1
Q
Autism spectrum disorder is made up of what two categories of symptoms?
A
- Deficits in social interactions and communication
- Restricted, repetitive patterns of behavior (RRBs), activity, interests
*level 1 severity- requires support
*level 2- requires substantial support
*level 3- requires the most support
2
Q
What 4 disorders does ASD encompass now on a spectrum?
A
- autistic dx
- asperger’s
- childhood disintegrative dx (kids 2yo+ with previous normal development show significant regression*)
- pervasive developmental dx
(impaired social interx & communication problems (verbal/nonverbal))
3
Q
List common characteristics of ASD
A
- lack of eye contact
- little/no interest in presence of others
- infants who rarely reach out for caregivers
- hand flapping
- rocking/spinning
- Echolalia (imitating and repeating words of others)
- obsessive interests in very narrow topics
- heavy emphasis on routine/consistency and violent reactions to change
4
Q
What is the age requirement for a diagnosis of ADHD?
A
Prior to 12yo and must possess at least 6 sxs of inattentive or hyperactive type (or 6 sxs of each time if combined type) that have persisted at least 6 months
5
Q
Describe characteristics of ADHD inattentive type
A
- forgetful/easily distracted
- makes careless mistakes/no attention to detail
- difficulty focusing
- doesn’t appear to listen even when directly spoken to
- starts tasks but doesn’t follow through
- frequently loses essential items
- avoids activities that require prolonged mental exertion
6
Q
Describe characteristics of ADHD hyperactive/impulsive type
A
- restless…frequently gets out of chair, runs/climbs at inappropriate times
- frequently talks more than peers/frequent interruptions
- difficulty waiting their turn/enjoying leisure activities in silence
- often moves hands and feet
7
Q
What are common co-occurring dxs for ADHD?
A
Conduct dx occurring 30%-90%
as well as
ODD, anxiety, depression
8
Q
Repetitive boring environments encourage ADHD sxs?
A
True! Stimulation matters!
9
Q
How are conduct disorder and oppositional defiant disorder different?
A
Both are behavioral disruption dxs, but ODD is characterized by persistent defiance, irritability and arguing with authority figures whereas CD involves more severe antisocial behaviors that violate the rights of others/societal norms (ex. theft, destruction of property, cruelty to animals)
10
Q
Disorder characterized by persistent violation of the basic human rights of others (i.e. aggression to people/animals, destruction of property) or age-appropriate rules (i.e. truancy, theft), with little to no remorse for their actions and high likelihood of interpreting other’s behaviors as hostile threats
A
Conduct dx
*diagnosed between ages 5-18
11
Q
What are the two types of conduct disorder?
A
- Persistent type- sxs get worse over time
- Adolesence-limited type- no sxs before 10yo, sxs emerge during teen years
12
Q
Successful treatment of conduct disorder should include what?
A
The immediate family and rewarding good behaviors
13
Q
Disorder characterized by less severe violation of human rights; behavior mainly motivated by irritability and resentfulness towards authority figures
A
Oppositional Defiant Disorder
*common in preschoolers, sxs must occur at least 1/wk for at least 6mo BEFORE adolescence
14
Q
Repeated involuntary urinating during day/night on bed/clothes at least 2x/wk for 3+mo in kid ~5yo
A
Enuresis
15
Q
Involuntary fecal soiling in kids already toilet trained;
~4yo
A
Encopresis
16
Q
Persistent eating of non-food items, but no aversion to real food
A
Pica
*sxs must persist for at least 1mo without client losing interest in real food
*most often between 12-24mo
17
Q
Regurgitation and re-chewing of food
A
Rumination Disorder
18
Q
Limiting the volume/variety of foods consumed that leads to nutritional deficiency and failure to gain weight; selective not due to fear of being fat but because of a lack of interest in eating/food, sensory sensitivities, or fear of choking/vomiting
A
Avoidant/Restrictive Food Intake Disorder (ARFID)
19
Q
Recurrent, unexpected panic attacks (psych/physio sxs), along with at least 1mo of persistent fear of another attack or significant behavioral change to avoid them
A
Panic Disorder
*physical exam first!
