Exam 2: Spring 2005
A brief note: there were a lot of great questions at the end of class today! Some of
the questions seemed a little too broad for me to respond to here, so I may at
times refer you to specific lecture notes or textbook sections for this lengthier
information. In addition, some questions asked specifically about the upcoming
exam. I don’t really have much to add about what the exam will look like, other
than what I’ve said in class – the format/questions will look very similar to the
first exam. Exceptions to this are that you will choose which fill-in-the-blank and
short-answer questions you respond to.
My responses to other questions are below:
How well should we know the neurological aspects of the disorders?
You want to be familiar with any major neurological/neurobiological findings
related to specific disorders. I typically discuss these in class under the Etiology
section of lecture. This includes neurological structures that have been
connected with disorders, as well as specific mechanisms or neurotransmitters.
Which treatments/methods of treatments are most important to know?
In general, if I talk about treatment in lecture, you want to be familiar with it. In
this unit, we actually spent a good bit of time discussing various treatments for
anxiety disorders and mood disorders. It would be a good idea to study these.
Otherwise, other treatments that aren’t discussed in lecture – just skim those
sections in the text (have some basic familiarity).
Will it be important to know the exact statistical numbers involved in the
You should be familiar with prevalence rates and gender ratios. If you’re having
trouble absorbing/retaining all this information, see some tips from me at the
end of the study guide.
Are you using abbreviations for disorders on the test?
They may show up there. If there is an abbreviation on the exam that is not
defined, you can ALWAYS ask myself or a TA to tell you what it stands for.
Specific abbreviations people asked about:
SAD = Separation Anxiety Disorder
CBCL = Child Behavior Checklist
What is the etiology of delirium (causes)?
Discussion of this can be found in the Cognitive Disorders lecture and Chapter 15,
Does dementia cause Alzheimer’s or is it a symptom?
Dementia is a broad category of disorders that is broken down into subgroups
based on the presumed etiology. Alzheimer’s is one of these subgroups, a type
of dementia, that is presumed to be grouped together because of similar causes.
Who is more at risk for dementia, is it correct that for dementia in general M=F
then for Alzheimer’s F>M?
Yes. The F>M discrepancy for Alzheimer’s is slight, as well.
Why does dementia increase so much after the age of 45?
There are a number of reasons. Older adults are typically at more risk for a
variety of medical problems because of their increasingly vulnerable immune
systems. They are exposed to a greater number of medications and medical
procedures. In addition, some deterioration of functioning is a normal aspect of
aging, so it’s related to the typical progression of development at older ages.
Can you explain “neurofibrillary tangles” and “amyloid plaques”?
Neurofibrillary tangles, which are strandlike fibers, and amyloid plaques, which
are protein deposits, are two structures found in the brain of individuals with
Alzheimer’s on autopsy. They aid in identifying cases of Alzheimer’s, and it is
believed they may be a cause of some of the associated deficits.
How is dementia different with various subgroup populations, such as
individuals with AIDS compared to Alzheimer’s patients?
It gets back to the subgroups of dementia – based on etiology. Dementia due to
HIV falls under a broader category, “Dementia due to other general medical
conditions.” The subgroups of dementia, which are based on etiology, can show
characteristic symptoms, features, and epidemiological information as well as
What is the difference between delirium and amnesia? What exactly is an
amnestic disorder, and can you give us an example? Is it a dementia subtype or
an individual class of disorder?
A diagnosis of amnestic disorder specifically refers to an impairment in memory
(see criteria and an example on p.538). Wernicke-Korsakoff syndrome is a specific
type of amnestic disorder that sometimes presents in chronic alcoholics.
Delirium, dementia, and amnestic disorders are all different categories.
What are the main differences in the cognitive disorders?
I highlighted important differences in the Cognitive Disorders lecture, and the
book discusses it on p. 523.
What is the difference between a panic attack and panic disorder? What is the
criteria and prevalence of Panic Disorder?
There are different types of panic attacks, as we discussed in lecture. An
individual must have at least one unexpected panic attack AND must have more
than one attack to meet criteria for the disorder. Just having one panic attack
does not qualify for panic disorder. (You might think of it like
episodes:disorders in Mood Disorders – you assess the panic attacks first, then
determine whether they meet criteria for the disorder). You can find information
on criteria and prevalence in the Anxiety Disorders lecture and in the text, pp.
What is the difference between unexpected/uncued panic attacks vs.
situationally predisposed ones?
Unexpected attacks come “out of the blue,” in situations where the individual is
not feeling excessively anxious and does not expect to have an attack.
Situationally predisposed attacks occur when the individual is in a situation that
makes them very anxious to begin with, so there is an identifiable trigger.
What is the difference between panic and anxiety disorder?
Panic disorder is a type of anxiety disorder.
Can agoraphobia be present in more disorders other than panic disorders?
