Diagnosis & Psychopathology

Question 1

DSM-5

Answer 1

Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic classification
- Provides a nonaxial assessment system
- Uses a categorical approach that describes each disorder (criteria sets that specify the defining and minimum features for the diagnosis)

Question 2

DSM-5 Outline for Cultural Formulation

Answer 2

Framework for assessing cultural features of a client’s problems
- Cultural identity of the individual
- Individual’s cultural conceptualization of distress
- Psychosocial stressors and cultural features that affect the individual’s vulnerability and resilience
- Cultural features that affect the relationship between the client and therapist
- Cultural assessment

Question 3

Intellectual Disability

Answer 3

3 criteria must be met for a diagnosis of Intellectual Disability – deficits in intellectual functioning, deficits in adaptive functioning, and an onset of symptoms during the developmental period

Question 4

ASD

Answer 4

(a) the individual has impairments in social communication and interactions and restricted, repetitive behavior patterns, interests, and activities
(b) symptoms had an onset during the early developmental period
(c) symptoms cause impaired functioning

Tend to do as well or better than children their age on field dependence-independence is a construct viewed as a dimension of cognitive style, or the way in which individuals think, perceive, remember, and use information to solve problem

Treatment - early intensive training, ABA

Question 5

ADHD

Answer 5

Inattention and/or hyperactivity-impulsivity that has lasted for at least 6 months; had an onset before 12 years of age, is apparent in at least two settings, and impairs social, academic, or occupational functioning

Prevalence: 5% for children and 2.5% for adults, with a male to female gender ratio of about 2:1 for children and 1.6:1 for adults

Course/Prognosis
15% of children with ADHD continue to meet the diagnostic criteria for the disorder as adults and up to 60% continue to have symptoms in adulthood that do not meet the full dx

Etiology
Prefrontal cortex (which mediates higher-order cognitive functions)
Cerebellum (which coordinates motor activity)
Caudate nucleus and putamen (which are part of the basal ganglia and are involved in the control of movement)
*all smaller/less activity

Question 6

SLD

Answer 6

Academic skill difficulties by at least 1 characteristic symptom that has lasted for at least 6 months despite interventions targeting difficulties; skills are substantially below what is expected for the individual’s chronological age

Co-diagnosis - ADHD, with 20 to 30% of children; other common co-diagnoses include Oppositional Defiant Disorder, Conduct Disorder, and Major Depressive Disorder

Question 7

Childhood-Onset Fluency Disorder

Answer 7

(Stuttering) involves impairment in normal fluency and time patterning of speech that is inappropriate for the person’s age

• Stuttering increases with stress

Treatment
- Habit reversal training (HRT) - treat stuttering, tics, and nervous habits; awareness training, competing response training, and social support; used to treat stuttering, the competing response is diaphragmatic (deep) breathing

Question 8

Tourette’s Disorder

Answer 8

Diagnosed when the individual has at least 1 vocal tic + multiple motor tics that may appear simultaneously OR at different times and began before 18 years of age

Associated features
-Co-exists w/ ADHD, OCD

Treatment
- Antipsychotic drugs haloperidol and pimozide; clonidine (an antihypertensive drug) is sometimes recommended b/c fewer and less severe side effects
- Comprehensive behavioral treatment for tics (CBIT) = empirically supported treatment - combines habit reversal training with education about the disorder and relaxation exercises

Question 9

Delusion Disorder

Answer 9

Presence of 1 or more delusions that last at least 1 month

Question 10

Schizophrenia

Answer 10

• 2 or more Active Phase Symptoms (delusions, hallucinations, disorganized speech, grossly disorganized behavior, negative symptoms) for at least 1 month, **w/ at least 1 symptom being delusions, hallucinations, disorganized speech
• Continuous Signs of the disorder must be present for at least 6 months
• Symptoms cause impaired functioning
• Late teens to mid 30s, not more common in upper class communities

Avolition = lack of initiative, motivation or goal-directed activities and is considered a “negative” symptom of Schizophrenia

• Enlarged lateral and third ventricles in brain (have less brain matter), smaller cerebral cortex and thalamus (filters sensory info), decrease frontal lobe activity (planning, initiating, organizing

