DSM-5 Flashcards
(86 cards)
1
Q
intellectual disability
A
- deficits in general mental ability + adaptive functioning across multiple environments
- typically have an IQ score that is 2 or more standard deviations below the mean
- severity is based on adaptive functioning (i.e. how much support a person will require), NOT IQ
- male to female ratio of 1.5 : 1
- cause is known in 25-50% (80/85% prenatal factors- genetics, chromosomal, 5/10% perinatal- asphyxia, 5/10% post natal.
- most common chromosomal cause is Down syndrome, fragile X syndrome and most common preventable cause= FAS
2
Q
autism spectrum disorder
A
- persistent deficits in social communication/interactions across multiple contexts*
- restricted and repetitive patterns of behaviour, interests, or activities
- onset of symptoms must be during early developmental period
- severity is based on level of support
- male to female ratio of 4 : 1
- best prognosis: IQ over 70, functional language skills by 5 and no comorbid mental health problems
Etiology: 69-95% monozygotic twins. Non genetic risk factors: make gender, birth before 26 weeks, advanced parental age, exposure to environmental toxins during prenatal development.
3
Q
ADHD
A
- persistent pattern of inattention and/or hyperactivity/impulsivity
- 6 month duration and onset is before age 12
- must occur in at least 2 settings
- children must have at least 6 symptoms, adults and adolescents at least 5
- male to female ratio of about 2 : 1 but it decreases in adulthood when ratio becomes 1.6 : 1
- often comorbid with oppositional defiant disorder (about 50% of the time), conduct disorder (about 25% of the time), anxiety and depression
- most prevalent disorder diagnosed in youth 3-17
- heritability: 71% for ID twins, 41% for frat. Twins
- ADHD linked to low bw, premature birth and maternal smoking/alcohol use during pregnancy
4
Q
specific learning disorder (how long must symptoms be present for diagnosis etc)
A
- difficulties learning and using academic skills
- must be present for at least 6 months despite interventions targeting the difficulties
- for diagnosis: skills must be substantially below for expected age, interfere with academic/occupational performance, onset during school yrs, not better accounted by other disorder/impairment (visual difficulty)
- specifiers = reading, writing, mathematics
- stats: 5-15% of school age kids have learning disability & 80% of those have a reading disorder (dysphonic dyslexia is most common). People with specific learning disorder usually have average/above average IQ but elevated rates of other disorders (ADHD most common)
5
Q
brief psychotic disorder
vs.
schizophreniform disorder
vs.
schizophrenia
A
___________________ = episode lasts 1-30 days
___________________ = symptoms present for 1-6 months
___________________ = symptoms persist past 6 months
6
Q
good prognosis for schizophrenia
A
- acute (rapid/sudden) onset, later age of onset
- confusion or perplexity
- good premorbid social and occupational functioning
- absence of flat/blunted affect (negative symptoms)
- minimal cognitive impairment
- female gender
- immigrant
7
Q
concordance rates for schizophrenia
A
- identical twins = 50%
- child of parents who both have the diagnosis = 45%
- siblings/fraternal twins = 10-15%
- parent to child = 5-10%
8
Q
5 types of delusions
A
- eromatic = thinking another person is in love with you (often someone of higher status)
- grandiose = inflated self-worth, power, knowledge or speciality
- jealous = you believe that a sexual partner is being unfaithful
- persecutory = you believe you are being persecuted or mistreated (may trigger violent behaviour)
- somatic = delusions related to bodily functions or sensations
9
Q
schizoaffective disorder
A
- mood symptoms without delusions for at least 2+ weeks
- combination of schizophrenia and bipolar (mania and depression)
10
Q
bipolar specifiers (anxious, rapid cycling, melancholic, seasonal, peripartum)
A
- anxious distress = feeling keyed up/tense, restless, fearful, out of control
- rapid cycling = at least 4 or more mood cycles in the previous 12 months
- melancholic features = near complete absence of the capacity for pleasure
- peripartum onsent = during pregnancy or within 4 weeks of giving birth
- seasonal pattern = regular temporal relationship between mood episode and time of year
11
Q
bipolar I vs bipolar II
A
bipolar I = presence of at least one manic episode (marked disturbance in functioning, requires hospitalization because of danger to self or others, presence of psychotic symptoms
bipolar II = presence of at least one hypomanic episode and one major depressive episode (no manic episodes)
12
Q
concordance rates for bipolar
A
- identical twins = 80%
- fraternal twins and siblings = 20-25%
13
Q
suicide risk factors
A
- men (4x the rate of women)
- 45-64 years of age (next is 85+, then 15-24)
- Whites (next is Native Americans)
- having a mental disorder (often mood, personality, substance use, or schizophrenia)
- expressions of hopelessness
- history of suicide attempts
- being single/living alone
- family history of suicide
- chronic pain/illness
14
Q
separation anxiety disorder
A
- inappropriate and excessive anxiety about being away from home or away from a person whom the individual is attached to
- duration of at least 4 weeks for children/teens, 6 months for adults (SEPA vs SEPARA)
- typically develops after life stress or significant loss
- treatment: CBT, CBT+parent training, address School refusal first.
