Diagnosis And Psychopathology Flashcards
What DSM-5 term refers to a diagnosis will eventually be met but not sufficient info for firm diagnosis
“Provisional”
What does the term “provisional” mean in the DSM-5?
That a diagnosis will eventually be met but not sufficient info for firm diagnosis
What DSM-5 term allows the clinition to indicate why the symptoms do not met the full diagnosis criteria?
“Other-specified”
What does the term “Other-specified” mean in the DSM-5?
It allows the clinition to indicate why the symptoms do not met the full diagnosis criteria
What DSM-5 term allows the clinician to indicate that symptoms don’t meet criteria when they do not want to say why?
“Unspecified”
What does the term “unspecified” mean in the DSM-5?
That symptoms don’t meet criteria and clinician does not want to say why
- deficit in intellectual functioning
- deficits in adaptive functioning across multiple settings in 1 or more activities of daily living
- onset during early developmental period
The diagnosis crtieria for an Intellectual Disability
What are the diagnosis crtieria for an Intellectual Disability?
- deficit in intellectual functioning
- deficits in adaptive functioning across multiple settings in 1 or more activities of daily living
- onset during early developmental period
The two basic diagnostic criteria that Autism Spectrum Disorder lies at the intersection of
- Full criteria:*
- impairments in social communication*
- Restricted, repetitive behavior patterns, interests, and activities*
- Onset during EARLY developmental period*
- Symptoms cause impaired functioning*
- impairments in social communication
- Restricted, repetitive behavior patterns, interests, and activities
- Onset during EARLY developmental period
- Symptoms cause impaired functioning
The diagnostic criteria for Autism Spectrum Disorder
What are the diagnostic criteria for Autism Spectrum Disorder?
- impairments in social communication
- Restricted, repetitive behavior patterns, interests, and activities
- Onset during EARLY developmental period
- Symptoms cause impaired functioning
Intellectual Disability etiology
30% due to chromosomal abnormalities (Down Syndrome)
5% due to hereditary (Tay-Sach’s disease, PKU, fragile X syndrome)
10% pregnancy and perinatal complications (fetal malnutrtition, anoxia, HIV)
15-20% environmental factors and mental disorders (severe deprivation, autism)
30-40% of cases cause is unknown
What is the largest known etiological factor for ID?
Down Syndrome
Accounts for 30% of cases
What is the second-largest known etiological factor for ID?
Environmental factors and mental disorders (e.g., severe deprivation, autism)
(accounts for 15-20% of children with ID)
What percentage of ID is due to pregnancy or perinatal complications?
Ex. fetal malnutrition, anoxia, HIV
10% of ID cases are due to these factors
What percentage of ID is due to hereditary reasons?
(e.g., Tay-Sach’s, PKU, Fragile X syndrome)
5% of ID cases are due to these reasons
strongest predictor of ID
low birth weight
What are the early symptoms of Autism?
- Delay in lang. development (not speaking by 2) and abnormal communication (echolalia)
- Lack of social interest or unusual social interactions
- Unusual patterns of play (lining up toys)
Best prognosis for Autism will include
- Development of functional language by age 5
- IQ over 70
- later onset of symptoms
- absence of comorbid disorders
What is a major contributing etiological factor for Autism?
Genetics
(higher concordance between MO vs. DI twins)
Neurotransmitters associated with Autism
Serotonin and GABA
Autistic brain irregularities are found in the…
amygdala and cerebellum
Best Autism Treatment?
Early intensive behavioral intervention in the home setting before age 5
ADHD definition
Pattern of inattention and/or hyperactivity
that lasts at least six months
apparent in at least two settings
ADHD onset requirement
Before 12 years
ADHD symptom requirement (children; adults)
6 symptoms for less than 17 years
5 symptoms for 17+
ADHD Prevalence in children; adults
5% in children; 2.5% in adults
ADHD prevalence by gender (male:female)
____ in children
____ in adults
2: 1 in children
1. 6:1 in adults (male:female)
Behavioral experiences of hyperactivity and impulsivity in ADHD children vs. adults
Children more likely to experience hyperactivity;
Adults present as more inattentive
What four brain areas are theorized to be impacted by ADHD?
PFC
Cerebellum
Caudate Nucleus
Putamen
Behavioral Disinhibition Hypothesis describes ADHD as
an inability to adjust activity levels to the requirements of the situation.
How is ADHD treated?
combination of medication and behavioral intervention.
Central Nervous stimulants work on ___% of individuals.
80%
Specific Learning Disorder
Impairment in reading, written expression, math (lasting for six months), despite intervention
What percentage of children with SLD also have ADHD?
