Psychopathology Flashcards

Question

Agoraphobia | Anxiety Disorder

Answer 1

Dx requires – fear/avoid/require companion nearly always to 2+ of the 5 situations (public transportation, open spaces, enclosed spaces, standing in line/in a crowd, being outside alone) due to concern that escape will be difficult or no one is available for help if the person develops panic/incapacitating/embarrassing symptoms; fear/anxiety must be disproportionate to actual danger. Tx – * First-line in vivo exposure + response prevention. * Gradual exposure is used most often, but intense exposure is more effective w/ longer-term effects. * Combining in vivo exposure, applied relaxation, breathing or cognitive techniques does not significantly improve outcomes; key to outcomes is exposure & learning to tolerate high levels of fear/anxiety.

Answer 2

GAD more worry, worry about more things, & more somatic symptoms than nonpathological anxiety. Dx requires – excessive worry across events, activities on **most days for 6+ mo**; worry must be difficult to control, symptoms cause significant distress/impaired functioning; **3+ (or 1+ in kids) of the symptoms.** Location – **abnormalities in the ventrolateral & dorsolateral prefrontal cortex, anterior cingulate cortex, posterior parietal cortex, amygdala, & hippocampus. (reduced connectivity between prefrontal cortex & anterior cingulate cortex & amygdala leading to weak top-down control of amygdala activity)** Symptoms – * **restlessness, difficulty concentrating** * **sleep disturbance, easily fatigued** * **irritability, muscle tensions** * **children/adolescents**: worry more about **catastrophic events** + **competence** in sports/school * **older adults**: worry more about **health + safety** Comorbid – most common w/ MDD, followed by social anxiety, specific phobia, & PTSD in order. Risk factors – family hx of anxiety, neuroticism, harm avoidance, exposure to trauma in childhood or chronic stress Tx – * Most effective is CBT combined w/ psychopharm * First-line drugs are SSRIs & SNRIs * Patients who don’t respond to antidepressants, may benefit from anxiolytic buspirone/Buspar or benzodiazepine. * For severe symptoms , combining MI + CBT is helpful for anxiety disorders & OCD

Answer 3

Dx requires – Time-consuming (1+hr/d) recurrent obsession/compulsions &/or significant distress/impaired functioning; specifiers used to indicate level of insight. Location – **low serotonin w/ elevated activity in the caudate nucleus, orbitofrontal cortex, cingulate gyrus, & thalamus** Symptoms – * **Obsessions**: intrusive unwanted recurrent, persistent thoughts, urges, or images that on tries to suppressed/ignore & causes anxiety/distress. * **Compulsions**: repetitive behaviors or mental acts one is driven to perform resulting from rigid rules or obsessions * **Males**: earlier age of onset than females, slightly higher prevalence rate than females in childhood. * **Females**: slightly higher prevalence rate than males in adulthood Comorbid – 90% have other psychiatric disorders, most commonly anxiety followed by depressive or bipolar disorder, impulse-control disorder, & substance use disorder, in order. Tx – * **First-line tx exposure & response prevention (ERP; exposure & ritual prevention)**, which is in vivo or imagined exposure to anxiety-arousing thoughts, objects, situations & **preventing the engagement of the ritualistic behaviors.** * **Combined use of ERP + SSRI or clomipramine (TCA) is most effective for severe symptoms**, comorbid symptoms that respond to antidepressants, or when SSRI/TCA & ERP don’t work alone. * **CBT & ACT** are also effective tx

Answer 4

**Preoccupation w/ perceived defect/flaw in physical appearance that are considered non-existent or minor to others. Often believe others are mocking or noticing this flaw & often seek medical treatment to correct it.** Dx requires – **repetitive behaviors or mental acts for some time because of the defect/flaw; must cause significant distress/impaired functioning.**

Answer 5

Dx requires – **a) deficits in intellectual functioning as determined by clinical assessment, standardized intelligence testing (2+ SD below population mean)**;** b) deficits in adaptive functioning** causing failure to meet developmental/socio-cultural standards; **c) onset of deficits during developmental period.** **Specifiers used to indicate level of severity (mild, moderate, severe, or profound).** * 25-50% of case the cause is known * 80-85% prenatal factors (chromosomal or genetic causes) * 5-10% perinatal factors (asphyxia) * 5-10% postnatal factors. * Most common chromosomal causes are Down’s syndrome, then fragile X syndrome. * Most common preventable prenatal cause is fetal alcohol syndrome

Answer 6

Dx requires – **a) deficits in social communication/interaction across contexts; b) restrictive/repetitive patterns of behavior, interest, & activities w/ an insistence on sameness, hypo- or hypersensitivity to sensory input; onset of symptoms must be in early developmental period.** Chemicals – **-serotonin in several brain areas, +serotonin in the blood; dopamine, GABA, glutamate, & acetylcholine** Location – **abnormalities in the cerebellum, corpus callosum, & amygdala** **Prognosis – best w/ IQ over 70, functional language skills by 5y/o, & absences of comorbid mental health problems.** * Impaired face/emotion recognition; children 3-4y/o w/ ASD reacted differently to familiar & novel objects but reacted similarly to novel & familiar faces. **Difficulty recognizing face, voice, & body** * US 1-2% prevalence rates * Dx 4x more in males than females * Etiology is unknown, believed to be genetic & non-genetic factors * Accelerated brain growth starting at 6mo & plateaus by preschool w/ arger head circumference + brain volume & weight during that time Risk factors – * **Male gender** * **Birth prior to 26wks** * **Advanced parental age** * Exposure to environmental toxins during prenatal development Concordance rates – * **MZ twins 69-95%** * **DZ twins 0-24%** Tx – * **Goal is to minimize core symptoms, maximize independence** by promoting functional skills, reduce skills counterproductive to functional skills *** Early Intensive behavioral Intervention (EIBI)**, uses ABA skills for 40+hrs/wk (**greatest outcome on intelligence + language acquisition; less outcomes w/ adaptive, social, & core symptoms severity**)

Answer 7

Dx requires – **symptoms persisting for 6mo+, onset before 12y/o, present in 2+ settings, interferes w/ social, academic, or occupational functioning; requires 6+ symptoms (5+ if 17+)**. Specifiers indicate inattentive, hyperactive/impulsive, or combined presentations. Location – **abnormalities in the prefrontal cortex, cerebellum, amygdala, striatum, & thalamus; impaired temporal information processing.** **Children have reduced total brain volume, smaller prefrontal cortex, striatum, corpus callosum, & cerebellum with reduced activity in these areas.** Chemicals – **-dopamine, -norepinephrine ** Symptoms – *inattention* * Doesn’t listen when spoken to * Fails to attend to details * Doesn’t follow through on instructions * Easily distracted by extraneous stimuli * Often forgetful in daily activities * **Inattention continues in adulthood** *hyperactivity-impulsivity* * Unable to engage in play or leisure activities quietly * Often runs/climbs in inappropriate situations * Talk excessively * Trouble waiting their turn * Interrupt/intrudes * **Excessive motor symptoms decrease in adulthood, turn into impatience, restlessness** * **Impulsivity decrease in adulthood, turn into reckless driving, ending jobs/relationships abruptly, overspending** Comorbid – high rates with oppositional defiant disorder, followed by conduct disorder, anxiety disorder, & depressive disorder in order. Etiology – **low birth weight, premature birth, & maternal smoking/alcohol use during pregnancy.** Concordance rates – **of the most heritable psychiatric disorders, 76% across twin studies** * **MZ twins 71%** * **DZ twins 41%** Tx – * **Parent training in behavioral management (PTBM) most recommended** * **Parent- and teacher-administered behavioral intervention for preschoolers** * **Parent-child interaction therapy (PCIT)** * **Elementary/middle-school**: combo of meds + behavior interventions at home/school * **Adolescents**: combo of meds + behavioral/instructional interventions * **Adults**: first-line is meds; CBT is the strongest support Comorbid – dx in childhood is linked to increased risk of substance use in adolescence & adulthood (comorbidity rates have no impact w/ med use in childhood).

