abnormal psych exam 2

ADHD diagnostic criteria

Persistent pattern of attention/hyper activity and impulsivity that interferes with functioning and development

Several in attention or hyperactive impulse symptoms that are present prior to 12 years old

Several intentional hyperactivity symptoms that are present in 2 or more settings

Clear evidence that the symptoms interfere with social academic, or occupational functioning

The symptoms on correct exclusively during the course of schizophrenia or other psychotic disorders and are not better explained by another mental disorder

An attention and ADHD occurs for six months with 6 symptoms

Often fails to get close attention to detail details, difficulty sustaining attention doesn’t seem to listen when spoken to directly doesn’t follow through on instructions, difficulty organizing task, avoids, dislike, and reluctance to engage in tasks that require mental efforts, loses things necessary for task, easily distracted And forgetful

Hyperactivity and impulsivity symptoms 6 symptoms for six months

Often fidgets or taps, hands or feet leaves see in situations when remaining your seat is expected, runs inclines where it’s inappropriate unable to employ an engage in leisure activities quietly on the go talk, excessively blurred out an answer before question is complete difficulty waiting their turn, interrupts others

Specify if for ADHD diagnostic criteria

Specify of combine presentation predominantly inattentive presentation or predominantly hyper active/impulsive presentation and if it’s severe smiled or moderate and in partial emission

Combine presentation ADHD

Present and majority of kids

Hyper active/impulsive presentation ADHD

Least common in kids

Rule government behavior ADHD

Behaving a certain way because they’re expected to

Academic performance variability ADHD

Performance in school differs, depending on the subject

Significant symptoms with ADHD

Anxiety/depression

problems a kid might have with ADHD

Problem with pure relations and problems in school and low frustration tolerance more medical/health problems, self-esteem issues and tend to have lower IQs than people without ADHD

ADHD prevalence

Girls 2 to 4%

boys 6 to 9%

average for both 5%

Average for adults 2.5%

ADHD development and course

Elementary school years about 5 to 8 years old, 70% of children trying to keep symptoms into their adolescence, as adults they end up learning to compensate with their symptoms (don’t meet the criteria anymore)

ADHD culture and gender related issues

Two one ratios: two girls to one boy

Girls in intensive presentation not as much disruptive as boys are

Boys more disruptive behavior, so it is a little easier to diagnose them Girls

There is no evidence that ADHD is more prevalent in other cultures versus others

ADHD genetics

Monozygotic twins have a rate of 0.51%

Dizygotic twins have a concordance rate of 0.33%

Biological parents/siblings have a rate of 20 to 32%

ADHD physiological abnormalities

Central nervous system disturbances: substance abuse/exposure to toxins

prefrontal/Olympic/basal ganglia area under activity (disrupts focus/impulsivity/emotion control)

People with ADHD respond to medication because it increases the activity neurotransmitters

ADHD temperament

Emotionally regulated/lots of physical activity/difficulty sooth

ADHD chronic health problems

More trips to ER/more injuries/more sleep problems/more respiratory problems

ADHD behavioral issues

More negative interpersonal interactions with kids/adults, kids appear to be more in control of actions/interactions “so the adult react to them”, rapid situation/stop responding to stimulus “meaning the neuron stop firing” this can apply to social interactions

How to help kids with ADHD in their behavior

Kids with ADHD obituary really fast meaning that they respond well to new stimuli/environmental changes and if you want to help them in the classroom, she needs to change continuously with the kid will stop responding because of a lack of interest so they end up looking for self stimulation

ADHD cognitive behavioral causes and maintainers

Poor executive management skills to others, deficit attention, poor behavioral inhibition

Poor behavioral inhibition, ADHD

1. have to stop any prepotent response meaning any behavior we are about to do

2. Stop any ongoing response meaning any current behavior

3. Blackout any interference meaning either external/internal

   Any deficits in these areas cause implications for planning self regulation, including gratification delay

4. This means that they can’t calculate every detail meaning that they can’t plan and do things efficiently

ADHD social ecological causes a main maintainers

The way they’re treated in the family can’t cause ADHD but parents of kids with ADHD Don’t think they’re good parents think they don’t know enough of our parenting

sociological is more or less evenly distributed among different social classes

ADHD development in toddlers

May have few demands for sustained detention, poor impulse control, and it may look like excessive impulsivity, excessive activity, excessive temper, tantrums, defiance, aggression, or behavior, and more sleep problems, and more excessive accident

