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209 Cards in this Set

  • Front
  • Back
DSM uses a __________ approach to diagnosis
Categorical, which means that mental disorders are divided into types based on criteria sets with defining features.

DSM most likely moving to using a DIMENSIONAL approach

Dx often include a POLYTHETIC criteria set which means a person can meet some but not all criteria
DSM-IV diagnoses often include a POLYTHETIC criteria set, which means
for a diagnosis to be made, a person may present with some but not all of the diagnostic criteria
GAF 91-100
Superior functioning
GAF 81-90
Absent or minimal symptoms, good functioning in all areas, no more than everyday problems or concerns.
GAF 71-80
Symptoms are transient and expectable reactions to psychosocial stresses; no more than slight impairment in social, occupational,
or school functioning
GAF 61-70
Some mild symptoms
GAF 51-60
Moderate symptoms
GAF 41-50
Serious symptoms
GAF 31-40
Some impairment in reality testing or communication (e.g., speech is at times
illogical, obscure, or irrelevant) OR major impairment in several areas, such
as work or school, family relations, judgment, thinking, or mood
GAF 21-30
Behavior is considered influenced by delusions or hallucinations OR serious impairment
in communications or judgment OR inability to function in all areas.
GAF 11-20
Some danger of hurting self or others OR occasionally fails to maintain minimal
personal hygiene OR gross impairment in communication.
GAF 1-10
Persistent danger of severely hurting self or others OR persistent inability to maintain
minimum personal hygiene OR serious suicidal act with clear expectation of
death.
Delerium Sx's
**Disturbance in consciousness (distracted, less aware of environment)
** A change in cognition (loss of recent memory, disorientation to time/place) and/or the development of perceptual abnormalities (illusions, delusions, hallucinations)
**Sx’s are random, haphazard
Delerium Tx
Antipsychotics and environmental manipulation
Delerium: Risk Groups
Likely to involve brain dysfunction:
-Adults over 60
-patients who just had open heart surgery
-rapid withdrawal from sedatives
-burn patients
-decreased cerebral reserve
Some facts about Dementia
(gender? education? how common? best tx?)
most likely to impact women, higher rates for those with a lower level education, most common disorder in elderly (age of onset, 65 and older, is more common), best tx is at home with family
Sx's of Dementia
Memory Impairment (anterograde, in early phase, and retrograde) and Aphasia, Apraxia (unable to perform tasks or movements when asked, even though they could), Agnosia, and/or EF deficits
Differentiating btwn Dementia and Pseudodementia: DEMENTIA
Progressive course, person will often deny impairments, hit declarative memory, poor recall and recognition
DIfferentiating btwn Dementia and Pseudodementia: PSEUDODEMENTIA
--onset is abrupt

--exaggerates/overly concerned about impairments

--impaired recall but recognition is fine

--hits procedural memory
Alzheimer's: Brain
amyloid plaques and tangles, initially in hippocampus, amygdala (entorhinal cortex), low levels of ACh (use Cognex, Aricept to slow breakdown of Ch)
Alzheimer's: Making DX
dx is made when other causes of observed progressive dementia (like parkinson’s or hiv) have been ruled out by a combination of history, physical findings and test results
Alzheimer's: Stages
Initial Stage: wandering, irritability, anomia
--Second Stage: retrograde and anterograde amnesia, flat or labile mood, restlessness, and fluent aphasia (unable to understand language though can speak fine)
Vascular Dementia
abrupt sx's, flunctuating course, NO MARKED PERSONALITY CHANGE, weakness in extremeties
HIV Dementia
motor slowness, an absence of aphasia, severe depression and
anxiety, forgetfulness, lapses in concentration, apathy, social withdrawal.

MAD AS FAC
Amnestic Disorder Due to a MEdical Condition
always involve anterograde amnesia but may or may not involve retrograde amnesia
Parkinson's
**for 20% of individuals, depression preceded the onset of motor and other physical sx’s (50% have depression)

**age of onset-50
**20-60% develop dementia
****Substantia Nigra (dopamine) is compromised; it sends info to basal ganglia
Huntington's Disease
--hereditary--involuntary jerky movements--impaired memory and judgment--depression--MRI would show atrophy in the caudate nucleus (basal ganglia)
The most common cause of Mental Retardation is:

a. embryonic development
b. perinatal factors
c. heredity
a. embryonic development (prenatal factors: before and during pregnancy)

Perinatal: from 22 weeks to 7 days after birth

30-40% unknown

least heredity and medical (lead poisoning)
What are the three diagnostic criteria for Mental Retardation?
1) Significantly subaverage intellectual functioning (70 or below)

2) Concurrent deficits or impairments in adaptive functioning in at least two areas (e.g., self care, social skills)

3) Onset prior to age 18

(parents report earliest sign in infancy is lack of interest in environment)
Name the four degrees of severity of Mental Retardation, and the corresponding IQ score ranges for each.
Mild
(IQ=50-69)

Moderate
(IQ= 35-49)

Severe
(IQ=20-34)

Profound
(IQ below 20)
What are common comorbid diagnoses you may see with Mental Retardation?
ADHD
Mood Disorders
Pervasive Developmental Disorders
Stereotypic Movement Disorder
Mental Disorder Due to GMC
A)Name the various causes of Mental Retardation.

B)How frequent is each cause? (i.e., give a percent)
Heredity (fragile X): 5%

Early alterations in embryonic development (prenatal, Down's, damage due to toxins): 30%

Pregnancy and perinatal problems: 10%

GMC's in infancy or childhood (i.e. lead poisoning): 5%

Environmental factors (nutritional deprivation) and other mental disorders (autism): 15 to 20%

Unknown etiology: 30-40%
A) PKU can be detected at birth by a blood test, and its symptoms prevented by a diet that is ___________.

B) Name the three main consequences of untreated PKU.
A) low in phenylalanine

B) irreversible moderate to profound retardation

impaired motor and language development

unpredictable and erratic behaviors
-Both parents must pass on the defective gene in order for a baby to have the condition. This is called an autosomal recessive trait
-Babies with PKU are missing an enzyme called phenylalanine hydroxylase, which is needed to break down an essential amino acid called phenylalanine. The substance is found in foods that contain protein.

Without the enzyme, levels of phenylalanine and two closely-related substances build up in the body. These substances are harmful to the central nervous system and cause brain damage.
Down Syndrome is also known as _____ and is due to the presence of ______.
Trisomy 21, an extra chromosome.
Down syndrome is estimated to be the cause of about _____% of all cases of moderate to severe retardation.
10 to 30%
What do treatment approaches for children with Mental Retardation emphasize?
Providing education and training that enhance the skills needed to live productively and independently. Mild is not necessarily lifelong if treated early and effectively
If a person has an IQ of 73, with deficits in adaptive functioning, what would be the most appropriate diagnosis?

A) Mild Mental Retardation
B) Borderline Intellectual Functioning
C) Moderate Mental Retardation
D) None
A) While Borderline Intellectual Functioning is typically associated
with an IQ between 71 and 84, Mild Mental Retardation is the most
appropriate diagnosis when a person's IQ is between 71 and 75, with
substantial deficits in adaptive functioning.
A Learning Disorder is defined as when achievement is 'substantially
below' that which is expected given age, schooling, and intelligence.

"Substantially below" is usually defined as a discrepancy of ___ standard deviations between achievement and IQ test scores.

a) One or more
b) Two or more
c) Three or more
d) Four or more
b) Two or more
____ is the most frequent comorbid disorder in individuals with Learning Disorder.

a) Oppositional Defiant Disorder
b) Conduct Disorder
c) ADHD
d) Tourette's Disorder
c) 20 to 25% of children with Learning Disorders also have ADHD
Which of the following has been found to be helpful in the treatment of Learning Disorders?

a) Cognitive restructuring
b) Social-cognitive skills training
c) Neurocognitive rehabilitation
d) None of the above
b) Because children with learning disabilities often have peer relationship problems, training in social-cognitive skills is beneficial.
A promising treatment method for older children with Stuttering is the _______ method.

a) Controlled respiration
b) Regulated breathing
c) Monitored exhalation
d) None of the above
b) The regulated breathing method has been found to be a treatment for older children who stutter.