Answer 8

Dx requires –**1+ vocal tic & multiple motor tics occurring together or separate time; may wax & wane in frequency, but is persistent for 1yr+, onset before 18y/o.** Chemicals – **+dopamine** Location – **small caudate nucleus** Symptoms – * **Motor**: eye blinking, facial grimacing shoulder shrugging, echopraxia (mimicking others’ actions) * **Vocal**: throat clearing, barking, echolalia (mimicking others’ words) Tx – * **Antipsychotics** (haloperidol) * **CBIT** (CBT for tic interventions, psychoed, social support, habit reversal, competing response, relaxation training) Comorbid - most common with ADHD

Answer 9

Dx requires – **1+ vocal tic & 1+ motor tics persisting for 1yr+, onset before 18y/o.** Symptoms – * **Motor**: eye blinking, facial grimacing shoulder shrugging, echopraxia (mimicking others’ actions) * **Vocal**: throat clearing, barking, echolalia (mimicking others’ words)

Answer 10

Dx requires – **1+ vocal tic &/or 1+ motor tics persisting for less than 1yr, onset before 18y/o, usually 4-6y/o w/ severity peaking at 10-12y/o.** Symptoms – * **Motor**: eye blinking, facial grimacing shoulder shrugging, echopraxia (mimicking others’ actions) * **Vocal**: throat clearing, barking, echolalia (mimicking others’ words)

Answer 11

Deficits in language, speech, & communication. Dx requires – **disturbance in normal fluency & time patterning in speech, persists over time, includes 1+ of the seven symptoms. Onset 2-7y/o, 65-85% of children recover by 8y/o** Symptoms – * Sound & syllable repetitions * Sound prolongations * Broken words * Audible or silent blocking * Circumlocutions * Word pronounced w/ excessive physical tensions * Monosyllabic whole-word repetitions Tx – * **habit reversal, competing response, regulating breathing**

Answer 12

Deficits in language, speech, & communication. Dx requires – **difficulties in academic skills; 1+ of the six symptoms for 6mo+ despite interventions that address the difficulties. Academic skills must be substantially lower than age-appropriate, interfere with academic/occupational performance or ADL; onset during school-aged yr. Specifiers indicate subtype (reading, written expression, math) and level of severity.** Symptoms – * Inaccurate/slow/effortful word reading * Difficulty w/ comprehending read words, spelling, written expression. * Difficulty w/ number sense, number facts, or calculation & difficulties w/ math reasoning * **5-15% of school-aged children have this dx w/ 80% having reading disorder, most commonly dysphonic dyslexia** (struggle to connect sounds to letter) * They have average to above average IQ * More comorbidities Comorbidity - **ADHD**

Answer 13

Dx requires – **exposure to a traumatic/stressful event**; a) persistent pattern of **inhibited/withdrawn emotions/behaviors toward caregivers** by not seeking comfort when distressed + b) persistent social & emotional disturbances **including 2+ symptoms**; + **hx of extreme insufficient care** by caregiver; **onset between 9mo – 5/yo.** Symptoms – * **minimal social/emotional responsiveness to others** * **limited positive affect** * **unexplained irritability, sadness, or fearfulness when interacting w/ adult caregivers**

Answer 14

Dx requires – **exposure to a traumatic/stressful event**; a) persistent pattern of **inappropriate interactions w/ unfamiliar adults**, as demonstrated by 2+ of the symptoms + **hx of extreme insufficient care by caregiver**; **onset of at least 9mo.** Symptoms – * **reduced/absent reticence in approaching/interacting w/ strangers** * **overly familiar behavior w/ strangers** * **diminished/absent checking w/ adult caregivers after separation** * **willingness to accompany stranger w/ little/no hesitation**

Answer 15

Dx requires – **exposure to real threat**; **symptoms lasting 1mo+**& cause significant distress/impaired functioning;**four types: intrusion** (recurrent memories of event), **persistent avoidance** of associated stimuli, **negative mood/cognitive changes**, **arousal/reactivity changes.** Chemicals -**+dopamine, +norepinephrine, +glutamate, -serotonin, - GABA** Location – **hyperactive amygdala + anterior cingulate cortex, hypoactive ventromedial prefrontal cortex which inhibits top-down amygdala control resulting in exaggerated fear response, reduced volume of the hippocampus.** Tx – * **adults**: strongly recommended **CBT, CPT, cognitive therapy, prolonged exposure**; conditionally recommended **brief ECT, EMDR, narrative therapy; single-session debriefing or incident stress debriefing or group debriefing is no effective & may be harmful.** * **teletherapy** of trauma-focused therapies were **equal** to **face-to-face** * **children/adolescents**: APA does not address guidelines, but **trauma-focused CBT** was designed for 3-18y/o & involves family therapy, parenting skills, & parent-child therapy. * **APA guidelines gives conditional recommendations for SSRIs** (fluoxetine/Prozac, paroxetine, & sertraline) **& SNRI** (venlafaxine) t**o alleviate core symptoms of avoidance/numbing, re-experiencing, & hyperarousal**

Answer 16

Dx requires – **exposure to a real threat**; 9+ symptoms from any of the 5 categories (intrusion, negative mood, dissociative symptoms, avoidance, or arousal); lasting 3d – 1mo, causing significant distress/impaired functioning.

Answer 17

Dx requires – **death of close person 12mo+ ago (adults) 6mo+ (children/adolescents); intense yearning for the deceased &/or preoccupation w/ thoughts + 3+ of the eight symptoms nearly daily for 1mo+.** Some symptoms – * marked **sense of disbelief about the death** * **avoidance of reminders** about the dead person * **emotional numbness** * **intense loneliness**

Answer 18

often related to exposure/victimization to a traumatic event. Dx requires – **inability to recall important info** that is beyond ordinary forgetfulness & causes significant distress/impaired functioning; **amnesia either localized** (most common, inability to recall event during a period of time), **selective** (inability to recall some events during a period of time), **generalized** (complete loss of memory for one’s entire life), **systematized** (loss of memory for specific information category), or **continuous** (inability to remember new events as they happen). **Specifier used to indicate dissociative fugue** (purposeful travel or purposeless wandering associated w/ memory loss)

Answer 19

Dx requires – **persistent/recurrent episodes of depersonalization** (sense of unreality, detachment, or outside observer of one’s thoughts/actions) **or derealization** (sense of unreality or detachment w/ regard to one’s surroundings); **paired w/ intact reality testing & significant distress/impaired functioning.**

Answer 20

Dx requires – **1+ somatic symptoms causing distress or impaired functioning; paired w/ excessing thoughts/emotions/behaviors related to the symptoms/health concerns in the form of 1+ of the following:** **disproportionate/persistent thoughts** about the seriousness of symptoms, **persistently high anxiety level** about health/symptoms, **excessing time/energy spent** on health concerns/symptoms. **Specifiers used to indicate mild, moderate, or severe symptoms, if symptoms involve predominant pain, &/or are persistent (severe w/ marked impairment for 6mo+)**

Answer 21

Dx requires – **6mo+ of preoccupation w/ having a serious illness w/ no/mild somatic symptoms, excessive anxiety about health, & either excessive health-related behaviors or avoidance of healthcare.**

Answer 22

Dx requires – **1+ symptoms involving disturbance in voluntary motor or sensory functioning (paralysis, blindness).** **Symptoms incompatible w/ known neurological/medical conditions** & cause significant distress or impaired functioning. **Specifiers indicate symptom type, acute or persistent course of disorder, & presence/absence of psychological stressor.** *disorder **can include psychogenic non-epileptic seizure (PNES) that only behaviorally resembles true epileptic seizures; EEGs are used for dx** because the person’s behaviors won’t correspond w/ the brains electrical activity.

