Diagnosis and Psychopathology; DSM 5- EPPP Prep

compulsions (OCD)

(1) Repetitive behaviors (hand washing, ordering, checking) or other mental acts (praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly; (2) Behaviors or mental acts are aimed at preventing or reducing anxiety or distress, prevented some dreaded event or situation; however these mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

Agoraphobia (diagnostic criteria)

(A) Involves marked fear or anxiety about 2 of the 5 situations: 1. Using public transportation 2. Being in open spaces 3. Being in enclosed spaces 4. Standing in line or being in a crowd 5. Being outside of the home alone (B) Fears or avoids these situations because escape might be difficult or not available if panic like symptoms are developed. (C) symptoms provoke fear or anxiety (d) active avoidance (e) out of proportion to actual danger (f) persistent fear and anxiety- 6 months or more (g) clinically significant distress or impairment (h-i) not explained by another medical or mental disorder

Autism Spectrum Disorder

(Neurodevelopmental) Characterized by persistent problems in social interaction and communication across a range of activities, including reduced ability to share emotions and interests, and poor ability in communication and understanding both verbal and nonverbal cues and gestures. Also indicated by repetitious behaviors and patterns, insistence on sameness in routines, and fixation on restricted interests. Heightened sensitivity or lack thereof to environmental sensory stimuli.

communication disorders

(Neurodevelopmental) Persistent difficulties, with onset during early development in the learning and use of language in its various forms (written, spoken) due to deficits in comprehension or production. Deficits are significantly below accepted age norms. Manifested by reduced vocabulary, inability to express oneself due to limited sentence structure, and impaired discursive abilities. Not attributable to an underlying medical condition.

Stereotypic Movement Disorder

(neurodevelopmental) a motor disorder in which the individual voluntarily repeats nonfunctional behaviors, such as rocking or head banging, that can be damaging to his or her physical well-being

Insomnia Disorder (co-morbidity)

*40-50% of people with this sleep-wake disorder also suffer from a co-morbid condition *medical- diabetes, coronary disease, pulmonary disease, athritis, fibromyalgia-- insomnia increases the risk of medical conditions mental health- bipolar, depressive, anxiety- insomnia could be an early symptom *could engage in substance use to manage functionality

Panic attacks (in children)

*6 to 12-year-olds are capable of experiencing these attacks, typically manifested as chest pain, tachycardia (rapid heart rate), shortness of breath, and refusal to go to school. · Onset for Panic Disorder typically occurs between late adolescence and the mid-30s. · A small number of cases do begin in childhood. · Unclear whether children have the cognitive ability to catastrophize

Binge eating disorder (associated features)

*Approximately 20% of individuals in weight-control programs suffer from this dx *Occurs in normal weight, overweight, and obese people *Approximately half of candidates for bariatric surgery *Better response to treatment than other eating disorders *Tend to be older than sufferers of anorexia and bulimia *Higher rates of psychopathology than non-binging obese individuals

Factitious disorder

*falsification of medical or psychological signs and symptoms in oneself or others *misrepresenting or simulating without obvious reward. *could have an actual medical condition, but act more impaired Example: report of feelings of suicidality or depression following the death of a spouse; but they may not even have been married! Doctoring lab results; inducing symptoms *may have an actual medical disorder as well; may be manipulating results to make it seem worse. *specifiers: single episode or recurring episode (2 or more falsifications)

Depression (risk factors)

*family history of depression increases the risk of childhood depression more than any other one factor. *maternal depression increases the risk of childhood depression by a factor of 3 to 5. *The presence of depression in a parent can lead to depression in multiple ways, such as genetics, marital discord, and poor parenting skills. *substance abusing parents, a divorce, parental unemployment, frequent moves, and illness. Research findings show having a biological parent with depression increases an offspring's risk for major depression. What may be surprising however is that the risk is similar whether one or both parents experience major depression. Studies also indicate maternal and paternal depression affect biological offspring similarly in terms of rates of major depression.

Anxiety Disorders (age issues)

*most common psychiatric disorder in older adults, with generalized anxiety disorder being the most prevalent. *older adults also may have more co-morbidities · Older and younger adults with anxiety have been found to benefit about equally from cognitive-behavioral therapy (CBT) and pharmacotherapy. · Underdiagnosis is more common among older adults, as well as undertreatment of anxiety disorders compared to younger adults. · older adults are more likely than younger adults to attribute anxiety symptoms to physical health problems and therefore more likely to see a medical professional instead of a mental health professional for help.

narcolepsy (cataplexy)

*sudden muscle weakness triggered by strong emotions like embarrassment, laughter, surprise, or anger. A person who has this might try to suppress emotions. *can cause your head to drop, your face to droop, your jaw to weaken, or your knees to give way. Attacks can also affect your whole body and cause you to fall down. *occurs a few times a month with narcolepsy *Occurs in very few other conditions. *70% of people with narcolepsy are thought to have this Not everybody with narcolepsy has this, but almost everybody who has this has narcolepsy. So if you have this, you most likely have narcolepsy.

Insomnia Disorder (Specifiers)

*with non-sleep disorder mental comorbidity- including substance use disorder *with other medical co-morbidity- *with other sleep disorder Also: episodic (at least 1 month; <3 months), persistent, or recurrent (2 or more episodes in a year)

anorexia nervosa (treatment)

-Therapy for this feeding/eating disorder is multidisciplinary --> weight restoration & psychotherapy -Plan w/ pt, regular mealtimes, varied & moderate intake, gradually reintroduce feared foods -Focus on benefits & life-sustaining aspects of food (reason to eat) -family therapy- family lunch (Minuchin)

Cyclothymic Disorder (differential diagnosis)

-differentiated from substance or medication induced bipolar; Bipolar with rapid cycling- frequent marked shifts; and Borderline personality disorder. Comorbidity- more likely to have ADHD

anorexia nervosa (prevalence & course)

.4% among girls; 10:1 female to male ratio. Begins during adolescence or young adulthood; associated with a stressful life event (leaving for college); late onset = longer duration of illness. elevated suicide risk

Bipolar Disorders (Prevalence and Course)

.6 % Less common than depressive disorders Men and women are equally susceptible No consistent differences in the prevalence among ethnic groups or across cultures Develops mainly in late adolescence or early adulthood; mean age is 18; can occur at any course in the lifespan. More than 90% of people who have a manic episode will have recurrent episodes. People suffering face problems on the job and in their relationships. No gender differences, but women experience more rapid cycles and are more likely to get treatment. Severe mental illnesses. Genetics is a strong risk factor

Generalized anxiety disorder (prevalence)

.9 % adolescents; 2.9% adults in the US; Females 2x as likely as males. prevalence peaks in middle age

Selective mutism (prevalence)

0.03-1%- rare social anxiety disorder; more likely to manifest in young children than adults.

OCD (prevalence)

1.2% in US, similar internationally; Females slightly higher than males, though more males are affected in childhood. Occurs around the globe with similar presentation

Agoraphobia (prevalence & course)

1.7% of adults and adolescents; females as likely as males; peaks in early adulthood- mean age: 17 years ; heritability: 61%; Preceded by other anxiety disorders (separation anxiety disorder, specific phobias, panic disorder); could be associated with families with low warmth and high demand & overprotectiveness (Weiss, 2014)

Insomnia Disorders (prevalence)

1/3rd of adults report symptoms of this slee-wake disorder; 10-15% experience daytime impairments; Most prevalent of all sleep disorders; More prevalent among females- 1.44:1 40-50% present with a co-morbid mental disorder!

major depressive disorder (prevalence & course)

12-month prevalence rate for Major Depressive Disorder of about 7%, with the rate for individuals ages 18 to 29 being 3x times the rate for individuals ages 60 and older. Younger people are more depressed. *Starting in early adolescence, the rate for females is 1.5 to 3 X the rate for males. The peak age of onset is the mid-20s, but the course, number of episodes, and likelihood of full recovery vary. *This gender difference becomes evident in mid-adolescence. Prior to puberty the incidence of Major Depressive Disorder is about equal for boys and girls.

Depersonalization/Derealization disorder (prevalence & course)

2% males & females same prevalence for this Dissociative disorder mean age- 16 years; can start in early or middle childhood; only 5% experience onset after the age of 25; does not happen after age 40- check other medical issues symptoms wax and wane for some individuals, but sometimes it can be persistent for years

Panic Disorder (prevalence)

2-3% in US and Europe; less among Latinos, Asian folks and Black folks in the US; more for White Americans and Native Americans. females more impacted 2:1, starting in adolescence, observable by age 14. Panic attacks occur in children, but the prevalence of panic disorder is low in children under 14 (.4%)

disruptive mood dysregulation disorder (prevalence & course& etiology)

2-5% range; rates are higher for school-age boys; very low rates of conversion to Bipolar; high risk for depressive or anxiety disorders in adulthood. -mostly boys in clinical populations -kids have complicated psycholgical histories; may also meet the criteria for ADHD & anxiety disorder -face-emotion labeling deficits & perturbed decision making and cognitive control.

Social anxiety disorder (comorbidity)

2/3 of people with this anxiety disorder have another anxiety disorder, 20% major depressive (from chronic isolation) disorder and self medicate with alcohol and drugs. Frequently co-morbid with bipolar or body dysmorphic: Example: an individual may have body dysmorphic because of a perceived problem with the shape of her nose, and this because of being worried she sounds unintelligent. Performance type is co-morbid with avoidant personality disorder. Children: co-morbidities with ASD and selective mutism are common.

Bipolar (suicide risk)

40-60%- This disorder may account for 1/4 of all completed suicides; more likely to occur when symptoms are lifting. Successful medication treatment could help prevent suicide.

Social Anxiety Disorder (prevalence & Course)

7% in US; comparable in children and adults; less common in older folks: 2-5%; higher rates in females: gender difference more pronounced in teens and young adults. -Median onset- 13 years. May follow a stressful or humiliating situation (being bullied). Teens- broader pattern of fear & anxiety; dating Younger adults- higher for specific situations Older adults- disabilities related to aging (tremors) influenced by social inhibition, which has a genetic component

Bipolar I Disorder

A Clinical depressive disorder characterized by the presence of at least one lifetime manic episode- distinct period involving an abnormally and persistently elevated, expansive, or irritable mood and increased activity or energy. Episodes last at least one week and cause marked mental impairment in functioning, require hospitalization, or include psychotic features. Treatment of choice: Lithium or anti-seizure medication. Evolution in the thinking about classic manic-depressive disorder.

Psychosis (Bipolar)

A break from reality, a condition which more often happens during a manic episode and even a depressive episode (but never with a hypomanic episode). Psychosis involves hallucinations (experiencing things that are not real) and/or delusions (believing things that are not real). Mood congruence and incongruence are used to describe it.

Bipolar II Disorder

A clinical depressive disorder characterized by the presence of at least one hypomanic episode and at least one major depressive episode. A hypomanic episode lasts for at least 4 days and is similar to a manic episode but does not cause marked impairment or require hospitalization. A major depressive episode lasts at least 2 weeks & includes 5 or more characteristic symptoms, one of which must be depressed mood or loss of interest or pleasure.

Panic attack/disorder (general characterstics)

A panic attack is an abrupt surge of fear or intense discomfort that reaches a peak within minutes. It could be expected (known trigger) or seem to come out-of-the-blue. The disorder involves repeated, unexpected panic attacks (no obvious cue or trigger) and for at least one month after, one or both of intense worry about another panic attack and avoidance.

Disinhibited Social Engagement Disorder

A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults, and 2 of the following: (1) reduced or absent reference in approaching & interacting with adults; (2) overly familiar behavior (3) diminished or absent checking with an adult caregiver after venturing aware (4) willingness to go with an adult with no hesitation Evidence of insufficient care: social neglect or deprivation; repeated changes in primary caregivers; unusual circumstances; at least 9 months old

Dissociative identity disorder

A rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. Also called multiple personality disorder. The identities assume control of the person's behavior, accompanied with the inability to recall important personal information is too extensive to be accounted for by ordinary forgetfulness. often misdiagnosed for Bipolar II-- rapid shifts in moods (Bipolar, slower shifts) "I feel like someone else wants to cry with my eyes"

semantic paralexias

A reading error that involves producing a response that is similar in meaning to the target word (e.g. dog for cat; leg for arm); happens to people with deep dyslexia

Major Depressive Episode (Bipolar Dx)

A. 5 or more symptoms present during the same 2-week period and represent a change from previous functioning; one symptom is either a depressed mood or loss of interest or pleasure 1. Depressed mood most of the day, nearly every day from subjective report or observation (in children - can be irritable mood) 2. Markedly diminished interest or pleasure in all, or almost all activities most of the day 3. Significant weight loss when not dieting or weight gain (change of more than 5% in a month); OR decrease in appetite nearly every day- (children fail to make expected weight gain); 4. Insomnia or hypersomnia nearly every day 5. psychomotor agitation or retardation every day that is observable by others 6. Fatigue or loss of energy every day 7. Worthlessness or excessive guilt 8. Diminished ability to think or concentrate, indecisiveness every day 9. Recurrent thoughts of death; recurrent suicidal ideation without a specific plan or suicide attempt B-C. Significant distress or impairment; not attributable to another condition or substance.