Etiology
- Dopamine hypothesis - Schizophrenia is due to elevated dopamine levels or oversensitive dopamine receptors
- 13% risk if 1 parent has dx, 46% if both parents have dx, 50% identical

Treatment
- Antispychotics + (social skills training, CBT)

Question 11

Schizophreniform Disorder

Answer 11

Same symptoms to Schizophrenia

Except that duration = at least 1 month but less than 6 months; impaired functioning is not required

Question 12

Brief Psychotic Disorder

Answer 12

The symptoms similar to Schizophrenia (delusions, hallucinations, disorganized speech, grossly disorganized behavior) – goes back to normal behavior after

Except that duration = 1 day to less than 1 month; impaired functioning is not required

Question 13

Schizoaffective Disorder

Answer 13

Uninterrupted period of illness during which, at some time, there are concurrent psychotic symptoms + symptoms of a major depressive or manic episode with a period of 2 weeks or more in which psychotic symptoms are present without prominent mood symptoms

Question 14

Bipolar I Disorder

Answer 14

1 or more MANIC episodes (= distinct period involving an abnormally and persistently elevated, expansive, or irritable mood and persistently increased activity or energy)
- Episodes cause marked impairment in functioning, require hospitalization, or include psychotic features
- Avg age for first episode = 18 yrs old
- Treatment = mood stabilizing drug (lithium or an antiseizure medication); CBT and interpersonal therapy, family focused brief treatment

Question 15

Bipolar II Disorder

Answer 15

• 1 or more HYPOMANIC episodes
• 1 or more major depressive episode
• hypomanic episode is similar to a manic episode but does not cause marked impairment in functioning or require hospitalization

Question 16

Cyclothymic Disorder

Answer 16

• Multiple HYPOmanic episodes + multiple episodes of depressive symptoms that last at least 2 yrs for adults or 1 yr for children – not symp free more than 2 yrs
• can’t meet dx for hypomanic OR depressive episodes

Question 17

Major Depressive Disorder

Answer 17

• 1 or more major depressive episodes (w/ 4 or more characteristic symptoms, 1 of which must be a depressed mood or loss of interest or pleasure)
• w/ out hypomanic or manic episodes

Psychosocial stressors play a more significant role in triggering 1st or 2nd episodes than subsequent episodes in Major Depressive Disorder Recurrent

Risk factor = same if you have 1 or 2 parents w/ depression

Before puberty, rate is = for boy and girls

Treatment = antidepressant and/or cognitive behavioral therapy or interpersonal therapy

Question 18

Persistent Depressive Disorder

Answer 18

Depressed mood on most of the time for at least 2 yrs in adults or 1 yr in children – not symp free more than 2 months

Question 19

Separation Anxiety Disorder

Answer 19

Dx requires the presence of developmentally inappropriate and excessive fear or anxiety related to separation from home or attachment figures

Can be an adult too

Question 20

Specific Phobia

Answer 20

Characterized by marked ear of or anxiety about a specific object or situation. The object or situation nearly always causes fear or anxiety, and the individual either avoids it or endures it with marked distress.

Question 21

Social Anxiety Disorder

Answer 21

Characterized by marked fear of or anxiety about 1 or more social situations in which the individual may be exposed to the scrutiny of others

Question 22

Panic Disorder

Answer 22

involves recurrent unexpected panic attacks with at least 1attack being followed by at least 1 month of persistent concern about having other attacks or about their consequences and/or a significant maladaptive change in behavior that is related to the attacks.

Question 23

Agoraphobia

Answer 23

Characterized by the presence of marked fear or anxiety about at least 2 of 5 situations; person fears or avoids these situations due to concern that escape might be difficult or help will not be available if he or she develops panic-like, incapacitating, or embarrassing symptoms.

e.g., using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, and being outside the home alone

Question 24

Generalized Anxiety Disorder: Generalized Anxiety Disorder (GAD)

Answer 24

Diagnosed in the presence of excessive anxiety and worry about several events or activities on most days for 6 months or longer

Question 25

Obsessive-Compulsive Disorder (OCD)

Answer 25

Involves recurrent obsessions (recurrent, intrusive cognitions experienced as outside the person’s control) and/or compulsions (repetitive, senseless behaviors or rituals that occur in response to obsessions and/or serve to relieve tension)

Question 26

Posttraumatic Stress Disorder (PTSD)

