INTRODUCTION (PPT #1) origins of a client's problems through clinical

assessment and diagnosis.

Abnormal Psychology - the scientific study Clinical Assessment - It determines whether
of abnormal behavior undertaken to describe, how and why a person is behaving abnormally
predict, explain, and change abnormal patterns and how that person may be helped.
of functioning. Diagnosis - A determination that a person's
problems reflect a particular disorder.
Patterns of Psychological Abnormality Treatment - refers to therapies.
(1) Deviant - different, extreme, unusual, Clinical Assessment
even bizarre abnormal behavior, ❖ most important and complex
thoughts and emotions differ markedly responsibilities of mental health
from society' s ideas about proper professionals
functioning - norms and culture. ❖ extent to which an individual's
❖ Norms - stated and unstated rules for problems are understood and
proper conduct appropriately treated depends on the
❖ Culture - a people's common history, adequacy of the psychological
values, institutions, habits, skills, assessment
technology and arts. ★ Goals:
❖ Abnormality depends on specific ❖ identifies and describes the individual's
circumstances and cultural norms. symptoms
(2) Distressing -unpleasant and upsetting ❖ determines the chronicity and severity
to the person's behavior, ideas and of the problems
emotions usually have to cause distress ❖ evaluates the potential causal factors in
before labeling as abnormal. the person's background
(3) Dysfunctional - interfering with the ❖ explores the individual's personal
person' s ability to conduct daily resources that might contribute to his
activities in a constructive way upsets, treatment program.
distracts or confuses people that they Methods and Tools
cannot care for themselves properly, ❖ Assessment Tools - (should be)
participate in ordinary social standardized, reliable, and valid
interactions or work productively. ❖ 3 categories: clinical interview, tests
❖ Society holds that carrying out daily and observations
activities in an effective way is Clinical Interviews
important. ❖ permits the practitioner to interact
with a client and generally get a sense
Clinical Assessment, Diagnosis and of who he/she is
Treatment ❖ 2 interview procedures: structured
The Practitioners' Tasks - clinical and unstructured clinicians favor one
practitioners are interested primarily in category over the other
gathering idiographic information about the (1) Structured Interview
clients to understand the specific nature and ❖ specific questions/standard set of
 questions designed for all interviews interpret vague stimuli -
❖ ensures to cover the same kinds of inkblots/ambiguous pictures, or follow
important issues in all of interviews open-ended instructions - Draw a
and compares the responses of different Person
individuals ❖ when clues and instructions are
❖ used by Behavioral and Cognitive general, individual will project aspects
clinicians - pinpoint behavior, attitudes of his personality into the task
or thinking processes underlie ❖ used by Psychodynamic clinicians to
abnormal behavior help assess the unconscious drives and
❖ Mental Status Exam - set of conflicts they believe to be at the root
questions/observations that of abnormal functioning
systematically evaluate the client's ❖ Examples: Rorschach Inkblot Tests,
awareness, orientation, Thematic Apperception Test, Sentence
attention span, memory, judgment/insight, Completion Test, and Drawings
thought content/process, mood appearance. (2) Objective Tests /Personality
(2) Unstructured Interview Inventories - subject required to read
❖ open-ended questions and as simple as and respond to itemized statements or
"Would you tell me about yourself? questions
❖ lack of structure allows the interviewer ❖ clinicians use the responses to draw
to follow leads and explore relevant conclusions about the person's
topics that could not be anticipated personality and psychological
before the interview functioning
❖ appeals to Psychodynamic and ❖ Examples: MMPI 2 and BPI
Humanistic clinicians (3) Response Inventories - tests designed
Common Questions to measure a person's responses in one
❖ How strong? Intensity specific area of functioning - affect,
❖ How often? Frequency social skills or cognitive processes
❖ How long? Duration ❖ Examples: (1) Affective - measure the
Clinical Tests - devices for gathering severity of emotions - anxiety,
information about a few aspects of an depression and anger (Beck Depression
individual's psychological functioning from Inventory), (2) Social skills - react in a
which broader information about the variety of social situations, (3)
individuals can be inferred. Cognitive inventories - typical
★ 6 types thoughts to uncover
● Projective Tests counterproductive patterns of thinking
● Personality Inventories (4) Psychophysiological Tests - measures
● Response Inventories physical responses - heart rate and muscle
● Psychophysiological Tests tension as possible indicators of psychological
● Neurological-Neuropsychological Tests problems
● Intelligence Tests ❖ Example: Polygraph - Lie Detector
(1) Projective Tests - require the client (5) Neuropsychological Tests - detects brain
impairment by measuring a person's cognitive, schools, institutions/ focus:
perceptual and motor performances parent-child or sibling-sibling
❖ Clinicians interpret abnormal interactions; made by participant
performances as an indicator of observer -key person in client's
underlying brain problems brain environment then report to the
damage affects visual perception, clinician
memory and visual-motor (2) Analog - aided by video
coordination camera/one-way mirror/ focus:
❖ Example: Bender Visual-Motor Gestalt children interacting with parents
Test ❖ Self-monitoring - clients observe
(5) Neurological Tests - directly measures themselves and record designated
brain structure or activity behaviors, feelings or cognitions as they
❖ Neuroimaging techniques - provide occur.
images of brain structure or activity - Diagnosis - through diagnosis the client's
CT scan, PET, MRI, FMRI pattern of dysfunction reflects a particular
❖ Computerized axial tomography disorder - the pattern is the same as one
(CAT/CT scan) - x rays of the brain's displayed by many other people who are
structure at different angles investigated in various studies and responded
❖ Positron Emission Tomography (PET)- to a certain form of treatment.
computer-produced motion picture of ❖ apply what is generally known about
chemical activity throughout the brain the disorder to the particular individual
❖ Magnetic Resonance Imaging (MRI) - that the clinicians are trying to help
uses the magnetic property of certain ❖ better predict the future course of the
hydrogen atoms in the brain to create a person's problem and the treatments
detailed picture of the brain’s structure that are helpful
❖ Functional Magnetic resonance Classification System - a list of disorders,
imaging (FMRI) - converts MRI along with descriptions of symptoms and
pictures of brain structures into guidelines for making appropriate diagnoses
detailed pictures of neuron activity, ❖ Syndrome - a cluster of symptoms
offering a picture of the functioning that usually occur together.
(6) Intelligence Tests - designed to measure a ❖ Symptoms - subjective and reported
person's intellectual ability by the individual with
❖ Example: Wechsler Adult Intelligence condition/disorder
Scale R/IV/V ❖ Signs - objective, observable indication
Clinical Observation - involves the clinician's of a disorder
development of an objective description of the Diagnostic and Statistical Manual of
person’s appearance and behavior - emotional Mental Disorders (DSM) - American
responses and mental health symptoms he/she Psychiatric Association (APA)
manifests ❖ DSM 5 - recent version, lists
Types of Observation approximately 400 disorders;
(1) Naturalistic - takes place in homes, numerous additions and changes to the
 diagnostic categories, criteria and hospital or stay there overnight
organization found in past editions of ❖ see a private therapist
the DSM. ❖ receive treatment through the
➔ Gender, ethnicity and cultural outpatient department of a hospital
background are considered in ❖ team of professionals - psychiatrist -
the appraisal of mental health provide medication/psychotherapy;
symptoms for a DSM psychologist (clinical
diagnosis. assessment)/clinical social worker for
➔ Diagnostic impression - regular therapy session; counseling
diagnosis required in a mental psychologist, psychoanalyst, counselor
health setting. Inpatient Treatment
International Classification of ❖ inpatient care/hospitalization are
Diseases(ICD) - World Health Organization preferred option for those who need
(WHO) intensive treatment
❖ lists both medical and psychological ❖ admitted to the psychiatric units of
disorders general hospitals/private psychiatric
Treatment/Therapy - systematic procedure hospitals
designed to change abnormal behavior into ❖ team of professionals - psychiatrist
more normal behavior. prescribes medication and monitors
➔ Clinicians who see abnormality as an the patient for side effects; clinical
illness - "patient" but those who view psychologist assesses the functioning
it as a problem in living refers to the and provides individual therapy;
"client". clinical social worker helps the patient
➔ Not all persons with psychological resolve problems; psychiatric nurse
disorders receive treatment - checks in with the patient on a daily
deny/minimize suffering or cope on basis to provide support /cope better in
their own/manage to recover without the hospital environment
ever seeking aid from a mental health ❖ intensity of treatment helps the patient
professional get better as rapidly as possible.
