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EPPP > Abnormal Psychology > Flashcards

Abnormal Psychology Flashcards

1
Q

Categorical approach

A

The approach the DSM takes to defining and describing mental illness.

Illnesses are also categorized by general symptom clusters and the clinician decides if the patient meets the diagnostic criteria laid out

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2
Q

Polythetic Criteria

A

Criteria in the DSM don’t all have to be met to achieve a diagnosis

Allows for two people to have the same diagnosis with slightly different presentations. Accounts for heterogeneity of presentations

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3
Q

Nonaxial Assessment System

A

The DSM-5 got rid of the Axis system of diagnosing. Just list all medical and mental diagnoses together, with the primary diagnoses listed first

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4
Q

How to handle diagnostic uncertainty

A

Other specified - when you want to indicate why someone doesn’t meet criteria

Unspecified - when you don’t want to indicate why someone doesn’t meet criteria

Provisional - when person doesn’t meet full criteria but you believe they will in the future

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5
Q

Other specified disorders

A

When you want to list the reasons why someone doesn’t meet full criteria for another disorder

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6
Q

Unspecified disorders

A

When the clinician doesn’t want to list the reasons why a person doesn’t meet criteria

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7
Q

Provisional diagnoses

A

When someone is not meeting criteria for a disorder, but you believe they will in the near future

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8
Q

Assessment strategies for the DSM

A

Cross-cutting measures

Severity measures

WHODAS

Personality inventories

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9
Q

Cultural Formulation

A

Provides guidelines for assessing the clients cultural identity, cultural conceptualization of distress, stressors and cultural factors that contribute to distress, and cultural factors relevant to rapport

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10
Q

Neurodevelopmental Disorders

A 
Intellectual Disability
Autism Spectrum Disorder
ADHD
Specific Learning Disorders
Tourette’s 
Communication Disorders
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11
Q

Presentation of neurodevelopmental disorders typically manifest…

A

Early in development, often before the child enters grade school

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12
Q

Three diagnostic criteria for Intellectual Disability

A

Deficits in intellectual fxning, confirmed by standardized testing

Deficits in adaptive functioning

Must have onset in developmental period

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13
Q

Early signs of intellectual disability include…

A

Delays in motor development

Lack of age-appropriate interest in environmental stimuli
(May not make eye contact during feeding, less responsive to voice)

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14
Q

Etiology of Intellectual Disability

A 
30% unknown
30% chromosomal and exposure to toxins
15-20% environmental 
10% perinatal issues
5% acquired medical
5% heredity (Tay-Sachs, fragile X...)
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15
Q

Primary communication disorder

A

Childhood onset fluency disorder

Stuttering

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16
Q

Characteristics of Child-Onset Fluency Disorder

A

Disturbance in normal language fluency and time pattering

Involves repetition of sound and syllables, broken words, etc.

Inappropriate for the persons age

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17
Q

Course of child onset fluency disorder

A

Onset 2-7 years

Symptoms become more pronounced when speech performance matters

Severity of issue by age 8 is a good indicator of prognosis, 65-85% of children recover

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18
Q

Treatment for childhood onset fluency disorder

A

Reducing stress at home

Help child cope with frustration

Habit reversal training - relax muscles in throat and diaphragm

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19
Q

Diagnostic criteria for Autism Spectrum Disorder

A

Persistent deficits in social communication (reciprocity, difficulty understanding relationships, nonverbal comm issues)

Restrictive and repetitive interests or patterns of behavior

Early developmental period onset, impairments in many domains

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20
Q

Associated features with ASD

A

Intellectual deficits

Self-injurious behavior

Language abnormalities

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21
Q

Onset of ASD

A

Earliest signs are abnormalities of social orienting and responsivity

Apparent around 12 months of age

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22
Q

Prognosis of ASD

A

Generally poor

One third may obtain some independence as an adult

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23
Q

Best outcomes of ASD are associated with…

A

IQ above 70

Later onset of symptoms

Development of verbal communication abilities by age 5 or 6

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24
Q

Etiology of ASD

A

Associated with rapid head growth in first year of life

Brain abnormalities in amygdala and cerebellum

NT abnormalities (dopamine, serotonin)

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25
Q

Treatment for ASD

A

Special education
Parent management training
Social interaction and vocational skills

For communication: shaping and discrimination training

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26
Q

Diagnostic criteria for ADHD

A

At least six sx, last six months, onset before age 12, more than two settings

Hyperactivity
Inattention

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27
Q

Three specifiers in ADHD

A

Hyperactive type - six or more hyperactive sx, less than six inattentive sx

Inattentive type - six or more inattentive sx, less than six hyperactive sx

Combined - six or more inattentive, six or more hyperactive

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28
Q

Associated features of ADHD

For children

A

Intelligence is often avg to high average, but perform lower on IQ or standardized tests

Academic and social difficulties

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29
Q

Associated features of ADHD

For adults

A

Low self-esteem

Lower educational or occupational attainment

Problems related to social relationships

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30
Q

Prevalence of ADHD

A

5% for children

2.5% for adults

Males > females
(Males combined, females inattentive

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31
Q

Etiology of ADHD

A

Genetic component

Brain abnormalities in globus pallidus, caudate nucleus, and prefrontal cortex (lower than normal activity)

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32
Q

Behavioral disinhibition hypothesis for ADHD

A

Core feature of ADHD is an inability to regulate behavior to fir situational demands

(An alternative hypothesis said that it was an inability to regulate attention)

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33
Q

Treatments for ADHD

A

Methylphenidate or CNS stimulants are effective in 75% of cases

Behavioral treatments - parent and teacher training, positive reinforcement

Medical only and medical/tx have higher outcomes but only for short-term (similar improvement long term when compared to tx only)

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34
Q

Three domains of adaptive functioning deficits in Intellectual Disability

A

Conceptual

Social

Practical

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35
Q

Diagnostic criteria for Specific Learning Disorder

A

Deficit in an academic area for at least six months despite the provision of interventions

Academic abilities must be substantially below what’s expected given age

Begin during school years

Not attributed to other conditions or disorders

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36
Q

Three subtypes of SLD

A

Reading

Writing

Mathematics

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37
Q

Most frequent comorbid disorder with SLD

A

ADHD

20-30%

Also have a higher risk for antisocial behavior

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38
Q

Course and prognosis of SLD

A

Continue to struggle from childhood through to adulthood

One third have psychosocial problems as adults

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39
Q

Prevalence of SLD (gender)

