EPPP (AATBS, 2013) - Abnormal Psychology

Question 1

How does one indicate a diagnostic uncertainty about a client’s diagnosis in the new DSM-5 system?

Answer 1

There are three possible codes:

• Other specified disorder: used when a clinician wants to indicate the reason why the client’s symptoms do not meet the criteria for a specific diagnosis (e.g., “other specified depressive disorder, recurrent brief depression”).
• Unspecified disorder: used when a clinician does not want to indicate the reason why the client’s symptoms do not meet the criteria for a specific diagnosis.
• Provisional: used when a clinician does not currently have sufficient information for a firm diagnosis but believes the full criteria for the diagnosis will eventually be met.

Question 2

DSM-5 Assessment Measures

Answer 2

• Cross-cutting symptom measures
• Severity measures
• The World Health Organization Disability Assessment Schedule, Version 2.0 (WHODAS 2.0)
• Personality Inventories

Question 3

Cross-cutting symptom measures

Answer 3

• Designed to be used in initial patient interview and during tx to monitor progress.

They provide information on mental health domains important across the psychiatric diagnoses (2 levels):

Level 1: Useful for identifying areas that require additional evaluation (assess 13 domains for adults & 12 for children and adolescents).

Level 2: provide in-depth information on specific domains to help guide dx, tx planning, and follow-up.

Question 4

Severity Measures

Answer 4

• Designed to be administered during initial patient interview & at regular intervals during tx to monitor progress.
• Disorder specific (DEP, GAD, Panic D., Agoraphobia, etc.)
• correspond to DSM-5’s dx criteria

Question 5

The World Health Organization Disability Assessment Schedule, Version 2.0 (WHODAS 2.0)

Answer 5

Used to assess level of disability (6 domains):

• understanding and communication
• getting around
• self-care
• getting along with people
• life activities
• participation in society

Question 6

Personality Inventories

Answer 6

Measure personality traits (5 domains)

• negative affect
• detachment
• antagonism
• disinhibition
• psychoticism

Question 7

DSM-5 Cultural Formulation

Answer 7

Comprised of 3 tools to help clinicians consider and understand the impact of a client’s cultural background on dx and tx.

1. Outline for Cultural Formulation
2. Cultural Formulation Interview (CFI)
3. Cultural Concepts of Distress

Question 8

Outline for Cultural Formulation

Answer 8

Provides guidelines for assessing 4 factors:

• client’s cultural identity;
• client’s cultural conceptualization of distress;
• psychosocial stressors & cultural factors that impact client’s vulnerability & resilience;
• cultural factors relevant to relationship btw client & therapist.

Question 9

Cultural Formulation Interview (CFI)

Answer 9

Semi-structured interview with 16 Qs to obtain info on client’s views regarding the social/cultural context of his/her presenting problems (4 domains):

• cultural definition of problem;
• cultural perceptions of cause, context, and support;
• cultural factors affecting self-coping & past help seeking;
• cultural factors affecting current help seeking.

Question 10

Cultural Concepts of Distress

Answer 10

• “ways that cultural groups experience, understand, and communicate suffering, behavioral problems, or troubling thoughts and emotions” (DSM-5, p. 758).
• distinguishes btw 3 types of cultural concepts
  1. Cultural syndromes
  2. Cultural idioms of distress
  3. Cultural explanations (or perceived causes)

Question 11

Cultural syndromes

Answer 11

Clusters of symptoms and attributions that co-occur among individuals from a particular culture and are recognized by members of that culture as coherent patterns of experience.

Question 12

Cultural idioms of distress

Answer 12

Used by members of different cultures to express distress and provide shared ways for talking about personal and social concerns.

Question 13

Cultural explanations (or perceived causes)

Answer 13

Explanatory models that members of a culture use to explain the meaning and causes of symptoms, illness, and distress.

Question 14

The DSM-5 utilizes a ________ approach that divides the mental disorders into types that are defined by a set of diagnostic criteria.

Answer 14

categorical

Question 15

To allow for symptom heterogeneity, the DSM includes a ________ criteria set for most disorders.

