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Flashcards in Diagnosis Deck (173):
1

Likelihood of schizophrenic dx for a monozygotic twin vs dizygotic twin

Mono- 46%; Di- 17%

2

Concordance rate for Bipolar Disorder in identical twins

75-80%

3

Age of onset for OCD in males vs. females

Adult prevalence similar btwn males & females, but Male onset earlier (6 to 15 yrs old) than females (20 to 29)

4

Withdrawal syndromes that include hallucinations

Alcohol
Sedatives
Hypnotics
Anxiolytics

5

Withdrawal from amphetamines

dysphoria, fatigue, unpleasant dreams, increased appetite, and psychomotor agitation or retardation.

6

Opioid Withdrawal

flu like sxs

7

Timothy Crow theory of schizophrenia

Distinguished 2 types of schiz (I and II)
Type 1-del, hall, inappr affect, disorg thinking; neurotrans irregularies
Type II-due to brain structure abnormalities; begins in adol, poor prog, doesn't respond to antipsychotics

8

Reversal of pronouns is assoc w/

autism

9

research indicated that the best predictor for alcoholism is:

family hx

10

Delirium

disturbance in attention
develops over short period of time
additional dist in cognition (mem def, disorientation, lang, vis spat ability)
Direct phys consequence of another med cond, substance abuse, or withdrawal
specify:hyper, hypo, or mixed level of activity

11

Major Neurocognitive Disorder

A. evidence of SIG cog decline from previous level of fxing in 2 or more cognitive domains (complex attention, exec fx, learning, memory, language, percep, social cognition)
B. Cog Defs interfere w/independent ADLS
*Then must specify the type (from Alz, TBI, Vascular disease, HIV, Parkinson's, Huntington's, etc)
*Specify w/ or w/o behavioral dist

12

Mild Neurocognitive Disorder

A. modest decline in cog fxing in one or more domains
B. deficits do not interfere w/ADLS
*Then specify type (alz, vasc, etc)

13

Major or Mild Neurocog Disorder due to Alzheimer's disease

A.. crit met for maj or mild NCD
B. insidious onset & gradual progression of impairment in one or more domains (2 for major)
C. Determine if "probable" (fam hx or genetic testing) or "possible"

14

Major or mild Vascular NCD

Onset related to cerebrovascular events
Decline evident in complex attention, frontal exec fx
*dx probable or possible

15

NCD w/lewy bodies

Core feat: fluctuating attention & alterness, recurrent visual hallucinations (detailed), Spontaneous feat of parkinsons
Suggestive feat: meets crit for REM sleep disorder
Severe neuroleptic sensitivity

16

Autism Spectrum Disorder

A. persistent deficits in social communication & social interaction, manifested by deficits in:
-social emotional reciprocity
-nonverbal communicative bxs for social interaction
-developing, maintaining, understanding relationships
B. Restricted repetitive patterns of bx, interests, or activities, manifested by 2 of the following
-stereotyped mvmts, or speech
-inflexible adherence to routines, ritualized patterns of bx
-highly restricted interests abnormal in intensity
-hyper or hyporeactivity to sensory input
Specify w/or w/o accompanying intellectual impairment, language imp, assoc with med condition
w/catatonia?
*specify severity

17

ASD is dx __ times as often in boys than girls

4

18

ADHD-changes in criteria in DSM5

Inattentive & hyperactive/impulsive type are now specifiers rather than distinct diagnoses
some sxs evident before age 12
designation of just 5 sxs (as opposed to 6) required for dx in older adolescents and adults

19

very low birthweight increases risk for ADHD by __

2 to 3 fold

20

DSM 5 change to NOS categories

Now must choose "Other specified___" for sxs not meeting dx crit but causing sig distress or impairment

Unspecified ___ reserved for rare cases where clinician chooses not to specify reason for vague dx or more info needed

21

Delusions of Reference

belief that certain messages, comments, gestures are directed at oneself

22

Key Features of Psychotic Disorders

Delusions
Hallucinations
Disorganized thinking/speech
Grossly disorganized motor bx
Negative Sxs

23

Duration for dx of delusional disorder;
Impact on daily fxing

1 month or longer
fxing not markedly impaired, bx not obviously bizarre or odd; impairment directly related to the delusion