It is possible to receive a diagnosis of Agoraphobia w/out history of Panic
Disorder, but typically these individuals have experience panic-like symptoms in
the past (never quite meeting criteria for Panic Disorder), and the agoraphobia
develops in response to this.
What is the difference between having Panic Disorder with Agoraphobia and
In Panic Disorder with Agoraphobia, the individual develops severe anxiety
about being in situations where they might have a panic attack, or where escape
might be difficult in the event of an attack. Typically, they develop a behavioral
avoidance pattern because of this anxiety. It is possible to have Panic Disorder
without ever developing this fear of specific panic-related situations and
What are the cultural influences for agoraphobia?
As we discussed in lecture, some people have suggested that the reason
agoraphobia is so much more common in women than men is that
anxiety/avoidance is a more culturally-accepted coping response to the panic
attacks, whereas for men a more culturally-accepted coping response may be
relying on intoxicating substances.
Please describe the difference between Social Phobia and Agoraphobia.
Good question! I’m surprised this one didn’t come up in lecture. The key is that
in agoraphobia, the anxiety/avoidance is specifically in response to fear of having
a panic attack. In Social Phobia, it’s more broadly related to fears of looking
stupid in front of others, being evaluated by others, or humiliating oneself.
Can you ever outgrow a phobia?
Phobias do slightly decline with age. However, it’s important in children to
distinguish between a specific phobia and normal developmentally-appropriate
fears, which children do tend to outgrow. Typically, phobias are chronic
(although often remit with treatment, but many don’t seek this).
What characteristics of phobic disorders are found in phobias such as
The term “homophobia” was coined by a psychologist, but does not refer to the
sort of clinical phobias we talk about in this class. Individuals who exhibit
homophobic behavior don’t show the physiological characteristics or
distress/impairment that individuals with specific phobias show. In addition,
homophobia is largely rooted in a socio-cultural perspective with strong
ideological roots, as opposed to the phobia being rooted primarily in the
individual as a clinical entity.
What is the difference between social anxiety and social phobia?
You can perceive it as a matter of degree. Social anxiety is less severe, and often
found in normal individuals. Social phobia is more severe, less common, and
Can you have obsessions without compulsions? Is it possible to just have
compulsions and be diagnosed with OCD?
Yes, to meet criteria for OCD you only have to have obsessions or compulsions.
However, it is very rare for an individual to develop compulsion without
obsessions, as the compulsions are usually a ‘coping response’ to the obsessions.
What are hoarding subtypes in anxiety disorders?
Hoarding is a specific subtype in OCD, referring to the compulsions.
How do behavioral, cognitive, biological/genetic models view OCD
differently and the relationship to Tourette’s syndrome?
They view OCD differently because they posit different mechanisms behind the
development of the disorders – whether it is learned or behaviorally reinforced,
whether it is due to inaccurate thought patterns or misperceptions, or whether it
is caused by biological or genetic factors. These categories are NOT mutually
exclusive, and could all be factors in the development of the disorder. The
comorbidity between OCD and Tourette’s has prompted questions regarding
whether they have a similar genetic influence.
Can you explain more on the etiology of GAD? How is it hard to give a
diagnosis for GAD because it’s so severe?
The strongest support has come from behavior genetic studies, suggesting a
substantial genetic component. Much is unknown about the etiology of GAD,
but some have suggested that it may operate in a diathesis-stress fashion –
inherit a genetic vulnerability and then experience significant stress in their lives.
Some work is also being done to understand whether a cognitive component is
involved in the development of GAD. When I discussed it in lecture, I didn’t
mean to say that it’s hard to give a diagnosis of GAD. I tried to emphasize that in
addition the numerous and frequent worries, a number of physiological
characteristics must be associated – which makes it more difficult to get a
diagnosis of GAD than someone who is just worrying, without the physiological
Is post-partum (depression) closely related to Post-traumatic Stress Disorder?
No, these are different things. “Post-partum” is a specifier that can be added to a
major depressive or manic episode, if these symptoms develop within 4 wks
after giving birth. The symptoms would be different than those in PTSD.
In mood disorders, what exactly is the difference between an episode and a
Mood disorders are described as episodic, because the symptoms tend to appear
at the same time, within a given time period. Thus, an episode can be thought of
as a specific period of time in which the symptoms are occurring. You must
assess an individual’s various mood episodes before you determine what disorder
to diagnose them with. Disorders are defined, in part, by which episodes an
individual has experienced.
Many people said something like: The mood disorders are hard to
differentiate. Could you post the graph you made in class?
How about if I start it out for you again? Basically, one way to differentiate the
mood disorders is by differentiating how they would be graphed on the mood
Feelin’ just fine
BIPOLAR I BIPOLAR II
Now, you sketch in the others, based on the episodes involved in the disorder:
What are the differences between childhood and adult MDE?
There aren’t necessarily differences, but there can be. Specifically,
childhood depression can manifest as irritability rather than depressed mood.