Reactive Attachment Disorder (diagnostic criteria)

A. Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both: (1) rarely or minimally seeks comfort when distressed (2) rarely or minimally responds to comfort Persistent social and emotional disturbance that has 2: (1) minimal social and emotional responsiveness to others (2) limited positive affect (3) episodes of unexplained irritability, sadness, or fearfulness evident during non-threatening interactions with caregivers Patterns of extremes of insufficient care, by at least 1: (1) social neglect or deprivation- lack of having basic needs met by adults (2) repeated changes in primary caregiver (3) rearing in unusual settings (high child-caregiver ratios) No ASDs, between 9 months - 5 years

Manic episode (Bipolar; dx)

A. Distinct and abnormally and persistently elevated, expansive, or irritable mood &/or persistently goal directed activity or energy, lasting at least one week and present nearly every day. B. 3 or more of symptoms present during this elevated period; that are different from typical behavior: 1) inflated self-esteem or grandiosity 2) decreased need for sleep 3) more talkative; pressure to keep talking 4) Flight of ideas/ racing thoughts 5) Distractibility- attention drawn to unimportant stimuli 6) Increase in goal-directed activity or psychomotor agitation 7) Excessive involvement in activities that have a high potential for painful consequences- sexual indiscretion; buying sprees C-D. Manic episode caused marked impairment; not attributable tno any substances or medical conditions- psychotic features are distinguishing

Hypomanic episode (bipolar, dx)

A. Distinct period of abnormally & persistently elevated, expansive, or irritable mood and persistently increased activity or energy, lasting at least 4 consecutive days, most of the day. 3 or 4 of the symptoms which are markedly different from usual behavior: 1. Inflated self-esteem or grandiosity 2. Decreased need for sleep 3. more talkative than usual; pressure to keep talking 4. Flight of ideas or thoughts racing 5. Distractibility- attention drawn to unimportant content 6. Increase in goal-directed activity or psychomotor agitation 7. Excessive involvement in activities that are likely hurtful - indiscretion; shopping sprees C-F: unequivocal change; not typical; Observable by others; NOT severe enough to necessitate hospitalization, or cause marked impairment; not because of substances or other medical conditions

Generalized Anxiety Disorder (diagnostic criteria)

A. Excessive anxiety and worry, occurring more days than not for at least 6 months B. Difficult to control worry C. 3 or more of these symptoms (or 1 in children): 1. Restlessness; feeling keyed up 2. Easily fatigued 3. Difficulty concentrating/mind going blank 4. Irritability 5. muscle tensions 6. sleep disturbance D. significant impairment in areas of functioning E. Not attributable to substances; other mental conditions

Specific phobia (diagnostic criteria)

A. Marked fear or anxiety about a specified object or situation (flying, heights, animals, receiving an injection, seeing blood) B. Phobic object or situation almost always provokes immediate fear or anxiety C. Phobic object or situation is actively avoided or endured with intense fear or anxiety D. Fear or anxiety is out of proportion to actual danger posed by the specific object or situation & sociocultural concept E. Fear or anxiety is persistent, typically lasting for 6 months or more F. Fear or anxiety causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. G. Disturbance is not better explained by another mental disorder- agorophobia, panic, OCD, PTSD, Separation anxiety disorder, social anxiety disorder

OCD (Diagnostic criteria)

A. Presence of obsessions, compulsions, or both B. The obsessions or compulsions are time-consuming (take more than 1 hour per day); cause clinically significant distress or impairment C. Not attributable to substances or another medical condition D. Not better explained by another disorder: excessive worries in GAD; preoccupation with appearance in body dysmorphic; other OCD related disorders

Disruptive mood dysregulation disorder (diagnoses)

A. severe, recurrent temper outbursts manifested verbally (verbal raging) and behaviorally (physical aggression towards people or property) that is grossly out of proportion to the provocation. B. Temper outbursts are inconsistent with developmental level. C. temper outbursts occur 3 or more times/week D. The mood between temper outbursts is persistently angry most of the day. E. A-D present for more than 12 months, no period of more than 3 months without symptoms. F. A-D are present in 2 out of 3 settings (home, school, with peers) and are severe in at least 1 setting. G. Child must be between 6-18 years old. H. Age of onset has to be before 10 I. No dx of manic or hypomanic - if symptoms last more than 1 day J. Behaviors could not be better explained by another disorder- cannot co-exist with ODD, intermittent explosive disorder, bipolar. Can coexist with major depressive disorder, ADHD, conduct, substance use disorder. K. No substance or neurological condition can explain symptoms

Generalized anxiety disorder (features supporting dx)

Accompanied by muscle tension, trembling, twitching, feeling shaky, muscle aches or soreness, somatic (sweating, diarrhea), exaggerated startle reflex

Hoarding disorder

An OCD-related disorder indicated by chronic difficulty getting rid of possessions regardless of their value. Stems from the need to save items associated with distress of being without them. The accumulation of items is so excessive it makes living areas difficult.

CE credits and APA

An organization is approved by the APA to sponsor continuing education programs. The sponsor then becomes responsible for each program. The APA periodically asks for reports from the sponsor, but the specific program is not endorsed, sanctioned, or approved by the APA. Only the overall sponsorship is approved by the APA.

Haldol (haloperidol)

Antipsychotic drug that is especially effective for controlling violent behavioral outbursts experienced by schizophrenic patients.

Social Anxiety Disorder (general features)

Anxiety disorder indicated by inordinate fear of situations in which the person may be subject of evaluation by others; could consist of meetings, conversations with unfamiliar parties, being observed, or giving speeches. The person is greatly concerned they may behave in inappropriate ways that would be negatively construed (leading to rejection, embarrassment, ridicule, or being offended). Social situations are avoided or tolerated with great anxiety. Blushing is the hallmark response.

Schizoprenia (suicide risk)

Approximately 5-6% of individuals with this psychotic disorder die by suicide; 20% attempt suicide; many more have suicidal ideation. May be in response to hallucinations about self-harm. Younger males may be at higher risk for suicide.

When fee arrangements should be made with clients

As early as is feasible in a professional or scientific relationship, psychologists and recipients of psychological services reach an agreement specifying compensation and billing arrangements.

anti-depressants (mechanisms)

Associated with deficits or imbalances of some of the nuerotransmitter chemicals in the brain. Antidepressants work to restore the balance of neurotransmitters such as seratonin, dopamine, and norepinephrine.

Bipolar Disorder (brain abnormalities)

Associated with volume decrease in hippocampus- mood and memory processing; thinner cortical gray matter in frontal, temporal & parietal regions

persecutory delusion (psychotic disorders)

Belief that one is going to be harmed or harassed by an individual or group. Most common types.

Schizophrenia (etiology & prevalence)

Biological relatives of individuals with this disorder have an increased risk of developing it. The more similar their genes are, the greater the risk. · Risk for a monozygotic (identical) twin of a schizophrenic proband to be diagnosed with Schizophrenia is about 46%. (2.5X more likely than fraternal twin) · Risk for dizygotic (fraternal) twins is about 17%. · Likelihood of one of the parents or a non-twin sibling having or developing Schizophrenia is about 10%. · African American folks are slightly more at-risk than White folks, but this could be because of diagnostic issues · diathesis-stress, or vulnerability, theory (Mednick, 1958)- this disorder occurs in people who are psychologically predisposed when confronted with an adverse and stressful environment

ADHD (etiology)

Biological: genetic (very strong genetic component and tends to run in families) Neurological: Abnormalities in the pre-frontal cortex (higher order cognitive functions); cerebellum (coordinates motor function); Caudate nucleus and putamen (which are part of the basal ganglia and are involved in the control of movement)

Difference between OCD and anxiety disorders

Both involve recurrent thoughts, avoidant behaviors, repetitive requests for reassurance. But the recurrent thoughts in anxiety disorders are about real-life concerns; not odd, irrational, or magical in nature. Compulsions are also linked to obsessions.

FASD (implicated brain regions)

Brain imaging research has found that the basal ganglia, hippocampus, and frontal lobes are most likely to be negatively impacted by repeated exposure to alcohol during prenatal development. Other commonly affected areas include the, cerebellum, corpus callosum and hypothalamus.

Generalized anxiety disorder (treatment)

CBT is an empirically supported treatment for this anxiety disorder; SSRIs or SSNRIs augmented with benzodiaspene

Panic Disorder (treatment)

CBT- Panic Control Therapy (PCT)- brief form of CBT that involves pyschoeducation, cogntive restructuring, relaxation-based strategies, interoceptive exposure (exposure to the physical symptoms associated with panic attacks) In vivo exposure. Medicine: TCA (imipramine), SSRI, benzodiazepine; medication not usually used alone (high rate of relapse)

Disorganized Thinking/ Speech (psychotic disorders)

Can be inferred by someone's speech; switching from one topic to the next (loose associations); answers to questions are unrelated (tangentiality); rarely, completely incoherent (word salad). Severity might be difficult to evaluate.

Clozaril (clozapine, side effects)

Can cause agranulocytosis- condition affecting the immune system in which white blood cells (granulocytes) are depleted. Patient's ability to fight infections is compromised. Patients should have their white blood cells checked every two weeks.

dysfunctional beliefs (OCD)

Can include an inflated sense of responsibility, tendency to overestimate threat, perfectionism, intolerance of uncertainty, over-importance of thoughts (believing that having a forbidden thought is as bad as acting on it); the need to control things.

Schizophrenia (grossly disorganized or abnormal motor behavior)

Can range from childhood silliness to staring, grimacing, echoing, to catatonia- resistence to instructions, bizarre posture

anxiety disorders

Category of disorders that share features of excessive fear and anxiety relative to actual danger posed and related behavioral disturbances, including maladaptive behavior to avoid anxiety-provoking entity. Typically last for 6 months. Include: Separation Anxiety Disorder, Selective Mutism, Specific Phobia, Social Anxiety Disorder, Panic Disorder, Agorophobia, Generalized Anxiety Disorder and Substance/Medication-Induced Anxiety Disorder. Can be co-morbid, but disorders differ in the types of objects or situations that induce fear, and associated cognitive ideation. 2x as likely in females.

Brief Psychotic Disorder (general characteristics)

Characterized by sudden onset of positive psychotic symptoms: hallucinations, delusions, disorganized, incoherent speech, grossly disorganized catatonic behavior. sudden onset- the change is within 2 weeks duration: between 1 day- 1 month; then full return to previous functioning. Typical experience: emotional turmoil or overwhelming confusion. Disturbance is brief but intense level of impairment.

Selective mutism (general features)

Children with this anxiety disorder do not initiate speech or reciprocally respond when spoken to by others; Lack of speech in social interactions with children and adults. These children only speak in their homes with immediate family members, but not even in front of close friends or second degree family members such as grandparents or cousins. Sometimes use non-spoken means (grunting, pointing). Could be accompanied by excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, negativism, temper tantrums, mild oppositional behavior.

Separation Anxiety Disorder (Co-morbidity)

Children- Highly co-morbid with GAD and specific phobia; Adults- Common co-morbidities- specific phobia, PTSD; panic disorder, GAD, social anxiety disorder, agorophobia, OCD; personality disorders; depressive and bipolar

Reactive Attachment Disorder (RAD; general characterisitcs)

Chronic pattern of emotionally withdrawn behavior with adult caretakers; before age 5. Child rarely seeks comfort when distressed and is minimally responsive to comfort. Could be the result of receiving extremely insufficient care.

disruptive mood dysregulation disorder (functional consequences)

Chronic, severe irritability- marked disruption in child's family life & peer relationships & school performance. Low frustration tolerance makes school performance and participation in other activities hard. Family life is disrupted by outbursts and irritability; trouble initiating and sustaining friendships. comparable levels of disruption to bipolar- severe disruption in life of child & family. Dangerous behavior: suicidal ideation, severe aggression; hospitalizations.

Symptom dimensions common in OCD disorders

Cleaning, symmetry obsessions, ordering & counting compulsions, forbidden or taboo thoughts, harm (fears of harm to onself or others related to checking compulsions). High cognitive component have insight as the basis for specifiers.

Schizophrenia (diagnostic criteria)

Client must have 2 of the following symptoms: 1) hallucinations (core positive symptom); 2) delusions (core positive symptom; 3) disorganized speech (core positive symptom); 4) severely disorganized or catatonic behavior, negative symptoms. For diagnostic, a client must have 1 of the 3 core positive symptoms. The client's level of functioning must be significantly below that of onset.

Bulimia nervosa (co-morbidity)

Co-morbidity is common with this feeding/eating disorder; most experience at least one other disorder. *Depressive symptoms; bipolar *anxiety; social anxiety *substance use (alcohol = 30%) *borderline personality disorder

Specific phobia (specifiers)

Common for people to have multiple phobias- Average- fear of 3 objects or situations; 75% fear more than 1; need to give multiple diagnostic codes: animal, natural environment, blood-injection-injury, situational (airplanes/enclosed spaces); other (loud sounds; costumed characters)

enurisis (treatment)

Common treatment for this elimination disorder: urine alarm/moisture alarm-- bell & pad begins to ring as soon as the sleeping child urinates. evaluation: Found effective, but 1/3rd of kids relapse after 6 months. medication: anti-depressant imipramine; antidiuretic hormone desmopressin- both associated with higher relapse rates than the alarms.

