Psych Illness Scripts - Sheet2 Flashcards
1
Q
Antisocial (Cluster B)
A
Exploits others; manipulative and irresponsible; difficulty maintaining relationships; criminal activity
2
Q
Avoidant (Cluster C)
A
Wants relationships but fears rejection & humiliation; lacking self-esteem
3
Q
Borderline (Cluster B)
A
Constantly shifting mood; prominent anger; fear of abandonment; pushes & pulls others simultaneously; self-destructive; dysphoric
4
Q
Cluster A
A
Paranoid; Schizoid; Schizotypal. “mad”
5
Q
Cluster B
A
Antisocial; Borderline; Histrionic; Narcissistic. “bad”
6
Q
Cluster C
A
Avoidant; Dependent; Obsessive-Compulsive. “sad”
7
Q
Dependant (Cluster C)
A
Relies on others for decision-making; fears loss of emotional support; destructive relationship
8
Q
Histrionic (Cluster B)
A
Excessive emotionality disrupts healthy relationships
9
Q
Impulse; Temptation; or Drive to act in a manner
A
consciously resist impulse and on other occasions plan an impulsive act. Increased tension & release of tension reinforcement. Regret & guilt.
10
Q
Intermittent explosive disorder
A
Attacks of aggressiveness. M>F. Relatives at risk for disorder. Aura; nonspecific EEG abnormalities; childhood trauma; trauma; encephalitis; hyperactivity. No sx between episodes.
11
Q
Kleptomania
A
impulsive stealing. tension; reward/release. Guilt; anxiety; remorse after. Steal items they don’t need & can afford. Fewer than 5% of shoplifters. SSRIs & behavior modification
12
Q
Narcissistic (Cluster B)
A
Grandiose; self-important; generally distainful of others
13
Q
OCD (Cluster C)
A
Perfectionistic; orderly; driven by logic over emotion
14
Q
Paranoid personality disorder (Cluster A)
A
Views others at untrustworthy; exploitive. Self as victim. Protects self.
15
Q
Pathological gambling
A
Gambling; lying to hide it; recouping losses; relying on others to pay gambling debts. 3% of US M>F. Onset in adolescence(M) and middle age(F). FHx increases risk. F likely to be married to alcoholic; absent men. Impaired metabolism to catecholamines (NE); stimulation-release mechanism. GA is best Tx.
16
Q
Pyromania
A
Fire setting; preoccupation with fire; firefighting equipment; etc. Begins in childhood & increases in destructiveness over time. M>F. Associated with mental retardation; alcoholism; truancy; animal cruelty. (not to be confused with fire setting in other major disorders; e.g. with hallucinations)
17
Q
Schizoid (Cluster A)
A
Aloof; prefers to be alone & doesn’t enjoy interpersonal encounters; unable to reach intimacy
18
Q
Schizotypal (Cluster A)
A
Eccentric; odd speech/behavior. May believe self to have special abilities; but not delusional
19
Q
Trichotillomania (an obsessive-compulsive disorder)
A
Compulsive hair pulling. Scalp most common. Other self-mutilation. Biopsy of hair follicle (trichomalacia). F>M. Comorbid with OCD; depression. Difficult tx.
20
Q
Bipolar disorder example
A
Self medication with alcohol; then other drugs. Started in youth. Some blackouts; denial & rationalization.
21
Q
Blackouts
A
Temporal lobe spiking. Some patients are more susceptible. Loss of memory & won’t know about them if drinking/using alone.
22
Q
denial
A
incoming information that is threatening or contradictory to stored memory is refuted
23
Q
intellectualization
A
event or memory is re-conceptualized in sufficiently abstract terms to distance it from original referent and associated conditioned emotional responses
24
Q
projection
A
an idea; feeling or behavior inconsistent with one’s self-concept is attributed to another person
25
regression
stress is responded to using cognitive processes from earlier developmental stages associated with periods of less stressful coping
26
repression
perceptions of threatening or contradictory experiences are neither recognized or remembered
27
Acute stress disorder
Person experiences; witnesses; or is confronted with an event that involve actual threatened death or injury and responds with intense fear; helplessness or horror. Results in intrusion; arousal; avoidance. nonspecific somatic distress common. Less than a month.
