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EPPP 2024 Psychpath
Psychopathology Domain
| Question | Answer |
|---|---|
| What are the various neurodevelopmental disorders? | Intellectual disability, Autism, ADHD, communication disorders, Tic disorders & specific learning disorder |
| What is the etiology of ASD? | ➺ Brain abnormalities in cerebellum, corpus callosum, amygdala & ⬆ brain growth in early stages of life followed by a plateau = ⬆ brain volume ➺ Neurotransmitters: ⬆ serotonin in blood, ⬇ serotonin in brain; dopamine, GABA, glutamate & Ach ➺ Genetics |
| What factors are linked to the best prognosis for ASD? | IQ of 70+; functional language skills by age 5 & no comorbid mental health issues |
| What is the etiology of ADHD? | ➺ Brain abnormalities in striatum (caudate nucleus, putamen & nucleus accumbens), amygdala, hippocampus & overall brain volume; ⬇ activity in frontoparietal network; ⬇ size of prefrontal cortex ➺ Neurotransmitters: ⬇ dopamine, norepinephrine & serotonin |
| What are the main comorbidities for ADHD? | Oppositional defiant disorder = most common Conduct disorder = 2nd most common Anxiety disorder & depressive disorder |
| What is the etiology of tic disorders? | Abnormalities in caudate nucleus (smaller) ⬆ dopamine |
| How long do symptoms have to last for a diagnosis of specific learning disorder? | 6 months |
| What is the etiology of schizophrenia? | ➺ Abnormalities in ventricles and ⬇ activity in prefrontal cortex ➺ Abnormal levels of dopamine, glutamate & serotonin ➺ Revised dopamine hypothesis ➺ Genetics & heredity |
| What is the revised dopamine hypothesis | ➺ ⬆ dopamine activity in subcortical regions = Positive symptoms of schizophrenia (recall the mesolimbic dopamine pathway) ➺ ⬇ dopamine activity in cortical regions = negative symptoms of schizophrenia (recall the mesocortical dopamine pathway) |
| What are the highest and lowest concordance rates for schizophrenia? | Highest: identical twin (48%), child of two schizophrenic parents (46%), fraternal twin (17%) Lowest: parent of schizophrenic person (6%), biological sibling (9%), child of one schizophrenic parent (13%) |
| What are the main comorbidities for schizophrenia? | Smoking, anxiety, OCD |
| What factors are linked to the best prognosis for schizophrenia? | ➺ Females with acute, late onset of symptoms, comorbid mood symptoms, with predominantly positive symptoms and good pre-diagnosis adjustment |
| What does the prodromal/residual phase of schizophrenia include? | ➺ 2+ characteristic symptoms that are less severe OR negative symptoms only that occur prior to psychotic symptoms or after |
| What does the active phase of schizophrenia require? | ➺ 2+ characteristic symptoms with one being hallucinations, delusions or disorganized behavior for 1 month + signs for at least 6 months that may include prodromal and/or residual phase |
| What is a prodromal phase? | ➺ Process of changes or decline that precede onset of psychotic symptoms |
| How long do symptoms need to last for schizophreniform disorder? | ➺ 1 month to less than 6 months |
| How long do symptoms need to last for brief psychotic disorder? | ➺ 1 day to less than 1 month |
| What is the criteria for schizoaffective disorder? | Remember HATS ➺ Half or more of the total time ill must be spent w. mood symptoms ➺ Psychotic symptoms must occur alone w/o mood symptoms for 2+ weeks ➺ Mood & psychotic symptoms must occur together ➺ Rule out substances/medical conditions |
| What are the criteria for a manic epidose? | DIGFAST Distractibility, impulsivity, grandiosity, flight of ideas, ⬆ activity, ⬇ need for sleep, talkativeness Picture a person digging super fast trying to get to china and it takes one week to get there |
| What are the criteria for a major depressive episode? | SIGECAPS Sleep (disrupted), interest (⬇), guilt & hopelessness, energy (⬇), concentration (⬇), appetite (⬇), psychomotor slowing, suicidality |
| How long does a major depressive episode have to last? | ➺ 2 blue weeks |
| What are the symptoms of a hypomanic episode? | ➺ Abnormal mood (elevated, irritable, expansive) & ⬆ activity/energy for 4 consecutive days ➺ Symptoms ≠ severe enough to impair functioning or require hospitalization |
| What are the symptoms of BPI, BPII & cyclothymic disorder? | ➺ BPI: 1 manic +/- major depressive episode or hypomanic episode ➺ BPII: 1 hypomanic episode + 1 major depressive episode ➺ Cyclothymic: many hypomanic & depressive sx's that do not meet full criteria lasting for 2 years for adults and 1 year for youth |
