Child disorders exam 3

Major depressive disorder Onset, course, duration

Onset: 30 years old, rapid

Course: episodic, specify with psychotic features, in partial remission, in full remission, recurrent or single

Duration: has to be at least 2 weeks, clinical sample: 8 months, community sample: 1-2 months

Major depressive disorder Key Symptoms and treatments

Key Symptoms:

A). 5 or more of the symptoms during the same 2-week period and represent a change from previous functioning: Depressed or irritable mood, diminished interest, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, worthlessness, diminished concentration, thoughts of death and suicidal ideation

B). clinically significant distress or impairment

C). not attributable to the physiological effects of a substance or another medical condition

D). Not due to another disorder

E). There has never been a manic episode or a hypomanic episode

Treatments: Interpersonal psychotherapy (IPT), Cognitive therapy, Behavioral activation therapy, Dialectical behavior therapy, MAOIs, SSRIs

Persistent depressive disorder Onset, course, duration

Onset: gradual, often earlier age of onset

Course: chronic

Duration: at least 1 year, can be lifelong

Persistent Depressive Disorder Key Symptoms and treatments

Key symptoms:

A). depressed mood for most of the day, more days than not, at least 2 years in adults (1 year in children/adolescents)

B). presence of two (or more) of poor appetite, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness

C). during the 1-2 year period the individual has never been without symptoms A or B for more than 2 months at a time

D). criteria for Major depressive disorder may be continuously present for 2 years

E). never been manic or hypomanic episode

F). net better explained by schizophrenia or psychotic disorder

G). not attributable to the physiological effects of a substance or medical condition

H). significant distress or impairment

XXX Specific Phobia Onset, course, duration, outcome

Onset:

Course:

Duration:

Outcome:

Specific phobia Key Symptoms and treatments

Key Symptoms

• fear or anxiety about a specific situation

• almost always provoke immediate fear or anxiety

• the object or situation is actively avoided

• fear is out of proportion to actual danger

• Persists for 6 months or more

• causes clinically significant distress and impairment

• not due to another disorder

Treatment

• graded exposure - exposure along hierarchy

• systematic desensitization - learn relaxation strategies

• Flooding

Separation Anxiety Disorder Onset, course, duration

Onset: usually 7-9, can be earlier, insidious/gradual

Course: variable, often lessening in severity

Duration: usually remits by adolescence; rare in older adolescents

Separation Anxiety Key Symptoms and treatments

Key Symptoms

• excessive fear or anxiety concerning separation from those to whom the individual is attached, has three of the following

  • excessive distress when separated, worry about losing major attachment figures, worry about experiencing getting lost, kidnapped, etc, reluctance or refusal to go out, etc.

• 4 week in kids/adolescents

Treatment

• CBT based approach- graded exposure, participant modeling contingency management

Selective Mutism duration

Duration: symptoms may subside as children get older, but symptoms of social anxiety remain

Selective Mutism Key Symptoms and treatments

Key symptoms

• failure to speak in social situations, despite speaking in other situations

• interferes with education/occupational achievement

• lasts at least 1 month (not the first month of school)

Treatments

• behavioral treatment approach is the most effective for children

• Shaping by successive approximations with positive reinforcement

Panic Disorder Onset, course, duration

Onset: mid to late adolescence, median is 20 years

Course: chronic but waxing and waning

Duration: variable, often persists without treatment

Panic Disorder Key Symptoms and treatments

Key symptoms

• at least one panic attack has been followed by 1 month (or more) of one or both of the following

  • persistent concern or worry of an additional panic attack

  • a significant or maladaptive change in behavior related to the attacks

• not better explained by another disorder

Treatment

• cognitive and behavioral (like exposure therapy)

• Pharmacological (SSRIs)

Agoraphobia Onset, course, outcome

Onset: mean is 17, later without comorbid panic attacks

Course: chronic

Outcome: 10% experience complete remission without treatment

Agoraphobia Key Symptoms and treatments

Key symptoms

• fear or anxiety about two or more of the following

  • using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, being outside of the home alone

• think that escape might be difficult or help might not be available

• situations provoke fear or anxiety

• situations are actively avoided, require the presence of a companion, or endured with lots of anxiety

• out of proportion to actual danger

• fear, anxiety, avoidance present for 6 months or more

• causes impairment

Treatment

• exposure therapy

Generalized Anxiety Disorder Onset, course, duration

Onset: early adolescence

Course: increase in number and severity of symptoms, chronic but wax and wane

Duration: rates of remission, particularly among severe cases, are low

Generalized Anxiety Key Symptoms and treatments

Key symptoms

• anxiety and worry occurring more days than not for 6 months

• difficult to control worry

• associated with three or more of the following (only one needed in children)

  • restlessness or felling keyed up or on edge

  • being easily fatigued

  • difficulty concentrating or mind going blank

  • irritability, muscle tension, sleep disturbances

• Anxiety, worry, or physical symptoms causes distress or impairment

Treatment:

