diagnoses and populations Flashcards
Anxiety Disorders
features of excessive fear and anxiety
differ from one another in types of objects or situations that induce fear, anxiety, or avoidance behavior and cognitive ideation
highly comorbid with each other
excessive or persisting beyond dev appropriate periods
persistent (6 months or more)
many dev in childhood and persist
most occur in females 2:1
selective mutism
consistent failure to speak in specific social situation
at least 1 month
associated features: excessive shyness, fear of social embarrassment, social isolation, withdrawal, clinging, compulsive traits, negativism, temper tantrums, mild oppositional behavior
DD: communication disorders, neurodev, schizophrenia, social anxiety
comorbidity: other anxiety disorders
specific phobia
marked fear or anx about specific object or situation
object or situation almost always provokes immediate fear or anx
object or situation is actively avoided or endured with intense fear or anx
fear or anx is out of proportion to actual danger
persistent 6+ months
sometimes dev following traumatic event
DD: agoraphobia, social anxiety, separation anx, panic dis, ocd, trauma and stressor related, eating, schizophrenia
comorbidity: depression, anx, bipolar, substance related, somatic symptom, personality dis
social anxiety disorder (social phobia)
fear or anx about one or more social situations in which ind is exposed to possible scrutiny by others
fear they will act in way or show anx symptoms that will be neg evaluated
social situations almost always provoke fear or anx
multiple DDs
comorbidity: other anx, major dep, substance use
panic disorder
recurrent unexpected panic attacks
persistent concern or worry about additional panic attacks
Risk / prognostic: neg affect, anx, sex and phy abuse, smoaking, poss genes
comorbidity: anx, major dep, bipolar, mild alcohol use
agoraphobia
fear or anxiety about two or five situations:
using public transportation
open spaces
enclosed places
standing in line or being in crowd
being outside home alone
thoughts that escape might be difficult or unavailable
resk / prog:
behavioral inhibition and neurotic desposition, anx sensitivity, ACEs, heritability 61%
comorbidity: anx, depressive, ptsd, alcohol use
generalized anxiety disorder
excessive anxiety and worry occurring more days than for for number of events or activities
difficult to control worry
three symptoms:
restlessness
easily fativured
difficulty concentrating
irritability
muscle tension
sleep disturbance
risk/prog:
behavioral inhibition, negative affect, harm avoidance
comorbidity: anx, unipolar depressive
substance / medication - induced anxiety disorder
panic attacks or anx is predominant
symptoms dev during or soon after substance intoxication or withdrawal
substance/med is capable of producing symptoms
anxiety disorder dure to another medical condition
panic attacks or anx is predominant
disturbance is direct consequence of another med condition
lab assessments / medical exam necessary to confirm diagnosis
other specified anxiety disorder
presentations in which symptoms characteristic of anxity disorder predominate but dont meet full criteria for other disorders
limited symptom attacks
generalized anxiety not occurring more days than not
“wind attacks”
“attack of nerves” ataque de nervios
panic attack
abrupt surge of intense fear or intense discomfort that reaches peak within minutes, and during which time multiple physical symptoms arise
palpitations
sweating
trembling
shortness of breath
choking
chest pain
nausea
dizzyness
chills or heat
parasthesias (tingling)
derealization (unreality)
fear of losing control
fear of dying
separation anxiety disorder
dev inappropriate and excessive fear or anxiety concerning separation from those whom ind is attached
may be associated w/ increased risk for suicide
children: highly comorbid with generalized anxiety and specific phobia
adults: common comorbidities specific phobia, ptsd, panic disorder, generalized anxiety, social anxiety, agoraphobia, ocd, personality disorders, depressive, bipolar
fear
emotional response to real or perceived imminent threat
associated w/ surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviors
anxiety
anticipation of future threat
muscle tension and vigilance
cautious or avoidant behaviors
Depressive Disorders
presenece of sad, empty, or irritable mood
accompanied by somatic and cognitive changes that significantly affect capacity to function
differences: duration, timing, or presumed etiology
disruptive mod dysregulation disorder
severe recurrent temper outbursts manifested verbally and/ or behaviorally that are grossly out of proportion in intensity or duration to situation or provocation
temper outbursts inconsistent with dev level
temper outbursts occur three or more times / week
mood btwn outbursts is persistently irritable or angry
criteria are present in at least two settings and are severe in at least one
first diagnosis between 6 and 18 with age of onset before 10
risk / prog:
chronic irritability, ADHD
comorbidity:
ODD, mood, anx, ASD
major depressive disorder
five or more symptoms during same 2 week period
depressed mood
loss of interest or pleasure
significant weight loss
insomnia or hypersomnia
psychomotor agitation
fatigue
feelings of worthlessness
diminished ability to think
recurrent thoughts of death
risk / prog:
neuroticism, ACEs, genetic, major nonmood disorders
comorbidity: substance related, panic, ocd, anorexia, builimia, borderline
persistent depressive disorder
depressed mood for most of day for more days than not
presence, while depressed of two..
