DSM Flashcards
Mental Retardation
percentage of people in:
mild, moderate, severe, profound
modle 85%; moderat 10%; severe 3-4%; profound 1-2%
ADHD
percentage of all kids; ratio of boys:girls; percentage of kids with ADHD that also have CD; percentage of kids with LD
3-5% of all kids; 4-9 times more boys; 50% of ADHD kids have Conduct Disorder; 20% of kids iwth ADHD have LD
ADHD
neurological areas affected and problems related to ADHD
right frontal lobe, striatum which is part of the basal ganglia and composed of the caudate nucleus and putamen; cerebellum
smaller corpus callosum; genetic influence 57%; twins 80%, globus palladus and caudate nucleus
Tourettes Disorder
diagnostic criteria
co morbidity
treatment
multiple tics, multiple times per day for 12 months
co existing diagnosis: obsession and compulsions, ADHD, LD, depression and social problems
Tx: school, individual, family, drugs: ?Haloperidol and pimozide, clonidine (hypertension)
antidepressants: clomipramine, fluxetine to decrease obsessions and compulsions
Dementia of the Alzheimer’s Type
Stage 1
Stage 2
Stage 3
Alzheimers
Stage 1: 1-3 years; anterograde amnesia/declarative/explicit memory; deficits in visuospatial skills; indifference, irritability, sadness, anomia (1: MEMORY)
Stage 2: 2-10 years; increasing deficits in recent and remote recall/retrograde amnesia; falt or labile mood; restlessness and agitation; delusions; fluent aphasia, acalculia, and ideomotor apraxia/insbility to translate an idea into movement (2:COGNITIVE)
Stage 3: 8-12 years; severely deteriorated intellectual functioning; apathy; limb rigidity; urinary and fecal incontinence
Alzheimers Dementia
Etiology
neurotransmitter
neurological abnormalities
linked to genetics; low levels of ACh; neurofibrilarry tangles and plaques in certain areas of the cebral cortex especially in the temproal lobes, hippocampus and other areas of the brain
Jane smokes marijuana every weekend. She also smokes occasionally during the week, in response to a particular stressful event. Based on this informaiton, we know that Jane, in terms of DSM IV TR diagnostic classification, is suffering from
a. substance abuse
b. substance dependence
c. cannabis inducted psychotic disorder
d. none of the above
D - none of the above;
there is no indication from the quesion that the criteria for substance absue or dependence are met. in other words, just because someone regularly uses a substance does not mean that there is a maladaptive pattern of use leading to significant impairment or distress (the key criterion for dependence and abuse)
Marlatt and Gordon:
an initial relapse in a recovering alcoholic is most likely to lead to further relapses if the person:
a. attributes the relapse to internal and stable causes
b. attributes the relapse to external and unstable causes
A - the abstinence violation effect (AVE) occurs when an initial relapse leads to feelings such as guilt and depression, which in turn lead to further relapses. the AVE is most likely to occur if the person makes internal, stable attributions for the relapse (e.g. “I am worthless”), as opposed to external, unstable attributions (e.g. “I drank because temprorary relapses are to be expected”)
Caffeine Intoxication is associated with
diuresis, boundless energy, significant distress for the person who is intoxicated
Korsakoff’s Syndrome
alcohol inducated persisting amnestic disorder
due to a thiamine deficiency that causes damage to the thalamus. primary sumptoms is impaired recent memory. also disorientation, lack of insight into probelms, retrograde amnesia and confabulation (filling in memory gaps randomly)
- SUBSTANCE ABUSE
: In DSM-IV, a Substance-Use Disorder characterized by a maladaptive pattern of substance use involving clinically significant impairment or distress as manifested by the presence of at least one symptom during a 12-month period.
- SUBSTANCE DEPENDENCE:
A Substance-Use Disorder involving the continued use of a substance despite significant substance-related problems, as evidenced by the presence of at least three characteristic symptoms during a 12-month period. Dependence may or may not involve tolerance and withdrawal (physiological dependence). Substance Dependence is more serious than Substance Abuse.
- DELIRIUM TREMENS (A.K.A. ALCOHOL WITHDRAWAL DELIRIUM):
- DELIRIUM TREMENS (A.K.A. ALCOHOL WITHDRAWAL DELIRIUM): Disturbances in consciousness and other cognitive functions, autonomic hyperactivity, vivid hallucinations, delusions and/or agitation following a period of prolonged or heavy use
Schizophrenia is a disturbance of ______or more that includes _______________of active-phase symptoms.
Active phase symptoms include ____
Schizophrenia is a disturbance of six months or more that includes at least one month of active-phase symptoms (one week in DSM-III-R). Active phase symptoms include delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior and/or negative symptoms (e.g., flat affect, avolition, alogia).
Rates of Schizophrenia are:
males:females
twin studies
Rates of Schizophrenia are about equal for males and females.
