1
Q
DSM-5
Categorical Approach
A
divides mental disorders into types, defined by a set of diagnostic criteria
2
Q
DSM-5
Polythetic Criteria Set
A
clients present with a subset of symptoms, meaning two clients with the same diagnosis may have completely non-overlapping presentations
3
Q
DSM-5
Nonaxial Assessment
A
all mental and medical diagnoses are listed together with primary diagnosis first
no more “axis 2”
4
Q
DSM-5
Diagnostic Uncertainty
A
- other-specified - when the clinician wants to indicate why symptoms do not meet criteria
- unspecified disorder is when they do not want to indicate why client’s symptoms do not meet criteria
5
Q
DSM-5
Outline for Cultural Formation
A
- the client’s cultural identity
- the client’s cultural conceptualization of distress
- the psychosocial stressors and cultural factors that impact the client’s vulnerability and resilience
- cultural factors relevant to the relationship between the client and therapist
6
Q
Intellectual Disability
Diagnostic Criteria
2 deficits, onset
A
- deficits in intellectual functions (e.g., reasoning, problem solving, abstract thinking);
- deficits in adaptive functioning that result in a failure to meet community standards of personal independence and social responsibility and impair functioning across multiple environments in one or more activities of daily life
- an onset of intellectual and adaptive functioning deficits during the developmental period.
7
Q
Intellectual Disability
Etiology
A
- 5% heredity
- 30% chromosomal changes, toxins
- 10% pregnancy and perinatal problems
- 5% acquired medical issues during infancy or childhood
- 15-20% environmental factors
- 30% unknown
8
Q
Stuttering
Course/Prognosis
A
- gets worse when there is social pressure to communicate
- 65-85% of children recover
9
Q
Stuttering
Treatment
A
- Reduction of stress @ home
- habit reversal training
- deep breathing training, relaxing muscles in the throat
10
Q
Autism Spectrum Disorder
Diagnostic Criteria
A
For a diagnosis of Autism Spectrum Disorder, the individual must exhibit (a) persistent deficits in social communication and interaction across multiple contexts as manifested by deficits in social-emotional reciprocity, nonverbal communication, and the development, maintenance, and understanding of relationships; (b) restricted, repetitive patterns of behavior, interests, and activities as manifested by at least two characteristic symptoms (e.g., stereotyped or repetitive motor movements, use of objects, or speech; inflexible adherence to routines, or ritualized patterns of behavior); (c) the presence of symptoms during the early developmental period; and (d) impaired functioning as the result of symptoms.
11
Q
Autism Spectrum Disorder
Prognosis
A
The best outcomes are associated with an ability to communicate by age 5 or 6, an IQ over 70, and a later onset of symptoms.
12
Q
Autism Spectrum Disorder
Treatment
A
- shaping and discrimination training
- vocational training and placement
13
Q
ADHD
Diagnostic Criteria
onset, settings
A
ADHD is the appropriate diagnosis when the individual has at least six symptoms of inattention and/or six symptoms of hyperactivity-impulsivity and symptoms had an onset prior to 12 years of age, are present in at least two settings (e.g., home and school), and interfere with social, academic, or occupational functioning.
14
Q
ADHD
Course/Prognosis
A
About 15% of children with ADHD continue to meet the full diagnostic criteria for the disorder as young adults and another 60% meet the criteria for ADHD in partial remission.
15
Q
ADHD
Treatment
A
- Ritalin/methylphenidate
- behavioral interventions- positive reinforcement, time out, etc
16
Q
ADHD
ADHD in Adults
A
In adults, inattention predominates the symptom profile.
17
Q
ADHD
Etiology
A
lower-than-normal activity and smaller than normal size of the
- caudate nucleus
- globus pallidus
- prefrontal cortex
18
Q
ADHD
Multimodal Study
A
showed that the best outcome is from a mixture of medication and behavioral intervention
19
Q
SLD
Comorbidity
A
20-30% of kids with SLD have ADHD
20
Q
SLD
Diagnostic Criteria
A
six months of presentation (with intervention) of persistent difficulties with reading, writing, math
21
Q
SLD
etiology
A
linked to cerebellar-vestibular dysfunction, hemispheric abnormalities, toxins
22
Q
Tourettes
A
23
Q
Tourettes
Diagnostic Criteria
onset age, duration
A
Tourette’s Disorder is characterized by the presence of at least one vocal tic and multiple motor tics that may appear simultaneously or at different times, may wax and wane in frequency, have persisted for more than one year, and began prior to age 18.