20-30% of children with SLD also have ADHD
SLD etiology
- Exposure to toxins
- Early malnutrition
- Hemispheric dominance (incomplete dominance or mixed laterality)
- Cerebellar-vestibular dysfunction (due to otitis media; inflammation in middle ear)
Childhood-Onset Fluency Disorder (colloquial term)
stuttering
Childhood-Onset Fluency Disorder
Impairment in fluency and time patterning of speech
Onset of stuttering (COFD) is between
2-7 years of age
Predictor of persistence in Childhood-onset Fluency Disorder?
severity of stuttering at age 8
COFD treatment
Habit Reversal Training
Stuttering increases alongside levels of
stress
What are the components of habit reversal training?
Awareness training
Competing response training (deep breathing)
Social support
Habit reversal training is a treatment for…
Stuttering.
(also–component of CBIT for Tics)
Criteria for Tourette’s Disorder
One vocal tic and multiple motor tics
When is the typical onset of Tourette’s disorder?
Between 4-6 years
What is the age of onset criteria for Tourette’s?
Before age 18
What is the criteria of duration for Tourette’s diagnosis?
at least 1 year
Tourette’s disorder is often comorbid with
OCD and ADHD
Medication management for Tourette’s with ADHD
Anti-hypertensive drugs (e.g., clonodine)
What is the criteria for duration in order to receive a diagnosis of Delusional Disorder?
Presence of one or more delusions for at least 1 month:
Erotomanic
Grandiose
Jealous
Persecutory
Somatic
Mixed
Unspecified
A person’s overall functioning (IS/IS NOT?) markedly impaired by the delusion in Delusional Disorder?
Is Not
Duration of symptoms required for a diagnosis of schizophrenia
signs of disorder for at least six months
active phase symptoms for at least a month
Active phase symptoms of schizophrenia include:
delusions
hallucinations
disorganized speech
disorganized behavior
negative symptoms (anhedonia, avolition)
At least one of the symptoms of schizophrenia must be:
delusions, hallucinations, or disorganized speech
Schizophrenia symptoms typically appear between
late teens and early 30’s
Peak age of first psychotic episode in schizophrenia occurs…
(early to mid 20’s)
Best prognosis for schizophrenia includes
- Late and acute onset
- Insight
- Brief duration of active phase
- Family history of mood disorder but no family history of schizophrenia
Which racial group have highest rates for schizophrenia?
African Americans; may be incorrect as AA’s have more delusions and hallucinations with MDD and Bipolar Disorder which could be misdiagnosed as Schizophrenia
Better prognosis for patients in developing countries
Schizophrenia
Brain-based etiology for Schizophrenia
- Increased volume in lateral and third ventricles
- Reduced size of hippocampus and amygdala
- Hypofrontality (LOW PFC) relates to negative symptoms
Neurotransmitter hypotheses for Schizophrenia
- Dopamine Hypothesis
- Imbalance in Norepinephrine and Dopamine levels (see second gen. antipsychotic meds)
Second-generation antipsychotic medications are based on the theory that…
Imbalance in Norepinephrine and dopamine levels
Dopamine hypothesis for Schizophrenia posits…
Elevated dopamine receptors or oversensitive dopamine receptors
Now expanded to include Norepinephrine, serotonin, and glutamate
Schizophrenia prevalence in general population
less than 1% of gen. pop.
Two highest schizophrenia prevalence is found in:
Monozygotic Twins: 48%
Child of 2 parents: 46%
Schizophrenia genetic concordance rates for dizygotic twins and biological siblings:
Dizygotic Twins: 17%
Bio Sibs: 10%
Schizophrenia genetic concordance rates for child of 1 parent with Schizophrenia is:
Child of 1 parent: 13%
Three first-generation drugs used to treat schizophrenia.
Chloropromazine
Thioridazine
Haloperiodol
Four second-generation antipsychotic drugs used to treat schizophrenia
Clozapine
Risperidone
Olanzapine
Ariprazole
Why are second-generation drugs for the first line of treatment for schizophrenia?
Targets both positive and negative symptoms; doesn’t cause tardive dyskinesia
First-generation only targets positive symptoms
Schizophreniform criteria for duration?