Specific phobia (prevalence)

Community prevalence of this anxiety disorder is 7-9% for adults in the US and Europe; lower in Africa and Asia & Latin America. 5% in children and 16% in teens. Lower in older folks. Females more affected than males: 2:1

Cyclothymic Disorder (diagnosis)

DX Criteria: A. For at least 2 years (at least 1 year in children), numerous periods in which hypomanic symptoms that do not meet the criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet the criteria for a depressive episode. B. The periods have been present for at least half the time and the individual has not been without symptoms for more than 2 months. C. Symptoms not better explained by a disorder on the schizophrenia spectrum d. Symptoms not attributable to physiological effects of substances F. Cases clinically significant distress. If there is a major depressive episode or hypomanic episode that meets full criteria, dx could change (15-50% risk)

Catatonic behavior (psychotic disorders)

Decrease in reactions that is dramatic. From resistance to instructions to rigid, inappropriate, or bizarre postures; to a complete lack of verbal and motor responses-- mutism and stupor. with excitement- excessive motor activity without a cause. Could be features of other disorders, such as Bipolar; and also medical conditions.

avoidance symptoms

Deliberate attempts to avoid the memories, people, places, activities, and objects associated with the trauma as manifested by at least 1: attempts to avoid distressing thoughts, feelings or memories reminiscent of the traumatic event; avoidance of external stimuli that may serve as reminders

MAOIs (effectiveness for these disorders)

Depression and atypical or treatment-resistent depression; panic disorder with agorophobia, social phobia, Parkinson's

Premenstrual Dysphoric Disorder

Depressive disorder involving: 1) Symptoms must be present during the majority of the mentstrual cycle, with 5 symptoms manifesting during the final week; 1) severe mood swings; 2) increased emotional sensitivity; 3) interpersonal friction; 4) significantly depressed mood; 5) considerable anxiety or emotional agitation. At least 1 symptom must manifest with the 5 above: 1) decreased interest in daily activities; 2) difficulty in focus and concentration; 3) significant lethargy; 4) marked changes in eating habits; 5) insomnia or hypersomnia; feelings of being overwhelmed; 6) notably physical changes (bloating, swelling, muscle pain).

Lithium (side effects)

Derived from a mineral that occurs naturally in the body; mood stabilizer that is used to treat Bipolar Disorders (manic & depressed moods); Side effects: excessive thirst, frequent urination, loss of motor coordination, blackouts, seizures, slurred speech, hallucinations, altered heartbeat, changes in eyesight, itches, rashes, swelling of eyes, lips, face, tongue, throat, hands, ankles, lower legs. When this is prescribed blood levels should be monitored; kidney & thyroid function.

Adjustment Disorders

Development of emotional or behavioral symptoms in response to 1 or more psychosocial stressors with 3 months of onset of stressors. Symptoms cause marked distress not proportional to severity of stressor; significant impairment in functioning; symptoms remit within 6 months; specifiers

Separation Anxiety Disorder (diagnostic criteria)

Developmentally inappropriate (A), and evidenced by at least 3 of the following: 1. Recurrent, excessive distress when anticipating or experiencing separation from home or major attachment figures 2. Persistent, excessive worry about major attachment figures or possible harm to them, such as illness, injury, disasters or death 3. persistent worry about experiencing an untoward event (getting lost; being kidnapped; having an accident) that causes separation from an attachment figure 4. Persistent refusal to go out, away from home, to school or work or elsewhere because of fear of separation 5. Persistent or excessive fear about being alone, without major attachment figures 6. Persistent reluctance to sleep away from home or go to sleep without a major attachment figure 7. Repeated nightmares involving the theme of separation 8. Repeated complaints of physical symptoms (headaches; stomachaches; nausea) when separation is anticipated. Fear or anxiety must last 4 months in children; 6 months in adults (B) . Significant distress or impairment (C); Not related to another impairment, such as ASD; GAD, agorophobia (D).

Delusional Disorder (diagnosis)

Diagnosis: A. Presence of 1 or more delusions with a duration of 1 month or longer; B. Criterion A not met for Schizophrenia C. Functioning is not markedly impaired; behavior is not bizarre or odd D. If manic or major depressive episodes- these are brief compared to delusional periods E. Not better explained by another medical or psychological disorder Specify type of delusion (erotmanic, grandiose, persecutory, somatic, jealous) Differential dx from OCD, body dysmorphic, other psychotic disorders, bipolar

Schizoaffective disorder (diagnostic criteria)

Diagnosis: A. uninterrupted period of illness when there is a major mood episode concurrent with criterion A of schizophrenia B. delusions or hallucinations for 2 or more weeks C. Symptoms that meet the criteria for a major mood episode are present for the majority of the illness D. Disturbance cannot be attributed to a substance or medical condition.

Schizotypal personality disorder (diagnosis)

Diagnosis: Indicated by 5 or more of the following: 1) ideas of reference (not delusions of reference) 2) odd beliefs or magical thinking inconsistent with cultural norms- preoccupied with paranormal 3) unusual perceptual experience, including bodily illusions 4) Odd thinking and speech 5) Suspiciousness or paranoid ideation 6) inappropraite or constricted affect 7) behavior or appearance that is odd, eccentric, or peculiar 8) lack of close friends or confidants other than relatives 9) Excessive social anxiety that is associated with paranoid fears rather than negative self-judgments Does not occur exclusively in the course of schizophrenia, bipolar, or depressive disorder with psychotic features.

Disruptive mood dysregulation disorder (differential diagnosis)

Differentiating from Bipolar- longitudinal course of the cor symptoms- this is NOT an episodic illness; the mood perturbation is NOT distinct from the child's typical functioning or mood. This disorder involves irritability that is persistent over many months. There is no elevated/expansive mood or grandiosity, and the child should never have experienced full-duration manic or hypomanic episodes. Differentiating from ODD. This dx has frequent and severe outbursts and persistent disruption in moods between outbursts, so a high risk for behavioral problems. kids with this disorder may meet the criteria for ODD, but only this dx should be made because of the more prominent mood component. Differentiating from ADHD; Depressive, ASDs; anxiety. Can be co-morbid ADHD; major depressive, and anxiety disorders. Be wary of whether irritability is only presented in these anxiety-provoking contexts, or when routines of OCD or ASD kid are disturbed. Rates of co-morbidity are extremely high. Differentiating from intermittent explosive disorder: same severe temper outbursts; but no persistent irritability in between outbursts. IED only requires 3 months of symptoms; this dx requires 12 months.

Persistent Depressive Disorder (Dysthymia)

Disorder characterized by a depressed mood (or in children and adolescents, a depressed or irritable mood) on most days for at least two years in adults or one year in children and adolescents. Requires the presence of at least 2 of the following symptoms: 1) poor appetite or overeating; 2) insomnia or hypersomnia; 3) low energy or fatigue; 4) low self-esteem; 5) impaired concentration or decision-making; and 6) feelings of hopelessness. During the 1-2 year period, a person cannot have been without symptoms for more than 2 months, and symptoms must cause significant distress or impaired functioning.

Pica

Disorder characterized by eating of non-nutritive, non-food substances (paper, soil, cloth, paint) for at least one month; inconsistent with developmental level or culturally sanctioned norms. *Can occur at any age; most common in childhood *Can be associated with ID, ASD, schizophrenia; separate dx made only if severe enough to warrant special attention.

schizotypal personality disorder (general characteristics)

Disorder characterized by the presence of pervasive social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships and cognitive or perceptual distortions and behavioral eccentricities. Onset in early adulthood and further characterized by perceptual distortions and odd thinking, speech, beliefs, and behavior.

Feeding and eating disorders (general characteristics)

Disorders in this category involve a persistent disturbance in eating or eating-related behaviors that impairs physical health or psychosocial functioning. *classification scheme for these disorders is mutually exclusive- only one dx can be given at a time (except for pica)

Trauma and stressor related disorders

Disorders in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion: Reactive attachment disorder, disinhibited social engagement disorder, adjustment disorders

Depressive disorders (DSM 5)

Disruptive mood dysregulation disorder, major depressive disorder, persistent depressive disorder (dysthymia), permenstrual dysphoric disorder (and others caused by substances or other medical conditions). Common features: presence of sad, empty, or irritable mood, accompanied by somatic & cognitive changes that significantly impact ability to function. Differences: issues of duration, timing, presumed etiology.

typical antipsychotics (side effects)

Drowsiness/sedation, dizziness upon standing up; changing position; blurred vision; tachycardia; photosensitivity; skin rashes; menstrual problems; physical rigidity; muscle spasms; tremors; and restlessness.

with psychotic features (specifier; manic episodes)

During manic episodes, specifiers: mood-congruent: content of delusions and hallucinations are consistent with the typical manic themes of grandiosity (etc.), but will also include suspiciousness or paranoia, especially with respect to doubts about the individual's capacities. mood-incongruent: content of delusions and hallucinations do not match the situation or emotional state: example incongruence : Laughing when your dog dies Believing you have superpowers despite going through a major depressive episode example congruence: feeling like you want to commit suicide when your dog dies; believing you have superhuman powers when going through a manic period.

Depression (treatments compared)

Effectiveness of different treatments for this disorder: · Cognitive therapy is as effective as anti-depressants · Interpersonal therapy is as effective · Insight-oriented, psychotherapies are not as effective Meta-analysis by NIMH

Agoraphobia (general characteristics)

Essential factor of this anxiety disorder is marked, intense fear or anxiety triggered by real or anticipated exposure to a wide range of situations. Individuals feel that something terrible might happen if they are in these situations, and that escape may be difficult. Fear and anxiety happens nearly every time the individual is in contact with the situation, and there is active avoidance. Can cause people to become completely homebound; alcohol abuse; self-medication.

Generalized anxiety disorder (general characteristics)

Essential feature of this anxiety disorder is excessive anxiety and worry about a number of events or activities. Intensity, frequency, and duration of worry is out of proportion to impact of anticipated event. Worries about everyday, routine life circumstances; focus of the worry may shift from one concern to another. Anxiety and worry is accompanied by restlessness, fatigue, difficulty concentrating, muscle tension, disturbed sleep

major depressive disorder

Essential features of this disorder is a major episode of at least 2 weeks in which there is a loss of interest or pleasure in nearly all activities. In children, the mood may be irritable rather than sad. The criterion symptoms for this dx must be present nearly every day to be considered present (except weight change or suicidal ideation).

Separation Anxiety Disorder

Excessive, enduring fear in some children that harm will come to them or their parents while they are apart to the degree that it is developmentally inappropriate. school refusal in childhood can be partially attributed to this; nightmares or physical symptoms of distress. Symptoms develop in childhood, but can endure into adulthood.

Bartering

Exchanging products or services with others by agreeing on their values without using money. Psychologists may barter only if (1) it is not clinically contraindicated, and (2) the resulting arrangement is not exploitative." The previous version of the standards contained a statement to the effect that psychologists ordinarily refrain from bartering, but that statement was removed in the most recent version, perhaps in recognition of the fact that bartering is a common arrangement in some communities and may be the only option for cash poor clients

Specific Phobias (treatment)

Exposure is currently considered the best intervention for most (if not all) Anxiety Disorders. However, the best way of exposing clients to stimuli that elicit anxiety depends on the particular disorder. For Specific Phobia, brief in vivo exposure is effective for many clients, and adding a cognitive component usually does not improve the effects of the intervention substantially. For some specific phobias, 2-4 sessions is enough.

posttraumatic stress disorder (PTSD)

Exposure to a traumatic event; re-experiencing of the event; negative alterations in cognitions and mood associated with the event; marked alterations in arousal associated with the event Symptoms have a duration of more than one month and significant impairment in functioning.

PTSD in young children (>6)

Exposure to actual or threatened death, serious injury, or sexual violence must occur in at least one of the following ways: direct experience of the event, witnessing the event in person as it happened to others (especially a primary caregiver), learning the event occurred to a caregiver.

PTSD in adults/adolescents/children over 6

Exposure to actual or threatened death, serious injury, sexual violence in one or more of the following ways: direct experience of the event, witnessing the event in person as it happened to others, learning the event happened to a close family member, repeated or extreme exposure to aversive details of an event (not through media; but first responders collecting human remains; etc)

Specific Phobia (treatment)

Exposure with response prevention (ERP); and in vivo exposure is the most effective type for this anxiety disorder. ERP- exposing the individual to the feared object or situation without letting them make the usual avoidance response. Exposure + applied relaxation can help with claustrophobia.

Hallucinations (Schizophrenia)

False sensory experience that feels real; hear voices, see things, smell things; common to commit suicide to avoid voices; positive symptom; can affect any sensory modality but auditory types are most frequent. -Hearing voices - Common: a perjorative, threatening voice or running commentary on thoughts and actions.

