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Psychopathology Flashcards

1
Q

What are a) the most common chromosomal causes of intellectual disability, and b) the most common preventable prenatal cause?

Neurodevelopmental

A

a) Down Syndrome followed by Fragile X syndrome
b) fetal alcohol syndrome

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2
Q

What are the three diagnostic criteria for intellectual developmental disorder, and what is the severity specifier based on?

Neurodevelopmental

A

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.

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3
Q

What % of IDD cases with a known etiology are due to
a) prenatal factors
b) perinatal factors
c) postnatal factors

Neurodevelopmental

A

a) 80%
b) 5-10%
c) 5-10%

Etiology is only known in 25-50% of cases!!!

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4
Q

Prognosis for ASD is best when…

Neurodevelopmental

A

IQ >70, functional language acquired by age 5, no comorbid mental health problems.

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5
Q

Dawson’s study of preschool children with and without autism showed that when shown novel and familiar objects and faces, children with autism _______

Neurodevelopmental

A

Reacted differently to novel objects, but not to novel faces.

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6
Q

children with autism have difficulty recognizing emotions across which expression modalities?

Neurodevelopmental

A

All (face, body, voice)

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7
Q

Name some non-genetic risk factors for ASD

Neurodevelopmental

A

Prematurity (<26 weeks), older parental age, exposure to toxins in prenatal development.

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8
Q

What are some brain abnormalities associated with ASD?

Neurodevelopmental

A
  • larger brain volume & weight
  • abnormalities in cerebellum, corpus callosum, and amygdala

accelerated brain growth starting at 6 months leads to bigger brain

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9
Q

What are neurotransmitter abnormalities associated with ASD?

Neurodevelopmental

A
  • 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

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10
Q

What is Lovaas method of EIBI and what does it actually improve?

Neurodevelopmental

A

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.

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11
Q

What medication is typically prescribed for aggression in individuals with ASD?

Neurodevelopmental

A

Atypical antipsychotics (risperidone, aripiprazole)

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12
Q

What is the most prevalent diagnosed disorder in youth ages 3-17?

Neurodevelopmental

A

ADHD

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13
Q

What is ADHD most often comorbid with?

Neurodevelopmental

A

1) ODD
2) Conduct disorder
3) anxiety disorder
4) depressive disorder

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14
Q

What two neurotransmitter abnormalities are associated with ADHD?

Neurodevelopmental

A

Low levels of dopamine and norepinephrine in certain brain areas (PFC)

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15
Q

What are some brain abnormalities associated with ADHD?

Neurodevelopmental

A
  • 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
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16
Q

What are some risk factors for ADHD?

Neurodevelopmental

A
  • prematurity
  • low birth weight
  • maternal smoking/alcohol use
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17
Q

What are the best treatments for ADHD across the lifespan?

Neurodevelopmental

A
  • 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!

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18
Q

What are the diagnostic criteria for Tourette’s vs persistent motor or vocal tic disorder?

Neurodevelopmental

A

Tourette’s requires one vocal and several motor tics, persistent motor or vocal tic disorder requires one motor or vocal tic.

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19
Q

What brain and neurotransmitter abnormalities are associated with Tourette’s?

Neurodevelopmental

A

Dopamine overactivity, smaller caudate nucleus

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20
Q

What is the most common comorbid disorder for Tourette’s?

Neurodevelopmental

A

ADHD

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21
Q

What is the treatment of choice for childhood-onset fluency disorder?

Neurodevelopmental

A

Habit reversal- regulated breathing incompatible with stuttering

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22
Q

What is the treatment of choice for tic disorders?

Neurodevelopmental

A

comprehensive behavioral intervention for tics (CBIT)

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23
Q

What is the most common learning disorder?

Neurodevelopmental

A

specific learning disorder in reading, most often dyslexia

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24
Q

What is the most common comorbid psychiatric condition for learning disorders?

Neurodevelopmental

A

ADHD

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25
Q

What is the diagnostic criteria for brief psychotic disorder?

