Psychopathology Flashcards
What are a) the most common chromosomal causes of intellectual disability, and b) the most common preventable prenatal cause?
Neurodevelopmental
a) Down Syndrome followed by Fragile X syndrome
b) fetal alcohol syndrome
What are the three diagnostic criteria for intellectual developmental disorder, and what is the severity specifier based on?
Neurodevelopmental
Diagnostic criteria: deficits in intellectual functioning determined by clinical assessment and standardized testing, deficits in adaptive functioning, onset in the developmental period.
Severity specifier is based on adaptive functioning.
What % of IDD cases with a known etiology are due to
a) prenatal factors
b) perinatal factors
c) postnatal factors
Neurodevelopmental
a) 80%
b) 5-10%
c) 5-10%
Etiology is only known in 25-50% of cases!!!
Prognosis for ASD is best when…
Neurodevelopmental
IQ >70, functional language acquired by age 5, no comorbid mental health problems.
Dawson’s study of preschool children with and without autism showed that when shown novel and familiar objects and faces, children with autism _______
Neurodevelopmental
Reacted differently to novel objects, but not to novel faces.
children with autism have difficulty recognizing emotions across which expression modalities?
Neurodevelopmental
All (face, body, voice)
Name some non-genetic risk factors for ASD
Neurodevelopmental
Prematurity (<26 weeks), older parental age, exposure to toxins in prenatal development.
What are some brain abnormalities associated with ASD?
Neurodevelopmental
- larger brain volume & weight
- abnormalities in cerebellum, corpus callosum, and amygdala
accelerated brain growth starting at 6 months leads to bigger brain
What are neurotransmitter abnormalities associated with ASD?
Neurodevelopmental
- lower serotonin levels in the brain, but higher serotonin levels in the blood
- abnormalities in dopamine, GABA, glutamate, & acetylcholine
Serotonin finding possibly because blood serotonin enters the brain through the blood-brain barrier during prenatal dev
What is Lovaas method of EIBI and what does it actually improve?
Neurodevelopmental
Lovaas method for early intensive behavioral intervention (EIBI) is 40+ hours of ABA based intervention. Most improvement in cognitive and language skills, not so much in core ASD x’s, social or adaptive skills.
What medication is typically prescribed for aggression in individuals with ASD?
Neurodevelopmental
Atypical antipsychotics (risperidone, aripiprazole)
What is the most prevalent diagnosed disorder in youth ages 3-17?
Neurodevelopmental
ADHD
What is ADHD most often comorbid with?
Neurodevelopmental
1) ODD
2) Conduct disorder
3) anxiety disorder
4) depressive disorder
What two neurotransmitter abnormalities are associated with ADHD?
Neurodevelopmental
Low levels of dopamine and norepinephrine in certain brain areas (PFC)
What are some brain abnormalities associated with ADHD?
Neurodevelopmental
- smaller volume in striatum (na, putamen, cn), hippocampus, and amygdala
- EF difficulties associated with abnormalities in PFC and striatum (putamen and caudate nucleus)
- difficulty with temporal processing (sequence of events, anticipating future events) associated with abnormalities in PFC and cerebellum
- emotion dysregulation assoc with abnormalities in PFC and amygdala
What are some risk factors for ADHD?
Neurodevelopmental
- prematurity
- low birth weight
- maternal smoking/alcohol use
What are the best treatments for ADHD across the lifespan?
Neurodevelopmental
- Preschoolers, behavioral interventions and meds only in behavioral interventions fail.
- school age children: meds + behavioral intervention at home and school
- Adolescents: meds (with assent) and behavioral intervention if available
- Adults: Meds, although CBT also effective.
Stimulants do NOT increase risk of substance use disorders!
What are the diagnostic criteria for Tourette’s vs persistent motor or vocal tic disorder?
Neurodevelopmental
Tourette’s requires one vocal and several motor tics, persistent motor or vocal tic disorder requires one motor or vocal tic.
What brain and neurotransmitter abnormalities are associated with Tourette’s?
Neurodevelopmental
Dopamine overactivity, smaller caudate nucleus
What is the most common comorbid disorder for Tourette’s?
Neurodevelopmental
ADHD
What is the treatment of choice for childhood-onset fluency disorder?