❖ Stigma - factor that makes some Mental Disorder
reluctant to seek help. ❖ syndrome present in an individual
❖ wait for a long time before deciding to involving clinically significant
seek help disturbance in behavior , emotion
❖ treated by family physician rather than regulation or cognitive functioning.
by a mental health specialist ➔ disturbances reflect
❖ majority of mental health treatment is dysfunction in biological,
administered on outpatient basis psychological or developmental
Outpatient Treatment processes
❖ requires that a patient visits a mental ❖ associated with significant
health facility practitioner distress/disability in key areas of
❖ does not have to be admitted to the functioning - social, occupational or
 other activities ● Substance dependence
➔ excluding: responses to NEURODEVELOPMENTAL
common stressors/losses; DISORDERS (PPT #2)
dysfunctional pattern of
behavior from social deviance/ Neurodevelopmental Disorders - are a group
conflicts from society of conditions with onset in the developmental
❖ based on input from various DSM - 5 period
work groups and other sources ❖ typically manifest early in
❖ good working description development, often before the child
Important Terms enters grade school
❖ Incidence - number of new cases that ❖ characterized by developmental deficits
occur in a given period of time that produce impairments of personal,
❖ Prevalence - total number cases in a social, academic, or occupational
population during any specified period functioning
of time ❖ usually co-occur with other disorders
❖ Risk Factors - factor/characteristic Intellectual Disabilities - characterized by
associated with an increased risk of deficits in general mental abilities, such as
developing a certain condition reasoning, problem solving, planning, abstract
❖ Causal Risk Factors - changing X thinking, judgment, academic learning, and
leads to a change in Y learning from experience
What’s new in DSM 5? Diagnostic Criteria
❖ New Categories (A) Deficits in intellectual functions
● Hoarding (B) Deficits in adaptive functioning
● Excoriation (C) Onset of intellectual and adaptive
● Persistent depressive deficits during the developmental
● Premenstrual dysphoric period
● DisruptiveMood dysregulation
● Somatic symptom Severity Levels For Intellectual Disability
● Binge eating Severi Concept Social Practical
● Mild neurocognitive ty ual Domain Domain
❖ Name Changes Level Domain
● Intellectual disability
● Major Neurocognitive Mild preschool immature in may
● Illness Anxiety – no social function
● Delayed Ejaculation obvious interaction age-approp
● Gender Dysphoria conceptu riately
❖ Dropped Categories al difficulty in in personal
● Dissociative fugue difference regulating care
● Asperger’s disorder s emotion
● Sexual aversion and need some
● Substance abuse
 school-ag behavior support world tion in
e – with rather speech or
difficultie limited complex than
s in understandi daily living symbolic
learning ng of risk task
academic Intellectual Disability
skills ❖ Prevalence – 1% for overall
Mode skills lag social may population, 6 per 1000 for severe
rate behind judgment function ❖ Age of Onset
those of and age-approp ● Severe – identifiable within the
peers decision-ma riately first 2 years of life
king abilities in personal ● Mild – school age
are care ❖ Gender Differences - overall, more
limited males than females
need some ❖ Causal Factors
support ● Genetic and physiological –
with prenatal cause – genes,
complex maternal disease,
daily living environmental influences
task - perinatal cause – labor and
delivery related events
Severe attainmen spoken requires - postnatal cause – brain
t of language is support for injuries, infections,
conceptu quite all intoxications
al limited activities of ❖ Treatment
skills is daily living ● Occupational therapy
limited can ● Speech therapy
understand requires Global Developmental Delay
simple supervision ❖ diagnosed when an individual fails to
speech and at all times meet expected developmental
gestural milestones across multiple context
communica ❖ reserved for individuals under the age
tion of 5 when clinical severity level cannot
be reliably assessed during early
Profo conceptu has very dependent childhood
und al skills limited on others ❖ applies to individuals who unable to
generally understandi for all undergo systematic assessments,
involve ng of aspects of including children who are too young
the symbolic daily living for standardized testing
physical communica ❖ requires assessment after a period of
 time that include the ge
Unspecified Intellectual Disability following: ability
(Intellectual Developmental Disorder) 1.Reduced is more
❖ reserved for individuals over the age of vocabulary stable
5 when assessment of the degree of and
intellectual disability is difficult or 2.Limited disorde
impossible because of associated sentence r can
sensory or physical impairments structure be
*only used in exceptional circumstances diagno
and requires reassessment after a period 3. Impairments sed
of time in discourse
Communication Disorders Language
❖ characterized by deficits in language, abilities are
speech, and communication. substantially
● Speech is the expressive production of and quantifiably
sounds and includes an individual’s below those
articulation, fluency, voice, and expected for
resonance quality. age.
● Language includes the form, function,
and use of a conventional system of Onset of
symbols. symptoms is in
● Communication includes any verbal or the early
nonverbal behavior that influences the developmental
behavior, ideas, or attitudes of another period.
individual.
The difficulties
Disorder Diagnostic Age of Causa are not
Criteria Onset l attributable to
Facto hearing or other
rs sensory
impairment,
Language A. Persistent early geneti motor
Disorder difficulties in the develo c and dysfunction, or
acquisition pment physio other medical or
and use of al logical neurological
language across period condition.
modalities due
to deficits in by age
comprehension 4, Speech A. Persistent early geneti
or production langua Sound difficulty with devel c and
Disorder speech sound opme physi following:
production ntal ologic
perio al 1. Sound and
B. The d syllable
disturbance repetitions
causes
limitations in 2. Sound
effective prolongations of
communicatio consonants as
n well as
C. Onset of vowels.
symptoms is in
the early 3. Broken words
developmental
period. 4. Audible or
silent blocking
D. The
difficulties are 5.
not Circumlocution
attributable to s
congenital
or acquired 6. Words
conditions, or produced with
other medical an excess of
or physical
neurological tension
conditions.
7. Monosyllabic
whole-word
Childhoo A. Disturbances early gen repetitions
d-Onset in the normal deve etic
Fluency fluency and time lop and B. The
Disorder patterning of men phy disturbance
(Stutterin speech, tal siol causes anxiety
g) characterized by peri ogi
frequent od cal C. Onset of
and marked symptoms is in
occurrences of 2-7 the early
one (or more) of years developmental
the period.
 rules for
D. The conversation
disturbance is and
not attributable storytelling
to a
speech-motor or 4. Difficulties
sensory deficit. understandin
g what is
explicitly
stated
Social A. Persistent early gen
(Pragmati difficulties in develop etic B. The
c) the social use mental deficits result
Communi of verbal period in functional
cation and limitations
Disorder nonverbal by age 4
communicati or 5 C. The onset
on as identific of the
manifested by ation symptoms is
all of in the early
of the deficits developmenta
following: is l period
permitt
1. Deficits in ed D. The
using symptoms are
communicati not
on for social attributable
purposes to another
medical or
2.Impairment neurological
of the ability condition
to change
communicati
on to match Treatment for Communication Disorder
context or the ❖ Speech Therapy
needs ● Improves communication
of the listener skills;
● Improves receptive and
3. Difficulties expressive languages skills;
following ● Improves speech articulation;
● Improves vocabulary.
