Flashcards in Diagnosis & Psychopathology 1 Deck (49):
List the five DSM-IV-TR Pervasive Developmental Disorders.
- Autistic Disorder
- Rett's Disorder
- Childhood Disintegrative Disorder
- Asperger's Disorder
- Pervasive Developmental Disorder NOS (including Atypical Autism)
What are the key diagnostic criteria for Autistic Disorder?
Before age three, delayed or abnormal functioning in social interaction, language used in social communication or symbolic or imaginative play.
Also, at least two symptoms from category 1, and one each from categories 2 and 3:
1. Qualitative impairment in social interaction, e.g.:
- impairment in nonverbal behavior
- lack of social or emotional reciprocity
- absence of peer relationships
2. Qualitative impairment in communication, e.g.:
- delay in developing or lack of spoken language
- impaired ability to initiate or carry on conversations
- stereotyped and repetitive use of language or idiosyncratic language
- lack of developmentally appropriate play
3. Restricted repetitive and stereotyped patterns of behavior, interest, and activities, e.g.:
- preoccupation with stereotyped and limited patterns of interest
- inflexible adherence to purposeless routines or rituals
- stereotyped and repetitive motor movements
- persistent preoccupation with parts of objects
What are some notable language deficits associated with Autistic Disorder?
- dramatically reduced speaking (half don't speak at all)
- pronoun reversal (e.g., "you"" for ""I"")
What are the prevalence rates and comorbidities of Autism Disorder?
- prevalence of ~3 in 500
- 4-5x more common in boys than girls
- unrelated genetically to Schizophrenia
- 75% co-diagnosed with Mental Retardation, although some "savant" specialized skills
- ~2% attain independence in adulthood (with Tx)
- ~40% attain high functioning as adults (with Tx)
- DiffDx (childhood Schizophrenia): AD does not involve psychotic features
What is known of the etiology of Autistic Disorder?
- etiology is unknown
- higher concordance in monozygotic twins than dizygotic
- associated with maternal rubella, birth complications
- not correlated with SES, parent personality, education, occupation, race, religion
What are some macro-neurological abnormalities associated with Autistic Disorder?
- persistently high autonomic arousal
- ventricular enlargement
- frontal lobe dysfunction
- underdeveloped cerebellum
- abnormal brain lateralization
What neurotransmitter is affected by Autistic Disorder and how?
Serotonin levels tend to be elevated in Autistic patients.
What treatments have been shown to be effective for Autistic Disorder?
- operant techniques, especially when introduced early, help with
* elimination of abnormal behaviors
* improvement of communication (esp. if all communication is reinforced, rather than just "successful" efforts)
- neuroleptics (e.g.
What are the best prognostic indicators for Autistic Disorder?
- language skills before age 7
- overall intellectual level (by itself, only predicts worst outcomes)
- severity of disorder
- developmental milestones
- social maturity/behavior
- time in school
- comorbid neuropsychiatric disorders
What factors have been shown to be unrelated to outcome of Autistic Disorder?
- birth weight
- perinatal complications
- age of onset
- normal development before onset
- late development of seizures
- type of treatment
- family mental illness
Describe Rett's Disorder.
- progressive pattern of developmental regression starting before age four
* deceleration of head growth
* loss of hand skills (can exhibit hand-wringing or repetitive washing >30 months)
* uncoordinated gait and trunk movement and eventual severe psychomotor retardation
* severe language deficiencies (expressive & receptive)
* loss of interest in social interaction (some may regain later)
- normal appearance for at least first five months of life
- etiology: genetic mutation, female only (X-linked)
- 50%-80% develop epilepsy
- associated with severe or profound Mental Retardation
Describe Childhood Disintegrative Disorder.
- progressive developmental regression starting after age two and before age 10
- loss of developed skills:
* language (expressive and receptive)
* social skills
* bowel/bladder control
* motor skills
- very rare
DiffDx (Autism): AD irregularities apparent from w/in first year
Describe Asperger's Disorder.
- similar to Autistic Disorder except no clinical delay in language, self-help skills, cognitive development, or curiosity about environment
- more common in males
- prognosis much better than Autistic Disorder
What characterizes Learning Disorders?
considerably lower (~2SD) than expected achievement, relative to age, education, intelligence, on standardized reading, math, and writing tests
What are the three types of Learning Disorders?
- Mathematics Disorder
- Reading Disorder (aka, dyslexia)
- Disorder of Written Language
What are the two types of Reading Disorder (dyslexia)?
