DSM-5 TR Disorders Flashcards
(284 cards)
1
Q
What are the 3 Intellectual Disability criteria?
A
1) Intellectual deficit confirmed by assessment
2) Deficits in adaptive functioning that result in a failure of independence and social responsibility and impair functioning across multiple environments in 1+ ADL
3) Onset during developmental period
2
Q
What is the Intellectual Disability specifier?
A
Severity - Mild, moderate, severe, and profound based on adaptive functioning
3
Q
What are the early indicators for Intellectual Disability?
A
1) Motor delays
2) Poor eye contact during feeding
3) Lack of interest in environmental stimuli (e.g., voices, movement)
4
Q
What are the 3 domains of adaptive functioning for Intellectual Disabilities?
A
1) Conceptual (e.g., academics)
2) Social (e.g., making friends)
3) Practical (e.g., transportation)
5
Q
What are the 6 common Intellectual Disability etiologies?
A
1) 5% hereditary (Tay-Sachs, fragile X syndrome, PKU)
2) 5% acquired medical condition
3) 10% pregnancy and perinatal problems
4) 15-20% environmental factors (neglect)
5) 30% chromosomal and prenatal toxins (Down Syndrome, fetal alcohol disorder)
6) 30% unknown cause
6
Q
What are the 5 Intellectual Disability differentials?
A
1) Neurocognitive disorder
2) Communication disorders
3) SLD
4) ASD
5) Borderline intellectual functioning
7
Q
What are the Childhood-Onset Fluency Disorder criteria?
A
Disturbance in normal fluency and time patterning of speech
8
Q
What is the typical age of onset for Childhood-Onset Fluency Disorder?
A
Ages 2-7
9
Q
What is the prognosis for Childhood-Onset Fluency Disorder and what is a good predictor of the prognosis?
A
1) 65-85% of children recover
2) Severity at age 8 is a good predictor of prognosis
10
Q
What are the Childhood-Onset Fluency Disorder differentials?
A
Normal early childhood speech problems
11
Q
How is Childhood-Onset Fluency Disorder treated?
A
1) Young children: Reduce stress at home (limit criticism, reduce demands, increase coping skills)
2) Older individuals: Habit reversal training (awareness, relaxation, motivation, competing response, and generalization training)
12
Q
What are the 4 ASD criteria?
A
1) Deficits in social communication/interaction across contexts
2) Restricted, repetitive bx, interests, or activities by 2+ symptoms
3) Onset during developmental period
4) Impairs functioning
13
Q
What is the ASD specifier?
A
Severity:
1) Level 1 (support)
2) Level 2 (substantial support)
3) Level 3 (very substantial support)
14
Q
What are the 5 additional features of ASD?
A
1) Intellectual impairments
2) Language abnormalities
3) Uneven cognitive profiles
4) Motor deficits
5) Self injurious behavior
15
Q
What are the early warning signs of ASD and the prognosis?
A
1) Early signs: Abnormal social orienting and responsivity (social gaze, eye contact, joint attention) that are apparent by age 1
2) Only 1/3 adults achieve partial independence
16
Q
What are 3 factors associated with a better prognosis for ASD?
A
1) Verbal by age 5/6
2) IQ over 70
3) Later age of onset
17
Q
What are the 3 etiological factors for ASD?
A
1) Unusually rapid head growth during 1st year of life
2) Structural brain abnormalities (amygdala, cerebellum)
3) Abnormalities with serotonin, dopamine, and other neurotransmitters
18
Q
What are the 7 ASD differentials?
A
1) Rett syndrome
2) Selective mutism
3) Language disorder
4) ID
5) Stereotypic movement disorder
6) ADHD
7) Schizophrenia
19
Q
What are the 4 treatments for ASD?
A
1) Parent management training
2) Special education
3) Training in self-care and supported employment
4) Behavioral techniques - shaping and discrimination training
20
Q
What are the 5 ADHD criteria?
A
1) 6+ sxs for children and 5+ for ages 17+
2) Pattern of inattentive, hyperactive, or impulsive bx
3) Duration 6+ months
4) Symptoms 2+ context
5) Symptom onset prior to age 12
21
Q
How long do ADHD symptoms need to be present?
A
6+ months
22
Q
When do ADHD symptoms need to start?
A
Prior to age 12
23
Q
What are the 3 ADHD specifiers?
A
1) Predominantly inattentive,
2) Predominantly hyperactive/impulsive
3) Combined presentation
24
Q
What are the 5 additional features for ADHD?
A
1) Avg or above avg IQ but lower scores on IQ tests
2) Academic difficulties
3) Social problems
4) Low self-esteem
5) Poorer health, educational, and occupational outcomes
25
What 7 disorders are individuals with ADHD at risk for?
1) Depression
2) Bipolar
3) Anxiety disorders
4) Antisocial behavior
5) CD
6) ODD
7) SLD
26
What is the typical course and prognosis for ADHD (4)?
1) 65% - 80% of children continue to meet criteria as adolescents
2) 15% of children continue to meet criteria as young adults
3) 60% eventually meet criteria for partial remission
4) Symptoms vary over lifespan with gross motor activity declining/evolving over time
27
What are the ADHD prevalence rates and differences by age and gender?
1) Prevalence 5% for children
2) Prevalence 2.5% for adults
2) More prevalent in males (2:1 children, 1.6:1 adults)
3) Combined more common in males, inattentive in females
28
What are the etiological brain findings for ADHD?
Smaller and less active caudate nucleus, globus pallidus, and prefrontal cortex
29
What are the 2 etiological theories for ADHD?
1) Barkley’s behavioral disinhibition hypothesis suggests ADHD is due to inability to fit bx to situational demands
2) Another theory suggests an inability to regulate attention
30
What are the 9 differentials for ADHD?
1) ODD
2) CD
3) Intermittent explosive disorder
4) SLD
5) ID
6) ASD
7) Anxiety disorders
8) Mood disorders
9) Substance use disorders
31
What are the typical ADHD treatments?
1) CNS stimulants reduce core symptoms 75% of cases
2) Parent/teacher management training
32
What did the ADHD Mental Health Multimodal Treatment study find?
1) Medication only and combined treatment performed similarly at symptom reduction
2) Combined treatment was superior in other ways
3) But long-term the treatment groups were indistinguishable from the control groups
33
What are the Cluster A Personality Disorders?
Cluster A (Odd & Eccentric) - Paranoid, Schizoid, Schizotypal
34
What are the Cluster B Personality Disorders?
Cluster B (Dramatic, Emotional, Erratic) - Antisocial, Borderline, Histrionic, Narcissistic
35
What are the Cluster C Personality Disorders?
Cluster C (Anxious & Fearful) - Avoidant, Dependent, OCPD
36
What are the 8 Paranoid PD criteria?
Pervasive distrust and suspiciousness of malevolence as evidenced by 4+ sxs:
1) Suspects malevolence w/o proof
2) Unjustified doubts
3) Reluctance to confide in others
4) Misperceives benign events
5) Holds grudges
6) Misperceives attacks on character
7) Reactive anger
8) Suspects fidelity w/o justification
37
What are the 7 Schizoid PD criteria?
Pervasive pattern of social detachment and restricted range of emotional expression in social settings and 4+ sxs:
1) Doesn’t desire/enjoy close relationships
2) Prefers solitary activities
3) Little interest in sex
4) Anhedonia
5) Lacks close friends besides relatives
6) Seems indifferent to others’ opinions
7) Emotionally cold/detached
38
What are the 11 Schizotypal PD criteria?
Pervasive social and interpersonal deficits, discomfort or limited capacity for close relationships, and eccentric cognition, perception, or bx and 5+ sxs:
1) Ideas of reference
2) Odd beliefs
3) Odd perceptions
4) Odd thinking/speaking
5) Peculiar bx or appearance
6) Magical thinking
7) Bodily illusions
8) Suspicious or paranoid, odd affect
9) Lacks close friends other than relatives
10) Excessive social anxiety
11) Desire for close friends but has few and paradoxically prefers being alone
39
What are Personality Disorders in general?
Patterns of inner experience and bx that:
1) Deviate from cultural norms
2) Are pervasive and inflexible
3) Are stable over time
4) Cause distress or impairment
40
What are the 8 Antisocial PD criteria?
Disregard/violation of others’ rights and needs history of CD before 15 but cannot be diagnosed before 18 and 3+ symptoms:
1) Nonconformity to social norms or laws
2) Deceitfulness
3) Impulsivity
4) Irritability
5) Aggressiveness
6) Recklessness
7) Irresponsibility
8) Lack of remorse
41
What are the 3 additional features of Antisocial PD?
1) Inflated self-esteem/grandiosity
2) Lack of empathy
3) Superficial charm
42
What are the 2 universal diagnostic criteria for Personality Disorders?
