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Abnormal Psychology Exam Three Study Guide

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by: Margaret Bloder

Abnormal Psychology Exam Three Study Guide PSYCH 3830

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Margaret Bloder

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This study guide covers everything that is going to be on exam 3 including disorders in childhood and adolescence, neurodevelopmental disorders, feeding and eating disorders, and neurocognitive dis...
Abnormal Psychology
Pam Alley
Study Guide
50 ?




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"The content was detailed, clear, and very well organized. Will definitely be coming back to Margaret for help in class!"
Vern Johns

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This 24 page Study Guide was uploaded by Margaret Bloder on Wednesday March 30, 2016. The Study Guide belongs to PSYCH 3830 at Clemson University taught by Pam Alley in Winter 2016. Since its upload, it has received 40 views. For similar materials see Abnormal Psychology in Psychlogy at Clemson University.

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The content was detailed, clear, and very well organized. Will definitely be coming back to Margaret for help in class!

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Date Created: 03/30/16
Abnormal Psychology Exam Three Study Guide Disorders in Childhood and Adolescence I. On Disorders in Childhood and Adolescence A. Historical development in the study and treatment of child psychopathology  In the DSM I, there were only two childhood disorders (childhood schizophrenia and adjustment reaction of childhood). Neither of these are in the current DSM  In 1975, Congress passed the Education of all Handicapped Children Act (revised in 1977, renamed individuals with disabilities education act): I.D.E.A. o Assures that every child is entitled to a free public school education o Each child with a special need needs to have an individualized program that addresses their specific needs o Child should be placed in the least restrictive environment (ex: put them in a classroom with other children) o Parental participation is encouraged o Served learning disorders (ADHD, autism), emotional problems, speech impairments B. Prevalence  About 1/5 children have some kind of special need that causes some interference  About 1/10 children have some kind of problem that causes significantly more disturbance C. Reorganization of Childhood and Adolescent Disorders in the DSM DSM-IV-TR Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence  Mental Retardation  Learning Disorders  ADHD  Autistic Disorder  Asperger’s Disorder  Separation Anxiety Disorder (had to be under 18 to be diagnosed)  Oppositional Defiant Disorder  Conduct Disorder  Enuresis Personality Disorders  Antisocial Personality Disorder Sleep Disorders  Sleep Terror Disorder  Sleepwalking Disorder DSM-5 Neurodevelopmental Disorders  Intellectual Disability  Specific Learning Disorder  ADHD  Autism Spectrum Disorder Anxiety Disorders  Separation Anxiety Disorder (any age can get it) Depressive Disorders  Disruptive Mood Dysregulation Disorder (new diagnosis) Elimination Disorders  Enuresis Disruptive, Impulse-Control, and Conduct Disorders  Oppositional Defiant Disorder  Conduct Disorder  Antisocial Personality Disorder Personality Disorders  Antisocial Personality Disorder Sleep-Wake Disorders  Non-Rapid Eye Movement Sleep Arousal Disorder II. Anxiety in Children and Adolescents A. On anxiety in children and adolescents: Etiology  Behavioral inhibition (genetic component)  Environment factors (have been hospitalized, accident of some kind, abused, parents who are overly protective or parents who are detached  More common in girls  Often times remit before adulthood B. Separation Anxiety Disorder Diagnostic Criteria Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidence by three of the following: o Recurrent excessive distress when separated from home o Persistent and excessive worry about losing major attachment figures o Persistent and excessive worry that an event will lead to separation from one’s major attachment figures o Persistent reluctance or refusal to go away from home (to school, to work) o Persistently and excessively fearful or reluctant to be alone o Persistent reluctance or refusal to go to sleep alone o Repeated nightmares involving the theme of separation o Repeated complaints of physical symptoms when anticipating or following separation from major attachment figures  The duration of the disturbance is at least 4 weeks in children and adolescents and 6 months in adults  The disturbance causes clinically significant distress