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Definition
| Mental Retardation (MR) requires three criteria 1. Subaverage intellectual functioning (i.e., an IQ of less than 70) 2. Marked deficits in adaptive functioning in at least two areas of adaptive functioning (e.g., communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety) 3. Onset before age 18 Classified on basis of severity of intellectual impairment 1. Mild Mental Retardation: IQ is between 50-55 to approximately 70; accounts for 85 percent of all MR cases; may not become apparent until a child is of school age and has difficulty meeting educational demands; generally acquire both communication and social skills during the preschool years 2. Moderate Mental Retardation: approximately 10 percent of individuals with MR; IQ ranges from 35-40 to 50-55; usually develop communication skills during early childhood; can be trained to perform unskilled work under close supervision 3. Severe Mental Retardation: 3 to 4 percent of the MR population; IQ between 20-25 and 35-40; communicative speech usually does not develop during early childhood, although it may be acquired during the school-age years; can learn basic self-care, but need more supervision 4. Profound Mental Retardation: approximately 1 to 2 percent of people with MR; IQ of less than 20-25; communication skills and sensorimotor functioning are significantly impaired; need nearly constant supervision and generally benefit from a one-to-one relationship with a caregiver Early warning signs 1. May be evident in more severe cases of MR: infant's lack of age-appropriate interest in environment and delays in motor development; failure to make eye contact during feeding; may be less responsive to voice or movement; and may be less ready to interact with their parents or other stimuli Assessing Mental Retardation 1. WISC-IV has a high floor, or a minimum possible score of about 50 (about three standard deviations below the mean); this test cannot provide an accurate assessment of the level of Mental Retardation 2. Stanford-Binet: best to assess Mental Retardation because its floor is much lower (also to assess giftedness) Causes of Mental Retardation 1. Varied and etiology may be undetermined in approximately 30 percent to 40 percent of cases 2. Clear etiologies: easier to ascertain with Severe or Profound Mental Retardation 3. Most common identifiable cause: (accounting for approximately 30 percent of Mental Retardation diagnoses) early abnormalities in embryonic development; maternal illness (e.g., syphilis, rubella, toxoplasmosis, cytomegalovirus), maternal consumption of alcohol, maternal use of nicotine or drugs, and chromosomal changes (e.g., Down Syndrome due to trisomy) may all alter embryonic development; environmental influences (e.g., deprivation of nurturance, stimulatory deprivation) and other mental disorders (e.g., Autistic Disorder and other Pervasive Developmental Disorders) are implicated in 15 percent to 20 percent of MR cases. Approximately 10 percent of MR cases due to pregnancy and perinatal problems (e.g., premature birth, fetal trauma or trauma at birth, hypoxia, fetal malnutrition). Hereditary factors (e.g., Tay-Sachs disease, fragile X syndrome, PKU, translocation, Down Syndrome) account for approximately 5 percent of MR cases 4. Also be caused by childhood illness (e.g., meningitis or encephalitis due to measles or whooping cough) or childhood injuries (e.g., head trauma, near drowning) Individuals with Mental Retardation 1. Three to four times more likely to experience other mental disorders 2. Associated comorbid disorders: Attention-Deficit/Hyperactivity Disorder, Mood Disorders, Pervasive Developmental Disorders, Stereotypic Movement Disorder, and Mental Disorders due to a General Medical Condition |
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Term
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Definition
| 1. Significantly sub average (or below predicted levels, based on IQ) performance in reading, mathematics, or writing 2. Reading disorder (dyslexia) most common form; attributable to poor phonological processing in most cases 3. Close to 1:1 male:female ratio 4. Untreated, leads to considerable impairment in later life 5. Achievement level in a specific academic domain must be at least two standard deviations below his or her IQ 6. 40 percent don't complete high school 7. 20 percent to 30 percent have ADHD 8. Treatment involves direct remediation rather than a focus on underlying, alleged sensorimotor deficits |
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Definition
| 1. Stuttering is a communication disorder, marked by disturbance in normal fluency and time patterning of speech 2. May take form of sound or syllable repetitions or prolongations; repetition of whole monosyllabic words is also common; circumlocutions can be present (word substitutions to avoid a frequently stuttered word) 3. Signs of physical tension often present in those who stutter; anxiety or pressure to communicate may increase Stuttering 4. Onset nearly always under 10 years of age; approximately 3:1 boy:girl ratio 5. Often transitory, resolving by end of childhood or adolescence, but may persist into adulthood 6. Patience, reducing tension, and regulated breathing may provide clinical benefit |
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Term
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Definition
| 1. Autistic Disorder begins before age 3; it involves serious and impairing sxs related to social interaction, language and communication, and restricted/unusual/stereotypic interests 2. Social impairments range from unusual interactions to a nearly complete lack of social interest 3. Language may be odd or idiosyncratic, when present; in severe cases, no spoken language develops 4. Repetitive interests and insistence on identical routines are often salient 5. Most individuals with Autistic Disorder show mental retardation; one in four develops seizures by late adolescence 6. Good prognosis associated with normal-range IQ and spoken language 7. Intensive application of applied bx analysis (bx modification) during the first few years of life is the most effective treatment; medications may play an adjunctive role |
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Definition
| 1. Asperger's Disorder involves impairments in social interaction and restrictions in bxs/interests, similar to those seen in autistic disorder 2. Key difference: There are no childhood-onset delays in language acquisition or communication, as there are in autistic disorder 3. Over time, social idiosyncrasies, oddities, and restricted interests are salient in cases with Asperger's Disorder Characterized by 1. Marked impairments in social interaction as well as restricted, repetitive, and stereotyped patterns of bx, interests, and activities that cause impairment in social or occupational functioning 2. Poor motor coordination and clumsiness 3. Do not present with cognitive deficits or delayed language acquisition (score higher on assessments of verbal skills as compared to nonverbal skills; in some cases, verbal abilities are highly developed) 4. Social impairment: failure to develop age-appropriate peer relationships, and difficulty using and interpreting nonverbal social cues (e.g., direct eye contact, gestures, body posture, and vocal tone), which may interfere with an individual's ability to understand jokes or sarcasm 5. Deficits in interpersonal interactions: may not spontaneously seek to share enjoyment, achievements, or interests with others 6. May lack social or emotional reciprocity, tending to relate to others in an eccentric or one-sided manner 7. Have a restricted range of interests and learn as much as possible about these topics 8. Often passionately pursue their preferred activities while neglecting other important areas of functioning 9. Often develop coping mechanisms to address their impairments as they progress through childhood 10. High overlap between Asperger's Disorder and high-functioning autistic disorder Long-term effect 1. Lifelong, prognosis can be good, depending on level of severity 2. Some individuals with the disorder capable of developing meaningful relationships, achieving a high degree of academic success, and displaying relatively normal occupational functioning 3. In childhood, language functioning among youths with Pervasive Developmental Disorders highly linked with good prognosis; the absence of language deficits in Asperger's Disorder therefore predicts better outcomes Treatment 1. Social skills interventions and/or group-based bxal procedures |
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Term
| Attention-Deficit/Hyperactivity Disorder (ADHD) |
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Definition
| Sx Qualifiers 1. Childhood onset: must be exhibited before age 7 (except inattentive type 2. Apan at least six months duration 3. Result in impairment of overall functioning levels 4. Be exhibited in at least two settings 5. Condition marked by developmentally extreme sxs of inattention/disorganization and/or hyperactivity/impulsivity Types 1. Predominantly Hyperactive-Impulsive 2. Predominantly Inattentive 3. Combined Diagnosis 1. Hyperactivity could include motor agitation, fidgeting, difficulty engaging in quiet activities, constantly being "on the go," intruding upon others, and/or excessive talking 2. Difficult to diagnose in preschoolers, because constituent bxs relatively normative in that age group; assessment must include informants with knowledge of everyday bxs 3. Impairments span low achievement, peer rejection, problematic family interactions, accidental injuries 4. ADHD lasts through adulthood in a majority of cases 5. Characteristics of ADHD in adulthood include experiencing sujective feelings of restlessness or irritability, becoming bored quickly, engaging in reckless bx (impulsive sexual encounters, poor money management), and having difficulty concentrating, establishing and maintaining routines, prioritizing, and organizing and completing tasks. Furthermore, adults diagnosed with ADHD may change jobs frequently and switch their intimate partners more often than do adults without ADHD. Prevalence 1. 9.5% of children and adolescents; somewhat lower in adults 2. Sex ratio is 3:1 male-to-female 3. Comorbidity with Oppositional Defiant Disorder/Conduct Disorder (40%), Anxiety Disorders, (25-40%), Mood Disorders (10-30% in children; 47% in adults), Learning Disorders (50%), Bipolar Disorder (20%) 4. Strongly heritable (approaching 80 percent) Etiology 1. Strongly heritable (approaching 80%) 2. Frontal-lobe functioning and frontal-striatal pathways are implicated in ADHD sxatology 3. Maladaptive parenting styles may fuel persistence of the condition as well as potential comorbidities Evidence-based treatments 1. Medications (stimulants; SNRIs) 2. Bxal strategies |
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Definition
| Descriptors A condition characterizing children or adolescents and involving persistent problems linked to aggression toward people and animals, destruction of property, deceitfulness or theft, and/or serious violations of rules. Rather than taking responsibility for their actions, individuals with Conduct Disorder tend to blame others for their misbx. Sxs Heightened levels of irritability. Low tolerance for frustration. Substance abuse. Sexual promiscuity at early ages. Reckless bx Subtypes. Childhood-Limited Conduct Disorder: Children in this group experience severe, pervasive, and persistent conduct problems during childhood, which remit by adolescence. Children with Childhood-Limited subtype do not engage in antisocial bx in adulthood but may become depressed, anxious, socially isolated and financially dependent on others. Child-onset type: Sxs present before age 10 (highest likelihood of progression to Antisocial Personality Disorder; multiple, interactive, early-onset risk factors; 5:1 male-female ratio). Adolescent-onset type: Sxs emerge only after age 10 (fewer risk factors present here; closer to even male:female ratio). Prevalence. 1. Typically diagnosed in children and adolescents (can be present in adults, but only if adult does not meet criteria for Antisocial Personality Disorder) 2. Only a minority of youths with Conduct Disorder will go on to develop Antisocial Personality Disorder 3. High likelihood of comorbidity with ADHD (30-80%); lesser likelihood with Major Depression (21-50%) Risk Factors 1. Individual: Difficult temperament 2. Familial: a. Harsh, inconsistent discipline b. History of mental disturbances c. Abuse 3. Societal: Peer rejection 4. Community: Exposure to violence 5. Typically interaction between multitude of factors, especially in Child-Onset 6. Patterson's Coercive Family Interaction Proess proposes an interaction between ineffective parental discipline and child non-compliance Treatments Systematic, bxal/cognitive-bxal interventions such as Multi-Systemic Therapy, parent management training, anger control treatment . Medications, though not primary intervention, may be used |
