Exam II Final Review

Matching Quiz Instructions

• Write answers in your notebook.
• No need to turn this in, just for practice.

Matching Items

1. Acute Stress Disorder
2. Adjustment Disorder
3. Agoraphobia
4. Anorexia Nervosa
5. Childhood Schizophrenia
6. Conversion Disorder
7. Disinhibited Social Engagement Disorder (DSED)
8. Disruptive Mood Dysregulation Disorder
9. Encopresis
10. Enuresis
11. Factitious Disorder
12. Post Traumatic Stress Disorder (PTSD)
13. Somatic Symptom Disorder
14. Selective Mutism
15. Rumination Disorder

Matching Definitions

• a) Development of distressing symptoms, like intrusive memories and heightened arousal after exposure to a traumatic event. Lasts > 1 month. (Acute Stress Disorder)
• b) Lack of control over one’s passage of urine, at an abnormal developmental stage. (Enuresis)
• c) Lack of control of one’s passage of feces, at an abnormal developmental stage. (Encopresis)
• d) Disorder characterized by repeated regurgitation and chewing of food, without actually ingesting it. (Rumination Disorder)
• e) Attachment disorder associated with disturbances in establishing appropriate social boundaries, no “stranger danger.” (DSED)
• f) Development of 1+ unpleasant physical symptoms with no medical root cause. (Somatic Symptom Disorder)
• g) Impaired bodily function with no medical root cause. (Conversion Disorder)
• h) Falsification of symptoms in order to assume a sick role, gain sympathy from others. (Factitious Disorder)
• i) Involves a maladaptive response to an identifiable stressor; symptoms don’t persist 6 months after the stressor is removed. (Adjustment Disorder)
• j) Marked by severe restriction of food, preoccupation with weight gain, and a BMI <17. (Anorexia Nervosa)
• k) An assortment of positive and negative symptoms, including hallucinations and delusions. (Childhood Schizophrenia)
• l) Frequent and severe temper outbursts. (Disruptive Mood Dysregulation Disorder)
• m) Disproportionate fear of being trapped in a situation where help might not be able to arrive (e.g., public transit). (Agoraphobia)
• n) Anxiety disorder characterized by severe restriction of speech in certain settings only. (Selective Mutism)
• o) Exposure to traumatic event, symptoms can last for 3 days to 4 weeks after the event occurs. (PTSD)

Answers

1. Acute Stress Disorder - o
2. Adjustment Disorder - i
3. Agoraphobia - m
4. Anorexia Nervosa - j
5. Childhood Schizophrenia - k
6. Conversion Disorder - g
7. Disinhibited Social Engagement Disorder (DSED) - e
8. Disruptive Mood Dysregulation Disorder - l
9. Encopresis - c
10. Enuresis - b
11. Factitious Disorder - h
12. Post Traumatic Stress Disorder (PTSD) - a
13. Somatic Symptom Disorder - f
14. Selective Mutism - n
15. Rumination Disorder - d

Somatic Symptom and Related Disorders

Somatic Symptom Disorder

Main Features:

• Presence of 1+ somatic symptoms, causing distress/impairment.
• Thoughts and feelings around symptoms or health are excessive, accompanied by excessive anxiety or preoccupation with symptoms.
• Somatic complaints are a common response to environmental stressors in children.

Prevalence/Course:

• Little known about this disorder.
• Females tend to endorse more somatic complaints overall.

Illness Anxiety Disorder

Main Features:

• Incorrect belief that they have a serious illness.
• Experience health anxiety, with serious impairment as a result.

Course:

• Requires medical assessment to rule out medical causes.
• Very little documentation about this disorder overall.

Factitious Disorder

Main Features:

• Feign illness with a desire to be placed in the sick role.
• Distressed if others don’t believe their symptoms and may engage in self-harm.
• Actions are often done to reap the benefits of secondary gain.

Neurodevelopmental Disorders

Attention Deficit Disorder (ADHD)

Three Subtypes:

Study the specific criteria and know them well

1. Hyperactive-Impulsive:
   • a) 6/9 symptoms must be present for diagnosis (excessive fidgeting, squirming, speech, etc.).
   • b) Often results in academic and social difficulties.
2. Inattentive:
   • a) 6/9 symptoms must be present for diagnosis (carelessness, tendency to lose objects, easily distracted, etc.).
   • b) Less likely to be diagnosed, often develops into internalizing disorders.
3. Combined:
   • a) Meet criteria for both hyperactive-impulsive and inattentive.