A

Males > females

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40
Q

Etiology of SLD

A

Genetic component

Incomplete hemispheric dominance or other abnormalities

Cerebellar-vestibular dysfunction

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41
Q

Criteria for Tourette’s Disorder

A

At least one vocal tic
Multiple motor tics

Onset before age 18, lasts at least one year

Less than 1yr = provisional // over 1yr = persistent (chronic)

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42
Q

Prognosis of Tourette’s

A

Frequency, severity, and disruptive ness of symptoms often decline in adolescence and adulthood

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43
Q

Most common associated symptoms with Tourette’s

A

Obsessive compulsive symptoms

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44
Q

Etiology of Tourette’s

A

Increase of dopamine, hypersensitivity to dopamine

In caudate nucleus

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45
Q

Treatment for Tourette’s

A

Antipsychotics (80% effective, bad SEs)

Antidepressants, stimulants

Comprehensive behavioral treatment for tics (CBIT)
(Habit reversal training, relaxation skills, psyched)

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46
Q

Comprehensive Behavioral Treatment for Tics

CBIT

A

Habit reversal

Relaxation training

Psychoeducation

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47
Q

Behavioral Pediatrics

A

Aka pediatric psychology

Concerned with the psychological aspects of children’s medical illnesses
(Compliance with medical regimens, coping with painful procedures)

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48
Q

Disclosure in behavioral pediatrics

A

Open communication with children about their medical issues is advisable (leads to better coping)

MUST be done with developmentally appropriate

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49
Q

Behavioral pediatrics and medical procedures

A

Stress inoculation techniques to help children cope with anxiety and stress

Ex. Modeling, reinforcement, breathing exercises, distraction, imagery, behavioral rehearsal

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50
Q

Impact of hospitalization on medically ill children

A

Ages 1-4 are at highest risk of distress due to separation from family

Can be prevented by “rooming in” programs (where parents are allowed to stay at the hospital)

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51
Q

Impact of medical illness on children’s academic adjustment

A

Children with chronic medical conditions have higher rates of school-related issues

Can be due to the medical treatments themselves, or the constant absences from school

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52
Q

Reason for medical noncompliance in children

A

Lack of knowledge or skill

Parent-child conflict or communication deficits

Developmental issues

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53
Q

Reasons for medical noncompliance specific to adolescents

A

Fear of peer rejection

Desire for nonconformity

Reduced parental supervision

Questioning credibility of medical provider

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54
Q

Delusions

A

False beliefs that are firmly held in the face of contradictory evidence

In schizophrenia, they are often persecutory or bizarre

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55
Q

Hallucinations

A

Perception-like experiences that occur without an external stimulus

Auditory are most common and take the form of pejorative or threatening messages, or are a running dialogue of the persons actions

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56
Q

Disorganized thinking

A

Loosening of associations (incoherence, answers to questions that are unrelated, or slipping from topic to topic)

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57
Q

Grossly disorganized or abnormal behavior

A

Unpredictable agitation

Catatonia

Markedly disheveled appearance

Clearly inappropriate sexual behavior

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58
Q

Negative symptoms

A

A restriction in the range or intensity of emotional expression

Alogia - diminished speech output
Anhedonia - inability to feel pleasure
Asociality - lack of interest in social interactions
Avolition - decrease in goal-directed behavior

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59
Q

Diagnostic criteria for delusional disorder

A

Presence of one or more delusions for at least one month

Functioning is otherwise fine, save for functional impairment relatives directly to the delusion

Erotomanic, grandiose, jealous, persecutory, somatic, mixed, unspec.

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60
Q

Types of delusions

A

Erotomanic - believes someone is romantically in love with them
Grandiose - great but unrecognized talent or discovery
Jealous - partner is being unfaithful
Persecutory - being conspired against, spied on
Somatic - has abnormal body functions or sensations
Mixed
Unspecified

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61
Q

Diagnostic criteria for schizophrenia

A

At least two active symptoms for one month
(Delu, halu, disorganized speech, disorganized behavior, neg sx)

Duration for at least six months
One of the symptoms must my disorganized speech, del, or halu

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62
Q

Associated features of Schizophrenia

A

Inappropriate affect
Dysphoric mood
Disturbed sleep
Lack of interest in eating

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63
Q

Prognosis of schizophrenia

A

Chronic condition, with full remission being rare

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64
Q

Indicators of better outcomes in patients with schizophrenia

A 
Later onset
Good premorbid functioning
Insight
Being female
Presence of a precipitating event 
Brief duration
No family hx of schizophrenia
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65
Q

Prevalence of schizophrenia

A

0.3-0.7%

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66
Q

Predictors of relapse in schizophrenia

A

Family with high EE

Treatment noncompliance

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67
Q

Comorbid diagnosis commonly seen with schizophrenia

A

Substance abuse disorders

Tobacco Use disorder being particularly high

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68
Q

Onset of schizophrenia

A

Late teens to early 30s

Earlier onset for men, later onset for women

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69
Q

Concordance rates for schizophrenia

A

Identical twin with schizophrenia 48%
Both bio parents have schizophrenia 46%
Fraternal twin with schizophrenia 17%
Biological sibling with schizophrenia 10%

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70
Q

Strong evidence that schizophrenia is highly genetic

A

Relatives of individuals with schizophrenia aren’t just at a higher risk for schizophrenia, but for other schizophrenia spectrum disorders

(Especially schizotypal personality disorder)

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71
Q

Dopamine hypothesis for schizophrenia

A

Overabundance of DA or oversensitivity of DA receptors

Role of DA May differ for the expression of positive and negative symptoms though

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72
Q

Brain abnormalities in schizophrenia

A

Enlarged ventricles

Decrease activity in the frontal cortex and prefrontal cortex

Smaller globus pallidus, amygdala, and hippocampus

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73
Q

Prenatal exposure to the influenza virus may be connected to what diagnosis

A

Schizophrenia

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74
Q

Schizophrenia vs Schizoaffective vs Mood w psychotic features

A

Schizophrenia - mood symptoms are brief, do not meet full criteria, and are not present during active phase

Schizoaffective - predominant mood sx will occur with psychosis and at least two week period where psychotic sx only

