Flashcards in DSM-V Deck (57):
IQ disability: SDs below mean? Level of severity based on...?
2+ SDsBased on adaptive functioning.
IQ disability: Adaptive functioning areas are x3... Specifiers are...
Conceptual/academic - memory, lang, reading, math etcSocial - empathy, friendship, soc judgmtPractical - $, personal care, task organizationSpecifiers: mild, mod, sev, profound
IQ disability: Etiologies, Genetics (%) v Environment
Environmental factors...pre- 75% from embryonic stage (0-8 wks), mom's health peri 10-15%, virus, hypoxia, nutrit.post natal (10-15% each), hypoxia, tbi, seizure, deprivedGenetic factors = 5% of cases.,
Global Dev Delay:Age restrictionWhy not IQ disability?
Under 5, cannot be reliably assessed = reassess over time.
Unspec. IQ disability
Over 5, cannot be reliably assessed = reasses.
Language Disorder - Age dxd? Speech sound - lifelong? Ch-onset fluency (stutter) - age? recovery? Soc./Prag. comm disorder - what?
Lang D - Age 4+, likely lifelong; SS may not be lifelong; Stutter - normal until age 2; age 2-7 dxd; 65-85% recovery. Soc/Prag comm - probs changing comm to fit context; understanding nonliteral meanings (humor, idioms)
Autism - criteria; m/f ratio, heretability, age onset
a) x context soc. difficultiesb) restricted/repetitive actions inc 2 of: routine, fixated, hyper/hyporeactivityc) presence in early devd) levels: 1 - req sup, 2 substantial sup, 3 very subs.e) w/wo IQ impairmt / lang imp.M:F = 4:1;twins: 35-90% heretabilitysxs at age 2
Only fems; 5-48 mos deceleration of head growth, aut sxs, and poor coord. Then improvement wo aut sxs.
ADHD - %kids/adults; m:f; age criteria; sxs (kids.v.adult) meds? txs? Warnings?
5% kids, 2.5% adults; 2:1 m:f; 6 v 5 - in partial rem if 6mos woRitalin (mthylph); Concerta (methylph), Adderall (amph), Dexedrivne (dextroamph), & nonstim Strattera (atomoxetine)Txs: beh ther, soc. skills, parenting ed, neurofb; CBT for adults. Incr suicide risk esp w mood/conduct/subs disorder
SLD - criteria?prevalence? m:f?
skills 1.5+ SDs (<7th%ile) below expected for age for 6 mos+5-15% prev.; 2-3:1
Motor Disorders - x3 + unspec.; duration criteriaTx?Prevalence; m:f?Comorb dxs?
dev coord (delays in ach milestones)sterotypic mvmt (rep, nonfxl w/wo self inj + severity)Tic = b4 18yo (tourette's >1yr 1st tic; Voc/Motor not both dx; <1yr = provisional)Catapres (clonidine, antihypertensive), Haldol, SSRI (prozac/fluoxetine)5/1000 kids; 2-4:1Dxs: adhd, ocd, sep anx; adult: mdd, subs, bipolar.
Schizoph - severity ratings
assessing primary sxs of psychosis; 5-pt scale for ea sx 0=not present, 4=present and severe
Brief psychotic disorder - dur and specifiers
1 day to 1 month; spec: w/wo marked stressors, w postpartum onset, w catatonia.
Schizophreniform - sxs? duration?
Provisional dx; Same sxs as schzphnia; 1mo - <6mosSpec: w/wo good prog features (2+ of onset of psychotic sx w/i 4wks of beh chg; good premorbid fx, confusion/perplexity, flat affect (depx?).
Schizophrenia - sx criteria? onset? prevalence? concordance?risk?Brains?Txs?
2+ sxs AND 1+ is halls/dels/disorg spch;Onset: late teens and early 30s; median age early to mid20s for men, late 20s for women; Prev: 0.3-0.7%; m:f is equal. Suicide: 5-6% complete, 20% attempt.Concordance: 1st deg rel = 10% (12x); Twins=50%; 2parents=45%; relatives have sxs 8(MRI: enlarged lat+3rd ventricles, smallr cortex+thalPET: decr FL activity (resp 4 neg sxs)Tx: CBT, fam ed (EE preds relapse), soc skills train'g.
Schizoaffective - sxs;specifiers
concurrent mood sxs AND 2+ wks wo mood but w psychotic sxs;Specifiers: bipolar (if any mania even wo depx), depressive types
Other spec/unspec schizph spect and other psych disorder
halls wo other sxs (below threshold for psychosis)
Bipolar - sx dur/crit; manic, hypomanic episode, maj depx episodes
>> rap cycling? melancholy? atypical?
1+ week of "up"; impaired fxg; no min sx dur if hospitlzd.4 days of "up"; doesn't impair fxg and no hospitalization5+ sxs in 2wks; melancholic feats=anhedonia; 3+ of despondency, am depx, am waking, agit/retard, appet/wt loss, guilt.rap cycling=4+ episodes in 12mos w part/full remission for 2+mos OR switch polesatypical=reactivity(to positive events) and 2+ physio sxs
Bipolar I - sx dur/crit, prev., concordance? risk? onset? tx? m:f?
1+ manic epis.; 1% prev., 1:1, risk: higher income; HIGHEST concordance rate (80% twins, 20-25% fraternal/sibs);suicide risk 15x; 25% of all completed suicides.Onset: 18yo; recurrence in 90% ppl; stress = 1st/2nd episodes, not later ones.Tx: lithium, tegretol, depakene (valproic acid); psychoed strong.
Bipolar 2 - sxs crit? onset?