It involves reassuring the individual he can speak without stuttering, and incorporates breathing and vocalization exercises and graded speech assignments.
A diagnosis of Autism requires that abnormal functioning in social
interaction, communication, or symbolic or imaginative play develops
prior to age ___.

a) two
b) three
c) four
d) five
b) three
Autism is about _____ times more common in ____.

a) two to three, males
b) four to five, males
c) four to five, females
d) four to five, females
b) Autism is about four to five times more common in males than females.
About ___ of individuals with Autism achieve some degree of partial independence as adults.

a) 1/8
b) 1/4
c) 1/3
d) 1/2
one-third
About ___% of people with Autism are mentally retarded.

a) 45%
b) 60%
c) 75%
d) 90%
c) 75%
The earliest signs of Autism are _____.

a) Steadfast refusal to communicate verbally
b) High-pitched echolalic speech
c) Delayed motor movement
d) A lack of normal responding to caregivers
d) A lack of normal responding to caregivers
Which of the following are associated with a better prognosis for children with Autism?

a) Ability to communicate verbally by age 4
b) An IQ over 70
c) Earlier onset of symptoms
d) b and c
B) An IQ over 70, ability to communicate verbally by age 5 or 6, and a later onset of symptoms are all associated with a better prognosis for children with Autism.

If communicating verbally, may b echolalic and reverse pronouns
In temrs of etiology, Autism has been linked to a number of _______, the most common of which are ______.

a) Prenatal influences; cocaine and marijuana exposure in utero
b) Social impoverishments; parental abuse and neglect
c) Neurological factors; reduced cerebellum and enlarged ventricles
d) Physical traumas in infancy; shaken baby syndrome and open head injuries
c)
____________ have been found to be most effective in increasing communication skills in children with Autism.

a) contingency training
b) shaping and discrimination training
c) social skills training
d) all of the above
b) While all of the above are behavioral techniques, shaping and discrimination training have been found to be most effective in this population.
Autistic children have been found to be relatively strong in _____
processing, which has led to the development of educational
interventions that emphasize the use of ________.

a) motor; psychomotor stimulation
b) verbal; speech therapy
c) visual; visual structures and cues
d) kinesthetic; physical therapy
c) visual; visual structures and cues
Autistic Disorder is one subcategory of Pervasive Developmental
Disorders (PDD). Another PDD is Rett's Disorder, which involves a
characteristic pattern of symptoms following a period of normal
development for _____ months or more.

a) three
b) four
c) five
d) six
c) five
Which of the following is NOT characteristic of Rett's Disorder?

a) Head growth acceleration
b) loss of purposeful head skills and development of stereotypical hand movements
c) impairments in gait or trunk coordination
d) severely impaired language development
a) Rett's Disorder is characterized by head growth deceleration.
Rett's Disorder is ____ times more common in ____.

a) three, males
b) five, females
c) six, females
d) none of the above
D) Rett's Disorder has been reported only in females.
In __________ Disorder, there is a distinct pattern of developmental
regression in at least two areas of functioning (e.g., motor skills,
play, social skills) following at least ____ of apparently normal
development.

a) Asperger's Disorder, 1 year
b) Childhood Disintegrative Disorder, 1 year
c) Asperger's Disorder, 2 years
d) Childhood Disintegrative Disorder, 2 years
d)
Which of the following is true about Asperger's Disorder?

a) Social development is not severely impaired
b) Language development is not substantially impaired
c) Cognitive development is substantially impaired
d) Self-help skills are substantially impaired
b) Language development is not impaired in children with Asperger'S Disorder.
A diagnosis of ADHD requires:

a) Onset of symptoms prior to age 6
b) Persistence of symptoms for at least three months
c) Some degree of impairment in at least one setting, as observed by at least two people
d) None of the above
d) ADHD requires an onset of symptoms prior to age 7, persistence of
symptoms for at least six months, and some degree of impairement in at
least two settings.
A co-diagnosis of ________ is very common in children with ADHD, to the
extent that some experts believe these two conditions are the same
disorder.

a) Tourette's Disorder
b) Oppositional Defiant Disorder
c) Conduct Disorder
d) Rett's Disorder
c) While Oppositional Defiant Disorder, Mood Disorders, Anxiety
Disorders, Learning Disorders and Communication Disorders are all common
co-diagnoses, Conduct Disorder is very common.
Up to ___% of children continue to have symptoms of ADHD as adults.

a) 20%
b) 40%
c) 60%
d) 80%
c) 60%
The prognosis for children with ADHD is poorest for those who have a co-diagnosis of Conduct Disorder, a low IQ, and _____.

a) Authoritarian parents
b) A first-degree relative with ADHD
c) Low social support
d) Parents with severe mental disorders
d
Which of the following brain abnormalities have been linked to ADHD?

a) Reduced activity in the frontal cortex and basal ganglia
b) Malfunction in the right hemisphere
c) Smaller than normal caudate nucleus, globus pallidus, and prefrontal cortex
d) All of the above
d
Barkley (1990) proposed that the core feature of ADHD is an inability to
regulate one's behavior to fit situational demands. This is known as:

a) The overstimulation hypothesis
b) The behavioral regression hypothesis
c) The behavioral disinhibition hypothesis
d) The impulsive discontrol hypothesis
c) The behavioral disinhibition hypothesis
_____ are a class of drugs that have been used to treat ADHD since the
1930's, and have had beneficial effects on its core symptoms in about
__% of cases.

a) Antipsychotics; 80%
b) SSRI's; 65%
c) Benzodiazepines; 55%
d) Stimulants; 75%
d
The effects of stimulants in treating ADHD symptoms are said to be "dose dependent." This means:

a) Greater reductions in overactivity and improved attention are both usually obtained with lower doses
b) Greater reductions in overactivity and improved attention are both usually obtained with higher doses
c) Greater reductions in overactivity are associated with lower doses, while improved attention is associated with higher doses
d) Greater reductions in overactivity are associated with higher doses, while improved attention is associated with lower doses
d
Which of the following adverse side effects may be seen when using stimulants to treat ADHD?

a) dysphoria
b) loss of appetite
c) increased heart rate
d) all of the above
d) all of the above.

Other side effects of stimulants include
insomnia, increased blood pressure, and suppression of height and weight
(which can be alleviated via "drug holidays" during summer and winter
vactions).
___________ have been observed in 30 to 70% of hyperactive children taking stimulant drugs

a) Motor tics
b) Vocal tics
c) Motor and Vocal Tics
d) Neurological Tics
c) Motor and Vocal Tics.

Thus, some experts have concluded that
stimulants are contraindicated, or must be closely monitored, in
children with pre-existing tics or a family history of a Tic Disorder.
Another class of drugs used to treat ADHD are the _______.

a) SSRI's
b) MAO Inhibitors
c) Tricyclic Antidepressants
d) Anxiolytics
c) Tricyclic Antidepressants. They tend to inhibit reuptake of norepinephrine

Also note that bupropion which effects norepinephrine, dopamine system, also used for ADHD

These drugs are similar to CNS
stimulants in terms of benefits, and may be useful when stimulants are
contraindicated because of adverse side effects.
Which of the following is true regarding treatment interventions for ADHD?

a) Pharmacotherapy is the optimal form of treatment
b) Psychosocial interventions is the optimal form of treatment
c)
There is some evidence that pharmacotherapy, in combination with
psychosocial interventions, result in better outcomes than either
treatment alone
d) There is considerable evidence that
pharmacotherapy, in combination with psychosocial interventions, result
in better outcomes than either treatment alone
d
What is the most accurate statement concerning parental involvement in the treatment of ADHD?

a) It is helpful, but not seen as particularly important
b) It is seen as important
c) It is not seen as relevant
d) It has not been adequetely studied
b) Parental involvement is considered an important part of the treatment for ADHD.
The diagnosis of Conduct Disorder requires the presence of at least
three characteristic symptoms during the past 12 months. Symptoms are
divided into four categories.