• children tend to avoid problem solving - problem solving skills

• Change maladaptive thoughts

Obsessive Compulsive Disorder Onset, course, duration

Onset: after age of 35 is unusual, gradual

Course: usually chronic, often with waxing and waning symptoms

Duration: 40% of those with onset in childhood or adolescence experience remission by early adulthood

Obsessive Compulsive Key Symptoms and treatments

Key symptoms

A). presence of obsessions, compulsions or both

B). obsessions or compulsions are time-consuming or cause distress or impairment

C). not attributable to the physiological effect of substance or another medical condition

D). not better explained by the symptoms of another mental disorder

Treatment

• exposure with response prevention

• SSRIs

Post Traumatic Stress Disorder course, duration

Course: varied and often dependent on triggers

Duration: varied - some experience relief in 3 months, others lifetime

Post Traumatic Stress Disorder Key Symptoms and treatments

Key symptoms

• presence of one or more of the following intrusion symptoms beginning after a traumatic event occurred

  • recurrent involuntary distressing memories

  • recurrent, distressing dreams related to the event

  • dissociative reactions (flashbacks)

  • intense distress at exposure to cues that resemble the trauma

  • marked physical reactions to cues

• persistent avoidance of stimuli evidenced by

• negative alterations in cognitions and mood

• alterations in arousal and reactivity

Treatments: prolonged exposure therapy, EMDR, TF-CBT, Cognitive processing therapy

Anorexia Nervosa Onset, course, duration, outcome

Onset: adolescence or young adulthood (onset before puberty or after 40 is uncommon but possible)

Course: variable (some recover after short episode, other more chronic/waxing and waning)

Duration: 50-70% eventually recover, usually within 5 years (relapse common; lower if history of hospital admission)

Outcome: could be deadly if not treated

Anorexia Nervosa Key Symptoms and treatments

Key symptoms

• significantly low body weight

• intense fear of gaining weight, behavior that interferes with weight gain (excessive exercise)

• disturbance in the way in which one’s body weight or shape

Treatment

• inpatient, recommended for severely below ideal body weight

• CBT change automatic thoughts and core beliefs

Bulimia Nervosa Onset, course, duration, outcome

Similar to AN

Onset: adolescence or young adulthood

Course: variable

Duration: 50-70% eventually recover

Outcome:

Bulimia Nervosa Key Symptoms and treatments

Key symptoms

• recurrent episodes of binge eating (where lose control)

• compensatory behaviors to avoid weight gain

• once a week for three months

• Self-evaluations are made based on weight or shape

• disturbance does not occur exclusively during episodes of anorexia

Treatment

• SSRIs/Antidepressants reduce binge eating and purging in BN for short term

• CBT

Major depressive disorder vs ADHD differential diagnosis

• distractibility, academic problems, low frustration tolerance in both

• symptoms are present outside of mood episode?

• Course: chronic vs episodic

Disruptive Mood Dysregulation disorder vs oppositional defiant disorder differential diagnosis

Look for mood in between temper tantrums and who tantrums are directed at

• DMDD - mood is irritable; directed at people and property; more severe

• ODD- mood is euthymic; directed at particular person

Disruptive mood dysregulation disorder vs bipolar disorder differential diagnosis

Look for the course of symptoms

• course in DMDD is chronic

• Course in bipolar disorder is episodic

Bipolar I vs Bipolar II vs Cyclothymic disorder differential diagnosis

Bipolar I

• at least one manic episode

• depressive and hypomanic episode may occur in between

Bipolar II

• at least on HYPOmanic episode AND one depressive episode

Cyclothymia

• milder bipolar. At least 1 year of subthreshold symptoms of hypomania and depression

Specific phobia vs social phobia vs agoraphobia differential diagnosis

specific phobia situational type vs agoraphobia

• if fearful of one situation, specific phobia

• fearful for reason other than panic-like or other incapacitating symptoms - is specific phobia

Tourette’s disorder vs persistent (chronic) motor or vocal tic disorder differential diagnosis

tourettes: multiple motor AND one or more vocal tics

Persistent motor or vocal tic disorder: single or multiple motor OR vocal tics

• not both, need to specify motor tics only or vocal tics only

Anorexia vs Bulimia vs Binge Eating Disorder differential diagnosis

Anorexia - has to be severely underweight (can still engage in binging OR purging)

Bulimia- does not have to be underweight, could turn into anorexia

Binge Eating - not associated with compensatory behaviors,

difference between mood vs affect and the common descriptors

mood: pervasive and sustained emotion that can color perception of the world; typically assessed by asking client

Affect: observable behaviors that express emotions, variable over time in response to changing emotional states; typically assessed by observed behavior

Cognitive and behavioral theories of depression etiology

Behavioral perspective: learned helplessness

• uncontrollable environments are inescapable stimuli that lead to low mood and MDD

Cognitive perspective: negative cognitive schemas

• negative cognitive triad

• automatic thoughts (cognitive distortions)

3 treatments for depression and how to perform them

Interpersonal psychotherapy:

• short-term psychodynamic therapy

• focus on current/past relationships

• limited evidence in children

Cognitive therapy: monitor and identify automatic thought. Replace negative thoughts with more neutral or positive thoughts (healthy thinking team)

