1
Q
What is APGAR?
A
A - appearance (color) P - pulse G - grimace (reflex irritability) A - Activity (muscle tone) R - Respiration
Used to predict likelihood of immediate survival (of neonates)
Normal = 8-9
2
Q
Post Partum Major Depression occurs in ___ of new mothers, within ___ of child birth, and can persist ___
A
10%
1 month
1 year
3
Q
Criterion for premature and very premature birth
A
Premature: 37 Weeks
Very premature: 32 Weeks
4
Q
4 Necessary infant reflexes necessary for survival
A
- Rooting: touch cheek –> turn toward nipple
- Palmar Grasp: grip any object put in palm
- Moro: limb extended when child is startled
- Babinski: dorsiflexion of toes when sole is stroked
5
Q
3 Spheres of Development:
A
- Motor
- Social
- Verbal/Cognitive
6
Q
How does development tend to occur (progress)? From ___ to ___
A
- Cephalad to caudal
- Central to peripheral
- From self to others
- From understanding to expressing
7
Q
Stranger anxiety starts at ___
A
9 months
8
Q
Social smile starts at ___
A
12 weeks
9
Q
Separation anxiety starts at age ___
But ____always comes first
Separation Anxiety Disorder Starts at age ___
A
Late in first year
Object permanence comes first
7 years: school phobia/refusal
10
Q
Babinski reflex disappears at ___
A
1 year
11
Q
What milestone at age 2?
A
Say “No!”
Terrible Twos
12
Q
Gender identify by age ___
A
3 years
13
Q
Play progression:
Cooperative by age ___
A
Solitary –> parallel –> associative –> cooperative
4 years
14
Q
Year 6 Milestones
A
- “Superego”
- Morality
- Empathy
- Lying is wrong
- Finality of death
15
Q
Rett’s Disorder Characteristics:
A
- 4 Years of normal functioning
- Hand wringing
- Breathing problems
- Intellectual impairment
- Ataxia
- Motor and social declines,
- X-linked
16
Q
Universality of death by age ___
Morality by age ___
A
9 years
12 years
17
Q
Body image and popularity ideas by age ___
A
15 years
18
Q
3 Predisposing factors for teen pregnancy
A
- Depression
- Poor school achievement
- Divorced parents
19
Q
Selective Mutisum usually starts at age ___
A
6 years
20
Q
Phonological vs Articulation disorders
A
Phonological: leaves out or misplaces speech sounds
Articulation: unable to make necessary motor movements for accurate speech. ex: lisp
21
Q
Separation Anxiety Disorder Characteristics
A
- School phobia or refusal
- Starts at 7 years/stressful life event/anxious family
22
Q
Autism Spectrum Disorder Findings:
A
- Seen before age 3
- No finger pointing (theory of mind)
- Larger head circumference (overgrowth during first year)
- More common in boys
23
Q
5 Stages of Dying:
A
Denial Anger Bargaining Depression Acceptance
24
Q
Bereavement (normal grief) vs. Complicated Bereavement (abnormal)
A
- Both have initial shock and denial
- Both include sadness and crying
- Abnormal involves suicidal thinking or hallucinations
25
Schizophrenia definition:
"Split Mind"
| Behavior vs. thought content divergence
26
Hallmark symptom of schizophrenia:
Psychosis: impairment in reality testing
27
List 12 Symptoms of Psychosis
1. Illusion
2. Hallucination
3. Ideas of reference
4. Delusions
5. Loss of ego boundaries
6. Alogia
7. Echolalia
8. Thought Blocking
9. Neologisms
10. Circumstantiality
11. Tangentiality
12. Loose associations
28
Difference between Illusion vs Hallucinations
Illusion: misinterpretation of real external stimuli
Hallucinations: sensory perceptions not generated by external stimuli
29
What is false conviction that one is subject of attention by other people?
Ideas of reference
30
Delusions:
| Most common type?
- False beliefs
- Not correctable by logic or reason
- Delusions of persecution most common
31
Loss of ego boundaries:
Not knowing where one's mind and body end and those of others begin
32
Alogia:
- Lack informative content in speech
| - Mute or speaks few words
33
"I'm very sure I've got the cure and I'm not pure"
Echolalia:
- Repeating statements of others
- Associating words by their sounds, not meanings
34
"I have to take my....."
| Often because of ___
Thought blocking
hallucinations
35
"I'm fatigloo"
Neologisms
36
Circumstantiality vs Tangentiality
Circumstantiality: responds to questions, but presenting voluminous details
Tangentiality: beginning logically, getting further from the point, fail to answer question
37
"I drive a brown car. So i like brown snickers and the sun is really nice today."