at least 1 month of active phase; continuous signs for less than 6 months
Schizophreniform vs. Schizophrenia
continuous signs of disorder for less than 6 months
impaired functioning not required
same symptom requirement
Brief Psychotic Disorder symptom duration
One day to less than one month
Brief Psychotic Disorder vs. Schizophreniform/Schizophrenia
Only one or more main symptoms required
Eventual return to premorbid function
onset follows stressful event
Schizoaffective disorder
- concurrent psychotic symptoms and major depressive or manic episode
- Period of 2 weeks or more with only psychotic symptoms w/o mood symptoms
Schizophrenia vs. Schizophreniform vs. Brief Psychotic Disorder
Schizophrenia
- 2 or more symptoms, with at least one core symptom
- 1 month symptoms; 6+ months of continuous illness
- impaired functioning
Schizophreniform
- 2 or more symptoms; at least one core symptom
- 1 month symptoms; less than 6 months of continuous illness
- impaired functioning not required
Brief Psychotic Disorder
- one symptom required
- 1 day to 1 month duration
Symptoms of Seasonal Affective Disorder include
- decreased energy
- increased sleep
- overeating and weight gain
- craving for carbs
Mahler’s Object Relations Theory of BPD
“separation-individuation”
BPD vacillates between separation and fear of abandonment
Kernberg’s Caregiver Theory of BPD
unpredictable caregivers that alternate between nurturing and depriving/punitive
causes defenese mechanism of “splitting” (all good or all bad)
Linehan (1978) theory for BPD
BPD caused by pervasive emotion dysregulation;
BPD people were exposed to invalidating environments;
sharing of private experiences met with significant others –> responded in erratic and negative ways
Drugs for Premature Ejaculation
SSRI’s (fluoxetine, sertraline, paroxetine)
TCA (clomipramine)
Drugs for Erectile Function Disorder
Sildenafil Citrate (Viagra)
Tadalafil (Cialis)
Drugs for Female Sexual Arousal Disorder
Testosterone
Parkinson’s disease has low levels of _____ and ____.
Dopamine and Serotonin
Parkinson’s disease often co-occurs with ________?
Depression
40% of people with PD have depression
Depression IS/IS NOT? correlated with extent of motor impairment or duration of PD symptoms
IS NOT
Depression precedes the onset of motor symptoms in ____% of Parkinson’s patients
20%
Four categories of SUD
- impaired control
- social impairment
- Risky Use
- Pharmacological criteria (tolerance/withdrawal)
CBT theories of maintenance of Anorexia nervosa disorder
- Need to control eating
- Self worth = body weight and body image
Alzheimer’s disorder, neuritic plaques found on
hippocampus, amygdala, entorhinal cortex
medial temporal structures
“Permissive” theory of depression
depression caused by low levels of serotonin and norepinephrine (early biochemical theory) low serotonin and high norepinephrine causes mania
“Catelcholamine” hypothesis of depression
low levels of norepinephrine; early biochemical theory
MDD atypical features
hypersomnia, increase in appetite, weight gain (non-vegetative)
CBIT components for tics
habit reversal training, psychoeducation, relaxation training
Most common comorbid disorders of Tourette’s
ADHD and OCD
Best predictors for Alcohol are…
family history of alcoholism
Core feature of CD
violation of the rights of others and/or rules and societal norms
Hypokalemia
low levels of serum potassium that can lead to kidney failure and cardiac arrest; caused by anorexia due to imbalanced electrolytes
Ritalin works on ____% of people with ADHD
80%
Childhood-onset fluency disorder–how many children recover?
65-85%
Tourette’s disorder is chronic, and the frequency of the symptoms__________ in adolescence or adulthood
Declines
Comprehensive Behavioral treatment (CBIT)
Empirically supported treatment for Tourette’s that combines habit reversal training, with psychoeducation and relaxation techniques.
Bipolar I
at least one manic episode (distinct, period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy) lasts for one week
Bipolar I prevalence
.6% for 12 month prevalence
1.1:1 prevalence ratio; male to female
90% of individuals who have one episode have additional episodes
Bipolar I avg. age of onset
18
Bipolar I etiology
Hereditary (family history of Bipolar disorder strongest predictor of risk)
Life stressors can precipitate the onset of symptoms
Bipolar I Treatment
Lithium (mood-stabilizing drug–reduce periods of mania, prevent mood swings, reduce suicide risk)
Antiseizure medication (valproate, carbamazepine) alternative to those who are intolerant of lithium
Bipolar I Treatment (therapy)
Cognitive Behavioral Therapy–identify and alter thought patterns contributing to symptoms
Interpersonal and Social Rhythm Therapy (IPSRT)–recognize the impact on interpersonal activities and relationships on social and circadian rhythms and regularize those rhythms so they can gain control over their mood cycles
Family-focused treatment (FFT)–brief treatment for patients and their family members that includes psychoeducation, communication enhancement training, and problem-skills training
Bipolar II Disorder
At least one hypomanic (lasts at least four days) and one major depressive episode (lasts at least two weeks)
Cyclothymic
multiple periods of hypomanic and depressive symptoms (not full mdd) for at least two years;
symptoms present half the time and not without symptoms for more than two months.
Major Depressive Disorder
5 or more symptoms with at least one being a depressed mood or loss of interest or pleasure
MDD specifiers
with atypical features–significant weight gain, or increase in appetite, hypersomnia, leaden paralysis, pattern of interpersonal rejection sensitivity with peripartum onset—symptoms began during pregnancy or within 4 weeks postpartum; 10-20% have MDD after birth; .1% to .2 % develop postpartum psychosis with seasonal pattern—occurs at a particular time of year; beginning of fall and continuing into the winter months. Due to disruption of circadian rhythms resulting in increased melatonin which causes drowsiness and lower serotonin.
