Exam:)

Question 1

What is a Learning Disability?

Answer 1

Learning Disability is a lay term (not a diagnostic term) that refers to significant problems in mastering one or more of the following skills: listening, speaking, reading, writing, reasoning, and mathematics.

Question 2

What is a Communication Disorder?

Answer 2

Communication Disorder is a diagnostic term that refers to deficits in language, speech, and communication. Communication disorders include the following diagnostic categories:
1. Language disorder (problems using language to communicate, such as spoken words or sign language, or understanding what other people say)
2. Speech sound disorder (deficits in productive speech sounds).
3. Childhood-onset fluency disorder (problems in speech fluency, such as stuttering).
4. Social (pragmatic) communication disorder.

Question 3

Features of Language Development.

Answer 3

1. Adults play an important role in encouraging language development by providing clear examples of language and enjoying the child’s expressions.
2. Language consists of phonemes, which are the basic sounds (such as sharp ba’s and da’s and drawn-out ee’s and ss’s) that make up language.

Question 4

What is a Specific Learning Disorder?

Answer 4

Specific Learning Disorder is a diagnostic term that refers to specific problems in learning and using academic skills.
1. Specific learning disorder is determined by achievement test results that are substantially below what is expected for the child’s age, schooling, and intellectual ability.
2. People with learning disabilities have normal intellectual processes in most areas but are relatively weaker in others, which is known as having an unexpected discrepancy between measured ability and actual performance.

Question 5

What is Phonological Awareness?

Answer 5

Phonological Awareness is a broad construct that includes recognizing the relationship between sounds and letters, detecting rhyme and alliteration, and being aware that sounds can be manipulated within syllables in words.

Question 6

What is Phonology?

Answer 6

Phonology is the ability to learn and store phonemes as well as the rules for combining the sounds into meaningful units or words.

Question 7

Features of Phonological Awareness.

Answer 7

1. Not all children progress normally through the milestones of language development. Some are noticeably delayed, continuing to use gestures or sounds rather than speech.
2. Deficits in phonology are a chief reason that most children and adults with communication and learning disorders have problems in language-based activities.
3. Primary-grade teachers detect phonological awareness as they ask children to rhyme words and manipulate sounds.
4. Readers with core deficits in phonological processing have difficulty segmenting and categorizing phonemes, retrieving the names of common objects and letters, storing phonological codes in short-term memory, and producing some speech sounds.

Question 8

Features of Communication Disorders.

Answer 8

1. Children with communication disorders have difficulty producing speech sounds, using spoken language to communicate, or understanding what other people say.
2. Communication disorders include the diagnostic subcategories of language disorder, speech sound disorder, childhood-onset fluency disorder (stuttering), and social (pragmatic) communication disorder.

Question 8

What is a Language Disorder?

Answer 8

Language Disorder is a communication disorder characterized by difficulties in the comprehension or production of spoken or written language.

Question 9

Features of Language Disorder.

Answer 9

1. Children with language disorder may have difficulty understanding particular types of words or statements, such as complex if–then sentences.
2. In severe cases, the child’s ability to understand basic vocabulary or simple sentences may be impaired, and there may be deficits in auditory processing of sounds and symbols and in their storage, recall, and sequencing.
3. When the developmental language problem involves articulation or sound production rather than word knowledge, a Speech Sound Disorder may be an appropriate diagnosis.

Question 10

The DSM-5 diagnostic criteria for Language Disorder.

Answer 10

A. Persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign language, or other) due to deficits in comprehension or production that include the following:
1. Reduced vocabulary (word knowledge and use).
2.Limited sentence structure (ability to put words and word endings together to form sentences.
3.Impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation).
B. Language abilities are substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, or occupational performance, individually or in any combination.
C. Onset of symptoms is in the early developmental period.
D. The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.

Question 11

Treatment of Language Disorders

Answer 11

1. Treatment for children with communication disorders is based on three principles:
   (a) Treatment to promote the child’s language competencies.
   (b) Treatment to adjust the environment in ways that accommodate the child’s needs.
   (c) Therapy with the child to equip him or her with knowledge and skills to reduce behavioral and emotional symptoms.
2. Specialized preschools use a combination of computer and teacher assisted language skills to young children, which helps pace the child’s practice of new skills.
3. Simple forms of ignoring and distracting and the occasional time-out.

Question 12

What is Childhood-Onset Fluency Disorder (Stuttering)?

Answer 12

Childhood-Onset Fluency Disorder (Stuttering) is the repeated and prolonged pronunciation of certain syllables that interferes with communication.

Question 13

Features of Childhood-Onset Fluency Disorder (Stuttering).

Answer 13

1. It takes practice and patience for a child to develop the coordination for the tongue, lips, and brain to work in unison to produce unfamiliar or difficult combinations of sounds.
2. Some children, however, progress slowly through this stage, repeating (wa-wa-wa) or prolonging (n-ah-ahah-o) sounds; they struggle to continue or develop ways to avoid or compensate for certain sounds or words.

Question 14

THE DSM-5 Diagnostic Criteria For Childhood-Onset Fluency Disorder.

Answer 14

A. Disturbances in the normal fluency and time of patterning of speech that are inappropriate for the individual’s age and language skills, persist over time, and are characterized by frequent and marked occurrences of one (or more) or the following:
1. Sound and syllable repetitions.
2. Sound prolongations of consonants as well as words.
3. Broken words (e.g., pauses within a word).
4. Audible or silent blocking (filled or unfilled pauses in speech).
5. Circumlocutions (word substitutions to avoid problematic words).
6. Words produced with an excess of physical tension.
7. Monosyllabic whole-word repetitions (e.g., “I-I-I-I” see him).
B. The disturbance causes anxiety about speaking or limitations in effective communication, social participation, or academic or occupational performance, individually or in any combination.
C. The onset of symptoms is in the early developmental period (Note: Later-onset cases are diagnosed as adult-onset fluency disorder).
D. The disturbance is not attributable to a speech-motor or sensory deficit, dysfluency associated with neurological insult (e.g., stroke, tumor, trauma), or another medical concern and is not better explained by another mental disorder.

Question 15

What is Pragmatics?

Answer 15

Pragmatics are culturally specific practices and skills related to social uses of language, conversational norms, and the use of nonverbal communication, such as eye contact and gestures.

Question 15

Features of Social (Pragmatic) Communication Disorder (SCD).

Answer 15

1. Social (Pragmatic) Communication Disorder (SCD) is a new disorder in DSM-5.
2. It involves persistent difficulties with pragmatics - the social use of language and communication.
3. Pragmatic difficulties involve both expressive and receptive skills - being able to adapt one’s communication to the social context and being able to understand the nuances and social meanings expressed by others.
4. A diagnosis of SCD is not typically made until the child is 4 or 5 years old, to determine whether he or she has shown adequate developmental progress in speech and language.
5. Social (pragmatic) communication disorder was added to the DSM because of the number of children who did not meet conventional criteria for an autism spectrum disorder (ASD) yet who had persistent difficulties with social aspects of communication and peer relations.
6. The symptoms of SCD also overlap with ADHD, social anxiety disorder and intellectual disability in that they share problems in social, pragmatic communication.
7. Children with SCD may suffer lasting impairments in peer relations due to their early difficulties: Thus, peer-assisted interventions are recognized as effective ways to build pragmatic communication and social skills for these children.

Question 16

THE DSM-5 Diagnostic Criteria For Social (Pragmatic) Communication Disorder.

Answer 16

A. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
1. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
2. Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
3. Difficulties following rules for language and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
C. The onset of the symptoms is early in the developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).
D. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.

Question 17

What is Specific Learning Disorder (SLD)?

Answer 17

1. When achievement in reading, math, or writing is well below average for the child’s age and intellectual ability, he or she may be diagnosed with a Specific Learning Disorder (SLD).

Question 17

Features of Specific Learning Disorder (SLD).

Answer 17

1. A child with a specific learning disorder is intellectually capable of learning key academic concepts of reading, writing, and math, but seems unable to do so.
2. The phrase “unexpected academic underachievement” captures this notion that the child’s learning problems are indeed specific and not due to intellectual disability.
3. Emotional problems are often seen in children who are bright enough to recognise that their performance is below that of others.
4. Because many aspects of speaking, listening, reading, writing, and arithmetic overlap and build on the same functions of the brain, it is not surprising that a child or adult can have more than one form of SLD.

Question 18

THE DSM-5 Diagnostic Criteria For Specific Learning Disorder.

Answer 18

A. Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties:
1. Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly or slowly and hesitantly, frequently guesses words, has difficulty sounding out words).
2. Difficulty understanding the meaning of what is read (e.g., may read text accurately but not understand sequence, relationships, inferences, or deeper meanings of what is read).
3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants).
4. Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization; written expression of ideas lacks clarity).
5. Difficulties mastering number sense, number facts, or calculation (e.g., has poor understanding of numbers, their magnitude, and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact as peers do; gets lost in the midst of arithmetic computation and may switch procedures).
6. Difficulties with mathematical reasoning (e.g., has severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems).
B. The affected academic skills are substantially and quantifiably below those expected for the individual’s chronological age, and cause significant interference with academic or occupational performance, or with activities of daily living, as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment. For individuals aged 17 years and older, a documented history of impairing learning difficulties may be substituted for the standardized assessment.
C. The learning difficulties begin during school-age years but may not become fully manifest until the demands of those affected academic skills exceed the individual’s limited capacities (e.g., as in timed tests, reading or writing lengthy complex reports for a tight deadline, excessively heavy academic loads).
D. The learning difficulties are not better accounted for by intellectual disabilities, uncorrected visual or auditory acuity, other mental or neurological disorders, psychosocial adversity, lack of proficiency in the language of academic instruction, or inadequate educational instruction.

Question 19

Specifiers for Specific Learning Disorder.

Answer 19

Specify if:
1. With impairment in reading: Word reading accuracy, Reading rate or fluency, Reading comprehension.
2. With impairment in written expression: Spelling accuracy, Grammar and punctuation accuracy, Clarity or organization of written expression
3. With impairment in mathematics: Number sense, Memorization of arithmetic facts. Accurate or fluent calculation. Accurate math reasoning
Specify current severity:
1. Mild: Some difficulties learning skills in one or two academic domains, but the individual may be able to function well when provided with appropriate accommodations or support services.
2. Moderate: Marked difficulties learning skills in one or more academic domains, so that the individual is unlikely to become proficient without some intervals of intensive and specialized teaching.
3. Severe: Severe difficulties learning skills, affecting several academic domains, so that the individual is unlikely to learn these skills.

Question 20

Specific Learning Disorder with Impairment in Reading.

Answer 20

1. By the first grade, natural interest and developmental readiness are channeled into formally learning how to read.
2. For many children, this process is difficult and tedious; for a sizable minority, however, it can be confusing and upsetting.
3. The most common underlying feature of a reading disorder, however, is an inability to distinguish or to separate the sounds in spoken words: Phonological skills are fundamental to learning to read, and therefore this deficit is critical.
4. There are two systems that operate when one reads words, which are essential in the development of reading: The first system operates on individual units (phonemes) and is relatively slow. The second system operates on whole words more quickly.
5. Persistently poor readers rely on rote memory for recognizing words.
6. Have trouble learning basic sight words, especially those that are phonetically irregular and must be memorized, such as the, who, what, where, was, laugh, said, and so forth.
7. Children with reading disorders may prefer a mode of touch or manipulation to assist them in learning.
8. A child with an SLD with impairment in reading lacks the critical language skills required for basic reading: word reading accuracy, reading comprehension, and reading rate or fluency: Dyslexia is an alternative term sometimes used to describe this pattern of reading difficulties.
9. These core deficits stem from problems in decoding (breaking a word into parts rapidly enough to read the whole word) coupled with difficulty reading single small words.
10. When a child cannot detect the phonological structure of language and automatically recognize simple words, reading development will very likely be impaired.

Question 21

Specific Learning Disorder with Impairment in Written Expression.

Answer 21

1. SLD with impairment in written expression may manifest as problems in spelling accuracy, grammar and punctuation accuracy, and/or clarity or organization of written expression.
2. Children with impairment in written expression often have problems with tasks that require eye–hand coordination, despite their normal gross motor development.
3. Children with impairments in writing produce shorter, less interesting, and poorly organized essays and are less likely to review spelling, punctuation, and grammar to increase clarity.
4. However, spelling errors or poor handwriting that do not significantly interfere with daily activities or academic pursuits do not qualify a child for this diagnosis.

Question 22

Specific Learning Disorder with Impairment in Mathematics.

Answer 22

1. The DSM-5 criteria for SLD with impairment in mathematics include difficulties in number sense, memorization of arithmetic facts, accurate or fluent calculation, and/or accurate math reasoning: Dyscalculia is an alternative term sometimes used to describe this pattern of math difficulties.
2. Many skills are involved in arithmetic: recognizing numbers and symbols, memorizing facts (the multiplication table), aligning numbers, and understanding abstract concepts such as place value and fractions. Any or all may be difficult for children with a mathematics disorder.
3. Children with an SLD with impairment in mathematics typically have core deficits in naming amounts or numbers; enumerating, comparing, and manipulating objects; reading and writing mathematical symbols.

Question 23

The Psychological and Social Adjustment of Specific Learning Disorder.

Answer 23

1. Children with SLD often do not know how or why they are different, but they do know how it feels to be unable to keep up with others in the classroom: These daily experiences may cause some children to act out by either withdrawing or becoming angry and noncompliant.
2. Students with SLD with reading impairment feel less supported by their parents, teachers, and peers and they are more likely to express poor academic or scholastic self-concepts.
3. Children and adolescents with SLD are more likely than their peers to show internalizing problems such as anxiety and mood disorders as well as externalizing behaviors such as ADHD.
4. Children with SLD encounter considerable challenges that are likely to take a toll on self-esteem and, in time, their social relationships.
5. Behavior problems may precede, follow, or co-occur with learning problems: However, many of these behavioral and emotional problems gradually decrease for childhood to adolescence, adolescents with SLD continue to face challenges in their social relationships.

Question 24

Adult Outcomes of Specific Learning Disorder.

Answer 24

1. The social and emotional difficulties connected to communication and learning disorders may continue into adulthood, largely because of inadequate recognition and services.
2. Adults may find ways to disguise their problems, such as watching television news rather than reading newspapers.
3. Men perceive lower levels of social support from parents and relatives-the only people still in their lives who knew of their problems as children.
4. Women have more adjustment problems than men as they leave school and face the demands of adult life. They also face greater risk of sexual assault and related forms of abuse.
5. Reading problems often cause poorly qualified graduates to take relatively undemanding and unrewarding jobs.
6. Women who lack competitive skills and strong career options because of school failure tend to get involved at an early age in intimate relationships that are generally unsupportive.
7. Young men have more wide-ranging options once they leave school, which facilitates more positive social functioning in adulthood.
8. People who are given proper educational experiences have a remarkable ability to learn throughout their life spans.
9. Adults can learn to read, although it is difficult because brain development slows down after puberty.

Question 25

Social and Psychological Factors of Specific Learning Disorder.

Answer 25

1. Emotional and behavioral disturbances and other signs of poor adaptive ability often accompany SLD.
2. SLD is commonly associated with deficits in phonological awareness, whereas ADHD has more variable effects on cognitive functioning, especially in areas of rote verbal learning and memory.

Question 26

Prevention and Treatment of Specific Learning Disorder.

Answer 26

1. Specific learning disorders are not usually outgrown, but there is reason for optimism if educational planning and accommodations are ongoing.
2. Intervention methods rely primarily on educational and psychosocial methods.
3. Combined with proper treatment strategies, children and their families may benefit from counselling aimed at helping the children develop greater self-control and a more positive attitude toward their own abilities.
4. Some children respond favorably to stimulant medications that may temporarily improve attention, concentration, and the ability to control their impulsivity, albeit with little or no improvement in learning.
5. Training children in phonological awareness activities at an early age may prevent subsequent reading problems among children at risk. These activities involve games of listening, rhyming, identifying sentences and words, and analyzing syllables and phonemes.

Question 27

The Inclusion Movement of Specific Learning Disorder.

Answer 27

1. Integrating children with special needs into the regular classroom began as the inclusion movement during the 1950s.
2. Children with special needs must be afforded access to all educational services, regardless of their handicaps.

Question 28

Response to Intervention Models of Specific Learning Disorder.

Answer 28

1. RTI consists of tiered instruction, in which children who have difficulty learning to read using typical methods of instruction are provided with small-group, intensive instruction.
2. This approach seeks to provide each child with the appropriate level of instruction required for his or her individual needs.
3. Initiatives allow children with special needs to receive services without being diagnosed or labeled as intellectually disabled, learning disabled, and so forth.

Question 29

Instructional Models of Specific Learning Disorder.

Answer 29

1. Direct instruction is a straightforward approach to teaching based on the premise that to improve a skill, the instructional activities must approximate those of the skill being taught.
2. Direct instruction in word structure is necessary because of the child’s phonological deficits.
3. Direct instruction in reading emphasizes the specific learning of word structure and word reading until the skill is learned, without concern for the full context of the sentence.
4. Based on the premise that a child’s ability to decode and recognize words accurately and rapidly must be acquired before reading comprehension can occur.
5. To prevent dyslexia, it is important to provide early interventions that teach both phonological and verbal abilities: Children must be able to learn the sounds of words to decode them, but they must also understand the meaning of a word to understand the message of the text.
6. The components of effective reading instruction are the same whether the focus is prevention or intervention—phonemic awareness and phonemic decoding skills, fluency in word recognition, construction of meaning, vocabulary, spelling, and writing.
7. Instruction in phonemic awareness, phonics, and other reading skills produces more activation in the automatic recognition process.

Question 30

Behavioural Strategies of Specific Learning Disorder.

Answer 30

1. Providing children with a set of verbal rules that can be written out and reapplied may be more beneficial than one that relies on memory.
2. During an engaging activity with a younger child, the therapist may talk about toys and then encourage the child to use the same sounds or words.
3. Behavioral methods are used in conjunction with a complete program of direct instruction, which typically proceeds in a cumulative, highly structured manner.

Question 31

Cognitive-Behavioural Interventions for Specific Learning Disorder.

