EPPP Abnormal

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Criteria for autism: 6 symptoms:

2+ in Category 1 = soc interaction

1+ in Category 2 = communication

1+ in Category 3 = stereotyped behaviour

PRIOR to 3 yrs - abnormal soc interaction, soc language or imaginative play
Phenlketonuria (PKU): rare recessive gene syndrome

unable to metabolise amino acide phenylalanine in high-protein foods

produces mental retardation, impaired motor & language dev & erratic behaviours
Down Syndrome: "trisomy 21"

due to extra chromosome

cause of 10-30% of all cases of mod to severe retardation
Differential for mental retardation: borderline intellectual functioning

IQ = 71-84

BUT could be retardation if IQ < 75 PLUS deficits in adaptive functioning
Types of learning disorders (3): Reading

Mathematics Disorder

Written Expression
Types of communication disorders (4): Expressive Language Disorder

Mixed Receptive-Expressive Language Disorder

Phonological Disorder

Stuttering
Types of pervasive developmental disorders (4): Autistic Disorder

Rett's Disorder

Childhood Disintegrative Disorder

Asperger's Disorder
Gender differences in rates of autism: 4 - 5 times more common in males
treatment for autism: shaping & discrimination training (Lovaas, 1960s)
Rett's Disorder: characteristic pattern of symptoms FOLLOWING 5+ MONTHS OF NORMAL DEVELOPMENT for 5 months +

head growth decelaration
loss of purposeful hadn skills
stereotypical hand movements
impairments in gaid
loss of interest in social environment
impaired language development
psychomotor retardation
Childhood Disintegrative Disorder: developmental regression in 2 areas of development FOLLOWING 2+ YEARS OF NORMAL DEVELOPMENT
Asperger's Disorder: severed impairment in social interactions
restricted behaviours / interestes
normal interlligence
good verbal skills

NO DELAYS IN LANGUAGE, COGNITIVE SKILLS etc.
Indicator for favorable prognosis in Autism: verbal communication by age 5 or 6

Qu = 70+

later onset symptoms
ADHD very common with comorbid ___________: conduct disorder
Gender ratio with ADHD: 2 - 9 times more common in boys

more equal gender ratio with Inattentive Type

more equal gener ratio in adults
distinguishing characteristic of ADHD: fluctuation of symptoms in different settings

sx more likely in situations that are:

familiar
highly repetitive
highly structured
no regular feedback
behavioral disinhibition hypothesis of ADHD: inability to regulate behaviour to fit situational demands

hypothesis supported by flucuation of sx in diff settings
Ritalin: CNS stimulant

methylphenidate
Attention-Deficity and Disruptive Behavior Disorders (3): ADHD

Conduct Disorder

Oppositional Defiant Disorder
Conduct Disorder: pattern of behaviours that violate rights of others and/or age-appropriate social rules

childhood-onset type (<10 yrs)
vs.
adolescent-onset type (>10 yrs)

life-course persistent type
vs.
adolescence-limited type
Oppositional Defiant Disorder: pattern of negativistic, defiant, and hostile behaviours toward authority figures
Other Disorders of Infancy, Childhood, or Adolescence: Separation Anxiety Disorder

Selective Mutism

Reactive Attachment Disordxer

Stereotypic Movement Disorder
Separation Anxiety Disorder: < 18 yrs
4+ weeks
3 characteristic behaviours

DIFF - school refusal (can be a sign of depresssion during adolescence)
Reactive Attachment Disorder: developmentally inappropriate social relatedness

<5 yrs
must be evidence of pathogenic care
diagnosis: Delirium: 1. distubance in consciousness

2. change in cogntition and/or perceptual abnormalities
high risk groups for Delirium (5): elderly

people with decreased cerebral reserve due to dementia, stroke, HIV

postcardiotomy patients

burn patients

people with drug dependence experiencing withdrawal
diagnosis: Dementia: multiple cognitive deficits that include:

1. some memory impairment

2. aphaisa, apreaxia, agnosis, and/or impaired executive functioning
aphasia: deterioration in language functioning

difficulty naming people and objects and understanding writen and spoken language
apraxia: difficulty executing motor actions

e.g. unable to dress
agnosia: inability to recognize and identify familiar objects and people
executive functioning: abstract thinking, trouble shoting, initiating, monitoring, stopping complex behaviours
Dementia differentials: age-related cognitive declines

mental retardation (< 18 yrs)

major depressive disorder
stages of Alzheimer's: Stage 1 (1-3 yrs)
anterograde amnesia, wandering, irritability, sadness

Stage 2 (2-10 yrs)
retrograde amnesia, flat mood, agitation, delusions

Stage 3 (8-12 yrs)
severely deteriorated interllectual functioning, limb rigidity, incontinence
types of Dementia e.g. Dementia Due to...: Dementia of the Alzheimer's Type

