EPPP Psychopathology
Terms
undefined, object
copy deck
- DSM Axes
-
I Focus of clinical attention
II Mental retardation and personality disorders; also traits and defenses
III Relevant medical conditions
IV Psychosocial and environmental problems
V GAF - Expression of diagnostic uncertainty in DSM
-
Diagnosis / condition deferred
not enough information
Provisional
tentative diagnosis
NOS
when class but not specific disorder can be identified
or insufficient features for a specific diagnosis - Def: polythetic criteria sets
- Criteria sets from which the patient need only present with n of m
- Criteria for mental retardation
-
IQ < 70
Impairments in adaptive functioning in at least 2 areas
Onset < 18 - Criteria for autism
-
Qualitative impairments in social interaction and communication
Narrow repetitive and stereotyped behavior, interests and activities
Before 3: abnormal social interaction, social language or imaginative play - Difference between Asperger's and autism
- Like autism but with no significant delay in language development
- Def of learning disorder
- 2 SD difference between IQ and achievement
- Difference between Conduct disorder and Oppositional Defiant Disorder *
-
Both involve hostile, negative or defiant behavior,
but Conduct Disorder is associated with more severe violations of the rights of others, eg stealing or fire-setting, breaking major rules before age 13 such as staying out late, picking fights, lying - Def: pica
- persistent eating of non-nutritive substances for at least a month
- Def: rumination disorder
- Repeated regurgitation ond rechewing of food that begins after a period of normal eating
- Degrees of mental retardation *
-
Mild IQ 50-70
85% of retarded population
Top out at 6th grade ability
Can live independently and do semi-skilled jobs
Moderate 35-50
10% of retarded population
Top out at 2nd grade ability
Need supervision in semi-skilled jobs
Severe 20-35
3-4% of retarded population
Poor motor skills, limited speech
Closely supervised living
Profound <20
1-2% of retarded population
Severely limited motor and sensory functioning
Closely supervised living - Autistic language deficits
-
Rarely speak (~50% never speak)
Echolalia
Pronoun reversals (I for you) - Indicator for favorable prognosis in Autism
-
Higher early functioning,
eg some pre-school langugage - Symptoms of ADHD *
-
Symptom classes:
inattention
hyperactivity
impulsivity
Subtypes
combined: 6+ inattention; 6+ hyper
inattentive 6+ inattention; <6 hyper
hyperactive-impulsive: <6 inattention; 6+ hyper
onset of symptoms before age 7
min 6 mo duration
symptoms present in 2 settings - adult ADHD
-
decrease in activity level
often delinquint or antisocial
common: restlessness, low frustration tolerence, emotional lability, low self-esteem, impulsivity, difficulty concentrating - side effects of Ritalin (methylphenidate)
-
anorexia, insomnia, stomach aches
tics, exacerbates Tourette's
ocd symptoms
growth retardation - Tourette's comorbidity *
-
obsessions / compulsions
ADHD
learning disorders
depression
social problems - Treatment of enuresis
-
In order of efficacy
Bell (rings) and pad (when wet)
Antidepressants
Hypnosis
Bladder control exercises - Desc pseudodementia
-
Cognitive impairment as a result of depression
Cognitive symptoms improve with mood
Acute onset
Self-conscious about cognitive deficits
Deficits mostly in procedural memory and recall - Alzheimer's progression
-
Recent memory
Lost procedural facility
Aphasia, apraxia, agnosia
Personality changes, delusions, hallucinations
Incontinent, unintelligible, unable to walk or sit
Lack of disease awareness - AIDS dementia progression *
-
Loss of concentration; confusion, general forgetfulness
Apathy, social withdrawal, depression
Seizures, incontenence, etc
Also includes:
Slowed motor and thought processes
Visuospatial defects
But
language function is intact
ability to acquire new information is intact - Def: confabulation
- Filling memory gaps with imaginary events
- Symptoms of alcohol withdrawal
-
agitation
hand tremor
insomnia
depression
grand mal seizures
nausea or vomiting
anxiety
hallucinations or illusions
convulsive seizures - Desc: delirium tremens
-
characteristic delirium (disturbance of consciousness) plus:
hallucination, delusions
agitation
< %5 of people in withdrawal - Desc: cocaine and amphetamine intoxication *
-
euphoria
