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EPPP Psychopathology


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DSM Axes
I Focus of clinical attention
II Mental retardation and personality disorders; also traits and defenses
III Relevant medical conditions
IV Psychosocial and environmental problems
Expression of diagnostic uncertainty in DSM
Diagnosis / condition deferred
not enough information

tentative diagnosis

when class but not specific disorder can be identified
or insufficient features for a specific diagnosis
Def: polythetic criteria sets
Criteria sets from which the patient need only present with n of m
Criteria for mental retardation
IQ < 70
Impairments in adaptive functioning in at least 2 areas
Onset < 18
Criteria for autism
Qualitative impairments in social interaction and communication

Narrow repetitive and stereotyped behavior, interests and activities

Before 3: abnormal social interaction, social language or imaginative play
Difference between Asperger's and autism
Like autism but with no significant delay in language development
Def of learning disorder
2 SD difference between IQ and achievement
Difference between Conduct disorder and Oppositional Defiant Disorder *
Both involve hostile, negative or defiant behavior,

but Conduct Disorder is associated with more severe violations of the rights of others, eg stealing or fire-setting, breaking major rules before age 13 such as staying out late, picking fights, lying
Def: pica
persistent eating of non-nutritive substances for at least a month
Def: rumination disorder
Repeated regurgitation ond rechewing of food that begins after a period of normal eating
Degrees of mental retardation *
Mild IQ 50-70
85% of retarded population
Top out at 6th grade ability
Can live independently and do semi-skilled jobs

Moderate 35-50
10% of retarded population
Top out at 2nd grade ability
Need supervision in semi-skilled jobs

Severe 20-35
3-4% of retarded population
Poor motor skills, limited speech
Closely supervised living

Profound <20
1-2% of retarded population
Severely limited motor and sensory functioning
Closely supervised living
Autistic language deficits
Rarely speak (~50% never speak)
Pronoun reversals (I for you)
Indicator for favorable prognosis in Autism
Higher early functioning,
eg some pre-school langugage
Symptoms of ADHD *
Symptom classes:

combined: 6+ inattention; 6+ hyper
inattentive 6+ inattention; <6 hyper
hyperactive-impulsive: <6 inattention; 6+ hyper

onset of symptoms before age 7
min 6 mo duration
symptoms present in 2 settings
adult ADHD
decrease in activity level
often delinquint or antisocial
common: restlessness, low frustration tolerence, emotional lability, low self-esteem, impulsivity, difficulty concentrating
side effects of Ritalin (methylphenidate)
anorexia, insomnia, stomach aches
tics, exacerbates Tourette's
ocd symptoms
growth retardation
Tourette's comorbidity *
obsessions / compulsions
learning disorders
social problems
Treatment of enuresis
In order of efficacy

Bell (rings) and pad (when wet)
Bladder control exercises
Desc pseudodementia
Cognitive impairment as a result of depression
Cognitive symptoms improve with mood
Acute onset
Self-conscious about cognitive deficits
Deficits mostly in procedural memory and recall
Alzheimer's progression
Recent memory
Lost procedural facility
Aphasia, apraxia, agnosia
Personality changes, delusions, hallucinations
Incontinent, unintelligible, unable to walk or sit

Lack of disease awareness
AIDS dementia progression *
Loss of concentration; confusion, general forgetfulness
Apathy, social withdrawal, depression
Seizures, incontenence, etc

Also includes:
Slowed motor and thought processes
Visuospatial defects

language function is intact
ability to acquire new information is intact
Def: confabulation
Filling memory gaps with imaginary events
Symptoms of alcohol withdrawal
hand tremor
grand mal seizures
nausea or vomiting
hallucinations or illusions
convulsive seizures
Desc: delirium tremens
characteristic delirium (disturbance of consciousness) plus:
hallucination, delusions

< %5 of people in withdrawal
Desc: cocaine and amphetamine intoxication *
interpersonal sensitivity
impaired judgement

pupil dilation
Desc: cocaine / amphetamine withdrawal
dysphoric mood
fatigue, insomnia, vivid dreams
Def: abstinence violation effect (AVE) (Marlatt and Gordon)
Relapse leads to feelings of guilt and failure leading to further relapse
Marlatt and Gordon addiction treatment model
Change attributions for failure from:
internal to external
stable to unstable
global to specific
Factors in treatment for nicotine dependence *
Time without intervention
Strong desire to quit
Awareness of consequences
Social support
relapse prevention training
stimulus control

Patch works best when combined with behavioral intervention, especially for long term abstinence of 6 months or more
Difference between schizophrenia and schizophreniform disorder
6 months
Positive symptoms of schizophrenia
hallucinations (usually auditory)
disorganized speech
grossly disorganized behavior
Negative symptoms of schizophrenia
alogia - restricted speech/thought fluency/production
Positive prognostic factors for schizophrenia
late and acute onset
precipitating event
being female
good premorbid adjustment
brief active phase
family history of mood disorder, but not schizophrenia
positive symptoms - which can be medicated
prompt treatment with medication right after onset
good medication compliance
Types of schizophrenia
Treatment for schizophrenia

family therapy
interpersonal skills training

individual insight oriented therapy
Schizoaffective disorder vs schizophrenia
symptoms of both mood disorder and schizophrenia, not meeting full criteria for either

psychotic features must be present for at least 2 weeks without mood symptoms

mood symptoms must otherwise be generally present
Differences among PTSD, Acute Stress Disorder and and Adjustment Disorder
PTSD and ASD are both responses to extreme stressors, with a specific set of symptoms:
most noteably flashbacks,
and dissociative symptoms (amnesia, being in a daze, depersonalization)

while symptoms an Adjustment Disorder are less severe and more various

4 weeks difference between PTSD and ASD
Def: agoraphobia
Anxiety about being in places or situations from which excape might be difficult or embarassing
Desc: dissociative disorder
Dissociative amnesia
inability to remember important personal information