24
Q
Tourettes
Treatment
A
- haloperidol and pimozide, effective 80% of the time
- reversal training, relaxation training, psychoeducation
25
# Tourettes
Etiology
elevated levels of dopamine and supersensitivity of dopamine receptors in caudate nucleus
26
# Behavioral Pediatrics
Hospitalization
Hospitalized children are at increased risk for emotional and behavioral problems, and children ages **one to four tend to have the most negative reactions to hospitalization.**
27
# Behavioral Pediatrics
School Related Problems
Children and adolescents with chronic medical conditions have higher rates of school-related problems (e.g., CNS irradiation and intrathecal chemotherapy for leukemia have been linked to impaired neurocognitive functioning and learning disabilities).
28
# Behavioral Pediatrics
Compliance
**Compliance with medical regimens is a particular problem for adolescents.** because of peer acceptance concerns
29
# Schizophrenia
Diagnostic Criteria
A diagnosis of Schizophrenia requires the presence of at least two active phase symptoms - i.e., delusions, hallucinations, disorganized speech, grossly disorganized behavior, negative symptoms - for at least one month with at least one symptom being **delusions, hallucination, or disorganized speech**
30
# Schizophrenia
Prognosis
best outcome associated with:
* acute and late onset
* female gender
* precipitating event
* brief duration of active-phase symptoms
* insight
* family history of mood disorder
* no family history of schizo
31
# Schizophrenia
Concordance Rates
* Siblings- 10%
* Fraternal 17%
* Identical 48%
* Child of two schizo parents 46%
32
# Schizophrenia
Etiology
* Elevated dopamine reason for symptoms
* enlarged ventricles
* smaller than normal hippocampus, amygdala, globus pallidus
* hypofrontality
33
# Schizophrenia
Treatment
Treatment usually includes an antipsychotic drug, cognitive-behavioral therapy, psychoeducation, social skills training, supported employment, and other interventions for the individual with Schizophrenia and psychosocial interventions for his/her family.
34
# Schizophrenia
Expressed Emotion (EE)
family based interventions are most effective when they target high levels of of EE, which have been linked to relapse and hospitalization
35
# Delusional Disorder
Diagnostic Criteria
one or more delusions that last a month
36
# Delusional Disorder
Types
* **erotomanic** (belief that someone is in love with you)
* **grandiose** (believes they are great but unrecognized)
* **jealous** (belief that spouse is unfaithful)
* **persecutory** (belief that they are being conspired against, cheated on, spied on, poisoned)
* **somatic** (abnormal body function/sensation)
* mixed
* unspecified
37
# Schizophreniform Disorder
Diagnostic Criteria
The diagnostic criteria for Schizophreniform Disorder are identical to those for Schizophrenia except that the disturbance is present for **at least one month but less than six months** and impaired social or occupational functioning may occur but is not required.
38
# Brief Psychotic Disorder
Diagnostic Criteria
Brief Psychotic Disorder is characterized by the presence of one or more of four characteristic symptoms (**delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior**) with at least one symptom being delusions, hallucinations, or disorganized speech.
Symptoms are present for at least one day but less than one month with an eventual return to full premorbid functioning.
39
# Schizophenia
Differential Diagnosis
* between 1 day and 1 month- "Brief Psychotic"
* between 1 month and 6mo- **schizophreniform**
* 6mo or more **schizophrenia**
* schizoaffective- schizophrenia + major depressive or manic episode
40
# Bipolar 1
Diagnostic Criteria
A diagnosis of Bipolar I Disorder requires at least **one manic episode** that lasts for at least one week, is **present most of the day nearly every day,** and includes at least three characteristic symptoms - e.g., inflated self-esteem or grandiosity; decreased need for sleep; flight of ideas.
Symptoms must cause marked impairment in social or occupational functioning, require hospitalization to avoid harm to self or others, or include psychotic features.This disorder may include one or more episodes of hypomania or major depression.