poor appetite or overeating
insomnia or hypersomnia
low energy or fatigue
low self esteem
poor concentration
feelings of hopelessness
criteria for MDD present for 2 yuears
never been manic episode or hypomanic episode
risk / prog: neuroticism, poorer global function, anx or conduct disorder, parental loss or separation, poss polysomnographic abnormalities
comorbidity: anx, substance use, personality disorders
premenstrual dysphoric disorder
in majority of menstrual cycles, at least 5 symptoms in final week before onset on memses, start to improve w/in few days after, and become min or absent in week post
affective lability
irritability or anger
depressed mood
anxiety
decreased interest in usual activities
difficulty in concentration
easy fatigability
change in appetite
hypersomnia or insomnia
overwhelmed
breast tenderness, joint or muscle pain, bloating, or weight gain
risk and prog:
stress, interpersonal trauma, seasonal changes, oral contraceptives have fewer premenstrual complaints
comorbidity: MDD, wide range of medical or other mental disorders may worsen
substance / dedication - induced depressive disorder
prominent and persistent disturbance in mood
symptoms dev during or soon after substance intoxication or withdrawal
substance is capable of producing symptoms
comorbidity: any mental disorder, pathological gambling and paranoid, histrionic, and antisocial personality disorders
depressive disorder due to another medical condition
prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all or almost all activities
disturbance is direct consequence of another medical condition
other specified depressive disorder
recurrent brief depression
short duration depressive episode
depressive episode with insufficient symptoms
Trauma and Stressor Related Disorders
exposure to a traumatic or stressful event is listed explicitly as diagnostic criterion
close relationship with anxiety, ocd, and dissociative disorders
reactive attachment disorder
consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers
child rarely or min seeks comfort when distressed
“ “ responds to comfort when distressed
persistent social and emotional disturbance
min social and emotional responsiveness to others
limited pos affect
episodes of unexplained irritability, sadness, or fearfulness
child has experienced pattern of extremes of insufficient care
social neglect or deprivation
repeated changes of primary caregivers
rearing in unusual settings
criteria not met for ASD and evident prior to 5 years
risk/ prog: serious social neg, prog depends on quality of caregiving environment following neg
comorbidity: cog delays, lang delays, stereotypies, medical condition, depressive symptoms
disinhibited social engagement disorder
pattern of behavior in which child actively approaches and interact with unfamiliar adults
reduced or absent reticence in approaching and interacting with unfamiliar adults
overly familiar verbal or physical behavior
diminished or absent checking back with adult caregiver
willingness to go off with unfamiliar adult
not limited to impulsivity but include socially disinhibited behavior
child experienced pattern of extremes of insufficient care
social neg
repeated changes of primary caregivers
rearing in unusual settings
risk/prog: serious social neg, caregiving quality moderate course
comorbidity: cog delays, language delays, stereotypies, ADHD
posttraumatic stress disorder
exposure to actual or threatened death, serious injury, or sexual violence in one of following ways…
directly
witnessing
learning it occurred to close family member or friend
repeated or extreme exposure to details
presence of 1+ symptoms
recurrent, involuntary, intrusive distressing memories
recurrent distressing dreams
dissociative reactions
intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble aspect of event
marked physiological reactions to internal or external cues that “”
persistent avoidance of stimuli associated with event
neg alteration in cognitions and mood
inability to remember an important aspect of event
persistent and exaggerated neg beliefs
persistent, distorted cognitions about cause or consequences
neg emotional state
diminished interest or participation in significant activities
detachment or estrangement
inability to experience pos emotions
PTSD risk / prognostic
pretraumatic factors:
emotional problems prior to 6 years
