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192 Cards in this Set
- Front
- Back
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This area is the brain is out of wack for ocd, adhd, and biploar
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Prefrontal cortex through the striatum to the thalamus
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the Prefontal cortex, striatum, and thalamus are related to adhd, ocd, and biploar how?
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OCD- overactive
ADHD underactived Bipolar- "revved up" |
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What were some rule outs for the MTA study? (multimodal treatment student of adhd)
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PDD
IQ deficits psychosis tourette's severe ocd treated with antipsychotic |
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What type of ADHD was included in the multimodal treatment study of adhd
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Combined type
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What behavioral TX were part of the MTA?
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-Parent training (27 group and indiv)
-Chjild focused (8 week, 5 days/week, 9 hours day in group based recreational setting) -school based (10-16 sessions teacher training and 60 school days part time thera. aid) |
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What treatment conditions were in the MTA?
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1) medication management
2) behavioral treatment 3)combined (meds and bx) 4) community care |
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What was involved in the medication condition in MTA?
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14 months
-double blind 28 daily switch titration of methylphenidate -parent and teacher ratings -after methylphenidate then dextroamphetamine, then pernoline, then imipramine |
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How many outcome measures in the MTA?
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19
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What was involved in the communicy care condition?
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-67% received meds, mostly methylphenidate
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What percentage of the sample of MTA was girls/
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20%
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What were some of the intial findings of the MTA?
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-All 4 conditions saw reduction in symptom
-Medication tx superior to bx in managing adhd -bx tx not statisticially sig contributions -combined had higher satisfaction than meds -combined was superior to bx and community in improving odd/cd, internalizing, parentchild relations etc -community care superior to bx only but inferior to meds and combo -bs alone showed 75% improve |
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At 24 months how many were normalized in the MTA study?
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36%
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What is best dose for methylphenidate?
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30.5 mg/day 3 doses a day
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What is the outcome for 36 months for the MTA study?
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-No differences between the groups- marked clinical improve. still
-high doses of meds produced better outcome -50% met full criteria for adhd |
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What is the perspective of the AACAP in regads to interventions?
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psychosocial interventions don't make sig. contribution to reduction of adhd symptoms above and beyond meds
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What is the profile of kids with the best outcomes in mta?
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not as impaired
more likely to have recieved meds |
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profile of kids with worse outcome in mta?
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high impairment at start
lower iq comorbidity lower social skills |
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What are the moderators seen at 36 month review of mta?
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-comorbid anxiety responded best (= meds and bx)
-odd/cd- medication required, poorer outcome than adhd alone -anxiety+odd/cd: comb helped most -maternal depression +severe adhd : lower rates of response |
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what was found in regards to moderators of minorites at the 36 month review?
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-Af. Amer did better with bx without meds
-latinos did better with comb than meds except when public assis. controlled -girls hyperac/impulse better dealt with comb -maternal smoking during pregnancy: growth supppresion with kids who had stim meds |
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In what % of kids are adhd symtpoms normalized?
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80%
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what is stimulants effect on substance use?
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stimulant use in adhd reduces in half the risk of sub. use
-protection against it |
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what are effects of long term stim use?
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kidsn 2 cm shorter and 2.7kg lighter
-most retardation in growth in 1st year -adhd kids wi/o meds were larger than controls |
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how do you make the child successful as fast as possible?
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for adhd
-meds -edu for comorbid bx -defiance and aggression: contingency managment -anx and depression: cbt or ipt -ld: academic support |
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Who did the Anger coping program?
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larson and lochman
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how many session in anger coping program?
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18
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what're ideal ranges in age for ACP?
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8-12
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how many kids for 1 leader in ACP? 2 leaders?
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4-5
5-7 |
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how long are acp meetings?
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45-60 minutes
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how does e/ session start? end?
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bx goals, ask about success, review of content from ealier
-end with play/free time, affirmations, cooldown |
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what is one get to know you strategy with the acp?