Mood w psychotic features - psychotic symptoms only occur during the course of a mood episode (MDD or BD)

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75
Q

First generation vs second generation antipsychotics

A

First gen - fluphenazine and haloperidol - positive sx only - bad SEs (tardive dyskinesia)

Second gen - risoeridone and clozapine - positive and negative sx - loss likely to develop TD

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76
Q

Psychotherapy for schizophrenia

A

Good results when paired with medical treatment

Family interventions (if high EE), psychoed, CBT, social skills training, vocational work…

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77
Q

Examples of high EE

A

Being over emotional or overprotective

Being openly critical or hostile towards the person

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78
Q

Diagnostic criteria for Schizophreniform Disorder

A

Same as for schizophrenia, but for less than six months and more than one month

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79
Q

Prognosis of schizophreniform disorder

A

Two thirds eventually meet criteria for schizophrenia or Schizoaffective disorder

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80
Q

Diagnostic criteria for Brief Psychotic Disorder

A

One or more of delu, halu, disorganized speech, disorganized behavior (one must be one of the first three)

More than one day, less than one month

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81
Q

Prognosis of brief psychotic disorder

A

Return to premorbid functioning common

Usually occurs after a significant life stressor

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82
Q

Schizoaffective criteria

A

Concurrent schizophrenia and mood symptoms

For at least a two week period, there should be psychosis only (without any mood symptoms)

Mood symptoms are depression or mania that meet diagnostic criteria

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83
Q

Age as a suicide risk factor

A

Highest number of suicides in 45-54 age range

This is highest in women, in men it’s 75+

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84
Q

Gender as a risk factor for suicide

A

Men 4x more likely to die by suicide
(More lethal means)

Women 2-3x more likely to attempt

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85
Q

Ethnicity/Race as a risk factor for suicide

A

Alaskan Natives and American Indians age 15-34 have the highest rates (2.5x higher than the national average)

Then whites

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86
Q

Marital status as a risk factor for suicide

A

Divorced, separated, widowed are highest

Then single

Lowest rates for married persons

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87
Q

Statistics for suicidal thoughts and behaviors

A

60-80% have had a previous attempt

80% give a definite warning of their intention

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88
Q

Early warning signs of suicide

A

Threatening self harm or suicide
Talking or writing about death or suicide
Seeking means for suicide
Making preparations (will, giving away possessions, saying goodbye)

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89
Q

Among adolescents, completed suicide is often mmediately preceded by…

A

Interpersonal conflict (social or romantic rejection, argument with a parent)

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90
Q

Psychological disorders and suicide

A

MDD or BD dx are 15-20x more likely than the general population

With depression, suicide is most commonly seen after about three months of symptom improvement

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91
Q

Personality correlates of suicide

A

Hopelessness biggest predictor

Perfectionism may also be a predictor when coupled with high life stress

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92
Q

Biological predictors of suicide

A

Low levels of serotonin and 5-HIAA (serotonin metabolite)

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93
Q

How to decide appropriate intervention for someone who is suicidal

A

Outpt psychotherapy, outpt crisis intervention, or inpatient hospitalization

Depends on the level of risk, clients preference, and the potential benefits of each approach

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94
Q

When is hospitalization an appropriate intervention for suicide

A

When someone has just attempted or has a plan with access to lethal means
(+ impaired judgment, no social support, SMI or chemical dependency, history of previous attempts)

Always encourage voluntary first, then initiate a hold if need be

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95
Q

When is outpatient crisis intervention appropriate for suicide

A

Moderate risk clients - plan with a lack of access

Fair judgement, social support, decision making abilities, willingness to comply with treatment recommendations

Tx will focus on decreasing isolation, relieving sleep issues, coping skills for anger, addressing ambivalence about suicide

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96
Q

When is outpatient psychotherapy appropriate for suicide

A

Follow-up to hospitalization, or
For initial interventions for those who are at low risk (no prev attempts, good judgement, adequate support…)

Tx: CBT, CBT, IPT, Problem-Solving Therapy

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97
Q

Diagnostic criteria for Bipolar I Disorder

A

At least one manic episode

Marked impairment in functioning, requires hospitalization, may include psychotic symptoms

May include one or more episodes of depression or hypomania

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98
Q

Manic episode

A

For at least one week

At least three of: inflated self esteem or grandiosity, decreased need for sleep, excessive talkativeness, flight of ideas

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99
Q

Associated diagnoses with Bipolar I Disorder

A

Anxiety

Substance abuse

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100
Q

Prevalence of bipolar I disorder

A

0.6 percent

Men:women
1.1:1

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Perfectly
101
Q

Concordance rates for Bipolar I

A

0.67 to 1.0 for monozygotic twins
.2 for dizygotic twins

(Strongest genetic loading out of all the disorders)

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102
Q

Treatment of Bipolar I

A

60-90% effectiveness with Lithium
(Noncompliance due to mania highs and side effects)

May also use anti-seizure meds

TCAs may trigger mania if taken with a mood stabilizer (not so much with an SSRI)

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103
Q

Diagnostic criteria for Bipolar II Disorder

A

At least one hypomanic episode and one depressive episode

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104
Q

Hypomanic episode

A

Lasts at least four consecutive days

At least three of the criteria for mania, but not severe enough to cause marked dysfunction or hospitalization

105
Q

Diagnostic criteria for Cyclothymic Disorder

A

Symptoms of hypomania (without meeting criteria)
Symptoms of depression (without meeting criteria)

Cause significant distress or impaired functioning

Sx last for at least two years (adults, one year for youth)…cannot be symptom free for longer than two months at a time

106
Q

Diagnostic criteria for Disruptive Mood Dysregulation Disorder

A

Severe temper outbursts
Out of proportion to the situation (and not developmentally appropriate)

At least 12 months, in at least two settings

Onset: before age 10, can’t dx before 6yo or after 18yo

107
Q

Diagnostic Criteria for Major Depressive Disorder

A

At least five sx of SPACERAGS for at least two weeks

At least one symptom being depressed or sad mood, or loss of interest or pleasure

Sad, psychomotor, appetite, concentration, energy, recurring thoughts, anhedonia, guilt, sleep

108
Q

SPACERAGS

A 
Sadness
Psychomotor 
Anhedonia
Concentration
Energy
Recurring thoughts
Appetite
Guilt
Sleep
109
Q

