Abnormal Flashcards
(117 cards)
1
Q
What are the DSM-5 19 diagnostic categories?
A
Neurodevelopmental disorders, schizophrenia spectrum and other psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, obsessive compulsive and related disorders, trauma and stress related disorders, dissociative disorders, somatic disorders, feeding and eating disorders, elimination disorders, sleep wake disorders, sexual dysfunctions, gender dysphoria, disruptive impulsive control and conduct disorders, substance related and addictive disorders, personality disorders, paraphilic disorders.
2
Q
When does a clinician use other specified disorder?
A
When clinician wants to indicate the reason why the person’s symptoms do not meet the criteria for the diagnosis.
3
Q
When does a clinician use unspecified disorder?
A
When clinician does not want to indicate the reason why the person’s symptoms do not meet the criteria for the diagnosis.
4
Q
When does a clinician use provisional?
A
When clinician does not have enough information for a firm diagnosis, but believes the full criteria for the diagnosis will eventually be met.
5
Q
What three tools does the DSM-5 have to help clinicians consider and understand the impact of the client’s cultural background on diagnosis and treatment?
A
Outline for cultural formulation
Cultural formulation interview
Cultural concepts of distress
6
Q
What type of criterion does the DSM-5 use?
A
Polythetic - person only needs a subset of characteristics from the larger list of illness criteria.
7
Q
Does the DSM-5 use an axis system?
A
No, it is nonaxial - mental and medical listed together (primary diagnosis listed first). Psychosocial and contextual factors and levels of disabilities listed separately.
8
Q
How is psychosocial and contextual factors, as well as levels of disabilities listed separately assessed and coded?
A
Psychosocial and contextual factors are coded using ICD codes and levels of disabilities are assessed using WHO disability assessment schedule or other appropriate measures.
9
Q
What are the three tools the DSM 5 has to assess cultural impact?
A
- Outline for Cultural Formulation: provides guidelines for assessing.
- Cultural Formulation Interview: semi structured interview; 2 versions - one for the person and the other for an informant of the person.
- Cultural Concepts of Distress: usually broken-down into cultural syndromes, cultural idioms of distress, and cultural explanations.
10
Q
What are 5 neurodevelopmental disorders?
A
- Intellectual Disabilities
- Autism Spectrum Disorder
- Attention Deficit/Hyperactivity Disorder (ADHD)
- Specific Learning Disorder
- Tourette’s Disorder
11
Q
What is the diagnostic criteria for intellectual disabilities?
A
- Deficits in intellectual functioning reasoning (about IQ of 70 or below)
- Deficits in adaptive functioning (failure to meet society’s standards of personal independence and social responsibility)
- Onset was during developmental period
12
Q
What are the DSM-5 severity levels for intellectual disabilities?
A
Mild, moderate, severe, and profound.
13
Q
What is the main determinate for intellectual disabilities severity level?
A
Severity is based mainly on the person’s adaptive functioning which includes conceptual, social, and practical domains.
14
Q
Is intellectual disabilities a lifelong condition?
A
No, with the right intervention a person may no longer meet the criteria or may meet one for a less severe form.
15
Q
What is the strongest predictor for intellectual disabilities?
A
Low birth weight
16
Q
What is the disorder formerly known as stuttering?
A
Childhood Onset Fluency Disorder
17
Q
What is the criteria for Childhood Onset Fluency Disorder?
A
Disturbance in normal fluency and time patterning of speech that is not appropriate for age.
18
Q
At what age does Childhood Onset Fluency Disorder begin?
A
Usually between 2 to 7
19
Q
What happens for those diagnose with Childhood Onset Fluency Disorder when there is special pressure to communicate?
A
Symptoms may become worse
20
Q
What is the prognosis for Childhood Onset Fluency Disorder?
A
65-85% children recover with severity level at age 8 being a good predictor of prognosis.
