Behavioral JG Flashcards
discrete trial instruction used for acquiring new behavior in people with ______ (dz)
autism
reinforcement-based tx most effective for decreasing problematic behavior in ______ (dz)
autism
diagnosis of intellectual disability: IQ at or below 70, deficients in 2 or more areas of adaptive functioning, onset before age __
18
mild ID (IQ 55-70) achieve what grade level academically?
6th grade, can self support with minimal intervention
moderate ID (IQ 35-55) benefit from vocational and social training, can reach what grade level academically
2nd grade
ID is about twice as common in (males/females)
males
repetitive behaviors are considered an (associated/essential) feature of autism
essential
self-injury behaviors are considered an (associated/essential) feature of autism
assoc
pica: persistent eating of non-nutritive substances for at least _____ (time period), inappropriate for age level, not culturally sanctioned
1 month
autism: medication use (increases/decreases) as patient ages
increases
autism: complementary and alternative medical treatment use (increases/decreases) as patient ages
decreases (special diets, O2, facilitated communication)
dx ADHD: need 6 features of inattention for more than 6 months before age __ OR 5 features or more after age __
17
dx ADHD: several symptoms present prior to age __, symptoms in 2+ settings, symptoms interfere with functioning, not explained by another disorder
12
most common ADHD presentation: (combined/predominantly inattentive/predominantly hyperactive+impulsive)
combined
(ADHD/Oppositional Defiant Disorder/Conduct Disorder): tx with direct contingency management, daily report cards, token reinforcement and response cost systems, behavioral parent training, Incredible Years program
ADHD
(ADHD/Oppositional Defiant Disorder/Conduct Disorder): tx with problem-solving skills training, focus on cognitive processes, parent child interaction therapy
ODD (authoritative parenting)
(ADHD/Oppositional Defiant Disorder/Conduct Disorder): tx with multisystemic therapy, address at multiple levels, multidimensional treatment foster care while parents receive PMT, functional family therapy
CD
(ADHD/Oppositional Defiant Disorder/Conduct Disorder): angry, argumentative, vindictive, impacts functioning
ODD
ODD (mild/moderate/severe): symptoms confined to one setting
mild
ODD (mild/moderate/severe): symptoms present in at least 2 settings
moderate. (severe=3+ settings)
(ADHD/Oppositional Defiant Disorder/Conduct Disorder): bullies, threatens, uses weapons, cruel to animals, steals, sets fires
CD
Conduct Disorder: 3+ symptoms must be displayed within the past __ months, and at least one symptom must be displayed within the past __ months
12 months, 6 months
Conduct disorder: stays out at night despite parental prohibitions, truant at school starting before age __
13
CD childhood onset vs adolescent onset cutoff is age __
10
to diagnose Major Depressive Disorder: need _/9 symptoms including persistent depressed mood and anhedonia
5/9
SMIGECAPS stands for
sleep disturbed, mood, interest reduction, guilt, energy loss, concentration impairment, appetite change, psychomotor symptoms, suicidal ideation
(atypical depression/pseudodementia/diurnal variation/psychomotor symptoms): more likely to have weight gain and hypersomnia, carb cravings, rejection sensitivity
atypical
(atypical depression/pseudodementia/diurnal variation/psychomotor symptoms): cognitive symptoms in depressed elderly often misdiagnosed as dementia
pseudodementia
(atypical depression/pseudodementia/diurnal variation/psychomotor symptoms): melancholic type depression, extreme anhedonia
diurnal (worse in AM)
(atypical depression/pseudodementia/diurnal variation/psychomotor symptoms): body aches, headaches, vegetative depression
psychomotor symptoms
Masked depression more likely seen in (young/old) patients, obsessive compulsive, narcissistic personalities
elderly
MDD: (increased/decreased) levels of DA, 5HT, NE
decreased
MDD: (high/low) number of receptors with low amounts of transmitter
high number of receptors
MDD: (hypo/hyper) active amygdala
hyperactive amygdala
MDD: (hypo/hyper) active dorsolateral prefrontal cortex
hypoactive DLPFC
MDD lifetime prevalence: (men/women) experience more
women (women also seek more tx)
three frontline drug groups for MDD
SSRI, SNRI, NDRI
use vagus nerve stimulation, transcranial magnetic stimulation, deep brain stimulation to treat ______
MDD
increasing cortisol (increases/decreases) brain neurotrophic factors, making depression more likely to occur
decreases
after several depressive episodes, subsequent episodes are (shorter and less severe/longer and more severe)
more severe
which 5HT receptor impacts sleep schedules: (3/1a/7/2)
7
higher suicide risk: (younger/older) adults
older
higher suicide risk: (male/female)
male
higher suicide risk: (white/black) race
white
higher suicide risk: (Muslim/Jewish)
Jewish
higher suicide risk: (non-professional/professional)
professional
suicide risk triad components
ideation, plan, intention
(men/women) attempt 4x as much as (opposite)
women but men are 3x more successful
5HTT gene polymorphism: (little s/long s) allele is higher risk for suicide
little s is bad (long s is more resilient)
FDA boxed warnings indicate that antidepressants increase suicide risk for patients up to __ years old
24
ADHD: chromosome __ is most obvious finding
16
ADHD: (increased/decreased) NE, (increased/decreased) DA
decreased both
alpha 2 NE agonists used in tx of ADHD (2): (atomoxetine/guanfacine ER/clonidine ER), no addiction risk
guan and clonidine
NRI used in tx of ADHD: (atomoxetine/guanfacine ER/clonidine ER), no addiction risk
atomoxetine
(NE/DA) makes you focus. (NE/DA) makes you ignore everything else
NE makes you focus, DA makes you ignore everything else
ADHD patient with another psychiatric disorder most commonly has:
anxiety