Answer 31

1. Procedures actively involve students in learning, particularly in monitoring their own thought processes.
2. Considerable emphasis is placed on self-control by using strategies such as self-monitoring, self-assessment, self-recording, self-management of reinforcement, and so on.

Question 32

Computer-Assisted Learning for Specific Learning Disorder.

Answer 32

1. One problem in reading instruction is maintaining a balance between the basic, but dull, word decoding and the complex, but engaging, text comprehension.
2. Not all the issues have been resolved, but computer-assisted methods for spelling, reading, and math provide more academic engagement and achievement than traditional pencil-and-paper method.
3. Computer programs are able to slow down these grammatical sounds, allowing young children to process them more slowly and carefully.

Question 33

What is Attention-Deficit/Hyperactivity Disorder (ADHD)?

Answer 33

Attention-Deficit/Hyperactivity Disorder (ADHD) describes children who display persistent age-inappropriate symptoms of inattention, hyperactivity, and impulsivity that are sufficient to cause impairment in major life activities.

Question 34

Features of ADHD.

Answer 34

1. Primary symptoms of ADHD: Inattentive, Hyperactive, Impulsive.
2. ADHD has no distinct physical symptoms that can be seen in an x-ray or a lab test: it can only be identified by characteristic behaviors that vary considerably from child to child.
3. ADHD can severely disrupt an individual’s life, consume vast amounts of energy, produce emotional pain, damage self-esteem, and seriously disrupt relationships.

Question 35

The History of ADHD.

Answer 35

1. The symptoms of ADHD were first described in a 1775 medical textbook by the German physician Melchior Adam Weikard.
2. In 1798, Sir Alexander Crichton described a syndrome similar to ADHD that included early onset, restlessness, inattention, and poor school performance.
3. In the early 1900s, the onset of widespread compulsory education demanded self-controlled behavior in a group setting, which further focused attention on children with the symptoms of ADHD.
4. 1917 to 1926- children who had developed encephalitis (brain inflammation) and survived experienced multiple behavior problems, including irritability, impaired attention, and hyperactivity (brain-injured child syndrome).
5. In the late 1950s, ADHD was referred to as hyper-kinesis, which was attributed to poor filtering of stimuli entering the brain.
6. 1970s- it was argued that in addition to hyperactivity, deficits in attention and impulse control were also primary symptoms of ADHD. This had a lasting impact on the DSM criteria for defining ADHD.
7. 1980s- interest in children with ADHD increased dramatically, and the sharp rise in the use of stimulants generated controversy that continues to this day.

Question 36

The DSM-5 Diagnostic Criteria For Attention-Deficits/Hyperactivity Disorder.

Answer 36

A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):
1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g. starts tasks but quickly loses focus and is easily sidetracked).
e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks: difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).
f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).
2. Hyperactivity and Impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
a. Often fidgets with or taps hands or feet or squirms in seat.
b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
c. Often runs about or climbs in situations where it is inappropriate.
d. Often unable to play or engage in leisure activities quietly.
e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or is uncomfortable being still for extended time, as in restaurants, meetings; may be seen by others as being restless or difficult to keep up with).
f. Often talks excessively.
g. Often blurts out answers before a question has been completed (e.g., completes people’s sentences; cannot wait for a turn in conversation).
h. Often has difficulty waiting his or her turn (e.g., while waiting in line).
i. Often interrupts or intrudes on others (e.g., butts into conversations, games or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).
B. Several inattentive or hyperactive–impulsive symptoms were present before age 12 years.
C. Several inattentive or hyperactive–impulse symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).
D. There must be clear evidence that the symptoms interfere with, or reduce the quality of, social academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).

Question 37

Specifiers of ADHD.

Answer 37

Specify whether:
1. Combined presentation: If both Criterion A1 (inattention) and Criterion A2 (hyperactivity–impulsivity) are met for the past 6 months.
2. Predominantly inattentive presentation: If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity–impulsivity) is not met for the past 6 months.
3. Predominantly hyperactive–impulsive presentation: if Criterion A2 (hyperactivity–impulsivity) is met but Criterion A1 (inattention) is not met for the past 6 months.
Specify if:
1. In partial remission: When full criteria were previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still result in impairment in social, academic, or occupational functioning.
Specify current severity:
1. Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor impairments in social or occupational functioning.
2. Moderate: Symptoms or functional impairment between “mild” and “severe” are present.
3. Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning.

Question 37

What are the Core characteristics of ADHD?

Answer 37

1. Inattention.
2. Hyperactivity-Impulsivity.

Question 38

What is Inattention?

Answer 38

Inattention refers to an inability to sustain attention or stick to tasks or play activities, to remember and follow through on instructions or rules, and to resist distractions.
1. Common complaints about inattention are that the child doesn’t or won’t listen, follow instructions, or finish chores or assignments.

Question 39

What is Attentional Capacity?

Answer 39

Attentional Capacity is the amount of information we can remember and attend to for a short time.
1. Children with ADHD do not have a deficit in their attentional capacity. They can remember the same amount of information for a short time as do other children.

Question 40

What is Selective Attention?

Answer 40

Selective Attention is the ability to concentrate on relevant stimuli and ignore task-irrelevant stimuli in the environment.
1. Distractibility is a term commonly used to indicate a deficit in selective attention. Children with ADHD are much more likely than others to be distracted by stimuli that are highly salient and appealing.

Question 40

What is Sustained Attention or Vigilance?

Answer 40

Sustained Attention, or Vigilance, is the ability to maintain a persistent focus over time on unchallenging, uninteresting tasks or activities or when fatigued.
1. A primary attention deficit in ADHD seems to be sustained attention. However, children with ADHD may show performance deficits from the very beginning of a task or response, not just a decline over time.

Question 41

What is Alerting?

Answer 41

Alerting refers to an initial reaction to a stimulus.
1. It involves the ability to prepare for what is about to happen.
2. A child with an alerting deficit may respond too quickly in situations requiring a slow and careful approach and too slowly in situations requiring a quick response.

Question 42

What is Hyperactivity–Impulsivity?

Answer 42

Hyperactivity–Impulsivity involves the under control of motor behavior, poor sustained inhibition of behavior and the inability to delay a response or defer gratification.

Question 43

Outline Hyperactivity as a core characteristic of ADHD.

Answer 43

1. Sitting still through a class lesson can be impossible for children with ADHD. They may fidget, squirm, climb, run about the room aimlessly, touch everything in sight, or noisily tap a pencil.
2. Their activity is excessively energetic, intense, inappropriate, and not goal-directed.
3. The amount of activity depends on environmental demands: to slow down or sit still in response to the structured task demands of the classroom

Question 44

Outline Impulsivity as a core characteristic of ADHD.

Answer 44

1. Children who are impulsive seem unable to bridle their immediate reactions or think before they act.
2. It’s very hard for them to stop an ongoing behavior or to regulate their behavior in accordance with the demands of the situation or the wishes of others.
3. As a result, they may blurt out inappropriate comments or give quick, incorrect answers to questions that have not yet been completed.
4. They also have trouble resisting immediate temptations and delaying gratification.
5. Minor mishaps are common, such as spilling drinks or knocking things over, but more serious accidents and injuries can result from reckless behavior, such as running into the street without looking or risky bike riding.

Question 45

What are the different forms of Impulsivity?

Answer 45

1. Cognitive Impulsivity is reflected in disorganization, hurried thinking, and the need for supervision.
2. Behavioural Impulsivity includes impulsively calling out in class or acting without considering the consequences. A child may touch a stove to see if it is hot even when she is old enough to know better.
3. Emotional Impulsivity/Dysregulation is demonstrated by impatience, low frustration tolerance, hot temper, quickness to anger, and irritability. It refers to how quickly and how likely an individual will react with negative emotions in response to negative events.

Question 46

What is Presentation Type?

Answer 46

Presentation Type refers to a group of individuals with something in common (symptoms, etiology, problem severity, or likely outcome) that makes them distinct from other groupings.

Question 47

Outline the Presentation Types of ADHD.

Answer 47

1. Predominantly Inattentive Presentation (ADHD-PI) describes children who meet symptom criteria for inattention but not hyperactivity–impulsive: inattentive to details, easily distracted, careless, not listening, unfocused, disorganized, unable to sustain effort, and forgetful. Anxious and apprehensive and socially withdrawn and may display anxiety and mood disorders. Sluggish Cognitive Tempo (SCT), a cluster that includes symptoms such as daydreams, sleepy/drowsy, easily confused, stares blankly, lost in thoughts, slow thinking and responding.
2. Predominantly Hyperactive–Impulsive Presentation (ADHD-HI) describes children who meet symptom criteria for hyperactivity–impulsivity but not inattention: ADHD-HI is the rarest presentation and includes primarily preschoolers.
3. Combined Presentation (ADHD-C) describes children who meet symptom criteria for both inattention and hyperactivity–impulsivity.
4. Presentations may also be unstable over time: a child described as ADHD-PI at one time may be categorized as ADHD-HI or ADHD-C at another point in time, and vice versa.

Question 47

Outline Cognitive Deficits as an associated characteristic of ADHD.

Answer 47

1. Executive functions (EFs) are cognitive processes in the brain that activate, integrate, and manage other brain functions.
2. Cognitive processes, such as working memory, mental computation, planning and anticipation, flexibility of thinking, and the use of organizational strategies.
3. Language processes, such as verbal fluency and the use of self-directed speech.
4. Motor processes, such as allocation of effort, following prohibitive instructions, response inhibition, and motor coordination and sequencing.
5. Emotional processes, such as self-regulation of arousal level and tolerating frustration.

Question 48

List some of the Impaired Executive Functions and their resulting Impairment in ADHD.

Answer 48

1. Organise, prioritise: Trouble getting started. Misunderstanding directions.
2. Focus, sustain attention: Lose focus when trying to listen. Easily distracted.
3. Monitor and regulate action: Find it hard to sit still.

Question 49

Outline Intellectual Deficits as an associated characteristic of ADHD.

Answer 49

1. Their difficulty lies not in a lack of intelligence, but rather in applying their intelligence to everyday life situations.
2. Lower IQ scores can be the direct result of the effects of ADHD symptoms on test-taking behavior: For example, a child who scores lower on an IQ test because he or she is not paying attention to instructions or is engaging in off-task behaviors is not necessarily less intelligent.
   Impaired Academic Functioning
3. Most children with ADHD experience severe difficulties in school; this is especially true for those with co-occurring disorders.
4. They may also fail to advance in grade or may be placed more frequently in special education classes.
5. The academic skills of many children with ADHD are impaired before they enter the first grade.

Question 50

Outline Specific Learning Disorder as an associated characteristic of ADHD.

Answer 50

1. As many as 45% of children with ADHD have a specific learning disorder.
2. The child’s cognitive and intellectual deficits may directly lead to learning problems.
3. The impact of childhood ADHD symptoms on long-term academic achievement may also be indirect—they influence later school grades because of their effects on homework management and classroom performance.
4. The association between ADHD and learning disorders could also be due to common neuropsychological deficits or a common genetic link.

Question 51

Outline Distorted Self-Perceptions as an associated characteristic of ADHD.

Answer 51

1. Positive Bias or Positive Illusory Bias is that children with ADHD may perceive their relationships with their parents, teachers, or peers no differently than do control children, even though their parents, teachers, or peers see things in a more negative light.
2. Children with ADHD who display inattentive and depressive/anxious symptoms tend to report lower self-esteem, whereas those with symptoms of hyperactivity–impulsivity and conduct problems appear to exaggerate their self-worth.
3. Positive bias in children with hyperactivity–impulsivity serves a self-protective function that allows the child to cope every day despite frequent failures.
4. Children with ADHD also display distortions in their perceptions of quality of life: Despite experiencing many life difficulties, children with ADHD rate their own quality of life more positively than others rate it.

Question 52

Outline Speech and Language Impairments as an associated characteristic of ADHD.

Answer 52

1. The type of speech and language impairment may be related to the child’s specific ADHD symptoms: Symptoms of hyperactivity–impulsivity were related to poor language skills, whereas those of inattention were more highly correlated with weaker receptive and expressive vocabulary skills.
2. Children with ADHD may have difficulty in understanding others’ speech and in using appropriate language in everyday situations.
3. Impairment in pragmatic language skills relates to these children’s social difficulties and may, in part, account for these difficulties.
4. Children with ADHD not only ramble on, but also their conversation is characterized by speech production errors, fewer pronouns and conjunctions and unrelated comments and unclear links.

Question 53

Outline Health-Related Problems (Medical Conditions) as an associated characteristic of ADHD

Answer 53

1. In terms of specific problems, higher rates of enuresis and encopresis and asthma have been reported.
2. Other health risks include dental health problems, poor fitness, eating problems/disorders, and sleep disturbances.
3. Some of the sleep problems in children with ADHD may be related to shared brain pathways involving areas responsible for regulation and arousal, their use of stimulant medications.

Question 53

Outline Family Problems (Social Problems) as an associated characteristic of ADHD.

Answer 53

1. Families of children with ADHD experience many difficulties, including interactions characterized by negativity, noncompliance by the child, excessive parental control, and sibling conflict.
2. Further stress on family life stems from the fact that parents of children with ADHD may themselves have ADHD and related conditions.
3. Families of children with ADHD also report less parenting competence, fewer contacts with extended family members, greater caregiver strain, less instrumental support, and slightly higher rates of marital conflict, separation, and divorce.
4. Many also report stigmatizing experiences, including concerns about how society would label their child, social isolation and rejection, and perceptions that health care and school personnel are dismissive of their concerns.
5. Siblings of children with ADHD report that they feel victimized by their ADHD sibling and that this experience is often minimized or overlooked.

Question 54

Outline Peer Problems (Social Problems) as an associated characteristic of ADHD.

Answer 54

1. Peer problems in both boys and girls with ADHD are apparent at an early age and are quickly evident when the child enters a new social situation.
2. Children with ADHD can be bothersome, stubborn, socially awkward, and socially insensitive.
3. Children with ADHD seem to get into trouble even when trying to be helpful, and although their behavior seems thoughtless, it is often unintentional.
4. Children with ADHD are disliked and uniformly rejected by peers, have few friends and a higher proportion of friends with learning and behavior problems, and report receiving low social support from peers.
5. For girls with ADHD-PI, internalizing symptoms may play a particularly salient role in their being disliked or rejected by peers.
6. Once their peers label them “ADHD,” a negative process begins whereby the child suffers more negative treatment, victimization, and rejection by peers, leading to a cascading of negative effects over time.
7. Children with ADHD are not deficient in social reasoning or understanding: They simply do not use what they know during social exchanges, and they may continue to be dominant or assertive even when the situation changes and requires accommodation, negotiation, or submission.

Question 55

Outline Accident-Proneness and Risk Taking (Medical Conditions) as an associated characteristic of ADHD

Answer 55

1. Children are about three times more likely to experience serious accidental injuries, such as broken bones, lacerations, severe bruises, burns, poisonings, or head injuries.
2. Young adult drivers with ADHD are at higher risk than others for traffic accidents, and deviant peer associations may play an important role.
3. ADHD is a significant risk factor for the early initiation of cigarette smoking, substance-use disorders, Internet and videogame use problems and addictions, and risky sexual behaviors such as multiple partners and unprotected sex. the relationship between
4. ADHD and risk taking was accounted for by the later development of Conduct Disorder (CD).
5. A reduced life expectancy for individuals with ADHD seems to be predicted by a pattern of accident-proneness, auto accidents, and risk taking, combined with a reduced concern for health-promoting behaviors, such as exercise, proper diet, safe sex, and moderate use of tobacco, alcohol, and caffeine.

Question 56

Outline Oppositional Defiant Disorder and Conduct Disorder as an Accompanying Psychological Disorder And Symptom of ADHD.

Answer 56

1. About half or more children and adolescents with ADHD meet criteria for oppositional defiant disorder (ODD) by age 7 or later.
2. Children with ODD overreact by lashing out at adults and other kids. They can be stubborn, short-tempered, argumentative, and defiant.
3. The symptoms of ODD generally fall into two types—irritability (tantrums, crankiness) and defiance (talking back, argumentativeness).
4. Children with ADHD eventually develop conduct disorder (CD), which is more severe than ODD.
5. ADHD that occurs early, particularly when it is accompanied by severe symptoms of hyperactivity–impulsivity, increases the odds of ODD/CD by about 10-fold.
6. ADHD and ODD/CD symptoms codevelop from childhood to adulthood.
7. ADHD is also a risk factor for the later development of antisocial personality disorder (APD), a pervasive pattern of disregard for, and violation of, the rights of others, as well as involvement in multiple illegal behaviors.
8. ADHD, ODD, and CD run together in families, which suggests a common predisposing cause.

Question 57

Outline Anxiety Disorders as an Accompanying Psychological Disorder And Symptom of ADHD.

Answer 57

1. About 25% to 50% of children with ADHD experience excessive anxiety or one or more anxiety disorders.
2. These children worry about being separated from their parents, trying something new, taking tests, making social contacts, or visiting the doctor.
3. Children with co-occurring ADHD and anxiety disorder(s) display less aggressive behavior but experience more social and academic difficulties, more impairment in daily functioning, poorer quality of life.
4. The strong association between ADHD and anxiety symptoms is almost entirely accounted for by attention problems and not hyperactivity–impulsivity.

Question 58

Outline Mood Disorders as an Accompanying Psychological Disorder And Symptom of ADHD.

Answer 58

1. As many as 20% to 30% of young people with ADHD experience depression, and even more will develop depression or another mood disorder by early adulthood.
2. A number of individuals with ADHD experience disruptive mood dysregulation disorder, characterized by severe emotional and behavioral problems with the characteristic feature of chronic irritability.
3. Many youths with ADHD have higher rates of suicidal ideation and deliberate self-harm than controls; however, the highest risk for suicide is among those with ADHD with co-occurring depression and conduct problems.
4. The association between ADHD and depression may be due to the notion that family risk for one disorder increases the risk for the other.

Question 59

Outline Developmental Coordination and Tic Disorders as an Accompanying Psychological Disorder And Symptom of ADHD.