28
Agoraphobia
marked persistent fear or anxiety about 2 or more of the following situations; accompanied by avaoidance of the situations: using public transportation; being in open spaces; being in shops; theaters; cinemas; being in a crowd or being outside of the home alone
29
cognitive behavioral therapy
addresses factors of disorders by educating the pt about how anxiety develops; persists. Identify & confront their misperceptions; relax; interract; disrupt avoidance behaviors that perpetuate sx.
30
Dissociation
disruption; loss; absense of the usual integration of memory; consciousness and personal identity. Normally occurs when absorbed in a book. Associated with periods of fatigue and monotony like driving without remembering it.
31
Generalized Anxiety Disorder (GAD)
>6 mos of uncontrolled worries about health; safety; access to resources; and threats to other people. Mid teens-20s. Sometimes after onset of chronic illness. 5% prevalence 2F>1M
32
Medical-induced anxiety disorder
Due to another medical condition such as encocrinopathies (pheochromocytoma; hyperthyroidism; hypoglycemia); metabolic problems and neurological problems (such as vestibular dysfunction). Dx can be made if pt's medical condition is known to induce anxiety; and preceded the onset of anxiety.
33
Medication-induced anxiety disorder
Brought on by stimulants (cocaine; meth; ADHD meds; caffeine); alcohol (via mini-wthdrawals); and OTC decongestants and cough syrup. Panic attacks predominate.
34
OCD (Note that obsessive-compulsive disorders in DSM 5 include the following: body dysmorphic disorder; hoarding disorder; trichotillomania; excoriation disorder and body-focused repetitive behavior)
intrusive arousal and avoidance Sx. Rarely fear of doing something bad. Repeated acts. Recognize that fears are irrational and still neutralize them. M6-15; F 20-29 esp postpartum. 2% M>F peds; M=F adults. Common compulsions: checking; washing; counting; confessing; symmetry and precision; hoarding; >50% have multiple compulsions. Obsessions are intrusive thoughts that the patient perceives as unwanted; whereas delusions are unshakeable false beliefs; firmly held.
35
Panic Disorder
Recurrent panic attacks occuring over at least 1 month involving anticipatory anxiety and avoidance of situations. Sympathetic symptoms & anxiety. Onset in teens-40s. Chronic; relapsing. 1-3% community. 2F:1M.
36
PTSD
Person experiences; witnesses; or is confronted with an event that involve actual threatened death or injury and responds with intense fear; helplessness or horror. Results in intrusion; arousal; avoidance. nonspecific somatic distress common. At least a month. 8% varied prevalence by exposure risk. F>M with equal exposure. F sexual trauma; M War
37
PTSD physiology
unique pattern of endocrine dysfunction with low urinary cortisol; high NE metabolites. Partly reversible hippocampal shrinkage. Failure of glucocorticoid receptors to hinhibit initial intense alarm response.
38
Simple phobias
Fear of a situation or item. No tx until interfering with life. Blood; injury; and injection uniquely associated with vasovagal responses. Onset: animals 7; Blood 9; situations 2-7 & early 20s. 11% prevalence most common. Blood injury & injection more common in males. Treat with short acting benzos for symptomatic relief and densensitization for lasting relief.
39
Social phobia
Fear/panic with blushing of anticipated humiliation or rejection by others in social situations. Pt desires social activities & relationships. Dread leads to avoidance. Familial modeling; bullied past; humiliation as discipline; and disfiguring lesions associated. Bimodal onset 5yo & adolescence. Chronic. 3-4%. 3F:2M males seek tx. Use beta-blockers to reduce distress for public speaking.
40
Tx of anxiety disorders
Psychotherapy; SSRIs; MAOIs; dualacting antidepressants; Benzos. Beta blockers.
41
Major depressive episode
9 vegetative symptoms: SIG E CAPS
sleep; loss of interest; guilt; decreased energy; concentration difficulty; appetite disturbance; psychomotor retardation / agitation; suicidal thoughts. 5 are required for diagnosis.
