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Criteria for autism
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6 symptoms: 2+ in Category 1 = soc interaction,
1+ in Category 2 = communication,
1+ in Category 3 = stereotyped behavior,
PRIOR to 3 yrs = abnormal soc interaction, soc language or imaginative play
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Phenlketonuria (PKU)
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Rare recessive gene syndrome, unable to metabolize amino acid phenylalanine in high-protein foods.
Produces mental retardation, impaired motor & language dev & erratic behaviors.
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Down Syndrome
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"trisomy 21" due to extra chromosome.
Cause of 10-30% of all cases of mod to severe retardation.
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Differential for mental retardation
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borderline intellectual functioning IQ = 71-84.
BUT could be retardation if IQ < 75 PLUS deficits in adaptive functioning.
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Types of learning disorders (3)
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Reading, Mathematics Disorder, Written Expression.
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Types of communication disorders (4)
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Expressive Language Disorder, Mixed Receptive-Expressive Language Disorder, Phonological Disorder, and Stuttering
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Types of pervasive developmental disorders (4)
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Autistic Disorder,
Rett's Disorder,
Childhood Disintegrative Disorder, and
Asperger's Disorder.
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Gender differences in rates of autism
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4 - 5 times more common in males
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treatment for autism
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shaping & discrimination training (Lovaas, 1960s)
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Rett's Disorder
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Characteristic pattern of symptoms FOLLOWING 5+ MONTHS OF NORMAL DEVELOPMENT lasting for 5 months +
head growth deceleration, loss of purposeful hand skills, stereotypical hand movements, impairments in gait, loss of interest in social environment, impaired language development, psychomotor retardation.
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Childhood Disintegrative Disorder
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developmental regression in 2 areas of development, FOLLOWING 2+ YEARS OF NORMAL DEVELOPMENT
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Asperger's Disorder
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Severe impairment in social interactions, restricted behaviors / interests, normal intelligence, good verbal skills with NO DELAYS IN LANGUAGE, COGNITIVE SKILLS etc.
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Indicator for favorable prognosis in Autism
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verbal communication by age 5 or 6, Qu = 70+, later onset symptoms.
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ADHD very common with comorbid ___________
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conduct disorder
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ADHD: Gender ratio
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2 - 9 times more common in boys.
More equal gender ratio with Inattentive Type.
More equal gender ratio in adults.
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ADHD: distinguishing characteristic
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Fluctuation of symptoms in different settings.
Sx more likely in situations that are: familiar, highly repetitive, highly structured with no regular feedback.
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ADHD: behavioral disinhibition hypothesis
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Inability to regulate behavior to fit situational demands.
Hypothesis supported by fluctuation of sx in diff settings.
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Ritalin
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CNS stimulant methylphenidate
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Attention-Deficit and Disruptive Behavior Disorders (3)
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ADHD, Conduct Disorder, and Oppositional Defiant Disorder
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Conduct Disorder
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Pattern of behaviors that violate rights of others and/or age-appropriate social rules.
Childhood-onset type (<10 yrs) Adolescent-onset type (>10 yrs) life-course persistent type
Adolescence-limited type
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Oppositional Defiant Disorder
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pattern of negativistic, defiant, and hostile behaviors toward authority figures
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Other Disorders of Infancy, Childhood, or Adolescence
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Separation Anxiety Disorder, Selective Mutism,
Reactive Attachment Disorder,and Stereotypic Movement Disorder.
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Separation Anxiety Disorder
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< 18 yrs, 4+ weeks 3 characteristic behaviors.
DIFF DIAG - school refusal (can be a sign of depression during adolescence)
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Reactive Attachment Disorder
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Developmentally inappropriate social relatedness, onset <5 yrs , there must be evidence of pathogenic care.
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Delirium: diagnosis
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1. disturbance in consciousness 2. change in cognition and/or perceptual abnormalities.
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Delirium: high risk groups (5)
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1. Elderly people with decreased cerebral reserve due to dementia.
2. stroke
3. HIV
4. postcardiotomy patients
5. burn patients
6. people with drug dependence experiencing withdrawal
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Dementia: diagnosis
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multiple cognitive deficits that include:
1. some memory impairment
2. aphasia, apreaxia, agnosis, and/or impaired executive functioning
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aphasia
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Deterioration in language functioning:
difficulty naming people and objects, and
difficulty understanding written and spoken language.
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apraxia
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difficulty executing motor actions e.g. unable to dress
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agnosia
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Inability to recognize and identify familiar objects and people.
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executive functioning
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Abstract thinking,
trouble shooting,
initiating behaviors,
monitoring behavior, and stopping complex behaviors.
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Dementia: differentials
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1. age-related cognitive declines
2. mental retardation (< 18 yrs) 3. major depressive disorder
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Alzheimer's: stages
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Stage 1 (1-3 yrs) anterograde amnesia, wandering, irritability, sadness.
Stage 2 (2-10 yrs) retrograde amnesia, flat mood, agitation, delusions.
Stage 3 (8-12 yrs) severely deteriorated intellectual functioning, limb rigidity, incontinence.
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Dementia: Types (e.g. Dementia Due to…)
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1. Dementia of the Alzheimer's Type
2. Vascular Dementia
3. Dementia Due to HIV Disease
4. Dementia Due to Parkinson's Disease
5. Dementia Due to Huntington's Disease
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Dementia: % caused by Alzheimer's Type
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65%
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Dementia Alzheimer's Type: possible causes
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1. genetics (chromosome 21)
2. aluminum deposits in brain tissues
3. malfunctioning immune system
4. low level ACh
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Vascular Dementia: risk factors
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1. hypertension
2. diabetes
3. cigarette smoking
4. atrial fibrillation
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Vascular Dementia
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caused by arteriosclerosis or other cerebrovascular disease
course is stepwise & fluctuating
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Dementia Due to Parkinson's Disease
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1. Bradykinesia
2. rigidity resting tremor
3. mask like expression
4. loss of coordination
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bradykinesia
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Extreme slowness of movement
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akathesis
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Inability to sit still
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Dementia Due to Huntington's Disease
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30 - 40 yrs sx fall into 3 categories: affective, cognitive , and motor.
Often starts with depression, irritability, apathy.
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apathy
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absence of feeling or enthusiasm
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Marlatt & Gordon re: Substance Dependence
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relapse prevention program dealing with high risk situations
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Substance Dependence
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3 symptoms in 12 months
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Substance Abuse
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1 symptom in 12 months
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Substance-Induced Disorders (5)
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1. Alcohol Intoxication
2. Alcohol Withdrawal
3. Alcohol Withdrawal Delirium
4. Alcohol-Induced Dementia
5. Alcohol-Induced Persistic Amnestic Disorder (Wernicke-Korsakoff Syndrome
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Wernicke-Korsakoff Syndrome
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Alcohol-Induced Persisting Amnestic Disorder
retrograde & anterograde amnesia, confabulation, abnormal eye movements.
Due to thiamine deficiency.
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Schizophrenia
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disturbance for 6+ months
1+ month of >2 active-phase symptoms
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Schizophrenia: Active phase symptoms
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a. delusions
b. hallucinations
c. disorganized speech
d. grossly disorganized behavior
e. negative symptoms
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