Disorders

Study Notes on Behavioral Health Disorders, Treatments, Therapies & Services

Overview

  • This study guide is designed for the HOSA SQE Behavioral Health Exam, covering various mental health disorders, their definitions, causes, symptoms, treatments, and professional involvements based on CDC, NIMH, and SAMHSA sources.

General Topics

  • Major Disorders

  • Treatments and Therapies

  • Key Professionals Involved

  • Diagnostic Codes (DSM-5 and ICD-10)

  • Symptoms and Co-occurring Conditions

Autism Spectrum Disorder (ASD)

Definition

  • ASD: A neurodevelopmental disorder characterized by:

    • Persistent deficits in social communication and social interaction

    • Restricted, repetitive patterns of behavior, interests, or activities

    • Symptoms typically develop in early childhood but may be recognized later.

    • Spectrum: Variation exists in severity, abilities, and support needs.

Causes & Risk Factors

  1. Genetic Factors

    • Strong heritability

    • Increased likelihood with siblings who have ASD

    • Associated conditions: Fragile X syndrome, among others.

  2. Environmental Factors

    • Advanced parental age

    • Low birth weight or prematurity

    • Pregnancy complications

    • Prenatal exposures (e.g., valproic acid)

    • Vaccination: No evidence links vaccines to autism. (CDC)

  3. Brain Development Differences

    • Early brain overgrowth

    • Atypical neural connectivity affecting social communication areas.

Core Symptoms

  1. Social Communication Deficits

    • Reduced eye contact

    • Difficulty understanding social cues

    • Challenges in conversation and relationships

  2. Repetitive & Restricted Behaviors

    • Repetitive movements (e.g., hand flapping)

    • Insistence on routines

    • Sensory processing differences

Co-occurring Conditions

  • ADHD

  • Anxiety disorders

  • Depression

  • Intellectual disabilities (in some instances)

  • Epilepsy/seizure disorders

  • GI problems

  • Sleep disturbances

Screening & Diagnosis

Diagnostic Tools:

  • M-CHAT-R/F (Modified Checklist for Autism in Toddlers)

  • ASQ (Ages and Stages Questionnaire)

Professionals Diagnosing:

  • Developmental pediatricians, child psychologists, psychiatrists, neurologists, clinical psychologists.

DSM-5 Category & Codes

  • Category: Neurodevelopmental Disorders

    • DSM-5 Code: 299.00

    • ICD-10 Code: F84.0

  • Severity Levels:

    • Level 1: Requiring support

    • Level 2: Requiring substantial support

    • Level 3: Requires very substantial support.

Treatment (Evidence-Based)

  1. Behavioral & Developmental Interventions

    • Applied Behavior Analysis (ABA): Gold standard of therapy.

    • Early Start Denver Model (ESDM): For toddlers.

    • Speech-language therapy, occupational therapy, social skills training.

  2. Educational Services

    • Individualized Education Programs (IEPs).

    • Special education supports.

  3. Medications: Address irritability, anxiety, ADHD symptoms.

    • IRRITABILITY: Risperidone, Aripiprazole.

  4. Family Support Services

    • Parent training programs, respite services, case management.

Professionals Involved in Treatment

  • Child psychologists, developmental pediatricians, psychiatrists, neurologists, therapy support staff, education professionals.

  • Key roles: ABA therapists, speech-language pathologists, occupational therapists, special education teachers, and social workers.

Key Facts for SQE

  • ASD is diagnosed based on DSM-5 criteria.

  • Early intervention is crucial for improving outcomes.

  • ABA is widely utilized and evidence-based.

  • Vaccines do not cause autism.

Attention-Deficit/Hyperactivity Disorder (ADHD)

Definition

  • ADHD: A neurodevelopmental disorder characterized by:

    • Patterns of inattention and/or hyperactivity-impulsivity affecting functioning.

    • Symptoms must be present before age 12 and occur in multiple settings (home, school, etc.).