Answer 59

1. As many as 50% of children with ADHD may have a Developmental Coordination Disorder (DCD), a condition characterized by marked motor incoordination and delays in achieving motor milestone.
2. 20% of children with ADHD also have Tic Disorders—sudden, repetitive, nonrhythmic motor movements or sounds such as eye blinking, facial grimacing, throat clearing, and grunting.
3. These children experience more behavioral, social, and academic difficulties than do those with ADHD alone.

Question 60

Outline Family Influences as a Theory and Cause of ADHD.

Answer 60

1. Family influences may lead to ADHD symptoms or to a greater severity of symptoms: In some cases, ADHD symptoms may be the result of interfering and insensitive early caregiving practices.
2. For children at risk for ADHD, family conflict may raise the severity of their hyperactive–impulsive symptoms to a clinical level.
3. Goodness Of Fit refers to the match between the child’s early temperament and the parent’s style of interaction.
4. Family problems may result from interacting with a child who is impulsive and difficult to manage.
5. Family conflict or parental psychopathology is likely related to the presence, persistence, or later emergence of associated oppositional and conduct disorder symptoms.

Question 61

Outline Educational Intervention as a Primary Intervention for ADHD.

Answer 61

1. Educational Interventions focus on managing inattentive and hyperactive–impulsive behaviors that interfere with learning and on providing a classroom environment that capitalizes on the child’s strengths.
2. The teacher and child set realistic goals and objectives, set up a mutually agreed-upon reward system, carefully monitor performance, and reward the child for meeting goals.
3. Disruptive or off-task classroom behaviors may be punished with Response-cost Procedures that involve the loss of privileges, activities, points, or tokens following inappropriate behavior or with brief periods of time-out.
4. Letting children know what is expected of them, using visual aids, providing cues for expected behavior, and giving written as well as oral instructions all help children focus their attention.
5. Repeating instructions, providing extra time, writing assignments on the board, and listing the books and materials needed for a task may increase the likelihood that children with ADHD will complete their work.

Question 61

Outline Parent Management Training (PMT) as a Primary Intervention for ADHD.

Answer 61

1. Parent management training (PMT) focuses on teaching both effective parenting practices and strategies for coping with the challenges of parenting a child with ADHD.
2. It provides parents with a variety of skills to help them: Manage their child’s oppositional and noncompliant behaviors. Cope with the emotional demands of raising a child with ADHD. Contain the problem so that it does not worsen. Keep the problem from adversely affecting other family members.
3. Parents are first taught about ADHD so that they understand the biological basis of the disorder.
4. Parents are also given a set of guiding principles for raising a child with ADHD, such as using more immediate and powerful consequences and planning ahead.
5. Parents are next taught behavior management principles and techniques, such as identifying behaviors to encourage or discourage.
6. Parents may also learn to use a school–home-based reward program, in which teachers evaluate the child on a daily report card.
7. Parents are encouraged to spend time each day sharing an enjoyable activity with their child.

Question 62

Outline Summer Treatment Program as an Intensive Intervention for ADHD.

Answer 62

1. Treatment is provided to children and adolescents with ADHD in a camplike setting where they engage in classroom and recreational activities with other children.
2. Summer treatment has two major advantages over other interventions: It maximizes opportunities to build effective peer relations in normal settings. It provides continuity to academic work to ensure that gains made during the school year are not lost.
3. These programs are coordinated with stimulants medication trials, parent management training, social skills training, and educational interventions.

Question 63

Outline The MTA Study as an Intensive Intervention for ADHD.

Answer 63

1. The Multimodal Treatment Study of Children with ADHD represents the first large-scale, randomized clinical trial for children with ADHD.
2. The study sought to answer three questions: How do long-term medication and behavioral treatments compare with one another? Are there additional benefits when they are used together? What is the effectiveness of systematic, carefully delivered treatments versus routine community care?
3. It conducted 4 treatment groups: Medication management, Behavioural Treatment, Combined Behavioural treatment and Medication, Routine Community Treatment.
4. Stimulant medication was superior to behavioral treatment and to routine community care in treating the symptoms of ADHD.
5. Combining behavioral treatments with medication resulted in no additional benefits for the core symptoms of ADHD over medication alone, but it did provide modest benefits for non-ADHD symptoms and other outcomes related to positive functioning.
6. Composite outcome measures showed that combined treatment was best, followed by medication, then behavior therapy, and finally, community treatment.
7. The long-term findings from the MTA study indicate that the initial clinical presentation in childhood (e.g., severity, co-occurring conduct problems, social disadvantage) and the strength of ADHD symptom response to any treatment are better predictors of adolescent outcomes than the type of treatment received in childhood.

Question 64

Outline Family Counselling and Support Groups as an Additional Intervention for ADHD.

Answer 64

1. Many families of children with ADHD experience frustration, blame, and anger for some time.
2. Counseling the family helps everyone develop new skills, attitudes, and an ability to relate more effectively.
3. Support groups for people who are coping with ADHD in various ways can be very helpful to member.
4. Members share information, emotional support, personal frustrations and successes, referrals to qualified professionals, discoveries about what works.
5. There are also online bulletin boards and discussion groups.
6. Sharing experiences with others that have similar concerns helps parents feel that they are not alone.

Question 65

Outline Individual Counselling as an Additional Intervention for ADHD.

Answer 65

🗣Life can be very hard for children with ADHD. They have few successes on which to build their sense of self-competence.
🗣Even when they succeed, they may attribute their success to uncontrollable factors such as task ease or luck.
🗣They have few friends and are constantly in trouble.
🗣Individual counseling attempts to address these concerns.

Question 66

What are Conduct Problem(S) and Antisocial Behavior(S)?

Answer 66

Conduct Problem(S) and Antisocial Behavior(S) are terms used to describe a wide range of age-inappropriate actions and attitudes of a child that violate family expectations, societal norms, and the personal or property rights of others.

Question 66

Outline the Legal Perspective of Conduct Problem(S) and Antisocial Behavior(S).

Answer 66

1. Legally, conduct problems are defined as delinquent or criminal acts: The broad term Juvenile Delinquency describes children who have broken a law, ranging from sneaking into a movie without paying to homicide. Delinquent acts include property crimes (e.g., vandalism, theft, breaking and entering) and violent crimes (e.g., robbery, aggravated assault, homicide).
2. Delinquency, the legal definition, involves apprehension and court contact and excludes the antisocial behaviors of very young children that usually occur at home or school: Youths who display antisocial behavior and are apprehended by police may differ from youths who display the same patterns but are not apprehended because of their intelligence or resourcefulness.
3. Some criminal acts such as arson and truancy, are included in current mental health definitions, whereas selling drugs, receiving stolen property, and prostitution are not.
4. A legal definition of delinquency may result from one or two isolated acts, whereas a mental health definition usually requires the child to display a variety and persistent pattern of antisocial behaviors.

Question 67

What are the Social and Economic Costs of Conduct Problem(S) and Antisocial Behavior(S)?

Answer 67

1. The staggering costs borne by the educational, health, criminal justice, social service, and mental health systems that deal with youths with conduct problems make it one of the most costly mental health problems.
2. These children cause considerable and disproportionate amounts of harm, accounting for over 50% of all crime in the United States, and about 30% to 50% of clinic referrals.
3. The additional public costs per child with conduct problems across the health care, juvenile justice, and educational systems are enormous—at least $10,000 or more a year.

Question 67

Outline the Context of Conduct Problem(S) and Antisocial Behavior(S)?

Answer 67

1. Although most young people break the rules, adolescents with conduct problems engage in more, and more severe, antisocial and risk-taking behavior compared to their peers.
2. Antisocial behaviors appear and then decline during normal development.
3. Frequencies of three common antisocial behaviors for clinic-referred and non-referred boys and girls of different ages: Antisocial behaviors vary in severity, from minor disobedience to fighting. Some antisocial behaviors decrease with age (e.g., disobeying at home), whereas others increase with age and opportunity (e.g., hanging around with kids who get into trouble). Antisocial behaviors are more common in boys than in girls during childhood, but this difference narrows in adolescence.
4. Even though many antisocial behaviors decrease with age, children who are the most physically aggressive in early childhood maintain their relative standing over time.

Question 68

Outline the Psychological Perspective of Conduct Problem(S) and Antisocial Behavior(S).

Answer 68

1. Conduct problems fall along a continuous dimension of Externalizing Behavior.
2. Children at the upper extreme of this dimension, usually one or more standard deviations above the mean, are considered to have conduct problems.
3. The externalizing dimension itself consists of two related but independent subdimensions, labeled “rule-breaking behavior” and “aggressive behavior”.
4. Rule-breaking behaviors include running away, setting fires, stealing, skipping school, using alcohol and drugs, and committing acts of vandalism.
5. Aggressive behaviors include fighting, destructiveness and disobedience, showing off, being defiant, threatening others, and being disruptive at school.
6. Two additional independent dimensions of antisocial behavior have been identified: overt–covert and destructive–nondestructive.
7. The Overt–Covert Dimension ranges from overt visible acts such as fighting to covert hidden acts such as lying or stealing.
8. Children who display overt antisocial behavior tend to be negative, irritable, and resentful in their reactions to hostile situations.
9. Those displaying covert antisocial behaviour are less social, more anxious and more suspicious of others.
10. The destructive–nondestructive dimension ranges from acts such as cruelty to animals or physical assault to nondestructive behaviors such as arguing or irritability.

Question 69

Outline the Psychiatric Perspective of Conduct Problem(S) and Antisocial Behavior(S).

Answer 69

1. From a psychiatric perspective, conduct problems are defined as distinct mental disorders based on DSM-5 symptoms.
2. DSM-5 contains the general category of Disruptive, Impulse-Control, and Conduct Disorders.
3. All disorders in this category involve problems in the self-control of emotions and behaviors, including two that refer to persistent patterns of antisocial behavior in youth—oppositional defiant disorder (ODD) and conduct disorder (CD).
4. This general category also includes intermittent explosive disorder (impulsive aggressive outbursts in response to minor provocations), pyromania (multiple episodes of deliberate and purposeful fire setting), and kleptomania (recurrent failure to resist impulses to steal items not needed for personal use or monetary value).

Question 70

The DSM-5 Diagnostic Criteria For Oppositional Defiant Disorder (ODD).

Answer 70

A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with a least one individual who is not a sibling.
Angry/Irritable Mood
1. Often loses temper.
2. Is often touchy or easily annoyed.
3. Is often angry or resentful.
Argumentative/Defiant Behavior
4. Often argues with authority figures or, for children and adolescents, with adults.
5. Often actively defies or refuses to comply with requests from authority figures or with rules.
6. Often deliberately annoys others.
7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness
8. Has been spiteful or vindictive at least twice within the past 6 months.
Note: The persistence and frequency of these behaviors should be used to distinguish a behavior that is within normal limits from behavior that is symptomatic.
B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning.
C. The behaviors do not occur exclusively during the course of a psychotic, substance-use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood disorder.

Question 71

The DSM-5 Diagnostic Criteria For Conduct Disorder (CD).

Answer 71

A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:
Aggression to People and Animals
1. Often bullies, threatens, or intimidates others.
2. Often initiates physical fights.
3. Has used a weapon that can cause serious physical harm to others (a bat, brick, broken bottle, knife, gun).
4. Has been physically cruel to people.
5. Has been physically cruel to animals.
6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
7. Has forced someone into sexual activity.
Destruction of Property
8. Has deliberately engaged in fire setting, with the intention of causing serious damage.
9. Has deliberately destroyed others’ property (other than by fire setting).
Deceitfulness or Theft
10. Has broken into someone else’s house, building, or car.
11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).
Serious Violations of Rules
13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
14. Has run away from home overnight at least twice while living in parental or parental surrogate home, or once without returning for a lengthy period.
15. Is often truant from school, beginning before age 13 years.
B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
C. If the individual is 18 years or older, criteria are not met for Antisocial Personality Disorder.

Question 72

Specifiers for Conduct Disorder.

Answer 72

1. Childhood-onset type: Individuals show at least one symptom characteristic of conduct disorder prior to age 10 years.
2. Adolescent-onset type: Individuals show no symptom characteristic of conduct disorder prior to age 10 years.
3. Unspecified onset: Criteria for a diagnosis of conduct disorder are met, but there is not enough information available to determine whether the onset of the first symptom was before or after age 10 years.
   Specify if:
4. With limited prosocial emotions: an individual must have displayed at least two of the following characteristics persistently over at least 12 months and in multiple relationships and settings.
5. Shallow or deficient affect: Does not express feelings or show emotions to others, except in ways that seem shallow.
6. Lack of remorse or guilt: Does not feel bad or guilty when he or she does something wrong (excludes remorse when expressed only when caught and/or facing punishment). The individual shows a general lack of concern about the negative consequences of his or her actions.
7. Callous–lack of empathy: Disregards and is unconcerned about the feelings of others. The individual is described as cold and uncaring.
8. Unconcerned about performance: Does not show concern about poor/problematic performance at school, at work, or in other important activities. The individual does not put forth the effort necessary to perform well.

Question 73

Discuss CD and Age of Onset.

Answer 73

1. Those with childhood-onset conduct disorder display at least one symptom of the disorder before age 10, whereas those with adolescent-onset conduct disorder do not.
2. Children diagnosed with childhood-onset CD are more likely to be boys, show more aggressive symptoms, account for a disproportionate amount of illegal activity, and persist in their antisocial behavior over time: They are also more likely to have ADHD and family dysfunction
3. Youths diagnosed with adolescent-onset CD are as likely to be girls as boys and do not display the severity or psychopathology that characterizes the childhood-onset group: They are also less likely to commit violent offenses or to persist in their antisocial behavior as they get older.

Question 74

Discuss The ODD and CD Connection.

Answer 74

1. There is much overlap between the symptoms of ODD and CD: Symptoms of ODD typically emerge 2 to 3 years before CD symptoms, at about 6 years of age for ODD versus 9 years for CD.
2. Since ODD symptoms emerge first, it is possible that they are precursors of early onset CD symptoms for some children.
3. However, nearly half of all children with CD have no prior ODD diagnosis and most children who display ODD do not progress to more severe CD.
4. Thus, for most children, ODD is an extreme developmental variation and a strong risk factor for later ODD and other problems, but not one that necessarily signals an escalation to more serious conduct problems.

Question 75

Discuss Antisocial Personality Disorder (APD) and Psychopathic Features of Conduct Disorder.

Answer 75

1. Persistent aggressive behavior and CD in childhood may be a precursor of Adult Antisocial Personality disorder (APD), a pervasive pattern of disregard for, and violation of, the rights of others, including repeated illegal behaviors, deceitfulness, repeated physical fights or assaults, reckless disregard for the safety of self or others, repeated failure sustain work behavior or honor financial obligations, and a lack of remorse.
2. In addition to their early CD, adolescents with APD may also display Psychopathic Features, which are defined as a pattern of callous, manipulative, deceitful, and remorseless behavior—the more menacing side of human nature.

Question 76

What is a Callous and Unemotional (CU) Interpersonal Style?

Answer 76

Callous and Unemotional (CU) Interpersonal Style is characterized by an absence of guilt, lack of empathy, uncaring attitudes, shallow or deficient emotional responses, and related traits of narcissism and impulsivity.
1. Children with CU traits display a greater number and variety of conduct problems, and they have more frequent contact with police and a stronger parental history of APD than other children with conduct problems.
2. CU symptoms in childhood are about as stable as ODD and CD symptoms over time, but developmental changes have been noted.
3. CU traits in childhood and early adolescence are likely precursors of adult forms of psychopathy.

Question 77

Discuss Cognitive and Verbal Deficits as an Associate Characteristic of Conduct Disorder.

Answer 77

1. Lower IQ scores in children with CD may be related to the co-occurrence of ADHD.
2. Verbal IQ is consistently lower than performance IQ in children with CD, suggesting a specific and pervasive deficit in language.
3. This deficit may affect the child’s receptive listening, reading, problem solving, pragmatic language, expressive speech and writing, and memory for verbal material.
4. Verbal deficits, such as poor receptive language skills, may also lead to rejection by mainstream peers, adding to the development of conduct problems.
5. Cool executive function (attention, working memory, planning, and inhibition) deficits are more characteristic of children with ADHD.
6. Hot executive function (incentives and motivation) deficits are more characteristic of children with conduct problems.

Question 78

Discuss School and Learning Problems as an Associate Characteristic of Conduct Disorder.

Answer 78

1. Children with conduct problems display many school difficulties, including academic underachievement, grade retention, special education placement, dropout, suspension, and expulsion.
2. It is more likely that a common factor, such as a neuropsychological or language deficit, lack of self-control, or socioeconomic disadvantage, underlies both conduct problems and school difficulties.
3. Over time, underachievement and conduct problems influence each other: Subtle early language deficits may lead to reading and communication difficulties, which in turn may heighten conduct problems in elementary school.
4. Children with poor academic skills are increasingly likely to lose interest in school and to associate with delinquent peers.

Question 79

Discuss Family Problems as an Associate Characteristic of Conduct Disorder.

Answer 79

1. General family disturbances include parental mental health problems, a family history of antisocial behavior, family instability, limited resources.
2. Specific disturbances in parenting practices and family functioning include excessive use of harsh discipline, lack of supervision, lack of emotional support and involvement, and parental disagreement about discipline.
3. General family disturbances such as maternal depression often lead to poor parenting practices, resulting in antisocial behavior and feelings of parental incompetence.
4. High levels of conflict are common in families of children with conduct problems.
5. There is often a lack of family cohesion, which is reflected in emotional detachment, poor communication and problem solving, low support, and family disorganization.
6. Household chaos, characterized by high noise levels, crowding, people coming and going all the time and a lack of predictability and family routines is also associated with child conduct problems.
7. There are many possible reasons for the similarities in the problem behaviors of siblings, including poor parenting practices, the effects of modeling, direct influence of the other sibling.

Question 80

Discuss Peer Problems as an Associate Characteristic of Conduct Disorder.

