Midterm (DSM)

Question 1

Bipolar - Etiology

Answer 1

Diathesis-Stress Model

Heritability is high: 60-85%

• 10-25% chance of having bipolar if one parent has it
• Shared genetic origin with schizophrenia

MRI studies

• Prefrontal cortex smaller and functions less well
• Reduced grey matter
• Demyelination in white matter

Question 2

Hallucinations

Answer 2

a false sensory perception that occurs in the absence of an external sensory stimulus

involuntary, appear real

auditory or visual hallucinations are most common

a person must be awake and fully alert to experience a hallucination

-hypnaogic or hynopompic (waht we see or hear when we’re falling asleep) are normal and are not hallucinations

Question 3

Autism Spectrum Disorder - Specifiers

Answer 3

With or without accompanying inteliectual impairment

With or without accompanying language impairment
-without language was aspergers

Associated with a icnown medicai or genetic condition or environmental factor
-Used to be Retts and CDD

Associated with another neurodevelopmental, mental, or behavioral disorder

With catatonia

Question 4

Autism Spectrum Disorder - Differential Diagnosis - Stereotypic movement disorder

Answer 4

Motor stereotypies are among the diagnostic characteristics
of autism spectrum disorder, so an additional diagnosis of stereotypic movement
disorder is not given when such repetitive behaviors are better explained by the presence
of autism spectrum disorder. However, when stereotypies cause self-injury and become a
focus of treatment, both diagnoses may be appropriate.

Question 5

ADHD - Differential Diagnosis - Other Neurodevelopmental Disorders

Answer 5

The increased motoric activity that may occur in
ADHD must be distinguished from the repetitive motor behavior that characterizes stereotypic
movement disorder and some cases of autism spectrum disorder. In stereotypic
movement disorder, the motoric behavior is generally fixed and repetitive (e.g., body rocking,
self-biting), whereas the fidgetiness and restlessness in ADHD are typically generalized
and not characterized by repetitive stereotypic movements. In Tourette’s disorder,
frequent multiple tics can be mistaken for the generalized fidgetiness of ADHD. Prolonged
observation may be needed to differentiate fidgetiness from bouts of multiple tics.

Question 6

Persistent (Chronic) Motor or Vocal Tic Disorder Criteria

Answer 6

A. Single or multiple motor or vocal tics have been present during the illness, but not both
motor and vocal.

B. The tics may wax and wane in frequency but have persisted for more than 1 year since
first tic onset.

C. Onset is before age 18 years.

D. The disturbance is not attributable to the physiological effects of a substance (e.g., cocaine)
or another medical condition (e.g., Huntington’s disease, postviral encephalitis).

E. Criteria have never been met for Tourette’s disorder.

Specify

• with motor tics only
• with vocal tics only

Question 7

Delusions

Answer 7

A strongly held false belief that remains unchanged, despite evidence to the contrary

Several types

• Persecutory
• Referential
• Grandiose
• Erotomanic
• Jealous
• Nihilistic
• Somatic
• Thought control
• Passivity

Bizarre (non-possible) or nonbizarre (improbable but possible)

Question 8

Major Depressive Epidsode - Criteria

Answer 8

A. Five (or more) of the following symptoms have been present during the same 2-week
period and represent a change from previous functioning; at least one of the symptoms
is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly attributable to another medical condition.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective
   report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g.,
   appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the
   day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than
   5% of body weight in a month), or decrease or increase in appetite nearly every
   day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others; not
   merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional)
   nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either
   by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without
   a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or another
medical condition.

Note: Criteria A-C constitute a major depressive episode. Major depressive episodes are
common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.

Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a
natural disaster, a serious medical illness or disability) may include the feelings of intense
sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion
A, which may resemble a depressive episode. Although such symptoms may be understandable
or considered appropriate to the loss, the presence of a major depressive
episode in addition to the normal response to a significant loss should also be carefully
considered. This decision inevitably requires the exercise of clinical judgment based on
the individual’s history and the cultural norms for the expression of distress in the context
of loss.

Question 9

Schizophrenia - Differential Diagnosis - Schizophreniform Disorder and Brief Psychotic Disorder

Answer 9

These disorders are of shorter
duration than schizophrenia as specified in Criterion C, which requires 6 months of symptoms.
In schizophreniform disorder, the disturbance is present less than 6 months, and in
brief psychotic disorder, symptoms are present at least 1 day but less than 1 month.

Question 10

Intellectual Disability - Differential Diagnosis - Communication Disorders and Specific Learning Disorder

Answer 10

These neurodevelopmental disorders are specific to the communication and learning domains and do not show deficits in intellectual and adaptive behavior. They may co-occur with intellectual disability. Both diagnoses are made if full criteria are met for intellectual disability and a communication disorder or specific learning disorder.

Question 11

Syndrome

Answer 11

this term is applied to a constellation of symptoms that occur together or co-vary over time

Question 12

Tic Disorders - Prevalence

Answer 12

3 per 1000 in school-age children

Meta-analysis of 35 studies
.77% tourette’s
2.99% “Transient Tic Disorder”
.05% among adults

2:1 to 4:1 male to female ratio

Tends to be lower in African American and Hispanic populations

Question 13

ADHD - Course

Answer 13

Continues through adolescence and often adulthood

Typically hyperactivity decreases (brain maturation)

Higher risk for ODD, CD, and Substance Use Disorder

Functional Outcomes:

Power school/work performance
Lower academic/work atainment 
Unemployment
Social rejection
Accidents and injuries
Fmaily conflict

Question 14

ADHD - Differential Diagnosis - Neurocognitive Disorders

Answer 14

Early major neurocognitive disorder (dementia) and/or
mild neurocognitive disorder are not known to be associated with ADHD but may present
with similar clinical features. These conditions are distinguished from ADHD by their late
onset.

Question 15

Tic Disorders - Differential Diagnosis - Abnormal Movements that may accompany other medical conditiosn and stereotypic movement disorder

Answer 15

Motor stereotypies are defined as involuntary rhythmic, repetitive,
predictable movements that appear purposeful but serve no obvious adaptive function or
purpose and stop with distraction. Examples include repetitive hand waving/rotating,
arm flapping, and finger wiggling. Motor stereotypies can be differentiated from tics based
on the former’s earlier age at onset (younger than 3 years), prolonged duration (seconds to
minutes), constant repetitive fixed form and location, exacerbation when engrossed in activities,
lack of a premonitory urge, and cessation with distraction (e.g., name called or
touched). Chorea represents rapid, random, continual, abrupt, irregular, unpredictable,
nonstereotyped actions that are usually bilateral and affect all parts of the body (i.e., face,
trunk, and limbs). The timing, direction, and distribution of movements vary from moment
to moment, and movements usually worsen during attempted voluntary action. Dystonia
is the simultaneous sustained contracture of both agonist and antagonist muscles,
resulting in a distorted posture or movement of parts of the body. Dystonie postures are often
triggered by attempts at voluntary movements and are not seen during sleep.

Question 16

Stererotypic Movement Disorder - Differential Diagnosis - Other neurological and medical conditions

Answer 16

The diagnosis of stereotypic movements
requires the exclusion of habits, mannerisms, paroxysmal dyskinesias, and benign hereditary
chorea. A neurological history and examination are required to assess features
suggestive of other disorders, such as myoclonus, dystonia, tics, and chorea. Involuntary
movements associated with a neurological condition may be distinguished by their signs
and symptoms. For example, repetitive, stereotypic movements in tardive dyskinesia can
be distinguished by a history of chronic neuroleptic use and characteristic oral or facial
dyskinesia or irregular trunk or limb movements. These types of movements do not result
in self-injury. A diagnosis of stereotypic movement disorder is not appropriate for repetitive
skin picking or scratching associated with amphetamine intoxication or abuse (e.g.,
patients are diagnosed with substance/medication-induced obsessive-compulsive and related
disorder) and repetitive choreoathetoid movements associated with other neurological
disorders.

Question 17

Specific Learning Disorder - Differential Diagnosis - Learning Difficulties Due to Neurological or Sensory Disorders

Answer 17

Specific learning disorder
is distinguished from learning difficulties due to neurological or sensory disorders
(e.g., pediatric stroke, traumatic brain injury, hearing impairment, vision impairment), because
in these cases there are abnormal findings on neurological examination.

Question 18

What makes bipolar hard to diagnose?

Answer 18

People come in for the depression, not the manias, may not see mania as a problem

High rates of comorbidity

Shared psychotic features

Difficulty disentangling timelines from substance use

So many variations in how it presents in the room/how people experience the disorder

Question 19

ADHD - Differential Diagnosis - Specific Learning Disorder

Answer 19

Children with specific learning disorder may appear inattentive
because of frustration, lack of interest, or limited ability. However, inattention in
individuals with a specific learning disorder who do not have ADHD is not impairing outside
of academic work.

