What are the positive and negative symptoms of schizophrenia?

What are the positive and negative symptoms of schizophrenia?

• Positive: delusions, hallucinations, disorganized thinking, disorganized behavior, catatonic motor behaviors
• Negative: affect flattening, alogia (poverty of speech), avolition (inability to engage in goal-directed activities)

What are the diagnostic criteria for schizophrenia?

What are the diagnostic criteria for schizophrenia?

• two or more of the following, each present for a significan portion of time during a 1-month period (or less if successfully treated):
• delusions
• hallucinations
• disorganized speech
• grossly disorganized or catanic behavior
• negative symptoms (affective flattening, alogia, avolition)
• continues for at least 6 months and must include at least 1 month of symptoms 
• significant mood disorder  must not be present
• psychotic symptoms must not be associated with substance abuse or general medical conditions

What is the rate of suicide in people with schizophrenia?

What is the rate of suicide in people with schizophrenia?

• 10% successfull, 20-40% attempt

What personality disorder straddles the criteria between psychotic and non-psychotic disorders?

What personality disorder straddles the criteria between psychotic and non-psychotic disorders?

• borderline P.D. 

What delusions are specific to delusion disorder? (7)

What delusions are specific to delusion disorder?

• erotomanic: the belief that another person is in love with the individual
• grandiose: the belief that they have some great, unrecognized talent, insight, or discovery
• jealous: the belief that one’s spouse or lover is being unfaithful, without due cause, can lead to anger or violent behavior
• persecutory: the belief that they (or someone close to them) are being conspred against, small slights may become exaggerated, may lead to anger, violence or litigious behavior
• somatic: the central belief involves bodily functions or sensations, can result in doctor shopping and medical testing
• mixed: no delusional theme predominates
• unspecified: no dominant delusion can be clearly identified

What sensory systems can hallucinations occur in?

What sensory systems can hallucinations occur in?

• can occur in any sensory modality (auditory, visual, olfactory, gustatory, and tactile)

Be able to describe different types of delusions and how they can impact an individual

Be able to describe different types of delusions and how they can impact an individual

• bizarre: clearly not plausible, not understandable, and not derived from ordinary life
• non-bizarre: involves situations that can occur in real-life

Delusion - distortion of thought

Hallucination - distortion of perception

What medical conditions can lead to psychosis?

What medical conditions can lead to psychosis?

• neurological (epilepsy, neoplasms, huntington's, multiple sclerosis, CNS infection, migraines)
• endocrine (hyper/hypothyroid, hyper/hypo parathyroid, hyper/hypo adrenal)
• metabolic conditions (electrolyte imbalances, systemic lupus, hepatic or renal disease, hypoxia, hypoglycemia)

What types of medication are used to treat OCD?

What types of medication are used to treat OCD?

• SSRIs and CBTs, higher dose antidepressants (esp SSRIs + some tricyclics)

What are the cognitive disturbances associated with Alzheimer’s?

What are the cognitive disturbances associated with Alzheimer’s?

• may begin with mild cognitive impairment:
• memory problems, trouble remembering recent events, and assimilating new info
• gradually onset of difficulty with speech, finding objects, judgement, orientation, recognition
• difficulty with daily routines, time orientation; may be changes in demeanor
• person becomes non-ambulatory, mute, incontinent
• eventually can't move, eat, swallow - leads to death if person doesn't die of pneumonia first

What are the diagnostic criteria for Generalized Anxiety Disorder?

What are the diagnostic criteria for Generalized Anxiety Disorder?

• at least 6 months with more days that not exhibiting excessive anxiety and worrying concerning a number of events or activities
• person has difficulty controlling worry
• 3 of the following:
• restlessness/feeling on edge
• muscle tension
• being easily fatigued
• difficulty concentrating, mind blank
• sleep disturbance
• irritability

• motor tension (easily startled)
• hyperactive autonomic nervous system (sweat, cold hands)
• apprehensive expectation (worrying about possible misfortunes)
• vigilance or hyperscanning
• cognitive signs (inattention, negative self-talk)

• Panic Attack:
• discrete period with sudden onset of intense apprehension, fearfulness, or terror, often associated with sense of impending doom.
• may have: shortness of breath, chest pain, palpitations, choking sensation and fear of losing control

• Agoraphobia:
• avoidance of places or situations from which escape might be difficult or in which help may not be available in the event of a panic attack

• specific phobia:
• clinically significant anxiety
• reaction to a specific object or situation

• social phobia:
• clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behaviors.
• causes social disruption

• OCD:
• obsessions - unwanted ideas or impulses that come up spontaneously and cause anxiety
• contamination, responsibility anxiety, scrupulosity, hoarding
• compulsions - repetitive behavior aimed at managing obsessions and anxiety; rituals (ie washing and checking)

• PTSD:
• hyperarousal, intrusion (reliving trauma through flashbacks/nightmares), avoidance of stimuli associated with trauma, emotional numbing/feelings of detachment
• often accompanied with a mood disorder, anxiety disorder, or substance use disorder

• Dissociative Disorder:
• extreme “disruption in usually integrated functions of consciousness, memory identity, or perception of environment.
• types: amnesia, fugue, depersonalization disorder, and dissociative identity disorder (presence of two or more distinct identities or personality states which take control, no memory)

• Acute Stress Disorder:
• similar to PTSD but occurs in immediate aftermath of trauma and is time limited

• Generalized Anxiety Disorder:
• at least 6 months of persistent, excessive anxiety and worrying

What are the DSM-IV criteria for a Major Depressive episode?

