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54 Cards in this Set
- Front
- Back
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DSM I (1952) and DSMII (1968) |
predominantly psychoanalytic, focused on psychiatry, descriptive more than diagnostic, no focus on children, about 60 disorders |
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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 |
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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 |
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DSM IV (1994) and DSM IV TR (1998) |
continues prototypic model criteria gets bumped around psychology and psychiatry does not agree on anything |
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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 |
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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 |
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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 |
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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 |
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Neurodevelopmental Disorders |
include intellectual disability, communication and speech disorders, learning disabilities, autism, ADHD, tic disorders - BRAIN |
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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 |
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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 |
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first reference to ADHD symptoms was ...? |
in 1770, in a german medical textbook |
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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" |
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first stimulant to be used with ADHD |
straight speed, (amphetamine), meth, chalk |
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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) |
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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 |
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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) |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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Tourette's Disorder |
multiple motor tics (at least two) and vocal tics (at least one) |
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Persistent Motor Tic Disorder Persistent Vocal Tic Disorder |
only motor tics only vocal tics |
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Provisional Tic Disorder |
symptom presentation usually changes within a year not great stability |
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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 |
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stigmatizing tics: coprolalia and copropaxia |
offensive language offensive gestures |
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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 |
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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 |
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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 |
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neuropsychological implications (3) |
speed of performance - child with tic is slower procedural learning - much more effortful executive functioning - self control, time management, self monitoring |
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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 |
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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 |
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risk factors for ODD |
harsh, abusive families, manipulative parents, difficult baby most likely to develop ODD lower basal cortisol levels |
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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 |
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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 |
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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 |
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risk factors of IED |
more common with less education (intelligence? poverty?) history of trauma heightened activity in the limbic system |
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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 |
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4 dimensions of CD |
aggressive to people and animals destruction of property deceitfulness or theft serious violation of rules |
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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 |
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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) |
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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 |
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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... |
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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 |
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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 |
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risk of suicide: gender differences |
females are more likely to attempt suicide, males are more likely to complete suicide |
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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 |
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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 |
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rumination |
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 |
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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 |
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Double Depression |
Dysthymia + Major depressive disorder |
