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Assessment I
| Question | Answer |
|---|---|
| A) disturbed attachment behaviors -Does not seek comfort -No response to comfort offered B) persistent social and emotional disturbance -Lack of responsiveness -Limited positive affect -Irritable/sad/fearful episodes C) & D) pathogenic c | Reactive Attachment Disorder |
| Pathogenic Care | 1) Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults 2) Repeated changes of primary caregiver that limit opportunities to form stable attachments |
| A) Actively approaches and interacts with unfamiliar adults -No reticence to approach -Overly familiar behavior -No checking back -Willingness to go with stranger • B) not impulsivity • C) & D) evidence of pathogenic care • E) developmental age | Disinhibited Social Engagement Disorder |
| Is there a correlation between reactive attachment disorder and a lack of empathy/sociopathy? | No |
| A) exposure to actual or threatened death, serious injury, or sexual violation, by -Direct experience -Witnessing event -Learning about event occurring to close family member or friend -Experiencing repeated or extreme exposure to aversive details B) | Acute Stress Disorder |
| • A) exposure to actual or threatened death, serious injury, or sexual violation, by o Direct experience o Witnessing in person o Learning about event occurring to close family member or friend o Repeated or extreme exposure to details of trauma • B) | Post Traumatic Stress Disorder |
| Prognosis for delayed onset of PTSD? | Poor |
| Prognosis for length of sx | acute = good; chronic = guarded, >1 = poor |
| Most powerful correlation to completed suicide... | o Sx > 1 year o Childhood trauma o Comorbid MDD o Self-medicating |
| Why only some develop PTSD? | o Emotional processing theory |
| Treatment: activating the trauma-related fear structures, new info to correct them | o Imaginal exposure, in vivo exposure, cognitive restructuring o Edna Foa: EBP for PTSD (2009) |
| • A) exposure to 1+: death, injury, sexual violation o Direct experience o Witnessing occurring to others o Learning occurred to caregiver • B) 1+ intrusion sx: o Distressing memories o Recurrent nightmares o Dissociative rxns o Distress at exposu | PTSD (in Preschool Children) |
| Prognosis for PTSD in preschool (if tx is timely) | Excellent! |
| Is there a correlation to cannabis and ETOH in adolescents + significant correlation to suicide and risk taking in preschool children with PTSD? | Yes! |
| • A) sx in response to identifiable stressor, occurring within 3 months • B) distress or impairment • C) R/O other disorders or pre-existing disorder • D) R/O Bereavement • E) sx do not persist for more than additional 6 months | Adjustment Disorder |
| • A) death at least 12 months ago • B) since the death, 1+: o Yearning/longing for deceased o Intense sorrow and pain o Preoccupation with deceased o Preoccupation with circumstances of death • C) since the death, 6+ : o Difficulty accepting death | Persistent Complex Bereavement Disorder; Section III |
| Dissociative Disorders...ego dystonic or ego syntonic? | Could be either |
| Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body or actions | Depersonalization |
| Experiences of unreality or detachment with respect to surroundings | Derealization |
| • A) Depersonalization OR Derealization • B) intact reality-testing • C) distress or impairment • D) R/O substance-induced or medical • E) R/O schizphrenia, panic disorder, MDD, or other Dissociative | Depersonalization-Derealization Disorder |
| Predictors for DDD | Child physical or sexual abuse |
| • A) inability to recall important autobiographical info, usually of a traumatic or stressful nature, inconsistent with ordinary forgetting • B) distress or impairment • C) R/O substance or medical • D) R/O DID, PTSD, Acute Stress, Somatization Specif | Dissociative Identity Disorder |
| Dissociative disorder related to significant child physical and sexual abuse | Dissociative Identity Disorder |
| Dissociative Identity Disorder suicide rate | 70% attempt |
| • A) somatic sx (1+ that are distressing) • B) excessive thoughts, feelings and behaviors related to these somatic sx, at least 1: o Disproportionate and persistent thoughts o Persistently high level of anxiety about sx o Excessive time and energy dev | Somatic Symptom Disorder |
| Somatic Symptom - men or women? | women! |
| • A) preoccupation with illness • B) somatic sx not present • C) high anxiety about health • D) excessive health-related behaviors or maladaptive avoidance • E) chronic (> 6 months) • F) R/O other mental disorder (SSD, PD, GAD, OCD) | Illness Anxiety Disorder |
| Illness Anxiety Disorder - Types | Care-seeking or Care-avoidant |
| Subgroups of hypochondriacs with prevalence | 75% somatic sx are primary concern (= Somatic Sx Disorder) and 25% highly anxious and seeking sx (= Illness Anxiety Disorder) |
