Diagnosis Flashcards
Likelihood of schizophrenic dx for a monozygotic twin vs dizygotic twin
Mono- 46%; Di- 17%
Concordance rate for Bipolar Disorder in identical twins
75-80%
Age of onset for OCD in males vs. females
Adult prevalence similar btwn males & females, but Male onset earlier (6 to 15 yrs old) than females (20 to 29)
Withdrawal syndromes that include hallucinations
Alcohol
Sedatives
Hypnotics
Anxiolytics
Withdrawal from amphetamines
dysphoria, fatigue, unpleasant dreams, increased appetite, and psychomotor agitation or retardation.
Opioid Withdrawal
flu like sxs
Timothy Crow theory of schizophrenia
Distinguished 2 types of schiz (I and II)
Type 1-del, hall, inappr affect, disorg thinking; neurotrans irregularies
Type II-due to brain structure abnormalities; begins in adol, poor prog, doesn’t respond to antipsychotics
Reversal of pronouns is assoc w/
autism
research indicated that the best predictor for alcoholism is:
family hx
Delirium
disturbance in attention
develops over short period of time
additional dist in cognition (mem def, disorientation, lang, vis spat ability)
Direct phys consequence of another med cond, substance abuse, or withdrawal
specify:hyper, hypo, or mixed level of activity
Major Neurocognitive Disorder
A. evidence of SIG cog decline from previous level of fxing in 2 or more cognitive domains (complex attention, exec fx, learning, memory, language, percep, social cognition)
B. Cog Defs interfere w/independent ADLS
*Then must specify the type (from Alz, TBI, Vascular disease, HIV, Parkinson’s, Huntington’s, etc)
*Specify w/ or w/o behavioral dist
Mild Neurocognitive Disorder
A. modest decline in cog fxing in one or more domains
B. deficits do not interfere w/ADLS
*Then specify type (alz, vasc, etc)
Major or Mild Neurocog Disorder due to Alzheimer’s disease
A.. crit met for maj or mild NCD
B. insidious onset & gradual progression of impairment in one or more domains (2 for major)
C. Determine if “probable” (fam hx or genetic testing) or “possible”
Major or mild Vascular NCD
Onset related to cerebrovascular events
Decline evident in complex attention, frontal exec fx
*dx probable or possible
NCD w/lewy bodies
Core feat: fluctuating attention & alterness, recurrent visual hallucinations (detailed), Spontaneous feat of parkinsons
Suggestive feat: meets crit for REM sleep disorder
Severe neuroleptic sensitivity
Autism Spectrum Disorder
A. persistent deficits in social communication & social interaction, manifested by deficits in:
-social emotional reciprocity
-nonverbal communicative bxs for social interaction
-developing, maintaining, understanding relationships
B. Restricted repetitive patterns of bx, interests, or activities, manifested by 2 of the following
-stereotyped mvmts, or speech
-inflexible adherence to routines, ritualized patterns of bx
-highly restricted interests abnormal in intensity
-hyper or hyporeactivity to sensory input
Specify w/or w/o accompanying intellectual impairment, language imp, assoc with med condition
w/catatonia?
