Abnormal

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Diagnostic Uncertainty is addressed with the following diagnoses

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Other Specified

Unspecified

Provisional

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Cross-cutting symptom measures - Level 1

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assess 13 domains for adults and 12 for children and adolescents

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Level 2 cross-cutting symptom measures

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provide in-depth info on special domains (depression, anxiety, substance used) to help guide treatment planning, diagnosis, and follow ups

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World Health Organization Disability Assessment Schedule (WHODAS 2.0)

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used to assess level of disability in 6 domains, understanding and communicating, getting around, self-care, getting along with other people, life activities, and participation in society

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Outline for Cultural Formation

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provides guidelines for assessing four factors: the client's cultural identity; the client's cultural conceptualization of stress; the psychosocial stressors and cultural factors that impact the client's vulnerability and resilience; and cultural factor;s relevant to the relationship between the client and therapist.

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Cultural Formulation Interview

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Semi-structured intervention consisting of 16 questions; obtains info about client's view regarding social/cultural problems of presenting problem.

Four domains - cultural definition of the problem; cultural perceptions of cause, context, and support; cultural factors affecting self-coping and past help seeking; cultural factors affecting current help seeking.

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Cultural Concepts of Distress

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cultural syndromes

cultural idioms

cultural explanations

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Intellectual Disability

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Deficits in intellectual functioning

deficits in adaptive functioning

onset during developmental period

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Intellectual Disability Etiology

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5% due to heredity - Tay Sachs, Fragile X syndrome, PKU)

30% due to chromosomal changes and exposures to toxins during pregnancy and prenatal development

5% medical conditions

30% unknown

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Treatment for Childhood-Onset Fluency Disorder

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Reduce psychological stress from home (children)

Habit reversal - adults and older children

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Autism Spectrum Disorder

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persistent deficits in social communication and interaction across multiple domains; restricted repetitive patterns of behavior; symptoms during early developmental; impairments in social, occupational or other area of functioning.

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Treatment for ASD

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Types of training: parent management training, special education; training in self-care and interaction skills; vocational training and placement; shaping and discrimination training (Lovas)

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Attention-Deficit Hyperactivity Dirsorder

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a pattern of inattention and/or hyperactive-impulsivity; 6+ months; onset prior to age 12; present in 2 settings; interferes with social, academic functioning

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Prevalence rate for ADHD

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5% for children

2.5% for adults

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Gender differences for ADHD

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more prevalent in males than females, gender ration = 2:1 for children; 1.6:1 for adults; combined more common for males; Inattentive more common for femailes

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Brain abnormalities in ADHD

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lower than normal activity in caudate nucleus; globus pallidus, and prefrontal cortex

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behavioral disinhibition hypothesis

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core feature of ADHD is inability to regulate behavior to fit situational demands

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Treatment for ADHD

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Ritalin

Behavioral interventions - parent training, teacher training

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Specific Learning Disorder

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difficulties related to academic skills as indicated by at least one characteristic symptom that persists for at least 6 months despite provision of interventions targeting difficulties

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Subtypes of Specific Learning Disorder

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impairment in reading; impairment in written expression; impairment in mathematics

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Gender with Specific Learning Disoreder

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more common in males than females gender ration 2:1 or 3:1

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Tic

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sudden, rapid, recurrent nonrhythmic motor movement or vocalization

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Tourrette's Disorder

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at least one vocal tic and multiple motor tics; may appear simultaneously or at different times; persisted more than one year; began prior to 18

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Persistent (chronic) Motor or Vocal Tic Disorder

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one or more motor or vocal tics that have persisted for more than one year and began prior to age 18

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Provisional Tic Disorder

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one more more motor and/or vocal tics; present less than 1 year; began prior to age 18

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Treatment of Tourrette's

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pharmactherapy - haloperidol and pimozide; SSRI - alleviates OCD sx; clonidine or desipramine - treats hyperacitve/inattention sx; comprehensive behavioral treatment for tics (CBIT)

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Disclosure with children and illnessess

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children who are told about their diagnosis in early stages of treatment cope better than those who learn about diagnosis later; disclosure must be developmentally appropriate

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Meichenbaum's stress inoculation model

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Common treatments for leukemia

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CNS irradiation adn intrathecal chemotheraphy

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Reduce anxiety about Medical procedures in children

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CBT,stress innoculation model

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Schizoprenia Spectrum and Other Psychotic Disorders

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Delusional Disorder; schiozophrenia; schizophreniform Disorder; Brief Psychotic Disorder; Schizoaffective Disorder

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Delusional Disorder

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Presence of one or more delusions that last at least a month.