21
Q
How is Childhood Onset Fluency Disorder treated?
A
Reducing psychological stress, increase frustration coping skills, habit reversal training (eg. stop speaking, breathe and start speaking on the exhale)
22
Q
What is the diagnostic criteria for specific learning disorder?
A
- Persistent difficulty with academic skills (word reading, reading comprehension, spelling problems, writing issues, and mathematical difficulties) for at least SIX MONTHS.
- Academic skills significantly below expected for age and causes impairment overall.
- Occurs during school age years.
23
Q
What are the DSM-5 severity specifiers for specific learning disorder?
A
Mild, moderate, and severe
24
Q
What are the DSM-5 subtype specifiers for specific learning disorder?
A
- Impairment in reading
- Impairment in written expression
- Impairment in mathematics
25
What are typical IQ scores for those with specific learning disorder?
They tend to have average to above average range, but higher than normal rates of other problems and disorders.
26
What is the most common comorbid disorder with specific learning disorder?
ADHD (higher risk for antisocial and legal issues)
27
What is the prognosis for specific learning disorder?
Continue to have learning issues throughout adolescence and adulthood with reading problems increasing psychosocial issues.
28
Is specific learning disorder more common in females or males?
Males (2:1 to 3:1)
29
What is the diagnostic criteria for Autism Spectrum Disorder?
1. Persistent deficits in social interaction and communication across multiple contexts.
2. Restricted, repetitive patterns of behavior, interests and activities.
3. Symptoms present during early development period.
4. Symptoms cause significant impairment in functioning.
30
What is the DSM-5 severity specifiers for autism spectrum disorder?
Level 1: requiring support
Level 2: requiring substantial support
Level 3: requiring very substantial support
31
When would you see the earliest signs of autism spectrum disorder?
Usually observe abnormalities in social orienting and responsivity by about 12 months of age.
32
What are some of the associated features of autism spectrum disorder?
Intellectual impairments and/or language abnormalities. They also typically exhibit an uneven profile of cognitive abilities.
33
What are some of the biological links to autism spectrum disorder?
Abnormalities in the cerebellum, amygdala, hippocampus and abnormal levels of norepinephrine, serotonin, and dopamine.
34
The best outcome for autism spectrum disorder is linked to?
Ability to communicate verbally by age 5 or 6, an IQ over 70, and a later onset of symptoms.
35
What are some of the treatments for autism spectrum disorder?
Parent management training, special education, training in self care and social interaction skills, vocational training and placement, shaping and discrimination training
36
What are some of the motor tics indicated by the DSM-5?
Eye blinking, facial grimacing and gestures, jumping, smelling objects, and echokinesis (imitating someone else’s movements)
37
What are some of the vocal tics indicated by the DSM-5?
Grunting, snorting, barking, echolalia, and coprolalia (repeating socially undesirable words)
38
What are the three Tic Disorders that the DSM-5 includes?
1. Tourette’s disorder
2. Persistent (Chronic) Motor or Vocal Tic Disorder
3. Provisional Tic Disorder
39
What is the diagnostic criteria for Tourette’s Disorder?
1. Presence of at least ONE VOCAL tic and MULTIPLE MOTOR tics (may occur together or at different times)
2. Persisted for more than ONE YEAR
3. Began before 18
40
How does the frequency, severity and disruptiveness change for those with Tourette’s disorder?
They decrease in adolescence or adulthood.
41
What is the diagnostic criteria for Persistent (Chronic) Motor or Vocal Tic Disorder?
1. Includes ONE or MORE motor OR vocal tics.
2. Persisted for more than ONE YEAR
3. Began before 18
42
What is the diagnostic criteria for Provisional Tic Disorder?
1. Includes ONE or MORE motor AND/OR vocal tics.
2. Persisted for more than ONE YEAR
3. Began before 18
43
What is the most common comorbid disorder with Tourette’s disorder?
OCD, but hyperactivity, impulsivity and distractibility are also common.
