AP EXAM 2 :)

bella use this one for abnormal

Steps in Diagnosis

1. Ruling out Malingering and Factitious Disorder

2. Ruling out substance etiology

3. Ruling out an etiological medical condition

4. Determining primary disorder

5. Differentiating Adjustment Disorder from the residual Other Specified and Unspecified conditions

6. Establishing the boundary with no mental disorder

Malingering

• Exaggerate or make-up symptoms

• “what can i get?”

External gain of Malingering

1. Insurance fraud or other form of financial gain

2. To get time off work

3. To get prescriptions for controlled medications

4. Shirking obligations for military service

5. Reducing work obligations

6. An attempt to avoid prison time

Secondary gain

• Being worse by chance.

•  The external rewards that come afterward (attention, help, avoidance of duties). 

Factitious Disorder

• A mental illness classified as a somatic symptom disorder

• the individual exaggerates or lies about having medical or psychiatric symptoms

• “please take care of me”

Munchausen Syndrome

• Factitious disorder

• where individuals induce illness in themselves.

Munchausen by Proxy

• Factitious Disorder

• Where an individual, typically a caregiver, induces illness in another person (usually a child).

Someone with a history of seeking treatment at multiple places is more likely to have

factitious disorder

People with a long and/or dramatic medical history are more likely to have

factitious disorder

Someone with antisocial personality disorder is more likely a

malingerer

If a lawyer is involved early in the diagnostic process, the person is likely

malingering

Somatoform Disorder

• feel very real to the patient but are often imagined, especially when they are unable to be diagnosed.

• OCD is not one of them. 

• An individual who experiences neurotic behavior may be prone to developing this disorder. 

• Individuals suffering from this disorders often see several doctors about their symptoms because they are looking to find a doctor to give them a diagnosis.

Impaired Control (substance use disorder)

• Using the substance in larger amounts or for longer periods than intended.

• Having a persistent desire or unsuccessful attempts to cut down or control use.

• Spending a lot of time obtaining, using, or recovering from the substance.

• Feeling cravings or strong urges to use.

Social Impairment

• Failure to meet major obligations at work, school, or home because of use.

• Continuing use despite having social or relationship problems caused or worsened by it.

• Withdrawing from activities—less time spent with friends, hobbies, or work due to substance use.

Risky Use: 

• Using the substance in situations where it’s physically dangerous (ex: driving)

• Continuing to use despite knowing it’s causing or worsening physical or psychological problems.

Tolerance

Needing more of the substance to get the same effect.

Withdrawal 

Experiencing physical or mental symptoms when use stops or decreases.

Any substance use in past 12 months?

• No → Nonuser

• Yes → User

Dependence Symptoms (3+ is a Dependence Diagnosis)

(0-2 check for abuse symptoms)

• Tolerance

• Withdrawal

• Using more/longer than intended

• Can’t cut down

• Lots of time spent using

• Gives up activities

• Keeps using despite problems

:

Abuse Symptoms (1+ = Abuse Diagnosis)

No Dependence and No abuse = No Diagnosis

• Fails responsibilities (work/school/home)

• Uses in dangerous situations

• Legal problems

• Keeps using despite social issues

Brain Based Issues That Can Interfere with Proper Diagnosis: 

1. Availability Bias 

2. Confirmation Bias

3. Cognitive Laziness

4. Complicated Cases

5. Lack of knowledge/Jumping to Conclusions

Availability Bias

• when we judge how likely something is based on how easily we can think of examples.

• If something comes to mind quickly, we assume it’s common or important even if it’s not.

• Ex: After learning about schizophrenia, you might start thinking you notice “signs” of it in lots of people, just because that information is fresh in your mind

Confirmation Bias

• only look for or remember information that supports what we already believe

• ignore evidence that contradicts it.

• “confirm” our own opinions instead of looking at all sides fairly.

• Ex: If a therapist thinks a client has depression, they might focus on signs of sadness and overlook signs of anxiety, seeing only what fits their first idea.

Medical Diagnoses That Appear Psychological:

1. Thyroid Disorders: Depression, Cognitive slowing, Anxiety 

2. Vitamin B12 Deficiency: Cognitive Impairment, Memory Loss, Depression, Psychosis

3. Hyponatremia: Confusion, Cognitive Dysfunction. Delirium (low blood levels)

4. Systemic Infections: Acute confusion, Delirium (infection that spreads through blood stream or affects whole body)

5. Intracranial mass: Personality changes, cognitive decline

Cardinal Signs

• key or defining feature of a disorder the main symptom(s) that strongly suggest a particular diagnosis.

Depression cardinal signs are persistent

sad mood and loss of interest or pleasure.