1) Onset is in adolescence or early adulthood
2) People under 18 must have had symptoms for at least 1 year
* Except Antisocial PD which cannot be diagnosed until 18+
43
What are the 9 Borderline PD critiera?
Pattern of unstable relationships, self-image, and affect paired with impulsivity across context. Must have 5+ sxs:
1) Frantic efforts to avoid abandonment
2) Relationships characterized by idealization and devaluation
3) Identity disturbance
4) Risky impulsivity in 2+ ways
5) Recurrent suicidality
6) Affective instability
7) Chronic feelings of emptiness
8) Anger dysregulation
9) Transient paranoia or dissociation
44
When is Borderline PD usually diagnosed?
Ages 19-34
45
When are Borderline PD symptoms most severe and how do they change over the life span?
1) Young adulthood
2) Substantial improvement by age 40 with 75% no longer meeting criteria
46
What is the pattern of symptom improvement for Borderline PD?
Symptom improvement best to worst:
1) Impulsivity
2) Cognitive/interpersonal problems
3) Affect
47
What is Stern's Borderline PD etiological theory?
Stern related BPD to narcissism and disturbances in early mother-child attachment
48
What is Mahler's Borderline PD etiological theory?
Mahler attributed PDs to fixation at the rapprochement phase of separation-individuation resulting in need for separation paired with fear of abandonment
49
What is Kernberg's Borderline PD etiological theory?
Kernberg traced BPD to adverse, unpredictable caregiving that vacillate between rejection and smothering. This produces an insecure ego that tends to engage in “splitting” or the dichotomization of self and others into good vs bad
50
What is Linehan's Borderline PD etiological theory?
Linehan’s biosocial model says BPD is caused by emotion dysregulation and vulnerability paired with an invalidating environment
51
What is the typical treatment for Borderline PD and what are its 2 components and 3 associated outcomes?
DBT and it reduces premature termination, hospitalizations, and parasuicidality. DBT involves:
1) CBT combined with Rogerian acceptance being necessary to change
2) Group skills training, individual outpatient therapy, and telephone coaching
52
What are the 8 Histrionic PD criteria?
Intense emotionality and attention-seeking and 5+ sxs:
1) Discomfort not being the center of attention
2) Inappropriate seduction
3) Rapidly shifting/shallow emotions
4) Use of appearance to gain attention
5) Excessively impressionistic speech
6) Exaggerated expression of emotion
7) Easily influenced
8) Considers relationships to be more intimate than they are
53
What are the 10 Narcissistic PD criteria?
Pervasive grandiosity, need for admiration, and lack of empathy and 5+ sxs:
1) Grandiosity
2) Preoccupation with grandiose fantasies
3) Belief in uniqueness and can only be understood by high-status people
4) Requires excessive admiration
5) Sense of entitlement
6) Interpersonally exploitative
7) Lacks empathy
8) Often envious
9) Believes others are envious of them
10) Arrogance
54
For schizophrenia, what 3 factors are associated with a better prognosis?
1) Female gender
2) Later onset
3) More positive symptoms (which are more responsive to pharmacological treatment)
55
What are the 3 levels of severity for Substance Use Disorders?
The 3 levels of severity are based on the number of symptoms:
1) Mild = 2 - 3 symptoms
2) Moderate = 4 - 5 symptoms
3) Severe = 6+ symptoms
56
What are the 3 criteria for Specific Learning Disorder?
1) Difficulty with 1+ academic skill
2) Difficulty persists 6+ months
3) Targeted interventions do not help
57
What 5 features are associated with a Specific Learning Disorder?
1) An average or better IQ
2) Delays in language development
3) Delays in motor development
4) Difficulty with attention and memory
5) Low self-esteem
58
What 3 bx or outcomes are individuals with Specific Learning Disorder at-risk for?
1) Antisocial behavior
2) Arrests
3) Convictions
59
What is SLD's comorbidity rate with ADHD?
20 - 30%
60
What is the typical course and prognosis for Specific Learning Disorder?
1) Persistent learning difficulties throughout lifespan
2) 33% of children with reading disorders develop psychosocial problems as adults
61
What are the gender differences for Specific Learning Disorder?
A SLD is more common in males than in females (estimated ratio 2:1 to 3:1)
62
What are the 3 etiologies for SLD?
1) Cerebellar-vestibular dysfunction (due to otitis media - ear infections)
2) Incomplete dominance and other hemispheric abnormalities
3) Exposure to toxins (especially lead)
63
What is dyslexia?
1) A deficit in phonological processing
2) An etiology for SLD
64
What are the 3 criteria for Tourette's disorder?
1) Presence of 1+ vocal tic AND multiple motor tics
2) Tics persist for 1+ year
3) Tics began prior to age 18
65
When is Provisional Tic Disorder diagnosed instead of Tourette's or Persistent Motor/Vocal Tic Disorder?
Provisional Tic Disorder is diagnosed with there is 1+ motor OR vocal tic that began before age 18 but has been present for LESS than 1 year
66
When is Persistent Motor or Vocal Tic Disorder diagnosed instead of Tourette's?
Persistent Motor or Vocal Tic Disorder is diagnosed with there is only 1+ motor OR vocal tic that has been present for 1+ year and began prior to age 18.
67
What are the 5 additional features of Tourette's disorder?
1) Obsessions and compulsions (higher rates for biological relatives too)
2) Hyperactivity
3) Impulsivity
4) Distractibility
5) High rates of school problems
68
What is the prognosis for Tourette's disorder?
Frequency, severity, and disruptiveness of symptoms tend to decline with age
69
What is the etiology of Tourette's disorder?
1) Elevated levels of dopamine
2) Super sensitive dopamine receptors in the caudate nucleus
70
How can Tourette's and related disorders be treated (4 treatments)?
1) Antipsychotics (haloperidol, pimozide) are effective in 80% of cases
2) SSRIs can help alleviate the obsessive-compulsive symptoms
3) Clonidine (hypertension med) or desipramine (an antidepressant) can treat hyperactivity and inattention
4) Comprehensive behavioral intervention for tics (CBIT)
71
What are the 3 diagnostic criteria for Delusional Disorder?
1) Presence of 1+ delusions
2) Delusion(s) last 1+ month
3) Psychosocial functioning is not markedly impaired or any impairment is directly related to the delusions (e.g., a person loses his job because he’s afraid to leave the house and repeatedly misses work)
72
What are the 7 types of delusions?
1) Erotomanic (love)
2) Grandiose (importance)
3) Jealous (infidelity)
4) Persecutory (persecution)
5) Somatic (abnormal bodily functions or sensations)
6) Mixed
7) Unspecified
73
What are the 2 specifiers for Delusional Disorder?
1) If delusions are bizarre
2) To describe the disorder’s course (first episode, currently in acute episode)
74
What are the 3 diagnostic criteria for Schizophrenia?
1) Presence of 2+ active phase symptoms that last 1+ month with 1+ being delusions, hallucination, or disorganized speech (so you can't just be blunted and disheveled)
2) Signs of the disorder for at least 6+ months
3) Causes distress or impairment
75
What are the 5 active phase symptoms associated with Schizophrenia?
1) Delusions*
2) Hallucinations*
3) Disorganized speech*
4) Grossly disorganized behavior
5) Negative symptoms
76
What are the 2 specifiers for Schizophrenia?
1) Course
2) Catatonia
77
What are the 6 associated features of Schizophrenia?
1) Inappropriate affect (e.g., laughing for no reason)
2) Dysphoric mood
3) Disturbed sleep
4) Lack of interest in eating
5) Anosognosia
6) Substance Use Disorder (particularly Tobacco Use Disorder)
78
What are the prevalence rates for Schizophrenia and differences by gender?
1) Lifetime prevalence of Schizophrenia ranges from 0.3 to 0.7%
2) Prevalence rate is slightly lower for females than for males
79
What were the 3 results of the World Health Organization’s International Pilot Study of Schizophrenia?
The WHO study found that patients from developing countries compared to developed countries were more likely to exhibit:
1) An acute onset of symptoms
2) A shorter clinical course
3) Complete remission of symptoms
80
What is the typical course and prognosis for Schizophrenia?
1) Onset of Schizophrenia is usually between the late teens and early 30s
2) Peak age of onset being in the early to mid-20s for males and the late 20s for females
3) Course is ordinarily chronic with complete remission being rare
81
What 8 factors are associated with a better prognosis for Schizophrenia?
1) Good premorbid adjustment
2) An acute/later onset
3) Female gender
4) A precipitating event
5) A brief duration of active-phase symptoms
6) Insight into the illness
7) A family history of a mood disorder
8) No family history of Schizophrenia
82
What is the concordance data for Schizophrenia?
1) High risk among first-degree biological relatives
2) Biological siblings 10%
3) Fraternal twins 17%
4) Child of 2 parents with schizophrenia 46%
5) Identical twins 48%
83
What are the 8 etiologies for Schizophrenia?
