DSM & Diagnosis Flashcards

(218 cards)

1
Q

Mental Disorder (Broad Definition)
Areas affected

A

Syndrome characterized by clinically significant disturbance in ones cognition, emotions, behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Usually associated with distress or disability in social, occupational, and other important activities.

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2
Q

What type of assessment system does the DSM-5 use?

A

Nonaxial assessment system

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3
Q

What does ‘Polythetic Criteria Set’ mean in relation to the DSM-5?

A

For each diagnosis, a person may only have some of diagnostic criteria

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4
Q

What are the 3 ways to handle diagnostic uncertainty?

A
  1. Provisional: full criteria will eventually be met, but not enough info currently
  2. Other specified disorder: symptoms don’t meet full diagnostic criteria and clinician wants to provide reason why
  3. Unspecified Disorder: client’s symptoms don’t meet full criteria but clinician doesn’t want to indicate why
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5
Q

Level 1 Assessment Tool in DSM-5

A

Assesses 13 adult domains, 12 child domains

Identifies areas for further evaluation

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6
Q

Level 2 Assessment Tool in DSM-5

A

Detailed info on specific domains to assess with diagnosis, treatment planning, and follow up

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7
Q

WHODAS 2.0
SLUG PG

A

WHO Disability Assessment Schedule

  1. Understanding/communication
  2. Getting around
  3. Self-care
  4. Getting along with people
  5. Life activities
  6. Participation in society
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8
Q

Personality Inventory Domains (5)
What Personality Inventory?
DADNP

A
  1. Negative affect
  2. Detachment
  3. Antagonism
  4. Disinhibition
  5. Psychoticism
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9
Q

Cultural Formation

A

3 components that assess cultural features of a clients concerns

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10
Q

Outline for Cultural Formation

A

Includes identity, cultural conceptualizations of distress, cultural features affecting relationships between client and therapist, over all cultural assessment

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11
Q

Cultural Formation Interview (CFI)

A

Semi-Structured, 16 questions that assess impact of culture on client’s presenting concerns & treatment

  1. Cultural definition of concern
  2. Cultural perception of cause/context
  3. Cultural factors affecting coping
  4. Cultural factors affecting past/present help seeking
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12
Q

Cultural Concepts of Distress
Brief Description

A

Ways that a cultural group experiences, understands and communicates suffering, behavioural problems, or troubling cognitions.

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13
Q

Ataque de Nervios

A

Latino syndrome. Symptoms of intense emotional upset, uncontrollable crying, heat rising from chest to head, aggression, inhibition

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14
Q

Kufungisisa

A

South African. Depression.

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15
Q

Susto

A

Latin. Chronic somatic suffering stemming from emotional trauma. “spirit attack”

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16
Q

Neurodevelopmental Disorders (7)
GASCAIM

A

Onset during developmental period

  1. Intellectual disability
  2. Global Developmental Delay
  3. ASD
  4. ADHD
  5. Specific Learning Disorder
  6. Communication Disorder
  7. Movement Disorder
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17
Q

Intellectual Disability

A

Intellectual reasoning deficit
Adaptive Functioning deficit
2+ standard deviations below mean (70)
Severity rating is determined by…conceptual, social, practical domains. Not IQ

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18
Q

Vineland Adaptive Behaviours Scale

A

Assessment of adaptive functioning
Assesses what kids can DO, not necessarily their capabilities
1. Conceptual/Academic: memory, language, reading, writing
2. Social: empathy, interpersonal, social judgment
3. Practical: personal care, money, organization

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19
Q

Etiology of Intellectual Disability

A
75% prenatal
5% heredity 
30% chromosomal abnormalities 
10% pregnancy/perinatal complications
5% Childhood medical conditions
15-20% Environmental factors, comorbid conditions
30-40% unknown
Low birth weight is strongest predictor
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20
Q

Borderline Intellectual Functioning

A

IQ 70-85

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21
Q

Global Developmental Delay

A

Under 5 yo
Not meeting developmental milestones
Too young for standardized testing

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22
Q

ASD previous conditions

A

Encompasses the previous: Autistic disorder, aspergers, childhood disintegrative disorder, pervasive developmental disorder NOS

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23
Q

ASD Diagnosis

A
  1. Social communication deficit (NV, V, Peer, reciprocity)
  2. Restricted & repetitive behaviour, interest, activities
  3. Onset in early developmental period (2yo)
  4. Impaired social, occupation, and other
  5. Language abnormalities (echolalia, pronoun reversal)
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24
Q

ASD Severity Ratings

These are so dumb

A

Level 1-requires support
Level 2-substantial support
Level 3-very substantial support