Autism Spectrum Disorders - characterized ❖ Prevalence - 1% of the population
by persistent deficits in social communication ❖ Age of Onset - 12-24 months of age
and social interaction across multiple contexts, ❖ Gender Differences – more males
including deficits in social reciprocity, than females
nonverbal communicative behaviors used for ❖ Causal Factors - Environmental,
social interaction, and skills in developing, Genetic and physiological
maintaining, and understanding relationships
❖ diagnosis also requires the presence of
Severity Social Restricted,
restricted, repetitive patterns of Level Communicati Repetitive
behavior, interests, or activities. on Behaviors
Diagnostic Criteria
A. Persistent deficits in social communication Level 1 Deficits in Inflexibility
and social interaction across multiple contexts, social of behavior
as manifested by the following, currently or by Requiring communication
history: support Difficulty
(1) Deficits in social-emotional reciprocity Difficulty switching
(2) Deficits in nonverbal communicative initiating social between
behaviors used for social interaction interactions activities
(3) Deficits in developing, maintaining,
and understanding relationships Decrease
B. Restricted, repetitive patterns of behavior, interest in social
interests, or activities, as manifested by at least interactions
two of the following:
(1) Stereotyped or repetitive motor Level 2 Marked deficits Inflexibility
movements, use of objects, or speech in verbal & of behavior
(2) Insistence on sameness, inflexible Requiring nonverbal
adherence to routines, or ritualized substantial communication Difficulty
patterns of verbal and nonverbal support skills coping with
behavior change
(3) Highly restricted, fixated interests that Social
are abnormal in intensity or focus impairments are Obvious
(4) Hyper- or hypo reactivity to sensory apparent frequent
input or unusual interest in sensory restricted/rep
aspects of the environment Limited etitive
C. Symptoms must be present in the early initiation of behaviors
developmental period social
D. Symptoms cause clinically significant interactions Distress/diffi
impairment culty
E. These disturbances are not better explained Reduced or changing
by intellectual disability or global abnormal focus or
developmental delay. response action
 Level 3 Severe deficits Inflexibility inattention, disorganization, and/or
in verbal & of behavior hyperactivity-impulsivity
Requiring nonverbal social ❖ Inattention and disorganization
very communication Extreme entail inability to stay on task, seeming
substantial skills difficulty not to listen, and losing materials, at
support coping with levels that are inconsistent with age or
change developmental level.
❖ Hyperactivity-impulsivity entails
Restricted/re overactivity, fidgeting, inability to stay
petitive seated, intruding into other people’s
behaviors activities, and inability to wait.
markedly Diagnostic Criteria
interfere with A. Persistent pattern of inattention and/or
all hyperactivity-impulsivity that interferes with
functioning functioning or development, as characterized
by (1) and/or (2):
Great (1)Inattention: Six (or more) of the
distress/diffic following symptoms have persisted for
ulty at least 6 months
changing (2)Hyperactivity and Impulsivity: Six
focus or more symptoms have persisted for at
or action least 6 months
B. Symptoms were present prior to age 12
C. Symptoms are present in two or more
Treatment for Autism Spectrum Disorder settings
❖ Applied Behavioral Analysis (ABA)- D. The symptoms interfere with, or reduce the
encourages positive behaviors and quality functioning
discourages negative behaviors, and E. The symptoms do not occur exclusively
teaches new skills and applies those during the course of schizophrenia or other
skills to new situations psychotic disorder and are not better explained
❖ Speech Therapy by another mental disorder
❖ Occupational Therapy (OT) - often ❖ Prevalence – 5% of children and
used as a treatment for the sensory about 2.5% of adults
integration issues associated with ❖ Age of onset - symptoms are difficult
ASDs, help teach life skills to distinguish before age 4, it is more
❖ Medications - can help ameliorate identified during elementary years
some of the behavioral symptoms ❖ Gender Differences – more frequent
(irritability, aggression, and in males than in females in the general
self-injurious behavior) population
Attention-Deficit/Hyperactivity Disorder ❖ Causal factors - Genetic and
(ADHD) - is defined by impairing levels of Physiological
Treatment for ❖ Other terms used:
Attention-Deficit/Hyperactivity Disorder ● Dyslexia - difficulty with reading
❖ Medication ● Dyscalculia – difficulty in learning
❖ Behavior Therapy number related concepts
❖ Parent training and school-based
intervention ❖ Prevalence –5%-15% among
Specific Learning Disorder - diagnosed school-age children, approximately 4%
when there are specific deficits in an in adults
individual’s ability to perceive or process ❖ Age of Onset – occurs during the
information efficiently and accurately elementary years
❖ characterized by persistent and ❖ Gender Differences – more frequent
impairing difficulties with learning in males than in females
foundational academic skills in reading, ❖ Causal factors – Environmental,
writing, and/or math Genetic, and Physiological
Diagnostic Criteria Treatment for Specific Learning Disorder
A. Difficulties learning and using academic ❖ Early intervention
skills, presence of at least one of the following ❖ Special education
symptoms that have persisted for at least 6 Motor Disorders - characterized by deficits in
months, despite the provision of interventions the acquisition and execution of coordinated
that target those difficulties: motor skills and is manifested by clumsiness
● Inaccurate or slow and effortful word and slowness or inaccuracy of performance of
reading motor skills that cause interference with
● Difficulty of understanding the activities of daily living.
meaning of what is read Developmental Coordination Disorder
● Difficulties with spelling Diagnostic Criteria
● Difficulties with written expression A. The acquisition of coordinated motor skills
● Difficulties mastering number sense, are substantially below that expected.
number facts, or calculation Difficulties are manifested clumsiness,
● Difficulties with mathematical slowness, and inaccuracy of performance.
reasoning B. The motor skills deficit in Criterion A
B. The affected academic skills are substantially significantly and persistently interferes with
and quantifiably below those expected for the activities of daily living .
individual’s chronological age C. Onset of symptoms is in the early
C. The learning difficulties begin during developmental period.
school-age years but may not become fully D. The motor skills are no better explained by
manifest until the demands for those affected intellectual disability and not attributable to
academic skills exceed the individual’s limited neurological conditions.
capacities. ❖ Prevalence - ages 5-11 - 5%-6%
D. The learning difficulties are not better ❖ Age of onset - early childhood
accounted for by intellectual disabilities, or ❖ Gender Difference - males are more
other mental or neurological disorders. affected than females
 ❖ Causal Factors - Environmental, first tic onset.
Genetic, and Physiological (C.) Onset is before age 18 years.
Stereotypic Movement Disorder (D.) The disturbance is not attributable to the
Diagnostic Criteria physiological effects of a substance or another
A. Repetitive, seemingly driven, and apparently medical condition
purposeless motor behavior (E.) Criteria have never been met for Tourette’s
B. The repetitive motor behavior interferes disorder
with social, academic, or other activities and Provisional Tic Disorder
may result in injury. (A.) Single or multiple motor and/or vocal tics.
C. Onset is in the early developmental period. (B.) The tics have been present for less than 1
D. Not attributable to the physiological effects year since first tic onset.
of a substance or neurological condition and is (C.) Onset is before 18 years.
not better explained by another (D.) The disturbance is not attributable to the
neurodevelopmental or mental disorder. physiological effects of a substance or another
❖ Prevalence - 3%-4% -developing medical condition.
children 4%-16% - with intellectual (E.) Criteria have never been met for Tourette’s
disability 10%-15% -with severe disorder or persistent motor or vocal disorder.