Answer 23

Dx requires – **DSM-5-TR distinguishes between imposed on self & imposed on another. Self: falsify or induce physical or psychological symptoms associated w/ deception; present to others as being ill/impaired w/o obvious external reward. Others: same by on others (child/parent).** **Differential: Malingering** – faking symptoms** for external reward** (drugs, money); research shows malingering patients **answer forced-choice questions more than 50% incorrectly, which is beyond that of chance.** **Feigned memory loss is present both disorders when mimicking a TBI or related disorder.** Ppl w/ genuine **memory loss & recovery is gradual & hazy & believe that hints/clues will help them remember; fakers experience it suddenly & deny any memory of event** (as opposed to hazy memories). Tests – **Test of Memory Malingering (TOMM; forced choice**; malingering patients score 50% below chance level)

Answer 24

Dx requires – **persistent eating of non-nutritive, nonfood substances**; **1mo+** that’s inappropriate for the developmental level/culture/social acceptance practice. **No age of onset, but most common in children + pregnant women.** Can lead to medical complications including lead poisoning intestinal obstruction.

Answer 25

Dx requires – **restricting food** to cause **significant low body weight**; a) i**ntense fear of weight gain** + related behaviors; b) **disturbance in their experience w/ their weight/shape** or lack of awareness of their low weight. **Specifiers indicate type (restricting or binge-eating/purging), course (partial or full remission), & severity (BMI).** Tx – * **Goal**: restore healthy weight + address physical complications. * **Subsequent goals**: increase tx motivation, nutrition education, cognitive restructuring, improving low self-esteem, impulse control, enlisting family support, prevent relapse. * **CBT for anorexia post-hospitalization** * **family-based tx (FBT) for anorexia in outpatient for adolescents** includes 1) parents in charge of weight/nutrition restoration w/ therapist’s help 2) control over food is gradually returned to the teen 3) developmental issues are address w/ health parent-child relationships & balance of independence * **enhanced CBT (CBT-E) for eating disorders**, personalized/flexible treatment focusing on the individual patient’s symptoms * **antipsychotic olanzapine is linked but not proven to foster weight gain; SSRI fluoxetine is linked but not proven to improve weight maintenance; due to the lack of psychopharm consensus, its recommended to treat comorbid symptoms (depression/anxiety)** Comorbidity – **depression & anxiety (mainly OCD) w/ evidence anxiety preceding symptoms onset** Prognosis – **high relapse rates, of the most difficult to treat, harder to treat than bulimia.**

Answer 26

**More distressed by their symptoms than anorexics & therefore more motivated to change. This autonomous motivation has led to better outcomes + lower risk of tx drop-out than controlled (extrinsic) motivation.** **dysfunctional dieting precedes bulimia** Dx requires – binge-eating, sense of no control, compensatory behaviors (self-induced vomiting, excessive exercise); **binge-eating w/ compensatory behavior must occur 1x/wk for 3mo+.Specifiers indicate course (partial or full remission) & severity (average number of episodes per wk)** Tx – * **Nutritional rehabilitation plus CBT, CBT-E, IPT, or family-based therapy (FBT)** * **CBT, CBT-E, & IPT have comparable effects, but CBT & CBT-E are preferred since IPT takes longer.** * **FBT** for bulimia is similar to FBT for anorexia, except in phase one, the **focus is on disrupting the binging, purging,** & the nature of all phases is also different because bulimic experience their symptoms as ego-dystonic so **they’re motivated to change, resulting in more collaboration w/ parents.** * **SSRI (mainly fluoxetine) is effective for alleviating comorbid depression, as well as reducing bulimic symptoms.** * **Combined SSRI w/ CBT is as or more effective than CBT alone.** * **CBT-E is most effective**, involves **stage 1)**engaging in treatment, self-monitoring, identifying processes that maintain behaviors; **stage 2)** reviewing progress, identifying new problems, revising if necessary; **stage 3)** addressing overevaluation of shape/weight + thought origins, identifying triggers, addressing perfectionisms, low self-esteem, interpersonal problems; **stage 4)** identifying ways to maintain progress + reduce risk of relapse. * **Teletherapy and face-to-face are equally effective w/ in-person clients abstaining from binge/purge behaviors slightly more than virtual & having significantly greater reductions in eating-disordered cognitions.** Comorbidity – **depression & anxiety w/ evidence anxiety preceding symptoms onset**

Answer 27

**2-3x more common in women than men; dieting often follows BED onset.** Dx requires – recurrent episode of binge eating, sense of no control over food;** 3+ of the five symptoms occurring 1x+/wk for 3mo+. Severity (mild, moderate, severe, extreme) determined by number of episodes/wk.** Symptoms – * Eating faster * Eating until uncomfortably full * Eating large amounts when not hungry * Feeling alone because of binging * Feeling disgusted/depressed/guilty about one’s binging Tx – * **CBT-E + IPT; CBT-E is more effective.** * **SSRIs (fluoxetine, paroxetine, sertraline), anti-seizure medication topiramate, & CNS stimulant lisdexamfetamine; meds alone are less effective than CBT + combining meds w/ CBT is no more effective than CBT alone.** * **Recommended to focus on binge-eating before/concurrent w/ weight loss w/ those who are obese/overweight.** Comorbidity – **depression & anxiety w/ evidence anxiety preceding symptoms onset**

Answer 28

Dx requires – **repeated voiding of urine in bed/clothing occurring 2x+/wk for 3+ consecutive mo**; always involuntary, no due to other condition; **must be 5y/o+** or of similar developmental level. **Specifier indicates nocturnal only, diurnal only, or both.** Symptoms – * **nocturnal enuresis most common tx is moisture alarm** (bell-&-pad) in which a bell rings when the child begins to urinate while sleeping. * **antidiuretic hormone desmopressin** used alone also reduces/stops bedwetting, but has high risk for relapse when discontinued

Answer 29

**Patients overestimate sleep latencies & time spent awake & underestimate total time asleep. (basically exaggerate symptoms)** Dx requires – unsatisfied sleep quality/quantity associated w/ **1+ of three symptoms occurring 3+ nights/wk for 3mo+** despite opportunities for sleep causing significant distress/impaired functioning. **Types: sleep-onset (initial), sleep maintenance (middle), late. Most common is all three, with middle type being most common single-type.** Symptoms – * Difficulty initiating sleep **(initial)** * Difficulty maintaining sleep **(middle)** * Early-morning waking w/ inability to return to sleep **(late)** Tx – * **Multi-component CBT** that incorporates **stimulus control** (only being in bed when tired/going to sleep) **+ sleep restriction** (restricting time allotted for sleep) **w/ sleep-hygiene education, relaxation training, &/or cognitive therapy**

Answer 30

Many have **hypnagogic** (right before sleep) or **hypnopompic** (right after waking) **hallucinations** which are vivid &/or experience sleep paralysis. **Cataplexy is triggered by strong emotion so ppl try to emotion regulate to prevent sleep episodes.** Dx requires – **irrepressible need to sleep causing** sleep or daytime naps 3x+/wk for 3mo+; cataplexy** (loss of muscle tone), **hypocretin deficiency, or REM latency of 15min- as determined by nocturnal sleep polysomnography.** Tx – * **Combo of behavioral strategies** (good sleep habits, naps, staying active) **+ meds to increase alertness & reduce cataplexy** (modafinil/armodafinil to increase dopamine; amphetamines; psychostimulants like methylphenidate to increase dopamine mainly, along w/ serotonin & norepinephrine) * **Meds targeting cataplexy is antidepressants (venlafaxine, fluoxetine, & clomipramine).** * **Treatment resistant patients find sodium oxybate helpful**as it improves deep sleep at night, & reduces cataplexy & daytime sleepiness.