Specifies of MDD, BD I, and BD II

A

Peripartum Onset - before baby or up to four weeks after
Usually includes anxiety about the baby, or delusions

Seasonal Pattern - temporal relationship between the sx and the seasons
SAD most common in the winter in North America

110
Q

Percentage of women who experience depression after giving birth

A

10-20%

.1-.2% postpartum psychosis

111
Q

MDD vs Baby Blues

A

80% of women experience mild mood symptoms

MDD is more disabling and severe

112
Q

Sleep disturbances and MDD

A

Sleep continuity disturbances

Reduced stage 3/4 sleep

Decreased REM latency

More REM in early night sleep

113
Q

Prevalence of MDD

A

7%

18-29 years most prevalent

114
Q

Age of onset of MDD

A

Mid-20s

May initially be caused by severe psychosocial stressors
(However with repeated episodes, the need for the stressor drops off)

115
Q

Presentation of MDD as a function of age

A

Youth - somatic complaints, social isolation, irritability
(Aggression and destructiveness in preadolescent boys)

Older adults - memory loss, distractibility, disorientation, other cog sx
(Distinguishes from neurocog because onset is abrupt and distressing)

116
Q

MDD in older adults vs Neurocognitive Disorder

A

MDD onset cognitive symptoms are abrupt, and the person is usually concerned about their functioning and deficits

True neurocognitive symptoms usually come on gradually, and the person is unaware or denies their impairments

117
Q

Two biochemical theories of depression

A

Indolamine Hypothesis - low levels of serotonin cause depression

Catecholamine Hypothesis - low levels of norepinephrine

118
Q

Lewinsohn’s Behavioral Theory of Depression

A

Depression is caused by a low rate of response-contingent reinforcement for social or other behaviors

Results in isolation and pessimism

119
Q

Seligman’s Learned Helplessness Model of Depressin

A

A series of uncontrollable negative events is attributed to internal, stable, and global factors

Hopelessness is the proximal cause

120
Q

Rehm’s Self-Control Model of Depression

A

Depression is a result of problems with self-monitoring, self-evaluation, and self-reinforcement

121
Q

Beck’s Cognitive Triad Model for depression

A

Negative and irrational thoughts about the self, world, and the future

122
Q

When psychotic symptoms occur exclusively within the context of a mood episode…

A

MDD (or BD) with psychotic features

123
Q

MDD vs Adjustment Disorder

A

MDD criteria are not met with true adjustment disorder

124
Q

MDD vs Uncomplicated Bereavement

A

UB typically presents with normal mood, but added feelings of emptiness or loss

UB tends to decrease over days to weeks - May occur in waves that are triggered by reminders of the deceased

125
Q

Drug treatment for MDD

A

TCAs - for vegetative, classic depression that is worse in the morning

SSRI - first-line treatment that does not have the risk of overdose that TCAs do

MAOIs - last line for people who do not respond to other meds, and have atypical sx

126
Q

Psychotherapy for MDD

A

Combine it with medication for a better effect than meds or psychotherapy alone

127
Q

ECT for MDD

A

Severe, treatment-resistant depression
With sx of delusions or severe SUI

Side effects: temporary amnesia, confusion, disorientation

128
Q

Diagnostic Criteria for Persistent Depressive Disorder

A

For at least two years (one for youth)
At least two CHEESE symptoms

Concentration, hopelessness, esteem, energy, sleep, eating

Cannot be sx-free for more than two months

129
Q

Treatment for Persistent Depressive Disorder

A

SSRI, CBT, IPT

130
Q

Similarities between anxiety and depression

A 
Impaired concentration and attention
Irritability
Fatigue
Insomnia
Hopelessness
131
Q

Dissimilarities between depression and anxiety

A

Anxiety - higher levels of positive affect and autonomic arousal

Pure depression - low mood, anhedonia, suicidal ideation, low libido
Pure anxiety - apprehension, tension, worry, nightmares

132
Q

Diagnostic criteria for Separation Anxiety

A

Developmentally inappropriate fear or anxiety related to separation from home or an attachment figure

excessive distress when anticipating or experiencing separation
persistent fear of being alone
physical symptoms

At least four weeks in children, six months in adults

133
Q

School Refusal

A

A manifestation of separation anxiety in children

Stomachache, headache, nausea, other physical sx

Typically occurs 5-7yrs, 10-11yrs, 14-16yrs
May be associated with social phobia, depression, change of schools…

134
Q

Etiology of Separation Anxiety

A

Frequently precipitated by a major life stress (death of a relative or pet, divorce, or move to a new place)

135
Q

Treatment for separation anxiety

A

Systematic desensitization
Cognitive approaches

When the sx include school refusal, the primary goal is immediate return to school to prevent academic failure and social isolation

136
Q

Diagnostic Criteria for Specific Phobia

A

Intense fear or anxiety about a specific situation or object
Object or situation is avoided or endured with marked distress

Subtypes: animal, blood/injection/injury, environmental, situational, other

137
Q

Subtypes of specific phobia

A 
Animal
Blood/injection/injury
Environmental 
Situational
Other
138
Q

Two-factor theory for Specific Phobia

A

Avoidance conditioning

Learn to fear a neutral (conditioned) stimulus because of its pairing with a fear-arousing (unconditioned) stimulus

Avoidance of the conditioned stimulus is negatively reinforced because it because it keeps the from experiencing the anxiety

139
Q

Treatment for Specific Phobia

A

Exposure with response prevention
(Especially in vivo exposure)

Exposes the person to the feared object while preventing them from engaging in behavioral or cognitive avoidance

140
Q

Exposure therapy is most effective when…

A

It is paired with APPLIED TENSION

Involves repeatedly tensing and releasing the muscles in the body’s major muscle groups (to increase blood pressure)

141
Q

Diagnostic criteria for Social Anxiety Disorder (Social Phobia)

A

Fear of one or more social situations where you may be exposed to the scrutiny of others

Fears they will exhibit symptoms and will be negatively evaluated

Typically lasts at least six months

142
Q

Situations commonly association with Social Anxiety Disorder…

A

Public speaking

Attending parties

Initiating conversations

Speaking to authority figures

143
Q

Treatment for Social Anxiety Disorder (Social Phobia)