Which of the following is NOT a symptom category?

a) aggression to people and animals
b) destruction of property
c) deceitfulness or theft
d) All of the above are symptom categories
d) All of the above are symptom categories.

Additionally, serious violation of rules is a symptoms category of Conduct Disorder.
There are two subtypes of Conduct Disorder. When the onset of symptoms is prior to age _____, _____ is diagnosed.

a) 8, Unruly Type
b) 8, Childhood-Aggression Type
c) 10, Childhood-Behavior Type
d) 10, Childhood-Onset Type
d)
The two subtypes of Conduct Disorder are
Childhood-Onset Type and _______:

a) Adolescent-Behavior Type
b) Teenage-Behavior Type
c) Adolescent-Acting Type
d) None of the above
d) None of the above.

Adolescent-Onset Type is the other subtype of Conduct Disorder.
Moffit (1993) distinguishes between two types of Conduct Disorder that
differ in terms of onset, symptom severity and etiology, They are:

a) Chronic Conduct Disorder Type and Teenage-Only Type
b) Lifelong Persistent Type and Childhood Type
c) Life-course-persistent type and Adolescence-limited type
d) Life-stage-evolving type and School-aged-limited type
c) The life-course-persistent type begins early, with symptoms sometimes
apparent by age three, and involves a pattern of increasingly serious
transgressions that continues into adulthood.

By contrast, the
adolescence-limited type is a temporary form of antisocial behavior that
reflects a maturity gap between the adolescent's biological maturation
and lack of opportunities for adult privileges and rewards.
Which of the followng is true about treatment for Conduct Disorder?

a) Treatment is best targeted at children once they reach adolescence
b) Treatment can be directed at children either in pre-adolescence or adolescence, with equal effectiveness
c) Preadolescence is the optimal time for intervention
d) None of the above
c) Interventions that target preadolescents (versus adolescents) are most effective
Which form(s) of family interventions are commonly associated with treatment of Conduct Disorder?

a) Parent management training
b) Multisystemic treatment
c) Structural family therapy
d) a and b
e) b and c
d) a and b
A 7 year old child argues often with his parents, is quick to lose his temper, and is defiant of the rules when playing games with his friends.

What is the most accurate diagnosis for this child?

a) Conduct Disorder, Childhood-Onset type
b) ADHD, Hyperactive-Impulsive Type
c) Oppositional Defiant Disorder
d) Tourette's Disorder
c) Oppositional Defiant Disorder: A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months

Conduct DO: A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated (Destruction of property, theft, aggression to people or animals, serious rule breaking) age 10 is the cutoff of "childhood onset"
WHich of the following best describes the gender differences in children with Oppositional Definat Disorder (ODD)?

a) Equally common in males and females throughout childhood
b) More common in females than males until puberty; afterwards, more common in males
c) More common in males than females until puberty; afterwards, more common in females
d) More common in males than females until puberty; afterwards, about equal in males and females
d
Which of the following is NOT a Feeding and Eating Disorder of Infancy or Early Childhood?

a) Pica
b) Rumination Disorder
c) Feeding Disorder of Infancy or early childhood
d) b and c
e) all of the above are accurate categories
e
What is the essential feature of Tourette's Disorder?

a) multiple vocal tics and at least one motor tic beginning prior to age 16
b) at least one vocal tic and multiple motor tics beginning prior to age 16
c) multiple vocal tics and at least one motor tic beginning prior to age 18
d) at least one vocal tic and multiple motor tics beginning prior to age 18
d)
The most common associated feature of Tourette's Disorder are:

a) Impulsive behaviors
b) Obsessions and compulsions
c) Echolalic speech
d) None of the above
b) The rate of OCD is higher not only for individuals with Tourette's Disorder but also for their biological relatives.

Impulsivity,
hyperactivity and distractibility are also common and have been
identified as a cause of the high rate of school problems exhibited by
children with this disorder.
The treatment of Tourette's Disorder usually involves _________, particularly through the use of _______.

a) behavior modification; contingency management
b) social skills training; role play
c) pharmacotherapy; antipsychotics
d) pharmacotherapy; anxiolytics
c) Haloperidol and Pimozide have been studied most extensively and have been found to be effective in about 80% of cases.
In terms of pharmacotherapy, it is believed that Tourette's Disorder is related to ____________.

a) insufficient serotonin
b) excessive GABA
c) excessive dopamine
d) insufficent norepinephrine
c
Enuresis is only diagnosed when children have reached a developmental
age where continence is expected (usually ___ years). Encopresis is
usually _____ and the child must have a chronological or mental age of
at least ___ years.

a) 6, voluntary, 4
b) 5, involuntary, 4
c) 4, voluntary, 5
d) 6, involuntary, 3
b
A drug of choice for treating Enuresis is ______. A drawback to this
drug is that most children relapse within ____ after discontinuing the
drug.

a) Clompiramine, 4 months
b) Desyrel, 6 months
c) Imipramine, 3 months
d) Inderal, 4 mnths
c) Imipramine reduces wetting frequency in 85% of cases and suppresses
wetting entirely in 30% of cases. However, most children relapse within 3
months after discontinuing.
Separation Anxiety Disorder is best defined as:

a) excessive anxiety about going to public school
b) excessive anxiety about being left alone in public setings
c) excessive anxiety related to separation from home or attachment figures
d) excessive anxiety surrounding parental rejection
c
Separation Anxiety Disorder is sometimes manifested as:

a) refusal to listen to caregivers
b) school refusal
c) refusal to attend public gatherings without caregivers present
d) refusal to leave room
b)School refusal often occurs at three different ages:

5 to 7 years (when the child first begins school);

11 to 12 (when the child changes school);

and at 14 years or older

When
school refusal occurs between 5 and 7 it is usually due to separation
anxiety, whereas during adolescence it is usually a sign of depression
or a more severe disorder.
In terms of treatment for school refusal, most authorities agree that:

a) parents should exercise their best judgment in deciding when children should return to school
b) parents should forcibly insist that children return under any and all circumstances
c) parents should leave children alone until they feel emotionally ready to return
d) an immediate return to school is recommended
d)
Pica involves:

a) Persistent eating of food for at least one month
b)
Persistent eating of nonnutritive substances (e.g., paint, clay) for at
least one month, with a corresponding aversion to food
c) Sporadic eating of nonnutritive substances for at least one month, without an aversion to food
d) Persistent eating of nonnutritive substances for at least one month, without an aversion to food
d) Additionally, the onset of this disorder is most often between the
ages of 12 and 24 months, is frequently associated with Mental
Retardation, and is occasionally found in pregnant women.
The essental feature of Reactive Attachment Disorder of Infancy or Early
Childhood is markedly disturbed and developmentally inappropriate:

a) Oppositional behavior
b) Clinging behavior
c) Social relatedness
d) None of the above
c) Additionally, a diagnosis of this disorder requires evidence of
pathogenic care (e.g., neglect or freqent changes in caregivers that
prevented the development of attachment)
The two subtypes of Reactive Attachment Disorder are:

a) Inhibited and Disinhibited
b) Dependent and Neglected
c) Ambivalent and Unambivalent
c) Affiliated and Unaffiliated
a) The Inhibited Type is characterized by a persistent failure to
initiate and respond to most social interactions and involves a pattern
of inhibited, hypervigilant or highly ambivalent responses.