Behavioral activation (BA) therapy: increase participation in positively reinforcing activities to disrupt spiral of depression, withdrawal, and avoidance

Key symptoms and why DMDD diagnosis was added to DSM-5

There was nowhere for children with chronic irritability, temper outbursts, biological relative have depression and anxiety,

A). severe, recurrent temper outbursts that are out of proportion

B). temper outbursts are inconsistent with developmental level

C). occur three or more times per week

D). Mood in between outbursts is persistently irritably or angry most of the day, nearly every day, and is noticeable

E). Criteria A-D have been present for 12 months with little remission

F). present in at least two setting (home, school, peers) and severe in at least one of these

G). Diagnosis not made for first time younger than 6 or older than 18

H). age of onset before age 10

I). does not meet criteria for manic or hypomanic episode

J). behaviors not exclusively during MDD and not better accounted for by another disorder

Manic vs Hypomanic episodes

manic

• elevated, expansive, or irritable mood and increased goal directed activity or energy

• cause impairment

hypomanic

• elevated, expansive, or irritable mood, lasting at least 4 days and present for most of the day, nearly every day

• Not severe to cause marked impairment, does not require hospitalization

How are phobia developed and maintained

• phobias develop through classical conditioning (can be observational learning or informational transmission)

• phobias maintained through operant conditioning

  • mostly negative reinforcement (by escaping, remove a negative)

How does extinction relate to the theory of phobia maintenance?

The extinction pathway is NOT avoiding the fear, experiencing the temporary increase in anxiety, and developing an adaptive response.

Panic disorders vs panic attacks

panic attack criteria: abrupt surge of intense that reaches a peak within, four or more physical symptoms occur (cued)

Panic disorder: recurrent, unexpected panic attacks (uncued)

Exposure with response prevention definition and what disorder it treats

Treats OCD

• response prevention: confront fears and reduce escape response

• eventually to decouple CS (thought) - CR (anxiety and compulsion) relationship

Systematic desensitization definition and what disorder it treats

Treats Specific Phobia

Learn relaxation strategies while gradually facing objects of situations they fear.

Graduated/graded exposure definition and what disorder it treats

Treats specific phobia

exposure along hierarchy (exposures start small then build up to the real thing)

Flooding definition and what disorder it treats

Treats specific phobia

• exposure to feared stimuli without relaxation training or without gradual buildup

Interoceptive therapy definition and what disorder it treats

Treat panic disorder

Induces panic attack physiological symptoms to teach individuals to manage the fear associated with panic attacks

Shaping by successive approximations definition and what disorder it treats

treats Selective Mutism

Reinforces approximated desired behavior in order to build up to speaking

Changing maladaptive thoughts (ex cognitive therapy) definition and what disorder it treats

Treats Major Depressive Disorder, Monitor and identify automatic thought and replace negative thoughts with more neutral or positive thoughts

Habit reversal training definition and what disorder it treats

Treats tourette’s

• tic description, identify start of tic

• create competing response

  • tense muscles during a neck or arm motor tic

Risk factors for developing PTSD after a trauma (4)

• Genetic- twin studies put heritability between 23-71%

• Early childhood emotional problems

• childhood trauma

• Childhood adversity

• minority status, IQ, low social support, female gender

How does depression present differently in children?

Mood: irritable

At school: difficulty concentrating, poor grades

Physical problems: headaches, stomachaches

Social withdrawal or neglect of pleasurable activities, appetite changes, lack of interest in appearance, overly clingy

CBT-based etiology of eating disorders

low self-esteem → dieting to feel better about self → food intake is restricted too much → diet is broken → binge → compensatory behaviors to reduce fears of weight gain

Dyssomnias vs parasomnias, examples of each

Dyssomnia: disorders falling and staying asleep

• narcolepsy, insomnia, breathing related sleep disorder

Parasomnias: Behavioral or physiological events intrude on ongoing sleep

• nightmares, sleep terror/sleep walking,

Sleep hygiene activities and the conditioning behind them

based on classical conditioning - bed acting like a neutral stimulus - tools turn bed into CS with CR being falling asleep

• same bed/wake time, every day

• beds are for sleeping only

• bedtime routine

• get out of bed if you can’t sleep

Behavioral treatments for nocturnal enuresis. two kinds, types of conditioning, explain the conditioning

Classical conditioning: Alarm

• bell rings - wake up

• bell rings when you have a full bladder - wake up

• able to wake up when bladder is full

Operant conditioning

• dry bed training - rewards for dry nights

obsession definition

Recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, and cause marked anxiety or distress

• individual attempts to ignore or suppress these, or neutralize them with some other thought or action

compulsions definition

repetitive behaviors or mental acts that they feel driven to perform in response to an obsession

• aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation

double depression definition

Depressive episode during persistent depressive disorder

• poorer long-term outcomes, higher rates of relapse

learned helplessness definition

suggests that uncontrollable environments are inescapable stimuli that lead to low mood and MDD

mixed mood episode/mixed features definition

common presentation of Bipolar in children

• exhibit some symptoms of depression during manic/hypomanic episode or vice-a-versa