*also rule-out substance use, medication or other MI
20
Q
Having a cue or environmental trigger to panic attacks
(ex. having one every time you pass a bridge)
A
Cued Panic Attacks/ Situationally-Bound
21
Q
Panic attacks that occur out of nowhere/no trigger
A
Uncued Panic Attacks/
Unexpected
22
Q
How are cued panic attacks different from phobias?
A
Both involve intense fear triggered by specific situations, but they differ primarily in their focus: phobias are centered on the fear of an external object or situation (e.g., spiders, flying), while cued panic attacks are triggered by the fear of the physical sensations of panic themselves (fear of fear)
23
Q
Persistent fear (at least 6mo+) of a specific object or situation; the fear is disproportionate to the actual danger
A
Phobia
*differential dxs: OCD, PTSD, social phobia
24
Q
Difference between phobia & anxiety?
A
Phobia- source is known
Anxiety- usually unknown source
25
What are the 5 phobia subtypes?
1. Animal
2. Natural environment
3. Situational (ex. claustrophobia, heights)
4. Blood-Injection Injury
5. Other
*BII subtype has different physical sxs than others (increase in heart rate and bp, followed by a drop in both, often resulting in loss of consciousness)
26
Fear of being in situation/place from which escape would be difficult, or being in place where help might not be available in event of panic attack
Agoraphobia
*differential dxs: panic dx (untriggered attacks), PTSD, separation anxiety
27
What is the Two-Factor Theory related to agoraphobia?
Argues that phobias are the result of avoidance conditioning (when client engages in avoidance to prevent an aversive stimulus) or associates a neutral stimulus with anxiety, even though the neutral stimulus is not to blame
Factor 1- Acquisition of fear through classical conditioning
- panic attack (UCS)
- intense fear response (UCR)
- specific space (CS)
- result: client pairs safe space with panic attacks so the space now triggers panic attacks
Factor 2- Fear Maintenance through operant conditioning
- Client avoids the space and anxiety decreases (avoids CS)
- decreased anxiety reinforces avoidance (neg. reinforcement)
- client never stays in place long enough to realize it's not dangerous (cycle)
28
Excessive anxiety about multiple events for at least 6mo
GAD
29
Persistent fear of social situations in which client may face criticism or evaluation by others; knows fear is irrational
Social anxiety disorder/ Social phobia
*differential dxs: avoidant PD,
agoraphobia (fear of no escape), GAD, body dysmorphic dx
30
Repetitive thoughts or imagined things that are unwanted and distressing
Obsessions
31
Recurrent behaviors or thoughts client feels obliged to perform after an obsession to reduce anxiety
Compulsions
32
OCD cycle must take at least 1hr/day and cause significant distress
True!
33
OCD equally occurs in males and females
True!
34
What are the different types of OCD?
1. Contamination (germs)
2. Checking (safety)
3. Symmetry (just right)
4. Intrusive thoughts (religious, sexual, harm)
*OCD sxs are not fixed and can change/overlap
35
What are the obsessive-compulsive spectrum disorders?
1. Body dysmorphic dx
2. Hoarding dx
3. Trichotillomania
4. Excoriation (skin-picking)
36
Caused by experiencing or witnessing a traumatic event; sxs may begin within 3mo of event or years later, but last at least 6mo
PTSD
*differential dxs: acute stress dx (<1mo), adjustment dx, MDD, GAD, SUD, dissociative dxs
37
What are the 4 clusters of sxs for PTSD?