15
Q
reactive attachment disorder
A
- consistent pattern of inhibited, emotionally withdrawn behaviour toward the caregiver
- child rarely seeks or responds to comfort when distressed
- child has experienced grossly insufficient care
- present before the age of 5
- developmental age of at least 9 months
- think r for not reaching for caregiver
16
Q
disinhibited social engagement disorder
A
- child actively approaches and interacts with adult strangers inappropriately and overly familiarly
- child has experienced grossly insufficient care
- present before the age of 5
- developmental age of at least 9 months
17
Q
evidence based treatments for anxiety disorders
A
specific phobias - exposure-based therapies (in-vivo, participant modeling, virtual reality, systematic desensitization)
social anxiety - CBT and behaviour therapy (including exposure and relaxation)
panic disorder - CBT (psycho-ed, cognitive restructuring, in-vivo exposure to triggering environments), interoceptive exposure, Panic Control Treatment (PCT)
agoraphobia - CBT, similar to treatment for panic disorder
GAD - CBT and behaviour approaches
18
Q
evidence based treatments for OCD
A
- exposure with response prevention and cognitive therapy
19
Q
evidence based treatments for PTSD
A
- cognitive processing therapy
- prolonged exposure
- EMDR (effects mixed on whether effectiveness is due to rapid eye movements or repeated imaginal exposure. Research finds CBT more effective at trauma treatment than EMDR)
- single session briefing: makes things worse
- stress inoculation therapy
20
Q
factitious disorder vs. malingering
A
factitious = intentional feigning of physical or psychological symptoms, creation of disease or injury (can be inflicting on self or other), ABSENCE of external incentives
malingering = intentional reporting of symptoms for personal gain. Tests for malingering= TOMM (forced choice)
21
Q
substance use disorder
A
- cognitive, behavioural, and physiological symptoms that indicate continued used despite adverse substance-related consequences
22
Q
alcohol and sedative/hypnotic/anxiolytic intoxication and withdrawal
A
intoxication = slurred speech, incoordination, unsteady gait, nystagmus (eye movements), impaired memory and concentration
withdrawal = autonomic hyperactivity, hand tremor, insomnia, nausea/vomiting, transient hallucinations or illusions, anxiety, psychomotor agitation, seizures
23
Q
caffeine intoxication
A
- restlessness, nervousness, insomnia, flushed face, excessive urination, gastrointestinal disturbance, muscle twitching, rambling speech, agitation, periods of inexhaustibility, tachycardia
24
Q
cocaine and amphetamine intoxication and withdrawal
A
intoxication = psychomotor agitation or retardation, tachycardia or bradycardia, changes in blood pressure, nausea/vomiting, muscular weakness, chest pain, pupillary dilation, sweating or chills, respiratory problems, weight loss, seizures or coma (think over the top excited to the death/max)
withdrawal = fatigue, unpleasant dreams, increased appetite, psychomotor agitation or retardation, insomnia or hypersomnia (think super tired;crash)
25
opioid withdrawal
- dysphoric mood, nausea or vomiting, muscle aches, diarrhea, fever, yawning, insomnia, pupillary dilation or sweating, weepiness, runny nose
26
schizoid vs schizotypal personality disorder vs avoidant
____________________ = detachment and indifference to social relationships, FLAT AFFECT.
____________________ = discomfort and reduced capacity for close relationships (want them), peculiarities in thoughts, ideas, appearance, behaviour, social anxiety doesn’t decrease from being around others.