*specify severity
ASD is dx __ times as often in boys than girls
4
ADHD-changes in criteria in DSM5
Inattentive & hyperactive/impulsive type are now specifiers rather than distinct diagnoses
some sxs evident before age 12
designation of just 5 sxs (as opposed to 6) required for dx in older adolescents and adults
very low birthweight increases risk for ADHD by __
2 to 3 fold
DSM 5 change to NOS categories
Now must choose “Other specified___” for sxs not meeting dx crit but causing sig distress or impairment
Unspecified ___ reserved for rare cases where clinician chooses not to specify reason for vague dx or more info needed
Delusions of Reference
belief that certain messages, comments, gestures are directed at oneself
Key Features of Psychotic Disorders
Delusions Hallucinations Disorganized thinking/speech Grossly disorganized motor bx Negative Sxs
Duration for dx of delusional disorder;
Impact on daily fxing
1 month or longer
fxing not markedly impaired, bx not obviously bizarre or odd; impairment directly related to the delusion
Brief Psychotic Disorder
A. Presence of 1 or more of: delusions, halluc, disorg speech, disorg bx
B. Duration 1 day, less than month, eventual return to premorbid fx
Specify w/or w/o marked stressor & postpartum onset
Schizophreniform Disorder
A. 2 or more for the past month (or less if treated): del, hall, disorg speech, disorg bx, neg sxs
B. at least one month but less than 6 months
C. No MDD or manic episodes during active phase sxs, or if mood sxs present, it is a minority of the time frame of illness
*If symptomatic for less than 6 months, it’s provisional. If sxs continue past 6 months dx changed to schizophrenia
Schizophrenia
A. 2 or more during a 1 month period: Del, Hall, Disorg Speech, Grossly disorg bx, negative sxs (dim emotion & avolition)
B.Level of fxing (work, rel, self care, markedly below level prior to onset
C. Continuous signs of dist for at least 6 months (at least 1 month of active phase sxs, may incl prodromal or residual sxs (negative sxs, and less severe crit A sxs)
D. No MDD or manic episodes or if mood sxs present they are a minority of the total duration
F. If hx of autism, dx only made if there are prominent hall or del
Schizoaffective Disorder
Uninterrupted period of illness during which there are concurrent sxs of schiz and sxs of major depressive or manic episode
Must be a period of at least 2 weeks without prominent mood sxs
Neurodevelopmental Disorders
Intellectual Disability Autism Spectrum Disorder ADHD Specific Learning Disorder Tourette's D/o Behavioral Pediatrics
Intellectual Disability
A. DEf in intell fxing confirmed by assessment & IQ testing
B. Def in adaptive fxing resulting in failure to meet community standards of independence, impair fxing across mult settings, ADLS
C. Onset during developmental period
Mild, Mod, Severe, Profound
Course, Prog, Etiology of Intellect Disability
Early signs: delayed motor dev, lack of interest in environ stim,
Infancy: poor eye contact during feeding
Can lessen severity with intervention, not necessarily lifelong condition
Etiology: 5% hereditary, 30% chrom changes/exposures to toxins; 10% pregnancy & perinatal(anoxia, malnutrition, trauma); 5% acquired med conditions; 15-20% environmental factors
Unknown cause in 30% of cases
Childhood Onset Fluency Disorder
Stuttering; sound & syllable repetitions, sound prolongations, broken words, substitutions, monosyllabic whole word repetitions
Onset between 2 and 7
65 to 85% recover; severity at age 8 is good predictor
Tx of Childhood Onset Fluency Disorder
Reduce stress at home
Habit reversal training (awareness, relaxation, motivation, competing response, generalization training)
Autism Spectrum Disorder Levels of severity
1- requiring support
2- req substantial support
3. very substantial support
Assoc features & Etiology of ASD
Intell imp, lang difficulties, unevenly developed cognitive ability (strong visual spatial but poor verbal comp & abstract reasoning
Signs often present by 12 months (decreased social gaze, impaired joint attention)
Etiology: struc abnorm in amygdala & cerebellum, abnorm serotonin, dop,
Common Co-occurring disorders w/ADHD