SAD symptoms
lack of energy, hypersomnia, increased appetite and weight gain, carbohydrate craving
MDD prevalence
7% 12-month prevalence; 18-29 3x more likely than 60+ after puberty females 1.5-3x rate of males Peak age of onset is mid-20s The initial episode triggered by stressful event; but additional episodes relate to # of prior episodes rather than presence of stressor
Current MDD biochemical hypothesis
high level of cortisol that causes degeneration of cells in the hippocampus
Behavioral and Cog. Behavioral Explanations for Depression
- Seligmans “learned helplessness model” (1978) 2. Lewinsohn’s “behavioral theory” (1974) 3. Beck’s “cognitive theory of depression” (1976) 4. Rehm’s “self-control” model
Seligman’s “learned helplessness model”
Depression caused by uncontrollable negative life events. Caused by stable, internal, global factors (own incompetence).
Lewinson’s behavioral therapy
no response-contingent reinforcement of adaptive behaviors and reinforcement of non-adaptive behaviors by sympathy from others pessimism, low self-esteem, social isolation, dsyphoria
Beck’s “cognitive theory of depression”
negative self-statements about self, world, and future “depressive cognitive triad”
Rehm’s “self-control” model
self-monitoring–attend more to neg. vs. pos life events self evaluation–strict standards of eval and internal attributions to neg. events self reinforcement–insufficient reinforcement and excessive punishment
Depression symptoms in children
physical complaints, irritability, social withdrawal
Depression symptoms in older adults is called…
pseudodementia–memory loss, distractibility, disorientation, and other cog. symptoms
Three types of Antidepressants
Tricyclics(TCA’s) Selective Serotonin Reuptake Inhibitors (SSRI’s) Monoamine oxidase inhibitors (MAOI’s)
Treatment for Depression
CBT Interpersonal Therapy
Combo of CBT and antidepressants ______ more effective than either alone
“somewhat”
But therapy has slightly better long term effects;
overall long term prospects not good across CBT, IPT, or Tricyclics
Schizophrenics are most likely to have ________ hallucinations
auditory
Negative Symptoms of Schizophrenia
anhedonia–reduced capacity to experience pleasure avolition–reduced motivation and goal orientation alogia–absence of speech
Depression is linked to elevated levels of this hormone
cortisol
causes a degeneration of cells in the hippocampus, which causes memory problems
Agoraphobia
presence of fear or anxiety related to 2 out of 5 situations:
1) public transport
2) open spaces
3) enclosed spaces
4) standing in line or being in a crowd
5) outside the home alone
* fear that escape will be difficult or help will be unavailable if a panic attack occurs*
Rate for MDD for adolescent and adult females vs. males
1.5-3x rate of females to males
Rate of MDD for prepubescent males and females
about the same
Treatment of choice for most anxiety disorders
in vivo exposure with response prevention
Duration of seperation anxiety must last at least…{children vs. adults]
4 weeks in children and 6 months in adults
School refusal in children vs. adults
separation anxiety (5-7 year old) vs. depression
Separation Anxiety etiology
parent overprotectiveness insecurity resulting from a loss or trauma Symptoms precipitated by a major life stressor
Seperation Anxiety treatment (younger and older)
Behavioral therapy that incorporates younger–>systematic desensitization older–>CBT that focuses on replacing maladaptive behaviors with more adaptive ones
Specific Phobia is treated with…
exposure with response prevention
Specific phobia and John Watson
classical conditionining for phobia US–> fear response US - CS CS–>CR
Claustrophobia treatment
exposure with response prevention and applied relaxation
Blood-injection injury type
Exposure with applied tension (to avoid fainting; to increase blood pressure)
Social Anxiety Treatment
Exposure with Response Prevention Can be combined with cog. restructuring, social skills training, antidepressant drug (ssri), anti-anxiety drug, beta- blocker
Panic Disorder Treatment (therapy)
Panic Control Therapy (Brief form of CBT that combines psychoeducation, cognitive restructuring, relaxation-based strategies, interoceptive exposure, and in-vivo exposure)
Panic Disorder symptoms (panic attack)
Surge of fear or intense discomfort that reaches a peak within minutes and involves heart palpitations sweating trembling or shaking paresthesia derealization or depersonalization fear of losing control or dying **check rule outs
Panic Disorder definition
recurrent unexpected panic attack with at least one month or more of persistent concern about having another attack —OR— maladaptive change in behavior that is related to the attack
Panic Disorder (drugs)
Pharmocotherapy–> imipramine or other TCA; SSRI; or benzodiazepine Should not use medicine alone because high rate of relapse when no longer taking drugs
