Diagnosis (DMS-V)

Question 1

Hallmark of intellectual disability, severity, sex ratio

Answer 1

It involves deficits in general mental abilities and adaptive functioning across multiple environments. Onset is during the developmental period. IQ is 70 SS or below (2 or more SD below the mean); Adaptive functioning (conceptual/academics, social, and practical domains) and determines the level of severity: mild, moderate, severe, and profound.

Causes: 75% due to prenatal (poor maternal nutritional state, poor maternal personal health habits, limited access to health care, and exposure in utero to pollutants, chemicals and toxins (e.g. maternal alcohol consumption).

10-15% perinatal (from 1 pound in utero to 1 month after birth, caused by fetal malnutrition, hypoxia, prematurity, trauma, or viral infections

10-15%- postnatal due to hypoxic ischemic injury, transmatic brain injury, seizure disorders, severe and chronic social deprivation, toxins, or infection.

5% due to genetic factors (chromosomal abnormalities i.e. Down’s syndrome)

1% of general population has an intellectual disability of which

85% mild severity
10% moderate severity
3-4% severe severity
1-2% profound severity

Male to female ratio is about 1.5:1

Question 2

Hallmark of a Specific Learning Disorder

Answer 2

The continued difficulties in 1 or more academic areas after 6 months of interventions; academic skills are at least 1.5 SD below the age mean (below the 7th percentile)

5-15% of general population has a specific learning disability

Male to Female Ratio ranges 2:1 to 3:1

Comorbir disorders include HDHD, ASD, Anxiety, Depressive and Bipolar Disorders, ODD, and CD

Question 3

Hallmark of Autism Spectrum Disorder (including sex ratio)

Answer 3

(a) deficits in social communication and social interactio. and (b)restricted, repetitive patterns of behavior, interests, or activities

1% of general population
35-90% of twins
15% genetic mutation

Male to Female Ratio: 4:1

Onset 12-24 months

Comorbid cognitive and language impairements

ASD shares some features with Rett Syndrome, but Rett only affects females

Prognosis is best with an absence of intellectual impairment and functional language by the age of 5

Question 4

ADHD vs. Conduct Disorder vs. Oppositional Defiant

Answer 4

ADHD has onset before the age 12. At least 6 months of limited attention span and/or poor impulse control (hyperactivity-impulsivity) in 2 or more settings (homes, school, church). It occurs in 5% of children and 2.5% of adults and male to female ration is 2:1. Treamtments include steimuants Ritaline (methylphenidate), Concerta (methylphenidate), Adderral (amphetamine) and Dexerine (dextroamphetamine), and non-stimulats Stettera (atomixetine), Intuniv (guanfacine), and Catapres (clonidine); behavioral therapy, social skills training, parenting education, and neurofeedback; for adults CBT

Conduct Disorder (CD) is characterized as repetitive, pervasive behavior violation societal norms or the basic rights of others (e.g. aggression towards people and animals, destruction of property, theft). Treatment CBT

Oppositional Defiant Disorder (ODD) is defined as enduring pattern of anger and irritability with argumentative, vindictive, and defiant behavior toward authority figers. Treatment CBT

Question 5

Schizophrenia vs. Schizophreniform vs. Brief Psychotic Disorder

Answer 5

Brief Psychotic Disorder is caraterized by 1 or more of the following: delusions, hallucinations, disorganizationspeech, or grossly disorganized or catatonic behavior and lasts less than 30 days

Schizophreniform is identical to schizophrenia, distinguished by only duration , 1 - 6 months

Schizophrenia requires at least 2 of the following symptoms: hallucinations, delusions, disorganized incoherent speech, grossly disorganized or catatonic behavior, negative symptoms (diminished emotional expression, abolition, alogia, anhedonia, and asocility) for at least 6 months and this condition significantly negatively impacts the individuals ability to function (ie. work, school, interpersonal, or self-care).

Question 6

Best prognosis for schizophrenia

Answer 6

Good prior functioning, abrupt onset, fewer negative symptoms, minimal cognitive impairment, and femal gender.