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Subtypes of delusions

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erotomanic; grandiose; jealous; persecutory; somatic; mixed; unspecified

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Schizophrenia

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2 active phase symptoms (hallucinations, delusions, disorganized speech; disorganized behavior, negative sx) for at least 1 month w/ at least 1 sx being delusions, hallucinations, or disorganized speech; at least 6 months

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Anosognoisa

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poor insight into their illness

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Cultural implications of schizophrenia

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those from developing countries mroe likely to show acute onset of sx, shorter clinical course;complete remission of sx

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Onset of Schizophrenia

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late teens and early 30s, peak onset being in the early to mid 20s for males and the late 20s for females

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dopamine hypothesis

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1st biochemical explanation, attributes schizophrenia to elevated dopamine levels or oversensitive dopamine receptors

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Treatment of schizophrenia

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Traditional first-generation antipsychotics, atypcial second-generation

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1st generation antipsychotics

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haloperidol and fluephenzine

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Atypical antipsychotics

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clozapine and risperidone

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Schizophreniform Disorder

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same sx of shizophrenia except sx are present for at least one month but less than 6 months

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Brief Psychotic Disorder

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presence of one or more of 4 sx - delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior; last at least more than one day but less than one month

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schizoaffective disorder

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concurrent sx of schizophrenia and major depressive disorder

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Bipolar Disorder I

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consists of one manic episode that lasts at least one week and at least 3 characteristic sx

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Treatment of Bipolar I

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psychopharmocotherapy; lithium

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Disruptive Mood Dysregulation Disorder

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severe temper outbursts; a chronic or persistently angry or irritable mood; symptoms present for at least 12 months, exhibited in 2-3 settings; diagnosed b/w 6-18, age of onset = >10

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High Expressed Emotion

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characterized by open criticism and hostility towards pt; Family based interventions for schizophrenia are helpful when they target this, as this has been linked to high relapse and rehospitalization rates

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Concordance rates for schizophrenia

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biological sibling - 10%

fraternal (dizygotic twin) - 17%

identical (monozygotic twin) 48%

child of 2 parents with schizophrenia - 46%

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Major Depressive Disorder

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Presence of at least 5 sx of MD episode nearly every day for at least 2 weeks

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peripartum onset

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specifier applied to MDD, BP1, BP2, when onset of sx is during pregnancy or w/in 4 weeks post partum; 10-20% of women experience depression either during pregnancy or first several months after giving birth

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with seasonal pattern

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specifier applied to MD, BP1, BP2, when there is a temporal relationship between onset of mood episode and time of year. aka SAD; phototherapy involves exposure to artificial bright light - effective tx for this disorder

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Sleep abnormalities with depression

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sleep continuity disturbances (early morning awakening); reduced stage 3 and 4 sleep; decreased REM latency (earlier onset of REM sleep), and increased duration of REM sleep early in the night

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Prevalence rate of depression

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7% prevalence rate; prevalence rate for 18-29 is 3x the prevalence rate for individuals 60+

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Depression age of onset

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mid-20s,

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symptom presentations for different ages of depression

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somatic complaints, irritability, and social withdrawal common in children; aggresivness and destructiveness in preadolescents; older adults - memory loss, distractibility, disoreinteaton, cognitive symptoms

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concordance rate for depression

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.5 for monozygotic twins; .20 for dizygotic twins

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Catecholamine hypothesis

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some forms of depression are due to deficiency in norepineprine

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indolamine hypothesis

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depression is the result of low levels of seratonin

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Lewinsohn's behavioral theory of depression

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based on principles of operant conditioning; attributes depression to low rate of response contingent reinforcement for social and other behaviors, which results in extinction of those behaviors as well as in pessimism, low self-esteem, social isolation, and other features of depression