Neurodevelopmental
Habit reversal- regulated breathing incompatible with stuttering
What is the treatment of choice for tic disorders?
Neurodevelopmental
comprehensive behavioral intervention for tics (CBIT)
What is the most common learning disorder?
Neurodevelopmental
specific learning disorder in reading, most often dyslexia
What is the most common comorbid psychiatric condition for learning disorders?
Neurodevelopmental
ADHD
What is the diagnostic criteria for brief psychotic disorder?
Schizophrenia Spectrum/Psychotic Disorders
one or more of the following lasting more than 1 day and less than 1 month:
* hallucinations
* delusions
* disorganized speech
* catatonia/grossly disorganized behavior (this one alone is not enough)
What are the diagnostic criteria for schizophreniform disorder?
Schizophrenia Spectrum/Psychotic Disorders
2 of the 5 following symptoms lasting at least 1 month but less than 6 months:
* hallucinations
* delusions
* disorganized speech
* catatonia/grossly disorganized behavior
* negative symptoms (avolition, alogia, anhedonia)
At least 1 symptom must be hallucinations, delusions, or disorganized speech.
What are the diagnostic criteria for schizophrenia?
Schizophrenia Spectrum/Psychotic Disorders
- An active phase that lasts at least 1 month and includes 2/5 characteristic symptoms with at least one symptom being hallucinations, delusions, disorganized speech, (the other two are disorganized behavior/catatonia, negative symptoms).
- A residual or prodromal phase for at least 6 months with 2 or more characteristic symptoms in attenuated form or negative symptoms only
Discordant mono and dizygotic twin studies (one twin has schizophrenia) show what about risk for their offspring?
Schizophrenia Spectrum/Psychotic Disorders
Risk of DZ twin without schizophrenia having a child with schizophrenia is significantly lower, but risk of MZ twin without schizophrenia has same risk.
List concordance rate of schizophrenia for the following relatives of someone with schizophrenia:
* Parent
* Biological sibling
* Child of one parent with schizophrenia
* Dizygotic (fraternal) twin
* Child of two parents with schizophrenia
* Monozygotic twin
Schizophrenia Spectrum/Psychotic Disorders
- Parent = 6 %
- Biological sibling = 9%
- Child of one parent with schizophrenia = 13%
- Dizygotic (fraternal) twin = 17%
- Child of two parents with schizophrenia = 46%
- Monozygotic twin = 48%
What neurotransmitters are associated with schizophrenia?
Schizophrenia Spectrum/Psychotic Disorders
Dopamine, glutamate, serotonin.
Describe the original dopamine hypothesis of schizophrenia and the revised hypothesis.
Schizophrenia Spectrum/Psychotic Disorders
Original: schizophrenia is caused by high levels of dopamine/dopamine overactivity
Modified: positive symptoms are due to overactivity in subcortical areas (esp. striatum), while negative symptoms are due to underactivity in cortical areas (esp. PFC)
Describe brain abnormalities associated with schizophrenia.
Schizophrenia Spectrum/Psychotic Disorders
- enlarged ventricles
- hypofrontality (decreased activity in PFC)
What disorders are most comorbid with schizophrenia?
Schizophrenia Spectrum/Psychotic Disorders
- tobbaco use disorder
- anxiety disorders
- OCD
How do psychotic and negative symptoms of schizophrenia progress with age?
Schizophrenia Spectrum/Psychotic Disorders
Psychotic symptoms decrease with age, while negative and cognitive symptoms persist.
What is the ‘immigrant paradox’ in schizophrenia?
Schizophrenia Spectrum/Psychotic Disorders
Recent immigrants to US (vs people who immigrated long ago or US born individuals) have better outcomes.
Immigrant paradox also applies to alcohol use disorder and other psychiatric conditions.
What is the best treatment for schizophrenia?
Schizophrenia Spectrum/Psychotic Disorders
Psychosocial intervention + antipsychotic medication
Which antipsychotic is most effective for treatment-resistant schizophrenia?
Schizophrenia Spectrum/Psychotic Disorders
Clozapine (second-gen)
What is the diagnostic criteria for schizoaffective disorder?
Schizophrenia Spectrum/Psychotic Disorders
Concurrent symptoms of schizophrenia and a major depressive or manic episode for most of the duration of the illness, but with the presence of delusions or hallucinations for two or more weeks without mood symptoms.
