DSM IV 2 Flashcards
Substance Use Disorders
person is having a problem with problematic, excessive use
dependence or abuse
Substance Induced Disorders
problems that come about from using substances
Substance Dependence
impaired control and continued use despite adverse consequences
3 symptoms over a 12 month period
Tension Reduction Hypothesis
1950s
mixed reviews
people drink to reduce tension, unpleasant stress
Substance Abuse
pattern of using a substance that results in problems
1 or more symptoms within a 12 month period
Substance Intoxication
effects of immediate consumption of substance
Substance Withdrawal
when you’ve stopped or cut down on substance
Effects of alcohol are identical to…
Sedatives, hypnotics, and anxiolytics
identical intoxication and withdrawal
alcohol intoxication
slurred speech, lack of incordination, stupor or coma, impaired memory and concentration
alcohol withdrawal
sympathetic branch of autonomic nervous system may become hyperactive psychomotor agitation seizures can be fatal insomnia nausea and vomiting transient hallucinations or illusions
Amphetamine intoxication
similar to cocaine intoxication
makes you UP
euphoria, hypervigilance, anger, impaired judgment
psychomotor agitation, tachycardia, nausea or vomiting, muscular weakness, perspiration or chills, respiratory problems, weight loss, confusion, seizures, coma
PUPILLARY DILATION
Amphetamine WIthdrawal
OPPOSITE of intoxication
dysphoria, fatigue, unpleasant dreams, increased appetite, psychomotor agitation or retardation
Caffeine Intoxication
restlessness, flushed face, diuresis (excessive urination), gastrointestinal disturbance, muscle twitching, insomnia, rambling speech, agitation, tachycardia
Cannabis Intoxication
impaired motor coordination, sensation of slowed time, euphoria, anxiety, increased appetite, dry mouth, tachycardia
Hallucinogen-Related Disorders
e.g. LSD - cause you to hallucinate
perceptual changes, illusions, hallucinations, depersonalization, paranoid ideation, ideas of reference, impaired judgment, feeling like you’re losing your mind
Hallucinogen Persisting Perception Disorder
After consuming hallucinogens, you can have flashbacks for months or even years
Inhalant-Related Disorders
belligerence, assaultiveness, impaired judgment
dizzy, slurred speech, problems with reflects, muscle weakness
Nicotine Withdrawal
within 24 hours of ending or reducing use
dysphoria, insomnia, irritability, anxiety, problems with concentration, restlessness, slowed heart rate, increased appetite, weight gain
Nicotine dependence
one of hardest drugs to quit
15-20% success rate considered good program
many people make multiple attempts before success
Zyban (antidepressant)
Nicotinue patch
Opioid-Related Disorders
e.g. heroin, Codein
initial period of euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment
PUPILLARY CONSTRICTION
Opioid Withdrawal
flu-like symptoms - nausea and vomiting, muscle aches, diarrhea, fever, insomnia, dysphoric mood
PUPILLARY DILATION
PCP-Related Disorders
belligerence, assaultiveness, impulsivity, unpredictability, impaired judgment
Sedative, hypnotic, or anxiolytics-related disorders
symptoms identical to alcohol intoxication and alcohol withdrawal
Schizophrenia
2 or more symptoms present more often than not during 1 month period
must have had signs of disturbance for at least 6 months
Symptoms of Schizophrenia
Delusions - always about beliefs
Hallucinations - perceive something that’s not there
Disorganized Speech
Grossly Disorganized or Catatonic behavior
Negative symptoms (flat affect, poverty of speech, avolition)
if delusions are bizarre or if hallucinations involve running commentary or two or more voices are conversing with each other, only one symptoms required
Schizophrenia, Paranoid Type
one or more delusions or frequent auditory hallucinations
NO disorganized speech, catatonic behavior, flat or inappropriate affect
Schizophrenia, Disorganized Type
disorganized speech, disorganized behavior, and flat or inappropriate affect
Schizophrenia, Catatonic Type
at least two of following: motoric immobility, excessive and purposeless motor activity, negativism or mutism, peculiarities of voluntary movement, echolalia
Schizophrenia, Undifferentiated Type
does not meet criteria for any subtype, but meets overall criteria
Schizophrenia, Residual Type
absence of prominent delusions, hallucinations, disorganized speech, and disorganized/catatonic behavior, but there is continuing evidence of Schizophrenia, such as negative symptoms or a weakened form of at least two characteristic symptoms (e.g. odd behavior)