____________________= want relationships but avoid them due to fear of rejection and critique. Fear/suspect things without reason/proof.
All share symptoms of lack of close relationships. But reasons why vary.
27
cluster A, B, C
A = paranoid, schizoid, schizotypal
B = antisocial, borderline, histrionic, narcissistic
C = avoidant, dependent, obsessive-compulsive
28
Conduct Disorder diagnosis
Pattern of behaviour that violates basic rights, norms/rules. 3 Symptoms for 1 yr*, 1 for 6months*.
1)Aggression to people & animals
2)Destruction of property
3)Deceitfulness/theft
4)Serious violation of rules
Can’t be given to people over 18 who meet antisocial p d criteria.
Motiff: 1) life course persistent: neuropsych deficits+adverse environment. 2)adolescence limited type: maturity gap, temporary
29
Lewy bodies vs Alzheimer’s vs Parkinson’s vs Huntington’s
Lewy: caused by abnormal protein (alpha-synuclein) build up in brain. Core Symptoms: fluctuating cognition, visual hallucinations and late parkinsonism.
Suggestive features: sleep disorder, neuroleptic sensitivity (probable: 2 core+1 suggestive, possible: 1 core +1 suggestive)
vs Alzheimer’s: Lewy has early attention/visual problems. Alzheimer’s has early MEMORY problems.
Vs Parkinson’s: Lewy has cognitive symptoms and then motor symptoms (same time or later). Parkinson’s has early motor issues before cognitive symptoms
Vs Huntingtons: caused by genetic dominant gene. early emotional symptoms: irritability (parkinsons has early motor symptoms, lewy has attention/visual symptoms, Alzheimer’s has early memory problems). Characteristic symptoms: involuntary movements and cognitive decline (chorea).
30
Somatic symptom disorder vs illness anxiety disorder vs conversion
Somatic symptom: preocupied with 1 or + somatic symptoms that are bringing distress
Conversion: no physio explanation, stress related
Illness anxiety: no symptoms, worried about getting sick
31
Delusional D (hint: delusional Juan Juan)
1) person has 1 or more delusions for at least 1 month and 2) overall functioning is impaired
32
PTSD vs acute stress disorder (hint: focus on 3 vowels for min.)
symptoms last: 1 month+**
Must: 1) cause distress/impair functioning 2) be due to exposure to actual threat/event.
All symptoms represent 4 types: 1) intrusion 2) persistent avoidance of stimuli 3) negative mood/cognitions 4) changes in arousal/reactivity
Acute stress disorder:
Symptoms last: 3 days-1 month** require: 1)exposure to threat 2) at least 9 symptoms from any 5 categories 3) cause distress + impaired functioning
33
Prolonged grief
12 months for adults
6 months for teens/kids
* person must die to trigger this
Symptoms last for at least 1 month
34
Dissociative amnesia types and specifiers
1) localized amnesia: most common. Inability to recall ALL events in a specific period of time
2) selective: inability to recall SOME events in a specific period of time
3) generalized: complete loss for one’s entire lifetime
4) systematic: loss of memory for a specific category of life
5) continuous: inability to form new memories as they happen
Specifiers: 1) dissociative fugue: purposeful/purposefulness travel associated with loss of memory 2) dissociative amnesia: related to amnesia/exposure to trauma
35
Feigned memory loss vs real memory loss
Feigned: sudden (beginning and end), individuals don’t remember anything.
Real: cues help to recover memories, gradual, hazy, remember fragments
36
Anorexia
1) intense fear of weight gain/engage in practices that prevent weight gain
2) disturbance in way they experience their weight/body shape
3) self evaluations are influenced by their weight/body shape
4)lack of awareness about seriousness of low weight
Prognosis. Worse than bulimia, but in long term follow up= recovery rates are similar 62.8 for anorexia and 68.2 for bulimia
Anxiety comes first* then anorexia (same as Bulimia)
37
Bulimia (U-Bul)
binge eating must occur ONCE/week for 3 months or more
Anxiety and diet comes first here too.