24

Brief Psychotic Disorder

A. Presence of 1 or more of: delusions, halluc, disorg speech, disorg bx
B. Duration 1 day, less than month, eventual return to premorbid fx
Specify w/or w/o marked stressor & postpartum onset

25

Schizophreniform Disorder

A. 2 or more for the past month (or less if treated): del, hall, disorg speech, disorg bx, neg sxs
B. at least one month but less than 6 months
C. No MDD or manic episodes during active phase sxs, or if mood sxs present, it is a minority of the time frame of illness
*If symptomatic for less than 6 months, it's provisional. If sxs continue past 6 months dx changed to schizophrenia

26

Schizophrenia

A. 2 or more during a 1 month period: Del, Hall, Disorg Speech, Grossly disorg bx, negative sxs (dim emotion & avolition)
B.Level of fxing (work, rel, self care, markedly below level prior to onset
C. Continuous signs of dist for at least 6 months (at least 1 month of active phase sxs, may incl prodromal or residual sxs (negative sxs, and less severe crit A sxs)
D. No MDD or manic episodes or if mood sxs present they are a minority of the total duration
F. If hx of autism, dx only made if there are prominent hall or del

27

Schizoaffective Disorder

Uninterrupted period of illness during which there are concurrent sxs of schiz and sxs of major depressive or manic episode
Must be a period of at least 2 weeks without prominent mood sxs

28

Neurodevelopmental Disorders

Intellectual Disability
Autism Spectrum Disorder
ADHD
Specific Learning Disorder
Tourette's D/o
Behavioral Pediatrics

29

Intellectual Disability

A. DEf in intell fxing confirmed by assessment & IQ testing
B. Def in adaptive fxing resulting in failure to meet community standards of independence, impair fxing across mult settings, ADLS
C. Onset during developmental period
Mild, Mod, Severe, Profound

30

Course, Prog, Etiology of Intellect Disability

Early signs: delayed motor dev, lack of interest in environ stim,
Infancy: poor eye contact during feeding
Can lessen severity with intervention, not necessarily lifelong condition
Etiology: 5% hereditary, 30% chrom changes/exposures to toxins; 10% pregnancy & perinatal(anoxia, malnutrition, trauma); 5% acquired med conditions; 15-20% environmental factors
Unknown cause in 30% of cases

31

Childhood Onset Fluency Disorder

Stuttering; sound & syllable repetitions, sound prolongations, broken words, substitutions, monosyllabic whole word repetitions
Onset between 2 and 7
65 to 85% recover; severity at age 8 is good predictor

32

Tx of Childhood Onset Fluency Disorder

Reduce stress at home
Habit reversal training (awareness, relaxation, motivation, competing response, generalization training)

33

Autism Spectrum Disorder Levels of severity

1- requiring support
2- req substantial support
3. very substantial support

34

Assoc features & Etiology of ASD

Intell imp, lang difficulties, unevenly developed cognitive ability (strong visual spatial but poor verbal comp & abstract reasoning
Signs often present by 12 months (decreased social gaze, impaired joint attention)
Etiology: struc abnorm in amygdala & cerebellum, abnorm serotonin, dop,

35

Common Co-occurring disorders w/ADHD

Conduct D/O
LD
ODD
Anxiety
MDD

36

Etiology of ADHD:

Low activity and small size in caudate nucleus, globus pallidus, prefrontal cortex

37

Behavioral Disinhibition Hypothesis of ADHD

Inability to regulate behavior to fit situational demands

38

Multimodal Tx Study of ADHD (MTA)

Initial results: Med mngmt alone & combined tx (med & intensive bx tx) had similar benefit to core sxs; this was not maintained on 3 and 8 year followup

39

Specific Learning Disorder

Presence of one sx for at least 6 months despite intervention
Academic skills below what expected for age
Interfere with academic, occ perf or ADLs
Onset during school age years
3 Subtypes: Imp w/reading, imp w/written exp, w/imp in mathematics

40

Assoc feat of LDs

Avg to above avg IQ
delayed lang dev
attention & mem deficits
low self esteem
20-30% also have ADHD
inc risk for conduct d/o

41

Motor Tic Disorders (3)

Tourette's
Persistent (Chronic) motor or vocal tic disorder
Provisional Tic Disorder