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Term
| Oppositional Defiant Disorder (ODD) |
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Definition
| 1. A Disruptive Bx Disorder marked by a negativistic, hostile, and defiant bx toward authority figures persisting for at least six months 2. In around one-third of cases, there is a developmental progression to Conduct Disorder; the vast majority of cases of Conduct Disorder are preceded by ODD 3. ODD often manifests through excessive stubbornness, revenge-seeking, oppositionality, and blaming of others for wrongdoing 4. Verbal aggression and outbursts common, but physically aggressive bx typical of Conduct Disorder is often not present 5. Onset typically before 8 years of age; sxs most often present around family members 6. Wide estimates of prevalence rates (2 to 16 percent). In childhood, boys more likely than girls to have ADHD; gender disparity diminishes by adolescence 7. Linked to inconsistent, neglectful, or overly harsh parenting. High comorbidity with Attention-Deficit/Hyperactivity Disorder Treatments 1. Bxal parent management training 2. Cognitive-bxal therapy related to anger management 3. Social skills training (though contagion can occur in group treatments) 4. No primary medication treatment; stimulant medications can reduce defiance and impulsive or retaliatory aggression |
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Term
| Feeding & Eating Disorders: Infancy or Early Childhood |
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Definition
| Three Feeding and Eating Disorders of Infancy or Early Childhood 1. Pica 2. Rumination Disorder 3. Feeding Disorder of Infancy or Early Childhood (failure to thrive) Pica 1. Regular ingestion of non-nutritive substances; exact substances vary by age 2. Often linked to mental retardation or Pervasive Developmental Disorders 3. Can lead to serious medical complications (lead poisoning, for example) Rumination Disorder 1. Repeated regurgitation and (often) re-chewing of food without apparent distress 2. May result in malnutrition and even death, as food not fully digested 3. Linked to stress in parent-child relationships, along with lack of stimulation, child neglect Feeding Disorder of Infancy or Early Childhood (also termed "failure to thrive") 1. Persistent failure to eat adequately for at least one month 2. Linked with developmental delays, sometimes with child abuse or neglect, extreme stress in family, clear failures in parental "reading" of infant/child hunger cues |
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Term
| Attachment Disorder of Infancy or Early Childhood |
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Definition
| Reactive Attachment Disorder (RAD) 1. Marked by a child's display of significantly disturbed social relatedness, linked directly to grossly pathological care (and not to Mental Retardation or Pervasive Developmental Disorders) 2. Onset before the age of 5 Types 1. Inhibited Type: Children do not engage in many interactions, are hypervigilant, wary of letting other people come close to or make eye contact with them ("frozen watchfulness"), and often resistant toward physical affection 2. Disinhibited Type: Children are indiscriminately sociable and fail to make selective attachments, act overly familiar (i.e., overly affectionate) with strangers Etiology 1. Pathologenic care giving may be marked by continued and severe neglect (i.e., failure to provide for the basic emotional or physical needs or by frequent changes in primary caregivers such as foster care or institutional placement) 2. Caregivers may have substance use problems, major life stressors, poverty, or histories of maltreatment themselves Association 1. Can be associated with developmental delays, Rumination Disorder, and Feeding Disorder of Infancy or Early Childhood |
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Term
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Definition
| 1. Rapid, recurrent, stereotyped motor movements or vocalizations 2. Many children display tics to some extent (boys more than girls) Tic Disorders 1. Transient Tic Disorder involves motor or vocal tics daily for between four weeks and 12 months 2. Chronic Tic Disorder involves at least 12 months of daily motor or vocal tics, but not both 3. Tourette's Disorder involves at least 12 months of daily motor and vocal tics a. Comorbidity with OCD and ADHD is common Treatments 1. Both medications and bxal techniques show efficacy for Tic Disorders |
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Term
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Definition
| 1. Diagnosis: Inappropriate voiding of urine, at age 5 or after, at least twice a week for three consecutive months. Subtypes are Nocturnal (most common), Diurnal, and Nocturnal and Diurnal. Enuresis is present in 5 percent to 10 percent of 5-year-olds, 3 percent to 5 percent of 10-year-olds, and 1 percent of individuals age 15 and older. Often accompanied by shame and peer rejection. Involuntary causes: recurrent urinary tract infections, underdeveloped bladder, severe stress. Intentional causes: other mental diagnoses, premature toilet training. Treatments: bell-and-pad (most successful, based on classical conditioning) and medications (desmopressin) . a. Bell-and-pad method entails an alarm awaking the child when sensing wetness; the child is eventually conditioned to awake when sensing the need to urinate, and use the bathroom. Leads to successful results in 80 percent of the cases, of which most are lasting. b. Medications only partially effective; work until administered, but, if used alone, usually Enuresis returns when discontinued. The majority of individuals with Enuresis do not suffer from additional mental disorders. |
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Term
| Separation Anxiety Disorder |
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Definition
| A common anxiety disorder in children, involving inappropriate/excessive anxiety and worry over separation from attachment figures. May involve great worry about negative events befalling the attachment figures, school refusal, somatic sxs, and/or excessive anxiety over sleep. School refusal is present in approximately 75 percent of children with Separation Anxiety Disorder. Must have onset before 18. Must be differentiated from normative worry over separation in young children. Slightly more common in females, in community samples. Adolescents often deny anxiety about separation, more likely to complain of physical sxs (e.g., cardiovascular sxs such as dizziness and heart palpitations). Both adolescents and adults with Separation Anxiety Disorder may have difficulty engaging in independent activities. Adults may experience impairment in their ability to cope with major life changes such as getting married or moving. Associated with parental over-protectiveness, family history of anxiety disorders, immigrant status, moves, family stress, separation/divorce. Bxal/cognitive-bxal treatments optimal . a. Child must not be reinforced for school refusal; reinstatement in school is crucial. b. Parental involvement in treatment is recommended, as parents may be inadvertently reinforcing their child's fears and anxious bx |
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Term
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Definition
| Involves a child's failure to speak in situations in which speech is expected (often presenting as failure to speak in school, despite normal communication at home). Selective Mutism must be distinguished from excessive shyness at beginning of school year, from Communication Disorders (e.g., embarrassment over stuttering), or from immigrant children's reluctance to speak while learning new language. Children may use nonverbal techniques (pointing, pushing/pulling objects, nodding). Indicative of anxiety rather than negativism; not indicative of abuse or trauma. Majority of those diagnosed have sxs of Social Phobia: excessive shyness, fear of embarrassment, clinging to or difficulty separating from parents, frequent crying or tantrums, and social isolation or withdrawal. May also demonstrate excessive fears or worries, a need to be in control, inflexibility, and heightened sensitivity to sensory stimulation. Occurring in less than 1 percent of individuals seen in mental health settings. Slightly more common in females than in males. Onset is generally between the ages of 5 and 7. Treatment with cognitive-bx or bxal strategies, and/or with SSRIs |
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Term
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Definition
| 1. Marked by major disturbance in consciousness and in cognition/perception, usually resulting from a general medical condition or substance intoxication or withdrawal. 2. Onset is relatively sudden (hours to days). 3. Disturbance in consciousness marked by individual's diminished awareness of the environment and impairment in focusing, sustaining, and shifting attention (easily distracted, mind often wanders). 4. Disturbance in cognition marked by memory deficits (usually short-term memory), disorientation (to time and place), and language impairments (dysarthria/articulation; dysnomia/naming objects; dysgraphia/writing; aphasia/spoken or understood language; and pressured, rambling, or incoherent speech). 5. Perceptual disturbances may take the form of illusions, hallucinations, or misinterpretations of sensory stimuli. 6. Alternating agitation and lethargy common; emotional lability often present (anger that family is trying to harm; fearful when experiencing visual hallucination) At risk 1. Older adults at highest risk; large percentage of nursing home residents over age 75 may experience Delirium 2. Medical conditions and withdrawal from sedative-hypnotic drugs implicated 3. Children also at increased risk, especially via high fevers or medication reactions 4. May co-occur with dementia (nearly half of cases with dementia experience some Delirium); overall, Delirium involves reduction of consciousness, whereas patients with dementia remain alert Treatment 1. Alleviating underlying condition 2. Decreasing agitated bxs |
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Term
| Dementia of the Alzheimer's Type |
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Definition
| A gradual-onset, progressive course, neurodegenerative disease, afflicting growing percentages of the population after 50 years of age. Memory impairments are a hallmark, along with agnosia, apraxia, aphasia and deficits in executive functions. Stages of progression: a. Early (within three years from onset): Marked by forgetfulness, low energy, misplaced items b. Middle (from three up to 10 years from onset): Marked by personality changes, decreased ability to perform daily living activities, aphasia, restlessness, may wander off, difficulty remembering names of loved ones c. Late: Person is bedridden, grave cognitive degeneration, decerebration, unable to speak meaningfully, need for total care; death may ensue eight to 10 year from onset, up to 15 years from first sxs Diagnoses of Alzheimer's disease are often made through a process of elimination after testing for other types of dementia with neuropsychological batteries. Definitive diagnosis made only at autopsy, on basis of characteristic neurofibrillary tangles, amyloid plaques, and cholinergic dysfunction. Depression can mimic or exist comorbidly with Alzheimer's; characteristic sx of depression with Alzheimer's disease is decreased positive affect or pleasure in response to social contacts and usual activities. Declarative memory more affected than procedural memory during initial phases of depression that is comorbid with Alzheimer's. Risk factors include age, having Down Syndrome and a history of brain trauma. Women are also slightly more likely to become ill. By age 95, disease has 36 percent prevalence in males, and 45 percent in females. Treatment involves cholinergic medications, support for the family, optimizing living environment |
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Term
| Cerebrovascular Accidents |
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Definition
| Descriptors. Involves disrupted blood flow to brain, which causes oxygen deprivation in the brain and neural cell death. Involves a range of physical, cognitive, and bxal effects, including unilateral weakness or paralysis in the arms and legs; facial muscle weakness or "drooping"; numbness, tingling, or impaired sensations; changes in vision; aphasia; loss of memory; drooling or difficulty swallowing; loss of balance or coordination; vertigo; personality changes; uncontrollable eye movements; drowsiness, lethargy, or loss of consciousness; and emotional lability. Two primary types of stroke. a. Hemorrhagic: bleeding into brain from weakened blood vessels (often linkedto hypertension) b. Ischemic: obstructed blood flow related to clots or dislodged tissues;85% of CVA's. Short-lived CVA called transient ischemic attack (TIA), sxs remit within 24 hours. Risk Factors for CVA's Being male . Using oral contraceptives. Smoking . Hypertension . Heart disease . Hypercholesterolemia (iexcessive cholesterol in the blood) . History of TIA's . Advancing age; every decade after age 45 the likelihood of having a stroke doubles. Prevalence 1. After age 75, the probability of having a stroke is 1-2% 2. Mortality rate in the U.S. is approximately 1 in every 18 deaths 3. Only 10% make full recovery |