Conduct D/O LD ODD Anxiety MDD
Etiology of ADHD:
Low activity and small size in caudate nucleus, globus pallidus, prefrontal cortex
Behavioral Disinhibition Hypothesis of ADHD
Inability to regulate behavior to fit situational demands
Multimodal Tx Study of ADHD (MTA)
Initial results: Med mngmt alone & combined tx (med & intensive bx tx) had similar benefit to core sxs; this was not maintained on 3 and 8 year followup
Specific Learning Disorder
Presence of one sx for at least 6 months despite intervention
Academic skills below what expected for age
Interfere with academic, occ perf or ADLs
Onset during school age years
3 Subtypes: Imp w/reading, imp w/written exp, w/imp in mathematics
Assoc feat of LDs
Avg to above avg IQ delayed lang dev attention & mem deficits low self esteem 20-30% also have ADHD inc risk for conduct d/o
Motor Tic Disorders (3)
Tourette’s
Persistent (Chronic) motor or vocal tic disorder
Provisional Tic Disorder
Tourette’s Disorder: Crit & Assoc Feat
At least 1 vocal tic Multiple motor tics Persist at least 1 year Onset prior to 18 Higher rate of OCD (also for bio relatives)
Etiology & Tx of Tourette’s Disorder
Elevated dop, sensitivity of dop receptors in caudate nucleus
Antipsychotics (haloperidol & pimozide) effective in 80% cases
SSRIs help w/OCD sxs
Hyperactivity treated w/ clonidine & desipramine to avoid aggravating tics
Comp Bx Tx for Tics (CBIT)
Tx for Tourette’s
Habit reversal
Relaxation
Psychoeducation
Interventions for pediatric medical procedures
Based on Meichenbaum’s Stress Inoc Model
May include: filmed modeling, reinforcement, breathing exercises, emotive imagery, behavioral rehearsal
Children between the ages of __ and __ have most neg reactions to being in hospital
1 to 4
Children & adol w/ ___ ___ ___ are at highest risk of psychiatric probs
major neurological disorder, like hemiplegic cerebral palsy (3x higher than controls)
CNS irradiation & Intrathecal chemo are both assoc w/:
Impaired cog fxing
learning disabilities
Hallucinations are most often ___ and are characterized by:
auditory
Perjorative, threatening
Running commentary of person’s thoughts or actions
Subtypes of delusions
erotomanic grandiose jealous persecutory somatic mixed unspecified
Assoc features of Schizophrenia
Inappr affect dysphoric mood disturbed sleep lack interest in eating anosagnosia Subtance use often co occurs Freq tobacco use
Over dx of Schiz among AA thought to be related to:
increased occurrence of hall or del as sxs of depression amongst AAs
Improved prognosis for schiz assoc w/:
good premorbid adjustment acute & late onset female presence of precipitating event brief duration of active phase sxs insight fam hx of mood d/o no fam hx of schiz
Concordance rate for Schizophrenia
Bio sibling- 10%
Frat/dizygotic twin- 17%
Identical/monozy twin- 48%
Child of 2 parents w/schiz- 46%
Family members of ind w/schiz also especially at risk for :
other schiz spectrum disorders, esp Schizotypal Pers Disorder
Or, Schizoid, Paranoid, or Avoidant pers d/o
Brain abnormalities linked to Schiz:
enlarged ventricles
smaller hippocampus, amygdala, globus pallidus
negative sxs- hypofrontality (lower than normal activity of the prefrontal cortex)
In Schizophrenia, mood sxs:
are brief relative to duration of the disorder
do not occur during active phase
do not meet full criteria for a mood episode
In Schizoaffective disorder, prominent mood sxs:
occur concurrently w/psychotic sxs for most of the disorder
at least 2 week period when only psychotic sxs are present
In major depressive or bipolar disorder w/psychotic feats, psychotic sxs:
only occur during episodes of mood disturbance
Treatment of Schizophrenia
Traditional (1st gen) antipsychotics- haloperidol, fluphenazine; most effective for + sxs, but high risk of tardive dyskinesia
Atypical (2nd gen) antipsychotics- clozapine, risperidone
lower risk of tardive dyskinesia, eff for + and - sxs
Diffs btwn crit for Schiz and Schizophreniform
Duration at least one month, less than six months
Impaired soc or occ fxing may occur but not required
About __ of ppl w/schizophreniform d/o will eventually meet crit for ____ or ___
Schizophrenia or Schizoaffective