Schizophrenia cardinal signs include

delusions, hallucinations, or disorganized thinking

Mania

a distinct period of elevated or irritable mood and increased energy/activity.

Neurodevelopment Disorders

a group of conditions that affect brain development and function, typically manifesting in childhood or adolescence

• Poor school performance

• Behavioral problems in a child or adolescent

• Speech disturbance

• distractibility

Intellectual Disability

• Deficits in intellectual functioning

• Deficits in adaptive functioning and failure to meet standards for personal independence and social responsibility.

Language Disorder

Difficulties in acquisition and use of language

Speech Sound Disorder

• Difficulty with speech sound production that interferes with speech intelligibility

• prevents verbal communication

The Steps

1. Referral Question

2. Current Complaints

3. Relevant History 

4. Behavioral Observations 

5. Testing 

6. Diagnosis 

Continuous Performance Test: Go/Nogo

• measure impulse control and attention

• Tests ability to inhibit a response to stop yourself from acting automatically

• Used study self-control, impulsivity, ADHD. 

DSM 5- TR Criterion

• Inattention: Are there 6 or more symptoms of being inattentive?

• Hyperactivity/Impulsivity: Are there 6 or more symptoms of being hyperactive or impulsive?

• Early Start: Did symptoms start before age 12?

• Multiple Settings: Do symptoms appear in 2 or more places (home, school, work, etc.)?

• impact on Life: Do the symptoms interfere with daily life or functioning?

• Rule Out Other Causes: Are the symptoms not better explained by schizophrenia or another mental disorder (like mood, anxiety, dissociative, or personality disorders)

Autism Spectrum Disorders (ASD)

• the presence of profound difficulties in social interaction & communication

• combined with the presence of repetitive or restricted interests, congintions, and behaviors

• The diagnostic process involves a combination of parental report and clinical observatio

ASD Facts:

• emerges in the first 3 years and persists 

• No biological test for it

• Characterized by substantial heterogenity (which makes research difficult) within and btwn indvs. 

• Not a single entity a range of “autisms”

• “spectrum” reflects in how much (continuous) and in what kind (qualitative) of differences can exist together in any person.

• females more severely affected

• different in girls than boys

Core Features of ASD

• deficits in social-emotional reciprocity 

• deficits in non verbal communicative behaviors used social interaction 

• deficits in developing, maintaining, and understanding

Core Features of ASD 2 (requires 2 of 4)

• Repeating things over and over: This could be moving your body the same way, repeating words, or always using objects in the same exact way.

• Needing things to stay the same: You get upset if routines change or if things aren’t exactly how you expect them.

• Super focused interests: You might be obsessed with one topic or activity more than usual, way beyond what most people do.

• Unusual reactions to senses: You might overreact or barely react to things you see, hear, touch, taste, or smell—or you might be super interested in certain textures, lights, or sounds

Unusual Interests Related to ASD

• lines up toys 

• plays with toys the same way everytime 

• likes parts of objects

• organized

• upset by minor changes

• obsessive interests 

• has to follow certain routines

• flaps hands, rocks body, or spins self in circles 

Social Issues Related to ASD

• not respond to name by 12 months 

• avoids eye contact 

• prefers to play alone 

• does not share interests with others 

• only interacts to achieve a desired goal 

• Falt facial expressions 

• not understand boundaries 

• avoids physical eye contact 

• not comforted by others during distress

• trouble understanding others feeling’s or talking about own feelings 

Echolalia

repeats words or phrases over and over 

Rett Syndrome

• profound intellectual disability disorder

• caused by a change in a gene called MECP2.

• gene helps the brain make and control important protein

• When it doesn’t work right, the brain can’t grow or communicate normally

• People with this syndrome often have trouble with movement, learning, and social skills

Fragile X Syndrome

• gene mutation that is the most common hereditary cause of developmental disabilities in all populations

• commonly diagnosed with ADHD and autism. 

Angel’smann Syndrome

• targets the bodies' nervous system specifically

• Genetic disorder.

• No Cure, Seizures, Very happy demeanor,

• fascination of water, delayed development, hand-flapping movements

• severe speech impairment, and short attention span. 

Gold Standard: ADOS

• Autism Diagnostic Observation Schedule

• Diagnostic test not just a screening

• done by trained professional who observes and interacts with person directly

• communication & social skills

• behaviors through structured activities

M-Chat R

• Modified Checklist for Autism in Toddlers.