The Disinhibited Type involves indiscriminate sociability or a lack of selectivity in the choice of attachment figures.
Behavioral pediatrics (pediatric psychology) is defined as:

a) psychological study of developmental issues
b) psychological study of children's intellectual functioning
c) psychological study of children's medical illnesses
d) psychological study of any and all aspects of children's lives
c
In terms of behavioral pediatrics, multicomponent cognitive-behavioral
interventions have been found useful for reducing both anxiety about
medical procedures, and the pain they cause.

These interventions, are based in part, on Meichenbaum's _______ model.

a) stress tolerance
b) stress inoculation
c) illness inoculation
d) behavioral inoculation
b) Meichenbaum's stress inculation model involves providing the child
with information about the medical procedure and using a variety of
techniques to help the child cope with anxiety and stress.
Research has found that a major contributor to risk for emotional and
behavioral disorders in children with medical illnesses involves:

a) Frequent medical interventions
b) Separation from family
c) Lack of emotional support from family
d) Few friends
b) Recognition of the impact of separation has led to increased
visitation hours in hospitals and "rooming-in" (24 hour visitation)
Brown and Madan-Swain (1993) looked at the effects of CNS irradiation
and intrathecal chemotherapy, which are common treatments for leukemia.

Whichof the following is most accurate, about the impact of these two treatments?

a) Neither treatment is associated with a significant impact on neurocognitive functioning
b) Both treatments are associated with deficits in neurocognitive functioning
c)
CNS irradiation is associated with deficits in neurocognitive
functioning, as well as a higher-than-normal rate of learning
disabilities
d) CNS irradiation and intrathecal chemotherapy have
both been found to be associated with deficits in neurocognitive
functioning, and a higher-than-normal rate of learning disabilities
d
The two main criteria for a diagnosis of Delirirum are:

a) 1) A disturbance in consciousness, and 2) a change in cognition, and/or development of abnormal behaviors
b) 1) Intact consciousness, and 2) A change in cognition, and/or development of perceptual abnormalities
c) 1) A disturbance in consciousness, and 2) a change in cognition, and/or development of perceptual abnormalities
d) 1) A disturbance in consciousness, and 2) a change in behavior, and/or development of perceptual abnormalities
c
**Disturbance in consciousness (distracted, less aware of environment)
** A change in cognition (loss of recent memory, disorientation to time/place) and/or the development of perceptual abnormalities (illusions, delusions, hallucinations)
**Sx’s are random, haphazard
Wise (1995) idetified five groups who are at high risk for delirium. All of the following are identified groups, EXCEPT:

a) People with decreased cerebral reserve
b) Postcardiotomy patients
c) Elderly people
d) Burn patients
e) All of the above are considered to be high-risk
e) Additionally, people with drug dependence who are experiencing withdrawal are considered to be high risk.
Which of the following age grops are at the highest risk for delirium?

a) Young children
b) Middle-aged adults with a history of head trauma
c) HIV infected patients
d) Older people
D) Older people are at the highest risk to develop delirium, followed by young children.
The two components of treatment for delirium are:

a) Surgical intervention and social skills training
b) Drug intervention and reduction of agitated behaviors
c) Treatment of the underlying medical condition and psychotherapy
d) Treatment of the underlying medical condition and reduction of agitation
d) Reduction of agitation is addressed by a combination of environmental
manipulation (e.g., providing an environment that minimizes
disorientation) and psychosocial intervention.
Dementia is characterized by multiple cognitive deficits that include:

a) Severe memory impairment
b) Some degree of memory impairment
c) aphasia, apraxia, agnosia, and/or impaired executive functioning
d) b and c
e) a and c
d) b and c. Only some degree of memory impairment (versus severe memory impairment) is required.
Which of the following interventions are NOT typically used in treating dementia?

a) group therapy that emphasizes reminiscence
b) antidepressants
c) cognitive rehabilitation
d) environmental manipulation
c) While cognitive rehabilitation and memory training are effective for people with age-related memory declines or focal brain disorders, they have not been found useful for people with dementia.
The psychiatric condition underlying
"pseudodementia" is:

a) Dysthymic Disorder
b) Major Depressive Disorder
c) Depressive Disorder Due to a General Medical Condition
d) Substance-Induced Mood Disorder
b
The single-most common cause of dementia is _______ and accounts for ____ of all cases of dementia.

a) Vascular Dementia; 70%
b) Vascular Dementia; 65%
c) Dementia of the Alzheimer's Type; 70%
d) Dementia of the Alzheimer's Type; 65%
d
There are three stages of Dementia of the Alzheimer's Type. Stage 2
occurs ___ to ___ years into the illness, and is characterized by
________.

a) 8 to 12; increasing retrograde amnesia and flat or labile mood
b) 2 to 10 years; increasing anterograde amnesia and flat or labile mood
c) 1 to 3 years; increasing retrograde amnesia and flat or labile mood
d) 2 to 10 years; increasing retrograde amnesia and flat or labile mood
d) The three stages:

Stage 1 (1 to 3 years)
Stage 2 (2 to 10 years)
Stage 3 (8 to 12 years)
A definitive diagnosis of Dementia of the Alzheimer's Type requires:

a) Genetic testing
b) Neuroimaging
c) A brain biopsy
d) Evidence that both biological parents were afflicted
c
The key word here is "definitive". Only a biopsy can provide concrete evidence of plaques and tangles; neuroimage is dependent on the course of the disorder (early stages, might not see anything)
A low level of ________ has been implicated in the etilogy of Dementia of the Alzheimer's Type.

a) Epinephrine
b) Serotonin
c) Acetylcholine
d) Dopamine
c) Cognex and Aricept are drugs used in these patients to increase cholinergic activity.
Vascular Dememtia is caused by ______ disease and is characterized by a ____ course.

a) Systemic; progressive
b) Gastric; stepwise and fluctuating
c) Cerebrovascular; progressive
d) Cerebrovascular; stepwise and fluctuating
d
The most salient symptoms of Dementia due to ______ disease are bradykinesia, rigidity, and resting tremor.

a) Huntington's
b) Parkinson's
c) Alzheimer's
d) HIV
b
The most salient features of Dementia due to _____ disease are dementia, chorea, and athetosis.

a) Huntington's
b) Parkinson's
c) Alzheimer's
d) HIV
a (chorea: repetitive, brief, jerky, large-scale, dancelike, uncontrolled movements that start in one part of the body and move abruptly, unpredictably, and often continuously to another)

(athetosis: a continuous stream of slow, sinuous, writhing movements, generally of the hands and feet)
Substance _____ is diagnosed with a person continues to use a substance
despite significant substance-related problems, as evidenced by ___ or
more symptoms at any time during a ___ month period.

a) Abuse, 3, 6
b) Dependence, 3, 6
c) Abuse, 6, 12
d) Dependence, 3, 12
d
It has been said that people with Substance Dependence experience a "craving" for the substance.