reverses DA pump, pro DA: (guanfacine ER/atomoxetine/amphetamine/clonidine ER)
amphetamine
ADHD: (hypo/hyper) active anterior cingulates
hypoactive anterior cingulate
(illusion/delusion): misperception of real external stimuli
illusion
(illusion/delusion): false beliefs not correctable by logic or reason, not based on simple ignorance
delusion
sensory perceptions not generated by external stimuli
hallucinations
patients with schizophrenia (have/do not have) clouding of consciousness
do not (unlike delirium or substance abuse)
dx? 2+ of the following during a 1 month period: delusions, hallucinations, grossly disorganized or catatonic behavior, disorganized speech, negative symptoms
schizophrenia
to dx schizophrenia, need continuous signs of disturbance persisting for at least __ months
6 months
schizophrenia types: (undifferentiated/paranoid/residual/disorganized/catatonic): most common type
undifferentiated
schizophrenia types: (undifferentiated/paranoid/residual/disorganized/catatonic): older age of onset, better functioning than other types
paranoid
schizophrenia types: (undifferentiated/paranoid/residual/disorganized/catatonic): at least one psychotic episode with subsequent negative symptoms
residual
schizophrenia types: (undifferentiated/paranoid/residual/disorganized/catatonic): onset before age 25, incoherent speech, inappropriate emotional responses
disorganized
schizophrenia types: (undifferentiated/paranoid/residual/disorganized/catatonic): rare since introduction of antipsychotic agents
catatonic
schizophrenia onset occurs earlier in (women/men)
men
(men/women) respond better to antipsychotic medication
women
schizophrenia: enlarged (hippocampus/ventricles)
ventricles, lateral and third
schizophrenia: decreased volume of (hippocampus/ventricles/amygdala)
hippocampus and amygdala
schizophrenia: (increased/decreased) DA activity in mesolimbic tract
excessive DA
schizophrenia: Glutamate hypothesis relies on a defective _____
NMDA receptor
schizophrenia tx: effective antipsychotics (upregulate/block) D2 receptors in the mesolimbic DA path
block
(traditional first generation antipsychotics/atypical second generation antipsychotics): block D2 receptors and 5HT2a receptors
atypicals
(traditional first generation antipsychotics/atypical second generation antipsychotics): high potency versions cause more side effects in the nigrostriatal path and tuberoinundibular path
first generation
being older at the age of onset of schizophrenia is a (poor/good) indicator for prognosis
good prognosis. as is being female, married, good employment hx, presence of mood symptoms, presence of positive symptoms
(generalized anxiety/panic/social anxiety/obsessive compulsive/acute stress & PTS) disorder: symptoms must be persistent (6+ months), interfere with normal functioning, cause distress
generalized anxiety
generalized anxiety dx requires a longer period of symptoms in (children/adults)
longer period in adults. children may be diagnosed in a shorter amount of time
generalized anxiety disorder: 5HT is (up/down), GABA is (up/down), NE is (up/down), glutamate is (up/down)
5HT is down, GABA is down
NE is up, glutamate is up
generalized anxiety disorder dx: excessive worry occurring more days than not for 6+ months, about 1+ event, difficult to control worry, assoc with __+ (number) of: restless, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
3+ of these symptoms must be assoc to dx GAD
anxiety disorders affect women more than men except for which one
OCD
what’s the risk with giving benzodiazepines for anxiety disorders
addiction
why give beta blockers for anxiety disorders
for symptomatic relief of performance anxiety
(generalized anxiety/panic/social anxiety/obsessive compulsive/acute stress & PTS) disorder: abrupt surge of fear, peaks within minutes, that is unexpected
panic disorder
panic disorder assoc with \_\_+ (number) of the following: Palpitations, pounding heart, or accelerated heart rate Sweating Shaking/trembling Sensation of shortness of breath or smothering Choking feeling Chest pain/discomfort Nausea Dizziness, lightheadedness or fainting Chills or heat Paresthesias Derealization Fear of Losing of control Fear of dying
4+ to make dx of panic disorder
(specific phobia/panic/social anxiety/obsessive compulsive/acute stress & PTS) disorder: 6+ months, signif impairment, marked fear about a specific object/situation, actively avoids object/situation, fear out of proportion to actual danger
specific phobia. (clowns, snakes, airplanes, snakes on a plane, bald people, doctors)
(generalized anxiety/panic/social anxiety/obsessive compulsive/acute stress & PTS) disorder: 6+ months, causes signif impairment, fear of acting in ways that will be negatively scrutinized, fear out of proportion to actual threat, marked fear when exposed to social situation
social anxiety disorder (performance only: fear is restricted to public speaking/performing)
social phobia occurrence: men (>/=/
men = women
(generalized anxiety/panic/social anxiety/obsessive compulsive/acute stress & PTS) disorder: use cognitive behavioral therapy
all of them
(generalized anxiety/panic/social anxiety/obsessive compulsive/acute stress & PTS) disorder: use systemic desensitization
panic and specific phobia
(generalized anxiety/panic/social anxiety/obsessive compulsive/acute stress & PTS) disorder: use flooding therapy
specific phobia
(generalized anxiety/panic/social anxiety/obsessive compulsive/acute stress & PTS) disorder: use assertiveness training, group therapy
social anxiety disorder
OCD dx: obsessions and compulsions must be EITHER: time consuming (__+hr/day) or cause clinically signif distress
1hr+
what is ego dystonia in the context of OCD?
unwanted thoughts/urges–obsession
what is a compulsion versus an obsession
the compulsion is the repetitive behavior or activity that the patient performs in response to an obsession or as a set of rules that must be strictly adhered to
