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143 Cards in this Set

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Steps for differential dx
1) Is the presenting sx real
2) R/O substance Etiology
3) R/O d/o d/t a general medical condition
4) Determine the specific primary d/o
5) Differentiate adjustment d/o from NOS
6) Estab the boundary w/ no mental d/o
DSM-IV-TR Axes
Axis I: most psych clinical d/o and other d/o, that may be a focus of clinical attention
Axis II: Stable enduring problems (personality d/o, MR, habitual defense mehanisms)
Axis III: Medical conditions
Axis IV: Psychosocial & environmental problems affecting fxning or tx
Axis V: Global clinical rating of highest level of adaptive fxning (GAF: time identified~ current & in the last year)
MDD Primary sx
Either depressed mood or loss of interest or pleasure

Sx @ least 2 weeks
MDD criteria
Depressed mood or loss of interest or pleasure

AND @ least 4 of the following

~sig wt loss or gain
~insomnia/hypersomnia
~psychomotor agitation or retardation
~Fatigue or loss of Energy
~Worthlessness/guilt
~decreased concentration: indecisiveness
~Recurrent thoughts of death
MDD time frame
must have sx for 2 weeks
MDD need at least 5 of these sx along with the primary sx of depressed mood or loss of interest or pleasure
~significant wt loss or wt gain (5% of body wt)

~insomnia/hypersomnia

~psychomotor agitation or psychomotor retardation

~fatigue or loss of energy

~worthlessness/guilt

~decreased concentration: indecisiveness
MDD qualifiers
~Sx for at least 2 wks
~significant distress or impairment
~not d/t substance or general medical condition
~not accounted for by bereavement
Is bereavement pathology?
No

Bereavement sx w/o a loss is adjustment d/o
Dysthymic disorder primary sx adult
Depressed mood for at least 2 years
Dysthymic d/o primary sx adol/kiddo
Depressed mood for at least 1 yr
Dsythymic d/o

While depressed @ least 2 of the following
~poor appetite or overeating
~Insomnia/hypersomnia
~low energy/ fatigue
~low self-esteem
~poor concentration: indecisiveness
Hopelessness
Dsythymic d/o time frame
depressed mood for @ least 2 yrs adult

depressed mood for @ least 1 yr (child/adolescents)

Not w/o sx for greater than 2 months
Dysthymic d/o full criteria
Depressed mood for @ 2 yrs

While depressed @ least 2 of:
~hopelessness
~poor concentration: indecisiveness
~low self esteem
~ low energy/fatigue
~insomnia/hypersomnia
~poor appetite or overeating
Bipolar I disorder primary sx
Persistently elevated expansive or irritable mood lasting at least one week
BIpolar I d/o qualifiers
~ don't have to have had a depressive episode

~marked impairment, hospitalization or psychotic features

~sx not d/t substance or medical condition
Bipolar I
need ___ of the following sx if predominant mood elevated of expansive
Need 3 (THREE) of the following for BP I if predominant mood elevated of expansive

~inflated self esteem: gradiosity
~decreased need for sleep
~pressured speech
~flight of ideas/racing thoughts
~distractibility
~increased goal directed activity/psychomotor agitation
~impulsivity
Bipolar I
Need ___ of the following sx if predominant mood is irritable
Need 4 (FOUR) of the following if predominant mood is irritable

~inflated self esteem:grandiosity
~Decreased need for sleep
~pressured speech
~flight of idea/racing thoughts
~distractibility
~increased goal-directed activity/psychomotor agitation
~impulsivity
Bipolar I full DSM criteria
Persistently elevated expansive or irritable mood lasting at least one week

3 of the following if predominant mood elevated or expansive: 4 of the following if predominant mood is irritable

~inflated self esteem; grandiosity
~decreased need for sleep
~pressured speech
~flight of ideas/racing thoughts
~distractibility
~increased goal-directed activity/psychomotor agitation
~impulsivity

*Don't have to have had a depressive episode
*Marked impairment, hospitalization. or psychotic features
*sx not d/t substance or medical problems
Bipolar I time frame
Persistently elevated expansive or irritable mood lasting at least one week
Bipolar II primary sx
@ least 1 (one) depressive episode
@ least 1 (one) hypomanic episode [persistently elevated, expansive, or irritable mood at least 4 days]
Time frame of Bipolar II
@ least ONE (1) hypomanic episode
***persistently elevate, expansive or irritable mood AT LEAST (4) FOUR days
Bipolar II
___of the other s/s if mood elevated/expansive
@ least 3 (THREE) OF THE OTHER S/S if mood elevated/expansive