Bipolar I Disorder
At least one manic episode, lasting at least one week, present most of day nearly every day
3 charac sxs:
1. inflated self esteem or grandiosity
2, decrease need for sleep
3. excessive talkativeness/flight of ideas
marked impairment, require hospitalization, or incl psychotic features
May incl 1 or more episodes of hypomania or major depression
Comorbid conditions w/Bipolar I Disorder
Anxiety
Substance use
15x greater risk of completed suicide
Prevalence of Bipolar I
0.6%
male to female 1.1:1
Concordance rates for Bipolar I disorder
Identical twins- .67 to 1.0
Frat twins- .20
1st degree relatives at greater risk for bipolar and depression
Pharmacotherapy Treatment of Bipolar I
Lithium effective for classic presentation, prevents recurrent mood swings
For Rapid cycling or dysphoric mania anticonvulsants effective- carbamazepine or divalproex sodium
Acute mania- antipsychotics like olanzapine, risperidone,
Antidepressants can be used to treat depression, but may trigger mania (risk greater for TCAs than SSRIs)
Psychosocial tx of Bipolar Disorder
CBT, FFT, Interpersonal and social rhythm therapy
Bipolar II Disorder
At least one hypomanic episode and one MDD ep
Hypomania must last 4 consecutive days
Same charac sxs as mania, but less severe, less fx imp, does not require hosp
Cyclothymic Disorder
Numerous periods of hypomanic & depressive sxs that do not meet crit for hypomanic ep or depr ep
Duration of at least 2 years (adults), 1 year (chil & adol)
Sxs must be present at least half the time, symptom free for no more than 2 months at a time
Disruptive Mood Dysregulation Disorder
A. Severe recurrent temper outbursts, grossly out of prop in intensity & duration
B. Chronic persistently irritable or angry mood on most days
Duration 12 months in at least 2 settings
Outbursts at least 3 times per week
Cannot be dx before 6 years of age or after 18 years of age
Onset before 10 years
With Perinatum onset applied when:
onset of sxs is during pregnancy or within 4 wks postpartum
often incl preoccupations re:infant’s well being or possibly delusions
Percentage of women experiencing perinatum depression; postpartum psychosis
10 to 20%
.1 to .2%
w/seasonal pattern specifier
hypersomnia
increased app & weight gain
carb craving
*phototherapy an effective tx
Impact of depression on sleep
sleep continuity disturbances (early morning awake)
reduced stage 3 and 4 sleep (slow wave, delta)
earlier onset of REM sleep, increased duration early in night
Prevalence of depression
7% 12 month, age related diffs:
prev for 18 to 29 year olds 3x prev of ppl 60+ yrs old
Manifestation of depression in children
somatic complaints, irritability, social withdrawal
Depr in adolescence
aggressiveness & destructiveness more often in boys
Depr in older adults
memory loss, distractibility, disorientation, other cognitive sxs
depr in asians
weakness, tiredness, imbalance
Concordance rates for depression
identical twins- .50
frat- .20
1.5 to 3x more common in 1st degree relatives
genetically linked to neuroticism
Indolamine hyp of depression
too little serotonin
Impact of cortisol in depression
increased cortisol, causes atrophy of hippocamps
Lewinsohn’s behavioral theory of depression
operant conditioning basis: low rate of response contingent reinforcement, resulting in extinction of those bxs and pessimism, low self esteem, isolation
which all reduce likelihood of reinforcement in the future
Seligman’s Learned Helplessness Model of Depression
Attribute negative events to internal, stable, global factors
Abramson & Alloy revision of Learned Helplessness model
de-emphasizes attributions and proposes hopelessness as sufficient & primary cause of depression
Uncomplicated bereavement charac by:
predominant mood emptiness or loss, decreases over days to weeks
occurs in waves
Tricyclics (TCAs) prescribed for depr when:
“classic” presentation, vegetative sxs, worse sxs in morning, acute onset, short duration, moderate severity
SSRIS prescribed for depr when:
1st line for mod to severe depr; fewer side effects, lower risk of overdose
MAOIs presc for depr when:
poor response to TCAs or SSRIs atypical sxs (anxiety, hypersomnia, hyperphagia, interpersonal sensitivity)
