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Axis II Disorders

Behavioral Medicine

MR defn IQ <70; limitations in multiple skill domains & adaptive functioning. Must manifest before age 18
MR classifications by IQ: Mild (55-70), moderate (35-55), severe (20-35); profound (<25)
Hypotonia, oblique palpebral fissures, flattened skull, short inward-curving fingers, single palmar transverse crease, weak Moro reflex = Down syndrome
Large, long head / ears; short; hyperextensible joints; macroorchidism; intellectual decline during puberty; often comorbid ADHD = Fragile X syndrome
Compulsive eating / hyperphagia / obesity; hypogonadism; hypotonia; small hands = Prader-Willi syndrome
Severe MR; microcephaly; low set ears; oblique palpebral fissures; hypertelorism; micrognathia = Cri du Chat syndrome
Hyperactive; erratic behavior; eczema; N/V, convulsions; stereotypies; severely impaired communication = Phenylketonuria
Axis II personality disorders as clusters of symptoms A. Odd-Eccentric; B. Dramatic-Erratic; C. Anxious-Fearful
Personality disorders: Odd-Eccentric Cluster Paranoid, Schizoid, Schizotypal
Personality disorders: Dramatic-Erratic cluster Antisocial, Borderline, Histrionic, Narcissistic
Personality disorders: Anxious-fearful cluster Avoidant, Dependent, Obsessive-Compulsive
Cluster A PD: pattern of withdrawal, inhibition / absence of emotional expression, shy; bland / constricted affect = Schizoid PD
Cluster A PD: thought & behaviors suggesting schizophrenia w/o sxs of psychosis = Schizotypal PD (3% of population)
Cluster A PD: suspiciousness, delusions of persecution / grandeur w/o hallucination; global, excessive, or irrational suspicion = Paranoid PD (0.5 – 2.5%)
Cluster B PD: behaviors deviating from norms, rules, & laws; no remorse = Antisocial PD (3% M; 1% F); often conduct disorder as kids; runs in families; transient or poor urban areas
Cluster B PD: excessive, impulsive behaviors, intense brief chaotic relationships, promiscuity, substance abuse; splitting; chronic anger; suicidal threats; depression = Borderline PD (1-2%, F>M)
Borderline PD lab workup Abnormal dexamethasone suppression & thyrotropin tests; possible sleep disturbance
Borderline PD mgmt. Psychotherapy is tx of choice; meds for specific personality problems
Cluster B PD: emotionality, self-absorption, attention seeking; tantrums = Histrionic PD (2-3%)
Cluster B PD: grandiose, self-important; arrested development / infantile = Narcissistic PD (1%); runs in families
Cluster C PD: inhibited social behaviors, exquisitely sensitive to perceived negative eval; feel inadequate = Avoidant PD (5-10%)
Cluster C PD: dependent / submissive behavior; longstanding pathologic relationship with one person = Dependent PD (F>M); may tx panic attacks with imipramine
Cluster C PD: preoccupied with order, perfectionism, control; emotional constriction; inflexible, inefficient = Obsessive Compulsive PD (M>F, oldest kid, runs in families)
Schizoid vs schizotypal personality disorder Schizotypal: superstitious, isolated, suspicious, eccentric, odd speech. Schizoid: shy, withdrawn, avoids close relationships
Created by: Abarnard