Which of the following statments is true?

a) "Craving" is required for a diagnosis of Substance Dependence
b) "Craving is a listed diagnostic criterion, but is not required for a diagnosis of Substance Dependence
c) "Craving" is simply not required for a diagnosis of Substance Dependence
d) None of the above
c
Which of the following treatment interventions have been found to be successful in the treatment of Substance Dependence?

a) aversion therapy
b) multicomponent interventions to include social skills training, contingency management and other treatments
c) self-control techniques that emphasize alternative methods for responding to events that trigger drinking
d) all of the above
d
According to Marlatt and Gordon (1985), which of the following is the
most common precipitant of relapse among people with Alcohol and other
types of Substance Dependence?

a) reintroduction to the substance
b) organicity
c) negative emotions
d) mania or hypomania
c) According to Marlatt and Gordon, the experience of anxiety,
frustration, depression or other negative emotional state is seen as the
most common precipitant of relapse.
Marlatt and Gordon (1985) describe substance dependence as __________,
and refer to the typical reaction to relapse as the "_________".

a) learned via observation,
"overconsumption effect"
b) largely physiological, "neuochemical effect"
c) characterologically driven,
"social choice effect"
d) an overlearned habit pattern,
"abstinence violation effect"
d)the "abstinence violation effect"involves anxiety, self-blame,
depression, and an increased susceptibility to further drinking.
According to Marlatt and Gordon (1985), the potential for future substance relapse is reduced when the person is encouraged to view the episode of drinking as a mistake resulting from ____, ____, and ____ factors.

a) general, external, uncontrollable
b) specific, internal, controllable
c) general, external, controllable
d) specific, external, controllable
d)
Marlatt and Gordon's treatment program can be most accurately described as emphasizing:

a) group therapy
b) cognitive restructuring
c) relapse prevention
d) none of the above
c)Their relapse prevention program combines behavioral and cognitive
techniques that are aimed at helping individuals deal effectively with
situations that elicit negative emotions and other high risk
circumstances.
Research on smoking cessation has found that:

a) After more than five years smoking, cessation does not result in any health benefits
b)one to five years after smokers quit, risk for such diseases as cardiac arrest or stroke is the same as that in those who never smoked
c) one to five years after smokers quit, their risk for cardiac disease is lessened, but still higher than that in lifelong nonsmokers
d) None of the above
b
Which of the following best describes nicotine addiction in smokers?

a) Most smokers are addicted, but reasons for addiction are uncertain
b) Most smokers are addicted, and addiction is based solely on the need to attain reinforcing effects
c)
Most smokers are addicted, and addiction is based on the need to attain
reinforcing effects and to avoid depression and other withdrawal
symptoms
d) None of the above
c
It has been found that even when a person has been abstinent for months
or years, he or she continues to crave nicotine and is therefore at risk
for relapse.

Research on relapse has found that it is most often precipitated by the presence of ______ and/or ______.

a) an identifiable psychosocial stressor, negative mood states
b) smoking cues (e.g., others smoking), a psychiatric condition
c) smoking cues, negative mood states
d) a and b
c
Substance ______ is characterized by a maladaptive pattern of substance use that involves clinically significant impairment or distress, as manifested by at least ____ symptom during a ____-month period.

a) dependence, 2, 12
b) abuse, 1, 6
c) dependence, 1, 6
d) none of the above
d) None of the above.

Substance abuse is diagnosed when one or more symptoms are present during a twelve month period.

SUBSTANCE DEPENDENCE: at least 3 sx’s over 12months
Alcohol Intoxication is associated with all of the following EXCEPT:

a)slurred speech
b)nystagmus
c)stupor or coma
d)autonomic hyperactivity
d) Autonomic hyperactivity is associated with Alcohol Withdrawal.
Alcohol Withdrawal is associated with all of the following EXCEPT:

a) hand tremor
b) illusions or hallucinations
c) grand mal seizures followoing heavy or prolonged use
d) impaired memory
d) impaired memory is associated with Alcohol Intoxication and Alcohol-Induced Dementia.
Alcohol Withdrawal Delirium (i.e., Delirium Tremens) is associated with all of the following EXCEPT:

a) disturbances in consciousness
b) delusions
c) agitation following heavy or prolonged use
d) none of the above
d) all are associated with Alcohol Withdrawl Delirium.
Alcohol-Induced Dementia is characterized by:

a) Symptoms of dementia, with greater impairment in verbal (versus visuospatial) memory
b) Symptoms of dementia, with greater impairment in visuospatial (versus verbal) memory
c) Equal impairment in both verbal and visuospational memory
d) Impairment in declarative and procedural memory
b) Visuospatial memory is more impaired than verbal memory in Alcohol-Induced Dementia.

Additionally, some improvement in symptoms may occur after five or more years of sobriety.
In Wernicke-Korsakoff Syndrome, which of the following is true?

a)Retrograde and anterograde amnesia are both affected, with anterograde amnesia most severe, especially for declarative memories

b) Retrograde and anterograde amnesia are both affected, with retrograde amnesia affecting recent long-term memories more than remote memories

c) Anterograde amnesia is not significantly affected

d) a and b
d

Retrograde and anterograde amnesia are both affected, with anterograde amnesia most severe, especially for declarative memories and retrograde amnesia affecting recent long-term memories more than remote memories (short-term and procedural memories unaffected)

Other sx's include confabulation, ataxia; abnormal eye movements, confusion
Amphetamine or Cocaine Intoxication are characterized by all of the following EXCEPT:

a) tachycardia
b) paranoia
c) auditory hallucinations
d) weight gain
d
Amphetamine or Cocaine Withdrawal are characterized by all of the following EXCEPT:

a) Euphoria
b) Fatigue
c) Insomnia or Hypersomnia
d) Psychomotor changes
a
Caffeine Intoxication is characterized by all of the following EXCEPT:

a) Insomnia
b) Depression
c) Muscle twitching
d) Cardiac arrhythmias
b
Sedative, Hypnotic or Anxiolytic Intoxication, Withdrawal and Withdrawal
Delirium most closely resemble the intoxication, withdrawal and
withdrawal delirium presentions of:

a) Cocaine
b) Alcohol
c) Caffeine
d) None of the above
b
How many active-phase symptoms typically need to be present for at least one month, for a diagnosis of Schizophrenia?

a) one or more
b) two or more
c) three or more
d) all five
b) Although the presence of bizarre delusions, and/or hallucinations
consisting of a running commentary, are sufficient (if present), two or
more active-phase symptoms are generally required.
________ hallucinations are most common in Schizophrenia.

a) auditory
b) visual
c) olfactory
d) auditory and visual are equally common
a) auditory hallucinations are most common, and often take the form of
pejorative or threatening voices, or a running commentary on the
person's thoughts or actions.
________ is considered by some experts to be the key feature of Schizophrenia.

a) delusions
b) hallucinations
c) disorganized speech
d) grossly disorganized or catatonic behavior
c
A person comes into your clinic. He demonstrates preoccupation with one
or more delusions and/or frequent auditory hallucinations, within the
context of relatively intact cognition and affect.

The most accurate subtype of Schizophrenia to describe this individual would be:

a) Disorganized Type
b) Catatonic Type
c) Undifferentiated Type
d) Residual Type
e) None of the above
e) Paranoid Type is the most appropriate subtype, most common subtype...most with this subtype can function fine (intact cognition and affect but delusions/hallucinations present, tend to be about persercution or conspiracy)

Disorganized Type: disorganization of thoughts, significant impairments in their ability to maintain the activities of daily living, impairment in the emotional processes, can't communicate effectively

Catatonic: disturbances in movement, can alternate btwn complete stopping and over-excitement

Undifferentiated: doesn't fit into a specific type

Residual: not currently displaying prominent sx's
Which of the following is NOT true regarding Schizophrenia, Disorganized Type?

a) delusions and hallucinations, if present, are fragmentary
b) delusions and hallucinations, if present, are organized around a coherent theme
c) delusions and hallucinations, if present, indicate a different subtype of Schizophrenia
d) None of the above
b. Disorganized Type is characterized by disorganized speech, disorganized behavior, and flat or inappropriate affect.