1) Enlarged ventricles
2) Smaller hippocampus
3) Smaller amygdala
4) Smaller globus pallidus
5) Hypofrontality (e.g., lower prefrontal cortex activity)
6) Dopamine hypothesis (e.g., elevated dopamine or oversensitive dopamine receptors)
7) Imbalance of serotonin, glutamate, and GABA
8) Prenatal exposure to an influenza virus during winter
84
What are the 5 differentials for Schizophrenia?
1) Amphetamines and cocaine
2) Schizoaffective Disorder
3) Major Depressive Disorder
4) Bipolar
5) Autism
In Schizophrenia, mood symptoms are brief, do not occur during the active phase, and do not meet the full criteria for a mood episode.
85
How can you differentiate Mood Disorders with psychotic features from Schizoaffective Disorder?
Schizoaffective disorder would be diagnosed instead of a mood disorder if there was a period of 2+ weeks without prominent mood symptoms
86
How can you differentiate Mood Disorders with psychotic features from Schizophrenia?
Schizophrenia is not diagnosed when the psychotic symptoms only occur during episodes of mood disturbances (e.g., depressive or manic episode)
87
What are the 7 treatments for Schizophrenia?
1) Traditional antipsychotics (haloperidol, fluphenazine)
2) Atypical antipsychotics (clozapine, risperidone)
3) Individual CBT
4) Psychoeducation
5) Social skills training
6) Supported employment
7) Family-based interventions especially with high EE families (e.g., families who are hostile or overinvolved emotionally)
88
What are the 2 diagnostic criteria for Schizophreniform Disorder?
1) Presence of 2+ active phase symptoms
2) Symptoms persist 1-6 months
*The criteria are essentially identical to those for Schizophrenia except that the disturbance is present for at least one month but less than six months and impairment may occur but is not required.
89
What is the prognosis for Schizophreniform Disorder?
66% eventually meet criteria for Schizophrenia or Schizoaffective Disorder
90
What are the 4 diagnostic criteria for Brief Psychotic Disorder?
1) Presence of 1+ symptoms (delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior) with 1+ being delusions, hallucinations, or disorganized speech
2) Symptoms persist 1-30 days
3) Eventual return to premorbid functioning
4) Onset usually follows exposure to an overwhelming stressor
91
What are the 3 diagnostic criteria for Schizoaffective Disorder?
Concurrent symptoms of:
1) Schizophrenia
2) Major depression or mania
3) A period of 2+ weeks without prominent mood symptoms
92
What are the 4 diagnostic criteria for Bipolar 1?
1) Occurrence of 1+ manic episode
2) Mania must last 1+ one week with sxs being present most of the day, nearly every day
3) Mania must include 3+ characteristic sxs – e.g., grandiosity, decreased need for sleep, excessive talkativeness, or flight of ideas
4) Dx requires impairment, hospitalization, or psychotic features
93
What are the 3 specifiers for Bipolar 1?
1) Severity (mild, moderate, or severe) based on number of symptoms
2) Type of most recent episode (manic, hypomanic, depressed, or unspecified)
3) Pattern (e.g., rapid cycling, mood-congruent psychotic features, mood-incongruent psychotic features, peripartum onset, seasonal pattern)
94
What are the 5 patterns for Bipolar 1?
1) Rapid cycling
2) Mood-congruent psychotic features
3) Mood-incongruent psychotic features
4) Peripartum onset
5) Seasonal pattern
95
What are the 3 associated features of Bipolar Disorder?
1) Anxiety disorders
2) Substance use disorders
3) Lifetime risk for completed suicide is about 15x higher than the general population
96
What are the prevalence rates for Bipolar 1 and differences by gender?
1) 12-month prevalence for Bipolar I Disorder in the United States is 0.6%
2) Lifetime male-to-female prevalence ratio is approximately 1.1 : 1
97
What is the typical course for Bipolar 1?
1) Average age of first episode is 18 years old
2) 90% of individuals who have one episode experience additional episodes
98
What is the general concordance pattern for Bipolar Disorder?
1) Identical twins - concordance rates ranging from .67 to 1.0
2) Fraternal twins - concordance rates of .20
3) Higher risk for first-degree relatives
* Genetic factors have been most consistently linked to the Bipolar Disorders
99
What are the 3 best therapy options to treat Bipolar Disorder?
1) Cognitive-behavioral therapy (CBT)
2) Family-focused treatment (FFT)
3) Interpersonal and social rhythm therapy (IPSRT)
100
What are the 3 basics about prescribing antidepressants for Bipolar 1?
1) Antidepressants may be prescribed to treat depressive symptoms
2) Antidepressant may trigger a manic episode when combined with a mood stabilizer
3) Triggering mania is more likely with TCAs compared to SSRIs
101
What medication works best for Bipolar with rapid cycling or dysphoric mania?
Anticonvulsants like carbamazepine or divalproex sodium
102
What medication works best for acute mania?
Antipsychotics like Olanzapine or Risperidone
103
What is classic Bipolar 1 and what medication works best for it?
Classic Bipolar involves distinct episodes of mania and depression.
Lithium works best for classic Bipolar 1 and is effective in 60 - 90% of cases.
104
What are the 2 diagnostic criteria for Bipolar 2?
1) Occurrence of 1+ hypomanic episodes that last 4+ consecutive days, and involve 3+ characteristic sxs of mania that don't cause marked impairment or require hospitalization
2) Occurrence of 1+ major depressive episodes that last 2+ weeks, and involves 5+ characteristics of depression
105
What are the 5 diagnostic criteria for Cyclothymic Disorder?
1) Numerous periods of hypomanic sxs that don't meet criteria for a hypomanic episode
2) Numerous periods with depressive sxs that don't meet criteria for a major depressive episode
3) Causes distress or impairment
4) Symptoms last for 2+ years in adults or 1+ year in youth
5) Symptoms cannot remit for greater than 2+ months at a time
106
What are the 7 diagnostic criteria for Disruptive Mood Dysregulation Disorder?
1) Severe recurrent temper outbursts that are disproportionate to the situation and atypical for developmental level
2) A persistently irritable or angry mood between outbursts
3) Sxs have persisted for 12+ months
4) Sxs are present in 2+ settings
5) Outbursts occur on average 3+ times per week
6) Dx must be assigned between ages 6 - 18 years
7) Onset must occur before 10 years old
107
What are the 4 diagnostic criteria for Major Depressive Disorder?
Presence of 5+ sxs nearly every day for at least 2+ weeks with 1+ depressed mood or a loss of interest or pleasure:
1) Changes in weight
2) Changes in appetite
3) Sleep disturbances
4) Psychomotor agitation or retardation
5) Fatigue or loss of energy
6) Feelings of worthlessness or excessive guilt
7) Diminished ability to think or concentrate
8) Recurrent suicidality
9) Causes distress or impairment
108
What are the 3 specifiers for Major Depressive Disorder?
1) Severity (mild, moderate, severe)
2) Course (single episode or recurrent episode and in partial remission or in full remission)
3) Accompanying features (e.g., with psychotic features, with atypical features, with peripartum onset, with seasonal pattern)
109
When do you use the specifier peripartum onset?
Peripartum onset is applied to MDD or the Bipolar Disorders when sxs occur during pregnancy or within 4 weeks postpartum
110
What are the prevalence rates of the 3 peripartum conditions?
1) 10 - 20% experience peripartum depression
2) .1 to .2% develop postpartum psychosis
3) “Baby blues” occurs in 80% of people within 2 weeks of delivery and involve mild mood symptoms
111
What 3 factors have been associated with Seasonal Affective Disorder?
1) Changes in the dark-light cycle that increases melatonin levels
2) A phase-delay in circadian rhythms
3) Serotonergic dysfunction
112
What are the 3 peripartum onset Mood Disorder symptoms?
1) Anxiety
2) Preoccupation with the infant’s well-being
3) Delusional thoughts about the infant
113
When do you use the seasonal pattern onset for Mood Disorders?
The seasonal pattern specifier is applied to MDD and the Bipolar Disorders when the onset of mood episodes are related to particular times of the year
114
What are the 3 common symptoms associated with Mood Disorders with a seasonal pattern?
1) Hypersomnia
2) Increased appetite and weight gain
3) Craving for carbohydrates
115
What are the 2 associated features of Major Depressive Disorder?
1) 40 - 60% of people experience sleep disturbances (disturbed sleep continuity, early morning awakenings, reduced deep sleep, earlier onset of REM sleep and increased REM early in night)
2) 60% lifetime comorbidity with anxiety, which is related to a poorer prognosis and greater risk for suicide
116
What are the prevalence rates for Major Depressive Disorder and differences by age and gender?
1) 12-month prevalence rate is 7%
2) Prevalence for individuals ages 18 to 29 is 3x higher than individuals 60+
3) Beginning in early adolescence, rates for females is 1.5 - 3 times the rate for males
117
What is the typical course for Major Depressive Disorder?
