Midterm (DSM) Flashcards
Bipolar - Etiology
Diathesis-Stress Model
Heritability is high: 60-85%
- 10-25% chance of having bipolar if one parent has it
- Shared genetic origin with schizophrenia
MRI studies
- Prefrontal cortex smaller and functions less well
- Reduced grey matter
- Demyelination in white matter
Hallucinations
a false sensory perception that occurs in the absence of an external sensory stimulus
involuntary, appear real
auditory or visual hallucinations are most common
a person must be awake and fully alert to experience a hallucination
-hypnaogic or hynopompic (waht we see or hear when we’re falling asleep) are normal and are not hallucinations
Autism Spectrum Disorder - Specifiers
With or without accompanying inteliectual impairment
With or without accompanying language impairment
-without language was aspergers
Associated with a icnown medicai or genetic condition or environmental factor
-Used to be Retts and CDD
Associated with another neurodevelopmental, mental, or behavioral disorder
With catatonia
Autism Spectrum Disorder - Differential Diagnosis - Stereotypic movement disorder
Motor stereotypies are among the diagnostic characteristics
of autism spectrum disorder, so an additional diagnosis of stereotypic movement
disorder is not given when such repetitive behaviors are better explained by the presence
of autism spectrum disorder. However, when stereotypies cause self-injury and become a
focus of treatment, both diagnoses may be appropriate.
ADHD - Differential Diagnosis - Other Neurodevelopmental Disorders
The increased motoric activity that may occur in
ADHD must be distinguished from the repetitive motor behavior that characterizes stereotypic
movement disorder and some cases of autism spectrum disorder. In stereotypic
movement disorder, the motoric behavior is generally fixed and repetitive (e.g., body rocking,
self-biting), whereas the fidgetiness and restlessness in ADHD are typically generalized
and not characterized by repetitive stereotypic movements. In Tourette’s disorder,
frequent multiple tics can be mistaken for the generalized fidgetiness of ADHD. Prolonged
observation may be needed to differentiate fidgetiness from bouts of multiple tics.
Persistent (Chronic) Motor or Vocal Tic Disorder Criteria
A. Single or multiple motor or vocal tics have been present during the illness, but not both
motor and vocal.
B. The tics may wax and wane in frequency but have persisted for more than 1 year since
first tic onset.
C. Onset is before age 18 years.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., cocaine)
or another medical condition (e.g., Huntington’s disease, postviral encephalitis).
E. Criteria have never been met for Tourette’s disorder.
Specify
- with motor tics only
- with vocal tics only
Delusions
A strongly held false belief that remains unchanged, despite evidence to the contrary
Several types
- Persecutory
- Referential
- Grandiose
- Erotomanic
- Jealous
- Nihilistic
- Somatic
- Thought control
- Passivity
Bizarre (non-possible) or nonbizarre (improbable but possible)
Major Depressive Epidsode - Criteria
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition.
- Depressed mood most of the day, nearly every day, as indicated by either subjective
report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g.,
appears tearful). (Note: In children and adolescents, can be irritable mood.) - Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by either subjective account or observation). - Significant weight loss when not dieting or weight gain (e.g., a change of more than
5% of body weight in a month), or decrease or increase in appetite nearly every
day. (Note: In children, consider failure to make expected weight gain.) - Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others; not
merely subjective feelings of restlessness or being slowed down). - Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional)
nearly every day (not merely self-reproach or guilt about being sick). - Diminished ability to think or concentrate, or indecisiveness, nearly every day (either
by subjective account or as observed by others). - Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without
a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another
medical condition.
Note: Criteria A-C constitute a major depressive episode. Major depressive episodes are
common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a
natural disaster, a serious medical illness or disability) may include the feelings of intense
sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion
A, which may resemble a depressive episode. Although such symptoms may be understandable
or considered appropriate to the loss, the presence of a major depressive
episode in addition to the normal response to a significant loss should also be carefully
considered. This decision inevitably requires the exercise of clinical judgment based on
the individual’s history and the cultural norms for the expression of distress in the context
of loss.
Schizophrenia - Differential Diagnosis - Schizophreniform Disorder and Brief Psychotic Disorder
These disorders are of shorter
duration than schizophrenia as specified in Criterion C, which requires 6 months of symptoms.
In schizophreniform disorder, the disturbance is present less than 6 months, and in
brief psychotic disorder, symptoms are present at least 1 day but less than 1 month.