Answer 26

• For adults, adolescents, and children over age 6 AND for children 6 years of age and younger
• Symptoms for the 1st age group vary somewhat
• Both have ame diagnostic categories: exposure to a traumatic event, re-experiencing of the event, negative alterations in cognition and mood associated with the event, and marked alterations in arousal associated with the event
• For both age groups, symptoms must last for more than 1 month

Question 27

Acute Stress Disorder

Answer 27

Similar to PTSD but symptoms last from 3 days to 1 month

Question 28

Adjustment Disorders

Answer 28

• Development of emotional or behavioral symptoms in response to one or more psychosocial stressors within 3 months of the onset of the stressors
• Once the stressor or its consequences have terminated, symptoms must remit within 6 months

Question 29

Dissociative Amnesia

Answer 29

Characterized by an inability to recall important autobiographical information that can’t be explained by ordinary forgetfulness and causes significant distress or impaired functioning

Question 30

Depersonalization/Derealization Disorder

Answer 30

Characterized by recurrent or persistent episodes of depersonalization or derealization
- Depersonalization = involves a sense of unreality, detachment, or being an outside observer of one’s own thoughts, feelings, and actions
- Derealization = is characterized by a sense of unreality or detachment with regard to one’s surroundings but symptoms cause significant distress or impaired functioning

Question 31

Somatic Symptom Disorder

Answer 31

Characterized by the presence of one or more somatic symptoms that cause distress or a significant disruption in daily life with excessive thoughts, feelings, or behaviors related to the symptoms

Question 32

Illness Anxiety Disorder

Answer 32

Involves a preoccupation with having a serious illness with no or mild somatic symptoms, a high level of anxiety about health, and performance of excessive health-related behaviors or maladaptive avoidance of medical care

Question 33

Factitious Disorder

Answer 33

• Involves falsification of symptoms in oneself or another person that are associated with an identified deception with engagement in deceptive behavior even in the absence of an external reward
• Factitious Disorder must be distinguished from Malingering, which involves the intentional production of symptoms for personal gain

Treatment = supportive therapy

Question 34

Insomnia Disorder

Answer 34

Characterized by dissatisfaction with sleep quality or quantity due to difficulty maintaining or initiating sleep

Treatment:
- Benzodiazepine, antihistamine, or other drug and a cognitive-behavioral intervention that includes one or more techniques – e.g., sleep restriction (restricting time in bed to improve sleep continuity), stimulus control (strengthening the bed and bedroom as cues for sleep), sleep-hygiene education (providing information on healthy sleep behaviors and environmental conditions conducive to sleep), relaxation training, and/or cognitive restructuring

Question 35

Narcolepsy

Answer 35

Characterized by attacks of an irresistible need to sleep with brief episodes of sleep that occur 3+ times per week and have been present for at least 3 months

Treatment
- Mild symptoms = positional therapy (special pillows or devices to maintain sleep posture), nose strips, and oral/dental appliances
- Moderate to severe symptoms, treatment = continuous positive airway pressure (CPAP), in which continuous pressurized air is blown into the airway through a nasal mask to keep the airway open

Question 36

Sleep Terror Disorder

Answer 36

• Characterized by repeated episodes of awakening in fear, often with a scream of panic
• Person displays evidence of fear and autonomic arousal, and responds poorly or not all to the efforts of others to offer comfort
• At the time, person does not remember any dream in detail and cannot recall the entire episode later on

i.e., person repeatedly awakens from sleep in a state of fear, disorientation, and

Question 37

Non-Rapid Eye Movement Sleep Arousal Disorders

Answer 37

Characterized by recurrent episodes of incomplete awakening that occur most often during Stage 3 or 4 sleep in the first third of a major sleep episode and that involve sleepwalking or sleep terrors

Question 38

Anorexia Nervosa

Answer 38

Characterized by a restriction of energy intake that causes a significantly low body weight; an intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain; and a disturbance in the experience of one’s body weight or shape or lack of recognition of the seriousness of one’s low body weight

Treatment:
- Get person back to a normal weight in order to reduce or avoid medical complications (may require hospitalization)
- Behavioral and cognitive-behavioral interventions are then used to ensure maintenance of weight gain and healthy eating and to alter the person’s faulty thinking about weight and food
* CBT theorists say a central factor in maintaining symptoms is need to control weight