Answer 15

polythetic

Question 16

In contrast to the previous version of the DSM, the DSM-5 provides a ________ assessment system.

Answer 16

nonaxial

Question 17

Uncertainty about a person’s diagnosis is indicated by coding ________ when the clinician wants to indicate the reason why a client’s symptoms do not meet the criteria for a specific diagnosis.

Answer 17

other specified disorder

Question 18

The DSM-5 includes several assessment measures including _______ symptom measures that are designed to be used in the initial client interview and during treatment to monitor progress as well as ________ severity measures that correspond to DSM-5 diagnostic criteria.

Answer 18

cross-cutting; disorder-specific

Question 19

To help clinicians consider and understand the impact of a client’s cultural background on diagnosis and treatment, the DSM-5 includes an Outline for ________ that provides guidelines for assessing the client’s cultural identity, the client’s cultural conceptualization of distress, the psychosocial stressors and cultural factors affecting the client’s vulnerability and resistance, and cultural factors relevant to the therapist-client relationship.

Answer 19

Cultural Formulation

Question 20

It also includes a section on cultural concepts of distress that distinguishes between three types of concepts: cultural syndromes, cultural idioms of distress, and cultural ________.

Answer 20

explanations

Question 21

What characterizes the Neurodevelopmental Disorders?

Answer 21

This category “typically manifest early in development, often before the child enters grade school, and are characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning” (APA, 2013, p. 31).

Question 22

Which are the Neurodevelopmental Disorders?

Answer 22

• Intellectual Disability (Intellectual Developmental Disorder)
• Communication Disorders: Childhood-Onset Fluency Disorder (Stuttering)
• Autism Spectrum Disorder
• Attention-Deficit/Hyperactivity Disorder
• Specific Learning Disorder
• Motor Disorders: Tic Disorders

Question 23

Intellectual Disability

Intellectual Developmental Disorder

Answer 23

3 diagnostic criteria must be met:

• deficits in intellectual functions (e.g., reasoning, problem solving, abstract thinking) that are confirmed by a clinical assessment and individualized, standardized intelligence testing;
• deficits in adaptive functioning that result in a failure to meet community standards of personal independence and social responsibility and impair functioning across multiple environments in one of more activities of daily life (e.g., communication, social participation, independent living); &
• the onset of intellectual and adaptive functioning deficits during the developmental period.

Course: Early signs include delays in motor development and a lack of age-appropriate interest in environmental stimuli (e.g., eye contact during feeding, less responsive to voice and movement than expected).

Prognosis: not necessarily a lifelong condition, especially with proper intervention.

Question 24

Communication disorders: Childhood-Onset Fluency Disorder

Stuttering

Answer 24

Characterized by a disturbance in normal fluency and time patterning of speech that is inappropriate for the person’s age and involves sound and syllable repetitions, sound prolongations, broken words, word substitutions to avoid troublesome words, and/or monosyllabic whole-word repetitions.

Course: Usually begins btw the ages of 2 and 7 and symptoms may become worse when there is special pressure to communicate (e.g., when giving an oral report).

Prognosis: about 65-85% of children recover, with the severity of dysfluency at age 8 being a good predictor of prognosis.

Treatment: may be alleviated, especially in young children, by reducing psychological stress at home: parents asked to stop reprimanding child for speech difficulties, reduce demands, help cope with frustration. For older children and adults, habit reversal training.

Question 25

What is habit reversal training?

Answer 25

A treatment option for communication disorders that can be used with older children and adults.

It incorporates awareness, relaxation, motivation, competing response (regulated breathing), and generalization training.

Question 26

Autism Spectrum Disorder

Answer 26

Individual must exhibit:

• persistent deficits in social communication and interaction across multiple contexts as manifested by deficits in social-emotional reciprocity, nonverbal communication, and the development, maintenance, and understanding of relationships;
• restricted repetitive patterns of behavior, interests, and activities as manifested by at least two of the following:
• stereotyped or repetitive motor movements, use of objects, or speech;
• insistence on sameness, inflexible adherence to routines, or ritualized patterns of behavior;
• highly restricted, fixated interests that are abnormal in intensity or focus;
• hyper- or hyporeactivity to sensory input;
• symptoms during the early developmental period; &
• impairments in social, occupational, or other area of functioning as the result of symptoms.