1. Intrusion
2. Avoidance
3. Negative mood/cognition
4. Hyperarousal
38
Similar to PTSD but sxs last 3-4 days (less than 1 month) and sxs occur immediately after event
Acute Stress Disorder
*differential dxs: brief psychotic dx, mild TBI, dissociative dxs
39
Disorder characterized by child rarely seeking/responding to comfort when upset, typically due to neglect of emotional needs by caregivers
Reactive Attachment Disorder
*begins before 5yo
*must be proof of pathogenic care (neglect, abuse, unhealthy attachment)
40
Disorder characterized by indiscriminate friendliness (kid doesn't hesitate to go off with strangers)
Disinhibited Social Engagement Disorder
41
Disorder causing behavioral or emotional changes occurring within 3 months of a stressor
Adjustment Disorder
*differential dxs: bereavement,
MDD, GAD, PTSD
42
Conditions involving intense physical sxs that cannot be explained by a physical medical condition (physical medical exam needed!)
Somatoform Disorders
43
Either loss of bodily functions or sxs of a serious physical/neurological condition (blindness, deaf) in response to a stressor; sxs NOT intentional
Conversion Disorder
44
Those with conversion disorder may sometimes display
La Belle Indifference
Not being concerned about their condition
45
Conversion disorder may be used for primary or secondary gains. Explain.
Primary gain- when sxs help client keep an internal conflict out of consciousness
Secondary gain- when sxs help client avoid an unpleasant activity or gain support from others
46
Intentional fabrication of medical sxs for external, tangible gain (ex. money)
Malingering
47
Intentional creation or exaggeration of sxs for internal gratification (ex. wanting to be sick for attention)
Fictitious Disorder
48
A significant focus on one's physical sxs; excessive worrying and thinking about physical sxs; no medical condition found
Somatic Symptom Disorder
(was hypochondriac)
49
Unrealistic preoccupation with having or getting a serious illness despite having none/mild sxs
Illness Anxiety Disorder
*sxs present for at least 6mo
*illness can change
50
How do SSD and IAD differ?
Both are health-related anxiety conditions, but SSD involves significant, distressing physical symptoms (e.g., pain, fatigue) with excessive worry, while IAD involves minimal/no symptoms but intense fear of having a serious illness
51
Clinically significant deficit in cognition compared to previous functioning; develops over short period of time and fluctuates throughout the day; caused by medical condition/substance-use
Delirium
52
Who are at risk for delirium?
1. Eldery
2. Those with major neurocognitive dxs
3. Burn victims
4. Whose in withdrawal from drug use
5. Those recently undergone cardiotomy
53
A change in cognitive ability from baseline, not defined by delirium
Neurocognitive Disorders
54
What is the difference between major and minor NCDs?
Major- cognitive change affects ADLs and independence
Minor- doesn't
55
Over half of all NCDs are caused by Alzheimer's?
True!
56
When sxs of NCDs mimic MDD it is called?
Pseudo-dementia- clients have issues with recall memory (remembering info without being asked to ex. essay tests) and is reversible
vs
NCDs- clients have difficulty with recall and recognition memory (remembering info after being prompted) and is permanent
57
Difficulty learning new info
Anterograde amnesia
58
Difficulty recalling previously learned info
Retrograde amnesia
59
A delusion that lasts more than 1 day but less than 1 month; client returns to baseline
Brief Psychotic Disorder
60
Presence of persistent delusion that lasts more than one month, client doesn't meet criteria for schizophrenia and functioning is not significantly impaired
Delusional Disorder
*differential dxs: schizophrenia, mood dxs with psychotic sxs, substance-induced psychosis
61
Bipolar disorders should always be documented with what info?
Current features, whether manic/hypomanic/dep, severity, and other specifiers
*differential dxs: MDD, BPD, ADHD, schizophrenia
62
Bipolar II never has manic or mixed episode?
True!
63
What is the difference between BPI and BPII?