Question 39

Bulimia Nervosa

Answer 39

Characterized by recurrent episodes of binge eating that involve eating a larger amount of food than most people would eat in a similar period of time with a sense of lack of control over eating; recurrent compensatory behaviors to prevent weight gain; and self-evaluation that is overly influenced by body weight and shape

• most serious medical side effect = electrolyte imbalance (hypokalemia = reduced level of potassium in blood) which can cause cardiac irregularities/arrest

Treatment
- Restore normal eating behaviors
- Maintain those behaviors and alleviate family and individual factors that underlie the disorder

Question 40

Oppositional Defiant Disorder

Answer 40

Requires a recurrent pattern of an angry/irritable mood, argumentative/defiant behavior, or vindictiveness.

Inability to control one’s emotions and behaviors

Question 41

Conduct Disorder

Answer 41

Characterized by a persistent pattern of behavior that involves violation of the basic rights of others or age-appropriate societal norms or rules as manifested by symptoms that represent 4 categories:
- aggression to people and animals
- destruction of property
- deceitfulness or theft
- serious violation of rules

Inability to control one’s emotions and behaviors

dx of childhood onset Conduct Disorder is associated with poorer prognosis than adolescent onset Conduct Disorder

Question 42

Pica

Answer 42

• Characterized by persistent eating of non-nutritive, non-food substances (e.g., paper, soil, cloth, paint) for at least one month
• The behavior is inconsistent with the person’s developmental level and is not part of a culturally sanctioned or socially normative practice
• Pica can occur at any age but is most common during childhood

Question 43

Rumination Disorder

Answer 43

Requires regurgitation of food for at least 1 month that is not attributable to a gastrointestinal or other medical condition or other Eating Disorder

Question 44

Binge-Eating Disorder

Answer 44

• Recurrent episodes of binge eating that are characterized by eating a larger amount of food than most people would eat in a similar period of time and a sense of lack of control over eating
• DX 3 or more symptoms (e.g., eating much more rapidly than usual, eating until uncomfortably full, feeling disgusted with oneself), with episodes of binge-eating causing marked distress and occurring, on average, at least 1/wk for 3 months

Question 45

Enuresis

Answer 45

• Characterized by repeated voiding of urine into the bed or clothes at least 2x/wk for at least 3 consecutive months
• Urination is usually involuntary but can be intentional and is not due to substance use or a medical condition
• For the diagnosis, the person must be at least 5 years of age or the equivalent developmental level
• Specifiers = 3 subtypes: nocturnal only, diurnal only, nocturnal and diurnal; nocturnal most common

Treatment
- Urine alarm

Question 46

Encopresis

Answer 46

• Repeated involuntary or intentional passage of feces into inappropriate places
• For dx – Must have occurred at least 1 month for at least 3 months
• Be at least 4 yrs old or the equivalent developmental level (most common age to be dx w/), symptoms must not be due to a substance or medical condition except through a mechanism that causes constipation

Question 47

Intermittent Explosive Disorder

Answer 47

Recurrent behavioral outbursts that are due to a failure to control aggressive impulses and are characterized by
(a) verbal or physical aggression that has occurred, on average, 2x/wk for at least 3 months or
(b) at least 3 behavioral outbursts during a 12-month period that caused damage or destruction of property and/or physical assault that injured people or animals. The severity of the person’s aggression is grossly out of proportion to the provocation or precipitating psychosocial stressor
- his or her aggressive outbursts are not premeditated or committed to obtain a tangible objective
- the outbursts cause marked distress, result in impaired functioning, or have negative legal or financial consequences
- DXT only to individuals who are at least 6 years of age or the equivalent developmental level

Question 48

Erectile Disorder

Answer 48

Characterized by the presence of at least 2 of 3 symptoms during all or almost all occasions of sexual activity (difficulty obtaining an erection during sexual activity; marked difficulty maintaining an erection until completion of sexual activity; marked decrease in erectile rigidity)

Question 49

Premature Ejaculation

Answer 49

Involves a persistent/recurrent pattern of ejaculation during partnered sexual activity within about 1 minute of vaginal penetration or before the person desires it