~inflated self-esteem: grandiosity
~decreased need for sleep
~pressured speech
~flight of ideas/racing thoughts
~distractibility
~increased goal-directed activity/psychomotor agitation
~impulsivity
Bipolar II
___ of the other s/s if mood irritable
Four (4) of the other s/s if mood irritable

~Impulsivity
~increased goal-directed activity/psychomotor agitation
~distractibility
~Flight of ideas/racing thoughts
~pressured speech
~decreased need for sleep
~inflated self esteem: grandiosity
Bipolar II
full DSM criteria
@ least 1 depressive episode
@ least 1 hypomanic episode
****persistently elevated, expansive or irritable mood lasting @ least 4 days

3 of the other s/s (if mood elevate/expansive) 4 s/s (if mood irritable)

~Impulsivity
~increased goal-directed activity/psychomotor agitation
~distractibility
~Flight of ideas/racing thoughts
~pressured speech
~decreased need for sleep
~inflated self esteem: grandiosity

**S/s uncharacteristic of person
**disturbance is observable by others
**never needed hospitalization
**never needed hospitalization
**never had psychotic s/s
*has NEVER been a manic episode or mixed episode
Bipolar II
qualifiers
~s/s uncharacteristic of person
~disturbance is observable by others
~never needed hospitalization
~never had psychotic s/s
~has never been a manic episode or mixed episode
Cyclothymic d/o time frame adults
Sx last at least 2 yrs

Not w/o sx for greater than 2 months
Cyclothymic d/o time frame child and adolescents
Sx last at least 1 yr

Not w/o sx for greater than 2 months
Cyclothymic d/o primary sx
Hypomanic and depressive sx that don't meet criteria for MDD or BP
Cyclothymic d/o qualifiers
Sx not d/t substance or medical condition

Significant distress or impairment
Cyclothymic d/o full criteria
Hypomanic and depressive sx that don't meet criteria for MDD or BP

Sx last at least 2 yrs (1 yr in in kids and adolescents)

not w/o s/s for greater than 2 months

Sx not d/t substance or medical condition

Significant distress or impairment
Panic d/o time frame
***4 physical/behavioral s/s develop abruptly and reach a peak w/in 10 mins

***1 month or more of at least one of the following:
~persistent concern about having attacks
~worry about implications of attacks
~change in behavior r/t attacks
Panic d/o primary sx
Period of intense fear/discomfort (panic)
Panic d/o qualifiers
~not d/t substance or general medical condition

~with or without agoraphobia
Panic d/o full criteria
~period of intense fear/discomfort
~4 physical/behavioral s/s develop abruptly & reach a peak w/in 10 mins
~1 (one) month or more of at least one of the following:
*persistent concern about having an attack
*worry about implications of attack
*change in behavior r/t attacks

~Not d/t substance or general medical condition
~with or without agoraphobia
Specific phobia subtypes
~animal type
~natural environment type
~blood-injection-injury type
~situational type
~other type
Specific phobia primary sx
Excessive or unreasonable persistent fear cued by presence or anticipation of specific object or situation
Specific phobia time frame
In children under age 18 must last at least 6 mo
Person recognized fear is excessive or unreasonable
Specific phobia
Specific phobia full criteria
~Excessive or unreasonable persistent fear cued by presence or anticipation of specific object or situation
~Exposure to stimulus provokes immediate anxiety response
~person recognized fear is excessive or unreasonable
~situation is avoided or endured with intense anxiety/distress
~significant interference with life
~In kids under 18 must last at least 6 months

Subtypes: animal type, natural environment type, blood-injection-injury type, situational type, other type
Social phobia
(social anxiety d/o)
primary sx
Persistant fear of 1 (one) or more social or performance situations where person is exposed to unfamiliar people or to possible scrutiny of others

In kids must be evidence of capacity for age-appropriate social relationships with familiar people & anxiety must occur in peer settings not just interactions with adults
Social phobia time range
If under 18 the duration must be at least 6 months

over 6 mo if adult
Social phobia full criteria in adults
~persistent fear or one (1) or more social or performance situations where person is exposed to unfamiliar people or the possible scrutiny of others
~exposure to feared social situation provokes anxiety
~recognition that fear is unreasonable or excessive
~the situation is avoided or endured with intense anxiety/distress
~significant interference
~social phobia should be dx only if sx persist for longer than 6 mo
Social phobia full criteria kiddos
~persistent fear of (1) one or more social or performance situations where person is exposed to unfamiliar people or to possible scrutiny by others
~In kids must be evidence of capacity for age-appropriate social relationships with familiar people and anxiety must occur in peer settings, not just interactions with adults

