AP LESSON 3

• Separation Anxiety Disorder


  • Concerns with real or imagined separating from attachment figures
  • Separation may lead to extreme anxiety and panic attacks
  • Not entirely responsible for school absences or school avoidance
  • Do not attend school so they won't be separated with their attachment figure
  • Fear of possible separation is the central thought
  • Concerned about the proximity and safety of key attachment figures
  • At least 4 weeks (children) or 6 months or more (adults)
• Selective mutism


  • Rare childhood disorder
  • Characterized by a lack of speech in one or more setting in which speaking is socially expected
  • Restricted to a specific social situation
  • A child could speak in one setting but cannot / do not in another setting
  • Not better explained by communication disorder
  • Only diagnosed when a child has established a capacity to speak in some social situations
  • Learn to perform avoidance and safety behaviors to avoid disasters
  • At least 1 month
• Specific phobia


  • Irrational fear of a specific object or situation that markedly interferes with an individual's ability to function
  • Acquired through direct experience, experiencing in false alarm, and observation
  • It only fears one setting, unlike Agoraphobia (requires 3 settings), then Specific phobia – situational can be diagnosed
  • 6 months or more
• Social anxiety disorder


  • Fear or anxiety about possible embarrassment or scrutiny
  • Can have panic attacks but it is cued by social situations
  • Typically have adequate age – appropriate social relationships and social communication capacity
  • 6 months or more
• Panic disorder


  • Cannot be diagnosed unless full symptom panic attacks were experienced
  • Norepinephrine activities are irregular
  • Abrupt surge of intense fear or discomfort out of nowhere, with no triggers
  • Followed by persistent concerns about more attacks or the consequences of it or maladaptive change in behavior related to the attacks
• Agoraphobia


  • Developed after a person has unexpected panic attacks
  • Fear in two or more situations (public transportation, open spaces, enclosed spaces, standing in line, being outside of the home alone) due to thoughts that escape might be difficult or no one will help them in case panic – like symptoms would manifest
  • 6 months or more
• Generalized anxiety disorder


  • Difficulty to control worry
  • Excessively anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities
  • "the world is a dangerous place"
  • Intensive cognitive processing in the frontal lobes, particularly in the left hemisphere
  • Intense worrying may act as avoidance
  • Worry whether or not they are judged / evaluated
  • Fear circuit is excessively active
• Reactive attachment disorder


  • Withdrawn toward adult caregivers
  • Evident before age 5 years
  • History of severe social neglect
• Disinhibited social engagement disorder


  • Actively approaches and interacts with unfamiliar adults
  • Can be distinguished from ADHD by not showing difficulties in attention or hyperactivity
• Posttraumatic stress disorder


  • Exposure to actual death, injury or sexual violence (direct experience, witness, learning that the event happened to a close family, repeated exposure)
  • More than 1 month
  • Heightened activity in the HPA axis
  • Requires trauma exposure precede the onset of the symptoms
  • Too much use of dissociation
• Acute stress disorder


  • Exposure to trauma (direct experience, witness, learning that event occurred to close fam, repeated exposure)
  • 3 days to 1 month after trauma exposure
  • If the symptoms persist for more than 1 month and meet the criteria for PTSD, then PTSD will be diagnosed
• Adjustment disorder


  • Development of emotional or behavior symptoms in response to identifiable stressors occurring within 3 months of the onset of the stressors
  • If symptoms persist beyond 6 months after the stressor or its consequences have ceased, the diagnosis will no longer apply
  • May sometimes be diagnosed instead of bereavement if bereavement is judged to be out of proportion to what would be expected or significantly impairs self – care and interpersonal relations
• Prolonged grief disorder


  • Death, at least 12 months, of a person close to the bereaved individual (6 months for children)
  • Focused on loss and separation from a loved one rather than reflecting generalized low mood
  • Distress from a deceased person
• Obsessive – Compulsive Disorder


  • Obsessions – intrusive and mostly nonsensical thoughts, images, or urges that the individual tries to resist or eliminate
  • Compulsions – thoughts or actions used to suppress the obsessions and provide relief
  • Tic disorders is common to co-occur in patients with OCD
  • Obsessions usually do not involve real life concerns and can include one, irrational, or magical content
  • In BDD and Tricho, the compulsive behavior is limited to hair pulling or distortions in absence of obsessions
  • Obsessions and compulsions are not limited to concerns about weight and food
  • Compulsions are usually preceded by obsessions, tics, are often preceded by premonitory sensory urges
• Body Dysmorphic Disorder


