Block 2 Linton Flashcards
what does it mean to say a mental disorder is organic
it has a biological basis or medical cause
what does it mean to say a mental disorder is neurosis
a chronic non-psychotic mental disorder recognized by the the patient as being unacceptable
how many major classifications are in the DSM-5
21
when is an “other specified disorder” used clinically
allows the physician to state why a patient’s individual presentation does not meet criteria for a specific category
when is “unspecified disorder” used clinically
if the physician chooses not to state a reason the criteria are not met for a specific disorder (when there is insufficient information to make a more specific diagnosis- ex: in the ER)
in the DSM IV, how did axis I disorders differ from axis II disorders
axis 1- all other mental diagnoses
axis II- personality disorders and intellectual developmental disorders
does DSM V use an axial or nonaxial system of documentation
nonaxial
what is the world health organization disability assessment schedule 2.0 (WHODAS 2.0)
it assesses disability across 6 domains for the past 30 days
(understanding and communicating, getting around, self-care, getting along with people, life activities, participation in society)
bariatric surgery is recommended for what types of patients
obese with BMI >40
how does a gastric balloon work for weight loss
it’s an inflatable device that is temporarily placed in the stomach to take up space in the stomach
how does liraglutide work for weight loss
suppresses appetite
delays gastric emptying
how does orlistat work for weight loss
it’s a pancreatic lipase inhibitor that limits the breakdown of dietary fats
how does naltrexone-bupropion work for weight loss
reduced food craving
how does Phentermine/topiramate work for obesity
suppresses appetite
what OTC supplements have been successful for lowering caloric consumption and body weight
fiber glucomannan (konjac root)
guar gum
what is the difference between reliability and validity
reliability assesses the reproducibility of test results
validity assesses whether the test measures what the was supposed to measure
what are criterion referenced psychometric tests
results are compared to a preset standard
(ex: a grade above a 60% will pass)
what is a norm referenced psychometric test
the results of a test are compared to the norm of a group
what is mental age
a person’s level of intellectual functioning
(median test score for a given age)
what is the intelligence quotient an estimate of
functional capacities
behavior genetic studies suggest IQ is more than __% inherited
70
the distribution mean for IQ is __ with a standard deviation of __
100
15
an IQ less than 69 is associated with what
intellectual developmental disorder
an IQ of less than 69 accounts for what percent of the population
2.5%
an IQ between _ and _ is considered average
90 to 109
an IQ more than 130 accounts for what percentage of the population
2.5%
what is the equation to calculate IQ
mental age/chronological age x100
(chronological age is the patient’s actual age)
what is the highest age to determine IQ since past this age, IQ becomes stable
15
the margin of error for mental age and deviation from norms is + or - _
5
does intelligence decline with age
no
what ability holds up best as we age
verbal
why do cross sectional studies of IQ show lower levels for older people
older people tend to be less educated than the young
increased exposure to __ early in life leads to a higher IQ
verbal behavior
what are 2 factors that may influence the result of an IQ test
cultural bias
emotional response (test anxiety)
what is the most commonly used IQ test
Wechsler adult intelligence scale IV
what are the components of the Wechsler adult intelligence scale IV IQ test
there is a score for a full scale IQ and a score for subcomponents (verbal comprehension, working memory, perceptual reasoning, processing speed)
verbal IQ= verbal comprehension+working memory
performance IQ= perceptual reasoning+processing speed
the Wechsler intelligence scale for children is for ages __
the Wechsler preschool and primary scale of intelligence is used for children ages __
children= 6-17
preschool/primary= 4-6.5
the Wechsler nonverbal scale of ability is used for what populations
cultural and linguistically diverse
what was the first formal IQ test
stanford binet intelligence scale (this is still used for ages 2-18)
what is the Vineland social maturity scale used for
evaluate skills for daily living in those mentally/intellectually disabled
what do both the Wisconsin card sorting test and the Stroop color word test evaluate
executive function, ability to reason abstractly, solve problems, attend to a specific task while inhibiting interfering stimuli
what types of patients may have abnormal results in the Wisconsin card sorting test
those with frontal lobe/caudate damage
schizophrenics
what are objective tests
questions with limited range of responses scored mathematically
little/no clinical experience required to score
what is the Minnesota multiphasic personality inventory-2 test
it has statements in which patients answer true or false about themself
in the Minnesota multiphasic personality inventory-2 test, results are considered significant if they are > or < ___
2 standard deviations from the mean
is the Minnesota multiphasic personality inventory 2 test a criterion referenced or norm referenced test
norm (demographics, SES, education, and lifestyles choices may cause variation in readings)
how do projective tests differ from objective tests
projective tests involve ambiguous stimuli and a possibility of a wide range of responses
what is the most commonly uses projective personality test
Rorschach inkblot test
what is involved in the Rorschach inkblot test
10 bilaterally symmetrical inkblot designs are shown and the patient is asked to interpret them
results are then standardized using the Exner scoring method
is the Rorschach inkblot test an objective or projective test
projective
is the thematic aperception test objective or projective
projective
what is involved in the thematic aperception test
patients are asked to create a verbal scenario about a series of cards, each depicting a scene
is a sentence completion test an objective or projective test
projective
are projective drawings an objective or projective test
projective
what is involved in the projective drawing test
the patient is asked to draw a house, tree, person, family, or another object, with the drawings scored for size, placement, distortion, details, etc.