ADHD in school age kids

Environment demands presence circumstances for symptom expression, and it may look like the the regular symptoms

ADHD and adolescence may look like

More internal restlessness, more disorganization, more gold-ected behavior, and more mistaken behavior

ADHD in adulthood

May show four or five with the symptoms and the symptoms are the same became manifest differently

Example, disorganization in work environment/procrastination/poor concentration

Anxiety

Product of multi complex response system involving effective/behavioral/cognitive/physiological components

Core feature of anxiety

Is regulation of normal response system (flight/flight response or general adaptation syndrome)

Fight flight response

What component of the general adaptation syndrome it’s a set of bodily changes designed to counteract stress related to affects

For example, heat/cold, environmental, poison, surgery, strong, emotional reactions

General adaptation syndrome

Also known as alarm/sympathetic response

Involves hypothalamus

Hypothalamus

Two pathways

1. Lot of flight response/alarm response is the sympathetic pathway. The sympathetic nerves moved to the organs, then create a stress response. They also move through the adrenal glands and secrete epinephrine and Norepinephrine

2. Resistance stage of general adaptation syndrome. The hypothalamus moves of the pituitary glands then you move through the adrenal glands. With Almus secretes corticotropin RH the pituitary gland secretes a CTH the adrenal gland secrete Cortisol

3. Hypothalamic, pituitary, adrenal axis or HPA

anxiety symptoms, either physical, cognitive or behavioral

Physical: sweating, shaking, or restlessness

Cognitive: impending doom/rumination negative thoughts aware of threat/danger poor concentration

Behavioral: trembling, nail, biting stuttering, playing with hair, avoidance, crying/being attached, immobilized, clenching, rocking or freezing up

Fear

Present orient response(in the moment)

Anxiety is a future oriented response

Panic

Set a symptoms that occur in the absence of any obvious threat/danger(from fight/flight)

Panic attack

Abrupt surge of intense fear/intense discomfort that reaches a peak within minute during which several physiological symptoms occur

Separation anxiety

Age inappropriate/excessive/disabling anxiety while being apart from parents/home (most common in adolescence)

generalized anxiety

chronic/exaggerated worry or tension, almost constant anticipation of disaster, even though nothing seems to provoke it (apprehensive expectations)

Specific phobias

Extreme/disabling, fear of specific objects or situations that pose little or no danger

Example, phobias of animals, natural environments, blood injections or injuries, situations

Social anxiety disorder(social phobia)

Fear of being the focus of attention or scrutiny or doing something that will be intensely humiliating

Panic disorder

Panic attack/sudden feelings of terror that repeatedly without warning

(person has to dread/be afraid of the next attack)

Physical symptoms of panic disorder

Shaking uncontrollably/unable to be calm or sit still/chest tightening/not being able to breathe

Panic attack peek in about 10 minutes

Two types of panic attack attacks

Unexpected panic attack attacks(required for diagnosis of panic disorder)(also the persistent concern about having another attack and the possible invocation has consequences of that attack. Meaning, you are high anxiety, sensitivity, and more cognitive based)

Expected panic attacks

agoraphobia

Fear of the marketplace, which is marked by intense fear that occurs upon exposure to/anticipation of a broader range of situations, the individual fears that escape might be difficult or help might not be available in the event of a developing panic like symptom or other incapacitating/embarrassing symptoms

90% of people with panic disorder develop agoraphobia within a year

Selective mutism

Failure to speak in specific social situations, despite the ability to speak and despite speaking in other settings

Substance/medication induced anxiety disorder

Panic attack/anxiety developed during/soon after substance intoxication or withdrawal or after exposure to a Medication

For example exposure to alcohol/caffeine/cannabis/and cyclodiene/cocaine/sedative/Anxiolytic

Anxiety disorders in the DSM four but not in the DSM five

Obsessive, compulsive disorder, OCD and posttraumatic stress disorder, PTSD

obsessive compulsive disorder, OCD

Now under obsessive/compulsive and related disorders in the DSM five

obsessions: repeated/intrusive/unwanted thoughts

Compulsions: accompanied by ritualized behaviors to reduce anxiety

Posttraumatic stress disorder PTSD

Now under trauma and stress related disorders in a DSM five

criteria: exposure to a dramatic event/intrusive symptoms/avoidance/negative cognition in mood/hyper arousal