Prevalence/Course:

• Symptoms must be present before age 12 years.
• Half of cases persist into adolescence.
• Males tend to exhibit hyperactive/impulsive symptoms, whereas females tend to exhibit inattentive symptoms.

Autism Spectrum Disorder (ASD)

Features:

1. Deficits in social communication and interaction.
2. Restricted/repetitive patterns of behavior.
   Study the specific criteria and know them well.

• Symptoms must be present early in development and not explained by Intellectual Disability.

Prevalence/Course:

• Prevalence has drastically increased in recent years.
• There are numerous controversies emerging regarding this increase.
• Primarily diagnosed in males.

Intellectual Disability

Core Features:

• Substantial limitations in functioning, indicated by low intellectual functioning (IQ <70).
• Deficits in adaptive functioning, including academic, social, and practical domains.
• Age of onset must be before age 18.
• Not classified as a mental disorder but as a “state of functioning.”

Prevalence/Course:

• More common in males.
• Higher likelihood of comorbidity with ADHD, ASD, anxiety, impulse control, etc.
• Down syndrome is one of the most commonly recognized causes.

Specific Learning Disabilities

• Dyslexia: Deficit in reading.
• Dysgraphia: Deficit in writing.
• Dyscalculia: Deficit in math.
• Nonverbal Learning Disability: Visuospatial deficit.
• Dyspraxia or Developmental Coordination Disorder (DCD): Deficit in fine/gross motor skills.

Prevalence/Course:

• 5-15% of school-aged children are diagnosed.
• Dyslexia is the most common learning disability.
• Early intervention can significantly promote more adaptive functioning.

Schizophrenia Spectrum

Childhood Schizophrenia

Main Features:

• Positive Symptoms: Hallucinations, delusions, disorganized speech/behavior, catatonia.
• Negative Symptoms: Flat affect, alogia, avolition.
• May also manifest as awkwardness, delayed milestones, peculiar posture/physical presentation, cognitive deficits, and emotional/social impairment.

Prevalence/Course:

• Prevalence in children is not well established, making it considered very rare.
• Onset typically occurs during late adolescence or early adulthood.

Bipolar Disorder

Bipolar Disorder Features:

• Characterized by oscillating manic and major depressive episodes.
• Has a strong genetic component.

Prevalence/Course:

• Childhood-onset Bipolar Disorder can be chronic with rapid-cycling features.
• More rapid mood shifts and sleep difficulties commonly present.
• Equal prevalence among both sexes.

Depressive Disorders

Major Depressive Disorder (MDD) vs. Persistent Depressive Disorder (PDD)

Main Features of MDD:

• Symptoms include depressed mood, anhedonia, sleep difficulties, and appetite disturbances.
• In childhood, may present as irritability.
• Criteria requires symptoms to last at least 2 weeks.

Main Features of PDD:

• Chronic depression for most of the day, more days than not for at least 2 years (1 year for children).
• Symptoms may consistently present as irritability in children.

Prevalence/Course:

• Affects about 5% of the general population, with rates doubling during adolescence.
• Equal prevalence in childhood, with increased incidence in females during adolescence.

Disruptive Mood Dysregulation Disorder (DMDD)

Main Features:

• Characterized by severe and persistent irritability.
• Frequent and severe temper outbursts occurring 3+ times a week.
• Onset likely after age 6 and before age 10.
• Must differentiate from mania/bipolar disorder.

Anxiety Disorders

Generalized Anxiety Disorder

Main Features:

• Symptoms of anxiety are pervasive (lasting 6 months or more) with no identifiable source.
• Must cause impairment in life functioning.
• Symptoms include inability to relax and an excessive need for reassurance.

Prevalence/Course:

• Generally favorable results with treatment, including Cognitive Behavioral Therapy (CBT) and medication.

Agoraphobia

Main Features:

• Excessive fear/anxiety regarding anticipation of 2+ situations, such as:
  1. Open, public spaces.
  2. Enclosed spaces.
  3. Standing in lines.
  4. Being out of the home alone.

Prevalence/Course:

• More common in females.
• Mean onset is around 17 years of age.
• Has a significant genetic contribution, higher than all other specific phobias.

Panic Disorder

Features:

• Characterized by unexpected and recurrent panic attacks.
• Panic attacks are brief episodes that can include:
  • Heart palpitations.
  • Sweating.
  • Trembling/shaking.
  • Fear of death.
  • Sensations of choking.
  • Chest pain.

