Disorder, Comorbidity, Treatment Planning and Instrumentation – Flashcards

Intellectual Disability Comorbidity: ADHD, depressive and bipolar disorders, anxiety disorders, Autism spectrum, stereotypic movement disorders, impulse-control disorders, and major neurocognitive disorders (p. 40). Treatment: (SIB) Behavior modification is treatment of choice (for self-injury), parent training, and community based treatment and individual psychotherapy Instrumentation: Wechsler Intelligence Test and Stanford-Binet Intelligence Scales

Autism Spectrum Disorder (combined the DSM-IV disorders into one spectrum; autistic disorder, asperger's disorder, childhood disintegrative disorder, pervasive developmental disorder, NOS) Comorbidity: Specific learning difficulties, developmental coordination disorders, medical conditions (epilepsy, sleep problems, constipation, avoidant-restrictive food intake disorders (p. 59) Treatment: Behavioral (no best treatment is currently found in the literature), floor technique, The Pervasive Development Pivotal Response Training (PRI) Instrumentation: Childhood Autism Rating Scale (CARS; Scholper, Reichler, DeVelis & Daly, 1991) is the most widely used. Disorders Screening Test II (Siegel, 1999), Individual Education Plan (IEP). The Social Communication Questionnaire, Taylor and Jasper's Social Skills Inventory (Maurice, Green, & Foxx, 1996) (eye contact, taking turns, initiating greetings, answering social questions, employing empathy, asking questions, relating to peers)

Attention Deficit Hyperactive Disorder Comorbidity: Oppositional defiant disorder, conduct disorder, disruptive mood dysregulation disorder, specific learning disorder, anxiety disorders, major depressive disorder, intermittent explosive disorder (p. 65) Adults: Intermittent explosive disorder, substance use disorder, antisocial personality disorder, obsessive-compulsive disorder, tic disorders, and autism spectrum (APA, 2005). Treatment: Stimulant medications, parent training, counseling, behavioral targeted classroom intervention, social skills, interferes with functioning in social, academic, and occupational domains Instrumentation: Achenbach Child Behavior Checklist is most commonly used as well as the Behavior Assessment System for Children, 2nd edition, Conners's Rating Scale-Revised (1996) and Conners's Teacher Rating Scales-Revised

Conduct Disorder (CD) Comorbidity: Antisocial personality disorder, specific learning disorders, anxiety disorders, depressive or bipolar disorders, substance-related disorders, academic achievement especially reading and verbal skills (p. 485). Treatment: Problem-Solving Skill (PSST) dysregulation, impulsivity social skills, anger management, parent management. Instrumentation: Achenbach Child Behavior Checklist is most commonly used as well as the Behavior Assessment System for Children, 2nd edition, Conners' Teacher Rating Scales-Revised

Oppositional Defiant (OD) Comorbidity: Conduct disorder, ADHD, anxiety disorders, major depressive disorder, substance use disorder (p. 466) Treatment: Problem-solving skills training (PSST)-cognitive, behavioral, individual therapy Instrumentation: Achenbach Child Behavior Checklist is most commonly used as well as the Behavior Assessment System for Children, 2nd edition, Conners' Teacher Rating Scales-Revised

Separation Anxiety (SAD) Comorbidity: GAD, specific phobia and for adults (phobias, PTSD, panic disorder, generalized anxiety disorder, social anxiety disorder, agoraphobia, OCD, and personality disorders (p. 195) Treatment: Exposure therapy-highly effective, cognitive-behavioral most effective, Coping Cat model (manual) Instrumentation: Child's Depression Inventory (ages 7-17), The Washington University Schedule for Affective Disorders and Schizophrenia for school age children. Young Mania Rating Scale (YMRS) distinguishes between bipolar and other disorders.

