Cards Flashcards

Question

Dysthymia (persistent depression)

Answer 1

· Does not need to meet threshold of major depressive episode, but can · No hx of hypomanic episodes * Depressive symptoms present for 2 years (Adult) or 1 year (child and adolescent, mood may also be irritable)

Answer 2

· Persistent irritability - Severe recurrent temper outbursts, 3+ times/week · Sx present for at least 12 months · Child is aged 6-18 years; onset before 10 y.o. · Present in 2-3 settings (home, school, peers) · No manic or hypomanic episode * rule out ASD, PTSD, separation anxiety * r/o substance, neurological or medical conditions

Answer 3

· Mood sx usually occur in week before menses, improve during menses, and are minimal after menses · Sx: Mood lability, irritability and interpersonal conflicts, depressed mood, hopelessness, self-deprecation, anxiety or tension, anhedonia, difficulty concentrating, lack of energy, change in appetite and/or sleep, feeling overwhelmed and out of control, physical sx such as breast tenderness or bloating · Two symptomatic cycles

Answer 4

· Short-lasting (schizophreniform or brief psychotic disorder) or persistent subthreshold psychosis (schizotypal personality, delusional disorder) · Psychosis only during mood disorder (major depressive disorder, bipolar disorder with psychotic features) · Psychosis during mood disorder and also outside mood disorder (schizoaffective) · Psychosis without mood symptoms (schizophrenia)

Answer 5

2+ Symptoms for ≥ 1 month, with 6 months of prodromal or residual sx (e.g., odd beliefs, unusual perceptual experiences). o Delusions o Hallucinations o Disorganized speech o Grossly disorganized or catatonic behavior o Negative symptoms (flat affect, avolition) o Marked decline in functioning o Mood disorders have been ruled out