Question 20

Schizophrenia - Differential Diagnosis - Postraumatic Stress Disorder

Answer 20

Posttraumatic stress disorder may include flashbacks that
have a hallucinatory quality, and hypervigilance may reach paranoid proportions. But a traumatic
event and characteristic symptom features relating to reliving or reacting to the event
are required to make the diagnosis.

Question 21

Schizoaffective Disorder - Prevalence and Course

Answer 21

Lifetime Prevalence = .3%

More common among females, especially depressive type

Typical age of onset – early adulthood

• Bioplar type more common amongst young adults
• Depressive type more common among older adults

Prognosis slightly better than schizophrenia, but worse than mood disorders

-often associated with impaired functioning, although not part of criterion

Question 22

Intellectual Disability - Differential Diagnosis - Autism Spectrum Disorder

Answer 22

ID is common among individuals with autism spectrum disorder. Assessment of intellectual ability may be complicated by social- communication and behavior deficits inherent to autism spectrum disorder, which may interfere with understanding and complying with test procedures. Appropriate assessment of intellectual functioning in autism spectrum disorder is essential, with reassessment across the developmental period, because IQ scores in autism spectrum disorder may be unstable, particularly in early childhood.

Question 23

Bipolar - Prevalence

Answer 23

1.8% - 4.4% of US population (lifeactime) across BDI, BDII, and BDNOS

12-month prevalence rate
BDI = 0.6%
BDII = 0.8%

Nearly equal in men and women

Rapid cycling, mixed states, and depressive episodes more often in women

Question 24

Schizophreniform Disorder - Criteria

Answer 24

A. Two (or more) of the following, each present for a significant portion of time during a
1-month period (or less if successfully treated). At least one of these must be (1), (2),
or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional expression or avolition).
B. An episode of the disorder lasts at least 1 month but less than 6 months. When the
diagnosis must be made without waiting for recovery, it should be qualified as “provisional.”
‘
C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have
been ruled out because either 1 ) no major depressive or manic episodes have occurred
concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during
active-phase symptoms, they have been present for a minority of the total duration
of the active and residual periods of the illness.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication) or another medical condition.

Note: impairment in social and occupational functioning is not required

Question 25

Specific Learning Disorder - Etiology

Answer 25

Genetic X Environment - runs in families - prematurity - low birth weight - prenatal exposure to toxins

Question 26

Complex Motor tic examples

Answer 26

Combo of motor tics Echopraxia (repeating a movement they have seen) Coprapraxia (doing obsene things)

Question 27

Schizoaffective Disorder

Answer 27

Specify whether: Bipolar type: This subtype applies if a manic episode is part of the presentation. Major depressive episodes may also occur. Depressive type: This subtype applies if only major depressive episodes are part of the presentation. Specify if: With catatonia Specify if: The following course specifiers are only to be used after a 1 -year duration of the disorder and if they are not in contradiction to the diagnostic course criteria. First episode, currently in acute episode: First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a time period in which the symptom criteria are fulfilled. First episode, currently in partial remission: Partial remission is a time period during which an improvement after a previous episode is maintained and in which the defining criteria of the disorder are only partially fulfilled. First episode, currently in full remission: Full remission is a period of time after a previous episode during which no disorder-specific symptoms are present. Multiple episodes, currently in acute episode: Multiple episodes may be determined after a minimum of two episodes (i.e., after a first episode, a remission and a minimum of one relapse). Multiple episodes, currently in partial remission Multiple episodes, currently in full remission Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for the majority of the illness course, with subthreshold symptom periods being very brief relative to the overall course. Unspecified Specify current severity: Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). Note: Diagnosis of schizoaffective disorder can be made without using this severity specifier.

Question 28

Tic Disorders - Development and Course

Answer 28

Onset typically between ages 4-6 Peak severity typically between ages 10-12, after which severity declines Tics may wax/wane or change Comorbidity depends on age - childhood: ADHD, OCD, separation anxiety - Teens/Adults: MDD, SUD, or Bipolar Disorder Many with mild symptoms experience little to no impairment

Question 29

Autism Spectrum Disorder - Differential Diagnosis - Schizophrenia

Answer 29

Schizophrenia with childhood onset usually develops after a period of normal, or near normal, development. A prodromal state has been described in which social impairment and atypical interests and beliefs occur, which could be confused with the social deficits seen in autism spectrum disorder. Hallucinations and delusions, which are defining features of schizophrenia, are not features of autism spectrum disorder. However, clinicians must take into account the potential for individuals with autism spectrum disorder to be concrete in their interpretation of questions regarding the key features of schizophrenia (e.g., "Do you hear voices when no one is there?" "Yes [on the radio]").

Question 30

Intellectual Disability Course

Answer 30

Lifelong, but serverity may change Improved functioning with early and ongoing interventions -Reassess infants and young children post-intervention Many live full lives

Question 31

ADHD - Differential Diagnosis - Medication Induced Symptoms of ADHD

Answer 31

Symptoms of inattention, hyperactivity, or impulsivity attributable to the use of medication (e.g., bronchodilators, isoniazid, neuroleptics [resulting in akathisia], thyroid replacement medication) are diagnosed as other specified or unspecified other (or unknown) substance-related disorders.

Question 32

Steps to determining a diagnosis

Answer 32

1. Consider GMC or Physical causes 2. Consider Substance-Induced or Related Disorder 3. Consider Cultural and Developmental Factors 4. Determine Diagnoses 5. Resolve Diagnostic Uncertainty 6. Consider Comorbidity and Assocaited Features 7. Assess Level of Distress and/or Impairment

Question 33

ADHD - Differential Diagnosis - Depressive Disorders

Answer 33

Individuals with depressive disorders may present with inability to concentrate. However, poor concentration in mood disorders becomes prominent only during a depressive episode.

Question 34

Symptom

Answer 34

refers to an observable behavior or state

Question 35

Developmental Coordination Disorder - Differential Diagnosis

Answer 35

Motor impairments due to another medical condition ID ADHD ASD Joint hypermobility syndrome

Question 36

Intellectual Disability - Differential Diagnosis

Answer 36

A diagnosis of intellectual disability should not be assumed because of a particular genetic or medical condition. A genetic syndrome linked to intellectual disability should be noted as a concurrent diagnosis with the intellectual disability. Major and Mild Neurocognitive Disorders Communication Disorders and Specific Learning Disorders Autism Spectrum Disorder

Question 37

Schizophrenia Specifiers

Answer 37

The following course specifiers are only to be used after a 1-year duration of the disorder and if they are not in contradiction to the diagnostic course criteria. First episode, currently in acute episode: First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a time period in which the symptom criteria are fulfilled. First episode, currently in partial remission: Partial remission is a period of time during which an improvement after a previous episode is maintained and in which the defining criteria of the disorder are only partially fulfilled. First episode, currently in full remission: Full remission is a period of time after a previous episode during which no disorder-specific symptoms are present. Multiple episodes, currently in acute episode: Multiple episodes may be determined after a minimum of two episodes (i.e., after a first episode, a remission and a minimum of one relapse). Multiple episodes, currently in partial remission Multiple episodes, currently in full remission Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for the majority of the illness course, with subthreshold symptom periods being very brief relative to the overall course. Unspecified Specify if: With catatonia Specify current severity: Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe).

Question 38

Bipolar with atypical features

Answer 38

This specifier can be applied when these features predominate during the majority of days of the current or most recent major depressive episode. A. Mood reactivity (i.e., mood brightens in response to actual or potential positive events). B. Two (or more) of the following features: 1. Significant weight gain or increase in appetite. 2. Hypersomnia. 3. Leaden paralysis (i.e., heavy, leaden feelings in arms or legs). 4. A long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment. C. Criteria are not met for “with melancholic features” or “with catatonia” during the same episode.

Question 39

Specific Learning Disorder - Cultural Considerations

Answer 39

Occurs across cultures but may manifest differently -e.g. alphabetic languages vs. non-alphabetic languages Consider language proficiency in diagnosis

Question 40

Childhood Onset Fluency Disorder - Differential Diagnosis - Adult-onset dysfluencies

Answer 40

If onset of dysfluencies is during or after adolescence, it is an "adult-onset dysfluency" rather than a neurodevelopmental disorder. Adult-onset dysfluencies are associated with specific neurological insults and a variety of medical conditions and mental disorders and may be specified with them, but they are not a DSM-5 diagnosis

Question 41

What does appropriate diagnosis involve?