What is the diagnostic criteria for delusional disorder? What are the types of delusions?
Schizophrenia Spectrum/Psychotic Disorders
Delusions for at least 1 month, with no impact on functioning except for direct effects of the delusion.
Types of delusions: grandiose, persecution, jealous, somatic, erotomaniac
Mood episodes
What is a manic episode, hypomanic episode, and major depressive episode?
Bipolar & Depressive Disorders
Manic episode: abnormally elevated/expansive/irritable mood and increased activity/energy for at least 1 week, 3 or more characteristic symptoms (inflated self esteem/grandiosity, decreased need for sleep, flight of ideas) AND functional impairment, need for hospitalization, or psychotic features.
Hypomanic episode: abnormally elevated/expansive/irritable mood, increased activity/energy, and 3 or more symptoms of mania for at least 4 consecutive days but NO functional impairment, need for hospitalization or psychotic features.
Major depressive episode: five or more characteristic symtpom (must include depressed mood or anhedonia) that last at least 2 weeks and cause significant distress or functional impairment.
What is the diagnostic criteria for
- bipolar I
- bipolar II
- cyclothymic disorder
Bipolar & Depressive Disorders
- Bipolar I: at least one manic episode, may be preceeded/followed by hypomanic or major depressive episode
- Bipolar II: at least one hypomanic episode and at least one major depressive episode
- Cyclothymic disorder: numerous periods of hypomanic symptoms (not enough for hypomanic episode) and numerous periods of depressive symptoms (not enough for major depressive episode) that last at least 2 years for adults, 1 year for children/adolescents
What neurotransmitters are associated with bipolar disorder?
Bipolar & Depressive Disorders
Norepinephrine, serotonin, dopamine, glutamate.
What brain abnormalities are associated with bipolar disorder?
Bipolar & Depressive Disorders
Structural and functional abnormalities of PFC, amygdala, hippocampus, basal ganglia
What circadian rhythm abnormalities are associated with bipolar disorders?
Bipolar & Depressive Disorders
sleep-wake cycle, secretion of hormones, appetite, core body temperature
What psychosocial interventions are appropriate for bipolar disorders?
Bipolar & Depressive Disorders
CBT, psychoeducation, interpersonal and social rhythm therapy, family-focused therapy (when family members are high in expressed emotion)
Heritability of bipolar disorder
70-90%
What drugs are used for ‘classic bipolar’ vs ‘atypical bipolar’?
Bipolar & Depressive Disorders
Lithium for classic bipolar, second gen antipsychotics or some AEDs for atypical bipolar.
These are not DSM-5 categories.
DSM-5-TR bipolar with atypical features: significant weight gain/appetite increase, hypersomnia, leaden paralysis, interpersonal rejection sensitivity.
What are the diagnostic criteria for persistent depressive disorder?
Bipolar & Depressive Disorders
Depressed mood + two or more symptoms (ex, sleep disturbance, apetite changes, hopelessness) lasting 2 years in adults, and 1 year in children/adolescents.
What are the diagnostic criteria for disruptive mood dysregulation disorder?
Bipolar & Depressive Disorders
Severe and recurrent temper outbursts (out of proportion for stimulus) 3+ times/week, and persistently irritable/angry mood the rest of the time lasting at least 12 months.
What antidepressant is especially effective for peripartum depression?
Bipolar & Depressive Disorders
Sertraline
What are the physiological abnormalities linked to depression with season pattern (aka seasonal affective disorder)?
Bipolar & Depressive Disorders
Low levels of serotonin and high levels of melatonin.
Phototherapy suppresses production of melatonin.
Sex differences in depression rates
Similar rates for boys and girls, by adolescence females>males (1.5-3 times higher rates)
Heredity of MDD- monozygotic vs dizygotic twin concordance
Monozygotic- .50
Dizygotic- .20
concordance rates are slightly higher for female twins
What neurotransmitter abnormalities are associated with depression?
Bipolar & Depressive Disorders
Low levels of serotonin, dopamine and norepinephrine.
What brain abnormalities are associated with depression?
Bipolar & Depressive Disorders
Structural and functional abnormalities in PFC (high activity of vmPFC and low activity of dlPFC,, opposite pattern with antidepressants), cingulate cortex, hippocampus, caudate nucleus, putamen, amygdala, thalamus.