MRIs on individuals with Schizophrenia
enlarged lateral and third ventricles (fluid-filled spaces; no brain tissue)
smaller cerebral cortex
smaller thalamus (filter for sensory input)
PET scans on individuals with Schizophrenia
decreased frontal love activity
frontal lobe abnormalities have been associated predominantly with the negative symptoms of Schizophrenia (e.g. flat affect, avolition, amotivation)
age of onset for Schizophrenia
typically late teens to early 20s
median age of onset is in early to mid 20s for men and late 20s for women
onset of Schizophrenia
may be abrupt or gradual
most cases involve prodromal phase - characterized by deterioration in overall functioning before symptoms
Remission of Schizophrenia
full remission rather uncommon
Schizophrenia and SES
more common among lower SES
male: female ratio for Schizophrenia
about equal
prognosis of Schizophrenia
prognosis is best with good prior functioning, late onset, abrupt onset, concomitant Mood Disorder, presence of a stressor
_____ type has best prognosis
Paranoid Type
Prevalence rate of Schizophrenia
1%
First degree relatives of Schizophrenia concordance rate
10%
Identical twins concordance rate (Schizophrenia)
50%
Concordance rate of Schizophrenia when both parents have the disorder
about 45%
Relatives of people with Schizophrenia also have increased risk of developing ______
other Schizophrenia spectrum disorders, including Schizotypal and Paranoid Personality Disorder, and other nonaffective psychotic disorders (e.g. Delusional Disorder)
Treatment of Schizophrenia - medications
antipsychotics
traditionals - e.g. Thorazine (Chlorpromazine), Prolixin (fluphenazine), Haldol (haloperidol)
These people have confusion, flight of ideas, and hallucinations
atypical/novel antipsychotics - Clozaril (Clozapine), Risperdal (Risperidone), Zyprexa (Olanzapine), Seroquel (quantiapine)
Can rude zebras see crocodiles running on aQuatics
Many end with “azine” “apine”’
Non-medication treatment of Schizophrenia
skills training - particularly social skills
family treatment that focuses on reducing expressed emotion (e.g. criticism, hostility, and emotional over-involvement)
Schizophreniform DIsorder
identical to Schizophrenia except in terms of duration of symptoms
made when between 1 months and 6 months
Schizoaffective Disorder
period of illness in which you have a mood disorder as well as symptoms of schizophrenia
must have period where you have psychotic symptoms of at least 2 weeks WITHOUT mood symptoms
Delusional Disorders
involve non-bizarre delusions that last at least 1 month
apart from delusion, person relatively unimpaired and not obviously odd
Delusional Disorder, Erotomanic Type
believe a person of higher status in love with you (e.g. president)
Delusional Disorder, Grandiose Type
delusions of inflated self-worth, power, knowledge, or special relationship to a deity or famous person
Delusional Disorder, Jealous Type
person believes sexual partner is being unfaithful
Delusional Disorder, Persecutory TYpe
person believes he/she (or someone close to him/her) is being persecuted or ill-treated
Delusional Disorder, Somatic Type
delusions of having a physical defect or medical problem
Onset of delusional disorder
middle to late adulthood
Brief Psychotic Disorder
looks like Schizophrenia, except up to one month
Shared Psychotic Disorder
aka Folie a Deux
person becomes delusional in the context of being in a relationships with someone else who is delusional
Major Depressive Episode
five or more symptoms during a two week period
Manic episode
abnormally elevated, expansive, or irritable mood that lasts at least one week, with three or more symptoms present
causes marked impairment in functioning or necessitates hospitalization to prevent harm to self or others
Mixed Episode
criteria for a Manic Episode and for a Major Depressive Episode are met nearly every day for a one-week period
Hypomanic Episode
period of elevated, expansive, or irritable mood that lasts at least four days, with three or more symptoms present
hypomanic episode is not severe enough to impair functioning or to necessitate hospitalization
Major Depressive Disorder, Single Episode
Individual must meet criteria for a Major Depressive Episode, but have no history of a Manic, Mixed, or Hypomanic Episode, or a history of a prior Major Depressive Episode
Major Depressive Disorder, Recurrent
two or more Major Depressive Episodes without a history of a Manic, Mixed, or Hypomanic Episode
average age of onset for Major Depressive Disorder
mid-20s
most prevalent in 25-44 year old range
Major Depressive Episodes often occur….