Bipolar I Comorbidity: Anxiety disorders, panic attacks, social anxiety disorder, ADHD, disruptive, impulse-control disorder, conduct disorder, intermittent explosive disorder, oppositional defiant disorder, substance use disorder (p. 132) Treatment: CBT, Interpersonal therapy, combination family focused and CBT, psychoeducation, other treatment recommended - DBT has some support Instrumentation: 1) Child's Depression Inventory (ages 7-17), 2) The Washington University Schedule for Affective Disorders and Schizophrenia for school age children. 3) Young Mania Rating Scale (YMRS) (distinguishes between bipolar and other disorders.)

PTSD Comorbidity: Depressive, bipolar, anxiety and substance use disorders (p. 280) Treatment: CBT, exposure therapy, emotion focused cognitive-behavioral, trauma focused CBT (sexually abused children) Instrumentation: Trauma Symptom Checklist for Children, Beck Anxiety Inventory (neurophysiological, subjective, panic related and autonomic)

Adult & Children Mood Disorders

Adjustment Disorder (6 types) Comorbidity: Most mental disorders and medical disorders (p. 289) Treatment: Little research available for choice of therapy, a crisis-intervention model - relieving acute symptoms, brief psychodynamic psychotherapy Instrumentation: No specific instruments for assessment other than the SCAD

Major Depressive Disorder Comorbidity: Substance related disorders, panic disorder, OCD, anorexia nervosa, bulimia nervosa, borderline personality disorder (p. 168) Treatment: CBT, low level of social functioning perform best with interpersonal psychotherapy (Seligman & Reichman, 2010). Newer therapies are: Behavioral Activation Therapy (BAT; Martell, Dimidjian, & Herman-Dunn, 2010), CBT-I (I-insomnia), Mindfulness, exercise, Vagus nerve therapy Instrumentation: Beck Depression Inventory, Hamilton Rating Scale, SCID

Persistent Depressive Disorder (dysthymic disorder) Comorbidity: Anxiety disorders and substance use disorders (p. 171) Treatment: Cognitive-behavioral therapy, interpersonal therapy, social skills, assertiveness & decision-making Instrumentation: Beck Depression Inventory, Steen Happiness Index

Bipolar Disorders Comorbidity: Panic attack, social anxiety, ADHD, conduct disorder, impulse control disorder, substance use disorder, intermittent explosive disorder, oppositional defiant disorder (APA, 2005) Treatment: Medication first line, family focused psycho-educational treatment, social rhythm therapy, and cognitive-behavioral therapy, group therapy during recovery Combination treatment: Family focused therapy (FFT), IPT with social rhythm therapy, and CBT. Other treatments helpful include day treatment, group therapy, self-help groups, electroconvulsive therapy, and Vagus nerve stimulation. Instrumentation The Structured Clinical Interview (SCID) can be used to validate, The Treatment Attitudes Questionnaire (limited research, better for planning). Bipolar II use the Hypomania Checklist 32 (HCL-32).

Cyclothymic Disorder Comorbidity: Substance-related and sleep disorders (children-ADHD; p. 141) Treatment: Two years experiencing numerous episodes of hypomania and mild to moderate depression (one year for children, two for adults). Treatments proven to be helpful are IPT, FFT, regulating sleep, circadian rhythms, and social rhythm. Supplements may be career counseling and interpersonal skill development. Group counseling may be useful. First degree relatives of people with cyclothymic disorder have increased incidences of bipolar disorders, childhood history of being hypersensitive, hyperactive, and moody. Children with parents who have bipolar disorders are more likely to exhibit cyclothymic disorder compared with other children. Little research, regulate sleep, circadian rhythms and social rhythms thus, interpersonal and social rhythm therapy (IPSRT), family focused therapy (FFT), and cognitive-behavioral therapy. Instrumentation: Hypomanic Checklist (HCL32) has been used to differentiate between unipolar depression and depression with hypomania symptoms (Angstet al., 2005).