Delusions and hallucinations, if present, are fragmentary and not organized into a coherent theme.
Schizophrenia, Catatonic Type, is characterized by all of the following EXCEPT:

a) motoric immobility
b) excessive motor activity
c) extreme negativism or mutism
d) echolalia and echopraxia
e) all are characteristic of this type of Schizophrenia
e) all are characteristic of Schizophrenia, Catatonic Type.
A
person comes into your clinic. He states that he has had frequent
delusions and hallucinations several years ago, but is not having these
symptoms now. However, he states that he still sometimes believes that
aliens may in fact be present. He also states he feels depressed for
several days, every few months.

The best diagnosis for this patient would be:

a) Schizophrenia, Paranoid Type
b) Schizophrenia, Undifferentiated Type
c) Schizophrenia, Residual Type
d) Schizoaffective Disorder, Depressive Type
c) Residual Type is diagnosed when the person is not currently
exhibiting prominent delusions, hallucinations or other positive
symptoms, but has had such symptoms i n the past and continues to
display negative and/or attenuated positive symptoms (e.g., eccentric
speech, odd beliefs).
Which of the following statements is true, regarding the distinction between Type I and Type II Schizophrenia?

a) Type I is characteritized by positive symptoms and is associated with relatively poor premorbid functioning
b) Type I is characterized by negative symptoms and is associated with relatively good premorbid functioning
c) Type II is characterized by negative symptoms and is associated with relatively good premorbid functioning
d) Type II is characterized by negative symptoms and is associated with relatively poor premorbid functioning
d) Type II involves negative symptoms, is associated with relatively
poor premorbid adjustment and a poor response to traditional
antipsychotics, and is more likely the result of structural brain
abnormalities.

Type I is characterized by positive symptoms, is
associated with relatively good premorbid functionign and a favorable
response to traditional antipsychotic drugs, and is believed to be due
to neurotransmitter abnormalities.
Most people with Schizophrenia have ____ insight regarding their illness.

a) Good
b) Fair
c) Poor
d) No definitive trend has been seen
c
The risk for suicide is __________ for people with Schizophrenia.

a) Higher
b) Lower
c) The same, as compared to national statistics for other groups
d) Unstudied
a
The risk for suicide is _higher__ for people with Schizophrenia.
Which of the following has been found to be associated with a higher risk of suicide in Schizophrenics?

1. female
2. people over 30
3. Depressive symptoms
4. Recent inpatient psychiatric discharge

a) 1 and 2 only
b) 2 and 3 only
c) 3 and 4 only
d) 2, 3 and 4
c) Depressive symptoms and recent inpatient psychiatric discharge have been found to be associated with a higher risk for suicide.
Which of the following have been found to be associated with a better prognosis in patients with Schizophrenia?

1. Good premorbid adjustment
2. Absence of a precipitating event
3. Male gender
4. Insight into the illness
5. Family history of a Mood Disorder

a) 1 and 3 only
b) 2 and 4 only
c) 1 and 4 only
d) 1, 2 and 4
e) 1, 4 and 5
e) Good premorbid adjustment, insight into the illness, and a family history of a Mood Disorder are all associated with better prognosis.(the only reason I can think that mood d/o is here is because it's related to NT, and a NT determinant of schizophrenia is better than a structural determinant for it, can use meds if it's mood)

Other factors associated with a better prognosis are an acute and late onset, female gender, the presence of a precipitating event, a brief duration of active-phase symptoms, and no family history of Schizophrenia.
The rate of schizophrenia in an identical twin is approximately ___
times higher than that in found in non-twin biological siblings.

a) 3
b) 5
c) 7
d) 10 or more
b) Identical twins have an approximately 48% concordance rate, while biological siblings have an approximately 10% concordance rate.
A number of brain abnormalities have been linked to Schizophrenia, including:

a) increased volume of lateral and third ventricles
b) hyperfrontality
c) increased volume of limbic system structures
d) a and b
a) ventricular enlargement and hypofrontality (versus hyperfrontality) have been found in Schizophrenics.

Other
brain abnormalities include diffuse or focal neocortical atrophy, and
diminished size of the hippocampus, amygdala and globus pallidus.
According to the dopamine hypothesis, which of the following has been implicated in Schizophrenia?

a) elevated dopamine levels
b) excess dopamine receptors
c) oversensitive dopamine receptors
d) a and b
e) all of the above
e) all of the above have been implicated in Schizophrenia
In recent years, the dopamine hypothesis has been modified by research indicating ______ in some schizophrenic patients.

a) elevated levels of norepinephrine and serotonin
b) high levels of GABA
c) high levels of glutamate
d) a and b
e) all of the above
a) elevated levels of norepinephrine and serotonin, low levels of GABA,
and low levels of glutamate have all been implicated in some
schizophrenic patients
In the Northern hemisphere, it has been found that an abnormally large number of people with Schizophrenia were born in:

a) late fall or early winter
b) late winter or early spring
c) late spring or early summer
d) late summer or early fall
b
Family factors that have been linked to Schizophrenia include:

a) double-bind communication
b) low expressed emotion
c) high expressed emotion
d) a and b
e) a and c
e
An advantage of atypical (versus typical) antipsychotics in the treatment of Schizophrenia is that:

a) atypicals are less likely to cause tardive dyskinesia
b) atypicals are more likely to reduce positive symptoms
c) atypicals are more likely to reduce depression and hostility
d) a and c
e) all of the above
d
An advantage of atypical (versus typical) antipsychotics in the treatment of Schizophrenia is that atypicals are less likely to cause tardive dyskinesia and are more likely to reduce depression and hostility
Resarch has found that effectiveness of antipsychotic drugs is enhanced
when pharmacotherapy is combined with psychosocial interventions.

One such psychosocial intervention that has been found to be helpful for reducing relapse in schizophrenics is:

a) social skills training
b) evironmental manipulation
c) family intervention
d) cognitive therapy
c) Family interventions that focus on reducing stress and nonbeneficial
emotional expression among family members have been found to be helpful
for reducing relapse rates.
In Schizoaffective Disorder, prominent mood symptoms occur concurrently with psychotic symptoms. However, there is also a period of at least _____ during which only psychotic symptoms are present.

a) one week
b) two weeks
c) four weeks
d) two months
b

(another way to say this is if a person has experienced mood sx's almost every day through the course of the disorder, most likely a mood d/o with psychotic features)
The diagnostic criteria for Schizophreniform Disorder are identical to those for Schizophrenia, EXCEPT:

a) the disturbance is present for at least one month but less than three months
b) impaired social or occupational functioning is required
c) both a and b
d) Neither a nor b
d) In Schizophreniform Disorder, the disturbance is present for at least
one month but less than six months. Impaired social or occupational
functioning, though it may occur, is not required.
Delusional Disoder is characterized by the presence of:

a) one or more bizarre delusions
b) presence of delusions for at least one month
c) marked impairment in psychosocial functioning
d) both a and b
b) Delusional Disorder is characterized by the presence of one or more
nonbizarre (versus bizarre) delusions that last at least one month.
Overall psychosocial functioning is not markedly impaired.
All of the following are subtypes of Delusional Disorder EXCEPT:

a) Grandiose
b) Persecutory
c) Referential
d) Unspecified
c) The seven subtypes of Delusional Disorder are:

Erotomanic, Grandiose, Jealous, Persecutory, Somatic, Mixed and Unspecified.

A referential delusion, while possible, would be classified under the "unspecified" type.
Brief Psychotic Disorder is characterized by:

a) hallucinations in the absence of delusions
b) symptoms present for at least one day but less than one month
c) eventual return to premorbid functioning
d) b and c
e) all of the above
d) Brief Psychotic Disorder is characterized by delusions,
hallucinations, disorganized speech, and/or grossly disorganized or
catatonic behavior that is present for at least one day but less than
one month.

There is an eventual return to premorbid functioning.