BPI- client must have had at least 1 manic episode, preceeded or followed by MDE; sxs lasts at least 1week+ and cause significant impairment or hospitalization
BPII- client has had one or more MDEs and one or more hypomanic episodes (lasting at least.4 days) but NEVER mania; hypomanic episode is severe enough to cause a clear change in normal functioning but not severe enough for hospitalization
64
What is the best treatment for bipolar disorders?
Lithium!
65
How are Bipolar Dxs and BPD different?
Both involve severe mood swings, but BPD is characterized by rapid, hours-long emotional shifts triggered by INTERPERSONAL STRESS and treated with therapy, whereas Bipolar dxs involve longer-lasting (weeks/months) cycles of mania and depression and treated with medication
66
Chronic, fluctuating mood with many hypomanic and depressive sxs, but not as severe as either BPI or BPII; mood shifts are quicker and client experiences sxs for 2years+
Cyclothymic Disorder
*differential dxs: BPII, BPD, persistent depressive dx, ADHD, endocrine dysfunction
67
What is the difference between grief and depression?
Normal grief is limited to the loss itself, while depression isn't limited to a single event
68
What are positive sxs of schizophrenia?
Positive (loss of touch with reality)
1. Delusions: false beliefs held despite clear evidence to the contrary
- persecutory (client believes someone is out to get him
-referential (client believes messages in media (song lyrics, newspaper) are directed to them)
bizarre (client imagines something impossible)
-erotomanic- believing someone of higher status (ex. celebrity) is in love with them
-grandiose- believing you have a special power
2. Hallucinations
69
What are negative sxs of schizophrenia?
Deficits in normal functioning
- restricted range of emotions
- reduced body language
- lack of facial expression
- lack of coherent thought
- Avolition: inability to set goals or work in rational manner
*sxs must be present for at least 6mo, with 1mo of active sxs
70
What is catatonic schizophrenia?
Client has extreme disruptions in body movements
examples:
-Stupor (near-total immobility)
-Waxy Flexibility (client maintains position set by someone else)
- Posturing (client voluntarily assumes abnormal posture)
- Echopraxia (client involuntarily mimics another's movements)
71
Difference between schizophrenia & schizoaffective dx?
Similar sxs, but schizoaffective experiences significant depressive or manic episodes
72
Disorder similar to schizophrenia but isn't lifelong- only lasts 1-6 months
Schizophreniform Disorder
73
Experiencing severe depressive sxs for at least 2 consecutive weeks that interfere with daily functioning
Major Depressive Disorder
74
What is generally the most effective form of therapy for mood disorders?
Interpersonal Therapy
- time-limited (12-16wks)
-emphasizes social connectedness NOT thoughts!
- assumes interpersonal rts significantly affect functioning and addressing these (ex. role disputes, grief)
75
Belief that MDEs are due to a norepinephrine deficiency
Catecholamine Hypothesis
76
Belief that MDEs are due to a serotonin deficiency
Indolamine Hypothesis
77
When preteen males experience MDEs, they display aggression. When elderly experience MDEs, they display what?
Cognitive issues
(ex. memory loss)
78
Affects people in the Northern Hemisphere from October-April and is believed to be caused by the lack of melatonin produced by a decrease in sunlight
Seasonal Affective Disorder
*phototherapy (light therapy) is best tx
79
A low-level chronic depression occurring more days than not for at least 2 years; sxs less severe than MDD but longer-lasting
Persistent Depressive Disorder
formerly known as
Dysthymia
80
More than one episode of inability to recall important personal info, typically due to a traumatic event
Dissociative Amnesia
81
When a client cannot remember ALL EVENTS around a defined period
Localized Amnesia
82
When a client cannot recall SOME EVENTS around a defined period
Selective Amnesia
83
When a client's memory loss spans across their entire life
Generalized Amnesia
84
Abrupt, purposeful flight from home/stressful location coupled by inability to remember the past
Dissociative Fugue
*client will not remember anything during fugue state and may take on new identity
85
Intense, recurrent sexual urges/behaviors involving either non-human objects, non-consenting partners, or the suffering/humiliation of oneself/other
(ex. fetishes, pedophiles, voyeuristic dx (peepers))
Paraphilic Disorders
*differential dxs: OCD, SUD
86
Rubbing against a non-consenting person for arousal
Frotteuristic Disorder
87
Masochism vs. Sadism
M- aroused from being physically harmed/humiliated
S- aroused from inflicting pain/humiliation onto others
88
What is the treatment of choice for paraphilic disorders?
