Psychopathology Flashcards
Brief Psychotic Disorder
Psychotic Disorder
Dx requires – 1+ of the four symptoms for at 1+ day, but less than 1mo; & must include 1+ of the main three (delusions, hallucinations, or disorganized speech). 1d to 1mo
Symptoms –
* delusions
* hallucinations
* disorganized speech/derailment/tangentiality
* grossly disorganized or catatonic behavior
Tx -
Schizophreniform Disorder
Psychotic Disorder
Dx requires – 2+ of the five symptoms for 1+mo but less than 6mo; and must include 1+ of the main three (delusions, hallucinations, or disorganized speech). 1mo to -6mo
Symptoms –
* delusions
* hallucinations
* disorganized speech/derailment/tangentiality
* grossly disorganized or catatonic behavior
* negative symptoms (avolition or no motivation, alogia or limited spoken words, anhedonia or inability to experience joy)
Tx –
Schizophrenia
Psychotic Disorder
Dx requires – active phase lasting 1+ mo and includes 2 of the five symptoms and must include 1+ of the main three (delusions, hallucinations, or disorganized speech). Must also include continuous signs of the disorder for 6+ mo that may include prodromal &/or residual phases (consist of 2+ characteristics in an attenuated form or negative symptoms only) along with the required active phase.
Comorbid - anxiety, OCD, tobacco use.
Location - temporal-limbic-frontal network causes negative symptoms; striatum linked to positive symptoms; linked to hypfrontality (low activity in the prefrontal cortex)
Chemicals - +glutamate, +serotonin, +-dopamine
Symptoms –
* delusions
* hallucinations
* disorganized speech/derailment/tangentiality
* grossly disorganized or catatonic behavior
* negative symptoms (avolition or no motivation, alogia or limited spoken words, anhedonia or inability to experience joy)
*extra - 80-85% have tobacco use disorder.
Tx –
* Multimodal tx, psychosocial, FGAs + SGAs, + adjunctive meds to treat comorbidities.
* CBTp (for psychosis), cognitive remediation, ACT, assertive community tx, family psychoed, illness self-management training, social skills, supported employee services.
* SGA clozapine most effective for treatment-resistant schizophrenia (2 antipsychotic attempts at 6wks each).
* NAVIGATE team-based programs targeting high risk or early stages, includes family psychoed + individual resiliency training based on CBTp
Schizophrenia Facts
Psychotic Disorder
Etiology – the greater the degree of genetic similarity, the greater the concordance rate (likelihood that two people who share the same genes will develop the same disorder).
* Parent 6%
* Bio siblings 9%
* Child of 1 parent w/ dx 13%
* Dizygotic (fraternal) twin 17%
* Child of 2 parents w/ dx 46%
* Monozygotic (identical) twin 48%
*If an MZ twin has a child, the child has a high risk of having schizophrenia or related disorders, regardless if the child is from the affected or non-affected MZ twin. Discordant DZ twins have less likelihood of this, but more likelihood than non-affected twins.
*70-85% have comorbid tobacco use
*Psychotic symptoms 1st appear in late teens and early 30s, peak onset early-mid 20s for male + late 20s for females. Psychotic symptoms decrease w/ age, negative symptoms + cognitive symptoms persist.
Prognosis –
* better for females w/ acute & late onset of symptoms, comorbid mood symptoms (mainly depressive), mostly positive symptoms, precipitating factors, family hx of mood disorder, & good premorbid adjustment.
* patients in non-Western developing countries have acute onset, short course, and higher remission rates.
* immigrant paradox (newly arrive immigrants gave better health outcomes than more acculturated ppl in the same county w/ the same ethnicity) applies to schizophrenia & alcohol use disorder.
* anosognosia leads to nonadherence to tx + increased risk for relapse.
* patients whose family have high expressed emotion (criticism/hostility toward patient) also have increased risk of relapse.
Schizoaffective Disorder
Psychotic Disorder
Dx requires – concurrent symptoms of schizophrenia AND MDD or manic episode for majority of illness duration, but with the presence of delusions or hallucinations for 2+ wks w/o mood symptoms.
Delusional Disorder
Psychotic Disorder
Dx requires – a) 1+ delusions for 1+ mo, b) overall functioning not markedly impaired aside from the delusions.
