Exam 2

Question 1

anxiety and fear

Answer 1

complex pattern of three types of reactions to perceived threat

• behavioral responses: running away, avoiding, fight, or flight
• cognitive responses: overthinking, being overwhelmed
• physiological responses: sweating, heart palpitations

Question 2

fear

Answer 2

immediate reaction to current threat

Question 3

anxiety

Answer 3

alarm reaction to future-oriented concerns

Question 4

worry

Answer 4

thought about possible negative outcomes (cognitive component of anxiety)

Question 5

normal fears

Answer 5

• parents may underestimate fears, especially in adolescents
• girls exhibit more fears than boys
  girls exhibit more intensity than boys
• fears commonly report to decline with age
• worry becomes more prominent and complex with age
• certain fears coincide with different stages of development
• few cultural differences

Question 6

empirical approach for anxiety

Answer 6

prevalence among children vary

• usually 2.5-5% but some report 12-25%
• slightly higher prevalence in girls
• limited info on ethnic differences, but may exist

Question 7

specific phobias

Answer 7

persistent fear in response to object or situation

• immediate anxiety response that occurs almost every time
• person realizes fear is unreasonable/excessive
• must either avoid the anxiety situations or endure any exposure with anxiety or distress
• fears interfere significantly with child’s routine, academic functioning, or social relationships
• duration: at least 6 months
• prevalence: 3 to 4% (higher in girls than boys)

Question 8

separation anxiety disorder

Answer 8

• developmentally inappropriate and excessive anxiety about separation from home or a major attachment figure
• may follow a stress or trauma
• prevalent in 3 to 12%, decreases with age
• comorbid with other diagnoses,most commonly GAD
• symptoms:
  
  • distress when separation from home or major attachment figure occurs or is anticipated
  • worry about losing or harm befalling attachment figures
  • persistent reluctance or refusal to go to school
  • persistent refusal to be alone or to go to sleep
  • physical symptoms when separation occurs or is anticipated

Question 9

diagnostic criteria of social anxiety disorder (social phobia)

Answer 9

A) marked, persistent fear of acting in an embarrassing or humiliating way in social or performance situations
- speaking
- reading
- writing
- public performances
- initiating or maintaining conversations
- speaking to authority figures
- interacting in informal social situations
B) fear that he/she will act in a way or show anxiety symptoms that will be negatively evaluated (humiliation/rejection)
C) social situations are avoided or endured with intense fear/anxiety
E) fear or anxiety is out of proportion to the actual threat posed by the social situation and the sociocultural context
F) persistent for 6+ months

Question 10

school refusal

Answer 10

• not a diagnosis
• often associated with separation anxiety, but other causes possible
• functional analysis (going in and trying to understand each component of environment, thoughts, etc. to determine cause and treat) may help in identifying cause
• prevalence: 1-2% of general population
• no gender differences
• majority of clinicians emphasize importance of getting the child back to school

Question 11

generalized anxiety disorder

Answer 11

• excessive anxiety and worry about multiple general life circumstances (not confined to a specific stress or situation)
• associated with nervous habits, sleep disturbances
• prevalence: 2-14% (all ages)
• sometimes reported as more common in girls
• median age of onset: 10
• commonly comorbid with depression, separation anxiety, and phobias
• may be over diagnosed
• does not appear to be transitory

Question 12

diagnostic criteria of separation anxiety disorder

Answer 12

A) developmentally inappropriate and excessive fear or anxiety concerning separation from those whom the individual is attached, as evidenced by at least three of the following:
- recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures
- persistent and excessive worry about losing major attachment figures\ or about possible harm to them such as illness, injury, disasters, or death
- persistent and excessive worry about experiencing an untoward event (getting lost kidnapped etc) that causes separation from a major attachment figure
- persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation
- persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings
- persistent reluctance or refusal to sleep away from home or go to seep without being near a major attachment figure
- repeated nightmares involving separation
- repeated complaints of physical symptoms when separated from major attachment figures occurs or is anticipated
B) duration lasting 4 weeks in children and adolescents and typically 6 months in adults
C) clinically significant distress and impairment
D) not better explained by another mental disorder