Intellectual Disability - Differential Diagnosis - Communication Disorders and Specific Learning Disorder
These neurodevelopmental disorders are specific to the communication and learning domains and do not show deficits in intellectual and adaptive behavior. They may co-occur with intellectual disability. Both diagnoses are made if full criteria are met for intellectual disability and a communication disorder or specific learning disorder.
Syndrome
this term is applied to a constellation of symptoms that occur together or co-vary over time
Tic Disorders - Prevalence
3 per 1000 in school-age children
Meta-analysis of 35 studies
.77% tourette’s
2.99% “Transient Tic Disorder”
.05% among adults
2:1 to 4:1 male to female ratio
Tends to be lower in African American and Hispanic populations
ADHD - Course
Continues through adolescence and often adulthood
Typically hyperactivity decreases (brain maturation)
Higher risk for ODD, CD, and Substance Use Disorder
Functional Outcomes:
Power school/work performance Lower academic/work atainment Unemployment Social rejection Accidents and injuries Fmaily conflict
ADHD - Differential Diagnosis - Neurocognitive Disorders
Early major neurocognitive disorder (dementia) and/or
mild neurocognitive disorder are not known to be associated with ADHD but may present
with similar clinical features. These conditions are distinguished from ADHD by their late
onset.
Tic Disorders - Differential Diagnosis - Abnormal Movements that may accompany other medical conditiosn and stereotypic movement disorder
Motor stereotypies are defined as involuntary rhythmic, repetitive,
predictable movements that appear purposeful but serve no obvious adaptive function or
purpose and stop with distraction. Examples include repetitive hand waving/rotating,
arm flapping, and finger wiggling. Motor stereotypies can be differentiated from tics based
on the former’s earlier age at onset (younger than 3 years), prolonged duration (seconds to
minutes), constant repetitive fixed form and location, exacerbation when engrossed in activities,
lack of a premonitory urge, and cessation with distraction (e.g., name called or
touched). Chorea represents rapid, random, continual, abrupt, irregular, unpredictable,
nonstereotyped actions that are usually bilateral and affect all parts of the body (i.e., face,
trunk, and limbs). The timing, direction, and distribution of movements vary from moment
to moment, and movements usually worsen during attempted voluntary action. Dystonia
is the simultaneous sustained contracture of both agonist and antagonist muscles,
resulting in a distorted posture or movement of parts of the body. Dystonie postures are often
triggered by attempts at voluntary movements and are not seen during sleep.
Stererotypic Movement Disorder - Differential Diagnosis - Other neurological and medical conditions
The diagnosis of stereotypic movements
requires the exclusion of habits, mannerisms, paroxysmal dyskinesias, and benign hereditary
chorea. A neurological history and examination are required to assess features
suggestive of other disorders, such as myoclonus, dystonia, tics, and chorea. Involuntary
movements associated with a neurological condition may be distinguished by their signs
and symptoms. For example, repetitive, stereotypic movements in tardive dyskinesia can
be distinguished by a history of chronic neuroleptic use and characteristic oral or facial
dyskinesia or irregular trunk or limb movements. These types of movements do not result
in self-injury. A diagnosis of stereotypic movement disorder is not appropriate for repetitive
skin picking or scratching associated with amphetamine intoxication or abuse (e.g.,
patients are diagnosed with substance/medication-induced obsessive-compulsive and related
disorder) and repetitive choreoathetoid movements associated with other neurological
disorders.
Specific Learning Disorder - Differential Diagnosis - Learning Difficulties Due to Neurological or Sensory Disorders
Specific learning disorder
is distinguished from learning difficulties due to neurological or sensory disorders
(e.g., pediatric stroke, traumatic brain injury, hearing impairment, vision impairment), because
in these cases there are abnormal findings on neurological examination.
What makes bipolar hard to diagnose?
People come in for the depression, not the manias, may not see mania as a problem
High rates of comorbidity
Shared psychotic features
Difficulty disentangling timelines from substance use
So many variations in how it presents in the room/how people experience the disorder
ADHD - Differential Diagnosis - Specific Learning Disorder
Children with specific learning disorder may appear inattentive
because of frustration, lack of interest, or limited ability. However, inattention in
individuals with a specific learning disorder who do not have ADHD is not impairing outside
of academic work.
Schizophrenia - Differential Diagnosis - Postraumatic Stress Disorder
Posttraumatic stress disorder may include flashbacks that
have a hallucinatory quality, and hypervigilance may reach paranoid proportions. But a traumatic
event and characteristic symptom features relating to reliving or reacting to the event
are required to make the diagnosis.