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pass the ball
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In what acp is there a puppet and what is the safety zone?
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3, and their puppets make fun of therapist puppet
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in what acp session is there a CAT?
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childrens apperception test, 5th to see mutliple interpretations
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in what session is hassle log introed?
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6th
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what session(s) do kids produce own videos in acp?
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11-18
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what is ouctome of acp?
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-3 year follow up less sub abuse, gain in self esteem and ps
-aggression and delinqent bx not different -booster help with gain maintainence |
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What components are added to the ACP with the Coping Power Prgrame?
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-child : emotional awareness, relaxtion, ss, setting goals, peer pressure
-parents: 16 group session, pt, home visits -teachers- 5 two hour in services, lean about kid and parent, ps practice, home school comm., social skills (ss) |
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what are some of the principles of themst?
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-problems make sense in youths ecology
-emphasize positive -facilitate good behavior for parents and youth -present and action focused interventions -focus on systems include pro social peer contacts, academics, community -developmentally appropriate -people have to work at it -outcomes measured with multiple methods -designed for treatment generalization and maintence through empowerment |
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what is best for externalizing symptoms?
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behavioral management, not cbt!
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how many families per ft mst therapist?
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4-5
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how long is mst tx?
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3-5 months
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In what acp is there a puppet and what is the safety zone?
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3, and their puppets make fun of therapist puppet
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in what acp session is there a CAT?
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childrens apperception test, 5th to see mutliple interpretations
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in what session is hassle log introed?
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6th
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what session(s) do kids produce own videos in acp?
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11-18
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what is ouctome of acp?
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-3 year follow up less sub abuse, gain in self esteem and ps
-aggression and delinqent bx not different -booster help with gain maintainence |
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What components are added to the ACP with the Coping Power Prgrame?
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-child : emotional awareness, relaxtion, ss, setting goals, peer pressure
-parents: 16 group session, pt, home visits -teachers- 5 two hour in services, lean about kid and parent, ps practice, home school comm., social skills (ss) |
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what are some of the principles of themst?
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-problems make sense in youths ecology
-emphasize positive -facilitate good behavior for parents and youth -present and action focused interventions -focus on systems include pro social peer contacts, academics, community -developmentally appropriate -people have to work at it -outcomes measured with multiple methods -designed for treatment generalization and maintence through empowerment |
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what is best for externalizing symptoms?
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behavioral management, not cbt!
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how many families per ft mst therapist?
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4-5
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how long is mst tx?
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3-5 months
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cost of mst
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-50 families per year at 5000 costs 250,000 annual
-saves 60,000 per youth -98% completion rate -needs advocay at the state level!! |
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one of two required symptoms for diagnosis of MDD
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anadonia
depressed mood |
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Satisfies mood critieria for diagnosis of dysthymia in kida
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irritability
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name of seligman's theory of depression
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learned helplessness
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acronym in PASCET for problem solving
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STEPS
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this multisite rct designed to measure efficacy of fluoxetine, cbt, and combined
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TADS
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PASCET program age range
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8-15
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Number of pre-ado children who appear depressed at any given time
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2%
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reynolds and starks cbt protocal draws upon these two theorities
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cognitive
social learning |
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according to fonagy this % of depressed youth don't respond and remain depressed
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50%
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the presence of youth depression increase the probability of comboridity by
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20 times
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A score of 13 or more on this rating scale suggests that a child is depressed
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CDI childrens depression inventory
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what is depression in preshcoolers associated with?
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abuse and neglect
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what is prevelence in ado?
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2-5%
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what is the cumulative percent of children affected up to age 18 for depression?
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35% girls
19% boys |
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how many ado expereicne a major depressive episode?
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50%
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how more likely than controls are depressed ado to be referred for service?
disruptive disorders? |
0
4-5 times |
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what is length of avg episode of mdd?
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-6 months 40% remitted, 90 % in two years
-median recovery 9.5 |
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what is average episode of DD?