what are the 4 common rating scales for depression
Hamilton
Beck
Zung
Raskin
how do the Zung and Beck scales compare to the Hamilton and Raskin scales for depression
Zung and Beck scales are scored by the patient
Hamilton and Raskin are scored by the examiner
what is the brief psychiatric rating scale used to assess
severity of psychiatric symptoms, especially psychotic symptoms
what is the Hamilton anxiety scale used for
quantifying the symptoms of anxiety
what is the Yale Brown obsessive compulsive scale used for
rate the severity of OCD symptoms
what are the scale for assessment of negative (SAN) and the scale for assessment of positive symptoms (SAP) used to measure
positive and negative symptoms of schizophrenia
neuropsychological tests are used to assess patients with what types of conditions
suspected neurological problems (ex: dementia) or brain damage
what is the Halstead Reitan battery used for
to test for presence and localization of brain function to provide an impairment index
what is the Luria Nebraska neuropsychological battery used for
tests for impairment and functioning to assess cognitive function and specific types of brain dysfunction (ex: dyslexia)
what test is useful for determining left or right cerebral dominance
Luria Nebraska neuropsychological battery
what type of test is the Bender visual motor gestalt test
visuomotor coordination
what occurs in the Bender Visual Motor Gestalt Test
the patient is asked to copy 9 shapes from memory
what test is used most frequently in adults as a screening device for signs of neuropsychiatric dysfunction
Bender Visual Motor Gestalt Test
what type of test is the Benton Visual Retention Test
memory
what test is sensitive to short term memory loss
Benton Visual Retention Test
what is tested in the Benton Visual Retention Test
visual perception and visual memory
what is the Wechsler memory scale uses to access
memory impairment
what test can pick up memory/amnestic problems due to conditions such as Korsakoff’s syndrome
Wechsler memory scale
what memory test battery is most widely used
Wechsler memory scale
what type of test is the Boston naming test
language
how does the Boston naming test work
it has 60 line drawings of objects from more common to lesser common and it measures word retrieval
what type of test is the Digit Symbol Substitution Test
cognitive
what type of test is the Folstein Mini Mental State Examination
cognitive
what is used to assess level of consciousness by rating patient responsiveness
Glasgow Coma Scale
with the Glasgow Coma Scale, a score of __ indicates mild neurological impairments, __ is moderate, and __ is severe impairment
<12= mild
9-12= moderate
<9= severe
expansiveness, flight of ideas, decreased sleep, heightened self esteem, and grandiose ideas represent what state
mania/hypomanis
expansiveness, flight of ideas, decreased sleep, heightened self esteem, and grandiose ideas represent what state
mania/hypomania
it is estimated that at least __% of patients referred to primary care for any reason have depression
the diagnosis of depression is missed in __% of cases
10
50
only __% of patients are prescribed antidepressant medication
25
what complaint may be the primary complaint, making the diagnosis of depression difficult
somatic complaints
what is anaclitic depression
infants who appeared depressed due to separation from the mother
*this is not recognized by the DSM
major depressive disorder has a lifetime prevalence of __%
__% in men, __% in women
12-15%
men= 5-12%
women= 10-20%
what percent of the population worldwide suffers from depression
4.4%
according to WHO, what is the leading cause of disability worldwide
depression
bipolar I has a lifetime prevalence of __%
1%
bipolar II has a lifetime prevalence of __%
1%
what is the lifetime prevalence of bipolar disorders
4.4%
what is the ratio of female:male for bipolar I
2:1
what 2 neurotransmitters are of the most concern in depression
NE
serotonin
what is the main drug class used for depression
SSRI
Fluoxetine (Prozac) is an example of what class of drug that is used to treat depression
SSRI