CBT approaches better than IPT due to length. Telepsych comparable but face to face better for rates of abstinence (slightly) and higher decreases in disordered cognitions. Higher levels of automous motivation also decrease risk of drop out and symptoms
38
Bulimia vs BED (binge eating)
BED doesn’t engage in inappropriate compensatory behaviours and respond better to treatment. Bulimia has inappropriate compensatory behaviours. ***Dieting comes AFTER BED. Dieting comes BEFORE Bulimia.***
BED & Bulimia both require symptoms to occur at least 1x/ week for 3 MONTHS for diagnosis. Similar comorbidities
39
Medications for BED
SSRIs: fluoxetine, paroxetine, sertraline
Anti seizure medication: topiramate
CNS stimulant: lisdexamfetamine
40
Insomnia
3x/week for 3 months.
Research= people OVERESTIMATE sleep onset latency (time it takes to fall asleep), time spent awake and UNDERESTIMATE time sleeping (aka people sleep more than they think)
Treatment= multi component CBT (including stimulus control or sleep restriction with sleep hygiene education, relaxation training and CT). Stimulus control= strengthen bedroom as cues for sleep (bed only for sleeping) and sleep restriction= restrict time sleeping each night so time in bed matches sleep requirements
41
Narcolepsy
3xs/week for 3 months
Diagnosis requires: cataplexy (muscle weakness or paralysis triggered by emotions), hypocretin deficiency and REM latency for 15 mins or less. Many have hypnagogic (awake>sleep), hypnopompic (sleep>awake)
Meds for alertness: modafil, armodafil and methylphenidate
Meds for cataplexy: venlafaxine, fluoxetine, clomipramine, and sodium oxybate
42
NREM vs Nightmares
NREM= stage 3/4 in 1st half of 3rd major sleep period
Nightmare= REM, 2nd half of sleep
43
ODD
Recurrent pattern of angry, irritable mood, argumentative/defiant behaviour and vindictiveness. Has to happen with others who are not siblings. Symptoms last at least 6 months.
Study on kids with ODD vs no ODD: ODD teens showed HYPOREACTIVE (reduced) cortisol AND cardiovascular responses to stress. All 3 groups reported similar levels of negative feelings when exposed to procedure. Morning all were the same too.
44
Intermittent explosive disorder
Recurrent behavioural outbursts due to failure to control impulses
Anger not proportional to the provocation/stressor. Must be at least 6 years old.
45
Prion (CJD)
Rapid progression* 6 months
Symptoms: confusion, disorientation, apathy, anxiety, ataxia, chorea, myoclonus, mood swings
Lesions seen in MRI
Sporadic (most common, unknown cause), familial (inherited), acquired (due to meat, medical procedure or blood transfusion)
46
Frontotemporal NCD
Gradual onset/progression. No significant learning/memory or motor functioning issues in early stages. Meet criterial for behavioural (sweet foods, perseverative responses, dietary changes) or language variants (semantic=issue comprehending written/spoken language, agramatical= incorrect grammar, logopenic= impaired repetition of phrases and difficulty finding right word)
47
Antisocial personality disorder
Must be 18, history of conduct disorder before 15 yrs old. Disregard for rights, lack of remorse etc.
Course: gets less severe by 4th decade of life
Comorbidity: substance use disorder, mood disorder, BPD, anxiety.
Group CBT + contingency management (reinforcement for desirable behaviours) and drugs for Comorbid disorders
48
BPD
Unstable emotionally, impulsive in at least 2 areas + causing harm, history of unstable relationships.
75% don’t meet criteria by 40
DBT: group, individual psychotherapy (TIBs, quality of life interference behaviours, safety), intercession coaching, consultation
49
Histrionic vs antisocial personality d
Histrioinic: wants to be centre of attention
Similar: impulsive, superficial, excitement seeking, reckless, seductive and manipulative
Differences: antisocial- behaviours done to gain power and material gratification. Histrionic- exaggerated emotions and manipulation to gain nurturance
50
Avoidant personality disorder
Feelings of inadequacy, hypersensitivity to rejection and negative evaluation, views self as socially inept, reluctant to engage in new activities because they may be embarrassing
51
OCPP vs OCD
Share similar names. But OCD involves true obsessions and compulsions. OCPPD doesn’t.