Subtypes –
* Erotomanic (belief that another is in love with them)
* Grandiose (belief that they have great, unrecognized talent/insight)
* Jealous (belief their spouse/partner is unfaithful
* Persecutory (belief they’re being conspired against, spied on, poisoned)
* Somatic (belief involves bodily functions/sensations)
Manic Episode
Bipolar Disorder
Dx requires - abnormal, persistent elevated irritable mood, inflated self-esteem/grandiosity, + increased activity/energy, decreased need for sleep + flight of ideas for 1+ wk; also includes impaired functioning, need for hospitalization to avoid harming self/others, psychotic features.
*Geller (2002) proposed that manic-specific symptoms in 7-16y/o were elation, grandiosity, flight of ideas/ruminations, decreased need for sleep, & hypersexuality.
*Salvi (2021) proposed manic-specific symptoms in 18+ were euphoric or irritable mood, increased self-esteem/grandiosity, distracted by thoughts, decreased need for sleep w/o physical discomfort.
Hypomanic Episode
Bipolar Disorder
Dx requires - similar to manic symptoms but less severe, no functional impairment, no hospitalizations, no psychotic features, & lasts 4+ d.
Major Depressive Episode
Bipolar Disorder/Depressive Disorder
Dx requires - 5+ depressive symptoms w/ 1 being depressed mood or loss of interest/pleasure in most/all activities lasting 2+ wks, causing significant distress/impaired functioning.
Bipolar Disorders
Bipolar Disorder
Dx Requires – bipolar I: 1+ manic episode w/ 1+ major depressive or hypomanic episodes, order not important. bipolar II: 1+ hypomanic episodes & 1+ major depressive episodes. cyclothymic disorder: numerous hypomanic symptoms that don’t meet hypomanic episode criteria & numerous depressive symptoms that do no meet criteria for major depressive episodes w/ a minimum duration of 2yr for 18+, 1yr for 18-
Tx –
* psychoeducation
* interpersonal /rhythm therapy
* CBT
* family focused therapy (high expressed emotion linked to relapse)
* lithium (most effective for “classic bipolar”, no mixed episodes, no rapid cycling, long recovery between episodes, onset 15-19y/o)
* anticonvulsant drugs + SGA (most effective for “atypical bipolar”, mixed episodes, rapid cycling, lack of recovery, hypersomnia, increase appetite/weight gain, interpersonal rejection sensitivity, onset 10-15y/o)
Bipolar Facts
Bipolar Disorder
Etiology – linked to heredity, neurotransmitter/brain abnormalities, circadian rhythm irregulates (sleep/wake, hormone secretion, appetite, body temp).
Chemicals – norepinephrine, dopamine, serotonin, glutamate
Location – abnormalities in the prefrontal cortex, amygdala, hippocampus, & basal ganglia
Concordance rates –
* MZ twins 67%+
* DZ twins 20%
ADHD
Neurodevelopmental Disorder
*adult ADHD includes labile, dysphoric mood, reduced self-esteem, distracted by wandering (not rumination), fatigue, + discomfort w/ loss of sleep.
MDD
Depressive Disorder
Dx requires – 5+ symptoms, 1 must include depressed mood or loss of interest/pleasure in activities, for 2+ wks.
Etiology -
age
* young adults linked to genetics, life stressors, + limited problem solving/cognitive abilities.
* older adults linked to chronic illness, especially if it decreased psychical functioning & leads to social isolation.
* older adults are less likely to refer to affective symptoms & more likely to refer to somatic symptoms, cognitive changes, & loss of interest in activities.
culture
* Latinx, Mediterranean, Middle Eastern, Asian, & non-Western cultures report more somatic symptoms.
* Western cultures report more psychological symptoms.
Comorbidity –
* mostly linked with substance use (mostly alcohol), then anxiety, then personality
* sleep abnormalities, prolonged latency (linger initiation), reduced REM + slow-wave, increased REM density (more eye movements per unit of time)
* coronary heart disease, stroke, diabetes, Parkinson’s
* can be bidirectional in causality of heart attacks (myocardial infarction)
Tx -
* psychotherapy, psychopharm (equal), & a combination (more effective)
* St. John’s Wort has similar effects as SSRIs; helpful for mild-moderate, but can cause serotonin syndrome when taken w/ SSRI & can decrease drug effects when taken w/ alprazolam/Xanax or bupropion/Wellbutrin.