intellectual disability Treatment for Motor Disorders
❖ Age of onset - within the first 3 years ❖ Occupational therapy - helps kids
of life gain motor skills and learn to do basic
❖ Gender Difference - ? tasks that are needed for school and
❖ Causal Factors - Environmental, everyday living
Genetic, and Physiological ❖ Physical therapy - can help with
Tic Disorders - a sudden, rapid, recurrent, muscle strength, balance and
nonrhythmic motor movement or vocalization. coordination
Tourette’s Disorder ❖ Behavior therapy - for co-occurring
(A.) Both multiple motors and one or more symptoms
vocal tics have been present. Key Features That Define The Psychotic
(B.) The tics may wax and wane in frequency Disorders - Schizophrenia Spectrum and
but have persisted for more than 1 year since other Psychotic Disorders include
first tic onset. schizophrenia, other psychotic disorders, and
(C.) Onset is before age 18 years. schizotypal (personality) disorder. They are
(D.) The disturbance is not attributable to the defined by ab­normalities in one or more of the
physiological effects of a substance or another following five domains:
medical condition. ● Delusions
Persistent (Chronic) Motor or Vocal Tic ● Hallucinations
Disorder ● Disorganized Thinking (Speech)
(A.) Single or multiple motor or vocal tics have ● Grossly Disorganized or Abnormal
been present, but not both. Motor Behavior (Including Catatonia)
(B.) The tics may wax and wane in frequency ● Negative Symptoms
but have persisted for more than 1 year since Delusions - are fixed beliefs that are not
amenable to change in light of conflicting modality. (e.g. Smell, Light, sound,
evidence. Their content may include a variety temperature, pressure, taste, etc.)
of themes: ❖ Auditory hallucinations are usually
❖ Persecutory Delusions – Belief that one experienced as voices , whether familiar
is going to be harmed, harassed and so or unfamiliar, that are perceived as
forth by an individual, organization or distinct from the individual’s own
other group. These are most common. thoughts.
❖ Referential Delusions – Belief that ❖ Hallucinations must occur in the
certain gestures, comments, context of a clear sensorium.
environmental cues, and so forth are ➔ The hallucinations that occur while
directed at oneself. These are also falling asleep (HYPNAGOGIC) or
common. waking up (HYPNOPOMPIC) are
❖ Grandiose Delusions – When an considered to be within the range of
individual believes that he or she has normal experience.
exceptional abilities, wealth, or fame. ➔ Hallucinations may be a normal part of
❖ Erotomanic Delusions – When an religious experience in certain cultural
individual believes falsely that another contexts.
person is in love with him or her. Are Disorganized Thinking (Speech)/Thought
also seen. Disorder - typically inferred from the
❖ Nihilistic Delusions – Involve the individual’s speech
conviction that a major catastrophe ➔ Derailment or Loose Associations -
will occur. The individual may switch from one
❖ Somatic Delusions – Focus on topic to another.
preoccupations regarding health and ➔ Tangentiality – Answers to questions
organ function. may be obliquely related or completely
❖ Bizarre Delusions – Delusions are unrelated.
deemed BIZARRE if they are clearly ➔ Incoherence or “Word Salad” – Rarely,
implausible and not understandable to speech may be so severely disorganized
same-culture and do not derive from that it is nearly incomprehensible and
ordinary life experiences (e.g. The resembles receptive aphasia in its
belief that an outside force has removed linguistic disorganization.
his or her internal organs and replaced ❖ Because mildly disorganized speech is
them with someone else's organs common and nonspecific, the
without leaving any wounds or scars.) symptom must be severe enough to
Hallucinations - are perception-like substantially impair effective
experiences that occur without an external communication.
stimulus. ❖ The severity of the impairment may be
❖ They are vivid and clear, with full force difficult to evaluate if the person
and impact of normal perceptions. making the diagnosis comes from a
❖ Not under voluntary control different linguistic background than
❖ They may occur in any sensory that of the person being examined.
 ❖ Less severe disorganized thinking or schizophrenia:
speech may occur during the ❖ Diminished Emotional Expression -
prodromal and residual periods of includes reductions in the expression of
schizophrenia. emotions in the face, eye contact,
Grossly Disorganized or Abnormal Motor intonation of speech (prosody), and
Behavior (including Catatonia) - may movements of the hand, head, and face
manifest itself in a variety of ways, ranging that normally give an emotional
from childlike ‘silliness” to unpredictable emphasis to speech.
agitation. ❖ Avolition - is a decrease in motivated
❖ Problems may be noted in any form of self-initiated purposeful activities. The
goal-directed behavior, leading to individual may sit for long periods of
difficulties in performing activities of time and show little interest in
daily living. participating in work or socialactivities.
➔ Catatonic Behavior - is marked ➔ Other negative symptoms include:
decreased in reactivity to the ❖ Alogia - is manifested by diminished
environment speech output.
➔ Negativism - This ranges from ❖ Anhedonia - is the decreased ability to
resistance to instructions. experience pleasure from positive
➔ Mutism and Stupor - to maintain a stimuli or a degradation in the
rigid, inappropriate or bizarre posture; recollection of pleasure previously
to a complete lack of verbal and motor experienced.
responses. ❖ Asociality - refers to the apparent lack
➔ Catatonic Excitement - It can also of interest in social interactions and
include purposeless and excessive may be associated with avolition, but it
motor activity without obvious cause. can also be a manifestation of limited
➔ Other features are repeated stereotyped opportunities for social interactions.
movements, staring, grimacing, Magnitude and Impact
mutism, and the echoing of speech. ❖ Schizophrenia affects approximately 24
❖ Although catatonia has historically million people or 1 in 300 people
been associated with schizophrenia, (0.32%) worldwide. This rate is 1 in
catatonic symptoms are nonspecific 222 people (0.45%) among adults
and may occur in other mental ❖ It is not as common as many other
disorders (e.g., bipolar or depressive mental disorders. Onset is most often
disorders with catatonia) and in during late adolescence and the
medical conditions (catatonic disorder twenties, and onset tends to happen
due to another medical condition). earlier among men than among
Negative Symptoms - account for a women.
substantial portion of the morbidity associated ❖ However, the impact of schizophrenia
with schizophrenia but are less prominent in tends to be highest in Oceania, the
other psychotic disorders. Two negative Middle East, and East Asia, while the
symptoms are particularly prominent in nations of Australia, Japan, the United
 States, and most of Europe typically ❖ Psychotherapy
have low impact. ➔ Typical Antipsychotic Drugs
❖ Research has not identified one single ➔ Atypical Antipsychotic Drugs
cause of schizophrenia. It is thought ➔ Tranquilizer
that an interaction between genes and a *Brief psychotic disorder lasts for less than 1
range of environmental factors may month, after which most people recover fully.
cause schizophrenia. Psychosocial It’s rare, but for some people, it may happen
factors may also affect the onset and more than once. If symptoms last for more
course of schizophrenia. Heavy use of than 6 months, doctors may consider whether
cannabis is associated with an elevated the person has schizophrenia.
risk of the disorder. Schizophreniform Disorder
Treatments – Psychological and ❖ Psychotherapy
Pharmacological ➔ Atypical Antipsychotic Drugs
Schizotypal (Personality) Disorder *After symptoms improve, patient should
❖ Cognitive Behavioral Therapy (CBT) continue treatment for 12 months. This
❖ Supportive Therapy includes gradually reducing the dosage of
❖ Supportive-expressive Therapy medication and carefully monitoring for signs
❖ Family Therapy of relapse (return of symptoms). Also, it’s
➔ Typical Antipsychotic Drugs important to educate patients and the family to
➔ Stimulants help them cope with the illness and detect early
➔ Guanfacine signs of relapse.
