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eppp abnormal 2


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brain damage (especially left hemisphere damage) is suggested when
Verbal IQ is significantly lower than Performance IQ.
-caused by chromosomal deletion (part of a chromsome is missing)
- obesity and MR
Heredity is responsible for MR in ____ % of cases?
___% of MR cases have an unknown cause?
Most common known cause of MR?
early alterations in embryonic development
-rare recessive gene syndrome
-detected by blood test at birth
-if untx, irreversible mod to profound MR
-unable to metabolize phenyl found in high protein foods
Down syndrome
-extra chromosome (trisomoy 21)
-causes 10-30% of mod to sev MR cases
-high risk for alzheimer's
-often have heart lesions, repiratory defects, intestinal defects, cataracts
Learning Disabilities
-IQs usu in ave to above ave range
-Most frequent comorbid disorder is ADHD (20-30% have)
-high risk for antisocial beh
-1/3 of ppl w/reading d/os have psychosocial problems as adults
-usu begins b/n ages 2-7
-3 times more common in males
-60% of cases remit by age 16
-tx: elim stress in home, lowered demands overall, habit reversal (breathing, social supp, awareness training)
-some evidence prior to age 3
-impairments in social interaction (2), communication (1), restricted/repetitive behs, interests (1)
-1/2 remain mute throughout lives
-if speech, may be abnorm in prosody, echolalia
-up to 70% have IQs in MR range
-1/3 achieve partial independence as adults
best outcome for autism
-verbal communication by 5 or 6
-IQ over 70
-later onset
shaping and discrimination training
most effective tx for autism
-improves communication skills
-only in females
-follows normal dev for 5 mos or more
-head growth deceleration
-loss of purposeful hand skills
-stereotyped hand mvts
-limited coordination of gait or trunk mvts
-loss of interest in soc environ
-impaired language dev
childhood disintegration d/o
regression in at least 2 areas of funct after at least 2 yrs of normal dev
do better on verbal tasks versus non-verbal
-onset prior to 7
-IQ ave or above ave (but test lower on IQ)
-almost all have academic probs
-25-30% have LDs
-30-90% have conduct disorder
-In kids, 4-9X more common in boys (more equal for inattentive type)
-adults, rates for adhd equal
In early adolescence, overactivity declines but conduct probs increase
-60% have sx as adults (more divorce, job probs, accidents, sub ab, aspd)
effective in 75% of cases
Conduct D/O
childhood onset: sx prior to age 10, more aggressiveness, higher risk for ASPD and/or sub ab
Adolescent onset: sx at 10 or later
-sx for at least 1 month without aversion to food
-usu begins between 12 and 24 months
-night alarm (bell & pad or moisture alarm) effective in 80% of cases but 1/3 relapse in 6mos
-Imipramine and Desmopressin also used - st effects good, lt effects poor
separation anxiety
-onset before 18
-lasts at least 4 weeks
-usu from close warm families
-freqently precip by major life stress
-school refusal:
5-7 when begins sch
11-12 when changes sch
14 or older
-school refusal during adolescence usu sign of dep or something else
irradiation and chemo for Leukemia
-assoc w/ deficits in neurocog fx and higher rates of LDs
-disturbance in consciousness
-change in cognition (memory disorientation, lang) OR
-perceptual abnormalities (halluc, illusions)
depression vs dementia
depression: impaired recall, but good recognition; procedural memory is affected
Dementia: deficits in both recall and recognition, deficits in declarative memory
procedural memory
-know-how memory
-memory storage of skills and procedures
declarative memory
-memory for facts
-broken down into semantic and episodic memory
-episodic: memory for past and personally experienced events)
-Semantic: knowledge for the meaning of words and how to apply them.
Dementia of Alz type
-highest cause of dementia
-accounts for 65% of cases
Alzheimer's Stage 1 (1 to 3 yrs)
-anterograde amnesia, esp for declarative memory
-visuospatial deficits (wandering)
Alzheimer's Stage 2 (2 to 10 yrs)
-retrograde amnesia
-flat or labilie mood
-ideomotor apraxia (difficulty translating an idea into movement)
Alzheimer's Stage 3 (8 to 12 yrs)
-severely impaired IQ fx
-limb rigidity
Alzheimer's: duration from onset to death is?