SNRIs for depression
venlafaxine (Effexor)
desvenlafaxine (Pristiq)
duloxetine (Cymbalta)
*inc nor & ser
NIMH study comparing CBT, IPT, & TCA imipramine for depression
No sig diff overall
Imipramine slightly better for severe depr
Follow up study indicated only 30%, 26%, 19% respectively were symptom free at 18 months post tx
Side effects of ECT can be reduced by:
administering ECT unilaterally to right (nondom) hemi
reserved for severe endogenous forms of depr
Premenstrual Dysphoric Disorder
For most menstrual cycles, at least 5 sxs the week before onset of menses with improvement in sxs a few days after onset of menses
At least one sx must be affective lability, irritability, depressed mood or self deprecating thoughts
At least one sx must be: decr interest in activities, imp concentration, lethargy, appetite change, hyper or insomnia, physical sxs
Risk Factors for Suicide-Age
Highest age range 45 to 54 (male, female combined)
Females: 45 to 54
Males: 75+
Risk for suicide- Gender
Males 4x as likely to complete
Females 2-3 x as likely to attempt
Risk for suicide-Race
Highest for whites
except for American Indians/Alaskan natives (15 to 34), rate 2.5x the national avg
Risk for suicide: Thoughts & Bxs
60-80% prior attempt
80% give definite warning
For adolescents, suicide often follows:
And risk increases w/dx of:
interpersonal conflict, rejection, argument w/parents
Conduct d/o, substance use, ADHD
Most common Dx for suicide
MDD
Bipolar (mood d/o 15 to 20% more likely than gen pop)
When suicide assoc w/depression, most likely to commit:
w/in 3 months after depressive sxs start to improve
Separation Anxiety Disorder
Requires -recurrent distress when anticipating or exp sep from attachment figs -excessive fear of being alone -phys sxs when separated 4 wks in children 6 months in adults Freq school refusal Often from close, warm families Tx: Systematic Desens W/school refusal: goal to immediately return to school
School refusal typically happens at:
5 to7
10 to 11
14 to 16
Specific Phobia
Intense fear of specific object or situation, avoidance or endured w/marked distress
At least 6 months
Specifiers: animal, natural environ, blood injection injury, situational, other
Etiology of phobia
Serotonin, Nor, GABA implicated
Mower’s 2 factor theory: Avoidance cond- 1st lear to fear neutral stim due to pairing w/fear arousing US, avoidance then negatively reinforced
Duration req for Social Anxiety Disorder (Social Phobia)
Etiology
Treatment
at least 6 months
Behavioral inhibition, temperament, information processing biases
ERP combined w/social skills, cog restructuring
Beta blocker propranolol for perf anxiety
Panic Disorder: Duration, sxs, Prev, Tx
Recurrent attacks, followed by at least 1 month of fear of having another/significant behavioral change
at least 4 sxs: inc HR, sweating, trembling, choking, chest pain, paresthesias, derealization, fear of losing control
*Other med issues must be ruled out!
Prev: 2-3% for adults; females 2x as likely
Tx: Panic Control Therapy psychoed, relaxation training, cog restruc, interoceptive exp
Meds: imipramine, TCAs, SSRIs, SNRIs benzos
30-70% of ppl relapse with drug tx alone
Duration for Agoraphobia, distinguishing feat from phobia
At least 6 months
fear of experiencing panic or embarrassing sxs in public place
Graded & Intense Exposure both effective, but Intense more effective long term
Over __ of pts w/prin dx of anxiety disorder have a comorbid dx
50%, highest w/GAD (most often MDD, PDD, Substance, Phobia, Soc Anx)
Med tx of GAD
SSRIs, SNRIs,
If not resp: benzo, or buspirone (buspar)
OCD specifiers
Level of insight, presence of tics
OCD Prevalence,etiology, tx
1.2%
Equally common in males & females
Age of onset earlier for males, so more common in males for childhood/adol
Right caudate nuc implicated-overactive, orbitofrontal cortex, cingulate cortex
SSRIs treat, ERP, TCA clomipramine
antidepr have high relapse when used alone
OCD & Related Disorders (other 2 disorders)
Body Dysmorphic Disorder
Hoarding Disorder
Trauma & Stress Related Disorders (5 dxs)
Reactive Attachment Disinhibited Social Engagement Disorder PTSD Acute Stress Disorder Adjustment Disorders