44
Biologically, Tourette’s disorder is linked to what?
Elevated levels of dopamine and hypersensitivity of dopamine receptors in the caudate nucleus.
45
How do you treat Tourette’s disorder?
Pharmotherapy - antipsychotics, SSRIs for OCD symptoms, usually treated with clo
46
What is the diagnostic criteria for ADHD?
1. Pattern of inattention and/or hyperactive/impulsivity for at least SIX MONTHS.
2. Onset before age 12.
3. Present in at least TWO SETTINGS
4. At least SIX SYMPTOMS of inattentive and/or SIX SYMPTOMS of hyperactive/impulsivity.
47
What are some inattention symptoms?
Fails to pay close attention to details, difficulty sustaining attention to tasks or play activities, doesn’t listen when directly spoken to, fails to finish schoolwork or chores, easily distracted, and often forgetful in daily activities.
48
What are some hyperactive/impulsivity symptoms?
Frequently fidgets or squirms in seat, often leaves seat at inappropriate times, frequently runs or climbs in inappropriate situations, talks excessively, has difficulty waiting turn, and interrupts or intrudes on others.
49
What are the DSM-5 ADHD subtypes?
1. Predominantly inattentive (when inattentive symptoms are six or more, but hyperactive/impulsivity ones are less than six)
2. 1. Predominantly hyperactive/impulsivity (when hyperactive/impulsivity symptoms are six or more, but inattention ones are less than six)
3. Combined Presentation (when there is six or more of inattention symptoms and six or more of hyperactive/impulsivity symptoms)
50
Do children with ADHD have lower IQs?
Yes, as well as other academic and social adjustment issues.
51
What other disorders are common with those who have ADHD?
Conduct disorder, oppositional defiant disorder, specific learning disorder, anxiety disorder, and major depressive disorder.
52
What type of problems do adults with ADHD have?
Low self esteem, social relationships issues, poorer health outcomes, lower educational and occupational achievement, higher risk for Bipolar, depression, anxiety, antisocial behaviors, and substance use.
53
What is the prevalence rate of ADHD in children and adults?
Children - 5%
| Adults - 2.5%
54
Is ADHD more prevalent in males or females?
More prevalent in males (children 2:1 and adults 1.6:1. Combined subtype more common for males, but inattention more common in females.
55
What is the prognosis for ADHD?
65-80% of children tend meet criteria in adulthood (15% full, 60% partial remission).
56
How does the symptoms of ADHD vary throughout the lifespan?
Gross motor activity characteristics in children decline over time; hyperactivity tend to manifest in adults as fidgeting, excessive talking, restlessness and feeling overwhelmed. Whereas, impulsivity usually exhibits as impact irritability, poor time and money management, reckless driving and impulsive sexuality
57
Which profile is predominate in adulthood?
Inattention (issues with concentration, difficulty establishing and maintaining routines, can’t prioritize and complete important tasks.
58
What brain abnormalities have been linked to ADHD?
Lower than normal activity in the caudate nucleus, globus pallidus, and prefrontal cortex as well as smaller in size.
59
What situations are ADHD symptoms likely to occur?
Familiar, highly repetitive, boring or highly structured situations and those that don’t provide regular feedback.
60
What is the behavioral disinhibition hypothesis as it relates to ADHD?
Those with ADHD lack the ability to regulate behavior to fit situational demands.
61
What is another hypothesis about ADHD?
It is the result of inability to regulate attention-paying attention to irrelevant things and focusing too much on certain stimuli at the exclusion of others.
62
What is the most common treatment for ADHD?
Medication-Methylphenidate (Ritalin), a CNS stimulant, good for both children and adults
Behavioral interventions like positive reinforcement, time out, etc
63
What does the research say about medication versus behavioral intervention effectiveness?
Short term: medication better
| Long term: medication similarly effective as behavioral interventions
64
What age children have the most negative reactions to being hospitalized?