A

Exposure with response prevention
Social skills, cognitive techniques

SSRI, SNRI, beta blocker propranolol

144
Q

Diagnostic criteria for Panic Disorder

A

Recurrent, unexpected panic attacks
At least one attack being followed by a period of concern about having additional attacks (lasting at least a month)

PA sx: heart race, sweating, trembling, choking, chest pain, paresthesias, derealization, fear of losing control

145
Q

Medical rule outs before a diagnosis of Panic Disorder can be rendered…

A

Hyperthyroidism, hypoglycemia, cardiac arrhythmia

146
Q

Prevalence of Panic Disorder

A

2-3% in a twelve month period

Females twice as likely as males

147
Q

Treatment for Panic Disorder

A

CBT
Panic Control Therapy (PCT) - psychoed, relaxation, cognitive restructuring, interoceptive exposure (expose to physical sensations of panic)

Also responsive to TCAs, SSRIs, SNRIs, and benzos
But if med only you have a 30-70% chance of sx rebound once you discontinue

148
Q

Diagnostic criteria for Agoraphobia

A

Fear or anxiety about being in at least two spaces:
Public transportation, open spaces, enclosed spaces, standing in line, crowd, being outside of the home alone

Fears or avoids because escape may be difficult or help will not be available if panic occurs

At least six months

149
Q

Agoraphobia vs Specific Phobia vs Social Anxiety

A

Specific - anxiety only for a single situation, concern is related to something other than experiencing panic

Social anxiety - anxiety is related to being scrutinized, may increase sx when in the presence of family or friends

Agoraphobia - anxiety is related to panic, in multiple situations, may be helped by the presence of a family member or friend

150
Q

Treatment for Agoraphobia

A

In vivo exposure with response prevention

Graded vs nongraded have similar effects in the short term
Nongraded exposure has better effect in the long term

151
Q

Diagnostic criteria for Generalized Anxiety Disorder

A

Excessive worry about multiple events

At least six months

Difficult to control

At least three (1 for children): restlessness, fatigue, muscle tension, irritability, difficulty with concentration, sleep disturbance

152
Q

Cormorbid diagnoses with GAD

A

50% of patients with GAD have a second diagnosis

MDD, PDD, SUD, Phobia, Social Anx

153
Q

Age-related anxiety features

A

Children and adolescents - performance in school, sport, natural disasters

Young Adults - work, family, finances, future

Older Adults - personal health, minor or routine matters

154
Q

Treatment for GAD

A

CBT and pharmacotherapy

SSRIs, SNRIs, and benzos or Buspar when those don’t work

155
Q

Obsessions

A

Persistent thoughts, impulses, or images that a person experiences as intrusive or unwanted, that they cannot ignore or suppress

Ex. Repeated thoughts of contamination, repeated doubts of one’s abilities

156
Q

Compulsions

A

Repetitious and deliberate behaviors or mental acts that a person feels driven to perform (either in response to an obsession or according to rigid rules)

Goal of the behavior is to reduce distress or prevent a dreaded situation from happening (but the behavior is excessive or not logically connected)

157
Q

Diagnostic criteria for Obsessive-Compulsive Disorder

A

Recurrent obsessions and/or compulsions

Time consuming

Cause impairment in functioning

158
Q

Gender and OCD

A

Equal prevalence in males and females

More prevalent in younger males because onset is earlier in males

159
Q

Etiology in OCD

A

OCD is caused by low levels of serotonin

Increased activity in the right caudate nucleus
Responsible for conversing sensory input into actions

160
Q

OCD vs OCPD

A

OCPD does not involve obsessions or compulsions
(Preoccupation with perfection, control, orderliness)

Rituals are performed to

  • reduce anxiety (OCD)
  • gain perfection (OCPD)
161
Q

Treatment of OCD

A

Exposure with response prevention

SSRI

Don’t just medicate without therapy, the risk of relapse is really high for medication-only patients

162
Q

Body Dysmorphic Disorder

A

(Obsessive-Compulsive and Related Disorders)

Preoccupation with a perceived defect or flaw in appearance
That is minor or unobservable to others

163
Q

Hoarding Disorder

A

Persistent difficulty discarding or parting wit possessions

Regardless of their actual value

164
Q

Reactive Attachment Disorder

A

Emotionally withdrawn behavior with adult caregivers
(At least 2) irritability, low positive affect, limited emotional responsiveness, sadness, fearful…when with caregiver

Must have experienced extreme insufficient care

Developmentally older than 9mo, sx must present before 5yo

165
Q

Disinhibited Social Engagement Disorder

A

Inappropriate actions with unfamiliar adults
(At least 2) absence of hesitance with unfamiliar adults, overly familiar with unfamiliar adults, diminished checking for approval from caregiver, following unfamiliar adult with little/no hesitation

Child must have experienced extreme insufficient care

Must be developmentally older than 9mo, sx onset must be before 5yo

166
Q

Acute Stress Disorder diagnostic criteria

A

Nine sx from PTSD categories

Three days to one month

167
Q

PTSD criteria

A

Exposure to actual or threatened death/injury/violence
(In one of four ways)

At least one intrusion sx
Avoidance of stimuli associated with event
Two negative changes or affect or mood
Two changes to arousal or reactivity

More than one month

168
Q

Four ways to meet PTSD criteria for exposure to events

A

Direct experience

Witnessing the event

Learning the event occurred to a loved one

Repeated exposure to adverse effects of the event

169
Q

Treatment for PTSD

A

CBT - exposure, cognitive restructuring, anx mgmt

SSRI - for comorbid depression or anxiety - may lead to relapse without psychotherapy

170
Q

Two controversial treatments for PTSD

A

Eye movement desensitization and reprocessing (EMDR)
- beneficial, but nothing to demonstrate this is something special

Cognitive incident stress debriefing (CISD)

  • one lengthy session within 72 hours of trauma, regardless of whether or not the person is evidencing trauma sx
  • may actually worsen symptoms
171
Q

Adjustment Disorder

A

Emotional or behavioral sx after one or more identifiable psychosocial stressors

Must occur within three months of the stressor
Must remit after six months of the stressor or its consequences

Not diagnosed when symptoms represent normal bereavement

172
Q

Delayed onset specified for PTSD

A

When full diagnostic criteria are not met until at least six months after the traumatic event

173
Q

Diagnostic criteria for dissociative identity disorder

A

One individual experiencing two or more distinct personality states

Gaps in recall of ordinary events, personal information, or traumatic events that are not consistent with ordinary forgetfulness

174
Q

Important ruleout for dissociative identity disorder

A

Cultural considerations

May be acceptable form of religious expression

175
Q

Dissociative Amnesia criteria

A

Inability to recall personal information that cannot be attributed to ordinary forgetfulness.