Reactive Attachment Disorder
inhibited, emotionally withdrawn bx toward caregivers
Lack of seeking or responding to comfort
Minimal social responsiveness to others, limited pos affect, unexplained irritability, sadness, fearfulness
*Has experienced extremely insufficient care
Sxs must be evident before 5 years, must have developmental age of at least 9 months
Disinhibited Social Engagement Disorder
Inappropriate interactions w/unfamiliar adults
reduced or absent reticence in approaching
overly familiar bx
willingness to accompany other adults w/o hesitation
*Has experienced extremely insufficient care
Dev age of at least 9 months
PTSD (age 6 and above)
-Exp to threat directly, witnessing, learning that occurred to family member, repeated extreme exposure to details of the event
-At least 1 intrusion sx: intrusive memories, dreams, dissociative reactions, marked phys reacitons when reminded of event
-Avoidance of stimuli
-Negative changes in cognition or mood (at least 2)
-Marked change in arousal & reactivity (irritable, angry outbursts, reckless bx, hypervigilance, startle response, sleep disturbance
Duration more than a month
Delayed expression if dx crit not met until 6 months after event
PTSD (age 6 and below)
Incorporates threats to caregiver explicitly
- Dreams do not have to be specific to the event
- Memories expressed through play reenactment
- Duration at least one month
Tx of PTSD
Tx of choice: Comprehensive CB intervention (exposure, cog restruc, anxiety mngmt)
SSRI for comorbid depr & anxiety
Cog Incident Stress Debriefing-single lengthy session within 72 hrs of event even if no sxs of distress; may actually worsen sxs
EMDR- evidence that benefit is due to exposure rahnte that eye mvmts
Acute Stress Disorder
Mirrors crit for PTSD but duration is 3 days to one month
Dissociative Amnesia- most common forms
-Inability to recall personal info, often following trauma
*Localized amnesia- can’t remember events from a circumscribed period of time
*Selective-inability to recall some events from circumscribed period of time
Generalized-person’s entire life
Continuous- can’t recall events subsequent to a specific time through the present
Systematized-can’t remember things related to a certain category of info
-Specify if accompanied by fugue
Somatic Symptom & Related Disorders
Somatic Sx Disorder
Illness Anxiety Disorder
Conversion Disorder
Factitious Disorder
Somatic Sx Disorder
1 or more somatic sxs
- Disruptive to daily life
- Excessive thoughts, feelings, bxs related to the sx (believe very serious, high anxiety, time & energy devoted to these concerns)
- Predominant Pain specifier
Illness Anxiety Disorder
Preoccupation w/having a serious illness Absence of somatic sxs or only mild sxs High anxiety about health Excessive health related bxs At least 6 months, illness of concern can change throughout
Conversion Disorder (Fx Neur Sx Disorder)
Dist to voluntary motor or sensory functioning
(paralysis, seizures, blindness, loss of pain sensation)
Evidence of incompatibility between sx & neur or med conditions
Factitious Disorder- Imposed on Self or Imposed on Another
Falsify phys or psych sxs, present as being impaired, engage in deceptive bx, absence of obvious external reward
Malingering should be considered when:
seeking eval for legal reasons, marked discrepancy btwn reported sxs and objective findings, does not cooperate w/assessment or treatment, person has antisocial personality disorder
Pica-duration; age range
eating non-nutritive substances
at least 1 month
can occur at any age, most common during childhood
Anorexia
a. restriction of energy intake leading to sig low body weight
b. intense fear of gaining wt or becoming fat; bx interfering w/wt gain
c. disturbance to perception of body shape/wt; lack recognition of seriousness of low body wt
Anorexia- Assoc Features
Excessive exercise, purging, preoccupied w/food, hoard food, collect recipes
Over 1/2 meet crit for anxiety disorder, esp social phobia & OCD (onset typically prior to anorexia)
Depression common after onset
Phys complications
Onset adol/young adult, 90% female
Etiology of Anorexia