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Seligman's refromulated learned helplessness model

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describes depression as the result of prior exposure to uncontrollable negative events coupled with a tendency to attribute those events to internal, stable, and global factors

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Rehm's self-control model of depression

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depression is result of combination of problems related to self-monitoring, self-evaluation, and self-reinforcement (people who are depressed attend most to negative events and immediate outcomes; fail to make accurate internal attributions and set stringent criteria for self-evaluation; have low rates of self-reinforcement and high rates of self-punishment

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Beck's cognitive theory of depression

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views depression as being related to negative, illogical self-statements about oneself, the world, and the future (depressive cognitive triad)

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Treatment of depression

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combination of antidepressants and psychotherapy

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Classes of antidepressants

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Tricyclics

Selective seratonin reuptake inhibitor

Monamine Oxidase Inhibitors (MAOIs)

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Tricyclics (TCAs)

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most effective for "classic" depressions that inovlve vegitative symptoms, worsening of sx in the morning, acute onset and short duration of sx, and sx of moderate anxiety

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Selective seratonin reuptake inhibitor (SSRI)

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Considered first line drug treatment for moderate to severe depression, have fewer side effects and a lower risk for fatal overdose than the TCAs

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Monamine Oxidase Inhibitors (MAOIs)

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may be beneficial for individuals who do not respond to TCAs or SSRIs and or who have atypical symptoms

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Seratonin Norepinephrine Reuptake Inhibitors (SNRI)

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increase levels of norepinephrine and seratonin (Effexor, Pristiq, Cymbalta)

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Undesireable effects of ECT

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temporary anterograde and retrograde amnesia, confusion, disorientation - reduced if administered to right (nondominant) hemisphere

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Persistent Depressive Disorder (Dysthymia)

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characterized by depressed mood on most days for 2 years in adults or one year in children;

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Premesntrual Dysphoric Disorder

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presence of at least 5 characteristic sx during the week before onset of menses with an improvement in sx within a few days after onset of menses and the absence or presence of minimal sx during week post menses

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Suicide rate with those with a mood disorder

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60%

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Risk factors for suicide

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age - highest rate was 45 to 54 in 2010 (women; men - 75+);

Gender - 4x as many males as females commit, females attempt more;

race - higher for whites, except for American Indians/Alaskan Natives

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Risk factors for suicide (marital status; thoughts and behaviors; early warning signs)

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Divorced, separated, widowed = highest rates; married = lowest rates; 60-80% have made previous attempt, 80% give warning of intention; Early warning signs = threatening self-harm or suicide writing or talking about death or suicide, seeking means to commit suicide, making preps for dying, writing a will, giving away possessions, saying goodbye

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Risk factors for suicide (life stressors, psychiatric disorders, pesonality correlates

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Failure at work/school, rejection by a loved one, absence of social support; Major Depression and Bipolar most common; suicide = 3 months after depression sx begins to approve; hopelessness found to be more predictive, perfectionism; low levels of seratonin

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Interventions for Suicide

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hospitalization, outpatient crisis intervention; outpatient psychotherapy

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differences between anxiety and depression

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anx - associated with a higher level of positive affect and autonomic arousal; apprehension, tension, trembling, excessive worry, and nightmares are pure anxiety sx; depressed mood, anhedonia, loss of interest in usual activities, suicidal ideation, and decreased libido are pure depressive sx

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Specific phobia

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intense fear of or anxiety about a specific objec or situation

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Specific phobia subtypes

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animal, natural, environment, blood-injection injury, situational, other

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Mower's two factor theory

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attributes phobias to avoidance conditioning, which involves a combination of classical and operant conditioning

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Treatment for Specific Phobia

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exposure withe response prevention (invivo exposure); blood -injection -injury - exposure paired with applied tension

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Etiology of Social Anxiety Disorder

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behavioral inhibition (social avoidance and fear of unfamiliar people)

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Treatment of Social Anxiety Disorder

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Exposure with response prevention; social skills training; cognitive restructuring; SSRI or SNRI, or beta blocker propanolol

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Panic Disorder

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recurrent or unexpected panic attacks with at least one attack begin followed by at least one month of persistent concern about having additional attacks