Often related to the exposure of a traumatic event

5 types: localized (all events around a period of time), selective (some events around a period of time), generalized (encompasses whole life), continuous (from a certain point until present), systematized Ed to a certain caregory)

176
Q

Five types of amnesia

A

Localized - all events within a circumscribed period of time

Selective - some events within a circumscribed period of time

Generalized - whole life

Continuous - from a period open time until present

Systematized - can’t remember reacted to a specific category

177
Q

Depersonalization and Derealization Disorder

A

Depersonalization - sense of detachment, unreality

Derealization - detached from one’s surroundings

More than six months in duration

178
Q

Somatic Symptom Disorder criteria

A

One or more somatic sx that cause distress
Accompanied by excessive thoughts, feelings, behaviors, related to the symptoms

Disproportionate worry about seriousness, excessive time devoted to health, high anx about medical…

More than six months in duration

179
Q

Illness Anxiety Disorder

A

Preoccupation with having a serious illness
No somatic symptoms (or very mild)
High level of anxiety about one’s health

For at least six months

180
Q

Conversion disorder

A

Incompatibility between your symptoms and the medical issues they may represent

Ex. Paralysis, blindness, seizures, etc.

181
Q

Two subtypes of factitious disorder

A

Imposed in self

Imposed on another

182
Q

Criteria for Factitious disorder

A

Falsify physical or psychological conditions
Present self or other as being impaired
Engage in the deceptive behavior without an external reward

Falsification can include: feigning, exaggerating, simulating, induction

183
Q

Differential diagnosis for Factitious Disorder

A

Malingering

For secondary gain, external rewards

Should be considered when someone is being evaluated for legal reasons

184
Q

Pica

A

Eating nonnutritive food items

At least one month

Most common during childhood

Not part of a culturally sanctioned practice

185
Q

Criteria for Anorexia Nervosa

A

RESTRICTION
Intense fear of gaining weight or becoming fat
Disturbance in the way a person views their body shape

Levels of severity based on BMI

186
Q

Associated diagnoses with AN And BN

A

Anxiety and depression

Anxiety is commonly a precursor to the feeding disorder, and depression can have onset before or after

187
Q

Physical symptoms of anorexia nervosa

A 
Cold intolerance
Constipation
Abdominal pain
Lethargy
Bradycardia
188
Q

Prevalence and onset of eating disorders

A

Adolescence and young adult

90% females

189
Q

Biological etiology of Anorexia

A

Genetics

High serotonin

190
Q

Psychological etiology for anorexia nervosa

A

Highly correlated with perfectionism

191
Q

Environmental etiologies for anorexia nervosa

A

Inconsistent results related to family functioning

Maybe high levels of family conflict, rigid parents, concern in home with thinness, domineering dads…

192
Q

Treatment of anorexia nervosa

A

Primary goal is weight gain!
(Hospitalization, contingency management with weight maintenance)

Garner’s CBT
Est positive alliance, normalize eating and weight, modify negative beliefs about weight and food, relapse prevention

193
Q

Family therapy for the treatment of anorexia nervosa

A

May be beneficial

If family has high EE, then do family therapy without the patient and treat them separately… family treatment with the patient and a high EE family could lead to increased risk of relapse

194
Q

Diagnostic criteria for Bulimia Nervosa

A

Binging (sense of lack of control)
Compensatory behavior
Self-evaluation is unduly influenced by weight and body shape

Binging and compensation need to occur at least once a week for three months

195
Q

What can commonly trigger a binge eating episode

A

Interpersonal stress

Dysphoric mood

196
Q

Difference between BN and AN binge/purge type

A

AN bpt - still has restriction as a component, no insight

BN - no restriction, realizes there’s a problem, not necessarily underweight

197
Q

Medical complications associated with BN

A

Fluid and electrolyte imbalances…
Can cause cardiac arrhythmia and arrest

Dental problems, metabolic acidosis or alkalosis, menstrual abnormalities

198
Q

Narcolepsy

A

Attacks of irresistible needs for sleep

At least three times per week, for three months

Includes: cataplexy (muscle weakness), hypocretin deficiency, REM latency

199
Q

What can trigger narcolepsy

A

Anger, surprise, or other strong emotions

Can trigger cataplexy more specifically

200
Q

Non-REM Sleep Arousal Disorders

2 types

A

Sleep walking

Sleep terrors

No recall of the episode
Occurs most commonly in children

201
Q

Non-REM sleep issues usually occur during what sleep stages

A

3 and 4

202
Q

Rule out conditions for Sexual Dysfunctions

A

Nonsexual mental disorders
Relationship distress or other stressor
Effects of substances, medication, or other medical condition

203
Q

Erectile disorder

A

Problems maintaining an erection during sexual activity
Maintaining an erection until the completion of sexual activity
Marked decrease in erectile rigidity

Occurs during all or nearly all sexual encounters
For at least six months

204
Q

Premature Ejaculation

A

Persistent pattern of premature ejaculation
(Within one minute of penetration, or before the person desires it)

Occurs during all or nearly all sexual encounters
For at least six months

205
Q

Treatment methods for premature ejaculation

A

Viagra

Senate focus - reduce performance anxiety

Squeeze techniques - control the ejaculatory reflex

206
Q

Gender Dysphoria

A

Marked incongruence between assigned gender at birth and one’s expressed or perceived gender

Manifests as intense desires or urges to dress like, look like, be treated like, engage in social interests like the gender you are identifying as

Must meet criteria (and marked distress) for at least six months

207
Q

Oppositional Defiant Disorder

A

Angry/irritable behavior
Defiant/argumentative
Vindictiveness

At least six months
With at least one person who is not a sibling
Cause distress to person or individuals in immediate social environment

208
Q

Intermittent Explosive Disorder

A

Inability to control aggressive impulses…
(1) manifested as verbal or physical aggression
(2) occurring at least 2x/week for at least three months
(3) or, three outbursts that cause damage/destruction in 12mo
Agitation is not proportional to the triggers