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25
Etiology of ASD GACCS
Amygdala abnormality Cerebellum (repetitive movements) Corpus callosum Serotonin, GABA abnormalities Genetic
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Differential diagnosis for ASD
Rett Syndrome - Female predominated - Normal pre/perinatal development - Normal psychomotor until 5mo - 5-48 months=deceleration of cranial growth, stereotyped hand movements, loss of social engagement - After this period, there is an improvement
27
ADHD Min. duration of symptoms How many symptoms required? When does it start?
Diagnosis: 1. Symptoms for at least 6 months 2. Onset before 12yo 3. Evident in ~2 settings 4. Social, academic, occupational impairments Child: minimum 6 symptoms of inattention and/or 6 symptoms of hyperactivity Adult: minimum 5 5% children; 2.5% adults Mostly male
28
Disinhibition Hypothesis of ADHD
Barkley Inability to adjust activity levels to the requirement of the situation E.g. issues with doing tasks that have limited interest to them, or tasks that have inconsistent reinforcement
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Common meds for ADHD
1. Ritalin (methylphenidate) 2. Concerta (methylphenidate) 3. Adderall (amphetamine) 4. Dexedrine (dextroamphetamine) 5. Straterra (atomoxetine) nonstimulant
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Most common comorbid conditions with ADHD
ODD CD Learning Disorder
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Specific Learning Disorder Criteria (5 things)
Diagnosis: 1. Difficult using academic skills for at least 6 months 2. Reading difficulties, spelling/writing difficulties, mathematical difficulties 3. Skill must be far below average for chronological age 4. Interferes with academic/occupational performance, daily living 5. Can't be accounted for by other condition
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Three areas and severities of Specific Learning Disorder
1. Reading impairment 2. Written expression impairment 3. Mathematic impairment Mild/Moderate/Severe
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Dyslexia
Difficulties with word recognition, poor decoding and spelling abilities Due to phonological processing abilities
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Discalculia
Difficulties in numerical processing, accurate calculations
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Etiology of Specific Learning Disabilities THEC
Toxins (lead) Early malnutrition/food allergies Hemispheric abnormality Cerebellar-vestibular dysfunction (inflammation of middle ear)
36
Communication Disorders LSSS
1. Language disorder (4yo--> adulthood) 2. Speech sound disorder (phonology & articulation, may not be lifelong) 3. Social (pragmatic) communication disorder (V and NV communication) 4. Stuttering (Childhood onset fluency disorder)
37
Childhood Onset Fluency Disorder What is it? Prognosis Treatment
Diagnosis: - Impairment in normal fluency and time patterning of speech - Repetitions, prolongations, pauses, word substitutions and avoidance Prognosis: - 65-85% of children recover - Symptom severity at 8yo a good indicator Treatment: - Reduce stress - Habit Reversal Training
38
Movement Disorders (3) DST
1. Developmental Coordination Disorder: delays in motor milestones 2. Stereotypic Movement Disorder: repetitive and nonfunctional 3. Tic Disorders: Tourettes, persistent motor or vocal tic disorder
39
Tourette's Disorder
Diagnosis: - At least 1 vocal tic - Multiple motor tics, simultaneously or at different times - Persisted for more than a year - 4-6 yo develops - Usually improves in adolescence Treatment: - Antipsychotics - Comprehensive behavioural treatment
40
What 5 symptoms accompany psychotic disorders?
1. Delusions 2. Hallucinations 3. Disorganized thinking 4. Disorganized/abnormal motor behaviour 5. Negative symptoms *Each symptom ranked on 5 point scale for severity*
41
Delusional Disorder Diagnosis
Diagnosis: - Delusion (false beliefs maintained despite evidence) May be bizarre or non-bizarre - Delusions present for 1 month or more - Functioning is not impaired by delusion Onset in middle to late adulthood
42
Types of Delusions (7) JEGPUMS
1. Erotomanic: someone famous is in love with them 2. Grandiose: inflated self-worth, power, knowledge 3. Jealous 4. Persecutory 5. Somatic: abnormal bodily functions/sensations 6. Mixed: more than one of them 7. Unspecified: doesn't fit in other categories
43
Schizophrenia Diagnosis
- Requires two + active symptoms for at least one month - Must include one of: delusions, hallucinations, disorganized thinking/speech - Continuous signs of disorder for at least 6 months - Must cause impairment in functioning
44
Schizophrenia Prognosis
Onset: early to mid-twenties for men; late twenties for females Chronic condition; can be managed but remission is unlikely Good prognosis linked to: - Late onset - Brief active symptom phase - No family history of schizophrenia
45
Schizophrenia and Culture
Do African Americans get it more? -They may have delusions and hallucinations as part of MDD, Bipolar In developed countries, clients more likely to experience... - Acute onset - Shorter clinical course - Complete remission - May be met with better social support and acceptance
46
Schizophrenia Etiology
Brain Abnormalities: - Increased volume in lateral and third ventricles - Reduced size of hippocampus and amygdala - Lower activity and flow to PFC...this causes negative symptoms Dopamine Hypothesis: linked to elevated dopamine levels/over sensitive dopamine receptors.
47
Schizophrenia Treatment
1st gen antipsychotics - Chlorpromazine - Thioridazine - Haloperidol - Use: for positive, not negative symptoms - Risks: tardive-dyskenesia 2nd gen antipsychotics: - Clozapine - Risperidone - Olanzapine - Ariprazole - Use: both + and - symptoms - Risk: tardive dyskenesia less likely
48
Schizophreniform Disorder (Schizo-mini-form)
Exactly the same as schizophrenia, but differing timeline Minimum 1 month, but less than 6 months Impaired functioning not required for diagnosis
49
Brief Psychotic Disorder
Requires 1+ of: - Delusions - Hallucinations - Disorganized speech - Disorganized movement - Catatonia Duration: 1 day-1 month...eventually return to their unique normal Usually preceded by stressor
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Schizoaffective Disorder Symptoms + Specifiers (3)
Concurrent psychotic and MDD/manic episodes -Must have at least 2 weeks of ONLY psychotic symptoms with no mood symptoms Specifiers: - Bipolar type - Depressive type - With Catatonia
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Bipolar I Diagnosis
- Manic episode: elevated/irritable/swinging mood, excessive goal directed energy, inflated self-esteem and grandiosity, decreased need for sleep, flight of ideas - Requires at least one manic episode that lasts for minimum one week - May include 1+ episodes of hypomania or depression, but not required for diagnosis - Causes marked impairment in functioning - Requires hospitalization the the safety of self or others
52
Bipolar I Diagnostic Specifiers Status Severity Does it come with friends? Pattern
- In partial/full remission - Mild/moderate/severe - With anxious distress - With mixed features - With rapid cycling (4+ mood episodes in last year) - With mood-congruent or mood-incongruent psychotic features - With catatonia - With peripartum onset - With seasonal pattern
53
Bipolar I Etiology
Heredity is the strongest factor Biologically: - Neurotransmitter dysfunction - Brain abnormalities - Psychosocial Risk for relapse: -Perfectionist, goal driven
54
Bipolar I Treatment
Mood stabilizers - Lithium: good for when there is both mania and MDD - If intolerant to lithium...valproate, carbamazepine, other anti-seizure meds Meds + Psychosocial support the best Therapies: - CBT and Interpersonal & Social Rhythm Therapy - FFT
55
Bipolar II Diagnosis
- One hypomanic episode (3-4 days)...does not cause significant impairment nor hospitalization - One MDD episode...depressed mood + anhedonia - Increase creativity, productivity, efficiency (without impairment)
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Bipolar II Diagnostic Specifiers (9)
- Status - Mild/Moderate/Severe - With anxious distress - With mixed features - With rapid cycling - With congruent mood/mood incongruent psychotic features - With catatonia - With peripartum onset - With seasonal pattern
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Cyclothymic Disorder
- Multiple episodes of hypomanic symptoms - Multiple episodes of depressive symptoms (not meeting MDD) - Must last for 2 years in adults, 1 year in children - Cause significant distress + impaired functioning - Symptoms present for at least half the time; can't be without symptoms for 2+ months **Can't meet criteria for manic/hypomanic/MDD episode**
58
Separation Anxiety Disorder Diagnosis 7 Symptoms Timeline