interpersonal sensitivity
talkativeness
hypervigilence
impaired judgement
vomiting
confusion
pupil dilation - Desc: cocaine / amphetamine withdrawal
-
dysphoric mood
fatigue, insomnia, vivid dreams
etc - Def: abstinence violation effect (AVE) (Marlatt and Gordon)
- Relapse leads to feelings of guilt and failure leading to further relapse
- Marlatt and Gordon addiction treatment model
-
Change attributions for failure from:
internal to external
stable to unstable
global to specific - Factors in treatment for nicotine dependence *
-
Time without intervention
Strong desire to quit
Awareness of consequences
Social support
Also:
relapse prevention training
stimulus control
Patch works best when combined with behavioral intervention, especially for long term abstinence of 6 months or more - Difference between schizophrenia and schizophreniform disorder
- 6 months
- Positive symptoms of schizophrenia
-
delusions
hallucinations (usually auditory)
disorganized speech
grossly disorganized behavior - Negative symptoms of schizophrenia
-
alogia - restricted speech/thought fluency/production
avolition
anhedonia - Positive prognostic factors for schizophrenia
-
late and acute onset
precipitating event
being female
good premorbid adjustment
brief active phase
family history of mood disorder, but not schizophrenia
positive symptoms - which can be medicated
prompt treatment with medication right after onset
good medication compliance - Types of schizophrenia
-
Disorganized
Paranoid
Catatonic
Undifferentiated
Residual - Treatment for schizophrenia
-
Anti-psychotics
chlorpromazine
haloperidol
plus
family therapy
interpersonal skills training
not
individual insight oriented therapy - Schizoaffective disorder vs schizophrenia
-
symptoms of both mood disorder and schizophrenia, not meeting full criteria for either
psychotic features must be present for at least 2 weeks without mood symptoms
mood symptoms must otherwise be generally present - Differences among PTSD, Acute Stress Disorder and and Adjustment Disorder
-
PTSD and ASD are both responses to extreme stressors, with a specific set of symptoms:
most noteably flashbacks,
and dissociative symptoms (amnesia, being in a daze, depersonalization)
while symptoms an Adjustment Disorder are less severe and more various
4 weeks difference between PTSD and ASD - Def: agoraphobia
- Anxiety about being in places or situations from which excape might be difficult or embarassing
- Desc: dissociative disorder
-
Dissociative amnesia
inability to remember important personal information
Dissociative fugue - abrupt, unanticipated travel away from home, inability to remember one's past and identity confusion
Dissociative Identity Disorder
multiple personality disorder
Depersonalization disorder
repeated episodes of depersonalization, characterized by feelings of unreality - Desc: narcolepsy
-
Irresistible episodes of refreshing sleep nearly every day for 3 mo
Either of:
abrupt loss of muscle tone
REM sleep while going to sleep or waking
20-40% experience hypnagogic or hypnopompic hallucinations - Desc: dyssomnias
-
Disturbances in sleep amount, quality or timing
insomnia
hypersomnia
narcolepsy
breathing-related sleep disorder
circadian rhythm sleep disorder - Desc: parasomnias
-
Aberrant sleep event, where the focus is the event, not the sleep quality
nightmares
sleep terrors - intense, anxious awakening without dreams
sleepwalking - Parasomnias by stage of sleep
-
Stages 3&4: sleep terror and sleepwalking
REM: nightmares and sleep paralysis - Family characteristics in anorexia according to Minuchin
-
Parental over-control
Lack of power or autonomy for the anorexic - Location of complex-partial seizures
- temporal or frontal lobes
- Defining characteristic of substance dependence
-
a maladaptive pattern of use, including cognitive, behavioral and psychological symptoms, usually including tolerance and withdrawal that is distressing or impairs functioning
at least 3 symptoms over a 12 month period
Tolerance
Withdrawal
Excessive use
Inability to quit
Time consuming acquisition
Severe personal impact - Time constraints on adjustment disorder
- Must occur within 3 mo of stressor and last no more than another 9
- Duration of a brief psychotic disorder
- 1 psychotic symptom for at least 1 day and no more than 1 month, with return to permorbid condition
- Def: delirium
-