Dissociative fugue - abrupt, unanticipated travel away from home, inability to remember one's past and identity confusion

Dissociative Identity Disorder
multiple personality disorder

Depersonalization disorder
repeated episodes of depersonalization, characterized by feelings of unreality
Desc: narcolepsy
Irresistible episodes of refreshing sleep nearly every day for 3 mo

Either of:
abrupt loss of muscle tone
REM sleep while going to sleep or waking

20-40% experience hypnagogic or hypnopompic hallucinations
Desc: dyssomnias
Disturbances in sleep amount, quality or timing

breathing-related sleep disorder
circadian rhythm sleep disorder
Desc: parasomnias
Aberrant sleep event, where the focus is the event, not the sleep quality

sleep terrors - intense, anxious awakening without dreams
Parasomnias by stage of sleep
Stages 3&4: sleep terror and sleepwalking

REM: nightmares and sleep paralysis
Family characteristics in anorexia according to Minuchin
Parental over-control
Lack of power or autonomy for the anorexic
Location of complex-partial seizures
temporal or frontal lobes
Defining characteristic of substance dependence
a maladaptive pattern of use, including cognitive, behavioral and psychological symptoms, usually including tolerance and withdrawal that is distressing or impairs functioning

at least 3 symptoms over a 12 month period

Excessive use
Inability to quit
Time consuming acquisition
Severe personal impact
Time constraints on adjustment disorder
Must occur within 3 mo of stressor and last no more than another 9
Duration of a brief psychotic disorder
1 psychotic symptom for at least 1 day and no more than 1 month, with return to permorbid condition
Def: delirium
syndrome with a disturbance of consciousness and either a change in cognition or perceptual disturbance

caused by medical condition and / or substance abuse
Def: obsessive compulsive disorder
Recurrent, persistent, intrusive, distressing thoughts (obsessions) OR compulsive actions (compulsions) recognized as irrational or excessive
Def: functional disorder
Mental disorders not clearly caused by a physiological factor
Wolpe's explanation of depression
Depression is linked to anxiety and should be treated with systematic desensitization
Factor associated with negative prognosis for ADHD
Conduct disorders
Cognitive impairments as a result of chronic alcoholism
More effects visuospatial skills than verbal skills
Core requirements of a diagnosis of separation anxiety disorder
Three symptoms including:

Fear that harm will come to a major attachment figure

But not necessarily an excessive need for attention
Strategies for treating OCD
deliberate exposure and thought stopping
relaxation training
paradoxical intent
covert sensitization
systematic desensitization
IQ criterion for borderline intellectual functioning
1-2 SD below the mean
Types of headache pain *
Migraine - unilateral throbbing pain

Cluster - intense pain behind the eye

Side effects of ECT
Largely reversible memory deficits, though problems with autobiographical memory may persist for months

Unilateral ECT to the right hemisphere is associated with far fewer adverse side effects

However bilateral ECT is more potent
Def: dyspareunia
painful intercourse
Brain abnormalities in schizophrenia
Enlarged ventricles
Organic disorders that may cause a Mood Disorder
hyper / hypo thryroidism
pancreatic CA
viral illness

but NOT pot
Wechsler IQ standard scoring
mean = 100
sd = 15
Defense mechanisms used by people with narcissistic personality disorder (Millon)
Rate of post-partum major depression
Diagnostic criteria for Tourette's Disorder *
Multiple motor tics
One or more vocal tics
For at least a year
Diagnostic criteria for Somataform Disorders *
Physical symptoms not explained by a medical disorder

Undifferentiated - If fewer than 3 symptoms present for more than 6 mo

NOS if symptoms present for less than 6 mo
Gender prevalence of OCD *
Equal in adult males and females, but higher incidence in young boys
Primary difference between obese and non-obese people
Inherited differences in metabolism
Substances causing substance induced delirium *
Alcohol or sedatives
IPT accounting of depression
Interpersonal relations

Symptom formation (but treated with medication)
Symptoms of cannabis intoxication
dry mouth
Symptoms of caffeine intoxication
flushed face
periods of inexhaustability
Symptoms of alcohol intoxication
slurred speech
memory impairment
nystagmus (rapid, involuntary, oscillatory motion of the eyeball)
Psychological correlates of smoking
80% of quitters gain weight
Average weight gain is 7-9 lbs

Fear of weight gain inhibits attempts at quitting, and signs of weight gain trigger relapse

Higher depression rate

Cessation can trigger a depressive episode in smokers with depression history
Def: cataplexy
Episodes of sudden bilateral loss of muscle tone resulting in collapse, often in association with intense emotions

Occurs in about 70% of people with narcolepsy
Defining characteristic of antisocial personality disorder
Lack of remorse
Depression vs dementia
In depression only free recall is affected

In dementia both recall and recognition are affected
Treatment of choice for PTSD
Prolonged exposure

Not much added by stress inocculation training
Desc: PET scan (Positron Emission Tomography)
Functional brain imaging technique providing information about metabolic and chemical activities of the brain such as blood flow
Symptoms of hypoglycemia
Acute phase includes panic and anxiety

Chronic phase includes depression, psychosis and/or personality change
Learning disorder comorbitity
ADHD - 20-25% of children with learning disorder are also diagnosed with ADHD
Concordance rates for schizophrenia
1% in general population
10% among biological sibs
Incidence of Generalized Anxiety Disorder
Diagnosed more frequently in females

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