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DSM 5-

Catergorical approach that divides the mental disorders into types that are defined by diagnostic criteria and whether client meets minimum criteria for diagnosis


Polythetic Criteria

allows for individual differences, requires client to present with only a subset of characteristics from a larger list , two clients can have somewhat different symptoms but receive same diagnossi


Diagnostic Uncertainty

indicated by either
Other Specified Disorder: coded when clinician wants to specify why clients symptoms do not meet criteria for a specific diagnosis
Unspecified Disorder: coded when the clinician does want to indicate the reasons why the clients symptoms do not meet criteria for a specific diagnosis


Outline for Cultural Formulation:

guidelines for assessing four factors: clients cultural identity, the clients cultural conceptualization of distress, psychosocial stressors, and cultural factors that impact clients vulnerablity and resilence, and cultural factors relevant to relationship between client and therapist


Cultural Formation Interview:

CFI semi structured interview consisting of 16 questions designed to obtain information on clients view of social cultural context of problems,
Four domains: cultural perceptions of cause, context, support,


Cultural Syndromes:
Cultural Idioms:

Cultural syndromes- clusters of symptoms and attributions that co occur among individuals from a particular culture
Cultural Idioms of distress: members of different cultures to express distress and provide shared ways of talking about personal and social concerns


Intellectual Disability :

deficits in intelluctual functioning
Deficits in adaptive functioning
Onset during developmental period
Severity based on conceptual, social and practical domains


Intellectual Disability Etiology

5% due to hererdity( Tay sachs, Fragile X syndrome, PKU)
30% chromosomal changes and exposure to toxins 10% to pregnancy and prenatal problems, 5% to acquired medical conditions, and unknown in 30% -low birth weight strongest predictor of severity in unknown cases


Childhood Onset Fluency Disorder( Stuttering)

begins around 2-7 and symptoms become worse when pressure to communicate
65 to 85% of children recover, with severity of dysfluency at age 8 being a good predictor of prognosis


Childhood Onset Fluency Treatment:

reducing psychological stress at home in young children,
Habit reversal treatment for adults and adolescents - awareness, relaxation, motivation, competing, and generalization training
competing response is regulated breathing, deep diaphragmatic breath


Autism Spectrum Disorder Criteria:

Persistent deficits in social communication and interaction across mutiple contexts as manifested in nonverbal communication, social emotional reciprocity, and development of relationships
Restricted repetitive patterns of behavior, interests, manifeted by repepitive motor movements, use of objects or speech, insistence on sameness, inflexible adherence to routines, or ritualized by behavior,
Symptoms during developmental period


Autism Spectrum prognosis

Generally poor. Best outcome is associated with an ability to communicate verbally by age 5 or 6 an IQ over 7, later onset of symptoms


Autism Spectrum Etiology:

unusually rapid head growth during first year of life abornormalities in amygdala and cerebellum, higher among biological siblings of individuals with this disorder


Autism Spectrum Disorder Treatment:

parent management training, social interaction skills, shaping and discrimination training


Attention Deficit Hyperactivity Disorder Criteria;

characterized by pattern of inattention and hyperactivity that has lasted at least 6 months has an onset prior to age 12 and occurs in at least 2 settings and requires at least 6 symptoms of inattention or hyperactivity
Inattention- fails to give close attention to detail, sustaining attention to tasks, doesnt listen to when spoken to directly, fails to finish schoolwork or chores, is easily distracted by extraneous stimuli, often forgetful in daily activities
Hyperactivity- impulsivity- frequently fidgets or squirms in seats, often leaves seat at inappropriate times, frequently runs or climes in inappropriate situations, talks excessively, difficulty waiting his or her turn


ADHD associated features:

test lower on IQ tests than other children although their intelligence is average or above average,
Social adjustment, peer rejection, low self esteem, poorer health outcomes,
Adults with ADHD elevated risk for Bipolar disorder, anxiety, antisocial behavior and substance abuse


Prevalence and Gender of ADHD

5% for children and 2.5% for adults,
Gender: overall more prevalent in males than females, inattentive more common for females