~exposure to feared social situation provokes anxiety

~recognition that fear in unreasonable or excessive

~the situation is avoided or endured with intense anxiety/distress

~significant interference

~If under 18 the duration must be at least 6 months
Obsessive-Compulsive d/o
primary sx
Either obsessions or compulsions

Person has recognized obsessions/compulsions excessive/unreasonable
TIme frame of OCD
Obsessions/compulsions are excessive/unreasonable consuming more than one hour per day
OCD full criteria
Either obsessions or compulsions

~person has recognized obsessions/compulsions excessive/unreasonable

~marked distress, time consuming (more than 1 hour per day) significant interference
PTSD sx clusters
1 re-experiencing sx
2 increased arousal sx
3 avoidance sx
PTSD time frame
Sx last greater than one month
PTSD full cirteria
~exposure to traumatic event with threatened or actual injury or death (DSM does not define exposure)

~response was extreme fear, horror or helplessness

1 Re-experiencing sx
2 Increased Arousal sx
3 Avoidance sx

Sx last greater than one (1)mo
Sig distress or impairment
GAD primary sx
Excessive anxiety & worry on most days for at least 6 mo

Difficulty controlling the worry
Generalized anxiety d/o time frame
Lasts at least 6 mo with excessive anxiety & worry on most days during that 6 mo
GAD
___ or more of the following sx
3 (THREE) or more of the following sx

~restlessness, keyed up, or on edge
~easily fatigued
~difficulty concentrating
~irritability
~muscle tension
~sleep disturbance
GAD qualifiers
Significant distress/impairment

not d/t substance or medical problem
GAD Full criteria
~Excessive anxiety & worry on most days for at least 6 months
~Difficulty controlling the worry
~3 or more of the following:
***Restlessness, keyed up, or on edge
***easily fatigued
***difficulty concentrating
***irritability
***muscle tension
***sleep disturbance
~sig distress/impairment
~not d/t substance or med problem
Dementia of Alzheimer's type how is it coded on axis?
Dementia goes on axis III (dementia classified as neurologic d/o but in DSM-IV b/c of behavioral manifestations

But the TYPE goes on AXIS I
Dementia Alzheimers type primary sx
memory impairment
Dementia Alzheimers type

___ or more of the following
TWO (2) or more of the following
Aphasia
apraxia
agnosia
executive fxn problems
Onset of Dementia Alzheimers type
gradual onset and continuing cognitive decline

Significant impairment: DECLINE FROM PREVIOUS FXNING
Dementia Alzheimers type qualifiers
~Not d/t other CNS conditions, systemic conditions or substance induced conditions

~s/s do NOT occur exclusively during course of delirium

~not accounted for by another Axis I d/o
Aphasia
disruption of language

2nd sign of dementia
Apraxia
disturbance in the organization of voluntary action

forget how to do something, not a problem with muscles; lesions in frontal lobe

3rd to go in dementia
Agnosia
disorganization of perception and recognition

4th area to go in dementia
Amnesia
dysfxn of memory process

Primary sx of Dementia Alzheimers type

1st sign of dementia
Ataxia
problem with fine muscle movements; prob with cerbellum

people confuse ataxia (prob with fine muscle movement) with apraxia (forgetting how to do something NOT a problem with muscles)
Dementia Alzheimers type full criteria
~Memory impairment (amnesia)
~2 or more of the following:
**Aphasia
**apraxia
**agnosia
**executive fxning problems
~sig impairment: decline from previous fxning
~gradual onset & continuing cognitive decline
~not d/t other CNS conditions, systemic conditions, or substance induced conditions
~s/s do not occur exclusively during course of delirium

~Not accounted for by another Axis I d/o
Schizophrenia positive sx
Hallucinations
Delusions
referential thinking
disorganized behavior
hostility
grandiosity
mania
suspiciousness
Schizophrenia negative sx
~affective flattening
~alogia or poverty of speech
~avolition
~apathy
~abstract-thinking problems
~anhedonia
~attention deficits
Schizophrenia DSM criteria
2 of the following for at least 1 mo (or 1 bizarre delusion; or hallucinations consisting of a voice keeping a running commentary; or 2 or more voices conversing with each other)
~hallucinations
~delusions
~disorganized speech
~disorganized behavior
~negative s/s (flat affect, alogia, avolition)