* Ketamine/Esketamine (used since 1960s) nose spray is fast-acting tx for treatment resistant depression + SI; it increased glutamate & is used w/ an oral antidepressant
* ECT & rTMS
* telepsychotherapy; similar effects to face-to-face
* children: insufficient evidence to recommend a specific tx
* adolescents: CBT, interpersonal psychotherapy for adolescents (IPT-A), fluoxetine/Prozac but insufficient evidence to recommend one tx over another.
* adults: MCBT, IPT, behavior, psychodynamic, & supportive therapy, or second-gen antidepressants (SSRI or SNRI); strong recommendation for combined tx of CBT or IPT plus second-gen antidepressant
* older adults: recommended either group-CBT or combo of IPT & second-gen antidepressant; insufficient evidence for bibliotherapy or life review therapy
Persistent Depressive Disorder
Depressive Disorder
Dx requires – 2+ symptoms (poor appetite/overeating, insomnia/hypersomnia, hopelessness), 1 must include depressed mood, for 2+ yrs 18+ or 1yr+ 18-
Disruptive Mood Dysregulation Disorder
Depressive Disorder
Dx requires – 1+ on a) severe/recurrent overreactive temper outbursts (verbal or behavioral) occurring 3+x/wk; b) persistently irritable/angry mood for most of the day, nearly every day between outbursts.
Depressive Disorders Specifiers
Depressive Disorder
Specifier: peripartum onset(during pregnancy or 4wks after delivery)
* 80% of women experience “baby blues” after birth
* 9% of women experience major depressive episode between conception & birth
* 7% of women experience major depressive episode between birth – 1yr postpartum
Specifier: seasonal pattern (mood correlates w/ time of yr; also known as SAD)
* symptoms include hypersomnia, overeating eating, weight gain, craving carbs
* low serotonin levels, high melatonin
* Tx – phototherapy (light exposure)
Depression Disorder Facts
Depressive Disorder
Etiology – linked to heredity, neurotransmitter/brain/hormone abnormalities, & cog/behavior factors (Lewinsohn’s Social Reinforcement Theory; Seligman’s Learned Helplessness; Beck’s Cogntive Theory).
Chemicals - -serotonin, -dopamine, -norepinephrine
Location – abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis (early life stress w/ hypersecretion of cortisol); prefrontal cortex (high activity in the ventromedial prefrontal cortex [vmPEC] + low activity in the dorsolateral prefrontal cortex [dlPFC])
Concordance rates –
* MZ twins 50% for unipolar depression
* DZ twins 20% for unipolar depression
* MZ female twins 50%
* DZ female twins 34%
* MZ male twins 40%
* DZ male twins 28%
*Depressive rates for females increase in early adolescence & persists into adulthood, rates for males remains stable over time; theory is that puberty hormones sensitized females & desensitizes males of negative life stressors. female adolescents + adults have 1.5 – 3x higher depressive rates than male adolescents + adults.
Electroconvulsive Therapy
ECT
Depressive Disorder
Treats Major Depressive Disorder
Pros –
* successful w/ severe depression + SI,
* higher response (80%) & higher + faster remission (70%) than psychotherapy (30-60%) & psychopharm (25-45%).
* produces remission w/i 1-3wks, IPT/CBT 6-10wks, antidepressants 4-12wks.
Cons –
* anterograde (resolves w/i 2wks) & retrograde amnesia (resolves w/i wks to mos, older memories return first)
Repetitive Transcranial Magnetic Stimulation
rTMS
Depressive Disorder
noninvasive technique using magnetic fields to stimulate the left dorsolateral prefrontal cortex; mostly used for treatment-resistant depression.
Pros -
* doesn’t require sedation nor cause memory loss.
Cons -
* lower response + remission rates than ECT
Suicide Rates
Depressive Disorder
- US 2000-2018 increased; decreased 2018-2020
- consistently higher for males than females; in 2000-2020 being 3-4x higher for males
- 2020 was the highest for 75y/o+ & Native Americans/Alaskans, followed by (in order) White, Hispanics, Blacks, & Asian/Pacific Islanders.
- 2020 highest rates for males 75y/o+, highest rates for females 45-64y/o
- 2020 highest for Native Americans/Alaskans, Hispanics, & Blacks ages 25-34y/o; highest for Whites ages 45-54; highest for Asian/Pacific Islanders ages 85+
Separation Anxiety Disorder
Anxiety Disorder
described as developmentally inappropriate/excessive fear/anxiety about being separated from attachment figure. Often develops after exposure to stressful event (parental divorce, death or relative or pet).