- surface/orthagonal: inability to decipher irregularly spelled words (e.g., "might" read as "mit")
- deep: multiple reading errors, including semantic paralexia, reading a word as an incorrect one which is semantically but not phonologically or visually related (e.g., "hot" for "cold")
Name some issues from which Learning Disorders must be differentially diagnosed.
- lack of opportunity
- poor teaching
- cultural factors
- Mental Retardation
- Pervasive Developmental Disorder
- sensory deficit
If a person meets criteria for both a Learning Disorder and Mental Retardation, what should be considered for a dual diagnosis?
LD must clinically interfere with academic or daily life
What tests might be administered to identify a Reading Disorder?
WISC might be administered for general intelligence, then Woodcock-Johnson subtest for spelling and reading. If full-scale WISC substantially exceeds (e.g., 2SD) the W-J subtest scores, RD might be considered.
What other disorders are persons with a Learning Disorder at higher risk for?
- ADHD (20%-50% LD children)
- Conduct Disorder
- Oppositional Defiant Disorder
- Major Depressive Disorder
What are some neuropsychological factors associated with Reading Disorder (dyslexia)?
- visual perception
- linguistic processes
- short term memory
- left-right confusion
What environmental factors have Learning Disorders been associated with?
- toxic exposure (esp. lead)
- early malnutrition
- early iron deficiency
- food allergies
- hemispheric abnormalities (incomplete dominance, mixed laterality)
- cerebellar-vestibular dysfunction (assoc. w/otitis media with effusion, middle ear infection w/accumulation of liquid)
Describe Mixed Receptive-Expressive Language Disorder.
- developmental deficits in both receptive and expressive language
- expr/recep language scores are considerably lower than nonverbal intellectual abilities
- same as expressive Language Disorder, but difficulty understanding words or sentences
Describe Phonological Disorder.
- non-use of speech sounds expected for age/dialect
- wide range of disorder, but diagnosed only when significant impairment in occupation, academia, social functioning
- age-inappropriate speech abnormalities, including repetition or prolongation of sounds or syllables, interjections, broken words
- usually begins between two and seven
- often function of anxiety; successful treatment often addresses anxiety, rather than speech
- pattern can be developmentally normal, remitting w/o intervention in 60% of cases
Describe Motor Skills Disorder.
- substantial impairment of age-appropriate motor coordination development
- must be clinically significant, not due to Pervasive Developmental Disorder, Mental Retardation, or general medical condition
Discuss prevalence rates of ADHD.
- 3-5% of all children meet criteria; up to 10% show multiple signs
- 4 to 9 times more common in boys than girls
- lower IQ test performance is typical, but relatively variability, with some in above average to gifted range
- ~50% hyperactive children have behavioral issues < age 3, but not diagnosed until school age
- 50% comorbid with conduct/antisocial behavior
- 25% comorbid with emotional disorder
- 20% comorbid with Learning Disorder
Discuss ADHD in adults.
- 70% show symptoms lifelong:
* low frustration tolerance
* emotional lability
* low self-esteem
* concentration issues
- common life issues from ADHD in adults:
* chronic procrastination
* needless worry
* relationship difficulty
* sexual promiscuity
- treatable personality characteristics arising from ADHD:
* passive-aggressive traits
Discuss etiology of ADHD.
- unclear, but appears to have biological basis
- heritability index of .80 for hyperactivity and impulsivity
- parents with ADHD have 57% chance of having children with ADHD
- environmental toxins, such as food allergies, lead, and prenatal alcohol & nicotine use
- arousal studies inconclusive
Abnormalities in what primary brain regions and processes are implicated in ADHD?
- right pre-frontal cortex
- striatum (putamen and esp. caudate nucleus)
- parts of parietal lobe (less involved than above)
- diminished glucose metabolism
- decreased blood-flow in prefrontal lobe and connections to caudate nucleus
Describe the behavioral disinhibition hypothesis of ADHD.
ADHD represents an inability to adjust activity levels to fit settings, not attentional disregulation. This is consistent with the finding that individuals can have difficulty increasing, as well as decreasing activity.
Discuss pharmacological interventions for ADHD.
- CNS stimulants such as methlyphenidate/Ritalin most common
* paradoxical effect also occurs in non-ADHD people
* higher doses = reduced activity, improved socialization
* lower doses = improved attention
- can produce OCD-like side effects (30%-50%), tics, and temporarily limit growth
What are some limitations of treating ADHD with CNS stimulants?
- not all patients respond
- responses short-lived
- positive or negative outcome hard to predict at outset of drug regimen
Discuss cognitive and behavioral interventions for ADHD.