Facitious disorder by proxy

Falsification of physical or psychological signs or symptoms in another; *presenting another individual (victim) to others as ill, impaired, or injured *evident even in the absence of external rewards perpetrator, not the victim is given the dx; could constitute abuse and maltreatment of a child

Fear vs. Anxiety

Fear- emotional response to real or perceived imminent threat Anxiety- anticipation of future threat

Rumination Disorder

Feeding/Eating disorder that involves regurgitation of food for at least one month; not attributable to gatrointestinal, medical or other eating disorder -specifier- In remission- if the full criteria was previously met, but has not been met for some time Could be the result of neglect, lack of stimulation; could result in malnutrion

Social anxiety disorder (gender related issues)

Females with this anxiety disorder report a greater number of social fears; co-morbid depressive, bipolar and anxiety disorders. Males are likely to fear dating, have ODD or CD and use substances. parusesis- unable to urinate in public settings

Clozaril (clozapine)

First drug of atypical antipsychotic class developed for schizophrenia was Clozaril (clozapine). Prescribed for patients who did not respond to to the typical class of these drugs, or to patients with atypical symptoms. Very effective for reducing certain symptoms, including hallucinations, delusions, psychotic breaks from reality.

Insomnia Disorder (course)

First episode of this more common sleep-wake disorder is usually in young adulthood, but can happen anytime in life; new onset can happen at menopause; later onset is associated with onset of other health conditions; maintaining sleep more common in middle age and older. *Can be episodic, and re-occur after other stressful events; 45-75% chronicity rates;

Separation Anxiety Disorder (Prevalence & Etiology)

For adults, this disorder is only .9-1.9%; for children, 1.6%- Most prevalent anxiety disorder for children under 12. More frequent in females in community samples. Often develops after life stress/loss. Can be associated with parental overprotection & intrusiveness. Develops after a major life stressor (divorce, death of loved one or pet, change in schools) Heritability: 73% in twins

Schizophrenia (factors associated with better prognoses)

For this disorder, several factors are associated with better prognoses: · Being female · A later age onset · Positive symptoms (which are more responsive to medication · Good premorbid adjustment · Acute onset · Precipitating events · Treatment with anti-psychotics soon after onset · Consistent medication compliance · No family history of this disorder

Depersonalization/Derealization Disorder (risk factors)

For this dissociative disorder tempermental: harm avoidant temperament, immature defenses; overconnection and disconnection schemata environmental: childhood interpersonal traumas; emotional abuse and neglect; growing up with a mentally ill or impaired parent; unexpected death or suicide of a friend or family member; ingestion of substances (15% of cases) Symptoms can develop in the context of a new-onset panic disorders and can progress and worsen.

Etiology (Major Depressive Disorder)

Genetic contribution: 1st degree blood relatives: 2-4X times higher than the rate for the general population; inked to neuroticism (negative affectivity); linked to a high level of cortisol (a stress hormone released by the adrenal gland), which causes degeneration of cells in the hippocampus (Sheline, Gado, & Kraemer, 2002). psychosocial stressors are more likely to trigger an episode early in the course of the disorder than they are later on.

MAOIs (examples)

Hydrazine: (antidepressant) Isocarboxazid (Marplan) Nialamide (Niamid) Phenelzine (Nardil, Nardelzine) Hydracarbazine Non-hydrazines: Tranylcypromine (Parnate, Jatrosom)

Treating a child involved in divorce

If it becomes apparent that psychologists may be called on to perform potentially conflicting roles (such as family therapist and then witness for one party in divorce proceedings), psychologists take reasonable steps to clarify and modify, or withdraw from, roles appropriately (such as contacting the attorneys of both parents)

Parents withdraw consent for treatment (not in best interest of child)

If psychologists' ethical responsibilities conflict with law, psychologists make known their commitment to the Ethics Code and take steps to resolve the conflict in a responsible manner." Therefore, the psychologist would not just terminate without attempting to advocate for the patient; nor continue to treat the child without the parents consent, as violating the law is not consistent with resolving the conflict in a responsible manner; in this case, a psychologist should seek judicial intervention.

Tourette's Disorder (Co-morbidities)

In a recent study of more than 3100 children with this disorder, ADHD was the most prevalent comorbid disorder occurring in 58% of subjects. Of those with this disorder plus learning disabilities, 80% also had a diagnosis of ADHD. The increased rates of ADHD in those diagnosed with this disorder + LD and the finding that only 11 % of the children with this disorder, without ADHD had a diagnosis of LD demonstrates the potential impact of ADHD on LD as a causal factor or as a confounder for the diagnosis of LD (L. Burd, et. al 2005).

Social anxiety disorder vs. Agoraphobia (differential DX)

In both of these anxiety disorders, social situations are avoided due to fear or humiliation of embarrassment. In agoraphobia, it is not limited to social situations. People with agoraphobia prefer to be with a trusted companiona, and people with social anxiety disorder do not, because they are afraid of scrutiny.

Blood-Injection-Injury Type of Specific Phobia (special considerations)

In most of the Specific Phobias there is an increase in heart rate and blood pressure. However, in this type there is an initial brief acceleration in heart rate followed by a deceleration and a drop in blood pressure. This often results in vasovagal fainting. Due to this unique physiological response to the feared stimulus, the recommended treatment involves tensing muscles, rather than relaxing them, in the presence of the feared stimulus. *as with many specific phobias, this begins in childhood *in all specific phobias, the person recognizes their fear is excessive (except in children)

Cyclothymic Disorder

In the Bipolar Class- For a period of at least 2 years the symptoms of hypomania and depression have appeared numerous times; however the criteria for hypomanic episode or major depressive disorder have not been satisfied. During a 2-year interval, hypomanic and depressive periods have occurred at least half the time; the patient has not been symptom free for more than 2 months. Chronic, fluctuating mood disturbance.

Agoraphobia (treatment)

In vivo exposure with response prevention is the most effective treatment for this anxiety disorder. Benefits of exposure might be increased if significant others are involved in treatment (Cerny et al, 1987)

Schizophrenia (gender)

Incidence of this psychotic disorder is lower in females, and the age of onset is later. Symptoms are more affect-laden, more psychotic symptoms later in life. Social functioning may be better preserved.

Obsessive compulsive and related disorders (general characteristics)

Includes OCD, body dysmorphic disorder, hoarding disorder, trichotillomania (hair pulling), excoriation (skin-picking), substance, medication-induced OCD. Some disorders are characterized, but obsessions, compulsions, preoccupations or repetitive behaviors or mental acts in response to preoccupations. Some are characterized by recurrent body-focused repetitive behaviors. There are overlaps between these conditions if one is being screened for. All of these symptoms persist beyond developmentally normal periods.

OCD (treatment/medication)

Includes a combination of medication and either exposure with ritual prevention or CBT that integrates exposure with cognitive restructuring, relaxation training & other techniques. Effective medications: Clomipramine (TCA), fluvoxamine, sertraline- SSRIs

Body dysmorphic disorder

Indicated by inordinate attention to at least 1 perceived flaw in physical appearance that is unnoticable or appears slight to other observers. Individual engages in repetitive behaviors as a means of obtaining reassurance about appearance concerns. Pre-occupations/rituals usually take 3-8 hours/day! Must be differentiated from an eating disorder.

catatonia (psychotic disorders)

Indicated by the presence of 1 or more of stupor, catalepsy, waxy flexibility, mutism, posturing, mannerism, stereotypy, agitation, grimacing, echolalia, echopraxia

Specific phobia (general features)

Individuals with this anxiety disorder are fearful or anxious about or avoidant of specific objects or situations (snakes, height, flying) disproportionate to danger -- Fear, anxiety, or avoidance is immediately induced by the phobic situation; no cognitive ideation features. Various types of specific: animal, natural environment, blood injection/injury, situational.

Schizophrenia (functional cognitive symptoms)

Individuals with this disorder don't perform as well on cognitive tasks, possibly because of decreased blood flow to the prefrontal cortex (as revealed by PET scan). Particularly true of individuals with negative symptoms · remembering things - compared to those without this disorder, they may be less able to remember things they learned 5-minutes ago, but have no problem remembering long-term memories from the past · being able to flexibly shift between various tasks (known as executive functioning) · making judgment, etc.) · figuring out rules from consequences · reduced hand grip strength · reduced memory attention span and reaction time · being more distractible · having a harder time engaging in problem solving and planning · sensory processing

Schizophrenia (brain abnormalities)

Individuals with this disorder have a smaller volume in the hippocampus, amygdala, thalamus, nucleus accumbens and intracranial space than people without this disorder, and larger pallidum and lateral ventricle volumes - 15-30%

Somatic symptom disorder

Involves one or more somatic symptoms that cause distress or a significant disruption in daily life with excessive thoughts, feelings, or behaviors related to teh symptoms characterized by at least 1 of: 1) disproportionate and persistent thoughts about the seriousness of symptoms; 2) persistently high levels of anxiety about one's health and symptoms 3) excessive time and enorgy devoted to symptoms or concerns about health *Individuals present with somatic symptoms and a medical disease conviction; the individual's suffering is authentic, whether or not it is medically explained. *most individuals with hypochondrias now qualify for this dx *health concerns become a dominant feature of identity *could have the specifier: with predominant pain

Terminating therapy

Is in order when it is no longer benefiting a client or is harming a client and allows psychologists to "terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship." It also requires psychologists to provide pretermination counseling and referrals to avoid abandoning clients when terminating therapy except when termination is due to "the actions of clients/patients or third-party payors." Note that, in some situations, referring clients may not be the best course of action.

Wikline case

It is the health professional's obligation to protest in a situation such as the one described in the question, and a number of commentators suggest that advocacy for the patient's needs in such situations is an ethical obligation.

situational/acute insomnia

Lasts a few days to a few weeks, often associated with changes in sleep schedules because of life events; may remit or eventually qualify for insomnia

Forms of amnesia

Localized & selective are the most common localized- inability to recall all events related to a specific period of time; selective- inability to recall some events related to a specific period generalized- uncommon; may include a loss of memory from one's personal identity and semantic and skill knowledge- complete loss of memory of life history; maybe be more common among sexual assault victims and combat veterans

malingering vs factitious disorder

Malingering is different from factitious disorder because malingering involves personal gain (time off, money)

OCD (co-morbidity)

Many have a lifetime dx of anxiety disorders (76%); or depressive disorder (63%); the most common is major depressive disorder (41%). Could also have co-morbid OCD personality disorder (23-32%). tic disorder (30%).

Conversion Disorder (Functional Neurological Symptom Disorder)

May be one or more symptoms of: *motor-weakness, paralysis, abnormal movements, gait abnormalities *sensory- altered or reduced or absent skin sensation vision, or hearing *unresponsiveness; non-epilleptic/psychogenic seizures * "bizarre" symptoms not explained by a neurological disease. Could have dissociative symptoms *Specifiers- with weakness or paralysis, weith attacks or seizures, with anesthesia or sensory loss. DX should be based on overall clinical picture, and not just one finding.

OCD (development & course)

Mean age: 19.5 years; 25% of cases start by age 14. Onset after 35 is unusual, but can occur. 25% of males have an onset earlier than age 10. Most kids have both obsessions and compulsions. Higher content of harm obsessions (fears of catastrophic events- in children than adults).

Panic Disorder (course)

Median age for onset is 20-24 years; small number of cases begin in childhood -- usual course (untreated) is chronic waxing and waning; course complicated by a range of other co-morbid anxiety disorders. Lower prevalence in older adults- dampening of ANS. Associated with reports of childhood physical and sexual abuse; amygdala and related structures implicated. Parents with anxiety or depressive or bipolar disorders; asthma

care-avoidant type (specifier, illness anxiety disorder)

Medical care is rarely used, though there is a tremendous preoccupation with getting a serious illness.

care-seeking type (specifier, illness anxiety disorder)

Medical care, including physician visits and undergoing tests & procedures is frequently used.

illusion

Mis-perception of a stimuli Example: Mistaking a coat rack for a person

Bipolar Disorder (treatment)

Mood stabilizers are the most common treatment for this disorder; Lithium: chemical salt of the mineral that occurs naturally in the body; oldest mood stabilizer (approved in 1970); anti-seizure medications when lithium is ineffective- Depakote (valproic acid); Tegretol (carbamazepine); Lamictal (lamotrigine); Trileptal (oxcarbazapine). When psychotic symptoms are also present, aytpical antispychotics such as Ablify, Clozaril, Risperdal are presecribed.

Schizotypal personality disorder (etiology & treatment)

More frequent in males; surfaces by early adulthood treatment: therapy, mood stabilizers, SSRIs, anti-psychotics

Selective mutism (co-morbidity)

Most common co-morbid disorders for this childhood disorder are other anxiety disorders. Social anxiety disorder, specific phobia; communication disorders may be present and should be ruled out.

Agoraphobia (co-morbidity)

Most frequent for this anxiety disorder are other anxiety disorders- specific phobias, panic disorder, social anxiety disorder- often precede this, depressive disorder, PTSD, alchohol use disorder- are secondary

enurisis (co-morbidity)

Most kids with this issue do not have another disorder; but some have developmental delays- speech, language, and learning, motor skills delays, encopresis, night terros, UTIs (esp. with the diurnal type)

Tic Disorders

Motor disorder- sudden, repetitive, nonrhythmic motor movements or sounds such as eye blinking, facial grimacing, throat clearing, and grunting

PTSD (treatment)

Multicomponent CBT- Cognitive processing therapy (CPT)- incorporates psychoeducation, exposure, cognitive restructuring exposure- writing, then reading a detailed narrative about the event cognitive restructuring- used to identify challenging and maladaptive behaviors related to the trauma and feelings of self blame and guilt EMDR- effects may be due to exposure of the fear stimuli and not eye movement

Negative mood (PTSD)

Negative transformations of mood or thought related to the traumatic event with onset after the event transpired, and manifested by at least 2 of the following: *dissociative amnesia- inability to recall specific *chronic negative expectations about oneself *Self-blame due to chronic, inaccurate thoughts about the cause of the trauma *Chronic negative affect *Loss of interest in significant activities *Alienation from others *Chronic inability to experience positive affect

Intellectual Disabilities

Neurodevelopmental Disorder (formerly referred to as mental retardation) 3 criteria: 1) onset during development; 2) deficits in reasoning, problem-solving, and abstract thinking; 3) adaptive functioning deficits are also present that relate to independent living and social responsibility. Degree of severity (mild, moderate, or profound) is based on adaptive functioning in the conceptual, social, and practical domains.