42
Bipolar I
One or more episodes of mania (which lasts at least 1 week) with recurrent depressive episodes. Classic manic depression.
43
Bipolar II
Recurrent depressive episodes and one or more episodes of hypomania (mood with some or all of the features of mania; without psychosis — elevated mood that does not fulfill criteria for mania). The hypomanic episodes must last at least 4 consecutive days; for most of each of those days.
44
Cyclothymic disorder
Rapidly alternating mood states occurring continuously over a period of 2 years. Moods include symptoms of hypomania or depression but do not meet criteria for a full episode of either one. Not clinically impaired.
45
Dysthymic disorder (now called PERSISTENT DEPRESSIVE DISORDER)
“Eeyore” — persistently experience symptoms of depressed mood and at least 2 of the other characteristics of major depression. Dysthymic symptoms must be present for > 2 years. May be a lifelong quality or “personality trait.” superimposed episodes of major depression result in “double depression.” Must cause distress / impairment. Resembles borderline personality but less history of abuse.
46
Premenstrual Dysphoric Disorder
In week prior to menses; pt suffers from symptoms that include: modd lability; irritability; anger; anxiety; depression; sleep problems; over-eating; out of control; etc. Symptoms must be documented prospectively for at least 2 menstrual cycles. Symptoms must disappear after menses; and are not just exacerbation of ongoing interpersonal conflicts.
47
DSM Qualifiers (Mood disorder "with" ...)
- atypical features
- catatonic features
- melancholic features
- postpartum onset
- psychotic features
48
Somatization disorder aka somatic symptom disorder
Physical complaints without demonstrable physical findings and psychosocial factors sufficient to maintain or worsen the physical complaints. Includes complaints / symptoms in 4 domains: GI; sexual function; "pseudoneurological" and pain. More common in females. Most common symptoms in order: nervousness; back pain; weakness; joint pain; dizziness; extremity pain; fatigue .... Treat with CBT and routine frequent office visits. Do not offer unnecessary testing. Must begin prior to 30. Weekly to bimonthly visits indicated. (this is a learned expression of emotional or other stressor through somatic complaints - alexothymia)
49
Conversion disorder aka Functional Neurologic Symptom disorder
Alteration or loss of physical functioning with no explanatory pathology (for example focal paralysis; non-epileptic seizures). Common in children; can be associated in time or symbolically to a psychological stressor. Symptoms typically look neurological with pseudo-seizures and unexplained paralyses most common. Often starts under conditions of overwhelming stess such as funerals; etc. Treat with hypnosis; psychotherapy or PT. Unconscious response to stress. Often seen in rural / uneducated patients.
50
Body dysmorphic disorder (an obsessive-compulsive disorder)
"Imagined ugliness" -- preoccupation with minor or imagined physical flaw or deformity. Face most commonly involved. Equal between M and F. Comorbid with anxiety disorders. May lead to repeated cosmetic procedures. Consumers of recreational surgery and they are usually dissatisfied with the results. Treat with SSRIs; CBT.
51
Factitious disorder / Munchausen's Syndrome
Purposeful self inflicion of signs of illness or injury to elicit medical attention and care. Often seen in health care workers who are knowledgable. F > M. Munchausen's syndrome by proxy is when parents make kids sick; may qualify as abuse. In Factitious disorder the rewards for feigning illness are not clear; other than attention. Pt may respond to empathetic interview targetic stresses. Subconscious.
52
Malingering
Purposeful self-injury; inflicting or feigning of illness to escape punishment or achieve financial or other compensation. Common among prisoners and soldiers. Associated with antisocial personality disorder. NOT a mental illness; just aberrant behavior. The rewards of faking illness are clear -- time off; money; etc. Fully conscious.
53
Somatoform disorder not otherwise specified
Somatization that does not meet criteria for one of these other disorders. This is the most common one; not enough symptoms of sufficient duration to be otherwise diagnosed.