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Prevalence Rate of Panic Disorder

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2-3% for adolescents as adults, females are 2x as likely than males

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Treatment of Panic Disorder

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Cognitive behavioral interventions that incorporate exposure; Panic Control theory PCT

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Agoraphobia

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presence of marked fear or anxiety about at least 2 of the following: using public transportation, being in open spaces, being in enclosed spaces, standing in line or being part of a crowd, and being outside the home alone

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Agoraphobia

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in vivo exposure with response prevention

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Generalized anxiety disorder

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excessive worry about multiple events; relatively constant for at least 6 months; at least 3 characteristic sx

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Treatment for GAD

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cognitive behavioral therapy; SSRIs or SNRIs, benzodiazepine (when pt is nonresponsive to SSRI, Busbar

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Obsessive Compulisive Disorder

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recurrent obsessions and/or compulsions that are time-consuming or cause clinically significant distress

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Prevalence rate of OCD

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1.2%

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OCD gender differences

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Average onset is earlier for males; in adolescents - more prevalent in males than females

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Etiology of OCD

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low levels of serotonin;

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brain structures that contribute to OCD

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right caudate nucleus; obitofrontal cortex and cingulate cortex

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Treatment for OCD

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exposure with response preention; clomipramine (tricyclic) SSRI

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Body Dysmorphic Disorder

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characterized by a pre-occupation with a defect or flaw in appearance that appears minor and is not observable to others

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Reactive Attachment Disorder

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consistent pattern of inhibited and emotionally withdrawal behavior toward adult caregivers as manifested by a lack of seeking or responding to comfort when distressed and a persistent social and emotional disturbance that includes at least two characteristic symptoms; must be evident before the age of 5

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Disinhiitied Social Engagement Diosrder

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characterized by a pattern of behavior that invovles inappropriate interactions with unfamiliar adults as evidenced by at least two of the following: reduced or absence of reticence in approaching or interacting with unfamiliar adults.

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Post Traumatic Stress Disorder

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-exposure to actual or threatened death, serious injury, or sexual violence; presence of at least one intrusion sx; persistent avoidance of stimuli associated with event; negative changes in cognition or mood associated with the event; marked changes in reactivity and arousal associated with the event; symptoms present for more than one month

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Treatment of choice for PTSD

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comprehensive cognitive-behavioral intervention that incorporates exposure, cognitive restructuring, and anxiety management; SSRI; Critical incident stress debriefing (CISD); EMDR

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Acute Stress Disorder

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same sx as PTSD, only sx are present for 3 days to one month following traumatic experience

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Dissociative Identity Disorder

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existence in one individual of two or more distinct personality states or the experience of possession, with recurrent gaps in recall of ordinary events, personal info, or traumatic events that impaired functioning

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Dissociative Amnesia

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inability to recall important personal info that cannot be attributed to ordinary forgetfulness and causes clinically significant distress or impaired functioning; often related to traumatic event

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Forms of dissociative amnesia

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localized amnesia

selective amnesia

generalized amnesia

continuous amnesia

systematized amnesia

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Localized amnesia

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type of amnesia which involves an inability to remember all events related to a circumscribed period of time

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Selective amnesia

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type of amnesia that involves an inability to recall some events related to a circumscribed period.

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Generalized amnesia

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Type of amnesia characterized by a loss of memory that encompasses the person's entire life

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Continuous amnesia

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type of amnesia that involves inability to recall events subsequent to a specific time through the present

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Systematized amnesia

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type of amnesia characterized by an inability to recall memories related to a certain category of information (i.e. related to individual's spouse)

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Depersonalization/Derealization Disorder

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characterized by persistent or recurrent episode of depersonalization (sense of unreality, detachment, or being an outside observer of one's thoughts, feelings, etc), or derealization (sense of unreality or detachment involving one's surroundings)

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Somatic Symptom Disorder

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presence of one or more somatic symptoms that cause distress or significant disruption in daily life accompanied by excessive thoughts, feelings, or behaviors related to the symptoms as manifested by one of the following: persistent and disproportionate thoughts about the serious of sx; high level of anxiety about one's health or sx; 6+ months in duration;

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Illness anxiety disorder

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disorder characterized by having a preoccupation with having a serious illness; an absence of somatic sx or presence of mild somatic sx, high level of anxiety about one's health; performance of excessive health-related behaviors or maladaptive avoidance of doctors, hospitals; 6+ months

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Conversion Disorder (Functional Neurological Symptom Disorder)

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disorder that requires the presence of symptoms that involve disturbances in voluntary motor or sensory functioning and suggest a serious neuolgical or other medical condition with evidence of an incompatiblity between the sx and recognized neurological or medical conditions.