42

Tourette's Disorder: Crit & Assoc Feat

At least 1 vocal tic
Multiple motor tics
Persist at least 1 year
Onset prior to 18
Higher rate of OCD (also for bio relatives)

43

Etiology & Tx of Tourette's Disorder

Elevated dop, sensitivity of dop receptors in caudate nucleus
Antipsychotics (haloperidol & pimozide) effective in 80% cases
SSRIs help w/OCD sxs
Hyperactivity treated w/ clonidine & desipramine to avoid aggravating tics

44

Comp Bx Tx for Tics (CBIT)

Tx for Tourette's
Habit reversal
Relaxation
Psychoeducation

45

Interventions for pediatric medical procedures

Based on Meichenbaum's Stress Inoc Model
May include: filmed modeling, reinforcement, breathing exercises, emotive imagery, behavioral rehearsal

46

Children between the ages of __ and __ have most neg reactions to being in hospital

1 to 4

47

Children & adol w/ ___ ___ ___ are at highest risk of psychiatric probs

major neurological disorder, like hemiplegic cerebral palsy (3x higher than controls)

48

CNS irradiation & Intrathecal chemo are both assoc w/:

Impaired cog fxing
learning disabilities

49

Hallucinations are most often ___ and are characterized by:

auditory
Perjorative, threatening
Running commentary of person's thoughts or actions

50

Subtypes of delusions

erotomanic
grandiose
jealous
persecutory
somatic
mixed
unspecified

51

Assoc features of Schizophrenia

Inappr affect
dysphoric mood
disturbed sleep
lack interest in eating
anosagnosia
Subtance use often co occurs
Freq tobacco use

52

Over dx of Schiz among AA thought to be related to:

increased occurrence of hall or del as sxs of depression amongst AAs

53

Improved prognosis for schiz assoc w/:

good premorbid adjustment
acute & late onset
female
presence of precipitating event
brief duration of active phase sxs
insight
fam hx of mood d/o
no fam hx of schiz

54

Concordance rate for Schizophrenia

Bio sibling- 10%
Frat/dizygotic twin- 17%
Identical/monozy twin- 48%
Child of 2 parents w/schiz- 46%

55

Family members of ind w/schiz also especially at risk for :

other schiz spectrum disorders, esp Schizotypal Pers Disorder
Or, Schizoid, Paranoid, or Avoidant pers d/o

56

Brain abnormalities linked to Schiz:

enlarged ventricles
smaller hippocampus, amygdala, globus pallidus
negative sxs- hypofrontality (lower than normal activity of the prefrontal cortex)

57

In Schizophrenia, mood sxs:

are brief relative to duration of the disorder
do not occur during active phase
do not meet full criteria for a mood episode

58

In Schizoaffective disorder, prominent mood sxs:

occur concurrently w/psychotic sxs for most of the disorder
at least 2 week period when only psychotic sxs are present

59

In major depressive or bipolar disorder w/psychotic feats, psychotic sxs:

only occur during episodes of mood disturbance

60

Treatment of Schizophrenia

Traditional (1st gen) antipsychotics- haloperidol, fluphenazine; most effective for + sxs, but high risk of tardive dyskinesia
Atypical (2nd gen) antipsychotics- clozapine, risperidone
lower risk of tardive dyskinesia, eff for + and - sxs

61

Diffs btwn crit for Schiz and Schizophreniform

Duration at least one month, less than six months
Impaired soc or occ fxing may occur but not required

62

About __ of ppl w/schizophreniform d/o will eventually meet crit for ____ or ___

Schizophrenia or Schizoaffective

63

Bipolar I Disorder

At least one manic episode, lasting at least one week, present most of day nearly every day
3 charac sxs:
1. inflated self esteem or grandiosity
2, decrease need for sleep
3. excessive talkativeness/flight of ideas
marked impairment, require hospitalization, or incl psychotic features
May incl 1 or more episodes of hypomania or major depression

64

Comorbid conditions w/Bipolar I Disorder

Anxiety
Substance use
15x greater risk of completed suicide

65

Prevalence of Bipolar I

0.6%
male to female 1.1:1

66

Concordance rates for Bipolar I disorder

Identical twins- .67 to 1.0
Frat twins- .20
1st degree relatives at greater risk for bipolar and depression