54
Illness Anxiety Disorder (formerly called Hypochondriasis)
Conviction that one has a particular disorder / disease despite no evidence. May lead to excessive testing which can cause damage; increasing anxiety. Often seen in older patients; but can begin at any age. Focus is on one particular symptom -- convinced they have a brain tumor. May respond to CBT.
55
Dissociative amnesia
Sudden amnesia; often related to traumatic experiences
56
Dissociative fugue
Sudden unexpected travel with inability to recall one's past. Often the pt does not know his own identity.
57
Depersonalization disorder
Feeling like one is outside looking in.
58
Dissociative identity disorder (multiple personality disorder)
Assuming one of several identities or "alters" when stressed. Usually related to childhood trauma
59
Psychosis
General term for a state where reality testing is impaired characterized by hallucinations; delusions; & varying degrees of disorganized thought; speech; behavior; and social impairment.
60
hallucinations
internally generated percieptions
61
delusions
Fixed; false beliefs
62
Schizophrenia
1% of world's population. M=F. Presents earlier in M. Reduced life expectancy; 10-15% suicide. Delusions; auditory hallucinations; thought disorder; + and - symptoms. Loose associations of thought. Agnosia.
63
Phases of schizophrenia
Prodromal (gradual change in behavior weeks-mos); Active (classical findings; disorganized thinking & behavior); Residual (continuing oddities of thinking adn behavior; delusions & hallucinations absent)
64
Types of schizophrenia
paranoid; catatonic; disorganized; undifferentiated; residual
65
Schizophrenia etiology
Decreased blood flow to frontal lobe cortex; temporal lobe; and hippocampus w/enlarged ventricles. Hereditary component observed (45-65% monozygoitc concorddence; 10% 1st degree relatives). Neurodevelopment disorder. Manipulation of D2 and 5HT are mainstays; also GABA & glutamate.
66
Schizophrenia tx
Typical (DA-2) and Atypical (DA-2 & 5-HT) drugs. Psychosocial interventions also critical.
67
Typical antipsychotics
EPS; Tardive dyskinesia; Neuroleptic malignant syndrome
68
Atypical antipsychotics
Metabolic syndrome & neuroleptic malignant syndrome
69
delerium (tremens)
50-yo F; 4 day hx of confusion "off her rocker" increasingly agitated & confused. treat with thiamine; IV sugars; diazepam/BNZ. look for other causes of illness or inability to drink precipitating current state.
70
Sundown syndrome/anaesthesia delerium
Post-op delerium. Slow EEG waves. Had a lengthy operation. Not demented. Give antipsychotic if tx at all (no need for BNZ) (haloperidol/risperidol) or wait. Won't remember it.
71
Mild dementia in elderly
Agitation in elderly pts (nursing home). Have a hard time analyzing; understanding environment. Structure/predictability is important. More effort put into making conversation & relationship clear & understandable.
72
Alzhemier's dimensia
Alleles coding for APOE4 is associated with formation of amyloid plaques which contribute to Alzheimer's. Alzheimer's findings include beta amyloid; tau proteins and neurofibrillary tangles. Cortical radiations of cholinergic neurons in the hippocampus; parietal lobes and occipital lobes are especially affected. Characterized by short term memory loss; progressive confusion; later personality changes; depression; etc.
73
Vascular dimensia aka "multi-infarct" dimensia
Small infarcts with variable; stepwise deterioration. Second most prevalent type of dimensia. Related to CV risk factors.
74
Huntington disease
AD disease with CAG repeats; increased huntingtin protein; chromosome 4. Causes destruction of caudate. Symptoms are paranoia; impulse dyscontrol; memory loss; psychosis and chorea. Characteristic "butterfly" pattern on neuroimaging.
75
Parksinson disease
Affects cortical radiations of dopamine neurons originating in the basal ganglia. Characterized by Lewy bodies on histo (alpha synuclein). Changes are due to cholinergic deterioration. Dimensia occurs late in the course of the disease.