Anxiety Disorders

Anxiety Disorders Treatment: Cognitive-behavioral therapy, exposure therapy, acceptance-based therapy (interoceptive exposure, mindfulness meditation, SIT, DBT, and ACT target thoughts). Group therapy, cultural factors-ethnic identity, gender roles, acculturation play in clinical presentation, assessment and treatment. Eye contact, verbal and nonverbal communication, personal space, and verbal cues, tone/ volume may vary from culture to culture. Coping styles vary - African-Americans tend to use gratitude and religiosity more frequently than Europeans. Ethnicity: According to the literature, panic disorder co-exists with sleep paralysis more frequently in African- Americans (60%) than Caucasians (8%). Cambodian populations. Of 89 Cambodian refugee patients with Panic Disorder, surveyed at two psychiatric clinics, 53 (60%) currently suffered panic disorder. Among the 53 patients suffering panic disorder, the most common panic attack subtypes during the previous month were the following: "sore neck" (51%), orthostatic dizziness (49%), gastro-intestinal distress (26%), and effort induced (21%). (Hinton, D, Phalnarith Ba, Sonith Peou, and Khin Um, Gen Hosp Psychiatry. 2000 Nov-Dec; 22(6): 437-444). Hispanic patients (ataque de nervios) may experience uncontrollable behaviors such as physical or verbal aggression, crying, shouting (Paniagua, 2001). Instrumentation: Beck Anxiety Inventory more commonly utilized-4 categories of anxiety symptoms are neurophysiological, subjective, panic related, and autonomic (Beck & Steer, 1990). Anxiety Disorders Interview Schedule (Brown, et al, 1994), Structured Clinical

Panic Disorder Comorbidity: Anxiety disorders, agoraphobia, major depression, bipolar disorder, mild alcohol use disorders (p. 213) Treatment: Cognitive-behavioral therapy treatment of choice; panic control therapy (PCT), new treatments include ACT, SFIT and some support for family and group therapy, graduated and pacing exposure can be helpful. Instrumentation: ADVIS (Brown et al.,1994) measures avoidance, severity of panic and panic related symptoms, Burns Anxiety Inventory

Phobias Comorbidity: See specific phobias Treatment: Exposure-based are empirically validated and considered effective. May include exposure as relaxation training, breathing retraining and paradoxical intention. Instrumentation: Beck Anxiety Inventory and Burns Anxiety Inventory assess for differences in phobias and delusional fears.

Agoraphobia Comorbidity: Anxiety disorders, panic disorder, social anxiety disorder, depressive disorders, major depressive disorder, PTSD, and alcohol use disorder (p. 221) Treatment: Panic control therapy (PCT) is well documented. Newer therapies, but not necessarily validated, are sensation-focused intensive treatment (SFIT) and ACT shows promise. Instrumentation: Beck Anxiety Inventory, Mobility Inventory for Agoraphobia, Agoraphobic Cognition Questionnaire

Social Anxiety Disorder Comorbidity: Anxiety disorders, major depressive disorders, and substance use disorders (p. 208) Treatment: Cognitive therapy with exposure is most commonly recommended. Cognitive-behavioral group therapy (CBGT) has empirical support (Hofmann & Barlow, 2002). Other treatments recommended are exposure alone, cognitive restructuring alone, exposure combined with cognitive restructuring, social skills training, and relaxation, homework and role playing, mindfulness, attention training, self-efficacy interventions and interpersonal therapy all show promise. Instrumentation: Fear of Negative Evaluation and Social Interaction Anxiety Scale (SIAS), Achenbach System of Empirically Based Assessment (ASEBA)-assesses for social problems (ages 6-18), Revised Children's Manifest Anxiety Scale (RCMAS-2) measures for social anxiety (ages 6-19).