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Term
| Dementia Due to HIV Disease |
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Definition
| Human Immunodeficiency Virus (HIV) is a progressive viral disease, often divided into three stages (first, within six months of infection, second, up to eight years after infection, and third, 10-plus years after infection). During the third stage opportunistic infections (e.g., pneumocystis pneumonia, tuberculosis) develop, and the infection may meet official criteria for a diagnosis of Acquired Immune Deficiency Syndrome, or AIDS. Approximately 66 percent of individuals diagnosed with AIDS will develop Dementia Due to HIV Disease. Dementia Due to HIV Disease (also known as AIDS dementia complex) is related to cognitive and bxal effects of HIV, related to effects of the virus on the brain. Usually occurs in the second and third stage of the infection. It is a subcortical dementia, involving diffuse, multifocal destruction of the brain's white matter and subcortical regions. Progresses from impaired concentration and forgetfulness to more severe neurological signs. Highly active antiretroviral therapy (HAART) may prevent or delay its onset in HIV-positive individuals who do not yet have cognitive impairments. HAART may also slow the progression of the dementia in individuals already diagnosed with the disorder. Stages of progression of Dementia involve: a. Subclinical (sxs result in minimal impairment without deficits in activities of daily living) b. Mild (there is unequivocal evidence of functional, intellectual, or motor impairments, but patients are able to perform most activities of daily living and are fully ambulatory c. Moderate (patients are unable to work or perform demanding activities of daily living, but are able to perform basic self-care activities; they require some assistance in walking d. Severe (patients demonstrate significant intellectual impairments and cannot walk unassisted e. End Stage (patients are nearly vegetative) |
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Term
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Definition
| A progressive neurological disorder; linked to selective loss of dopamine-containing neurons in substantianigra and nigrostriatal pathway. Dopamine involved in the coordination of smooth and complex movement; dopamine deficits result in impaired motor activity. Main sxs: Resting tremor, motor slowness (bradykinesia), rigidity; postural instability, decreased voice volume, and mask-like facial expression may also result. 20 percent to 60 percent of Parkinson's patients will develop dementia: Cognitive slowing, impaired memory retrieval, and executive dysfunction. More likely to occur in older individuals, in advanced stages of the disease. Depression also highly comorbid (up to 50 percent of cases; may follow initial motor sxs or, in some cases, actually precede their display). Depression may exacerbate dementia. In some individuals, depression precedes other sxs of the disorder. In the year prior to Parkinson diagnosis, individuals taking antidepressants almost twice as likely to develop Parkinson's Disease as were individuals who did not take antidepressants; this may suggest that depression is an early sx of the disease in some cases. Onset typically after 65 years of age. Etiology unclear -- could involve environmental toxins; heritability modest overall. Dopamine agonists (L-dopa) and other medications may provide some sxatic relief; no cure at present |
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Term
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Definition
| Characteristic syndrome of bxal and physiological responses related to ceasing alcohol use, or cutting back, typically after periods of heavy use 2. Typically associated with alcohol dependence Sxs 1. As in all substance withdrawal syndromes, the sxs are largely the opposite of those involved in alcohol use or intoxication (e.g., autonomic hyperactivity, tremors, insomnia, short-lived hallucinations or illusions, agitation, grand mal seizures) 2. Typically fosters craving for alcohol (which could temporarily allay the syndrome), leading to vicious cycle of re-use 3. Sxs occur within several hours to several days of cessation or cutting back of alcohol use 4. Rarely, Alcohol Withdrawal Delirium ("delirium tremens" or DTs) occurs, with auditory, visual, and/or tactile hallucinations Treatment 1. Treatment is supportive, with a need in some cases to add a longer-acting and safer sedative-hypnotic substance (which is then tapered) to ease the sxs |
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Term
| Alcohol-Induced Persisting Dementia |
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Definition
| 1. Indicates a dementia linked to the long-lasting effects of alcohol on brain functioning 2. The dementia-related sxs must persist beyond usual duration of Alcohol Intoxication or Alcohol Withdrawal Sxs involve 1. Memory impairment 2. One or more of the following: ataxia, apraxia, agnosia, or executive function deficits 3. Significant impairment in social or occupational functioning and decline from prior functioning 4. However, aphasia is less likely to appear in Alcohol-Induced Persisting Dementia than in other dementias Associated with 1. Frontal lobe atrophy, malnutrition, vitamin deficiencies (especially vitamin B1 or thiamine), head trauma, Wernicke's encephalopathy, and cirrhosis of the liver. Most often, damage is permanent, even if alcohol use stopped Alcohol-Induced Persisting Amnestic Disorder 1. More commonly known as Korsakoff'sSyndrome 2. Putative cause is severe deficiencies in thiamine (vitamin B1), linked to chronic alcoholism Substance-Induced Amnestic Disorders 1. Marked by inability to learn new information (always present) and inability to recall past information/events (variably present), which represent a decline from past levels of functioning 2. The deficits persist beyond the course of Substance Abuse or Withdrawal and are not diagnosed in the presence of a clear Delirium or Dementia Development of Alcohol-Induced Amnestic Disorder 1. Usually preceded by Wernicke's encephalopathy, which produces sxs of confusion, loss of muscle coordination, and nystagmus (rapid, involuntary eye movements) 2. If treated early with large doses of thiamine, the progression to Alcohol-Induced Persisting Amnestic Disorder may be slowed or stopped; otherwise, Wernicke's encephalopathy recedes but more permanent Korsakoff'sSyndrome emerges Memory impairment 1. Shows via anterograde amnesia, retrograde amnesia, and confabulation (fabrication of information to make up for gaps in memory); insight for memory loss usually very low 2. Disorientation to time/place and affective flattening also are present 3. Course is typically persistent and chronic, with severe impairment for the rest of life |
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Term
| Alcohol-Induced Sleep Disorder |
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Definition
| 1. Characterized by the Insomnia Type 2. Alcohol leads initially to increased somnolence, leading to increased slow-wave (deep) sleep and decreased REM sleep in the first half of a night's sleep but increased REM sleep during the second half of a night's sleep) 3. Overall, sleep is restless, with increased night wakefulness, fatigue during the day, and vivid and sometimes anxiety-producing dreams 4. Alcohol consumption exacerbates problems in people with sleep apnea, so that the individual may not be able to awaken because of increased bodily relaxation; thus increasing asphyxiation risk 5. Alcohol withdrawal can induce vivid dreaming, related to an abundance of REM sleep |
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Term
| Smoking and Nicotine Use Disorders |
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Definition
| Major health concern 1. 24 percent of men, 19 percent of women smoke 2. Smoking will be leading cause of morbidity and mortality by 2030 3. Smoking increases risk of cancer, emphysema, chronic bronchitis, and cardiovascular disease Reproductive implications 1. Increased risk of miscarriage 2. Increased impotence 3. Increased infertility in both sexes 4. Newborns have increased risk of low birth weight, impaired lung function, prematurity Nicotine withdrawal 1. Occurs with abrupt cessation or reduction of nicotine 2. Within 24 hours, four-plus of following: dysphoric/depressed mood, insomnia, irritability, frustration/anger, anxiety, difficulty concentrating, restlessness, decreased heart rate, increased appetite/weight gain 3. Sxs of withdrawal increase likelihood of relapse 4. Associated sxs include dry or productive cough, sweet cravings, impaired performance on vigilance tasks 5. Those who smoke experience more intense withdrawal than those using other forms of nicotine due to the rapid onset of drug effects via inhalation Nicotine dependence 1. 80-90 percent of regular smokers 2. Develop tolerance or withdrawal 3. Tolerance presents as more intense morning nicotine effects, lack of nausea and dizziness despite regular heavy use 4. Those with nicotine dependence often find they have used more than expected and run out of supply sooner 5. May avoid situations with limited ability to smoke 6. Use continues despite awareness of the negative effects 7. 80 percent desire to quit, 35 percent attempt to quit each year, < 5 percent are successful in unaided attempts to quit 8. Success predicted by: male, over 35, married with partner, later age of onset of smoking 9. Twice as common for individuals with mental disorders (Schizophrenia, Mood Disorders, Anxiety Disorders, other Substance-Related Disorders) Most successful cessation treatments 1. Include nicotine replacement therapy 2. Multimodal bxal therapy (including skills training, relapse prevention, stimulus control, and aversive techniques) 3. Social support 4. Nicotine replacement (gum, transdermal patch inhaler or nasal spray) for those who smoke > 10 cigarettes daily Somewhat successful treatments 1. Hypnosis 2. Acupuncture 3. Antidepressants (buprioprion, clonidine, and nortriptyline) Treatments not recommended 1. Biofeedback 2. Family therapy 3. Psychodynamic therapy 4. Interpersonal therapy Indicators of reduced likelihood of success 1. Those who smoke upon waking 2. Those who smoke more in the morning than afternoon 3. Those who smoke while they are ill 4. These are linked to higher dependency, increasing difficulty with abstinence 5. Relapse more likely during negative affect, withdrawal sxs, and smoking cues |
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Term
| Substance-Induced Psychotic Disorder |
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Definition
| 1. Presence of hallucinations or delusions during or within a month of substance intoxication or withdrawal 2. Hallucinations must not be recognized, by the individual in question, as the product of substance use 3. Intoxication with alcohol/sedatives/hypnotics, amphetamines, cannabis, cocaine, hallucinogens, inhalants, opioids, phencyclidine, or anxiolytics may lead to Substance-Induced Psychotic Disorder 4. Withdrawal from alcohol/sedatives/hypnotics or anxiolytics may lead to Substance-Induced Psychotic Disorder 5. Psychotic Disorder induced by amphetamines, phencyclidine, or cocaine may persist longer than one month 6. Substance-Induced Psychotic Disorder may also be produced by prescription or over-the-counter medications |
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Definition
| A mental/brain disorder marked by positive/excess sxs (psychosis, thought disorder, agitation) and negative/deficit sxs (flat affect, low motivation, social isolation). Six months of continuous sxs required for diagnosis; shorter than this time yields diagnosis of Schizophreniform Disorder. Subtypes: a. paranoid (better prognosis) b. disorganized (worse prognosis) c. catatonic d. undifferentiated e. residual. Type I and Type II Schizophrenias a. Type I Schizophrenia is believed to result from dopamine abnormalities, linked to positive/excessive sxs, less likely to experience intellectual deficits, associated with good response to medication, including traditional antipsychotics, better prognosis, and more positive outcomes overall b. Type II Schizophrenia is believed to be caused by structural brain abnormalities (i.e., atrophy in the prefrontal and temporal lobes), linked to negative sxs, less positive outcomes, negative/deficit sxs, worse prognosis. Overall, Schizophrenia has a life course that involves substantial impairment for many years. 1 percent prevalence worldwide, evenly divided between men and women; women better course and prognosis. Heritability moderately strong (up to 50 percent to 60 percent concordance for identical twins). Risk to become ill is 15 percent for children of one schizophrenic parent, and 40 percent if both parents are ill. Dopamine and glutamate implicated in many cases; actual brain tissue loss (enlarged ventricles) in chronic cases. Violence predicted by non-adherence with medication, male gender, and comorbid substance use. Comorbidities: Substance Use Disorders, Obsessive-Compulsive Disorder, Panic Disorder. Some cases of Schizophrenia may be preceded by Schizotypal, Schizoid, or Paranoid Personality Disorders. Treatments include antipsychotic medications, structured bxal and social skills treatments, and psychoeducation for families |