Answer 31

**Often occurring in childhood, decreased frequency w/ age.** Occurring during the **first third of a major sleep period in stage 3 or 4; they are unresponsive to being woken up or comforted; little or no memory of the dream/episode.** **Sleepwalking**: getting out of bed during sleep, walking about, eating, or sex behaviors; **Sleep terrors**: abrupt arousal from sleep starting w/ panicky scream + intense fear & ANS arousal (tachycardia, rapid breathing).

Answer 32

Dx requires – **repeated occurrence** of extended, extremely dysphoric, well-remembered dreams involving threats to survival, security, or physical integrity; **paired w/ REM in the second half of a major sleep period;** when awake is alert, oriented, by mood may still be dysphoric.

Answer 33

Dx requires – intense/persistent sexual interest of a physically immature non-consenting human; causes significant distress/impairment or entails risk of harm to self or others. * Frotteuristic Disorder * Transvestic Disorder * Pedophilic Disorder * Fetishistic Disorder * Exhibitionistic Disorder Tx – * **Combined CBT w/ group therapy, marital therapy, &/or pharmacotherapy.** * **Cognitive strategies** include cognitive restructuring & empathy + skills training. * **Behavioral strategies** include classical conditioning using covert sensitization (aversive counterconditioning, replacing inappropriate fantasy w/ fear/negative response) and orgasmic (masturbatory) reconditioning. Drugs – *reduce sexual desire, but w/ severe SE + high relapse risk w/ discontinuation.* * **Gonadotropin-releasing hormone (Lupron)** * **Antiandrogens (Depo-Provera)** *** SSRIs are used w/ less serious disorders** to** reduce depression/compulsions that trigger paraphilic behavior**

Answer 34

Dx requires – clinically significant disturbance in ability to respond sexually or experience sexual pleasure. **All but one disorder have specifiers for onset (lifelong or acquired), extent (generalized or situational), & severity (mild, moderate, severe).** * Erectile Disorder * Premature (Early) Ejaculation * Genito-Pelvic Pain/Penetration Disorder * Female Orgasmic Disorder

Answer 35

Dx requires – 1+ of the 3 symptoms on 75-100% of all occasions for 6+ mo of sexual activity; organic etiology can be r/o if erections occur during unplanned events (mornings, spontaneous, other sexual partners). Tx – * **Behavioral techniques** (performance anxiety + increase sexual stimulation using Masters & Johnson sensate focus method) + **pharmacotherapy**. * **Masters & Johnson sensate focus**: series of activities for couples designed to promote intimacy, reduce anxiety by focusing on **pleasurable sensations associated w/ non-sexual touching, then sexual touching, & lastly with sexual intercourse.** Drugs – **increase blood flow to the penis** * Sildenafil/Viagra * Tadalafil/Cialis * Vardenafil/Levitra Symptoms – * **difficulty obtaining** an erection during sexual activity * **difficulty maintaining** an erection during sexual activity * **decreased erectile rigidity**

Answer 36

Dx requires – symptoms present for **6mo+, occurring 75-100% of all sexual activity;** persistent/recurrent pattern of ejaculation during sexual activity **w/i 1min of virginal penetration or before one desire it.** Chemicals -**-serotonin** Tx – * **Masters & Johnson sensate focus** * **Start-stop or pause-squeeze** technique to learn to** control ejaculation** Drugs – * **SSRIs (paroxetine/Paxil) can delay ejaculation** in some men

Answer 37

Dx requires – persistent/recurrent problems w/ **1+ of the symptoms for 6mo+; linked to hx of sexual/physical abuse & sometimes onset is after hx of vaginal infections.** Symptoms – * Vaginal penetration during intercourse * Vulvovaginal/pelvic pain during intercourse or penetration attempts * Anxiety about vulvovaginal/pelvic pain before, during, or resulting from vaginal penetration * Tensing of pelvic floor muscles during attempted vaginal penetration Tx – * Masters & Johnson sensate focus * Relaxation training * Topical anesthetic * Vaginal dilators * Kegel exercises to increase pelvic muscle control

Answer 38

Involves problems with self-control of emotions + behaviors. * **Oppositional Defiant Disorder** * **Conduct Disorder** * **Intermittent Explosive Disorder**

Answer 39

Dx requires – recurrent pattern of angry/irritable mood, argumentative/defiant behavior, &/or vindictiveness as evidenced by **4+ symptoms that occur with 1+ persons other than siblings for 6mo+,**have caused distress for the individual + others in their immediate social context or has negative impact on their functioning. **Etiology** – * More common in boys than girls for children * Equally often in boys & girls when it occurs in adolescence. * 30% of children who have dx of ODD eventually receive a dx of Conduct Disorder with an early age of onset being associated with a higher risk of Conduct Disorder. Symptoms – * Often loses temper * Angry resentful * Often deliberately annoys others * Often blames other for their own mistakes/misbehavior Tx- * **No optimal tx but most effective is multimodal + tailored to the age, symptoms, & comorbidities.** * **1st line tx is the same for those with Disruptive Behavior Disorder**

Answer 40

Dx requires – **persistent pattern of behavior that violates the basic rights of others &/or age-appropriate social norms/rules by 3+ symptoms within the past 12mos + 1+ symptoms with the past 6mos. Cannot be given to a person 18y/o+ who meets criteria for Antisocial Personality. Specifiers based on number of conduct problems + their consequences (mild, moderate, & severe).** **Subtypes** – * **Childhood-onset with 1+ symptoms prior to 10y/o (associated with higher aggressiveness + greater risk for future dx of Antisocial Personality &/or substance use.)** * **Adolescent-onset with no symptoms prior to 10y/o** * **Unspecified onset when onset unknown** **Etiology** – * More common in males than females * Symptoms may occur during early childhood, more often emerge between middle childhood & middle adolescence * * Biological + environmental influences: abnormalities in the brain structure/function, neurotransmitter +neuroendocrine abnormalities (-serotonin, -dopamine) linked to more aggression + risky behaviors & less sensitivity to punishment, prenatal exposure to opiates/alcohol, & negative parenting practices (harsh + inconsistent punishment). * Teen males with childhood or adolescent onset CD have the same cortisol levels in the morning but have higher cortisol levels in the evening than others of the same age/sex. * These teens also didn’t experience an increase in cortisol levels when in stressful situations (although affectively they presented the same). Leading Fairchild to suggest CD youth have poorer coordination between emotional & physiologic arousal. Symptoms – *Categories* * **Aggression to people + animals** * **Destruction of property** * **Deceitfulness/theft** * **Serious violation of rules**

Answer 41

**Life-Course-Persistent Type**– * Pattern of increasingly serious antisocial behaviors beginning in early childhood & continues into adulthood & across situations. * Result of neuropsychological deficits affecting temperament, cognitive abilities, & other characteristics & adverse child-rearing environment. **Adolescence-Limited Type** – * Temporary + situational type of antisocial behavior. * Result of “maturity gap” between an adolescent’s biological + sexual maturity & their social maturity. Behaviors serve as a way to attain mature status. *DSM-5 aligns with Moffitt’s descriptions, such that Conduct Disorder remits by adulthood, especially for those with adolescent onset. In contrast, those whose symptoms began in childhood have a worse prognosis & “increased risk for criminal behavior, conduct disorder, & substance-related disorders in adulthood.”