67

Pharmacotherapy Treatment of Bipolar I

Lithium effective for classic presentation, prevents recurrent mood swings
For Rapid cycling or dysphoric mania anticonvulsants effective- carbamazepine or divalproex sodium
Acute mania- antipsychotics like olanzapine, risperidone,
Antidepressants can be used to treat depression, but may trigger mania (risk greater for TCAs than SSRIs)

68

Psychosocial tx of Bipolar Disorder

CBT, FFT, Interpersonal and social rhythm therapy

69

Bipolar II Disorder

At least one hypomanic episode and one MDD ep
Hypomania must last 4 consecutive days
Same charac sxs as mania, but less severe, less fx imp, does not require hosp

70

Cyclothymic Disorder

Numerous periods of hypomanic & depressive sxs that do not meet crit for hypomanic ep or depr ep
Duration of at least 2 years (adults), 1 year (chil & adol)
Sxs must be present at least half the time, symptom free for no more than 2 months at a time

71

Disruptive Mood Dysregulation Disorder

A. Severe recurrent temper outbursts, grossly out of prop in intensity & duration
B. Chronic persistently irritable or angry mood on most days
Duration 12 months in at least 2 settings
Outbursts at least 3 times per week
Cannot be dx before 6 years of age or after 18 years of age
Onset before 10 years

72

With Perinatum onset applied when:

onset of sxs is during pregnancy or within 4 wks postpartum
often incl preoccupations re:infant's well being or possibly delusions

73

Percentage of women experiencing perinatum depression; postpartum psychosis

10 to 20%
.1 to .2%

74

w/seasonal pattern specifier

hypersomnia
increased app & weight gain
carb craving
*phototherapy an effective tx

75

Impact of depression on sleep

sleep continuity disturbances (early morning awake)
reduced stage 3 and 4 sleep (slow wave, delta)
earlier onset of REM sleep, increased duration early in night

76

Prevalence of depression

7% 12 month, age related diffs:
prev for 18 to 29 year olds 3x prev of ppl 60+ yrs old

77

Manifestation of depression in children

somatic complaints, irritability, social withdrawal

78

Depr in adolescence

aggressiveness & destructiveness more often in boys

79

Depr in older adults

memory loss, distractibility, disorientation, other cognitive sxs

80

depr in asians

weakness, tiredness, imbalance

81

Concordance rates for depression

identical twins- .50
frat- .20
1.5 to 3x more common in 1st degree relatives
genetically linked to neuroticism

82

Indolamine hyp of depression

too little serotonin

83

Impact of cortisol in depression

increased cortisol, causes atrophy of hippocamps

84

Lewinsohn's behavioral theory of depression

operant conditioning basis: low rate of response contingent reinforcement, resulting in extinction of those bxs and pessimism, low self esteem, isolation
which all reduce likelihood of reinforcement in the future

85

Seligman's Learned Helplessness Model of Depression

Attribute negative events to internal, stable, global factors

86

Abramson & Alloy revision of Learned Helplessness model

de-emphasizes attributions and proposes hopelessness as sufficient & primary cause of depression

87

Uncomplicated bereavement charac by:

predominant mood emptiness or loss, decreases over days to weeks
occurs in waves

88

Tricyclics (TCAs) prescribed for depr when:

"classic" presentation, vegetative sxs, worse sxs in morning, acute onset, short duration, moderate severity

89

SSRIS prescribed for depr when:

1st line for mod to severe depr; fewer side effects, lower risk of overdose

90

MAOIs presc for depr when:

poor response to TCAs or SSRIs
atypical sxs (anxiety, hypersomnia, hyperphagia, interpersonal sensitivity)

91

SNRIs for depression

venlafaxine (Effexor)
desvenlafaxine (Pristiq)
duloxetine (Cymbalta)
*inc nor & ser

92

NIMH study comparing CBT, IPT, & TCA imipramine for depression

No sig diff overall
Imipramine slightly better for severe depr
Follow up study indicated only 30%, 26%, 19% respectively were symptom free at 18 months post tx

93

Side effects of ECT can be reduced by:

administering ECT unilaterally to right (nondom) hemi
reserved for severe endogenous forms of depr