or impairment in functioning Demographics Time of onset: childhood More common in girls More common in children who come from close-knit families Most typically diagnosed in elementary age Prevalence declines with age Tends to come and come/wax and wane Separation Anxiety Disorder vs. Normal Separation Anxiety in Children  Normal separation anxiety is excepted in the first 2-3 years of age  Healthy, secure attachment to primary care giver  Not a factor of developing separation anxiety disorder C. School Phobia (not a disorder)  Used to be defined as an unrealistic fear that keeps children away from school  Now, defined as the fear of leaving one’s parents, not the fear of school itself  Considered a possible symptom of Separation Anxiety Disorder  Treatment: re-integrate child into school gradually, parent goes to school with child, move the parent out gradually III. Depression in Children and Adolescents A. Major Depressive Disorder  Criteria is same for children and adolescents as for adults  But, instead of sadness, children may get cranky/irritable  More common in females beginning in early adolescence B. Persistent Depressive Disorder  Symptoms must be present for only one year in children and adolescents  Chronic C. Disruptive Mood Dysregulation Disorder  New disorder in the DSM-5  Specific to children; onset must be prior to age 10 in order to get this diagnosis  Chronic, severe, persistent, irritability  Predominant in boys Etiology  Environmental factors (parent’s divorce, abused, depressed mother, etc.)  Genetic component Treatment  Anti-depressants  Play therapy for children: put them in a less stressful setting. This type of therapy is difficult, takes a lot of training  Cognitive therapy (adolescents) IV. Disorders Associated with Defiance and Aggression ODD  CD APD (all three more common in males) A. Oppositional Defiant Disorder (ODD)  First symptoms usually evident during preschool years and rarely later than early adolescence  Involves a pattern of hostile and defiant behavior that is usually limited to the home  Includes loss of temper, arguing, refusal of requests, anger, resentfulness, and deliberate annoyance of others  Sometimes develops into a Conduct Disorder (as they get older)  Onset is typically gradual  Some remit with time, others have counseling B. Conduct Disorder (CD): more serious disorder  Usually emerges in middle childhood through middle adolescence  Involves a pattern of conduct in which societal norms and the basic rights of others are violated over the course of the past year in a variety of settings (in the home, at school, with peers)  Includes stealing, lying, running away from home, school truancy, fighting, destruction of others’ property, fire setting, and cruelty to animals  Typically preceded developmentally by Oppositional Defiant Disorder  May develop into Antisocial Personality Disorder typically if onset is in early childhood  Prevalence has increased over time; higher in city (urban) areas than in rural areas  Doesn’t limit behavior just to home C. Antisocial Personality Disorder (APD): even more serious  Not diagnosed until 18 years of age  Involves pattern of disregard for and violation of the rights of others  Includes irritability, aggressiveness, stealing and harassing others, deceitfulness, recklessness, irresponsibility, and lack of remorse (they feel entitled)  Typically preceded developmentally by Conduct Disorder It’s important to recognize the difference between Conduct Disorder and Juvenile Delinquency, the difference between Antisocial Personality Disorder and Psychopathy, and the difference between Antisocial Personality Disorder and criminal behavior Causal Factors  Might be a genetic component (temperamental predisposition)  Many environmental factors (mom & dads parenting style, stress in family setting, abused, poor peer relationship, lower SE group) Treatment  Family therapy is the treatment of choice  Advise parents to use authoritative style  Also teach parents behavior techniques (reinforcement)  Helping parents modify environmental conditions (create structure: a time to eat, sleep, play, do homework, etc.) V. Sleep-Wake Disorders in Children and Adolescents A. Normal Sleeping Patterns in Childhood  Children usually sleep well through the night and take a nap up until 5 years of age  Elaborate bedtime routine (helps to transition from day to night, repetitive and reassuring)  Many children have a transitional object (bunny, blanket, etc.) o These children tend to be more confident B. Sleep Patterns across the Lifespan  Newborn: 18 hours a day, wake up every 2-3 hours; 3 months of age start to sleep through the night  6 months: more than half of their sleeping is done at night; less naps during the