Answer 80

1. Young children with conduct problems display verbal and physical aggression toward other children as well as poor social skills.
2. Pre-schoolers who show poor self-regulation have difficulty understanding the perspectives of others, experience corporal punishment from their parents, and display higher levels of peer aggressiveness during the transition to grade school.
3. Peer rejection in elementary school is a strong risk factor for adolescent conduct problems. For example, children rejected for 2 or 3 years by grade 2 are about five times more likely than others to display conduct problems later in adolescence.
4. Children with conduct problems are able to make friends. Unfortunately, their friendships are often with like-minded antisocial individuals.
5. Reactive–Aggressive children (those showing an angry, defensive response to frustration or provocation) display a Hostile Attributional Bias, which means they are more likely to attribute hostile and mean-spirited intent to other children, especially when the intentions of others are unclear.
6. Proactive–Aggressive children (those who use aggressive behavior deliberately to obtain a desired goal) are more likely to display emotional underarousal, view their aggressive actions as positive, and value social goals of dominance and revenge rather than affiliation.

Question 81

Discuss Self-Esteem Deficits as an Associate Characteristic of Conduct Disorder.

Answer 81

1. Many children with conduct problems have low self-esteem. However, there is little support for the view that low self-esteem is the primary cause of conduct problems.
2. Aggressive children may overestimate their social competence and acceptance by other children. Any perceived threat to their biased view of self (e.g. rejection) may lead to aggressive behavior, which provides a way to avoid a lowering of self-concept.
3. Youths with conduct problems may experience high self-esteem that over time permits them to rationalize their antisocial conduct.

Question 82

Outline ADHD as an Accompanying Disorder and Symptom of Conduct Disorders.

Answer 82

1. More than 50% of children with CD also have ADHD.
2. A shared predisposing vulnerability such as impulsivity, poor self-regulation, or temperament may lead to both ADHD and CD.
3. ADHD may be a catalyst for CD by contributing to its persistence and escalation to more severe forms, particularly when shaped by ineffective parent emotional reactions and behaviors.
4. ADHD may lead to childhood onset of CD, which is a strong predictor of continuing problems.
5. CD is less likely than ADHD to be associated with cognitive impairments, neurodevelopmental abnormalities, inattentiveness in the classroom, and higher rates of accidental injuries.

Question 82

Outline Depression and Anxiety as an Accompanying Disorder and Symptom of Conduct Disorders.

Answer 82

1. About 50% of youths with conduct problems also receive a diagnosis of depression or anxiety.
2. It is ODD and not CD that best accounts for the connection between conduct problems and depression and that this relationship is driven by the negative mood symptoms of ODD (e.g. anger/irritability) rather than by its behavioral symptoms of defiance.
3. Adolescent CD is also a risk factor for completed suicide in young people with a family history of depression.
4. Anxiety related to shyness, inhibition, and fear may protect against conduct problems, whereas anxiety associated with negative emotionality and social avoidance/withdrawal based on a lack of caring about others may increase the child’s risk for conduct problems.

Question 83

Discuss the Pathways of Conduct Disorder.

Answer 83

1. Preschoolers with ODD display stubbornness, temper tantrums, irritability, and spitefulness problems that remain stable from 2 to 5 years of age. Discipline problems and poor self-control and emotion regulation during early childhood.
2. Most children with conduct problems show diversification—they add new forms of antisocial behavior over time rather than simply replacing old behaviors.
3. When the child enters school, impulsivity and attention problems may result in reading difficulties and academic failure.
4. From ages 12 to 14, property destruction, running away from home, truancy, mugging, breaking and entering, use of a weapon, and forced sex occur with increasing frequency.
5. By age 18, many young people with conduct problems display antisocial personality development and behaviors that forecast an antisocial future, including substance dependence, unsafe sex, dangerous driving habits, delinquent friends, and unemployment.

Question 84

Discuss Family Factors as a Cause of Conduct Disorder.

Answer 84

1. Many family factors have been implicated as possible causes of children’s antisocial behavior: early maternal age at childbearing, poor disciplinary practices, harsh discipline, a lack of parental supervision, a lack of affection, marital conflict, family isolation, and violence in the home.
2. A combination of individual child risk factors (e.g., difficult temperament) and extreme deficits in family management skills most likely accounts for the more persistent and severe forms of antisocial behavior.
3. Physical abuse is a strong risk factor for later aggressive behavior.
4. An important concept for understanding family influences on antisocial behavior is Reciprocal Influence, which means that the child’s behavior is both influenced by and influences the behavior of others.

Question 85

Discuss the Pathways of Conduct Disorder.

Answer 85

1. The Life-Course–Persistent (LCP) path describes children who engage in aggression and antisocial behavior at an early age and continue to do so into adulthood.
   (a) They may display “biting and hitting at age 4, shoplifting and truancy at age 10, selling drugs and stealing cars at age 16, robbery and rape at age 22, and fraud and child abuse at age 30”.
   (b) Antisocial behavior begins early because of subtle neuropsychological deficits that may interfere with their development of language, memory, and self-control, resulting in cognitive deficits and a difficult temperament by age 3 or younger.
   (c) LCP youths display consistency in their behavior across situations, for example, by lying at home, stealing from stores, and cheating at school. As young adults, they have difficulty forming lasting relationships and may display a hostile mistrust of others.
2. The Adolescent-Limited (AL) path describes youths whose antisocial behavior begins around puberty and continues into adolescence, but who later cease these behaviors during young adulthood.
   (a) Includes most juvenile offenders whose antisocial behavior is limited primarily to their teen years.
   (b) Teens on the AL path display less extreme antisocial behavior than those on the LCP path, are less likely to drop out of school, and have stronger family ties.
   (c) Their delinquent activity is often related to temporary situational factors, especially peer influences.
   (d) The behavior of AL youths is not consistent across situations; they may use drugs or shoplift with their friends while continuing to follow rules and to do well in school.

Question 86

Discuss Social-Cognitive Factors as a Cause of Conduct Disorder.

Answer 86

1. Social–Cognitive Abilities refer to the skills involved in attending to, interpreting, and responding to social cues.
2. Some approaches focus on immature forms of thinking, such as egocentrism, a lack of social perspective taking, theory of mind deficits, or deficits in moral reasoning.
3. Others emphasize cognitive deficiencies, such as a child’s failure to use verbal mediators to regulate his or her behavior or cognitive distortions, such as interpreting a neutral event as an intentionally hostile act.
4. Deficits in facial expression recognition and eye contact in children with conduct problems may further contribute to their antisocial behavior and social difficulties.

Question 87

Discuss Family Instability and Stress as a Cause of Conduct Disorder.

Answer 87

1. Family instability is related to a child’s heightened risk for antisocial behavior, academic problems, anxiety and depression, association with deviant peers, and criminal conviction.
2. High family stress is associated with negative child behavior in the home, and may be both a cause and an outcome of antisocial behavior.
3. Unemployment, low SES, and multiple family transitions are all related to childhood conduct problems.
4. The Amplifier Hypothesis states that stress amplifies the maladaptive predispositions of parents (e.g., poor mental health), thereby disrupting family management practices and compromising parents’ ability to be supportive of their children.

Question 88

Discuss Parental Criminality and Psychopathology as a Cause of Conduct Disorder.

Answer 88

1. Children’s aggression is correlated with their parents’ childhood aggression at the same age.
2. Parents of antisocial children have higher rates of arrests, motor vehicle violations, license suspensions, and substance abuse.
3. For mothers, antisociality, histrionic personality (pattern of excessive emotionality and attention seeking), and depression are related to children’s antisocial behavior.

Question 89

Discuss The Coercion Theory as a Cause of Conduct Disorder.

Answer 89

1. Gerald Patterson’s Coercion Theory contends that parent–child interactions provide a training ground for the development of antisocial behavior. This occurs through a four-step, escape-conditioning sequence in which the child learns to use increasingly intense forms of noxious behavior to escape and avoid unwanted parental demands.
2. The relationship between parental discipline and conduct problems may also be affected by the amount of discipline—too much or too little can both have adverse effect.
3. The relationship between parental discipline and antisocial behavior may also vary with the family’s cultural background, the emotional climate in which discipline is used, and the gender of the parent–child pair.

Question 90

Discuss Parent Management Training (PMT) as a Treatment and Prevention of Conduct Disorder.

Answer 90

1. Its underlying assumption is that maladaptive parent–child interactions are at least partly responsible for producing and sustaining the child’s antisocial behavior.
2. The assumption is that a change in parenting behavior mediates the changes in child conduct problems in PMT.
3. The goal of PMT is for the parent to learn specific new skills.
4. Many variations of PMT can be individual versus group training, training in the clinic versus in the home, or the use of live versus videotaped.
5. Short-term effectiveness in producing changes in parent and child behavior.
6. PMT has also been associated with reductions in the problem behaviors of siblings and reduced stress and depression in the parents.
7. PMT has been most effective with parents of children younger than 12 years of age and less so with adolescents.

Question 91

Discuss Problem-Solving Skills Training (PSST) as a Treatment and Prevention of Conduct Disorder.

Answer 91

1. Problem-Solving Skills Training (PSST) is a form of cognitive behavioral therapy that focuses on the cognitive deficiencies and distortions displayed by children and adolescents with conduct problems in interpersonal situations.
2. PSST is used both alone and in combination with PMT, as required by the family’s circumstances.
3. The underlying assumption of PSST is that the child’s perceptions and appraisals of environmental events will trigger aggressive and antisocial responses, and that correcting faulty thinking will lead to changes in behavior.
4. During PSST, the therapist uses instruction, practice, and feedback to help the child discover different ways to handle social situations.
5. Emphasis on the relationship between maladaptive cognitions and aggressive behavior on which PSST is based, and PSST procedures are carefully specified in treatment manuals.

Question 92

What is Multisystemic Therapy (MST)?

Answer 92

Multisystemic Therapy (MST) is an intensive, empirically supported family and community-based treatment for adolescents with severe conduct problems that make out-of-home placement highly likely.

Question 93

The 9 Principles of Multisystemic Therapy (MST).

Answer 93

1. Finding the fit: The primary purpose of assessment is to understand the “fit” between the identified problems and their broader systemic context
2. Positive and strength-focused: Therapeutic contacts emphasize the positive and use systemic strengths as levers for change.
3. Increasing responsibility: Interventions are designed to promote responsible behavior and decrease irresponsible behavior among family members.
4. Present-focused, action-oriented, and well-defined: Interventions are present-focused and action-oriented, targeting specific and well-defined problems.
5. Targeting sequences: Interventions target sequences of behavior within and between multiple systems that maintain identified problems.
6. Developmentally appropriate: Interventions are developmentally appropriate and fit the developmental needs of the youth.
7. Continuous effort: Interventions are designed to require daily or weekly effort by family members.
8. Evaluation and accountability: Intervention efficacy is evaluated continuously from multiple perspectives, with providers assuming accountability for overcoming barriers to successful outcomes.
9. Generalization: Interventions are designed to promote treatment generalization and long-term maintenance of therapeutic change by empowering caregivers to address family members’ needs across multiple systemic contexts.

Question 94

The DSM-5 Diagnostic Criteria for Intellectual Disability (Intellectual Developmental Disorder).

Answer 94

Intellectual disability (intellectual developmental disorder) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. The following three criteria must be met:
A. Deficits in intellectual functions, such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing.
B. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community.
C. Onset of intellectual and adaptive deficits during the developmental period.

Question 95

The DSM-5 Diagnostic Criteria For Autism Spectrum Disorder.

Answer 95

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative not exhaustive):
1. Deficits in social–emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
Specify current severity based on social communication impairments and restricted, repetitive patterns of behavior.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g.extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper- or hypo reactivity to sensory input or unusual interest in sensory aspects of environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
Specify current severity based on social communication impairments and restricted, repetitive patterns of behavior.
C. Symptoms must be present in early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life)
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Question 96

What is Anxiety?

Answer 96

Anxiety is a future-orientated mood state, characterised by apprehension because we cannot predict or control upcoming events. Fear, on the other hand, is an immediate emotional reaction to a current threat geared towards averting danger.

Question 97

What is a Panic Attack?

Answer 97

A Panic Attack is an abrupt experience of intense fear or discomfort accompanied by a number of physical symptoms, such as dizziness or heart palpitation.

Question 98

What are the types of Panic Attacks?

Answer 98

1. Expected (cued) panic attack: If you know that you are afraid of high places, you might have a panic attack in that situation but not anywhere else.
2. Unexpected (uncued) panic attack: If you are assailed by an attack for no good reason, out of the blue.

Question 99

The DSM-5 Diagnostic Criteria For Generalised Anxiety Disorder.

Answer 99

A. Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities.
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with at least 3 or more of the following symptoms:
1. Restlessness or feeling on the edge.
2. Being easily fatigued.
3. Difficulty concentrating.
4. Irritability.
5. Muscle tension.
6. Sleep disturbances.
D. The anxiety, worry or physical symptoms cause clinically significant impairment in important areas of functioning.
E. The disturbances is not attributable to the physiological effects of a substance.
F. The disturbances is not better explained by another mental disorder.

Question 100

What is Agoraphobia?

Answer 100

Agoraphobia is an anxiety disorder characterised by anxiety about being in places or situations from which escape might be difficult in the event of panic symptoms.

Question 101

The DSM-5 Diagnostic Criteria For Panic Disorder (PD).

Answer 101

A. Marked by fear or anxiety about 2 or more of the following situations:
1. Using public transportation.
2. Being in open spaces.
3. Being in enclosed places.
4. Standing in line or being in a crowd.
5. Being outside the home alone.
B. The individual fears or avoids these situations due to the thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms.
C. The agoraphobia situation almost always provoke fear or anxiety.
D. The agoraphobic situations are actively avoided, require the presence of a companion or a endured with intense fear or anxiety.
E. The fear or anxiety is not proportionate to the actual danger posed by the agoraphobic situations or to the sociocultural context.
F. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.
G. The fear, anxiety or avoidance causes clinically significant impairment in important areas of functioning.
H. If another medical disorder is present, the fear, anxiety or avoidance is excessive.
I. The fear, anxiety or avoidance is not better explained by the symptoms of another mental disorder.

Question 102

What is Specific Phobia?

Answer 102

Specific Phobia is the unreasonable fear of a specific object or situation that markedly interferes with daily life functioning.

Question 103

The DSM-5 Diagnostic Criteria For Specific Phobia.

Answer 103

A. Marked fear or anxiety about a specific objects or situation (flying, heights). In children, the fear may be expressed by crying, tantrums.
B. The phobic object or situation almost always provokes immediate fear and anxiety.
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation.
E. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.
F. The fear, anxiety or avoidance causes clinically significant impairment in important areas of functioning.
G. The disturbances is not better explained by another medical disorder, including panic-like symptoms, objects related to obsession, reminders of traumatic events.

Question 104

What are the types of Specific Phobias?

Answer 104

1. Blood-Injection-Injury Phobia is the unreasonable fear and avoidance of exposure to blood, injury or the possibility of an injection.
2. Situational Phobia is anxiety involving enclosed places or public transportation. Claustrophobia, a fear of small enclosed places is a situational phobia.
3. Natural Environmental Phobia is the fear of situations or events in nature, especially heights, storms and water.
4. Animal Phobia is the unreasonable, enduring fear of animals or insects that usually develops early in life.

Question 105

The DSM-5 Diagnostic Criteria for Social Anxiety Disorder.

Answer 105

A. Marked fear or anxiety about one or more social situations in which the person is exposed to possible scrutiny by others. Examples include having a conversation, eating or drinking, giving a speech.
B. The individual fears that he/she will act in a way, or show anxiety symptoms, that will be negatively evaluated.
C. The social situations are avoided, or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportions to the actual threat posed by social situation, and to the sociocultural context.
E. The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.
F. The fear, anxiety, or avoidance causes clinically significant impairment in important areas of functioning.

Question 106

The DSM-5 Diagnostic Criteria for PTSD.

Answer 106

A. Exposure to actual or threatened death, actual or threatened serious injury, or actual or threatened sexual violence in 1 or more of the following:
1. Directly experiencing the traumatic event.
2. Learning that the event occurred to a close relative or friend.
3. Witnessing, in person, the event as they occurred to others.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event.
B. Presence of one or more of the following intrusion symptoms associated with the traumatic event, beginning after it occurred:
1. Recurrent, involuntary distressing memories of the event.
2. Recurrent, involuntary dreams in which the content of the dream is related to the traumatic event.
3. Dissociative reaction in which the individual feels or acts if the traumatic event were occurring.
4. Intense or prolonged psychological distress at exposure to internal or external cues that resemble an aspect of the traumatic event.
5. Marked physiological reactions to internal or external cues that resemble an aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the traumatic event, beginning after it occurred as evidenced by one or both of the following:
1. Avoidance of distressing memories, thoughts, feeling, or conversations closely related to the event.
2. Avoidance of external reminders (people, places, activities) that arouse distressing memories, thoughts, feelings closely associated with the event.
D. Negative alterations in cognitions and mood associated with the traumatic event, as evidenced by two or more of the following:
1. Inability to remember an important aspect of the traumatic event.
2. Persistent and exaggerated negative beliefs or expectations about oneself (the world is bad).
3. Persistent distorted cognitions about the cause or consequence of the traumatic event that lead to the individual to blame oneself or others.
4. Persistent negative emotional state (fear, guilt, shame).
5. Marked diminished interest or participation in significant activities.
6. Feelings of detachment from others.
7. Persistent inability to experience positive emotions.
E. Marked alterations in arousal and reactivity associated with the event, as evidence by 2 or more of the following:
1. Irritable behavior and angry outbursts.
2. Recklessness or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbances.
F. Duration of the disturbances is more than one month.
G. The disturbances cause clinically significant impairment in important areas of functioning.
H. The disturbances is not attributable to the physiological effects of a substance.

Question 107

The DSM-5 Diagnostic Criteria for Prolonged Grief Disorder.

Answer 107

A. The death, at least 12 months ago, of a person who was close to the bereaved individual.
B. Since the death, the development of a persistent grief response characterized by one or both of the following symptoms, in addition, the symptoms have occurred nearly every day for at least the last month:
1. Intense yearning/longing for the deceased person.
2. Preoccupation with thoughts or memories of the deceased person.
C. Since the death, at least 3 of the following symptoms have been present most days to a clinically significant degree:
1. Identity disruption since the death.
2. Marked sense of disbelief about the death.
3. Avoidance of reminders that the person is dead.
4. Intense emotional pain (anger, bitterness, sorrow) related to the death.
5. Difficulty reintegrating into one’s relationships and activities after the death.
6. Emotional numbness as a result of the death.
7. Feeling that life is meaningless as a result of the death.
8. Intense loneliness.
D. The disturbance clinically significant impairment in important areas of functioning.
E. The duration and severity of the bereavement reaction clearly exceed expected social, cultural or religious norms for the individual’s culture and context.
F. The symptoms are not better explained by another mental disorder, or attributable to the effects of a substance.