94

Premenstrual Dysphoric Disorder

For most menstrual cycles, at least 5 sxs the week before onset of menses with improvement in sxs a few days after onset of menses
At least one sx must be affective lability, irritability, depressed mood or self deprecating thoughts
At least one sx must be: decr interest in activities, imp concentration, lethargy, appetite change, hyper or insomnia, physical sxs

95

Risk Factors for Suicide-Age

Highest age range 45 to 54 (male, female combined)
Females: 45 to 54
Males: 75+

96

Risk for suicide- Gender

Males 4x as likely to complete
Females 2-3 x as likely to attempt

97

Risk for suicide-Race

Highest for whites
except for American Indians/Alaskan natives (15 to 34), rate 2.5x the national avg

98

Risk for suicide: Thoughts & Bxs

60-80% prior attempt
80% give definite warning

99

For adolescents, suicide often follows:
And risk increases w/dx of:

interpersonal conflict, rejection, argument w/parents
Conduct d/o, substance use, ADHD

100

Most common Dx for suicide

MDD
Bipolar (mood d/o 15 to 20% more likely than gen pop)

101

When suicide assoc w/depression, most likely to commit:

w/in 3 months after depressive sxs start to improve

102

Separation Anxiety Disorder

Requires
-recurrent distress when anticipating or exp sep from attachment figs
-excessive fear of being alone
-phys sxs when separated
4 wks in children
6 months in adults
Freq school refusal
Often from close, warm families
Tx: Systematic Desens
W/school refusal: goal to immediately return to school

103

School refusal typically happens at:

5 to7
10 to 11
14 to 16

104

Specific Phobia

Intense fear of specific object or situation, avoidance or endured w/marked distress
At least 6 months
Specifiers: animal, natural environ, blood injection injury, situational, other

105

Etiology of phobia

Serotonin, Nor, GABA implicated
Mower's 2 factor theory: Avoidance cond- 1st lear to fear neutral stim due to pairing w/fear arousing US, avoidance then negatively reinforced

106

Duration req for Social Anxiety Disorder (Social Phobia)
Etiology
Treatment

at least 6 months
Behavioral inhibition, temperament, information processing biases
ERP combined w/social skills, cog restructuring
Beta blocker propranolol for perf anxiety

107

Panic Disorder: Duration, sxs, Prev, Tx

Recurrent attacks, followed by at least 1 month of fear of having another/significant behavioral change
at least 4 sxs: inc HR, sweating, trembling, choking, chest pain, paresthesias, derealization, fear of losing control
*Other med issues must be ruled out!
Prev: 2-3% for adults; females 2x as likely
Tx: Panic Control Therapy psychoed, relaxation training, cog restruc, interoceptive exp
Meds: imipramine, TCAs, SSRIs, SNRIs benzos
30-70% of ppl relapse with drug tx alone

108

Duration for Agoraphobia, distinguishing feat from phobia

At least 6 months
fear of experiencing panic or embarrassing sxs in public place
Graded & Intense Exposure both effective, but Intense more effective long term

109

Over __ of pts w/prin dx of anxiety disorder have a comorbid dx

50%, highest w/GAD (most often MDD, PDD, Substance, Phobia, Soc Anx)

110

Med tx of GAD

SSRIs, SNRIs,
If not resp: benzo, or buspirone (buspar)

111

OCD specifiers

Level of insight, presence of tics

112

OCD Prevalence,etiology, tx

1.2%
Equally common in males & females
Age of onset earlier for males, so more common in males for childhood/adol
Right caudate nuc implicated-overactive, orbitofrontal cortex, cingulate cortex
SSRIs treat, ERP, TCA clomipramine
antidepr have high relapse when used alone

113

OCD & Related Disorders (other 2 disorders)

Body Dysmorphic Disorder
Hoarding Disorder

114

Trauma & Stress Related Disorders (5 dxs)

Reactive Attachment
Disinhibited Social Engagement Disorder
PTSD
Acute Stress Disorder
Adjustment Disorders

115

Reactive Attachment Disorder

inhibited, emotionally withdrawn bx toward caregivers
Lack of seeking or responding to comfort
Minimal social responsiveness to others, limited pos affect, unexplained irritability, sadness, fearfulness
*Has experienced extremely insufficient care
Sxs must be evident before 5 years, must have developmental age of at least 9 months