Answer 6

· Same symptoms as schizophrenia · But only lasts 1-6 months

Answer 7

``` · Similar to schizophreniform, but symptoms last \< 1 month and do not include negative symptoms (flat affect, avolition). Has better prognosis ```

Answer 8

· Concurrent major mood episode (major depressive or manic) with two of the five key sx of Schizophrenia · Delusions or hallucinations for 2 weeks outside of major mood episode · Mood episode lasts for majority of duration of active and residual psychotic sx (note: if not, diagnose schizophrenia) · Less severe compared to Schizophrenia (e.g., less occupational impairment)

Answer 9

· Acute discomfort in close relationships · Perceptual and cognitive distortions · Eccentric behavior o Ideas of reference o Odd ideas or magical thinking o Unusual perceptual experiences o Odd thinking and speech o Paranoia o Flat affect o Lack of close friends o Social anxiety

Answer 10

· ≥ 1 delusion for duration of ≥ 1 month · Criteria A for Schizophrenia has never been met · Functioning is not impaired, behavior is not bizarre or odd · Mood episodes are brief relative to delusional periods

Answer 11

· Most prevalent anxiety disorder for children \< 12 y.o. · Decreases in prevalence with age · Attachment related · Sx lasting 4 weeks (children) or ≥ 6 months (adults), causing distress or impairment: o Distress when anticipating or experiencing separation from home or major attachment figures (MAF) o Excessive worry about loss of MAF o Excessive worry about event causing separation from MAF o Staying home for fear of separation o Fear/reluctance to be alone, without MAF o Reluctance/refusal to sleep away from home or without MAF o Repeated nightmares with theme of separation o Repeated c/o physical sx with separation

Answer 12

· For ≥ 1 month, does not speak in social situations when speaking is expected · despite speaking in other situations · Interferes with occupational/educational achievement or social communication · Not attributable to language barriers

Answer 13

· For ≥ 6 months, fear/anxiety about object or situation · Avoided or endured with intense fear/anxiety

Answer 14

· For ≥ 6 months, fear/anxiety about exposure to scrutiny in social situations · Fear of anxiety sx being negatively evaluated, causing humiliation, embarrassment, rejection · Fear is out of proportion to threat · In children, must occur with peers (not just adults)

Answer 15

· For ≥ 6 months, fearful avoidance of difficult-to-escape situations in event of panic or incapacitating, embarassing symptoms · Person may require presence of companion · Fear occurs in ≥ 2 of 5 situations: 1. Using public transportation 2. Being in open spaces 3. Being in enclosed spaces 4. Standing in line, being in a crowd 5. Outside of home alone.

Answer 16

· Recurrent unexpected panic attacks\* · ≥ 1 attack is followed by ≥ 1 month of… o Persistent concern or worry about additional attacks o Significant maladaptive bx change (e.g., avoidance of antecedents) o (i.e., attempt to organize life around prevention of panic attacks) Can occur in context of anxiety, depression, PTSD, SUDs, medical conditions; add “with panic attacks” · If Panic Disorder is coded, do not add “with panic attacks” to other dx · Four or more Symptoms: 1. Palpitations, increased heart rate 2. Sweating 3. Trembling or shaking 4. Shortness of breath; smothering sensation 5. Feelings of choking 6. Chest pain or discomfort 7. Nausea or abdominal distress 8. Feel dizzy, unsteady, light-headed, faint 9. Chills or heat sensations 10. Paresthesias (numbness, tingling sensations) 11. Derealization or depersonalization 12. Fear of losing control, “going crazy” 13. Fear of dying

Answer 17

· For ≥ 6 months, excessive anxiety and worry occuring more days than not about a number of events/activities · Anxiety is difficult to control · ≥ 3 of 6 symptoms (1 in children) o Restlessness, “keyed up,” on edge o Easily fatigued o Difficulty concentrating, mind going blank o Irritability o Muscle tension o Sleep disturbance (DFA, DSA, restless, unsatisfying sleep)

Answer 18

· Either obsessions, compulsions, or both, that are time consuming or cause distress/impairment · Obsessions: o Recurrent, persistent, intrusive, unwanted thoughts, urges, images that cause anxiety or distress in most individuals o Attempts at ignoring or suppressing them, often by neutralizing them (i.e., compulsion) · Compulsions: o Repetitive behaviors or mental acts that individual feels driven to perform, where rules must be applied rigidly o Behaviors or mental acts are meant to prevent or reduce anxiety, though seem disconnected · i.e., compulsions are attempts to control obsessions · Insight: Good/fair, poor, absent/delusional

Answer 19

· Difficulty discarding items, regardless of value · Discarding items causes distress · Accumulation clutters and congests living space