Question 13

selective mutism

Answer 13

• do not talk in specific situations (when peers do talk)
• usual onset: 2.5 to 4yrs old
• large percentage of SM children (90-100%) also meet criteria for social phobia

Question 14

diagnostic criteria for selective mutism

Answer 14

A) consistent failure to speak in specific social situations where there is an expectation for speaking despite speaking in other situations
B) disturbance interferes with educational or occupational achievement or with social communication
C) duration 1+ month
D) failure to speak is not attributed to lack of knowledge of, or comfort with, the spoken language required in the situation
E) disturbance is not better explained by a communication disorder and does not occur exclusively during the course of ASD, schizophrenia, or another psychotic disorder

Question 15

diagnostic criteria for generalized anxiety disorder

Answer 15

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 three or more of the following symptoms (only one required for children) (with at least some symptoms being present more days than not for 6 months):
- relentlessness of feeling keyed up or on edge
- being easily fatigued
- difficulty concentrating or mind going blank
- irritability
- muscle tension
- sleep disturbance
D) distress and impairment
E) not better accounted for by anything else

Question 16

panic attack

Answer 16

• discrete period of intense fear, terror that has sudden onset and reaches a peak quickly (10 min or less)
• unexpected (uncued): spontaneous, no trigger
• recurring panic attacks makeup panic disorder
• not a mental disorder alone

Question 17

diagnostic criteria for panic disorder

Answer 17

A) panic attack
B) at least on of the panic attacks has been followed by 1 month or more of one or both of the following:
- persistent concern or worry about additional panic attacks or their consequences (losing control, having a heart attack, going crazy)
- a significant maladaptive change in behavior related to the attacks (behaviors designed to avoid the attacks such as avoidance of situations)
C) not attributed to physiological effects of a substance or medical condition
D) not better explained by another mental disorder

Question 18

panic disorder

Answer 18

• prevalence in clinical samples 10-15%
• panic attacks are more common than panic disorder
• rare in childhood
• more common in females
• few seek treatment
• appears to run in families
• commonly comorbid with other diagnoses

Question 19

PTSD

Answer 19

• likely to experience repetitive, intrusive thoughts
• younger children may reenact aspects of event in drawing stories, play
• increased frequency and intensity of specific fears
• clingy, dependent behaviors are common
• sleep problems, depression, “survivor guilt”
• associated with maltreatment
• about 1/3 of children exposed to trauma experience PTSD
• some findings indicate that the figure is 50% or more
• higher incidence in girls
• early trauma may cause changes to the brain (HPA axis)
• can have chronic course
• reactions may be influenced by:
  
  • nature of trauma (acute, non-abusive vs. chronic or abusive)
  • degree of exposure
  • subjective experiences of threat
  • individual differences prior to event (anxiety level)
  • other factors

Question 20

diagnostic criteria for PTSD

Answer 20

A) event: trauma (exposure to actual or threatened death, serious injury, or sexual violence
- directly experiencing
- witnessing
- learned events occurred to close family member or friend
- repeated or extreme exposure to aversive details of event (work related, first responders, police officers)
B) intrusion symptoms (1+)
- recurrent, involuntary, and intrusive distressing memories of event (children <6 repetitive play may occur where themes of events are expressed)
- recurrent distressing dreams related to event (in children there may be frightening dreams without recognizable content)
- dissociative reactions (flashbacks) where the individual feels or acts as if the events were recurring (in children, trauma-specific reenactment may occur in play)
- intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of events
- marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic events
C) avoidance of stimuli associated with event (1+)
- avoidance of or efforts to avoid distressing memories, thoughts, or feeling about or closely associated with the traumatic events
- avoidance of or efforts to avoid external reminds that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic events
D) negative alterations in cognition and mood associated with the event (2+)
- inability to remember important aspects of event
- exaggerated negative beliefs or expectations about oneself, others, or the world
- distorted cognitions about consequences = blame self/others
- diminished interest in activities
- feelings of detachment/estrangement from others
- persistent in ability to experience positive emotions
E) alterations in arousal and reactivity
- irritable behavior/ anger outburst
- reckless or self-destructive behavior
- hypervigilance
- exaggerated startle response
- problems with concentration
- sleep disturbance
F) 1+ month of symptoms
G) distress/ impairment
H) not better accounted for by anything else

