DSM IV 1 Flashcards
hallmarks of mental retardation
<70 IQ
deficits in adaptive functioning in at least 2 areas
onset before age 18
origin of mental retardation - prenatal vs. perinatal vs. postnatal
75% of cases are prenatal
10-15% perinatal (from one pound in utero to one month after birth)
10-15% postnatal
genetic vs environmental factors in MR
genetic factors account for only about 5% of cases of mental retardation (e.g. chromosomal abnormalities such as Down’s)
environmental factors play a much larger role - usually during embryonic development - poor maternal nutrition, poor maternal personal health habits, limited access to health care, exposure to in utero to pollutants, chemical toxins (e.g. maternal alcohol consumption)
MR comorbidities
3 - 4X more comorbid mental disorders in comparison with general population
most common - ADHD, Mood DIsorders, PDDs, Stereotypic Movement DIsorders
Male to female ratio of MR
3:2
mild mental retardation
85% of all individuals with MR
IQ 55-70
can develop social and communication skills
minimal sensorimotor impairments
can acquire skills up until 6th grade level
may achieve a minimum level of self-support
moderate mental retardation
40-55 IQ
develop communication skills and can usually attend to personal care
progress up to 2nd grade level in academic subjects
able to perform unskilled or semi-skilled work under supervision
profound mental retardation
<25 IQ
significant impairment in sensorimotor functioning and typically need highly structured environment
likely to have underlying neurological basis for their disorder
how to diagnose a learning disorder
significant discrepancy between IQ and achievement (2 or more SDs)
learning problem interferes with academic achievement or activities of daily living
comorbid disorders with LD
Conduct Dsorder
ADHD
ODD
Depressive Disorders
Reading Disorder
type of LD
significant deficits in reading achievement
seldom diagnosed before end of kindergarten
Mathematics Disorder
type of LD
significant deficits in mathematics ability
Disorder of Written Expression
type of LD
deficiency in writing skills, which interferes with writing grammatically correct sentences and organized paragraphs
Developmental Coordination Disorder
Motor Skills Disorder
deficits in daily activities that require motor coordination, which may be manifested by marked delays in achievement motor milestones or by clumsiness, poor performance in sports, or poor handwriting
Expressive Language Disorder
Communication Disorder
performance that is significantly below what would be expected in the area of expressive language
1/2 of children tend to outgrow it, while other half tend to have more long-lasting difficulties
Mixed Receptive-Expressive Language Disorder
Communication Disorder
symptoms of Expressive Language Disorder as well as problems in receptive language ability
Phonological Disorder
Communication Disorder
involves errors in sound production and use
including substituting one sound for another or omitting sounds such as final consonants
Stuttering
Communication Disorder
disturbance in the normal fluency and time patterning of speech, characterized by sound and syllable repetitions, introjections, broken words, blocking, circumlocutions, and monosyllabic whole-word repetitions
considered normal until about age 2 or 3
Pervasive Developmental Disorders
severe and pervasive problems in several areas of development, including reciprocal social interactions, communication, or presence of stereotyped behavior, interests, and activities
Autistic Disorder
PDD a) impairment in social interaction b) impairment in communication c) restricted repertoire of activities onset must be prior to age 3
comorbidities of Autistic Disorder
75% of children also diagnosed with Mental Retardation
best prognosis with Autistic Disorder
late onset
high IQ
when child speaks before age 5
male: female ratio for Autistic Disorder
4 or 5 : 1
savant
individual who has lower intelligence, but has striking and unusual abilities
Rett’s Disorder
PDD
between ages of 5 months and 48 months,
sudden deceleration of head growth,
acquisition of stereotyped hand movements, loss of social engagement, and appearance of poorly coordinated movements
severely impaired language development with psychomotor retardation
found only in females
Childhood Disintegrative Disorder
PDD
more common among males
normal development for 2 years, followed by significant loss of previously acquired skills before age 10 in at least two areas: language, social skills, play, motor skills, and bowel/bladder control
Asperger’s Disorder
PDD
impaired social interaction and restricted repertoire of behavior, but not language, cognitive problems, or adaptive problems (other than social interaction)
more common in males
onset somewhat later than Autistic Disorder
ADHD
at least six months
inattention and/or hyperactivity-impulsivity
some of symptoms must have been present before age 7
must occur in at least two settings and interfere with functioning
male: female ADHD
6-9 times more common in males than females
medications used to treat ADHD
mostly using stimulants Ritalin (methylphenidate) Concerta (metheylphenidate) Adderall (amphetamine) Dexedrine (dextroamphetamine)
ADHD over lifespan
symptoms tend to attenuate during adolescence or adolescence
treatment of ADHD
behavior therapy
social skills
parenting education
EEG biofeedback
Concomitant diagnoses with ADHD
ODD or CD
may also be higher prevalence of Mood Disorders, Anxiety Disorders, and Learning Disorders
Conduct Disorder - hallmark
persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated
4 categories of Conduct DIsorder
1) aggression to people or animals
2) destruction of property
3) deceitfulness or theft