Answer 20

Recurrent hair-pulling, resulting in hair loss. Can lead to feelings of shame

Answer 21

Recurrent skin-picking, lesions Rule out substance use, medical cause, dysmorphia, psychotic

Answer 22

· Preoccupation with perceived flaws in physical appearance that unobservable or seem slight to others · Repetitive behaviors or mental acts are connected with preoccupation · Appearance preoccupation is different from eating disorder

Answer 23

· Two criteria depending on client age (≤ 6 years old, \> 6 years). For the latter: · Traumatic event: Experiencing, witnessing, learning it happened to family member or close friend, repeated or extreme exposure to aversive details · For ≥ 1 month duration… o Distress: memories, dreams, dissociative reactions such as flashbacks, intense or prolonged distress at exposure to symbols/ resemblances, physiological reactions o Avoidance: of memories, thoughts, feelings; external reminders o Change in cognition/mood: dissociative amnesia of event, negative beliefs about self or the world, distorted cognitions resulting in blaming self/others, negative emotional state, anhedonia, detachment/estrangement from others, flat/dulled positive emotions o Arousal/reactivity: irritability and outbursts, reckless or self-destructive bx, hypervigilance, hyperstartle response, problems concentrating, sleep disturbance

Answer 24

Symptoms must begin within 3 days to 1 month of traumatic event, and resolve in 1 month

Answer 25

stres· Emotional/behavioral sx in response to an identifiable stressor occurring within past 3 months · Causes distress or impairment · Does not meet criteria for another mental disorder, is not an exacerbation of mental disorder · Not normal bereavement · Once stressor/consequences have terminated, symptoms cease within 6 months

Answer 26

· I conceptualize this as attachment trauma · History of “insufficient care” (traumatic events). My experience of Eastern adoptions · Symptomatic response: o Consistent pattern of inhibited, withdrawn behavior toward adult caregivers o Minimally seeks or responds to comfort when distressed o Persistent social and emotional disturbance § limited positive affect, § social/emotional response to others, § unexplained negative emotions during nonthreatening interactions with caregivers

Answer 27

· Used to be categorized as a type of RAD, now its own disorder · Isn’t this just another example of disorganized attachment? · History of “insufficient care” · Symptomatic responses: o Low reticence in approaching/interacting with adults, overly familiar behavior o Diminished “checking back” with adult caregiver after venturing away o Willingness to leave with strangers

Answer 28

· Formerly “multiple personality disorder” · Disruption of identity, ≥ 2 personality states · Loss of agency – can’t control states · “Possession” in some cultures · Amnesia of everyday events, personal info, traumatic events inconsistent with ordinary forgetting · Not part of “broadly accepted” cultural or religious practice

Answer 29

· Amnesia of autobiographical info, usually of traumatic or stressful nature · Example: can’t recall childhood sexual abuse, or can’t recall large sections of childhood history · Symptoms cause distress · Rule out SUDs, other mental disorders first

Answer 30

In individuals with intact reality testing, at least one of… o Depersonalization: feeling detached from one’s body, unreal or absent self, distorted sense of time, numbing o Derealization: unreality, dreamlike, foggy, visually distorted state

Answer 31

A: odd or eccentric/Schizophrenia spectrum B: dramatic, emotional, erratic/instability spectrum C: anxious or fearful/Anxiety spectrum

Answer 32

Considered “stable” and thus untreatable

Answer 33

Pervasive distrust and suspiciousness of the malevolent motives of others without evidence o Suspects exploitation, harm, deceit o Preoccupied with doubts about trustworthiness and loyalty of friends/ associations o Reluctant to confide in others out of fear info will be used against them o Reads hidden meanings into benign remarks or events o Bears persistent grudges/unforgiving o Perceives character attacks and quickly reacts angrily or counterattacks o Suspicious of fidelity of partner

Answer 34

Detachment from social relationships and restricted emotional expression in interpersonal settings o Apathetic to close relationships, including family, lacks close friends o Almost always selects solitary activities o Almost nonexistent sexual interest o Anhedonic o Seems indifferent to praise or criticism o Emotionally detached, cold, flat affect

Answer 35

