Everything Else Flashcards
(169 cards)
1
Q
What is a problem with DSM 4 classification?
A
Assumption that each disorder is separate
Often we see comorbidity
2
Q
What is the goal of DSM 5?
A
Prognosis based on individual rather than testing
3
Q
What are some criticisms of DSM-5?
A
- lacks transparency
- conflict of interest
- ## lack of outside input
4
Q
What is the Bereavement exclusion?
A
No exclusion of diagnosis for 2 months
- now you can diagnosis something directly after a situation occurs (like depression after a loved ones death)
5
Q
For something to be diagnosed what criteria must be met?
A
- symptoms - patterns of cognition and behavior subjectively reported
- signs - patterns of cognition and behavior objectively observed
- timing - symptoms and signs present at a certain frequency
- impairment - in two or more realms
6
Q
How many major diagnostic classes are in the DSM-5?
A
19
7
Q
What is body integrity disorder?
A
Wanting healthy limbs cut off because “it feels right”
8
Q
What is the official coding system?
A
Not DSM 5
- international classification of diseases, clinical manifestation (ICD-9-CM)
9
Q
When must ADHD be presented?
A
- Before age 12
- 2 or more settings - academic, social, family
- 3-5% of school aged children have ADHD
10
Q
What are the two types of ADHD?
A
- inattentive: focus and organize
- hyperactive/impulsive: loud and interruptive
11
Q
Where does inattentive ADHD present most?
A
In girls
12
Q
What are things that cause ADHD?
A
Genetics, in utero exposure (nicotine, alcohol, cannibis), notochord trauma, frontal lobe trauma (heavy metal exposure),
13
Q
What are some comorbidities of ADHD?
A
Learning disabilities ODD Anxiety disorders Mood disorders Psychotic
14
Q
What can TICS be confused for?
A
ADHD
15
Q
What is a function problem in ADHD?
A
The executive function is significantly lower than IQ
16
Q
What are some things you rule out before diagnosing ADHD?
A
- Neuro seizures
- Tourette’s
- migraines
- endocrine
- diabetes
- drugs
- sleep disorders
17
Q
What may “i can’t play video games all day long” indicate?
A
ODD or learning disorder
18
Q
What may “video games are boring” indicate?
A
ADHD
19
Q
What are some tests for ADHD?
A
Wisconsin card sorting test
- working memory and processing speed
20
Q
What is cloninger “dimensions?”
A
It describes personality
- increased risk taking
- decreased harm avoidance
- reward dependance
- only ADHD
21
Q
What are the stages of ADHD treatment?
A
- Stage 0: adjunctive - special ed if with learning disabilities. Parent education. Behavior modifications. Individual therapy.
- Stage 1: methylphenidate (Ritalin) or amphetamine
- stage 2: Ritalin, adderall, focalin (continuous-concerta)
- stage 3: atomoxetine
- stage 4: atomoxetine plus stim
- stage 5: TCAs
- stage 6: alpha agonist (2) BP meds to calm - little focus
22
Q
What are two last stage ADHD meds?
A
Alpha agonists
Clonidine
Gaunfacine
23
Q
What drug can cure both ADHD and anxiety?
A
Atomoxetine
24
Q
How do you treat ADHD with tic disorders?
A
1: stim mono therapy
2: stim and alpha agonists
3: add atypical antipsychotic
4: add pimozide or haloperidol
25
How do you treat ADHD with aggression?
```
ADHD
Stim
Atypical stim
Lithium or divalproex
Add both
```
26
How do you treat ADHD with chemical dependency?
- chemical dependancy
- strattera vs bupropion
- treatment with urine testing
27
What are the most common comorbidities of PTSD?
* ODD
- depression
- anxiety
- substance abuse disorder
28
What is reactive attachment disorder?
- emotionally withdrawn behavior toward adult caregivers
- a persistent social and emotional disturbance
- child has experienced a pattern of extremes of insufficient care
- event before age 5 at least 9 months
29
What is disinhibited social engagement disorder?
- overly familiar behavior with relative strangers
| - childhood disorders
30
What is ASD?
Acute stress disorder
- pre PTSD
- 3days- 1 month
31
What is criteria A for PTSD?
How the event is experienced
- directly experiencing
- witnessing in person
- learning an event happened to someone close
- repeated exposure to aversive details (1st respon)
32
What are the four symptoms of PTSD? (Criteria B-E)
B: intrusive symptom (dreams, flashbacks)
C: avoidance of reminders
D: neg alterations in cognition and mood (depress)
E: alterations of arousal and reactivity (hyper vigilance, sleep probs)
33
What is criteria F of PTSD?