Prognosis: generally poor. Best outcome is associated with an ability to communicate verbally by age 5 or 6, an IQ of over 70, and a later onset of symptoms.

Question 27

Attention-Deficit/Hyperactivity Disorder (ADHD)

Diagnostic Criteria

Answer 27

A neurodevelopment disorder characterized by a pattern of inattention and/or hyperactivity-impulsivity that

• has persisted for at least six months
• has had an onset prior to 12 years of age
• is present in at least two settings (e.g., home & school)
• interferes with social, academic, or occupational functioning.

The diagnosis requires at least six characteristic symptoms of inattention and/or six characteristic symptoms of hyperactivity-impulsivity:

• inattention - e.g., fails to give close attention to details; has difficulty sustaining attention to tasks or play activities; doesn’t listen when directly spoken to; fails to finish schoolwork or chores; is easily distracted by extraneous stimuli; is often forgetful in daily activities
• hyperactivity-impulsivity - e.g., frequently fidgets or squirms in seat; often leaves seat at inappropriate times; frequently runs or climbs in inappropriate situations; talks excessively; has difficulty waiting his/her turn; interrupts or intrudes on others

Three specifiers provided to indicate subtype:
• predominantly inattentive,
• predominantly hyperactive/impulsive, &
• combined.

Question 28

Attention-Deficit/Hyperactivity Disorder (ADHD)

Associated Features

Answer 28

Children & adolescents:
• typically test lower on IQ tests than other children through their intelligence is average or above average
• nearly all exhibit some academic difficulties
• many have problems related to social adjustment (e.g., few friends, victims of peer rejection)
• common co-diagnosis: Conduct Disorder, a Specific Learning Disability, Oppositional Defiance Disorder, and Anxiety Disorder, Major Depressive Disorder.

Adults: tend to have…
• low self-esteem
• problems related to social relationships
• poorer health outcomes
• lower educational & occupational achievement (e.g., more likely to change jobs frequently & be fired from job).
• elevated risk for Bipolar Disorder, depression, anxiety, antisocial behavior, and substance abuse.

Question 29

Attention-Deficit/Hyperactivity Disorder (ADHD)

Prevalence

Answer 29

Rate in most cultures is ~ 5% for children & 2.5% for adults.

Gender differences:
• more prevalent in males than females
• male:female ratios are 2:1 for children & 1.6:1 for adults

Note: gender differences depend on subtype, though.
• combined: more common for males
• inattentive: more common for females

Question 30

Attention-Deficit/Hyperactivity Disorder (ADHD)

Course & Prognosis

Answer 30

• 65-80% of children with ADHD continue to meet dx criteria in adolescence
• 15% continue to meet full dx criteria as young adults
• up to 60% meet criteria in partial remission

Symptoms vary somewhat over lifespan:
• gross motor activity characteristic of children declines over time
• hyperactivity in adults usually manifests as fidgeting, excessive talking, inner sense of restlessness, & feeling overwhelmed
• impulsivity in adults usually manifests as impatience and irritability, problems related to management of time & money, reckless driving, and impulsive sexuality
• inattention in adults usually manifests as inconsistency in ability to concentrate, difficulty establishing & maintaining routines, & inability to prioritize & complete important tasks.

Question 31

Attention-Deficit/Hyperactivity Disorder (ADHD)

Etiology

Answer 31

Evidence for genetic component (twin studies)

Brain abnormalities linked to ADHD:
• lower-than-normal activity in the caudate nucleus, globus pallidus, & prefrontal cortex
• smaller-than-normal size of above structures

Question 32

Attention-Deficit/Hyperactivity Disorder (ADHD)

What is a distinguishing characteristic?

Answer 32

The fluctuation of symptoms in different settings.

