Dx And Pathology Flashcards
What are the 5 axis?
Axis I Clinical do;focus of attention Axis II mr and pd; borderline iq; traits Axis III. General medical Axis IV psychosocial and environmental problems Axis v global assessment of fx 1 to 100 (superior fx) Rating usually for current eval
Dsm IV TR is? Atheoretical Symptom based classification Underscores importance of gender, age, and culture Multiaxial assessment Categorical approach Polythetic criteria sets
Eliminated gender bias
Cultural diff explained
Glossary w cultural info
Tr…changes only to text accompanying dx
Categorical bc either meet or not meet (dimension is 1 to 10). Works best when homogeneous, clear category boundaries, mutually exclusive. So use polythetic criteria or have to meet a sunset of sx, not all.
Give the degrees of mental retardation.
Mild 50 - 70. 85 percent Discover late childhood in school 6th grade level of education Independently live in semi skilled jobs Moderate 35/40 -50/55. 10 percent 2nd grade. Un or semiskilled w supervision. Severe. 20/25 - 30/35. 3 or 4 perc Poor motor. Limited communication . Elementary hygiene skills. Close supervision in home or grp home. Profound. Below 20/25. 1 to 2 perc Constant aid
What is the most common contributing factor to mental retardation? A. Environmental influences B. pregnancy and perinatal C. Hereditary D. Embryonic development
A. 15 to 20 percent. Cultural-familial retardation; Lack nurturance; or mental do like autism
B. 10 percent. Malnutrition; HIV;premature; anoxia; injury
C. 5 percent. PKU;Tay saks; fragile x;
D. 30 percent. Downs; prenatal use of alcohol/drugs
30 to 40 percent no etiology.
What is borderline iq?
71 to 84
Mr may be appropriate at the lower end and significant deficits I’m adaptive fx.
Put under other conditions that mAy be a focus of attention.
What are the important dx criteria for autism?
By three..delayed or abnormal fx in social intx, language, or play
6 sx 2 sx re; impaired social fx 1 sx impaired communication 1 sx restricted or repetitive behavior Other: Half don't speak ; echolalia, reversals in pronouns Older more interest in others Perseveration play 4 to 5 timeshare common in males 75 percent codx of mr Distinct from schizophrenia No correlation w ses, parent characteristics, education, job, race, religion. Potential genetic (mono twins hi rate) or neuro factors, rubella, birth probs, hi SE
What is the tx for autism?
Neuroleptics, haloperidol for aggressiveness, lability, withdrawal, stereotyped behaviors. other pharmacological do not work.
Intense behavior intervention. Operant techniques . Reinforce all efforts to communicate.
Best when started very very young, involved parents, use at home, intensive, structured environment, uses contract to delineate changes and methods.
2 percent hi fx
40 percent hi fx
Best prognosis..
Early language skills, overall intellectual ability, disorder severity, usable language by age 7.
Iq alone predicts only worst outcome.
Correlation…developmental milestones, social maturity, time in school and comorbidity neuropsychiatric do
No correlation…birthwt, perinatal, age or onset, normal development before, ses, late development of seizures, type of tx, family mental illness.
What are the important criteria for retts?
Females only
Developmental regression starting at 4.
Seem normal in prenatal and perinatal pd and for last 5 mo after birth.
Usually life long communicative and behavioral problems.
Initial signs…head growth deceleration, loss hand skills, hand washing/ringing , later gait problems, language problems. Within a few years loses interest in social environment . Eventually epilepsy, mr
Cause..genetic mutation
Childhood disintegrative disorder?
Pd of normal development 2 plus yrs
After 2 and before 10
Regression in several areas. At least 2. Language, social or adaptive, bowel/bladder, play, motor
Very rare. But social and communication impairments and behavioral signs look like autism.
Difference between aspergers and autism?
No significant deficit in language, self-help, Cognitive development, or curiosity about the environment.
Better prognosis
Many jobs and self sufficient
More in males as well.
What are the two types of dyslexia?
Surface or orthogonal dyslexia
Ability to read regularly spelled words but can’t decipher words that are spelled irregularly. This limits the comprehension of written material.
Deep dyslexia…reading errors including semantic paralexia (response related to the word in meaning but not visually or phonoloically).
Differ from lack of opportunity, bad teaching, cultural factors, mr, pdd, sensory deficit.
Can have ld and mr. Must impede achievement or daily living that require the deficient skill.
Etiology..many..neuro, genetics, malnutrition, iron deficiency, allergies, otitis media , underlying cognitive deficit..
Dx of stuttering.
Usually begins between 2 and 7.
Often tx emotional pressure bc tension may aggravate it.
60 percent of cases it remits by age 16 on its own
ADHD
Onset before age 7
6 mo
2 settings
Not due to another disorder, including mr
3 to 5 percent meet criteria 10 percent some signs Many have academic problems Often behavioral issues start by 3 Often delayed dx, when they start school due to look like normal behavior of kids and more apparent in structured setting.