Question 108

The DSM-5 Diagnostic Criteria for OCD.

Answer 108

A. Presence of obsessions, compulsions or both:
Obsessions are defined by:
1. Recurrent and persistent thoughts, urges or images that are experienced, as intrusive and inappropriate and in most individuals causes marked anxiety or distress.
2. The individual attempts to ignore such thoughts, impulses or images, or to neutralize them with some other thought.
Compulsions are defined by:
1. Repetitive behaviours (hand washing, checking) or mental acts (praying, counting) that the individual feels driven to perform in response to an obsessions.
2. The behaviours or mental acts are aimed at preventing or reducing distress, however, are not connected in a realistic way with what they are designed to prevent.
B. The obsessions or compulsions are time-consuming or cause clinically significant impairment in important areas of functioning.
C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental disorder.

Question 109

Types of obsessions and their compulsions.

Answer 109

1. Symmetry/exactness/just right (Needing things to be symmetrical. Urgers to do things over and over until they feel ‘just right’): Putting things in a certain order. Repeating rituals.
2. Forbidden thoughts or action (Fears, urges to harm self or others. Fears of offending God: (Checking. Avoidance)
3. Cleaning/contamination (Germs. Fears of contamination) Repetitive/excessive washing. Using gloves, masks to do daily tasks.
4. Hoarding (Fears of throwing anything away): Collecting/saving objects with little/no actual value.

Question 110

Tic Disorder and OCD.

Answer 110

1. A tic is defined as a semi-purposeful muscular behaviour, usually a sudden jerk of a limb, neck movement, grimace, tight closure to the eye, grunt or other simple vocalisation.
2. More complex tics with involuntary vocalisations are referred to as Tourette’s disorder.
3. OCD and tics suggest that problems occur after a bacterial tonsillitis cause by Group A Streptococcus, which causes rheumatic fever.
4. Rheumatic fever is characterised by involuntary jerky movements, sometimes dance-like.

Question 111

The DSM-5 Diagnostic Criteria for Body Dysmorphic Disorder.

Answer 111

A. Preoccupation with one/more defects or flaws in physical appearance that are not observable to others.
B. At some point during the course of the disorder, the individual has performed repetitive behaviours or mental acts in response to the appearance concerns.
C. The occupation causes clinically significant impairment in important areas of functioning.
D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet the criteria for an eating disorder.

Question 112

Outline Hoarding Disorder.

Answer 112

1. The 3 major characteristics of this problem are: Excessive acquisition of things. Difficulty discarding anything. Living with excessive clutter under gross disorganisations.
2. These individuals usually begin acquiring things during their teenage years and often experience great pleasure from collecting various items.
3. They experience strong anxiety and distress about throwing anything away, because everything has either some potential value in their minds
4. Their homes may become almost impossible to live in.

Question 113

What is Trichotillomania (Hair Pulling) And Excoriation (Skin Picking)?

Answer 113

1. Trichotillomania refers to people’s urge to pull out their own hair from anywhere on the body, including the scalp, eyebrows and arm.
2. Excoriation disorder is the recurrent, difficult-to-control picking of your skin leading to significant impairment and scarring.

Question 113

The DSM-5 Diagnostic Criteria for Major Depressive Episode.

Answer 113

A. Five or more of the following symptoms have been present during the same 2-week period, most of the day, nearly every day:
1. Depressed mood as indicated by subjective report or observation by others.
2. Markedly diminished interest or pleasure in all or almost all activities.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite.
4. Insomnia or hypersomnia.
5. Psychomotor agitation or retardation.
6. Fatigue or loss of energy.
7. Feelings of worthlessness or inappropriate guilt.
8. Diminished ability to think or concentrate.
9. Recurrent thought of death, suicidal ideation, without specific plan, or suicide attempt.

Question 114

What is Anhedonia?

Answer 114

Anhedonia is the inability to experience pleasure, associated with some mood and schizophrenic disorder.

Question 115

The DSM-5 Diagnostic Criteria for Manic Episode.

Answer 115

A. A distinct of persistently elevated or irritable mood and abnormally goal-directed energy, lasting at least 1 week and present most of the day, nearly every day.
B. During this period, 3 or more of the following symptoms are present to a significant degree:
1. Inflated self-esteem.
2. Decreased need for sleep.
3. More talkative/pressure to keep talking.
4. Flight of ideas.
5. Distractibility.
6. Increased goal-directed activity.
7. Excessive involvement in high-risk activities.
C. The mood disturbance is severe to cause impairment in important area of functioning or to necessitate hospitalization to prevent harm to self or others.
D. The episode is not attributable to the physiological effects of a substance or medical condition.

Question 116

What is Unipolar Mood Disorder and Mixed Features?

Answer 116

1. Unipolar Mood Disorder is a mood disorder characterised by depression or mania but not both. Most cases involve unipolar depression.
2. Mixed Features is a condition in which the individual experiences both elation and depression or anxiety at the same time. Also known as dysphoric manic episode or mixed manic episode.

Question 117

The DSM-5 Diagnostic Criteria for Major Depressive Disorder.

Answer 117

A. At least 1 major depressive episode.
B. At least 1 major depressive episode is not better explained by a schizophrenia spectrum or other psychotic disorder.
C. There has never been a manic or hypomanic episode.

Question 118

The DSM-5 Diagnostic Criteria for Bipolar I Disorder.

Answer 118

A. Criteria have been met for at least 1 manic episode.
B. At least 1 manic episode is not better explained by a schizophrenia spectrum or other psychotic disorder.

Question 119

The DSM-5 Diagnostic Criteria for Persistent Depressive Disorder.

Answer 119

A. Depressed mood for most of the day, for at least 2 years.
B. Presence, while depressed, of 2 or more of the following:
1. Poor appetite/overeating.
2. Insomnia/hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentrating/difficulty making decisions.
6. Feelings of hopelessness.
C. During the 2-year period, a person has never been without symptoms for more than 2 months at a time.
D. Criteria for depression may be continuously present for 2 years.
E. There has never been a manic/hypomanic episode and criteria for a cyclothymic disorder has never been met.
F. Disturbance is not better explained by a schizophrenia spectrum or other psychotic disorder.
G. Symptoms are not attributable to the effects of a substance or medical condition.
H. Symptoms cause clinically significant impairment in important areas of functioning.

Question 120

The DSM-5 Diagnostic Criteria for Bipolar II Disorder.

Answer 120

A. Criteria have been met for at least 1 hypomanic and at least 1 major depressive episode.
B. At least 1 hypomanic and at least 1 major depressive episode is not better explained by a schizophrenia spectrum or other psychotic disorder.

Question 121

Discuss the risk factors of Suicide.

Answer 121

1. Family History: If a family member committed suicide, there is an increased risk that someone else in the family will too. If individual shave an early onset of their mood disorder, as well as aggressive traits, then their families are at a greater risk of suicidal behaviour.
2. Neurobiology: Low central nervous system serotonin activity may be associated with suicide. Certain chronic medical conditions exhibit much heightened suicide risks than other conditions, such as epilepsy.
3. Existing Psychological Disorders and other 3. Psychological Risk Factors: Suicide is often associated with mood disorders. Depression and suicide are strongly related, but still independent. Combination of disorders, such as substance abuse and mood disorders seem to create a stronger vulnerability.
4. Stressful Events: Stressful event experienced as shameful or humiliating, such as failure at school is a risk factor. Stress and disruption of natural disasters increase the likelihood of suicide.

Question 122

Feeding and Eating Disorders.

Answer 122

1. Persistent disturbances to eating, and associated behaviours, cause significant impairments in both bodily and psychological health.
2. DSM-5 recognises three feeding and three eating eating disorders: Pica. Rumination Disorder. Avoidant Restrictive Food Intake Disorder. Anorexia Nervosa. Bulimia Nervosa. Binge-Eating Disorder.
3. Obesity is not included as it is not regarded as a mental disorder.

Question 123

The Scope and Severity of Eating Disorders.

Answer 123

1. Bulimia Nervosa is an eating disorder involving recurrent episodes of uncontrolled excessive (binge) eating followed by compensatory actions to rid the body of the food itself (for example, deliberate vomiting, laxative abuse and excessive exercise).
2. Binge is the relatively brief episode of uncontrolled, excessive consumption, usually of food or alcohol.
3. Anorexia Nervosa is an eating disorder characterised by recurrent food refusal, leading to dangerously low body weight.
4. Binge-Eating Disorder (BED) is a pattern of eating involving distress-inducing binges not followed by purging behaviours.
5. Avoidant/Restrictive Food Intake Disorder (AFRID) is a type of eating disorder where people limit their food intake not because they are concerned about weight or body shape but because they are not interested in eating or they avoid certain sensory characteristics of food or eating.

Question 124

Features of Anorexia Nervosa.

Answer 124

1. Individuals with anorexia nervosa (which means a ‘nervous loss of appetite) differ in one important way from individuals with bulimia.
2. The major difference seems to be whether the individual loses a significant amount of weight.
3. People with anorexia are proud of both their diets and control.
4. People with bulimia are ashamed of both their eating issues and their lack of control.
5. Many individuals with bulimia have a history of anorexia.

Question 125

The DSM-5 Diagnostic Criteria for Anorexia Nervosa.

Answer 125

A. Restriction of energy intake relative to requirements, leading to a significant low body weight in the context of age, sex, developmental trajectory and physical health. Significantly low weight is defined as a weight that is less than minimally normal.
B. Intense fear of gaining weight or of becoming fat, even though at a significant low weight.
C. Disturbances in the way in which one’s body weight or shape is experiences, undue influence of body weight or shape on self-evaluation.
Specify type:
1. Restrictive type: during the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior. This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, exercise.
2. Binge-eating/purging type: during the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior.

Question 126

Medical Consequences of Anorexia Nervosa.

Answer 126

1. Physical conditions arise due to nutritional deficiency, the chronic state of catabolism, metabolic and electrolyte disturbances, physical wasting and surgical complications: One common complication of anorexia nervosa is amenorrhea, or the cessation of menstruation. Amenorrhea occurs unpredictably and does not affect all patients.
2. Other medical signs and symptoms of include dry skin, brittle hair or nails and cold intolerance.
3. It is relatively common to see lanugo, downy hair on the limbs and cheeks.
4. Cardiovascular problems, such as chronically low blood pressure and heart rate can also result.
5. If vomiting is part of the anorexia, cardiac and kidney problems can result.

Question 127

Associated Psychological Disorders of Anorexia Nervosa.

Answer 127

1. Anxiety disorders and depressive disorders are often present in individuals with anorexia.
2. OCD is a common comorbid condition.
3. In anorexia, unpleasant thoughts are focused on gaining weight, and individuals engage in a variety of behaviours, some of them ritualistic, to rid themselves of such thoughts.
4. Substance abuse is also common in individuals with anorexia nervosa, and in conjunction with anorexia, a strong predictor of mortality, particularly suicide.

Question 128

Features of Bulimia Nervosa.

Answer 128

1. Bulimia Nervosa is one of the most common psychological disorders on universities.
2. The hallmark of bulimia nervosa is eating a larger amount of food, typically more junk food than fruits and vegetables.
3. Purging techniques: in bulimia nervosa, the self-induced vomiting or laxative abuse used to compensate for excessive food ingestion.
4. Bulimia nervosa was subtypes in DSM-5-IV-TR into purging type or non-purging type, but the non-purging type turned out to be quite rare, as a result, this distinction was dropped in DSM-5.

Question 129

The DSM-5 Diagnostic Criteria for Bulimia Nervosa.

Answer 129

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. Eating, in a discrete period of time within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
2. A sense of lack of control over eating during the episode (feeling that one cannot stop eating).
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, fasting, excessive exercising, medications.
C. The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Question 130

Medical Consequences of Bulimia Nervosa.

Answer 130

1. Chronic bulimia with purging had a number of medical consequences: One is salivary gland enlargement caused by repeated vomiting, which gives the face a chubby appearance. Repeated vomiting also may erode the dental enamel on the inner surface of the front teeth and tear the aesophagus.
2. Electrolyte imbalance can result if unattended, including cardiac arrhythmia (disrupted heart-beat), seizures and renal (kidney) failure, of all which can be fatal.
3. Women with bulimia develop more body fat.
4. Intestinal problems like severe constipation or colon damage can result from laxative abuse.
5. Individuals with bulimia have marked calluses on their fingers or back of their hands.

Question 131

Associated Psychological Disorders of Bulimia Nervosa.

Answer 131

1. Additional psychological disorders are particularly anxiety and mood disorders.
2. Patients with anxiety disorders do not necessarily have an elevated risk of eating disorders.
3. Depression also co-occurs with bulimia.
4. Substance-use disorders commonly accompany bulimia nervosa.
5. The emotional instability and impulsivity also point towards borderline personality, a recognised and common comorbid condition.
6. Bulimia seems strongly related to anxiety disorders and somewhat less so to mood and substance-use disorders.

Question 132

Features of Binge-Eating Disorders.

Answer 132

1. Focuses on groups of individuals who experienced marked distress because of binge eating but did not engage in extreme compensatory behaviours.
2. Different patterns of heritability compared to other eating disorders, as well as a greater likelihood of occurrence in males and a later age of onset.
3. There is also a greater likelihood of remission and a better response to treatment in binge-eating disorder compared to other eating disorders.
4. BED is a disorder caused by a separate set of factors from obesity without BED and is associated with more severe obesity.
5. About half of individuals with BED attempt modified, weight-restricting diets before bingeing, and start with bingeing before modifying diet.
6. Individuals have some of the same concerns about shape and weight as people with anorexia and bulimia, which distinguishes them from individuals who are obese with BED.
7. Binge eat to alleviate ‘bad moods’ or negative affect.
8. Some individuals may engage in purging behaviour to influence their weight or shape by self-induced vomiting, using laxatives, but they do not show binge eating as in BED.

Question 133

What is Obesity?

Answer 133

Obesity is the excess of body fat resulting in a body mass index (BMI), a ration of weight to height of 30 or more.

Question 134

What is Body Mass Index (BMI)?

Answer 134

Body Mass Index (BMI) is a normalised index relating body weight to height used to define underweight, normal and overweight individuals. It is calculated by dividing the body mass in kilograms by the square of the height in metre. BMI= mass/(height)2 expressed in unites kg.m -2

Question 135

What is Bariatric Surgery?

Answer 135

Bariatric Surgery is a surgical approach to extreme obesity, usually accomplished by stapling the stomach to create a small stomach pouch.

Question 136

The DSM-5 Diagnostic Criteria for Binge-Eating Disorders.

Answer 136

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. Eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode.
B. The binge-eating episodes are associated with 3/more of the following:
1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not feeling physically hungry.
4. Eating alone because of feeling embarrassed by how much one is eating.
5. Feeling disgusted with oneself, depressed or very guilty afterwards.
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for 3 months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Question 137

Developmental Considerations of Binge-Eating Disorders.

Answer 137

1. Developmental factors play a role because eating disorders typically emerge in adolescence.
2. Differential patterns of physical development in girls and boys interact with cultural influences to create eating disorders.
3. After puberty, girls gain weight primarily in fat tissue, whereas boys develop muscle and lean tissue.
4. Physical development brings boys closer to the ideal and takes girls further away as the ideal look in Western countries is tall and muscular for men and thin for women.
5. Eating disorders, particularly anorexia nervosa, occasionally occur in children under the age of 11.
6. Concerns for weight are somewhat less common in young children, however, negative attitudes towards being overweight emerge as early as 3 years of age.
7. Bulimia and anorexia can occur in later years, particularly after the age of 55.
   Concerns about body image decrease with age.

Question 138

Causes of Eating disorders: An Integrative Model.

Answer 138

1. Biological vulnerability: All eating disorders share psychological attributes: anxiety about physical appearance and presentation to others, distorted body imaged and maladaptive eating-related behaviour. Anxiety and mood disorders are also common in the families of individuals with eating disorders.
2. Relationships: In high-achieving families, an emphasis on appearance and achievement may help establish strong attitudes about the overriding importance of physical appearance.
3. Socio-Cultural Aspects: Social and cultural pressures about thin body motivate significant restriction of eating, usually through severe dieting. Many people go on strict diets, but few develop eating disorders: dieting alone does not account for the disorders. Negative emotions and mood intolerance seem to trigger binge-eating in many patients. Other risk factors for developing an overt eating disorder are established bingeing, purging behaviour, eating in secret, a desire to have an empty stomach, food preoccupations and fears of losing control over eating. Much biopsychosocial vulnerability therefore seems to be shared.

Question 139

Management of Eating Disorders: General Considerations.

Answer 139

1. Pharmacological Treatments: Pharmacological treatments have not been found to be effective in treating anorexia nervosa. The use of antidepressants medication (SSRIs) in managing the bingeing and purging cycle. Antidepressant agents alone do not have substantial long-lasting effects on bulimia nervosa.
2. Psychological Treatments: Short-term cognitive-behavioural treatments (CBT) target problem eating behaviour and associated attitudes about the overriding importance and significance of body weight and shape, and they become the treatment of choice for bulimia. The principal focus is on the distorted evaluation of body shape and weight, and maladaptive attempts to control weight in the form of strict dieting, methods to compensate for overeating.

Question 140

Anorexia Nervosa: Specific Treatment Considerations.

Answer 140

1. The important initial goal is to restore the patient’s weight to a point that is at least within low-to-normal range, through inpatient treatments.
2. Restoring weight is the easiest part of the treatment: Knowing they cannot leave the hospital until their weight gain is adequate is often sufficient to motivate adolescents with anorexia.
3. The more difficult stage: initial weight gain is a poor predictor of long-term outcome in anorexia. Treatment must shift to their marked anxiety over becoming obese and losing control of eating, as well as their undue emphasis on thinness.
4. Effort is made to include the family to accomplish 2 goals: first, the negative and dysfunctional communication in the family regarding food and eating must be eliminated. Second, attitudes towards body shape and image distortions are discussed.

