DSM-5 Flashcards
intellectual disability
- 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
autism spectrum disorder
- 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.
ADHD
- 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
specific learning disorder (how long must symptoms be present for diagnosis etc)
- 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)
brief psychotic disorder
vs.
schizophreniform disorder
vs.
schizophrenia
___________________ = episode lasts 1-30 days
___________________ = symptoms present for 1-6 months
___________________ = symptoms persist past 6 months
good prognosis for schizophrenia
- 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
concordance rates for schizophrenia
- identical twins = 50%
- child of parents who both have the diagnosis = 45%
- siblings/fraternal twins = 10-15%
- parent to child = 5-10%
5 types of delusions
- 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
schizoaffective disorder
- mood symptoms without delusions for at least 2+ weeks
- combination of schizophrenia and bipolar (mania and depression)
bipolar specifiers (anxious, rapid cycling, melancholic, seasonal, peripartum)
- 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
bipolar I vs bipolar II
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)
concordance rates for bipolar
- identical twins = 80%
- fraternal twins and siblings = 20-25%
suicide risk factors
- 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
separation anxiety disorder
- 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.
reactive attachment disorder
- 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
disinhibited social engagement disorder
- 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
evidence based treatments for anxiety disorders
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
evidence based treatments for OCD
- exposure with response prevention and cognitive therapy
evidence based treatments for PTSD
- 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
factitious disorder vs. malingering
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)
substance use disorder
- cognitive, behavioural, and physiological symptoms that indicate continued used despite adverse substance-related consequences
alcohol and sedative/hypnotic/anxiolytic intoxication and withdrawal
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
caffeine intoxication
- restlessness, nervousness, insomnia, flushed face, excessive urination, gastrointestinal disturbance, muscle twitching, rambling speech, agitation, periods of inexhaustibility, tachycardia
cocaine and amphetamine intoxication and withdrawal
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)
opioid withdrawal
- dysphoric mood, nausea or vomiting, muscle aches, diarrhea, fever, yawning, insomnia, pupillary dilation or sweating, weepiness, runny nose
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.
cluster A, B, C
A = paranoid, schizoid, schizotypal
B = antisocial, borderline, histrionic, narcissistic
C = avoidant, dependent, obsessive-compulsive
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
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).
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
Delusional D (hint: delusional Juan Juan)
1) person has 1 or more delusions for at least 1 month and 2) overall functioning is impaired
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
Prolonged grief
12 months for adults
6 months for teens/kids
* person must die to trigger this
Symptoms last for at least 1 month
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
