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EPPP > DSM & Diagnosis > Flashcards

DSM & Diagnosis Flashcards

1
Q

Mental Disorder (Broad Definition)
Areas affected

A

Syndrome characterized by clinically significant disturbance in ones cognition, emotions, behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Usually associated with distress or disability in social, occupational, and other important activities.

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2
Q

What type of assessment system does the DSM-5 use?

A

Nonaxial assessment system

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3
Q

What does ‘Polythetic Criteria Set’ mean in relation to the DSM-5?

A

For each diagnosis, a person may only have some of diagnostic criteria

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4
Q

What are the 3 ways to handle diagnostic uncertainty?

A
  1. Provisional: full criteria will eventually be met, but not enough info currently
  2. Other specified disorder: symptoms don’t meet full diagnostic criteria and clinician wants to provide reason why
  3. Unspecified Disorder: client’s symptoms don’t meet full criteria but clinician doesn’t want to indicate why
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5
Q

Level 1 Assessment Tool in DSM-5

A

Assesses 13 adult domains, 12 child domains

Identifies areas for further evaluation

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6
Q

Level 2 Assessment Tool in DSM-5

A

Detailed info on specific domains to assess with diagnosis, treatment planning, and follow up

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7
Q

WHODAS 2.0
SLUG PG

A

WHO Disability Assessment Schedule

  1. Understanding/communication
  2. Getting around
  3. Self-care
  4. Getting along with people
  5. Life activities
  6. Participation in society
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8
Q

Personality Inventory Domains (5)
What Personality Inventory?
PANDD

A
  1. Negative affect
  2. Detachment
  3. Antagonism
  4. Disinhibition
  5. Psychoticism
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9
Q

Cultural Formation

A

3 components that assess cultural features of a clients concerns

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10
Q

Outline for Cultural Formation

A

Includes identity, cultural conceptualizations of distress, cultural features affecting relationships between client and therapist, over all cultural assessment

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11
Q

Cultural Formation Interview (CFI)

A

Semi-Structured, 16 questions that assess impact of culture on client’s presenting concerns & treatment

  1. Cultural definition of concern
  2. Cultural perception of cause/context
  3. Cultural factors affecting coping
  4. Cultural factors affecting past/present help seeking
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12
Q

Cultural Concepts of Distress
Brief Description

A

Ways that a cultural group experiences, understands and communicates suffering, behavioural problems, or troubling cognitions.

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13
Q

Ataque de Nervios

A

Latino syndrome. Symptoms of intense emotional upset, uncontrollable crying, heat rising from chest to head, aggression, inhibition

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14
Q

Kufungisisa

A

South African. Depression.

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15
Q

Susto

A

Latin. Chronic somatic suffering stemming from emotional trauma. “spirit attack”

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16
Q

Neurodevelopmental Disorders (7)
GASCAIM

A

Onset during developmental period

  1. Intellectual disability
  2. Global Developmental Delay
  3. ASD
  4. ADHD
  5. Specific Learning Disorder
  6. Communication Disorder
  7. Movement Disorder
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17
Q

Intellectual Disability

A

Intellectual reasoning deficit
Adaptive Functioning deficit
2+ standard deviations below mean (70)
Severity rating is determined by…conceptual, social, practical domains. Not IQ

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18
Q

Vineland Adaptive Behaviours Scale

A

Assessment of adaptive functioning
Assesses what kids can DO, not necessarily their capabilities
1. Conceptual/Academic: memory, language, reading, writing
2. Social: empathy, interpersonal, social judgment
3. Practical: personal care, money, organization

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19
Q

Etiology of Intellectual Disability

A 
75% prenatal
5% heredity 
30% chromosomal abnormalities 
10% pregnancy/perinatal complications
5% Childhood medical conditions
15-20% Environmental factors, comorbid conditions
30-40% unknown
Low birth weight is strongest predictor
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20
Q

Borderline Intellectual Functioning

A

IQ 70-85

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21
Q

Global Developmental Delay

A

Under 5 yo
Not meeting developmental milestones
Too young for standardized testing

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22
Q

ASD previous conditions

A

Encompasses the previous: Autistic disorder, aspergers, childhood disintegrative disorder, pervasive developmental disorder NOS

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23
Q

ASD Diagnosis

A
  1. Social communication deficit (NV, V, Peer, reciprocity)
  2. Restricted & repetitive behaviour, interest, activities
  3. Onset in early developmental period (2yo)
  4. Impaired social, occupation, and other
  5. Language abnormalities (echolalia, pronoun reversal)
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24
Q

ASD Severity Ratings

These are so dumb

A

Level 1-requires support
Level 2-substantial support
Level 3-very substantial support

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25
Q

Etiology of ASD
GACCS

A

Amygdala abnormality
Cerebellum (repetitive movements)
Corpus callosum
Serotonin, GABA abnormalities
Genetic

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26
Q

Differential diagnosis for ASD

A

Rett Syndrome

  • Female predominated
  • Normal pre/perinatal development
  • Normal psychomotor until 5mo
  • 5-48 months=deceleration of cranial growth, stereotyped hand movements, loss of social engagement
  • After this period, there is an improvement
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27
Q

ADHD
Min. duration of symptoms
How many symptoms required?
When does it start?

A

Diagnosis:

  1. Symptoms for at least 6 months
  2. Onset before 12yo
  3. Evident in ~2 settings
  4. Social, academic, occupational impairments

Child: minimum 6 symptoms of inattention and/or 6 symptoms of hyperactivity
Adult: minimum 5

5% children; 2.5% adults
Mostly male

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28
Q

Disinhibition Hypothesis of ADHD

A

Barkley
Inability to adjust activity levels to the requirement of the situation
E.g. issues with doing tasks that have limited interest to them, or tasks that have inconsistent reinforcement

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29
Q

Common meds for ADHD

A
  1. Ritalin (methylphenidate)
  2. Concerta (methylphenidate)
  3. Adderall (amphetamine)
  4. Dexedrine (dextroamphetamine)
  5. Straterra (atomoxetine) nonstimulant
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30
Q

Most common comorbid conditions with ADHD

A

ODD
CD
Learning Disorder

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31
Q

Specific Learning Disorder Criteria (5 things)

A

Diagnosis:

  1. Difficult using academic skills for at least 6 months
  2. Reading difficulties, spelling/writing difficulties, mathematical difficulties
  3. Skill must be far below average for chronological age
  4. Interferes with academic/occupational performance, daily living
  5. Can’t be accounted for by other condition
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32
Q

Three areas and severities of Specific Learning Disorder

A
  1. Reading impairment
  2. Written expression impairment
  3. Mathematic impairment

Mild/Moderate/Severe

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33
Q

Dyslexia

A

Difficulties with word recognition, poor decoding and spelling abilities
Due to phonological processing abilities

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34
Q

Discalculia

A

Difficulties in numerical processing, accurate calculations

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35
Q

Etiology of Specific Learning Disabilities
THEC

A

Toxins (lead)
Early malnutrition/food allergies
Hemispheric abnormality
Cerebellar-vestibular dysfunction (inflammation of middle ear)

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36
Q

Communication Disorders
LSSS

A
  1. Language disorder (4yo–> adulthood)
  2. Speech sound disorder (phonology & articulation, may not be lifelong)
  3. Social (pragmatic) communication disorder (V and NV communication)
  4. Stuttering (Childhood onset fluency disorder)
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37
Q

Childhood Onset Fluency Disorder
What is it?
Prognosis
Treatment

A

Diagnosis:

  • Impairment in normal fluency and time patterning of speech
  • Repetitions, prolongations, pauses, word substitutions and avoidance

Prognosis:

  • 65-85% of children recover
  • Symptom severity at 8yo a good indicator

Treatment:

  • Reduce stress
  • Habit Reversal Training
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38
Q

Movement Disorders (3)
DST

A
  1. Developmental Coordination Disorder: delays in motor milestones
  2. Stereotypic Movement Disorder: repetitive and nonfunctional
  3. Tic Disorders: Tourettes, persistent motor or vocal tic disorder
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39
Q

Tourette’s Disorder

A

Diagnosis:

  • At least 1 vocal tic
  • Multiple motor tics, simultaneously or at different times
  • Persisted for more than a year
  • 4-6 yo develops
  • Usually improves in adolescence

Treatment:

  • Antipsychotics
  • Comprehensive behavioural treatment
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40
Q

What 5 symptoms accompany psychotic disorders?

