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54 Cards in this Set

  • Front
  • Back

DSM I (1952) and DSMII (1968)

predominantly psychoanalytic,

focused on psychiatry,

descriptive more than diagnostic,

no focus on children,

about 60 disorders

DSM III (1980)

beginning of modern DSM

first time we see descriptive criteria (3 of 6 of these...)

cookbook approach

start seeing children's disorders

beginning or reliability

multi-axal system: disorders were separated, changeable, treatable, from mental retardation (untreatable)

behaviourissts begin to have input - "learning may play a role in this"

went a little too far... viewed all disorders as treatable

DSM III-R (1987)

everyone hated it - attempted to try to clarify the diagnostic criteria

prototypic model

one person does not look the same as another person with this disorder

DSM IV (1994) and DSM IV TR (1998)

continues prototypic model

criteria gets bumped around

psychology and psychiatry does not agree on anything

DSM 5 (2013)

took 15 years before people could agree

criticism: the disorder resides within the individual, no consideration for environmental factors, family influences, or genetics/heritability

lists over 400 disorders

What is psychopathology?

any disorder or syndrome that resides within the individual - problem is the person with the diagnosis - and causes impairment or restricts daily life activities

- symptoms are only a part of diagnosis, you have to have impairment or life restriction as well

What was the problem with the NIH?

The NIH flat out rejected the DSM 5, would not fund any research that bases their criteria on the DSM,

they are the largest research funders in the world

specifically they had a problem with childhood disorders, mainly ADHD and autism

What is comorbidity?

you can be diagnosed with more than one disorder, (different from the ICD model - international classification of disorders stated you have only one, the one that is more prominent is your diagnosis)

DSM says you can have lots of disorders

problem is, disorders are overlapping

19% of the general population has one disorder

10% two or more disorders

17% have three or more disorders

Neurodevelopmental Disorders

include intellectual disability, communication and speech disorders, learning disabilities, autism, ADHD, tic disorders - BRAIN

Who is Dr. Russel Barkley? (hint: ADHD)

wrote over 500 articles on ADHD, done work since the 1970s, wrote the "ADHD bible"

executive functioning and long term outcomes

George Still

British Paediatrician - describes in a letter to British medical society, patients who had impairment problems in sustaining attention, deficits in moral control, sense of right and wrong is defective

first reference to ADHD symptoms was ...?

in 1770, in a german medical textbook

Equine Encephalitis Outbreak

during the first world war - brain infection

resulted in sleeping sickness, most people died, those that didn't had 1 of 2 outcomes: 1 they looked like they were always asleep, semi-vegetable state, if they had good outcomes they would be impulsive, increase activity level, "minimum brain dysfunction"

first stimulant to be used with ADHD

straight speed, (amphetamine), meth, chalk

ADHD: four subtypes

1. primarily inattentive type (ADHD-PI) more common for girls

2. hyperactive impulsive subtypE (ADHD-HI)

3. combined type - both symptoms of above (ADHD-CO)

4. NOS - not otherwise specified (controversial)

Sex differences in ADHD

5 to 10 times more likely in males than females

in adulthood, men and women are almost even

men are more likely to be diagnosed earlier

comorbidities: females: anxiety disorders, males: ODD

Etiology of ADHD

migration hypothesis: first people should have higher rates of ADHD - thousand of miles journey

cross cultural studies: exists everywhere, more likely to see it in places where you are supposed to sit still, pay attention, etc. (developed world more than developing world)

Biological Risk Factors (ADHD)

this is not a disorder that parents cause - the brain is not symmetrical - subcortical structures are asymmetrical

functional differences - activity level, prefrontal cortex,

Braca gene

heritability rates are between 70-80%

- more heritability that type 1 diabetes, early alzheimers, and thyroid disease

prenatal influences (ADHD)

low birth weight

premature babies

anoxia: not getting enough oxygen to the brain during delivery

brain not "fully cooked"

mother's consumption of tobacco and alcohol increase risk

Psychosocial factors (ADHD)

how parents respond is a big factor - even though it is not a result of bad parenting

poverty - no access to resources

family adversity

Drugs used with ADHD

stimulant drugs - increase availability of dopamine

non stimulant drugs - adomoxatine - increase norepinephrine

anti-hypertensive drugs - blood pressure medications - chemical straightjacketing

antiepileptic drugs, anticonvulsive drugs

what are tics?

brief, stereotypical, non-rhytemic movements and vocalizations

motor tics and vocal tics

usually same ones over and over again

eye blinking, throat clearning, grimacing

what is a tic storm?

when the tic is really bad/more frequent

tic disorders have a waxing and waning pattern to them, the come in waves of less severe to more intense

diagnostic criteria

must be present for at least one year to be considered a tic

age of onset before 18 years

exclusionary criteria: cannot be the result of a substance problem

Tourette's Disorder

multiple motor tics (at least two) and vocal tics (at least one)