Question 21

second set of diagnostic criteria for PTSD for children 6 or younger

Answer 21

A) directly experiencing, witnessing, or learning about caregiver experiencing
B) 1+ intrusions: distressing memories, dreams, dissociative reactions (flashbacks), prolonged physiological distress to cues, markekd physiological reaction to reminder
C) 1+ avoidance of stimuli or negative alterations in cognition (socially withdrawn)
D) 2+ arousal and reactivity: irritable, hypervigilant, startle response, concentration, sleep
E) 1+ month of symptoms

Question 22

Acute stress disorder

Answer 22

• reaction to trauma that lasts 3 days to 1 month
• exposure to actual or threatened death/serious injury/sexual violence
• encompasses PTSD criteria B-E as 1-14 (need 5+)
• less strenuous version of PTSD to account for trauma

Question 23

OCD

Answer 23

• obsessions: unwanted, repetitive, intrusive thoughts
• compulsions: repetitive, stereotyped behaviors
• OCD may have either or both
• highly time-consuming, interferes with normal routines, academic functions, and social relationships
• in children, compulsions reported more often
• broad themes: preoccupation with cleanliness/ averting danger and pervasive doubting
• parents may not see problem
• prevalence 1%
• boys more than girls in childhood, but evens out by teens
• mean age of onset is 10
• commonly comorbid with at least one other disorder

Question 24

diagnostic criteria for OCD

Answer 24

A) presence of obsessions, compulsions, or both
- obsessions:
1. recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress
2. the individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (ex: performing a compulsion)
- compulsions:
1. repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly
2. the behaviors or mental acts are aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation; however they are not connected in a realistic way with what they are designed to neutralized or prevent or are clearly excessive (young children may not be able to articulate the aims)
B) the obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
C) symptoms are not attributable to physiological effects of a substance or medical condition
D) not better explained by another mental disorder

specify if:

• with good or fair insight
• with poor insight
• with absent insight/ delusional beliefs
• tic-related

Question 25

trichotillomania (hair pulling disorder)

Answer 25

A) recurrent pulling out of one’s hair, resulting in hair loss
B) repeated attempts to decrease or stop hair pulling
C) the hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
D) the hair pulling or hair loss is not attributable to another medical condition
- the hair pulling is not better explained by symptoms of another mental disorder

Question 26

excoriation (skin-picking) disorder

Answer 26

A) recurrent skin picking resulting in skin lesions
B) repeated attempts to decrease or stop skin picking
C) skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
D) the skin picking is not attributable to the physiological effects of a substance or medical condition
E) not better explained by symptoms of another mental disorder

Question 27

DSM approach to classification of mood disorders

Answer 27

• unipolar vs bipolar
• major depressive episode
• manic episode
• mixed
• hypomanic

Question 28

depression

Answer 28

• no definitive definition at this time
• clinical usage:
  
  • irritability/temper tantrums
  • loss of pleasure
  • social withdrawal
  • low self esteem
  • inability to concentrate
  • impact on work/school
  • impact of biological functioning (sleeping/eating) or somatic complaints