~continuous s/s of disturbance persists at least 6 mo
~significant impairment
~not d/t substance or medical problem

Subtypes: paranoid type, disorganized type, catatonic type, undifferentiated type, residual type
Schizophrenia time frame
continuous s/s of disturbance persists at least 6 months
Schizophrenia subtypes
~paranoid type
~disorganized type
~catatonic type
~undifferentiated type
~residual type
Schizoaffective disorder primary sx
meet criteria for schizophrenia along with a major depressive episode (must be depressed mood), a manic episode, or a mixed episode
Schizoaffective disorder mood sx time frame
Mood s/s present for substantial portion of total duration of active and residual periods of illness
Schizoaffective disorder delusions or hallucination in absence of prominent mood s/s sx time frame
Delusions or hallucination in absence of prominent mood s/s for at least 2 weeks
Subtypes of schizoaffective d/o
Bipolar type

depressive type
Schizoaffective d/o full criteria
~meet criteria for schizophrenia along with a major depressive episode (must be depressed mood) a manic episode or a mixed episode

~delusions or hallucinations in absence of prominent mood s.s for at least 2 weeks

~mood s.s present for substantial portion of total duration of active and residual periods of illness

~Not d/t substance or medical condition

Subtypes: Bipolar type, depressive type
Schizophreniform d/o
criteria met for schizophrenia except that the s/s have been present @ least 1 month but less than 6 months
Brief psychotic d/o
time frame
Duration at least (1) one day but less than (1) one month with full return to premorbid fxning level
Brief psychotic d/o full criteria
1 or more of the following s/s
*delusions
*hallucinations
*disorganized speech
*disorganized or catatonic behavior

~Duration at least (1) one day but less than (1) one month with full return to premorbid fxning level

~not d/t substance, medical condition

~Specifiers: with marked stressor, w/o marked stressor w/ postpartum onset
Delusional d/o time frame
Nonbizarre delusions for at least one month duration
Delusional d/o diagnostic criteria
~nonbizarre delusions for at least (1) one month duration
~criteria for schizophrenia never met
~fxning not markedly impaired & not obviously odd or bizarre
~if mood episodes have occurred with delusions their duration is brief relative to duration of delusional periods
~not d/t substance or medical condition

Subtypes: erotomanic, grandiose, jealous, persecutory, somatic, mixed, unspecified types
Delusion disorder subtypes
~erotomanic
~grandiose
~jealous
~persecutory
~somatic
~mixed
~unspecified types
If mood episodes have occurred with delusions their duration is brief relative to duration of delusional periods
Delusional d/o
Substance dependence time frame
Maladaptive pattern of substance use leading to impairment/distress in same
(12) TWELVE MONTH PERIOD
Substance dependence full criteria
Maladaptive pattern of use leading to impairment/distress with 3 of the following in same 12 month period;

~tolerance
~withdrawal
~substance taken in larger amounts or over longer period than was intended
~persistent desire or unsuccessful efforts to cut down
~Large amount of time spent obtaining substance, using substance, or recovering from its effects
~Social, occupational or recreational activities given up or decreased d/t substance use
~substance use continues despite consequences
Substance dependence primary sx
Maladaptive pattern of substance use leading to impairment/distress manifested by (3) THREE of the following within 12 month period
Substance ABUSE time frame
Maladaptive pattern of substance use leading to impairment/distress within 12 month period
Symptoms never met criteria for substance dependence for this class of substance
Substance abuse
Substance abuse full criteria
Maladaptive pattern of substance use leading to impairment/distress manifested by one (1) or more of the following within 12 month period;

~recurrent use resulting in failure to fulfill major role obligations

!recurrent use in situation which it is physically hazardous

~recurrent substance related legal problems

~continuous use despite consequences

~Sx never met criteria for substance dependence for this class of substance
EtOH withdrawal time frame
s/s within several hours to few days after decreasing or discontinuing use
EtOH withdrawal primary sx
Cessation of or decrease in EtOH use that has been heavy and prolonged
EtOH Withdrawal Full criteria
~Cessation of or decrease in EtOH use that has been heavy & prolonged
~2 or more of the following w/in several hrs to few days after decreasing or discontinuing use;
***autonomic hyperactivity
***increased hand tremor
***Insomnia
***n/v
***transient hallucinations/illusions
***psychomotor agitation
***anxiety
***gran mal seizures

s/s cause distress/impairment
s/s not d/t medical condition or another mental d/o

ppl can die from
Clinical institute for withdrawal assessment for alcohol
CIWA-Ar