Obsessive-Compulsive Comorbidity: Panic disorder, social anxiety disorder, GAD, specific phobia, bipolar disorder, tic, body dysmorphic disorder, trichotillomania excoriation and possibly schizophrenia or schizoaffective disorder (p. 242) Treatment: Exposure and response prevention therapy is first choice. Other treatments found to be helpful are cognitive approaches that focus on thinking (Head & Gross, 2008), checking family (children and adolescents), ACT more research needed. Instrumentation: Yale-Brown Obsessive Compulsive Scale (Y-BOCS) one of most useful, Obsessive-Compulsive Inventory-Revised, (OCI-R; Foa et al., 2002). The OCI-R has 18 items with 6 subscales (washing, ordering, hoarding, obsessing and neutralizing (Franklin, Ledley, & Foa, 2008)

PTSD Comorbidity: Depressive, bipolar, anxiety and substance use disorders (p. 280) Treatment: Prolonged exposure therapy (Foa, Keane, Friedman & Cohen, 2009) considered the best therapy treatment of choice based on research, cognitive processing therapy (CPT) designed for survivors of sexual assault and traumatic brain injury-PTSD, anxiety management training. Other treatments sometimes used in therapy include EMDR, group and family therapy, stress inoculation training Instrumentation: The Clinician-Administered PTSD Scale The PTSD Checklist For Children: K-SADS PTSD section Child Behavior Checklist Childhood Trauma Questionnaire Psychometric Evaluation of the Children's Impact of Traumatic Events Scale-Revised

Generalized Anxiety Disorder (GAD) Comorbidity: Anxiety disorder, unipolar disorder (APA, 2000) Treatment: Cognitive-behavioral therapy (cognitive restructuring) is most frequently used, behavior therapy, affective therapy (AWARE) although less effective than cognitive and behavioral therapies, and ACT. Instrumentation: Beck Anxiety Inventory The Penn State Worry Questionnaire Anxiety Disorders Interview Schedule

Alcohol-related (USE) Comorbidity: Bipolar disorders, schizophrenia, antisocial personality disorder (p. 496) Treatment: Combined behavior interventions - motivation enhancement, cognitive therapy, social skills training, cognitive restructuring, relaxation training, stress management, 12-Step, Family therapy Instrumentation: Screeners: Rapid Alcohol Problems Screen (RAPS4), Michigan Alcoholism Screening Test (MAST), CAGE (Screening for Alcohol Abuse), Alcohol Use Disorders Identification Test (AUDIT)

Feeding and Eating Disorders Comorbidity: Social phobia, OCD, generalized anxiety disorder (Kaye, Bulik, Thornton, Barbarich, & Masters) and PTSD and schizophrenia (Blinder, Cumella, & Sanathara, 2006). Treatment: Multidisciplinary approach, cognitive-behavioral therapy, DBT for BED, active comparison group therapy (ACGT) Instrumentation: Questionnaire on Eating & Weight Patterns-Revised (QEWP-R) Eating Disorder Examination Questionnaire

Anorexia Nervosa Comorbidity: Bipolar, depressive and anxiety disorders, alcohol use disorder (p. 344) Treatment: Multidisciplinary approach, cognitive-behavioral therapy, DBT, group therapy, transdiagnostic approach, interpersonal psychotherapy and family therapy. Instrumentation: Questionnaire on Eating and Weight Patterns-Revised (QEWP-R)

Bulimia Nervosa Comorbidity: Depressive symptoms, bipolar nervosa, depressive Treatment: Manualized based CBT treatment is preferred and DBT for BED. Instrumentation: DBT, CBT, Focus on therapeutic alliance, reducing negative affect, modifying eating behaviors, identifying situations that trigger behavior Eating Disorder Inventory (EDI)

Sexual Dysfunctions

Female Sexual Interest/Arousal Disorder Comorbidity: Depression, thyroid problems, anxiety, urinary incontinence and other medical problems, arthritis, irritable bowel disease (p. 436) Treatment: Medication, couples and group therapy can be appropriate, 12-Step Program modeled after alcoholics anonymous, sex addicts anonymous, sexual compulsives anonymous and sex and love addicts Instrumentation: The Sexual Interest & Desire Inventory-Female (SIDI-F), The Sexual Opinion Survey Sexual Dysfunction Scale Sexual Desire Inventory The Early Sexual Experiences Checklist used to detect unwanted sexual experiences before age 16. Interview for Sexual Functioning in 5 domains (sexual fantasy and cognition, sexual behavior and experiences, orgasm, sexual drive, and sexual arousal).