Onset is 18y/o
41
# Bipolar 1
Treatment
Treatment usually includes **lithium or an anti-seizure medication** and cognitive-behavior therapy or other form of therapy.
42
# Bipolar
Differential Diagnosis
* cyclothymic- less intense, hypomanic symptoms
* BD 2- hypomania, 4 days
* BD 1- mania, 7 days
43
# Bipolar 2
Criteria
shorter episodes, "hypomania," abnormally and persistently elevated, expansive, or irritable mood
44
# Disruptive Mood Dysregulation
Diagnostic Criteria
- temper outbursts- verbal or behavioral
- two of three settings (home/school/peers)
- diagnosed between ages 6 and 18, symptoms must persist for a year
45
# MDD
Diagnostic Criteria
A diagnosis of Major Depressive Disorder requires the presence of at least five symptoms of a major depressive episode nearly everyday for at **least two weeks**, with at least one symptom being depressed mood or loss of interest or pleasure
Symptoms are:
* depressed mood (or, in children and adolescents, a depressed or irritable mood)
* markedly diminished interest or pleasure in most or all activities
* significant weight loss when not dieting or weight gain or a decrease or increase in appetite
* insomnia or hypersomnia
* psychomotor agitation or retardation fatigue or loss of energy
* feelings of worthless or excessive guilt
* diminished ability to think or concentrate
* recurrent thoughts of death
* recurrent suicidal ideation
* suicide attempt.
46
# MDD
Variations
* peripartum onset
* seasonal pattern
47
# MDD
Associated features
* sleep disturbances
* anxiety (60% comorbidity)
48
# MDD
Prevalence
* 18-29 is 3x the 60+ prevalence
* 7%
* females is 1.5-3x males
49
# MDD
Pseudodementia
- pseudodementia- onset is sudden and is actually depression, patient is concerned about symptoms
- dementia- onset is slow and patient is unaware
50
# MDD
catecholamine hypothesis
deficiency in norepiphephrine
51
# MDD
indolamine hypothesis
low levels of serotonin
52
# MDD
other etiology hypotheses
* elevated levels of cortisol (stress hormone)
* shrinkage of the hippocampus
53
# MDD
Behavioral Theory of Depression
Lewinsohn's behavioral theory attributes depression to a low rate of response-contingent reinforcement. (operant extinction of social behaviors)
54
# MDD
learned helplessness model
Seligman's learned helplessness model proposes that depression is due to **exposure to uncontrollable negative events and internal, stable, and global attributions for those events.** A reformulation of the theory by Abramson, Metalsky, and Alloy emphasizes the role of hopelessness.
55
# MDD
Beck's Depressive Triad
negative illogical self-statements about oneself, the world, and the future
56
# MDD
Treatments
TCAs, SSRIs (first-line), MAOIs (for those who don't respond to other drugs)
57
# Dysthymia
Diagnostic Criteria & Treatment
* depressed mood on most days for at least two years (in adults, one year in children)
* CBT + Medication
58
# Suicide
Early Warning Signs
High risk for suicide is associated with a warning; **previous attempts; a plan (especially one involving a lethal weapon); male gender; being divorced, separate, or widowed; and feelings of hopelessness.**
59
# Suicide
Age
For most age groups, the rates are highest for Whites; an exception is for American-Indian/Alaskan Native individuals ages 15 to 34 who have a rate 2.5 times higher than the national average for this age group.
60
# Suicide
Gender
Suicide **attempters** (vs. completers) are most likely to be **female.**
61
# Suicide
Paradoxical Depression Improvement Effect
suicide most likely to occur within three months of depression *improving*
62
# Suicide
Biological Correlates
low levels of serotonin and 5-HIAA
63
# Separation Anxiety Disorder
Diagnostic Criteria
Separation Anxiety Disorder involves **developmentally inappropriate and excessive fear or anxiety related to separation from home or attachment figures** as evidenced by at least three symptoms - e.g., recurrent excessive distress when **anticipating** or experiencing separation from home or major attachment figures; **persistent excessive fear of being alone;** repeated complaints of **physical symptoms** when separation from an attachment figure occurs or is anticipated.