  • Preoccupation with some imagined defect
  • Imagined ugliness
  • Excessive appearance – related preoccupations and repetitive behaviors that are time – consuming
  • Can be co-morbid with eating disorders
• Hoarding


  • Difficulty discarding or parting with possessions
  • Prader – Willi Syndrome: characterized by severe hypotania, poor apetite, and feeding difficulties in early infancy, followed in early childhood by excessive and gradual development of morbid obesity
  • Not direct consequence of neurodevelopmental disorder, nor delusion, nbor psychomotor retardation, fatigue, or loss of energy
• Trichotillomania


  • Should not be diagnosed when hair removal is performed solely for cosmetic reasons
  • Diagnosis will be OCD, if there is obsession of symmetry
  • Someone with ASD could have hair – pulling behaviors when frustrated or angry, so if it's impairing then it can be diagnosed as stereotypic movement disorder
  • Note the delusion or hallucination, if then, psychotic disorder
• Excoriation


  • Note delusion or tactile hallucination
  • In absence of deception, excoriation disorder can be diagnosed if there are repeated attempts to decrease or stop skin picking
• Somatic Symptom Disorder


  • 1 or more symptoms cause distress and disruption of daily life
  • Chronic, influenced by the number of symptoms, age, level of impairment, and any comorbidity
  • Ineffectiveness of analgesics, history of mental disorders, unclear palliative factors, persistence without cessation, and stress
  • Must be accompanied by excessive or disproportionate thoughts, feelings, or behavior
  • Focus is on the distress that particular symptoms cause
  • Individual's belief that somatic symptoms might reflect serious underlying physical illness are not held with delusional intensity
  • With enhanced perceptual sensitivity to illness cues
• Illness Anxiety Disorder


  • Preoccupation with having or acquiring serious illness
  • Usually minimal to no symptoms, mild intensity
  • Interpret ambiguous stimuli as threatening
  • Develop in the context of a stressful life
  • People who develop these disorders tend to have a disproportionate incidence of disease in their family when they were children
• Conversion Disorder (Functional Neurological Symptom Disorder)


  • Altered voluntary motor or sensory function
  • Incompatibility between the symptom and recognized neurological or medical conditions
  • Unexpected neurological disease cause for the symptoms is rarely found at follow – up
  • Too much use of denial
• Psychological Factors affecting other Medical Conditions


  • Medical symptom is present
  • Psychological or behavioral factors affect medical condition
  • Psychological or behavioral factors are judged to affect the course of medical condition
  • Psychological factors affecting other medical conditions is diagnosed when the psychological traits or behaviors do not meet criteria for mental diagnosis
• Factitious Disorder


  • Imposed on self: individual present himself or herself as ill
  • Imposed on another: presents another individual as ill
  • Absence of obvious rewards
  • Malingering: false medical symptoms or exaggerating existing symptoms in hopes of being rewarded
• Depersonalization – Derealization Disorder


  • Depersonalization: Your perception alters so that you temporarily lose the sense of your own reality, as if you are in a dream watching yourself
  • Derealization: Your sense of external world is lost; thing may seem to change shape or size, people may seem dead or mechanical
  • Characterized by the presence of constellation of typical depersonalization/derealization symptoms and the absence of manifestations of illness anxiety disorder
  • Must precede the onset of major depressive epi or clearly continues even after its resolution
  • When symptoms occur ONLY during panic attacks, it must not be diagnosed with D/DD
• Dissociative Amnesia


  • Inability to recall important autobiographical information, usually of traumatic or stressful nature, that is inconsistent with ordinary forgetting
  • Usually localized or selective amnesia for specific events, then generalized, if entire life history
• Dissociative fugue


  • Memory loss revolves around specific incident, an unexpected trip; individuals just take off and later find themselves in a new place, unable to remember why or how you got there
  • If a person experience PTSD cannot recall part or all specific trauma event and that extends to beyond the immediate time of the trauma, comorbid diagnosis of DA may be warranted
  • There must be not true neurocognitive deficits
  • Too much use of repression
• Dissociative Identity Disorder