- Developmentally inappropriate fear/anxiety related to separation from the home or attachment figures - Distress when anticipating separation from home and/or attachment figure - Persistent worry about losing the attachment figure - Refusal to leave home without the attachment figure - Refusal to go to sleep without being near the attachment figure - Nightmares about separation - Physical symptoms even at thought of separation Causes significant distress and impaired functioning Symptoms present for 4 weeks in children, 6 months in adults
59
School Phobia + School Refusal
May be related to Separation Anxiety In children aged 5-7 this is due to separation anxiety In adolescents, it may be more indicative of another underlying mental illness
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Separation Anxiety Etiology
- Parental over protectiveness - Previous trauma - Past separations - Life stressors
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Separation Anxiety Disorder Treatment (according to the DSM)
- Behavioural therapies such as systematic desensitization, contingency management - CBT with the goal of fostering adaptive thinking
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Selective Mutism Diagnosis + Treatment
- Consistent failure to speak in specific social situation where speaking is expected - They can speak in other situations - Impairs educational and occupational achievement or social occupation - Onset before age 5 - Underlying feeling is fear and anxiety, not counterwill Treatment: - Behavioural and cognitive - Desensitization and relaxation
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Specific Phobia Diagnosis
- Fear/anxiety about a specific object or situation - This situation ALWAYS causes the distress - Avoidance or endures the stimuli with great distress - Fear is not proportionate to the danger actually present - Impaired functioning
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Specific Phobia Etiology
- Most start in childhood - Hereditary - Neurotransmitter abnormalities - Dysfunctional cognitions - Observational learning - Classical conditioning (John Watson and poor little Albert)
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Specific Phobia Treatment
Exposure with response prevention | Relaxation exercises
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Social Anxiety Disorder Diagnosis
- Marked anxiety about one + social situation where a person is exposed to the scrutiny of others - Avoidance or endures situations with marked distress - Symptoms must last for 6+ months - Causes impaired functioning and high distress
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Social Anxiety Disorder Etiology
- Heredity - Behavioural inhibition - Direct conditioning - Observational learning - Cognitive biases
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Social Anxiety Disorder Treatment
- Exposure - Social skills training, cognitive restructuring - Medication
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Panic Attack Symptoms
An abrupt surge of intense fear that reaches a peak within minutes. Includes at least 4 symptoms - Heart palpitations - Sweating - Trembling, shaking - SOB - Dizziness - Chest pain - Parethesias (pins and needles) - Depersonalization/derealization - Fear of losing control & dying
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Panic Disorder Diagnosis
-Recurrent and unexpected attacks with at least one attack being followed by one month of persistent concern about having another attack and significant maladaptive change in behaviour related to them Must first rule out: - Hyperthyroidism - Seizure disorder - Cardiac arrhythmia - Other medical disorders Onset: -20-24 years Risk: -Increase risk of suicide
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Panic Disorder Etiology
Genetic Classical conditioning Cognitive biases (especially regarding body related cues)
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Panic Disorder Treatment
-CBT + meds Common meds: - Imipramine - Other TCA - SSRI - Benzodiazepine * *High risk of relapse when med not taken** Therapies: - Panic control therapy: brief form of CBT developed by David Barlow. Includes exposure, restructuring, relaxation - Interoceptive Exposure: used with CBT. Exposure to physical sensations associated with panic attack
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Agoraphobia Diagnosis
-Presence of anxiety in at least 2 situations LA TOE (Lines, Alone, Transport, Open, Enclosed) -Situations are avoided for fear of having no escape if they have embarrassing or incapacitating symptoms -Situations always have: Anxiety, require the presence of a safe companion, and are endured with intense anxiety -Anxiety is not proportional to danger present Must first rule out: - Specific phobia (they are likely to have ~one agoraphobic situation and it is more related to the situation itself, not embarrassment) - Social Anxiety Disorder (mostly related to negative evaluation, they are often fine when left alone)
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Agoraphobia Treatment
- In vivo exposure | - Success rates boosted when significant others are involved in treatment
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Generalized Anxiety Disorder Diagnosis
``` -Excessive worry about events/activities that lasts for ~6 months Includes 3 or more symptoms (1 or more for children) -Restlessness/feeling on edge -Easily fatigued -Difficulty concentrating -Irritability -Muscle tension -Sleep disturbance ``` Onset: 30+ years Most common MI in older adults Difficulties with controlling the worries Significant distress and impairment Many have comorbid disorders, such as depression and other anxiety disorders
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GAD Etiology
Genetic Behavioural inhibition Neuroticism Cognitive Theory: automatic catastrophic thoughts maintain anxiety and cause avoidance behaviours
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OCD Diagnosis
Obsessions: recurrent and persistent thoughts, urges or images that are intrusive and unwanted and cause marked anxiety and distress Compulsions: repetitive behaviours and mental acts that a person feels compelled to perform in response to an obsession or rigid rules. The purpose is to reduce anxiety, but it doesn't actually work Must be time-consuming (more than 1 hour per day) and/or cause distress and impairment Symptoms for 12+ months Affects both genders equally Presents in males before females (10 years for males)
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OCD Specifiers (related to insight)
1. Good/fair insight 2. Poor insight 3. Absent insight/delusional beliefs
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OCD Etiology
- Heredity - Low 5-HT - Brain abnormalities: orbitofrontal cortex, caudate nucleus
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OCD Treatments
``` Exposure with ritual prevention + CBT Medications: -Clomipramine (TCA) -Fluvoxamine -Sertraline ``` Therapy + Meds is the best
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Body Dysmorphic Disorder Symptoms Onset Specifiers
Diagnosis: - Preoccupation with defect or flaw in appearance that are hardly noticeable by others - Repetitive behaviours or mental acts related to defect (checking, grooming, hiding) Onset: - A bit more common in women - Begins in teens Specifiers - Good/fair insight - Poor insight - Absent insight/delusional beliefs
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Hoarding Disorder + specifiers
Diagnosis: -Difficulty throwing out or giving up possessions, regardless of their value Specifiers: - Good/fair insight - Poor insight - Absent insight/delusional beliefs
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Trichotillomania
- Pulling of one's hair - Repeated attempts to stop, but to no avail - Distress and impairment
84
Reactive Attachment Disorder
Summary: child doesn't develop attachments, mood is erratic, stuck in 3 F's Symptoms (start before 5yo): - Emotionally withdrawn - No connection seeking towards CG - Low positive affect - Unexplained irritability, sadness, fearfulness, withdrawal - Little smiling - No asking for support - Lack of response to connect seeking from CG's - No interest in play - Changes in routine & unsolicited comfort may be met with external or internal rage Requires child to have extreme developmental trauma such as neglect, repeated separations, unusual rearing that disrupts attachment Child must developmentally be at least 9 months
85
Disinhibited Social Engagement Disorder
Summary: low boundaries with everyone Has ~2 of: -Low restraint in approaching & interacting with unfamiliar adults -Over familiar behaviour with strangers -Low checking with CG after venturing away from them -Willingness to go with unfamiliar adults Child must have history of developmental trauma - Neglect - Repeated separations - Unusual rearing Must have developmental age of 9mo