A
  1. Delusions
  2. Hallucinations
  3. Disorganized thinking
  4. Disorganized/abnormal motor behaviour
  5. Negative symptoms

Each symptom ranked on 5 point scale for severity

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41
Q

Delusional Disorder Diagnosis

A

Diagnosis:

  • Delusion (false beliefs maintained despite evidence) May be bizarre or non-bizarre
  • Delusions present for 1 month or more
  • Functioning is not impaired by delusion

Onset in middle to late adulthood

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42
Q

Types of Delusions (7)
JEGPUMS

A
  1. Erotomanic: someone famous is in love with them
  2. Grandiose: inflated self-worth, power, knowledge
  3. Jealous
  4. Persecutory
  5. Somatic: abnormal bodily functions/sensations
  6. Mixed: more than one of them
  7. Unspecified: doesn’t fit in other categories
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43
Q

Schizophrenia Diagnosis

A
  • Requires two + active symptoms for at least one month
  • Must include one of: delusions, hallucinations, disorganized thinking/speech
  • Continuous signs of disorder for at least 6 months
  • Must cause impairment in functioning
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44
Q

Schizophrenia Prognosis

A

Onset: early to mid-twenties for men; late twenties for females

Chronic condition; can be managed but remission is unlikely

Good prognosis linked to:

  • Late onset
  • Brief active symptom phase
  • No family history of schizophrenia
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45
Q

Schizophrenia and Culture

A

Do African Americans get it more?
-They may have delusions and hallucinations as part of MDD, Bipolar

In developed countries, clients more likely to experience…

  • Acute onset
  • Shorter clinical course
  • Complete remission
  • May be met with better social support and acceptance
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46
Q

Schizophrenia Etiology

A

Brain Abnormalities:

  • Increased volume in lateral and third ventricles
  • Reduced size of hippocampus and amygdala
  • Lower activity and flow to PFC…this causes negative symptoms

Dopamine Hypothesis: linked to elevated dopamine levels/over sensitive dopamine receptors.

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47
Q

Schizophrenia Treatment

A

1st gen antipsychotics

  • Chlorpromazine
  • Thioridazine
  • Haloperidol
  • Use: for positive, not negative symptoms
  • Risks: tardive-dyskenesia

2nd gen antipsychotics:

  • Clozapine
  • Risperidone
  • Olanzapine
  • Ariprazole
  • Use: both + and - symptoms
  • Risk: tardive dyskenesia less likely
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48
Q

Schizophreniform Disorder
(Schizo-mini-form)

A

Exactly the same as schizophrenia, but differing timeline

Minimum 1 month, but less than 6 months

Impaired functioning not required for diagnosis

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49
Q

Brief Psychotic Disorder

A

Requires 1+ of:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Disorganized movement
  • Catatonia

Duration: 1 day-1 month…eventually return to their unique normal

Usually preceded by stressor

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50
Q

Schizoaffective Disorder
Symptoms + Specifiers (3)

A

Concurrent psychotic and MDD/manic episodes
-Must have at least 2 weeks of ONLY psychotic symptoms with no mood symptoms

Specifiers:

  • Bipolar type
  • Depressive type
  • With Catatonia
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51
Q

Bipolar I Diagnosis

A
  • Manic episode: elevated/irritable/swinging mood, excessive goal directed energy, inflated self-esteem and grandiosity, decreased need for sleep, flight of ideas
  • Requires at least one manic episode that lasts for minimum one week
  • May include 1+ episodes of hypomania or depression, but not required for diagnosis
  • Causes marked impairment in functioning
  • Requires hospitalization the the safety of self or others
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52
Q

Bipolar I Diagnostic Specifiers
Status
Severity
Does it come with friends?
Pattern

A
  • In partial/full remission
  • Mild/moderate/severe
  • With anxious distress
  • With mixed features
  • With rapid cycling (4+ mood episodes in last year)
  • With mood-congruent or mood-incongruent psychotic features
  • With catatonia
  • With peripartum onset
  • With seasonal pattern
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53
Q

Bipolar I Etiology

A

Heredity is the strongest factor

Biologically:

  • Neurotransmitter dysfunction
  • Brain abnormalities
  • Psychosocial

Risk for relapse:
-Perfectionist, goal driven

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54
Q

Bipolar I Treatment

A

Mood stabilizers

  • Lithium: good for when there is both mania and MDD
  • If intolerant to lithium…valproate, carbamazepine, other anti-seizure meds

Meds + Psychosocial support the best

Therapies:

  • CBT and Interpersonal & Social Rhythm Therapy
  • FFT
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55
Q

Bipolar II Diagnosis

A
  • One hypomanic episode (3-4 days)…does not cause significant impairment nor hospitalization
  • One MDD episode…depressed mood + anhedonia
  • Increase creativity, productivity, efficiency (without impairment)
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56
Q

Bipolar II Diagnostic Specifiers (9)

A
  • Status
  • Mild/Moderate/Severe
  • With anxious distress
  • With mixed features
  • With rapid cycling
  • With congruent mood/mood incongruent psychotic features
  • With catatonia
  • With peripartum onset
  • With seasonal pattern
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57
Q

Cyclothymic Disorder

A
  • Multiple episodes of hypomanic symptoms
  • Multiple episodes of depressive symptoms (not meeting MDD)
  • Must last for 2 years in adults, 1 year in children
  • Cause significant distress + impaired functioning
  • Symptoms present for at least half the time; can’t be without symptoms for 2+ months

Can’t meet criteria for manic/hypomanic/MDD episode

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58
Q

Separation Anxiety Disorder Diagnosis
7 Symptoms
Timeline

A
  • Developmentally inappropriate fear/anxiety related to separation from the home or attachment figures
  • Distress when anticipating separation from home and/or attachment figure
  • Persistent worry about losing the attachment figure
  • Refusal to leave home without the attachment figure
  • Refusal to go to sleep without being near the attachment figure
  • Nightmares about separation
  • Physical symptoms even at thought of separation

Causes significant distress and impaired functioning

Symptoms present for 4 weeks in children, 6 months in adults

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59
Q

School Phobia + School Refusal

A

May be related to Separation Anxiety
In children aged 5-7 this is due to separation anxiety
In adolescents, it may be more indicative of another underlying mental illness

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60
Q

Separation Anxiety Etiology

A
  • Parental over protectiveness
  • Previous trauma
  • Past separations
  • Life stressors
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61
Q

Separation Anxiety Disorder Treatment (according to the DSM)

A
  • Behavioural therapies such as systematic desensitization, contingency management
  • CBT with the goal of fostering adaptive thinking
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62
Q

Selective Mutism Diagnosis + Treatment

A
  • Consistent failure to speak in specific social situation where speaking is expected
  • They can speak in other situations
  • Impairs educational and occupational achievement or social occupation
  • Onset before age 5
  • Underlying feeling is fear and anxiety, not counterwill

Treatment:

  • Behavioural and cognitive
  • Desensitization and relaxation
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63
Q

Specific Phobia Diagnosis

A
  • Fear/anxiety about a specific object or situation
  • This situation ALWAYS causes the distress
  • Avoidance or endures the stimuli with great distress
  • Fear is not proportionate to the danger actually present
  • Impaired functioning
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64
Q

Specific Phobia Etiology

A
  • Most start in childhood
  • Hereditary
  • Neurotransmitter abnormalities
  • Dysfunctional cognitions
  • Observational learning
  • Classical conditioning (John Watson and poor little Albert)
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65
Q

Specific Phobia Treatment

A

Exposure with response prevention

Relaxation exercises

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66
Q

Social Anxiety Disorder Diagnosis

A
  • Marked anxiety about one + social situation where a person is exposed to the scrutiny of others
  • Avoidance or endures situations with marked distress
  • Symptoms must last for 6+ months
  • Causes impaired functioning and high distress
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67
Q