1) Peak age of onset for MDD is mid-20s
2) Initial episodes may be precipitated by a severe psychosocial stressor
3) As the number of previous episodes increase, the risk for subsequent episodes is less related to stress than to the number of previous episodes
118
What are the 3 age differences for symptoms of Major Depressive Disorder?
1) Children - Somatic complaints, irritability, and social withdrawal
2) Preadolescents - Aggressiveness and destructiveness
3) Older adults - Memory loss, distractibility, disorientation, and other cognitive symptoms (usually with faster onset compared to neurocognitive disorders)
119
What are 2 cultural variations of Major Depressive Disorder?
1) Latinos may complain of of “nerves” and headaches
2) Asians often experience depression as weakness, tiredness, or an “imbalance"
120
What is the general concordance pattern for Major Depressive Disorder (4)?
1) Identical twin concordance rate is .50
2) Fraternal twin concordance rate is .20
3) MDD is about 1.5 - 3.0 times more common among first-degree biological relatives
4) Risk is similar between one parent or two parents with MDD
121
What are the 4 etiologies for Major Depressive Disorder?
1) Neuroticism is associated with MDD
2) Catecholamine hypothesis (MDD is caused by deficiency in norepinephrine)
3) Indolamine hypothesis (MDD is caused by low levels of serotonin or receptors)
4) MDD is associated with elevated levels of cortisol which causes atrophy of neurons in the hippocampus
122
What is the indolamine hypothesis?
The indolamine hypothesis proposes that MDD is caused by norepinephrine deficits
123
What is the catecholamine hypothesis?
The catecholamine hypothesis proposes that MDD is caused by low levels of serotonin or serotonin receptors
124
What is Lewinsohn’s theory of depression?
Lewinsohn’s believed depression occurred because of a low rate of response-contingent reinforcement which resulted in the extinction of behaviors and reduced the likelihood of positive reinforcement in the future. This caused the classic symptoms like pessimism, low self-esteem, and social isolation.
125
What was Seligman's theory about depression?
Seligman thought depression was caused by exposure to uncontrollable negative events coupled with learned helplessness that was caused by a tendency to attribute those events to internal, stable, and global factors
126
What was Rehm's theory of depression?
Rehm proposed that depression is caused by problems self-monitoring, self-evaluation, and self-reinforcement. He thought depressed people:
1) Focus on negative events and immediate outcomes
2) Fail to make accurate internal attributions
3) Set stringent criteria for self-evaluation
4) Have low rates of self-reinforcement and high rates of self-punishment
127
What was Beck's theory of depression?
Beck thought depression was related to negative, illogical self-statements about oneself, the world, and the future.
Some argued that depressed people's negative beliefs may actually reflect a more accurate awareness of reality though. For example, Lewinsohn et al. found that non-depressed individuals tended to overestimate their abilities.
128
What are the 3 differentials for Major Depressive Disorder?
1) Psychotic disorders involve psychosis being present without mood sxs
2) Adjustment Disorder would only be made if criteria for MDD were not met
3) Uncomplicated Bereavement tends to involve waves of mood problems but a generally normal mood
129
What type of depression are Tricyclics best for?
Vegetative depression
130
What type of depression are SSRIs best for?
Melancholic or severe/suicidal depression
131
What type of depression are MAOIs best for?
Atypical symptoms
132
What type of depression are SNRIs best for?
Comparable to TCAs and SSRIs for vegetative, melancholic, or severe depression but with different side effects
133
What type of depression is ECT best for?
Very severe endogenous depression w/ delusions or suicidal ideation
134
What does research say about treatment for depression?
1) An NIMH study found cognitive therapy (CT), interpersonal therapy (IPT), and tricyclic imipramine were all effective and imipramine was particularly effective for severe symptoms.
2) An 18-month follow-up study showed only 30% of CT patients, 26% of IPT patients, 19% of imipramine patients, and 20% of placebo patients stayed symptom free.
3) Research confirms that combining CBT with medication is better than either alone and that CBT is associated with a lower risk for relapse compared to medication.
135
What are the 9 diagnostic criteria for Persistent Depressive Disorder?
PDD is diagnosed when 2+ characteristic symptoms have been present for 2+ years in adults or 1+ year in youth and sxs have not remitted for more than 2 months:
1) Depressed or irritable mood
2) Poor appetite or overeating
3) Insomnia or hypersomnia
4) Low energy or fatigue
5) Low self-esteem
6) Poor concentration
7) Difficulty making decisions
8) Feelings of hopelessness
9) Causes distress or impairment
136
What are the 14 diagnostic criteria for Premenstrual Dysphoric Disorder?
PDD is diagnosed when there are 5+ sxs during the week before a period, an improvement in sxs during the period, and an absence of sxs after the period:
1) Affective lability
2) Irritability or anger
3) Depressed mood
4) Self-deprecating thoughts
5) Anxiety or tension
6) Decreased interest in usual activities
7) Impaired concentration
8) Lethargy
9) Changes in appetite
10) Sleep disturbances
11) A sense of being overwhelmed or out of control
12) Physical symptoms (e.g., breast swelling, joint or muscle pain)
13) Causes distress or impairment
14) Cannot be better explained by something else
137
How does age relate to suicide?
1) Historically, suicide rates were highest for individuals 65+
2) Currently, highest rates are for females ages 45 - 54 and males ages 75+
138
How does gender relate to suicide?
1) Males are 4x more likely to complete suicide
2) Females are 2-3x more likely to attempt suicide
139
How does race/ethnicity relate to suicide?
1) Suicide rates are generally highest for Whites at all age groups
2) Natives age 15 - 24 are 2.5x more likely to attempt suicide than other groups
140
How does marital status relate to suicide?
1) Lowest rates are found for married individuals
2) Highest rates are found for divorced, separated, and widowed individuals
3) Single individuals are in the middle for suicide rates
141
How do suicidal thoughts, behaviors, and warning signs relate to suicide?
1) 60 - 80% of individuals who complete suicide made 1+ past attempt
2) 80% of individuals gave definite warnings of their intentions (threats, writing/talking about death/suicide, seeking means, and making preparations)
142
How does life stress and social factors relate to suicide (4)?
Suicide is often associated with:
1) Failure at work or school
2) Interpersonal rejection (particularly for adolescents)
3) Living alone
4) Absence of social support
143
How do psychiatric disorders relate to suicide?
1) Most suicide victims have a mental disorder
2) Individuals with mood disorders are 15 - 20% more likely to die by suicide
3) Suicide is most likely to occur within 3 months after depression improves
4) In adolescents, risk increases when depression co-occurs with Conduct Disorder, Substance Use Disorder, or ADHD
144
How does personality relate to suicide?
1) Hopelessness more than intensity of depression
2) Socially prescribed perfectionism
3) Self-oriented perfectionism combined with high stress
145
How does neurobiology relate to suicide?
Low levels of serotonin and 5-HIAA (a serotonin metabolite) have been linked to an increased risk for suicide and violent suicide attempts
146
How is anxiety differentiated from depression?
1) Anxiety is associated with a higher level of positive affect and autonomic arousal
2) Pure anxiety sxs: Apprehension, tension, trembling, excessive worry, and nightmares
2) Pure depressive sxs: Depressed mood, anhedonia, loss of interest in usual activities, suicidal ideation, and decreased libido
147
What are the 3 diagnostic criteria for separation anxiety disorder?
Inappropriate and excessive fear related to separation from home or attachment figures as evidenced by 3+ characteristic symptoms for 4+ weeks in youth or 6+ months in adults:
1) Recurrent excessive distress when anticipating or experiencing separation
2) Persistent excessive fear of being alone
3) Repeated complaints of physical symptoms when anticipating or experiencing separation
148
What 3 ages categories does school refusal typically occur and why?
1) Ages 5 to 7 due to separation anxiety
2) Ages 10 to 11 due to change of schools and possibly social phobia
3) Ages 14 to 16 due to disorders and has the poorest prognosis
149
What is the etiology for separation anxiety disorder?
Children with Separation Anxiety Disorder often come from close, warm families and their symptoms are frequently precipitated by a major life stressor
150
What are the 3 differentials for separation anxiety disorder?
1) Developmentally appropriate levels of separation anxiety
2) Disorders involving marked anxiety (e.g., Agoraphobia, Generalized Anxiety Disorder)
3) Disorders involving school refusal (e.g., Conduct Disorder, Social Anxiety Disorder)
151
What are the 2 treatments for social anxiety disorder?
1) Systematic desensitization
2) Cognitive approaches
*A primary goal of treatment is an immediate return to school to avoid academic failure, social isolation, and other secondary impairments.
152
What are the 4 diagnostic criteria for Specific Phobia?