Discomfort and reduced capacity for close relationships and eccentric/odd behavior with distorted cognitions and perceptions o Ideas of reference o Magical thinking (superstition, clairvoyance, telepathy, “sixth sense,”) o Unusual perceptual experiences, e.g., bodily delusions o Odd thinking, speech, behavior, appearance o Suspiciousness and paranoia o Restricted affect o Excessive social anxiety r/t paranoid fears

Answer 36

· Must be 18 y.o., and have evidence of Conduct Disorder before 15 y.o. · Disregard or violation of rights of others o Unlawful behaviors that are grounds for arrest o Deceitfulness, lying, conning others for profit or pleasure o Impulsivity and lack of planning o Aggression and physical fights o Reckless disregard for safety of others/self o Irresponsibility at work, with finances o Lack of remorse and indifference or rationalizing after hurting, mistreating, stealing from others

Answer 37

· Unstable relationships, emotions, core self · Recurrent suicidal behavior, gestures, threats, or self-mutilation o Frantic avoidance of real or imagined abandonment o Intense relationships, vacillating between idealization/devaluation (splitting) o Self-damaging impulsivity (spending, sex, SA, binge eating) o Emotional instability, with moods shifting every few hours/days o Chronic emptiness, lack of self o Difficulties regulating intense anger o Transient, stress-related paranoia or dissociative symptoms

Answer 38

· Excessive attention-seeking and dramatic emotional displays · Discomfort when not center of attention o Uses physical appearance to draw attention to self o Sexually seductive or provocative behavior o Rapidly shifting and shallow expression of emotions o Impressionistic speech, lacking detail o Theatrics, exaggerated expression o Suggestible o Considers relationships more intimate than they are in reality

Answer 39

· Excessive attention-seeking and dramatic emotional displays · Discomfort when not center of attention o Uses physical appearance to draw attention to self o Sexually seductive or provocative behavior o Rapidly shifting and shallow expression of emotions o Impressionistic speech, lacking detail o Theatrics, exaggerated expression o Suggestible o Considers relationships more intimate than they are in reality

Answer 40

Grandiosity, need for admiration, and lack of empathy o Self-important, arrogant, haughty o Requires admiration o “Special” and unique, only associates with high-status people or institutions o Sense of entitlement, expects favorable treatment o Preoccupied with fantasies of unlimited success, power, ideal love o Exploits others to achieve own ends o Lacks empathy to feelings of others o Envious of others or believes others envy them

Answer 41

Social inhibition, inadequacy, hypersensitivity to negative evaluation o Fears of being criticized/rejected o Avoids occupations with social contact due to fears o Unwilling to connect with people unless certain of being liked o Restraint in relationships out of fear of being shamed or ridiculed o Inhibited by feelings of inadequacy in new interpersonal situations o Views self as inept, inferior o Reluctant to take risks for fear of embarrassment

Answer 42

· Need to be taken care of, clinging, submissive, fears separation. · Difficulty with… o Making decisions without advice or reassurance o Assuming responsibility for major life areas o Expressing disagreement, for fear of reprisal o Initiating projects d/t low self-confidence o Volunteering for unpleasant tasks d/t need for support o Being alone; fears ability to care for self o Tolerating single life after breakups – rushes into next relationship

Answer 43

· Preoccupation with orderliness, perfectionism, interpersonal control, at the expense of efficiency, flexibility, openness o Rigid and stubborn o Preoccupied with rules, lists, order, procedure, organization, schedules o Perfectionist task completion o Workaholism at expense of leisure, friends o Miserly spending style to hoard money o Difficulty delegating tasks, unless directions are strictly followed o Overly rigid about morality, ethics, values o “Pack rat”

Answer 44

Childhood and adolescence

Answer 45

· Angry or irritable mood, resentful · Argumentative or defiant behavior o Argues with authority figures, adults o Defies authority, refuses to comply with rules o Deliberately annoys others o Externalizes blame, avoids responsibility · Vindictiveness o Spiteful and vindictive x2 in past 6 months

Answer 46

Basic rights of others and rules are violated o Aggression to people and animals § Bullies, threatens, fights, intimidates, uses weapon § Physical cruelty to people or animals § Stolen while confronting a victim § Has forced someone into sexual activity o Destruction of property § E.g., deliberate fire setting with intent to cause damage o Deceitfulness or theft § Broken into someone’s house, building, car § Lies/cons to obtain goods, avoid obligations § Stealing without confronting victim o Serious rule violations § Stays out past parental curfew before 13 y.o § Run away from home overnight x2, or for lengthy period § Often truant from school before 13 y.o