day  5 years: about 11 hours of sleep at night  9 years: about 10 hours  13 (adolescents): about 9 hours  Late adulthood (65+): about 6 hours C. Sleep Disorders  As the night wears on, we spend less time in Stage 4 and more time in REM sleep  90 minute sleep cycle D. Classifying Sleep Disturbances in the DSM-5  Isolated or infrequent episodes of nightmares, night terrors, or sleepwalking are relatively common in the general population  These sleep related events are only classified as a disorder if they are recurrent and are accompanied by either distress or impaired functioning  They are classified in a category called Sleep-Wake Disorders under Parasomnias  Parasomnias are disorders characterized by abnormal events occurring in association with sleep and/or specific sleep stages  Individuals who experience abnormal sleep episodes involving night terrors or sleepwalking are both diagnosed with Non-Rapid Eye Movement (NREM) Sleep Arousal Disorder E. Sleep Disturbances 1. Nightmares: Frightening dreams during REM sleep (most likely occur in second half of sleep) 2. Night Terrors: Abrupt awakening during Stage 4 sleep which begins with a panicky scream or cry and typically lasts 1-10 minutes (child is unresponsive and will have amnesia when wakes up) o More common in boys o Tends to run in families o Usually remits spontaneously 3. Sleepwalking: Rising from bed during Stage 4 sleep that typically lasts only a few minutes (typically within the first 2-3 hours) o Typically has amnesia o More common in girls o Generally disappears in adolescents o Runs in families F. Nightmare Disorder vs. NREM Sleep Arousal Disorders Nightmare Disorder NREM Sleep Arousal Disorder  Occurs during REM sleep  Occurs during Stage 4 sleep  Occurs during second half of  Occurs during first third of sleep sleep  Awakens easily  Typically does not awaken  Reports vivid dreams fully  Has amnesia for the episode  Includes night terrors and sleepwalking VI. Enuresis Diagnostic Criteria  Repeated voiding of urine into bed or clothes  The behavior is clinically significant as manifested by either a frequency of twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning (can be less time if causes distress/impairment  Chronological age is at least 5 years  The behavior is not due exclusively to the direct physiological effect of a substance or a general medical condition (ex: if diabetes is the cause of wetting bed, will not get diagnosis of Enuresis) *Strong genetic component Types of Enuresis 1. Primary: diagnosed in a child who never established urinary continence (continence=can control wetting) 2. Secondary: diagnosed in a child who has regressed after at least a year of established urinary continence Prevalence  Decreases with age  5-10% of 5 year olds are diagnosed  10 year olds (middle childhood): 3-5% are diagnosed  15 years old (adolescents): 1% diagnosed  More common in boys  Runs in families  Negatively affects self esteem  Higher concordance rate for monozygotic twins Bell and Pad Method Technique developed by Mowrer and Mowrer using classical conditioning to treat individuals with Enuresis The child sleeps on a pad wired to an alarm  the first drops of urine set off the alarm and wake the child  the child comes to associate a full bladder with awakening Neurodevelopmental Disorders I. Overview  All of these disorders have an onset in the developmental period (before age 18)  New category in the DSM-5 II. Intellectual Disability (Intellectual Developmental Disorder) Diagnostic Criteria  Deficits in mental abilities or intellectual functioning (IQ score 70 or below)  Impairment in adaptive functioning for the individual’s age and sociocultural background (ex: not communicating, not caring for themselves, not dressing themselves, not functioning at appropriate age)  All symptoms must have an onset during the developmental period (prior to age 18) Prevalence  About 2.5% of the population will have an IQ of 70 or below  But, only 1% will fill all 3 categories of the diagnostic criteria  More common in boys Severity Levels: tests actual functioning vs. IQ scores  Mild (Large majority): able to function at about a 6 grade level  Moderate  Severe  Profound *Less and less are occurring at the more severe types Etiology Etiology Example Description Heredity Tay-Sachs Disease Brain disease: affects nervous system (more common in eastern European/Jewish ancestry) -inherent recessive gene from mom/dad -die before 5 birthday -degenerative disease Aberrations in Down’s Syndrome Abnormality in Chromosomal chromosomes: child Development inherits 3 21st chromosomes -most common of all chromosomal disorders -more likely to be born with eye, heart defects, & respiratory problems -occurrence increases with age of