  • Disruption of identity characterized by two or more distinct personality states
  • Host personality: The person who becomes the patient and asks for treatment; developed later
  • Switch: Transition form one personality to another
  • Extreme subtype of PTSD
  • Hypnotic trance: Tend to be focused on one aspect of their world and they become vulnerable to suggestions by the hypnotist
  • Does not have s classic bipolar sleep disturbance
  • Individuals with schizophrenia have low hypnotic capacity, whilst, individuals with DID have highest hypnotic capacity among all clinical groups
  • Appear to encapsulate a variety of severe personality disorder features
  • Too much use of dissociation
• Disruptive Mood Dysregulation Disorder


  • Recurrent temper outburst (verbally or behaviorally) that are grossly out of proportion
  • 3 or more times / week
  • Irritable or angry most of the day
  • 12 or more months, at least 2 settings
  • Onset should be after 6 – 18 yrs
  • Do not occur exclusively during MDE
  • Bipolar = episodic, DMD = persistent
  • Diagnosis cannot be assigned to a child who has ever experienced full – duration hypomanic or manic episode (irritable or euphoric) or who has ever had a manic or hypomanic episode lasting more than 1 day
  • Presence of severe and frequently recurrent outburst and persistent disruption in mood between outburst
  • Severe in at least 1 setting and mild to moderate to second setting
• Major Depressive Disorder


  • At least 2 weeks of either anhedonia or depressed mood
  • "other specified depressive disorder" can be made in addition to the diagnosis of psychotic disorder
  • In schizoaffective, delusions or hallucinations occur exclusively for 2 weeks without MDE
  • Seasonal, catatonic, melancholic
• Persistent Depressive Disorder


  • Depressed mood for at least 2 years
  • If full criteria for a MDE has been met at some point during the period of illness, a diagnosis of MDD would apply. Otherwise, a diagnosis of "other specified depressive disorder" or "unspecified depressive disorder" should be given
  • A separate diagnosis of PDD is not made if the symptom occur only during the course of the psychotic disorder
  • Double depression: suffer from both MDE and PDD
• Premenstrual Dysphoric Disorder


  Majority of menstrual cycles, at least 5 symptoms must be present
• Seasonal Affective Disorder


  • Episodes must have occurred for at least 2 yrs with no evidence of nonseasonal MDE during that period of time
  • Cabin fever
• Integrated Grief


  Acute grief, the finality of death and its consequences are acknowledged and the individual adjusts to the loss
• Complicated grief


  • This reaction can develop without preexisting depressed state
  • Bipolar disorder may simply be a more severe variant of mood disorders
• Bipolar I


  • At least 1 manic episode
  • Children should be judged according to his or her own baseline in determining whether a particular behavior is normal or evidence of manic episode
  • First ep usually MDE
  • Factors that should be considered: Family history, Onset, Medical history, Presence of psychotic symptoms, History of lack of response to antidepressant treatment
  • The diagnosis is "Bipolar 1 disorder, with psychotic features" if the psychotic symptoms have occurred EXCLUSIVELY during manic and major depressive episodes
  • Symptoms of mania in BP! Occur in distinct episodes and typically begin in late adolescence or early adulthood
  • When any child is being assessed for Mania, it is essential that the symptoms represent clear change from the child's typical behavior
  • Symptoms of mood lability and impulsivity must represent a distinct episode of illness, or there must be a noticeable increase in these symptoms over the individual's baseline in order to justify an additional diagnosis of BP1
• Bipolar II


  • MDE + Hypomanic episodes
  • Often begins with depressive episodes
  • Highly recurrent
  • Once hypomanic episode has occurred, it never reverts back to MDD
  • BP2 is distinguished from cyclothymic disorder by the presence of one or more hypomanic episodes and one or more MDE
• Cyclothymic disorder


  • Milder but more chronic version of bipolar disorder
  • Do not meet the complete criteria for depressive symptoms and hypomanic symptoms
• Pica


  Eating of non – nutritive, nonfood substances
• Mania


  Symptoms represent clear change from the child's typical behavior
• Mood lability and impulsivity


  Must represent a distinct episode of illness, or a noticeable increase over the individual's baseline