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