| Functional Neurological Symptom Disorder • A) 1+ sx that affect voluntary motor or sensory fx • B) incompatibility with recognized neurological or medical disease • C) sx not better explained by another disorder • D) distress or impairment | Conversion Disorder |
| Psychological Factors Affecting Medical Condition | • A) general medical condition • B) psych or behav adversely affect condition in 1+ ways: o Influence course o Interfere with treatment o Additional well-established health risks o Influence underlying pathophysiology to precipitate or exacerbate sx |
| • A) falsification of physical or psych signs or sx, or induction of injury or disease • B) presenting oneself to others as ill, impaired or injured • C) deception is evident even in absence of obvious external rewards • D) R/O Delusional Disorder or P | Factitious Disorder |
| • A) restriction of food intake leading to signif low body weight • B) intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain • C) disturbance in body image, undue influence of weight on self-esteem, lack | Anorexia Nervosa |
| Anorexia physical limits | BMI < 18.5 or below 10th %ile |
| • A) recurrent episodes of binge eating o Eating, in discrete period of time, amt of food definitely larger than most would eat in similar time o Lack of control during episode • B) recurrent inappropriate compensatory behaviors (e.g. vomiting, laxativ | Bulimia Nervosa |
| • Behavioral signs: o Binging, restriction of activities bc of embarrassment about weight, repeated dieting, eating little in public while high weight • Physiological signs: o Weight-related hypertension or fatigue, weight gain • Attitude shifts: o F | Binge Eating Disorder |
| Physical Effects of Disordered Eating | o Electrolyte imbalance o Damage to teeth and esophagus o Broken blood vessels o Loss of normal peristaltic and sphincter function o Protein deficiency o Changes in skin tone/color o Hair loss o Changes in body temperature o Fatigue o Erosion of |
| Biological theories of Eating Disorder | o Common pathway with depressive disorders o High heritability |
| Psychosocial theories of Eating Disorders | o Cultural pressure to be thin o Puberty = trap for women o Other feminist theories o Individual differences Low self-esteem, rigid, perfectionistic, no room to fail, controlling family = highest risk for anorexia |
| Psychodynamic theories of Eating Disorders | • Psychodynamic theories o Failure to separate/individuate o Issues with sexuality |
| Hilde Bruch’s theory of Eating Disorders | 1) inability to recognize hunger 2) lack of individuation Nutritional function is misused in service of emotional/interpersonal problems Incorrect/confusing early experiences (impingement, lack of sensitive care) Food = pacifier or reward |
| Effects of Chronic Dieting | • Yo-yo dieting o Changes metabolism o Alters set point o Tampers with hunger as reliable signal • Hibernation effect o Metabolism drop to “protect” them from starvation o 20% within 14 days on 1200 calorie diet o In beginning of diet, lose mainly |
| Management & Treatment of Anorexia | • First goal: keep patient alive o Hospitalization o Tube feeding/medical complications • Behavior tx used to restore eating and increase weight • Family tx: to relieve family of responsibility for patient’s weight and eating • Psychotx not an option |
| Management & Treatment of Bulimia | • Medical complications can be life-threatening o Electrolyte imbalances, dehydration, GI problems, parotid gland enlargement, gastric rupture • Hospitalization may be necessary o Medical emergency, out of control, or suicidal gestures • Antidepressan |
| Management & Treatment of Binge-Eating Disorder | • CBT: 50-80% reductions in binging, 30-70% remission, but little evidence of weight loss • IPT: 70% reduction in binging, 45% remission • Antidepressants useful with BED but not obesity |
| Sleep-Wake Disorders | Most sleep disturbances can be accounted for by medical condition or emotional disturbance |
| = disturbance in amount, timing, and quality of sleep Insomnia, hypersomnia, circadian rhythm sleep disorder, apneas, narcolepsy | Dyssomnias |
| inappropriate physiological sx during sleep-wake cycle Nightmares, sleep terrors, sleepwalking | Parasomnias |
| • A) dissatisfaction with quantity or quality of sleep (1+): o difficulty falling asleep, staying asleep, early morning wakening, non-restorative sleep, resistance to going to bed • B) distress or impairment • C) 3+ nights per week • D) 3+ mos • E) a | Insomnia Disorder |
| Insomnia higher in... | women, unemployed, unmarried |
| Comorbid with MDD % | 50% |
| Important criterion of Insomnia | Dissatisfaction |