parent Prenatal and Pregnancy Prenatal Alcohols Other examples: fetal Problems Exposure malnutrition/toxins/pre- mature babies at greater risk General Medical Trauma Child born with normal Conditions Acquired in IQ, something effects the Infancy/Childhood child early on Environmental Influences Deprivation Child institutionalized early on, child needs to be able to engage with others Prenatal Alcohol Exposure: occurs when an expectant mother consumes alcohol, predisposing her unborn child to increased likelihood of ID and birth defects  Leading preventable cause of birth defects in the US/within moms control  Most common cause of intellectual disability Fetal Alcohol Spectrum Disorder (FASD): a group of disorders caused by prenatal alcohol exposure. Alcohol Effects represents the less serious end of the spectrum of FASD, and Fetal Alcohol Syndrome represents the more serious end of the spectrum.  1 out of 10 children  Symptoms: o Smaller/low birth weight o Facial and/or body abnormality o Some degree of intellectual disability o Increased risk for intellectual disability, learning disorders, & ADHD Treatment Special Education: educational programs that help children with disabilities (I.D.E.A.: all children get public education) Rehabilitative Measures: skill-training programs for adolescents and adults that include sheltered workshops (learn how to do a simple task; repetitive) Community-Based Programs: programs that aim to teach self- supporting skills, such as ClemsonLIFE Institutionalization: last resort for disabled individuals (intended only for individuals who are profoundly disabled) III. Specific Learning Disorder (used to be called learning disorder in DSM-IV) What is it? A Specific Learning Disorder is diagnosed when the individual’s achievement on an individually administered standardized test in reading, mathematics, or written expression is substantially below that expected for their level of intelligence as measured on an individually administered aptitude test.  Aptitude Test: measures IQ  Achievement Test: measures what they know currently  If they score higher on IQ than achievement, learning disorder suspected Learning Skill Deficiencies 1. Reading (most common)  Word reading accuracy  Reading rate or fluency  Reading comprehension 2. Mathematics  Number sense  Memorization of arithmetic facts  Accurate or fluent calculation  Accurate math reasoning 3. Written Expression (least common) o Spelling accuracy o Grammar and punctuation accuracy o Clarity or organization of written expression Depending on the child’s skill deficiency, we would add one or more of the above impairments as a specifier to the diagnosis Prevalence Age of onset: early elementary 5-15% of all children have some degree of a learning disorder In the DSM-IV, it was about equal in boys & girls; more likely to be recognized and diagnosed in boys because they want attention…In DSM-5, more common in boys Associated Features Typically have at least average or above average IQ Typically have normal vision and hearing More common in lower socioeconomic groups Children having difficulty processing sensory information Lower self esteem More likely to have difficulty with social skills Disruptive in class More likely to drop out of high school (40%) Prognosis, Etiology, Treatment Lifelong diagnosis; can’t cure Genetic Prenatal factors (FASD) Environmental factors Treatment: different programs that teach children how to compensate IV. Attention Deficit/Hyperactivity Disorder (ADHD) Diagnostic Criteria A. Either (1) or (2): (1)Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Inattention:  Often fails to give close attention to details or makes careless mistakes  Often has difficulty sustaining attention  Often does not seem to listen when spoken to directly  Often does not follow through on instructions and fails to finish activities  Often has difficulty organizing tasks and activities  Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental efforts  Often loses things  Is often easily distracted  Is often forgetful (2)Six (or more) of the following symptoms of hyperactivity- impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Hyperactivity:  Often fidgets or squirms while seated  Often leaves seat in classroom when should be seated  Often runs about or climbs excessively  Often has difficulty playing or engaging in leisure activities quietly  Is often “on the go”  Often talks excessively Impulsivity:  Often blurts out answers  Often has difficulty awaiting turn  Often interrupts or intrudes on others B. Some hyperactive-impulsive or inattention symptoms that caused impairment were present prior to age 12 years (Was age 7 in the DSM-IV) C. Some impairments from the symptoms is present in