116

Disinhibited Social Engagement Disorder

Inappropriate interactions w/unfamiliar adults
reduced or absent reticence in approaching
overly familiar bx
willingness to accompany other adults w/o hesitation
*Has experienced extremely insufficient care
Dev age of at least 9 months

117

PTSD (age 6 and above)

-Exp to threat directly, witnessing, learning that occurred to family member, repeated extreme exposure to details of the event
-At least 1 intrusion sx: intrusive memories, dreams, dissociative reactions, marked phys reacitons when reminded of event
-Avoidance of stimuli
-Negative changes in cognition or mood (at least 2)
-Marked change in arousal & reactivity (irritable, angry outbursts, reckless bx, hypervigilance, startle response, sleep disturbance
Duration more than a month
Delayed expression if dx crit not met until 6 months after event

118

PTSD (age 6 and below)

Incorporates threats to caregiver explicitly
-Dreams do not have to be specific to the event
-Memories expressed through play reenactment
-Duration at least one month

119

Tx of PTSD

Tx of choice: Comprehensive CB intervention (exposure, cog restruc, anxiety mngmt)
SSRI for comorbid depr & anxiety
Cog Incident Stress Debriefing-single lengthy session within 72 hrs of event even if no sxs of distress; may actually worsen sxs
EMDR- evidence that benefit is due to exposure rahnte that eye mvmts

120

Acute Stress Disorder

Mirrors crit for PTSD but duration is 3 days to one month

121

Dissociative Amnesia- most common forms

-Inability to recall personal info, often following trauma
*Localized amnesia- can't remember events from a circumscribed period of time
*Selective-inability to recall some events from circumscribed period of time
Generalized-person's entire life
Continuous- can't recall events subsequent to a specific time through the present
Systematized-can't remember things related to a certain category of info
-Specify if accompanied by fugue

122

Somatic Symptom & Related Disorders

Somatic Sx Disorder
Illness Anxiety Disorder
Conversion Disorder
Factitious Disorder

123

Somatic Sx Disorder

1 or more somatic sxs
-Disruptive to daily life
-Excessive thoughts, feelings, bxs related to the sx (believe very serious, high anxiety, time & energy devoted to these concerns)
-Predominant Pain specifier

124

Illness Anxiety Disorder

Preoccupation w/having a serious illness
Absence of somatic sxs or only mild sxs
High anxiety about health
Excessive health related bxs
At least 6 months, illness of concern can change throughout

125

Conversion Disorder (Fx Neur Sx Disorder)

Dist to voluntary motor or sensory functioning
(paralysis, seizures, blindness, loss of pain sensation)
Evidence of incompatibility between sx & neur or med conditions

126

Factitious Disorder- Imposed on Self or Imposed on Another

Falsify phys or psych sxs, present as being impaired, engage in deceptive bx, absence of obvious external reward

127

Malingering should be considered when:

seeking eval for legal reasons, marked discrepancy btwn reported sxs and objective findings, does not cooperate w/assessment or treatment, person has antisocial personality disorder

128

Pica-duration; age range

eating non-nutritive substances
at least 1 month
can occur at any age, most common during childhood

129

Anorexia

a. restriction of energy intake leading to sig low body weight
b. intense fear of gaining wt or becoming fat; bx interfering w/wt gain
c. disturbance to perception of body shape/wt; lack recognition of seriousness of low body wt

130

Anorexia- Assoc Features

Excessive exercise, purging, preoccupied w/food, hoard food, collect recipes
Over 1/2 meet crit for anxiety disorder, esp social phobia & OCD (onset typically prior to anorexia)
Depression common after onset
Phys complications
Onset adol/young adult, 90% female

131

Etiology of Anorexia

Genetic- high concord for twins & 1st degree relatives
Neurotrans abnormalities-Higher than normal serotonin, causes restlessness, anxiety, obsessions; food restric lowers serotonin & alleviates unpleasant feelings; evidenced by fact that drugs increasing ser are not effective until person has reached normal wt

132

Tx of Anorexia

Wt restoration-contingency mngmt
Family therapy-should be separate if family exhibit high expressed emotion
CBT (Garner) Stages:
1-estab alliance & inc motivation
2-normalize eating patterns & body wt (self monitoring of eating)
3-Socratic qs, decatastrophizing to modify dysfunctional beliefs about food & wt
4-prep for term & relapse prevention