- contingency management
* reinforcement combined with response cost using concrete rewards is best
- self-monitoring with self-talk (for older children)
- specific attentional skill building
- parental support in structured environment
Discuss prognoses, comorbidities, and other factors associated with Conduct Disorder.
Childhood Onset is associated with more aggression, violence, and comorbidity, esp. ADHD and substance abuse compared to Adolescent Onset. Childhood Onset is also more likely to continue with antisocial behavior and eventually meet criteria for Antisocial Personality Disorder.
Relative to norms, children with CD have lower:
- school achievement
- achievement test scores
- verbal IQ scores, but similar non-verbal IQ scores
- abstract thinking ability
- moral judgment
What environmental and biological factors are associated with Conduct Disorder?
- family antisocial behavior/psychopathology
- large family size
- parental neglect/rejection
- family discord
- physical or sexual abuse
- inability to experience high emotional arousal
- genetic predisposition
Describe prevalence rates and onset of Pica.
- rare, occurring equally in boys and girls
- onset between one and two years typical
- remits usually early childhood, sometimes into adolescence, rarely into adulthood
Describe onset and issues in Rumination Disorder.
- typical onset age 3mos to 12mos
- potentially fatal due to malnutrition (25% mortality rate)
Describe onset and issues of Feeding Disorder of Infancy or Early Childhood.
- onset typically first year, but can be late as age three
- weight loss (or failure to gain) can be severe enough to be fatal
Describe prevalence rates and other factors associated with Tourette's Disorder.
- vocal tics include coprolalia in <10% of cases
- often comorbid with obsessions and compulsions, ADHD (58% of TD patients), Learning Disorders (80% of Pts w/LD also have ADHD), depression, and social issues
- IQ range normal
Define a tic.
involuntary, sudden, rapid, recurrent, nonrhythmic, and stereotyped motor movement or vocalization.
Describe common treatments for Tourette's Disorder.
- combination of school intervention, individual & family therapy, pharmacotherapy
- antipsychotics (haloperidol, pimozide; clonidine as alternative)
- antidepressants (clomipramine, fluoxetine)
- ADHD pharmacotherapy (CNS stimulants) can exacerbate tics
Describe etiology, prevalence rates, and treatments for Enuresis.
- psychopathological etiology not supported; generally believed to result from late-maturing genitourinary system
- at age five, more common in boys (7%) than girls (3%), but difference shrinks with age
- bell-and-pad most common, effective treatment; may take several weeks or months
- antidepressants effective short-term 30%, but not effective long-term
- hypnosis useful (empowering for child), but less effective than bell-and-pad
- bladder control exercises no longer Tx of choice
Describe key features of Fetal Alcohol Syndrome.
- result of chronic in utero exposure to alcohol (unknown threshold, but average of < 2 drinks/day shows no FAS effects)
- impaired motor coordination, impaired attention & memory, hyperactivity, impulsivity, poor judgment, mental retardation
- mean reported IQ scores is 68, but range is wide
- negatively affects basal ganglia, hippocampus, frontal lobes, crebellum, corpus callosum, hypothalamus
- thin, low-adipose body
- short nose, narrow upper lip, small chin, flat mid-face
- prevalence higher in low SES groups suggests poor nutrition, smoking & other drug use are factors
Describe relevant issues with Separation Anxiety Disorder.
- not to be confused with developmentally appropriate separation anxiety
* has variable course and can persist into young adulthood
- school phobia occurring in early childhood (5-7 years) usually results for SAD, but when it occurs in adolescence, it is associated with depression or SMI; in any case it is usually recommended that the child be returned to school
- associated with parental over-protectiveness, loss- or trauma-based insecurity, unresolved dependency issues
Describe key features of Sudden Infant Death Syndrome.
- believed to result from constitutional issues complicated by perinatal conditions
- typically associated with low birth weight and length, and apnea present at birth
- death typically occurs in sleep
- prevalence 1:10,000 in US, third most frequent cause of infant death from age 1mo to 1yo
What are the eleven Mental Disorders Due to A General Medical Condition?
- Amnestic Disorder
- Psychotic Disorder
- Mood Disorder
- Anxiety Disorder
- Sexual Dysfunction
- Sleep Disorder
- Catatonic Disorder
- Personality Change
- Mental Disorder NOS
Describe some features distinguishing depression in childhood from adult depression.
- accident proneness (interpreted as related to suicidal ideation/self-harm), psychomotor agitation
- separation anxiety (young children)
- antisocial behaviors (adolescents, esp. boys)
- associated with family abuse and neglect
- may be misdiagnosed as Conduct Disorder when psychomotor agitation and resultant misbehavior present
- rare but present in preschoolers and increases with age