Schizoaffective Disorder - Prevalence and Course
Lifetime Prevalence = .3%
More common among females, especially depressive type
Typical age of onset – early adulthood
- Bioplar type more common amongst young adults
- Depressive type more common among older adults
Prognosis slightly better than schizophrenia, but worse than mood disorders
-often associated with impaired functioning, although not part of criterion
Intellectual Disability - Differential Diagnosis - Autism Spectrum Disorder
ID is common among individuals with autism spectrum disorder. Assessment of intellectual ability may be complicated by social- communication and behavior deficits inherent to autism spectrum disorder, which may interfere with understanding and complying with test procedures. Appropriate assessment of intellectual functioning in autism spectrum disorder is essential, with reassessment across the developmental period, because IQ scores in autism spectrum disorder may be unstable, particularly in early childhood.
Bipolar - Prevalence
1.8% - 4.4% of US population (lifeactime) across BDI, BDII, and BDNOS
12-month prevalence rate
BDI = 0.6%
BDII = 0.8%
Nearly equal in men and women
Rapid cycling, mixed states, and depressive episodes more often in women
Schizophreniform Disorder - Criteria
A. Two (or more) of the following, each present for a significant portion of time during a
1-month period (or less if successfully treated). At least one of these must be (1), (2),
or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional expression or avolition).
B. An episode of the disorder lasts at least 1 month but less than 6 months. When the
diagnosis must be made without waiting for recovery, it should be qualified as “provisional.”
‘
C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have
been ruled out because either 1 ) no major depressive or manic episodes have occurred
concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during
active-phase symptoms, they have been present for a minority of the total duration
of the active and residual periods of the illness.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication) or another medical condition.
Note: impairment in social and occupational functioning is not required
Specific Learning Disorder - Etiology
Genetic X Environment
- runs in families
- prematurity
- low birth weight
- prenatal exposure to toxins
Complex Motor tic examples
Combo of motor tics
Echopraxia (repeating a movement they have seen)
Coprapraxia (doing obsene things)
Schizoaffective Disorder
Specify whether:
Bipolar type: This subtype applies if a manic episode is part of the presentation. Major depressive episodes may also occur.
Depressive type: This subtype applies if only major depressive episodes are part of the presentation.
Specify if:
With catatonia
Specify if:
The following course specifiers are only to be used after a 1 -year duration of the disorder
and if they are not in contradiction to the diagnostic course criteria.
First episode, currently in acute episode: First manifestation of the disorder meeting
the defining diagnostic symptom and time criteria. An acute episode is a time period
in which the symptom criteria are fulfilled.
First episode, currently in partial remission: Partial remission is a time period during
which an improvement after a previous episode is maintained and in which the defining
criteria of the disorder are only partially fulfilled.
First episode, currently in full remission: Full remission is a period of time after a
previous episode during which no disorder-specific symptoms are present.
Multiple episodes, currently in acute episode: Multiple episodes may be determined
after a minimum of two episodes (i.e., after a first episode, a remission and a
minimum of one relapse).
Multiple episodes, currently in partial remission
Multiple episodes, currently in full remission
Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are
remaining for the majority of the illness course, with subthreshold symptom periods being
very brief relative to the overall course.
Unspecified
Specify current severity:
Severity is rated by a quantitative assessment of the primary symptoms of psychosis,
including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior,
and negative symptoms. Each of these symptoms may be rated for its current
severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present)
to 4 (present and severe).
Note: Diagnosis of schizoaffective disorder can be made without using this severity
specifier.
Tic Disorders - Development and Course
Onset typically between ages 4-6
Peak severity typically between ages 10-12, after which severity declines
Tics may wax/wane or change
Comorbidity depends on age
- childhood: ADHD, OCD, separation anxiety
- Teens/Adults: MDD, SUD, or Bipolar Disorder
Many with mild symptoms experience little to no impairment
Autism Spectrum Disorder - Differential Diagnosis - Schizophrenia
Schizophrenia with childhood onset usually develops after a period of
normal, or near normal, development. A prodromal state has been described in which social
impairment and atypical interests and beliefs occur, which could be confused with the
social deficits seen in autism spectrum disorder. Hallucinations and delusions, which are
defining features of schizophrenia, are not features of autism spectrum disorder. However,
clinicians must take into account the potential for individuals with autism spectrum
disorder to be concrete in their interpretation of questions regarding the key features of
schizophrenia (e.g., “Do you hear voices when no one is there?” “Yes [on the radio]”).