Genetic- high concord for twins & 1st degree relatives
Neurotrans abnormalities-Higher than normal serotonin, causes restlessness, anxiety, obsessions; food restric lowers serotonin & alleviates unpleasant feelings; evidenced by fact that drugs increasing ser are not effective until person has reached normal wt
Tx of Anorexia
Wt restoration-contingency mngmt
Family therapy-should be separate if family exhibit high expressed emotion
CBT (Garner) Stages:
1-estab alliance & inc motivation
2-normalize eating patterns & body wt (self monitoring of eating)
3-Socratic qs, decatastrophizing to modify dysfunctional beliefs about food & wt
4-prep for term & relapse prevention
Bulimia Nervosa
a. recurrent episodes of binge eating (lack of control)
b.compensatory bx to prevent wt gain (fasting, exercise, vomiting, laxatives)
c. self image unduly infl by wt
At least once a wk for 3 months
Severity based on avg # of compensatory episodes each wk
Bulimia, Assoc Features
Anxiety disorder often precedes Depression most common comorbid Med complications Onset adol/early adulthood over 90% female Onset during or after dieting
Etiology of Bulimia
Low levels of endogenous opioid beta-endorph
Low level serotonin
Tx of Bulimia
Nutritional counseling
CBT-lower relapse rate & tx dropout than antidepr alone
imipramine (tofranil) & fluoxetine (Prozac)
Binge Eating Disorder
Binge eating: sense of loss of control & at least 3 charac sxs:
1.rapid eating
2. uncomfortably full
3. alone due to embarrassment re: amt of food
Marked distress
At least once a week for 3 months
Enuresis duration; age req, specifiers
At least 2x/week for 3 months
AT least 5 yrs old
Nocturnal only, diurnal only, both
Tx of Enuresis
Bell & pad alarm, effective in 80% of cases, but 1/3 relapse to some extent within 6 months of tx
Behavioral rehearsal
Overcorrection
Imipramine (tofranil) reduced freq in 85% of cases, suppresses entirely in 30%, but most relapse within 3 months
desmopressin- short term, but poor long term effects
Encopresis- duration & age
at least once a month for 3 months
4 years old
Insomnia disorder
At least 1:
Diff initiating sleep, maintaining, early morning awakening
3 nights a week, for at least 3 months
Hypersomnolence Disorder
Excessive sleepiness in spite of sleeping at least 7 hours
At least one:
-recurrent periods of sleep in the day
-prolonged non restorative sleep for more than 9 hours each day
-difficulty waking after abrupt waking
3x/week for at least 3 months
Narcolepsy
Irrepressible need to sleep 3x week for at least 3 months Req: cataplexy (loss of muscle tone) hypocretin deficiency REM latency < or = 15 minutes hynogogic hallucinations cataplexy triggerd by strong emotions
Non REM Sleep arousal disorders
episodes of incomplete awakening during first third of sleep cycle (stage 3 or 4)
Sleep walking or sleep terror
little to no recall upon awakening
Nightmare disorder
Occur during REM sleep, fully alert when wake up but continue feeling anxious
Erectile Disorder
at least one of:
-diff obtaining erection
-diff maintaining
-decreased erec rigidity
at least 6 months
have to rule out: diabetes, liver & kidney disease, MS, smoker, antipsychotic, antidepressant, hypertensive meds
Viagra can treat along with CBT techniques
Genito-Pelvic Pain/Penetration Disorder
Diff with 1 or more of:
- vaginal penetration
- genito pelvic pain during attempts at penetration
- anxiety
- tensing of pelvic floor muscles during attempted penetration
- Duration 6 months
- Often assoc w/hx of sexual abuse or physical abuse
Premature Ejaculation
6 months for all sex activity (1 minute)
Tx: SSRIs, sensate focus, stop start, squeeze techniques
Duration crit for Gender Dysphoria in Children
6 months
Specifier for congenital adrenogenital disorder or other disorder of sex dev
Onset 2 to 4 years of age
Persistence to adulthood varies for natal sex (sex at birth)
Males: 2.2 to 30%
Females: 12 to 50%
Tx of Paraphilias
In vivo aversion therapy-only short term benefits
CBT-red cog distortions, dev empathy toward victims, tolerate strong emotions
Bx Strategies: Covert sensitization, orgasmic reconditioning
DepoProvera reduces paraphilic bxs, but stops working as soon as discontinued