Answer 41

Identifying the individual's clinical presentation, characteristic signs, and symptoms Matching these to psychiatric diagnostic categories Comprehensive understanding of disorders, diagnostic assessment, ability to idenitfy diagnostic clues, signs and symptoms, common core symptoms and features that allow for differentiation between daignoses

Question 42

Specific Learning Disorder - Differential Diagnosis - ID

Answer 42

Specific learning disorder differs from general learning difficulties associated with intellectual disability, because the learning difficulties occur in the presence of normal levels of intellectual functioning (i.e., IQ score of at least 70 ± 5). If intellectual disability is present, specific learning disorder can be diagnosed only when the learning difficulties are in excess of those usually associated with the intellectual disability.

Question 43

Specific Learning Disorder - Differential Diagnosis - Normal Variations in Academic Attaintment

Answer 43

Specific learning disorder is distinguished from normal variations in academic attainment due to external factors (e.g., lack of educational opportunity, consistently poor instruction, learning in a second language), because the learning difficulties persist in the presence of adequate educational opportunity and exposure to the same instruction as the peer group, and competency in the language of instruction, even when it is different from one's primary spoken language.

Question 44

Bipolar I - Differential Diagnosis - Other Bipolar Disorders

Answer 44

Diagnosis of bipolar I disorder is differentiated from bipolar II disorder by determining whether there have been any past episodes of mania. Other specified and unspecified bipolar and related disorders should be differentiated from bipolar I and II disorders by considering whether either the episodes involving manic or hypomanic symptoms or the episodes of depressive symptoms fail to meet the full criteria for those conditions. Bipolar disorder due to another medical condition may be distinguished from bipolar I and II disorders by identifying, based on best clinical evidence, a causally related medical condition.

Question 45

Tic Disorders - Etiology and Risk Factors

Answer 45

Genetic X Environment - heritability in families - older parental age - brith complications - low birth weight - prenatal exposure to toxins (e.g. smoking) Worsened by anxiety, stress, exhaustions, and excitement

Question 46

Specific Learning Disorder - Diagnosis

Answer 46

Clinical Interview Education/Psychological Assessment -look at specific subscores to be 1.5 SD below average School reports Parent/Other reports Curriculum-based measures Portfolio of work Need to incorporate medical, developmental, educational and family hx

Question 47

Language Disorder - Comorbidity

Answer 47

Language disorder is strongly associated with other neurodevelopmental disorders in terms of specific learning disorder (literacy and numeracy), attention-deficit/hyperactivity disorder, autism spectrum disorder, and developmental coordination disorder. It is also associated with social (pragmatic) communication disorder. A positive family history of speech or language disorders is often present.

Question 48

ADHD Considerations

Answer 48

Inattention is hard to detect Hyperacgtivity can be mistaken for disciplinary problems Typically diagnosed in elementary school - normal child behavior is hyperactive - kids may not be required to sit still before that Symptoms may vary across settings and age Beware of over-diagnosis

Question 49

Schizophrenia - Differential Diagnosis - Schizotypal Personality Disorder

Answer 49

Schizotypal personality disorder may be distinguished from schizophrenia by subthreshold symptoms that are associated with persistent personality features.

Question 50

Why is diagnosis important?

Answer 50

# Define Clinical Entities - serves as a short-hand notation for a syndrome or cluster of symptoms that commonly occur together - Communication Determine Treatment - Prerequisite fro appropriate treatment - Allows for identification of appropriate interventions and prediction of treatment response and outcome

Question 51

ADHD - Specifiers

Answer 51

Combined presentation Predominantly inattentive presentation Predominantly hyperactive/impulsive presentation Specify if: in partial remission: When full criteria were previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still result in impairment in social, academic, or occupational functioning. Specify current severity: Mild - Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor impairments in social or occupational functioning. Moderate - Symptoms or functional impairment between “mild” and “severe” are present. Severe - Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning

Question 52

Schizophrenia prevalence & risk factors

Answer 52

.3-.7% lifetime prevalence ~1% in literature slightly fewer females males have earlier onset than females - males early-mid 20s - females late 20s Variation by race/ethnicity, across countries Genetics X Environmental - heritability, risk alleles idenitifed - approx 10% of first degree relaitves of patients with schizophrenia develop the condition prenatla/perinatal factors

Question 53

Specific Learning Disorder - Differential Diagnosis - Neurocognitive Disorders

Answer 53

Specific learning disorder is distinguished from learning problems associated with neurodegenerative cognitive disorders, because in specific learning disorder the clinical expression of specific learning difficulties occurs during the developmental period, and the difficulties do not manifest as a marked decline from a former state.

Question 54

Specific Learning Disorder - Specifiers

Answer 54

Specify all academic domains and subskills that are impaired - Reading - Writing - Math Severity Mild, Moderate, Severe (based on number of domains and how much support they need)

Question 55

Global Developmental Delay

Answer 55

This diagnosis is reserved for individuals under the age of 5 years when the clinical severity level cannot be reliably assessed during early childhood. This category is diagnosed when an individual fails to meet expected developmental milestones in several areas of intellectual functioning, and applies to individuals who are unable to undergo systematic assessments of intellectual functioning, including children who are too young to participate in standardized testing. This category requires reassessment after a period of time (not a permanent diagnosis)

Question 56

Catatonia

Answer 56

A. The clinical picture is dominated by three (or more) of the following symptoms: 1. Stupor (i.e., no psychomotor activity; not actively relating to environment). 2. Catalepsy (i.e., passive induction of a posture held against gravity). 3. Waxy flexibility (i.e., slight, even resistance to positioning by examiner). 4. Mutism (i.e., no, or very little, verbal response [exclude if known aphasia]). 5. Negativism (i.e., opposition or no response to instructions or external stimuli). 6. Posturing (i.e., spontaneous and active maintenance of a posture against gravity). 7. Mannerism (i.e., odd, circumstantial caricature of normal actions). 8. Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements). 9. Agitation, not influenced by external stimuli. 10. Grimacing. 11. Echolalia (i.e., mimicking another’s speech). 12. Echopraxia (i.e., mimicking another’s movements).

Question 57

Childhood Onset Fluency Disorder - Prevalance

Answer 57

3:1 Male to Female If speech doesn't improve by age 8 you could see it persist into teenage years

Question 58

ADHD - Etiology

Answer 58

Genetics Abnormal/delayed brain maturation (multiple genes developing normally but delayed in growth) -Specific brain areas include basal ganglia (emotional regulation) and cerebellum (timing, motor control) Environmental factors - prentalue eposure to alcohol/drugs - exposure to toxins (e.g. lead) - TBI Brain waves are dif in child with ADHD

Question 59

Schizoaffective Disorder - Differential Diagnosis - Schizophrenia, Bipolar, and Depressive Disorders

Answer 59

Distinguishing schizoaffective disorder from schizophrenia and from depressive and bipolar disorders with psychotic features is often difficult. Criterion C is designed to separate schizoaffective disorder from schizophrenia, and Criterion B is designed to distinguish schizoaffective disorder from a depressive or bipolar disorder with psychotic features. More specifically, schizoaffective disorder can be distinguished from a depressive or bipolar disorder with psychotic features based on the presence of prominent delusions and/or hallucinations for at least 2 weeks in the absence of a major mood episode. In contrast, in depressive or bipolar disorder with psychotic features, the psychotic features primarily occur during the mood episode(s). Because the relative proportion of mood to psychotic symptoms may change over time, the appropriate diagnosis may change from and to schizoaffective disorder. (For example, a diagnosis of schizoaffective disorder for a severe and prominent major depressive episode lasting 3 months during the first 6 months of a chronic psychotic illness would be changed to schizophrenia if active psychotic or prominent residual symptoms persist over several years without a recurrence of another mood episode.)

Question 60

Autism Spectrum Disorder - Prevalence and Development

Answer 60

1% of population 4:1 male to female Late, underdiagnosis in African American children (lack of access to healthcare?) Typically recognize symptoms between 1-2 years of age Higher rates in recent years

Question 61

What is a tic?

Answer 61

Sudden, rapid, recurrent, nonrhythmic motor movement or vocalization -usually occur in head and face Symptoms may change over time Can be simple or complex - simple: last a couple seconds - complex: can be combo of simple, last longer Usually preceded by an urge Typically experienced as "involuntary" although can be resisted

Question 62

Schizophreniform - Differential Diagnosis - Other mental disorders and medical conditions

Answer 62

A wide variety of mental and medical conditions can manifest with psychotic symptoms that must be considered in the differential diagnosis of schizophreniform disorder. These include psychotic disorder due to another medical condition or its treatment; delirium or major neurocognitive disorder; substance/medication-induced psychotic disorder or delirium; depressive or bipolar disorder with psychotic features; schizoaffective disorder; other specified or unspecified bipolar and related disorder; depressive or bipolar disorder with catatonic features; schizophrenia; brief psychotic disorder; delusional disorder; other specified or unspecified schizophrenia spectrum and other psychotic disorder; schizotypal, schizoid, or paranoid personality disorders; autism spectrum disorder; disorders presenting in childhood with disorganized speech; attention-deficit/hyperactivity disorder; obsessive-compulsive disorder; posttraumatic stress disorder; and traumatic brain injury. Since the diagnostic criteria for schizophreniform disorder and schizophrenia differ primarily in duration of illness, the discussion of the differential diagnosis of schizophrenia also applies to schizophreniform disorder.