Answer 42

Psychosocial interventions are 1st line tx, categorized as child-focused, parent-focused, family-focused, or multimodal. **Child-Focused Intervention** – * **Problem-Solving Skills Training (PSST)** for children + adolescents with CD or another disruptive behavior disorder (ODD); focuses on cognitive reprocessing underlining problem behaviors, helps to perceive others’ feelings more accurately, understand consequences of their actions, + identify prosocial ways to resolve interpersonal problems. **Parent-Focused Interventions** – * **Parent Management Trainings Oregon Model (PMTO)** for parents of children 2-18y/o; assumes the child’s aggressive, antisocial, & related behaviors are due to an escalating cycle of coercive interactions between child & parent; replaces coercive parenting with positive parenting (positive reinforcement, non-coercive discipline, setting limits, & monitoring behaviors). * **Kazdin’s Parent Management Training (PMT)** for parents of children 2 -17y/o with oppositional, aggressive, &/or antisocial behavior; based on operant conditioning, focuses on replacing antecedents + consequences that maintain problem behaviors with antecedents + consequences that foster desirable behaviors. PMT has positive effects on child symptoms, parent symptoms, & family relationships. * **PMT + PSST is more effective than either tx alone for improving child + parent functioning.** * **Parent-Child Interaction Therapy (PCIT)** for parents of children 2 -7y/o with severe behavioral problems; evidence-based intervention for children at risk of maltreatment; focuses on altering negative parent-child interactions + consists of child-directed interaction phase that enhances the parent-child relationship & parent-directed interaction phase teaches parents effective disciplinary practices. **Family-Focused Interventions** – * **Functional Family Therapy (FFT)** for families of children 11 -18y/o who externalize behavior disorder &/or substance use problems or high risk for delinquency; assumes problem behaviors within a family help regulate relational connections by fostering interdependence or independence + regulate hierarchies by creating power structures; main goal is to replace problem behaviors with non-problem behaviors that serve the same functions. * **Multidimensional Family Therapy (MDFT)** for families of children 11 -21y/o with substance use disorder + comorbid internalizing/externalizing symptoms &/or delinquency; has family systems theory, ecological theory, + developmental psychology; main goal is to reduce/eliminate adolescent substance use, aggression + other symptoms & improve adolescent + family functioning by facilitating change in 4 interdependent domains (adolescent, parents, family interactions, & extrafamilial sources of influence). **Multimodal Interventions** – * **Multisystemic Therapy (MST)** intensive family + community based interventions for 12 -18y/o with imminent risk for out-of-home placement due to antisocial behaviors, substance use, &/or SMI; based on **Bronfenbrenner’s ecological theory, assumes problem behaviors are from multiple risk factors at the individual, family, peer, school, + community levels & that interventions must be provided at all levels.** * **Research for MST mostly involved impoverished families, single-parent families, & African American & other racial/ethnic minority families.** * **MST-CAN is a version for abused + neglected children 6 -17y/o.** * **Multidimensional Treatment Foster Care (MTFC)** an alternative to RTC for children + adolescents when need intensive support because of maltreatment, severe emotional disturbance, &/or juvenile delinquency; creating a behavioral management plan tailored to the child & administered by a treatment team in the home, school, & community; children reside with highly trained + supervised foster parents while their bio-parents receive training + support for positive reunification. * **Scared Straight** programs for conduct disorder have harmful effects & increase likelihood that juvenile offenders or juveniles at-risk will engage in future criminal behaviors. * **Confrontational** “rap sessions” & nonconfrontational (educational) approaches have negative effects & lead to worse outcomes for seriously delinquent juveniles.

Answer 43

Dx requires – level of **aggression unproportionable to provocation or social stressors**; outbursts **aren’t premeditated or committed to achieve tangible outcomes**; causes significant distress to the individual, impaired functioning, interpersonal functioning issues, &/or negative financial/legal consequences; **must be 6y/o+ or of equal developmental level; onset in childhood or adolescence;** recurrent behavioral outbursts due to **failure to control aggressive impulses** manifested by **one of the following:** * **Verbal or physical aggression occurring 2x/wk on average for 3mo+** with physical aggression **not leading to property damage or physical injury to others.** * **3 behavioral outbursts in 12mo resulting in property damage or physical injury to others.**

Answer 44

**Substance Use Disorders** Dx requires – **a cluster or cognitive, behavioral, & physiological symptoms indicating the individual continues use despite significant substance-related problems**; can be dx for **all classes except caffeine**; **specifiers indicate severity determined by number of symptoms and if the person is in early or sustained remission, on maintenance therapy, or in a controlled environment;** **person must have 2+ symptoms within a 12mo period**. **Substance Induced Disorder** Dx requires – **intoxication, substance withdrawal, & substance/medication induced mental disorders** (substance-induced depressive disorder, anxiety disorder, major neurocognitive disorder, withdrawal delirium); hallucinogen-induced disorders include hallucinogen persisting perceptual disorder. **10 classes**: * Alcohol * Caffeine * Cannabis * Phencyclidine + other hallucinogens * Inhalants * Opioids * Sedatives * Hypnotics * Anxiolytics * Stimulants * Tobacco * Other/Unknown

Answer 45

Dx requires – **problematic behaviors + psychological changes** such as inappropriate sexual or aggressive behavior, mood lability, impaired judgment **with 1+ of the 6 symptoms.** Symptoms – * Slurred speech * Incoordination * Unsteady gait * Nystagmus (repetitive, uncontrollable eye movements) * Impaired attention/memory * Stupor or coma

Answer 46

Dx requires – **2+ of 8 symptoms that develop within several hours to a few days following cessation or reduction of heavy/prolonged alcohol use.** Symptoms – * Autonomic hyperactivity * Hand tremor * Insomnia * Nausea/vomiting * Transient hallucinations/illusions * Anxiety * Psychomotor agitation * Generalized tonic-clonic seizures

Answer 47

Dx requires – significant decline in **1+ cognitive domains inferring with independence in daily activities**; **specifiers used to indicate if nonamnestic-confabulatory type or amnestic-confabulatory type (Korsakoff’s).**

Answer 48

Dx requires – significant behavioral or psychological changes (**initial euphoria followed by apathy or dysphoria & impaired judgment) + pupillary constriction & 1+ of 3 symptoms during or shortly after opioid use**; **with or without perceptual disturbances** such as hallucinations with intact reality testing or illusion in the absence of delirium. Symptoms – * Drowsiness or coma * Slurred speech * Impaired attention/memory

Answer 49

Dx requires – **3+ of 9 symptoms following cessation of heavy & prolonged opioid use or administration of an opioid antagonist after opioid use.** Symptoms – * Dysphoric mood * Nausea/vomiting * Muscle aches * Diarrhea * Yawning * Fever * Insomnia

Answer 50

Dx requires – **maladaptive behavioral & psychological changes (euphoria or affective blunting, hypervigilance, interpersonal sensitivity, anxiety, anger, impaired judgment) + 2+ of the 9 symptoms during or shortly after stimulant use.** Symptoms – * Tachycardia or bradycardia * Pupillary dilation * Elevated or lowered blood pleasure * Perspiration or chills * Nausea/vomiting * Weight loss * Psychomotor agitation or retardation * Respiratory depression or cardiac arrhythmia * Seizures or coma

Answer 51

Dx requires – **dysphoric mood & 2+ of the 5 physiological changes that develop within a few hours to several days after cessation of prolonged stimulant use.** Symptoms - * Fatigue * Vivid & unpleasant dreams * Insomnia or hypersomnia * Increase appetite * Psychomotor agitation or retardation

Answer 52

Dx requires – **4+ of the 7 symptoms that develop within 24hrs of abrupt cessation or reduction of tobacco use. Severity & duration vary for different levels of addiction, but usually peak 48 – 72 hrs after cessation, then gradually wane over several weeks; cravings for nicotine last longer than withdrawal symptoms & can cause early or late relapses.** Symptoms - * Irritability * Anger or anxiety * Impaired concentration * Increased appetite * Restlessness * Depressed mood * insomnia