syndrome with a disturbance of consciousness and either a change in cognition or perceptual disturbance
caused by medical condition and / or substance abuse - Def: obsessive compulsive disorder
- Recurrent, persistent, intrusive, distressing thoughts (obsessions) OR compulsive actions (compulsions) recognized as irrational or excessive
- Def: functional disorder
- Mental disorders not clearly caused by a physiological factor
- Wolpe's explanation of depression
- Depression is linked to anxiety and should be treated with systematic desensitization
- Factor associated with negative prognosis for ADHD
- Conduct disorders
- Cognitive impairments as a result of chronic alcoholism
- More effects visuospatial skills than verbal skills
- Core requirements of a diagnosis of separation anxiety disorder
-
Three symptoms including:
Fear that harm will come to a major attachment figure
But not necessarily an excessive need for attention - Strategies for treating OCD
-
deliberate exposure and thought stopping
relaxation training
paradoxical intent
covert sensitization
systematic desensitization - IQ criterion for borderline intellectual functioning
- 1-2 SD below the mean
- Types of headache pain *
-
Migraine - unilateral throbbing pain
Cluster - intense pain behind the eye
Tension - Side effects of ECT
-
Largely reversible memory deficits, though problems with autobiographical memory may persist for months
Unilateral ECT to the right hemisphere is associated with far fewer adverse side effects
However bilateral ECT is more potent - Def: dyspareunia
- painful intercourse
- Brain abnormalities in schizophrenia
- Enlarged ventricles
- Organic disorders that may cause a Mood Disorder
-
hallucinogens
PCP
hyper / hypo thryroidism
pancreatic CA
viral illness
stroke
but NOT pot - Wechsler IQ standard scoring
-
mean = 100
sd = 15 - Defense mechanisms used by people with narcissistic personality disorder (Millon)
-
Repression
Rationalization
Projection - Rate of post-partum major depression
- 10-20%
- Diagnostic criteria for Tourette's Disorder *
-
Multiple motor tics
One or more vocal tics
For at least a year - Diagnostic criteria for Somataform Disorders *
-
Physical symptoms not explained by a medical disorder
Undifferentiated - If fewer than 3 symptoms present for more than 6 mo
NOS if symptoms present for less than 6 mo - Gender prevalence of OCD *
- Equal in adult males and females, but higher incidence in young boys
- Primary difference between obese and non-obese people
- Inherited differences in metabolism
- Substances causing substance induced delirium *
-
Alcohol or sedatives
Hypnotics
Anxiolytics - IPT accounting of depression
-
Interpersonal relations
Personality
Symptom formation (but treated with medication) - Symptoms of cannabis intoxication
- dry mouth
- Symptoms of caffeine intoxication
-
diuresis
flushed face
periods of inexhaustability - Symptoms of alcohol intoxication
-
slurred speech
memory impairment
nystagmus (rapid, involuntary, oscillatory motion of the eyeball) - Psychological correlates of smoking
-
80% of quitters gain weight
Average weight gain is 7-9 lbs
Fear of weight gain inhibits attempts at quitting, and signs of weight gain trigger relapse
Higher depression rate
Cessation can trigger a depressive episode in smokers with depression history - Def: cataplexy
-
Episodes of sudden bilateral loss of muscle tone resulting in collapse, often in association with intense emotions
Occurs in about 70% of people with narcolepsy - Defining characteristic of antisocial personality disorder
- Lack of remorse
- Depression vs dementia
-
In depression only free recall is affected
In dementia both recall and recognition are affected - Treatment of choice for PTSD
-
Prolonged exposure
Not much added by stress inocculation training - Desc: PET scan (Positron Emission Tomography)
- Functional brain imaging technique providing information about metabolic and chemical activities of the brain such as blood flow
- Symptoms of hypoglycemia
-
Acute phase includes panic and anxiety
Chronic phase includes depression, psychosis and/or personality change - Learning disorder comorbitity
- ADHD - 20-25% of children with learning disorder are also diagnosed with ADHD
- Concordance rates for schizophrenia
-
1% in general population
10% among biological sibs - Incidence of Generalized Anxiety Disorder
- Diagnosed more frequently in females