Types (DSM-5 Presentations)

  1. Predominantly Inattentive Presentation

  2. Predominantly Hyperactive-Impulsive Presentation

  3. Combined Presentation

Causes & Risk Factors

  1. Genetic Factors

    • High heritability; first-degree relatives increase risk.

  2. Brain Development Differences:

    • Related to attention, impulse control, and executive functioning networks.

  3. Environmental Risk Factors:

    • Prenatal exposure to toxins (e.g., alcohol, tobacco).

    • Low birth weight and brain injury (less common).

Core Symptoms

  1. Inattention

    • Difficulty maintaining attention

    • Careless mistakes and forgetfulness

    • Easily distracted.

  2. Hyperactivity:

    • Fidgeting and excessive movement

    • Difficulty remaining seated

    • “On the go” behavior.

  3. Impulsivity:

    • Interrupting others

    • Difficulty waiting for one's turn.

Co-Occurring Conditions

  • Learning disabilities

  • Anxiety disorders

  • Depression

  • Substance use disorders in adolescence/adulthood.

Diagnosis

ADHD diagnosis involves:

  • Clinical interviews, symptom checklists, behavioral observations, report collection from parents/teachers.

  • Professionals: Psychiatrists, psychologists, pediatricians.

DSM-5 Category & Codes

  • Category: Neurodevelopmental Disorders

    • DSM-5 Codes: 314.00 (Inattentive) / 314.01 (Combined)

    • ICD-10 Codes: F90.0-F90.9

Treatment (Evidence-Based & Highly Testable)

  1. Medications

    • Stimulants (first-line): Methylphenidate, Amphetamines.

    • Non-Stimulants: Atomoxetine, Guanfacine, Clonidine.

  2. Behavioral Therapy

    • Primarily for children under 12.

    • Parent training in behavior management, behavior modification programs, difficult to manage tasks.

  3. School/Educational Support

    • Accommodations like IEPs/504 Plans.

  4. Psychotherapy:

    • CBT for emotional regulation.

    • Social skills training.

  5. Family & Community Support

    • Case management, family education, peer support.

Professionals Involved

  • Diagnosis & Medication: Psychiatrists, psychologists; Pediatricians; Nurse practitioners.

  • Behavioral Treatment: Psychologists, therapists, school counselors, special education teachers.

Consequences if Untreated

  • Academic difficulties, behavioral issues, substance misuse, impaired relationships.

Key Facts Likely on SQE

  • Symptoms must start before age 12.

  • Diagnosis utilizes DSM-5 criteria, not blood tests or scans.

  • Stimulants are the most effective treatments, with CBT essential for young children.

Schizophrenia

Definition

  • Schizophrenia: A chronic, severe mental disorder affecting:

    • Thinking, perception, emotions, and behavior.

    • Involves psychosis, impairing reality distinction.

    • Symptoms often begin in late adolescence or early adulthood.

Causes & Risk Factors

  1. Genetic Factors

    • Strong hereditary link; higher risk with a family history.

  2. Brain Structure & Chemistry Differences

    • Abnormalities in dopamine pathways.

    • Differences in brain volume and cortical thickness.

  3. Environmental Factors

    • Complications at birth, prenatal malnutrition, stress, substance use (cannabis).

Core Symptoms (DSM-5)

Diagnosis requires two or more symptoms for at least 1 month:

  1. Positive Symptoms

    • Hallucinations (often auditory)

    • Delusions (firm false beliefs)

    • Disorganized speech/behavior.

  2. Negative Symptoms

    • Flat affect, reduced speech, lack of motivation, social withdrawal.

  3. Cognitive Symptoms

    • Impairments in executive functioning, focusing, and working memory.

Related Psychotic Disorders

  • Schizoaffective disorder, Schizophreniform disorder, Brief psychotic disorder.

DSM-5 Category & Codes

  • Category: Schizophrenia Spectrum and Other Psychotic Disorders

  • DSM-5 Code: 295.90

  • ICD-10 Code: F20.9

Diagnosis

  • Conducted by licensed mental health professionals, including psychiatric evaluations and symptom reviews.