• Screening tool not a diagnosis

• short questionaries parents fill out

ADHD

• psychiatric disorder

• diagnosed in school-aged children

• goal of clinicians is to identify the nature and cause (impt. step to guiding to a decision making)

• affects 3% to 7% of children

• 65% will continue to experience as adults

• Has 2 Clusters: Hyperactivity/impulsivity and Inattention -

• (more common in boys)

• Was belived children “matured out” by the time they are adults 

• 4.4% adults meet criteria and majority not receiving treatment 

• specific genes have been associated sereotinin & dopamine 

• POOR PARENTING MAJOR CAUSE 

• caused by genentics and environmental factors

Dopamine

A neurotransmitter in the brain that is thought to play an important role in 

Schizophrenia

• psychotic disorder that is the most impairing forms of psychopathology

• frequently associated with a profound negative effect on the individual’s educational, occupational, and social function

Schizophrenia Symptoms & Diagnostic Criterion A:

2 or more of the following

each present for 1 month period

one symptom must be 1-3

1. Dellusions

2. Hallucinations 

3. Disorganized speech (derailment or incoherence)

4. Grossly disorganized or catatonic behavior 

Negative symptoms of Schizophrenia 

• diminished emotional expression

• catatonia: staying frozen in one position for a long time, repeating movements, or resisting instructions

• anhedonia: Inability to feel pleasure, things that used to make them happy no longer do

• amotivation: Lack of drive or interest in pursuing goals.

• blunted affect

• alogia : speaking very little or giving short, empty answers. not shyness, but mental slowing or lack of thought content.

Schizophrenia Symptoms & Diagnostic Criterion B:

• since the illness began, the person’s ability to function in work, school, relationships, or self-care has clearly gotten worse

• If the person was a child or teen when symptoms started, they may not have reached the normal level of functioning expected for their age.

Schizophrenia Symptoms & Diagnostic Criterion C:

• symptoms must last for at least 6 months total

• at least 1 month of active symptoms (H,D DSP)

• include earlier or later stages when symptoms are milder—like unusual thoughts or a lack of motivation or emotion.

Catatonia

• Behaviors that reflects a reduction in responsiveness to the external environment

• include holding unusual postures for long periods of time

• failing to respond to verbal or motor prompts from another person

• excessive and seemingly purposeless motor activity.

Anhedonia/amotivation

A reduction in the drive or ability to take the steps or engage in actions necessary to obtain the potentially positive outcome.

Delusions

• False beliefs that are often fixed,

• hard to change even in the presence of conflicting information,

• culturally influenced in their content.

Types of Delusions

• They can be influenced by culture — for example, involving Jesus in Christian cultures or Allah in Muslim cultures.

• They can be very frightening for the person experiencing them.

• presence of one or more delusions of 1 month or longer

• criterion for schizophrenia has never been met 

Persecutory delusions

• Believing people or groups are out to harm

• spy on you

Grandiose Delusions

• Believing you have special powers

• are someone very important (like “I’m a famous musician” or “I’m chosen by God”).

Referential Delusions

Believing random events or objects are meant just for you

Control/ Mind-related Delusions

• Believing others can control your thoughts

• read your mindor

• your thoughts are being broadcast out loud

Hallucinations

• Perceptual experiences that occur even when there is no stimulus in the outside world generating the experiences

• can be auditory, visual, olfactory (smell), gustatory (taste), or somatic (touch).

• most common is hearing voices

• inside or outside head

• sometimes can be experienced the same as the person’s inner thoughts or speech 

Genetic Syndromes and ASD

• Some genetic conditions (caused by changes in a single gene)

• can make a person more likely to have autism.

• Around 1 in 5 children (20%) with autism also have a known genetic disorder.

• can happen because parts of DNA are missing 

• extra genes are “spelled wrong

• or the body has certain chemical imbalances

4  Major Dopaminergetric Pathways: 

1. Mesolimbic: wanting, liking reward, regulation of emotional behavior 

2. Mesocortical: cognition and executive functioning (thinking and reasoning) 

3. Nigrostriatal: motor functioning, learning 

4. Tuberoinfundibular: regulation of prolactin secretion (dopamine acts like a brake/ blocking pathway)

negative:

• hypodopamingeric

• alogia, affective flattening, avolition

• Shortage of dopamine in the mesocortical pathway.

• Increasing dopamine would be therapeutic 

postive

• hyperdopaminergic

• delusions, hallucinations, disorganized thought, speech, behavior

• Caused by excess of dopamine in meso pathway.

• Decreasing dopamine would be theraputic

2 Anti-Psychotic Medications

1. Typical (older)

2. Atypical (newer)

Typical

• Work by blocking dopamine (D2) receptors in the brain.

• Help with positive symptoms like hallucinations, delusions, and disorganized speech.

• Don’t really help with negative symptoms like:

• lack of emotion or motivation/ thinking problems.

