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Dsm IV TR is?
Symptom based classification
Underscores importance of gender, age, and culture
Multiaxial assessment
Categorical approach
Polythetic criteria sets

Eliminated gender bias
Cultural diff explained
Glossary w cultural info

Tr...changes only to text accompanying dx

Categorical bc either meet or not meet (dimension is 1 to 10). Works best when homogeneous, clear category boundaries, mutually exclusive. So use polythetic criteria or have to meet a sunset of sx, not all.


What are the 5 axis?

Axis I Clinical do;focus of attention
Axis II mr and pd; borderline iq; traits
Axis III. General medical
Axis IV psychosocial and environmental problems
Axis v global assessment of fx
1 to 100 (superior fx)
Rating usually for current eval


Give the degrees of mental retardation.

Mild 50 - 70. 85 percent
Discover late childhood in school
6th grade level of education
Independently live in semi skilled jobs
Moderate 35/40 -50/55. 10 percent
2nd grade. Un or semiskilled w supervision.
Severe. 20/25 - 30/35. 3 or 4 perc
Poor motor. Limited communication .
Elementary hygiene skills.
Close supervision in home or grp home.
Profound. Below 20/25. 1 to 2 perc
Constant aid


What is the most common contributing factor to mental retardation?
A. Environmental influences
B. pregnancy and perinatal
C. Hereditary
D. Embryonic development

A. 15 to 20 percent. Cultural-familial retardation; Lack nurturance; or mental do like autism
B. 10 percent. Malnutrition; HIV;premature; anoxia; injury
C. 5 percent. PKU;Tay saks; fragile x;
D. 30 percent. Downs; prenatal use of alcohol/drugs

30 to 40 percent no etiology.


What is borderline iq?

71 to 84

Mr may be appropriate at the lower end and significant deficits I'm adaptive fx.

Put under other conditions that mAy be a focus of attention.


What are the important dx criteria for autism?

By three..delayed or abnormal fx in social intx, language, or play

6 sx
2 sx re; impaired social fx
1 sx impaired communication
1 sx restricted or repetitive behavior
Half don't speak ; echolalia, reversals in pronouns
Older more interest in others
Perseveration play
4 to 5 timeshare common in males
75 percent codx of mr
Distinct from schizophrenia
No correlation w ses, parent characteristics, education, job, race, religion.
Potential genetic (mono twins hi rate) or neuro factors, rubella, birth probs, hi SE


What is the tx for autism?

Neuroleptics, haloperidol for aggressiveness, lability, withdrawal, stereotyped behaviors. other pharmacological do not work.

Intense behavior intervention. Operant techniques . Reinforce all efforts to communicate.
Best when started very very young, involved parents, use at home, intensive, structured environment, uses contract to delineate changes and methods.

2 percent hi fx
40 percent hi fx

Best prognosis..
Early language skills, overall intellectual ability, disorder severity, usable language by age 7.
Iq alone predicts only worst outcome.
Correlation...developmental milestones, social maturity, time in school and comorbidity neuropsychiatric do

No correlation...birthwt, perinatal, age or onset, normal development before, ses, late development of seizures, type of tx, family mental illness.


What are the important criteria for retts?

Females only
Developmental regression starting at 4.
Seem normal in prenatal and perinatal pd and for last 5 mo after birth.
Usually life long communicative and behavioral problems.
Initial signs...head growth deceleration, loss hand skills, hand washing/ringing , later gait problems, language problems. Within a few years loses interest in social environment . Eventually epilepsy, mr
Cause..genetic mutation


Childhood disintegrative disorder?

Pd of normal development 2 plus yrs
After 2 and before 10
Regression in several areas. At least 2. Language, social or adaptive, bowel/bladder, play, motor

Very rare. But social and communication impairments and behavioral signs look like autism.


Difference between aspergers and autism?

No significant deficit in language, self-help, Cognitive development, or curiosity about the environment.
Better prognosis
Many jobs and self sufficient

More in males as well.


What are the two types of dyslexia?

Surface or orthogonal dyslexia
Ability to read regularly spelled words but can't decipher words that are spelled irregularly. This limits the comprehension of written material.

Deep dyslexia...reading errors including semantic paralexia (response related to the word in meaning but not visually or phonoloically).