Question 29

diagnostic criteria for major depressive disorder

Answer 29

A) 5+ of following symptoms have been present during the same 2 week period and represent a change from previous functioning (at least one symptom is depressed mood or loss of interest or pleasure)
- depressed mood most of the day, nearly every day
- markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- significant weight loss when not dieting or wight gain (5% of body weight in a month) or decrease/increase in appetite nearly every day (in children, failure to make expected weight gain)
- insomnia or hypersomnia nearly every day
- psychomotor agitation or retardation nearly everyday
- fatigue or loss of energy nearly everyday
- feelings of worthlessness or excessive or inappropriate guilt nearly everyday
- diminished ability to think or concentrate, or indecisiveness nearly everyday
- recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan
B) distress or impairment
C) not attributed to effect of substance or medication
D) not better explained by another mental disorder
E) there has never been a manic episode or hypomanic episode

Question 30

severity/course specifiers for MDD

Answer 30

• mild
• moderate
• severe
• with psychotic features
• in partial remission
• in full remission
• unspecified

Question 31

things to specify for MDD

Answer 31

• anxious distress
• mixed features
• melancholic features
• atypical features
• mood-congruent psychotic features
• mood-incongruent psychotic features
• catatonia
• peripartum onset
• seasonal pattern

Question 32

key features of MDD

Answer 32

• symptoms are nearly everyday, most of the day
• sometimes depressed mood not endorsed, but observed/ inferred via reports
• episode at least 2 weeks
• prevalence 7%
• earlier onset = worse prognosis
• peak onset around 20s
• natural course of recovery in 3 months for many

Question 33

MDD in children

Answer 33

• sleep impairment screening
• somatic complaints frequent
• episode may contain irritability more so than depressed mood

Question 34

persistent depressive disorder

Answer 34

• shares symptoms of MDD but less severe, more chronic

- double depression possible

Question 35

diagnostic criteria for persistent depressive disorder

Answer 35

A) depressed mood for most of the day, for more days than not, for at least 2 yrs (1 yr in children and adolescents and mood can be irritable)
B) presence, while depressed, of 2+ of the following:
- poor appetite or overeating
- insomnia or hypersomnia
- low energy or fatigue
- low self-esteem
- poor concentration or difficulty making decisions
- feeling of hopelessness
C) during the 2 yr period (1 for children and adolescents), the individual has never been without symptoms in A and B for more than 2 months at a time
D) criteria for MDD may be continuously present for 2yrs
E) there has never been a manic or hypomanic episode and criteria have never been met for cyclothymic disorder
F) not better explained by another mental disorder
G) not attributed to physiological effects of substance or medication
H) distress or impairment

Question 36

defining depression in children

Answer 36

• experience of depression may differ at various points in youth development
• depression in young people perhaps best understood as dimensional, not categorical

Question 37

depression in infants

Answer 37

• less active
• feeding and sleep problems
• irritability
• less positive affect
• sad facial expression
• excessive crying
• decreased responsiveness

Question 38

depression in preschoolers

Answer 38

• irritability
• sad facial expression
• mood changes
• feeding and sleep problems
• lethargy
• excessive crying

Question 39

depression in middle childhood (6-12yrs)

Answer 39

may verbalize feelings of hopelessness, low self-esteem

Question 40

depression in adolescents

Answer 40

• in early adolescents, may look similar to depressionn in childhood
• later, starts to resemble adult depression
• median age: 15.5yrs

Question 41

biological influences in depression

Answer 41

• studies indicate genetic component
• role of neurotransmitter central to study (serotonin, norepinephrine, acetylcholine)
• neuroendocrine system dysregulaton (cortisol, growth hormones)

Question 42

temperament in depression

Answer 42

• considered to have genetic or biological basis (environmental influences may affect its development)
• negative affectivity (NA): includes tendency to experience negative emotion, sensitive to negative stimuli, to be wary, vigilant
• positive affectivity (PA): includes approach, energy, sociability, sensitivity to reward cues

Question 43

bipolar I disorder

Answer 43

must meet criteria for manic episode

- may be followed by hypomanic or MDD episodes

Question 44

diagnostic criteria for a manic episode

Answer 44

A) distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly everyday (or any duration if hospitalization is necessary)
B) 3+ of:
- inflated self esteem or grandiosity
- decreased need for sleep
- more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- distractibility
- increase in goal-directed activity or psychomotor agitation
- excessive involvement in activities that have high potential for painful consequence
C) distress impairment
D) not attributed to effects of substance

at least one lifetime manic episode is required for a diagnosis of bipolar I disorder