Dx requires – 4+ wks in children/adolescents, 6mos in adults; must cause significant distress or impaired functioning.
Symptoms –
* Excessive distress relating to separation from attachment figures
* Persistent reluctance to go to school, work, places away from home
* Repeated complaints of physical symptoms when separated
Tx –
* CBT + psychoed, exposure, relaxation techniques + cognitive restricting; increased effectiveness when CBT is combined w/ parent training.
* if school refusal is part of the disorder, initial tx goal is school attendance to avoid social isolation, academic failure, & other secondary impairments
*School refusal can be linked to social anxiety & other anxiety disorders
Specific Phobia
Anxiety Disorder
Intense fear/anxiety about a specific object/situation, accompanied by avoidance or endurance w/ intense distress. Mowrer’s (1947)
Dx requires – fear/anxiety must be disproportionate to actual danger, persistent for 6+ mo, & cause significant distress/impaired functioning. Specifiers are used to indicate type (animal, environment, blood-injection-injury, situational, other).
Symptoms –
* Specific phobias 2x more common in girls than boys; onset usually in childhood or by age 10.
Tx –
* Exposure + response prevention to extinguish conditioned anxiety response; two types of exposure that can be done in vivo or in imagination: flooding (immediate exposure lasting until the fear subsides) and graded (listing 10 related anxiety-provoking things from least to most fearful and gradually being exposed to the an increasingly fearful list-item; ex: standing on a chair, on a ladder, and then a roof)
Social Anxiety Disorder (Social Phobia)
Anxiety Disorder
Dx requires – fear/anxiety a social situation and either avoids it or endures with extreme fear/anxiety; must be disproportionate to actual danger, persistent for 6+ mo, & cause significant distress/impaired functioning.
Tx –
* CBT + antidepressants (SSRI + SNRI) first-line tx
* Internet driven CBT is found to be equally effective for adults as face-to-face
* School-based CBT is found to be effective for children/adolescents
Panic Disorder
Anxiety Disorder
Dx requires – unexpected panic attacks w/ 1+ attack followed by 1mo+ of persistent concern about future attacks or consequences &/or significant maladaptive behavior related to the attack; involves 4+ of the 13 symptoms.
Symptoms –
* heart palpitations, sweating, nausea/abdominal distress
* dizziness, fear of losing control/going crazy
* derealization/depersonalization
* paresthesia (burning/prickling sensation)
Symptoms are similar to hyperthyroidism, cardiac arrhythmia, & other medical conditions so those need to be ruled out first.
Tx –
* CBT
* Panic Control Treatment (interoceptive exposure: exposing patient to physical symptoms of panic attack & paired w/ relaxation techniques for controlling symptoms; ex: breathing through a straw, running in place)
* Antidepressants (imipramine) + benzodiazepines (high relapse rate when drugs are used as only tx)
Agoraphobia
Anxiety Disorder
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.
Generalized Anxiety Disorder
(GAD)
Anxiety Disorder
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
Obsessive-Compulsive Disorder
(OCD)
Obsessive-Compulsive Related Disorder
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
Body Dysmorphic Disorder
Obsessive-Compulsive Related Disorder
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.
Intellectual Developmental Disorder
(Intellectual Disability)
Neurodevelopmental Disorder
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
Autism Spectrum Disorder
(ASD)
Neurodevelopmental Disorder
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)
Attention-Deficit/Hyperactivity Disorder
(ADHD)
Neurodevelopmental Disorder
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).
Tourette’s
Tic Disorder
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
Persistent Chronic Motor or Vocal Tic
Tic Disorder
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)
Provisional Tic Disorder
Tic Disorder
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)
Childhood Onset Fluency Disorder (stuttering)
Communication Disorder
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
Specific Learning Disorder
Specific Learning Disorders
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
Reactive Attachment Disorder
Trauma Disorder
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
Disinhibited Social Engagement Disorder
Trauma Disorder
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
Posttraumatic Stress Disorder
(PTSD)
Trauma Disorder
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) to alleviate core symptoms of avoidance/numbing, re-experiencing, & hyperarousal
Acute Stress Disorder
Trauma Disorder
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.
Prolonged Grief Disorder
Trauma Disorder
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
Dissociative Amnesia
Dissociative Disorders
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)