two or more settings D. There must be clear evidence of clinically significant impairment in functioning Specify whether: 1. Predominantly inattentive presentation 2. Predominantly hyperactive/impulsive presentation 3. Combined presentation Prevalence  Age of onset: elementary school age  5% of all American public school children have ADHD  More common in boys  Commonly co-occur with specific learning disorder  More likely to have social problems  Most frequent reason that children are referred to a psychiatrist Etiology  Strong genetic component  Structural abnormalities  Environmental factors (prenatal, born prematurely, post natal: exposed to environment) Treatment Medication (stimulants): Ritalin (most common) I.D.E.A.: individualized program V. Autism Spectrum Disorder (ASD) Autistic Disorder Impairment in social interaction Impairment in ability to communicate Restricted, repetitive, and stereotyped behaviors, interests, or activities Onset prior to age three years Asperger’s Disorder Impairment in social interaction Typically evidence at least normal language and cognitive development Restricted, repetitive, and stereotyped behaviors, interests, or activities Autism Spectrum Disorder (includes both above)  Deficits in social communication and social interactions o Deficit in the ability to communicate nonverbally o Deficit in developing relationships with others o Deficit in understanding the emotions of others o Deficit in the ability to initiate/sustain a conversation with others 1. Stereotyped and repetitive use of language (ex: echolalia: parrot-like repetition of a few words 2. Idiosyncratic language (ex: pronoun reversal: refers to themselves as she/he instead of I)  Restricted, repetitive behavior patterns, interests, or activities o Adherence to routines or rituals (want everything exactly the same) o Persistent preoccupation with parts of objects (ex: spinning the wheels of a toy truck) o Self-stimulatory activity (ex: banging head on wall, rocking, waving arms) o Devotion of large amounts of time to specialized interests (ex: knows everything there is to know about dinosaurs, more typical for higher functioning individuals)  Onset in early childhood Specifiers With or without accompanying intellectual impairment With or without accompanying language impairment Autism Spectrum Disorder and Intellectual Disability  In many cases, the diagnosis of Autism Spectrum Disorder co- occurs with a diagnosis of Intellectual Disability  If this is the case, the individual will need to fully meet the DSM criteria for both disorders Autism Spectrum Disorder and Savant Syndrome Savant Syndrome is a condition whereby individuals with a developmental disorder demonstrate exceptional, usually isolated, abilities In some cases, individuals with Autism Spectrum Disorder will evidence Savant Syndrome If this is the case, the individual with Autism Spectrum Disorder will evidence an exceptional, usually isolated, cognitive or other ability which is inconsistent with their overall cognitive and social development Causal Factors of Autism Spectrum Disorder Autism Spectrum Disorder has a strong genetic component and is probably the most heritable form of psychopathology in the DSM In that the genetic contribution to Autism Spectrum Disorder is not 100%, it appears that environmental factors must also play a role In the past, a link between vaccines and Autism Spectrum Disorder was speculated, but no evidence has been found to substantiate the claim At this point, specific environmental factors are unknown Associated Features Difficulty maintaining eye contact Typically don’t use facial expressions/body language Difficulty establishing/maintaining a relationship Would prefer to play alone Can recognize others emotions, but don’t understand them (haven’t developed a theory of mind: beliefs, intentions, emotions that may be different from one’s own) More hyperactive, impulsive, aggressive, temper tantrums Prevalence Age of onset: symptoms are recognized in the 2 nd year of life most typically; early childhood (prior to age 6) Seems to be increasing; on the rise Approaching 1% of the population Much more aware of this disorder than we used to be More common in boys Prognosis Depends on:  Degree to which their behavior patterns are restricted  How severe is their inability to communicate  If they have an impairment, prognosis is not as good Etiology Strong genetic component (most heritable form of psychopathology in DSM) Biological defect Obesity (maybe; not enough research) Treatment No medication Most effective treatment: behavior therapy Mapping the brain Difficult, long term process Feeding and Eating Disorders I. Anorexia Nervosa: loss of appetite induced by nervousness Diagnostic