86
PTSD Diagnosis
Different criteria for all age groups, but all include 4 symptoms: 1. Intrusive: reexperiencing trauma 2. Avoidance: avoid memories, thoughts, reminders 3. Negative cogs/mood: guilt, shame, fear 4. Increased arousal: hypervigilance, reckless Adults/kids/teens exposure occurs: 1. direct 2. witnessing it happen 3. Learning it happened to close person 4. Repeated exposure to details Kids >6 yo exposure occurs: 1. Direct 2. Witnessing it 3. Learning it happened to P-CG Symptoms for longer than 1mo w/ Delayed expression = full diagnosis not met until 6mo after event
87
PTSD Treatment
Therapy: - Multicomponent CB intervention - Cognitive processing therapy - Psychological debriefing NOT WORK - EMDR
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Acute Stress Disorder
``` -Similar to PTSD Must have min 9 symptoms from 5 categories: -Intrusion -Negative mood -Dissociation -Avoidance -Arousal ``` Symptoms last 3 days-1 month
89
Adjustment Disorder Symptoms + Specifiers (5)
Development of symptoms in response to 1+ psychosocial stressors within 3 months of said stressors - Distress is disproportionate to stressor - Symptoms remit within 6 months Specifiers: - With depressed mood - With anxiety - With mixed anxiety and depressed mood - With disturbance of conduct - Unspecified **Not diagnosed when symptoms are due to bereavement**
90
What gets disrupted in Dissociative Disorders?
Include a disturbance in normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control and behaviour
91
Dissociative Identity Disorder
2+ distinct personalities, with gaps in recall of events, personal info, personal traumas. Cannot be explained by typical forgetfulness Not related to accepted cultural/religious practices Clients typically unaware of their symptoms Childhood abuse is a risk factor
92
Dissociative Amnesia
-Inability to recall important autobiographical information...not explained by forgetfulness Specifier: dissociated fugue (purposeful wandering away from home and forgets one identity and other important details) Risk: trauma
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Forms of Dissociative Amnesia (3)
1. Localized Amnesia: forget ALL events related to a period of time 2. Selective Amnesia: Forget SOME events related to a period of time 3. Generalized Amnesia: Uncommon, but may include forgetting personal identity and semantic/skill knowledge
94
Depersonalization Disorder
Sense of unreality, detachment, being an outsider observing one's own thoughts, feelings and actions Actual sense of reality is intact Recurrent
95
Derealization Disorder
Sense of unreality or detachment from one's surroundings Actual sense of reality is intact Recurrent
96
Somatic Symptoms Disorder
-1 or more somatic symptom that cause distress and impairment with excessive thoughts, feelings and behaviours associated with symptoms At least one of three symptoms: - Excessive time/energy devoted to symptoms and concerns about health - Persistently high levels of anxiety about health - Disproportionate and persistent thoughts about the seriousness of the symptoms More than 6 months, though symptoms may not be continuously present More common in females Specifiers: -With predominant pain
97
Illness Anxiety Disorder
Preoccupation with having a serious illness Absence of somatic symptoms or presence of mild symptoms High level of anxiety about health Performance of excessive health related behaviours or maladaptive avoidance of medical care Symptoms last for 6 months or longer...the feared illness may change over this time
98
Conversion Disorder (Functional Neurological Symptoms Disorder)
-At least 1 symptom that involved an alteration in voluntary motor and sensory function. Not related to neurological/medical conditions Specifiers: - With weakness or paralysis - With attacks or seizures - With anesthesia or sensory loss
99
Factitious Disorder Diagnosis
2 types: 1. FD imposed on self 2. FD imposed on other Summary: falsifying physical/psychological symptoms, but it is all deception with no external reward - Exaggerating - Simulating - Inducing **Munchausen Syndrome is most severe presentation of this**
100
Munchausen Syndrome
Falls under diagnosis of FD -Predominantly 'physical issues' Can include extensive travel and seeking of unnecessary invasive procedures -Impersonation and fabrication
101
Factitious Disorder Differential Diagnosis
Malingering: intentional production of exaggerated physical/psychological symptoms for personal gain (e.g. legal reasons) Discrepancy between symptoms and objective findings Person is uncooperative during evaluation and treatment Person may have antisocial PD
102
Factitious Disorder Treatment
Symptom management Need strong therapeutic alliance, support and consistent care Confrontational techniques not recommended due to premature termination Inpatient treatment may just support the persons deception related to symptoms
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Pseudocyesis
Woman has all symptoms of pregnancy except the fetus
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Sleep Wake Disorder Summary
Involves problems related to quality, timing and amount of sleep that causes daytime distress and impaired functioning
105
Insomnia Disorder Diagnosis
Dissatisfaction with sleep quality or quantity due to one more more symptoms: 1. Difficulty getting to sleep 2. Difficulty maintaining sleep 3. Early morning awakening and inability to return to sleep - Causes SD/IF - 3+ nights per week - Ongoing for 3+ months - Occurs even with sufficient opportunities for sleep
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Insomnia Etiology
- Major life events | - Less severe but chronic daily stresses
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Insomnia Treatment
Meds: - Benzodiazapine - Antihistamine Therapies: - Sleep restriction: restrict time in bed - Stimulus control: strengthen bed and bedroom cues for sleep - Sleep hygiene education - Relaxation training - Cognitive restructuring
108
Hypersomnolence Disorder
Diagnosis: -Excessive sleepiness despite sleeping minimum 7 hours w/ at least one of the following occurring: -Recurrent daytime sleep episodes -Prolonged sleep for more than 9 hours that is nonrestorative -Difficulty being fully awake after abrupt awakening Occurs min 3x per week for 3 months
109
Narcolepsy
Diagnosis: -Recurrent periods of irresistible need to sleep, lapsing into sleep, that occur in same day -3+ times per week for ~3 months Required for diagnosis: -Cataplexy: brief loss in muscle tone, triggered by emotional arousal -Hypocretin Deficiency: hormone involved in regulation of sleep -REM Latency: less than or equal to 15 minutes -May experience hallucinations Hypnogogic (falling asleep) Hypnopompic (waking up)
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Obstructive Sleep Apnea Hypopnea Diagnosis
Requires polysomnographic evidence of: - 15< obstructive apneas per hour or 15< hypopneas (airflow reduction) per hour - Sleep with disturbance in nocturnal breathing (snoring, snorting, breathing pauses) - Daytime sleepiness, fatigue, unrefreshing sleep despite enough sleep
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Sleep Apnea Etiology GOMME
- Genetic disorders that disrupt upper airway - Menopause - Obesity - Endocrine disorder - Medications
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Sleep Apnea Treatment
Mild symptoms: - Positional therapy (pillows, etc) - Nose strips - Oral/dental appliances Moderate symptoms: -CPAP (continuous positive airway pressure)
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Circadian Rhythm Sleep-Wake Disorder
Recurrent pattern of sleep disruptions due to alteration of circadian system Results in insomnia or excessive sleepiness
114
Non-REM Sleep Arousal Disorder
Diagnosis: - Recurrent episodes of incomplete awakening that occur during Stage 3 or 4 in the first 1/3 of a sleep episode - Sleep walking OR night terrors (no recall once awake) - Occurs mostly in childhood then reduces Specifiers: - Sleep walking type - Sleep terror type
115
Nightmare Disorder
- Recurrent, extended, dysphoric and well remembered dreams that involve efforts to avoid threats to survival, security or physical integrity - Usually occur during REM in second half of major sleep episode - After awakening, anxiety may linger
116
REM Sleep Behaviour Disorder
Diagnosis: - Recurrent episodes of arousal during REM, usually during later sleep period - Vocalizations, complex motor behaviour consistent with the dream - Wake up alert and not confused, remember dream Etiology: - Nerve pathways that are supposed to paralyze you during sleep are being lazy - May co-occur with narcolepsy
117
Restless Leg Syndrome