Twins: monozygotic (identical)=48%; Dizygotic (fraternal) -16%; biological siblings -10%; unrelated/general population=1%
Treatment of Schizophrenia
Rates of Schizophrenia are about equal for males and females. Treatment usually includes a neuroleptic family therapy, and social-skills training.
etiology
eltiology has been linked to genetics, oversensitivity to dopamine and other neurotransmitter abnormalities, and several structural brain abnormalities including enlarged ventricles and hypofrontality
prognosis
better prognosis is associated with abrupt and later onsent, a precipitating stressor, female gender, absence of anosognosia and absnence of structural brain abnormalities
Dopamine hypothesis of schizophrenia
schizophrenia is linked to excess dopamine; also serotoninin, large ventricles and decreased activity in the frontal lobes, small cerebral cortex and small thalamus
Antipsychotics:
positive symptoms
negative symptoms
positive symptoms - delusions, hallucinations, disorganized speech, disorganized or catatonic behavior - easier to treat + sxs; treated with typical antipsychotics
negative symptoms: alogia (restricted fluency/productivity of thought and speech), avolition (restricted initiation ofgoal directed beahvior), flat affect, anhedonia.
atypical antipsychotics treat + and - sxs w/o tardive dyskinesia
Schizophreniform Disorder
same diagnostic criteria as schizophrenia EXCEPT only present for 1 month but less than 6 months and impaired functioning is not required for this diagnosis
Brief Psychotic Disorder
delusions, hallucinations, disorganized speech, and/or grossly disorganized or catatonic behavior that are present for at least 1 day but less than 1 month
Schizoaffective Disorder
concurrent symptoms of schizophrenia and major depressive, manic, or mixed episode except for a period of at least two weeks without prominent mood symptoms. (psychotic without mood for 2 wks)
Paranoid Schizophrenia
vs.
Delusional Disorder
Paranoid Schizophrenia - bizarre delusions; “yellow men with purple feet are following me”
vs.
Delusional Disorder - persistent, non bizarre delusional systemt; “whenI slow down, all of the cars behind me slow down - I’m being followed” - the logic is off; can function much better generally and they look pretty normal.
Factitious Diosrder
vs.
Malingering
Factitious Disorder - fake, not real, intentionally producing symptoms, can be physical or psychological symptoms. Just to be in sick role
vs.
Malingering - there is an external incentive - get out of work, criminal case; not a mental disorder but a v code
Diagnosis and Psychopathology
3. Delirium may occur due to intoxication with all of the following substances except
A cocaine.
B cannabis.
C caffeine.
D LSD.
caffeine
agoraphobia
fear of being in a place where escape may be difficult or embarrassing or help won’t be available; or a situationally predisposed panic attack
situationally bound panic attack
vs.
situationally predisposed panic attack
bound - cued by a specific stimulus or situation (usually in social or specific phobia)
predisposed - do not always occur after person is exposed to the trigger
obsession
vs
delusion
obsession - recurrent and persistent thoughts, impulses or images that are experienced at some time as intrusive and inappropriate and that cause marked anxiety or distress
delusion - false but firmly sustained beliefs
Overall, studies investigating methods for reducing the risk for relapse for individuals with major depressive disorder have shown that:
cognitive behavioral therapy is clearly superior to other forms of treatment for reducing the risk for relapse. interpersonal therapy is clearly superior to other forms of treatment for reducing the risk for relapse. relapse is best avoided through maintenance therapy with an antidepressant following termination of the initial treatment. relapse is best avoided when the initial treatment combines psychosocial therapy and pharmacotherapy.
- The research on this issue is, not surprisingly, far from consistent. However, it has found that maintenance therapy is often required to prevent relapse.
a. Incorrect Although some studies have found cognitive therapy to have some advantage over other techniques for reducing relapse, others have not. Therefore, the phrase “clearly superior” eliminates this as the correct response.
b. Incorrect Interpersonal therapy has not been found to be “clearly superior” to other treatments in terms of preventing relapse.
c. CORRECT Most experts agree that continued maintenance treatment is the best way to reduce the risk for relapse; and, at this point, antidepressants have been the target of most of the research on maintenance therapy.
d. Incorrect Relapse is not ameliorated by combining psychosocial and drug therapies during the initial treatment.
. The feeling that one is an outside observer of one’s mental processes or body is referred to as:
dissociation. depersonalization. delusion. fugue.