Schizophrenia Spectrum/Psychotic Disorders

A

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)

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26
Q

What are the diagnostic criteria for schizophreniform disorder?

Schizophrenia Spectrum/Psychotic Disorders

A

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.

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27
Q

What are the diagnostic criteria for schizophrenia?

Schizophrenia Spectrum/Psychotic Disorders

A
  • 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
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28
Q

Discordant mono and dizygotic twin studies (one twin has schizophrenia) show what about risk for their offspring?

Schizophrenia Spectrum/Psychotic Disorders

A

Risk of DZ twin without schizophrenia having a child with schizophrenia is significantly lower, but risk of MZ twin without schizophrenia has same risk.

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29
Q

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

A
  • 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%
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30
Q

What neurotransmitters are associated with schizophrenia?

Schizophrenia Spectrum/Psychotic Disorders

A

Dopamine, glutamate, serotonin.

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31
Q

Describe the original dopamine hypothesis of schizophrenia and the revised hypothesis.

Schizophrenia Spectrum/Psychotic Disorders

A

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)

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32
Q

Describe brain abnormalities associated with schizophrenia.

Schizophrenia Spectrum/Psychotic Disorders

A
  • enlarged ventricles
  • hypofrontality (decreased activity in PFC)
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33
Q

What disorders are most comorbid with schizophrenia?

Schizophrenia Spectrum/Psychotic Disorders

A
  • tobbaco use disorder
  • anxiety disorders
  • OCD
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34
Q

How do psychotic and negative symptoms of schizophrenia progress with age?

Schizophrenia Spectrum/Psychotic Disorders

A

Psychotic symptoms decrease with age, while negative and cognitive symptoms persist.

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35
Q

What is the ‘immigrant paradox’ in schizophrenia?

Schizophrenia Spectrum/Psychotic Disorders

A

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.

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36
Q

What is the best treatment for schizophrenia?

Schizophrenia Spectrum/Psychotic Disorders

A

Psychosocial intervention + antipsychotic medication

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37
Q

Which antipsychotic is most effective for treatment-resistant schizophrenia?

Schizophrenia Spectrum/Psychotic Disorders

A

Clozapine (second-gen)

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38
Q

What is the diagnostic criteria for schizoaffective disorder?

Schizophrenia Spectrum/Psychotic Disorders

A

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.

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39
Q

What is the diagnostic criteria for delusional disorder? What are the types of delusions?

Schizophrenia Spectrum/Psychotic Disorders

A

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

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40
Q

Mood episodes

What is a manic episode, hypomanic episode, and major depressive episode?

Bipolar & Depressive Disorders

A

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.

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41
Q

What is the diagnostic criteria for
- bipolar I
- bipolar II
- cyclothymic disorder

Bipolar & Depressive Disorders

A
  • 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
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42
Q

What neurotransmitters are associated with bipolar disorder?

Bipolar & Depressive Disorders

A

Norepinephrine, serotonin, dopamine, glutamate.

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43
Q

What brain abnormalities are associated with bipolar disorder?

Bipolar & Depressive Disorders

A

Structural and functional abnormalities of PFC, amygdala, hippocampus, basal ganglia

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44
Q

What circadian rhythm abnormalities are associated with bipolar disorders?

Bipolar & Depressive Disorders

A

sleep-wake cycle, secretion of hormones, appetite, core body temperature

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45
Q

What psychosocial interventions are appropriate for bipolar disorders?

Bipolar & Depressive Disorders

A

CBT, psychoeducation, interpersonal and social rhythm therapy, family-focused therapy (when family members are high in expressed emotion)

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46
Q

Heritability of bipolar disorder

A

70-90%

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47
Q

What drugs are used for ‘classic bipolar’ vs ‘atypical bipolar’?

Bipolar & Depressive Disorders

A

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.

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48
Q

What are the diagnostic criteria for persistent depressive disorder?