52
Example of probable maj/mild neurocognitive disorder with Lewy bodies
Visual hallucinations (core) and concurrent REM sleep behaviour disorder (suggestive)
53
Major depressive disorder vs persistent depressive disorder vs disruptive mood dysregulation disorder
Major Depression: 5 or more symptoms for at least TWO weeks (think two blue weeks). Must include depressed mood and loss of interest/pleasure
Persistent depressive d: depressed mood with 2 or + symptoms. Lasts TWO years in adults*, ONE yr in children/teens
Disruptive mood Dysregution: severe/recurrent temper tantrums (verbal/behavioural), for ONE year.
54
Specifiers for Major Depressive Disorder (seasonal pattern, peripartum onset)
Peripartum: symptoms during pregnancy or 4 weeks after delivery. Treatement: CBT, IPT & ADs
Seasonal pattern: relationship between mood and time of the yr (typically winter). Symptoms: hypersomnia, overeating, weight gain and carbohydrate craving.
55
Phobia
Lasts at least 6months, causing distress + impairments. Intense fear, out of proportion and avoidance
Types: animal, natural environment, blood injection injury, situational and other
*more common in girls (2xs), onset is ~10yrs
56
Social anxiety
Lasts 6 months + distress. Fear in social situations, fear of negative evaluation, avoidance and excessive fear for actual threat
1st line: CBT+ SSRI/SNRI, school based CBT for kids/teens
Telepsych: virtual is equal in efficacy.
57
Panic disorder (think p and ptsd also has a p)
Recurrent panic attacks, 1 month of persistent concern, behaviour change due to attacks. Rule out medical disorders first.
Treatment: panic control treatment (included introceptive exposure)+ ADs (imipramine) and benzos. But high relapse when just use meds
58
Agoraphobia
Anxiety in at least 2 situations. Person must fear or avoid situations due to concern that escape will not be possible/help will be unavailable. Anxiety must be excessive for situation and lead to avoidance. Require presence of companion. Lasts for 6 months.
59
GAD
Anxiety for most activities lasting for at least 6 months. Person must find anxiety/worry difficult to control, symptoms must cause distress+ imp. Functioning.
GAD Vs non pathological anxiety= GAD unable to control anxiety, worry about a larger number of events, more likely to have somatic symptoms.
*worries age related
Treatement: CBT, combined with meds (1st line: SSRI/SNRI, then buspar or benzos for non responders). Combine MI & CBT for severe symptoms
60
OCD
Involves obsessions (intrusive urges/thoughts causing anxiety/distress) + compulsions (repetitive behaviours/mental acts driven to perform to reduce anxiety)
Prevalence: higher in males in childhood, higher in females as adults
Comorbid: anxiety
Specifiers: indicate insight and tic presence
Treatment: combined treatment: ERP+SSRI or clomipramine. ACT/CBT also effective
61
Body dysmorphic d
Preocupation with a perceived flaw. Not observable/minor to others. Involves repetitive behaviours/mental acts (mirror checking, skin picking) due to flaw and preoccupation causes distress + impairment.
Often seek medical treatment for flaw. Ideas/delusions of reference: believe others are mocking/taking special notice of them due to appearance
62
Tic Disorder
Sudden, rapid, motor movements or vocalizations.
Motor tics: eye blinking, facial grimacing, shoulder shrugging, echopraxia
Vocal tics: clearing, barking, echolia
Onset: 4-6yrs, peak at 10-12
3 types: persistent, provisional and Tourette’s
Co-currence: ADHD for Tourette’s
Meds: for Tourette’s: haldol, serotonin for OC symptoms, methylphenidate or clonidine for ADHD.
Treatment: comprehensive behavioural intervention for tics CBIT (psychoeducation+ social support+habit rehearsal+competing response+relaxation training)
63
Tourette vs persistent motor/vocal tic vs provisional Tic
Tourette: requires 1 vocal tic + multiple motor tics. Symptoms for MORE than 1 yr. onset before 18.