Answer 53

Dx requires – **1+ of the perceptual symptoms that were experienced while intoxicated, with symptoms causing significant distress or impairment; visual disturbances (flashes of color, halos around objects) are most common; episodes (flashbacks) often brief buy recur over days, weeks, months, or longer; reality testing intact (aware symptoms are from drugs use).**

Answer 54

Tx – * Depends on type of substances, severity of the disorder, presence of comorbidities, & person’s preferences * Usually includes individual, family, &/or group interventions + medications * **CBT, MI, contingency management, family behavior therapy, community reinforcement approach, personalized normative feedback, text messages, relapse prevention therapy, & 12-step facilitation.** * Combined interventions are most effective **Community Reinforcement Approach (CRA)** – * Principles of operant conditioning, healthy/drug-free life is rewarding & completes with alcohol & other drug use. * **Community reinforcement & Family training (CRAFT)** was derived from CRA & designed for those **refusing to seek tx & therefore the CRAFT therapist works with a concerned significant other (CSO)**; primary goal is to help the CSO influence their partner to enter treatment + teach the CSO to reduce their partner’s substance use + help CSO make positive life changes that improve the CSO’s quality of life with or without their partner entering tx. **Voucher-Based Reinforcement Therapy (VBRT)** – * Contingency management where patients get vouchers that can be exchanged for goods & services in the community when they achieve tx goals (negative urine drug screen). * Effective as a stand-alone for promoting abstinence for cocaine, opiates, marijuana, & tobacco. * Some suggest combining VBRT with another intervention so that when vouchers are discontinued, abstinence persists. * CBT is less useful for promoting initial abstinence but helps maintain abstinence following tx because of added coping skills. **Personalized Normative Feedback (PNF)** – * Originally developed to reduce college-student drinking. * One overestimates the perceptions of the prevalence of their behavior, so correcting the misperception should reduce the behavior. * Patient is provided information to compare their behavior frequency with perceived frequency for a typical person in a peer group to actual average frequency for a typical person in a peer group. * Example: student is given 3 bar graphs, 1 indicates their drinking frequency, 1 indicates the client’s perceptions of typical college students drinking frequency, & 1 indicated the actual average in an effort to reduce client’s drinking frequency. * Effective stand-along tx & in combination with MI & other interventions * Used for other disorders including IPV, eating, & gambling **Text-Messages** – * Useful for substance use, schizophrenia, & affective disorders * Serve 4 major functions 1) provides appointment + medication reminders; 2) health care information; 3) support; 4) means of self-monitoring * Useful for smoking cessation as a stand-alone tx or in combo with other interventions **Relapse Prevention Therapy (RPT)**– * Marlatt & Gordon’s RPT is a CBT approach to relapse prevention; describes substance addiction as a learned habit pattern & views relapse as being precipitated by a high-risk situation (negative emotional state, conflict, social pressure). * Relapse risk is increased by poor coping skills, low self-efficacy, & high expectations about positive effects of alcohol & responds to a “lapse” with guilt & sense of failure. * Tx includes coping skills training, enhancing self-efficacy, challenging myths about positive outcomes of substance use, cognitive restructuring to view lapse as mistakes instead of failures, altering lifestyle factors to decrease exposure of high-risk situations. **Project MATCH** – * Multisite clinical trial that elevated the client-treatment matching hypothesis, which predicts client outcomes can be improved by matching clients based on characteristics most appropriate (alcohol involvement, psychiatric severity, anger, & social support for drinking). * Results showed both at 1yr & 3yr follow-ups all 3 treatments (CBT coping skills training, motivational enhancement therapy, & 12-steps facilitation) reduced drinking with 12-step having a slight advantage. * Those high in anger benefited from motivational enhancement therapy. * Those high in social support for drinking benefited from 12-steps.

Answer 55

Dx requires – **disturbance in attention/awareness developed over a short-period of time (hours – days), fluctuates in severity over the course of the day, & 1+ additional disturbance in cognition** (memory or language); symptoms **must not be better explained by another neurocognitive disorder; must not occur in the context of a severely reduced level of arousal (coma)**; **must be evidenced by symptoms that are a direct physiological consequence of a medical condition, substance intoxication or withdrawal, &/or exposure to a toxin.** **Etiology** – * High fever * Nutritional deficiency * Electrolyte disturbance * Renal or hepatic failure * Head injury * Certain drugs/meds use (alcohol, lithium, sedatives, anticholinergic drugs)

Answer 56

Dx requires – cognitive dysfunction acquired rather than developmental; Major: dx when significant decline from previous level of functioning in 1+ cognitive domains (executive functioning, learning, memory, social cognition) not occurring in the context of delirium; interferes with daily independence; Mild: dx when modest decline from previous level of functioning in 1+ cognitive domains not occurring in the context of delirium; doesn’t interfere with daily independence but requires greater effort or compensation. Includes – * Neurocognitive Disorder Due to Alzheimer’s Disease * Neurocognitive Disorder with Lewy Bodies * Vascular Neurocognitive Disorder * Neurocognitive Disorder due to HIV Infection * Neurocognitive Disorder due to Prion Disease * Frontotemporal Neurocognitive Disorder * Neurocognitive Disorder Due to Another Medical Condition

Answer 57

Dx requires – accounts for 60-80% of all NCD cases; **NCD dx requirements met + insidious onset & gradual progression of impairment in 1+ cognitive domains for MILD & 2+ for MAJOR impairing daily independence + meets criteria for probable/possible form of the disorder + not better explained by another disorder.** **MAJOR with PROBABLE requires** – *if criteria not met, it’s POSSIBLE* * Evidence of causative genetic mutation from genetic testing or family hx &/or evidence of decline in memory/learning * 1+ other cognitive domain impairment * Steadily progressive & gradual decline in cognition * No evidence of mixed etiology **MILD with PROBABLE requires** – *if no evidence, it’s POSSIBLE* * Evidence of causative genetic mutation from genetic testing or family history * Decline in memory/learning * Steadily progressive & gradual decline in cognition * No evidence of mixed etiology *Extra- those with pseudodementia respond “IDK” & exaggerate cognitive symptoms whereas Alzheimer’s minimize/deny cognitive symptoms & respond with wrong answers. **Etiology** – * Prevalent for women (because they live longer but develop it at the same age as men * 65+ older Black Americans have highest prevalence & incidence rates, followed by Hispanics & White * Onset most often from 70 – 89y/o * Early onset 49 – 59y/o linked to chromosomal mutations (ApoE4 variant on chromosome 19) * Reduced Acetylcholine, excessive glutamate * Amyloid plaques & neurofibrillary tangles (disrupt cell-to-cell communication) first evident in the medial temporal/amygdala/hippocampus/entorhinal cortex & then goes to the frontal & parietal lobes; Extracellular consists of beta-amyloid protein clumps (APP); Intracellular consists of abnormal accumulation of tau protein. * Loss of locus coeruleus is linked to Alzheimer’s, Lewy Bodies, & Parkinson’s * Dx can only be confirmed through brain biopsy or autopsy. * Loss of smell is linked to the disease, with the greater the loss the greater cognitive impairment because of structural changes in the amygdala, hippocampus, & entorhinal cortex). **Factors** – * Increased risk for low educational status * Obesity * Hearing loss * Down syndrome, standard trisomy 21 most common type (extra 21) meaning an extra gene for APP so earlier onset in teens & 20s * Linked to Big Five personality traits, high neuroticisms, low conscientiousness (more amyloids, more tau)

Answer 58

**Stages – ~8 - 10yrs** * **Early**: lasts 2-4yrs, short-term memory loss, anomia, personality changes (indifference), anxiety, depression, impaired attention/concentration, poor judgement, & disorientation to time/space. * **Middle**: 2-10yrs worsened short-term memory loss, long-term memory loss, irritability, increased disorientation, delusions, hallucinations, wandering/pacing, perseveration speech/actions, loss of impulse control, impaired speech, disrupted sleep patterns, problems with ADLs, sundowning (confusions, restlessness in the late afternoon). * **Late**: 1-3yrs severe cognitive deterioration, loss of basic motor skills/self-care skills, abnormal reflexes, seizures, & frequent infections.