Question 63

Autism Spectrum Disorder - Core Features

Answer 63

Impairment in Social Communication and Interaction - Deficits in social-emotional reciprocity - Deficits in nonverbal communicative behaviors - Deficits in developing, maintaining and understanding relationships Restricted, Repetitive Patterns of Behavior, Interests, and Activites (at least 2) - Stereotyped/repetitive motor movements or speech - Insistence on sameness, rigid routines - Ex: handflapping, rocking, repeating one word a lot - High restricted, fixated interests abnormal in intensity - Hyper/hypo-sensitivity to sensory input - Could also be tactile

Question 64

Developmental Coordination Disorder - Etiology

Answer 64

genetics, especially severe cases possible cerebellar dysfunction Environmental factors - low birth weight - prematurity - prenatal alcohol exposure

Question 65

Stereotypic Movement Disorder Criteria

Answer 65

A. Repetitive, seemingly driven, and apparently purposeless motor behavior (e.g., hand shaking or waving, body rocking, head banging, self-biting, hitting own body). -often rhythmic B. The repetitive motor behavior interferes with social, academic, or other activities and may result in self-injury. C. Onset is in the early developmental period. -children will often move in repetitive patterns, but can stop if they are told to. Children will also go through phases of doing certain movements normally D. The repetitive motor behavior is not attributable to the physiological effects of a substance or neurological condition and is not better explained by another neurodevelopmental or mental disorder (e.g., trichotillomania [hair-pulling disorder], obsessivecompulsive disorder).

Question 66

ADHD - Differential Diagnosis - Substance Use Disorder

Answer 66

Differentiating ADHD from substance use disorders may be problematic if the first presentation of ADHD symptoms follows the onset of abuse or frequent use. Clear evidence of ADHD before substance misuse from informants or previous records may be essential for differential diagnosis.

Question 67

Schizophrenia - Differential Diagnosis - Schizoaffective Disorder

Answer 67

A diagnosis of schizoaffective disorder requires that a major depressive or manic episode occur concurrently with the active-phase symptoms and that the mood symptoms be present for a majority of the total duration of the active periods.

Question 68

Criticism of the DSM-5

Answer 68

Poor reliablity and validity Focus on symptoms rather than what causes the symptoms Problems distinguishing normal from abnormal Cultural Bias Distinct categories vs. dimensions Tendency to overpathologize

Question 69

Specific Learning Disorder - Differential Diagnosis - Psychotic Disorders

Answer 69

Specific learning disorder is distinguished from the academic and cognitive-processing difficulties associated with schizophrenia or psychosis, because with these disorders there is a decline (often rapid) in these functional domains.

Question 70

Bipolar - Comorbidities

Answer 70

approx 75% have comorbid disorders Prognosis is worse when comorbid

Question 71

Specific Learning Disorder - Impairment in Written Expression

Answer 71

Writing skills are below expected for age Difficulty with: - Grammar - Punctuation - Spelling - Clearly articulating ideas in writing Not due to poor coordination or penmenship (more related to act of writing (motor skills)

Question 72

Hypomania - Criteria

Answer 72

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree: *DIGFAST 1. Distractibility 2. Indiscretion/Recklessness. Excessive involvement in activities that have a high potential for painful consequences (e. g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). 3. Grandiosity or inflated self-esteem 4. Flight of ideas or subjective experience that thoughts are racing. 5. Activity increase, goal-directed (either socially, at work or school, or sexually) or psychomotor agitation (i.e., puposeless non-goal-directed activity). 6. Sleep loss; decreased need for sleep (e.g., feels rested after only 3 hours of sleep). 7. More talkative than usual or pressure to keep talking C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. D. The disturbance in mood and the change in functioning are observable by others. E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic. F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment). Note: A full hypomanic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a hypomanic episode diagnosis. However, caution is indicated so that one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant use) are not taken as sufficient for diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar diathesis. Note: Criteria A-'F constitute a hypomanic episode. Hypomanic episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.

Question 73

Social (Pragmatic) Communication Disorder - Differential Diagnosis - Intellectual Disability and Global Developmental Delay

Answer 73

Social communication skills may be deficient among individuals with global developmental delay or intellectual disability, but a separate diagnosis is not given unless the social communication deficits are clearly in excess of the intellectual limitations.

Question 74

WHODAS

Answer 74

World Health Organization Disability Assessment Scale Replaced GAF from DSM IV Used to determine disability

Question 75

Language Disorder - Differential Diagnosis - Language Regression

Answer 75

Loss of speech and language in a child younger than 3 years may be a sign of autism spectrum disorder (with developmental regression) or a specific neurological condition, such as Landau-Kleffner syndrome. Among children older than 3 years, language loss may be a symptom of seizures, and a diagnostic assessment is necessary to exclude the presence of epilepsy (e.g., routine and sleep electroencephalogram).

Question 76

Stereotypic Movement Disorder - Specifiers

Answer 76

With/without self-injurious behaviors Associated with a known medical or genetic condition, neurodevelopmental disorder, or enviornmental factor (specify condition) Severity mild, moderate, severe

Question 77

Bipolar - Risk/Prognostic Factors

Answer 77

More common in high income countries Marriage, education ,and fewer years of ilness predict better prognosis Presence of psychotic features predicts more psychosis Mood-incongruent psychotic features predict less complete recovery periods Functional recovery lags behind symptom recovery -30% severe work impairment --> lower SES Cognitive impairment High suicide risk: 15x greater than general population - 32-36% attempt suicide - Lethality appears to be higher for those with Bipolar II

Question 78

Specific Learning Disorder - Impairment in Math

Answer 78

Math skills are below expected for age Difficulty with: - counting - understanding math concepts and symbols - learning and performing simple math operations (e.g. adding or subtracting) - Math reasoning (e.g. applying concepts to solve problems -- word problems)

Question 79

Childhood-Onset Fluency Disorder (Stuttering)

Answer 79

A. Disturbances in the normal fluency and time patterning of speech that are inappropriate for the individual’s age and language skills, persist over time, and are characterized by frequent and marked occurrences of one (or more) of the following: 1. Sound and syllable repetitions. 2. Sound prolongations of consonants as well as vowels. 3. Broken words (e.g., pauses within a word). 4. Audible or silent blocking (filled or unfilled pauses in speech). 5. Circumlocutions (word substitutions to avoid problematic words). 6. Words produced with an excess of physical tension. 7. Monosyllabic whole-word repetitions (e.g., “I-I-I-I see him”). B. The disturbance causes anxiety about speaking or limitations in effective communication, social participation, or academic or occupational performance, individually or in any combination. C. The onset of symptoms is in the early developmental period. (Note: Later-onset cases are diagnosed as 307.0 [F98.5] adult-onset fluency disorder.) D. The disturbance is not attributable to a speech-motor or sensory deficit, dysfluency associated with neurological insult (e.g., stroke, tumor, trauma), or another medical condition and is not better explained by another mental disorder.

Question 80

Autism Spectrum Disorder - Differential Diagnosis - ADHD

Answer 80

Abnormalities of attention (overly focused or easily distracted) are common in individuals with autism spectrum disorder, as is hyperactivity. A diagnosis of attention-deficit/hyperactivity disorder (ADHD) should be considered when attentional difficulties or hyperactivity exceeds that typically seen in individuals of comparable mental age.

Question 81

Psychosis

Answer 81

out of touch with reality defined by 5 symptoms: - hallucinations - delusions - disorganized thinking (speech) - disoragnized behavior - negative symptoms

Question 82

Autism Spectrum Disorder - Differential Diagnosis - Selective Mutism

Answer 82

In selective mutism, early development is not typically disturbed. The affected child usually exhibits appropriate communication skills in certain contexts and settings. Even in settings where the child is mute, social reciprocity is not impaired, nor are restricted or repetitive patterns of behavior present.