ADHD course prognosis:

65 to 80% of children with ADHD continue to meet criteria in adolescence.
In adults impulsivity takes the form of impatience and irritability, problems related to management of time and money, reckless driving, and impulsive sexuality


ADHD treatment

Methyphenidate( Ritalin) and other CNS stimulants have benefical effects on core symptoms of ADHD in 75% of cases,
Parent training, and teacher training,
*studies indicate that medication management alone and and combined treatment of medication and behavioral management produce similar reduction in core symptoms of ADHD, however follow up in 3 and 8 years showed that the superior benefits of medication alone or combined did not persist and outcomes were comparable to those for children who only had behavioral management


Specific Learning Disorder:

diagnosed when a person exhibits difficulties related to academic skills indicated by presence of at least one characteristic symptom that persists for at least 6 months despite the provision of interventions targeting those difficulties , also require individual academic skills are below those expected, began during the school age years and impair functioning

Comorbid ADHD in 20 to 35% of children with SLD
More common in males than females
Etiology: cerebellar vestibular dysfunction, incomplete dominance and other hemisphere abnormalities, and exposure to toxins.


Tourettes Disorder Diagnostic Criteria

Presence of at least one one vocal tic and multiple motor tics that appear together or at different times, persist for more than 1 year and began prior to age 18.
*linked to elevated levels of dopamine in the caudate nucleus

common features related are obsessions and compulsions and the rate of OCD is not only higher for individuals with Tourettes Disorder but also biological relatives, also hyperactivity, impulsivity, and distractibility


Tourette's Disorder Treatment

pharmacotherapy of antipsychotic drugs including haloperidol and pimozide have been effective in 80% of cases.
*drawback is negative side effects,
SSRI can be helpful for alleviating the obsessive compulsive symptoms, clonidine or desipramine
CBIT- evidence based treatment for tics and incorporates habit reversal, relaxation training, and psychoeducation


Behavioral Pediatrics Hospitalization

hospitalized children are at increased risk for emotional and behavioral problems that range from mildly disruptive behaviors to anxiety, depression, or severe withdrawn
Children 1-4 have most negative reactions to hospitalization due to child's seperation


Behavioral Pediatrics Compliance

lack of compliance with medical regimens includes lack of knowledge or skill, parent child conflict, and developmental issues, studies have shown that compliance in adolescent is due to concerns about peer acceptance, reduced conformity to rules and reduced parental supervision


Delusional Disorder Diagnostic Criteria

presence of one or more delusions that least at least 1 month


Delusional Disorder Types:

Erotomanic- person believes someone is in love with him or her
Grandiose: person believes he or she has great but unrecognized talent
Jealous: person believes spouse is unfaithful
Persecutory: person believes that he or she is being conspired against
Somatic: person believes that he or she has an abnormal bodily function or sensation
Also, mixed and unspecified


Schizophrenia Diagnostic Criteria

Presence of at least 2 active phase symptoms:delusions, hallucinations, disorganized speech, grossly disorganized behavior or negative symptoms for at least 1 month with continuos signs of the disorder for at least 6 months and significant impairment in functioning

*prevelance is .3 to .7% for population, and slightly lower for females than males
common comorbid disorders are Substance Use Disorder, and Tobacco Use disorder


Schizophrenia Prognosis

onset is usually between late teens and early 30s with the peak being between early to mid 20s for males and late 20s for females.
*better prognosis is associated with good premorbid adjustment, an acute and late onset, female gender, presence of a precipitating event, brief duration of active phase symptoms, family history of mood disorder, and no family history of schizophrenia


Schizophrenia concordance rates

Risk for Schizophrenia
Biological Sibling 10%
Fraternal Twin 17%
Identical twin ( 48%
Children of two parents with schizophrenia 46%


Schizophrenia Etiology/Dopmaine Hypothesis

Enlarged ventricles is the most common structural brain abornmality , hypofrontality has been linked to the negative symptoms of schizophrenia
*dopamine hypothesis- attributes it to elevated dopamine levels