after significant stressors
% of individuals with Major Depressive Disorder, Single Episode have a second episode
50-60%
Rate of MDD in prepubertal girls and boys
equal
Rate of MDD in adolescent and adult females and males
twice as common in adolescent and adult females
MDD is _____ times more common among first degree biological relatives
1.5-3
Concordance rates of MDD for identical twins is _____%
55-60%
Concordance rates of MDD for fraternal twins and siblings is _____%
20%
Treatment for depression - medication management
Triciclycs (TCAS) - Elavel (amitryptyline), Anafranil (Clomipramine), Tofranil (Imipramine)
Even animals (would) take a car instead
SSRIs (most popular) - Prozac (Fluoxetine), Zoloft (Sertraline), Paxil (Paroxetine)
MAOIs (not used much anymore)- Nardil (Phenelzine)
can sometimes be recognized by the ending “amine” or “tyline”
Non-medication treatments for MDD
CBT, interpersonal therapy
Suicide - men vs. women
men complete suicide four times more often than women, but women attempt suicide more often
Suicide is higher in ___ states and lower in _____ states
Suicide is higher in western states and lower in eastern and midwestern states
Suicide rate among ethic groups
highest among Native Americans and then Whites
African Americans in between
lowest among Hispanics and Asian Americans
Whites are 2X as likely to commit suicide as AAs
Which age group has the highest suicide rate?
over 65 years
Within 65+ age group, _____ are at the most risk for suicide
divorced and widowed
Suicide rate among ____ has been rising sharply
Suicide rate among adolescents has been rising sharper, most rapidly among African American adolescents
___% of people who commit suicide have a mental disorder, most often _______
90% of people who commit suicide have a mental disorder, most often depression or substance abuse
______ are a stronger predictor of suicide than ________
Expressions of hopelessness are a stronger predictor of suicide than presence and severity of depression
Best predictor of completed suicide
history of serious suicide attempts, greatest risk occurring within three months of the first attempt
Dysthymic Disorder
depressed mood for most of the day, more days than not, for at least two years
no MD episode during first two years of the disorder, nor history of Manic, Mixed, or Hypomanic Episode
Dysthymia among children and adults, boys vs. girls
for children, equally common in girls and boys
for adults, 2-3X more common in females
Postpartum depression
looks most like MDD
10-15% of new mothers
Postpartum blues
not in DSM
50-80% of all new mothers
symptoms less severe and relatively short-lived than depression
usually goes away within days to a couple weeks
Postpartum psychosis
rare (0.2% of population)
very debilitation
psychotic symptoms developed after delivery
Bipolar I Disorder
1 manic episode or 1 mixed episode
do not need MD episode - could have one, not required
Bipolar disorder males vs. females
equal
Bipolar concordance rates for identical twins
80%
Bipolar concordance rates for fraternal twins and siblings
20-25%
medication for BIpolar disorder
mood stabilizer - Lithium
anticonvulsants - Tegretol, Depakene (Valproic Acid), Depakote (divulproex)
The DVDD
Bipolar II
at least 1 MD episode and at least 1 Hypomanic Episode (NOT manic)
Cyclothymic Disorder
parallels dysthymia
lower grade but more chronic
cycling for at at least two years
Panic Attack
period of intense fear or discomfort
symptoms tend to peak over ten minute period - palpitations or pounding heart, sweating, trembling, shortness of breath, etc.
