Test 2

Question 1

Bipolar disorder core symptoms

Answer 1

Dysregulation of mood and energy

Question 1

3 major aspects of functioning impacted by bipolar disorder

Answer 1

1. Emotion - now called mood
2. Intellect - now called cognition
3. Volition - now called energy level

Question 2

Hypomania vs mania

Answer 2

Hypomania - clear change from usual functioning, but not extreme enough to cause impairment: functioning in school. Duration requirement is shorter. 4 consecutive days. Not severe enough to warrant hospitalization.

Mania: 1 week or severe enough to warrant hospitalization.

Question 3

Atypical depression: bipolar

Answer 3

Hypersomnia instead of insomnia
Increased appetite instead of decreased
Weight gain instead of loss
Motor retardation
Decreased energy
Rejection sensitivity

Question 4

Bipolar I

Answer 4

Occurrence of at least 1 lifetime manic episode

Question 5

Bipolar II

Answer 5

Best considered a form of depressive illness
Meet full criteria for a hypomanic and major depressive episode

Question 6

Comorbidities with PDD

Answer 6

Depression
Psychosis
ADHD
Disruptive behavior disorders / ODD, CD
Anxiety
Pervasive developmental disorders/Autism spectrum disorder
Obesity and metabolic syndrome
Substance misuse

Question 7

Mood disorders in the DSM-5 TR

Answer 7

• Major Depressive Disorder
• Persistent Depressive Disorder
• Premenstrual Dysphoric Disorder
• Disruptive Mood Dysregulation Disorder
• Bipolar I *gen risk
• Bipolar II *gen risk
• Cyclothymic Disorder *gen risk

Question 7

Two key moods and what they’re characterized by

Answer 7

Depression: feelings of extraordinary sadness and dejection

Mania: intense and unrealistic feelings of excitement and euphoria

Question 8

Depression presentation in younger children

Answer 8

Lack vocabulary and self-awareness to specify feelings: mood and behavior might be irritable rather than sad

Question 9

Unipolar depressive disorder

Answer 9

A person experiences only depressive episodes

Question 10

Bipolar disorder

Answer 10

A person experiences both depressive and manic episodes

Question 11

Depressive episode

Answer 11

Feeling markedly depressed for at least 2 weeks

Question 12

Manic episode

Answer 12

Markedly elevated, expansive, or irritable mood for at least 4 days

Question 13

Hypomanic episode

Answer 13

Abnormally elevated, expansive, or irritable mood for at least 4 days; the person must also have 3 other symptoms similar to those involved in mania

Question 14

What is the most common mood disorder?

Answer 14

MDD in which only major depressive episodes occur

Question 15

MDD DSM-5 adults vs children

Answer 15

Essentially the same, but children might present irritably rather than with depression

Question 16

MDD Criteria

Answer 16

1. Must be in a major depressive episode, and never had a manic, hypomanic, or mixed episode
2. Depressed mood and/or loss of pleasure (anhedonia). In kids, this could be irritable mood.
3. Lasts most of the day, nearly every day, for 2 weeks at least
4. Four other physical or cognitive symptoms
   —–> Indecisiveness
   —–> Worthlessness
   —–> Fatigue
   —–> Appetite change
   —–> Psychomotor agitation or feeling slowed down
   —–> Sleep disturbance
   —–> Recurrent thoughts of death/suicide ideation/play/attempt

Question 17

Developmental considerations of MDD in children

Answer 17

1. More somatic complaints for kids
2. Hypersomnia -> adolescents
3. Boys: greater risk of suicide in late adolescence
4. Girls at higher risk of suicide in middle adolescence
5. Teens -> more fatigue, hypersomnia, suicidal thoughts, hopelessness/helplessness, weight loss

Question 18

MDD most common age of onset for the first episode

Answer 18

Middle to late adolescence

Question 19

PDD (dysthymia) age of onset

Answer 19

11 y.o

Question 20

Prognosis re: age of onset, MDD

Answer 20

When diagnosed as adolescents, course tracks with MDD

For younger children, an early diagnosis might = a different symptom course (could become another condition during adulthood)