4) serious violation of rules
Conduct Diagnostic criteria
3 criteria within a one year period, and at least one criterion in the past six months
subtypes of Conduct Disorder
Childhood-Onset (prior to age 10)
Adolescent-Onset (after age 10)
Concomitant diagnoses with Conduct Disorder
ADHD Learning Disorders Mood Disorders Anxiety Disorders Substance-Related Disorders
Prognosis for Conduct Disorder
poor prognosis associated with early onset
symptoms remit by adulthood in the majority of people
BUT substance number continue to exhibit features and meet criteria for Antisocial Personality Disorder in adulthood
Predisposing factors to Conduct Disorder
parental rejection and neglect
difficult infant temperament, inconsistent child-rearing with harsh discipline, physical or sexual abuse, lack of supervision, change in caregivers or institutional living, large family size, absent father, association with delinquent peer group
treatment for Conduct Disorder
behavior modification family therapy individual therapy social skills training medication as appropriate more severe cases - residential or inpatient treatment
Oppositional Defiant Disorder
recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures
4 criteria must be present for at least 6 months
typically present at home, may or may not be present at school, in community, or in clinical interview
Concomitant disorders with ODD
ADHD
Learning Disorder
Communication Disorder
PICA
eating nonnutritive substances for a period of at least one month
PICA is frequently associated with
Mental Retardation
Rumination Disorder
Repeated regurgitation and rechewing of food
minimum of one month period, following a period of normal functioning
age of onset between 3 and 12 months
Feeding Disorder of Infancy or Early Childhood
failure to eat adequately with significant failure to gain weight or weight loss over one month
only made when there is no general medical condition that accounts for the symptoms
onset before age 6
most closely associated with “failure-to-thrive” syndrome
Tics
sudden, rapid, recurrent, non=rhythmic, stereotyped motor movements or vocalizations
can be suppressed for a time, but eventually becomes irresistible
may increase under stress and decrease during absorbing activities
treatments for tics
Catapres (Clonidine) - anti-hypertensive
Haldol (Haloperidol) - antipsychotic
Prozac (Fluoxetine) - SSRI
Tourette’s DIsorder; treatment
MULTIPLE motor and ONE or more vocal tics
occur many times a day, nearly every day
period of one year of more
onset before age 18
Disorders comorbid with Tourette’s
ADHD is most common
Chronic Motor or Vocal Tic
single or multiple motor or vocal tics, but not both
for one year or more
onset before age 18
Transient Tic Disorder
single or multiple motor and/or vocal tics which occur many times a day for a minimum of four weeks, but not longer than 1 year
onset before age 18
Encopresis
passage of feces into inappropriate places
voluntary or involuntary
age of 4 years (chronological or mental)
at least once a month for a minimum of three months
Subtypes of Encopresis
With Constipation and Overflow Incontinence
Without Constipation and Overflow Incontinence
Enuresis
repeated voiding of urine into the bed or clothes
intentionally or involuntarily
minimal age of five years (chronological or mental)
occurs twice a week for at least three months
Subtypes of Enuresis
Noctural Only
Diurnal Only
Nocturnal and Diurnal
Remission of enuresis
99% of the time, remits by adulthood
Medications to treat Enuresis
Tofranil (imipramine) - tricyclic antidepressant
DDAVP (nasal spray)
Separation Anxiety Disorder
inappropriate and excessive anxiety concerning being away from home or away from person(s) to whom the individual is attached
at least four weeks and onset before age 18
may precede the development of Panic Disorder with Agoraphobia
Selective Mutism
minimum of one moth’s duration
onset usually before age 5
considered a childhood anxiety disorder related to social anxiety and social phobia
Reactive Attachment Disorder
significant disturbance in social relatedness in most contexts
begins before age 5 due to grossly pathological care
two subtypes of RAD
Inhibited Type
Disinhibited Type
Stereotypic Movement DIsorder
motor behavior that is repetitive and nonfunctional (e.g. body rocking, head banging, self-biting, etc)
interferes with normal activities or results in self-inflicted bodily injury
period of 4 weeks or more
Delirium
acute confusional state characterized by disturbance of consciousness and change in cognitive abilities
onset must be rapid
course must be fluctuating
reversible
symptoms remit once condition contributing to delirium is treated
Delirium most common….
in elderly and children
Dementia
impairment in short-term or long-term memory
PLUS: aphasia, praxia, agnosia, or disturbance in executive functioning
interferes with work or social activities and is decline from previous levels of functioning
Dementia of the Alzheimer’s Type
insidious onset and progressive deteriorating course
Early Onset - before age 65
diagnosed with neuropsychological testing, neurological examination, brain scans (CT or MRI)
diagnosis only confirmed with biopsy or autopsy after death
Vascular Dementia
stepwise pattern of deterioration and patchy distribution of deficits
brought out by series of small strokes
Amnestic Disorders
impairments in short-term or long-term memory
interferes with work and/or social functioning
other criteria for dementia are not met
Substance-Induced Persisting Amnestic Disorder
AKA Korsakoff’s syndrome
can be caused by alcohol or sedatives, hypnotics, and anxiolytics
caused by chronic thiamin deficiency
ANTEROGRADE amnesia most significant memory deficit