mental disorders - panic, depressive, ptsd, OCD
lower ses
low edu
ACEs
minority
family psychiatric history
female
younger age
peritraumatic factors:
severity
perceived life threat
personal injury
interpersonal violence
dissociation
posttraumatic factors:
neg appraisals
inappropriate coping
scute stress
exposure to repeated reminders
adverse life events
losses
** social support is most protective factor that moderates outcomes **
Acute Stress Disorder
exposure to actual or threatened death, serious injury, or sexual violation
resolve within 1 month after event
presentce of 9+ symptoms within
intrusion (memories, dreams, flashbacks, distress)
neg mood
dissociation
avoidance
arousal (sleep, irritability, hypervigilance, concentration, startle response)
adjustment disorders
dev of emotional or behavioral symptoms in response to identifiable stressors
distress is out of proportion to severity of stressor
stressor may be single, multiple, recurrent, or continuous
increased risk of suicide
Other Specified Trauma - and Stressor - Related Disorder
presentation in which symptoms do not meet full criteria for other disorders
adjustment disorders w/ delayed onset
” “ w/ prolonged duration
ataque de nervios
other cultural syndromes
persistent complex bereavement
Bipolar and Related Disorders
bridge btwn schizophrenia and depressive disorders
Bipolar 1 Disorder
manic episodes (required)
hypomanic episode ( common, but not required)
major depressive episode (common but not required)
risk / prog:
family history
comorbidity: anx disorder
ADHD
conduct
substance use
medical
Bipolar 2 Disorder
Hypomanic episode (required)
Major Depressive Episode (required)
never been a manic episode
risk/prog
genetic factors
high suicide risk
comorbidity: anx disorders, substance use
Cyclothymic disorder
for at least 2 years, hypomanic symptoms and depressive symptoms
symptoms present for at least half time
dont fit criteria for bipolar
risk/prog: genetic
comorbidity: substance use, sleep disorders
Substance / Medication-induced Bipolar and Related Disorder
symptoms dev during or soon after substance intoxication or withdrawal
manic episode
period of abnormally and persistently elevated, expansive, or irritated mood
increased goal directed activity or energy
last at least 1 week and present most of day, nearly every day
3+ of symptoms
inflated self-esteem
decreased need for sleep
talkative
racing thoughts
distractibility
involvement in activities with potential for painful consequences
Hypomanic Episode
period of abnormally and persistently elevated, expansive, or irritable mood
abnormally and persistently increased activity or energy
lasting at least 4 consecutive days
same symptoms as manic
Major Depressive Episode
5+ symptoms during 2-week period
depressed mood
diminished interest or pleasure in activates
significant weight loss
insomnia or hypersomnia
psychomotor agitation
fatigue
feelings of worthlessness
indecisiveness
recurrent thoughts of death
Disruptive, Impulsive Control and Conduct Disorders
problems in self control or emotions and behaviors
underlying causes can vary greatly
more common in males
first onset in childhood or adolescence
Oppositional Defiant Disorder
pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months
exhibited during interaction with at least one individual who is not a sibling
symptoms may be confined to only one setting (most freq home)
more prevalent in families where child care is disrupted
risk/prog
harsh, inconsistent, or neglectful child-rearing practices
comorbidity
ADHD
anx
MDD
Intermittent Explosive Disorder
failure to control aggressive impulses (verbal or behavioral)
magnitude is grossly out of proportion to stressors
outbursts not premeditated or committed to achieve some tangible objective
often less severe episodes in between more severe
risk/prog
physical and emotional trauma during first two decades of life
genetic influence
comorbidity
depressive disorders
anx
substance use
antisocial personality
borderline personality
Conduct Disorder
repetitive and persistent pattern of behavior where rights or others or societal norms or rules are violated
aggression to people and animals
destruction of property
deceitfulness or theft
serious violations of rules
specify:
- childhood, adolescent, or unspecified onset
- limited prosocial emotions: lack of remorse, callous, unconcerned about performance, shallow or deficient