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3 years
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what are relapse rates of depression?
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12% one year
33% four years 54% depressed in 3 years 72% in 5 |
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is depression on rise
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metaanalysis says no
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what is comorbidity rate for MDD?
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40-90% at least one
20-50% more than one |
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what is comorbidyt of mdd with
anx? conduct? |
30-80%
10-80% 14% substance odd/cd 8% in community |
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What percentage of 1st degree relatives meet criteraia for mdd?
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30-50, moms 56-73%
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what percent had an onset before age 20 of depression
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50%
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what are differences between kids and teens in mdd?
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kids: somatic, irritability, social withdrawl- express not discuss
teens: pyschomotor retardation, hypersomnia, delusions and suicide |
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what is becks diathesis (potential to develop disease)
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negative schema (self and relationships)
cognitive distortions stress(negative life events) |
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in learned helpness, which events are internal, and which are external?
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neg = int
pos= ext |
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what are depressed symptoms affieliated with?
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beliefs about competence and control
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how does ipt view depression?
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loss of attachment
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suicide rate since 1950 has
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quadrupled
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what is rate of ado suicide?
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8-12%
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how many commit suicide per year?
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2000
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in ages 15-24 what is leading causes of death
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accident
homicide suicide |
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kids with adhd have ___ times the accident proneness
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40
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in the MECA study, suicide attempters versus ideators
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numerous stressful life events
sexually active smoke more than 1 cig. a day history of smoking marijauna or hishish |
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this percent of suicide completers made a previous attempt
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1/2
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females are this more likely to attempt suicide
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2 times
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males more this more likely to complete suicide
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5 times
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which groups have the highest rates of suicide?
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native americans or non hispanic whites
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how many sucides suffered from psychiatric disorder
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90%
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what is basic cbt module?
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externalize problem
behavioral activation self soothing problem solbing thought testing coping thoughts social skills miscellaneous |
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what is TAP? who made it?
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Taking Action Program
stark, kendall, et al |
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what age is tap for?
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9-13 with unipolar depression, dysthym, or depressed mood
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what is average lenth of session?
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60 minu
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how many sessions with the child?
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18
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is TAP individual or group?
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both
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in session # 3 in identifying emotions and coping in tap, ACTION is introed. what does it mean?
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Always find something better to do
Catch the positive Think about it as a problem to be solved Inspect the situation Open yourself to the positive Never get stuck in the muck |
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Examples of programs that have handouts for doing ps as a family?
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TADS cbt manual
defiant teans program bogels and siqueland |
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what adjunctive protocols are needed for tap?
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sleep hygiene
compliance with hw class partici. making friends family interventions |
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What is paren component of TAP modeled after?
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Defiant Child- special time and attention, effective commands, contingency management
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the PASCET program for depression is focused on what ages and for how many sessions?
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5-15 for 20 sessions
10 manulaized learning primary and secondary strategies 5 individual sessions 3 sessions with parents 1 home and 1 school visit |
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Primary control
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problem solving (steps)
behaviora activiation pshyio calming social skills enhancement talent devel |
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Secondary (reactive) in pascet program
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coping thots
seek out sounding board seek out upside thott stopping persistance training toolbox metaphore |
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conclusions for psychosocial tx for children
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manualized is good
effect sizes from .25- .92 |
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common methodological weaknesses of psychosocial tx for children (depression etc)
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-lack of diversity
-lack of parent ratings -lack of folloow up -lack of comparison to equal doses of active placebos |
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Are TCA when compared to placebo effective?
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no
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what antidepressant found improvement on clinical rating but not parent of self ratings?
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fluoxetine
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what percentage of omega-3 group experienced reduction in cdrs scores?
placebo? |
70%, 0%
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What does TADS stand for?
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treatment of adolescent depression study
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how old were the 439 teens in tads?
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12-17
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who were excluded from tads?