Question 45

bipolar II disorder

Answer 45

• person has periods of hypomania and depression

Question 46

diagnostic criteria of a hypomanic episode

Answer 46

A) 4 consecutive days
B) 3+ symptoms:
- inflated self-esteem or grandiosity
- decreased need for sleep
- more talkative or pressure to keep talking
- flight of ideas
- distractibility
- goal-oriented behavior increase
excessive involvement in risky activities

Question 47

cyclothymia

Answer 47

chronic but mild fluctuations in mood that do not meet the criteria for mania or depression

Question 48

epidemiology of bipolar disorder

Answer 48

• rare in children
• prevalence of DSM-5 criteria to be determined
• males and females equally represented
• co-occurs with ADHD, conduct disorder, oppositional defiant disorder, substance abuse/dependence

Question 49

conduct problems (externalizing)

Answer 49

• aggression
• oppositional behaviors
• disruptive/antisocial behaviors
• early childhood: noncompliance, oppositional, temper tantrums
• middle childhood: overt and covert, antisocial behavior, relational aggression
• adolescence: delinquency, substance use, high risk sexual behavior

Question 50

antisocial personality disorder

Answer 50

• adults only (18+)
• aggressive behaviors begin by age 15 and continue into adulthood
• psychopathy is associated with APD
• traits: lack of empathy; deceitful, arrogant, manipulative, interpersonal style; impulsive and irresponsible behavioral style

Question 51

oppositional defiant disorder

Answer 51

• prevalence 1-11%, average 3.3%
• more often in males ( evens out in adulthood and adolescence
• frequent and persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness
• behaviors can occur without problems of negative mood (still can have angry/irritable mood at times)
• can be 1 or more settings

Question 52

diagnostic criteria of oppostional defiant disorder

Answer 52

A) a pattern of angry/ irritable mood, argumentative/defiant behavior, or vindictiveness lasting 6 months as evidenced by at least 4 symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling
- angry/irritable mood:
1. often loses temper
2. often touchy or easily annoyed
3. often angry or resentful
- argumentative/defiant behavior
4. often argues with authority figures
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
B) disturbance in behavior is associated with distress in individual or others in their immediate social context or impacts negatively on social, educational, occupational, or other important areas of functioning
C) behaviors don’t occur exclusively during the course of a psychotic, substance, use, depressive, or bipolar disorder. Also, criteria is not met for disruptive mood dysregulation disorder

Question 53

conduct disorder

Answer 53

• persistent pattern of behavior that violates the rights of others and age appropriate social norms
• three or more behaviors for at least 12 months
• behavior causes impairment
• childhood onset (prior to age 10) or adolescent onset
• diverse behaviors
• concerns

Question 54

diagnostic criteria for conduct disorder

Answer 54

A) repetitive and persistent pattern of behavior where the basic rights of other or major age-appropriate societal norms or rules are violated with the presence of 3+ of the following criteria in the past 12 months with at least on criterion present in the past 6 months
- aggression to people and animals
1. bullies, threatens, or intimidates others
2. initiates physical fights
3. has used a weapon that can cause serious physical harm to others
4. has been physically cruel to people
5. has been physically cruel to animals
6. has stolen while confronting a victim
7. has forced someone into sexual activity
- destruction of property
8. has deliberately engaged in fire setting with intentions of causing serious damage
9. has deliberately destroyed others’ property
- deceitfulness or thrift
10. has broken into someone else’s house, building, or car
11. lies to obtain goods or favors or to avoid obligations
12. has stolen items of nontrivial value without confronting a victim
- serous violation of rules
13. stays out at night despite parental prohibitions, beginning before 13
14. has run away from home overnight at least twice or once for a lengthy period
15. is often truant from school beginning before 13
B) the disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning
C) if the individual is age 18 or older, criteria are not met for antisocial personality disorder