Question 7

Concordance rates for schizophernia

Answer 7

Idential twins 50%
Both parents have disorder 45%
Siblings 10%

Onset late teems to early 30’s; median age for males is early to mid 20’s and lat 20’s for females

Lifetime prevalence rate is0.3% to 0.7% and full remission is rare

male to female ratio is 1:1

Question 8

Delusional Disorder

Answer 8

1 or more delusions that last at least 1 month and don’t include the other symptoms associated with schizophrenia

Types of delusions: erotomanic type, grandiose type, jealous type, persecutory type, somatic type, mixed type, and unspecified type.

Question 9

Schizoaffective vs. Bipolar I vs. Major Depressive Disorders with psychotic features

Answer 9

Schizoaffective disorder is charaterized by a mood disorder episode concurrent with symptoms of schizophrenia. In addition during the period of illness, there have been delusions or hallucinations for at least 2 wwks without prominent mood symptoms.

Bipolar I consist of at least 1 manic episode, plus or minus hypomanic or depressive episode

Major Depressive Disorder (MDD) with psychotic features consist of MDD (recurring episodes lasting at least 2 weeks of DIGS SPACE) plus hallucinations or delusions. Psychotic features are typically mood congruent and occur only in the context of major depression episode

Question 10

Bipolar I vs. Bipolar II Disorder

Answer 10

Bipolar I is at least 1 manic episode plus or minus a hypomanic or depressive episode

Bipolar II is a hypomanic and a depressive episode (no history of manic episodes)

Question 11

Concordance rates for Bipolar

Answer 11

80% for identical twins
20-25% for fraternal twins and siblings

lifetime prevalance rate of 1%
male to female ratio is 1:1

Question 12

Suicide risk factors

Answer 12

Individuals with Bipolar disorder is at least 15 times more at risk of suicide than general population

Bipolar disorder accounts for 25% of all completed suicides

90% of committed suicide due to mood disorder, schizophrenia, personality disorder, or substance use disorder

Expression of hopelessness is the stronger predictor than prescene and severity of depression

Whites 14.13%
Native American 11%
Asians, Blacks, and Hispanics less 6.5%

Risk factors for suicide completion: SAD PERSONS

Sex (male)
Age (25-64), then 85+ years
Depression

Previous attempt (highest risk factor)
Ethanol or drug use
Rational thinking loss (psychosis)
Sickness (medical illness)
Organized plan
No spouse or other support
Statef future intent

Question 13

Homicide risk factors

Answer 13

Ages 15-34, poverty, access to guns

Question 14

Evidence based treatments for Anxiety Disorders, Obessive-Compulsive Disorder, and PTSD

Answer 14

CBT, SSRI’s,

Question 15

Factitious Disorder vs. Malingering

Answer 15

Factitious disorder symptoms are intentional, motivation is unconscious.

Malingering symptoms are intentional, motivations is intentional. Patient cons

Question 16

Evidence based treatments for Anxiety Disorders, Obessive-Compulsive Disorder, and PTSD

Answer 16

CBT, SSRI’s, Benzodiazepines

Question 17

Factitious Disorder vs. Malingering

Answer 17

Factitious disorder symptoms are intentional, motivation is unconscious. Patient consciously creates physical and or psychological symptoms in order to assume “sick role” and to ger medical attention and sympathy for primary (internal) gains.

Malingering symptoms are intentional, motivations is intentional. Patient consciously fakes, profoundly exaggerates, or claims to have a disorder in order to attain a specific secondary (external) gain like avoiding work

Question 18

Hallmark of substance use disorders

Answer 18

A substance use disorder can occur with all substance except caffeine.

Maladaptivepattenr of substance use involving at least 2 of the following in the past year:

Tolerance
Withdrawal
Intense, distracting cravings

Question 19

Transvestitism vs. Transexualism

Answer 19

Transvestism- deriving pleasure from wearing clothers of the opposite sex for at least 6 months.