Dissociative Disorders

Dissociative Identity Disorder Comorbidity: PTSD, depressive disorders, avoidant and borderline personality disorders, conversion disorder, somatic symptom disorder, eating disorders, substance-related disorders, OCD, sleep disorders (p. 298) Treatment: No recommendations Instrumentation: No recommendations, includes social role, gender identification, sexuality and body

Sleep-Wake Disorders Sleep-Wake disorders include insomnia, hypersomnolence, narcolepsy, breathing-related sleep disorder, circadian rhythm, non-rapid eye movement (NREM), rapid eye movement (REM), nightmare disorder, restless leg syndrome (RLS), and substance/medication-induced sleep disorder. Comorbidity or co-existing: Depressive and anxiety disorders. King (2014b) listed other co-existing conditions to include autism, ADHD, panic and other related disorders, OCD, adjustment disorders, dissociative disorders, somatic symptom and related disorders, feeding and eating disorders, elimination disorders, amphetamine or other stimulant use disorders, neurocognitive disorders and persistent complex bereavement (p. 12). Voinescu, Szentagotai, and David (2012) found in their study the symptom of inattention in ADHD was associated with insomnia and together with sleep and circadian disorder. Treatment: Psychopharmacology, CBT, bright light therapy, sleep education, sleep hygiene, sleep restriction, stimulus control, cognitive restructuring, paradoxical intension, relaxation and relaxation therapy. Cognitive-behavioral therapy for insomnia is gaining support because of the relationship between depression and sleep disorders. CBT-I behavioral treatment, relaxation therapy including progressive relaxation, biofeedback, cognitive thought stopping have been found to be helpful. Positional therapy (head elevated) can be recommended for sleep apnea. Instrumentation: Level 2 Sleep Disturbance Patient-Reported Outcome Measurement Information System (PROMIS) Short Form Epworth Sleepiness Scale Sleep Disorders Questionnaire Sleep Condition Indicator The Composite Scale of Morningness Sleep timing Questionnaire Sleep History Questionnarie Sleep Disturbance Questionnaire Sleep Impairment Index Pittsburgh Sleep Quality Index A recent Semi-structured clinical interview, laboratory analysis, sleep log or diary are components of the different questionnaires with the exception of polysomnography

Physical and psychological factors

Somatization Symptom Disorder (Briquet's syndrome) Comorbidity: Medical issues, anxiety and depressive disorders (p. 314) Treatment: Affective cognitive-behavioral therapy (ACBT), group and family therapy (rare disorder)(forms include conversion, pain, hypochondriasis, and body dysmorphic). Treatment will vary depending upon form; example IPT-P and CBT for pain or HRT for skin scratching and picking. Instrumentation: Anxiety Disorders Interview Schedule

Factitious Disorders Comorbidity: None provided in the DSM-5 Treatment: No therapies known to be effective, stress management Instrumentation: Clinical interview

Delirium Comorbidity: None provided in the DSM-5. Differential diagnosis includes acute stress disorder, malingering and factitious disorder, other neurocognitive disorders (p. 601) Treatment: Medical and neurological assessment, psychotherapy and medication (slow the process), eliminate casual factors; medications causing side-effects, metabolic disorders, etc. Instrumentation: None provided Mental Status Examination Neurology

Major or minor neurocognitive disorder (Dementia) Comorbidity: Age related diseases and delirium (p. 610) Treatment: Support for caregivers Instrumentation: Comprehensive medical & neurological assessment

Personality Disorders (Clusters A, B, & C)

Personality Disorders (Clusters A, B, & C) Borderline, paranoid and schizotypical most dysfunctional (Millon & Grossman, 2007) obsessive compulsive, dependent, histrionic, narcissistic and avoidant typically least dysfunctional. Treatment: Psychodynamic, cognitive-behavioral, DBT, mindfulness, mentalization-focused, schema therapy (Young, 1999) Instrumentation: Millon Clinical Multiaxial Inventory, MMPI, Structured Clinical Interview

