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Autism7717 > Co-occurring Psychiatric Disorders 10/9 > Flashcards

Co-occurring Psychiatric Disorders 10/9 Flashcards

1
Q

True or False: Depressive disorders are less common among individuals with ID.

A

False

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2
Q

True/False: During an interview with an individual
with ID “yes” or “no” questions are the
best way to get information

A

False

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3
Q

True/False: Medication side effects may mimic the
signs and symptoms of mood
disorders

A

True

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4
Q

True/False: The signs and symptoms of mental
disorders are often expressed
differently in individuals with ID

A

True

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5
Q

True/False: Individuals with ID present the full
range of mental health problems that
are seen in the general population

A

Ture

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6
Q

True or False: Individuals with ID are MORE
vulnerable to developing mental health
problems that typically-developing
individuals

A

True

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7
Q

Generally accepted that ______% those with ID present mental health problem vs. _____% general population

A

30-40%

10-15%

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8
Q

Why differences in rates of mental health issues between ID and general population?

A

Subjects included and excluded, recruitment setting, source of information (teacher, self, person), diagnostic criteria (internalized symptoms, problem for certain time)

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9
Q

Why do we think there are more mental health issues in ID (etiology theories)?

A
  1. Biological/Genetic (condition, sensory sensitivity, thyroid, seizures)
  2. Structural brain abnormalities,
    neurotransmitter disruptions
  3. Developmental model
  4. Environmental effects including
    sociocultural influences, traumatic events
  5. Diathesis-stress mode
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10
Q

Difficulties even being REFERRED for diagnosis

A

Usually referred by others (need them to notice), symptoms misinterpreted, DSM for people who can self report DIAGNOSTIC INTERVIEW CORNERSTONE OF ASSESSMENT, importance of historical info

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11
Q

What makes the diagnostic process difficult?

A

Diagnostic Overshadowing, Psychosocial masking, Intellectual distortion, Baseline exaggeration, Cognitive disintegration

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12
Q

When symptoms of mental illness are labeled
behavior problems because the person has
a developmental disability this is what?

A

Diagnostic Overshadowing

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13
Q

If you have more limited social experiences, less colorful symptoms. Example: you say that you’re in manic phase, say that you will be going to college to be a doctor. You’ll be driving a car. Typical psychiatrist doesn’t see this as grandiose thinking.

What is this?

A

Psychosocial masking

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14
Q

Intellectual Distortion refers to

A

concrete thinking in communication problems.

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15
Q

Baseline exaggeration refers to

A

quantitative differences. SIB or irritability. Behavior with stable baseline, then increases due to psychiatric onset of problem.

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16
Q

The idea that people with ID have less cognitive resources to cope with stress is called

A

Cognitive disintegration

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17
Q

3 risks of diagnostic overshadow

A
  1. no diagnosis no treatment
  2. inaccurate diagnosis
  3. Polypharmacy
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18
Q

What was 1982 AJMR, now AJDD Alfred experiment?

A

When share IQ 65, PTSD was not a mentioned diagnosis for the boy

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19
Q

Most professionals agree that standard DSM criteria are applicable to who?

A

Verbal persons with mild ID (~85%)

But debate other levels

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20
Q

What is the Diagnostic Manual-ID (DM-ID)?

A

Remedy limits of DSM

NADD and APA
Complements DSM-5, reflects best practice of clinicians who specialize in DD. Expert consensus process- bridge gap between clinical research and practice.

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21
Q

What is in the DM-ID?

A

Information on assessing and diagnosing individuals with ID
* Some alterations in the source of information used in making a diagnosis
* Suggested adaptations to criteria (such as # of symptoms required)
* Suggestions vary based on level of functioning
* In many cases, no changes in criteria were recommended

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22
Q

Pros of modified diagnostic criteria for ID?

A

Good DM-ID2, gives some guidance for individuals with ID. Important enough that there’s a second book, if nothing else, demonstrates the need within this population.

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23
Q

Cons of modified diagnostic criteria for ID?

A

Different diagnostic criteria makes it more of a specialized field. CBCL. Modification for those with ASD. Other have said scoring for fragile x syndrome, down syndrome, etc. then it’s no longer standardized. Hard to make comparisons and know how groups differ and where the prevalence is.

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24
Q

What are interviewing techniques and issues for ID?