Differ from lack of opportunity, bad teaching, cultural factors, mr, pdd, sensory deficit.

Can have ld and mr. Must impede achievement or daily living that require the deficient skill.
Etiology..many..neuro, genetics, malnutrition, iron deficiency, allergies, otitis media , underlying cognitive deficit..


Dx of stuttering.

Usually begins between 2 and 7.

Often tx emotional pressure bc tension may aggravate it.

60 percent of cases it remits by age 16 on its own



Onset before age 7
6 mo
2 settings
Not due to another disorder, including mr

3 to 5 percent meet criteria
10 percent some signs
Many have academic problems
Often behavioral issues start by 3
Often delayed dx, when they start school due to look like normal behavior of kids and more apparent in structured setting.

4 to 9x more males
Co dx...conduct...50 percent
Emotional do...25 percent
Learning do....20 percent
Also social maladjustment, motor uncoordination and visual and auditory impairments.
70 percent show signs thruout life
Adults...childhood hx and 12 sx; often passive aggressive or narcissistic traits develop and recede once treated


Etiology and tx of ADHD?

Biological cause...abnormal frontal lobe, striatum (b ganglia), cerebellum. Part of parietal lobe has problems. Lower glucose metabolism, decrease bld flow, smaller corpus collosum, globus pallidus, caudate nucleus (this one smaller it is worse on inhibition)
Genetics..offspring of parent 57 percent.
5 to 10 percent implicated in minimal brain dysfx ..normal iq..mild to severe behavior probs, perceptual motor probs, memory probs, EEG abnormalities.

Tx...CNS stimulants
Low dose..improve attention
Hi dose reduce activity level, improve social (not at peer level)
Cognitive and behavioral interventions
Young...contingency mgmt
Older ...self monitoring, self talk
Parents participate..rules, structure
Positive reinforcement w punishment (response cost) and tangible rewards.


What is the behavioral disinhibition hypothesis?

Barkley proposed this way of viewing ADHD that suggests the essence of ADHD is a lack of ability to adjust activity levels to the requirements of different settings , not attention deficits.

Came about because some can attend in certain situations and not others. Overall, attention problems in full, repetitious, familiar, very structured and:or irregular reinforcement situations..
Seem to have trouble reducing and increasing their activity level.


Ritalin or methyphenidate has what side effects?

Somatic sx..decrease appetite, insomnia..mild. Change does or administration

Movement abnormalities...tics
30 to 70 percent
Don't use if have Tourette's

Obsessive compulsive sx.
30 to 50 percent.. Reduce dose

Growth suppression


Conduct do

3 or more signs for 12 mo
At least 1 sign in last 6 mo
1 sx before 10 yrs if childhood onset
After 10 for adolescent onset..less severe prognosis; more linked to peers

Below peers on verbal subtests not nonverbal
Associated w nicotine, drug, alcohol
Majority it remits
Others move on to antisocial pd

Related to biology...low levels of arousal; genetics; environment
Tx..multi systemic tx. Long term decrease in criminal behavior by working on social network..use family tx and parent training . Best tx before teens and includes parent education



Ingested on a persistent basis for 1
Onset 1 to 2 years
Remits early childhood.
May go to adolescence
Associated w mental retardation


Rumination disorder

3 to 12 mo
After period normal development
Regurgitate and rechew for at least one month after a period of normal fx
Mortality 25 percent


Feeding do of early infancy
Failure to thrive

Chronic failure to eat enough
Wt loss or failure to gain for at least one month
Onset before 6 years, usually 1st yr

Malnutrition can develop
Most eventually gain wt

General medical condition, mental do, or lack of available food are ruled out..


Tic do

Tourette's onset in childhood. B4 age 18.
Less 10 percent vulgar
Tics must occur multiple times a day, almost daily, for at least one year.
No more than 3 mo without tics
Chronic but may remit for brief pds

Often coexist w obsessive and compulsive behaviors, ADHD, ld, depression, social probs

Most co occuring w ADHD. Even don't meet dx often have attention and over activity that interferes w academics. Same iq range as pop
Tx..school interventions, meds (haloperidol and pimozide anyipsychotic that r fast acting; clonodine..fewer side effects; reduce ocd w antidrpressants), family tx, individual tx

Chronic motor or vocal tic
Do...one or more tic. Only 1 kind. Sx and impairment less severe.