Ages 1 - 4 which is usually due to separation from loved ones
65
What are the disorders in the DSM-5 schizophrenia spectrum and other psychotic disorders section?
1. Delusional Disorder
2. Brief Psychotic Disorder
3. Schizophreniform Disorder
4. Schizophrenia
5. Schizoaffective Disorder
66
What are the main symptoms of the disorders found in the DSM-5 schizophrenia spectrum and other psychotic disorders section?
1. Delusions
2. Hallucinations (auditory, visual, tactile, and olfactory)
3. Disorganized thinking (usually inferred by person’s speech)
5. Grossly disorganized or abnormal motor behavior
6. Negative symptoms (restrictive range and intensity of emotions and other functions like blunted emotional expression, anhedonia - decrease pleasure experience, asociality - lack of interest in social interactions, alogia - decrease speech output, and avolition - decrease initiation of goal directed behavior)
67
What types of delusions are typical for schizophrenia?
Persecutory, referential (messages are specifically directed at them), and bizarre (outside the normal life experience)
68
Which type of hallucination is most common?
Auditory hallucinations
69
What is the criteria for delusional disorder?
1. Presence of one or more delusions that last at least ONE MONTH.
2. Any impairment is directly related to the delusions.
70
What are the subtypes for delusional disorder?
1. Erotomanic
2. Grandiose
3. Jealous (significant other is unfaithful)
4. Persecutory (being conspired against, cheated or spied on, poisoned, etc)
5. Somatic
6. Mixed
7. Unspecified
71
What is the diagnostic criteria for schizophrenia?
1. Presence of at least TWO active phase symptoms for at least a month.
2. ONE of those symptoms at least has to be delusions, hallucinations, or disorganized speech.
3. Continuous signs of the disorder for at least SIX MONTHS.
72
What is the difference between diagnostic criteria for schizophrenia and that for brief psychotic disorder and schizophreniform?
Schizophrenia, brief psychotic disorder, and schizophreniform have the same symptoms, but the length of time is different.
73
How long should psychotic symptoms be present for a diagnosis of brief psychotic disorder?
Present for at least ONE DAY, but LESS THAN ONE MONTH.
74
How long should psychotic symptoms be present for a diagnosis of schizophreniform disorder?
Present for at least ONE MONTH, but LESS THAN SIX MONTHS. Also, impaired functioning may be present, but NOT REQUIRED.
75
What is anosognosia and which disorder is it related to?
Poor insight into illness and related to schizophrenia (contributes to medication noncompliance)
76
What is a common co occurring diagnosis of those with schizophrenia?
Substance use disorder with tobacco use disorder.
77
What is the lifetime prevalence rate for schizophrenia?
0.3 - 0.7%
78
Is schizophrenia more common in males or females?
Males
79
Why do African Americans have higher rates of schizophrenia?
It is believed to be the result of African Americans being misdiagnosed as they are more likely to experience psychotic symptoms in a depressive episode.
80
What is the difference in clinical presentation of those who have schizophrenia in western versus non western countries?
Those in developing countries were more likely to exhibit an acute onset of symptoms, shorter clinical course, and complete remission of symptoms.
81
When is the onset of schizophrenia?
Usually between late teens and early 30s with the peak age being early to mid 20s for males and late 20s for females.
82
What conditions indicate a better prognosis for schizophrenia?
Good premorbid adjustment, an acute and late onset, female gender, presence of a precipitating event, brief duration of active phase symptoms, insight into illness, and a family history of mood disorder and not schizophrenia.
83
What is the concordance rates for schizophrenia?
10% for biological siblings
17% for fraternal twins
48% for identical twins
46% for children with both parents having schizophrenia
84
What biological abnormalities are commonly related to schizophrenia?
Enlarged ventricles and smaller than normal hippocampus, amygdala, and globus pallidus.