Bipolar & Depressive Disorders

A

Depressed mood + two or more symptoms (ex, sleep disturbance, apetite changes, hopelessness) lasting 2 years in adults, and 1 year in children/adolescents.

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49
Q

What are the diagnostic criteria for disruptive mood dysregulation disorder?

Bipolar & Depressive Disorders

A

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.

50
Q

What antidepressant is especially effective for peripartum depression?

Bipolar & Depressive Disorders

A

Sertraline

51
Q

What are the physiological abnormalities linked to depression with season pattern (aka seasonal affective disorder)?

Bipolar & Depressive Disorders

A

Low levels of serotonin and high levels of melatonin.

Phototherapy suppresses production of melatonin.

52
Q

Sex differences in depression rates

A

Similar rates for boys and girls, by adolescence females>males (1.5-3 times higher rates)

53
Q

Heredity of MDD- monozygotic vs dizygotic twin concordance

A

Monozygotic- .50
Dizygotic- .20

concordance rates are slightly higher for female twins

54
Q

What neurotransmitter abnormalities are associated with depression?

Bipolar & Depressive Disorders

A

Low levels of serotonin, dopamine and norepinephrine.

55
Q

What brain abnormalities are associated with depression?

Bipolar & Depressive Disorders

A

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.

56
Q

Describe Lewinsohn’s social reinforcement theory of depression?

Bipolar & Depressive Disorders

A

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

57
Q

Describe Beck’s cognitive theory of depression.

Bipolar & Depressive Disorders

A

Negative cognitive triad (negative thoughts about oneself, world, future)

58
Q

Describe Seligman’s original theory of depression and the revised versions.

Bipolar & Depressive Disorders

A

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

59
Q

What sleep abnormalities are associated with depression?

Bipolar & Depressive Disorders

A
  • prolonged sleep latency
  • reduced REM latency
  • increased REM density
  • reduced slow-wave sleep
60
Q

What disorders are comorbid with MDD?

Bipolar & Depressive Disorders

A
  1. substance use disorder, especially alcohol use disorder
  2. anxiety disorders
  3. personality disorders
61
Q

What is APA’s recommended first-line treatment for depression in children, adolescents, adults and older adults?

Bipolar & Depressive Disorders

A

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

62
Q

What is the evidence for electroconvulsive therapy (ECT) and repeated transcranial magnetic stimulation (rTMS) for depression?

Bipolar & Depressive Disorders

A

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.

63
Q

What is Mowrer’s two-factor theory of specific phobias?

Anxiety & OCD

A

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.

64
Q

What are the diagnostic criteria for body dysmorphic disorder?

Anxiety & OCD

A

Preoccupation with perceived physical flaw and repetitive behaviors or mental acts (e.g., skin picking, mirror checking) due to the perceived flaw

65
Q

What are the diagnostic criteria for reactive attachment disorder?

Trauma/Stressor, Dissociative & Somatic

A

Inhibited/withdrawn behavior to caregivers + socioemotional disturbances following extreme insufficient care. Onset before age 5, developmental age of 9+ months

66
Q

What are the diagnostic criteria for disinhibited social engagement disorder?

Trauma/Stressor, Dissociative & Somatic

A

No stranger danger, limited checking in with caregivers, following extreme insufficient care. Developmental age of 9+ months.

67
Q

What brain abnormalities are associated with PTSD?

Trauma/Stressor, Dissociative & Somatic

A
  • Overactive amygdala & underactive vmPFC (reduced inhibitory top-down control of amygdala)
  • Hyperactive anterior cingulate cortex
  • Decreased hippocampus volume
68
Q

What are the four symptom types in PTSD?

Trauma/Stressor, Dissociative & Somatic

A
  • 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

69
Q

Which psychosocial treatments are effective vs not effective for PTSD?

Trauma/Stressor, Dissociative & Somatic

A

Most Effective: CBT, cognitive processing therapy, cognitive therapy, prolonged exposure.
Effective: EMDR, eclectic psychotherapy, narrative exposure therapy.
NOT effective: single session debriefing

70
Q

What pharmacological treatment is recommended for PTSD?