Prevalence/Course:

• Typically has an onset during late adolescence or early adulthood.

Social Anxiety Disorder

Main Features:

• Pervasive fear of negative evaluation or humiliation in social situations, leading to avoidance.
• Symptoms must be exaggerated, persistent, and impairing.
• Symptoms must occur in peer settings, not just with adults, and last at least 6 months.

Prevalence & Course:

• Lifetime prevalence ranges from 3-13%.
• Median age of onset is around 13 years.
• There is a genetic link, and it is equally prevalent in both sexes.

Specific Phobia

Main Features:

• Persistent, disproportionate fear of an object/place without reasonable basis.
• Must occur for longer than 6 months.
• Avoidance is common, and exposure can trigger a physiological response.

Prevalence/Course:

• Typically develops in early childhood (ages 7-11).
• Not often diagnosed in children due to common fears that usually don’t lead to functional impairments.

Obsessive-Compulsive & Related Disorders

Obsessive-Compulsive Disorder (OCD)

Main Features:

• Previously categorized as an anxiety disorder.
• Involves the presence of:
  1. Obsessions: Persistent, intrusive, unwanted thoughts or urges that the person cannot control.
  2. Compulsions: Ritualistic behaviors aimed at reducing the anxiety caused by the obsessions.

Prevalence/Course:

• High comorbidity with other disorders.
• Common issues include family conflicts, social withdrawal, and poor school performance.
• Prevalence is roughly 1% of the population, with a higher occurrence in males.

Trauma and Stressor-Related Disorders

Post-Traumatic Stress Disorder (PTSD)/Acute Stress Disorder

Development of Symptoms:

• Symptoms develop after exposure to one or more traumatic events, involving:
  • Actual or threatened death.
  • Serious injury.
  • Sexual violence.
• Symptoms may arise from either direct personal experience or witnessing the traumatic event.
• Symptoms must persist for at least 1 month (if symptoms last less than 3 days, it is categorized as Acute Stress Disorder).

Symptoms include:

• Intrusive symptoms (e.g., flashbacks).
• Avoidance behaviors.
• Negative thoughts/mood.
• Arousal/hyperreactivity.

Prevalence/Course:

• Affects approximately 8% of adults and 6.3% of adolescents.
• In preschool-aged children, symptoms can manifest as hyperarousal, fear, enuresis, and separation anxiety.
• School-aged children may experience nightmares, sleepwalking, and attention problems.

Adjustment Disorder

Definition:

• Psychological response to an identifiable stressor resulting in distressing emotional and behavioral reactions.
• Symptoms arise within 3 months of the stressful situation and do not last longer than 6 months after the stressor has been removed.

Prevalence/Course:

• Females are twice as likely to be diagnosed.
• Common stressors include school-related changes, familial stressors, and other environmental stressors.

Conversion Disorder

Main Features:

• Involves impaired motor/sensory function without a medical basis to explain the symptoms.

Prevalence/Course:

• More closely related to environmental stressors than to genetic factors.
• Symptoms often arise following family illnesses or stress.

Reactive Attachment Disorder (RAD)/Disinhibited Social Engagement Disorder (DSED)

Reactive Attachment Disorder (RAD):

• Characterized by significant inhibition and withdrawn behavior towards caregivers in two ways:
  1. Children do not seek comfort from caregivers when distressed.
  2. They are unable to be comforted when distressed.
• Show little ability to respond appropriately to others.
• Symptoms must be evident before age 5 and cannot be explained by Autism Spectrum Disorder (ASD).

Disinhibited Social Engagement Disorder (DSED):

• Demonstrate behaviors such as:
  1. Minimal discretion in approaching or interacting with strangers, often becoming overly familiar.
  2. Minimal checking back with caregivers in unfamiliar settings.
  3. Tendencies to wander off with random adults.
• Symptoms must be present for more than 12 months and not explained by Attention Deficit Hyperactivity Disorder (ADHD).

Feeding and Eating Disorders

Anorexia Nervosa

Main Features:

• Refusal to maintain a minimum body weight (BMI >17).
• Intense fear of weight gain.
• Distorted perception of weight/shape.

Subtypes:

1. Restricting type.
2. Binge-Purge type.

Prevalence/Course:

• Primarily diagnosed in women.
• Rare occurrence (0.9% of female adolescents).
• Highest mortality rate (5-10%) attributable to electrolyte imbalances; 50% do not fully recover.

