Psychopathology/DSM Flashcards
Prevalence and Gender ratio of ID
1% of population (of these – 85% mild severity)
Male to female is 1.5:1
Language disorder (brief summary)
Difficulty acquiring and using language (comprehension or production)
Speech Sound disorder (brief summary)
Articulation (eg lisps)
What are the severity levels and specifiers for ASD?
Level 1 (require support) Level 2 (require substantial support) Level 3 (require very substantial support) Specify with/without intellectual impairment and language impairment.
Prevalance and gender ratio for ASD
1%, male to female 4:1
Prevalence and gender ratio for ADHD
5% children and 2.5% adults
Males to females 2:1
Common associated features of ADHD
Low frustration tolerance, mood symptoms, social rejection/conflict.
Prevalence of SLD
5-15%
Differential between Tourette’s and other tic disorders
Tourettes has multiple motor and 1 or more vocal tics
Motor/Vocal tic disorders only have one type.
Differential tics vs stereopies
Stereotypies are consistent and rhythmic, Tics are variable and brief
Symptoms of Psychosis (5)
Delusions, Hallucinations, Disorganized speech, Grossly disorganized or catatonic behavior, negative symptoms.
Brief Psychotic Disorder
At least one of: delusions, hallucinations, disorganized speech.
Duration 1 – 30 days
Schizophreniform disorder
At lest 2 symptoms (must include one of delusions, hallucinations, or disorganized speech)
Duration 1-6 months
Schizophrenia
“Active phase” at least one month with 2 symptoms, followed by a prodromal/residual phase with attenuated symptoms or negative symptoms lasting longer than 6 months
Neurotransmitters involved in psychosis
Dopamine, Glutamate, serotonin.
Dopamine hypothesis of schizophrenia:
Positive symptoms are caused by too much dopamine in subcortical striatal areas.
Negative symptoms are caused by not enough dopamine in prefrontal cortex.
Brain regions in schizophrenia
Enlarged ventricles, small cortex, small thalamus.
Underactive frontal lobe.
Temporal-limbic-frontal network and striatum (caudate nucleus, putamen, nucleus accumbens).
Common comorbidities of schizophrenia
Anxiety, OCD, tobacco use.
Prevalence and heritability of Schizophrenia
Lifetime prevalence around 0.5%.
Identical twins .5, sibs .1 concordance.
Onset and course of schizophrenia
Usually early 20s for males and late 20s for females.
Positive symptoms decrease with age, negative/cognitive persist
Prognostic factors in schizophrenia
Better prognosis: Female, late and acute onset, comorbid mood symptoms, mainly positive symptoms, precipitating stressor, good prior adjustment.
Worse prognosis: lack of insight, high expressed emotion families (criticism/hostility)
Treatment for schizophrenia
Antipsychotic drugs, CBT, cognitive remediation, family psychoed, social skills training, ACT, supported employment
Schizoaffective Disorder
Concurrent mood episode AND one month of 2 active symptoms, AND at least 2 weeks with delusions/hallucinations without mood symptoms.
Delusional Disorder
1+ delusions for at least one month without any other psychotic symptoms, and without overall impairment in functioning
Subtypes of delusion disorder:
Erotomanic (someone is in love with them), grandiose, jealous (spouse unfaithful), persecutory, somatic, unspecified
Treatment for delusions
Medication, CBT for delusions (forming alternative explanations and evaluating both, starting with less closely held aspects)
Family therapy
Characteristics of Mania
Necessary: Elevated/Expansive/Irritable mood AND increased activity or energy for most of the day, nearly every day. Other symptoms: Inflated self-esteem/gradiosity Decreased sleep Pressured speech Flight of ideas/racing thoughts Distractibility Increased activity (goal-directed or non-goal directed) Excessive risky behavior
Manic Episode vs Hypomanic
Both have:
Elevated/Expansive/Irritable mood AND increased activity or energy for most of the day, nearly every day.