- Sensorimotor neurological sleep disorder that involves urge to move legs in response to unpleasant sensation in them - Worsens during inactivity and is relieved by activity - Worse in evening/night - 3x per week for min 3 months
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Feeding and Eating Disorders-Summary
Persistent disturbance of eating behaviour, leading to altered consumption/absorption of food that impairs physical health and psychosocial functioning
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Pica
- Persistent eating of non-nutritious, non-food substances - Lasts at least one month - Most common in young children, and pregnant women - Common w/ intellectual disability (severity worsens as disability does)
120
Rumination Disorder Symptoms + Etiology
RUMI Barfs it Up Diagnosis: - Repeated regurgitation of food for at least one month - It may be re-chewed, re-swallowed, spit out - Not bc of a medical disorder - Onset: 3-12 months - May result in weight loss and/or malnutrition Etiology: - Neglect - Stress - Parent-child issues
121
Avoidant Restrictive Food Intake Disorder (ARFID)
Afraid of Food ``` Diagnosis: -Don't eat adequately with one or more of the following... Weight loss/not meeting weight gains Nutritional deficiency Dependence on feeding tube/supplements Psychosocial functioning impairments ``` - No medical condition - Linked to FAILURE TO THRIVE - Like AN, but no dysmorphia - **Pathological Picky Eating**
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ARFID Etiology
- More likely in those with ASD, ADHD, Intellectual Disability - More likely in children who don't outgrow picky eating - Comorbid with anxiety disorders
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Anorexia Nervosa Diagnosis Symptoms Status Types Severity
*More psychological than ARFID* Diagnosis: - Restriction of food = low body weight - Fear of gaining weight - Distortions in: self image, importance given to body weight or shape through self-evaluation, denial of seriousness of the problem Subtypes: 1. Restricting type 2. Binge-eating/purging type Specifiers: 1. In partial remission 2. In full remission Severity: 1. Mild (BMI = 17+) 2. Moderate (BMI = 16-16.99) 3. Severe (BMI = 15-15.99) 4. Extreme (BMI <15)
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AN Comorbid Conditions
Bipolar Depression Anxiety Alcohol + SU disorders
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AN Etiology
- Onset: adolescence/young adulthood - Earlier onset = shorter duration - More common in females - Associated with cultures that encourage thinness (modelling, athletics, etc) - Upper/middle class backgrounds - Common in overprotective or depressed mothers, uninvolved fathers - Parenting that focuses on 'perfect children' - May have higher 5-HT (anxiety, irritablity, obsessional thinking) Food restriction lowers 5-HT
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AN Treatment
- Multidisciplinary - Family therapy (structural family therapy shows good evidence) - CBT = moderate support - Goal is to mitigate health problems and treatment may often require hospitalization
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Bulimia Nervosa Diagnosis Symptoms Status Severity
Weight is within normal range unlike AN Binge/Purging Type LACK of control, whereas AN is TOO MUCH control Diagnosis: - Recurrent episodes of binge eating followed by compensatory behaviours - Occur ~once a week for 3 months Specifers: 1. In partial remission 2. In full remission Severity (based on # of compensatory beh) 1. Mild = 1-3 2. Moderate = 4-7 3. Severe = 8-13 4. Extreme = 14+
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BN Etiology (5)
``` Onset: adolescence/young adulthood More common in females Associated with: -Childhood obesity -Early puberty -Low self esteem -Childhood sexual abuse -Life stressors ```
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BN Comorbid Illnesses
- Higher risk of suicide - Bipolar - Depression - Anxiety - PD's, esp BPD - SUD's
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BN Treatment
- CBT - Interpersonal therapy - Meds: antidepressants - High 5-HT
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Binge Eating Disorder
*No compensatory behaviours* ``` Diagnosis: -Recurrent episodes of binge eating with at least 3+ of... Eating rapidly Eating until uncomfortably full Eating a lot when not hungry Eating alone out of embarrassment Disgusted/guilt after -Binges occur at least once a week for 3 months ``` Specifiers: 1. In partial remission 2. In full remission Severity (based on episodes per week) 1. Mild = 1-3 2. Moderate = 4-7 3. Severe = 8-13 4. Extreme = 14+
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Atypical Anorexia (other specified/unspecified disorder)
Anorexic behaviours but with normal BMI
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Bulimia Nervosa of low frequency/duration (other specified/unspecified disorder)
Occurs less than once a week for less than 3 months
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Purging Disorder (other specified/unspecified disorder)
Purging in absence of binge eating
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Night Eating Syndrome
- Waking up throughout the night to eat - Eat a quarter of your daily calories after dinner, which causes you distress - Related to insomnia
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Enuresis Diagnosis Symptoms Subtype Prognosis
- Repeated peeing into bed or clothes (intentionally or involuntarily) - Occurs 2x a week for ~3 months, or causes SD/IF - Must be chronologically/developmentally ~5 yo - Not always a medical thing Subtypes: 1. Nocturnal only (most common) 2. Diurnal only 3. Both Characterizations: 1. Primary: child is 5 and never established continence 2. Secondary: disturbance develops after period of continence Prognosis: 99% of clients remit by adulthood
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Enuresis Etiology
- Lax toilet training - Psychosocial stress - Delays in development of circadian rhythm of urine production - Most common in children with enuretic fathers
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Enuresis Treatment
- Urine alarm bell and pad technique (classical conditioning). More effective than meds - Family/individual therapy esp if it's related to a stressor
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Encopresis Symptoms /Timeline Specifiers (2) Characterizations (2)
- Recurrent pooping in inappropriate places, intentionally or not - At least once a month for 3 months - Chronological/developmental age of 4yo Specifiers: - With constipation and overflow incontinence - Without constipation and overflow incontinence Characterizations: 1. Primary: person never established continence 2. Starts after a period of continence
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Encopresis Treatment
No evidence based treatment Medical management helpful when constipation is the underlying problem When deliberate, ODD and CD may be involved -Behavioural and family therapies
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Sexual Dysfunctions Overview Disqualifiers Timeline Specifiers Severity
Disturbance in sexual response or sexual experience Symptoms cannot be explained by: - Another mental illness - Relationship distress - Other stressors - Medical condition - Substance use/medication Must persist for ~6 months Specifiers: 1. Life long: since onset of sexual activity 2. Acquired: after period of sexual functioning 3. Generalized: occurs with all types of stimulation, situations, partners 4. Situational: only with certain types of stimulation, situations, partners Severity coded based on distress 1. Mild 2. Moderate 3. Severe
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Premature Ejaculation Symptoms +Treatment
Diagnosis: - Jizzing within one minute of penetration - Happens before person wishes it - Occurs 75-100% of the time Treatment: - Squeeze and stop-start techniques - Female superior position recommended - SSRI's & topical desensitizing agents
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Delayed Ejaculation
Diagnosis: - Marked delay, infrequency, absence of ejaculation - 75-100% of the time
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Erectile Disorder
``` Diagnosis: -One of the three... Can't achieve erection Difficult maintaining erection Decrease in erectile rigidity -75-100% of the time -Rule out: Diabetes MS Smoking Alcohol ``` Treatment: - CBT (Master & Johnson) - Medication (viagra)
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Female Orgasmic Disorder
Diagnosis: - Marked delay, infrequency or absence of orgasm - Reduced sensation of orgasm - 75-100% of the time Treatment: - Sensate focus - Directed masturbation - Kegel exercises
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Female Sexual Interest/Arousal Disorder