8 to 10 yrs
Alzheimer's more common in
-those with lower levels of educ
-late onset (after 65) more common than early
Etiology of Alzheimer's
--early onset assoc with abnormalities on chrom 21
--late onset assoc with abnormalities on chrom 19
--aluminum deposits in brain
--poor immune system
--low ACH
tourettes is due to
excessive dopamine
vascular dementia
-cog impairment AND neurological signs
-stepwise fluct course
-if due to stroke, most improvements in 1st six months and physical sx improve quicker than cog
dementia due to Parkinsons
-bradykinesia (slowness of movement)
-resting tremor
-masklike facial expression
-pill rolling
-loss of coordination & balance
-akathesia (cruel restlessness)
-50% develop depression
--20-60% dev dementia
-assoc with loss of dopamine producing cells and Lewy bodies in Substantia Nigra
-L-Dopa helps by increasing dopamine
-sx appear b/n 30 and 40
-cog, affective, motor sx
-affective sx first
-early motor signs: fidgeting and clumsiness - later, athetosis (slow, writhing movements) and chorea (invol jerky movements)
alcohol withdrawal
autonomic hyperactivity
Anterograde and retrograde amnesia, BUT ANTEROGRADE MORE SEVERE and retrograde memory is more affected for recent vs remote memories
-due to thiamine deficiency
-often preceded by Wernicke's
Alcohol-induced sleep disorder
when due to intox: sleepy then restless
when due to withdrawal: disruption in sleep continuity and vivid dreams
alogia (neg symptom)
poverty of thought and speech
restricted initiation of goal-directed behavior
poor insight into illness
-prevalence higher for males
-onset earlier for males
-over time, positive sx decrease, negative sx increase
Best prognosis: good premorbid fx, acute onset, late onset, female, precipitating event, brief duration of active phase sx, insight, fam hx of mood d/o, no fam hx of schiz
concordance rates for Schiz:
Gen pop: 1%
Fraternal twin: 17%
Identical Twin: 48%
Child (both parents schiz): 46%
Most common structural abnormality in schiz
Functional abnormalities: hypofrontality which is assoc with negative sx
Dopamine Hypothesis
-too much dopamine in Schiz (trad antipsychotics block dopamine)
-modified to: ELEVATED Seratonin and Norepinephrine and low GABA and Glutamate
Schizophreniform D/O
-less than six months of sx
-impaired soc/occup fx not required
-2/3rds eventually dev schiz
Manic episode
1 week or longer
Hypomanic episode
-At least 4 days
-Not marked impairment
-absence of psychosis
-often increase in creativity, efficiency
Mixed Episode
-At least one week
-rapid altering sx of manic and depressive episodes
-either poor functioning or psychosis
Postpartum Depression
-10-20% of women experience sx severe enough to warrant MDD after birth
-1/500 to 1/1000 develop depressive psychosis that may involve delusions re the newborn
Gender and Depression
-rates equal in children
-rate twice as high for women in adolescence and adulthood
depression in children
-irritability, social withdrawal, and somatic sx
-preadolescents (esp boys) may exhibit aggressiveness and destructiveness
Duration of Depression
-Untreated, sx usu last 6 months
-20-30% of cases, some sx remain for months to years
-50% of cases, person experiences more than 1 episode
Catecholamine Hypothesis
dep related to low norepinephrine
idolamine hypothesis
dep related to low seratonin
Bipolar I
-One or more Manic OR Mixed Episodes
-May or May not have had depressive episodes
-Equally common in males and females
Bipolar II
-At least one depressive episode and one hypomanic episode
-Never had Manic or Mixed Episode
-More common in men
Genetic Factors most consistently linked to which disorder?
Bipolar Disorder
-Identical Twins: 65%
-Fraternal Twins: 14%
effective in 60-90% of classic bipolar cases
Cyclothymic Disorder
-fluctuating hypomanic sx and numerous periods of depressive symptoms
-Depressive sx not severe enough for MDD
-Hypomanic sx not severe enough for Manic Episode
-Duration: 2 yrs in adults, 1 yr in kids
suicide risk increases dramatically in adolescents if they have:
conduct disorder, substance abuse, or ADHD
MOst effective meds for atypical depression
GAD and comorbidity
-GAD has the highest comorbidity rates of all anx d/os
-80% have at least one other anx or mood disorder
Panic D/O
-mustr have at least 2 unexpected attacks (with one being followed by 1 month of concern over having another, worry re: implications of another, or beh changes due to attack)
-33-50% have agoraphobia
-of the anxiety disorders, GAD most likely to occur with Panic
-Panic more common in women
-75% of agoraphobics are women
-60-70% respond to in vivo exposure with response prevention

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