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active substance use
truancy pdd current drug or therapy hx of non reponse to ssri or cbt hx of hospitalization |
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What are some sample characterics of TADS?
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96% moderate to severe range of illness
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how many in TADS had at least one comorbidity?
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52%
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What are the three tx conditions in TADS?
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fluoxetine
cbt combined |
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what are the effect sizes in tads?
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combined .98
fluxetine.68 cbt -.03 |
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TADS acute, who lost mdd
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overall 71.5%
comb 85.3 flx 78.6 cbt 61.1 pbo 60.4 |
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predictors in TADS acute phase of improving m ore
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adolecents younger than 16
those with overall better functioning briefer period of depression min. features less than 1 comorbid no cormorbid anx |
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moderators of the acute phase
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high family income- cbt and comb equally good
high levels of depression saw no diff between comb over flx severity of cog distortions |
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TADS 36 week follow showed
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increased cbt effectivesness
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Klerman was associated with what approached focused on loss of attachment bonding?
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interpersonal therapy
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what are problems suitable for ipt-a?
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grief work
interpersonal disputes role transitions interpersonal deficits single parent families |
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what is the ipta effect size at termination?
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.59
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Who got worse in the TADS accute phase?
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4.7% overall
worse cbt almost 10 |
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Limitations by Weisz regarding past meta-analytic studies
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last done in 1999
only used peer referred journals random assign not required didn't compare active to passive placebo used fixed effect sizes not random |
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what is the overall effect size for meta analytic studies of therapy?
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.34
.41 passive place .24 active placebo .35 for cog tx .47 for non cog .52 for research thera .27 for practicing clinicalns .41 for reearch setting .24 for clinic |
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What are the differences between for meta analytic studies of therapy?
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no difference between recurieted and clinic referred
no diff between kids and ado no difference between group vs indic treatment range from 4 to 32 hours no difference between peer review and on peer sign difference between effect sizes for youth and parent report |
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what is the conclusions TADS meta?
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need for booster session
need more moderator and mediator variables |
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Impulsive agression is more elevated in
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adhd biploar, unipolar depression
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planned agression is associated with
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psychopathology
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how much has bipolar disorder inc between 94 and 01?
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260%
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what are guildeines for diagnosing manic symptoms?
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freq: occur most days
intense extreme dist in one or mod dist in 2 symptoms 3-4 x days dur: 4+ hours day |
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Which is worse and includes all spectrum of moods (including mania), biploar I or biopolar II?
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Bipolar I
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what is rate of bpd in twins?
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67% mono
25% di |
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what is heritability estimate for bpd?
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.64 to .85
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has gender shown to moderate bpd?
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no
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What is pavuluris review in bpd?
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Increased activation of amygdala (horsepower)
reducaed activation of dlpfc (steering wheel) reduced activation of ofc(brakes) |
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bipolar is associated with
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higher rates of iq/ld
sud suicidal behaviors |
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what differentiates bpd from adhd
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elated mood
grandiose flight racing sleep rapid mood cycling hypersexuality |
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what symptoms don't differ b/t bpd from adhd
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-irritable mood -
-accelerated speech -distrability -inc energy |
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cardinal symptoms for bpd
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elated mood
grandiosity |
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what are some psychosocial predicots in the ppa-bp study of recovery?
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-live with bio family
-low maternal warmth 4x relapse!! |
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what are some 8 year outcomes for kids with jobp?
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-44% mania after 18
-35.2 had SUD -recovery time 55.6 weeks -73% relapse -99weeks from recov to relapse |
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what is shown in kids to trigger mania?
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SSRI
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what percent of kids repsonded to monotherapy for bpI?
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28%
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what are the recomended meds for nonpsychotic mania?
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divalporex
lithium |
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what is the increase in prescrbing antipsychotics?
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sixfold in mental health prov.
threefold in non mgp 32.4% of scripts by non mhp |
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which disorders are prescribed antipsychotics
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adhd/cd 29%
affective 23.6 schizphreia and pyschosis 13.5 autism/pdd 7.5 tourettes 5.0 |
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what are the two tx phases for jobp?