Bulimia Nervosa

Main Features:

• Involves a recurrent cycle of binge-eating and purging.
• Binge-eating and compensatory behaviors occur at least once a week for 3 months.
• Typically individuals present within the normal BMI range, distinguishing it from Anorexia Nervosa.

Prevalence/Course:

• Can result in various physical symptoms (e.g., fatigue, puffy cheeks, loss of dental enamel, etc.).
• Prognosis is generally better than Anorexia Nervosa, with 50-75% showing full recovery.
• Typically has an onset during adolescence.

Distinguishing Features of Anorexia Nervosa and Bulimia Nervosa

Shared Features:

• Both disorders include a preoccupation with being thin, with food, and a fear of becoming obese, along with a distorted sense of body shape and weight.

Anorexia Nervosa Specifics:

• The major defining feature is the success in refusing to maintain a normal body weight (15% below what is considered normal or a BMI < 17.5).
• Fear of weight gain is often severe, leading to potentially fatal outcomes.

Bulimia Nervosa Specifics:

• The bulimic cycle characteristic involves binge eating followed by compensatory methods to prevent weight gain.
• Diagnostic criteria require recurrent episodes of binge-eating and subsequent use of compensatory strategies, with occurrences of at least twice a week for three months.
• Two subtypes include:
  • Purging type (self-induced vomiting, laxatives, diuretics, enemas).
  • Non-purging type (fasting, excessive exercise).

Pica

Main Features:

• Involves the consumption of non-nutritive foreign objects for at least a month.
• Often comorbid with Autism Spectrum Disorder and Intellectual Disability.

Prevalence/Course:

• Ranges from 2-22% in various populations.
• Origins remain unclear; behavioral interventions are typically most effective.

Rumination Disorder

Main Features:

• Characterized by repeated regurgitation and rechewing of food, which is self-induced and pleasurable.

Prevalence/Course:

• As many as 25% of infants with Rumination Disorder may die if untreated.
• Onset typically occurs between 3-12 months of age, and males seem to have a higher prevalence.

Elimination Disorders

Encopresis

Main Features:

• Involves passing stool in inappropriate locations instead of the toilet at least once a month, ongoing for a minimum of 3 months.
• Child must be at least 4 years old, and there should be no medical explanation for the behavior.

Enuresis

Main Features:

• Characterized by urination in inappropriate situations other than the toilet.
• Symptoms may include excessive straining without any identifiable medical cause.

Disruptive, Impulse-Control, and Conduct Disorders

Conduct Disorder

Main Features:

• Involves a repetitive and persistent behavioral pattern that violates social norms or the rights of others, including:
  1. Acts of aggression toward others and animals.
  2. Destruction of property.
  3. Deceit or theft.
  4. Rule violations.

Prevalence:

• More common in males.
• An earlier onset is correlated with worse outcomes.
• Can serve as a precursor to Antisocial Personality Disorder.

Oppositional Defiant Disorder (ODD)

Required Symptoms (4 out of 8):

1. Anger & Irritability:
   • Loss of temper.
   • Touchiness.
   • Feelings of anger and resentment.
2. Argumentative/Defiant Behavior:
   • Argumentative with authority figures.
   • Defiance and noncompliance.
   • Deliberately annoying others.
   • Blaming others for misdeeds or problems.
3. Vindictiveness:
   • Spiteful or vindictive actions.

Important Considerations:

• Must be diagnosed before the age of 18.
• Developmental stage is crucial for diagnosis.

Course/Prevalence:

• More prevalent in males than females before puberty; rates tend to equalize during adolescence.
• Often comorbid with ADHD.

Additional Topics for Exam Preparation

Diagnostic Terms

• Diagnosis: The process of assigning an individual to a category of classification.
• Comorbidity: Occurs when two or more disorders exist together.
• Differential Diagnosis: Clinicians decide between two or more potential diagnoses based on assessment findings.
• Provisional Diagnosis: A tentative diagnosis resulting from time constraints or other limitations.
• Rule-out: A diagnosis that a clinician believes fits certain symptoms but requires further assessment to confirm.
• Deferred: A situation in which the clinician lacks confidence to provide an official diagnosis.

Biopsychosocial Model

• A holistic approach incorporating biological, psychological, and social factors in understanding mental health disorders.