Persistent: begins before 18. 1 or + tics (motor/vocal) persisting for over a year
Provisional: tics (motor/vocal) for less than one year, onset before 18.
64
Erectile dysfunction
Difficulty obtaining/maintaining an erection 75-100% of the time. Organic etiology ruled out. Symptoms for 6 months + distress
Treatment: behavioural techniques (reduce performance anxiety, increase sexual stimulation). Drugs: sildenafil citrate, tadalafil, vardenafil
65
Premature ejaculation
Ejaculate within 1 minute of vaginal penetration. Symptoms present for 6 months + distress.
Treatment: sensate focus, start-stop technique, pause-squeeze technique, SSRI (paroxetine)
66
Paraphillic disorders (frotteuristic vs transvestic vs pedophilic vs fetishstic vs exhibitionist)
Frotteuristic: arousal from touching non consenting adults (acting on urges+distress required for diagnosis)
Transvestic: cross dressing for sexual arousal>> distress+impairment. Most ID as straight
Pedophilic: arousal related to sexual activity with children (acting on urges + distress required for diag.)
Fetishstic: arousal from non living objects/non genital body parts. (Distress+impairment)
Exhibitionist: arousal from exposing genitals to unsuspecting individuals (acting on urges + distress required for diagnosis, subtypes based on target audience)
67
Genitopelvic pain/penetration disorder
Problems with vagunal penetration= panic anxiety, muscle tensing. Symptoms for 6 months + distress.
Interventions: relaxation trainings sensate focus, topical anesthetic, vaginal dilator, kegel
68
Female orgasmic disorder
Delay, absence of orgasm on all/almost all occasions. Symptoms last for 6 months + distress.
Treatment: CBT, directed masturbation, sex Ed, anxiety reduction and mindfulness
69
Gender dysphoria
Incongruence between assigned vs experienced gender identity.
Treatment approaches
1) Dutch: watchful waiting*, social transition, puberty blockers, cross sexual hormone therapy and gender affirming surgeries. Waits until puberty.
2) gender affirmative model: social transition followed by appropriate medical interventions. Acknowledge diverse gender presentations*. Doesn’t wait until puberty. Transition OK if: gender concerns not due to some other problem, central issue is gender identity vs gender expression, child expresses desire to transition, parents offer support
70
Study on individuals with congenital heart disease (CHD) and concurrent mental health disorders
In order: depression, anxiety, alcohol use and binge eating
71
Peak age of schizophrenia (males/females)
M= early to mid 20s
F= late 20s
72
EMDR (shapiro’s information professing model; how does it work?)
1) PTSD results when traumatic experiences are innadequTely processed
2) rapid eye movements facilitate information processing resulting in adaptive resolution of traumatic memories
Note: some research indicates rapid eye movements exert benefits by providing repeated exposure in imagination to traumatic memories but Shapiro didn’t account this as part of his explanations
73
Illusion vs hallucination vs delusion
Illusion: misperception/misinterpretation of an external stimulus (misperceiving the sound of running water as human voices)
Hallucination: sensory perception that occurs in the absence of an external stimulus
Delusion: false belief that is simply held despite contradictory evidence
74
Studies on emotions and face recognition and kids with ASD
Face recognition: individuals with ASD may struggle to distinguish between familiar and novel/new faces.
Emotion regulation: children with ASD has difficulties recognizing basic/complex emotions in various expression modalities (face, voice, body). It is believed challenges in ID and understanding emotions may contribute to difficulties in forming social relationships
75
ASD (etiology, brain/neurotransmitters and treatment)
Etiology: 69-95% monozygotic twins. Non genetic risk factors: male gender, birth before 26 weeks, advanced parental age, exposure to environmental toxins during prenatal development.
Brain: accelerated brain growth at 6months plateaus by preschool. Larger head circumference, brain volume and weight. Abnormalities in cerebellum, corpus callosum and amygdala.