``` Diagnosis: -Lack or reduced sexual interest/arousal evidence by ~3 of... Absent/reduced sexual interest A/R sexual thoughts/fantasies Reduced sexual initiation Low receptivity to partners initiation A/R pleasure (75-100% of time) A/R interest/arousal to sexual cues A/R sensation during sexual activity ```
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Genito-Pelvic Pain/Penetration Disorder
Diagnosis: -Recurrent difficulties with 1 or more of... Penetration Pain during penetration attempts Anxiety about pain Tensing of pelvis during attempted penetration Treatment: - Relaxation training - Manual stimulation - Progressive dilation of vagina
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Male Hypoactive Sexual Desire Disorder
Diagnosis: | -A/R sexual thoughts/fantasies/desires
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What substances may impact Sexual functioning? (6)
Substances that can cause it... - Alcohol - Opioids - Sedatives - Hypnotics - Anxiolytics - Stimulants
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Gender Dysphoria Diagnosis Children
-Marked incongruence between assigned gender and experienced/expressed gender -At least 6 of the following... Desire to be of other gender/insistence that they are Preference for cross dressing Preference for cross gender roles in play Preference for activities, toys, games that are stereotypically of the other gender Preference for playmates of other gender Rejection of things that are stereotypically of the same gender Dislike of ones sexual anatomy Desire sex characteristics of other gender Lasts for ~6 months
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Gender Dysphoria Diagnosis Adults 6 Characteristics
-Incongruence between assigned and experienced/expressed gender -At least 2 of the following... Shown in ones experienced/expressed gender and sex characteristics Desire to be rid of ones sex characteristics Want sex characteristics of other gender Desire to BE the other gender Desire to be treated as the other gender Believe that one has feelings/reactions of the other gender
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Gender Dysphoria Etiology
More common in bio males Onset 2-4yo in kids, persistent rates 2-50% Late onset occurs at puberty or later, more common in males
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Paraphilic Disorders Summary
Intense and persistent sexual urges, fantasies, behaviours that involve non-human objects, the suffering of ones self or one's partner, children or other nonconsenting persons It causes distress or impairment to the individual, or whose satisfaction involves personal harm or risk or harm to others Specifiers: 1. In a controlled environment: person living in an institutional setting, opportunities to engage in paraphilia are limited 2. In full remission: has not acted on urges, has not experiences distress or impairment while in an uncontrolled environment
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Voyeuristic Disorder
Diagnosis: - Observing an unsuspecting person who is naked and/or engaging in a sexual activity - Client is 18+ - Must occur for minimum 6 months
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Exhibitionist Disorder
Diagnosis: | Exposing one's genitals to a stranger
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Frotteuristic Disorder
Diagnosis: | -Rubbing or touching a non-consenting person
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Sexual Masochism Disorder
Diagnosis: | -Being humiliated, beaten, bound, made to suffer
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Sexual Sadism Disorder
Diagnosis: | -Sexual excitement resulting from physical or psychological suffering of another
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Pedophilic Disorders
Diagnosis: - Sexual contact with prepubescent child (>13 yo) - Perp must be min 16 years old, and at least 5 years older than the object of desire
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Fetishistic Disorder
Diagnosis: | -Use of non-living objects for sexual gratification
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Transvestic Disorder
Sexually aroused by wearing women's clothing Occurs mostly in men Most of the men identify as het, thought some engage in sexual activity with other men while "cross dressed"
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Personality Disorders Summary
Enduring patterns of inner experience and behaviour that deviates markedly from the expectations of the individual's culture They must have symptoms by adolescence or early adulthood Cause SD & IF Can be diagnosed in minors if symptoms present for >1 yr **Not ASPD** Affects three areas: - Cognition - Affect - Interpersonal functioning - Impulse control
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Cluster A Personality Disorder
Odd, eccentric - Paranoid - Schizoid - Schizotypal
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Cluster B Personality Disorders
Dramatic, emotional, erratic - Antisocial - BPD - Histrionic - Narcissistic
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Cluster C Personality Disorders
Anxiety, fearfulness - Avoidant - Dependent - OCD PD
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Paranoid Personality Disorder Pattern (1) Symptoms (9)
Diagnosis: -Pattern of suspiciousness towards others due to interpreting their motives as malevolent -Must have 4+... Suspects-without evidence-that others are exploiting, harming, deceiving them Preoccupied with doubts about peoples loyalty Reluctant to confide in others in case its used against them Misinterprets benign remarks Persistently bears grudges Perceives attacks on reputation and reacts with anger Unjustified suspicion about fidelity of partner -May be argumentative, complain a lot, hostile aloofness -Interpersonal difficulties
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Schizoid Personality Disorder
Diagnosis: -Pattern of detachment from interpersonal setting -Must have 4+... Doesn't want or enjoy close relationships Prefers solitude Little interest in sexual experiences with another Pleasure in few activities Lacks close friends other than first degree relatives Appears indifferent to praise/criticism Cold, flattened affect -Appears introverted & preoccupied -Social contact may impair work, but they are fine working in solitude
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Schizotypal Personality Disorder Symptoms (10)
Diagnosis: -Interpersonal deficits...discomfort in social situations and reduced capacity for close relationships -Must have 5+... Belief that irrelevant things are aimed at them Odd beliefs that influence behaviours Unusual perceptual experiences (not delusions) Odd thinking and speech Paranoid ideation Inappropriate/flat affect Odd behaviour & appearance Lack of close friends Social anxiety -They may want close relationships, but their behaviour suggests otherwise
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Antisocial Personality Disorder 7 Characteristics
``` Diagnosis: -Pattern of disregard and violation of the rights of others -Occur since ~15yo -History of CD before 15yo -Must have 3+... Not confirm to norms for lawful behaviour Deceitfulness Impulsivity Irritability/aggressiveness Reckless disregard for safety Irresponsibility Lack of remorse -Chronic, but may reduce with age ```
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ASPD Etiology
- Heredity - Family (parenting with high negativity, low warmth, inconsistency) - Personality traits: low empathy, lower than normal autonomic response to threatening stimuli
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ASPD Treatment
Therapies: - Multisystemic therapy: targets chronic violence, substance use. Often done in high risk, out of home placements - Home based family therapies, child-family therapies, CBT interventions
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BPD
``` Diagnosis: -Pervasive instability in: Interpersonal relationships Self image Affect (+ impulsivity) -Symptoms occur in multiple contexts -Must include 5+ Efforts to avoid real/imagined abandonment Unstable interpersonal relationships (idealization to devaluation) Identity disturbance Impulsivity Suicidal behaviours Affective instability Chronic feelings of emptiness Inappropriate anger Transient paranoid ideation/dissociative symptoms ```
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BPD Etiology
- Object Relations Theory (Mahler): issues in the separation-individuation that lead to a fixation; vacillate between need for separation and fear of abandonment; good CG/bad CG - Kernberg: inconsistent parenting that switches from nurturing to avoidant to punitive. This results in splitting - Linehan: pervasive dysregulation caused by biological vulnerability to high emotionality + inability to regular, and exposure to invalidating parenting with inconsistent parenting
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BPD Treatment