Intermittent Explosive Disorder
Outbursts at least 2x/week for 3 months
3 outbursts must have damaged property or injured other people or animals during a 12 month period
Must be at least 6 yrs old
Conduct Disorder
4 Categories of sxs: 1. aggression to ppl and animals 2. destruction of property 3. deceitfulness or theft 4. serious violation of rules 3 sxs past 12 months 1 sx past 6 months Childhood onset- up to 10 yrs Adol onset- no sx prior to age 10
2 Types of Conduct D/o (Moffitt)
Life Course Persistent-starts early (as early as toddler years), increasingly serious transgressions, cont to adulthood; attributed to neur impairments, diff temperament, adverse environ circumstances
Adol Limited Type: Maturity gap, antisoc acts usually committed with peers, inconsistent across situations
Conduct D/O Tx
Parent Management Training
Multisystemic treatment
4 categories of sxs for Substance Use Disorders
Impaired Control
Social Impairment
Risky Use
Pharmacological Cx
Tension Reduction Hypothesis of alcohol use
Negative reinforcement (anxiety/tension reduced) leads to addiction
Marlatt & Gordon’s Theory of substance use
addiction is an overlearned, maladaptive bx pattern
Relapse due to “Abstinence Violation Effect” feel so guilty for using that become more susceptible to ongoing use
Relapse Prevention Therapy- practice dealing with situations assoc w/risk of relapse
Successful smoking cessation assoc w/:
male age 35+ college educated smoke free home/work married or partnered started smoking later lower level nicotine dependence abstained for at least 5 days in prior attempts to quit
Smoking Cessation Intervention
Nicotine Replacement Therapy
Bx therapy including skills training, relapse prevention, stim control, rapid smoking
Support from clinician
Alcohol Intoxication
Maladaptive bx & psych changes (impaired judgment, mood, sexual or aggressive bx) and one of: slurred speech incoordination/unsteady gait nystagmus impaired memory stupor or coma
Alcohol Withdrawal*
Sedative Hypnotic Anxiolytic Withdrawal
2 or more of: autonomic hyperactivity (sweating tachycardia) hand tremor insomnia nausea or vomiting illusions or hallucinations anxiety agitation generalized seizures Onset hours or days following cessation of drinking
Alcohol Withdrawal Delirium
delirium sxs + autonomic hyperactivity, vivid halluc, delusions, agitation
Alcohol Induced Major NCD
Nonamnestic confabulatory type
Amnestic Confabulatory Type, also known as Korsakoff Syndrome- anterograde & retrograde amnesia, confab, thiamine def
Alcohol Induced Sleep Disorder*
result of either intox or withdr
Intox-sedation, inc stage 3 and 4, reduced REM followed by wakefulness, increased REM, red stage 3 &4
Withdr- severe disruption of sleep continuity w/vivid dreams
Stimulant Intoxication
Euphoria, affective blunting, hypervigilance, anxiety, anger, impaired judgment At least 2 of: tachycardia or bradycardia pupil dilation elevated or lowered BP perspiration or chills nausea or vomiting weight loss resp depre cardia arrhythmias, confusion, seizure, coma
Stimulant Withdrawal
fatigue, vivid unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor agitation or retardation
“crash”- intense lethargy, depression, increased app
Sedative, hypnotic, anxiolytic intox
slurred speech, incoordination, unsteady gait, nystagmus, impaired cognition
Opiod Intoxication
Initial euphoria followed by apathy, impaired judgment, pupil constriction, drowsiness or coma, slurred speech, poor attention & memory
Opioid Withdrawal*
dysphoric mood nausea muscle aches pupil dilation piloerection sweating diarrhea, fever
Inhalant Intox
much overlap w/alcohol intox
generalized muscle weakness, blurred vision, depressed reflexes
Tobacco Withdrawal*
Irritability anxiety impaired concentration inc appetite restlessness depressed mood insomnia
Alzheimers Stage 1
1 to 3 years
anterograde amnesia (esp declarative)
def in visuospatial skills (wandering)
indiff, irritability, sadness, anomia
Alzheimers Stage 2
2 to 10 years Inc retrograde amnesia flat or labile mood restlessness & agitation delusions fluent aphasia acalculia ideomotor apraxia (can't tran idea into movement)