Manic: Hospitalization AND/OR At least 1 week of “severe marked impairment” AND/OR psychotic features
Hypomanic: At least 4 days, no psychosis, less impairment
Criteria for Bipolar 1
One manic episode
Criteria for Bipolar 2
One hypomanic and one major depressive episode
Cyclothymic disorder
Several hypomanic and depressive symptoms that don’t meet full criteria for an episode. Sx are present at least half the time (periods of remission shorter than 2 months).
Adults: at least 2 years, Children: At least 1 year
Typical onset for bipolar
Late teens to mid 20’s. BP1 is earlier. Often preceeded by a stressor.
Neurotransmitters involved in Bipolar
Norepinephrine, Serotonin, Dopamine, Glutamate
Brain regions involved in Bipolar
Prefrontal cortex, amygdala, hippocampus, basal ganglia
Therapies for Bipolar
Family focused therapy, CBT, psychoed, “interpersonal and social rhythm therapy”
Medications for Bipolar
Lithium for Classic BPD
Anticonvulsants and 2nd gen Antipsychotics for atypical features
Frequent comorbidities for bipolar:
ADHD, anxiety, Substance use, sleep disorders, eating disorders, disruptive disorders
Symptoms of depression (10)
Depressed mood nearly every day (children: includes irritability) Diminished interest/pleasure Weight/appetite change Sleep disturbance Psychomotor agitation/retardation (observable by others) Fatigue/loss of energy Feel worthless/guilty Can’t concentrate or indecisive Thoughts of death/suicidal ideation
Depressive episode criteria
At least 5 symptoms (including mood or anhedonia) every day for 2 weeks
Depressive episode with anxious distress
Depressive episode with 2 of: feeling keyed up/tense Restlessness Trouble concentrating due to worry Fearful something awful will happen Feel they may lose self-control
Mood episode with mixed features
A depressive, manic, or hypomanic episode with at least 3 features of the “opposite” type of episode.
Mood disorder with rapid cycling
At least 4 episodes per year, with either 2 months of remission in between or switch to episode of the opposite pole.
Depressive episode with atypical features
Depressive episode with positive mood reactivity (when positive events occur) and at least 2 of: increased eating/weight gain, hypersomnia, leaden feeling in limbs, long standing rejection sensitivity (causing impairment).
Mood episode with psychotic features, mood-congruent or mood-incongruent
Delusions and/or hallucinations at any point during the episode.
Mood episode with peripartum onset
During pregnancy or 4 weeks postpartum
Mood episode with seasonal pattern
Majority of episodes occur in fall/winter, then remission.
Prognosis for recovery from mood episode
80% begin to recover within 1 year.
Positive prognostic factors: shorter duration, lower severity, no psychosis, no anxiety.
Age/gender pattern and course for major depressive disorder
Similar rates in childhood, in adolescence/adulthood more common in females.
Most common in adolescence and early adulthood.
Older adults describe less affective and more somatic/cognitive symptoms
Neurotransmitters involved in depression
Low Serotonin and norepinephrine
Brain regions involved in depression
HPA axis, prefrontal cortex, cingulate cortex, hippocampus, caudate nucleus, putamen, amygdala, thalamus
Lewinsohn’s social reinforcement theory of depression
Depression is due to lack of reinforcement due to poor social skills, causing isolation and low self esteem, creating a vicious cycle
Hopelessness theory of depression
Hopelessness is the cause of depression, which is caused by negative life events and negative cognitive style.
Disruptive Mood dysregulation disorder
-Severe recurrent temper outbursts at least 3x per week AND
-Persistent irritability or anger observable by others
For over 1 year in two settings starting before age 10.
Diagnosis must be made between age 6 and 18.
Persistent depressive disorder/Dysthymia
Depressed mood + 2 more symptoms, duration 2 years (adults) or 1 year (kids)
Persistent depressive disorder/Dysthymia
Depressed mood + 2 more symptoms, duration 2 years (adults) or 1 year (kids)
Premenstrual dysphoric disorder
During most cycles, 5 symptoms the week before menstruation, with improvement thereafter. Similar symptoms but not identical to depressive episode.