DBT very evidence based 1. Group skills training 2. Individual outpatient therapy 3. Telephone coaching
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Histrionic Personality Disorder
Histrionic Horny Harriet ``` Diagnosis: -Pattern of emotionality and "attention-seeking" -Begins in early adulthood -Present in multiple contexts -Must have 5+... Discomfort when not center of attn Inappropriately seductive Rapidly shifting & shallow affect Consistent use of physical appearance to draw attention Excessive impressionistic speech Self dramatization Highly suggestible Considers relationships more intimate than they are ```
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Narcissistic Personality Disorder
``` Diagnosis: -Pattern of grandiosity in fantasy or behaviour -Need for admiration -Lack of empathy -Symptoms present in multiple contexts -Must include 5+... Grandiose sense of self Preoccupation with fantasies of unlimited success, power, beauty Believe they are unique, understood by high status peoples Requires excessive admiration Sense of entitlement Interpersonally exploitive Lacks empathy Envious of others Arrogant ``` -Symptoms cause interpersonal strain
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Avoidant Personality Disorder Pattern (3) Symptoms (9)
Diagnosis: -Pervasive pattern of: Social inhibition Feeling inadequate Hypersensitivity to negative evaluation -Symptoms occur in multiple contexts -Must include 4+... Avoids activities requiring high interpersonal contact (fear of criticism, rejection, disapproval) Unwilling to get involved unless certain they will be liked Restraint in intimate relationships Preoccupied with being criticised/rejected Inhibited in new interpersonal situations Views self as socially inept, inferior Reluctant to take risks -No close relationships outside of immediate family -Long for relationships and fantasize about ideal ones
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Dependent Personality Disorder
Diagnosis: -Pervasive need to be cared for -Submissive, clingy, fear separation -Begins in early adulthood -Occurs in multiple contexts -Must have 5+ symptoms... Indecisive without reassurance from others Needs others to take responsibility for their lives Difficult disagreeing with others Difficulty initiating their own projects Goes to lengths to receive nurturance Uncomfortable/helpless when alone Urgently seeks new relationships when one ends Preoccupied with fear of being left to care for themselves **Must be excessive & not a cultural norm**
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OCD Personality Disorder
Diagnosis: - Pervasive preoccupation with: 1. orderliness 2. perfectionism 3. Mental/interpersonal control - Symptoms result in limited: 1. Flexibility 2. Openness 3. Efficiency - 4+ of... 1. Preoccupation with details/rules/lists 2. Perfectionism interferes 3. Devoted to work and productivity above all else 4. Over conscientious 5. Scrupulous 6. Inflexible morals and values 7. Can't get rid of old items 8. Hesitant to delegate or work with others 9. Frugal spending style 10. Rigidity and stubbornness No obsessions or compulsions. Not related to OCD though they can coexist
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What medical conditions may lead to changes in personality?
Causes: - CNS neoplasm - Head trauma - Stroke - Huntington's - Seizures - Infection (HIV) - Endocrine disorders (hypothyroidism) - Autoimmune conditions (Lupus)
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Disruptive Impulse-Control and Conduct Disorders Summaries
Violate rights of others, low control of emotions, conflict with societal norms or person's in authority ODD, CD, Intermittent Explosive Disorder
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ODD Symptoms Timeline Specifiers
Diagnosis: 1. Pattern of... - Angry mood - Argumentative/defiant - Vindictiveness 2. 4+ in interactions w/ other than siblings... - Loses temper - Easily annoyed - Often angry/resentful - Argues with authority figures - Refuses to comply with rules - Deliberately annoys others - Blames others for mistakes - Spiteful 3. Min 2x in last 6 months 4. Causes distress for others or self 5. Negative impact on individuals functioning Specifiers: 1. Mild-one setting 2. Moderate-two settings 3. Severe-three or more settings
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ODD Etiology
- More common in families with inconsistent parenting style, especially when harsh, inconsistent and/or neglectful - Comorbid with ADHD and CD
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Intermittent Explosive Disorder
Diagnosis: - Recurrent behavioural outbursts - Can't control aggressive impulses - Criteria 1. Verbal/physical aggression 2x week for 3 months OR 2. 3 behavioural outbursts in 12 months that have caused damage of property or physical assault that injured people or animals - Reaction not appropriate to stressor - No premeditation or end goal - Must be ~6 yo
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Conduct Disorder Diagnosis
``` Pattern of behaviours that violate others rights Symptom groups 1. Aggression to people/animals 2. Property destruction 3. Deceitfulness 4. Violation of rules ``` Specifiers: 1. Childhood onset: ~1 symptom >10yo 2. Adolescent onset: no symptoms before 10 yo 3. Unspecified onset: age unknown Childhood onset has most severe symptoms and worst prognosis
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Conduct Disorder Etiology Childhood VS Adolescent Onset
1. Life course persistent path - Symptoms start at 3-4 yo - Increasingly serious transgressions - Combo of: neurological deficits, difficult temperament, hyperactivity, adverse social environment 2. Adolescent-limited oath - After puberty - Due to maturity gap between biological & social maturity - Deviancy is nonconfrontational and inconsistent - Often peer related - Begins to decline in later adolescence
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Conduct Disorder Treatment
Most effective when began in adolescence and has family involvement FFT, multisystemic treatment, parent management trainings
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Within what timeframe must symptoms occur for an illness to be considered substance induced?
Within 1 month of intoxication, withdrawal or taking meds.
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Substance Use Disorder
*Applicable to all substances except caffeine* Diagnosis: - Cognitive, behavioural, physiological symptoms that show client continues to use the substance despite problems - 2+ symptoms for 12 months 1. Impaired control 2. Social impairment 3. Risky use 4. Pharmacological Criterion
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What are the 2 types of remission
1. In early remission: sober 3-12 months | 2. In sustained remission: 12+ months
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Etiology of Substance Use Disorders 3 theories, not factors
1. Incentivization-Sensitization Theory 2. Tension-Reduction Hypothesis 3. Self-Medication Hypothesis
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Relapse Prevention Model for SUDs FEGS
CBT approach focused on the factors that precede relapse - Environmental and emotional factors that may increase relapse - Self monitoring for immediate situation - Global life style changes (i.e. develop positive addictions) - Focus on situational rather than internal reasons for relapse (AVE-abstinence violation effect)
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Substance-Induced Disorders
Substance Intoxication - Reversible, caused by ingestion of substance - Has physiological effects on CNS - Can occur with all substances except tobacco Substance Withdrawal - Substance specific changes due to stopping or reducing heavy use - Doesn't occur with hallucinogens and inhalants
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Alcohol Withdrawal Symptoms
- Autonomic hyperactivity - Psychomotor agitating - Generalized tonic-clonic-seizure - Transient hallucinations
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Alcohol Withdrawal Delirium Symptoms
- Delirium tremens - Disturbance in attention, awareness and cognition - May include vivid hallucinations, delusions, autonomic hyperactivity, agitation
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Alcohol Induced Major Neurocognitive Disorder
- Significant decline in ~1 cognitive domain that interferes with independence 1. Non-amnestic confabulatory type 2. Amnestic confabulatory type - Anterograde and retrograde amnesia - Procedural, LT, WM memory intact. ST impaired -Related to thiamine deficiency
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Opioid Withdrawal Symptoms 10...think flu
- Withdrawal is not life threatening. - Dysphoria - Nausea, diarrhea - Muscle aches - Lacrimation - Rhinorrhea - Piloerection - Sweating - Fever - Yawning - Insomnia