Question 141

Bulimia Nervosa: Specific Treatment Considerations.

Answer 141

1. The first stage of CBT-E is teaching the patient the physical consequences of binge eating and purging, as well as the ineffectiveness.
   The adverse effects of dieting are also describes, and patients are scheduled to eat small, manageable amounts of food five or six times per day.
2. In later stages of treatment, CBT-E focuses on altering dysfunctional thoughts and attitudes about body shape, weight and eating.
3. Coping strategies for resisting the impulse to binge/purge are also developed.
4. CBT-E is more effective in terms of the number of sessions needed, with evidence for the durability in improvement.
5. Family therapy directed at the painful conflicts that exist in families with an adolescent who has an eating disorder can be helpful.
6. One problem with CBT is that access to the treatment is limited because trained therapists are not always available.

Question 142

Binge-Eating Disorder: Specific Treatment Considerations.

Answer 142

1. Adapting CBT for bulimia to obese binge eaters.
2. Stopping binge eating is critical to sustaining weight loss in obese patients.
3. Behavioural weight loss programmes for obese patients with BED, such as Weight Watchers, have some positive effect on bingeing, but not so much as CBT.
4. Some racial and ethnic differences are apparent in people with BED seeking treatment: black participants tend to have a higher BMI, while Hispanic participants have greater concerns with shape and weight than White participants. Thus, it would seem that tailoring treatment for ethnic groups would be useful.
5. CBT delivered as guided self-help is more effective than a standard behavioural weight-loss programme for BED, and should probably be the first treatment offered before engaging in therapist-led treatments.
   Severe cases (cases with comorbid conditions) may need more extensive treatment delivered by a therapist.

Question 143

Preventing Eating Disorders.

Answer 143

1. The development of eating disorders during adolescent is a risk factor for a variety of additional problems and disorders during adulthood, including chronic fatigue, binge drinking and substance abuse.
2. Before implementing a prevention programme, it is necessary to target specific behaviours to change.
3. Focus on eliminating an exaggerated focus on body shape or weight and encouraging acceptance of their bodies.
4. Education about food and eating habits.
5. Student Bodies: a structured, interactive health education programme designed to improve body image satisfaction and delivered through the internet.
6. The Body Project: a stand-alone intervention delivered over the internet with no clinician required.

Question 144

Preliminary Considerations of Sleep-Wake Disorders.

Answer 144

1. Patients with sleep-wake disorders typically complain about the amount of time spent sleeping, the timing of sleep and poor quality sleep.
2. Sleep disturbances commonly accompany depression, anxiety and cognitive disorders. They also herald the presence of medical conditions such as cardiovascular disease.
3. Chronically poor sleep is associated with depression, irritability, excessive emotionality, impulsivity, strained interpersonal relationships, suicide, depression, physical illness.
4. Poor sleep also predisposed people to develop a variety of psychiatric and physical illnesses, for example depression, infertility, miscarriages and even certain cancers are recognised.
5. Sleep deprivation can induce seizures, mania and psychosis.

Question 145

What is Rapid Eye Movement (REM)?

Answer 145

Rapid Eye Movement (REM) sleep is the periodic intervals of sleep during which the eyes move rapidly form side to side, and dreams occur, but the body is inactive.

Question 146

Our Evolving Understanding of Sleep-Wake Disorders.

Answer 146

1. DSM-5 considers sleep-wake disorders across five major categories: dyssomnias (the amount, timing and quality of sleep), narcolepsy (a neuropsychiatric condition with fairly well-elucidated aetiology), breathing-related sleep disorders (concern problems with ventilation associated with disturbed sleep), circadian rhythm sleep disorders (disturbances in in circadian functions and includes shift work and jetlag) and parasomnias (abnormal, distressing events that occur during various stages of sleep and include nightmares, night terrors and sleepwalking).
2. Chronotype (whether you are a morning person or evening type) is regulated by both a person’s circadian clock and genetic variation in clock genes and the environment.
3. Situational stress, habits and environmental factors represent more distinct risks in the precipitation of primary sleep-wake disorders, alongside the role of substance abuse, medication, psychiatric conditions.
4. Another classificatory approach considers the duration of insomnia and splits it into transient and chronic insomnia.

Question 147

What are Primary and Secondary sleep disorders?

Answer 147

1. Primary sleep disorders are sleep disorders in their own right, and not manifestation of another condition, the effects of medication or substances.
2. Secondary sleep disorders occur when sleep is disturbed due to a medical or other mental condition.

Question 148

What is Transient and Chronic insomnia?

Answer 148

1. Transient insomnia involves disturbed sleep for a limited time and typically occurs with physical illness and psychosocial stress.
2. Chronic insomnia is protracted and enduring.

Question 149

Features of Insomnia Disorder.

Answer 149

1. One of the most complaints in general practice.
2. A simple aid to understand insomnia is the acronym DIMS: Disorders of Initiation and Maintenance of Sleep.
3. Insomnia comprises initial, middle and terminal insomnia as well as non-restorative sleep.
4. Non-restorative sleep occurs where, despite sleeping for an adequate duration, patients continue to feel unrefreshed, or unrested upon awakening.
5. The patient’s psychosocial functioning becomes impaired and they may experience a variety of distressing psychological symptoms.

Question 150

The DSM-5 Diagnostic Criteria for Insomnia Disorder.

Answer 150

A. A predominant complaint of dissatisfaction with sleep quantity or quality associated with one or more of the following:
1. Difficulty initiating sleep (in children, this may manifest as difficulty initiating sleep without caregiver intervention.)
2. Difficulty to maintain sleep, characterized by frequent awakenings or problems returning to sleep.
3. Early morning awakening with inability to return to sleep.
B. The disturbances cause clinically significant impairment in important areas of functioning.
C. The sleep difficulty occurs at least 3 nights per week.
D. The sleep difficulty is present for at least 3 months.
E. The sleep difficulty occurs despite adequate opportunity for sleep.
F. The insomnia is not better explained by another sleep-wake disorder (e.g narcolepsy, parasomnia).
G. The insomnia is not attributable to the physiological effects of a substance.
H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.
Specify if
1. Episodic: symptoms last at least 1 month but less than 3 months.
2. Persistent: symptoms last 3 months or longer.
3. Recurrent: 2 or more episodes within the space of one year.

Question 151

The Epidemiology of Insomnia Disorder.

Answer 151

1. Women report insomnia twice as often as men.
2. Women often report hormonal differences.
3. Protective factors that can improve sleep in women include alcohol and caffeine use and following a Mediterranean diet.
4. Complaints of insomnia differs with age: children who have difficulty falling asleep usually throw a tantrum at bedtime. They often cry in the middle of the night.
5. Biological and cultural explanations for poor sleeping among adolescents: as children move into adolescence, their sleep schedules shift towards a later bedtime.
6. Complaints of poor sleep increase with age up to late middle age: in the elderly, there is a slight tail-off in complaints, although sleep duration decreases substantially.

Question 152

Integrative Understanding of Causation of Insomnia Disorder.

Answer 152

1. Six factors play a role in producing and maintaining insomnia: Biological vulnerability. Maladaptive sleep habits. Sleep expectations. Anxiety about sleep. Attitudes of parents. Persistence of the precipitant factor.
2. Sometimes, insomnia is related to problems with circadian functions.
3. Environmental factors such as noise, excessive light, uncomfortable bedding and extremes of temperature may participate and maintain insomnia.
4. Occupational, relationship and other situational stressors likewise serve as factors.
5. Poor sleep hygiene that promotes insomnia also includes daytime napping, excessive stimulation late in the day, drinking caffeine before bedtime or having a large, late meal.
6. It is important to recognise the role of cognition in insomnia (‘I need a full 8 hrs of sleep’); out thoughts alone may disrupt out sleep

Question 153

What is Hypersomnolence Disorders?

Answer 153

Hypersomnolence Disorder is a sleep disturbance characterised by excessive amount of sleep that disrupts normal routines.
1. Several factors that can cause excessive sleepiness would not be considered hypersomnolence: for example, people with insomnia disorder often report being tires during the day., however, people with hypersomnolence sleep through the night and appear rested upon awakening but still complain of being excessively tired throughout the day.
2. Another sleep problem that can cause similar excessive sleepiness is a breathing-related sleep disorder called sleep apnoea.

Question 154

What is Sleep Apnoea?

Answer 154

Sleep apnoea is a disorder involving brief periods when breathing ceases during sleep. People with this problem have difficulty breathing at night.
1. They often snore loudly, pause between breaths and wake in the morning with a dry mouth and headache.
2. In identifying hypersomnolence, the clinician needs to rule out insomnia, sleep apnoea or other reasons for sleeping during the day.

Question 155

The DSM-5 Diagnostic Criteria for Hypersomnolence Disorder.

Answer 155

A. Self-reported excessive sleepiness despite a main sleep period lasting at least 7 hours, with at least one of the following:
1. Recurrent periods of sleep or lapses into sleep within the same day.
2. A prolonged main sleep of more than 9 hours per day that is non-restorative.
3. Difficulty being fully awake after abrupt awakening.
B. The hypersomnolence occurs at least 3 times per week, for at least 3 months.
C. The hypersomnolence is accompanied by significant impairment in important areas of functioning.
D. The hypersomnolence is not better explained by another sleeping disorder.
E. The hypersomnolence is not attributable to the physiological effects of a substance.
F. Coexisting mental and medical disorders don not adequately explain the predominance complaint or hypersomnolence.
Specify if:
1. Acute: duration is less than 1 month.
Subacute: duration of 1 to 3 months.
Specify current severity based on degree of difficulty maintaining day time alertness as manifested by the occurrence of multiple attacks of irresistible sleepiness within any given day.
1. Mild: difficulty maintaining daytime alertness 1 to 2 days per week.
2. Moderate: difficulty maintaining daytime alertness 3 to 4 days per week.
3. Severe: difficulty maintaining daytime alertness 5 to 7 days per week.

Question 156

What is Narcolepsy?

Answer 156

1. Narcolepsy is a sleep disorder involving sudden and irresistible sleep attacks.
2. Sleep attacks are unexpected, irresistible episodes of falling asleep during the day.

Question 157

Features of Narcolepsy.

Answer 157

1. Patients may also experience sleep paralysis and vivid hallucinations (known as hypnagogic and hypnopompic hallucinations), typically when falling asleep or awakening.
2. Patients also suffer from cataplexy, a sudden loss of muscle tone, while the person is awake and can range from slight weakness in facial muscles to complete physical collapse.
3. Cataplexy lasts from several seconds to several minutes and it is usually preceded by strong emotion such as anger or happiness.
4. Cataplexy appears to result from a sudden onset of REM, where instead of falling asleep normally and going through the 4 non-rapid eye movement (NREM) stages that typically precede REM, people with narcolepsy progress through to this dream-sleep stage almost directly from the stage of being awake.
5. Patients commonly report sleep paralysis, a brief period after awakening when they cannot move or speak
6. Another characteristic is hallucinations in sleep transience: hypnagogic and hypnopompic hallucinations. These hallucinatory phenomena are vivid and terrifying experiences that are said to be unbelievably realistic because they include visual, touch, hearing and the sensation of body movement.
7. Narcolepsy is very rare and higher among males.
8. The problems associated with narcolepsy are usually first seen during the teenage years: excessive sleepiness occurs first, with cataplexy appearing either at the same time or with a delay of up to 30 years.
9. The cataplexy, hypnagogic hallucinations and sleep paralysis often decrease in frequency over time, although sleepiness during the day does not seem to diminish with age.
10. Sleep paralysis and hypnagogic hallucination may serve a role in explaining a certain phenomenon: Unidentified Flying Object (UFO) or alien abduction experiences.
    Sleep paralysis and hypnagogic hallucinations do occur in a portion of people with narcolepsy.

Question 158

The DSM-5 Diagnostic Criteria for Narcolepsy.

Answer 158

A. Recurrent periods or irrepressible need to sleep, lapsing into sleep occurring within the same day, for at least 3 times per week, for the past 3 months.
B. The presence of at least one of the following:
1. Episodes of cataplexy defined as either (a) or (b), occurring at least a few times per month.
a. In individuals with long-lasting disease, brief episodes of sudden loss of muscle tone with consciousness.
b. In children or individuals within 6 months of onset, jaw-opening episodes with tongue thrusting.
2. Hypocretin deficiency, as measured using cerebrospinal fluid hypocretin-1 immunoreactivity values.
3. Nocturnal sleep polysomnography showing REM sleep latency less than or equal to 15 minutes.
Specify current severity:
1. Mild: need for naps only once or twice per day. sleep disturbances, if present, is mild. Cataplexy, if present, is infrequent.
2. Moderate: needs for multiple naps daily. Sleep may be moderately disturbed. Cataplexy, when present, occurs daily.
3. Severe: nearly constant sleepiness and, often, highly disturbed nocturnal sleep.

Question 159

Features of Breathing-Related Disorders.

Answer 159

1. People whose breathing is interrupted during their sleep often experience numerous brief arousals throughout the night and do not feel rested even after 8-9 hours of sleep.
2. Breathing is constricted a great deal and may be labored, causing hypoventilation, or under-ventilation, and in the extreme, short periods (10-30 seconds) of total cessation of ventilation.
3. Hypoventilation is decreased, or movement of air in and out of the lungs.
   Often the affected person is only minimally aware of breathing difficulties and does not attribute the sleep problems to the breathing.
4. A bed partner usually notices loud snoring (one sign of this problem) or frightening episodes of interrupted breathing.
5. Other signs that a person has breathing difficulties are heavy sweating during the night, morning headaches and episodes of falling asleep during the day without feeling rested.

Question 160

What are the 3 types of Apnoea?

Answer 160

1. Obstructive sleep apnoea/hypopnea syndrome: the snoring and brief interruptions in breathing during sleep caused by blockage of the airway. Hypopnea refers to reduced effectiveness of breathing or ventilation.
2. Central sleep apnoea: brief periods of cessation in respiratory activity during sleep that may be associated with central nervous system disorder. Most clients wake often as a result but do not report sleepiness and may be unaware of any problem.
3. Sleep-related hypoventilation: a decrease in airflow without a complete pause in breathing. This tends to cause an increase in carbon dioxide pressure. All these breathing difficulties interrupt sleep and result in symptoms similar to those of insomnia.

Question 161

The DSM-5 diagnostic criteria for Obstructive sleep apnoea/hypopnea.

Answer 161

A. Evidence by polysomnograpghy of at least 5 obstructive apneas per hour sleep and either of the following sleep symptoms:
1. Nocturnal breathing disturbances: snoring, snorting, breathing pauses during sleep.
2. Daytime sleepinesss, fatigue despite sufficient opportunities to sleep that is not better explained by another mental disorder or medical condition.
B. Evidence by polsomnography of 15 or more obstructive apnoea per hour of sleep regardless of accompanying symptoms.
Specify current severity:
1. Mild: apnoae/hypopnea index is less than 15.
2. Moderate: apnoea/hpopnoea index is 15-30.
3. Severe: apnoea/hypopnea index is greater than 30.

Question 162

The DSM-5 Diagnostic Criteria for Central Sleep Apnoea.

Answer 162

A. Evidence by polysomnography of 5 or more central apneas per hour of sleep.
B. The disorder is not better explained by another current sleep disorder.
Specify current severity:
1. Severity of central sleep apnoea is graded according to the frequency of the breathing disturbances as well as the extent of sleep fragmentation that occur as a consequence of repetitive respiratory disturbances.

Question 163

Types of Circadian Rhythm Sleep Disorders.

Answer 163

1. Jet Lag Type Circardian Rhythm Sleep Disorder is a disorder in which sleepiness and alertness patterns conflict with local time and occur- after recent or repeated travel across time zones.
2. Shift Work Type Circadian Rhythm Sleep Disorder is characterized by insomnia during sleep time and sleepiness during wake time because of late-shift work. Many people, such as doctors, nurses and police experience this sleep disorder.
3. Delayed Sleep Phase Type is a type of circadian rhythm sleep disorder characterized by persistent pattern of late sleep onset and waking time.
   a4. Advanced Sleep Phase Type is a type of circadian rhythm sleep-wake disorder, new to DSM-5, involving a persistent pattern of early sleep onset and waking times

Question 164

The DMS-5 Diagnostic Criteria for Sleep-Related Hypoventilation.

Answer 164

A. Polysomnography demonstrates episodes of decreased respiration associated with elevated CO2 levels.
B. The disorder is not better explained by another current sleep disorder.
Specify current severity:
1. Severity is graded according to the degree of hypoxaemia present during sleep and evidence of end-organ impairment due to these abnormalities.

Question 165

Features of Circadian Rhythm Sleep Disorders.

Answer 165

1. Severe bodily rhythms that seem to persist without cues from the environment, in other words, rhythms that are self-regulated. Our natural circadian rhythm does not match the terrestrial day of 24 hours, it may be shorter or longer.
2. The light we see in the morning and the decreasing light at night signal the brain to reset the biological clock in out brain and entrains a 24-hour rhythm., yet some people suffer disrupted circadian rhythms because of external cues, such a crossing several times zones.
3. Several circadian rhythm sleep disorders seem to arise from within the person experiencing problems: people who stay up late and sleep late (night owls), may have a problem known as delayed sleep phase type.

Question 166

The DSM-5 Diagnostic Criteria for Circadian Rhythm Sleep-Wake Disorders.

Answer 166

A. A persistent or recurrent pattern of sleep disruption that is primary due to an alteration of the circadian system and the sleep-wake schedule required by an individual’s physical environment or social or professional schedule.
B. The sleep disruption leads to excessive sleepiness or insomnia or both.
C. The sleep disturbance causes clinically significant impairment in important areas of functioning.
Specify if:
1. Episodic: symptoms last at least 1 month but less than 3 months.
2. Persistent: symptoms last 3 months or longer.
3. Recurrent: 2 or more episodes occur within the space of 1 year.

Question 167

Medical Treatments of Sleeping Disorders.