Social Anxiety Disorder Etiology

A
  • Heredity
  • Behavioural inhibition
  • Direct conditioning
  • Observational learning
  • Cognitive biases
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68
Q

Social Anxiety Disorder Treatment

A
  • Exposure
  • Social skills training, cognitive restructuring
  • Medication
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69
Q

Panic Attack Symptoms

A

An abrupt surge of intense fear that reaches a peak within minutes. Includes at least 4 symptoms

  • Heart palpitations
  • Sweating
  • Trembling, shaking
  • SOB
  • Dizziness
  • Chest pain
  • Parethesias (pins and needles)
  • Depersonalization/derealization
  • Fear of losing control & dying
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70
Q

Panic Disorder Diagnosis

A

-Recurrent and unexpected attacks with at least one attack being followed by one month of persistent concern about having another attack and significant maladaptive change in behaviour related to them

Must first rule out:

  • Hyperthyroidism
  • Seizure disorder
  • Cardiac arrhythmia
  • Other medical disorders

Onset:
-20-24 years

Risk:
-Increase risk of suicide

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71
Q

Panic Disorder Etiology

A

Genetic
Classical conditioning
Cognitive biases (especially regarding body related cues)

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72
Q

Panic Disorder Treatment

A

-CBT + meds

Common meds:

  • Imipramine
  • Other TCA
  • SSRI
  • Benzodiazepine
  • *High risk of relapse when med not taken**

Therapies:

  • Panic control therapy: brief form of CBT developed by David Barlow. Includes exposure, restructuring, relaxation
  • Interoceptive Exposure: used with CBT. Exposure to physical sensations associated with panic attack
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73
Q

Agoraphobia Diagnosis

A

-Presence of anxiety in at least 2 situations
LA TOE (Lines, Alone, Transport, Open, Enclosed)
-Situations are avoided for fear of having no escape if they have embarrassing or incapacitating symptoms
-Situations always have:
Anxiety, require the presence of a safe companion, and are endured with intense anxiety
-Anxiety is not proportional to danger present

Must first rule out:

  • Specific phobia (they are likely to have ~one agoraphobic situation and it is more related to the situation itself, not embarrassment)
  • Social Anxiety Disorder (mostly related to negative evaluation, they are often fine when left alone)
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74
Q

Agoraphobia Treatment

A
  • In vivo exposure

- Success rates boosted when significant others are involved in treatment

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75
Q

Generalized Anxiety Disorder Diagnosis

A 
-Excessive worry about events/activities that lasts for ~6 months 
Includes 3 or more symptoms (1 or more for children)
-Restlessness/feeling on edge
-Easily fatigued
-Difficulty concentrating
-Irritability
-Muscle tension
-Sleep disturbance

Onset:
30+ years
Most common MI in older adults

Difficulties with controlling the worries
Significant distress and impairment
Many have comorbid disorders, such as depression and other anxiety disorders

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76
Q

GAD Etiology

A

Genetic
Behavioural inhibition
Neuroticism
Cognitive Theory: automatic catastrophic thoughts maintain anxiety and cause avoidance behaviours

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77
Q

OCD Diagnosis

A

Obsessions: recurrent and persistent thoughts, urges or images that are intrusive and unwanted and cause marked anxiety and distress
Compulsions: repetitive behaviours and mental acts that a person feels compelled to perform in response to an obsession or rigid rules. The purpose is to reduce anxiety, but it doesn’t actually work

Must be time-consuming (more than 1 hour per day) and/or cause distress and impairment

Symptoms for 12+ months
Affects both genders equally
Presents in males before females (10 years for males)

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78
Q

OCD Specifiers (related to insight)

A
  1. Good/fair insight
  2. Poor insight
  3. Absent insight/delusional beliefs
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79
Q

OCD Etiology

A
  • Heredity
  • Low 5-HT
  • Brain abnormalities: orbitofrontal cortex, caudate nucleus
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80
Q

OCD Treatments

A 
Exposure with ritual prevention + CBT
Medications:
-Clomipramine (TCA)
-Fluvoxamine 
-Sertraline

Therapy + Meds is the best

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81
Q

Body Dysmorphic Disorder
Symptoms
Onset
Specifiers

A

Diagnosis:

  • Preoccupation with defect or flaw in appearance that are hardly noticeable by others
  • Repetitive behaviours or mental acts related to defect (checking, grooming, hiding)

Onset:

  • A bit more common in women
  • Begins in teens

Specifiers

  • Good/fair insight
  • Poor insight
  • Absent insight/delusional beliefs
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82
Q

Hoarding Disorder
+ specifiers

A

Diagnosis:
-Difficulty throwing out or giving up possessions, regardless of their value

Specifiers:

  • Good/fair insight
  • Poor insight
  • Absent insight/delusional beliefs
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83
Q

Trichotillomania

A
  • Pulling of one’s hair
  • Repeated attempts to stop, but to no avail
  • Distress and impairment
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84
Q

Reactive Attachment Disorder

A

Summary: child doesn’t develop attachments, mood is erratic, stuck in 3 F’s

Symptoms (start before 5yo):

  • Emotionally withdrawn
  • No connection seeking towards CG
  • Low positive affect
  • Unexplained irritability, sadness, fearfulness, withdrawal
  • Little smiling
  • No asking for support
  • Lack of response to connect seeking from CG’s
  • No interest in play
  • Changes in routine & unsolicited comfort may be met with external or internal rage

Requires child to have extreme developmental trauma such as neglect, repeated separations, unusual rearing that disrupts attachment

Child must developmentally be at least 9 months

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85
Q

Disinhibited Social Engagement Disorder

A

Summary: low boundaries with everyone
Has ~2 of:
-Low restraint in approaching & interacting with unfamiliar adults
-Over familiar behaviour with strangers
-Low checking with CG after venturing away from them
-Willingness to go with unfamiliar adults

Child must have history of developmental trauma

  • Neglect
  • Repeated separations
  • Unusual rearing

Must have developmental age of 9mo

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86
Q

PTSD Diagnosis

A

Different criteria for all age groups, but all include 4 symptoms:

  1. Intrusive: reexperiencing trauma
  2. Avoidance: avoid memories, thoughts, reminders
  3. Negative cogs/mood: guilt, shame, fear
  4. Increased arousal: hypervigilance, reckless

Adults/kids/teens exposure occurs:

  1. direct
  2. witnessing it happen
  3. Learning it happened to close person
  4. Repeated exposure to details

Kids >6 yo exposure occurs:

  1. Direct
  2. Witnessing it
  3. Learning it happened to P-CG

Symptoms for longer than 1mo

w/ Delayed expression = full diagnosis not met until 6mo after event

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87
Q

PTSD Treatment

A

Therapy:

  • Multicomponent CB intervention
  • Cognitive processing therapy
  • Psychological debriefing NOT WORK
  • EMDR
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88
Q

Acute Stress Disorder

A 
-Similar to PTSD 
Must have min 9 symptoms from 5 categories:
-Intrusion
-Negative mood
-Dissociation
-Avoidance
-Arousal

Symptoms last 3 days-1 month

89
Q

Adjustment Disorder
Symptoms + Specifiers (5)

A

Development of symptoms in response to 1+ psychosocial stressors within 3 months of said stressors

  • Distress is disproportionate to stressor
  • Symptoms remit within 6 months

Specifiers:

  • With depressed mood
  • With anxiety
  • With mixed anxiety and depressed mood
  • With disturbance of conduct
  • Unspecified

Not diagnosed when symptoms are due to bereavement

90
Q

What gets disrupted in Dissociative Disorders?