64
# Separation Anxiety Disorder
Criteria Time
The disturbance must last at **least four weeks in children and adolescents or six months in adults and must cause clinically significant distress or impaired functioning.**
65
# Separation Anxiety Disorder
Treatment
systematic desensitization, cognitive approaches (identifying and replacing negative self-statements
(school refusal- first line is to return to school, cognitive work *after*)
66
# Specific Phobia
Diagnostic Criteria
Specific Phobia is characterized by intense fear of or anxiety about a **specific object or situation,** with the individual either avoiding the object or situation or enduring it with marked distress. The fear or anxiety is **not proportional** to the danger posed by the object or situation, is **persistent (typically lasting for at least six months), and causes clinically significant distress or impaired functioning.**
67
# Specific Phobia
Treatment
The treatment-of-choice is exposure with response prevention (especially in vivo exposure).
68
# Specific Phobia
Etiology
- abnormal levels of serotonin, norepinephrine, GABA
- classical conditioning
69
# Specific Phobia
Types
* animal
* natural/environmental
* blood/injection/injury
* situational
70
# Social Anxiety Disorder
Diagnostic Criteria
Social Anxiety Disorder involves intense fear or anxiety about one or more social situations in which the individual may be exposed to **scrutiny by others.** The individual fears that he/she will exhibit anxiety symptoms in these situations that will be negatively evaluated; he/she **avoids** the situations or endures them with intense fear or anxiety; and his/her fear or anxiety is **not proportional** to the threat posed by the situations.
71
# Social Anxiety Disorder
Treatment
- Exposure with response prevention is an effective treatment, and its benefits may be enhanced when it is combined with social skills training or cognitive restructuring and other cognitive techniques.
- medication- SSRI, SNRI, beta blocker
72
# Panic Disorder
Diagnostic Criteria
Panic Disorder is characterized by **recurrent unexpected panic attacks** with at least one attack being followed by one month of persistent concern about having additional attacks or about their consequences and/or involving a significant maladaptive change in behavior related to the attack.
- women 2x as likely to have it
73
# Panic Disorder
Treatment
**Cognitive behavioral interventions that incorporate exposure** are the treatment-of-choice for this disorder.
74
# Agoraphobia
Diagnostic Criteria
marked fear or anxiety in at least two of:
- public transit
- open spaces
- enclosed spaces
- standing in line
- part of a crowd
- outside the home alone
Concern about possibility of developing panic-like, embarassing or incapacitating symptoms
75
# Agoraphobia
Treatment
in vivo Exposure and Response Prevention
76
# GAD
Diagnostic Criteria
GAD involves excessive anxiety and worry about multiple events or activities, which are relatively constant for at least **six months**, the person finds difficult to control, and cause clinically significant distress or impaired functioning. Anxiety and worry must include at least three characteristic symptoms (or at least one symptom for children) - **restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating; irritability; muscle tension; sleep disturbance.**
77
# GAD
Treatment
Treatment usually involves cognitive-behavioral therapy or a combination of cognitive-behavioral therapy and pharmacotherapy.
78
# OCDPD
Diagnostic Criteria
Obsessive-Compulsive Personality Disorder is characterized by a persistent preoccupation with **orderliness, perfectionism, and mental and interpersonal control** that severely limits the individual's flexibility, openness, and efficiency.
At least four characteristic symptoms must be present - e.g., exhibits **perfectionism** that interferes with task completion; is **excessively** devoted to work and productivity to the exclusion of leisure activities and friendships; is **reluctant to delegate** work to others unless they are willing to do it his/her way; adopts a **miserly spending** style toward self and others.
79
# OCD
Treatment
A combination of exposure with response prevention and the tricyclic clomipramine or an SSRI is usually the treatment-of-choice for OCD.