10 parameters (scored 0-7)
Scoring
~*~0-9; absent or minimal withdrawal
~*~10-19; mild to moderate withdrawal
~*~greater than or equal too 20; severe withdrawal
CIWA-Ar
Clinical institute for withdrawal assessment for alcohol
Abuse of Rx meds

who is at highest risk?
Patients w hx of substance abuse/dep are at highest risk for developing rx drug problems

Opiates should be avoided long-term but in acute situations of pain, can be used cautiously w/ close f/u & built in accountability from peers. tx personnel, and PCP

Use long acting benzos (ie clonazepam (Klonopin)
Acute intoxication of opioids
General criteria for acute intoxication must be met
~dysfxn behavior AEB @ least (1) one of the following:
**Apathy/sedation
**disinhibition
**psychomotor retardation
**impaired attention
**impaired judgement
**interference w/ personal fxning

~At least 1 of the following s/s present;
**drowsiness
**slurred speech
**pupillary constriction
**decreased level of consciousness
Withdrawal of Opiates

do they die?
Persons with opioid dependence seldom die from withdrawal unless concomitant cardiac disease
Withdrawal of Opiates residual s/s
~insomnia
~bradycardia
~temperature dysregulation
~craving

MAY persist for months after withdrawl
Clinical Opioid withdrawal scale
COWS

11 parameters
(7 scored 0-4; 4scaled 0-5)
Score:
5-12 =mild
13-24= moderate
25-36 = moderately severe
36+ = severe withdrawal
Opiate withdrawal can be either of the following
Cessation of or reduction in opioid use that has been heavy and prolonged

OR

Several weeks of an opioid antagonist after period of opioid use
3 of the following sx within minutes to several days of decreasing or discontinuing opiate use = withdrawal form opiates
~dysphoric mood
~n/v
~lacrimation or rhinorrhea
~pupillary dilation, piloerection (goosebumps) or diaphoresis
~diarrhea
~yawning
~fever
~insomnia

Distress or impairment

not d/t medical condition or another mental d/o
Piloerection
goose bumps
Medical term for goose bumps
Piloerection
Cluster A personality disorders
Paranoid PD
Schizotypal PD
Schizoid PD
Cluster B personality d/o
Antisocial PD
Borderline PD
Histrionic PD
Narcissistic PD
Cluster C Personality disorder
Obsessive-compulsive PD
Dependent PD
Avoidant PD
General diagnostic criteria for a personality disorder
ENDURING PATTERN of inner experience and behavior

Behavior manifested in 2 (TWO) or more of the folloing:

~cognition (ways of perceiving and interpreting self, other people and events

~Affectivity ( the range, intensity, lability, and appropriateness of emotional response)

~INTERPERSONAL FXNING

~impulse control

Not better accounted for by another mental d/o

Not d/t substance or medical condition
Pattern in PD is _____ & ________
Pattern in personality disorder is INFLEXIBLE & PERVASIVE
Pattern in PD is _____ & of __________; onset traced back at least to adolescence or early adulthood
Pattern in personality d/o is STABLE & of LONG DURATION; onset traced back at least to adolescence or early adulthood
Reasons for tx difficult w/ personality d/o
~individual does not perceive problems

~non-acceptance of contribution to problem

~perceives characteristics as positive aspects of the self

~behaviors usually alienate others

~lack of support system
Cluster A PD characteristics
(cluster A = paranoid, schizoid, schizotypal)

Characteristics:
~odd, eccentric
~usually a 'loner'
~emotionally distant
Cluster A PD tx
(cluster A = paranoid, schizoid, sxhizotypal)

Tx:
~prolonged intensive psychotherapy
~pharm; tx of dysphoric sx; Aps
~Cautious group therapy-defense structure
Cluster B PD general characteristics
(cluster B= borderline, narcissistic, antisocial, histrionic)

Characteristics
~dramatic, erratic
~very egocentric
~lack appreciation for concerns of others
Cluster B PD Tx
(Cluster B= histrionic, antisocial, narcissistic, borderline)