Treatment

  1. Antipsychotic Medications (first-line):

    • Typical: Haloperidol, Chlorpromazine.

    • Atypical: Risperidone, Clozapine (monitoring required).

  2. Psychosocial Treatments:

    • CBT for psychosis (CBTp), social skills training, family psychoeducation, case management.

  3. Hospitalizations: For crisis stabilization and safety measures.

Professionals Involved

  • Treatment: Psychiatrists, psychiatric nurse practitioners, primary care providers, therapy professionals.

Complications if Untreated

  • Worsening symptoms, functional decline, homelessness, high relapse risk, increased suicide risk.

Key Facts Likely on SQE

  • Auditory hallucinations are common; diagnosis requires symptoms lasting at least six months.

Bipolar Disorder

Definition

  • Bipolar Disorder: A chronic mood disorder that involves:

    • Cycles of manic or hypomanic and depressive episodes.

Types of Bipolar Disorder (DSM-5)

  1. Bipolar I Disorder: At least one full manic episode (depressive episodes not required).

  2. Bipolar II Disorder: At least one hypomanic episode and one major depressive episode.

  3. Cyclothymic Disorder: Chronic mood disturbances lasting 2+ years, with periods not meeting full criteria for episodes.

Episode Definitions

  • Manic Episode: Lasts 1 week, requires elevated mood & additional symptoms (e.g., grandiosity, decreased sleep).

  • Hypomanic Episode: Similar to mania, but less severe and not requiring hospitalization.

  • Major Depressive Episode: Persistent low mood, loss of interest for 2+ weeks.

Causes & Risk Factors

  1. Biological & Genetic Factors: Strong heritability; brain structure differences in emotion regulation circuits.

  2. Environmental Factors: Stressful life events, trauma, substance use.

Signs & Symptoms

  • Mania/Hypomania: Elevated mood; decreased sleep; risky behavior.

  • Depression Symptoms: Feelings of hopelessness, fatigue, suicidal thoughts.

Co-occurring Conditions

  • Anxiety disorders, ADHD, substance use disorders, eating disorders.

DSM-5 Category & Codes

  • Category: Bipolar and Related Disorders

    • Bipolar I: 296.40–296.44

    • Bipolar II: 296.89

    • Cyclothymic Disorder: 301.13

  • ICD-10 Codes: F31.0–F31.9.

Diagnosis

  • Conducted by mental health professionals using DSM-5 criteria, clinical interviews, mood charting, and thorough history.

Treatment

  1. Mood Stabilizers (first-line): Lithium (reduces suicide risk); Valproate.

  2. Atypical Antipsychotics: For manic episodes.

  3. Psychotherapy: CBT, family-focused therapy, lifestyle support.

Professionals Involved

  • Medication: Psychiatrists, nurse practitioners.

  • Therapeutic Support: Psychologists, social workers, peer specialists, crisis treatment teams.

Key Facts Likely to Appear on SQE

  • Bipolar I requires a manic episode, while Bipolar II requires at least one major depressive episode.

Depression (Major Depressive Disorder & Related Disorders)

Definition

  • Depression: A serious mood disorder negatively affecting thoughts, emotions, and actions, with symptoms lasting 2+ weeks.

Types of Depressive Disorders (DSM-5)

  1. Major Depressive Disorder (MDD): Significant impairment for at least 2 weeks.

  2. Persistent Depressive Disorder (Dysthymia): Chronic depression for 2+ years.

  3. Seasonal Affective Disorder (SAD): Seasonal depression.

Causes & Risk Factors

  1. Biological Factors: Genetic predisposition, brain chemistry imbalances.

  2. Environmental Factors: Stress, trauma, major life changes.

  3. Other Risk Factors: History of depression, substance misuse, chronic illness.

Core Symptoms (DSM-5)

  • Emotional: Depressed mood, anhedonia, worthlessness.

  • Physical: Changes in sleep/appetite, fatigue.