1) Intense disproportionate fear of or anxiety about a specific object or situation
2) Avoidance or endurance of object or situation with distress
3) Fear persists for 6+ months
4) Causes distress or impairment
153
What are the 5 specifiers for Specific Phobia?
1) Animal
2) Natural environment
3) Blood-injection-injury
4) Situational
5) Other
154
What are the 2 etiologies for Specific Phobia and other Anxiety disorders?
1) Abnormal levels of serotonin, norepinephrine, and GABA
2) Two-factor theory attributes phobias to avoidance conditioning (cycle of avoidance)
155
What are the 3 treatments for Specific Phobia?
1) Exposure with response prevention (especially in vivo exposure)
2) For blood-injection-injury, exposure is most effective when it is combined with applied tension, which involves repeatedly tensing and releasing the body’s large muscle groups to increase blood pressure
3) Cognitive self-control is useful for children’s fear of the dark (relaxation, pleasant visualization, positive self-statements, and parental reinforcement)
156
What are the 5 diagnostic criteria for Social Anxiety Disorder?
1) Intense fear of or anxiety about social situations potentially involving scrutiny
2) Fear exhibiting symptoms and being negatively evaluated for them
3) Avoidance or endurance of situations with distress
4) Fear persists 6+ months
5) Causes distress or impairment
157
What are the 2 etiological theories of Social Anxiety Disorder?
1) Behavioral inhibition, a temperament characterized by social avoidance and fear of the unfamiliar
2) Information processing biases (e.g., tendency to attend selectively to threatening information and overestimate the likelihood for negative outcomes in social situations)
158
What are the 4 treatments for Social Anxiety Disorder?
1) Exposure with response prevention
2) Social skills training
3) Cognitive restructuring
4) SSRI, SNRI, or beta-blockers
159
How long do symptoms need to be present to diagnose Panic Disorder?
1+ month of persistent concern about additional attacks, their consequences, or maladaptive changes in behaviors
160
What are the 3 medical differentials for Panic Disorder?
1) Hyperthyroidism
2) Hypoglycemia
3) Cardiac arrhythmia
161
What are the prevalence rates for Panic Disorder and differences by gender?
1) The 12-month prevalence for Panic Disorder is about 2 to 3% for adolescents and adults
2) Females are 2x as likely as males to receive the diagnosis
162
Why are prepubertal children rarely diagnosed with Panic Disorder?
Due to cognitive limitations that do not allow them to make catastrophic interpretations of their bodily symptoms
163
What 4 types of drugs are used to treat Panic Disorder and what are the rates of relapse?
1) Imipramine and other TCAs
2) SSRIs
3) SNRIs
4) Benzodiazepines
5) 30 - 70% relapse rate
164
What are the 4 diagnostic criteria for Agoraphobia?
1) Fear or anxiety about 2+ situations: public transportation, open spaces, enclosed spaces, standing in line, crowds, and being outside the home alone
2) Fears is due to concern that escape might be difficult or help will be unavailable
3) Avoidance, required presence of a companion, or endurance with distress
4) Symptoms persistent 6+ months
165
How is agoraphobia distinguished from Specific Phobia (situational type)?
Specific Phobia is the more likely when anxiety involves only 1 situation and is related to something other than concern about experiencing panic-like, incapacitating, or embarrassing symptoms
166
How is agoraphobia distinguished from Social Anxiety Disorder?
Social Anxiety Disorder is the likely diagnosis when the individual’s anxiety is related to being scrutinized by others and increases in the presence of a companion
167
What are the 2 types of treatments for Agoraphobia?
1) In vivo exposure with response prevention (graded)
2) In vivo exposure with response prevention (ungraded)
*Some evidence suggests both treatments have similar short-term effects but that intensive exposure has better long-term effects
168
What are the 4 diagnostic criteria for Generalized Anxiety Disorder?
1) Excessive anxiety and worry about multiple things that are difficult to control
2) Persists 6+ months
3) For adults, 3+ sxs are needed and for youth, 1+ sxs: Restlessness, keyed up, easy fatigue, difficulty concentrating, irritability, tense, disturbed sleep
4) Causes distress or impairment
169
What is the most basic primary feature of Anxiety Disorders
50% are diagnosed with another disorder
170
What disorder is associated with the highest comorbidity rate?
GAD is associated with the highest comorbidity rates (90%)
171
What are the top comorbidities with Anxiety Disorders?
1) MDD
2) Persistent DD
3) Substance Use Disorder
4) Specific Phobia
5) Social Anxiety Disorder
172
What are the 3 age differences for Generalized Anxiety Disorder?
1) Youth worry about school/sports or natural disasters
2) Young adults worry about work, family, finances, and the future
3) Older adults worry about personal health and minor or routine matters
173
What is the differential for Generalized Anxiety Disorder?
Nonpathological anxiety is determined by:
1) Feelings of control
2) Number of domains of worry
3) Fewer somatic symptoms
174
What are the 4 treatments for Generalized Anxiety Disorder?
1) CBT
2) SSRIs or SNRIs
3) Anxiolytics - buspirone (Buspar)
4) Benzodiazepine
175
What are the 2 diagnostic criteria for OCD?
Obsessive-Compulsive Disorder (OCD) is characterized by recurrent obsessions and/or compulsions that are time-consuming or cause impairment/distress.
1) Obsessions are persistent thoughts, impulses, or images that are intrusive
2) Compulsions are repetitious behaviors or mental acts that the person feels driven to perform in order to reduce distress or prevent a dreaded situation from happening
176
What are the 2 specifiers for OCD?
1) Level of insight (good, fair, poor, absent)
2) Presence of tics
177
What is the prevalence rate of OCD and what are the differences by gender?
1) OCD has a12-month prevalence in the United States of about 1.2%
2) Equally common in adult males and females
3) Earlier age of onset for males so greater prevalence in adolescent males than females
178
What are the 4 etiological theories of OCD?
1) Low levels of serotonin
2) Hyperactive right caudate nucleus (which converts sensory input into cognitions and actions)
3) Hyperactive orbitofrontal cortex
4) Hyperactive cingulate cortex (which involve emotional reactions)
179
What is the differential for OCD?
OCPD - while both disorders involve rituals, they are performed to reduce anxiety in OCD but are related to perfectionism in OCPD.
180
What are the 3 treatments for OCD?
1) Exposure with response prevention (particularly thought stopping or other interventions targeting the obsessions)
2) Tricyclic clomipramine
3) SSRI
181
What are the 6 diagnostic criteria for Reactive Attachment Disorder?
1) Consistent pattern of inhibited and emotionally withdrawn behavior toward caregivers that includes 2+ sxs (minimal socio-emotional responsiveness, limited positive affect, unexplained irritability, sadness, or fearfulness with caregivers)
2) History of extremely insufficient care
3) Onset must be evident before age 5
4) Developmental age of 9+ months
182
What are the 4 diagnostic criteria for Disinhibited Social Engagement Disorder?
1) Inappropriate interactions with unfamiliar adults as evidenced by 2+ sxs
2) History of extremely insufficient care
3) Onset must be evident before age 5
4) Developmental age of 9+ months
183
What are the 7 diagnostic criteria for PTSD in individuals older than 6 years old?
1) Exposure to actual or threatened death, serious injury, or sexual violence
2) Presence of 1+ intrusive symptom
3) Presence of avoidance of stimuli associated with the event
4) Negative changes in mood or cognition
5) Marked change in arousal and reactivity
6) Symptoms must persist 1+ month
7) Causes distress or impairment
*Criteria for children 6 and younger only require avoidance OR negative changes in mood/cognition
184
What are the 3 treatments for PTSD
1) Comprehensive CBT (exposure, cognitive restructuring, and anxiety management)
2) SSRI
3) EMDR
*Cognitive incident stress debriefing (CISD) involves providing treatment (a single lengthy session) within 72 hours of the event regardless of symptoms and is contraindicated
185
What are the 4 diagnostic criteria for Acute Stress Disorder?
1) Exposure to trauma
2) 9+ sxs from any of the 5 PTSD categories (i.e., intrusion, negative mood, dissociative symptoms, avoidance symptoms, arousal symptoms)
3) Persists 3 days - 1 month
4) Causes distress or impairment
186
What are the 4 diagnostic criteria for Adjustment Disorders?
1) Development of sxs in response to 1+ identifiable stressors within 3 months of the onset of the stressor(s)
2) Causes distress or impairment
3) Sxs must remit within 6 months after termination of the stressor or its consequences
4) Must not be diagnosed when symptoms represent normal bereavement.
187
What are the 6 specifiers for Adjustment Disorders?
Description of the predominant symptoms:
1) With depressed mood
2) With anxiety
3) With mixed anxiety and depressed mood
4) With disturbance of conduct
5) With mixed disturbance of emotions and conduct
6) Unspecified
188
What is the primary feature of Dissociative Disorders?
A disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior
189
What are the 5 types of amnesias associated with Dissociative Amnesia?
1) Localized amnesia
2) Selective amnesia
3) Generalized amnesia
4) Continuous amnesia
5) Systematized amnesia
190
What is the specifier for Dissociative Amnesia?
With or without dissociative fugue (apparently purposeful travel with an inability to recall some or all of one’s past)
191
What is the primary feature of Somatic Symptom Disorder?
Presence of 1+ somatic symptoms that cause distress or impairment and excessive thoughts, feelings, or behaviors related to the symptoms
192
What are the 3 primary feature of Illness Anxiety Disorder?
1) A preoccupation with having a serious illness in the absence of serious symptoms
2) A high level of anxiety about one’s health
3) Performance of excessive health-related behaviors or maladaptive avoidance of doctors, hospitals, etc.
193
What is the primary feature of Conversion Disorder?
Disturbances in voluntary motor or sensory functioning that suggest a serious condition with evidence of an incompatibility between the symptoms and recognized neurological or medical conditions
194
What are the 2 types of Factitious Disorder and what do they entail?
Factious disorder involves falsifying physical or psychological symptoms via feigning, exaggeration, simulation, or induction in the absence of external rewards
1) Factitious Disorder Imposed on Self
2) Individuals with Factitious Disorder Imposed on Another
195
What is Malingering?
Malingering is characterized by the intentional production of physical or psychological symptoms for the purpose of obtaining an external reward
196
When should Malingering be suspected?
Malingering should be considered when the person seeks:
1) A medical evaluation for legal reasons
2) There is a marked discrepancy between symptoms and objective findings
3) The person does not cooperate with an evaluation or treatment
4) The person has Antisocial Personality Disorder
197
What are the 4 diagnostic criteria for Anorexia Nervosa?
1) A restriction of energy intake that leads to a significantly low body weight
2) An intense fear of gaining weight or becoming fat
3) Behavior that interferes with weight gain
4) Body dysmorphia or a lack of recognition of the seriousness of their low weight
198
What are the 3 specifiers for Anorexia Nervosa?
1) Type (restricting or binge-eating/purging)
2) Course (in partial remission or full remission)
3) Severity (mild, moderate, severe, or extreme) based on BMI
199
What are the 5 potential consequences associated with purging behavior?
1) Anemia
2) Impaired renal functioning
3) Cardiac abnormalities
4) Dental problems
5) Osteoporosis
200
How do Anorexia Nervosa and Anxiety Disorders relate?
1) Over half of individuals with Anorexia also have an anxiety disorder
2) Anxiety disorders often precede the onset of Anorexia
3) Social Phobia and OCD are particularly common
201
What 3 disorders are associated with Anorexia Nervosa?
1) Social Phobia
2) OCD
3) Depression
202
What 6 symptoms are associated with starvation and Anorexia Nervosa?
1) Constipation
2) Cold intolerance
3) Abdominal pain
4) Lethargy
5) Bradycardia
6) Amenorrhea
203
What are the 5 etiologies for Anorexia Nervosa?
1) Perfectionism with unrealistic expectations
2) High levels of family conflict
3) Parents who are overprotective, rigid, and excessively concerned with thinness
4) Mothers who are depressed or domineering
5) Fathers who are physically or emotionally absent
204
How do food and neurotransmitters interplay in Anorexia Nervosa?
Food restriction lowers elevated serotonin which may underlie the restlessness, anxiety, and obsessive thinking seen with Anorexia. Consequently, a drug that increases serotonin is not useful for people with Anorexia when they are still underweight and restricting. But it can help prevent relapse once the person has reached normal weight.
205
What are 3 treatments for Anorexia Nervosa?
1) Contingency management (reinforcement for maintaining minimum weight)
2) CBT that modifies dysfunctional beliefs about weight and food
3) Separated family therapy for high EE families (to prevent relapse)
* First priority is always to get the individual to gain weight in order to avoid or reduce medical complications
206
What are the 5 diagnostic criteria for Bulimia Nervosa?
1) Recurrent binging with a sense of a lack of control
2) Compensatory behavior
3) Self-evaluation that is unduly influenced by body shape and weight
4) Binges and purges 1+ time per week
5) Symptoms persist 3+ months
207
What are the 2 specifiers for Bulimia Nervosa?
1) Course (in partial remission or full remission)
2) Severity (mild, moderate, severe, or extreme) based on compensatory behavior
208
What are 7 associated features of Bulimia Nervosa?
1) Preceding comorbid Anxiety Disorder
2) Depression
3) Electrolyte disturbances
4) Metabolic alkalosis or acidosis
5 Dental problems
6) Menstrual abnormalities
7) Cardiac arrhythmia and arrest
209
What are the 2 etiologies for Bulimia Nervosa?
1) Low levels of endogenous opioid beta-endorphin
2) Low levels of serotonin
210
What are the 4 treatments for Bulimia Nervosa?
1) Nutritional counseling
2) CBT (self-monitoring, stimulus control, cognitive restructuring, problem-solving, and distraction)
3) Imipramine (tricyclic)
4) Fluoxetine (SSRI)
*Primary goal is to gain control over eating and modify dysfunctional beliefs
211
What are the 4 diagnostic criteria for Enuresis?
1) Intentional or involuntary inappropriate voiding of urine
2) Accidents 2+ times per week
3) Accidents for 3+ months
4) Individual must be 5+ years old
*Occurs most often during non-REM sleep (stages 3 & 4)
212
What are the 4 treatments for Enuresis?
1) The bell-and-pad is effective in 80% of cases but 33% relapse within 6 months
2) Behavioral rehearsal or overcorrection
3) Imipramine is effective in 85% of cases but relapse is high
4) Desmopressin (antidiuretic) works in the short-term but not the long term
213
What are the 3 diagnostic criteria for Encopresis?
1) Intentional or involuntary inappropriate pooping 1+ time per month
2) Persistent accidents for 3+ months
3) Individual must be 4+ years old
214
What are the 4 diagnostic criteria for Insomnia?
1) Distressing or impairing sleep quality or quantity despite sufficient opportunities
2) 3+ times per week
3) 3+ months
4) 1+ sxs (difficulty initiating, maintaining, or returning to sleep)
215
What are the 2 treatments for Insomnia?
1) Barbiturates
2) CBT that involves sleep-hygiene education, stimulus control, relaxation training, correction of maladaptive thoughts/beliefs
216
What are the 4 diagnostic criteria for Narcolepsy?
1) Attacks of an irrepressible need to sleep
2) Sleep attacks occur 3+ times per week
3) Symptoms persist 3+ months
4) Either cataplexy (loss of muscle tone), a hypocretin deficiency, or REM latency less than 15 minutes
217
What are the 4 diagnostic criteria for Non-REM Sleep Arousal Disorders?
1) Recurrent episodes of incomplete awakening that usually occur during Stage 3 or 4 sleep
2) Either sleepwalking and/or sleep terrors
3) Limited or no recall of an episode
4) Causes distress or impairment
218
What are the 4 diagnostic criteria for Nightmare Disorder?
1) Repeated occurrences of extremely dysphoric and well-remembered dreams
2) Occur during REM sleep
3) Fearful or anxious upon awakening
4) Causes distress or impairment
219
What are the 4 diagnostic criteria for Erectile Disorder?
1) Presence of 1+ erectile symptoms - obtaining, maintaining, rigidity
2) Symptoms during almost all sexual activity
3) Symptoms persist 6+ months
4) Causes distress
220
What are the 3 treatments for Erectile Disorder?
1) Referral for medical eval - absence of erections during REM sleep suggests an organic etiology
2) If psychological, CBT is preferred treatment
3) Sildenafil citrate (Viagra)
221
What are the 3 diagnostic criteria for Genito-Pelvic Pain/Penetration Disorder?
1) Presence of 1+ characteristic symptom: Pain, anxiety, or tension before, during, or as a result of vaginal penetration during intercourse
2) Symptoms persist 6+ months
3) Causes distress
222
What are the 2 specifiers for Genito-Pelvic Pain/Penetration Disorder?
1) Onset (lifelong or acquired)
2) Severity (mild, moderate, or severe)
223
What are the 4 diagnostic criteria for Premature Ejaculation?
1) Ejaculation during partnered sex within 1 minute or before desired
2) Symptoms during almost all sexual activity
3) Symptoms persist 6+ months
4) Causes distress
224
What are the 3 specifiers for Premature Ejaculation?
1) Onset (lifelong or acquired)
2) Extent (generalized or situational)
3) Severity (mild, moderate, or severe)
225
What are the 4 diagnostic criteria for Gender Dysphoria in children?