Describe Lewinsohn’s social reinforcement theory of depression?
Bipolar & Depressive Disorders
Lack of reinforcement in the environment/poor social skills –> Low rate of response-contingent reinforcement for social behavios –> social isolation, low self-esteem, pessimisim –> further decrease positive reinforcement in the future
Describe Beck’s cognitive theory of depression.
Bipolar & Depressive Disorders
Negative cognitive triad (negative thoughts about oneself, world, future)
Describe Seligman’s original theory of depression and the revised versions.
Bipolar & Depressive Disorders
Seligman’s original theory was learned helplessness (repeated exposure to uncontrollable negative events). Later, a negative cognitive style was added. Most recently, hopelessness theory says that repeated exposure to negative events + negative cognitive style leads to hopelessness
Negative cognitive style- attribute negative life events to stable, internal factors
What sleep abnormalities are associated with depression?
Bipolar & Depressive Disorders
- prolonged sleep latency
- reduced REM latency
- increased REM density
- reduced slow-wave sleep
What disorders are comorbid with MDD?
Bipolar & Depressive Disorders
- substance use disorder, especially alcohol use disorder
- anxiety disorders
- personality disorders
What is APA’s recommended first-line treatment for depression in children, adolescents, adults and older adults?
Bipolar & Depressive Disorders
Children: no recs for specific therapies or drugs
Adolescents: CBT or IPT-A, or fluoxetine
Adults: therapy + second gen antidepressant (SSRI or SNRI)
Older adults: group CBT or IPT + second-gen antidepressant
What is the evidence for electroconvulsive therapy (ECT) and repeated transcranial magnetic stimulation (rTMS) for depression?
Bipolar & Depressive Disorders
ECT is more effective than therapy or medication (faster and more remission), but it can have side effects including retrograde and anterograde amnesia.
rTMS stimulates the dlPFC. It has lower response and remission rates compared to ECT, but no side effects of amnesia or sedation.
What is Mowrer’s two-factor theory of specific phobias?
Anxiety & OCD
Involves classical and operant conditioning: classical conditioning happens when previously neutral stimulus is paired with US becomes conditioned stimulus that elicits anxiety (CR); operant conditioning happens because avoidance of CS reduces anxiety (negative reinforcement) and prevents person from experiencing CS without US.
What are the diagnostic criteria for body dysmorphic disorder?
Anxiety & OCD
Preoccupation with perceived physical flaw and repetitive behaviors or mental acts (e.g., skin picking, mirror checking) due to the perceived flaw
What are the diagnostic criteria for reactive attachment disorder?
Trauma/Stressor, Dissociative & Somatic
Inhibited/withdrawn behavior to caregivers + socioemotional disturbances following extreme insufficient care. Onset before age 5, developmental age of 9+ months
What are the diagnostic criteria for disinhibited social engagement disorder?
Trauma/Stressor, Dissociative & Somatic
No stranger danger, limited checking in with caregivers, following extreme insufficient care. Developmental age of 9+ months.
What brain abnormalities are associated with PTSD?
Trauma/Stressor, Dissociative & Somatic
- Overactive amygdala & underactive vmPFC (reduced inhibitory top-down control of amygdala)
- Hyperactive anterior cingulate cortex
- Decreased hippocampus volume
What are the four symptom types in PTSD?
Trauma/Stressor, Dissociative & Somatic
- flashbacks/intrusion
- avoidance of stimuli related to event
- alterations in arousal/reactivity
- negative changes in mood/cognition
Symptom duration > 1 month, exposure to actual trauma, distress/impaired functioning.
Acute stress disorder is the same criteria as PTSD but duration <1 month
Which psychosocial treatments are effective vs not effective for PTSD?
Trauma/Stressor, Dissociative & Somatic
Most Effective: CBT, cognitive processing therapy, cognitive therapy, prolonged exposure.
Effective: EMDR, eclectic psychotherapy, narrative exposure therapy.
NOT effective: single session debriefing
What pharmacological treatment is recommended for PTSD?
Trauma/Stressor, Dissociative & Somatic
SSRIs: fluoxetine, sertraline, paroxetine
SNRI: venlafaxine
What is the most common type of Dissociative Amnesia?