Persistent Motor Tic Disorder

Persistent Vocal Tic Disorder

only motor tics

only vocal tics

Provisional Tic Disorder

symptom presentation usually changes within a year

not great stability

Developmental course of Tic Disorders

average age of onset is 4-6 years of age

symptoms typically peak between 10 and 20 years of age

generally improves with puberty

not everyone experiences full remission with tics

more severe symptoms in early childhood predict persistence of disorder

stigmatizing tics: coprolalia and copropaxia

offensive language

offensive gestures

is there partial voluntary control for a person with a tic disorder?

people can try to limit their tics, but it is like the building of pressure, when they cannot suppress them anymore they begin to have a tic storm

tics provide a sense of relief, when they get to stop restricting them

cognitive tasks may suppress tic activity, situatinos of high stress may increase tics, happiness, stress, sadness, sickness, tired

comorbidities of tic disorders

60-70% of children who have a tic disorder also have ADHD

basal ganglia dysfunction

50% of people who have tics have OCD, 20-25% have a learning disability

Etiology of Tic disorders

largely unknown, we don't know why it happens

6-22 weeks of pregnancy?

basal ganglia all the way up to the prefrontal cortex

dopamine and serotonin are involved

epigenetics: gene and environment interaction

autoimmune hypothesis: PANDAS strep throat infection

neuropsychological implications (3)

speed of performance - child with tic is slower

procedural learning - much more effortful

executive functioning - self control, time management, self monitoring

assessment issues: psychoeducation

ticking is not a distraction to the child, if you ask them to "stop ticking so they can focus" they will focus on stopping their tics, which mans they are not focusing on the task they are supposed to be doing

oppositional defiant disorder

pattern of behaviour that is hostile, negativistic, and defiant

ODD is constant, defiant behaviours all the time without provocation

angry or irritable mood, defiant behaviours, vendictiveness - must see these behaviours every week in order to diagnose

typically develop during two developmental periods - preschool and adolescence

mild (1 setting) moderate (2 settings) severe (3 or more settings)

3% of preschoolers, 3% of adolescence

risk factors for ODD

harsh, abusive families, manipulative parents,

difficult baby most likely to develop ODD

lower basal cortisol levels

developmental course of ODD

babies are at least a little bit challenging

when these problems persist into early adulthood, it leads to conduct disorder

enhanced risk for substance abuse and other impulsive control problems

Intermittent Explosive Disorder

aggression displayed at least two times a week

at least three behavioural outbursts (resulting in injury to self, others or property)

outbursts are sudden, not premeditated

must cause distress to others and or impairment to functioning in the individual

must be at least six years old to diagnose

developmental course of IED

very rapid onset

many have preexisting ADHD or ODD, suddenly begin having explosions

short outbursts - 30 minutes or less - almost always involving a person who is close to them

CORE FEATURE: failure to control aggressive outbursts

risk factors of IED

more common with less education (intelligence? poverty?)

history of trauma

heightened activity in the limbic system

Conduct Disorder CD

repetative and persistent pattern of severely aggressive behaviour and antisocial acts involving the inflicting pain on others, interfering with the rights of others, or physical and/or verbal aggression

4 dimensions of CD

aggressive to people and animals

destruction of property

deceitfulness or theft

serious violation of rules

Age at onset (CD)

childhood onset conduct disorder: at least one symptom before the age of 10

adolescent-onset conduct disorder: no symptoms before age ten

girls are more likely to have adolescent onset, boys more likely to have child onset

Disruptive Mood Dysregulation Disorder (DMDD)

generally angry mood, all the time - severe temper outbursts at least three times a week

chronic, severe, and persistent irritability (negative mood, temper outburst)

Risk factors for DMDD

complicated psychiatric family history

history of substance abuse and dependence

most children have a previous diagnosis - ADHD or anxiety

difficulties in school, because of little tolerance of frustration

hard time maintaining friendships with others

Major Depressive Disorder (MDD)

two main symptoms and many other ones;

depressed mood

loss of pleasure (anhedonia)

must have at least five other symptoms: weight gain or loss, sleep disturbances, fatigue, feelings of worthlessness or guilt, thoughts of suicide or attempts, difficulty concentrating, low motivation...

depression versus grief

grief: events like the loss of a family member or pet, hard to understand for child, hard to move on, don't have control over their feelings like adults do

depression: don't have the energy or motivation, comes in waves, feeling happy then feeling hopeless

onset of MDD

often act out in response to depressive events

some people develop spontaneous remission of symptoms within 6 months, others full remission within 1 year

problem is it often comes back again and again

risk of suicide: gender differences

females are more likely to attempt suicide, males are more likely to complete suicide

Persistent Depressive Disorder (Dysthymia)

depressed mood most of the day, most days

see symptoms for 1 year in child

depressed mood may be irritability, cranky, sad, not acting out or destroying things

appetite changes, sleep problems, low energy, fatigue, sense of hopelessness

Depressive triad

things are going terrible with me, things are going terrible with the world, things will not get better for as long as i am alive


overthinking, bring up thoughts about how they could have changed, what they could have done instead, how they could have made it better... what they could have done different

rumination is a habit - depressed people don't have the energy to break a habit

age of onset (Dysthymia)

early onset is any time before age 21

1/2 of 1% of the population has dysthymia at any given time

Double Depression

Dysthymia + Major depressive disorder