Additionally, the disorder often, but not always, follows an overwhelming stressor.
The essential feature(s) of Major Depressive Disorder is/are:

a) depressed mood
b) loss of interest/enjoyment in customary activities
c) both a and b
d) none of the above
c)

Additionally, depressive symptoms should represent a change from previous functioning.
At least how many symptoms should be present for a diagnosis of Major Depressive Disorder?

a) four
b) five
c) six
d) seven
b) at least five of nine symptoms should be present.
A _____ episode involves a period of ____ or longer in which the prevailing mood is abnormally or persistently _______.

a) hypomanic; 1 week; elevated, expansive or irritable
b) Manic; 1 week; elevated
c) Manic; 1 week, elevated, expansive or irritable
d) Manic, four days; elevated, expansive or irritable
c
Which of the following MUST be present in a Manic Episode?

a) A distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least 1 week
b) need for hospitalization to present harm to self or others
c) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
d) all of the above
e) none of the above
a) must be present along with
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1) inflated self-esteem or grandiosity
2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3) more talkative than usual or pressure to keep talking
4) flight of ideas or subjective experience that thoughts are racing
5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6) increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation
7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
If a person's mood is only irritable during a manic episode, how does this change the number of symptoms required to make the diagnosis?

a) two symptoms (versus three) is required
b) three symptoms are still required
c) four symptoms (versus three) is required
d) none of the above
c) Four symptoms (versus three) are required if the mood is only irritable.

"A period of abnormally and persistently elevated, expansive or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)"

"During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree"
1) inflated self-esteem or grandiosity
2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3) more talkative than usual or pressure to keep talking
4) flight of ideas or subjective experience that thoughts are racing
5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6) increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation
7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
Which of the following MUST be present in a hypomanic episode?

a) marked impairment ini functioning
b) need to be hospitalized
c) presence of psychotic features
d) all of the above
e) none of the above
e) None of the above are present in a hypomanic episode.

*Similar sx's with MANIC episode EXCEPT hypomanic is 4 DAYS (vs manic 7 days)

*The mood disturbance IS NOT severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features. (opposite for manic episode)
Which of the following statements are true regarding Mixed Episodes?

a) Four days' duration
b) rapidly alternating symptoms of Manic and Major Depressive Episodes
c) significant change in funcitoning, need for hospitalization, and/or presence of psychotic symptoms
d) b and c
e) a, b and c
d)A mixed epsiode is defined by rapidly alternating symptoms of Manic and Major Depressive Episodes meeting the diagnostic criteria for both a manic episode as well as a major depressive episode nearly every day for at least a full week.

and significant change in funcitoning or need for hospitalization, and/or presence of psychotic symptoms
Suicide Risk Factors: Race
*Whites like to kill themselves (stupid ass crackers!), rates higher for most age groups EXCEPT adolescence (Native Americans 10-19)
*AfAm, aged 25-44 are @ highest risk, but more precise # indicate higher highest risk is 20-24
SIMILARITIES BETWEEN OCD AND OCPD
-BOTH HAVE REPETITIVE RITUALS:

*OCD = DECREASE ANXIETY

*OCPD = PERFECTIONISM

*Also,
the diagnosis of OCD (but not Obsessive-Compulsive Personality
Disorder) requires the presence of obsessions and/or compulsions
EFFECTIVE TREATMENTS (short-term & long-term) FOR BULIMIA NERVOSA
-SHORT-TERM EFFECTS:

CBT IS SUPERIOR TO INTERPERSONAL OR BEHAVIOR THERAPY

-LONG-TERM EFFECTS:

CBT + INTERPERSONAL THERAPY BOTH EQUALLY EFFECTIVE (SSRI like imiprimine, fluxetine)
Prevalence of Schizophrenia in Pop
1%
What did Garner and Bemis (1982), the authorities on the COGNITIVE TX for ANOREXIA and BULIMIA say about these disorders and TX?
According to Garner and Bemis, an initial step in treatment is to FOSTER DOUBT in the client about his or her assumption that it is worth the time and effort to deny one's appetite in order to stay thin.

This is followed by ADDRESSING THE VALIDITY of the anorectic's beliefs regarding the consequences of becoming fat and the conviction that thinness is a primary determinant of self-worth and personal value.
Suicide Risk Factors: Gender
Males
likely to commit

Female
likely to attempt
Suicide Risk Factors: Age
-Increases with age, but the greatest increase in suicide rates has been among those aged 15-24
-24-44 yrs for suicide attempts
-65+ for completers...concern about physical health is one of the most common reasons for suicide in the
elderly
Suicide Risk Factors: Marital Status
Marital Status: highest: divorced, sep, widowed, lowest: married
Suicide Risk Factors: Mental Illness
MAJOR DEPRESSIVE DISORDER, RECURRENT, WITH PSYCHOTIC FEATURES is most associated with
completed suicide)
Avoidant Personality is associated with low______ and high ______
extraversion, neuroticism (often want help)
Avoidant Personality is associated with low______ and high ______

(SOCIAL INHIBITION, FEELINGS OF INADEQUACY, HYPERSENSITIVE TO NEG EVAL)
Some factors to look out for in Dependent Personality
sx's could be intepretated as depression; make sure sx's are not part of a cultural norm and excessive and realistic
Quick facts about Borderline
(is there an age when longer meet all DSM criteria? which sx's resolve quickly?)
-by age 40, about 70% no longer meet all DSM criteria
-Impulsive sx resolve quickly, affective sx’s r chronic, and interpersonal sxs were in the middle
-Kernberg: aggressive impulses
-Object-relations: unsuccessful separation-individuation resulting in FEAR OF ABANDONMENT and FEAR OF DOMINATION
Cluster "B"
(4 personality types)
"B" is for "Blazing": Antisocial, Borderline, Histrionic, Narcissistic: all share affect instability
Narcissistic Personality Defense Mechanisms
Repression, Rationalization, Projection
Antisocial Personality Facts
(when can it be dx? what is lacking? is there a reduction in sx's? which personality traits are low? is genetic influence strong or weak?)
CANNOT BE DX B4 AGE 18
Can be charming but lack of empathy
Reduction in sx’s by 40’s
Low on neuroticism, agreeableness, conscientiousness
Strong evidence of genetic etiological influences
Schizoid vs Schizotypal
loner (schizoid, detached from social relationships, lack emotional responsitivity)
versus
may have a desire for personal contact (schizotypal, social deficits, eccentric)
Anxiety, compared to depression, involves a
similar level of______ affect but a higher level of both _______arousal
and _______ affect
Anxiety, compared to depression, involves a
similar level of negative affect but a higher level of both autonomic arousal
and positive affect
The rates for all phobias are _____ for younger
adults than for older adults
The rates for all phobias are higher for younger
For some specific phobias, ___ to ____ sessions
are often useful for reducing phobic reactions in many people.
For some specific phobias, two to four sessions
are often useful for reducing phobic reactions in many people.
In terms of gender and anxiety sensitivity,
women score _____ on physical concerns, males
score ____ on psychological and social concerns
Anxiety sensitivity is a high risk factor for Panic and other Anxiety DO; women score higher on physical concerns, males score higher on psychological and social concerns
Social Phobia connected to _______ and ________ systems
serotonergic and dopaminergic
Panic DO least likely to receive a comorbid do of
PTSD
_____ most comorbid with PD w/agoraphobia
GAD
MDD: gender rates
occurs at twice the rate for adolescent and
adult females as compared to adolescent and adult males. The rates for
prepubertal boys and girls are equal.
Bipolar with psychotic features vs Schizoaffective DO
Bipolar involves psychotic sx’s superimposed on mood
sx’s (when the mood sx’s remit, person doesn’t experience any psychotic sx’s)
while Schizoaffective involves a distinct period of psychotic sx’s without mood
sx’s.
Recent research has shown that single-session Psychological Debriefing is...
NOT Effective for preventing PTSD AND may actually increase the risk for PTSD sx's
The research has found individual therapy, group therapy, and family therapy are effective tx for Bulimia. With regard to individual therapy,
-CBT is superior in terms of short-term effects
-CBT and Interpersonal Therapy are equally effective in terms of long-term effects
Meta-analysis of the research on EMDR
EMDR is about as effective as exposure techniques for PTSD but eye movement is an unnecessary component of the treatment
Concordance rates of Schizophrenia
Parent of an individual who receives dx: 6%