76
Lewy body dimensia
Similar to Parksinson's but spares temporal areas. See Lewy bodies as in Parkinsons. It is much rarer than Alzheimer's but is the second most common primary degenerative dimensia. Severe motor symptoms; visual hallucinations; early memory loss and personality changes.
77
Pick disease (frontotemporal dimensia)
Characterized by frontal and temporal lobe atrophy. Dimensia is characterized by impulsive / disinhibited or anergic / apathetic; poor hygiene; loss of social skills; aphasia; no insight.
78
Dimensia secondary to other diseases
Mixed; fronto-temporal symptoms may predominate early on. Progression varies with the underlying condition. Diseases with associated dimensia include the following: HIV/AIDS; MS; SLE; alcohol related / thiamine deficiency; closed head injury; hypothyroidism; B12/folate deficiency; normal pressure hydrocephalus. See p. 354 for details.
79
Major causes of delirium
Major causes of delirium: drugs; metabolic or electrolyte abnormalities; endocrine disorders; nutritional deficiencies; infections; vascular disorders / autoimmune disorders; organ system failure; primary neurological disease and states of severe stress. No psychiatric etiologies of delirium. All medical. Characterized by alteration in consciousness. Test for delirium with mini mental status exam. Involves all neural circuits - not localized. Table on P362. EEG shows diffuse slowing of dominant rhythms (4-6 Hz vs 13-16 Hz nml) 1) treat underlying cause 2) modify risk fx 3) environmental interventions 4) pharmacological management of symptoms
80
Clinical features of delirium
Clinical features of delirium: acute onset; fluctuating course; impaired attention; altered level of consciousness; memory deficits; disorientation; disorganized throughts; perceptual disturbances; delusions; language disturbances; psychomotor disturbances; sleep disturbances and disturbances in affect.
81
Risk factors for delirium
Risk factors for delirium: extremes of age; preexisting cognitive impairment; preexisting medical condition; baseline poor health or disability; environmental conditions such as sensory deprivation; overstimulation; and intrusive medical procedures.
82
Delirium secondary to other diseases
Alzheimer's; Parkinson's ; MS; stroke; traumatic brain injury; epilepsy; AIDS; SLE; sleep apnea; endocrine tumors; vitamin deficiencies; chemotherapy and iatrogenic.
83
Descriptors of abnormal thought form in schizophrenia
derailment; tangential; circumstantial; neologism; blocking; word salad; clanging and preservation.
84
Schizophrenia
Positive symptoms and negative symptoms. See book. Criteria for Dx: an active phase with psychotic symptoms lasting > 1 month (unless interrupted by effective treatment); a total duration of symptoms regardless of phase (prodromal; active or residual) greater than or equal to 6 months.
85
Schizophreniform disorder
All the cardinal manifestations of schizophrenia but recover in less than the 6 months required to Dx schizophrenia. Better prognosis than schizophrenia.
86
Schizoaffective disorder
Major depression or mania co-occur with psychotic symptoms characteristic of schizophrenia. Psychotic symptoms persist during periods when the mood symptoms are absent for > 2 weeks. Treat with antipsychotic + antidepressant or mood stabilizer.
87
Delusional disorders
An isolated; non-bizarre delusion of a persecutory; jealous; somatic; or grandiose type. Onset is later in life than in schizophrenia. Treat with antipsychotics and SSRIs
88
Brief psychotic disorder
transient psychosis that develops suddenly after very stressful life event. Remits rapidly with minimal intervention; and does not typically develop a pattern of recurrence. Treatment is symptomatic.
89
Anorexia nervosa
AN characterized by overestimation of body size and shape with pursuit of thinness that combines excessive dieting and exercising. Can be restrictive or binge-purge subtype. Seen in white early adolescent females of above average SES and intelligence who are anxious and perfectionistic. (triad: distorted body image; fear of fatness; refusal to maintain normal body weight - <85%) - (can come in binge-purge version)
90
Bulemia nervosa
BN characterized by episodes of overeating followed by acts to eliminate or reduce the effects of the ingested calories: can be through vomiting; laxative use; exercise; or fasting. BN tends to be in later adolescence and is typified by impulsivity and difficulty in maintaining stable relationships and depression. HCl and K loss in vomiting.