Marked incongruence between assigned gender and experienced gender as evidenced by distress and all 6 of the characteristic sxs for 6+ months:
1-4) A strong preference for cross-gender clothing, roles, playmates, and toys/activities
5) A strong rejection of assigned gender's toys, games, and activities
6) A strong desire for sex characteristics of other gender
226
What are the 2 treatments for Premature Ejaculation?
1) Sex therapy - Sensate focus and the start-stop and squeeze techniques
2) SSRIs due to low serotonin being linked to premature ejaculation
227
What are the 4 diagnostic criteria for Gender Dysphoria for adolescents and adults?
Marked incongruence between one’s assigned and experienced gender as evidenced by distress and 2+ sxs for 6+ months:
1) A marked incongruence between sex characteristics and experienced gender
2) A strong desire to be rid of one’s sex characteristics
3) A strong desire for the sex characteristics of the opposite gender
4) A strong desire to be of the opposite gender
5) A strong desire to be treated as the opposite gender
6) A strong conviction that one has the feelings and reactions of the opposite gender
228
What is the course and prognosis for Gender Dysphoria (4)?
1) Onset is usually between the ages of 2 to 4 years
2) Persistence for natal males range from 2.2 to 30%
3) Persistence for natal females range from 12 to 50%.
4) Most who persist are sexually attracted to individuals of their natal gender (so they are straight)
229
What is the primary characteristic of Paraphilic Disorders and what are the 7 Paraphilics Disorders?
Abnormal sexual interest that is distressing or impairing and could harm self or others.
1) Voyeuristic Disorder (watching others)
2) Exhibitionistic Disorder (being watched)
3) Sadism Disorder (causing pain)
4) Pedophilic Disorder
5) Fetishistic Disorder
6) Frotteuristic Disorder (touching nonconsenting adults)
7) Transvestic Disorder (cross dressing)
230
What are the 5 diagnostic criteria for Oppositional Defiant Disorder?
1) Persistently irritable, argumentative, defiant, or vindictive bx
2) 4+ sxs (often loses temper, argues with authorities, noncompliant, blames others)
3) 1+ person who is not a sibling
4) Persists 6+ months
5) Causes distress for self or others
231
What are the 7 diagnostic criteria for Intermittent Explosive Disorder?
1) Disproportionate outbursts due to inability to control aggression
2) 2+ times per week
3) 3+ months or 3 outbursts in 12 months that have damaged property or caused injuries
4) Not premeditated
5) Not for tangible outcomes
6) Causes distress, impairment, or significant consequences
7) Must be age 6+
232
What are the 5 diagnostic criteria for Conduct Disorder?
1) Persistent violation of other’s rights, social norms, or rules
2) 3+ sxs within 12 months (aggression, destruction of property, theft, deceitfulness, violations of rules
3) 1+ sxs must occur within 6 months
4) Causes impairment
5) Cannot be assigned to individuals over age 18 who meet criteria for Antisocial Personality Disorder
233
What are the differences in prevalence and symptomology by gender for Conduct Disorder?
1) Conduct disorder is more common in males than in females
2) In females, symptoms often include lying, truancy, running away, relational aggression, and substance use
2) Males are likely to exhibit both physical and relational aggression
234
What are the 3 specifiers for Conduct Disorder?
1) Onset (childhood-onset if sxs emerge before age 10, adolescent-onset, and unspecified onset)
2) If limited prosocial emotions (lack of remorse or guilt, callous/lack of empathy, unconcerned about performance, and shallow or deficient affect)
3) Severity (mild, moderate, or severe) based on the number of conduct problems
235
What is Moffitt's theory of life-course-persistent Antisocial Personality Disorder (5)?
1) Began as early as age 3
2) Involved increasingly serious transgressions
3) Neurological impairments (deficits in verbal skills, executive functioning, and memory)
4) Difficult temperament
5) Adverse environment
236
What is Moffitt's theory of adolescence-limited Antisocial Personality Disorder?
Moffitt thought the adolescence-limited type was a temporary form of antisocial behavior that reflected a “maturity gap” and antisocial acts were usually committed with peers and were inconsistent across situations
237
What is the childhood-onset type of Antisocial Personality Disorder associated with?
1) Greater aggressiveness
2) Eventual diagnosis of Antisocial Personality Disorder and/or a Substance-Related Disorder
238
What are the 3 differentials for Conduct Disorder?
1) ADHD
2) ODD
3) Child or Adolescent Antisocial Behavior (an Other Conditions That May be a Focus of Clinical Attention)
239
What are the 2 treatments for Conduct Disorder?
Interventions are most effective when they target preadolescents (rather than adolescents) and when they include a family intervention. Two options include:
1) Parent management training
2) Multisystemic treatment that targets the individual, family, school, and community and combines behavioral, cognitive, family systems, and case-management strategies
240
What are the 4 diagnostic criteria for Substance Use Disorder?
A SUD is diagnosed when an individual continues using a substance despite significant problems for 12+ months as manifested by 2+ problems (e.g., impaired control, social impairment, risky use, withdrawal, or tolerance)
*SUD is not applicable to caffeine
241
How long do substance use problems need to be present for a diagnosis of Substance Use Disorder?
12+ months
242
What are the 4 problem areas associated with Substance Use Disorders?
1) Impaired control
2) Social impairment
3) Risky use
4) Pharmacological criteria – tolerance or withdrawal
243
What are the 2 specifiers for Substance Use Disorder?
1) Remission status
2) Severity (mild, moderate, or severe) based on the number of symptoms
244
What are the 3 etiological theories for Substance Use Disorder?
1) Conger’s tension-reduction hypothesis
2) Marlatt and Gordon overlearning hypothesis
3) Biopsychosocial models
245
What was Marlatt and Gordon's etiological theory of Substance Use Disorder?
Marlatt and Gordon describe addiction as an overlearned, maladaptive habit pattern
246
What was Conger's etiological hypothesis of Substance Use Disorder?
Conger’s tension-reduction hypothesis contends that alcohol reduces anxiety, fear, and other states of tension, which eventually leads to addiction via negative reinforcement
247
What was Marlatt and Gordon's treatment for Substance Use Disorder called and what did it involve?
Relapse Prevention Therapy (RPT)
1) Identifying risks for relapse
2) Identifying behavioral and cognitive strategies to prevent or respond to lapses
248
What are the 5 treatment barriers for Tobacco Use Disorder?
1) Reinforcing effects (e.g., relaxation, decreased anger, increased alertness)
2) Withdrawal symptoms
3) Fear of failure
4) Fear of gaining weight (average gain in first few months is 5 or 6 pounds)
5) Long-lasting cravings for nicotine
249
What 9 factors are associated with successful smoking cessation?
1) Male
2) Age 35 and older
3) Have a college education
4) Live in a smoke-free home
5) Have a non-smoking policy at work,
6) Be married or living with a non-smoking partner
7) Later starting age
8) Low level of nicotine dependence
9) History of abstaining longer than 5 days
250
What are the 3 elements associated with long-term tobacco abstinence?
1) Nicotine replacement therapy
2) Multicomponent behavioral therapy (skills training, relapse prevention, stimulus control, rapid smoking)
3) Support and assistance from a clinician
251
What are the 3 types of Substance-Induced Disorders?
1) Substance Intoxication
2) Substance Withdrawal
3) Substance/Medication-Induced Mental Disorders
252
What are the 6 shared diagnostic criteria for Substance/Medication Induced Mental Disorders?
1) Mental health symptoms
2) Evidence that sxs could be caused by a substance
3) Evidence that sxs developed with 1 month of exposure or withdrawal
4) Sxs cannot be better explained by something else
5) Sxs don't only occur during delirium
6) Sxs cause distress or impairment
253
What are the 7 characteristics of Alcohol Intoxication?
1) Maladaptive behavioral and psychological changes (e.g., inappropriate behaviors, impaired judgment, mood lability)
2) Slurred speech
3) Poor coordination
4) Unsteady gait
5) Nystagmus
6) Impaired attention or memory
7) Stupor or coma
*Same symptoms as Sedative, Hypnotic, or Anxiolytic Intoxication
254
What are the 8 characteristics of Alcohol Withdrawal?
1) Autonomic hyperactivity (e.g., sweating, tachycardia)
2) Hand tremor
3) Psychomotor agitation
4) Nausea or vomiting
5) Anxiety
6) Insomnia
7) Illusions or hallucinations
8) Generalized tonic-clonic seizures
255
What are the 4 characteristics of Alcohol Withdrawal Delirium?
1) Delirium (disturbances in attention, awareness, and cognition)
2) Autonomic hyperactivity
3) Vivid hallucinations, delusions
4) Agitation
256
What is Alcohol-Induced Major Neurocognitive Disorder in general and what are the two types?
Decline in 1+ cognitive domain causing impairment. It comes in 2 types:
1) Nonamnestic-confabulatory type
2) Amnestic-confabulatory type (Korsakoff Syndrome)
257
What is Korsakoff Syndrome and what are the 3 primary symptoms?