133

Bulimia Nervosa

a. recurrent episodes of binge eating (lack of control)
b.compensatory bx to prevent wt gain (fasting, exercise, vomiting, laxatives)
c. self image unduly infl by wt
At least once a wk for 3 months
Severity based on avg # of compensatory episodes each wk

134

Bulimia, Assoc Features

Anxiety disorder often precedes
Depression most common comorbid
Med complications
Onset adol/early adulthood
over 90% female
Onset during or after dieting

135

Etiology of Bulimia

Low levels of endogenous opioid beta-endorph
Low level serotonin

136

Tx of Bulimia

Nutritional counseling
CBT-lower relapse rate & tx dropout than antidepr alone
imipramine (tofranil) & fluoxetine (Prozac)

137

Binge Eating Disorder

Binge eating: sense of loss of control & at least 3 charac sxs:
1.rapid eating
2. uncomfortably full
3. alone due to embarrassment re: amt of food
Marked distress
At least once a week for 3 months

138

Enuresis duration; age req, specifiers

At least 2x/week for 3 months
AT least 5 yrs old
Nocturnal only, diurnal only, both

139

Tx of Enuresis

Bell & pad alarm, effective in 80% of cases, but 1/3 relapse to some extent within 6 months of tx
Behavioral rehearsal
Overcorrection
Imipramine (tofranil) reduced freq in 85% of cases, suppresses entirely in 30%, but most relapse within 3 months
desmopressin- short term, but poor long term effects

140

Encopresis- duration & age

at least once a month for 3 months
4 years old

141

Insomnia disorder

At least 1:
Diff initiating sleep, maintaining, early morning awakening
3 nights a week, for at least 3 months

142

Hypersomnolence Disorder

Excessive sleepiness in spite of sleeping at least 7 hours
At least one:
-recurrent periods of sleep in the day
-prolonged non restorative sleep for more than 9 hours each day
-difficulty waking after abrupt waking
3x/week for at least 3 months

143

Narcolepsy

Irrepressible need to sleep
3x week for at least 3 months
Req:
cataplexy (loss of muscle tone)
hypocretin deficiency
REM latency < or = 15 minutes
hynogogic hallucinations
cataplexy triggerd by strong emotions

144

Non REM Sleep arousal disorders

episodes of incomplete awakening during first third of sleep cycle (stage 3 or 4)
Sleep walking or sleep terror
little to no recall upon awakening

145

Nightmare disorder

Occur during REM sleep, fully alert when wake up but continue feeling anxious

146

Erectile Disorder

at least one of:
-diff obtaining erection
-diff maintaining
-decreased erec rigidity
at least 6 months
have to rule out: diabetes, liver & kidney disease, MS, smoker, antipsychotic, antidepressant, hypertensive meds
Viagra can treat along with CBT techniques

147

Genito-Pelvic Pain/Penetration Disorder

Diff with 1 or more of:
-vaginal penetration
-genito pelvic pain during attempts at penetration
-anxiety
-tensing of pelvic floor muscles during attempted penetration
-Duration 6 months
-Often assoc w/hx of sexual abuse or physical abuse

148

Premature Ejaculation

6 months for all sex activity (1 minute)
Tx: SSRIs, sensate focus, stop start, squeeze techniques

149

Duration crit for Gender Dysphoria in Children

6 months
Specifier for congenital adrenogenital disorder or other disorder of sex dev
Onset 2 to 4 years of age
Persistence to adulthood varies for natal sex (sex at birth)
Males: 2.2 to 30%
Females: 12 to 50%

150

Tx of Paraphilias

In vivo aversion therapy-only short term benefits
CBT-red cog distortions, dev empathy toward victims, tolerate strong emotions
Bx Strategies: Covert sensitization, orgasmic reconditioning
DepoProvera reduces paraphilic bxs, but stops working as soon as discontinued

151

Intermittent Explosive Disorder

Outbursts at least 2x/week for 3 months
3 outbursts must have damaged property or injured other people or animals during a 12 month period
Must be at least 6 yrs old