• Sx more likely to occur in familiar, highly repetitive, boring, or highly structured situations & situations in which regular feedback is not available.
• This finding let to development of the behavioral disinhibition hypothesis (Barkley, 1990), which proposes that the core feature of ADHD is an inability to regulate behavior to fit situational demands.
• Alternative theory: proposes that ADHD is due to an inability to regulate attention, which is manifested as problems in inhibiting attention to non relevant stimuli and focusing too intensely on certain stimuli to the exclusion of others (Montauk & Mayhall, 2002).

Question 33

Attention-Deficit/Hyperactivity Disorder (ADHD)

Treatment

Answer 33

Medication:
• Methylphenidate (Ritalin) & other central nervous stimulants have beneficial effects on core symptoms of ADHD in about 75% of cases (Swanson et al., 1993).
• These drugs appear to be effective not only for children but also for adults.

Behavioral Interventions:
• evidence they are effective for reducing symptoms.
• 2 commonly used interventions that involve the use of positive reinforcement, time-out, & other behavioral strategies: parent training in child behavior management & teacher training in classroom management.

Question 34

Attention-Deficit/Hyperactivity Disorder (ADHD)

Multimodal Treatment Study (MTA)

Answer 34

• A frequently cited study of ADHD by the National Institute of Mental Health (NIMH).
• Compared the effecs of medication management (methylphenidate) alone, intensive behavioral tx alone, combined tx, & routine community care.
• Initial results indicated that medication management alone and the combined tx produced a similar reduction in core symptoms & were significantly better at doing so that behavioral tx alone or routine community care (Jensen et al., 2001).
• However, three- & eight-year follow-up studies of children in MTA sample found that superior benefits of meds alone or combined tx did not persist & that outcomes for children in these groups were comparable to outcomes for children who received behavioral tx only or community care (Jensen et al., 2007; Molina et al., 2009).

Question 35

A diagnosis of Intellectual Disability requires deficits in intellectual functions, deficits in ________, and an onset during the ________.

Answer 35

adaptive functioning; developmental period

Question 36

The DSM-5 distinguishes between four degrees of severity based on adaptive functioning in three domains - conceptual, social, and _______.

Answer 36

practical

Question 37

The etiology of the disorder is unknown in about ________% of all cases.

Answer 37

30

Question 38

The onset of Childhood-Onset Fluency Disorder (Stuttering) is most often between the ages of ________, and it may be effectively treated with ________ training which combines awareness, relaxation, motivation, competing response, and generalization training.

Answer 38

2 and 7; regulated breathing

Question 39

A diagnosis of Autism Spectrum Disorder requires persistent deficits in ________ across multiple contexts; restricted, repetitive patterns of behavior, interests, and activities; symptoms during the early developmental period; and impairments in social, occupational, or other area of functioning.

Answer 39

social communication and interaction

Question 40

A better prognosis for this disorder is associated with the ability to communicate verbally by age ________, an IQ of 70 or above, and a later onset of symptoms.

Answer 40

5 ot 6

Question 41

In terms of treatment, ________ were originally used by Lovaas and continue to be used to improve communication skills.

Answer 41

shaping and discrimination training

Question 42

ADHD is characterized by a persistent pattern of ________ and/or hyperactivity-impulsivity that interferes with social, academic, or occupational functioning.

Answer 42

inattention

Question 43

The diagnosis requires an onset of symptoms prior to age ________ years and evidence of impairment in at least ________ different settings.

Answer 43

12; 2

Question 44

It has been estimated that ________% of children with ADHD continue to meet the diagnostic criteria for the disorder in adolescence.

Answer 44

65-80

Question 45

Among adults, ________ predominates the symptom profile.

Answer 45

inattention

Question 46

According to the ________ hypothesis, ADHD is due to an inability to regulate one’s behavior to fit the demands of the situation.

Answer 46

behavioral disinhibition

Question 47

The National Institute of Mental Health (NIMH) Multimodal Treatment Study of ADHD (MTA) found that, in terms of initial results, ________ and combined medication and behavioral treatment produced a similar reduction in the core symptoms of the disorder.

Answer 47

medication management