➔ Benzodiazepines Schizophrenia
➔ Gabapentin ❖ Psychotherapy
*People with schizotypal personality disorder ❖ Electroconvulsive Therapy (ECT)
rarely get treatment for the disorder itself. ❖ Individual Psychotherapy
When they do go to the doctor, it’s often for a ❖ Cognitive Behavior Therapy (CBT)
related disorder, such as depression or anxiety. ❖ Cognitive enhancement therapy (CET)
Delusional Disorder ❖ Psychosocial Therapies
❖ Individual Psychotherapy ➔ Typical Antipsychotic Drugs
❖ Cognitive Behavioral Therapy ➔ Atypical Antipsychotic Drugs
❖ Family Therapy *Schizophrenia treatment will center on
➔ Typical Antipsychotic Drugs managing your symptoms. You may need to
➔ Atypical Antipsychotics stay on medication for a long time, possibly
➔ Sedatives even for life. And because there’s no cure,
➔ Antidepressants getting the proper treatment early is the best
*Unfortunately, many people with this disorder way to improve chances of managing the
don’t seek help. It’s often hard for people with illness.
a mental disorder to know they aren’t well. Schizoaffective Disorder
Without treatment, delusional disorder can be ❖ Psychotherapy
a lifelong illness. ❖ Skills Training
Brief Psychotic Disorder ❖ Hospitalization
 ❖ Electroconvulsive Therapy (ECT) ● Dry mouth
➔ Typical Antipsychotic Drugs Guanfacine:
*If a person is diagnosed and starts treatment ● Sleepiness or drowsiness
ASAP, it can help him/her avoid or ease ● Dizziness
frequent relapses and hospitalizations, and help ● Headache
cut the disruptions in their life, family, and ● Irritability
friendships. ● Low blood pressure
Substance Medication Induced Psychotic ● Nausea
Disorder ● Stomach pain
❖ Psychotherapy ● Dry mouth
❖ Inpatient Rehabilitation for drug ● Constipation
and/or alcohol use ● Decreased appetite
❖ Outpatient rehabilitation for drug Most of the side effects of Benzodiazepines are
and/or alcohol use related to the depressant effect the drug has on
❖ Eye Movement Desensitization your central nervous system:
Reprocessing (EMDR) ● Constipation
❖ Dialectical Behavior Therapy (DBT) ● Confusion
➔ Typical Antipsychotic Drugs ● Depression
➔ Selective Serotonin Reuptake ● Diarrhea
Inhibitors (SSRI) ● Drowsiness
➔ Benzodiazepines ● Dry mouth
*Treatment for substance/medication-induced ● Erectile dysfunction
psychotic disorder will vary depending on the ● Fatigue
specific patient and their unique needs. In ● Headache
many cases, stopping the triggering substance ● Impaired motor skills and coordination
and closely monitoring the patient in a safe ● Irritability
environment may be enough. However, ● Loss of appetite or increased appetite
different substances, such as alcohol, may ● Low libido
require more intensive treatment. ● Muscle weakness
Common Side Effects ● Short-term memory loss and impaired
Different Typical and Atypical Antipsychotics cognition
may cause different side effects. Some common Gabapentin:
issues may include: ● Feeling tired.
● Weight gain ● Dizziness.
● Higher blood sugar and cholesterol ● Headache.
levels ● Nausea and vomiting.
● Low blood pressure ● Fever.
● Drowsiness ● Difficulty speaking.
● Type 2 diabetes ● Recurring infections.
● Constipation ● Memory loss.
● Blurry vision ● Weight gain.
 ● Movement problems: coordination conditions that do not reach full
problems, being unsteady, tremors, criteria for a psychotic disorder and
jerky movements. conditions that are limited to one
● Eye problems: unusual eye movements, domain of psychopathology.
double vision. Then they should consider
Sedatives: time-limited conditions.
● Changes in appetite Finally, the diagnosis of a schizophrenia
● Constipation spectrum disorder requires the
● Diarrhea exclusion of another condition that
● Balance problems may give rise to psychosis.
● Dizziness One Domain - two conditions are defined by
● Daytime drowsiness abnormalities limited to one domain of
● Dr mouth or throat psychosis: delusions or catatonia.
● Gas ❖ Delusional Disorder - is characterized
● Headache by at least 1 month of delusions but no
● Heartburn other psychotic symptoms.
● Impairment the next day ❖ Catatonia - defined by the presence of
● Mental slowing or problems with three or more psychomotor features
attention or memory such as Stupor, Catalepsy, Waxy
● Stomach Pain or tenderness Flexibility, Negativism etc..
● Uncontrollable shaking of a part of the Time-Limited
body (1) Brief Psychotic Disorder - 1+ day up to 1
● Unusual Dreams month - lasts more than 1 day and remits by 1
● Weakness month.
Selective Serotonin Reuptake Inhibitors (2) Schizophreniform Disorder - < 6 months -
(SSRI): is characterized by a symptomatic presentation
● Nausea, vomiting or diarrhea equivalent to that of schizophrenia except for
● Headache its duration (less than 6 months) and the
● Drowsiness absence of a requirement for a decline in
● Dry mouth functioning.
● Insomnia (3) Schizophrenia - 6+ months - lasts for at
● Nervousness, agitation or restlessness least 6 months and includes at least 1 month
● Dizziness of active-phase symptoms.
● Sexual problems, such as reduced (4) Schizoaffective Disorder - a mood episode
sexual desire, difficulty reaching orgasm and the active-phase symptoms of
or inability to maintain an erection schizophrenia occur together and were
(erectile dysfunction) preceded or are followed by at least 2 weeks of
● Impact on appetite, leading to weight delusions or hallucinations without prominent
loss or weight gain mood symptoms.
Schizophrenia Spectrum Induced by another condition
Clinicians should first consider ★ Psychotic disorders - may be induced
 by another condition. In guides treatment.
substance/medication-induced ❖ Clinical neuropsychological assessment
psychotic disorder, the psychotic can help guide diagnosis and
symptoms are judged to be a treatment, but brief assessments
physiological consequence of a drug of without formal neuropsychological
abuse, a medication, or toxin exposure assessment can provide useful
and cease after removal of the agent. In information that can be sufficient for
psychotic disorder due to another diagnostic purposes. Formal
medical condition, the psychotic neuropsychological testing, when
symptoms are judged to be a direct conducted, should be administered and
physiological consequence of another scored by personnel trained in the use
medical condition. of testing instruments. If a formal
★ Catatonia - can occur in several neuropsychological assessment is not
disorders, including conducted, the clinician should use the
neurodevelopmental, psychotic, best available information to make a
bi-polar, depressive, and other mental judgment.
disorders. This chapter also includes
the diagnosis of catatonia associated Categories of Schizophrenia Spectrum and
with another mental disorder Other Psychotic Disorders
(catatonia specifier), catatonic disorder Problem Primary Preval Gend Age
due to another medical condition, and Symptom ence er of
unspecified catatonia, and the Differ onse
diagnostic criteria for all three ences t
conditions are described together.
Clinician-Rated Assessment of Symptoms Delusio On or About About Mor
and Related Clinical Phenomena in nal more 0.03% Equal e
Psychosis Disorde delusions - prev
❖ Psychotic disorders are heterogeneous, r continuin 0.018 alent
and the severity of symptoms can g for at % in
predict important aspects of the illness, least 1 older
such as the degree of cognitive or month adult
neurobiological deficits. To move the s
field forward, a detailed framework for
the assessment of severity is included in Brief One or Up to Twice Can
Section III "Assessment Measures," Psychoti more 9% of as occu
which may help with treatment c psychotic new comm r at
planning, prognostic decision making, Disorde symptoms cases on in any
and research on pathophysiological r , of which in wome age
mechanisms. at least psycho n
❖ The severity of mood symptoms in one must sis Mos
psychosis has prognostic value and
 be t or
delusions, Much com disorganiz
hallucinati higher mon ed speech
ons, or in in
disorganiz develo 30s Impaired
ed speech ping life
lasting at countr functioni
least 1 day ies ng
but less
Schizoaf Episode of About More Usua
Schizop Two or Much About 18 – fective mania or 0.32% female lly
hrenifor more lower Equal 24 Disorde major s early
m psychotic rate for r depression adult
Disorde symptoms than men concurren hoo
r , of which Schizo t d
at least phreni 24- with
one must a 35 delusions,
be for hallucinati
delusions, Higher wom ons, or
hallucinati in en disorganiz
ons, or develo ed speech;
disorganiz ping psychotic
ed speech countr symptoms
lasting at ies persist
least 1 after the
month mood
but less episode
than 6 ends
months

Schizop Two or About About 18-2 Psychosis vs. Schizophrenia

hrenia more 1% of Equal 4 for Psychosis - an episode where one is detached
psychotic the men from reality
symptoms popula ❖ A symptom of sleep deprivation,
, of which tion 24 substance use, mental illness, and other
at -35 conditions
least one for Signs of Psychosis:
must be wom ● Hallucinations
delusions, en ● Delusions
hallucinati ● Agitation
ons, ● Disorganized thought and behavior
Schizophrenia - a mental illness that impacts For example, patients treated
thought processes, emotions, and behavior with this drug are at increased
❖ To be diagnosed, one must experience risk of developing orthostatic
at least two of the following symptoms hypotension, which can require
for six months, including one of the close monitoring. Moreover,
first three: high-dose clozapine has been
● Delusions associated with serious adverse
● Hallucinations effects, such as seizures.