Generalized Anxiety Disorder etiology
genetic factors; behavioral inhibition; neuroticism automatic catastrophic thoughts that maintain anxiety and cause avoidance behavior
GAD treatment
CBT (psychoeducation, relaxation training, cognitive restructuring, exposure and relapse prevention)
GAD medication
First line are SSRI’s and SNRI’s (benzodiazepines)
OCD prevalence; male female adults and male female children
equal in male and female adults higher in male children than female children
OCD Etiology
hereditary, low levels of serotonin, abnormalities in the orbitofrontal cortex and caudate nucleus
OCD Treatment
combination of medication and exposure with ritual prevention Medication includes TCA (clomipramine) and fluvoxamine, sertraline (SSRI’s)
Reactive attachment disorder
inhibited, emotinally withdrawn behavior toward adult caregiver Symptoms apparent before 5 years old
RAD etiology
EXTREME insufficient care as evidenced by social neglect repeated changes in primary caregivers such that the child could not for attachments rearing in unusual circumstances
Disinhibited Social Engagement Disorder
child actively approaches and interacts with unfamiliar adults
DSED etiology
EXTREME insufficient care as evidenced by social neglect or deprivation repeated changes in caregivers rearing in unusual circumstances
PTSD prevalence females vs. males
females have higher prevalence across lifespan experience symptoms for longer
PTSD treatment
multicomponent cog-behavioral intervention Cog. Processing Therapy–psychoeducation, exposure, cognitive restructuring
PTSD duration and Acute Stress Disorder Duration
1 month and 3 days to 1 month
Adjustment Disorder
development of emotional or behavioral symptoms in response to one or more psychosocial stressors within 3 months of onset of stressors; symptoms remit with 6 months of terminated stressors
Adjustment Disorder specifiers
with depressed mood, anxiety, mixed anxiety and depressed mood disturbance of conduct mixed disturbance of emotions and conduct unspecified
Biofeedback–HRV
Heart Rate Variability (electrocardiogram) monitors heart rate and cardiac activity; used to help manage stress, high blood pressure, anxiety, heartrate irregularities
Biofeedback–EMG
Electromyogram–measures impulses in muscles and indicated degree of relaxation or tension; tension headaches, chronic pain, stiffness, incontinence
Biofeedback–EDR
Electrodermal (galvanic response training); use for anxiety Skin surface changes, relation between emotional state and sympathetic system (sweat gland activity)
Biofeedback–EEG
Electroencephalogram–neurofeedback provides information about on brainwave activities used for ADHD, depression, and epilepsy to improve attention
Korsakoff’s syndrome
anterograde amnesia (impaired ability to learn new info)
retrograde amnesia (impaired ability to recall previously learned info)
confabulation
Alcohol Induced Neurocog Disorder;
memory impairment in psuedodementia (depression) vs. dementia
depression–recall dementia–recognition and recall
Therapy for Premature ejaculation
sensate focus ; start-stop or squeeze technique;
Four groups of symptoms for substance use
impaired control, social impairment, risky use, pharmacological challenges of tolerance or withdrawal
Neurocognitive disorder = impaired functioning in one of six domains
complex attention executive function learning and memory language perceptual motor social cognition
Delirium
disturbance in attention and awareness that develops over a short period of time (hours to day) with symptoms worsening at night one additional disturbance in cognition Symptoms direct consequence of medical condition, susbtance, or toxin
Alzheimer’s Disorder accounts for _____ of all cases of dementia. Duration of disease
60-90% 8-10 years
Early Stage of Alzheimer’s
anterograde amnesia, lost in familiar places, can’t recall familiar words or names (anomia) depression, impaired attention and judgement
Middle Stage of Alzheimer’s
anterograde and retrograde amnesia; problems with reading and writing, inability to remember names of family members + friends, pronounced mood swings and personality changes, fluent aphasia
Late stage of Alzheimer’s
severe impairment, need for assistance, urinary and fecal incontinence, bedridden, dies of respiratory infection
Early onset familial type
abnormal genes on chromosomes 1, 14, 21
Later-onset of Alzhemiers
abnormal ApoE4 gene on chromosome 19
Alzheimer’s treatment
cholinesterase inhibitors reduce breakdown of Ach (linked to memory impairment)
Major or Mild Vascular Dementia
- acute onset with partial recovery 2. stepwise decline 3. progressive course with fluctuations in symptom severity; plateaus that vary in duration
Autoplastic
“self-change”;
Alloplastic
changing or adapting to the environment by changing the environment;
Etic
“universal” all ppl from different cultures are the same
Emic
“culture-bound” culture specific approach