Transexualism- a disturbance of gender identity in which the person feels a life-long discomfort with his or her own sex and a compelling desire to be of the opposite sex

Question 20

Hallmark of substance use disorders

Answer 20

A substance use disorder can occur with all substance except caffeine.

Maladaptivepattenr of substance use involving at least 2 of the following in the past year:

Tolerance
Withdrawal
Intense, distracting cravings
Using more, or longer that intended
Persistent desire but inability to cut down
Time-consuming substance acquiring, ise or recovery
Impaired functioning at work, school, or home
Social or interpersonal conflicts
1 or more episode of use involving danger (unsafe sex, driving while impaired)
Continued use despite awareness of harm

Question 21

Alcohol and sedative/hyponotic/anxiolytic intoxication and withdrawal

Answer 21

Intoxication slurred speech, incoordination, unsteady gait, nystagmus, impaired memory and concentration, possible stupor or coma

Withdrawal autonomic hyperactivity (sweating, pulse 100+), hand tremor, insomia, nausea or vomitins, transient hallucinations or illusiongs, anxiety, pyschomtor agitation, and seizures. Can be fatal.

Question 22

Caffeine intoxication

Answer 22

5 or more of the following: restessness, nervousness, insomnia, flushed face, diuresis (excessive urination), gastrointestinal distrubancce, muscle twitching, rambling speech, agitation, periods of inexhaustibility, and tacycardia

Question 23

Cocaine and amphetamine intoxication and withdrawal

Answer 23

Intoxication- behavior or psychological canges (euphoria or affective blunting, interpersonal sensitivity, hypervigilance, anxiety or anger, and impairment judgement) follow by 2 or more of the following: psychomotor agitation or retardation, tachycardia (rapid heart rate) or bradycardia (slow heart rate), changes in blood presser, nausea or vomiting, muscular weakness or chest pain, pupillary dilation, perspiration or chills, respiratory problems, weight loss, seizers or coma.

Withdrawl- dysphoria and 2 or more of the following: fatigue, unpleasant dreams, increased appetite, psychomotor agitation or degradation, and insomnia or hypersomnia.

Question 24

Paranoid Personality Disorder vs. Delusional Disorder, paranoid type

Answer 24

Paranoid Peraonality Disorder is a pervasive district (Accusatory), supiciousness of others, hypervigilance, and the tendency to interpret actions of others as deliberately demeaning, threatening, and malevolent.

Delusional Disorder, paranoid or persecutory type is characterised by deluisons in which the person is being persecuted or ill treated ,which may trigger violent behavior.

Question 25

Obessive Compulsive Disorder (OCD) vs. Obsessive-Compulsive Personality Disorder

Answer 25

Obesessive-compulsive disorder- obessions (recurring intrusive thoughts, feelings, or sensations) that cause sever distress, relieved in part by compulsions (performance of repetitive, often time-comsuning actions). Ego-dystonic: behavior inconsistent with one’s own beliefs and attitudes.

Obsessive Compulsive Personality Disorder- preoccupations with order, perfectionsim, and control; ego-syntonic; behavior consistent with one’s own beliefs and attitudes

Question 26

Avoidant vs. Schizoid vs. Schizotypal vs. Schizophrenia

Answer 26

Avoidant Personality Disorder- hypersensitive to rejection and criticism, socally inhibited, timid, feelings of inadequacy, desires relationships with others

Schizoid Personality Disorder- a pervasive patterns of detachment for social relationships and a restricted range of emotions in interpersonal settings.

Schizotypal Personality Disorder- indicated by repeated instance of lacking adequate social or interpersonal skills, accompanied by acute uneasiness with, and diminished ability to maintain close relationships

Schizophrenia requires at least 2 of the following symptoms: hallucinations, delusions, disorganized incoherent speech, grossly disorganized or catatonic behavior, negative symptoms (diminished emotional expression, abolition, alogia, anhedonia, and asocility) for at least 6 months and this condition significantly negatively impacts the individuals ability to function (ie. work, school, interpersonal, or self-care).