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phase 1 meds/psyuchotherapy (behavioral, school, etc)
phase 2 cbt for child (taking action, pascet, star) |
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what does mfpg stand for?
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multifamily psychoeducational gruop
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how long is the mfpg?
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10 90 minute sessions
groups for parents and kids |
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what does mfpg do?
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establish marathon mentality
parental ratings of parent/child r/ship improved- worse for control increase coping skills improve peer and family r/ship |
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what is presented in mfpg session 2 for kids?
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naming the enemy
match medicine with symptom |
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what is in mfpg session 4 ?
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thinking feeling doing
top half is helpful, bottom is hurtful |
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what in session 5 is introduced in mfpg child session for pst?
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stop think plan check
thinking feeling doing used for think step |
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what in session 6 is introed in mfpg ?
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thoughts/feeling charade to look at emotions/learn tone of vioice
right hemi deal with nonverbal social data |
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session includes human knot exercise which is like
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twister; used to show imp of communication
Let's talk worksheet |
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what are triggers of bpd episdoes?
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stimulating situations
when the kids body is depleted new devleopment challenges transition points |
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how many conditions in dsm cover ax?
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12
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what 4 anx regard distinct situations
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SAD, agoraphobia, social phobia, phobias
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which anx regard trauma?
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ptsd asd
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what are the other categories?
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panic
ocd gad (sometimes called overanxious disorder) substance abuse induced adj other |
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what % comorbid
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40% of community samples
1/3 met criteria for depressive disorder |
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what are also categories of juvenile ax disorders?
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ptsd
ocd heavy bio ramining (gad, phobias) |
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what is beck's concept for anx
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fear of physical death
fear of social death |
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what is the three rections to perceived threat
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subjective
motor physiological |
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in clinic samples what is the comorbid rate?
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62-96 anx
25-45 depressive 8-28severe disrupstive inc sud |
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what is the tripartite model of depres/anx
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lack of pos affect, neg affect (both), physio arounsal (anx)
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what is the etiology of anx?
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1/3 genes
1/3 shared enviro 1/3 nonshared |
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what is the behavioral inhibiations temperment
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toddler irratable shy and fearful
shool age cautious quiet intro 30% develop ad |
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COPING CAT HAS how many session
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16
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what are the stic tasks in the coping cat?
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show that I can
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who developed coping cat?
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kendall
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what is outcome of coping cat?
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64% diagnoses free
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what does FEAR stand for?
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feeling frightened
expecting bad things attitudes held results and rewards |
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what is intent to treat?
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analysis of those who dropped out
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what works better, group or indiv coping?
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indiv (high anx)
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7 year follow up of cbt showed for ad
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less SUD
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from what did the friends program origniate?
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coping cat and koala
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For what age rages is FRIENDS
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7-11 child
12-16 teen |
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what is the differences beween friends and coping cat?
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promote friendships
use of behaviora ctivation stronger emphasis on parent wrok |
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why isn't behavioral activ. not used with anxiety?
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don't need help experiencing joe
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Friends outcome compared to waitlist
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89% vs 6%
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who benefited most from family cbt?
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younger kids (up to 10) and girls
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what are not moderators of coping cat?
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sex race comorbid ses severity
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moderators of coping cat include:
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parent bdi scores
hostility scores |
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what is outcome of group cbt vs bibliotherapy
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cbt benefits get better over time
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these manuals included social skills
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friends
tads cbt cat IPT-a |
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what meds have been more effective than placebo?
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imiprine
paroxetine fluox sertralin fluox |
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safety and efficacy has been show in what class of meds?
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ssri
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what are outcomes of cbt?
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-comorbidity not interfere with outcome
-precent relapse rates |
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what are findings of silverman's research on ad?
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mediators include reduction in kids anxious self talk(not frequency of pos statesments)
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