What are the DSM-IV criteria for a Major Depressive episode?

• 5 or more of the following symptoms in a 2 week period and at least one of the symptoms is either 1) depressed mood, or 2) loss of interest/pleasure:
• depressed mood
• diminished interest or pleasure
• significant weight loss or gain
• insomnia or hypersomnia
• psychomotor agitation or retardation
• fatigue or loss of energy
• feelings of worthlessness and excessive or inappropriate guilt
• diminished ability to think or concentrate or indecisiveness
• recurrent thoughts of death, or suicidal ideation

What are the DSM-IV criteria for a Manic episode?

What are the DSM-IV criteria for a Manic episode?

• distinct period of abnormally or persistently elevated, expansive or irritable mood, lasting at least 1 week
• during period of mood disturbance 3 or more of following:
• inflated self-esteem or grandiosity
• decreased need for sleep
• more talkative than usual
• slight of ideas or racing ideas
• distractibility
• increase in goal directed activity or psychomotor agitation 
• pleasurable but high risk activities

How should one communicate with a depressed person?

How should one communicate with a depressed person?

• with the same energy level

What areas of the brain are associated with increased incidence of depression?

What areas of the brain are associated with increased incidence of depression?

• frontal hypometabolism and increased activity in the thalamo-limbic area 

What areas of the brain show hypometabolism in depressed adolescents?

What areas of the brain show hypometabolism in depressed adolescents?

• frontal lobe

What neurotransmitters are most involved in treating depression?

What neurotransmitters are most involved in treating depression?

• increase norepinephrine, epinephrine, and dopamine levels in brain

What diagnostic factors are required for diagnosing PTSD?

What diagnostic factors are required for developing PTSD?

• occurs after experience/witness trauma and person’s response involved intense fear, helplessness, or horror
• traumatic event is re-experienced in one way:
• intrusive recollections
• recurrent stressful dreams
• feeling as if traumatic experience were recurring
• intense psychological distress at cues that resemble the trauma
• psychological reactivities at cues that resemble the trauma
• persistent avoidance of stimuli with trauma by 3 or more:
• effort to avoid thoughts/feelings/convos
• effort to avoid activities/places/people
• inability to recall important aspects of trauma
• markedly diminished interests/participation of significant activities
• feeling detachment/estrangement from others
• restricted range of effect
• sense of foreshortened
• persistent symptoms increased arousal 2 or more:
• difficulty falling/staying asleep
• irritability/outbursts of anger
• difficulty concentrating
• hyper vigilance
• exaggerated startle response
• duration of disturbnce is more than 1 month
• disturbance causes clinically significant distress that interferes with occupations...etc

What is the impact of norepinephrine?

What is the impact of norepinephrine?

• it is a mood regulator. a deficiency causes depression and hypersecretion causes mania

What personality disorder is associated with the risk for violence to others?

What personality disorder is associated with the risk for violence to others?

• antisocial personality disorder

What substance disorder can occur in the absence of substance dependence?

What substance disorder can occur in the absence of substance dependence?

• substance abuse

What substances have the potential to be abused?

What substances have the potential to be abused?

• alcohol, amphetamines, caffeine, marijuana, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, prescription, over the counter

What is the general age of onset for the majority of mental illness?

What is the general age of onset for the majority of mental illness?

• adolescents/ around 14

What is the most prevalent group of disorders in children and adolescents?

What is the most prevalent group of disorders in children and adolescents?

• anxiety disorders

What is the impact on children of parents with bipolar disorder?

What is the impact on children of parents with bipolar disorder?

• they are 4-6 times more likely to develop it. they are more likely to have symptoms of anxiety disorders and ADHD. youths with anxiety disorder are more likely to develop bipolar than not

In children with depression what is the most common comorbid diagnosis?

In children with depression what is the most common comorbid diagnosis?

• ADHD, conduct dis., anxiety dis., eating dis, general medical conditions, developmental dis., intellectual disabilities

In children with oppositional defiant disorder what is the most common comorbid diagnosis?

In children with oppositional defiant disorder what is the most common comorbid diagnosis?

• ADHD and depression/anxiety

What percentage of teens that have attempted suicide have also abused substances?

What percentage of teens that have attempted suicide have also abused substances?

• 53%

What cultural groups of youth are associated with a higher rate of suicide?

What cultural groups of youth are associated with a higher rate of suicide?