Criteria  Refusal to maintain body weight at or above minimally normal weight for age and height  Intense fear of gaining weight or becoming fat  Disturbance in the way in which one’s body weight or shape is experienced (thinks she is fat), undue influence of body weight or shape on self-evaluation (discounts everything else about her that is good), or denial of the seriousness of the current low body weight (doesn’t recognize the harm) *In the DSM-4, part of the diagnostic criteria was Amenorrhea, which is when a young woman has missed 3 consecutive menstrual cycles. Not part of the DSM-5 Restricting Type: During the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (nonpurging behavior) Binge-Eating/Purging Type (Most Common): During the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior Age of Onset & Prevalence Age of onset: 14-18 years (Average age: 17 years) Prevalence: 1% in females, significantly less in men About 90% who have it are females Frequency is increasing About 30-50% will start with restricting type, changes into the binge-eating/purging type Associated Features Pre-occupied with food (like to cook food, read about food, watch other people eat) Depressive symptoms (irritable, socially withdraw, insomnia) Obsessive-compulsive symptoms Course and Prognosis Varies based on individual One episode, treatment, they are fine Fluctuating patterns of normal eating followed by relapse Can come and go Chronically deteriorating Out of all cases admitted at a university clinic, 10% will die (either suicide or starvation) Etiology: Biopsychosocial Model Structural problem with hypothalamus Deficient in one or more neurotransmitters Low levels in serotonin Genetic component: concordance rate is greater in monozygotic twins Fear of growing up (becoming sexual) Control issue Excessive emphasis from parents Increase in stress Social media Treatment Hospitalization if necessary Treatment of choice: family therapy especially for adolescents Long term support component Compensatory Behavior in Anorexia Nervosa and Bulimia Nervosa Purging Behavior  Self-induced vomiting  Misuse of laxatives, diuretics, or enemas Nonpurging Behavior  Fasting  Excessive exercise II. Bulimia Nervosa Diagnostic Criteria Recurrent episodes of binge eating characterized by: 1. Eating an abnormally large amount of food in an inappropriately short period of time 2. A sense of lack of control over eating during the episodes  Recurrent inappropriate compensatory behavior in order to prevent weight gain  The binge eating and inappropriate compensatory behaviors both occur on average, at least once a week for 3 months  Self-evaluation is unduly influenced by body shape and weight  The disturbance does not occur exclusively during episodes of Anorexia Nervosa *In the DSM-IV, there were 2 types of bulimia, only 1 in the DSM-5 Age of Onset and Prevalence  Age of onset: 20-24 years  1.5% in females, significantly less for males  More common in females Associated Features Normal weight range Not typically obese or heavily overweight Extensive tooth decay Loss of hair Mood disorders Low self esteem: inclined toward depressive symptoms Prognosis Disorder can be chronic intermittent (come and go) Symptoms tend to decrease with age Less serious than anorexia, more chronic deterioration (Individuals with anorexia don’t believe they have a problem, bulimics are more likely to get help If individual meets criteria of both, you get diagnosis of anorexia Etiology: Biopsychosocial Model Genetic component: not as strong as anorexia nervosa Strongest predictor: having a family member make strong comments to a woman about her looks The desire for a woman to fit in with society Treatment Taking anti-depressants: decreases frequency & depressive symptoms Cognitive Behavioral Therapy (CBT): combination of cognitive and behavioral (Treatment of Choice) Help woman recognize distorted views and replace those with positive thoughts Encourage her eat smaller, healthy foods throughout the day *Eating disorders are the 2 ndmost common reason people visit university clinic Differential Diagnosis Anorexia Nervosa vs. Bulimia Nervosa Similarities Differences  Both eating disorders 1) Anorexia: extremely thin  Fear of gaining weight, want individuals to lose weight, not satisfied Bulimia: normal weight or with how they look somewhat overweight; not obese 2) Anorexia: don’t believe they have a problem Bulimia: recognize they have a problem, will binge & purge in private 3) Anorexia: not all binge Bulimia: all will binge Binge-Eating Disorder is a disturbance in eating that involves recurrent episodes of binge eating but does not involve the use of inappropriate compensatory behavior, that is, the individual doe not regularly purge or