A

Include a disturbance in normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control and behaviour

91
Q

Dissociative Identity Disorder

A

2+ distinct personalities, with gaps in recall of events, personal info, personal traumas. Cannot be explained by typical forgetfulness

Not related to accepted cultural/religious practices

Clients typically unaware of their symptoms

Childhood abuse is a risk factor

92
Q

Dissociative Amnesia

A

-Inability to recall important autobiographical information…not explained by forgetfulness

Specifier: dissociated fugue (purposeful wandering away from home and forgets one identity and other important details)

Risk: trauma

93
Q

Forms of Dissociative Amnesia (3)

A
  1. Localized Amnesia: forget ALL events related to a period of time
  2. Selective Amnesia: Forget SOME events related to a period of time
  3. Generalized Amnesia: Uncommon, but may include forgetting personal identity and semantic/skill knowledge
94
Q

Depersonalization Disorder

A

Sense of unreality, detachment, being an outsider observing one’s own thoughts, feelings and actions

Actual sense of reality is intact

Recurrent

95
Q

Derealization Disorder

A

Sense of unreality or detachment from one’s surroundings

Actual sense of reality is intact

Recurrent

96
Q

Somatic Symptoms Disorder

A

-1 or more somatic symptom that cause distress and impairment with excessive thoughts, feelings and behaviours associated with symptoms

At least one of three symptoms:

  • Excessive time/energy devoted to symptoms and concerns about health
  • Persistently high levels of anxiety about health
  • Disproportionate and persistent thoughts about the seriousness of the symptoms

More than 6 months, though symptoms may not be continuously present

More common in females

Specifiers:
-With predominant pain

97
Q

Illness Anxiety Disorder

A

Preoccupation with having a serious illness
Absence of somatic symptoms or presence of mild symptoms
High level of anxiety about health
Performance of excessive health related behaviours or maladaptive avoidance of medical care
Symptoms last for 6 months or longer…the feared illness may change over this time

98
Q

Conversion Disorder (Functional Neurological Symptoms Disorder)

A

-At least 1 symptom that involved an alteration in voluntary motor and sensory function. Not related to neurological/medical conditions

Specifiers:

  • With weakness or paralysis
  • With attacks or seizures
  • With anesthesia or sensory loss
99
Q

Factitious Disorder Diagnosis

A

2 types:

  1. FD imposed on self
  2. FD imposed on other

Summary: falsifying physical/psychological symptoms, but it is all deception with no external reward

  • Exaggerating
  • Simulating
  • Inducing

Munchausen Syndrome is most severe presentation of this

100
Q

Munchausen Syndrome

A

Falls under diagnosis of FD

-Predominantly ‘physical issues’
Can include extensive travel and seeking of unnecessary invasive procedures
-Impersonation and fabrication

101
Q

Factitious Disorder Differential Diagnosis

A

Malingering: intentional production of exaggerated physical/psychological symptoms for personal gain (e.g. legal reasons)

Discrepancy between symptoms and objective findings
Person is uncooperative during evaluation and treatment
Person may have antisocial PD

102
Q

Factitious Disorder Treatment

A

Symptom management
Need strong therapeutic alliance, support and consistent care
Confrontational techniques not recommended due to premature termination
Inpatient treatment may just support the persons deception related to symptoms

103
Q

Pseudocyesis

A

Woman has all symptoms of pregnancy except the fetus

104
Q

Sleep Wake Disorder Summary

A

Involves problems related to quality, timing and amount of sleep that causes daytime distress and impaired functioning

105
Q

Insomnia Disorder Diagnosis

A

Dissatisfaction with sleep quality or quantity due to one more more symptoms:

  1. Difficulty getting to sleep
  2. Difficulty maintaining sleep
  3. Early morning awakening and inability to return to sleep
    - Causes SD/IF
    - 3+ nights per week
    - Ongoing for 3+ months
    - Occurs even with sufficient opportunities for sleep
106
Q

Insomnia Etiology

A
  • Major life events

- Less severe but chronic daily stresses

107
Q

Insomnia Treatment

A

Meds:

  • Benzodiazapine
  • Antihistamine

Therapies:

  • Sleep restriction: restrict time in bed
  • Stimulus control: strengthen bed and bedroom cues for sleep
  • Sleep hygiene education
  • Relaxation training
  • Cognitive restructuring
108
Q

Hypersomnolence Disorder

A

Diagnosis:
-Excessive sleepiness despite sleeping minimum 7 hours
w/ at least one of the following occurring:
-Recurrent daytime sleep episodes
-Prolonged sleep for more than 9 hours that is nonrestorative
-Difficulty being fully awake after abrupt awakening

Occurs min 3x per week for 3 months

109
Q

Narcolepsy

A

Diagnosis:
-Recurrent periods of irresistible need to sleep, lapsing into sleep, that occur in same day
-3+ times per week for ~3 months
Required for diagnosis:
-Cataplexy: brief loss in muscle tone, triggered by emotional arousal
-Hypocretin Deficiency: hormone involved in regulation of sleep
-REM Latency: less than or equal to 15 minutes

-May experience hallucinations
Hypnogogic (falling asleep)
Hypnopompic (waking up)

110
Q

Obstructive Sleep Apnea Hypopnea Diagnosis

A

Requires polysomnographic evidence of:

  • 15< obstructive apneas per hour or 15< hypopneas (airflow reduction) per hour
  • Sleep with disturbance in nocturnal breathing (snoring, snorting, breathing pauses)
  • Daytime sleepiness, fatigue, unrefreshing sleep despite enough sleep
111
Q

Sleep Apnea Etiology
GOMME

A
  • Genetic disorders that disrupt upper airway
  • Menopause
  • Obesity
  • Endocrine disorder
  • Medications
112
Q

Sleep Apnea Treatment

A

Mild symptoms:

  • Positional therapy (pillows, etc)
  • Nose strips
  • Oral/dental appliances

Moderate symptoms:
-CPAP (continuous positive airway pressure)

113
Q

Circadian Rhythm Sleep-Wake Disorder

A

Recurrent pattern of sleep disruptions due to alteration of circadian system

Results in insomnia or excessive sleepiness

114
Q

Non-REM Sleep Arousal Disorder

A

Diagnosis:

  • Recurrent episodes of incomplete awakening that occur during Stage 3 or 4 in the first 1/3 of a sleep episode
  • Sleep walking OR night terrors (no recall once awake)
  • Occurs mostly in childhood then reduces

Specifiers:

  • Sleep walking type
  • Sleep terror type
115
Q

Nightmare Disorder

A
  • Recurrent, extended, dysphoric and well remembered dreams that involve efforts to avoid threats to survival, security or physical integrity
  • Usually occur during REM in second half of major sleep episode
  • After awakening, anxiety may linger
116
Q

REM Sleep Behaviour Disorder

A

Diagnosis:

  • Recurrent episodes of arousal during REM, usually during later sleep period
  • Vocalizations, complex motor behaviour consistent with the dream
  • Wake up alert and not confused, remember dream

Etiology:

  • Nerve pathways that are supposed to paralyze you during sleep are being lazy
  • May co-occur with narcolepsy
117
Q

Restless Leg Syndrome

A
  • Sensorimotor neurological sleep disorder that involves urge to move legs in response to unpleasant sensation in them
  • Worsens during inactivity and is relieved by activity
  • Worse in evening/night
  • 3x per week for min 3 months
118
Q

Feeding and Eating Disorders-Summary

A

Persistent disturbance of eating behaviour, leading to altered consumption/absorption of food that impairs physical health and psychosocial functioning

119
Q

Pica

A
  • Persistent eating of non-nutritious, non-food substances
  • Lasts at least one month
  • Most common in young children, and pregnant women
  • Common w/ intellectual disability (severity worsens as disability does)
120
Q

Rumination Disorder
Symptoms + Etiology

A

RUMI Barfs it Up

Diagnosis:

  • Repeated regurgitation of food for at least one month
  • It may be re-chewed, re-swallowed, spit out
  • Not bc of a medical disorder
  • Onset: 3-12 months
  • May result in weight loss and/or malnutrition

Etiology:

  • Neglect
  • Stress
  • Parent-child issues
121
Q

Avoidant Restrictive Food Intake Disorder (ARFID)