85
What is the dopamine hypothesis?
It tries to explain the cause of schizophrenia in biochemical terms. It attributes schizophrenia to elevated dopamine levels or the over sensitive dopamine receptors.
86
How is schizophrenia treated?
Medication: antipsychotics (neuroleptics) - traditional (first generation) antipsychotics like haloperidol and fluphenazine which are useful for eliminating positive symptoms (has potential for severe side effects) and atypical (second generation) antipsychotics like clozapine and risperidone which eliminate both negative and positive symptoms and less likely to cause severe side effects like tardive dyskinesia.
Also CBT interventions and family based interventions
87
What is high expressed emotion and what is it linked to?
It is when family members are openly critical and hostile towards the patient OR overprotective and emotional over involved. It is linked to high relapse and rehospitalization rates with people who have schizophrenia.
88
What is the diagnostic criteria for schizoaffective disorder?
1. Uninterrupted period of illness where there are concurrent symptoms of schizophrenia and symptoms of a major depressive or manic episode.
2. A period of at least TWO WEEKS without prominent mood symptoms.
89
What are the Bipolar and related disorders?
1. Bipolar I Disorder
2. Bipolar II Disorder
4. Cyclothymic Disorder
90
What are some of manic episode characteristic symptoms?
1. Elevated or irritable mood and abnormally and persistent goal directed activity or energy.
2. Inflated self esteem or grandiosity
3. Decreased need for sleep
4. Excessive talkativeness
5. Flight of ideas
91
What is the diagnostic criteria for Bipolar I disorder?
1. At least one MANIC episode
2. Episode last for at least ONE week.
3. Episode should include at least THREE characteristic symptoms
4. Impairment in functioning OR require hospitalization or include psychotic features
* 5. MAY include episodes of hypomania or major depression.
92
What other disorders are common with Bipolar I Disorder?
Anxiety and substance abuse
93
Does having Bipolar I Disorder increase the risk of suicide?
Yes, people with this disorder are 15 times more likely to commit suicide.
94
Are males or females more likely to be diagnosed with Bipolar I Disorder?
Males are more likely (1.1:1) with a US prevalence rate of 0.6%
95
What is the average age for first episode?
Age 18 with 90% having additional episodes.
96
Does Bipolar I Disorder have a strong genetic link?
Yes, identical twins is 0.67-1.0 and fraternal twins 0.20
97
What are the treatments for Bipolar I Disorder?
Medication:
lithium for classic bipolar (discrete periods of hypomania and depression) - reduces manic symptoms and prevents recurrent mood swings.
Anti seizure medication for those who don’t respond to lithium or who has rapid cycling or dysphoric mania.
Antipsychotic medication for those experiencing acute mania.
Antidepressants may be used, but their use may trigger a manic episode when combined with a mood stabilizer (especially with TCAs and SSRIs)
CBT, family focused, interpersonal and social rhythm therapy.
98
What is the diagnostic criteria for Bipolar II disorder?
1. At least one HYPOMANIC episode and one DEPRESSIVE episode.
2. The hypomanic episode last for at least FOUR DAYS.
3. Episode should include at least THREE characteristic symptoms
4. Impairment not severe enough to cause marked decrease in social or occupational functioning OR require hospitalization.
99
What is the diagnostic criteria for Cyclothymic disorder?
1. Numerous periods with hypomanic symptoms that don’t meet criteria for a hypomanic episode.
2. 1. Numerous periods with depressive symptoms that don’t meet criteria for a major depressive episode.
3. Cause significant distress or impairment.
4. Symptoms are persists for TWO YEARS for ADULTS and ONE YEAR for CHILDREN.
5. Can’t be symptom free for more than TWO MONTHS at a time.
100
What are the Depressive and other related disorders?
1. Disruptive Mood Dysregulation Disorder
2. Major Depressive Disorder
3. Persistent Depressive Disorder (dysthymia)
4. Premenstrual Dysphoric Disorder
101
What is the diagnostic criteria for Disruptive Mood Dysregulation Disorder?