80
# OCD
Gender
Prevalence the same, but onset is earlier in males, so there are a larger amount of males with OCD
81
# OCD
Etiology
- over-active right caudate nucleus
- problems with orbitofrontal cortex and cingulate cortex function
- low levels of serotonin
82
# Reactive Attachment Disorder
Diagnostic Criteria
| cold to caregivers
Reactive Attachment Disorder is characterized by a pattern of inhibited and emotionally withdrawn behavior toward adult caregivers as manifested by a **lack of seeking or responding to comfort when distressed** and a persistent social and emotional disturbance. The diagnosis requires evidence that the child has experienced **extreme insufficient care that is believed to be the cause of the disturbed behavior.** Symptoms must be apparent before the child is five years of age, and the child must have a **developmental age of at least nine months.**
83
# Disinhibted Social Engagement Disorder
Diagnostic Criteria
| Warm to strangers
inappropriate interactions with unfamiliar adults, must be related to extreme insufficient care
84
# PTSD
Diagnostic Criteria
The diagnosis of PTSD requires **exposure to actual or threatened death, serious injury, or sexual violence;** presence of at least one intrusion symptom related to the event; persistent avoidance of stimuli associated with the event; **negative changes in cognition or mood associated with the event;** and marked change in arousal and reactivity associated with the event.
85
# PTSD
Treatment
Comprehensive CBT intervention
* exposure
* cognitive restructuring
* anxiety management
86
# PTSD
Acute Stress Disorder
short term PTSD- three days to one month
87
# PTSD
Time requirement
Symptoms must have a duration of **more than one month** and must cause clinically significant distress or impaired functioning.
88
# Adjustment Disorder
Diagnostic Criteria
identifiable psychosocial stressors within three months of the onset of the stressors.
must remit after 6 months after the stressor goes away
89
# Dissociative Amnesia
Diagnostic Criteria
A diagnosis of Dissociative Amnesia requires an **inability to recall important personal information** that cannot be attributed to ordinary forgetfulness and causes clinically significant distress or impaired functioning. It is often related to exposure to one or more traumatic events. The most common forms of amnesia are **localized and selective.**
90
# Dissociative Amnesia
Types
| Localized, Selective, Generalized
* Localized - all events related to a circumscibed period of time
* Selective- some events related to a circumscribed period
* Generalized- person's entire life
| localized and selective most common
91
# Dissociative Amnesia
Types
| Continuous, Systematized
- continuous - inability to recall events subsequent to a specific time through the present
- systematized- memories related to a certain category of information
92
# Somatic Symptom Disorder
Diagnostic Criteria
- excessive thoughts, feelings, behaviors related to somatic symptoms
- more than six months in duration
93
# Illness Anxiety Disorder
Diagnostic Criteria
Concern of a serious illness with **absence** of somatic symptoms or with **mild** somatic symptoms
present for 6mo
94
# Conversion Disorder
Diagnostic Criteria
The symptoms of Conversion Disorder involve **disturbances in voluntary motor or sensory functioning** and suggest a serious neurological or other medical condition (e.g., paralysis, seizures, blindness, loss of pain sensation) with evidence of an **incompatibility between the symptom and recognized neurological or medical conditions.**
95
# Factitious Disorder
Diagnostic Criteria
Individuals with Factitious Disorder Imposed on Self **falsify physical or psychological symptoms** that are associated with their deception, present themselves to others as being ill or impaired, and engage in the deceptive behavior even in the absence of an obvious external reward for doing so. For both types of Factitious Disorder, falsification of symptoms can involve **feigning, exaggeration, simulation, or induction (e.g., by ingestion of a substance or self-injury).**
96
# Anorexia Nervosa
Diagnostic Criteria
The essential features of Anorexia Nervosa are (a) **a restriction of energy intake that leads to a significantly low body weight;** (b) an intense fear of gaining weight or becoming fat or behavior that interferes with weight gain; and (c) a disturbance in the way the person experiences his or her body weight or shape or a persistent **lack of recognition of the seriousness of his/her low body weight**.
97
# Anorexia Nervosa
Etiology
- higher than normal level of serotonin
- high in perfectionism, high expectations for themselves and others
- high EE in families is risk factor
98
# Anorexia Nervosa
Treatment
- weight gain first- hospitalization sometimes necessary
- CBT second, relapse prevention
99
# Bulimia Nervosa
Diagnostic Criteria
Bulimia Nervosa is characterized by (a) recurrent episodes of binge eating that are accompanied by a sense of a **lack of control**; (b) inappropriate compensatory behavior to prevent weight gain (e.g., self-induced vomiting, excessive exercise); and (c) self-evaluation that is unduly influenced by body shape and weight.