• native americans, alaskan americans, hispanic high-school students, homosexual youths

What do APGAR scores predict?

What do APGAR scores predict?

• activity, pulse, grimace, appearance, respiration
• can be an indication of poor neonatal outcome

What are the risk factors for prematurity?

What are the risk factors for prematurity?

• Maternal factors: malnutrition (IUGR), illness (eg high blood pressure, pre-eclampsia), other (uterine constraints or "incompetence," maternal age/size, placental abnormalities, chronic stress)
• multiple births (eg triplets)
• environment: low SES, mother, poor parenting skills, family dynamics, lack of medical insurance, lack of prenatal care, parent-child separation
• teratogens: radiation, drugs (licit and ilicit), smoking and drinking

What are the causes of hydrocephalus?

What are the causes of hydrocephalus?

• increased production of CSF
• blockage/occlusion of foramina
• from bleeding (IVH in infants)
• congenital malformation (Arnold Chiari malformation)
• infection
• meningitis can obstruct subarachnoid space

What are the teratogens that negatively impact the fetus?

What are the teratogens that negatively impact the fetus?

• thalidomide
• some antiepileptic drugs
• chemotherapy agents
• sex hormones
• tetracycline
• radiation
• smoking
• drinking
• drugs (ilicit licit)

What is the typical progression of cerebral palsy?

What is the typical progression of cerebral palsy?

• it’s non-progressive but not unchanging
• lesion of brain occurring before, during, and after birth

What is the synactive model of development?

What is the synactive model of development?

• views child interacting with environment
• environment and organism
• autonomic, motor, state (being able to smoothly transfer from asleep to awake. interaction with env) and attention interaction
• systems are interdependent and hierarchical, not sequential

What is adjusted age and how is it determined?

What is adjusted age and how is it determined?

• age that infant is developmentally 
• helps compensate for premature birth milesones
• AA = CA - (40 weeks -  PCA)

What is the Dubowitz exam and how/why is it used?

What is the Dubowitz exam and how/why is it used?

• determines gestational age based on infant motor maturity
• looks at physical components of baby and assigns a “grade” (neuromotor maturity, physical maturity)

Low Birth Weight

• between 3 lbs 5 oz - 5 lbs 8 oz (1500-2500 g)

Patent Ductus Arteriosis

• the fetal vessel that diverts blood flow from the lungs. it normally closes at birth, allowig blood to flow to the lungs and be oxygenated. 

Bronchopulmonary Dysplagia

• can be caused by Respiratory Distress Syndrome (RDS)
• chronic lung disease due to prolonged oxygen supplementation
• may also be a result of O2 dependence less than 28 dyas or (iatrogenic) less than 36 weeks of GA

Intraventricular hemorrhage

• bleeding into the ventricular system

Necrotizing Entercolitis

• lining of intestinal wall dies for unknown reasons
• could be due to vasculature to intestines
• could be bc bacterial infections

Retinopathy of Prematurity (ROP)

• oxygen toxicity to immature blood vessels of retina and can result in partial to complete blindness
• characterized in terms of 
• zones - where is damage (from 1 macula to 3 temporal crescent)
• stage - progression of damage from partial vascularization to full detachment of retina (1 to 5 most severe)

Periventricular Leukomalacia

• lack of blood to ventricular cells

What diagnostic factors are required for developing PTSD?  

What diagnostic factors are required for developing PTSD?  

• Occurs after experiencing or witnessing trauma (e.g., violent physical or sexual assault, combat, terrorism, natural disaster, serious accidents)
• Highest predictor is exposure to trauma eliciting “fear, helplessness or horror”
• Trauma = event beyond ordinary range of experience
• May be acute or chronic
• May have delayed onset
• Characterized by fixation on trauma
• Hyperarousal  (including sleep disturbance); intrusion, i.e., repeatedly reliving trauma through flashbacks and nightmares; and avoidance of stimuli associated with trauma, including emotional numbing/feelings of detachment
• Ranges from mild disruption to serious impact on  function, especially in Social Participation
• Often accompanied by Mood Disorder (e.g., depression), Anxiety Disorder (e.g., simple phobias) and/or Substance Use Disorder

What are complications of BPD?

• Complications of BPD:
• recurrent hypoxemia
• pulmonary hypertension
• acidemia
• cardiac dysfunction
• muscular hypertrophy
• peribronchial edema, emphysema, ulmonary air leaks
• trachobronchial injury
• gastroesophogeal reflux
• failure to thrive
• dehydration or overhydration
• difficuly weaning from the respirator or the need for O2

Prognosis of BPD?

• in the first year of life, 80% of infants with BPD, RDS have neuromotor and cognitive abnormalities
• as nutrition ad pulmonary status improves, children may improve and show long term limited or no impairments
• SIDS: 7 times the normal rate
• CP, other neuromotor problems, language difficulties, cognitive impairment, and school problems may become apparent
• endurance problematic in early childhood but by age 8 usually OK for exercise