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Factitious Disorder imposed on Self

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Disorder in which individuals falsify physical or psychological sx that are associated with their deception (i.e. falsify sx of depression following death of spouse and even though death did not occur; present themselves to others as being ill or impaired; and engage in deceptive behavior even in the absence of an external reward

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Factitious Disorder Imposed on Another

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Disorder in which individuals falsify physical or psychological symptoms in another person, present that person to others as being ill or impaired, and engage in the deceptive behavior even in the absence of external reward.

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Malingering

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(V-Code) disorder characterized by the intentional production of physical or psychological sx for the purpose of obtaining an external reward such as avoiding work, receiving financial compensation, or obtaining drugs.

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Pica

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persistent eating of non-nutritive, non-food substances for at least a month; behavior must be inappropriate for the individual's developmental level

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Anorexia Nervosa

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Essential features of disorder = restriction of energy intake that leads to a significantly low body weight for age, gender, developmental trajectory, and physical health; intense fear of gaining weight or becoming fat; disturbance in the way person experiences body wieght or shape; specifiers are restricting or binge-eating/purging

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Physical sx of Anorexia

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constipation, cold intolerance, abdominal pain, lethargy, bradycardia, amenorrhea

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Age of onset for anorexia

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adolescence or young adult hood; 90% female

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Etiology of Anorexia

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biological - genetic contribution, higher than normal seratonin; perfectionism with unrealistic expectations of self

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Treatment of anxorexia

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1. Get individual to gain weight; 2. CBT = Tx of choice; 3.

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Bulimia Nervosa

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Disorder characterized by recurrent episodes of binge eating that are accompanied by a sense of lack of control; inappropriate compensatory behavior to prevent weight gain; self-evaluation that is unduly influenced by body shape and weight; bingeing must occur at least 1x per wek for 3 months

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Medical complications of Bulimia

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fluid and electrolyte disturbances, metabolic alkalosis, metabolic acidosis, dental problems, and menstrual abnormalities

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Etiology of Bulimia

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low levels of endogenous opiod beta-endorphin and neurotransmitter abnormalities, low levels of seratonin

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treatment of bulimia

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objectives include helping individual gain control over eating and modyfing dysfunctional beliefs about eating, shape, and weight; Imipramine and Fluoxetine effetive for reducing binge eating or purging

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Binge-Eating Disorder

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disorder that requires recurrent episodes of binge eating that involves a sense of lack of control over eating,presence of at least 3 sx - eating more rapidly than usual, eating until feeling uncomfortably full, eating alone due to feeling embarrassed, binges must occur once a week for 3 months

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Enuresis

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repeated voiding of urine into bed or clothes at least 2x a week for 3+ consecutive months, at least 5 years old

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Encopresis

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repeated involuntary or intentional passage of feces into places not appropriate for that purpose

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Insomnia Disorder

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diagnosis requires dissatisfaction with sleep quality or quantity associated with least 1 of the following: difficulty initiating, difficulty maintaining, early-morning awakening with inability to return to sleep; occurs at least 3 nights per week, present for at least 3 months

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Treatment for Insomnia

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CBT approach that incorporates:

- sleep hygiene education, stimulus control, relaxation training, cognitive therapy

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Hypersomnolence Disorder

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disorder involves excessive sleepiness despite a main sleep period of ta least 7 hours with at least 1 of the following - recurrent periods of sleep within same day, prolonged but nonrestorative sleep period of more than 9 hrs each day; difficulty becoming fully awake after an abrupt waking; occurs at least 3x per week, present for 3 months, causes sig. distress