A

Afraid of Food

Diagnosis:
-Don't eat adequately with one or more of the following...
Weight loss/not meeting weight gains
Nutritional deficiency
Dependence on feeding tube/supplements
Psychosocial functioning impairments
  • No medical condition
  • Linked to FAILURE TO THRIVE
  • Like AN, but no dysmorphia
  • Pathological Picky Eating
122
Q

ARFID Etiology

A
  • More likely in those with ASD, ADHD, Intellectual Disability
  • More likely in children who don’t outgrow picky eating
  • Comorbid with anxiety disorders
123
Q

Anorexia Nervosa Diagnosis
Symptoms
Status
Types
Severity

A

More psychological than ARFID

Diagnosis:

  • Restriction of food = low body weight
  • Fear of gaining weight
  • Distortions in: self image, importance given to body weight or shape through self-evaluation, denial of seriousness of the problem

Subtypes:

  1. Restricting type
  2. Binge-eating/purging type

Specifiers:

  1. In partial remission
  2. In full remission

Severity:

  1. Mild (BMI = 17+)
  2. Moderate (BMI = 16-16.99)
  3. Severe (BMI = 15-15.99)
  4. Extreme (BMI <15)
124
Q

AN Comorbid Conditions

A

Bipolar
Depression
Anxiety
Alcohol + SU disorders

125
Q

AN Etiology

A
  • Onset: adolescence/young adulthood
  • Earlier onset = shorter duration
  • More common in females
  • Associated with cultures that encourage thinness (modelling, athletics, etc)
  • Upper/middle class backgrounds
  • Common in overprotective or depressed mothers, uninvolved fathers
  • Parenting that focuses on ‘perfect children’
  • May have higher 5-HT (anxiety, irritablity, obsessional thinking) Food restriction lowers 5-HT
126
Q

AN Treatment

A
  • Multidisciplinary
  • Family therapy (structural family therapy shows good evidence)
  • CBT = moderate support
  • Goal is to mitigate health problems and treatment may often require hospitalization
127
Q

Bulimia Nervosa Diagnosis
Symptoms
Status
Severity

A

Weight is within normal range unlike AN Binge/Purging Type

LACK of control, whereas AN is TOO MUCH control

Diagnosis:

  • Recurrent episodes of binge eating followed by compensatory behaviours
  • Occur ~once a week for 3 months

Specifers:

  1. In partial remission
  2. In full remission

Severity (based on # of compensatory beh)

  1. Mild = 1-3
  2. Moderate = 4-7
  3. Severe = 8-13
  4. Extreme = 14+
128
Q

BN Etiology (5)

A 
Onset: adolescence/young adulthood
More common in females
Associated with:
-Childhood obesity
-Early puberty
-Low self esteem
-Childhood sexual abuse
-Life stressors
129
Q

BN Comorbid Illnesses

A
  • Higher risk of suicide
  • Bipolar
  • Depression
  • Anxiety
  • PD’s, esp BPD
  • SUD’s
130
Q

BN Treatment

A
  • CBT
  • Interpersonal therapy
  • Meds: antidepressants
  • High 5-HT
131
Q

Binge Eating Disorder

A

No compensatory behaviours

Diagnosis:
-Recurrent episodes of binge eating with at least 3+ of...
Eating rapidly
Eating until uncomfortably full
Eating a lot when not hungry
Eating alone out of embarrassment 
Disgusted/guilt after 
-Binges occur at least once a week for 3 months

Specifiers:

  1. In partial remission
  2. In full remission

Severity (based on episodes per week)

  1. Mild = 1-3
  2. Moderate = 4-7
  3. Severe = 8-13
  4. Extreme = 14+
132
Q

Atypical Anorexia (other specified/unspecified disorder)

A

Anorexic behaviours but with normal BMI

133
Q

Bulimia Nervosa of low frequency/duration (other specified/unspecified disorder)

A

Occurs less than once a week for less than 3 months

134
Q

Purging Disorder (other specified/unspecified disorder)

A

Purging in absence of binge eating

135
Q

Night Eating Syndrome

A
  • Waking up throughout the night to eat
  • Eat a quarter of your daily calories after dinner, which causes you distress
  • Related to insomnia
136
Q

Enuresis Diagnosis
Symptoms
Subtype
Prognosis

A
  • Repeated peeing into bed or clothes (intentionally or involuntarily)
  • Occurs 2x a week for ~3 months, or causes SD/IF
  • Must be chronologically/developmentally ~5 yo
  • Not always a medical thing

Subtypes:

  1. Nocturnal only (most common)
  2. Diurnal only
  3. Both

Characterizations:

  1. Primary: child is 5 and never established continence
  2. Secondary: disturbance develops after period of continence

Prognosis: 99% of clients remit by adulthood

137
Q

Enuresis Etiology

A
  • Lax toilet training
  • Psychosocial stress
  • Delays in development of circadian rhythm of urine production
  • Most common in children with enuretic fathers
138
Q

Enuresis Treatment

A
  • Urine alarm bell and pad technique (classical conditioning). More effective than meds
  • Family/individual therapy esp if it’s related to a stressor
139
Q

Encopresis
Symptoms /Timeline
Specifiers (2)
Characterizations (2)

A
  • Recurrent pooping in inappropriate places, intentionally or not
  • At least once a month for 3 months
  • Chronological/developmental age of 4yo

Specifiers:

  • With constipation and overflow incontinence
  • Without constipation and overflow incontinence

Characterizations:

  1. Primary: person never established continence
  2. Starts after a period of continence
140
Q

Encopresis Treatment

A

No evidence based treatment
Medical management helpful when constipation is the underlying problem
When deliberate, ODD and CD may be involved
-Behavioural and family therapies

141
Q

Sexual Dysfunctions Overview
Disqualifiers
Timeline
Specifiers
Severity

A

Disturbance in sexual response or sexual experience

Symptoms cannot be explained by:

  • Another mental illness
  • Relationship distress
  • Other stressors
  • Medical condition
  • Substance use/medication

Must persist for ~6 months

Specifiers:

  1. Life long: since onset of sexual activity
  2. Acquired: after period of sexual functioning
  3. Generalized: occurs with all types of stimulation, situations, partners
  4. Situational: only with certain types of stimulation, situations, partners

Severity coded based on distress

  1. Mild
  2. Moderate
  3. Severe
142
Q

Premature Ejaculation
Symptoms +Treatment

A

Diagnosis:

  • Jizzing within one minute of penetration
  • Happens before person wishes it
  • Occurs 75-100% of the time

Treatment:

  • Squeeze and stop-start techniques
  • Female superior position recommended
  • SSRI’s & topical desensitizing agents
143
Q

Delayed Ejaculation

A

Diagnosis:

  • Marked delay, infrequency, absence of ejaculation
  • 75-100% of the time
144
Q

Erectile Disorder

A 
Diagnosis:
-One of the three...
Can't achieve erection
Difficult maintaining erection
Decrease in erectile rigidity 
-75-100% of the time
-Rule out:
Diabetes
MS
Smoking
Alcohol

Treatment:

  • CBT (Master & Johnson)
  • Medication (viagra)
145
Q

Female Orgasmic Disorder

A

Diagnosis:

  • Marked delay, infrequency or absence of orgasm
  • Reduced sensation of orgasm
  • 75-100% of the time

Treatment:

  • Sensate focus
  • Directed masturbation
  • Kegel exercises
146
Q

Female Sexual Interest/Arousal Disorder

A 
Diagnosis:
-Lack or reduced sexual interest/arousal evidence by ~3 of...
Absent/reduced sexual interest
A/R sexual thoughts/fantasies
Reduced sexual initiation
Low receptivity to partners initiation
A/R pleasure (75-100% of time)
A/R interest/arousal to sexual cues
A/R sensation during sexual activity
147
Q

Genito-Pelvic Pain/Penetration Disorder

A

Diagnosis:
-Recurrent difficulties with 1 or more of…
Penetration
Pain during penetration attempts
Anxiety about pain
Tensing of pelvis during attempted penetration

Treatment:

  • Relaxation training
  • Manual stimulation
  • Progressive dilation of vagina
148
Q