TX ;
~CBT/DBT; self help groups
~be aware of transference/countertransference
~Limit-settin
~pharm; Valproate for impulsiveness/rage
***sx minimization
CLuster C PD characteristics
(cluster C = avoidant, dependent, obsessive-compulsive)

Characteristics:
~Avoidant, anxious, and fearful
~preoccupied w/ rules or reactions of others
Cluster C PD tx
(cluster C = dependent, avoidant, obsessive compulsive

Tx:
~psychotherapy
~pharm: symptomatic-usually anxiety/depression sx
Conduct d/o
persistent pattern of conduct in which the child violates the basic rights of others

~onset of aggressive behavior is observed in toddler
~formal dx between ages 7-18
Tx conduct d/o
~problem solving skills training
~Pharm; for explosive aggression
~family therapy
Oppositional defiant d/o
Defiant and negativistic behavior that is more severe than seen in most children of the same mental age

~Precursors; 3-7yrs
~Disorder; age 8
Tx for oppositional defiant d/o
Therapy:
*accept responsibility for own behavior
*increase self esteem
*improve social interaction

Family:
*positive parenting strategies
*enforce consistency in discipline
Autism characteristics
~lack of awareness of others or treats others as an object

~abnormal communication

~repetitive behaviors

~stereotypes:hand flapping, rocking

Strong evidence of genetic factors
Autism tx
Prevention of self-directed violence

improve social interaction, communication and sense of self
Rett's d/o
Neurodegerative disease

*only affects females
*onset about 1 yr old
Presentation of Rett's d/o
*cease to gain developmental milestones

*loss of skills already acquired (speech, hand skills)

*stereotypic hand movements

*seizures, scoliosis, hypertonicity
Rett's d/o management
Goal is to perserve functional abilities
Asperger's d/o
Similar features as autism but speech is not affected

more males are affected than females

Females exhibit a more server form of the d/o
ADHD
Most commonly dx behavioral problem in childhood

essential impairment is a deficit in behavioral inhibition which disrupts the developmental process of learning how to self regulate behaviors
ADHD features
~inattention
~distractibility
~impulsiveness
~hyperactivity

Other elements
Sx must be present before age 7 and be more frequent & severe than in other children

Sx must interfere w/ fxning in at least 2 settings

High incidence in families with preexisting dx
MGMT of ADHD
Aimed at teaching kid to follow rules
~learn to complete important tasks and increase self-control
~family education
Mental retardation (MR) is coded where/
Coded on axis II
Mental retardation
~intellectual impairment affects fxning & self care

Impairment reflects severity of sub-average fxning based on IQ test less than 70

Onset BEFORE 18 y/o
Mild MR IQ range
IQ 50-70
Moderate MR IQ range
IQ 35-50
Severe MR IQ range
IQ 20-35
Profound MR IQ range
IQ below 20
Fetal EtOH syndrome
NOT DSM IV Dx
CODED ON AXIS III

~skin folds in the corner of the eyes
~low nasal bridge
~short nose
~indistinct philtrum (grove between nose & upper lip)
~thin upper lip
~small head circumference
~small midface
# 1 cause of suicide in teens
depression
Anorexia nervosa
~severe wt loss
~slightly younger
~purging uncommon
~introverted
~sexually inactive
~obsessional fears with paranoid features
~amenorrhea
Bulimia nervosa
~purging common
~less wt loss; avoidance of obesity
~slightly older
~more extroverted
~binging/purging
~sexually active
~histrionic features
~hypokalemic
Eating d/o are more common among _____
females
With Eating disorders ____ & _____ d/o are comorbid
With eating d/o affective and behavioral d/o are co-morbid

e.g MDD, OCD, Social Phobia, CD
Suicidal behaviors more likely in what eating d/o/
Bulima
Note of society and eating d/o
In a society where being thin is highly valued, teens who are preoccupied with their wt is not uncommon nor is it necessarily pathologic
Sx of depression in kiddos and adolescence
~sudden decline in academic performance

~ sudden outbursts, aggressiveness

~ drug, EtOH use

~somatic complaints, stomach aches, joint pain, w/o physical causes

~social isolation

~boredom

~reckless behavior

~likely to have more than one episode

~suicidal ideation

~* Adol: irritable mood more common than sad mood

~*kid: anhedonia is seen as lack of enjoyment of play