What is hypomania?
A hypomanic episode shows the same symptoms as a manic episode, but it is
less severe in that it is often shorter and does not cause impairment.
What is the cognitive triad set forth by Aaron Beck? The book doesn’t go into
Information on Beck’s theory can be found in the Mood Disorders lecture and in
the textbook, pp. 231-232.
Are there neurological explanations that would determine whether a person
would develop a manic vs. depressive episode?
Not that I know of. Serotonin is a neurological mechanism that has been
implicated in both.
Can you please explain how twin studies have influenced our understanding
of Mood Disorders?
There’s a nice chart on p.225 of the text that illustrates these findings. The upshot
is that all mood disorders show a strong genetic component, but bipolar in
particular seems to show a particularly strong influence.
How does mood-congruent and mood-incongruent relate to MDE?
“w/ psychotic features” is an optional specifier for an MDE. Mood-congruent
vs. –incongruent relates to the nature of the delusions or hallucinations,
specifically whether they are consistent with the individual’s mood state.
Explain the diathesis-stress model.
Diathesis = predisposition
Stress = environmental/life circumstance
The idea is that individuals must have both to develop the disorder, not just one
or the other.
To be diagnosed as a mood disorder, that person has to fulfill Axis I or Axis III
of DSM-IV-TR? Or both?
Mood disorders are classified on Axis I.
Who is Tom Achenbach?
He is a UMN PhD who developed the CBCL.
Can Separation Anxiety Disorder occur in older individuals whose spouse
leaves for a long period of time?
Onset must be before age 18.
For ADHD, can you explain how many characteristics you need out of each
category and how they are related to each other.
The subtypes of ADHD are correlated with each other. They are:
Inattentive subtype: at least 6 inattentive symptoms
Hyperactive/Impulsive subtype: at least 6 H/I symptoms
Combined subtype: at least 6 from each of the above subtypes (so, at least 12
Do you have to be diagnosed with childhood ADHD in order to be also
diagnosed with adult ADHD?
An onset before age 7 is required for diagnosis.
Are there any theories about the mechanism by which maternal smoking
increases the risk of ADHD?
At this time, the mechanisms are largely unknown.
What is the difference between ADHD and a Learning Disorder?
The criteria for these disorders is very different – completely different symptoms.
They may sometimes be misdiagnosed by parents, teachers, or doctors because
both can lead to acting out behaviors in the classroom.
Could you explain the difference between ODD and CD?
ODD refers to oppositional and defiant behaviors that look similar to having an
oppositional/defiant personality. CD refers to more severe, discrete antisocial
acts that represent objective violations of societal norms or the rights of others.
Is it possible for someone to improve or lose the diagnosis of autism?
As mentioned in lecture, eventual prognosis correlates strongly with IQ – the
higher IQ, the better chance of improvement. However, keep in mind the high
comorbidity rates with MR when thinking about this effect.
Are there any treatments for Autism?
If you’re interested in more information on treatments of Autism, the book gives
a nice summary on pp.505-507.
Explain the difference between Autism and Asperger’s disorder.
Difference: individuals with Asperger’s do not show the delays in language or
other cognitive skills. Thus, they will show somewhat similar symptom patterns.
The whole second section of autistic symptoms (“qualitative impairments in
communication”) would not apply to an individual with Asperger’s.
In your Asperger’s example, a man was trying to get custody of his child from
an ex-wife. Asperger’s is characterized by a lack of social interaction skills.
Can someone with Asperger’s still have a wife – a very substantial social
Each case is different – and it is actually quite relevant to your question that he
was in the process of getting a divorce, so the level of substance is questionable.
An individual can get this diagnosis if their symptoms of impaired social
interaction are marked impairment in nonverbal behaviors and lack of emotional
reciprocity, for example.
If Asperger’s disorder doesn’t affect a person’s social ability, is it really
considered a disorder?
It must include qualitative impairment in social interaction to receive a
How can the age of onset for MR be before the age of 18, that seems extremely
old. Isn’t it chronic from birth?
Yes, it is considered a chronic disorder. “Before the age of 18” refers to anytime
before the age of 18, including toddlerhood and childhood.
Why have diagnoses of autism increased so much these past few years?
There is no good answer at this point, but some researchers suggest it is due to
increased awareness upon the part of clinicians, teachers, and parents that is
leading to greater identification and assessment.
We do not understand what the “differing definitions” of MR mean – what are
the education settings of the “educability” differing definitions of MR?
The differences come into play when defining levels of MR. Educational settings
define different levels from the DSM-IV, which defines different levels than the
AAMR. See p. 509 for more information on these.
Are we going to have to know anything specific about any of the
developmental disorders that we didn’t spend much time on?
You should be familiar with bold-faced terms and diagnostic criteria, and you
should make sure you at least skim these sections.
Whew!! Good luck studying…