Korsakoff Syndrome is usually due to a thiamine deficiency and involves anterograde amnesia, retrograde amnesia, and confabulation
258
What are the 2 characteristics of Alcohol-Induced Sleep Disorder?
1) Intoxication tends to produce immediate sedation, increased deep sleep, and reduced REM sleep. This is followed by a rebound effect with decreased deep sleep and increased REM sleep.
2) Withdrawal tends to disturb sleep continuity and cause vivid dreams
259
What are the 11 characteristics of Stimulant Intoxication*?
1) Maladaptive behavioral and psychological changes (e.g., euphoria, aggression, hyperfocus, racing thoughts)
2) Fast or irregular heart rate
3) Pupillary dilation
4) High blood pressure
5) Sweating or chills
6) Weight loss
7) Psychomotor agitation
8) Fast breathing
9) Confusion
10) Psychosis
11) Impaired judgements
*Cardiovascular collapse (deadly low blood pressure) due to overdose
260
What are the 7 characteristics of Stimulant Withdrawal?
1) Fatigue/lethargy
2) Vivid, unpleasant dreams
3) Sleep disturbances
4) Increased appetite
5) Psychomotor agitation or retardation
6) Depression
7) Anxiety
261
What are the 10 characteristics of Opioid Intoxication?
The opioids include heroin, morphine, codeine, methadone, oxycodone, and fentanyl.
1) Euphoria followed by apathy or dysphoria
2) Psychomotor retardation
3) Impaired judgment
4) Pupillary constriction
5) Extreme drowsiness
6) Coma
7) Slurred speech
8) Impaired attention or memory
9) Depressed breathing or heart rate
10) Changes in weight or appetite
262
What are the 11 characteristics of Opioid Withdrawal?
1) Dysphoria
2) Nausea or vomiting
3) Muscle aches
4) Lacrimation or rhinorrhea
5) Pupillary dilation
6) Piloerection
7) Sweating
8) Diarrhea
9) Yawning
10) Fever
11) Insomnia
*Think flu symptoms
263
What are the 14 characteristics of Inhalant Intoxication?
1) Maladaptive behavioral and psychological
2) Dizziness
3) Nystagmus
4) Poor coordination
5) Slurred speech
6) Unsteady gait
7) Lethargy
8) Depressed reflexes
9) Psychomotor retardation
10) Tremor
11) Generalized muscle weakness
12) Blurred vision
13) Stupor or coma
14) Euphoria
264
What are the 7 characteristics of Tobacco Withdrawal?
1) Irritability or anger
2) Anxiety
3) Impaired concentration
4) Increased appetite
5) Restlessness
6) Depressed mood
7) Insomnia
265
What are the 5 characteristics of delirium?
1) A disturbance in attention and awareness that develops quickly (hours to a few days)
2) Fluctuations in severity (often worsening later in the day)
3) 1+ additional disturbance in cognition
4) Symptoms must not be due to another Neurocognitive Disorder or a severely reduced level of arousal (e.g., coma)
5) Evidence that sxs are the direct physiological consequence of a medical condition, substance, etc.
266
What 9 risk factors are associated with delirium?
1) Being old or young
2) Decreased cerebral reserve (e.g., dementia or HIV+ patients)
3) Post-operations
4) Burn injuries
5) Drug dependence and withdrawal (especially alcohol or benzos)
6) Systemic infections
7) Metabolic disorders
8) Electrolyte imbalances
9) Head trauma
267
What are the 3 treatments for delirium?
1) Treatment of the underlying cause
2) Reduction of agitated behaviors via environmental manipulation and psychosocial interventions
3) Antipsychotic drugs (e.g., Haloperidol)
268
What is Mild Neurocognitive Disorder?
A Mild Neurocognitive Disorder is a modest decline in 1+ cognitive domains that:
1) Does NOT cause impairment that cannot be overcome by effort or compensatory strategies
2) Does not occur only in the context of Delirium
269
What are the 10 known etiologies for Major and Mild Neurocognitive Disorders?
1) Frontotemporal lobe degeneration
2) Vascular disease
3) HIV infection
4) Prion disease
5) Traumatic brain injury
6) Substance/medication use
7) Lewy body disease
8) Alzheimer’s disease
9) Parkinson’s disease
10) Huntington’s disease
270
When is Neurocognitive Disorder diagnosed due to Alzheimer’s Disease (4 criteria)?
1) Criteria for a Neurocognitive Disorder are met
2) Criteria for probable or possible Alzheimer’s disease are met
3) Insidious onset
4) Gradual impairment
271
When is a Neurocognitive Disorder Due to Alzheimer’s Disease (Probable) diagnosed (4 criteria)?
Neurocognitive Disorder Due to Alzheimer’s Disease (Probable) is diagnosed when there is evidence of:
1) A causative genetic mutation
2) Clear evidence of a decline in memory and 1+ other cognitive domain
3) Steadily progressive and gradual decline without extended plateaus
4) No evidence of a mixed etiology
*When there is no causative genetic mutation identified, "possible" is diagnosed
272
How can you confirm Alzheimer's disease (3 signs)?
Neuron loss, amyloid plaques and neurofibrillary tangles in the medial temporal structures (entorhinal cortex, hippocampus, and amygdala)
*Alzheimer's disease can only be confirmed by a brain biopsy
273
What is the most common cause of dementia and what is the likely course of onset?
1) Alzheimer’s disease accounts for 60 - 90% of all case of dementia
2) Late onset (80s+) is more common than early onset
274
What are the 3 stages of Alzheimer's Disease?
1) Stage 1 (1 to 3 years)
2) Stage 2 (2 to 10 years)
3) Stage 3 (8 to 12 years)
275
What are the 6 characteristics of stage 1 Alzheimer's Disease?
Stage 1 (1 to 3 years) involves:
1) Anterograde amnesia (especially for declarative memories)
2) Deficits in visuospatial skills (wandering)
3) Indifference
4) Irritability
5) Sadness
6) Anomia
276
What are the 7 characteristics of stage 2 Alzheimer's Disease?
Stage 2 (2 to 10 years) involves:
1) Increasing retrograde amnesia
2) Flat or labile mood
3) Restlessness and agitation
4) Delusions
5) Fluent aphasia (Wernicke's aphasia)
6) Acalculia
7) Ideomotor apraxia (inability to translate an idea into movement)
277
What are the 4 characteristics of stage 3 Alzheimer's Disease?
Stage 3 (8 to 12 years) involves:
1) Severely deteriorated intellectual functioning
2) Apathy
3) Limb rigidity
4) Incontinence
278
What are the 9 etiological factors associated with Alzheimer's Disease?
1) Genetics
2) Early-onset familial type is linked to chromosomes 1, 14, and 21
3) Late-onset is linked to the ApoE4 gene on chromosome 19
4) Acetylcholine (ACh) deficits
5) Lower levels of formal education
6) Adult onset (type 2) diabetes
7) Depression
8) Traumatic brain injury
9) Down syndrome
279
What are the 7 treatments for Alzheimer's Disease?
1) Group therapy - reality orientation and reminiscence
2) Behavioral techniques
3) Antipsychotic drugs to reduce agitation
4) Antidepressant drugs to alleviate depression
5) Environmental manipulation
6) Cholinesterase inhibitors to reduce breakdown of ACh
7) Remaining at home with family
280
What are the 4 cholinesterase inhibitors and what do they do?
Cholinesterase inhibitors to reduce breakdown of ACh and include:
1) Tacrine
2) Donepezil
3) Galantamine
4) Rivastigmine
281
When is Vascular Neurocognitive Disorder diagnosed (3 criteria)?
1) Criteria for a Neurocognitive Disorder are met
2) Sxs are consistent with a vascular etiology
3) History of cerebrovascular disease
282
What are the 4 common courses for Vascular Neurocognitive Disorder?
1) Partial recovery
2) A stepwise decline
3) Progressive course with fluctuations in severity
4) Plateaus that vary in duration
283
What are the 6 symptoms of Neurocognitive Disorder Due to HIV Infection?
1) Impaired concentration and difficulty learning new information
2) Slowed psychomotor speed
3) Apathy and depression
4) Tremor
5) Clumsiness
6) Saccadic eye movements
284
What are the 6 stages of Neurocognitive Disorder Due to HIV Infection?
1) Stage 0 (Normal): Mental/motor functions are normal
2) Stage 0.5 (Subclinical): Mild/minimal sxs without impairment
3) Stage 1 (Mild): Unequivocal functional, intellectual, or motor impairment but intact performance of most tasks
4) Stage 2 (Moderate): Cannot work but ambulatory and can do basic self-care
5) Stage 3 (Severe): Major cognitive deficits (no complex convos) or motor disability (cannot walk independently)
6) Stage 4 (End Stage): Nearly vegetative and functioning is rudimentary (mute, paralyzed, incontinent)