Question 21

MDD Prevalence

Answer 21

Rare in childhood, rises in teen years

Pre-K: 1-2%
School age kids: 2.8%

Question 22

Gender differences MDD

Answer 22

Similar rates in childhood

12-15: rates for girls increase dramatically

Early maturing girls are at higher risk compared w/peers

Girls: more stress in general

Question 23

DSM Specifiers: MDD

Answer 23

With melancholic features With psychotic features With atypical features With catatonic features With seasonal pattern

Question 24

MDD with melancholic features

Answer 24

3 of the following Early morning awakening, depression worse in morning, marked psychomotor agitation/retardation, loss of appetite or weight, excessive guilt

Question 25

MDD with psychotic features

Answer 25

Delusions or hallucinations that are usually mood congruent; feelings of guilt and worthlessness common

Question 26

With catatonic features

Answer 26

Psychomotor symptoms like motoric immobility and extensive psychomotor activity Mutism Rigidity

Question 27

MDD with atypical features

Answer 27

Mood reactivity - brightens to positive events 2 of the 4: 1. weight gain or increase in appetite 2. hypersomnia 3. leaden paralysis 4. acutely sensitive to interpersonal rejection

Question 28

With seasonal pattern

Answer 28

2+ episodes in 2 years occurring at same time - usually fall/winter - with full remission at the same time - usually spring No other nonseasonal eps

Question 29

Persistent Depressive Disorder

Answer 29

Persistently depressed mood most of the day, for more days than not, for at least 2 years

Question 30

PDD "double depression"

Answer 30

chronic basis, but also times where person also meets MDD critera

Question 31

Disruptive mood dysregulation cannot coexist with

Answer 31

ODD IED BPD

Question 32

Disruptive mood dysregulation disorder can coexist with

Answer 32

MDD ADHD CD SUD

Question 33

What is disruptive mood dysregulation disorder?

Answer 33

New to the DSM Created due to excessive diagnosis of Bipolar Disorder Symptoms: pronounces and frequent temper outbursts with rage, persistently angry mood CONTROVERSY- really depressive? Too much like ODD/CD?

Question 34

Suicidality stats

Answer 34

15-25% of youth report ideation - not uncommon 1-4% of boys attempt, 1.5-10% of girls Completed suicides higher for boys Depression cited in 40% of completed suicides. Rates higher with substance use and behavior disorders

Question 35

Screening for depression

Answer 35

PHQ-9 often used in primary care/outpatient settings

Question 36

Depressive symptoms exist on a

Answer 36

continuum. DSM can give the impression of "having it" or "not having it"

Question 37

Alternative diagnosis if there is an identifiable stressor within 3 ms on symptom onset

Answer 37

Adjustment disorder w/depressed mood

Question 38

Negative affectivity is

Answer 38

HIGH in anxiety and depression

Question 39

Positive affectivity is

Answer 39

LOW in depression

Question 40

Physiological Hyperarousal

Answer 40

associated with panic disorder

Question 41

PANIC DISORDER

Answer 41

Recurrent, spontaneous, unexpected panic attacks for 1 ms Panic attack Change in behavior Palpitations, pounding heart, accelerated heart rate Sweating Trembling or shaking Sensations of shortness of breath, smothering Choking sensation Nausea, or abdominal distress Dizzy, unsteady, light-headed, faint Chills or heat sensations Derealization or depersonalization Fear of dying Fear of losing control or going crazy

Question 42

Cues in panic disorder

Answer 42

Interoceptive cues: internal, like increased HR and physiological arousal Exteroceptive cues: environmental cues like being in a crowd or a social situation Physiological symptoms become a CONDITIONED STIMULUS that precedes the next attack; this increases anxiety and this spiral leads to a panic disorder Example: running up the steps, HR picks up, conditioned stimulus leads to a panic attack Unlearning the connection - you can have the symptoms without having a panic episode