Vascular Dementia

Demential Due to HIV Disease

Demential Due to Parkinson's Disease

Demential Due to Huntingdon's Disease
rate of dementia caused by Alzheimer's Type: 65%
possible causes of Alzheimer's Type: genetics (chromosome 21)

aluminum deposits in brain tissues

malfunctioning immune system

low level ACh
risk factors fo Vascular Dementia: hypertension
diabetes
cigarette smoking
atrial fibrillation
Vascular Dementia: caused by arteriosclerosis or other cerebrovascular disease

course is stepwise & fluctuating
Dementia Due to Parkinson's Disease: bradykinesia
rigidity
resting tremor
masklike expression
loss of coordination
bradykinesia: slowness of movement
akathesis: inability to sit still
Dementia Due to Huntingdon's Disease: 30 - 40 yrs

sx fall into 3 categories:
affective
cognitive
motor

often starts with depression, irritability, apathy
apathy: absence of feeling or enthusiasm
Marlatt & Gordon re: Substance Dependence: relapse prevention program

dealing with high risk situations
Substance Dependence: 3 symptoms in 12 months
Substance Abuse: 1 symptom in 12 months
Substance-Induced Disorders (5): Alcohol Intoxication
Alcohol Withdrawal
Alcohol Withdrawal Delirium
Alcohol-Induced Dementia
Alcohol-Induced Persistic Amnestic Disorder (Wernicke-Korsakoff Syndrome
Wenicke-Korsakoff Syndrome: Alcohol-Induced Persisting Amnestic Disorder

retrograde & anterograde amnesia
confabulation
abnormal eye movements
Due to thiamine deficiency
Schizophrenia: disturbance for 6+ months

1+ month of >2 active-phase symptoms
active phase symptoms of Schizophrenia: delusions
hallucinations
disorganized speech
grossly disorganized behaviour
negative symptoms
age of onset for Schizophrenia: 18 - 25 yrs for men
25 - 35 yrs for women
concordance rate of Schizophrenic person to biological sibling: 10%
biological theories of schizophrenia: enlarged ventricles

dopamine hypothesis (elevated)

elevated norepinephrine & serotonin
treatment for schizophrenia: antipsychotics
side effect = tardive dyskinesia

atypical antipsychotics
e.g. clozapine
dec chances of tard. dys. & reduces -ve symptoms
Delusional Disorder: 1+ month of 1+ nonbizarre delusion

psychosocial functioning not markedly impaired
Delusional Disorder subtypes (7): erotomanic
grandiose
jealous
persecutory
somatic
mixed
unspecified
Brief Psychotic Disorder: same active symptoms of schizophrenia BUT for 1-30 days

often follows overwhelming stressor
Manic Episode: 1+ week

elevated mood + 3 symptoms

marked impairment and/or hospitalization
Hypomanic Episode: 4+ days

elevated mood + 3 symptoms

NO marked impairment or hospitalization
biological theories of depression (4): 1. catecholamine hypothesis
deficiency in norepinephrine

2. indolamine hypothesis
deficiency in serotonin

3. permissive theory
serotonin interacts with other neurotransmitters to produce depression

4. elevated levels of cortisol (stress hormone)
pharmacological treatment for depression: TCAs
for classic depression with vegetative symptoms, acute onset & short duration of sx

SSRIs
melancholic depression
fewer side effects than TCAs

MAOIs
if TCAs & SSRIs don't work
atypical depressions
Dysthymic Disorder: 2+ yrs depressed mood (adults)
1+ yr depressed mood (children)

<2 months symptom-free

no depression episode in first 2 yrs of disturbance
Bipolar I Disorder: 1+ manic or mixed episodes without hx major dep episode
Bipolar II Disorder: 1+ major dep episode

AND

1+ hypomanic episode

NEVER had manic or mixed episode
Cyclothymic Disorder: 2+ years fluctuating hypomanic sx and depressive sx

note: 1 yr for kids
pharmacotherapy for Panic Disorder: imiprapmine (TCA)
SSRIs
characteristic symptoms of PTSD: reexperiencing of trauma

avoidance of stimuli associated with trauma

symptoms of increased arousal
delayed onset PTSD: if onset of sx after 3 months
Actue Stress Disorder: PTSD sx

BUT

2 days to 4 weeks
main characteristic of Somatoform Disorders: physical symptoms suggesting a medical disorder

NOT intentionally produced
types of Somatoform Disorder (6): somatization disorder
conversion disorder
pain disorder
hypochondriasis
BDD
unfifferentiated somatoform disorder
Somatization Disorder: recurrent multiple somatic complaints for several yrs

4 pain sx
2 gastrointestinal sx
1 sexual sx
1 pseudoneurological sx

onset <30 yrs age
Conversion Disorder: sx that suggest a serious neurological or medical condition
2 etiological mechanisms of Conversion Disorder: primary gain
keeping inner conflict out of consciousness

secondary gain
avoiding unpleasant activity or obtaining support
differential diagnosis for Conversion Disorder: Factitious Disorder

Malingering
Factitious Disorder: intentional sx to fulfull a need for a sick role
Malilngering: intentional sx to obtain external reward
Munchausen's Syndrom by Proxy: a factitious disorder

intentional sx in child by his parent

sx absent in parent's absence
types of Dissociative Disorder (4): dissociative amnesia
dissociateive fugue
dissociative identity disorder
depersonalization disorder
Dyspareunia: genital pain associated with sexual intercourse
Vaginismus: involuntary spasms of vaginal muscle, interferring with intercourse
Paraphilia: intense recurrent sexual urges, fantasies or behaviours involving nonhuman objects, suffering, children or other nonconsenting partners
Dyssomnias vs. Parasomnias: Dys - disturbances in sleep amount, quality or timing

Paras - behavioural or physiological abnormalities, where focus is event, not sleep quality
subtypes of Anorexia Nervosa (2): restricting type

binge-eating/purging type
Bulimia Nervosa: compensatory behaviour twice a week for 3 months

NORMAL weight range
Cluster A Personality Disorders: Paranoid

Schizoid

Schizotypal
Cluster B Personality Disorders: Antisocial

Borderline

Histrionic

Narcissistic
Cluster C Personality Disorders: Avoidant

Dependent

Obsessive-Compulsive

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Deck Info

Number of cards 88