Question 83

Developmental Coordination Disorder Criteria

Answer 83

A. The acquisition and execution of coordinated motor skills is substantially below that expected given the individual’s chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness (e.g., dropping or bumping into objects) as well as slowness and inaccuracy of performance of motor skills (e.g., catching an object, using scissors or cutlery, handwriting, riding a bike, or participating in sports). B. The motor skills deficit in Criterion A significantly and persistently interferes with activities of daily living appropriate to chronological age (e.g., self-care and self-maintenance) and impacts academic/school productivity, prevocational and vocational activities, leisure, and play. C. Onset of symptoms is in the early developmental period. -typically not diagnosed before age 5 ``` D. The motor skills deficits are not better explained by intellectual disability (Intellectual developmental disorder) or visual impairment and are not attributable to a neurological condition affecting movement (e.g., cerebral palsy, muscular dystrophy, degenerative disorder). ```

Question 84

Social (Pragmatic) Communication Disorder - Differential Diagnosis - Autism Spectrum Disorder

Answer 84

Autism spectrum disorder is the primary diagnostic consideration for individuals presenting with social communication deficits. The two disorders can be differentiated by the presence in autism spectrum disorder of restricted/ repetitive patterns of behavior, interests, or activities and their absence in social (pragmatic) communication disorder. Individuals with autism spectrum disorder may only display the restricted/repetitive patterns of behavior, interests, and activities during the early developmental period, so a comprehensive history should be obtained. Current absence of symptoms would not preclude a diagnosis of autism spectrum disorder, if the restricted interests and repetitive behaviors were present in the past. A diagnosis of social (pragmatic) communication disorder should be considered only if the developmental history fails to reveal any evidence of restricted/repetitive patterns of behavior, interests, or activities

Question 85

Schizophrenia - Differential Diagnosis - Other Mental Disorders Associated with a Psychotic Episode

Answer 85

The diagnosis of schizophrenia is made only when the psychotic episode is persistent and not attributable to the physiological effects of a substance or another medical condition. Individuals with a delirium or major or minor neurocognitive disorder may present with psychotic symptoms, but these would have a temporal relationship to the onset of cognitive changes consistent with those disorders. Individuals with substance/medication-induced psychotic disorder may present with symptoms characteristic of Criterion A for schizophrenia, but the substance/ medication-induced psychotic disorder can usually be distinguished by the chronological relationship of substance use to the onset and remission of the psychosis in the absence of substance use.

Question 86

Stereotypic Movement Disorder - Etiology

Answer 86

Cause is unknown Associated risk & prognostic factors - lower cognitive functioning - may be behavioral sign of neurogenetic syndrome - medical conditions - stress/fear - social isolation