Must be at least six years old

209
Q

Diagnostic criteria for conduct disorder

A

Aggression to people or animals
Destruction of property
Deceitfulness or theft
Serious violation of rules

Cannot be assigned to individuals over the age of 18

210
Q

Specifiers for Conduct Disorder

A

Childhood-onset
(At least one symptom prior to age 10)

Adolescent-onset
(No symptoms prior to age 10)

Unspecified onset

211
Q

Two types of Conduct Disorder

Per Moffitt

A

Life-course persistent type
(Begins as early as 3yo, with increasingly serious issues into adulthood…related to neuro impairment, temperament, poor env)

Adolescent-limited type
(Caused by maturity gap between developmental maturity and the opportunities for adult behaviors and rewards, temporary, usually done with peers)

212
Q

Treatment for Conduct Disorder

A

Best when delivered to preadolescents through family interventions

Parent management training (PMT) - replace punishing negative behaviors with reinforcing positive ones

Multisystemic therapy (MST) - targets multiple levels of people in multiple different ways

213
Q

General criteria for Substance Use Disorder

A

At least two criteria within 12 months

Four major categories...
Impaired control (can’t quit or reduce), social impairment, risky use, and pharmacological criteria (tolerance and withdrawal)

Can be applied to all drugs except caffeine

214
Q

Tension-Reduction Hypothesis for substance use disorder

A

Substances (alcohol) reduces fear, anx, etc. causing people to drink to avoid those feelings, eventually leading to addiction.

Addiction is the result of negative reinforcement

215
Q

Most common precipitation of substance relapse

A

Experience of anxiety, frustration, depression, or other negative emotional state

216
Q

Abstinence Violation Effect

Mariatt And Gordon

A

Reaction to a relapse is shame, guilt, anxiety, depression…
Those negative feelings leads to another increased risk for relapse

Reduce the potential for another relapse by viewing the episode of substance use as a mistake resulting from specific, external, controllable factors

217
Q

Relapse Prevention Therapy

A

Mariatt and Gordon

RPT involves identifying the circumstances that increase the risk of relapse for the person, and then implement behavioral and cognitive strategies to prevent future lapses and cope more effectively if they do occur

218
Q

Difficulty on treating Tobacco Use Disorder

A

People are addicted to the nicotine…
…so they smoke for its inherent reinforcing effects and to avoid nicotine withdrawal

Cravings for nicotine can also last months or years

219
Q

Smoking Cessation Intervention

A

Posits that the likelihood of ling-term smoking cessation increases when…

(1) there is nicotine replacement therapy
(2) behavioral therapy includes skills training and stimulus control
(3) there is support and assistance from a clinician

220
Q

Substance-Induced Disorders

A

Potentially severe, usually temporary, but somewhat persisting CNS syndromes that develop in the context of the effects of substances of abuse, medication, or toxins

Must have developed within one month of the intoxication

Cannot be better explained by another medical condition or mental disorder

221
Q

Criteria for Alcohol Withdrawal

A

2+ of the following, within several hours to a few days of abrupt cessation or reduction…

Anxiety
Autonomic hyperactivity 
Generalized tonic-clonic seizures
Hand trembling
Insomnia
Nausea or vomiting
Psychomotor agitation
Transient hallucinations
222
Q

Alcohol-Induced Major Neurocognitive Disorder

A

Aka. Korsakoff Syndrome

Evidence of a significant decline in one or more cognitive domains that interferes with independence in everyday activities

Also includes anterograde or retrograde amnesia and confabulation (attempts to falsify memories to make up for memory loss)

223
Q

Alcohol-Induced Sleep Disorder

A

Typically insomnia that occurs in the intoxication or withdrawal phase

Intox - immediate sedation, increased stage 3/4 sleep, decreased REM
followed by increased wakefulness, increased REM with anxiety-provoking dreams, and decreased stage 3/4 sleep

With - vivid dreams and severe disruption in sleep continuity

224
Q

Opioid withdrawal symptoms

A 
Diarrhea 
Dysphoric mood
Fever
Insomnia
Lacrimation (watery eyes)
Muscle aches
Nausea or vomiting 
Pupil dilation or sweating
Yawning
225
Q

Tobacco withdrawal symptoms

A 
Irritability or anger
Anxiety
Impaired concentration
Increased appetite
Restlessness
Depressed mood
Insomnia

Occurs within 24 hours of abrupt cessation or reduction in tobacco use

226
Q

Areas of cognitive functioning impacted by neurocognitive disorders…
(Six domains)

A 
Complex attention
Executive function
Learning and memory
Language
Perceptual motor
Social cognition
227
Q

Criteria for delirium

A

Disturbance in attention and awareness that develops over a short period of time
Represents a change in baseline functioning
Tends to fluctuate in severity (worsening at night usually)

At least one additional cognitive domain must show impairment

228
Q

Five groups of people identified to be at high risk for delirium
(Per Wise)

A

Older adults
People with decreased cerebral reserve (dementia, stroke, HIV)
Postcardiotomy patients (heart surgery)
Burn patients
People with drug dependence experiencing withdrawal

229
Q

Treatment goals for Delirium

A

Treat the underlying cause of the delirium

Reduce agitation 
(Environmental manipulation, meds, psychosocial interventions (Family or friend stay with patient))
230
Q

Major Neurocognitive Disorder criteria

A

(Dementia)

Significant decline from previous level of functioning
One or more cognitive domains
Interferes with ability to perform everyday activities independently

231
Q

Mild Neurocognitive Disorder criteria

A

(Cognitive Disorder NOS is included here)

Modest decline from previous functioning
One or more cognitive domains
Does not interfere with independently performing everyday activities
(But may require greater effort and compensatory strategies)

232
Q

Neurocognitive Disorder d/t Alzheimer’s

Major

A

Evidence of a causative genetic mutation
Clear decline in memory and another cognitive domain
Steady and gradual decline without extended plateaus

233
Q

Neurocognitive Disorder d/t Alzheimer’s

Mild

A

May or may not be evidence for causative genetic mutation

Clear evidence of decline in memory and learning

Steady and progressive decline in cognition without extended plateaus

234
Q

How to definitively diagnose Alzheimer’s

A

Autopsy or brain biopsy

Confirms extensive neuron loss and the presence of:
Amyloid plaques and tau tangles

