EPPP - Psychopathology, Diagnoses

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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 behavior,
PRIOR to 3 yrs = abnormal soc interaction, soc language or imaginative play
Phenlketonuria (PKU): 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: "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, and Stuttering
Types of pervasive developmental disorders (4): 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: 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: 2 - 9 times more common in boys.

More equal gender ratio with Inattentive Type.

More equal gender ratio in adults.
ADHD: distinguishing characteristic: 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: 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: 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: Separation Anxiety Disorder, Selective Mutism,
Reactive Attachment Disorder,and Stereotypic Movement Disorder.
Separation Anxiety Disorder: < 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): 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: multiple cognitive deficits that include:
1. some memory impairment
2. aphasia, apreaxia, agnosis, and/or impaired executive functioning
aphasia: 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: Abstract thinking,
trouble shooting,
initiating behaviors,
monitoring behavior, and stopping complex behaviors.
Dementia: differentials: 1. age-related cognitive declines
2. mental retardation (< 18 yrs) 3. major depressive disorder
Alzheimer's: stages: 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⬦): 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: 1. genetics (chromosome 21)
2. aluminum deposits in brain tissues
3. malfunctioning immune system
4. low level ACh
Vascular Dementia: risk factors: 1. hypertension
2. diabetes
3. cigarette smoking
4. atrial fibrillation
Vascular Dementia: caused by arteriosclerosis or other cerebrovascular disease

course is stepwise & fluctuating
Dementia Due to Parkinson's Disease: 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: 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): 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: 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
Schizophrenia: Active phase symptoms: a. delusions
b. hallucinations
c. disorganized speech
d. grossly disorganized behavior
e. negative symptoms
Schizophrenia: age of onset: Men: 18 - 25 yrs

Women: 25 - 35 yrs
Schizophrenia: Concordance rate of biological sibling: 10%
Schizophrenia: Biological theories: a. enlarged ventricles
b. dopamine hypothesis (elevated)
c. elevated norepinephrine & serotonin
Schizophrenia: Treatment: Antipsychotic medication

Side effect = tardive dyskinesia (TD)

Atypical antipsychotics (e.g. clozapine) dec chances of TD & reduces neg. symptoms
Delusional Disorder: 1+ month of 1+ nonbizarre delusion

psychosocial functioning not markedly impaired
Delusional Disorder subtypes (7): 1. erotomanic
2. grandiose
3. jealous
4. persecutory
5. somatic
6. mixed
7. unspecified
Brief Psychotic Disorder: Same active symptoms of schizophrenia BUT for 1-30 days.

Often follows overwhelming stressor.
Manic Episode: 1+ week elevated mood, plus
3 symptoms marked impairment and/or hospitalization.
Hypomanic Episode: 4+ days elevated mood, plus
3 symptoms

NO marked impairment or hospitalization
Depression: Biological theories: 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: 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: 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: 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
Panic Disorder: Pharmacotherapy: imipramine (TCA)
SSRIs
PTSD: characteristic symptoms: 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: A. physical symptoms suggesting a medical disorder

B. NOT intentionally produced
Somatoform Disorder: Types (6): a. somatization disorder
b. conversion disorder
c. pain disorder
d. hypochondriasis
e. BDD
f. undifferentiated somatoform disorder
Somatization Disorder: 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): 1. primary gain keeping inner conflict out of consciousness

2. secondary gain avoiding unpleasant activity or obtaining support
Conversion Disorder: differential diagnosis: 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: A factitious disorder where sx in child intentionally caused by his parent(s)

sx absent in parent's absence
Dissociative Disorder: Types (4): 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: Dys - disturbances in sleep amount, quality or timing

Paras - behavioral or physiological abnormalities, where focus is event, not sleep quality
Anorexia Nervosa: subtypes (2): 1. restricting type
2. binge-eating/purging type
Bulimia Nervosa: a. compensatory behavior twice a week
b. for 3 months or longer

NORMAL weight range
Personality Disorders: Cluster A (3): a. Paranoid
b. Schizoid
c. Schizotypal
Personality Disorders: Cluster B (4): a. Antisocial
b. Borderline
c. Histrionic
d. Narcissistic
Personality Disorders: Cluster C (3): a. Avoidant
b. Dependent
c. Obsessive-Compulsive

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