Answer 59

Tx - * **Cholinesterase inhibitors** (Donepezil/Aricept; Rivastigmine/Exelon) delay ACh (acetylcholine) breakdown in the hippocampus + **memantine drugs (NMDA receptor antagonist to regulate glutamate)** reduce/stabilize memory loss & confusion. * **CBT** to reduce problem behaviors. * **Antidepressants** to reduce depressive symptoms. * **Anxiolytics** to reduce anxiety/restlessness. * **Antipsychotics** to reduce mania, psychosis, or dangerous behaviors. * **Support & skills training** are important for caregivers; better for outcomes especially because remaining at home leads to better outcomes.

Answer 60

Dx requires – abnormal protein build-up; meets NCD criteria. **Core Features** – * Insidious onset + gradual progression * Fluctuating cognitive with varying attention, alertness, & recurrent visual hallucinations * Parkinsonism developed after cognitive symptoms develop. **Suggestive Features** – * REM sleep behavior disorder * Severe neuroleptic sensitivity ***PROBABLE*** – * 2+ core features or 1 core feature & 1 suggestive feature ***POSSIBLE*** – * 1 core feature or 1 or both suggestive features *Extra- **NCD with Lewy Bodies early cognitive symptoms are deficits in complex attention, visuospatial, & executive functions; NCD due to Alzheimer’s early cognitive symptoms are deficits in learning & memory; NCD due to Parkinson’s motor symptoms precede cognitive symptoms.**

Answer 61

Dx requires – temporal (ability to process two) **relationship between symptom onset & stroke or by prominent decline in complex attention + executive functioning; family hx of cerebrovascular disease or evidence from physical exam or neuroimaging; meets NCD criteria.** **Prognosis** – * Depends on cause. * Acute onset with partial recovery, stepwise decline, or progressive course with fluctuations in symptom severity & plateaus varying in duration. * Prevention + intervention efforts target risk & causative factors (hypertension, heart disease, diabetes mellitus, obesity, high cholesterol, & heavy cig smoking.

Answer 62

Dx requires – meets NCD criteria + evidence of infection. Symptoms – * Forgetfulness * Impaired attention/concentration * Cognitive slowing * Psychomotor retardation * Clumsiness * Tremors * Apathy * Social withdrawal

Answer 63

Dx requires – meets NCD criteria + **insidious onset followed by rapid progression of impairment, motor features** of prion or biomarker evidence (**lesions on an MRI**). CJD **can be inherited or acquired** by **consuming infected meat (variant CJD)** or **through the blood (iatrogenic CJD).** **Symptoms – Creutzfeidt-Jakob disease (CJD) most common Prion** * **Confusion + disorientation** * **Impaired memory + judgment** * **Ataxia, myoclonus (twitching), chorea (jerky limbs)** * **Apathy, anxiety, mood swings**

Answer 64

Dx requires – **most common cause of early onset NCD ( before 65y/o)**; meets NCD criteria; **insidious onset + gradual progression; minor impact on learning/memory or perceptual motor functioning in early stages**; meets criteria for language or behavioral variant. **Behavioral Variant** – * Most common * **Prominent decline in social cognitive or executive abilities** (appropriate behaviors, organizing, planning) * **3+ of the following**: **behavioral disinhibition, apathy or inertia, loss of sympathy/empathy, perseverative/stereotyped/compulsive/ritualistic behaviors, hyperorality + diet changes** **Language Variant** – * Prominent decline in language (primary progressive aphasia; PPA) * **Semantic** (impaired comprehension or written or spoken); **agrammatic/nonfluent** (incorrect grammar or hesitant speech); **logopenic** (impaired repetition of phrases, trouble finding correct word)

Answer 65

Dx requires – meets criteria for NCD; evidence that symptoms are a pathophysiological **consequence of a medical condition**; **course of the disorder is commensurate with the underlying medical condition progression.** *Extra- **some NCDs will improve if the underlying medical condition is treatable, but not always.**

Answer 66

Onset in early adolescence or early adulthood, stable over time, leads to distress/impairment. **Dx to those under 18 when symptoms present for 1yr + EXCEPT antisocial personality disorder.** **Cluster A: Odd/eccentric behaviors** * Paranoid * Schizoid * Schizotypal **Cluster B: dramatic, emotional, or erratic behaviors** * Antisocial * Borderline * Histrionic * Narcissistic **Cluster C: anxiety & fearfulness** * Avoidant * Dependent * Obsessive-compulsive

Answer 67

Dx requires – pervasive pattern of distrust + suspiciousness involving interpreting motives of others as malevolent **evidenced by 4+ of the 7 symptoms.** Symptoms – * **Suspects w/o sufficient reason** that others are exploiting, harming, or deceiving them. * **Preoccupied with unjustified doubts about loyalty** + trustworthiness of others. * **Reluctant to confide** in others. * **Reads demeaning content into benign remarks/events.** * **Persistently bears grudges.** * **Perceives attacks on their characters & reputation + quick to react with anger.** * **Suspicious w/o justification** about fidelity of spouse of sexual partner.

Answer 68

Dx requires – pervasive pattern of **detachment from social relationships, restricted range of emotional expression, & 4+ of the 7 symptoms.** Symptoms – * Doesn’t desire/enjoy close relationships. * Nearly always chooses solitary activities. * Little/no interest in sexual relationships. * Takes pleasure in few activities. * Lacks close friends beyond first-degree relatives. * Indifferent to praise or criticism. * Emotionally cold/detached or flat affect.

Answer 69

Dx requires – pervasive pattern of disregard & violation of the rights of others since 15y/o including 3+ of the 7 symptoms; be 18y/o+ & have a hx of conduct dx before 15y/o; this dx is chronic but symptoms are less severe (mainly legally) by 40s. **Symptoms** – * Fail to conform to social norms including the law. * Deceitful. * Impulsive + fails to plan ahead. * Irritable + aggressive. * Reckless disregard for safety. * Consistently irresponsible. * Lack of remorse. **Tx** – * Of the most difficult to treat because the individual doesn’t believe they have a problem. * No intervention has received empirical support for its effectiveness in reducing symptoms. * Some evidence for CBT (especially group) to reduce re-offending rates. * Contingency management reinforces desirable behaviors. * Pharmacological tx may reduce comorbid substance use. **Comorbidity** – * Substance use disorder most common then mood then BPD, then anxiety.

Answer 70

Dx requires – **pervasive pattern of social deficits, acute discomfort with & reduced capacity for close relationships, distortions in cognition/perception, eccentricities in behaviors, & 5+ of the 9 symptoms.** Symptoms – * Ideas of reference * Odd beliefs or magical thinking that influence behavior. * Bodily illusions or other unusual perceptions. * Exhibits odd thinking + speech. * Suspicious or paranoid ideation. * Inappropriate/constrict affect. * Peculiarities in behavior + appearance. * Lacks close friends beyond first-degree family. * Excessive social anxiety that doesn’t diminish with familiarity. ***Individuals with this dx may express unhappiness about their lack of friends by act in ways that suggest a lack of interest in social relationships (only interacts when necessary), whereas schizoid personality disorder have limited desire/don’t find pleasure from close relationships, and avoidant personality desires such relationships but is fearful of rejection.**

Answer 71

Dx requires – pervasive pattern of instability in interpersonal relationships, self-image, affects, + impulsivity as indicated by **5+ of the 9 symptoms**; **onset late adolescence with symptoms being most severe in early adulthood but some experience a decrease in symptom severity with 70% no longer meeting full criteria by age 40.** **Symptoms** – * Engages in frantic efforts to avoid abandonment. * Pattern of unstable + intense interpersonal relationships. * Identity disturbance, instability in sense of self. * Impulsive in 2+ areas that are potentially self-damaging. * Recurrent suicide threats/gestures/ or self-harm * Affective instability * Chronic feelings of emptiness * Inappropriate intense anger * Transient stress-related paranoid ideation or severe dissociative symptoms Tx – * **Linehan’s DBT**, assumes the dx is an emotion dysregulation as a result of biological + environmental factors; includes 3 components. * **Group skills training**: focus on increasing emotion regulation, distress tolerance, relationship effectiveness, & mindfulness. * **Individual psychotherapy**: increasing skills + decrease SI, therapy-interfering behaviors (TIBs), & quality of life interfering behaviors. * **Intersession coachin**g: telephone coaching to help clients generalize their skills to real-world contexts + deal with crises & provide repairs in the therapeutic alliance. ***Therapist consultation team is referred to as the 4th component**, it’s a peer consultation team to help therapists stay motivated & effective in treating their clients.