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Term
| Schizophreniform Disorder |
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Definition
| Schizophreniform Disorder is a Psychotic Disorder, very similar to schizophrenia, but with (a) the duration criterion between one and six months, and (b) without the severe impairment criteria found in schizophrenia. In some cases Schizophreniform Disorder is time-limited -- a shorter version of schizophrenia but longer than a Brief Psychotic Disorder. In other cases it is a provisional diagnosis, yielding to schizophrenia when the individual crosses the six-month duration. Specifiers "With or Without Good Prognostic Features" can be applied (good prognostic indicators include good premorbid functioning, absence of affective blunting, confusion during psychotic episode, sudden appearance of psychotic features during initial change in functioning. May well be higher rates of Schizophreniform Disorder in developing nations than in U.S. or developed nations, given that recovery from schizophrenic sxs is higher in such nations. |
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Term
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Definition
| A Psychotic Disorder involving sxs of both schizophrenia and a Mood Disorder (either Bipolar Disorder or Major Depression). Diagnosis of Schizoaffective Disorder requires an uninterrupted period of illness, at least one month in duration, in which a Major Depressive Episode, Manic Episode, or Mixed Episode is concurrent with sxs that meet Criterion A for schizophrenia. There must be at least two weeks in which psychotic sxs are present in the absence of prominent mood sxs. Substantial social, self-care, and occupational impairment typically present. Men with schizoaffective disorder may often display antisocial traits. Distinct genetic links involving serotonergic and dopaminergic imbalances. Comorbidities: substance abuse, possibility of pre-existent Schizoid, Schizotipal, Borderline or Paranoid PD. Treatment involves medications and supportive psychotherapy. Medications targeting both the psychosis and the mood disturbance. Neuroleptics used to treat psychotic sxs. Manic mood disturbance: lithium may be used (with or without neuroleptic medication). Depressed mood disturbance: antidepressants and neuroleptics may be used in combination. Although these patients are often socially uncomfortable, it appears that support groups in which patients can participate, sometimes with family members, other times with others with same diagnosis, can be very helpful. Prognosis better for bipolar than depressed type |
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Term
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Definition
| A Psychotic Disorder, marked by presence of at least one non-bizarre delusion for at least one month. Individuals with Delusional Disorder lack the other types of thought disorder, psychosis, and negative/deficit sxs associated with Schizophrenia. Pathology focused on the specific delusion(s) expressed. Types: Erotomanic, Jealous, Grandiose, Persecutory, Somatic, Mixed, and Unspecified. Erotomanic: the false belief that another person, usually of higher status, is in love with the individual. Jealous: the delusion centers on the belief that one's romantic partner is unfaithful. Grandiose: the delusion generally focuses on the belief that one possesses some special talent or insight or has made some significant discovery that has gone unrecognized. Persecutory: individuals believe that others mean to cause them harm. Such individuals may believe that they are being conspired against, are the target of poisoning or drugging, are being followed or spied upon, are being cheated, are being maliciously maligned, or that others are intentionally preventing them from achieving long-term goals. Somatic: delusions focus on bodily functions and sensations. Common delusions in this subtype include the belief that one's body or a specific body part (e.g., skin, mouth, rectum, vagina) is emitting a foul odor, that there is an infestation of insects in or on the skin, that one has an internal parasite, that (despite evidence to the contrary) certain body parts are ugly or deformed, or that specific body parts or organs are not functioning properly. Mixed Type: there is no one predominant delusional theme (e.g., there are both grandiose and persecutory delusions). Unspecified Type: the dominant delusional belief either does not fit into a specific subtype or cannot be clearly determined. Rare (well under 1 percent of general population); onset age 40 or later; equally distributed in men and women. Comorbid with OCD, Body Dysmorphic Disorder, and Paranoid, Avoidant, or Schizoid Personality Disorders |
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Term
| Shared Psychotic Disorder |
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Definition
| Formerly termed Folie à Deux, occurs when an individual (or a group of persons) develops a shared delusion in concert with another delusional individual. Shared delusions may be bizarre or non-bizarre. In the United States, shared delusions are typically of the grandiose or persecutory nature. No otherwise odd or unusual bx. Delusional thinking limited between the primary case (the one with initial delusions) and the additional individual(s), also referred to as secondary case(s). a. Primary case dominant person, secondary case more submissive. b. Primary case often diagnosed with Psychotic Disorder, secondary vulnerable to mental illness. Often comorbid with depression, mental retardation, and dementia. Typically occur in the context of romantic relationships, sibling relationships, or parent-child relationships. Course tends to be chronic, unless separation from the primary case -- and treatment -- are effected. Treatment include separation from primary case, psychotherapy, and medications |
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Term
| Major Depressive Disorder (MDD) |
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Definition
| 1. Mood Disorder marked by Major Depressive Episodes, periods of two or more weeks of predominant mood, cognitive, interpersonal, and somatic sxs 2. If individual has Major Depressive Episode in presence of history of Manic, Mixed, or Hypomanic Episodes, diagnosis of Bipolar Disorder takes precedence 3. MDD highly likely to be cyclic and recurrent 4. High suicide risk (highest in the context of Bipolar Disorder) Sxs 1. Predominantly depressed or irritable mood each day for at least two weeks 2. Anhedonia, sense of worthlessness/inappropriate guilt, recurrent thoughts of death (suicidal ideation), somatic sxs (loss of appetite, difficulty sleeping, psychomotor retardation, lack of sexual desire, weight loss/gain, diminished energy level), cognitive impairment (diminished ability to concentrate or indecisiveness) 3. Children more likely than are adults or adolescents to present with an irritable rather than depressed mood, along with social withdrawal and/or aggressive bx 4. Older adults may present with pseudodementia (e.g., disorientation, memory loss, distractibility), often mistaken for Dementia Due to a General Medical Condition Lifetime prevalence rates 1. 10 to 25 percent in women, 5 to 12 percent in men 2. Sex difference begins during adolescence 3. Average onset in mid-20s, but may appear at any point in life cycle Seasonal Affective Disorder 1. Depressive sxs fall/winter, remission spring/summer 2. Broad-spectrum light therapy evidence based Treatment 1. Antidepressant medications (tricyclics, MAOIs, SSRIs) 2. Cognitive-bxal therapy (CBT) or interpersonal therapy (IPT) 3. Roughly equal efficacy; combinations optimal 4. Electroconvulsive therapy (ECT) effective for severe depressions Comorbidity common with 1. Eating Disorders 2. Substance-Related Disorders 3. Panic Disorder 4. Obsessive-Compulsive Disorder 5. Personality Disorders |
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Term
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Definition
| 1. Mood Disorder marked by chronic depressive sxs (two years in adults, one year in children/adolescents) 2. Sxs impairing, but do not cross the threshold for Major Depressive Episode; if sxs do cross that threshold within two-year period, Major Depressive Episode/Disorder diagnosis takes precedence 3. After two years or more of Dysthymic Disorder, a Major Depressive Episode may ensue, in what is termed "double depression" a. Double depression extremely impairing -- high severity, high suicide risk, low rates of recovery 4. Prevalence is approximately 6 percent 5. Women two to three times more likely than men to exhibit Dysthymic Disorder (though before adolescence, boy-to-girl ratio approximately 1:1) 6. Treatments: Same as for Major Depression (cognitive-bxal therapy, interpersonal therapy, antidepressant medication) |
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Term
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Definition
| Major Depressive Episode with Postpartum Onset 1. Refers to episode of major depression with onset within four weeks of delivery of baby 2. Prevalence: 10 percent to 15 percent of mothers 3. Distinguish from "postpartum blues" -- transient mood swings, tearfulness, irritability, difficulty sleeping, usually emerging three to four days after giving birth and dissipating within two weeks -- which may occur in two-thirds of mothers after giving birth 4. May have deleterious effects on infant's development Major Depressive Episode with Postpartum Onset, with Psychotic Features 1. Extremely rare, one to two per 1,000 Risk factors for Major Depressive Episode with Postpartum Onset 1. A previous similar episode, history of premenstrual mood sxs, depressive sxs during pregnancy, or Major Depressive Episodes at any time in life 2. Low perceived social support, low socioeconomic status, infant with difficult temperament, stressful life situations also implicated Treatments 1. Cognitive-bxal therapy 2. Interpersonal therapy 3. Antidepressant medications |
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Term
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Definition
| Descriptors 1. Bipolar I Disorder is diagnosed in the presence of at least one Manic or Mixed Episode(Depressions often occur as well, but are not necessary for diagnosis) 2. Bipolar II Disorder is diagnosed in the presence of at least one Hypomanic Episode aswell as one or more Major Depressive Episodes; never meets criteria for Manic or Mixed Episode 3. Bipolar I and II Disorders highly likely to be recurrent/cyclic 4. Average age of onset: approximately 20 years old 5. Hypomanic and Manic Episodes share features of elevated or irritable mood, grandiosity, decreased need for sleep, flight of ideas, racing thoughts, pressured speech, increasedtalkativeness, distractibility, increased goal-directed activities, and high levels ofengagement in pleasurable but risky activities (e.g., gambling, sex with multiple partners) a. Key distinction: Hypomanic Episodes are not characterized by major impairmentsin social or occupational functioning, do not require hospitalization, and do not incur psychosis and may result in increased creativity and productive, goal-driven bx.6. Cyclothymic Disorder: two years of fluctuating hypomanic and depressive sxs without meeting full criteria for manic or major depressive episodes.Prevalence 1. Bipolar I Disorder is 1% or more of the population 2. Bipolar II disorder: 0.5% of population 3. Men and women equally likely to develop Bipolar I Disorder; women, more likely to develop Bipolar II Disorder 4. Men have more Manic and Hypomanic episodes; wome have more Major Depressive Episodes 5. Completed suicides among people with untreated Bipolar Disorders between 10-15%; serious attempts is around 50% Treatments 1. Mood stabilizing medications (including lithium) 2. CBT 3. Social rhythm therapy 4. Psychoeducation |
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Term
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Definition