Treatment = sex therapy has been found to be most effective for this disorder
- Masters and Johnson their version of sex therapy effective (incorporates education about sexuality, training in communication skills, and the technique known as sensate focus)

Question 50

Genito-Pelvic Pain/Penetration Disorder

Answer 50

-Characterized by persistent or recurrent difficulties involving 1+ of following: vaginal penetration during intercourse; marked genito-pelvic pain during intercourse or penetration attempts; marked anxiety about genito-pelvic pain before, during, or as a result of vaginal penetration; marked tensing of pelvic floor muscles during attempted vaginal penetration
- Symptoms = lasted for at least 6 months and cause significant distress
- Treatment = relaxation training, manual stimulation to associate pleasure with sexual activity, and/or progressive dilation of the vagina with vaginal dilators

Question 51

Female Orgasmic Disorder

Answer 51

• Requires the presence of marked delay in, infrequency of, or absence of orgasm or markedly reduced intensity of orgasmic sensations during all or almost all occasions of sexual activity
• Symptoms = duration of at least 6 months and cause significant distress
• Treatment = sensate focus, directed masturbation, and Kegel exercises, which were originally developed as a treatment for urinary incontinence but are also used to enhance sexual pleasure

Question 52

Gender Dysphoria

Answer 52

• For children and for adolescents and adults, essential feature for both = marked incongruence between one’s assigned gender at birth and one’s experienced or expressed gender, but the specific symptoms differ somewhat
• Gender Dysphoria in Children – symptoms may include a strong preference for cross-gender roles during make-believe play, a strong preference for playmates of the opposite gender, and a strong preference for toys and activities ordinarily used or engaged in by the opposite gender
• Gender Dysphoria in Adolescents and Adults – symptoms may include a strong desire to be treated as the opposite gender and a strong conviction that one has the typical feelings and reactions of the opposite gender

Question 53

Paraphilic Disorder

Answer 53

A paraphilia (any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners) that causes distress or impairment to the individual or involves harm or risk of harm to others

Treatment = cognitive interventions (e.g., to modify cognitive distortions and rationalizations), behavior management strategies (e.g., to avoid and escape high-risk situations), and behavioral techniques that directly target undesirable sexual fantasies, urges, and behaviors
- E.g., covert sensitization, which involves pairing presentation of the object of sexual desire with an aversive stimulus in imagination, and orgasmic reconditioning

Question 54

Substance Use Disorder

Answer 54

Can be applied to all 10 classes of substances except caffeine

Essential feature of these disorders = presence of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems

Treatment = multimodal approach
- E.g., Smoking cessation interventions are most successful when they combine therapy (e.g., behavior therapy, cognitive-behavioral therapy, self-guided therapy), pharmacotherapy (nicotine replacement therapy and/or the antidepressant bupropion), and advice and support from medical or mental health professionals

Question 55

Substance-Induced Disorders

Answer 55

Include Substance Intoxication, Substance Withdrawal, and Substance/Medication-Induced Mental Disorders (e.g., Substance/Medication-Induced Depressive Disorder, Substance/Medication-Induced Anxiety Disorder, and Substance/Medication-Induced Psychotic Disorder)

Share features: (a) The disorder involves a clinically significant symptomatic presentation of a mental disorder. (b) Evidence from a history, a physical exam, or laboratory results confirms that the disorder developed during or within one month of substance intoxication or withdrawal or taking medication and the substance or medication is known to be capable of producing the mental disorder. (c) The disorder cannot be better accounted for by another mental disorder or medical condition. (d) The disorder does not occur exclusively during an episode of delirium. (e) The symptoms cause significant distress or impairment in functioning

Question 56

Schizoid Personality Disorder

Answer 56

Characterized by a pattern of detachment from interpersonal relationships and a restricted range of emotional expression in interpersonal settings

i.e., unable to form personal relationships, lack of emotional response to others, no close friends, shy/anxious, inappropriately serious about everything
- introverted, when social interaction is involved work suffers

Question 57

Schizotypal Personality Disorder

Answer 57

Presence of pervasive social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships and cognitive or perceptual distortions and behavioral eccentricities
- uninterested in close personal relationships and intimate relationships

i.e., graver form of schizoid pattern; aloof/isolated, bland/apathetic manner, magical thinking, delusions, superstitions, bizarre speech patterns

