Diagnosis (DMS-V) Flashcards
Hallmark of intellectual disability, severity, sex ratio
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
Hallmark of a Specific Learning Disorder
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
Hallmark of Autism Spectrum Disorder (including sex ratio)
(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
ADHD vs. Conduct Disorder vs. Oppositional Defiant
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
Schizophrenia vs. Schizophreniform vs. Brief Psychotic Disorder
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).
Best prognosis for schizophrenia
Good prior functioning, abrupt onset, fewer negative symptoms, minimal cognitive impairment, and femal gender.
Concordance rates for schizophernia
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
Delusional Disorder
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.
Schizoaffective vs. Bipolar I vs. Major Depressive Disorders with psychotic features
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
Bipolar I vs. Bipolar II Disorder
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)
Concordance rates for Bipolar
80% for identical twins
20-25% for fraternal twins and siblings
lifetime prevalance rate of 1%
male to female ratio is 1:1
Suicide risk factors
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
Homicide risk factors
Ages 15-34, poverty, access to guns
Evidence based treatments for Anxiety Disorders, Obessive-Compulsive Disorder, and PTSD
CBT, SSRI’s,
Factitious Disorder vs. Malingering
Factitious disorder symptoms are intentional, motivation is unconscious.
Malingering symptoms are intentional, motivations is intentional. Patient cons
Evidence based treatments for Anxiety Disorders, Obessive-Compulsive Disorder, and PTSD
CBT, SSRI’s, Benzodiazepines
Factitious Disorder vs. Malingering
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
Hallmark of substance use disorders
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
Transvestitism vs. Transexualism
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
Hallmark of substance use disorders
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
Alcohol and sedative/hyponotic/anxiolytic intoxication and withdrawal
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.
Caffeine intoxication
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
Cocaine and amphetamine intoxication and withdrawal
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.
Paranoid Personality Disorder vs. Delusional Disorder, paranoid type
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.
Obessive Compulsive Disorder (OCD) vs. Obsessive-Compulsive Personality Disorder
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
Avoidant vs. Schizoid vs. Schizotypal vs. Schizophrenia
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).