Siblings: 9%

Adopted sibling: 1%

Offspring of one schizophrenic parent: 13%

Twin: 48%
Somatization DO
-A history of somatic complaints over several years, starting prior to the age of 30.
-PAGISEPS
At least four different sites of PAin on the body, and at least two GastroIntestinal problems, and one SExual dysfunction, and one PSeudoneurological symptom.
-Such symptoms cannot be fully explained by a general medical condition or substance use OR, when there is an associated medical condition, the impairments due to the somatic symptoms are more severe than generally expected.
-Not malingering or facticious
Erectile Disorder:

a. inability to develop or maintain an erection during sexual performance (and cannot develop an erection during masturbation or in the morning)
b. inability to develop or maintain an erection during sexual performance (may be able to develop an erection during masturbation or in the morning)
b. inability to develop or maintain an erection during sexual performance (may be able to develop an erection during masturbation or in the morning)
For specific phobia, adding a cognitive component does/does not improve the effects of the interventions SUBSTANTIALLY
IT DOES NOT!

Brief in-vivo exposure is effective, 2-4 sessions
Sleepwalking, sleep terror, encopresis
What are other disorders most likely to be present with ENURESIS
For a diagnosis of Bulimia Nervosa, a person must have a history of binge eating and

a. a sense of a lack of control over eating for at least three months.
b. purging for at least six months.
c. inappropriate compensatory behavior for at least three months.
d vomiting, use of diuretics, or excessive exercising for at least four months.
Correct answer is C
This question is simply requiring you to be familiar with the DSM-IV diagnostic criteria for Bulimia Nervosa – i.e., (1) binge eating (which includes a sense of a lack of control) and (2) inappropriate compensatory behavior in order to lose weight (e.g., purging, excessive exercise) for three months or more

(ELECTROLYTE IMBALANCE IS MOST SERIOUS MEDICAL COMPLICATION)
Risk of a child developing ADHD is ____ if one parent has it
approx. 57%
functional disorders
a disorder which may or may not have a physiological component but is not directly caused by a known physiological factor
the prevalence of Depressive Disorders in the elderly is___ , and the prevalence of Bipolar Disorder is __.
Depressive DO: 5-10%,

Bipolar: 1%
Which of the following is most true about individuals with Moderate Mental Retardation?

a. They constitute 3-4% of the population of mentally retarded individuals.
b.They can reach up to about a sixth grade level in academic skills.
c.They can be trained to perform unskilled work in the competitive job market under close supervision.
d. They acquire little or no communicative speech during the pre-school period.
Correct answer is "C"

Individuals with moderate retardation have an IQ between 35-40 and 50-55. According to the DSM, as adults, they can contribute to their own support by performing unskilled or semi-skilled tasks under supervision -- in sheltered workshops or in the competitive job market. They constitute 10% of the mentally retarded population, they are unlikely to progress beyond the second grade level in academic skills, and they can talk or learn to communicate during the preschool years
What is the single best prognostic indicator of recidivism among juvenile offenders?
number of previous arrests was the single best predictor of recidivism. When multiple predictors are used, they found that the combination of previous arrests, school achievement, and history of drug use is most predictive of recidivism.
A 12-year-old child has been exhibiting several motor tics and a vocal tic many times each day for the past 6 months. The most likely diagnosis is:

a. Transient Tic Disorder
b. Tourette's Disorder
c. Chronic Motor or Vocal Tic Disorder
d. Tic Disorder Not Otherwise Specified
Correct Answer "A"
Transient Tic Disorder includes motor and/or vocal tics lasting at least 4 weeks but for no longer than 12 consecutive months. Choices B and C could be eliminated because Tourette's Disorder and Chronic Motor or Vocal Tic Disorder each have a duration of more than 12 months. Finally, Tic Disorder NOS (D) would be appropriate when symptoms last less than 4 weeks, for onset above 18 years, or if an individual presented with only one motor tic and only one vocal tic
General symptoms that may accompany the third stage of Alzheimer's Dementia include

a. apathy and emotional blunting.
b. depression and anomia.
c. irritability and anger.
d. paranoia and labile mood.
Correct answer is "A"
These symptoms are characteristic of the third stage of Alzheimer's Dementia according to many authors. The symptoms vary considerably from person to person and may include personality, behavioral, and cognitive changes. The symptoms of depression and anomia (answer B) and irritability and anger (answer C) are often seen during the first stage. Paranoia and labile mood (answer D) are characteristic of the second
The symptoms of Obsessive-Compulsive Disorder can be alleviated through cognitive-behavioral treatments and medication interventions that reduce activity in the

a. reticular activating system.
b. inferior colliculus.
c. caudate nucleus.
d.locus coeruleus.
Correct answers is "C"

The caudate nucleus appears to be overactive in people diagnosed with OCD. L.R. Baxter reports that both behavioral interventions and drug therapy affect metabolic rate in the caudate nucleus (Caudate glucose metabolic rate changes with both drug and behavior therapy for Obsessive-Compulsive Disorder, Archives of General Psychiatry, 1992, 49, 681-689). The reticular activating system (answer A), which you should remember by now, is involved in attention and arousal. The inferior colliculus (answer B), controls auditory reflexes, and the locus coeruleus (answer D) may be associated with Depression and Panic Disorder
The second stage of Alzheimer's Dementia is characterized by:

a. loss of implicit memory
b. loss of short-term memory
c. inability to perform complex tasks
d. inability to recognize family or friends
Answer is "C"
Alzheimer's Disease is often categorized into 3 stages. In Stage 1, which lasts 2-4 years, short-term memory loss begins. Patients in this stage frequently complain about forgetting where they placed things. In Stage 2, which lasts 2-10 years, there is further memory impairment (mostly explicit rather than implicit) and they begin having difficulty performing complex tasks, such as balancing a checkbook or going grocery shopping. They may get lost in familiar places and become apathetic. In the final stage -- Stage 3 -- which lasts 1-3 years, there is serious impairment in most areas. During Stage 3 they may lose the ability to speak and become unable to recognize family, friends, or even themselves. They lose all capacity to care for themselves and have difficulty walking, are incontinent, and are ultimately bedridden and often die of an opportunistic respiratory infection
Which of the following is one of the first signs of AIDS-related dementia?

a. loss of abstract thinking functions
b.mild memory loss for recent events
c.seizures
d.apathy
Correct Answer is "B"
AIDS dementia complex occurs in about 2/3 of all AIDS patients. Usually, one of the first cognitive signs of dementia (both in AIDS and non-AIDS patients) is a loss of concentration and a mild memory loss, especially for recent events
___ percent of patients with a primary dx of GAD have at least one other anx/mood do
80
A majority of women experience mild depression following childbirth but for about __% to __%, sx's are severe to qualify for postpartum depression
10 to 20%
Somatoform Disorder
4 pain, 2 GI, 1 Sex, 1 neuro
Undifferentiated Somatoform DO
1 or more physicla complaints that last 6 months or more
Nicotine Dependence-a combined tx of nicotine replacement and behavioral intervention...
is best especially in terms of long-term abstinence
NOS is used
-when not meeting criteria for specific d/o
-sx's meet criteria included in "Criteria Sets and Axes for Further Study"
-uncertainty of etiology