| What are the concordance rates for bipolar disorder? | Identical (monozygotic) twin: 75% Fraternal (dizygotic) twin: 20% Child of one bipolar parent: 25% Child of two bipolar parents: 60% |
| What does "with atypical features" refer to in the DSM for bipolar disorders? | ➺ Mood reactivity and 2+ of: significant weight gain/appetite ⬆, hypersomnia, leaden paralysis (heavy limbs) & rejection sensitivity |
| What is the etiology of bipolar disorders? | ➺ Abnormalities in structure & function of prefrontal cortex, amygdala, hippocampus & basal ganglia ➺ Dopamine, norepinephrine, serotonin and glutamate abnormalities ➺ Problems with circadian rhythms ➺ Heredity |
| What do mixed episodes refer to in bipolar disorder? | ➺ Symptoms of mania & depression at the same time |
| What does rapid cycling refer to in bipolar disorder | ➺ 4 or more depressive or manic episodes within 1 year |
| What are the recommended therapies for bipolar disorder? | ➺ Family focused therapy, psychoeducation, interpersonal and social rhythm therapy, CBT |
| What are the recommended therapies for schizophrenia? | ➺ Assertive community treatment, CBt for psychosis, cognitive remediation for schizophrenia, family psychoeducation, social skills training, supported employment, ACT |
| What is the etiology of major depressive disorder? | ➺ Structural/functional probs in prefrontal cortex, cingulate cortex, hippocampus, caudate nucleus, putamen, amygdala, thalamus & other areas ➺ ⬇ serotonin, dopamine & norepinephrine ➺ Heredity |
| What are the concordance rates for MDD? | Identical twins: 30-50% Fraternal twins: 20-30% |
| What are the requirements for a diagnosis of persistent depressive disorder (dysthymia)? | ➺ Depressed mood + 2+ SIGECAPS sx's lasting 2+ years for adults & 1+ year in children |
| In 2020, who had the highest rates of suicide? | ➺ Individuals aged 75+ & American Indians/Alaskan natives ➺ When gender/age are considered, highest rates for women are for ages 45-64 and for males it was 75+ ➺ Highest rates for American Indians, hispanics & blacks = 25-34 y/o; for whites = 45-54; |
| What are the 5 negative symptoms of schizophrenia? | Alogia, anhedonia, asociality, affect (blunted/flat) & ambivalence (decision paralysis) |
| How is the ventromedial & dorsolateral prefrontal cortex related to major depressive disorder? | ➺ ⬇ activity in the dorsolateral PFC & ⬆ activity in ventromedial PFC is linked to symptoms ➺ Antidepressants & therapy reverse this pattern |
| What are the main comorbidities for MDD? | SUD (alcohol), Anxiety disorders (generalized), personality disorders (BPD), sleep abnormalities & medical issues (heart disease, stroke, diabetes, Parkinson's) |
| What is the recommended treatment of MDD in adults? | Therapy (CBT, IPT & behavioral therapy = equally effective) + medication (SSRI/SNRI) ➺ Combining the two = more effective than either alone |
| What is the recommended treatment of MDD in adolescents? | CBT or IPT for adolescents (IPT-A) & fluoxetine = 1st line ➺ Not enough evidence to say which treatment is better |
| What is the recommended treatment of MDD in older adults (60+)? | Group CBT or combo of IPT & SSRI/SNRI |
| How long do symptoms need to be present for a diagnosis of separation anxiety disorder? | ➺ 4 weeks in children; 6 months in adults |
| What are the 8 symptoms of separation anxiety disorder? | Remember HUG PANDaS ➺ Must have 3+/8 |
| What are the recommended therapies for separation anxiety disorder? | CBT that includes psychoeducation, exposure, relaxation training & cognitive restructuring CBT effectiveness improves with parent training |
| How long do symptoms need to be present for a diagnosis of social anxiety disorder? | 6+ months |
| What is the acronym to remember the symptoms of social anxiety disorder? | FEAR Fear of social situations when exposed to possible judgment Exposure to situations almost always = fear/anxiety Avoids social interactions Recognizes that fear is disproportionate |
| How long do symptoms need to be present for a diagnosis of agoraphobia? | 6+ months |
| What is the acronym to remember the symptoms of agoraphobia? | COOPE - think cooped up in these places where help is unavailable if panic symptoms arise Must have 2+ places: Crowded areas Open spaces Outside the home Public transport Enclosed spaces |