Specific Learning Disorder

Neurodevelopmental disorder beginning in the school-age years and characterized by academic performance that is substantially below what would be expected given the person's age, IQ score, and education. Condition persists for 6 months or more despite intervention to improve academic skills and is not better explained by ID, sensory deficits, or other factors.

attention-deficit/hyperactivity disorder (ADHD)

Neurodevelopmental disorder characterized by chronic inability to pay attention and impulsivity /hyperactivity that impairs functioning and development. Frequently unable to sustain interest in an activity or maintain mental focus required to complete a task. Easily distracted and forgetful of routine activities. Inability to sit still or remain quiet; garrulous and impatient.

Motor Disorders

Neurodevelopmental disorders with onset early in development as manifested by poor learning and performance of coordinated motor skills, with performance significantly below accepted age norms. This class includes stereotypic and tic disorders.

Excoriation Disorder

OCD-related disorder that involves repeated skin picking behaviors resulting in skin lesions, accompanied by repeated attempts to stop this behavior.

typical antipscyhotics (longterm use)

Often necessary when treating schizophrenia; routinely cause tardive dyskinesia (involuntary muscular movements), particularly in the mouth area. These can be permanent, although some patients recover from it partially or totally when discontinuing the medication.

Wellbutrin (bupropion, zyban)

Older (1985), atypical anti-depressant that affects the nuerotransmitter, dopamine. Does not fit into any drug class and has more side effects than SSRIs. This is also used to stop smoking. Common side effects: dry mouth, difficulty sleeping, agitation, headaches. Serious side effects: risk for seizures & suicide.

Depression (older vs younger adults)

Older adults are less likely than younger adults to express feelings of depression or sadness. They are more willing to express feelings of hopelessness and anxiety. They are also more apt to have memory problems.

anorexia nervosa (associated features)

Other features associated with this feeding/eating disorder: *obsessive/compulsive preoccupation with food- some collect recipes or hoard food. *depressive signs and symptoms *concerns about eating in public *desire to control environment *Disorder preceded by increased levels of physical activity

Panic disorder (co-morbidity)

Panic attacks could be symptoms of other anxiety disorders and are expected. Prevalence elevated in agorophobia, major depression, bipolar. Co-morbidity rates range from 10-65%. Also co-morbid with several medical dx: cardiac arrhythmia, hyperthyroidism, asthma, COPD, IBS.

Bipolar (medication compliance)

Patients with this disorder don't want to take their medications because they don't want to give up the intense, manic states.

Autism Spectrum Disorders (field dependence-independence)

People with autism tend to have a field-independent cognitive style, and on some tasks that assess field independence, they consistently outperform their same-age peers. These folks use internal referents to solve problems and see environments in terms of constituent parts rather than organized wholes. Example: children with ASD outperform age-matched children on the Childhood Embedded Figures Test, which requires examinees to identify a simple figure hidden in a complex background design. Good performance on this test indicates field independence because it requires separating an item from the field in which it is embedded.

Psychologists with medical conditions

Personal problems, including emotional, social, health-related and other personal issues, are addressed in Standard 2.06: Psychologists "refrain from initiating an activity when they know or should know there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner." If a psychologist thinks the condition may impair his/her ability to provide effective services or perform work-related duties then the psychologist would "take appropriate measures."

Bipolar I Disorder (treatment)

Pharmacotherapy (specifically, Lithium therapy in most cases) is the treatment of choice for this disorder. Pharmacotherapy may be supplemented with adjunctive psychotherapy (e.g., to provide support and coping skills). However, psychotherapy is not considered that useful in treating the core symptoms of this disorder

Bulimia nervosa (associated features)

Physical features of this feeding/eating disorder: *dehydration *electrolyte imbalance- could lead to cardiac arrythmia *matabolic alkalosis or acidosis (imbalances) *esophageal damage *menstrual irregularities

social anxiety disorder (treatment)

Preferred treatment for this anxiety disorder is exposure with response prevention, can be combined with cognitive restructuring, social skills training, and other interventions. Treatment may include an anti-depressant (SSRI), anti-anxiety drug, or beta blocker.

PTSD (treatment, Foa 1999)

Prolonged exposure was the most effective treatment for this disorder. Foa also looked at stress inoculation, and combined prolonged exposure with stress inoculation. Prolonged exposure teaches clients to gradually approach trauma-related memories, feelings, and situations that you have been avoiding since your trauma. By confronting these challenges, in order to decrease symptoms of this disorder. · Medication- usually not indicated, but if the symptoms of intrusive experiences, flashbacks, transient psychosis, marked derealization, and avoidance and numbing markedly interfere with daily life, short term medication might be recommended.

Examples of SSRIs

Prozac (fluoxetine), Paxil (paroxetine), Zoloft (setraline), Celexa (citralapram), Lexapro (escitalopram) Have fewer side effects than older anti-depressants; first line anti-depressants

Cooperating with Ethics committees

Psychologists cooperate in ethics investigations, proceedings, and resulting requirements of the APA or any affiliated state psychological association to which they belong...Failure to cooperate is itself an ethics violation." In other words, failure to release the records is itself an ethical violation. Example: Any client who brings a complaint against the ethics committee about a psychologist has to file a release, so refusing to release client records in an investigation is another violation.

Can you provide free treatment to a report for publicity

Psychologists do not compensate employees of press, radio, television, or other communication media in return for publicity in a news item.

Respect for People's Rights and Dignity

Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination. This also applies to respecting and treating people with political views you might not like.

Can a psychologist evaluate and provide treatment for the same client?

Psychologists should avoid potentially conflicting relationships, which could result when conducting both an evaluation and treatment for a patient. Sometimes in rural settings, this may be necessary and if the psychologist takes steps to minimize negative effects, it could be ethical.

shizoaffective disorder

Psychotic disorder characterized by continuous period where the major symptoms of schizophrenia are present and also for the majority of the duration, major mood (depressive or manic) episodes are also present.

schizophreniform disorder

Psychotic disorder involving the symptoms of schizophrenia but lasting 1-6 months. At least 2 of the symptoms must be present: 1) hallucinations, 2) delusions, disorganized/incoherent speech; 3) grossly disorganized, catatonic behavior, negative symptoms such as reduced emotional expressiveness and avolition.

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)

Published in 2013; Provides a nonaxial assessment system in which all mental and medical diagnoses are listed together with the primary diagnosis listed first. Uses a categorical approach that views psychiatric disorders as separate entities and describes each disorder in terms of criteria sets that specify the defining minimum features of each diagnosis.

Schizotypal personality disorder (prevalence)

Range of .6% (Netherlands) to 4.6% (US) = community samples.

ADHD (brain regions implicated)

Recent research has established a biological basis for this disorder with abnormalities in the right frontal lobe, striatum, and cerebellum *parietal lobe, to a lesser extent *frontal lobes (mediates higher-order functions), the striatum (part of the basal ganglia and composed of the caudate nucleus and the putamen) *cerebellum (involved in motor activity) are the areas linked to this disord

obsessions (OCD)

Recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted; (2) Individual attempts to ignore or suppress such thoughts, urges, or images or neutralize them with some other thought or action (e.g. performing a compulsion).

Panic Attack/Disorder (diagnostic characterstics)

Recurrent or unexpected panic attacks that involve 4 or more of the following symptoms: 1. Palpitations, pounding heart, accelerated heart rate. 2. Sweating 3. Trembling or shaking 4. Sensation of shortness of breath 5. Feelings of choking 6. Chest pain or discomfort 7. Nausea or abdominal distress 8. Feeling dizzy, lightheaded, or faint 9. Chills or heat sensations 10. Parethesisas- numbness or tingling 11. Derealization; depersonalization/ detached 12. Fear of losing control or going crazy 13. Fear of dying At least one of the attacks are followed by one or both for 1 month or more 1) Persistent concern or worry about additional panic attacks; 2) significant maladaptive change in behavior related to the attacks- avoidance (3-4) Not attributable to a substance or other mental disorder

e-therapy

Refers to the delivery of mental health services online, usually delivered in the form of email communications, discussion lists, live chat rooms, or live audio or audiovisual conferencing and may include "coaching" , psychoeducation, emotional support, interactive journaling, etc.

Trichotillomania (Hair pulling disorder)

Repetitive pulling of one's own hair resulting in hair loss and accompanied by repeated attempts to cease this behavior.

Seasonal Affect Disorder (light treatment)

Research on the use this therapy for the treatment of various forms of depression has yielded the findings that atypical symptoms such as carbohydrate craving and hypersomnia predict a robust response, whereas melancholic symptoms such as insomnia and weight loss are generally less responsive to light (See: Terman et al., American Journal of Psychiatry, 1996). Additionally, a clear onset period with complete remission in the spring and summer months is the phenotype that is most likely to respond to light.

ADHD (course)

Research studies have found that between 30% and 70% of children with this disorder continue to exhibit signs of the disorder throughout their lives.

Anxiety Disorders (prevalence by gender)

Results of a meta-analysis on gender differences concluded that females (across all age groups) have a higher level of general anxiety than males. Males scored very slightly higher than females in level of social anxiety, although this difference was not significant

Builimia nervosa (risk factors)

Risk factors for this feeding/eating disorder include: temperamental: overanxious child, low self-esteem, depressive symptoms genetic/physiological: childhood obesity, early menstruation, family transmission; low levels of seratonin childhood physical or sexual abuse

Avoidant/Restrictive Food Intake Disorder (risk factors)

Risk factors include: temperamental- anxiety disorders, ASD, OCD, ADHD environmental- family anxiety, higher rate in children of moms with eating disorders genetic/physiological- gastrointestinal conditions, reflux, vomiting

atypical antipsychotics (side effects)

Risk of tardive dyskinesia caused by long-term use is lower with these drugs. Risk of metabolic syndrome: increased weight, blood glucose, triglycerides, and insulin resistance. Patients need regular monitoring of weight, blood glucose, and lipids (triglycerides).

Atypical antipsychotics [developed after Clozaril (clozapine)]

Risperdal (risperidone); Zyprexa (olanzapine); Seroquel (quetiapine); Geodon (ziprasidone); Abilify (aripiprazole); Invega (paliperidone).

negative symptoms (psychotic disorders)

Schizophrenic symptoms that involve behavioral deficits, such as flattened emotions, social withdrawal, apathy, impaired attention, and poverty of speech. Less apparent in other psychotic disorders;

Tourette's Disorder (Treatment)

School interventions, individual & family therapy, medication · antipsychotics: Haldol & pimozide · Clonadine (originally anti-hypertensive); less severe side effects: hypotension, sedation, dry mouth

SNRIs

Serotonin Norepinephrine Reuptake Inhibitors- preserve the levels of seratonin and norepinephrine in the brain rather than just seratonin. Common SNRIs include Venlafaxine (Effexor) and Duloxetine (Cymbalta). Adverse effects may include nausea, weight gain, and sexual dysfunction.

Arousal symptoms (PTSD)

Significant changes in sensitivity to traumatic events starting or worsening after the traumatic event as indicated by at least 2 of the following: *unprovoked irritability or temper tantrums *irresponsible self-destructive activities *hypervigilence *heightened startle reaction *difficulty focusing and concentrating *disrupted sleep patterns

Acute Stress Disorders

Similar to PTSD and triggered by exposure to actual or threatened death, severe injury, sexual violation in at least 1 of the following ways: (1) witnessing an event in person as it happened to others; (2) learning that the event happened to a close family member or friend; (3) repeated exposure to aversive details of the event. Symptoms from the following categories: intrusion, negative mood, dissociation, avoidance, and/or arousal. Symptoms last from 3 days - 1 month.

antidepressant medications (Bipolar treatment)

Since Bipolar disorders are characterized by alternating episodes of mania (or hypomania) & depression, doctors may prescribe antidepressants for depressive symptoms. Prozac, Paxil, & Zoloft = popular choices. These may stop the depressive symptoms, but may throw the patient into a manic state. Usually prescribed along with a mood stabilizer or an antipsychotic. According to research, results are mixed for alleviating depressive symptoms for patients with Bipolar, even when used in combination with mood stabilizers.