● Disorganized speech What is the most effective treatment for
● Catatonic behavior schizophrenia?
● Negative symptoms (lessened ❖ Medications are the cornerstone of
emotional expression) schizophrenia treatment, and
Efficacy of the Psychological Interventions antipsychotic medications are the most
How effective are antipsychotic commonly prescribed drugs. They're
medications for schizophrenia? thought to control symptoms by
❖ After 6 weeks, the proportion of affecting the brain neurotransmitter
patients who showed a marked to dopamine.
moderate degree of improvement was Is there any case of cured schizophrenia?
75% for those who received ❖ There is no known cure for
antipsychotic treatment and 23% for schizophrenia, but the outlook for
those who received placebo. There were people who have this illness is
no significant differences in efficacy improving. There are many ways to
between the three antipsychotics treat schizophrenia, ideally in a team
assessed. approach. These include medication,
➔ Clozapine is the most effective psychotherapy, behavioral therapy, and
antipsychotic in terms of managing social services, as well as employment
treatment-resistant schizophrenia and educational interventions.
❖ This drug is approximately 30% Neurocognitive Disorders (NCD) /
effective in controlling Formerly called Dementia
schizophrenic episodes in ❖ Primarily COGNITIVE disorders
treatment-resistant patients, ❖ ACQUIRED and represent
compared with a 4% efficacy DECLINE (NOT developmental)
rate with the combination of ❖ Underlying brain PATHOLOGY
chlorpromazine and ❖ Affects people ACROSS AGES
benztropine. Clozapine has
also been shown to increase ➔ Neuro – relating to nerves or the
serum sodium concentrations nervous system
in patients with polydipsia and ➔ Cognitive – conscious intellectual
hyponatremia. However, as activity
indicated earlier, clozapine has ➔ Disorder – an abnormal condition
a problematic safety profile.
Neurocognitive Domains ➔ There is evidence from the
❖ Language - object naming, word history, physical examination,
finding, fluency, grammar and syntax, or laboratory findings that the
receptive language disturbance is a direct
❖ Learning and memory - free recall, physiological consequence of
cued recall, recognition memory, another medical condition,
semantic and autobiographical, substance intoxication or
long-term memory, implicit learning withdrawal (i.e., due to a drug
❖ Social cognition - recognition of of abuse or to a medication), or
emotions, theory of mind, insight exposure to a toxin, or is due to
❖ Complex attention - sustained multiple etiologies.
attention, divided attention, selective ❖ Substance intoxication delirium
attention, processing speed ❖ Substance withdrawal delirium
❖ Executive function - planning, ❖ Medication-induced delirium
decision-making, working memory, ➔ Is it acute? (hours/days)
responding to feedback, inhibition, ➔ Is it persistent?(weeks/months)
flexibility What type of Delirium
❖ Perceptual-motor function - visual ❖ Hyperactive
perception, visuoconstructional ❖ Hypoactive
reason, perceptual-motor coordination ❖ Mixed level of activity
Types of NCD Prevalence
(1) Delirium ❖ Highest among hospitalized older
➔ A disturbance in attention and individuals and varies depending on
awareness the individuals' characteristics, setting
➔ The disturbance develops over of care, and sensitivity of the detection
a short period of time, and method
tends to fluctuate in severity ❖ The community overall is low (l%-2%)
during the course of a day. but increases with age, rising to 14%
➔ Presence of additional among individuals older than 85 years
disturbance in cognition (e.g., where delirium often indicates a
memory deficit, disorientation, medical illness.
language, visuospatial ability, ❖ The prevalence of delirium when
or perception). individuals are admitted to the hospital
➔ The disturbances in Criteria A ranges from 14% to 24%, and estimates
and C are not better explained of the incidence of delirium arising
by another preexisting, during hospitalization range from 6%
established, or evolving to 56% in general hospital populations.
neurocognitive disorder and do ❖ Delirium occurs in 15%-53% of older
not occur in the context of a individuals postoperatively and in
severely reduced level of 70%-87% of those in intensive care.
arousal, such as coma. Delirium occurs in up to 60% of
 individuals in nursing homes or
post-acute care settings and in up to (2) Major and Mild NCD (Dementia)
83% of all individuals at the end of life. ➔ Major NCD Indicators
Risk and Prognostic Factors ● Significant Cognitive Decline
❖ Environmental ● Interfere with independence
➔ May be increased in the context ● Not due to delirium
of functional impairment, ● Not due to other mental
immobility, a history of falls, disorder
low levels of activity, and use of ➔ Mild NCD Indicators
drugs and medications with ● Moderate Cognitive Decline
psychoactive properties ● Does NOT Interfere with
(particularly alcohol and independence
anticholinergics) ● Not due to delirium
❖ Genetic and physiological ● Not due to other mental disorder
➔ Both major and mild NCDs ❖ Without behavioral disturbance
can increase delirium risk ❖ With behavioral disturbance
➔ Older individuals are more Severity
susceptible than younger ones ❖ Mild (Difficulties with instrumental
Infancy and through activities of daily living – housework,
childhood may be greater than managing money)
in early and middle adulthood ❖ Moderate (Difficulties with basic
➔ In childhood, delirium may be activities of daily living – feeding,
related to febrile illnesses and dressing)
certain medications (e.g., ❖ Severe (fully dependent)
anticholinergics). (3) Mild or Major NCD due to Alzheimer’s
Other Specified Delirium and Unspecified Disease
Delirium ➔ Met the criteria of major and minor
❖ Applies to presentations in which NCD
symptoms characteristic of delirium ➔ Insidious and gradual progression of
that cause clinically significant distress impairment in one or more domains
or impairment in social, occupational, ➔ Criteria are met for either probable or
or other important areas of possible Alzheimer’s disease
functioning predominate but do not ➔ The disturbance is not better explained
meet the full criteria for delirium or by cerebrovascular disease, another
any of the disorders in the neuro-degenerative disease, the effects
neurocognitive disorders diagnostic of a substance, other mental,
class neurological, or systemic disorder.
❖ Specified (ex. With specific reason – ❖ Alzheimer's disease is a brain disorder
attenuated delirium syndrome) that slowly destroys memory and
❖ Unspecified (ex. Emergency room thinking skills and, eventually, the
settings) ability to carry out the simplest tasks.
Prevalence ❖ Detection of an NCD may be more
❖ Rises steeply with age difficult in cultural and socioeconomic
❖ In high-income countries, it ranges settings where memory loss is
from 5% to 10% in the seventh decade considered normal in old age, where
to at least 25% thereafter. older adults face fewer cognitive
❖ US --7% of individuals diagnosed with demands in everyday life, or where very
Alzheimer's disease are between ages 65 low educational levels pose greater
and 74 years, 53% are between ages 75 challenges to objective cognitive
and 84 years, and 40% are 85 years and assessment.
older. (4) Mild or Major Frontotemporal NCD
❖ Mild NCD due to Alzheimer's disease ➔ Met the criteria of major and minor
is likely to represent a substantial NCD
fraction of mild cognitive impairment ➔ Insidious onset and gradual
Risk and Prognostic Factors progression
❖ Environmental ➔ Either behavioral or language variant
➔ Traumatic brain injury ➔ Relative sparing of learning and
increases risk for major or mild memory and perceptual-motor
NCD due to AD. function.