Personality Disorder Age and Duration Requirments
1 year and less than 18 o.k.; Except Antisocial Personality Disorder
Antisocial Personality Disorder age requirements
must be at least 18 and have CD before 15
Medication treatment for nocturnal enuresis
Propanol and imipramine
ODD diagnosis duration requirement
at least 6 months
Erectile Dysfunction treatment
Sildenafil Citrate (Viagra)
Hypokelemia
reduced level of K+ in the blood typical with bulimia nervosa
High expressed emotion in families is associated with
increased risk of relapse for those with Schizophrenia, Depression, and Anorexia
Gender differences in MDD before puberty
equal
Gender differences in MDD as adults
Females have 1.5 to 3x rate of depression compared to males
ADHD prevalence boys:girls
2:1 for children
ADHD prevalence men: women
1.6:1 for adult males to female
Treatment for Alzheimer’s involves
Increasing acetylcholine
Diabetes mellitus symptoms involves
Increased appetite and weight loss, frequent urination, thirst, apathy, confusion
Cushing’s disease symptoms
emotional lability, memory loss, depression, obesity
Cushing’s diseases is caused by
hypersecretion of cortisol
Addison’s disease is caused by
hyposecretion of cortisol
Addison’s disease symptoms
muscle weakness, fatigue, decreased appetite and weight loss, darkening skin pigmentation
Hyperthyroidsim or Grave’s disease
speeds up metabolism, increased appetite and weight loss, accelerated heart rate, heat intolerance, insomnia
Example of antidepressant drug
imipramine
Stages of Alzheimers
1: short term memory loss (anterograde) 2: mood swings, sleep disturbances, completing complex tasks 3: lose ability to speak and recognize loved ones
Schizophrenia concordance rates: dizygotic twins
17%
Schizoprhenia concordance rates: monozygotic twins
48%
Schizophrenia concordance rates: sibling
10%
Schizophrenia concordance rates: chid of one parent with schizophrenia
13%
Schizophrenia concordance rates: child of two parents with schizophrenia
46%
Electroconvulsive Treatment used on…
nondominant hemisphere (right); less anterograde and retrograde amnesia
Wolpe is known for
Systematic desensitization
migraine headaches
throbbing on one side of head
tension headache
diffuse tight band of pain around head
cluster headache
unilateral, non-throbbing, behind the eye
OCD treatment
exposure with response prevention and thought stopping
Panic Disorder treatment
Panic Control Therapy (CBT)
Phobia treatment
exposure with response prevention
Psychoeducation, cognitive restructuring, relaxation-based strategies, interoceptive exposure, and in-vivo exposure)
Panic Control Therapy used for Panic Disorder
anti-hypertensive drug
clonodine; second line of treatment for Tourette’s
Generation I drugs for schizophrenia
Based on Dopamine hypothesis Targets positive symptoms does not alleviate negative symptoms
New Generation drugs for schizophrenia
Based on NE, Dopamine imbalance Only positive features
First generation antipsychotics
chloropromazine thioridazine haloperiodol
Second generation antipsychotics
Clozapine Risperidone olanzapine ariprazole
Second generation anti-pyschotics help alleviate
both pos. and negative symptoms; -tardive dyskinesia
Treatment for Bipolar Disorder
Lithium Antiseizure medication
Antiseizure medication
valproate carbamazepine
Medication management for Tourette’s without ADHD
antipsychotic drugs (e.g., haloperiodol and pimozide)
Tourette’s behavioral treatment
CBIT (Comprehensive Behavioral Treatment for tics); involves habit reversal training
Illness Anxiety vs. Somatic Disorder
no to mild symptoms vs. actual symptoms
how old should you be for enuresis
5 years of age
tobacco withdrawal symptoms
concentration, restlessness, insomnia, irritability, increased appetite, depressed mood, anxiety
stuttering onset between ages of…
ages 2 to age 7
covert sensitization
treatment for paraphilic disorder; pairing sexual desire with aversive stimulus in imagination
ADHD prevalence rates in children vs. adults
5% vs. 2.5 %
Initial signs of neurocog. disorder due to HIV
forgetfulness, impaired concentration, apathy, irritability
how old should you be for encopresis?
4 years of age
Symptoms of tobacco withdrawal
irritability
anxiety
depressed mood
impaired concentration; restlessness
increased appetite
insomnia
Symptoms of Alcohol Withdrawal
Autonomic hyperactivity
hand tremor
anxiety
insomnia
Symptoms of Opioid Withdrawal
dysphoric mood
muscle aches
nausea/vomiting
fever
Symptoms of Stimulant Withdrawal
fatigue
vivid dreams
increased appetite
insomnia or hypersomnia
Non-REM sleep arousal disorder involves
sleepwalking and sleep terrors
child cannot recall incident
Nightmare Disorder occurs during the
REM cycle in the second half of sleep
Nightmare Disorder dreams are usually…
dysphoric; center on trying to stay alive
What percentage of children with ADHD go on to have subclinical ADHD concerns in adulthood?