Answer 47

Must be 6 years old · Recurrent aggressive outbursts: o 2x weekly verbal or physical aggression for 3 months, without destroying property or injuring animals/people o 3x verbal or physical aggressive episodes in 12 months, destroying property or injuring animals/people · Aggressiveness is not premeditated and out of context with provocation

Answer 48

· Has similarities to process addictions · Tension/arousal beforehand · Pleasure, gratification, relief when setting fires or witnessing their aftermath · Not done for monetary gain, vengence, conceal criminal activity, as a result of psychotic episode or impaired cognition (NCD)

Answer 49

· Has similarities to process addictions · Failure to resist impulses to steal objects not needed for monetary value · Tension beforehand, pleasure/gratification/relief afterward · Not out of vengence or during psychotic episode

Answer 50

Three criteria: A. Restriction of energy intake and low body weight B. Fear of gaining weight, becoming overweight; or behavior interfering with weight gain C. Cognitive distortions: how body weight and shape is experienced, selfevaluation based on body weight, lack of recognition for seriousness

Answer 51

· Occurring ≥ 1x week for 3 months… · Recurrent binge eating episodes o feeling lack of control during episode · Recurrent inappropriate compensatory behaviors (i.e., purging) to prevent weight gain o Self-induced vomiting, laxatives, diuretics, fasting, exercise

Answer 52

§ Basically Bulimia without purging. Occurring for ≥ 1x week for 3 months… § Episodes of binge eating, causing distress

Answer 53

· Eating or feeding disturbance o Lack of interest in eating or food o Avoidance of sensory characteristics o Aversive consequences of eating · Resulting in malnutrition, not meeting energy need o Significant weight loss/stunted growth o Significant nutritional deficiency o Dependence on enteral feeding or supplements o Interference with functioning

Answer 54

· Persistent eating of nonnutritive, nonfood substances for \> 1 month · Not culturally supported practice

Answer 55

· Regurgitation of food \> 1 month o Re-chewed, re-swallowed, spit out · Not a gastrointestinal issue · No co-occurring eating d/o

Answer 56

· ≥ 2 or more in 12 months: o Substance taken in larger amounts or over longer period than intended o Persistent desire or unsuccessful efforts to curb use o Subsumes large amounts of time (obtaining, using, recovering) o Craving, strong urges o Failing obligations (work, school, home) o Use is despite social or interpersonal problems; activities are given up/reduced o Use in physically hazardous situations o Despite knowing it exacerbates problems o Tolerance, withdrawal

Answer 57

· ≥ 4 in 12 months: o Need to increase amounts spent on gambling to get same excitement o Restless/irritable when cutting down o Repeated unsuccessful efforts to stop o Preoccupied with gambling o Gamble when feeling distressed o “Chasing” one’s losses (returning after losing money the next day) o Lying to conceal extent of involvement o Jeopardized or lost significant relationship, job, opportunities o Rely on others to relieve financial burden o Not better explained by manic episode o Specifier: Episodic vs. persistent § Mild (4-5), moderate (6-7), severe (8-9)

Answer 58

· ≥ 6 months of sexual arousal from nonliving objects or non-genital body parts · Causes distress or impairment · Not limited to items of clothing used for cross-dressing, or objects used for tactile genital stimulation (vibrator)

Answer 59

· ≥ 6 months of sexual arousal from exposing genitals to unsuspecting person · Person has acted on urges, or it causes distress or impairment

Answer 60

· ≥ 6 months of sexual arousal from observing an unsuspecting naked person o In process of disrobing o Engaging in sexual activity · Person being watched is non-consenting, or it causes distress or impairment to onlooker · Onlooker must be 18 years of age

Answer 61

· ≥ 6 months of sexual arousal from fantasies, urges, behaviors, with a prepubescent child/children (≤ 13 y.o.) · Person has acted on urges, or it causes distress or “interpersonal difficulty” · Person is 16 y.o., and at least 5 years older than child/children · Does not include older adolescent’s sexual relationship with 12-13 y.o.

Answer 62

· ≥ 6 months of sexual arousal from touching or rubbing against an non-consenting person · Person being touched is non-consenting, or it causes distress or impairment

Answer 63