panic attacks can be mistaken for heart attack
treatment of Panic Attacks
antidepressants rather than anti-anxiety meds
anti-anxiety meds lead to addiction
Agoraphobia
anxiety about being in places or situations from which escape might be difficult or embarrassing
e.g. being alone outside home, being in crowd, standing in a line, being on a bridge, traveling on a bus, train, in a car
Panic DIsorder without Agoraphobia
recurrent, unexpected Panic Attacks
fear, worry of having another Panic Attack
Panic Disorder without Agoraphobia concordance rate between identical twins
25-30%
Panic Disorder without Agoraphobia concordance rate between fraternal twins
0-10%
Panic Disorder without Agoraphobia males vs. females
twice as common in females
Panic Disorder with Agoraphobia
meet diagnostic criteria for Panic Disorder and Agoraphobia
Onset of Panic Disorder with Agoraphobia
typically between adolescence and mid 30s
Panic Disorder with Agoraphobia males vs. females
3X as common in females
Agoraphobia without History of Panic Disorder
meet criteria for Agoraphobia, but have never met criteria for Panic Disorder
Treatment for Agoraphobia
flooding (exposure with response prevention)
massed in vivo exposure more effective than graded in vivo exposure
Specific Phobia
persistent fear that is excessive or unreasonable, caused by presence or anticipation of a specific object or situation
exposure to stimulus provokes an immediate anxiety response (which may include a Panic Attack)
subtypes: animal type, natural environment type (e.g. heights, storms), blood-injection type, situational type (e.g. elevators), or other type
Treatment for Specific Phobia
FLOODING - massed exposure results in the most robust clinical improvements
systematic desensitization
Social Phobia
fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to potential scrutiny by others
person fears behavior will be embarrassing or humiliating
Treatment for Social Phobia
social skills training relaxation exposure cognitive therapy most effective - exposure-based procedures combined with cognitive restructuring
Obsessive Compulsive Disorder
obsessions - recurrent thoughts and impulses that are experienced as intrusive and cause distress or anxiety
compulsions -repetitive behaviors or mental acts the person feels driven to perform to reduce or prevent distress or prevent some dreaded situation
treatment of OCD
Anafranil (clomipramine) - Tricyclic
Prozac (fluoxetine) - SSRI
flooding
though stopping to interrupt obsessions
OCD - males vs. females
males develop OCD between ages of 6 and 15
females develop OCD between 20 and 29
OCD much more common in boys than girls
OCD is equally common among adult males and females
Posttraumatic stress disorder
reexperiencing
avoidance
increased arousal
more than one month
PTSD - Acute vs. Chronic
Acute: less than three months
Chronic: more than three months
PTSD with Delayed Onset
onset of symptoms was at least 6 months after the stressor
treatment for PTSD
stress inoculation Cognitive Processing Therapy (CPT) Prolonged Exposure (PE) Psychological Debriefing (PD) Eye Movement Desensitization Retraining (EMDR)
Psychological Debriefing
group intervention lasting up to a few hours shortly after traumatic event
involves “debriefing” or relating what happened during the trauma
does not decrease likelihood of developing PTSD, may make recovery more difficult for some
Eye Movement Desensitization Retraining (EMDR)
effective, but no more so than other treatments based on exposure
may be better tolerated than other exposure-based treatments and may provide relief a little bit more quickly
Acute Stress Disorder
minimum of two days, maximum of four weeks (vs. PTSD)
occurs within four weeks of traumatic event
Generalized Anxiety Disorder
excessive fear, anxiety, and worry about a number of situations
three or more symptoms
GAD men vs. women
somewhat more frequently in women than men
treatment for GAD
Behavior Therapy (e.g. progressive muscle relaxation, graduated exposure, involvement in pleasurable activities) CBT - somewhat superior
Somatization Disorder
history of recurrent and multiple somatic complaints, which begins before age 30, and of at least several years duration
Four criteria for Somatization Disorder
four pain symptoms
two gastorintestinal symptoms
one sexual symptom other than pain
one pseudoneurological symptom (e.g. paralysis, weakness, difficulty swallowing)
Somatization Disorder men vs. women
more common in women and rarely occurs in me in the US
in other cultures, actually more common among men
Undifferentiated Somatoform Disorder
one or more physical complaints that cannot be fully explained medically
at least 6 months
Conversion Disorder
one or more symptoms or deficits affecting voluntary movement or sensory function
Conversion disorder men vs. women
occurs more frequently in women
prevalence of Conversion Disorder - SES, setting
tends to be more prevalent in rural and lower SES populations
Pain Disorder
pain in one ore more sites that is of sufficient severity to warrant clinical attention
Hypochondriasis
preoccupation with fear of having or belief that one has a serious illness, based on one’s perception of bodily symptoms
assessment and reassurance by medical providers doe snot lessen the preoccupation or fear
at least 6 months
Hypochondriasis men vs. women
equally common
Body Dysmorphic DIsorder
person is preoccupied with an imagined defect in appearance
if slight abnormality is present, person’s concern is markedly excessive
Body Dysmorphic Disorder men vs. women
equally frequent
Body Dysmorphic Disorder - age of onset
usually starts in adolescence
Meds for anxiety reduction
Anxiolytics (Benzodiazepines) Xanax (alprazolam) Klonopin (clonazepam) Valium (diazepam) Ativan (lorazepam)
Xavier Kardashian (is) Very Animated and Can Do Lots Benzos tend to end on "pam" or "lam"
Meds to induce sedation and improve sleep
Sedative/Hypnotics (Benzodiazepines) Restoril (temazepam) Halcion (triazolam) Doral (quezepam) Benzos tend to end in "pam" or "lam"
Resting has done the trick quite (well)
Non-Benzodiazepine Sedative/Hypnotics
Ambien (zolpidem)
Sonata (zaleplon)
