratory defects
- Tend to age more rapidly than other ppl,
- Life expectancy below normal,
At higher risk for Alzheimer‘s disease/dementia, leukemia & heart defects/lesions.
Know
Borderline Intellectual Functioning
Approp. Dx for people with IQ’s in the 71-84 range.
Persons who fall into this categorization have:
- A relatively normal expression of affect for their age, though their ability to think abstractly is rather limited.
- Reasoning displays a preference for concrete thinking.
- Others may describe such a person as “simple” or “a little slow”.
- They are usually able to Fx day to day w/out assistance, including holding down a simple job & the basic responsibilities of maintaining a dwelling
When is a diagnosis of Mental Retardation appropriate for persons with IQs between 71 to 75?
If s/he has substantial deficits in adaptive functioning.
Prader-Willi Syndrome
Due to a deletion on chromosome 15
Sx’s include:
- Mental Retardation
- Decreased muscle tone
- Short stature
- Insatiable appetite
- Morbit obesity
(Etiology of MR)
Learning Disorders
Dx when a person’s:
- Score on a measure of academic achievement is substantially below (usually 2 SD’s or more) his/ her score on a(n) IQ test & the discrepancy cannot be fully explained by a sensory deficit.
The most common co-diagnosis is ADHD (20-30%); evidence that LD associated w/high risk for antisocial behavior & arrest/conviction for antisocial behaviors.
More common in Boys.
Stuttering
(Communication D/O) is characterized by:
- Disturbance in normal fluency and
- Time patterning of speech that is inapprop. for the individual’s age;
- Connot be completely explained by a speech-motor or sensory deficit.
- Onset:* Btwn ages of 2-7
- Effective Tx*: Habit reversal, which combines regulated breathing, awareness training, & social support.
- Etiology:* 3 times more common in males, & in 60% of cases it remits spontaneously by 16 y.o.
What treatments have been successfully in helping people who stutter?
- Reduction of psychological stress at home, stop reprimanding child for stuttering & teach coping strategies for frustration
- Regulated breathing:
- Involves reassuring the individual that s/he can speak without stuttering
- Incorporates breathing & vocalization exercises & graded speech assignments
- Habit reversal, which combines regulated breathing, vocal exercises, awareness training (aware of situations words that evoke stuttering), & social support (parents encourage & reinforce childs efforts to speak w/out stuttering)
Pervasive Developmental Disorders
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.
Know
Autistic Disorder
(Pervasive Devel. D/O) Dx criteria includes 6 characteristic Sx’s by age 3:
- 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).
- 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).
- 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
Tx for Autistic Disorder
Most effective are:
- Behavioral techniques (e.g., shaping & discrimination training for communication) by Lovaas.
- improving daily living, communication, and social skills
- Reducing undesirable behaviors
Lovaas (1960)
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.
Rett’s Disorder
(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).
Childhood Disintegrative Disorder
(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
Asperger’s Disorder
(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.
Know
Attention Deficit Hyperactivity Disorder (ADHD)
(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
Know
ADHD in Adults
- 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%
What are common co-diagnoses for those also diagnosed with ADHD?
- conduct disorder (30 to 90%)
- learning disorder (up to 50%)
- oppositional defiant disorder
- anxiety disorder
- major depression
Conduct Disorder
Dx criteria requires the presence of at least 3 Sx during the past 12 mos.:
- Theft or decitfulness
- Rules; serious violation of rules
- Agression to people or animals
- Property 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:
- 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.)
- Adolescent-Onset Type - Dx when Sx begin at age 10 or later.
Conduct Disorder (Mofitt’s Types)
Moffitt’s (1993) distinguishes btwn 2 types of Conduct D/O:
-
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. -
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.
Oppositional Defiant Disorder (ODD)
Essential features are a recurrent pattern of:
- Negativistic, defiant, & hostile behaviors toward authority figures.
Sx include (Min. 4 Sx’s - BAD AVATAR):
- Blames others for own mistakes or misbehaviors;
- Argues with adults;
- Deliberately annoys people;
- Angry & resentful
- Vindictive or spiteful
- Actively defies or challenges the rules or requests of adults;
- Temper; often losses temper;
- Antagonistic
- Rule Refusal
Know
Tourette’s Disorder
(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.
If an individual has had one ore more motor and/or vocal tics for at least 4 weeks but no loner than 12 consecutive months, the diagnosis would be?
Transient Tic Disorder
Sx’s began before age 18
Tic Disorder NOS
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.
Know
Enuresis (Not Due to a General Medical Condition)
(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.
What is the most common treatment for Enuresis?
- 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)
Know
Separation Anxiety Disorder
(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)
Reactive Attachment Disorder
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:
- Inhibited - Persisiten failure to initiate & respond to most social interactions in a developmentally approp. way (Excessively inhibited, hypervigilant or highly ambivalent response).
- 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)
Behavioral Pediatrics
- Disclosure - Open communication w/child about illness; cope better if told early on in Devel. appropriate way.
- Hospitalization - Hospitalized children are at increased risk for emotional & behavioral problems (Dependency, disrputive behaviors, anxiety, depression or severe withdrawl).
- Physical Disabilities - Children with physical disabilities are at increased risk for emotional & behavioral problems.
- School-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).
- Compliance - with medical regimens is a particular difficulty for adolescents.
Pica
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.
Adjustment Disorders
- 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.)
Delirium
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:
- Target the underlying cause
- 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.
Alcohol Withdrawal Delirium
(Delirium Tremens)
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.
Dementia
Dx Criteria includes:
Onset is deceptive (insidious) & course progressive
- 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
- 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)
-
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
Psudodementia
(Dementia DDX: Depression)
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.
.
Dementia of the Alzheimer Type
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.) Severely deteriorated 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.
Vascular Dementia
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.
Dementia Due to Parkinson’s or Huntingtons Disease
(Subcortical Dementia)
Includes:
- Retrograde Amnesia initally prominent
- Parkinsonism
- Hallucinations
- Frontal & visospatial deficits
- Fluctuating course
Demetia Due to Head Trauma
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.
Dementia Due To HIV Disease
(AIDS Dementia Complex)
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.
Amnestic Disorder Due To A General Medical Condition
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
Alcohol-Induced Persisiting Amnestic Disorder (Korsakoff Syndrome)
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.
Dissociative Amnesia
- 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
Alcohol-Related Disorder
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.
Substance Dependence
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.
Tension-Reduction Hypothesis
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.
Marlatt & Gordon (Relapse Prevention Therapy)
(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).
Nicotine Dependence
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:
- Nicotine replacement therapy;
- Multicomponent behavior therapy; and
- Support & assistance from a clinician.
Opioid Withdrawal
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.
Nicotine Withdrawal
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.
Schizophrenia
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.