60%
What percentage of children with ADHD continue to meet the full criteria into adulthood?
15%
Those with BPD experience a remission of symptoms by…
middle age
impulsivity–>interpersonal–>affective remitt
Narcolepsy requires that the patient has at least ____ sleep attacks per week for _____ months
3 sleep attacks/week
for 3 months
Which neurotransmitter is associated with OCD?
low levels of Serotonin
Which abnormalities in brain structures is associated with OCD?
Caudate nuclues
orbitofrontal cortex
What medication is used to treat OCD?
TCA’s (clomipramine)
and
SSRI’s (?)
Reactive Attachment Disorder vs. Disinhibited Social Engagement Disorder
inhibited, emotional withdrawn toward caregiver
vs.
actively approaching unfamiliar adults
Requirements of Reactive Attachment Disorder
- Extreme neglect
- Symptoms apparent before age 5
- Developmental age of at least 9 months
Extreme insufficient care necessary for RAD includes
- social neglect or deprivation from caregiver
- repeated changes in primary caregiver
- rearing in unusual circumstances with few opportunities for selective attachments
Duration criteria for PTSD
1 MONTH
EDMR is one treatment for
PTSD
Due to exposure
Acute Stress Disorder is a less intense version of
PTSD
Acute Stress Disorder duration criteria
3 days to less than 1 month
localized amnesia means…
can’t recall any events during a period of time
selective amnesia means…
can’t recall SOME events during a period of time
malingering
involves telling lies for personal gain
In Factitious Disorder there is/isn’t any personal gain?
ISN’T
Insomnia and Narcolepsy: duration and frequency for criteria
3x3 rule
3 times a week for 3 months
Medication used to treat insomnia
Benzodiazepines and antihistamines
Requirements of Narcolepsy
- Cataplexy (loss of muscle tone)
- Deficiency in hypocretin (hormone)
- REM latency 15 minutes or less
Non-REM Sleep Arousal disorder occurs in what part of sleep?
First 1/3 of sleep episode
Stage 3 and Stage 4
Non-REM sleep arousal symptoms include
sleep terrors
sleepwalking
little to no recall of episode
Nightmare Disorder occurs during the…
REM cycle in second half of sleep period
PICA and Rumination Disorder have duration criteria of
1 month
Anorexia Nervosa is associated with ______ levels of serotonin
higher
food restriction creates a sense of calm by lowering serotonin levels
Binge eating duration…
at least 1 week of compensatory behavior + binge eating for at least 1 month
Encopresis duration
2x a week for 3 consecutive months
Encopresis
once a month for at least 3 months
age criteria of enuresis
at least 5 years old
age criteria of encopresis
4 years old
Medication for Erectile Dysfunction
(sildenafil citrate) Viagra
Medication for Early Ejaculation
SSRI’s (flouxetine, sertraline)
Sex therapy for Early Ejaculation
sensate focus (nondemanding pleasure)
Treatment for Paraphilic Disorder
covert sensitization
pairing object with aversive stimuli (i.e., going to jail)
Treatment for Paraphilic Disorder
orgasmic reconditioning
masturbate to bad stimulus and then when orgasm switch to appropriate stimulus
SUD you need two symptoms for at least ____ months
12
Risk of relapse is lower if an individual beleives a relaspe event is
specific, external, controllable factors
These three high-risk situations are associated with 75% of all lapses
- Neg. emotional state
- Interpersonal conflict
- Social Pressure
Substance-Induced behaviors occur within ___ month of intoxication or withdrawal
1 month
Alcohol Delirium symptoms
delirium tremens, hallucinations, delusions, agitation, autonomic hypersensitivity
Alcohol-Induced Major Neurocog. Disorder
nonamnesic-confabulatory type
amnesic-confabulatory type
Amnesic-confabulatory type due to what syndrome in Alcohol-Induced Major Neurocog. Disorder?
Korsakoff syndrome
anterograde and retrograde amnesia and confabulation due to a thiamine deficiency
What is confabulation?
fabrication of memories
seen in Alcohol-Induced Major Neurocognitive Disorder
Opioid Withdrawal
- dysphoric mood
- nausea and vomiting
- muscle aches
- fever
- yawning and insomnia
Sedative withdrawal
- Autonomic Hyperactivity
- hand tremor
- insomnia
- nausea
- transient hallucinations
- anxiety
- seizures
Stimulant Withdrawal
- fatigue
- insomnia or hypersomnia
- increased appetite
- psychomotor agitation or retardation
Stimulant crash (acute withdrawal symptoms)
intense depression and increase in appetite
Tobacco Withdrawal
(within 24 hours of cessation)
impaired concentration and restlessness
anxiety and low mood
irritability and frustration
insomnia
anterograde amnesia
inability to form new memories
retrograde amnesia
facts from the relatively recent past
procedural memory (ex.)