Panic Attacks (situationally-bound vs. situationally-pre-disposed)

Situationally bound (cued) panic attacks occur almost invariably on exposure to, or in anticipation of, a situational cue or trigger and are most characteristic of social and specific phobias. Situationally predisposed panic attacks are more likely to occur on exposure to a situational cue or trigger but are not invariably associated with the cue or trigger and do not necessarily occur immediately after the person has been exposed to the cue or trigger. Example: a person may have panic attacks associated with shopping mall environments; however, the person does not have an attack every time he or she goes to a shopping mall and/or does not necessarily have the attack immediately upon entering the mall (the attack may occur after he or she has been shopping for a while). These attacks are most common in panic disorder, but can also occur in social phobia or specific phobia.

psychotropic medications (symptom relief)

Some people may have a depressive episode and feel so much better after taking and anti-depressant medication for a few months that they can discontinue it. Others who suffer from severe or long-term depression, bipolar disorder, or schizophrenia will need to take medications for many years. *Usually takes about 6 weeks for an antidepressant to start working

psychotropics (Factors influencing reactions)

Specific type of mental disorder; Age, sex, body size & weight; physical illnesses; smoking and drinking; genetics; liver and kidney functioning; other medications, vitamins, and herbal supplements the patient is taking; patient's diet; whether the patient takes the medication as prescribed.

With seasonal pattern (major depressive disorder)

Specifier applied when the mood episode consistently occurs at a particular time of the year, beginning in the fall and continuing into the winter months. This condition is also known as seasonal affective disorder (SAD), and its symptoms often include a lack of energy, hypersomnia, increased appetite and weight gain, and carbohydrate craving. explanation: for SAD is that it's related to reduced exposure to sunlight which disrupts the body's normal circadian rhythms, resulting in an increased production of melatonin (a hormone that causes drowsiness) and a lower-than-normal level of serotonin

Provisional (specifier)

Specifier that is used when the clinician believes the full criteria for a diagnosis will eventually be met but does not currently have sufficient information for a firm diagnosis.

with delayed expression (PTSD)

Specifier that the full diagnostic criteria are not met until at least 6 months after exposure to the traumatic event

ADHD (co-morbidities)

Studies have consistently shown that the combination of hyperactivity and conduct problems is most associated with antisocial behavior and other serious problems in adulthood. Between 30-50% of kids with ADHD also meet the criteria for CD. 70% of patients with CD also have ADHD.

Schizoprehenia (treatment, antipsychotics)

Studies of individuals with this diagnosis show the "positive symptoms," such as delusions, hallucinations and thought disorder, usually respond better than the "negative symptoms" to antipsychotic treatment. Negative symptoms: Alogia, or speechlessness, avolition, or lack of initiative or goals and affective flattening are all negative symptoms of this disorder and are not as responsive to anti-psychotic medication. Mechanism: antipsychotics induce a "neuroleptic state" characterized by emotional quieting (decreased hallucinations and delusions), psychomotor slowing (less agitation, impulsivity, and aggressiveness), and affective indifference (lower arousability and lack of concern with the external environment).

Multimodal Treatment Study of Children with ADHD (MTA)

Study that compared medication (methylphenidate) alone, behavior modification alone, combined medication and behavior modification, and routine community care. *Initial results of the study found that medication alone and the combined treatment produced a similar reduction & were more effective than behavior modification alone or routine community care (Jensen et al., 2001). *three- and eight-year follow-up studies found that the superior effects of medication alone and the combined treatment did not persist and that outcomes for children in these groups were comparable to those for children who received behavior modification only or community care (Jensen et al., 2007; Molina et al., 2009). Mixed findings

ADHD (Diagnosis)

Symptoms must have onset prior to 12 years; presence of at least 6 symptoms of inattention and/or 6 symptoms of hyperactivity/impulsivity. Symptoms must be present in at least 2 settings, and interfere with functioning. 15% of children still meet the criteria as adults and 60% continue to have some symptoms that have adverse effects on health, relationships, and other aspects of functioning.

Generalized anxiety disorder (course)

Symptoms tend to be chronic and wax and wane across the lifespan; Primary difference at different ages: content of worries kids- more about school and sporting performances adults- well-being of family, physical health May be overdiagnosed in children; 1/3rd of the risk is genetic.

erotomanic delusion (psychotic disorders)

The (false) belief that someone is in love with you

Mood Disorder (caused by organic factors)

The DSM identifies the following disorders as possible causes of organically-based mood symptoms: substances such as hallucinogens and PCP; endocrine disorders, such as hypo- or hyperthyroidism; carcinoma of the pancreas; viral illness; and structural disease of the brain, such as that caused by a stroke.

OCD (implicated brain areas)

The caudate nucleus appears to be overactive in people diagnosed with this disorder. L.R. Baxter reports that both behavioral interventions and drug therapy affect metabolic rate in the caudate nucleus.

Illness anxiety disorder

The core features of this somatic symptom disorder are preoccupation with having a serious illness, and absence of somatic symptoms, or the presence of mild symptoms, a high level of anxiety about one's health & either performance of excessive health-related behaviors or maladaptive avoidance of medical care. Symptoms have to be present ofr 6 months or more, although the feared illness can change over time. similar to anxiety disorder, but somatic concerns *incessant worry may cause considerable strain in the family and may prevent them from visiting sick relatives, or fear might jeopardize their health (prevent exercising) *minimal somatic symptoms; primarily concerned with the idea that they are ill. *new in DSM V specifiers- care-seeking or avoidant

Dissociative disorders

The essential features of these disorders is a disruption in the integration of consciousness as this relates to memory, identity, and perception of the environment. Such disturbances may be gradual, transient, or chronic. frequently develop in the aftermath of trauma, many symptoms such as embarrassment, confusion, and desire to hide have to do with proximity to trauma.

Dissociative amnesia

The inability to recall important personal information , usually of a traumatic or stressful nature that cannot be explained with ordinary forgetfulness; ordinarily, this information would be easily remembered. Individuals may only be partially aware of the amnesia.

Generalized anxiety disorder (co-morbidity)

The majority of people with this anxiety disorder have co-morbid depression or other anxiety disorders.

Benzodiazepines

The most common group of anti-anxiety drugs, which includes Valium and Xanax.

intrusion symptoms of PTSD

The presence of at least one of these after a traumatic event: recurrent reliving of the event, flashbacks accompanied by dissociative reactions of reliving the event; nightmares, and prolonged & intense reactive distress when in the presence of cues that remind the individual of the traumatic event; severe physiological reactions in response to these cues.

active phase of schizophrenia

The stage during which one or more psychotic symptoms, such as delusions or hallucinations, appear. Unless there is successful treatment, there are continuous signs of this disorder for 6 months.

PTSD (children of people with this disorder)

The whole family is affected by a parent suffering from this disorder, and children are particularly vulnerable to the disruption it causes in the family system. *impaired ability to parent *may render parents more likely to become impatient, angry, or neglectful with their children. *Young children especially are not cognitively equipped to make sense of this behavior, and research has identified a number of behavioral problems they are likely to display. Depression, anxiety, self-blame, aggression, hyperactivity, and social withdrawal are common, and so are symptoms of PTSD itself, such as low frustration tolerance and outbursts of anger—some describe PTSD as a disorder that may be transmitted intergenerationally. *hyperactivity - one most commonly identified as occurring in children of PTSD sufferers.

Insomnia (Parasomnia)

These behavioral events are characterized by a complaint of unusual behavior or events during sleep that may lead to intermittent awakenings and difficulty resuming sleep. This would be more important than the sleep-wake disorder to the clinical picture.

Bipolar and related disorders (DSM 5)

These disorders are a bridge between schizophrenia spectrum and depressive disorders-- bridge in terms of symptoms, family history, and genetics.

Sleep-wake disorders (general characteristics)

These disorders are characterized by daytime distress and impairment. Most often accompanied by depression and anxiety that must be addressed in treatment planning & management. The disorders may be an early episode of other disorders. Other medical disorders may also be present (sleep apnea) Included in this category: insomnia, hypersomnolence, non-rapid eye movement sleep arousal disorders, rapid eye movement sleep behavior disorder, restless legs syndrome, substance/medication induced sleep disorder.

Elimination disorders

These disorders involve inappropriate elimination of urine or feces and are usually first diagnosed in childhood or adolescence. These may be voluntary or involunatry & include: enuresis- repeated voiding of urine in inappropriate places encopresis- repeated passage of feces in inappropriate places subtypes: nocturnal & diurnal (enurisis); with or without constipation overflow (encopresis) child is at least 4 for encopresis 5 years old (mental age); must occur at least 2x/week for 1 month (poop) 3 months (pee)

Depression (vegetative symptoms)

These symptoms include persistent problems with appetite, weight loss or gain, sleep difficulties, reduced energy level, psychomotor retardation, and changes in sexual desire or function. These symptoms are mostly objective, as opposed to subjective and can serve as useful data for diagnostic screening purposes as vegetative symptoms sometimes suggest a serious mental disorder. *it is useful to identify whether any of these symptoms reflects a change from the client's previous functioning.

Specific Phobia (course & development)

This anxiety disorder could develop after a specific traumatic event (even intensive media coverage of something violent); usually develop in early childhood- majority of cases before age 10, but can develop at any age. Young children may express fear and anxiety by crying, tantrumming, freezing, clinging. Older folks- natural environment, fear of falling; co-occurs with medical issues (heart disease) Could be a genetic component

Social Anxiety Disorder (diagnostic criteria)

This anxiety disorder is diagnosed by (fear, anxiety or avoidance): A. Marked fear or anxiety about one or more social situations in which there is scrutiny by others B. Individual fears they will act in a way that will be negatively evaluated C. social situations almost always provoke fear or anxiety D. Avoided or endured with intense fear or anxiety E. Fear or anxiety is out of proportion to actual threat F. Persistent- typically G. Clinically significant distress or impairment H. Not attributable to physiological effects of a substance I. Not better explained by another mental disorder (panic, body dysmorphic, ASD) J. Not excessive considering other medical conditions (Parkinson's obesity, burns or injury) Performance only- If restricted to speaking or performing in public

Specific phobia (co-morbidity)

This anxiety disorder is rarely seen alone, and often seen with depression in older adults; diagnosed early, so usually the primary disorder, but these individuals are at-risk for other anxiety disorders, bipolar and depressive, substance-related; somatic symptom related, personality disorders (dependent personality disorder).

Flooding

This approach involves exposing an individual to anxiety-provoking stimuli while preventing an avoidance response. In-vivo flooding is considered the most effective psychological treatment for Agoraphobia, with reports of long-term improvement for to 75% of treated patients.

schizophrenia spectrum and other psychotic disorders

This class includes schizophrenia, other psychotic disorders, and schizotypal personality disorder. They are defined by abnormalities in one or more of the following 5 domains: 1) delusions; 2) hallucinations; 3) disorganized thinking (speech); 4) grossly disorganized and abnormal motor behavior (including catatonia); 5) negative symptoms

grossly disorganized or abnormal motor behavior (psychotic disorders)

This could include catatonia. Could range from childlike silliness to unpredictable agitation. Difficulty in performing the activities of daily living.

Depression (sleep difficulties)

This diagnosis is associated with decreased slow-wave or non-REM sleep as well as, early morning waking, decreased sleep continuity, and earlier onset of REM sleep or decreased REM latency.

Obsessive Compulsive Disorder (gender differences)

This disorder has an earlier peak onset for males than females. For males the peak onset is between ages 6 and 15, and for females it is between ages 20 and 29. Thus, gender differences for OCD begin to become apparent at 6 years. However, in adulthood the incidence is about the same for both genders.

Tourette's Disorder (general characteristics)

This disorder must be diagnosed in childhood, and involves: · multiple motor (involuntary, jerky movements) and vocal tics (grunts, clicks, barks)- both motor and vocal tics · Coprolalia- involuntary utterances of obscenities, occurs in 10% or less of cases · 1.5 and 3 times more common in males than in females.

Radical Attachment Disorder (RAD; types)

This disorder occurs in children below the age of 5 and is characterized by disturbed social relatedness. There are two subtypes: · inhibited - inhibition, hypervigilance, and ambivalent responses in social situations. · disinhibited - involves indiscriminate attachments and sociability (e.g., familiarity with strangers, lack of selectivity in choice of attachment figures). In both subtypes, evidence of pathogenic care (e.g., disregard for the child's basic physical or emotional needs) must be present before the diagnosis can be made.