Male Hypoactive Sexual Desire Disorder

A

Diagnosis:

-A/R sexual thoughts/fantasies/desires

149
Q

What substances may impact Sexual functioning? (6)

A

Substances that can cause it…

  • Alcohol
  • Opioids
  • Sedatives
  • Hypnotics
  • Anxiolytics
  • Stimulants
150
Q

Gender Dysphoria Diagnosis Children

A

-Marked incongruence between assigned gender and experienced/expressed gender
-At least 6 of the following…
Desire to be of other gender/insistence that they are
Preference for cross dressing
Preference for cross gender roles in play
Preference for activities, toys, games that are stereotypically of the other gender
Preference for playmates of other gender
Rejection of things that are stereotypically of the same gender
Dislike of ones sexual anatomy
Desire sex characteristics of other gender

Lasts for ~6 months

151
Q

Gender Dysphoria Diagnosis Adults
6 Characteristics

A

-Incongruence between assigned and experienced/expressed gender
-At least 2 of the following…
Shown in ones experienced/expressed gender and sex characteristics
Desire to be rid of ones sex characteristics
Want sex characteristics of other gender
Desire to BE the other gender
Desire to be treated as the other gender
Believe that one has feelings/reactions of the other gender

152
Q

Gender Dysphoria Etiology

A

More common in bio males
Onset 2-4yo in kids, persistent rates 2-50%
Late onset occurs at puberty or later, more common in males

153
Q

Paraphilic Disorders Summary

A

Intense and persistent sexual urges, fantasies, behaviours that involve non-human objects, the suffering of ones self or one’s partner, children or other nonconsenting persons

It causes distress or impairment to the individual, or whose satisfaction involves personal harm or risk or harm to others

Specifiers:

  1. In a controlled environment: person living in an institutional setting, opportunities to engage in paraphilia are limited
  2. In full remission: has not acted on urges, has not experiences distress or impairment while in an uncontrolled environment
154
Q

Voyeuristic Disorder

A

Diagnosis:

  • Observing an unsuspecting person who is naked and/or engaging in a sexual activity
  • Client is 18+
  • Must occur for minimum 6 months
155
Q

Exhibitionist Disorder

A

Diagnosis:

Exposing one’s genitals to a stranger

156
Q

Frotteuristic Disorder

A

Diagnosis:

-Rubbing or touching a non-consenting person

157
Q

Sexual Masochism Disorder

A

Diagnosis:

-Being humiliated, beaten, bound, made to suffer

158
Q

Sexual Sadism Disorder

A

Diagnosis:

-Sexual excitement resulting from physical or psychological suffering of another

159
Q

Pedophilic Disorders

A

Diagnosis:

  • Sexual contact with prepubescent child (>13 yo)
  • Perp must be min 16 years old, and at least 5 years older than the object of desire
160
Q

Fetishistic Disorder

A

Diagnosis:

-Use of non-living objects for sexual gratification

161
Q

Transvestic Disorder

A

Sexually aroused by wearing women’s clothing
Occurs mostly in men
Most of the men identify as het, thought some engage in sexual activity with other men while “cross dressed”

162
Q

Personality Disorders Summary

A

Enduring patterns of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture

They must have symptoms by adolescence or early adulthood
Cause SD & IF
Can be diagnosed in minors if symptoms present for >1 yr Not ASPD

Affects three areas:

  • Cognition
  • Affect
  • Interpersonal functioning
  • Impulse control
163
Q

Cluster A Personality Disorder

A

Odd, eccentric

  • Paranoid
  • Schizoid
  • Schizotypal
164
Q

Cluster B Personality Disorders

A

Dramatic, emotional, erratic

  • Antisocial
  • BPD
  • Histrionic
  • Narcissistic
165
Q

Cluster C Personality Disorders

A

Anxiety, fearfulness

  • Avoidant
  • Dependent
  • OCD PD
166
Q

Paranoid Personality Disorder
Pattern (1)
Symptoms (9)

A

Diagnosis:
-Pattern of suspiciousness towards others due to interpreting their motives as malevolent
-Must have 4+…
Suspects-without evidence-that others are exploiting, harming, deceiving them
Preoccupied with doubts about peoples loyalty
Reluctant to confide in others in case its used against them
Misinterprets benign remarks
Persistently bears grudges
Perceives attacks on reputation and reacts with anger
Unjustified suspicion about fidelity of partner
-May be argumentative, complain a lot, hostile aloofness
-Interpersonal difficulties

167
Q

Schizoid Personality Disorder

A

Diagnosis:
-Pattern of detachment from interpersonal setting
-Must have 4+…
Doesn’t want or enjoy close relationships
Prefers solitude
Little interest in sexual experiences with another
Pleasure in few activities
Lacks close friends other than first degree relatives
Appears indifferent to praise/criticism
Cold, flattened affect
-Appears introverted & preoccupied
-Social contact may impair work, but they are fine working in solitude

168
Q

Schizotypal Personality Disorder
Symptoms (10)

A

Diagnosis:
-Interpersonal deficits…discomfort in social situations and reduced capacity for close relationships
-Must have 5+…
Belief that irrelevant things are aimed at them
Odd beliefs that influence behaviours
Unusual perceptual experiences (not delusions)
Odd thinking and speech
Paranoid ideation
Inappropriate/flat affect
Odd behaviour & appearance
Lack of close friends
Social anxiety
-They may want close relationships, but their behaviour suggests otherwise

169
Q

Antisocial Personality Disorder
7 Characteristics

A 
Diagnosis:
-Pattern of disregard and violation of the rights of others
-Occur since ~15yo
-History of CD before 15yo
-Must have 3+...
Not confirm to norms for lawful behaviour
Deceitfulness
Impulsivity
Irritability/aggressiveness
Reckless disregard for safety
Irresponsibility
Lack of remorse
-Chronic, but may reduce with age
170
Q

ASPD Etiology

A
  • Heredity
  • Family (parenting with high negativity, low warmth, inconsistency)
  • Personality traits: low empathy, lower than normal autonomic response to threatening stimuli
171
Q

ASPD Treatment

A

Therapies:

  • Multisystemic therapy: targets chronic violence, substance use. Often done in high risk, out of home placements
  • Home based family therapies, child-family therapies, CBT interventions
172
Q

BPD

A 
Diagnosis:
-Pervasive instability in:
Interpersonal relationships
Self image
Affect (+ impulsivity)
-Symptoms occur in multiple contexts
-Must include 5+
Efforts to avoid real/imagined abandonment
Unstable interpersonal relationships (idealization to devaluation)
Identity disturbance
Impulsivity 
Suicidal behaviours
Affective instability
Chronic feelings of emptiness
Inappropriate anger
Transient paranoid ideation/dissociative symptoms
173
Q

BPD Etiology

A
  • Object Relations Theory (Mahler): issues in the separation-individuation that lead to a fixation; vacillate between need for separation and fear of abandonment; good CG/bad CG
  • Kernberg: inconsistent parenting that switches from nurturing to avoidant to punitive. This results in splitting
  • Linehan: pervasive dysregulation caused by biological vulnerability to high emotionality + inability to regular, and exposure to invalidating parenting with inconsistent parenting
174
Q

BPD Treatment

A

DBT very evidence based

  1. Group skills training
  2. Individual outpatient therapy
  3. Telephone coaching
175
Q

Histrionic Personality Disorder

A

Histrionic Horny Harriet

Diagnosis:
-Pattern of emotionality and "attention-seeking"
-Begins in early adulthood
-Present in multiple contexts
-Must have 5+...
Discomfort when not center of attn
Inappropriately seductive
Rapidly shifting & shallow affect
Consistent use of physical appearance to draw attention
Excessive impressionistic speech 
Self dramatization
Highly suggestible 
Considers relationships more intimate than they are
176
Q

Narcissistic Personality Disorder

A 
Diagnosis:
-Pattern of grandiosity in fantasy or behaviour
-Need for admiration
-Lack of empathy
-Symptoms present in multiple contexts
-Must include 5+...
Grandiose sense of self
Preoccupation with fantasies of unlimited success, power, beauty
Believe they are unique, understood by high status peoples
Requires excessive admiration
Sense of entitlement 
Interpersonally exploitive 
Lacks empathy
Envious of others
Arrogant