Answer 167

1. People who complain of insomnia are likely to be prescribed one of several benzodiazepine or related medications, however, are not ideal for long-term use.
2. People over the age of 65 are most likely to use medication to help them sleep.
3. Methylphenidate is the preferred pharmacological treatment for narcolepsy and severe hypersomnolence, but it may cause undesirable side-effects such as headaches, agitation and aggression.
4. Cataplexy can be treated with antidepressant medications, as these suppress REM activity. Another alternative is sodium oxybate, which is prohibited under South African law.
5. Treatment of breathing-related sleep disorders focuses on helping the person breathe during sleep. For some, this means recommending weight loss.
6. The treatment of obstructive sleep apnoea involves the use of a mechanically assisted ventilation (CPAP machine) that provides positive pressure at the end of expiration. The patient wears a mask at night, breathing against a steady air stream during sleep. Although it can be life-changing, many patients complain of a dry mouth and nose bleeds.

Question 168

Environment Treatments of Sleep Disorders.

Answer 168

1. One general principle of treating circadian rhythm disorders is that phase delays are easier than phase advances, in other words, it is easier to stay up several hours later than usual than to force yourself to go to sleep several hours earlier.
2. Scheduling shift changes in a clockwise (going from day to evening) seems to help workers adjust better.
3. Going to bed several hours later each night until bedtime is at the desired hour.
4. Using bright light to trick the brain into readjusting the biological clock.

Question 168

Psychological Treatments for Sleeping Disorders.

Answer 168

1. Cognitive: focuses on changing the sleeper’s unrealistic expectations and beliefs about sleep. The therapist attempts to alter beliefs and attitudes about sleeping by providing information on topics such as normal amounts of sleep.
2. Guided Imagery Relaxation: uses meditation or imagery to help with relaxation at bedtime or after a night waking with people who become anxious when they have difficulty sleeping.
3. Graduated Extinction: used for children who have tantrums at bedtime, this treatment instructs parents to check on the child after progressively longer periods until the child falls asleep on their own.
4. Paradoxical Intention: involves instructing individuals in the opposite behaviour to the desired outcome. Telling poor sleepers to lie in bed and try to stay awake as long as they can is used to try to relieve performance anxiety surrounding efforts to fall asleep.
5. Progressive relaxation: involves relaxing the muscles of the body in an effort to introduce drowsiness.

Question 169

Preventing Sleep Disorders.

Answer 169

1. Sleep problems can be prevented by following a few steps during the day, which is referred to as Sleep Hygiene.
2. Establishing a set bedtime routine.
3. Try drinking milk before bedtime.
4. Limit the use of alcohol or tobacco.
5. Reduce noise and light in the bedroom.
6. Eat a balanced diet, limiting fat.

Question 170

The DSM-5 Diagnostic Criteria for Nightmare Disorder.

Answer 170

A. Repeated occurrence of extended, extremely dysphoric and well-remembered dreams that usually involve efforts to avoid threats to survival, security or physical integrity that occur during the second half of the major sleep episode.
B. On awakening form the dysphoric dreams, the person rapidly becomes oriented and alert.
C. The sleep disturbance causes clinically significant impairment in important areas of functioning.
D. The nightmare symptoms are not attributable to the physiological effects of a substance.
E. Coexisting mental and medical disorders do not explain the predominant complaint of dysphoric dreams.

Question 171

The DSM-5 Diagnostic Criteria for Non-Rapid Eye Movement Sleep Arousal Disorders.

Answer 171

A. Recurrent episodes of incomplete awakening from sleep occurring during the 1st third of the major sleep episode, accompanied by either one of the following:
1. Sleepwalking: repeated episodes of rising form bed during sleep and walking about. While sleeping, the person has a blank, starring face; is unresponsive to the efforts of others communicating with him/her.
2. Sleep terrors: recurrent episodes of abrupt terror arousal form sleep, usually beginning with a panicky scream.
B. No or little dream imagery is recalled.
C. Amnesia for the episodes is present.
D. The episodes cause clinically significant impairment in important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance.
F. Coexisting mental and medical disorders do not explain the episodes of sleepwalking or sleep terrors.

Question 172

The DSM-5 Diagnostic Criteria for Rapid Eye Movement (REM) Sleep Behaviour Disorder.

Answer 172

A. Repeated episodes of arousal during sleep associated with vocalization and/or motor behaviours.
B. These behaviours arise during rapid eye movement sleep and therefore usually occur greater than 90 minutes after sleep onset.
C. Upon awakening form these episodes, the individual is completely awake and alert and not confused.
D. Either of the following:
1. REM sleep without catatonia (muscle weakness).
2. A history of REM sleep behaviour and an established diagnosis of Parkinson’s disease.
E. The behaviours cause clinically significant impairment in important areas of functioning.
F. The disturbance is not attributable to the effects of a substance of another medical condition.
G. Coexisting mental and medical disorders don explain the episodes.

Question 173

What are Personality Disorders?

Answer 173

Personality Disorders are enduring maladaptive patterns for relating to the environment and self, exhibited in a range of contexts that cause significant functional impairment or distress.

Question 174

Aspects of Personality Disorders.

Answer 174

1. Personality disorders are chronic; they do not come and go, but originates in childhood and continue throughout adulthood.
2. Having a personality disorder may distress the affected person; they may not feel any subjective distress, however, it may be others who feel distress because of the actions of the person with the disorder.
3. Many people who have personality disorders in addition to other psychological problems tend to do poorly in treatment.

Question 175

Categorical and Dimensional Models of Personality Disorders.

Answer 175

1. The difficulties of people with personality disorders can be seen as of Degree rather than Kinds, in other words, the problems may just be extreme versions of the problems many of us experience temporarily.
2. The distinction between problems of degree and problems of kind is usually describes as Dimensions instead of Categories.
   Clinicians in this field see personality disorders as extremes of one or more personality dimensions.
3. The DSM-5 does not rate how dependent you are: if you meet the criteria, you are labeled as having dependent personality disorder.
4. The DSM-5 Alternative Model of Personality Disorders (AMPD) was created in a different section of DSM outline 6 trait domains: Negative affectivity, Detachment, Antagonism/Dissociality, Disinhibition, Anankastia and Psychotism.
5. The most important advantage of using categorical models of behaviours is their convenience, however, this leads clinicians to include disorders as real ‘things’, comparable to the realness of an infection or broken arm
6. The most widely accepted personality dimension is the Five-Factor Model (Big Five), where people can be rated on a series of personality dimensions, and the combination of 5 components describes why people are so different: Extroversion (talkative vs silent), Agreeableness (kind vs hostile), Conscientiousness (organized vs careless), Neuroticism (even-tempered vs nervous), Openness to Experience (imaginative vs shallow).

Question 175

Personality Disorder Clusters.

Answer 175

1. Cluster A (Odd or Eccentric Disorders): paranoid, schizoid, schizotypal.
2. Cluster B (Dramatic, Emotional or Erratic Disorders): antisocial, borderline, histrionic, narcissistic.
3. Cluster C (Anxious or Fearful Disorders): avoidant, dependent, obsessive-compulsive.

Question 176

Gender Differences of Personality Disorders.

Answer 176

1. Men diagnosed with a personality disorder tend to display traits characterized as more aggressive, structured and detached, and women tend to present with characteristics that are more submissive, emotional and insecure.
2. Antisocial personality disorder is present more often in males and dependent personality disorder more often in females.
3. Equal numbers of males and females have histrionic and borderline personality disorders.

Question 177

The DMS-5 Diagnostic Criteria for Paranoid Personality Disorder.

Answer 177

A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more of the following:
1. Suspects, without sufficient basis, that others are exploiting, harming or deceiving him/her.
2. Is preoccupied with unjustified doubts about the loyalty of friends or associates.
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously.
4. Reads hidden demeaning or threatening meanings into events.
5. Persistently bears grudges.
6. Has recurrent suspicious, without justification, regarding fidelity of spouse or sexual partner.
7. Perceives attacks on his/her character that are not apparent to others and is quick to react angrily.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder, depressive disorder, or other psychotic disorders and is not attributable to the physiological effects of another medical condition.

Question 178

Causes and Management of Paranoid Personality Disorder.

Answer 178

1. Slightly common among the relatives of people who have schizophrenia, although association is not strong.
2. A strong role of genetics.
3. Psychological contributions such as early mistreatment or traumatic childhood may play a role.
4. The thoughts of people with paranoid personality disorder: “People are malevolent and deceptive”
5. Roots in early development as parents may teach children to be careful about making mistakes.
6. Cultural factors such as groups of people (prisoners, refugees) are thought to be susceptible because of their unique experiences.
   Management
7. Establishing a meaningful therapeutic alliance between the client and the therapist becomes an important step.
8. The use of cognitive therapy to counter the person’s mistaken assumptions about others, focusing on changing the person’s beliefs that all people are malevolent and can’t be trusted.

Question 179

What is Paranoid Personality Disorder?

Answer 179

Paranoid Personality Disorder is a Cluster A personality disorder involving pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.

Question 180

What is Schizoid Personality Disorder?

Answer 180

Schizoid Personality Disorder is a Cluster A personality disorder featuring a pervasive pattern of detachment form social relationships and a range of restricted range of expression of emotions.

Question 181

Clinical Description of Schizoid Personality Disorder.

Answer 181

1. Individuals with schizoid personality disorder appear cold and detached and do not seem affected by praise or criticism.
2. The social deficiencies of people these people are similar to those with paranoid personality disorder, although they are more extreme.
3. They consider themselves to be observers rather than participants in the world around them.
4. Those with schizoid share the social isolation and constricted affect seen in people with paranoid personality disorder.

Question 182

The DSM-5 Diagnostic Criteria for Schizoid Personality Disorder.

Answer 182

A. A pervasive pattern of detachment form social relationships and a range of restricted range of expression of emotions, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more of the following:
1. Neither desires nor enjoys close relationships, including being part of a family.
2. Almost always chooses solitary activities.
3. Has little interest in having sexual experiences with another person.
4. Takes pleasure in few activities.
5. Lacks close friends or confidants other than first-degree relatives.
6. Appears indifferent to the praise or criticism of others.
7. Shows emotional coldness, detachment.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder, depressive disorder, and is not attributable to the physiological effects of another medical condition.

Question 183

What is Schizotypal Personality Disorder?

Answer 183

Schizotypal Personality Disorder is a Cluster A personality disorder involving a pervasive pattern of interpersonal deficits featuring acute discomfort with, and reduced capacity for, close relationships, as well as cognitive distortions and behaviours.

Question 183

Causes and Treatment of Schizoid Personality Disorder.

Answer 183

1. Brainstem inhibitory dysfunction was more pronounced under fear and sadness in schizoid personality disorder.
2. Childhood shyness is reported as precursor to later adult schizoid personality disorder.
3. Biological causes of autism spectrum disorder, and parents of children with autism are more likely to have schizoid personality disorder.
4. During treatment, therapists begin by pointing out the value in social relationships. The patient may even be taught the emotions felt by others to learn empathy.
   Patients often receive social skills training.

Question 184

The DSM-5 Diagnostic Criteria for Schizotypal Personality Disorder.

Answer 184

A. A pervasive pattern of interpersonal deficits featuring acute discomfort with, and reduced capacity for, close relationships, as well as cognitive distortions and behaviours, beginning by early adulthood, as indicated by 5 or more of the following:
1. Ideas of reference.
2. Odd beliefs or magical thinking that influences behaviour and is inconsistent with sub-cultural norms (superstitiousness, telepathy, sixth sense, bizarre fantasies).
3. Unusual perceptual experiences, including body illusions.
4. Odd thinking and speech.
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect.
7. Behaviour or appearance that is odd, eccentric or peculiar.
8. Lack of close friends or confidants other than first-degree relatives.
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder, depressive disorder, and is not attributable to the physiological effects of another medical condition.

Question 185

Causes and Management of Schizotypal Personality Disorder.

Answer 185

1. Schizotypal is viewed to be one phenotype of a schizophrenia genotype.
2. Schizotypal characteristics such as ideas of reference and illusions are similar but milder forms of behaviours observed among people with schizophrenia.
3. Symptoms are strongly associated with childhood maltreatment among men.
4. Mild to moderate decrements in memory and learning, suggesting some damage in the left hemisphere.
   Management
5. Treatment includes some of the medical and psychological treatment for depression.
6. Treating younger people with antipsychotic medication and cognitive behaviour therapy in order to avoid the onset of schizophrenia.

Question 185

The DMS-5 Diagnostic Criteria for Antisocial Personality Disorder.

Answer 185

A. A pervasive pattern of disregard for and violation of the rights of others, occurring since the age of 15 years, as indicated by 3 or more of the following:
1. Failure to conform to social norm with respect to lawful behaviours, as indicated repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal pleasure.
3. Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated or stolen from another.
B. The individual is at least 18 years of age.
C. There is evidence of conduct disorder with onset before 15 years of age.
D. The occurrence of antisocial behaviour is not exclusively during the course of schizophrenia or bipolar disorder.

Question 185

What is Antisocial Personality Disorder?

Answer 185

Antisocial Personality Disorder is a Cluster B personality disorder involving a pervasive pattern of disregard for and violation of the rights of others.
1. Antisocial personality disorder has had a number of names over the years: moral insanity, egopathy, sociopathy, psychopathy.

Question 186

Psychological and Social Dimensions of Antisocial Personality Disorder.

Answer 186

1. Once psychopaths set their sights on a reward goal, they are less likely than non-psychopaths to be deterred
2. Aggression in children with antisocial personality disorder may escalate.
3. The coercive family process combines with factors such as genetic influences to help maintain the aggressive behaviours.
4. Individuals with antisocial personality disorder come from homes with inconsistent parental discipline.

Question 187

Antisocial Personality Disorder and Criminality.

Answer 187

1. What separates many in this group from those who get into trouble with the law may be their IQ: having a higher IQ may help protect some people form developing more serious problems.
2. Identifying psychopaths among the criminal population seems to have important implications for predicting their future criminal behaviour.
3. Having personality characteristics such as lack of remorse can lead to difficulty staying out of trouble with the legal system.
   People who score high on measures of psychopathy commit crimes at a higher rate than those who score lower.

Question 188

Developmental Influences of Antisocial Personality Disorder.

Answer 188

1. As children move into adulthood, the forms of antisocial behaviours change: from truancy and stealing to extortion, assaults and armed robbery.
2. Rates of antisocial behaviour begin to decline around the age of 40.

Question 189

An Integrative Model of Antisocial Personality Disorder.

Answer 189

1. Psychopaths and criminals have a genetic vulnerability to antisocial behaviours.
2. One potential gene-environment interaction may be seen in the role of conditioning in children. But what if this conditioning is impaired and children do not learn to avoid things that can harm them?
3. Genetic influences (damage in the amygdala) interact with environmental influences (learning of fear threats) to produce adults who are relatively fearless and therefore engage in behaviours that cause harm to themselves and others.
4. Biological influences (family under stress) interact with other environmental experiences such as childhood adversity.

Question 190

Management of Antisocial Personality Disorder.

Answer 190

1. A major problem with treating people in this group: they rarely identify themselves as needing treatment.
2. Therapists agree with incarcerating these people to deter future antisocial acts.
3. Clinicians encourage identification of high-risk children so that treatment can be attempted before they become adults.
4. CBT can reduce the likelihood of violence 5 years after treatment.
5. Enabling individuals to examine their own states of mind and understand others’ minds and behave more prosocially.
6. The most common strategy for children involves parent training: to recognize behaviour problems and encourage prosocial behaviour.

Question 191

What is Borderline Personality Disorder?

Answer 191

Borderline Personality Disorder is a Cluster B personality disorder involving a pervasive pattern of instability of interpersonal relationships, self-image, affects and control over impulses.

Question 192

The DSM-5 Diagnostic Criteria for Borderline Personality Disorder.

Answer 192

A. A pervasive pattern of instability of interpersonal relationships, self-image, affects and impulsivity, beginning by early adulthood, as indicated by 5 or more of the following:
1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating extremes of idealization and devaluation.
3. Identity disturbances: markedly unstable self-image.
4. Impulsivity in at least 2 areas that are potentially self-damaging (spending, sex, substance abuse, reckless driving, binge eating).
5. Recurrent suicidal behaviour, gestures or threats, or self-mutilating behaviour.
6. Affective instability due to a marked reactivity of mood.
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (physical fights, controlling anger).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Question 193

Causes of Borderline Personality Disorder.

Answer 193

1. More prevalent in families with the disorder and is somehow linked to mood disorders.
2. Low serotonergic activity is involved with the regulation of mood and impulsivity.
3. The tendency to experience shame was associated with high levels of anger and hostility.
4. Cognitive factors such as memory bias where individuals with this disorder remember words associated with the disorder, for example, ‘suicidal’, ‘abandon’.
5. Environmental factors such as the possible contribution of early trauma, especially sexual and physical abuse.
6. Temperament (impulsive or irritable) or neurological impairments (substance abuse) and how they interact with parental styles may account for some cases of borderline personality disorder.

Question 193

What is Histrionic Personality Disorder?

Answer 193

Histrionic Personality Disorder is a Cluster B personality disorder involving a pervasive pattern of excessive emotionality and attention seeking.
1. Features of histrionic personality disorder, such as overdramatisation, seductiveness are characteristics of the Western ‘stereotypical female’ and may lead to an overdiagnosis among women.

Question 193

Management of Borderline Personality Disorder.

Answer 193

1. Individuals appear distressed and are more likely to seek treatment even more than people with mood disorders.
2. Efforts to provide successful treatment are complicated by problems with substance abuse and suicide attempts. And as a result, many clinicians are reluctant to work with individuals in this group.
3. Dialectical Behaviour Therapy is a promising treatment for borderline personality disorder that involves helping people cope with the stressors that seem to trigger suicidal behaviours, as well as helping the client regulate emotions.
4. There is a high rate of symptomatic remission in BPD.

Question 194

The DSM-5 Diagnostic Criteria for Histrionic Personality Disorder.