Question 58

Antisocial Personality Disorder

Answer 58

Involves a pervasive pattern of disregard for and violation of the rights of others since age 15 with a history of Conduct Disorder before age 15
*Cannot be diagnosed before age 18

i.e., pattern of socially irresponsible, exploitive, guiltless behavior; fails to conform to law; fails to sustain consistent employment; exploits/manipulates for personal gain; fails to develop stable personal relationships; lack of remorse

Treatment – Hard to treat bc people don’t believe anything is wrong w/ them; CBT and residential setting

Question 59

Borderline Personality Disorder

Answer 59

Requires the presence of a pervasive pattern of instability of interpersonal relationships, self-image, and affect plus marked impulsivity
- pervasive emotion dysregulation caused by inability to regulate intense emotional responses and exposure to invalidating environ.

Treatment = Linehan’s dialectical behavior therapy (DBT) is empirically supported; group skills training

i.e., pattern of intense/choatic relationships, instability, highly impulsive, emotionally unstable, directly/indirectly self-distructive, lacks clear sense of identity, manipulative

Question 60

Avoidant Personality Disorder

Answer 60

Characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

i.e., extreme sensitivity to rejection, socially withdrawn, awkward/uncomfortable in social situations, desire to avoid close relationships due to fear of rejections, lonely/feel unwanted, sees others as betraying, seen as timid/withdrawn/odd or strange

Question 61

Obsessive-Compulsive Personality Disorder

Answer 61

Involves a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control that limit flexibility, openness, and efficiency

i.e., inflexibility about the way things are done, devotion to productivity and the exclusion of personal pleasure, concerned about organization/efficiency, tend to be rigid and unbending, socially polite and formal, rank conscious, appear calm and controlled/ambivalence/conflict/hostility underneath

Question 62

Paranoid Personality Disorder

Answer 62

Involves a pervasive pattern of distrust and suspiciousness of others that involves interpreting their motives as malevolent
- express paranoia, have difficulty getting along with others and forming close relationships

i.e., distrust/suspiciousness, on guard constantly, doesn’t accept responsibility, blames others, ready for real/imagined threats, oversensitive, insensitive to to others’ feelings

Question 63

Histrionic Personality Disorder

Answer 63

Dx requires pervasive pattern of emotionality and attention-seeking that began by early adulthood, is present in multiple contexts; can also be sexually seductive/proactive; use of physical appearance to draw attention to self

i.e., excitable/distractable, emotional, colorful/dramatic, extroverted behavior, attention-seeking, seductive, manipulative, easily influenced, difficulty forming close relationships, strongly dependent, common somatic complaints

Question 64

Narcissistic Personality Disorder

Answer 64

Pervasive pattern of grandiosity in fantasy or behavior, a need for admiration, and a lack of empathy that began by early adulthood. Symptoms are apparent in multiple contexts and include 5 or more of the following: grandiose sense of self-importance; preoccupation with fantasies of unlimited success, power, beauty, or ideal love; belief that one is unique and can be understood only by other high-status people; requires excessive admiration; has a sense of entitlement; is interpersonally exploitative; lacks empathy; is often envious of others or believes others are envious of him or her; shows arrogant, haughty behaviors and attitudes

i.e., exaggerated sense of self-worth, lack of empathy, believe they have inalienable right for special consideration, exploit others to fulfil own desire, fragile self-esteem, expect positive feedback, criticism from others can cause anger/rage/shame/humiliation, envious of others

Question 65

Dependent Personality Disorder

Answer 65

Involves a pervasive and excessive need to be taken care of that leads to submissive, clinging behavior and fear of separation that began by early adulthood

i.e., pervasive/excessive need to. betaken care of, submissive/clingy behavior, fear of separation, lack of self-confidence, passive to desires of others, avoid positions of responsibility, overly generous and thoughtful while underplaying own attractiveness/achievements

Question 66

Delirium

Answer 66

• Neurocognitive disorder
• Characterized by a disturbance in attention and awareness + at least 1 additional disturbance in cognition w/ evidence that symptoms are the physiological consequence of a medical condition, substance intoxication or withdrawal, and/or exposure to a toxin