  • Cognitive: Trouble concentrating, suicidal thoughts.

Co-occurring Conditions

  • Anxiety disorders, PTSD, substance use disorders, chronic medical conditions.

DSM-5 Category & Codes

  • Major Depressive Disorder: 296.20–296.36.

  • ICD-10 Codes: F32 (single episode), F33 (recurrent).

Diagnosis

Diagnosis conducted by licensed professionals, considering questionnaires (PHQ-9) and rule-out of medical conditions.

Treatment

  1. Psychotherapy (Highly Testable):

    • Cognitive Behavioral Therapy (CBT): Gold standard for reframing negative patterns.

    • Interpersonal Therapy (IPT)

    • Behavioral Activation: Engagement in positive activities.

  2. Medications: Antidepressants (SSRIs, SNRIs).

    • Must be taken consistently; may take 4-6 weeks for effect.

  3. Severe Cases: ECT for severe treatment-resistant cases.

Professionals Involved

  • Medical Management: Psychiatrists, nurse practitioners.

  • Therapeutic Support: Psychologists, licensed counselors, social workers.

Key Facts Likely to Appear on SQE

  • Symptoms must last 2+ weeks for MDD.

  • SSRIs are first-line treatments.

Anxiety Disorders

Definition

  • Anxiety Disorders: Excessive fear or worry that interrupts daily function; the most common mental health disorders in the U.S.

Common Types (DSM-5)

  1. Generalized Anxiety Disorder (GAD): Chronic, excessive worry for at least 6 months.

  2. Panic Disorder: Recurrent, unexpected panic attacks.

  3. Social Anxiety Disorder: Intense fear of social situations.

  4. Specific Phobias: Intense fear of specific objects.

  5. Agoraphobia: Fear of situations where escape might be difficult.

  6. Separation Anxiety Disorder: Common in children.

Causes & Risk Factors

  1. Genetic & Biological Factors: Family history of anxiety disorders, neurotransmitter dysregulation.

  2. Environmental & Psychological Factors: Trauma, chronic stress, medical illness, or substance misuse.

Symptoms

  • Physical: Palpitations, shortness of breath.

  • Cognitive: Excessive worry, difficulty concentrating.

  • Behavioral: Avoidance of feared situations, restlessness.

Co-occurring Conditions

  • Depression, substance use disorders, PTSD, OCD.

DSM-5 Category & Codes

  • Generalized Anxiety Disorder: 300.02

  • Panic Disorder: 300.01

  • Social Anxiety Disorder: 300.23

  • ICD-10: F40–F41.

Diagnosis

Diagnosed by professionals using clinical interviews, symptom questionnaires (GAD-7), and rule-out of medical causes.

Treatment

  1. Psychotherapy (first-line):

    • Cognitive Behavioral Therapy (CBT): Gold standard for anxiety.

  2. Medications: SSRIs, SNRIs; benzodiazepines used for short-term management.

    • Lifestyle Adjustments: Stress reduction, exercise, sleep hygiene.

Professionals Involved

  • Medical: Psychiatrists, primary care providers.

  • Therapy: Psychologists, licensed counselors.

  • Community & Crisis Support: Peer support specialists, crisis teams.

Key Facts Likely to Appear on SQE

  • High prevalence and treatability of anxiety disorders.

  • CBT and SSRIs/SNRIs considered first-line treatments.

Obsessive-Compulsive Disorder (OCD)

Definition

  • OCD: Chronic mental health disorder featuring:

    • Obsessions: Intrusive, unwanted thoughts causing distress.

    • Compulsions: Repetitive behaviors performed to alleviate anxiety.

Causes & Risk Factors

  1. Biological Factors: Neurotransmitter dysregulation; genetic predisposition.

  2. Environmental Factors: Trauma, chronic stress, childhood abuse.

Symptoms

  • Obsessions: Fear of contamination, harming others, needing symmetry.

  • Compulsions: Hand washing, checking, counting rituals.

Co-occurring Conditions

  • Anxiety disorders, depression, tic disorders.