Covert Sensitization
- imagining the target behavior immediately followed by aversive stimuli (ex. nausea) to create aversion
89
Difficulty falling/staying asleep, or early rising without ability to fall back asleep
Insomnia
*differential dxs: MDD, anxiety, thyroid issues, sleep apnea, circadian rhythm disorders
90
Sleepiness despite getting at least 7 hours of sleep and lapses of sleep throughout the day
Hypersomnolence
91
Uncontrollable lapses into sleep; at least 3x/wk for at least 6mo
Narcolepsy
92
Describe Cluster A personality disorders
Eccentric/Odd
1. Paranoid
2. Schizoid
3. Schizotypal
93
Describe Cluster B personality disorders
Dramatic
1. Antisocial
2. Borderline
3. Histrionic
4. Narcissistic
94
Describe Cluster C personality disorders
Fear/Anxiety-based
1. Avoidant
2. Depressive
3. Obsessive-Compulsive
95
What is the difference between Schizoid and Schizotypal personality disorders?
Schizoid
- lack of interest in rts with others and limited range of emotional expression
Schizotypal
- may want rts with others but isolates due to social anxiety and eccentricity; experiences Magical Thinking (believing your thoughts/wishes directly influence external events ex. superstitions)
96
Personality disorder characterized by excessive emotionality and sexualized attention-seeking behaviors, usually to build self-esteem
Histrionic PD
97
Personality disorder characterized by a lack of concern for the rights/feelings of others; must be at least 18yo & have hx of Conduct Disorder before 15yo
Antisocial PD
98
Personality disorder characterized by need for others to take responsibility for your actions; helpless when alone
Dependent PD
99
Personality disorder characterized by an inflated SE, lack of empathy, and an overwhelming need for admiration
Narcissistic PD
100
Personality disorder characterized by preoccupation with rules and organization, workaholics, hoards money without spending, cannot delegate control
Obsessive-compulsive PD
101
Personality disorder characterized by extreme social inhibition, feelings of inadequacy, and intense sensitivity to social rejection/criticism (despite likely craving rts)
Avoidant PD
102
How are Avoidant PD and Social Anxiety different?
Both involve extreme fear of negative evaluation; however, AvPD is rooted in deep feelings of inadequacy and worthlessness where Social Anxiety is typically a situational dx where people fear specific scenarios (ex. public speaking) but have pretty stable SEs and social functioning outside of their triggers
103
What is the Disease Model of Substance Use?
Believes alcoholism to be a chronic disease that gets worse overtime
104
Identify the Stage of Progression in SUD
1. Experimentation- occasional use, typically in social settings or in reaction to stress
2. Regular Use- developing a pattern, usually to socialize or relax
3. Problem Use- substance use increases and problems begin (ex. declining performance at work/school, legal issues)
4. Dependence- Brain/body become accustomed to the drug, causing withdrawal if stopped
5. Addiction- Compulsive, chronic use despite severe negative consequences; cravings & drug-seeking behaviors (lying, stealing)
105
What is the purpose of the Michigan Alcohol Screening Test (MAST)?
Screens for alcohol problem, with the higher the score the more severe the problem
*Drug Abuse Screening Test (DAST) is the non-alcohol counterpart!
106
When an assessment is positive for addiction, what tool do we use?
The Addiction Severity Index (ASI)
to determine what areas of the client's life the addiction affects most (it asks about SES)
107
Which assessment is used on covert abusers?