fast in order to control their weight Binge-Eating Disorder vs. Bulimia Nervosa Similarities Differences Bulimia:  Both involve episodes of binge-eating  Individual behaves in  Frequency of binge eating is recurrent compensatory recurrent behavior  Individual feels like eating is  Normal weight/slightly out of their control overweight Binge-eating:  Binges, doesn’t purge or fast  Typically overweight or obese Neurocognitive Disorders Category of disorders included in the DSM that is characterized by the development of cognitive deficits -Individual used to function at a high level, now function at a low level because of something that happened I. Overview  All neurocognitive disorders share similar symptoms but are differentiated based on etiology  Cognitive deficits must represent a significant decline from a previous level of functioning  Some Neurocognitive Disorders were referred to as Dementia in earlier editions of the DSM  Senility is frequently used to describe this type of cognitive decline in older people, but it is not a true medical diagnosis II. Cognitive Deficits 1. Aphasia: deterioration of language function oftentimes manifested by difficulty producing the names of individuals and objects 2. Apraxia: impaired ability to execute motor activities despite intact motor abilities, sensory function, and comprehension of the required task 3. Agnosia: failure to recognize or identify objects or people despite intact sensory function (don’t recognize the person or object at all) 4. Disturbances in Executive Functioning: involves the inability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior III. Etiology  Symptoms involve cognitive deficiency: all caused by a medical condition or use of a substance  Medical Conditions o Brain injury  Substance o Chronic alcohol use  2/3 of neurocognitive disorders are caused by Alzheimer’s IV. Course and Treatment  Age of onset: depends on etiology, typically begins in late adulthood (65+)  Highest prevalence: over the age of 85  Uncommon in children or adolescents, but can happen (ex: brain tumor)  Gradual onset  In earlier editions of DSM, “dementia” was an official diagnosis; it implied a chronic course, resistant to any care  Now, not all neurocognitive disorders are chronic, but the majority are (ones due to Alzheimer’s are chronic) V. Neurocognitive Disorder Due to Alzheimer’s Disease (Most common neurocognitive disorder) On Alzheimer’s  Irreversible and degenerative brain disease that causes the vast majority of neurocognitive disorders  Most common & most feared disease Onset and Prognosis Increase in frequency Prevalence is increasing Public awareness is increasing Ages 60-64: 1% develop Alzheimer’s Ages 85 +: 40% develop More common in North America and Western Europe than Africa, India, and SE Asia Onset is gradual/continuous cognitive decline Slightly more common in females (partially because women tend to live longer lives Early & Late Onset of Alzheimer’s Disease Early Onset  Begins at or before 65 years  Less common  Greater genetic contribution  More rapid progression Late Onset  Begins after 65 years  More common  Greater environmental contribution  Slowly progressive Symptoms 1. At onset: deficit in memory (earliest symptom)  Most impacted early on: ability to recall recent events (ex: where did I put my keys?) 2. Progressive symptoms: confusion, disorientation, restlessness, agitation, irritability (ex: drive to friends house and don’t remember how to get home) 3. Final stage symptoms: bedridden, inability to use or understand language, inability to recognize people, inability to control bodily functions Etiology Strong genetic component: concordance rate is higher for monozygotic twins (but not 100%) Possible risk factors: o Obesity o Physical inactivity o Depression o Type 2 diabetes o Smoking o Low SES o Head trauma  Preventative measures: o Making dietary changes (diet high in fish, eggs, seeds, nuts) o Taking ibuprofen o Exercising o Engaging in mentally stimulating activities (crossword puzzles, learn an instrument) Diagnosis  Difficult to diagnose a living person because there are 50 different causes for dementia (hard to know if Alzheimer’s is causing it)  Different tests are done (interview, physical, lab tests, brain scans, etc.) to rule out other potential causes  Autopsy and physically examine the brain to know for sure Treatment  No cure  Slow down the progress/extend the person’s life o Medication o Antidepressants can help to treat depressive symptoms o Cognitive and behavioral therapy  Attend to the families needs o Counseling  Today, there’s more of an emphasis on preventing the onset since there is no cure once a person has the disease


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