Depersonalization/Derealization Disorder (co-morbidity)

This dissociative disorder is highly co-morbid with unipolar depressive disorders, for any anxiety disorder, Some co-morbidity with avoidant, borderline, and obsessive compulsive personality disorders low for PTSD

encopresis (prevalance & course)

This elimination disorder could be associated with inadquate, inconsistent toilet training. Can persist for years with intermittant exacerbations; primary and secondary types dependng on whether fecal contience was ever established. *more common to have UTIs with girls

Anorexia Nervosa

This feeding/eating disorder involves a restriction of energy intake that leads to significantly low body weight; an intense fear of gaining weight or becoming fat; persistent behaviors that interfere with weight gain; disturbance in the experience of one's body weight or shape or persistent lack of recognition about the seriousness of one's body weight. specifiers (in last 3 months)- for binge-eating/purging and restricting type Specifiers for severity- BMI (less than 18.5)

bulimia nervosa (general characteristics)

This feeding/eating disorder involves recurrent episodes of binge eating characterized by eating larger amounts of food than most people would eat in a similar period of time (2 hours); lack of control; recurrent compensatory behavior (self-induced vomitting or use of laxatives); self-evaluation is overly influenced by body weight and shape. *normal or overweight is maintained

Binge Eating Disorder (general characteristics)

This feeding/eating disorder is characterized by recurrent episodes of binge eating involving larger amounts of food than most people would eat in a similar amount of time. 3 or more symptoms: (1) eating much more rapidly than usual (2) eating until uncomfortably full (3) eating alone because of shame or embarassment (4) feeling disgusted with oneself -episodes cause significant distress and lasts at least a week for 3 months. -no compensatory behavior (like bulimia)

Avoidant/Restrictive Food Intake Disorder (co-morbidity & gender)

This feeding/eating disorder is equally common in males and females, but co-morbidty with ASD is more common in boys. common co-morbidities: anxiety disorders, OCD, ASD, ADHD, ID

loss of interest or pleasure (depressive disorders)

This is nearly always present in the dx; report of not being as interested in hobbies; social withdrawal or neglect of pleasurable activities.

persistent (specfier, somatic symptom disorder)

This kind of course is characterised by severe symptoms, marked impairment, and long duration (more than 6 months)

Narcolepsy (diagnostic criteria)

This sleep disorder involves recurrent, irrepressible needs to sleep *3 or more times/week for 3 months *Cataplexy *deficiency of hypocretin *REM latancy <15 minutes *vivid hallucinations Could be sleep paralysis; hallucinations; nighttime eating

Insomnia Disorder (diagnostic criteria)

This sleep-wake disorder is characterised by dissatisfaction with sleep quality or quantity with complaints about difficulty: *initiating or maintaining sleep (in children this could be trouble doing so independently; if this takes more than 20 minutes) *waking up in the morning and not being able to return to sleep *clinically significant distress or impairment in functioning *At least 3 nights/week; present for 3 months; *occurs in spite of adequate opportunity to sleep *This dx is given whether independent or comorbid with another mental disorder (major depressive disorder), sleep disorder (e.g. breathing related), or medical condition (pain)

narcolepsy (prevalence & course)

This sleep-wake disorder is relatively rare: .02-.04% *affects both genders; slightly more males *onset is in childhood/adolscence/young adulthood; rarely in older adults *abrupt onset can be associated with premature puberty; *young children who have this develop aggression

conversion disorder (course, risk)

This somatic symptom disorder can happen anytime in the lifecourse; it is 2 or 3x more likely in women; there could be a history of abuse and neglect and stressful life events; could be a co-morbid physical disease.

Unspecified disorder (specifier)

This specifier is coded when a client's symptoms do not meet the full criteria for a specific diagnosis and the clinician does not want to indicate the reason why - e.g., unspecified anxiety disorder."

Other specified "disorder" (specifier)

This specifier is coded when a client's symptoms do not meet the full criteria for a specific diagnosis and the clinician wants to indicate the reason why - e.g., other specified anxiety disorder, generalized anxiety not occurring more days than not."

With anxious distress (specifier, Bipolar)

To a more symptoms present most days during the mood episode: 1) feeling keyed up our tense, 2) 3) feeling unusually restless, difficulty concentrating because of worry, 4) fear that something awful may happen, or 5) feeling like one may lose self-control. Severity: mild- 2 symptoms moderate- 3 symptoms moderate-severe- 4-5 symptoms Severe- 4-5 symptoms with motor agitation

Insomnia Disorder (treatment)

Treatment for this common sleep-wake disorder may include benzodiazepine, antihistamine, or drug & cognitive behavioral intervention, that includes: *sleep restriction- restricting time in bed to improve sleep continuity *stimulus control- strengthening the bed and bedroom as cues for sleep *sleep-hygiene education- information about healthy sleep behaviors *relaxation training *cognitive restructuring

Bipolar (Psychosocial treatment)

Treatment for this disorder includes CBT; psychoeducation, and social rhythms therapy. These treatments may increase medication compliance, could lead mood stability and better functioning.

Separation Anxiety Disorder (treatment)

Treatment for this disorder is behavioral therapy that involves systematic desensitization; contingency management; and other strategies. Older kids- CBT that focuses on replacing maladaptive attitudes with more adaptive ones. school refusal- treatment goal is immediate return to school.

ADHD (Treatment)

Treatment for this disorder usually includes a combination of medication and behavioral interventions. Methylphenidate (Ritalin) and other central nervous stimulants have beneficial effects on hyperactivity, impulsivity, and inattention for up 80% of individuals with ADHD (Hamblin & Gross, 2012). Combination of child-focused interventions, parent training, and school-based interventions (Brock, Jimerson, & Hansen, 2009).

Factitious disorder (treatment)

Treatment for this somatic symptoms disorder involves symptom management rather than curing. establishing a strong therapeutic alliance is important; providing and supportive and consistent care. Should not use confrontational techniques.

Obsessive-Compulsive Disorders (behavioral treatments)

Two of the most treatments for this disorder are thought stopping and deliberate exposure with response prevention. · Thought stopping- applies to obsessions, involves teaching the client to yell "STOP!" (or self-apply another aversive technique) when he or she begins to engage in obsessive rumination. · Deliberate exposure with response prevention- exposing the client to situations which evoke obsessions or compulsions and then blocking him or her from engaging in them. Other behavioral treatments: relaxation training, paradoxical intent, covert sensitization, and systematic desensitization.

Bipolar I & II (severity of symptoms)

Type II is no longer considered a milder version of Type I, because: of the amount of time spent in depression & instability of mood & serious impairment in work and social functioning.

Binge eating disorder (prevalence & course)

US adults: 1.6%- females; .8% males; gender ratio is less skewed for this eating/feeding disorder than others; more prevalent in minority youth females than other eating disorders; more prevalent in those seeking weight loss treatment.

Panic attack (prevalence & course)

US- 11.2% Can occur in children, but mean age is 22-24 years.

Dissociative Identity Disorder (co-morbidity)

Usually a large number of co-morbid disorders: Most develop PTSD; depressive disorders, trauma- and stressor related disorders; personality disorders (borderline and avoidant); conversion, somatic, eating, OCD, sleep

Depakote (& side effects)

Valproic acid, anticonvulsant that was originally used to control seizure disorders. Found to be effective in the treatment of mania & depression associated with bipolar disorder when Lithium is ineffective. side effects: changes in weight, nausea, vomiting, stomach pain, loss of appetite or anorexia. can cause damage to liver and pancreas. in teenage girls, it can raise the level of testocerone, causing polycystic ovarian syndrome Can cause birth defects if taken during pregnancy

Schizophrenia (international research)

WHO found differences in the course and outcome of schizophrenia patients from developing and industrialized countries. Patients from developing countries more often exhibit an acute onset of symptoms, a shorter clinical course, and a complete remission of symptoms. No consistent differences were found between these two groups in regards to age, gender, or type of symptoms.

Bipolar treatment (anti-seizure medication)

When Lithium does not help, these may be prescribed. Can alleviate manic and depressive symptoms in patients with Bipolar Disorder. But these drugs can increase rather than decrease depressive symptoms in some patients. FDA warning for anticonvulsants: May increase suicidal ideations and behaviors. Must be carefully monitored; patients can't change the dosage themselves.

e-therapy and anonymity

While many e-therapists like to have their clients' names and contact information in case of an emergency, and some even require this, it is both legal and ethical to allow a client receiving e-therapy to remain anonymous if that's what he or she wants. An example of a parallel would be with an anonymous patient who calls a hotline or an emergency room. Like many e-therapists, this psychologist could start by letting this client remain anonymous if he insists and then, as trust develops between them, gradually convince him to provide his name and contact information.

Billing insurance companies for no-shows

While your financial agreement may or may not require the client to cover the co-payment for missed sessions, Current Procedural Terminology (CPT) codes do not provide a code for no-shows, and billing for services not rendered is unethical.

Specifiers for OCD

With good or fair insight- recognizes that OCD beliefs are definitely or probably not true or that they may not be true with poor insight- thinks OCD beliefs are probably true with absent insight/delusional beliefs- completely convinced that OCD beliefs are true tic-related- if the individual has a current or past history of tic disorder (up to 30% of individuals)

delusion of reference (psychotic disorders)

a delusion in which the person believes that objects or events in the immediate environment have an unusual and particular significance to him or her.

Disruptive mood dysregulation disorder (DMDD)

a depressive disorder in children (up to age 12) characterized by chronic and persistent irritability and frequent episodes of out-of-control behavior. New to the DSM 5; these children may go on to develop anxiety disorders or depressive disorders; not Bipolar (response to overdiagnoses of Bipolar in children)

Avoidant/Restrictive Food Intake Disorder

a disorder in which individuals avoid eating out of concern about aversive consequences (such as choking) or restrict intake of food with specific sensory characteristics (color, texture, or smell, temperature); persistent failure to meet appropriate nutritional and/or energy needs, manifested by 1 or more of the following: (1) Signficiant weight loss (2) Significant nutritional deficiency (3) dependece on enteral feeding or oral nutritional supplements (4) Marked interference with psychosocial functioning More common in children

depersonalization/derealization disorder

a dissociative disorder characterized by persistent and recurrent feelings of being estranged from oneself, or being a spectator in one's own life, and of being detached from one's mental processes or body that is accompanied by intact reality testing (e.g the individual is aware that this is only a feeling of self-alienation & not reality as such). I am no one and I have no self fear of irreversible brain damage hypoemotionality robot-like state general state of disconnectedness from life

Hypocretin

a neurotransmitter secreted by cells in the hypothalamus; helps regulate sleep-wake cycles; measured in cerebral spinal fluid; deficiencies associated with narcolepsy

electroconvulsive therapy (ECT)

a non-preferred treatment for depression because of its adverse side effects, but it has been found to be effective for severe endogenous depression that is resistant to antidepressants. The primary undesirable effects of ECT are disorientation and anterograde and retrograde amnesia. Autobiographical memory issues may persist for months. Memory effects are reduced when ECT is administered only to the right (nondominant) hemisphere (McCall et al., 2000; Weiner, 1986).

Schizophrenia

a psychotic disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression

delusional disorder (general characteristics)

a psychotic disorder in which the primary symptom is one or more delusions; may be accompanied by hallucinations. Behavior generally does not seem odd or peculiar.

schizophrenia (disorganized speech)

a severe disruption of verbal communication in which ideas shift rapidly and incoherently from one to another unrelated topic. Loosening of dissassociations to complete incoherence; word salad

neuroticism (DSM 5)

anxiety, insecurity, emotional instability- negative affectivity. Proneness to experiencing negative emotions. Temperament associated with several anxiety disorders.

Hypersomnolence Disorder (automatic behavior)

associated with a sleep-wake disorder; these are routine, low-complexity behaviors that the individual carries out with no recall; usually in low stimulation contexts (watching TV or listening to a lecture) example: Driving several miles from where they thought *these may be performed in a hazelike function without memory or consciousness

grandiose delusion (psychotic disorders)

belief that he or she has exceptional abilities, wealth, fame, but this is unrecognized.

Hypersomnolence Disorder (general characteristics)

broad diagnostic term for a sleep-wake disorder involving excessive quantity of sleep- extended nocturnal and involuntary daytime, deteriorated quality of wakefulness & sleep inertia- period of impaired performance following sleep/naps. *main sleep period lasts at least 7 hours; need for more sleep. *recurrent periods of sleep or lapses into sleep *prolonged sleep episode of more than 9 hours a day that is not restful = nonrestorative *difficulty being fully awake after abrupt awakening *3 times/week for at least 3 months specifiers: with mental disorder; medical conidtion, another sleep disorder *acute, subacute, persistent *mild, moderate, or severe

Disruptive Mood Dysregulation Disorder (differential diagnosis)

carefully distinguished from pediatric Bipolar Disorder (which has distinct periods of mania or hypomania; or episodic periods of bipolar symptoms). This dx involves very severe, non-episodic irritability. Co-morbidity: This disorder cannot co-exist with ODD, intermittent explosive disorder, bipolar. Can coexist with major depressive disorder, ADHD, conduct, substance use disorder.

somatic delusion (psychotic disorders)

central them of the delusion involves bodily functions or sensations. Most common: individual emits a foul odor; infestation of insects on skin; misshapen or ugly parts of the body.

Neurotransmitters

chemical messengers that cross the synaptic gaps between neurons; regulate many processes, including emotional responses, affect and mood.

risk factor for Dissociative Identity Disorder

childhood abuse & neglect

Schizophrenia (negative symptoms)

disturbance of affect, blunting (severe reduction in the intensity of affect expression), flat affect, inappropriate affect (might laugh hysterically while describing someones death)

Best protection against malpractice

documentation (keeping records) is considered the most critical by the experts. In malpractice litigation, courts generally take the position "if the psychologist didn't write it down, it didn't happen."

psychotropic medications

drugs that primarily affect the brain and reduce many symptoms of mental dysfunctioning; Do not cure mental disorders, but can relieve or control symptoms to improve mood, well-being, and ability to function.

typical antipsychotic drugs

drugs used to treat schizophrenia and other forms of severe thought disorder. Thorazine (chlorpromazine); Stelazine (trifluoperazine); Mellaril (thioridazine); Haldol (haloperidol); perphenazine; fluphenazine

Purging (bulimia nervosa)

engaging in inappropriate compensatory behaviors such as vomiting or misusing laxatives to rid the body of food; several methods may be used at once. vomitting = most common

derealization

experiences of unreality or detachment with respect to surroundings (e.g individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted)

depersonalization

experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions. (e.g. perceptual alterations, distorted sense of time, unreal or absent self, emotional and physical numbing)

Delusions (Schizophrenia)

false beliefs disorganized with reality and not shared by others in that individual's culture, and are maintained even though evidence is shown that's against it. These beliefs could be persecutorial (one is going to be harmed), referential, grandiose or bizarre.