| 1. A milder form of a Manic Episode 2. Hypomanic Episodes involve inflated self-esteem or grandiosity, decreased need for sleep, increased talkativeness or pressured speech; racing thoughts or flights of ideas; distractibility; increase in goal-directed activity or psychomotor agitation; or excessive involvement in pleasurable activities 3. In some cases, the change in functioning during a Hypomanic Episode may take the form of increased creativity, efficiency, and accomplishments 4. Sxs must be experienced for at least four consecutive days 5. Sxs must be distinct from person's usual mood and functioning 6. Leads to less impairment than in Manic Episodes 7. Individuals with Hypomania do not experience the marked impairment in social or occupational functioning and the display psychotic features that may be present in the Manic Episode, nor do they need hospitalization 8. What best differentiates Hypomania from full or disorganized mania is sx severity and level of impairment 9. When Hypomanic sxs occur in response to antidepressant medication. the person is diagnosed as having Substance-Induced Mood Disorder, with Hypomanic Features Hypomanic Episodes, alternating with Major Depression, yields diagnosis of Bipolar II Disorder |
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Term
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Definition
| The occurrence of recurrent, unexpected panic attacks, followed by at least a month of persistent concern about having another one (as defined by DSM-IV, APA, 2000). Panic attacks are sudden, intense, short-lived cognitive and physiological episodes. Involve frightening sensations of choking, sweating, trembling, being short of breath, feeling dizzy, etc.. Often lead sufferer to feel as though he or she is "going crazy" or dying. It often leads to great fear of suffering additional attacks and a consequent restriction of life activities, which is diagnosed as Panic Disorder with Agoraphobia. Onset typically in late adolescence or mid-30s. Comorbidity with other anxiety disorders common. Females more likely than males to develop Panic Disorder. Children develop Panic Disorder relatively rarely. Presentation in children differs from adults. Panic Disorder in children usually manifests itself in the form of shortness of breath, increased heart rate, chest pain, and school refusal. Family history of Panic Disorder, Mood Disorders, and personal use of substances, including some prescribed meds (e.g., asthma, heart) increase risk for Panic Disorder. Treatment: Combination of cognitive therapy and SSRIs most effective Descriptors. Intense and pervasive fear of being outside, in a public place, in a crowd, riding in anelevator, or traveling by car -- typically, situations that have been linked with panic. Activities limited to avoid being in such situations which could trigger onset of anadditional panic attack or situations from escape is deemed impossible or in which helpmay not be possible. Panic Disorder with Agoraphobia is the usual presentation of Agoraphobia in clinical settings; Agoraphobia without History of Panic Disorder is more likely to exist in community samples. In persons with history of Panic Disorder, Agoraphobia may develop as a conditioned fearresponse (i.e., escape from situations believed to be linked to panic is highly rewarded by cessation of anxiety). 3:1 female-to-male ratio; Agoraphobia is likely to be comorbid with other anxiety disorders. Treatments. 1. Bxal therapies (exposure, desensitization, in vivo exposure with response prevention). 2. Cognitive Bx Therapy. 3. Medication: SSRIs |
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Term
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Definition
| Involve excessive/persistent fears in response to specific stimuli or anticipation of these stimuli. Individuals with Specific Phobias attempt to avoid exposure to the phobic stimulus; when the stimulus cannot be escaped, it is endured with profound anxiety and distress. Anxiety may approach panic levels in extreme instances. Diagnosis made if phobia engenders considerable distress and yields true impairment. As a departure from most anxiety disorders, individuals with Specific Phobias do not experience pervasive anxiety. Anxiety generally limited to discrete, circumscribed phobic situations. Specific Phobia cannot be diagnosed if sxs are better accounted for by Social Phobia. Five types of specific phobias: Animal, Natural Environment, Blood-Injection-Injury, Situational, and Other. Blood-Injection-Injury Type experience strong vasovagal reaction, blood pressure drop, may faint. Up to 10 percent of population with lifetime risk of Specific Phobia; women more likely to develop Specific Phobias. Most effective treatments are bxal, often involving in vivo exposure to the feared stimulus, paired with relaxation training. In Blood-Injection-Injury Type, relaxation needs to be replaced with other strategies because of risk for fainting. Muscle tensing plus in vivo exposure used |
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Term
| Social Phobia (also termed Social Anxiety Disorder) |
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Definition
| 1. Marked by unreasonable fear of social or performance situations (e.g., speaking in front of a group, asking someone out, performing certain bxs in public) 2. With exposure to such social evaluation, individuals with Social Phobia experience marked anxiety that is sometimes tantamount to situationally bound/predisposed panic attacks. Insight usually present about the anxiety and avoidance of the feared situations 3. Distinguished from Panic Disorder because sxs limited to the anxiety-provoking social situation 4. Hypersensitivity to rejection common; poor self-esteem, feelings of inferiority, and depression can result 5. Public speaking is the most commonly feared performance situation; fear of interacting with strangers/meeting new people/eating or drinking in public/etc. also possible 6. Children demonstrate anxiety through crying, tantrums, freezing, clinging to familiar adults, refusal to engage in group play, school refusal, and excessive timidity in unfamiliar environments 7. Lifetime prevalence rates between 3 percent and 13 percent 8. Age of onset typically during the mid-teens. Although women with the disorder slightly outnumber men in community samples, clinical samples contain roughly equal numbers of men and women Treatment 1. Cognitive-bxal group therapy (CBGT), considered more effective than psychoeducation 2. Antidepressant medications (MAOIs or SSRIs) also effective, shorter-term |
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Term
| Obsessive-Compulsive Disorder |
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Definition
| A debilitating anxiety disorder, involving obsessions (persistent, intrusive, irrational thoughts/worries) and/or compulsions (repetitive bxs that serve the function of counteracting the anxiety related to obsessions). Common obsessions include fears of contamination, aggressive impulses, distressing sexual imagery, or somatic concerns; others involve a need for symmetry or rigid order. Common compulsions include washing, checking, counting, ordering, requesting assurances from others, and repeating actions. In most instances the individual realizes the irrationality of the obsessions and the compulsive rituals but feels powerless to stop them. Impairment may be severe, given the intensity of the obsessions and the time spent engaging in compulsive bxs. Prevalence up to 3 percent; roughly equal between adult men and women. Onset age differs between sexes. Childhood-onset OCD more likely to occur in boys than in girls (in males, typically occurs between the ages of 6 and 15). Onset in females typically occurs as adults, between the ages of 20 and 29. Sx manifestation similar across age groups. Children more likely to experience sxs as ego-syntonic, may be less likely to ask for help. Older adults tend to focus more on morality-related obsessions and washing rituals than on other sxs. Comorbidity of Tourette's Disorder in both children and adults (approximately 35 percent to 50 percent). Most effective treatment is Exposure and Response Prevention therapy, a bxal strategy of exposure to distressing stimulus and prevention of compulsive response. SSRI medications also effective; combination treatments particularly effective |
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Term
| Post-traumatic Stress Disorder |
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Definition
| 1. An Anxiety Disorder that develops in response to exposure to a traumatic event (e.g., threatened or actual death or injury), marked by at least one month of sxs of re-experiencing the traumatic event; avoiding stimuli that recall the event (and numbing); and increased levels of arousal 2. Event may be experienced personally (e.g., kidnap, rape), witnessed (e.g., observing a violent assault on another person), or learned about after event has occurred (e.g., hearing that your child has a life-threatening illness) 3. Survivor guilt, self-destructive bx, social withdrawal, hopelessness may also develop 4. Children may display sxs less directly (e.g., repetitive play, nightmares about unrelated phenomena) 5. Lifetime prevalence around 8 percent 6. Not all individuals exposed to traumatic stressors develop PTSD (30 percent to 50 percent on average) Specifiers 1. Acute (sxs span more than one but fewer than three months) 2. Chronic (more than three months) 3. Delayed Onset (sxs do not appear for more than six months after the traumatic event) Treatments 1. Cognitive-bxal therapies including Prolonged/Imaginal Exposure, Cognitive Processing, and (more controversially) EMDR, are evidence based and used in treatment 2. VA (combat PTSD): Prolonged Exposure, Cognitive Processing 3. Meditation emerging as an effective treatment choice for PTSD and stress-related disorders Descriptors 1. Involves the development of dissociative sxs, involuntary re-experiencing, numbness/avoidance, and strong anxiety/physiological arousal in the aftermath of experiencing a severe trauma 2. Sxs must emerge within four weeks of event(s); if they persist longer, Post-Traumatic Stress Disorder (PTSD) diagnosis can be considered 3. Trauma must involve experiencing, witnessing, or confronting event(s) involving actual or threatened death or serious injury, or severe threat to physical integrity 4. Sxs must be specific to the traumatic event(s); otherwise other Anxiety Disorders may be diagnosable 5. Despair/hopelessness may also ensue; comorbid Major Depression may be diagnosable 6. For individuals who experience an extreme stressor and develop sxs that do not meet the criteria for Acute Stress Disorder, a diagnosis of Adjustment Disorder may beappropriate. Treatments 1. CBT 2. Short-term anxiolytic medications: SSRIs |
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Term
| Generalized Anxiety Disorder |
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Definition
| Characterized by pervasive, impairing worry, which pertains to many issues (as opposed to focal worries in phobias or Separation Anxiety Disorder). GAD is less marked by psychophysiological indicators (for example, higher blood pressure and heart rate) than other anxiety disorders, except for muscle tension, which is a marker of this condition. Although GAD typically involves pervasive worries, developmental patterns can be seen. Children tend to worry more about disasters, academics, and athletics, while older adults worry mostly about illnesses. Lifetime prevalence may be 5 percent of population; twice as prevalent in women as men. GAD is usually not an independent disorder, more so than other psychiatric diagnosis. Comorbidity rates very high with major depression and dysthymia; substance abuse also seen. Comorbidity in the anxiety disorder group is very high as well, especially with Specific Phobia, Social Phobia/Social Anxiety Disorder; OCD and Panic Disorder also occur. Most effective treatment is cognitive-bx therapy, including relaxation training, mindfulness, and meditation. Medications may serve adjunctive role, either anxiolytics or SSRIs |
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Term
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Definition