-Symptoms cause interpersonal strain

177
Q

Avoidant Personality Disorder
Pattern (3)
Symptoms (9)

A

Diagnosis:
-Pervasive pattern of:
Social inhibition
Feeling inadequate
Hypersensitivity to negative evaluation
-Symptoms occur in multiple contexts
-Must include 4+…
Avoids activities requiring high interpersonal contact (fear of criticism, rejection, disapproval)
Unwilling to get involved unless certain they will be liked
Restraint in intimate relationships
Preoccupied with being criticised/rejected
Inhibited in new interpersonal situations
Views self as socially inept, inferior
Reluctant to take risks
-No close relationships outside of immediate family
-Long for relationships and fantasize about ideal ones

178
Q

Dependent Personality Disorder

A

Diagnosis:
-Pervasive need to be cared for
-Submissive, clingy, fear separation
-Begins in early adulthood
-Occurs in multiple contexts
-Must have 5+ symptoms…
Indecisive without reassurance from others
Needs others to take responsibility for their lives
Difficult disagreeing with others
Difficulty initiating their own projects
Goes to lengths to receive nurturance
Uncomfortable/helpless when alone
Urgently seeks new relationships when one ends
Preoccupied with fear of being left to care for themselves

Must be excessive & not a cultural norm

179
Q

OCD Personality Disorder

A

Diagnosis:

  • Pervasive preoccupation with:
    1. orderliness
    2. perfectionism
    3. Mental/interpersonal control
  • Symptoms result in limited:
    1. Flexibility
    2. Openness
    3. Efficiency
  • 4+ of…
    1. Preoccupation with details/rules/lists
    2. Perfectionism interferes
    3. Devoted to work and productivity above all else
    4. Over conscientious
    5. Scrupulous
    6. Inflexible morals and values
    7. Can’t get rid of old items
    8. Hesitant to delegate or work with others
    9. Frugal spending style
    10. Rigidity and stubbornness

No obsessions or compulsions. Not related to OCD though they can coexist

180
Q

What medical conditions may lead to changes in personality?

A

Causes:

  • CNS neoplasm
  • Head trauma
  • Stroke
  • Huntington’s
  • Seizures
  • Infection (HIV)
  • Endocrine disorders (hypothyroidism)
  • Autoimmune conditions (Lupus)
181
Q

Disruptive Impulse-Control and Conduct Disorders Summaries

A

Violate rights of others, low control of emotions, conflict with societal norms or person’s in authority

ODD, CD, Intermittent Explosive Disorder

182
Q

ODD
Symptoms
Timeline
Specifiers

A

Diagnosis:

  1. Pattern of…
    - Angry mood
    - Argumentative/defiant
    - Vindictiveness
  2. 4+ in interactions w/ other than siblings…
    - Loses temper
    - Easily annoyed
    - Often angry/resentful
    - Argues with authority figures
    - Refuses to comply with rules
    - Deliberately annoys others
    - Blames others for mistakes
    - Spiteful
  3. Min 2x in last 6 months
  4. Causes distress for others or self
  5. Negative impact on individuals functioning

Specifiers:

  1. Mild-one setting
  2. Moderate-two settings
  3. Severe-three or more settings
183
Q

ODD Etiology

A
  • More common in families with inconsistent parenting style, especially when harsh, inconsistent and/or neglectful
  • Comorbid with ADHD and CD
184
Q

Intermittent Explosive Disorder

A

Diagnosis:

  • Recurrent behavioural outbursts
  • Can’t control aggressive impulses
  • Criteria
    1. Verbal/physical aggression 2x week for 3 months OR
    2. 3 behavioural outbursts in 12 months that have caused damage of property or physical assault that injured people or animals
  • Reaction not appropriate to stressor
  • No premeditation or end goal
  • Must be ~6 yo
185
Q

Conduct Disorder Diagnosis

A 
Pattern of behaviours that violate others rights 
Symptom groups 
1. Aggression to people/animals 
2. Property destruction
3. Deceitfulness
4. Violation of rules

Specifiers:

  1. Childhood onset: ~1 symptom >10yo
  2. Adolescent onset: no symptoms before 10 yo
  3. Unspecified onset: age unknown

Childhood onset has most severe symptoms and worst prognosis

186
Q

Conduct Disorder Etiology
Childhood VS Adolescent Onset

A
  1. Life course persistent path
    - Symptoms start at 3-4 yo
    - Increasingly serious transgressions
    - Combo of: neurological deficits, difficult temperament, hyperactivity, adverse social environment
  2. Adolescent-limited oath
    - After puberty
    - Due to maturity gap between biological & social maturity
    - Deviancy is nonconfrontational and inconsistent
    - Often peer related
    - Begins to decline in later adolescence
187
Q

Conduct Disorder Treatment

A

Most effective when began in adolescence and has family involvement
FFT, multisystemic treatment, parent management trainings

188
Q

Within what timeframe must symptoms occur for an illness to be considered substance induced?

A

Within 1 month of intoxication, withdrawal or taking meds.

189
Q

Substance Use Disorder

A

Applicable to all substances except caffeine

Diagnosis:

  • Cognitive, behavioural, physiological symptoms that show client continues to use the substance despite problems
  • 2+ symptoms for 12 months
    1. Impaired control
    2. Social impairment
    3. Risky use
    4. Pharmacological Criterion
190
Q

What are the 2 types of remission

A
  1. In early remission: sober 3-12 months

2. In sustained remission: 12+ months

191
Q

Etiology of Substance Use Disorders
3 theories, not factors

A
  1. Incentivization-Sensitization Theory
  2. Tension-Reduction Hypothesis
  3. Self-Medication Hypothesis
192
Q

Relapse Prevention Model for SUDs
FEGS

A

CBT approach focused on the factors that precede relapse

  • Environmental and emotional factors that may increase relapse
  • Self monitoring for immediate situation
  • Global life style changes (i.e. develop positive addictions)
  • Focus on situational rather than internal reasons for relapse (AVE-abstinence violation effect)
193
Q

Substance-Induced Disorders

A

Substance Intoxication

  • Reversible, caused by ingestion of substance
  • Has physiological effects on CNS
  • Can occur with all substances except tobacco

Substance Withdrawal

  • Substance specific changes due to stopping or reducing heavy use
  • Doesn’t occur with hallucinogens and inhalants
194
Q

Alcohol Withdrawal Symptoms

A
  • Autonomic hyperactivity
  • Psychomotor agitating
  • Generalized tonic-clonic-seizure
  • Transient hallucinations
195
Q

Alcohol Withdrawal Delirium Symptoms

A
  • Delirium tremens
  • Disturbance in attention, awareness and cognition
  • May include vivid hallucinations, delusions, autonomic hyperactivity, agitation
196
Q

Alcohol Induced Major Neurocognitive Disorder

A
  • Significant decline in ~1 cognitive domain that interferes with independence
    1. Non-amnestic confabulatory type
    2. Amnestic confabulatory type
  • Anterograde and retrograde amnesia
  • Procedural, LT, WM memory intact. ST impaired

-Related to thiamine deficiency

197
Q

Opioid Withdrawal Symptoms

A
  • Withdrawal is not life threatening.
  • Dysphoria
  • Nausea, diarrhea
  • Muscle aches
  • Lacrimation
  • Rhinorrhea
  • Piloerection
  • Sweating
  • Fever
  • Yawning
  • Insomnia
198
Q

Sedative or anxiolytic Withdrawal

A
  • Autonomic hyperactivity
  • Transient hallucinations or illusions
  • Seizures
199
Q

Stimulant Withdrawal

A
  • Vivid, unpleasant dreams
  • Insomnia or hypersomnia
  • Increased appetite
  • May be followed by a crash
200
Q

6 Cognitive Domains of Neurocognitive Issues
SLEEP C

A
  1. Complex attention (sustained, divided, processing speed)
  2. Executive function
  3. Learning and memory
  4. Expressive and receptive language
  5. Perceptual motor
  6. Social cognition
201
Q