100
# Bulimia Nervosa
Etiology
- onset linked to a period of dieting
- low levels of endogenous beta-endorphin
- low levels of serotonin
101
# Bulimia Nervosa
Binge Eating Disorder
- distinct from bulimia because no purging
- lack of control over volume of food eaten
102
# Enuresis
Diagnostic Criteria/Treatment
- bed wetting, 5y/o and up, at least twice a week for three+ consecutive months
- bell and pad OR medication, but bell and pad is better
103
# Encopresis
Diagnostic Criteria/Treatment
- involuntary passage of feces
- at least once a month for at least three months
- at leat 4y/o
104
# Insomnia Disorder
Diagnostic Criteria
Insomnia Disorder is characterized by dissatisfaction with sleep quality or quantity that is associated with at least one characteristic symptom- **difficulty initiating sleep; difficulty maintaining sleep; early-morning awakening with an inability to return to sleep.** The sleep disturbance occurs at least three nights each week, has been present for at **least three months,** occurs despite sufficient opportunities for sleep, and causes significant distress or impaired functioning.
105
# Insomnia Disorder
Treatment
- sleep hygiene
- stimulus control (strengthen the bed/bedroom as cues for sleep)
- relaxation training
106
# Hypersomniac Disorder
Diagnostic Criteria
- difficulty becoming fully awake after an abrupt awakening
- three times a week, three months
107
# Narcolepsy
Diagnostic Criteria
Narcolepsy is characterized by attacks of an irrepressible need to sleep with lapses into sleep or daytime naps that occur at least three times per week and have been present for at least three months. **The diagnosis also requires episodes of cataplexy, a hypocretin deficiency, or a rapid eye movement latency less than or equal to 15 minutes.**
108
# Other Sleep Disorders
Non-REM Sleep Arousal
- sleepwalking
- sleep terror (no memory in the morning)
109
# Other Sleep Disorders
Nightmare disorder
vivid nightmares during REM, lingering sense of anxiety and fear
110
# Erectile Disorder
Diagnostic Criteria
A diagnosis of Erectile Disorder requires the presence of at least one of three symptoms **(marked difficulty in obtaining an erection during sexual activity, marked difficulty in maintaining an erection until completion of sexual activity, marked decrease in erectile rigidity)** on all or almost all occasions of sexual activity.
111
# Penetration Disorder
Diagnostic Criteria
- tensing of pelvic floor muscles
- pain during penetration
- linked to sexual/physical abuse
112
# Premature Ejaculation
Diagnostic Criteria/Treatment/Etiology
- ejaculation in less than a minute, or before the person wants it to last
- goes on for 6mo
- treated with sensate focus, start-stop, squeeze techniques
- linked to low serotonin
113
# Gender Dysphoria
Diagnostic Criteria
* strong desire to be the opposite gender
* duration of 6mo at least
114
# Paraphilic Disorder
Frotteuristic Disorder
| Description and Treatment
* inappropriate arousal from touching/rubbing against a non-consenting adult
* treatment is covert sensitization (aversive conditioning in imagination)
* DepoProvera (only effective while taking the drug)
115
# ODD
Diagnostic Criteria
Oppositional Defiant Disorder involves a recurrent pattern of an **angry/irritable mood, argumentative/defiant behavior, or vindictiveness** as evidenced by at least four characteristic symptoms that are exhibited during interactions with at least one person who is not a sibling - e.g., often loses temper; often argues with authority figures; often actively refuses to comply with requests from authority figures or with rules; often blames others for his/her mistakes.
116
# Transvestic Disorder
Diagnostic Criteria
- exclusively in males
- most are heterosexuals
117
# Intermittent Explosive Disorder
Diagnostic Criteria
* inability to control impulses, not proportional to provocation, aggresion
* twice a week
* 12mo
118
# Conduct Disorder
Diagnostic Criteria
The diagnosis of Conduct Disorder requires a persistent pattern of behavior that **violates the basic rights of others and/or age-appropriate social norms** or rules as evidenced by the presence of at least three characteristic symptoms during the past 12 months and at least one symptom in the past six months.