- mild, moderate, severe
risk/prog
difficult under controlled infant
most ACEs
some genetic factors
comorbidity
ADHD
ODD
Pyromania
deliberate and purposeful fire setting on more than one occasion
tension or arousal before act
fascination with, interest in, curiosity about, or attraction to fire
pleasure, gratification, or relief when setting fires or witnessing
not done for monetary gain, expression of sociopolitical ideology, or conceal criminal activity
may wax and wane in frequency
comorbidity
substance use disorder
gambling
depression and bipolar
disruptive, impulse, and conduct disorders
Kleptomania
failure to resist impulses to steal objects that are not needed for personal use or for monetary value
increasing sense of tension immediately before
pleasure, gratification, or relief at time
not committed to express anger or vengeance and not response to delusion or hallucination
risk/prog
OCD
substance use
comorbidity
depressive and bipolar disorders
anx
eating disorders
personality disorders
substance use
disruptive, impulse, and conduct
Personality Disorders
enduring pattern of inner experience and behavior that deviates markedly from expectations of individual’s culture
pervasive and inflexible
onset in adolescence or early adulthood
stable over time
cluster A: odd or eccentric
cluster B: dramatic, emotional, or erratic
cluster C: anxious or fearful
clusters not consistently validated and serious limitations
General personality disorder
enduring pattern of inner experience and behavior that deviates from expectations of culture
- cognition
- affectivity
- interpersonal functioning
- impulse control
inflexible and pervasive
paranoid personality disorder
cluster A
distrust and suspiciousness of others such that their motives are interpreted as malevolent
assume others will exploit, harm, or deceive them
persistently bear grudges
risk/prog
relatives of probands with schizophrenia
Schizoid personality disorder
cluster A
detachment from social relationships and restricted range of expression of emotions in interpersonal settings
risk/prog
relatives od individuals with schizophrenia or schizotypal personality disorder
Schizotypal personality disorder
cluster A
pattern of social and interpersonal deficits
discomfort and reduced capacity for close relationships
cognitive or perceptural distortions and eccentricities of behavior
risk/prog
genetic
Antisocial personality disorder
cluster B
pattern of disregard for and violation of the rights of others
at least 18 years old
evidence of conduct disorder with onset before 15 years
risk/prog
genetic
may be misapplied where behavior is survival strategy
Borderline Personality Disorder
Cluster B
pattern of instability of interpersonal relationships, self-image, and affects
impulsivity
-avoidance of abandonment
- unstable and intense relationships
- identity disturbance
- suicidal behavior
- reactivity of mood
- feelings of emptiness
- difficulty controlling anger
risk/prog
genetic, substance use, antisocial, depression
75% females
Histrionic personality disorder
cluster B
excessive emotionality and attention seeking
present in variety of contexts
- uncomfortable in situations where not center of attention
- inappropriate sexually seductive or provocative behavior
- rapidly shifting and shallow expression of emotions
- uses physical appearance to draw attention to self
- impressionistic and lacking detail in speech
- suggestible
Narcissistic Personality Disorder
cluster B
pattern of grandiosity, need for admiration, lack of empathy
- self importance
- fantasies of unlimited success, power, beauty
- requires excessive admiration
- sense of entitlement
- interpersonally exploitative
- lacks empathy
- envious of others
- arrogant, haughty behaviors
Avoidant Personality Disorder
cluster C
social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
- avoids occupational activities
- unwilling to get involved
- restraint within intimate relationships
- preoccupied with being criticized or rejected
- reluctant to take personal risks
Dependent Personality Disorder
cluster C
need to be taken care of, submissive and clinging behavior, fear of separation
- difficulty making everyday decisions
- needs others to assume responsibility
- difficulty expressing disagreement
- “ initiating projects
- feels uncomfortable or helpless when alone