DSM-5 Category & Codes

  • OCD: 300.3

  • ICD-10 Code: F42.

Diagnosis

Conducted by mental health professionals using symptom checklists and clinical interviews.

Treatment

  1. Psychotherapy:

    • Cognitive Behavioral Therapy (CBT): Gold standard, especially with exposure and response prevention.

  2. Medications: SSRIs (fluoxetine, fluvoxamine) as first-line treatments.

Professionals Involved

  • Psychiatrists, social workers, and therapists for comprehensive treatment approaches.

Key Facts Likely to Appear on SQE

  • OCD is time-consuming and involves compulsions designed to reduce anxiety. CBT with ERP is the most effective psychotherapy.

Post-Traumatic Stress Disorder (PTSD)

Definition

  • PTSD: A disorder that may develop after exposure to a traumatic event, characterized by:

    • Intrusive memories, avoidance, negative cognition, arousal symptoms persist for more than 1 month.

Causes & Risk Factors

  1. Exact Trauma Exposure: Military combat, sexual assault, natural disasters.

  2. Individual Vulnerability: Previous trauma, genetic predisposition, lack of social support.

Symptoms (DSM-5 Criteria)

  • Intrusion: Flashbacks, nightmares, distressing memories.

  • Avoidance: Steering clear of reminders of the trauma.

  • Negative Mood Alterations: Persistent negative beliefs, detachment.

  • Altered Arousal & Reactivity: Hypervigilance, irritability.

Co-occurring Conditions

  • Depression, anxiety disorders, substance use disorders.

DSM-5 Category & Codes

  • PTSD: 309.81

  • ICD-10 Code: F43.10.

Diagnosis

Diagnosed by clinical interviews, trauma history assessments, using standardized tools.

Treatment

  1. Psychotherapy:

    • Trauma-Focused CBT, Prolonged Exposure Therapy, EMDR as effective treatments.

  2. Medications: SSRIs as first-line pharmacotherapy.

Key Facts Likely to Appear on SQE

  • Core PTSD clusters include intrusive memories and changes in mood. Trauma-focused CBT is a primary treatment method.

Personality Disorders (PDs)

Definition

  • PDs: Enduring patterns of behavior affecting various domains, often deviating from cultural norms, leading to distress and impairment.

Causes & Risk Factors

  1. Biological & Genetic Factors: Heritability varies across different disorders.

  2. Environmental Factors: Childhood trauma, inconsistent parenting, and attachment issues also play roles.

Clinical Categories (DSM-5 Clusters)

  • Cluster A: Odd, eccentric behavior (e.g., Paranoid, Schizoid).

  • Cluster B: Dramatic, emotional behavior (e.g., Antisocial, Borderline).

  • Cluster C: Anxious, fearful behavior (e.g., Avoidant, Dependent).

Diagnosis

Conducted by mental health professionals considering behavioral patterns and functioning impact.

Treatment

  1. Psychotherapy:

    • DBT for Borderline PD, CBT for maladaptive thinking.

  2. Medications: To manage specific symptoms, but no direct treatments for PDs.

Key Facts Likely to Appear on SQE

  • Personality disorders evolve from complex interactions between genetic and environmental influences, entail lifelong issues requiring comprehensive management strategies.

Dissociative Disorders

Definition

  • Dissociative Disorders: Disorders involving disruptions in consciousness, memory, and identity often caused by severe trauma or stress.

Types of Dissociative Disorders (DSM-5)

  1. Dissociative Identity Disorder (DID): Two or more distinct identities.

  2. Dissociative Amnesia: Inability to recall information about oneself.

  3. Depersonalization/Derealization Disorder: Feelings of detachment from self or surroundings.

Treatment

  1. Psychotherapy:

    • Trauma-focused CBT, DBT, EMDR for DID.

  2. Community and Peer Support: Case management, support groups.

Key Facts Likely to Appear on SQE

  • Dissociative disorders are typically trauma-related and do not stem from neurological foundations.