Delusions (psychotic disorders)

false beliefs held by a person who refuses to accept evidence of their falseness. Not understood by someone of the same culture and not from everyday experiences. Different from a strongly held belief because despite contradictory evidence, the patient continues to beleive it. Could be persecutory; referential; grandiose; erotomanic. example of bizarre: an outside force has removed one's organs and replaced them with someone else's without leaving any wounds or scars. example of non-bizarre: belief that one is under surveillance by the police, despite a lack of convincing evidence.

Tachycardia

fast heart rate

Bulimia Nervosa (prevalence & course)

females- range: 1% - 1.5%; 10:1 ratio female: male *Begins after a stressful event *Symptoms preceded by dieting *Symptoms can persist for several years

Major depressive disorder (dx, DSM- 5)

for this disorder, 5 or more of the following symptoms must be present during the same 2-week period and represent a change in functioning. At least one is 1) depressed mood or 2) loss of interest or pleasure. 1. Depressed mood, most of the day, nearly every day (subjective report or observation); in children, can be irritable 2. Markedly diminished interest in pleasure in all, or nearly all activities. 3. Significant weight loss when not dieting or weight gain- change of more than 5%. 4. insomnia or hypersomnia nearly every day 5. psychomotor agitation or retardation observable by others (not just subjective report) 6. fatigue or loss of energy almost every day 7. worthlessness or excessive or inappropriate guilt. 8. can't think or concentrate; indecisiveness almost every day 9. recurrent thoughts of death; suicidal ideation without a plan. Symptoms cause significant impairment and can't be explained by substance use or another medical condition. No manic or hypomanic episodes.

Bulimia nervosa (differential diagnosis)

for this feeding/eating disorder, differentiate from: *anorexia nervosa, binge-eating/purging- if binge eating only occurs during anorexia nervosa, this is the primary dx; may be given an initial dx of anorexia, but if they no longer meet the criteria and are still binging and puring= this dx *Major depressive disorder, atypical features- Could be binging, but no compensatory purging; no excessive concern with body shape; could co-occur

group therapy and confidentiality

group therapy involves a moral responsibility to respect confidentiality extends beyond the therapist to each group participant. However, while there may be a moral obligation to maintain confidentiality, there isn't an ethically enforceable obligation. The Ethics Code, Standard 4.02, addresses the limitations of confidentiality and Standard 10.01, Informed Consent in Therapy, addresses the need to discuss the limits of confidentiality at the beginning of (group) therapy

hypnopompic hallucinations

hallucinations that occur when awakening from sleep; seen in narcolepsy

Bulimia nervosa (treatment)

immediate goal of treatment for this eating/feeding disorder is to restore normal eating behaviors; maintain and alleviate individual & family factors. *CBT- empirically supported *family or couples counseling *nutritional counseling *anti-depressants- less effective for relapse prevention

Hypnosis & Recovered Memories -

it is possible for memories of abuse that have been forgotten for a long time to be remembered." However, they recommend that "clients who seek hypnosis as a means of retrieving or confirming their recollections should be advised that it is not an appropriate procedure for this goal because of the serious risk that pseudomemories may be created in trance states and of the related risk due to increased confidence in those memories. Clients should also be informed that the use of hypnosis could jeopardize any future legal actions they might want to take

Cyclothymic disorder (course and prevalence)

lifetime prevalence: .4-1%; equally common in males and females, with females more likely to get treatment. Usually begins in adolescence or early adulthood. 15-50% will develop Bipolar I or II. For kids who have this, the average age of onset is 6.5 years.

schizophrenia (psychosis)

loss of contact with reality; radical changes in personality; impaired functioning, distorted sense of reality; could be genetic, caused by drugs or medication, or psychosocial

systematized amnesia

loss of memory for certain categories of information; such as memories relateing to one's family or childhood sexual abuse.

Specifiers based on severity (depressive disorders)

mild- few, if any symptoms in excess of those required to make the dx-- distressing, but manageable moderate- # and intensity of symptoms and functional impairment are between mild and severe severe- # of symptoms substantially in excess of the required to make the dx; seriously distressing and unmanageable; marked interference with social and occupational functioning

MAOIs

monoamine oxidase inhibitors; older form of antidepressant medications increase serotonin and norepinephrine at the synaptic cleft by inhibiting the enzyme monoamine oxidase which breaks down serotonin and NE--less enzyme, more neurotransmitter, dangerous when combined with tyramine (cheese; wine; pickles, over the counter cold medecines); could cause blood pressure to skyrocket and could cause stroke. other side effects: dry mouth, blurred vision, urinary retention, orthostatic hypotension--

enuresis (subtypes)

monosymptomatic enuresis- nighttime only; typcially during the first 3rd of the night. urinary incontence- diurnal only, absence of nighttime accidents; could be voluntary- voiding postponement

Tricyclic Antidepressants (TCAs)

older antidepressants (1950s) named after the three rings of atoms in their molecular structure; largely replaced by SSRIs and SNRIs. Fewer emotional blunting and sexual side effects. Side effects include: dry mouth, dry nose, blurry vision, lowered gastrointestinal motility or constipation, urinary retention, cognitive and/or memory impairment, and increased body temperature Examples: amitriptyline (Elavil), clomipramine (Anafranil), doxepin (Sinequan), imipramine (Tofranil),

fact witness (forensic)

one who testifies about facts relevant to the case; when a psychologist testifies as a fact witness, it would be because he has treated a client and the events or disclosures that occurred in the treatment are relevant to the case. treating psychologist's client is the patient A psychologist cannot serve as both an expert and fact witness for the same case.

hallucinations (psychotic disorders)

perception-like experiences that occur without external stimuli. Clear and vivid, with the full force of normal perceptions, and not under voluntary control. Auditory are the most common, and are usually experienced as voices that are different from the individual's own thoughts. When experiences when going to sleep or waking up, they can be within a range of normal experiences.

anorexia nervosa (diagnostic/physiological markers)

physical markers for this eating/feeding disorder: hematology- Leukopenia- reduced white blood cells; mild anemia *dehydration- elevated urea *T4 in the low range *low bone mass; high risk of fracture *loss of menstrual period

enurisis (prevalence & course)

prevalence rates for this elmination disorder: 5-10% for 5 year olds; 3-5% among 10 year olds; 1% among 15 year olds or older. course: an individual may never establish continence, or secondary type, where after having contince this happens. Could be because of social anxiety around using a shared toilet (at school), or preoccupation with play or school tasks. Frequency could increase if this persists beyond middle childhood.

Brief Psychotic Disorder (prevalence)

psychotic disorder with prevalence of US: 9% of cases of first onset psychosis. average onset: mid-30s; higher prevalence in women.

anorexia nervosa (risk factors)

risk factors for this feeding/eating disorder include: temperamental- anxiety disorders, obsessive tendencies in childhood genetic- increase among first degree relatives with an eating disorder; also bipolar and depressive disorders neurochemical- higher than normal seratonin family factors- upper or middle class background; controlling mother/underinvolved father; home environment that stresses dieting & weight perfectionist children who set high standards for themselves

SSRIs

selective serotonin reuptake inhibitors; most popular anti-depressants. They prevent too much seratonin from being eliminated from the brain, which causes depression, and allow more of it to remain, which elevates mood.

expert witness (forensic)

someone who has superior knowledge about a particular psychological issue in a legal case based on her training or experience, and offers that opinion if permitted or asked to do so by the court. The client is an attorney

With peripartum onset (major depressive disorder)

specifier applied to depressive disorder when symptoms began during pregnancy or within 4 weeks postpartum. While 50 to 80% of women experience minor mood symptoms (baby blues") after giving birth, only 10 to 20% have symptoms that are sufficiently severe for a diagnosis of Major Depressive Disorder and only 0.1 to 0.2% develop postpartum psychosis (Sit, Rothschild, & Wisner, 2006).

with rapid cycling (specifier, Bipolar)

specifier for Bipolar I and II; Presence of at least 4 mood episodes in the last 12 months that meet the criteria for manic, hypomanic, or major depressive disorder. Episodes can involve either full or partial remission; and the episodes can occur in any order.

with dissociative fugue

specifier fwhere travel or wandering associated with amnesia for identity or other personal info;

with atypical features (depressive episode)

specifier when mood reactivity plus at least 2 of the following predominate on most days during the current or most recent major depressive episode: significant weight gain or increase in appetite, hypersomnia, leaden paralysis, pattern of interpersonal rejection sensitivity.

OCD (risk factors)

temperament: Greater internalizing symptoms, higher negative emotionality; behavioral inhibition in childhood. enviornmental: physical and sexual abuse in childhood genetic: rate of OCD among first degree relatives is 2x; especially in childhood- 10x related to dysfunction in the orbitofrontal cortex, anterior cingulate cortex, striatum

Somatic symptom disorder (co-morbidity)

this disorder is co-morbid with many medical disorders as well as anxiety and depressive disorders. When there is a concurrent medical disorder, the degree of impairment is more extensive than expected; also overlaps with anxiety and depression.

Hypersomnolence Disorder (comorbidity)

this sleep-wake disorder is associated with depressive disorder, bipolar disorder (during a depressive episode), major depressive disorder, with seasonal pattern. *Could be associated with neurodegenerative conditons: Alzheimer's, Parkinson's

Insomnia Disorder (associated features)

this sleep-wake disorder may be associated with elevated scores on self-report psychological or personality inventories- associated with mild depression or anxiety; may have difficulty with performing tasks of higher cognitive complexity Increased physiological and cognitive arousal play a significant role in the disorder. Can appear fatigued/haggard, or overaroused.

hypnogogic hallucinations

vivid hallucinations that occur while falling asleep; associated with narcolepsy; 20-60% of people with narcolepsy experience this;

Brachycardia

when heartbeat is < 60

encopresis (subtupes and risk factors)

with constipation overflow- poorly formed; leakage; occurs mostly during the day (rarely at night); resolves after treatment for constipation; constipation could be based on psychological reasons without constipation overflow- normal form & consistency; intermittent soiling; may poop at a prominent location. Usually associated with ODD; CD- less common

Autism Spectrum Disorder (prevalence)

· 60/10,000 (historical: from the 1960s 4/10,000; 10/10,000 in year 2000); I/50 school-age children · prevalence rates are increasing; could be because of methodological issues with surveys & changing diagnostic classification · Not separated out by sub-types: Asperger's; PDD NOS

Schizophrenia (dopamine hypothesis)

· Biochemical explanation for this disorder; associated with either an excess of the monoamine neurotransmitters (particularly dopamine) or with increased sensitivity to the dopamine ordinarily present in the brain. · New research indicated norepinephrine, serotonin & glutamate could also be involved, and antipsychotics such as clozapine restore the balance between these neurtransmitters.

Learning Disorders (co-morbidities)

· Children with these disorders have higher rates of ADHD, CD, ODD, and Major Depressive Disorders · As adults, they continue to have trouble

Anxiety vs. Depressin (Beck & Wright)

· Depressed and anxious individuals both display demoralization, self-absorption, and reduced cognitive capacity for problem-solving and task performance; negative affect · Cognitions differ in the following ways: 1) In depression, cognitions about hopelessness, low self-esteem, and failure are more common; in anxiety, cognitive themes are usually related to anticipated harm or danger. 2) Depressed patients are more likely to have absolute thoughts about negative themes, while anxious individuals tend to have questioning thoughts about the uncertainty of future events

Premenstrual Syndrome

· Depression and dysfunctional symptoms associated with the menstrual cycle are not typical for most women! · Symptoms of this controversial disorder include: anxiety depression, lethargy, diminished interest in activities, physical symptoms (bloating) For the women who have this, symptoms usually occur shortly before and terminate shortly after the onset of menses

ADHD (Treatment, medications)

· First-line medications for ADHD are stimulant medications such as methylphenidate. If they don't respond to two or more first-line, second line may be tried · Side effect-motor tics, so for children with a family history of Tourette's it might be counter-indicated · Antidepressants- imiprime -CNS stimulants: Dexedrine, Ritalin, Concerta, Focalin, Adderall; potential for abuse

Depression vs. dementia (differential dx)

· Memory impairment- important differentiation from dementia · Recall memory is affected, but not recognition - retrieval from the past · Dementia- both recall and recognition memory are affected

PMS vs. PDD (differential diagnsosis)

· PDD is more serious than PMS (and is actually listed in the DSM V) · Requires symptoms to be present for most of the menstrual cycle · 5 symptoms must be present in the week before menses: severe mood swings, emotional sensitivity, irritability, considerable agitation or anxiety; physical symptoms (bloating, weight gain, swelling of joints, muscle pain)

Bipolar (Etiology)

· Strong genetic and biological components- heredity is the primary factor · Environmental factors can also trigger an episode; especially in the early stages of the disorder when psychosocial stressors can trigger ·

ADHD (concordance rates)

· Strong genetic component for this disorder · Parent having this: 57% chance of offspring · Identical twin- .80 for impulsivity and hyperactivity