152

Conduct Disorder

4 Categories of sxs:
1. aggression to ppl and animals
2. destruction of property
3. deceitfulness or theft
4. serious violation of rules
3 sxs past 12 months
1 sx past 6 months
Childhood onset- up to 10 yrs
Adol onset- no sx prior to age 10

153

2 Types of Conduct D/o (Moffitt)

Life Course Persistent-starts early (as early as toddler years), increasingly serious transgressions, cont to adulthood; attributed to neur impairments, diff temperament, adverse environ circumstances
Adol Limited Type: Maturity gap, antisoc acts usually committed with peers, inconsistent across situations

154

Conduct D/O Tx

Parent Management Training
Multisystemic treatment

155

4 categories of sxs for Substance Use Disorders

Impaired Control
Social Impairment
Risky Use
Pharmacological Cx

156

Tension Reduction Hypothesis of alcohol use

Negative reinforcement (anxiety/tension reduced) leads to addiction

157

Marlatt & Gordon's Theory of substance use

addiction is an overlearned, maladaptive bx pattern
Relapse due to "Abstinence Violation Effect" feel so guilty for using that become more susceptible to ongoing use
Relapse Prevention Therapy- practice dealing with situations assoc w/risk of relapse

158

Successful smoking cessation assoc w/:

male age 35+
college educated
smoke free home/work
married or partnered
started smoking later
lower level nicotine dependence
abstained for at least 5 days in prior attempts to quit

159

Smoking Cessation Intervention

Nicotine Replacement Therapy
Bx therapy including skills training, relapse prevention, stim control, rapid smoking
Support from clinician

160

Alcohol Intoxication

Maladaptive bx & psych changes (impaired judgment, mood, sexual or aggressive bx) and one of:
slurred speech
incoordination/unsteady gait
nystagmus
impaired memory
stupor or coma

161

Alcohol Withdrawal*
Sedative Hypnotic Anxiolytic Withdrawal

2 or more of:
autonomic hyperactivity (sweating tachycardia)
hand tremor
insomnia
nausea or vomiting
illusions or hallucinations
anxiety
agitation
generalized seizures
Onset hours or days following cessation of drinking

162

Alcohol Withdrawal Delirium

delirium sxs + autonomic hyperactivity, vivid halluc, delusions, agitation

163

Alcohol Induced Major NCD

Nonamnestic confabulatory type
Amnestic Confabulatory Type, also known as Korsakoff Syndrome- anterograde & retrograde amnesia, confab, thiamine def

164

Alcohol Induced Sleep Disorder*

result of either intox or withdr
Intox-sedation, inc stage 3 and 4, reduced REM followed by wakefulness, increased REM, red stage 3 &4
Withdr- severe disruption of sleep continuity w/vivid dreams

165

Stimulant Intoxication

Euphoria, affective blunting, hypervigilance, anxiety, anger, impaired judgment
At least 2 of:
tachycardia or bradycardia
pupil dilation
elevated or lowered BP
perspiration or chills
nausea or vomiting
weight loss
resp depre
cardia arrhythmias,
confusion, seizure, coma

166

Stimulant Withdrawal

fatigue, vivid unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor agitation or retardation
"crash"- intense lethargy, depression, increased app

167

Sedative, hypnotic, anxiolytic intox

slurred speech, incoordination, unsteady gait, nystagmus, impaired cognition

168

Opiod Intoxication

Initial euphoria followed by apathy, impaired judgment, pupil constriction, drowsiness or coma, slurred speech, poor attention & memory

169

Opioid Withdrawal*

dysphoric mood
nausea
muscle aches
pupil dilation
piloerection
sweating diarrhea, fever

170

Inhalant Intox

much overlap w/alcohol intox
generalized muscle weakness, blurred vision, depressed reflexes

171

Tobacco Withdrawal*

Irritability
anxiety
impaired concentration
inc appetite
restlessness
depressed mood
insomnia

172

Alzheimers Stage 1

1 to 3 years
anterograde amnesia (esp declarative)
def in visuospatial skills (wandering)
indiff, irritability, sadness, anomia

173

Alzheimers Stage 2

2 to 10 years
Inc retrograde amnesia
flat or labile mood
restlessness & agitation
delusions
fluent aphasia
acalculia
ideomotor apraxia (can't tran idea into movement)