Answer 194

A. A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood, as indicated by 5 or more of the following:
1. Is uncomfortable in situations in which he/she is not the centre of attention.
2. Interaction with others is often characterized by inappropriate sexually seductive/provocative behaviour.
3. Displays rapidly shifting and shallow expression of emotions.
4. Consistently uses physical appearance to draw attention to self.
5. Has a style of speech that is excessively impressionistic and lacking detail.
6. Shows self-dramatisation and exaggerated expression of emotion.
7. Is suggestible (easily influenced by others).
8. Considers relationships to be more intimate than they actually are.

Question 195

What is Narcissistic Personality Disorder?

Answer 195

Narcissistic Personality Disorder is a Cluster B personality disorder involving a pervasive pattern of grandiosity in fantasy or behaviour, need for admiration and a lack of empathy.

Question 195

The DSM-5 Diagnostic Criteria for Narcissistic Personality Disorder.

Answer 195

A. A pervasive pattern of grandiosity in fantasy or behaviour, need for admiration and a lack of empathy, beginning by early adulthood, as indicated by 5 or more of the following:
1. Has a grandiose sense of self-importance (exaggerates achievements and talent).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love.
3. Believes that he/she is special and unique and can only be understood by other special or high-status people or institutions.
4. Requests excessive admiration.
5. Has a sense of entitlement.
6. Is interpersonally exploitative.
7. Lacks empathy: is unwilling to recognize the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him/her.
9. Shows arrogant behaviours or attitudes.

Question 195

Causes and Treatment of Narcissistic Personality Disorder.

Answer 195

1. Narcissistic personality disorder arises from a profound failure by the parents to model empathy early in a child’s development.
2. The consequences of large scale social changes, individualism, competitiveness and success increase the prevalence of this disorder.
3. When therapy is attempted, it often focuses on grandiosity and the lack of empathy towards others.
4. Cognitive strategies such as relaxation training are used to help individuals face and accept criticism.

Question 196

The DSM-5 Diagnostic Criteria for Dependent Personality Disorder.

Answer 196

A pervasive and excessive need to be taken care of that leads to submissive and clinging behaviours and fears of separation, beginning by early adulthood, as indicated by 5 or more of the following:
1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
2. Needs others to assume responsibility for most major areas of his/her life.
3. Has difficulty expressing disagreement with others because of fear of loss of support or approval.
4. Has difficulty initiating projects or doing things on his/her own.
5. Goes to excessive lengths to obtain support from others.
6. Feels uncomfortable or helpless when alone because of exaggerated fear of being unable to take care of him/herself.
7. Urgently seek another relationship as a source of care and support when a close one ends.
8. Is unrealistically preoccupied with fears of being left to take care of him/herself.

Question 196

What is Avoidant Personality Disorder?

Answer 196

Avoidant Personality Disorder is a Cluster C personality disorder featuring a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to criticism.

Question 197

The DSM-5 Diagnostic Criteria for Avoidant Personality Disorder.

Answer 197

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to criticism, beginning by early adulthood, as indicated by 4 or more of the following:
1. Avoids occupational activities that involve significant interpersonal contact because of fear or criticism, disapproval or rejection.
2. Is unwilling to get involved with people unless certain of being liked.
3. Shoes restraint within intimate relationships because of fear of being shamed or ridiculed.
4. Is preoccupied with being critised or rejected in social situations
5. Is inhibited in new interpersonal situations because of feelings of inadequacy.
6. Views self as socially inept or inferior to others.
7. Is unusually reluctant to take personal risks.

Question 197

What is Dependent Personality Disorder?

Answer 197

Dependent Personality Disorder is a Cluster C personality disorder characterized by a person’s pervasive and excessive need to be taken care of, a condition that leads to submissive and clinging behaviours and fears of separation.

Question 198

What is Obsessive-Compulsive Personality Disorder?

Answer 198

Obsessive-Compulsive Personality Disorder is a Cluster C personality disorder featuring a pervasive pattern of preoccupation with orderliness, perfectionism and mental and interpersonal control at the expense of flexibility, openness and efficiency.

Question 199

The DSM-5 Diagnostic Criteria for Obsessive-Compulsive Personality Disorder.

Answer 199

A pervasive pattern of preoccupation with orderliness, perfectionism and mental and interpersonal control at the expense of flexibility, openness and efficiency, beginning by early adulthood, as indicated by 4 or more of the following:
1. Is preoccupied with details, rules, lists, order or schedules to the extent that the major point of the activity is lost.
2. Shows perfectionism that interferes with task completion.
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships.
4. Is over-conscientious and inflexible about matters of ethics or values.
5. Is unable to discard worthless objects even when they have no sentimental value.
6. Is reluctant to delegate tasks or work with others unless they submit to his/her way of doing things.
7. Adopts a spending style towards both self and others.
8. Shows rigidity and stubbornness.

Question 200

The DSM-5 Diagnostic Criteria for Schizophrenia.

Answer 200

A. Two or more of the following, each present for a significant portion of time during a one-month period:
1. Delusions.
2. Hallucinations.
3. Disorganized speech.
4. Negative symptoms.
B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more areas, such as work, is markedly below the level achieved prior to the onset.
C. Continuous signs of the disturbance persist for at least 6 months,
D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because of no major depressive or manic episode have occurred and mood episodes have occurred.
E. The disturbance is not attributable to the physiological effects of a substance or another medical condition.
F. If there is history of autistic spectrum disorder or communication disorder, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are present for at least 1 month.

Question 201

What are Positive Symptoms of Schizophrenia?

Answer 201

1. Delusions.
2. Hallucinations.
3. Disorganisation.
4. Catatonia.
5. Neuroscience and Hallucinations.

Question 202

What are Psychotic Behaviours?

Answer 202

Psychotic Behaviours is a severe psychological disorder category characterized by hallucinations and loss of contact with reality.
1. The characteristics of psychosis include severe mental disturbances, occurs in full consciousness.
2. The defining features are delusions (fixed false beliefs), hallucinations (aberrant perceptions), disorganization of communication and behaviour.

Question 203

Discuss Delusions as a Positive Symptom of Schizophrenia.

Answer 203

1. Delusion is a psychotic phenomenon of disturbed thought content, conceptualized as a fixed false belief. Delusions occur in clear consciousness.
2. The person is suspicious, believes that others have it in for them and may act aggressively.
3. Delusions may be somatic (involving some bodily belief), they may involve beliefs of infidelity of a partner and they may be bizarre, where the belief is outside the realm of ordinary human experience.
4. Other more unusual delusions include Capgras Syndorme, in which the person- believes someone they know has been replaced by a double.
5. Fregoli’s Syndrome is another form of delusion, which involves the belief that familiar people have changed appearance.
6. Delusional beliefs are attempts to deal with and relieve anxiety and stress.
7. Erotomania is when individuals believe that a famous person is in love with them.

Question 203

Discuss Hallucinations as a Positive Symptom of Schizophrenia.

Answer 203

1. Hallucinations are psychotic symptoms of perceptual disturbance in which things are seen, heard or otherwise sensed although they are not actually present.
2. Formed hallucinations involve discernible sounds, such as voices, or visions such as people (tiny hallucinated animal/people are called Lilliputian hallucinations).
3. Unformed hallucinations includes buzzing noises and flashed and blobs, and are strongly indicative of physical illness.
4. The most common tactile (haptic) hallucination is the tactile sensations of insects crawling on or under the skin.
5. Hallucinatory feelings in the body are called Coenaesthetic hallucinations.
6. Hallucinations are also possible during delirium, where they occur in a state of clouded consciousness.

Question 204

Discuss Disorganisation as a Positive Symptom of Schizophrenia.

Answer 204

1. Disorganisaed symptoms include a variety of behaviours that affect communication, motor behaviour and emotional reactions.
2. Behavioural disorganization is characterized by strange, apparently purposeless behaviours. For example, pushing around shopping trolleys full of rubbish.
3. Kraepelin’s hebephrenia is an illustration of motor disorganization.
4. Disorgaised Speech/Talk is a style of talking seen in people with schizophrenia, involving incoherence and a lack of typical logic patterns. Individuals may jump from topic to topic.
5. The problem with disorganized communication is neither speech or language, but one of thinking.

Question 205

Discuss Catatonia as a Positive Symptom of Schizophrenia.

Answer 205

1. One of the strangest and most serious schizophrenic symptoms.
2. Catatonia involves motor dysfunctions that range from wild agitation to immobility and cover a range of strange motor behaviours like grimacing.
3. Echolalia is the echoing of the speech of others, a normal intermediate step in the development of speech skills.
4. Echopraxia is the involuntary imitation of movement of another person.
5. On the active side, some people pace excitedly or move their fingers or arms in stereotyped ways. At the extreme end, people hold unusual postures (waxing flexibility).
6. Negativism is encountered frequently and involves a patient opposing what is done to them, for example, if someone pulls at an arm, they will pull away.

Question 206

Discuss Neuroscience and Hallucinations as a Positive Symptom of Schizophrenia.

Answer 206

1. Using sophisticated brain-imaging techniques to try to localize hallucinations in the brain.
2. Part of the brain that is most active during hallucinations is Broca’s Area.
3. This supports the theory that people who are hallucinating are not hearing the voices of others but are listening to their own thoughts/voices and are unable to recognize the difference.

Question 207

What are the Negative Symptoms of Schizophrenia?

Answer 207

1. Avolition/Apathy.
2. Alogia.
3. Affective Flattening.
4. Asociality.
5. Anhedonia.
6. Attentional Deficits (and other Cognitive Impairments).

Question 207

Discuss the Negative Symptoms of Schizophrenia.

Answer 207

1. Avolition/Apathy: Avolition apathy is the inability to initiate or persist in important activities, including those associated with personal hygiene.
2. Alogia: Alogia refers to the relative absence of verbal communication. A person with alogia may respond to questions with brief replies that have little content and they may appear uninterested in the conversation.
3. Affective Flattening: Flat Affect is the apparently emotionless demeanor when a reaction would be expected. Individuals may stare at you vacantly, speak in flat and toneless manner, and seem unaffected by things going on around them. However, although they do not react openly, they may be responding on the inside. Difficulty expressing emotion and not a lack of feeling.
4. Asociality: Asocialty captures a lack of interest in social interactions and can result from or be worsened by limited opportunities to interact with others.
5. Anhedonia: Anhedonia is the inability to experience pleasure. Signals an indifference to activities that would typically be considered pleasurable such as eating and sexual relations.
6. Attentional Deficits (and other Cognitive Impairments): Neurological impairments affecting working memory and executive functioning. A tendency to cognitive inflexibility is also noted.

Question 208

What is Schizophreniform Disorder?

Answer 208

Schizophreniform Disorder is a psychotic disorder involving the symptoms of schizophrenia but lasting less than six months.

Question 209

The DSM-5 Diagnostic Criteria for Schizophreniform Disorder.

Answer 209

A. Two or more of the following, each present for a significant portion of time during a one-month period:
1. Delusions.
2. Hallucinations.
3. Disorganized speech.
4. Negative symptoms.
B. An episode of the disorder lasts at least 1 month but less than 6 months.
C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because of no major depressive or manic episode have occurred and mood episodes have occurred.
D. The disturbance is not attributable to the physiological effects of a substance or another medical condition.
Specify if
1. With good prognostic features: the presence of at least 2 of the following: onset of psychotic symptoms within 4 weeks of the first noticeable change in usual behaviour; confusion; good social and occupational functioning; flat affect.
2. Without good prognostic features: two or more of the above features have not been present.

Question 210

What is Schizoaffective Disorder?

Answer 210

Schizoaffective Disorder is a psychotic disorder featuring symptoms of both schizophrenia and major depressive mood disorder.

Question 211

The DSM-5 Diagnostic Criteria for Schizoaffective Disorder.

Answer 211

A. An uninterrupted period of illness during which there is a major mood disorder current with Criterion A of schizophrenia.
B. Delusions or hallucinations for 2 or more week in the absence of a major mood episode.
C. Symptoms that meet the criteria for a major mood episode are present.
D. The disturbance is not attributable to the effects of a substance or another medical condition.
Specify whether:
1. Bipolar type: if a manic episode present and major depressive episode may also occur.
2. Depressive type: if only major depressive episodes are present.
3. With catatonia.

Question 212

What is Delusional Disorder?

Answer 212

Delusional disorder is a psychotic disorder featuring a persistent belief contrary to reality but no other symptoms of schizophrenia.
1. Previous versions of the DSM included a separate delusional disorder- Shared Psychotic Disorder (folie à deux), in which an individual develops s delusion similar to that of a person with whom they share a close relationship.

Question 213

The DSM-5 Diagnostic Criteria for Delusional Disorder.

Answer 213

A. The presence of one or more delusions with a duration of 1 month or longer.
B. Criteria A for schizophrenia has never been met.
C. Apart from the impact of the delusion, functioning is not markedly impaired and behaviour is not obviously bizarre.
D. If manic or major depressive episodes have occurred, these have been brief.
E. The disturbance is not attributable to the physiological effects of a substance or another medical disorder.
Specify whether:
1. Erotomanic type: central theme of delusion is that another person is in love with the individual.
2. Grandiose type: central theme of delusion is the conviction of having great talent.
3. Jealous type: central theme of delusion is that his/her spouse is unfaithful.
4. Persecutory type: central theme of delusion is the belief that he/she is conspired against, cheated, harassed.
5. Somatic type: central theme of delusion involves bodily sensations.
6. Mixed type: no delusional theme predominates.
7. Unspecified type: delusional belief is not clearly determined.

Question 214

What is a Brief Psychotic Disorder?

Answer 214

Brief Psychotic Disorder is a psychotic disturbance involving delusions, hallucinations, or disorganized speech or behaviour but lasting less than one month, which often occurs in reaction to stress.

Question 215

Cultural Factors of Schizophrenia Disorder.

Answer 215

1. Some people have argued that schizophrenia does not really exist, but is a derogatory label for people who behave in ways outside the cultural norm.
2. Schizophrenia is universal, affecting all racial and cultural groups.
   In South Africa, schizophrenia symptoms are associated with a spiritual calling.
3. The Cultural Formulation is a guide that help clinicians examine any biases they may have when interviewing people from other cultures. For example, one type of question asks, ‘Why do you think this is happening to you?’
4. The course and outcome of schizophrenia vary from culture to culture, for example, the stressors associated with political, social problems prevalent in areas of Africa, Latin America and Asia may contribute to poorer outcomes for people with schizophrenia in these countries.
5. The lack of adequate mental health infrastructure in low- and middle-income countries is also a problem.
6. People from devalued ethnic minority groups may be victims of bias and stereotyping, in other words, they may be more likely to receive a diagnosis of schizophrenia.

Question 216

Stress Influences of Schizophrenia.

Answer 216

1. The stress of living in a big city may precipitate the onset of schizophrenia.
   Individuals who engage in combat during a war experienced a high number of stressful events often display temporary symptoms that resemble those of schizophrenia.
2. People with schizophrenia may experience events differently from those without the disorder.
3. Being born during the winter increases a person’s chance of later developing schizophrenia.
4. The vulnerability stress model of schizophrenia suggests that symptoms of schizophrenia become worse as a result of stressful life events, such as a natural disaster.
5. Psychosocial stressors like poverty, homelessness influence the onset and possible development of schizophrenia.
6. Genes (gene variances) and environmental vulnerability (stress) can precipitate the onset of the disorder.

Question 217

Discuss Families and Relapse Influences of Schizophrenia.

Answer 217

1. The term Schizophrenogenic Mother was used to describe a mother whose cold, dominant and rejecting nature was thought to cause schizophrenia in her children.
2. The term Double Bind Communication was used to portray a communication style that produced conflicting messages, which, in turn, cause schizophrenia to develop.
3. Expressed Emotion (EE) is the hostility, criticism and over-involvement demonstrated by some families towards a family member with a psychological disorder and often contributes to the person’s relapse.
4. A schizophrenic person living with a family with high expressed emotions (I’ve tried to get him to do thing) is more likely to relapse than a person living with a family with low expressed emotions (I know it’s better for him to things on his own).

Question 218

The Psychosocial Interventions of Schizophrenia.

Answer 218

1. Reflects the belief that the disorder results from problems in adapting to the world because of early experiences.
2. Improving patients’ socialization, helping them establish routines of self-control and showing then the value of work and religion.
3. A Token Economy is a social learning behaviour system in which individuals could earn access to meals and small luxuries by behaving appropriately.
4. Individuals suffering from schizophrenia can learn to perform some skills that they need to live more independently.
5. Factors that play a role in the readmission of individuals into a mental institutional: people with more severe positive symptoms, a lifetime of substance abuse.
6. Addressing complex problems in communities and supporting people with the disorder in the communities.
7. Reteach social skills by dividing them into component parts, role-playing and practicing their new skills in the real world.
8. Programmes that teach a range of ways people can adapt to their disorder yet live in the community.
9. Assertive Community Treatment models are developed in SA where there is a shift away from hospital treatments to community rehabilitation.
10. Improving the understanding of the disorder by using virtual reality technology, create game-like tasks to test aspects of working memory and perseveration.
11. Help older people with the disorder improve their cognitive and general motor skills, for example, by having them push away colourful balls that are floating towards them in a virtual world.
12. Cognitive remediation aimed at improving cognitive processes, such as attention and memory in order to increase the individual’s functioning in the community.
13. Family-based treatments that teach families to be more supportive of individuals, informed about treatments, helped with communication skills.
14. Programmes focus on vocational rehabilitation, such as supportive employment, which involves providing coaches who give on-the-job training.
15. Treatment expands over the years from locked wards in large mental hospitals, to family homes, to local communities.

Question 219

Treatment across Cultures of Schizophrenia.

Answer 219

1. Xhosa people report using traditional healers who sometimes recommend the use of oral treatments to induce vomiting, the slaughter of cattle to appease the spirits.
2. Latinas seek more family support.
3. The British use more biological, psychological and community treatments, and the Chinese rely more on alternative medicine.
4. Supernatural beliefs about the cause of the disorder among members in Bali lead to limited use of antipsychotic medication.

Question 220

Prevention of Schizophrenia.

Answer 220

1. One strategy for preventing schizophrenia is to identify and treat children who may be at risk of getting the disorder later in life.
2. The treatment of people in the prodromal stage of the disorder, whereby the individual is beginning to show early mild signs but is aware of these changes.