❖ Genetic and physiological ➔ The disturbance is not better explained
➔ Age is the strongest risk factor by cerebrovascular disease, another
for AD. neuro-degenerative disease, the effects
➔ The genetic susceptibility of a substance, other mental,
polymorphism apolipoprotein neurological, or systemic disorder.
E4 increases risk and decreases ❖ Frontotemporal NCD is an umbrella
age at onset, particularly in term for a group of brain disorders that
homozygous individuals. primarily affect the frontal and
➔ There are also extremely rare temporal lobes of the brain. These
causative Alzheimer's disease areas of the brain are generally
genes. associated with personality, behavior
➔ Individuals with Down's and language.
syndrome (trisomy 21) develop Prevalence
Alzheimer's disease if they ❖ A common cause of early-onset NCD
survive to midlife. in individuals younger than 65 years.
➔ Multiple vascular risk factors ❖ Population prevalence estimates are in
influence risk for Alzheimer's the range of 2-10 per 100,000.
disease and may act by ❖ Approximately 20%-25% of cases of
increasing cerebrovascular frontotemporal NCD occur in
pathology or also through individuals older than 65 years.
direct effects on Alzheimer ❖ Frontotemporal NCD accounts for
pathology about 5% of all cases of dementia in
Culture-related Diagnosis Issues unselected autopsy series.
 ❖ Prevalence estimates of behavioral neuro-degenerative disease, the effects
variant and semantic language variant of a substance, other mental,
are higher among males, and prevalence neurological, or systemic disorder.
estimates of non-fluent language *Lewy bodies – clumps of protein that
variant are higher among females. can form in the brain
Risk and Prognostic Factors Prevalence
❖ Genetic and physiological ❖ The few population-based prevalence
➔ Approximately 40% of estimates for NCDLB available range
individuals with major or mild from 0.1% to 5% of the general elderly
frontotemporal NCD have a population, and from 1.7% to 30.5% of
family history or early-onset all dementia cases.
NCD. ❖ In brain bank (autopsy) series, the
➔ Approximately 10% show an pathological lesions known as Lewy
autosomal dominant bodies are present in 20%-35% of cases
inheritance pattern. of dementia.
➔ Other genetic factors: ❖ The male-to-female ratio is
mutations in the gene encoding approximately 1.5:1.
the microtubule associated Risk and Prognostic Factors
protein tau (MAPT), the ❖ Genetic and physiological
granulin gene (CRN), and the ➔ Familial aggregation may
C90RF72 gene. occur, and several risk genes
➔ A number of families with have been identified, but in
causative mutations have been most cases of NCDLB, there is
identified but many individuals no family history.
with known familial (6) Mild or Major Vascular NCD
transmission do not have a ➔ Met the criteria of major and minor
known mutation. NCD
➔ The presence of motor neuron ➔ The clinical features are consistent with
disease is associated with a a vascular etiology, as suggested by
more rapid deterioration. either of the following:
(5) Mild or Major NCD with Lewy Bodies ● On-set of the cognitive deficits
➔ Met the criteria of major and minor is temporally related to one or
NCD more cerebrovascular events.
➔ Insidious onset and gradual ● Evidence for decline is
progression prominent in complex
➔ Meets a combination of core diagnostic attention (including processing
features and suggestive diagnostic speed) and frontal-executive
features for either probable or possible function.
NCD with Lewy bodies ➔ There is evidence of the presence of
➔ The disturbance is not better explained cerebrovascular disease from history,
by cerebrovascular disease, another physical examination, and/or
 neuroimaging considered sufficient to are the same as those for
account for the neurocognitive deficits. cerebrovascular disease,
➔ The symptoms are not better explained including hypertension,
by another brain disease or systemic diabetes, smoking, obesity, high
disorder. cholesterol levels, high
Prevalence homocysteine levels, other risk
❖ Second most common cause of NCD factors for atherosclerosis and
after Alzheimer's disease. arteriolosclerosis, atrial
❖ In the United States, population fibrillation, and other
prevalence estimates for vascular conditions increasing the risk
dementia range from 0.2% in the 65-70 of cerebral emboli. Cerebral
years age group to 16% in individuals amyloid angiopathy is an
80 years and older. important risk factor in which
❖ Within 3 months following stroke, amyloid deposits occur within
20%-30% of individuals are diagnosed arterial vessels.
with dementia. ➔ Another key risk factor is the
❖ In neuropathology series, the hereditary condition cerebral
prevalence of vascular dementia autosomal dominant
increases from 13% at age 70 years to arteriopathy with subcortical
44.6% at age 90 years or older, in infarcts and
comparison with Alzheimer's disease leukoencephalopathy, or
(23.6%-51%) and combined vascular CADASIL
dementia and Alzheimer's disease (7) Mild or Major NCD Due to Brain
(2%-46.4%). Injury
❖ Higher prevalence has been reported in ➔ Met the criteria of major and minor
African Americans compared with NCD
Caucasians, and in East Asian ➔ There is evidence of a traumatic brain
countriesJapan, China). injury—that is, an impact to the head
❖ Prevalence is higher in males than in or other mechanisms of rapid
females movement or displacement of the brain
Risk and Prognostic Factors within the skull, with one or more of
❖ Environmental the following:
➔ The neurocognitive outcomes 1. Loss of consciousness.
of vascular brain injury are 2. Posttraumatic amnesia.
influenced by neuroplasticity 3. Disorientation and confusion.
factors such as education, 4. Neurological signs (e.g.,
physical exercise, and mental neuroimaging demonstrating injury; a
activity. new onset of seizures; a marked
❖ Genetic and physiological worsening of a preexisting seizure
➔ The major risk factors for disorder; visual field cuts; anosmia;
major or mild vascular NCD hemiparesis).
 ➔ The neurocognitive disorder presents ❖ Risk factors for neurocognitive
immediately after the occurrence of the disorder after traumatic brain injury
traumatic brain injury or immediately ➔ Repeated concussions can lead
after recovery of consciousness and to persistent NCD and
persists past the acute post-injury neuropathological evidence of
period traumatic encephalopathy.
*Traumatic Brain Injury usually results Co-occurring intoxication with
from a violent blow or jolt to the head a substance may increase the
or body. severity of a TBI from a motor
Prevalence vehicle accident, but whether
❖ In the United States, 1.7 million TBIs intoxication at the time of
occur annually, resulting in 1.4 million injury worsens neurocognitive
emergency department visits, 275,000 outcome is unknown
hospitalizations, and 52,000 deaths. ➔ Mild TBI generally resolves
❖ About 2% of the population lives with within a few weeks to months,
TBI-associated disability. although resolution may be
❖ Males account for 59% of TBIs in the delayed or incomplete in the
United States. The most common context of repeated TBI. Worse
etiologies of TBI in the United States outcome from moderate to
are falls, vehicular accidents, and being severe TBI is associated with
struck on the head. older age (older than 40 years)
❖ Collisions and blows to the head that and initial clinical parameters,
occur in the course of contact sports such a low Glasgow Coma
are increasingly recognized as sources Scale score; worse motor
of mild TBI, with a concern that function; pupillary
repeated mild TBI may have nonreactivity; and computed
cumulatively persisting sequelae. tomography (CT) evidence of
Risk and Prognostic Factors brain injury (e.g., petechial
❖ Risk factors for traumatic brain injury hemorrhages, subarachnoid
➔ Traumatic brain injury rates hemorrhage, midline shift,
vary by age, with the highest obliteration of third ventricle)
prevalence among individuals (8) Medication-Induced Mild or Major
younger than 4 years, older NCD
adolescents, and individuals ➔ Met the criteria of major and minor
older than 65 years. Falls are the NCD
most common cause of TBI, ➔ The neurocognitive impairments do
with motor vehicle accidents not occur exclusively during the course
being second. Sports of a delirium and persist beyond the
concussions are frequent causes usual duration of intoxication and
of TBI in older children, acute withdrawal.
teenagers, and young adults. ➔ The involved substance or medication
 and duration and extent of use are neurocognitive disturbances, but these
capable of producing the tend to clear with abstinence
neurocognitive impairment. Risk and Prognostic Factors
➔ The temporal course of the ❖ Risk factors for
neurocognitive deficits is consistent substance/medication-induced NCDs
with the timing of substance or include:
medication use and abstinence (e.g., ➔ older age, longer use, and
the deficits remain stable or improve persistent use past age 50 years.
after a period of abstinence). In addition, for
➔ The neurocognitive disorder is not alcohol-induced NCD,
attributable to another medical long-term nutritional
condition or is not better explained by deficiencies, liver disease,
another mental disorder. vascular risk factors, and
*The diagnostic name for a specific cardiovascular and
mental health condition where an cerebrovascular disease may
individual experiences hallucinations, contribute to risk.
delusions, or both within a month of (9) Mild or Major NCD Due to HIV
using or withdrawing from Infection
prescription drugs, illegal drugs, and/or ➔ Met the criteria of major and minor
alcohol. NCD
Prevalence ➔ There is documented infection with
❖ The prevalence of these conditions is human immunodeficiency virus
not known (HIV).
