EPPP - Psychopathology, Diagnoses
Terms
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- Criteria for autism
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6 symptoms: 2+ in Category 1 = soc interaction,
1+ in Category 2 = communication,
1+ in Category 3 = stereotyped behavior,
PRIOR to 3 yrs = abnormal soc interaction, soc language or imaginative play - Phenlketonuria (PKU)
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Rare recessive gene syndrome, unable to metabolize amino acid phenylalanine in high-protein foods.
Produces mental retardation, impaired motor & language dev & erratic behaviors. - Down Syndrome
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"trisomy 21" due to extra chromosome.
Cause of 10-30% of all cases of mod to severe retardation. - Differential for mental retardation
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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, and Stuttering
- Types of pervasive developmental disorders (4)
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Autistic Disorder,
Rett's Disorder,
Childhood Disintegrative Disorder, and
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
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Characteristic pattern of symptoms FOLLOWING 5+ MONTHS OF NORMAL DEVELOPMENT lasting for 5 months +
head growth deceleration, loss of purposeful hand skills, stereotypical hand movements, impairments in gait, 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
- Severe impairment in social interactions, restricted behaviors / interests, normal intelligence, good verbal skills with 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
- ADHD: Gender ratio
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2 - 9 times more common in boys.
More equal gender ratio with Inattentive Type.
More equal gender ratio in adults. - ADHD: distinguishing characteristic
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Fluctuation of symptoms in different settings.
Sx more likely in situations that are: familiar, highly repetitive, highly structured with no regular feedback. - ADHD: behavioral disinhibition hypothesis
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Inability to regulate behavior to fit situational demands.
Hypothesis supported by fluctuation of sx in diff settings. - Ritalin
- CNS stimulant methylphenidate
- Attention-Deficit and Disruptive Behavior Disorders (3)
- ADHD, Conduct Disorder, and Oppositional Defiant Disorder
- Conduct Disorder
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Pattern of behaviors that violate rights of others and/or age-appropriate social rules.
Childhood-onset type (<10 yrs) Adolescent-onset type (>10 yrs) life-course persistent type
Adolescence-limited type - Oppositional Defiant Disorder
- pattern of negativistic, defiant, and hostile behaviors toward authority figures
- Other Disorders of Infancy, Childhood, or Adolescence
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Separation Anxiety Disorder, Selective Mutism,
Reactive Attachment Disorder,and Stereotypic Movement Disorder. - Separation Anxiety Disorder
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< 18 yrs, 4+ weeks 3 characteristic behaviors.
DIFF DIAG - school refusal (can be a sign of depression during adolescence) - Reactive Attachment Disorder
- Developmentally inappropriate social relatedness, onset <5 yrs , there must be evidence of pathogenic care.
- Delirium: diagnosis
- 1. disturbance in consciousness 2. change in cognition and/or perceptual abnormalities.
- Delirium: high risk groups (5)
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1. Elderly people with decreased cerebral reserve due to dementia.
2. stroke
3. HIV
4. postcardiotomy patients
5. burn patients
6. people with drug dependence experiencing withdrawal - Dementia: diagnosis
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multiple cognitive deficits that include:
1. some memory impairment
2. aphasia, apreaxia, agnosis, and/or impaired executive functioning - aphasia
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Deterioration in language functioning:
difficulty naming people and objects, and
difficulty understanding written 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
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Abstract thinking,
trouble shooting,
initiating behaviors,
monitoring behavior, and stopping complex behaviors. - Dementia: differentials
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1. age-related cognitive declines
2. mental retardation (< 18 yrs) 3. major depressive disorder - Alzheimer's: stages
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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 intellectual functioning, limb rigidity, incontinence. - Dementia: Types (e.g. Dementia Due to⬦)
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1. Dementia of the Alzheimer's Type
2. Vascular Dementia
3. Dementia Due to HIV Disease
4. Dementia Due to Parkinson's Disease
5. Dementia Due to Huntington's Disease - Dementia: % caused by Alzheimer's Type
- 65%
- Dementia Alzheimer's Type: possible causes
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1. genetics (chromosome 21)
2. aluminum deposits in brain tissues
3. malfunctioning immune system
4. low level ACh - Vascular Dementia: risk factors
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1. hypertension
2. diabetes
3. cigarette smoking
4. atrial fibrillation - Vascular Dementia
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caused by arteriosclerosis or other cerebrovascular disease
course is stepwise & fluctuating - Dementia Due to Parkinson's Disease
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1. Bradykinesia
2. rigidity resting tremor
3. mask like expression
4. loss of coordination - bradykinesia
- Extreme slowness of movement
- akathesis
- Inability to sit still
- Dementia Due to Huntington's Disease
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30 - 40 yrs sx fall into 3 categories: affective, cognitive , and 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)
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1. Alcohol Intoxication
2. Alcohol Withdrawal
3. Alcohol Withdrawal Delirium
4. Alcohol-Induced Dementia
5. Alcohol-Induced Persistic Amnestic Disorder (Wernicke-Korsakoff Syndrome - Wernicke-Korsakoff Syndrome
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Alcohol-Induced Persisting Amnestic Disorder
retrograde & anterograde amnesia, confabulation, abnormal eye movements.