We usually need to R/O other dx before a neurodevelopmental d/o can be made The following disorders are considered to be primarily biological, rather than situational. Medication is therefore usually a first line of treatment All begin during developmental period

Answer 64

o Impaired intellectual functioning, using both clinical assessment & IQ scores o Impaired adaptive functioning (independence and personal responsibility)

Answer 65

Used when Intellectual Disabilityseverity cannot be assessed before age 5

Answer 66

Used when severity cannot be assessed after age 5, due to lack of local procedures, sensory or physical impairments, severe problem behaviors, or co-occurring mental disorders rendering assessment difficult

Answer 67

Deficits in two central areas: A. Social communication and social interaction § Lack of reciprocity, shared interest § Impaired nonverbal communication § Deficits developing, maintaining, understanding relationships, including absence of interest in peers B. Restricted repetitive patterns of behavior, interests, or activities § Stereotypic or repetitive motor movements § Insistence on sameness and inflexibility to change, rigid adherence to routine § Highly restricted, fixated interest (perseveration) § Hypo or hyper reactivity to environment (does not feel pain, excessive smelling/ touching objects, fascination with lights/movement, adverse response to stimuli)

Answer 68

Social skills deficits without other features of autism. Difficulties in… o Social communication, e.g., please, thank you, etc. o Changing communication to match context, e.g., classroom vs. playground o Following rules for conversation and storytelling, e.g., taking turns, attunement to verbal and nonverbal signals o Making inferences for what is not explicitly stated, especially with ambiguous or nonliteral language, e.g, humor, metaphor · A common co-occurring condition with ADHD

Answer 69

Repetitive motor behaviors without other features of autism. o Hand shaking, flapping, body rocking, head banging, self-biting, hitting one’s body o Interferes with other activities and may result in self-injury

Answer 70

Two tracks of sx, lasting ≥ 6 months: o Inattention · Lack of close attention to work, careless mistakes · Difficulty sustaining attention (lectures, conversations, reading), avoids tasks requiring sustained effort · Does not listen when spoken to directly (mind is “elsewhere”), Easily distracted, often forgetful · Does not follow through on instructions, schoolwork, chores/duties. Has difficulty with organization; messy, poor time management, fails to meet deadlines. Loses objects necessary for task completion o Hyperactivity and impulsivity · Fidgets, squirming in seat. Leaves seat when sitting is expected. Runs or climbs inappropriately; restless; “on the go” as if “driven by a motor” · Unable to engage in activities quietly · Talks excessively, difficulty waiting turrn, blurts out answer before question is asked, interrupts or intrudes on others

Answer 71

Tics that have persisted for ≥ 1 year: o F95.2 Tourette’s Disorder · Multiple motor and ≥ 1 vocal tic o F95.1 Persistent Motor or Vocal Tic d/o · Motor or vocal tics (not both) o F95.0 Provisional Tic Disorder · Tics for \< 1 year

Answer 72

· Difficulties learning and using academic skills:

Answer 73

· Difficulties with motor skills and motor planning, such as clumsiness, catching objects, using scissors/cutlery, handwriting) · Sometimes referred to as “dyspraxia” · Not better explained by visual impairment or neurological condition, e.g., cererbal palsy, muscular dystrophy

Answer 74

Example: Neurodevelopmental disorder associated with prenatal alcohol exposure

Answer 75

At least one day and less than one month

Answer 76

At least three days and less than one month

Answer 77

1-6 months

Answer 78

Less than 6 months since the stressor or its consequences has stopped

Answer 79

6 months, including 1 months of acute symptoms

Answer 80

• Schizotypal: odd/bizarre/eccentric, usually lacks active hallucinations. Doesn't have negative symptoms, not typically mood symptoms. • Schizophrenia: Hallucinations or delusions and resulting impairment • Schizoaffective: Mood disorder (depression or bipolar), with psychosis in between mood episodes • Bipolar with psychotic features: Mood disorder, with psychosis only during mood episodes

Answer 81

Whether or not functioning is impaired

Answer 82

Conduct disorder typically involves legal involvement and destruction of property/animal life. ODD you see a person with high emotional distress/power struggles with authority figures.

Answer 83

Reactive attachment disorder is more related to attachment and lacking a relational frame -- treat people like objects and not wanting relationships. Whereas in autism people generally want relationships.

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