| • A) self-reported excessive sleepiness o Recurrent sleep within same day o 9+ hours main sleep episode that is non-restorative o Sleep inertia, difficulty being fully awake • B) 3+ x week, 3+ months, at least 7 hours sleep • C) distress or impairmen | Hypersomnolence Disorder |
| • A) pattern of sleep disruption primarily due to alteration of the circadian system or misalignment betw system and external demands • B) leads to excessive sleepiness or insomnia or both • C) distress or impairment Subtypes: • Delayed Sleep Phase • | Circadian Rhythm Sleep-Wake Disorders |
| • A) incomplete awakening from sleep, 1+: o Sleepwalking o Sleep terrors • B) No/minimal dream imagery is recalled • C) amnesia for episode • D) distress or impairment • E) R/O substance or medical | Non-REM Sleep Arousal Disorders |
| Management & Treatment of Sleep-Wake Disorders | • Stimulus control therapy • Sleep restriction therapy • Relaxation therapy • Sleep hygiene education • Cognitive-Behavioral Therapy • Medication for sleep |
| Sleep Medications | o Benzodiazepines [highly addictive, chronic use affects sleep architecture—Klonopin, Xanax, Restoril] o Non-benzos [effects on GABA receptors, produce less rebound insomnia than benzos—Sonata, Ambien, Lunesta, Rozerem] o Trazodone (antidepressant—Desyr |
| • A) angry/irritable mood, defiant behavior, or vindictiveness for 6 mos, with 4+: o Loses temper o Touchy or easily annoyed o Angry & resentful o Argues with authority figures o Defies or refuses to comply o Deliberately annoys others o Bla | Oppositional Defiant Disorder |
| ODD under age 5... | most days for 6 months |
| ODD male/female? | More male before puberty, equal after |
| • A) recurrent outbursts w/out-of-control aggression, either: o Aggression toward other people, animals or property 2x week for 3 mos o 3 outbursts involving physical assault or destruction of property within 12 mos • B) aggression is out of proport | Intermittent Explosive Disorder |
| • Behavior where rights of others or major age-appropriate societal norms/rules are violated, by 3+ in last 12 mos, 1+ in last 6 mos: o Bullies, threatens o Initiates physical fights o Used weapon o Physically cruel to people o Physically cruel | Conduct Disorder |
| Most frequent dx in children to mental health services? | Conduct Disorder |
| One of the most costly mental disorders to society? | Conduct Disorder |
| Risk factors for Conduct Disorder | Parental Psychopathy, authoritarian parenting, permissive parenting, practices, middle children, more male siblings, school failure, learning disability, ADHD, |
| With limited prosocial emotions | callous and unemotional = sociopathy At least 2 over 12 months in multiple settings 1. lack of remorse or guilt 2. callous-lack of empathy 3. unconcerned about performance 4. shallow or deficient affect |
| Prosocial Conduct Disorder has more... | dysfunctional parenting, deficits in emotional processing, less sensitive to punishment cues, more thrill-seeking, less anxiety, stronger heritability (.81 vs .30) |
| Antisocial Personality Disorder males or females? | Males! |
| Management & Treatment of Conduct Disorder | -Most often, intervention is post-crisis -Parent management training -functional family treatment -cognitive problem-solving skills training -community-based interventions |
| Classes of drugs | 10! alcohol, caffeine, cannabis, hallucinogens, inhalant, opioid, sedative/hypnotic, stimulant, tobacco, unknown |
| Life risk of alcoholism | 15% |
| Prevalence of significant addiction | 10 = ETOH 25 = smoke 7 = illegal drugs |
| Biopsychosocial combination of effects | Drug effect + physiology + set + setting |
| • A) problematic pattern of ETOH use leading to impairment or distress, 2+ in 12 months: o Larger amounts o Persistent desire or unsuccessful effort to cut down o Time spent to obtain, use, or recover o Failure to fulfill obligations o Continued | Alcohol Use Disorder |
| Alcohol Use Disorder, Specify | Early Remission (3-12months) Sustained Remission (12 months+) In a controlled environment |
| • A) recent ingestion of ETOH • B) prob behav or psych changes • C) 1+ signs: o Slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, stupor or coma • D) R/O medical or other substance | Alcohol Intoxication |
| • A) cessation/reduction ETOH use • B) 2+, developing within hours of A: o Autonomic hyperactivity o Increased hand tremor o Insomnia o Nausea/vomiting o Transient visual, tactile, or auditory hallucinations o Psychomotor agitation o Anxie | Alcohol Withdrawal |
| Gambling Disorder | |
| Management & Treatment of Substance Use/Addictions | -Addiction recovery programs often run by people in recovery -Many inpatient programs are done in phases --phase 1 = 28 days --phase 2 = step-down outpatient care --phase 3 = maintenance/relapse prevention -Trend toward treating within own community |