Loose associations
- Loss of logical meaning
- No linked associations
- Illogically jumps from one subject to another
38
Differentiate Schizophrenia vs Medical Delirium
Schizophrenia= no clounding of consciousness: alert, oriented
39
Schizophrenia DSM-5 Criteria
A. Characteristic Symptoms (2+)
B. Social/Occupational dysfunction: at least 1 of work, interpersonal, self care
C. Duration: at least 6 months w/ 1 month of symptoms
D. Schizoaffective and Mood Disorder exclusion
E. Substance/general medical condition exclusion
40
5 Schizophrenia characteristic symptoms:
1. Delusions
2. Hallucinations
3. Grossly disorganized or catatonic behavior
4. Negative symptoms
5. Disorganized speech
41
3 Phases of Schizophrenia:
1. Prodromal: prior to 1st psychotic break
2. Psychogic/Active: loss of touch w/ reality
3. Residual: period between psychotic episodes, in touch w/ reality, but doesn't behave normally
42
Schizophrenia age of onset in men vs women
Men: 15-25
| Women 25-35
43
Enlargement of what brain structure(s) in Schizophrenia?
Lateral and third ventricle
44
Brain density change in what brain structure(s) in Schizophrenia?
Lower density --> smaller
| Hippocampus, amygdala, parahippocampal gyrus
45
What happens in frontal lobe in Schizophrenia?
Hypofrontality: decreased use of glucose
46
Dopamine Hypothesis of Schizophrenia:
| Glutamate Hypothesis of Schizophrenia
- Excessive DA activity in MESOLIMBIC tract
| - Hypoactivity of NDMA receptor in brain
47
2 Neuronal Pathways in Schizophrenia (positive/negative symptoms)
Positive: Glu-GABA-Glu-DA
Pathology: high DA in mesolimbic
Negative: Glu-GABA-Glu-GABA-DA
Pathology: low DA in mesocortical
48
Brief Psychotic Disorder
Schizophrenia symptoms
| 1-29 days **LESS than 1 month**
49
Schizophreniform Disorder
1-6 Months of Schizophrenia symptoms
50
Schizoaffective Disorder
Schizophrenia + mania and/or depression
51
All effective antipsychotics for Schizophrenia block ___ receptors in ___ DA pathway
D2
| mesolimbic
52
DSM-5 Criteria for Neurodevelopmental Disorder
New name for ADHD
- Start before age 12
- Symptoms in multiple (2+) settings
- Must cause social disability
- 6+/9 Symptoms (inattention or hyperactive/impulsive)
- 6 Months
53
Versions of ADHD
- Combined
- Inattentive
- Hyperactive/impulsive
- Other specified, or unspecified
54
2 neurotransmitter genes most commonly associated w/ ADHD
Dopamine system
| Noradrinergic system
55
ADHD __ symptoms tend to persist greater than ___ symptoms
Inattentive > hyperactivity/impulsivity
56
High dopamine/noradrinergic activity leads to ___
| Very high leads to ___
Hypervigilant
Very high --> Psychosis
57
Low dopamine/noradrinergic activity leads to ___
| Very low leads to ___
ADHD
Very low --> Schizophrenia (-) symptoms
58
In ADHD brains, selective pruning happens (earlier/later)
Later
59
3 Nonaddictive ADHD Drugs:
| Side effects?
Atomoxetine (NRI)
Guanfancine ER a2 agonist
Clonidine ER a2 agonist
Less efficacy than stimulants
Often sedating
May lower BP
60
Class of ADHD drugs that has greatest efficacy is ___
| Adverse effects?
Stimulant class
Risk of addiction
Too much --> paranoia
Stunt growth, weight loss (low appetite)
61
1st line ADHD treatment for preschool, children and adolescents, and adults
Preschool: behavioral therapy
Children and adolescents: Slow release Methylphenidate (MPH)
Adults: Nonaddictive (Atomoxetine, Modafinil, Ganfacine ER, Clonidine ER)
62
a2 Agonist mechanism of action for ADHD
Norepi a2 receptor: increase signal strength --> increase signal to noise ratio -->make glutamate function more efficient
63
Most common co-occuring disorder with ADHD:
Anxiety
64
Functional MRI finding in ADHD
Hypoactive Anterior Cingulate
65
3 Spheres of functioning:
1. Social
2. Academic
3. Occupational
66
Personality traits are [immutable/circumstantial/modifiable] risk for suicide
Immutable
67
Risk traid for suicide includes
Ideation
Intention
Plan
68
What religions are at increased risk for suicide?