119
# Conduct Disorder
Symptom Categories
Symptoms are divided into four categories: **aggression to people and animals; destruction of property; deceitfulness or theft; and serious violation of rules.**
120
# Conduct Disorder
Age
Symptoms must cause significant impairment in functioning, and the disorder cannot be assigned to individuals over age 18 who meet the criteria for Antisocial Personality Disorder.
121
# Conduct Disorder
Treatment
PMT- parent management training, teaches parents to reward positive behaviors
MST- alternative approach that targets individual, family, school, community
122
# Conduct Disorder
Types
* life-course-persistent
* adolescence-limited-type
123
# Substance Use Disorder
Diagnostic Criteria
Manifested by at least two symptoms during a **12-month period** - e.g., substance used in larger amounts or for a longer period of time than intended
* persistent desire or unsuccessful efforts to cut down or control use
* craving for the substance
* recurrent substance use despite persistent social problems caused or worsened by substance use
* recurrent substance use in situations in which it is physically dangerous to do so;
* tolerance
* withdrawal
124
# Substance Use Disorders
Treatment
* naltrexone, disulfiram for alcohol
* buproprion for tobacco
125
# Substance Use DIsorders
Marlatt & Gordon
reaction to relapse is "abstinence violation effect," they propose you see it as a mere mistake stemming from **specific, external and controllable factors**
126
# Substance Use DIsorders
Smoking Cessation Intervention
- nicotine replacement therapy
- multicomponent behavior therapy
- support and assistance from a clinician
127
# Substance Induced Disorders
Diagnostic Criteria
The Substance-Induced Disorders include Substance **Intoxication**, Substance **Withdrawal**, and **Substance/Medication-Induced Mental Disorders.**The latter "are potentially severe, usually temporary, but sometimes persisting central nervous system (CNS) syndromes that develop in the context of the effects of substances of abuse, medications, or toxins" (APA, 2013, p. 487) and include Substance/Medication-Induced Psychotic Disorder, Substance/Medication-Induced Depressive Disorder, and Substance/Medication-Induced Neurocognitive Disorders.
128
# Substance Induced Disorders
Korsakoff
* anterograde and retrograde amnesia, confabulation (invention of memories to cover for memory loss)
* thiamine deficiency
129
# Substance Induced Disorders
Alcohol Withdrawal
- autonomic hyperactivity
- nausea, insomnia, illusions, hallucinations
- tonic-clonic seizures
130
# Substance Induced Disorders
Stimulant Intoxication + Withdrawal
**Intoxication**
- euphoria, affective blunting, hypervigilance, anxiety
- after usage: tachycardia or bradycardia, irregular blood pressure, seizures
**Withdrawal**
* fatigue
* crash
* nystagmus (involuntary rapid movement of the eyes)
131
# Substance Induced Disorders
Sedative Intoxication + Withdrawal
**Intoxication**
* slurred speech
* incoordination
* unsteady gait
* nystagmus
**Withdrawal**
* tremors
* autonomic hyperactivity
* illusions, hallucinations
* grand mal seizures
132
# Substance Induced Disorders
Opioid Intoxication + Withdrawal
**Intoxication**
* euphoria followed by apathy
* drowsiness
* slurred speech
**Withdrawal**
* dysphoric mood, nausea, lacrimation and rhinorrea
133
# Delirium
Diagnostic Criteria
A diagnosis of Delirium requires(a) a **disturbance in attention and awareness** that develops over a short period of time, represents a change from baseline functioning, and tends to fluctuate in severity over the course of a day and (b) an additional **disturbance in cognition** (e.g., impaired memory, disorientation, impaired language, deficits in visuospatial ability, perceptual distortions).
134
# Delirium
Etiology
* older adults
* decreased cerebral reserve (dementia, stroke, HIV)
* postcardiotomy
* burn victims
* drug withdrawal
135
# Delirium
Treatment
* treatment of underlying issue
* reduction of agitated behaviors
* haloperidol
136
# Neurocognitive Disorder Due to Alzheimerrs
Stage 1
Stage 1 (1 to 3 years) involves anterograde amnesia (especially for **declarative memories);** deficits in visuospatial skills (wandering); indifference, irritability, and sadness; and anomia.