Intellectual Disability Course
Lifelong, but serverity may change
Improved functioning with early and ongoing interventions
-Reassess infants and young children post-intervention
Many live full lives
ADHD - Differential Diagnosis - Medication Induced Symptoms of ADHD
Symptoms of inattention, hyperactivity, or
impulsivity attributable to the use of medication (e.g., bronchodilators, isoniazid, neuroleptics
[resulting in akathisia], thyroid replacement medication) are diagnosed as other
specified or unspecified other (or unknown) substance-related disorders.
Steps to determining a diagnosis
- Consider GMC or Physical causes
- Consider Substance-Induced or Related Disorder
- Consider Cultural and Developmental Factors
- Determine Diagnoses
- Resolve Diagnostic Uncertainty
- Consider Comorbidity and Assocaited Features
- Assess Level of Distress and/or Impairment
ADHD - Differential Diagnosis - Depressive Disorders
Individuals with depressive disorders may present with inability
to concentrate. However, poor concentration in mood disorders becomes prominent
only during a depressive episode.
Symptom
refers to an observable behavior or state
Developmental Coordination Disorder - Differential Diagnosis
Motor impairments due to another medical condition
ID
ADHD
ASD
Joint hypermobility syndrome
Intellectual Disability - Differential Diagnosis
A diagnosis of intellectual disability should not be assumed because of a particular genetic or medical condition. A genetic syndrome linked to intellectual disability should be noted as a concurrent diagnosis with the intellectual disability.
Major and Mild Neurocognitive Disorders
Communication Disorders and Specific Learning Disorders
Autism Spectrum Disorder
Schizophrenia Specifiers
The following course specifiers are only to be used after a 1-year duration of the disorder
and if they are not in contradiction to the diagnostic course criteria.
First episode, currently in acute episode: First manifestation of the disorder meeting
the defining diagnostic symptom and time criteria. An acute episode is a time period
in which the symptom criteria are fulfilled.
First episode, currently in partial remission: Partial remission is a period of time
during which an improvement after a previous episode is maintained and in which the
defining criteria of the disorder are only partially fulfilled.
First episode, currently in full remission: Full remission is a period of time after a
previous episode during which no disorder-specific symptoms are present.
Multiple episodes, currently in acute episode: Multiple episodes may be determined
after a minimum of two episodes (i.e., after a first episode, a remission and a
minimum of one relapse).
Multiple episodes, currently in partial remission
Multiple episodes, currently in full remission
Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are
remaining for the majority of the illness course, with subthreshold symptom periods being
very brief relative to the overall course.
Unspecified
Specify if:
With catatonia
Specify current severity:
Severity is rated by a quantitative assessment of the primary symptoms of psychosis,
including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior,
and negative symptoms. Each of these symptoms may be rated for its current
severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present)
to 4 (present and severe).
Bipolar with atypical features
This specifier can be applied when these features predominate
during the majority of days of the current or most recent major depressive episode.
A. Mood reactivity (i.e., mood brightens in response to actual or potential positive
events).
B. Two (or more) of the following features:
1. Significant weight gain or increase in appetite.
2. Hypersomnia.
3. Leaden paralysis (i.e., heavy, leaden feelings in arms or legs).
4. A long-standing pattern of interpersonal rejection sensitivity (not limited to episodes
of mood disturbance) that results in significant social or occupational
impairment.
C. Criteria are not met for “with melancholic features” or “with catatonia” during the
same episode.
Specific Learning Disorder - Cultural Considerations
Occurs across cultures but may manifest differently
-e.g. alphabetic languages vs. non-alphabetic languages
Consider language proficiency in diagnosis
Childhood Onset Fluency Disorder - Differential Diagnosis - Adult-onset dysfluencies
If onset of dysfluencies is during or after adolescence, it is an
“adult-onset dysfluency” rather than a neurodevelopmental disorder. Adult-onset dysfluencies
are associated with specific neurological insults and a variety of medical conditions
and mental disorders and may be specified with them, but they are not a DSM-5 diagnosis
What does appropriate diagnosis involve?