Cluster A: Appear Odd or Eccentric

Paranoid Treatment: Little effectiveness studies available, individual treatment preferred, cognitive therapy, group therapy rarely recommended Instrumentation: Millon Clinical Multiaxial Inventory, MMPI, Structured Clinical In Interview

Schizoid Treatment: Schema therapy (Young, 1999), behavioral techniques such as social and communication skills Instrumentation: Millon Clinical Multiaxial Inventory, MMPI, Structured Clinical Interview

Schizotypal Treatment: Supportive, lengthy and slow, cognitive therapy, behavior therapy for speech patterns Instrumentation: Millon Clinical Multiaxial Inventory, MMPI, Structured Clinical Interview

Cluster B: Appear Dramatic, Emotional or Erratic

Antisocial Treatment: Individual therapy, with a structured and active approach to therapy is recommended, some support for reality based approach for anger management, substance use disorders, and social skills training, mentalization-based therapy and schema therapy hold promise. Behavior, reality and cognitive approaches are helpful. Instrumentation: Millon Clinical Multiaxial Inventory, MMPI, Structured Clinical Interview

Borderline Treatment: DBT, mentalization-based therapy, transference-focused therapy, schema-focused CBT, supportive psychotherapy, STEPP group therapy. Group therapy can be more effective than individual therapy (Farrell, et al, 2009). Psychodynamic Psychotherapy has one study equal to DBT. Instrumentation: Millon Clinical Multiaxial Inventory, MMPI, Structured Clinical In Interview

Histrionic Treatment: Long term individual psychotherapy, cognitive-behavioral therapy as the treatment of choice, group therapy can be helpful (feedback) Instrumentation: Millon Clinical Multiaxial Inventory, MMPI, Structured Clinical Interview

Narcissistic Treatment: Psychoanalytic (anger, envy, self-sufficiency), cognitive-behavioral, group therapy if all members are narcissistic and can tolerate the exposure and negative feedback. Instrumentation: Millon Clinical Multiaxial Inventory, MMPI, Structured Clinical Interview

Cluster C: Appear Anxious or Fearful

Avoidant Treatment: Randomized and control trials effective for psychodynamic psychotherapy (Gottdiener, 2006). Little empirical evidence available; behavioral interventions, schema- focused therapy, group therapy, and family therapy may be helpful. Instrumentation: Millon Clinical Multiaxial Inventory, MMPI, Structured Clinical Interview

Dependent Treatment: Psychodynamic, cognitive-behavioral therapy, schema therapy can be helpful Instrumentation: Millon Clinical Multiaxial Inventory, MMPI, Structured Clinical Interview

Obsessive-Compulsive Treatment: Randomized and control trials effective for psychodynamic psychotherapy (Gottdiener, 2006). Little evidence available for cognitive and behavioral therapies. Instrumentation: Dysfunctional Thought Record (active log), Millon Clinical Multiaxial Inventory, MMPI, Structured Clinical Interview

Reality Impairment

Psychotic Treatment: Schizophrenia , schizophrenoform, delusional, schizoaffective - randomized and control trials indicate behavior and psychosocial therapies are preferred for schizophrenia (Gottdiener, 2006) along with antipsychotic medications. Instrumentation: Positive and Negative Syndromes Scales Structured Interview for Psychotic Symptoms

Dissociative DID Treatment: There is limited recommendations for treatment, with the exception of individual therapy and medication. Instrumentation: Cambridge Depersonalization Scale Structured Clinical Interview for Depersonalization and Derealization Spectrum

Schizophrenia Treatment: Medication and psychosocial intervention; behavior therapy, skills training, social support, and group therapy can be helpful in providing information. Instrumentation: Positive and Negative Syndromes Scale Structured Interview for Psychotic Symptoms

Schizoaffective Treatment: Evidence not available for treatment Instrumentation: na