A

Motivational and response set issues
Question wording and content
Response format

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25
Q

Motivational and response set issues: Tendency to agree

A

Say yes to everything

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26
Q

Motivational and response set issues: social desirability

A

Answer what the interviewer wants to hear

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27
Q

Motivational and response set issues: wanting to “pass”

A

Want to appear like others, hide disability

“Cloak of confidence” pretending to play chess

28
Q

Motivational and response set issues: perseveration

A

Repeat subject and return to topic

29
Q

What is best practice for question wording and content?

A

Keep it CONCRETE and SIMPLE

30
Q

What are the pitfalls to question wording and content?

A

Abstract concepts (how are apples/oranges alike), comparisons across time and social comparisons self to others, double negatives, sequency events.

31
Q

When sequencing events for someone with ID, what should you use?

A

Anchor points

“Since your birthday” or “When you worked at ___”

32
Q

Response Format Good Ideas:

A

Open ended questions
Few choices (if multiple choice, don’t do long alternatives), use visual representations, branching questions?

33
Q

Response format: What if Yes No responses are necessary?

A

check later in interview
with reverse wording of same question

34
Q

What is the role of self report?

A

Limits, especially of internalizing disorder BUT

assist in diagnosis, track effects of intervention, self-determination and choice, one part of multi-modal assessment

35
Q

What should you look at to determine if it’s behavioral or psychiatric problem?

A

Symptom clusters, CHANGE/history, family history, impairment, motivation, deterioration from baseline, across situations, stressor and life events, medical issues, environment

36
Q

Why do we need the biopsychosocial approach?

A

Behavior is multi-determined

37
Q

What are medical influences on behavior?

A

Genetic syndromes
Medical Conditions
Current meds and side effects

Fragile X- ADHD, PraderW-psychotic, Williams-anxiety

Hypothyroid-depression, Hyperthyroid-anxiety

Risperidone-fatigue, anxiety, insomnia

38
Q

Why is physical assessment important?

A

Person with ID’s behavior could be due to physical pain or other problem

39
Q

Point of ADHD study?

A

1/3 only ADHD

Effect sizes of social skills training difference by comorbidity type. ADHD/anxiety better in behavior management, ADHD/conduct better with added meds

40
Q

Most people with ASD have _____ comorbidities

A

10% only ASD

2/3 had more than 2

41
Q

Differences and similarities between Depression (MDD) DSM-5 vs. DM-ID 2

A

Similar: 2 weeks or more, change in functioning

Different: 5 vs. 4 symptoms needed.
In ID, irritable mood is also accepted along with depressed/loss of interest (This is the cardinal symptom)

DM-ID reports by others also source of info for loss of interest: refuse activities, time alone, no signs of enjoyment, no longer likes reinforcers

42
Q

What are the problems diagnosing MDD among ASD folks?

A

Difficulty expressing emotion, poor integration of verbal/nonverbal expression, face neutral, people with ASD perfer alone time

43
Q

What is over-diagnosed and leads to risk for exposure to psychotropic meds unnecessarily?

A

Bipolar disorders

44
Q

Bipolar 1 vs. Bipolar 2

A

BP1: manic episode REQUIRED (can have hypo or depressive episodes)

BP2: Hypomanic REQUIRED and Depressive REQUIRED (No manic)

45
Q

Manic Episode: DSM-5 vs. DM-ID 2 similarities and differences

A

Similar: elevated, expansive or irritable mood, lasting 1 full week, during the week symptoms most of the day nearly every day.

DSM-5: 3+ symptoms sig degree (4 if irritable mood)

DSM-2: If limited expressive skills, 2 symptoms (3 if mood only irritable)

46
Q

DM-ID notes on what Manic episode look like in ID

A

Loud, inappropriate laughter/singer, smiling/giddy

Self-esteem/grandiosity (getting married when not dating anyone)

Decreased need for sleep - staff report “Up all night”

47
Q

____% adults with ID have comorbid anxiety

A

14-27%

48
Q

What two things make it difficult to diagnosis anxiety in ID?

A

Diagnostic overshadowing and intellectual distortion

49
Q

Adults with ASD have anxiety disorders at a rate of ___X greater than adults with ID.

As many as ____% of youth with ASD have anxiety.

Why is it hard to diagnose anxiety in ASD?