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Sedative or anxiolytic Withdrawal
- Autonomic hyperactivity - Transient hallucinations or illusions - Seizures
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Stimulant Withdrawal
- Vivid, unpleasant dreams - Insomnia or hypersomnia - Increased appetite - May be followed by a crash
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6 Cognitive Domains of Neurocognitive Issues SLEEP C
1. Complex attention (sustained, divided, processing speed) 2. Executive function 3. Learning and memory 4. Expressive and receptive language 5. Perceptual motor 6. Social cognition
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Delirium Symptoms Causes Specifiers (5)
- A disturbance in attention and awareness that develops rapidly over a short period of time - ~1 disturbance in cognition: Memory deficit, Language impairment, Disorientation, Perceptual abnormalities - Must be medical evidence that symptoms are resultant from something physiological Specifiers: - Substance intoxication delirium - Substance withdrawal delirium - Medication-induced delirium - Delirium due to medical condition - Delirium due to multiple etiologies Etiology: age, dementia, depression, male, visual/hearing impairment, dehydration/malnutrition, alcohol, medication, functional dependence, severe illness Triggers: infection, electrolyte imbalance, acute stroke, surgery, pain, withdrawal, some drugs Treatment: education, environment control, haloperidol
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Major and Mild Neurocognitive Disorders
1. Major Neurocognitive Disorder - Formerly dementia - Sig. decline from a prior level of functioning in ~1 cog. domain that interferes with independence - Does not just occur during delirium 2. Mild Neurocognitive Disorder - Modest decline from prior level of functioning in ~1 domain that does not interfere with independence but may require additional effort, compensations Specifiers: - Alzheimers - Frontotemporal lobar degeneration - Lewy body disease - Vascular disease - TBI - Substance/medication use - HIV - Prion disease - Parkinsons - Huntingtons - Other medical condition - Multiple etiologies - Unspecified
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Major/Mild CD due to Alzheimers (symptoms)
- Criteria for mild/major NCD met - Symptoms have insidious onset - Impairment in 1 cog domain for mild, 2 for major 1. Early Stage - Anterograde amnesia (no new memories) - Impaired attn and judgment - Becoming lost - Apathy - Depression - Irritability - Anomia 2. Middle stage - Antero and retrograde amnesia - Problems reading and writing - Inability to remember names, family, etc - Mood swings, personality changes - Sleep disturbance - Fluent aphasia - Restlessness - Difficulty with complex and sequential tasks 3. Late stage: - Severe impairment of most functions - Need daily assistance - Respiratory infection common
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Alzheimer's Etiology and Treatment
Etiology: - Genetic - Structural brain abnormalities - Early onset: chromosomes 1, 14, 21 - Late onset: chromosome 19 Treatment: - Behavioural interventions - Antipsychotics, antidepressants - Cholinestrase inhibitors to enhance cognitive functioning (keeps ACh high). Only helpful in early stages and is temporary - Better outcomes when kept at home
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Vascular Neurocognitive Disorder
- Criteria for mild/major NCD met - Symptoms consistent with vascular etiology - Caused by cerebrovascular disease (affect blood supply to brain) - Not progressive...a stepwise decline with fluctuations - Prevention: hypertension, hypotension, heart disease, diabetes, heavy smoking
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Traumatic Brain Injury
- Critera for major/mild NCD met - TBI with ~1: loss of consciousness, post traumatic amnesia, disorientation/confusion, neurological sign - Onset of symptoms after injury or after regaining consciousness - Symptoms persisted past post-injury period - Processing speed heavily impacted
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HIV Infection Related NCD
-Criteria for mild/major NCD met -Symptoms due to damage in subcortical areas: difficulty learning new things, impaired executive functions, psychomotor slowing, apathy, social withdrawal. decline in IQ Early symptoms: -Forgetfulness -Concentration issues -Mental slowing -Apathy -Irritability -Loss of balance/coordination Later symptoms: - psychomotor slowing - ataxia - tremors
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Prion Disease related NCD
- Criteria for mild/major NCD met - Insidious and rapid progression - Myoclonus: jerky muscle contractions - Ataxia - Biomarker evidence: Creutzfeldt-Jakob Disease is common
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Hypertension Types
1. Primary (essential) hypertension - Age - Obesity - Chronic stress - Family history - Cigarette smoking - High sodium intake 2. Secondary hypertension (related to other disorder) - Kidney disease - Artery blockage - Diabetes - Endocrine disorders - Pregnancy - Sleep apnea Treatment: -Life style changes and medication (anti-hypertensive meds, diuretics, anti-adrenergics, vasodilators, beta blockers, calcium channel blockers, angiotensin-receptor blockers, ACE inhibitors
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Stress Definition
When an individual perceives that the environmental demands tax or exceed their adaptive capacity
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General Adaptation Syndrome to Stress
- Chronic stress = contributor to disease bc cortisol suppresses immune system - People have same physical response to all types of prolonged stress - 3 stages: 1. Alarm (physiological, FFF) 2. Resistance (prolonged stress): pituitary release ACTH = adrenal cortex releases cortisol. Increases blood glucose levels, metabolism of fats and proteins 3. Exhaustion: pituitary and adrenal lose capacity to maintain elevated hormone levels and physical reserves are depleted. Leads to: mental/physical exhaustion, illness, collapse, death
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Transactional Model of Stress
- Events are not inherently stressful or nonstressful, but its how we appraise the event 1. Primary appraisal: relevance of event to wellbeing based on values, beliefs. May be irrelevant (no stress), positive (no stress) or challenging (stress...second appraisal) 2. Secondary appraisal: are my resources/abilities sufficient to cope with this threatening situation? If yes, no stress response. If no, stress response. 3. Cognitive reappraisal: monitors situation and uses new info to modify primary/secondary appraisals. This can increase or decrease the stress response
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Types of Headaches
1. Migraine (classic or common) 2. Tension 3. Cluster (O2 therapy, anesthetic, the usual migraine meds) 4. Sinus headache
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Major Depressive Disorder Symptoms Timeline Specifiers
1. Requires 5+ syptoms (1 must be depressed mood or anhedonia) 2. May also include: - Appetite changes - Weight changes - Sleep changes - Psychomotor changes - Loss of energy - Worthlessness/guilt - Decreased concentration - Suicidal ideation 3. Present every day for ~2 weeks 4. Cause distress + impaired functioning * Children: physical complaints, irritable, social withdrawal * Older adults: looks like dementia 5. May have: anxious distress, congruent/incongruent psychotic features, atypical features (weight gain, hypersomnia, leaden paralysis, rejection sensitivity) Peripartum onset (during pregnancy or 4 weeks post partum) Seasonal pattern Catatonia: catalepsy (holding in odd postures, rigidity of limbs), stereotypy (repetitive non-goal directed movements), mutism
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Prevalence and Etiology of MDD
Prevalence: - 7% 12 month prevalence - Peak onset in 20's - Initially triggered by stress Etiology: - Biopsychosocial - High genetic cause - Neuroticism, ACEs - Catecholamine hypothesis: low NE - Permissive theory: low NE and 5-HT - Stress: high cortisol damages hippocampus
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Seligman's Learned Helplessness Model of Depression
- Repeated exposure to uncontrollable negative life events + tendency to attribute life events to internal structures * Seligman uncontrollably slides down the inside of a volcano*
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Abramson, Metalsky & Alloy Theory of Depression
Hopelessness is the root cause of depression
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Lewinsohn Behavioural Theory of Depression
Low rate of response contingent reinforcement for adaptive behaviours *I'm doing everything right, but everything is still shit*