Trauma/Stressor, Dissociative & Somatic
Localized (can’t remember anything for a discrete period of time)
Other types:
* selective- can’t remember some info from a period of time
* generalized- complete loss of autobiographical memories
* systematized- for a specific category of information
* continuos- for new events as they happen
What is the difference between Somatic Symptom Disorder and Illness Anxiety Disorder?
Trauma/Stressor, Dissociative & Somatic
In Somatic Symptom Disorder, there are somatic symptoms that cause distress/impairment. In illness anxiety disorder, there are no/minimal somatic symptoms but person is worried about getting sick.
What are the diagnostic criteria for a substance use disorder?
Substance-Related & Addictive Disorders
Cognitive, behavioral, and physiological symtpoms that show that the person uses the substance despite it causing significant problems. 2 or more characteristic symptoms within a 12-month period.
What are the symptoms of alcohol withdrawal?
Substance-Related & Addictive Disorders
autonomic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient hallucinations or illusions, anxiety, psychomotor agitation, generalized tonic-clonic seizures
What is Korsakoff Syndrome and what medical condition is it linked with?
Substance-Related & Addictive Disorders
The amnestic-confabulatory type of alcohol induced major neurocognitive disorder. Involves anterograde & retrograde amnesia and confabulation (gaps in memory unconsciously filled with fabricated information).
Linked with thiamine defficiency.
what are the symptoms of opioid withdrawal?
Substance-Related & Addictive Disorders
dysphoric mood, nausea or vomiting, muscle aches, diarrhea, yawning, fever, insomnia
what are the symptoms of stimulant intoxication?
Substance-Related & Addictive Disorders
behavioral/psychological symtpoms (e.g., hypervigilance, interpersonal sensitivity, anger, etc.) plus at least two of: tachycardia or bradycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, respiratory depression or cardiac arrhythmia, seizures or coma
what are the symptoms of opioid intoxication?
Substance-Related & Addictive Disorders
behavioral/psychological symptoms, pupillary constriction and at least one of three (drowsiness or coma, slurred speech, impaired attention or memory)
What are the symtpoms of stimulant withdrawal?
Substance-Related & Addictive Disorders
Dysphoric mood and at least two of: fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor agitation or retardation.
What are the symtpoms of tobacco withdrawal?
Substance-Related & Addictive Disorders
at least 4 of: irritability, anger or anxiety, impaired concentration, increased appetite, restlessness, depressed mood, insomnia
What is relapse prevention therapy (RPT)?
Substance-Related & Addictive Disorders
Developed by Matlan & Gordon; a CBT approach that views lapses as happening when clients cannot deal with a high-risk situation (e.g., negative emotional state, social pressure). Focuses on equipping clients to deal with high-risk situations through coping skills, self-efficacy enhacement, and challenging myths about positive impacts of substance use.
What is community reinforcement approach (CRA)?
Substance-Related & Addictive Disorders
Treatment for substance use disorders based on operant conditioning; create more rewarding drug free environments to compete with substance use “benefits”. CRAFT (CRA family training) is used when identified substance user does not want to be involved.
What is project MATCH?
Substance-Related & Addictive Disorders
Multisite study comparing effectiveness of different treatments for substance use. All three treatments (12 step, CBT coping skills, motivational enhancement therapy) reduced drinking, some support for matching hypothesis (matching characteristics of person with characteristics of program to maximize results).
Diagnostic criteria for anorexia nervosa
Feeding/Eating, Elimination & Sleep
- Low body weight
- intense fear of gaining weight OR engaging in behaviors to prevent weight gain
- disturbance in perception of own weight/shape OR excessive importance of weight for self-evaluation OR lack of insight into seriousness of low weight
Type can be restrictive or binge eating-purging.
Severity determined by BMI.
Describe treatments that have research support for anorexia nervosa.
Feeding/Eating, Elimination & Sleep
- CBT for anorexia- focuses on behavioral strategies to promote healthy eating and cognitive strategies to challenge unhelpful thoughts and increase motivation
- CBT-E - transdiagnostic treatment for all eating disorders based on assumption that EDs are result of excessive value placed on appearance/weight. Personalized & flexible, focuses on maintaining factors for each person.