91
sleep apnea
depressed down & out; daytime drowsiness alternate presentation
92
sexual paraphilias
"Intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal physically mature consenting human partners" 1. Erotic activities (spanking; bondage; whipping; strangulation; autoerotic asphyxiation; frottage) 2. Erotic targets(Children; animals; corpses; amputees; inanimate objects)
93
Cocaine intoxication
FEVER (adrenergic action on heteroreceptors in posterior hypothalamus) vasoconstriction/BP elevation; high HR; pupil dilation. DA release VTA/NA. Blocks reuptake of NTs.
94
PCP intoxication
Sometimes laced on marijuana. Strong stimulation; rage; impaired pain sensation; induced psychosis.
95
Amphetamine intoxication
increase release of chatecholamines
96
Toluene/paint inhallation
hippicuric acid as a metabolyte. Fright can cause sudden surge in catecholamines cause pro-arrhythmic crisis. (Sudden sniffing death syndrome) Avoid fright - let rest & be quiet. Very short t1/2. Adolescents & teens - because of availability. Perioral rash. MRI: multifocal white matter hypo-densities consistent with demyelination axonal degeneration.
97
Opiate intoxication
Pinpoint pupils; comatose state; depressed respiration. (also cyanotic skin. Central inhibition of Edinger Westfall nucleus causes pupil constriction)
98
Serotonin Syndrome
Akathesia; tremor; altered mental status; clonus; muscular hypertonicity; hyperthermia. SSRI SNRI SJW MAOI. Tx includes management of symptoms/hyperthermia; cessation of causititive agent(s) and possibly serotonin antagonists.
99
Neuroleptic malignant syndrome
Blockade of D2 in brain --> hyperthermia; extrapyramidal tremor; muscle rigidity. Concomitant use of anticholinergics; antidepressants; lithium. Depot preparations increase risk; haloperidol >>> clozapine). Remove the source. Bromocriptine (D2 agonist); dantrolene (hyperthermia); lorazepam may help symptoms.
100
Benzodiazepine OD
flumazenil is tx.
101
Malignant hyperthermia
Preciptitated by volatile anesthetics & succinylcholine. Wide-open Ca release by SR leads to heat; rigidity & metabolic acidosis. Treat symptoms and give ryanodine receptor antagonist dantroline
102
Anticholinergic poisoning
Unimpeded sympathetic activity. No muscular rigidity.
103
Intellectual disability
significant sub-average IQ. (in terms of communication; self-care; life skills; health & safety) Lower IQ than 2 stdev (2.1%ile) 70ish. 1-2% of population. lower SES for mild; others no correlation with SES. 2:1 M:F.
104
Mild ID
55-70. 85% of ID. educatable with assistance; read; write; math; concrete thinking. Can hold a job & live independantly.
105
moderate ID
40-55. 10% of ID. talk; recognize name; basic hygiene; do laundry; handle change. minimal academics. needs supervision.
106
Severe and profound ID
25-40; <25. Unable to complete self help; institutional setting necessary
107
Causes of ID
all but mild often have identifiable cause. FAS most common. Down; fragile X; Tay-Sachs; etc.
108
Learning Disorders in general
generally borderline IQ or above; mismach between IQ and achievement (2 stdev). Tx involves special ed. 2-8% of children 3:1 M:F.
109
Communication disorders
expressive language; language (mixed receptive-expressive); speech sound (phonological); childhood onset fluency (stuttering); communication disorder NOS.
110
phonological disorder: substitution; distortions; omissions; additions
wabert for robert; brlu for blue; oke for joke; aluminuminum for aluminum
111
PDD - pervasive development disorder
Autistic; Rett's (F; 6 mos nml followed by regression); childhood disintegrative; Asperger's; PDD NOS all in Autism Spectrum Disorder
112
Autism Spectrum Disorder development
Problems with social interaction (smiling; cuddling response; failure to develop spoken language); intense and rigid commitment to routines. 70% ID; 25% seizure disorder; 10-15/10k. Universal screening at 18 mos recommended.