depletion of what precursor to serotonin may precipitate depressive symptoms
tryptophan
dopamine is elevated in __ and reduced in __
elevated in mania
reduced in depression
Wellbutrin (bupropion) is an example of a drug that is used for what
depression (it increases dopamine levels which are lowered in those with depression)
reduction of GABA in plasma, CSF, and the brain has been seen in those with what condition
depression
what may account for the neurocognitive effects of severe recurring depression
glutamate working in conjunction with hypercortisolemia
glutamate and glycine bund to what receptor site
NMDA
drugs that antagonize NMDA can have what effect
antidepressive
how does ketamine work
it antagonizes NMDA to have antidepressant effects
what is the most consistent brain abnormality in depressive disorders
increased frequency of abnormal hyperintensities in subcortical regions
reduced hippocampal or caudate nucleus volume have been seen in patients suffering from what
depression
what is most commonly found with PET scans in those with depression
decreased anterior brain metabolism
is decreased anterior brain metabolism most commonly seen on the left or right side
left
depression has been associated with increased __-sided activity (left or right)
right
reductions in cerebral blood flow or metabolism in the dopaminergically innervated mesolimbic and mesocortical tracts have been seen in patients suffering from ___
depression
in patients with severe recurring depression, what else is seen in neuroimaging besides a reduction of anterior cerebral metabolism
increased glucose metabolism
major depressive disorder is also known as __
unipolar disorder
severity of depression has been linked to hyper__
hypercortisolism
what has been considered the most common correlate of suicide
depression
those with depression have a __x higher rate of suicide than the nondepressed
17
__-__% of suicides are related to mental disorders
27-90%
increased corticotropin releasing factor occurs in __
major depressive disorder
abnormalities in what axis is seen in those with major depressive disorder
limbic hypothalamic pituitary
__% of depression/fatigue cases may be secondary to hypothyroidism
10
what is the sleep cycle seen in those with major depressive disorder
increased REM in the first half of sleep
decreased REM latency
decreased stage 4 sleep
increased REM overall
the prevalence of adults with major depressive disorder is highest among what age range
18-25
what is the median age of onset of major depressive disorder based on symptoms
26
what is the median age of onset of major depressive disorder based on diagnosis
31
are the elderly or young more likely to be depressed
young
depression usually co-occurs with __
pain
__% of those diagnosed with depressive disorders may also be diagnosed with anxiety
50
what is the immunological abnormality seen in those with depression
increased levels of cytokines
what are the 5 criteria for major depressive disorder
A. 5 out of 9 symptoms present for at least 2 weeks (1 symptom must be anhedonia or depressed mood)
B. symptoms cause significant distress/impairment in social, occupational, or other functions
C. the episode is not attributed to the effects of a substance or other medical condition
D. the occurrence is not better explained by schizophrenia/other delusional disorder
E. there has never been a manic or hypomanic episode
what are the 9 symptoms of depression
- depressed mood most of the day
- anhedonia
- weight loss or gain (change in 5% of body weight in one month)
- insomnia or hypersomnia
- psychomotor agitation/retardation
- fatigue/loss of energy
- feeling of worthlessness or excessive guilt
- diminished ability to think/concentrate
- recurrent thoughts of death/suicidal ideations
what criteria of major depressive disorder represent a major depressive episode
A. 5 out of 9 symptoms present for at least 2 weeks (1 symptom must be anhedonia or depressed mood)
B. symptoms cause significant distress/impairment in social, occupational, or other functions
C. the episode is not attributed to the effects of a substance or other medical condition