- Family based treatment (FBT) for anorexia- three phases (1. parents and therapist have control over diet, 2. control is gradually transferred to adolescent, 3. developmental adolescent issues and healthy parent-child relationships
- Inconsistent support for pharmacotherapy
All of these treatments are post-hospitalization
Diagnostic criteria for bulimia nervosa
Feeding/Eating, Elimination & Sleep
- episodes of binge eating and feeling out of control
- innapropriate compensatory behavior to prevent weight gain (exercise, purging)
- self-evaluation too focused on physical appearance/weight
- binge eating and compensatory behavior at least 1/week for 3 months
Severity determined by frequency of compensatory behavior per week
Bulimia tends to be more ego-dystonic and distressing to patients
Name and describe the most effective treatment for bulimia
Feeding/Eating, Elimination & Sleep
CBT-E; consists of four stages:
1. engage pt in therapy, collaborative plan, monitor thoughts/feelings/behaviors around eating, establish regular eating patterns
2. review progress and revise plan as needed
3. discuss underlying issues of overevaluation of weight/shape, perfectionism, self-esteem, interpersonal problems
4. relapse prevention strageties
Other treatments include FBT for bulimia, Interpersonal therapy (IPT) or regular CBT.
What pharmacotherapy is supported for bulimia?
Feeding/Eating, Elimination & Sleep
SSRIs (esp. fluoxetine)
YET, SSRI + CBT not more effective than CBT alone
What are the diagnostic criteria for binge eating disorder?
Feeding/Eating, Elimination & Sleep
- binge episodes + sense of lack of control
- at least 3 of: eating until uncomfortably full, eating more quickly than usual, eating a lot when not feeling hungry, feeling alone due to embarassment about binges, feeling disgusted/depressed/guilty about binges
- episodes occur at least weekly for 3 months
Severity determined by frequency of episodes.
What psychosocial treatments have support for binge eating disorder?
What support is there for pharmacotherapy for binge eating disorder?
Feeding/Eating, Elimination & Sleep
CBT-E, IPT
Not much support for pharmacotherapy- pharmacotherapy is less effective than CBT alone, and CBT + meds is no more effective than CBT alone
Diagnostic criteria for enuresis and common treatments
Feeding/Eating, Elimination & Sleep
Criteria:
* repeated urination in bed or clothing at least 2/week for 3 consecutive months OR cause significant distress/impaired functioning
* developmental age of 5+ years
* subtypes: nocturnal, diurnal, nocturnal/diurna
Common treatment: moisture alarm (bell-and-pad)
Diagnostic criteria for insomnia disorder and most common (non-pharma) treatment.
Feeding/Eating, Elimination & Sleep
Criteria:
* dissatisfaction with quantity/quality of sleep
* at least 3/week for 3 months
* not due to lack of opportunity to sleep
* cause significant distress or imparied functioning
* subtypes: initial (sleep onset), maintenance (waking up in the middle of the night), late (early morning awakening)
Treatment: multicomponent CBT with stimulus control (bed only for sleeping), sleep restriction, psychoeducation, relaxation training, CBT
Diagnostic criteria for narcolepsy and treatments.
Feeding/Eating, Elimination & Sleep
Criteria:
* episodes of falling asleep during the day at least 3/week for 3 months
* cataplexy (loss of muscle tone) OR hypocretin deficiency OR REM sleep latency of < 15 mins
* may include sleep paralysis, hypnagogic or hypnopompic hallucinations
Behavioral strategies: daytime naps, staying active, good sleep habits.
Medications:
* for alertness- stimulants including amphetamines, modafinil/armodafinil
* for cateplexy -antidepressants
* for both if tx resistant- sodium oxybate
What are non-rapid eye movement sleep arousal disorders?
Feeding/Eating, Elimination & Sleep
Sleepwalking, or sleep terror (sudden awakening that starts with a scream and involves intense fear and autonomic arousal)
usually in stage 3 or 4 of sleep
What is nightmare disorder?
Feeding/Eating, Elimination & Sleep
- repeated dreams that are dysphoric and usually involve threats for survival, security, physical integrity. Dysphoric mood presists when awakened
- occur during REM sleep
What is sensate focus and what disorders does it treat?
Sexual, Gender, Paraphillic
Technique developed by Masters & Johnson (1970) to treat sexual dysfunctions. Focuses on reducing performance anxiety and increasing non-sexual & sexual intimacy between partners. Treats erectile disorder, premature ejaculation, female orgasmic disorder, and genito/pelvic pain/penetration disorder.