Duration
Must persist at least a month
34
What is criteria G of PTSD?
Distress - in social and occupational life
35
What are the specifies for PTSD?
Acute - within 3 months of event
| Chronic - after 3 months
36
What are the criteria for PTSD?
```
A: how it is experienced
B: intrusive symptoms
C: avoidance
D: neg alterations in cog and mood
E: alterations in arousal and reactivity
F: duration
G: distress (social and job)
```
37
What is the major change in the DSM-5 for PTSD?
Sexual assault is specifically included (also recurring exposure like first responders)
38
What is the evaluation of PTSD?
```
15-1hr if needed for legal claims
- use DREAMS
D: detachment
R: re experiencing event
E: emotional effects
A: avoidance
M: month of duration
S: sympathetic hyperactivity of vigilance
```
39
What is the biological basis for PTSD?
NE: fear, flight response, sympathetic activation, arousal, hyperactvity, (too much)
5HT: self defense, rage and attenuation of fear
(Too little): aggression, violence, depression, anxiety, impulsive
40
What is the lifetime prevalence of PTSD?
7.8% up to 12%
10.4% for women
5% for men
41
What is the PTSD risk by event?
Rape-49
Severe beating/assault-31.9
Other sexual assault-23.7
42
What is the prevalence by gender of PTSD?
Men: rape, combat, childhood neglect, childhood abuse
Women: rape, sexual molestation,physical attack, weapon, childhood physical abuse
43
What are some risk factors for ptsd?
Women: anxiety and depression,
Men: irritability, impulsiveness, substance abuse
African Americans and Hispanic war vets
44
What is the comorbidity of PTSD?
80%
- anxiety
- affective (MDD, bipolar)
- depression and mania are more likely to occur
45
What is the rate of suicide for PTSD Pxs?
20%
46
What are the three types of stress injuries in PTSD?
- traumatic stress is due to horror or terror
- operational fatigue is due to accumulation of stresses over time
- grief is due to loss of important friends or leaders
47
What is the trauma transmission model?
Partners use sympathy and empathy
| Results in realistic experience
48
What percent of partners of military members with PTSD have significantly higher clinical levels of relational distress?
71% compared to 36% without a partner with PTSD
49
What are the two types of therapies for PTSD?
Exposure: education to common rxns to trauma, repeated exposure to past trauma
Cognitive: separating the intrusive thoughts from associated stress and anxiety
Also stress inoculation - variant of exposure training
50
What medications do you use to treat PTSD?
SSRIs and TCA
51
What percent of soldiers need mental health assessment and get care?
33% need it
Only 12.5% get it
More likely to contact a medical professional
52
What is the difference between the percentage of PTSD Pxs who go to their behavioral health specialist?
44% go if reffered
| 76% go when introduced
53
What is the symptom experience of PTSD and when should he have therapy?
- on and off symptoms
| - therapy 1 month or sooner and then every 3 months
54
What is a problem with professional training with relation to PTSD?
They aren't trained to assess for psychosocial difficulties
55
What is the assessment tool used to assess neuro development?
Ages and stages questionnaire (ASQ-3)
| Completed by parents in 10-15min
56
How do you diagnosis a neuro developmental disorder?
- individualized intelligence testing (score below or at 70 +\- 5)
- multiple low function in normal life
- onset of intellectual and adaptive deficits
57
What are the adaptive functioning severity domains?
Conceptual - symbolic thought, reasoning, problems
Social - awareness of others, empathy, communication and friendship skills
Practical - learning and self-management skills
58
What is the overall general prevalence of intellectual disability?
1%
| 6 in 1000 for severe
59
What is the gender ratio of ASD?
4:1
60
What is the prevalence of ASD?
1%
| 1 out of 68 people in the U.S.
61
What are the diagnostic criteria for ASD?
- persistent deficits in social communication and interactions
- restricted repetitive patterns of behavior, interests, and activities manifested by at least 2 of the following: repetitive motor movements, insistence and sameness, fixated interests, hypo or hyper reactivity to sensory input
- early development
- clinically sig impairment in areas
- disturbances are not better explained by intellectual disability
62
What is the treatment of ASD?
- behavioral treatment and management (ABA)
- specialized therapies
- child and family therapy: social play, and to support family
- meds: according to conditions and behaviors
- local community resources
- web
63
What is Yerke's Dodson anxiety-performance curve?
A curve showing the spectrum of anxiety disorder
psychotic symptoms can be normal
64
What is the hallmark of panic disorder?
Fight-or-Flight response
Feel they are losing control
Can feel like an MI
65
What is the epidemiology of panic disorder?