113
Autism SD tx
educational; speech; language; social skills training; sensorimotor therapies; intensive behavior therapy; pharmacotherapy (no DMARDs; tx of sleep disturbance; aggression; etc)
114
ADHD
Combined; inattentive; and hyperactive-impulse types. Significant difficulty focusing and maintaining attn; hyperactivity; impulsivity. Must present for at least 6 mos; onset before 12 years (7 in IV); Impairment in at least 2 settings. 3-10% children 3:1 M:F; all cultures.
115
When does ADHD get diagnosed? Outcomes? Risks?
Not until 5-8 years because age-appropriate discretion doesn't happen until then. Executive functioning deficits. 1/3s: no change; some change; full remission. Associated with academic failure; legal difficulties; substance abuse; MVAs; vocational problems. 60% ODD. Also anxiety/depressive/learning/conduct/substance use associated.
116
ADHD etiology
Runs in families; more F FHx (but 3:1 M:F!) associated with familial mood/learning/substance abuse/antisocial disorders. Genes related to DA implicated. No neuroimaging currently being used.
117
Meds for ADHD
stimulants (methylphenidate; amphetamines) atomoxetine (BBW suicide); Alpha agonists (clonidine; guanfacine); antidepressants (buprion; TCAs like imipramine). Tx = decreased risk of substance abuse.
118
Oppositional Defiant Disorder
>6 mos with 4 or more symptoms and a pattern of negativistic; hostile; and defiant behavior. Looses temper; argues; defies; annoys; blames; touchy; angry; vindictive. 3-15% M:F 3:1; comorbid ADHD. Dx usually before 8; always before adolescence.
119
conduct disorder
Repetitive and persistent pattern in which the rights of others or apropriate norms or rules are violated. 3 or more criteria ind 12 mos at least in past 6 mos. Begins prior to Age 10. Bullies; fights; uses weapon; cruel to ppl or animals; robbery; forced sexual activity; fire setting; destroy property; breaking into things; lies; stealing; stays out at night before 13yo; ran away twice; truant before 13yo. 6-16% M; 2-9% F; 3-12:1. Males more likely violent. Leads to antisocial personality disorders in adulthood. Risks include poor discipline/supervision; low IQ; family conflict/low warmth/parental acceptance/affection; parental criminality. Tx involves training parents & pts; social skills training; conflict mgmt; multisystemic therapy.
120
transient tic disorder
Hasn't lasted long enough to be Tourette's; but has both motor and vocal tics.
121
chronic motor or vocal tic disorder
as much as 20% of kids. One or the other tic.
122
Tourette's disorder
Both motor and vocal tics; not necessarily concurrently; >1 yr duration; no tic-free prd >3 mos. Onset before 18yo; no organic cause can explain it; 10/10k; 3:1 M:F. 3-8 yrs; peak in adolescence; 20% remit in 20s. Alpha agents (clonidine/guanfacine) and neuroleptics (haloperidol; pimozide)
123
Enuresis
at least 5yo urine incontinence. Alarms are most effective Tx! (also DDAVP or desmopressin. imipramine)
124
Encopresis
at least 4 years old fecal incontinence. Tx complex.
125
Separation Anxiety Disorder
Separation is normal at 9 mos; but failure to outgrow it; causing impairment and lasting at least 4 wks is Dx. 3 or more of: distress; worry of loosing attachment figures; refusal to go to school; fear of being alone; failure to sleep; nightmares; physical symptoms. 4%; preschool and up to adolescent onset. May develop after life stress.
126
Selective mutism
<1% prevalence. Often speak at home; but nowhere else.
127
Reactive attachment disorder of infancy or early childhood
Begins before 5yo; inappropriate social relatedness. Associated with grossly pathological care. Inhibited: fails to initiate and respond to social interaction. Disinhibited: indiscriminate sociability or lack of selectivity in attachment figures.
128
Stereotypic Movement Disorder
repetitive; seemingly driven and nonfunctional motor behavior. interferes with normal activity or injurious. Commonly associated with ID