• cause motor side effects

• like stiffness, tremors, or restlessness

Atypical

• affect more than one kind of brain receptor

• though they still impact dopamine.

• Cause fewer movement problems, but they’re not always more effective for schizophrenia overall.

• Can cause metabolic side effects

• Weight gain, Higher risk for heart disease, Type 2 diabetes

• Increased risk of early death

4 DS

Deviance, Distress, Dysfunction, and Danger.

Person-First Language

• Emphasizes the individual first rather than the disorder

• to promote empathy and respect in discussing disabilities.

Rorschach Test

• projective test using inkblots to assess personality and emotional functioning

MMPI-3

• Minnesota Multiphasic Personality Inventory

• true or false questions based of numerical scores

• linked to mental health symptoms and personality traits

• depression & anxiety

• Objective Test 

 Delirium

• sudden and quick change in a person's attention and awareness.

• develops over a short time 

• problems with memory, disorientation (not knowing where you are), language, visual skills, how a person perceives things.

• SHOULD NOT be confused with other medical conditions.

Causes of Delirium (PINCHE ME)

1. Pain

2. Infection

3. Nutrition problems

4. Constipation

5. Hydration issues (not enough fluids)

6. Environment (changes or stressors)

7. Medications (side effects or interactions)

8. Electrolyte Imbalance (unbalanced chemicals in the body)

Dementia

• Major Neurocognitive Disorder

• primarily means a significant decline in different brain abilities like memory, thinking, speech, and understanding space and time

• changes in emotions and behavior,

• making daily tasks harder.

Mini-Cog

• objective test used to check for dementia and cognitive functioning over time such as the MMSE. It involves two parts 

1. Delayed three-word recall test: The person is asked to remember three words and recall them later.

2. Clock drawing test: The person is asked to draw a clock showing a specific time (ex: 10 minutes past 11).

Vascular Dementia

reduce blood flow & strokes

Lewy Body Dementia

• protein clumps in brain

• movement issues and hallucinations 

Frontatemporal Demential

• affects front and side brain

• personality and behavior changes 

• (not memory) 

Wernicke-Korsakoff’s

• Lack of vitamin B1 (thamine)

• heavy alchohol use which leads to memory loss

Parkisons Diease

• movement disorder from loss of brain cells

• affects memory later

Thyroid disease

• thyroid is too slow

• so is brain and body 

• reversible

• memory and thinking problems can go away.  

Beta-amyloid plaques

• are harmful clumps that form in the brain in Alzheimer's Disease

• A protein called Amyloid Precursor Protein (APP) normally sits in the neuron (brain cell) membrane.

• Special enzymes cut the APP into smaller pieces, one of which is called beta-amyloid.

• These types of pieces then stick together and form sticky plaques. These plaques get in the way of normal brain cell function, especially in important memory and thinking areas like the hippocampus and cerebral cortex.

Delirium Signs

1. affect attention and awareness

2. actue illness, meds, recreational drugs

3. reversible 

4. medical emergency 

5. sudden onset 

6. alerted mental status 

7. age- independent 

Dementia Signs

1. affects memory and congitive functions 

2. anatomic changes in brain, slower onset 

3. irreversible 

4. results from brain disorders 

5. altered mental status 

6. cognitive decline 

Dorothea Dix

• worked to change the negative perceptions of people with mental illness

• helped create institutions where they could receive compassionate care

• advocated for the establishment of state hospitals.

• Between 1840 and1880, she helped establish over 30 mental institutions in the US and Canada

Benjamin Rush

• the somatogenic theory of mental illness

• promoted especially by the father of America psychiatry

Thomas Szasz

• psychiatrist known for his critical views on the concept of mental illness

• often arguing that 'mental illness' is a metaphor rather than a disease.

Coprolalia

Potty Mouth

Involuntary and Compulsive

inappropriate remarks.

Orientation

• Who you Are

• Where you Are

• Time

• Situation

“Schizo”

Spilt from reality

Adjustment Disorder

Having trouble coping with new life situation

Personality Disorders

• Schizoid

• schizotypal

Psychotic Disorders

• Schizophreniform,

• Schizoaffective

• Schizophrenia 

• Major Depressive Disorders, w/ Psych. Features 

Schizoid Personality Disorder  

• no interests in relationships/ not want them 

• seclusive to self 

• “Loner”

• Works night time jobs

Schizotypal Personality Disorder

• eccentric, magical thinking 

• odd beleifs

• aloof, dresses weirdly 

• malignant 

Brief Psychotic Time Line

0-1 months of symptoms 

Schizophreniform Time Line

 1-6 months of symptoms