1.5% lifetime prevalence
4:1 women:men
Late teens - early 30s
3.5% general pop
6-10% primary care
30-50% cardiology
66
What is the epidemiology of social anxiety disorder?
3-13%
16 years
20% report fear of public speaking
67
What are the most common obsessions of OCD?
Contamination and violent images
68
What are features of compulsions seen in OCD?
Ritualized behaviors to alleviate obsessions
- recurrent
- Px recognizes these are unreasonable
69
What is the prevalence of OCD?
Lifetime: 2-3%
| One year: 1.5-2.1%
70
What are comorbidities of OCD?
Depression and panic disorders
71
What is the little Albert experiment?
Loud noise conditioned to other things
72
What is the behavioral model of anxiety?
Two factor learning theory
- neutral and anxiety stimulus paired
- avoidance of neutral seems good
- associative learning
73
What is the behavioral model of OCD?
Obsession: pairing mental stim with anxiety provoking thoughts
Compulsion: neutral behaviors to relieve obsessions
Cycle: obsessions-->anxiety-->cumpulsion-->relief-->repeat
74
What is the cognitive model of panic?
Trigger--> perceived threat--> apprehension --> body sensations --> interpretation of sensations as catastrophic
75
What are factors of OCD?
Concordance in identical twins is 75%
| 32% in non
76
What neuro chemistry disorder is a risk factor for anxiety?
GABA dysfunction
Activation will help (benzos)
Blocking increases panicogenic effect (caffiene)
77
What is wrong with 5HT in OCD?
```
Too little (mostly stim)
High rates of metabolism in CSF
```
78
What does CRH have to do with anxiety?
Central stress signature
| Hypothalamus
79
What does adenosine have to do with anxiety?
Receptors are anxiolytic similar to GABA
Relief of stress
Blocking can induce panic
80
What other things are anxiolytic?
Neuropeptide Y and endogenous opioids
81
What do lactate and co2 do?
Can increase anxiety
82
What is TKS mostly concerned with?
Px is concerned about doing something, or presenting an appearance, that will offend or embarrass the other person, compared to oneself as in SAD
Males:females - 3:2
83
What are the four types of kyofu in TKS?
Fear of blushing
Of a deformed body
Or eye-to-eye contact
Of ones own foul body Oder
84
What are some concerns in the LBGTQ community?
Major depression
GAD
Substance abuse or dependance
Men- panic attacks
Women- GAD
85
What percent of rape victims experience depression?
30%
- Compared to a normal 10%
- 33% of rape victims have serious thoughts of killing themselves as opposed to 8% normal
- 13X more likely to commit suicide
- 13.4X more to alcohol
- 26X more for substance abuse
86
What are physicians required to do in mn in regard to child abuse?
Report it, not diagnosis
87
When are you required to report child abuse?
When suspected
88
What is child abuse an expression of?
Family pathology
89
What percent of abused children become violent adults?
33%
90
What are the gender differences of child abuse?
Women - physical (54%)
| Men - sexual (75%)
91
When does child physical abuse occur?
Usually at a younger age than sexual abuse
92
What are bruises on padded areas considered?
Inflicted injuries until proven otherwise
Bruises over bony prominences are not bad
93
What are the behaviors of children who are abused?
Extreme
| Aggressive or withdrawn
94
What can be evidence of inflicted injuries?
Burns, bruises, welts, fractures, lacerations, and failure to thrive
95
When does child sexual abuse usually occur?
5-7
Usually ending at 13
At every socio economical level
96
What is true of sexually abused children?
They believe they caused the abuse
Poor self esteem
They learn to separate from their emotions to cope
97
What is the epidemiology of sexual child abuse?
1/4 females
1/7 males
Before 18
98
What is Diathesis?
Genetic substrate + huge environmental component
99
What is key of conduct disorder?
Lacks empathy
100
What are behaviors of conduct disorder?
- aggression toward animals and people
- destruction of property
- theft or deceit fullness
- serious violation of rules
Presence of 3 or more in the past 12months, 1 in 6months. Usually before 13
101
What is the gender differences in CD?
- 9-10% in boys, 3-4 in girls
- male predom in adolescence
- closer by age 15
- less outward in girls
- indirect aggression is more common in girls
102
Who was Malala Yusufzai?
given CD but organized women to stand up against Taliban
Diagnosis depends on the situation, some may be trying to break down injustice
103
What is treatment of CD?
Multi systemic family therapy (MST)
- home based model
- low case load, available 24/7
- understand
- build on strengths
-
104
What is the criteria for Oppositional Defiant Disorder? (ODD)
Negative and hostile behavior lasting at least 6 months with at least 4 of the following present
1: temper
2: argues with adults
3: defies
4: annoy on purpose
5: blames others
6: angry and resentful
7: touchy
8: spiteful
105
What disorders must be ruled out for behavior related aggression?