- This question describes feelings of detachment or estrangement from oneself.
a. Incorrect Dissociation refers to a “disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment” (DSM-IV-TR, p. 822). Although depersonalization disorder is a type of dissociative disorder, depersonalization is a better response to this question.
b. CORRECT Depersonalization refers to “an alteration in the perception or experience of the self so that one feels detached from, and as if one is an outside observer of, one’s mental processes or body” (DSM-IV-TR, p. 822). When depersonalization co-occurs with intact reality testing and significant distress or impaired functioning, a diagnosis of depersonalization disorder may be appropriate.
c. Incorrect Delusions are false but firmly sustained beliefs based on incorrect inferences about external reality. Depersonalization could achieve delusional proportions, but that is not implied by the question.
d. Incorrect Dissociative fugue is a dissociative disorder involving sudden, unexpected travel away from home with an inability to recall some or all of one’s past.
The differential diagnosis of dementia and pseudodementia in older adults can be difficult because of the overlap in symptoms. However, the presence of which of the following suggests that pseudodementia is the appropriate diagnosis?
The onset of the patient’s cognitive symptoms was insidious. The severity of cognitive symptoms increases in the evening. The patient seems unaware of his cognitive deficits. The patient is uncooperative during cognitive testing.
- Several symptoms help distinguish pseudodementia (memory and cognitive impairments associated with depression in older adults) from true dementia.
a. Incorrect In pseudodementia, symptom onset is usually sudden; in dementia, it is typically insidious (gradual and subtle).
b. Incorrect Increased severity of symptoms in the evening is characteristic of some forms of dementia but is uncommon in pseudodementia.
c. Incorrect A patient with pseudodementia is likely to complain about and exaggerate his/her cognitive problems; a patient with dementia often denies problems in the early stage of the disorder and is unaware of them in the later stages.
d. CORRECT A lack of cooperation during testing is more characteristic of patients with pseudodementia (depression) than of those with dementia. Patients with dementia are more likely to be cooperative (but inaccurate in their responses).
- For the past year, Maria M., age 47, has experienced several periods during which she is irritable and restless, has little energy, is unable to concentrate at work, and has trouble falling asleep. Maria says she feels “fine” between these episodes and is quite productive at work and socially active. Maria’s symptoms are most suggestive of:bipolar I disorder.
cyclothymic disorder.
major depressive disorder with atypical features.
major depressive disorder, recurrent.
- Maria seems to be experiencing fluctuating periods of depression and “normal” mood and functioning.
a. Incorrect The diagnosis of bipolar I disorder requires the presence of at least one manic or one mixed episode.
b. Incorrect A diagnosis of cyclothymic disorder requires the presence of hypomania and depression for at least two years.
c. Incorrect The “atypical features” specifier is appropriate when the individual exhibits mood reactivity and at least two other characteristic symptoms (e.g., increased appetite and weight gain, hypersomnia).
d. CORRECT Maria’s symptoms suggest she is experiencing recurrent episodes of major depression. There is no evidence that she has experienced manic or mixed episodes, which would be required for a diagnosis of bipolar I disorder, or episodes of hypomania and depression, which are characteristic of cyclothymic disorder.
Sleep terror episodes:
usually begin during REM sleep. usually begin with a panicky scream. are associated with vivid frightening dreams that the individual can recall in detail upon awakening. are associated with rhythmic, stereotyped motor activity during the episode and upon awakening from it.
- Sleep terror episodes are associated with sleep terror disorder and involve “abrupt awakenings from sleep usually beginning with a panicky scream or cry” (DSM-IV-TR, p. 634).
a. Incorrect Sleep terrors usually begin during stage 3 or 4 NREM sleep.
b. CORRECT As noted above, a sleep terror episode typically begins with a panicky scream or cry.
c. Incorrect The individual usually does not have a detailed memory of a dream upon awakening but may have amnesia for the episode or may recall only fragmentary images of a dream.
d. Incorrect Awakening from sleep with rhythmic, stereotyped motor activity is characteristic of nocturnal paroxysmal dystonia, which is diagnosed as a parasomnia NOS.
- A cognitive therapist is treating a 20-year old woman who has received a diagnosis of anorexia nervosa. The therapist’s first priority will be to give the woman graded task assignments designed to increase her food intake. In addition, an initial intervention will be to:foster the woman’’s doubt about her belief that she is accomplishing something by staying thin.
challenge or refute the woman’’s belief that she is “too fat” and that eating will make her obese.
educate the woman about the underlying meaning of her attitudes and behaviors.
identify ways in which family members are reinforcing the woman’’s eating behaviors.
Approaches to treating anorexia vary, even among cognitive therapists. However, by definition, cognitive therapy entails addressing the cognitions that underlie or support a disorder.
a. CORRECT Of the strategies given in the answers, this one is most similar to Garner and Bemis’s (1982) approach, which is based on Beck’s cognitive therapy. According to Garner and Bemis, an initial step in treatment is to foster doubt in the client about his or her assumption that it is worth the time and effort to deny one’s appetite in order to stay thin. This is followed by addressing the validity of the anorectic’s beliefs regarding the consequences of becoming fat and the conviction that thinness is a primary determinant of self-worth and personal value.