Demographic Suicide predictors
Highest among whites, then indigenous. Elderly and 45-65 are the highest rates.
Male gender, living alone, family history of suicide.
History of suicide attempts, hospital discharge.
Common medical conditions that can resemble/co-occur with depression
Huntington’s, Parkinson’s, stroke, brain injury, hypothyroidism, Cushing’s disease.
What is the most common anxiety disorder under age 12?
Separation Anxiety
5 specifiers for specific phobia (types)
Animal, natural environment, blood-injection-injury, situational, other
Focus of social anxiety disorder
Fear of scrutiny by others – concern behavior will be embarrassing or lead to rejection.
Agoraphobia
Fear of 2 or more situations (eg closed spaces, crowds, outside) due to concern that escape might be difficult or help unavailable when embarrassing symptoms occur)
Prevalence and gender in OCD
About 1%. For males onset is earlier, but by adolescents females are more affected than males.
Body Dysmorphic disorder
Preoccupation with 1+ perceived flaws in appearance, excessive repetitive behaviors or mental acts are performed.
Common comorbidities for body dysmorphic
MDD, social anxiety, substance related
Oppositional Defiant Disorder
Angry, argumentative, vindictive behavior for >6 months
Four symptoms across those three categories, at least twice per week
Oppositional Defiant Disorder
Angry, argumentative, vindictive behavior for >6 months
Four symptoms across those three categories, at least twice per week
Intermittent Explosive Disorder
Recurrent aggressive outbursts (physical or verbal) twice per week for 3 months (or 3 severe instance in a year). Age 6+
Conduct disorder
Pattern of violation of rights of others or societal rules. 3 symptoms for 12 months.
Symptoms include aggression, destruction, deceitfulness/theft, serious rule violation.
Common comorbidities with conduct disorder
ADHD, ODD, learning probs, mood/anxiety, bipolar, substance abuse.
Prognosis and treatment of conduct disorder
Poorer prognosis with childhood onset.
Majority remit by adulthood, but others age into ASPD.
Tx: Parent training and MST
Pyromania
2 or more intentional fires set, with affective arousal, fascination with fire, and pleasure/relief resulting from firesetting
Kleptomania
Impulsive theft, with initial affective tension then relief/pleasure.
Basic criteria for personality disorders
Enduring pattern of experience/behavior that: deviates from expectations, is pervasive/inflexible, onset in adolescence/early adulthood, stable over time, impairment and distress. Symptoms in at least 2 of: Cognition Affect Interpersonal functioning Impulse control
Criteria for personality disorders under 18
Symptoms present for at least 1 year (except antisocial, never under 18)
Cluster A personality disorders
Odd/eccentric presentation.
Paranoid, Schizoid, and Schizotypal.
Cluster B personality disorders
Dramatic, Emotional, erratic behavior
Antisocial, borderline, histrionic, narcissistic
Cluster C personality disorders
Anxious or fearful
Avoidant, Dependent, Obsessive-Compulsive
Paranoid Personality Disorder
Distrustful/Suspicious of others, negative interpretation of others’ behavior and intentions. 4 symptoms.
Schizoid Personality Disorder
Social detachment/indifference and restricted range of emotion (flat, cold). 4 symptoms.
Doesn’t desire/enjoy relationships or activities
Schizotypal PD
Deficits in social functioning (including discomfort), and abnormal cogntions/perceptions/behavior. Psychotic symptoms as not as marked/persistent and in full blown psychosis. 5 symptoms
Eg ideas of reference, odd beliefs, inappropriate affect, paranoid fears
Differentiate Schizoid from Schizotypal PD
Schizoid - asociality/flat affect
Schizotypal - social probs AND more positive sx.
