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- brain damage (especially left hemisphere damage) is suggested when
- Verbal IQ is significantly lower than Performance IQ.
- Prader-Willi
-
-caused by chromosomal deletion (part of a chromsome is missing)
- obesity and MR - Heredity is responsible for MR in ____ % of cases?
- 5%
- ___% of MR cases have an unknown cause?
- 30-40%
- Most common known cause of MR?
- early alterations in embryonic development
- PKU
-
-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 - stuttering
-
-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) - autism
-
-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 - Rett's
-
-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
- asperger's
- do better on verbal tasks versus non-verbal
- ADHD
-
-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) - Ritalin
- 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 - pica
-
-sx for at least 1 month without aversion to food
-usu begins between 12 and 24 months - enuresis
-
-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
- Delirium
-
requires:
-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)
-indifference
-irritability
-sadness - Alzheimer's Stage 2 (2 to 10 yrs)
-
-retrograde amnesia
-flat or labilie mood
-restlessness/agitation
-delusions
-ideomotor apraxia (difficulty translating an idea into movement) - Alzheimer's Stage 3 (8 to 12 yrs)
-
-severely impaired IQ fx
-apathy
-limb rigidity
-incontinence - Alzheimer's: duration from onset to death is?
- 8 to 10 yrs
- Alzheimer's more common in
-
-women
-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)
-rigidity
-resting tremor
-masklike facial expression
-pill rolling
-loss of coordination & balance
-akathesia (cruel restlessness) - Parkinson's
-
-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 - Huntington's
-
-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
- Korsakoff's
-
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
- avolition
- restricted initiation of goal-directed behavior
- anosognosia
- poor insight into illness
- Schizophrenia
-
-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
-
ENLARGED VENTRICLES
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% - Lithium
- 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
- SSRIs and MAOIs
- 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