Question 67

Neurocognitive Disorder Due to Alzheimer’s Disease

Answer 67

Dx when
- Criteria for Major or Mild Neurocognitive Disorder are met
- Symptoms had an insidious onset and have caused a gradual progression of impairment in at least 1 cognitive domain for Mild Neurocognitive Disorder OR at least 2 cognitive domains for Major Neurocognitive Disorder
- Criteria for probable or possible Alzheimer’s disease are met

Question 68

Vascular Neurocognitive Disorder

Answer 68

Dx when
- Criteria for Major or Mild Neurocognitive Disorder are met
- Symptoms are consistent w/ vascular etiology
- Evidence of cerebrovascular disease from the individual’s history, a physical exam, and/or neuroimaging

Question 69

Hypertension

Answer 69

= high blood pressure
impacts 1/3 of adults in USA

Primary (essential) hypertension is diagnosed when the cause is unknown

Secondary hypertension is diagnosed when high blood pressure is known to be secondary to another disorder or condition

Treatment = Antihypertensive medications include diuretics (usually the first-line medication), anti-adrenergics, direct-acting vasodilators, beta-blockers, calcium-channel blockers, angiotensin-receptor blockers, and ACE inhibitors

Question 70

Hans Selye (1956) - General Adaptation Syndrome (GAS)

Answer 70

Model of STRESS

Selye said that people have the same physical response (general adaptation syndrome = GAS) to all types of prolonged stress

Includes 3 stages: Alarm, Resistance, Exhaustion
* Alarm: The hypothalamic-pituitary-adrenal (HPA) axis is activated by the stressor, which results in an increase in the release of catecholamines (epinephrine and norepinephrine) by the adrenal medulla. This causes an increase in blood glucose level, heart and respiration rates, and muscle tension and other physical changes that provide the individual with the energy needed to cope with the stress.
* Resistance: If the stress continues, the hypothalamus signals the pituitary gland to release adrenocorticotropic hormone (ACTH) which, in turn, signals the adrenal cortex to release cortisol and other stress hormones. Elevated levels of stress hormones maintain high blood glucose levels and increase the metabolism of fats and proteins, which allows the individual to continue responding to the stressor.
* Exhaustion: With prolonged stress, the pituitary and adrenal glands lose their ability to maintain elevated hormone levels and physical reserves become depleted. As a result, the individual may experience mental and physical exhaustion, illness, and, in extreme cases, collapse or death.

Question 71

Lazarus and Folkman’s (1984) -Transactional Model of Stress

Answer 71

Lazarus and Folkman said that people do not always respond eth same way to the same potentially stressful situation; how people respond dependson their cognitive appraisal of event

3 types of cognitive appraisal: Primary Appraisal, Secondary Appraisal, Cognitive Appraisal
* Primary appraisal = refers to a person’s evaluation of the relevance of a potentially stressful event to his or her own well-being. The outcome of this appraisal is affected by several factors including the person’s values, beliefs, and expectations, and it results in one of three conclusions – i.e., the event is irrelevant, positive-benign, or challenging-harmful (threatening). If the event is interpreted as irrelevant or positive-benign, a stress reaction does not occur. However, if the event is perceived as threatening, secondary appraisal occurs.
* Secondary appraisal = refers to the person’s evaluation of whether his or her resources and abilities are sufficient to adequately cope with the threatening situation. If the person determines that his or her energy level, sources of support, etc. are adequate, a stress response does not occur. However, if the person determines that he or she does not have adequate resources or abilities, a stress response is likely to occur.
* Cognitive reappraisal = refers to the person’s continuous monitoring of the situation and use of new information to modify his or her primary and secondary appraisals. Reappraisal can result in an increase or decrease in the stress response.

Question 72

Premenstrual Syndrome (PMS)

Answer 72

• Used to sescribe behavioral, psychological, and physical symptoms that begin following ovulation and persist until just before or after menstruation begins
• Symptoms of PMS may include anxiety, depression, affective lability, diminished interest in usual activities, lethargy, marked changed in appetite, sleep disturbances, and physical symptoms (e.g., bloating, abdominal pain, backache, headache, breast tenderness)
• dx = at least 5 premenstrual symptoms during most menstrual cycles in the previous year, with at least 1 mood symptom and at least 1 physical, cognitive, or behavioral symptom + significant distress or interference with activities or relationships as the result of the symptoms