| What is the efficacy of treatments for agoraphobia? | In-vivo exposure, applied relaxation, breathing retraining or cognitive techniques do not significantly improve outcomes |
| What is the recommended and most efficacious treatment for agoraphobia? | ➺ In-vivo exposure & response prevention |
| What is the acronym to remember the 13 symptoms of panic attacks in panic disorder? | STUDENTS FEAR the 3C's: need 4+ Sweating, trembling, unsteadiness, depersonalization or derealization, excessive heart rate, nausea, tingling, fear of dying, losing control, faiting, 3 c's (chest pain, chills, choking) |
| What are the recommended treatments for treating panic disorder? | CBT that includes panic control treatment such as interoceptive exposure |
| What medications might be used for treating panic disorder? | ➺Some antidepressants or benzos but relapse is very high |
| What are the requirements for a diagnosis of panic disorder? | ➺ One attack + behavior to avoid having another attack & concern/worry about having more panic attacks for 1+ month |
| What is the acronym to remember the symptoms of GAD? | I CAN'T REST: need 3+ Irritability, concentration (⬇), anxiety on most days, no control over worry, time (6+ months), restlessness, energy (⬇), sleep (impaired), tense muscles |
| What are the causes of GAD? | Abnormalities in ventro & dorsolateral prefrontal cortex, cingulate cortex, posterior parietal cortex, amygdala, hippocampus |
| What disorders is the hippocampus involved in? | ➺Generalized anxiety disorder, Major depressive disorder, bipolar disorder, ADHD, Alzheimer's, schizophrenia, PTSD |
| What disorders is the amygdala involved in? | ➺ Autism, ADHD, bipolar, MDD, GAD, PTSD |
| What disorders is the cingulate cortex involved in? | ➺ GAD, MDD, PTSD |
| What disorders is the basal ganglia and associated structures involved in? | ➺Bipolar, Huntington's (caudate nucleus), Parkinson's, ADHD (striatum), Major depressive disorder (putamen & caudate nucleus), Tic disorders (caudate nucleus), OCD |
| What disorders is the thalamus associated with? | ➺ MDD, OCD |
| What disorders is serotonin involved in? | ➺ASD, ADHD, schizophrenia, bipolar, MDD, OCD, PTSD, conduct disorder |
| What disorders is dopamine involved in? | ➺ ASD, ADHD, Tic disorders, Schizophrenia, bipolar, MDD, PTSD, conduct disorder, Parkinson's |
| What disorders is glutamate involved in? | ➺ ASD, schizophrenia, bipolar, PTSD, Alzheimer's, Huntington's, Parkinson's |
| What disorders is norepinephrine involved in? | ➺ ADHD, bipolar, MDD, PTSD, Parkinsons (non-motor symptoms) |
| What disorders is GABA involved in? | ➺ ASD, PTSD, Huntington's |
| What disorders is acetylcholine involved in? | ➺ ASD, Alzheimer's Remember A for acetylcholine and the two A's for Autism & Alzheimer's |
| What are the main comorbidities of OCD? | ➺ Anxiety disorder, depressive or bipolar disorder, impulse control disorder, SUD Note: 90% have a comorbid psychiatric disorder |
| What is the acronym to remember the symptoms of specific phobia? | PHOBIA Persistent (6+ months), Handicapping (restricted lifestyle), Out of proportion, Beginning immediately and almost always, Intense fear/anxiety, Avoidance |
| What is the gender ratio & onset for specific phobia? | 2:1 for females to males Onset: childhood |
| What is the gender ratio for anxiety disorders & major depressive disorder? | 2:1 for females to males |
| What is the gender ratio of ADHD? | In childhood, 2:1 for men to women, with the rate decreasing in adulthood to about 1.6:1 (men to women) |
| What is the gender ratio of OCD? | In childhood, rate is higher for men but reverses in adulthood where the rate for women is higher. |
| What is the gender ratio of body dysmorphic disorder? | M = F |
| What is the required age of onset for a diagnosis of reactive attachment disorder? | Before age 5 or a developmental age of at least 9 months |
| What medications are conditionally recommended for treating PTSD and what do they do? | ➺ SSRIs (fluoxetine, paroxetine, sertraline) & SNRI (venlafaxine) to treat depression & reduce re-experiencing, avoidance & hyperarousal |
| How long do symptoms have to last for a diagnosis of prolonged grief disorder? | ➺ 3+ symptoms occurring nearly every day for the past month following the death of a close person that occurred 12 months ago (for adults) or 6 months ago (for youth) |