Delirium
Symptoms
Causes
Specifiers (5)

A
  • A disturbance in attention and awareness that develops rapidly over a short period of time
  • ~1 disturbance in cognition: Memory deficit, Language impairment, Disorientation, Perceptual abnormalities
  • Must be medical evidence that symptoms are resultant from something physiological

Specifiers:

  • Substance intoxication delirium
  • Substance withdrawal delirium
  • Medication-induced delirium
  • Delirium due to medical condition
  • Delirium due to multiple etiologies

Etiology: age, dementia, depression, male, visual/hearing impairment, dehydration/malnutrition, alcohol, medication, functional dependence, severe illness

Triggers: infection, electrolyte imbalance, acute stroke, surgery, pain, withdrawal, some drugs

Treatment: education, environment control, haloperidol

202
Q

Major and Mild Neurocognitive Disorders

A
  1. Major Neurocognitive Disorder
    - Formerly dementia
    - Sig. decline from a prior level of functioning in ~1 cog. domain that interferes with independence
    - Does not just occur during delirium
  2. Mild Neurocognitive Disorder
    - Modest decline from prior level of functioning in ~1 domain that does not interfere with independence but may require additional effort, compensations

Specifiers:

  • Alzheimers
  • Frontotemporal lobar degeneration
  • Lewy body disease
  • Vascular disease
  • TBI
  • Substance/medication use
  • HIV
  • Prion disease
  • Parkinsons
  • Huntingtons
  • Other medical condition
  • Multiple etiologies
  • Unspecified
203
Q

Major/Mild CD due to Alzheimers (symptoms)

A
  • Criteria for mild/major NCD met
  • Symptoms have insidious onset
  • Impairment in 1 cog domain for mild, 2 for major
  1. Early Stage
    - Anterograde amnesia (no new memories)
    - Impaired attn and judgment
    - Becoming lost
    - Apathy
    - Depression
    - Irritability
    - Anomia
  2. Middle stage
    - Antero and retrograde amnesia
    - Problems reading and writing
    - Inability to remember names, family, etc
    - Mood swings, personality changes
    - Sleep disturbance
    - Fluent aphasia
    - Restlessness
    - Difficulty with complex and sequential tasks
  3. Late stage:
    - Severe impairment of most functions
    - Need daily assistance
    - Respiratory infection common
204
Q

Alzheimer’s Etiology and Treatment

A

Etiology:

  • Genetic
  • Structural brain abnormalities
  • Early onset: chromosomes 1, 14, 21
  • Late onset: chromosome 19

Treatment:

  • Behavioural interventions
  • Antipsychotics, antidepressants
  • Cholinestrase inhibitors to enhance cognitive functioning (keeps ACh high). Only helpful in early stages and is temporary
  • Better outcomes when kept at home
205
Q

Vascular Neurocognitive Disorder

A
  • Criteria for mild/major NCD met
  • Symptoms consistent with vascular etiology
  • Caused by cerebrovascular disease (affect blood supply to brain)
  • Not progressive…a stepwise decline with fluctuations
  • Prevention: hypertension, hypotension, heart disease, diabetes, heavy smoking
206
Q

Traumatic Brain Injury

A
  • Critera for major/mild NCD met
  • TBI with ~1: loss of consciousness, post traumatic amnesia, disorientation/confusion, neurological sign
  • Onset of symptoms after injury or after regaining consciousness
  • Symptoms persisted past post-injury period
  • Processing speed heavily impacted
207
Q

HIV Infection Related NCD

A

-Criteria for mild/major NCD met
-Symptoms due to damage in subcortical areas: difficulty learning new things, impaired executive functions, psychomotor slowing, apathy, social withdrawal. decline in IQ
Early symptoms:
-Forgetfulness
-Concentration issues
-Mental slowing
-Apathy
-Irritability
-Loss of balance/coordination

Later symptoms:

  • psychomotor slowing
  • ataxia
  • tremors
208
Q

Prion Disease related NCD

A
  • Criteria for mild/major NCD met
  • Insidious and rapid progression
  • Myoclonus: jerky muscle contractions
  • Ataxia
  • Biomarker evidence: Creutzfeldt-Jakob Disease is common
209
Q

Hypertension Types

A
  1. Primary (essential) hypertension
    - Age
    - Obesity
    - Chronic stress
    - Family history
    - Cigarette smoking
    - High sodium intake
  2. Secondary hypertension (related to other disorder)
    - Kidney disease
    - Artery blockage
    - Diabetes
    - Endocrine disorders
    - Pregnancy
    - Sleep apnea

Treatment:
-Life style changes and medication (anti-hypertensive meds, diuretics, anti-adrenergics, vasodilators, beta blockers, calcium channel blockers, angiotensin-receptor blockers, ACE inhibitors

210
Q

Stress Definition

A

When an individual perceives that the environmental demands tax or exceed their adaptive capacity

211
Q

General Adaptation Syndrome to Stress

A
  • Chronic stress = contributor to disease bc cortisol suppresses immune system
  • People have same physical response to all types of prolonged stress
  • 3 stages:
    1. Alarm (physiological, FFF)
    2. Resistance (prolonged stress): pituitary release ACTH = adrenal cortex releases cortisol. Increases blood glucose levels, metabolism of fats and proteins
    3. Exhaustion: pituitary and adrenal lose capacity to maintain elevated hormone levels and physical reserves are depleted. Leads to: mental/physical exhaustion, illness, collapse, death
212
Q

Transactional Model of Stress

A
  • Events are not inherently stressful or nonstressful, but its how we appraise the event
    1. Primary appraisal: relevance of event to wellbeing based on values, beliefs. May be irrelevant (no stress), positive (no stress) or challenging (stress…second appraisal)
    2. Secondary appraisal: are my resources/abilities sufficient to cope with this threatening situation? If yes, no stress response. If no, stress response.
    3. Cognitive reappraisal: monitors situation and uses new info to modify primary/secondary appraisals. This can increase or decrease the stress response
213
Q

Types of Headaches

A
  1. Migraine (classic or common)
  2. Tension
  3. Cluster (O2 therapy, anesthetic, the usual migraine meds)
  4. Sinus headache
214
Q

Major Depressive Disorder
Symptoms
Timeline
Specifiers

A
  1. Requires 5+ syptoms (1 must be depressed mood or anhedonia)
  2. May also include:
    - Appetite changes
    - Weight changes
    - Sleep changes
    - Psychomotor changes
    - Loss of energy
    - Worthlessness/guilt
    - Decreased concentration
    - Suicidal ideation
  3. Present every day for ~2 weeks
  4. Cause distress + impaired functioning
    * Children: physical complaints, irritable, social withdrawal
    * Older adults: looks like dementia
  5. May have: anxious distress, congruent/incongruent psychotic features, atypical features (weight gain, hypersomnia, leaden paralysis, rejection sensitivity)
    Peripartum onset (during pregnancy or 4 weeks post partum)
    Seasonal pattern
    Catatonia: catalepsy (holding in odd postures, rigidity of limbs), stereotypy (repetitive non-goal directed movements), mutism
215
Q

Prevalence and Etiology of MDD

A

Prevalence:

  • 7% 12 month prevalence
  • Peak onset in 20’s
  • Initially triggered by stress

Etiology:

  • Biopsychosocial
  • High genetic cause
  • Neuroticism, ACEs
  • Catecholamine hypothesis: low NE
  • Permissive theory: low NE and 5-HT
  • Stress: high cortisol damages hippocampus
216
Q

Seligman’s Learned Helplessness Model of Depression

A
  • Repeated exposure to uncontrollable negative life events + tendency to attribute life events to internal structures
  • Seligman uncontrollably slides down the inside of a volcano*
217
Q

Abramson, Metalsky & Alloy Theory of Depression

A

Hopelessness is the root cause of depression

218
Q

Lewinsohn Behavioural Theory of Depression

A

Low rate of response contingent reinforcement for adaptive behaviours
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