1. Severe recurrent temper outbursts, verbal and/or behavioral.
2. Outbursts grossly .out of proportion in intensity or duration to the situation.
3. Chronic, persistent irritable or angry mood between temper outbursts.
4. Symptoms lasts for at least 12 MONTHS
5. Symptoms exhibited in at least TWO of THREE SETTINGS (home, school, with peers)
6. Outbursts inconsistent with individual’s developmental level.
7. Occurs at least THREE TIMES a WEEK
8. Can’t be diagnosed for the first time BEFORE SIX years old or AFTER 18, onset must be BEFORE TEN
102
What are some depressive symptoms?
1. Depressed mood
2. Loss of interest or pleasure
3. Weight changes
4. Appetite changes
5. Sleep changes
6. Psychomotor agitation or retardation
7. Fatigue or loss of energy
8. Feelings of worthlessness or excessive guilt
9. Diminished ability to think or concentrate
10. Recurrent thoughts of death, suicidal ideation or suicide attempt
103
What is the diagnostic criteria for Major Depressive Disorder?
1. At least FIVE depressive symptoms with ONE of them being depressed mood (depressed or irritable mood in children and adolescents) OR a loss of interest or pleasure in most or all activities.
2. Symptoms must be present for at least TWO WEEKS.
3. Causes significant impairment in functioning.
104
What is the accompanying feature specifiers for Major Depressive Disorder?
1. with Psychotic features
2. with Atypical features
3. with Peripartum onset
4. with Seasonal pattern (as known as seasonal affective disorder - SAD)
105
When can Peripartum onset be used?
1. When onset of symptoms began DURING pregnancy or WITHIN FOUR WEEKS postpartum.
2. Usually includes anxiety and preoccupation with infant’s well being or in extreme cases delusions about the infant (infant is possessed)
3. It can be used for major depressive disorder, but also bipolar I and bipolar II.
106
How prevalent is major depressive disorder with peripartum onset?
About 10-20% of women experience it with 0.1-0.2% develop postpartum psychosis.
107
What does major depressive disorder with peripartum onset have to be distinguished from?
Baby Blues - mild transitional mood symptoms that affects about 80% of women during the first TWO weeks following delivery.
108
When can Seasonal onset be used?
When there is a temporal relationship between the onset of a mood episode and a particular time of the year.
109
What are some symptoms of major depression disorder with seasonal onset or seasonal affective disorder?
1. Hypersomnia
2. Increased appetite and weight gain
3. Cravings for carbohydrates
110
What is an effective treatment for major depression disorder with seasonal onset or seasonal affective disorder?
Phototherapy - exposure to artificial bright light
111
What are common sleep odd related to major depressive disorder?
Sleep continuity, reduced stage 3 and 4 (slow wave) sleep, decreased REM latency (earlier onset of REM sleep), and increased duration of REM sleep early in the night.
112
What is the most frequently diagnosed disorder with major depressive disorder?
Anxiety disorders
113
What are the prevalence rates for major depressive disorder?
1. About 70% with age related differences.
| 2. 18-29 is THREE times for those 60 years and older.
114
Does major depressive disorder rates differ for males and females?
Rates are EQUAL before puberty, but by early adolescence it is higher for females (1.5-3 times more) than males.
115
What is the peak onset age for major depressive disorder?
Mid-20s and may be precipitated by severe psychosocial stressor.
116
What is the etiology for intellectual disabilities?
```
30%: chromosomal changes & toxins
15-20%: environmental
5%: hereditary
5%: medical conditions
10%: pregnancy & perinatal issues
30%: unknown cause
```
117
What are some early signs of intellectual disabilities?
Delays in motor development, lack of age appropriate interest in environmental stimuli, may not make eye contact during feeding, and less responsive to voice.