Trauma/Stressor, Dissociative & Somatic

A

SSRIs: fluoxetine, sertraline, paroxetine
SNRI: venlafaxine

71
Q

What is the most common type of Dissociative Amnesia?

Trauma/Stressor, Dissociative & Somatic

A

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

72
Q

What is the difference between Somatic Symptom Disorder and Illness Anxiety Disorder?

Trauma/Stressor, Dissociative & Somatic

A

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.

73
Q

What are the diagnostic criteria for a substance use disorder?

Substance-Related & Addictive Disorders

A

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.

74
Q

What are the symptoms of alcohol withdrawal?

Substance-Related & Addictive Disorders

A

autonomic hyperactivity, hand tremor, insomnia, nausea or vomiting, transient hallucinations or illusions, anxiety, psychomotor agitation, generalized tonic-clonic seizures

75
Q

What is Korsakoff Syndrome and what medical condition is it linked with?

Substance-Related & Addictive Disorders

A

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.

76
Q

what are the symptoms of opioid withdrawal?

Substance-Related & Addictive Disorders

A

dysphoric mood, nausea or vomiting, muscle aches, diarrhea, yawning, fever, insomnia

77
Q

what are the symptoms of stimulant intoxication?

Substance-Related & Addictive Disorders

A

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

78
Q

what are the symptoms of opioid intoxication?

Substance-Related & Addictive Disorders

A

behavioral/psychological symptoms, pupillary constriction and at least one of three (drowsiness or coma, slurred speech, impaired attention or memory)

79
Q

What are the symtpoms of stimulant withdrawal?

Substance-Related & Addictive Disorders

A

Dysphoric mood and at least two of: fatigue, vivid and unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor agitation or retardation.

80
Q

What are the symtpoms of tobacco withdrawal?

Substance-Related & Addictive Disorders

A

at least 4 of: irritability, anger or anxiety, impaired concentration, increased appetite, restlessness, depressed mood, insomnia

81
Q

What is relapse prevention therapy (RPT)?

Substance-Related & Addictive Disorders

A

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.

82
Q

What is community reinforcement approach (CRA)?

Substance-Related & Addictive Disorders

A

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.

83
Q

What is project MATCH?

Substance-Related & Addictive Disorders

A

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).

84
Q

Diagnostic criteria for anorexia nervosa

Feeding/Eating, Elimination & Sleep

A
  • 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.

85
Q

Describe treatments that have research support for anorexia nervosa.

Feeding/Eating, Elimination & Sleep

A
  • 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

86
Q

Diagnostic criteria for bulimia nervosa

Feeding/Eating, Elimination & Sleep

A
  • 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

87
Q

Name and describe the most effective treatment for bulimia

Feeding/Eating, Elimination & Sleep

A

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.

88
Q

What pharmacotherapy is supported for bulimia?

Feeding/Eating, Elimination & Sleep

A

SSRIs (esp. fluoxetine)

YET, SSRI + CBT not more effective than CBT alone

89
Q

What are the diagnostic criteria for binge eating disorder?

Feeding/Eating, Elimination & Sleep

A
  • 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.

90
Q

What psychosocial treatments have support for binge eating disorder?
What support is there for pharmacotherapy for binge eating disorder?

Feeding/Eating, Elimination & Sleep

A

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

91
Q

Diagnostic criteria for enuresis and common treatments

Feeding/Eating, Elimination & Sleep

A

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)

92
Q

Diagnostic criteria for insomnia disorder and most common (non-pharma) treatment.

Feeding/Eating, Elimination & Sleep

A

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

93
Q

Diagnostic criteria for narcolepsy and treatments.

Feeding/Eating, Elimination & Sleep

A

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

94
Q

What are non-rapid eye movement sleep arousal disorders?

Feeding/Eating, Elimination & Sleep

A

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

95
Q

What is nightmare disorder?