| • A) Disturbance in attention and awareness (orientation to environ) • B) Develops rapidly, acute change, fluctuates in severity • C) Change in additional cognitive domain • D) A and C not due to severely reduced arousal • E) evidence from history, | Delirium |
| Key Features of Delirium | Key Features --fluctuating symptoms, abrupt onset, impairment in attention/orientation -Duration unusually brief -Language: rambling, incoherent, inability to name -Disoriented to time, person, place -The causes are usually systemic or metabolic - |
| Domains of Cognitive Function | -Complex Attention -Executive Function -Learning & Memory -Language -Perceptual-Motor Social cognition |
| • A) modest cognitive decline (1-2 SD below norms) in 1+ domains, based on concerns of indiv, knowledgeable informant, or clinician • B) Cognitive deficits are insufficient to interfere with independence • C) R/O Delirium • D) R/O MDD, schizophrenia | Mild Neurocognitive Disorder |
| Mild cognitive impairment is known as... | "mild cognitive impairment" |
| • A) substantial cognitive decline (2+ SD’s below norms) in 1+ domains, based on concerns of indiv, knowledgeable informant, or clinician • B) cognitive deficits are sufficient to interfere with independence • C) R/O Delirium • D) R/O MDD, schizophr | Major Neurocognitive Disorder |
| Major cognitive impairment is known as... | Dementia |
| Types... | due to alzheimer's; vascular; frontotemporal; TBI; Lewy Bodies; Parkinson's Disease; HIV; Medication-induced; Huntington's disease; Prion Disease; etc. |
| Essential Features: Personality Disorder | A. Enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture; 2+ of the following. --Cognition;Affectivity;Interpersonal functioning; Impulse control B.enduring pattern is inflexible and p |
| Types of Personality Disorder | Odd/Eccentric (Paranoid; Schizoid; Schizotypal) Dramatic/Emotional (Antisocial; Borderline; Histronic; Narcissistic) Cluster C; Anxious/Fearful (Avoidant; Dependent; Obsessive-Compulsive) |
| • A) pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, 4+: o 1. suspects others are exploiting, harming, or deceiving him/her o 2. preoccupied with unjustified doubts about the loyalty and trustwort | Paranoid Personality Disorder |
| • A) pervasive detachment from social relationships and restricted range of emotions in interpersonal settings, 4+: o 1. neither desires nor enjoys close relationships, inc. family o 2. almost always chooses solitary activities o 3. has little, if a | Schizoid Personality Disorder |
| • A) pervasive social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, 5+: o 1. ideas of reference o 2. odd beli | Schizotypal Personality Disorder |
| • A) pervasive disregard for and violation of the rights of others, since age 15, with 3+: o 1. failure to conform to social norms/laws o 2. deceitfulness (lying, conning, use of aliases) o 3. impulsivity or failure to plan ahead o 4. irritability | Antisocial Personality Disorder |
| • A) instability of interpersonal relationships, self-image, and affects, and marked impulsivity, 5+: o 1. frantic efforts to avoid real or imagined abandonment o 2. pattern of unstable and intense interpersonal relationships charac by alternating bet | Borderline Personality Disorder |
| • A) excessive emotionality and attention seeking, 5+: o 1. uncomfortable in situations where he/she is not center of attention o 2. interaction with others is often charac by inappropriate sexually seductive or provocative behavior o 3. displays ra | Histrionic Personality Disorder |
| • A) pervasive grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, 5+: o 1. grandiose sense of self-importance o 2. preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love o 3. believes h | Narcissistic Personality Disorder |
| • A) pervasive social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, 4+: o 1. avoids occupational activities that involve significant interpersonal contact bc fears of criticism, disapproval, or rejection o 2. unwilli | Avoidant Personality Disorder |
| • A) pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, 5+: o 1. difficulty making everyday decisions without excessive advice and reassurance o 2. needs others to assume responsibi | Dependent Personality Disorder |
| • A) pervasive preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, 4+: o 1. preoccupied with details, rules, lists, order, organization or schedules to the extent | Obsessive-Compulsive Personality Disorder |
| Personality disorders Egosyntonic? | Yes |
| Prevalence rate for personality disorders | Avoidant Personality Disorder & Obsessive Compulsive Personality Disorder = Highest Antisocial and Narcissistic Personality Disorder = Lowest |
| New personality disorder diagnosis | • Borderline PD • OCPD • Avoidant PD • Schizotypal PD • Antisocial PD • Narcissistic PD • PDTS = Personality Disorder Trait Specified |
Created by:
egirschick
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