| 1. A somatoform disorder, involving a history of multiple medical complaints that cannot be fully verified medically 2. Onset by age 30, with multiple years of sxs and significant impairment 3. Not feigning or malingering 4. Diagnostic criteria: a. A history of pain related to at least four separate sites (e.g., head, abdomen, joints, chest) or bodily functions (e.g., menstruation, urination) b. A history of at least two gastrointestinal sxs other than pain, such as nausea, diarrhea, food intolerance, bloating, or vomiting c. A history of at least one sexual or reproductive sx, such as irregular menses, erectile dysfunction, or vomiting throughout pregnancy d. A history of at least one pseudoneurologicalsx other than pain, such as impaired balance, paralysis, localized weakness, difficulty swallowing, vision impairments, seizures, amnesia, hallucinations, or loss of consciousness e. In addition, a diagnosis of Undifferentiated Somatoform Disorder requires the presence of at least one physical complaint that cannot be explained by a known medical condition and that has lasted at least six months (e.g., fatigue or stomach pain) Highly comorbid with 1. Histrionic, Borderline, and interesting link with Antisocial Personality Disorder (both impulsive, short-term goals) 2. Increased risk of developing Major Depressive Disorder, Panic Disorder, and Substance-Related Disorders 3.Twice as prevalent in women as men Treatment concerns and modalities 1. Individuals with Somatization Disorder well known for being in and out of the hospital 2. Often prefer to see many different specialists due to the variety of sxs 3. As a result, treatment for this disorder usually costs twice as much as for the average patient 4. To save money, patients often assigned a gatekeeper physician who has to authorize visits to see another specialist 5. Treatment requires collaboration between mental health and medical professionals 6. Psychological treatment involves support, reassurance, relief of anxiety and depression, and reduction of unneeded help-seeking and, hence, secondary gain |
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Term
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Definition
| 1. A condition in which an individual develops motor or sensory sxs that are not faked, yet that do not have an identifiable neurological cause 2. Onset of sxs often sudden and linked with psychosocial stressor 3. Individual often not overly concerned with sxs ("la belle indifference"), which is at odds emotionally with the often-severe physical and sensory sxs presented 4. Occurs more frequently in women than in men 5. Sxs tend to affect the left side of the body more than the right side, especially in women 6. Women with Conversion Disorder may eventually go on to meet criteria for a diagnosis of Somatization Disorder; this progression is rare in men 7. Prognosis good with above-average intelligence, identifiable psychosocial stressor, treatment, and presence of sxs of aphonia, blindness, and paralysis 8. Prognosis poor with seizures or tremors in sx picture Subtypes 1. "With Motor System or Deficit" subtype includes sxs such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing, aphonia, and urinary retention 2. "With Sensory System or Deficit" subtype includes sxs such as loss of touch or pain sensation, double vision, blindness, and hallucinations 3. "With Seizures and Convulsions" subtype includes seizures or convulsions with voluntary motor or sensory components 4. "With Mixed Presentation "subtype is used if more than one subtype is present. The sxs must not be strictly limited to pain or sexual dysfunction, in which case they would be better explained by another diagnosis Maintenance of Conversion Disorder related to 1. Primary gain (reduction of anxiety) 2. Secondary gain (attention; avoidance of responsibilities) 3. Sx benefit: a. Primary gain refers to the fact that physical sxs reduce anxiety by preventing conscious awareness of the individual's psychological conflicts or needs b. Secondary gain refers to the external benefits that result from the perception of illness (e.g., receiving attention, avoiding unpleasant tasks) Often co-occurs with 1. Dissociative Disorders, Major Depressive Disorder, Antisocial Personality Disorder, Histrionic Personality Disorder, Borderline Personality Disorder, and Dependent Personality Disorder |
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Term
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Definition
| 1. Intentional production of physical or psychological signs or sxs, motivated by desire to assume sick role (and not for direct secondary gain) 2. Factitious Disorder With Predominantly Psychological Signs and Sxs may include depression, dissociative sxs, amnesia, and hallucinations 3. Factitious Disorder With Predominantly Physical Signs and Sxs may include pain, infection, seizures, fainting or dizziness, rashes, vomiting, diarrhea, etc. 4. Sxs may be exaggerated or actually fabricated; patterns may emerge after hospitalization; multiple lab tests and hospitalizations may ensue 5. If confronted, individuals deny that sxs are feigned or exaggerated Factitious Disorder by Proxy 1. Formerly termed Münchausen syndrome by proxy 2. Involves intentionally causing another to be in sick role, typically a parent with respect to child 3. Chronic Factitious Disorder (Münchausen syndrome) typically middle-age men, estranged from family Treatment 1. Little evidence regarding effective treatment; supportive therapy, cognitive-bxal therapy, family therapy may be helpful |
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Term
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Definition
| Formerly termed Psychogenic Amnesia: the inability to recall personal information linked to traumatic or stressful events in one's life. Usually reversible (unlike amnesia related to brain trauma). Recovery may occur spontaneously when the affected person is removed from the traumatic or stressful situation. Other individuals may recover their memories through hypnosis or exposure to a specific stimuli. Often anterograde; that is, memory is lost for events subsequent to the trauma. Five types: Localized amnesia, selective amnesia, generalized amnesia, continuous amnesia and systematized amnesia a. Localized type: Memory is lost for specific time period following event b. Selective type: Only some aspects of events are recalled c. Generalized type (rarer): Person cannot recall entire life d. Continuous type: Person forgets events from time of trauma until present e. Systematized type: Person forgets one category of information (e.g., related to specific person) f. These latter three types often lead to a more generalized diagnosis, such as Dissociative Identity Disorder. Can be differentiated from Dissociative Fugue, which is marked by the presence of sudden travel away from the usual place of residence |
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Term
| Dissociative Identity Disorder |
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Definition
| The existence, in a person, of at least two distinct identities or personality states (alters), which recurrently take control over the individual's bx. It is also marked by an inability to remember significant personal information, beyond normal forgetfulness. The primary personality (host) usually carries the individual's given name and personal history; it often presents as passive, guilty, dependent, and depressed. Alternate personalities may be unaware of each other; if awareness exists, the differing "alters" are often hostile toward one another. More hostile and controlling "alter" personalities often have greater awareness of other alters and fewer sxs of amnesia than do more passive personalities. Transitions between personalities are typically abrupt and occur as a result of psychosocial stress. The core risk factor appears to be extreme childhood trauma. Severe physical or sexual abuse is a primary risk factor; additional posttraumatic sxs (e.g., nightmares, flashbacks, hypervigilance) often accompany the differing personalities. Dissociation via forming of new personality state allows the child to escape from traumatic environment. Comorbidity with Borderline Personality Disorder, Mood Disorders, Substance Disorders, Eating Disorders and Sleep Disorders is likely. More frequent in women than men. Treatment goals include reintegrating the separate personalities into a single identity, ensuring the person's safety, processing traumatic memories, and developing more adaptive coping skills |
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Term
| Female Sexual Dysfunctions |
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Definition
| Disorders in desire, arousal, and orgasm in the female. They are: Female Sexual Arousal Disorder, Female Orgasmic Disorder, and Vaginismus. a. Female Sexual Arousal Disorder: Involves inability to maintain lubrication/swelling response when sexually excited b. Female Orgasmic Disorder: Involves lack of orgasm or delayed orgasm c. Vaginismus: Involves recurrent, persistent, involuntary spasms in outer third of vagina that interfere with intercourse. Can be associated with misinformation, unrealistic expectations, and/or performance anxiety. Lifelong Type (present since onset of sexual functioning) vs. Acquired Type (appears after a period of normal functioning). Generalized Type (appears in a variety of contexts) vs. Situational Type (limited to specific forms of stimulation, situations). Sexual disorders in which psychological factors play a significant role in the onset, severity, or exacerbation of the dysfunction are classified as "Due to Psychological Factors". Treatment involves relationship counseling, cognitive therapy, and sensate focus; for vaginismus, relaxation may be used. Masturbation encouraged. Kegel exercises (repeated and voluntary tightening of the pelvic floor muscles) also useful to enhance sexual functioning and increase pleasure |
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Term
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Definition
| Three sexual disorders specific to men 1. Male Orgasmic Disorder 2. Male Erectile Disorder 3. Premature Ejaculation. 4. Diagnosed only when they engender distress/interpersonal dysfunction (and not linked to medical condition) Male Orgasmic Disorder 1. Persistent delay in (or inability to reach) orgasm 2. Treatment: Non-SSRI antidepressants; sensate focus (renewing pleasure without intense "need" for orgasm) Male Erectile Disorder 1. Persistent inability to maintain or obtain erection 2. Most common Male Sexual Disorder 3. Linked with age greater than 40, performance anxiety, and/or a number of medical conditions 4. Treatment: Viagra-like medications, sensate focus, avoidance of alcohol/smoking Premature Ejaculation 1. Too-early orgasm and ejaculation 2. Related to young age and/or sexual guilt/anxiety 3. Treatment: "squeeze" technique; SSRIs Types 1. Lifetime vs. Acquired 2. Generalized vs. Situational |
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Term
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Definition
| Intense and recurrent sexually arousing fantasies, urges, or bxs that cause significant distress or functional impairment. If Paraphilias are acted out with non-consenting partners, for example children, objects of voyeurism, while engaging in sadomasochistic acts etc., there need not be experience of distress for diagnosis. Occur almost exclusively in males. Can be ego-dystonic or ego-syntonic. Sexual Dysfunctions often co-occur with Paraphilias; the presence of the paraphilic stimulus may become necessary for any sexual arousal. Individuals diagnosed with a Paraphilia may seek out occupations or hobbies that allow them access to their preferred sexual stimuli. Psychosocial stressors, availability of stimuli or mental disorders may increase paraphilic bx. Eight specific kinds Exhibitionism (exposure of one's genitals). Fetishism (use of nonliving objects, often involving a specific tactile sensation). Frotteurism (rubbing against or touching a non-consenting person in a sexual manner). Pedophilia (attraction to prepubescent children). Sexual Sadism (infliction of pain, humiliation, or suffering). Sexual Masochism (experiencing pain, humiliation, or suffering). Voyeurism (observing others' sexual activity). Transvestic Fetishism (cross-dressing). Occurs in heterosexual males, who are aroused by the femininity of the clothing (and imagining being female) Treatment. Mostly CBT techniques, including aversive conditioning, with the goal of learning to become aroused in response to a more appropriate stimulus: a. Covert sensitization: The individual is taught to associate the sexually arousing stimulus with its negative consequences, inducing aversive conditioning (in the imagination rather than in vivo) b. Orgasmic reconditioning: The person masturbates to his typical, inappropriate stimulus, but immediately prior to ejaculation, the man switches his fantasy to a more appropriate sexual stimulus. With repetition, this practice helps the person think of the appropriate stimulus earlier and earlier in the masturbatory episode until it replaces the inappropriate stimulus entirely c. Satiation therapy: The man masturbates to orgasm while fantasizing about an appropriate stimulus, then continues to masturbate past the point of orgasm while fantasizing about paraphilic images. This eventually reduces the man's arousal in response to the paraphilic stimulus |
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Term
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Definition