Feeding/Eating, Elimination & Sleep

A
  • repeated dreams that are dysphoric and usually involve threats for survival, security, physical integrity. Dysphoric mood presists when awakened
  • occur during REM sleep
96
Q

What is sensate focus and what disorders does it treat?

Sexual, Gender, Paraphillic

A

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.

97
Q

What drugs are used to treat erectile disorder?

Sexual, Gender, Paraphillic

A

Sildenafil citrate (Viagra), tadalafil (Cialis), and vardenafil (Levitra). These increase bloodflow to penis.

98
Q

What drugs are effective for premature ejaculation?

Sexual, Gender, Paraphillic

A

SSRIs

99
Q

What conditions/factors are associated with genito-pelvic pain/penetration disorder?

Sexual, Gender, Paraphillic

A

Sexual or physical abuse, vaginal infections.

100
Q

What is the first-line treatment for female orgasmic disorder?

Sexual, Gender, Paraphillic

A

Directed masturbation

101
Q

What are the differences between the Dutch Model and the gender-affirmative protocol for gender dysphoria?

Sexual, Gender, Paraphillic

A

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.

102
Q

Name and describe behavioral strategies used to treat paraphillic disorders.

Sexual, Gender, Paraphillic

A

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.

103
Q

What drugs are used to treat paraphillic disorders?

Sexual, Gender, Paraphillic

A

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.

104
Q

What are the age criteria for pedophillic disorder?

Sexual, Gender, Paraphillic

A

Attracted to a child 13 or younger, person must be at least 16 and at least 5 years older than the child.

105
Q

Diagnostic criteria for ODD

Disruptive, Impulse-Control & Conduct

A

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.

106
Q

% of children with ODD that develop CD?
Prevalence in males vs females

Disruptive, Impulse-Control & Conduct

A

30%
More common in young boys vs girls, equally common in adolescents/older children.

107
Q

Diagnostic criteria for CD, symptom categories, and subtypes.

Disruptive, Impulse-Control & Conduct

A

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

108
Q

Biological & environmental factors associated with CD

Disruptive, Impulse-Control & Conduct

A
  • 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
109
Q

Describe Moffitt’s life-course-persistent type and adolescent-limited type of antisocial behavior in CD.

Disruptive, Impulse-Control & Conduct

A

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.

110
Q

Name and describe child focused and parent focused interventions for CD.

Disruptive, Impulse-Control & Conduct

A

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.

111
Q

Name and describe family focused and multimodal interventions for CD.

Disruptive, Impulse-Control & Conduct

A

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

112
Q

Diagnostic Criteria for Intermittent Explosive Disorder

Disruptive, Impulse-Control & Conduct

A

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.

113
Q

Diagnostic criteria for NCD due to Alzheimer’s Disease (mild vs major, probable vs possible)

Neurocognitive Disorders

A

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

114
Q

Risk factors for Alzheimer’s

A
  • genetic- APOE4 gene
  • Standard Trisomy 21- extra gene for amyloid precursor protein
  • sudden loss of smell
115
Q

What drugs are used to treat Alzheimer’s Disease

A

Cholinisterase inhibitors (to increase ACh): donepezil, rivastigmine
Memantine (NMDA inhibitor, regulates glutamate)

116
Q

Features of NCD due to Alzheimer’s
Stages of Alzheimer’s

A
  • 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.
117
Q

Features of NCD due to Lewy Bodies, first cognitive symptoms

Neurocognitive Disorders

A

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.

118
Q

Vascular Dementia

A
  • 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
119
Q

Characteristic symptoms of NCD due to HIV

Neurocognitive Disorders

A

Subcortical symptoms (forgetfulness, attention, processing speed, psychomotor retardation, clumsiness, tremors, apathy, social withdrawal.

120
Q

Features of NCD due to Prion Disease, most common type

Neurocognitive Disorders

A

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.

121
Q

Characteristics of frontotemporal NCD and types.

A

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.

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