Identifying the individual’s clinical presentation, characteristic signs, and symptoms
Matching these to psychiatric diagnostic categories
Comprehensive understanding of disorders, diagnostic assessment, ability to idenitfy diagnostic clues, signs and symptoms, common core symptoms and features that allow for differentiation between daignoses
Specific Learning Disorder - Differential Diagnosis - ID
Specific learning disorder
differs from general learning difficulties associated with intellectual disability, because the
learning difficulties occur in the presence of normal levels of intellectual functioning (i.e.,
IQ score of at least 70 ± 5). If intellectual disability is present, specific learning disorder can
be diagnosed only when the learning difficulties are in excess of those usually associated
with the intellectual disability.
Specific Learning Disorder - Differential Diagnosis - Normal Variations in Academic Attaintment
Specific learning disorder is distinguished
from normal variations in academic attainment due to external factors (e.g., lack of educational
opportunity, consistently poor instruction, learning in a second language), because
the learning difficulties persist in the presence of adequate educational opportunity
and exposure to the same instruction as the peer group, and competency in the language of
instruction, even when it is different from one’s primary spoken language.
Bipolar I - Differential Diagnosis - Other Bipolar Disorders
Diagnosis of bipolar I disorder is differentiated from bipolar II
disorder by determining whether there have been any past episodes of mania. Other specified
and unspecified bipolar and related disorders should be differentiated from bipolar I
and II disorders by considering whether either the episodes involving manic or hypomanic
symptoms or the episodes of depressive symptoms fail to meet the full criteria for
those conditions.
Bipolar disorder due to another medical condition may be distinguished from bipolar
I and II disorders by identifying, based on best clinical evidence, a causally related medical
condition.
Tic Disorders - Etiology and Risk Factors
Genetic X Environment
- heritability in families
- older parental age
- brith complications
- low birth weight
- prenatal exposure to toxins (e.g. smoking)
Worsened by anxiety, stress, exhaustions, and excitement
Specific Learning Disorder - Diagnosis
Clinical Interview
Education/Psychological Assessment
-look at specific subscores to be 1.5 SD below average
School reports
Parent/Other reports
Curriculum-based measures
Portfolio of work
Need to incorporate medical, developmental, educational and family hx
Language Disorder - Comorbidity
Language disorder is strongly associated with other neurodevelopmental disorders in
terms of specific learning disorder (literacy and numeracy), attention-deficit/hyperactivity
disorder, autism spectrum disorder, and developmental coordination disorder. It is
also associated with social (pragmatic) communication disorder. A positive family history
of speech or language disorders is often present.
ADHD Considerations
Inattention is hard to detect
Hyperacgtivity can be mistaken for disciplinary problems
Typically diagnosed in elementary school
- normal child behavior is hyperactive
- kids may not be required to sit still before that
Symptoms may vary across settings and age
Beware of over-diagnosis
Schizophrenia - Differential Diagnosis - Schizotypal Personality Disorder
Schizotypal personality disorder may be distinguished
from schizophrenia by subthreshold symptoms that are associated with persistent personality
features.
Why is diagnosis important?
Define Clinical Entities
- serves as a short-hand notation for a syndrome or cluster of symptoms that commonly occur together
- Communication
Determine Treatment
- Prerequisite fro appropriate treatment
- Allows for identification of appropriate interventions and prediction of treatment response and outcome
ADHD - Specifiers
Combined presentation
Predominantly inattentive presentation
Predominantly hyperactive/impulsive presentation
Specify if:
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:
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.
Moderate - Symptoms or functional impairment between “mild” and “severe” are present.
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
Schizophrenia prevalence & risk factors
.3-.7% lifetime prevalence ~1% in literature
slightly fewer females
males have earlier onset than females
- males early-mid 20s
- females late 20s
Variation by race/ethnicity, across countries
Genetics X Environmental
- heritability, risk alleles idenitifed
- approx 10% of first degree relaitves of patients with schizophrenia develop the condition
prenatla/perinatal factors
Specific Learning Disorder - Differential Diagnosis - Neurocognitive Disorders
Specific learning disorder is distinguished from learning
problems associated with neurodegenerative cognitive disorders, because in specific
learning disorder the clinical expression of specific learning difficulties occurs during the
developmental period, and the difficulties do not manifest as a marked decline from a former
state.