4 to 9x more males
Co dx…conduct…50 percent
Emotional do…25 percent
Learning do….20 percent
Also social maladjustment, motor uncoordination and visual and auditory impairments.
70 percent show signs thruout life
Adults…childhood hx and 12 sx; often passive aggressive or narcissistic traits develop and recede once treated
Etiology and tx of ADHD?
Biological cause…abnormal frontal lobe, striatum (b ganglia), cerebellum. Part of parietal lobe has problems. Lower glucose metabolism, decrease bld flow, smaller corpus collosum, globus pallidus, caudate nucleus (this one smaller it is worse on inhibition)
Genetics..offspring of parent 57 percent.
5 to 10 percent implicated in minimal brain dysfx ..normal iq..mild to severe behavior probs, perceptual motor probs, memory probs, EEG abnormalities.
Tx...CNS stimulants Low dose..improve attention Hi dose reduce activity level, improve social (not at peer level) Cognitive and behavioral interventions Young...contingency mgmt Older ...self monitoring, self talk Parents participate..rules, structure Positive reinforcement w punishment (response cost) and tangible rewards.
What is the behavioral disinhibition hypothesis?
Barkley proposed this way of viewing ADHD that suggests the essence of ADHD is a lack of ability to adjust activity levels to the requirements of different settings , not attention deficits.
Came about because some can attend in certain situations and not others. Overall, attention problems in full, repetitious, familiar, very structured and:or irregular reinforcement situations..
Seem to have trouble reducing and increasing their activity level.
Ritalin or methyphenidate has what side effects?
Somatic sx..decrease appetite, insomnia..mild. Change does or administration
Movement abnormalities…tics
30 to 70 percent
Don’t use if have Tourette’s
Obsessive compulsive sx.
30 to 50 percent.. Reduce dose
Growth suppression
Holidays
Conduct do
3 or more signs for 12 mo
At least 1 sign in last 6 mo
1 sx before 10 yrs if childhood onset
After 10 for adolescent onset..less severe prognosis; more linked to peers
Below peers on verbal subtests not nonverbal
Associated w nicotine, drug, alcohol
Majority it remits
Others move on to antisocial pd
Related to biology…low levels of arousal; genetics; environment
Tx..multi systemic tx. Long term decrease in criminal behavior by working on social network..use family tx and parent training . Best tx before teens and includes parent education
Pica
Ingested on a persistent basis for 1 Month Onset 1 to 2 years Remits early childhood. May go to adolescence Equally Associated w mental retardation
Rumination disorder
3 to 12 mo
After period normal development
Regurgitate and rechew for at least one month after a period of normal fx
Mortality 25 percent
Feeding do of early infancy
Failure to thrive
Chronic failure to eat enough
Wt loss or failure to gain for at least one month
Onset before 6 years, usually 1st yr
Malnutrition can develop
Most eventually gain wt
General medical condition, mental do, or lack of available food are ruled out..
Tic do
Tourette’s onset in childhood. B4 age 18.
Less 10 percent vulgar
Tics must occur multiple times a day, almost daily, for at least one year.
No more than 3 mo without tics
Chronic but may remit for brief pds
Often coexist w obsessive and compulsive behaviors, ADHD, ld, depression, social probs
Most co occuring w ADHD. Even don’t meet dx often have attention and over activity that interferes w academics. Same iq range as pop
Tx..school interventions, meds (haloperidol and pimozide anyipsychotic that r fast acting; clonodine..fewer side effects; reduce ocd w antidrpressants), family tx, individual tx
Chronic motor or vocal tic
Do…one or more tic. Only 1 kind. Sx and impairment less severe.
Enuresis vs encopresis
Encopresis..feces
Age 4 plus or develop age equivalent
Voluntary or intentional
1 x per mo for 3 mo
Enuresis
Age 5 plus
2 x per week for 3 mo or marked distress or impaired fx
Most bladder fx by 3. Daytime wetting higher chance of physical problem
More in males at age 5 (7 vs 3 percent). Difference shrinks w age
Think due to late mature fx plus self esteem and motivation
Bell and pad best long term result
Meds Antidepressants. Sterm use
Hypnosis..less expensive and gives power
Diurnal or awake or nocturnal
Separation anxiety do vs reactive attachment do
Separation anxiety do
4 weeks in response to separation from home or attachment figure
Somatic complaints
Fantasies of danger
School phobia can be a sx (ESP if develops between 5 and 7; start in adolescence it is depression)
Causes..overprotection, insecurity due to trauma, dependency issues
Tx..individual, family tx; behavioral interventions
Reactive attachment do
Before 5
Inhibited…fail to initiate or respond in age expected way in most social situations
Disinhibited..indiscriminate sociability Too familiar
Pathogenic care…chronic neglect, multiple caregivers..
Fetal alcohol syndrome
What structures impacted?
Basal ganglia, hippocampus, frontal lobes most effected
Also cerebellum, corpus collosum, hypothalamus
Ave iq is mild mr. 68
No effects at less than 2 drinks per day…