Substance Abuse Subtle Screening Inventory (SASSI-4)
108
Explain the stages of withdrawal
Early withdrawal (6-12hrs)
- tremors, cramping, irritable
Intermediate withdrawal (12-48hrs)
- high anxiety, raised bp and heart rate, incontinence
Severe withdrawal (24-72hrs)
- extreme confusion with hallucinations, seizure, possible death
109
What are the strategies to prevent relapse?
1. Contingency Management (aka positive reinforcement for abstaining)
2. Cognitive therapy to replace negative thoughts which could trigger relapse
3. Strong support system
110
What tool identifies problem drinkers?
CAGE
C- cutting down
A- annoyed at criticism
G- guilt
E- eye opener ("do you increasingly need a drink earlier in the day?")
111
Codes in DSM used when the focus of treatment is not classified as a mental disorder
Z-codes
(ex. housing/economic struggles, educational difficulties, etc)
112
Stuttering is now billed as a childhood-onset fluency disorder under communication disorders?
True!
113
The DSM-5 removed the bereavement inclusion, meaning clients experiencing depressive sxs following death of a loved one are no longer automatically excluded from a MDD dx
True!
DSM-5 introduced Prolonged Grief Disorder
-intense longing/preoccupation with the deceased lasts at least 12mo (6mo in youth) and interferes with daily life
114
Paraphilias vs Paraphilic disorders
Paraphilias- sexual behaviors that do not cause distress/impairment to client or others
Paraphilic dxs- do
115
Bulimia can now be diagnosed with one weekly bout of binge eating and inappropriate compensatory behaviors, whereas old DSM required 2 bouts/wk
True!
116
All Ts required to submit ICD-10 codes for insurance payments
True!
DSM codes (diagnosis)
ICD-10 codes (biling)
117
What are the benefits of a formal diagnosis?
- gives Ts shared language to communicate with other practitioners/clients
- a label can help client not feel alone and family members could feel more compassion
118
What are the disadvantages of a formal diagnosis?
- the dx can become the client's identity ("I can't help it, I have ...")
- the dx can make the client feel out of control and therefore, not responsible for their behaviors
- loved ones could coddle client/client become scapegoat
119
Empathy can be measured in the brain
True!
*Mirror Neuron Concept
neurons fire if you perform a behavior and that same neuron fires if you witness someone else perform that behavior
120
Benzos (Xanax, Ativan, Valium) commonly used for what dx?
Anxiety
121
Abilify, Zyprexa, and Thorazine are what kind of medications?
Antipsychotics
122
Ritalin, Adderall commonly used for what dx?
ADHD
123
SSRIs (Prozac, Zoloft, Lexapro) and SNRIs (Cymbalta) and Tricyclics commonly used for what dx?
Depression
*Zoloft & Prozac used for OCD
*Cognitive therapy also raises serotonin, much like antidepressants!
124
What is the criteria for a dx of intellectual disability?
1. IQ of 70 or below
2. onset prior to 18yo
3. Client's ability to adapt to normal life in school/work must be impaired
125
Binge-eating disorder is the most common ED?
True!
*bulimia is more prevalent than anorexia
126
Research shows which hemisphere is dominant in the brain?
Left
127
IS PATH WARM assesses for what?
Suicide
I deation
S ub abuse
P urposelessness
A nxiety
T rapped
H opelessness
W ithdrawal
A nger
R ecklessness
M ood changes
128
Some people are more vulnerable than others to a particular experience/medication due to genetics
Differential Sensitivity
129
More students are harassed in the hallways than on social media and sibling bullying is a more common variety of school bullying
True and True!
130
Who came up with 1st, 2nd, 3rd wave categories?
Steven Hayes
1st Wave- txs based on operant and classical conditionings
2nd Wave- txs based heavily on cognitions
3rd Wave- txs incorporate DBT, MI, ACT