1st: Antisocial personality disorder (if above 18)
2nd: CD
3rd: ODD
106
What % of children with ODD go on to have CD and to ASPD?
25% to CD
| 25-40% to ASPD
107
How do you treat ODD?
Under 12 - parents
Positive parenting program - population based intervention
Problem-solving communication training - identify and rank family disagreement and solve one per session
108
What does effective parenting of ODD look like?
Early!
- attention and praise with short commands
- ignore bad behavior
- do tokens for compliance (6-8 remove for bad)
- early is good because progression is costly
109
What are criteria for substance related disorders in adolescents?
1. Recurrent substance result in failure in life
2. Use in hazardous situations
3. Legal problems
4. Continued use despite having problems
- 2-3 of these in a 12 month period
110
What is are the three leading causes of adolescent mortality associated with substance abuse?
Motor vehicle accidents
Homicide
Suicide
111
What is the percent of alcohol and smoking by 18yrs?
80% have drank
33% have smoked
50% used an illegal drug
112
What is CRAFTT?
Assesses SUD especially with young people
- Car
- Relax
- Alone
- family/friends
- Forget
- Trouble
113
What are some comorbidities of SUD?
- CD precedes 50-80%
- ADHD in SUD and CD
- mood disorders (depression)
114
What is the treatment of SUD?
MST
CBT
Motivational interviewing (MI)
MEP
115
8.9mil adults had mental illness and SUD, what percentage did not receive treatment?
55.8%
32.9% received mental health
Only 3.8% for SUD
116
What is a risk factor for mental illness?
Drug abuse - alters the brain as a result of chronic use
117
What NT is high in schizophrenia and how is this pertinent to drug abuse?
- dopamine, drugs increase this
| 80% of schizophrenics use tobacco --> regulate DA
118
What behavior does ketamine increase?
Antisocial behavior
119
What do SUDs increase the risk for in adolescents?
Development of psychiatric disorders
However it also goes the other way
Also genetic and environmental factors
120
How do you treat comorbid Pxs of SUD and psychiatric disorders?
At the same time.
| But you can delay treatment 4weeks to determine the cause, which came first
121
What is sertraline used for?
Psychotherapy
| However, doesn't work with methadone but does for depression
122
Why in studies is there such a high improvement of depression with placebo in substance abuse Pxs?
Because substance may have caused depression
123
What percent of schizophrenics have SUD?
50%
124
What is the treatment of schizophrenia and SUD?
- DA antagonists: haloperidol, fluphenazine
- 5HT/DA receptor antagonists: Clozaril
- naltrexone: in EtOH dependance and schizophrenia
125
How can you treat anxiety disorders?
SSRIs without SUD
126
What can Buspirone be used for?
GAD/alcoholism
Use B for AA (anxiety and alcoholism)
127
What can paroxetine be used for?
Social phobia/alcoholism
128
What can sertraline be used for?
PTSD and alcoholism
129
What are the criteria for MDD?
5 or more symptoms persistent for 2 weeks
- persistent sadness
- loss of interest
- weight changes
- sleeping problems
- agitation
- no energy
130
What is persistent depressive disorder?
Depressed mood for at least 2 years (1 in children)
| Plus others: over/under eating, low energy...
131
What are bipolar 1 and 2?
1: mania 7days
2: hypo mania 4 days
132
What is disruptive mood deregulation disorder?
- intent to distinguish children with mild mood dys regulation from bipolar
- most do not develop bipolar
- may develop anxiety or depression as adults
-
133
What are criteria of DMDD?
Onset before 10 restricted to 6-18
- temper outbursts recurrent
- temper outburst inconsistent with age
- temper outburst 3 times a week
- mood between outburst persistently irritable or angry
134
What is the epidemiology of adolescent depression?
5% ages 9-17
| 3% for dysthymia
135
What are some comorbidities for adolescent depression?
Eating disorder in girls
ADHD
Cd
136
What meds should be used for treatment of adolescent depression?
For severe use SSRIs
TCAs should not be used
Be maintained for a year, if on add or ADHD watch closely
137
What are non med therapies for adolescent depression?
CBT - identify negative feelings and link the, with outside world
138
What drugs are best and worse for suicide in adolescents?
Prozac is best (fluoxetine)
| Effexor is worst (Venlafaxine)
139
What is the black box warning on depression meds for adolescents?
May increase suicide chance
140
How often do you watch kids on anti depressants?