A

3x

50%

Overlap with core ASD symptoms

50
Q

Generalized Anxiety: Differences between DSM-5 and DM-ID2

A

DSM-5: Excessive worry 6 months, hard to control, associated with 3+ physical symptoms.

DM-ID2: Worry will be exceedingly difficult to assess, look at fear/anxiety instead. NO requirement for difficult to control

51
Q

Separation Anxiety DSM-5 vs. DM-ID2

A

DM-ID2: Fear observed rather than subjective report.

DSM-5: Developmentally inappropriate excessive fear about separation from primary attachments (3+ symptoms)

52
Q

Specific Phobia DSM-5/DM-ID2

A

DSM-5: Marked fear of specific, fear out of proportion, feared object avoided, 6+ months

DM-ID2: fear observed, crying, tantrums, freeze, cling

53
Q

Social Anxiety Disorder: DSM-5 vs. DM-ID2

A

DSM-5 fear/anxiety about 1+ social situation when individual is exposed to scruinty, fear of negative eval. 6+ months, out of proportion, social situations avoided

DM-ID2: Fear observed (crying, tantrums, freeze, cling, shrinking, no speech in social)

54
Q

Panic Attacks DSM-5/DM-ID2

A

DMS-5: attacked with 4+ symptoms

DM-ID2: Panic attack = surge of intense fear/discomfort observed that reaches peak in 15 min max

Severe ID- only need 3 symptoms

55
Q

Panic Disorder DSM-5 vs. DM-ID2

A

DSM-5: Recurrent panic attacks with 1 month+ of either fear of panic attacks or maladaptive behaviors change related to panic attacks

DM-ID2: temporal sequencing is challenge, use anchors

56
Q

What interventions are there for ID psychiatric illness?

A

Psych meds, behavioral interventions, psychotherapy/Counseling

57
Q

General principles for interventions with patients with IDD

A

Identify specific index behaviors to track to test efficacy

Baseline data

Track index behaviors with recognized measurements

Serially assess functional status (ADLs, memory, cognition, communication, etc.)

58
Q

Historical Perspective on Psychiatric Meds in ID

A

Majority don’t have signs of psychiatric illness

Behavioral disturbance

More meds, more antipsychotics utilized (typicals mostly)

Side effects: weight gain, glucose issues (diabetes), cardiovascular issues, oral health issues, extra pyramidal symptoms, TD

Longer you take meds, more adverse effects

59
Q

What are the general principles for prescribing meds to those with ID?

A

Start low go slow

Soame or lower Maintenace and maximum doses

Periodically consider gradual does reduction, taper gradually.

Avoid frequent dose or drug changes

60
Q

How should meds for ID patients be reviewed?

A

Regular and systemic review of meds. At least every 3 months and within 1 month of dose or drug changes

Prescriber sees patient at every clinical review

Collateral data utilized judiciously

61
Q

Polypharmacy: Is there a place for it in ID?

A

Intraclass polypharmacy (same class same time) rarely justified

BUT
IntERclass polypharmacy ok IF rationale: mood and psych symptoms, partial response to single med, comorbid conditions

62
Q

RCT with more than 30 people for drugs in ASD

A

Not a lot. 7 studies for atypical antipsychotics, 4 for antidepressants, 3 for atomoxetine, 2 for methylphenidate, etc. very few

Yet less for psychotherapies

63
Q

Behavioral Interventions in ID: history and what are they good for

A

Long history in DD

Good for adaptive behavior and skills of daily living

Combined with meds and other treatment

Continuing data collection is valuable tool for tracking response to intervention

64
Q

Behavioral Interventions: Monitoring (sharing behavior data with other professions. Yay or nay)?

A

Fine with appropriate consent

Useful to track response to interventions, signal changes in mental status and can promote integration of treatments

65
Q

What ID patients use counseling and psychotherapy the most?

Is this evidence based?

A

Mild IDD

Yes

Most often address interpersonal issues, general psych function, work

66
Q

What issues are in an ID person’s social circle?

A

Might be socially isolated, social networks may be family members/paid staff, desire for social contacts increases risk of vulnerability to influence and victimization.

67
Q

Goals and Benefits of Therapy

A

Achieve understanding and acceptance of self
* Increase knowledge of diagnosis and
medications
* Facilitate the appropriate expression of feelings
and emotions
* Improve interpersonal relationships
* Improve social skills
* Increase skills to deal with stress
* Improve self-esteem and self-image

Autism7717 (6 decks)

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