| Gender Identity Disorder (transsexualism) 1. An intense, persistent cross-gender identification, plus extreme discomfort with gender role of the person's biological sex 2. Boys and girls with G.I.D. wish to be of the opposite sex or insist that they are; play is strongly identified with the opposite sex's gender roles 3. Three-fourths of young boys with G.I.D. grow up to be homosexual or bisexual, but without persisting G.I.D. 4. The vast majority of adults with G.I.D. adjust well after sex reassignment surgery 5.Gender identity is independent from sexual orientation, and most homosexual individuals identify with their apparent gender 6. Individuals with Gender Identity Disorder, regardless of their biological sex, may be sexually attracted to members of either gender, both genders, or neither gender; this is particularly true for men. The majority of women with Gender Identity Disorder are attracted to females 7. The etiology of G.I.D. is unknown; it may involve biological or psychosocial factors, or both |
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Term
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Definition
| 1. Eating Disorder marked by recurrent episodes of binge eating and compensatory bxs (to rid oneself of the excess calories consumed and keep weight under control), which occur at least twice a week for at least three months 2. Binge involves eating far more than people would normally eat during a discrete time period, and a sense of lack of control over such eating 3. Purging Type: When compensatory bxs include self-induced vomiting or the misuse of laxatives, diuretics, or enemas 4. Non-Purging Type: When fasting or exercise or other compensatory bxs predominate 5. Differentiated from Anorexia Nervosa on basis of high levels of weight loss (at least 15 percent) in Anorexia Nervosa; no weight criterion for Bulimia Nervosa 6. Severe physical consequences may ensue from vomiting and other means of purging Prevalence 1. 1 percent to 3 percent of population 2. 9:1 female-to-male sex ratio 3. Typical onset in late teen years Risk factors 1. Chaotic family situations, parental overconcern with body image, low self-esteem, sexual abuse 2. Comorbidity with Major Depression, Anxiety Disorders, and Substance Abuse common Treatments 1. Cognitive-bxal therapy 2. SSRI medications |
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Term
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Definition
| 1. Sleep Disorder marked by irresistible attacks of sleep (10-20 minutes in duration) that occur every day for at least three months, often in inappropriate or dangerous situations (e.g., while driving) 2. Diagnosis of Narcolepsy also requires the presence of either cataplexy (i.e., brief, sudden loss of muscle tone, ranging from drooping eyelids to falling down) or recurrent infiltration of REM sleep elements into the transitional period between waking and sleeping 3. The REM sleep elements involve (a) hypnagogic hallucinations (vivid dreamlike imagery experienced just before falling asleep), (b) hypnopompic hallucinations (vivid dreamlike imagery experienced just after awakening), or (c) sleep paralysis between awake and sleep states 4. Prevalence well under 1 percent of population; men and women equally affected 5. Early sign (excessive daytime sleepiness) may promote automatic bx, e.g., driving or conversing without full awareness of bx Treatment 1. Stimulant medications are efficacious; tricyclic antidepressants and SSRIs may reduce cataplectic episodes 2. Bx management (e.g., regular sleep cycle; short, scheduled naps; avoiding alcohol and caffeinated beverages before bed) helpful |
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Term
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Definition
| 1. Sleep Disorders in which an individual experiences abnormal bxal or physiological events in association with sleep 2. Most start in childhood and resolve by adolescence; adult onset also occurs, with a more chronic course Three types 1. Sleep Terror Disorder: Recurrent episodes of sudden awakening, with intense arousal and extreme fear; individual resistant to being comforted and may react violently if touched; little memory of any dream content; amnesia for event in the morning a. One to 10 minutes in length b. Occurs during Stages 3 and 4 of non-REM sleep c. Onset usually 4-12 years of age (males predominate) or during 20s (equal sex ratio) d. Sleep Terror in adults often associated with emotional stressors or alcohol consumption 2. Sleepwalking Disorder: Recurrent episodes of rising from bed while still asleep and walking about, often performing routine bxs (eating, going outside); coherent dialogue rare. Amnesia for event upon awakening a. Occurs during Stages 3 and 4 of sleep b. Initial episode occurs between the ages of 4 and 8; peak prevalence at age 12 c. Sleepwalking disorder often co-occurs with Sleep Terror Disorder 3. Nightmare Disorder: Repeated awakening after vivid and frightening dreams related to personal threat, which can be recalled in detail a. Nightmares occur during REM sleep, usually without movement or vocalizations b. Onset usually between 3 and 6 years old; two to four times more common in girls c. Often related to severe stress |
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Term
| Schizoid Personality Disorder |
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Definition
| 1. Cluster A personality disorder, marked by detachment from social interactions and relationships, restricted range of emotional expression, and oblivion to subtleties of social interaction 2. Little desire for intimacy and close relationships; appear odd and aloof to others 3. Limited affective range; educational or occupational impairment likely, though may function well in jobs requiring little or no human contact (computers, movie operators, etc.) 4. Prefer solitary activities and hobbies often mechanical or abstract in nature (e.g., computer or mathematical games) 5. Very few activities from which these individuals derive pleasure, as they appear to have a limited capacity for enjoying sensory, bodily, or interpersonal experiences 6. As children or adolescents, these individuals are likely to have experienced poor peer relationships, academic underachievement, and teasing 7. Distinguishable from Avoidant Personality Disorder because of the heightened sensitivity and fear of rejection in the latter. In Schizoid P.D., there is not the motivation for contact in the first place 8. Schizotypal, Paranoid, and Antisocial Personality Disorders often co-occur 9. Risk for developing Major Depressive Disorder or becoming homeless, possibly due to the lack of a social support networks 10. Rare in clinical settings, because lack of self-referral. Psychosocial stress may lead the person to seek treatment Treatment 1. Usually solution-focused, addressing immediate concerns 2. Lack of interpersonal engagement prevents deep therapeutic, longer term interactions |
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Term
| Schizotypal Personality Disorder |
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Definition
| Cluster A Personality Disorder characterized by either extreme discomfort or a reduced capacity to engage in close interpersonal relationships, as well as cognitive and perceptual distortions and/or eccentric bx. Inappropriate and restricted affect when interacting with others. Suspicious and susceptible to paranoid ideation, unusual appearance, magical thinking, circumstantial or stereotyped speech, etc. Ideas of reference, perceptual illusions, and unusual thought processes apparent, but usually not frank hallucinations or delusions. Early signs may emerge during childhood or adolescence. Children may be awkward, hypersensitive, bizarre fantasies, have unusual thoughts or speech, so may be ostracized. In adolescence, often gravitate toward solitary pursuits, high levels of social anxiety. Childhood risk factors include neglectful environment, emotionally detached parents, maltreatment, or other trauma. Slightly more common in males than in females. May occur more frequently in first-degree biological relatives of individuals with Schizophrenia. Strong comorbidity with Major Depression; may progress to a Psychotic Disorder. Also comorbid with Schizoid, Paranoid, Avoidant, Borderline Personality Disorders |
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Term
| Antisocial Personality Disorder |
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Definition
| 1. Cluster B personality disorder marked by pervasive transgression of rights of others. 2. Onset in adulthood, but Antisocial Personality Disorder is always preceded by Conduct Disorder (with onset by age 15 years) 3. Sxs involve disobeying of laws, deceitfulness, impulsivity, irritability/aggressiveness, chronic irresponsibility, lack of remorse for harm to others, and reckless disregard for safety of others 4. At least 3:1 male:female ratio 5. Personality traits involve charm, superficiality, deceit, and manipulativeness 6. May be characterized by low arousal and low anxiety 7. Over lifetime, remission or at least reduction in sxs often occurs by mid-adulthood 8. Treatments difficult to institute; bxal treatments optimal |
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Term
| Borderline Personality Disorder |
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Definition
| Is a Cluster B Personality Disorder characterized by a pervasive pattern of instability in interpersonal relationships, self-image, affect and by marked impulsivity Individuals must show at least five of the following sxs: 1. Extreme avoidance of abandonment 2. Intense and unstable relationships (with vacillation between idealizing or devaluing the other person) 3. Marked instability in self-image or sense of self 4. Impulsivity in at least two areas (e.g., gambling, sex, spending, binge eating, or substance use) 5. Recurrent suicidal threats 6. Recurrent self-injurious bx 7. Unstable affect/mood reactivity 8. Persistent feeling of emptiness 9. Extreme anger 10. Temporary periods of paranoid ideation or severe dissociative sxs Other Key Points 1. Splitting is a primary defense: viewing people as being either completely good or completely bad 2. Risk of actual suicide is pronounced, with a 3:1 female-to-male ratio 3. Typical age of onset is between 19-34 years, but sxs may diminish as a person ages 4. Common history of physical or sexual abuse 5. Various antipsychotic, mood stabilizing, or antidepressant medications are used for certain sxs Treatment of choice: Dialectical Bx Therapy (Marsha Linehan) 1. DBT is a cognitive-bxal approach that includes training in mindfulness, emotional regulation and social skills 2. It focuses on bxs that bring harm to the client or interfere with healthy functioning in life 3. It reduces suicide attempts, premature termination of therapy, and the number of hospitalizations in clients with Borderline Personality Disorder |
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Term
| Histrionic Personality Disorder |
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Definition
| A Cluster B Personality Disorder, marked by extreme emotionality and attention-seeking bx; need to be the center of attention to be comfortable. Overly dramatic/theatrical emotional displays are common, to draw attention; impressionistic speech. Individuals rely on their physical appearance in order to gain attention; they tend to be inappropriately sexually provocative. Excessive yet shallow emotional expression. Superficial interpersonal relationships; relationships may be perceived as more intimate than are in actuality. Tendency to abandon established relationships in favor of excitement of a new relationship. High novelty- and excitement-seeking; delayed gratification met with frustration or anger. High suggestibility; easily influenced by others and by current fads; overly trusting of authority figures. Dependency upon others for validation; tendency for excessive flattery and gift-giving. Prevalence rate estimated at 2 percent to 3 percent; clear comorbidity with Somatization Disorder, Conversion Disorder, and Major Depressive Disorder, along with Borderline, Narcissistic, Dependent, and Antisocial Personality Disorders. Will apparently remain a "disorder," rather than be changed into a "type" in DSM-V |
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Term
| Narcissistic Personality Disorder |
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Definition
| 1. Related to grandiosity, entitlement, a sense of specialness, and lack of empathy for others 2. Difficulty recognizing and understanding needs and viewpoints of others, devaluing others' contributions 3. Often overestimating importance or noteworthiness of their actions and talents 4. Such overzealous self-assurance may actually mask fragile self-worth 5. Developmental roots emanate from childhood a. Family factors include either unempathic/unresponsive parents (Kernberg) or parental failure to provide realistic sense of self to child so that early egocentricism and grandiosity are not overcome (Kohut) 6. Often comorbid with other personality disorders (especially Cluster B), substance use disorders, and/or Major Depressive Disorder/Dysthymia (associated disorders include Anorexia Nervosa, Substance-Use Disorders(particularly cocaine), Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Paranoid Personality Disorder) 7. Appears to be more prevalent in men than women 8. Treatment possible through psychotherapy aimed at fostering realistic perceptions of self and world and enhancing empathy |