Anxiety disorders to focus on

Social anxiety disorder, panic disorder, OCD, PTSD

Associated features of panic disorder

Anticipate catastrophic consequences from mouth, physical sensations, less tolerance of medication side effects, pervasive concerns about abilities to complete daily task, excessive drug/alcohol used to prevent panic attacks and extreme behaviors aim at controlling the panic attacks, may experience nocturnal panic attacks, higher of suicide attempt/suicidal ideation

Prevalence rates of panic disorder

28.3% of adults report having one, but the rate is 2 to 3%

Development/course of panic disorder

Median age onset is usually between 20 to 24 years old and usually between late adolescent/mid 30s, agoraphobia usually appears within first year panic attack attacks

Course: chronic waxing/waning

Culture/gender related issues in panic disorder

Female male ratio is 2:1, non-Latino whites have higher rates than Latinos, African-Americans, and Asian Americans

Associated features and obsessive compulsive disorder

Common themes of obsessions and compulsions

Cleaning: contamination obsession/cleaning compulsion

Forbidden/taboo thoughts: aggressive, sexual, or religious obsessions/compulsions

Harm: views of harm to self/others in checking compulsions

Some may hoard objects may experience, anxiety, including panic attacks, and response to situations that trigger obsessions or compulsions. Others may experience discussed in many a distressing sense of “incompleteness” or not being “just right”

Prevalence rate of OCD

1.2%

Development/course of OCD

Main age of onset: 19.5 years old with 25% of cases starting by the age of 14

On typically gradual

Gorgeous/gender related issues of OCD

Males have earlier onset nearly 25% of males having onset before the age of 10

Associated features of PTSD

Developmental regression may occur/auditory, pseudo-hallucinations or paranoid ideation may occur, if prolonged = repeated/severe traumatic events, problems, regulating emotions, problems, maintaining stable into personal relationships, or problems with dissociative symptoms occurring

In children, the clinical expression may very significantly

Pseudo hallucinations

Sensory experiences hearing your thoughts in different voices

Prevalence rate of PTSD

The risk in the US is 8.7%

12 month prevalence rate is about 3.5%

Highest rates among rape, survivors/military combat or captivity/ethnic, or political motivated genocide

Development course of PTSD

Can occurred any age beginning after the first year of life, symptoms occur within the first few months after trauma, although delays may occur for months/years to meet full criteria “ delayed expression”

culture/gender related issues of PTSD

More prevalent among females, clinical expression may vary across cultures, may expressed depression in a physiological way

Bio medical causes, and maintainers of all anxiety disorders

Monozygotic twins have a concordia rate of 0.34% and dizygotic twins have a concordia rate of 0.17%.

Temperament as a risk factor in all anxiety disorders

Anxious parents more likely to have kids with inhibited temperament treats that put them at a risk to develop anxiety disorders during childhood about 50%

For example, behavior and ambition creates kids that are fearful of new stimulant or people

AMagdala dysfunction in all anxiety disorders

People with anxiety disorders, and they have more over activity in the amaglyda (which is part of the system → controls the motion regulation) which leads to the heighten fight/flight response/anxiery

Medication’s for anxiety disorders

The medication can help when emotion regulation is overactive benzodiazepines work well to lower brain activity

Benzodiazepine

Gamma aminobutryic acid (gaba)

Work by attaching themselves to receptor sites on neurons

They facilitate the binding of GABA, which increases the probability of neurons which lowers the activity of the

(short acting but stops brain from unnecessary fight/flight response)

GABA

Inhibitor, which means it depolarized is the action of a neuron making it less likely to fire

(no action potential equals inhibition of neural activity)

Selective serotonin reuptake inhibitors SSRI

first developed target depression

Increase the activity of neurons and help alleviate anxiety by helping individual regulate their emotions

They do this by increasing the reuptake of serotonin, meaning that it stays in synaptic gap for a longer period of time

Behavioral causes and maintainers of all anxiety disorders

Behavioral means anxious behaviors get reinforced overtime/before an after thr diagnosis

clsssical conditioning paradigm

Certain disorders developed by association of a stimulus

operant learning paradigm

Reinforcement/punishment

Cognitive behavioral causes and maintainers of all anxiety disorders

Bias in info processing: encode → interpret → choose response → engage response

• People with anxiety end up choosing anxious/avoiding responses

Modeling of fearful/anxious behavior: children, an anxious parents learn to catastrophize and not cope well by watching their parents do that