What drugs are used to treat erectile disorder?
Sexual, Gender, Paraphillic
Sildenafil citrate (Viagra), tadalafil (Cialis), and vardenafil (Levitra). These increase bloodflow to penis.
What drugs are effective for premature ejaculation?
Sexual, Gender, Paraphillic
SSRIs
What conditions/factors are associated with genito-pelvic pain/penetration disorder?
Sexual, Gender, Paraphillic
Sexual or physical abuse, vaginal infections.
What is the first-line treatment for female orgasmic disorder?
Sexual, Gender, Paraphillic
Directed masturbation
What are the differences between the Dutch Model and the gender-affirmative protocol for gender dysphoria?
Sexual, Gender, Paraphillic
The Dutch Model- believes that gender dysphoria is transient for most children (will “grow out of it”), recommends watchful waiting and support until puberty starts, then start social transiiton and puberty blockers. Surgery at 18.
Gender affirmative model- believes children can have identity awareness at any age, children can transition socially at any age, puberty blockers, cross sex hormones, and surgery as deemed appropriate. This model is most common now.
Name and describe behavioral strategies used to treat paraphillic disorders.
Sexual, Gender, Paraphillic
Covert sensizitation- aversive counterconditioning, replaces desire elicited by paraphillic object with fear/other aversive response.
Masturbation reconditioning- while masturbating, instructed to switch from imagining paraphillic object to other more appropriate object.
What drugs are used to treat paraphillic disorders?
Sexual, Gender, Paraphillic
Gonadotropin-releasing hormones and anti-androgens to reduce sexual desire in more severe cases (but these have side effects and benefits stop once they are discontinued).
Some SSRIs to reduce depression/compulsions that lead to behaviors in less severe cases.
What are the age criteria for pedophillic disorder?
Sexual, Gender, Paraphillic
Attracted to a child 13 or younger, person must be at least 16 and at least 5 years older than the child.
Diagnostic criteria for ODD
Disruptive, Impulse-Control & Conduct
Angry/irritable mood, argumentative/defiant behavior, and/or vindictiveness (evidenced by 4 or more symptoms e.g. blames others, deliberately annoys others, angry/resentful). Must be with at least 1 person who is not a sibling. Duration of at least 6 months and must cause distress to child or immediate social circle or impact functioning.
% of children with ODD that develop CD?
Prevalence in males vs females
Disruptive, Impulse-Control & Conduct
30%
More common in young boys vs girls, equally common in adolescents/older children.
Diagnostic criteria for CD, symptom categories, and subtypes.
Disruptive, Impulse-Control & Conduct
Persistent pattern of disregard for basic rights of others and/or disregard for rules/social norms. At least 3 symptoms in past 12 months, and at least 1 symptom in past 6 months . Symptom categories: destruction of property, aggression to people/animals, deceitfulness/theft, serious violation of rules.
Subtypes: childhood onsent (<10 yo), adolescent onset, unspecified onset.
Person >18 that meets criteria for antisocial personality disorder cannot meet for CD
Biological & environmental factors associated with CD
Disruptive, Impulse-Control & Conduct
- heredity
- brain abormalities
- neurotransmitter abnormalities (reduced serotonin & dopamine)
- neuroendocrine abnormalities (cortisol paterns, less cortisol response to stressful events despite negative affect)
- prenatal exposure to alcohol/opiates
- negative parenting practices
Describe Moffitt’s life-course-persistent type and adolescent-limited type of antisocial behavior in CD.
Disruptive, Impulse-Control & Conduct
Life-course persistent type starts in childhood and involves incraesingly serious behaviors, is consistent accross situations. Attributed to neuropsych deficits.
Adolescence-limited type begins in adolescence and is temporary and situational, “gap” between physical/sexual and emotional maturity.
This matches the course of CD, with childhood onset having higher likelihood of having CD, substance use problems, and criminality in adulthood.
Name and describe child focused and parent focused interventions for CD.
Disruptive, Impulse-Control & Conduct
Child focused: Problem solving skills training (PSST) (Kazdin), teaches conflict resolution, how to accurately perceive others’ emotions, understand consequences of actions.
Parent Management Training- Oregon (PMTO) focuses on decreasing coercive parenting strategies.