- First weekly follow up for 4 weeks
- then biweekly for a month
- then quarterly
141
What are common side effects of SSRIs?
```
Restlessness
Dizziness
Drowsiness
GI distress
HA
Tremor
```
142
What are finding of TADS?
Combined treatment accelerates benefits
- at 12 weeks: 71% both, 43% CBT, 61% Prozac.
- Treating Pxs longer makes a big diff (6month)
- fluoxetine leads to sx lessening
143
How do you interview for suicide?
Be direct, available, interested. Listen
No judgement or shock
Don't reassure
Don't be secret
144
What percent of adolescent mothers get PPD?
56% for up to 4 years
| Higher than if they waited until 20
145
What is the DSM-5 definition of personality disorders?
- enduring meal adaptive patterns of behavior
- deviating markedly from those accepted by culture
- patterns develop early and are inflexible and are associated with significant distress or disability
146
What is Baldes definition of a personality disorder?
- people problems
- no personality with others around
- dimensional personality problems not categorical contradicts DSM-5
- imagine what it's like to be that person
147
What are the three clusters of personality disorders?
Cluster A - weird
Cluster B - wild
Cluster C - worried
148
What disorders are in cluster A?
Weird - largely heritable
1. Paranoid: threat detector is over active
Distrust, early adulthood, suspects, unjustified doubts, unwarranted fear, bears grudges,
2. Schizoid: basement boys, not psychotic just disconnected from reality, detachment, coldness, no interest in sex
3. Schizotypal: mild schizophrenia, social and interpersonal deficits, distortions, eccentricities of behavior, early adulthood, ideas of reference, odd beliefs, magical thinking, social anxiety
149
What are wild personality disorders?
```
50/50 causes
Borderline
Narcissistic
Antisocial
Histrionic
```
150
What is borderline personality disorder?
Best chance to intervene positively
- women > men
- instability of interpersonal relationships, self image
- avoid real or imagined abandonment
- unstable relationships
- suicidal or self mutilating behavior
- feelings of emptiness
- inappropriate intense anger
- stress related paranoid ideation
- dialectical behavioral therapy: works, individual therapist, emotional skill management
- I hate you, don't leave me. Makes sense to them
151
What can cause antisocial PD?
Abused as a child
152
What is antisocial PD?
- disregard for and violation of the rights of others
- no social norms
- deceit fullness
- impulsivity
- aggressiveness
- reckless disregard for safety
- irresponsibility
- lack of remorse
153
What is Histrionic PD?
- a pervasive pattern of excessive emotionally and attention seeking
- center of attention
- sexually seductive
- emotionally shallow
- self dramatize
- is suggest able
- consider relationships to be more intimate than they are
154
What are worried PDs?
Heritable but developmental environment is key
155
What is avoidant PD?
- the world is dangerous respond by internalizing
- hypersensitive, inadequacy, social inhibition
- unwilling to get involved with people
- mostly is a view of self disorder not disinterest
- psychotherapy can help
156
What is dependent PD?
- needy
- submissive, clingy, follower
- uncomfortable or alone
157
What is obsessive compulsive PD?
- perfectionism
- control
- unable to complete a project
- inflexible
- reluctant to delegate
- unable to disregard worn out items
- rigidity or stubbornness
158
What is the natural history of BPD?
Mania: 1wk - 6mo
| Major depression: 4wks - 2yrs
159
What protein has been implicated in BPD?
BDNF - a neuropeptide
| Val66Met polymorphism
160
What are some brain abnormalities of BPD?
- low inferior frontal cortex and Ventrolateral prefrontal cortex
- limbic hyperactivity
161
What meds are proven to have anti suicidal effects?
Clozapine and lithium
162
What is activation syndrome?
Side effect of SSRIs or hypo mania
| - agitated
163
What are the three mood stabilizers?
Lithium carbonate
Divalproex sodium
Carbamazepine
164
What are the three primary algorithms of BPD treatment?
1. Tx of acute mania: mono therapy with lithium perhaps dual, later clozapine
2. Tx of acute/chronic depression: lamotrigine--> quetiapine--> antidepressants
3. Maintenance: lithium
165
What is key of BPD tx in children?
No controlled studies
| Lithium --> dual --> tri --> combination
166
What is Ross Greens's approach to behavior used for?
Emotionally labile children
167
What is the concordance of schizophrenia?
50% between monozygotic twins
168
What are some candidate genes for schizophrenia?
Dysbindin - glutamate and mem stab
Neuregulin-1 - migration, glial diff, myelin
COMT - monoamine metab
169
What infection is schizophrenia most related?
Influenze during second trimester