Enuresis vs encopresis

Age 4 plus or develop age equivalent
Voluntary or intentional
1 x per mo for 3 mo

Age 5 plus
2 x per week for 3 mo or marked distress or impaired fx
Most bladder fx by 3. Daytime wetting higher chance of physical problem
More in males at age 5 (7 vs 3 percent). Difference shrinks w age
Think due to late mature fx plus self esteem and motivation
Bell and pad best long term result
Meds Antidepressants. Sterm use
Hypnosis..less expensive and gives power
Diurnal or awake or nocturnal


Separation anxiety do vs reactive attachment do

Separation anxiety do
4 weeks in response to separation from home or attachment figure
Somatic complaints
Fantasies of danger
School phobia can be a sx (ESP if develops between 5 and 7; start in adolescence it is depression)
Causes..overprotection, insecurity due to trauma, dependency issues
Tx..individual, family tx; behavioral interventions

Reactive attachment do
Before 5
Inhibited...fail to initiate or respond in age expected way in most social situations
Disinhibited..indiscriminate sociability Too familiar

Pathogenic care...chronic neglect, multiple caregivers..


Fetal alcohol syndrome
What structures impacted?

Basal ganglia, hippocampus, frontal lobes most effected

Also cerebellum, corpus collosum, hypothalamus

Ave iq is mild mr. 68

No effects at less than 2 drinks per day...


SIDS. Occurrence and causes

5 in 10,000 births
3rd most frequent cause of death for infants one mo and 1 yr

Constitutional factors complicated by adverse perinatal conditions

Respiratory difficulties, apnea, at birth, low birth wt, shorter body length


What criteria need to be met for mental do due to a general medical condition?

Personality change due to medical

Catatonic do due to medical

1. Do due to direct physiological consequence of a general medical condition. 3 factors to consider:
Onset together in time
If signs rep primary mental do or are
If medical condition produces such sx
2. Mental disturbance can't be better explained by another mental do
3. Can't occur during delirium.

Personality change.. Due to direct medical condition
Cause marked distress or impairment and depart from usual
Aggression, impulse etc out if proportion to trigger,
Different types...labile, aggressive, disinhibited, apathetic, paranoid, unspecified, combo
Causes...CNS neoplasms, cerebrovascular disease, Huntington's, epilepsy, HIV, endocrine probs

Catatonic due to medical
Head trauma, cerebrovascular, encephalitis, metabolic

Record medical condition on axis 1 and 3.


Substance induced disorders

Can develop during intoxication, withdrawal, or long after

Substance intoxication...includes maladaptive behavioral or psychological changes and specific signs of the substance effects on the CNS.

Substance withdrawal ...result of reducing or terminating use; associated distress or impairment. Develop w in few hrs or days
Usually associated w dependence
Differential dx..hx, timing of drug use and sx onset, if sx atypical
If psychotic do ruled out, dx of intox and withdrawal are sufficient to account for most presentations where sx caused by substance. If in excess of what is usually associated w intox or withdrawal then gets independent class sunstance induced psychotic do

Hallucinogen persisting do
Flashbacks. First when using then when not.


Or has Huntington's and significant personality change. Mental do due to Huntington's ?
A. Change just after dx
B. personality change and dx related thru physiological mechanism
C. Nature and duration do not meet personality do dx
D. No evidence use substances.

B. by definition due to direct physiological consequences of the medical condition


Signs of mania after use if cocaine. Which inclined to dx of cocaine induced mood do?
A. Sx typical during cocaine intox
B. hx of hospitalizations due bipolar
C. Used only small amt of cocaine
D. Manic sx severe enough to require hospitalization.

D. Differential of primary mood do, cocaine intox, cocaine induced mood do.

D allows for dx because the mood sx are significant enough to warrant independent clinical attention


All of the following are true about mental do due to a general medical condition except:
A. Dx whenever mental sx connected by a physical factor
B. sometimes emerge years after medical condition
C. Involve variety of diff sx
D. Name condition on axis 1 and 3

A. Need more than a physical sx. Must be evidence that they are a direct physiological consequence of medical condition.