Test 2 Flashcards
Bipolar disorder core symptoms
Dysregulation of mood and energy
3 major aspects of functioning impacted by bipolar disorder
- Emotion - now called mood
- Intellect - now called cognition
- Volition - now called energy level
Hypomania vs mania
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.
Atypical depression: bipolar
Hypersomnia instead of insomnia
Increased appetite instead of decreased
Weight gain instead of loss
Motor retardation
Decreased energy
Rejection sensitivity
Bipolar I
Occurrence of at least 1 lifetime manic episode
Bipolar II
Best considered a form of depressive illness
Meet full criteria for a hypomanic and major depressive episode
Comorbidities with PDD
Depression
Psychosis
ADHD
Disruptive behavior disorders / ODD, CD
Anxiety
Pervasive developmental disorders/Autism spectrum disorder
Obesity and metabolic syndrome
Substance misuse
Mood disorders in the DSM-5 TR
- 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
Two key moods and what they’re characterized by
Depression: feelings of extraordinary sadness and dejection
Mania: intense and unrealistic feelings of excitement and euphoria
Depression presentation in younger children
Lack vocabulary and self-awareness to specify feelings: mood and behavior might be irritable rather than sad
Unipolar depressive disorder
A person experiences only depressive episodes
Bipolar disorder
A person experiences both depressive and manic episodes
Depressive episode
Feeling markedly depressed for at least 2 weeks
Manic episode
Markedly elevated, expansive, or irritable mood for at least 4 days
Hypomanic episode
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
What is the most common mood disorder?
MDD in which only major depressive episodes occur
MDD DSM-5 adults vs children
Essentially the same, but children might present irritably rather than with depression
MDD Criteria
- Must be in a major depressive episode, and never had a manic, hypomanic, or mixed episode
- Depressed mood and/or loss of pleasure (anhedonia). In kids, this could be irritable mood.
- Lasts most of the day, nearly every day, for 2 weeks at least
- 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
Developmental considerations of MDD in children
- More somatic complaints for kids
- Hypersomnia -> adolescents
- Boys: greater risk of suicide in late adolescence
- Girls at higher risk of suicide in middle adolescence
- Teens -> more fatigue, hypersomnia, suicidal thoughts, hopelessness/helplessness, weight loss
MDD most common age of onset for the first episode
Middle to late adolescence
PDD (dysthymia) age of onset
11 y.o
Prognosis re: age of onset, MDD
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)
MDD Prevalence
Rare in childhood, rises in teen years
Pre-K: 1-2%
School age kids: 2.8%
Gender differences MDD
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
DSM Specifiers: MDD
With melancholic features
With psychotic features
With atypical features
With catatonic features
With seasonal pattern
MDD with melancholic features
3 of the following
Early morning awakening, depression worse in morning, marked psychomotor agitation/retardation, loss of appetite or weight, excessive guilt
MDD with psychotic features
Delusions or hallucinations that are usually mood congruent; feelings of guilt and worthlessness common
With catatonic features
Psychomotor symptoms like motoric immobility and extensive psychomotor activity
Mutism
Rigidity
MDD with atypical features
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
With seasonal pattern
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
Persistent Depressive Disorder
Persistently depressed mood most of the day, for more days than not, for at least 2 years
PDD “double depression”
chronic basis, but also times where person also meets MDD critera
Disruptive mood dysregulation cannot coexist with
ODD
IED
BPD
Disruptive mood dysregulation disorder can coexist with
MDD
ADHD
CD
SUD
What is disruptive mood dysregulation disorder?
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?
Suicidality stats
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
Screening for depression
PHQ-9 often used in primary care/outpatient settings
Depressive symptoms exist on a
continuum. DSM can give the impression of “having it” or “not having it”
Alternative diagnosis if there is an identifiable stressor within 3 ms on symptom onset
Adjustment disorder w/depressed mood
Negative affectivity is
HIGH in anxiety and depression
Positive affectivity is
LOW in depression
Physiological Hyperarousal
associated with panic disorder
PANIC DISORDER
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
Cues in panic disorder
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
AGORAPHOBIA
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
SPECIFIC PHOBIA
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
PHOBIA SPECIFIERS
Animal (wasps)
Natural environment
Situational (flying, bridges, tunnels, elevators, ESCALATORS, automatic toilets)
Blood-injury-injection (physiological factors)
Other (clowns, loud noises, etc)
SOCIAL ANXIETY DISORDER
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
GENERALIZED ANXIETY DISORDER
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
SEPARATION ANXIETY DISORDER (SAD)
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
SELECTIVE MUTISM
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
RELATED disorders to OCD
Related: body dysmorphic, hoarding, trichotillomania & excoriation - picking at skin
OCD
- Recurrent and persistent thoughts, urges or images that are intrusive and unwanted
- to ignore or suppress such thoughts with a compulsion
- Repetitive behaviors in response to an obsession
- Behaviors/mental acts aimed at preventing/reducing distress but are excessive/not connected
- Obsessions/compulsions are time consuming
- Not better explained by another disorder
- Not due to a substance
BODY DYSMORPHIA
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
PANDAS
PANDAS syndrome describes a group of symptoms, such as tics and obsessive-compulsive behavior, thought to affect certain children who’ve had strep infections.