Specific Learning Disorder - Specifiers
Specify all academic domains and subskills that are impaired
- Reading
- Writing
- Math
Severity
Mild, Moderate, Severe (based on number of domains and how much support they need)
Global Developmental Delay
This diagnosis is reserved for individuals under the age of 5 years when the clinical severity
level cannot be reliably assessed during early childhood. This category is diagnosed when
an individual fails to meet expected developmental milestones in several areas of intellectual
functioning, and applies to individuals who are unable to undergo systematic assessments
of intellectual functioning, including children who are too young to participate in
standardized testing.
This category requires reassessment after a period of time (not a permanent diagnosis)
Catatonia
A. The clinical picture is dominated by three (or more) of the following symptoms:
- Stupor (i.e., no psychomotor activity; not actively relating to environment).
- Catalepsy (i.e., passive induction of a posture held against gravity).
- Waxy flexibility (i.e., slight, even resistance to positioning by examiner).
- Mutism (i.e., no, or very little, verbal response [exclude if known aphasia]).
- Negativism (i.e., opposition or no response to instructions or external stimuli).
- Posturing (i.e., spontaneous and active maintenance of a posture against gravity).
- Mannerism (i.e., odd, circumstantial caricature of normal actions).
- Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements).
- Agitation, not influenced by external stimuli.
- Grimacing.
- Echolalia (i.e., mimicking another’s speech).
- Echopraxia (i.e., mimicking another’s movements).
Childhood Onset Fluency Disorder - Prevalance
3:1 Male to Female
If speech doesn’t improve by age 8 you could see it persist into teenage years
ADHD - Etiology
Genetics
Abnormal/delayed brain maturation (multiple genes developing normally but delayed in growth)
-Specific brain areas include basal ganglia (emotional regulation) and cerebellum (timing, motor control)
Environmental factors
- prentalue eposure to alcohol/drugs
- exposure to toxins (e.g. lead)
- TBI
Brain waves are dif in child with ADHD
Schizoaffective Disorder - Differential Diagnosis - Schizophrenia, Bipolar, and Depressive Disorders
Distinguishing schizoaffective disorder
from schizophrenia and from depressive and bipolar disorders with psychotic features
is often difficult. Criterion C is designed to separate schizoaffective disorder from
schizophrenia, and Criterion B is designed to distinguish schizoaffective disorder from a
depressive or bipolar disorder with psychotic features. More specifically, schizoaffective
disorder can be distinguished from a depressive or bipolar disorder with psychotic features
based on the presence of prominent delusions and/or hallucinations for at least 2 weeks in
the absence of a major mood episode. In contrast, in depressive or bipolar disorder with
psychotic features, the psychotic features primarily occur during the mood episode(s). Because
the relative proportion of mood to psychotic symptoms may change over time, the
appropriate diagnosis may change from and to schizoaffective disorder. (For example, a
diagnosis of schizoaffective disorder for a severe and prominent major depressive episode
lasting 3 months during the first 6 months of a chronic psychotic illness would be changed
to schizophrenia if active psychotic or prominent residual symptoms persist over several
years without a recurrence of another mood episode.)
Autism Spectrum Disorder - Prevalence and Development
1% of population
4:1 male to female
Late, underdiagnosis in African American children (lack of access to healthcare?)
Typically recognize symptoms between 1-2 years of age
Higher rates in recent years
What is a tic?
Sudden, rapid, recurrent, nonrhythmic motor movement or vocalization
-usually occur in head and face
Symptoms may change over time
Can be simple or complex
- simple: last a couple seconds
- complex: can be combo of simple, last longer
Usually preceded by an urge
Typically experienced as “involuntary” although can be resisted
Schizophreniform - Differential Diagnosis - Other mental disorders and medical conditions
A wide variety of mental and medical
conditions can manifest with psychotic symptoms that must be considered in the differential
diagnosis of schizophreniform disorder. These include psychotic disorder due to
another medical condition or its treatment; delirium or major neurocognitive disorder;
substance/medication-induced psychotic disorder or delirium; depressive or bipolar
disorder with psychotic features; schizoaffective disorder; other specified or unspecified bipolar
and related disorder; depressive or bipolar disorder with catatonic features; schizophrenia;
brief psychotic disorder; delusional disorder; other specified or unspecified schizophrenia
spectrum and other psychotic disorder; schizotypal, schizoid, or paranoid
personality disorders; autism spectrum disorder; disorders presenting in childhood with
disorganized speech; attention-deficit/hyperactivity disorder; obsessive-compulsive disorder;
posttraumatic stress disorder; and traumatic brain injury.