Question 87

Intellectual Disability

Answer 87

``` Intellectual disability (intellectual developmental disorder) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. The following three criteria must be met: ``` A. Deficits in intellectual functions, such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing. -IQ of 70 or lower (>2 SD below mean +/- 5 for error) generally but need to look at adaptive functioning deficits B. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community. - 3 Domains: conceptual, social, and practical - Impairment present in at least one but often it is all three C. Onset of intellectual and adaptive deficits during the developmental period.

Question 88

Childhood Onset Fluency Disorder - DIfferential Diagnosis - Sensory Deficits

Answer 88

Dysfluencies of speech may be associated with a hearing impairment or other sensory deficit or a speech-motor deficit. When the speech dysfluencies are in excess of those usually associated with these problems, a diagnosis of childhood-onset fluency disorder may be made.

Question 89

Autism Spectrum Disorder - Course

Answer 89

Symptoms most marked in early childhood Typically not degenerative Majority need some support in adulthood Comorbid with anxiety, depression, ADHD, oCD, ID, SLD Prognosis linked to impairements in language and intellect and other mental health problems -the more problems the worse off they will be later on

Question 90

Stererotypic Movement Disorder - Differential Diagnosis - Normal Development

Answer 90

Simple stereotypic movements are common in infancy and early childhood. Rocking may occur in the transition from sleep to awake, a behavior that usually resolves with age. Complex stereotypies are less common in typically developing children and can usually be suppressed by distraction or sensory stimulation. The individual's daily routine is rarely affected, and the movements generally do not cause the child distress. The diagnosis would not be appropriate in these circumstances.

Question 91

Language Disorder - Differential Diagnosis

Answer 91

Normal variations in language Hearing or other sensory impairment Intellectual disability (intellectual developmental disorder) Neurological disorders Language regression Comorbidity

Question 92

Intellectual Disability Etiology

Answer 92

Prenatal - Genetic - Inbord errors of metabolism - Brain malformations - Maternal/placental disease - Environmental influences Perinatal (at or around time of birth) - Prematurity - Anoxia - Birth trauma Postnatal/acquired - TBI - Hypoxic ischemic injury - Infections/illnesses - Seizure disorders - Toxins - Severe/chronic social deprivation Sometimes unexplained or no cause

Question 93

Tic Disorders - Other specified/unspecified

Answer 93

When to use? - Atypical in age of onset - Atypical in presentation - known etiology

Question 94

ADHD General Criteria

Answer 94

A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2): B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years. C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities). D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning. E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).

Question 95

Substance/Medication-Induced Psychotic Disorder Critieria

Answer 95

A. Presence of one or both of the following symptoms: 1. Delusions. 2. Hallucinations. B. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2): 1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication. 2. The involved substance/medication is capable of producing the symptoms in Criterion A. C. The disturbance is not better explained by a psychotic disorder that is not substance/ medication-induced. Such evidence of an independent psychotic disorder could include the following: The symptoms preceded the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication: or there is other evidence of an independent non-substance/medication-induced psychotic disorder (e.g., a history of recurrent non-substance/medication-related episodes). D. The disturbance does not occur exclusively during the course of a delirium. E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Note: This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention.

Question 96

ADHD - Differential Diagnosis - Psychotic Disorders

Answer 96

ADHD is not diagnosed if the symptoms of inattention and hyperactivity occur exclusively during the course of a psychotic disorder.

Question 97

Developmental Coordination Disorder - Differential Diagnosis - ASD

Answer 97

Individuals with autism spectrum disorder may be uninterested in participating in tasks requiring complex coordination skills, such as ball sports, which will affect test performance and function but not reflect core motor competence. Cooccurrence of developmental coordination disorder and autism spectrum disorder is common. If criteria for both disorders are met, both diagnoses can be given.

Question 98

ADHD - Associated Features

Answer 98

Language, motor, social delays Cognitive problems (poor executive functioning, memory) Academic/work impairement Mood, conduct, and substance use disorders (higher in ADHD individuals)

Question 99

Simple vocal tic examples

Answer 99

Throat clearing sniffing grunting bark, squeak

Question 100

Stererotypic Movement Disorder - Differential Diagnosis - ASD

Answer 100

Stereotypic movements may be a presenting symptom of autism spectrum disorder and should be considered when repetitive movements and behaviors are being evaluated. Deficits of social communication and reciprocity manifesting in autism spectrum disorder are generally absent in stereotypic movement disorder, and thus social interaction, social communication, and rigid repetitive behaviors and interests are distinguishing features. When autism spectrum disorder is present, stereotypic movement disorder is diagnosed only when there is self-injury or when the stereotypic behaviors are sufficiently severe to become a focus of treatment.

Question 101

Stereotypic Movement Disorder - Prevalence & Course

Answer 101

3-4% develop complex stereotypies More common in boys than girls Highly comorbid with ID Typically onset in first 3 years of life Usually resolves over time or can be suppressed in typically developing kids

Question 102

Bipolar - Development

Answer 102

Average age of onset is late adolescence (BDI) to mid-20s (BDII) Median onset prior to age 18 Prevalence is estimated at 1.8-2.5% in adolescnece For BDII, onset often begins with depressive episode Early onset associated with worse outcomes >90% with mania, go on to have recurring episodes ~60% of manic episodes are follwed by depressive episode Aprox 6% of adults & 20-25% of adolescents with BDII progress to BDI

Question 103

Bipolar - Brain

Answer 103

Neural Correlates - Hyperactiviation of amygdala - Decreased activity in hippocampus and anterior cingulate - Hypoactivation in vIPFC Neurotransmitters: - Dopamine levels appear to be increased during mania and depleted during depression - Levels of serotonin are diminished lead to depressive episodes - Elevated glutamate levels

Question 104

Intellectual Disability Prevalence

Answer 104

1% of general population May be identifiable within first 2 years of life More prevalent in males than females (3:2)

Question 105

Speech Sound Disorder - Differential Diagnosis - Normal variations in speech

Answer 105

Regional, social, or cultural/ethnic variations of speech | should be considered before making the diagnosis.

Question 106

Autism Spectrum Disorder - Criteria

Answer 106

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text): 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures: to a total lack of facial expressions and nonverbal communication. 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. Specify current severity: Severity is based on social communication impairments and restricted, repetitive patterns of behavior (seeTable 2). B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text): 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day). 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). Specify current severity: Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see Table 2). C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level. Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Question 107

Speech Sound Disorder - Differential Diagnosis

Answer 107

Normal variations in speech Hearing or other sensory impairment Structural deficits Dysarthria Selective mutism

Question 108

Psychotic Disorder Due to Another Medical Condition

Answer 108

A. Prominent hallucinations or delusions. B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition. C. The disturbance is not better explained by another mental disorder. D. The disturbance does not occur exclusively during the course of a delirium. E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Question 109

Childhood Schizophrenia

Answer 109

very rare visual hallucinations are more common more prominent negative symptoms poorer outcomes

Question 110

Stererotypic Movement Disorder - Differential Diagnosis - Tic disorders

Answer 110

Typically, stereotypies have an earlier age at onset (before 3 years) than do tics, which have a mean age at onset of 5-7 years. They are consistent and fixed in their pattern or topography compared with tics, which are variable in their presentation. Stereotypies may involve arms, hands, or the entire body, while tics commonly involve eyes, face, head, and shoulders. Stereotypies are more fixed, rhythmic, and prolonged in duration than tics, which, generally, are brief, rapid, random, and fluctuating. Tics and stereotypic movements are both reduced by distraction.

Question 111

Language Disorder - Differential Diagnosis - Normal Variations in Language

Answer 111

Language disorder needs to be distinguished from normal developmental variations, and this distinction may be difficult to make before 4 years of age. Regional, social, or cultural/ethnic variations of language (e.g., dialects) must be considered when an individual is being assessed for language impairment.

Question 112

Brief Psychotic Disorder - Prevalence, course, risk

Answer 112

Accounts for 9% of first-onset psychosis Onset can ocur across lifespan, avergae age in mid-30s More common in females Predisposition for those with certain personality disorders Full remission -- better functional outcomes

Question 113

Schizophrenia - Brain

Answer 113

Decreased brain volume - Reduced gray matter - Less white matter connectivity - white matter transfers information from cell to cell - Reduction increases with age reducation especially prevelant in frontal lobe and temporal lobe enlarged ventricles neurotransmitters - evelated dopamine and noradrenaline (noraepinephrine) - decreased GABA and glutamate

Question 114

ADHD - Differential Diagnosis - Personality Disorders

Answer 114

In adolescents and adults, it may be difficult to distinguish ADHD from borderline, narcissistic, and other personality disorders. All these disorders tend to share the features of disorganization, social intrusiveness, emotional dysregulation, and cognitive dysregulation. However, ADHD is not characterized by fear of abandonment, self-injury, extreme ambivalence, or other features of personality disorder. It may take extended clinical observation, informant interview, or detailed history to distinguish impulsive, socially intrusive, or inappropriate behavior from narcissistic, aggressive, or domineering behavior to make this differential diagnosis.

Question 115

Specific Learning Disorder - Differential Diagnosis - ADHD

Answer 115

Specific learning disorder is distinguished from the poor academic performance associated with ADHD, because in the latter condition the problems may not necessarily reflect specific difficulties in learning academic skills but rather may reflect difficulties in performing those skills. However, the co-occurrence of specific learning disorder and ADHD is more frequent than expected by chance. If criteria for both disorders are met, both diagnoses can be given.

Question 116

Autism Spectrum Disorder - Differential Diagnosis - Language Disoders and Social (Pragamtic) Communication Disorder

Answer 116

In some forms of language disorder, there may be problems of communication and some secondary social difficulties. However, specific language disorder is not usually associated with abnormal nonverbal communication, nor with the presence of restricted, repetitive patterns of behavior, interests, or activities. When an individual shows impairment in social communication and social interactions but does not show restricted and repetitive behavior or interests, criteria for social (pragmatic) communication disorder, instead of autism spectrum disorder, may be met. The diagnosis of autism spectrum disorder supersedes that of social (pragmatic) communication disorder whenever the criteria for autism spectrum disorder are met, and care should be taken to enquire carefully regarding past or current restricted/repetitive behavior.

Question 117

Speech Sound Disorder - Differential Diagnosis - Hearing or Other Sensory Impairment

Answer 117

Hearing impairment or deafness may result in abnormalities of speech. Deficits of speech sound production may be associated with a hearing impairment, other sensory deficit, or a speech-motor deficit. When speech deficits are in excess of those usually associated with these problems, a diagnosis of speech sound disorder may be made.

Question 118

Speech Sound Disorder - Differential Diagnosis - Dysarthria

Answer 118

Speech impairment may be attributable to a motor disorder, such as cerebral palsy. Neurological signs, as well as distinctive features of voice, differentiate dysarthria from speech sound disorder, although in young children (under 3 years) differentiation may be difficult, particularly when there is no or minimal general body motor involvement (as in, e.g., Worster-Drought syndrome).

Question 119

Schizoaffective Disorder Criteria

Answer 119

A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia. Note: The major depressive episode must include Criterion A1 : Depressed mood. B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness. -helps you seperate from mood disorders with psychotic features C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness. -many people switch between SA and Schizophrenia because of this "majority" rule D. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Question 120

Intellectual Disability Etiology

Answer 120

Prenatal - Genetic - Inbord errors of metabolism - Brain malformations - Maternal/placental disease - Environmental influences Perinatal (at or around time of birth) - Prematurity - Anoxia - Birth trauma Postnatal/acquired - TBI - Hypoxic ischemic injury - Infections/illnesses - Seizure disorders - Toxins - Severe/chronic social deprivation Sometimes unexplained or no cause

Question 121

Autism Spectrum Disorder - Differential Diagnosis

Answer 121

Rett Syndrome Selective Mutism Language Disorders and social (pragmatic) communication disorder Intellectual Disability wihtout autism spectrum disorder Stereotypic movement disorder ADHD Schizophrenia

Question 122

Brief Psychotic Disorder - Specifiers

Answer 122

Specify if: With marked stressor(s) (brief reactive psychosis): If symptoms occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture. Without marited stressor(s): If symptoms do not occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture. With postpartum onset: If onset is during pregnancy or within 4 weeks postpartum. Specify if: With catatonia Severity

Question 123

Schizoaffective Disorder - Differential Diagnosis - Psychotic Disorder Due to Another Medical Condition

Answer 123

Other medical conditions and substance use can manifest with a combination of psychotic and mood symptoms, and thus psychotic disorder due to another medical condition needs to be excluded.

Question 124

Cyclothymic Disorder - Criteria

Answer 124

A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode. B. During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time. C. Criteria for a major depressive, manic, or hypomaniec episode have never been met. D. The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. E. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism). F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify if: With anxious distress (see p. 149)

Question 125

Disorganized Behavior

Answer 125

Physical actions that don't appear goal-directed Strange/bizarre behavior Inappropriate affect Catatonia

Question 126

ADHD Hyperactivity/Impulsivity

Answer 126

Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: ``` Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required. ``` a. Often fidgets with or taps hands or feet or squirms in seat. b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place). c. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.) d. Often unable to play or engage in leisure activities quietly. e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with). f. Often talks excessively. g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation). h. Often has difficulty waiting his or her turn (e.g., while waiting in line). i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

Question 127

Language Disorder Criteria

Answer 127

A. Persistent difficulties in the acquisition and use of language across modalities (i.e.,spoken, written, sign language, or other) due to deficits in comprehension or production that include the following: 1. Reduced vocabulary (word knowledge and use). 2. Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology). 3. Impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation). B. Language abilities are substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, or occupational performance, individually or in any combination. C. Onset of symptoms is in the early developmental period. D. The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.

Question 128

Bipolar II - Specifiers

Answer 128

Specify current or most recent episode: Hypomanic Depressed Specify if: With anxious distress (p. 149) With mixed features (pp. 149-150) With rapid cycling (pp. 150-151) Withi mood-congruent psychotic features (p. 152) With mood-incongruent psychotic features (p. 152) With catatonia (p. 152). With péripartum onset (pp. 152-153) With seasonal pattern (pp. 153-154): Applies only to the pattern of major depressive episodes. Specify course if full criteria for a mood episode are not currently met: in partial remission (p. 154) In full remission (p. 154) Specify severity if full criteria for a mood episode are currently met: Mild (p. 154) Moderate (p. 154) Severe (p.154)

Question 129

Specific Learning Disorder - Course

Answer 129

Lifelong, persisting into adulthood - May manifest differently with age - May result in poorer life outcomes Variable in course - Severity - Environment/Task demands - Learning ability - Comorbidity - Available Support

Question 130

Schizophrenia Criteria

Answer 130

A. Two (or more) of the following, each present for a significant portion of time during a 1 -month period (or less if successfully treated). At least one of these must be (1 ), (2), or (3): 1. Delusions. 2. Hallucinations. 3. Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorganized or catatonic behavior. 5. Negative symptoms (i.e., diminished emotional expression or avolition). B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning). C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences). D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1 ) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness. E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).

Question 131

Manic Episode - Criteria

Answer 131

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior: *DIGFAST 1. Distractibility 2. Indiscretion/Recklessness. Excessive involvement in activities that have a high potential for painful consequences (e. g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). 3. Grandiosity or inflated self-esteem 4. Flight of ideas or subjective experience that thoughts are racing. 5. Activity increase, goal-directed (either socially, at work or school, or sexually) or psychomotor agitation (i.e., puposeless non-goal-directed activity). 6. Sleep loss; decreased need for sleep (e.g., feels rested after only 3 hours of sleep). 7. More talkative than usual or pressure to keep talking. C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition. Note: A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a bipolar I diagnosis. Note: Criteria A-D constitute a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder.

Question 132

Shizophrenia - Considerations

Answer 132

Culture - what beliefs are considered delusional - part of one's religious experiences? - differences in emotional expression? langauge barriers? Gender - females have later onset, more psychotic and mood symptoms, which may worsen later in life - less negative sympoms and disorganization

Question 133

Negative Symptoms

Answer 133

Affect - Flat or blunted affect Alogia - Reduced speech and fluency Avolition - Loss of motivation or the will to do things Anhedonia - Reduced experience of pleasure Asociality - Lack of interest in social interactions

Question 134

Bipolar I - Specifiers

Answer 134