137
# Neurocognitive Disorder Due to Alzheimerrs
Stage 2
Stage 2 (2 to 10 years) is characterized by increasing retrograde amnesia; flat or labile mood; restlessness and agitation; delusions; fluent aphasia; acalculia; and ideomotor apraxia (inability to translate an idea into movement).
138
# Neurocognitive Disorder Due to Alzheimerrs
Stage 3
Stage 3 (8 to 12 years) entails severely deteriorated intellectual functioning; apathy; limb rigidity; and urinary and fecal incontinence.
139
# Neurocognitive Disorder Due to Alzheimerrs
Prevalence/Course
* accounts for 60-90% of cases of dementia
* gradual onset/progressive decline
140
# Neurocognitive Disorder Due to Alzheimerrs
Etiology
* chromosomal abnormalities (1, 14, 21)
* ACh
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# Neurocognitive Disorder Due to Alzheimerrs
Treatment
* group therapy
* behavioral therapy
* antipsychotic drugs
* cholinesterase inhibitors
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Vascular Neurocognitive Disorder
criterion for Major or Mild Neurocog met, clinical features are consistent with vascular etiology
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# Neurocognitive Disorder due to HIV
Stages
* 0: normal
* 0.5: minimal or equivocal symptoms, no impairment
* 1: functional, intellectual, motor impairment, can still function
* 2: cannot work, can perform basic tasks of daily life
* 3: major intellectual incapacity/motor disability
* 4: nearly vegetative
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# Paranoid Personality Disorder
Diagnostic Criteria
* distrust
* suspiciousness
* doubts about benign remarks, grudges
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Schizoid Personality Disorder
* detachment from interpersonal relationships
* restricted range of emotional expression
* little interest in relationships, sexual activity, lacks close friends
* indifferent to praise/criticism
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Schizotypal Personality Disorder
* ideas of reference
* odd beliefs
* magical thinking
* inappropriate or constricted affect
* usually have few friends and prefer being alone
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Antisocial Personality Disorder
* violation of the rights of others
* failure to conform to social norms
* since 15, must have had a history of conduct disorder before age 15
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# Borderline Personality Disorder
Diagnostic Criteria
* frantic efforts to avoid abandonment
* instable, intense interpersonal relationships
* fluctuations between idealization and devaluation
* affective instability
* inappropriate anger, trouble controlling it
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# Borderline Personality Disorder
Onset/Course
* onset age range 19-34
* substantial improvement in 15-year follow-up
* by age 40, 75% of individuals no longer meet criteria
* impulsive symptoms resolve fastest, affective instability resolves slowest
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# Borderline Personality Disorder
DBT
* group skills training to help clients regulate emotions
* individual outpatient therapy to strengthen client's motivation and newly acquired skills
* telephone consultation to provide support and coaching
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# Borderline Personality Disorder
Etiology
Stern: disturbance in the mother-child relationship
Mahler: fixation of reapprochment phase of separation-individuation
Kernberg: traced to adverse, unpredictable caregiver-child interactions that alternate between **rejection and smothering**
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Histrionic Personality Disorder
* pervasive pattern of emotionality
* attention-seeking
* sexually seductive or provocative
* shifting and shallow emotions
* impressionistic speech
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Narcissistic Personality Disorder
* grandiosity
* need for admiration
* fantasies of unlimited success
* thinks theyre only understood by other high-status people
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Avoidant Personality Disorder
* social inhibition, inadequacy, hypersensitivity
* avoidant, fear of rejection/criticism
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Dependent Personality Disorder
need to be taken care of, submissive clinging behavior, fear of separation
needs assurances
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Obsessive Compulsive Personality Disorder
does not involve obsessions and compulsions
preoccupation with orderliness, perfectionism, need for control that limits flexibility
miserly, incapable of delegating
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Schizoid vs Schizotypal
People living with schizoid personality disorder have a limited desire for social relationships, whereas those with schizotypal personality disorder have a desire for social relationships but struggle with social interaction due to their eccentricities.
Madsen Triad EPPP
flashcards
Decks in class (9)
# Cards