Lower sense of control/self efficacy: don’t believe they can change the outcome of situation/everything is out of their control

Self efficacy

How will a person believe they can accomplish something

Family/extra familial systems in all anxiety disorders

Parents of kids with anxiety are more controlling and more rejecting of the kids individuality

Parents contribute a lot, but aren’t the only factora

Exposure

Best treatment for anxiety

sociological causes and maintainers of all anxiety disorders

Increased exposure to trauma/violence happens to people in lower socioeconomic status

Learning disorder

Clinical diagnostic term referring to specific problems in reading/math/writing expression

• If you have a learning disorder, you can have a learning disability

Learning disability

general term referring to significant problems

For example could be problems with mastering a skill/doing anything really it’s an umbrella term

Specific learning disorder, diagnostic criteria

1. Difficulties learning/using academic skills as indicated about a presence of at least one of these symptoms that are persisted for at least six months despite the intervention that target does difficulties

2. Affected academic skills or substantially/quantified below those expected for the individual individuals chronological age, and they call significant inference with their academic or occupational performance or activities of daily living that are confirmed by individually administered with standardized achievement measures/comprehensive clinical assessments

• If the person is 17 years or older, a documented history of impairing, learning difficulties may be substituted for the standardized assessment

  3. Learning difficulties begin during school years, but may not become fully manifested until the demands for those affect the skills exceed the individual capacity

  4. The learning difficulties are not better accounted for by intellectual disabilities, neurological disorders psychosocial adversity, lack proficiency in the language of academic instruction or inadequate, educational instruction/environment

     • At least one and 1/2 of a standard deviation below the main has to be seen as well

     • Mean equals 100/standard deviation is 15

Specific learning disorder, diagnostic symptoms

Inaccurate/solo and effortful word, reading, difficulty understanding the meaning of what to read, difficulties, with spelling, difficulties with written expression, difficulties with mastering Number and Number fact/calculation, difficulties with mathematical reasoning

Specify these for learning disorder, diagnostic criteria

Specify if there’s an impairment in reading, impairment, written expression, impairment in math

Specify if it’s mild/moderate/severe

Genetics, and learning disorders

With genetics, they are higher rates of learning disorders among the first- degree relatives of kids with a learning disorder (4 to 8 times higher)

Math: rates are 5 to 10 times higher than the general population

Reading: rates are 4 to 8 times higher than the general population

Physiological abnormalities in learning disorders

Central nervous system trauma/dysfunction: or example, head injuries, or pregnancy trauma

Symmetry in the brain: with reading people would learn disorders their brains are more symmetrical and don’t have a difference in size for right handed kids

(Normally brain should be asymmetrical and if your right handed the left side should be bigger, but for kids would learn disorders, The left side is small smaller, so the right and left side tend to be more symmetrical)

Areas in the brain involved in reading disorder

These areas are all made smaller: meaning less activity in these 3 areas and in between these 3 areas

Brokers area: articulation/word analysis

Parietal- temporal: word analysis

Occipital temporal: word form

Less no activity means that these kids suffer with not having great phonemic awareness

Possible biomedical causes, and maintainers of learning disorders

Chronic health problems: problems that interfere with sensory function is very sensitive Period for language development.

(May contribute to learning disorders, for example, if a kid has chronic ear infections, they can grow up having a hard time actually hearing what sounds are made in different words)

Possible behavioral causes, and main maintainers of learning disorders

Learn avoidance of academic task or history of non-reward in academic settings

Possible cognitive behavioral causes in maintainers of learning disorders

Poor executive management skills poor self monitoring learned helplessness, poor attention to social cues poor self-esteem, low academic expectations poor language comprehension, poor planning, psycho-somatic complaints

Possible social/ecological causes and maintainers of learning disorders

Stress on the family system = social isolation, negative thoughts and parental guilt/anger

Lower social economic children are penalizing diagnosis by some definitions

Learning disorders development in course

Monozygotic twins is 71% concordance rate and dizygotic twin 49% concordance rate

Learning disorder treatment

Math: arithmetic/memorization

Reading: phonics/disability accommodations(for example more time when they’re taking a test)

Learning disorders associated features

Dyscalculia: bad at math

Dysgraphia: bad at writing

Dyslexia: bad at reading

Learning disorders, prevalence rates

5 to 10% of school kids

Most common in reading: 2 to 8% of all kids