Due to thiamine deficiency. - Schizophrenia
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disturbance for 6+ months
1+ month of >2 active-phase symptoms - Schizophrenia: Active phase symptoms
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a. delusions
b. hallucinations
c. disorganized speech
d. grossly disorganized behavior
e. negative symptoms - Schizophrenia: age of onset
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Men: 18 - 25 yrs
Women: 25 - 35 yrs - Schizophrenia: Concordance rate of biological sibling
- 10%
- Schizophrenia: Biological theories
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a. enlarged ventricles
b. dopamine hypothesis (elevated)
c. elevated norepinephrine & serotonin - Schizophrenia: Treatment
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Antipsychotic medication
Side effect = tardive dyskinesia (TD)
Atypical antipsychotics (e.g. clozapine) dec chances of TD & reduces neg. symptoms - Delusional Disorder
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1+ month of 1+ nonbizarre delusion
psychosocial functioning not markedly impaired - Delusional Disorder subtypes (7)
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1. erotomanic
2. grandiose
3. jealous
4. persecutory
5. somatic
6. mixed
7. unspecified - Brief Psychotic Disorder
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Same active symptoms of schizophrenia BUT for 1-30 days.
Often follows overwhelming stressor. - Manic Episode
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1+ week elevated mood, plus
3 symptoms marked impairment and/or hospitalization. - Hypomanic Episode
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4+ days elevated mood, plus
3 symptoms
NO marked impairment or hospitalization - Depression: Biological theories
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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) - Depression: Pharmacological tx
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TCAs = classic depression with vegetative symptoms, acute onset & short duration of sx.
SSRIs = melancholic depression, fewer side effects than TCAs or MAOIs.
MAOIs = TCAs & SSRIs don't work, atypical depressions. - Dysthymic Disorder
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A. 2+ yrs depressed mood (adults)
1+ yr depressed mood (children)
B. <2 months symptom-free
C. no depression episode in first 2 yrs of disturbance - Bipolar I Disorder
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1+ manic or mixed episodes
without hx major dep episode - Bipolar II Disorder
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1+ major dep episode
AND 1+ Hypomanic episode
NEVER had manic or mixed episode - Cyclothymic Disorder
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2+ years fluctuating hypomanic sx and depressive sx
note: 1 yr for kids - Panic Disorder: Pharmacotherapy
-
imipramine (TCA)
SSRIs - PTSD: characteristic symptoms
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A. reexperiencing of trauma
B. avoidance of stimuli associated with trauma
C. symptoms of increased arousal - delayed onset PTSD
- Onset of sx occur after 3 months of event
- Acute Stress Disorder
- PTSD sx BUT duration is 2 days to 4 weeks
- Somatoform Disorders: main characteristic
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A. physical symptoms suggesting a medical disorder
B. NOT intentionally produced - Somatoform Disorder: Types (6)
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a. somatization disorder
b. conversion disorder
c. pain disorder
d. hypochondriasis
e. BDD
f. undifferentiated somatoform disorder - Somatization Disorder
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A. recurrent multiple somatic complaints for several yrs
B. 4 pain sx
C. 2 gastrointestinal sx
D. 1 sexual sx
E. 1 pseudoneurological sx
onset <30 yrs age - Conversion Disorder
- Sx that suggest a serious neurological or medical condition
- Conversion Disorder: Etiological mechanisms (2)
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1. primary gain keeping inner conflict out of consciousness
2. secondary gain avoiding unpleasant activity or obtaining support - Conversion Disorder: differential diagnosis
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1. Factitious Disorder
2. Malingering - Factitious Disorder
- intentional sx to fulfill a need for a sick role
- Malingering
- intentional sx to obtain external reward
- Munchausen's Syndrome by Proxy
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A factitious disorder where sx in child intentionally caused by his parent(s)
sx absent in parent's absence - Dissociative Disorder: Types (4)
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1. dissociative amnesia
2. dissociative fugue
3. dissociative identity disorder
4. depersonalization disorder - Dyspareunia
- genital pain associated with sexual intercourse
- Vaginismus
- involuntary spasms of vaginal muscle, interfering with intercourse
- Paraphilia
- intense recurrent sexual urges, fantasies or behaviors involving nonhuman objects, suffering, children or other nonconsenting partners
- Dyssomnias vs. Parasomnias
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Dys - disturbances in sleep amount, quality or timing
Paras - behavioral or physiological abnormalities, where focus is event, not sleep quality - Anorexia Nervosa: subtypes (2)
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1. restricting type
2. binge-eating/purging type - Bulimia Nervosa
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a. compensatory behavior twice a week
b. for 3 months or longer
NORMAL weight range - Personality Disorders: Cluster A (3)
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a. Paranoid
b. Schizoid
c. Schizotypal - Personality Disorders: Cluster B (4)
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a. Antisocial
b. Borderline
c. Histrionic
d. Narcissistic - Personality Disorders: Cluster C (3)
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a. Avoidant
b. Dependent
c. Obsessive-Compulsive