``` With anxious distress (p. 149) With mixed features (pp. 149-150) With rapid cycling (pp. 150-151) With melancholic features (p. 151) With atypical features (pp. 151-152) With mood-congruent psychotic features (p. 152) With mood-incongruent psychotic features (p. 152) With catatonia (p. 152). With peripartum onset (pp. 152-153) With seasonal pattern (pp. 153-154) ```

Question 135

Language Disorder - Differential Diagnosis - Intellectual Disability

Answer 135

Language delay is often the presenting feature of intellectual disability, and the definitive diagnosis may not be made until the child is able to complete standardized assessments. A separate diagnosis is not given unless the language deficits are clearly in excess of the intellectual limitations

Question 136

ADHD - Differential Diagnosis - Bipolar Disorder

Answer 136

Individuals with bipolar disorder may have increased activity, poor concentration, and increased impulsivity, but these features are episodic, occurring several days at a time. In bipolar disorder, increased impulsivity or inattention is accompanied by elevated mood, grandiosity, and other specific bipolar features. Children with ADHD may show significant changes in mood within the same day; such lability is distinct from a manic episode, which must last 4 or more days to be a clinical indicator of bipolar disorder, even in children. Bipolar disorder is rare in preadolescents, even when severe irritability and anger are prominent, whereas ADHD is common among children and adolescents who display excessive anger and irritability.

Question 137

Pediatric Bipolar

Answer 137

Controversial How do we know it exists? Retrospective studies - Most adult bipolar patients report an onset prior to age 21 (as early as 13) - Associated with worse outcome Prospective - Depression in adolescnece has high rates of conversion to BP (20-40%) - 30% with BDNOS progress to I or II within 4 years

Question 138

Tourette's Disorder Criteria

Answer 138

A. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently. B. The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset. C. Onset is before age 18 years. D. The disturbance is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington’s disease, postviral encephalitis).

Question 139

Developmental Coordination Disorder - Differential Diagnosis - Joint Hypermobility Syndrome

Answer 139

Individuals with syndromes causing hyperextensible joints (found on physical examination; often with a complaint of pain) may present with symptoms similar to those of developmental coordination disorder

Question 140

Speech Sound Disorder Criteria

Answer 140

A. Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages. B. The disturbance causes limitations in effective communication that interfere with social participation, academic achievement, or occupational performance, individually or in any combination. C. Onset of symptoms is in the early developmental period. D. The difficulties are not attributable to congenital or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, traumatic brain injury, or other medical or neurological conditions. Different from langauge disorder because child can produce language in their head but have a hard time expressing languge

Question 141

Social (Pragmatic) Communication Disorder - Etiology and Course

Answer 141

High heritability, likely family hx Onset in early childhood, but problems not clearly distinguishable or stable until around age 4

Question 142

Motor Disorders (List)

Answer 142

Developmental Coordination Disorder Stereotypic Movement Disorder Tic Disorders Other Specified Tic Disorder Unspecified Tic Disorder

Question 143

Speech Sound Disorder - Differential Diagnosis - Structural Deficits

Answer 143

Speech impairment may be due to structural deficits (e.g., cleft palate).

Question 144

Disorganized Speech

Answer 144

Tangential or loose associations Circumstantial (so much detail you lose the train of thought) "Word Salad" - Unintelligible, incoherent speech Impairs effective communication Representative of impaired or disorganized thinking

Question 145

Disease

Answer 145

- a disorder where the underlying etiology is known | - it is the highest level of conceptual understanding

Question 146

Developmental Coordination Disorder - Differential Diagnosis - ID

Answer 146

If intellectual disability is present, motor competences may be impaired in accordance with the intellectual disability. However, if the motor difficulties are in excess of what could be accounted for by the intellectual disability, and criteria for developmental coordination disorder are met, developmental coordination disorder can be diagnosed as well.

Question 147

Schizophreniform - Specifiers

Answer 147

Specify if: With good prognostic features: This specifier requires the presence of at least two of the following features: - onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning - confusion or perplexity - good premorbid social and occupational functioning - absence of blunted or flat affect. Without good prognostic features: This specifier is applied if two or more of the above features have not been present. ``` Specify if: With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition). ``` Specify current severity: Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-Rated Dimensions of Psychosis Symptom Severity in the chapter “Assessment Measures.”) Note: Diagnosis of schizophreniform disorder can be made without using this severity specifier.

Question 148

Specific Learning Disorder - Impairment in Reading

Answer 148

Cannot read at the expected age level Dyslexia is one type Difficulty with: - Speed of reading (reading fluency) - Accuracy of reading (e.g. decoding) - Comprehension

Question 149

Complex vocal tic examples

Answer 149

combo of vocal tics echolalia (repetition of something heard) Copralalia (says profane things) Palilalia (repeating ones own words)

Question 150

Childhood Onset Fluency Disorder - Differential Diagnosis - Normal Speech Dysfluencies

Answer 150

The disorder must be distinguished from normal dysfluencies that occur frequently in young children, which include whole-word or phrase repetitions (e.g., 'T want, I want ice cream"), incomplete phrases, interjections, unfilled pauses, and parenthetical remarks. If these difficulties increase in frequency or complexity as the child grows older, a diagnosis of childhood-onset fluency disorder is appropriate.

Question 151

Developmental Coordination Disorder - Pevalence and Associated Features

Answer 151

Prevalence 5-6% amongth children ages 5-11 Male to female ranges from 2:1 to 7:1 Associated feature - "overflow" movements - Choreiform movements - Mirror movements

Question 152

Delusional Disorder - Criteria

Answer 152

The presence of one (or more) delusions with a duration of 1 month or longer. B. Criterion A for schizophrenia has never been met. Note: Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation). C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd. D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods. E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder.

Question 153

Simple motor tic examples

Answer 153

eye blinking head jerk shoulder shrug facial grimace

Question 154

Bipolar I - Criteria

Answer 154

A. Criteria have been met for at least one manic episode (Criteria A-D under “Manic Episode” above). B. The occurrence of the manic and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Question 155

Disorder

Answer 155

- like a syndrome, refers to a cluster of symptoms | - implies there is a disruption of normal functions in the body

Question 156

ADHD - Differential Diagnosis - ID

Answer 156

Symptoms of ADHD are common among children placed in academic settings that are inappropriate to their intellectual ability. In such cases, the symptoms are not evident during non-academic tasks. A diagnosis of ADHD in intellectual disability requires that inattention or hyperactivity be excessive for mental age.