| What are the symptoms of somatic symptom disorder? | SOMAT Somatic symptoms, Out of proportion (to seriousness of symptoms), Medically unexplained, Anxiety (about health & symptoms), Time (excessive time/energy spent on concerns/symptoms) |
| What is the specifier of severity based on for anorexia, bulimia & binge-eating disorder? | Anorexia: BMI Bulimia: # of compensatory behaviors per week BED: # of binging episodes per week |
| What is the duration required for symptoms of binge-eating disorder and bulimia? | ➺ Weekly episodes for 3+ months |
| What are the main comorbidities for anorexia & bulimia? | ➺ Depression, anxiety (esp. OCD) which are often present before eating disorder |
| What is the efficacy of medication and/or therapy for treating binge-eating disorder? | ➺ Medication alone is less effective than CBT-E and combining with medication is not more effective than CBT alone |
| How long do symptoms of Pica have to last? | 1 month |
| How long do symptoms of insomnia & narcolepsy need to last for a diagnosis? | 3/week for 3 months |
| How long do symptoms of all the sexual dysfunction, gender dysphoria and paraphilic disorders need to last? | 6+ months |
| What is covert sensitization and what is it used for? | ➺ Aversive counterconditioning conducted with imaginal imagery that replaces arousal caused by a paraphilic object/behavior with fear or other unpleasant response ➺ Used to treat paraphilic disorders |
| What is orgasmic reconditioning? | ➺ Instructing person to switch from fantasizing about paraphilic object/behavior to fantasizing about more appropriate object/behavior when masturbating |
| How long do symptoms have to last for a diagnosis of ODD? | 6+ months |
| How long do symptoms have to last for a diagnosis of intermittent explosive disorder? | ➺ Physical or verbal aggressive not resulting in property damage occurring 2x/week for 3+ months OR ➺ Outbursts resulting in property damage or harm to self/other occurring 3+ times in a 1 year period |
| How long do symptoms have to last for a diagnosis of disruptive mood dysregulation disorder? | 3x/week for 1+ year |
| What is the gender ratio for conduct disorder? | 3-4x more common in boys |
| What factors are associated with a worse prognosis for conduct disorder? | ➺ Earlier onset of symptoms, which results in higher risk for aggressiveness, a later diagnosis of ASPD and higher risk for criminal behavior & substance related disorders. |
| What are the two types of conduct disorder according to Moffitt? | ➺ Life-course persistent type ➺ Adolescence-limited type |
| What are parenting focused interventions used to treat conduct disorder? | ➺ Parent management training - Oregon model (PMTO) - positive parenting skill building ➺ Parent management training (PMT)-building antecedents and consequences that reinforce preferred behaviors ➺ PCIT-repairing negative parent-child interaction |
| What family focused interventions are used to treat conduct disorder? | ➺ Functional family therapy (FFT)-replace problem behavior with non-problem behavior that serve the same function ➺ Multidimensional Family therapy (MDFT)- ⬇ substance use/aggression & ⬆ family functioning |
| What are child focused interventions used to treat conduct disorder? | Problem-solving skills training (PSST) - identify cognitions that underlie problem behavior, ⬆ empathy/perspective taking, understand consequences & build conflict resolution skills |
| What is multisystemic therapy based on? | Bronfenbrenner’s ecological theory |
| What is the gender ratio for intermittent explosive disorder? | 2:1 M to F |
| How does the involvement of family members relate to the prognosis for a person with schizophrenia? | ➺ Involvement of the family or other support system in the care of a patient with schizophrenia increases the patient’s medication adherence and reduces the risk for relapse |
| What multimodal interventions are used to treat conduct disorder? | Multisystemic Therapy (MST): for youth at risk of home displacement, targets risk factors at individual, family, peer, school and community levels Multidimensional Treatment Foster Care (MTFC): for abused/neglected/delinquent kids; trained team |
| What combination of treatments for conduct disorder is most effective? | Parent Management Training + Problem-Solving Skills Training (PSST) |
Created by:
JSalisbury
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