- Jewish or protestant
| - Highest in protestant
69
Highest risk demographic for suicide:
Middle aged
White/Caucasian
Male
70
Top 3 leading causes of death for adolescents 15-19
1. Accidents
2. Homocide
3. Suicide
71
Age and gender pattern for suicide risk
- Increases substantially after 55
- Decrease for old women
- Increase for old men
- Men ALWAYS higher risk than women
72
Top suicide method in US vs. elsewhere
US: firearms
Elsewhere: hanging
73
[Short/long] allele for serotonin transporter gene (SERT) associated with increased MDD and suicide risk
Short allele (ss) -->highest risk
Long allele (l/l) --> protective
74
Antidepressents [raise/lower] risk of suicide for what group of people?
Raise
| 24 or younger
75
Why increased suicide risk initially after being put on antidepressants?
-Increased energy and clear thinking improve before lifting of depressed mood --> More energy to act on suicidal thoughts
76
Greatest predictor of suicide risk:
Past violence
77
DSM-5 Major Depressive Disorder Criteria:
1. 5+/9 Symptoms during 2-week period (at least 1 is depressed mood or loss of interest/pleasure)
2. Symptoms cause distress or impairment in functioning
3. Not attributable to physiological effects
78
SIG E CAPS
```
Sleep disturbance
Interest/pleasure reduction
Guilt, worthlessness
Energy loss, fatigue
Concentration/attention impairment
Appetite changes
Psychomotor symptoms
Suicide Ideation
```
79
How to differentiate normal sadness vs. depression?
```
S.W.A.G
Have at least one of the following in depression:
Suicidality
Weight loss
Anhedonia
Guilt
```
80
Atypical Depression likely findings:
- Weight gain, hypersomnia
| - Leaden paraysis, carb cravings, rejection sensitivity
81
Medical conditions that mimic depression:
- Hypothyroidism -->tired
- Cushing's
- Anemia -->tired
- Vitamin deficiency (B12, Folate)
- Obstructive sleep apnea --> poor brain perfusion at night
82
2 Biological Theories of Depression:
- Monoamine deficinecy
- Monoamine receptor excess
-Reality= combination of both
83
(Genetic/Environmental) factors more important in depression
Environmental
84
Functional Neuroanatomy in MDD:
- Hypoactive dorsolateral prefontral cortex
| - Hyperactive amygdala
85
Gender difference in MDD
- Lifetime prevalence: women > men
| - Women more likely to seek help
86
2 Common comorbidities of MDD:
- Substance abuse
| - Generalized anxiety
87
3 Frontline treatment classes of MDD:
SSRI
SNRI
NDRI
Less severe side effects than MAOIs and TCAs
88
Increasing cortisol in brain does what to make depression more likely?
Decrease brain neurotrophic factors
89
What is Delay of Reinforcement Gradient?
- Individuals w/ ADHD are MORE sensitive to IMMEDIATE reinforcement
- LESS sensitive to DISTAL reinforcement
- Compared to normally developing individuals
90
Oppositional Defiant Disorder (ODD) Criteria:
| How to define severity?
- 4+ Symptoms (3 groups: Angry/Irritable, Argumentative/Defiant, Vindictive) for 6+ Months
- Negative Impact
- Not during course of other disease (psychotic, depressive)
- Severity based on number of settings (1, 2, 3+)
91
Conduct Disorder (CD) Criteria:
Violate norms or rights of others
- 3+ symptoms for 12+ months (agression, destruction, deceit/theft, violate rules)
- Functional impairment
- If 18+, criteria not met for Antisocial personality disorder
92
Limited prosocial emotions is:
Specific manifestation of Conduct Disorder
-2+ findings for 12+ months in multiple relationship/ssettings
Symptoms:
1. no remorse/guilt
2. no empathy
3. unconcerned about performance
4. shallow/deficient affect
93
Development impairment characteristics of Autism (4)
1. No babble or coo by 12 months
2. No gesture (point, wave, grasp) by 12 months
3. Doesn't say single words by 16 months or 2-word phrases by 24 months
4. Loss of language or social skills at any age
94
Asperger's Syndrom is Autism with high ___
IQ
95
Diagnosis of Autism based on:
- Autism Diagnostic Interview-R (ADI-R)
| - Observation (home, school, video analysis)
96
3 Criteria for Intellectual Disability Diagnosis:
1. IQ
97
Academic level achievement in Mild vs Moderate ID:
Mild: 6th grade, minimal supervision
Moderate: 2nd grade, under supervision
98
Examples of "essential" vs "associated" feature of Autism:
Essential: repetitive behavior, flapping, body rocking
Associated: self-injury, aggression, pica
99
3 Diagnostic criteria for Pica
1. >1 month eating non-nutritive substancces
2. Eating is inappropriate for developmental level
3. eating is not culturally sanctioned
100
Medication use in Autism
~27% of children take >1 med
Increase use of meds with age
CAM treatment decreases w/ age
MQW U3
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