Answer 72

Dx requires – pervasive pattern of excessive emotionality + attention seeking with 5+ of the 8 symptoms **Symptoms** – * Uncomfortable when not the center of attention * Inappropriately sexually seductive or provocative * Rapidly shifting + shallow emotions * Consistently uses physical appearance to gain attention * Exhibits speech that’s impressionistic & lacking detail * Exaggerated expression of emotions * Easily influenced by others & impulsive * Considered relationships to be more intimate than they are *Shares features with antisocial personality (impulsivity, superficiality, excitement seeking, reckless, seductive, manipulative); histrionic exaggerates emotions & manipulate in order to gain nurturance, while antisocial are manipulative to gain power or material gratification.

Answer 73

Dx requires – pervasive pattern of grandiosity, need for admiration, & lack of empathy as indicated by **5+ of the 9 symptoms** **Symptoms** – * Grandiose sense of self-importance. * Preoccupied with fantasies of unlimited success, power, beauty, & love. * Believes they’re unique & can be understood only by special or high-status people. * Requires excessive admiration. * Sense of entitlement. * Interpersonally exploitative. * Lack empathy. * Often envious of others of believes others envy them. * Arrogant behaviors/attitudes.

Answer 74

Dx requires – pervasive pattern of **social inhibition, feelings of inadequacy, & hypersensitive to negative evaluation with 4+ of the 7 symptoms.** **Symptoms** – * Avoids occupational activities involving interpersonal contact due to fear, criticism, disapproval, or rejection. * Unwilling to get involved with people unless certain of being liked. * Restraint in intimate relationships out of fear of being ridiculed. * Preoccupies with concerns about being criticized or rejection in social situations. * Inhibited in new relationships because feels inadequate. * Views self as socially inept, unappealing, or inferior to others. * Usually reluctant to engage in new activities out of fear of embarrassment.

Answer 75

Dx requires – pervasive pattern of **excessive need to be taken care of leading to submissive & clinging behavior + fear of separation as indicated by 5+ of the 8 symptoms.** **Symptoms** – * Difficulty making everyday decisions w/o advice & reassurance from others. * Needs others to assume responsibility for most areas of their life. * Avoid disagreeing with others out of fear of losing their support/approval. * Difficulty doing things alone. * Excessive lengths to obtain nurturance and support. * Feels uncomfortable or helpless when alone. * Urgently seeking another relationship for care/support when a close relationship ends. * Unrealistically preoccupied with fears of being left to care for themselves.

Answer 76

Dx requires – pervasive pattern of **preoccupation with orderliness, perfectionism, & mental + interpersonal control that severely limits flexibility, openness, & efficiency as indicated by 4+ of the 8 symptoms.** **Symptoms** – * Preoccupied with details & schedules so the major point of any activity is lost. * Shows perfectionism that interferes with task completion. * Excessively devoted to work & productivity to the exclusions of leisure activities + friendships. * Overly conscientious, scrupulous, & inflexible about morality, ethics, or values. * Unable to discard worn-out or worthless objects even when they don’t have sentimental value. * Reluctant to delegate work to others unless they’ll do it their way. * Adopts a miserly spending style toward self + others. * Shows rigidity + stubbornness.

Answer 77

Dx requires – delayed frequency or absence of orgasm or reduce orgasmic sensations on all/most occasions for 6mo+ Tx – * CBT, with directed masturbation is 1st line of tx + most empirically supported (especially for lifelong FOD) * Sex education, Masters & Johnson’s sensate focus, anxiety reduction techniques, mindfulness training &/or communication skills.

Answer 78

Dx requires – incongruence between assigned gender at birth + one’s experienced gender. Children require 6+ of 8 symptoms. Adolescents + adults require 2+ of 6 symptoms lasting 6mo+. **Symptoms** – ***Children*** * Strong desire to be the other gender * Strong preference for wearing clothes of the other gender * Strong preference for toys + activities used/engaged in by the other gender * Strong preference for playmates of the other gender * Strong dislike of one’s sexual anatomy ***Adolescents + Adults*** * Strong desire to be rid of one’s primary/secondary sex characteristics * Strong desire to be the other gender * Strong desire to be treated as the other gender * Strong conviction that one has feelings/reactions that are characteristic of the other gender. Tx – * **The Dutch Protocol**: under this tx, it is understood this dx only persists into adolescents in a small minority of people; under 12y/o, the tx recommends watchful waiting + support for the child & their families -> then, at 1st signs of puberty, start social transition + puberty-blocking drugs if dx persists to give time to decide if they want to transition @16y/o + gender affirming surgery @18y/o. * **Gender Affirmation Model**: widely accepted model + assumes we’re all aware of our identity at any age & will benefit from social transition at any developmental stage. Also assumes a) gender variations are not disorders; b) gender presentations are diverse + vary across cultures; c) gender is not always binary & may be fluid; d) if present, a child’s psychological problems are secondary to negative interpersonal/cultural reactions to transphobia, homophobia, sexism. Social transition -> puberty blockers ->cross-sex hormones -> surgeries; throughout transition process, gender issues are addressed with youth + families in a non-judgmental way. * **Gender confirmation/affirming surgery** research shows it’s associated with decreased gender dysphoria, improved self-satisfaction, low incidence of regret; transgender males have more positive outcomes; factors linked to positive outcomes are careful dx screening, psychological stability, social support, lack of surgical complications.

Answer 79

Dx requires – recurrent + intense sexual arousal for 6mo+ from touching/rubbing against a nonconsenting adult manifested by fantasies, urges, &/or behaviors.

Answer 80

Dx requires – cross-dressing for the purpose of sexual arousal for 6mo+ manifested by fantasies, urges, &/or behaviors causing significant distress/impaired functioning. Most men w/ this dx identify as heterosexual but may have occasional homosexual intercourse especially when cross-dressed.

Answer 81

Dx requires – recurrent + intense sexual arousal for 6mo+ manifested by fantasies, urges, &/or behaviors involving sexual activity w/ a child 13y/o or younger. The person must be 16y/o+ & 5yr+ older than the child, have acted on these urges or experienced significant distress/interpersonal struggles because of them.

Answer 82

Dx requires – recurrent + intense sexual arousal 6mo+ in response to nonliving object or specific non-genital body part with the arousal causing significant distress/impaired functioning.

Answer 83

Dx requires – recurrent + intense sexual arousal for 6mo+ from exposing one’s genitals to an unexpecting person manifested by fantasies urges, or behaviors; dx can be applied to those who admit symptoms, or deny symptoms despite objective evidence to the contrary; must have acted on the urges or experienced significant distress/impaired functioning as a result of the sexual urges/fantasies. Subtypes: sexually aroused by exposing genitals to prepubertal children; physically mature individuals; both.

Psychopathology Flashcards

(107 cards)