❖ For alcohol abuse, the rate of mild ➔ The neurocognitive disorder is not
NCD of intermediate duration is better explained by non-HIV
approximately 30%- 40% in the first 2 conditions, including secondary brain
months of abstinence. diseases such as progressive multifocal
❖ Or individuals quitting cocaine, leukoencephalopathy or cryptococcal
methamphetamine, opioids, meningitis.
phencyclidine, and sedative, hypnotics, ➔ The neurocognitive disorder is not
or anxiolytics, attributable to another medical
substance/medication-induced mild condition and is not better explained
NCD of intermediate duration may by a mental disorder.
occur in one-third or more, and there is *HIV (human immunodeficiency
some evidence that these substances virus) is a virus that attacks cells that
may also be associated with persistent help the body fight infection, making a
mild NCD. person more vulnerable to other
❖ The presence of NCD induced by infections and diseases. It is spread by
cannabis and various hallucinogens is contact with certain bodily fluids of a
controversial. With cannabis, person with HIV, most commonly
intoxication is accompanied by various during unprotected sex (sex without a
 condom or HIV medicine to prevent attributable to another medical
or treat HIV), or through sharing condition and is not better expiated by
injection drug equipment. another mental disorder
Prevalence *Prion diseases or transmissible
❖ Depending on the stage of HIV spongiform encephalopathies (TSEs)
disease, approximately one-third to are a family of rare progressive
over one-half of HIVinfected neurodegenerative disorders that affect
individuals have at least mild both humans and animals. They are
neurocognitive disturbance, but some distinguished by long incubation
of these disturbances may not meet the periods, characteristic spongiform
full criteria for mild NCD. An changes associated with neuronal loss,
estimated 25% of individuals with HIV and a failure to induce inflammatory
will have signs and symptoms that meet response
criteria for mild NCD, and in fewer Prevalence
than 5% would criteria for major NCD ❖ Annual incidence of sporadic CJD is
be met approximately one or two cases per
Risk and Prognostic Factors million people. Prevalence is unknown
❖ Risk factors for HIV infection include: but very low given the short survival.
➔ drug use, unprotected sex, and Risk and Prognostic Factors
unprotected blood supply ❖ Environmental
❖ Prognostic factors for major or mild ➔ Cross-species transmission of
neurocognitive disorder due to HIV prion infections, with agents
infection: that are closely related to the
➔ Paradoxically, NCD due to human form, has been
HIV infection has not declined demonstrated (e.g., the
significantly with the advent of outbreak of bovine spongiform
combined antiretroviral encephalopathy inducing
therapy, although the most variant CJD in the United
severe presentations (consistent Kingdom during the
with the diagnosis of major mid1990s). Transmission by
NCD) have decreased sharply. corneal transplantation and by
(10) Mild or Major NCD Due to Prion human growth factor injection
Disease has been documented, and
➔ Met the criteria of major and minor anecdotal cases of transmission
NCD to healthcare workers have
➔ There is insidious onset, and rapid been reported
progression of impairment is common ❖ Genetic and physiological
➔ There are motor features of prion ➔ There is a genetic component
disease, such as myoclonus or ataxia, or in up to 15% of cases,
biomarker evidence associated with an autosomal
➔ The neurocognitive disorder is not dominant mutation.
(11) Mild or Major NCD Due to ➔ Met the criteria of major and minor
Parkinson’s Disease NCD
➔ Met the criteria of major and minor ➔ There is insidious onset and gradual
NCD progression
➔ The disturbance occurs in the setting ➔ There is clinically established
of established Parkinson’s disease Huntington’s disease, or risk for
➔ There is an insidious onset and gradual Huntington’s disease based on family
progression of impairment history or genetic testing
➔ The neurocognitive disorder is not ➔ The neurocognitive disorder is not
attributable to another medical attributable to another medical
condition and is not better explained condition and is not better explained
by another mental disorder by another mental disorder
*Parkinson's disease is a progressive *Huntington's disease is a rare,
nervous system disorder that affects inherited disease that causes the
movement. progressive breakdown (degeneration)
Prevalence of nerve cells in the brain
❖ The prevalence of Parkinson's disease Prevalence
in the United States steadily increases ❖ Neurocognitive deficits are an eventual
with age from approximately 0.5% outcome of Huntington's disease
between ages 65 and 69 to 3% at age 85 ❖ The worldwide prevalence is estimated
years and older. Parkinson's disease is to be 2.7 per 100,000
more common in males than in ❖ The prevalence of Huntington's
females. Among individuals with disease in North America, Europe, and
Parkinson's disease, as many as 75% will Australia is 5.7 per 100,000, with a
develop a major NCD sometime in the much lower prevalence of 0.40 per
course of their disease. The prevalence 100,000 in Asia
of mild NCD in Parkinson's disease has Risk and Prognostic Factors
been estimated at 27% ❖ Genetic and physiological
Risk and Prognostic Factors ➔ The genetic basis of
❖ Environmental Huntington's disease is a fully
➔ Risk factors for Parkinson's penetrant autosomal dominant
disease include exposure to expansion of the CAG
herbicides and pesticides trinucleotide, often called a
❖ Genetic and physiological CAG repeat in the
➔ Potential risk factors for NCD Huntington's gene. A repeat
among individuals with length of 36 or more is
Parkinson's disease include invariably associated with
older age at disease onset and Huntington's disease, with
increasing duration of disease longer repeat lengths associated
(12) Mild or Major NCD Due to with early age at onset. A CAG
Huntington’s Disease repeat length of 36 or more is
 invariably associated with other important areas of functioning
Huntington's disease. predominate but do not meet the full
(13) Mild or Major NCD Due to Another criteria for any of the disorders in the
Medical Condition neurocognitive disorders diagnostic
➔ Met the criteria of major and minor class. The unspecified neurocognitive
NCD disorder category is used in situations
➔ There is evidence from the history, in which the precise etiology cannot be
physical examination, or laboratory determined with sufficient certainty to
findings that the neurocognitive make an etiological attribution
disorder is the pathophysiological
consequence of another medical
condition.
➔ The cognitive deficits are not better
explained by another mental disorder
or another specific neurocognitive
disorder (e.g., Alzheimer’s disease, HIV
infection)
(13) Mild or Major NCD Due to Multiple
Etiologies
➔ Met the criteria of major and minor
NCD
➔ There is evidence from the history,
physical examination, or laboratory
findings that the neurocognitive
disorder is the pathophysiological
consequence of more than one
etiological process, excluding
substances (e.g., neurocognitive
disorder due to Alzheimer’s disease
with subsequent development of
vascular neurocognitive disorder)
➔ The cognitive deficits are not better
explained by another mental disorder
and do not occur exclusively during the
course of a delirium
(+) Unspecified Neurocognitive Disorder
➔ This category applies to presentations
in which symptoms characteristic of a
neurocognitive disorder that cause
clinically significant distress or
impairment in social, occupational, or