remembering getting dressed; not impacted by Korsakoff’s
Vegetative (physical) symptoms of depression
fatigue
insomnia
loss of appetite
weight loss
loss of libido
peak age of onset of schizophrenia for males
early to mid 20’s
peak age of onset of schizophrenia for girls
late 20’s
What is passive coping
assigning responsibility for pain to an outside source and allowing other areas of life to be impacted by pain
active coping
patient takes responsibility for pain management
Borderline Personality in girls shares symptoms with Antisocial Personality in boys. Specifically, in both disorders…
Both involve manipulative behavior;
boys manipulate to gain power and females manipulate to gain attention/concern from caregivers
Marriage reduces the likelihood of depression to a greater extend
gender differences
for men more than for women
More children leads to ________ risk of depression
increase
male coping styles differ from females by
males use more action/mastery for distraction (work, sports, going out with friends)
while females brood/dwell on problems
women who have multiple roles are _____ vulnerable to depression
more or less?
Less
Avolition
reduced motivation or goal directed activity
anhedonia
reduced capacity to experience pleasure
alogia
relative absence (poverty) of speech
ADHD affected brain areas
- PFC
- Cerebellum
- Caudate nucleus and putament (basal ganglia)
Lazarus’s appraisal theory (3 types of cognitive appraisal to stressors)
- primary–decide if pos., neg., neutral?
- secondary–decide if resources to address?
- reappraisal–changing others appraisals as new info comes in?
apraxia
inability to enact purposeful movements
caused by damage to the frontal or parietal lobes
What percentage of women experience “baby blues” after pregnancy
50 - 80 percent
Exposure and Response Prevention is based on which behavioral theory
classical extinction
expose client to CS without the US (break the pairing; show white rate without sound to extinguish fear reaction)
Which personality disorder becomes less severe or even remits by the fourth decade in life?
Antisocial Personality Disorder
Why is flouxetine (SSRI) and clomipramine (TCA) used to treat OCD?
affects levels of serotonin;
neurotransmitter is hypothesized to impact OCD
Seperation Anxiety begins to appear at around
8 or 9 months
DSM-5 diagnosis for seperation anxiety duration criteria for children and adults?
4 weeks for children
6 months for adults
Lazarus and Folkman’s 1984 transactional model has what three stages?
- Primary appraisal “is this a threat”
- Secondary appraisal “can I deal with this threat?”
- Cognitive Reappraisal “let’s look at new info…”
Said that how ppl respond to stress is determined by thier cognitive appraisal of the stressor
Lazarus and Folkman
transactional model of stress
Said that everyone responds the same physiologically to prolonged stressors
Selye
General Adaptation Syndrome
What are the three stages of Selye’s General Adaptation Syndrome?
- Alarm
- Resistance
- Exhaustion
What happens in the alarm stage of Selye’s General Adaptation Syndrome
HPA activated by stressor
E and NE released by adrenal medula
Increase in glucose, heart rate, muscle tension, etc.
What happens in the resistance stage of Selye’s General Adaptation Syndrome
- With prolonged stress, hypothalamus signals pituary to release the adrenocorticotropic hormone (ACTH)
- hormone signals adrenal medula to release cortisol
What happens in the exhaustion stage of Selye’s General Adaptation Syndrome?
physical reserves are depleted
Criteria for Binge Eating Disorder (# of binges)
1/week for a 3 months
Cluster A Personality Disorders are characterized by:
odd or eccentric behaviors
Ex. Paranoid, Schizoid, Schizoptypal
Characteristics associated with Cluster B Personality Disorders
Emotional, erratic, dramatic behaviors
Ex. Antisocial, Borderline, Histrionic, and Narcissitic
Characteristics associated wtih Cluster C Personality Disorders
Anxiety and Fearfulness
Ex. Anxiety and Fearfulness
Borderline Personality Disorder is characterized by
instability in self-image and marked impulsivity
(see Linehan for emotion regulation)
(Mahler for object relations for seperation-individuation and fear of abandonment)
(Kernberg for caregiver explanation and “splitting” )
Hypnogogic hallucinations occur
when you are falling asleep
associated with narcolepsy
hypnopompic hallucinations occur
when you are waking up
associated with narcolepsy
Schizoid vs. Schizotypal
Schizoid are not interested in relationships; detached; no emotional expression
Schizotypal are uncomfortable in relationships but say they want them; odd and eccentric thinking and speech
What disorder is associated with children of parents who have PTSD?
depression and anxiety
hyperactivity
aggression
social withdrawal
peripartum onset criteria (length)
during pregnancy or within 4 weeks post pregnancy
babies develop vision in the order of:
kinetic, binocular, pictorial