Differentiate Schizoid from Schizotypal PD
Schizoid - asociality/flat affect
Schizotypal - social probs AND more positive sx.
Antisocial Personality Disorder
Pervasive disregard for rights of others since age 15. 3 symptoms,
eg Law-breaking/predatory behavior, impulsivity, disregard for safety of self/others, lack of remorse.
Borderline PD
Unstable mood, relationships, self image, Plus impulsivity. 5 symptoms.
Eg. Try to avoid abandonment, splitting, unstable self image, recurrent self harm, emptiness, anger, stress-related paranoia or dissociation
Histrionic PD
Excessive emotionality and attention seeking, 5 symptoms, eg:
Exaggerated/shallow emotion, promiscuity, easily influenced by others, considers relationships closer than they are
Narcissistic PD
Grandiosity, need for admiration, lack of empathy. 5 symptoms
Eg fantasies of greatness, entitlement, exploitative, envious
Narcissistic PD
Grandiosity, need for admiration, lack of empathy. 5 symptoms
Eg fantasies of greatness, entitlement, exploitative, envious
Avoidant pd
Social inhibition, feelings of inadequacy, hypersensitivity. 4 symptoms
Eg avoids situations/relationships due to fear of negative evaluation, inhibited in new situations
Dependent PD
Excessive need to be cared for – submissive/clingy, indecisive, fear of separation. 5 symptoms, eg:
Abandonment fears, difficulty expressing disagreement, excessive support seeking
Obsessive Compulsive Personality Disorder
Preoccupation with order, perfectionism, control, resulting in inflexibility and inefficiency. 4 symptoms,
Eg rigid/stubborn, too detail focused, hoarding
“true” obsessions/compulsions are absent, though can be comorbid with OCD
Reactive Attachment Disorder
Inhibited, withdrawn behavior toward caregiver (rarely seeks/responds to comfort)
Some mood symptoms, minimal social responsiveness.
History of neglect
Disinhibited Social Engagement Disorder
Indiscriminant attachment behavior – overly familiar, lack of checking back, no apprehension. Insufficient care (eg changing caregivers)
Sources of trauma in PTSD
Direct experience, learning it occurred to a family member, repeated exposure to aversive details.
Must be physical threat (violence/integrity)
4 characteristic symptoms of ptsd
Must have symptoms in all categories: Intrusive (eg re-experiencing) Avoidance of associated stimuli Negative change in thoughts/mood (e.g., can’t remember the event, distorted cognitions) Increased arousal
What are the evidence based interventions for PTSD?
Cognitive processing therapy, prolonged exposure, seeking safety (for comorbid substance use), EMDR.
Describe psychological debriefing for ptsd
Intended as a brief preventative intervention for ptsd but it doesn’t work and might even be harmful.
Acute Stress Disorder
Traumatic event, 9 ptsd symptoms (any category), lasts 3 days to 1 month
Adjustment Disorder
Identified stressor, symptoms develop within 3 months and remit within 6 months.
Adjustment Disorder
Identified stressor, emotional/behavioral problems develop within 3 months and remit within 6 months.
Explain the distinctions between PTSD, Acute stress, adjustment
PTSD- can be onset any time, sx in all categories
Acute stress – sig trauma, lasts 3-30 days after trauma
Adjustment – stressor (less extreme), lasts up to 6 months
Dissociative Identity Disorder
2+ distinct identities, including: discontinuity of sense of self, with alterations in behavior/experience.
Frequent gaps in recall.
Common associated features with DID
Mood/anxiety, substance use, NSSI, seizures, flashbacks
Dissociative Amnesia
Inability to recall important information , usually associated with trauma/stressful event.
Dissociative Fugue
A feature/specifier for dissociative amnesia, during which the person travels/wanders during amnesia.
Depersonalization/Derealization
Sense of unreality or detachment from oneself/surroundings
Depersonalization/derealization disorder
Repeated/persistent episodes of depersonalization and/or derealization during which reality testing remains in tact.