1 depx and 1 HYPOmanic episode - NEVER mania.Onset: mid-20s (later than 1)More fem than males.
2yrs of episodes wo>2mos sx-free. NO MET other mood episode criteria.
Disruptive mood dysreg disorder - onset
Not dxd before 6yo or after 18yo; Sxs pres b4 10yo; No more than 1 day of mania/hypomania sxs.
MDD fun facts -
prev = in b:g prepubertal; 1.5:3 adolescence+55-60% twins; 20% frat/sibs; tx: cog, interpersonal, beh, selfmgmt/ctrl therapies; Beh activation = meds, better than cog for sev depx
Suicide - m:f; age risk
4:1 m:f; women attempts x3:1; 45 to 64yo highest rate; 85+yo next highest; lowest 15-24;ethnic: white, nat amer, highest in western states99% have mental disorder;>risk w/i weeks of hosp dischrg. male, single/livg alone, fam hx of suix, ch pain/illness
Disthymia/PDD - sxs
Depression for 2+ yrs (1yr in kids) wo sx-free for >2mos;NO mania/hypomaniaearly onset=<21yo; late-onset=21+yo
5+ sxs for majority of cycles
Panic Dx - tx, concordance
Panic Control Tx dev by David Barlow
Concordance = 20-30% twins; 0-10% frat (sibs?)
OCD - m/f, risk?
Males = earlier onset (25% b4 10yo); comorb tic.
Fem = >in adulthood.
Suicide higher (ideation in 50%, attempts 25%)
BDD - specifiers
w good/fair insight, poor insight, or absent insight.
+w muscle dysmorphia
Med induced dx
OCD by Sydenham's chorea leading to pediatric acute-onset neuropsychiatric syndrome.
Other-specified/unspec OC and rel disorder
BDD wo repetitive behaviors, obsessional jealousy, and koro (intense anx that genitals are retreating internally towards death)
Trauma: disinhibited soc engagement disorder
developmental age of at least 9mos; persistent >12mos; severe = all sxs & @ high level
PTSD - sx dur? delayed expression? recovery? risk factors?
>1 month sxs; onset 6mos+ after event. ////
50% recover wi 3mos; ///// . Risk factors = prior dx, percvd life threat, dissociation, poor soc supp, female, younger age, lower ses, low ed/IQ, minority status.
Acute stress dx
3 days - 1 month
wi 3 mos of event, remits wi 6mos of stressor termination.
Dissociative Dx - culture? fugue?
"Possession"; too extensive to be explained by forgetfulness. Fugue = w travel/wandering.
Depers/Derealization - why not dissociative?
reality remains intact.
Other spec/unspec dissociative disorder
Prolonged coercive persuasion or acute dissociation.
Somatic sx - risk factors? txs (chronic pain)?
Demos: fem, old, low ed/ses, hx abuse, 2ndary gain . Comorb anx/depx common. TX = CBT/ACT when chronic pain.
Illness Anxiety dx; Conversion dx
6+ mos of sxs; Conversion f:m = 2 to 3:1
feignning or creation of illness WO external incentives ($, not attention tho)
false belief of pregnancy; other spec/unspec somatic sx and rel dxs
PICA and rumination dur, onset
1 mo; rum onset = 3-12mos
Bulimia sev ratings; f:m; risk? tx?
episodes per week: mild (1-3), moderate (4-7), sev (8-13), extreme (14+) [same as binge eating dx] /// 10:1; suicide heightened.
TX = CBT, interpersonal, meds (antidepx: tricyclics, SSRIs); Serotonin is key.
Elimination - enu/encop; age; spec? recovery? tx?
Enuresis = 2x/wk for 3+mos; min age 5yo; noc/diurn/both; 99% recover by adult; TX = urine alarm/bell pad > Tofranil (imipramine) and DDAVP (nasal spray) given relapse. Fam/indvl therapy.
//// Encopresis = 1x/mo for 3+mos; min chrono+dev age of 4yo; Primary = never continence OR secondary = regress.
Hypersomnolence dx - dur and specifiers
sleepy even w 7+ hours of sleep leading to 9+ hrs non restorative sleep or difficulty waking after abrupt waking; 3x+/wk for 3+mos. /// specifiers: acute, subacute, persistent AND sleepiness sev of mild, mod, sev
Breathing dxs - obstruct/central/hypovent; hypopnea
gasping/no obstruction/low respiration,highCO2; hypopnea = shallow breathing.
walking (difficult to alert), terrors (not comforted), nightmares (rapid alert)
Restless leg dur
Sex dxs dur of sxs
Gender Dysphoria - onset, specs
2-4yo w 2-50% persist to adulthood; late onset uncommon in fem.
6+mos of 4+ sxs; spec = mild (1 setting), moderate (2 settings), severe (3+settings)
/// Inconsistent parenting, harsh or neglectful. mf = 1.4:1
Intermit Explosive Dx
2x wk for 3+mos OR 3x w damage wi 12mos; age 6+
Conduct dx - crit, risk factors, tx
3 criteria in past 12mos; mispercv others' intentions as hostile, so feel justified. Difficult baby, parent rejection/neg, harsh inconstnt discipline, abuse, multiple caregivers, institutional, large fams. TX = Parent mgmt training (BT), CBT, multisystemic therapy.
Paraphillic dxs - voyeur, exhibit, frotteur, masochism, sadism, pedo, fetish, transv
6+mos; Voyeur = observing // Exhib = exposing genitals // Frotteuristic = rubbing/touching wo consent // masoch = be humiliated/suffer // sadism = suff of others // pedo = target <14, pt 16+ and 5+yrs older than target. // fetish = nongenital body pt // transv = cross dressing