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Narcolepsy

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disorder characterized by attacks of an irrepressible need to sleep with lapses into sleep or daytime napes that occur at least 3 times per week and have been present for 3 months; requires episodes of cataplexy, hypocretin deficiency, or REM latency less than or equal to 15 minutes; prevent sleep attacks by controlling emotion

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Obstructive Sleep Apnea Hypopnea

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most common of 3 breathing related sleep disorders; diagnosis requires evidence of polysomnography of at least 15 obstructive apneas or hypopneas

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Non-REM Sleep Arousal Disorder

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recurrent episodes of incomplete awakening that usually occur during the first third of major sleep episode, (often during stage 3 or 4) accompanied by sleepwalking and/or sleep terror

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Nightmare Disorder

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disorder characterized by repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity; nightmares usually occur during REM sleep in 2nd half of major sleep period,

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Erectile Disorder

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diagnosis that requires the presence of at least one of 3 sx (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

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Treatment of Erectile Dysfunction disorder

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1.Referral for a medial evaluation

2. CBT techniques - targeting anxiety, faulty attitudes and beliefs, deficient knowledge and skills

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Genito-Pelvic Pain/Penetration Disorder

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Disorder diagnosed in presence of persistent or recurrent difficulties involving one or more of the following: vaginal penetration during intercourse, marked genito-pelvic pain during intercourse or penetration attempts; marked anxiety about such, marked tensing of pelvic floor muscles, sx present for 6 months

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Premature Ejaculation

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disorder diagnosed in the presence of presistent or recurrrent pattern of ejaculation during partnered sexual activity within about one minute of vaginal penetration, sx present for at least 6 months

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Oppositional Defiant Disorder

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disorder including a recurrent pattern of an angry/irritable mood, argumentative/defiant behavior, or vindictiveness as evidenced by at least 4 characteristic sx (loses temper, argues with authority figures; often actively refuses to comply with requests from authority figures or with rules; sx have often persisted for at least 6 months

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Intermittent Explosive Disorder

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disorder characterized by recurrent behavioral outbursts that are related to an inability to control aggressive impulses as manifested by physical or verbal aggression that occurs 2x per week, persisted for 3+ months; at least 6 years of age

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Conduct Disorder

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persistent pattern of behavior that violates the basic rights of others and/or age appropriate social norms or rules

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Parent management Training

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Program that teaches parents to reward positive behaviors of children and replace physical punishment for undesireable behaviors with time-out, response cost, and similar techniques

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Multisystemic Treatment

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alternative approach that targets the indivdual, family, school,, and community and combines behavioral, cognitive, family systems, and case management strategies

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Substance Use Disorders

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a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance related problems.

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Symptom Categories of Substance use disorders (4)

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impaired control, social impairment, risky use, pharmacological criteria

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Etiology of Substance use disorders

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Conger's tension-reduction hypothesis

Marlatt and Gordon's theory

Biopsychosocial

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Conger's tension-reduction hypothesis

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Theory that Alcohol reduces anxiety, fear, and other states of tension and that people drink alcohol to reduce tension, which eventually leads to addiction

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Marlatt and Gordon's theory of substance use disorder

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Theory that addictive behaviors are acquired; describes addiction as an overlearned, maladaptive habit pattern

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Biopsychosocial theory of substance use development

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View the initiation, maintenance, and progression of addiction as involving an interaction between physical, psychological, sociocultural

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Treatment of Substance Use Disorder

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-combination of psychotherapeutic interventions and medication

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Abstinence Violation effect (Marlatt and Gordon)

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typical reaction to relapse of addiction, involves self-blame, guilt, anxiety, and depression, which leads to further alcohol consumption; potential relapse is produced when person views the episode of drinking as a mistake resulting from specific, external, and controllable factors

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Relapse Prevention Therapy (RPT; Marlatt and Gordon)

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involves identifying circumstances that increase the individual's risk for relapse and then implementing behavioral and cognitive strategies that help indivdual prevent future lapses and deal more effectively if they occur.

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smoking cessation intervention

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increases the likelihood of long-term abstinence when it includes nicotine replacement therapy, multicomponent behavioral therapy that includes skills training, relapse prevention, and stimulus control; and support/assistance from a clinician

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Alcohol-Induced Disorders

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Alcohol Intoxication