Question 157

Brief Psychotic Disorder Criteria

Answer 157

A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2), or (3): 1. Delusions. 2. Hallucinations. 3. Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorganized or catatonic behavior. Note: Do not include a symptom if it is a culturally sanctioned response. B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning. C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition

Question 158

Speech Disorder - Age

Answer 158

Most speech sounds should be produced clearly by age 7 Late eight (l, r, s, z, th, ch, dzh, and zh) after age 8

Question 159

Shizophrenia - Development and Course

Answer 159

Onset stypically between late teens to early 30s - earlier onset predicts worse prognosis - worse inital psychotic episode, more likely they are to relapse (biggest predictor) Prodromal period - abnormalities of thought, language, perception, and motor behavior Gradual worsening of illness Psychotic event Causes impairment -- impaired cognition is common and can persist Chronic and lifelong: few recover to their premorbid state 30-40% of patients on therapeutic doses of antipsychotic medications continue to experience symptoms Negative symptoms more persistent and predict worse prognosis

Question 160

Developmental Coordination Disorder - Course

Answer 160

50-70% of children continue to have problems w/ movement and coordination through teens Functional outcomes: - Reduced participation in sports - Obesity and poorer physical fitness - poor self-esteem - emotional/behavior problems - impaired academic achievement

Question 161

ADHD Inattention Criteria

Answer 161

Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: ``` Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required. ``` a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate). b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading). c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction). d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked). e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines). ``` f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers). ``` g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, papenwork, eyeglasses, mobile telephones). h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts). i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

Question 162

Stages of Schizophrenia

Answer 162

3 stages - at least 6 months for the whole cycle - hard to pin point where prodrom begins and ends which makes it harder to track time Prodromal - usually 1-2 years ahead of active stage - symptoms vague, easy to miss - two types: initial prodrom and relapse prodrom Active - presence of positive and negative symptoms - at least one month Residual -presently no strong positive symptoms, may have mild symptoms, or negative symptoms

Question 163

Bipolar II - Critieria

Answer 163

A. Criteria have been met for at least one hypomanie episode (Criteria A-F under “Hypomanic Episode” above) and at least one major depressive episode (Criteria A-C under “Major Depressive Episode” above). B. There has never been a manic episode. C. The occurrence of the hypomanie episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. D. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Question 164

Schizophrenia - Differential Diagnosis - Delusional Disorder

Answer 164

Delusional disorder can be distinguished from schizophrenia by the absence of the other symptoms characteristic of schizophrenia (e.g., delusions, prominent auditory or visual hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms).

Question 165

Other Specified Bipolar and Related Disorder

Answer 165

Short duration hypomanic episodes Insufficient symptoms for hypomanic episodes Hypomanic episode w/o depression Short duration cyclothymia

Question 166

Shizophrenia - Functional Outcomes

Answer 166

Men are less likely to marry Social isolation Often need supported living Difficult to sustain employement -avolition, cognitive impairments, relapse of symptoms More medical problems - poor self-care - weight gain, diabetes, metabolic syndrome, cardiovascular and pumonary diseases Reduced life expectancy 20% attempt suicide, 10% complete

Question 167

Provisional Tic Disorder - Criteria

Answer 167

A. Single or multiple motor and/or vocal tics. B. The tics have been present for less than 1 year since first tic onset. C. Onset is before age 18 years. D. The disturbance is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., Huntington’s disease, postviral encephalitis). E. Criteria have never been met for Tourette’s disorder or persistent (chronic) motor or vocal tic disorder

Question 168

Delusional Disorder - Prevalence and course

Answer 168

.2% lifetime prevalence (approx.03% in literature) No gender differences -Jealous type more common in females Most frequent subtype is persecutory Generally stable, but a few go on to develop schizophrenia

Question 169

ADHD - Differential Diagnosis - ASD

Answer 169

Individuals with ADHD and those with autism spectrum disorder exhibit inattention, social dysfunction, and difficult-to-manage behavior. The social dysfunction and peer rejection seen in individuals with ADHD must be distinguished from the social disengagement, isolation, and indifference to facial and tonal communication cues seen in individuals with autism spectrum disorder. Children with autism spectrum disorder may display tantrums because of an inability to tolerate a change from their expected course of events. In contrast, children with ADHD may misbehave or have a tantrum during a major transition because of impulsivity or poor self-control.

Question 170

Specific Learning Disorder - Differential Diagnosis

Answer 170

Normal variations in academic attainment ID Learning difficulties due to neurological or sensory disorders Neurocognitive disorders ADHD Psychotic disorders

Question 171

Schizophreniform - Prevalence and Course

Answer 171

In the US 5x less common than schizophrenia 1/3 Recover and 2/3 go on to meet criteria for schizophrenia or schizoaffective people that truly have schizophreniform recover

Question 172

Specific Learning Disorder - Prevalence & Manifestation

Answer 172

5-15% among school-age children Estimated 4% among adults -people learn to cope and end up pursuing something that plays to their strengths rather than their weaknesses More common in males (2-3:1) Frequently preceded by attention, language, and motor delays Uneven profiles are common -Avg IQ, doing generally well but specifically bad at math, for example May include behavioral manifestations

Question 173

Bipolar I - Differential Diagnosis - ADHD

Answer 173

This disorder may be misdiagnosed as bipolar disorder, especially in adolescents and children. Many symptoms overlap with the symptoms of mania, such as rapid speech, racing thoughts, distractibihty, and less need for sleep. The "double counting" of symptoms toward both ADHD and bipolar disorder can be avoided if the clinician clarifies whether the symptom(s) represents a distinct episode.

Question 174

Speech Sound Disorder - Key Features

Answer 174

May be due to poor knowledge of speech sounds or trouble coordinating movements to make the sounds Substituting one sound for another or omitting certain sounds, or speaking with a lisp - wabbit - gaspetti - cotco Diagnosis must consider child's age and development -Age 2, gibberish speech is common By late teens, prevalance = 1 in 200

Question 175

Social (Pragmatic) Communication Disorder - Differential Diagnosis - ADHD

Answer 175

Primary deficits of ADHD may cause impairments in social communication and functional limitations of effective communication, social participation, or academic achievement.

Question 176

Autism Spectrum Disorder - Differential Diagnosis - ID without ASD

Answer 176

Intellectual disability without autism spectrum disorder may be difficult to differentiate from autism spectrum disorder in very young children. Individuals with intellectual disability who have not developed language or symbolic skills also present a challenge for differential diagnosis, since repetitive behavior often occurs in such individuals as well. A diagnosis of autism spectrum disorder in an individual with intellectual disability is appropriate when social communication and interaction are significantly impaired relative to the developmental level of the individual's nonverbal skills (e.g., fine motor skills, nonverbal problem solving). In contrast, intellectual disability is the appropriate diagnosis when there is no apparent discrepancy between the level of social-communicative skills and other intellectual skills.

Question 177

Developmental Coordination Disorder - Differential Diagnosis - ADHD

Answer 177

Individuals with ADHD may fall, bump into objects, or knock things over. Careful observation across different contexts is required to ascertain if lack of motor competence is attributable to distractibility and impulsiveness rather than to developmental coordination disorder. If criteria for both ADHD and developmental coordination disorder are met, both diagnoses can be given.

Question 178

Specific Learning Disorder - Criteria

Answer 178

A. Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties: 1. Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly or slowly and hesitantly, frequently guesses words, has difficulty sounding out words). 2. Difficulty understanding the meaning of what is read (e.g., may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings of what is read). 3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants). 4. Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization; written expression of ideas lacks clarity). 5. Difficulties mastering number sense, number facts, or calculation (e.g., has poor understanding of numbers, their magnitude, and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact as peers do; gets lost in the midst of arithmetic computation and may switch procedures). 6. Difficulties with mathematical reasoning (e.g., has severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems). -academic skills that are acquired or learned (not like IQ) B. The affected academic skills are substantially and quantifiably below those expected for the individual’s chronological age, and cause significant interference with academic or occupational performance, or with activities of daily living, as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment. For individuals age 17 years and older, a documented history of impairing learning difficulties may be substituted for the standardized assessment. C. The learning difficulties begin during school-age years but may not become fully manifest until the demands for those affected academic sl

Question 179

Language Disorder - Differential Diagnosis - Hearing or Other Sensory Impairment

Answer 179

Hearing impairment needs to be excluded as the primary cause of language difficulties. Language deficits may be associated with a hearing impairment, other sensory deficit, or a speech-motor deficit. When language deficits are in excess of those usually associated with these problems, a diagnosis of language disorder may be made.

Question 180

ADHD - Differential Diagnosis - Disruptive Mood Dysregulation Disorder

Answer 180

Disruptive mood dysregulation disorder is characterized by pervasive irritability, and intolerance of frustration, but impulsiveness and disorganized attenhon are not essential features. However, most children and adolescents with the disorder have symptoms that also meet criteria for ADHD, which is diagnosed separately.

Question 181

Intellectual Disability - Differential Diagnosis - Major and Mild Neurocognitive Disorders

Answer 181

Intellectual disability is categorized as a neurodevelopmental disorder and is distinct from the neurocognitive disorders, which are characterized by a loss of cognitive functioning. Major neurocognitive disorder may cooccur with intellectual disability (e.g., an individual with Down syndrome who develops Alzheimer's disease, or an individual with intellectual disability who loses further cognitive capacity following a head injury). In such cases, the diagnoses of intellectual disability and neurocognitive disorder may both be given.

Question 182

ADHD - Differential Diagnosis

Answer 182

Oppositional defiant disorder Intermittent explosive disorder Other neurodevelopmental disorders Specific Learning Disorder ID ASD Reactive attachment disorder Anxiety disorders Depressive disorders Bipolar disorder Disruptive mood dysregulation disorder Substance use disoders Personality Disorders Psychotic disorders Medication-induced symptoms of ADHD Neurocognitive disorders