Since the diagnostic criteria for schizophreniform disorder and schizophrenia differ
primarily in duration of illness, the discussion of the differential diagnosis of schizophrenia
also applies to schizophreniform disorder.
Autism Spectrum Disorder - Core Features
Impairment in Social Communication and Interaction
- Deficits in social-emotional reciprocity
- Deficits in nonverbal communicative behaviors
- Deficits in developing, maintaining and understanding relationships
Restricted, Repetitive Patterns of Behavior, Interests, and Activites (at least 2)
- Stereotyped/repetitive motor movements or speech
- Insistence on sameness, rigid routines
- Ex: handflapping, rocking, repeating one word a lot
- High restricted, fixated interests abnormal in intensity
- Hyper/hypo-sensitivity to sensory input
- Could also be tactile
Developmental Coordination Disorder - Etiology
genetics, especially severe cases
possible cerebellar dysfunction
Environmental factors
- low birth weight
- prematurity
- prenatal alcohol exposure
Stereotypic Movement Disorder Criteria
A. Repetitive, seemingly driven, and apparently purposeless motor behavior (e.g., hand
shaking or waving, body rocking, head banging, self-biting, hitting own body).
-often rhythmic
B. The repetitive motor behavior interferes with social, academic, or other activities and
may result in self-injury.
C. Onset is in the early developmental period.
-children will often move in repetitive patterns, but can stop if they are told to. Children will also go through phases of doing certain movements normally
D. The repetitive motor behavior is not attributable to the physiological effects of a substance
or neurological condition and is not better explained by another neurodevelopmental
or mental disorder (e.g., trichotillomania [hair-pulling disorder], obsessivecompulsive
disorder).
ADHD - Differential Diagnosis - Substance Use Disorder
Differentiating ADHD from substance use disorders may be
problematic if the first presentation of ADHD symptoms follows the onset of abuse or frequent
use. Clear evidence of ADHD before substance misuse from informants or previous
records may be essential for differential diagnosis.
Schizophrenia - Differential Diagnosis - Schizoaffective Disorder
A diagnosis of schizoaffective disorder requires that a major
depressive or manic episode occur concurrently with the active-phase symptoms and that
the mood symptoms be present for a majority of the total duration of the active periods.
Criticism of the DSM-5
Poor reliablity and validity
Focus on symptoms rather than what causes the symptoms
Problems distinguishing normal from abnormal
Cultural Bias
Distinct categories vs. dimensions
Tendency to overpathologize
Specific Learning Disorder - Differential Diagnosis - Psychotic Disorders
Specific learning disorder is distinguished from the academic and
cognitive-processing difficulties associated with schizophrenia or psychosis, because with
these disorders there is a decline (often rapid) in these functional domains.
Bipolar - Comorbidities
approx 75% have comorbid disorders
Prognosis is worse when comorbid
Specific Learning Disorder - Impairment in Written Expression
Writing skills are below expected for age
Difficulty with:
- Grammar
- Punctuation
- Spelling
- Clearly articulating ideas in writing
Not due to poor coordination or penmenship (more related to act of writing (motor skills)
Hypomania - Criteria
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood
and abnormally and persistently increased activity or energy, lasting at least 4 consecutive
days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or
more) of the following symptoms (four if the mood is only irritable) have persisted, represent
a noticeable change from usual behavior, and have been present to a significant
degree:
*DIGFAST
- Distractibility
- Indiscretion/Recklessness. Excessive involvement in activities that have a high potential for painful consequences
(e. g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). - Grandiosity or inflated self-esteem
- Flight of ideas or subjective experience that thoughts are racing.
- Activity increase, goal-directed (either socially, at work or school, or sexually) or psychomotor agitation (i.e., puposeless non-goal-directed activity).
- Sleep loss; decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic
of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational
functioning or to necessitate hospitalization. If there are psychotic features, the
episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance (e.g., a drug
of abuse, a medication, other treatment).
Note: A full hypomanic episode that emerges during antidepressant treatment (e.g.,
medication, electroconvulsive therapy) but persists at a fully syndromal level beyond
the physiological effect of that treatment is sufficient evidence for a hypomanic episode
diagnosis. However, caution is indicated so that one or two symptoms (particularly increased
irritability, edginess, or agitation following antidepressant use) are not taken
as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar
diathesis.
Note: Criteria A-‘F constitute a hypomanic episode. Hypomanic episodes are common in
bipolar I disorder but are not required for the diagnosis of bipolar I disorder.