Question 43

AGORAPHOBIA

Answer 43

Fear or anxiety of being in situations where escape would be difficult if incapacitating or embarrassing symptoms occur, 6 months, more common in females Fear or anxiety of 2+ situations Using public transport Open spaces Closed spaces Standing in line/crowd Being outside of the home alone Fears/avoids these situations bc escape doesn’t seem possible Almost always provokes fear or anxiety Out of proportion Avoided, need a companion, or endure with intense fear/anxiety Persistent, 6 ms more Clin. sig distress or impairment Not better explained by another med condition Not better explained by another mental disorder

Question 44

SPECIFIC PHOBIA

Answer 44

Marked fear or anxiety cued by specific objects or situations, 6 months, more common in females Disproportionate fear of an object or situations Any danger proposed does not provoke the level of fear in most people The object is avoided or endured with great distress Associated fear = major distress, impairment in functioning 6 ms duration

Question 45

PHOBIA SPECIFIERS

Answer 45

Animal (wasps) Natural environment Situational (flying, bridges, tunnels, elevators, ESCALATORS, automatic toilets) Blood-injury-injection (physiological factors) Other (clowns, loud noises, etc)

Question 46

SOCIAL ANXIETY DISORDER

Answer 46

Marked fear or anxiety cued by social or performance situations, 6 months, more common in females Anxiety in one or more social situations with possible scrutiny by others Fears he/she will act in a way or show anxiety symptoms that will be neg evaluated Social situations almost always provoke fear/anxiety - Crying, tantrums, clinging Social situations avoided or endured w/intense fear or anxiety Out of proportion Persistent, 6ms or more Not attributable to substance Not attributable to another mental disorder Not attributable to another visible medical condition Specify if: performance only

Question 47

GENERALIZED ANXIETY DISORDER

Answer 47

6ms Excessive anxiety or worries about a number of events or activities Excessive anxiety or worries (...) Difficult to control the worry 3 or more of the following 6 symptoms Restlessness, feeling keyed up or on edge Easily fatigued Difficulty concentrating or mind going blank Irritability Muscle tension Sleep disturbance Cause clinically significant stress/impairment, not due to substance effect, not better explained by another mental disorder

Question 48

SEPARATION ANXIETY DISORDER (SAD)

Answer 48

Excessive anxiety concerning separation from home or caregiver, 4 weeks for children/adolescents, 6 months for adults, more common in females 3 of the following Distress when anticipating sep. Persistent and excessive worry about losing figure Refusal to go out, away from home, to work, elsewhere Persistent and excessive fear of being alone or w/out figure Nightmares, theme of sep. Physical symptoms Clin. sig distress, impairment Not better explained by another mental disorder Take developmental norms into account

Question 49

SELECTIVE MUTISM

Answer 49

consistent failure to speak in certain situations but not in others, 1 month grace period, equal gender distribution Consistent failure to speak in certain (...) Interferes with achievement or social com Not due to lack of knowledge re: spoken language Not attributable to a communication disorder, autism, schizophrenia, or another psychotic disorder

Question 50

RELATED disorders to OCD

Answer 50

Related: body dysmorphic, hoarding, trichotillomania & excoriation - picking at skin

Question 51

OCD

Answer 51

1. Recurrent and persistent thoughts, urges or images that are intrusive and unwanted 2. to ignore or suppress such thoughts with a compulsion 3. Repetitive behaviors in response to an obsession 4. Behaviors/mental acts aimed at preventing/reducing distress but are excessive/not connected 5. Obsessions/compulsions are time consuming 6. Not better explained by another disorder 7. Not due to a substance

Question 52

BODY DYSMORPHIA

Answer 52

Preoccupation with one or more defects or flaws in physical appearance that are small or not noticeable to others Repetitive behaviors Significant distress Preoccupation with body not better explained May spend several hours a day checking body for defects

Question 53

PANDAS

Answer 53

PANDAS syndrome describes a group of symptoms, such as tics and obsessive-compulsive behavior, thought to affect certain children who’ve had strep infections.