PMT (Kazdin’s model) uses operant conditioning to reinforce positive behaviors and decrease problematic behaviors.
PCIT
PMT + PSST are more effective than either alone.
Name and describe family focused and multimodal interventions for CD.
Disruptive, Impulse-Control & Conduct
Family focused:
functional family therapy focuses on interdependece/independece, hierarchies and power structures.
multidimensional family therapy based on family systems theory, creates change in adolescent, parents, family interactions, and extrafamilial sources of influence
Multimodal:
Multisystemic therapy (MST) based on Bronfenbrenner’s theory, researched on minority families, for children at-risk of out-of-home placement
Multidimensional Treatment Foster Care alternative to residential placement, child lives with trained foster parents and receives treatment at home, school, community while parents receive their own treatment
Diagnostic Criteria for Intermittent Explosive Disorder
Disruptive, Impulse-Control & Conduct
Outbursts due to failure to control aggressive impulses with either
a) verbal/physical aggression that does not result in injury/destruction at least 2/week for 3 months
b) 3 outbursts in a 12 month period that did result in injury/destruction
at least 6 y/o developmentally, out of proportion to provocation, not for tangible outcome, cause impairment/legal or financial problems.
Diagnostic criteria for NCD due to Alzheimer’s Disease (mild vs major, probable vs possible)
Neurocognitive Disorders
General criteria: a) meet criteria for mild or major NCD, b) gradual onset & progression, c) meet criteria for probable or possible AD, d) not better explained by another disorder.
Major NDC Probable AD: evidence of genetic mutation and/or evidence of decline in memory + another domain, steadily progressive & gradual cognitive decline, no mixed etiology.
Major NDC Possible AD: when above criteria are not met ???
Mild NDC Probable AD: evidence of genetic mutation
Mild NDC Possible AD: no evidence of genetic mutation but evidence of decline in memory, gradual cognitive decline, no mixed etiology
check these definitions
Risk factors for Alzheimer’s
- genetic- APOE4 gene
- Standard Trisomy 21- extra gene for amyloid precursor protein
- sudden loss of smell
What drugs are used to treat Alzheimer’s Disease
Cholinisterase inhibitors (to increase ACh): donepezil, rivastigmine
Memantine (NMDA inhibitor, regulates glutamate)
Features of NCD due to Alzheimer’s
Stages of Alzheimer’s
- features: memory loss (STM then LMT), anomia, attention/concentration, disorientation (time & space), personality & mood
- Early stage: STM, anomia, impaired attention/concentration, disorientation, personality & mood
- Middle stage: LTM, impulse control, impaired speech, labile mood, irritability, sundowning
- Late stage: severe disorientation & communication impairments, agitation/aggression.
Features of NCD due to Lewy Bodies, first cognitive symptoms
Neurocognitive Disorders
Core features: fluctuating cognition with variable attention/alertness, visual hallucinations, cognitive symptoms followed by symptoms of parkinsonism
Suggestive features: symptoms of REM sleep behavior disorder, neuroleptic hypersensitivity
First cognitive symptoms: visuospatial, complex attention, and EF deficits.
Slow onset, gradual progression.
Vascular Dementia
- due to acute event (stroke) or cardiovascular conditions that limit oxygen flow to the brain.
- decline in complex attention, EF, cognitive processing
- can be acute onset following stroke
Characteristic symptoms of NCD due to HIV
Neurocognitive Disorders
Subcortical symptoms (forgetfulness, attention, processing speed, psychomotor retardation, clumsiness, tremors, apathy, social withdrawal.
Features of NCD due to Prion Disease, most common type
Neurocognitive Disorders
Gradual onset followed by rapid progression, motor symptoms assoc w/ prion disease, or biomarker of prion disease
Symptoms: confusion/disorientation, memory, judgment, ataxia, myoclonus, chorea, mood.
Most common is Creutzfeld-Jakob Disease.
Characteristics of frontotemporal NCD and types.
Characteristics: gradual onset & gradual progression, no memory or perceptual motor impairments, meet for behavioral or language variant.
Behavioral variant: socially inappropriate (e..g, pee jars), social cognition, EF, personality changes; more common than language variant.
Language variant: aka Primary Progressive Aphasia (semantic, agrammatic/nonfluent, logopenic), most often speech production problems.