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Term
| Avoidant Personality Disorder |
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Definition
| Marked by hypersensitivity to criticism and social rejection. Individual avoids social contacts despite a clear desire for closeness, to avoid being judged/criticized/rejected. See themselves as socially inept. Very low threshold for detection of criticism or ridicule. Extremely low self-esteem and low confidence in social situations. Differential Diagnosis: Avoidant Personality Disorder is distinguished from Schizoid Personality Disorder by lack of motivation for social contact in the latter, whereas the intense social anxiety prevents desired contact in the former. Developmental roots in childhood shyness and inhibition, although most shy-withdrawn children do not grow up to have Avoidant Personality Disorder. Often accompanied by concurrent diagnoses of Social Phobia (with which it shares many similarities), Dependent Personality Disorder, Borderline Personality Disorder, and Cluster A Personality Disorders. Prevalence in community samples ranges from 0.5 percent to 1 percent (Hersen, 2007). Treatment involves social skills training in group therapy, bx therapy (exposure), CBT, and possibly SSRIs |
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Term
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Definition
| 1. Can be subdivided into overt (physical or verbal aggression) or covert (stealing, property destruction, lying) components 2. Noncompliance at the midpoint of the continuum 3. Involves bx violating legal or social norms, with the potential for serious harm to others 4. May appear in Oppositional Defiant Disorder, Conduct Disorder, or adult Antisocial Personality Disorder Risk factors 1. Many risk factors identified, divisible into individual, family-social, and school-related categories 2. Children with persistent patterns of ASB are likely (but not inevitably) to persist with escalating actions into adolescence and beyond; they typically have multiple risk factors for ASB 3. Adolescent-onset youth have fewer risk factors and tend to desist once adolescence ends (though many long-term negative consequences can emanate from adolescent-onset bxs) 4. Adult onset is rare Treatment 1. Bxally based interventions (parent management training; anger management) are optimal for children and early adolescents 2. Multi-Systemic Therapy (MST) has been rigorously tested in adolescents with ASB, appreciably reducing recidivism. Therapist on call 24/7, work in multiple settings with the youth and family, promote pro-social peer association and recreation, help families to access community-based services, teach effective parental discipline and other parenting skills, aid in the creation of an extended support system, and improve performance in both school and work. |
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Term
| Borderline Intellectual Functioning |
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Definition
| 1. Not a mental disorder per se but is listed as V Code (on Axis II) in DSM-IV-TR 2. Defined as IQ score between 1 and 2 standard deviations below population mean, i.e., 71-84 on nearly all IQ tests 3. Mental Retardation requires both significantly sub-average intellectual functioning AND adaptive deficits; as a result, it is problematic to know whether a person with an IQ of 74 but with major adaptive functioning deficits -- or a person with an IQ of 65 but good adaptive skills -- should be classified under Mental Retardation or Borderline Intellectual Functioning 4. Borderline Intellectual Functioning often not salient until formal schooling |
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Term
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Definition
| 1. Not a mental disorder in DSM-IV-TR but may still come to clinical attention 2. Nearly all humans experience some bxal expressions linked to depression after a major loss Major depression 1. Not diagnosed unless grief sxs are prolonged or involve such serious features as psychomotor retardation, feelings of worthlessness, psychotic sxs, suicidal ideation, excessive guilt, and the like 2. Pathological grief reactions more likely in those with histories of depression, life stress, trouble with emotional expression, low social support Children 1. May express grief in developmentally appropriate ways (e.g., play acting a funeral); open expression of emotion may prevent bxal and emotional problems in children |
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Term
| Global Assessment of Functioning (GAF) |
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Definition
| 1. Coded as a number between 0 and 100; coded on Axis V of the DSM-IV-TR multiaxial system 2. GAF rates level of functioning in terms of (a) sx severity and (b) psychological, social, or occupational impairment 3. Score of 0 signifies inadequate information to code; 1 is lowest level possible, 100 is highest 4. GAF scores should be based on whichever component (sxs, impairment) is worse. Timeframe may be week of referral or, in some cases, longer timeframe |
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Term
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Definition
| A pain in the head area, with the pain being above the eyes or the ears, behind the head (occipital), or in the back of the upper neck. Five major types 1. Tension, migraine, cluster, sinus, plus a category known as "secondary Headaches" 2. Tension Headaches: related to contraction of head and neck muscles; dull pain. Thought to be related to stress and sustained contraction of back and neck 3. Migraine Headaches are pulsating and often unilateral; auras often precede the pain; light sensitivity and intense nausea and vomiting can ensue a. Classic migraines (80 percent of migraine cases) typically involve visual areas, whereas common migraines do not 4. Cluster Headaches involve intense, piercing pain radiating from behind eye to other portions of head; come in "clusters" of several days to weeks a. They appear to be triggered by an individual's circadian rhythm, as onset of Headaches tends to occur one to two hours after a person goes to sleep and cluster periods tend to recur during specific seasons of the year 5. Sinus Headaches involve pain and pressure in cheeks and forehead; often associated with sinus infection, discharge, fever, cough, and fatigue 6. Secondary Headaches may result from a variety of different conditions (hence, are secondary to it) a. These conditions range from life-threatening illnesses (brain tumors, strokes, meningitis, subarachnoid hemorrhages) to less serious but common ones, such as withdrawal from caffeine and discontinuation of analgesics (pain-killing medication) Treatment 1. Aside from typical medical treatment, centered on the use of medications, psychological treatment interventions include stress-reduction programs, which entail teaching relaxation and meditation techniques, as well as cognitive restructuring, to change the response of the body to stress and pain |
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Term
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Definition
| Occur when there is a sudden, uncontrolled and excessive burst of electrical activity in cerebral neurons. The location of the excessive neural activity determines how the Seizure manifests. Types include partial and generalized Seizures. Partial Seizures are restricted to one part of brain (and one hemisphere) and usually occur in the frontal (60 percent of the cases) or temporal lobe. They are the most commonly experienced Seizures in epileptic attacks. Partial Seizures include simple partial and complex partial . a. Simple partial Seizures: Change in consciousness but no loss of consciousness b. Complex partial Seizures: Greater changes in consciousness or loss of consciousness (may convert to generalized type). Generalized Seizures: Involve most of brain; bilateral. Include tonic-clonic and absence seizures a. Tonic-clonic (grand mal): Tonic phase involves muscle rigidity which lasts from 15 to 20 seconds; clonic phase involves violent rhythmic convulsions lasting one to two minutes. Consciousness is lost b. Absence (petit mal): Brief lapse in consciousness, but may be repeated many times during day (often attributed to attentional lapses in children) Treatment: Anticonvulsant medications, surgery (rarely), or vagal nerve stimulation. 1.5 percent to 5 percent of individuals will have at least one seizure in their lifetime |
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Term
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Definition
| 1. The intentional taking of one's own life 2. Most common means of committing Suicide involve the use of firearms, suffocation, or poison 3. According to the Center for Disease Control and Prevention and the National Institute of Mental Health, Suicide is the third leading cause of death among children between the ages of 10 and 14, adolescents between the ages of 15 and 19, and young adults between the ages of 20 and 24 (CDC, 2009; NIMH, 2007); it is also the second leading cause of death among college students 4. Because women are more likely to suffer from depression than men, they are three times more likely to attempt Suicide. Yet Suicide attempts by men are more likely to be successful because they tend to employ more lethal methods, such as the use of firearms. Men are approximately four times more likely than women to die by Suicide 5. Between the ages of 24 and 44 is the range of those most likely to attempt Suicide 6. 65 and older are most likely to actually complete Suicide 7. Non-Hispanic white men age 85 or older were the most likely of all groups to die from Suicide (CDC, 2009; NIMH, 2007) 8. Suicide rates among the elderly have been rising rapidly, probably because of increased medical illnesses and diminishing social supports 9. Greatest increases in Suicide rates over the past 10 years in adolescents, between the ages of 10 and 14, especially girls 10. Vast majority of individuals who commit Suicide have a mental disorder 11. 60 percent of people who commit Suicide have a Mood Disorder (most often Major Depressive Disorder or Bipolar Disorder) 12. When associated with depression, Suicide attempts are most likely to occur within the three months after an individual begins to show some clinical improvement (more energy to carry out plan) 13. Schizophrenia, OCD, and other mental disorders are also associated with suicidal ideation and attempts 14. Conduct Disorder, Attention-Deficit/Hyperactivity Disorder, and substance abuse are all associated with increased risk of Suicide in adolescents 15. The presence of comorbid mental disorders increases the risk of Suicide in both adults and adolescents 16. Alcohol abuse involved in anywhere from one-quarter to one-half of all completed Suicides 17. Other risk factors include: a. previous Suicide attempts (60 percent to 80 percent of individuals who complete Suicide have a history of at least one previous Suicide attempt) b. family history of Suicide c. divorce, separation, or widowhood (married individuals have the lowest suicide rates, followed by single individuals) d. access to lethal methods e. loss, feelings of hopelessness, feelings of isolation f. impulsivity or aggressive tendencies g. history of physical or sexual abuse h. physical illnesses i. socioeconomic status (SES) also linked with Suicide: Individuals with middle to high SES are more likely to commit Suicide than those wth low SES Prevalence (Summary) 1. Given that 30,000 Suicides occur annually in the U.S., and a million or more in the world, Suicide constitutes a major public health problem 2. Men approximately four times more likely than women to die by Suicide, but women three times as likely to attempt Suicide 3. Men use more lethal means; women more likely than men to experience depression 4. Suicide is third leading cause of death among people ages 10-24 and second leading cause of death among college students 5. Across age groups, Suicide rates are highest among Caucasians 6. EXCEPTION: between the ages of 15 and 24, American Indians and Native Alaskans have the highest rate of completed Suicide 7. Suicide rates are lower in African-American male teenagers compared to Caucasian male teenagers 8. Lowest among Hispanics, Asian and Pacific Islanders, and African-Americans 9. Individuals age 24-44 most likely to attempt Suicide, but individuals age 65 and up most likely to complete Suicide 10. Greatest increases in Suicide rates over the past 10 years in adolescents, between the ages of 10 and 14 (especially girls) |
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