Neurotransmitters: lower serotonin in brain, higher serotonin levels in blood. Some can also have dopamine, GABA, glutamate and Ach abnormalities>> comorbidities
Treatment: min. Core symptoms, max independence by promoting functional skill acquisition, reduce/eliminate behaviours that interfere with functional skills. EIBI (shaping+discrimination= verbal communication) has greatest positive impact on intelligence and language acquisition and less on adaptive skills/social functioning/ severity of symptoms.
No medication for ASD, just for Comorbid symptoms.
76
Research on: ADHD symptoms change in adulthood
- excessive motor ability= decreases and is replaced by inability to sit still, impatience, relax and restlessness
- impulsivity= decreases and changes to reckless driving, abruptly quitting jobs and ending relationships and overspending
- inattention = continues during adulthood and involves inability to meet deadlines, making careless mistakes, procrastination and is most apparent in boring/tedious tasks
77
ADHD brain & neurotransmitters
- abnormalities in PFC, striatum (caudate nucleus/putamen) and thalamus = impaired response inhibition, working memory, sustained attention and exec functions
- abnormal PFC & cerebellum = impaired temporal info. Processing (inability to perceive/org sequences of events or anticipate when future events will occur)
- abnormalities in PFC & amygdala= emotion dysregulation
- brain: have smaller total brain volume and lower volume in brain structures: PFC, corpus callosum, cerebellum as well as reduced activity.
- neurotransmitters: low dopamine and norepinephrine in PFC linked to impairments in impulse control, attention and executive functioning
78
ADHD treatment
- preschool kids: parent training in behavioural management (PTBM), PCIT. Meds only sent when behavioural interventions don’t work.
- elementary/middle school kids: combo (meds + behavioural @ home/school)
- teens: combo (meds with teen assent + instructional intervention (MI, BT, mindfulness based training and classroom training)
- adults: MEDS (1st line) + CBT (if needed)
79
Adhd study on substance use and psychostimulants
conclusion: there is an increased risk for substance use in teens/adults with ADHD but this is not due to stimulant use.
80
Tourette’s vs persistent motor/vocal tic vs provisional tic disorder
All have onset before 18
- Tourette: at least one vocal tic + multiple* motor tics, present 1+ yr, tics may occur together/different times
- persistent: 1 or more vocal/motor tics, persistent for 1+ yr
- provisional: 1 or more vocal/motor tic, present for LESS than 1yr
81
Communication disorder (childhood-onset fluency disorder aka stuttering)
- stuttering: disturbance in normal fluency + time pattern of speech that’s inappropriate for age/language skills + persists overtime
- symptoms: sound syllable repetition, sound prolongations, broken words, audible/silent blocking, circumlocutions, excessive physical tension in pronunciation, monosyllabic whole word repetitions.
- onset: 2-7yrs
- fact: 85% recover, with severity @ 8 being good predictor for recovery.
- treatment: habit rehearsal training + regulated breathing
82
Dysphonic dyslexia
- diff connecting sounds to letters
- other names: dysphonetic, auditory and phonological dyslexia
83
Research on Black Americans being diagnosed with schizophrenia
Research suggests that the higher reported rates of AA schizophrenics is a result of MISDIAGNOSIS due to the fact that AA’s are more likely to experience hallucinations/delusions as symptoms of depression
84
Outline for cultural formulation vs cultural formulation interview
Outline for cultural formulation provides guidelines for assessing 4 factors; highly structured:
1) Cultural ID of client
2) clients cultural conceptualization of distress
3) psychosocial stressors/cultural factors that impact clients vulnerability and resilience
4) cultural factors relevant to the relationship between client and therapist
Cultural formulation interview CFI: semi structured interview consisting of 16 q’s designed to obtain client views regarding the social/cultural context of their presenting concerns. More flexible has open ended questions.
85
ASD should be differentiated from the following diagnoses
Rhett syndrome, selective mutism, language disorder, intellectual disability, stereotypic movement disorder, ADHD and schizophrenia.
86
Treatment resistant depression/atypical depression (not on DSM)
-treated with MAOIs
- symptoms: increased appetite, hypersomnia (too much sleep), reactive moods (sensitivity to rejection), leaden paralysis (when arms/legs feel too heavy to lift)