235
Q

Three stages of deterioration in Alzheimer’s…

A

(1) 1-3 years - anterograde amnesia (esp for declarative memories), wandering and visuospatial deficits, indifference, irritability, sadness, and anomia (word finding deficits)
(2) 2-10 years - increasing retrograde amnesia, flat or labile mood, restlessness and agitation, delusions, fluent aphasia (receptive), acalculia, ideomotor apraxia (inability to translate an idea into movement)
(3) 8-12 years - severely deteriorated intellectual functioning, apathy, incontinence, limb rigidity

236
Q

Stage one of Alzheimer’s decline

A

1-3 years

Anterograde amnesia (esp for declarative memory)
Deficits in visuospatial skills (wandering)
Indifference, apathy, and sadness
Anomia (word finding trouble)

237
Q

Stage 2 of Alzheimer’s decline

A

2-10 years

Increasing retrograde amnesia 
Flat or labile mood
Restlessness and agitation
Delusions
Fluent aphasia (receptive)
Acalculia
Ideomotor apraxia (inability to transform an idea into movement)
238
Q

Stage 3 of Alzheimer’s decline

A

8-12 years

Severely deteriorated intellectual functioning
Limb rigidity
Incontinence

239
Q

Cluster A Personality Disorders are characterized by what general traits?

A

Odd or eccentric behavior

240
Q

Name the three Cluster A personality disorders

A

Paranoid PD

Schzoid PD

Schizotypal PD

241
Q

Paranoid Personality Disorder

A

Pervasive pattern of suspiciousness that entails interpreting the motives of others as malevolent

(4+) suspects others are harming without sufficient evidence, preoccupied with unjustified doubts about the trustworthiness of others, reluctant to confide in others, reads demeaning content from benign interactions, bears grudges, perceived attacks on character and responds with hostility, perceived infidelity from sexual partner

242
Q

Symptoms of Schizoid Personality Disorder

A

Displays a pervasive detachment from interpersonal relationships with a restricted range of emotion in social settings

(4+) doesn’t enjoy close relationships, chooses solitary activities, no interest in sexual relationships, little pleasure from activities, indifferent to praise or criticism, emotional coldness, lack of friends other than first degree relatives

243
Q

Criteria for Schizotypal Personality Disorder

A

Pervasive social deficits and eccentricities in cognition, perception, and behavior

(5+) ideas of reference, odd beliefs that influence behavior, unusual perceptions, odd thinking and speech, paranoia, inappropriate affect, peculiarities in behavior or appearance, social anxiety, lack of friends other than first degree relatives

244
Q

General characteristics of Cluster B Personality Disorders

A

Dramatic, emotional, erratic

245
Q

List the four Cluster B personality disorders

A

Borderline PD

Histrionic PD

Narcissistic PD

Antisocial PD

246
Q

Antisocial Personality Disorder

A

Pattern of disregard for, and the violation of the rights of others that has occurred since age 15 (w prev dx of Conduct Disorder)

(3+) failure to conform to norms or laws, deceitfulness, aggressive, reckless disregard for safety of self or others, irresponsibility, lack of remorse

247
Q

Prognosis for ASPD

A

Symptoms (especially involvement with criminal behavior) typically become less severe by the fourth decade of life

248
Q

Borderline Personality Disorder diagnostic criteria

A

Instability in interpersonal relationships, sense of self, and affect

(5+) frantic attempts to prevent abandonment, unstable relationships, disturbance in identity, impulsivity in at least two areas, recurrent SUI threats or gestures, affective instability, chronic emptiness, inappropriate and intense negative emotions, stress-related paranoia or dissociation

249
Q

Treatment for BPD

A

DBT

Group skills training
Individual therapy to maintain motivation
Phone calls for consultation

250
Q

Prognosis for BPD

A

Symptoms begin to remit into the 40s, with more than half no longer meeting criteria

Impulsivity remits fastest, affective symptoms were most pervasive

251
Q

Etiology of BPD

Per Linehan

A

Biosocial model

Genes
Invalidating environment
Excessive emotional vulnerability
Inability to modulate distressing emotions

252
Q

Histrionic Personality Disorder criteria

A

High levels of emotionality and attention-seeking behavior

(5+) discomfort when not the center of attention, inappropriately sexually provocative, rapidly shifting of shallow emotions, physical appearance changes to garner attention, impressionistic speech, exaggerated emotional expression, easily influenced by others, considers relationships to be much more serious than the actually are

253
Q

Narcissistic Personality Disorder criteria

A

Pattern of grandiosity, a need for admiration, and a lack of empathy

(5+) grandiose self-importance, requires excessive admiration, beliefs uniqueness can only be understood by important others, preoccupied with unlimited success, entitlement, lacks empathy, envious of other or believes others are envious of them, arrogant

254
Q

General traits consistent with Cluster C Personality Disorders

A

Anxiety and fearfulness

255
Q

Three clusters for personality disorders

A

A - odd and eccentric

B - dramatic, erratic, emotional

C - anxious and fearful

256
Q

Avoidant Personality Disorder criteria

A

Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation

(4+) avoids activities due to fear of criticism, unwilling to get involved with others for fear of not being liked, restraint in relationships for fear of rejection, overly concerned with criticism, inhibited in new relationships due to inadequacy, views self as inept, reluctant to try new things for fear of embarrassment

257
Q

Dependent Personality Disorder criteria

A

Pervasive and excessive need to be taking care of, leading to submissive, clinging behavior and fear of separation

(5+) difficult making decisions without reassurance, needs others to assume responsibility for many aspects of life, fears disagreement, difficulty initiating things on their own, goes to great lengths to obtain support from others, urgently seeks new relationships when old ones end, unrealistically occupied with having to fend for self

258
Q

Three Cluster C Personality Disorders

A

Dependent PD

Avoidant PD

Obsessive-Compulsive PD

259
Q

Obsessive-Compulsive Personality Disorder criteria

A

Preoccupation with orderliness, perfectionism, and the mental control severely limits their flexibility, openness, and efficiency

(4+) preoccupation with details and rules so that the point of the activity is lost, perfectionism interferes with task completion, devoted to work at cost of friends and leisure, overconscientious and inflexible about ethics and values, cannot discard worthless objects, reluctance to delegate work, miserly about spending time with others, stubborn

EPPP (14 decks)

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